PURPOSE OF REVIEW: Although many therapeutic approaches have been lined up nowadays to treat Diabetes, there are no proper treatment modalities proposed yet in treating diabetic wounds due to the lack of understanding about the role of inflammatory mediators, especially Pro-inflammatory mediators- Cytokines, in the process of Wound healing which we mainly focus on this review.
RECENT FINDINGS: Although complications of Diabetes mellitus are most reported after years of diagnosis, the most severe critical complication is impaired Wound Healing among Diabetes patients. Even though Trauma, Peripheral Artery Disease, and Peripheral Neuropathy are the leading triggering factors for the development of ulcerations, the most significant issue contributing to the development of complicated cutaneous wounds is wound healing impairment. It may even end up with amputation. Newer therapeutic approaches such as incorporating the additives in the present dressing materials, which include antimicrobial molecules and immunomodulatory cytokines is of better therapeutic value.
SUMMARY: The adoption of these technologies and the establishment of novel therapeutic interventions is difficult since there is a gap in terms of a complete understanding of the pathophysiological mechanisms at the cellular and molecular level and the lack of data in terms of the assessment of safety and bioavailability differences in the individuals' patients. The target-specific pro-inflammatory cytokines-based therapies, either by upregulation or downregulation of them, will be helpful in the wound healing process and thereby enhances the Quality of life in patients, which is the goal of drug therapy.
MATERIALS AND METHODS: A cross-sectional design was used in this study involving 245 participants of type 2 diabetes mellitus (T2DM) was conducted at a Kitamura Wound Care Clinic, PKU Muhammadiyah, located in Pontianak, West Kalimantan, Indonesia, between September 2022 and February 2023. The Kruskal-Wallis test was used to assess the relationship between the foot care practices and infection status. A linear regression test to examine the independent risk factors.
RESULTS: Wounds' characteristics regarding foot care practice group were significantly including more than 5 months wound heal from previous wounds (p = 0.045), the percentage of wound site on dorsal was higher in the foot care practice group (p < 0.001), the percentage had no deformity feet was higher in the foot care practice group (p < 0.001), the percentage had no previous amputation feet was higher in the foot care practice group (p < 0.001). Also, the percentage had grade three was higher in the foot care practice group (p < 0.001), the percentage had grade three was higher in the foot care practice group (p < 0.001), and the percentage had mild infection status was higher in the foot care practice group (p < 0.001). The predictors of diabetic foot infection were Wagner and SHID classification and foot care (p < 0.001, p < 0.001, and p < 0.01) respectively.
CONCLUSION: This study demonstrated that foot-care behaviour in diabetic patients in Indonesia is poor. In addition, this study also has shown Wagner grading, SHID grading, and foot-care are predictors of infection in recurrent DFUs.
AIM OF THE STUDY: However, there are no scientific reports documented on the wound healing activities of this plant against Staphylococcus aureus infections in the Sprague Dawley male rat model. Thus, the present study was conducted to evaluate the wound healing potential of E. guineensis extract leaves.
MATERIALS AND METHODS: The crude extract was prepared in 10% (w/w) ointment and evaluated for wound healing activity using excision and infected wound models in Sprague Dawley rats. The wound healing activity was evaluated from wound closure rate, CFU reduction, histological analysis of granulation tissue and matrix metalloprotease expression.
RESULTS: The results show that the E. guineensis extract has potent wound healing ability, as manifest from improved wound closure and tissue regeneration supported by histopathological parameters. Assessment of granulation tissue every fourth day showed a significant reduction in the microbial count. The expression of matrix metalloproteinases was well correlated with the other results, hence confirming E. guineensis wound healing activity's effectiveness.
CONCLUSIONS: E. guineensis enhanced infected wound healing in rats, thus supporting its traditional use.
PATIENTS AND METHODS: Free buccal fat pad grafting was carried out in 15 patients in our institution. All were harvested using an intraoral approach. The buccal fat pad graft was used to correct periorbital contour depressions, nasal tip deformities, as a camouflage graft over exposed silicon nasal implants and as a filler in the depression deformity after mass excision.
RESULTS: All 15 patients demonstrated good contour deformity correction without a significant graft resorption up to 3 years of follow-up. There were no donor site complications. The amount used ranged from 1 to 5 cc in volume as a spacer or barrier for the moderate-sized volume defect or depression, even though more than 5 cc of fat graft could be harvested if required.
CONCLUSION: In conclusion, the buccal fat pad graft represents an easy, expedient and exceptional tool for the correction of contour deformities, volume replacement or for aesthetic augmentation.
LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
MATERIALS AND METHOD: Forty-five patients with dry socket were divided into two treatment groups. Group I dry socket patients (n = 30) received conventional treatment while group II patients (n = 15) were irradiated with LLLT at a setting of 200-mW, 6-J, continuous-wave mode using an R02 tipless handpiece (Fotona Er:YAG, Europe), on the buccal, lingual, and middle surfaces of the socket for 30 s from a delivery distance of 1 cm. Pain score and quantification of granulation tissue in the socket were recorded at 0, 4, and 7 days post-dry socket treatment.
RESULTS: Results showed that the LLLT-irradiated group II sockets showed a much lower VAS pain score of 1-2 as early as day 4, and a richer amount of granulation tissue compared to the conventional treated group I socket. The amount and rate of granulation tissue formation in the dry socket are inversely proportional to the pain score showing significant clinical effectiveness of LLLT on promoting the healing of the dry socket, with improvement in symptoms (P = .001). Conventionally treated dry sockets take at least 7 days to match the effective healing of an LLLT-irradiated dry socket.
CONCLUSION: LLLT irradiation influences biomodulation of dry socket healing by dampening inflammation, promoting vascularization, stimulating granulation, and controlling pain symptoms.
CLINICAL RELEVANCE: LLLT may be an additional effective tool for managing dry sockets in general dental practice.
MATERIALS AND METHODS: Sixty patients with one dry socket each, at University Dental Hospital Sharjah, were divided into three treatment groups based on their choice. In group I (n = 30), conventional treatment comprising of gentle socket curettage and saline irrigation was done. Group II (n = 15) dry sockets were treated with CGF and group III (n = 15) sockets were lased with LLLT. All dry socket patients were seen at day 0 for treatment and subsequently followed-up at 4, 7, 14, and 21 days. Pain score, perisocket inflammation, perisocket tenderness, and amount of granulation tissue formation were noted.
STATISTICAL ANALYSIS: Data were analyzed as mean values for each treatment group. Comparisons were made for statistical analysis within the group and among the three groups to rank the efficacy of treatment using one-way analysis of variance (ANOVA). Statistically significant difference is kept at p < 0.05.
RESULTS: Conventional treatment group I took more than 7 days to match the healing phase of group II CGF treated socket and group III LLLT irradiated socket (p = 0.001). When healing rate between CGF and LLLT are compared, LLLT group III showed a delay of 4 days compared with CGF in granulation tissue formation and pain control.
CONCLUSION: CGF treated socket was superior to LLLT in its ability to generate 75% granulation tissue and eliminate pain symptom by day 7 (p = 0.001).
MATERIALS AND METHODS: Male rats were rendered diabetes mellitus via intraperitoneal injection of streptozotocin and nicotinamide. Following diabetes development, wound was created at the back of the neck. 1% and 2% mangiferin gel and 1% silver sulphurdiazine (SS) gel (positive control) were applied to the wound for twenty-one (21) days. Fasting blood glucose (FBG) levels were weekly monitored. At the end of the treatment, rats were sacrificed and wound was excised and subjected for histopathological and molecular biological analysis.
RESULTS: No changes to serum FBG levels was noted throughout the period of mangiferin treatment. Albeit, a significant decrease in the size of the wound with increased in the skin thickness of surrounding the wound were observed. Increased expression and distribution of EGF, FGF, TGF-β, VEGF, PI3K, MMP and Nrf2 and decreased expression and distribution of TNFα and NF-κB p65 were observed in diabetic wound treated with topical mangiferin.
CONCLUSIONS: Mangiferin has potential to be used as an agent to promote wound healing in diabetic condition.