Evaluation of Polyvinyl Alcohol/Cobalt Substituted Hydroxyapatite Nanocomposite as a Potential Wound Dressing for Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) caused by diabetes are prone to serious and persistent infections. If not treated properly, it will cause tissue necrosis or septicemia due to peripheral blood vessel embolism. Therefore, it is an urgent challenge to accelerate wound healing and reduce the risk of bacterial infection in patients. In clinical practice, DFUs mostly use hydrogel dressing to cover the surface of the affected area as an auxiliary treatment. Polyvinyl alcohol (PVA) is a hydrophilic hydrogel polymer widely used in dressings, drug delivery, and medical applications. However, due to its weak bioactivity and antibacterial ability, leads to limited application. Filler adding is a useful way to enhance the biocompatibility of PVA. In our study, cobalt-substituted hydroxyapatite (CoHA) powder was prepared by the electrochemically-deposited method. PVA and PVA-CoHA nanocomposite were prepared by the solvent casting method. The bioactivity of the PVA and composite was evaluated by immersed in simulated body fluid for 7 days. In addition, L929 cells and E. coli were used to evaluate the cytotoxicity and antibacterial tests of PVA and PVA-CoHA nanocomposite. The results show that the addition of CoHA increases the mechanical properties and biological activity of PVA. Biocompatibility evaluation showed no significant cytotoxicity of PVA-CoHA composite. In addition, a small amount of cobalt ion was released to the culture medium from the nanocomposite in the cell culture period and enhanced cell growth. The addition of CoHA also confirmed that it could inhibit the growth of E. coli. PVA-CoHA composite may have potential applications in diabetic trauma healing and wound dressing.

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Blind Comparative study between Silver nanoparticles dressings and Standard Moist Wound Dressings (SMWD) in management of diabetic foot ulcers

QJM ◽

10.1093/qjmed/hcab097.040 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Amr Abdelaal ◽

Mostafa Soliman ◽

Hany Rafik ◽

Mohamed Emam ◽

Mohamed Mahmoud Mohamed Elsadek

Keyword(s):

Silver Nanoparticles ◽

Diabetic Foot ◽

Wound Dressing ◽

Treatment Modalities ◽

Controlled Study ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Group A ◽

Group B

Abstract Background Diabetic foot ulcers (DFUs) are the main cause of hospitalization in diabetic patients and they are considered a major worldwide health problem. Thus, there is a need to evaluate various treatment modalities. In this study we will assess the clinical efficacy of Silver nanoparticles dressing vs Standard Moist Wound Dressing (SMWD) in management of diabetic foot ulcers. Objective To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers and cost effectiveness in terms of duration of hospital stay between Silver nanotechnology dressings and Standard moist wound therapy (SMWT) in management of diabetic foot ulcers. Patients and Methods This is a prospective randomized controlled study involving 34 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Silver nanoparticles wound dressing. Results Our study correlates with the study conducted by K.Suhas et al. which had observed that Silver nanoparticles wound dressing was safe and effective treatment for complex diabetic foot wounds and could lead to higher proportion of healed wounds and faster healing rates. At the end of the study, group B promised a better outcome as compared to group A. Conclusion The role of Silver nanoparticles wound dressing in healing of diabetic foot ulcers has been proposed as a novel method of manipulating the chronic wound environment in a way that it reduces bacterial burden and chronic interstitial wound fluid, increases vascularity and cytokine expression and to an extent mechanically exploiting the viscoelasticity of peri wound tissues.

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A parallel open-label trial to evaluate microbial cellulose wound dressing in the treatment of diabetic foot ulcers

International Wound Journal ◽

10.1111/j.1742-481x.2010.00750.x ◽

2010 ◽

Vol 8 (1) ◽

pp. 69-73 ◽

Cited By ~ 43

Author(s):

Douglas R Solway ◽

William A Clark ◽

Dennis J Levinson

Keyword(s):

Diabetic Foot ◽

Wound Dressing ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Open Label ◽

Microbial Cellulose ◽

Open Label Trial

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A clinicopathogical study on diabetic foot ulcer with special reference to the causative factors and its management

International Surgery Journal ◽

10.18203/2349-2902.isj20191469 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1540

Author(s):

Sailendranath Paul ◽

Dilip Kumar Das

Keyword(s):

Diabetic Foot ◽

Age Of Onset ◽

Management Strategies ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Major Amputation ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

E Coli ◽

Related Risk

Background: Diabetic ulcers are the most common foot injuries leading to lower extremity amputation. The present study was done to identify the incidence and related risk factors of diabetic foot ulcers in study participants.Methods: This was a prospective done on 50 patients with diabetic foot ulcers. All the patients were examined thoroughly and related laboratory investigations were done. Wound culture and sensitivity was done in all cases.Results: Mean age of onset with foot ulcers was 53.5 yrs in male and 55 yrs in females. Nephropathy was present in 12 (24%) patients. Sensorimotor neuropathy was present in 29 (58%) cases and autonomic neuropathy was present in 06 (12%) cases. Most common infection identified in diabetic foot ulcers was due to gram-negative bacteria (E. coli in 45 cases). Major amputation was done in 2 (4%) patients.Conclusions: Implementation of management strategies at early stages prevents the development of complications related to diabetic foot ulcers in patients.

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Antibiotic Resistance in Aerobic Bacterial Isolates From Infected Diabetic Foot Ulcers in North Eastern Tanzania: An Urgent Call to Establish A Hospital Antimicrobial Stewardship Committee

10.21203/rs.3.rs-569062/v1 ◽

2021 ◽

Author(s):

Ahmed Ali Shabhay ◽

Pius Horumpende ◽

Martin Mujuni ◽

Edna-Joy Munisi ◽

Stephen Mshana ◽

...

Keyword(s):

Diabetic Foot ◽

Foot Ulcers ◽

Coagulase Negative Staphylococcus ◽

Surgical Removal ◽

Diabetic Foot Ulcers ◽

Bacterial Isolates ◽

Diabetic Ulcer ◽

Gram Negative ◽

Surgical Department ◽

E Coli

Abstract Background. Diabetic foot ulcers (DFU) is among major health problems which impact the socio economic burden globally. We aimed at assessing the susceptibility pattern of antimicrobials in DFU infections among patients admitted in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC). Methods. This descriptive cross-sectional study was conducted from September 2018 through March 2019. Pus swabs were collected on the first day of admission by deep wound swabbing after irrigation with normal saline solution. Kirby-Bauer method was done according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. Results. Sixty diabetic ulcer patients had 62 bacterial isolates. Majority of the isolates were gram negative 49/62(79.03%). The most common isolate was Escherichia coli 15/62(24.19%) followed by Pseudomonas aeruginosa 14/62(22.58%), Proteus mirabilis 8/62(12.9%) and Staphylococcus aureus 5/62(8.06%). Klebsiella pneumoniae, Coagulase Negative Staphylococcus, Proteus Vulgaris, and Streptococcus pyogenes each contributed 4/62(6.25%) isolates. Of the 49/62(79.3%) gram negative isolates, 8/49(16.33%) were mono resistant, 30/49(61.22%) were multiresistant, and 11/49(22.45%) were susceptible. Of the multi-resistant isolates, E. coli 12/15(80.00%), and P.aeruginosa 7/14(50.00%) were predominant. A total of 39/62(62.90%) isolates in patients contributed to poorer outcomes including loss of body part. Patients with ulcers infected by P. aeruginosa 11/39 (28.21%) had the highest number of surgical removal of body parts followed by E. coli 8/39(20.51%). Gram negative bacteria were highly susceptible to amikacin 91.18%, meropenem 93.33% and imipenem 95.24%. Isolates susceptibility to ceftriaxone was 32%. Conclusions. Amikacin, meropenem and imipenem can be safely used as broad-spectrum antimicrobials in DFU. The Standard of care remains culture and sensitivity of isolated microorganisms in combating diabetic foot ulcers infections.

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Open, non-comparative, multi-centre post clinical study of the performance and safety of a gelling fibre wound dressing on diabetic foot ulcers

Journal of Wound Care ◽

10.12968/jowc.2016.25.5.290 ◽

2016 ◽

Vol 25 (5) ◽

pp. 290-300 ◽

Cited By ~ 2

Author(s):

P. Chadwick ◽

J. McCardle

Keyword(s):

Clinical Study ◽

Diabetic Foot ◽

Wound Dressing ◽

Foot Ulcers ◽

Diabetic Foot Ulcers

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Evaluation of the safety and healing potential of a fibroin-aloe gel film for the treatment of diabetic foot ulcers

Journal of Wound Care ◽

10.12968/jowc.2021.30.12.1020 ◽

2021 ◽

Vol 30 (12) ◽

pp. 1020-1028

Author(s):

Saran Worasakwutiphong ◽

Tanapron Termwattanaphakdee ◽

Thanpawee Kamolhan ◽

Preeyawass Phimnuan ◽

Anuphan Sittichokechaiwut ◽

...

Keyword(s):

Porous Structure ◽

Diabetic Foot ◽

Wound Dressing ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Swelling Ratio ◽

Wound Area ◽

Area Reduction ◽

Gel Film ◽

Aloe Gel

Objective: This study aimed to develop a wound dressing prepared from the blending of silkworm fibroin and aloe gel extract for use in the treatment of diabetic foot ulcers (DFUs). Methods: Fibroin extracted from silkworm cocoons and aloe gel extract were dissolved in deionised water. pH levels were then adjusted with lactic acid solution. A simple casting technique was used to obtain the fibroin–aloe gel film. The surface morphology, hardness, flexibility and infrared spectrum of the sterilised film were tested. Swelling ratio was measured from changes in weight. The cytocompatibility of the film to human dermal fibroblast was determined using XTT assay. Hard-to-heal DFUs (grade I Wagner score) were treated with the film for four weeks. The application site was assessed for allergic reactions and/or sensitisation. Wound size was measured using standardised digital photography. Results: A total of five hard-to-heal DFUs were treated. The obtained film sterilised with ozonation showed a non-porous structure. The elongation at break and tensile strength of the wet film were 9.00±0.95% and 6.89±1.21N, respectively. Fourier-transform infrared spectroscopy data indicated the presence of amides I, II and III, of peptide linkage, which are the chemical characteristics of the fibroin. Functional groups relating to healing activity of the aloe gel extract were also found. The swelling ratio of the film immersed in water for 24 hours was 0.8±0.01. In three DFUs (40–50mm2 in size), a wound area reduction of 0.4–0.8mm2/day was observed and were healed in 2–3 weeks. The remaining two SFUs (500mm2 in size) showed a wound area reduction of 4mm2/day and were almost closed at four weeks. No allergic reaction or infection was observed in any of the wounds. Conclusion: The obtained film showed a non-porous structure, and its strength and flexibility were adequate for storage and handling. The film tended to increase the proliferation of fibroblasts. The wound dressing showed potential for accelerating the healing rate of DFUs.

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Bacterial Infections Profile and Patterns for Diabetic Foot Ulcers in Nongovernmental Hospitals of Jordan

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i1331260 ◽

2021 ◽

pp. 7-14

Author(s):

Hashem A. Abu-Harirah ◽

Ammar Saleem ◽

Haytham M. Daradka ◽

Ali Ahmad Abu Siyam ◽

Audai Jamal Al Qudah ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Diabetic Foot ◽

Bacterial Infections ◽

Foot Ulcers ◽

P Value ◽

Diabetic Foot Ulcers ◽

Diabetic Mellitus ◽

Foot Ulceration ◽

E Coli ◽

Acinetobacter Spp

Background: Many types of infection can cause diabetic foot ulcers Infections involving the bacteria; E. coli, Acinetobacter spp (MDR) and K. pneumoniae, pseudomonas aeruginosa, so the assessment of Bacterial profile and patterns is needed to understand the source and management of these injuries. Objective: To determine Bacterial infections profile and patterns for diabetic foot ulcers in nongovernmental. Method: During a period of eleven months, 148 patients with diabetic mellitus foot syndrome (DMFS). Patients were involved, out of 130 which foot ulceration infections. data analysis was done using SPSS version 20. p value was set at <0.05. Results: Out of 607 Patients with diabetic foot ulceration (DFU) were 130 out of 148 with diabetic mellitus foot syndrome (DMFS). Diabetic foot ulceration (DFU) therefore contributed 20.3% of DMFS among these subjects. Microbiological culture pattern was total of 17 different pathogenic microorganisms were isolated from the participants, one yeast and 16 types of bacteria, from the diabetic foot swabs for ulcers. S. aureus was the most frequent pathogen followed by E.coli then Acinetobacter spp (MDR) and K. pneumonia, then pseudomonas aeruginosa , then p. mirabilis then Streptococcus agalactiae ( group b) then (Enitrobacteria spp and pseudomonas spp and Candida spp and P. vulgaris and K. oxytoca ESBL) then S. viridanse and Enterobacter spp ESBL and Staphylococcus coag. negative). The Enterobacter spp ESBL was the less frequent pathogen. Conclusion: Diabetic Foot Ulcerations (DFU), is forming about a quarter of the diabetic patient’s tissue infections, the causative agents were bacterial and fungal(yeast). Most of the causative pathogens were; Staphylococcus aureus, and Acinetobacter spp (MDR). The risk of development of High resistant drug isolates of diabetic foot ulcers to be multidrug resistance were high by 53% of total isolated pathogens specially with K. pneumonia (K. pneumoniae), Escherichia coli (E. coli) and Proteus mirabilis bacterial.

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