Pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro / Patients with amputation of lower limbs due to vascular causes in Cerro municipality

Introducción: La amputación provoca discapacidad física e invalidez como consecuencia de la enfermedad vascular periférica. Objetivo: Caracterizar a los pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro. Métodos: Se realizó un estudio descriptivo en los 114 amputados de miembros inferiores que estaban registrados, entre 2016 y 2018, en la Dirección Municipal de Salud del municipio Cerro. La muestra quedó constituida por los 64 amputados de causa vascular. Las variables de estudio fueron: edad, sexo, factores de riesgo, tipo de amputación y su nivel, miembro más afectado y causa vascular de amputación. Se estimaron las frecuencias absolutas y relativas, y la prueba de chi cuadrado, para identificar la asociación entre las variables. Resultados: Hubo predominio de los amputados de causa vascular (56,1 por ciento), el sexo femenino (54,7 por ciento), el grupo etáreo de 60 años y más (84,4 por ciento), y la HTA y el tabaquismo (ambos con 60,9 por ciento). La amputación supracondílea fue la más realizada (64,1 por ciento). El pie diabético isquémico y la aterosclerosis obliterante resultaron las causas vasculares que provocaron los mayores porcentajes de amputación. Se halló asociación altamente significativa entre el sexo masculino y la ateroesclerosis obliterante (X2 = 5,4; p = 0,113, OR = 2,68 y RR = 1,81), lo que señaló a este como un factor de riesgo de amputación. Conclusiones: Las amputaciones aparecieron con mayor frecuencia en las mujeres mayores de 60 años, del tipo supracondílea y por pie diabético como causa vascular. La ateroesclerosis obliterante en los hombres constituyó un factor de riesgo de amputación(AU)

Introduction: Amputation as a result of peripheral vascular disease causes physical disability and impairment. Objective: Characterize amputee patients of lower limbs due to vascular causes in Cerro municipality. Methods: A descriptive study was carried out in the 114 lower limbs amputee patients that were registered, between 2016 and 2018, in the Municipal Health Division of Cerro municipality. The sample consisted of the 64 vascular-cause amputees. The study variables were: age, sex, risk factors, type of amputation and its level, most affected limb and vascular cause of amputation. Absolute and relative frequencies were estimated, and the chi square test was used to identify the association between variables. Results: There was predominance of vascular-cause amputees (56.1 percent), the female sex (54.7 percent), the 60-year-old and older age group (84.4 percent), and HTA and smoking having (both 60.9 percent). Supracondylar amputation was the most performed one (64.1 percent). Ischemic diabetic foot and obliterating atherosclerosis resulted in the vascular causes that produce the highest percentages of amputation. A highly significant association was found between the male sex and obliterating atherosclerosis (X2 = 5.4; p = 0.113; OR = 2.68 and RR = 1.81), which pointed to this as an amputation risk factor. Conclusions: Amputations most often appeared in women over the age of 60, as supracondyle type and diabetic foot as a vascular cause. Obliterating atherosclerosis in men was a risk factor for amputation(AU)

Infecciones en pie diabético: Elección del tratamiento antibiótico empírico / Infections in diabetic foot. Choice of empirical antibiotic regimen

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.

Conhecimentos e práticas para a prevenção do pé diabético / Conocimientos y prácticas para la prevención del pie diabético / Knowledge and practices for the prevention of the diabetic foot

Resumo OBJETIVO Descrever os problemas e as práticas realizadas para a prevenção do pé diabético. MÉTODOS Estudo descritivo, transversal com amostragem aleatória estratificada, em 304 pessoas com Diabetes Mellitus tipo 2. Os dados foram coletados com o uso de um instrumento delineado pelas pesquisadoras que avalia aspectos sociodemográficos e o nível de conhecimentos e práticas dos participantes no cuidado dos pés para a prevenção do pé diabético. RESULTADOS A avaliação dos cuidados na prevenção do pé diabético mostra conhecimentos de níveis baixo e médio, enquanto as práticas foram medianamente adequadas. CONCLUSÕES Os resultados dos conhecimentos e práticas orientadas para a prevenção do pé diabético não pouco animadores, e frente a este panorama são relevantes os programas de atenção primária, onde de utilize uma educação efetiva da parte de enfermeiros, como mecanismo para modificar os comportamentos de pessoas com Diabetes Mellitus.

Resumen OBJETIVO Describir los conocimientos y prácticas que realizan las personas para la prevención del pie diabético. MÉTODOS Estudio descriptivo, transversal con muestreo aleatorio estratificado, participaron 304 personas con Diabetes Mellitus tipo 2, la información se recolectó mediante el empleo de un instrumento diseñado por las investigadoras que evaluaban los aspectos sociodemográficos, nivel de conocimientos y prácticas de los participantes en el cuidado de sus pies para la prevención del pie diabético. RESULTADOS Al evaluar los cuidados en la prevención del pie diabético, los conocimientos se ubicaron en un nivel bajo y medio, mientras que las prácticas fueron medianamente adecuadas. CONCLUSIONES Los resultados en los conocimientos y prácticas orientadas a la prevención del pie diabético son poco alentadores, ante este panorama cobran relevancia los programas de atención primaria, donde se emplee una educación efectiva por parte de Enfermería, como mecanismo para modificar los comportamientos de la persona con Diabetes Mellitus.

Abstract OBJECTIVE Describe the knowledge and practices performed by people for diabetic foot prevention. METHODS This was a cross-sectional, descriptive study, with a random stratified sample, comprised of 304 people with type 2 diabetes mellitus. The information was collected through an instrument designed by the researchers that assessed sociodemographic aspects, and level of knowledge and practices of the participants in diabetic foot care prevention. RESULTS In the assessment of diabetic foot care prevention, there was a low and average level of knowledge, whereas practices were moderately adequate. CONCLUSIONS The results for diabetic foot prevention knowledge and practices are not very encouraging. In light of this situation, primary care programs are important, where nurses provide effective education, as a mechanism for modifying the behavior of people with diabetes mellitus.

Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.

Assessment of ulceration risk in diabetic individuals / Evaluación del riesgo de ulceración en los individuos diabéticos / Avaliação do risco de ulceração em indivíduos diabéticos

ABSTRACT Objective: To identify the risk factors for foot ulceration through the tracing of diabetic peripheral neuropathy and peripheral arterial disease in individuals with type I and II diabetes, who were assisted in reference centers of the Federal District, Brazil. Method: a cross-sectional and analytical study, with the assessment of 117 individuals in outpatient clinics of the Federal District. Continuous variables were compared through Mann-Whitney test, and categorized variables, through Chi-square test for univariate analysis and Logistics regression test for multivariate analysis. Results: painful diabetic peripheral neuropathy was present in 37 (75.5%) of the individuals with neuropathy. Deformities and loss of protective plant sensibility were related to neuropathy (p=0.014 and p=0.001, respectively). Of the 40 (34.2%) individuals in the sample who presented peripheral arterial disease, 26 (65%) presented calcification risk. Conclusion: signs of painful peripheral polyneuropathy, peripheral arterial disease, deformities, loss of protective plantar sensibility, and dry skin were identified as risk factors for ulceration.

RESUMEN Objetivo: Identificar los factores de riesgo para la ulceración del pie de acuerdo con el rastreo de neuropatía diabética periférica y la enfermedad arterial periférica en los individuos diabéticos tipo I y II asistidos en los centros de referencia del Distrito Federal, Brasil. Método: Estudio transversal y analítico, con la evaluación de 117 individuos en ambulatorios del Distrito Federal. Las variables continuas fueron comparadas por medio de la prueba de Mann-Whitney, y las variables categorizadas, de las pruebas de chi cuadrado para los análisis univariados y la regresión logística para los análisis multivariados. Resultados: La neuropatía diabética periférica dolorosa estuvo presente en 37 (el 75,5%) de los individuos con neuropatía. Las deformidades y la pérdida de sensibilidad protectora plantar tuvieron relación con la neuropatía (p=0,014 y p=0,001, respectivamente). De los 40 (el 34,2%) individuos de la muestra con enfermedad arterial periférica, 26 (el 65%) presentaron riesgo de calcificación. Conclusión: Identificadas las señales de polineuropatía dolorosa periférica, la enfermedad arterial periférica, las deformidades, la pérdida de sensibilidad protectora plantar y la piel seca como los factores de riesgo para ulceración.

RESUMO Objetivo: Identificar os fatores de risco para ulceração do pé mediante o rastreamento de neuropatia diabética periférica e doença arterial periférica em indivíduos diabéticos tipo I e II assistidos em centros de referência do Distrito Federal, Brasil. Método: estudo transversal e analítico, com avaliação de 117 indivíduos em ambulatórios do Distrito Federal. As variáveis contínuas foram comparadas por meio do teste de Mann-Whitney, e as variáveis categorizadas, dos testes de qui-quadrado para análises univariadas e regressão logística para análises multivariadas. Resultados: a neuropatia diabética periférica dolorosa esteve presente em 37 (75,5%) dos indivíduos com neuropatia. Deformidades e perda de sensibilidade protetora plantar tiveram relação com neuropatia (p=0,014 e p=0,001, respectivamente). Dos 40 (34,2%) indivíduos da amostra com doença arterial periférica, 26 (65%) apresentaram risco de calcificação. Conclusão: identificados sinais de polineuropatia dolorosa periférica, doença arterial periférica, deformidades, perda de sensibilidade protetora plantar e pele seca como fatores de risco para ulceração.

Etiología y perfil de resistencia antimicrobiana en infecciones del pie diabético / Etiology and antimicrobial resistance profile in diabetic foot infections

El pie diabético infectado (PDI) es aquel que presenta infección de piel y partes blandas u óseas por debajo del maléolo; constituye la complicación más frecuente de diabetes que causa hospitalización y amputación. En nuestro hospital los pacientes con pie diabético son asistidos en un consultorio multidisciplinario; el 40% presenta infección leve moderada o grave

Fatores associados à ulceração nos pés de pessoas com diabetes mellitus residentes em área rural / Factores asociados a la ulceración en los pies de personas con diabetes mellitus residentes en área rural / Factors associated with foot ulceration of people with diabetes mellitus living in rural areas

RESUMO Objetivo Analisar os fatores associados ao risco de ulceração nos pés de pessoas com diabetes mellitus residentes em área rural. Métodos Estudo transversal realizado com 293 pessoas com diabetes mellitus, com 40 anos ou mais, residentes em município do sul do Brasil, em 2014. Analisou-se variáveis socioeconômicas, clínicas e o autocuidado com os pés. Utilizou-se o modelo de regressão múltipla de Poisson e como medida de associação a Razão de Prevalência (RP) e p-valor<0,05. Resultados 43,7% da amostra apresentou risco de ulceração nos pés. A maior prevalência desse risco foi associada a pessoas com menor poder aquisitivo (RPajustada=1,62/IC95%:1,52-2,22), retinopatia (RPajustada=1,30/IC95%:1,12-1,68) e alteração na umidade dos pés (RPajustada=1,57/IC95%:1,22-2,01). Identificou-se baixa escolaridade (64,2%), alta prevalência de hipertensão arterial (86,3%) e onicomicose nos pés (72%). Conclusões Pessoas com diabetes necessitam de avaliação do risco de ulceração nos pés, principalmente, os com maior tempo de diagnóstico, complicações crônicas e baixo nível socioeducacional.

RESUMEN Objetivo Analizar los factores asociados al riesgo de ulceración en los pies de personas con diabetes mellitus residentes en área rural. Métodos Estudio transversal realizado con 293 personas con diabetes mellitus, con 40 años o más, residentes en una ciudad en el sur de Brasil, en 2014. Se analizaron las variables socioeconómicas, las condiciones clínicas y el autocuidado con los pies. Se utilizó el modelo de regresión múltiple de Poisson y para el análisis de la asociación fue utilizada la Razón de Prevalencia (RP) y p-valor<0,05. Resultados 43,7% de la muestra presentó riesgo de ulceración en los pies. La mayor prevalencia de este riesgo fue asociada a personas con menor poder adquisitivo (RPajustada=1.62/IC95%:1.52-2.22), con retinopatía (RPajustada=1.30/IC95%:1.12-1.68) y alteración en la humedad de los pies (RPajustada=1.57/IC95%:1.22-2.01). Se identificó baja escolaridad (64,2%), alta prevalencia de hipertensión arterial (86,3%) y onicomicosis en los pies (72%). Conclusiones Los diabéticos deben ser evaluados cuanto al riesgo de ulceración en los pies, sobre todo, aquellos con diagnóstico a largo tiempo, complicaciones crónicas y bajo nivel socioeducativo.

ABSTRACT Objective To analyze the factors associated with the risk of ulceration in the feet of people with diabetes mellitus living in rural areas. Methods This is a cross-sectional study conducted with 293 individuals with diabetes mellitus, aged 40 years or older, living in the south of Brazil, in 2014. We analyzed socioeconomic variables, clinical conditions and foot self-care. We used the Poisson multiple regression model and the Prevalence Ratio (PR) and p-value<0.05 as a measure of association. Results 43.7% of the sample presented risk of foot ulceration. The highest prevalence of foot ulceration risk was associated with people with lower purchasing power (PRadjusted=1.62/IC95%:1.52-2.22), with retinopathy (PRadjusted=1.30/IC95%:1.12-1.68) and alteration in foot moisture (PRadjusted=1.57/IC95%:1.22-2.01). We identified low education level (64.2%), high prevalence of arterial hypertension (86.3%) and onychomycosis in the feet (72%). Conclusions Diabetic patients need an assessment of the risk of foot ulceration, especially those with longer diagnosis, chronic complications and low socio-educational level.

The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload). Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

Risk factors for Charcot foot

Objective Diabetes mellitus is the main cause of Charcot neuroarthropathy and is clinically classified as follows: Charcot foot, acute Charcot foot (ACF) when there is inflammation, and inactive Charcot foot when inflammatory signs are absent. The aim of this study was to identify the risk factors for ACF in patients with type 2 diabetes mellitus.Materials and methods A matched case-control study was conducted to assess the factors associated with acute Charcot foot from February 2000 until September 2012. Four controls for each case were selected 47 cases of ACF and 188 controls without ACF were included. Cases and controls were matched by year of initialization of treatment. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).Results In multivariate analysis, patients having less than 55 years of age (adjusted OR = 4.10, 95% CI = 1.69 – 9.94), literate education age (adjusted OR = 3.73, 95% CI = 1.40 – 9.92), living alone (adjusted OR = 5.84, 95% CI = 1.49 – 22.86), previous ulceration (adjusted OR = 4.84, 95% CI = 1.62 – 14.51) were at increased risk of ACF. However, peripheral arterial disease (adjusted OR = 0.16, 95% CI = 0.05 – 0.52) of 6.25 (1.92 – 20.0) was a protective factor.Discussion The results suggest that PCA in type 2 diabetes primarily affects patients under 55 who live alone, are literate, and have a prior history of ulcers, and that peripheral arterial disease is a protective factor. Arch Endocrinol Metab. 2015;59(3):226-30.

Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure / Meta-Analysis of Ultrafiltration versus Diuretics Treatment Option for Overload Volume Reduction in Patients with Acute Decompensated Heart Failure

Introduction: Although diuretics are mainly used for the treatment of acute decompensated heart failure (ADHF), inadequate responses and complications have led to the use of extracorporeal ultrafiltration (UF) as an alternative strategy for reducing volume overloads in patients with ADHF. Objective: The aim of our study is to perform meta-analysis of the results obtained from studies on extracorporeal venous ultrafiltration and compare them with those of standard diuretic treatment for overload volume reduction in acute decompensated heart failure. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases were systematically searched using a pre‑specified criterion. Pooled estimates of outcomes after 48 h (weight change, serum creatinine level, and all-cause mortality) were computed using random effect models. Pooled weighted mean differences were calculated for weight loss and change in creatinine level, whereas a pooled risk ratio was used for the analysis of binary all-cause mortality outcome. Results: A total of nine studies, involving 613 patients, met the eligibility criteria. The mean weight loss in patients who underwent UF therapy was 1.78 kg [95% Confidence Interval (CI): −2.65 to −0.91 kg; p < 0.001) more than those who received standard diuretic therapy. The post-intervention creatinine level, however, was not significantly different (mean change = −0.25 mg/dL; 95% CI: −0.56 to 0.06 mg/dL; p = 0.112). The risk of all-cause mortality persisted in patients treated with UF compared with patients treated with standard diuretics (Pooled RR = 1.00; 95% CI: 0.64–1.56; p = 0.993). Conclusion: Compared with standard diuretic therapy, UF treatment for overload volume reduction in individuals suffering from ADHF, resulted in significant reduction of body weight within 48 h. However, no significant decrease of serum creatinine level or reduction of all-cause mortality ...

Introdução: Embora os diuréticos sejam utilizados como o principal tratamento na insuficiência cardíaca aguda descompensada, sua significativa taxa de complicações e respostas inadequadas levou ao uso de ultrafiltração extracorpórea como uma alternativa. Objetivo: Realizar uma meta-análise de estudos de ultrafiltração venosa extracorpórea e diuréticos no tratamento de sobrecarga hídrica na insuficiência cardíaca aguda descompensada. Métodos: MEDLINE, EMBASE e o banco de dados do Cochrane Central Register of Controlled Trials foram pesquisados sistematicamente usando um critério pré-estabelecido. Estimativas combinadas para os resultados na alteração de peso em 48 horas, creatinina sérica e mortalidade por todas as causas foram calculados utilizando modelos de efeitos aleatórios. As diferenças entre as médias ponderadas combinadas foram calculadas para a perda de peso e alteração nos níveis de creatinina e relação risco partilhado foi utilizada para o resultado binário de todas as causas de mortalidade. Resultados: Nove estudos foram considerados elegíveis para a análise, com inclusão de 613 pacientes. Pacientes submetidos a ultrafiltração perderam em média 1,78kg (intervalo de confiança [IC] 95% -2,65 a 0,91kg, p < 0,001) quando comparados com pacientes submetidos à terapia diurética padrão. Os níveis de creatinina pós-intervenção, no entanto, não diferiram entre os grupos (diferença média de -0,25 mg/dL CI 95% -0,56 a 0,06mg/dL p = 0,112). Não observamos evidências de redução de risco de mortalidade por todas as causas em pacientes submetidos à UF quando comparados àqueles tratados com terapia diurética padrão (RR combinado = 1,00 CI 95% 0,64 1,56, p = 0,993). Conclusão: Quando comparado à terapia diurética padrão, o uso de UF no tratamento de sobrecarga hídrica em ICAD resultou em uma redução significativa de peso em 48 horas. No entanto, não foi observada melhoria significativa na redução dos níveis de creatinina ou na taxa de ...

Análise do risco de pé diabético em um ambulatório interdisciplinar de diabetes / Risk of diabetic foot in an interdisciplinary outpatient clinic of diabetes

Introdução: Pé diabético é uma complicação crônica do diabetes mellitus e sua prevalência é de 4 a 10%. É definido como infecção, ulceração e/ou destruição de tecidos moles associadas a alterações neurológicas e doenças arteriais periféricas nos membros inferiores. O objetivo deste estudo foi caracterizar os pacientes com risco para o pé diabético e avaliar os fatores envolvidos no desenvolvimento de lesões. Método: Estudo quantitativo transversal, realizado em Ambulatório Interdisciplinar de Diabetes. Dados coletados do prontuário e exame físico dos pés entre dezembro de 2013 e março de 2014. Resultados: De um total de 299 pacientes, 76 (25,4%) apresentavam risco para o desenvolvimento do pé diabético. Esse grupo apresentou associações significativas nos seguintes parâmetros: sexo masculino (34,17 versus 19,55%); idade média de 61,02 anos; média do tempo de diagnóstico de 14,95 anos, em uso de insulina (28,98 versus 9,26%); presença de hipertensão arterial sistêmica (28,78 versus 18,09%); acometido por complicações macrovasculares (52,63 versus 19,01%) e microvasculares (39,58 versus 22,71%). Conclusão: No presente estudo, pacientes do sexo masculino, com idade superior a 60 anos, com diagnóstico há mais de 15 anos, em insulinoterapia, hipertensos, associados a complicações macro e microvasculares do diabetes mellitus apresentaram maior risco para o pé diabético. A estratificação dos pacientes em graus de risco é de extrema importância para acompanhamento e manejo adequado (AU)

Introduction: Diabetic foot is a chronic complication of diabetes mellitus and its prevalence is 4-10%. It is defined as infection, ulceration and/or destruction of soft tissue associated with neurological disorders and peripheral arterial disease in the lower limbs. The aim of this study was to characterize patients at risk for diabetic foot and evaluate the factors involved in the development of lesions. Methods: Cross-sectional quantitative study conducted in an Interdisciplinary Outpatient Clinic of Diabetes. Data collected from medical records and physical examination of the feet from December 2013 to March 2014. Results: From a total of 299 patients, 76 (25.4%) were at risk for developing diabetic foot. This group showed significant associations in the following parameters: males (34.17 versus 19.55%), mean age 61.02 years, average time from diagnosis = 14.95 years, use of insulin (28.98 versus 9.26%), presence of systemic arterial hypertension (28.78 versus 18.09%), macrovascular (52.63 versus 19.01%) and microvascular (39.58 versus 22.71%) complications. Conclusion: In this study, male patients older than 60 years, diagnosed for more than 15 years, in insulin therapy, with high blood pressure associated with macrovascular and microvascular complications of diabetes mellitus were at a higher risk for diabetic foot. Stratification of patients by degree of risk is of utmost importance for monitoring and proper management (AU)

Adesão das pessoas com diabetes mellitus ao autocuidado com os pés / Adhesion de las personas con diabetes mellitus autocuidado con sus pies / Adherence to foot self-care in diabetes mellitus patients

Objetivo: analisar o autocuidado de pacientes com diabetes mellitus tipo 2 na Estratégia Saúde da Família, em Teresina-PI. Método: pesquisa transversal selecionou, por amostragem probabilística simples, 331 pessoas com diabetes mellitus. A coleta de dados aconteceu de agosto a dezembro de 2012, com uso de questionário de atividades de autocuidado com o diabetes e instrumento estruturado para registro de informações socioeconômicas e orientações recebidas pelo profissional enfermeiro. Resultados: os dados revelaram que os pacientes têm baixa adesão à automonitorização glicêmica, à prática de exercícios físicos e cuidados com os pés, porém com boa aderência ao uso da medicação. Apenas 38,7% da amostra examinavam os pés de cinco a sete dias na semana. Houve associação estatisticamente signifi cativa entre as atividades de autocuidado com os pés e as orientações do enfermeiro (p < 0,05). Conclusão: conclui-se que há necessidade de sensibilização no concernente ao desenvolvimento de habilidades para o autocuidado. .

Objetivo: analizar el autocuidado de los pacientes con diabetes mellitus tipo 2 en la Estrategia Salud de la Familia en Teresina-PI. Método: búsqueda Cruzada seleccionada por muestreo aleatorio simple, 331 personas con diabetes mellitus. La recolección de datos se llevó a cabo entre agosto y diciembre de 2012 con el uso de las actividades de autocuidado Cuestionario con Diabetes e instrumento estructurado para registrar la información socioeconómica y la orientación recibida por la enfermera profesional. Resultados: los pacientes tienen una mala adherencia a la supervisión de glucosa en sangre, el ejercicio físico y el cuidado de los pies, pero con buena adherencia a la medicación. Sólo el 38,7% de la muestra examinada los pies de cinco a siete días a la semana. Asociación estadísticamente signifi cativa entre las actividades de auto-cuidado con los pies y las orientaciones de las enfermeras (p <0,05). Conclusión: la necesidad de crear conciencia en relación con el desarrollo de habilidades para el autocuidado. .

Objective: to analyze the self-care of patients with type 2 diabetes mellitus in the Family Health Strategy in Teresina-PI. Method: search cross selected by simple random sampling, 331 people with diabetes mellitus. Data collection took place from August to December 2012 with the use of Self-Care Activities Questionnaire with Diabetes and structured instrument for recording information socioeconomic and guidance received by the professional nurse. Results: the data revealed that patients have poor adherence to blood glucose monitoring, the physical exercise and foot care, but with good adherence to the medication. Only 38.7% of the sample examined the feet of fi ve to seven days a week. Statistically signifi cant association between self-care activities with their feet and orientations of nurses (p < 0,05). Conclusion: that there is need to raise awareness with regard to the development of skills for self-care. .

Knowledge, attitudes and practices for the prevention of diabetic foot / Conocimiento, actitudes prácticas y de escrituras de la prevención en pie diabético / Conhecimento, atitudes e práticas de medidas preventivas sobre pé diabético

The purpose of this study was to identify the knowledge, attitudes and practices for the prevention of diabetic foot in patients with diabetes mellitus type 2. This study was based on a cross-sectional survey conducted in two Family Health Units, in the city of Picos - PI, Brazil, with 85 diabetics of both sexes, by means of a semi-structured Knowledge, Attitude and Practice questionnaire. There was a predominance of females in the study (62.4%). On the topic of foot care, 49.4% had no knowledge on hygiene or what to observe in their feet. In relation to nail care, 56.5% were unaware of the correct way to cut nails. Regarding attitudes, 80% were willing to engage in self-care. In terms of practice, results showed that activities such as washing, drying, moisturizing and massaging were not executed together. It is therefore necessary to develop educational strategies to create awareness, both for diabetics and health professionals, on the effective prevention of diabetic foot.

Este estudio tuvo como objetivo identificar los conocimientos, actitudes y prácticas orientadas a la prevención del pie diabético en pacientes con diabetes mellitus tipo 2. Se trata de estudio transversal realizado en dos Unidades de Salud de la Familia, en la ciudad de Picos-PI, con 85 diabéticos de ambos sexos, mediante el uso de un formulario de encuesta semiestructurada conocimiento, Actitudes y Prácticas tipo. Hubo un predominio del sexo femenino en el estudio (62,4%). En el conocimiento de cuidado de los pies, el 49,4% no sabía cómo hacer la higiene y lo que quiere ver en los pies. En el cuidado de las uñas, el 56,5% desconocía el corte correcto. En cuanto a las actitudes, el 80% tuvo que realizar la prestación de cuidados personales. A partir de la práctica, se investigó que la atención como el lavado, secado, hidratación y masaje no se corrieron juntos. Es necesario desarrollar estrategias educativas para crear conciencia, tanto en diabéticos como profesionales de la salud, la prevención efectiva del pie diabético.

Objetivou-se identificar o conhecimento, as atitudes e as práticas voltadas à prevenção do pé diabético em pacientes com diabetes mellitus tipo 2. Trata-se de pesquisa transversal desenvolvida em duas Unidades de Saúde da Família, no município de Picos, PI, com 85 diabéticos de ambos os sexos, mediante o uso de um formulário semiestruturado, do tipo inquérito sobre Conhecimento, Atitude e Prática. Houve predominância do sexo feminino no estudo (62,4%). Sobre o conhecimento dos cuidados com os pés, 49,4% não sabiam como se faz a higiene e o que se deve observar nos pés. Nos cuidados com as unhas, 56,5% desconheciam o corte correto. Em relação às atitudes, 80% tinham disposição para executar o autocuidado. Partindo para a prática, averiguou-se que cuidados como lavagem, secagem, hidratação e massagem não eram executados juntos. É necessário o desenvolvimento de estratégias educativas para sensibilizar, tanto os diabéticos quanto os profissionais de saúde, para a eficaz prevenção do pé diabético.

Uso del factor de crecimiento epidérmico recombinante humano (EGF), en úlceras de pie diabético / Use of Epidermal Growth Factor Recombinant Human (EGF), in diabetic foot ulcers

El pie diabético es una de las complicaciones frecuentes de la Diabetes Mellitus 2 mal controlada, se reporta una incidencia entre el 15 y el 30 % de ulceras en el paciente diabético durante su enfermedad, con un alto costo económico y social, debido a la prolongada estadía hospitalaria y a la alta tasa de amputaciones, que dificultan la reincorporación del paciente a la sociedad. Teniendo en cuenta la capacidad reparadora del factor de crecimiento epidérmico (EGF) el cual favorece el proceso de cicatrización al acelerar la regeneración epidérmica, se realiza un estudio observacional, retrospectivo en 300 pacientes tratados con EFG intradérmico, perilesional , dos veces a la semana hasta la granulación y/o completa cicatrización. Se logró cicatrización en un promedio de ocho semanas de tratamiento en un 40% de la población, un 30% no cicatrizo, 20% abandonaron el tratamiento debido a reacciones adversas tales como fiebre, escalofríos, dolor, y un 10% ameritó amputación. Se concluye, que el tratamiento de elección del pie diabético es la prevención, pero el EGF intradérmico perilesional es una opción terapéutica efectiva para los pacientes con ulcera de pie diabético grado 1 al 4 de Wagner(AU)

The diabetic foot is one of the common complications of poorly controlled diabetes mellitus 2, an incidence between 15 and 30% of ulcers in diabetic patients during their illness is reported, with high economic and social costs due to prolonged hospital stay and the high rate of amputations, which hinder the reintegration of the patient into society. Considering the repair capacity of epidermal growth factor (EGF) which promotes the healing process to accelerate epidermal regeneration, an observational retrospective study was performed on 300 patients treated with intradermal perilesional EFG, twice a week until granulation and / or complete healing. Healing was achieved in an average of eight weeks of treatment in 40% of the population, 30% not healed, 20% discontinued treatment due to adverse reactions such as fever, chills, pain, and 10% required amputation. It is concluded that the treatment of choice for diabetic foot is prevention, but the perilesional intradermal EGF is an effective therapeutic option for patients with diabetic foot ulcer grade 1 to 4 of Wagner(AU)

Foot Wear and Footcare Knowledge - An Independent Risk Factor for Diabetic Foot in Indian Diabetics.

Diabetic foot lesions are significant health and socioeconomic problems holding adverse effect on the quality of life and imposing a heavy economic burden on patient or state. In Indian diabetics poor knowledge about footwear and foot care ,social and religious customs like walking barefoot, walking on fire also have significant role in diabetic foot problems beside traditional risk factor like peripheral neuropathy, peripheral vascular disease.

Causas referidas para o desenvolvimento de úlceras em pés de pessoas com diabetes mellitus / Root causes for the development of foot ulcers of people with diabetes mellitus

OBJETIVO: Analisar as causas referidas na etiologia das úlceras em pés de pessoas com Diabetes mellitus (DM). MÉTODOS: Estudo seccional, quantitativo, realizado no Ambulatório de Diabetes de um Hospital Universitário em Ribeirão Preto - SP. Os dados foram coletados com instrumento estruturado e exame físico dos pés de amostra de 30 pacientes diabéticos. RESULTADOS: Amostra com idade média de 57,5 anos, predominância do sexo masculino e baixa escolaridade; 90% possuíam DM tipo 2, de longa duração e mal controlado; obesidade/sobrepeso em 77% e insensibilidade plantar em 93,3%. A região metatarsiana foi o local de úlcera referido com maior frequência, e a causa foi a calosidade. CONCLUSÃO: as causas referidas envolvidas na etiologia das úlceras correspondem, de forma direta ou indireta, a fatores extrínsecos que podem ser prevenidos com cuidados básicos e de baixo custo. A insensibilidade plantar, fator fundamental desencadeador das úlceras, no entanto não foi reconhecida pelas pessoas.

OBJECTIVE: To analyze the root causes referred to in the etiology of foot ulcers in people with diabetes mellitus (DM). METHODS: A sectional study, quantitative, conducted at the Diabetes Clinic of a University Hospital in Ribeirão Preto - SP (Brazil). Data were collected using a structured instrument and physical examination of the feet of a sample of 30 diabetic patients. RESULTS: The sample had a mean age of 57.5 years, was predominantly male with a low educational level; 90% had type 2 DM, long-term and poorly controlled; obesity / overweight in 77%; and, 93.3% had plantar insensitivity. The metatarsal region was the site of ulcer most frequently mentioned, and the cause was the callus. CONCLUSION: The root causes involved in the etiology of these ulcers correspond, directly or indirectly, to extrinsic factors that can be prevented with basic care and at low cost. The plantar insensitivity, a key factor triggering the ulcers, was not recognized by these people.

OBJETIVO: Analizar las causas referidas en la etiología de las úlceras en piés de personas con Diabetes mellitus (DM). MÉTODOS: Estudio seccional, cuantitativo, realizado en el consultorio externo de Diabetes de un Hospital Universitario en Ribeirão Preto - SP. Los datos fueron recolectados con un instrumento estructurado y examen físico de los piés de una muestra de 30 pacientes diabéticos. RESULTADOS: muestra conformada por personas con una edad promedio de 57,5 años, predominio del sexo masculino y baja escolaridad;el 90% poseían DM tipo 2, de larga duración y mal controlado; obesidad/sobre peso en el 77% e insensibilidad plantar en el 93,3%. La región metatarsiana fue referida, con mayor frecuencia, como el lugar de la úlcera y la causa fue la callosidad. CONCLUSIÓN: Las causas que están involucradas en la etiología de las úlceras corresponden, de forma directa o indirecta, a factores extrínsecos que pueden ser prevenidos con cuidados básicos y de bajo costo. Entre tanto la insensibilidad plantar, factor fundamental desencadenante de las úlceras, no fue reconocida por las personas.

A pilot study on the effects of a polyherbal formulation cream on diabetic foot ulcers.

Background & objectives: Diabetic foot ulcers are the most common cause of non-traumatic lower extremity amputations in developing countries. The aim of this pilot study was to evaluate the safety of using a polyherbal formulation in healing diabetic foot ulcers in comparison with standard silver sulphadiazine cream among patients with type 2 diabetes. Methods: A total of 40 (M:F=29:14) consecutive type 2 diabetes patients with foot ulcers were enrolled in this study. They were randomly assigned to two groups of 20 each; Group 1 was treated with polyherbal formulation and group 2 with silver sulphadiazine cream. All the patients were followed up for a period of 5 months. The baseline ulcer size was noted and photograph of the wound was taken at the baseline and at each follow up visit. Number of days taken for healing of the wound was recorded. Results: The mean age of patients, duration of diabetes and HbA1c% were similar in both the study groups. The mean length and width of the ulcers was also similar in both the groups at baseline visit. There was a significant decrease in the size of the wound (length and width) in both the study groups (P<0.001). The mean time taken for the healing of the ulcer was around 43 days in both groups. Interpretation & conclusions: Diabetic wound cream prepared by using polyherbal formulation was found to be effective as well as safe in healing diabetic foot ulcers like the standard silver sulphadiazine cream.

Risk factors of diabetic foot in central Saudi Arabia

To identify the risk factors of diabetic foot [DF] in diabetic patients. In a case-control study, medical records of 50 patients with DF, and 50 diabetic controls without DF were selected randomly from the patients seen at King Abdulaziz Medical City [KAMC], Riyadh, Kingdom of Saudi Arabia. Selected vascular, neuropathic, metabolic, health care, and lifestyle risk factors were investigated. Multiple logistic regression was used to relate these potential risk factors to the odds of DF. Diabetic foot was significantly associated with: gender, age, education, type of diabetes, duration of disease, level of erythrocyte sedimentation rate [ESR], presence of peripheral neuropathy, peripheral vascular disease, chronic renal diseases, ischemic heart diseases, hypertension, and previous history of diabetic foot. After adjusting for the potentially confounding effects of age and gender by using the logistic regression analysis, independent predictors of DF were: the duration of diabetes, presence of neuropathy, and ESR level. In the prediction of DF, receiver operating characteristic curves [ROC] were applied to identify the most valid cut-off points of the duration of diabetes [11 years], and ESR level [54 mm/hr]. These findings could help diabetologists recognize early, and manage DF, and thus reduce the risk of limb amputation, and the cost that accompanies limb loss in this prevalent condition