Becaplermin gel in the treatment of diabetic neuropathic foot ulcers

Diabetic foot ulcers remain a major cause of morbidity. Significant progress has been accomplished in ulcer healing by improved management of both ischemia and neuropathy in the diabetic foot. Nevertheless, there is a vital need for further improvement. Becaplermin gel represents an important therapeutic advance for diabetic neuropathic foot ulcers with adequate blood supply. Randomized controlled trials have shown that it is effective in increasing healing rates. However, this efficacy has not translated to positive clinical experience, and the drug is not widely used. Moreover, becaplermin is an expensive medication. Even though it has repeatedly been estimated as cost-effective, its high cost may be prohibitive for some clinicians, especially in developing countries. Clearly, further work is needed to clarify whether use of becaplermin is justified in everyday clinical practice. Future research also needs to assess the potential room for improvement with becaplermin, for instance by combination with other growth factors or by exploring alternative modes of drug delivery

Mounier-Kuhn Syndrome in an Elderly Female with Pulmonary Fibrosis

Mounier-Kuhn syndrome (MKS), or tracheobronchomegaly, is a rare clinical and radiologic condition characterized by pronounced tracheobronchial dilation and recurrent lower respiratory tract infections. Tracheobronchomegaly presents when the defect extends to the central bronchi. MKS can be diagnosed in adult women when the transverse and sagittal diameters of the trachea, right mainstem bronchus, and left mainstem bronchus exceed 21, 23, 19.8, and 17.4 mm, respectively. Its diagnosis is based on chest radiograph and chest computed tomography (CT). Patients, usually middle-aged men, may be asymptomatic or present with clinical manifestations ranging from minimal symptoms with preserved lung function to severe respiratory failure. Pulmonary function tests (PFTs) typically reveal a restrictive pattern. This report presents an elderly woman with previously diagnosed pulmonary fibrosis with symptoms of increased sputum production and haemoptysis. High-resolution chest CT showed tracheal and main stem bronchi dilatation along with bronchial diverticulosis. PFTs indicated a restrictive pattern characteristic of the underlying pulmonary fibrosis. The patient is the oldest, referred to the female gender, at presentation of MKS hitherto reported. This case highlights the need to include MKS in the differential diagnosis of recurrent lower respiratory tract infections, even in older subjects

Diabetic Amputations in 2023 are Still More Frightening Than Death—Act Now Before it is Too Late

Despite huge medical and technological advances to date for the diagnosis, monitoring, and management of diabetic foot complications, their prevalence is still alarmingly high. Patients’ quality of life may be severely compromised. Patients may fear amputations more than death. An effort to minimize the impact of these complications and to ensure prompt access to care for everyone is still required. Urgent therapeutic measures should become possible when needed. Improved physician training in and management of peripheral arterial disease are also vital. We need to act now before it is too late. This will definitely be one of the greatest challenges for 2023 and the years to come

The effect of polyvinyl alcohol antimicrobial foam dressing with two organic pigments vs. silver antimicrobial foam on exuding venous ulcerations : a comparative pilot study

Background: Treatment of venous ulcers often includes incorporation of dressings, for reduction of bio-load. Evidence is lacking with regards to which dressing is ideal for healing chronic venous wounds. This study aimed to compare the healing effect of polyvinyl alcohol (PVA) antimicrobial foam dressing impregnated with two organic pigments (gentian violet and methylene blue) vs. silver antimicrobial foam dressing.Research Design and Method: A quasi-experimental study was conducted. 28 participants were divided into two groups and treated with one of the antimicrobial foams. Patients reviewed weekly for 3 weeks. Wound healing was assessed using the Bates-Jensen Wound Assessment Tool.Results: Over a period of 3weeks, both the PVA antimicrobial foam with two organic pigments and the silver antimicrobial foam dressings were effective in reducing mean BJWAT scores and wound healing (p < 0.001). The former was significantly better at week 1 (p = 0.001) and 2 (p = 0.014) but not at week 3 (p = 0.881).Conclusion: PVA antimicrobial foam with two organic pigments showed some superiority over silver antimicrobial foam dressings in chronic venous ulcers. This should be considered when treating chronic venous ulcerations since the rate of healing was greater despite the extreme severity of ulcers at the start of the study.peer-reviewe

New strategies to improve clinical outcomes for diabetic kidney disease

BACKGROUND: Diabetic kidney disease (DKD), the most common cause of kidney failure and end-stage kidney disease worldwide, will develop in almost half of all people with type 2 diabetes. With the incidence of type 2 diabetes continuing to increase, early detection and management of DKD is of great clinical importance. MAIN BODY: This review provides a comprehensive clinical update for DKD in people with type 2 diabetes, with a special focus on new treatment modalities. The traditional strategies for prevention and treatment of DKD, i.e., glycemic control and blood pressure management, have only modest effects on minimizing glomerular filtration rate decline or progression to end-stage kidney disease. While cardiovascular outcome trials of SGLT-2i show a positive effect of SGLT-2i on several kidney disease-related endpoints, the effect of GLP-1 RA on kidney-disease endpoints other than reduced albuminuria remain to be established. Non-steroidal mineralocorticoid receptor antagonists also evoke cardiovascular and kidney protective effects. CONCLUSION: With these new agents and the promise of additional agents under clinical development, clinicians will be more able to personalize treatment of DKD in patients with type 2 diabetes