To Evaluate Antimicrobial Properties of Platelet Rich Plasma and Source of Colonization in Pressure Ulcers in Spinal Injury Patients

Background. Exposure of pressure ulcers (PrUs), particularly to urine and feces, leads to increased colonization of wounds. The aim of the present study was to evaluate the source of microbial colonization and antimicrobial properties of autologous platelet rich plasma (PRP) in controlling it in PrUs. Methods. Twenty-five patients of spinal cord injury (SCI) with at least two PrUs were taken for the study. Local application of autologous PRP on one PrU (case) was compared with saline dressing on the other PrU (control). Urine cultures, urethral meatus, PrUs, and perineal swabs were taken at weekly interval for five weeks. Result. Colonization rate of PrUs (case) decreased from 92% at enrollment to 24% at the 5th week but did not significantly decrease in PrUs (control) from enrollment (84%) to the 5th week (76%). Association between PrU (case) and perineal cultures was observed for Staphylococcus aureus at enrollment 41% (χ2=6.76, P<0.01) and at the 2nd week 47% (χ2=5.83, P<0.05). 47% association between PrU (control) and perineal cultures at enrollment (χ2=4.11, P<0.05) and 29% association at the 2nd week (χ2=8.41, P<0.01) were observed for Staphylococcus aureus. There was association between bacteria present in perineum/urine and those colonizing PrUs. Conclusion. There is a significant association between PrUs colonization and bacteria present in local environment (urine and feces). Local application of autologous PRP changes the “biological milieu” of the PrUs through its antimicrobial properties leading to reduction in bacterial colonization.

Anti-Inflammatory and Gastroprotective Evaluation of Prodrugs of Piroxicam

Therapeutically potential prodrugs of piroxicam were synthesized by effective masking of enolic hydroxyl group through generation of ester congeners. The reaction facilitated using N,N′-dicyclohexylcarbodiimide coupled with acetic acid, benzoic acid, p-toluic acid, m-toluic acid, and cinnamic acid. Synthesized prodrugs were characterized for confirmation of the said structures. The modification of piroxicam showed better anti-inflammatory activity as evoked by all prodrugs. Interestingly, compound 3e, cinnamic acid ester prodrug, depicted 75 percent inhibition of rat paw edema as compared to 56 percent for parent piroxicam at 6 h of study. The present work proves the applicability not only with increased anti-inflammatory activity, but also with marked attenuation in ulcerogenicity. Novel prodrug 3e, cinnamic acid derivative, was found to be the least ulcerogenic having ulcer index of 0.67 as compared to parent drug piroxicam with 2.67.

Herbal Remedy: An Alternate Therapy of Nonsteroidal Anti-Inflammatory Drug Induced Gastric Ulcer Healing

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly used therapeutic drug groups used worldwide for curing an array of health problems like pain, inflammation, cardiovascular complications, and many other diseases, but they may cause different side effects including gastroduodenal disorders. So, there is a growing interest and need to search for nontoxic, antiulcer formulations from medicinal plants to treat NSAIDs induced gastric ulcer. Extensive research has reported on many natural plants like Camellia sinensis, Phyllanthus emblica, Myristica malabarica, Piper betle, Picrorhiza kurroa, and so forth, and their active constituents reduced NSAIDs induced gastric ulcer via their antioxidative as well as immunomodulatory activity. Therefore, use of herbal formulations in daily life may prevent NSAIDs induced gastric ulceration and other side effects.

Giant Prepyloric Ulcer Haemorrhage: Patient Characteristics, Treatment, and Outcome in 2003–2012

The aim of the study was to characterize patients with giant prepyloric ulcer haemorrhage, their treatment, and outcome. The data for 929 peptic ulcer haemorrhage (PUH) patients were divided into three groups according to ulcer location: group I: 165 prepyloric ulcer patients, group II: 353 gastric ulcer patients, and group III: 411 duodenal ulcer patients. Among these groups giant ulcer (ulcer diameter ≥ 2 cm) haemorrhage cases were selected for the study and the data for group I were compared with the data for groups II and III. The study shows that the proportion of giant ulcers in all prepyloric ulcers was significantly 2.2 times lower compared with the proportion of giant ulcers in all gastric ulcers and 1.5 times lower than the proportion of giant ulcers in all duodenal ulcers. The share of surgical therapy for haemorrhages from giant prepyloric ulcers did not differ from the share of surgical therapy in the case of giant gastric ulcers but was 3.5 times lower than in the case of giant duodenal ulcers. Generally, treatment for PUH from giant prepyloric ulcers was successful not involving inhospital mortality.

Urease Inhibitory Activity of Aerial Parts of Artemisia scoparia: Exploration in an In Vitro Study

Artimisia scoparia has been used in the treatment of different disorders including ulcers. The current study was therefore designed to investigate the aerial parts of Artemisia scoparia (crude extract, total sterol and flavonoidal contents, and aqueous fraction) for its urease inhibitory potential. The crude of the plant evoked marked attenuation on urease activity, when tested in various concentrations with IC50 values of 4.06 mg/ml. The inhibitory potential was further augmented in the aqueous fraction (IC50: 2.30 mg/ml) of the plant. When the total sterol and flavonoidal contents were challenged against urease, both showed concentration dependent activity; the latter showed maximum potency with IC50 values of 8.04 and 2.10 mg/ml, respectively. In short, the aerial parts of the plant demonstrated marked antagonism on urease and thus our study validated the traditional use of Artemisia scoparia in the treatment of ulcer.

Antiulcerogenic Activity of 1-Hydroxy-3,7,8-trimethoxyxanthone Isolated from the Methanol Extract of Anthocleista vogelii PLANCH. in Rats

Anthocleista vogelii (Loganiaceae) PLANCH. is used in Cameroonian ethnomedicine for the treatment of stomach ache and for curing fever and is used as purgative. Further investigations have shown that the stem bark of this plant possesses potent antiulcer properties. We have investigated the cytoprotective and antisecretory actions of 1-hydroxy-3,7,8-trimethoxyxanthone (AV), the xanthone obtained from the methanol extract of the stem bark. Oral administration of AV at the doses of 1, 2, and 5 mg/kg prevented in a dose-dependent manner ulcers induced by HCl/ethanol (60.90 to 93.22%), Indometacin (46.86 to 89.68%), and pylorus ligation (0.00 to 70.69%). AV reduced pylorus-ligated gastric acid secretion from 134.17 mEq/l in the controls to 118.55, 121.50, and 96.93 mEq/l, respectively, for the 1, 2, and 5 mg/kg doses and increased mucus secretion significantly in a dose-dependent manner in all experimental models. The cytoprotective and antisecretory properties of AV could thus be due to its ability to strengthen gastric mucosal defences through enhanced gastric mucus production.

Crossectomy and Foam Sclerotherapy of the Great Saphenous Vein versus Stripping of Great Saphenous Vein and Varicectomy in the Treatment of the Legs Ulcers

Objective. To show our results in the surgical treatment of legs varicose ulcers, with crossectomy and foam sclerotherapy (CAFE) of the great saphenous vein (GSV) in group I and stripping of GSV and varicectomy in group II. Methods. 35 patients with active venous leg ulcers were recruited and treated. They were collected in two groups. Group I were treated by crossectomy and foam sclerotherapy of the GSV and group II were treated by stripping of GSV and varicectomy. The healing time of the ulcer and the complications were recorded after the procedure in the follow-up visits. Results. 29 out of the 35 patients completed the follow-up. There were eight cases of incomplete healing of the leg ulcer, 4 in group I (19.04%) and 4 in group II (40%), P<0.05. The average rate of healing in group I was 0.38 cm/day and 0.13 in group II, P<0.05. Conclusion. CAFE technique of the great saphenous vein in the treatment of 6 CEAP patients is a procedure that improves the rate of ulcer healing as compared to these two groups. It is a safe and reliable minimally invasive method, with less morbidity.

Profile, Bacteriology, and Risk Factors for Foot Ulcers among Diabetics in a Tertiary Hospital in Calabar, Nigeria

Diabetic foot disease is a major medical, social, and economic problem. This retrospective study assessed the profile of diabetes mellitus patients with foot ulcers in the University of Calabar Teaching Hospital (UCTH), Nigeria. Admission records of all patients admitted unto the medical wards of UCTH over a 5 year period were analysed. The records of diabetic patients were retrieved. Data on patient characteristics and possible risk factors for diabetes mellitus foot ulcers was extracted. Of the 3,882 patients admitted, 297 (7%) were on account of complications of diabetes mellitus. Foot ulcers accounted for 63 (21.2%) of all diabetic admissions. The elderly constituted the majority of patients admitted with foot ulcers. The average duration of stay of diabetics with foot ulcers was 38.5 days. Diabetics admitted for other conditions had average duration of admission of 15.8 days. Staphylococcus aureus was the commonest organism isolated from swabs of foot ulcers. Most of the organisms identified from ulcer swab cultures were sensitive to quinolones and resistant to penicillins. These diabetic foot ulcers were significantly associated with peripheral sensory neuropathy, peripheral vascular disease, intermittent claudication, and walking barefoot. An effective diabetes foot programme is required to address these risk factors and reverse the current trend.

In Vivo Models Used for Evaluation of Potential Antigastroduodenal Ulcer Agents

Peptic ulcer is among the most serious gastrointestinal diseases in the world. Several orthodox drugs are employed for the treatment of the disease. Although these drugs are effective, they produce many adverse effects thus limiting their use. In recent years, there has been a growing interest in alternative therapies, especially those from plants due to their perceived relative lower side effects, ease of accessibility, and affordability. Plant medicines with ethnomedicinal use in peptic ulcer management need to be screened for their effectiveness and possible isolation of lead compounds. This requires use of appropriate animal models of various ulcers. The limited number of antiulcer models for drug development against gastric and duodenal ulcer studies has hindered the progress of targeted therapy in this field. It is, therefore, necessary to review the literature on experimental models used to screen agents with potential antigastroduodenal ulcer activity and explain their biochemical basis in order to facilitate their use in the development of new preventive and curative antiulcer drugs. Clinical trials can then be carried out on agents/drugs that show promise. In this paper, current in vivo animal models of ulcers and the pathophysiological mechanisms underlying their induction, their limitations, as well as the challenges associated with their use have been discussed.