Factors that influence healing of chronic venous leg ulcers: a retrospective cohort

BACKGROUND: Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates.OBJECTIVES: To identify clinical and therapeutic factors that influence healing of venous ulcers.METHODS: Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects.RESULTS: Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95% CI 31.9 to 48.4%) at T6 and 49.6% (95% CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95% CI 10.5 to 23.1%) at T6 and 27% (95% CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95% CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95% CI 1.31 to 12.41), and infection episodes (RR=0.42; 95% CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95% CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95% CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95% CI 0.40 to 0.99).CONCLUSIONS: Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates.

Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Cross-sectional Study

OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.

Effect of menthol in experimentally induced ulcers: Pathways of gastroprotection

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Sodium fluorescein for early detection of skin ulcers in Aeromonas hydrophila infected Piaractus mesopotamicus

The increase in aquaculture global fish production has been associated with an increase in infectious diseases affecting aquacultured species.. The aim of this study was to identify ulcers in pacu (Piaractus mesopotamicus) with sodium fluorescein before it was possible to observe them visually. Twenty one fish with no apparent skin lesions were divided into three groups. Group 1 were injected with saline 0.65% (Group 1), Group 2 with 6 x 10(8) CFU of Aeromonas hydrophila and group 3 with 6 x 10(8) CFU of Streptococcus agalactiae into the peritoneal cavity. All animals showed a positive reaction to fluorescein. A. hydrophila infected fish presented with large round marks with irregular borders, the characteristic ulcers caused by this agent. However, the other groups only displayed markings associated with handling caused by the netting procedures. We concluded that sodium fluorescein may be useful for an early and fast evaluation of cutaneous infection of A. hydrophila in pacu.

Anti-Helicobacter pylori activity and oxidative burst inhibition by the naphthoquinone 5-methoxy-3,4-dehydroxanthomegnin from Paepalanthus latipes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Limbal autograft transplantation in a dog with alkali-induced ulceration

Descreve-se um caso de um animal da espécie canina, fêmea, sem raça definida, de três meses de idade, com histórico de apatia, contato prévio com produto alcalino (hidróxido de sódio) e relutância em abrir o olho direito. Ao exame oftálmico, foram observados blefarospasmo, fotofobia, epífora, quemose discreta, hiperemia conjuntival, e edema corneal difuso com comprometimento do limbo. Foram realizados o teste da fluoresceína positivo e o Teste Lacrimal de Schirmer 32mm min-1. Com base nos achados, firmou-se o diagnóstico de úlcera por álcali e realizou-se transplante autógeno do limbo. No pós-operatório, observou-se vascularização corneal a partir do terceiro dia e sua intensificação, em número e calibre, nos dias subseqüentes. Também foram observadas mínimas áreas de transparência corneal. Os resultados obtidos permitem admitir que o transplante autógeno de limbo é procedimento factível para o manejo da terapia de úlceras de córnea por álcali.

Casearia sylvestris na permeabilidade gástrica à sacarose em equinos submetidos a protocolo de indução de úlcera gástrica

Estudos em animais de laboratório sugerem um efeito antiulcerogênico do extrato de Casearia sylvestris. Esse extrato ainda não foi estudado para a profilaxia e/ou o tratamento de úlceras gástricas em equinos. Para avaliar a influência do extrato de C. sylvestris na permeabilidade gástrica à sacarose, seis equinos adultos foram submetidos a modelo de indução de úlceras gástricas. Os animais foram submetidos ao teste de permeabilidade à sacarose antes e ao término do protocolo de restrição alimentar intermitente, para detecção de ulceração gástrica. Durante os sete dias da indução, os animais foram submetidos a tratamentos diários via sondagem nasogástrica com extrato de C. sylvestris (9mg kg-1 de peso corpóreo) ou veículo (ágar). Após intervalo de 32 dias em piquete, para permitir a cicatrização das úlceras induzidas, cada animal foi submetido novamente ao protocolo de indução de úlcera gástrica, e os tratamentos foram alternados. Dessa forma, cada animal foi submetido a ambos os tratamentos em períodos distintos. A concentração de sacarose na urina foi determinada para cada amostra obtida, por cromatografia líquida de alto desempenho e detecção amperométrica pulsátil. Não foram observadas alterações nos exames clínicos e hemogramas. O tratamento com o extrato de C. sylvestris evitou o aumento da concentração de sacarose urinária (P<0,05) quando comparado ao veículo, sugerindo um efeito antiulcerogênico gástrico em equinos. Estudos mais amplos incluindo gastroscopia são necessários para avaliar a possibilidade de usar o extrato para a profilaxia e/ou o tratamento das úlceras gástricas em equinos.

Freqüência de lesões gástricas em suínos destinados ao abate na região de Ribeirão Preto, SP

Foram colhidos e examinados 1085 estômagos de suínos, machos castrados ou fêmeas, todos com idade entre 140 e 150 dias. As lesões encontradas foram classificadas de acordo com a localização, tipo e severidade. A análise macroscópica revelou que 694 (64%) estômagos apresentavam algum tipo de lesão. A paraqueratose foi identificada como alteração patológica única em 213 (19,6%) estômagos. em outros 319 (29,4%) estômagos, ela estava associada apenas a processos erosivos ou associada a erosões e úlceras. Erosões isoladas ou associadas a ulcerações foram identificadas em 121 (11,2%) animais, enquanto que úlceras, foram verificadas em 41 (3,8%) animais. A avaliação por regiões, revelou que 62,8% apresentaram lesões na região gastresofágica e apenas 6,6% na região fúndica do órgão. Tais achados sugerem a existência de diferentes causas na etiopatogenia desses dois processos gástricos. A ulceração gastresofágica estava presente em 213 (19,6%) animais, dos quais 22,7% eram machos castrados e 16,5% eram fêmeas, fato que evidencia possível influência do sexo na freqüência dessa patologia em suínos. Os exames microscópicos, realizados em parte das amostras, apenas confirmaram as alterações, já identificadas pelo exame macroscópico. Apenas o exame macroscópico conduz a resultados confiáveis na avaliação de lesões gástricas em suínos.

Detection of anti-Toxoplasma gondii antibodies in experimentally and naturally infected non-human primates by Indirect Fluorescence Assay (IFA) and indirect ELISA

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Involvement of nitric oxide in the gastroprotective effects of an aqueous extract of Pfaffia glomerata (Spreng) Pedersen, Amaranthaceae, in rats

The plants belonging to Pfaffia genus are used in folk medicine to treat gastric disturbances. This study examined the effects of an aqueous extract of Pfaffia glomerata (Spreng) Pedersen (AEP) on the gastrointestinal tract. Wistar rats were pretreated orally (p.o.) with the AEP (125, 250, 500 and 1000 mg.kg(-1)) before induction of ulcers by hypothermic restraint stress (HRS, 3 h restraint stress at 4 degreesC), ethanol (ET, 70%; 0.5 ml/animal; p.o.) or indomethacin (IND, 20 mg.kg(-1); s.c.). Control animals received water (C) or ranitidine (60 mg.kg(-1)) p.o. The AEP protected rats against HRS and ET-induced ulcers, but was not able to protect the gastric mucosa against IND-induced ulcers. When injected into the duodenal lumen, the AEP reduced total acidity and both basal and histamine-stimulated acid secretion in pylorus-ligated rats. In addition, gastric secretion from AEP-treated animals exhibited increased concentrations of nitrite and nitrate. Treatment of animals with L-NAME (120 mg.kg(-1), p.o.) prevented both the reduction of total acidity and the increase in NO, levels promoted by AEP treatment. In conclusion, AEP effectively protected the gastric mucosa and inhibited gastric acid secretion in rats, probably by involving the histaminergic pathway and an enhanced production of nitric oxide in the stomach. (C) 2003 Elsevier B.V. All rights reserved.

Anti-Helicobacter pylori activity and immunostimulatory effect of extracts from Byrsonima crassa Nied. (Malpighiaceae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of Byrsonima crassa and Phenolic Constituents on Helicobacter pylori-Induced Neutrophils Oxidative Burst

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Mutagenicity of Mouriri pusa Gardner and Mouriri elliptica Martius

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Genotoxicity of polar and apolar extracts obtained from Qualea multiflora and Qualea grandiflora

Ethnopharmacological relevance: The species Qualea grandiflora and Qualea multiflora, which belong to the Vochysiaceae family, are common in the Brazilian savannah (Cerrado biome), and the local inhabitants use these species to treat external ulcers and gastric diseases and as an anti-inflammatory agent. Studies have demonstrated that these plants contain compounds that exhibit pharmacological activities; however, the risks associated with their consumption are not known.Material and methods: In the present study, the mutagenicity of polar and apolar extracts from Qualea grandiflora and Qualea multiflora were assessed by employing the Ames assay with and without metabolic activation. Additionally, phytochemical analyses (HPLC-ESI-IT-MS, HPLC-UV-PDA and GC-IT-MS) were performed to identify the chemical constituents present in these species, including the evaluation of physico-chemical properties, such as polarity or apolarity of the organic compounds, which are related to each fraction obtained. These studies provide important information regarding the biochemical behaviour of these compounds.Results: All extracts exhibited mutagenicity, inducing frameshift mutations and base substitutions in DNA. Phytochemical analysis identified terpenes, ellagic acid derivatives and phytosteroids.Conclusions: The mutagenicity observed might be due to the presence of pentacyclic triterpenes and polyphenols, which are able to generate reactive oxygen species (ROS) and result in the potential to cause DNA damage. The genetic risk identified in this present work shows that special attention should be considered for the use of compounds obtained from these plant species in medicinal treatments. Further studies must be conducted to identify safe therapeutic doses. (C) 2011 Elsevier B.V. All rights reserved.