Práticas de autocuidado com os pés realizadas por homens com diabetes mellitus / Foot self-care practices performed by men with diabetes mellitus

Identificar o conhecimento e as formas de adesão as práticas de autocuidado com os pés por homens com diabetes mellitus. Método: Pesquisa do tipo exploratória, descritiva com abordagem qualitativa, realizada em duas unidades de atenção primária e uma unidade de atenção secundária do município de Fortaleza-CE. recebeu aprovação do Comitê de Ética em Pesquisa da UNIFOR de n. 5.100.589. Resultados: Dentro do universo de homens com diabetes foram entrevistados 26 homens na faixa etária de 45 a 81 anos, predominando-se aqueles com 48 a 69 de idade (84,6%), a escolaridade variou do analfabeto a ensino superior completo, sendo em sua maioria com fundamental incompleto (42,3%). Conclusão: Percebeu-se que os pacientes com maior nível de conhecimento apresentaram mais chances de praticar o autocuidado. Entretanto, notou-se que os déficits mesmo quando são isolados, podem oferecer o mesmo potencial de risco.(AU)

To identify the knowledge and forms of adherence to foot self-care practices by men with diabetes mellitus. Method: This is an exploratory, descriptive study with a qualitative approach, carried out in two primary care units and one secondary care unit in the city of Fortaleza-CE. The study received approval from the UNIFOR Research Ethics Committee (n. 5.100.589). Results: Within the universe of men with diabetes, 26 men aged between 45 and 81 were interviewed, with a predominance of those aged between 48 and 69 (84.6%). The level of education ranged from illiterate to complete higher education, with the majority having incomplete primary education (42.3%). Conclusion: Patients with a higher level of knowledge were more likely to practice self-care. However, it was noted that deficits, even when isolated, can offer the same risk potential.(AU)

Identificar el conocimiento y las formas de adherencia a las prácticas de autocuidado de los pies por hombres con diabetes mellitus. Método: Se trata de un estudio exploratorio, descriptivo, con abordaje cualitativo, realizado en dos unidades de atención primaria y una unidad de atención secundaria de la ciudad de Fortaleza, Ceará. El estudio recibió aprobación del Comité de Ética en Investigación de la UNIFOR (n. 5.100.589). Resultados: Dentro del universo de hombres con diabetes, fueron entrevistados 26 hombres con edades comprendidas entre 45 y 81 años, predominando los de edades comprendidas entre 48 y 69 años (84,6%), su nivel de escolaridad osciló entre analfabetos y estudios superiores completos, siendo la mayoría con estudios primarios incompletos (42,3%). Conclusión: Los pacientes con un mayor nivel de conocimientos eran más propensos a practicar el autocuidado. Sin embargo, se observó que los déficits, incluso aislados, pueden ofrecer el mismo potencial de riesgo.(AU)

Complicaciones vasculares en pacientes diabéticos con hemoglobina glicosilada alterada internados en el Centro Médico Nacional - Hospital Nacional periodo 2022 - 2023 / Vascular complications in diabetic patients with altered glycated hemoglobin admitted to Centro Médico Nacional - Hospital Nacional period 2022 ­ 2023

Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

Ankle-foot orthosis in patients with Duchenne muscular dystrophy: a retrospective study / Órtese tornozelo-pé em pacientes com distrofia muscular de Duchenne: um estudo retrospectivo

Abstract Introduction: Duchenne muscular dystrophy (DMD) is a recessive genetic disease linked to the X chromosome, leading to progressive muscle tissue loss. Initially, there is difficulty getting up from the floor and an increased frequency of falls. Maintaining ambulation as long as possible is essential, and the use of ankle-foot orthosis (AFO) has been investigated as an ally in this process. Objective: To verify the prescription and use of an AFO for ambulant boys with DMD. Methods: Information was collected using the medical records of 181 patients with DMD from the Neuropediatric Service of the Instituto de Puericultura e Pediatria Martagão Gesteira of the Universidade Federal do Rio de Janeiro. Variables used were: age at the first medical appointment, age at first symptoms, age at loss of independent gait, time between the first symptoms and loss of gait, prescription of orthosis, time of use, and surgical intervention in the lower limbs. Results: The orthosis was prescribed for 63.5% of patients and used by 38.1%. The range of orthosis time was 2 to 4 years (62.3%). The night sleep period was the most prescribed for orthosis use, with 67.2%. Patients who used the orthosis for a longer time were older at gait loss. However, the children who arrived earlier for the first appointment had a higher frequency of orthosis prescriptions and later loss of gait. Conclusion: The use of AFO can help maintain ambulation for longer in boys with DMD.

Resumo Introdução: A distrofia muscular de Duchenne (DMD) é uma doença genética recessiva ligada ao cromossomo X, que cursa com a perda progressiva do tecido muscular. Inicialmente, observa-se dificuldade para levantar do chão e aumento dafrequência de quedas. A manutenção da deambulação pelo maior tempo possível é importante e o uso de órtese tornozelo-pé (OTP) tem sido investigado como aliado nesse processo. Objetivo: Verificar a prescrição e uso de OTP para meninos deambulantes com DMD. Métodos: As informações foram coletadas dos prontuários de 181 pacientes com DMD do Serviço de Neuropediatria do Instituto de Puericultura e Pediatria Martagão Gesteira, da Universidade Federal do Rio de Janeiro. As variáveis utilizadas foram: idade na primeira consulta, idade aos primeiros sintomas, idade na perda da marcha independente, tempo entre os primeiros sintomas e a perda da marcha, prescrição de órtese, tempo de uso e intervenção cirúrgica nos membros inferiores. Resultados: A órtese foi prescrita para 63,5% dos pacientes e utilizada por 38,1%. A variação do tempo de uso foi de 2 a 4 anos (62,3%). O período noturno foi o mais prescrito para uso da órtese, com 67,2%. Os pacientes que a usaram por mais tempo apresentaram maiores idades na perda da marcha. Crianças que chegaram mais precocemente à primeira consulta tiveram maior frequência de prescrição de órtese e perda da marcha mais tardiamente. Conclusão: O uso de OTP pode ajudar a manter a deambulação por mais tempo em meninos com DMD.

Running intralimb coordination patterns after a foot core exercise program in recreational runners

This study investigated the effects of a foot core intervention on the coordination of foot joints in recreational runners. This was a secondary analysis from a randomized controlled trial conducted with 87 recreational runners allocated to the control group (CG), which followed a placebo lower limb stretching protocol, or the intervention group (IG), which underwent an 8-week (3 times/week) foot core training. The participants ran on a force-instrumented treadmill at a self-selected speed (9.5-10.5 km/h) while the foot segment motion was captured. The vector coding technique was used to assess inter-joint coordination for four selected coupled segment and joint angles. The coordination patterns of the calcaneus and midfoot (CalMid) and midfoot and metatarsus (MidMet) joint pairs were affected. In the frontal plane, IG showed an in-phase with proximal dominancy coordination at heel strike, with a decrease in its frequency after the training (P=0.018), suggesting a longer foot supination. Additionally, IG showed an anti-phase with distal dominancy pattern at early stance compared to CG due to a smaller but earlier inversion of the CalMid-MidMet pair (P=0.020). The intervention also had an effect on the transverse plane of the CalMid-MidMet pair, with IG showing a significantly greater frequency of anti-phase coordination with proximal dominancy during propulsion than CG (P=0.013), probably due to a reduction in the CalMid abduction. Overall, the results suggested that the foot core intervention reduces the occurrence of running-related injuries by increasing the resistance to calcaneus pronation and building a more rigid and efficient lever during push-off.

Pé diabético: o cuidado de enfermeiras / Diabetic foot: nurses' care / Pie diabético: cuidados de enfermeira

Objetivo: Descrever o cuidado para prevenção do pé diabético realizado por enfermeiras. Método:revisão integrativa da literatura a partir do levantamento realizado em janeiro de 2024 através da biblioteca virtual da PubMed. Foram incluídos artigos nos idiomas inglês e português, artigos originais relacionados ao tema e disponíveis na íntegra com acesso gratuito, publicados entre os anos de 2012 até o ano de 2024. Como critérios de exclusão: artigos que não atendam o objeto de estudo, duplicados, teses, livros, revisões e artigos não originais.Resultados:O levantamento resultou na seleção de 15 artigos que evidenciaram que o cuidado para prevenção do pé diabético se desenvolvem a partir da atuação do enfermeiro, e por meio da aplicação de cuidados, como avaliação do paciente, educação em saúde para os pacientes e a educação permanente para os profissionais de saúde, controle glicêmico, verificação do Índice tibial braquial-ITB para diagnóstico de doença arterial obstrutiva periférica (DAOP), uso de termometria cutânea ou imagem infravermelha, criação de software e exames laboratoriais. Conclusão:O estudo poderá contribuir para melhoria da qualidade de vida dos pacientes diabéticos através do conhecimento dos profissionais de enfermagem acerca dos cuidados elencados para melhor atender aos pacientes bem como contribuir com a diminuição de casos de úlceras em pé diabético.

Objective: To describe the care to prevent diabetic foot provided by nurses. Method:integrative literature review based on the survey carried out in January 2024 through the PubMed virtual library. Articles in English and Portuguese were included, original articles related to the topic and available in full with free access, published between 2012 and 2024. Exclusion criteria were: articles that do not meet the object of study, duplicates, theses, books, reviews and non-original articles. Results:The survey resultedin the selection of 15 articles that showed that care to prevent diabetic foot develops from the role of nurses, and through the application of care, such as patient assessment, health education for patients and continuing education for health professionals, glycemic control, verification of the brachial tibial index-ABI for diagnosing peripheral arterial obstructive disease (PAOD), use of skin thermometry or infrared imaging, creation of software and laboratory tests. Conclusion:The study may contribute to improving the quality of life of diabetic patients through the knowledge of nursing professionals about the care provided to better serve patients as well as contributing to the reduction of cases of diabetic foot ulcers.

Objetivo: Describir los cuidados para la prevención del pie diabético brindados por enfermeras. Método:revisión integrativa de la literatura a partir de la encuesta realizada en enero de 2024 a través de la biblioteca virtual PubMed. Se incluyeron artículos en inglés y portugués, artículos originales relacionados con el tema y disponibles íntegramente con acceso gratuito, publicados entre 2012 y 2024. Los criterios de exclusión fueron: artículos que no cumplan con el objeto de estudio, duplicados, tesis, libros, reseñas y artículos no originales. Resultados:La encuesta resultó en la selección de 15 artículos que mostraron que los cuidados para prevenir el pie diabético se desarrollan desde el rol del enfermero, y a través de la aplicación de cuidados, como la evaluación del paciente, la educación en salud de los pacientes y la educación continua de los profesionales de la salud, la glucemia. control, verificación del índice braquial tibial-ITB para el diagnóstico de enfermedad arterial obstructiva periférica (EAP), uso de termometría cutánea o imágenes infrarrojas, creación de software y pruebas de laboratorio. Conclusión:El estudio puede contribuir a mejorar la calidad de vida de los pacientes diabéticos a través del conocimiento de los profesionales de enfermería sobre los cuidados brindados para atender mejor a los pacientes, así como contribuir a la reducción de casos de úlceras del pie diabético.

Efficacy of current vaccines against recently isolated foot and mouth disease virus type A South America (Venezuela) in Egypt 2022

Foot and mouth disease is a highly contagious viral disease that poses a significant economic threat to cloven-hoofed animals, including cattle and sheep. The emergence of a novel foot and mouth disease virus-A isolate, FMDV-A-Egy-AHRI-RL385-Ven-2022, in Egypt in 2022 has raised concerns about its potential impact on existing vaccination programs. Given that vaccination is a key strategy for foot and mouth disease virus control, the present study was aimed to assess the cross-protective efficacy of both local and imported inactivated vaccines against this new threat. Through challenge experiments and serum neutralization tests, we observed limited effectiveness of both vaccine types. The calculated r1-values at 28 days post-vaccination indicated a minimal immune response to FMDV-A-Egy-AHRI-RL385-Ven-2022 (0.176 and 0.175 for local and imported vaccines, respectively). Challenge experiments further confirmed these findings, revealing 0percent protection from the local vaccine and only 20percent rotection from imported vaccines by day 7 post-challenge. These results underscore the urgent need to update existing foot and mouth disease virus vaccines in Egypt by incorporating the newly circulating FMDV-A-Egy-AHRI-RL385-Ven-2022 strain. This proactive measure is crucial to prevent future outbreaks and ensure effective disease control(AU)

La fiebre aftosa es una enfermedad vírica muy contagiosa que supone una importante amenaza económica para los animales biungulados, entre ellos el ganado vacuno y ovino. La aparición de un nuevo aislado del virus A de la fiebre aftosa, el FMDV-A-Egy-AHRI-RL385-Ven-2022, en Egipto en 2022 ha suscitado preocupación por su posible impacto en los programas de vacunación existentes. Dado que la vacunación es una estrategia clave para el control del virus de la fiebre aftosa, el objetivo del presente estudio fue evaluar la eficacia protectora cruzada de las vacunas inactivadas locales e importadas frente a esta nueva amenaza. Mediante experimentos de desafío y pruebas de seroneutralización, observamos una eficacia limitada de ambos tipos de vacuna. Los valores r1 calculados a los 28 días posvacunación indicaron una respuesta inmunitaria mínima frente a FMDV-A-Egy-AHRI-RL385-Ven-2022 (0,176 y 0,175 para las vacunas local e importada, respectivamente). Los experimentos de provocación confirmaron aún más estos resultados, revelando un 0 por ciento de protección de la vacuna local y sólo un 20 por ciento de protección de las vacunas importadas al séptimo día después de la provocación. Estos resultados subrayan la urgente necesidad de actualizar las vacunas existentes contra el virus de la fiebre aftosa en Egipto incorporando la nueva cepa circulante FMDV-A-Egy-AHRI-RL385-Ven-2022. Esta medida proactiva es crucial para prevenir futuros brotes y garantizar un control eficaz de la enfermedad(AU)

Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

Duplex ultrasound and pedal acceleration time as tools to evaluate foot perfusion: a literature review / Ultrassonografia dúplex e tempo de aceleração plantar como ferramentas para avaliar a perfusão do pé: uma revisão da literatura

Abstract Currently, the standard non-invasive test for diagnosing Peripheral Arterial Disease is the Ankle-Brachial Index. However, this test becomes unfeasible in a certain population. New evidence proposes the pedal acceleration time, an ultrasound index, as an alternative test. An integrative bibliographic review was carried out between June 3, 2022 and January 8, 2023, to investigate this new index as a tool to assess foot perfusion. Papers published in English, Portuguese, or Spanish between 2012 and 2022 were searched on PubMed, Google Scholar, and Scielo, using the keywords "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Research that didn't assess foot perfusion using the methods of interest or did not present human data and also case series or reports were excluded. Seven out of the sixty-six articles identified in the searches were selected for the review, all of which had notable methodological limitations. Pedal acceleration time seems to be able to diagnose and stratify and may reflect prognosis.

Resumo Atualmente, o teste não invasivo padrão para diagnosticar a doença arterial periférica é o índice tornozelo-braquial, porém, em uma determinada população, este torna-se inviável. Novas evidências propõem o tempo de aceleração plantar, que é um índice ultrassonográfico, como alternativa. Para investigá-lo no contexto do estudo da perfusão do pé, uma revisão bibliográfica integrativa foi realizada entre 03/06/2022 e 08/01/2023. Artigos em inglês, português ou espanhol, publicados entre 2012 e 2022 foram pesquisados através das ferramentas PubMed, Google Scholar e SciELO, com as palavras-chave "Peripheral Arterial Disease" AND "Acceleration Time" AND (Pedal OR Plantar). Pesquisas que não avaliaram a perfusão do pé pelos métodos de interesse, sem dados em humanos e relatos ou séries de casos, foram excluídos. Dos 66 artigos, 7 foram selecionados; todos com notáveis limitações metodológicas. O tempo de aceleração plantar aparenta ser capaz de diagnosticar, estratificar e prognosticar os doentes.

Is ankle taping effective to limit the ankle dorsiflexion in a single-training session? An observational study in semi-professional basketball players

ABSTRACT BACKGROUND: Ankle taping (AT) is effective in preventing ankle sprain injuries in most common sports and is employed in rehabilitation and prevention sports. OBJECTIVE: This study aimed to investigate the effectiveness of AT to restricting excessive frontal plane ankle movements in semi-professional basketball players throughout the training session. DESIGN AND SETTING: A cross-sectional study was performed at the Universidad Europea de Madrid. METHODS: Forty male and female semi-professional basketball players were divided into two groups. The ankle dorsiflexion range of motion (ROM) and interlimb asymmetries in a weight-bearing lunge position were evaluated at four time points: 1) with no tape, 2) before practice, at 30 min of practice, and 3) immediately after practice. RESULTS: In male basketball players, no differences were observed in the right and left ankles between the baseline and 30 min and between baseline and 90 min of assessment. In female athletes, significant differences were reported between baseline and pre-training assessments for the right ankle and also significant differences between baseline and 90 min in both ankles. CONCLUSIONS: Ankle taping effectively decreased the ankle dorsiflexion ROM in male and female basketball players immediately after application. However, ROM restriction was very low after 30 and 90 min, as assessed in a single basketball practice. Therefore, the classic taping method should be revised to develop new prophylactic approaches, such as the implementation of semi-rigid bracing techniques or the addition of active stripes during training or game pauses.

Costos directos en el tratamiento del pie diabético Unidad de Pie Diabético. Hospital de Clínicas. Universidad de la República

En el mundo un paciente diabético gasta entre dos y tres veces más que el no diabético. El pie diabético disminuye la calidad de vida, aumenta la morbimortalidad y la carga económica del sistema de salud. Objetivo: comunicar la investigación realizada sobre costos directos en el tratamiento de la úlcera del pie diabético. Material y método: estudio observacional, descriptivo, retrospectivo de pacientes asistidos en la Unidad de Pie del Hospital de Clínicas, Universidad de la República, entre octubre de 2014 y septiembre de 2016. Se estimaron gastos directos del tratamiento ambulatorio e internación a través de información de la historia clínica. El horizonte de tratamiento fue de tres meses. Se calcularon los gastos en unidades reajustables (UR), pesos y dólares. Los gastos se actualizaron a octubre del 2022 utilizando el índice de precios al consumo (IPC), ajustado a la tasa de inflación acumulada. Resultados: incluimos 49 pacientes, 11 mujeres y 38 hombres, edad promedio 61,5 años. El gasto general fue mayor a 400.000 dólares, con el mayor costo en gastos de internación. El gasto total promedio por paciente fue de 8.799 dólares. El tratamiento convencional fue 3.707,93 dólares, la amputación mayor 32.003,61 dólares y amputación menor 12.385,34 dólares. El gasto en internación fue muy superior al del paciente ambulatorio. En emergencia, 28 pacientes gastaron 4.396 dólares. El incremento de costos al año 2022 fue de 37,45%, suponiendo un gasto general de 16.682.993,4 pesos o 410.830,2 dólares. Conclusión: primera evaluación en nuestro país de estimación de gastos en pie diabético. El costo de la úlcera genera una carga económica notoria y en aumento. La gravedad inicial de la úlcera determina ingresos con elevados costes. Los gastos de internación y amputaciones representan la mayor erogación económica.

On a global scale, a diabetic patient incurs healthcare expenses that are 2 to 3 times higher than those of a non-diabetic individual. Diabetic foot syndrome reduces the quality of life, increases morbidity and mortality, and places an economic burden on the healthcare system. Objective: Communicating the research conducted on direct costs in the treatment of diabetic foot ulcers. Method: Observational, descriptive, retrospective study of patients treated at the Foot Unit of the Hospital de Clínicas (UDELAR) between October 2014 and September 2016. Direct treatment costs for outpatient care and hospitalization were estimated using information from the medical records. The treatment horizon extended over a period of 3 months. Expenses were calculated in readjustable units, Uruguayan pesos (UYU), and United States dollars (USD). Expenses were updated to October 2022 using the Consumer Price Index (IPC) adjusted for the cumulative inflation rate. Results: 49 patients were included in the study: 11 women and 38 men, average age was 61.5 years old. The overall expenditure exceeded 400,000 USD, with the highest cost attributed to hospitalization expenses. The average total expenditure per patient amounted to 8,799 USD. The cost of conventional treatment was 3,707.93 USD, major amputation represented USD 32,003.61, and minor amputation USD 12,385.34. Hospitalization expenses significantly exceeded those of outpatient care. In the emergency department, 28 patients spent USD 4,396. The increase in costs by the year 2022 amounted to 37.45%, resulting in a total expenditure of UYU 16,682,993.4 (Uruguayan pesos) or USD 410,830.2. Conclusions: It was the first assessment in our country to estimate diabetic foot costs. The cost of ulcer management imposes a significant and increasing economic burden. The initial severity of the ulcer results in hospitalization which implies high associated costs. Hospitalization and amputation costs constitute the most substantial economic expenditure.

Em todo o mundo, um paciente diabético gasta entre 2 e 3 vezes mais do que um paciente não diabético. O pé diabético reduz a qualidade de vida, aumenta a morbimortalidade e a carga económica no sistema de saúde. Objetivos: Comunicar os resultados da pesquisa realizada sobre os custos diretos no tratamento das úlceras do pé diabético. Materiais e métodos: Estudo observacional, descritivo e retrospectivo de pacientes atendidos na Unidade de Pie do Hospital de Clínicas (UDELAR), entre outubro de 2014 e setembro de 2016. Foram estimados gastos diretos com tratamento ambulatorial e internação, por meio de informações do prontuário do paciente. O período de tratamento estudado foi de 3 meses. As despesas foram calculadas em Unidades Ajustáveis, em pesos uruguaios (UYU) e em dólares norte-americanos (USD). As despesas foram atualizadas para outubro de 2022 pelo Índice de Preços ao Consumidor (IPC) ajustado à inflação acumulada. Resultados: Foram incluídos 49 pacientes: 11 mulheres e 38 homens com idade média de 61,5 anos. A despesa global foi superior a US$ 400.000, com o maior custo em despesas de hospitalização. A despesa total média por paciente foi de US$ 8.799. Os custos por tratamento foram: Tratamento convencional US$ 3.707,93 USD, amputação maior US$ 32.003,61 e amputação menor US$ 12.385,34. O gasto com internação foi muito superior ao do ambulatório. No atendimento de emergência 28 pacientes gastaram US$ 4.396. O aumento dos custos até 2022 foi de 37,45%, assumindo uma despesa geral de UY$ 16.682.993,4 ou US$ 410.830,2 USD. Conclusão: Esta é a primeira avaliação de estimativa de gastos com pé diabético realizada no Uruguai. O custo das úlceras gera uma carga económica notável e crescente. A gravidade inicial da úlcera determina internações com custos elevados. As despesas com hospitalização e amputação representam o maior gasto financeiro.

Efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética: revisión sistemática y metaanálisis / Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis / Efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética: revisão sistemática e metanálise

Objetivo: analizar los efectos de las tecnologías educativas en la prevención y tratamiento de la úlcera diabética. Método: revisión sistemática realizada en siete bases de datos, un índice bibliográfico, una biblioteca electrónica y literatura gris. La muestra estuvo compuesta por 11 ensayos clínicos controlados aleatorizados. La síntesis de los resultados fue descriptiva y mediante metaanálisis. Resultados: las tecnologías educativas predominantes fueron la capacitación y la orientación verbal, se destacaron las tecnologías blandas-duras. En comparación con la atención habitual, las tecnologías educativas demostraron ser un factor protector para prevenir la incidencia de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) y la evaluación de certeza de evidencia fue baja. Las tecnologías educativas también demostraron ser un factor protector para prevenir la incidencia de amputación en miembros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) y la certeza de evidencia fue muy baja. Conclusión: tecnologías educativas blandas-duras, como orientación verbal estructurada, juegos educativos, clase expositiva, capacitación teórico-práctica, video educativo, folder, rotafolio educativo y dibujos lúdicos, y tecnologías duras, como calzado terapéutico, plantillas, termómetro infrarrojo digital, kits para el cuidado de los pies, aplicación de telemedicina y teléfono móvil, resultaron efectivas para la prevención y el tratamiento de la úlcera diabética, sin embargo, es necesario que se realicen estudios más robustos.

Objective: to analyze the effects of educational technologies in the prevention and treatment of diabetic ulcers. Method: a systematic review conducted in seven databases, a bibliographic index, an electronic library and the Gray Literature. The sample consisted of 11 randomized controlled clinical trials. The synthesis of the results was descriptive and through meta-analysis. Results: the predominant educational technologies were training sessions and verbal guidelines, with soft-hard technologies standing out. When compared to usual care, the educational technologies presented a protective factor to prevent the incidence of diabetic ulcers (RR=0.40; 95% CI=0.18-0.90; p=0.03) and the certainty of the evidence assessment was low. The educational technologies also had a protective factor to prevent the incidence of lower limb amputations (RR=0.53; 95% CI=0.31-0.90; p=0.02) and certainty of the evidence was very low. Conclusion: soft-hard educational technologies such as structured verbal guidelines, educational games, lectures, theoretical-practical training sessions, educational videos, folders, serial albums and playful drawings, and hard technologies such as therapeutic footwear, insoles, infrared digital thermometer, foot care kits, Telemedicine app and mobile phone use, were effective for the prevention and treatment of diabetic ulcers, although more robust studies are required.

Objetivo: analisar os efeitos das tecnologias educativas na prevenção e tratamento da úlcera diabética. Método: revisão sistemática conduzida em sete bases de dados, um índice bibliográfico, uma biblioteca eletrônica e na literatura cinzenta. A amostra foi constituída de 11 ensaios clínicos controlados randomizados. A síntese dos resultados foi descritiva e por meio de metanálise. Resultados: as tecnologias educativas predominantes foram os treinamentos e as orientações verbais, destacando-se as tecnologias leve-duras. Na comparação com o cuidado usual, as tecnologias educativas apresentaram fator de proteção para prevenção da incidência de úlcera diabética (RR=0,40; IC 95%=0,18-0,90; p=0,03) e a avaliação de certeza da evidência foi baixa. As tecnologias educativas também tiveram fator de proteção para prevenção da incidência de amputação em membros inferiores (RR=0,53; IC 95%=0,31-0,90; p=0,02) e a certeza da evidência foi muito baixa. Conclusão: as tecnologias educativas leve-duras, como orientações verbais estruturadas, jogos educativos, aula expositiva, treinamentos teórico-práticos, vídeo educativo, folder, álbum seriado e desenhos lúdicos, e as tecnologias duras, a exemplo do calçado terapêutico, palmilhas, termômetro digital de infravermelho, kits de cuidados com os pés, aplicativo de telemedicina e telefone móvel, foram efetivas para prevenção e tratamento da úlcera diabética, porém, estudos mais robustos são necessários.

El efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis: un estudio de metaanálisis / The effect of foot reflexology on fatigue in hemodialysis patients: a meta-analysis study / O efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise: um estudo de metanálise

Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.

Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.

Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.

Diagnóstico prenatal, síndrome Freeman-Sheldon mediante ultrasonido y estudio genético. Reporte de caso / Prenatal diagnosis of Freeman-Sheldon syndrome using ultrasound and genetic testing. Case report

Objetivos: Describir un caso de diagnóstico prenatal de síndrome de Freeman-Sheldon mediante hallazgos ecográficos y secuenciación completa del exoma fetal. Materiales y métodos: Mujer de 33 años, con antecedentes de hipotiroidismo en tratamiento, a quien en semana 19 se realizó ecografía de detalle anatómico, en la cual se observaron deformidades en el feto en más de dos áreas corporales (extremidades superiores e inferiores), sugiriendo el diagnóstico de artrogriposis. Posteriormente, se brindó asesoría genética y se realizó amniocentesis en semana 20 de gestación, con análisis de la hibridación in situ por fluorescencia, seguido de secuenciación completa del exoma fetal. Este último examen permitió identificar una variante patogénica heterocigota en el gen MYH3, la cual se asocia con la artrogriposis distal tipo 2A. Conclusiones: La realización de la secuenciación completa de exoma fetal es un factor clave para identificar la mutación del gen MYH3, y confirma que las deformidades evidenciadas por ultrasonido estaban relacionadas con la artrogriposis distal tipo 2A. Es importante hacer la secuenciación de exoma fetal en fetos que muestren hallazgos de malformaciones articulares en el ultrasonido prenatal.

Objectives: To describe a case of prenatal diagnosis of Freeman-Sheldon syndrome based on ultrasound findings and complete fetal exome sequencing. Materials and methods: A 33-year-old woman currently on treatment for hypothyroidism in whom a 19-week detailed anatomical ultrasound scan showed fetal deformities in more than two body areas (upper and lower limbs), suggesting a diagnosis of arthrogryposis. Genetic counseling was provided and amniocentesis was performed at 20 weeks for fluorescence in situ hybridization (FISH) analysis and complete fetal exome sequencing, with the latter allowing the identification of a heterozygous pathogenic variant of the MYH3 gene which is associated with type 2A distal arthrogryposis. Conclusions: Complete fetal exome sequencing was a key factor in identifying the MYH3 gene mutation and confirmed that the deformities seen on ultrasound were associated with type 2A distal arthrogryposis. It is important to perform complete fetal exome sequencing in cases of joint malformations seen on prenatal ultrasound.

Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Úlceras de pie diabético infectadas con bacterias multirresistentes a los antimicrobianos en pacientes venezolanos / Diabetic Foot Ulcers Infected with Bacteria Multiresistant to Antimicrobials in Venezuelan patients

Introducción: Las úlceras de pie diabético tienen una importante morbimortalidad, más aun, si están asociadas a bacterias multirresistentes a los antimicrobianos. Objetivo: Analizar las características de las úlceras de pie diabético infectadas con bacterias multirresistentes a los antimicrobianos. Métodos: Se realizó una investigación descriptiva, no experimental y transversal, en 87 pacientes con úlceras de pie diabético infectadas, atendidos en una consulta especializada del estado Zulia, Venezuela. Se realizó la anamnesis y exploración física, especialmente centrada en las características de las úlceras de pie diabético. Se obtuvieron muestras de tejido ulceroso para identificar las bacterias presentes y el antimicrobiano correspondiente. Resultados: Todos los pacientes tenían úlcera previa, con agudización de la infección (75,86 por ciento), rehospitalización (59,77 por ciento), amputación previa (36,78 por ciento), úlceras de pie diabético infectadas de larga duración (86,21 por ciento). El 95,40 por ciento recibieron antibióticos previos y 57,62 por ciento habían sido hospitalizados, la antigüedad de la enfermedad fue 16,17 ± 8,41 años y la HbA1c 8,87 ± 1,23. Las úlceras de pie diabético infectadas más frecuente fue neuroisquémica (71,26 por ciento). Predominó la flora monomicrobiana con un (62,07 por ciento) y bacterias gramnegativas (87,36 por ciento). El 79,3 por ciento presentaron bacterias multirresistentes a los antimicrobianos y el 20,69 por ciento panresistencia. Las bacterias multirresistentes fueron predominantemente gramnegativas, y para las grampositivas solo estuvo el Staphylococcus aureus. Conclusiones: Se presenció una alta frecuencia de úlceras de pie diabético infectadas con multirresistencia, predominantemente monomicrobianas y todas con resistencia a betalactámicos y fluoroquinolonas(AU)

Introduction: Diabetic foot ulcers have significant morbidity and mortality, even more so if they are associated with multi-resistant bacteria to antimicrobials. Objective: To analyze the characteristics of diabetic foot ulcers infected with bacteria multi-resistant to antimicrobials. Methods: A descriptive, non-experimental and cross-sectional investigation was carried out in 87 patients with infected diabetic foot ulcers. They were treated in a specialized clinic in Zulia state, Venezuela. Anamnesis and physical examination were performed, especially focused on the characteristics of diabetic foot ulcers. Ulcer tissue samples were obtained to identify the bacteria existing and the corresponding antimicrobial. Results: All the patients had previous ulcer, with exacerbation of the infection (75.86percent), rehospitalization (59.77percent), previous amputation (36.78percent), long-lasting infected diabetic foot ulcers (86.21percent). 95.40percent received previous antibiotics and 57.62percent had been hospitalized, the disease age was 16.17 ± 8.41 years and Hb A1c was 8.87 ± 1.23. The most frequent infected diabetic foot ulcers were neuroischemic (71.26percent). The monomicrobial flora (62.07percent) and gram-negative bacteria (87.36percent) predominated. 79.3percent had multi-resistant bacteria to antimicrobials and 20.69percent pan-resistance. Multi-resistant bacteria were predominantly gram-negative and for gram-positive only staphylococcus aureus. Conclusions: High frequency of multidrug-resistant infected diabetic foot ulcers was found, predominantly monomicrobial and all with resistance to beta-lactams and fluoroquinolones(AU)

Type of Feet in a Mexican Population: Analysis of the Footprint Morphology and Literature Review / Tipos de pies en una Población Mexicana: Análisis de la Morfología de la Huella Plantar y Revisión de la Literatura

ABSTRACT There is no specific age when the vault of the feet is completely formed. The objective of this study was to analyze the footprint morphology and obtain the Chippaux-Smirak Index in a Mexican population to identify the type of feet and its prevalence. A database of images of the soles of both feet was analyzed. The database contained images of 1,014 persons between 2 and 73 years old from Guanajuato state, Mexico. Moreover, a literature review was performed to identify the type of feet in the Mexican population. It was observed that less than 17 % of the population have cavus foot (p= 0.018). Furthermore, less than 25 % of the population between 17 and 73 years have flatfoot 3 (p= 0.0079) in the left foot. Also, only nine articles related to the type of foot in the Mexican population were found, but most of them were performed on young population. The formation of the medial arc could be beyond the first decade of life and the relatively high prevalence of flatfoot in adult life should be studied. Finally, the results found can be useful for orthopedists, physiotherapists, clinicians, and parents who are concerned about the foot health of their children.

RESUMEN No hay una edad específica en la que la bóveda de los pies esté completamente formada. El objetivo de este estudio fue analizar la morfología de la huella de los pies y obtener el Índice de Chippaux-Smirak en una población mexicana para identificar el tipo de pie y su prevalencia. Se analizó una base de datos de imágenes de las plantas de ambos pies. La base de datos contenía imágenes de 1,014 personas de entre 2 y 73 años del estado de Guanajuato, México. Además, se realizó una revisión bibliográfica para identificar el tipo de pie en la población mexicana. Se observó que menos del 17 % de la población tiene pie cavo (p= 0,018). Además, menos del 25 % de la población entre 17 y 73 años tiene pie plano 3 (p= 0,0079) en el pie izquierdo. Además, se encontraron 9 artículos relacionados con el tipo de pie en población mexicana, pero la mayoría de ellos fueron desarrollados en población joven. La formación del arco medial podría estar más allá de la primera década de vida. Se encontró una prevalencia relativamente alta de pie plano en la vida adulta que debe ser estudiada. Finalmente, los resultados encontrados pueden ser útiles para ortopedistas, fisioterapeutas, médicos y padres preocupados por la salud de los pies de sus hijos.

Ozonoterapia como apoyo en el tratamiento de la úlcera del pie diabético. Presentación de un caso

Una de las complicaciones más comunes de la diabetes mellitus es la úlcera del pie diabético, como una fuente importante de morbilidad y mortalidad. Se presenta el caso de una paciente de 43 años, con diagnóstico de diabetes mellitus tipo 2, de siete años de evolución, remitida desde el Cuerpo de Guardia del Policlínico Universitario Dr. Mario Muñoz Monroy, de Abreus, con el diagnóstico de pie diabético neuroinfeccioso complicado con un absceso. Se realizó drenaje del absceso, modificación del tratamiento con insulina y desbridamiento de la lesión. Además, se indicó antibiótico y Heberprot-P®. Ante la ausencia de evolución satisfactoria, se realizó nuevo desbridamiento, con amputación de tercer y cuarto dedos del pie izquierdo; se retomó el tratamiento inicial, eta vez combinado con ozonoterapia vía local y rectal. A partir de la semana 18 la paciente evolucionó favorablemente, con presencia de buena granulación, desaparición gradual del dolor y aceleración del proceso de cicatrización completa de la lesión, además de conseguir un control metabólico eficiente. El caso descrito confirma la eficacia y seguridad del uso combinado del Heberprot-P® y la terapia con ozono.

One of the most common complications of diabetes mellitus is diabetic foot ulcer, as an important source of morbidity and mortality. The case of a 43-years-old patient with a diagnosis of type 2 diabetes mellitus, of seven years of evolution, referred from the Emergency Department of the Dr. Mario Muñoz Monroy University Polyclinic, Abreus, with the diagnosis of neuroinfectious diabetic foot complicated with an abscess is presented. Drainage of the abscess, modification of insulin treatment, and debridement of the lesion were performed. In addition, antibiotics and Heberprot-P® were indicated. In the absence of satisfactory evolution, new debridement was performed, with amputation of the third and fourth toes of the left foot; the initial treatment was resumed, this time combined with local and rectal ozone therapy. From week 18 on, the patient progressed favorably, with the presence of good granulation, gradual disappearance of pain and acceleration of the complete healing process of the lesion, in addition to achieving efficient metabolic control. The described case confirms the efficacy and safety of the Heberprot-P® combined use and ozone therapy.

3D Foot Anthropometric Measurements Under Two Weight- Bearing Conditions for Ergonomic Design of Foot-Related Products / Mediciones Antropométricas del Pie en 3D Bajo Dos Condiciones de Soporte de Peso para el Diseño Ergonómico de Productos Relacionados con los Pies

SUMMARY: This study collected 3D models of the left and right feet from 317 Chinese youth (155 females and 162 males) under half weight-bearing and no weight-bearing conditions. Thirteen dimensions and one angle were taken for each sample. By measuring 13 foot dimensions and 1 angle, this study comprehensively investigated the differences in foot shape between genders and the bilateral differences, as well as the foot shape differences under different conditions. The results showed that regardless of the condition, male foot dimensions were significantly larger than those of females. However, female foot shape was not simply a scaled-down version of male foot shape. On the contrary, the average angle of female feet was greater than that of males under both conditions, indicating a higher prevalence of hallux valgus in females. Both males and females exhibited significant correlation in foot dimensions between the left and right feet, with minimal differences. Under the half weight-bearing condition, the average foot length, width, and circumference were significantly larger than the corresponding measurements under the no weight-bearing condition, while the average height and angle were significantly smaller. Therefore, when designing footwear and foot-related medical rehabilitation aids, it is important to consider foot shape and dimensions under different conditions as a reference. The results of this study provide manufacturers of foot- related products with more detailed data support and are of significant value to the field of medical foot morphology research.

Este estudio recolectó modelos 3D de los pies izquierdo y derecho de 317 jóvenes chinos (155 mujeres y 162 hombres) en condiciones de carga media de peso y sin carga de peso. Para cada muestra se tomaron trece dimensiones y un ángulo. Al medir 13 dimensiones del pie y 1 ángulo, se investigó exhaustivamente las diferencias en la forma del pie entre ambos sexos y sus diferencias bilaterales, así como las diferencias en la forma del pie en diferentes condiciones. Los resultados mostraron que, independientemente de la condición, las dimensiones del pie de los hombres, estos eran significativamente más grandes que los de las mujeres. Sin embargo, la forma del pie femenino no era simplemente una versión reducida de la forma del pie masculino. Por el contrario, el ángulo promedio de los pies de las mujeres fue mayor que el de los hombres en ambas condiciones, lo que indica una mayor prevalencia de hallux valgus en las mujeres. Tanto hombres como mujeres exhibieron una correlación significativa en las dimensiones del pie, entre el pie izquierdo y el derecho, con diferencias mínimas. Bajo la condición de medio soporte de peso, la longitud, el ancho y la circunferencia promedio del pie fueron significativamente mayores que las medidas correspondientes bajo la condición sin soporte de peso, mientras que la altura y el ángulo promedio fueron significativamente más pequeños. Por lo tanto, al diseñar calzado y dispositivos médicos de rehabilitación relacionados con los pies, es importante tener en consideración la forma y las dimensiones del pie en diferentes condiciones como referencia. Los resultados de este estudio, brindan a los fabricantes de productos relacionados con los pies un soporte de datos más detallado y son de gran valor para el campo de la investigación médica de la morfología del pie.

Características clínicas y evolución de pacientes con pie diabético en Argentina: estudio longitudinal multicéntrico / Clinical features and outcomes of diabetic foot in Argen tina: a longitudinal multicenter study

Resumen Introducción : El pie diabético (PD) representa una complicación con elevada morbimortalidad. En Ar gentina, carecemos de datos acerca de tasas de am putación y mortalidad relacionada a esta enfermedad. El objetivo de este estudio fue describir las caracte rísticas de todos los pacientes adultos con diabetes que consultaron por PD durante 3 meses y evaluar su evolución a 6 meses. Métodos : Se realizó un estudio descriptivo longitudi nal con seguimiento a 6 meses. Resultados : Se estudiaron 312 pacientes de 15 cen tros de Argentina. Durante el estudio, el porcentaje de amputación mayor total fue de 8.3% (IC95; 5.5-11.9) (n = 26) y el de amputación menor de 29.17% (IC95%; 24.2-34.6) (n = 91). En el seguimiento a 6 meses, el por centaje de muerte fue de 4.49% (IC95%; 2.5-7.4) (n = 14), el 24.3% (IC95%; 19.6-29.5) presentaba la herida aún abierta (n = 76), el 58.0% (IC95%; 52.3-63.5) (n = 181) cicatrizó y 7.37% se perdió del seguimiento (n = 23). De los pacientes que sufrieron una amputación mayor antes de los 6 meses (n = 24), 5 fallecieron (20.8%) en contraste con el 3% de quienes no se amputaron (p = 0.001). La amputación mayor se relacionó con la edad, el índice tobillo brazo (ITB), la escala de San Elián, la de SINBAD y la clasificación de WIfI, la isquemia y con algunos aspectos de la herida. Discusión : El conocimiento de datos locales permitirá mejorar la toma de decisiones en cuanto a políticas de salud relacionadas a la prevención y el tratamiento de los pacientes con PD.

Abstract Introduction : The diabetic foot (DF) is a complica tion with high rate of morbi-mortality. There are no data about amputation rates and mortality in Argentina related to this disease. The aim of this study was to de scribe clinical features of adult patients with diabetes that consulted for a foot ulcer in a 3 months' period and to evaluate outcomes six months later. Methods : This is a multicenter longitudinal study with six months follow up. Results : Three hundred and twelve patients from 15 health centers in Argentina were analyzed. During the follow up, the rate of major amputation was 8.3% (IC95; 5.5-11.9) (n = 26) and minor amputation 29.17% (IC95%; 24.2-34.6) (n = 91). After six months, the mortality rate was 4.49% (IC95%; 2.5-7.4) (n = 14), and 24.3% (IC95%; 19.6-29.5) remained with open wounds (n = 76) while 58.0% (IC95%; 52.3-66.5) (n = 181) healed and 7.37% be came lost to follow up (n = 23). From those who required a major amputation during the study (n = 24), 5 patients died (20.8%) and in patients without amputation, 3% died (p = 0.001). Major amputation was related to age, ankle brachial index (ABI), Saint Elian score (SEWSS), SINBAD, WIfI classification, ischemia and some aspects of the wound. Discussion : Knowledge about local data will enable better decisions on health policies related to prevention and treatment of diabetic foot patients.

Validación de clasificaciones de pie diabético en Argentina / Validation of diabetic foot classifications in Argentina

Introducción: las clasificaciones de pie diabético (PD) son una herramienta que tienen el objetivo de mejorar la comunicación entre los profesionales, la referencia y contrarreferencia; proporcionar un pronóstico; ayudar en la valoración de las lesiones, y contribuir con fines estadísticos. Objetivos: describir las características de los pacientes que se presentaron al consultorio o a la guardia con un PD durante un período de 3 meses, determinar el riesgo según cinco clasificaciones (Texas, IDSA, San Elián, WIfI y SINBAD) y evaluar su evolución a 6 meses en relación con el grado de gravedad determinada por cada clasificación. Materiales y métodos: se analizaron 312 pacientes de 15 instituciones en Argentina. Para el análisis se utilizó la calculadora de clasificaciones de pie diabético/score de riesgo del Comité de Pie Diabético de la Sociedad Argentina de Diabetes. Resultados: el 43% de los pacientes (n=133) requirió internación al momento de la primera consulta y el 61% (n=189) había consultado previamente. El porcentaje de amputación mayor total fue de 8,33% (IC 95%; 5,5-11,9) (n=26) y el de amputación menor de 29,17% (IC 95%; 24,2-34,6) (n=91). A los 6 meses, el porcentaje de muerte fue de 4,49% (IC 95%; 2,5-7,4) (n=14), el 24,3% (IC 95%;19,6-29,5) presentaba la herida aún abierta (n=76), el 58,0% (IC 95%; 52,3-66,5) (n=181) cicatrizó y el 7,37% se perdió del seguimiento (n=23). Las clasificaciones de San Elián y WIfI se relacionaron con amputación mayor, cicatrización y muerte. En relación a la clasificación de Texas, el 49% de los pacientes presentó herida penetrante a hueso o articulación (Texas 3), con o sin infección. El 65,3% de las amputaciones mayores y el 78,6% de las muertes se produjeron en pacientes con isquemia. El punto de corte de San Elián para amputación mayor fue 20. Conclusiones: conocer los datos locales permite organizar los recursos para mejorar la atención de los pacientes.

Introduction: the classifications of diabetic foot (DF) are a tool that aims to improve communication between professionals, referral and counter-referral, provide a prognosis, help in the assessment of lesions, and contribute to statistical purposes. Objectives: to describe the characteristics of patients who presented to the clinic or emergency department with DF over a period of 3 months, determine the risk according to 5 classifications (Texas, IDSA, SEWSS, WIfI, and SINBAD), and evaluate their evolution at 6 months in relation to the severity degree determined by each classification. Materials and methods: 312 patients from 15 institutions in Argentina were analyzed. The Diabetic Foot Classification Calculator/Risk Score from the Diabetic Foot Committee of the Argentina Argentina Diabetes Society was used for the analysis. Results: 43% of patients (n=133) required hospitalization at the time of the first consultation and 61% (n=189) had previously consulted. The total major amputation percentage was 8.33% (95%CI; 5.5-11.9) (n=26), and the minor amputation percentage was 29.17% (95% CI; 24.2-34.6) (n=91). At 6 months, the death rate was 4.49% (95% CI; 2.5-7.4) (n=14), 24.3% (95% CI; 19.629.5) had an open wound (n=76), 58.0% (95% CI; 52.3-66.5) (n=181) had healed, and 7.37% were lost to follow-up (n=23). The SEWSS and WIfI classifications were related to major amputation, healing, and death. Regarding the Texas classification, 49% of patients had a penetrating wound to bone or joint (Texas 3), with or without infection. 65.3% of major amputations and 78.6% of deaths occurred in patients with ischemia. The SEWSS cut-off point for major amputation was 20. Conclusions: knowing local data allows organizing resources to improve patient care.