Efficacy and tolerance of calcium alginate versus vaseline gauze dressings in the treatment of diabetic foot lesions.

BACKGROUND: The study aimed at comparing the efficacy and tolerance of an alginate wound dressing with a vaseline gauze dressing in the treatment of diabetic foot lesions. METHODS: This open-label randomized multicenter controlled study was designed to assess the effect of an up to 6-week treatment with either calcium alginate or vaseline gauze dressings. Lesions were either acute or chronic, under cleansing, and with a surface area of 1-50 cm(2); osteomyelitis and severe hypovascularization were non-inclusion criteria. Dressings were changed every day then, once granulation had occurred, every 2 to 3 days. Primary outcome was the proportion of patients with granulation tissue over 75% of the wound area and having a 40% decrease in wound surface area; secondary outcomes were pain on dressing changes, the number of dressing changes, and adverse events. RESULTS: Seventy-seven patients were enrolled. Due to the premature cessation of treatment in 13 patients, it was decided to reduce the period of the efficacy analysis to 4 weeks (without revising the criteria of efficacy). The success rate was of 42.8% in the calcium alginate group and of 28.5% in the vaseline gauze group (not significant difference). A subsequent analysis of granulation tissue surfaces covering the wounds at week 4 (all surfaces taken together) showed a superiority of calcium alginate (p=0.04). Pain on dressing change was lower in the calcium alginate group (p=0.047) and the total number of dressing changes tended also to be lower (p=0.07). Adverse events, which occurred 4 times in the calcium alginate group and 6 times in the other, were judged independent of the treatments. CONCLUSIONS: As compared with vaseline gauze, calcium alginate appears to be more appropriate for topical treatment of diabetic foot lesions in terms of both healing and tolerance.

Multicenter randomized evaluation of a nutritional education software in obese patients.

OBJECTIVE: To study the efficacy of the nutritional education software, Nutri-Expert, in the management of obese adult patients. MATERIAL AND METHODS: Two groups of obese patients were followed up over one year in a randomized study: the first group received close traditional management (seven nutritional visits over the year, with physicians and dietitians conjointly) and the second one also used at home by Minitel the Nutri-Expert system. 557 patients were enrolled in the study by 16 French centers of diabetology and nutrition. Body mass index (BMI), tests of dietetic knowledge, dietary records and centralized biological measurements were assessed at inclusion, 6 and 12 months. 341 patients were evaluable at the end of the year. RESULTS: The group using Nutri-Expert scored significantly better in the tests of dietetic knowledge than the control group. For all patients, nutritional education led to a significant improvement in BMI, dietary records and biological measurements, without significant difference between the two groups. Five years after the end of the study, the weight of 148 patients was recorded; mean BMI was significantly lower than the initial value but there was no significant difference between the two groups. CONCLUSION: In the management of obese patients, Nutri-Expert system has a role to play in reinforcing nutritional knowledge; if regular follow-up is not possible, or if a large series of obese patients is to be treated, Nutri-Expert could partly replace traditional management, for example between visits.

Physical activity and type 2 diabetes. Recommandations of the SFD (Francophone Diabetes Society) diabetes and physical activity working group.

Although regular physical activity is an integral part of T2D management, few diabetic patients have a sufficient level of physical activity. However over the past decade or so, the beneficial effects of regular physical activity have been well demonstrated, both in T2D prevention (50% reduction in the incidence of T2D in subjects with high metabolic risk) as well as T2D management for the improvement of glycaemic control (mean 0.7% improvement of HbA1c) and the reduction of T2D-related comorbidities (improvement in blood pressure values and lipid profile, decrease in insulin resistance). Physical activity has both acute effects (effects of one exercise session) and more prolonged effects of exercise when it is repeated on a regular basis (training effect). In addition, the physical activity recommendations have been extended to a wide range of physical activities (by combining both endurance and muscle strengthening exercises), thus varying the physical activity practiced according to the patient's available time, practice sites, preferences and interests. Following a pathophysiology review, the effects of physical activity will be discussed and presented in terms of evidence-based medicine. The recommendations will be defined and practical prescribing information will be suggested, while taking into account that clinicians are concerned with answering questions regarding how, where and with whom: how can patients be motivated to practice a physical activity over the long-term? And how can qualified exercise trainers and appropriate practice settings be found?

[Anorectal lesions in hemopathies]. / Les lésions anorectales au cours des hémopathies.

An understanding of anorectal lesions during hemopathy is of value since this disorder can be difficult to identify and treat. The authors report three cases of anorectal lesions during hemopathy. The following points emerged from this study, and from literature data: hemopathic disorders should be born in mind in cases of acute anal syndromes; the relative frequency of acute leukemia of specific lesions: nodules, in patches or aspecific: purpura, hematoma, fissures, ulceration, ulcers; marked neutropenia in leukemia and agranulocytosis; severity of anal surgery, which should be prudent. Atypical anal lesions may indicate hemopathy. They may respond favorably to medical treatment; prognostic severity of these lesions, especially if ulcerous and necrotic.

[Pseudomembranous rectocolitis]. / Les rectocolites pseudo-membraneuses.

The following conclusions were drawn from a study of 15 cases of pseudo-membranous coloproctitis (PMCP): PMCP was seen in subjects of both sexes and all ages. The causative agent was found in all antibiotic classes. Clinical signs comprised constant diarrhea, fever, abdominal pain, toxic shock and, more rarely, pseudo-occlusive, pseudo-perforative surgical evidence. Diagnosis involved visualization of pseudo-membranes by endoscopy. Lesions were most frequent in the left colon and increased in severity towards the distal end. Three stages were distinguished by histological examination: superficial necrosis of the mucous membranes, interruption of glands, complete necrosis of the mucous membrane. Without preparation the abdomen did not provide specific information; nor did barium enema which revealed lesions that were frequently diffuse but more marked in the left colon. Conventional coprocultures did not provide diagnostic information. Only a more sophisticated technique will be capable of detecting the pathogen currently considered to be the cause of PMCP: Clostridium difficile. The course of the disorder is generally satisfactory under medical treatment (parenteral feeding, vancomycin) but may sometimes call for surgery.