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Tamashunas NL, Williamson SJ, Wypasek E, DiSano K, Somach S, Ray AJ, Crowe DR. Necrotic ulcers in a HIV-positive man. JAAD Case Rep 2024; 47:14-16. [PMID: 38576902 PMCID: PMC10993132 DOI: 10.1016/j.jdcr.2023.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
| | | | - Evan Wypasek
- Department of Internal Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Katherine DiSano
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
| | - Stephen Somach
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
| | - Amy J. Ray
- Department of Infectious Disease, MetroHealth Medical Center, Cleveland, Ohio
| | - David R. Crowe
- Department of Dermatology, MetroHealth Medical Center, Cleveland, Ohio
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2
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Gönüllü Ö, Kahraman FC, Yıldırım UM. Leg Ulcers in a Patient With Systemic Lupus Erythematosus and Successful Treatment With Anticoagulant Therapy. INT J LOW EXTR WOUND 2024:15347346241248260. [PMID: 38632946 DOI: 10.1177/15347346241248260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Among specific skin manifestations of systemic lupus erythematosus such as leukocytoclastic vasculitis, and vasculopathy, the development of leg ulcers is rare and frequently seen in patients with antiphospholipid antibody positivity. Here we report the rapid healing of a leg ulcer without antiphospholipid antibody positivity in a patient with lupus in response to anticoagulant therapy. As in our case, when immunosuppressive agents are inadequate in lupus patients who develop leg ulcers, it may be beneficial to support the treatment with anticoagulants.
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Affiliation(s)
- Öykü Gönüllü
- Department of Dermatology and Venerology, Göztepe Süleyman Yalçın Şehir Hastanesi, Istanbul Medeniyet University, Istanbul, Turkey
| | - Filiz C Kahraman
- Deparment of Dermatology and Venerology, Sultan 2, Abdülhamid Han Eğitim ve Araştırma Hastanesi, Sağlık Bilimleri University, Istanbul, Turkey
| | - Umut Mert Yıldırım
- Department of Dermatology and Venerology, Göztepe Süleyman Yalçın Şehir Hastanesi, Istanbul Medeniyet University, Istanbul, Turkey
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Suprakasan A, Prabhu S, Padma Priya J, Pai SB. Non-healing ulcer in a farmer. Int J Dermatol 2024. [PMID: 38622783 DOI: 10.1111/ijd.17179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/13/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Affiliation(s)
| | | | - J Padma Priya
- Department of Commerce, Manipal Academy of Higher Education, Manipal, India
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Doni NY, An İ. Geriatric cutaneous leishmaniasis: a retrospective analysis of 622 cases. Postgrad Med J 2024:qgae048. [PMID: 38598958 DOI: 10.1093/postmj/qgae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Cutaneous leishmaniasis (CL) is most common in childhood because children are exposed to the parasite early and, unlike adults, do not have immunity to CL. Since CL is less common in geriatric patients, clinical and epidemiological data in this age group are limited. This study aims to compare the clinical and demographic characteristics of geriatric patients diagnosed with CL with young patients. METHODS In this retrospective study, 622 patients aged 65 and over and 6350 patients aged 19-64, who applied to Şanlıurfa Oriental Boil Diagnosis and Treatment Center between January 2013 and February 2024 and were diagnosed with CL by parasitological examination, were included. Clinical and demographic characteristics of patients diagnosed with CL, such as age, gender, location of the lesion, lesion size, duration of the lesion, and treatments applied due to the diagnosis of CL, were recorded. Clinical and demographic characteristics of geriatric and young patients were compared. RESULTS The mean age of elderly CL cases was 72.95 ± 6.54 years, and 65.2% were female. The most common clinical forms were ulcers (51.9%) and plaques (41%), respectively, in young and elderly patients. The most common locations of the lesions were upper limbs (54.8%) in all patients. The most preferred treatment method was intralesional (IL) meglumine antimoniate (MA) treatment (98.3%) in all patients. There were no difference between young and elderly CL cases in terms of mean number of lesions, average lesion duration, average lesion size, lesion location, clinical forms of lesions, and treatments options (P > 0.05). CONCLUSIONS Based on the results of our study, it can be said that the clinical and demographic characteristics of CL are similar in young and old patients and systemic MA treatment shows similar clinical benefit in both age groups. In addition, it can be said that systemic MA therapy can be used safely in young patients and elderly patients without contraindications. IL MA therapy can be used in elderly patients where systemic MA therapy is contraindicated.
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Affiliation(s)
- Nebiye Yentur Doni
- Department of Medical Microbiology, Harran University Medical Faculty, Şanlıurfa 63000, Turkey
| | - İsa An
- Department of Dermatology, Şanlıurfa Training and Research Hospital, Şanlıurfa 63000, Turkey
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5
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Richter CF, Skibicka KP, Meyer U, Rohrmann S, Krieger JP. A vagal influence on schizophrenia? A nationwide retrospective cohort of vagotomized individuals. medRxiv 2024:2024.01.30.24301418. [PMID: 38352405 PMCID: PMC10862985 DOI: 10.1101/2024.01.30.24301418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background and Objectives Emerging preclinical evidence suggests that vagal signals contribute to the development of schizophrenia-related abnormalities in brain and behavior. Whether vagal communication in general, and its impairment in particular, is a risk factor for schizophrenia in humans remains, however, unclear. Vagotomy, the surgical lesion of the vagus nerve, was routinely performed as a treatment for peptic ulcer before modern treatment options were available. Hence, the primary aim of this study was to investigate whether vagotomy modulates the subsequent risk of developing schizophrenia. Moreover, given the existence of diverse vagotomy techniques (i.e., "truncal" or "selective"), our secondary goal was to test whether the extent of denervation modulates the risk of schizophrenia. Methods Using a nationwide retrospective matched cohort design, we identified 8,315 vagotomized individuals from the Swedish National Patient Register during the period 1970-2020 and 40,855 non-vagotomized individuals matching for age, sex and type of peptic ulcer. The risk of being diagnosed with schizophrenia and associated psychoses (ICD10 codes F20-29) was analyzed using Cox proportional hazards regression models, including death as competing risk. Results When considering all types of vagotomy together, vagotomy was not significantly associated with schizophrenia (HR: 0.91 [0.72; 1.16]). However, truncal vagotomy (which denervates all subdiaphragmatic organs) significantly increased the risk of developing schizophrenia by 69% (HR: 1.69 [1.08; 2.64]), whereas selective vagotomy (which only denervates the stomach) showed no significant association (HR: 0.80 [0.61; 1.04]). Discussion Our results provide epidemiological support for the hypothesis that impairments in vagal functions could increase the risk of schizophrenia. Notably, the finding that truncal but not selective vagotomy is associated with an increased risk of schizophrenia raises the possibility that the activity of subdiaphragmatic non-gastric vagal branches may be of particular relevance for the development of schizophrenia.
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Affiliation(s)
- Cornelia F Richter
- Institute of Veterinary Pharmacology and Toxicology, University of Zurich-Vetsuisse, Switzerland
| | - Karolina P Skibicka
- Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA, United States
| | - Urs Meyer
- Institute of Veterinary Pharmacology and Toxicology, University of Zurich-Vetsuisse, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Jean-Philippe Krieger
- Institute of Veterinary Pharmacology and Toxicology, University of Zurich-Vetsuisse, Switzerland
- Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
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6
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Coe A, Grossman A, Nace G, Pogoriler J, Mamula P. Small bowel diaphragm disease. J Pediatr Gastroenterol Nutr 2024; 78:998-999. [PMID: 38334234 DOI: 10.1002/jpn3.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 02/10/2024]
Affiliation(s)
- Alexander Coe
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Andrew Grossman
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gary Nace
- Division of General Pediatric Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer Pogoriler
- Division of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Petar Mamula
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Ethier R, Krishnamurthy A, Jeffrey M, Tompkins TA. Profiling of Metabolites in a Fermented Soy Dietary Supplement Reinforces its Role in the Management of Intestinal Inflammation. Mol Nutr Food Res 2024; 68:e2300770. [PMID: 38522032 DOI: 10.1002/mnfr.202300770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Indexed: 03/25/2024]
Abstract
SCOPE Gastro-AD (GAD) is a soy flour derived product that undergoes an industrial fermentation with Lactobacillus delbrueckii R0187 and has demonstrated clinical effects in gastroesophageal reflux and peptic ulcer symptom resolution. The aim of this study is to describe and link GAD's metabolomic profile to plausible mechanisms that manifest and explain the documented clinical outcomes. METHODS AND RESULTS 1H NMR spectroscopy with multivariate statistical analysis is used to characterize the prefermented soy flour and GAD products. The acquired spectra are screened using various resources and the molecular assignments are confirmed using total correlation spectroscopy (TOCSY). Peaks corresponding to different metabolites are integrated and compared between the two products for relative changes. HPLC and GC are used to quantify some specific molecules. NMR analyses demonstrate significant changes in the composition of various assigned bioactive moieties. HPLC and GC analysis demonstrate deglycation of isoflavones after fermentation, resulting in estrogenically active secondary metabolites that have been previously shown to help to reduce inflammation. CONCLUSION The identification of bioactive molecules, such as genistein and SCFAs, capable of modulating anti-inflammatory signaling cascades in the stomach's gastric and neuroendocrine tissues can explain the reported biological effects in GAD and is supported by in vivo data.
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Affiliation(s)
- Richard Ethier
- Richard Ethier Consulting, Montreal, Quebec, H4C 2J9, Canada
| | - Arun Krishnamurthy
- Purity-IQ Inc., Suite# 102, 150 Research Lane, Guelph, Ontario, N1G 4T2, Canada
| | - Michael Jeffrey
- Faculty of Science, Engineering & Information Technology, Durham College, Oshawa, Ontario, L1G 0C5, Canada
| | - Thomas A Tompkins
- Lallemand Bio-Ingredients, 1620 rue Prefontaine, Montreal, Quebec, H1W 2N8, Canada
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8
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Li Pomi F, Motolese A, Paganelli A, Vaccaro M, Motolese A, Borgia F. Shedding Light on Photodynamic Therapy in the Treatment of Necrobiosis Lipoidica: A Multicenter Real-Life Experience. Int J Mol Sci 2024; 25:3608. [PMID: 38612420 PMCID: PMC11011432 DOI: 10.3390/ijms25073608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Necrobiosis Lipoidica (NL) is a dermatological condition characterized by the development of granulomatous inflammation leading to the degeneration of collagen and subsequent formation of yellowish-brown telangiectatic plaques usually localized on the pretibial skin of middle-aged females. Due to its rarity and unclear etiopathogenesis, therapeutic options for NL are not well-standardized. Among them, photodynamic therapy (PDT) is an emerging tool, although its efficacy has primarily been evaluated in single case reports or small case series. This study reports the real-life experience of a cohort of NL patients treated with PDT at the Section of Dermatology of the University Hospital of Messina and Reggio-Emilia. From 2013 to 2023, 17 patients were enrolled -5 males (29%) and 12 females (71%) aged between 16 and 56 years (mean age: 42 ± 13 years), with a median duration of NL of 8 years. The overall complete clearance (>75% lesion reduction) was 29%, while the partial clearance (25-75% lesion reduction) was 59%, with 12% being non-responders. This study adds to the little amount of evidence present in the literature regarding the effectiveness of PDT in the treatment of NL. Variability in treatment responses among patients underscores the need for personalized protocols, optimizing photosensitizers, light sources, and dosimetry. The standardization of treatment protocols and consensus guidelines are essential to ensure reproducibility and comparability across studies.
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Affiliation(s)
- Federica Li Pomi
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, 90127 Palermo, Italy;
| | - Alfonso Motolese
- Dermatology Unit, Department of Surgery, Infermi Hospital, AUSL Romagna, 47923 Rimini, Italy;
| | - Alessia Paganelli
- Dermatology Unit, Santa Maria Nuova Hospital IRCCS, 42123 Reggio Emilia, Italy; (A.P.); (A.M.)
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy;
| | - Alberico Motolese
- Dermatology Unit, Santa Maria Nuova Hospital IRCCS, 42123 Reggio Emilia, Italy; (A.P.); (A.M.)
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 98125 Messina, Italy;
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Dege T, Glatzel B, Borst V, Grän F, Goller S, Glatzel C, Goebeler M, Schmieder A. Patient-Centered Chronic Wound Care Mobile Apps: Systematic Identification, Analysis, and Assessment. JMIR Mhealth Uhealth 2024; 12:e51592. [PMID: 38533818 PMCID: PMC11004612 DOI: 10.2196/51592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 03/28/2024] Open
Abstract
Background The prevalence of chronic wounds is predicted to increase within the aging populations in industrialized countries. Patients experience significant distress due to pain, wound secretions, and the resulting immobilization. As the number of wounds continues to rise, their adequate care becomes increasingly costly in terms of health care resources worldwide. eHealth support systems are being increasingly integrated into patient care. However, to date, no systematic analysis of such apps for chronic wounds has been published. Objective The aims of this study were to systematically identify and subjectively assess publicly available German- or English-language mobile apps for patients with chronic wounds, with quality assessments performed by both patients and physicians. Methods Two reviewers independently conducted a systematic search and assessment of German- or English-language mobile apps for patients with chronic wounds that were available in the Google Play Store and Apple App Store from April 2022 to May 2022. In total, 3 apps met the inclusion and exclusion criteria and were reviewed independently by 10 physicians using the German Mobile App Rating Scale (MARS) and the System Usability Scale (SUS). The app with the highest mean MARS score was subsequently reviewed by 11 patients with chronic wounds using the German user version of the MARS (uMARS) and the SUS. Additionally, Affinity for Technology Interaction (ATI) scale scores were collected from both patients and physicians. Results This study assessed mobile apps for patients with chronic wounds that were selected from a pool of 118 identified apps. Of the 73 apps available in both app stores, 10 were patient oriented. After excluding apps with advertisements or costs, 3 apps were evaluated by 10 physicians. Mean MARS scores ranged from 2.64 (SD 0.65) to 3.88 (SD 0.65) out of 5, and mean SUS scores ranged from 50.75 (SD 27) to 80.5 (SD 17.7) out of 100. WUND APP received the highest mean MARS score (mean 3.88, SD 0.65 out of 5) among physicians. Hence, it was subsequently assessed by 11 patients and achieved a similar rating (uMARS score: mean 3.89, SD 0.4 out of 5). Technical affinity, as measured with the ATI scale, was slightly lower in patients (score: mean 3.62, SD 1.35 out of 6) compared to physicians (score: mean 3.88, SD 1.03 out 6). Conclusions The quality ratings from physicians and patients were comparable and indicated mediocre app quality. Technical affinity, as assessed by using the ATI scale, was slightly lower for patients. Adequate apps for patients with chronic wounds remain limited, emphasizing the need for improved app development to meet patient needs. The ATI scale proved valuable for assessing technical affinity among different user groups.
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Affiliation(s)
- Tassilo Dege
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bernadette Glatzel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Vanessa Borst
- Department of Computer Science, University of Würzburg, Würzburg, Germany
| | - Franziska Grän
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Simon Goller
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Glatzel
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Astrid Schmieder
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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10
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Thompson RN, Pearson E, McDonough SP, Iannitti H, Van de Walle GR, Banse H, Perkins GA, Tomlinson JE. Equine gamma herpesvirus presence and viral load are not associated with equine glandular gastric disease. Am J Vet Res 2024:1-9. [PMID: 38484465 DOI: 10.2460/ajvr.23.12.0282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To investigate the role of equine herpesvirus-2 (EHV-2) and equine herpesvirus-5 (EHV-5) in equine glandular gastric disease (EGGD) by visualizing and quantifying these gamma herpesviruses in EGGD-affected and normal glandular gastric mucosa of horses. A secondary objective was to describe the histopathological abnormalities in the equine gastric glandular mucosa in horses with EGGD. ANIMALS 29 horses (n = 21 postmortem and 8 gastroscopy) categorized as normal (11), EGGD (12), or both EGGD and equine squamous gastric disease (6). METHODS Glandular gastric mucosal samples were collected from horses by gastroscopy or postmortem. Histopathology and in situ hybridization targeting EHV-2 and EHV-5 were performed on grossly normal and abnormal glandular gastric mucosa. The number of in situ hybridization-positive cells per millimeter squared of tissue was calculated. Evaluators were blinded to groups. RESULTS Glandular gastric tissues from horses without EGGD had higher viral loads in the mucosa than normal or abnormal tissues from EGGD horses. There was no difference in viral loads for EHV-2 or EHV-5 between grossly or endoscopically normal to abnormal gastric tissues within horses with EGGD. Lymphocytic plasmacytic gastritis was the most common histopathological abnormality, with only 3 horses having mucosal disruption (glandular ulcer or erosion). CLINICAL RELEVANCE Equine gamma herpesviruses are unlikely to play a role in the pathophysiology of EGGD. EGGD is frequently inflammatory with occasional mucosal disruption (ulcer or erosion).
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Affiliation(s)
| | - Erin Pearson
- Department of Clinical Sciences, Cornell University, Ithaca, NY
| | - Sean P McDonough
- Department of Population Medicine, Cornell University, Ithaca, NY
| | | | | | - Heidi Banse
- School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | | | - Joy E Tomlinson
- Baker Institute for Animal Health, Cornell University, Ithaca, NY
- Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA
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Rich AF, Naguib M. Shewanella xiamenensis-associated ulcerative dermatitis in koi carp (Cyprinus rubrofuscus). J Fish Dis 2024:e13942. [PMID: 38492216 DOI: 10.1111/jfd.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
Ulcerative dermatitis (UD) is common in ornamental fish collections and is typically associated with a wide range of bacterial aetiologies. Clinical reports describing Shewanella xiamenensis-associated UD are limited, however, despite growing attention to pathogenic Shewanella species in fish. Two out of 95 koi carp with UD were presented for clinical assessment by a commercial collection (n = 3000 fish) and subsequently killed on welfare grounds for necropsy. Both specimens exhibited extensive cutaneous ulcers and coelomic fat necrosis with petechial haemorrhages on post-mortem examination. Shewanella xiamenensis was cultured from ulcerated skin tissues taken from both fish, with consistent intralesional gram-negative rod-like bacteria seen on skin scrape cytology. Histology also confirmed intralesional gram-negative rod-like bacteria within multiple ulcerative and erosive dermatitis lesions, plus myofibre necrosis and necrotising coelomic steatitis, in both specimens. Features associated with impaired generalised osmoregulation secondary to UD were detected within the striated muscle underlying the ulcers, the gills, and the caudal aspects of the kidneys. Additional histological features suggestive of sepsis were also seen in one of the fish. In the interim period, morbidity had increased from 3.2% to around 30% of the entire stock. Following culture results, increased pond water changes were implemented (q.2-3d) and the remaining stock was treated with florfenicol, resulting in complete resolution of UD in the collection (as per client). This article highlights the first description of S. xiamenensis-associated UD in koi carp/diseased ornamental fish in the United Kingdom.
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12
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de Moraes Silva MA, Nelson A, Bell-Syer SE, Jesus-Silva SGD, Miranda F. Compression for preventing recurrence of venous ulcers. Cochrane Database Syst Rev 2024; 3:CD002303. [PMID: 38451842 PMCID: PMC10919450 DOI: 10.1002/14651858.cd002303.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Up to 1% of adults will have a leg ulcer at some time. Most leg ulcers are venous in origin and are caused by high pressure in the veins due to blockage or damaged valves. Venous ulcer prevention and treatment typically involves the application of compression bandages/stockings to improve venous return and thus reduce pressure in the legs. Other treatment options involve removing or repairing veins. Most venous ulcers heal with compression therapy, but ulcer recurrence is common. For this reason, clinical guidelines recommend that people continue with compression treatment after their ulcer has healed. This is an update of a Cochrane review first published in 2000 and last updated in 2014. OBJECTIVES To assess the effects of compression (socks, stockings, tights, bandages) for preventing recurrence of venous leg ulcers. SEARCH METHODS In August 2023, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, three other databases, and two ongoing trials registries. We also scanned the reference lists of included studies and relevant reviews and health technology reports. There were no restrictions on language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that evaluated compression bandages or hosiery for preventing the recurrence of venous ulcers. DATA COLLECTION AND ANALYSIS At least two review authors independently selected studies, assessed risk of bias, and extracted data. Our primary outcome was reulceration (ulcer recurrence anywhere on the treated leg). Our secondary outcomes included duration of reulceration episodes, proportion of follow-up without ulcers, ulceration on the contralateral leg, noncompliance with compression therapy, comfort, and adverse effects. We assessed the certainty of evidence using GRADE methodology. MAIN RESULTS We included eight studies (1995 participants), which were published between 1995 and 2019. The median study sample size was 249 participants. The studies evaluated different classes of compression (UK class 2 or 3 and European (EU) class 1, 2, or 3). Duration of follow-up ranged from six months to 10 years. We downgraded the certainty of the evidence for risk of bias (lack of blinding), imprecision, and indirectness. EU class 3 compression stockings may reduce reulceration compared with no compression over six months (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.27 to 0.76; 1 study, 153 participants; low-certainty evidence). EU class 1 compression stockings compared with EU class 2 compression stockings may have little or no effect on reulceration over 12 months (RR 1.70, 95% CI 0.67 to 4.32; 1 study, 99 participants; low-certainty evidence). There may be little or no difference in rates of noncompliance over 12 months between people using EU class 1 stockings and people using EU class 2 stockings (RR 1.22, 95% CI 0.40 to 3.75; 1 study, 99 participants; low-certainty evidence). UK class 2 hosiery compared with UK class 3 hosiery may be associated with a higher risk of reulceration over 18 months to 10 years (RR 1.55, 95% CI 1.26 to 1.91; 5 studies, 1314 participants; low-certainty evidence). People who use UK class 2 hosiery may be more compliant with compression treatment than people who use UK class 3 hosiery over 18 months to 10 years (RR for noncompliance 0.69, 95% CI 0.49 to 0.99; 5 studies, 1372 participants; low-certainty evidence). There may be little or no difference between Scholl UK class 2 compression stockings and Medi UK class 2 compression stockings in terms of reulceration (RR 0.77, 95% CI 0.47 to 1.28; 1 study, 166 participants; low-certainty evidence) and noncompliance (RR 0.97, 95% CI 0.84.1 to 12; 1 study, 166 participants; low-certainty evidence) over 18 months. No studies compared different lengths of compression (e.g. below-knee versus above-knee), and no studies measured duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. AUTHORS' CONCLUSIONS Compression with EU class 3 compression stockings may reduce reulceration compared with no compression over six months. Use of EU class 1 compression stockings compared with EU class 2 compression stockings may result in little or no difference in reulceration and noncompliance over 12 months. UK class 3 compression hosiery may reduce reulceration compared with UK class 2 compression hosiery; however, higher compression may lead to lower compliance. There may be little to no difference between Scholl and Medi UK class 2 compression stockings in terms of reulceration and noncompliance. There was no information on duration of reulceration episodes, ulceration on the contralateral leg, proportion of follow-up without ulcers, comfort, or adverse effects. More research is needed to investigate acceptable modes of long-term compression therapy for people at risk of recurrent venous ulceration. Future trials should consider interventions to improve compliance with compression treatment, as higher compression may result in lower rates of reulceration.
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Affiliation(s)
- Melissa Andreia de Moraes Silva
- Interdisciplinary Surgical Science Program, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
- Vascular Surgery, Hospital de Clinicas de Itajuba - MG, Itajuba, Brazil
| | - Andrea Nelson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Fausto Miranda
- Division of Vascular and Endovascular Surgery, Department of Surgery, Paulista School of Medicine - Federal University of São Paulo, São Paulo, Brazil
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Kilmer LH, Samuel A, Forster GL, Stranix JT, Black JS, Campbell CA, DeGeorge BR. Determinants of pressure injury development in patients with COVID-19. J Wound Care 2024; 33:156-164. [PMID: 38451788 DOI: 10.12968/jowc.2024.33.3.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Pressure injuries (PIs) often develop in critically ill patients due to immobility, and underlying comorbidities that decrease tissue perfusion and wound healing capacity. This study sought to provide epidemiological data on determinants and current managements practices of PI in patients with COVID-19. METHOD A US national insurance-based database consisting of patients with coronavirus or COVID-19 diagnoses was used for data collection. Patients were filtered by International Classification of Diseases (ICD) codes corresponding to coronavirus or COVID-19 diagnosis between 2019-2020. Diagnosis of PI following COVID-19 diagnosis was queried. Demographic data and comorbidity information was compared. Logistic regression analysis was used to determine predictors for both PI development and likelihood of operative debridement. RESULTS A total of 1,477,851 patients with COVID-19 were identified. Of these, 15,613 (1.06%) subsequently developed a PI, and 8074 (51.7%) of these patients had an intensive care unit (ICU) admission. The average and median time between diagnosis of COVID-19 and PI was 39.4 and 26 days, respectively. PI was more likely to occur in patients with COVID-19 with: diabetes (odds ratio (OR): 1.39, 95% confidence interval (CI): 1.29-1.49; p<0.001); coronary artery disease (OR: 1.11, 95% CI: 1.04-1.18, p=0.002), hypertension (OR: 1.43, 95% CI: 1.26-1.64; p<0.001); chronic kidney disease (OR: 1.18, 95% CI: 1.10-1.26; p<0.001); depression (OR: 1.45, 95% CI 1.36-1.54; p<0.001); and long-term non-steroidal anti-inflammatory drug use (OR: 1.21, 95% CI: 1.05-1.40; p=0.007). They were also more likely in critically ill patients admitted to the ICU (OR: 1.40, 95% CI: 1.31-1.48; p<0.001); and patients requiring vasopressors (OR:1.25, 95% CI: 1.13-1.38; p<0.001), intubation (OR: 1.21, 95% CI 1.07-1.39; p=0.004), or with a diagnosis of sepsis (OR: 2.38, 95% CI 2.22-2.55; p<0.001). ICU admission, sepsis, buttock and lower back PI along with increasing Charlson Comorbidity Index (CCI) (OR: 1.04, 95% CI 1.00-1.08; p=0.043) was associated with surgical debridement. The vast majority of patients with COVID-19 did not undergo operative debridement or wound coverage. CONCLUSION PIs are widely prevalent in patients with COVID-19, especially in those who are critically ill, yet the vast majority do not undergo operative procedures. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Lee H Kilmer
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Ankita Samuel
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Grace L Forster
- University of Virginia School of Medicine, Charlottesville, VA, 22903, US
| | - John T Stranix
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | - Jonathan S Black
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
| | | | - Brent R DeGeorge
- Department of Plastic Surgery, University of Virginia, Charlottesville, VA, 22903, US
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Zhao B, Kim HJ, Tam L, Xiong W, Rosenfeld G. A Rare Case of Gastric Extranodal NK/T-Cell Lymphoma With Orbital Involvement. ACG Case Rep J 2024; 11:e01280. [PMID: 38425941 PMCID: PMC10901430 DOI: 10.14309/crj.0000000000001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
Gastric extranodal NK/T-cell lymphoma (ENKTL) is a rare presentation of a rare disease. We report a 33-year-old woman presenting with epigastric pain, nausea, and vomiting. Endoscopic examination revealed gastric and duodenal ulceration. Biopsy of the ulcers revealed ENKTL. The patient began treatment, but developed hemorrhagic shock from her ulcers and died. Gastric ENKTL is a rare disease that presents with gastric ulceration. It has a high rate of mortality, and treatment is challenging because of its aggressive nature and lack of high-quality data to guide therapy.
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Affiliation(s)
- Billy Zhao
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Jae Kim
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Landon Tam
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wei Xiong
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Rosenfeld
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Sanchez A, Hartstein A, Ashry H, Raza M. Use of hypothermically stored amniotic membrane on diabetic foot ulcers: a multicentre retrospective case series. J Wound Care 2024; 33:S16-S23. [PMID: 38457306 DOI: 10.12968/jowc.2024.33.sup3.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The aim of this retrospective case series was to report on the outcomes of diabetic foot ulcers (DFUs) managed with hypothermically stored amniotic membrane (HSAM). METHOD Deidentified case data of patients who received HSAM were obtained from wound care sites across the US. Data were collected, beginning at the first patient visit to the wound care site (first presentation), at the visit in which the first HSAM application occurred (baseline), and at each subsequent visit over 12 weeks of treatment (follow-up). All patients received standard of care (SoC) between first presentation and baseline. RESULTS Of the 50 patients in the study, 68% were male. Mean age of the entire cohort was 66.7 years. Of the DFUs, 88% were present for <6 months at first presentation. Mean wound area was 3.5cm2, and mean percentage area reduction was -68.3% from first presentation to baseline. The mean number of HSAM applications was 5.5, and mean number of days between applications was 7.5. A >60% area reduction was attained in 96.0% of DFUs, and 78% attained complete wound closure (CWC) by week 12. The median time to CWC was 55 days. CONCLUSION The results of this retrospective case series suggest positive outcomes for DFUs managed with HSAM. A reduction in time to CWC may lead to lesser financial burden and improved quality of life for DFU patients. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
| | - Alan Hartstein
- Palm Beach Foot & Ankle, Palm Beach Gardens, FL 33410, US
| | - Hisham Ashry
- Palm Beach Foot & Ankle, Palm Beach Gardens, FL 33410, US
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Cancel-Artau KJ, Marrero-Pérez AC, Michelén-Gómez EA, Sánchez-Flores X. Amivantamab, the first epidermal growth factor receptor and mesenchymal-epithelial transition factor inhibitor, associated with penile and inguinal ulcers and paronychia. JAAD Case Rep 2024; 45:113-116. [PMID: 38439765 PMCID: PMC10909656 DOI: 10.1016/j.jdcr.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Karina J. Cancel-Artau
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | | | | | - Xavier Sánchez-Flores
- Department of Dermatology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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Golledge J, Thanigaimani S, Barratt KS, Fadini GP. Recent developments in targets for ischemic foot disease. Diabetes Metab Res Rev 2024; 40:e3703. [PMID: 37563926 DOI: 10.1002/dmrr.3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023]
Abstract
Diabetes is a key risk factor for ischaemic foot disease, which causes pain, tissue loss, hospital admission, and major amputation. Currently, treatment focuses on revascularisation, but many patients are unsuitable for surgery and revascularisation is frequently unsuccessful. The authors describe recent research in animal models and clinical trials investigating novel medical targets for ischaemia, including theories about impaired wound healing, animal models for limb ischaemia and recent randomised controlled trials testing novel medical therapies. Novel targets identified in animal models included stimulating mobilisation of CD34+ progenitor cells through upregulating oncostatin M or microRNA-181, downregulating tumour necrosis factor superfamily member 14, or activating the Wingless pathway. Within the ischaemic limb vasculature, upregulation of apolipoprotein L domain containing 1, microRNA-130b or long noncoding RNA that enhances endothelial nitric oxide synthase expression promoted limb blood supply recovery, angiogenesis, and arteriogenesis. Similarly, administration of soluble guanylate cyclase stimulators riociguat or praliciguat or 3-ketoacyl-CoA thiolase inhibitor trimetazidine promoted blood flow recovery. Translating pre-clinical findings to patients has been challenging, mainly due to limitations in clinically translatable animal models of human disease. Promising results have been reported for administering plasmids encoding hepatocyte growth factor or intra-arterial injection of bone marrow derived cells in small clinical trials. It remains to be seen whether these high resource therapies can be developed to be widely applicable. In conclusion, an ever-expanding list of potential targets for medical revascularisation is being identified. It is hoped that through ongoing research and further larger clinical trials, these will translate into new broadly applicable therapies to improve outcomes.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Department of Vascular and Endovascular Surgery, The Townsville University Hospital, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Shivshankar Thanigaimani
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Kristen S Barratt
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Gian Paolo Fadini
- University Hospital of Padova, Padova, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
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18
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Suludere MA, Öz OK, Rogers LC, Wukich DK, Malone M, Lavery LA. MRSA infection, re-infection and clinical outcomes in diabetic foot infections. Wound Repair Regen 2024. [PMID: 38419162 DOI: 10.1111/wrr.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/27/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
The aim was to investigate methicillin-resistant Staphylococcus aureus (MRSA) incidence, conversion and outcomes in diabetic foot infections (DFIs). This is a pooled patient-level analysis of combined data sets from two randomised clinical trials including 219 patients admitted to the hospital with moderate or severe DFIs. Intraoperative bone and tissue cultures identified bacterial pathogens. We identified pathogens at index infections and subsequent re-infections. We identified MRSA conversion (MSSA to MRSA) in re-infections. MRSA incidence in index infections was 10.5%, with no difference between soft tissue infections (STIs) and osteomyelitis (OM). MRSA conversion occurred in 7.7% of the re-infections in patients who initially had MSSA in their cultures. Patients with re-infection were 2.2 times more likely to have MRSA compared to the first infection (10.5% vs. 25.8%, relative risk [RR] = 2.2, p = 0.001). Patients with MRSA had longer antibiotic treatment during the 1-year follow-up, compared to other pathogens (other 49.8 ± 34.7 days, MRSA 65.3 ± 41.5 days, p = 0.04). Furthermore, there were no differences in healing, time to heal, length of stay, re-infection, amputation, re-ulceration, re-admission, surgery after discharge and amputation after discharge compared to other pathogens. The incidence of MRSA at the index was 10.5% with no difference in STI and OM. MRSA incidence was 25.8% in re-infections. The RR of having MRSA was 2.2 times higher in re-infections. Patients with MRSA used more antibiotics during the 1-year follow-up. Furthermore, there were no differences in clinical outcomes compared to other bacterial pathogens.
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Affiliation(s)
- Mehmet A Suludere
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Orhan K Öz
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lee C Rogers
- Department of Orthopedic Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Dane K Wukich
- Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Matthew Malone
- Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Liverpool, New South Wales, Australia
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Headd VA, Mathien A, Pei S, Kuraitis D. Nivolumab-induced lichenoid penile ulceration and re-emergent mucocutaneous eruption treated with hydroxychloroquine. Australas J Dermatol 2024. [PMID: 38337182 DOI: 10.1111/ajd.14223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Affiliation(s)
- Virginia A Headd
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - August Mathien
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Susan Pei
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Drew Kuraitis
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
- Department of Dermatology, Tulane University, New Orleans, Louisiana, USA
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Zhang XQ, Tang ZW, Jing J. Progressive Facial Ulcer: A Case Report of Pyoderma gangrenosum. J Inflamm Res 2024; 17:687-691. [PMID: 38332897 PMCID: PMC10849904 DOI: 10.2147/jir.s441751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by rapidly developing and painful skin ulcers with distinctive features. As far as we are concerned, there is no previous case report on facial PG in East-Asia. In this case, we describe a case of a 79-year-old man with a 3-month history of progressive painful ulcers on his cheek and upper lip. Initial suspicion of atypical mycobacterium infection led to an ineffective treatment regimen. Comprehensive infectious testing yielded negative results, and a positive pathergy test indicated a potential diagnosis of PG. A skin biopsy confirmed the diagnosis, and the patient showed significant improvement with intravenous methylprednisolone and oral cyclosporine treatment. After three months, complete resolution of the lesions was achieved without recurrence. The case highlights the diagnostic challenges associated with PG, which is often misdiagnosed due to its resemblance to other conditions. Thorough evaluation is crucial to exclude alternative diagnoses, particularly cutaneous infections. Clinical morphology, tissue biopsy, and culture are essential for accurate diagnosis. The presence of pathergy, the development of new lesions following minor trauma, can also be a diagnostic clue.
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Affiliation(s)
- Xian-Qi Zhang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
| | - Zhen-Wei Tang
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
| | - Jing Jing
- Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, People’s Republic of China
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Zhong T, Zhang L, Tang W, Wu Y, Pan Y, Fu Y, Xu J, Cao Q, Jiang Z. Mucosal Architectural Change is an Important Feature in Distinguishing Crohn's Disease From Others in Terminal Ileum Ulcer Biopsy. Int J Surg Pathol 2024; 32:75-82. [PMID: 37128682 DOI: 10.1177/10668969231171135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Besides Crohn's disease (CD), there are a variety of other causes that can also lead to ulcerations in the terminal ileum. The purpose of this study was to identify useful diagnostic features for CD when evaluating terminal ileum biopsies in patients with endoscopic finding of ulcers. METHODS Five hundred and seventy-one patients with endoscopic finding of ulcers were included in this retrospective study. Five main histological features were analysed, which were crypt irregularity, mucosal thickening, villous stromal widening (including villous atrophy), granulomas, and pseudopyloric gland metaplasia. Clinical and pathological features were determined by uni- and multivariable logistic regression. Then another independent cohort of 99 patients was established for verifying this nomogram. RESULTS The crypt irregularity, mucosal thickening, and villous stromal widening were combined to be considered as one new variable named mucosal architectural change which was an independent variable in diagnosing CD. We found that mucosal architectural change, age <40 years, the presence of granulomas, and the presence of pseudopyloric gland metaplasia were independent factors for the pathological diagnosis of CD. Then nomogram was developed, with receiver operating characteristic (ROC) curve (area under the ROC curve [AUC] = 0.927) in training sets, and ROC curve (AUC = 0.913) in validation sets. CONCLUSIONS We found mucosal architectural change is very helpful in distinguishing CD from non-CD patients. In the context of small biopsy which may lack full scope of changes, the model developed by combining these key features is valuable in predicting a diagnosis of CD, especially in younger patients (age <40 years).
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Affiliation(s)
- Tingting Zhong
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lizhi Zhang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Wen Tang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanchuang Wu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yipeng Pan
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yujuan Fu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Xu
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhinong Jiang
- Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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22
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Imtiaz S, Akhter TS, Bushra HT, Khan JZ, Niazi A, Saleem M, Umar M. Effective Treatment of Solitary Rectal Ulcer Syndrome by Using Photobiomodulation Therapy: A Case Report. Photobiomodul Photomed Laser Surg 2024; 42:182-185. [PMID: 38301213 DOI: 10.1089/photob.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Objective: To investigate the efficacy of Photobiomodulation therapy (PBMT) for the treatment of solitary rectal ulcer syndrome (SRUS). Background: SRUS is a benign disease, diagnosed by symptoms, clinical, and histological findings. PBMT has been reported for the treatment of various inflammation-based diseases including aphthous ulcer, but still no such study on the treatment of SRUS is published. Materials and methods: A 29-year Asian women, diagnosed for SRUS of 0.57 cm diameter, was treated by a laser at 635 nm through seven sessions. Laser fluence of 85 J/cm2 was delivered to ulcer lesion during each session for 10 min. Clinical results were valued by physician with sigmoid probe throughout PBMT sessions and no medicines were prescribed to the patient. Results: After seven sessions, the lesion was completely healed with 100% clinical response. In follow-up, patient did not respond to any additional/recurring abnormality, and no side effects were observed. Conclusions: In conclusion, PBMT by using laser at 635 nm is an effective treatment for SRUS without any side effects and patient remained comfortable throughout treatment sessions. Patient registration No. H-744/23.
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Affiliation(s)
- Sana Imtiaz
- National Institute of Lasers and Optronics College, Pakistan Institute of Engineering and Applied Sciences, Nilore, Pakistan
| | | | - Hamama Tul Bushra
- Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Javeria Zahid Khan
- Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Aasiya Niazi
- Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Muhammad Saleem
- National Institute of Lasers and Optronics College, Pakistan Institute of Engineering and Applied Sciences, Nilore, Pakistan
| | - Muhammad Umar
- Holy Family Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan
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Untari EK, Andayani TM, Yasin NM, Asdie RH. A Review of Patient's Knowledge and Practice of Diabetic Foot Self-Care. Malays J Med Sci 2024; 31:33-50. [PMID: 38456109 PMCID: PMC10917598 DOI: 10.21315/mjms2024.31.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/04/2023] [Indexed: 03/09/2024] Open
Abstract
Since diabetic foot ulcers (DFUs) are common among diabetes patients, it is essential to increase patients' knowledge and self-care practices to ensure early recognition and management and reduce amputation risk. Therefore, the goal of this review was to identify the range and level of knowledge of people with DFUs and the type of self-care they undertake. A literature review was conducted using the electronic databases PubMed and Google scholar with 'diabetic foot', 'self-care', 'practice' and 'behaviour' as searching keywords. The identification and selection process were conducted to sort the eligible papers through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The criteria are the original papers describing knowledge and practice in DFU; reporting knowledge and practice in their non-intervention studies; writing in English language; and publishing between years 2016 and 2022. The eligible papers were assessed using the strength of reporting observational studies in epidemiology (STROBE) checklist for appraising their quality. Twenty-two papers of 2,073 titles met the inclusion criteria and included in the review. The lowest and the highest quality score of included papers based on STROBE checklist are 11 and 26, respectively. The included papers showed various levels of knowledge from good to poor, which prominent the highest percentage are 88% (good knowledge) and 84.8% (poor knowledge). The majority of the foot-care activities found in the reviewed papers involved the following steps: washing, drying, applying moisturiser and trimming nails routinely. Those activity should be followed by checking the feet with a mirror for ulcers, looking for ingrown nails, choosing appropriate footwear, not walking barefoot and routinely consulting a healthcare provider. The knowledge levels were found variable and acceptable. Daily foot care, choosing the right footwear, foot activity and regular health checks should all be used to manage diabetes.
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Affiliation(s)
- Eka Kartika Untari
- Doctoral Graduate Program, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Pharmacy Department, Medical Faculty of Tanjungpura University, Pontianak, Indonesia
| | - Tri Murti Andayani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | - Rizka Humardewayanti Asdie
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada - Dr. Sardjito General Hospital, Yogyakarta, Indonesia
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Sutton MM, Gregoski MJ, Rockey DC. Delay in Post-Endoscopic Refeeding in Patients with Upper GI Bleeding Leads to Increased Hospital Length of Stay. Am J Med Sci 2024:S0002-9629(24)00010-7. [PMID: 38253257 DOI: 10.1016/j.amjms.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Patients with acute upper gastrointestinal bleeding (UGIB) are made NPO prior to endoscopy. It is standard practice in those found to have low risk lesions to immediately resume a usual diet. Here, we evaluated refeeding practices in hospitalized patients with UGIB after endoscopy. METHODS In this retrospective single-center cross-sectional study, we examined patients over the age of 18 with acute UGIB and low risk or no endoscopic lesion(s). Appropriate refeeding was categorically defined as resuming normal diet ≤ 4 hours post-endoscopy. RESULTS Of 230 patients (mean age, 62 years; 57% female) with acute UGIB and low-risk lesions or no lesion(s), 96 [41% (95% CI: 35% to 48%)] received their usual diet within 4 hours after EGD. For the remaining 134 patients, refeeding was delayed on average from 13 (NPO until regular diet) to 31 (NPO until liquid diet, then regular diet) hours. Baseline clinical features were identical in patients who received their regular diet within 4 hours after EGD and those who did not. Hospital length of stay was shorter in patients receiving usual diets promptly (5.3 days vs. 6.4 days, p = 0.03). Patients in an ICU at the time of their endoscopy had a statistically significantly higher probability of not being refed appropriately [OR 2.371, 95% CI 1.191-4.722). CONCLUSIONS Inappropriate dietary restrictions are frequent in patients with UGIB caused by low risk lesions. This delay in refeeding leads to increased length of hospital stay - suggesting that appropriate refeeding is an opportunity to improve patient care.
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Affiliation(s)
- Michael M Sutton
- Department of Internal Medicine, Department of Public Health Sciences, and Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA
| | - Mathew J Gregoski
- Department of Public Health Sciences, and Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA
| | - Don C Rockey
- Digestive Disease Research Center, Medical University of South Carolina, Charleston, S.C. USA..
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Basu S, Barman P, Das J, Kabeerdoss J, Attri SV, Mahajan R, Vignesh P, Rawat A. Expanding the clinical and immunological phenotype of prolidase deficiency: A case report. Pediatr Dermatol 2024; 41:115-118. [PMID: 37574707 DOI: 10.1111/pde.15413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
Prolidase deficiency (PD) is a rare autosomal recessive disorder associated with recurrent infections, immune dysregulation, and autoimmunity. PD is characterized by persistent dermatitis, skin fragility, and non-healing ulcerations on the lower limbs as its main dermatologic characteristics. Herein, we report a boy with PD due to a novel variant in PEPD who had abnormal facies, cognitive impairment, corneal opacity, recurrent infections, and persistent non-healing leg ulcers. Th17 lymphocyte counts and phosphorylated-STAT5 expression following IL-2 stimulation were reduced in our patient as compared to healthy control.
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Affiliation(s)
- Suprit Basu
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prabal Barman
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jhumki Das
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayakanthan Kabeerdoss
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- Pediatric Biochemistry Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Mahajan
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pandiarajan Vignesh
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Pediatric Allergy Immunology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hobayan CGP, Nourse EJ, Paradiso MM, Fernandez Faith E. Delayed ulceration following combination pulse dye laser and topical sirolimus treatment for port wine birthmarks: A case series. Pediatr Dermatol 2024; 41:108-111. [PMID: 37571864 DOI: 10.1111/pde.15409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023]
Abstract
Port wine birthmarks (PWB) are capillary vascular malformations within the papillary and reticular dermis, most commonly occurring on the head and neck and may darken and thicken with age. Pulsed dye laser (PDL) is the gold standard of treatment for PWB as it selectively targets involved vessels. Sirolimus is a macrolide antibiotic that selectively inhibits mammalian target of rapamycin, thereby suppressing the angiogenesis pathways that can be activated by PDL. Sirolimus and PDL may be used together to treat PWB. We present a case series describing three cases of delayed ulceration and systemic sirolimus absorption following combination therapy, highlighting a potential complication and patient safety concern.
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Affiliation(s)
| | - Elizabeth J Nourse
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michela M Paradiso
- Department of Dermatology, The Ohio State University, Columbus, Ohio, USA
| | - Esteban Fernandez Faith
- Division of Pediatric Dermatology, Nationwide Children's Hospital and College of Medicine, The Ohio State University, Columbus, Ohio, USA
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Kontoangelos K, Kousta F, Potouridou I, Chasapi V, Dikeos D, Stratigos A. Factitious Disorder as a Skin Ulcer: A Case Report. Cureus 2024; 16:e51642. [PMID: 38313954 PMCID: PMC10837820 DOI: 10.7759/cureus.51642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
Dermatitis artefacta (factitious dermatitis) is a dermatological disease of different types; it could appear on various parts of the body. It is associated with severe difficulties, such as psychic distress and negative feelings aroused in healthcare personnel or borderline personality disorder, and the long-term possibility of patient self-harm to create more symptoms, resulting in unnecessary medical procedures. This is a case of a 17-year-old girl who was hospitalized with a skin ulcer on her right ankle that proved to be a factitious disorder. She was experiencing severe symptoms of anxiety, such as feeling nervous, having trouble sleeping and concentrating, and an inability to control worry due to her preparation for university studies. She refused to see a mental health professional since the onset of anxiety symptoms, i.e., the last four months. Patients who present with factitious disorder deliberately create clinical signs of a somatic disease because they need warmth and attention in a medical environment. Symptoms offer no significant benefit, and the pathophysiological mechanisms are mainly psychological. The primary treatment for factitious disorder is psychotherapy while the management of the ulcer requires dermatosurgical treatment.
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Affiliation(s)
- Konstantinos Kontoangelos
- 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Fiori Kousta
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Irene Potouridou
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Vasiliki Chasapi
- Department of Dermatology and Venereology, Andreas Syggros Hospital, Athens, GRC
| | - Dimitris Dikeos
- 1st Department of Psychiatry, Eginition Hospital, National and Kapodistrian University of Athens, Athens, GRC
| | - Alexander Stratigos
- 1st Department of Dermatology, Hospital of Venereal & Dermatological Diseases, National and Kapodistrian University of Athens, Athens, GRC
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Yao H, Deng Y, Du G, Wang Y, Tang G. Cardiovascular diseases, risk factors, and ulcer relapse in older adults with aphthous stomatitis. J Oral Pathol Med 2024; 53:3-7. [PMID: 37932031 DOI: 10.1111/jop.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To test the hypothesis that cardiovascular diseases and risk factors are associated with ulcer relapse in after-retirement patients with recurrent aphthous stomatitis. SUBJECTS AND METHODS This retrospective cohort study analyzed the data of 40 minor recurrent aphthous stomatitis patients aged 55-75 years, admitted to Oral Medicine Clinic at one university hospital in China between 2016 and 2018. The diagnosis of minor recurrent aphthous stomatitis was made based on the history and manifestation of oral ulcers. The ulcer relapse was evaluated after a 5-week anti-inflammatory treatment, and the history of systemic diseases was collected. cardiovascular disease/metabolic risk referred to the presence of any cardiovascular diseases and metabolic cardiovascular disease risks. Associations among cardiovascular diseases, risk factors, and ulcer relapse were evaluated. RESULTS The mean age of 40 patients with minor recurrent aphthous stomatitis was 62.4 years (SD 5.1), and 60% were women. The ulcer relapse rate was 37.5% (95% CI, 0.242-0.530). The proportion of cardiovascular disease/metabolic risk was higher in the relapse group than in the no-relapse group after 5-week anti-inflammatory treatment (Fisher's exact test, p = 0.041). CONCLUSIONS According to this single-center experience, older patients with cardiovascular disease/metabolic risk may be more prone to oral ulcer recurrence. Nevertheless, larger prospective studies are needed to confirm our findings.
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Affiliation(s)
- Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Jiao Tong University, Shanghai, China
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Yao H, Deng Y, Du G, Wang Y, Tang G. Elevated serum fibrinogen levels in Chinese patients with minor recurrent aphthous stomatitis: An observational study. Exp Dermatol 2024; 33:e14915. [PMID: 37638770 DOI: 10.1111/exd.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
Fibrinogen is a protein that reflects systemic inflammation and regulates the immune response to disease. However, there is a scarcity of data on fibrinogen in recurrent aphthous stomatitis (RAS). We aimed to test the hypothesis that fibrinogen is involved in the aetiology of RAS. Between November 2016 and November 2018, we included 109 minor RAS patients and 29 age- and sex-matched controls in a single-center, observational study. Their clinical history and ulcer manifestations led to the diagnosis of minor RAS. The ulcer severity score (USS) was used to assess disease severity, and fibrinogen was also collected. We conducted three analyses: Analysis 1 (comparison of fibrinogen levels between patients and controls), Analysis 2 (comparison of fibrinogen levels between high and low USS patients) and Analysis 3 (comparison of fibrinogen levels between before and after anti-inflammatory treatment in patients). The fibrinogen levels in the 109 minor RAS patients were statistically higher than in the 29 controls (mean [SD], 2.6 [0.5] vs. 2.3 [0.3]; Student's t-test, p < 0.001). However, there were no significant differences in fibrinogen levels among the 43 patients with high USS and the 39 patients with low USS (mean [SD], 2.7 [0.5] vs. 2.6 [0.4]; Student's t-test, p = 0.278). Furthermore, fibrinogen levels were significantly higher before anti-inflammatory treatment in comparison to those after anti-inflammatory treatment in the 35 paired patients (mean [SD], 2.6 [0.4] vs. 2.5 [0.4]; Student's t-test, p = 0.026). Interestingly, fibrinogen levels were significantly higher in the 35 paired patients after anti-inflammatory treatment compared to the 29 control subjects (mean [SD], 2.5 [0.4] vs. 2.3 [0.3]; Student's t-test, p = 0.026]. Fibrinogen may play a role in the aetiology of RAS and may be a drug target for RAS treatment. Clinicians should be alert that high serum fibrinogen levels might be associated with the risk of RAS.
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Affiliation(s)
- Hui Yao
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yiwen Deng
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Guanhuan Du
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yufeng Wang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Guoyao Tang
- Department of Oral Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
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Verdenius CY, Broens EM, Slenter IJM, Djajadiningrat-Laanen SC. Corneal stromal ulcerations in a referral population of dogs and cats in the Netherlands (2012-2019): Bacterial isolates and antibiotic resistance. Vet Ophthalmol 2024; 27:7-16. [PMID: 36878893 DOI: 10.1111/vop.13080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To evaluate bacterial isolates from corneal stromal ulcerations in dogs and cats in the Netherlands, review their antibiotic susceptibility, determine whether recent topical treatment affected bacterial culture results, and investigate whether (multi-drug) resistance patterns changed over time. ANIMALS STUDIED Client-owned dogs and cats were diagnosed with corneal stromal ulceration at the Utrecht University Clinic for Companion Animals between 2012 and 2019. PROCEDURES Retrospective analysis. RESULTS In total, 163 samples were collected from 122 dogs (130 samples) and 33 cats. Positive cultures were obtained from 76 canine and 13 feline samples (59% and 39%, respectively) and included Staphylococcus (42 in dogs, 8 in cats), Streptococcus (22 in dogs, 2 in cats), and Pseudomonas (9 in dogs, 1 in cats) species. Significantly fewer positive cultures were found in dogs and cats previously treated with topical antibiotics (χ2 = 6.52, p = .011 and χ2 = 4.27, p = .039, respectively). Bacterial resistance to chloramphenicol was more common in dogs previously treated with chloramphenicol (χ2 = 5.24, p = .022). The incidence of acquired antibiotic resistance did not increase significantly over time. In dogs, the incidence of multi-drug-resistant isolates increased significantly between 2012-2015 and 2016-2019 (9.4% vs. 38.6%, p = .0032). CONCLUSIONS Staphylococcus, Streptococcus, and Pseudomonas species were the most common bacteria associated with canine and feline corneal stromal ulcerations. Previous treatment with antibiotics affected bacterial culture results and antibiotic sensitivity. Although the overall incidence of acquired antibiotic resistance did not change over time, the incidence of multi-drug-resistant isolates in dogs increased over an 8-year period.
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Affiliation(s)
- Clara Y Verdenius
- Division of Surgery of Companion Animals - Ophthalmology Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Els M Broens
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Inge J M Slenter
- Division of Surgery of Companion Animals - Ophthalmology Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sylvia C Djajadiningrat-Laanen
- Division of Surgery of Companion Animals - Ophthalmology Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Godoy M, Coca Y, Suárez R, Montes de Oca M, Bledsoe JW, Burbulis I, Caro D, Pontigo JP, Maracaja-Coutinho V, Arias-Carrasco R, Rodríguez-Córdova L, Sáez-Navarrete C. Salmo salar Skin and Gill Microbiome during Piscirickettsia salmonis Infection. Animals (Basel) 2023; 14:97. [PMID: 38200828 PMCID: PMC10778177 DOI: 10.3390/ani14010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/13/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Maintaining the high overall health of farmed animals is a central tenant of their well-being and care. Intense animal crowding in aquaculture promotes animal morbidity especially in the absence of straightforward methods for monitoring their health. Here, we used bacterial 16S ribosomal RNA gene sequencing to measure bacterial population dynamics during P. salmonis infection. We observed a complex bacterial community consisting of a previously undescribed core pathobiome. Notably, we detected Aliivibrio wodanis and Tenacibaculum dicentrarchi on the skin ulcers of salmon infected with P. salmonis, while Vibrio spp. were enriched on infected gills. The prevalence of these co-occurring networks indicated that coinfection with other pathogens may enhance P. salmonis pathogenicity.
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Affiliation(s)
- Marcos Godoy
- Centro de Investigaciones Biológicas Aplicadas (CIBA), Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile; (M.M.d.O.); (D.C.)
- Laboratorio de Biotecnología, Facultad de Ciencias de la Naturaleza, Escuela de Medicina Veterinaria, Universidad San Sebastián, Sede Patagonia, Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile
| | - Yoandy Coca
- Doctorado en Ciencias de la Ingeniería, Departamento de Ingeniería Química y Bioprocesos, Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Avenida Vicuña Mackenna 4860, Santiago 7820436, Macul, Chile;
| | - Rudy Suárez
- Programa de Magíster en Acuicultura, Facultad de Ciencias del Mar, Universidad Católica del Norte, Coquimbo 1780000, Elqui, Chile;
| | - Marco Montes de Oca
- Centro de Investigaciones Biológicas Aplicadas (CIBA), Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile; (M.M.d.O.); (D.C.)
| | - Jacob W. Bledsoe
- Department of Animal, Veterinary, and Food Sciences, Aquaculture Research Institute, University of Idaho, Hagerman, ID 83332, USA;
| | - Ian Burbulis
- Facultad de Medicina y Ciencia, Centro de Investigación Biomédica, Universidad San Sebastián, Sede Patagonia, Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile;
| | - Diego Caro
- Centro de Investigaciones Biológicas Aplicadas (CIBA), Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile; (M.M.d.O.); (D.C.)
| | - Juan Pablo Pontigo
- Laboratorio Institucional, Facultad de Ciencias de la Naturaleza, Escuela de Medicina Veterinaria, Universidad San Sebastián, Sede Patagonia, Lago Panguipulli 1390, Puerto Montt 5480000, Región de Los Lagos, Chile;
| | - Vinicius Maracaja-Coutinho
- Unidad de Genómica Avanzada, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 7820436, Macul, Chile;
- Centro de Modelamiento Molecular, Biofísica y Bioinformática (CM2B2), Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santiago 7820436, Macul, Chile
- Beagle Bioinformatics, Santiago 7820436, Macul, Chile
| | - Raúl Arias-Carrasco
- Programa Institucional de Fomento a la Investigación, Desarrollo e Innovación (PIDi), Universidad Tecnológica Metropolitana, Santiago 7820436, Macul, Chile;
| | | | - César Sáez-Navarrete
- Departamento de Ingeniería Química y Bioprocesos, Escuela de Ingeniería, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago 7820436, Macul, Chile;
- Centro de Investigación en Nanotecnología y Materiales Avanzados (CIEN-UC), Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Santiago 7820436, Macul, Chile
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Izzo P, De Intinis C, Molle M, Polistena A, Sibio S, Codacci-Pisanelli M, Biacchi D, Di Cello P, Santini D, Izzo L, Izzo S. Case report: The use of PRP in the treatment of diabetic foot: case series and a review of the literature. Front Endocrinol (Lausanne) 2023; 14:1286907. [PMID: 38170077 PMCID: PMC10760803 DOI: 10.3389/fendo.2023.1286907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
Background Diabetes mellitus is a prevalent chronic condition that significantly impacts global health. Diabetic foot complications, such as foot ulcers, pose a substantial burden on individuals with diabetes and can lead to serious consequences, including amputation. Platelet-rich plasma (PRP) has emerged as a promising therapeutic approach for enhancing the healing of diabetic foot ulcers. Methods In our study, we treated 12 patients with chronic diabetic ulcers using PRP injections administered at three-week intervals. Our objective was to assess the reduction in wound size and the rate of complete healing at 6 months after the start of the treatment. Additionally, we conducted a comprehensive literature review to contextualize our findings. Results Out of the 12 patients, 8 achieved complete healing of their diabetic foot ulcers, while the remaining four showed significant improvement with more than 50% reduction in the initial lesion size. 3 patients developed mild irritation at the inoculation site. These outcomes, combined with the evidence from published studies, highlight the effectiveness of PRP in promoting the healing of diabetic foot ulcers. Conclusion In conclusion, our study demonstrates the potential of platelet-rich plasma (PRP) as a successful therapeutic option for enhancing the healing process of chronic diabetic foot ulcers. The favorable outcomes observed, including a high rate of complete healing and significant wound size reduction, underscore the value of PRP treatment in managing this challenging complication. Further research and larger studies may provide additional insights into the mechanisms and long-term benefits of PRP in diabetic wound healing.
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Affiliation(s)
- Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Claudia De Intinis
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Marcello Molle
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Andrea Polistena
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Massimo Codacci-Pisanelli
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Daniele Biacchi
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Pierfrancesco Di Cello
- Department of General Surgery, Unità Operativa Complessa (UOC) General Surgery Frosinone-Alatri at ASL Frosinone, Frosinone, Italy
| | - Daniele Santini
- Department of Pathology, Oncology and Radiology, Sapienza University of Rome, Rome, Italy
| | - Luciano Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, Sapienza University of Rome, Rome, RM, Italy
| | - Sara Izzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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Janke TM, Kozon V, Valiukeviciene S, Rackauskaite L, Reich A, Stępień K, Chernyshov P, Jankechová M, van Montfrans C, Amesz S, Barysch M, Montero EC, Augustin M, Blome C. Validation of the Wound-QoL-17 and the Wound-QoL-14 in a European sample of 305 patients with chronic wounds. Int Wound J 2023; 21:e14505. [PMID: 38049311 PMCID: PMC10898406 DOI: 10.1111/iwj.14505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
The Wound-QoL assesses the impact of chronic wounds on patients' health-related quality of life (HRQoL). A 17-item and a shortened 14-item version are available. The Wound-QoL-17 has been validated for multiple languages. For the Wound-QoL-14, psychometric properties beyond internal consistency were lacking. We aimed to validate both Wound-QoL versions for international samples representing a broad range of European countries, including countries for which validation data had yet been pending. Patients with chronic wounds of any aetiology or location were recruited in Austria, Lithuania, the Netherlands, Poland, Slovakia, Spain, Switzerland and Ukraine. Psychometric properties were determined for both Wound-QoL versions for the overall sample and, if feasible, country-wise. We included 305 patients (age 68.5 years; 52.8% males). Internal consistency was high in both Wound-QoL-17 (Cronbach's α: 0.820-0.933) and Wound-QoL-14 (0.779-0.925). Test-retest reliability was moderate to good (intraclass correlation coefficient: 0.618-0.808). For Wound-QoL-17 and Wound-QoL-14, convergent validity analyses showed highest correlations with global HRQoL rating (r = 0.765; r = 0.751) and DLQI total score (r = 0.684; r = 0.681). Regarding clinical data, correlations were largest with odour (r = -0.371; r = -0.388) and wound size (r = 0.381; r = 0.383). Country-wise results were similar. Both Wound-QoL versions are valid to assess HRQoL of patients with chronic wounds. Due to its psychometric properties and brevity, the Wound-QoL-14 might be preferrable in clinical practice where time is rare. The availability of various language versions allows for the use of this questionnaire in international studies and in clinical practice when foreign language patients are being treated.
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Affiliation(s)
- Toni Maria Janke
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Vlastimil Kozon
- Society Wound Diagnosis and Wound Management AustriaVienna Medical AcademyViennaAustria
| | - Skaidra Valiukeviciene
- Department of Dermatology and VenereologyHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Laura Rackauskaite
- Department of Dermatology and VenereologyHospital of Lithuanian University of Health Sciences Kauno KlinikosKaunasLithuania
| | - Adam Reich
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszów UniversityRzeszówPoland
| | - Katarzyna Stępień
- Department of Dermatology, Institute of Medical SciencesMedical College of Rzeszów UniversityRzeszówPoland
| | - Pavel Chernyshov
- Department of Dermatology and VenereologyBogomolets National Medical UniversityKievUkraine
| | - Monika Jankechová
- Faculty of Health and Social Work St. Ladislaw in Nove ZamkySt. Elizabeth University of Health and Social WorkBratislavaSlovakia
| | - Catherine van Montfrans
- Department of DermatologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | - Stella Amesz
- Department of Health Sciences, Section of Nursing ScienceUniversity Medical Center GroningenGroningenThe Netherlands
| | - Marjam Barysch
- Department of DermatologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
| | - Christine Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP)University Medical Center Hamburg‐Eppendorf (UKE)HamburgGermany
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Su YN, Li J, Feng DH, Lu RR, Dong GX, Zhao DY. Efficacy and safety of autologous platelet-rich plasma for diabetic foot ulcers: a systematic review and meta-analysis. J Wound Care 2023; 32:773-786. [PMID: 38060413 DOI: 10.12968/jowc.2023.32.12.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of autologous platelet-rich plasma (au-PRP) for diabetic foot ulcer (DFU) treatment. METHOD We conducted database searches (MEDLINE, EMBASE, evidence-based medicine reviews: CENTRAL, PubMed, and Web of Science) and reference mining for randomised controlled trials from inception to 23 January 2022. Results were scrutinised, data were extracted and research quality was investigated by two independent authors. Primary outcome was the proportion of complete ulcer healing. Secondary outcomes included both the mean time to complete healing and the incidence of adverse events. Statistical analyses were performed in RevMan 5.4 (Cochrane, UK). Kaplan-Meier curves for time to complete healing were pooled in R software (version 4.1.2) (R Foundation, Austria). RESULTS Of the 231 records identified, 17 studies with a total of 1303 participants (649 randomised to the au-PRP group and 654 to a standard of care (SOC) group) met the eligibility criteria and were included in our study. Compared with SOC, au-PRP appeared to promote the complete healing rate (odds ratio (OR): 2.11; 95% Confidence Interval: 1.55-2.86). Au-PRP also appeared to significantly shorten complete healing time (mean duration: -19.04 days; 95%CI: -20.46--17.61]). There was no significant difference on adverse events. Results were robust on sensitivity analyses. CONCLUSION Based on the findings of this review and meta-analysis, Au-PRP is an effective and safe adjuvant therapy for DFUs.
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Affiliation(s)
- Ya-Na Su
- Department of Health Management, The School of Smart Health and Wellness (Health Medical College), Zhejiang Dongfang Polytechnic, Wenzhou City, Zhejiang Province, PR China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, PR China
- The Chinese Cochrane Center, Chengdu City, Sichuan Province, PR China
| | - Dai-Hao Feng
- Department of Elderly Services and Management, The School of Smart Health and Wellness (Health Medical College), Zhejiang Dongfang Polytechnic, Wenzhou City, Zhejiang Province, PR China
| | - Ruo-Ruo Lu
- Department of Elderly Services and Management, The School of Smart Health and Wellness (Health Medical College), Zhejiang Dongfang Polytechnic, Wenzhou City, Zhejiang Province, PR China
| | - Guo-Xi Dong
- Department of Nursing Teaching and Research, The School of Smart Health and Wellness (Health Medical College), Zhejiang Dongfang Polytechnic, Wenzhou City, Zhejiang Province, PR China
| | - Ding-Yun Zhao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou City, Zhejiang Province, PR China
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Saberianpour S, Saeed Modaghegh MH, Montazer M, Kamyar MM, Sadeghipour Kerman F, Rahimi H. Relation Between Tissue Iron Content and Polarization of Macrophages in Diabetic Ulcer and the Transitional Zone of Diabetic Ulcers with Major Amputation. INT J LOW EXTR WOUND 2023; 22:672-679. [PMID: 34402324 DOI: 10.1177/15347346211037448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Most diabetic lower-limb amputations probably result from combinations of contributing causes rather than from unitary causes. Iron-induced damage might modulate the development of chronic diabetes complications. In this study, the relationship between tissue iron levels and polarization of macrophages in induction of angiogenesis was investigated in diabetic ulcer samples and the transitional zone of diabetic ulcers. Patients with diabetic ulcers who underwent amputation were included. The transitional zone of diabetic ulcers, from the same diabetic patients, was used as a control group. After tissue preparation, Perls Prussian blue staining and immunohistochemistry for CD11c, CD163, and CD68 markers were done. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), Tie2, and protein kinase B (also known as AKT) transcription of genes were measured by real-time polymerase chain reaction. For statistical analysis, we used independent samples t-test or its nonparametric equivalents, Mann-Whitney U test was used for quantitative variables, and chi-square (or Fisher's exact test) for qualitative variables. According to the results, the ratio of M2 to M1 macrophages was decreased in ulcers tissue compared to the transitional zone of diabetic ulcers. The expression of angiogenesis-related genes was increased due to hypoxia induction such as HIF and VEGF in ulcer tissue (P < .0001), but the expression of vascular stability-related genes such as Tie2 was decreased (P < .0001).In amputated diabetic ulcers, the polarization of macrophages is toward the classic type, but no connection was found in terms of tissue iron and help in the polarization of macrophages.
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Affiliation(s)
- Shirin Saberianpour
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad H Saeed Modaghegh
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Montazer
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad M Kamyar
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Sadeghipour Kerman
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Rahimi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Genetics and Molecular Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Yang CC, Wu MS, Hsu H. Management of diabetic foot ulcers using topical probiotics in a soybean-based concentrate: a multicentre study. J Wound Care 2023; 32:S16-S21. [PMID: 38063295 DOI: 10.12968/jowc.2023.32.sup12.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is a common complication in people with diabetes. Standard management includes strict glycaemic management, control of the infection, revascularisation, debridement, mechanical offloading and foot care education. This study aimed to evaluate the efficacy of using topical probiotics in a soybean-based concentrate in the management of DFUs. METHOD A retrospective, multicentre evaluation of patients with diabetes with non-infected DFUs between October 2020 and October 2021, and who were treated with twice daily topical application of probiotics in a soybean-based concentrate as an adjunct to standard wound care. RESULTS A total of 22 patients were enrolled into this study, including 16 males and six females, with a mean age of 61 years (range: 31-89 years). Defect size ranged from 1-33.5cm2 (mean: 7.2cm2). The mean number of days until complete healing was 51 (range: 21-112 days). Of the patients, 83% showed complete healing at the end of 16 weeks, 72% showed complete healing at 12 weeks, 56% at eight weeks, and 22% at four weeks. The wounds showed an average decrease in size of 0.59cm2 (9%) per week, calculated using generalised estimating equation. CONCLUSION This findings of this study provide a new perspective on the therapeutic potential of probiotics as an effective form of management in patients with small, hard-to-heal (chronic) DFUs.
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Affiliation(s)
- Chao-Chih Yang
- Attending Plastic Surgeon and Chief of Division of Plastic Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan
| | - Megn-Si Wu
- Attending Plastic Surgeon, Lecturer, Division of Plastic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
| | - Honda Hsu
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Attending Plastic Surgeon, Associate Professor, Division of Plastic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Taiwan
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常 树, 杨 尉, 宋 荷, 陈 伟, 周 健, 张 芳, 闫 雪, 莫 小, 聂 开, 邓 呈, 魏 在. [Effectiveness of tibial transverse transport combined with modified neurolysis in treatment of diabetic foot ulcers]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1410-1417. [PMID: 37987053 PMCID: PMC10662404 DOI: 10.7507/1002-1892.202306016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Objective To investigate the effectiveness of tibial transverse transport (TTT) combined with modified neurolysis in treatment of diabetic foot ulcer (DFU) through a prospective randomized controlled study. Methods The patients with DFU and diabetic peripheral neuropathy, who were admitted between February 2020 and February 2022, were selected as the research objects, of which 31 cases met the selection criteria and were included in the study. The patients were divided into two groups by random number table method. The 15 patients in the trial group were treated with TTT combined with modified neurolysis, and the 16 patients in the control group received treatment with TTT alone. There was no significant difference in gender, age, duration of DFU, ulcer area, Wagner classification, as well as preoperative foot skin temperature, visual analogue scale (VAS) score, ankle-brachial index (ABI), motor nerve conduction velocity (MNCV) of the common peroneal nerve, MNCV of the tibial nerve, MNCV of the deep peroneal nerve, two-point discrimination (2-PD) of heel, and cross-sectional area (CSA) of the common peroneal nerve between the two groups ( P>0.05). The time for ulcer healing, foot skin temperature, VAS scores, ABI, 2-PD of heel, and CSA of the common peroneal nerve before operation and at 6 and 12 months after operation were recorded and compared between groups. The differences in MNCV of the common peroneal nerve, MNCV of the tibial nerve, and MNCV of the deep peroneal nerve between pre-operation and 12 months after operation were calculated. Results All patients in both groups were followed up 12-24 months (mean, 13.9 months). The surgical incisions in both groups healed by first intention and no needle tract infections occurred during the bone transport phase. Ulcer wounds in both groups healed successfully, and there was no significant difference in the healing time ( P>0.05). During the follow-up, there was no ulcer recurrences. At 12 months after operation, the MNCV of the common peroneal nerve, the MNCV of the tibial nerve, and the MNCV of the deep peroneal nerve in both groups accelerated when compared to preoperative values ( P<0.05). Furthermore, the trial group exhibited a greater acceleration in MNCV compared to the control group, and the difference was significant ( P<0.05). The foot skin temperature, VAS score, ABI, 2-PD of heel, and CSA of the common peroneal nerve at 6 and 12 months after operation significantly improved when compared with those before operation in both groups ( P<0.05). The 2-PD gradually improved over time, showing significant difference ( P<0.05). The 2-PD of heel and VAS score of the trial group were superior to the control group, and the differences were significant ( P<0.05). There was no significant difference in ABI, foot skin temperature, and CSA of the common peroneal nerve between groups after operation ( P>0.05). Conclusion Compared with TTT alone, the TTT combined with modified neurolysis for DFU can simultaneously solve both microcirculatory disorders and nerve compression, improve the quality of nerve function recovery, and enhance the patient's quality of life.
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Affiliation(s)
- 树森 常
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 尉 杨
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 荷花 宋
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 伟 陈
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 健 周
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 芳 张
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 雪萍 闫
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 小金 莫
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 开瑜 聂
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 呈亮 邓
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
| | - 在荣 魏
- 遵义医科大学附属医院烧伤整形外科(贵州遵义 563003)Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
- 遵义医科大学组织损伤修复与再生医学省部共建协同创新中心(贵州遵义 563003)The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China
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Baral S, Rajbhandari S. Diabetic foot problem in Nepal. Front Endocrinol (Lausanne) 2023; 14:1277940. [PMID: 38027189 PMCID: PMC10661256 DOI: 10.3389/fendo.2023.1277940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Nepal is a developing country where diabetes is becoming a major health challenge due to its high prevalence of 8.5% affecting around 2 million people. Due to limited resources, there are many barriers to providing affordable and convenient diabetes care or regular screening for complications. There is no reliable data on incidence, prevalence, and complications of diabetic foot problems in Nepal. Methods We conducted an online survey amongst senior physicians, who were members of 'Diabetes & Endocrine Association of Nepal' to assess their perception of diabetic foot problems in Nepal. Results Thirty-Eight physicians responded to the survey who saw a total of 17597 patients in the preceding month. They recalled seeing 647 with 'Diabetic Foot Ulcers', giving a crude Diabetic Foot Ulcer prevalence rate of 3.7%. They recalled seeing 2522 patients with painful neuropathy that required medical treatment, giving a crude painful neuropathy prevalence rate of 14.3%. A history of foot ulcer was present in an additional 578 patients. Previous minor amputation had been performed in 215 patients (1.2%) and major amputation in 135 patients (0.8%). Discussion Despite having expertise in various fields there is no dedicated multi-disciplinary diabetic foot clinic in Nepal. This survey shows that diabetic foot problems are abundant in Nepal and there is a need for structured multi-disciplinary approach for screening and treatment.
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Affiliation(s)
- Suman Baral
- Department of Diabetes & Endocrinology Mediciti Hospital, Lalitpur, Nepal
| | - Satyan Rajbhandari
- Department of Diabetes & Endocrinology Lancashire Teaching Hospital, Chorley, United Kingdom
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Goss R, Adams VJ, Heinrich C, Grundon R, Linn-Pearl R, Scurrell E, Hamzianpour N. Progressive ulcerative keratitis in dogs in the United Kingdom: Microbial isolates, antimicrobial sensitivity, and resistance patterns. Vet Ophthalmol 2023. [PMID: 37933885 DOI: 10.1111/vop.13160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES The objective of the study was to identify bacterial pathogens and their antimicrobial sensitivity profile associated with cases of canine progressive ulcerative keratitis. MATERIALS AND METHODS Analysis of microbial culture and sensitivity results from dogs with progressive ulcerative keratitis presenting to a UK referral practice between December 2018 and August 2020. RESULTS Positive bacterial cultures were obtained from 80/148 (54%) of the canine ulcers sampled with 99 bacterial isolates cultured. Streptococcus canis (n = 29), Pseudomonas aeruginosa (n = 19), and Staphylococcus pseudintermedius (n = 16) were the most common isolates. Pseudomonas aeruginosa was more likely to be isolated whether the ulcer was clinically malacic at the time of sampling (OR = 10.1, p < .001). Ulcers treated prior to culture with fusidic acid were 7.6 times more likely to be positive than those treated with any other antimicrobial(s). Bacterial isolates demonstrated resistance against neomycin (85%), fusidic acid (78%), and tetracycline (68%). Conversely, isolates were most likely to be sensitive to gentamicin (88%), ofloxacin (77%), ciprofloxacin (73%), and chloramphenicol (64%). Antimicrobial combinations of chloramphenicol or gentamicin with a fluoroquinolone (ofloxacin or ciprofloxacin) or chloramphenicol combined with gentamicin were the most effective on in vitro analysis (over 90% susceptibility of all isolates). CONCLUSION The most common bacterial species associated with canine progressive ulcerative keratitis in a UK referral population were S. canis, P. aeruginosa, and S. pseudintermedius. Combination antimicrobial therapy is recommended pending culture and sensitivity results given the varied antimicrobial susceptibility profiles and significant bacterial in vitro resistance to antimicrobial monotherapy.
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Mitsui I, Uchida K. Canine Gallbladder Erosion/ Ulcer and Hemocholecyst: Clinicopathological Characteristics of 14 Cases. Animals (Basel) 2023; 13:3335. [PMID: 37958090 PMCID: PMC10649012 DOI: 10.3390/ani13213335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/08/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Gallbladder mucosal erosion and/or ulceration are illnesses associated with unexpected gallbladder intra-cystic bleeding (hemocholecyst), an under-reported problem in dogs. (2) Methods: Clinicopathological characteristics of 14 dogs with gallbladder erosion/ulcer were investigated in this single-center retrospective study using clinical data and archived gallbladder tissues of client-owned dogs. (3) Results: Canine gallbladder erosion/ulcer tends to occur in older, neutered dogs of various breeds. Vomiting, lethargy, and anorexia are common. Concurrent gallbladder rupture occurred in 5/14 cases (35.7%), while rupture was absent in 6/14 cases (42.8%) and undetermined in 3/14 (21.4%) cases. Histologically, the gallbladder wall was markedly thickened due to mucosal hyperplasia, inflammatory infiltrates, fibrosis, edema, hemorrhage, and smooth muscle hyperplasia/hypertrophy. Twelve out of fourteen cases (85.7%) had concurrent cholecystitis of varying severity. Bacteria were detected by Giemsa or Warthin-Starry stain in 8/14 (57.1%) cases. Bacterial rods immunoreactive to the anti-Helicobacter antibody were present in one case. Mucosal epithelial cells of the gallbladder erosion/ulcer cohort were immunopositive for the cyclooxygenases COX-1 or COX-2 in only 5/14 (35.7%) cases. In contrast, COX-1 and COX-2 were more frequently expressed in a reference pool of cases of gallbladder mucocele (n = 5) and chronic cholecystitis (n = 5). COX-1 was expressed in 9/10 cases (90.0%) of gallbladder mucocele and chronic cholecystitis and in 10/10 cases (100%) for COX-2. (4) Conclusions: Canine gallbladder erosion/ulcer is an under-reported condition which requires active clinical intervention. Based on the clinicopathological information reported in this study in addition to the COX-1 and COX-2 IHC results, we suggest that canine gallbladder erosion/ulcer may be related to decreased cytoprotection physiologically provided by arachidonic acid, but which is decreased or absent due to reduced COX expression because of yet undetermined etiologies.
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Affiliation(s)
- Ikki Mitsui
- Laboratory of Veterinary Anatomy, Faculty of Veterinary Medicine, Okayama University of Science, Imabari 794-8555, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agriculture and Life Sciences, The University of Tokyo, Bunkyo-ku, Tokyo 113-8657, Japan;
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McIntyre N, Finlayson K, Galazka A, Lindsay E, Renyi R. The Lindsay Leg Club ® Well Leg Regime: an evidence review. J Wound Care 2023; 32:642-648. [PMID: 37830830 DOI: 10.12968/jowc.2023.32.10.642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
This article aims to review the scarce available evidence on the effectiveness of the Well Leg Programme within the Lindsay Leg Clubs in terms of preventing wound recurrence and improving members' wellbeing. It collates the numerical data on members' wounds and healing rates from the Lindsay Leg Club relational database and members' narratives from a qualitative service evaluation of the Lindsay Leg Clubs. Findings of the review suggest that remaining within the Well Leg regime for several months (or longer) after having had a healed ulcer seems to provide further opportunity to prevent recurrence, and may also provide non-clinical benefits, such as improved wellbeing. Based on the review of available published evidence into the effectiveness of the Well Leg regime, we conclude that there is scope for further studies, including a comparison with other existing treatment and prevention protocols.
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Affiliation(s)
| | - Kathleen Finlayson
- Centre for Healthcare Transformation, Queensland University of Technology, Australia
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Chen Z, OuYang S. Three cases of scrub typhus with hemorrhage: a case report and literature review. J Int Med Res 2023; 51:3000605231204430. [PMID: 37890141 PMCID: PMC10612463 DOI: 10.1177/03000605231204430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/13/2023] [Indexed: 10/29/2023] Open
Abstract
Scrub typhus (ST) is an acute focal infectious disease that is caused by Orientia tsutsugamushi. The Asia-Pacific region is an area of relatively high incidence. There is a high incidence in China, principally owing to the disease being endemic in the south of the country. The main source of ST infection is rats, which act as reservoirs of infection after being bitten by the chigger mite, and the human population is generally susceptible to the disease. ST can be controlled and treated successfully if antibiotics are administered in a timely manner. However, because it does not have a specific clinical manifestation, it is difficult to distinguish ST from other febrile diseases in clinical practice. Therefore, rapid diagnostic methods are still needed to help clinicians make a timely diagnosis. Here, we share three cases of patients with ST who experienced hemorrhage, but did not have typical skin lesions, such as eschar and ulcer, early in the course of their disease, and review the relevant literature regarding ST. We conclude that clinicians should pay attention to the risk of hemorrhage associated with this disease, and emphasize the importance of making an early diagnosis.
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Affiliation(s)
- Ziren Chen
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of the Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shi OuYang
- Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of the Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Schiefer-Niederkorn A, Sadoghi B, Binder B. Literaturrecherche zur Therapie der Necrobiosis lipoidica in der Kindheit. J Dtsch Dermatol Ges 2023; 21:1120-1130. [PMID: 37845061 DOI: 10.1111/ddg.15137_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/25/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungDie Necrobiosis lipoidica (NL) ist eine seltene granulomatöse Erkrankung mit scharf begrenzten, teleangiektatischen, braun‐roten Plaques mit atroph‐gelblichen Zentren, die zu Ulzerationen neigen und hauptsächlich an den Schienbeinen auftreten. Bei Kindern ist NL sehr selten, jedoch sind die Therapieresistenz, das problematische kosmetische Erscheinungsbild, die schmerzhaften Ulzerationen und die mögliche Entwicklung von Plattenepithelkarzinomen besonders herausfordernd für diese Altersgruppe. Unsere Literaturrecherche inkludiert 29 Berichte über NL bei Patienten unter 18 Jahren, die seit 1990 auf PubMed, EMBASE und Medline publiziert wurden. Das mittlere Alter war 14,3 Jahre mit weiblicher Prädominanz von 2 : 1 und hoher Prävalenz von Diabetes mellitus (80%). Aus den Daten geht hervor, dass hochpotente topische Steroide bis zu zweimal täglich Behandlung erster Wahl sind. Therapierefraktäre Fälle können auf Tacrolimus umgestellt werden. Ulzerationen profitieren von phasenadaptierter Wundversorgung und antientzündlichen medizinischen Verbänden wie mit medizinischem Honig. Das Hinzufügen einer hyperbaren Sauerstoffbehandlung zur lokalen oder systemischen Therapie kann bei schwer behandelbaren ulzerierten Läsionen in Betracht gezogen werden. Therapieresistente Fälle können umgestellt werden auf topische Photochemotherapie oder systemische Behandlung mit TNF‐alpha‐Inhibitoren, systemischen Steroiden (bevorzugt bei Patienten ohne Diabetes), Pentoxifyllin oder Hydroxychloroquin. Necrobiosis lipoidica in der Kindheit ist mit über 40% fehlgeschlagenen Therapieversuchen schwer zu behandeln, weshalb weitere Forschung über Patientenregister empfohlen wird.
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Affiliation(s)
- Anna Schiefer-Niederkorn
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Birgit Sadoghi
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
| | - Barbara Binder
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Graz, Graz, Österreich
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Schiefer-Niederkorn A, Sadoghi B, Binder B. Necrobiosis lipoidica in childhood: a review of literature with emphasis on therapy. J Dtsch Dermatol Ges 2023; 21:1120-1129. [PMID: 37401158 DOI: 10.1111/ddg.15137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/25/2023] [Indexed: 07/05/2023]
Abstract
Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that manifests as sharply demarcated, telangiectatic, brownish-red plaques with atrophic yellowish centers prone to ulceration and occurs predominantly on the shins. In children, NL is extremely rare, but resistance to therapy, troublesome cosmetic appearance, painful ulcerations, and possible development of squamous cell carcinoma in long-persisting lesions are challenges during treatment. Our review includes 29 reports of NL in patients aged <18 years published from 1990 on PubMed, EMBASE, and Medline. The mean age of patients was 14.3 years, with a female predominance of 2 : 1 and a high prevalence of diabetes mellitus (80%). Data showed that potent topical steroids up to twice daily is the first-line treatment. For refractory cases, therapy can be switched to tacrolimus. Ulcerations benefit from phase-adapted wound care and anti-inflammatory medical dressings such as medical honey. Adding hyperbaric oxygenation to local or systemic therapy in difficult-to-treat ulcerated lesions can be considered. Refractory cases may be switched to topical photochemotherapy or systemic treatment with TNF-α inhibitors, systemic steroids (preferably in non-diabetic patients), pentoxifylline, or hydroxychloroquine. Necrobiosis lipoidica in childhood is difficult to treat, with a treatment failure rate of 40%. Therefore, further research through patient registries is recommended.
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Affiliation(s)
| | - Birgit Sadoghi
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Barbara Binder
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
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Nair HK, Yan TD. Use of bioelectric dressings for patients with hard-to-heal wounds: a case report. J Wound Care 2023; 32:S8-S14. [PMID: 37830843 DOI: 10.12968/jowc.2023.32.sup10a.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
There are many types of dressings available for the management of hard-to-heal (chronic) wounds. This case report illustrates the efficacy of bioelectric dressings in healing hard-to-heal wounds in five patients. Of the patients, four had diabetic foot ulcers (DFUs) and one had a surgical site infection. Wounds were examined using the TIMES concept and debridement was carried out if needed. Amorphous hydrogel was used as conduction fluid before the application of the bioelectric wound dressings. The wound was covered with foam dressing and crepe bandage. In this case report, among all five wounds, one wound healed completely while the other four reduced in size, with the presence of more granulation and re-epithelialisation. In this case report, bioelectric wound dressings were effective in managing infection and promoting wound healing.
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Affiliation(s)
- Harikrishna Kr Nair
- Editor-in-Chief, Wound Asia
- Head of the Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur, Malaysia
| | - Teong Dun Yan
- Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur, Malaysia
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Schmidt BM, Kaye KS, Armstrong DG, Pop-Busui R. Empirical Antibiotic Therapy in Diabetic Foot Ulcer Infection Increases Hospitalization. Open Forum Infect Dis 2023; 10:ofad495. [PMID: 37849506 PMCID: PMC10578503 DOI: 10.1093/ofid/ofad495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/02/2023] [Indexed: 10/19/2023] Open
Abstract
Background We evaluated the outcomes associated with initial antibiotic management strategies for infected diabetic foot ulcers (DFUs) diagnosed in an outpatient multidisciplinary center. Methods Consecutive outpatient individuals with infected DFUs, stratified according to Infectious Diseases Society of America infection severity, were followed for 1 year from the initial antibiotic administration to treat acute infection. The main outcomes were hospitalization rates for a diabetes-related foot complication within 30 days of diagnosis and requiring an amputation or death during follow-up. Outcomes were analyzed by regression analysis, accounting for demographics, clinical characteristics, and antibiotic therapy. Results Among 147 outpatients with infected DFUs, 116 were included. Infections were categorized as mild (68%), moderate (26%), and severe (6%). Empirical antibiotics (not culture-guided) were prescribed as initial treatment in 39 individuals, while 77 received culture-based antibiotics. There were no differences in demographic or clinical characteristics between the antibiotic administration groups, except for a higher body mass index and prevalence of chronic kidney disease in the empirical cohort. Forty-two infected DFU patients required hospitalization within 30 days of diagnosis for the same reason. The relative risk for hospitalizations was 1.87 greater in those with mild infections when treated with empirical antibiotics compared with culture-directed antibiotics. There were no differences in amputations and/or death at 1 year follow-up. Conclusions These data support obtaining tissue culture to guide antibiotic therapy, regardless of DFU infection severity, to decrease hospitalizations.
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Affiliation(s)
- Brian M Schmidt
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Keith S Kaye
- Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - David G Armstrong
- Department of Surgery, Southwestern Academic Limb Salvage Alliance (SALSA), Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Health, Ann Arbor, Michigan, USA
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Jones PJ, Lavery L, Davies MJ, Webb D, Rowlands AV. Hotspots: Adherence in home foot temperature monitoring interventions for at-risk feet with diabetes-A narrative review. Diabet Med 2023; 40:e15189. [PMID: 37489103 DOI: 10.1111/dme.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a > 2.2°C difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting a recurrent hotspot. METHODS PubMed and Google Scholar were searched until 9 June 2023 for English-language peer-reviewed HFTM studies which reported adherence to HFTM, daily step reduction or HCP hotspot notification. The search returned 1030 results excluding duplicates of which 28 were shortlisted and 11 included. RESULTS Typical adherence among HFTM study participants for >3 days per week was 61%-93% or >80% of study duration was 55.6%-83.1%. Monitoring foot temperatures >50% of the study duration was associated with decreased ulcer risk (Odds Ratio: 0.50, p < 0.001) in one study (n = 173), but no additional risk reduction was found for >80% adherence. Voluntary dropout was 5.2% (Smart mats); 8.1% (sock sensor) and 4.8%-35.8% (infrared thermometers). Only 16.9%-52.5% of participants notified an HCP upon hotspot detection. Objective evidence of adherence to 50% reduction in daily steps upon hotspot detection was limited to one study where the average step reduction was a pedometer-measured 51.2%. CONCLUSIONS Ulcer risk reduction through HFTM is poorly understood given only half of the participants notify HCPs of recurrent hotspots and the number of reducing daily steps is largely unknown. HFTM adherence and dropout are variable and more research is needed to determine factors affecting adherence and those likely to adhere.
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Affiliation(s)
- Petra J Jones
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Lawrence Lavery
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
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Mardani G, Shahidi Dadras M, Abdollahimajd F, Safari Giv T, Pourgholi E, Rakhshan A, Ghalamkarpour F. Facial pyoderma gangrenosum associated with fallopian tube carcinosarcoma. Clin Case Rep 2023; 11:e8065. [PMID: 37850059 PMCID: PMC10577160 DOI: 10.1002/ccr3.8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/24/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with underlying disorders. The association between PG and solid organ tumors (SM), including gynecologic cancers, has been previously reported. Here, we report a case of a 61-year-old woman with pyoderma gangrenosum on the posterior auricular region associated with an underlying fallopian tube carcinosarcoma: a rare and aggressive gynecologic malignancy. The patient's ulcer responded favorably to treatment, and surgical resection of the tumor was performed. The patient was then referred for further cancer management. No new lesions or recurrences were found over the 18 months of routine follow-up.
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Affiliation(s)
- Ghazal Mardani
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | | | - Toktam Safari Giv
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Elnaz Pourgholi
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Azadeh Rakhshan
- Pathology DepartmentShahid Beheshti University of Medical SciencesTehranIran
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Tomás-Velázquez A, Antoñanzas J, Salido-Vallejo R, Redondo P. Enhancing Lower Extremity Defect Coverage: High Viability Ultra-Thin Split-Thickness Skin Grafts Obtained from the Scalp. J Clin Med 2023; 12:6109. [PMID: 37834753 PMCID: PMC10573162 DOI: 10.3390/jcm12196109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes. OBJECTIVES This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade. METHODS Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted. CONCLUSIONS In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects.
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Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (A.T.-V.); (R.S.-V.); (P.R.)
- School of Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Javier Antoñanzas
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (A.T.-V.); (R.S.-V.); (P.R.)
- School of Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Rafael Salido-Vallejo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (A.T.-V.); (R.S.-V.); (P.R.)
- School of Medicine, University of Navarra, 31008 Pamplona, Spain
| | - Pedro Redondo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain; (A.T.-V.); (R.S.-V.); (P.R.)
- School of Medicine, University of Navarra, 31008 Pamplona, Spain
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Ahmed SF, Saafan AM, Rasmy AH, Bakr MA. Histomorphometric Analysis of the Healing Capacity of Low-Level Laser on Thermally Induced Tongue Ulcers for Gamma-Irradiated Rats. Photobiomodul Photomed Laser Surg 2023; 41:467-474. [PMID: 37738367 DOI: 10.1089/photob.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Objective: This study aimed to assess the efficacy of low-level laser therapy (LLLT) for treating thermal tongue ulcers in gamma-irradiated rats. Background: Postradiotherapeutic trauma may cause cell death, tissue damage, organ dysfunction, and loss of hematological components. Materials and methods: Thermal ulcers were induced on the dorsal surfaces of tongues of gamma-irradiated rats (15 Gy). Rats were divided into three groups, group 1 received no treatment, group 2 was subjected to a single dose of diode laser 807 nm with energy density 4 J/cm2, and group 3 was subjected to the same dose of LLLT but fractionated into three sessions at days 1, 3, and 5 after ulcers induction. Ulcers were assessed clinically for their areas and healing percentage. Specimens were examined for the quality of ulcer closure and expression of IL-1β and TGF-β1. Results: Results revealed significant improvement of ulcer healing clinically and histologically in both treatment groups compared to control. Moreover, IL-1β and TGF-β1 expression in both treatment groups was high at the earlier stage of healing then declined by time to reach a normal level. However, untreated group showed higher expression of IL-1β and TGF-β1 compared to treatment groups. In addition, IL-1β expression decreased by time but still of high level and TGF-β1 expression increased then declined. Conclusions: We concluded that gamma radiation-impaired mucosal healing could be related to the over expression of IL-1β and TGF-β1. LLLT, whether one session or fractionated, could be an effective treatment for postradiotherapeutic ulcers. The healing power of LLLT might be due to modulation of IL-1β and TGF-β1. Clinical Trial Registration number is 25A122.
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Affiliation(s)
- Salwa Farid Ahmed
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Ali Mohamed Saafan
- Medical Laser Applications Department, National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt
| | - Amr H Rasmy
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Mostafa A Bakr
- Health Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
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