ABSTRACT
Neuropathic ulcers pose a global burden carrying a risk of amputation of 15-46 times especially in developing countries. These ulcers are mainly managed with offloading techniques. In this study we share our experience of using an easy to use, cost effective method the Suvidha offloading dressings in terms of its acceptability and effectiveness in managing these cases. A prospective case series of 83 patients with mean age 58 years, managed with Suvidha offloading dressing in our institution from 2016 till 2019, excluding patients with ABI less than 0.4 and Wagner 4 and 5. They were reviewed after 6 months/SOS. Ulcer measured 1×1 to 4×4 cm, was present most commonly in the mid foot and least commonly in the lateral aspect of the foot. 53 cases were Wagner grade 2 and 9 cases Wagner grade 3. Forty cases were initially infected, 29 cases had a deformed foot, 5 cases needed interval wound debridement. The duration of ulcer healing was 2 weeks for 1×1 cm great toe ulcer, to 12 weeks for the 4×4 cm mid foot ulcer. All 83 patients were followed up for 6 months. 5 ulcers recurred. The patient satisfaction was measured by a 5-points Likert scale with a mean value of 17.4 out of 20. The Suvidha offloading footwear is a cost effective, easily replicable and efficient dressing requiring only the readily available dressing materials, with good healing rates, good patient satisfaction and adapted for developing countries. The results are comparable with other methods of offloading practiced worldwide.
ABSTRACT
We examined interactions between the 83 kDa heat-shock protein (Hsp83) and hsrω long noncoding RNAs (lncRNAs) inhsrω66 Hsp90GFP homozygotes, which almost completely lack hsrω lncRNAs but over-express Hsp83. All +/+; hsrω66Hsp90GFP progeny died before the third instar. Rare Sp/CyO; hsrω66 Hsp90GFP reached the third instar stage butphenocopied l(2)gl mutants, becoming progressively bulbous and transparent with enlarged brain and died after prolongedlarval life. Additionally, ventral ganglia too were elongated. However, hsrω66 Hsp90GFP/TM6B heterozygotes, carrying +/+ or Sp/CyO second chromosomes, developed normally. Total RNA sequencing (+/+, +/+; hsrω66/hsrω66, Sp/CyO; hsrω66/hsrω66, +/+; Hsp90GFP/Hsp90GFP and Sp/CyO; hsrω66 Hsp90GFP/hsrω66 Hsp90GFP late third instar larvae) revealedsimilar effects on many genes in hsrω66 and Hsp90GFP homozygotes. Besides additive effect on many of them, numerousadditional genes were affected in Sp/CyO; hsrω66 Hsp90GFP larvae, with l(2)gl and several genes regulating the centralnervous system being highly down-regulated in surviving Sp/CyO; hsrω66 Hsp90GFP larvae, but not in hsrω66 orHsp90GFP single mutants. Hsp83 and several omega speckle-associated hnRNPs were bioinformatically found topotentially bind with these gene promoters and transcripts. Since Hsp83 and hnRNPs are also known to interact, elevatedHsp83 in an altered background of hnRNP distribution and dynamics, due to near absence of hsrω lncRNAs and omegaspeckles, can severely perturb regulatory circuits with unexpected consequences, including down-regulation of tumoursuppressor genes such as l(2)gl.