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Awasthi A, Singh SK, Kumar B, Gulati M, Kumar R, Wadhwa S, Khursheed R, Corrie L, Kr A, Kumar R, Patni P, Kaur J, Vishwas S, Yadav A. Treatment Strategies Against Diabetic Foot Ulcer: Success so Far and the Road Ahead. Curr Diabetes Rev 2021; 17:421-436. [PMID: 33143613 DOI: 10.2174/1573399816999201102125537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is one of the leading complications of type-2 diabetes mellitus. It is associated with neuropathy and peripheral arterial disease of the lower limb in patients with diabetes. There are four stages of wound healing, namely hemostasis phase, inflammatory phase, proliferative phase and maturation phase. In the case of DFU, all these stages are disturbed which lead to delay in healing and consequently to lower limb amputation. Conventional dosage forms like tablets, creams, ointments, gels and capsules have been used for the treatment of diabetic foot ulcer for many years. INTRODUCTION In this review, the global prevalence as well as etiopathogenesis related to diabetic foot ulcer have been discussed. The potential role of various synthetic and herbal drugs, as well as their conventional dosage forms in the effective management of DFU have been discussed in detail. METHODS Structured search of bibliographic databases from previously published peer-reviewed research papers was explored and data has been represented in terms of various approaches that are used for the treatment of DFU. RESULTS About 148 papers, including both research and review articles, were included in this review to produce a comprehensive as well as a readily understandable article. A series of herbal and synthetic drugs have been discussed along with their current status of treatment in terms of dose and mechanism of action. CONCLUSION DFU has become one of the most common complications in patients having diabetes for more than ten years. Hence, understanding the root cause and its successful treatment is a big challenge because it depends upon multiple factors such as the judicious selection of drugs as well as proper control of blood sugar level. Most of the drugs that have been used so far either belong to the category of antibiotics, antihyperglycaemic or they have been repositioned. In clinical practice, much focus has been given to dressings that have been used to cover the ulcer. The complete treatment of DFU is still a farfetched dream to be achieved and it is expected that combination therapy of herbal and synthetic drugs with multiple treatment pathways could be able to offer better management of DFU.
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Affiliation(s)
- Ankit Awasthi
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Bimlesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Monica Gulati
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sheetu Wadhwa
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rubiya Khursheed
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Leander Corrie
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Arya Kr
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Rajan Kumar
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Pooja Patni
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Jaskiran Kaur
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Sukriti Vishwas
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
| | - Ankit Yadav
- School of Pharmaceutical Sciences, Lovely Professional University Phagwara, 144411, Punjab, India
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Ruszkowski P, Masajtis-Zagajewska A, Nowicki M. Effects of combined statin and ACE inhibitor therapy on endothelial function and blood pressure in essential hypertension - a randomised double-blind, placebo controlled crossover study. J Renin Angiotensin Aldosterone Syst 2020; 20:1470320319868890. [PMID: 31486700 PMCID: PMC6728690 DOI: 10.1177/1470320319868890] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: The aim of this study was to compare the influence of
3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors on endothelial
function and blood pressure in patients with essential hypertension on
long-term angiotensin-converting enzyme inhibitor therapy. Method: The study was designed as a prospective, double-blind, randomised, placebo
controlled, crossover clinical trial. Twenty patients with essential
hypertension were treated with an angiotensin-converting enzyme inhibitor;
the control group included 10 healthy subjects. Hypertensive patients
received in random order 80 mg of fluvastatin daily or placebo for 6 weeks.
The following parameters were assessed at baseline and after each treatment
period: serum lipids, flow-mediated vasodilation, activity of von Willebrand
factor, concentration of vascular endothelial growth factor, C-reactive
protein and 24-hour blood pressure profile. Results: Hypertensive patients did not differ from healthy subjects with respect to
age, body mass and biochemical parameters, with the exception of C-reactive
protein, which was higher in hypertensive patients
(P=0.02). After statin therapy, low-density lipoprotein
cholesterol (P<0.0001), C-reactive protein
(P=0.03), von Willebrand factor
(P=0.03) and vascular endothelial growth factor
(P<0.01) decreased and flow-mediated vasodilation
improved (P<0.001). Statins had no significant effect on
blood pressure. Conclusions: Statins added to angiotensin-converting enzyme inhibitors may improve
endothelial function and ameliorate inflammation independently of blood
pressure.
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Affiliation(s)
- Piotr Ruszkowski
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
| | - Anna Masajtis-Zagajewska
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
| | - Michał Nowicki
- Department of Nephrology, Hypertension and Kidney Transplantation, Medical University of Lodz, Poland
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Parvin A, Yaghmaei P, Noureddini M, Haeri Roohani SA, Aminzadeh S. Comparative effects of quercetin and hydroalcoholic extract of Otostegia persica boiss with atorvastatin on atherosclerosis complication in male wistar rats. Food Sci Nutr 2019; 7:2875-2887. [PMID: 31572581 PMCID: PMC6766565 DOI: 10.1002/fsn3.1136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/12/2022] Open
Abstract
The use of herbal remedies is significantly considered in the atherosclerosis treatment, reduction of fatty elements, and prevention of activity of oxidative stress factors. The present study was conducted on 48 rats in 6 groups. The experimental and sham groups were fed with 2% cholesterol for 40 days; and experimental groups were separately treated by atorvastatin, quercetin, and hydroalcoholic extract for 4 weeks. After treatment procedure, some serum factors such as low-density lipoprotein (LDL), total cholesterol (TC), malondialdehyde (MDA), and reactive oxygen species (ROS) were evaluated. Serum levels of LDL, TC, MDA, and ROS were significantly lower in experimental groups than sham group (p < .01). There was a significant decrease in serum MDA levels of these two groups in comparison with the atorvastatin-treated group (p < .05). Blood pressure parameters were decreased in treated with quercetin and hydroalcoholic extract in comparison with the sham group (p < .05). Quercetin and hydroalcoholic extract similar to atorvastatin could decrease serum lipids [except high-density lipoprotein (HDL)], oxidative stress factors, aorta contraction, weight gain, and blood pressure. These reagents improved the vascular structure and prevented the plaque formation.
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Affiliation(s)
- Ali Parvin
- Department of Biology, Science and Research BranchIslamic Azad UniversityTehranIran
| | - Parichehreh Yaghmaei
- Department of Biology, Science and Research BranchIslamic Azad UniversityTehranIran
| | - Mehdi Noureddini
- Physiology Research CenterKashan University of Medical SciencesKashanIran
- Gametogenesis Research CeneterKashan University of Medical SciencesKashanIran
| | | | - Saeed Aminzadeh
- Bioprocess Engineering Research GroupNational Institute of Genetic Engineering and BiotechnologyTehranIran
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Li H, Lin YL, Diao SL, Ma BX, Liu XL. Does short preoperative statin therapy prevent infectious complications in adults undergoing cardiac or non-cardiac surgery? A meta-analysis of 5 randomized placebo-controlled trials. Saudi Med J 2017; 37:492-7. [PMID: 27146610 PMCID: PMC4880647 DOI: 10.15537/smj.2016.5.13733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objectives: To evaluate the effect of preoperative statin therapy on the incidence of postoperative infection. Methods: This systematic review of the literature was carried out in August 2015. Studies were retrieved via PubMed, Embase, and the Cochrane Library (1980 to 2015), and the reference files were limited to English-language articles. We used a standardized protocol, and a meta-analysis was performed for data abstraction. Results: Five studies comprising 1,362 patients qualified for the analysis. The incidence of postoperative infections in the statin group (1.1%) was not significantly lower than that in the placebo group (2.4%), with a risk ratio (RR) of 0.56 (95% confidence interval [CI] 0.24-1.33, p=0.19). Patients of 3 studies underwent cardiac surgery. The aggregated results of these studies failed to show significant differences in postoperative infection when a fixed effects model was used (RR: 0.39; 95% CI: 0.08-1.97, p=0.26]. Conclusions: We failed to find sufficient evidence to support the association between statin use and postoperative infectious complications. The absence of any evidence for a beneficial effect in available randomized trials reduces the likelihood of a causal effect as reported in observational studies.
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Affiliation(s)
- Hua Li
- Department of Cardiology, Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong Province, China. E-mail.
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