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1.
Rev. baiana saúde pública ; 45(Supl. Especial 2): 66-78, 2021/12/28.
Article in English | LILACS | ID: biblio-1352330

ABSTRACT

Hyperbaric oxygenation (HBO2) is a successful treatment of diabetic foot ulcerations. Research on the characterization of tissue by ultrasonography (CATUS) or by imaging (CATIM) has grown. We investigated the photographic pCATIM feasibility to quantitate HBO2 effects. Besides, we analyzed pre and post HBO2 treatment photographs quantitatively based on pixel brightnesses of gray-scale imaging versions. Grayscale Medians (GSM) for (1) entire ulceration, (2) inner core, (3) ulceration border, and (4) adjacent skin decreased from 92 to 77, 60 to 56, 105 to 101, and 105 to 90. Entire ulceration post-HBO2 pixel percentages were lower in the 112-153 intervals, 11% vs 29% (p = .0013 by Chi-square), and higher in the 41-111 brightness range, 87% vs 68% (p = .0008). A case report showed quantifiable relative changes detected by pCATIM post HBO2 treatment of diabetic foot ulceration. Further investigation may quantify brightness variabilities and/or specific GSM for ulceration and skin regions.


A oxigenioterapia hiperbárica (HBO2) tem sido um tratamento de sucesso para úlceras do pé diabético, enquanto cresce o número de pesquisas caracterizando o tecido por meio de ultrassonografia (Catus) ou imagem (Catim) ­ sendo que a pCatim torna viável quantificar os efeitos da oxigenioterapia hiperbárica. Fotografias do pré e pós tratamento foram analisadas quantitativamente com base em brilhos de pixel de versões de imagens em escala de cinza. Houve redução das medianas da escala de cinza (gray scale medians ­ GSM) para (1) ulceração inteira, de 92 para 77; (2) núcleo interno, de 60 para 56; (3) borda da ulceração, de 105 para 101; e (4) pele adjacente, de 105 para 90. Na úlcera completa, após a HBO2, as porcentagens de pixels foram menores nos intervalos 112-153 (11% contra 29%, p = 0,0013 por qui-quadrado) e maiores na faixa de brilho 41-111 (87% contra 68%, p = 0,0008). Um relato de caso demonstrou mudanças relativas quantificáveis detectadas por pCatim após o tratamento com HBO2 de uma úlcera do pé diabético, e investigações mais aprofundadas podem quantificar as variabilidades de brilho e/ou GSM específicas para cada ulceração e regiões da pele.


La oxigenación hiperbárica (HBO2) ha sido un tratamiento exitoso de las ulceraciones del pie diabético. Ha crecido la investigación sobre la caracterización de tejidos por ecografía (CATUS) o por imágenes (CATIM). Se investigó la viabilidad fotográfica de pCATIM para cuantificar los efectos de HBO2. Las fotografías anteriores y posteriores al tratamiento con HBO2 se analizaron cuantitativamente en función del brillo de los píxeles de las versiones de imágenes en escala de grises. Medianas de escala de grises (GSM) para (1) ulceración completa, (2) núcleo interno, (3) borde de ulceración y (4) piel adyacente disminuyeron de 92 a 77, 60 a 56, 105 a 101 y 105 a 90, respectivamente. En la ulceración completa, después de HBO2, los porcentajes de píxeles fueron más bajos en los intervalos 112-153, 11% vs 29% (p = .0013 por Chi-cuadrado) y más altos en el rango de brillo 41-111, 87% vs 68% (p = .0008). Un informe de caso demostró cambios relativos cuantificables detectados por pCATIM después del tratamiento con HBO2 de una ulceración del pie diabético. Una investigación adicional puede cuantificar las variaciones de brillo y o GSM específico para ulceraciones y regiones de la piel.


Subject(s)
Foot Ulcer , Diabetic Foot , Research Report , Hyperbaric Oxygenation
2.
Rev. méd. Urug ; 37(3): e37302, set. 2021. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1341550

ABSTRACT

Resumen: Las úlceras de pie diabético (UPD) generan un alto costo para el paciente y el sistema de salud. Una deficiente vascularización, la inhibición de la generación de factores de crecimiento y la migración celular, entre otros factores, influyen en su cronicidad. Los factores de crecimiento derivados de las plaquetas (PDGF) estimulan la quimiotaxis, la neovascularización y la regeneración tisular. Objetivo: evaluar la efectividad de una formulación de plasma rico en plaquetas autólogo (PRP) como una modalidad complementaria para el tratamiento de UPD, valorando su seguridad y efectos adversos. Materiales: estudio observacional. Se aplicó PRP a seis pacientes con UPD crónicas, Wagner II, III, con una media en el retraso de la cicatrización de 94 semanas. Se administró mediante punción y como gel sobre la lesión una vez por semana hasta el cierre de la úlcera o durante12 semanas. Las UPD se analizaron con respecto al área y su progresión mediante Mobile Wound Analyzer (MOWA), software de análisis de imágenes de úlceras. El porcentaje de reducción del área se calculó entre la medición inicial y la semana 12. Como criterio de mejoría se eligió una reducción >70% de la lesión. Resultados: predominó el sexo masculino con una media de edad de 53 años ± 7,3. Luego de 12 semanas de tratamiento, se reportó una reducción media del tamaño de la úlcera de 78%, con dos cicatrizaciones completas y dos en 99%. Un paciente recibió una amputación luego de presentar infección no controlada. Conclusión: la aplicación del PRP mejoró la regeneración de tejidos, acortando la duración de la úlcera, promoviendo su curación sin efectos adversos, al tiempo que eliminó la necesidad de procedimientos de manejo en una úlcera crónica.


Summary: Diabetic foot ulcers imply high expenditure for both patients and the health system. Vascular impairment, growth factor inhibition and cell migration, among other factors, affect the chronicity of the condition. Platelet-derived growth factors (PDGFs) stimulate chemotaxis, neovascularization and tissue regeneration. Objective: to evaluate effectiveness of a formulation of autologous platelet-rich plasma to complement the treatment of diabetic foot ulcer, assessing safety and adverse effects. Material: observational study. Platelet rich plasma was applied to six patients with chronic diabetic foot ulcer Wagner II, III, with an average delayed healing of 94 weeks. PRP gel was administered by puncture technique on the lesion, once a week until the ulcer healed or for 12 weeks. Diabetic foot ulcers were analysed in regards to surface area and progression through the Mobile Wound Analyzer (MOWA) software to analyse ulcer images. The area reduction percentage was calculated comparing the initial measurement and that of week 12. The improvement criteria was defined in a reduction that is >70% of the lesion. Results: men prevailed with an average age of 53 years ± 7.3. After 12 weeks of treatment an average reduction of 78% of the size of the ulcer was reported, two complete healings and two 99% healed. One patient required amputation because of uncontrolled infection. Conclusion: the application of PRP improved tissue regeneration and shortened the duration of the ulcer, promoting healing with no adverse effects, and it likewise eliminated the need for procedures to handle chronic ulcers.


Resumo: As úlceras do pé diabético (UPD) geram alto custo para o paciente e para o sistema de saúde. A vascularização deficiente, a inibição da geração de fatores de crescimento e migração celular, entre outros fatores, influenciam sua cronicidade. Os fatores de crescimento derivados de plaquetas (PDGF) estimulam a quimiotaxia, a neovascularização e a regeneração de tecidos. Objetivo: avaliar a eficácia de uma formulação autóloga de plasma rico em plaquetas (PRP) como modalidade complementar para o tratamento da UPD, avaliando sua segurança e efeitos adversos. Materiais: estudo observacional. O PRP foi aplicado a 6 pacientes com UPD crônica, Wagner II, III, com um atraso médio na cicatrização de 94 semanas. Foi administrado por punção e como gel sobre a lesão uma vez por semana até o fechamento da úlcera ou por 12 semanas. As UPD foram analisadas em relação à área e sua progressão, utilizando o software de análise de imagem de úlcera Mobile Wound Analyzer (MOWA). A redução percentual da área foi calculada entre a medição inicial e a semana 12. Como critério de melhora, optou-se pela redução > 70% da lesão. Resultados: predominou o sexo masculino com média de idade de 53 ± 7,3 anos. Após 12 semanas de tratamento, foi relatada uma redução média no tamanho da úlcera de 78%, sendo 2 com cicatrização completa e 2 em 99%. Um paciente foi amputado após desenvolver infecção descontrolada. Conclusão: a aplicação do PRP melhorou a regeneração tecidual, encurtando o tempo de duração da úlcera, promovendo sua cicatrização sem efeitos adversos, ao mesmo tempo que eliminava a necessidade de procedimentos de manejo na úlcera crônica.


Subject(s)
Diabetic Foot/therapy , Platelet-Rich Plasma , Foot Ulcer/therapy
3.
An. bras. dermatol ; 96(3): 352-354, May-June 2021. graf
Article in English | LILACS | ID: biblio-1285072

ABSTRACT

Abstract Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.


Subject(s)
Humans , Male , Leishmania braziliensis , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Foot Ulcer , Leishmania , Ulcer , Meglumine Antimoniate
4.
An. Fac. Cienc. Méd. (Asunción) ; 54(1): 93-100, 20210000.
Article in Spanish | LILACS | ID: biblio-1178639

ABSTRACT

El 15% de los individuos con DM2 presenta una úlcera en el pie y una fracción importante de ellos sufrirá en algún momento una amputación. Se realizó un estudio analítico, de corte trasversal retrospectivo de muestreo no probabilístico de casos consecutivos en pacientes con diagnóstico de pie diabético que acudieron al servicio de Urgencias del Hospital de Clínicas de San Lorenzo, en el periodo Enero ­ Diciembre del año 2019. Sobre un número total de 138 pacientes, se observa que el 51% recibió un manejo quirúrgico, con amputaciones de varios tipos. Se comparó el manejo instaurado en los pacientes, sea este quirúrgico o conservador según la presencia o no de ciertas comorbilidades, como edad mayor a 65 años, lugar de procedencia, glicemia capilar promedio del paciente e hipertensión arterial al ingreso; de estos existió una relación estadísticamente significativa (p<0,05) entre la necesidad de amputación y la glicemia capilar y la hipertensión arterial. El éxito de la intervención requiere un completo entendimiento de la patogénesis de las úlceras del pie diabético y una implementación rápida y estandarizada de un tratamiento efectivo. El manejo multidisciplinario puede lograr el salvataje de la extremidad, que conducirá a una mejor calidad de vida y sobrevida.


Among diabetic patients, 15% have a foot ulcer and a significant fraction of them will suffer an amputation at some point. An analytical, retrospective cross-sectional study of non-probabilistic sampling of consecutive cases was carried out in patients with a diagnosis of diabetic foot who attended the Emergency Service of the Clínicas Hospital in San Lorenzo, during January - December of the year 2019. In a total of 138 patients, the management established in the patients, whether surgical or. conservative, was compared according to certain comorbidities, such as age over 65 years, place of origin, average capillary glycemia and arterial hypertension on admission; Of these, there was a statistically significant relationship (p <0.05) between the need for amputation and capillary glycemia and arterial hypertension. Successful intervention requires a thorough understanding of the pathogenesis of diabetic foot ulcers and a rapid and standardized implementation of effective treatment. Multidisciplinary management can achieve limb salvage, leading to better quality of life and survival.


Subject(s)
Ulcer , Pathogenesis, Homeopathic , Foot Ulcer , Diabetic Foot , Amputation , Hypertension , Cross-Sectional Studies , Diagnosis
5.
MedUNAB ; 24(1): 27-40, 23-04-2021.
Article in English | LILACS | ID: biblio-1222541

ABSTRACT

Introducción. Nursing interventions used for the treatment of diabetic foot ulcers include traditional and advanced healing techniques. Often their choice depends on the nurse's personal judgment, rather than recognition of cost-effectiveness. The objective of this study is to identify the most cost-effective nursing interventions for the management of patients with diabetic foot ulcers. Methodology. A systematic review was conducted at Pubmed, Cochrane and the Virtual Health Library. Randomized and non-randomized studies of any nursing intervention used for diabetic foot ulcer management with reported cost-effectiveness were included. The selection of eligible articles was made by two independent reviewers. The risk of bias was assessed using the following guidelines: Critical Appraisal Skills Programme. Results. Six of the eight included articles were classified at high risk of bias. The two interventions in which a better cost-effectiveness ratio was evidenced compared to the control group were the use of Beta- Glucan gel (compared to placebo) and negative pressure wound therapy (compared to advanced wet wound therapy). Discussion. National and international guidelines for the nursing management of diabetic foot ulcers propose at least 15 different interventions. However, the limited availability of high-quality cost-effectiveness studies makes selection difficult and generates greater variability in nursing practices. Conclusion. Cost-effectiveness studies with direct comparisons of nursing interventions for diabetic foot ulcer management are needed. Citation. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Cost-effectiveness of nursing interventions for diabetic foot ulcer management: systematic review. MedUNAB. 2021;24(1): 27-40. Doi: https://doi.org/10.29375/01237047.3832


Introduction. Las intervenciones de enfermería usadas para el tratamiento de las úlceras por pie diabético incluyen técnicas de cura tradicionales y avanzadas. Frecuentemente su elección depende del criterio personal de la enfermera, en lugar del reconocimiento de la relación costo-efectividad. El objetivo de este estudio es identificar las intervenciones de enfermería de mayor costo-efectividad para el manejo de pacientes con úlceras por pie diabético. Metodología. Se realizó una revisión sistemática en Pubmed, Cochrane y la Biblioteca Virtual De La Salud. Se incluyeron estudios aleatorizados y no aleatorizados de cualquier intervención de enfermería usada para el manejo de úlcera por pie diabético con reporte de costo-efectividad. La selección de los artículos elegibles fue realizada por dos evaluadores independientes. El riesgo de sesgos fue evaluado con las guías Critical Appraisal Skills Programme. Resultados. Seis de los ocho artículos incluidos fueron clasificados con alto riesgo de sesgos. Las dos intervenciones en las que se evidenció una mejor relación costo- efectividad en comparación con el grupo control fueron el uso de Beta-Glucan gel (comparado con placebo) y la terapia de presión negativa (comparada con terapia de herida húmeda avanzada). Discusión. Guías nacionales e internacionales para el manejo de enfermería de úlceras por pie diabético proponen al menos 15 diferentes intervenciones. Sin embargo, la escasa disponibilidad de estudios de alta calidad sobre la relación costo-efectividad dificulta la selección y genera mayor variabilidad en las prácticas de enfermería. Conclusión. Es necesario realizar estudios de la relación costo-efectividad con comparaciones directas de las intervenciones de enfermería para el manejo de úlceras por pie diabético. Citation. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Cost-effectiveness of nursing interventions for diabetic foot ulcer management: systematic review. MedUNAB. 2021;24(1): 27-40. Doi: https://doi.org/10.29375/01237047.3832


Introdução. As intervenções de enfermagem usadas para tratar úlceras do pé diabético incluem técnicas de cura tradicionais e avançadas. Frequentemente, sua escolha depende do julgamento pessoal da enfermeira, ao invés do reconhecimento da relação custo-efetividade. O objetivo deste estudo é identificar as intervenções de enfermagem com um maior custo-efetividade para o tratamento de pacientes com úlceras de pé diabético. Metodologia. Foi realizada uma revisão sistemática no Pubmed, Cochrane e na Biblioteca Virtual em Saúde. Foram incluídos estudos randomizados e não randomizados de qualquer intervenção de enfermagem utilizada para o tratamento de úlceras do pé diabético com relatórios de custo-efetividade. A seleção dos artigos elegíveis foi feita por dois avaliadores independentes. O risco de tendências foi avaliado com as diretrizes do Critical Appraisal Skills Program. Resultados. Seis dos oito artigos incluídos foram classificados como de alto risco de tendência. As duas intervenções que mostraram uma melhor relação custo-efetividade em comparação com o grupo de controle foram o uso de gel de Beta-Glucan (em comparação com o placebo) e a terapia de pressão negativa (em comparação com a terapia avançada de feridas úmidas). Discussão. Diretrizes nacionais e internacionais para o tratamento de enfermagem de úlceras do pé diabético propõem pelo menos 15 intervenções diferentes. No entanto, a disponibilidade limitada de estudos de alta qualidade sobre a relação custo-efetividade torna difícil a seleção e leva a uma maior variabilidade nas práticas de enfermagem. Conclusão. São necessários estudos que tratem a relação custo-efetividade com comparações diretas de intervenções de enfermagem para o tratamento de úlceras do pé diabético. Citation. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Cost-effectiveness of nursing interventions for diabetic foot ulcer management: systematic review. MedUNAB. 2021;24(1): 27-40. Doi: https://doi.org/10.29375/01237047.3832


Subject(s)
Foot Ulcer , Patient Care Management , Efficacy , Cost-Benefit Analysis , Diabetic Foot
6.
MedUNAB ; 24(1): 13-26, 23-04-2021.
Article in Spanish | LILACS | ID: biblio-1222537

ABSTRACT

Introducción. Las intervenciones de enfermería usadas para el tratamiento de las úlceras por pie diabético incluyen técnicas de cura tradicionales y avanzadas. Frecuentemente su elección depende del criterio personal de la enfermera, en lugar del reconocimiento de la relación costo-efectividad. El objetivo de este estudio es identificar las intervenciones de enfermería de mayor costo-efectividad para el manejo de pacientes con úlceras por pie diabético. Metodología. Se realizó una revisión sistemática en Pubmed, Cochrane y la Biblioteca Virtual De La Salud. Se incluyeron estudios aleatorizados y no aleatorizados de cualquier intervención de enfermería usada para el manejo de úlcera por pie diabético con reporte de costo-efectividad. La selección de los artículos elegibles fue realizada por dos evaluadores independientes. El riesgo de sesgos fue evaluado con las guías Critical Appraisal Skills Programme. Resultados. Seis de los ocho artículos incluidos fueron clasificados con alto riesgo de sesgos. Las dos intervenciones en las que se evidenció una mejor relación costo-efectividad en comparación con el grupo control fueron el uso de Beta-Glucan gel (comparado con placebo) y la terapia de presión negativa (comparada con terapia de herida húmeda avanzada). Discusión. Guías nacionales e internacionales para el manejo de enfermería de úlceras por pie diabético proponen al menos 15 diferentes intervenciones. Sin embargo, la escasa disponibilidad de estudios de alta calidad sobre la relación costo-efectividad dificulta la selección y genera mayor variabilidad en las prácticas de enfermería. Conclusión. Es necesario realizar estudios de la relación costo-efectividad con comparaciones directas de las intervenciones de enfermería para el manejo de úlceras por pie diabético. Cómo citar. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Costo-efectividad de las intervenciones de enfermería para el manejo de úlceras por pie diabético: revisión sistemática. MedUNAB. 2021;24(1): 13-26. Doi: https://doi.org/10.29375/01237047.3832


Introduction. Nursing interventions used for the treatment of diabetic foot ulcers include traditional and advanced healing techniques. Often their choice depends on the nurse's personal judgment, rather than recognition of cost-effectiveness. The objective of this study is to identify the most cost-effective nursing interventions for the management of patients with diabetic foot ulcers. Methodology. A systematic review was conducted at Pubmed, Cochrane and the Virtual Health Library. Randomized and non-randomized studies of any nursing intervention used for diabetic foot ulcer management with reported cost-effectiveness were included. The selection of eligible articles was made by two independent reviewers. The risk of bias was assessed using the following guidelines: Critical Appraisal Skills Programme. Results. Six of the eight included articles were classified at high risk of bias. The two interventions in which a better cost-effectiveness ratio was evidenced compared to the control group were the use of Beta-Glucan gel (compared to placebo) and negative pressure wound therapy (compared to advanced wet wound therapy). Discussion. National and international guidelines for the nursing management of diabetic foot ulcers propose at least 15 different interventions. However, the limited availability of high-quality cost-effectiveness studies makes selection difficult and generates greater variability in nursing practices. Conclusion. Cost-effectiveness studies with direct comparisons of nursing interventions for diabetic foot ulcer management are needed. Cómo citar. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Costo-efectividad de las intervenciones de enfermería para el manejo de úlceras por pie diabético: revisión sistemática. MedUNAB. 2021;24(1): 13-26. Doi: https://doi.org/10.29375/01237047.3832


Introdução. As intervenções de enfermagem usadas para tratar úlceras do pé diabético incluem técnicas de cura tradicionais e avançadas. Frequentemente, sua escolha depende do julgamento pessoal da enfermeira, ao invés do reconhecimento da relação custo-efetividade. O objetivo deste estudo é identificar as intervenções de enfermagem com um maior custo-efetividade para o tratamento de pacientes com úlceras de pé diabético. Metodologia. Foi realizada uma revisão sistemática no Pubmed, Cochrane e na Biblioteca Virtual em Saúde. Foram incluídos estudos randomizados e não randomizados de qualquer intervenção de enfermagem utilizada para o tratamento de úlceras do pé diabético com relatórios de custo-efetividade. A seleção dos artigos elegíveis foi feita por dois avaliadores independentes. O risco de tendências foi avaliado com as diretrizes do Critical Appraisal Skills Program. Resultados. Seis dos oito artigos incluídos foram classificados como de alto risco de tendência. As duas intervenções que mostraram uma melhor relação custo-efetividade em comparação com o grupo de controle foram o uso de gel de Beta-Glucan (em comparação com o placebo) e a terapia de pressão negativa (em comparação com a terapia avançada de feridas úmidas). Discussão. Diretrizes nacionais e internacionais para o tratamento de enfermagem de úlceras do pé diabético propõem pelo menos 15 intervenções diferentes. No entanto, a disponibilidade limitada de estudos de alta qualidade sobre a relação custo-efetividade torna difícil a seleção e leva a uma maior variabilidade nas práticas de enfermagem. Conclusão. São necessários estudos que tratem a relação custo-efetividade com comparações diretas de intervenções de enfermagem para o tratamento de úlceras do pé diabético. Cómo citar. Vásquez-Hernández, S., Rico-Ardila, D., Gómez-Camargo, L., Álvarez-Quintero, L. Costo-efectividad de las intervenciones de enfermería para el manejo de úlceras por pie diabético: revisión sistemática. MedUNAB. 2021;24(1): 13-26. Doi: https://doi.org/10.29375/01237047.3832


Subject(s)
Foot Ulcer , Patient Care Management , Efficacy , Cost-Benefit Analysis , Diabetic Foot
7.
Rev. cuba. angiol. cir. vasc ; 21(2): e135, mayo.-ago. 2020. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1126383

ABSTRACT

Introducción: El Heberprot-P® es un medicamento novedoso y único en su tipo, prescrito para la terapia de la úlcera del pie diabético. Objetivo: Evaluar la frecuencia y las características de la recidiva de úlcera del pie en pacientes diabéticos tratados con Heberprot-P®. Métodos: Se realizó una investigación descriptiva-retrospectiva. La población estuvo constituida por 16 pacientes con recidiva de úlcera de pie diabético de los 841 tratados con Heberprot-P® en policlínicos y hospitales de la provincia de Matanzas desde enero hasta diciembre de 2018. Las variables revisadas fueron llevadas a una base de datos, y los resultados obtenidos se tabularon y se expresaron en frecuencias absolutas y relativas. Se respetaron las consideraciones éticas requeridas para este estudio. Resultados: El grupo de edades 61-75 años y los diabéticos de tipo 2 fueron los más afectados, y no existieron diferencias entre ambos sexos. El pie diabético neuropático con una severidad Wagner 2 se manifestó con mayor frecuencia. Asimismo, a partir de la primera lesión y la recidiva se observó un gran número de pacientes con la enfermedad entre las 13 y 16 semanas, y al 56,2 por ciento de estos se les administró, durante la primera lesión, de 6 a 12 dosis de Heberprot-P®. El cierre total de la lesión en el desenlace fue lo más encontrado en la población de estudio, y el 1,9 por ciento de los pacientes tratados presentó una recidiva de esta. Conclusiones: Quedaron expuestas la frecuencia y las características de la recidiva de la úlcera del pie en los pacientes diabéticos tratados con Heberprot-P®(AU)


Introduction: Heberprot-P® is a novel medicine, unique among its kind, prescribed for diabetic foot ulcer therapy. Objective: To evaluate frequency and characteristics of foot ulcer recurrence among diabetic patients treated with Heberprot-P®. Methods: A descriptive-retrospective research was carried out. The study population consisted of 16 patients with diabetic foot ulcer recurrence from among the 841 treated with Heberprot-P® in polyclinics and hospitals in Matanzas Province from January to December 2018. The variables reviewed were taken to a database, and the results obtained were represented in charts and expressed in absolute and relative frequencies. The ethical considerations required for this study were respected. Results: The age group 61-75 years and type 2 diabetic patients were the most affected. There were no differences between both sexes. Neuropathic diabetic foot with Wagner 2 severity appeared more frequently. Likewise, after the first injury and recurrence, a large number of patients with the disease were observed at 13-16 weeks, 56.2 percent of whom, were administered, during the first injury, 6-12 doses of Heberprot-P®. The total closure of the lesion was the most found outcome in the study population, and 1.9 percent of the treated patients presented recurrence of this. Conclusions: The frequency and characteristics of foot ulcer recurrence in diabetic patients treated with Heberprot-P® were exposed(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Recurrence , Pharmaceutical Preparations , Foot Ulcer/therapy , Diabetic Foot/complications , Diabetes Mellitus, Type 2
8.
Rev. cuba. angiol. cir. vasc ; 21(1): e90, ene.-abr. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126369

ABSTRACT

Introducción: La diabetes mellitus cada año aumenta su incidencia, entre los casos diagnosticados y los no diagnosticados a nivel mundial. Debido a que esta trae como consecuencia un daño neuropático y vascular, están consideradas las úlceras del pie diabético la principal causa de amputaciones no traumáticas. El tratamiento oportuno con Heberprot-P® ha mejorado la cicatrización de estas úlceras. Objetivo: Caracterizar los pacientes con úlcera del pie diabético tratado con Heberprot-P®. Métodos: Estudio descriptivo retrospectivo en 312 individuos con diagnóstico de úlcera del pie diabético tratados con Heberprot-P® en el Hospital Universitario Clínicoquirúrgico Docente "General Calixto García Iñiguez" del 2013 al 2017. Las variables recogidas fueron edad, sexo, tipo de diabetes, Wagner, daño vascular, dosis, evolución. Resultados: El 79,7 por ciento de los casos tenían 50 años o más; predominaron los hombres con el 63,4 por ciento y presentaron diagnóstico de diabetes mellitus tipo 2 el 93,6 por ciento. El 35 por ciento de las úlceras se encontraban en el grado 3 de la clasificación de Wagner y el rango de dosis utilizado con más frecuencia fue de 5 a 10 administraciones. Se observó daño vascular en el 23,8 por ciento, con la cicatrización total del 76,6 por ciento y solo se amputaron el 8,9 por ciento. Conclusiones: Los hombres mayores de 50 años, diabéticos tipo 2, con frecuencia presentan úlcera del pie diabético. Cicatrizaron la mayoría de los pacientes con tratamiento con Heberprot-P® y existieron pocas amputaciones(AU)


Introduction: Diabetes mellitus each year increases its incidence among the diagnosed and undiagnosed cases at the global level. Since this disease brings as a consequence a neuropathic and vascular damage, diabetic foot ulcers are considered to be the main cause of non-traumatic amputations. Prompt treatment with Heberprot-P® has improved the healing of these ulcers. Objective: To characterize patients with diabetic foot ulcer treated with Heberprot-P®. Methods: Retrospective descriptive study in 312 individuals diagnosed with diabetic foot ulcer treated with Heberprot-P® in "General Calixto García Iñiguez" University-Teaching- Clinical-Surgical Hospital from 2013 to 2017. The variables collected were: age, sex, type of diabetes, Wagner, vascular damage, dosage, evolution. Results: 79.7 percent of the cases were 50 or more years old; men predominated being the 63.4 percent and 93.6 percent presented diagnosis of diabetes mellitus type 2. The 35 percent of the ulcers were in stage 3 of Wagner classification and the most frequently dose range used was 5 to 10 dosages. Vascular damage was observed in the 23.8 percent, with 76.6 percent of total healing and only the 8.9 percent were amputated. Conclusions: Men over 50 years old being type 2 diabetics present with frecuency diabetic foot ulcer. The majority of patients treated with Heberprot-P® healed and there were few amputations(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Foot Ulcer/diagnosis , Diabetic Foot/complications , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Epidemiology, Descriptive , Retrospective Studies
9.
Rev. cuba. med. mil ; 49(1): e427, ene.-mar. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1126678

ABSTRACT

Introducción: La prevalencia de diabetes aumenta paulatinamente a nivel mundial y con ello, se incrementa el riesgo de complicaciones microvasculares como la retinopatía diabética. El riesgo de ceguera se reduce con control metabólico estable, diagnóstico temprano y tratamiento adecuado. Objetivo: Comparar el resultado del examen oftalmológico realizado antes de iniciar el tratamiento con Heberprot-P, con el realizado a los cinco meses de iniciado, a diferentes dosis. Métodos: Se realizó un estudio observacional, retrospectivo, en 77 pacientes incluidos en cuatro ensayos clínicos de Heberprot-P. Se realizó análisis de las variables examen oftalmológico antes y después del tratamiento, tipo de diabetes y años de evolución. Resultados: Se observó predominio de los diabéticos tipo 2 respecto a los tipo 1 en una razón 11:1, con una media de 16,3 años de evolución de la diabetes. La mitad de los pacientes tenían retinopatía diabética no proliferativa, con predominio de la forma leve, en el examen realizado antes del tratamiento con Heberprot-P. Solo un paciente anciano con otras comorbilidades, desarrolló una retinopatía diabética proliferativa, luego de un examen previo en que se observó retinopatía diabética no proliferativa y edema macular diabético. Conclusiones: La aparición o progresión de retinopatía diabética es infrecuente en pacientes complicados con úlcera del pie diabético tratados con Heberprot-P, hasta cinco meses después de tratamiento(AU)


Introduction: The prevalence of diabetes gradually increases worldwide and with it, the risk of microvascular complications such as diabetic retinopathy. The risk of blindness is reduced with stable metabolic control, early diagnosis and adequate treatment. Objective: To compare the result of the ophthalmological examination performed before starting treatment with Heberprot-P, with that performed five months after initiation, at different doses. Methods: A retrospective observational study was conducted in 77 patients included in four clinical trials of Heberprot-P. Analysis of the ophthalmological examination variables before and after treatment, type of diabetes and years of evolution were performed. Results: Prevalence of type 2 diabetics was observed with respect to type 1 in an 11: 1 ratio, with an average of 16.3 years of diabetes evolution. Half of the patients had nonproliferative diabetic retinopathy, predominantly of the mild form, in the examination performed before treatment with Heberprot-P. Only one elderly patient with other comorbidities developed a proliferative diabetic retinopathy, after a previous examination in which non-proliferative diabetic retinopathy and diabetic macular edema were observed. Conclusions: The appearance or progression of diabetic retinopathy is uncommon in complicated patients with diabetic foot ulcer treated with Heberprot-P, up to five months after treatment(AU)


Subject(s)
Humans , Male , Female , Blindness , Prevalence , Foot Ulcer , Early Diagnosis , Diabetic Retinopathy
10.
Article in Chinese | WPRIM | ID: wpr-879338

ABSTRACT

Diabetic foot ulcers (DFUs) is a severe complication of the diabetes mellitus, which is the first leading cause of non-traumatic lower limbs amputations. The pathogenesis of diabetic foot involves a variety of mechanisms, treatment involves the department of foot and ankle surgery, department of vascular surgery, endocrinology, and infection control. Treatment need multidisciplinary diagnosis and treatment. Debridement is the basis of treating diabetic foot ulcers, and the normal anatomical structure should be maintained during the process. Vacuum sealing drainage (VSD) and antibiotic-laden bone cement (ALBC) have more advantages of controlling infection and ulceration wound healing, which could receive good clinical effect. Tendon lengthening could alleviate the problem of ulcer occurrence and progression caused by stress concentration on the bottom of foot, which has widely application and has advantages of preventing formation of foot ulcers. Flap transplantation could solve the problem of wound healing, but it is necessary to consider whether the transplanted flap could bear the same function as plantar tissue. Tibial bone transverse distraction is a relatively new technique, and the mechanism is not clear, but it has certain application prospects from the perspective of clinical efficacy.


Subject(s)
Debridement , Diabetes Mellitus , Diabetic Foot/surgery , Foot Ulcer , Humans , Salvage Therapy , Wound Healing
11.
Ciênc. cuid. saúde ; 19: e50361, 20200000.
Article in Portuguese | LILACS, BDENF | ID: biblio-1122854

ABSTRACT

Objective: Analyze the scientific literature addressing mobile technologies to prevent and diagnose diabetic foot ulcers and studies addressing foot care among individuals with diabetes mellitus. Method: this integrative literature review was conducted in the PubMed, LILACS, and BDENF databases in September 2019. The full texts of six studies were analyzed. Results: The studies date back to 2015, and all were identified in PubMed. Experimental studies stood out, totaling three (50%). As for the mobile technologies directed to prevention and self-care, two papers used mobile phone text messaging to reinforce the learning and practice of diabetic foot care, reporting satisfactory results. Four studies adopted technologies to diagnose foot ulcers. Although they used different methods, almost all of the studies monitored plantar foot temperature increases, which can serve as an alert system to detect foot ulcers early on. Conclusion: even though few studies were found, mobile technologies were effective to prevent and diagnose foot ulcers, and to promote foot care among individuals with diabetes.


Objetivo: Analisar produções científicas sobre o uso das tecnologias móveis na prevenção e diagnóstico do pé diabético, bem como publicações que abordem o autocuidado com os pés em pessoas com diabetes mellitus. Métodos: Revisão integrativa realizada nas bases de dados PubMed, LILACS e BDENF, em setembro de 2019, com uma amostra de seis artigos analisados na íntegra. Resultados: As publicações datam desde o ano 2015, todas na PubMed. Destacaram-se os estudos experimentais, totalizando três (50%) publicações. Com relação às tecnologias móveis voltadas para a prevenção e autocuidado, dois artigos foram encontrados, ambos usaram mensagens de texto por telefone celular para reforçar o aprendizado e a prática de cuidados com os pés dos diabéticos e trouxeram resultados satisfatórios. Quanto às tecnologias voltadas para o diagnóstico de úlceras nos pés, identificaram-se quatro artigos e, apesar de terem utilizado métodos diferentes, quase todos eram voltados para rastrear aumentos de temperatura na parte inferior dos pés, podendo servir como um sistema de alerta para a detecção precoce de úlceras nessa região. Conclusão: Apesar da escassez de estudos, o uso de tecnologias móveis voltadas para a prevenção e autocuidado com os pés em pessoas diabéticas e as voltadas para diagnóstico de úlceras nos pés, mostraram-se efetivas.


Subject(s)
Humans , Diabetes Mellitus , Wireless Technology , Foot , Self Care , Foot Ulcer , Diabetic Foot , Disease Prevention
12.
Rev. Esc. Enferm. USP ; 54: e03640, 2020. tab, graf
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1143694

ABSTRACT

RESUMO Objetivo: Avaliar os efeitos da espuma de feltro no tratamento da úlcera plantar do pé diabético. Método: Revisão sistemática, com metanálise. As buscas foram realizadas na Cochrane Library, PubMed, CINAHL, Science Direct, Web of Science, SCOPUS, IBECS e LILACS. A Cochrane Collaboration Risk of Bias Tool foi utilizada para a avaliação do risco de viés. As metanálises foram calculadas pelo programa Review Manager, enquanto o Grades of Recommendation, Assessment, Development and Evaluation foi utilizado para a avaliação da qualidade da evidência. Resultados: Foram incluídos quatro ensaios clínicos e duas coortes. Houve a redução de 10,77 quilos pascais (IC 95% −14,92, −6,62; p<0,001) na média de pressão plantar dos indivíduos expostos ao feltro. Conclusão: Evidenciou-se maior redução da pressão plantar com o uso do feltro. Recomenda-se o desenvolvimento de novos modelos de órteses de alívio de pressão plantar a partir da espuma de feltro, acompanhado de mais pesquisas clínicas que elucidem outros desfechos relacionados.


RESUMEN Objetivo: Evaluar los efectos de la espuma de fieltro en el tratamiento de la úlcera plantar del pie diabético. Método: Revisión sistemática con metaanálisis. Las búsquedas se realizaron en Cochrane Library, PubMed, CINAHL, Science Direct, Web of Science, SCOPUS, IBECS y LILACS. Se utilizó la herramienta Cochrane Collaboration Risk of Bias Tool para evaluar el riesgo de sesgo. Los metaanálisis fueron calculados por el programa Review Manager, mientras que para la evaluación de la calidad de las pruebas se utilizó Grades of Recommendation, Assessment, Development and Evaluation. Resultados: Se incluyeron cuatro ensayos clínicos y dos cohortes. Hubo una reducción de 10,77 kilopascales (95% IC −14,92, −6,62; p<0,001) en la presión plantar media de los individuos expuestos al fieltro. Conclusión: Hubo una mayor reducción de la presión plantar con el uso del fieltro. Se recomienda el desarrollo de nuevos modelos de ortesis de alivio de presión plantar a partir de espuma de fieltro, acompañado de nuevas investigaciones clínicas para dilucidar otros resultados conexos.


ABSTRACT Objective: To evaluate the effects of felted foam in the treatment of diabetic foot plantar ulcer. Method: Systematic review with meta-analysis. Research was conducted in Cochrane Library, PubMed, CINAHL, Science Direct, Web of Science, SCOPUS, IBECS and LILACS. Cochrane Collaboration Risk of Bias Tool was employed to evaluate risk of bias. The meta-analyses were calculated in the program Review Manager, while Grades of Recommendation, Assessment, Development and Evaluation was used for evaluating evidence quality. Results: Four clinical essays and two cohorts were included. Mean plantar pressure of individuals exposed to felt was reduced by 10.77 kilopascals (CI 95% −14.92, −6.62; p<0.001). Conclusion: Higher reduction of plantar pressure was observed to be associated with the use of felt. Development of new models of relief orthosis with felted foam for plantar pressure is recommended, along with more clinical research elucidating related outcomes.


Subject(s)
Humans , Middle Aged , Aged , Foot Ulcer , Diabetic Foot , Meta-Analysis , Systematic Review
13.
Rev. cuba. angiol. cir. vasc ; 20(3): e61, jul.-dic. 2019. tab, fig
Article in Spanish | LILACS, CUMED | ID: biblio-1093137

ABSTRACT

Introducción: El 3 a 5 por ciento de los pacientes diabéticos en Cuba sufren úlcera del pie diabético. Las imágenes fotográficas de estas úlceras permiten hacer evaluaciones cuantitativas de los tratamientos. En Cuba, dicha evaluación se hace manual o semiautomáticamente. No se registra software cubano que automáticamente realice la medición de las áreas de la lesión y permita conocer las características de la úlcera, antes y después de la aplicación de un tratamiento. Objetivo: Comparar cualitativamente métodos de preprocesamiento y segmentación de la úlcera, dada la ausencia de una regla de oro. Método: Estudio descriptivo y transversal en 6 pacientes diabéticos del Instituto Nacional de Angiología y Cirugía Vascular en octubre de 2018, con lesiones de grado I-IV en la escala de Wagner. Se utilizó el marco estereotáxico para extremidades FrameHeber03® para obtener imágenes planimétricas estandarizadas de las úlceras. Se obtuvieron 51 imágenes de úlceras que se preprocesaron mediante el algoritmo Transformada Wavelet Discreta Logarítmica en un modelo S-LIP y se determinó su borde mediante los métodos de segmentación Chan-Vese, modelo de mezclas gaussianas y GrabCut. Resultados: Se mostró la utilidad de preprocesar las imágenes para lograr mejores resultados en la segmentación. El mejor y más factible método de segmentación fue el de mezclas gaussianas. Los algoritmos resultaron ser más precisos en pacientes de piel oscura, debido al mayor contraste entre la piel y el borde de la úlcera. Conclusiones: El algoritmo de segmentación automática de mezclas gaussianas. puede incluirse en un software para medir el área de la úlcera(AU)


Introduction: The 3 to 5 percent of Cuban diabetic patients suffer from diabetic foot ulcer. The diabetic foot ulcer photographic images allow quantitative evaluations of a treatment. In Cuba, the ulcer area measurement is done manually or semi-automatically. There is no Cuban software reported that automatically measures the area, and allows knowing the state of the foot ulcer before and after a treatment. Goal: To compare qualitatively (given the absence of a gold standard) ulcer´s pre-processing and segmentation methods. Method: We develop a descriptive and transversal study with 6 diabetic patients from Nacional Institute of Angiology and Vascular Surgery during October, 2018, with lesions of degree I-IV in the Wagner scale. The stereotaxic frame FrameHeber03® was used for obtaining planimetric images of the ulcers. In all, 51 ulcer images were obtained, and then we pre-processed it by Logarithmic Discrete Wavelet Transform under a S-LIP model, and found the ulcer border with the segmentation methods Chan-Vese, Gaussian Mixture Model (GMM), and GrabCut. Results: The pre-processing step was crutial for obtaining good results in the segmentation step. The best performance was reached by the GMM segmentation method. The algorithms were more accurate in images with black skin patients, due to the high contrast between the skin and the ulcer border. Conclusions: The automatic segmentation method (GMM) could be included in a software for detecting the border of the diabetic foot ulcer(AU)


Subject(s)
Humans , Foot Ulcer , Diabetic Foot
14.
Rev. bras. cir. plást ; 34(4): 497-503, oct.-dec. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1047912

ABSTRACT

Introdução: A úlcera plantar por hanseníase é uma lesão no pé resultante da falta de sensibilidade plantar. O objetivo é descrever o tratamento realizado em portadores de úlceras plantares por hanseníase. Métodos: Estudo de prontuários de portadores de úlcera plantar atendidos no Hospital Sarah em Brasília, de 2006 a 2016, quanto ao sexo, idade, etiologia, localização e tratamento. Resultados: Foram atendidos 27 pacientes, 17(62,96%) homens e 10 (37,04%) mulheres, procedentes de Goiás e DF, na faixa etária de 41 a 60 anos (40,74%). Todos necessitaram de um ou mais procedimentos cirúrgicos. Conclusão: Observou-se maior frequência no sexo masculino, grau avançado, localizadas no primeiro artelho. Todos necessitaram de procedimentos cirúrgicos e não cirúrgicos, evoluindo com cicatrização completa da ferida, amputação transtibial em um caso e de artelhos em sete casos, e 90% dos casos apresentaram recorrência da úlcera após um ano.


Introduction: Leprosy-induced plantar ulcers result from a lack of plantar sensitivity. Objective: This study aimed to describe the treatment provided to patients with leprosy-induced plantar ulcers. Methods: We retrospectively reviewed the medical records of patients with plantar ulcers treated at Sarah Hospital in Brasilia from 2006 to 2016 and collected information about sex, age, etiology, location, and treatment. Results: A total of 27 patients (17 [62.96%] men, 10 [37.04%] women; 40.74% were aged 41­60 years) were treated from Goiás and the Federal District. All required ≥1 surgical procedure. Conclusion: A higher frequency of advanced grade was observed in men, primarily on the first toe. All needed surgical and non-surgical procedures and achieved complete wound healing. Transtibial amputation was required in 1 case and toe amputation in 7 cases; 90% patients developed ulcer recurrence after 1 year.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Rehabilitation , Therapeutics , Tertiary Treatment , Medical Records , Foot Ulcer , Leprosy , Rehabilitation/methods , Rehabilitation/statistics & numerical data , Therapeutics/methods , Therapeutics/statistics & numerical data , Tertiary Treatment/methods , Tertiary Treatment/statistics & numerical data , Medical Records/standards , Medical Records/statistics & numerical data , Foot Ulcer/surgery , Foot Ulcer/complications , Foot Ulcer/therapy , Leprosy/surgery , Leprosy/complications , Leprosy/therapy
16.
Article in English | WPRIM | ID: wpr-763603

ABSTRACT

BACKGROUND: Traditionally, conservative management with an offloading orthosis, such as total contact cast (TCC), has been the standard of care for midfoot Charcot arthropathy. Considering complications of TCC and surgery, we treated midfoot Charcot arthropathy without TCC in our patients. The purpose of this study was to report clinical and radiological outcomes of conservative management of midfoot Charcot arthropathy. METHODS: A total of 34 patients (38 feet) who were diagnosed as having midfoot Charcot arthropathy between 2006 and 2014 were included. Patients started full weight bearing ambulation in a hard-soled shoe immediately after diagnosis. Outcomes such as progression of arch collapse, bony prominence, ulcer occurrence, limb amputation, and changes in Charcot stage were evaluated. RESULTS: Of 38 feet, arch collapse was observed in four while progression of bottom bump of the midfoot was observed in five feet. Foot ulcers related to bony bumps were found in two feet. CONCLUSIONS: Conservative treatment without restriction of ambulation is recommended for midfoot Charcot arthropathy because it is rarely progressive, unlike hindfoot-ankle arthropathy. In some cases, simple bumpectomy can be required to prevent catastrophic infection.


Subject(s)
Amputation , Arthropathy, Neurogenic , Diagnosis , Extremities , Foot , Foot Ulcer , Humans , Orthotic Devices , Shoes , Standard of Care , Ulcer , Walking , Weight-Bearing
17.
Salud(i)ciencia (Impresa) ; 23(3): 238-244, oct.-nov. 2018. ilus.
Article in Spanish | LILACS, BINACIS | ID: biblio-1015798

ABSTRACT

Diabetic foot ulcers are one of the most important complications of diabetes mellitus type 2. In fact, up to 30% of diabetic patients develop this complication. In recent years new therapies have been implemented to try to promote rapid healing in this type of ulcers, focusing on antibiotic therapy, restoration of vascularization, induction of healing and counteracting neuropathy. Antimicrobial peptides are versatile molecules that induce wound healing, have antimicrobial activity and also promote angiogenesis. Because of these properties, they have been proposed as adjuvants in the therapy for diabetic foot ulcers. In order to avoid excessive costs in the treatment of diabetic ulcers with the use of synthetic AMP, some research groups have chosen to induce peptides with exogenous molecules. Many molecules are capable of inducing antimicrobial peptides both in blood cells and in endothelial cells. Research into the use of AMP as adjuvants in the treatment of diabetic foot ulcers continues in several lines of research, such as synthesis of peptides with specific angiogenic activities, use of peptides from insects or amphibians, as well as the use of synthetic peptides. In the present review, we analyze the possible use of AMP and their inducers in the treatment of diabetic foot ulcers based on the reported studies either in vivo or in vitro.


La úlcera de pie diabético es una de las complicaciones más importantes de la diabetes mellitus tipo 2; de hecho, hasta un 30% de los pacientes diabéticos presentan esta complicación. En los últimos años se han implementado nuevas terapias para tratar de promover la rápida cicatrización de este tipo de úlceras, enfocándose en la terapia antibiótica, el restablecimiento de la vascularización, la inducción de la cicatrización y contrarrestar la neuropatía. Los péptidos antimicrobianos son moléculas versátiles que inducen cicatrización, tienen actividad antimicrobiana y además promueven angiogénesis; dadas estas propiedades se ha propuesto su uso como adyuvantes en la terapia de las úlceras de pie diabético. Con el fin de evitar costos excesivos en el tratamiento de las úlceras diabéticas con el uso AMP sintéticos, algunos grupos de investigación han optado por inducir péptidos con moléculas exógenas. Existen muchas moléculas capaces de inducir péptidos antimicrobianos tanto en células sanguíneas como en células epiteliales. La investigación en el uso de AMP como coadyuvantes en el tratamiento de las úlceras de pie diabético sigue avanzando en varias líneas de investigación: síntesis de péptidos con actividades angiogénicas específicas, uso de péptidos de insectos o anfibios, así como el uso de péptidos sintéticos. En la presente revisión se analiza, sobre la base de los estudios realizados tanto in vivo como in vitro el posible uso de AMP y sus inductores en el tratamiento de úlceras de pie diabético.


Subject(s)
Humans , Wound Healing , Foot Ulcer , Diabetic Foot , Diabetes Mellitus, Type 2/therapy
18.
J. vasc. bras ; 17(4): 296-302, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-969080

ABSTRACT

A lesão no pé de pacientes com diabetes é um importante problema de saúde pública que frequentemente está associado a amputações em membros inferiores e mortalidade nessa população. Objetivos: Investigar os fatores de risco associados a mortalidade em pacientes com pé diabético infectado submetidos a amputação maior. Métodos: Estudo observacional, retrospectivo e caso-controle. Amostra composta por 78 pacientes com pé diabético e úlcera infectada submetidos a amputação maior em um serviço de cirurgia vascular em um hospital universitário no período de 5 anos. Resultados: A média de idade da amostra estudada foi de 63,8 ± 10,5 anos, com 54 (69,2%) pacientes do sexo masculino, com creatinina sérica média de 2,49 ± 2,4 mg/dL e hemoglobina sérica média de 7,36 ± 1,7 g/dL. Houve 47,4% de reinternação. Foi realizada amputação transtibial em 59,0% e transfemoral em 39,7% da amostra estudada. Nesta amostra, 87,2% dos pacientes apresentaram cultura positiva, predominantemente monomicrobiana (67,9%), e 30,8% presentaram infecção hospitalar da úlcera. Os gêneros de bactérias mais frequentes foram Acinetobacter spp. (24,4%), Morganella spp. (24,4%) e Proteus spp. (23,1%). Nenhum gênero bacteriano foi identificado como fator de risco para óbito. O nível de creatinina ≥ 1,3 mg/dL (OR 17,8; IC 2,1-150) e a amputação transfemoral (OR 4,5; C: 1,3-15,7) foram fatores de risco para o óbito. Conclusões: Os níveis séricos de creatinina ≥ 1,3 mg/dL e amputação transfemoral foram fatores de risco para óbito


Foot ulcers in patients with diabetes are a major public health problem and are often associated with lower limbs amputation and mortality in this population. Objectives: To investigate the risk factors associated with mortality in patients with infected diabetic foot ulcers and major lower limb amputations. Methods: This was an observational, retrospective, case-control study with a sample of 78 patients with infected diabetic foot ulcers who had major lower limb amputations at a Vascular Surgery Service at a university hospital. Results: The mean age of the study sample was 63.8 ± 10.5 years, 54 (69.2%) were male, mean serum creatinine was 2.49 ± 2.4 mg/dL and mean serum hemoglobin was 7.36 ± 1.7 g/dL.There was a 47.4% rate of readmissions to the same hospital.Transtibial amputation was performed in 59.0%; and transfemoral amputation in 39.7% of the sample. In this sample, 87.2% had a positive culture, predominantly (68.0%) monomicrobial and nosocomial infection of ulcers was observed in 30.8%. The most common bacterial genera were Acinetobacter spp. (24.4%), Morganella spp. (24.4%) and Proteus spp. (23.1%). No bacterial genus was identified as a predictor of death. Creatinine level ≥ 1.3 mg/dL (OR 17.8; IC 2.1-150) and transfemoral amputation (OR 4.5; IC: 1.3-15.7) were associated with death. Conclusions: Serum creatinine levels ≥ 1.3 mg/dL and transfemoral amputation were risk factors for death


Subject(s)
Humans , Male , Female , Middle Aged , Risk Factors , Diabetic Foot/mortality , Amputation , Wound Infection , Comorbidity , Cross Infection/complications , Foot Ulcer/complications , Lower Extremity , Diabetes Mellitus/mortality , Diabetic Nephropathies/mortality , Observational Study , Infections , Anti-Bacterial Agents/therapeutic use
19.
An. bras. dermatol ; 93(3): 419-421, May-June 2018. graf
Article in English | LILACS | ID: biblio-949878

ABSTRACT

Abstract: Basal cell carcinoma is the most frequent skin cancer, generally located in hair-bearing, sunlight-exposed areas. Basal cell carcinoma usually occurs on the head and neck, but very rarely on extra-facial locations. We report a case of a 65-year-old woman presenting with a solitary non-healing ulcer on the sole of the right foot for two years. Histopathological examination showed a typical nodular basal cell carcinoma, confirmed by positivity to Ber-EP4 on immunohistochemistry. There was no history of trauma, exposure to noxious agents, basal cell nevus syndrome, or xeroderma pigmentosum.


Subject(s)
Humans , Female , Aged , Skin Neoplasms/pathology , Carcinoma, Basal Cell/pathology , Foot Ulcer/pathology , Immunohistochemistry
20.
An. bras. dermatol ; 93(1): 145-147, Jan.-Feb. 2018. graf
Article in English | LILACS | ID: biblio-1038263

ABSTRACT

Abstract: Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.


Subject(s)
Humans , Biguanides/therapeutic use , Foot Ulcer/drug therapy , Disinfectants/therapeutic use , Treatment Outcome , Foot Ulcer/complications , Preliminary Data , Leprosy/complications
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