Resultados del tratamiento con Heberprot-P® en pacientes con diagnóstico de pie diabético / Outcomes of Treatment with Heberprot-P® in Patients Diagnosed with Diabetic Foot

Introducción: El pie diabético es una alteración clínica de base etiopatogénica neuropática e inducida por la hiperglucemia mantenida, en la que con o sin coexistencia de isquemia, y previo desencadenante traumático, produce lesión y/o ulceración del pie. Objetivo: Describir los resultados del tratamiento con Heberprot-P® en pacientes con pie diabético. Métodos: Estudio de corte transversal descriptivo y prospectivo en pacientes con pie diabético pertenecientes al policlínico Joaquín de Agüero y Agüero del municipio Camagüey, durante el período de julio del 2019 a julio del 2020. El universo de estudio estuvo integrado por un total de 60 pacientes con diagnóstico de pie diabético a quienes se les aplicó factor de crecimiento epidérmico. La información se procesó a través del paquete estadístico SPSS versión 21. Resultados: Predominaron los pacientes del grupo de edad de 65 a 74 años (35 por ciento), el sexo femenino (58,8 por ciento), con hipertensión arterial asociada (81,8 por ciento). El 38,4 por ciento de los diabéticos se presentaron con lesiones en los dedos, grado II (63,3 por ciento) según la escala de Wagner. Conclusiones: Con la aplicación del Heberprot-P® presentaron dolor (78,3 por ciento) como efecto adverso y una cicatrización total a la respuesta del tratamiento (96,6 por ciento), lográndose mantener la integridad del miembro(AU)

Introduction: Diabetic foot is a clinical alteration of neuropathic etiopathogenic basis, induced by maintained hyperglycemia, in which, with or without coexistence of ischemia, as well as previous traumatic trigger, foot injury or ulceration is produced. Objective: To describe the outcomes of treatment with Heberprot-P® in patients with diabetic foot. Methods: Descriptive and prospective cross-sectional study carried out in patients with diabetic foot belonging to the Joaquín de Agüero y Agüero Polyclinic of Camagüey Municipality, during the period from July 2019 to July 2020. The study universe was made up of a total of sixty patients diagnosed with diabetic foot who were applied epidermal growth factor. The information was processed through the statistical package SPSS version 21. Results: Patients in the 65-74 years age group predominated (35 percent), together with the female sex (58.8 percent), as well as associated arterial hypertension (81.8 percent). 38.4 percent of diabetic patients presented with finger lesions of grade II (63.3 percent) according to the Wagner's classification. Conclusions: With the application of Heberprot-P®, pain (78.3 percent) appeared as an adverse effect. There was also total healing as a response to treatment (96.6 percent), which permitted to maintain limb integrity(AU)

Prescription Pattern And Usage Of Antimicrobial Agents For Treating Diabetic Foot Infections At Tertiary Care Centre

Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used. Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel. Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms. Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.

A Study to Evaluate Clinical and Bacteriological Profile and the Effect of the Treatment to Diabetic Foot Ulcer Patients Both in Outpatient and Hospitalized Settings in a Newly Set Up Diabetic Foot Care Unit.

The problem of diabetes continues to explode in our country today. India now has the dubious distinction of being called, “the diabetic capital of the world”. Diabetic foot ulcerations & infections are one of the leading causes of mortality & morbidity from diabetes. It is the most expensive complication of diabetes & the leading cause of hospitalization when compared to other complication of diabetes. The number of cases & problems associated with diabetic foot infection have dramatically increased in the recent years. In rural Bengal, the problem is grave as detection and treatment initiation is very late.METHODSA prospective observational study was conducted in Medicine & Surgery OPD and IPD of Bankura Sammilani Medical College for twenty weeks. Baseline characteristic were noted, ulcer classification was done followed by swab culture, debridement and antimicrobial therapy. Then outcome was observed.RESULTSMaximum patients were aged between 38 to 58 years, were male and were Wagner 1-3 classification. From culture report S. aureus was predominant followed by Enterobacteriaceae group and anaerobes. Amoxicillin-clavulanic acid combination was the most effective antibiotic followed by amikacin. Treatment was satisfactory with dressing, debridement and appropriate antibiotic.CONCLUSIONSS. aureus, Enterococcus, Pseudomonas aeruginosa, E. coli & Anaerobes were the most common causes of diabetic foot infections in my study, and were sensitive to the conventional antibiotics indicating that there is no evidence to suggest significant resistance to these antibiotics. Hence, their empirical usage, either oral or injectable (depending on the type of foot ulcer) is justified. Proper education regarding footwear & foot care is strongly recommended in such patients.

Evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner / Evolution of the diabetic foot graded 4 and 5 in Wagner's classification scale

Introducción: Las úlceras del pie diabético en estadio 4 y 5 de Wagner constituyen lesiones crónicas avanzadas con deterioro vascular, de pronóstico reservado y predicen riesgo de amputación superior a 90 por ciento. Objetivo: Describir la evolución del pie diabético en los grados 4 y 5 de la clasificación de Wagner. Métodos: Estudio descriptivo, retrospectivo, en el Hospital "Manuel Fajardo" desde junio 2011 hasta mayo 2016. La muestra estuvo constituida por 46 pacientes; se les aplicó Heberprot-P® y se asoció cámara hiperbárica al pie diabético complicado. Las variables estudiadas fueron: edad, sexo, factores de riesgo, tiempo de evolución de la diabetes mellitus, nivel anatómico de ausencias de pulsos, escala de Wagner, evolución de la lesión, cámara hiperbárica, porcentaje de granulación y semanas de tratamiento. Resultados: Habían 22 (47,8 por ciento) pacientes mayores de 67 años de edad, el sexo masculino fue el más afectado 38 (82,6 por ciento); la hipertensión arterial y el hábito de fumar fueron los factores de riesgo más frecuentes; 32 pacientes con más de 20 años de evolución de la diabetes mellitus. La ausencia de pulso poplíteo se observó en 37 pacientes. Con pie diabético en estadio 4 y 5 de Wagner hubo 31 (67,3 por ciento) y 15 (32,6 por ciento) pacientes respectivamente; 24 mostraron infección sobreañadida, de ellos 20 usaron cámara hiperbárica, 7 fracasos al tratamiento, 3 amputaciones infracondilia y 4 supracondilia. Epitelizaron al 100 por ciento 33 pacientes y 6 evolucionan satisfactoriamente. Conclusiones: El pie diabético en estadios terminales evoluciona favorablemente con Heberprot-P® y cámara hiperbárica(AU)

Introduction: The diabetic foot ulcers classified as 4 and 5 grades in Wagner´s classification scale are advanced chronic vascular lesions with a worse prognosis and they predict a risk of amputation over 90 percent. Objectives: To describe the evolution of the 4th and 5th grade diabetic foot in the Wagner classification scale. Methods: A retrospective and descriptive study was conducted in a sample of 46 patients at ¨Manuel Fajardo¨ hospital from June 2011 to May 2016. These patients were treated with Heberprot-P® and hyperbaric chamber therapy was added to manage complicated diabetic foot. The study variables were age, gender, risk factor, length of time with diabetes mellitus, anatomical level of pulse absence, Wagner's classification scale, ulcer evolution, hyperbaric chamber, granulation percentage and number of weeks of treatment. Results: There were 22 (47.8 percent) patients aged over 67 years, males were the most affected with 38 individuals (82.6 percent), hypertension and smoking were the most frequent risk factors and 32 patients had suffered from diabetes for more than 20 years. The popliteal pulse was not found in 37 patients. Thirty one (67.3 percent) and 15 (32.6 percent) patients showed diabetic foot graded 4 and 5, respectively. Twenty four patients showed added infection, 20 of them were treated with hyperbaric chamber, 7 patients did not succeed in treatment, 4 underwent supracondylar and 3 infracondylar amputations. Thirty three patients reached 100 percent epithelization and 6 recovered satisfactorily. Conclusions: The diabetic foot classified as terminal staging may present favorable evolution with the use of Heberprot-P® and hyperbaric chamber(AU)

Effect of vacuum-assisted closure in the treatment of diabetic foot / 中国综合临床

Objective To explore the effect of vacuum-assisted closure (VAC) in the treatment of diabetic foot.Methods Sixty-seven cases patients with diabetic foot in Chaoyang Central Hospital from January 2010 to January 2016 were recruited successively,according to wagner criteria for 2-5 diabetic foot classification.They were divided into VAC group with 34 cases and control group with 33 cases according to the different treatment methods.Both groups were given debridement treatment.After debridement,the patients in control group were given wound dressing every day or every other day.When fresh granulation tissue on wound surface became well-stacked,skingrafting or skin flap reparation was carried out.After debridement,patients in VAC group were given VAC treatment for 5 days.When fresh granulation tissue on wound surface became wellstacked,skingrafting or skin flap reparation was performed.The wound healing duration,healing rate and amputation rate were compared between the two groups.Results The wound healing time,healing rate and amputation rate of VAC group were (30.91 ± 15.61) d,97.1％ (33/34) and 3％ (1/34) respectively,of the control group were (58.86± 14.23) d,75.8％ (25/33) and 24.2％ (8/33) respectively.There were significant differences between the two groups(P＜0.05).Conclusion VAC treatment of diabetic foot ulcer has significant effect,can promote wound healing,improve the healing rate and reduce the risk of amputation(toe).

Identificación de los factores de riesgo que conducen al desarrollo de las lesiones neuropáticas ulceradas / Identification of the risk factors for the development of the neuropathic ulcerated wounds

Introducción: el pie diabético es una complicación crónica de la diabetes mellitus, que constituye un problema sanitario por el enorme gasto económico que ocasiona a los servicios de salud y provocar en las personas que lo padecen y su entorno familiar repercusiones sociales y emocionales. Objetivo: identificar la presencia de los factores de riesgo que condujeron al desarrollo de las lesiones neuropáticas ulceradas. Métodos: estudio descriptivo, retrospectivo, en los 109 pacientes diabéticos, sin distinción de sexo y tipo de diabetes, ingresados en el Servicio Provincial de Angiología y Cirugía Vascular, de Matanzas con el diagnóstico de pie diabético neuropático ulcerado en los grados 2 y 3 de Wagner. El período de estudio osciló entre enero de 2010 y mayo de 2014. Resultados: se constató la presencia de neuropatía diabética, existencia de helomas/hiperqueratosis y calzado inadecuado, asociados en más de la mitad de las circunstancias, con un déficit de los cuidados del pie. El número de factores de riesgo por paciente osciló entre seis y siete. En correspondencia con lo anterior, la estratificación de riesgo demostró una elevada frecuencia de pacientes con nivel de riesgo 3. Conclusión: la neuropatía diabética, la presencia de helomas/hiperqueratosis, y el uso de calzado inapropiado constituyen los factores de riesgo más frecuentemente asociados a la aparición de la ulceración neuropática del pie diabético en la población estudiada(AU)

Introduction: the diabetic foot is a chronic complication of diabetes mellitus that represents a health problem due to the high economic cost for the health care services and the social and emotional effects on the people suffering the disease and their family environment. Objective: to identify the risk factors leading to ulcerated neuropathic lesions. Methods: a descriptive and retrospective study conducted in 109 diabetic patients, regardless of sex and type of diabetes, who were diagnosed as 2nd and 3rd degree ulcerated neuropathic diabetic foot according to Wagner classification, and admitted to the Angiology and Vascular Surgery Service of Matanzas province. It was conducted from January 2010 to May 2014. Results: the following risk factors were determined: diabetic neuropathy, callus/hyperkeratosis, wearing wrong shoes; they were mostly associated to inappropriate foot care. The number of risk factors ranged six to seven per patient. In line with the aforementioned, the risk stratification showed a high frequency of patients with risk degree level 3. Conclusions: the presence of diabetic neuropathy, callus/hyperkeratosis, and wearing inappropriate shoes are the most frequent risk factors associated with the occurrence of neuropathic foot ulceration in the studied population(AU)

Pattern of diabetic foot - presentation and complications in rural Indian population.

Background: Foot ulcer is one of the most common and deadest complications of diabetes mellitus. This is also a frequent cause of hospitalization and disability. Most of the patients with diabetic foot ulcers living in developing countries present to healthcare facilities fairly late with advanced foot ulcers because of poor economic status, inadequate knowledge of self-care, sociocultural reasons and poor and inadequate diabetes healthcare. Methods: A prospective study was conducted in the department of Surgery, JNMC Sawangi (Meghe), Wardha of DMIMS (DU) with the aim to evaluate the pattern of distribution of foot ulcers in diabetic foot patients and related complications. We enrolled 30 diabetic patients in the study, of these 21 (70%) were males and 9 (30%) were females with male to female ratio 2.33. Results: The mean age of presentation was 52.93 ± 14.10 and the mean duration of diabetes was 8.20 ± 10.06. The maximum numbers of lesion was present in the region of second to fifth metatarsal (53.33%), followed by heel (26.66%) and great toe (10%). Maximum patients 9 (30%) had grade II lesions as per Wagner’s classification and 12 (40%) had II B as per University of Texas diabetic wound classification. Associated deformity was present in 36.66%, insensitivity to the 5.07 S-W monofilaments in 56.66%, impaired vibration in 43.33%, and abnormal Achilles tendon reflex in 40%. Ankle–brachial index <0.8 was present in 33.33%. Only 13.33% patients were using customized footwear whereas 46.66% were walking barefoot, the difference was statistically significant P = 0.0027. Conclusion: The health education to promote Knowledge, Attitude, Behavior and Practice (KABP) is essential to prevent diabetes associated foot complications.

Eficacia del Heberprot-P® en el tratamiento de las úlceras del pie diabético / Effectiveness of the Heberprot-P® in the treatment of diabetic foot ulcers

Se realizó un estudio descriptivo y transversal de 120 pacientes con úlceras del pie diabético, atendidos en el Centro de Diagnóstico Integral El Bajo perteneciente al municipio San Francisco, Maracaibo, Estado de Zulia, República Bolivariana de Venezuela, desde febrero de 2011 hasta igual mes de 2012, con vistas a evaluar la efectividad de la administración del factor de crecimiento epidérmico humano. En la casuística predominaron el grupo etario de 55-59 años y el sexo femenino. En todos los integrantes de la serie se logró la granulación y la cicatrización de las lesiones y no fue necesario efectuar la amputación. La administración intralesional del Heberprot-P® puede completar el cierre de la lesión, por lo cual es un medicamento seguro y conveniente para sanar dichas úlceras

A descriptive and cross-sectional study was conducted in 120 patients with diabetic foot ulcers treated at El Bajo Comprehensive Diagnosis Center belonging to San Francisco municipality, Maracaibo, State of Zulia, Bolivarian Republic of Venezuela, from February 2011 to February 2012 in order to evaluate the effectiveness of the administration of human epidermal growth factor. Age group of 55-59 years and the females prevailed in the case material. In all patients of the series granulation and healing of lesions was obtained and amputation was not necessary. Intralesional administration of Heberprot-P® can complete closure of the lesion; therefore it is a safe and advisable drug to heal these ulcers