Ulcer

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Scott Cunningham - One of the best experts on this subject based on the ideXlab platform.

  • scottish foot Ulcer risk score predicts foot Ulcer healing in a regional specialist foot clinic
    Diabetes Care, 2007
    Co-Authors: Christopher Schofield, Brian Mcmurray, Gillian Libby, Judith Golden, Ritchie Macalpine, Graham P Leese, Scott Cunningham
    Abstract:

    OBJECTIVE —To determine whether patients developing Ulcers had previously been identified as being at high risk of Ulceration using the Scottish Care Information–Diabetes Collaboration (SCI-DC) Ulcer risk score and whether the risk score predicts Ulcer healing. RESEARCH DESIGN AND METHODS —All patients attending the diabetes foot clinic with an Ulcer had been assessed for foot Ulcer risk using the SCI-DC risk calculator, which categorizes patients into low, moderate, or high risk of Ulceration. Information on foot pulses, neuropathy, foot deformity, previous Ulcer, Ulcer site, depth, and presence of sepsis was recorded and related to Ulcer outcome. Patients were followed up until outcome was achieved (median 3 months [range 1–33]). RESULTS —Of patients attending the clinic with a foot Ulcer (mean [±SD] age 67.3 ± 12.7 years, 68% male), 68% were previously recognized to be at high risk of foot Ulceration, and 98% were high or moderate risk. Of 221 Ulcers, the healing rate was 75% overall but was lower for high-risk patients compared with other patients (68 vs. 93%; P < 0.0001). Of the remainder, 3% became chronic Ulcers, 12% required minor or major amputation, and 10% died with their Ulcer. In multivariate analysis, absent pulses, neuropathy, increased age, and deep Ulcers were associated with poor healing. The combination of neuropathy and ischemia was particularly associated with poor outcome of an Ulcer (61% healing). CONCLUSIONS —The Scottish foot Ulcer risk score predicts both Ulcer development and Ulcer healing. The risk score can be a useful initial guide to determine the likelihood of poor healing. The individual criteria contributing to this overall risk are similar to other studies.

Dinka Dugassa - One of the best experts on this subject based on the ideXlab platform.

  • incidence of diabetic foot Ulcer among diabetes mellitus patients admitted to nekemte referral hospital western ethiopia prospective observational study
    Endocrinology and Metabolic Syndrome, 2019
    Co-Authors: Firomsa Bekele, Ginenus Fekadu, Kumera Bekele, Dinka Dugassa
    Abstract:

    Background: Diabetic foot is defined as the foot of the diabetic patients with Ulceration, infection, and/or distraction of the deep tissues associated with neurological abnormalities and varying degrees of peripheral vascular disease of the lower limb. Diabetic foot Ulcers are a common and much feared complication of diabetes. The study is aimed to identify incidence of diabetic foot Ulcer in diabetes patients of Nekemte Referral Hospital (NRH). Methods: A prospective observational study of diabetes mellitus patients who had diabetic foot Ulcer was conducted from March15 to June 15, 2018.The data was entered into EPI-manager 4.0.2 software and analyzed using SPSS V.24. The Wagner classification of diabetic foot Ulcer was used to assess the severity of foot Ulcers. Size of Ulcer was determined by multiplying the largest by the second largest diameter perpendicular to the first and the etiology of diabetic foot Ulcer was identified by using gram stains. Results: Over the study period, 644 diabetes patients were admitted to the NRH medical service; of these, 115 (17.86%) had foot Ulcers. About 61 (55.7%) were males and mean age of participants was 44.4 ± 14.7. After the gram stain was performed, about 77 (66.96%) of the patients with foot Ulcer developed infection. From the diabetes mellitus who had developed diabetic foot Ulcer, about 31 (26.96%) of Ulcer were located on dorsal/interdigital toes. About 49 (42.61%) of the diabetic foot Ulcer patients had previous history of Ulcer of any location. Of infected diabetic foot Ulcers, Forty two (54.55%) of microorganism isolated was gram positive. Conclusion: The incidence of diabetic foot Ulcer among diabetic patients in Nekemte referral hospital was high. Therefore, East wollega zone health sector and Nekemtereferal hospital diabetic clinic diabetic care providers should strive to reduce its incidence through enhancing the regular diabetic foot evaluation.

In Sung Song - One of the best experts on this subject based on the ideXlab platform.

  • omeprazole may be superior to famotidine in the management of iatrogenic Ulcer after endoscopic mucosal resection a prospective randomized controlled trial
    Alimentary Pharmacology & Therapeutics, 2006
    Co-Authors: Jae Hee Cheon, Kee Don Choi, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung, In Sung Song
    Abstract:

    Summary Background Acid suppressing agents are widely used to treat the iatrogenic Ulcers following endoscopic mucosal resection for gastric neoplasms. However, the relative merits of proton pump inhibitor or histamine2-receptor antagonist for endoscopic mucosal resection-induced Ulcers are not known. Aim To prospectively compare omeprazole and famotidine for the healing of endoscopic mucosal resection-induced Ulcers and for bleeding control. Methods After endoscopic mucosal resection, patients were randomly assigned to omeprazole (20 mg/day) or to famotidine (40 mg/day) group for a 28-day treatment period. The Ulcer sizes and stages, bleeding rates and Ulcer-related symptoms were compared. Results A total of 100 patients were randomized equally to each group. Forty-one patients in each group were finally compared. The two groups were comparable in terms of baseline characteristics. Twenty-eight days after treatment, the two groups were not different with respect to Ulcer stage (P = 0.137) or Ulcer reduction ratio (P = 0.380). No difference was observed with respect to Ulcer-related symptoms (P = 0.437) and no bleeding episode occurred in any of the 82 patients. In subgroup that underwent endoscopic submucosal dissection, fewer patients in the omeprazole group showed active Ulcers than those in the famotidine group (P = 0.035). Conclusion Our results demonstrate that omeprazole may be superior to famotidine for iatrogenic Ulcers following endoscopic mucosal resection, especially for large Ulcers.

Andrew J M Boulton - One of the best experts on this subject based on the ideXlab platform.

  • the effects of Ulcer size and site patient s age sex and type and duration of diabetes on the outcome of diabetic foot Ulcers
    Diabetic Medicine, 2001
    Co-Authors: Samson O Oyibo, Edward B Jude, I Tarawneh, H C Nguyen, David G Armstrong, Lawrence B Harkless, Andrew J M Boulton
    Abstract:

    AIMS: The outcome of foot Ulcers is affected by wound depth, infection, ischaemia and glycaemic control. The aim of this study was to determine the effects of Ulcer size, site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot Ulcers. METHODS: Diabetic patients with new foot Ulcers presenting during a 12-month period had demographics and Ulcer characteristics recorded at presentation. Ulcers were followed-up until an outcome was noted. RESULTS: One hundred and ninety-four patients (77% males) with a mean (+/- SD) age and duration of diabetes of 56.6 +/- 12.6 and 15.4 +/- 9.9 years, respectively, were included in the study. The majority of Ulcers were neuropathic (67.0%) and present on the forefoot (77.8%) with a median (interquartile range) area of 1.5 (0.6-4.0) cm2. Amputations were performed for 15% of Ulcers; 65% healed; 16% remained unhealed and 4% of patients died. The median (95% confidence interval) time to healing was 10 (8.8-11.6) weeks. Ulcer area at presentation was greater in the amputation group compared to healed Ulcers (3.9 vs. 1.2 cm2, P < 0.0001). Ulcer area correlated with healing time (rs = 0.27, P < 0.0001) and predicted healing (P = 0.04). Patient's age, sex, duration/type of diabetes, and Ulcer site had no effect on outcome. CONCLUSIONS: Ulcer area, a measure of Ulcer size, predicts the outcome of foot Ulcers. Its inclusion into a diabetic wound classification system will make that system a better predictor of outcome.

  • causal pathways for incident lower extremity Ulcers in patients with diabetes from two settings
    Diabetes Care, 1999
    Co-Authors: Gayle E. Reiber, Lawrence A Lavery, Loretta Vileikyte, Edward J Boyko, M Del Aguila, Douglas G Smith, Andrew J M Boulton
    Abstract:

    OBJECTIVE: To determine the frequency and constellations of anatomic, pathophysiologic, and environmental factors involved in the development of incident diabetic foot Ulcers in patients with diabetes and no history of foot Ulcers from Manchester, U.K., and Seattle, Washington, research settings. RESEARCH DESIGN AND METHODS: The Rothman model of causation was applied to the diabetic foot Ulcer condition. The presence of structural deformities, peripheral neuropathy, ischemia, infection, edema, and callus formation was determined for diabetic individuals with incident foot Ulcers in Manchester and Seattle. Demographic, health, diabetes, and Ulcer data were ascertained for each patient. A multidisciplinary group of foot specialists blinded to patient identity independently reviewed detailed abstracts to determine component and sufficient causes present and contributing to the development of each patient9s foot Ulcer. A modified Delphi process assisted the group in reaching consensus on component causes for each patient. Estimates of the proportion of Ulcers that could be ascribed to each component cause were computed. RESULTS: From among 92 study patients from Manchester and 56 from Seattle, 32 unique causal pathways were identified. A critical triad (neuropathy, minor foot trauma, foot deformity) was present in > 63% of patient9s causal pathways to foot Ulcers. The components edema and ischemia contributed to the development of 37 and 35% of foot Ulcers, respectively. Callus formation was associated with Ulcer development in 30% of the pathways. Two unitary causes of Ulcer were identified, with trauma and edema accounting for 6 and

Kee Don Choi - One of the best experts on this subject based on the ideXlab platform.

  • degree of healing and healing associated factors of endoscopic submucosal dissection induced Ulcers after pantoprazole therapy for 4 weeks
    Digestive Diseases and Sciences, 2009
    Co-Authors: Taehoon Oh, Hwoonyong Jung, Kee Don Choi, Ho June Song, Kwisook Choi, Junwon Chung, Jeongsik Byeon, Seungjae Myung, Sukkyun Yang
    Abstract:

    Background There is no consensus regarding the degree of healing of endoscopic submucosal dissection (ESD)-induced Ulcers and the optimal duration of proton pump inhibitor (PPI) treatment. Aim To evaluate the degree of healing and the factors associated with healing of ESD-induced Ulcers after PPI therapy for 4 weeks. Methods Fifty-six patients who underwent complete ESD for adenoma or early gastric cancer were enrolled. All patients underwent follow-up endoscopy to evaluate the degree of Ulcer healing after pantoprazole therapy (40 mg per day) for 4 weeks. We evaluated change in size of ESD-induced Ulcers between baseline and 4 weeks, and correlated relevant factors with degree of healing of small and large Ulcers. Results At follow-up, 28 (50%) patients had large Ulcers (area > 10 mm2). Ulcer size at 4 weeks was closely correlated with initial Ulcer size (P < 0.001) and abruptly increased when initial Ulcer size was larger than 4 cm. Comorbidity, procedure time, and initial specimen size were significantly associated with healing rate, but multivariate analysis showed that initial Ulcer size was the only significant parameter (P < 0.015). Conclusions Healing degree of ESD-induced Ulcers at 4 weeks is dependent on initial Ulcer size, indicating that duration of treatment with PPI should be dependent on initial Ulcer size.

  • omeprazole may be superior to famotidine in the management of iatrogenic Ulcer after endoscopic mucosal resection a prospective randomized controlled trial
    Alimentary Pharmacology & Therapeutics, 2006
    Co-Authors: Jae Hee Cheon, Kee Don Choi, Sang Gyun Kim, Joo Sung Kim, Hyun Chae Jung, In Sung Song
    Abstract:

    Summary Background Acid suppressing agents are widely used to treat the iatrogenic Ulcers following endoscopic mucosal resection for gastric neoplasms. However, the relative merits of proton pump inhibitor or histamine2-receptor antagonist for endoscopic mucosal resection-induced Ulcers are not known. Aim To prospectively compare omeprazole and famotidine for the healing of endoscopic mucosal resection-induced Ulcers and for bleeding control. Methods After endoscopic mucosal resection, patients were randomly assigned to omeprazole (20 mg/day) or to famotidine (40 mg/day) group for a 28-day treatment period. The Ulcer sizes and stages, bleeding rates and Ulcer-related symptoms were compared. Results A total of 100 patients were randomized equally to each group. Forty-one patients in each group were finally compared. The two groups were comparable in terms of baseline characteristics. Twenty-eight days after treatment, the two groups were not different with respect to Ulcer stage (P = 0.137) or Ulcer reduction ratio (P = 0.380). No difference was observed with respect to Ulcer-related symptoms (P = 0.437) and no bleeding episode occurred in any of the 82 patients. In subgroup that underwent endoscopic submucosal dissection, fewer patients in the omeprazole group showed active Ulcers than those in the famotidine group (P = 0.035). Conclusion Our results demonstrate that omeprazole may be superior to famotidine for iatrogenic Ulcers following endoscopic mucosal resection, especially for large Ulcers.