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AlMotawa RY, Alhamid G, Badran MM, Orfali R, Alomrani AH, Tawfik EA, Alzahrani DA, Alfassam HA, Ghaffar S, Fathaddin A, Al-Taweel A, Almomen A. Co-Delivery of Dragon's Blood and Alkanna tinctoria Extracts Using Electrospun Nanofibers: In Vitro and In Vivo Wound Healing Evaluation in Diabetic Rat Model. Pharmaceutics 2024; 16:704. [PMID: 38931828 PMCID: PMC11206803 DOI: 10.3390/pharmaceutics16060704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
The increasing prevalence of diabetic wounds presents a significant challenge due to the difficulty of natural healing and various obstacles. Dragon's blood (DB) and Alkanna tinctoria (AT) are well recognized for their potent healing abilities, which include potent antibacterial and anti-inflammatory activities. In this study, electrospun nanofibers (NFs) based on polyvinyl pyrrolidone (PVP) were co-loaded with both DB and AT, aiming to magnify their efficacy as wound-dressing applications for diabetic wound healing. The evaluation of these NFs as wound dressings was conducted using a streptozotocin-induced diabetic rat model. Electrospun NFs were prepared using the electrospinning of the PVP polymer, resulting in nanofibers with consistent, smooth surfaces. The loading capacity (LC) of AT and DB into NFs was 64.1 and 70.4 µg/mg, respectively, while in the co-loaded NFs, LC was 49.6 for AT and 57.2 µg/mg for DB. In addition, X-ray diffraction (XRD) revealed that DB and AT were amorphously dispersed within the NFs. The loaded NFs showed a dissolution time of 30 s in PBS (pH 7.4), which facilitated the release of AT and DB (25-38% after 10 min), followed by a complete release achieved after 180 min. The antibacterial evaluation demonstrated that the DB-AT mixture had potent activity against Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus). Along with that, the DB-AT NFs showed effective growth inhibition for both P. aeruginosa and S. aureus compared to the control NFs. Moreover, wound healing was evaluated in vivo in diabetic Wistar rats over 14 days. The results revealed that the DB-AT NFs improved wound healing within 14 days significantly compared to the other groups. These results highlight the potential application of the developed DB-AT NFs in wound healing management, particularly in diabetic wounds.
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Affiliation(s)
- Rana Y. AlMotawa
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Ghadeer Alhamid
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Mohamed M. Badran
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
- Nanobiotechnology Unit, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
| | - Raha Orfali
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Abdullah H. Alomrani
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
- Nanobiotechnology Unit, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia
| | - Essam A. Tawfik
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Dunia A. Alzahrani
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Haya A. Alfassam
- Advanced Diagnostics and Therapeutics Institute, Health Sector, King Abdulaziz City for Science and Technology (KACST), Riyadh 11442, Saudi Arabia
| | - Safina Ghaffar
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Amany Fathaddin
- Pathology Department, College of Medicine, King Saud University, Riyadh 11495, Saudi Arabia
| | - Areej Al-Taweel
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia; (R.Y.A.); (G.A.); (A.A.-T.)
| | - Aliyah Almomen
- Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh 11495, Saudi Arabia;
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Chow J, Imani S, Kavisinghe I, Mittal R, Martin B. Definitive single-stage surgery for treating diabetic foot osteomyelitis: a protocolized pathway including antibiotic bone graft substitute use. ANZ J Surg 2024. [PMID: 38760999 DOI: 10.1111/ans.19032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a challenging complication of diabetes mellitus, often leading to poor clinical outcomes and significant socioeconomic burdens. We evaluated the effectiveness of a definitive single-stage protocolized surgical management pathway, including the use of local antibiotic bone graft substitute, for the treatment of infected DFUs with associated osteomyelitis. METHODS A retrospective cohort study was conducted. Medical records were extracted (from January 2017 to December 2020) to establish a database consisting of patients who underwent surgical intervention for the treatment of an infected DFU with osteomyelitis. Patients were divided into conventional (control) and protocolized (intervention) surgical groups depending on the treatment received. Clinical outcomes were assessed over a 12-month follow-up period. RESULTS A total of 136 consecutive patients were included (conventional = 33, protocolized = 103). The protocolized group demonstrated a statistically significant reduction in the mean number of operations performed per patient (1.2 vs. 3.5) (P < 0.001) and a shorter accumulative hospital length of stay (12.6 vs. 25.1 days) (P < 0.001) compared to the conventional group. Major amputation rates were significantly lower in the protocolized group (2% vs. 18%) (P < 0.001). Within 12 months of surgical intervention, the protocolized group exhibited an ulcer healing rate of 89%, with a low rate of recurrence (3%). CONCLUSION The protocolized surgical pathway, including local antibiotic bone graft substitute use, demonstrated superior outcomes compared to conventional management for the treatment of infected DFUs with osteomyelitis. Further research is needed to evaluate the cost-effectiveness and generalizability of this approach.
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Affiliation(s)
- Jason Chow
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Greater Sydney Foot and Ankle Research and Education Organisation, Sydney, New South Wales, Australia
| | - Sahand Imani
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Greater Sydney Foot and Ankle Research and Education Organisation, Sydney, New South Wales, Australia
| | - Isuri Kavisinghe
- Greater Sydney Foot and Ankle Research and Education Organisation, Sydney, New South Wales, Australia
| | - Rajat Mittal
- Greater Sydney Foot and Ankle Research and Education Organisation, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Brian Martin
- Department of Orthopaedic Surgery, Nepean Hospital, Sydney, New South Wales, Australia
- Greater Sydney Foot and Ankle Research and Education Organisation, Sydney, New South Wales, Australia
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Tabanjeh SF, Al-Malki T, Kharabsheh RA, Mahmood D. A case series of autologous platelet-rich plasma injection in treating chronic ulcers conducted in Saudi Arabia. Int J Health Sci (Qassim) 2023; 17:46-56. [PMID: 36891041 PMCID: PMC9986877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Objective This is a case series study of 14 cases of chronic unhealed ulcers involving patients of 19-85 years, aimed to demonstrate the positive therapeutic outcomes of using autologous platelet rich plasma (PRP) in diabetic foot ulcer (DFU) and other chronic wound healing. Methods This is a formal consecutive clinical case series. Patients with chronic unhealed ulcers were enrolled from the amputation prevention clinic by an interdisciplinary team includes podiatrist, general surgeon, orthopedic, vascular surgeon, and wound care nurses at Kahel Specialized Centre, a specialized center for managing foot and ankle diseases, located in Riyadh, Saudi Arabia. Those patients who presented with chronic wounds and showed no significant wound reduction despite following the standard wound care protocol were included in the study. There were no specific predetermined exclusion criteria when considering patients for treatment with this modality. Results In this case series, majority (80%) of the patients were above 50 years of age, and 10 (66.7%) patients were male and 5 (33.3%) were female. Of all the cases presented to the amputation prevention clinic, majority (73.3%) reported suffering from type 2 diabetes mellitus (DM) and also, one reported type 1 DM [6.7%]). All the cases of DFU received a combination of hydrogel and autologous PRP treatment and were put of suitable offloading devices, except one case received a combination of Cadexomer iodine, hydrogel and PRP treatment. In the present case series involving 3-14 weeks of the treatment duration, only 2-3 doses of autologous PRP provided complete healing and or maximum wound closure. Conclusion Autologous PRP therapy is efficacious in facilitating, enhancing wound healing and aids in complete wound closure. This case series was limited in term of the sample size which is the number patients enrolled for the study, hence, the study finding remain inconclusive to some extent and hence, further study is required with greater number of sample size. The strength of this study is that it is the first study in Saudi Arabia and gulf region, to report the beneficial effect of PRP in chronic unhealed ulcers including diabetic ulcers.
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Affiliation(s)
| | - Talal Al-Malki
- Department of Orthopedics and Trauma, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Rola Al Kharabsheh
- Department of Nursing, Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Danish Mahmood
- Department of Pharmacology and Toxicology, Unaizah College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
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Alsheikh S, AlGhofili H, Alageel R, Ababtain O, Alarify G, Alwehaibi N, Altoijry A. Diabetic Foot Care: A Screening on Primary Care Providers' Attitude and Practice in Riyadh, Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010064. [PMID: 36676687 PMCID: PMC9861771 DOI: 10.3390/medicina59010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.
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Affiliation(s)
- Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Correspondence: ; Tel./Fax: +966-114671585
| | - Hesham AlGhofili
- Department of Vascular Surgery, King Salman Heart Center, King Fahad Medical City, Riyadh 12231, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON 11525, Canada
| | - Reema Alageel
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Omar Ababtain
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Ghadah Alarify
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Nasser Alwehaibi
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Department of Surgery, King Fahad Specialist Hospital, Buraidah 52366, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
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Moore Z, Avsar P, Wilson P, Mairghani M, O'Connor T, Nugent L, Patton D. Diabetic foot ulcers: treatment overview and cost considerations. J Wound Care 2021; 30:786-791. [PMID: 34644133 DOI: 10.12968/jowc.2021.30.10.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Zena Moore
- Professor of Nursing, Head of School of Nursing and Midwifery and Director of the Skin Wounds and Trauma Research Centre. RCSI University of Medicine and Health Sciences, Dublin; Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Adjunct Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Honorary Professor, Lida Institute, Shanghai, China; Visiting Professor, University of Wales, Cardiff, UK; Adjunct Professor, Griffith University, Australia
| | - Pinar Avsar
- Senior Postdoctoral Fellow. Skin Wounds and Trauma Research Centre. The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
| | - Pauline Wilson
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Maisoon Mairghani
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Tom O'Connor
- Director of Academic Affairs and Deputy Head of School, School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin; Honorary Professor, Lida Institute, Shanghai, China; Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Adjunct Professor, Griffith University, Australia
| | - Linda Nugent
- Lecturer and Programme Director, School of Nursing and Midwifery. The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin; Adjunct Assistant Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Declan Patton
- Director of Nursing and Midwifery Research and Deputy Director of the Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin; Adjunct Associate Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Adjunct Professor, Griffith University, Australia
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Karim S, Alkreathy HM, Ahmad A, Khan MI. Effects of Methanolic Extract Based-Gel From Saudi Pomegranate Peels With Enhanced Healing Potential on Excision Wounds in Diabetic Rats. Front Pharmacol 2021; 12:704503. [PMID: 34122120 PMCID: PMC8194859 DOI: 10.3389/fphar.2021.704503] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction: Current study was designed to evaluate the wound healing activity of a Saudi pomegranate peel extract on excision wound healing in experimentally induced diabetes in rats. Methodology: Animals were divided into three groups: diabetic excision wound with no treatment, diabetic excision wound with gel alone and diabetic excision wound with Saudi pomegranate peel extract in gel. Animals were monitored for clinical signs, weekly body weight, morbidity and mortality during entire study period. The efficacy parameters evaluated were percent wound contraction, Hydroxyproline content, estimation of Transforming Growth Factor ß1 (TGF-ß1), Vascular Endothelial Growth Factor (VEGF), and Epidermal Growth Factor (EGF) in wound lysates by ELISA, mRNA expression of TGF-ß1, VEGF, and EGF in wound lysates by qPCR, Estimation of nitric oxide (NO) and NO synthase (NOS) in Wound Lysates and histopathology of skin for reepithelization, neovascularization, and inflammation. Results: The Saudi pomegranate peel extract in gel (5.0 g extract per 100 g gel) showed significant wound healing activity when compared to the vehicle control [p < 0.05] following 21 days of treatment. Animals in the control and treatment groups were apparently normal through the study with no significant differences in body weights between groups. Expression of mRNA of TGFβ1, EGF and VEGF in wounds was the highest on day 14 post treatment 4.3, 3.5 and 0.9 fold higher respectively in the treatment group when compared to vehicle control, and on day 21, the values were 0.12, 0.3 and 0.83, respectively. No statistically significant differences were observed in TGF-ß1 levels in wounds on days 4, 7, 14 and 21 post treatment when compared to the vehicle control (p > 0.05). Significantly higher levels of VEGF were observed in treatment group on day 7 and 21 when compared to vehicle control (p < 0.05). Significantly higher levels of EGF were observed in treatment group on day 7 and 21 when compared to vehicle control (p < 0.05). Mean hydroxyproline levels were higher in treatment group on days 4 and 7 when compared to vehicle control. NO levels in treatment group were significantly lower on days 7, 14 and 21 when compared to vehicle control (p < 0.05). NOS activity in treatment group were significantly lower on days 4 and 7 when compared to vehicle control (p < 0.05). Histopathological changes in skin wound in the treatment group were consistent with wound healing when compared to the vehicle group. Conclusion: This study's findings suggest that topical application of SPPE gel effectively enhanced wound healing in experimentally induced diabetic conditions.
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Affiliation(s)
- Shahid Karim
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Huda M Alkreathy
- Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Aftab Ahmad
- Health Information Technology Department, Faculty of Applied Studies, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad Imran Khan
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.,Centre for Artificial Intelligence in Precision Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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Altoijry A, AlGhofili H, Alanazi SN, AlHindawi DA, AlAkeel NS, Julaidan BS, AlHamzah M, Altuwaijri T. Diabetic foot and peripheral arterial disease. Single centre experience. Saudi Med J 2021; 42:49-55. [PMID: 33399171 PMCID: PMC7989311 DOI: 10.15537/smj.2021.1.25640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To determine the prevalence of vasculopathic diabetic foot and the associated factors in a Saudi tertiary center. Methods: This retrospective chart review included adult patients (≥18 years) diagnosed with diabetic foot between May 2015 and July 2019 in King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. Based on clinical presentation and laboratory results, the patients were categorized into 2 groups namely, "vascular induced diabetic foot group" and "non-vascular induced diabetic foot group". RESULTS A total of 404 diabetic patients were enrolled in the study. The mean age of the patients was 62.03±12.30 years; 61.9% were males. Most of the diabetic foot cases had a non-vascular etiology (n=327, 80.9%), while 77 cases (19.1%) were due to vasculopathy. Patient in the vascular group had a significantly higher incidence of coronary artery disease (32.5% versus 14.4%; p greater than 0.001), and a higher incidence of peripheral artery disease (PAD) in the unaffected limb (22.1% versus 2.1%; p less than 0.001). Conclusion: Most cases of diabetic foot were due to non-vascular causes. Old age, history of coronary artery disease, or PAD in the unaffected limb were factors that were significantly associated with diabetic foot due to arterial disease.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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