Topical Treatment with Bergamot Flavonoid-Based Gel in Post-Surgical Wounds after Hemorrhoidectomy: Preliminary Results

Background: Haemorrhoidal Disease (HD) is a very diffuse anorectal condition that involves a large part of the population, both male and female of every age. Among the several procedures proposed to treat HD, conventional excisional surgery remains one of the most performed, it is characterized by important post-operative pain whose historical knowledge often scare the patients. The pain is mainly related to the anal wounds and the healing speed surely influence the post-operative course. The aim of this study was to evaluate the effect of using Benebeo Gel® on post-operative wound healing after open haemorrhoidectomy. Methods and Results: This was an observational prospective study conducted in the Proctological and Pelvic Floor Clinical Centre (PPFCC) of the University Hospital of Pisa. From April 2019 to January 2020 all the 175 patients aged between 18 and 75 undergone to open hemorrhoidectomy were enrolled. The post-operative follow-up was scheduled as follows: 7 day, 15 day, 22 days and 30 days after surgery. The primary end point was: time taken to get complete wound healing with a re-epithelized tissue. Secondary endpoints were: evaluate post-operative pain using VAS scale, bleeding, discharge and overall patients satisfaction about the procedure and the topical gel. All the patients were instructed to take topical gel by using the cannula provided with the product put it into the finger phalanx and then upon injured area twice a day (once in the morning after defecation and once before sleeping) for 25 days after. The administration of the product begins in 4th post-operative day. The mean post-operative pain at 7 days was 6±2, at 15 days 4±1 at 22 day 3 and at 30 days was 2±1. The mean time to get complete wound healing was 23±4 days. Conclusions: He present study aimed to evaluate the efficacy of a new topical gel mainly composed by bergamot-derived flavonoids and hyaluronic acid in patients treated with excisional hemorrhoidectomy. The results after 2 weeks of treatment seems to be promising with a very good clinical outcome and patient satisfaction within 1 month.

Chronic Paronychia of Great Toe Treated with Excision of Nail Plate along with Surrounding Tissue and Split Thickness Skin Graft: An Observational Prospective Study

Paronychia is an inflammatory condition of alongside of nail of toe or finger. It is seen commonly in housewives and housemaids. Paronychia may be acute or chronic. Majority of patients with acute paronychia respond well to nonsurgical treatment. Patients with chronic paronychia of great toe do not respond to nonsurgical treatment. Patients suffer from chronic pain in finger or toe. Many treatment methods are available for chronic paronychia of great toe. All have merits, demerits, and different outcomes. This study is conducted to find out the outcome of a modified surgical technique in chronic paronychia of great toe of patients. This is a method adopted with a little modification of existing method.This study was conducted among 50 patients of chronic paronychia of great toe, who were between 15 to 55 years of age, from December 2019 to December 2020. These patients were operated and kept on follow-up for 1 year and observed for different outcomes likes skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease. Clinical data was recorded in case record form by examining the patient, asking questions to them, and conducting descriptive analysis. Results in terms of skin graft take off, complete wound healing of operated area, relief from chronic pain of great toe, acceptance of cosmetic appearance, and recurrence of disease were assessed during follow-up period. Postoperative result showed that 98% of patients had complete wound healing and complete graft take up, acceptance of cosmetic appearance was 94%, recurrence was 2%, and 90% were relieved from chronic pain of disease great toe. It was concluded that this was a better method for treatment of chronic paronychia of great toe.

Efficacy and Safety of Pentoxifylline for Venous Leg Ulcers: An Updated Meta-Analysis

The venous leg ulcers are debilitating, painful, and often unresponsive to advanced dressing treatments, so drugs used locally and systematically are essential adjuvant therapy—pentoxifylline (PTX) whose anti-inflammatory effects may offer a promising avenue to treat venous leg ulcers. However, the current results are controversial. To further evaluate the efficacy and safety of PTX, we performed an updated meta-analysis of randomized placebo-controlled trials of PTX in the treatment of venous leg ulcers. We systematically searched multiple electronic databases PubMed, Web of Science, Embase, the Cochrane Library, the Cochrane Central Register of Controlled Trials, China Science and Technology Journal Database, WanFang Data, China National Knowledge Infrastructure, and the Chinese Biomedical Literature Database to identify eligible studies. Randomized clinical trials of pentoxifylline versus placebo treatment in patients with venous leg ulcers were considered for inclusion. The primary outcomes included ulcer healing rate and the incidence of adverse events after treatment. The secondary outcomes were the ulcer significant improvement (the ulcer size shrank by more than 60% after treatment) rate, mean duration of complete wound healing and changes in mean ulcer size. A meta-analysis and qualitative analysis were conducted to estimate endpoints. A total of 13 randomized clinical trials, including 921 individuals, were finally included. Compared with placebo, pentoxifylline significantly improved the ulcer healing rate (RR = 1.59, 95%CI 1.22 to 2.07, P < .001) and significant improvement rate (RR = 2.36, 95%CI 1.31 to 4.24, P = .004) while increased the incidence of gastrointestinal disturbances (RR = 2.29, 95%CI 1.04 to 5.03, P = .04) at the same time. Moreover, pentoxifylline also shortened mean duration of complete wound healing ( P = .007) and shrank ulcer size ( P = .02). Currently available evidence suggests that pentoxifylline could help venous leg ulcers heal more quickly and effectively. However, the evidence is insufficient to prove the results due to moderate-certainty evidence. Large-scale, well-designed randomized clinical trials are warranted.

Hyperbaric oxygen treatment for University of Texas grade 3 diabetic foot ulcers: a retrospective cohort study

Aim: Hard-to-heal diabetic foot ulcers (DFUs) may increase the risk of amputation. This study reports the positive influence of hyperbaric oxygen therapy (HBOT) on hard-to-heal DFUs involving underlying bone. Method: A single-centre, retrospective cohort study reporting the results of HBOT and wound care on hard-to-heal University of Texas grade 3 DFUs (i.e., involving underlying bone) between 2013 and 2019. Outcome measures were primarily (near-) complete wound healing (i.e., ≥80% ulcer surface area reduction) and amputation rate (minor or major), and secondarily the number of hyperbaric sessions and improvement in quality of life (QoL) and pain score. Results: The study included 206 patients, of whom 74 (36%) achieved complete wound healing, and 75 (36%) near-complete healing. Amputations were performed in 27 patients (13%): 12 (6%) minor and 15 (7%) major. The median number of HBOT sessions was 42. Participants who achieved complete healing received a median of 43 sessions, compared with 10 for those who required major amputation. Patients with at least 30 sessions were less likely to undergo amputation (odds ratio: 0.08; 95% confidence interval (CI): 0.03–0.21). Mean QoL increased by 7.6 points (95%CI: 3.9–11.3; p<0.01) and median pain score fell from 3 to 1 (0–3) (p<0.01). Conclusions: The addition of HBOT to standard wound care may lead to a decreased amputation risk, improved wound healing and increased QoL for people with a University of Texas grade 3 DFU. An adequate number of HBOT sessions is required to achieve optimal clinical results. Objective selection criteria and shared decision-making are suggested to improve dropout rates.

Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

Clinical effect of Apamarga Kshara Taila and adjuvant drugs in the management of Diabetic wound – A Case Report.

Diabetic foot ulcer is a serious devastating complication of diabetes mellitus (DM) when it involves deep tissues and bone which may require amputations. In this case report a 70 year old male patient presented with non healing ulcer of sized (3.5 *3.2) cm2 at dorsum of the left foot since last 4 years. The ulcer was on the dorsum having most movable part in daily activity so it was reluctant to meal by all means of conventional management. So patient consultant to Ayurveda OPD and he was treated with local dressing of Apamarga Kshara Taila till wound healing for 50days. Along with local dressing patient prescribed with Haritaki Churna 5gm at night with luke warm water and Punarnavashtak Kwatha 40ml twice in a day on empty stomach for 50 days. Inj. wosulin 12 units thrice in day and Inj. basalog 14 units at nigh were continued simultaneously as prescribed by diabetologist during the treatment. Complete wound healing was achieved within 50days with unit healing time 4.46 day/cm2. This single case report showed wound healing potential of Ayurvedic medicine in diabetic wound.

Comparison of insulin soaked dressing with the conventional dressing in diabetic ulcers.

Objective: This study aims at demonstrating the benefits of insulin soaked dressing for the treatment and accelerating the healing process of diabetic ulcers thus helping the faster wound healing, reducing morbidity and also decrease the cost of management in patients with diabetic ulcers. Study Design: Randomized Controlled Trial. Setting: Surgical Unit 1, Holy Family Hospital, Rawalpindi Medical University, Rawalpindi. Period: November 2016 to May 2017. Material & Methods: The study was initiated after approval from the institutional research forum of Rawalpindi medical college. Patients fulfilling the selection criteria reporting at surgical unit – I, Holy Family Hospital, Rawalpindi were included in the study. Written informed consent was taken. Random allocation of the study participants to either study group was done by using lottery method, 60 patients were randomly allocated to either group A(insulin soaked dressing) or Group B (conventional dressing), each with 30 patients. Results: In Group A, insulin soaked dressing was applied whereas patients in Group B were applied with conventional dressing. Mean age (years) of patients was 48.04+13.45 whereas there were 32 (53.3) male and 28 (46.7) female patients. In the study, mean duration (day) of complete wound healing in patients with diabetic ulcers receiving insulin soaked dressing and conventional dressing was 39.80 + 8.04 and 47.60+6.52 respectively which was statistically significant (p-value 0.000). Conclusion: The study concluded that in patients with diabetic foot ulcer, average duration of complete wound healing was significantly less in patients with insulin soaked dressing as compared to conventional dressing.

Efficacy of riboflavin/UV-A corneal phototherapy as stand-alone treatment for ulcerative keratitis in horses

The purpose of this study was to assess the efficacy of riboflavin/UV-A corneal phototherapy in comparison with topical antimicrobials for the treatment of corneal ulcers in horses. Nineteen horses with a diagnosis of corneal ulceration were randomised to receive either corneal phototherapy (11 horses) or topical antimicrobial therapy (8 horses). The corneal phototherapy consisted in the application of a riboflavin-enriched ophthalmic solution onto the cornea for 20 min followed by cornea UV-A irradiation at 30 mW/cm² for 3 min using a point-of-care UV-A device. A complete ophthalmological examination was performed at enrolment and then at day 1, 3, 7, 14, 21, 28, 35, 42, and 49 after treatment. The corneal ulcer was considered healed when the fluorescein staining was negative. The corneal phototherapy succeeded in the complete corneal wound healing in 91% cases (10/11 horses) by 12.7 ± 5.5 days. In the topical antimicrobial group, no horse showed improvement of the corneal ulceration (0/8; 0%) and two eyes had a corneal perforation. Six horses, due to an enlarged corneal lesion, underwent corneal phototherapy at day 14 and achieved complete wound healing by 17.2 ± 5.5 days in 83% cases (5/6). The corneal phototherapy was shown to be an effective and safe treatment for equine corneal ulcers.

COMPARISON OF QUALITY OF LIFE AND EFFECTIVENESS OF LIMBERG FLAP VERSUS LAY OPEN IN SACROCOCCYGEAL PILONIDAL SINUS TREATMENT: A PROSPECTIVE CLINICAL STUDY.

Aim:to compare the quality of life and effectiveness of limberg ap vs lay open in sacrococcygeal pilonidal sinus treatment. Methods: This randomized prospective study was carried out in the Government Hospital Sarwal, Jammu, India among 30 patients. Patients were randomized into two groups; group Awith 15 patients was undergone wide local excision followed by limberg ap primary closure while the other group B with 15 patients was undergone wide local excision followed by Lay open ap (healing by Post operatively assessment of healing time and quality of life at 4 and 8 weeks was done.). Results: Mean age of the subject of the limberg ap group and lay open group was 22.42 years and 22.38 years respectively. 90% of the patient's (27 patients) of the present study were males. In limberg ap group 53.3% patient achieved complete wound healing around 20-30 days while in lay open group 60.0% patient achieved complete wound healing around 51-60 days post operatively Conclusions:Excision with primary closure is a better modality than excision with lay open technique in treatment of pilonidal sinus