Discussion
ulcer, diabetic foot ulcer, diabetic wounds
DIABETIC FOOT ULCER, EPITHELIALIZATION, INFILTRATES, ULCER, INFLAMMATORY RESPONSE
Partial or poor response of CL to standard pentavalent antimony (SbV) treatment caused by host, parasite factors [We have therefore looked for additional healing effects of a topical treatment of CL wounds in addition to systemic SbV treatment with APG and its plasma secreted growth factors (APG-GF) which has become increasingly popular to improve healing of chronic non-leishmania wounds during the last decade. This study is the first report on the use of APG-GF for CL wound healing. We evaluated the pre- and post-treatment pathohistology of the CL lesions to find hints on a shorter and hence more cosmetic healing.Our preliminary findings suggest that in patients with 2 CL lesions treated with 20 mg /kg body weight, SbV daily for 14 days, additionally receiving topical APG-GF for one lesion once weekly for 8 weeks improves clinical healing of this lesion in comparison to the lesion left without topical treatment.10 (66%) of the APG-GF treated wounds healed completely till day 56, and 5 (34%) lesions showed partial healing. The Kaplan–Meier wound of both lesion groups confirm faster healing of the APG-GF treated CL lesions. Meanwhile, no statistically significant change was observed in the wound healing, as well as wound area over time in the control group.Martins et al. study showed that the use of platelet gel can be highly effective in the treatment of various types of chronic wounds [Researches on wound healing have shown that platelet gels accelerate wound healing, epithelialization, and angiogenesis. Platelets induce an intense inflammatory response in the used site and play a key role in the healing of the injured tissue [Gupta et al., reported that the inflammatory response and tissue repair of burn lesions treated with autologous platelet concentrate were significantly different compared to the control group. In their study, all patients who received the intervention demonstrated significantly better graft uptake rate when compared to patients in the control group [In another study, Elsaid et al. showed that platelet gel dressing is clinically effective in healing diabetic wounds and use of platelet gel dressing for diabetic foot ulcer resulted in a more significant reduction in the size of the ulcer when compared to routine dressing.Also, the time to reach the point of maximal healing with the least wound dimensions was significantly shorter when using platelet gel [APG is rich in growth factors and its application on the injury site summons the inflammatory cells and causes the onset of cell differentiation, which in turn accelerates the wound healing process and can be used as an auxiliary treatment in wound healing [The results of the present study showed that the use of APG accelerates the formation of granulation tissue. An increase in granulation tissue and accelerated wound healing was observed in the patients who used APG, which is consistent with the results of similar studies on this subject [In the present study, histopathological findings of CL lesions were also represented.Botelho et al. found that evaluation of histopathological samples is important for analyzing and understanding of the tissue healing process [Although, in some cases even after complete treatment of patients, when the CL lesions were considered clinically healed, an inflammatory pattern still persisted in lesions. Similar histopathological features have been described in Viana, et al. reports [Generally, the results of present study showed that wounds caused by CL may heal faster and more effectively with the additional use of APG than the standard anti-protozoal chemotherapy with SbV alone. The presence of moderate to intense infiltrates of inflammatory cells noticed before APG-GF treatment start was not absent after the end of APG-GF treatment, even with a complete clinical cure, the subjects still showed a mild inflammatory process.