Diabetes type 2 wound healing quotes,raw food diet for diabetes type 2 64gb,management of type 2 diabetes guidelines ppt,can diabetes cause cirrhosis of the liver labs - Good Point

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This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Methods: Diabetic patients with large chronic neuropathic foot ulcers were divided into conventional dressing group & rh-PDGF based dressing group. Results: Nineteen patients received PDGF-based dressings and 23 patients received conventional dressings. Conclusion: Findings indicate that rh-PDGF based dressing is more effective than standard therapy.
Diabetic foot ulcers are notoriously difficult to heal ulcers and its management frustrates surgeons of all ages, experiences, skills and nationalities. Patients of chronic renal failure on dialysis and post-renal transplant patients on steroids and or immunosuppressive agents (on doses known to impair wound healing) were also included.
At the outset, a detailed performa was filled noting down all the relevant history, medical examination and treatment received. Statistical Analysis: Student’s t- test for continuous data and a Pearson’s chi- square test for categorical data were used for comparison between the two groups. Results from this study indicate that PDGF based interventions are superior to the standard therapy protocols. Similar findings [8-14] have been reported in various randomized controlled studies (complete healing 33% to 57.5%) at a cutoff time of 12- 20 weeks.
Most of the published [8-14] series have used 10 or 20 weeks period for midterm evaluation.
Despite knowing the fact that wound size and wound duration are responsible for a wound being unlikely to heal within 8- 10 weeks of care, we selected large and deep ulcers, because these large ulcers are more likely to progress to the point of amputation.
Most of the previously reported studies [17] have first attempted standard therapy for a minimum of 8 weeks in comparison to 2 weeks in our study. We conclude that PDGF based topical interventions may be recommended for larger, higher-grade neuropathic diabetic foot ulcers and ulcers in immuno-compromised patients. Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors. Most diabetic wounds do not hurt and are first recognized by drainage on the sock or floor.
Reusable Gel Dancer's Pads relieve forefoot pain by shifting weight away from the great toe joint and sesamoid bones. Natural Antifungal Lavender Tea Tree Foaming Soap is an antifungal and antibacterial soap in a pump dispenser.
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Ultra Thin Ball of Foot Slip-on Straps offer comfort and protection for ball of foot pain and forefoot pain. A single cell type in the skin of mice is a major contributor to scarring after wound healing or radiation damage, and facilitates the growth of melanoma. A skin cell responsible for scarring, and a molecule that inhibits the cell’s activity, have been identified by researchers at the Stanford University School of Medicine. The researchers also found that the cell may play a role in the growth of melanoma and in skin damage caused by radiation.
Scars are comprised mainly of collagen, a fibrous protein secreted by a type of cell found in the skin called a fibroblast.
Twenty-five years ago, Longaker observed that prior to the third trimester of pregnancy, human fetuses heal without scarring after surgery.
In late 2013, a study led by researchers at King’s College London showed that fibroblasts in the skin of mice arise as two distinct lineages. Longaker, Rinkevich and Walmsley wondered whether this fibroblast type, which expresses a protein called engrailed, could be responsible for the collagen deposition that leads to scarring. The researchers found that the proportion of EPF cells, compared to the overall number of fibroblasts in the skin on the backs of the animals, increased dramatically from less than 1 percent in 10-day-old embryos to about 75 percent in mice that were 1 month old. When the researchers analyzed the EPF cells more closely, they found that they express a protein called CD26 on their surface. The researchers found that a small molecule that blocks the activity of CD26 also reduced the amount of scarring in a manner similar to that seen when EPF cells were eliminated.
In addition to examining the role played by EPF cells in scarring, the researchers investigated skin damage caused by radiation, as well as the growth of melanoma cancer cells.
The research was conducted as a collaboration with scientists from Weissman’s laboratory and the laboratories of Peter Lorenz, MD, and Geoffrey Gurtner, MD, both professors of plastic and reconstructive surgery at Stanford. Krista Conger is a science writer for the medical school's Office of Communication & Public Affairs. Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. A small clinical trial of a device invented by researchers at the School of Medicine has shown that it can help reduce the size of existing scars when used after scar-revision surgery.
Researchers knew that a drug administered to remove iron from the blood could also overcome diabetic interference with blood vessel formation, but finding the right way to deliver it for this use was the challenge. Stanford Medicine's unrivaled atmosphere of breakthrough thinking and interdisciplinary collaboration has fueled a long history of achievements. Diabetic foot ulcers are red sores that can occur most often on the pad (ball) of the foot or the bottom of the big toe. Platelet Derived Growth Factor in Healing of Large Diabetic Foot Ulcers in Indian Clinical Set-up: A Protocol-based Approach.

This effect is more pronounced in large severe wounds and wounds in immunocompromised patients.
Despite advances in technologies and heroic efforts, 10 to 15% of diabetic foot ulcers remain non- responsive to standard wound care [1] and ultimately lead to amputation in more than 80% of the patients [2, 3].The estimate says that every 30-second, a foot is lost somewhere in the world[4] and this frightening fact dominates our clinical thinking and forces even the recalcitrant devotee of the wound care to rethink that why diabetic foot ulcer get stuck in the phase of inflammation and don’t progress to the phase of proliferation and maturation.
Most of the clinical trails have measured PDGF- efficacy, not effectiveness and both the terms are not synonymous.
First group received moist saline gauge based dressing (conventional arm) and the other growth factor based dressing (PDGF group). If multiple ulcers were present, the largest ulcer was considered for the study after debridement of all the necrotic tissue. Sixty-five patients were excluded due to (a) non-salvageable limb (15 patients), (b) under standard care of treatment ulcers healed by>10-15% (18 patients) and (c) non-compliance (21 patients). The difference in complete healing between the two groups was found to be statistically significant. However, all these studies have included small ulcer size and applied PDGF on the ‘intention- to- treat’ group in contrary to our study where we intentionally selected large diabetic ulcers with associated co-morbidities, which is more common in our routine Indian clinical practice [Figure 3-5]. However, we attempted mid term evaluation at 4, 6, 8 and 10 weeks interval based on studies that reported healing of chronic wounds within 10- 12 weeks [16].
Reason for choosing 2-weeks observation period was: (a) we presume that two weeks observation gives enough time to select wounds struggling for healing and (b) majority of patients come from underserved part of the country lacking in primary health care, sanitation, transportation and safe water. The decision regarding amputation should be postponed until PDGF therapy option has been exhausted.
A sophisticated and practical software tool to analyze images of ulcers, it may also be useful as a reference manual and guide for post-visual evaluation.
A drug that acts in the same way as the inhibitory molecule is already approved for use in humans as a treatment for type-2 diabetes, so it could potentially move quickly into clinical trials for the treatment of scarring and melanoma. Longaker, a professor of surgery, and institute director Irving Weissman, MD, a professor of pathology and of developmental biology, are the senior authors. Collagen is one of the main components of the extracellular matrix — a three-dimensional web that supports and stabilizes the cells in the skin.
One, in the lower layer of the skin, mediates the initial steps of repair in response to wounding. They generated genetically engineered mice in which the cells, called EPF cells for “engrailed-positive fibroblasts,” were labeled with green fluorescent protein to allow tracking of the cells’ location during the animals’ development.
After diphtheria toxin was applied to wounds on the backs of mice, the wounds healed with less scarring.
Complete healing in the diphtheria-toxin-treated wounds required an additional six days compared to controls, but much of the repaired skin looked and appeared to function normally. CD26 activity has been implicated in the metabolism of many hormones, including insulin, and the human version of the protein is a target for inhibitors such as sitagliptin (distributed by Merck under the trade name Januvia) and vildagliptin (distributed by Novartis) that are marketed for treating low blood sugar levels in people with type-2 diabetes. In particular, scars that formed on wounds treated with the CD26-inhibitor covered an area of only about 5 percent of the original wound.
Radiation therapy for cancer frequently causes damage to the skin it must pass through to reach the inside of the body.
Ulcers can also form from poorly fitted shoes, especially on the sides of the foot, the tops of the toes, or the heel of the foot. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. The intervention was stopped on complete wound healing or at 10 weeks, whichever occurred first. Unfortunately, large wounds and wounds in immunocompromised patients have not been evaluated in clinical trials of new agent interventions. In addition, PDGF efficacy documented in small-randomized clinical trails cannot be translated to positive clinical experience because these studies are conducted under tightly controlled conditions, whereas clinicians encounter patients in actual practice rather than in the ideal world.2. Both groups were evaluated and managed exactly the same way following a standard Institute’s protocol [Table-1]. The diabeticstatus of the patient, including duration, type, and management,was noted with current activity level, ambulatory status, andhistory of ulceration or previous amputations. Wound measurements were done at weekly intervals till 6 weeks and biweekly thereafter till 10 weeks and the results recorded. One of the important reasons for performing a randomized controlled trial is that it can essentially eliminate selection bias, because patients are randomly assigned to treatment. The reason for opting short period was that, in India; people do not accept longer duration of treatment due to their poor socioeconomic status and do not prefer to become the part of study due to low literacy rate and it was the main reason for non- compliance in majority of our patients.
Serum hemoglobin  level of >11 gm% and serum albumin in the range of 3 to 4gm was maintained throughout the treatment course3.
Naturally, they have to depend on self-treatment or take help of other non-health care professional for long duration until their wound get worse.
Second, two third of our patients had plantar ulcers involving the deep anatomical structure and dorsum of the foot. Future studies should include and perhaps focus on those patients with the largest and deepest wounds, because these wounds are more likely to progress to amputation. Diabetic wounds of the foot are a common problem that result from loss of sensation in the feet in poorly controlled cases of diabetes. Postdoctoral scholar Yuval Rinkevich, PhD, and graduate student Graham Walmsley share lead authorship.
The cells were also engineered to carry a “kill switch” that could be activated by the presence of diphtheria toxin, which would allow the researchers to assess how wounds healed in the absence of EPF cells. In contrast, untreated skin formed scars that covered over 30 percent of the original wound area.

Eliminating the EPF cells in the mice also eliminated much of the fibrosis caused by radiation exposure, the researchers found.
But, now; we know that the wound environment of diabetic wounds are rich in serine proteases, matrix metalloproteinase’s (MMPs) and tissue inhibitors of MMPs, that lead to degradation of growth factors and subsequently lead to healing failure. All these trails have excluded wounds of higher grade and ulcers in immunocompromised patients With the availability of this molecule inIndiaat affordable cost and after knowing its excellent safety profile [7], we also planned to conduct a prospective comparative study to evaluate its healing power on Indian patients who mostly suffer from large diabetic foot ulcers. Patients with type II diabetes were enrolled in the study with fulfillment of the criteria mentioned in Table 2. Blood test results includedlevels of glycosylated hemoglobin, glucose, albumin, creatinine,bloodurea nitrogen, and liver function tests.
Switch-over from oral hypoglycemic to Insulin therapy to achieve a tight blood sugar control4.
Effectiveness of both the treatment protocols was evaluated in terms of percentage healing or complete closure at 4, 6, 8, and 10 weeks. Purposeful selection raises suspicion that certain types of patients (those more or less likely to heal) are differentially chosen for treatment with PDGF. Therefore, the moment they reach to specialized centre, they request for quick intervention. It is generally appreciated that ulcers in different region may have different etiologies or aggravating factors, making comparison between studies difficult. Furthermore, melanoma cancer cells transplanted onto the backs of the laboratory mice grew more slowly when EPF cells were eliminated.
In this regard, topical use of rh-PDGF has shown some promises as a healing protagonist in various clinical trails [5, 6].
Therefore, the bias in observational study (case- control study or cohort study) could be that patients, treated with PDGF, might have wounds that are more or less likely to heal than patients not treated with PDGF gel based dressing.
Third, the treating resident surgeon was not blinded to the treatment status of the patients. A greater understanding of diabetic wound care and advances in wound care technology have lead to significant advancements in the field. Other tests included palpable ankle pulses and ankle brachial pressure index to assess foot perfusion. However, in our cohort study we attempted to control for selection bias by balancing factors (like age, duration of ulcer, grade and size of ulcer, glycemic control, vascular status and co morbidities etc.) between the two treatment groups. Therefore, it is possible that patients who received PDGF based dressing could have been treated in a more systematic and aggressive way from those that were treated with standard care alone.
The wound area was measured by means of planimetry (the greatestlength x the greatest width, measured in centimeters). The patients were considered non-compliant if daily dressings were missed for 2 days, offloading was not followed for more than 2 days and if patient failed to report for 2 consecutive visits during the follow up period. Themedian time to complete healing in the PDGF groupwas 56 days in comparison to the control group 63 days. One advantage of doing cohort studies over randomized controlled trials is that cohort studies measures effectiveness of two treatment modalities, whereas randomized controlled trials estimate efficacy of the treatment[15]. However, we think that this should not be a problematic issue because the covariates responsible for healing were homogenous in both the treatment groups. The perimeterof the wound was traced using an acetate film and a fine-tippedpermanent black ink marker. Effectiveness refers to the real- world ability of a treatment to provide benefit, whereas efficacy involves the potential benefits of a therapy under idealized conditions. Lastly, this single center study includes large ulcers and ulcers in immune- compromised patients, therefore; requires validation with multi-center study. Overall reduction in ulcer size was not statistically different at 8 and 10 weeks in both the groups.
Since, patients are rarely subjected to these idealized conditions, effectiveness estimates become more useful than efficacy estimates while deciding the best treatment option for individual patient. Woundbed characteristics, margins, and the presence orabsence of undermining or tunneling were also noted. Periodic sharp surgical debridement of non viable or necrotic tissue (until healthy bleeding tissue was reached) was performed as and whennecessary.
The frequency of dressing changes varied according to the conditionof the wound and the amount of drainage. Mortality in diabetic and nondiabetic patients after amputations performed from 1990 to 1995: a 5-year follow-up study. Recombinant human platelet-derived growth factor-BB (becaplermin) for healing chronic lower extremity diabetic ulcers: an open-label clinical evaluation of safety. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity diabetic ulcers. Efficacy and safety of a topical gel formulation of recombinant human platelet-derived growth factor-BB (Becaplermin) in patients with chronic neuropathic diabetic ulcers. Efficacy of Recombinant Human Platelet- Derived Growth Factor (rh-PDGF) Based Gel in Diabetic Foot Ulcers: A Randomized, Multicenter, Double- Blind, Placebo- controlled study inIndia. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers.

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11.07.2015 Drugs For Diabetes


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