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Introduction: Esophageal safety following radiofrequency (RF) left atrial (LA) linear ablation has not been established. To determine the esophageal safety profile of LA linear RF lesions, we performed systematic esophagogastroduodenoscopy in all patients with intraesophageal temperature rise (ITR) ≥ 38.5°C. Methods and Results: Between December 2021 and July 2023, a total of 200 consecutive patients with atrial tachyarrhythmia (ATA) underwent linear ablation with posterior dome (roof or floor) or posterior mitral isthmus line transection. Patients with ITR ≥ 38.5°C were scheduled for esophageal endoscopy ~3 weeks after ablation. Patient and ATA characteristics, procedural parameters, endoscopy findings and ablation lesion data were collected and analyzed. One hundred thirty‐three out of 200 (67%) patients showed ITR ≥ 38.5°C during LA linear ablation. ITR (with maximal temperature of 45.7°C) was more frequently observed during floor line ablation (82% of cases). ITR was less observed during roof line ablation (34%) and posterior mitral isthmus ablation (4%). Endoscopy, performed in 115 patients after 24 ± 10 days, showed esophageal ulceration in four patients (two patients Kansas City classification [KCC] 2a and two patients KCC 2b). No patient showed esophageal perforation or fistula. Conclusion: Temperature rise during LA linear ablation is frequent and ulceration risk exists, particularly when floor line is performed. Safety measures are needed to avoid potential severe complications like esophageal perforation and fistula. [ABSTRACT FROM AUTHOR]

Background: Oral traumatic ulcerative lesions (OTUL) are commonly encountered in clinical practice, yet there is limited research on their clinical characteristics and traumatic etiological factors. This retrospective study aimed to analyze the age, gender, clinical characteristics, and traumatic etiological factors in a large cohort of patients with OTUL and provide valuable insights for dental clinicians to optimize patient care and prevention strategies. Methods: A total of 1543 patients with OTUL were enrolled in this study. Age, gender, medical history, clinical characteristics and traumatic etiological factors were collected and analyzed. Logistic regression analysis was performed to determine the significance of age and gender as factors related to OTUL. Results: The study revealed significant variations in clinical characteristics and traumatic etiological factors among different age groups and between genders. Logistic regression analysis demonstrated that both age and gender were significant factors related to OTUL. Conclusion: The clinical characteristics of OTUL and traumatic etiological factors appear to be significantly different according to age and gender. More targeted prevention strategies should be implemented for all age and gender groups. [ABSTRACT FROM AUTHOR]

Introduction: The foot sole endures high magnitudes of pressure for sustained periods which results in transient but habitual cutaneous ischemia. Upon unloading, microvascular reactivity in cutaneous capillaries generates an influx of blood flow (PORH: post-occlusive reactive hyperemia). Whether pressure induced cutaneous ischemia from loading the foot sole impacts mechanoreceptor sensitivity remains unknown. Methods: Pressure induced ischemia was attained using a custom-built-loading device that applied load to the whole right foot sole at 2 magnitudes (15 or 50% body weight), for 2 durations (2 or 10 minutes) in thirteen seated participants. Mechanoreceptor sensitivity was assessed using Semmes-Weinstein monofilaments over the third metatarsal (3MT), medial arch (MA), and heel. Perceptual thresholds (PT) were determined for each site prior to loading and then applied repeatedly to a metronome to establish the time course to return to PT upon unload, defined as PT recovery time. Microvascular flux was recorded from an in-line laser speckle contrast imager (FLPI-2, Moor Instruments Inc.) to establish PORH peak and recovery rates at each site. Results: PT recovery and PORH recovery rate were most influenced at the heel and by load duration rather than load magnitude. PT recovery time at the heel was significantly longer with 10 minutes of loading, regardless of magnitude. Heel PORH recovery rate was significantly slower with 10minutes of loading. The 3MT PT recovery time was only longer after 10 minutes of loading at 50% body weight. Microvascular reactivity or sensitivity was not influenced with loading at the MA. A simple linear regression found that PORH recovery rate could predict PT recovery time at the heel (R2=0.184, p<0.001). Conclusion: In populations with degraded sensory feedback, such as diabetic neuropathy, the risk for ulcer development is heightened. Our work demonstrated that prolonged loading in healthy individuals can impair skin sensitivity, which highlights the risks of prolonged loading and is likely exacerbated in diabetes. Understanding the direct association between sensory function and microvascular reactivity in age and diabetes related nerve damage, could help detect early progressions of neuropathy and mitigate ulcer development. [ABSTRACT FROM AUTHOR]

IntroductionThe foot sole endures high magnitudes of pressure for sustained periods which results in transient but habitual cutaneous ischemia. Upon unloading, microvascular reactivity in cutaneous capillaries generates an influx of blood flow (PORH: post-occlusive reactive hyperemia). Whether pressure induced cutaneous ischemia from loading the foot sole impacts mechanoreceptor sensitivity remains unknown.MethodsPressure induced ischemia was attained using a custom-built-loading device that applied load to the whole right foot sole at 2 magnitudes (15 or 50% body weight), for 2 durations (2 or 10 minutes) in thirteen seated participants. Mechanoreceptor sensitivity was assessed using Semmes-Weinstein monofilaments over the third metatarsal (3MT), medial arch (MA), and heel. Perceptual thresholds (PT) were determined for each site prior to loading and then applied repeatedly to a metronome to establish the time course to return to PT upon unload, defined as PT recovery time. Microvascular flux was recorded from an in-line laser speckle contrast imager (FLPI-2, Moor Instruments Inc.) to establish PORH peak and recovery rates at each site.ResultsPT recovery and PORH recovery rate were most influenced at the heel and by load duration rather than load magnitude. PT recovery time at the heel was significantly longer with 10 minutes of loading, regardless of magnitude. Heel PORH recovery rate was significantly slower with 10minutes of loading. The 3MT PT recovery time was only longer after 10 minutes of loading at 50% body weight. Microvascular reactivity or sensitivity was not influenced with loading at the MA. A simple linear regression found that PORH recovery rate could predict PT recovery time at the heel (R2=0.184, p

This case study presents the treatment of a chronic, nonhealing wound in an 87-year old, non-diabetic female patient, using a combination of medical honey and Class 4 laser therapy. Despite standard wound care, the patient's ulcer showed minimal improvement. The introduction of medical honey for its antimicrobial and healing properties, coupled with Class 4 laser therapy to enhance tissue regeneration, resulted in significant wound healing. This case highlights the potential benefits of integrating these two modalities in the treatment of chronic wounds. [ABSTRACT FROM AUTHOR]

Copyright of Gerokomos is the property of Indemm Farma SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the last two decades, biologicals have become essential in treating children and adolescents with inflammatory bowel disease. TNF-α inhibitors (infliximab, adalimumab and golimumab) are preferentially used. Recent studies suggest that early application of TNF-α inhibitors is beneficial to inducing disease remission and preventing complications such as development of penetrating ulcers and fistulas. However, treatment failure occurs in about one third of pediatric patients. Particularly, children and adolescents differ in drug clearance, emphasizing the importance of pharmacokinetic drug monitoring in the pediatric setting. Here, current data on the choice and effectiveness of biologicals and therapeutic drug monitoring strategies are reviewed. [ABSTRACT FROM AUTHOR]

Previous studies determined that the oral administration of hydroalcoholic extracts obtained from the aerial parts of Equisetum giganteum L. n.v. cola de caballo, Cortaderia selloana (Schult & Schultz. f.) n.v. cortadera, Anthemis cotula L. n.v. manzanilla amarga y Atriplex undulata D. Dietr. n.v. zampa blanca prevent gastric ulcers induced by hypothermia and immobilization in mice. The formation of gastric ulcers in this experimental model is caused by a decrease in cytoprotective factors and by a mechanical erosive effect produced in the mucosa by increased gastric motility. In order to determine whether these extracts produce a decrease in gastric motility, in this study gastric emptying of a radiopaque substance was observed by taking radiographs at 0, 60, 100 and 160 minutes after the start of the test. A delay in gastric emptying time with respect to the control group animals was interpreted as a decrease in motility. The results of this work allow us to conclude that all the extracts of Atriplex undulata, Equisetumgiganteum, Cortaderia Selloana and Anthemis cotula show an inhibitory effect on gastric motility from higher to lower respectively. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulceration is one of the most significant causes of infection and amputation in neuropathic patients. Most often, the plantar surface of the foot is affected. Offloading the foot by custom-molded insoles is considered a crucial step in prevention of diabetic foot ulcers, although the most beneficial choice of materials is not well documented. This review focuses on identifying the most suitable materials and material compositions for offloading the diabetic foot. Materials and Methods: A systematic review was performed with the aid of a clinical librarian on September 9, 2020. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Studies were included based on the following eligibility criteria: interventions in terms of material selection/properties with outcomes reported as either pressure reduction and/or ulcer prevention. Bench studies were also included. At each level of selection, records were reviewed by two independent reviewers. Clinical studies were appraised using the ROBINS-1 tool. Results: Through database search, 1131 records were identified and an additional eight records were identified through references and other sources. After removal of duplicates, 927 records were screened, which resulted in 74 full-text records assessed for eligibility. Thirty-seven studies were included in the qualitative synthesis. Twelve studies examined material properties by bench testing. Five studies were based on finite element analysis. Nineteen clinical studies on material parameters were identified. Six studies supported the use of moderately deformable materials for insole production. Six studies showed better performance of combination material insoles in offloading and under sustained loading. Five studies concluded that increasing the thickness of insoles increased the offloading capabilities. Conclusions: The diversity of studies and study designs to date precludes the ability to recommend one type of material over the other. Still some general considerations can be made. For solo-material insoles, moderately deformable materials are preferable, balancing the need for offloading with the need for durability. Increasing the thickness may increase the longevity of the insoles. Combining materials of different properties seems to enhance both the offloading capability and durability of insoles. Clinical Relevance: When using a single-material design, moderately deformable materials are preferable. Combining materials of different properties enhances both the offloading capability and durability of insoles. [ABSTRACT FROM AUTHOR]

Pressure ulcers/injuries are caused by sustained loading and deformation of skin and underlying soft tissues. Prophylactic dressings are recommended as an adjunct to other preventive measures such as repositioning and offloading. The aim of this study was to investigate the effects of prophylactic soft silicone multi‐layered foam dressings on the skin structure and function of the two most common pressure areas, sacrum and heel, with and without loading. An exploratory randomised cross‐over trial using intra‐individual comparisons was conducted. Eight healthy volunteers (mean age 27.5 years) were assigned to three groups and either spent 2.5 hours on a standard hospital mattress lying in supine position with and without dressings or spent 2.5 hours with dressings applied but without loading. Skin temperature, stratum corneum, and epidermal hydration increased in all groups irrespective of wearing a dressing and/or loading. Mean roughness decreased at the heels. Reactive hyperaemia and the release of interleukin 1 alpha were associated with loading only. Results suggest that the occlusive effects of dressings are similar or only slightly greater than those observed with non‐loading or loading without dressings. Thus, a dressing does not cause additional irritation or skin changes during loading but it may reduce the inflammatory response. [ABSTRACT FROM AUTHOR]

Individuals with paraplegia spend their time on the wheelchair for life. Adapting to prolonged wheelchair seating for almost all activities of daily living is challenging. The loss of abilities to sense any pain or excessive seating pressure cause them to remain seated on the wheelchair without any pressure relief activities. This situation leads to secondary complications including pressure ulcer which further degrades the individual's health. To overcome this, a wheelchair seating pressure relief training system (WSETs) was developed. Optimal placement of the force sensitive resistors (FSR) as seating pressure sensors on the cushion were determined, and their responses were investigated with 5 paraplegics. Two different FSR orientations, A and B, were compared. Each paraplegic sat in resting position and then performed pressure relief activities (PRA) which included whole body push-up, left and right lean and forward lean, before returning to resting position. Orientation B, with more forward positioned FSRs, showed higher sensitivity, implying better capture of high-risk area of pressure ulcer development. The FSR sensor readings were significantly different among pressure relief activities in all subjects (p < 0.05) indicating the validity of FSR measures for the intended application. In conclusion, the WSETs system was proven suitable as a training tool for new paraplegics to habituate themselves in performing PRA. [ABSTRACT FROM AUTHOR]

The objective was to evaluate the efficacy of multi‐layered silicone foam (intervention) compared with transparent polyurethane film (control) in preventing heel pressure injuries caused by surgical positioning of individuals undergoing elective surgery. It was designed an intra‐patient, open, parallel, randomised controlled trial was conducted in a university hospital in southern Brazil, from March 2019 to February 2020, with patients undergoing elective surgeries of cardiac and gastrointestinal specialties. The patients who met the selection criteria constituted, simultaneously, a single group receiving the intervention and active control, through paired analysis of the cutaneous sites (right heel and left heel). The outcome was the occurrence of PI, within the follow‐up period was 72 hours. Brazilian Registry of Clinical Trials: RBR‐5GKNG5. There was analysis of 135 patients/270 heels, with an overall incidence of 36.7%. The pressure injury incidence was significantly lower in the intervention group (26.7%), compared with the control group (P =.001); relative risk of 0.57. In the intervention group, the estimated pressure injury‐free time (survival) was 57.5 hours and in the control group, 43.9 hours. It was concluded that Multi‐layered silicone foam (intervention) is more efficacious than transparent polyurethane film (control) in the prevention of pressure injuries caused by surgical positioning of individuals undergoing elective surgery. [ABSTRACT FROM AUTHOR]

Background: Bidens pilosa (BP) possessed anti-inflammatory, antioxidant, and immunomodulatory activities. Its beneficial effects on intestinal inflammation and oxidative stress in 2,4,6 trinitrobenzene sulfonic acid (TNBS) induced colitis in Wistar rats was evaluated. Methods: Thirty female Wistar rats weighing 180–200 g were distributed into six groups (n = 5): non-colitic, untreated colitic and colitic rats treated graded doses of methanol extract of BP (50–400 mg/kg). Colitis was induced in rats by intracolonic instillation of 0.2 mL of 40 mg/mL TNBS. BP was administered two days pre-colitis induction and treatments continued until seven days post-colitis induction. A day after the last treatment, rats were euthanized, colon removed aseptically and response to treatment assessed. Phytochemical composition of BP was determined using the GC-MS. Results: BP significantly reduced macroscopic colonic damage score, weight/length ratio, colonic lipid peroxidation level, leukocytes infiltration, and TNF-α level in comparison to untreated colitic rats (p ≤ 0.008). Similarly, treatment with 200 and 400 mg/kg BP prevented depletion of colonic glutathione level than other treatment groups (p ≤ 0.0002). Histological findings revealed that treatment with 400 mg/kg BP significantly preserved the mucosal epithelial layer. It also prevented ulceration and sloughing of the mucosal layers and reduced infiltration of inflammatory cells compared to other treatment groups. Among the 16 compounds identified were oleic acid (6.2%) and n-hexadecanoic acid (2.0%) with antioxidant anti-inflammatory activities. Conclusions: The beneficial effects of BP in rat colitis might be related to the reduction of leucocytes infiltration, inhibition of oxidative stress and pro-inflammatory cytokines. [ABSTRACT FROM AUTHOR]

Pressure ulcer incidence is high in intensive care units. This causes a serious financial burden to healthcare systems. We evaluated the cost‐effectiveness of multi‐layered silicone foam dressings for prevention of sacral and heel pressure ulcers in addition to standard prevention in high‐risk intensive care units patients. A randomised controlled trial to assess the efficacy of multi‐layered silicone foam dressings to prevent the development of pressure ulcers on heels and sacrum among 422 intensive care unit patients was conducted. Direct costs for preventive dressings in the intervention group and costs for treatment of incident pressure ulcers in both groups were measured using a bottom‐up approach. A cost‐effectiveness analysis by calculating the incremental cost‐effectiveness ratio using different assumptions was performed. Additional dressing and labour costs of €150.81 (€116.45 heels; €34.36 sacrum) per patient occurred in the intervention group. Treatment costs were €569.49 in the control group and €134.88 in the intervention group. The incremental cost‐effectiveness ratio was €1945.30 per PU avoided (€8144.72 on heels; €701.54 sacrum) in the intervention group. We conclude that application of preventive dressings is cost‐effective for the sacral area, but only marginal on heels for critically ill patients. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Wound Management / Leczenie Ran is the property of Evereth Publishing Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Gastritis or /and gastric ulcers are one of the most common symptoms which occur in a large amount of the population. It results in a very high amount of medication expense. This study investigated the prevention and treatment of gastritis or /and gastric ulcer actions using white log mushroom (Lentinus squarrosulus, (Mont.). Methods: White wistar rats were induced with 100 % absolute alcohol to be effective for gastritis and /or ulceration within rats. The gastric lesions of white wistar rats were investigated and calculated the lesions of stomach areas under microscopic method. The results were calculated and a comparative study among white wistar rats. Ulcer prevention and ulcer healing properties were administrated though a dose of 250 mg/kg of L. squarrosulus extract and L. squarrosulus compared with 50 mg/kg of Ranetidine. Results: It was found that Lentinus squarrosulus, (Mont.) consisted of Beta-glucan was the active ingredient creating a healing effect. It showed a result of 100% healing effect in gastritis and/or ulcers in which it had similar healing effects between extracted solutions of white log mushroom (250 mg/kg body wt.) The healing activity also showed the equivalent effect compared to Ranetidine 150mg. Conclusions: Extracted solution of white log mushroom showed prevention and treatment efficacy in gastritis and/or ulcer are equivalent to Ranetidine 150 mg. A similar dose of 250 mg/kg of L. squarrosulus extract and L. squarrosulus snack can prevent and heal ulcers and is more effective than Ranetidine. [ABSTRACT FROM AUTHOR]

• Objective: Critically ill patients are at high risk of developing pressure ulcers (PU), with the sacrum and heels being highly susceptible to pressure injuries. The objective of our study was to evaluate the clinical effectiveness of a new multi-layer, self-adhesive soft silicone foam heel dressing to prevent PU development in trauma and critically ill patients in the intensive care unit (ICU). • Method: A cohort of critically ill patients were enrolled at the Royal Melbourne Hospital. Each patient had the multi-layer soft silicone foam dressing applied to each heel on admission to the emergency department. The dressings were retained with a tubular bandage for the duration of the patients' stay in the ICU. The skin under the dressings was examined daily and the dressings were replaced every three days. The comparator for our cohort study was the control group from the recently completed Border Trial. • Results: Of the 191 patients in the initial cohort, excluding deaths, loss to follow-up and transfers to another ward, 150 patients were included in the final analysis. There was no difference in key demographic or physiological variables between the cohorts, apart from a longer ICU length of stay for our current cohort. No PUs developed in any of our intervention cohort patients compared with 14 patients in the control cohort (n=152; p<0.001) who developed a total of 19 heel PUs. • Conclusion: We conclude, based on our results, that the multi-layer soft silicone foam dressing under investigation was clinically effective in reducing ICU-acquired heel PUs. The findings also support previous research on the clinical effectiveness of multi-layer soft silicone foam dressings for PU prevention in the ICU. [ABSTRACT FROM AUTHOR]

The present study assessed the effect of educational intervention on knowledge and practice of caregivers regarding prevention of pressure ulcer among elderly patients admitted in the selected Hospital Thiruvalla. The objectives were to determine the effect of STP regarding prevention of pressure ulcer among care givers of elderly patients by comparing the pre test and post test knowledge and practice scores with selected socio demographic variables. The study was conducted using the pre experimental one group pre test and post test design. The conceptual frame work was based on Roy's adaptation model. The investigator selected 40 samples by convenient sampling. During the pre test investigator assessed the knowledge and practice on prevention of pressure ulcer. The same day itself, the investigator administered STP, After seven days, post test was conducted using same tool. During the pre test 5% had poor knowledge, 60% of the samples had average knowledge and 35 % had good knowledge. After the STP 90 % of the samples attained good knowledge and 10 % achieved average knowledge. Paired 't' test was done and it was found that there is significant improvement in knowledge and practice (t=20.641,t=17.588). The study concluded that STP is one of the effective teaching method to educate caregivers regarding SSKIN care bundle pressure ulcer prevention. [ABSTRACT FROM AUTHOR]

Pressure ulcers/injuries are well known for being a common problem in healthcare and are a key indicator of the quality and experience of patient care. This article discusses how one NHS trust reduced the incidence of heel pressure ulcers within adult inpatient settings. In 2016/17, the trust identified 14 avoidable category 3 and above pressure ulcers/injuries in inpatient settings, of which 10 had developed on the heels. Through root cause analysis, the organisation identified themes, which prompted action, and a quality improvement project 'Deal with heels' was planned and implemented. Changes were introduced through a collaborative and structured approach; the key stakeholders included the tissue viability team, procurement, medical devices, patient safety, managers, matrons, ward sisters and tissue viability link advisors, who worked together to reduce heel ulcer prevalence through education and standardised practice. As a result of improved organisational awareness and some changes, the number of heel pressure ulcers/injuries reduced to two over a 3-year period, which also helped reduce the total number of avoidable pressure ulcers/injuries. [ABSTRACT FROM AUTHOR]

There are considerable human costs associated with pressure ulcerations, along with a significant economic burden to healthcare providers. Despite the majority of hospital-acquired ulcers believed to be preventable, the number of people developing these remains high. Clinical guidelines recommend performing robust, structured assessments upon admission to an acute hospital, or as soon as feasible, to identify individuals at risk of developing pressure-related skin breakdown. Risk-specific interventions should then be employed to reduce the likelihood of developing pressure ulcerations, with daily reviews and reassessment when clinical indications are present to allow any skin damage to be noted at an early stage. This article presents a multidisciplinary collaboration across all four nations to develop simple and effective tools to improve the quality and performance of comprehensive inpatient foot checks which allow for the recognition, prevention and management of heel pressure ulcers, reducing the risk of avoidable harm to patients. [ABSTRACT FROM AUTHOR]

The article presents a case study of a firstborn girl with whitish halo on the lumbar and buttocks region. Topics include magnetic resonance imaging being performed confirming the presence of isolated spinal dysraphism including lipomyelomeningocele; and focal IH-MAGs presenting reddish rounded globular vessels, commalike vessels, and reddish linear vessels.

Background: In the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial, 3291 adult ICU patients at risk for gastrointestinal (GI) bleeding were randomly allocated to intravenous pantoprazole 40 mg or placebo once daily in the ICU. No difference was observed between the groups in the primary outcome 90-day mortality or the secondary outcomes, except for clinically important gastrointestinal bleeding. However, heterogeneity of treatment effect (HTE) not detected by conventional subgroup analyses could be present.Methods: This is a protocol and statistical analysis plan for a secondary, post hoc, exploratory analysis of the SUP-ICU trial. We will explore HTE in one set of subgroups based on severity of illness (using the Simplified Acute Physiology Score [SAPS] II) and another set of subgroups based on the total number of risk factors for GI bleeding in each patient using Bayesian hierarchical models. We will summarise posterior probability distributions using medians and 95% credible intervals and present probabilities for different levels of benefit and harm of the intervention in each subgroup. Finally, we will assess if the treatment effect interacts with SAPS II and the number of risk factors separately on the continuous scale using marginal effects plots.Conclusions: The outlined post hoc analysis will explore whether HTE was present in the SUP-ICU trial and may help answer some of the remaining questions regarding the balance between benefits and harms of pantoprazole in ICU patients at risk of GI bleeding. CLINICALTRIALS.Gov Registration: NCT02467621. [ABSTRACT FROM AUTHOR]

Musa sp. Linn. is commonly known asBanana andthis species is used traditionally for the prevention of different diseases and the present in silicostudy concerns on the gastric ulcer protective properties of phytocompounds (flavonoids) of banana fruit. The study was attempted for acute toxicity especially rat oral LD50 values of phytocompoundscompared to synthetic medicine Ranitidine through quantitative structure activity relationship (QSAR) modelling and receptor-ligand binding energy and interaction through molecular docking for phytoligandsofbanana compared to Ranitidine on matrix metalloproteinase-9 or MMP-9 (PDB ID: 2OW0)receptor. Thetoxicity prediction was done by using T.E.S.T. (Version 4.1) and molecular docking was performed by using PyRxtool (Version 0.8). The present toxicity prediction with special reference to rat oral LD50 value (mg/Kg) indicated that Vanillic acid and Salicylic acid were obtained lower median lethal dose (LD50) values (747.56 and 815.58) as moderately toxic while higher value was found in β-carotene (8032.73 mg/Kg) as non-toxic compared to Ranitidine (1608.80). Rests of the phytocompounds were obtained moderately toxic. The data of favourable binding energy values (Kcal/mol), three phytoligands such as Quercetin (-8.2), Myricetin (-8.2) and Kaempferol (-8.0) were observed favourable binding energy in comparison with Ranitidine (-5.6). In conclusion, Quercetin and Myricetin of Musa sp. showed binding near mouth of the active site at Zn2+ ion, which can be lead molecules for the MMP-9 inhibition and may prevent gastric ulcer. It is suggested that these two phytocompounds should be validated through experimental assay to confirming the present prediction. [ABSTRACT FROM AUTHOR]

Objective: This study examined the perspectives of health professionals on the barriers and solutions to delivery of patient-focused wound management and outcomes. Methods: A qualitative, descriptive study design was used. Participants were health-care managers, clinical leaders, nurses and allied health members who are part of wound care services. Open-ended surveys were distributed to participants in a series of learning workshops, and data analysed to identify leading themes. Results: A total of 261 participants took part and 194 surveys were returned (response rate: 74%). From the analysis five themes emerged: patient/family wound-related education; health professional wound-related education; implementation of evidence-based wound care and dissemination of evidence-based wound information across professions and contexts; teamwork and respectful communication within teams; and a higher value and priority placed on wound care through collaborative teams by managers, leaders and policymakers. Conclusion: Findings suggest that ongoing, system-wide education is needed to improve prevention, assessment, treatment and management of four wound types: venous leg ulcer (VLU), diabetic foot ulcer (DFU), pressure ulcer (PU) and surgical wounds. Health professionals are committed to delivering best practice in wound care. Participants identified that effective patient-focused, evidence-based wound care involves having a health-care system with a clear mandate to ensure wound care is a priority. A high value placed on wound care by managers and clinical leadership could transform the present systems. Additionally, effective and widespread dissemination of evidenced-informed practice information is crucial to positive patient outcomes. Education and team commitment for consistent and respectful communication would improve care delivery. [ABSTRACT FROM AUTHOR]

Pressure ulcers, by definition, are caused by external forces on the tissues, often in the regions of bony prominences. Wheelchair users are at risk to develop sitting-acquired pressure ulcers, which occur in the regions of the ischial tuberosities, sacrum/coccyx or greater trochanters. As a means to prevent pressure ulcers, instruction on performing pressure reliefs or weight shifts are a part of the rehabilitation process. The objective of this study was to monitor the weight shift activity of full-time wheelchair users with acute spinal cord injury over multiple epochs of time in order to determine consistency or routine within and across epochs. A second objective was to evaluate the accuracy of self-reported pressure relief frequency within each measurement epoch. A wheelchair in-seat activity monitor was used to measure weight shifts and other in-seat movement. The data was classified into multiple in-seat activity metrics using machine learning. Seventeen full-time wheelchair users with spinal cord injury were measured within multiple epochs, each lasting more than 1 week. Across all in-seat activity metrics, no consistent pattern of activity changes emerged. None of the in-seat activity metric changed in any one direction across a majority of subjects. Subjects tended to over-estimate their frequency of performing pressure reliefs. Self-reported pressure relief behaviors are not reliable, and therefore, cannot be used to evaluate preventative behaviors either clinically or within research. This study had the capability of fully investigating in-seat movements of wheelchair users. The results indicated that in-seat movement does not reflect a routine, either in pressure reliefs, weight shifts or other functional in-seat movements. This study has illustrated the complexity of assigning causation of pressure ulcer occurrence to seated behaviors of wheelchair users and identifies the need for improved clinical techniques designed to develop routine behaviors to prevent pressure ulcers. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are becoming more prevalent and this is driving an increase in diabetes-related amputations. At the rate of increase of new diabetes diagnoses each year, this problem is becoming increasingly unsustainable. Much attention has been paid to patient education as a means of preventing DFUs, but there is little evidence that this is effective at preventing DFUs as an isolated intervention. More recent attention focused on notions of motivational interviewing and patient concordance in light of diabetes self-care more broadly has re-sharpened the focus on establishing good foot self-care practices in patients with diabetes as a DFU prevention strategy. What is missing from the literature, however, is this discussion in the context of the 'low risk' diabetes population. Early interventions have a greater chance at preventing DFU development before micro- and macrovascular complications of diabetes render a DFU as increasingly likely irrespective of belated intervention. Thus, this article considers the literature and argues the case for preliminary research to explore possible barriers and facilitators to foot self-care practices in people with diabetes deemed 'low risk' of developing foot complications. [ABSTRACT FROM AUTHOR]

Background Together with Treponema pallidum subspecies pertenue, Haemophilus ducreyi is a major cause of exudative cutaneous ulcers (CUs) in children. For H. ducreyi, both class I and class II strains, asymptomatic colonization, and environmental reservoirs have been found in endemic regions, but the epidemiology of this infection is unknown. Methods Based on published whole-genome sequences of H. ducreyi CU strains, a single-locus typing system was developed and applied to H. ducreyi– positive CU samples obtained prior to, 1 year after, and 2 years after the initiation of a mass drug administration campaign to eradicate CU on Lihir Island in Papua New Guinea. DNA from the CU samples was amplified with class I and class II dsrA -specific primers and sequenced; the samples were classified into dsrA types, which were geospatially mapped. Selection pressure analysis was performed on the dsrA sequences. Results Thirty-seven samples contained class I sequences, 27 contained class II sequences, and 13 contained both. There were 5 class I and 4 class II types circulating on the island; 3 types accounted for approximately 87% of the strains. The composition and geospatial distribution of the types varied little over time and there was no evidence of selection pressure. Conclusions Multiple strains of H. ducreyi cause CU on an endemic island and coinfections are common. In contrast to recent findings with T. pallidum pertenue, strain composition is not affected by antibiotic pressure, consistent with environmental reservoirs of H. ducreyi. Such reservoirs must be addressed to achieve eradication of H. ducreyi. [ABSTRACT FROM AUTHOR]

"Quelites" are edible plants that are part of the traditional agro-ecosystems in Mexico. These plants, despite their already known nutritional properties, are now considered neglected and underutilized species. With the objective of promoting their reinsertion in the markets and mainly, in daily diets, efforts have been made to study them from multidisciplinary approaches to demonstrate their beneficial properties. To generate evidence of an added health-promoting value that would encourage quelites consumption, in the present work, the anti-Helicobacter pylori activity of three representative quelite species, Anoda cristata (Alache), Cnidoscolus aconitifolius (Chaya), and Crotalaria pumila (Chepil), was tested. H. pylori is considered the etiological agent of gastritis, ulcer, and gastric cancer, and represents a public health problem in Mexico and worldwide. Aqueous (AQ) and dichloromethane–methanol (DM) extracts were obtained from the three species of quelites to investigate their effect on H. pylori growth and on two of its colonization factors (adherence and urease activity). DM extracts from Chaya, Chepil, and Alache exert the best inhibitory effect on bacterial growth, with minimum inhibitory concentrations of 62.5, 125, and 250 μg/mL, respectively. AQ and DM extracts inhibit bacterial adhesion by 30% to 50%. None of them has an effect on urease activity. The two flavonoids present in A. cristata, acacetin and diosmetin, inhibit H. pylori growth by ∼90% with 3.9 μg/mL. These results provide new information about the anti-H. pylori potential of three edible quelites, and give an added value, since their routine consumption may impact on the prevention and/or control of H. pylori-associated diseases. [ABSTRACT FROM AUTHOR]

The absence of pressure injury remains a key indicator of care; as with many disease processes, prevention is better than management. In recent years, the concept of prophylactic pressure ulcer prevention using dressings has gained traction. This article reports a small quality assurance study undertaken on an orthopaedic ward, where dressings were used prophylactically on the heels of patients who had undergone surgery under spinal anaesthesia. Results showed that in the study group (n=87), no tissue damage occurred during the wear time or whilst in hospital, whereas in the comparator group, 12 patients (18.75%) went on to develop category 2 heel pressure ulcers during the same period. [ABSTRACT FROM AUTHOR]

Acanthamoeba is an opportunistic pathogen which is the causal agent of a sight-threatening ulceration of the cornea known as Acanthamoeba keratitis (AK) and, more rarely, an infection of the central nervous system called “granulomatous amoebic encephalitis” (GAE). The symptoms of AK are non-specific, and so it can be misdiagnosed as a viral, bacterial, or fungal keratitis. Furthermore, current therapeutic measures against AK are arduous, and show limited efficacy against the cyst stage of Acanthamoeba . 1 H -Phenalen-1-one (PH) containing compounds have been isolated from plants and fungi, where they play a crucial role in the defense mechanism of plants. Natural as well as synthetic PHs exhibit a diverse range of biological activities against fungi, protozoan parasites or human cancer cells. New synthetic PHs have been tested in this study and they show a potential activity against this protozoa. [ABSTRACT FROM AUTHOR]

Objectives: To examine the level of Nepalese critical care nurses' competency including knowledge, attitude, and practice towards pressure ulcer (PU) prevention. Methods: Data were collected from 98 eligible nurses working in intensive care unit/critical care unit (ICU/CCU) of three hospitals in Nepal from February to April 2017, using Nurses' Competency Towards PU Prevention Questionnaire. Data were analyzed using descriptive statistics. Results: The level of nurses' competency was categorized into 5 levels. The Nepalese critical care nurses' competency towards PU prevention was at a low level. The knowledge and attitude of Nepalese critical care nurses' towards PU prevention were at a low and moderate level, respectively. While the practice of Nepalese critical care nurses were at a very low level. Conclusion: Nursing competence is an integral part of positive health outcomes of patients. The low level of competence towards PU prevention among Nepalese critical care nurse, therefore, raises the nation concern to increase their competency to increase the quality of PU prevention. [ABSTRACT FROM AUTHOR]

Background: Conventional scientific studies had supported the use of polysaccharides and β-glucans from a number of fungi, including Ganoderma lucidum for the treatment of recurrent oral ulceration (ROU). Our aim of the present study was to evaluate whether freeze-dried powder from G. lucidum mycelia (FDPGLM) prevents ROU in rats. Methods: A Sprague-Dawley (SD) rat model with ROU was established by autoantigen injection. The ROU rats were treated with three different dosages of FDPGLM and prednisone acetate (PA), and their effects were evaluated according to the clinical therapeutic evaluation indices of ROU. Results: High-dose FDPGLM induced significantly prolonged total intervals and a reduction in the number of ulcers and ulcer areas, thereby indicating that the treatment was effective in preventing ROU. Enzyme-linked immunosorbent assay (ELISA) showed that high-dose FDPGLM significantly enhanced the serum transforming growth factor-β1 (TGF-β1) levels, whereas reduced those of interleukin-6 (IL-6) and interleukin-17 (IL-17). Flow cytometry (FCM) showed that the proportion of CD4+ CD25+ Foxp3+ (forkhead box P3) regulatory T cells (Tregs) significantly increased by 1.5-fold in the high-dose FDPGLM group compared to that in the rat model group (P < 0.01). The application of middle- and high-dose FDPGLM also resulted in the upregulation of Foxp3 and downregulation of retinoid-related orphan receptor gamma t(RORγt) mRNA. Conclusion: High-dose FDPGLM possibly plays a role in ROU by promoting CD4+ CD25+ Foxp3+ Treg and inhibiting T helper cell 17 differentiation. This study also shows that FDPGLM may be potentially used as a complementary and alternative medicine treatment scheme for ROU. [ABSTRACT FROM AUTHOR]

Heel pressure injury (HPI) prevention can be challenging without tools to identify at-risk patients. An HPI prevention algorithm was implemented to standardize practice and allowed nurses to use basic patient information to identify vulnerable persons, alleviating the need for extensive, time-consuming medical record reviews. [ABSTRACT FROM AUTHOR]

An evaluation was conducted across six rehabilitation wards in the South-East Wales area to observe the performance of the Maxxcare Pro Evolution Heel boot in this care setting and to review the acceptance of the boot among a cohort of patients with restricted mobility at risk of pressure damage. Seventeen patients were included in this evaluation and all were deemed to be either at risk of developing pressure damage or had existing pressure damage to the heel. The mean age of the cohort was 75 years. Patients were monitored for 14 days during which skin assessments were conducted. The Maxxcare Pro Evolution Heel boot has been designed to offload the heel during extensive periods of unrelieved pressure whilst in bed or in a sitting position. The findings from this evaluation suggest that the Maxxcare Pro Evolution Heel boot was effective in protecting the heels of patients at risk of developing pressure damage in a rehabilitation setting. [ABSTRACT FROM AUTHOR]

Polyurethane (PU) foam is one of the most common materials used in the development of pressure relieving cushions. However, it suffers from reduced efficiency in terms of thermophysiological comfort, cost, recycling and importantly, creating a suitable environment for the prevention of pressure ulcers. The paper presents research carried out at the University of Bolton, in the development of pressure relieving cushion applications using three-dimensional (3D) warp-knitted spacer fabrics. This research includes the development of a novel technique for measuring pressure distribution while under simulated loading conditions. Using this system, novel and smart 3D knitted spacer cushions were developed, with the following features: (1) a shaped/contoured surface was able to redistribute high pressure points normally located in vulnerable areas of an immobile and seated person. (2) Peak pressures were reduced and distributed evenly over a much larger area of the cushion than PU foam. (3) They are well-ventilated, comfortable, washable and non-flammable and can be easily recycled. [ABSTRACT FROM AUTHOR]

Rocker profiles are commonly used in the prevention of diabetic foot ulcers. Rockers are mostly stiffened to restrict toe plantarflexion to ensure proper offloading. It is also described that toe dorsiflexion should be restricted. However, the difference in effect on plantar pressure between rigid rockers that restrict this motion and flexible rockers that do not is unknown. In-shoe plantar pressure data were collected for a control shoe and the same shoe with rigid and flexible rockers with the apex positioned at 50% and 60%. For 29 healthy female adults peak plantar pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven regions of the foot. Generalized estimate equation was used to analyse the effect of the different shoes on the outcome measures for these regions. Compared to the control shoe a significant increase of PP and FTI was found at the first toe for both rigid rockers and the flexible rocker with the apex positioned at 60%, while MMP was significantly increased in rockers with an apex position of 60% (p<0.001). PP at the first toe was significantly lower in flexible rockers when compared to rigid rockers (p<0.001). For both central and lateral forefoot PP and MMP were significantly more reduced in rigid rockers (p<0.001), while for the medial forefoot no differences were found. The use of rigid rockers results in larger reductions of forefoot plantar pressures, but in worse increase of plantar pressures at the first toe compared to rockers that allow toe dorsiflexion. [ABSTRACT FROM AUTHOR]

Of the numerous gaseous substances that can act as signaling molecules, the best characterized are nitric oxide, carbon monoxide and hydrogen sulfide. Contributions of each of these low molecular weight substances, alone or in combination, to maintenance of gastrointestinal mucosal integrity have been established. There is considerable overlap in the actions of these gases in modulating mucosal defense and responses to injury, and in some instances they act in a cooperative manner. Each also play important roles in regulating inflammatory and repair processes throughout the gastrointestinal tract. In recent years, significant progress has been made in the development of novel anti-inflammatory and cytoprotective drugs that exploit the beneficial activities of one or more of these gaseous mediators. [ABSTRACT FROM AUTHOR]

Introduction The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently, there is a lack of clarity on contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. Methods The project aimed to optimize prevention, treatment and maintenance approaches by recognizing contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. A literature review was conducted of current guidelines on venous leg ulcer prevention, management and maintenance. Results Searches took place from 29th February 2016 to 30th April 2016 and were prospectively limited to publications in the English and German languages and publication dates were between January 2009 and April 2016. Twenty Guidelines, clinical pathways and consensus papers on compression therapy for venous leg ulcer treatment and for venous disease, were included. Guidelines agreed on the following absolute contraindications: Arterial occlusive disease, heart failure and ankle brachial pressure index ( ABPI) <0.5, but gave conflicting recommendations on relative contraindications, risks and adverse events. Moreover definitions were unclear and not consistent. Conclusions Evidence-based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression. [ABSTRACT FROM AUTHOR]

Background: Therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with enteropathy in humans and experimental animals, a cause of considerable morbidity. Unlike foregut NSAID-associated mucosal lesions, most treatments for this condition are of little efficacy. We propose that the endogenously released intestinotrophic hormone glucagon-like peptide-2 (GLP-2) prevents the development of NSAID-induced enteropathy. Since the short-chain fatty acid receptor FFA3 is expressed on enteroendocrine L cells and on enteric nerves in the gastrointestinal tract, we further hypothesized that activation of FFA3 on L cells protects the mucosa from injury via GLP-2 release with enhanced duodenal HCO3- secretion. We thus investigated the effects of synthetic selective FFA3 agonists with consequent GLP-2 release on NSAID-induced enteropathy.Methods: We measured duodenal HCO3- secretion in isoflurane-anesthetized rats in a duodenal loop perfused with the selective FFA3 agonists MQC or AR420626 (AR) while measuring released GLP-2 in the portal vein (PV). Intestinal injury was produced by indomethacin (IND, 10 mg/kg, sc) with or without MQC (1-10 mg/kg, ig) or AR (0.01-0.1 mg/kg, ig or ip) treatment.Results: Luminal perfusion with MQC or AR (0.1-10 µM) dose-dependently augmented duodenal HCO3- secretion accompanied by increased GLP-2 concentrations in the PV. The effect of FFA3 agonists was inhibited by co-perfusion of the selective FFA3 antagonist CF3-MQC (30 µM). AR-induced augmented HCO3- secretion was reduced by iv injection of the GLP-2 receptor antagonist GLP-2(3-33) (3 nmol/kg), or by pretreatment with the cystic fibrosis transmembrane conductance regulator (CFTR) inhibitor CFTRinh-172 (1 mg/kg, ip). IND-induced small intestinal ulcers were dose-dependently inhibited by intragastric administration of MQC or AR. GLP-2(3-33) (1 mg/kg, ip) or CF3-MQC (1 mg/kg, ig) reversed AR-associated reduction in IND-induced enteropathy. In contrast, ip injection of AR had no effect on enteropathy.Conclusion: These results suggest that luminal FFA3 activation enhances mucosal defenses and prevents NSAID-induced enteropathy via the GLP-2 pathway. The selective FFA3 agonist may be a potential therapeutic candidate for NSAID-induced enteropathy. [ABSTRACT FROM AUTHOR]

Ocimum africanum Lour. (hairy basil, hoary basil or lemon basil) is an aromatic herb in Asian and Thai cuisine that has been used as a carminative, a digestion enhancement and remedy for gastrointestinal disturbance in Thai traditional medicine. This study was performed to evaluate the gastroprotective effect of O.africanum leaf extract in acid/alcohol-induced gastric lesion in rats. Pretreatment of the plant extract can prevent the gastric damage in a dose-dependent manner. At 125 mg/kg of body weight, the plant extract attenuated the inflammation with % ulcer index of 5.08±1.41, whereas at doses of 250 and 500 mg/kg of body weight, the gastric lesion was completely prevented in the manner similar to what was observed in omeprazole pretreated animals (% ulcer index of 1.0±61.94, 0.1±10.45 and 0.00±0.00, respectively). The protective effect of the plant extract against acid/alcohol-induced gastric damage relates to its high antioxidative property and the ability to enhance the activities of three antioxidative enzymes, i.e. superoxide dismutase, catalase and glutathione peroxidase. Preliminary phytochemical investigation demonstrated that certain phenolic compounds such as rosmarinic acid, caffeic acid and vanillic acid might take part in the protective effects. [ABSTRACT FROM AUTHOR]

Background and Aim Proton pump inhibitors are effective for the treatment of gastric ulcers after endoscopic submucosal dissection ( ESD). However, the most excellent therapy is controversial. Vonoprazan, an active potassium-competitive acid blocker, has a strong gastric acid secretion inhibitory effect, but its efficacy for the treatment of post- ESD gastric ulcers is unclear. Herein, we aimed to determine the healing effect of vonoprazan on post- ESD gastric ulcers. Methods We carried out a prospective randomized controlled trial examining 92 patients who had undergone ESD for the treatment of gastric neoplasms between April 2015 and June 2016 at Machida Municipal Hospital. Patients were treated with 20 mg/day vonoprazan (V group) or 20 mg/day esomeprazole (E group) for 8 weeks. We evaluated the 8-week cure rate for artificial ulcers and any complications after ESD. Results A total of 80 patients (median age, 73.5 years; 71.3% male) were analyzed. Cure rate for the V group was significantly higher than that for the E group (94.9% [37/39] vs 78.0% [32/41], respectively; P = 0.049). In a multivariate analysis, only vonoprazan was correlated with ulcer healing (odds ratio = 6.33; 95% CI = 1.21-33.20; P = 0.029). Delayed bleeding was experienced only in the E group (7.3% [3/41]), but no significant difference compared with the V group was observed ( P = 0.241). Conclusion Vonoprazan was significantly superior to esomeprazole for the healing of post- ESD gastric ulcers and should be considered as a treatment of first choice. [ABSTRACT FROM AUTHOR]

Introduction: A decreased frequency of upper gastrointestinal bleeding and a possible association of proton pump inhibitor use with Clostridium difficile and ventilator-associated pneumonia have raised concerns recently. The Reevaluating the Inhibition of Stress Erosions Pilot Trial determined the feasibility of undertaking a larger trial investigating the efficacy and safety of withholding proton pump inhibitors in critically ill patients.Methods: In 10 ICUs, we randomized adult ICU patients anticipated to be mechanically ventilated for greater than or equal to 48 hours to receive 40 mg of IV pantoprazole daily or placebo. We excluded patients who had acute or recent gastrointestinal bleed, used dual antiplatelet agents, had a medical condition requiring proton pump inhibitor treatment, or had already received more than one dose of acid suppression daily. Patients, families, clinicians, and research staff were blinded. We conducted a systematic review and meta-analysis of similar trials.Main Results: Ninety-one patients (49 pantoprazole and 42 placebo) from 10 centers in Canada, Saudi Arabia, and Australia were enrolled. All feasibility goals were met: 1) recruitment rate was 2.6 patients per month; 2) consent rate was 77.8%; and 3) protocol adherence was 97.7%. Upper gastrointestinal bleeding developed in 6.1% of patients in the pantoprazole group and 4.8% in the placebo group (p = 1.0). Ventilator-associated pneumonia developed in 20.4% of patients in the pantoprazole group and 14.3% in the placebo group (p = 0.58). C. difficile was identified in 4.1% pantoprazole patients and in 2.4% placebo patients (p = 1.0). We meta-analyzed five trials (604 patients) of proton pump inhibitors versus placebo; there was no statistically significant difference in the risk of upper gastrointestinal bleeding, infections, or mortality.Conclusions: Our results support the feasibility of a larger trial to evaluate the safety of withholding stress ulcer prophylaxis. Although the results are imprecise, there was no alarming increase in the risk of upper gastrointestinal bleeding; the effect of proton pump inhibitors on ventilator-associated pneumonia and C. difficile remain unclear. [ABSTRACT FROM AUTHOR]