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

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.

KAJIAN LITERATUR: PERBANDINGAN EFEKTIVITAS TEKNIK WET TO DRY DRESSING DAN TEKNIK MOIST DRESSING PADA ULKUS DIABETIK [LITERATURE REVIEW: COMPARISON OF THE EFFECTIVENESS OF THE WET TO DRY DRESSING TECHNIQUE AND THE MOIST DRESSING TECHNIQUE IN DIABETIC ULCUS]

<p><em>Diabetes Mellitus is a metabolic disorder characterized by hyperglycemia. The most common complication of DM is diabetic neuropathy which causes an increase in further complications, including diabetic ulcers and often leads to amputation. In Indonesia, about 15% of DM patients have diabetic ulcers, 30% have a risk of amputation and 32% mortality. There are several types of wound care techniques, but the most used are the wet to dry and moist techniques. This study aims to compare the effectiveness of diabetic ulcer treatment with wet to dry and moist techniques. The research method used is thematic analysis: a simplified approach, by searching for articles using the Google Scholar database, EBSCO, Science Direct, JSTOR. The data selection process uses the PRISMA Flow Diagram and the JBI Critical Appraisal Checklist. The keywords used were "Wet to dry dressing AND moist dressing AND diabetic ulcer stage III", and "wet to dry dressing AND moist dressing AND grade III diabetic ulcer". The results showed that the moist wound dressing technique was more effective than wet to dry dressing in the treatment of diabetic ulcers, in terms of cost, dressing change, absorbency, basic ingredients and ingredients, pain caused and duration of wound healing. This study recommends that future researchers can conduct quantitative research on diabetic ulcer patients using both treatment techniques.</em></p><p><strong><em></em>BAHASA INDONESIA ABSTRAK: </strong>Diabetes Melitus merupakan gangguan metabolik dengan karakteristik hiperglikemia. Komplikasi DM paling umum adalah neuropati diabetik yang menyebabkan peningkatan komplikasi selanjutnya, diantaranya luka ulkus diabetik dan tidak jarang berlanjut pada amputasi. Di Indonesia sekitar 15% penderita DM mengalami ulkus diabetik, 30% memiliki risiko amputasi dan 32% mortalitas. Terdapat beberapa jenis teknik perawatan luka, namun yang paling sering digunakan adalah teknik <em>wet to dry</em> dan <em>moist</em>. Tujuan penelitian untuk membandingkan efektivitas perawatan luka ulkus diabetik dengan teknik <em>wet to dry</em> dan teknik <em>mois</em>t. Metode penelitian yang digunakan yaitu <em>thematic analysis: a simplified approach</em>, dengan pencarian artikel menggunakan database Google Scholar, EBSCO, Science Direct, JSTOR. Proses penyeleksian data menggunakan Flow Diagram PRISMA dan JBI <em>Critical Appraisal Checklist</em>. Kata kunci yang digunakan yaitu “<em>Wet to dry dressing AND moist dressing AND diabetic ulcer stage III</em>”, dan “balutan basah ke kering <em>AND</em> balutan lembab <em>AND</em> ulkus diabetik derajat III”. Hasil penelitian menunjukkan bahwa teknik <em>moist wound dressing</em> lebih efektif dari pada <em>wet to dry dressing</em> dalam perawatan luka ulkus diabetik, dilihat dari biaya, pergantian balutan, kemampuan menyerap, kandungan dan bahan dasar, nyeri yang ditimbulkan dan durasi penyembuhan luka. Penelitian ini merekomendasikan peneliti selanjutnya dapat melakukan penelitian kuantitatif pada pasien ulkus diabetik yang menggunakan kedua teknik perawatan.</p>

The Effect Of Wound Care With Palm Sugar On Diabetic Ulcer Repairing In Type 2 Diabetes Patients

Diabetic ulcers are one of the most common complications of type 2 diabetes mellitus. Diabetic ulcers are infected sores that develop in the lower extremities. Proper diabetic foot wound care methods will improve wound healing. One of the efforts to treat the complement to prevent infection is wound care with palm sugar. Palm sugar contains antibiotic-like substances such as vitamin C, riboflavin, vitamin A, and ascorbic acid. Dr. Slamet Garut's study aims to determine the effectiveness of wound care with palm sugar media against the repair of diabetic ulcers in patients with type 2 diabetes mellitus after hospitalization in 2021. The study used a quasi experimental research design with one group pretest and posttest design (Pre-action) and one group of subjects receiving palm sugar therapy on diabetic ulcer wounds (Post-action). The researcher used consecutive sampling techniques, samples that met the inclusion criteria could have 8 people. The wounds were treated with palm sugar for two weeks. The findings revealed that wound care with palm sugar had an effect on the repair of diabetic ulcers in patients with type 2 diabetes mellitus, with a Pvalue = 0.000. Then it is possible to conclude that treating wounds with palm sugar affects the improvement of diabetic ulcers.

Nutritional status of patients referred for hyperbaric oxygen treatment; a retrospective and descriptive cross-sectional study

Introduction: Due to the global rise of obesity, the role of nutrition has gathered more attention. Paradoxically, even overweight persons may be malnourished. This may delay wound healing or recovery of late radiation tissue injury (LRTI). Hyperbaric oxygen treatment (HBOT) is used to improve wound healing or LRTI complaints. The aim of this study was to assess the dietary intake levels of nutrients important for recovery in patients referred for HBOT. Methods: This was a retrospective, cross-sectional study of patients referred for HBOT to a single centre between 2014 and 2019. Patients were offered a consultation with a dietitian as standard care. Information on nutrients was calculated from questionnaires, and compared to recommended daily allowances. Results: One hundred and forty-six patients were included (80 female). Eighteen patients were treated for diabetic ulcers, 25 for non-diabetic ulcers and 103 for LRTI. Most were overweight or obese (64.4%), but did not consume the recommended quantities of calories, protein, or micronutrients. Vitamin C consumption was higher than recommended. Male patients had a higher intake of calories and protein than female patients but not other nutrients. No differences in intake existed between age or body mass index categories. Conclusions: The nutritional status of patients referred for HBOT may be inadequate for healing wounds or LRTI, despite anthropomorphic data indicating a positive energy balance. Daily attendance for HBOT provides a unique opportunity to monitor and correct these deficiencies. Routine screening for malnutrition and supplement deficiencies is recommended for patients referred for HBOT.

A Comparative Study between the Use of Negative Pressure Wound Therapy and Silver-Releasing Foam Dressings in the Management of Diabetic Ulcers

Introduction Diabetic foot ulcers are one among the most commonly encountered complication of diabetes mellitus tackled by the surgical department worldwide. Negative pressure wound therapy (NPWT) and silver-releasing foam dressings are effective modalities for the treatment of ulcers. This study compares the two treatment modalities. Methods Sixty adult patients admitted with diabetic foot ulcers undergoing NPWT (vacuum-assisted closure [VAC]) or silver-releasing foam dressing (Biatain Ag) treatment were included in the study. Patients undergoing either of the treatment modalities were observed and followed up on a weekly basis prospectively. Wounds were routinely examined for the size of ulcer in area (cm2) and time taken for wound healing. Patients were also assessed qualitatively by means of a questionnaire to find out patient satisfaction and compliance. Results Time taken for wound healing among Biatain Ag group was found to be 24±9.483 days compared with only 19.73±7.575 days in the VAC group. Decrease in size ulcer measured in area was found to be 38.79% in Biatain Ag group, whereas in the VAC group it was found to be 26.56%. Patients were satisfied with both modalities of treatment; however, patient compliance was better for the Biatain Ag Group due to decrease in restriction of mobility and decrease in cost. Conclusion Overall, both modalities of treatment were found to be comparable and can be used with similar efficacy. It can be concluded that silver-releasing foam dressing can act as a beneficial alternative to NPWT in the treatment of diabetic ulcers.

Pelatihan Uji Sentuh Jari Kaki Sebagai Upaya Peningkatan Ketrampilan Kader Kesehatan Dalam Mendeteksi Gangguan Sensasi Kaki

Background: Increased life expectancy will be followed by increasing problems if health care is not carried out properly. Problems will arise, one of which is endocrine system disorders such as diabetes mellitus which has complications. One of the complications of diabetes mellitus is diabetic ulcers on the feet by 7.5% of patients who experience impaired sensation which ultimately have to undergo amputation. This condition can be prevented early, such as by checking the sensation of the feet. This activity aims to increase the role of health cadres in detecting the incidence of neuropathy. Methods: In order to provide knowledge and skills of the toe touch test to 30 health cadres, the method chosen was training supported by guidebooks, videos and demonstrations. Results: There was an increase in the knowledge of cadres in good categories from 13% to 89% between before and after training. Meanwhile, the skills of the cadres showed that all of the training participants were skilled in doing the toe touch test. Conclusion: Improving the knowledge and skills of cadres can be pursued through training by combining the use of manuals, videos and demonstrations.