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.

Bio-mediated Synthesis of Silver Nanoparticles Using Fruit Extract of Ananas Comosus L. Merrill (Pineapple)

Silver is an agent used for different wounds and ulcer treatment as it is nontoxic. However, silver in an ionic or Nanoparticles form is highly toxic to microorganisms. Hence, silver Nanoparticles has wide range of applications than silver ion. Over the physical and chemical methods green synthesis is eco-friendly and cost effective. The present study reveals the formation of silver Nanoparticles by using the fruit extract (Ananas Comosus) by observing the colour change. The produced nanoparticles are characterized by the physicochemical techniques, X-ray diffraction, UV-Visible and antimicrobial activity. The diffraction peaks attributed to 2θ values of 38.11˚ and 44.27˚ (111, 200) reveals the formation of silver nanoparticles. UV-Vis spectrophotometer shows Surface Plasmon resonance (SPR) at 459 nm. The antibacterial studies promise the formation of silver nanoparticle with the ability to inhibit growth of Escherichia coli.

Investigating The Lived Experience of People With Diabetic Foot Ulcers Receiving Podiatry Care in a Tertiary Hospital Clinic

Background: Diabetic foot ulcers can have physical, social, emotional, and financial impacts on the daily life and wellbeing of many people living with diabetes. Effective treatment of diabetic foot ulcers requires a multi-faceted, multi-disciplinary approach involving a podiatrist, other healthcare professionals, and the person with diabetes however, limited research has been conducted on the lived experience of managing a diabetic foot ulcer with podiatry treatment. Therefore, this study aimed to explore the lived experience of receiving podiatric treatment for diabetic foot ulcers in a tertiary care outpatient setting. Methods: Participants with diabetic foot ulcers were purposively recruited from the outpatient podiatry clinic at a tertiary hospital in a metropolitan region of South Australia. Semi-structured interviews were conducted to gain insight into the lived experience of people receiving podiatric treatment for their foot ulcer. Data were analysed using Interpretative Phenomenological Analysis method. Results: Ten participants were interviewed. All were male, with mean age of 69 (SD 15) years and currently undergoing podiatric treatment for a diabetic foot ulcer in a tertiary care setting. Four themes were identified that provide an understanding of the lived experience of participants: ‘Trusting the podiatrists with the right expertise’, ‘Personalised information’, ‘Happy with the service, not the equipment’, and ‘It’s a long journey’. Participants perceived professional behaviour and demonstrated expertise as key to trusting a podiatrist’s care. Information tailored to individual needs was helpful for participants. Offloading devices and ulcer dressings were often burdensome. Podiatric treatment for foot ulcers was a lengthy and onerous experience for all participants. Conclusions: The findings of this study suggest podiatrists can use practical strategies of maintaining consistency in who provides podiatry care for the person, demonstration of high organisational and hygiene standards, and using innovation to adapt information and equipment to suit an individual’s lifestyle to support positive experiences of podiatric ulcer care. There is a need for further research to understand how a person’s experience of podiatric ulcer treatment differs between genders and healthcare settings to facilitate positive care experiences and reduce treatment burden for all people with diabetes requiring podiatric ulcer treatment.

Exploring the Medication Pattern of Chinese Medicine for Peptic Ulcer Based on Data Mining

During the last decades, Chinese medicine has been widely used for curing various diseases in the healthcare domain. Based on the databases of medicine wisdom and modern application of prescriptions, we have explored the medication pattern of ancient and modern prescriptions for the treatment of peptic ulcer in various patients. In this paper, we have proposed a neural network model which is based on the time series decomposition and is able to mine and predict the medication pattern of peptic ulcer treatment in Chinese medicine. For this purpose, cumulative distance level method, Mann–Kendall trend analysis, Hurst exponent, and characteristic point methods are used for the trend analysis. Likewise in the proposed model, the wavelet analysis method is used for the periodicity analysis and Mann–Kendall mutation test method along with Pettitt methods is used for mutability analysis. In addition, autocorrelation and unit root methods are utilized to test the random terms. The Chinese herbal formulas (where the main diseases are peptic ulcer, peptic ulcer, cerebral leakage, and cerebral abscess) are collected from the databases of medicine wisdom and modern application of prescriptions. Furthermore, methods of frequency analysis, association rule analysis, and factor analysis are used to evaluate the grouping pattern of prescriptions for peptic ulcer treatment. The error in the proposed scheme between the predicted and the measured values of 87 prescriptions, which involve five Chinese medicines for peptic ulcer and 160 Chinese medicines, obtained from the neural network was 16.79%.

Gastroprotection and mucus stimulation by vitamin D3 in pyloric ligation and Indomethacin-induced gastric ulcers rats models

The effect of vitamin D3 (VD3) on gastric ulcers was investigated by evaluating ulcer index, biochemical aggressive, and protective factors. Rats were divided into 4 groups; untreated indomethacin ulcer, VD3 pre-treated + indomethacin ulcer, untreated pyloric-ligation ulcer and VD3 pre-treated + pyloric-ligation ulcer. Treatment with VD3 (400 IU/kg intramuscular) was done daily for 6 days and an hour before ulcers induction. Four hours post-induction, the blood sample was obtained for the determinations of 1,25-dihydroxy vitamin D (1,25-DHCC), Parathyroid Hormone (PTH), and Calcium (Ca). Laparotomy was performed and the stomach was harvested for gastric acidity, ulcer index, and biochemical evaluations. The data were analyzed using statistical tools and the “student t-test” was performed at p<0.05. VD3 pre-treatmment caused an increase in serum levels of 1,25-DHCC, has no significant effect on PTH and Ca levels but decreased gastric acidity and ulcer index (p<0.05) with protective ratios of 42.11% and 60.00% against indomethacin and pyloric-ligation ulcers respectively. Pretreatment resulted in decreased gastric MDA, increased gastric protein, mucin, and nitric oxide levels. Gastric protection by VD3 was through oxidative stress inhibition and stimulation of mucus and blood flow against indomethacin and pyloric ligation gastric damage.

Ellagic Acid (EA), a Tannin Was Isolated From Eucalyptus Citriodora Leaves and Its Anti-Inflammatory Activity

A tannin, EA ( 1 ), and other nine non-tannins compounds, gallic acid ( 2 ), quercetin ( 3 ), myricetin ( 4 ), 3-O-methylellagic acid 4'-O-α-L-rhamnopyranoside ( 5 ), quercetin-3-O-β-D-galactopyranoside ( 6 ), kaempferol-3-O-β-D-glucoside ( 7 ), quercetin 3-O-β-D-glucuronide ( 8 ), quercetin-3-O-rutinoside ( 9 ), 3,3',4-tri-O-methylellagic acid-4'-O-β-D-glucopyranosyl ( 10 ) were isolated from a valuable medicinal plant, Eucalyptus citriodora . Structural identification of these compounds was conducted using 1 H NMR and 13 C NMR spectroscopy and comparing their spectral data with those previously reported in literatures. The anti-inflammatory effects of EA were evaluated in ethanol-induced acute gastric ulcer mice models in our study. The result demonstrated that the intragastric administration of EA significantly prevented the gastric ulceration caused by ethanol treatments. Especially, the gastric tissue in the middle dose EA (100 mg/kg) showed few ulcerations with only slight focal congestion which indicated that it has a significant protective effect on gastric ulcer by increasing the IL-10 and PGE 2 levels, and reducing the IL-6, TNF-α, GAS and COX-2 levels. In addition, the middle-dose EA has no adverse effect on liver and kidney. These findings imply that EA exerts gastroprotective effects by means of its anti-inflammatory effects and may be a potential drug for anti-ulcer treatment.

First known case of successful pressure ulcer treatment in a lung transplant patient with post-COVID-19 pneumonia

Given the current COVID-19 crisis, multiple clinical manifestations and related complications of COVID-19 disease, especially in lung transplant patients following post-COVID-19 pneumonia, are a major challenge. Herein, we report the therapeutic course of the first reported case of sacrococcyx pressure ulcers (PU) in a 65-year-old male COVID-19 patient who underwent lung transplantation and developed a PU following surgery. We used a combination of regulated negative pressure-assisted wound therapy system (RNPT, six treatment courses, five days per treatment course), a skin tension-relief system (an intraoperative aid in minimising wounds caused by sacrococcygeal PUs) and a gluteus maximus myocutaneous flap to repair sacrococcygeal wounds. This successfully treated case provides a reference point for the treatment of similar cases.

Patient Explanation of Adherence and Non-Adherence to Venous Leg Ulcer Treatment: A Qualitative Study

The aim of this study was to understand which factors influence patients’ adherence to venous leg ulcer treatment recommendations in primary care. We adopted a qualitative study design, conducting phone interviews with 31 people with venous leg ulcers in Melbourne, Australia. We conducted 31 semi-structured phone interviews between October and December 2019 with patients with clinically diagnosed venous leg ulcers. Participants recruited to the Aspirin in Venous Leg Ulcer Randomized Control Trial and Cohort study were invited to participate in a qualitative study, which was nested under this trial. We applied the Theoretical Domains Framework to guide the data analysis. The following factors influenced patients’ adherence to venous leg ulcer treatment: understanding the management plan and rationale behind treatment (Knowledge Domain); compression-related body image issues (Social Influences); understanding consequences of not wearing compression (Beliefs about Consequences); feeling overwhelmed because it’s not getting better (Emotions); hot weather and discomfort when wearing compression (Environmental Context and Resources); cost of compression (Environmental Context and Resources); ability to wear compression (Beliefs about Capabilities); patience and persistence (Behavioral Regulation); and remembering self-care instructions (Memory, Attention and Decision Making). The Theoretical Domains Framework was useful for identifying factors that influence patients’ adherence to treatment recommendations for venous leg ulcers management. These factors may inform development of novel interventions to optimize shared decision making and self-care to improve healing outcomes. The findings from this article will be relevant to clinicians involved in management of patients with venous leg ulcers, as their support is crucial to patients’ treatment adherence. Consultation with patients about VLU treatment adherence is an opportunity for clinical practice to be targeted and collaborative. This process may inform guideline development.

Study of Development problems dynamics of Ukrainian market of stomach ulcer treatment drugs

This article presents the analysis results of Ukrainian pharmaceutical market segment of stomach ulcer treatment drugs. It was determined that, judging by the quantitative indexes, Ukrainian market of anti-ulcer medication is an actively developing structure that maintains the stability of its development qualitative characteristics nonetheless. For example, during two years (01 June 2016 – 01 June 2018) the quantities of medicinal products and companies that represent these products in Ukraine have both grown: from 396 to 448 names (13.13%) and from 90 companies (25 of them Ukrainian) to 98 (28, correspondingly). On the background of quantity growth of Ukrainian-made drugs from 84 (2016) to 92 (2018), the specified market segment has shown significant dependency on import. For example, the proportion (%) of foreign production drugs has grown from 78.79% (2016) to 79.46% (2018). KRKA is an uncontested leader by the quantity of marketed medicinal products (2016 – 28 products, 2018 – 32 products). The products of Takeda Pharmaceutical Company Limited are presented in the second place (22 and 23 products, corresponding to the years under study). The products of Dr. Reddy's Laboratories take the third place (20 and 21 products, corresponding to the years under study). The said pharmaceutical market segment has kept its monopolistic pattern of distribution as judged by the manufacturing companies whose products are presented in Ukraine, and by international non-proprietary names of products and their pharmacotherapeutic groups. For example, just 8 foreign manufacturing companies were responsible for 40.17% (2016) and 31.92% (2018) of imported assortment of anti-ulcer drugs, and 7 domestic companies were responsible for 64.29% (2016) and 61.54% (2018) of domestic assortment of these drugs. In 2016 75.76% and in 2018 – 71.65% of the whole assortment of anti-ulcer drugs were presented by the drugs from the following groups: A02B-Drugs for peptic ulcer and gastro-oesophageal reflux disease (Gord), A02BC Proton pump inhibitors (55.30% and 50.22%, corresponding to the years under study). Five drugs (A02BC02-Pantoprazole, A02BC01-Omeprazole, A02BC05-Esomeprazole, A02BC03-Lansoprazole, A02BD Combinations for eradication of Helicobacter pylori) presented more than a half of marketed assortment of anti-ulcer products (2016 – 56.57%, and 2018 – 55.14%). Tableted dosage forms (2016 – 58.33%, and 2018 – 55.80%) and drugs of synthetic origin (2016 – 76.26%, and 2018 – 78.13%) have kept their leading positions on the market. Authors have discovered that during 2015-2018 the average retail prices of anti-ulcer drugs have shown the trend of systematic growth. The highest growth of average retail prices was observed for A02BX13-Alginic acid ( avg.=1.37), and the lowest ‒ for A02BC06-Dexlansoprazole ( avg.=1.04). The given above characteristics of the market segment that was studied allow us to state the need to develop and establish the national program of import substitution for the assortment of anti-ulcer drugs in Ukraine.