Mumtaz Ansari

Wound healing research: a perspective from India

W and particularly chronic wounds are major concerns for the patient and clinician alike; chronic wounds affect a large number of patients and seriously reduce their quality of life. Current estimates indicate that nearly 6 million people suffer from chronic wounds worldwide. There are very few Indian studies on the epidemiology of chronic wounds. In one study, the prevalence of chronic wounds in the community was reported as 4.5 per 1000 population whereas that of acute wounds was nearly doubled at 10.5 per 1000 population. The causes for chronic wounds are many, including such systemic conditions as diabetes mellitus, atherosclerosis, tuberculosis, and leprosy. Other major causes include venous ulcers, pressure sores, and trauma vasculitis. Such conditions as tuberculosis and leprosy, which are uncommon in Western societies, are often encountered in India. However, diabetic foot ulcers are an extremely common clinical condition encountered in Varanasi, India, similar to that seen in the Western population. In the above-referenced study, inadequate and inappropriate treatment of acute wounds was the commonest cause of chronic wounds. The practice of walking and working barefoot especially in the agricultural fields also contributed as causes. This unequivocally underscores the importance of conceptualizing and implementing quality wound care programs at the community level. Needless to say, these programs imply a multidisciplinary approach composed of a dedicated group of wound care health personnel including wound care nurses. In India, the problem of chronic wounds is compounded by other demographic factors such as low literacy rates, poor access to health care, lack of adequate manpower, and inadequate health infrastructure. The other major area of concern for wound care physicians is a limited knowledge of the physiological processes involved in wound healing. The field of wound healing and tissue regeneration represents a tremendously diverse area of clinical and scientific activity encompassing the most basic of wound care therapies to the most advanced analysis of cellular regulatory mechanisms. Chronic wounds, burns, and scars are complex, they have many causes, and they affect patients in many different ways. As a result, they can only be understood using a broad range of scientific and medical disciplines. Chronic wounds afflict a very large number of patients and seriously reduce their quality of life. Why some wounds heal in a reasonable time frame whereas others do not is something that we still do not understand despite the almost limitless scientific advances in the past few decades. The physiology of wound healing should be a major area of focus for ongoing scientific research. At present, there is a multitude of therapeutic approaches for the management of chronic wounds. Many of these are driven by industry, and the actual benefits of these treatment protocols are yet to be published. In the past, not much attention was devoted to chronic wounds, as the federal governments, the private sector, and the medical community were slow to focus on this growing health care problem. But with the rising elderly population and the increasing incidence of diabetes, the care of these wounds is fast becoming a billion-dollar business. Treatments that exist today, however, are often expensive and often not reimbursed through medical insurance. Current efforts in woundhealing research are directed toward developing new methods for promoting wound closure to be used alongside the traditional approaches of debridement and infection control. The most important of these innovations includes the use of skin substitutes and biomolecules that stimulate skin repair. Future research may identify targets for newer therapies. The Wound Management Research Team should be a multidisciplinary team composed of laboratory scientists as well as medical and clinical specialists. The development of a new therapy by the research team would involve various considerations such as the efficacy of the product, its side effects, the health economics, marketing of strategies, and above all the cost-benefit analysis. It is thus imperative that the research team must develop a network of contacts and collaborations with academic

Study of Anxiety and Depression among Breast Cancer Patients from North India

Background: The prevalence of psychological distress among breast cancer patients is high, and they are at higher risk of developing severe anxiety, depression and potential mood disorders. In the present study, we conducted prospective study to determine the socioeconomic factors associated with anxiety and depression among breast cancer patients and to access the changes of psychological distress after the completion of treatment at 1 year of follow-up. Methods: This study was conducted among breast cancer patients enrolled in the Department of General Surgery, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India. A total of 200 patients who were diagnosed from January, 2013 to December, 2014 were interviewed using the questionnaires of Hospital Anxiety and Depression (HADS). The HADS was administered at two time points: at time of diagnosis and 12 months after completion of treatment. The associated factors investigated concerned socio-demographics, socio-economic background and the cancer stage. Results: Prevalence of anxiety and depression among the breast cancer patients was 37.0% (n=74) and 28.0% (n=56) respectively. We found strong association of anxiety with age group (p=0.014), educational level (p=0.034), monthly income (p=0.001) and financial support (p=0.041). However, marital status (p=0.014), monthly income (p=0.017), accompanying person (p=0.005) and financial support (p=0.002) were significantly associated with depression. Binary logistic regression analysis shows age younger than 50 years old, those earned less income, illiterate or low level of education, being single and receiving less financial support are more likely to have anxiety. For depression, those earned less income, being single and receiving lesless financial support are more likely to have depression. At the 12 month follow-up, 184 breast cancer patients were re-interviewed. We found significant improvement (P<0.001) after 12 month follow-up in both anxiety and depression level (mean anxiety level improved from 11.14 ? 4.23 to 8.64 ? 3.63 and mean depression score improved from 6.87 ? 3.11 to 5.13 ? 4.51. Conclusion: Study clearly shows that younger age group, low monthly income, having less financial support, low education level and being single were associated with anxiety and depression. For managing breast cancer patients, more care or support should be given to this type of patients as they are at high risk of anxiety and depression.