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We report on the case of a 40-year-old male who was admitted to the clinic with a large ulcer on his left buttock, 3 days after an intramuscular benzathine penicillin injection. The patient was diagnosed with Nicolau syndrome, a rare vascular complication in which a lesion develops after intramuscular injection. Symptoms are intense pain at the injection site, erythema, and livedoid dermatitis, which leads to necrosis of skin, subcutaneous tissue and muscle tissue. It was described by Nicolau after intramuscular injections of bismuth salt for syphillis therapy. Nicolau syndrome is rare, but its symptoms are devastating and healthcare professionals must be aware of this clinical entity, since intramuscular injections are common procedures for administration of drugs. [ABSTRACT FROM AUTHOR]

Objective To describe the clinical course, outcomes, and complications associated with use of commercially available porcine urinary bladder extracellular matrix ( ECM) grafts ( ACell Vet® Corneal Discs) in equid patients with keratomalacia, and to evaluate the efficacy of ECM grafts as a viable alternative to other biomaterials for corneal grafting in equid patients. Animals Sixteen horses and one donkey (17 eyes) with unilateral keratomalacia severe enough to warrant surgical repair between August 2012 and September 2013. Procedure Retrospective medical record review to identify equid patients meeting inclusion criteria of (i) diagnosis with keratomalacia severe enough to warrant surgical repair and (ii) surgical repair with an extracellular matrix graft. Results Eleven geldings, four mares, and two colts met inclusion criteria. Patients averaged 9 years of age. Twelve of 17 eyes (71%) were considered infected based on either corneal cytology (10/17, or 59%) or corneal culture (12/17, or 71%) positive for bacteria (8/17, or 47%) or fungi (9/17, or 53%). At the time topical medications were discontinued, 16 eyes (94%) were visual. One operated eye ruptured 5 days postoperatively and was enucleated. Keratouveitis developed in 14/14 eyes that underwent regular examinations approximately 2 weeks postoperatively which responded to systemic nonsteroidal anti-inflammatory drug therapy. Conclusions Extracellular matrix grafts may be a viable alternative to other biomaterials for corneal grafting in equids. Advantages include commercial availability and shelf storage. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the impact of leukocytes reaction on rebleeding development among patients with peptic ulcers. Methods This was a single-center cohort study enrolling 232 patients with a diagnosis of gastroduodenal ulcer bleeding. The end point was the in-hospital rebleeding rate during the three days after admission. The impact of clinical, demographic, endoscopic and laboratory data at the time of admission, as well as macrophages (CD68) and neutrophils count in ulcer margin, on bleeding outcome was assessed. In addition, impact of the leukocytes on the platelets aggregation induced with ADP (5 μM) and collagen (1 μM) was measured in vitro. Results Acute ulcer bleeding was accompanied with an acute inflammatory response to damage and hemorrhage. Despite the increase of neutrophil count ( P = 0.031) in peripheral blood of bleeders, there were not significant influence of this parameter on the outcome. It was shown that the most significant predicting factors were an increased neutrophils (OR 1.4; 95% CI 1.1–1.8) and macrophages count in the ulcer margin (OR 3.5; 95% CI 1.9–4.87); an endoscopically diagnosed active bleeding (OR 3.0; 95% CI 1.4–6.3); an enhanced level of plasma fibrinogen (OR 1.04; 95% CI 1.0–1.08). Co-incubation of platelets with leukocytes significantly decreased the collagen induced aggregation ( P = 0.008) that could indicate either alteration of mechanisms of platelets adhesion, or inhibition of stabilization phase of thrombogenesis. Conclusion The severity of the local acute inflammatory reaction promotes progressive tissue damage of ulcer margin, and increases the risk of rebleeding. [ABSTRACT FROM AUTHOR]

This paper presents an image processing algorithm for the diagnosis of ulcers, which is a lesion occurring in the digestive tract, based on endoscopic images. In general, ulcers are visually distinguishable from normal tissues owing to the defective state in the mucosal membrane, cornea or skin tissue. Based on this characteristic, we used different colors to distinguish between ulcer and normal tissues in the proposed method. First, image luminance was adjusted to ensure similar luminance distribution values through a preprocessing stage in which the captured images were normalized to achieve uniform intensity distribution for each channel. Then, we selected distinctive elements for the detection of ulcer tissues with distinct image-associated chromatic characteristics. Because image luminance can affect detection even after preprocessing, we selected elements that were distinguishable from normal tissues based on the distribution of values displayed by ulcers from both RGB and HSV bands. Moreover, most of the digestive tract ulcers occur on the mucosal surface and tend to cluster together to form a specific zone. This implies that a detected ulcer pixel is more likely to be surrounded by ulcer tissue than normal tissue. Therefore, we used the intensity of each image channel as an additional detection element and performed ulcerative zone detection. An additional advantage of the zone detection process is the exclusion of errors caused by image-emanated random impulse noise. For performance evaluation of the image processing algorithm, we used fifty sheets of endoscopic images and conducted ulcer detection experiments. Finally, we validated our algorithm as showing 91.05% sensitivity and 98.64% specificity. [ABSTRACT FROM AUTHOR]

Intra-gastric pH monitoring is an important tool in the validation of acid suppressive drugs. To date, several methods of monitoring intra-gastric pH in the horse have been described. However significant limitations are present in the existing models. This article describes the placement of a percutaneous gastrotomy (PEG) tube secured with a button gastropexy in the standing horse through which the pH of the ventral stomach can readily be measured under both fed and fasted conditions. [ABSTRACT FROM AUTHOR]

Introduction: Although Behcet's disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behcet's disease in African black population. Results: The study included 50 patients with Behcet's disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behcet's disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%). Conclusion: The Behcet's disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to investigate the clinical features and outcome of eosinophilic gastroenteritis (EGE) in children. Methods: Our study enrolled 24 children who were diagnosed with EGE from 1993 to 2014 at the Department of Pediatrics, Seoul National University Children's Hospital. The patients' clinical manifestations, treatments, and outcomes were reviewed from the medical records. Results: The mean age at diagnosis was 5.3 years. Most patients had gastrointestinal symptoms including diarrhea (54.2%) and abdominal pain (45.8%). Peripheral eosinophilia was present in 91.7% of the patients. Thirteen patients (54.2%) showed anemia, and 15 patients (62.5%) had hypoalbuminemia. EGE was classified as mucosal, subserosal, or muscular in 75.0%, 20.8%, and 4.2% of cases, respectively. Three patients showed gastroduodenal ulcers upon endoscopic analysis. A history of allergy was reported in 13 patients, including atopic dermatitis, allergic rhinitis, and asthma. Five patients (20.8%) improved with food restrictions. Among the 19 patients treated with steroids, 11 (57.9%) discontinued steroid treatment without subsequent relapse, 4 (21.1%) relapsed after ceasing steroid treatment, and 4 (21.1%) showed no response to steroids. Two patients who were resistant to steroids underwent therapeutic surgery. The presence of gastroduodenal ulcers was significantly associated with relapse and steroid resistance. Conclusion: A high suspicion of EGE is warranted when children have nonspecific gastrointestinal symptoms and peripheral eosinophilia. Most patients improved with food restrictions or steroid treatment, although one-third of patients showed a relapse or steroid resistance. [ABSTRACT FROM AUTHOR]

Background: Although post-endoscopic submucosal dissection (ESD) iatrogenic ulcer is known to heal faster than peptic ulcer, some iatrogenic ulcers show delayed healing. The aim of this study was to clarify risk factors of delayed ulcer healing after gastric ESD.Methods: We retrospectively reviewed medical records of all patients who had ESD for gastric neoplasms (866 adenomas and 814 early gastric cancers) between January 2005 and February 2011.Results: Of 1680 subjects, 95 had delayed ulcer healing in 3-month follow-up. Multivariate analysis showed that diabetes (OR 1.743; 95% CI 1.017-2.989, p = 0.043), coagulation abnormality (OR 3.195; 95% CI 1.535-6.650, p = 0.002), specimen size greater than 4 cm (OR 2.999; 95% CI 1.603-5.611, p = 0.001), and electrocoagulation (OR 7.149; 95% CI 1.738-29.411, p = 0.006) were revealed to be independent risk factors of delayed ulcer healing. Meanwhile, persistent Helicobacter pylori infection was not related to the delayed ulcer healing.Conclusions: Large iatrogenic ulcer by ESD with massive hemostasis, especially in patients with diabetes mellitus or coagulation abnormalities, tends to take more than 3 months to heal. For such cases, initial dosage increment of PPI or addition of other anti-ulcer agents after ESD may be beneficial. [ABSTRACT FROM AUTHOR]

Background: The eradication rate of Helicobacter pylori (H. pylori) infection might be affected by the degree of inflammation of gastric mucosa represented by the endoscopic stage of peptic ulcer disease (PUD). The aims of this study were to evaluate the eradication rates of H. pylori infection according to the endoscopic stage of PUD and to document whether early eradication in the active stage could yield a higher eradication rate in patients with peptic ulcer bleeding (PUB). Materials and Methods: A total of 1,177 patients with PUD (380 gastric ulcer, 710 duodenal ulcer, and 87 combined ulcer) who received protonpump inhibitor (PPI)-based triple therapy were included, and the eradication rates were compared by ulcer stage. Univariate and multivariate analyses were conducted to identify factors influencing eradication rate. In PUB, the eradication rates between the early eradication group (≤7 days) and the late eradication group (>7 days) were compared. Results: The eradication rates according to endoscopic stage were signifi- cantly different in gastric ulcer (active vs healing vs scarring; 84.8% vs 82.7% vs 70.6%, p = .014, respectively), but there were no significant differences in duodenal ulcer (active vs healing vs scarring; 87.6% vs 80.9%% vs 80.9% p = .169, respectively). In multivariate analyses, active ulcer as well as age younger than 50 was a significantly independent predictor of successful eradication (Odds ratio; 2.799, 95% CI; 1.659-4.723, p = .0001). The eradication rate of the early eradication group was significantly higher than the late eradication group in PUB (89.2% vs 71.9%, 95% CI; 1.265--8.269, p = .011). Conclusions: There was a significant difference in the eradication rate according to the endoscopic stage of gastric ulcer. Active ulcer was an independent predictor of successful eradication. Furthermore, early H. pylori eradication should be considered in patients with PUB to yield a higher eradication rate. [ABSTRACT FROM AUTHOR]

Collagen cross-linking (CXL) with ultraviolet light-activated riboflavin is a corneal surface procedure developed for the treatment of keratoconus and corneal ectasia. With the known microbicidal and corneal stiffening effects of ultraviolet irradiation and photoactivated riboflavin, it has recently been introduced for the management of infectious keratitis, especially for ulcers resistant to antimicrobial therapy or associated with corneal melting. Various authors have attempted to use CXL as an adjunctive, salvage or even as the sole treatment for infectious corneal ulcers. The aim of this review was to provide a summary of the clinical studies in the literature. It is worth noting that there is still no consensus on the treatment protocol of CXL against infectious keratitis. The disparities in outcome measures, treatment protocol and study design can confound the interpretation and hamper the generalization of the study results. Based on current evidence, the role of CXL in infectious keratitis remained unclear despite the reported success in some clinical cases. Further investigations are warranted concerning the efficacy and safety of treating infectious keratitis with CXL. [ABSTRACT FROM AUTHOR]

Background Inorganic nitrate from exogenous and endogenous sources is accumulated in saliva, reduced to nitrite by oral bacteria and further converted to nitric oxide (NO) and other bioactive nitrogen oxides in the acidic gastric lumen. To further explore the role of oral microbiota in this process we examined the gastric mucus layer in germ free (GF) and conventional mice given different doses of nitrate and nitrite. Methods Mice were given either nitrate (100 mg/kg/d) or nitrite (0.55–11 mg/kg/d) in the drinking water for 7 days, with the lowest nitrite dose resembling the levels provided by swallowing of fasting saliva. The gastric mucus layer was measured in vivo. Results GF animals were almost devoid of the firmly adherent mucus layer compared to conventional mice. Dietary nitrate increased the mucus thickness in conventional animals but had no effect in GF mice. In contrast, nitrite at all doses, restored the mucus thickness in GF mice to the same levels as in conventional animals. The nitrite-mediated increase in gastric mucus thickness was not inhibited by the soluble guanylyl cyclase inhibitor ODQ. Mice treated with antibiotics had significantly thinner mucus than controls. Additional studies on mucin gene expression demonstrated down regulation of Muc5ac and Muc6 in germ free mice after nitrite treatment. Conclusion Oral bacteria remotely modulate gastric mucus generation via bioactivation of salivary nitrate. In the absence of a dietary nitrate intake, salivary nitrate originates mainly from NO synthase. Thus, oxidized NO from the endothelium and elsewhere is recycled to regulate gastric mucus homeostasis. [ABSTRACT FROM AUTHOR]

Objective: To assess the beneficial effects of silver foam dressing on the healing of wounds with ulcers and infection control of burn patients. Methods: Eighty-four second-degree burn patients were selected and divided into a study group and a control group (n=42). After disinfection and cleaning, wound beds of the study group were covered with silver-containing soft-silicone foam dressing, and wound surfaces of the control group were wiped with 1% silver sulfadiazine cream (60 g/100 cm2). The two groups were checked weekly to observe wound healing progress and adverse reactions of the skin around wounds. Wound secretions were collected and subjected to bacterial culture. Related indices were recorded and quantified. Results: Thirty seven cases of the study group (88.1%) and 36 cases of the control group (85.7%) recovered to normal, and 3 (7.1%) and 2 cases (4.8%) in the two groups failed to recover. The recovery rates of the two groups were similar (P>0.05), but unrecovered patients in the study group had significantly higher proportions of repaired wounds (P<0.05). Wounds of the study group were healed significantly more rapidly than those of the control group (22.3±3.1 vs. 25.1±4.4, P<0.05). The study group had significantly higher proportions of repaired wounds from Day 7 to Day 21 (P<0.05), but the difference became less obvious with extended time to Day 28. The bacterial culture-positive (exceeding 105 organisms per gram of tissue) rates of both groups significantly reduced after treatment (Day 7 for the study group and Day 14 for the control group), and the rate of the study group was significantly lower at last (P<0.05). The study and control groups were observed 134 and 149 person-times respectively, with the normal wound-surrounding skin rates of 96.3% (129/134) and 88.6% (132/149) (P>0.05 except for on Day 14). Except for on Day 28, the study group had significantly lower pain scores than those of the control group (P<0.05), especially on Day 7 and Day 14 (P<0.01). From Day 7 to Day 28, the study group was significantly less prone to burning sensation than the control group (P<0.05), but both groups felt anxious during dressing change (P>0.05). Dressing of the study group was changed significantly more easily (P<0.05), but the fixing outcomes were similar (P>0.05). Conclusion: Silver foam dressing rapidly, easily and safely resisted wound bacteria, promoted wound healing and shortened recovery time, effectively relieving the pain of patients. [ABSTRACT FROM AUTHOR]

Introduction: Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract. Patients and Methods: 30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena. Results: The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions). Conclusions: The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer. [ABSTRACT FROM AUTHOR]

Wound healing is a complex physiological process including overlapping phases (hemostatic/inflammatory, proliferating and remodeling phases). Every alteration in this mechanism might lead to pathological conditions of different medical relevance. Treatments for chronic non-healing wounds are expensive because reiterative treatments are needed. Regenerative medicine and in particular mesenchymal stem cells approach is emerging as new potential clinical application in wound healing. In the past decades, advance in the understanding of molecular mechanisms underlying wound healing process has led to extensive topical administration of growth factors as part of wound care. Currently, no definitive treatment is available and the research on optimal wound care depends upon the efficacy and cost-benefit of emerging therapies. Here we provide an overview on the novel approaches through stem cell therapy to improve cutaneous wound healing, with a focus on diabetic wounds and Systemic Sclerosis-associated ulcers, which are particularly challenging. Current and future treatment approaches are discussed with an emphasis on recent advances. [ABSTRACT FROM PUBLISHER]

Background: Eradication of Helicobacter pylori prior to Roux-en-Y gastric bypass (RYGB) has been advocated as a measure to reduce the complications of anastomotic ulceration. However, evidence to support a causal relationship between preoperative H. pylori status and postoperative anastomotic ulceration is weak.Methods: Intraoperative gastric biopsies were obtained on consecutive patients who underwent laparoscopic RYGB at our institution from December 2007 to June 2010. These samples were analyzed by Warthin-Starry stain for H. Pylori organisms. Retrospective chart review was conducted to determine the preoperative presence of acid dyspepsia and acid suppression therapy and to determine postoperative ulcer symptoms, smoking, NSAID or steroid use, and compliance with ulcer prophylaxis. The incidence of ulcer visualization, perforation, and stricture were obtained from a prospectively collected database. Fisher's exact test was used for analyzing associations between discrete groups. Multiple logistic regression was used to assess associations between anastomotic ulcer complications and potential predictors.Results: Histologic evaluation for H. pylori was available in 708 of the 728 patients who underwent RYGB. Fourteen patients were lost to follow up leaving 694 patients available for review. H. pylori was positive in 66 (9.5 %) patients who did not go on to receive definitive treatment for eradication. Marginal ulcers or related late complications were seen in a total of 113 (16.3 %) patients. In the H. pylori positive group, five patients (7.6 %) developed ulcer complications compared to 108 (17.1 %) in the H. pylori negative group (p = 0.05). Groups were not different in terms of preoperative demographics, postoperative ulcer prophylaxis compliance, steroid, NSAIDs, and cigarette use.Conclusion: The presence of H. pylori infection at the time of RYGB was found to be associated with a significantly lower incidence of anastomotic ulcer complications postoperatively. This study brings into question efforts and expense allocated to identify and eradicate H. pylori prior to RYGB. [ABSTRACT FROM AUTHOR]

Mixed arterial venous disease is estimated to affect up to 26% of patients with lower extremity ulcerations. However, its clinical significance and pathophysiology are incompletely understood. Furthermore, there is no consensus on the optimal treatment modality, whether conservative or operative. In this review paper, we describe the current understanding of the pathophysiology of mixed arterial venous lower extremity ulcers. Guidelines for diagnostic tests for patients with mixed arterial venous diseases are discussed. We review some of the newer biological skin substitutes for conservative wound care. Finally, we propose a treatment algorithm based on current available data. [ABSTRACT FROM AUTHOR]

Potentially fatal chemotherapy (CT)-related gastrorrhagia and gastric perforation in patients with gastric lymphoma present difficult problems to doctors. We retrospectively analyzed 54 patients with ulcerative gastric diffuse large B-cell lymphoma (G-DLBCL) to compare the safety and efficacy of low-dose pre-phase CT before 4–6 cycles of conventional-dose CT (n= 28) with 4–6 cycles of conventional-dose CT (n= 26) between October 2005 and August 2014. Patients who received low-dose pre-phase before conventional-dose CT showed a lower gastrorrhagia or gastric perforation rate (0% vs. 15.4%,p= 0.047) and higher complete response (CR) rate (78.6% vs. 46.2%,p= 0.023) and 5-year progression-free survival (PFS) rate (63% vs. 31%,p= 0.021) than patients who received conventional-dose CT alone. Our study suggests that low-dose pre-phase therapy before conventional-dose CT provides a safe and effective method for ulcerative G-DLBCL. [ABSTRACT FROM PUBLISHER]

ABSTRACT Evidence-based ulcer care guidelines detail optimal components of care for treatment of ulcers of different etiologies. We investigated the impact of providing specific evidence-based ulcer treatment components on healing outcomes for lower limb ulcers (LLU) among veterans in the Pacific Northwest. Components of evidence-based ulcer care for venous, arterial, diabetic foot ulcers/neuropathic ulcers were abstracted from medical records. The outcome was ulcer healing. Our analysis assessed the relationship between evidence-based ulcer care by etiology, components of care provided, and healing, while accounting for veteran characteristics. A minority of veterans in all three ulcer-etiology groups received the recommended components of evidence-based care in at least 80% of visits. The likelihood of healing improved when assessment for edema and infection were performed on at least 80% of visits (hazard ratio [HR] = 3.20, p = 0.009 and HR = 3.54, p = 0.006, respectively) in patients with venous ulcers. There was no significant association between frequency of care components provided and healing among patients with arterial ulcers. Among patients with diabetic/neuropathic ulcers, the chance of healing increased 2.5-fold when debridement was performed at 80% of visits ( p = 0.03), and doubled when ischemia was assessed at the first visit ( p = 0.045). Veterans in the Pacific Northwest did not uniformly receive evidence-based ulcer care. Not all evidence-based ulcer care components were significantly associated with healing. At a minimum, clinicians need to address components of ulcer care associated with improved ulcer healing. [ABSTRACT FROM AUTHOR]

Background and Aims Cellular and animal models investigating extremely low frequency magnetic fields (ELF-MF) have reported promotion of leukocyte-endothelial interactions, angiogenesis, myofibroblast and keratinocyte proliferation, improvement of peripheral neuropathy and diabetic wound healing. In humans, it has also been reported that systemic exposure to ELF-MF stimulates peripheral blood mononuclear cells, promoting angiogenesis and healing of chronic leg ulcers. The aim of the study was to investigate the effect of exposing different blood volumes to specific ELF-MFs (120 Hz sinusoidal waves of 0.4–0.9 mT RMS) to induce healing of diabetic foot ulcers (DFUs). Methods Twenty six diabetic patients with non-responsive DFUs were divided into two exposure groups to receive treatment and record healing time. The forearm group, exposed to ELF-MF 2 h/day, twice weekly (3.6 l of blood/session); and the thorax group, exposed 25 min/day, 2 times/week (162.5 l of blood/session). Treatment period was 100 days or upon complete healing. Ulcer recurrences and adverse effects were investigated during short-term (<1 year) and long-term (3.4–7.8 years) follow-up. Results Mean healing time was 61.48 ± 33.08 days in the forearm group and 62.56 ± 29.33 days for the thorax group. No adverse effects or ulcer recurrences in the original ulcer site were reported during treatment, the short-term follow-up period or the long-term follow-up period in both groups. Conclusions Healing time was independent of the amount of blood exposed to ELF-MF used in this trial. ELF-MFs are effective and safe and could be applied to non-healing DFUs in conjunction with other preventive interventions to reduce DFUs complications. [ABSTRACT FROM AUTHOR]

Diabetic foot infections (DFI) are a common cause of morbidity and, on occasion, even mortality. Infection can be either mono- or polymicrobial, with a wide variety of potential pathogens. Anaerobes may be involved, particularly in wounds that are deeper or more chronic, and are more frequently identified when using modern molecular techniques, such as 16s PCR and pyrosequencing. It remains unclear whether the presence of anaerobes in DFI leads to more severe manifestations, or if these organisms are largely colonizers associated with the presence of greater degrees of tissue ischemia and necrosis. Commonly used empiric antibiotic therapy for diabetic foot infections is generally broad-spectrum and usually has activity against the most frequently identified anaerobes, such as Peptostreptococcus and Bacteroides species. Adequate surgical debridement and, when needed, foot revascularization may be at least as important as the choice of antibiotic to achieve a successful treatment outcome. [ABSTRACT FROM AUTHOR]

The cytomegalovirus infection is prevalent in developed countries. The natural history of disease includes three phases: primoinfection (majority is asymptomatic), latency and reactivation. In certain immunosuppressive states, as in the case of transplantation and HIV infection, the virus can reactivate, occurring cutaneous manifestations, of what stands out the occurrence of genital ulcers. In these, co-infection with other etiologic agents is common, particularly with the herpes simplex virus, leading to more severe manifestations and difficulty in the differential diagnosis. In this context, it is relevant to know the pathogenesis of this virus and the diagnostics means available in order to optimize its therapy. [ABSTRACT FROM AUTHOR]

This study aimed to describe gastric ulcer in donkeys. 10 donkeys (Equus asinus) were studied in Bodonal de la Sierra, Badajoz-Extremadura, Spain. They were referred for necropsy and dead due to non-digestive causes. 4 males and 6 females were examined. The ages were classified of 4-16 years old. The stomach and gastric mucosa was evaluated for classified Merrit, 2003. Samples of gastric tissue were collected. The samples fixed in formalin were processed by conventional histological techniques and examined by histopathology. None of the donkeys presented clinical signs for gastric ulcers syndrome. Of the 10 donkeys studied, 10% had Grade 0; 30% Grade 1; 40% Grade 2; 10% Grade 3; and 10% Grade 4. In 30% (3/10) parasites such as Gasterophilus sp. were observed. The histological slices revealed severe damage on the gastric mucosa, a loss of continuity of the gastric mucosa with corium exposure, and subchorionic edema with parakeratotic hyperkeratosis, together with a mixed lymphoplasmocytic mononuclear infiltrate. In conclusion, we reported gastric ulcers syndrome in donkeys in Spain. [ABSTRACT FROM AUTHOR]

Leprosy leads to chronic granulomatous inflammation in skin and peripheral nerves that can lead to sensory, motor and autonomic impairments. Autonomic dysfunctions may result in dryness and cracking of the skin. In this study, we present the use of ozone provided by a high-frequency device to treat hand ulcers (wounds) in an 80-year-old man who was diagnosed as multibacillary in 2007. In the first visit, the patient was evaluated and received verbal and written instructions about self-care. Treatment consisted of five sessions, once per week. The ozone provided by a high-frequency device seemed to be useful in the treatment of ulcers, thus, contributing to the healing process. Research that investigates the use of high frequencies in the treatment of ulcers associated or not with other interventions (self-care strategies, protective clothing, adapted tools and footwear adaptation) is strongly recommended. [ABSTRACT FROM AUTHOR]

Rabeprazole, antiulcer drug, was labeled with Tc to obtain an agent for ulcer imaging. The radiochemical yield of Tc-rabeprazole reaches approximately 98.5 ± 0.4%.The optimum conditions are as follows: pH 9, 50 μg of SnCl·2HO, 30 min, and 3 mg of the substrate.Tc-rabeprazole was stable for 6 h. Intravenous biodistribution studies of Tc-rabeprazole revealed high concentration in the stomach ulcer, reaching about 33.4% of the total injected dose at 30 min post injection. This concentration of Tc-rabeprazole in stomach ulcer makes this agent promising for stomach ulcer imaging. [ABSTRACT FROM AUTHOR]

Key Clinical Message The oral manifestations of EBV-positive mucocutaneous ulcers have a worrisome clinical appearance but relatively benign clinical course, responding well to conservative treatment. Elderly patients who develop an unexplained, persistent ulcer of the oral mucosa should have the lesion examined for EBV. [ABSTRACT FROM AUTHOR]

4 Yu S, Yu H. A patient with subacute cutaneous lupus erythematosus along Blaschko lines: implications for the role of keratinocytes in lupus erythematosus. Diagnosis: Linear (blaschkoid) cutaneous lupus erythematosus Dermoscopic features suggested active-stage discoid lupus erythematosus. Keywords: blaschkoid lupus erythematosus; dermoscopy; eschar; linear; ulcer EN blaschkoid lupus erythematosus dermoscopy eschar linear ulcer e41 e42 2 11/11/21 20210901 NES 210901 CASE A 15-year-old boy, with skin phototype IV presented with a 4-month history of a unilateral, left-sided, painful, erythematous eruption. [Extracted from the article]

Foot ulcers are rare in patients with COVID-19 but in patients with additional risk factors such as DM, ulcers could be seen more frequently than normal population. Bilateral foot ulcers in a COVID-19 patient under favipiravir treatment Keywords: COVID-19; foot; ulcer EN COVID-19 foot ulcer 2390 2391 2 08/06/21 20210801 NES 210801 CONFLICT OF INTEREST None declared. [Extracted from the article]

Introduction: Palbociclib is an approved drug in the treatment of women with advanced or metastatic estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative, breast cancer. The purpose of this article is to present the first case ever described of oral ulcers caused by palbociclib. Observation: A case of drug-induced oral ulcers is reported. The patient was treated with a combination of palbociclib and Fulvestrant for a breast cancer relapse with pulmonary involvement. These ulcers were localized on the ventral face of the tongue and on the gum. A therapeutic combination of infrared laser biostimulation and a topical application of Dermoval® and Dynexan® were carried out. Palbociclib was concurrently discontinued. The lesions healed in about 15 days. Comments: Palbociclib is an inhibitor of cyclin-dependent kinases 4 and 6 (CDK 4/6). Thereby, it blocks many signaling pathways responsible for cell proliferation. This property weakens the oral mucosa and could be the cause of the observed ulcers. These latter having been particularly debilitating for the patient. Conclusion: Palbociclibrelated oral aphthous ulcers are similar to those reported with other targeted therapies. The combination of infrared laser biostimulation and local corticosteroid therapy did not prevent the discontinuation of the cancer treatment. [ABSTRACT FROM AUTHOR]

Primary myelofibrosis is characterized by bone marrow fibrosis, splenomegaly and presence of JAK-2 V617F mutation in more than 90% of patients. Ruxolitinib is a Janus kinase inhibitor used for the treatment of primary myelofibrosis. We describe herein a persistent foot ulcer development attributed to ruxolitinib therapy. We are unaware of any previous reports of this phenomenon in the scientific literature. A thorough examination of the lower extremities is perhaps necessary before initiating this oral agent. If ruxolitinib therapy cannot be safely discontinued, diligent wound care and a course of antibiotics are warranted. [ABSTRACT FROM AUTHOR]

Background: Cutaneous horn is a clinical term used to describe a hard, keratotic conical lesion. Its base may be a papule, plaque or nodule. Objectives: An approach for how to diagnose and manage a cutaneous horn. Materials and methods: Here-in we report an aged male 85-years old presented with a history of painful slowly progressive skin lesion over his right foot 7 months ago. Results: The past medical history revealed that the lesion was preceded by presence of a cutaneous horn (CH) at the same site of the current skin lesion. That CH was persistent for a year before it spontaneously fell down. Skin biopsy from the base of the CH was taken at that time, it was consistent with underlying actinic keratosis. He did not receive any treatment for his CH. Currently skin examination revealed fungating ulcer measuring 6X6 cm on the dorsum of the right foot. There was no inguinal lymphadenopathy. Punch skin biopsy was taken from the edge of the ulcer for histo-pathological examination. Conclusion: On the basis of the above clinicopathological findings, a diagnosis of well differentiated Squamous Cell Carcinoma was made. The patient was referred to Oncologist for appropriate management. [ABSTRACT FROM AUTHOR]

This article aims at raising clinical awareness about pyoderma gangrenosum especially when presenting in primary care settings. Due to its initial manifestation as a nonspecific ulcer, physicians with relatively less dermatology experience usually misdiagnose PG as cutaneous infection or vascular disease. This usually leads to inappropriate treatment with subsequent worsening of condition and devastating effects on patients’ lives. [ABSTRACT FROM AUTHOR]

Aim of the work: the contact lenses are widely used for management of refractive errors and cosmetic purposes as well. Their complications are rare and usually caused by in appropriate maintenance of the lens and bad habits for wearing too long. Methodology: all the English data related to the subjects were collected after reviewing Pubmed, SCOPUS, ScienceDirect and other search engines. Results: this review showed the most common complications, risk factors and management of diseases related to contact lens wearing. Eachproblemwas described by its symptoms, risk factors and management as well as prognosis. Conclusion: the selection of proper lens and education about the lens care system is efficient for reducing the complications related to contact lens. [ABSTRACT FROM AUTHOR]

Rebleeding after initially successful endoscopic variceal ligation (EVL) occurs in 20-60% of patients, most commonly from band ulcers, and is associated with 20-50% mortality. Although band ulcer bleeding has been treated in a number of different ways, no single therapeutic intervention has shown a clear benefit. Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) is a relatively new non-contact hemostatic modality used in the management of bleeding peptic ulcers. It is a nano-powder that can be sprayed over a larger mucosal area. Here we describe a patient with end stage liver disease who presented with recurrent bleeding from a deep esophageal ulcer following band ligation and sclerotherapy, effectively managed with multiple sessions of Hemospray. [ABSTRACT FROM AUTHOR]

Malignant tumors of anal margin and perianal skin are rare, which accounts for approximately 2%-3% of all anorectal malignancies. Because of the variable presentation and pathologic similarity to benign anal lesions, the diagnosis and treatment is often delayed. We report the case of a 54-year-old Indian male who presented with non-healing anal fistula which progressed to a large chronic ulcer and was later diagnosed as anaplastic large cell lymphoma of perianal skin. Primary cutaneous anaplastic large cell lymphoma (PCALCL) of perianal area has been rarely reported, that too masquerading anal fistula is being reported for the first time. [ABSTRACT FROM AUTHOR]

Aortic intramural hematoma (IMH) is a variant of acute aortic syndrome, which can be life-threatening. Ascending aorta IMHs, particularly accompanied by penetrating aortic ulcer (PAU), can cause dissection, rupture, and cardiac tamponade. Therefore, early surgical treatment is recommended for IMHs of the ascending aorta. Herein, we present the case of a 60-year-old male patient who was on warfarin sodium treatment and in whom an IMH localized to the arcus aorta was detected incidentally via computed tomography, with the suspicion of pulmonary embolism, and an endovascular stent graft was inserted into the arcus aorta. This case highlights the importance of following ulcerated aortic plaques and suggests that IMH can be successfully treated with endovascular stent grafting. [ABSTRACT FROM AUTHOR]

Gastric ulcer and duodenal ulcer represent unique or continuous circumscribed breaks of the continuity of gastric or duodenal wall, accompanied by a fibrous reaction, beginning with the mucosa and being capable of penetrating to the serosa. Ulcers appear when the stomach or duodenal mucosa is chronically inflamed or is exposed to irritating agents, such as the excess of stomach acid or digestive enzymes (pepsin). Peptic ulcers that appear in the stomach mucosa are called gastric ulcers, and those that appear in the duodenal mucosa are called duodenal ulcers, while those affecting the esophagus are calld esophageal ulcers. Diet is meant for gastric sparing and, if correctly prescribed, acts as a real “gastric dressing” for the stomach. Food will be prepared so that it wouldn't increase the gastric acid secretion and would not stagnate in the stomach. [ABSTRACT FROM AUTHOR]

Gastric ulcer and duodenal ulcer represent unique or continuous circumscribed breaks of the continuity of gastric or duodenal wall, accompanied by a fibrous reaction, beginning with the mucosa and being capable of penetrating to the serosa. Ulcers appear when the stomach or duodenal mucosa is chronically inflamed or is exposed to irritating agents, such as the excess of stomach acid or digestive enzymes (pepsin). Peptic ulcers that appear in the stomach mucosa are called gastric ulcers, and those that appear in the duodenal mucosa are called duodenal ulcers, while those affecting the esophagus are calld esophageal ulcers. Diet is meant for gastric sparing and, if correctly prescribed, acts as a real “gastric dressing” for the stomach. Food will be prepared so that it wouldn't increase the gastric acid secretion and would not stagnate in the stomach. [ABSTRACT FROM AUTHOR]

Extramammary Paget's disease (EMPD) is uncommon and only a few cases have been reported in the literature. They are identical to the Mammary Paget's disease. This can occur where the apocrine glands are in abundance, more commonly in the genitalia and perianal area. We report here a case of Extramammary Paget's disease in the perianal region. The colourful background of this ulcer is analysed and the literature reviewed. [ABSTRACT FROM AUTHOR]

Brisket edema, ulcer, tumor and abscess in twelve buffaloes was reported and managed. The brisket edema was treated by diuretics, while abscess was treated by incision and drainage. The tumors and ulcers were subjected for radical surgery. It is concluded that affections of brisket in buffaloes which are negative for traumatic pericarditis can be surgically managed. [ABSTRACT FROM AUTHOR]

Syzygium aromaticum L. volatile oil (clove oil) has been traditionally used for various stomach disorders including inflammatory conditions. Eugenol is the major constituent present in the volatile oil, and it has been established as a gastroprotective agent through many published studies, but the exact and complete mechanism of ulcer protection is not delineated yet. Moreover, it plays precisely the opposite effect in higher dose in antiulcer properties with worsening the ulcer at a higher dose. This study aims to carry out the prophylactic cytoprotective effect of eugenol with single low doses and explore the probable interrelated underlying transcriptional and translational level mechanism of cytoprotection such as antioxidative, anti-inflammatory, mucous generation in rats using ethanol-induced ulcer model. Rats were administered with different doses of eugenol before ethanol intragastrically. The effects of the eugenol on mucous production, Nitric oxide generation, PGE2 synthesis, lipid peroxidation were recorded together with cytokines measurement in the blood. TNF-α and IL-6, two key cytokines, were also studied in specific. In addition, studies on the immunohistochemical and gene expression of HSP70 and iNOS indicators have been conducted. According to our findings, Eugenol substantially reduced the ulcer index and completely protected the mucosa from lesions. By restoring the lowered GSH and NP-SH levels, the protective effect of the eugenol was found to be augmented at both doses. This finding has corresponded to an increase in MDA, which was lowered by ethanol administration. Pre-treatment with eugenol on the ethanol-induced ulcer reduced the plasma NO levels and increased PGE2 along with a decreased TNF-α and IL-6 concentration. Additionally, significant transcriptional and translational upregulation of HSP70 and downregulation of iNOS were detected in the eugenol-treated rat stomach tissue. Our findings demonstrated that eugenol had a considerable gastroprotective impact at low doses, which could be attributed to its ability to regulate inflammatory reactions and antioxidant capacity. [Display omitted] [ABSTRACT FROM AUTHOR]

• A new series of diazenyl azo-phenol derivatives have been synthesized via diazo-coupling approach. • Spectroscopic characterization (FTIR, NMR and HR-MS) was carried out to confirm the synthesis of the synthesized diazenyl azo-phenol derivatives. • The compounds were tested for urease inhibition potential and kinetic analysis. • In silico structure-activity against urease, ribosomal protein S1 (RpsA) of Mycobacterium tuberculosis , main protease (Mpro) of SARS-CoV-2 and ADME studies were also carried out to explore the drug-like properties of the synthesized diazenyl azo-phenol derivatives. In the present study, a new series of diazenyl azo-phenol derivatives (TC-1 to TC-8) have been synthesized via diazo-coupling approach between substituted aromatic amines and phenol derivatives produced azo–phenol compounds in moderate to good yields (40–80%). The appearance of characteristic prominent peak of azo derivatives i.e. N=N peak at 1500–1400cm−1 and disappearance of NH 2 stretch at 3500–3200 cm−1, presence of a broad OH stretch in the range of 3300–3000 cm−1 in FTIR spectra, while presence of OH peak in spectral range of 15–10 ppm and aromatic protons in the region of 8.0–6.0 ppm and disappearance of NH 2 peak in 5.0–4.0 spectral region in 1H NMR spectra confirms the synthesis of new diazenyl azo-phenol derivatives. Similarly, appearance of carbon attached with -N=N- group in the range of 149–144 ppm, C−OH in the range of 164–162 ppm, C−N of pyridine ring at 175 ppm, aromatic carbons at 140–108 ppm while aliphatic carbons at 21–20 ppm in 13C NMR spectra give strong indication of synthesis of proposed compounds and HRMS also confirmed the masses of proposed structure of diazenyl azo-phenol derivatives. In case of urease inhibition potential, the in vitro results suggested that the compound TC-6 (IC 50 value 0.62 ± 0.04 µM) to be most active compared to the standard drug thiourea (IC 50 value 21.44 ± 0.78 µM), kinetic analysis revealed that TC-6 behaved as a mixed-type inhibitor with irreversible mode of action. The SAR showed the stable docked complex due to the presence of dihydroxy hydrogen atoms in TC-6 (-6.01 kcal/mol) and strong binding interactions with the active site residues of the target protein urease (3LA4). The detailed in silico analysis of the diazenyl azo-phenol derivatives (TC-1 to TC-17) against the ribosomal protein S1 (RpsA) of Mycobacterium tuberculosis (4NNI) and main protease (Mpro) of SARS-CoV-2 (6LU7) was also performed and SAR showed that among all the docked compounds, TC-6 and TC-9 showed best docked conformational poses by exhibiting strong interactions with the active site residues of the target proteins (4NNI & 6LU7) with minimum binding energy values i.e. -5.36 kcal/mol and -4.84 kcal/mol respectively. The ADME calculations showed that the synthesized ligands quietly obey rule of five without any considerable violations. [ABSTRACT FROM AUTHOR]

We review herein the basis for using dietary components to treat and/or prevent Helicobacter pylori infection, with emphasis on ( a ) work reported in the last decade, ( b ) dietary components for which there is mechanism-based plausibility, and ( c ) components for which clinical results on H pylori amelioration are available. There is evidence that a diet-based treatment may reduce the levels and/or the virulence of H pylori colonization without completely eradicating the organism in treated individuals. This concept was endorsed a decade ago by the participants in a small international consensus conference held in Honolulu, Hawaii, USA, and interest in such a diet-based approach has increased dramatically since then. This approach is attractive in terms of cost, treatment, tolerability, and cultural acceptability. This review, therefore, highlights specific foods, food components, and food products, grouped as follows: bee products (eg, honey and propolis); probiotics; dairy products; vegetables; fruits; oils; essential oils; and herbs, spices, and other plants. A discussion of the small number of clinical studies that are available is supplemented by supportive in vitro and animal studies. This very large body of in vitro and preclinical evidence must now be followed up with rationally designed, unambiguous human trials. [ABSTRACT FROM AUTHOR]

One of the most severe complications of diabetes mellitus is the diabetic foot, which is the sum of macroangiopathy, microangiopathy and neuropathy, which leads to low vascular flow, and development of lesions which rapidly progress to ulcer and may attain all tissues; the Wagner classification1 shows how a little superficial lesion may affect all tissues: tendons, muscles and even bones, to severely affect the general health and may end on death by sepsis. The conventional treatment has good results, but requires a careful program of local attention, protection from larger lesions, antibiotics, etc., and if does not have good results, may ends on foot amputation. The use of nanoparticles of metallic oxides, silicium dioxide and titanium dioxide, prepared by the sol-gel technique, may offer a viable alternative for diabetic ulcer treatment due a mechanism which allows to keep it dry and at the same time, inhibit bacterial growing through a biocatalytic effect2. To evaluate the use of these nanoparticles in diabetic foot, a research protocol was established in a group of diabetic patients who attend to the Center Specialized on Handling of the Diabetic Patient from Mexico City of Secretary of Health; this protocol was approved by the Educations and Research Direction of the Secretary of Health. 62 diabetic patient with diabetic ulcers of different degree were studied; the nanoparticles were applied every 48 hours and evaluated with photos and bacterial cultures. All patients who received the complete treatment healed their ulcers, with satisfactory healing. Conclusion: The topical application of metallic oxides nanoparticles seems to be useful in the treatment of diabetic ulcers. [ABSTRACT FROM AUTHOR]

Objectives: Percutaneous pharmacomechanical thrombectomy is an emerging therapy for acute deep vein thrombosis and may reduce long-term incidence of post-thrombotic syndrome. This study investigates the proportion of patients presenting with lower limb deep vein thrombosis who are potentially suitable for percutaneous pharmacomechanical thrombectomy. Methods: A retrospective review of all duplex ultrasound scans for lower limb deep vein thrombosis over two-year period at a regional vascular unit was conducted. All acute occlusive iliofemoral deep vein thrombosis were screened for percutaneous pharmacomechanical thrombectomy suitability according to predefined criteria. Results: There were 2513 duplex ultrasound scans for suspected lower limb deep vein thrombosis in the two-year period. There were 120 cases of acute occlusive iliofemoral deep vein thrombosis. After application of inclusion and exclusion criteria 48 out of 120 (40%) patients were identified as potential candidates for percutaneous pharmacomechanical thrombectomy. Conclusions: This indicates that a large randomised trial of percutaneous pharmacomechanical thrombectomy is feasible given expected recruitment rates in a multicentre study [ABSTRACT FROM AUTHOR]

Background: Marginal ulceration after gastric bypass surgery is a recognized complication and has been reported in 1-16 % of patients. There is evidence that acidity may play a role in the disease pathophysiology and it is a common practice for bariatric surgeons to begin a prophylactic course of proton pump inhibitors (PPI), postoperatively. Methods: MEDLINE, EMBASE, CINAHL, and the Cochrane Controlled Trials Register were searched using the most comprehensive timeline for each database up to January 2012. Studies that included patients undergoing gastric bypass who received a prophylactic course of PPI postoperatively were eligible. Two reviewers independently selected trials and extracted data. The primary outcome was the incidence of marginal ulcers diagnosed on the basis of endoscopic findings. Inverse variance random effects models were used to estimate odds ratio (OR) and weighted proportion of ulcers. Odds ratio and weighted pooled proportion with corresponding 95 % confidence intervals (CI) are reported. Results: The strategic search identified 167 citations. A total of seven studies involving 2,917 participants were eligible for inclusion and 2,114 were used for analysis. The weighted pooled proportion of ulcer formation in PPI groups including all seven studies (four single group cohort studies and PPI arm of three cohort studies) was 5.0 % [95 % CI 2-10 %] ( N = 1,407). The OR of marginal ulcer formation comparing PPI to no PPI for three comparative cohort studies was 0.50 [95 % CI 0.28-0.90, p = 0.02] ( N = 1,022) with low heterogeneity ( I = 12 %) showing that the PPI group significantly experienced twice less ulceration with PPI treatment compared to no PPI treatment. Conclusion: This finding suggests a significant incremental benefit of prophylactic PPI in reducing marginal ulcer after gastric bypass surgery. Prospective randomized trials are needed to further define the role of PPI following gastric bypass surgery. [ABSTRACT FROM AUTHOR]

Aim: Diabetic foot syndrome (DFS) is a multifactorial debilitating complication of diabetes mellitus (DM). The identification of markers for predicting the risk of developing DFS could help and direct the efforts in the prevention to the highest risk patients. Type I collagen a1 (COL1A1) is the main component of type I collagen, the most abundant structural protein of the extracellular matrix of subcutaneous tissue. COL1A1 polymorphism has been previously investigated with regard to many clinical conditions affecting the bone or the skin. In this prospective study, we have assessed COL1A1 polymorphism in patients without and with DFS. Patients and methods: 202 DM patients without and 103 patients with DFS have been recruited. COL1A1 polymorphism, due to a mutation affecting the zinc-finger transcription factor specific protein, has been investigated. The most relevant clinical data (HbA1c, vascular risk factors, insulin treatment) have been collected and analyzed. Results: No statistically significant difference in the distribution of the 3 genotypes constituting COL1A1 polymorphism between patients without and with DFS has been observed. Almost all DFS patients had at least one vascular risk factor, with a high rate of arterial hypertension and dyslipidemia. Conclusion: A multifaceted set of factors is involved in the development of DFS and only a combination of them may lead to such occurrence. In our DM patient population, COL1A1 polymorphism does not correlate with the occurrence of DFS, which appears to depend mostly on the presence of vascular risk factors. However, the impact of genetic factors affecting other components of the subcutaneous tissue cannot be excluded. [ABSTRACT FROM AUTHOR]

The clinical significance of small intestinal damage caused by nonsteroidal anti-inflammatory drugs (NSAIDs) remains under-appreciated. It occurs with greater frequency than the damage caused by these drugs in the upper gastrointestinal tract, but is much more difficult to diagnose and treat. Although the pathogenesis of NSAID enteropathy remains incompletely understood, it is clear that bacteria, bile, and the enterohepatic circulation of NSAIDs are all important factors. However, they are also interrelated with one another. Bacterial enzymes can affect the cytotoxicity of bile and are essential for enterohepatic circulation of NSAIDs. Gram-negative bacteria appear to be particularly important in the pathogenesis of NSAID enteropathy, possibly through release of endotoxin. Inhibitors of gastric acid secretion significantly aggravate NSAID enteropathy, and this effect is due to significant changes in the intestinal microbiome. Treatment with antibiotics can, in some circumstances, reduce the severity of NSAID enteropathy, but published results are inconsistent. Specific antibiotic-induced changes in the microbiota have not been causally linked to prevention of intestinal damage. Treatment with probiotics, particularly Bifidobacterium, Lactobacillus, and Faecalibacteriaum prausnitzii, has shown promising effects in animal models. Our studies suggest that these beneficial effects are due to colonization by the bacteria, rather than to products released by the bacteria. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot complications are the leading cause of lower extremity amputation and diabetes-related hospitalisation in Australia. Studies demonstrate significant reductions in amputations and hospitalisation when health professionals implement best practice management. Whilst other nations have surveyed health professionals on specific diabetic foot management, to the best of the authors' knowledge this appears not to have occurred in Australia. The primary aim of this study was to examine Australian podiatrists' diabetic foot management compared with best practice recommendations by the Australian National Health Medical Research Council. Methods: A 36-item Australian Diabetic Foot Management survey, employing seven-point Likert scales (0 = Never; 7 = Always) to measure multiple aspects of best practice diabetic foot management was developed. The survey was briefly tested for face and content validity. The survey was electronically distributed to Australian podiatrists via professional associations. Demographics including sex, years treating patients with diabetes, employment-sector and patient numbers were also collected. Chi-squared and Mann Whitney U tests were used to test differences between sub-groups. Results: Three hundred and eleven podiatrists responded; 222 (71%) were female, 158 (51%) from the public sector and 11-15 years median experience. Participants reported treating a median of 21-30 diabetes patients each week, including 1-5 with foot ulcers. Overall, participants registered median scores of at least "very often" (>6) in their use of most items covering best practice diabetic foot management. Notable exceptions were: "never" (1 (1 - 3)) using total contact casting, "sometimes" (4 (2 - 5)) performing an ankle brachial index, "sometimes" (4 (1 - 6)) using University of Texas Wound Classification System, and "sometimes" (4 (3 - 6) referring to specialist multi-disciplinary foot teams. Public sector podiatrists reported higher use or access on all those items compared to private sector podiatrists (p < 0.01). Conclusions: This study provides the first baseline information on Australian podiatrists' adherence to best practice diabetic foot guidelines. It appears podiatrists manage large caseloads of people with diabetes and are generally implementing best practice guidelines recommendations with some notable exceptions. Further studies are required to identify barriers to implementing these recommendations to ensure all Australians with diabetes have access to best practice care to prevent amputations. [ABSTRACT FROM AUTHOR]

Background: Numerous, often multi-faceted regimens are available for treating complex wounds, yet the evidence of these interventions is recondite across the literature. We aimed to identify effective interventions to treat complex wounds through an overview of systematic reviews. Methods: MEDLINE (OVID interface, 1946 until October 26, 2012), EMBASE (OVID interface, 1947 until October 26, 2012), and the Cochrane Database of Systematic Reviews (Issue 10 of 12, 2012) were searched on October 26, 2012. Systematic reviews that examined adults receiving care for their complex wounds were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Results: Overall, 99 systematic reviews were included after screening 6,200 titles and abstracts and 422 full-texts; 54 were systematic reviews with a meta-analysis (including data on over 54,000 patients) and 45 were systematic reviews without a meta-analysis. Overall, 44% of included reviews were rated as being of high quality (AMSTAR score ≤8). Based on data from systematic reviews including a meta-analysis with an AMSTAR score ≤8, promising interventions for complex wounds were identified. These included bandages or stockings (multi-layer, high compression) and wound cleansing for venous leg ulcers; four-layer bandages for mixed arterial/venous leg ulcers; biologics, ultrasound, and hydrogel dressings for diabetic leg/foot ulcers; hydrocolloid dressings, electrotherapy, air-fluidized beds, and alternate foam mattresses for pressure ulcers; and silver dressings and ultrasound for unspecified mixed complex wounds. For surgical wound infections, topical negative pressure and vacuum-assisted closure were promising interventions, but this was based on evidence from moderate to low quality systematic reviews. Conclusions: Numerous interventions can be utilized for patients with varying types of complex wounds, yet few treatments were consistently effective across all outcomes throughout the literature. Clinicians and patients can use our results to tailor effective treatment according to type of complex wound. Network meta-analysis will be of benefit to decision-makers, as it will permit multiple treatment comparisons and ranking of the effectiveness of all interventions. [ABSTRACT FROM AUTHOR]

Chronic venous ulcers are a medical challenge with a socioeconomic impact. Tissue characterization was quantified by photographic imaging (p-CATIM) of a leg wound treated with Unna boot for 45 days. Three photographs, taken pre-treatment, post Unna boot and post healing were analyzed. Brightness on a 0-255 gray image was re-scaled with black as 0 and adjacent skin as 200. GrayScale Median (GSM) and the percentages of pixels in each of 14 brightness intervals were calculated. Open ulcer GSM increased from 110 to 159 post Unna boot treatment, reaching 203 post healing. Predominant brightness intervals for the ulcer were 41-153 pre-treatment, 83% of pixels; 133-196 post Unna boot, 80%; and 175-255 post healing, 97%. The GSM of the subcutaneous wound around the ulcer increased from 117 to 137 post healing; the proportion of pixels in the 91-174 interval increased from 67% to 88% (p<0.001). CATIM quantified photographic changes during venous ulcer healing with comparison to the adjacent skin. [ABSTRACT FROM AUTHOR]