Search results for: diabetic wound

Authors: Mohamed Amine Adaour, Mohamed Sadek Bachene, Mosaab Fortassi, Wafaa Siouda

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Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea.The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73%, and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic, biopsy, diabetic foot

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Authors: Adaour Mohamed Amine, Bachene Mohamed Sadek, Fortassi Mosaab, Siouda Wafaa

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Foot infections are responsible for a significant number of hospitalizations and amputations in diabetic patients. The objective of our study is to analyze and evaluate the management of diabetic foot in a surgical setting. A retrospective study was conducted based on a selected case of suspected diabetic foot infections of osteitis treated at the Mohamed Boudiaf hospital in Medea. The case was reiterated as a therapeutic charge, consisting of treating first the infection of the soft tissues, then the osteitis: biopsy after at least 15 days of cessation of antibiotic therapy. Successful treatment of osteitis was defined at the end of a follow-up period of complete wound healing, lack of bone resection/amputation surgery at the initial bone site during follow-up , Instead, biopsies are prescribed in the treatment of soft tissue infection. The mean duration of treatment for soft tissue infection was 2-3 weeks, the duration of the antibiotic-free window of therapy prior to bone biopsy was 2-4 weeks. This patient received medical management without surgical resection. The success rate for treating osteitis at one year was 73% and healing at one year was 88%.It is often limited to a sausage of the foot at the cost of repeated amputations. The best management remains prevention, which necessarily involves setting up a specialized and adapted centre.

Keywords: osteitis, antibiotic therapy, bone biopsy, diabetic foot

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Authors: Hayden R Schott, John M Felder III

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Introduction: Chronic lower extremity wounds in the diabetic and vasculopathic populations are associated with a high degree of morbidity.When wounds require more extensive treatment than can be offered by wound care centers, more aggressive solutions involve local tissue transfer and microsurgical free tissue transfer for achieving definitive soft tissue coverage. These procedures of autologous tissue transfer (ATT) offer resilient, soft tissue coverage of limb-threatening wounds and confer promising limb salvage rates. However, chronic osteomyelitis and recalcitrant soft tissue infections are common in severe diabetic foot wounds and serve to significantly complicate ATT procedures. Stimulan is a resorbable calcium sulfate antibiotic carrier. The use of stimulan antibiotic beads to treat chronic osteomyelitis is well established in the orthopedic and plastic surgery literature. In these procedures, the beads are placed beneath the skin flap to directly deliver antibiotics to the infection site. The purpose of this study was to quantify the success of Stimulan antibiotic beads in treating recalcitrant infections in patients with diabetic foot wounds receiving ATT. Methods: A retrospective review of clinical and demographic information was performed on patients who underwent ATT with the placement of Stimulan antibiotic beads for attempted limb salvage from 2018-21. Patients were analyzed for preoperative wound characteristics, demographics, infection recurrence, and adverse outcomes as a result of product use. The primary endpoint was 90 day infection recurrence, with secondary endpoints including 90 day complications. Outcomes were compared using basic statistics and Fisher’s exact tests. Results: In this time span, 14 patients were identified. At the time of surgery, all patients exhibited clinical signs of active infection, including positive cultures and erythema. 57% of patients (n=8) exhibited chronic osteomyelitis prior to surgery, and 71% (n=10) had exposed bone at the wound base. In 57% of patients (n=8), Stimulan beads were placed beneath a free tissue flap and beneath a pedicle tissue flap in 42% of patients (n=6). In all patients, Stimulan beads were only applied once. Recurrent infections were observed in 28% of patients (n=4) at 90 days post-op, and flap nonadherence was observed in 7% (n=1). These were the only Stimulan related complications observed. Ultimately, lower limb salvage was successful in 85% of patients (n=12). Notably, there was no significant association between the preoperative presence of osteomyelitis and recurrent infections. Conclusions: The use of Stimulanantiobiotic beads to treat recalcitrant infections in patients receiving definitive skin coverage of diabetic foot wounds does not appear to demonstrate unnecessary risk. Furthermore, the lack of significance between the preoperative presence of osteomyelitis and recurrent infections indicates the successful use of Stimulan to dampen infection in patients with osteomyelitis, as is consistent with the literature. Further research is needed to identify Stimulan as the significant contributor to infection treatment using future cohort and case control studies with more patients. Nonetheless, the use of Stimulan antibiotic beads in patients with diabetic foot wounds demonstrates successful infection suppression and maintenance of definitive soft tissue coverage.

Keywords: wound care, stimulan antibiotic beads, free tissue transfer, plastic surgery, wound, infection

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Authors: Sahar Oudeh, Abbas Javaheri Vayeghan, Mahmood Ahmadi-Hamedani

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This study aimed to investigate the effect of diabetic duration on platelet and platelet indices in streptozotocin-induced diabetic male and female rats. Thirty-two healthy adult Wistar rats (16 females and 16 males) were randomly divided into 4 groups of eight, including 1) control group (4 females and 4 males who did not undergo any treatment until the end of 28 days), 2) 7-day diabetic group (4 females and 4 males who were diabetic for 7 days and were euthanized after 7 days), 3) 14-day diabetic group (4 females and 4 males who were diabetic for 14 days and were euthanized after 14 days), and 28-day diabetic group (4 females and 4 males who were diabetic for 28 days and were euthanized after 28 days). Diabetes was induced by intraperitoneal injection of streptozotocin (65 mg/kg). After induction of diabetes in the groups, blood samples were taken from their hearts after anesthesia, and platelet counts (PLT) and platelet indices were measured by an automatic blood cell counter (Nihon Kohden, Celltac Alpha VET MEK-6550, Japan). Statistical differences among groups were analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s multiple tests. The results of this study showed that PLT and mean platelet volume (MPV) significantly increased in 7 and 14-day diabetic groups compared to the control group, whereas plateletcrit (PCT) and platelet distribution rate (PDW) significantly increased in 14 and 28-day diabetic groups, respectively. Significant differences were observed between female and male rats in PCT and PLT in the 14-day diabetic group and PDW in the 28-day diabetic group. According to the results of this study, measurement and analysis of platelet indices can be used as a method for the early diagnosis of diabetes and its complications.

Keywords: diabetic duration, streptozotocin, female and male rats, platelet indices

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Authors: S. Bilal, S. A. Bhat, I. Hussain, J. D. Parrah, S. P. Ahmad, M. R. Mir

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Background: The wound healing involves a highly coordinated cascade of cellular and immunological response over a period including coagulation, inflammation, granulation tissue formation, epithelialization, collagen synthesis and tissue remodeling. Wounds in aged heal more slowly than those in younger, mainly because of comorbidities that occur as one age. The present study is about the influence of age on wound healing. 1x1cm^2 (100 mm) wounds were created on the back of the animal. The animals were divided into two groups; one group had animals in the age group of 3-9 months while another group had animals in the age group of 15-21 months. Materials and Methods: 24 clinically healthy rabbits in the age group of 3-21 months were used as experimental animals and divided into two groups viz A and B. All experimental parameters, i.e., Excision wound model, Measurement of wound area, Protein extraction and estimation, Protein extraction and estimation and DNA extraction and estimation were done by standard methods. Results: The parameters studied were wound contraction, hydroxyproline, glucosamine, protein, and DNA. A significant increase (p<0.005) in the hydroxyproline, glucosamine, protein and DNA and a significant decrease in wound area (p<0.005) was observed in the age group of 3-9 months when compared to animals of an age group of 15-21 months. Wound contraction together with hydroxyproline, glucosamine, protein and DNA estimations suggest that advanced age results in retarded wound healing. Conclusion: The decrease wound contraction and accumulation of hydroxyproline, glucosamine, protein and DNA in group B animals may be associated with the reduction or delay in growth factors because of the advancing age.

Keywords: age, wound healing, excision wound, hydroxyproline, glucosamine

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Authors: Xiuguo Zhao, He Li, Alireza Yazdani, Xiaoning Zheng, Xinxi Xu

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Wound infected poses a serious threat to the surgery on the patient during the process of surgery. Understanding the bacteria-carrying particles (BCPs) transportation and deposition in the open surgical wound model play essential role in protecting wound against being infected. Therefore BCPs transportation and deposition in the surgical wound model were investigated using force-coupling method (FCM) based computational fluid dynamics. The BCPs deposition in the wound was strongly associated with BCPs diameter and concentration. The results showed that the rise on the BCPs deposition was increasing not only with the increase of BCPs diameters but also with the increase of the BCPs concentration. BCPs deposition morphology was impacted by the combination of size distribution, airflow patterns and model geometry. The deposition morphology exhibited the characteristic with BCPs deposition on the sidewall in wound model and no BCPs deposition on the bottom of the wound model mainly because the airflow movement in one direction from up to down and then side created by laminar system constructing airflow patterns and then made BCPs hard deposit in the bottom of the wound model due to wound geometry limit. It was also observed that inertial impact becomes a main mechanism of the BCPs deposition. This work may contribute to next study in BCPs deposition limit, as well as wound infected estimation in surgical-site infections.

Keywords: BCPs deposition, computational fluid dynamics, force-coupling method (FCM), numerical simulation, open surgical wound model

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Authors: Ho-Hsin Lee, Yue-Min Jiang, Shu-Hui Tsai, Jian-Ren Chen, Mei-Yu XU, Wen-Tien Wu

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This project presents an AI-based method and system for wound status analysis. The system uses a three-in-one sensor device to analyze wound status, including color, temperature, and a 3D sensor to provide wound information up to 2mm below the surface, such as redness, heat, and blood circulation information. The system has a 90% accuracy rate, requiring only one manual correction in 70% of cases, with a one-second delay. The system also provides an offline application that allows for manual correction of the wound bed range using color-based guidance to estimate wound bed size with 96% accuracy and a maximum of one manual correction in 96% of cases, with a one-second delay. Additionally, AI-assisted wound bed range selection achieves 100% of cases without manual intervention, with an accuracy rate of 76%, while AI-based wound tissue type classification achieves an 85.3% accuracy rate for five categories. The AI system also includes similar case search and expert recommendation capabilities. For AI-assisted wound range selection, the system uses WIFI6 technology, increasing data transmission speeds by 22 times. The project aims to save up to 64% of the time required for human wound record keeping and reduce the estimated time to assess wound status by 96%, with an 80% accuracy rate. Overall, the proposed AI method and system integrate multiple sensors to provide accurate wound information and offer offline and online AI-assisted wound bed size estimation and wound tissue type classification. The system decreases delay time to one second, reduces the number of manual corrections required, saves time on wound record keeping, and increases data transmission speed, all of which have the potential to significantly improve wound care and management efficiency and accuracy.

Keywords: wound status analysis, AI-based system, multi-sensor integration, color-based guidance

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Authors: Yasin Akgül, Yusuf Polat, Emine Canbay, Ali Kılıç

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Wound dressings have strategically and economic importance considering increase of chronic wounds in the world. In this study, TPU nanofibrous membranes containing propolis as wound dressing are produced by two different methods. Firstly, TPU solution and propolis extract were mixed and this solution was electrospun. The other method is that TPU/propolis blend was centrifugally spun. Properties of nanofibrous membranes obtained by these methods were compared. While realizing the experiments, both systems were optimized to produce nanofibers with nearly same average fiber diameter.

Keywords: nanofiber, wound dressing, electrospinning, centrifugal spinning

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Authors: Khalil Abdullah Ahmed Khalil, Elsadig Mohamed Ahmed

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Ginger is one of the most important medicinal plants, which is widely used in folk medicine. This study was designed to go further step and evaluate the hypoglycemic and hypolipidaemic effects of the aqueous ginger root extract in normal and alloxan diabetic rabbits. Results revealed that the aqueous ginger has a significant hypoglycemic effect (P<0.05) in diabetic rabbits but a non-significant hypoglycemic effect (P>0.05) in normal rabbits. There were also significant decreases in the concentrations (P<0.05) in serum cholesterol, triglycerides and LDL – cholesterol in both normal and diabetic rabbits. Although there was an elevation in serum HDL- cholesterol in both normal and diabetic rabbits, these elevations were non-significant (P>0.05). Our data suggest the aqueous ginger has a hypoglycemic effect in diabetic rabbits and lipid-lowering properties in both normal and diabetic rabbits.

Keywords: aqueous extract of ginger root (AEGR), hypoglycemic, cholesterol, triglyceride

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Authors: Sanaa AM Elgayar, Sohair A Eltony, Maha Mahmoud Abd El Rouf

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Background: Retinopathy remains an important complication of diabetes. Aim of work: This work was carried out to evaluate the protective effects of genistein from diabetic retinopathy in rat. Material and Methods: Fifteen adult male albino rats were divided into two groups; Group I: control (n=5) and Group II: streptozotocin induced diabetic group (n=10), which is equally divided into two subgroups; IIa (diabetic vehicle control) and IIb (diabetic genistein-treated). Specimens were taken from the retina 12 weeks post induction, processed and examined using light, immunohistochemical, ultrastructural techniques. Blood samples were assayed for the levels of glucose. Results: In comparison with the diabetic non-treated group, the histological changes in macro and microglial glial cells reactivity and retinal blood capillaries were improved in genistein-treated groups. In addition, GFAP and iNOS expressions in the retina and the blood glucose level were reduced. Conclusion: Genistein ameliorates the histological changes of diabetic retinopathy reaching healing features, which resemble that of a normal retina.

Keywords: diabetic retinopathy, genistein, glia, capillaries.

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Authors: Ji Jiazheng, Wang Jingrao, Jin Xin, Zhang Hong

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Diabetes mellitus is a metabolic disease characterized by high blood sugar. A long-standing hyperglycemic state can lead to various tissue damage. Diabetic retinopathy is the most common and widely studied ocular complication and has become the leading cause of blindness in my country. At the same time, diabetes has profound clinically relevant effects on the cornea, leading to keratopathy and vision-threatening. The cornea is an avascular tissue and is sensitive to hyperglycemia, Keratopathy caused by diabetes is usually chronic, they are called diabetic keratopathy or diabetic neurotrophic keratopathy, leading to several diabetic corneal complications including delayed epithelial wound healing, recurrent erosions, neuropathy, loss of sensitivity. Corneal stem cell dysfunction in diabetic patients as an important influencing factor of diabetic keratopathy. The consequences of this condition are often underestimated. The limbus is located between the cornea and the sclera tissue. The limbal stroma consists of a series of radial elevations with fibrovascular centers known as palisades of Vogt (POV). Previous studies have shown that palisades of Vogt (POV), as the main site of limbal stem cells, plays an important role in the homeostasis of the corneal epithelium. Therefore, POV plays a vital role in the healing of corneal epithelial surgery and postoperative evaluation. IVCM can observe the condition of the corneal epithelium at the cellular level. It has profound significance and guidance for the evaluation of limbal and limbal stem cells. We have previously observed structural changes in POV in HSK and HZO patients on IVCM. At present, there have been reports involving limbal stem cell dysfunction in diabetic patients, but the specific pathogenesis is still unclear. However, there are no studies on POV morphological changes in patients with DM. Therefore, we performed statistics and compared the correlation between POV morphological changes and corneal epithelial basal cell density, corneal nerves, and length of disease in DM patients and normal humans using IVCM studies. At the same time, fundoscopy was used to observe the correlation between the thickness of RNFL and the thickness of GCC and POV in diabetic patients. And to observe the correlation between SVD, DVD and POV for research.

Keywords: confocal microscopy, fundus, limbal stem cells, diabetes

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Authors: Li-Ting Kung, Hui-Zhu Chen, Hsin-Tzu Lee, Wan-Yin Hsu

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Patients with spinal cord injury combined with diabetic nephropathy may under a lot of painful conditions due to complications related to the illness itself or treatments, such as recurrent pressure ulcers, autonomic and peripheral neuropathy, as well as dialysis, for long term. This case report illustrated the nursing experience of transferring a spine cord injure patient who received hemodialysis due to adverse lifestyle-induced diabetic nephropathy to the hospice ward. Nursing care was provided in this patient from July 25th to August 30th, 2015. The tool of 'Gordon’s 11-item functional health assessment' and clinical observation, interviews as well as physical examination were used as data collections. Based on results of health assessment as above, the patient’s health problems were identified as the following: impaired skin integrity, chronic pain, and hopeless. Besides to relieve the symptom of pain due to disease or the treatment of hemodialysis and provide wound care, the first author also played a role to assist the patient to achieve his goal of receiving the hospice palliative care. Finally, with much effort of nurses to communicate with medical teams between the surgical and hospice wards, the patient was transferred to the hospice ward to have fulfilled his last wish of having a good death. We hope this nursing experience can be applied to other similar cases in the future.

Keywords: diabetic nephropathy, hospice care, palliative care, spinal cord injury

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Authors: Neelamshobha Nirala, R. Periyasamy, Awanish Kumar

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Diabetes is a metabolic disorder and with the increase of global prevalence of diabetes, cardiovascular diseases and mortality related to diabetes has also increased. Diabetes causes the increase of arterial stiffness by elusive hormonal and metabolic abnormalities. We used photoplethysmograph (PPG), a simple non-invasive method to study the change in arterial stiffness due to diabetes. Toe PPG signals were taken from 29 diabetic subjects with mean age of (65±8.4) years and 21 non-diabetic subjects of mean age of (49±14) years. Mean duration of diabetes is 12±8 years for diabetic group. Rise-time (RT) and area under rise time (AUR) were calculated from the PPG signal of each subject and Welch’s t-test is used to find the significant difference between two groups. We obtained a significant difference of (p-value) 0.0005 and 0.03 for RT and AUR respectively between diabetic and non-diabetic subjects. Average value of RT and AUR is 0.298±0.003 msec and 14.4±4.2 arbitrary units respectively for diabetic subject compared to 0.277±0.0005 msec and 13.66±2.3 a.u respectively for non-diabetic subjects. In conclusion, this study support that arterial stiffness is increased in diabetes and can be detected early using PPG.

Keywords: area under rise-time, AUR, arterial stiffness, diabetes, photoplethysmograph, PPG, rise-time (RT)

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Authors: L. Sasikala, Bhaarathi Dhurai

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Increase in antibiotic resistance bacteria leads to the development of active wound dressings, which absorb any bodily fluid, evaporation of moisture at a certain rate and can be easily removed after healing. Natural materials like chitosan, herbs, and honey have number of active materials present in them to accelerate wound healing and to arrest wound in infections. Hence with the advantages of biomaterials, a film was prepared using chitosan and honey. There are a lot of practical considerations with respect to honey. Honey exerts many beneficial actions on the wound surface only when it remains. The attempts to hold honey on the surface of the wound remain a question because honey becomes a very runny liquid when it comes to body temperature. Hence, this research was focused on development of a new form of wound dressing, by holding honey on the wound surface in different form and also which has a combined effect of manuka (Leptospermum scoparium) honey and chitosan. Chitosan-honey film was prepared using casting technique. Films were prepared in different variations; with acetic acid and with lactic acid; with and without honey. In summary, the film produced from 2% chitosan- 1% lactic acid as a solvent, with 10% honey shows optimum inclined values in all the tests, like thickness, folding endurance, weight, water vapor transmission, tensile strength, swelling ratio and antimicrobial activity, with specific reference to wound dressings. The film has water vapor transmission of 1680 g/m²/day, water absorption of 225%, tensile strength of 39.1N/mm² and elongation of 50.3%. There is a notable inhibition zone of 29 mm against S. aureus and 24 mm against E. coli in the case of chitosan-lactic acid-honey film. The film also arrests, microbes transmitting from the outside environment to wound bed, which can be used as an effective wound dressing material.

Keywords: casting technique, chitosan, honey, film, wound dressings

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Authors: Isa Naina Mohamed, Mazliadiyana Mazlan, Ahmad Nazrun Shuid

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Stichopus chloronotus (Black Knobby or green fish) is a sea cucumber species commonly found along Malaysia’s coastline. In Malaysia, it is believed that sea cucumber can expedite healing of wounds, provide extra energy and used as an ointment to relieve pain. The aim of this study is to determine the best concentration of Stichopus chlronotus extract to promote wound healing. 12 male Sprague-Dawley rats with wounds created using 6mm disposable punch biopsy were divided into 6 treatment groups. The normal control group (untreated), positive control group (flavin treated only), negative control group (emulsifying ointment only), and group 0.1, group 0.5, group 1 were each treated with 0.1%, 0.5% and 1% of Stichopus chlronotus water extract mixed in emulsifying ointment, respectively. Treatments were administered topically for 10 days. Changes in wound area were measured using caliper and photographs were taken on day 2, 4, 6, 8, and 10 after index wound. Results showed that wound reduction of group 0.5 on day 4, 6, and 8 was significantly higher compared to normal control group and positive control group. Group 0.5 also had higher wound reduction from day 6 until day 10 compared to all other groups. In conclusion, Sea Cucumber (Stichopus chloronotus) extract demonstrated the best minor wound healing properties at concentration 0.5%. The potential of Stichopus chlronotus extract ointment for wound healing shall be investigated further.

Keywords: minor wound healing, expedite wound healing, sea cucumber, Stichopus chloronotus

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Authors: Jyh-Ping Chen, Yu-Tin Lai

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Wound healing is a complicated process involving overlapping hemostasis, inflammation, proliferation, and maturation phases. Ideal wound dressings can replace native skin functions in full thickness skin wounds through faster healing rate and also by reducing scar formation. Poly(lactic-co-glycolic acid) (PLGA) is an U.S. FDA approved biodegradable polymer to be used as ideal wound dressing material. Several in vitro and in vivo studies have demonstrated the effectiveness of curcumin in decreasing the release of inflammatory cytokines, inhibiting enzymes associated with inflammations, and scavenging free radicals that are the major cause of inflammation during wound healing. Heparin has binding affinities to various growth factors. With the unique and beneficial features offered by those molecules toward the complex process of wound healing, we postulate a composite wound dressing constructed from PLGA, curcumin and heparin would be a good candidate to accelerate scarless wound healing. In this work, we use electrospinning to prepare curcumin-loaded aligned PLGA nanofibrous membranes (PC NFMs). PC NFMs were further subject to oxygen plasma modification and surfaced-grafted with heparin through carbodiimide-mediated covalent bond formation to prepare curcumin-loaded PLGA-g-heparin (PCH) NFMs. The nanofibrous membranes could act as three-dimensional scaffolds to attract fibroblast migration, reduce inflammation, and increase wound-healing related growth factors concentrations at wound sites. From scanning electron microscopy analysis, the nanofibers in each NFM are with diameters ranging from 456 to 479 nm and with alignment angles within  0.5°. The NFMs show high tensile strength and good water absorptivity and provide suitable pore size for nutrients/wastes transport. Exposure of human dermal fibroblasts to the extraction medium of PC or PCH NFM showed significant protective effects against hydrogen peroxide than PLGA NFM. In vitro wound healing assays also showed that the extraction medium of PCH NFM showed significantly better migration ability toward fibroblasts than PC NFM, which is further better than PLGA NFM. The in vivo healing efficiency of the NFMs was further evaluated by a full thickness excisional wound healing diabetic rat model. After 14 days, PCH NFMs exhibits 86% wound closure rate, which is significantly different from other groups (79% for PC and 73% for PLGA NFM). Real-time PCR analysis indicated PC and PCH NFMs down regulated anti-oxidative enzymes like glutathione peroxidase (GPx) and superoxide dismutase (SOD), which are well-known transcription factors involved in cellular inflammatory responses to stimuli. From histology, the wound area treated with PCH NFMs showed more vascular lumen formation from immunohistochemistry of α-smooth muscle actin. The wound site also had more collagen type III (65.8%) expression and less collagen type I (3.5%) expression, indicating scar-less wound healing. From Western blot analysis, the PCH NFM showed good affinity toward growth factors from increased concentration of transforming growth factor-β (TGF-β) and fibroblast growth factor-2 (FGF-2) at the wound site to accelerate wound healing. From the results, we suggest PCH NFM as a promising candidate for wound dressing applications.

Keywords: Curcumin, heparin, nanofibrous membrane, poly(lactic-co-glycolic acid) (PLGA), wound dressing

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Authors: Rajesh Kumar, Roopali Dogra, Puneet Aggarwal

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In recent advancements in electric machine and drives, wound rotor motor is extensively used. The merit of using wound rotor induction motor is to control speed/torque characteristics by inserting external resistance. Wound rotor induction motor can be used in the cases such as (a) low inrush current, (b) load requiring high starting torque, (c) lower starting current is required, (d) loads having high inertia, and (e) gradual built up of torque. Examples include conveyers, cranes, pumps, elevators, and compressors. This paper includes speed control of wound induction motor using MATLAB/Simulink for rotor resistance and slip power recovery method. The characteristics of these speed control methods are hence analyzed.

Keywords: MATLAB/Simulink, rotor resistance method, slip power recovery method, wound rotor induction motor

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Authors: Saba Atefyekta

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Aim: Control of bacterial bioburden in wounds is an important step for minimizing the risk of wound infection. An antimicrobial hydrogel wound dressing is developed out of soft polymeric hydrogels that contain antimicrobial peptides (AMPs). Such wound dressings can bind and kill all types of bacteria, even the resistance types at the wound site. Methods: AMPs are permanently bonded onto a soft nanostructured polymer via covalent attachment and physical entanglement. This improves stability, rapid antibacterial activity, and, most importantly, prevents the leaching of AMPs. Major Findings: Antimicrobial analysis of antimicrobial hydrogels using in-vitro wound models confirmed >99% killing efficiency against multiple bacterial trains, including MRSA, MDR, E. Coli. Furthermore, the hydrogel retained its antibacterial activity for up to 4 days when exposed to human serum. Tests confirmed no release of AMPs, and it was proven non-toxic to mammalian cells. An in-vivo study on human intact skin showed a significant reduction of bacteria for part of the subject’s skin treated with antibacterial hydrogels. A similar result was detected through a qualitative study in veterinary trials on different types of surgery wounds in cats, dogs, and horses. Conclusions: Antimicrobial hydrogels wound dressings developed by permanent attachment of AMPs can effectively and rapidly kill bacteria in contact. Such antibacterial hydrogel wound dressings are non-toxic and do not release any substances into the wound.

Keywords: antibacterial wound dressing, antimicrobial peptides, post-surgical wounds, infection

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Authors: Naveen Kumar Challa, Pavan Verıkıcherla, Madhubalan, Ashısh Sharma

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Aim: Aim of the study was to find whether any difference exists in pupil mydriasis measured with Orbscan in non-diabetic and type 2 diabetic patients at various intervals after installation of Tropicamide 0.8% and Phenylephrine 5%. Methods: the Observational study conducted at a tertiary care eye hospital during September 2014 to March 2015. 240 eyes from 120 patients (40 non-diabetic, 80 diabetic) were dilated with Tropicamide 0.8% and Phenylephrine 5%. One drop of a drug was installed twice. The second drop is installed at 20 minutes after installation of the first drop. In two groups’ pupil diameter was measured before installation of drops and also at 15, 30, 45 and 60 minutes after installation of the first drop using both Orbscan. Result: Mean age of the non-diabetic group is 48.67 ± 7.93 years; Diabetic group is 59.97 ± 8.77 years. Mean duration of Diabetes was 7.01 ± 5.05 years. Mean pupil diameter measured with Orbscan before installation of the drops and also at 15, 30, 45 and 60 minutes after installation of first drop in non-diabetic group was 4.18 ± 0.64mm, 6.15 ± 0.41mm, 7.76 ±0.34, 9.59 ± 0.30, and 9.97 ± 0.10 mm respectively and for the diabetic group it was 4.00 ± 0.56 mm, 5.53 ± 0.52 mm, 7.018 ± 0.58mm, 8.25±0.51mm and 9.18 ± 0.46mm respectively. The mean difference between the mean pupil diameters of the non-diabetic and diabetic group shows a significant difference (P< 0.01) at all intervals except before dilatation. There is a significant negative correlation (r = 0.78 – 0.92) between the duration of diabetes and pupil dilatation at all intervals after installation of the drops. There is also significant difference (P< 0.005) in the mean values of pupil diameter between non retinopathy diabetic subjects and diabetic retinopathy subjects at all intervals after installation of drops. Conclusion: People attending eye clinic, whose pupil mydriasis values falls below the normal may be referred for diabetic evaluation. If normative data is established for the pupil size in Indian population using Orbscan then the values fall under normative data could be a predictor for diabetes. This would in turn help ophthalmologist to detect the diabetes at an early stage and prevent the complications resulting from the diabetes.

Keywords: diabetes mellitus, pupil diameter, orbscan, tropicamide

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Authors: Reda Goweda, Mokhtar Shatla, Arawa Alzaidi, Arij Alzaidi, Bashair Aldhawani, Hibah Alharbi, Noran Sultan, Daniah Alnemari, Badr Rawa

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Background: 20.5% of Saudis between 20 and 79 years are diabetics. Diabetic foot is a chronic complication of diabetes. The incidence of non traumatic lower extremity amputations is at least 15 times greater in those with diabetes than non diabetics. Patient education is important to reduce lower extremity complications. Objective: To assess the knowledge and practices of the diabetic patients regarding foot care and diabetic foot complications. Methods: In Makkah hospitals, 350 diabetic patients who met the inclusion criteria were involved in this cross sectional study. Interviewing questionnaire and patients’ charts review were used to collect the data. Results: Mean age of patients was 53.0083±13.1 years, and mean duration of diabetes was 11.24±8.7 years. 35.1% had history of foot ulcer while 25.7% had ulcer on the time of interview. 11.7 % had history of amputation and 83.1% had numbness. 77.1 % examine their feet while 49.1% received foot care education and 34% read handouts on foot care. 34% walk around in bare feet. There is a significant statistical association between foot education, foot care practices, and diabetic foot ulcer (p-value < 0.022). Conclusion: Patient knowledge and practices regarding diabetic foot care is significantly associated with the reduction of diabetic foot ulcer.

Keywords: knowledge, practice, attitude, diabetes, foot, care

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Authors: L. B. Naves, L. Almeida

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The development of Drugs Delivery System (DDS), has been wildly investigated in the last decades. In this paper, first a general overview of traditional and modern wound dressing is presented. This is followed by a review of what scientist have done in the medical environment, focusing the possibility to develop a new alternative for DDS through transdermal pathway, aiming to treat melanoma skin cancer.

Keywords: cancer therapy, dressing polymers, melanoma, wound healing

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Authors: Erfan Ghasemi, Mohammadreza Khani, Hamidreza Mahmoudi, Mohammad Ali Nilforoushzadeh, Babak Shokri, Pouria Akbartehrani

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Given the global significance of treating infectious wounds, the goal of this study is to use spark plasma as a new treatment for infectious wounds. To generate spark plasma, a high-voltage (7 kV) and high-frequency (75 kHz) source was used. Infectious wounds in the peritoneum of mice were divided into control and plasma-treated groups at random. The plasma-treated animals received plasma radiation every 4 days for 12 days, for 60 seconds each time. On the 15th day after the first session, the wound in the plasma-treated group had completely healed. The spectra of spark plasma emission and tissue properties were studied. The mechanical resistance of the wound healed in the plasma treatment group was considerably higher than in the control group (p<0.05), according to the findings. Furthermore, histological evidence suggests that wound re-epithelialization is faster in comparison to controls. Angiogenesis and fibrosis (collagen production) were also dramatically boosted in the plasma-treated group, whereas the stage of wound healing inflammation was significantly reduced. Plasma therapy accelerated wound healing by causing considerable wound constriction. The results of this investigation show that spark plasma has an influence on the treatment of infectious wounds.

Keywords: infectious wounds, mice, spark plasma, treatment

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Authors: M. Wisnu Pamungkas, Patrianef Darwis

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Introduction: Critical limb ischemia (CLI) is a vascular disease that has a significant amputation and mortality risk with diabetes mellitus, the most significant risk factor in CLI, is very common among Indonesian. Endovascular intervention (EVI) is preferred in treating CLI because it is noninvasive and effective. Balloon angioplasty and stent angioplasty are the most common method of EVI in Indonesia. This study aims to compare the effectiveness of balloon angioplasty and stent angioplasty on wound healing in CLI. Method: A cross-sectional study enrolled 90 subjects of CLI who underwent endovascular intervention using balloon angioplasty and stent angioplasty from January 2013 to July 2017 in dr. Cipto Mangunkusumo General Hospital, Jakarta. The wound healing period between balloon angioplasty dan stent angioplasty was analyzed using unpaired T-test with p<0,05 considered as statistically significant. Data of intervention method wound healing period, and subjects characteristic data (age, amputation, BMI, smoking habit, DM, occlusion site, and blood profile) were obtained. Result: The wound healing period in balloon angioplasty and stent angioplasty distributed normally. Mean value of wound healing period in balloon angioplasty and stent angioplasty are 84,8+/-2,423 and 59,93 +/- 2,423 days with a mean difference of 25 days. The difference in wound healing period in both groups is statically significant (p<0,05). The amputation event in balloon angioplasty and stent angioplasty is 22 and 16 event with no difference statistically. Conclusion: Stent angioplasty is a better method than balloon angioplasty for wound healing in patients with CLI.

Keywords: critical limb ischemia, endovascular intervention, wound healing, angioplasty

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Authors: Abrar Noorain, Zeinab Amara, Sulaf Abdelaziz

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Background: Diabetic foot disease imposes a financial burden on diabetic patients and healthcare services. In Sudan, diabetic foot ulcer prevalence reached 18.1%. This study aims to assess the knowledge, attitudes, and practices and the correlation between the level of foot care knowledge and self-care practices among diabetic patients in Sudan. Methodology: In a cross-sectional study involving 262 patients with type 1 and type 2 diabetes attending diabetic clinics in three primary care centers in Khartoum, Sudan, during September to November 2022, information regarding participants sociodemographic status, foot care knowledge, attitudes, and practices was gathered using a validated, structured questionnaire in a face-to-face interview method. These data were analyzed using the statistical package for the social sciences (SPSS) 22. Results: The patients’ mean age was 54.9 years, with a female predominance (56%). Of the participants, 37% had diabetes mellitus for over ten years. On the topic of foot care, 35.5% of patients showed good knowledge, and 76% were aware of the risk of reduced foot sensation. In relation to nail care, only 19% knew how to cut nails correctly. Conclusion: Knowledge, attitudes, and practices about diabetic foot care are substandard. There is a positive correlation between foot care knowledge and self-care practices. Hence, educating diabetic patients with foot care knowledge through an awareness program and the characteristics of diabetic shoes may improve self-care practices.

Keywords: DM, DFD, DFU, PHC, SPSS

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Authors: Elham Rouhollahi, Soheil Zorofchian Moghadamtousi, Salma Baig, Mahmood Ameen Abdulla, Zahurin Mohamed

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This study was designed to assess cutaneous wound healing potential of hexane extract of Curcuma purpurascens rhizomes (HECP). Twenty-four rats were divided into 4 groups: 1. Negative, 2. Low dose, 3. High dose and 4. Treatment, with 6 rats in each group. Full-thickness incisions with a diameter of 2 cm were made on the back of each rat. Rats were topically treated two times a day for 15 days. Group 1-4 were treated with sterile distilled water, 5% and 10% of extract and intrasite gel, respectively. Masson's trichrome and hematoxylin staining techniques are employed for histological analysis revealed strong wound healing potential closer to that of conventional drug intrasite gel. HECP significantly decreased wound area and an increase in hydroxyproline, cellular proliferation, the number of blood vessels and the level of collagen synthesis was observed. Thus, it could be concluded that HECP possesses strong wound healing potential.

Keywords: Curcuma purpurascens, wound healing, histopathology, hematoxylin staining

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Authors: Solomon Assefa Huluka

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Wounds account for severe morbidity, socioeconomic distress, and mortality around the globe.For several years, various herbal products are used to expediteand augment the innate wound healing process. In Ethiopian folkloricmedicine, Verbascum sinaiticum L. (V. sinaiticum) is commonlyapplied as a wound-healing agent. The present study investigated the potential wound healing and antioxidant properties of hydroalcoholic leaf extract of V. sinaiticum. The 80% methanol extract, formulated as 5% (w/w) and 10% (w/w) ointments, was evaluated in excision and incision wound models using nitrofurazone and simple ointment as positive and negative controls, respectively. Parameters such as wound contraction, period of epithelialization, and tensile strength were determined. Moreover, its in vitro antioxidant property was evaluated using a DPPH assay. In the excision model, both doses (5% and 10% w/w) of the extract showed a significant (p<0.001) wound healing efficacy compared to the negative control, as evidenced by enhanced wound contraction rate and shorter epithelialization time records. In the incision model, the lower dose (5% w/w) ointment formulation of the extract exhibited the maximum increment in tensile strength (85.6%) that was significant (p<0.001)compared to negative and untreated controls. Animals treated with 5% w/wointment, furthermore, showed a significantly (p < 0.05) higher percentage of tensile strength than nitrofurazone treated ones. Moreover, the hydroalcoholic extract of the plant showed a noticeable free radical scavenging property. The result of the present study upholds the folkloric use of V. sinaiticum in the treatment of wounds.

Keywords: wound healing, antioxidant, excision wound model, incision wound model, verbascum sinaiticum

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Authors: N. Uchegbu Nneka

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This study was conducted to investigate the effect of the antioxidant activity of germinated African Yam Bean (AYB) on oxidative stress markers in alloxan-induced diabetic rat. Rats were randomized into three groups; control, diabetic and germinated AYB–treated diabetic rats. The Total phenol and flavonoid content and DPPH radical scavenging activity before and after germination were investigated. The glucose level, lipid peroxidation and reduced glutathione of the animals were also determined using the standard technique for four weeks. Germination increased the total phenol, flavonoid and antioxidant activity of AYB extract by 19.14%, 32.28%, and 57.25% respectively. The diabetic rats placed on germinated AYB diet had a significant decrease in the blood glucose and lipid peroxidation with a corresponding increase in glutathione (p<0.05). These results demonstrate that consumption of germinated AYB can be a good dietary supplement in inhibiting hyperglycemia/hyperlipidemia and the prevention of diabetic complication associated with oxidative stress.

Keywords: African yam bean, antioxidant, diabetes, total phenol

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Authors: Guo Yu, Haoming Ma, Peiru Zhou

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BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, a decrease in the time in the targeted blood glucose range (TIR) may be associated with an increased risk of death for critically ill patients. However, the relationship between the TIR and mortality may be influenced by the presence of diabetes and glycemic variability. METHODS: A total of 998 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9–10.0 mmol/L within 24 hours. The relationship between TIR and in-hospital in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. RESULTS: The binary logistic regression model showed that there was a significant association between the TIR as a continuous variable and the in-hospital death of severely ill non-diabetic patients (OR=0.991, P=0.015). As a classification variable, TIR≥70% was significantly associated with in-hospital death (OR=0.581, P=0.003). Specifically, TIR≥70% was a protective factor for the in-hospital death of severely ill non-diabetic patients. The TIR of severely ill diabetic patients was not significantly associated with in-hospital death; however, glycemic variability was significantly and independently associated with in-hospital death (OR=1.042, P=0.027). Binary logistic regression analysis of comprehensive indices showed that for non-diabetic patients, the C3 index (low TIR & high CV) was a risk factor for increased mortality (OR=1.642, P<0.001). In addition, for diabetic patients, the C3 index was an independent risk factor for death (OR=1.994, P=0.008), and the C4 index (low TIR & low CV) was independently associated with increased survival. CONCLUSIONS: The TIR of non-diabetic patients during ICU hospitalization was associated with in-hospital death even after adjusting for disease severity and glycemic variability. There was no significant association between the TIR and mortality of diabetic patients. However, for both diabetic and non-diabetic critically ill patients, the combined effect of high TIR and low CV was significantly associated with ICU mortality. Diabetic patients seem to have higher blood glucose fluctuations and can tolerate a large TIR range. Both diabetic and non-diabetic critically ill patients should maintain blood glucose levels within the target range to reduce mortality.

Keywords: severe disease, diabetes, blood glucose control, time in targeted blood glucose range, glycemic variability, mortality

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Authors: Harpreet Kaur, Er. Arjun, Kirandeep Kaur, P. K. Mittal

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Simulation of a human body from 20% gelatin & 80% water mixture is examined from wound ballistics point of view. Parameters such as incapacitation energy & temporary to permanent cavity size & tools of hydrodynamics have been employed to arrive at a model of human body similar to the one adopted by NATO. Calculations using equations of motion yield a value of 339 µs in which a temporary cavity with maximum size settles down to permanent cavity. This occurs for a 10mm size bullets & settle down to permanent cavity in case of 4 different bullets i.e. 5.45, 5.56, 7.62,10 mm sizes The obtained results are in excellent agreement with the body as right circular cylinder of 15 cm height & 10 cm diameter. An effort is made here in this work to present a sound theoretical base to parameters commonly used in wound ballistics from field experience discussed by Col Coats & Major Beyer. Keywords. Gelatin, gunshot, hydrodynamic model, oscillation time, temporary cavity and permanent cavity, Wound Ballistic.

Keywords: gelatin, gunshot, wound, cavity

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Authors: Xuan Li, Xiaobing Cui, Nan Meng, Shuangshuang Guo, Lingling Wang

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Objective: To investigate the influence of Paeonol on diabetic nephropathy progression in streptozocin (STZ) -induced diabetic rats. Method Male Wistar rats were injected STZ 30mg.kg-1 combined with Freund's complete adjuvant (CFA) 0.1mL/rat once a week for three weeks. The diabetic rats were treated with Paenol for 13 weeks. At the end of the experiments, the rats were anesthetized. Serum and the kidney were collected. Serum superoxide dismutase (SOD) activity, malondialdehyde (MDA), blood urea nitrogen (BUN), creatinine (Cr) and total cholesterol (Chol) level were detected; kidney paraffin sections were prepared and HE and PAS staining sections were used to evaluate the pathology changes of the kidney. Immunohistochemical analysis was used to observe the expression of VEGF and fibernectin expression in the kidney. Result The blood glucose level remained over 16mmol. L-1 for 13 weeks and the ECM accumulated in the diabetic kidney apparently. Paeonol treatment increased serum SOD activity, however, MDA, BUN, Cr, and Chol level was decreased by paeonol treatment. VEGF and fibernectin expression were increased significantly in the DN rats and paeonol treatment ameliorated the overexpression. Conclusion: paeonol prevented the progression of DN.

Keywords: paeonol, STZ, diabetic nephropathy, fibernectin expression, kidney paraffin sections

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