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Biotherapy in none healing wound in diabetic patient Dr.Seyed Ali Asghar Sefidgar,Dr.M.Mirzaei Hamzde sharfifi Babol Medical University Mycology department, Introduction In 2007, 246million people aged 20 - 79 years were diagnosed with diabetes mellitus – a global epidemic affecting 6% of the adult population. 25% of these develop foot problems...that are 61.5 million diabetic feet! And, worryingly, the prevalence of diabetes mellitus is expected to reach 333 million by 2025. “That’s a lot! How many of these get foot ulcers?” Developed countries: 15% of people with diabetes get ulcers at least once in their lifetime Developing countries: the prevalence is even higher at 20%. “...and does amputation use vary from place to place?” Yes! See below; Incidence of minor and major amputations per 1000 people with diabetes Source: International Diabetes Federation and The international Working Group on Diabetes joint publication 2005. Incidence per 1000 Population Year Mauritania 680 Hospital-oriented 1998-2002 Tanzania 400 Hospital-oriented 2002 Croatia 6.8 Hospital-oriented 2002 UK 2.6 Regional 1998 The Netherlands 3.6 Nationwide 1991-2000 In recent wound healing problems increased for antibiotic resistanc of causal agent bacteria such as Methicillin resistant Staphyloccocus Aureus (MRSA) and group A and B Streptococci, ), Pseudomonas aeruginosa, Vancomycin resistant enteroccocus (VRE), and Candida albicans. and so on in nosocomial infection and other condition we require new source for treatment of this acquired non healing wound. Biotherapy is a alternative aid for increased wound healing in patines with nonhealing wound. The popularity of Biotherapy is growing in the United States and around the world. Biotherapy is the medical use of live organisms. Such as: Leach thrapy :Hirudo medicinalis (medicinal leech). The leeches in action on the body of a patient with haematoma. Leeches suck blood as part of a therapy Leech Therapy For Acne and other skin wound Ichthyotherapy :As Alternative Treatment for Patients with Psoriasis Fecal Bacteriotherapy:, Fecal Transplant, and the Microbiome fecal transplant enema Fecal Transplant Therapy Fecal Bacteriotherapy, Fecal Transplant, and the Microbiome Bee Venom Therapy: is also sometimes referred to as Bee Sting Therapy. Bee Venom Therapy is also sometimes referred to as Bee Sting Therapy. (BVT) powerful properties of bee venom (BV) in treatment of various diseases such as RA Snake Venom Therapy: Using snake venom for treatment of various diseases .Snake venom toxins contributed significantly to the treatment of many medical conditions. Venomous Snakes: Envenoming, Therapy Maggothrapy: Maggot – Larva of the fly. Maggots from the green blowfly are used for medical purposes. Electron microscopic image of a Lucilia (Phaenicia) sericata larve The foot of diabetic patient showing extensive tissue necrosis Maggot debridement therapy, (MDT) Chronic bacterial colonization or infection of ulcer is one of the major factors interfering proper wound healing, especially in diabetic foot ulcers. The maggot therapy has been used for debridement of necrotic tissues, however, never been studied for potential antimicrobial properties Maggots clean up wounds beautifully, a fact known for centuries, especially to military surgeons, who found that battle wounds accidentally infested with maggots healed quickly without becoming infected. According to Dr. Ronald Sherman (University of California, Irvine, CA, USA), maggot therapy was introduced into civilian medicine in the USA in the 1930s but fell out of favor with the introduction of antibiotics. But maggots are now making a comeback, especially in the treatment of chronic wounds infected with antibiotic-resistant bacteria. Recently, Dr. Sherman presented the preliminary results of his prospective trial of conventional wound care followed by maggot therapy at a Wound Healing Society symposium in Toronto, Canada. 43 maggot-treated wounds were derided faster and more completely than they had been during conventional treatment. Live maggots were clinically suggested to kill or inhibit the growth of a range of pathogenic bacteria, especially Methicillin resistant Staphylococcus aurous (MRSA) and group A and B Streptococci. They show clinical activity against Pseudomonas species, although no formal prospective experimental study was arranged in the past. The clinical findings are consistent with the observations that maggots can combat infections in a variety of wound types, including those In fact the treatment of wounds infected with MRSA is infected with antibiotic-resistant strains. likely to become a major indication for the use of maggot therapy in the future. The presence of large amounts of necrotic tissue in wounds can prevent topical antibacterials, such as mupirocin, from reaching the site of infection. Maggots were used to clean wounds from battles to prevent infection. Without the aid of maggots wounds would become infected and many people had limbs amputated because of small wounds that could not be healed. Maggot Debridement Therapy (MDT) The use of maggots in the removal of necrotic tissue. Maggots are used in wounds that are non receptive to antibiotics and are deemed as non-healing wounds. Maggots from the Green Blowfly are used, because they are a species that only eat necrotic tissue. Maggot is the larva of Lucilia (Phaenicia) sericata after sterilization of fly egg by suitable chemical material or UV beam in a special wave length .After surgeon debridment and cleaning wound by sterile normal saline put 7- 10 larva per cm3 and after 2-4 days remove larva and put another Seri of new larva to heal wound. Some healing materials in larval activity are: allantoin, urea, phenylacetic acid, phenylacetaldehyde, calcium carbonate,NH4OH , proteolytic enzymes and many others . The Benefits of MDT Before MDT After MDT MDT: a wound after 4 treatments 1 2 4 Some References: 1: Jarvis A. Maggot therapy.Lancet. 2000 Dec 9; 356(9246):2016. • 2. Wayman J, Nirojogi V, Walker A, Sowinski A, Walker MA... The cost effectiveness of larval therapy in venous ulcers. J Tissue Viability. 2000 Jul; 10(3):91-4. Erratum in: J Tissue Viability 2001Jan; 11(1):51. • 3: Bonn D. Maggot therapy: an alternative for wound infection. Lancet. 2000 Sep 30;356(9236):1174. • . 4. Dissemond J, Koppermann M, Esser S, Schultewolter T, Goos M, Wagner SN Treatment of methicillin-resistant Staphylococcus aureus (MRSA) as part of biosurgical Hautarzt 2002 Sep;53(9):608-1 management of a chronic leg ulcer. • 5-B., K. Maggots as healers: the increasing use of maggot debridement therapy. University of Washington, Zoology, 2000. • 6-Church, J.C.T. The traditional use of maggots in wound healing, and the development of larva therapy (biosurgery) in modern medicine. J. Alt. Compl. Med. Vol 2 Iss 4, 525, 1996. • 7-McGovern, Celeste. Brave new world. Report/Newsmagazine, Vol. 28, Issue 10, 60, 2001. • 8-Namias, N., Varela, et al. Biodebridement: A case report of maggot therapy for limb salvage after fourth-degree burns. J. Burn Care Rehab, Vol 21, 254, 2000. • 9-Reames, M.K, Christensen, C., and Luce, E.A. The use of maggots in wound debridement. Annual Plastic Surgery, Vol 21, Iss 4, 388, 1988. • 10-Sherman, R.A. et al. Maggot debridement therapy in outpatients. Archives of Physical Medicine and Rehabilitation, Vol 82, 1226, 2001. • 11-Shinkman, Ron. Worms and squirms. Modern Healthcare, Vol 30, Iss 43, 54, 2000. •