Micronutrients and Antioxidants Status in Sickle Cell Anaemia Patients with Chronic Leg ulcer

The aetiology of chronic leg ulcer in patients with sickle cell anaemia is multifactorial and complex, prevention and management is a daunting task. Micronutrients and antioxidants contribute to the pathogenesis of sickle cell disease and chronic leg ulcers. Therefore, this study was carried out to determine the serum levels of zinc, copper and vitamin E in sickle cell anaemia patients with chronic leg ulcer. Twelve sickle cell anaemia patients with leg ulcer (SLU), 12 sickle cell anaemia patients without leg ulcer (NLU) and 15 healthy volunteers who were age and sex-matched were recruited for the study. Questionnaires were administered to obtain biodata and history of ulcers with chronic leg ulcers. Venous blood was collected from all respondents and analyzed for complete blood count, zinc, copper and vitamin E levels. The data generated was analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. Descriptive statistics such as frequency, counts, percentages, mean and standard deviation were used to summarize the result. Independent T test and ANOVA were used as appropriate determine significant association between variables. The level of significance was set at P value <0.05. The mean age of the sickle cell anaemia patients with chronic leg ulcer was 31± 10.3 years. There was no statistically significant association between the serum zinc, copper levels and the presence of chronic leg ulcer in sickle cell anemia patients. There was a statistically significant association between the serum vitamin E levels, and the presence of chronic leg ulcer in sickle cell anemia patients’ Low serum vitamin E level may play a significant role in the pathogenesis, sustenance and healing of sickle cell chronic leg ulcer. We therefore recommend the supplementation of vitamin E in the management of chronic leg ulcer in patients with sickle cell anaemia

The expression of inflammatory cytokines, TAM tyrosine kinase receptors and their ligands is upregulated in venous leg ulcer patients: A novel insight into chronic wound immunity

The systemic host defence mechanisms, especially innate immunity, in venous leg ulcer patients are poorly investigated. The aim of the current study was to measure Candida albicans killing activity and gene expressions of pro- and anti-inflammatory cytokines and innate immune response regulators, TAM receptors and ligands of peripheral blood mononuclear cells separated from 69 venous leg ulcer patients and 42 control probands. Leg ulcer patients were stratified into responder and non-responder groups on the basis of wound healing properties. No statistical differences were found in Candida killing among controls, responders and non-responders. Circulating blood mononuclear cells of patients overexpress pro-inflammatory (IL-1α, TNFα, CXCL-8) and anti-inflammatory (IL-10) cytokines as well as TAM receptors (Tyro, Axl, MerTK) and their ligands Gas6 and Protein S compared with those of control individuals. IL-1α is notably overexpressed in venous leg ulcer treatment non-responders; in contrast, Axl gene expression is robustly stronger among responders. These markers may be considered as candidates for the prediction of treatment response among venous leg ulcer patients. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd

Cost effectiveness of community leg ulcer clinics: randomised controlled trial

Objectives: To establish the relative cost effectiveness of community leg ulcer clinics that use four layer compression bandaging versus usual care provided by district nurses. Design: Randomised controlled trial with 1 year of follow up. Setting: Eight community based research clinics in four trusts in Trent. Subjects: 233 patients with venous leg ulcers allocated at random to intervention (120) or control (113) group. Interventions: Weekly treatment with four layer bandaging in a leg ulcer clinic (clinic group) or usual care at home by the district nursing service (control group). Main outcome measures: Time to complete ulcer healing, patient health status, and recurrence of ulcers. Satisfaction with care, use of services, and personal costs were also monitored. Results: The ulcers of patients in the clinic group tended to heal sooner than those in the control group over the whole 12 month follow up (log rank P=0.03). At 12 weeks, 34% of patients in the clinic group were healed compared with 24% in the control. The crude initial healing rate of ulcers in intervention compared with control patients was 1.45 (95% confidence interval 1.04 to 2.03). No significant differences were found between the groups in health status. Mean total NHS costs were £878.06 per year for the clinic group and £859.34 for the control (P=0.89). Conclusions: Community based leg ulcer clinics with trained nurses using four layer bandaging is more effective than traditional home based treatment. This benefit is achieved at a small additional cost and could be delivered at reduced cost if certain service configurations were used

Leg Ulcer Outcomes

Background Venous disease is the most common cause of leg ulceration. Treatment of superficial venous reflux has been shown to reduce the rate of ulcer recurrence but the effect of early endovenous ablation of superficial venous reflux on ulcer healing remains unclear. It is generally accepted that there is considerable global variation in the management of leg ulcers. Objectives To determine: the clinical and cost-effectiveness of early endovenous treatment of superficialvenous reflux in addition to standard care compared to standard care alone in patients with venous ulceration; the current standards of global management of venous leg management and the impact on these following the results of the randomised controlled trial. Methods i. The Early Venous Reflux Ablation Trial (EVRA) multi-centre randomised clinical trial of 450 participants compared early versus deferred intervention at 12 months and at 3.5 years. ii. Health professionals treating patients with leg ulcers globally were surveyed before and after the publication of the RCT results to gain insight on the management of venous leg ulceration, and subsequent impact on practice. Results i. EVRA: i. time to ulcer healing was shorter in the early group at 12 months; no clear difference in time to first ulcer recurrence at 3.5 years; early intervention at 3 years is 91% likely to be cost-effective at £20,000/QALY. ii. Surveys: ⁃ Pre/post-EVRA UK primary care: 90/643 responses received; Pre/post-EVRA global clinicians: 799/644 responses were received. Conclusions The EVRA RCT showed that early intervention reduces the time to healing of venous leg ulcers, does not affect the time to recurrent ulceration but is highly likely to be cost-effective and therefore is beneficial for both patients and healthcare providers. The surveys demonstrated that the management of venous ulceration is disparate globally. It is likely that the EVRA RCT results influenced the timing of intervention worldwide.Open Acces

EVALUATION OF HEALING EFFECTS OF NEW HERBAL FORMULATION ON VENOUS LEG ULCER: PILOT STUDY

Venous leg ulcers represent a significant public health problem that will increase as the population ages. A wide variety of agents are available for the treatment of venous leg ulcers, including ointments and dressings. Numerous herbs and their extracts are potentially conducive to wound healing, including the ability to serve as an antimicrobial, antifungal, astringent and etc.The aim of the study was to establish the healing effects of herbal therapy on non-infected venous leg ulcers. The major components of the DermaplantG were extract of Allii bulbus, Hyperici herba and extract of Calendulae flos. In the study were included 18 patients with venous leg ulcers treated by DermaplantG herbal therapy. Our investigation focused on the five controls (baseline, 1st , 3rd, 5th 7th weeks) of the parameters changes important for ulcer healing: wound surface area and reduction of venous leg ulcer score (fibrin deposits, exudation and eczema). Within-treatment analysis showed that, following DermaplantG herbal treatment, there was a significant decrease in surface leg ulcer and venous leg ulcer score after 7th treatment week (P < 0.05). The results of this pilot study demonstrate healing and antimicrobiologic efects of herbal therapy on non-infected venous leg ulcer

Venous leg ulcer management

The National Institute for Health and Care Excellence (NICE, 2016) define a leg ulcer as a loss of skin on the foot or the leg (below the knee), which has not healed within 2 weeks and is considered chronic if not healed within 4 weeks. The cause of venous leg ulcers is prolonged venous hypertension consequential of an insufficient calf muscle pump and/or chronic venous insufficiency. Symptoms of venous leg ulceration include swelling, pain and itching, which is sometimes accompanied by foul-smelling discharge and hardening of the skin around the skin-loss (NHS Choices, 2016)

Leg Ulcer. Conservative Treatment

Durante um período de 16 anos foram estudados, de forma prospectiva, 202 doentes portadores de insuficiência venosa crónica complicada de úlcera de perna, totalizando 257 úlceras. Este conjunto constitui uma série homogénea, em que foi sempre mantida a mesma orientação diagnóstica e terapêutica, quer médica, quer cirúrgica. Foi definido como objectivo a cura da úlcera em ambulatório, com tratamento conservador. O tratamento cirúrgico definitivo, quando indicado, é preferencialmente executado em diferido, após a cura da úlcera. Dos 202 doentes incluídos inicialmente no estudo, 166 mantiveram-se até à cura ou durante um período de tratamento prolongado. Nos doentes que se mantiveram no estudo foi obtida uma taxa de curas de 91%, o que está acima dos resultados habitualmente reportados na literatura internacional. Salienta-se a importância do controlo directo de todo o tratamento pelo médico responsável

Successful Management of a Chronic Refractory Leg Ulcer in an Adolescent with Sickle Cell Anemia

Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by a wide range of clinical manifestations. Chronic leg ulcers are a disabling complication with repercussions on the quality of life. We report the case of a 14-year-old girl with a diagnosis of SCD who developed a chronic leg ulcer that was successfully treated with a multi-disciplinary approach, including local and systemic therapies. The role of different treatments, in particular low molecular weight heparin, in the refractory chronic leg ulcer healing process will be discussed. </p

Ask the expert: How to prevent leg ulcer recurrence when moving into compression hosiery. Leg ulceration

Once patients’ leg ulcers are healed, it is recommended that you move them from compression bandaging into leg ulcer hosiery kits or maintenance hosiery. But nurses often have difficulty in getting patients to comply with long-term hosiery use — which does require a lot of commitment — and ulcers often return. We asked Leanne Atkin, vascular nurse specialist at Mid- Yorkshire NHS Trust, how to ensure that your patients keep healing and remain healed when they move into maintenance compression hosiery

Topical agents or dressings for pain in venous leg ulcers.

Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used