Rickettsia parkeri Rickettsiosis in Kidney Transplant Recipient, North Carolina, USA, 2023.

Spotted fever rickettsiosis is rarely observed in solid organ transplant recipients, and all previously reported cases have been associated with tick bite months to years after transplantation. We describe a kidney transplant recipient in North Carolina, USA, who had a moderately severe Rickettsia parkeri infection develop during the immediate posttransplant period.

Sexual activity at 1 year after total hip arthroplasty in Indian patients.

PURPOSE: This study aimed to report changes in sexual activity and related difficulties and concerns among Indian patients at the end of 1-year after primary total hip arthroplasty (THA). MATERIALS AND METHODS: A detailed questionnaire related to sexual difficulty, frequency, position, satisfaction, stress, and concerns pre- and postoperatively was administered through an in-person interview at 1-year post-THA. RESULTS: Preoperatively, 77% of patients reported difficulties in sexual activities, which reduced significantly (p < 0.0001) to 30% at the end of 1-year post-operatively. A majority of patients reported no change in the frequency (56.5%) or satisfaction with their sexual activity (54%), and moderate to severe stress (53%) related to sexual activity at 1 year postoperatively. A significantly higher percentage (p = 0.01) of female patients (63%) reported changing their coital position postoperatively due to difficulty in leg positioning when compared to male patients (37.5%). Most patients (69%) were not able to procure information on sexual activity after THA surgery. and only 17.5% of patients discussed the topic with their surgeon. CONCLUSION: Although THA significantly reduced difficulty in sexual activity, most patients reported no change in the frequency of sexual activity or sexual satisfaction, had moderate to severe stress regarding sex, and were primarily concerned about safety of coital position and fear of dislocation at the end of 1-year postoperatively. Pre- and postoperative counselling by their surgeons will provide the patient with relevant information and help reduce anxiety and stress, improve satisfaction, and enhance the overall sexual health of the patient undergoing primary THA.

Colorectal Cancer Risk and Recommendations for Colorectal Cancer Surveillance in Adult Survivors of Childhood Cancer.

While many organizations have published guidance on the approach to colorectal cancer (CRC) screening in average-risk and certain high-risk groups, adult survivors of childhood cancer (ASCC) who have a heightened risk of CRC are rarely included as a target group for enhanced CRC surveillance. The population of ASCC continues to grow due to increasingly effective cancer therapies and improved survival. With this increased survival comes an increased risk for subsequent malignant neoplasms, including CRC. Since there is little published guidance for CRC surveillance in ASCC and limited awareness of increased CRC risk among both physicians and patients, the objectives of our paper are to review the incidence of and risk factors for colorectal neoplasia in ASCC, describe the clinical phenotypes of colorectal neoplasia in ASCC, review published surveillance strategies based on consensus-based survivorship guidelines, and outline areas for future research to optimize surveillance strategies.

Dolichoectatic vertebrobasilar aneurysms: a systematic review and meta-analysis of management strategies and outcomes.

OBJECTIVE: The aim of this study was to describe the efficacy, clinical outcomes, and complications of open cerebrovascular surgery, endovascular surgery, and conservative management of dolichoectatic vertebrobasilar aneurysms (DVBAs). METHODS: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane databases according to PRISMA guidelines. A meta-analysis was conducted for clinical presentation, treatment protocols, and clinical outcomes-good (improved or stable clinical status) or poor (deteriorated clinical status or death)-and mortality rates. RESULTS: The 9 identified articles described 41 cases (27.5%) of open cerebrovascular surgery, 61 endovascular procedures (40.9%), and 47 cases (31.5%) of conservative management for DVBAs. The total cohort had a good outcome rate of 51.9% (95% CI 28.3%-74.6%), a poor outcome rate of 45.5% (95% CI 23.0%-70.1%), and a mortality rate of 22.3% (95% CI 11.8%-38.0%). The treatment groups had comparable good clinical outcome rates (open cerebrovascular surgery group: 24.7% [95% CI 2.9%-78.2%]; endovascular surgery group: 69.0% [95% CI 28.7%-92.5%]; conservative management group: 57.7% [95% CI 13.0%-92.5%]; p = 0.19) and poor outcome rates (open vascular surgery group: 75.3% [95% CI 21.8%-97.1%]; endovascular surgery group: 27.2% [95% CI 5.6%-0.70.2%]; conservative management group: 39.9% [95% CI 9.1%-81.6%]; p = 0.15). The treatment groups also had comparable mortality rates (open vascular surgery group: 39.5% [95% CI 11.4%-76.8%]; endovascular surgery group: 15.8% [95% CI 4.4%-43.0%]; conservative management group: 19.2% [95% CI 6.8%-43.5%]; p = 0.23). CONCLUSIONS: The current study of DVBAs illustrated poor outcomes and high mortality rates regardless of the treatment modality. The subgroup analysis showed heterogeneity among the subgroups and advice for personalized management.

Primary constrained condylar knee arthroplasty in severe varus deformity: a prospective 5-year functional follow-up study in Iraqi patients.

PURPOSE: The outcomes of the constrained condylar knee (CCK) implant used during primary total knee arthroplasty (TKA) in knees with severe varus in patients from low- and middle-income countries (LMICs) such as Iraq are not known. Hence, this study aimed to analyze and report the functional outcome of CCK TKA in patients with severe varus deformities at the end of 5 years in Iraqi patients. METHODS: In this prospective study, pre- and post-operative (at the end of 5 years) clinical outcome using Knee Society Score (KSS) and radiological deformity using hip-knee-ankle (HKA) angle was analyzed in 76 CCK TKAs (20 bilateral and 36 unilateral TKAs) performed in 56 patients with severe varus deformity (> 15°). RESULTS: At a mean follow-up of 60.3 months (range 60-68 months), the mean preoperative KSS knee score of 6.6 ± 4.5 improved significantly (p < 0.0001) to 87.2 ± 6.6 and the mean preoperative KSS function score of 7.1 ± 6.4 improved significantly (p < 0.0001) to 70.4 ± 7.8. The function score was good to excellent in 64.3% (36 patients), fair in 28.5% (16 patients), and poor in 7.1% (4 patients) at the end of 5 years. The mean preoperative HKA angle significantly improved (p < 0.001) from 25.5° ± 6° varus (range 17°-37°) to 3° ± 2.5° varus (range 0°-7.5°) at final follow-up. CONCLUSION: The CCK implant significantly improved pain and function in patients with severe varus deformity at the end of 5 years. The CCK implant is a good option during primary TKA in severe varus knees in patients from LMICs and can help achieve clinical outcomes similar to patients from high-income countries.

Predictors of failure to achieve minimal clinical important difference for pain and disability after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain: a retrospective analysis of 4998 patients.

PURPOSE: To determine predictors of failure to achieve minimal clinical important difference (MCID) for pain and disability at discharge after mechanical diagnosis and therapy (MDT)-based multimodal rehabilitation for neck pain (NP). METHODS: Pre- and post-treatment numerical pain rating scale (NPRS) and neck disability index (NDI) in patients with mechanical NP were analysed in this retrospective study. Multivariate analysis was performed to investigate the effect of covariates such as age, gender, lifestyle, body mass index, presentation, diabetes, osteoporosis, response to repeated movement testing, treatment sessions, compliance rate, and pre-treatment NPRS and NDI scores on failure to achieve MCID of ≥ 30% for NPRS and NDI scores post-treatment. RESULTS: In the 4998 patients analysed for this study, 7% and 14.5% of patients failed to achieve MCID for NPRS and NDI scores, respectively, at the end of treatment. Age > 70 years, diabetes, osteoporosis, partial or non-response to repeated movements, lesser treatment sessions, and lower compliance rate were associated with increased risk for failure to achieve MCID for NPRS and NDI scores. A higher pre-treatment NDI score was associated with failure to achieve MCID for NPRS score, whereas lower pre-treatment NPRS and NDI scores were associated with failure to achieve MCID for NDI score. CONCLUSION: Although MDT-based multimodal rehabilitation helped to achieve significant reduction in pain and disability in mechanical NP, several baseline risk factors were associated with failure to achieve MCID for pain and disability after treatment. Identifying and modifying these factors as part of rehabilitation treatment may help to achieve better outcomes in mechanical NP.

Impact of the intersection of anaesthesia and gender on burnout and mental health, illustrated by the COVID-19 pandemic.

Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.

Efficacy of an integrated, active rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain.

PURPOSE: This retrospective study aimed to determine the efficacy of an integrated active, rehabilitation protocol in patients ≥ 65 years of age with chronic mechanical low back pain and compare the results in similar patients in 50-64 years age group. METHODS: Pre- and post-treatment mean numerical pain rating scale (NPRS) score, mean Oswestry disability index (ODI) score, treatment outcome category and minimal clinically important difference (MCID) thresholds achieved for NPRS and ODI scores post-treatment were compared among 697 patients in the 50-64 years and 495 patients in the ≥ 65 years age groups. RESULTS: At a mean treatment duration of 57 days (range, 30-90 days), both mean NPRS score (p < 0.0001) and mean ODI score (p < 0.0001) were significantly higher in the ≥ 65 years age group when compared to the 50-64 years age group. However, post-treatment outcome categories (p = 0.17) and percentage of patients who achieved MCID thresholds for NPRS score (p = 0.13) and ODI score (p = 0.18) were not significantly different between the two groups. There was a significant correlation between post-treatment NPRS score and patient age and pre-treatment NPRS score and between post-treatment ODI score and incidence of osteoporosis and pre-treatment ODI score. CONCLUSION: Although mean NPRS and ODI scores achieved were significantly better in patients of 50-64 years of age, our integrated active, rehabilitation protocol helped achieve significant improvement in NPRS score, MCID thresholds for NPRS and ODI scores and treatment outcomes in patients ≥ 65 years of age, similar to patients in the 50-64 years of age group, at the end of 3 months of treatment. These slides can be retrieved under Electronic Supplementary Material.

Modifiable Clinical Correlates of Vascular Health in Children and Adolescents with Dyslipidemia.

Atherosclerosis promoting cardiovascular disease risk factors (CVDrf) are highly prevalent among youth in the U.S. Determining which standard modifiable clinical measures (SMCMs) has the greatest impact on vascular structure and function is valuable for the health care provider to help identify children at highest risk. The aim of this study was to determine modifiable outpatient clinical predictors of vascular health in youth with CVDrf. Children and adolescents with CVDrf (n = 120, 13.1 ± 1.9 years, 49% female) were recruited from a pediatric preventive cardiology clinic. The SMCMs included BMI z-score, waist-to-height ratio (WTHR), lipid panel, hemoglobin A1c, blood pressure (BP), presence of tobacco smoke exposure, and presence of hypertriglyceridemic waist (HTW) phenotype (triglycerides ≥ 110 mg/dL and waist circumference ≥ 90 percentile). Vascular function and structure were measured with pulse wave velocity (PWV), central systolic BP (CSP), augmentation index (AIx), and carotid artery intima-media thickness (cIMT). Sex and height specific z-scores for PWV, CSP, and cIMT were used. Multiple linear regression with backwards selection identified SMCMs which strongly predicted vascular function and structure. Among SMCMs, WTHR and HTW were the most frequent predictors of vascular function (PWV: R2 = 0.32; CSP: R2 = 0.35; AIx R2 = 0.13). Other predictors of vascular function included hemoglobin A1C, BP, and BMI z-score. Systolic BP and LDL cholesterol were predictors of vascular structure (cIMT: R2 = 0.14). The strongest predictors of vascular health in youth with CVDrf were related to measures of central obesity. Targeting these SMCM in lieu of vascular testing in outpatient clinic setting may be practical to identify children and adolescents at greatest risk for CVD.

The Effectiveness of Accelerated Skill Acquisition Program for Upper Extremity Motor Training in Bilateral Stroke.

The bilateral stroke is an added challenge for functional recovery. The evidence of effective therapy intervention for bilateral stroke is rare. A protocol of 30 hours (5 hours/week for 6 weeks) of accelerated skill acquisition program (ASAP) has been administered to a patient with bilateral ischemic middle cerebral artery syndrome at sub-acute stage. Two sessions per day (separately for right and left) were administered. Nepali Wolf Motor Function Test (WMFT) was used to evaluate performance time before and after the treatment. The performance time on Wolf Motor Function Test got largely and consistently reduced on all items of both extremities. There was improvement in grip strength and weight lifting items. Bilateral hand items and turn key in lock were successfully completed after the treatment. Thus, the accelerated skill acquisition program yielded large reduction in performance time, improved hand skills and demonstrated functional improvement of both upper extremities in individual with bilateral stroke.

Control of clinical paratuberculosis in New Zealand pastoral livestock.

This review summarises current control measures for clinical paratuberculosis (Johne's disease; JD) in New Zealand pastoral livestock. Most New Zealand sheep, deer, beef and dairy cattle herds and flocks are infected by Mycobacterium avium ssp. paratuberculosis (Map). Dairy cattle and deer are mostly infected with bovine (Type II), and sheep and beef cattle with ovine (Type I) strains. Control in all industries is voluntary. While control in sheep and beef cattle is ad hoc, the dairy and deer industries have developed resources to assist development of farm-specific programmes. The primary target for all livestock is reduction of the incidence rate of clinical disease rather than bacterial eradication per se. For dairy farms, a nationally instituted JD-specific programme provides guidelines for risk management, monitoring and testing clinically suspect animals. While there is no formal programme for sheep farms, for those with annual prevalences of clinical disease >2%, especially fine wool breeds, vaccination may be a cost effective control option. The deer industry proactively monitors infection by a national abattoir surveillance programme and farmers with an apparent high disease incidence are encouraged to engage with a national network of trained consultants for management and control advice. Evaluation of the biological and economic effectiveness of control in all industries remains to be undertaken. Nevertheless, opportunities exist for farmers, who perceive significant JD problems in their herds/flocks, to participate in systematic best-practice activities that are likely to reduce the number of clinical infections with Map on their farms, and therefore the overall prevalence of JD in New Zealand's farming industries.

Open-wedge high tibial osteotomy versus unicompartmental knee arthroplasty: no difference in progression of patellofemoral joint arthritis.

PURPOSE: The purpose of this retrospective comparative study was to evaluate and compare, radiographically and clinically, progression of osteoarthritis (OA) in the patellofemoral (PF) compartment after open-wedge high tibial osteotomy (OWHTO), and unicompartmental knee arthroplasty (UKA) over a minimum follow-up of 5 years. METHODS: In this study, 42 knees in an OWHTO group were compared with 59 knees in a UKA group in terms of radiographic parameters, such as the grading system for OA progression in the PF compartment, and clinical parameters, such as the PF pain and function scores over a minimum follow-up of 5 years. RESULTS: There was no significant difference of OA progression in the PF compartment between the two groups on knee radiography. Compared with the preoperative grades, the UKA group showed significant progression of OA in the medial PF compartment at the final follow-up, whereas the medial PF compartment showed significant stepwise progression by only one grade when compared to the OWHTO group. The PF pain and function scores showed no statistical differences between the two groups at the final follow-up, regardless of OA progression. CONCLUSIONS: There was no significant difference between OWHTO and UKA in terms of progression of OA in the PF compartment or deterioration of PF function score over a minimum follow-up of 5 years. However, the medial PF compartment of the UKA group was minimal, and worsened or progressed by only one grade. LEVEL OF EVIDENCE: III.

Mobile-bearing medial unicompartmental knee arthroplasty restores limb alignment comparable to that of the unaffected contralateral limb.

Background and purpose - Medial unicompartmental knee arthroplasty (UKA) is undertaken in patients with a passively correctable varus deformity. We investigated whether restoration of natural soft tissue tension would result in a lower limb alignment similar to that of the contralateral unaffected lower limb after mobile-bearing medial UKA. Patients and methods - In this retrospective study, hip-knee-ankle (HKA) angle, position of the weight-bearing axis (WBA), and knee joint line obliquity (KJLO) after mobile-bearing medial UKA was compared with that of the unaffected (clinically and radiologically) contralateral lower limb in 123 patients. Results - Postoperatively, HKA angle was restored to within ±3° of the contralateral lower limb in 87% of the patients and the WBA passed within ±1 Kennedy and White's tibial zone of the unaffected contralateral lower limb in 95% of the patients. The mean KJLO in the operated limbs was not significantly different from that in the unaffected lower limbs (p = 0.07) and the KJLO in the operated limb was restored to within ±3° of that in the contralateral lower limb in 96% of the patients. Interpretation - Lower limb alignment and knee joint line obliquity after mobile-bearing medial UKA were comparable to that of the unaffected contralateral limb in most patients. Comparison with the contralateral unaffected lower limb is a reliable method for evaluation and validation of limb mechanical alignment after mobile-bearing medial UKA.

Role of neurokinin type 1 receptor in nociception at the periphery and the spinal level in the rat.

OBJECTIVES: Noxious stimuli activate small to medium-sized dorsal root ganglion (DRG) neurons. Intense noxious stimuli result in the release of substance P (SP) from the central terminals of these neurons. It binds to the neurokinin type 1 receptor (NK1r) and sensitises the dorsal horn neurons. SP is also released from the peripheral terminals leading to neurogenic inflammation. However, their individual contribution at spinal and peripheral levels to postincisional nociception has not been delineated as yet. METHODS: Sprague-Dawley rats were administered different doses (3-100 µg) of an NK1r antagonist (L760735) by intrathecal (i.t.) route before hind paw incision. On the basis of its antinociceptive effect on guarding behaviour, the 30 µg dose was selected for further study. In different sets of animals, this was administered i.t. (postemptive) and intrawound (i.w.). Finally, in another group, drug (30 µg) was administered through both i.t and i.w. routes. The antinociceptive effect was assessed and compared. Expression of SP was examined in the spinal cord. Intrawound concentration of SP and inflammatory mediators was also evaluated. RESULTS: Postemptive i.t. administration significantly attenuated guarding and allodynia. Guarding was alone decreased after i.w. drug treatment. Combined drug administration further attenuated all nociceptive parameters, more so after postemptive treatment. Expression of SP in the spinal cord decreased post incision but increased in the paw tissue. Inflammatory mediators like the nerve growth factor also increased after incision. CONCLUSION: In conclusion, SP acting through the NK1r appears to be an important mediator of nociception, more so at the spinal level. These findings could have clinical relevance.

Clinical Outcome of Posterior Cruciate Ligament Reconstruction With and Without Remnant Preservation.

PURPOSE: The purpose of this study was to analyze clinical outcomes in patients who underwent posterior cruciate ligament reconstruction (PCLR) with and without remnant preservation. METHODS: A search of the literature was performed with the established medical databases Medline, Embase, and the Cochrane Register. Two authors screened the selected articles for title, abstract, and full text in accordance with predefined inclusion and exclusion criteria. The inclusion criteria were as follows: English-language articles on isolated posterior cruciate ligament injury; clinical trials with a clear description of surgical technique; outcome evaluation using a well-defined knee score, arthrometry, and posterior stress radiography; follow-up longer than 2 years; and a Coleman Methodology Score (CMS) of 65 points or greater. The methodologic quality of all articles was assessed by 2 authors according to the CMS. RESULTS: Eleven studies were included, with a mean CMS of 78.9 points (SD, 5.37 points). There was no direct comparative study between remnant-preserving PCLR and standard PCLR. At final follow-up, the knees of 72% to 100% of patients who underwent remnant-preserving PCLR and 41% to 95% of patients who underwent standard PCLR were rated as normal or nearly normal on the International Knee Documentation Committee subjective knee assessment. Patients who underwent remnant-preserving PCLR showed an increase of 16.4 to 47 points in Lysholm scores, and patients who underwent standard PCLR showed an increase of 22 to 29 points. The ranges of mean postoperative side-to-side differences on KT-1000 (MEDmetric, San Diego, CA) testing were 0.7 to 2.8 mm in patients who underwent remnant-preserving PCLR and 1 to 3.5 mm in patients who underwent standard PCLR. The ranges of mean postoperative side-to-side differences on stress radiography were 2.2 to 5 mm in patients who underwent remnant-preserving PCLR and 4.7 to 6 mm in patients who underwent standard PCLR. CONCLUSIONS: All studies on PCLR with remnant preservation showed satisfactory outcomes despite using numerous surgical techniques, graft types, intervals from injury to surgery, and follow-up periods. LEVEL OF EVIDENCE: Level IV, systematic review of Level II through IV studies.

Health-seeking behaviour of elderly individuals: A community-based cross-sectional study.

BACKGROUND: The health-seeking behaviour of elderly individuals can help in ascertaining the determinants and in developing appropriate policies for their healthcare. METHODS: In this community-based cross-sectional study, we included 250 elderly persons above 60 years of age living in the urban field practice area of Shri Vasantrao Naik Government Medical College, Yavatmal, Maharashtra. We used a structured proforma to collect information about their health-seeking behaviour. RESULTS: Overall, 48% of the study subjects chose an allopathic practitioner. The difference in the health-seeking behaviour for self-treatment, treatment from traditional healers and paraprofessionals as one group and allopathic treatment as another group was significant for the determinants of age (p<0.001), educational level (p<0.0001) and poverty status (p=0.0007) and registration under any government scheme (p=0.0446). The average expenditure on health was significantly more among those who were above 75 years of age, employed, educated and above the poverty line, irrespective of gender. CONCLUSION: Elderly persons who prefer allopathic treatment are likely to be above 75 years of age, those having some education and those above poverty line.

Effectiveness of device-based therapy for conservative management of low back pain.

[Purpose] Device based therapy for low back pain (LBP) involves quantitative assessment of muscle strength, resistance and lumbar motion and tailoring the rehabilitation protocol based on this objective assessment. The purpose of this study was to determine the effectiveness of device based therapy for LBP. [Subjects and Methods] In this retrospective study, clinical data of 235 patients who underwent device-based physiotherapy for low back pain was reviewed. Pre and post-treatment outcome measures for pain (visual analogue scale or VAS score), disability (Oswestry disability index) and functional ability were compared to determine effectiveness of device-based physiotherapy at the end of 6 weeks of treatment. [Results] All outcome measures including VAS Score and mean Oswestry Disability Score showed significant improvement at the end of 6 weeks of device-based physical therapy. Before treatment, 73% of patients had moderate to severe disability which reduced to 28% after treatment. [Conclusion] Device-based therapy is effective in relieving pain, improving function and reducing disability in patients with low back pain in the short term. Device-based therapy may help to objectively evaluate the function of the spine and paraspinal muscles and help the therapist tailor treatment accordingly.

Correction of varus deformity during TKA with reduction osteotomy.

BACKGROUND: Reduction osteotomy (removing the posteromedial tibial bony flare) is one step to aid in achieving deformity correction in varus arthritic knees during TKA. However, the amount of deformity correction achieved with reduction osteotomy during TKA is unclear. QUESTIONS/PURPOSES: We therefore addressed the following questions: (1) What is the amount of deformity correction achieved with reduction osteotomy during TKA in varus knees? (2) What is the correlation of amount of deformity correction achieved to the amount of bone osteotomized and the degree of varus deformity? METHODS: We prospectively collected and analyzed intraoperative data on the degree of varus deformity before and after reduction osteotomy (using computer navigation) and the amount of reduction osteotomy performed (using a measuring scale) in 71 primary, computer-assisted TKAs. RESULTS: For a mean reduction osteotomy of 7.5 ± 2 mm, a mean correction of 3.5° ± 1° was achieved; a mean osteotomy of 2 mm was required (confidence interval, 1.7-2.6 mm) for every 1° correction of varus deformity. Degree of varus correction achieved correlated positively with the amount of osteotomy performed, especially in knees with preoperative varus deformity of < 15° (r = 0.77, p < 0.001) and the preosteotomy residual varus deformity correlated positively with the amount of correction achieved (r = 0.81, p < 0.001). CONCLUSIONS: Reduction osteotomy can achieve deformity correction in a predictable 2 mm for 1° in most varus arthritic knees during TKA. Further studies are required to ascertain its effectiveness as a soft tissue-sparing step when performed early on during TKA to achieve deformity correction.

In vivo healing potential of Aegle marmelos in excision, incision, and dead space wound models.

The study incorporates the wound healing potential of Aegle marmelos fruit pulp extract (AME) on excision, incision, and dead space wound models in rats. AME (200 mg/kg) was administered orally once daily for variable days depending on the type of wound ulcer study. AME was studied for its wound breaking strength (incision wound), rate of contraction, period of epithelization and histology of skin (excision model), and granulation tissue free radicals, antioxidants, acute inflammatory marker, and connective tissue markers and deep connective tissue histology (dead space wound). Complete wound contraction and epithelization were observed at the 20th day after treatment with AME as compared to the 24th day in control rats. Mean epithelization period and scar area were decreased while wound breaking strength was increased with AME compared with control. Granulation tissue showed increased levels of collagen determinants (33.7 to 64.4%, P < 0.001) and antioxidants (13.0 to 38.8%, P < 0.05 to P < 0.001), whereas markers of oxidative stress (55.0 to 55.6%, P < 0.001) and myeloperoxidase (21.3%, P < 0.001) were decreased in AME treated group. A. marmelos seems to promote wound healing by enhancing connective tissue formation and antioxidants status with decrease in free radicals and myeloperoxidase having tissue damaging effects.