Intermediate Results of the Research for Percutaneous and Surgical Treatment for Left Anterior Descending Artery Chronic Total Occlusion

Objective: Is to find out which revascularization methods have less of risk factors and complications after the surgery and long-term period. Method(s): From January 2018 to December 2019 were operated 134 patients with LAD CTO. 48 of them underwent MIDCAB: 36 (75%) males and 12 (25%) females;aged 58.7 +/-8.7;7 (14.6%) with previous diabetes;10 (20.8%) with previous PCI of LAD with drug-eluting stent. In the PCI group there were 86 patients: 52 (60.5%) males and 34 (39.5%) females;aged 64.8 +/-8.3;23 (26.7%) with previous diabetes. Result(s): Hospital mortality was 0 (0%) in MIDCAB unlike 1 (1.2%) in PCI. Myocardial infarction was 0 (0%) in both the groups. In MIDCAB the number of conversions to onpump and sternotomy was 0 (0%), there were 6 (12.5%) pleuritis with pleural puncture and 3 (6.2%) with long wound-aches. The hospitalization period was 10.7+/-2.9 days for MIDCAB and 9.9 +/-3.9 days for PCI. In the PCI group 2.0 +/-1.0 drug-eluting stents were used. In-hospital costs were higher for PCI 3809 unlike 3258 for MIDCAB. After one year in MIDCAB group died 2 (4.2%) patients, from noncardiac causes. In PCI group died 3 (3.5%) patients, all from cardiac causes. Because of pandemic COVID-19 were checked only 48 patients by angiography and general clinical examination: 25 after MIDCAB and 23 after PCI. 5 patients have a graft failure, caused by surgical mistakes. 4 patients have stents restenosis and 1 has LAD's reocclusion. Conclusion(s): Both methods of revascularization for LAD CTO are demonstrated similar results. EuroSCORE II (P = 0.008) and glomerular filtrating rate (P = 0.004) are significant potential risk factors for mortality in both groups, age is potential risk factor for graft failure (P = 0.05). Dyslipidemia is significant risk factor for LAD restenosis in PCI group (P = 0.02). MIDCAB is associated with lower incidence of revascularization repeat and in-hospital mortality in the literature data and it costs lower than PCI for LAD CTO as our study has shown.

Using Absorbable Suture For Traumatic Wound Closure To Avoid Additional Hospital Visit For Suture Removal During The Covid 19 Pandemic: A Randomized Controlled Trial

Introduction: The COVID-19 pandemic worldwide forced governments to undertake intervention measures to encourage social distancing. Meanwhile, traumatic skin lacerations require multiple hospital visits for dressing, changings, and suture removal since they are usually repaired with non-absorbable sutures. In a matter of fact, these visits can be avoided by using absorbable sutures instead. However, absorbable sutures carry the theoretical risk of wound infection. In this study, our aim was to determine whether absorbable sutures are better than non-absorbable sutures in repairing lacerations during the COVID-19 pandemic. The first and second objectives were to assess the rate of infection and the number of postoperative hospital visits. Method(s): A sample of 469 patients with traumatic skin lacerations were analysed during the COVID-19 pandemic in April-July 2020. In the control group, wounds were repaired using non-absorbable sutures, while rapid-onset absorbable sutures were used in the treatment group. By conducting a phone call follow-up after 21 days, several parameters regarding infection signs and hospital visits were compared between both groups. Result(s): No statistically significant difference was observed between both groups regarding wound infection (p-value= 0.623). Using absorbable sutures resulted in fewer postoperative hospital visits than non-absorbable sutures (p-value= 0.001). This study is limited because the assessment of wound infection was subjective to the patient by a phone call follow-up. Conclusion(s): Using absorbable sutures to close traumatic skin lacerations is safe. They should be considered during a pandemic to reduce hospital visits for suture removal, which will subsequently enhance social distancing and relieve hospital load.

Long-term safety and efficacy of Oleogel-S10 (birch triterpenes) in epidermolysis bullosa wounds: 24-month open-label data from the EASE study

Objectives: The 90-day double-blind phase (DBP) of the Phase 3 EASE study demonstrated accelerated wound healing for Oleogel-S10 (birch triterpenes) versus control gel in epidermolysis bullosa (EB). Here, we report safety and total wound burden results from the 24-month open-label phase (OLP) in which all patients received treatment with Oleogel-S10. Method(s): Total wound burden was assessed using EB Disease Activity and Scarring Index (EBDASI) and Body Surface Area Percentage (BSAP). Data are reported without visit windows to reflect a realworld situation more accurately, particularly considering the COVID- 19 pandemic. Result(s): The patient population was made up of dystrophic EB (n = 178, 86.8%) and junctional EB (n = 25, 12.2%);71.7% (n = 147) of patients were aged <18 years. 141 patients (68.8%) completed the OLP. The mean (SD) treatment duration for all patients was 584.7 (246.1) days. Adverse events were reported in 77.1% of all patients in the OLP versus 81.7% of those receiving Oleogel-S10 in the DBP. Mean BSAP for patients treated with Oleogel-S10 in the DBP reduced from 12.1% at study entry to 6.1% with 27 months of treatment. Similarly, the mean EBDASI skin activity score in the Oleogel-S10 group improved from 19.6 to 15.1 after 27 months. In addition, reductions in both BSAP and EBDASI from OLP baseline were observed in patients who transitioned from control gel to Oleogel-S10 in the OLP. Discussion(s): These data support a reassuring long-term safety profile of Oleogel-S10. Furthermore, the reduction in wound burden previously reported with 15 months of Oleogel-S10 treatment is maintained to the end of OLP. This is encouraging given the nature of this chronic genetic disorder in which there is regular cycling of patients' fragile wounds.

The Effect of COVID-19 on Care for Chronic Wounds Among Medicare Beneficiaries Using Medicare Claims - 2019, 2020, and 2021

Objectives: Examine the effect of COVID-19 on chronic wound care service provision for Medicare beneficiaries in 2019, 2020, and 2021. Method(s): This retrospective analysis of Medicare claims data included beneficiaries who received care for diabetic foot ulcers and infections, arterial ulcers;skin disorders and infections, surgical wounds and infections;traumatic wounds;venous ulcers and infections, unspecified chronic ulcers, and others. We extracted all claims for each targeted beneficiary across all care settings and from the Medicare Beneficiary Summary File for 2019 to 2021. The outcomes were: 1) prevalence of each wound type, 2) Medicare expenditures by wound type, and expenditures by type of service. Result(s): Over the 3-year period, the number of Medicare beneficiaries with a wound generally decreased in 2020, then increased in 2021 to a higher level than in 2019. In 2019, 16.4% of Medicare beneficiaries (10.6M) had at least one type of wound. In 2020, 14.9% of Medicare beneficiaries (9.8M) were diagnosed with wounds (a decrease of 7.1%), and in 2021, 16.1% of Medicare beneficiaries (10.8M) were diagnosed with wounds, an increase of 1.9% from 2019. In 2021, approximately 2.7% of beneficiaries had a claim with a wound diagnosis that had been added in FY2020, or 0.4% of all Medicare beneficiaries. The prevalence of COVID-19 among beneficiaries with chronic wounds was 896,198 (9.1%) in 2020, rising to 1.2M (11.1%) in 2021. Using our mid-range estimates of Medicare expenditures, wound care totaled $24.7B in 2019, $23.9B in 2020, and $26.3B in 2021. Conclusion(s): These results emphasize the ongoing prevalence of chronic wounds among Medicare beneficiaries and suggest the decrease in care during the pandemic contributed to a relative increase in care and expenditures in 2021. We found a shift in the site of care from skilled nursing facilities toward home health as individuals sought to avoid COVID-19 exposure.Copyright © 2023

Extracorporeal membrane oxygenation for airway emergencies

Objectives: Extracorporeal membrane oxygenation (ECMO) is well established in cardiorespiratory failure. Here we report the use of ECMO in an airway emergency to provide respiratory support. Method(s): Informed consent was obtained from patient at the time of admission. Result(s): A 48-year-old with COVID-19 requiring venovenous ECMO (VVECMO) for 32 days and tracheostomy for 47 days had developed tracheal stenosis three months after tracheostomy removal, and undergone tracheal resection and reconstruction. He presented two weeks later with acute dyspnea, bloody drainage and a bulge in his neck with coughing. A computerized tomography (CT) of the cervical spine and chest showed dehiscence of the tracheal wound and a gap in the trachea. He was managed with High Flow Nasal Canula and supported on VVECMO support using 25 Fr. right femoral drainage cannula and 23 Fr. left IJ return cannula. A covered stent was placed, neck wound was irrigated and debrided. Patient was decannulated after 10 days on ECMO. Future therapeutic considerations include mediastinal tracheostomy, aortic homograft interposition of the disrupted segment of trachea with stent placement and permanent self-expandable stent with internal silicone stent. Conclusion(s): ECMO is increasingly used in complex thoracic surgery as well as in the perioperative period as salvage support. One of the areas where it has shown promising results is traumatic main bronchial rupture, airway tumor leading to severe airway stenosis, and other complex airway problems. The ease of cannulation, the technological advances and growing confidence in the management of ECMO patients are the main reasons for the expansion of ECMO use beyond conventional indications. The case described above is an example of the use of ECMO in the perioperative management of impending respiratory failure due to airway obstruction or disconnection. (Figure Presented).

The Impact of the COVID Pandemic on Diverticulitis Surgery

Introduction: The COVID-19 pandemic disrupted maintenance healthcare and elective surgical volume, particularly for benign diseases, including diverticulitis. The study evaluates if the surgical management of diverticulitis was impacted by the pandemic. Method(s): All colectomies for diverticulitis in ACS-NSQIP between 2017-2020 were identified by CPT and ICD codes. Cases were divided into groups by the operation year and quarter variables. The first quarter of 2020 was excluded. The pre- COVID group included cases before 2020 and the post-COVID group included cases after the first quarter of 2020. Associations between groups and baseline demographics and postoperative outcomes were compared. Result(s): 46,839 colectomies were evaluated with 38,860 pre- COVID and 7,979 post-COVID. The groups were similar except for CHF(p=0.027) and ASA classification (p<0.001), which were higher post-COVID. However, pandemic cases were associated with significant markers of disease severity. Pandemic cases were more likely to have preoperative sepsis (p<0.001), wound class 4 (p<0.001), and emergency status (p<0.001). There was no difference in the rates of minimally invasive surgery (MIS) or conversion to open among MIS cases. There were also a higher percentage of Hartmann's procedures (p<0.001) post-COVID. However, there was no difference in mortality rates, length of stay, reoperation, open abdomen, readmission, reintubation, or prolonged intubation. There was an association between the pandemic and rates of postoperative pneumonia(p<0.001), ileus (p=0.003), and septic shock (p<0.001). Conclusion(s): During the first year of the pandemic diverticulitis surgeries were performed on sicker patients, more commonly emergencies, and Hartmann's procedures. However, these patients maintained comparable postoperative outcomes.

Developing a mobile health application for wound telemonitoring: a pilot study on abdominal surgeries post-discharge care.

BACKGROUND: Many early signs of Surgical Site Infection (SSI) developed during the first thirty days after discharge remain inadequately recognized by patients. Hence, it is important to use interactive technologies for patient support in these times. It helps to diminish unnecessary exposure and in-person outpatient visits. Therefore, this study aims to develop a follow-up system for remote monitoring of SSIs in abdominal surgeries. MATERIAL AND METHODS: This pilot study was carried out in two phases including development and pilot test of the system. First, the main requirements of the system were extracted through a literature review and exploration of the specific needs of abdominal surgery patients in the post-discharge period. Next extracted data was validated according to the agreement level of 30 clinical experts by the Delphi method. After confirming the conceptual model and the primary prototype, the system was designed. In the pilot test phase, the usability of the system was qualitatively and quantitatively evaluated by the participation of patients and clinicians. RESULTS: The general architecture of the system consists of a mobile application as a patient portal and a web-based platform for patient remote monitoring and 30-day follow-up by the healthcare provider. Application has a wide range of functionalities including collecting surgery-related documents, and regular assessment of self-reported symptoms via systematic tele-visits based on predetermined indexes and wound images. The risk-based models embedded in the database included a minimum set with 13 rules derived from the incidence, frequency, and severity of SSI-related symptoms. Accordingly, alerts were generated and displayed via notifications and flagged items on clinicians' dashboards. In the pilot test phase, out of five scheduled tele-visits, 11 (of 13) patients (85%), completed at least two visits. The nurse-centered support was very helpful in the recovery stage. Finally, the result of a pilot usability evaluation showed users' satisfaction and willingness to use the system. CONCLUSION: Implementing a telemonitoring system is potentially feasible and acceptable. Applying this system as part of routine postoperative care management can provide positive effects and outcomes, especially in the era of coronavirus disease when more willingness to telecare service is considered.

HPTLC and GC-MS finger-printing of two potential multifunctional siddha tailams: Mathan and maha megarajanga tailam.

The Siddha system of medicine is an ancient medical lineage that is practiced primarily in the southern part of India. Siddha system of medicine has been in practice for thousands of years with documented evidence dating back to the 6th century BCE. According to siddha system of medicine's basic fundamental principle, the human body is made up of 96 thathuvam (primary components), which encompass physical, physiological, psychological, and intellectual aspects. Medicine (marunthu) is classified as a wide range of internal and external medicines. The major components of its medical formulations include plant parts, minerals and animal products. Various methods were carried out for the purification process to eliminate the toxins. Choornam, Guligai, Tailam, Parpam, Chendooram, Kattu, Pasai and Poochu are the most common medicines used in Siddha system of medicine for the treatment of various diseases. The pathophysiological classification of diseases is elaborated in detail in the classical Siddha literature. Siddha system of medicine plays an important role in protecting people from diseases such as COVID-19 by providing immune-protecting and immune-boosting medicines in today's world. Mathan tailam and maha megarajanga tailam are the two unique preparations used widely for various skin diseases including chronic wounds and burns. Scientific validation of both medicines will help in understanding their effectiveness against a typical wound condition. In the present study physio-chemical and phytochemical, HPTLC, and GC-MS analyses were carried out and discussed in detail on the multifunctional properties exhibited in the patient communities.

Cooperate with community health centers to eliminate HCV in low prevalence region of South China

Background: Shenzhen, a city of immigrants in South China, has a low HCV incidence rate of 19.47 per 100,000. To eliminate HCV in this low prevalence region, it may be efficiency to collaborate with the communities to screen HCV in high risk population. There are 849 Community Health Centers up to now in Shenzhen. The study aimed to evaluate the model of HCV elimination in high-risk population with Community Health Centers. Method(s): The Shenzhen Medical Association assigned hepatologists to educate Primary Care Physicians (PCPs) of 13 Community Health Centers in Bao'an District from 2021.6-2022.6. The PCPs need to take HCV knowledge tests before and after the training. Only when all the questions are answered correctly can the test be passed. Then they recommend the high risk population, e.g., PWID, pricking wound, iatrogenic exposure, to do the HCV antibody test and transfer the patients with HCV-Ab (+) to the hepatologist of Shenzhen Bao'an People's Hospital. Result(s): 151 PCPs participated in HCV knowledge education, the pass rate improved from 15.2% to 53.8% after the training. The high risk population screening number in Community Health Centers improved from 192 (a year before) to 300, even affected by the lockdown of COVID-19. The HCV antibody positive rate in high risk population is 4% (12/300), higher than the hospital population (0.8%, Shenzhen Bao'an People's Hospital), the blood donor (0.3%, Shenzhen Blood Center). The HCV-Ab positive patients in communities transferred to Shenzhen Bao'an People's Hospital, where the rate of DAA treatment is improved from 36.6% (a year before) to 64.1%. Conclusion(s): It is an efficient way to achieve HCV elimination earlier to screening in high risk population through PCPs in low prevalence region. Expanding this model to other Community Health Centers in Shenzhen may accelerate HCV elimination. (Figure Presented).

Epidemiological Features of Healthcare-associated Acinetobacter baumannii Infections in Taiwan During 2008 - 2019

Background: Acinetobacter baumannii can reside in humans without causing infection or symptoms but can opportunistically cause community and nosocomial infections. Few studies from Taiwan have used national-level data to investigate antibiotic resistance rates of A. baumannii infections in the intensive care units (ICUs) of medical centers. Aim(s): This study determined the number of infection sites of A. baumannii and the resistance rates of carbapenem-resistant A. baumannii (CRAB) infections in ICUs in Taiwan, and identified trends over time, variations of infection site, and factors associated with resistance. Method(s): This study used the database provided by Taiwan's Centers for Disease Control. Yearly, Taiwan Nosocomial Infections Surveillance System Surveys from 2008 to 2019 were analyzed, including data on the site of infection and resistance rates of A. baumannii and patient and hospital characteristics. Result(s): On average, 21 hospitals as medical center/year participated in the survey, and 6803 A. baumannii isolates were identified. All isolates were health care-related infections. The most frequent sites of infection were the urinary tract (50.6%), respiratory tract (19.6%), bloodstream (18.2%), surgical wounds (4.3%), and others (7.4%). Infection rates were the highest in the urinary tract in 2019 (63.6%;P < 0.001). On average, the rate of carbapenem resistance was 66.6% (95% confidence interval: 63.1-70.1) among ICU patients at medical centers. Considerable regional differences were observed, with the highest rates of resistance in the central regions. Higher resistance rates were observed between 2019 and 2020 COVID-19 pandemic (74.2%). Conclusion(s): This is the first report on the prevalence of health care-related A. baumannii infection in Taiwan in 2008-2019. Several invasive diseases, such as urinary tract infections, are associated with higher rates of carbapenem resistance. The resistance rate of CRAB in Taiwan is exceptionally high. The current big-data-derived findings may inform future surveillance and research efforts in Taiwan.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Surgical outcomes of breast conserving surgery performed under local versus general anaesthesia

Background: Surgical resection remains the mainstay for early breast cancer. However, older patients with multiple co-morbidities may be deemed unsafe for general anaesthesia (GA). The Covid-19 pandemic necessitated some such surgery under local anaesthesia (LA) especially those who lacked anti-hormonal bridging therapy option. We present a retrospective study comparing outcomes following breast conserving surgery (BCS) under LA and GA. Method(s): 31 patients under LA (April 2018-March 2022) were compared with 31 age-matched patients under GA during the same period. Main outcomes were length of hospital stay and rates of margin positivity, re-operation, and post-operative complications within 1 month (including wound infections, seromas needing >=3 aspirations). Statistical analysis (with R-4.2.2) used two-tailed test with significant p-value (<0.05). Result(s): Only 5 LA cases were performed in the 2 years prior to first UK Covid-19 lockdown (March 2020), whilst 26 cases were performed in the 2 years after. [Formula presented] Conclusion(s): The number of BCS cases under LA increased five-fold following Covid-19 pandemic. Outcomes under LA were no worse than under GA. BCS under LA can allow BCS in patients unfit for or unwilling to have GA, especially older patients. Dedicated lists for BCS under LA may reduce need for resources such as hospital beds and overnight stays in the current resource and financially constrained health-care system.Copyright © 2023

Skin graft as a modality reconstruction of post-burn contractures during pandemic area: case series

Background: The Covid-19 pandemic causes the postponement of elective surgery. At the same time, patients with post-burn contractures require immediate operation due to impaired function that can lead to depression and disruption of daily life. Operations on contracture patients during a pandemic must be carried out using the principles of accuracy, speed, and safety. The skin graft is one of the most appropriate treatments modalities for releasing contractures. This case study aims to evaluate the skin graft as a modality reconstruction of post-burn contractures during pandemic area. Case Presentation: We present three cases of post-burn contractures who underwent contracture release and skin graft surgery with a hospital stay of 3-5 days. Surgical results showed that graft take reached 90%-100% in all patients, and 100% epithelialization occurred at donor sites between 2-4 weeks postoperatively. There were no post-operative complications. Conclusion: The skin graft is an effective and suitable technique for treating post-burn contractures in the pandemic era. © 2023, Sanglah General Hospital. All rights reserved.

2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

Ensuring Quality Care in the COVID-19 Era: Applying the Donabedian Model to Tertiary Wound Care Center Practices.

The COVID-19 pandemic has disrupted healthcare, with its far-reaching effects seeping into chronic disease evaluation and treatment. Our tertiary wound care center was specially designed to deliver the highest quality care to wounded patients. Pre-pandemic, we were able to ensure rapid treatment via validated protocols delivered by a co-localized multidisciplinary team within the hospital setting. The pandemic has disrupted our model's framework, and we have worked to adapt our workflow without sacrificing quality of care. Using the modified Donabedian model of quality assessment, we present an analysis of pre- and intra-pandemic characteristics of our center. In this way, we hope other providers can use this framework for identifying evolving problems within their practice so that quality care can continue to be delivered to all patients.

The Impact of COVID-19 Lockdowns in Germany on Mood, Attention Control, Immune Fitness, and Quality of Life of Young Adults with Self-Reported Impaired Wound Healing.

BACKGROUND: Previous studies in Dutch young adults revealed that individuals with self-reported impaired wound healing reported poorer mood, increased inattention and impulsivity, poorer quality of life, and poorer immune fitness compared to healthy controls. Another study revealed that the negative impact of lockdowns during the 2019 coronavirus disease (COVID-19) pandemic was significantly more profound among the impaired wound healing group than the control group. The purpose of the current study was to replicate and extend these findings among young adults living in Germany. METHODS: A retrospective, cross-sectional survey was conducted among N = 317 young adults living in Germany, 18-35 years old. They were allocated to the IWH group (N = 66) or the control group (N-251). Participants completed the Attention Control Scale, and mood, quality of life, and immune fitness were assessed with single-item ratings. All assessments were made for (1) the period before the COVID-19 pandemic, (2) the first lockdown period, March-May 2020, (3) the first no-lockdown period, summer 2020, (4) the second lockdown, November 2020 to May 2021, and (5) the second no-lockdown period, summer 2021. RESULTS: The impaired wound healing group reported significantly poorer mood, quality of life, and immune fitness. The effects were evident before the pandemic. The impaired wound healing group scored significantly poorer on attention focusing, but no significant differences between the groups were found for attention shifting. During the pandemic, negative lockdown effects (i.e., further aggravation of mood and immune fitness and lower quality of life) were evident in both groups but significantly more profound in the impaired wound healing group. No differences between the groups were found for the no-lockdown periods. CONCLUSION: Individuals with self-reported impaired wound healing have significantly poorer mood, attention focusing, and immune fitness and report a poorer quality of life than healthy controls. The impact of COVID-19 lockdowns was significantly more profound in the impaired wound-healing group.

Advanced Nitric Oxide Generating Nanomedicine for Therapeutic Applications.

Nitric oxide (NO), a gaseous transmitter extensively present in the human body, regulates vascular relaxation, immune response, inflammation, neurotransmission, and other crucial functions. Nitrite donors have been used clinically to treat angina, heart failure, pulmonary hypertension, and erectile dysfunction. Based on NO's vast biological functions, it further can treat tumors, bacteria/biofilms and other infections, wound healing, eye diseases, and osteoporosis. However, delivering NO is challenging due to uncontrolled blood circulation release and a half-life of under five seconds. With advanced biotechnology and the development of nanomedicine, NO donors packaged with multifunctional nanocarriers by physically embedding or chemically conjugating have been reported to show improved therapeutic efficacy and reduced side effects. Herein, we review and discuss recent applications of NO nanomedicines, their therapeutic mechanisms, and the challenges of NO nanomedicines for future scientific studies and clinical applications. As NO enables the inhibition of the replication of DNA and RNA in infectious microbes, including COVID-19 coronaviruses and malaria parasites, we highlight the potential of NO nanomedicines for antipandemic efforts. This review aims to provide deep insights and practical hints into design strategies and applications of NO nanomedicines.

Anti-IL17A, Ixekizumab, for treatment-resistant chronic venous leg ulcers: A phase II randomized, double-blind, placebo-controlled pilot trial

Chronic venous leg ulcers cause significant morbidity in patients and the majority reoccur after resolution. The current standard of care, double layer compression, is not effective in all patients. Interleukin 17A (IL17) antagonist therapy has been shown to promote healing in murine models of chronic wounds. This has not previously been explored in humans. Therefore, we aim to undertake a phase II randomized, double-blinded, placebo-controlled pilot trial to assess whether Ixekizumab, an anti-IL17A therapy, is effective at reducing chronic venous ulcer size. In addition, to determine the feasibility and safety of undertaking a randomized control trial. Patients with a venous leg ulcer not responsive to 4 weeks of compression therapy were recruited. Participant were randomized to receive either Ixekizumab (80mg) or placebo injected subcutaneously every fortnight for 12 weeks while continuing standard of care. From 30 eligible, 4 patients consented, were enrolled and randomized. Initially, COVID-19 risk, medical history and distance from recruiting site were the main causes of exclusion or refusal to participate. All participants completed the 12-week treatment period. At completion, two participants in the Ixekizumab group reduced by >40% and one completely resolved their ulcer. Ulcers in the Ixekizumab group reduced by an average size of 955mm2 to 529mm2at baseline to final review respectively (p-value 0.12). The placebo group reduced in size by <5%.There were no adverse events related to the intervention. This pilot clinical trial investigated a novel treatment for chronic venous ulcers and showed IL17 inhibition does not impede and may improve chronic wound healing. It also showed a lack of major safety issues in using anti-IL17A therapy in this population. Moreover, the findings reinforce the feasibility of a larger trial to more accurately evaluate anti-inflammatory strategies in chronic wounds.Copyright © 2023

The use of monopolar diathermy in laparoscopic appendectomy, Is it really safe?

Background: There have been numerous techniques used in laparoscopic appendectomy (LA) to divide the mesoappendix, including LigaSure, Harmonic scalpel, clips, endoloop ligatures, Endo GIA staplers, and bipolar coagulation. However, few studies have investigated monopolar diathermy for mesoappendix division. Therefore, this study aimed to assess both its safety and efficacy in LA. Method(s): In this prospective non-randomized study, patients (n = 87) who underwent LA for acute appendicitis were included. The bipolar electrocautery was used for mesoappendix division in the first 33 patients (BC group), while the monopolar electrocautery was used in the next 54 patients (MC group). Result(s): The median operative time was significantly shorter in the MC group (42 min. vs 47 min. in BE group, p = 0.01). One patient converted to open surgery in the MC group due to uncontrollable bleeding. There were no significant differences between both groups regarding postoperative complications and hospital stay (p = 0.91, p = 0.13, respectively). Conclusion(s): Monopolar electrocautery is safe and effective for mesoappendix division in LP in comparison to bipolar electrocautery. However, larger and multicentric studies are required to validate our results.Copyright © 2023 The Authors

Anxiety and depression among patients attending a multidisciplinary foot clinic

Aim: Diabetic foot ulcers (DFUs) are linked to morbidity, decreased mobility, and feelings of isolation, powerlessness and sadness. The aim of our study was to explore the prevalence of anxiety and depression symptoms in adult patients with DFU. Method(s): We analysed questionnaires completed by patients with DFU attending our University Hospital Multidisciplinary Foot Clinic service over a one-month period in March 2022. The patients had completed three questionnaires, comprising of questions relating to socio-demographic status and care perceptions, the Patient Health Questionnaire-9 (PHQ-9) scale to assess depression, and the Generalized Anxiety Disorder scale (GAD-7) to assess anxiety. Result(s): Of the 60 patients who completed the questionnaires, 35% (n=21) reported anxiety symptoms and 40% (n=24), depressive symptoms. Individuals with comorbidities were three times more likely to report depression relative to those without any comorbidities (OR 3.3;95% CI 1.13-12.56). Younger individuals (less than 50 years), were almost nine times more likely to report anxiety in comparison to those aged 60 years or more (adjusted OR 8.9;95% CI 1.01-86.41), despite adjustment for confounding variables. Conclusion(s): The prevalence of depression and anxiety in this cohort of patients with DFU was low, but those who were affected reported moderate to severe symptoms. Younger individuals and those with comorbid conditions with DFU are more likely to experience an adverse impact on their mental health. This is a crucial factor to consider in the management of people undergoing DFU care. Strategies to reduce anxiety and/or depressive symptoms could impact both quality of life and wound healing. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Medicinal bismuth: Bismuth-organic frameworks as pharmaceutically privileged compounds

Historically organometallic compounds have been used to cure certain diseases with limited applications. Although bismuth belongs to the category of heavy metals, many of its derivatives have found applications in modern drug discovery research, mainly because of its low toxicity and higher bioavailability. Being an eco-friendly mild Lewis acid, compounds having bismuth as a central atom are capable of binding several proteins in humans and other species. Bismuth complexes demonstrated antibacterial potential in syphilis, diarrhea, gastritis, and colitis. Apart from antibacterial activities, bismuth compounds exhibited anticancer, antileishmanial, and some extent of antifungal and other medicinal properties. This article discusses major synthetic methods and pharmacological potentials of bismuth complexes exhibiting in vitro activity to significant clinical performance in a systematic and timely manner.Copyright © 2022 Elsevier Ltd