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Arai K, Yoshida S, Furuichi E, Iwanaga S, Mir TA, Yoshida T. Transplanted artificial amnion membrane enhanced wound healing in third-degree burn injury diabetic mouse model. Regen Ther 2024; 27:170-180. [PMID: 38571890 PMCID: PMC10987674 DOI: 10.1016/j.reth.2024.03.016] [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: 12/07/2023] [Revised: 02/29/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Wound healing is severely compromised in patients with diabetes owing to factors such poor blood circulation, delayed immune response, elevated blood sugar levels, and neuropathy. Although the development of new wound healing products and prevention of serious complications such as infections in wounds have received substantial interest, wound healing remains a challenge in regenerative medicine. Burn wounds, especially third-degree burns, are difficult to treat because they are associated with immune and inflammatory reactions and distributive shock. Wound care and treatment that protects the burn site from infection and allows wound healing can be achieved with bioengineered wound dressings. However, few studies have reported effective dressings for third-degree burn wounds, making it important to develop new dressing materials. Methods In this study, we developed an artificial amniotic membrane (AM) using epithelial and mesenchymal cells derived from human amnion as a novel dressing material. The artificial AM was applied to the wound of a diabetic third-degree burn model and its wound healing ability was evaluated. Results This artificial amnion produced multiple growth factors associated with angiogenesis, fibroblast proliferation, and anti-inflammation. In addition, angiogenesis and granulation tissue formation were promoted in the artificial AM-treated mouse group compared with the control group. Furthermore, the inflammatory phase was prolonged in the control group. Conclusions Our preliminary results indicate that the artificial AM might be useful as a new dressing for refractory ulcers and third-degree burns. This artificial AM-based material represents great potential for downstream clinical research and treatment of diabetes patients with third-degree burns.
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Affiliation(s)
- Kenichi Arai
- Department of Clinical Biomaterial Applied Science, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Biotechnology, Faculty of Bioresource Sciences, Akita Prefectural University, Akita, Japan
| | - Satoshi Yoshida
- Department of Medical Oncology, Toyama University Hospital, Toyama, Japan
| | - Etsuko Furuichi
- Department of Clinical Biomaterial Applied Science, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shintaroh Iwanaga
- Division of Biomedical System Engineering, Graduate School of Science and Engineering, University of Toyama, Toyama, Japan
| | - Tanveer Ahmad Mir
- Tissue/Organ Bioengineering and BioMEMS Lab, Organ Transplant Centre of Excellence (TR&I Dpt), King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
| | - Toshiko Yoshida
- Department of Clinical Biomaterial Applied Science, Faculty of Medicine, University of Toyama, Toyama, Japan
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Alhassan E, Yi BY, Rodman J, Weisman MH, Crew A, Wise L. Unique characteristics of anti-MDA-5 associated dermatomyositis in Southern California with a large Hispanic population. Semin Arthritis Rheum 2024; 66:152434. [PMID: 38503149 DOI: 10.1016/j.semarthrit.2024.152434] [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: 10/08/2023] [Revised: 02/08/2024] [Accepted: 03/01/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVES There is little to no data about the presentation and clinical course of anti-melanoma differentiation-associated gene-5 antibody (anti-MDA-5) dermatomyositis in a primarily U.S. Hispanic population. We describe the clinical course of anti-MDA-5 dermatomyositis in our majority Hispanic population. METHODS This is a multicenter, retrospective case series of anti-MDA-5 dermatomyositis. Patients diagnosed with anti-MDA-5 dermatomyositis from June 2015 to March 2023 at four medical centers in Los Angeles, California, were included. Demographics and clinical characteristics were obtained. Descriptive statistics, Pearson's chi-squared, Fisher's exact, Wilcoxon rank sum, and Kruskal-Wallis tests were performed as applicable. RESULTS Thirty anti-MDA-5 dermatomyositis patients were included. Twenty-two (73 %) were Hispanic. Twenty-one patients (70 %) were female, with a median age of 40.5 years. Hispanic patients were diagnosed with anti-MDA-5 dermatomyositis at a younger age than non-Hispanic patients (p = 0.025). Inflammatory arthritis was prominent; more males were affected than females (p = 0.027). Thirteen patients (43 %) were amyopathic. Twenty-five patients (83.3 %) had evidence of interstitial lung disease (ILD), and a higher ferritin level was associated with ILD (p = 0.049). There were six deaths (20 %); five (17 %) were ascribed to rapidly progressive ILD. CONCLUSION ILD was the most common presentation of anti-MDA-5 dermatomyositis in our cohort and was associated with higher ferritin levels. Hispanic patients had a younger age of diagnosis than non-Hispanic patients. Necrotic skin lesions and inflammatory arthritis were frequently seen. This is the first study looking at clinical phenotypes and outcomes of anti-MDA-5 dermatomyositis in a primarily Hispanic U.S. POPULATION Future studies are needed to better understand the clinical manifestations (to promptly recognize and treat) of this population of anti-MDA-5 dermatomyositis.
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Affiliation(s)
- Eaman Alhassan
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Belina Y Yi
- Division of Rheumatology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jack Rodman
- Clinical & Translational Science Institute, University of Southern California, Los Angeles, CA, USA
| | - Michael H Weisman
- Division of Rheumatology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashley Crew
- Department of Dermatology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Leanna Wise
- Division of Rheumatology, Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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Abstract
Cantharidin is the toxic component of blister beetles of the genus Epicauta. Cantharidin is a potent vesicant which causes blisters, erosions, and ulcerations in the gastrointestinal and urinary tracts, and can cause myocardial necrosis. Blister beetles are found over most of North America and specifically contaminate alfalfa at harvest. History of alfalfa feeding, with colic, dysuria, hypocalcemia, and hypomagnesemia are suggestive of blister beetle toxicosis. Myocardial damage causes increased serum cardiac troponin 1. Tentative diagnosis can be made by finding the beetles in feed or ingesta. Definitive diagnosis requires detection of cantharidin in urine or gastric contents. Treatment involves ending exposure, decreasing absorption, controlling pain, using gastroprotectants, and fluids and electrolyte replacement. Prognosis is guarded to poor.
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Affiliation(s)
- Karyn Bischoff
- Department of Population Medicine and Diagnostic Sciences, Cornell University College of Veterinary Medicine, New York State Animal Health Diagnostic Center, PO Box 5786, Ithaca, NY 14853, USA.
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Sandri G, Spinella A, Sartini S, Caselgrandi F, Schiavi M, Bettelli V, Gherardini F, Amati G, Lumetti F, Mascia MT, Secchi O, Giuggioli D. Assessing hand grasp in patients with systemic sclerosis using the 16-grasp test: Preliminary results from a multidisciplinary study group. J Hand Ther 2024:S0894-1130(23)00140-0. [PMID: 38342637 DOI: 10.1016/j.jht.2023.09.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Reports on hand dysfunction and rehabilitation in SSc are quite scarce in the literature and mainly focus on functional assessment tools, such as the Duruoz Hand Index and the HAMIS test for evaluating hand mobility by simulating specific grasps with nine different objects. PURPOSE OF THE STUDY This study aimed to provide an adequate assessment methodology for hand grasp dysfunctions in patients suffering from systemic sclerosis (SSc) through the 16-grasp test. STUDY DESIGN Case-control study. METHODS Ninety-seven consecutive SSc patients were recruited at our Scleroderma Unit, where a 16-grasp test was performed by all patients and supervised by an experienced hand therapist. Sixteen different patterns of grasp have been divided into power grasps and precision pinch and two more modalities: static and dynamic prehension evaluation on scale from 0 to 4. We also compared previous evaluations on 19 of patients recruited. RESULTS The majority of SSc patients (84 females and 13 males; mean age 56.0±12.0 years; mean disease duration 8.0±6.0 years) displayed grasp dysfunctions; in particular 48% and 54% reported slight difficulty in the right and left grasps respectively, 6% medium difficulty in both hands, and only 3% and 1% experienced severe difficulty respectively, while 31.5% had no issues in either hand. Our results showed that the limited cutaneous subset (lcSSc) scored a lower deficit for either grasp compared to diffuse form (dcSSc). No statistically significant differences in total grasp deficit had been noticed when comparing patients having a disease duration < 5 years or longer. In the retrospective study on 19 of these patients, 8 out of 10 lcSSc patients showed no significant changes, while in 2 out of 10, slight improvements were observed in both hands. However, in the dcSSc group, 4 out of 9 worsened bilaterally while the grasp scores for 5 of them remained unchanged. CONCLUSION Our study reported hand involvement in both lcSSc and dcSSc forms, more significantly in dcSSc patients. This test is intended to be a more objective means of assessing grasp alterations linked to scleroderma hand deformities. Furthermore, thanks to its intuitiveness, the test may be useful for engineers designing personalized ergonomic assistive devices.
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Affiliation(s)
- Gilda Sandri
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy.
| | - Amelia Spinella
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Silvana Sartini
- Head of IOR-Argenta Rehabilitation Unit, IRCCS Rizzoli Bologna, Bologna, Italy
| | - Francesco Caselgrandi
- Hand Rehabilitation Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Margherita Schiavi
- Department of Health Professions, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Bettelli
- Rehabilitation Medicine, University Hospital of Modena, Baggiovara, Modena, Italy
| | - Francesco Gherardini
- Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriele Amati
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Federica Lumetti
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy
| | - Maria Terasa Mascia
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ottavio Secchi
- Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Dilia Giuggioli
- Scleroderma Unit, Rheumatology Unit, University Hospital of Modena, Policlinico of Modena, Modena, Italy; Department of Medical and Surgical Sciences of Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Haddadin OM, Jacobson ME, Chen DM, Croitoru DO, Dissemond J, Gontijo JRV, Hampton PJ, Kelly RI, Marzano AV, Tada Y, Gerbens LAA, Ortega-Loayza AG. Minimum data set for treatment effectiveness in pyoderma gangrenosum (MIDSTEP): an international protocol of an e-Delphi study to develop a clinical physician-driven treatment effectiveness registry on behalf of the UPGRADE initiative. Arch Dermatol Res 2023; 315:2913-2919. [PMID: 37755505 DOI: 10.1007/s00403-023-02729-9] [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: 08/02/2023] [Revised: 08/02/2023] [Accepted: 09/06/2023] [Indexed: 09/28/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare inflammatory condition with an immense disease burden that remains understudied. With limited approved treatments and low-quality clinical evidence, PG continues to have poor patient outcomes. Unfortunately, improvement in PG treatments and patient care is based on additional research endeavors that can only be developed from existing high-quality data. The following protocol outlines the development of the Minimum Data Set for Treatment Effectiveness in Pyoderma gangrenosum (MIDSTEP), a core set of domains and domain items for the Pyoderma Gangrenosum Treatment Effectiveness (PyGaTE) international registry. The outcomes and benefits are focused on providing real-world data for physicians to improve their clinical decisions on PG treatment and inform clinical trial design, promoting clinical research among the international scientific community. MIDSTEP is a multi-phase project. The first phase will produce a domain item list from a literature review to take into the second phase which would finalize the core data set by an e-Delphi exercise. There will be a single stakeholder group participating together in the e-Delphi consisting of PG experts (healthcare providers, researchers, methodologists, industry representatives, and regulators), ulcerative PG patients, and PG patient advocates. The methodology outlined in the protocol is a systematic method based on several guidelines through COMET and established dermatologic registries and outcome sets with systematic methodologies of their own. The third phase will identify the instruments for the items, the 'when to measure' the items, and the platform for the registry. The last phase is the implementation and continued maintenance of the international registry PyGaTE. By solidifying a consensus on standardized outcomes and collecting information on PG treatment effectiveness in a centralized database, existing treatments can be compared more systematically and analyzed with increased evidence. MIDSTEP and the PyGaTE international registry will have the ambitious goal to generate and disseminate real-world data that can be used by all stakeholders to improve health outcomes for PG patients. Future potential for the outcome of this project includes the development of a gold-standard PG treatment.
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Affiliation(s)
- Olivia M Haddadin
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Michael E Jacobson
- Department of Dermatology, Center for Health and Healing, Oregon Health and Science University, Portland, OR, USA
| | | | - David O Croitoru
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Joachim Dissemond
- Department of Dermatology, Venerology and Allergology, University of Essen, Essen, Germany
| | - Joao Renato V Gontijo
- Professor of Dermatology, Medical School of Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Philip J Hampton
- Department of Dermatology, The Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Robert I Kelly
- Department of Dermatology, St Vincent's Hospital, Melbourne, Australia
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yayoi Tada
- Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
| | - Louise A A Gerbens
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, Amsterdam, The Netherlands
| | - Alex G Ortega-Loayza
- Department of Dermatology, Center for Health and Healing, Oregon Health and Science University, Portland, OR, USA.
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Viadé J, Nicolás M, Bundó M, Sirvent M, Riera C, Sabriá M. A novel assessment, diagnostic and treatment system for diabetic foot. J Foot Ankle Res 2023; 16:84. [PMID: 38001471 PMCID: PMC10675945 DOI: 10.1186/s13047-023-00687-z] [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: 08/12/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND This report aims to present a novel system for the management of foot lesions in patients with diabetes. It was developed in the diabetic foot unit (DFU) of the Mutua de Terrassa University Hospital (HUMT) by primary care professionals, the Diabetic Foot Clinic (DFC), and during emergency cases treated by our group based on daily activities in patients with neuropathy or neuroischemia. BODY: This system considers five degrees of action based on two fixed variables: presence of infection and lesion depth. These two variables allowed the user to investigate aspects of the system until the overall action required by the pathology is made clear. These variables establish pathology stages of various severities that require different actions in aspects of care, management and treatment. CONCLUSION This tool facilitates diagnosis, treatment, and coordination among different members of a multidisciplinary team working in specialized hospital units, primary care centers, and emergency settings.
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Affiliation(s)
- Jordi Viadé
- Department of Endocrinology & Nutrition, Hospital Germans Trias I Pujol, Autonomous University of Barcelona, Badalona, Spain
| | - Maria Nicolás
- Private Practice Diabetic Foot Clinic, Autonomous University of Barcelona, Sabadell, Barcelona, Spain.
| | - Magdalena Bundó
- Primary Health Care Center Ronda Prim, Gerència d'Àmbit d'Atenció Primària Metropolitana Nord de Barcelona, Institut Català de La Salut, Mataró, Spain
| | - Marc Sirvent
- Department General, University Hospital of Granollers, CIBERCV, ISCIII, Granollers, Spain
| | - Clàudia Riera
- Department of Angiology and Vascular Surgery, University Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Miquel Sabriá
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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Sciascia S, Arbrile M, Trunfio M, Calcagno A, Radin M, Roccatello D, Lembo D, Civra A. The role of bacteria and viruses in Behçet syndrome: Should we move towards new paradigms? Autoimmun Rev 2023; 22:103237. [PMID: 36414220 DOI: 10.1016/j.autrev.2022.103237] [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: 10/22/2022] [Accepted: 11/17/2022] [Indexed: 11/21/2022]
Abstract
The etiological complexity of Behçet syndrome (BS), an immune-mediated rare form of vasculitis characterized by multi-organ involvement, is still elusive due to an incomplete understanding of the synergy between genetic susceptibility, environmental triggers, and an abnormal immune response. Long-standing theories regarding the origins of BS include the involvement of infectious organisms supporting an aberrant immunological response through different mechanisms, including molecular mimicry. Additionally, it has been demonstrated that the BS phenotypes are linked to oral and gut microbiome dysbiosis, which is a dynamic reservoir of millions of microbes containing proteins and metabolites that can mimic the autoantigens. Infections, including viral pathogens, could potentially trigger the inflammation and symptoms of BS. In this review, we aim to describe the available evidence on the cross-talk between BS and infections in order to discuss potential clinical implications and possible therapeutic targets.
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Affiliation(s)
- Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy.
| | - Marta Arbrile
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - Mattia Trunfio
- Unit of Infectious diseases, Department of medical sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Andrea Calcagno
- Unit of Infectious diseases, Department of medical sciences at Amedeo di Savoia Hospital, University of Turin, Turin, Italy
| | - Massimo Radin
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley (North-West Italy), San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences of the University of Turin, Turin, Italy
| | - David Lembo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Andrea Civra
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Levy V, Chaouat M, Mimoun M. [Buried chipped skin grafts for patients in failure of treatment]. ANN CHIR PLAST ESTH 2023; 68:86-91. [PMID: 36123253 DOI: 10.1016/j.anplas.2022.08.001] [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: 05/17/2022] [Accepted: 08/01/2022] [Indexed: 01/18/2023]
Abstract
Local conditions can lead to a failure of traditional skin grafts. We propose here our technique about the realization of autologous skin graft using it buried chipped grafts, for wounds in failure of treatments or at risk of failure. The protocol includes cutting the skin graft within little squared pieces of a few millimeters of length, that are then buried directly deep into the wound. We can then obtain little islands of epidermisation on the random places of the wound that will heal by confluence of those epidermal islands.
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Affiliation(s)
- V Levy
- Hôpital Tenon, Paris, France.
| | | | - M Mimoun
- Hôpital Saint-Louis, Paris, France
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Shaigany S, Wong PW, Caplan A, Kim RH, Femia A. Diagnostic work-up and treatment in patients with pyoderma gangrenosum: retrospective analysis of US insurance claims-based data. Arch Dermatol Res 2023; 315:95-99. [PMID: 34714405 DOI: 10.1007/s00403-021-02278-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/12/2021] [Revised: 08/18/2021] [Accepted: 09/03/2021] [Indexed: 01/07/2023]
Abstract
Pyoderma gangrenosum (PG) is a rare, and often challenging to diagnose, inflammatory disorder with relatively high rates of morbidity and mortality. Central to the diagnosis of PG is histologic evaluation and exclusion of other entities. Large-scale studies investigating the proportion of patients receiving a thorough diagnostic work-up, as well as prevalence studies regarding comorbidities and systemic treatment in PG using claims-based data, are sparse. Our objective was to identify patients diagnosed with PG and describe the diagnostic work-up and prevalence of common comorbidities and therapies in this population using claims-based data in a retrospective cohort study. In order to better understand practices of diagnostic work-up, we captured rates of skin biopsy, tissue culture, and/or surgical debridement prior to initial diagnosis. We also identified the prevalence of PG-associated comorbidities and initial immunosuppressive therapy given for PG. Of the 565 patients diagnosed with PG, 9.4% underwent skin biopsy, 8% tissue culture, and 1.4% both skin biopsy AND tissue culture prior to diagnosis. Inflammatory bowel disease was the most prevalent comorbidity (16.3%). The most common treatment administered was systemic corticosteroids (17%). Although practice guidelines explicitly delineate histology and exclusion of infection as important diagnostic criteria, only a minority of patients in this study underwent skin biopsy and/or tissue culture prior to receiving a diagnosis of PG, suggesting that patients may receive a diagnosis of PG without having tissue evaluation. Such discordance between practice guidelines and "real-world" practice inevitably increases the risk for misdiagnosis of PG and misdirected treatment with immunosuppressants for presumptive PG in cases of PG mimickers. Moreover, comorbidities associated with PG may occur, or be identified in, a lower proportion of patients as compared with what is reported in the existing literature. Study limitations include a population restricted to < 65 years with commercial insurance and the reliance upon ICD diagnostic coding to capture the population.
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Affiliation(s)
- Sheila Shaigany
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Fl, New York, NY, 10016, USA
| | - Priscilla W Wong
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Fl, New York, NY, 10016, USA
- New York City Housing Authority, New York, NY, 10007, USA
| | - Avrom Caplan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Fl, New York, NY, 10016, USA
| | - Randie H Kim
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Fl, New York, NY, 10016, USA
| | - Alisa Femia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th St, 11th Fl, New York, NY, 10016, USA.
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Langford B, Pittelkow TP, Abcejo AS. Atypical dermatologic manifestations in complex regional pain syndrome: a case report. J Med Case Rep 2022; 16:251. [PMID: 35754020 PMCID: PMC9235195 DOI: 10.1186/s13256-022-03466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Complex regional pain syndrome is a chronic pain condition characterized by autonomic dysfunction, changes in sympathetic and vasomotor activity, and sensory and motor changes. Complex regional pain syndrome is a clinical diagnosis and may occur after trauma or surgery. Complex regional pain syndrome-related pain may occur spontaneously and is out of proportion with the inciting event. We report herein the rare case of a man who developed concomitant painful generalized ulcerations after diagnosis of complex regional pain syndrome. CASE PRESENTATION A 43-year-old Caucasian male with history of four-extremity complex regional pain syndrome type 2 secondary to right rotator cuff surgery performed at an outside hospital presented to a tertiary care center for treatment of generalized ulcerations on all extremities of unknown etiology. Dermatology performed an extensive work-up including laboratory evaluations and biopsies, which were relatively unremarkable. His ulcers were treated with vinegar-based dressings, hydrotherapy, and irrigation and debridements. He was started on methadone (replacing a home fentanyl patch), ketamine infusion, and amitriptyline in addition to his home adjuncts. He obtained good symptom control, improved sleep, and diminished cognitive slowing, compared with his fentanyl patches. CONCLUSION This case report emphasizes an atypical case of generalized ulceration formation in the setting of complex regional pain syndrome. This case highlights the challenging nature of treating complex regional pain syndrome and using multimodal analgesia to target various nociceptive receptors to successfully reduce symptoms.
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Affiliation(s)
- Brendan Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Thomas P Pittelkow
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arnoley S Abcejo
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Lazzarini PA, Raspovic A, Prentice J, Commons RJ, Fitridge RA, Charles J, Cheney J, Purcell N, Twigg SM. Guidelines development protocol and findings: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:28. [PMID: 35440052 PMCID: PMC9017044 DOI: 10.1186/s13047-022-00533-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 08/19/2021] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Background Diabetes-related foot disease (DFD) is a leading cause of the Australian disease burden. The 2011 Australian DFD guidelines were outdated. We aimed to develop methodology for systematically adapting suitable international guidelines to the Australian context to become the new Australian evidence-based guidelines for DFD. Methods We followed the Australian National Health Medical Research Council (NHMRC) guidelines for adapting guidelines. We systematically searched for all international DFD guideline records. All identified records were independently screened and assessed for eligibility. Those deemed eligible were further assessed and included if scoring at least moderate quality, suitability and currency using AGREE II and NHMRC instruments. The included international guidelines had all recommendations extracted into six sub-fields: prevention, wound classification, peripheral artery disease, infection, offloading and wound healing. Six national panels, each comprising 6–8 multidisciplinary national experts, screened all recommendations within their sub-field for acceptability and applicability in Australia using an ADAPTE form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a GRADE Evidence to Decision tool. Recommendations were adopted, adapted, or excluded, based on the agreement between the panel’s and international guideline’s judgements. Each panel drafted a guideline that included all their recommendations, rationale, justifications, and implementation considerations. All underwent public consultation, final revision, and approval by national peak bodies. Results We screened 182 identified records, assessed 24 full text records, and after further quality, suitability, and currency assessment, one record was deemed a suitable international guideline, the International Working Group Diabetic Foot Guidelines (IWGDF guidelines). The six panels collectively assessed 100 IWGDF recommendations, with 71 being adopted, 27 adapted, and two excluded for the Australian context. We received 47 public consultation responses with > 80% (strongly) agreeing that the guidelines should be approved, and ten national peak bodies endorsed the final six guidelines. The six guidelines and this protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ Conclusion New Australian evidence-based guidelines for DFD have been developed for the first time in a decade by adapting suitable international guidelines. The methodology developed for adaptation may be useful for other foot-related conditions. These new guidelines will now serve as the national multidisciplinary best practice standards of DFD care in Australia. Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00533-8.
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Affiliation(s)
- Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia. .,Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia.
| | - Anita Raspovic
- School of Allied Health, Human Services and Sport College of Science, Health & Engineering, La Trobe University, Bundoora, Australia
| | - Jenny Prentice
- Hall and Prior Health and Aged Care Group, Perth, Australia
| | - Robert J Commons
- Internal Medicine Services, Ballarat Health Services, Ballarat, Victoria, Australia.,Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Robert A Fitridge
- Vascular and Endovascular Service, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - James Charles
- First Peoples Health Unit, Faculty of Health, Griffith University, Gold Coast, Australia
| | | | - Nytasha Purcell
- Diabetes Feet Australia, Brisbane, Australia.,Australian Diabetes Society, Sydney, Australia
| | - Stephen M Twigg
- Sydney Medical School (Central), Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Australia
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12
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Baldassarro VA, Lorenzini L, Giuliani A, Cescatti M, Alastra G, Pannella M, Imbimbo BP, Villetti G, Calzà L, Giardino L. Molecular mechanisms of skin wound healing in non-diabetic and diabetic mice in excision and pressure experimental wounds. Cell Tissue Res 2022. [PMID: 35386010 DOI: 10.1007/s00441-022-03624-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/25/2022] [Indexed: 12/15/2022]
Abstract
Experimental models for chronic skin lesions are excision and pressure ulcer, defined as “open” and “closed” lesions, respectively, only the latter characterized by tissue hypoxia. Moreover, systemic diseases, such as diabetes mellitus, affect wound repair. Thus, models for testing new therapies should be carefully selected according to the expected targets. In this study, we present an extensive and comparative histological, immunohistochemical, and molecular characterization of these two lesions in diabetic (db/db) and non-diabetic (C57BL/6 J) mice. In db/db mice, we found significant reduction in PGP9.5-IR innervation, reduction of capillary network, and reduced expression of NGF receptors. We found an increase in VEGF receptor Kdr expression, and the PI3K-Akt signaling pathway at the core of the altered molecular network. Db/db mice with pressure ulcers showed an impairment in the molecular regulation of hypoxia-related genes (Hif1a, Flt1, and Kdr), while extracellular matrix encoding genes (Itgb3, Timp1, Fn1, Col4a1) were upregulated by hyperglycemia and lesions. Overall, the molecular analysis suggests that db/db mice have a longer inflammatory phase of the wound repair process, delaying the progression toward the proliferation and remodeling phases.
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13
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Afonso J, Saraiva MM, Ferreira JPS, Cardoso H, Ribeiro T, Andrade P, Parente M, Jorge RN, Macedo G. Automated detection of ulcers and erosions in capsule endoscopy images using a convolutional neural network. Med Biol Eng Comput 2022. [PMID: 35038118 DOI: 10.1007/s11517-021-02486-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/14/2021] [Indexed: 02/07/2023]
Abstract
Capsule endoscopy (CE) is an important tool in the management of patients with known or suspected inflammatory bowel disease. Ulcers and erosions of the enteric mucosa are prevalent findings in these patients. They frequently occur together, and their identification in CE is crucial for an accurate evaluation of disease severity. Nevertheless, reviewing CE images is a time-consuming task, and the risk of overlooking lesions is significant.Over the last decade, artificial intelligence (AI) has emerged as a means for overcoming these pitfalls. Of all AI methods, convolutional neural networks (CNN), due to their complex multilayer architecture present the best results in medical image analysis, particularly capsule endoscopy. Therefore, we aimed to develop a CNN for the automatic identification of ulcers and erosions in the small bowel mucosa. A total of 1483 CE exams (PillCam SB3®) performed at a single center between 2015 and 2020 were analysed. From these exams, a total of 6130 frames of the enteric mucosa were obtained, 4233 containing enteric ulcers and erosions, and the remaining containing normal mucosa or other findings. Ulcers and erosions were stratified according to Saurin's classification for bleeding potential: P1E-erosions with intermediate bleeding risk; P1U-ulcers with intermediate bleeding risk; P2U-ulcers with high bleeding risk. For automatic identification of these lesions, these images were inserted into a CNN model with transfer learning. The pool of images was divided for constitution of training and validation datasets, comprising 80% and 20% of the total number of images, respectively. The output provided by the CNN was compared to the classification provided by a consensus of specialists. After optimizing the neural architecture of the algorithm, our model was able to automatically detect and distinguish ulcers and erosions (any bleeding potential) in the small intestine mucosa with an accuracy of 95.6%, sensitivity of 90.8%, and a specificity of 97.1%. We believe that our study lays the foundation for the development and application of effective AI tools to CE. These techniques should improve diagnostic accuracy and reading efficiency. Schematic representation of the workflow and summary of the results.
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14
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Bekeschus S, von Woedtke T, Emmert S, Schmidt A. Medical gas plasma-stimulated wound healing: Evidence and mechanisms. Redox Biol 2021; 46:102116. [PMID: 34474394 PMCID: PMC8408623 DOI: 10.1016/j.redox.2021.102116] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Defective wound healing poses a significant burden on patients and healthcare systems. In recent years, a novel reactive oxygen and nitrogen species (ROS/RNS) based therapy has received considerable attention among dermatologists for targeting chronic wounds. The multifaceted ROS/RNS are generated using gas plasma technology, a partially ionized gas operated at body temperature. This review integrates preclinical and clinical evidence into a set of working hypotheses mainly based on redox processes aiding in elucidating the mechanisms of action and optimizing gas plasmas for therapeutic purposes. These hypotheses include increased wound tissue oxygenation and vascularization, amplified apoptosis of senescent cells, redox signaling, and augmented microbial inactivation. Instead of a dominant role of a single effector, it is proposed that all mechanisms act in concert in gas plasma-stimulated healing, rationalizing the use of this technology in therapy-resistant wounds. Finally, addressable current challenges and future concepts are outlined, which may further promote the clinical utilization, efficacy, and safety of gas plasma technology in wound care in the future.
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Affiliation(s)
- Sander Bekeschus
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany.
| | - Thomas von Woedtke
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany; Institute for Hygiene and Environmental Medicine, Greifswald University Medical Center, Sauerbruchstr., 17475, Greifswald, Germany
| | - Steffen Emmert
- Clinic for Dermatology and Venereology, Rostock University Medical Center, Strempelstr. 13, 18057, Rostock, Germany
| | - Anke Schmidt
- ZIK Plasmatis, Leibniz Institute for Plasma Science and Technology (INP), A Member of the Leibniz Research Alliance Leibniz Health Technology, Felix-Hausdorff-Str. 2, 17489, Greifswald, Germany
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15
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Felice F, Mancini S, Di Stefano R. The importance of Mediterranean diet and hydration habitus in patients with lower limb ulcers: A pilot study. J Vasc Nurs 2021; 39:76-83. [PMID: 34507704 DOI: 10.1016/j.jvn.2021.06.003] [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: 01/24/2020] [Revised: 05/27/2021] [Accepted: 06/20/2021] [Indexed: 11/15/2022]
Abstract
Chronic leg ulcers are a common condition among adults, causing pain and social distress. Population aging has contributed to the amplification of the disease with increased cardiovascular diseases such as myocardial infarction, stroke, limb ischemia, cancers, chronic respiratory diseases, and diabetes. The aim of this study was to evaluate the influence of the Mediterranean Diet (MD) and hydration on the healing rate of the ulcers. A group of 35 patients (M/F 16/19, mean age 78 ± 10 years) with venous, arterial, or mixed ulcers was subjected to a Food Frequency Questionnaire (FFQ) and a Hydration Habits Questionnaire (HHQ). Clinical and anthropometric data were collected. A one-year follow-up was conducted. Complete ulcer healing was observed in 26% of the patients, of whom 67% had a habit of high hydration (more than 1 liter /day), regardless of adherence to the MD. In our study population, about half showed a low adherence to the MD. A moderate-high adherence to the MD showed an increase of arterial ulcer healing compared to subjects with a low adherence to the MD, however, only when associated to a consumption of more than 1 liter of water daily. In conclusion, dietary assessments could help identify patients who are likely to benefit from nutritional interventions for improving overall health and wound healing. The habit of high hydration, namely more than 1 liter daily, can influence the wound healing rate.
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Affiliation(s)
- Francesca Felice
- Cardiovascular Research Laboratory, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56100 Pisa, Italy
| | - Sandra Mancini
- Cardioangiology Unit, Pisa University Hospital, 56100 Pisa, Italy
| | - Rossella Di Stefano
- Cardiovascular Research Laboratory, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56100 Pisa, Italy; SD Sport Medicine Department of Clinical and Experimental Medicine, University of Pisa 56100, Pisa, Italy; Interdepartmental Research Center "Nutraceuticals and Food for Health", University of Pisa, 56100 Pisa, Italy.
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16
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Lauer H, Goertz O, Landscheidt K, Hernekamp JF. [The proximally pedicled anterolateral thigh flap for reconstruction of complex soft tissue wounds of the hip and caudal trunk region]. Chirurg 2021; 93:388-394. [PMID: 34432070 DOI: 10.1007/s00104-021-01483-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Accepted: 07/15/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Groin and lower trunk defects are common problems, especially for elderly patients. While groin defects are often due to prior vascular interventions, trochanteric defects are mainly caused by pressure sores. Plastic reconstructive methods are manifold; however, the pedicled anterolateral thigh (ALT) flap is supposed to be reliable with sustainable results. OBJECTIVE We present our experiences using the pedicled ALT flap for soft tissue reconstruction in patients with large wounds of the medial and lateral proximal thigh. MATERIALS AND METHODS A total of 16 patients with groin and lower trunk defects due to prior vascular surgery or pressure sores received locoregional soft tissue reconstruction using a proximal pedicled ALT flap. Patient characteristics, defect size, surgery time, clinical outcome and complication rate were assessed. RESULTS With the exception of two cases, sufficient soft tissue reconstruction was achieved. In all, 81,3% of patients were categorized as ASA (American Society of Anesthesiologists) 3. The average duration of surgery was 149 min. Length of stay was 18,3 days. A total of 31% needed revision surgery due to limited wound healing problems. Two patients died. All patients showed healed wound conditions when they were discharged. CONCLUSION The proximal pedicled ALT-flap is a reliable method for soft tissue reconstruction in groin and lower trunk defects. This reconstructive procedure enables reliable wound closure, especially in elderly patients with substantially reduced general health condition.
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Affiliation(s)
| | | | | | - J F Hernekamp
- Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Martin-Luther-Krankenhaus Berlin, Caspar-Theyß-Straße 27, 14193, Berlin, Deutschland.
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17
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Abstract
A variety of acute oral lesions may be encountered in the scope of dermatology. Oral lesions may be single or multiple; may arise secondary to infectious, immune, congenital, medication use, or idiopathic causes; and may take a variety of forms. A thorough evaluation of the oral cavity is required to assess patients with oral lesions. Affected patients may be monitored, treated, or referred to an appropriate specialist for further management as needed. Many acute oral lesions are self-limiting in nature and patients may require only assessment and reassurance. Several common acute oral lesions are discussed in this article.
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Affiliation(s)
- Katherine France
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Alessandro Villa
- Department of Orofacial Sciences, University of California San Francisco, 513 Parnassus Avenue, Suite 512A, San Francisco, CA 94143, USA
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18
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Laurent A, Scaletta C, Michetti M, Hirt-Burri N, Flahaut M, Raffoul W, de Buys Roessingh AS, Applegate LA. Progenitor Biological Bandages: An Authentic Swiss Tool for Safe Therapeutic Management of Burns, Ulcers, and Donor Site Grafts. Methods Mol Biol 2021; 2286:49-65. [PMID: 32572700 DOI: 10.1007/7651_2020_296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Clinical experience gathered over two decades around therapeutic use of primary human dermal progenitor fibroblasts in burn patient populations has been at the forefront of regenerative medicine in Switzerland. Relative technical simplicity, ease of extensive serial multitiered banking, and high stability are major advantages of such cell types, assorted to ease of safety and traceability demonstration. Stringent optimization of cell source selection and standardization of biobanking protocols enables the safe and efficient harnessing of the considerable allogenic therapeutic potential yielded by primary progenitor cells. Swiss legal and regulatory requirements have led to the procurement of fetal tissues within a devised Fetal Progenitor Cell Transplantation Program in the Lausanne University Hospital. Proprietary nonenzymatic isolation of primary musculoskeletal cell types and subsequent establishment of progeny tiered cell banks under cGMP standards have enabled safe and effective management of acute and chronic cutaneous affections in various patient populations. Direct off-the-freezer seeding of viable dermal progenitor fibroblasts on a CE marked equine collagen scaffold is the current standard for delivery of the therapeutic biological materials to patients suffering from extensive and deep burns. Diversification in the clinical indications and delivery methods for these progenitor cells has produced excellent results for treatment of persistent ulcers, autograft donor site wounds, or chronic cutaneous affections such as eczema. Herein we describe the standard operating procedures for preparation and therapeutic deployment of the progenitor biological bandages within our translational musculoskeletal regenerative medicine program, as they are routinely used as adjuvants in our Burn Center to treat critically ailing patients.
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19
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Frykberg RG, Attinger C, Smeets L, Koller A, Bal A, Kavarthapu V. Surgical strategies for prevention of amputation of the diabetic foot. J Clin Orthop Trauma 2021; 17:99-105. [PMID: 33738238 PMCID: PMC7944028 DOI: 10.1016/j.jcot.2021.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022] Open
Abstract
Prevention of amputation has become a key objective of clinicians providing care to patients with high-risk diabetic foot problems. In this regard, the multidisciplinary diabetic foot team (MDFT) has been embraced as the most effective way to manage patients with foot ulcers, infections, and Charcot feet. Importantly, such specialized teams have also integrated various surgical specialties to enable more expedient management of these often complex conditions. Experienced diabetic foot surgeons over the last three or four decades have contributed much to this discipline, whereby foot-sparing reconstructive procedures or minor amputations have become fundamental strategies for limb preservation teams. Central to limb salvage, of course, is the recognition of underlying vascular insufficiency and the importance of prompt (endo)vascular intervention. Restoration of adequate perfusion is essential to allow the podiatric, orthopaedic, or plastic surgeon to perform indicated functional reconstructive or minor amputation procedures. This evidence-based overview discusses the various indications and surgical principles inherent in modern concepts aimed at preventing amputation in the high-risk diabetic foot.
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Affiliation(s)
| | - Christopher Attinger
- Departments of Plastic and Orthopedic Surgery, Medstar Georgetown University Hospital, USA
| | | | - Armin Koller
- Department of Technical Orthopaedics, Dr. Guth Hospital, Hamburg, Germany
| | - Arun Bal
- Fortis Raheja Hospital, Mumbai, India
| | - Venu Kavarthapu
- King’s College Hospital, London, UK
- University of Southern Denmark, Denmark
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20
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Shrestha D, Napit IB, Ansari S, Choudhury SM, Dhungana B, Gill P, Griffiths F, Gwyther H, Hagge D, Kandel S, Puri S, Sartori J, Watson SI, Lilford R. Evaluation of a self-help intervention to promote the health and wellbeing of marginalised people including those living with leprosy in Nepal: a prospective, observational, cluster-based, cohort study with controls. BMC Public Health 2021; 21:873. [PMID: 33957899 PMCID: PMC8101219 DOI: 10.1186/s12889-021-10847-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People affected by leprosy are at increased risk of ulcers from peripheral nerve damage. This in turn can lead to visible impairments, stigmatisation and economic marginalisation. Health care providers suggest that patients should be empowered to self-manage their condition to improve outcomes and reduce reliance on services. Self-care involves carrying out personal care tasks with the aim of preventing disabilities or preventing further deterioration. Self-help, on the other hand, addresses the wider psychological, social and economic implications of leprosy and incorporates, for example, skills training and microfinance schemes. The aim of this study, known as SHERPA (Self-Help Evaluation for lepRosy and other conditions in NePAl) is to evaluate a service intervention called Integrated Mobilization of People for Active Community Transformation (IMPACT) designed to encourage both self-care and self-help in marginalised people including those affected by leprosy. METHODS A mixed-method evaluation study in Province 5, Nepal comprising two parts. First, a prospective, cluster-based, non-randomised controlled study to evaluate the effectiveness of self-help groups on ulcer metrics (people affected by leprosy only) and on four generic outcome measures (all participants) - generic health status, wellbeing, social integration and household economic performance. Second, a qualitative study to examine the implementation and fidelity of the intervention. IMPACT This research will provide information on the effectiveness of combined self-help and self-care groups, on quality of life, social integration and economic wellbeing for people living with leprosy, disability or who are socially and economically marginalised in low- and middle- income countries.
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Affiliation(s)
- Dilip Shrestha
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Indra B. Napit
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Subi Ansari
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Sopna Mannan Choudhury
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Bishnu Dhungana
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Paramjit Gill
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Frances Griffiths
- grid.7372.10000 0000 8809 1613Warwick Centre for Applied Health Research & Delivery (W-CAHRD), Warwick Medical School, University of Warwick, Warwick, UK
| | - Holly Gwyther
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Deanna Hagge
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Shovakhar Kandel
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Suraj Puri
- grid.413718.8Anandaban Hospital, The Leprosy Mission Nepal, Tika Bhairav, Lele-9, Lalitpur, P. O. Box 151, Kathmandu, Nepal
| | - Jo Sartori
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Samuel Ian Watson
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Richard Lilford
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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21
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Akbarzadeh S, McKenzie MB, Rahman MM, Cleland H. Allogeneic Platelet-Rich Plasma: Is It Safe and Effective for Wound Repair? Eur Surg Res 2021; 62:1-9. [PMID: 33621973 DOI: 10.1159/000514223] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 08/17/2020] [Accepted: 01/04/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) and its derivatives are an emerging biotechnology whereby concentrated platelets provide damaged tissue with growth factors, cytokines, and other mediators to improve healing outcomes. Although there is strong evidence in the benefits of autologous PRP for both acute and chronic wounds, allogeneic PRP has been studied far less in comparison. SUMMARY In this mini-review, we discuss critical steps of allogenic PRP (and its derivatives) preparation. We performed a non-systematic review of the literature to identify animal and human subject studies testing allogenic PRP for wound treatment. We searched OVID Medline and PubMed for articles using the keywords "wound, ulcer, lesion, skin, and cutaneous" and "PRP, or platelet-rich plasma, or platelet-rich fibrin, or PRF, or platelet releasate" and "homologous, allogeneic or allogenic," which were limited to non-review articles and English language. Two studies in animal models and 8 studies in patients were reviewed. There were inconsistencies in preparation methods, treatment regimens, and some lacked a control group in their studies. Despite these variations, none of the studies identified any major side effects or adverse events. The treatment resulted in a reduced time to heal and/or reduced wound size in most cases. Key Messages: In situations where autologous PRP is not available or suitable, allogeneic PRP appears to provide a safe alternative. Its efficacy, however, requires larger-scale studies with appropriate controls. Standardization in PRP preparation and treatment regime are also needed to be able to interpret allogenic PRP efficacy.
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Affiliation(s)
- Shiva Akbarzadeh
- Victorian Adult Burns Service, Alfred Health, Melbourne, Victoria, Australia, .,Department of Surgery, Monash University, Melbourne, Victoria, Australia,
| | - Maxwell B McKenzie
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Md Mostafizur Rahman
- Victorian Adult Burns Service, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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22
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Afifi ANAM, Powerski M, Jechorek D, Brunner TB, Weigt J, Venerito M. Radiation-induced damage in the upper gastrointestinal tract: clinical presentation, diagnostic tests and treatment options. Best Pract Res Clin Gastroenterol 2020; 48-49:101711. [PMID: 33317797 DOI: 10.1016/j.bpg.2020.101711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 01/31/2023]
Abstract
Radiation-induced damage of the upper gastrointestinal (GI) tract results from radiation of GI tumors or structures adjacent to the GI tract. Radiation-induced damages of the upper GI tract may be acute or delayed, and ranges from lack of appetite, mucosal inflammation (i.e. esophagitis, gastritis, duodenitis) to ulcers, which may be complicated by perforation, penetration, bleeding and stenosis. Radiation-related factors as well as individual patient predisposing factors may increase susceptibility to post-radiation damage. High quality evidence for the treatment of radiation-induced GI damage is scarce and the management is often extrapolated from studies on GI lesions of different etiology. Treatment depends on severity and localization of the radiation-induced damage, and ranges from supportive and dietary measures to endoscopic interventions or surgery. Modern radiation techniques may decrease the incidence and severity of the radiation-induced upper gastrointestinal disease.
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Affiliation(s)
- Ahmed N A M Afifi
- Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Germany
| | - Maciej Powerski
- Universitätsklinik für Radiologie und Nuklearmedizin, Germany
| | | | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Otto-von-Guericke Universitätsklinikum Magdeburg, Germany
| | - Jochen Weigt
- Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Germany
| | - Marino Venerito
- Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Germany.
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Abu-Qamar MZ, Kemp V, Whitehead L. Foot ulcers associated with external trauma among people with diabetes: An integrative review of the origin of trauma and outcomes. Int J Nurs Stud 2020; 114:103822. [PMID: 33248292 DOI: 10.1016/j.ijnurstu.2020.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/07/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Foot ulcers are common among people with diabetes. These ulcers are caused by a number of factors including trauma. To date, research findings on the origin of external trauma and the outcome of foot ulcers resulting from an external trauma have not been summarised. OBJECTIVE To examine the origin of external trauma that contribute to the development of foot ulcers among people with diabetes and the outcome of such ulcers. DESIGN An integrative review. SETTINGS Hospital/community. PARTICIPANTS Patients with diabetes and foot ulcer. METHOD The Joanna Briggs framework was used to underpin this integrative review. Six different databases (CINAHL +, Medline, SCOPUS, Embase, ProQuest and Web of Science databases) were searched systematically to find research publications reporting traumas that contributed to foot ulcers sustained by people with diabetes. The search was limited to articles published in English. The search revealed 3193 articles that were filtered to 78 articles to be assessed at the full-text level and 45 articles were subsequently included. Quality appraisal was conducted independently by two reviewers, using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were extracted into a form developed for the purpose of this review. Narrative synthesis was used to manage the extracted verbatim details on the origin of external trauma contributing to foot ulcers and the outcomes. RESULTS The origins of external trauma were summarised into two domains and further specified into 16 categories. The identified traumas were mainly minor and originated within the home environment. The most commonly reported origins of external trauma were puncture wounds, ill-fitting shoes and self-care practices that caused foot ulcers. Twenty-seven studies reported outcomes following the development of an ulcer. Twenty-two studies reported amputation as an outcome and mortality was reported in 10 studies. It was not clear whether these outcomes were directly related to the foot ulcer or related to other diabetes-related complications. CONCLUSIONS The majority of ulcers occurred in the home environment and were preventable in nature. The assessment of an individual's local context, particularly the home and actions to reduce risk is a priority. The extent of the risks related to external trauma need to be more widely communicated through clinical guidelines and training opportunities for frontline staff. TWEETABLE ABSTRACT The main origins of external foot trauma among people with diabetes were puncture wounds, ill-fitting footwear and self-care practices.
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Affiliation(s)
- Ma'en Zaid Abu-Qamar
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; Department of Adult Health Nursing, Faculty of Nursing, Mu´tah University, Mu´tah, Jordan.
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
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Thompson DK, Sharkady SM. Expanding spectrum of opportunistic Cedecea infections: Current clinical status and multidrug resistance. Int J Infect Dis 2020; 100:461-9. [PMID: 32950733 DOI: 10.1016/j.ijid.2020.09.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 12/16/2022] Open
Abstract
Members of the bacterial genus Cedecea cause acute infections worldwide in compromised hosts with serious underlying medical conditions. While global reports of Cedecea infections remain sporadic in the medical literature, cases of multidrug-resistant clinical isolates have been documented each year over the past decade, warranting a comprehensive update on this emerging opportunistic pathogen. Here, we review the clinical manifestations, pathogenesis, natural distribution, epidemiology, and antimicrobial resistance of Cedecea species. Acute infection commonly manifests as bacteremia and pneumonia; however, the spectrum of infectious pathologies associated with Cedecea has expanded to include oral and cutaneous ulcers, orbital cellulitis, and peritonitis. The frequency of resistance among reported clinical isolates was highest to ampicillin, cephalothin, cefoxitin, cefazolin, and ceftazidime. Cedecea isolates harboring metallo-β-lactamases exhibited resistance to carbapenems and fourth-generation cephalosporins. Further research is needed to understand the pathogenicity and multidrug resistance of Cedecea species. Appropriate therapeutic management of Cedecea infections depends on antibiotic susceptibility testing because of variable resistance patterns and the enhanced infection risk in vulnerable populations.
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Riad A, Kassem I, Hockova B, Badrah M, Klugar M. Tongue ulcers associated with SARS-CoV-2 infection: A case series. Oral Dis 2020; 28 Suppl 1:988-990. [PMID: 32889763 DOI: 10.1111/odi.13635] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Abanoub Riad
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Center of Excellence, Masaryk University GRADE Center), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Public Health , Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Islam Kassem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Barbora Hockova
- Department of Maxillofacial Surgery, F. D, Roosevelt University Hospital, Banska Bystrica, Slovak Republic
| | - Mai Badrah
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Center of Excellence, Masaryk University GRADE Center), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Kaur J, Singanamalla B, Suresh RG, Saini AG. Insensitivity to Pain, Self-mutilation, and Neuropathy Associated With PRDM12. Pediatr Neurol 2020; 110:95-96. [PMID: 32409124 DOI: 10.1016/j.pediatrneurol.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/26/2019] [Revised: 03/01/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jasmine Kaur
- Senior Resident, Employee's State Insurance- Postgraduate Institute of Medical Science and Research, Basaidarpur, New Delhi, India
| | - Bhanudeep Singanamalla
- Senior Resident, Pediatric Neurology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ramprabhu Gopalan Suresh
- Junior Resident, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Arushi Gahlot Saini
- Assistant Professor, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India.
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Affiliation(s)
- Jolan Dupont
- Department of Gastroenterology, AZ Sint-Blasius, Dendermonde, Belgium; Gerontology & Geriatrics, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | | | - Erwin Colpaert
- Department of Gastroenterology, AZ Sint-Blasius, Dendermonde, Belgium
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Chapelle N, Mosnier JF, Coron E. Bleeding Ulcers of the Right Colon. Gastroenterology 2020; 159:449-450. [PMID: 32205171 DOI: 10.1053/j.gastro.2020.03.033] [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: 02/18/2020] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Nicolas Chapelle
- Institut des Maladies de l'Appareil Digestif, Service de Gastroenterologie, Oncologie digestive et Assistance Nutritionnelle, CHU de Nantes, Nantes; INSERM UMR 1235 The Enteric Nervous System in Gut and Brain Disorders, Faculté de Médecine, Nantes; Université de Nantes, Nantes.
| | - Jean-François Mosnier
- Université de Nantes, Nantes; Service d'Anatomo-cytopathologie, CHU de Nantes, Nantes
| | - Emmanuel Coron
- Institut des Maladies de l'Appareil Digestif, Service de Gastroenterologie, Oncologie digestive et Assistance Nutritionnelle, CHU de Nantes, Nantes; INSERM UMR 1235 The Enteric Nervous System in Gut and Brain Disorders, Faculté de Médecine, Nantes; Université de Nantes, Nantes
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García-Gómez-Heras S, Garcia A, Zubiaga L, Artuñedo P, Ferrigni C, Duran M, Ruiz-Tovar J. Prevalence of Endoscopic Findings Before Bariatric Surgery and Their Influence on the Selection of the Surgical Technique. Obes Surg. 2020;30:4375-4380. [PMID: 32588172 DOI: 10.1007/s11695-020-04800-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most popular procedures performed. The decision of which technique is most appropriate depends on the surgeon's preferences and experience. However, several factors strongly influence the decision of the procedure performed, including gastrointestinal disorders or asymptomatic upper gastrointestinal endoscopy (UGE) findings. This study aimed to describe the pathological endoscopic findings in morbidly obese patients undergoing preoperative routine UGE. MATERIALS AND METHODS A retrospective review of a prospectively collected database of all UGEs performed before bariatric surgery was performed. UGE was routinely performed to all the patients as part of the preoperative evaluation protocol. RESULTS A total of 790 patients were included. Surgical technique included 610 (77.2%) RYGB and 180 (22.8%) SG. Twenty-one asymptomatic patients presented esophagitis at UGE. In only seven patients (0.89%), the endoscopic findings of esophagitis had changed the initial surgical decision. The presence of ulcers or adenomatous or incompletely resected polyps was an indication for SG, to assure future endoscopic access in case it is needed. In 25 patients (3.17%), the initial operation would have been changed based on UGE findings. CONCLUSION Preoperative UGE allows the diagnosis of asymptomatic esophagitis related to gastroesophageal reflux disease and the identification of asymptomatic polyps and ulcers, with the potential ability for malignant transformation. In up to 3.17% of the cases, the endoscopic findings changed the operative strategy. As the complication rate associated with the procedure is low, we recommend the routine performance of preoperative UGE before bariatric surgery.
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Deol ZK, Lakhanpal S, Franzon G, Pappas PJ. Effect of obesity on chronic venous insufficiency treatment outcomes. J Vasc Surg Venous Lymphat Disord 2020; 8:617-628.e1. [PMID: 32335333 DOI: 10.1016/j.jvsv.2020.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 02/01/2020] [Accepted: 04/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obesity is a known risk factor for the development and progression of chronic venous disorders (CVDs). It is currently unknown whether the treatment outcomes, after an intervention for CVDs, are affected by obesity. The purpose of the present investigation was to assess the effectiveness of various CVD treatments in obese patients and determine what level of obesity is associated with poor outcomes. METHODS Data were prospectively collected in the Center for Vein Restoration electronic medical record system (NexGen Healthcare Information System, Irvine, Calif) and retrospectively analyzed. The patients and limbs were categorized by the following body mass index (BMI) categories: <25, 26 to 30, 31 to 35, 36 to 40, 41 to 45, and >46 kg/m2. The changes in the revised venous clinical severity score and Chronic Venous Insufficiency Quality of Life Questionnaire 20-item (CIVIQ-20) quality of life survey were used to determine the CVD treatment effectiveness for patients who had undergone endovenous thermal ablation (TA), phlebectomy, or ultrasound-guided foam sclerotherapy (USGFS). RESULTS From January 2015 to December 2017, 65,329 patients (77% female; 23% male) had undergone a venous procedure. Of these patients, 25,592 (39,919 limbs) had undergone ablation alone, ablation with phlebectomy, or ablation with phlebectomy and USGFS. The number of procedures performed was as follows: TA, n = 37,781; USGFS, n = 22,964; and phlebectomy, n = 17,467. The degree of improvement at 6 months after the procedure was progressively less with an increasing BMI for the patients who had undergone TA, and the decrease was more significant for those patients with a BMI >35 kg/m2 (P ≤ .001). The outcomes improved ∼12% with the addition of phlebectomy to TA. The patients who had undergone a combination of TA, phlebectomy, and USGFS demonstrated no additional improvement. Significantly inferior outcomes were noted in patients with a BMI ≥35 kg/m2, with the poorest outcomes observed in patients with a BMI ≥46 kg/m2 (P ≤ .001). The average number of TAs per patient increased with an increasing BMI and was significantly different compared with the number for those with a BMI <30 kg/m2 (P ≤ .001). All pre- and post-CIVIQ-20 quality of life scores, within a BMI category, at 6 months were significantly different (P ≤ .01). No differences in the degree of improvement were observed in patients with a BMI ≥31 kg/m2. Finally, multivariate logistic regression analysis indicated that when controlling for BMI, diabetes, a history of cancer, female gender, and black and Hispanic race were independently associated with poorer outcomes. CONCLUSIONS Progressive increases in BMI negatively affected CVD-related treatment outcomes as measured using the revised venous clinical severity score and CIVIQ-20. The outcomes progressively worsened with a BMI >35 kg/m2 for patients undergoing CVD treatment. The treatment outcomes for patients with a BMI ≥46 kg/m2 were so poor that weight loss management should be considered before offering CVD treatment.
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Affiliation(s)
- Zoe K Deol
- Center for Vein Restoration, Greenbelt, Md.
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Abstract
Hansen disease remains a common problem worldwide with 750,000 new cases diagnosed each year. Nerve injury is a central feature of the pathogenesis because of the unique tendency of Mycobacterium leprae to invade Schwann cells and the peripheral nervous system, that can be permanent and develop into disabilities. The orthopedic surgeon has an important role in the management of neuropathy, performing surgical release of the tibial and common peroneal nerves in potentially constricting areas, thus providing a better environment for nerve function. In cases of permanent loss of nerve function with drop foot, specific tendon transfers can be used.
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Affiliation(s)
- Jose Carlos Cohen
- Foot and Ankle Service, Federal University Hospital of Rio de Janeiro (UFRJ/HUCFF), Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro - RJ CEP 21941-913, Brazil.
| | - Silvana Teixeira de Miranda
- Federal University Hospital of Rio de Janeiro (UFRJ/HUCFF), Rua Rodolpho Paulo Rocco, 255, Cidade Universitária, Ilha do Fundão, Rio de Janeiro - RJ CEP 21941-913, Brazil
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Mecoli CA, Perin J, Van Eyk JE, Zhu J, Fu Q, Allmon AG, Rao Y, Zeger S, Wigley FM, Hummers LK, Shah AA. Vascular biomarkers and digital ulcerations in systemic sclerosis: results from a randomized controlled trial of oral treprostinil (DISTOL-1). Clin Rheumatol 2020; 39:1199-1205. [PMID: 31858338 PMCID: PMC8211019 DOI: 10.1007/s10067-019-04863-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Although there is abundant evidence of vascular perturbation from studies of peripheral blood in systemic sclerosis (SSc), there are few data about the ability to use biomarkers of vascular injury and growth factors to predict vascular outcomes and response to therapy. We sought to explore the association between candidate vascular biomarkers and digital ulcerations (DU) in a clinical trial context. METHODS We examined 19 circulating vascular, angiogenic, and inflammatory biomarkers in 124 patients with scleroderma and DU who participated in a randomized controlled trial of oral treprostinil diolamine (ClinicalTrials.gov identifier NCT00775463). Correlation, regression, and random forest analyses were conducted to assess biomarker relationships in response to drug treatment. RESULTS Over the 20-week trial, 82 (66%) patients had their cardinal ulcer completely heal, 54 (44%) developed new ulcers, and 72 (58%) had complete healing of all ulcers; mean change in ulcer burden comparing week 20 with baseline was - 0.36 ± 1.70. Nineteen biomarkers were analyzed for their association and ability to predict clinical DU outcomes. After adjusting for multiple comparisons, no individual biomarker (baseline level, week 20 level, or change over time) was significantly associated with any of the clinical outcomes, suggesting that traditional vascular, angiogenic or inflammatory drivers are not predictive of ulcer fate. CONCLUSIONS The lack of strong response to any of the vascular, angiogenic, or inflammatory markers suggest that these pathways are not primary drivers in the development of DU clinical outcomes in a SSc population with prevalent DU. KEY POINTS • Currently we lack robust biomarkers to predict vascular outcomes or response to therapy in scleroderma patients with Raynaud's phenomenon.• Longitudinal assessment of vascular biomarkers in a clinical trial setting provides a unique opportunity to define biomarkers that predict vascular outcomes.• In a randomized controlled trial of oral treprostinil diolamine for treatment of scleroderma-associated digital ulcers, biomarkers involved in several vascular, inflammatory, and angiogenic pathways did not predict short-term clinical response to therapy or digital ulcer outcomes.• Further study of these and other biomarkers should be considered in Raynaud's clinical trials in scleroderma patients without prevalent digital ulcers.
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Affiliation(s)
- Christopher A Mecoli
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Jamie Perin
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Jennifer E Van Eyk
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Jie Zhu
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Qin Fu
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
- Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Advanced Health Sciences Pavilion, 9th Floor, Los Angeles, CA, 90048, USA
| | - Andrew G Allmon
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Youlan Rao
- United Therapeutics, 1040 Spring Street, Silver Spring, MD, 20910, USA
| | - Scott Zeger
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E3650, Baltimore, MD, 21205, USA
| | - Fredrick M Wigley
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Laura K Hummers
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Ami A Shah
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Bldg, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
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Reed L, MacNicol JL, Charchoglyan A, Brewer D, Murrant C, Pearson W. A Botanical-Based Equine Nutraceutical Reduces Gastric Smooth Muscle Contractile Force In Vitro. J Equine Vet Sci 2019; 84:102836. [PMID: 31864457 DOI: 10.1016/j.jevs.2019.102836] [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: 05/29/2019] [Revised: 08/14/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
The objective of this study was to evaluate the effect of a botanical-based equine nutraceutical on contractility of gastric smooth muscle in vitro. Gastric ulcers are prevalent in performance horses and negatively impact horse welfare. Gastric hypermotility has been positively associated with the development of gastric ulceration in nonequine species, and reduction of hypermotility may be protective against their development. Stomachs from 12 pigs processed for food at a provincially inspected abattoir were collected within 1 hour of slaughter. Explants of nonglandular gastric tissue were prepared and suspended in a tissue bath, attached to a force transducer, in the presence or absence of a simulated digest extract of the nutraceutical. Tissue was stimulated to contract using increasing doses of acetylcholine. Peak and mean contractile force over 1 and 2 minutes after exposure to acetylcholine were measured. Exposure of gastric smooth muscle to the nutraceutical significantly reduced contractility of the tissue. These data provide support for the use of this nutraceutical to reduce contractility of nonglandular gastric smooth muscle and may indicate a protective effect of this nutraceutical in horses with mechanically induced gastric ulcers. Future studies are needed to clarify the role of gastric hypermotility on development of equine gastric ulcers and to determine the effect of this nutraceutical on equine gastric contractility and ulcerogenesis in vivo.
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Affiliation(s)
- Lexie Reed
- Department of Animal Biosciences, Ontario Agriculture College, University of Guelph, Guelph, Ontario, Canada
| | - Jennifer L MacNicol
- Department of Animal Biosciences, Ontario Agriculture College, University of Guelph, Guelph, Ontario, Canada
| | | | - Dyanne Brewer
- Advanced Analysis Centre, University of Guelph, Guelph, Ontario, Canada
| | - Coral Murrant
- Department of Human Health and Nutritional Sciences, College of Biological Science, University of Guelph, Guelph, Ontario, Canada
| | - Wendy Pearson
- Department of Animal Biosciences, Ontario Agriculture College, University of Guelph, Guelph, Ontario, Canada.
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Abstract
Malignant wounds arise either primary or secondary in the context of a malignant transformation of already existing wounds. A plethora of skin tumors, such as basal cell carcinoma, squamous cell carcinoma, melanoma, lymphoma as well as cutaneous metastases of other malignancies can ulcerate and be the cause of malignant wounds. Ulcerating tumors or metastases of the skin can however mimic chronic wounds from other causes and remain unrecognized over a longer period. In patients with chronic ulcerations, the correct and timely diagnosis is paramount. Based on this, the stage and disease-oriented treatment should be chosen in harmony with the wishes of the patient. In addition, general measures, such as atraumatic dressing changes to reduce pain and bleeding and the use of antiseptic dressing materials to prevent bacterial colonization and associated odors should be considered.
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Affiliation(s)
- Michael Constantin Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - Cornelia Erfurt-Berge
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
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Lenz AL, Bush TR. Evaluating shear and normal force with the use of an instrumented transtibial socket: A case study. Med Eng Phys 2019; 71:102-7. [PMID: 31331756 DOI: 10.1016/j.medengphy.2019.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 11/21/2022]
Abstract
Patients with transtibial amputation experience ulcers on their residual limb. The loading between the device and underlying material plays a role in loads transmitted to the skin. The objective was to evaluate normal and shear forces at the socket/liner interface during walking. A 53 year old male (85.45 kg and 177.8 cm) with a transtibial amputation participated in this case study. A transtibial prosthesis was instrumented with a load cell to measure normal and shear forces at the socket interface. Three conditions were evaluated during walking: gel liner, additional three ply sock and a hole in the gel liner. Shear and normal forces were highest with the addition of a three ply. Longitudinal shear stresses ranged from 0.4-7.66 kPa, transverse shear stresses ranged from 0.01-7.79 kPa and normal stresses ranged from 2.7-61.9 kPa. Increased shear and normal forces can cause a significant decrease in blood perfusion, linked to an increased risk of ulcer formation. Experimental force results are also important for future work involving finite element modeling of the skin/liner/device interface.
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Sabzevari N, Schapiro BL, Stewart B. Necrotic leg ulcers secondary to hydrophilic polymer gel emboli. J Vasc Surg Cases Innov Tech 2019; 5:310-3. [PMID: 31334407 DOI: 10.1016/j.jvscit.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
A 63-year-old man presented with left lower extremity ischemia and pain. Left lower extremity angiography revealed calcification throughout the superficial femoral artery, prompting atherectomy and angioplasty with a drug-coated balloon. About 1 week after the procedure, he developed angulated ulcers with central eschar on the left lower extremity and was referred to the dermatology clinic. A biopsy showed cutaneous intravascular foreign material consistent with hydrophilic polymer gel. In patients who develop retiform purpura and ulcerations after endovascular procedures, the diagnosis of hydrophilic polymer embolus should be considered. Treatment consists of supportive care, making early identification vital to avoid unnecessary amputation.
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Abstract
Behcet's disease is a rare systemic vasculitis disorder of unknown etiology characterized by recurrent attacks of acute inflammation affecting multiple parts of the body.
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Zubair M, Ahmad J. Potential risk factors and outcomes of infection with multidrug resistance among diabetic patients having ulcers: 7 years study. Diabetes Metab Syndr 2019; 13:414-418. [PMID: 30641735 DOI: 10.1016/j.dsx.2018.10.014] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022]
Abstract
Diabetes Mellitus is characterized as a hyperglycemic condition, which results due to alteration in the secretion of insulin or action of insulin. The development and spread of microorganisms is known as a key health concern, and such cases are growing drastically in hospitals and communities. Therefore, the study aims to determine the potential risk factors and infection outcomes among diabetic patients with multi drug resistance, who are suffering from foot ulcerations. A prospective cohort analysis was carried out among 192 diabetic patients admitted in the Rajiv Gandhi Centre for Diabetes and Endocrinology of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, India. The patients having ulcer or ulcers in their foot during the period December 2008-June 2015 were included in the study. The results indicated the rate of resistance to CS and PC, which was 56.7% and 51.9%. The most common isolates included Escherichia coli (25.5%), Staphylococcus aureus (22.6%), and Klebsiella sp (5.4%). A total of 121 isolates from 278 were associated with the MDR. Furthermore, anaerobic isolates were also included in the study which included Peptostreptococcus spp, Propionibacterium spp, Clostridium perfringens, Eggerthella lenta, and Bacteroides ureolyticus. Ulcer was found among majority of patients with the duration of 1 month; whereas, the ulcer size was also the major risk factor for diabetic patients. Therefore, it is concluded that there is a major need for surveillance of resistant bacteria to reduce the risk of major complications.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia; Former DSK-PDF, Rajiv Gandhi Centre for Diabetes and Endocrinology, Former Dean, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
| | - Jamal Ahmad
- Former Professor of Endocrinology and Dean, Faculty of Medicine, Ex-Director, Rajiv Gandhi Centre for Diabetes and Endocrinology, Former Dean, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India; Consultant, Diabetes and Superspeciality Center, Central Tower Ground Floor, Kela Nagar Chauraha, Aligarh, 202002, India
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Bini Antunes M, Costa L, Carneiro M, Santos F, Oliveira R, Ferreira A, Sampaio M, Guimarães R, Pereira J, Neto H, Amil M, Coutinho J, Carvalho R. Topic platelet gel application in chronic diabetic foot ulcers. Diabetes Metab Syndr 2019; 13:644-647. [PMID: 30641782 DOI: 10.1016/j.dsx.2018.11.032] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/11/2018] [Indexed: 11/30/2022]
Abstract
UNLABELLED In this observational study performed during 45 months we evaluated patients with chronic and recalcitrant diabetic ulcers who were treated with homologous platelet gel. METHODS platelet gels were obtained from homologous platelet concentrates that were aliquoted and freezed, being then activated with calcium gluconate and applied in the ulcer after cleaning and debridement. We evaluated patient's comorbidities, wound characteristics (size, tissue, inflammatory signs, pain), number and time of treatment as well as outcome (classified as complete epithelialization; partial improvement- 50% reduction in wound size or pain relief; no evolution). RESULTS Fifty-two patients (42 males, 10 females), with a median age of 65 years (range 43-85) were proposed for platelet gel. The following associated comorbidities were observed: hypertension (n = 41), dyslipidemia (n = 29), polyneuropathy (n = 30), peripheral arteriopathy (n = 32), retinopathy (n = 21), nephropathy (n = 15), cardiac ischemic disease (n = 14), obesity (n = 9). Thirty-eight patients presented with 3 or more associated comorbidities. The more frequent ulcer locations were sole of the foot (n = 13) and heel (n = 10). The median number of applications was 16, during 8.5 weeks. Nineteen patients (44%) achieved complete healing, 3 patients (7%) had a partial response and 21 (49%) had no progression. We did not observe a statistically significant relationship between patient age and response nor between number of comorbidities and response. We observed a more favorable evolution in patients with good compliance and good glycemic control. CONCLUSION Platelet gel is an effective therapeutic alternative, provided compliance and effective metabolic control are ensured.
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Affiliation(s)
- Marika Bini Antunes
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Lidia Costa
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Carneiro
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Filipa Santos
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rita Oliveira
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Andreia Ferreira
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Marco Sampaio
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rosa Guimarães
- Diabetic Foot Multidisciplinary Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joel Pereira
- Diabetic Foot Multidisciplinary Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Helena Neto
- Diabetic Foot Multidisciplinary Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Margarida Amil
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Coutinho
- Haematology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Carvalho
- Diabetic Foot Multidisciplinary Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Haydara T, Kabel AM, Elsaka AM. The role of silent helicobacter pylori infection in intragastric ulcers induced by balloon insertion used for management of obesity. Diabetes Metab Syndr 2019; 13:116-121. [PMID: 30641681 DOI: 10.1016/j.dsx.2018.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 07/25/2018] [Accepted: 08/21/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Obesity represents one of the common medical disorders that carries a high risk of morbidity and mortality. Insertion of intragastric balloon is one of the recently introduced lines of treatment of obesity. It allows patients to sense abdominal fullness and reduce their food intake. However, gastric ulceration may be a serious adverse effect that may be associated with intragastric balloon insertion. AIM To assess the role of silent helicobacter pylori infection in intragastric balloon-induced ulcers and to explore the possible methods for amelioration of this effect. METHODS Thirty patients were divided into 2 equal groups; one of them received triple therapy for helicobacter pylori eradication and the other group received placebo treatment. Then, they underwent intragastric balloon insertion. After removal of the balloon, gastroscopy was performed to evaluate the gastric mucosal lesions, if present. RESULTS There was significant decrease in the incidence of gastric erosions and ulcerations in the group that received triple therapy for helicobacter pylori eradication compared to the group that received placebo treatment. CONCLUSION Eradication of silent helicobacter pylori infection may represent a promising hope to decrease the incidence and improve symptoms of gastric erosions and ulceration that may be associated with intragastric balloon insertion.
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Affiliation(s)
- Tamer Haydara
- Internal Medicine Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Ahmed M Kabel
- Pharmacology Department, Faculty of Medicine, Tanta University, Tanta, Egypt; Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, Saudi Arabia.
| | - Ayman M Elsaka
- Department of Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Marson BA, Deshmukh SR, Grindlay DJC, Ollivere BJ, Scammell BE. A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics. Bone Joint J 2018; 100-B:1409-1415. [PMID: 30418057 DOI: 10.1302/0301-620x.100b11.bjj-2018-0720] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. MATERIALS AND METHODS Databases were searched to identify eligible studies and 13 were identified for inclusion. RESULTS Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. CONCLUSION There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409-15.
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Affiliation(s)
- B A Marson
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - S R Deshmukh
- Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J C Grindlay
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B J Ollivere
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK and Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
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Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Affiliation(s)
- Roderick Hay
- Kings College London, Dermatology Department, Denmark Hill, London SE5 9RS, UK
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Cieslik-Bielecka A, Skowroński R, Jędrusik-Pawłowska M, Pierchała M. The application of L-PRP in AIDS patients with crural chronic ulcers: A pilot study. Adv Med Sci 2018; 63:140-146. [PMID: 29120855 DOI: 10.1016/j.advms.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/04/2017] [Accepted: 10/17/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE Nonhealing wounds or skin ulcerations are the result of insufficient repair and destruction of a local healing potential. Opportunistic infections which cause a lot of ulcer complications influence the worsening general condition of patients with AIDS, ultimately leading to death. The chronicity of the condition and poor results of conventional therapy have prompted the search for new methods of treatment. MATERIALS AND METHODS We have examined venous or arteriovenous insufficiency-related extensive crural ulcers in AIDS patients. Crural ulcer healing processes were evaluated with clinical observations and histopathological, immunohistochemical and molecular examinations of tissue samples harvested from the wound edges before and on day 10 after L-PRP cover dressing. RESULTS Clinical observations showed positive effects of L-PRP in all patients. However, complete wound closure was noted in 60% of cases. Statistical analysis of histological examination showed increased epidermal processes between samples, but the difference was nonsignificant. However, immunohistochemical investigations showed an increased healing process with strong statistical significance. The mean VEGF level before L-PRP usage was 114.3 vessels/mm2 and on day 10 118.9 (p=0.001523). The mean FLK level was 103.2 and 109.9 respectively (p=0.008241). The biggest differences were observed for CD34, with values of 68.2 on day 0 and 100.8 on day 10 (p=0.006982). Molecular analysis generally showed decreased gene expression and confirmed vascular formation and reepithelialization processes. CONCLUSIONS In our opinion, L-PRP may be used to eradicate microorganisms from wounds, to induce neovascularization, and in unhealed cases prepare the base and edge of the ulcer for skin grafting and tissue expansion procedures.
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Dhatariya KK, Li Ping Wah-Pun Sin E, Cheng JOS, Li FYN, Yue AWY, Gooday C, Nunney I. The impact of glycaemic variability on wound healing in the diabetic foot - A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic. Diabetes Res Clin Pract 2018; 135:23-29. [PMID: 29097286 DOI: 10.1016/j.diabres.2017.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 07/26/2017] [Revised: 10/11/2017] [Accepted: 10/24/2017] [Indexed: 12/17/2022]
Abstract
AIMS Glycaemic variability - the visit-to-visit variation in HbA1c - plays a possible role in the development of micro and macrovascular disease in patients with diabetes. Whether HbA1c variability is a factor determining wound healing in diabetic foot ulcers remains unknown. We aimed to determine whether HbA1c variability is associated with foot ulcer healing time. METHODS A retrospective analysis of patients presenting to our specialist multidisciplinary foot clinic between July 2013 and March 2015, with at least three HbA1c measurements within five years of presentation and more than two follow-up reviews. HbA1c variation was measured by magnitude of standard deviation. RESULTS 629 new referrals were seen between July 2013 and March 2015. Of these, 172 patients had their number of days to healing recorded and sufficient numbers of HbA1c values to determine variability. The overall geometric mean days to heal was 91.1 days (SD 80.8-102.7). In the low HbA1c variability group the geometric mean days to heal was 78.0 days (60.2-101.2) vs 126.9 days (102.0-158.0) in the high Hb1Ac variability group (p = .032). Those with low HbA1c (<58 mmol/mol) and low variability healed faster than those with high HbA1c and high variability (73.5 days [59.5-90.8] vs 111.0 days [92.0-134.0], p = .007). Additionally, our results show that time to healing is more dependent on the mean HbA1c than the variability in HbA1c (p = .007). CONCLUSIONS/INTERPRETATION Our data suggest that there was a significant association between HbA1c variability and healing time in diabetic foot ulcers.
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Affiliation(s)
- Ketan K Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK; Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK.
| | | | | | | | - Anson Wei Yue Yue
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Catherine Gooday
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK; Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY, UK
| | - Ian Nunney
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Alasmary FAS, Awaad AS, Alafeefy AM, El-Meligy RM, Alqasoumi SI. Novel quinazoline and acetamide derivatives as safe anti-ulcerogenic agent and anti-ulcerative colitis activity. Saudi Pharm J 2018; 26:138-43. [PMID: 29379346 DOI: 10.1016/j.jsps.2017.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/27/2017] [Indexed: 01/02/2023] Open
Abstract
Two novel quinazoline derivatives named as; 3-[(4-hydroxy-3-methoxy-benzylidene)-amino]-2-p-tolyl-3H-quinazolin-4-one (5) and 2-p-Tolyl-3-[3,4,5-trimethoxy-benzylidene-amino]-3H-quinazolin-4-one (6) in addition to one acetamide derivative named as 2-(2-Hydroxycarbonylphenylamino)-N-(4-aminosulphonylphenyl) 11 were synthesized, and evaluated for their anti-ulcerogenic & Anti-Ulcerative colitis activities. All of the three compounds showed curative activity against acetic acid induced ulcer model at a dose of 50 mg/kg, they produced 65%, 85% & 57.74% curative ratio for compounds 5, 6 & 11 respectively. The effect of the tested compounds 5, 6 & 11 at dose 50 mg/kg were significantly (P < 0.01) more effective than dexamesathone (0.1 mg/kg) in reducing all parameters. Compounds showed curative activity of for peptic ulcer (induced by absolute alcohol (at a dose of 50 mg/kg, it produced Curative of control ulcer 56.00%, 61.70% & 87.1% for compounds 5, 6 & 11 respectively at dose 50 mg/kg, while the standard drug (Omeprazole 20 mg/kg) produced 33.3%. In both tests, the activity of our target compounds were higher than the standard drugs used for treatment of peptic ulcer and ulcerative colitis. No side effects were reported on liver and kidney functions upon prolonged oral administration of this compounds.
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Imbernon-Moya A, Ortiz-de Frutos FJ, Sanjuan-Alvarez M, Portero-Sanchez I, Merinero-Palomares R, Alcazar V. Pain, Quality of Life, and Functional Capacity With Topical Sevoflurane Application for Chronic Venous Ulcers: A Retrospective Clinical Study. EJVES Short Rep 2017; 36:9-12. [PMID: 29296683 PMCID: PMC5626915 DOI: 10.1016/j.ejvssr.2017.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 08/02/2017] [Accepted: 08/09/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction Chronic venous ulcers (CVU) commonly have poorly controlled pain. Report Thirty patients older than 65 years of age with painful CVU were reviewed. At the initial visit, cleaning without sevoflurane was performed. Cleaning visits with sevoflurane every 2 days for 1 month were scheduled. The results of subsequent treatment with sevoflurane at the first, second, seventh, and twelfth cleanings were analysed. Pain was measured using a visual analog scale (VAS), quality of life by the Charing Cross Venous Leg Ulcer Questionnaire, and functional capacity by the Barthel Index. Discussion Initial VAS was 8.8 ± 1.3 points and at the twelfth cleaning VAS was 0.8 ± 1 points (p = .001). Latency time ranged between 2 and 7 m and duration ranged between 8 and 18 h. It improved quality of life (83 ± 14 points before treatment vs. 50 ± 14 at the twelfth cleaning) and functional capacity (82 ± 13.3 before treatment vs. 91 ± 11.6 points at the twelfth cleaning) (p = .001). The safety profile was favourable with mild and self limited local cutaneous adverse effects, including pruritus, erythema, and heat. No systemic toxicity was detected. Topical sevoflurane may be a therapeutic alternative for painful CVU with a fast, intense, and long-lasting analgesic effect.
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Affiliation(s)
- Adrian Imbernon-Moya
- Department of Dermatology, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
| | | | - Monica Sanjuan-Alvarez
- Department of Anesthetics, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
| | | | - Raul Merinero-Palomares
- Department of Crystallography and Mineralogy, Complutense University of Madrid, Madrid, Spain
| | - Victoria Alcazar
- Department of Endocrinology, Hospital Severo Ochoa, Avenida de Orellana, Leganés, Madrid 28911, Spain
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Abstract
Altered skin integrity increases the chance of infection, impaired mobility, and decreased function and may result in the loss of limb or, sometimes, life. Skin is affected by both intrinsic and extrinsic factors. Intrinsic factors can include altered nutritional status, vascular disease issues, and diabetes. Extrinsic factors include falls, accidents, pressure, immobility, and surgical procedures. Ensuring skin integrity in the elderly requires a team approach and includes the individual, caregivers, and clinicians. The twenty-first century clinician has several online, evidence-based tools to assist with optimal treatment plans. Understanding best practices in addressing skin integrity issues can promote positive outcomes with the elderly.
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Affiliation(s)
- Rose W Murphree
- Wound, Ostomy, and Continence Nursing Education Center, Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
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Abstract
A 73-year-old female was admitted to our hospital with abdominal pain and diarrhea. Computed tomography detected distension of the small intestine. A palmar erythema, multiple oral ulcers, and desquamation of the fingers appeared after hospitalization. Small-bowel endoscopic images showed multiple ulcers. We attributed this case to infection with Yersinia pseudotuberculosis based on the changes in Y. pseudotuberculosis antibody titers throughout the course of the illness. This report is valuable, as it illustrates the endoscopic characteristics of a Y. pseudotuberculosis infection with skin lesion and ileus, which may enable us to deepen the pathologic understanding of this disease.
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Affiliation(s)
- Azusa Kawasaki
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hisashi Doyama
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
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Affiliation(s)
- Amr Bugshan
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, 6th Floor, Boston, MA 02111, USA; Collage of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam 31441, Kingdom of Saudi Arabia.
| | - Arwa M Farag
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, 6th Floor, Boston, MA 02111, USA; Department of Oral Medicine, Faculty of Dentistry, King AbdulAziz University, 1 Umm Al Muminin Road, Jeddah 21589, Kingdom of Saudi Arabia
| | - Bhavik Desai
- Division of Oral Medicine, Department of Diagnostic Sciences, Tufts University School of Dental Medicine, 1 Kneeland Street, 6th Floor, Boston, MA 02111, USA
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