Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes.

Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.

Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol.

OBJECTIVE: Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD: The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.

Topical cream containing nanoparticles with vitamin E to prevent radiodermatitis in women with breast cancer: a clinical trial protocol.

OBJECTIVE: Little is known about the efficacy of products aiming to prevent radiodermatitis, which affects between 90-95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidenceon their effectiveness. Here, the authors present a clinical trial protocol to evaluate the effects of applying a cream containing nanoparticles with vitamin E to prevent radiodermatitis in patients with breast cancer. METHOD: The protocol recommends that 108 women with breast cancer, receiving radiotherapy, are included in this triple-blinded, randomized, controlled study at an oncology hospital. Patients will be divided in three groups of 36 individuals each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will receive a cream without nanoparticles nor vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree, and time of onset of radiodermatitis. The secondary endpoints will focus on the quality of life, symptoms, and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved and registered on an international trials database.

Determinantes sociales y demográficos relacionados con la cicatrización de heridas en un centro de asistencia y educación en enfermería.

OBJECTIVE: Analyse the social and demographic variables that affect healing in patients with hard-to-heal wounds. METHOD: This retrospective study looked at 349 patient records of people with hard-to-heal wounds at an educational and care centre in San Pablo, Brazil, between 1994 and 2015. Healing was measured using the Pressure Ulcer Scale for Healing (PUSH). RESULTS: A total of 128 patient records were included. Most had identified themselves as white (62%), with an incomplete education (31%), household income under three minimum wages (86%), diabetes mellitus (61%), and systemic hypertension (58.4%). The PUSH scale varied between 4-7. The healing rate was 60%. Patients with white/yellow skin had 3.43 more chances to achieve healing (p<0,001). CONCLUSION: The social determinants observed were similar to Brazil's major inequality indicators. Statistical significance for white/yellow skin colour related to wound healing was observed. Nursing consultations contributed in achieving wound healing.

OBJETIVO: Analizar los determinantes sociodemográficos que influyen en la evolución de los pacientes con heridas de difícil cicatrización. MÉTODO: Este estudio epidemiológico retrospectivo analizó 349 historias clínicas de personas con heridas de difícil cicatrización en un centro de asistencia y educación en enfermería en San Pablo, Brasil, entre 1994 y 2015. Se usó la escala Pressure Ulcer Scale for Healing (PUSH) para evaluar la cicatrización. RESULTADOS: Se analizaron datos de 128 personas, la mayoría, adultos mayores. Los participantes se autodeclararon blancos (62%), con educación básica incompleta (31%), ingresos económicos familiares de hasta tres salarios mínimos (86%), diabetes mellitus (61%), e hipertensión arterial sistémica (58,4%). La escala PUSH varió entre 4 y 17 puntos (0­17 posibles), y el puntaje medio en la última valoración fue de, aproximadamente, 12. La tasa de cicatrización fue 60%. El color de piel blanca/amarilla aumentó 3,43 veces las chances de lograr la cicatrización (p<0,001). CONCLUSIÓN: Los atributos sociales estudiados se asemejan a los principales indicadores de inequidades sociales en salud en Brasil. Se observó significancia estadística para los colores de piel blanca/amarilla, relacionados con la cicatrización de la herida. La consulta de enfermería contribuyó en lograr la cicatrización de las heridas. CONFLICTO DE INTERÉS: Ninguno.

Risk for undernutrition and development of pressure injury in hospitalised patients in Brazil: Multicentre prospective cohort study.

Although pressure injury (PI) is preventable, the number of patients developing this type of injury is still high. In this prospective cohort study, we aimed to assess whether high risk for undernutrition was a risk factor for PI in 1937 patients aged ≥18 at six hospitals in Sao Paulo, Brazil. Patients' risk for undernutrition was assessed using three unique screening tools. Risk for PI was assessed using the Braden Scale. Data were analysed using Poisson regression with robust variance (95% CI, P ≤ .05). While 57.1% of patients were at risk for undernutrition in the Nutritional Risk Screening (NRS 2002), only 36.8% and 2.6% were at risk in the Braden Scale Nutrition Subscale (BSNS) and Subjective Global Assessment of Nutritional Status (SGANS), respectively. The cumulative incidence rate was 5.9%. Of those who developed PI, 91.2%, 56.2%, and 18.4% were at risk for undernutrition in the NRS 2002, BSNS, and SGANS scales, respectively. We found a significantly higher risk for PI in patients who were at risk for undernutrition compared with those who were not at risk, supporting previous evidence about the role of undernutrition as a key risk factor for PI in hospitalised patients.

Clinical protocol for the topical use of a cream with nanoparticles and vitamin E to prevent radiodermatitis in patients with breast cancer]. / Aplicación tópica de crema con nanopartículas con vitamina E para prevenir radiodermatitis en cáncer de mama: protocolo de ensayo clínico.

Objetivo: Poco se conoce sobre la eficacia de productos para la prevención de radiodermatitis, que afecta al 90­95% de las mujeres con cáncer de mama. El uso de antioxidantes es promisorio, sin embargo, poco estudiado. Los autores desarrollaron un protocolo de ensayo clínico para evaluar el efecto potencial de la aplicación de crema con nanopartículas con vitamina E para prevenir radiodermatitis aguda en mujeres con cáncer de mama. Método: El protocolo sugiere que 108 mujeres adultas con cáncer de mama, que estén recibiendo radioterapia, sean incluidas en este ensayo clínico, controlado, aleatorizado y triple ciego, en un hospital oncológico. Se prevé la distribución de pacientes en tres grupos de 36 personas: el grupo A recibirá una crema con nanopartículas lipídicas con vitamina E, el grupo B obtendrá una crema sin nanopartículas ni vitamina E, y el grupo C usará una crema con nanopartículas sin vitamina E. Los resultados primarios evaluarán la incidencia, el grado y el tiempo de surgimiento de la radiodermatitis. Los resultados secundarios se centrarán en la calidad de vida, los síntomas y la temperatura local. Las pacientes serán evaluadas tres veces por semana, desde el inicio de la radioterapia hasta dos semanas después de la última sesión. El presente proyecto fue aprobado por el comité de ética en investigación de las instituciones involucradas.Objective: Little is known about the efficacy of products that aim to prevent radiodermatitis, which affects between 90­95% of women with breast cancer. The use of antioxidants is promising, however, there is a lack of evidence on their effectiveness. Here, the authors present a clinical trial protocol to evaluate the potential effects of applying a nanoparticle cream with vitamin E to prevent radiodermatitis in patients with breast cancer. Method: The protocol recommends that 108 women with breast cancer, who are receiving radiotherapy, be included in a triple-blinded, randomised, controlled study in an oncology hospital. Patients will be divided in three groups of 36 people each: group A will receive a cream with lipid nanoparticles and vitamin E, group B will obtain a cream without nanoparticles or vitamin E, and group C will receive a cream with nanoparticles without vitamin E. The primary endpoints will evaluate the incidence, degree and time of onset of radiodermatitis. The secondary endpoints will focus on quality of life, symptoms and local temperature. Patients will be assessed three times a week, from the start of their radiotherapy treatment to two weeks after the last session. This protocol was approved by the research ethics committee of the institutions involved.