The Impact of Nutritional Condition and Compression Treatment on Venous Ulcer Recovery: A Systematic Review.

Venous ulcers are open wounds commonly associated with chronic venous insufficiency. Each patient's healing process is unique, and factors like nutrition and compression therapy can affect it. Compression therapy and optimal nutritional status can assist in improving venous blood circulation, decreasing swelling, and promoting wound healing. This in-depth review looks at all the recent research on how nutrition and compression therapy can help heal venous ulcers, aiming to develop evidence-based guidelines for improving treatment outcomes. The systematic review, registered in the International Prospective Register of Systematic Reviews (PROSPERO) and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles, conducted an extensive electronic search in databases such as PubMed, MEDLINE, Cochrane, Web of Science, and Scopus. Using Medical Subject Headings (MeSH) terms and different types of studies, the search method focused on studies that directly looked at how nutrition and compression therapy affected the healing of venous ulcers. After deduplicating and screening publications, a collaborative full-text review was conducted to determine their inclusion. As a result, several research studies were chosen for the qualitative synthesis. The authors created a data extraction form to document important variables such as demographics, therapy specifics, and wound features. Several studies on patients with venous ulcers have shown that consuming basic nutrients can improve wound healing. Treatment results differed depending on the types of compression and pressure intensity. Although minimal data indicates the possible benefits of two-layer therapy, a definitive comparison is still uncertain. Further clinical studies are necessary to investigate a wider range of dietary factors and to evaluate different treatments in similar situations.

Operative versus non-operative treatment in diabetic dry toe gangrene.

BACKGROUND AND AIM: Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS: We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS: One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION: Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.

Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

Diabetes is associated with various complications and reduced quality of life. Of the many complications, some are life-threatening. Among these, foot complications remain an important concern. The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them. Gangrene occurs due to reduced blood supply in the body tissues that leads to necrosis. This condition may arise because of an injury, infection, or other health conditions, majorly diabetes. Gangrene is classified as dry, wet, and gas gangrene. In case of wet and gas gangrene, surgical amputation is usually performed to prevent the spread of infection to other tissues. In dry gangrene, due to the presence of clear demarcation, autoamputation is preferred in certain parts of the globe. The present review aims to analyze the mode of dry gangrene management in diabetic patients based on previous evidence and plans to highlight various management strategies available for dry gangrene and the advantages/disadvantages of different treatments with special consideration to autoamputation.

Evaluation of pain during endovenous laser ablation of the great saphenous vein with ultrasound-guided femoral nerve block.

BACKGROUND: Endoluminal laser ablation is now considered the method of choice for treating greater saphenous vein insufficiency. General anesthesia and peripheral nerve blocks with sedation have the risk of post-procedural delay in discharge and prolonged immobilization with the risk of deep vein thrombosis. The main pain experienced by patients during the procedure is during the laser ablation and the multiple needle punctures given along and around the great saphenous vein. The aim of our study was to evaluate the safety and efficacy of blocking the femoral nerve only under ultrasound-guidance without sedation, to reduce or prevent pain during injectable tumescent anesthesia in endovenous laser ablation of the greater saphenous vein. METHODS: Sixty patients in two groups underwent endovenous laser ablation for the greater saphenous vein insufficiency at an outpatient clinic. All patients received tumescent anesthesia. However, one group received a femoral nerve block (FNB) under ultrasound guidance before the procedure. All patients were asked to record the pain or discomfort, using the visual analog score, from the start of the procedure until the end of the great saphenous vein laser ablation. The length of the great saphenous vein and duration of the procedure were also recorded. The results were analyzed using statistical methods. RESULTS: No complications from FNB were observed. The pain associated with application of tumescent anesthesia and laser ablation was more intense in the group without an FNB (P < 0.001). There was no significant difference between the two groups in the length of the great saphenous vein or procedure duration. CONCLUSION: Ultrasound-guided FNB (without other peripheral nerve blocks) is a safe, adequate, and effective option to decrease and/or eliminate the intraoperative discomfort associated with tumescent anesthesia injections and laser ablation during endoluminal laser ablation of the greater saphenous vein.

Isolated large vulvar varicose veins in a non-pregnant woman.

Vulvar varicosities are often asymptomatic, and they may be associated with varicose veins of the lower extremity. Also, they may be a part of pelvic congestion syndrome and usually occur during pregnancy. We present a case of a huge isolated and disfiguring vulvar varicosities in a non-pregnant women managed successfully by combination of surgery and sclerotherapy.

Risk factors for amputation in extremity vascular injuries in Saudi Arabia.

Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies.

Leg ischemia post-varicocelectomy.

Varicocelectomy is the most commonly performed operation for the treatment of male infertility. Many surgical approaches are used as each of them has advantages over the other and is preferred by surgeons. Vascular injury has never been reported as a complication of varicocelectomy apart from testicular artery injury. We present a 36-year-old male who developed leg ischemia post-varicocelectomy due to common femoral artery injury. He was successfully treated by using a vein graft.

The need for faculty training programs in effective feedback provision.

An important aspect of professional teaching practice is a practitioner's ability to critically evaluate the performances of subordinates for whom he or she is responsible. This is a common practice within social sciences as well as for professionals from applied specialties. The literature on professional clinical expertise identifies reflective practice as perfect when they are thoroughly accepted by practitioners. In health-related professions, critical reflection in the form of feedback that serves as the bridge between theory and practice is endorsed. The aims and objectives of this study were directed toward the application of a mixed methodology approach in order to evaluate the requirements for a feedback training program and to detect the present feedback provision skills of clinical mentors in practice. The quantitative analysis measured the effectiveness of clinical teachers' feedback in order to understand whether their understanding of and skills for giving feedback to promote students were adequate. On the other hand, the qualitative methods explored self-perceptions of feedback skills and efficacy in enabling students to improve their clinical practice. Effective feedback from faculty and the learner provides a useful and meaningful experience for absorbing knowledge and critical thinking into clinical practice. Nonadherence and limited expertise of mentors in giving feedback are the main themes of this study, and were evaluated and acknowledged through systematic analysis.

Barriers to feedback in undergraduate medical education. Male students' perspective in Central Saudi Arabia.

OBJECTIVE: To explore the views of undergraduate medical students regarding the presence and sources of barriers to effective feedback in their setting. METHODS: This cross-sectional study was conducted at the College of Medicine, Department of Medical Education, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia from April to June 2010. A self-administered questionnaire was used to explore the objectives of the study. RESULTS: One hundred and eighty-six male undergraduate medical students participated in this study. Approximately 45% indicated presence of barriers to effective feedback. These include: absence of a clear system of feedback; inadequate skills of teachers for provision-effective feedback; and to a lesser extent, students' fear of insult due to feedback. Most participants showed their interest and readiness to receive more professional feedback in the future. CONCLUSION: This study has showed the presence of barriers as perceived by medical students, which could significantly minimize utilization of feedback in medical education. The reported barriers should be addressed to utilize the vital role of feedback in the learning process of undergraduate medical students.

Time to move away from damage control strategy in hemodialysis vascular access management: a view from Saudi Arabia.

For the last 40 years, most of the research and publications on hemodialysis access, has focused on the management of its complications e.g. thrombosis, infection, aneurysms. In other words, a damage control strategy. While this is undoubtedly an important part of access management, it is a deficient reactive strategy that does not enhance a better quality of life for patients or help reduce the burden on health care resources. To achieve these objectives, efforts should be directed at ways which provide a longer access life with fewer complications. Such an approach would save costs and reduce the suffering of the patient. In this paper we will focus on hemodialysis management in Saudi Arabia, describe the reasons for the current unsatisfactory situation, and highlight possible remedies.

Giant celiac artery aneurysm: Treatment by transcatheter coil embolization.

Celiac artery aneurysms (CAA) are one of the rarest forms of visceral artery aneurysms. Most patients are a symptomatic at the time of diagnosis and aneurysms are detected incidentally during diagnostic imaging for other diseases. We present the case of a 42-year-old man who had an asymptomatic giant CAA detected incidentally by an abdominal ultrasound investigating an abdominal pain. A contrast enhanced computed tomography angiogram (CTA) revealed a large CAA measuring 7.1 cm × 4.3 cm with extensive collaterals from the superior mesenteric artery (SMA). The aneurysm sac was mostly filled with thrombus with the celiac artery branches occluded. Pre-procedural angiography and transcatheter embolization procedures were performed at the same session. Endovascular exclusion was performed by transcatheter coil embolization and packing of the aneurysm sack. Technical success was achieved by the absence of flow in the aneurysm, and preservation of the native circulation on angiograms obtained just after the transcatheter coil embolization procedure. One week postembolization, a CTA confirmed thrombosis of the aneurysm. The patient returned for a follow-up CTA 3, 6, 12 and 48 months after embolization. The aneurysm was thrombosed and the patient remained a symptomatic. The surgical mode of treatment of CAA is increasingly being replaced by endovascular embolization because of the lower morbidity and mortality and high success rate. The accepted endovascular approach is by coil embolization of the aneurysmal lumen, the proximal and distal aneurysmal neck, or both.

Stent-grafts in the management of life-threatening hemorrhage following inadvertent femoral catheterization in high-risk patients: report of two cases and review of the literature.

Bleeding related to inadvertent femoral catheter insertion is an infrequent but morbid complication. We report two cases of acute life-threatening bleeding after attempts at femoral vein catheterization. Both patients were morbidly obese, had multiple comorbidities, and were at high risk for surgical intervention. Aggressive resuscitation failed to stabilize the patients. Emergency digital subtraction angiography diagnosed the site of the femoral artery bleeding. In one patient, the site of injury was the right profunda femoris artery. Both bleeding sites were controlled successfully with endovascular covered stent placement, without complication. Although prior publications have reported the concept of endovascular repair in femoral artery injuries, to the best of the author's knowledge, covering the profunda femoris artery with no complications has not been described previously. In critically ill patients with life-threatening hemorrhage following inadvertent femoral catheterization, management with endovascular covered stents is safe and effective.

Impact of a diabetic foot care education program on lower limb amputation rate.

BACKGROUND: Diabetic foot complications are a leading cause of lower extremity amputation. With the increasing incidence of diabetes mellitus in the Arab world, specifically in the Kingdom of Saudi Arabia, the rate of amputation will rise significantly. A diabetic foot care program was implemented at King Abdulaziz Medical City in Riyadh, Saudi Arabia, in 2002. The program was directed at health care staff and patients to increase their awareness about diabetic foot care and prevention of complications. The purpose of this study was to perform a primary evaluation of the program's impact on the rate of lower extremity amputation due to diabetic foot complications. METHOD: This pilot study was the first analysis of the diabetic foot care program and examined two groups of participants for comparison, ie, a "before" group having had diabetic foot ulcers managed between 1983, when the hospital was first established, and 2002 when the program began and an "after group" having had foot ulcers managed between 2002 and 2004, in the program's initial phase. A total of 41 charts were randomly chosen retrospectively. A data sheet containing age, gender, medical data, and the presentation, management, and outcome of diabetic foot cases was used for the analysis. RESULTS: The before group contained 20 patients (17 males) and the after group contained 21 patients (16 males). There was no difference between the two groups with regard to age and comorbidities. The rate of amputation was 70% in the before group and 61.9% in the after group. There was a decrease in the percentage of toe amputation in the after group and an increase in the percentage of below-knee amputation in the before group. However, these changes were not significant. CONCLUSION: The program, although evaluated at an early stage, has increased the awareness of both patients and health care staff about the prevention and management of diabetic foot disease, and decreased the rate of lower extremity amputation. We believe that the statistical proof of its impact will be evident in the final evaluation.

Axillofemoral bypass with local anesthesia: a way forward to enable limb salvage in high-risk patients.

For an active, ambulant patient with critical, lower limb ischemia, amputation can lead to a poor quality of life. A small group of older people with critical limb ischemia are considered at high risk for revascularization under conventional anesthesia owing to their comorbid conditions. In these cases, when endovascular therapy is not an option, the decision to amputate or revascularize presents a dilemma, especially in ambulant patients. In this article, we present 2 cases in which the individuals had diabetic foot gangrene, rest pain, and multiple comorbidities, and were unfit to undergo conventional anesthesia. In addition, they had severe aortoiliac occlusive disease, which cannot be managed by endovascular methods. Both patients were living independently and were ambulant before their foot ulcer and ischemia. They underwent an axillofemoral bypass under local anesthesia. The postoperative course was uneventful. After a 3-year follow-up, both patients continue to be ambulant and have no complaints. With selective use of local anesthetic techniques, surgical teamwork to shorten the procedure time, and close meticulous postoperative care, an axillofemoral bypass can enable limb salvage for ambulant patients who are considered unfit for conventional anesthesia.

The diabetic foot. In the Arab world.

The literature is replete with diabetic foot problems throughout the world, but few has been written about the problem in the Middle East and even in the Arab world. After reviewing these discussions, we realized that the magnitude of the problem is not yet appreciated for many reasons. In this paper, we explained why it is more prevalent, less managed and has been associated with worse health outcomes in diabetic patients in the Arab world. We believe that the leading problems are preventable, and this cancer can be controlled in a simple cost-effective way.