HYPOCHLOROUS ION BASED DRESSING: THROWBACK TO THE SURGEONS’ CHOICE

2021 ◽  
pp. 273-276
Author(s):  
Manikantha G ◽  
Hemant Muktaram Jawale ◽  
Akshat Awdhesh Kumar Mishra ◽  
Amarjeet E Tandur ◽  
Pratik J Agrawal
Keyword(s):  
Vascular Disease ◽  
Surface Area ◽  
Peripheral Vascular Disease ◽  
Pressure Ulcer ◽  
Normal Saline ◽  
Tertiary Care ◽  
Care Facility ◽  
Control Group ◽  
Wound Surface ◽  
Peripheral Vascular

1.1 BACKGROUND : As per Robbin's pathology(Robbins & Cotran Pathologic Basis of Disease - 10th Edition, n.d.) "an ulcer is the breach of the continuity of skin, epithelium or mucous membrane caused by sloughing out of inamed necrotic tissue." In an era of modern-day fast track surgery and premier practices of medicine, management of wound remains an archaic, almost omnipresent challenge to a health care provider mediating the need for solutions. The hunt for an optimum dressing agent has been everlasting, one of which is our point of discussion in this study. The addition of Chlorine(Cl2) to Water(H2O) gives rise to Hypochlorous ion, a weak acid that has been used traditionally as disinfectant, sterilizer and beaches. These properties can be utilised for wound disinfection and swifter wound healing. 1.2 AIMS AND OBJECTIVES: Ÿ To study the efcacy of Hypochlorous ion-based dressing over traditional normal saline based dressing . Ÿ To study the effects factoring in various associated comorbidities in patients such as Diabetes Mellitus, Peripheral Vascular Disease, Trauma and Pressure Ulcer. 1.3 METHODOLOGY: A comparative study was conducted in a tertiary care facility in India that included 101 patients who were distributed randomly utilizing computerised algorithms into study and control group. The control group received daily normal saline dressing whereas the study group underwent daily hypochlorous ion-based dressing. The subjects were analysed after 4 weeks and evaluated for decrease in wound surface area and improvement of wound quality and tabulated for analysis. 1.4 CONCLUSION: Hypochlorous ion based daily dressing shows signicant reduction in wound surface area as well as signicantly better and faster improvement in the quality of wound in patients of Traumatic, Diabetic and Pressure Ulcer whereas the results in patients suffering from Peripheral Vascular Disease were equivocal.

scholarly journals Prevalence of Peripheral Vascular Disease in Diabetic Foot Infections and its Effect on Management Outcome

2019 ◽  
Vol 38 (1) ◽  
pp. 12-17
Author(s):  
Farah Nobi ◽  
Syed Al Nahian ◽  
Afrin Sultana ◽  
Rokhsana Sarmin ◽  
Ayesha Rahman ◽  
...  
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Peripheral Vascular ◽  
Tertiary Care Centre ◽  
Term Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics with faster progression. Aim: This study aimed to observe the prevalence of peripheral vascular disease in patients with diabetic foot infections presenting to this tertiary care centre. Methods: This prospective observational study evaluated 250 patients with diabetic foot infection admitted to Ibrahim Medical College and BIRDEM General Hospital, Dhaka, from 1st January 2015 to 31st December 2015.Total 72 patients were selected for Duplex study of lower limb vessels, Ankle Brachial Pressure Index (ABPI) and Pulse oxymetrywhich established the diagnosis of peripheral vascular disease and all patients were treated according to the standard protocol. Results: Of the 72 patients peripheral vascular disease was found in 25 patients (34.7%) and majority of them (88%) had distal below the knee vessel stenosis. There was significant correlation with older age (75%) and history of tobacco use (64%). The clinical presentations and outcomes such as hospital stay, healing time, pain were worse in individuals with peripheral vascular compromise on Duplex study of lower limb vessels, ABPI and pulse oxymetry. Conclusion: In this study we observed that significant number of diabetics presenting with foot infections have underlying peripheral vascular disease .The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. Early detection of peripheral vascular disease in patients presenting with diabetic foot infection, using Duplex study,ABPI and Pulse oxymetrywith routine clinical and laboratory assessment can be of great value in long term care of these individuals. J Bangladesh Coll Phys Surg 2020; 38(1): 12-17

Chiropody May Prevent Amputations in Diabetic Patients on Peritoneal Dialysis

2003 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Jennifer Lipscombe ◽  
Sarbjit V. Jassal ◽  
Susan Bailey ◽  
Joanne M. Bargman ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Peripheral Vascular ◽  
Foot Care ◽  
Care Assessment ◽  
Patients With Diabetes

← Background A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment. ← Objective The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD). ← Design Retrospective chart review. ← Setting The PD program at a tertiary-care hospital. ← Patients Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included. ← Intervention Education about foot care, assessment, and, in some instances, treatment by a chiropodist. ← Results Patients with an amputation were more likely to be male ( p < 0.01) and have peripheral vascular disease ( p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure ( p < 0.05), lower weekly creatinine clearance ( p < 0.01), higher mean erythropoietin dose ( p < 0.05), and longer duration of end-stage renal disease ( p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p < 0.01), and cerebrovascular disease (HR = 2.70, p < 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01). ← Conclusion The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.

scholarly journals Morphometric Analysis of Connective Tissue Sheaths of Sural Nerve in Diabetic and Nondiabetic Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Braca Kundalić ◽  
Slađana Ugrenović ◽  
Ivan Jovanović ◽  
Natalija Stefanović ◽  
Vladimir Petrović ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Sural Nerve ◽  
Nerve Fibers ◽  
Diabetic Group ◽  
Control Group ◽  
Peripheral Vascular ◽  
Disease Group ◽  
Imagej Software

One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P<0.05) and endoneurial connective tissue percentage (P<0.01). The diabetic group showed significantly higher epineurial area (P<0.01), as well as percentage of endoneurial connective tissue (P<0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.

scholarly journals A clinical study of peripheral vascular disease due to atherosclerosis in diabetic foot infections

2018 ◽  
Vol 5 (3) ◽  
pp. 931
Author(s):  
A. Tyagi ◽  
S. Lavanya ◽  
S. Lavanya ◽  
G. Hari Prasad ◽  
G. Hari Prasad
Keyword(s):  
Clinical Study ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Diabetic Foot ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Peripheral Vascular ◽  
Foot Care ◽  
Below The Knee ◽  
Diabetic Foot Infections

Background: Foot infection is a common problem affecting diabetics. Ischemia is a major factor contributing to progress and morbidity of the disease. The prevalence of peripheral vascular disease is higher in diabetics, with faster progression. The prevalence differs among populations. This study aimed to clinical prevalence of peripheral vascular disease due to atherosclerosis in patients with diabetic foot infections presenting to this tertiary care centre.Methods: This clinical study was conducted in ASRAM hospital, Eluru, Andhra Pradesh, India. All patients admitted with a diagnosis of diabetic foot infection to the department of general surgery during a period between October 2015 to October 2017, who fulfilled the inclusion and exclusion criteria, were enrolled for the study. After recording the pertinent information (as per performa), patients were subjected to a lower limb arterial Doppler and ABPI findings were tabulated.Results: Peripheral vascular disease was found in 35% of patients studied. Majority had distal below the knee vessels stenosis or occlusion. There was significant correlation with age, history of tobacco use and various risk factors. The clinical presentations and outcomes were worse in individuals found to have peripheral vascular compromise on arterial Doppler study.Conclusions: The care of diabetic patients should start with preventive measures which include proper foot care, glycaemic control and education about diabetic foot are key factors for better out come and quality of life.

Cerebrovascular CO2Reactivity during Anesthesia in Patients with Diabetes Mellitus and Peripheral Vascular Disease 

1998 ◽  
Vol 89 (4) ◽  
pp. 887-893 ◽  
Author(s):  
Ryuichi Kawata ◽  
Kazuhiko Nakakimura ◽  
Mishiya Matsumoto ◽  
Kouji Kawai ◽  
Mitsuru Kunihiro ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Carbon Dioxide ◽  
Blood Flow ◽  
Vascular Disease ◽  
Flow Velocity ◽  
Peripheral Vascular Disease ◽  
Blood Flow Velocity ◽  
Control Group ◽  
Peripheral Vascular ◽  
Carbon Dioxide Reactivity

Background Diabetes mellitus (DM) and systemic atherosclerosis are risk factors for stroke. Although the origins of increased risk are complex, one possibility is that cerebrovascular reactivity is impaired and does not allow the brain to compensate for aberrations in physiology. The current study tested this issue by evaluating mean blood flow velocity of the middle cerebral artery (Vmca) and carbon dioxide reactivity during anesthesia in patients with DM and peripheral vascular disease (PVD). Methods Fifty-two patients were observed: 20 patients with DM (the DM group), 12 patients with PVD (the PVD group), and 20 patients classified as American Society of Anesthesiologists physical status 1 or 2 (the control group). The Vmca was measured using transcranial Doppler ultrasonography during isoflurane-nitrous oxide anesthesia. After measuring baseline Vmca at a partial pressure of carbon dioxide in arterial blood (PaCO2) of 37.7 +/- 4.5 mmHg (mean +/- SD), measurements were repeated at a PaCO of 44.2 +/- 3.8 mmHg, and the carbon dioxide reactivity (absolute value: cm x s(-1) x mmHg(-1); relative value: percentage of baseline Vmca/mmHg) was calculated. Results The baseline Vmca of the DM group (51 +/- 12 cm/s) was significantly greater than those of the control group (42 +/- 6 cm/s) and the PVD group (42 +/- 13 cm/s). The absolute and relative values of carbon dioxide reactivity in the DM group (3.1 +/- 1.3 cm x s(-1) x mmHg(-1); 6.3 +/- 2.4%/mmHg) were significantly greater than or equivalent to those of the control group (2.3 +/- 0.8 cm x s(-1) x mmHg(-1); 5.3 +/- 1.7%/mmHg), respectively. In the PVD group, the baseline Vmca was equivalent to the control group, but the carbon dioxide reactivity (1.1 +/- 0.5 cm x s(-1) x mmHg(-1) 2.8 +/- 1.2%/mmHg) was significantly less. Conclusions The patients with DM have increased baseline cerebral blood flow velocity and normal carbon dioxide reactivity during anesthesia. The patients with PVD have decreased carbon dioxide reactivity, but baseline flow velocity is maintained.

scholarly journals An audit of vascular surgery experience at North Surgical Unit, Mayo Hospital Lahore

2016 ◽  
Vol 12 (1) ◽  
Author(s):  
Khalid Irshad ◽  
Omar Salahuddin ◽  
Intesarur Rashid ◽  
Raza S ◽  
Abdul Majeed Chaudhry
Keyword(s):  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Tertiary Care ◽  
Late Presentation ◽  
Aortic Aneurysms ◽  
Peripheral Vascular ◽  
Non Invasive ◽  
Run Off ◽  
First Choice ◽  
Risk Patients

The prevalence of Peripheral vascular disease, Carotid artery stenosis and Aortic aneurysm in our society is higher than generally accepted because of higher incidence of established modifiable risk factors like Smoking, Diabetes, Hypertension and Hyperlipidaemia. We present a review of 246 patients with prospective collection of data who were referred for opinion to North Surgical Ward Mayo Hospital Lahore from March 2005 to February 2006. Surgical treatment was possible in 165 patients. Amongst remaining 81 patients 38 presented late and had amputations either in referring unit or with us and 43 were managed conservatively or under follow up. 24 prosthetic grafts were used, 8 in Aortic aneurysms, 4 in carotid endarterectomies and 11 in iliofemoral reconstructions with no peri-operative mortality or stroke. We had 2 grafts occlusion and amputations in critically ischaemic patients who had single vessel run off. Non invasive investigations were the first choice in Carotid and peripheral vascular disease. Conclusion: Our experience shows higher incidence of late presentation and under treatment of these high risk patients which need patient awareness and life style modification at community level. We advocate multidisciplinary approach and establishment of fully supported dedicated peripheral vascular and endovascular services at tertiary care level.

scholarly journals Management of upper extremity peripheral vascular disease: a multimodality approach

2020 ◽  
Vol 7 (6) ◽  
pp. 1842
Author(s):  
Prasad Upganlawar ◽  
Ashwinee Rahalkar ◽  
Sneha Joshi ◽  
Simran Khatri
Keyword(s):  
Interventional Radiology ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Upper Extremity ◽  
Tertiary Care ◽  
General Surgeon ◽  
Peripheral Vascular ◽  
Vascular Surgeon ◽  
Early Management ◽  
Number Of Patients

Background: It is estimated that more than 200 million people suffer from peripheral vascular disease worldwide. However very few studies are available on upper extremity vascular disease, thus making it an under diagnosed and under treated condition.Methods: In the present study we included 20 participants suffering from upper limb peripheral vascular disease and managed them with multi-modality approach involving general surgeon, interventional radiologist and vascular surgeon for medical line of management, thrombolysis and thrombo-embolectomy procedures.Results: In the present study we observed that early management of these patients with medical management, interventional radiology and embolectomy procedures helped in limb salvage. However alarmingly high number of patients (35%) landed up in amputation because of low index of suspicion and delayed referral.Conclusions: A high level of suspicion and early referral to a tertiary care centre where multi-modality facilities like interventional radiology and vascular surgeon are available should be done.

scholarly journals Clinical Analysis of Peripheral Vascular Diseade in Patients with Diabetes Mellitus

2019 ◽  
Vol 3 (2) ◽  
pp. 18-24
Author(s):  
Dipak Malla ◽  
Sukesh Purush Dhakal
Keyword(s):  
Diabetes Mellitus ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Tertiary Care ◽  
Clinical Syndrome ◽  
Peripheral Vascular ◽  
Diabetic Mellitus ◽  
Tertiary Care Centre ◽  
Laboratory Assessment ◽  
Term Care

Introduction: Diabetes Mellitus (DM) is clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. The metabolic dysregulation associated with DM causes multitude of secondary pathophysiological changes in multiple organ system causing macro vascular (coronary artery disease, peripheral vascular disease, cerebrovascular disease) and micro vascular (retinopathy, neuropathy, and nephropathy) complications. This study aimed to study the prevalence of peripheral vascular disease in patients with diabetic mellitus presenting to this tertiary care centre. Methods: This clinical study was conducted in first affiliated hospital of Yangtze university, Jingzhou. All patients with a diagnosis of diabetic mellitus who came to Out patient department of Endocrinology & diabetic clinic and admitted in the hospital during a period between October 2013 to October 2014, who fulfill, were enrolled for the study. This was a single centered retrospective observational analylitcal study conducted in Department of Endocrinology of First affiliated Hospital of Yangtze, China. Results: Peripheral vascular disease was found in 35% of patients studied . There was significant correlation. Conclusion: A significant number of diabetics presenting with diabetes mellitus have underlying peripheral vascular disease. The patients might not all be symptomatic or show obvious signs of PVD but need to be investigated for the same. The older the individual the more the chances of having peripheral vascular compromise. Also a tobacco user and patient presenting with worse clinical findings is more likely to have PVD. Thus the detection of peripheral vascular disease in patients using Arterial Doppler studies along with routine clinical and laboratory assessment can be of great value in long term care of these individualsith age, and history of tobacco use.  

scholarly journals Olive oil- and fish oil-enriched diets modify plasma lipids and susceptibility of LDL to oxidative modification in free-living male patients with peripheral vascular disease: the Spanish Nutrition Study

1999 ◽  
Vol 82 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Carmen Ramírez-Tortosa ◽  
Jose M. López-Pedrosa ◽  
Antonio Suarez ◽  
Eduardo Ros ◽  
José Mataix ◽  
...  
Keyword(s):  
Fish Oil ◽  
Olive Oil ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Dietary Intervention ◽  
Plasma Lipids ◽  
Reference Group ◽  
Oxidative Modification ◽  
Control Group ◽  
Peripheral Vascular

The present study describes a clinical trial in which Spanish patients suffering from peripheral vascular disease (Fontaine stage II) were given specific lipid supplements. Designed as a longitudinal intervention study, patients were provided with olive oil for 3 months, followed by a 3 month wash-out period, then supplemented with a combination of fish oil and olive oil for the final 3 months. Changes in plasma and lipoprotein fatty acid composition and susceptibility of LDL toin vitrooxidation were examined. Furthermore, lipid-supplement-induced changes in LDL properties were measured as relative electrophoretic mobility and macrophage uptake. In addition, thirteen patients not provided with olive oil and fish oil were included as a control group and twenty healthy age-matched individuals were used as a reference group. A complete clinical study and a nutritional survey concerning food habits and lifestyle were performed every 3 months. Yao indices and claudicometry did not change significantly with dietary intervention although changes in plasma lipid composition suggested an improvement in the condition of the patients. The intake of the fish-oil supplement resulted in significantly increased plasma levels of eicosapentaenoic acid (20:5n−3) and docosahexaenoic acid (22:6n−3) in comparison with baseline concentrations, olive-oil and control groups. Fish-oil consumption significantly decreased plasma triacylglycerol levels compared with the olive-oil period, control and reference groups. The susceptibility of LDL to Cu-mediated oxidation was lower in the patients consuming olive oil and the fish-oil supplement than in the control group, and the uptake of LDL by macrophages was significantly lower in the group supplemented with fish oil. In conclusion, consumption of olive oil together with a dietary supplement of fish oil may be useful in the nutritional management of patients suffering from peripheral vascular disease in terms of increasing plasman−3 long-chain polyunsaturated fatty acids and decreasing susceptibility of LDL to oxidation.

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