[Prevalence of Bell's phenomenon and changes after surgery for aponeurotic ptosis]. / Prévalence du réflexe de Charles Bell et évolution postopératoire dans la chirurgie du ptosis aponévrotique.

BACKGROUND: Ptosis surgery is common in oculoplastics, and its most threatening complication is corneal ulceration. Several factors have been associated with postoperative corneal disorders, such as the strength of the orbicularis muscle, the type of surgery performed, and the Bell's phenomenon reflex (BPR). The goal of this study was to investigate the prevalence of physiological BPR, absence of BPR, and presence of inverse BP in patients undergoing surgery for aponeurotic ptosis. The changes in the BPR during the postoperative course as well as the occurrence of corneal complications were also studied. MATERIALS AND METHODS: A retrospective study was conducted at the University Hospital of Nice from January 2018 to December 2023. Patients operated on for aponeurotic ptosis were included. Patients with myogenic or neurogenic ptosis or with missing data were excluded. Data were recorded preoperatively and one month postoperatively and included: eyelid height, orbicularis muscle strength, prevalence of BPR, lack of BPR, inverse BPR, and postoperative corneal ulcer. RESULTS: Ninety-eight eyelids of 57 patients were included over the study period. Preoperatively, the prevalence of physiological BPR, no BPR, and inverse BPR were 71.4%, 18.4%, and 10.2%, respectively. At one month postoperatively, 30.6% of patients experienced a change in BPR (p=0.004). The postoperative prevalence of BPR, no BPR, and inverse BPR were 77.5%, 17.4%, and 5.1%, respectively. The rate of postoperative corneal ulcers was 1.02%. CONCLUSION: Among patients operated on for aponeurotic ptosis, the prevalence of physiological BPR was 71.4% preoperatively. Approximately one-third of patients experienced a change in BPR one month postoperatively with a postoperative physiological BPR prevalence of 77.5%. The rate of corneal complications was low.

Collaboration and Partnership in a 5-Level Engagement Framework for Diabetic Foot Ulcer Management: A Patient-oriented Scoping Review.

OBJECTIVE: The management of diabetic foot ulcers (DFUs) is complex, and patient engagement is essential for DFU healing, but it often comes down to the patient's consultation. Therefore, we sought to document patients' engagement in terms of collaboration and partnership for DFUs in 5 levels (direct care, organizational, policy level, research, and education), as well as strategies for patient engagement using an adapted engagement framework. METHODS: We conducted a scoping review of the literature from inception to April 2022 using the Joanna Briggs Institute method and a patient-oriented approach. We also consulted DFU stakeholders to obtain feedback on the findings. The data were extracted using PROGRESS+ factors for an equity lens. The effects of engagement were described using Bodenheimer's quadruple aims for value-based care. RESULTS: Of 4,211 potentially eligible records, 15 studies met our eligibility criteria, including 214 patients involved in engagement initiatives. Most studies were recent (9 of 15 since 2020) and involved patient engagement at the direct medical care level (8 of 15). Self-management (7 of 15) was the principal way to clinically engage the patients. None of the studies sought to define the direct influence of patient engagement on health outcomes. CONCLUSIONS: Very few studies described patients' characteristics. Engaged patients were typically men from high-income countries, in their 50s, with poorly managed type 2 diabetes. We found little rigorous research of patient engagement at all levels for DFUs. There is an urgent need to improve the reporting of research in this area and to engage a diversity of patients.

[Technical Orthopedics - Chronic Diabetic Foot Wounds]. / Technische Orthopädie ­ Chronische Wunden im Bereich der diabetischen Füsse.

Technical Orthopedics - Chronic Diabetic Foot Wounds Abstract: Chronic foot wounds are a very common and a growing problem. This review focuses on the treatment and the prophylaxis of diabetic foot ulcers from the perspective of technical orthopedics. Diabetic foot ulcers are of great importance for those affected, in particular because of the risk of infections and resulting amputations. With a good prophylaxis and consistent treatment, these complications can often be avoided.

Particle size distribution in commercial pig compound feeds in Switzerland: survey and methodological considerations.

INTRODUCTION: The grinding intensity of pig feed is considered one potential predisposing factor for gastric ulcers, and a variety of particle size recommendations have been published for pig feeds. We subjected 51 different commercial compound feeds for pigs (38 meals, 13 pellets/granulates) to dry and/or wet sieve analysis. The amount of particles passing the finest sieve (or being soluble) was estimated by the difference to the total dry matter weighed prior to sieving. Mean particle size was calculated based on the weighted average of the material retained on the sieves (MPSsieves), and additionally with accounting for this lost material (MPStotal). Dry sieve analysis of the meals yielded MPSsieves of 0,58-2,90 mm and MPStotal of 0,58-2,89 mm; only 0,02 to 2,71 % of the dry matter passed all sieves. Wet sieve analysis of all meals and pellets yielded similar MPSsieves of 0,63-1,66 mm, but dramatically lower MPStotal of 0,26-1,04 mm; between 35 and 66 % of the dry matter was not retained on the sieves. Pellets had smaller MPS, and a higher proportion of particles passing all sieves than meals. Depending on the reference used, a maximum of 26 % of meals conformed to recommendations for pig feed particle size. None of the pelleted feeds met these criteria, irrespective of the source consulted for the recommendation. Wet sieving should be considered the standard analysis, because in dry sieving, very fine particles adhering to larger particles may not be registered separately but contribute erroneously to larger particle weight. In addition, the MPS calculation should account for material lost through the finest sieve. Reasons why Swiss pig feed does not meet particle size recommendations should be further investigated.

INTRODUCTION: L'intensité de broyage des aliments pour porcs est considérée comme un facteur potentiel de prédisposition aux ulcères gastriques et diverses recommandations sur la taille des particules ont été publiées pour les aliments pour porcs. Nous avons soumis 51 différents aliments composés commerciaux pour porcs (38 farines, 13 pellets/granulés) à une analyse par tamisage à sec et/ou humide. La quantité de particules passant le tamis le plus fin (ou étant solubles) a été estimée par la différence avec la matière sèche totale pesée avant le tamisage. La taille moyenne des particules a été calculée sur la base des moyennes pondérées du matériel retenu sur les tamis (MPSsieves) en tenant compte en plus du matériel perdu (MPStotal). L'analyse des mélanges par tamisage à sec a donné des MPSsieves de 0,58­2,90 mm et des MPStotal de 0,58­2,89 mm ; seule 0,02 à 2,71 % de la matière sèche a passé tous les tamis. L'analyse par tamisage humide de toutes les farines et des granulés a donné des MPSsieves similaires de 0,63­1,66 mm, mais des MPStotal nettement inférieurs de 0,26­1,04 mm ; entre 35 et 66 % de la matière sèche n'a pas été retenue sur les tamis. Les granulés présentaient des MPS plus faibles et une proportion plus élevée de particules passant par tous les tamis que les farines. Selon la référence utilisée, un maximum de 26 % des farines étaient conformes aux recommandations relatives à la taille des particules des aliments pour porcs. Aucun des aliments granulés ne répondait à ces critères, quelle que soit la source consultée pour la recommandation. Le tamisage humide devrait être considéré comme l'analyse standard car, dans le tamisage sec, les particules très fines adhérant à des particules plus grosses peuvent ne pas être enregistrées séparément mais contribuer de manière erronée au poids des particules plus grosses. En outre, le calcul du MPS devrait tenir compte de la matière perdue par le tamis le plus fin. Les raisons pour lesquelles les aliments pour porcs suisses ne répondent pas aux recommandations sur la taille des particules devraient être étudiées plus en détail.

Physical Activity Participation in People With an Active Diabetic Foot Ulceration: A Scoping Review.

BACKGROUND: Being physically active on a regular basis has a favourable impact on diabetes-related complications. With the exception of evidence advising individuals with an active diabetic foot ulceration (DFU) to avoid weight-bearing activity, no physical activity (PA) recommendations are currently provided for this population. OBJECTIVE: The aim of this scoping review was to examine and map the existing research evidence of PA participation for individuals with an active DFU. DESIGN: A scoping review using the Arksey and O'Malley framework was conducted in electronic databases and grey literature from inception to June 2020 to identify publications that investigated individuals with type 1 or type 2 diabetes and an active DFU at enrolment in relation to a PA intervention. Reported outcomes had to inform on effects of PA on any health or wound parameters. RESULTS: Nineteen articles from 17 distinct studies met inclusion criteria. Fourteen of the included studies were published in the last 10 years. Types of exercises and materials used, duration of studies, offloading considerations and provision of wound care varied greatly between studies. Included studies are heterogenous in methodological designs and aims, and reporting was often lacking important components of wound care and PA interventions. A discussion based on descriptive statistics and narrative analysis is provided. CONCLUSIONS: It is not possible from this scoping review to determine what would be the ideal components of a PA program for this specific population. Conclusions are limited by the quality and design of the included studies. No articles evaluated quality of life, mortality or cardiorespiratory capacity, nor were adverse effects routinely reported.

Economic Evaluation of Sucrose Octasulfate Dressing for Treatment of Diabetic Foot Ulcers in Patients with Type 2 Diabetes.

OBJECTIVES: Patients with noninfected neuroischemic diabetic foot ulcers (DFUs) treated with sucrose octasulfate (SOS) dressing have been shown to have improved healing compared with patients wearing a similar type of dressing without SOS. In this study, we aimed to estimate the cost-effectiveness of SOS dressing compared with conventional dressings from a Canadian public payer's perspective. METHODS: We built a Markov model in a hypothetical cohort of 1,000 inpatients with type 2 diabetes with DFUs. The time horizon was 5 years, and the cycle length was 3 months. We incorporated effectiveness data from the Explorer trial and cohort studies, cost data (2020 Canadian dollars) from published Canadian studies and administrative databases, and utility parameters from the Alberta's Caring for Diabetes cohort. We used probabilistic analysis to calculate the incremental cost-effectiveness ratio of SOS dressing compared with conventional dressings. RESULTS: In the comparison with conventional dressings, use of SOS dressing resulted in an expected increase of 0.16 quality-adjusted life-year (QALY) and an expected $5,878 decrease in health-care costs over 5 years. Adding SOS dressing resulted in a cost savings of $37,061 for every QALY gained. The probability that adding SOS dressing is cost-saving and cost-effective compared with conventional dressings was 89% and 86%, respectively, at a $50,000/QALY willingness-to-pay threshold. CONCLUSIONS: SOS dressing accelerates ulcer healing and helps reduce the spending induced by persistent ulcer management and amputation. Therefore, SOS dressing is likely to be cost-effective and cost-saving, which is consistent with previous health technology assessments in other health-care systems.

Ulcère Perforé-Bouché: A Case Report.

Peptic ulcer disease refers to a break in the gastric or duodenal mucosal wall extending into the muscular mucosa. Although peptic ulcer disease commonly presents with dyspepsia, about 70% of patients initially present asymptomatically. A perforated peptic ulcer is a life-threatening complication of peptic ulcer disease that has high morbidity and mortality and requires emergent surgery. To prevent complications of peptic ulcer disease, an extensive history, physical examination, and appropriate imaging are required for appropriate management. In addition, the use of appropriate imaging and diagnostic modalities, such as an oral contrast computerized tomography of the abdomen, may lead to emergent treatment if complications arise. We present a unique case of a contained perforated duodenal ulcer within a fistula tract (Ulcère Perforé-Bouché) and diagnostic tools yielding detection and treatment of an Ulcère Perforé-Bouché. Abdominal x-rays may be inadequate the detect Ulcère Perforé-Bouché. However, an oral contract computerized tomography of the abdomen may have greater detection capabilities to diagnose cases of Ulcère Perforé-Bouché.

Adequacy Between Canadian Clinical Guidelines and Recommendations Compared With International Guidelines for the Management of Diabetic Foot Ulcers.

OBJECTIVES: Although quality of care in the prevention and management of diabetic foot ulcer (DFU) has improved with the use of comprehensive evidence-based clinical practice guidelines, disparities between national and international guidelines have been demonstrated in one study conducted in Western Pacific regions. Although there are challenges of systematic implementation of evidence-based care in some clinical settings, their applications have demonstrated positive outcomes on DFU-associated burdens in many countries. The aim of this study was to review and evaluate 3 Canadian clinical practice guidelines and recommendations (CPGRs) in comparison with the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines. METHODS: Extraction of all 85 recommendations from the IWGDF guidelines was performed and 3 independent investigators used a rating recommendations adequacy method with descriptive statistics. The Appraisal of Guidelines REsearch & Evaluation (AGREE) II instrument was used for quality appraisal, and reliability scores were noted using intraclass correlation coefficients. RESULTS: The Wounds Canada CPGR had the higher adequacy with the IWGDF guidelines. However, its development method was poor to fair. The Registered Nurses' Association of Ontario CPGR was superior for its development and implementation strategies, but major gaps were found in all chapters. The Diabetes Canada CPGR obtained a good quality appraisal evaluation, but was not dedicated exclusively to DFU and some important recommendations were absent. Reliability scores of AGREE II were good between investigators (p<0.0001). Some disparities were noted between Canadian and international recommendations. CONCLUSIONS: Some disparities were noted, future orientations for development should include various health-care professionals involved in the team approach, patient-oriented research, recommendations published along with their level of evidence and strength of recommendations (such as with the Grading of Recommendations, Assessment, Development and Evaluations system) and implementation strategies to enhance evidence-based practice in Canada.

Prevalence and Risk Evaluation of Diabetic Complications of the Foot Among Adults With Type 1 and Type 2 Diabetes in a Large Canadian Population (PEDAL Study).

OBJECTIVES: The lower limb complications of diabetes contribute significantly to patient morbidity and health-care costs in Canada. Despite practice guidelines, awareness of and screening for modifiable early pathologies has been inconsistent. Our study objective was to determine the prevalence and types of early foot pathology in a large, Canadian, community care-based diabetes population. METHODS: This study was a retrospective, observational analysis of the LMC Diabetes & Endocrinology foot care program launched in 2017. We examined foot pathologies associated with vascular, nerve, nail and dermatologic complications, as well as foot deformities. Individuals ≥18 years of age with diabetes, assessed by an LMC chiropodist in Ontario between February 2018 and April 2019, were included in the analysis. RESULTS: Of the 5,084 individuals assessed, 470 with type 1 diabetes and 3,903 with type 2 diabetes met the study criteria. Mean age, body mass index and diabetes duration were 61.5 years, 31.3 kg/m2 and 13.9 years, respectively. Reduced pedal pulses, sensory neuropathy and onychomycosis were reported in 8.9%, 16.7% and 14.5% of those in the type 1 diabetes group, and in 19.4%, 26.6% and 28.7% of those in the type 2 group, respectively. Hyperkeratosis was present in 51% and foot deformities were present in 44.5% among both groups. Foot ulcer prevalence was 1.7%, and pedal pulses, sensory neuropathy, hyperkeratosis and onychauxis, adjusted for age, sex, body mass index and diabetes duration, were each significantly associated with ulceration. CONCLUSIONS: In a large foot screening program of community-based adults with diabetes, modifiable early foot pathologies were prevalent and provided further evidence of the value of consistent screening to alleviate the morbidity and economic burden of lower limb complications.

Possible protective effect of TNF-α inhibition and triad NO/cGMP/VEGF activation on gastric ulcer in rats.

Peptic ulcers are one of the world's major gastrointestinal disorders, embracing both gastric and duodenal ulcers, and affecting 10% of the world population. The current study aimed to investigate the possible protective effect of tadalafil and pentoxifylline (PTX) on indomethacin-induced peptic ulcers. Male albino rats were divided into five groups: control group; ulcerated group; Indomethacin + Tadalafil, in which animals were pretreated with tadalafil orally before indomethacin; Indomethacin+ PTX, in which animals were pretreated with PTX orally before indomethacin; and Indomethacin + Tadafil + PTX. Indomethacin treatment revealed histopathological changes and ulcer scoring and ulcer index were markedly increased. Serum levels of prostaglandin and heme oxygenase-1 were significantly decreased. The ulcerogenic also induced marked oxidative stress as evident from the increased malondialdehyde, decreased in gastric glutathione content and superoxide dismutase activity, while the gastric myeloperoxidase was increased. Gastric nitric oxide content was decreased and the expression of vascular endothelial growth factor was downregulated while the tumor necrosis factor α (TNF-α) level was dramatically increased. Pretreatment of the ulcerative group by either tadalafil or PTX or their combination improved all these pathological changes. Tadalafil or PTX may have a role in protecting gastric mucosa damage caused by indomethacin which may be useful in the future for the treatment of gastric ulceration.

Quality of Diabetic Foot Ulcer Care: Evaluation of an Interdisciplinary Wound Care Clinic Using an Extended Donabedian Model Based on a Retrospective Cohort Study.

OBJECTIVES: Diabetic foot ulcer (DFU), a serious complication of diabetes, is associated with increased morbidity and mortality and presents a substantial socioeconomic burden. However, DFU quality of care has been insufficiently studied. Therefore, the aim of this study was to evaluate the quality of DFU care at an interdisciplinary wound care clinic in Canada, based on an extended Donabedian model: structure, process and outcome quality indicators combined with patient characteristics. METHODS: This was a retrospective cohort study of 140 adult patients with diabetes who were treated between 2012 and 2018 at a wound care clinic in a university-affiliated hospital in the Québec City area of Canada. Twenty-two internationally recognized quality-of-care indicators were identified from the literature. Data were collected from medical files, and the results were used to document the selected quality-of-care indicators. RESULTS: The principal indicators regarding structure and process were met, and outcome indicators were influenced by study population characteristics, particularly peripheral artery disease and critical limb ischemia. Moreover, this study highlights that quality-of-care indicators are essential when evaluating DFU outcomes, as structure and process indicators can also affect wound healing outcomes. CONCLUSIONS: This study suggests that DFU care at a Canadian wound care clinic, with an interdisciplinary approach, meets most quality-of-care indicators. The socioeconomic burden of DFUs for patients, health-care organizations and policymakers, and the paucity of quality and performance evaluations, call for more studies evaluating DFU care.

The intervention of tert-butylhydroquinone protects ethanol-induced gastric ulcer in type II diabetic rats: the role of Nrf2 pathway.

Ethanol consumption increases the prevalence of gastric ulcer (GU) in rats with type II diabetes (T2D). Induction of GU by absolute ethanol (5 mL/kg or 3.94 g/kg) in the animal model resembles human ulcer characteristics. The aim was to investigate the role of the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway in the treatment of GU in diabetic condition. The rats were exposed to absolute ethanol 1 h before sacrifice and T2D was induced by combined exposure of high-fat diet and low dose streptozotocin. Pretreatment of tert-butylhydroquinone (tBHQ) (25 and 50 mg/kg), metformin (500 mg/kg), and omeprazole (20 mg/kg) were given once daily for last three consecutive weeks. In ethanol-exposed diabetic rats, pretreatment with tBHQ, omeprazole, and metformin reduced gastric mucosal lesion, ulcer index, histological alterations, malondialdehyde level, and apoptosis. Furthermore, the intervention of tBHQ, omeprazole, and metformin improved the integrity of the stomach mucosa, glutathione, gastric pH, collagen, and goblet cells. tBHQ treatment improved ethanol-induced alterations of Nrf2, catalase, heat shock protein 70 (HSP70), NF-κB, and endothelin-1 expressions in diabetic rats. In diabetic conditions, the incidence of GU is increased due to elevated levels of reactive oxygen species, inflammatory mediators, depleted levels of cellular antioxidants, and altered gastric parameters. The tBHQ intervention could be a rational strategy to protect these changes.

Outcomes of Diabetic Foot Ulcers in a Tertiary Referral Interdisciplinary Clinic: A Retrospective Canadian Study.

OBJECTIVES: The objectives of this work were to evaluate demographic data, healing rate, recurrence rate, amputation rate and death rate of patients with diabetic foot ulcers (DFUs) treated in a Québec outpatient diabetic foot ulcer multidisciplinary clinic. Another objective was to determine factors associated with higher ulcer recurrence. METHODS: We conducted a retrospective cohort study of adults with diabetes with a DFU referred to a Québec City diabetic foot clinic between December 1, 2013 and May 1, 2019. The primary outcome was recurrence rate at 6 months after first ulcer healing. We also evaluated the recurrence rate at 12 months, mean and median time for ulcer healing, mean and median time before recurrence after first ulcer healing, amputation rate, mortality rate and factors associated with DFU recurrence. RESULTS: Of the 85 patients included in the study, 26 (37.1%) and 36 (54.4%) had DFU recurrence at 6 months and 12 months, respectively, after first ulcer healing. Mean healing time from first consultation in the ulcer clinic was 19.64±21.02 weeks. Of the patients, 36.9% patients underwent lower limb amputation and 30.6% died during follow up. Both previous history of a DFU before first consultation and amputation after first DFU consultation were statistically significant risk factors for DFU recurrence at 12 months. CONCLUSIONS: DFU recurrence was significantly higher in patients with a past history of DFU before the first one evaluated in the diabetic foot clinic and a previous history of amputation. Thus, systematic follow up should be done specifically with these patients.

[Diagnostic pitfall: Early arising, multiple and recurrent Marjolin's ulcer. About 8 patients (16 tumors) and literature review]. / Piège diagnostique : l'ulcère de Marjolin d'apparition précoce, multiple ou récidivant. À propos d'une série de 8 patients (16 tumeurs) et revue de la littérature.

INTRODUCTION: Marjolin's ulcer (MU) is a large entity representing skin cancers resulting from the transformation of chronic wounds of a heterogeneous nature. Burn scars are the most at risk of degeneration, in particular because there are the sites of important skin tension. Atypical forms are not uncommon. The objective of this study is to present these exceptions which are underestimated. MATERIALS AND METHODS: All patients with UM in our centre between January 2011 and February 2019 have been included permitting to report the initial pathology, the location, the latency time, the histology and the management carried out. RESULTS: Eight patients were treated in our center for MU, they developed 16 skin cancers. Fourteen were squamous cell carcinomas (SCC). The shortest latency period was 2 months. The youngest patient was 22 years old when she was diagnosed with MU. Three patients had at least 2 synchronous SCC. One patient had a recurrence after a split-thickness skin grafting on artificial dermis and 2 patients had second locations. CONCLUSION: Atypic forms are not rare. MU is commonly recurrent, multiple, early arising and may appear in young people. The treatment of chronic wounds cannot be dissociated from the treatment of contractures, otherwise the wound will inevitably reappear.

Clinical, laboratory and ultrasonographic findings in 94 cows with type-1 abomasal ulcer.

INTRODUCTION: This study included 94 cows aged 2.1 to 12.0 years (5.2 ± 2.05 years) that were examined at a referral clinic because of type-1 abomasal ulcer. The most common clinical findings were poor general health status (94%), partial or complete anorexia (93%), congested scleral vessels (89%), decreased skin surface temperature (76%), decreased or absent faecal output (72%), abdominal guarding (59%), tachypnoea (56%), rumen atony (53%) and positive percussion and simultaneous auscultation and/or ballottement and simultaneous auscultation on the right side (53%). The most common laboratory findings were hypokalaemia (68%), positive base excess (60%) and azotaemia (51%). The chloride concentration of rumen fluid was increased in 48% of the cows. The diagnosis of type-1 ulcer was made during laparotomy and/or postmortem examination. One or more concurrent diseases were diagnosed in 97% of the cows. Seventy-eight (83%) cows were euthanased immediately after the initial examination, during laparotomy or after unsuccessful treatment, and eight (8.5%) cows died, and all were examined postmortem. Eight (8.5%) cows were discharged and six of these made a complete recovery.

INTRODUCTION: La présente étude a inclus 94 vaches âgées de 2,1 à 12,0 ans (5,2 ± 2,05 ans) qui ont été examinées dans une clinique de référence en raison d'un ulcère de la caillette de type 1. Les signes cliniques les plus courants étaient un mauvais état de santé général (94%), une anorexie partielle ou complète (93%), des vaisseaux scléraux congestionnés (89%), une diminution de la température de la surface de la peau (76%), une diminution ou une absence de débit fécal (72%), une défense abdominale (59%), de la tachypnée (56%), une atonie du rumen (53%) et une percussion positive avec auscultation simultanée (PSA) et / ou ballottement et auscultation simultanée (BSA) du côté droit (53%). Les résultats de laboratoire les plus courants étaient l'hypokaliémie (68%), l'excès de base positif (60%) et l'azotémie (51%). La concentration en chlorure du liquide du rumen a augmenté chez 48% des vaches. Le diagnostic d'ulcère de type 1 a été posé lors de la laparotomie et/ou de l'autopsie. Une ou plusieurs maladies concomitantes ont été diagnostiquées chez 97% des vaches. Soixante-dix-huit vaches (83%) ont été euthanasiées immédiatement après l'examen initial, pendant la laparotomie ou après un traitement infructueux, et huit vaches (8,5%) sont mortes. Toutes ont été examinées post-mortem. Huit vaches (8,5%) sont sorties de clinique et six d'entre elles ont complètement récupéré.

At-Home Self-Applied Photobiomodulation Device for the Treatment of Diabetic Foot Ulcers in Adults With Type 2 Diabetes: Report of 4 Cases.

Diabetic foot ulcers (DFUs) incidence is increasing with the rising global prevalence of diabetes. In spite of following best practice standard of care, most DFUs are slow to heal. Photobiomodulation (PBM), previously known as low-level laser therapy, has been shown to accelerate healing of acute or chronic wounds, and specifically DFUs. However, the frequent applications required translates to frequent visits at the clinic, which are difficult for patients with DFU. In the following case series, we present our preliminary experience with a recently approved (Health Canada) consumer home-use PBM device as an adjuvant to standard treatment. Four men presented at the clinic (67 to 84 years of age) with DFUs/diabetic leg ulcers. The PBM treatment (808 nm, 250-mW peak power, 15 KHz, 5 J/min, ray size 4.5×1.0 cm2) was applied by the patients themselves at the clinic or at home. In the cases presented, all wounds closed within 1 to 3 weeks with no reported adverse events. Patients found the routine easy to follow and painless. In wounds that involved pain, patients reported pain reduction after 1 to 3 treatments. Based on our previous experience with these patients, self-applied PBM as an adjunct therapy led to accelerated healing and rapid pain alleviation compared with standard care alone. In summary, hard-to-heal diabetic wounds are a burden for patients, a burden for caregivers and costly for the health-care system. These observations support the view that the home-use device can be easily integrated as an adjuvant treatment to standard care at the clinic or home and, most importantly, encourage patient involvement in his or her own care.

Assessment of the Risk Factors of Multidrug-Resistant Organism Infection in Adults With Type 1 or Type 2 Diabetes and Diabetic Foot Ulcer.

OBJECTIVES: To our knowledge, this is the first review to analyze the literature identifying risk factors for multidrug-resistant organism (MDRO) infection in patients with diabetic foot ulcer. The purpose of this study was to collect the currently published data to determine the most commonly and consistently identified risk factors for MDRO infection. METHODS: PubMed, MEDLINE, BIOSIS, Web of Science and the Cochrane Library electronic databases were searched. The last search updated was in September 2019. The evaluated outcomes included age, male sex, type of diabetes, diabetes duration, level of glycated hemoglobin, ulcer type, wound duration, ulcer size, ulcer grade, osteomyelitis, previous antibiotic therapy and previous hospitalization. The standard mean difference or the odds ratio (OR) was calculated for continuous or dichotomous data, respectively. The quality of the studies was assessed, and meta-analyses were performed with Cochrane Collaboration's RevMan 5.0 software. RESULTS: A total of 11 studies, including 1,229 patients provided evidence for 6 possible risk factors for MDRO infection. Ischemic ulcer (OR, 0.50; 95% confidence interval [CI], 0.35 to 0.71), ulcer size (standard mean difference, -0.27; 95% CI, -0.46 to -0.08), ulcer grade (OR, 0.36; 95% CI, 0.15 to 0.83), osteomyelitis (OR, 0.33; 95% CI, 0.25 to 0.45), previous antibiotic therapy (OR, 0.08; 95% CI, 0.04 to 0.14) and previous hospitalization (OR, 0.15; 95% CI, 0.08 to 0.28) were identified as risk factors for MDRO infection in patients with diabetic foot ulcer. CONCLUSIONS: Our meta-analysis indicated that ischemic ulcer, ulcer size, ulcer grade, osteomyelitis, previous antibiotic therapy and previous hospitalization were associated with MDRO infection in patients with diabetic foot ulcer.

[Digital ischaemia with fingertip ulcers during ipilimumab therapy]. / Ischémie digitale avec ulcération pulpaire sous ipilimumab.

BACKGROUND: Anti-cancer drugs have many adverse effects including vascular side effects. Herein we present the case of a patient presenting digital ischaemia with high imputability of ipilimumab. OBSERVATION: A 47-year-old male patient was treated for popliteal melanoma, initially stage IIIA but which subsequently became metastatic (stage IV), and for which ipilimumab was given after the failure of two lines of chemotherapy. During the 4th course of ipilimumab, the patient developed autoimmune hepatitis. Ipilimumab was suspended. Three months later, he developed a drug-like neuropathy followed one month later by ulceration of the right index finger. Causes of embolic, autoimmune and occupational origin (thrombotic microangiopathy, thrombosed aneurysm) were rapidly ruled out. Although a paraneoplastic origin could not be formally excluded, drug-induced immune disorder remained the most plausible origin. DISCUSSION: This is the first reported case of digital ulceration under ipilimumab.

Extracorporeal Shock Wave Therapy for Treating Foot Ulcers in Adults With Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Extracorporeal shock wave therapy (ESWT) as a new adjuvant therapy has shown a potential capability to promote diabetic foot ulcer (DFU) healing. The purpose of this study was to assess the efficacy and safety of ESWT on the healing of DFUs. The Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine and reference lists were searched for studies published up to December 2018. Randomized controlled trials of any design, including ESWT for patients with DFU, were included. Two reviewers extracted data, including the wound surface area (WSA), percentage of re-epithelialization, population of complete cure and unchanged and other related outcomes. Eight randomized controlled trials (N=339) were included. ESWT was found to be associated with a greater reduction of WSA by 1.54 cm2, and increase of re-epithelialization by 26.31%. A greater population with complete cure was found at the end of treatment (risk ratio [RR] = 2.22; 95% confidence interval [CI], 1.46 to 3.40); however, there was no statistically significant difference at the end of follow up (p=0.052). It can also reduce treatment inefficiency by 4.8-fold (95% CI, 0.12 to 0.37). In addition, ESWT also showed a higher superiority than hyperbaric oxygen therapy in the population for complete cure and unchanged ulcer (RR=1.83; 95% CI, 1.14 to 2.94 and RR=0.25; 95% CI, 0.13 to 0.48, respectively). ESWT is a feasible adjuvant treatment for DFUs. It can effectively improve the complete cure rate, shorten the healing period of DFUs and significantly reduce treatment ineffectiveness. This can provide new therapeutic ideas for clinical practice of intractable and recurrent DFUs.

Clinical and laboratory findings in 60 cows with type-3 abomasal ulcer.

INTRODUCTION: This study involved 60 cows aged 1.9 to 13 years (mean 4.8 ± 2.3 years) with type-3 abomasal ulcer. The most common clinical signs were, in decreasing order of frequency, partial or complete anorexia (98%), obtunded demeanour (95%), decreased skin surface temperature (78%), congested scleral vessels (73%), abdominal guarding (61%), tachypnoea (58%), fever (58%) and tachycardia (55%). One or more concomitant disorders were diagnosed in 86% of the cows. The most common abnormal laboratory findings were hypokalaemia (75%), shortened glutaraldehyde test time (46%) and hyperfibrinogenaemia (43%). The diagnosis of type-3 abomasal ulcer was made in all cows during laparotomy and/or at postmortem examination. Forty-eight (80%) cows were euthanased immediately after the initial examination, during laparotomy or after unsuccessful treatment. Twelve (20%) cows were treated with a solution of sodium chloride and glucose administered via an indwelling jugular catheter, antibiotics, metamizole or flunixin, and discharged from the clinic. Ten cows were still in production two years later.

INTRODUCTION: Cette étude portait sur 60 vaches âgées de 1,9 à 13 ans (moyenne de 4,8 ± 2,3 ans) atteintes d'un ulcère de la caillette de type 3. Les signes cliniques les plus fréquents étaient, par ordre de fréquence décroissante, une anorexie partielle ou complète (98%), un comportement apathique (95%), une diminution de la température de la peau (78%), des vaisseaux scléraux congestionnés (73%), une défense abdominale (61%) de la tachypnée (58%), de la fièvre (58%) et tachycardie (55%). Un ou plusieurs troubles concomitants ont été diagnostiqués chez 86% des vaches. Les résultats de laboratoire anormaux les plus fréquents étaient une hypokaliémie (75%), une durée réduite du test du glutaraldéhyde (46%) et une hyperfibrinogénémie (43%). Le diagnostic d'ulcère de la caillette de type 3 a été posé chez toutes les vaches au cours d'une laparotomie et/ou lors de l'examen post mortem. Quarante-huit (80%) des vaches ont été euthanasiées immédiatement après l'examen initial, pendant la laparotomie ou après un traitement infructueux. Douze (20%) vaches ont été traitées avec une solution de chlorure de sodium et de glucose administrée via un cathéter jugulaire à demeure, des antibiotiques, du métamizole ou de la flunixine et ont quitté la clinique. Dix de ces vaches étaient encore en production deux ans plus tard.