The financial burden of diabetes-related foot disease in Australia: a systematic review.

BACKGROUND: Diabetes-related foot disease (DFD) is a common, costly, and severe complication of diabetes mellitus. DFD is associated with high rates of morbidity and mortality and poses a significant burden on patients, healthcare systems and society. While the detrimental impact of DFD is widely recognised, the precise financial implications of its management in Australia remain unclear due to inconsistent and inconclusive contemporary data. Therefore, the aim of this review was to identify, summarise and synthesise existing evidence to estimate the costs associated with DFD management in Australia. METHODS: Searches were conducted in MEDLINE, Embase, AMED, CINAHL, Joanna Briggs Institute EBP, and the Cochrane Library from November 2011 to July 2023. Australian studies investigating costs associated with DFD management were eligible for inclusion. Two independent reviewers performed the study selection, data extraction and quality assessment steps. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS 2022) checklist was used to assess study quality. A descriptive analysis was performed due to limited existing evidence and large heterogeneity between study populations to conduct meta-analyses. RESULTS: Three economic evaluations were included in the review. One study was rated as 'poor', one as 'very good' and one as 'excellent' when assessed against the CHEERS checklist. The estimated cost of DFD management varied between studies and comparisons were not possible due to the different methodological approaches and data sources. The studies were unable to provide an overall cost of DFD with respect to all aspects of care as they did not capture the multi-faceted level of care throughout the entire patient journey between sectors and over time. CONCLUSION: There is limited contemporary evidence for the costs associated with DFD management within Australia, particularly related to direct costs and resource utilisation. Further research into the economic impact of DFD management is needed to inform optimisation of national service delivery and improve health outcomes for individuals with DFD in Australia. Integrating real-world data on impact of clinical interventions with parallel economic evaluation could be a valuable approach for future research, which would offer a more comprehensive understanding of the clinical and economic outcomes beyond solely model-based evaluations. TRIAL REGISTRATION: PROSPERO Registration No. CRD42022290910.

Signo de Leser-Trélat asociado a adenocarcinoma gástrico: Caso clínico / Leser-Trélat sign associated with gastric cancer: Report of one case

We report a 66-year-old male presenting with malaise, heartburn and pruritic seborrheic keratoses in both feet of sudden onset, suggesting a Leser-Trélat sign. An upper gastrointestinal endoscopy disclosed a gastric cancer. The patient was subjected to a total gastrectomy and duringfollow up, the skin lesions had disappeared.

Cuidados y competencias de enfermería en la valoración, tratamiento y seguimiento de un paciente diabético con lesiones del pie / Care and nursing skills in the assessment, treatment and monitoring of diabetic patients with foot injuries

El presente artículo tiene la finalidad de compartir una experiencia asistencial, en la cuál se efectuó un tratamiento conservador en el pie de un paciente diabético, y que fue sugerido por el equipo de enfermería. En primer lugar se hace una introducción sobre los problemas en colaboración o potenciales de la diabetes, y los tratamientos mas frecuentes; luego se presenta el caso, los cuidados y seguimiento durante la internación y posteriores al alta, hasta lograr la derivación del paciente para realizar un injerto en el talón.

Hipofosfatemia revertida al extirpar hemangioendotelioma compuesto del dedo mayor del pie / Reversion of hypophosphatemia after the excision of a composite hemangioendothelioma in the great toe

We report a 43 years old male admitted to the hospital for progressive lumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serum phosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkaline phosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximum phosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increased radionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violet colored mass was detected in a great toe. It was removed and the pathological diagnosis was a composite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normal values and symptoms disappeared within 15 days.

Carcinoma epidermóide em úlcera angiodérmica: relato de nove casos / Epidermoid carcinoma in angiodermic ulcer: report of 9 cases

Säo relatados nove casos de carcinoma epidermóide em úlcera angiodérmica, diagnosticados no período de 1978-1989 no Hospital Universitário Clementino Fraga Filho (UFRJ). O grupo consistiu de cinco pacientes masculinos e quatro femininos na faixa etária de 48 a 87 anos, nos quais o tempo de evolouçäo da úlcera variou de dois a 40 anos. A biópsia demonstrou seis carcinomas bem diferenciados e três pouco diferenciados: a amputaçäo foi realizada em sete casos e a ressecçäo local com enxertia em um caso. Concluiu-se que a condiçäo é relativamente rara e que a biópsia é imperativa em úlceras crônicas

Aspectos da assistência de enfermagem na hanseníase: prevençäo da úlcera plantar / Aspects of nursing care in hanseniasis: prevention of plantar ulcer

Foram estudados 206 pacientes hansenianos com anestesia plantar internados em hospital, a fim de verificar as variáveis que influenciam na ocorrência da úlcera plantar. A coleta de dados foi realizada mediante entrevista com preenchimento de formulário específico. Os resultados submetidos a tratamento estatístico, demonstraram que o sexo, a idade, a escolaridade, a ocupaçäo e o tempo de anestesia plantar näo interferem na ocorrência da úlcera plantar. Acreditando-se no real valor preventivo das técnicas simples, fez-se um levantamento do conhecimento e da prática dessas técnicas nos pacientes com ou sem úlcera plantar. Verificou-se que os pacientes hansenianos com pé anestésico sem úlcera plantar, conhecem e praticam mais as técnicas simples de prevençäo do que aqueles que têm úlcera plantar