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La Diabetes Mellitus es una enfermedad crónica que afecta a millones de personas en todo el mundo causando problemas socioeconómicos y emocionales; una de las complicaciones más temidas de la enfermedad son las úlceras crónicas por pie diabético (UCPD), ya que constituyen una de las principales causas de amputación de miembros inferiores, la prevalencia más alta se halló en Norteamérica (13%), en Bolivia la diabetes tipo 2 tuvo una prevalencia nacional para adultos de 6,5% y de ellos aproximadamente el 20% desarrollaron las UCPD. Por ello, fue indispensable contar con un tratamiento efectivo que evite la cronicidad, infección y amputación del miembro afectado por las úlceras. El Plasma rico en plaquetas es un producto derivado de la sangre con varios elementos que intervienen en la regeneración de tejidos y con efectos antiinflamatorios en varias lesiones; por tal motivo, surge como una opción promisoria para el tratamiento de las UCPD sin importar el grado de lesión (grados de Wagner).Para exponer sus beneficios y considerarlo como tratamiento de primera línea, se efectuó una revisión sistemática, con objetivos de carácter descriptivo-exploratorio; la recolección de la literatura se realizó de fuentes primarias (últimos 5 años), secundarias y terciarias. Finalmente, tras el análisis de los resultados se concluye indicando que el PRP como tratamiento disminuye el tiempo de curación de las úlceras del pie diabético, riesgo de infección, etc.
Diabetes Mellitus is a chronic disease that affects millions of people around the world, causing socioeconomic and emotional problems; one of the most feared complications of the disease are chronic diabetic foot ulcers (UCPD), since they constitute one of the main causes of lower limb amputation, the highest prevalence was found in North America (13%), in Bolivia the Type 2 diabetes had a national adult prevalence of 6.5%, and approximately 20% of them developed UCPD. Therefore, it was essential to have an effective treatment that prevents chronicity, infection and amputation of the limb affected by ulcers. Platelet-rich plasma (PRP) is a blood-derived product with several elements involved in tissue regeneration and with anti-inflammatory effects on various lesions; For this reason, it emerges as a promising option for the treatment of UCPD regardless of the degree of injury (Wagner grades). To expose its benefits and consider it as first-line treatment, a systematic review was carried out, with descriptive-exploratory objectives; the literature was collected from primary (last 5 years), secondary and tertiary sources. Finally, after analyzing the results, it is concluded that PRP as a treatment decreases the healing time of diabetic foot ulcers, the risk of infection, etc.
Subject(s)
Diabetic FootABSTRACT
Background: Chronic non healing ulcers are a challenge to the patient and health care professional. They require special care and intensive treatment often for prolonged periods. These ulcers do not generally heal with conventional types of treatment within a reasonable time period and need special types of treatment like collagen particles, vacuum dressing, chemical debridement etc. The aim of the study was to compare the effect of sterile collagen particles with saline dressings in treatment of chronic non healing ulcers.Methods: 30 test subjects were dressed using sterile collagen particles and 30 controls using saline gauze on day 2 and every 3rd day. The condition of the ulcer was followed up using the Bates-Jensen wound assessment score (BJWA score).Results: BJWA score was significantly lesser at 4th week in test group. The p value was 0.00021. Test group mean score was 17.23 and for control group it was 21.467. BJWA score was significantly lesser even at 8th week in Test group. The p value was 0.00026. Test group mean score was 12.47 and control group it was 17.43. This signifies that healing rate is better in test group compared to control group.Conclusions: Comparing the components in BJWA score we can conclude from our study that; collagen dressings are superior to saline dressing in all type of ulcers and irrespective of gender and age of a person. The best response was seen in non diabetic ulcer without Saphenofemoral incompetence who are non smokers.
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Background: Insulin being a growth factor was proved to stimulate angiogenesis, collagen formation, matrix formation and granulation tissue proliferation in several preclinical studies. The objective was to study effectiveness of topical insulin on healing of diabetic ulcers at tertiary health care centre.Methods: This was a cross sectional study carried out in the Department of surgery of a tertiary health care centre during August 2018 to August 2019 so during this period there were 60 patients. Group A was given topical insulin application. Group B was given saline application. The statistical analysis was done by using SPSS 24.0 version and un-paired t-test and chi-square tests are applied as test of significance.Results: Average time required for granulation tissue to appear (mean±SD) was significantly less in group A as compared to Group B (p<0.001, df=58, t=5.87); Average surface area of wound (mm2) at day 6th day was significantly less in group A (p<0.05, df=58,t=3.98); average depth of the wounds (mm) at day 6th day was significantly less in Group A as compared to in Group B (p<0.001, df=58, t=4.92).Conclusions: The topical application of insulin is significantly associated with fastening of wound healing in the diabetic ulcer.
ABSTRACT
Resumen El empleo de células mesenquimales ha emergido como una parte importante en la medicina regenerativa con efectos positivos en la recuperación de tejidos dañados o perdidos. Las úlceras crónicas incluyen lesiones cutáneas que afectan a una gran parte de la población con diabetes mellitus, (por ejemplo 9.14% desarrollan lesiones por pie diabético según ENSANUT 2016) y representan gastos económicos considerables, debido a la pobre calidad de vida que llevan los pacientes. El tratamiento convencional que se lleva a cabo en estos casos es a largo plazo, y los efectos benéficos generados que se presentan son limitados, ya que las lesiones reinciden por no contar con un tratamiento específico y regenerativo, solo paliativo. Es por ello que en este trabajo se obtuvieron y emplearon células troncales mesenquimales derivadas de gelatina de Wharton (CTM-GW) bajo los criterios propuestos por la Sociedad Internacional de la Terapia Celular. El tratamiento fue aplicado en dos pacientes con úlceras crónicas flebostáticas de diferentes condiciones médicas y se monitoreo a corto plazo, por lo que fue un estudio limitado. Los resultados mostraron que las CTM-GW indujeron la reconstrucción cutánea mediante formación de tejido de granulación, además de disminuir el proceso inflamatorio crónico en la zona de daño, lo que favoreció el índice de cierre de la herida. Por lo anterior, se propone la utilización de CTM-GW en úlceras flebostáticas crónicas como tratamiento en la regeneración de la estructura tisular con resultados a corto plazo.
Abstract Use of mesenchymal cells has emerged as an important part in regenerative medicine with positive effects in the recovery of damaged or lost tissues. Chronic ulcers include skin lesions that affect a large part of the population with diabetes mellitus, (for example, 9.14 develop diabetic foot according to ENSANUT 2016) and represent considerable economic expenses, due to poor quality of life in patients. The conventional treatment that is carried out in these cases is long term, and the generated beneficial effects that are presented are limited, since the injuries recur due to not having a specific and regenerative treatment, only palliative. That is why in this work they were obtained and used mesenchymal stem cells derived from Wharton's jelly (MSC-WJ) under the criteria proposed by the International Society for Cell Therapy. The treatment was applied in two patients with chronic ulcers phlebostatic of different medical conditions and short-term monitoring, so it was a limited study. The results showed that MSC-WJ induced skin reconstruction by tissue formation granulation, in addition to decreasing the chronic inflammatory process in the area of damage, which favored the index of wound healing. Therefore, the use of MSC-WJ in chronic phlebostatic ulcers is proposed as a treatment in the regeneration of the tissue structure with short-term results.
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Objetivo: Revisar la literatura científica publicada en las principales bases de datos, entre los años 1962 y 2016, cuyo objetivo fue abordar el tema de la calcifilaxia y sus principales características. Metodología: Se llevó a cabo una revisión de la literatura en las principales bases de datos de las Ciencias de la Salud y las Ciencias Sociales (medline-pubmed, cinhal, web of science, lilacs, sociological abstracts, cuiden, embase, psycoinfo e isi web of knowledge). Se emplearon descriptores en español, inglés y portugués: Calcifilaxis, diálisis, hiperparatiroidismo, necrosis, gangrena, calcificación vascular, cuidados de enfermería y diagnósticos de enfermería. Se hizo una revisión sistemática de los artículos seleccionados utilizando un protocolo para extraer los datos. Resultado: Se encontraron 45 artículos que cumplían con los criterios de búsqueda establecidos, 35 reportaron los resultados de ensayos clínicos o estudios cualitativos, 4 correspondían a revisiones sistemáticas y 6 se catalogaron como estudios retrospectivos. Los autores señalaron las principales características de la enfermedad, de los pacientes y los tratamientos más usados, pero poco del cuidado que debe brindar el profesional enfermero. Conclusión: En los estudios analizados se identificaron principalmente aspectos sobre el curso de la enfermedad y el tratamiento; se reportó la efectividad de algunos tratamientos utilizadas en la atención de dichos pacientes, pero ninguna de ellas definitiva, lo que permite proponer algunas acciones desde la disciplina enfermera.
Objective: To analyze the scientifi c literature published in the main databases between 1962 and 2016, whose objective was to address the issue of calciphylaxis and its main characteristics? Methodology: A literature review was carried out in the main databases of the Health Sciences and Social Sciences (medline-pubmed, cinhal, web of science, lilacs, sociological abstracts, cuiden, embase, psycoinfo and isi web of knowledge). An analytical review of the selected articles was made using a protocol to extract the data. Results: 45 articles were found that fulfi lled the established search criteria, 35 reported the results of clinical trials or qualitative studies, 4 corresponded to systematic reviews and 6 were classifi ed as retrospective studies. The authors pointed out the main characteristics of the disease, the patients and the most used treatments, but little of the care that should be provided by the nurse practitioner. Conclusion: In the analyzed studies, aspects regarding the course of the disease and treatment were identifi ed; it was reported the effectiveness of some treatments used in the care of these patients, but none of them defi nitive, which allows to propose some actions from the nurse discipline.
Objetivo: Revisar a literatura científica publicada nas principais bases de dados, entre os anos 1962 e 2016, cujo objetivo era abordar o tema da calcifilaxia e suas principais características. Metodologia: Uma revisão da literatura foi realizada nas principais bases de dados das Ciências da Saúde e das Ciências Sociais (Medline-Pubmed, Cinhal, Web of Science, Lilacs, Sociological abstracts, Cuiden, Embase, Psycoinfo e Isi Web of Knowledge). Foram usados descritores em espanhol, inglês e português: calcifilaxia, diálise, hiperparatiroidismo, necrose, gangrena, calcificação vascular, cuidados de enfermagem e diagnósticos de enfermagem. Foi feita uma revisão sistemática dos artigos selecionados utilizando um protocolo para extrair os dados. Resultados: Encontraram-se 45 artigos que cumpriam com os critérios de busca estabelecidos, 35 reportaram os resultados de ensaios clínicos ou estudos qualitativos, quatro (4) correspondiam a revisões sistemáticas e seis (6) se catalogaram como estudos retrospectivos. Os autores apontaram as principais características da doença, dos pacientes e os tratamentos mais usados, mas pouco do cuidado que debe oferecer o professional da enfermagem. Conclusão: Nos estudos analisados se identificaram principalmente aspectos sobre o curso da doença e o tratamento; se reportou a efetividade de alguns tratamentos utilizados no atendimento desses pacientes, mas nenhum deles definitivo, o que permite propor algumas ações desde a profissão da enfermagem.
Subject(s)
CalciphylaxisABSTRACT
RESUMEN En los últimos años, las células troncales mesenquimales (Mesenchymal Stem Cells, MSC) han adquirido mucha importancia debido a su gran plasticidad y su capacidad de liberar factores paracrinos con capacidad de interactuar con diversos tipos celulares, tejidos y órganos. El uso de MSC en medicina regenerativa es importante debido a que, al no expresar las moléculas del complejo mayor de histocompatibilidad (MHC) clase II ni moléculas co-estimuladoras y tener baja expresión del MHC clase I, haría que no sean rechazadas por individuos de la misma especie, es posible utilizarlas no sólo de manera autóloga, sino también, eventualmente, alogénica. Sin embargo, es importante demostrar científicamente muchas de sus propiedades, entre ellas las inmunomoduladoras. Al tener varias fuentes de obtención, se debe estandarizar la que sea la mejor para garantizar la pureza y calidad de las MSC. Finalmente, es importante que cuando se trabaje con estas células se demuestre completamente las características del cultivo celular, la inmunotipificación y su capacidad de diferenciación. Se están ensayando muchas aplicaciones clínicas de las MSC. Dentro de ellas, su capacidad para mejorar la recuperación y potencial curación de úlceras crónicas como las diabéticas, ha atraído la atención por su potencial impacto terapéutico.
ABSTRACT In recent years, mesenchymal stem cells (MSC) have become very important due to their high plasticity and their ability to release paracrine factors able to interact with various cell types, tissues and organs. The use of MSC in regenerative medicine became of vital importance, since they do not express histocompatibility MHC molecules class II nor costimulant molecules, and low expression of MHC class I, will not be rejected by individuals of same species, they could be used in an autologous, and eventually, allogeneic manner. However, it is important to scientifically demonstrate many properties, including immunomodulatory ones. Having several sources of obtaining, it should be standardized the best one to ensure the purity and quality of these cells. Finally, it is important when working with these cells, that characteristics of cell culture, immunophenotyping and differentiation capacity are fully demonstrated. MSC have been applied in several clinical uses. Among them, their ability to improve, and even heal chronic ulcers, as diabetic, has attracted attention for its potential therapeutic impact.
Subject(s)
Humans , Mesenchymal Stem Cells , Mesenchymal Stem Cell TransplantationABSTRACT
Úlceras crônicas são suscetíveis à infecção devido à perda estéril da função de barreira inata da pele e dos anexos cutâneos, facilitando o desenvolvimento de comunidades microbianas. O objetivo do estudo foi investigar a suscetibilidade de bactérias associadas a úlceras crônicas aos extratos brutos de Prosopis juliflora. Os testes in vitro foram realizados com extratos brutos das folhas e casca do caule contra as estirpes de Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923) e Proteus mirabilis (ATCC 7002), por meio de ensaio de difusão em agar com poço e determinação da Concentrações Inibitórias Mínimas (MIC). Os resultados mostraram que as estirpes de E. coli, P. aeruginosa, S. aureus e P. mirabilis foram mais susceptíveis aos extratos brutos da folha, com diâmetro de zona de inibição de 21,0; 33,0; 20,0; 21,0 mm, respectivamente, enquanto, E. coli e S. aureus foram mais susceptíveis aos extratos brutos da casca do caule, com diâmetro da zona de inibição de 21,5 e 20,0 mm, respectivamente. Os melhores valores de CIM foram registrados para EBF de P. juliflora. Estudo químico para a extração e o isolamento de compostos ativos é recomendado para realização de ensaios in vitro para investigar a atividade antimicrobiana destes compostos.
Chronic ulcers are prone to infection due to the sterile lossof the innate barrier of the skin and cutaneous annexes, coupled to the development of microbial communities. Current study investigates the susceptibility of bacteria associated with chronic ulcers to crude extracts of Prosopis juliflora. In vitro tests with the crude extracts of leaves and stem bark were performed against strains of Escherichia coli (ATCC 25922), Pseudomonas aeruginosa (ATCC 27853), Staphylococcus aureus (ATCC 25923) and Proteus mirabilis (ATCC 7002), by a diffusion assay in agar and determination of Minimum Inhibiory Concentration (MIC). Results showed that E. coli, P. aeruginosa, S. aureus and P.mirabilis strains were affected by the crude extracts of the leaves, with a diameter of the inhibition zone measuring respectively 21.0; 33.0; 20.0; 21.0 mm, whereas E. coli and S. aureus were more affected to the crude extracts of the stem bark, with an inhibition zone diameter of 21.5 and 20.0 mm, respectively. Best MIC rates were reported for the crude extracts of P. juliflora leaves. Chemical studies for the extraction and isolation of compounds are recommended for the execution of in vitro assays to investigate the compounds´ antimicrobial activity.
Subject(s)
Ulcer , Prosopis , Anti-Infective Agents , In Vitro TechniquesABSTRACT
Aims: The aim of the current study was to assess the clinical efficacy of the FlaxAid dressing for the treatment of chronic venous wounds in a patient unresponsive to previous treatment protocols. Presentation of Case: A 50-year old male patient presented with recurrent venous ulcers of the lower extremities. All of the ulcers had lasted for 5 years and their size was increasing despite clinically relevant local therapy. FlaxAid dressing were applied to the wound area in three stages consisting of FlaxAid dressings wetted with: isotonic salt solution; oil emulsion; and seedcake extract. Discussion and Conclusion: After 12 weeks of therapy with the newly developed FlaxAid bandages, all of the patient’s ulcers had been cured. After 6 months of follow-up, the sites of the patient’s ulcers were found to still be in a healthy state.
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Introducción: las úlceras en los miembros inferiores constituyen una causa importante de hospitalización y deterioro en la calidad de vida de los pacientes, al interferir con sus actividades laborales y sociales. Estas lesiones obedecen a diferentes enfermedades, la más frecuente de las cuales en Medellín es la insuficiencia venosa; una vez diagnosticadas, existen muchas alternativas de tratamiento, que buscan crear un lecho apropiado para el cierre de la herida. El uso de larvas para el desbridamiento es una alternativa rápida y de bajo costo, con la cual se logra un tejido de granulación adecuado para la aplicación de equivalentes cutáneos autólogos, que constituyen una opción para pacientes refractarios a otros tratamientos. Materiales y métodos: se seleccionó y evaluó a una paciente de acuerdo con los criterios de inclusión establecidos para el estudio. Para desbridar la úlcera se recurrió a la aplicación de larvas de Lucilia sp. (Diptera: Calliphoridae), btenidas a partir de huevos previamente desinfectados con hipoclorito de sodio y sembrados en un medio de cultivo con antibióticos. Se aplicaron las larvas directamente en la lesión y posteriormente se procedió a tapar esta con muselina, permitiendo la obtención de oxígeno y facilitando el drenaje del tejido necrótico. Las larvas se dejaron por 48 horas, al cabo de las cuales se retiraron con una pinza estéril y se descartaron en alcohol al 70%; luego se procedió a evaluar la limpieza de la lesión. Este procedimiento se llevó a cabo en el Laboratorio de Entomología (GIEM) de la Universidad Antioquia. Se procesó una biopsia de piel de la paciente, obtenida siguiendo un protocolo previamente establecido, para obtener queratinocitos y fibroblastos. Para el cultivo primario de queratinocitos el 90% de las células obtenidas de la biopsia se sembró en cajas de cultivo de 75 cm2, en presencia de 7 x 106 células de la línea 3T3-Swiss tratadas con mitomicina C (10 μg/mL) como capa alimentadora; para el cultivo primario de fibroblastos, se sembró el 10% de las células en cajas de cultivo de 75 cm2 con el medio DMEM suplementado. En la producción del equivalente cutáneo se utilizó un gel obtenido con una mezcla de plasma humano de sangre AB de banco de sangre, 6-7,5 x 104 fibroblastos, CaCl2 y ácido tranexámico. Sobre dicho gel se sembraron luego los queratinocitos provenientes del cultivo primario y se hizo seguimiento del cultivo en microscopio invertido. Cuando se obtuvo una confluencia celular cercana al 100%, se desprendió el equivalente cutáneo con pinzas estériles para aplicarlo inmediatamente sobre la úlcera. Se reportan los resultados del tratamiento de una úlcera en el miembro inferior izquierdo de una paciente de 66 años con la terapia combinada de desbridamiento con larvas y cultivo de equivalentes cutáneos autólogos. Después de 15 meses de iniciado el tratamiento, la úlcera continúa cerrada y la paciente no tiene dolor ni impedimentos funcionales en la extremidad.
Subject(s)
Debridement , Cell Culture Techniques , Leg UlcerABSTRACT
OBJECTIVE Chronic ulcers on the limbs are a common problem in diabetic patients with pathological changes in nerve and vessels.Such ulcers can result in disablement and may even be life-threatening.The treatment of these chronic ulcers is a difficult issue in current medical practice.The development of an effective and easily handled treatment is,therefore,an important topic in the management of diabetes to improve patients′ quality of life. METHODS Povidone iodine water bath was given to 54 diabetes patients with chronic ulcer on their limbs at a time when their glucose levels were controlled by insulin to FBG
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It has been known to the Chinese for a long time that Centella asiatica (L.) Urban, the umbelliferous pennywort, possesses a property that lessens the internal inflammatory process. The use of crushed leaves to treat ulcers is also known in India and Pakistan. At Mahidol University, pure triterpene acids and glycosides are extracted from dried leaves. One percent of this extract in cream base was used in this experimental modality. Twenty-two patients with chronic infected ulcer measuring 1-12 cm in width, 1-19 cm in length and 0.5-3.7 cm in depth, were treated with the 1% extracted alkaloids cream. The size of the ulcers were measured and recorded at the beginning of the experiment and one, two and three weeks later. It was observed that the size of the ulcers decreased at an average rate of 24 percent of the original size in the first week, 37 percent at the second week and 47 percent at the end of the third week, It is noted that the healing rate of the depth is faster than the other two dimensions by aboout 20 percent. At the end of the experiment, seventeen out of twenty-two ulcer patients were completely healed, either by epithelialization or skin grafting. The remaining five ulcer patients did not heal completely but their ulcer size were much decreased. A variety of bacteria was recovered from the wounds throughout the experiment and it seemed that they did not play any important role in the healing of the wounds.