Randomized single-blind trial of topical ketanserin for healing acceleration of diabetic foot ulcers

The objective of this study was to determine the efficacy of topically applied ketanserin for healing acceleration of diabetic foot ulcers. From august 1993 to september 1994, 140 NIDDM patients entered a randomized single-blind trial of topical ketanserin (Sufrexal, Janssen Pharmaceuticals; n=69) vs. normal saline (labeled here as placebo; n=71). All patients were subjected to surgical debridement of necrotic tissue and lavage with normal saline. Wound were <100 cm² in area. Persons with NIDDM and foot ulcers Wagner 2 and 3 with a median of 8 (interquartile range 4 -26) weeks duration were included. Ulcer area was measured at 0, 4, 8 and 12 weeks. The groups were similar in age, sex, years of diabetes duration, obesity, ulcer Wagner type, number of previous amputations and surgical debridements during this hospital stay. Average percent reduction in ulcer area at 12 weeks was 87 percent for ketanserin vs. 63 percent for placebo (p<0.001). The regression equations for the leastsquares fit to the area (y) against time (x) data points were y = 43.46-3.181x(r=0.995) for ketanserin and y= 39.46-2.016x(r=-0.999) for placebo (p<0.01). The 95 percent confidence limits for slopes were -3.181 ñ 0.98 and -2.016ñ0.15. Thus, average daily reduction in ulcer area was 4.5 mm²/day for ketanserin vs. 2.88 mm²/day for placebo. In clnclusion, topical ketanserin significantly accelerated wound healing in diaetic neurothrophic foot ulcers when applied as part of a comprehensive healing program

Morbilidad y mortalidad hospitalaria en la atención integral del diabético / Hospital morbility and mortality in the diabetic's integral case

De una cohorte de 326 diabéticos tipo II hospitalizados entre 1990 a 1992 en instalaciones del Instituto Mexicano del Seguro Social de Cosamaloapan, Veracruz, se comparó la morbilidad y la mortalidad de 73 pacientes (grupo A) integrados al Programa de Atención del Diabético (PAID) contra 253 que no pertenecían al mismo (grupo B). El pie del diabético fue el principal motivo de internamiento sin diferencia grupal y su frecuencia de amputaciones fue independiente de su atención en el PAID (p>0.05). La mortalidad de 1990 a 1992 descendió 26 por ciento, mientras que en el grupo B aumentó 13 por ciento (p<0.01). Esta reducción fue mayor en el último año de seguimiento (p< 0.05). La mortalidad global fue de 87 (27 por ciento) primordialmente por insuficiencia renal crónica. Las complicaciones sépticas causaron seis defunciones únicamante en el grupo B. El grupo A mostró una reducción de la mortalidad y ausencia de complicaciones sépticas como causa de defunción.

Clinical stage, age and treatment in tropical pyomyositis: a retrospective study including forty cases

A comparative and retrospective trial of 40 patients with tropical pyomyositis covering studies done between January 1, 1987 and November 31, 1990, at the General Hospital at Cosamalopan, Veracruz, IMSS, was undertaken. The objectives were to compare predisposing factors, clinical data, morbidity, mortality and hospital stay among 1) medial (group I) and surgical treatment (II), 2) adult and pediatric populations and 3) the clinical stage of the disease (invasive, suppurative and late). In group I, the family history of diabetes (56 per cent), fever (66 per cent) and hospital stay (6.5 ñ 1.8 days) were significantly different from group II (19 per cent, 100 per cent and 12.8 ñ 5.5 days), respectively. The mean age in adult and pediatric population was 38 and 8 years, respectively. Pediatric patients had lowest hemoglobin levels (9.7 ñ 1.3). Upper respiratory antecedent was highest in suppurative stage (65 per cent). In the late stage eosinophilia (5.9 ñ 6.9), fluctuance muscles (100 per cent), complication rate of 57 per cent, surgical drainage (100 per cent) and mortality of 29 per cent were found. Cultures were performed in 20 cases with negative results in 55 per cent and the remaining 45 per cent were positive to Staphylococcus aureus. Pyomyositis appears to be multifactorial in origin, the antecedents of trauma and upper respiratory infection were the major predisposing factors. Septicemia cuased high morbidity and mortality in the late stage. Surgical treatment was frequently needed, increasing costs

Diagnóstico situacional de la diabetes mellitus tipo II en el paciente ambulatorio, hospitalizado y pensionado / Situational diagnosis of diabetes mellitus type II in an ambulatory patient who was hospitalized and pensioned

Estudio retroprolectivo, descriptivo y observacional de 211 diabéticos ambulatorios (grupo A); de 100 egresos hospitalarios (grupo B) y 20 pensionados por invalidez por diabetes mellitus (grupo C) en el Hospital general de Zona con Medicina Familiar No. 35 (HGZUMF 35), Cosamaloapan Veracruz, Instituto Mexicano del Seguro Social, en el periodo del 1 de julio de 1988 al 30 de junio de 1990. El sobrepeso (66 por ciento), la escolaridad baja (69 por ciento), la vida sedentaria (66 por ciento), el antecedente familiar de diabetes (40 por ciento), la hiperglucemia "permanente" (74 por ciento), la hipertensión (12 por ciento), la presencia de complicaciones agudas (37 por ciento) y crónicas (55 por ciento), caracterizan al grupo A. En el grupo B el pie diabético fue la primera causa de egreso hospitalario (39 por ciento) y de complicaciones sépticas que incrementaron el número de amputaciones (29 por ciento), la estancia hospitalaria (ocho días) y la mortalidad (20 por ciento). El costo de atención fue mayor en el paciente hospitalizado que en el ambulatorio en una relación de 7:1. El daño renal fue la primera causa de invalidez (50 por ciento) y el pie diabético la segunda (30 por ciento). Independientemente del número de consultas y su atención integral, el diabético persiste en descontrol metabólico por escaso autocuidado. Se enfatiza la atención integral, detección oportuna y medidas preventivas