Early diagnosis of diabetic neuropathy and prophylaxis of diabetic foot / Diagnóstico precoce da neuropatia diabética e profilaxia do pé diabético

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The "Michigan Neuropathy Screening Instruments" classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy

Introdução: o pé diabético é uma das complicações mais sérias do diabetes mellitus. Cerca de 50% das amputações não traumáticas ocorrem nesses pacientes. Além disso, é um importante problema de saúde pública por ser um distúrbio metabólico crônico e complexo que se caracteriza pelo comprometimento do metabolismo da glicose associada a outras complicações em órgãos essenciais para manutenção vital. Objetivo: avaliar a sensibilidade e especificidade para neuropatia diabética da autoavaliação e do exame físico de Michigan nos diabéticos tipo 1 e tipo 2. Método: trata-se de um estudo transversal. Foi utilizada a classificação "Michigan Neuropathy Screening Instruments" para avaliação do grau de neuropatia periférica, em que os participantes responderam ao questionário e foram avaliados quanto a presença de lesões nos pés. Todos os participantes foram estratificados quanto ao risco de desenvolver úlcera nos pés de acordo com o protocolo do IWGDF. Resultados: a amostra contou com 200 participantes. Quanto à classificação do IWGDF, 23 pacientes foram classificados como risco moderado (11,50%) e 61 como alto risco para o desenvolvimento de úlceras nos pés (30,50%). Utilizando-se um corte de 2,5 na pontuação do exame físico para diagnosticar a neuropatia, foi obtida uma sensibilidade de 97,62% e uma especificidade de 47,41%. Utilizando-se uma pontuação maior ou igual a 6 na autoavaliação para o diagnóstico de neuropatia, foi obtida uma sensibilidade de 50,00% e uma especificidade de 94,83%. Conclusão: a associação do exame físico de Michigan (alta sensibilidade) com a autoavaliação (alta especificidade) tem melhor acurácia para o diagnóstico de neuropatia diabética.

Ineffective peripheral tissue perfusion in patients with diabetic foot: a mid-range theory / Perfusión de tejido periférico ineficaz en pacientes con pie diabético: una teoría de rango medio / Perfusão tissular periférica ineficaz em pacientes com pé diabético: uma teoria de médio alcance

ABSTRACT Objective: to develop a mid-range theory for nursing diagnosis ineffective peripheral tissue perfusion in patients with diabetic foot. Method: the theory construction was carried out in six stages: approach definition; theoretical-conceptual model definition; definition of the main concepts; pictogram development; construction of propositions and establishment of causal relationships evidence for practice. Results: twelve etiological factors and 22 clinical indicators were included in the theory, some of which were not listed in NANDA International (Inc.) and others were adapted to better characterize patients with diabetic foot. A pictogram was constructed and eight propositions were established to verify causal relationships and evidence for practice. Conclusion: medium-range theory made it possible to broaden the concepts and demonstrate the causal relationships between the elements of ineffective peripheral tissue perfusion, providing subsidies to minimize gaps in knowledge and assist clinical nursing practice.

RESUMEN Objetivo: desarrollar una teoría de rango medio para el diagnóstico de enfermería de la perfusión tisular periférica ineficaz en pacientes con pie diabético. Método: la construcción de la teoría se realizó en seis etapas: definición del enfoque; definición del modelo teórico-conceptual; definición de los principales conceptos; desarrollo de pictogramas; construcción de proposiciones y establecimiento de relaciones causales basadas en evidencia para la práctica. Resultados: se incluyeron en la teoría 12 factores etiológicos y 22 indicadores clínicos, algunos de los cuales no estaban incluidos en NANDA International (Inc.) y otros se adaptaron para caracterizar mejor a los pacientes con pie diabético. Se construyó un pictograma y se establecieron ocho proposiciones para verificar las relaciones causales y la evidencia de la práctica. Conclusión: la teoría de rango medio permitió ampliar los conceptos y demostrar las relaciones causales entre los elementos del diagnóstico de perfusión tisular periférica ineficaz, brindando subsidios para minimizar las brechas en el conocimiento y ayudar a la práctica clínica de la enfermería.

RESUMO Objetivo: desenvolver uma teoria de médio alcance para o diagnóstico de enfermagem perfusão tissular periférica ineficaz em pacientes com pé diabético. Método: a construção da teoria foi realizada em seis etapas: definição da abordagem; definição do modelo teórico-conceitual; definição dos conceitos principais; desenvolvimento de pictograma; construção das proposições e estabelecimento das relações de causalidade evidências para a prática. Resultados: foram incluídos na teoria 12 fatores etiológicos e 22 indicadores clínicos, alguns destes não estavam listados na NANDA Internacional (Inc.) e outros foram adaptados para melhor caracterização dos pacientes com pé diabético. Construiu-se um pictograma e foram estabelecidas oito proposições para verificar as relações causais e evidências para a prática. Conclusão: a teoria de médio alcance possibilitou ampliar os conceitos e demonstrar as relações causais entre os elementos do diagnóstico perfusão tissular periférica ineficaz, fornecendo subsídios para minimizar as lacunas no conhecimento e auxiliar a prática clínica da enfermagem.

Effect on influence of continuous closed negative pressure drainage on serum IGF1 and NO in patients with diabetic feet / 国际检验医学杂志

Objective To observe the clinical effect of continuous vacuum sealing drainage (VSD) in trea-ting diabetic foot and its influence on the expression of serum insulin-like growth factor(IGF1) and nitric ox-ide(NO) .Methods Sixty-eight cases of diabetic foot in this hospital from June 2014 to December 2015 served as the research subjects and randomly divided into the control group and observation group .The control group took the common wound dressing treatment ,while the observation group adopted the VSD treatment ;the clin-ical efficacies after three courses of treatment were compared between the two groups .The treatment time , number of dressing change and wound healing time in the two groups were performed the statistics .The data after completely statistics were performed the contrastive analysis ;glycosylated hemoglobin (HbA1c) ,IGF1 and NO expression levels before and after treatment were compared between the two groups .The correlation between clinical effect with the levels of IGF1 ,NO and HbA1c was analyzed .Results The clinical cure rate of the observation group was 52 .94％ ,the total effective rate was 94 .12％ ,the clinical cure rate of the control group was 35 .29％ ,the total effective rate was 67 .65％ ,and the results of curative effect evaluation in the ob-servation group was better than that of the control group ,the difference was statistically significant ( P<0 .05) .The observation group was significantly better than the control group in the treatment time ,dressing change frequency and wound healing time ,the difference was statistically significant (P<0 .05) .After three courses of treatment ,the average expression level of IGF1 and NO in the observation group were higher than those in the control group ,the difference was statistically significant (P<0 .05) .There was a negative correla-tion between the curative effect and the level of serum IGF1 and NO (r= -0 .997 ,-0 .923 ,P< 0 .05) ,and there was a positive correlation between the curative effect with the HbA 1c level(r=0 .816 ,P<0 .05) .Conclu-sion VSD has an ideal effect in the treatment of diabetic feet ,can effectively shorten the treatment time ,and has the recovery of serum IGF1 and NO expression level .

Pé diabético, uma avaliação sistematizada / Diabetic foot – a systematic examination

O objetivo deste trabalho é descrever o processo de avaliação dos pés de portadores de diabetes mellitus, classificando-os quanto ao grau de risco para o desenvolvimento de úlceras. O estudo foi realizado em um Ambulatório de Hospital Universitário e em duas Unidades Básicas de Saúde de pequenos municípios situados na região norte do estado do Paraná. Trata-se de um estudo descritivo exploratório cuja amostra se constituiu de 228 indivíduos. Os dados foram coletados por meio de um instrumento que registrou a identificação dos participantes, informações sobre a doença e suas complicações e os resultados do exame dos pés, destacando aspectos ortopédicos, dermatológicos e neurovasculares. Dentre a população estudada, 79,5% dos indivíduos apresentaram grau de risco 0, 12% grau de risco 1 e 8,5% grau de risco 2 para o desenvolvimento de úlceras nos pés, segundo classificação do Ministério da Saúde, 2001.

The objective of this study is to describe the process of evaluating the foot of diabetic patients, classifying them according to the degree of risk for the development of ulcers. The study was conducted in a university hospital and two Basic Health Units of small municipalities in northern Paraná State. This is a descriptive study in which the sample consisted of 228 individuals. Data were collected using an instrument that included the identity of the participants, information about the disease and its complications and results of examination of the feet, emphasizing orthopedic, dermatologic and neuro-vascular factors. Results showed that 79.5% of patients had 0, 12% risk level 1 and 8.5% had risk level 2 for developing foot ulcers, according to the classification of the Ministry of Health, 2001.

Efficacy of Ginseng and Aconiti Praeparatae Injection in Combination with Prostaglandin E_1 for Diabetic Feet:Observation of 40 Cases / 中国药房

OBJECTIVE:To observe the curative efficacy of Ginseng and aconiti praeparatae injection in combination with prostaglandin E1 for diabetic feet.METHODS:A total of 40 patients with diabetic feet were randomized to receive Ginseng and aconiti praeparatae injection in combination with prostaglandin E1 plus basic therapy(treatment group)or to receive prostagla-ndin E1 plus basic therapy(control group).The cure rate of the ulcer of the diabetic feet,the vascular ultrasonography and blood coagulation indexes in two groups before and after treatment were evaluated.RESULTS:There were significant differences between the treatment group and the control group in total response rate(90.0% vs.60.0%)(P

Clinical research of early stage of diabetic feet with TCM internal and external / 中华中医药杂志

Objective:To observe the clinical efficacy of Jianpiqinghua Particles and Wentong Powder on early stage of diabetic feet adding to basal treatment,and to establish a standardized clinical diabetic foot prevention program of integrated traditional Chinese medicine.Methods:Take a randomized blind placebo-controlled add-on trial:The treatment group of 20 was given with Jianpiqinghua Particle(oral),Wentong Powder(foot washing),the control group of 20 was given placebo by same methods.The course in both groups was16 weeks.The change of total effect body and foot feeling(VAS scale),electro-neurophysiological examination and ankle/brachial ratio were evaluated.Results:The TCM group was superior to the control group in improving the body and feet clinical symptoms,nerve conduction velocity,evoked potential amplitude and the ABI index(P