I fear COVID but diabetic foot (DF) is worse: a survey on patients' perception of a telemedicine service for DF during lockdown.

AIMS: To evaluate the patients' perceptions of telemedicine visits during COVID-19 lockdown and their level of anxiety about COVID and diabetic foot (DF). METHODS: In May 2020, we contacted by phone all the patients who underwent in March and April to remote monitoring visits for DF during the lockdown for COVID-19, with a structured interview, focusing on their perceptions about telemedicine service for DF and on the anxiety toward COVID and DF. RESULTS: We analyzed 257 remote monitoring visits in 211 patients. Two hundred and six patients answered the follow-up interview; 177 patients (85.9%) remembered the monitoring visit, 140 (67.9%) the health care professional and 181 patients (87.9%) the reason of contact; 169 patients were alone during the visit, 37 with a relative. Patients judged useful both the monitoring during pandemic (4.35 ± 0.28 on a maximum of five) and the possibility to continue after the lockdown (4.34 ± 0.23 on a maximum of five). Eventually, we observed that DF patients were more worried by DF than by COVID on a scale from 0 (not fear at all) to 5 (terrified) (4.79 ± 0.05 vs. 3.27 ± 1.03, p < 0.05). This difference was higher in previously ulcerated patients (4.84 ± 0.03 vs. 3.03 ± 1.13, p < 0.05) and even more in amputees (4.93 ± 0.03 vs. 2.73 ± 1.21, p < 0.05). CONCLUSIONS: DF patients appreciated televisits during lockdown and the continuation of this service after its end. In this context DF prevails on COVID in the worries of patients, especially if they are recurrent ones.

Safety and effectiveness of therapeutic magnetic resonance in diabetic foot ulcers: a prospective randomised controlled trial.

OBJECTIVE: To test the efficacy and safety of therapeutic magnetic resonance (TMR) in the management of diabetic foot ulcers (DFU), the authors designed a prospective randomised controlled trial in three highly specialised diabetic foot clinics. METHOD: All the patients consecutively visited in a period of 18 months were screened according to the inclusion (presence of an ulcer >1 cm2 in the foot lasting at least 6 weeks; ABPI>0.6; consent to participate in the study) and exclusion (Charcot's foot; local or systemic infections; chronic renal failure; any wearable electrically-driven life-supporting device) criteria. Patients, who were treated according to international guideline protocols, were randomised into two groups: group A received for four weeks the sham application of TMR, while group B received the active TMR for the same period. People were followed-up to 10 weeks and healing rate (HR), healing time (HT), rate of granulation tissue on wound bed (% GT), reduction of the area of the lesion (∆AL) and a score (0-3) evaluating erythema, oedema, pain and tenderness, respectively, were measured. Adverse events (AE) were registered and monitored throughout the study. RESULTS: No differences were observed in HR, HT and ∆AL between the two groups during follow-up, while % GT and the scores for erythema, oedema and pain at 10 weeks showed significant (p<0.05) improvements in group B compared with group A and versus baseline. When restricted to non-ischaemic patients (ABPI>0.8), ∆AL was significantly (p<0.05) more pronounced in group B than in group A. No difference in AE occurrence was observed between the two groups. CONCLUSION: Our study, despite not being able to demonstrate the effectiveness of TMR on healing rate at 10 weeks, with 4 weeks of active treatment in neuro-ischaemic DFUs, shows positive effects on clinical aspects of the DFU and is associated with a significant increase of GT in the wound bed. DECLARATION OF INTEREST: The study has been fully sponsored by Thereson S.p.A., manufacturer of TMR devices.

KPC-producing Klebsiella pneumoniae rectal colonization is a risk factor for mortality in patients with diabetic foot infections.

To evaluate the relationship between carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) gut colonization and mortality in diabetic patients with a foot infection (DFI) we performed a single-centre, retrospective, matched case-control study. In the study period, we identified 21 patients with DFI who had KPC-Kp gut colonization and 21 controls. The 90-day mortality rate was significantly higher in patients with colonized guts (47%) than the controls (4%) (p 0.013). A multivariate analysis demonstrated that gut colonization with KPC-Kp was the only independent predictor of mortality: odds ratio 13.33, 95% CI 1.90-272.80, p 0.024. In patients with DFI, KPC-Kp gut colonization appears to be an important risk factor for mortality.

Cosmética sustentable: Propuesta de guía para la certificación de cosméticos ecológicos en Venezuela / Sustainable Cosmetic: Guidelines Proposal for Certification of Ecological Cosmetics in Venezuela

Las universidades son centros de producción de conocimiento y de desarrollo científico y tecnológico. Asimismo, una de sus responsabilidades es promover en la sociedad la preservación del medio que nos rodea. Investigadores en el área cosmética de la Universidad Central de Venezuela, preocupados por el medio ambiente y los consumidores, diseñaron una propuesta venezolana como guía para la estandarización y clasificación de los cosméticos ecológicos. Conociendo que las economías de América Latina y del Caribe dependen en su mayoría de la productividad de sus ecosistemas, esta guía contribuirá como una herramienta para el desarrollo sustentable en los países de la región. Para su elaboración, se tomó en consideración la situación actual de estos países. Igualmente, se tomó en cuenta los reglamentos establecidos por los organismos internacionales para la certificación de cosméticos ecológicos más empleados en Latinoamérica. Adicionalmente, se estableció comunicación directa con algunos organismos certificadores y se realizó una revisión bibliográfica de revistas cosméticas de reconocido prestigio. Al comparar los diferentes procedimientos de certificación, se encontraron coincidencias en cuanto al uso de las materias primas permitidas, materiales de empaque y requerimientos para las empresas fabricantes. Sin embargo, se observaron diferencias tanto para la clasificación del producto, basado en el contenido del mismo, así como en los requerimientos exigidos en el texto de la etiqueta. Esta guía podría contribuir con el diseño de una legislación venezolana en materia de productos ecológicos que desarrolle ventajas competitivas en el mercado y que permita alcanzar con éxito el comercio de integración regional.

The universities are centers for knowledge production and scientific and technological development. Therefore, one of their responsibilities is to encourage the society to preserve the environment. Cosmetic researchers at the Universidad Central de Venezuela, aware of the environment as well as the necessities of the consumers, designed a proposal Venezuelan Guide for the Standardization and Classification of Ecologic Cosmetics. Ever since the economies of Latin America and the Caribbean highly depend on the productivity of the ecosystems; this guide will represent a tool for sustainable development for the countries in the region. The guide was elaborated taking into consideration the current situation of those countries. The design of the guide takes into account the rules established by the international bodies on the certification of ecologic cosmetics - mostly used in the Latin American countries-. In addition, direct communications with certifying agencies as well as important cosmetic journals were used. As we compared the different certification procedures used by the agencies, we found consensus in matters of the using of raw materials, packing materials and the requirements for these cosmetic producers. Nevertheless, there was a discrepancy in the classification of ecologic products based on their contents, as well as the information required in the labeling of the products. This guide will help to design a Venezuelan legislation on ecologic cosmetic products that will develop advantages on the market in terms of competition and, at the same time, achieving the access of these products on the regional integration markets.

Efeito do soro de cadela em estro na maturação in vitro de ovócitos caninos / Effect of estrus bitch serum on in vitro maturation of canine oocyte

Avaliou-se o efeito do soro de cadela em estro na maturação in vitro de ovócitos caninos, utilizando-se 92 ovócitos de cadelas, submetidas à cirurgia eletiva de ovarioisterectomia. Os ovócitos foram selecionados e distribuídos em dois tratamentos: T1 (n = 48), ovócitos cultivados in vitro durante 96 horas utilizando meio base - TCM199 + 5µg/mL de LH + 20µg/mL de FSH - mais 10 por cento de soro inativado de vaca em estro e T2 (n = 44), ovócitos cultivados em meio base mais 10 por cento de soro inativado de cadela em estro. O percentual de ovócitos observados em metáfase I não indicou diferenças (P>0,05) entre T1 (2,1 por cento) e T2 (0,0 por cento), porém a taxa de ovócitos maduros (metáfase II) foi diferente (P<0,05), sendo 27,1 por cento em T1 e 47,7 por cento em T2. O mesmo fato ocorreu com a taxa de cromatina condensada (P<0,01), com 14,6 e 0,0 por cento, respectivamente. Nos ovócitos sem configuração cromossômica, não foram observadas diferenças (P>0,05), sendo 56,3 por cento em T1 e 52,3 por cento em T2. Estes resultados indicam que a adição de soro de cadela em estro no meio de cultivo oferece melhores condições para o desenvolvimento in vitro, quando comparado à de soro de vaca em estro.

This study aimed to evaluate the effect of estrus on in vitro canine oocyte. A total of 92 oocyte from bitches under ovary-hysterectomy surgery was used. The oocytes were selected and randomly assigned to two different treatments, being T1 (n = 48) in vitro cultured for 96h using basic medium (TCM199 + 5µg/mL of LH + 20µg/mL of FSH), plus 10 percent of cow inactive serum in estrus and T2 (n = 44) basic medium plus 10 percent of bitch inactive serum in estrus. The percentage of oocyte observed on metaphase I do not indicate a difference (P>0.05) between T1 (2.1 percent) and T2 (0.0 percent). However, the rate of mature oocyte (metaphase II) was different (P<0.05), being 27.1 percent for T1 and 47.7 percent for T2. There was difference (P<0.05) in the condensed chromatin rate for T1 (14.6 percent) and T2 (0.0 percent), respectively. There was no difference (P>0.05) between T1 (56.3 percent) and T2 (52.3 percent) in oocyte with no chromosome configuration. These results indicate that supplementation with estrus bitch serum on culture media offer better conditions to in vitro development, when compared to estrus cow serum.

Iloprost in the management of peripheral arterial disease in patients with diabetes mellitus.

Diabetic complications in the lower extremities, especially those secondary to diabetic macroangiopathy, have increasingly become a clinical emergency, given the high prevalence and progression of the disease. Until recently, the only approach to treating advanced stage disease was medical therapy and major amputation; however, the advent of revascularization procedures has radically improved the prognosis of patients with critical lower limb ischemia. In this setting, iloprost holds a dual position: as first-choice therapy in patients ineligible for revascularization and as complementary therapy in candidates for surgical or endovascular revascularization.

A randomized controlled trial to examine the efficacy and safety of a new super-oxidized solution for the management of wide postsurgical lesions of the diabetic foot.

This randomized trial was done to test the effectiveness and safety of using a novel antiseptic solution (Dermacyn(R) Wound Care [DWC], Oculus Innovative Sciences, Petaluma, CA) in the management of the postoperative lesions on the infected diabetic foot. 40 patients with postsurgical lesions wider than 5 cm2 left open to heal by secondary intention were randomized into 2 groups. Group A was locally treated with DWC, whereas group B received povidone iodine as local medication, both in adjunct to systemic antibiotic therapy and surgical debridement if needed. Ischemia, renal failure, bilateral lesions, or immunodepression were considered as exclusion criteria. Patients were followed up weekly for 6 months. The primary endpoint was healing rate at 6 months, while secondary endpoints were healing time, time to achieve negative cultures, duration of antibiotic therapy, number of reinterventions, and adverse events. Healing rates at 6 months were significantly shorter in group A (90%) than in group B (55%; P < .01). The time taken for cultures to become negative and duration of antibiotic therapy were also significantly (P < .05) shorter in group A than in group B, whereas the number of reinterventions was significantly higher in group B (P < .05). No difference was noted in the adverse events except that for reinfections, which were more frequent in group B than in group A (P < .01). DWC is as safe as and more effective than standard local antiseptics in the management of wide postsurgical lesions in the infected diabetic foot.

Effectiveness and safety of a novel gel dressing in the management of neuropathic leg ulcers in diabetic patients: a prospective double-blind randomized trial.

Neuropathic leg ulcers (NLUs) affect more than 10% of diabetic patients with peripheral neuropathy and represent the most common cause of ulceration of the leg in these patients. Though their pathogenesis is well known, related to the chronic neuropathic edema, the management of NLUs, mainly based on elastocompression, is still controversial, with lower healing rates than nondiabetic venous leg ulcers. The authors tested if a novel gel formulation, containing amino acids and hyaluronic acid (Vulnamin)gel; Errekappa, Milan, Italy), will improve the outcomes of NLUs when used together with elastocompression. Thirty patients affected by NLU were randomized into 2 groups, both treated with 4-layer elastocompressive bandaging: patients in group A were topically treated with the application of Vulnamin) gel, whereas patients in group B received only the inert gel vehicle. The healing rate at 3 months was evaluated as the primary endpoint, whereas the secondary endpoints were healing time, reduction in ulcer area and ulceration score in 4 weeks, number of infective complications, and overall satisfaction of patients. Healing rate was significantly (P < .05) higher in patients in group A when compared with those in group B; healing time, patients' satisfaction, and reduction in ulcer area and ulceration score in 4 weeks were also higher in patients in group A. However, no significant differences were found in the prevalence of infections and other adverse events. The use of Vulnamin) gel with elastocompression is safe and effective in the management of NLUs of diabetic patients.

The Epibloc system for the treatment of wrist fractures.

The current prospective study was conducted to verify the results obtained in a heterogeneous group of 50 displaced fractures of the wrist treated with the Epibloc system. This method is simple and rapid to use and it does not require plaster. The results obtained are very satisfactory (good and excellent 91.6%) in AO type A2 and A3 fractures and in type C1 fractures (92.8%) and in C2 fractures (88.3%); in fractures with multiple fragments and compromise of the joint surface (C3) the results were not very significant because of the small number of lesions treated (4 cases), but they do not seem to differ very much from what was obtained by other authors when more complicated methods were used. The results were very unsatisfactory in type B fractures (Goyrand); it is our belief that this method is not indicated for lesions such as these, because of the intrinsic difficulty in monitoring dislocation of the volar metaepiphyseal fragment.

Medial fractures of the femoral neck in the elderly treated by SEM bipolar prosthesis.

The authors present 335 cases of medical fracture of the femoral neck in the elderly patient (mean age 80.5 years) treated by SEM type bipolar prosthesis. A total of 93 patients (28.3%) were followed-up for a total of 98 hips submitted to surgery (5 bilateral) after a mean period of 42 months, minimum 12 months, maximum 96. Clinical follow-up included these parameters: pain, movement, walking, according to Merle D'Aubigné. Radiographic follow-up consisted in standard views and maximum adduction and abduction. Pain was present in 49% of cases, although it did not significantly invalidate movement (quotients 6 and 5 in 96% of cases); in 60% of the cases there were problems with walking mostly due to the general conditions of the patient. Wear phenomena in the acetabulum were present in 32 hips (32.6%) with no correlation with clinical data. Dynamic x-rays showed that only 31% of the implants maintained intraprosthetic movement. What emerges from the study is the importance of adequate measurement of the prosthetic cupola to improve acetabular fit.

Arthroscopic lateral meniscectomy in adults with stable knees. A medium term evaluation of the results and a comparison with similar lesions of the medial meniscus.

The results obtained in 37 cases of arthroscopic meniscectomy in isolated lesions of the lateral meniscus in adult patients are analysed. Isolated lesions were chosen as it is our belief that the results may be considerably influenced by the presence of ligamentous lesions. After an average follow-up of 33 months the results were: excellent, 32; good, 2; fair, 2; poor, 1. The lowest percentage of improvement was observed in subtotal meniscectomies. The presence of changes in the joint cartilage is not always responsible for mediocre results.