A Novel Bathing Therapeutic Approach for Diabetic Foot Ulcers
, Brett Hiebert 2, Rohan Sanjanwala 2, Paul Komenda 3, Chris Sathianathan 4, Amarjit S. Arneja 5 and Bram Ramjiawan 1,6Round 1
Reviewer 1 Report
It is an original article and can become a great investigationif the sample increases, as it is too short. Still, it can be a good therapeutic complement to diabetic foot treatment,
although there are things like tap water that should be changed in a larger study.
Author Response
Reviewer response (Reviewer 1)
We thank the reviewer for their comments and some kind words on our work. This reviewer raised two points:
- Sample size.
We have already noted that the sample size of the study is small and thus a large scale study would need to be conducted. This is indicated in the discussion section of the paper, page 13 lines 414-415 and in the conclusion, page 13, line 427.
- Tap water should be changed.
We are in agreement with this reviewer that tap water should be changed in a larger study. In this regard, we have now added use of distilled water in any follow up large study, in the discussion on page 13, lines 410-415 in the revised manuscript.
Reviewer 2 Report
The paper is devoted to a study on the effect of CO2-enriched water on the treatment of trophic ulcers against the background of diabetes mellitus. The authors consider modern local methods of treating trophic ulcers and propose a new method of influencing the course of the wound process.
The positive effect of CO2-enriched water can be explained by the appearance of carbonate salts, which are part of hydrocarbons and amino acids. Their formation contributes to the epithelization of the wound.
The paper is well structured. Nevertheless, there are some comments to the authors.
1) The purity of tap water used in the study is questionable. Tap water may contain various impurities and salts used for its purification. Salts dissolved in water, when exposed to CO2 can lead to the formation of substances that can cause chemical burns. I would advise the authors to use distilled water.
You can add new data with distilled water and compare it with the current one in the Discussion section.
2) Were there any negative effects from exposure to CO2-enriched water?
3) What local medicines for the treatment of trophic ulcers were used after baths with CO2-enriched water?
4) How often were bandages performed between procedures?
5) Introduction should be extended and enriched by new references.
Author Response
Reviewer response (Reviewer 2)
We thank the reviewer for their comments and some gratifying words on our work. Several points were raised by this reviewer and have been addressed as follows:
- The purity of tap water is questionable.
We thank the reviewer for this very important and relevant point. Accordingly, in agreement we have added the potential risk for chemical burns when using CO2 and tap water as well as using distilled water in the revised manuscript on page 13, lines 410-415.
- ere there any negative effects from exposure to CO2-enriched water?
We have already indicated the negative effects of exposure to CO2-enriched water. Specifically the occurrence of new pressure-type ulcers that was observed in 28% of hemodialysis patients and thus this patient population may be contraindicated for foot bathing in CO2-enriched water. This is in the discussion section of the paper, page 13, lines 404-410 in the revised manuscript.
- What local medicines for the treatment of trophic ulcers were used after baths with CO2-enriched water?
We have added that the standard of care for wound healing (i.e. debridement, use of povidone iodine and new dressing) was continued throughout the study period and was not interrupted by participation in the study on page 3, lines 119-122 in the revised manuscript. In addition, we clarify that after foot bathing feet were meticulously towel dried and new dressing applied and Povidone iodine was applied if indicated on page 5, lines 211-213 in the revised manuscript.
- How often were bandages performed between procedures?
While standard of care for foot ulcer was not interrupted with participation in the study, we have indicated (as above point #4) that at the end of each foot bathing session new dressing was applied.
- Introduction should be extended and enriched by new references.
We have improved and clarified the introduction and enriched it with newer references (Ref # 4, 11, 21,22,23 and 26).
Reviewer 3 Report
Dear Author's Thank you for having a chance to read such an interesting article. I believe like the authors, that the use of physical methods in complex treatment is indispensable and should be applied in various forms. In manuscript in Material and methods chapter,the Authors included two fragments of: Study design and Institutional
Review.
best regards!
Author Response
Reviewer response (Reviewer 3)
We thank the reviewer for their supportive words on our work. This reviewer noticed that a duplication of study design and institutional review sections in the Materials and methods section. This has now been corrected in the revised manuscript.
Round 2
Reviewer 2 Report
The authors answered all my questions. So, paper can be accepted.
