A Systematic Review of Randomized Controlled Trials of Antibiotic Use in Diabetic Foot Ulcer Infections: Focus on Clinical Cure / 감염과화학요법

Background@#The use of antibiotics in diabetic foot ulcer infections (DFUI) is essential in reducing morbidity. Optimal administration of antibiotics can improve clinical outcomes and reduce the risk of antibiotic resistance. This study aims to review the efficacy, in terms of clinical cure, of various regimens and the duration of antibiotic administration in DFUI patients, based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The efficacy based on microbiological response is also reviewed as the secondary outcome. @*Materials and Methods@#We used three databases, namely PubMed, Scopus, and ScienceDirect, to search for randomized controlled trials (RCTs) in patients with DFUI who required antibiotics. @*Results@#A total of 16 studies were included in the systematic review. The study locations and bacterial patterns varied, with the most common pathogen being Staphylococcus aureus. Most studies did not demonstrate a significant difference in clinical cure and pathogen eradication, either in the comparison between systemic and topical antibiotics or in the duration of administration. Some studies had similar characteristics and were analyzed to conclude. These studies showed that ertapenem had comparable efficacy to piperacillin/tazobactam. Similar results were also conducted from studies of piperacillin-+amoxicillinclavulanic acid vs. moxifloxacin. @*Conclusion@#Most studies have heterogeneous characteristics, possibly due to differences in research location. Therefore, there is no strong evidence to recommend a specific antibiotic with the highest efficacy. However, since all included studies are RCTs, this review provides a good summary in considering antibiotic choices when treating DFUI patients.

Autologous Bone-Marrow vs.Peripheral Blood Mononuclear Cells Therapy for Peripheral Artery Disease in Diabetic Patients

Diabetes mellitus (DM) remains one of the most important risk factors for peripheral artery disease (PAD), with approximately 20% of DM patients older than 40 years old are affected with PAD. The current standard management for severe PAD is endovascular intervention with or without surgical bypass. Unfortunately, up to 40% of patients are unable to undergo these revascularization therapies due to excessive surgical risk or adverse vascular side effects.Stem cell therapy has emerged as a novel therapeutic strategy for these ‘no-option’ patients. Several types of stem cells are utilized for PAD therapy, including bone marrow mononuclear cells (BMMNC) and peripheral blood mononuclear cells (PBMNC). Many studies have reported the safety of BMMNC and PBMNC, as well as its efficacy in reducing ischemic pain, ulcer size, pain-free walking distance, ankle-brachial index (ABI), and transcutaneous oxygen pressure (TcPO2). However, the capacity to establish the efficacy of reducing major amputation rates, amputation free survival, and all-cause mortality is limited, as shown by several randomized placebo-controlled trials. The present literature review will focus on comparing safety and efficacy between BMMNC and PBMNC as cell-based management in diabetic patients with PAD who are not suitable for revascularization therapy.

Molecular Dynamic Simulation of Centella asiatica Compound as an Inhibitor of Advanced Glycation End Products

The studies have suggested that advanced glycation end products (AGEs) induce stress oxidative and inflammatorypathway, which results in chronic complication. Centella asiatica (CA) has been shown as a promising candidate forAGE inhibitor due to its ability of reducing AGE production. This study aims to explore the molecular docking ofCA active compound as an inhibitor of AGEs and receptor AGEs (RAGEs). The top three docking structures werepicked for molecular dynamic (MD) simulations. Based on MD simulation in this study, we found that CA activecompound had been proven to interact with AGEs and RAGE. AGEs bound to asiaticoside, madasiatic acid, andmadecassic acid with a binding energy of −11.8253, −10.6724, and −10.1462 kcal/mol, respectively. Nonetheless,Asn106, Asp324, Asp376, Tyr420, and Tyr500 of AGEs made a significant contribution to the complex of asiaticosideAGE, as well as those for the madasiatic acid AGE, which were Asn118 and Tyr500. RAGE bound to asiaticoside,asiatic acid, and isothankunik acid with a binding energy of −10.6125, −9.4469, and −9.1015 kcal/mol, respectively.CA active compounds, specifically asiatic acid, madasiatic acid, and madecassic acid, interacted with AGEs, whereasasiaticoside and isothankunik acid interacted with RAGE based on docking and model studies.

Generalized hyperpigmentation caused by Addison’s Disease in a patient with HIV/AIDS and multiple opportunistic infections / Journal of the ASEAN Federation of Endocrine Societies

@#One of the neglected complications of patients with HIV/AIDS is primary adrenal insufficiency also known as Addison’s disease. This condition can be caused by several mechanisms, such as tuberculosis, CMV, cryptococcal, or HIV-related adrenalitis, and also drugs commonly used for HIV/AIDS especially antifungal therapy. This is a case report of a man infected with HIV/AIDS and multiple opportunistic infections. He reported darkening of the skin and reduction of body hair 4 months after diagnosis of HIV/AIDS. From the clinical features and laboratory examinations, he was diagnosed as having primary adrenal insufficiency and was then treated with longterm corticosteroids.