Risk factor analysis on the healing time and infection rate of diabetic foot ulcers in a referral wound care clinic.

OBJECTIVE:: Objectives. To determine the prevalence and risk factors for diabetic foot infection (DFI), and to identify factors associated with delayed wound healing of diabetic foot ulcer (DFU). METHOD:: The retrospective study was performed in a referral wound care clinic in Hospital Kuala Lumpur. Data was collected from January 2014 to October 2016 on DFU patients who attended this clinic. RESULTS:: Of the 340 patients (216 male and 124 female) DFU patients who attended the clinic (mean age: 58.1±10.8 years old), 41.5% presented with infection with a mean cross-sectional ulcer area of 21.5±33.2cm2. Binary logistic regression analysis revealed that patients of Chinese ethnicity (OR: 3.39; 95%CI 1.49 to 7.70), with fasting blood glucose ≥7mmol/l (OR: 3.41; 95%CI 1.57 to 7.39), ulcer size ≥10cm2 (OR: 2.90; 95%CI 1.45 to 5.82) and blood pressure ≥140/90mmHg (OR: 2.52; 95%CI 1.54 to 4.14) were more likely to develop DFI. The median healing time for patients with DFUs was three months. There were six variables identified as significantly associated with prolonged healing time of DFU, namely presence of infection (p<0.001), poor glycaemic control with fasting blood glucose ≥7mmol/l (p<0.001), high blood pressure ≥140/90mmHg (p<0.001), large DFU size ≥2cm2 (p<0.001), history of amputation (p<0.005) and plantar location of the DFU (p<0.05). CONCLUSION:: Large DFU size, poor glycaemic and blood pressure control are common risk factors for both DFU and DFI. Unexpected high prevalence and ethnicity risk factor for DFI urge more comprehensive primary and secondary preventative strategies to reduce its incidence.

Topical application of omega-3-, omega-6-, and omega-9-rich oil emulsions for cutaneous wound healing in rats.

Wound healing is a physiological event that generates reconstitution and restoration of granulation tissue that ends with scar formation. As omega fatty acids are part of membrane phospholipids and participate in the inflammatory response, we investigated the effects of omega-3, omega-6, and omega-9 fatty acids in the form of oils on wound healing. Linseed (LO), evening primrose (EPO), and olive oils (OO) rich in omega-3, omega-6, and omega-9 fatty acids were formulated into emulsions and were topically applied on rats with excision wounds. All omega-3-, omega-6-, and omega-9-rich oil formulations were found to accelerate wound closure compared to untreated, with significant improvement (p < 0.05) being observed at day 14. EPO induced early deposition of collagen as evaluated by Masson trichrome staining that correlated well with the hydroxyproline content assay, with the highest level at days 3 and 7. Vascular endothelial growth factor (VEGF) showed greater amount of new microvasculature formed in the EPO-treated group, while moderate improvement occurs in the LO and OO groups. EPO increased both the expression of proinflammatory cytokines and growth factors in the early stage of healing and declined at the later stage of healing. LO modulates the proinflammatory cytokines and chemokine but did not affect the growth factors. In contrast, OO induced the expression of growth factors rather than proinflammatory cytokines. These data suggest that LO, EPO, and OO emulsions promote wound healing but they accomplish this by different mechanisms.

Immunomodulatory Effectiveness of Fish Oil and omega-3 Fatty Acids in Human Non-melanoma Skin Carcinoma Cells.

Fish oil is composed of various fatty acids among which omega-3 fatty acids are considered as most beneficial. The effects of fish oil on the activity of a topical anticancer drug, imiquimod, and the immunomodulatory activity of omega-3 fatty acids was investigated in human basal and squamous cell carcinoma cell lines. Imiquimod-fish oil mixture exhibited higher carcinoma cell growth inhibition and immunomodulatory activity than imiquimod alone, especially against squamous cell carcinoma cells. Omega-3 fatty acids exhibited growth inhibition of both basal cell and squamous cell carcinoma cell lines and modulated the immune response. Omega-3 fatty acids of fish oil serve as inducers of interleukin-10, an anti-inflammatory cytokine, and as suppressors of interleukin-6 and tumor necrosis factor-alpha, which not only depress tumor growth but also adequately control the inflammatory side effects of imiquimod. Thus, imiquimod administration with fish oil could be beneficial for inhibition of non-melanoma skin carcinoma cells but further in vivo studies are needed to understand their role in skin cancer.