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BACKGROUND RESULTS CONCLUSIONS Stress‐related diseases are on the rise and stress is one of the common factors that lead to ulcer. Stress‐induced mucosal bleeding is a serious complication observed in many critically ill patients. Due to the harmful side effects of proton pump inhibitors, natural and active alternative treatment methods for peptic ulcer treatment that are safe in terms of side effects are an urgent need for human health. We aimed to investigate the dose‐dependent protective effects of Lactobacillus rhamnosus GG (LGG) against stress ulcers induced by cold restraint stress in rats. This study was performed in a total of 42 rats, in control group (C), stress group (S), pantoprazol (20 mg kg−1 day−1) group (P), LGG (3 × 108 cfu mL−1 day−1) + stress group (M1), LGG (15 × 108  mL−1 day−1) + stress group (M5) and LGG (30 × 108  mL−1 day−1) + stress group (M10) (each n = 7). Ulceration areas (mm2) were determined quantitatively with ImageJ software. Glucocorticoid, catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels were determined by ELISA and malondialdehyde levels were determined by spectrophotometric measurement. Histopathological examinations were performed in gastric tissue.Therapeutic dose of LGG increased CAT, SOD and GPx levels; prevented excessive activation of the hypothalamic–pituitary–adrenal axis; reduced ulceration and bleeding in the gastric mucosal layer; and provided stabilization of mast cells.We can suggest that LGG may be beneficial for reducing the negative effects of stress on the body, for protecting against ulcer disease and for reducing or preventing the risk of stress‐induced gastrointestinal bleeding in patients staying in intensive care units. © 2024 The Author(s). Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate the role of equine herpesvirus-2 (EHV-2) and equine herpesvirus-5 (EHV-5) in equine glandular gastric disease (EGGD) by visualizing and quantifying these gamma herpesviruses in EGGD-affected and normal glandular gastric mucosa of horses. A secondary objective was to describe the histopathological abnormalities in the equine gastric glandular mucosa in horses with EGGD. ANIMALS 29 horses (n = 21 postmortem and 8 gastroscopy) categorized as normal (11), EGGD (12), or both EGGD and equine squamous gastric disease (6). METHODS Glandular gastric mucosal samples were collected from horses by gastroscopy or postmortem. Histopathology and in situ hybridization targeting EHV-2 and EHV-5 were performed on grossly normal and abnormal glandular gastric mucosa. The number of in situ hybridization-positive cells per millimeter squared of tissue was calculated. Evaluators were blinded to groups. RESULTS Glandular gastric tissues from horses without EGGD had higher viral loads in the mucosa than normal or abnormal tissues from EGGD horses. There was no difference in viral loads for EHV-2 or EHV-5 between grossly or endoscopically normal to abnormal gastric tissues within horses with EGGD. Lymphocytic plasmacytic gastritis was the most common histopathological abnormality, with only 3 horses having mucosal disruption (glandular ulcer or erosion). CLINICAL RELEVANCE Equine gamma herpesviruses are unlikely to play a role in the pathophysiology of EGGD. EGGD is frequently inflammatory with occasional mucosal disruption (ulcer or erosion). [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusions To describe patient demographics and treatment protocols in a population of feline patients undergoing photoactivated chromophore for keratitis–corneal cross‐linking (PACK–CXL) as an adjunctive treatment for infectious keratitis. Furthermore, to determine the proportion of PACK–CXL treatment success in the population studied, explore risk factors for treatment failure, and provide recommendations for future PACK–CXL clinical studies.Records from four veterinary ophthalmology practices were reviewed to identify eligible patients and extract data. Recorded variables included patient‐related factors, ocular examination findings, PACK‐CXL protocol parameters, and treatment outcome.Records for 153 cats (154 eyes) were included. Median age in the treatment success group was 8 years (interquartile range (IQR) 4–12), with a median ulcer depth of 30% (IQR 30–40). Median age in the treatment failure group was 10.5 years (IQR 4.75–12) with a median ulcer depth of 45.9% (IQR 30–75). Persian cats were the most represented brachycephalic breed (52 out of 64 cats). Modified PACK–CXL protocols were used, including fast energy delivery (134 eyes), and increased fluence (52 eyes). The overall proportion of success was 88% (95% CI 84–93), which was variable between clinics. Eighty‐two of 89 mesocephalic cat eyes (92%), and 54 of 65 brachycephalic cat eyes (83%) were classified as treatment successes.PACK–CXL appeared to be a useful, adjunctive therapeutic modality for the treatment of infectious keratitis in the feline patient population presented here. Brachycephalic cats, older cats, and those with deeper ulcers may be at increased risk for treatment failure. [ABSTRACT FROM AUTHOR]

Objectives Neoadjuvant chemotherapy (NACT) is recommended for muscle-invasive bladder cancer, and robust treatment response may result in lack of grossly identifiable tumor in the cystectomy specimen. Current gross examination and reporting protocols, however, do not include specific guidance on the approach to these specimens. Methods A Qualtrics survey was disseminated by email and X (formerly Twitter). Responses from pathologists and pathologists' assistants (PAs) were included. The survey interrogated demographics, practice settings, prevalence of NACT use, approach to gross examination, and reporting practices in the setting of both grossly visible tumor or ulcer bed and the complete absence of a gross lesion. Results Based on 55 respondents' experience, identifying gross tumor occurred less frequently than tumor or ulcer bed (40% vs 71%). Lack of identification of any gross lesions was estimated to occur in 29% of cases. Gross examination practices were relatively consistent in cases with residual gross tumor or gross tumor bed, with agreement that gross tumor should be submitted as 1 block per centimeter (66%), and tumor or ulcer bed should be submitted in its entirety (97%). Gross examination practices appeared more varied when no gross lesions were identified. Overall, most responders stated they "definitely" or "maybe" support a standardized gross examination (89%) and reporting (96%) protocol. Conclusions With the increased use of NACT, lack of any gross lesion leads to inconsistent gross examination techniques. This study provides insight into the current approach to examination of post-NACT cystectomies and suggests that a desire exists among pathologists and pathologists' assistants for more standardized practice. [ABSTRACT FROM AUTHOR]

Lipedema is a progressive connective tissue disease with enlargement of adipose tissue, fibrosis, fluid collection, and dermal thickening. Herein, we present a case of lipedema associated with skin hypoperfusion and ulceration in which soft tissue debulking with liposuction improved patients' symptoms. A 39-year-old female presented with asymmetric progressive initially unilateral lower limb swelling with severe pain with subsequent skin ulceration. Conservative management failed to improve her condition. After excluding other causes and detailed radiologic investigation, lipedema was diagnosed with an associated impaired skin perfusion. Trial of local wound care and compression therapy failed to improve the condition. Subsequent soft tissue debulking with circumferential liposuction and ulcer debridement and immediate compression showed dramatic improvement of the symptoms and skin perfusion. The unique nature of this case sheds light on lipedema as a loose connective tissue disease. Inflammation and microangiopathies explain the associated pain with hypoperfusion and ulceration being quite atypical and in part might be related to the large buildups of matrix proteins and sodium contents leading to fragility in microvessels with frequent petechiae and hematoma and subsequent tissue ischemia. Conservative measures like compression therapy plays a significant role in disease course. Surgical debulking with liposuction was shown to be efficacious in reducing the soft tissue load with improvement in limb pain, edema, circumference, and skin perfusion that was seen in our patient. Lipedema is a frequently misdiagnosed condition with disabling features. Skin involvement in lipedema with potential hypoperfusion was shown and it requires further investigation. [ABSTRACT FROM AUTHOR]

Necrobiosis Lipoidica (NL) is a dermatological condition characterized by the development of granulomatous inflammation leading to the degeneration of collagen and subsequent formation of yellowish-brown telangiectatic plaques usually localized on the pretibial skin of middle-aged females. Due to its rarity and unclear etiopathogenesis, therapeutic options for NL are not well-standardized. Among them, photodynamic therapy (PDT) is an emerging tool, although its efficacy has primarily been evaluated in single case reports or small case series. This study reports the real-life experience of a cohort of NL patients treated with PDT at the Section of Dermatology of the University Hospital of Messina and Reggio-Emilia. From 2013 to 2023, 17 patients were enrolled —5 males (29%) and 12 females (71%) aged between 16 and 56 years (mean age: 42 ± 13 years), with a median duration of NL of 8 years. The overall complete clearance (>75% lesion reduction) was 29%, while the partial clearance (25–75% lesion reduction) was 59%, with 12% being non-responders. This study adds to the little amount of evidence present in the literature regarding the effectiveness of PDT in the treatment of NL. Variability in treatment responses among patients underscores the need for personalized protocols, optimizing photosensitizers, light sources, and dosimetry. The standardization of treatment protocols and consensus guidelines are essential to ensure reproducibility and comparability across studies. [ABSTRACT FROM AUTHOR]

Ulcerative dermatitis (UD) is common in ornamental fish collections and is typically associated with a wide range of bacterial aetiologies. Clinical reports describing Shewanella xiamenensis‐associated UD are limited, however, despite growing attention to pathogenic Shewanella species in fish. Two out of 95 koi carp with UD were presented for clinical assessment by a commercial collection (n = 3000 fish) and subsequently killed on welfare grounds for necropsy. Both specimens exhibited extensive cutaneous ulcers and coelomic fat necrosis with petechial haemorrhages on post‐mortem examination. Shewanella xiamenensis was cultured from ulcerated skin tissues taken from both fish, with consistent intralesional gram‐negative rod‐like bacteria seen on skin scrape cytology. Histology also confirmed intralesional gram‐negative rod‐like bacteria within multiple ulcerative and erosive dermatitis lesions, plus myofibre necrosis and necrotising coelomic steatitis, in both specimens. Features associated with impaired generalised osmoregulation secondary to UD were detected within the striated muscle underlying the ulcers, the gills, and the caudal aspects of the kidneys. Additional histological features suggestive of sepsis were also seen in one of the fish. In the interim period, morbidity had increased from 3.2% to around 30% of the entire stock. Following culture results, increased pond water changes were implemented (q.2‐3d) and the remaining stock was treated with florfenicol, resulting in complete resolution of UD in the collection (as per client). This article highlights the first description of S. xiamenensis‐associated UD in koi carp/diseased ornamental fish in the United Kingdom. [ABSTRACT FROM AUTHOR]

Background: Both vonoprazan and proton pump inhibitors (PPIs) are currently used to treat artificial ulcers after gastric endoscopic submucosal dissection. However, evidence-based medicine proving the efficacy of vonoprazan is still lacking. Therefore, this meta-analysis aimed to compare the efficacy of vonoprazan and PPIs for the treatment of artificial ulcers after gastric endoscopic submucosal dissection. Methods: The PubMed, EMBASE and Cochrane Library databases were searched up to September 2023 for related randomized controlled trials (RCTs). RCTs that compared the efficacy of vonoprazan and PPIs in treating artificial gastric ulcers after gastric endoscopic submucosal dissection were included. Two independent reviewers screened the included studies, extracted the data and assessed the risk of bias. The following outcomes were extracted for comparison: ulcer healing rate, ulcer shrinkage rate, delayed postoperative bleeding rate, and ulcer perforation rate. Results: Nine randomized controlled trials involving 926 patients were included. The pooled results showed that vonoprazan had a significantly lower rate of delayed postoperative bleeding than did PPIs (RR = 0.46; 95% CI = 0.23–0.91; P = 0.03). No significant differences were found in terms of ulcer healing, shrinkage rates, or ulcer perforation rates between vonoprazan and PPIs. Conclusions: Compared with PPIs, vonoprazan is superior at reducing delayed postoperative bleeding after endoscopic submucosal dissection. However, further studies are needed to prove the efficacy of vonoprazan. Systematic Review Registration: Identifier CRD42024509227. [ABSTRACT FROM AUTHOR]

The aim was to investigate methicillin‐resistant Staphylococcus aureus (MRSA) incidence, conversion and outcomes in diabetic foot infections (DFIs). This is a pooled patient‐level analysis of combined data sets from two randomised clinical trials including 219 patients admitted to the hospital with moderate or severe DFIs. Intraoperative bone and tissue cultures identified bacterial pathogens. We identified pathogens at index infections and subsequent re‐infections. We identified MRSA conversion (MSSA to MRSA) in re‐infections. MRSA incidence in index infections was 10.5%, with no difference between soft tissue infections (STIs) and osteomyelitis (OM). MRSA conversion occurred in 7.7% of the re‐infections in patients who initially had MSSA in their cultures. Patients with re‐infection were 2.2 times more likely to have MRSA compared to the first infection (10.5% vs. 25.8%, relative risk [RR] = 2.2, p = 0.001). Patients with MRSA had longer antibiotic treatment during the 1‐year follow‐up, compared to other pathogens (other 49.8 ± 34.7 days, MRSA 65.3 ± 41.5 days, p = 0.04). Furthermore, there were no differences in healing, time to heal, length of stay, re‐infection, amputation, re‐ulceration, re‐admission, surgery after discharge and amputation after discharge compared to other pathogens. The incidence of MRSA at the index was 10.5% with no difference in STI and OM. MRSA incidence was 25.8% in re‐infections. The RR of having MRSA was 2.2 times higher in re‐infections. Patients with MRSA used more antibiotics during the 1‐year follow‐up. Furthermore, there were no differences in clinical outcomes compared to other bacterial pathogens. [ABSTRACT FROM AUTHOR]

Background: Besides Crohn's disease (CD), there are a variety of other causes that can also lead to ulcerations in the terminal ileum. The purpose of this study was to identify useful diagnostic features for CD when evaluating terminal ileum biopsies in patients with endoscopic finding of ulcers. Methods: Five hundred and seventy-one patients with endoscopic finding of ulcers were included in this retrospective study. Five main histological features were analysed, which were crypt irregularity, mucosal thickening, villous stromal widening (including villous atrophy), granulomas, and pseudopyloric gland metaplasia. Clinical and pathological features were determined by uni- and multivariable logistic regression. Then another independent cohort of 99 patients was established for verifying this nomogram. Results: The crypt irregularity, mucosal thickening, and villous stromal widening were combined to be considered as one new variable named mucosal architectural change which was an independent variable in diagnosing CD. We found that mucosal architectural change, age <40 years, the presence of granulomas, and the presence of pseudopyloric gland metaplasia were independent factors for the pathological diagnosis of CD. Then nomogram was developed, with receiver operating characteristic (ROC) curve (area under the ROC curve [AUC] = 0.927) in training sets, and ROC curve (AUC = 0.913) in validation sets. Conclusions: We found mucosal architectural change is very helpful in distinguishing CD from non-CD patients. In the context of small biopsy which may lack full scope of changes, the model developed by combining these key features is valuable in predicting a diagnosis of CD, especially in younger patients (age <40 years). [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of Photobiomodulation therapy (PBMT) for the treatment of solitary rectal ulcer syndrome (SRUS). Background: SRUS is a benign disease, diagnosed by symptoms, clinical, and histological findings. PBMT has been reported for the treatment of various inflammation-based diseases including aphthous ulcer, but still no such study on the treatment of SRUS is published. Materials and Methods: A 29-year Asian women, diagnosed for SRUS of 0.57 cm diameter, was treated by a laser at 635 nm through seven sessions. Laser fluence of 85 J/cm2 was delivered to ulcer lesion during each session for 10 min. Clinical results were valued by physician with sigmoid probe throughout PBMT sessions and no medicines were prescribed to the patient. Results: After seven sessions, the lesion was completely healed with 100% clinical response. In follow-up, patient did not respond to any additional/recurring abnormality, and no side effects were observed. Conclusions: In conclusion, PBMT by using laser at 635 nm is an effective treatment for SRUS without any side effects and patient remained comfortable throughout treatment sessions. Patient registration No. H-744/23. [ABSTRACT FROM AUTHOR]

Background/Aims: Upper gastrointestinal bleeding (UGIB) is a frequent medical issue. The primary risk factors for bleeding peptic ulcers are Helicobacter pylori infection and non-steroidal anti-inflammatory drugs. The association between acute gastric/duodenal ulcer and opium use has been previously proposed; however, there is no available data on endoscopic findings of patients with acute UGIB who use opium. Materials and methods: In the present descriptive cross-sectional study, endoscopic data of 50 consecutive patients with oral opium use and 50 consecutive patients without any opium use who were admitted for UGIB were recorded. The size (5–10 mm, 11–20 mm, or more than 20 mm), number (single, double, or multiple), and location of the ulcers (esophagus, gastric corpus including the fundus and body, antrum, angulus, or duodenum) were examined by endoscopy in both groups. Results: Three or more ulcers were observed in 46% and 16% of patients with oral opium use and without opium use, respectively (P-value = 0.001). The rate of giant ulcers (> 20 mm) was significantly higher in patients who used oral opium (40% vs. 12%; P-value = 0.007). Esophageal ulcers were also more common in oral opium users (30%) than non-users (8%) with UGIB (P-value = 0.01). Nevertheless, the location of the ulcers between the two groups generally was not statistically different. Conclusions: This study has demonstrated that multiple, large peptic ulcers in GIB are potential complications of oral opium use. This could aid the needed modifications in the treatment protocol for these patients. [ABSTRACT FROM AUTHOR]

Introduction: This retrospective chart review aims to find evidence supporting a difference in complications rates and progression of Charcot deformity between two orthotic interventions: the CROW and the custom calf lacer ankle foot orthosis. The existing evidence base to support the use of orthoses in the prevention and treatment of diabetic foot ulcers secondary to Charcot arthropathy is extremely limited. Methods: Subjects were diagnosed with diabetes mellitus and Charcot arthropathy and referred for orthotic treatment. A billing audit of subjects treated between September 1, 2018, and May 1, 2020, was generated using L codes L2330 and L4631. Subjects were excluded if they received a midfoot or higher amputation before application of the offloading device. In total, 87 charts were retrospectively reviewed, and 47 subjects were included. Results: No significant difference was found in complication rate between the two groups. The first year of orthotic intervention had the highest number of complications for both devices. In addition, most calf lacer subjects wore the orthosis for 2 to 3 years, whereas most CROW subjects wore the orthosis for 2 years. Conclusions: These findings suggest that both orthotic interventions available to treat diabetic foot ulcers secondary to Charcot arthropathy have similar complication rates. More research is needed to determine the clinical benefits of prescribing one intervention over the other. Clinical Relevance: Although clinical empirical evidence suggests lower complication rates with the use of calf lacer AFOs, this study found no statistical difference in the overall number of complications observed with the two orthotic interventions. [ABSTRACT FROM AUTHOR]

Prolidase deficiency (PD) is a rare autosomal recessive disorder associated with recurrent infections, immune dysregulation, and autoimmunity. PD is characterized by persistent dermatitis, skin fragility, and non‐healing ulcerations on the lower limbs as its main dermatologic characteristics. Herein, we report a boy with PD due to a novel variant in PEPD who had abnormal facies, cognitive impairment, corneal opacity, recurrent infections, and persistent non‐healing leg ulcers. Th17 lymphocyte counts and phosphorylated‐STAT5 expression following IL‐2 stimulation were reduced in our patient as compared to healthy control. [ABSTRACT FROM AUTHOR]

Port wine birthmarks (PWB) are capillary vascular malformations within the papillary and reticular dermis, most commonly occurring on the head and neck and may darken and thicken with age. Pulsed dye laser (PDL) is the gold standard of treatment for PWB as it selectively targets involved vessels. Sirolimus is a macrolide antibiotic that selectively inhibits mammalian target of rapamycin, thereby suppressing the angiogenesis pathways that can be activated by PDL. Sirolimus and PDL may be used together to treat PWB. We present a case series describing three cases of delayed ulceration and systemic sirolimus absorption following combination therapy, highlighting a potential complication and patient safety concern. [ABSTRACT FROM AUTHOR]

Fibrinogen is a protein that reflects systemic inflammation and regulates the immune response to disease. However, there is a scarcity of data on fibrinogen in recurrent aphthous stomatitis (RAS). We aimed to test the hypothesis that fibrinogen is involved in the aetiology of RAS. Between November 2016 and November 2018, we included 109 minor RAS patients and 29 age‐ and sex‐matched controls in a single‐center, observational study. Their clinical history and ulcer manifestations led to the diagnosis of minor RAS. The ulcer severity score (USS) was used to assess disease severity, and fibrinogen was also collected. We conducted three analyses: Analysis 1 (comparison of fibrinogen levels between patients and controls), Analysis 2 (comparison of fibrinogen levels between high and low USS patients) and Analysis 3 (comparison of fibrinogen levels between before and after anti‐inflammatory treatment in patients). The fibrinogen levels in the 109 minor RAS patients were statistically higher than in the 29 controls (mean [SD], 2.6 [0.5] vs. 2.3 [0.3]; Student's t‐test, p < 0.001). However, there were no significant differences in fibrinogen levels among the 43 patients with high USS and the 39 patients with low USS (mean [SD], 2.7 [0.5] vs. 2.6 [0.4]; Student's t‐test, p = 0.278). Furthermore, fibrinogen levels were significantly higher before anti‐inflammatory treatment in comparison to those after anti‐inflammatory treatment in the 35 paired patients (mean [SD], 2.6 [0.4] vs. 2.5 [0.4]; Student's t‐test, p = 0.026). Interestingly, fibrinogen levels were significantly higher in the 35 paired patients after anti‐inflammatory treatment compared to the 29 control subjects (mean [SD], 2.5 [0.4] vs. 2.3 [0.3]; Student's t‐test, p = 0.026]. Fibrinogen may play a role in the aetiology of RAS and may be a drug target for RAS treatment. Clinicians should be alert that high serum fibrinogen levels might be associated with the risk of RAS. [ABSTRACT FROM AUTHOR]

Objective: To evaluate bacterial isolates from corneal stromal ulcerations in dogs and cats in the Netherlands, review their antibiotic susceptibility, determine whether recent topical treatment affected bacterial culture results, and investigate whether (multi‐drug) resistance patterns changed over time. Animals studied: Client‐owned dogs and cats were diagnosed with corneal stromal ulceration at the Utrecht University Clinic for Companion Animals between 2012 and 2019. Procedures: Retrospective analysis. Results: In total, 163 samples were collected from 122 dogs (130 samples) and 33 cats. Positive cultures were obtained from 76 canine and 13 feline samples (59% and 39%, respectively) and included Staphylococcus (42 in dogs, 8 in cats), Streptococcus (22 in dogs, 2 in cats), and Pseudomonas (9 in dogs, 1 in cats) species. Significantly fewer positive cultures were found in dogs and cats previously treated with topical antibiotics (χ2 = 6.52, p =.011 and χ2 = 4.27, p =.039, respectively). Bacterial resistance to chloramphenicol was more common in dogs previously treated with chloramphenicol (χ2 = 5.24, p =.022). The incidence of acquired antibiotic resistance did not increase significantly over time. In dogs, the incidence of multi‐drug‐resistant isolates increased significantly between 2012–2015 and 2016–2019 (9.4% vs. 38.6%, p =.0032). Conclusions: Staphylococcus, Streptococcus, and Pseudomonas species were the most common bacteria associated with canine and feline corneal stromal ulcerations. Previous treatment with antibiotics affected bacterial culture results and antibiotic sensitivity. Although the overall incidence of acquired antibiotic resistance did not change over time, the incidence of multi‐drug‐resistant isolates in dogs increased over an 8‐year period. [ABSTRACT FROM AUTHOR]

Objectives: To test the hypothesis that cardiovascular diseases and risk factors are associated with ulcer relapse in after‐retirement patients with recurrent aphthous stomatitis. Subjects and Methods: This retrospective cohort study analyzed the data of 40 minor recurrent aphthous stomatitis patients aged 55–75 years, admitted to Oral Medicine Clinic at one university hospital in China between 2016 and 2018. The diagnosis of minor recurrent aphthous stomatitis was made based on the history and manifestation of oral ulcers. The ulcer relapse was evaluated after a 5‐week anti‐inflammatory treatment, and the history of systemic diseases was collected. cardiovascular disease/metabolic risk referred to the presence of any cardiovascular diseases and metabolic cardiovascular disease risks. Associations among cardiovascular diseases, risk factors, and ulcer relapse were evaluated. Results: The mean age of 40 patients with minor recurrent aphthous stomatitis was 62.4 years (SD 5.1), and 60% were women. The ulcer relapse rate was 37.5% (95% CI, 0.242–0.530). The proportion of cardiovascular disease/metabolic risk was higher in the relapse group than in the no‐relapse group after 5‐week anti‐inflammatory treatment (Fisher's exact test, p = 0.041). Conclusions: According to this single‐center experience, older patients with cardiovascular disease/metabolic risk may be more prone to oral ulcer recurrence. Nevertheless, larger prospective studies are needed to confirm our findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: The World Health Organization (WHO) classifies leishmaniasis as an emerging and uncontrolled disease. It is caused by protozoa of the Leishmania genus and transmitted to animals and humans by vectors of the Psychodidae family. Its distribution is worldwide and it is estimated that about 2 million new cases occur each year. CLINICAL CASE: A 66-year-old male patient, resident of Cancun, Quintana Roo, Mexico, with cutaneous leishmaniasis who received amphotericin B deoxycholate, which is reserved to treat the disease in its most severe presentation. CONCLUSIONS: The use of an intravenous polyene antibiotic is an option for the management of leishmaniasis in endemic areas, when first-line treatments are limited. [ABSTRACT FROM AUTHOR]

Simple Summary: Farmed Atlantic salmon are routinely exposed to bacterial pathogens, e.g., Piscirickettsia salmonis. Infection by Piscirickettsia sp. leads to a complex array of skin ulcers that can be difficult to treat and increases susceptibility to opportunistic infections. Evidence indicates that bacterial networks residing on salmon skin protect against developing ulcers by excluding pathogen colonization. A collapse of these beneficial interactions is thought to promote susceptibility to pathogen colonization during early stages of infection. We characterized the types and abundances of bacterial constituents on the skin of healthy Atlantic salmon compared with fish suffering from P. salmonis infection to test this hypothesis. The knowledge we gained can be used to optimize methods for early detection and prevention of skin ulcers by disrupting cooperative interactions between pathogenic bacteria. Maintaining the high overall health of farmed animals is a central tenant of their well-being and care. Intense animal crowding in aquaculture promotes animal morbidity especially in the absence of straightforward methods for monitoring their health. Here, we used bacterial 16S ribosomal RNA gene sequencing to measure bacterial population dynamics during P. salmonis infection. We observed a complex bacterial community consisting of a previously undescribed core pathobiome. Notably, we detected Aliivibrio wodanis and Tenacibaculum dicentrarchi on the skin ulcers of salmon infected with P. salmonis, while Vibrio spp. were enriched on infected gills. The prevalence of these co-occurring networks indicated that coinfection with other pathogens may enhance P. salmonis pathogenicity. [ABSTRACT FROM AUTHOR]

Since diabetic foot ulcers (DFUs) are common among diabetes patients, it is essential to increase patients' knowledge and self-care practices to ensure early recognition and management and reduce amputation risk. Therefore, the goal of this review was to identify the range and level of knowledge of people with DFUs and the type of self-care they undertake. A literature review was conducted using the electronic databases PubMed and Google scholar with 'diabetic foot', 'self-care', 'practice' and 'behaviour' as searching keywords. The identification and selection process were conducted to sort the eligible papers through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The criteria are the original papers describing knowledge and practice in DFU; reporting knowledge and practice in their non-intervention studies; writing in English language; and publishing between years 2016 and 2022. The eligible papers were assessed using the strength of reporting observational studies in epidemiology (STROBE) checklist for appraising their quality. Twenty-two papers of 2,073 titles met the inclusion criteria and included in the review. The lowest and the highest quality score of included papers based on STROBE checklist are 11 and 26, respectively. The included papers showed various levels of knowledge from good to poor, which prominent the highest percentage are 88% (good knowledge) and 84.8% (poor knowledge). The majority of the foot-care activities found in the reviewed papers involved the following steps: washing, drying, applying moisturiser and trimming nails routinely. Those activity should be followed by checking the feet with a mirror for ulcers, looking for ingrown nails, choosing appropriate footwear, not walking barefoot and routinely consulting a healthcare provider. The knowledge levels were found variable and acceptable. Daily foot care, choosing the right footwear, foot activity and regular health checks should all be used to manage diabetes. [ABSTRACT FROM AUTHOR]

Objective: Using non-geriatric type 2 diabetic patients with and without diabetic foot ulcers (DFUs), this study investigated the frequency of poor handgrip strength and examined the association between handgrip strength and diabetic foot disorder. Methods: The study comprised a total of 525 patients with type 2 diabetes who visited the endocrinology outpatient clinic between August 2020 and June 2022; 242 of them had DFUs. Patients were selected according to inclusion and exclusion criteria. Data on medications used, as well as demographic and clinical information, were taken from hospital archives. The severity of ulcers was assessed using the Wagner score. Using a portable digital dynamometer, a test of handgrip strength was conducted. Low handgrip strength was defined as less than 16 kg for females and 27 kg for males. Results: Patients with DFUs exhibited lower handgrip strength, older age, a longer duration of diabetes diagnosis, a lower body mass index, and higher fasting plasma glucose and hemoglobin A1c levels. Comorbidities such as peripheral artery disease and ischemic heart disease were more frequent in patients with DFUs and low handgrip strength. Diabetic foot ulcer frequency was 3.149 times higher among those with poor hand grip strength than those with good strength (odds ratio = 3.149; 95% CI, 2.118-4.672; P < .001). Conclusion: Non-geriatric type 2 diabetes patients with DFUs had a higher frequency of low handgrip strength. Low handgrip strength was independently associated with the presence of DFUs. This study emphasizes the importance of addressing low handgrip strength as a potential risk factor in managing diabetic foot disease in non-geriatric type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

This article discusses the management of peptic ulcer bleeding, which is the most common cause of gastrointestinal bleeding and a significant source of healthcare expenditures in the United States. The article highlights the various therapeutic options available, including endoscopic therapy, angiography, and surgery, and their success rates. It also acknowledges the disparities in access to endoscopic therapies among rural or minority populations. The study analyzed hospitalization data from 2018 and found that endoscopic therapy had the highest rates of hemostasis, followed by radiologic and surgical interventions. However, there are limitations to the study, such as the inability to account for certain factors that may affect the success of hemostasis. The article concludes by emphasizing the need for further exploration of new tools and advances in medicine to improve ulcer hemostasis. [Extracted from the article]

This article discusses a case of a patient with metastatic renal cell carcinoma who developed nivolumab-induced lichenoid dermatitis (LD), which initially presented as a penile ulcer. The patient later developed extensive mucocutaneous re-emergent LD, which was successfully treated with hydroxychloroquine. The article highlights the diverse clinical presentations and variable time of onset of cutaneous immune-related adverse events (cirAEs) associated with immune checkpoint inhibitor (ICI) treatment. It also suggests that hydroxychloroquine may be a safe and effective option for managing severe lichenoid cirAEs. [Extracted from the article]

Pemphigus is a rare autoimmune mucocutaneous bullous disease that can be life-threatening. We report a case of pemphigus vulgaris with pharyngeal ulcer as the initial presentation that was treated with glucocorticoid therapy. [ABSTRACT FROM AUTHOR]

Over the past years, the development of innovative smart wound dressings is revolutionizing wound care management and research. Specifically, in the treatment of diabetic foot wounds, three-dimensional (3D) bioprinted patches may enable personalized medicine therapies. In the present work, a methacrylated hyaluronic acid (MeHA) bioink is employed to manufacture 3D printed patches to deliver small extracellular vesicles (sEVs) obtained from human mesenchymal stem cells (MSC-sEVs). The production of sEVs is maximized culturing MSCs in bioreactor. A series of in vitro analyses are carried out to demonstrate the influence of MSC-sEVs on functions of dermal fibroblasts and endothelial cells, which are the primary functional cells in skin repair process. Results demonstrate that both cell populations are able to internalize MSC-sEVs and that the exposure to sEVs stimulates proliferation and migration. In vivo experiments in a well-established diabetic mouse model of pressure ulcer confirm the regenerative properties of MSC-sEVs. The MeHA patch enhances the effectiveness of sEVs by enabling controlled release of MSC-sEVs over 7 days, which improve wound epithelialization, angiogenesis and innervation. The overall findings highlight that MSC-sEVs loading in 3D printed biomaterials represents a powerful technique, which can improve the translational potential of parental stem cell in terms of regulatory and economic impact. [ABSTRACT FROM AUTHOR]

Introduction: Small-bowel ulcers have many causes and nonsteroidal anti-inflammatory drugs (NSAIDs) represent the most common causes of drug-induced intestinal injury. Peripheral blood mononuclear cell (PBMC) therapy plays an important role in tissue healing and repair, and their priming with activated platelet supernatant (APS) has been known to augment their efficacy through induction of angiogenesis and tissue regeneration. Aim of the Work: The research aimed to study the influence of APS-primed mononuclear cells on the ileal ulcers induced by indomethacin in adult male albino rats. Materials and Methods: 45 adult male albino rats were used, 10 of them were used as donors and the other 35 were used as recipient rats which were divided into; group I (acted as a control) and group II were subdivided into subgroup II-A (animals received a single oral dose of 25 mg/kg indomethacin and were sacrificed 6 hours after ulcer induction), subgroup II-B (animals treated by intravenous injection of APS-primed PBMCs after induction of ileal ulcer and were sacrificed after 2 weeks). Finally, the ileum was obtained and processed for histological and immunohistochemical studies. Results: Subgroup II-A (ulcer induction) revealed marked histological structural changes as focal damage, atrophy of villi, desquamated cells, shrunken irregular cells, darkly stained nuclei, vacuolated cytoplasm, cellular infiltration and congestion of blood vessels. APS-primed mobilized PBMCs therapy induced significant improvement in the histological structure of the ileum (Subgroup II-B). Conclusion: APS-primed mononuclear cells exerted a significant ameliorative effect on the ileum after ulcer induction by indomethacin. [ABSTRACT FROM AUTHOR]

We investigated the anti-ulcer activity of ethanol extracts of Polygonum cognatum on indomethacin induced gastric damage in rats. We evaluated the number of ulcer areas, oxidant and antioxidant parameters as well as histopathologic features in rat stomach. We measured the total antioxidant status of P. cognatum in concentrations from 1.56–100 mg/ml. P. cognatum extract inhibited indomethacin induced ulcer formation with an effect similar to a 20 mg/kg dose of the standard anti-ulcer drug, esomeprazole. All doses of P. cognatum extract exhibited positive effects on oxidative stress markers and histopathological features in the stomach tissue of rats. We suggest that the antioxidant activity of P. cognatum extract may be responsible for its gastroprotective effect and that P. cognatum extract may be a useful gastroprotective agent. [ABSTRACT FROM AUTHOR]

Objectives Materials and Methods Results Conclusion The objective of the study was to identify bacterial pathogens and their antimicrobial sensitivity profile associated with cases of canine progressive ulcerative keratitis.Analysis of microbial culture and sensitivity results from dogs with progressive ulcerative keratitis presenting to a UK referral practice between December 2018 and August 2020.Positive bacterial cultures were obtained from 80/148 (54%) of the canine ulcers sampled with 99 bacterial isolates cultured. Streptococcus canis (n = 29), Pseudomonas aeruginosa (n = 19), and Staphylococcus pseudintermedius (n = 16) were the most common isolates. Pseudomonas aeruginosa was more likely to be isolated whether the ulcer was clinically malacic at the time of sampling (OR = 10.1, p < .001). Ulcers treated prior to culture with fusidic acid were 7.6 times more likely to be positive than those treated with any other antimicrobial(s). Bacterial isolates demonstrated resistance against neomycin (85%), fusidic acid (78%), and tetracycline (68%). Conversely, isolates were most likely to be sensitive to gentamicin (88%), ofloxacin (77%), ciprofloxacin (73%), and chloramphenicol (64%). Antimicrobial combinations of chloramphenicol or gentamicin with a fluoroquinolone (ofloxacin or ciprofloxacin) or chloramphenicol combined with gentamicin were the most effective on in vitro analysis (over 90% susceptibility of all isolates).The most common bacterial species associated with canine progressive ulcerative keratitis in a UK referral population were S. canis, P. aeruginosa, and S. pseudintermedius. Combination antimicrobial therapy is recommended pending culture and sensitivity results given the varied antimicrobial susceptibility profiles and significant bacterial in vitro resistance to antimicrobial monotherapy. [ABSTRACT FROM AUTHOR]

Simple Summary: This study illustrates so far under-reported canine gallbladder erosion/ulcer. Based on the clinicopathological information in addition to the COX-1 and COX-2 IHC results, canine gallbladder erosion/ulcer is possibly related to decreased cytoprotection physiologically provided by arachidonic acid. (1) Background: Gallbladder mucosal erosion and/or ulceration are illnesses associated with unexpected gallbladder intra-cystic bleeding (hemocholecyst), an under-reported problem in dogs. (2) Methods: Clinicopathological characteristics of 14 dogs with gallbladder erosion/ulcer were investigated in this single-center retrospective study using clinical data and archived gallbladder tissues of client-owned dogs. (3) Results: Canine gallbladder erosion/ulcer tends to occur in older, neutered dogs of various breeds. Vomiting, lethargy, and anorexia are common. Concurrent gallbladder rupture occurred in 5/14 cases (35.7%), while rupture was absent in 6/14 cases (42.8%) and undetermined in 3/14 (21.4%) cases. Histologically, the gallbladder wall was markedly thickened due to mucosal hyperplasia, inflammatory infiltrates, fibrosis, edema, hemorrhage, and smooth muscle hyperplasia/hypertrophy. Twelve out of fourteen cases (85.7%) had concurrent cholecystitis of varying severity. Bacteria were detected by Giemsa or Warthin–Starry stain in 8/14 (57.1%) cases. Bacterial rods immunoreactive to the anti-Helicobacter antibody were present in one case. Mucosal epithelial cells of the gallbladder erosion/ulcer cohort were immunopositive for the cyclooxygenases COX-1 or COX-2 in only 5/14 (35.7%) cases. In contrast, COX-1 and COX-2 were more frequently expressed in a reference pool of cases of gallbladder mucocele (n = 5) and chronic cholecystitis (n = 5). COX-1 was expressed in 9/10 cases (90.0%) of gallbladder mucocele and chronic cholecystitis and in 10/10 cases (100%) for COX-2. (4) Conclusions: Canine gallbladder erosion/ulcer is an under-reported condition which requires active clinical intervention. Based on the clinicopathological information reported in this study in addition to the COX-1 and COX-2 IHC results, we suggest that canine gallbladder erosion/ulcer may be related to decreased cytoprotection physiologically provided by arachidonic acid, but which is decreased or absent due to reduced COX expression because of yet undetermined etiologies. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis associated with underlying disorders. The association between PG and solid organ tumors (SM), including gynecologic cancers, has been previously reported. Here, we report a case of a 61‐year‐old woman with pyoderma gangrenosum on the posterior auricular region associated with an underlying fallopian tube carcinosarcoma: a rare and aggressive gynecologic malignancy. The patient's ulcer responded favorably to treatment, and surgical resection of the tumor was performed. The patient was then referred for further cancer management. No new lesions or recurrences were found over the 18 months of routine follow‐up. [ABSTRACT FROM AUTHOR]

Background: Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes. Objectives: This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade. Methods: Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted. Conclusions: In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects. [ABSTRACT FROM AUTHOR]

Background: Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a > 2.2°C difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting a recurrent hotspot. Methods: PubMed and Google Scholar were searched until 9 June 2023 for English‐language peer‐reviewed HFTM studies which reported adherence to HFTM, daily step reduction or HCP hotspot notification. The search returned 1030 results excluding duplicates of which 28 were shortlisted and 11 included. Results: Typical adherence among HFTM study participants for >3 days per week was 61%–93% or >80% of study duration was 55.6%–83.1%. Monitoring foot temperatures >50% of the study duration was associated with decreased ulcer risk (Odds Ratio: 0.50, p < 0.001) in one study (n = 173), but no additional risk reduction was found for >80% adherence. Voluntary dropout was 5.2% (Smart mats); 8.1% (sock sensor) and 4.8%–35.8% (infrared thermometers). Only 16.9%–52.5% of participants notified an HCP upon hotspot detection. Objective evidence of adherence to 50% reduction in daily steps upon hotspot detection was limited to one study where the average step reduction was a pedometer‐measured 51.2%. Conclusions: Ulcer risk reduction through HFTM is poorly understood given only half of the participants notify HCPs of recurrent hotspots and the number of reducing daily steps is largely unknown. HFTM adherence and dropout are variable and more research is needed to determine factors affecting adherence and those likely to adhere. [ABSTRACT FROM AUTHOR]

Objectives: We conducted this study to clarify the progress of cutaneous arteritis. Methods: We examined 21 cases of cutaneous arteritis that were diagnosed at our hospital between 2005 and 2020. The male‐to‐female ratio was 1:6 with a mean age of 52.2 years. Results: The lower legs were involved in all cases, and the upper extremities or trunk was also involved in some cases. Cutaneous manifestations presented as indurated erythema (n = 15), subcutaneous induration (11), edema (7), livedo (6), and ulcer (3). In addition, extracutaneous conditions including numbness (10), arthritis (8), fever (2), and myalgia (1) were observed. Laboratory tests showed an increase of inflammatory markers in most cases (14). Histopathological features showed necrotizing vasculitis of small‐sized arteries at the dermo‐subcutaneous junction, and the inflammatory stages of arteritis were histopathologically divided into acute stage (5), subacute stage (5), reparative stage (7), and healed stage (1). The therapies administered were oral prednisolone (11), antiplatelet drug (14), warfarin (1), non‐steroidal anti‐inflammatory drugs (6), biological drug (1), and other drugs (14). There were no cases showing progression to systemic polyarteritis nodosa during follow‐up period. All three patients with ulceration complained of numbness, and one was revealed to have mononeuropathy multiplex. They were treated with low‐dose oral prednisolone. Three ulceration cases were histopathologically classified into the acute and subacute stages. Conclusions: In conclusion, all 21 patients followed a chronic course with recurrent skin lesions without systemic complications. Cases with ulceration seem to reveal neurological symptoms and need systemic steroid treatment. We conducted this study to clarify the progress of cutaneous arteritis. We examined 21 cases of cutaneous arteritis that were diagnosed at our hospital between 2005 and 2020 and all patients followed a chronic course with recurrent skin lesions without systemic complications. [ABSTRACT FROM AUTHOR]

Background We evaluated the outcomes associated with initial antibiotic management strategies for infected diabetic foot ulcers (DFUs) diagnosed in an outpatient multidisciplinary center. Methods Consecutive outpatient individuals with infected DFUs, stratified according to Infectious Diseases Society of America infection severity, were followed for 1 year from the initial antibiotic administration to treat acute infection. The main outcomes were hospitalization rates for a diabetes-related foot complication within 30 days of diagnosis and requiring an amputation or death during follow-up. Outcomes were analyzed by regression analysis, accounting for demographics, clinical characteristics, and antibiotic therapy. Results Among 147 outpatients with infected DFUs, 116 were included. Infections were categorized as mild (68%), moderate (26%), and severe (6%). Empirical antibiotics (not culture-guided) were prescribed as initial treatment in 39 individuals, while 77 received culture-based antibiotics. There were no differences in demographic or clinical characteristics between the antibiotic administration groups, except for a higher body mass index and prevalence of chronic kidney disease in the empirical cohort. Forty-two infected DFU patients required hospitalization within 30 days of diagnosis for the same reason. The relative risk for hospitalizations was 1.87 greater in those with mild infections when treated with empirical antibiotics compared with culture-directed antibiotics. There were no differences in amputations and/or death at 1 year follow-up. Conclusions These data support obtaining tissue culture to guide antibiotic therapy, regardless of DFU infection severity, to decrease hospitalizations. [ABSTRACT FROM AUTHOR]

Background and objective. The pedicled DIEP flap offers a reproducible alternative in the management of ischial and trochanteric ulcers where healthy peripheral tissue is not available for the realization of a local flap. We describe the surgical technique and present 2 clinical cases in which this procedure has been used, offering a reproducible alternative in the treatment of these conditions. Methods. A doppler ultrasound scan of the periumbilical perforating arteries is carried out, tracing a 10 x 15 cm vertical skin island. The pedicle is dissected down to the junction with the deep inferior epigastric artery, which is dissected as proximal as possible. A subcutaneous tunnel is made to the area to be treated for the passage without tension of the vascular pedicle and the flap is placed in its receiving area, suturing it in two planes. Results. We present 2 clinical cases in which we obtained excellent functional results and low morbidity in the donor area. Conclusions. In our experience, the pedicled DIEP flap was an adequate reconstructive option in patients with ischial and trochanteric ulcers in whom peripheral tissues do not allow reconstruction with local flaps, since it has low morbidity in the donor area and a relatively long pedicle that allows it to reach the defect area. [ABSTRACT FROM AUTHOR]

We present the case of a 3-week-old girl with LUMBAR syndrome, a rare condition involving segmental infantile hemangiomas (IH) in the lumbosacral region, myelopathy, and other congenital anomalies. The patient developed severe ulceration of a left buttock IH. Treatment included broad-spectrum antibiotics, debridement, and a laparoscopic temporary colostomy. Propranolol therapy, wound care, and fecal diversion led to successful healing of the ulceration. The report highlights the challenges of ulcerated IH in the perineal area due to exposure to urine and stool. The comprehensive approach resulted in positive outcomes, including the successful surgical treatment of spinal dysraphism, successful colostomy reversal, and developmental progress. This case contributes insight into the surgical management of severe perianal ulcerated IH associated with LUMBAR syndrome, highlighting the importance of a tailored surgical approach with a multidisciplinary framework. [ABSTRACT FROM AUTHOR]

Gastrocolic fistulas are very rare in children and their association with Helicobacter pylori is poorly described. We present the case of a 10-year-old boy with a history of chronic abdominal pain, diarrhea, halitosis, and growth delay diagnosed with H. pylori -associated gastritis and gastrocolic fistula. The boy recovered with resection surgery and antibiotic therapy for eradication of the pathogen. This is the first description of a gastrocolic fistula in pediatrics related to H. pylori. [ABSTRACT FROM AUTHOR]

Hard-to-heal wounds do not heal spontaneously and need long-term care provided by specialists. That burdens the patients as well as the healthcare systems. Such wounds arise from several pathologies, which result in venous leg ulcers (VLU), diabetic foot ulcers (DFU), pressure ulcers (PU), or ulcers originating from post-surgical wounds (pSW). Given the complex nature of hard-to-heal wounds, novel treatments are sought to enable wound healing. We tested the clinical efficacy and applicability of fluid comprising hyaluronic acid and iodine complex (HA-I) in the treatment of hard-to-heal wounds. Patients (n = 56) with VLU, DFU, PU, or pSW hospitalised in multiple wound-care centres in the Czech Republic were treated with HA-I. Wound size, classically visible signs of infection, exudation, pain, and wound bed appearance were monitored for 12 weeks. The highest healing rate was in DFU (71.4%), followed by pSW (62.5%), VLU (55.6%), and PU (44.4%). Classical visible signs of infection were resolved within 8 weeks in all types of wounds. Wound bed appearance improved most noticeably in pSW and then in VLU. Exudation was lowered most significantly in DFU and pSW. The highest decrease in pain was in pSW and DFU. The treatment with HA-I successfully led to either complete closure or significant improvement in the wound's healing. Therefore, the complex of hyaluronic acid and iodine is suitable for the treatment of hard-to-heal wounds of various aetiologies. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the efficacy of low-level laser therapy (LLLT) for treating thermal tongue ulcers in gamma-irradiated rats. Background: Postradiotherapeutic trauma may cause cell death, tissue damage, organ dysfunction, and loss of hematological components. Materials and methods: Thermal ulcers were induced on the dorsal surfaces of tongues of gamma-irradiated rats (15 Gy). Rats were divided into three groups, group 1 received no treatment, group 2 was subjected to a single dose of diode laser 807 nm with energy density 4 J/cm², and group 3 was subjected to the same dose of LLLT but fractionated into three sessions at days 1, 3, and 5 after ulcers induction. Ulcers were assessed clinically for their areas and healing percentage. Specimens were examined for the quality of ulcer closure and expression of IL-1β and TGF-β1. Results: Results revealed significant improvement of ulcer healing clinically and histologically in both treatment groups compared to control. Moreover, IL-1β and TGF-β1 expression in both treatment groups was high at the earlier stage of healing then declined by time to reach a normal level. However, untreated group showed higher expression of IL-1β and TGF-β1 compared to treatment groups. In addition, IL-1β expression decreased by time but still of high level and TGF-β1 expression increased then declined. Conclusions: We concluded that gamma radiation-impaired mucosal healing could be related to the over expression of IL-1β and TGF-β1. LLLT, whether one session or fractionated, could be an effective treatment for postradiotherapeutic ulcers. The healing power of LLLT might be due to modulation of IL-1β and TGF-β1. [ABSTRACT FROM AUTHOR]

In this paper, a novel method is proposed to detect common abnormalities in Wireless Capsule Endoscopy (WCE) video frames including Lymphoid Hyperplasia, ulcer, and angiodysplasia lesions. Inspecting WCE video frames to detect abnormality is a tedious task for physicians. One important step in the proposed approach is to extract the region of interest (ROI), i.e., suspicious region, using the expectation–maximization (EM) algorithm. Suspicious regions in WCE frames are segmented using the EM algorithm considering the color and texture information of the image. Then, suitable descriptors associated with the shape, texture, and color of ROIs are examined for further analysis. These descriptors include histogram of gradients for shape, local binary patterns for texture and different statistical characteristics from pixel values for color information. These features are then fed to a support-vector machine for classification. The results show that the proposed approach can detect abnormalities in WCE frames with the accuracy of 91.3%. [ABSTRACT FROM AUTHOR]

Objective(s): To evaluate the gastroprotective potential of zafirlukast against indomethacin-induced gastric ulcers in rats. Materials and Methods: Thirty-two male Wistar rats were included in this study and randomly divided into 4 equal groups (n=8); control (normal) group, indomethacin group, Ranitidine group, and Zafirlukast group. Indomethacin was given as a single oral dose of (20 mg/kg) for the induction of ulcers. Both ranitidine (50 mg/kg) and zafirlukast (20 mg/kg) were given orally for seven days after inducing the ulcer. All animals were sacrificed by an overdose of anesthesia at the end of the experimental period and their gastric tissues have been collected for histopathological and biological assay. Levels of prostaglandin E2 (PGE2), thiobarbituric acid reactive substances (TBARS), and interleukin 1ß (IL-1ß) were measured as well as a histopathological study to evaluate the effect of zafirlukast on gastric tissues. Results: Significant abnormalities were found in both the histological and biochemical parameters of the indomethacin group reflecting the changes seen with gastric ulcers. Significant improvement was found in the Zafirlukast group as reflected by the morphological improvement seen in the gastric tissues. An effect that was associated with an increase in the PGE2 levels along with reductions in IL-1ß expression and TBARS concentrations. Conclusion: As per the results of this study, zafirlukast shows promising gastroprotective properties possibly through enhancement of PGE2 levels as well as having anti-inflammatory and anti-oxidant properties. [ABSTRACT FROM AUTHOR]

Riga-Fede disease is characterized by benign inflammatory ulcerated lesions located on the ventral surface of the tongue, buccal mucosa, gingiva, or base of the tongue, resulting from repeated trauma. Although it is most commonly observed up to 1 year of age due to the traumatizing effect of the neonatal mandibular anterior teeth, Riga-Fede disease, as in this case, can occasionally occur in older children. Tongue biting is one of the causes of this disease in older children. A case in a 9-year-old girl was reported. [ABSTRACT FROM AUTHOR]

Endoscopic hemostatic therapy is not indicated for clean-based ulcers or ulcers with flat pigmented spots, which have low risks of rebleeding. Endoscopic Hemostasis of Bleeding Peptic Ulcers with Adherent Clots Keywords: Ulcer; Gastrointestinal bleeding; Endoscopy; Hemostasis EN Ulcer Gastrointestinal bleeding Endoscopy Hemostasis 3843 3845 3 09/26/23 20231001 NES 231001 Peptic ulcer disease, the leading gastrointestinal cause of hospitalization, is the most common cause of upper gastrointestinal bleeding [[1]]. [Extracted from the article]

Key Clinical Message: Oral chemical ulceration is a rare condition. The causes differ from misuse of dental material by dentists and over‐the‐counter drugs (OTC) to the herbal ingredients in our foods. Detailed patient history helps to explore the diagnosis and further management of such a lesion, which extend from no intervention in mild cases to surgical intervention in severe cases. This report represents a case of chemical ulceration of the mouth caused by hydraulic fluid oil leakage inside a dental chair in a 24‐year‐old female, leading to the patient developing multiple painful oral ulceration after surgical extraction. The purpose of the report is to increase awareness among health practitioners of unusual causes that could happen during dental interventions. [ABSTRACT FROM AUTHOR]

Background: A systematic review was conducted to investigate the prevalence of onychomycosis in patients with diabetes. The association of onychomycosis with risk factors in patients with diabetic foot syndrome was also examined. Methods: The recommendations in the preferred reporting items for systematic reviews and meta‐analysis (PRISMA) checklist were applied, and the included studies were assessed using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) method. Searches were conducted in October 2022 using PubMed (Medline) and Scopus for clinical studies, clinical trials, comparative studies, observational studies, and randomised clinical trials or controlled clinical trials addressing the prevalence and consequences of onychomycosis in patients with diabetes, diagnoses or treatments. Two authors performed the study selection and data extraction, and any discrepancies between the two reviewers were resolved through discussion with a third reviewer. Results: The systematic review included ten studies that met the inclusion criteria, and these studies enrolled 5664 patients with diabetes. Among these patients, 29.18% had onychomycosis that was mainly caused by Trichophyton rubrum. A significant association was found between the occurrence of onychomycosis and the presence of diabetic neuropathy (p =.012) and elevated glycosylated haemoglobin values (p =.039). There was no significant association between onychomycosis and ulceration (p =.185). Eight studies had a grade 4 level of evidence and a grade C recommendation, and one study had a grade 1b level of evidence and a grade A recommendation. Conclusion: The information described in the literature is insufficient and heterogeneous regarding the association of risk factors and ulceration in patients with diabetic foot compared with developing onychomycosis. There is also a need to implement onychomycosis diagnostic testing instead of relying only on a clinical diagnosis. Additional prospective, randomised, comparative studies are needed to increase the quality of studies in the literature. [ABSTRACT FROM AUTHOR]

This study aimed to formulate a pharmaceutical dosage form containing omeprazole (OMP) and curcumin (CURC) to treat experimental peptic ulcers. OMP and CURC were preliminarily complexed with hydroxypropyl-β-cyclodextrin for enhancing their solubilization. After that, the combined complex (CURC/OMP) was loaded to alginate beads to sustain their release and then coated with chitosan. Finally, we tested the anti-ulcerogenic impact of the best formula versus free OMP or OMP-only-loaded beads. The formulated spherical beads' diameter ranged from a minimum value of 1.5 ± 0.08 mm to 2.6 ± 0.24 mm; the swelling results ranged from 400.00 ± 8.5% to 800.00 ± 6.2%. The entrapment efficiency was in a range from 60.85 ± 1.01% to 87.44 ± 1.88%. The optimized formula (F8) showed a maximum EE% (87.44 ± 1.88%), swelling (800.00 ± 6.2%), and diameter in the range of 2.60 ± 0.24, with a desirability of 0.941. In the first hour following the administration of the free drug complex, 95% of OMP and 98% of CURC were released. This is unacceptable for medications that require a delayed release in the stomach. The initial drug release from hydrogel beads was 23.19% for CURC and 17.19% for OMP after 2 h and 73.09% for CURC and 58.26% for OMP after 12 h; however, after 24 h, 87.81% of CURC and 81.67% of OMP had been released. The OMP/CURC beads showed a more stable particle size (0.52 ± 0.01 mm) after 6 weeks. In conclusion, the OMP/CURC hydrogel beads give stronger anti-ulcer effectiveness compared to free OMP, CURC-only beads, and OMP-only-loaded beads, indicating a prospective application for managing peptic ulcers. [ABSTRACT FROM AUTHOR]

Diabetes is a fast-growing chronic metabolic disorder that is widely associated with foot ulcers. The major challenge among these ulcers is wound infections, altered inflammatory responses, and a lack of angiogenesis that can complicate limb amputation. The foot, because of its architecture, becomes the part most prone to complications and the infection rate is higher mainly between the toes due to the humid nature. Therefore, the infection rate is significantly higher. Wound healing in diabetes is a dynamic process usually delayed due to poor immune function. Diabetes-related pedal neuropathy and perfusion disturbances can lead to a loss of sensation in the foot. This neuropathy can further be a risk factor for ulcer development due to repetitive mechanical stress that later might get infected by the invasion of microorganisms extending to the bone and causing an infection called pedal osteomyelitis. This review details the pathophysiology, the biomaterials aiding in the infection cure and regeneration of bone along with their limitations, as well as their future prospects. [ABSTRACT FROM AUTHOR]

Background: Clove (Eugenia caryophyllata Thunberg) and lime (Citrus aurantifolia) are medicinal plants traditionally used to treat various diseases such as gastritis. Some studies reported that cloves leaf and lime leaf extract showed a gastroprotective effect by decreasing the gastric acid secretion and increasing the gastric mucus. Aim: This study aims to investigate the anti-gastritis activity of the combination of ethanolic extract of cloves leaf and lime leaf extract in alcohol absolute-induced mice. Methods: Mice were treated with the combination extract 0.7 g/kg BW, 1.4 g/kg BW, and 2.8 g/kg BW. Famotidine was used as a positive control, and Na CMC suspension was used as a negative control. After 45 minutes of oral administration, 0.14 ml/20g BW alcohol absolute was given to all mice. All groups were sacrificed one hour later. The evaluation showed that extract combination in all doses significantly decreased ulcer index (UI) compared to a negative control group (p<0.005) in macroscopic evaluation. Results: In histopathologic evaluation, all doses significantly decreased mucosal edema and epithelial cell loss (p<0.005), but in gastric bleeding evaluation, only 0.7 and 1.4 g/kg BW doses showed a significant decrease. Conclusion: This study showed that a combination of clove and lime leaf extracts has anti-gastritis activity and could be a possible therapeutic of anti-gastritis. The most effective dose is 1.4 g/kg BW in mice which showed the lowest ulcer index and gastric mucosal edema, bleeding and epithelial cells loss reduction on histopathological observation. [ABSTRACT FROM AUTHOR]