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Introduction: Chronic venous insufficiency causes skin pigmentation of the leg ranging from small patches of mild dyschromia to extensive areas of severe skin pigmentation. It is thought that the pigmentation is mainly due to haemosiderin or melanin deposition. Erythrodiapedesis which occurs as a result of venular hypertension causes erythrocytes to migrate across the microvascular network into the dermis. Methods: We categorized the grading of pigmentation into four grades: +, few spots; ++, pigmentation over gaiter area; +++, pigmentation involving leg and ankle; ++++, heavily pigmented (dark). Skin biopsies were taken from the patient while undergoing surgery; two biopsies were taken from each patient, one from apparently normal skin and other from the site of pigmentation. A total of 45 patients diagnosed as chronic venous insufficiency with pigmentation were included in the study and five patients included in control. The biopsy specimens were sent to pathology department for H&E, Perls stain and IHC for S100. Results: Majority of cases, i.e. 62% of limbs fall under (++) grade of pigmentation, followed by (+) grade of pigmentation in 20%, while (+++) and (++++) constitute 9% of the cases each. Increased melanin deposition was seen in 40 pigmented skin biopsies and 3 normal skin biopsies from the case group, and normal melanin deposition was seen in all the non-varicose controls. Conclusion: We have tried to categorize pigmentation in chronic venous insufficiency into four grades. As the grade of pigmentation increases the per cent of cases with ulceration is increasing. It was observed that presence of melanin deposition irrespective of the grade of pigmentation was distributed more towards the advanced clinical classification (C5 and C6). [ABSTRACT FROM AUTHOR]

Objectives: Diabetic foot disease causes substantial morbidity and mortality, but it can be prevented. Our study examined the frequency of diabetes-related foot problems and foot self-care practices, as reported by consecutive patients attending primary and secondary diabetes services in Muscat, Oman. Methods:. A cross-sectional survey utilizing a newly developed and pre-tested questionnaire was conducted at eight primary health care centers and one polyclinic (secondary care) in A'Seeb, Muscat. A convenience sample of 353 consecutive Omanis, aged 20 years and above, diagnosed with diabetes were invited to participate in this study. We collected data on clinico-demographic characteristics, patient-reported foot complications, and foot self-care practices. Results: Of the 350 patients who agreed to participate (mean diabetes duration 7.9±7.4 years, response rate: 99.2%), 62.3% were female, 57.4% were unemployed, more than half were illiterate (52.9%), and around three-quarters (71.4%) were unsure of the type of diabetes they had. More than half (55.1%) reported having at least one or more sensory peripheral neuropathy symptoms, almost half (49.1%) reported one or more peripheral vascular disease symptoms in the previous month, and 12.5% a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 54.7% did not examine the bottom of their feet each day. Conclusions: Although self-reported diabetes-related foot complications were common in this population, foot self-care practices were inadequate. These findings suggest a need for the provision of regular foot care education to patients with diabetes. Future research should explore barriers to recommended foot self-care practices. [ABSTRACT FROM AUTHOR]

Lung carcinoma is the most common carcinoma seen in males with the skin being a rare metastatic site. Adenosquamous carcinoma as a rare histologic subtype, showing cutaneous metastasis is an unusual event with no reports in the literature till date. Skin metastasis is an alarming sign, carries poor prognosis, and is associated with shortened survival. Herein, we report a case of 60-year-old male who presented with isolated cutaneous metastasis as a chronic nonhealing ulcer over the sternal region for 3 years (unusual) in the first place, without any other associated symptoms and clinical evidence of the primary. Wide local excision of the lesion was performed after proper workup which revealed metastatic adenosquamous carcinoma. The patient was advised systemic chemotherapy. A high index of suspicion along with clinico-radio-pathological correlation in these cases is of utmost importance and forms the basis of accurate diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Medical ozone is a strong oxidant, can kill bacteria, resist inflammation, improve circulation, relieve pain and promote regeneration. It has been reported that medical ozone has a positive effect on ulcer wounds such as caries. OBJECTIVE: To explore the clinical effect of ozone bath on the control of diabetic foot ulcer’s infection and the promotion of wound healing. METHODS: According to the treatment methods, 100 patients with type 2 diabetic foot ulcer who met the inclusion criteria were divided into two groups randomly. In the experimental group, ozone bath was applied to the wound for 30 minutes after cleaning the wound with local normal saline; in the control group, air bath was applied to the wound for 30 minutes after cleaning the wound with local normal saline, once a day. Three weeks later, the bacterial control (quantitative analysis of bacteria, distribution of pathogenic bacteria), the degree of decline of inflammation index, the reduction of ulcer wound, the rate of wound healing and the visual analogue scale score of wound pain were counted in both groups. The expression levels of vascular endothelial growth factor, transforming growth factor-β and platelet-derived growth factor in wound tissues were measured before and after treatment. The protocols were approved by the Ethics Committee of Beijing Shijitan Hospital Affiliated to Capital Medical University. Patients and their family member signed the informed consent. RESULTS AND CONCLUSION: After 3 weeks of treatment, bacteria were still detected in 46 patients in the control group and 5 patients in the experimental group. The number of pathogenic bacteria was 73 before treatment and 66 after treatment in the control group, 74 before treatment and 7 after treatment in the experimental group. Bacterial quantitative analysis was significantly higher in the control group than in the experimental group after treatment. The indexes of ulcer healing, including the reduction of ulcer wound, the visual analogue scale score of wound pain, and the degree of decline of inflammation index, were better in the experimental group than those in the control group (P < 0.05). (4) The expression levels of vascular endothelial growth factor, transforming growth factor-β and platelet-derived growth factor in local wound tissues were significantly higher in the experimental group than in the control group (P < 0.05). The percentage of wound healing in the experimental group was significantly higher than that in the control group (P < 0.05). To conclude, ozone bath can significantly control the local infection of diabetic foot, reduce the distribution of pathogenic bacteria on the wound surface, relieve the inflammatory pain of the wound, stimulate the secretion of growth factor in wound, and improve the wound healing rate. [ABSTRACT FROM AUTHOR]

The assessment of bird-based welfare indicators plays an important role in the evaluation of bird welfare. The aim of the study was to histologically validate a visual scoring system for hock burn in broilers and to detect threshold values of a visual score to define welfare-relevant alterations in terms of mild lesions or ulcers of the hock. We collected 200 hocks of 39- to 42-day-old Ross 308 broilers after the slaughter process. Each hock was scored visually ("macro scores" 0–4) and evaluated histologically ("micro scores" 0–3), with high scores representing more severe lesions. Although we found a tendency for higher micro scores with increasing macro scores, an exact allocation of macro to micro scores was not possible. For example, macro score 1 could represent micro scores 1, 2 and 3, whereas macro scores 3 and 4 always represented micro score 3 (ulcer). The conditional probability of certain micro scores for given macro scores was estimated using a multinomial logistic regression model. Ulcer showed the highest probability at macro score 1, whereas mild lesions were not found to have an estimated highest probability at any macro score. The depth of inflammation of hock burn lesions increased with increasing macro scores up to macro score 3 with an average depth of 1019 µm. Visually more severe and deeper lesions were also histologically rated with higher scores. Thus, considering limitations, the herein validated macroscopic assessment scheme for hock burn allows an estimation of histological alterations in hocks of broilers. RESEARCH HIGHLIGHTS Histological validation of a visual assessment scheme for hock burn in broilers. Tendency for higher micro scores with increasing macro scores. Estimation of histological score via macro score possible with limitations. Histological depth of inflammation increased with an increasing macro score. [ABSTRACT FROM AUTHOR]

Objectives: To assess the in vitro activities of acetylmidecamycin, a 16-membered macrolide, and 11 other antimicrobial agents against human mycoplasmas.Methods: A total of 187 clinical isolates, Mycoplasma pneumoniae (n = 110), Mycoplasma hominis (n = 26) and Ureaplasma species (n = 51), were included in this study. The MICs of 12 antimicrobial agents, including acetylmidecamycin, thiamphenicol, chloramphenicol and some other macrolides, fluoroquinolones and tetracyclines, for these clinical isolates were determined by the broth microdilution method.Results: For M. pneumoniae, the MIC90 values of the tested macrolides were: acetylmidecamycin (1 mg/L)128 mg/L). Thiamphenicol and chloramphenicol had the same MIC90 (2 mg/L). For Ureaplasma species, the MIC90 values were: acetylmidecamycin (0.25 mg/L)128 mg/L)=erythromycin. The MIC90 values of chloramphenicol and thiamphenicol were 2 and 4 mg/L, respectively.Conclusions: The results indicated that acetylmidecamycin and thiamphenicol are active in vitro against the most common mycoplasma species infecting humans, including those resistant to macrolides and fluoroquinolones. Acetylmidecamycin and thiamphenicol might be a promising option for clinicians to treat infections caused by Mycoplasma and Ureaplasma spp., particularly macrolide-resistant M. pneumoniae in paediatrics and fluoroquinolone-resistant M. hominis in adults. Further investigation of their clinical roles in treating infections caused by these organisms is warranted. [ABSTRACT FROM AUTHOR]

• Molecular mechanisms underlying skin alterations in diabetes are largely unknown. • A general down-regulation of miRNA baseline expression was found in diabetic skin. • Down-regulated miRNAs control pathways involved in skin homeostasis. • Altered expression also involved pri-miRNAs and miRNA biogenesis genes. • These molecular defects likely contribute to diabetic skin manifestations. Clinical skin manifestations are common in diabetes; however, molecular mechanisms underlying such defects are largely unknown. Several findings indicate a role for microRNAs (miRNAs) in skin homeostasis. To investigate whether miRNA expression is altered in diabetic skin. Type 1 and 2 mouse models of diabetes were used. MiRNA profiling was performed on RNA extracted from the skin of type 1 diabetic mice and non-diabetic controls. Expression levels of pri-miRNAs and of miRNA-biogenesis genes were also analyzed. Biogenesis gene expression analysis was performed in human dermal fibroblasts cultured in hyperglycemic, hypoxic or oxidative stress conditions. Several miRNAs were differentially expressed in diabetic skin with a general down-modulation as compared to controls. Bioinformatics analysis of signature-miRNA target genes showed the enrichment in pathways involved in skin homeostasis, such as TGF-β and Wnt. MiRNA alteration in diabetic skin associated with reduced expression levels of DROSHA, DGCR8, XPO5, DICER1, AGO2, both as mRNA and protein. Reduced biogenesis gene expression did not correlate with accumulation of pri-miRNAs, which displayed differences in expression levels similar to those found for their mature miRNAs. Experiments with cultured fibroblasts showed that hypoxia and oxidative stress induced the down-regulation of miRNA-biogenesis genes in this skin cell type. A general down-regulation of differentially expressed miRNAs was found in diabetic skin. This alteration is part of and is dependent from a wider transcriptional defect also affecting the expression of pri-miRNAs and of genes responsible for miRNA biogenesis. Such an alteration is likely contributing to diabetic skin manifestations. [ABSTRACT FROM AUTHOR]

African Histoplasmosis is deep mycosis caused by Histoplasma duboisii and genitourinary involvement is extremely rare. We report a case of African histoplasmosis in a 27-year-old subject with painful penis ulcer. Ulcer edge biopsy had revealed inflammatory granulomas made of epithelioid cells, lymphoplasmocytes, polynuclear eosinophils and giant multinucleated cells, with ovoid yeasts surrounded by a clear halo. PAS and Grocott stains revealed numerous fungal structures with a morphology measuring 7 to 15 nm. The diagnosis Histoplasma capsulatum var. duboisii was placed and the patient put on itraconazole (400 mg/day) for six months with a good course. African histoplasmosis of the subject penis is an extremely rare entity. The diagnosis of certainty often makes use of histology and mycological examination, and makes it possible to eliminate differential diagnoses such as cryptoccocosis, tuberculosis or cancer. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) colitis with a cobblestone appearance is rare, and its endoscopic and pathological features remain poorly described. A 78-year-old woman was admitted to our hospital for disturbance of consciousness, high-grade fever, and diarrhea occurring up to 7 times a day. Sigmoidoscopy revealed a circumferential ulcer with mucosal defect, an ulcer with a cobblestone appearance extending from the upper rectum to the sigmoid colon, and an irregular ulcer on the lower rectum. She was histopathologically diagnosed with CMV colitis and intravenously treated with ganciclovir (5 mg/kg) for 7 weeks. Colonoscopy after treatment revealed an improvement of the ulcers extending from the rectum to the sigmoid colon, but no significant improvement of her general condition. She died from sepsis 4 months after hospitalization. To our knowledge, this report represents a valuable addition to the CMV literature describing a rare case of CMV colitis with a cobblestone appearance. [ABSTRACT FROM AUTHOR]

Background Surgical reconstruction of chronic wounds is often infeasible due to infection, comorbidities, or poor viability of local tissues. The aim of this study was to describe the authors' technique for improving the regenerative and antimicrobial potential of a combination of modified nanofat and platelet-rich plasma (PRP) in nonhealing infected wounds. Methods Fourteen patients met the inclusion criteria. Fat tissue was harvested from the lower abdomen following infiltration of a solution of 1,000 mL of NaCl solution, 225 mg of ropivacaine, and 1 mg of epinephrine. Aspiration was performed using a 3-mm cannula with 1-mm holes. The obtained solution was decanted and mechanically emulsified, but was not filtered. Non-activated leukocyte-rich PRP (naLR-PRP) was added to the solution before injection. Patients underwent three sessions of injection of 8-mL naLR-PRP performed at 2-week intervals. Results Thirteen of 14 patients completed the follow-up. Complete healing was achieved in seven patients (53.8%). Four patients (30.8%) showed improvement, with a mean ulcer width reduction of 57.5%±13.8%. Clinical improvements in perilesional skin quality were reported in all patients, with reduced erythema, increased thickness, and increased pliability. An overall wound depth reduction of 76.6%±40.8% was found. Pain was fully alleviated in all patients who underwent re-epithelization. A mean pain reduction of 42%±33.3% (as indicated by visual analog scale score) was found in non-re-epithelized patients at a 3-month follow-up. Conclusions The discussed technique facilitated improvement of both the regenerative and the antimicrobial potential of fat grafting. It proved effective in surgically-untreatable infected chronic wounds unresponsive to conventional therapies. [ABSTRACT FROM AUTHOR]

Background/Aims: Opioid-induced bowel dysfunction includes nausea, vomiting, constipation and abdominal distension. We describe patients presenting with gastrointestinal (GI) ulcers and ulcerated strictures secondary to opioid abuse, an entity not well described in literature. Methods: This retrospective observational study included patients with opioid abuse gastroenteropathy presenting to Dayanand Medical College and Hospital, Ludhiana, India between January 2013 and December 2018. Opioid abuse gastroenteropathy was defined as gastric or small bowel ulcers and ulcerated strictures in patients abusing opioids, where all other possible etiologies of GI ulcers/strictures were excluded. Clinical, biochemical, endoscopic, radiological and histological parameters as well as response to treatment were assessed. Results: During the study period, 20 patients (mean age, 38.5 ± 14.2 years; 100% males) were diagnosed to have opioid induced GI ulcers and/or ulcerated strictures. The mean duration of opioid consumption was 6.2 ± 3.4 years. The mean duration of symptoms at presentation was 222.1 ± 392.3 days. Thirteen patients (65%) had gastroduodenal involvement, 6 (30%) had a jejunoileal disease and 1 (5%) had an ileocecal stricture. Two patients (10%) presented with upper GI bleeding, 11 (55%) had features of gastric outlet obstruction and 7 (35%) presented with small bowel obstruction. Abdominal pain and iron deficiency anemia were the most common presentations. Only 1 patient (5%) responded to proton pump inhibitors, 3 (15%) had a lasting response to endoscopic balloon dilatation, while all other (80%) required surgical intervention. Conclusions: Opioid abuse gastroenteropathy presents as ulcers and ulcerated strictures which respond poorly to medical management and endoscopic balloon dilatation. A majority of these cases need surgical intervention. [ABSTRACT FROM AUTHOR]

Wireless capsule endoscopy (WCE) is a novel imaging technique that can view the entire small bowel in human body. Therefore, it has been gradually adopted compared with traditional endoscopies for gastrointestinal diseases. However, the task of reviewing the vast amount of images produced by a WCE test is exhaustive for the physicians. This paper presents a new feature extraction scheme for pathological inflammation and ulcer regions discrimination in WCE images. In addition, the novel approach is adopted for polyp recognition in colonoscopy videos. A novel idea based on extracting certain local features from the image is proposed. Then, the occurrence histogram of these features is used as descriptor of the image. The new feature descriptor scheme is grayscale rotation invariant and computationally simple as the operator can be realized with a few operations in a small neighborhood. The proposed operator does not discard the contrast information. Besides, we propose to test the quality of the model using logarithmic loss metric and show how calibration can be useful in reducing the aforementioned measure. Extensive classification experiments have been applied on different datasets, which prove that the occurrence histogram of the extracted features is powerful. The proposed method achieved 99.1%, 99.7% and 99.2% in terms of the precision in the first, second and third datasets, respectively, and surpassed some known local descriptors on a texture dataset. [ABSTRACT FROM AUTHOR]

Gout is a metabolic disease that occurs either because of increased uric acid production or decreased uric acid secretion. It most commonly affects middle‑aged to elderly men and postmenopausal women. Chronic tophaceous gout frequently occurs after 10 years or more of recurrent polyarticular gout. Gouty tophi are deposition of monosodium urate (MSU) crystals in and around joints as well as soft tissues. We present a case of chronic tophaceous gout in a 21‑year‑old male, which occurred after 4 years of onset of gouty arthritis. The patient presented with tophaceous gout in four forms, that is, periarticular subcutaneous tophi, disseminated intradermal tophi, ulcerative form, and miliarial tophi along with multiple sinuses discharging chalky white material. The case was diagnosed as chronic tophaceous gout on the basis of raised serum uric acid, imprint smear showing needle‑shaped crystals and negatively birefringent crystals on polarized microscopy. The case is interesting for varied morphological forms of tophaceous gout in a patient at an early age and shorter interval between onset of gouty arthritis and tophaceous gout. [ABSTRACT FROM AUTHOR]

Objectives: Healing of gastric endoscopic submucosal dissection (ESD)-induced ulcer is critical for patient recovery. During ESD treatment, submucosal incisions are made with an electrosurgical knife to accomplish en bloc resections of superficial lesions. Nevertheless, excess electrocoagulation may decrease the blood supply of ESD-induced ulcer and delay the ulcer healing. The aim of this retrospective study was to evaluate the effectiveness of conservative electrocoagulation followed by porcine fibrin sealant (FS) as a wound microvessels-protective hemostatic technique in promoting the healing of ESD-induced ulcer.Methods: A total of 332 patients with early gastric cancer (EGCs), or gastric precancerous lesion and gastric adenoma were retrospectively analyzed. Propensity score matching was used to compensate for the differences in age, gender, tumor location, resected specimen area, and pathology. One-month ulcer healing rates and delayed bleeding were compared between two matched groups (combined hemostats group and electrocautery group).Results: A total of 115 matched pairs were created after propensity score matching. There was no difference in tumor location, specimen surface area, tumor differentiation and invasion depth between groups. The completed healing rate 1 month after ESD was 44.3% in combined hemostats group and 30.4% in electrocautery group (P = 0.004). There was no difference in delayed massive bleeding rate between two groups (P = 0.300). In addition, based on the multivariate regression analysis for ulcer healing rate, the use of FS (OR, 0.348, 95% CI 0.196 - 0.617, P = 0.000) and larger specimen size (OR, 2.640, 95% CI 2.015-3.458, P = 0.000) were associated with nonhealing ulcer 1 month after ESD.Conclusion: Applying conservative electrocoagulation followed by porcine FS as a wound microvessels-protective hemostatic technique can promote ESD-induced ulcer healing without increasing delayed bleeding. [ABSTRACT FROM AUTHOR]

Background: Gastric schwannomas are rare benign tumors originating from the intramuscular plexus of the stomach and account for just 2.6% of gastric mesenchymal tumors. Gastric schwannoma (GS) with a surface ulcer is very rare. Herein, we report a rare case of an ulcer-bearing GS, which in conjunction with multiple enlarged regional lymph nodes, readily mimicked gastric cancer (GC).Case Presentation: A 79-year-old female presented with poor appetite and intermittent vomiting of gastric contents during the past month. Gastroscopy revealed a giant crateriform ulcer within the stomach body (at the angular notch). Its raised and indurated border was fragile and bled easily. GC was thus suspected. Contrast-enhanced computer tomography (CT) revealed a mild enhancement of the corresponding irregularly thickened gastric wall, and an annular zone of mucosal discontinuity. Enlarged regional lymph nodes were also found, making GC with metastases of lymph nodes our primary concern. 18F-fluorodeoxyglueose position emission tomography (18F-FDG PET)/CT was then performed for further staging. Obviously increased FDG uptake was shown in the gastric lesion ((maximum standardized uptake value (SUVmax) 14.6), but no FDG uptake was observed in the enlarged regional lymph nodes. Given the strong suspicion of GC, subtotal gastrectomy was performed. GS was revealed by postoperative pathology, with no evidence of metastasis in the 13 resected lymph nodes.Conclusions: This was a rare case of GS with a giant surface ulcer and multiple enlarged regional lymph nodes. The uptake of 18F-FDG in the tumor was substantially higher than previously published literature reports. Under these circumstances, it is difficult to be differentiated from GC. [ABSTRACT FROM AUTHOR]

In addition to the differential diagnosis of the leg ulcer, an entity hardly mentioned in the literature is considered, namely the gout ulcer. On the basis of a case study, newer forms of diagnosis and their significance in case of suspicion of gout ulcer are discussed. [ABSTRACT FROM AUTHOR]

Fat injections aid in the healing of radiation-induced skin damage. We hypothesized that the direct application of fat grafts to the surfaces of radiation-induced ulcers is also effective. Here, we aimed to evaluate the effectiveness of a combination treatment comprising fat injections around ulcers and fat grafts on ulcer surfaces. The dorsal skin of inbred rats was irradiated at a single dose of 20 Gy before producing ulcers. After the inguinal fat was harvested using the Coleman technique, the rats were divided into four groups: Group 1, ulcer wounds were covered using dressing materials and staples only; Group 2, fat was injected around the ulcers using a cannula; Group 3, fat was grafted onto ulcer surfaces; and Group 4, a combination of fat injection around the ulcers and fat grafts onto ulcer surfaces was employed. The mean healing time (± standard deviation) of each group was as follows: Group 1, 16.0 ± 2.2 days; Group 2, 14.5 ± 2.0 days; Group 3, 15.2 ± 1.7 days; and Group 4, 13.4 ± 1.0 days. The healing time of Group 4 was significantly shorter than that of Group 1 (p =.0005) and Group 3 (p =.023). In both groups that received fat grafts, fat tissue was observed in the dermis on hematoxylin-eosin-stained slides at 4 and 8 weeks after the ulcers were created. In conclusion, the combination treatment of fat grafted onto ulcer surfaces and injected around ulcers was effective in accelerating the epithelization of radiation-induced ulcers. [ABSTRACT FROM AUTHOR]

Introduction: Oral Lichen Planus (OLP) is a chronic inflammatory, immune mediated disease that affects the oral mucosa and skin. Though conventional therapies have aimed to alleviate the signs and symptoms of OLP, they have side effects. To combat this, trend is towards natural products such as curcumin which has antioxidant, anti-inflammatory and anticancer properties. Aim: This systematic review aimed to evaluate the existing literature on the role of curcumin in the alleviation of pain, burning sensation, erythema and ulceration in OLP patients. Materials and Methods: Articles on curcumin in the treatment of oral lichen planus were extensively searched in PubMed, Google scholar, Science direct, Cochrane database using key terms "turmeric extracts", "curcuma longa", "curcumin", "curcuminoids", "oral lichen planus," "erosive oral lichen planus" with no year restrictions. Screening was based on title and abstract with preset inclusion and exclusion criteria, and full text articles were procured. Included studies were 7 randomised clinical trial, 2 pilot clinical trial, 3 comparative studies. Primary outcome measure was reduction in pain symptoms and clinical improvement, secondary outcome was to achieve complete healing without recurrence. Results: Publications identified through electronic search revealed 1499 articles, from which twelve studies met inclusion criteria. This systematic review comprised 315 OLP patients, wherein four studies revealed that topical curcumin had no statistically significant difference when compared to corticosteroids in treating pain, burning sensation, erythema and ulceration. In three clinical trials compared with placebo, one study showed statistical significance with increased oral dosage (6000 mg) of curcumin, two were not significant due to its reduced oral dosage (2000 mg). Two studies showed that curcumin was effective with increased concentration. Three studies with no controls were statistically significant in reducing burning sensation and clinical appearance of OLP. Conclusion: Though curcumin exhibited promising effects in alleviating symptomatic OLP, majority of studies were evaluated in very small sample size, hence there is insufficient evidence to draw definitive conclusions. We recommend novel curcumin formulations to increase their bioavailability and to initiate high quality Randomised Controlled Trials (RCT). [ABSTRACT FROM AUTHOR]

A traumatic ulcer is open sore that occur anywhere inside the oral cavity due to trauma. Curcumin was active component of curcuminoid from turmeric extract, its multifaceted biological effects such as, anti-inflammatory, anti-oxidant, anti-carcinogenic and antiinfectious effects. Wound healing properties of curcumin has received tremendous attention. It accelerates wound healing by exerting its action on various stages of wound repair. The aim of the present study is to assess the impact of topical application of curcumin on induced traumatic oral ulcer healing by evaluation immunohistochemical expression of transforming growth factor beta II receptors. Thirty-six male white New Zealand rabbits age between (2-8) months with body weight between (1000-1400 gm), were exposed to traumatic ulcer on the buccal mucosa by 'punch biopsy' with (8 mm) diameter and (2mm) depth. The animals classified into two groups; control group: the ulcer treated with sterilized distal water, and experimental group: the ulcer treated with 1% curcumin oral gel. The rabbits were sacrificed at 3,7,14 days. Immunohistochemical techniques were used to identify the expression of transforming growth factor beta II receptors (TGFßII-Rs) in both control and study groups. The current study revealed treatment with curcumin raised transforming growth factor beta II receptors expression from the 3rd day until 14th day in ulcer area, with maximum expression in keratinocyte, inflammatory cells, endothelial cell, fibroblast cell, and highly significant differences between control and study group. Curcumin facilitated oral mucosa ulcer healing by increase the expression of transforming growth factor beta II receptors from early healing period than in control. [ABSTRACT FROM AUTHOR]

Introduction: Some studies suggest that the accuracy of Helicobacter pylori diagnostic tests is decreased in peptic ulcer bleeding (PUB). We aimed to assess the accuracy of diagnostic tests for H. pylori in patients with PUB in a diagnostic test accuracy (DTA) network meta-analysis. Methods: A systematic search was carried out in seven databases until November 2019. We collected or calculated true and false positive and negative values, and constructed 2×2 diagnostic contingency tables with reference standards including histology, rapid urease test, urea breath test, serology, stool antigen test, culture, and polymerase chain reaction. We ranked the index tests by the superiority indices (SI) and calculated pooled sensitivity and specificity of each test. Discussion: Our search yielded 40 eligible studies with 27 different diagnostic strategies for H. pylori. In 32 articles, the reference standard was a combination of multiple tests. In 12 studies, the index tests were compared with a single testing method. We analyzed seven networks with the reference standards against a single or a combination of diagnostic index tests. None of the index tests had better diagnostic accuracy (SI between 9.94 and 2.17) compared with the individual index tests as all the confidence intervals included 1. Combined testing strategies had higher sensitivities (0.92–0.62) and lower specificities (0.85–0.46) while single tests proved to have higher specificities (0.83–0.77) and lower sensitivities (0.73–0.42). Conclusion: Use of combined tests may have a rationale in clinical practice due to their higher sensitivities. The differences between the included DTA studies limited the comparison of the testing strategies. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical characteristics, bacterial isolates, and in vitro antimicrobial susceptibility patterns for cats with bacterial keratitis. Animals Studied: Eighty one cats with bacterial keratitis. Procedures: Medical records of cats with a clinical diagnosis of bacterial keratitis, confirmed by corneal culture, were reviewed from June 2004 to July 2017. Animal signalment, bacterial isolates, aerobic bacteria in vitro antimicrobial susceptibility test results, and pertinent clinical features were recorded. Percentages of susceptible aerobic bacterial isolates were statistically compared among selected antimicrobials. Results: There were 102 aerobic bacterial isolates recovered from corneal samples of the 81 cats presented with bacterial keratitis. The most frequent bacteria isolated were Staphylococcus species, which constituted 55% (56/102) of total isolates. All aerobic bacterial isolates grouped together had the highest percentage of susceptibility to ofloxacin (100%), ciprofloxacin (94%), chloramphenicol (93%), doxycycline (92%), ticarcillin (90%), gentamicin (89%), moxifloxacin (89%), tobramycin (86%), neomycin (85%), amikacin (84%), and cefazolin (84%). The same isolates had the lowest percentage of susceptibility to polymyxin B (2%), bacitracin (15%), and clindamycin (31%). When analyzed separately, the isolated Staphylococcus species had the highest percentage of susceptibility to ofloxacin (100%), tobramycin (93%), and neomycin (85%) and the lowest percentage of susceptibility to polymyxin B (3%) and bacitracin (13%). Conclusions: Members of the Staphylococcus genus were the most frequent bacteria isolated from cases of feline bacterial keratitis. On the basis of in vitro susceptibility testing and mechanism of action, ofloxacin, ciprofloxacin, ticarcillin, gentamicin, or moxifloxacin are recommended for initial antimicrobial therapy of suspected bacterial keratitis in cats. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a disease with significant impact on public health, given the characteristics of the tegumentary lesions. Experimental treatment with larval therapy (LT) has shown its potential use for the cure of leishmaniosis. However, fly species not easy to collect and/or colonize have been used. The objective of the present work was to use a fly of accessible collection and high fecundity, not a producer of human myiasis, such as Musca domestica. A qualitative-quantitative study of a descriptive type was carried out through an experimental design with an animal model (Mesocricetus auratus) with infection by Leishmania amazonensis to evaluate the therapeutic effect of LT and compare the results with the antimonial chemical treatment of the drug experimental "Ulamina". Scarring were observed with the use of LT in 66.66% with TL-simple and 100% with TL-combined. However, the combined use of LT + Ulamina, shows an enhancing effect of the clinical cure of the lesions, but with persistent inflammation. Optimal effectiveness of TL with M. domestica was observed on the ulcers; however, an effect on L. amazonensis was not observed given the presence of amastigotes in the smears and the 480 bp amplicons from the tissue of the ulcers of animals. [ABSTRACT FROM AUTHOR]

Introduction: Histoplasmosis is a fungal infection caused by the agent Histoplasma capsulatum, a dimorphic fungus. The spectrum of illness ranges from subclinical infection to progressive disseminated disease. The major bulk of histoplasma infections are asymptomatic or pulmonary histoplasmosis. In immune compromised patients it can cause disseminated infections involving different organs of the body. In immune competent individuals it may cause isolated adrenal histoplasmosis. Material and methods: A retrospective study was done to look for mucocutaneous histoplasmosis. The excised tissue samples were cultured and only culture confirmed cases were included in the study. Result: Here, we present five cases of primary mucocutaneous histoplasmosis in immune competent individuals in a tertiary care centre in India. These patients had no other co-morbidities and had only isolated lesions in oral cavity or penis. The tissue on excision was cultured and showed growth of Histoplasma capsulatum. All the patients improved with treatment. There are limited cases of mucocutaneous ulcerated lesions caused by Histoplasma capsulatum in immune competent people in published literature. Conclusion: This study emphasizes the necessity of a vigilant look out and clinical suspicion of fungal causes like histoplasma in chronic non healing ulcers which should be confirmed by the laboratory investigations. Accurate diagnosis helps in specific management of these cases. [ABSTRACT FROM AUTHOR]

Background: Peptic ulcers recur, suggesting that ulcer healing may leave tissue predisposed to subsequent damage. In mice, we have identified that the regenerated epithelium found after ulcer healing will remain abnormal for months after healing.Aim: To determine whether healed gastric mucosa has altered epithelial function, as measured by electrophysiologic parameters.Method: Ulcers were induced in mouse gastric corpus by serosal local application of acetic acid. Thirty days or 8 months after ulcer induction, tissue was mounted in an Ussing chamber. Transepithelial electrophysiologic parameters (short-circuit current, Isc. resistance, R) were compared between the regenerated healed ulcer region and the non-ulcerated contralateral region, in response to luminal hyperosmolar NaCl challenge (0.5 M).Results: In unperturbed stomach, luminal application of hyperosmolar NaCl transiently dropped Isc followed by gradual recovery over 2 h. Compared to the starting baseline Isc, percent Isc recovery was reduced in 30-day healing mucosa, but not at 8 months. Prior to NaCl challenge, a lower baseline Isc was observed in trefoil factor 2 (TFF2) knockout (KO) versus wild type (WT), with no Isc recovery in either non-ulcerated or healing mucosa of KO. Inhibiting Na/H exchanger (NHE) transport in WT mucosa inhibited Isc recovery in response to luminal challenge. NHE2-KO baseline Isc was reduced versus NHE2-WT. In murine gastric organoids, NHE inhibition slowed recovery of intracellular pH and delayed the repair of photic induced damage.Conclusion: Healing gastric mucosa has deficient electrophysiological recovery in response to hypertonic NaCl. TFF2 and NHE2 contribute to Isc regulation, and the recovery and healing of transepithelial function. [ABSTRACT FROM AUTHOR]

Objective: To examine the incidence of umbilical cord ulcer (UCU) that causes intrauterine fetal death (IUFD) in fetal duodenal or jejunoileal atresia and the association between UCU and bile acid concentrations in amniotic fluid.Methods: Perinatal outcomes were evaluated in cases of fetal intestinal atresia between 2003 and 2017. A pathological examination of the umbilical cord was performed, and bile acid concentrations in the amniotic fluid were measured.Results: Among the 46 cases included in this study, there were 27 with duodenal atresia and 19 with jejunoileal atresia. There were 4 cases (8.7%) of IUFD and 1 (2.2%) neonatal death with multiple structural anomalies. UCUs were found in 37.5% (15/40) of cases, and severe UCUs with exposed vessels were significantly more common in IUFD (3/4) than in livebirth (0/42) cases (p < 0.01). The incidences of chromosomal abnormality and structural anomalies were not markedly different between livebirth (9/30 and 11/42, respectively) and IUFD (1/3 and 1/4, respectively) cases. Bile acid concentrations in amniotic fluid were significantly higher in cases of UCUs than in those without (p < 0.01).Conclusion: UCUs were not rare in fetal intestinal atresia and were associated with high bile acid concentrations in amniotic fluid. UCUs with exposed vessels were associated with IUFD in intestinal atresia. [ABSTRACT FROM AUTHOR]

Wound repair is regulated by overlapping cellular, physiological and biochemical events. Prostaglandins and nitric oxide have been a focus for inflammation research particularly since the discovery of their inducible isoforms nitric oxide synthase (iNOS) and cyclooxygenase‐2 (COX‐2). Study of the cellular expression of iNOS and COX‐2 and arginase which competes with iNOS for its substrate, in an in vivo model of wound healing could reveal important roles for these enzymes in the physiological progression of wound repair. Adult male rats received full thickness dermal wounds which were harvested at different times. Protein levels and activities of the enzymes were assessed by western blot and biochemical assays respectively. The cellular distribution and the colocalization were assessed by immunostaining. The protein levels and activities of iNOS, arginase, and COX‐2 increased only during the inflammatory phase of wound. Immunocytochemistry showed that the three enzymes were coexpressed and the main cellular source was inflammatory cells mainly macrophages. iNOS was induced at the wound site and was the earliest to increase significantly (p < 0.05) for only up to 3 days postwounding. However, arginase and COX‐2 significant (p < 0.05) upregulation started at a later time points and continued for up to 14 days postwounding. Therefore iNOS, compared with arginase and COX‐2, showed a temporal difference in expression during wound healing which could be explained by their products being required at different stages of the healing process. The coordinated expression of the three enzymes at different time points could account for the physiological progression of the healing process. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is a common kind of malignancies, with yearly occurrences exceeding one million worldwide in 2017. Typically, ulcerous and cancerous tissues develop abnormal morphologies through courses of progression. Endoscopy is a routinely adopted means for examination of gastrointestinal tract for malignancy. Early and timely detection of malignancy closely correlate with good prognosis. Repeated presentation of similar frames from gastrointestinal tract endoscopy often weakens attention for practitioners to result in true patients missed out to incur higher medical cost and unnecessary morbidity. Highly needed is an automatic means for spotting visual abnormality and prompts for attention for medical staff for more thorough examination.Methods: We conduct classification of benign ulcer and cancer for gastrointestinal endoscopic color images using deep neural network and transfer-learning approach. Using clinical data gathered from Gil Hospital, we built a dataset comprised of 200 normal, 367 cancer, and 220 ulcer cases, and applied the inception, ResNet, and VGGNet models pretrained on ImageNet. Three classes were defined-normal, benign ulcer, and cancer, and three separate binary classifiers were built-those for normal vs cancer, normal vs ulcer, and cancer vs ulcer for the corresponding classification tasks. For each task, considering inherent randomness entailed in the deep learning process, we performed data partitioning and model building experiments 100 times and averaged the performance values.Results: Areas under curves of respective receiver operating characteristics were 0.95, 0.97, and 0.85 for the three classifiers. The ResNet showed the highest level of performance. The cases involving normal, i.e., normal vs ulcer and normal vs cancer resulted in accuracies above 90%. The case of ulcer vs cancer classification resulted in a lower accuracy of 77.1%, possibly due to smaller difference in appearance than those cases involving normal.Conclusions: The overall level of performance of the proposed method was very promising to encourage applications in clinical environments. Automatic classification using deep learning technique as proposed can be used to complement manual inspection efforts for practitioners to minimize dangers of missed out positives resulting from repetitive sequence of endoscopic frames and weakening attentions. [ABSTRACT FROM AUTHOR]

Genital ulcer disease can be caused by a wide variety of sources. Most commonly, genital ulcer disease is grouped into infectious and noninfectious causes. HSV, syphilis, lymphogranuloma venereum, and chancroid represent some common infectious ulcers. Noninfectious causes on the other hand can be inflammatory, noninflammatory, or malignant (eg, squamous cell carcinoma). Depending on the etiology, genital ulcers may present with unique features that can help clinicians identify the etiology and start treatment in a timely manner. The clinical presentation and management of infectious and noninfectious genital ulcers will be discussed in this review. [ABSTRACT FROM AUTHOR]

Background: Dogs with immune‐mediated disease often receive glucocorticoids with clopidogrel, but ulcerogenic effects of current protocols are unknown. Hypothesis/Objectives: To compare gastrointestinal endoscopic findings among dogs administered clopidogrel, prednisone, and combination treatment. Animals: Twenty‐four healthy research dogs. Methods: Double‐blinded, placebo‐controlled randomized trial. Dogs received placebo, clopidogrel (2–3 mg/kg q24h), prednisone (2 mg/kg q24h), or prednisone with clopidogrel PO for 28 days. Attitude, food intake, vomiting, and fecal score were determined daily. Clinicopathologic testing was performed at baseline and on day 28. Gastrointestinal hemorrhages, erosions, and ulcers were numerated by 2 blinded investigators for endoscopies performed on days 0, 14, and 28, and endoscopic mucosal lesion scores were calculated. Results were compared using mixed model, split‐plot repeated measures ANOVAs and generalized estimating equation proportional odds models as appropriate. P < .05 was considered significant. Results: Clinical signs of gastrointestinal bleeding were not noted. Endoscopic mucosal lesion scores differed significantly by group (F[3, 20] = 12.8, P < .001) and time (F[2, 40] = 8.3, P < .001). Posthoc analysis revealed higher lesion scores in the prednisone‐receiving groups (P ≤ .006 for each) and on day 14 (P ≤ .007 for each). Ulcers were identified in 4 dogs administered prednisone and 3 dogs administered prednisone/clopidogrel. Odds of having endoscopic mucosal lesion scores ≥4 were 7‐times higher for dogs in prednisone (95%CI 1.1, 43.0; P =.037) and prednisone‐clopidogrel (95%CI 1.1, 43.4; P =.037) groups than those in the placebo group. Conclusions and Clinical Importance: Gastrointestinal bleeding and ulceration occur commonly in healthy dogs administered prednisone or prednisone/clopidogrel treatment, but not clopidogrel monotherapy. Though lesions are severe in many cases, they are not accompanied by clinical signs. [ABSTRACT FROM AUTHOR]

A wound is described as any laceration in normal anatomic structure and functional integrity of the skin. Chronic wounds don't progress through the normal wound healing process in 3 months leaving open laceration of different degrees of severity. Diabetic wound healing is an insurmountable process due to the chronic nature of diabetic wounds. For these complications, this has been a challenge in the health care system. By the appearance of regenerative medicine, advisedly stem cell-based therapies and ingredients have been gained the focus of researchers and professionals as well. As there is no definite cure for diabetic wounds and forasmuch as the appearance of regenerative medicine and cell-based therapies there is a big hope to find a definite treatment for diabetic wounds. In this article novel therapies based on stem cells were observed. [ABSTRACT FROM AUTHOR]

Objective: Artificial ulcers after endoscopic submucosal dissection (ESD) are usually treated by proton pump inhibitors (PPIs) in clinical setting. Vonoprazan, a newly developed potassium‐competitive acid blocker, has recently been used to treat post‐ESD ulcers. We aimed to evaluate the efficacy and safety of vonoprazan on the healing of post‐ESD artificial ulcers compared with those of proton pump inhibitors (PPIs) using a meta‐analysis. Methods: EMBASE, MEDLINE, Scopus and Cochrane Library databases were searched for all studies comparing the efficacy and safety of vonoprazan with those of PPIs in the treatment of post‐ESD ulcers. Results: Fourteen articles with 1328 patients were included in this meta‐analysis. When comparing ulcer shrinkage rate, vonoprazan showed a better efficacy than PPIs (mean difference 0.56, 95% confidence interval [CI] 0.18‐0.93). Vonoprazan also led to a higher scar formation rate (odds ratio [OR] 1.58, 95% CI 1.00‐2.47) and showed a potential superiority on reducing the risk of post‐ESD bleeding compared with PPIs, with a pooled OR of 0.69, although there was no statistically significant difference. Conclusions: Compared with PPIs, vonoprazan showed a better efficacy in ulcer shrinkage rate and achieved more complete healing in the treatment of post‐ESD ulcers. Vonoprazan did not induce any incremental risk of post‐ESD bleeding as well. It may be an appropriate choice in the management of artificial ulcers after ESD. [ABSTRACT FROM AUTHOR]

Background: Dogs with immune‐mediated disease are often coadministered glucocorticoids and aspirin, but ulcerogenic effects of current protocols are unknown. Objectives: To compare gastrointestinal changes among dogs administered aspirin, prednisone, and combination treatment. Animals: Twenty‐four healthy research dogs. Methods: Double‐blinded, placebo‐controlled randomized trial of dogs administered placebo, aspirin (2 mg/kg q24h), prednisone (2 mg/kg q24h), or combination treatment PO for 28 days. Clinical signs were recorded daily, with laboratory work performed at baseline and day 28. Gastrointestinal mucosal hemorrhages, erosions, and ulcers were numerated for endoscopic studies performed on days 0, 14, and 28; endoscopic mucosal lesion scores were calculated. Results were compared using mixed model repeated‐measures analyses of variance and generalized estimating equation proportional odds models. P <.05 was considered significant. Results: Gastric mucosal lesion scores differed by treatment‐by‐time (F[6, 40] = 4.4, P = .002), treatment (F[3, 20] = 7.1, P =.002), and time (F[2, 40] = 18.9, P <.001). Post hoc analysis revealed increased scores in the aspirin (day 14 only), prednisone, and prednisone/aspirin groups during treatment. Ulcers were identified on 14 studies, representing 10 dogs. Dogs receiving prednisone and prednisone/aspirin had 11.1 times (95% CI, 1.7‐73.6) and 31.5 times (95% CI, 3.5‐288.0) higher odds, respectively, of having endoscopic mucosal lesion scores ≥4 than dogs receiving placebo (P ≤.01). Conclusions and Clinical Importance: Gastrointestinal bleeding occurs commonly in dogs administered aspirin, prednisone, or prednisone/aspirin treatment, with higher lesion scores for dogs receiving combination treatment. Even severe lesions are not accompanied by clinical signs. [ABSTRACT FROM AUTHOR]

Causes of cervical ulceration include infection, collagen disease, malignant tumors and external stimuli. Cervical ulceration during pregnancy is rare. We present a case of cervical ulceration caused by group C streptococcal infection during pregnancy. A 36‐year‐old woman (gravida 1, para 0) complained of metrorrhagia, and a circular cervical ulcer of about 1.5 cm in diameter was detected on her cervix at 37 weeks' gestation. A biopsy and a cultivation test of the ulcer were performed, and pathological diagnosis was made as suppurative inflammation, and group C streptococcal infection was detected by the cultivation test. The ulcer had expanded to about 3 cm in diameter at the onset of labor at 40 weeks' gestation. An emergency cesarean section was performed because of failed induction of labor, and she was delivered of a male baby. The ulcer became gradually smaller after delivery, and completely disappeared on the 35th day after delivery. [ABSTRACT FROM AUTHOR]

Summary: Oral omeprazole has been the cornerstone of equine gastric ulcer syndrome (EGUS) treatment for nearly 20 years. However, approximately 15–30% of equine squamous gastric disease (ESGD) cases and 75% of equine glandular gastric disease (EGGD) cases fail to heal within current treatment guidelines. Recently, a number of factors that may affect the efficacy of oral omeprazole have been highlighted and the pharmacodynamics of a number of novel proton pump inhibitors (PPIs) have been described in the horse. The purpose of this article is to review the factors that affect oral omeprazole efficacy, with the goal of maximising therapeutic response, and the novel PPIs recently described. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of pyodine solution and hydrocolloid gel in the management of diabetic foot ulcers. Material and methods: This descriptive study was carried out over 149 patients. After written informed consent, all the patients were treated with I/V antibiotics according to culture and sensitivity reports and were then followed by oral antibiotics for a period of 2 weeks. Multiple dressings with pyodine solution and gel were performed till the complete healing of wound after one month time. Results: This study included 149 patients of either gender. Average age was 50.64 years+9.24SD. Male to female ratio was 2.14:1.97(65.36%) patients showed efficacy of pyodine solution and hydrocolloid gel in diabetic foot ulcer. Conclusion: The efficacy of pyodine solution and hydrocolloid gel in the management of diabetic foot ulcer is high. We recommend the use of pyodine solution and hydrocolloid gel in the treatment of diabetic foot ulcers in developing countries. [ABSTRACT FROM AUTHOR]

Introduction: Patients with oncologic injuries or tumors have specific care needs due to pain, exudate and smelliness. Therefore, nursing professionals must provide them with integral care, comfort and symptom relief in order to improve the quality of life of both the patient and the family. Objective: To consolidate the findings in the literature regarding nursing practices of palliative care to patients with oncologic injuries for dealing with exudate, pain and smelliness. Method: This is a unifying review after an online search of articles answering the research question: Which are the nursing practices of palliative care in patients with oncologic injuries regarding the management of exudate, pain and smelliness? The search covered the term 2000-2017 and the English, Spanish and Portuguese languages. The databases included IdeA, Pubmed, ScienceDirect, SciELO, ProQuest amd Dialnet. Results: Fifty-two articles were identified and 22 of them did answer the question and showed relevant information. This review managed to consolidate some important aspect related to the nursing practices of palliative care, which is quite useful for nursing professionals as an intervention benchmark when dealing with the study population having special care needs. Conclusion: More studies are required on the management of these symptoms. However, the practices documented so far are based on an appropriate technique, injury cleaning, bacterial load control, choosing a high-absorption non-traumatic dressing, and multiple non-pharmacological interventions. [ABSTRACT FROM AUTHOR]

Abomasum ulcers are rare and quite unknown among small ruminants and, in general, in all ruminants. These are due to different causes such as diet, stress, changes in the gastric mucosa protection mechanisms, among others. This article reports the case of a female criollo-breed goat about 17 years old. It had an injury in the abdominal ventral region, between the navel and the xiphisternum. It also had an articular disease. As a diagnostic method, paraclinical tests were carried out such as blood count, stool test and X-ray. This led to a final diagnosis of a grade 3 abomasum ulcer and degenerative articular disease. The treatment consisted in penicillin sodium (22000 UI/kg for 5 days, every 12 hours), gentamicin (6 mg/kg for 3 days, every 24 hours), 4 doses of B complex (2 ml every 48 hours), Omeprazol (10 mg/kg every 12 hours for 15 days) and daily cleaning of the injury with saline for 15 days. The animal was discharged on day 20 with the injury fully closed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and safety of honey dressing in the treatment of diabetic foot ulcers (DFU). Methods Databases of PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI, WanFang and VIP were searched to collect randomized controlled trials (RCT) about the honey dressing for DFU from database building to December, 2017. RevMan5.3 was used for data merge, Egger′s and Begg′s test were used for publication bias detection. GRADE profiler 3.6 was used for evidence grades assessment. Results A total of 8 RCTs involving 767 patients with DFU were included in this study. The results showed that honey dressing was more favorable than control dressing in complete healing rate (RR=1.32, 95%CI: 1.10-1.57, P=0.003), mean healing time (SMD=-1.12, 95%CI: -2.06--0.19, P=0.02), percentage of healing (SMD=1.84, 95%CI: 0.27-3.42, P=0.02) and wound bacterial clearance rate (RR= 2.56, 95%CI: 1.33-4.92, P=0.005), while there was no significant difference between these two groups in amputation rate (RR=0.55, 95%CI: 0.19-1.54, P=0.25). No serious side effects were reported in all of these studies. GRADE recommendation level is B grade, medium recommendation. Conclusion Honey dressing is a relatively safe and effective method in the treatment of DFU. [ABSTRACT FROM AUTHOR]

Syringocystadenocarcinoma Papilliferum (SCACP) is a rare adnexal malignant neoplasm. Most of the cases present with a long standing mass with a sudden progression in size. A 60-year-old female presented with history of swelling over the anterolateral aspect of left thigh since three years. The lesion was associated with history of pain and ulceration. Grossly, the external surface showed three ulcerated areas. The largest ulcer measured 4×5.5 cm. On cut section, the tumour showed variegated appearance consisting of grey-white to pink areas, multiple cysts, focal necrosis and hemorrhagic areas. Microscopically, tumour cells were arranged in papillary configuration, solid sheets, tubular and acinar pattern. Individual tumour cells showed pleomorphic vesicular nucleus and mitotic figures. The intervening connective tissue showed dense chronic inflammatory cell infiltrate composed of lymphocytes, plasma cells and eosinophils. Also seen were areas of necrosis and Gamna-Gandy body. Based on histological features, a diagnosis of malignant appendageal tumour of the skin with apocrine differentiation, favouring SCACP was offered. By Immunohistochemistry (IHC), tumour cells showed focal positivity for CEA and negative for GCDFP-15. IHC may be helpful, but a pathologist has to primarily depend on the histopathological characteristics of the lesion for diagnosing the condition. [ABSTRACT FROM AUTHOR]

• Lifetime risk of diabetic foot disease (DFD) was 33% in the general population. • Age, glycemic control, diabetes duration, and vascular disease were risk factors. • DFD was associated with amputation, cardiovascular events, major falls, and death. • DFD is a high-risk marker for major morbidity and mortality. Data on the long-term consequences of diabetic foot disease (DFD) are scarce. We examined the association between DFD and major clinical outcomes in patients with diabetes in the general population. We conducted a prospective cohort analysis of 1,428 participants with diabetes in the Atherosclerosis Risk in Communities Study. DFD and four clinical outcomes (nontraumatic lower-extremity amputation, cardiovascular disease, major fall, and death) were captured through 2018 using administrative data. We used Cox regression models to evaluate the association between incident DFD (modeled as a time-varying exposure) and the subsequent risk of clinical outcomes. During over two decades of follow-up (1996–1998 to 2018), the cumulative incidence of DFD was 33.3%. Risk factors for DFD included older age, poor glycemic control, long diabetes duration, and prevalent vascular disease (chronic kidney disease, retinopathy, cardiovascular disease). Following incident DFD, the five-year cumulative incidence of major clinical outcomes was 38.9% for mortality, 25.2% for cardiovascular disease, 14.5% for nontraumatic lower-extremity amputation, and 13.2% for major fall. DFD remained associated with all four clinical outcomes after multivariable adjustment, with hazard ratios ranging from 1.5 (cardiovascular disease) to 34.7 (lower-extremity amputation). DFD is common and confers substantial risk for major morbidity and mortality. [ABSTRACT FROM AUTHOR]

[Display omitted] • The gastro-protective effect of fucoidan is investigated against ethanol-induced gastric ulcer. • Fucoidan exerts its effect via inflammasome NLRP3-induced pyroptosis. • Pre-treatment with omeprazole or fucoidan suppressed TLR4 expression. • The further investigations regarding structure–activity relationships shall be followed. This study aimed to elucidate the gastro-protective effect of fucoidan against ethanol-induced gastric ulcer mediated via NLRP3-induced pyroptosis as an underlying mechanism, not yet assessed in prior research. Forty-eight male Albino mice were divided into six groups: Group I (normal control), group II (Ulcer/ethanol control), group III (Omeprazole + ethanol), group IV (fucoidan 25 mg + ethanol), group V (fucoidan 50 mg + ethanol) and group VI (fucoidan only). Fucoidan was administered orally for seven consecutive days followed by ulcer induction by a single oral dose of ethanol. Using colorimetric analysis, ELISA, qRT-PCR, histological assessment, and immunohistochemical studies, the results revealed that ethanol-induced ulcer exhibited an ulcer score of 42.5 ± 5.1 and a significant increase (p < 0.05) in malondialdehyde (MDA), nuclear factor kappa B (NF-κB), and interleukin 6 (IL-6) with a significant decrease in the gastro-protective mediators, prostaglandin E2 (PGE2), superoxide dismutase (SOD) and glutathione (GSH), accompanied with an increase in NLRP3, interleukin 1 β (IL-1 β), interleukin 18 (IL-18), caspase 1, caspase 11, gasdermin D, and toll-like receptor 4 (TLR4), compared with the normal control. Pre-treatment with fucoidan showed a comparable result with omeprazole. Additionally, pre-treatments elevated the levels of the gastro-protective mediators and lessened oxidative stress, relative to the positive control findings. Conclusively, fucoidan has a promising gastro-protective role by inhibiting inflammation and pyroptosis. [ABSTRACT FROM AUTHOR]

Diaper dermatitis is a common dermatosis that usually responds to adequate hygiene and topical treatment, but can be a therapeutic challenge. Continuous exposure to feces and urine can cause extensive erosions and pain. The use of hydrocolloid dressings may be helpful in keeping the skin isolated from stool and urine, reducing pain, and enabling skin lesions to heal. We explain an easy technique, utilizing stoma powder and a hydrocolloid dressing, for parents to apply at home. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is an uncommon entity based on a diagnosis of exclusion. It can manifest itself mimicking various ulcerative cutaneous conditions and nonhealing wounds. With its less known etiology and presentation, there is a danger of mistreatment. Herein, we present an interesting case of pyoderma gangrenosum in a young woman, developing around the area of a lower segment Cesarean scar, but not involving the scar tissue. The PG was not associated with any underlying systemic ailments and responded well to a tapering dose of oral corticosteroids. Prompt diagnosis and initiation of therapy lead to a good response and favorable prognosis. Recognizing the atypical clinical presentations of PG is pertinent. Treatment with immunosuppressive agents and a multidisciplinary approach are recommended. [ABSTRACT FROM AUTHOR]

Chronic skin ulcer can rarely be caused by Salmonella typhi and it is a very uncommon condition to be noticed. 41 years old male patient with a skin ulcer at the xiphoid process was resistant to antibiotics, incision and drainage was admitted. No diagnosis was made through investigations for 5 months. Local skin tissue culture showed growth of Salmonella typhi, which was sensitive to Ceftriaxone (Rocephin). The ulcer was successfully treated by the usage of Ceftriaxone for 2 weeks. A chronic skin ulcer is expected to be the result of Salmonella typhi as a rare condition. It can occur in an immunocompetent person and diagnosis is only made by local skin tissue culture. [ABSTRACT FROM AUTHOR]

The article describes the cases of 21 post-COVID-19 patients who had oral mucormycosis. Topics include descriptive data of palatal lesions among the post-COVID-19 patients with oral mucormycosis, oral manifestations of mucormycosis in COVID-19 patients, and important role of dentists in mucormycosis patients.

Background: NICE Clinical Guidelines (CG) 168, published in July 2013, recommend specialist vascular referral for all leg ulcers, defined as a break in the skin below the knee that has not healed within two weeks. Aim: To examine the impact of CG168 on the primary care management of leg ulcers using The Health Improvement Network database. Methods: An eligible population of approximately two million adult patients was analysed over two 18-month periods before and after publication of CG168. Those with a new diagnosis of leg ulcers in each time period were analysed in terms of demographics, specialist referral and superficial venous ablation. Results: We identified 7532 and 7462 new diagnoses of leg ulcers in the pre- and post-CG168 cohorts, respectively. Patients with a new diagnosis of leg ulcers were elderly (median age: 77 years both cohorts) and less likely to be male (47% both cohorts). There were 2259 (30.0%) and 2329 (31.2%) vascular service referrals in the pre- and post-CG168 cohorts, respectively (hazard ratio, 1.05, 95% CI: 0.99, 1.11, p¼0.096). The median interval between general practitioner diagnosis and referral was 1.5 days in both cohorts. Patients from both cohorts who were referred for a new diagnosis of leg ulcers were equally likely to receive superficial venous ablation. Conclusions: Disappointingly, we have been unable to demonstrate that publication of NICE CG168 has been associated with a meaningful change in leg ulcer management in primary care in line with guideline recommendations. [ABSTRACT FROM AUTHOR]

Objectives - To understand the relationship between plantar pressures and the ulcers' occurrence in individuals with neuropathic diabetic foot, using this factor as a possible method of risk assessment and identification. To investigate the association between the epidemiological data and the ulcer's occurrence. To identify an indicative value for its occurrence. Methods - A quantitative cross-sectional, correlational, and epidemiological study was carried out by collecting sociodemographic and clinical information from the participants and conducting sensitivity tests to identify neuropathy. The sample (N = 60) was divided into two groups: neuropathic diabetics and non-neuropathic diabetics. Podological evaluations were performed using a baropodometric platform, and later statistical analyses were made with the results obtained. Results - There is an association between age, gender, and increased BMI with the occurrence of neuropathy. More than half of the diabetic population in the study has associated peripheral neuropathy. The presence of deformities in the feet of the individuals in the sample was shown to have an influence on the occurrence of ulcer, as well as PPP and IPT values. It can be assumed that the value 88.06 kPa is a reference value for the development of an ulcer. Conclusions - There is a relationship between PP and the occurrence of ulcers. Podological analysis on a baropodometric platform allows us to understand whether or not the patient is at risk of developing an ulcer. This study shows a possible PPP value that serves as an indicator of the development of an ulcer on a diabetic foot. [ABSTRACT FROM AUTHOR]

A previously healthy 2.5-year-old male child presented with vomiting, diarrhea, and fever. During hospitalization he developed odynophagia and refusal to eat. His symptoms did not respond to acid suppressant therapy. He underwent upper endoscopy which showed severe inflammation, ulcerations and abundant necrosis. Histopathological features and serological testing were consistent with herpetic esophagitis. He had no history of recurrent infections or history of sick contacts. His immunological work up showed normal level of immunoglobulins and his White Blood Cells subpopulations were normal. His HSV serology was positive. The patient was started on acyclovir 5 mg/kg q 8 hours. He resolved his symptoms within 24 hours of treatment. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a reactive non-infectious inflammatory dermatosis falling under the spectrum of the neutrophilic dermatoses. There are several subtypes, with 'classical PG' as the most common form in approximately 85% cases. This presents as an extremely painful erythematous lesion which rapidly progresses to a blistered or necrotic ulcer. There is often a ragged undermined edge with a violaceous/ erythematous border. The lower legs are most frequently affected although PG can present at any body site. Other subtypes include bullous, vegetative, pustular, peristomal and superficial granulomatous variants. The differential diagnosis includes all other causes of cutaneous ulceration as there are no definitive laboratory or histopathological criteria for PG. Underlying systemic conditions are found in up to 50% of cases and thus clinicians should investigate thoroughly for such conditions once a diagnosis of PG has been made. Treatment of PG remains largely anecdotal, with no national or international guidelines, and is selected according to severity and rate of progression. Despite being a well-recognised condition, there is often a failure to make an early diagnosis of PG. This diagnosis should be actively considered when assessing ulcers, as prompt treatment may avoid the complications of prolonged systemic therapy, delayed wound healing and scarring. [ABSTRACT FROM AUTHOR]