Relation Between Tissue Iron Content and Polarization of Macrophages in Diabetic Ulcer and the Transitional Zone of Diabetic Ulcers with Major Amputation

Most diabetic lower-limb amputations probably result from combinations of contributing causes rather than from unitary causes. Iron-induced damage might modulate the development of chronic diabetes complications. In this study, the relationship between tissue iron levels and polarization of macrophages in induction of angiogenesis was investigated in diabetic ulcer samples and the transitional zone of diabetic ulcers. Patients with diabetic ulcers who underwent amputation were included. The transitional zone of diabetic ulcers, from the same diabetic patients, was used as a control group. After tissue preparation, Perls Prussian blue staining and immunohistochemistry for CD11c, CD163, and CD68 markers were done. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), Tie2, and protein kinase B (also known as AKT) transcription of genes were measured by real-time polymerase chain reaction. For statistical analysis, we used independent samples t-test or its nonparametric equivalents, Mann–Whitney U test was used for quantitative variables, and chi-square (or Fisher's exact test) for qualitative variables. According to the results, the ratio of M2 to M1 macrophages was decreased in ulcers tissue compared to the transitional zone of diabetic ulcers. The expression of angiogenesis-related genes was increased due to hypoxia induction such as HIF and VEGF in ulcer tissue ( P < .0001), but the expression of vascular stability-related genes such as Tie2 was decreased ( P < .0001).In amputated diabetic ulcers, the polarization of macrophages is toward the classic type, but no connection was found in terms of tissue iron and help in the polarization of macrophages.

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Effect of Health Education on Improving the Knowledge among Diabetes Mellitus Patients in the Prevention of Diabetic Ulcer in Regional Hospital of Tidore Island

International Journal of Nursing and Health Services (IJNHS) ◽

10.35654/ijnhs.v4i4.452 ◽

2021 ◽

Vol 4 (4) ◽

pp. 379-384

Author(s):

Haeril Amir ◽

Nur Wahyuni Munir

Keyword(s):

Diabetes Mellitus ◽

Health Education ◽

Diabetic Foot ◽

Regional Hospital ◽

Foot Ulcers ◽

Control Group ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Diabetic Ulcer ◽

Diabetic Ulcers

International Diabetes Federation (IDF) reported that the number of diabetes mellitus patients worldwide increases every year. Diabetes mellitus is a chronic disease due to damage to the pancreas in producing enough insulin and characterized by impaired metabolism of fats, increased blood sugar, carbohydrates and protein both absolutely and relatively. Diabetic foot ulcers (DFU) are among the most common complications in diabetic patients and are associated with high mortality, morbidity, and health costs. This study was to determine the effect of health education on knowledge improvement about diabetic ulcers in the regional hospital of Tidore Islands. This research is a quasi-experimental type with a pretest-posttest without a control group design. The research sample consisted of 30 respondents who met the inclusion criteria. Data were analyzed using a paired test and processed with statistic version 21. Based on the research results, there was an improved knowledge in pre and post-health education counseling, where the average score before health education counseling was 11.6. After health counseling, the average value was 15.0. The results showed the effect of knowledge in the prevention of diabetic ulcers with a p-value =0,000. Health education is an effort to improve patient's ability to prevent diabetic foot ulcers that have been proven in several scientific studies. Health education methods provide additional information so that patients who previously wondered about their disease can directly ask health workers. Health education affects the knowledge improvement of Diabetes Mellitus patients in the Regional hospital of Tidore Islands

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Perbandingan efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.8.1.2016.12335 ◽

2016 ◽

Vol 8 (1) ◽

Author(s):

Angelica M. J. Wagiu ◽

Richard M. Sumangkut ◽

Heber B. Sapan ◽

Louise A. J. Waworuntu

Keyword(s):

Peripheral Arterial Disease ◽

Proteus Mirabilis ◽

Peracetic Acid ◽

Arterial Disease ◽

Diabetic Patients ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Citrobacter Diversus ◽

Peripheral Arterial ◽

Topical Antimicrobial

Abstract: Diabetic ulcer is a condition of infection, ulceration, and or destruction of inner skin tissue related to neurological disorders and degrees of peripheral arterial disease (PAD) in diabetic patients. Diabetic ulcer is prone to infection due to decreased immune response, therefore, opportunistic microbes can become pathogens. Infection is sttill a serious problem in diabetic ulcer since the high cost and long duration of treatment lead to complicated neclected ulcer. This study aimed to obtain the present profile of microbes in diabetic ulcers and the effectivitveness of peracetic acid dan feracrylum in the treatment of diabetic ulcers. This was a descriptive analytical study. The ulcer degree was determined by using PEDIS criteria. Pus specimen was taken with a sterile technique using a transport media, cultured in the Baxtec machine, and the microbes were identified and further tested for sensitivity to peracetic acid dan feracrylum 1%. The results showed that of the 57 patients there were 36 females with a mean age of 58.77+ 9.077 years. Most of the patients (30 patients) had diabetic ulcers of 4th degree. The result of pus culture showed Gram negative Proteus mirabilis as the most frequent microbe (17.5%). The sensitivity test showed that 100% of 12 types of microbes, 83.3% of Citrobacter diversus, and 60% of Proteus mirabilis samples were sensitive to peracetic acid, meanwhile, all microbes were resistant to feracrylum 1% dan NaCl as controls,. Conclusion: Peracetic acid was more effective than feracrylum 1% as topical antimicrobial for diabetic ulcer.Keywords: diabetic ulcer, microbe, topical antimicrobial agentAbstrak: Ulkus diabetik adalah suatu kondisi adanya infeksi, ulserasi dan atau kerusakan jaringan kulit yang lebih dalam yang berhubungan dengan kelainan neurologik serta berbagai tingkatan peripheral arterial disease (PAD) pada penderita diabetes melitus (DM). Ulkus diabetik lebih mudah terinfeksi karena respons kekebalan tubuh penderita DM biasanya menurun, bahkan kuman oportunistik juga dapat menjadi patogen. Infeksi masih menjadi masalah yang paling serius dialami penderita ulkus diabetik oleh karena biaya pengobatan yang besar dan waktu perawatan yang lama sehingga ulkus sering dibiarkan terinfeksi dengan komplikasi tanpa perawatan adekuat. Penelitian ini bertujuan untuk memperoleh data terkini pola kuman penderita ulkus diabetik dan untuk mengetahui efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik. Jenis penelitian ini ialah deskriptif analitik. Derajat ulkus dinilai dengan kriteria PEDIS. Spesimen pus diambil secara steril dengan media transpor, ditanam dalam mesin Baxtec, kemudian dilakukan identifikasi kuman dan uji sensitivitas terhadap asam perasetik dan feracrylum 1%. Hasil penelitian memperlihatkan dari 57 penderita ulkus diabetik terbanyak ialah perempuan (36 penderita) dengan rerata usia 58,77+9,077 tahun. Sebagian besar ulkus diabetik (30 penderita) termasuk derajat 4. Hasil kultur memperlihatkan Proteus mirabilis (Gram negatif) yang tersering (17,5%). Hasil uji sensitivitas pola kuman memperlihatkan 100% sampel dari 12 jenis kuman, 83,3% dari Citrobacter diversus, dan 60% dari Proteus mirabilis sensitif terhadap asam perasetik, sedangkan terhadap feracrylum 1% dan NaCl sebagai kontrol, seluruh kuman telah resisten. Simpulan: Asam perasetik lebih efektif dibandingkan feracrylum 1% sebagai antimikroba topikal pada ulkus diabetik.Kata kunci: ulkus diabetik, mikroba, antimikroba topikal

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Transdermal deferoxamine prevents pressure-induced diabetic ulcers

Proceedings of the National Academy of Sciences ◽

10.1073/pnas.1413445112 ◽

2014 ◽

Vol 112 (1) ◽

pp. 94-99 ◽

Cited By ~ 89

Author(s):

Dominik Duscher ◽

Evgenios Neofytou ◽

Victor W. Wong ◽

Zeshaan N. Maan ◽

Robert C. Rennert ◽

...

Keyword(s):

Wound Healing ◽

Delivery System ◽

Transdermal Delivery ◽

Reactive Oxygen ◽

Diabetic Patients ◽

Ulcer Formation ◽

Diabetic Wound ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Diabetic Wound Healing

There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation.

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Differences Exudates After Irrigation With Measured Pressure on Diabetic Ulcers

Media Keperawatan Indonesia ◽

10.26714/mki.2.2.2019.1-5 ◽

2019 ◽

Vol 2 (2) ◽

pp. 1

Author(s):

Mohammad Arifin Noor ◽

Suyanto Suyanto

Keyword(s):

Anaerobic Bacteria ◽

Intervention Group ◽

Control Group ◽

Measurement Tool ◽

P Value ◽

Wound Irrigation ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Quasi Experimental ◽

Number Of Bacteria

Diabetic ulcer is a further complication of the presence of diabetic ulcers that are not handled properly. Gangren ulcers are very difficult to cure. One of them is the characteristic of gangrene wounds that have a hollow (hard) that is very difficult to do cleansing. In addition, the types of bacteria that are in gangrene are anaerobic bacteria that are difficult to treat with antibiotics. The number of bacteria will also be proportional to the number of production of pus. One of the most possible actions is to irrigate the wound tunnel so that the wound is clean and anaerobic bacteria are reduced. The modern wound irrigation device, which is one of the developments of existing irrigation devices, is expected to be able to reach gangrenous wound tunnels with a modified form of output. This study aimed to determine the effect of modification of the output of the modern wound irrigation device (MWID) on the number of bacteria in diabetic gangrenous ulcer sufferers. The method used in this study was quasi-experimental without a control group. The intervention group was given wound irrigation using a modified MWID tool. The instrument was used to determine exudate production using the observation sheet Leg Ulcer Measurement Tool (LUMT). The results of the analysis by the Mc Nemar test showed that p value 0.67 (p value> 0.05) means that there is no difference in the amount of exudate production with modification of the MWID output. Further research is needed regarding the effect of irrigation angle on the number of bacteria in diabetic ulcers.

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Treating hard-to-heal ulcers: biocellulose with nanosilver compared with silver sulfadiazine

Journal of Wound Care ◽

10.12968/jowc.2020.29.sup12.s33 ◽

2020 ◽

Vol 29 (Sup12) ◽

pp. S33-S37

Author(s):

Orawan Chansanti ◽

Atthawit Mongkornwong

Keyword(s):

Demographic Data ◽

Good Choice ◽

Silver Sulfadiazine ◽

Randomised Control Trial ◽

Control Group ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Group Control Group ◽

Experimental Group ◽

Ulcer Treatment

Objective: Controlling infection and promoting healing should be the aims of hard-to-heal diabetic ulcer treatment, along with improving a patient's general condition and their blood sugar control. Many hard-to-heal diabetic ulcers present with cavities, tracks or a combination of these. There is a new biocellulose (with a nanosilver dressing) which has the ability to contour around and conform to the irregular surface of a wound bed. The purpose of this study was to evaluate its efficacy compared with a silver sulfadiazine cream, for hard-to-heal diabetic ulcer treatment. Methods: In this randomised control trial, patients with hard-to-heal diabetic ulcers were divided into two equal-sized groups: treatment with the biocellulose with blue nanosilver (experimental group), and treatment with silver sulfadiazine cream group (control group). Cotton gauze was used as the secondary dressing for both groups. Demographic data, wound size, wound classification, wound photography and bacterial cultures were recorded at the beginning of the study. Wounds were debrided as necessary. Dressings were changed twice daily in the control group, and every three days in the experimental group. Results: A total of 20 patients took part in the study (10 patients in each group). The highest mean wound healing rates were 91.4% in the experimental group and 83.9% in the control group. No wound infections or adverse effects from the dressings were detected in either group. Conclusion: In this study, biocellulose with blue nanosilver adapted well to the wound bed. Wound reduction was greater in the experimental group than the control group. Biocellulose with blue nanosilver could therefore be a good choice for hard-to-heal diabetic ulcer treatment, due to its good healing rates and minimal care requirements.

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Efektifitas Perawatan Luka Modern Kombinasi Mendengarkan Musik Klasik Terhadap Penyembuhan Ulkus Diabetik Di Rumah Luka Surabaya

Jurnal Ilmiah Keperawatan STIKES Hang Tuah Surabaya ◽

10.30643/jiksht.v13i1.22 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Imroatul Farida ◽

Diyah Arini ◽

Risca Putri Mardayati

Keyword(s):

Treatment Group ◽

Classical Music ◽

Chronic Wounds ◽

Wound Care ◽

Healing Process ◽

Sampling Technique ◽

Wound Complications ◽

Control Group ◽

Diabetic Ulcer ◽

Diabetic Ulcers

Diabetic ulcer need a long time for its healing process, failure during healing process of chronic wounds caused by necrotic tissue which becomes something foreign object for body and infected wounds. Proper wound care is needed to prevent wound complications. In this modern day, dressings combination of classical music becomes one of the diabetic ulcer therapy, this study aims to analyze the affectivity dressing combination of classical music to the acceleration of healing of diabetic ulcers at Rumah Luka Surabaya. Design of this study uses Quasi Experimental that is done by pre-test post-test in treatment group and control group. Total population in this study is 35 patients with diabetic ulcers in the Rumah Luka Surabaya, using random sampling from Probability sampling technique and obtained 32 people as sample which divided into 2 groups: 16 people in control group and 16 groups in treatment group. Furthermore tested by using Two sample T test that results are modern influences dressing combination of classical music to healing diabetic ulcers are indicated by p 0.001 <α 0:05 means there is an influence of classical music therapy in the treatment group. The implications of this study can serve as a reference for future studies related to wound healing. In addition, further studies should be done to reinforce the concept centers on a diabetic ulcer care in managing diabetic ulcers in patients with diabetes mellitus.Keywords: Classic Music, Diabetic Ulcer, Modern Dressing

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A COMPARATIVE STUDY OF PLATELET RICH PLASMA DRESSING VS NORMAL SALINE DRESSING IN THE MANAGEMENT OF DIABETIC FOOT ULCER

10.36106/ijsr/7515167 ◽

2021 ◽

pp. 19-22

Author(s):

Vijay kumar Siddalingappa ◽

Mohan kumar Kariyappa ◽

Subhashish Das

Keyword(s):

Diabetic Foot ◽

Platelet Rich Plasma ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Control Group ◽

Diabetic Patients ◽

Study Group ◽

Diabetic Ulcer ◽

Plantar Aspect ◽

Diabetic Wounds

90 patients with diabetic foot ulcer admitted in Department of General Surgery R. L. JALAPPA HOSPITAL, TAMAKA, KOLAR, in between the study period of December 2017 to June 2019. The study is estimated to include diabetic foot ulcer patients satisfying inclusion criteria who are admitted in surgical wards of RLJH and RC. A complete detailed history, as per standard proforma will be obtained and documented. All patients will undergo clinical examination with relevant investigations after obtaining an informed consent. Patients are divided into 2 groups using even-odd method to include similar type of cases in both groups, where even group is study group and odd group is control group. RESULTS: Predisposition of diabetic foot ulcer was common among males than in females, More number of diabetic patients presented with diabetic foot ulcer arising from trauma than those occurring spontaneously. The spontaneous onset ulcers healed better with PRP than those arising due to traumatic onset. The ulcers on dorsal aspect heal faster than on plantar aspect, PRP dressing improved the rate of healing in lower Wagner grade ulcer than in higher grade ulcer, Patients who were on insulin alone showed better healing than those on OHA. Over all PRP dressing group showed higher rate of ulcer size reduction than those on saline dressing. CONCLUSION: The diabetic ulcer in the study group treated with PRP dressing contracted in wound size more than in the control group. This indicates that PRP dressing is an effective method to facilitate wound contraction in diabetic patients with foot ulcer. PRP dressing is found to be more effective, cost efcient and safe promoter of ulcer wound healing and can be used as an adjunct to saline dressings for enhanced healing of diabetic wounds.

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Reduction of Staphylococcus aureus bacteria collaboration in diabetic ulcers by giving virgin coconut oil

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20205142 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4733

Author(s):

Siti Aisyah Nur ◽

Siska Sakti Anggraini ◽

Putri Dafriani ◽

Honesty Diana Morika

Keyword(s):

Staphylococcus Aureus ◽

Wound Care ◽

Intervention Group ◽

Coconut Oil ◽

Bivariate Analysis ◽

Control Group ◽

P Value ◽

Virgin Coconut Oil ◽

Diabetic Ulcer ◽

Diabetic Ulcers

Background: Diabetic ulcers often result in amputations. The bacteria found in diabetic ulcers are Enterobacter sp, Staphylococcus aureus, Salmonella sp and Pseudomonas sp. Nursing management of ulcer patients has been attempted but nothing has been effective yet. Using virgin coconut oil (VCO) contains anti-inflammatory, antipyretic and has an analgesic effect to increase the formation of new blood vessels with faster wound healing. Aim was to study the effect of wound care by giving VCO on the colonization of Staphylococcus aureus bacteria in diabetic ulcers.Methods: Quasi-experimental research with the two-group pre-test and post-test design approach involved 36 diabetic ulcer patients with consecutive sampling by doing wound care for 4 days. The duration of treatment was 30-40 minutes. Data was taken by swab on wound fluid before and after the intervention. Bivariate analysis carried out t-independent test of DM ulcers.Results: The results showed the average number of colony staphylococcus in the intervention group before being given wound care with VCO 72.88, while after being treated with 38.88 wound VCO and the average results of the number of colony staphylococcus in the control group before being treated with NaCl 77.88, whereas after being treated with VCO 38.88 wound with NaCl 72.88 in the statistical test the p value is 0,000.Conclusions: There was a significant influence between the number of colony Staphylococcus in the control group and the intervention group.

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MODERN WOUND IRRIGATION DEVICE (MWID) REDUCE THE NUMBER OF BACTERIA IN DIABETIC ULCER PATIENTS

INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) ◽

10.24990/injec.v2i1.125 ◽

2017 ◽

Vol 2 (1) ◽

pp. 105

Author(s):

Suyanto Suyanto ◽

Ahmad Ikhlasul Amal

Keyword(s):

Wound Care ◽

Intervention Group ◽

Vascular Complications ◽

Control Group ◽

P Value ◽

Wound Irrigation ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Significant Difference ◽

Number Of Bacteria

Background and Purpose: One of the micro-vascular complications in patients with diabetes mellitus is a diabetic ulcer. One of he goals of care in diabetic ulcers is to reduce infection in the wound area by doing a cleansing method particularly utilizing irrigation techniques. Irrigation technique aims to reduce the number of bacteria in the wound, so that the inflammatory process is expected to be more quickly achieved. Many diabetic ulcer care-related research but researches on irrigation tools on diabetic ulcers are very minimal. This study aims to determine the effect of Modern Wound Irrigation Device (MWID) to decrease the amount of bacteria on patients with diabetic ulcers. Method: This study was utilized quasi-experimental post test only with control group design. A total of 20 respondents in this study were divided into 10 respondents for intervention group that was given wound care using MWID. 10 respondents as control group that was given manual irrigation wound care. Results: The average number of bacteria in intervention group is 30,4x109 colonies/ml, while the average number of bacteria for control group is 59x109 colonies/ml. Analysis with independent t test was found that there is no significant difference between the average number of bacteria on the intervention and control groups with p value of (0.001 < 0.005). Conclusion and recommendation: the use of MWID for current wound irrigation is proven can reduce the amount of bacteria on diabetic ulcers as compared with manual irrigation technique. Further developmental researches utilize MWID tool is to modify the output of irrigation to reduce anaerobic bacteria for gangrene wound.Key words: Diabetic Ulcer, Wound irrigation, amount of bacteria

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Nano-Oxy: Diabetic ulcer treatment using oxygen nanoparticles concept as innovation in reducing amputation rates and antibiotics usage

World Journal of Advanced Research and Reviews ◽

10.30574/wjarr.2022.13.1.0031 ◽

2022 ◽

Vol 13 (1) ◽

pp. 309-316

Author(s):

Shofiuddin Al Mufid ◽

Naufal Achmad Tsany Daffa ◽

Dedy Firmansyah ◽

Octaviana Galuh Pratiwi ◽

Innas Safira Putri ◽

...

Keyword(s):

Oxygen Therapy ◽

Activation Mechanism ◽

Limb Amputation ◽

Target Cells ◽

Diabetic Patients ◽

Diabetic Ulcer ◽

Diabetic Ulcers ◽

Ulcer Therapy ◽

Chronic Hyperglycemia ◽

Ulcer Treatment

Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia caused by defects in insulin secretion, insulin reactions, or both. More than one third of diabetic patients have complications in the form of diabetic ulcers, and half are infected, and 15% of these infections require limb amputation. High cost expenditure and risks of microbial resistance to antibiotics also adds the complexity of the problem. The purpose of this literature review is to offer Nano-Oxy, using oxygen in nanoparticle size, as an alternative diabetic ulcer treatment. Literature searching was conducted through online search method. Oxygen therapy has been widely used to treat diabetic ulcers, including hyperbaric oxygen therapy (HOT) and topical oxygen therapy (TOT). Both of them have good results on diabetic ulcer therapy. Oxygen can act as an antimicrobial agent through the activation mechanism of neutrophils and macrophages which play a role in phagocytosis process and ROS regeneration. Nano-Oxy has advantages than the previous therapy, such as it does not cause barotrauma, oxygen poisoning, and low risk of burning. The mechanism of how Nano-Oxy works is similar with the Micro-nanobubbles (MNBs) concept. The negatively charged surface of MNBs can prevent them from aggregating, attracts particles, and help remove debris. MNBs also generate free radicals while shrinking in water, which contribute to its antibacterial effect. In addition, Nano-oxygen technology can be applied externally, but still have effect on the intended target cells. Therefore, Nano-oxygen can be used as a diabetic ulcer therapy to replace the role of antibiotics.

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