ABSTRACT
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.
Subject(s)
Diabetes MellitusABSTRACT
La osteomielitis (OM) es una complicación de las úlceras en pie diabético que habitualmente es subdiagnosticada y tratada en forma tardía e inadecuada. La demora en el tratamiento de estos pacientes aumenta el riesgo de amputación. En esta revisión, se analiza la bibliografía actual acerca del diagnóstico de OM y se realizan recomendaciones en base a la misma, y a las características de los pacientes, los insumos y las posibilidades en nuestro medio.
Diabetic foot osteomyelitis (OM) is a diabetic foot ulcer complication. Usually, it is misdiagnosed and the treatment is delayed and inadequate. Delaying the treatment of these patients rises the risk of amputation. In this revision, current bibliography about this topic is updated and clinical practice recommendations are done, based on the publications and adapted to the characteristics of our country
Subject(s)
Osteomyelitis , Biopsy , Diabetic Foot , DiagnosisABSTRACT
Resumen La osteomielitis (OM) es una complicación de las úlceras en pie diabético que habitualmente es subdiagnosticada y tratada en forma tardía e inadecuada. La demora en el tratamiento de estos pacientes aumenta el riesgo de amputación. En esta revisión, se analiza la bibliografía actual acerca del diagnóstico de OM y se realizan recomendaciones en base a la misma, y a las características de los pacientes, los insumos y las posibilidades en nuestro medio.
Abstract Diabetic foot osteomyelitis (OM) is a diabetic foot ulcer complication. Usually, it is misdiagnosed and the treatment is delayed and inadequate. Delaying the treatment of these patients rises the risk of amputation. In this revision, current bibliography about this topic is updated and clinical practice recommendations are done, based on the publications and adapted to the characteristics of our country.
ABSTRACT
The objective of this study was to compare standard treatment versus the combination of intrapancreatic autologous stem cell (ASC) infusion and hyperbaric oxygen treatment (HBOT) before and after ASC in the metabolic control of patients with type 2 diabetes mellitus (T2DM). This study was a prospective, randomized controlled trial. The combined intervention consisted of 10 sessions of HBOT before the intrapancreatic infusion of ASC and 10 sessions afterwards. ASCs were infused into the main arterial supply of the pancreas to maximize the presence of the stem cells where the therapeutic effect is most desired. A total of 23 patients were included (control group = 10, intervention group = 13). Age, gender, diabetes duration, number of medications taken, body weight and height, and insulin requirements were recorded at baseline and every three months. Also, body mass index, fasting plasma glucose, C-peptide, and HbA1c, C-peptide/glucose ratio (CPGR) were measured every three months for one year. HbA1c was significantly lower in the intervention group compared with control throughout follow-up. Overall, 77% of patients in the intervention group and 30% of patients in the control group demonstrated a decrease of HbA1c at 180 days (compared with baseline) of at least 1 unit. Glucose levels were significantly lower in the intervention group at all timepoints during follow-up. C-peptide levels were significantly higher in the intervention group during follow-up and at one year: 1.9 ± 1.0 ng/mL versus 0.7 ± 0.4 ng/mL in intervention versus control groups, respectively, p = 0.0021. CPGR was higher in the intervention group at all controls during follow-up. The requirement for insulin was significantly lower in the intervention group at 90, 180, 270, and 365 days. Combined therapy of intrapancreatic ASC infusion and HBOT showed increased metabolic control and reduced insulin requirements in patients with T2DM compared with standard treatment.
