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Woulgan® Biogel is an advanced wound healing dressing containing an ancillary medicinal substance: soluble beta-glucan (SBG). Woulgan® Biogel also have a slightly acidic pH around 6 which further facilitates wound healing and inhibits excessive protease activity in the wound which may degrade newly generated tissue, a well-recognized problem in chronic wounds.
The product is intended to be used under supervision of health care professionals and primarily in hospitals or care units. Woulgan® Biogel is initially intended to be applied to a prepared wound bed every third day until complete wound healing or for a maximum of 12 weeks unless improvements are seen at this stage. Do not use in patients with known sensitivity or allergies to Woulgan® Biogel or any of its ingredients.
Infected wounds should be treated after consultation with health care professional and treatment with Woulgan® Biogel may be continued in combination with additional treatment.
SBG has immunomodulatory capacities and activates the white blood cells, in particular the macrophages, to speed up the wound healing process. This wound is due to loss of blood flow to the small blood vessels causing the tip to turn black.
This patient has a major deformity of the foot that causes him to walk on the outside of his foot. Diabetes is a group of disorders that revolves around high blood sugar, also known as hyperglycemia. Pancreas produce insulin, which is a hormone used to help the cells to absorb glucose and use it in the form of energy, for the body to function properly. You may observe a lot of symptoms of diabetes besides thirst and urination in people who are suffering from diabetes.
Unhealthy lifestyle, laid back routine, lack of exercise, addiction to smoking and alcohol are some of the main causes of diabetes. In order to prevent oneself from developing diabetes, it is important that you maintain a healthy lifestyle in your day to day life.
One may not realize that sometimes being overweight can be a great threat to one’s health and the overall quality of life. Editor’s Note: For related articles, see “Current And Emerging Treatment Options For Diabetic Neuropathy” in the March 2005 issue, “How To Diagnose Diabetic Peripheral Neuropathy” in the March 2006 issue, and “Expert Insights On Painful Diabetic Neuropathy” in the March 2003 issue. Intertrigo is the clinical description of a cutaneous inflammatory process on opposing skin surfaces. Preventing and treating intertrigo in the large skin folds of adults: a literature overview.
Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy. Acute genitocrural intertrigo: a sign of primary human immunodeficiency virus type 1 infection. A comparison of a new antifungal agent, 1 percent econazole nitrate (Spectazole) cream versus 1 percent clotrimazole cream in the treatment of intertriginous candidosis.
Chronic alcoholism is the most important cause of chronic pancreatitis, generating over 90% of cases of chronic pancreatitis.
Gallstones, although it is certainly a factor for acute pancreatitis, is not a generator factor for chronic pancreatitis. Hypercalcemia of hyperparathyroidism, is another possible etiologic factor of acute pancreatitis, but certainly not one for chronic pancreatitis. Ductal obstructions given by pancreatic trauma, pancreatic tumors, stenosis of Oddi’s sphincter, presence of stones in Wirsung duct. Hereditary pancreatitis involves the presence of a gene that is transmitted autosomal reigned.
Various conditions such as malnutrition (tropical chronic pancreatitis in India, Africa and Southeast Asia), hemochromatosis (tanned diabetes – cause is iron deposition in the liver, pancreas and myocardium).
In conclusion, the cause of chronic pancreatitis is almost exclusively represented by chronic alcoholism. In conditions of chronic alcoholism, the pancreas secretes a pancreatic juice with higher protein content than normal. Chronic pancreatitis have most often inisidios onset, sometimes difficult to differentiate from repetitive acute pancreatitis alcoholic relapse. Symptomatology is dominated by epigastric pain or around the navel, often with radiation to back. Other symptoms may include obstructive jaundice made by the compression of the pancreatic head over the coledoc, malabsorption with steatorrhea or diabetes mellitus (occurs in 50% – 70% of chronic pancreatitis calcified). Blood glucose levels may be increased because of secondary diabetes, is useful a oral glucose tolerance test. Endoscopic retrograde pancreatography, highlights aspects of morphological pancreatic duct, stenosis and dilatation, as occurs in chronic pancreatitis. Fecal elastase 1 test, a functional test, which highlights the early pancreatic failure, it is the gold test for the diagnosis of chronic pancreatits used nowadays.
Mixed chronic pancreatitis with pancreatic tissue calcification and dilatation of the duct. Treatment should begin with some dietary measures, the most important is the final and complete suppression of alcohol consumption. The product has typical hydrogel properties and provides optimal moist wound healing environment, re-hydrates necrotic tissue and aids in autolytic debridement. Macrophages are key players in wound healing and provide signal molecules important for healing and also orchestrate the wound healing process. The wound closing rate (A), contraction (B), cell proliferation (C) and angiogenesis (D) were studied on full thickness wounds after administration of Woulgan Biogel (green), vechicle control (black) or water (blue).
Treatment included antibiotics, debridement, wound care, offloading by taking pressure off the ulcer. Treatment for this ulcer is similar to those with diabetes, offloading, diabetic inserts, shoe modifications, wound care, debridement and antibiotics if necessary. In this photo the end of the second toe is enlarged and swollen secondary to a chronic bone infection. The first picture is her wound surrounded with blood, she is on coumadin and her INR levels were higher than normal on this day. This medical condition is basically a metabolism disorder in which the body fails to effectively use the digested food in the form of energy. However, in diabetes, the body either fails to make sufficient insulin or becomes unable to use the insulin properly, or in some cases both.
It may combine with other significant factors such as environmental and lead to one of the most chronic diseases, known as diabetes.
Viruses and bacteria such as rubella and chicken pox can be the potent factors that can cause diabetes. This can cause an insulin resistance, which is a very common symptom in people with Type-2 diabetes. The most prevalent form is somatic or sensorimotor neuropathy, which is often simply referred to as diabetic neuropathy. Accordingly, let us take a closer look at case studies involving the use of current, emerging diabetic neuropathy treatments. The patient also felt that his sense of balance was diminished but thought it was merely a sign of aging and was reluctant to see a doctor. The patient had no open lesions on either foot and had intact protective sensation for both feet.
The medical history of the sedentary accountant includes congestive heart failure, hypertension, peripheral arterial disease of bilateral lower extremity, DPN, diabetic foot ulcers, Charcot foot deformity, a partial fifth ray amputation, and a kidney transplant from a non-matched donor. However, within the past three months, he has felt persistent pain to both feet and has had to take Tylenol #3 to help alleviate the pain.
Common side effects included mild to moderate dizziness, somnolence, peripheral edema, headache and dry mouth.


A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. The presence of steatorrhea (bulky, paste and rancid odor stools) is a very late sign, when the disease is already accompanied by malabsorption and weight loss. Thus, a cholecystectomy in asymptomatic patients to prevent chronic pancreatitis is unjustified, as well as a correlation between chronic pancreatitis and gallstones. These proteins will precipitate in the form of protein plugs, which will cause obstruction of small ducts of the pancreas and will activate the pancreatic enzymes. Pain can be dragged, annoying, less occasionally, sometimes may be intense, permanent, disabling.
Values of this enzymes are not so high as in acute pancreatitis, but there are severe forms of chronic pancreatitis which have normal levels of these parameters.
At first it may be asymptomatic, but in time the symptoms will appear of which the most important is pain.
Should be avoided heavy meals, rich in fat and protein because it stimulates pancreatic secretion and may cause exacerbation of pain.
The novelty of the product is the component SBG which is a proprietary substance made by Biotec BetaGlucan. They are essential in all the different phases of wound healing, thus Woulgan® Biogel may have positive effects throughout the treatment until complete closure of the wound. The mode of action of SBG in Woulgan® Biogel has further been investigated in a several diabetic mouse models where overall healing in addition to wound contraction, cell proliferation and angiogenesis were studied.  Woulgan® Biogel was in these studies compared to a gel without the active component SBG, mimicking regular hydrogel products commercially available. The main mode of action of Woulgan Biogel is shown to be wound contraction, Woulgan Biogel also has positive effects on cell proliferation and angiogenesis, traits associated with macrophage activities.
The patient achieved control of his blood sugar with diet and adding insulin to his oral medication.
It is very important to know the proper break in for new shoes and to always check your feet when removing your shoes. He is having a skin graft done soon to help him heal, and possible reconstructive surgery to correct the deformity. Ideally, the digestive tract is responsible for breaking down the carbohydrates into glucose, which is a form of sugar that is sent to the blood stream. Diabetes can develop in a person due to various causes such as impaired immune system, environmental factors, genetics and hormonal changes. In this attack, the immune system destroys the healthy cells that help produce insulin, the hormone needed to convert the digested food into energy. In many cases, it is observed that when a mother is not immune to these viruses, it makes the child vulnerable to this disease.
When a person does not do much physical activity and continue eating fat-rich food, the belly fat tends to increase and produce hormones that can prove harmful to the body.
In addition, obesity can also be dangerous for the heart and can cause cardiovascular diseases. Symptoms often exhibit a distal symmetric pattern, beginning distally at the base of the toes and ascending proximally up the lower leg as the disease progresses.
A complete blood count, lipid panel, liver screening and a renal profile were all normal as was a prostate-specific antigen (PSA) test.
The patient reported that his burning and tingling sensation started going away after taking the medication for only two days. The patient denied fever, chills, nausea, vomiting, chest pain, shortness of breath or changes to his medication. He was hoping for topical alternatives so we utilized a 5% lidocaine patch (Lidoderm, Endo Pharmaceuticals). Prevention remains the foundation of clinical intervention and the prerequisite of adequate treatment.
Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science in Chicago. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. The presence of a case history of chronic alcoholism is an important element for diagnosis.
At autopsy 45% of chronic alcoholics show morphological changes of chronic pancreatitis, even if they had no clinical signs of disease. Diagnosis is usually after age 40 years, but sometimes can occur in cases diagnosed around the age of 30 years, in these cases is possible the existence of a genetic factor. Often the pain is caused by diet and therefore, patients with chronic pancreatitis prefer not to eat, but only to consume alcohol, which can have an analgesic effect for them.
SBG had positive impacts on all the studied parameters and significantly outperformed existing products and treatment options in this model.
Patients with these types of wounds may benefit from laser or radiofrequency ablation of incompetent veins or sclerotherapy. Treatment includes referral to a vascular surgeon for possible revascularization, smoking cessation, amputation and antibiotics for infection. This leads to reduced or sometimes no production of insulin, which causes the glucose to pile up in the blood stream and contribute to the development of diabetes. These symptoms are often described as burning, tingling, stabbing and a pins-and-needles sensation in a stocking and glove distribution.
Other medical problems include hypertension and hypercholesterolemia, which are treated with an angiotensin-converting enzyme inhibitor and a statin respectively. We also noted the patient’s serum levels of B12, T3, T4 thyroid stimulating hormone (TSH) were within normal limits. He has been taking duloxetine for almost four months now and reports no side effects from taking the medications. After using the 5% lidocaine patch twice daily for five weeks, the patient states the patch alleviates 80 percent of his pain and discomfort. With advances in technology and ongoing research, we hope to one day elucidate the ideal treatment of this debilitating disease process. Clinical symptoms of chronic pancreatitis usually are installed later, after 10-20 years of important use of alcohol. Stone formation is favored by the alteration done by the alcohol over the synthesis of litostatin, a pancreatic enzyme known in the past as pancreatic stone protein. At 10% – 20% of chronic pancreatitis, painful symptoms may be absent, the diagnosis being made at the laboratory of exploration. The enhanced cell proliferation and angiogenesis may be explained by activation of macrophages by SBG stimulation.
Prevention of future ulcers is achieved with periodic visits and extra depth diabetic shoes with diabetic inserts. The patient states the medication helped reduce the uncomfortable sensations down to about 10 percent of the original presenting pain. The patient also denied resting tachycardia, orthostatic lightheadedness, early satiety, early morning nausea, changes in bowel habits or postprandial sweating. The friction in these folds can lead to a variety of complications such as secondary bacterial or fungal infections. At some patients may occur an ethanol liver damage (steatosis, alcoholic hepatitis or ethanolic cirrhosis). He is very happy that his wife urged him to seek medical attention for what he thought was normal signs of aging. The usual approach to managing intertrigo is to minimize moisture and friction with absorptive powders such as cornstarch or with barrier creams. The condition is particularly common in obese patients with diabetes who are exposed to high heat and humidity, but it can occur in anyone. Following obstruction some ducts will broke, others will suffer o process of fibrosi, leading in the final to the appearance of stenosis.


This loss of protective sensation can lead to the formation of foot ulcerations, infections, even amputations, and cause significant morbidity and mortality. He was referred for diabetes education, learned home glucose monitoring, and followed a diet and exercise program suggested by the diabetes educator.
The patient also better understands the importance of maintaining proper blood glucose levels. Patients should wear light, nonconstricting, and absorbent clothing and avoid wool and synthetic fibers. Other predisposing risk factors include urinary and fecal incontinence, hyperhidrosis, poor hygiene, and malnutrition.
Physicians should educate patients about precautions with regard to heat, humidity, and outside activities.
Toe interweb intertrigo may be associated with closed-toe or tight-fitting shoes and commonly affects persons participating in athletic, occupational, or recreational activities.
Physical exercise usually is desirable, but patients should shower afterward and dry intertriginous areas thoroughly. Infants are at high risk for intertrigo because they have short necks, relative chubbiness, and flexed posture.3,4 Drooling also can facilitate intertrigo in infants. Persons with prominent skinfolds on either side of the chin are at a high risk for intertrigo.5Secondary Skin InfectionsThe moist, damaged skin associated with intertrigo is a fertile breeding ground for various microorganisms, and secondary cutaneous infections commonly are observed in these areas. Secondary bacterial and fungal infections should be treated with antiseptics, antibiotics, or antifungals, depending on the pathogens. Gram-positive and gram-negative bacteria also can worsen the effects of interdigital intertrigo.
Yeasts also are commonly found at the site of interdigital intertrigo.9 Sometimes seborrheic dermatitis is located in the folds. Patients may present with itching, burning, and pain in the affected areas.1,3 More prominent inflammation could be a sign of secondary infection. In severe examples, patients may have a purulent discharge with edema and intense erythema of tissues surrounding the infected area.
Patients with severe toe web intertrigo who are overweight or who have diabetes are at a higher risk for cellulitis.
Patients with advanced gram-negative infections may have green discoloration at the infection site.
Role for nitrosative stress in diabetic neuropathy: evidence from studies with a peroxynitrite decomposition catalyst. Acute genitocrural intertrigo in patients with human immunodeficiency virus type 1 (HIV-1) infection may present as a maculopapular eruption.12DiagnosisDiagnosis of intertrigo and its secondary complications often is clear and is generally based on clinical manifestations. If secondary bacterial infections are suspected, culture with sensitivities should be performed. A Wood’s light examination may identify a Pseudomonas or erythrasma infection more quickly than would a culture. Loss of pain perception in diabetes is dependent on a receptor of the immunoglobulin superfamily. The Wood’s light characteristically shows a green fluorescence with Pseudomonas infection and a coral-red fluorescence with erythrasma. Potassium hydroxide cytologic examination is helpful in diagnosing secondary fungal infections. Seborrheic dermatitis and psoriasis vulgaris inversa may have presentations similar to intertrigo.13,14 Seborrheic dermatitis may involve the axillae or inguinal regions or the scalp.
Psoriasiform lesions elsewhere on the body or pitting of the nails also may distinguish psoriasis from intertrigo. Point of NO return for nitrergic nerves in diabetes: a new insight into diabetic complications. Rarely, skin biopsy specimens are needed to distinguish less common skin diseases from intertrigo.
Atopic dermatitis, primary irritant contact dermatitis, allergic contact dermatitis, scabies, and pemphigus vegetans sometimes are mistakenly diagnosed as intertrigo because these conditions also may involve skinfolds. Some suggest the use of absorptive powders, such as talc and cornstarch, or barrier creams. These topical treatments, however, have little or no proven benefit and may cause irritation or facilitate yeast colonization.2 Obese patients should lose weight, if possible. Erythrocytic sorbitol contents in diabetic patients correlate with blood aldose reductase protein contents and plasma glucose levels, and are normalized by the potent aldose reductase inhibitor fidarestat (SNK-860).
Cutaneous erythrasma is best managed with oral erythromycin (250 mg four times daily for two weeks). If the patient does not improve after treatment, bacterial culture and sensitivity should be performed.Toe web infections can be serious,7,8 and severe cases may warrant hospitalization. Proper identification of gram-negative organisms is critical so that effective antibiotic therapy can be initiated. Tissue removal may be needed to allow absorption of topical antibiotic agents, which promote healing and slow the spread of infection.
Third-generation cepha-losporins and quinolones are active, together with aminoglycosides.7,8 Oral antibiotics combined with cleansing and debridement, 5 percent amikacin gel, and hot compresses of 2 to 5 percent acetic acid for 15 days may be effective. Physical exercise usually is desirable, but patients should shower after exercise and keep intertriginous areas thoroughly dry. The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns.
From mechanisms to management: translating the neuropathic pain consensus recommendations into clinical practice. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort.
Efficacy of duloxetine, a potent and balanced serotonin-norepinephrine reuptake inhibitor in persistent pain models in rats. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain.
Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial.
Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens.
Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial. Effectiveness of the lidocaine patch 5% on pain qualities in three chronic pain states: assessment with the Neuropathic Pain Scale. Introduction: chronic pain studies of the lidocaine patch 5% using the Neuropathic Pain Scale. An open-label study of the lidocaine patch 5% in painful idiopathic sensory polyneuropathy.



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