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Background: Pressure lesions are chronic wounds causing the development of infection and inflammation into deeper structures and finally necrosis. In Persian medicine, Alkanna orientalis (Boraginaceae) has been used for centuries as a naturally derived remedy for managing lesions. A cross-sectional pilot clinical trial was conducted to assess the wound healing effect of an ointment made of chloroform extract of roots of A. orientalis (CERAO). Methods: Sixty patients (36 men and 24 women) diagnosed with bedsore staging 1-2 entered the study for one year. They were divided into two groups of control and treatment with equal proportions. The control group received conventional treatment from the hospital, including irrigation serum, mupirocin, phenytoin ointments, and gauze dressing. After rinsing and cleansing with normal saline, in the intervention group, patients received a thin layer of CERAO once daily for four weeks. Clinical outcomes were measured at weeks 2 and 4. Results: Recovery assessment was carried out by measuring wound area, days of epithelia formation, and complete wound closure. The difference between the two groups was statistically significant (P-value

A meta‐analysis was implemented to appraise the effect of hydrocolloid dressings (HCDs) in the management of different grades of pressure wound ulcers (PWUs) in critically ill adult subjects (CIUSs). Inclusive literature research until April 2023 was done, and 969 interconnected researches were revised. The 8 picked researches, enclosed 679 critically ill adult persons at the utilized researchers' starting point; 355 of them were utilizing HCDs, and 324 were controls. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the consequences of HCDs in treating CIUSs by the dichotomous approach and a fixed or random model. HCDs had significantly higher PWU complete healing (OR, 2.15; 95% CI, 1.54–3.02, p < 0.001), PWU stage II ulcers complete healing (OR, 2.82; 95% CI, 1.40–5.69, p = 0.004), and PWU stage III ulcers complete healing (OR, 3.73; 95% CI, 1.23–11.35, p = 0.02) compared to control in critically ill adult persons. HCDs had significantly higher PWU complete healing, PWU stage II ulcers complete healing, and PWU stage III ulcers complete healing compared with control in critically ill adult persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta‐analysis. [ABSTRACT FROM AUTHOR]

Decreased tissue blood flow causes pressure ulcers due to prolonged pressure on the area, which becomes problematic for immobile individuals. The medical community has often been involved in curing such a problem in individuals with disabilities and immobility. To alleviate this problem, therefore, plenty of investigations are always seeking novel methods. Furthermore, herbal plants are increasingly used owing to the accepted status of plant-derived drugs in recent years. Our female case aged 52 years that was referred to the wound clinic complaining sensory and motor weakness of the upper extremity and sudden paralysis of the lower extremity as of 1 year ago, which was diagnosed as myelitis. She complained of two wounds on both sides of the right and left buttocks with a size of 9 x 5 and another 6 x 4.5 cm from 3 months ago, and a wound with a size of 5 x 4.5 in the sacral area (sacrum) from 20 days prior to the admission. There was tissue necrosis without muscle engagement, osteomyelitis, or tunneling; besides, nasty odors and sludge were absent accounted for in class 3 in the group of wounds. She received starting therapy using Arnebia euchroma oil. As of the 2nd week onward, she was treated very successfully, and the complete wound healing occurred in 8 weeks. The use of A. euchroma for wound healing and reducing infection and inflammation can greatly contribute to the cure of pressure ulcers and can be properly suggested in healing these ulcers. [ABSTRACT FROM AUTHOR]

Bedsore (pressure ulcers)is a major nurse-careoutcome. There are many influences that can contribute to the progress of pressure ulcers, but the final common pathway to ulceration is tissue ischemia. This study aimed to detect some etiological factors that predispose to bedsore. The study was conducted on patients attending intensive care departments. Out of 82 inpatients who suffered from pressure ulcer, 54were males and 28were females. Specimens were collected during the period of September, 2019 –February, 2020 from different Hospitals (Alkadhimiya Teaching Hospital, General Hospital of AlshaheedAl-Sadr, and Medical City/ Ghazi Al-Hariri hospital) in Baghdad, Iraq. Simultaneously, other 20 specimens were collected as control frominpatientswho did not suffer from any skin lesion.The patients were categorizing according to the causative agent into 48 patients with chronic diseases (58.6%), 26 with accidental and surgical processes (31.7%), and 8 dehydrated cases (severe diarrhea) (9.7%). The demographic results showed that malesconstituted a percentage of 65.9% of patients, while 34.1% were females. The majority of the patients wereat an age range of 36-65 years. The study also revealed that smoking did not affect significantly bed sore development. In addition, most patients were under chronic disease, and diabetes mellitus incidence significantly varied among different age groups. The results of the microbiological study showed that the most prevalent microbial isolates followed the order Staphylococcus spp.>Enterobacteriaceae spp. > Fungi >Acinetobacter spp. > Bacillus spp. > Pseudomonas spp. and Streptococcus spp. >Corynobacterium. The resultsrevealed no significant differences in microbial distribution between patients and control group [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this systematic review was to determine the effect of vasopressor agents on the development of pressure ulcers (PUs) among critically ill patients in intensive care units (ICUs). The secondary outcome of interest was length of stay in the ICU. Method: A systematic review was undertaken using the databases searched: Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to formulate the review. Data were extracted using a predesigned data extraction table and analysed as appropriate using RevMan. Quality appraisal was undertaken using the EBL Critical Appraisal Tool. Results: The inclusion criteria were met by 13 studies. Two studies provided sufficient data to compare the number of patients who developed a PU with and without the use of vasopressors. Consistently, within these two studies, being treated with a vasopressor increased the likelihood of PU development. RevMan analysis identified that shorter duration of administration of vasopressors was associated with less PU development (mean difference (MD) 65.97 hours, 95% confidence interval (CI): 43.47–88.47; p=0.0001). Further, a lower dose of vasopressors was also associated with less PU development (MD: 8.76μg/min, 95% CI: 6.06–11.46; p<0.00001). Mean length of stay increased by 11.46 days for those with a PU compared to those without a PU (MD: 11.46 days; 95% CI: 7.10–15.82; p<0.00001). The overall validities of the studies varied between 45–90%, meaning that there is potential for bias within all the included studies. Conclusion: Vasopressor agents can contribute to the development of PUs in critically ill patients in ICUs. Prolonged ICU stay was also associated with pressure ulcers in this specific patient group. Given the risk of bias within the included studies, further studies are needed to validate the findings of this review paper. [ABSTRACT FROM AUTHOR]

The subcutaneous or hypodermic tissue is the innermost layer of the skin, which is essential for adipose tissue. The dermal attachment to the epidermis is a basal layer composed of collagen. This basal layer performs four different functions and acts as a scaffold for soft tissue organization. It is citing for regeneration that has selective permeability for serum filtration. Also, it is a barrier between different cell types, and cite where the epithelium subcutaneous to the cells. Untreated, bedsores can lead to serious complications, one of which is cellulite, a potentially life-threatening bacterial infection. As the bedsore wound spreads to the joints and bones, it may cause bone and joint infections that can damage the cartilage, tissue, and reduce joint function. The bacteria can then enter the bloodstream through wounds, leading to shock and life-threatening conditions. Stage II wounds can heal in one to six weeks, but wounds that lead to stage three or four may last several months or may never heal, especially in children with health problems. The purpose of this study was to design bio-based wounds with gelatin, Gum Arabic, and polyurethane. The wounds were made with different bio composite specimens. The procedure is gelatin, and gum Arabic was combined with certain percentages. The temperature of mixing and solubilization was set at 50°C. After complete fabrication of the material and complete dissolution of the samples in the solvent without any agglomeration, the samples were placed in a low-temperature freezer at -70°C and were placed in a freeze dryer. After the drying process is completed and the pores are ready on the wound heal sample, in the next stages, several tests are carried out to check the suitability of the produced wounds. The SEM analysis was performed on bio-based wounds in which the results showed the suitability and porosity of these wound dress were suitable. The presence of proper porosity and moisture level for wound healing and non-acidity, as well as the use of bed wound healing, have been distinguished from other conventional wound healing products in the market and research domain. [ABSTRACT FROM AUTHOR]

A study on predictive value of pressure sore by the Braden scale in surgical intensive care units was conducted during the period of October 2018 to October 2019. 50 patients of age group above 40, post-operative hospital stay more than 48 hours, post-operative patients who were admitted in the Department of General Surgery, Government Stanley Medical College and Hospital were included. All patients were thoroughly examined and given scores according to Braden scale. According to the scores the patients were categorized as severe risk, high risk, moderate risk and mild risk. All patients were regularly examined for development of pressure sores 4 times at post-operative day -1, 7, 14 and 28 days or at the time of discharge. Based on scores patients were advised regarding preventive measures of pressure sores. All patients were monitored. All patients were followed up for a period of six months. Comparison of total Braden scale score revealed S.D of 1.57 and p-value of 0.0005 for those who developed pressure sore which was highly significant. The sensitivity of the scale was 90% and specificity of the scale was 93.70% with the cut off value at 16. Thus the Braden scale was highly significant and has high predictive value in predicting pressure sore in intensive care units. [ABSTRACT FROM AUTHOR]

Decubitus ulcer commonly known as Bed sore or Pressure ulcer is one of the commonest cause of skin and tissue disruptions 1. So here arises a need to create awareness regarding prevention of bed sores through education of student nurses to reduce the burden of bed sores. The study was undertaken to assess the knowledge regarding prevention of bed sores among B.Sc Nursing 1st year students and develop and implement a structured teaching programme in Army College of Nursing, Jalandhar cantt. The objectives of the study were to assess the pre - test knowledge scores, develop and implement structured teaching programme, to assess the post-test knowledge scores and to compare the pre - test and post-test knowledge scores. The pre experimental study was conducted on 40 selected subjects of B.Sc Nursing 1st year students, Army College of Nursing, Jalandhar cantt, Punjab. Data was collected by self structured questionnaire. The results indicated that the overall pre - test mean was 18.32 with the Standard deviation of 2.09 whereas the overall post-test mean knowledge score was 21.42 with the Standard deviation of 1.62 with the significant mean diffence of 3.1. Effectiveness of structured teaching programme was determined by Paired-t test. Value of t was found to be 5.58 which was greater than value of t0.05 at 39 degree of freedom that is 2.023. [ABSTRACT FROM AUTHOR]

Background: The 2005 South Asian earthquake led to large-scale injuries and disabilities in northern Pakistan, which were dealt with using various approaches. In this regard, a community-based rehabilitation approach was initiated in the Muzaffarabad district of Pakistan in early 2006, focused on preventing complications among persons with Spinal Cord Injury. This case study briefly describes its development, aims and service provision components, in addition to the distribution of injuries from the disaster. Pressure ulcer prevention education, its recall and decrease in prevalence over a year are presented as key outcomes and illuminate the process of implementing rehabilitation in this context. Methods: This case study presents findings from a larger internal program evaluation in 2010–11. The study design was cross-sectional, to elicit recall of education components and the resulting prevalence of pressure ulcers over the year, in 33 randomly selected persons with Spinal Cord Injury. Outcomes included retention of knowledge about pressure ulcer prevention, practices and reduction in the prevalence of pressure ulcers over the last year. We also conducted a narrative literature review on the types of injuries and complications in the Spinal Cord population from Northern Pakistan. Results: Hospital cohort studies reported "spine" injuries at 5%, while persons with spinal cord injury were identified as the most underserved needing rehabilitation services after the quake. Results from the evaluation of prevention education revealed that all 33 respondents were trained in detection of pressure ulcers, while 32 recalled "danger signs" for which they would seek immediate help. All correctly recalled postural change timings, however, their actual practices differed. Twenty-seven respondents (82%) reported no pressure ulcers over the last year. Conclusion: The decrease in pressure ulcer prevalence over the last year in persons with spinal cord injury highlights the strengths of the community-based rehabilitation approach, particularly preventive education in geographically challenging and highly resource constrained settings. The research also begins to fill a critical gap in the present literature as most research is limited to hospital based interventions from the first year of the 2005 earthquake. Prevention education for targeting pressure ulcers can be effective in reducing incidence of this important complication in persons with spinal cord injury. Community-based rehabilitation approaches can prove beneficial in post-disaster settings, especially in resource constrained settings and difficult hilly terrain. Rehabilitation programs should consider nutrition interventions to reduce multiple pressure ulcers, especially in lower middle income countries. [ABSTRACT FROM AUTHOR]

Reduced blood flow due to obstruction is in most cases a primary factor in pressure ulcer formation and creation of bedsores. The aim of this study is to design and manufacture a care system for tissue under pressure, based on variations in blood flow at different depths of tissue. In the manufacture of the system two infrared light transmitters and receivers were located between 5 and 10 mm depth to measure the flow of blood at different in the under- pressure heel tissue. In addition, blood flow was evaluated in an unloaded and loaded condition, with 30 mmHg and 60.0 mmHg. A total of 15 people participated with a mean age of 50. Of these 15; 9 (60%) were men and 6 (40%) were women. Primary measurement results showed different individual differences in variation of blood flow in the tissue. To study signal amplitude changes significantly influenced by external pressure the PPG, P-value was measured. It was noted that there were significant changes in PPG signal amplitude during loading both pressures of 30 and 60 mmHg. Further development of this system would be possible with the use of a more flexible probe and by using a stronger optical receiver and transmitter to access more depth.

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Aim: To report the prevalence and outcomes of pressure ulcers (PU) seen in a cohort of cancer patients requiring home-based palliative care. Materials and Methods: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. Results: Twenty-one of 108 (19.4%) enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9%) patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. Conclusions: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. Clinical Trial Registry Number: CTRI/2014/03/004477 [ABSTRACT FROM AUTHOR]

Pressure ulcer in an otherwise sick patient is a matter of concern for the care givers as well as themedical personnel. A lot has been done to understand the disease process. So much so that USAand European countries have established advisory panels in their respective continents. Sincethe establishment of these organizations, the understanding of the pressure ulcer has improvedsignifi cantly. The authors feel that the well documented and well publicized defi nition of pressureulcer is somewhat lacking in the correct description of the disease process. Hence, a modifi eddefi nition has been presented. This disease is here to stay. In the process of managing theseulcers the basic pathology needs to be understood well. Pressure ischemia is the main reasonbehind the occurrence of ulceration. Different extrinsic and intrinsic factors have been described indetail with review of literature. There are a large number of risk factors causing ulceration. The riskassessment scales have eluded the surgical literature and mostly remained in nursing books andwebsites. These scales have been reproduced for completion of the basics on decubitus ulcer. Theclassifi cation of the pressure sores has been given in a comparative form to elucidate that most ofthe classifi cations are the same except for minor variations. The management of these ulcers isever evolving but the age old saying of "prevention is better than cure" suits this condition the most. [ABSTRACT FROM AUTHOR]

Background: Bed sore is one of the main problems for people confined to bed for long time and cannot move. According to the fact that prevention is easier and cheaper than therapy, in this study the effect of fish oil ointment on the improvement of first stage bed sore was assessed. Materials and Methods: This study was carried out on two groups with 30 patients that had bed sore on shoulders, sacrum or heel. In the intervention group patients' position was changed every 2-3 hours and the bed sore was washed with water and cotton-wool and fish oil with thickness of 2-3 mm was applied on the place of sore. This method was used for seven days. If they improved, the method was stopped in the first days of procedure. At the end of seven days, again the first day checklist was completed, and it was compared to the questionnaire of the two groups, and analyzed separately according to the daily changes of intervention and control group. Findings: There was statistically significant difference between the average of changes in the size of sore of the study group and control group (p < 0.002). The time average of improvement in the intervention group was less than control group. Conclusions: Local use of fish oil could increase the improvement of first stage bed sore and increase in vessels, blood and oxygen supply of the place of sore. [ABSTRACT FROM AUTHOR]

Pressure ulcer is a complex and significant health problem. Although the factors including pressure, shear, and ischemia have been identified in the etiology of pressure ulcer, the cellular and molecular mechanisms that contribute to the development of pressure ulcer are unclear. This study tested the hypothesis that the early-onset molecular regulation of pressure ulcer involves apoptosis in muscle tissue. Adult Sprague-Dawley rats were subjected to an in vivo protocol to mimic pressure-induced deep tissue injury. Static pressure was applied to the tibialis region of the right limb of the rats for 6 h each day on two consecutive days. The compression force was continuously monitored by a three-axial force transducer equipped in the compression indentor. The contralateral uncompressed limb served as intra-animal control. Tissues underneath the compressed region were collected for histological analysis, terminal dUTP nick-end labeling (TUNEL), cell death ELISA, immunocytochemical staining, and real-time RT-PCR gene expression analysis. The compressed muscle tissue generally demonstrated degenerative characteristics. TUNEL/dystrophin labeling showed a significant increase in the apoptotic muscle-related nuclei, and cell death ELISA demonstrated a threefold elevation of apoptotic DNA fragmentation in the compressed muscle tissue relative to control. Positive immunoreactivities of cleaved caspase-3, Bax, and Bcl-2 were evident in compressed muscle. The mRNA contents of Bax, caspase-3, caspase-8, and caspase-9 were found to be higher in the compressed muscle tissue than control. These results demonstrated that apoptosis is activated in muscle tissue following prolonged moderate compression. The data are consistent with the hypothesis that muscle apoptosis is involved in the underlying mechanism of pressure-induced deep tissue injury. [ABSTRACT FROM AUTHOR]

The most common complication associated with immobilization is pressure sores caused by sustained localized tissue strain and stress. Computational simulations have provided insight into tissue stress-strain distribution, subject to loading conditions. In the simulation process, adequate soft tissue material parameters are indispensable. An in vivo procedure to characterise material parameters of human gluteal skin/fat and muscle tissue has been developed. It employs a magnetic resonance imaging (MRI) device together with an MRI compatible loading device. Using the derived data as constraints in an iterative optimization process the inverse finite element (FE) method was applied. FE-models were built and the material constants describing skin/fat and muscle tissue were parameterized and optimized. Separate parameter sets for human gluteal skin/fat and muscle were established. The long-term shear modulus for human gluteal skin/fat was G_{∞, S/F}= 1182 Pa and for muscle G_{∞, M} = 1025 Pa. The Ogden form for slightly compressible materials was chosen to define passive human gluteal soft tissue material behaviour. To verify the approach, the human skin/fat-muscle tissue compound was simulated using the derived material parameter sets and the simulation result was compared to empirical values. A correlation factor of R^{2} = 0.997 was achieved. [ABSTRACT FROM AUTHOR]

Bed sores are among life-threatening factors in patients during hospital confinement. Thus, treating bed sores is one of the major responsibilities of nursing personnel. This study aimed to compare the effects of Frankincense gel and hydrocolloid dressing on healing of second- and third-degree pressure ulcers among hospitalized patients. This clinical trial was conducted on 75 patients with second- and third-degree pressure ulcers in the hospital affiliated Shiraz University of Medical Sciences, Iran. After obtaining the participants' informed consent forms, they were randomly divided into three groups. Accordingly, groups A, B, and C were treated by Frankincense (Boswellia corteri) gel and hydrocolloid dressing, placebo gel and hydrocolloid dressing, and hydrocolloid dressing alone, respectively for five weeks. The study data were collected via Pressure Ulcer Scale for Healing (PUSH), which was used to assess and compare pressure ulcers regarding size, tissue, and exudate. Additionally, blood samples were taken from the patients before and two weeks after the treatment in order to measure the level of Transforming Growth Factor (TGF). Pairwise comparisons revealed a significant difference between different time points in respect to PUSH scores (p < 0.001). Additionally, a significant difference was found between Frankincense and the two other groups regarding the ulcer score (p < 0.014). However, no significant difference was observed among the three groups concerning the tissue, exudate, and PUSH scores. Moreover, TGF-β1 increased in the three study groups, but the differences were not statistically significant. TGF-β3 also increased in Frankincense, but not in the two other groups. The study results indicated that the ulcers were healing after five weeks and growth factors increased in the study groups. Furthermore, Frankincense is cheaper and more easily prepared compared to hydrocolloid and does not cause allergic reactions. Therefore, it can be utilized as an appropriate treatment for bed sores. [ABSTRACT FROM AUTHOR]