1
|
Karalilova RV, Batalov ZA, Sapundzhieva TL, Matucci-Cerinic M, Batalov AZ. Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound. Rheumatol Int 2021; 41:1743-1753. [PMID: 34313812 PMCID: PMC8390399 DOI: 10.1007/s00296-021-04956-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by fibrosis of the skin and internal organs, autoimmunity-driven damage and vasculopathy. The current approved disease-modifying treatments have limited efficacy, and treatment is guided toward alleviating organ complications. Thus, there is an unmet need for discovering new effective treatment options. There is recent evidence that the JAK/STAT signaling pathway is markedly activated in SSc patients. To assess the efficacy and safety of tofacitinib (TOF) on skin and musculoskeletal involvement as compared to methotrexate (MTX) in systemic sclerosis (SSc). In this 52-week pilot study, 66 patients with SSc were enrolled: 33 patients received 5 mg of oral TOF twice a day; 33 received 10 mg of MTX weekly. The proportion of dcSSc and lcSSc patients was similar (dcSSc: 42% TOF group and 36% MTX group; lcSSc: 58% TOF group and 64% MTX group). The primary outcome was the change in the modified Rodnan skin score (mRSS). Secondary outcomes included ultrasound (US) skin thickness and musculoskeletal involvement (US10SSc score). Digital ulcers (DUs) and adverse events (AEs) were documented through the treatment. Both groups had similar characteristics and medians on the outcome measures at baseline. At week 52, the TOF median mRSS was significantly lower than the MTX (p < 0.001) with a mean reduction of 13 points versus MTX 2.57. The mean percent improvement in the TOF group was 44% higher than in the MTX group. TOF median US skin thickness was significantly lower than MTX (p < 0.001), with a mean reduction of 0.31 mm versus 0.075 mm in the MTX group. The US10SSc median score was significantly lower in the TOF group (p = 0.002); mean reduction of 10.21 versus 5.27 in the MTX group. Healing of DUs with no new occurrences was observed in the TOF group. There was no significant difference between the groups in the number of AEs from baseline to week 52. TOF showed greater efficacy than MTX in reducing mRSS, skin thickness and musculoskeletal involvement in SSc and a satisfactory safety profile.
Collapse
Affiliation(s)
- Rositsa Valerieva Karalilova
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital “Kaspela”, Plovdiv, Bulgaria
| | - Zguro Anastasov Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital “Kaspela”, Plovdiv, Bulgaria
| | - Tanya Lyubomirova Sapundzhieva
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital “Kaspela”, Plovdiv, Bulgaria
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, University of Florence, Rheumatology Section, Florence, Italy
| | - Anastas Zgurov Batalov
- Department of Internal Diseases, Medical University of Plovdiv, Plovdiv, Bulgaria
- Rheumatology Clinic, University Hospital “Kaspela”, Plovdiv, Bulgaria
| |
Collapse
|
2
|
Wu T, Gao J, Liu W, Cui J, Yang M, Guo W, Wang FY. NLRP3 protects mice from radiation-induced colon and skin damage via attenuating cGAS-STING signaling. Toxicol Appl Pharmacol 2021; 418:115495. [PMID: 33741346 DOI: 10.1016/j.taap.2021.115495] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
In the present study, the effects of NLRP3 on radiation-induced tissue damage, including colon and skin damage in mice, and the possible mechanisms were explored in vivo and in vitro. The mice were subjected to whole abdomen radiation by timed exposure to X-ray at a cumulative dose of 14 Gy. The survival rate showed that NLRP3 deficiency increased the mortality rate in mice. Furthermore, colon damage, evaluated by H&E staining and barrier function analysis, were significantly aggravated by NLRP3 deficiency. Enhanced phosphorylation of p-TBK1 and p-IRF3 in colonic tissue as well as elevated IFN-β levels in the serum indicated hyperactivation of cGAS-STING signaling. Moreover, radiation-induced expression of p-TBK1, p-IRF3, and IFN-β in BMDMs increased in vitro after NLRP3 knockout. Thus, our study outcomes suggest that NLRP3 may protect mice from radiation-induced tissue damage via attenuating cGAS-STING signaling.
Collapse
Affiliation(s)
- Tiancong Wu
- Department of Gastroenterology and Hepatology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, China; Jinling Hospital, Department of Radiation Oncology, Nanjing University, School Medicine, Nanjing 210002, China
| | - Jianhua Gao
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing 210093, China
| | - Wen Liu
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing 210093, China
| | - Jian Cui
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing 210093, China
| | - Miaofang Yang
- Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu Province, China
| | - Wenjie Guo
- State Key Laboratory of Pharmaceutical Biotechnology, School of Life Science, Nanjing University, Nanjing 210093, China.
| | - Fang-Yu Wang
- Department of Gastroenterology and Hepatology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing 210002, China; Department of Gastroenterology and Hepatology, Jinling Hospital, Medical School of Nanjing University, 305 Zhongshan East Road, Nanjing 210002, Jiangsu Province, China.
| |
Collapse
|
3
|
Adderley U. National Wound Care Strategy Programme. Br J Community Nurs 2019; 24:5. [PMID: 31166794 DOI: 10.12968/bjcn.2019.24.sup6.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Una Adderley
- Director, National Wound Care Strategy Programme; Queen's Nurse
| |
Collapse
|
4
|
El-Ela FIA, Farghali AA, Mahmoud RK, Mohamed NA, Moaty SAA. New Approach in Ulcer Prevention and Wound Healing Treatment using Doxycycline and Amoxicillin/LDH Nanocomposites. Sci Rep 2019; 9:6418. [PMID: 31015527 PMCID: PMC6478882 DOI: 10.1038/s41598-019-42842-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/07/2019] [Indexed: 01/24/2023] Open
Abstract
Doxycycline (DOX) and amoxicillin (AMOX) are important Broad-spectrum antibiotics used in treating multiple human and animal diseases. For the sake of exploring novel medical applications, both antibiotics were loaded into magnesium aluminium layer double hydroxide (Mg-Al)/LDH nanocomposite through the co-precipitation method. The synthesized materials were characterized by XRD, FT-IR, particle size analysis, FESEM and HRTEM. Acute toxicological studies were conducted using median lethal dose LD50, where a total number of 98 rats (200-150 gm) of both sexes were used. An experimental wound was aseptically incised on the anterior-dorsal side of each rat, while 98% of pure medical ethanol was used for ulcer induction. Acute toxicity, wound closure rate, healing percentages, ulcer index, protective rate and histopathological studies were investigated. Antibiotic Nanocomposites has significantly prevented ulcer formation and improved wound healing process to take shorter time than that of the typical processes, when compared with that of same drugs in microscale systems or commercial standard drugs. These results were confirmed by the histopathological findings. By converting it into the Nanoform, which is extremely important, especially with commonly used antibiotics, novel pharmacological properties were acquired from the antibiotics. The safe uses of DOX/LDH and AMOX/LDH Nanocomposites in this study were approved for biomedical applications.
Collapse
Affiliation(s)
- Fatma I Abo El-Ela
- Lecturer of Pharmacology, Department of Pharmacology, Faculty of Veterinary Medicine, Beni-Suef University, Beni-Suef, Egypt.
| | - Ahmed A Farghali
- Materials Science and Nanotechnology Department, Faculty of Postgraduate Studies for Sciences, Beni-Suef University, Beni-Suef, Egypt
| | - Rehab K Mahmoud
- Department of Chemistry, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - Nada A Mohamed
- Department of Chemistry, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| | - S A Abdel Moaty
- Materials Science Lab, Department of Chemistry, Faculty of Science, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
5
|
Rees J, Pagnamenta F. A trust-wide skin guideline to reduce incidence of moisture lesions. Br J Nurs 2018; 27:862-864. [PMID: 30089056 DOI: 10.12968/bjon.2018.27.15.862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Jackie Rees
- Nurse Consultant (Continence Care), Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - Fania Pagnamenta
- Nurse Consultant (Tissue Viability), Newcastle upon Tyne Hospitals NHS Foundation Trust
| |
Collapse
|
6
|
Khanna D, Denton CP, Merkel PA, Krieg T, Le Brun FO, Marr A, Papadakis K, Pope J, Matucci-Cerinic M, Furst DE. Effect of Macitentan on the Development of New Ischemic Digital Ulcers in Patients With Systemic Sclerosis: DUAL-1 and DUAL-2 Randomized Clinical Trials. JAMA 2016; 315:1975-88. [PMID: 27163986 DOI: 10.1001/jama.2016.5258] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Digital ulcers in patients with systemic sclerosis are associated with pain and poor quality of life. Endothelin-1 promotes vasculopathy in systemic sclerosis after macitentan, an endothelin-1 blocker. OBJECTIVE To evaluate the efficacy of macitentan in reducing the number of new digital ulcers in patients with systemic sclerosis. DESIGN, SETTING, AND PARTICIPANTS Two international, randomized, double-blind, placebo-controlled trials (DUAL-1, DUAL-2) were conducted between January 2012 and February 2014. Participants were patients with systemic sclerosis and active digital ulcers at baseline. Target enrollment for each study was 285 patients. INTERVENTIONS Patients were randomized (1:1:1) to receive oral doses of 3 mg of macitentan, 10 mg of macitentan, or placebo once daily and stratified according to number of digital ulcers at baseline (≤3 or >3). MAIN OUTCOMES AND MEASURES The primary outcome for each trial was the cumulative number of new digital ulcers from baseline to week 16. Treatment effect was expressed as the ratio between treatment groups. RESULTS In DUAL-1, among 289 randomized patients (mean age 51.2 years; 85.8% women), 226 completed the study. The adjusted mean number of new digital ulcers per patient over 16 weeks was 0.94 in the 3-mg macitentan group (n = 95) and 1.08 in the 10-mg macitentan group (n = 97) compared with 0.85 in the placebo group (n = 97) (absolute difference, 0.09 [95% CI, -0.37 to 0.54] for 3 mg of macitentan vs placebo and 0.23 [-0.27 to 0.72] for 10 mg of macitentan vs placebo). Among 265 patients randomized in DUAL-2 (mean age 49.6 years; 81.9% women), 216 completed the study. In DUAL-2, the adjusted mean number of new digital ulcers was 1.44 in the 3-mg macitentan group (n = 88) and 1.46 in the 10-mg macitentan group (n = 88) compared with 1.21 in the placebo group (n = 89) (absolute difference, 0.23 [95% CI, -0.35 to 0.82] for 3 mg of macitentan vs placebo and 0.25 [95% CI, -0.34 to 0.84] for 10 mg of macitentan vs placebo). Adverse events more frequently associated with macitentan than with placebo were headache, peripheral edema, skin ulcer, anemia, upper respiratory tract infection, diarrhea, and nasopharyngitis. CONCLUSIONS AND RELEVANCE Among patients with systemic sclerosis and active ischemic digital ulcers, treatment with macitentan did not reduce new digital ulcers over 16 weeks. These results do not support the use of macitentan for the treatment of digital ulcers in this patient population. TRIAL REGISTRATION clinicaltrials.gov Identifiers: NCT01474109, NCT01474122.
Collapse
Affiliation(s)
- Dinesh Khanna
- Department of Internal Medicine, University of Michigan Scleroderma Program, Ann Arbor
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Disease, Royal Free Hospital, London, United Kingdom
| | - Peter A Merkel
- Division of Rheumatology, University of Pennsylvania, Philadelphia
| | - Thomas Krieg
- Department of Dermatology, University of Cologne, Cologne, Germany
| | | | - Angelina Marr
- Actelion Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Janet Pope
- Department of Medicine, Division of Rheumatology, University of Western Ontario, London, Ontario, Canada
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, AOUC, University of Florence, Florence, Italy
| | | | | | | |
Collapse
|
7
|
Atsumi Y. [Prevention and care of diabetic foot ulcer]. Nihon Rinsho 2016; 74 Suppl 2:368-372. [PMID: 27266119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
8
|
Soldevilla Agreda JJ. [Not Available]. Rev Enferm 2016; 39:6-7. [PMID: 27349056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
9
|
Gan H, He H, Sato A, Hatta H, Nakao M, Somamoto T. Ulcer disease prophylaxis in koi carp by bath immersion with chicken egg yolk containing anti-Aeromonas salmonicida IgY. Res Vet Sci 2015; 99:82-6. [PMID: 25687817 DOI: 10.1016/j.rvsc.2015.01.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 01/06/2015] [Accepted: 01/25/2015] [Indexed: 02/02/2023]
Abstract
Ulcer disease, caused by atypical Aeromonas salmonicida, is a serious concern in ornamental koi carp, because it induces skin ulceration, disfiguring ornamental fish and causing economic loses. The present study aimed to establish a novel prophylaxis with chicken egg yolk immunoglobulin, IgY, against ulcer disease and to assess its feasibility in the ornamental fish industry. Addition of egg yolk powder containing anti-A. salmonicida IgY to rearing water provided significant protection against an A. salmonicida bath infection, whereas administration of non-specific IgY did not. Consecutive immersion of fish into rearing water containing specific IgY completely prevented ulcer disease resulting from cohabitation infection, indicating that this prophylaxis could prevent infection from such type of contact. Thus, passive immunization induced by immersing fish into aquarium water containing specific IgY is a prospective prophylaxis against diseases caused by pathogens that invade the skin and gills.
Collapse
Affiliation(s)
- Hongjian Gan
- Laboratory of Marine Biochemistry, Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka 812-8581, Japan
| | - Haiwen He
- Laboratory of Marine Biochemistry, Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka 812-8581, Japan
| | - Atsushi Sato
- Kyorin Co. Ltd., 9 Minami-machi, Himeji, Hyogo, Japan
| | - Hajime Hatta
- Department of Food and Nutrition, Kyoto Women's University, Kyoto, Japan
| | - Miki Nakao
- Laboratory of Marine Biochemistry, Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka 812-8581, Japan
| | - Tomonori Somamoto
- Laboratory of Marine Biochemistry, Department of Bioscience and Biotechnology, Graduate School of Bioresource and Bioenvironmental Sciences, Kyushu University, Fukuoka 812-8581, Japan.
| |
Collapse
|
10
|
Maruyama K, Koshihara N. [Pharmacological and clinical profile of dexrazoxane (SAVENE® Intravenous Infusion 500 mg), a therapeutic agent for anthracycline extravasation]. Nihon Yakurigaku Zasshi 2015; 145:27-34. [PMID: 25743233 DOI: 10.1254/fpj.145.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
11
|
Novinscak T, Filipović M, Kristofić J, Toplek G. [The impact of education on chronic wound care improvement]. Acta Med Croatica 2014; 68 Suppl 1:9-12. [PMID: 25326984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although not fully understood, close relationship between health and education ensures unambiguous health and quality of life advantages to educated individuals. Education ensures different thinking and decision making processes and man is enabled to receive information from the external world. Even though the process of education and learning still relies on banking principles and coping of common knowledge, modern and technological society drives the system as well as education opportunities towards the new learning sources. In the developed world, the impact of chronic wounds on health systems is fairly perceived, as well as chronic wound treatment and education. Our health system still neglects the significant impact of chronic wounds on social and economic, individual and community well-being. Recognizing the importance of chronic wounds and implementation of a developed educational system gives us the potential for improving care for chronic wounds, and thus to substantially improve the quality of life of patients. Furthermore, consequent reduction of unnecessary health costs could reallocate substantial resources to other points of interest.
Collapse
|
12
|
Abstract
Most infantile hemangiomas have a spontaneous and uneventful involution and, hence, may be treated expectantly. Others, however, will present some complication along their evolution that may require prompt therapeutic interventions. Ulceration is the most common complication, and amblyopia is frequently associated with periocular tumors. Airways hemangiomas may be life-threatening, and disfigurement can heavily impact the patient's quality of life.
Collapse
Affiliation(s)
- Bernardo Gontijo
- Department of Dermatology, Federal University of Minas Gerais School of Medicine, Rua Domingos Viera, 300 Suite 505,30150-240 Belo Horizonte, MG, Brazil.
| |
Collapse
|
13
|
Leung TH, Zhang LF, Wang J, Ning S, Knox SJ, Kim SK. Topical hypochlorite ameliorates NF-κB-mediated skin diseases in mice. J Clin Invest 2013; 123:5361-70. [PMID: 24231355 DOI: 10.1172/jci70895] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022] Open
Abstract
Nuclear factor-κB (NF-κB) regulates cellular responses to inflammation and aging, and alterations in NF-κB signaling underlie the pathogenesis of multiple human diseases. Effective clinical therapeutics targeting this pathway remain unavailable. In primary human keratinocytes, we found that hypochlorite (HOCl) reversibly inhibited the expression of CCL2 and SOD2, two NF-κB-dependent genes. In cultured cells, HOCl inhibited the activity of inhibitor of NF-κB kinase (IKK), a key regulator of NF-κB activation, by oxidizing cysteine residues Cys114 and Cys115. In NF-κB reporter mice, topical HOCl reduced LPS-induced NF-κB signaling in skin. We further evaluated topical HOCl use in two mouse models of NF-κB-driven epidermal disease. For mice with acute radiation dermatitis, topical HOCl inhibited the expression of NF-κB-dependent genes, decreased disease severity, and prevented skin ulceration. In aged mice, topical HOCl attenuated age-dependent production of p16INK4a and expression of the DNA repair gene Rad50. Additionally, skin of aged HOCl-treated mice acquired enhanced epidermal thickness and proliferation, comparable to skin in juvenile animals. These data suggest that topical HOCl reduces NF-κB-mediated epidermal pathology in radiation dermatitis and skin aging through IKK modulation and motivate the exploration of HOCl use for clinical aims.
Collapse
|
14
|
Molina PG. [Journal of a congressman. Chronicle of the IX National Symposium on Pressure Ulcers and Chronic Wounds, held in Seville]. Rev Enferm 2013; 36:46-48. [PMID: 23527441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
15
|
Neithercott T. Best foot forward. How to tread carefully and avoid foot problems. Diabetes Forecast 2012; 65:28-31. [PMID: 23270274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|
16
|
Ferguson TS. Foot care and footwear practices in patients with diabetes: simple interventions and adherence to guidelines may be limb saving. W INDIAN MED J 2012; 61:657-658. [PMID: 23620960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
17
|
|
18
|
Elson D. "Compulsory training would help every HCA spot moisture lesions". Nurs Times 2011; 107:11. [PMID: 22220386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
19
|
Abstract
Pressure ulceration causes much distress to patients and family, and can be taken as an indication of poor nursing care. It is vital that both parties understand when pressure damage can be prevented, and those circumstances when skin failure at the end of life cannot be avoided. Appropriate risk assessment, provision of all appropriate care, and use of pressure relieving equipment to minimize the risk of any loss of skin integrity are required. The recognition of Skin Changes at Life's End (SCALE) ulcers may herald the imminent demise of a loved one. Families require support and good communication from nursing staff at this difficult time.
Collapse
|
20
|
Fiori G, Amanzi L, Moggi Pignone A, Braschi F, Matucci-Cerinic M. The treatment of skin ulcers in patients with systemic sclerosis. Reumatismo 2011; 56:225-34. [PMID: 15643477 DOI: 10.4081/reumatismo.2004.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Systemic Sclerosis (Ssc) is a complex disease of the connective tissue, characterized by progressive thickening and fibrosis of the skin and the internal organs and by diffused damage of the microvascular system. The fibrosis ones of the skin associated to the characteristic vascular alterations lead to the genesis of ulcers, more or less extended, often multiple, peripheral localization, chronic course, painful, able to influence patient's quality of life. Indeed, immunity reactivity, the thinning and the loss of elasticity of the skin, the peripheral neurological damage and the eventual drug assumption that can reduce regenerative/reparative abilities, can easily make an ulcer chronic and become infected complicating still more the patient disease, rendering more difficult the cure often, ulcer evolves to gangrene, and in some cases, in amputation too. For all these reasons, we have begun to study ulcers therapy (local and systemic), considering this activity it leave integrating of the charitable distance of the sclerodermic patient, putting to point on strategy both diagnostic and therapeutic, but above all with the primary scope, if possible, is to prevent ulcers, in contrary case, to alleviate the pain and to render the quality of the life of the patient better.
Collapse
Affiliation(s)
- G Fiori
- Università degli studi di Firenze, Medicina Interna I e II, Sezione di Reumatologia, 50139 Firenze.
| | | | | | | | | |
Collapse
|
21
|
Bredemeier M. A higher degree of criticism about the effectiveness of bosentan for digital ulcers in scleroderma patients, as for interstitial disease, is also necessary: comment on the article by Seibold et al. ACTA ACUST UNITED AC 2010; 62:3128-9; author reply 3129-30. [PMID: 20597113 DOI: 10.1002/art.27637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
22
|
Tasew G, Nylén S, Lieke T, Lemu B, Meless H, Ruffin N, Wolday D, Asseffa A, Yagita H, Britton S, Akuffo H, Chiodi F, Eidsmo L. Systemic FasL and TRAIL neutralisation reduce leishmaniasis induced skin ulceration. PLoS Negl Trop Dis 2010; 4:e844. [PMID: 20967287 PMCID: PMC2953481 DOI: 10.1371/journal.pntd.0000844] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 09/09/2010] [Indexed: 11/30/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is caused by Leishmania infection of dermal macrophages and is associated with chronic inflammation of the skin. L. aethiopica infection displays two clinical manifestations, firstly ulcerative disease, correlated to a relatively low parasite load in the skin, and secondly non-ulcerative disease in which massive parasite infiltration of the dermis occurs in the absence of ulceration of epidermis. Skin ulceration is linked to a vigorous local inflammatory response within the skin towards infected macrophages. Fas ligand (FasL) and Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) expressing cells are present in dermis in ulcerative CL and both death ligands cause apoptosis of keratinocytes in the context of Leishmania infection. In the present report we show a differential expression of FasL and TRAIL in ulcerative and non-ulcerative disease caused by L. aethiopica. In vitro experiments confirmed direct FasL- and TRAIL-induced killing of human keratinocytes in the context of Leishmania-induced inflammatory microenvironment. Systemic neutralisation of FasL and TRAIL reduced ulceration in a model of murine Leishmania infection with no effect on parasitic loads or dissemination. Interestingly, FasL neutralisation reduced neutrophil infiltration into the skin during established infection, suggesting an additional proinflammatory role of FasL in addition to direct keratinocyte killing in the context of parasite-induced skin inflammation. FasL signalling resulting in recruitment of activated neutrophils into dermis may lead to destruction of the basal membrane and thus allow direct FasL mediated killing of exposed keratinocytes in vivo. Based on our results we suggest that therapeutic inhibition of FasL and TRAIL could limit skin pathology during CL. Cutaneous leishmaniases are associated with parasite-induced inflammatory lesions of the skin. The degree of clinical pathology is not associated with parasitic burden; on the contrary, ulcerative lesions are associated with low infectious load, and non-ulcerative lesions are associated with an abundant parasite infiltration. Leishmania are intracellular parasites in mammalian hosts and reside in macrophages in the deep layers of the skin, the dermis. The exact mechanism of ulceration in CL is not known and Leishmania parasites do not directly induce destruction of keratinocytes in the most superficial layer of the skin, the epidermis. In this study we investigated if ulcerated lesions were associated with higher expression of FasL- and TRAIL-induced cell-death of keratinocytes. We found a higher expression of FasL and TRAIL in human skin samples from ulcerative as compared to non-ulcerative leishmaniasis. In a mouse model of ulcerative leishmaniasis neutralisation of FasL and TRAIL reduced ulceration. We suggest that FasL and TRAIL participate in the ulcer formation during leishmaniasis both as a chemoattractant of activated neutrophils leading to tissue destruction and through direct killing of keratinocytes. Possible approaches to use this concept in therapeutical interventions with the aim to reduce immunopathology associated with leishmaniasis are discussed.
Collapse
Affiliation(s)
- Geremew Tasew
- Ethiopian Health and Nutrition Research Institute (EHNRI), Parasitology Laboratory, Addis Ababa, Ethiopia
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Nylén
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Thorsten Lieke
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Transplantationslabor, Klinik für Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Befekadu Lemu
- St. Paulos General Specialized Hospital, Addis Ababa, Ethiopia
| | - Hailu Meless
- Ethiopian Health and Nutrition Research Institute (EHNRI), Parasitology Laboratory, Addis Ababa, Ethiopia
| | - Nicolas Ruffin
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Dawit Wolday
- Ethiopian Health and Nutrition Research Institute (EHNRI), Parasitology Laboratory, Addis Ababa, Ethiopia
| | - Abraham Asseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Hideo Yagita
- Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan
| | - Sven Britton
- Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hannah Akuffo
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Francesca Chiodi
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Liv Eidsmo
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Unit of Dermatology and Venerology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| |
Collapse
|
23
|
Abstract
Skin care is a fundamental aspect of basic nursing care, with the outcome of these interventions often used to gauge the quality of the care provided. However, possibly as a result of the 'basic' nature of this aspect of care, little attention has been paid to developing a firm evidence base to guide decision-making in this area. This is compounded by the wide variety of products now available, ranging from simple cleansers and moisturizers, to more complex agents that cleanse, moisturize and protect all in one, which can add to the confusion. This article explores the basic principles of skin care, and considers the evidence available to support the nursing interventions used, and the range of products available. Finally, it suggests the adoption of clear skin care protocols, and recommends actions that should form part of these.
Collapse
Affiliation(s)
- David Voegeli
- Continence Technology and Skin Health Group, School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
24
|
Abstract
This article discusses the role of the nurse specialist in the management of patients with systemic sclerosis, focusing on helping patients to deal with the physical, psychological and social effects associated with digital ulcers.
Collapse
Affiliation(s)
- S Brown
- Royal National Hospital for Rheumatic Diseases NHS Foundation Trust, Bath.
| |
Collapse
|
25
|
|
26
|
Abstract
HYPOTHESIS Impaired wound healing in diabetics is due to pathologic angiogenesis, which is a result of aberrant sphingosine-1-phosphate signaling. Pharmacologic modulation of sphingosine-1-phosphate-dependent signaling normalizes healing in diabetic wounds.
Collapse
Affiliation(s)
- Kellie N Francis-Goforth
- Department of General Surgery, University of California San Francisco-East Bay, Oakland, CA, USA
| | | | | |
Collapse
|
27
|
[Fecal incontinence. Can the integrity of the skin be maintained?]. Rev Enferm 2009; 32:30-1. [PMID: 19354137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
28
|
Toner L. Where is the DoH's strategy for tissue viability? Br J Community Nurs 2008; 13:S3. [PMID: 19060826 DOI: 10.12968/bjcn.2008.13.sup6.31841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Pressure ulcers are estimated to cost the NHS in the region of £2 Billion pounds per year - 4% of the NHS total budget and more than the whole budget allocated for Mental Health Services. A significant cost for what is claimed by many to be preventable in 95% of cases. Given this situation, the significant question is why tissue viability does not feature more strategically on the NHS agenda. It has to be acknowledged that pressure ulcers have been under the spotlight with Grade 2 and above ulcers subject to clinical incident reporting but what of leg ulcers, ulcers associated with intravenous drug use and diabetic foot ulcers to name a few? The burden of caring for these patients falls mainly within primary care with community and practice nurses bearing the greatest load.
Collapse
|
29
|
Girot R, Stankovic K, Lionnet F. [New issues in adult sickle sell disease]. Bull Acad Natl Med 2008; 192:1395-1411. [PMID: 19445365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Over the past 20 years, early medical treatment has significantly increased the life expectancy of children with sickle cell disease. More than 90% of patients now reach the age of 20, and the median life expectancy of sickle cell patients is at least 50 years in countries with advanced healthcare systems. The increase in the number of adults with homozygous sickle cell disease is accompanied by increasingly frequent chronic osteoarticular, renal, cardiorespiratory, ocular, cutaneous and cerebral complications. Pregnancy is a high-risk situation for the mother and child The efficacy and safety of hydroxyurea and long-term blood transfusions in adults with sickle cell disease are currently under investigation.
Collapse
Affiliation(s)
- Robert Girot
- Centre de la drépanocytose, Hôpital Tenon, 4, rue de la Chine, 75020 Paris
| | | | | |
Collapse
|
30
|
Deitz D, Gates J. The future is now: wound care in the 21st century. Nurs Manag (Harrow) 2008; 39:44-46. [PMID: 21412197 DOI: 10.1097/01.numa.0000338307.25502.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Diane Deitz
- Jersey Shore University Medical Center, Neptune, NJ, USA
| | | |
Collapse
|
31
|
Llabrès JM. [Management of a breast cancer wound in the Hospital of Leman]. Soins 2008:59-60. [PMID: 18972824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
32
|
Schindler CA, Mikhailov TA, Fischer K, Lukasiewicz G, Kuhn EM, Duncan L. Skin integrity in critically ill and injured children. Am J Crit Care 2007; 16:568-574. [PMID: 17962501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Skin breakdown increases the cost of care, may lead to increased morbidity, and has negative psychosocial implications because of secondary scarring or alopecia. The scope of this problem has not been widely studied in critically ill and injured children. OBJECTIVES To determine the incidence of skin breakdown in critically ill and injured children and to compare the characteristics of patients who experience skin breakdown with those of patients who do not. METHODS Admission and follow-up data for a 15-week period were collected retrospectively on children admitted to a large pediatric intensive care unit. The incidence of skin breakdown was calculated. The risk for skin breakdown associated with potential risk factors (relative risk) and 95% confidence intervals were determined. RESULTS The sample consisted of 401 distinct stays in the intensive care unit for 373 patients. During the 401 stays, skin breakdown occurred in 34 (8.5%), redness in 25 (6.2%), and breakdown and redness in 13 (3.2%); the overall incidence was 18%. Patients who had skin breakdown or redness were younger, had longer stays, and were more likely to have respiratory illnesses and require mechanical ventilatory support than those who did not. Patients who had skin breakdown or redness had a higher risk of mortality than those who did not. CONCLUSIONS Risk factors for skin breakdown were similar to those previously reported. Compared with children of other ages, children 2 years or younger are at higher risk for skin breakdown.
Collapse
Affiliation(s)
- Christine A Schindler
- Division of Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee 53201-1997, USA.
| | | | | | | | | | | |
Collapse
|
33
|
Pollard T. A new research focus for skin breakdown. J Wound Care 2007; 16:281. [PMID: 17708376 DOI: 10.12968/jowc.2007.16.7.27069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Affiliation(s)
- Susan Hunter
- University of North Dakota College of Nursing, Grand Forks, ND, USA
| | | | | | | | | |
Collapse
|
35
|
Casiraghi A, Ardovino P, Minghetti P, Botta C, Gattini A, Montanari L. Semisolid formulations containing dimethyl sulfoxide and α-tocopherol for the treatment of extravasation of antiblastic agents. Arch Dermatol Res 2007; 299:201-7. [PMID: 17370081 DOI: 10.1007/s00403-007-0746-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Revised: 01/25/2007] [Accepted: 02/20/2007] [Indexed: 10/23/2022]
Abstract
The topical treatment with dimethyl sulfoxide (DMSO) and/or alpha-tocopherol (alpha-T) is widely used in order to prevent the local complications of extravasation of cytostatic drugs and protect patients against skin ulceration. Till now, DMSO and alpha-T have been mainly used in solution. The goal of this study was to formulate semisolid preparations for cutaneous application differing in the hydrophilic and lipophilic properties and containing DMSO and alpha-T in combination. With respect to solutions, the use of semisolid preparations containing DMSO and alpha-T could be advantageous in patients having extravasation as DMSO and alpha-T can remain in contact with the skin over an extended period of time. As a consequence, the action of the active principles can be limited specifically on the injured skin area, reducing the cutaneous irritative effects of DMSO. The following types of semisolid formulations containing 50% m/m DMSO and 2.5% m/m alpha-T were prepared: hydrophilic ointment, o/w emulsion, hydrophilic gel and lipophilic gel. The ex vivo skin permeation of DMSO and alpha-T was evaluated by using modified Franz's diffusion cells and human stratum corneum and epidermis (SCE) as a membrane. The permeated and retained amounts of DMSO and alpha-T were determined. The oleogel preparation, the hydrophilic gel and the o/w emulsion were uniform in colour and aspect, without any evidences of phase separation over the period of the study. Hydrophilic ointments were discarded as they showed phase separation after 12 h. All formulations had a different behaviour in terms of skin permeability. In particular, hydrogel and o/w emulsion showed the best control on the drug release considering the interactions of the vehicle components with the SCE and the drugs partition between the vehicle and the SCE. The DMSO permeated amount after 24 h was 4.1 mg/cm(2) for hydrogel and 2.5 mg/cm(2) for emulsion while the permeated amount of pure DMSO after 24 h was 47.5 mg/cm(2). Therefore, aiming to reduce side effects after the topical application of the antidotes DMSO and alpha-T, these results suggested that hydrogel and o/w emulsion could be considered the most promising formulations for further clinical evaluations in managing of extravasation of anthracyclines.
Collapse
Affiliation(s)
- Antonella Casiraghi
- Istituto di Chimica Farmaceutica e Tossicologica Pietro Pratesi, Università degli Studi di Milano, Viale Abruzzi, 42, 20131 Milan, Italy.
| | | | | | | | | | | |
Collapse
|
36
|
Johnson PDR, Hayman JA, Quek TY, Fyfe JAM, Jenkin GA, Buntine JA, Athan E, Birrell M, Graham J, Lavender CJ. Consensus recommendations for the diagnosis, treatment and control of Mycobacterium ulcerans infection (Bairnsdale or Buruli ulcer) in Victoria, Australia. Med J Aust 2007; 186:64-8. [PMID: 17223765 DOI: 10.5694/j.1326-5377.2007.tb00802.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 08/15/2006] [Indexed: 11/17/2022]
Abstract
Mycobacterium ulcerans causes slowly progressive, destructive skin and soft tissue infections, known as Bairnsdale or Buruli ulcer (BU). Forty-six delegates with experience in the management of BU attended a 1-day conference in Melbourne on 10 February 2006, with the aim of developing a consensus approach to the diagnosis, treatment and control of BU. An initial draft document was extended and improved during a facilitated round table discussion. BU is an environmental infection that occurs in specific locations. The main risk factor for infection is contact with an endemic area. Prompt cleaning of abrasions sustained outdoors, wearing protective clothing, and avoiding mosquito bites may reduce an individual's risk of infection. BU can be rapidly and accurately diagnosed by polymerase chain reaction testing of ulcer swabs or biopsies. Best outcomes are obtained when the diagnosis is made early. To aid early diagnosis, health authorities should keep local populations informed of new outbreaks. BU is best treated with surgical excision, which, if possible, should include a small rim of healthy tissue. For small lesions this may be all that is required. However, there is a role for antibiotics for more extensive disease, and their use may allow more conservative surgery.
Collapse
Affiliation(s)
- Paul D R Johnson
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Nackers F, Dramaix M, Johnson RC, Zinsou C, Robert A, DE Biurrun Bakedano E, Glynn JR, Portaels F, Tonglet R. BCG vaccine effectiveness against Buruli ulcer: a case-control study in Benin. Am J Trop Med Hyg 2006; 75:768-74. [PMID: 17038709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BCG remains the only possible prophylactic intervention against Buruli ulcer (BU). Estimating its public health impact on BU control is an important issue. We conducted a case-control study to investigate the vaccine effectiveness of routine BCG vaccine against BU in southern Benin. From August 2002 to August 2003, BCG vaccination status was obtained for 279 clinically diagnosed BU cases and 988 age- and sex-matched neighborhood controls. BCG coverage, which was estimated by the presence of a scar or a vaccination record, was 64.5% in cases and 67.2% in controls. There was no evidence of a protective effect of routine BCG vaccination against BU in southern Benin (vaccine effectiveness adjusted for socioeconomic status = 12%, 95% confidence interval = -24% to 37%).
Collapse
Affiliation(s)
- Fabienne Nackers
- Unité d'Epidemiologie, Ecole de Santé Publique, Université Catholique de Louvain, Brussels, Belgium.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Puentes Sánchez J, Pardo González CM, Pardo González MB, Navarro Casado FJ, Puentes Sánchez R, Méndez González JM, González Rojo J, Juárez Morales A, López Fernández IM. [Prevention of vascular ulcers and diabetic foot. Non-randomized open clinical evaluation on the effectiveness of "Mepentol Leche"]. Rev Enferm 2006; 29:25-30. [PMID: 17144630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Vascular ulcers and diabetic foot ulcers present a health serious problem which affects a large number of patients, creating a major challenge for health professionals. Hyper-oxygenated fatty acid dressings have proven to be effective thanks to their favorable action on the skin in three ways: increasing the microcirculation of the blood, promoting the renovation of the epidermic cells, and notably increasing cutaneous hydration. OBJECTIVE Evaluate the effectiveness of Mepentol Leche, an emulsion based on Hyper-oxygenated fatty acids, Aloe barbadensis and Mimosa tenuiflora, used to treat the skin and alleviate symptoms in patients who suffer from vascular ulcers and diabetic foot ulcers. METHODS Clinical evaluation carried out between June 2004 and December 2005. 195 patients were studied. The parameters for inclusion in this study were 32.82% for venous pathology 35.90% for skin care, 26.67% due to arterial pathology, and 4.62% for a lymphatic pathology. These patients were evaluated over a one month period and each had a follow-up by means of a data collection file. The guideline to apply this product was twice a day and always over integral skin. The effectiveness of this product has been established based on these epigraphs: symptoms of itching, smarting and pain, and skin conditions: color, dryness, edema, maceration, rashes, and desquamation. RESULTS Not one patient developed new lesions in healthy skin protected by Mepentol Leche. Symptoms linked to this pathology saw improvements in these percents: itching 96%, smarting 93%, and pain 96%, and skin conditions: color 100%, edema 90%, maceration 96%, rashes 92%, and desquamation 100%. Health professionals' evaluation of this product has been highly favorable in regards to ease of use, tolerance, absorption, and ease of application. CONCLUSIONS This study showed the benefits in applying this product systematically to alleviate the symptoms prior to the appearance of ulcers, thus avoiding skin dryness and reducing itching, smarting, pain and eczema while returning normal color to the skin.
Collapse
|
40
|
Fikar CR, Delinois B. Wound-care resources on the Internet: a second update. J Am Podiatr Med Assoc 2006; 96:264-8. [PMID: 16707641 DOI: 10.7547/0960264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An updated selection of high-quality Internet resources related to wound and ulcer care is presented. Of potential use to the podiatric medical practitioner, educator, resident, and student, some Web sites that cover hyperbaric medicine, antibiotic use, and wound and ulcer prevention are also included. These Web sites have been evaluated on the basis of their potential to enhance the practice of podiatric medicine, in addition to contributing to the educational process. Readers who require a quick reference source to wound and ulcer care may find this report useful.
Collapse
Affiliation(s)
- Charles R Fikar
- St. Vincent Catholic Medical Centers, Woods Health Sciences Library, 88-25 153rd Street, Jamaica, NY 11432, USA
| | | |
Collapse
|
41
|
Oztuna V, Eskandari MM, Unal S, Colak M, Karabacak T. The effect of pentoxifylline in treatment of skin degloving injuries: an experimental study. Injury 2006; 37:638-41. [PMID: 16769312 DOI: 10.1016/j.injury.2006.02.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2005] [Revised: 02/06/2006] [Accepted: 02/20/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Management of skin degloving injuries is still a problematic issue and the avulsed part of the skin may become necrotic. In this pilot study, we attempted to develop an experimental model for degloving injuries and investigated the efficacy of pentoxifylline, a well-known potent agent in enhancement of erythrocyte flexibility and tissue vascularization, in treatment of this injury model. METHODS Degloving injuries were created in 15 rats' tails by circular puncturing of the skin at the middle of the tail and then applying moderate force to avulse the skin from the underlying tissue. Then, the skin was repaired back to its original position. No treatment was given in the first group (n=6). In the second group (n=3), 0.4cm(3) physiological serum was administered intraperitoneally for 10 days. In the third group (n=6), intraperitoneal 25mg/kg pentoxifylline was administered for 10 days. Tails were observed daily for 21 days and then examined histopathologically. RESULTS At the end of the study, the avulsed segment of the skin became cyanotic and ulcerated in the first and the second group, and in the third group, the skin was intact. In histopathological examination, loss of superficial ephitelium and dense infiltration of inflammatory cells were seen in groups 1 and 2, and the skin layers were normal in the group 3. CONCLUSION Pentoxifylline improved tissue preservation and was proved to be highly beneficial in treatment of skin degloving injuries.
Collapse
Affiliation(s)
- Volkan Oztuna
- Department of Orthopaedics, Mersin University School of Medicine, Ihsaniye Mah, 4935 Sokak No. 3, 33079 Mersin, Turkey.
| | | | | | | | | |
Collapse
|
42
|
Coutanceau E, Legras P, Marsollier L, Reysset G, Cole ST, Demangel C. Immunogenicity of Mycobacterium ulcerans Hsp65 and protective efficacy of a Mycobacterium leprae Hsp65-based DNA vaccine against Buruli ulcer. Microbes Infect 2006; 8:2075-81. [PMID: 16781179 DOI: 10.1016/j.micinf.2006.03.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2005] [Revised: 02/17/2006] [Accepted: 03/17/2006] [Indexed: 11/20/2022]
Abstract
Buruli ulcer, a disease caused by Mycobacterium ulcerans, is emerging as an increasingly important cause of morbidity throughout the world, for which surgery is the only efficient treatment to date. The aim of this work was to identify potential vaccine candidates in an experimental model of mouse infection. In BALB/c mice infected with M. ulcerans subcutaneously, Hsp65 appeared to be an immunodominant antigen eliciting both humoral and cellular responses. However, vaccination of mice with a DNA vector encoding Mycobacterium leprae Hsp65 only poorly limited the progression of M. ulcerans infection. In contrast, a substantial degree of protection was conferred by subcutaneous vaccination with BCG, suggesting that BCG antigens that are conserved in M. ulcerans, such as TB10.4, the 19 kDa antigen, PstS3 and Hsp70, may be interesting to consider as subunit vaccines in future prospects.
Collapse
Affiliation(s)
- Emmanuelle Coutanceau
- Unité de Génétique Moléculaire Bactérienne, Institut Pasteur, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France
| | | | | | | | | | | |
Collapse
|
43
|
Chung L, Fiorentino D. A pilot trial of treprostinil for the treatment and prevention of digital ulcers in patients with systemic sclerosis. J Am Acad Dermatol 2006; 54:880-2. [PMID: 16635673 DOI: 10.1016/j.jaad.2006.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2005] [Revised: 01/26/2006] [Accepted: 02/02/2006] [Indexed: 10/24/2022]
Abstract
We performed a pilot trial of subcutaneous treprostinil for the treatment of digital ulcers in scleroderma. Of the 5 patients completing therapy, ulcer size significantly decreased and no new ulcers occurred on continuous therapy. Although effective, the high rate of injection site reactions may limit the utility of this therapy.
Collapse
Affiliation(s)
- Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California 94305, USA
| | | |
Collapse
|
44
|
Zeiger BC. For the little people. Ostomy Wound Manage 2006; 52:22-4. [PMID: 16625758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
|
45
|
Affiliation(s)
- Frances Healey
- Patient Safety Manager NPSA, North and East Yorkshire and North Lincolnshire
| |
Collapse
|
46
|
Di Paolo N, Bocci V, Salvo DP, Palasciano G, Biagioli M, Meini S, Galli F, Ciari I, Maccari F, Cappelletti F, Di Paolo M, Gaggiotti E. Extracorporeal blood oxygenation and ozonation (EBOO): a controlled trial in patients with peripheral artery disease. Int J Artif Organs 2006; 28:1039-50. [PMID: 16288443 DOI: 10.1177/039139880502801012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since 1990 our group has been using extracorporeal circulation to ozonate blood by an original method, known as extracorporeal blood oxygenation and ozonation (EBOO), with the aim of amplifying the results observed with ozone autohemotherapy. OBJECTIVE To verify the hypothesis that EBOO improves the skin lesions typical of peripheral artery disease (PAD) patients. METHODS Twenty-eight patients with PAD were randomized to receive EBOO or intravenous prostacyclin in a controlled clinical trial. The primary efficacy parameters were regression of skin lesions and pain,and improvement in quality of life and vascularisation. RESULTS Patients treated with EBOO showed highly significant regression of skin lesions with respect to patients treated with prostacyclin. Other parameters that were significantly different in the two groups of patients were pain,pruritus, heavy legs and well-being. No significant differences in vascularisation of the lower limbs before and after treatment were found in either group. No side effects or complications were recorded during the 210 EBOO treatments. CONCLUSION EBOO was much more effective than prostacyclin for treating skin lesions in PAD patients and also had a positive effect on patient general condition without any apparent change in arterial circulation. This suggests other mechanisms of action of EBOO.
Collapse
Affiliation(s)
- N Di Paolo
- Nephrology and Dialysis Department, University Hospital of Siena, Siena--Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Krathwohl MD, Anderson JL. Chemokine CXCL10 (IP-10) is sufficient to trigger an immune response to injected antigens in a mouse model. Vaccine 2005; 24:2987-93. [PMID: 16500735 DOI: 10.1016/j.vaccine.2005.11.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Revised: 11/11/2005] [Accepted: 11/15/2005] [Indexed: 11/22/2022]
Abstract
The induction of chemokines by interferons might represent a link between innate and adaptive immunity. Whether these induced chemokines might be useful by themselves to induce an immune response is not known. We hypothesized that the interferon-inducible chemokine CXCL10 could stimulate dendritic cells (DC) to mature and cross-present exogenous antigen to T cells, resulting in a Th1-type immune response. We found that injecting mice with CXCL10 together with ovalbumin (OVA) as a test antigen was sufficient to produce functional OVA-specific T cells in 7 of 10 mice. Further, using only CXCL10 and a peptide antigen derived from vaccinia virus, we were able to induce peptide-specific cytotoxic T cells in 4 of 4 mice tested. These cytotoxic T cells protected 9 of 10 mice from subsequent infectious challenge with vaccinia virus. Unlike traditional adjuvants, no side effects were observed in any of the injected mice. We conclude that CXCL10 co-administration with a variety of antigens may represent a unique strategy of inducing a protective T cell response to a number of pathogens that merits further study.
Collapse
|
48
|
Todkar M. Sciatic nerve block after total knee replacement. MedGenMed 2005; 7:4. [PMID: 16614626 PMCID: PMC1681715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Manoj Todkar
- Department of Orthopaedics, Nuffield Orthopaedic Centre, Headington, Oxford, United Kingdom
| |
Collapse
|
49
|
Abstract
Patients with systemic sclerosis (SSc) develop often acral ulcers which are resistant to therapy and may result in gangrene and amputation. We investigated the effects of iloprost infusion on the acral ulcers and necrosis in patients with five patients with SSc and one with mixed connective tissue disease who had been previously treated with various modalities without improvement. All patients had Raynaud phenomenon, acral ulcers and necrosis. Iloprost 25 microg per day was administered intravenously daily over six hours for ten consecutive days. Eight weeks later all patients were treated with a second iloprost therapy cycle for five days. Two patients with severe ulceration received a third cycle until remission occurred. In all cases acral ulcers healed completely and no patient relapsed during an observation period of 6 months.
Collapse
|
50
|
Abstract
Digital ulcers (DU), defined as necrotic lesions located at distal digits or overlying bony prominences, occur in up to 50% of patients with limited or diffuse systemic sclerosis (SSc). These lesions are extremely painful and lead to substantial functional disability. The pathogenesis of DU differs depending on their location. DU located at distal aspects of digits are thought to be related to tissue ischemia from several processes, including vasospasm secondary to Raynaud's phenomenon, intimal fibro-proliferation, and thrombosis of digital arteries. DU located over bony prominences, such as the phalangeal joints and elbows, are thought to be due to repetitive microtrauma and difficulty healing due to atrophic, avascular tissue overlying the joints. Management of DU include non-pharmacologic and pharmacologic modalities. This review summarizes the current available and investigational therapies for the treatment and prevention of DU in patients with SSc.
Collapse
Affiliation(s)
- Lorinda Chung
- Stanford University School of Medicine, Department of Immunology and Rheumatology, 1000 Welch Road, Suite #203, Stanford, CA 94305, USA.
| | | |
Collapse
|