Precision soft tissue balancing: grid-assisted pie-crusting in total knee arthroplasty.

Introduction: The varus and valgus knee deformities result from imbalance in tension between medial and lateral soft tissue compartments. These conditions need to be addressed during total knee arthroplasty (TKA). However, there is no consensus on optimal soft-tissue release techniques for correcting varus and valgus deformities during TKA. We assessed the efficacy of a novel grid-based pie-crusting technique on soft-tissue release. Methods: Cadaver knees were dissected, leaving only the femur and tibia connected by an isolated MCL or the femur and fibula connected by an isolated LCL. Bone cuts were made as performed during primary TKA. Mechanical testing was performed using an MTS machine. A 3D-printed 12-hole grid was placed directly over the MCL and LCL. Using an 18-gauge needle, horizontal in-out perforations were made 3 mm apart. Deformation and stiffness of the ligaments were collected after every 2 perforations. Means were calculated, and regression analyses were performed. Results: A total of 7 MCL and 6 LCL knees were included in our analysis. The mean medial femorotibial (MFT) space increased from 6.018 ± 1.4 mm-7.078 ± 1.414 mm (R2 = 0.937) following 12 perforations. The mean MCL stiffness decreased from 32.15 N/mm-26.57 N/mm (R2 = 0.965). For the LCL group, the mean gap between the femur and fibula increased from 4.287 mm-4.550 mm following 8 perforations. The mean LCL stiffness decreased from 29.955 N/mm-25.851 N/mm. LCL stiffness displayed a strong inverse relationship with the number of holes performed (R2 = 0.988). Discussion: Our results suggest that using this novel grid for pie-crusting of the MCL and LCL allows for gradual lengthening of the ligaments without sacrificing their structural integrity. Our proposed technique may serve as a valuable piece in the soft-tissue release toolkit for orthopaedic surgeons performing TKA in varus and valgus deformed knees.

Initial handgrip strength as a predictive factor for amputation risk in diabetic foot patients.

BACKGROUND: We aimed to analyze the prognostic significance of handgrip strength as predictor of lower extremity amputation at 1 year follow up in patients with type 2 diabetes. METHODS: We evaluated 526 patients with type 2 diabetes between August 2020, and, June 2022. We collected from the electronic medical records demographic variables, laboratory data and history of amputation. The handgrip strength was assessed using a handheld Smedley digital dynamometer following the NHANES Muscle Strenght/Grip Test Procedure. Low handgrip strength was defined for women as less than 16 kg and for men less than 27 kg. Outcome variable was major or minor lower extremity amputation. RESULTS: A total of 205 patients with complete data entered the study. Patients mean age was 59 years old, 37% were women and the mean diabetes disease duration was 14 years. Seventy-seven (37%) patients suffered from lower extremity mputations (26 major and 51 minor amputations). After controlling for age, gender, presence of peripheral artery disease, body mass index and white cell counts as confounder variables, patients with low handgrip had an increased risk for amputations (Odds Ratio 2.17; 95% confidence Interval: 1.09-4.32; <0.001). CONCLUSION: Low handgrip stregth is an independent prognostic marker for lower limb amputation at one year in patients with diabetes.

Precision medicine: "Point of Care Ultrasound" (PoCUS) in the diagnostic approach to the patient with hyponatremia.

Hyponatremia is a multifactorial disorder defined as a decrease in plasma sodium concentration. Its differential diagnosis requires an adequate evaluation of the extracellular volume (ECV). However, ECV determination, simply based on the clinical history, vital signs, physical examination, and laboratory findings can leads to misdiagnosis and inappropriate treatment. The use of Point-of-Care Ultrasound (POCUS), through the combination of Lung Ultrasound (LUS), Venous Excess UltraSound (VExUS) and Focused Cardiac Ultrasound (FoCUS), allows a much more accurate holistic assessment of the patient's ECV status in combination with the other parameters.

The potency of hematopoietic stem cell reprogramming for changing immune tone.

Innate immune memory endows innate immune cells with antigen independent heightened responsiveness to subsequent challenges. The durability of this response can be mediated by inflammation induced epigenetic and metabolic reprogramming in hematopoietic stem and progenitor cells (HSPCs) that are maintained through differentiation to mature immune progeny. Understanding the mechanisms and extent of trained immunity induction by pathogens and vaccines, such as BCG, in HSPC remains a critical area of exploration with important implications for health and disease. Here we review these concepts and present new analysis to highlight how inflammatory reprogramming of HSPC can potently alter immune tone, including to enhance specific anti-tumor responses. New findings in the field pave the way for novel HSPC targeting therapeutic strategies in cancer and other contexts of immune modulation. Future studies are expected to unravel diverse and extensive effects of infections, vaccines, microbiota, and sterile inflammation on hematopoietic progenitor cells and begin to illuminate the broad spectrum of immunologic tuning that can be established through altering HSPC phenotypes. The purpose of this review is to draw attention to emerging and speculative topics in this field where we posit that focused study of HSPC in the framework of trained immunity holds significant promise.

Medicina de precisión: «Point of Care Ultrasound» (PoCUS) en el abordaje diagnóstico del paciente con hiponatremia / Precision medicine: “Point of Care Ultrasound” (PoCUS) in the diagnostic approach to the patient with hyponatremia

La hiponatremia es un trastorno multifactorial definido como una disminución en la concentración plasmática de sodio. Su diagnóstico diferencial requiere una evaluación adecuada del volumen extracelular. Sin embargo, la determinación del volumen extracelular, simplemente basada en la historia clínica, las constantes vitales, el examen físico y los hallazgos de laboratorio, conducen en ocasiones a un diagnóstico erróneo por lo que el enfoque terapéutico puede ser equivocado. El empleo de ecografía a pie de cama (Point-of-Care Ultrasound [PoCUS]), mediante la combinación de ecografía pulmonar (Lung Ultrasound [LUS]), Venous Excess UltraSound (VExUS) y la ecocardioscopia (Focused Cardiac Ultrasound [FoCUS]) permiten, en combinación con el resto de los parámetros, una valoración holística mucho más precisa del estado del volumen extracelular del paciente.(AU)

Hyponatremia is a multifactorial disorder defined as a decrease in plasma sodium concentration. Its differential diagnosis requires an adequate evaluation of the extracellular volume. However, extracellular volume determination, simply based on the clinical history, vital signs, physical examination, and laboratory findings can leads to misdiagnosis and inappropriate treatment. The use of Point-of-Care Ultrasound (PoCUS), through the combination of Lung Ultrasound (LUS), Venous Excess UltraSound (VExUS) and Focused Cardiac Ultrasound (FoCUS), allows a much more accurate holistic assessment of the patient's extracellular volume status in combination with the other parameters.(AU)

Osteotomía de descarga ambulatoria mínimamente invasiva en el tratamiento de la úlcera de pie diabético: análisis de 25 pacientes / Minimally invasive offloading osteotomy in the treatment of diabetic foot ulcer: Analysis of 25 patients

Introducción: La diabetes mellitus y sus complicaciones suponen uno de los mayores problemas sanitarios en la actualidad. La úlcera del pie diabético es una de las complicaciones más características. Material, métodos y objetivo: El objetivo es describir los resultados y complicaciones obtenidos en una serie de 25 casos de úlcera neuropática tratada mediante osteotomías de descarga mínimamente invasivas y ambulatorias. Resultados: Del total de intervenciones, 18 fueron sobre úlceras refractarias a un tratamiento conservador previo de una duración media±desviación estándar de 29,28±18,42 meses. El período de seguimiento fue 26,46±4,89 meses. Las tasas agrupadas de respuesta al tratamiento fueron: 100% cicatrización de la úlcera (tiempo medio de cicatrización 22,41±7,01 días), 5,56% recurrencia de la úlcera, 16,67% translocación de la úlcera. En 7 casos se realizó una intervención preventiva sobre áreas con lesiones preulcerosas. Del total, únicamente 3 presentaron infección leve en la zona de la intervención. Conclusiones: La osteotomía de descarga mínimamente invasiva ambulatoria es un procedimiento técnicamente sencillo, que presenta una alta tasa de éxito con mínimas complicaciones en nuestra serie. (AU)

Introduction: Diabetes mellitus and its complications are one of the main burdensome health problems at the present time. The diabetic foot is one of the most characteristic complications. Material, methods and objective: The objective of this work is to describe the results and complications obtained in a series of 25 cases of diabetic foot treated by minimally invasive offloading osteotomies. Results: Of the total number of interventions, 18 were performed on refractory ulcers with prior conservative treatment, for a mean (±SD) duration of 29.28±18.42 months. The mean follow-up period was 26.46±4.89 months. Weighted pooled rates of response to treatment were as follows: 100% for ulcer healing (with a mean healing time of 22.41±7.01 days), 5.56% for ulcer recurrence, and 16.67% for ulcer transfer. In 7cases, a preventive intervention was performed on areas with pre-ulcerative lesions. Of the total number of cases, only 3presented mild infection in the intervention area. Conclusions: Minimally invasive offloading osteotomy is a technically simple intervention, which presents a high success rate with minimal complications in our series. (AU)

Sequential surgery for the treatment of type I knee ankylosis: a series of 62 cases.

BACKGROUNDS: The lack of systematic classification and standard treatment principles for knee ankylosis prevents optimal treatments. This study explored treatments for type I (mild) knee joint ankylosis. METHOD: This retrospective study analysed patients with knee joint ankylosis admitted from March 2013 to January 2018 who underwent sequential arthroscopic release. RESULT: The 62 patients had 12-36 (average, 18) months of follow-up. Thirty-eight patients were released; of these, 18 were assisted by limited incision with partial quadriceps femoris expansion myotomy and released according to arthroscopy. Six patients underwent lengthening and release of the quadriceps femoris. All surgeries combined with full-course rehabilitation resulted in improved joint mobility. The range of motion (ROM) of the knee joint recovered to a range of 0° to 85°-140° (mean: 118.32 ± 9.42°) from the preoperative range of 30°-70° (mean: 45° ± 15.50°). The clinical effect was evaluated according to the Judet criteria at the final follow-up. The outcomes at the last follow-up (at least for 1 year) were excellent in 55 cases, good in six cases, and fair in one case. CONCLUSION: Sequential arthroscopic release, minimal selective invasion of limited incision of partial quadriceps femoris expansion myotomy, assisted by pie-crusting technique to release, or quadriceps femoris lengthening, and release surgery for type I knee joint ankylosis, accompanied by early rehabilitation training provided satisfactory results without significant complications.

The potential impact and diagnostic value of inflammatory markers on diabetic foot progression in type II diabetes mellitus: A case-control study.

BACKGROUND: The wound-healing process in diabetic foot is affected by pro and anti-inflammatory markers, and any disruption in the inflammatory reaction interferes with tissue homeostasis, leading to chronic non-wound healing. AIM: This study aimed to determine the diagnostic value and effect of CRP, IL-6, TNF, and HbA1c on initiation the and progression of diabetic foot ulcers. METHOD: ELISA was used to quantify IL-6, TNF, CRP, and HbA1c in 205 patients with diabetes, and 105 were diabetic foot free. The prevalence and progression of diabetic foot were also evaluated. The area under the curve (AUC) was calculated using the receiver operating characteristic (ROC) curve to analyze the predictive values. Forward stepwise logistic regression analysis was used to compute the odds ratio (OR) and the corresponding 95% confidence intervals (CIs). RESULTS: CRP, IL-6, and FBS were found to be significant predictors of diabetic foot (OR=1.717, 95% CI=1.250-2.358, P=0.001; OR=1.434, 95% CI=1.142-1.802, P=0.002; and OR=1.040, 95% CI=1.002-1.080, P=0.037), respectively. The AUCs for CRP, IL-6, and HbA1c in predicting diabetic foot were 0.839, 0.728, and 0.834, respectively, demonstrating a good predictive value for each diagnostic marker. CONCLUSION: The current study demonstrated that IL-6, CRP, and HbA1c may be useful biomarkers to indicate diabetic foot progression. Furthermore, our findings showed a substantial relationship between CRP and HbA1c in individuals with diabetic foot conditions.

Exploring the extension quantities of a medial collateral ligament pie-crusting model using a finite element method.

Medial collateral ligament (MCL) pie-crusting can balance the soft tissue during total knee arthroplasty but requires more studies with the finite element method (FEM). We have developed three models of MCL pie-crusting utilizing FEM, treating the MCL in the following ways: (1) as a singular elastic body with both ends attached to the bone (model A), (2) as 19 bundled elastic bodies, each attached to both ends of the bone (model B), and (3) as 19 bundled elastic bodies with an adhesive component in the gap, attached to both ends of the bone (model C). The pie-crusting model was created by adding a cut around the center of each model. The left side of the model was fixed and forces of 80 and 120 N in the positive direction of the x-axis were applied. Model A was extended by 0.0068 and 0.010 mm for approximately 10 punctures. Model B-2 was extended by 1.34 and 2.01 mm, approximately twice as much as model B-1. Model C was extended by 0.34 and 0.50 mm for every 10 punctures added. These findings clarify that the model composed of aggregates of fibers with adhesive parts (model C) is suitable for MCL pie-crusting analysis.

Práticas de autocuidado com os pés realizadas por homens com diabetes mellitus / Foot self-care practices performed by men with diabetes mellitus

Identificar o conhecimento e as formas de adesão as práticas de autocuidado com os pés por homens com diabetes mellitus. Método: Pesquisa do tipo exploratória, descritiva com abordagem qualitativa, realizada em duas unidades de atenção primária e uma unidade de atenção secundária do município de Fortaleza-CE. recebeu aprovação do Comitê de Ética em Pesquisa da UNIFOR de n. 5.100.589. Resultados: Dentro do universo de homens com diabetes foram entrevistados 26 homens na faixa etária de 45 a 81 anos, predominando-se aqueles com 48 a 69 de idade (84,6%), a escolaridade variou do analfabeto a ensino superior completo, sendo em sua maioria com fundamental incompleto (42,3%). Conclusão: Percebeu-se que os pacientes com maior nível de conhecimento apresentaram mais chances de praticar o autocuidado. Entretanto, notou-se que os déficits mesmo quando são isolados, podem oferecer o mesmo potencial de risco.(AU)

To identify the knowledge and forms of adherence to foot self-care practices by men with diabetes mellitus. Method: This is an exploratory, descriptive study with a qualitative approach, carried out in two primary care units and one secondary care unit in the city of Fortaleza-CE. The study received approval from the UNIFOR Research Ethics Committee (n. 5.100.589). Results: Within the universe of men with diabetes, 26 men aged between 45 and 81 were interviewed, with a predominance of those aged between 48 and 69 (84.6%). The level of education ranged from illiterate to complete higher education, with the majority having incomplete primary education (42.3%). Conclusion: Patients with a higher level of knowledge were more likely to practice self-care. However, it was noted that deficits, even when isolated, can offer the same risk potential.(AU)

Identificar el conocimiento y las formas de adherencia a las prácticas de autocuidado de los pies por hombres con diabetes mellitus. Método: Se trata de un estudio exploratorio, descriptivo, con abordaje cualitativo, realizado en dos unidades de atención primaria y una unidad de atención secundaria de la ciudad de Fortaleza, Ceará. El estudio recibió aprobación del Comité de Ética en Investigación de la UNIFOR (n. 5.100.589). Resultados: Dentro del universo de hombres con diabetes, fueron entrevistados 26 hombres con edades comprendidas entre 45 y 81 años, predominando los de edades comprendidas entre 48 y 69 años (84,6%), su nivel de escolaridad osciló entre analfabetos y estudios superiores completos, siendo la mayoría con estudios primarios incompletos (42,3%). Conclusión: Los pacientes con un mayor nivel de conocimientos eran más propensos a practicar el autocuidado. Sin embargo, se observó que los déficits, incluso aislados, pueden ofrecer el mismo potencial de riesgo.(AU)

Minimally invasive offloading osteotomy in the treatment of diabetic foot ulcer: Analysis of 25 patients. / Osteotomía de descarga ambulatoria mínimamente invasiva en el tratamiento de la úlcera de pie diabético: análisis de 25 pacientes.

INTRODUCTION: Diabetes mellitus and its complications are one of the main burdensome health problems at the present time. The diabetic foot is one of the most characteristic complications. MATERIAL, METHODS AND OBJECTIVE: The objective of this work is to describe the results and complications obtained in a series of 25 cases of diabetic foot treated by minimally invasive offloading osteotomies. RESULTS: Of the total number of interventions, 18 were performed on refractory ulcers with prior conservative treatment, for a mean (±SD) duration of 29.28±18.42 months. The mean follow-up period was 26.46±4.89 months. Weighted pooled rates of response to treatment were as follows: 100% for ulcer healing (with a mean healing time of 22.41±7.01 days), 5.56% for ulcer recurrence, and 16.67% for ulcer transfer. In 7cases, a preventive intervention was performed on areas with pre-ulcerative lesions. Of the total number of cases, only 3presented mild infection in the intervention area. CONCLUSIONS: Minimally invasive offloading osteotomy is a technically simple intervention, which presents a high success rate with minimal complications in our series.

Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético / Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot

Objetivo Corynebacterium striatum (C. striatum) es un microorganismo emergente en la infección de pie diabético poco estudiado. El objetivo es evaluar los factores de riesgo (FR) relacionados con osteomielitis por C. striatum en paciente con pie diabético. Métodos Estudio casos-controles en la Unidad de Pie Diabético entre 2015 y 2021. Un número de 44 pacientes con osteomielitis por C. striatum (casos) y 44 con osteomielitis por microorganismo distinto (controles) fueron incluidos. Resultados Enfermedad arterial periférica (odds ratio [OR]: 2,8, p = 0,037), fibrilación auricular (OR: 3,7, p = 0,034), pie diabético isquémico (OR: 3,3, p = 0,020) y antibioterapia previa prolongada más de 14 días (OR: 3,4, p = 0,012) fueron FR para la osteomielitis por C. striatum. En el análisis multivariado la antibioterapia más de 14 días fue el único FR independiente (OR: 3,46; p = 0,017) para osteomielitis por C. striatum. Conclusiones La antibioterapia previa recibida durante más de 14 días es un FR independiente y estadísticamente significativo de osteomielitis por C. striatum en pacientes con pie diabético (AU)

Objective Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. Methods A case–control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. Results Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). Conclusions Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot (AU)

Complicaciones vasculares en pacientes diabéticos con hemoglobina glicosilada alterada internados en el Centro Médico Nacional - Hospital Nacional periodo 2022 - 2023 / Vascular complications in diabetic patients with altered glycated hemoglobin admitted to Centro Médico Nacional - Hospital Nacional period 2022 ­ 2023

Introducción: la diabetes mellitus es una enfermedad crónica que, al no ser controlada, puede desencadenar en complicaciones macro y microvasculares. Uno de los indicadores de un adecuado control glucémico es la hemoglobina glicosilada. Objetivos: determinar la frecuencia de complicaciones macro y microvasculares en pacientes diabéticos tipo 2 con hemoglobina glicosilada alterada internados en el Hospital Nacional de Itauguá periodo 2022 - 2023 Metodología: estudio observacional, descriptivo de corte transversal que incluyó a 170 pacientes adultos internados en el servicio de clínica médica del Hospital Nacional (Itauguá, Paraguay) durante los años 2022 y 2023. Resultados: la edad media fue de 58 ± 12 años, con predominio del sexo femenino (51 %). La complicación más frecuentemente diagnosticada fue la enfermedad del pie relacionada a la diabetes con 83 pacientes (49 %), seguido por retinopatía diabética 23 (14 %). El valor promedio de hemoglobina glicosilada fue de 10 ± 2 %. Solamente 6 (4 %) del total de pacientes presentó un valor de HbA1C≥ 7,1 %. La comorbilidad asociada más frecuente fue la hipertensión arterial 87 (51 %). El 91 % de los pacientes conocía ser portador de la enfermedad, el 80 % recibía algún tipo de tratamiento. Conclusiones: el pie diabético fue la complicación vascular diagnosticada con mayor ,frecuencia, especialmente en pacientes con HbA1C≥ 7,1 %.

Introduction: diabetes mellitus is a chronic disease that, if not controlled, can lead to macro- and microvascular complications. One of the indicators of adequate glycemic control is glycosylated hemoglobin. Objectives: to determine the frequency of macro and microvascular complications in type 2 diabetic patients with altered glycosylated hemoglobin admitted to the Hospital Nacional from 2022 to 2023 Methodology: this was an observational, descriptive, cross-sectional study that included 170 adult patients admitted to the Internal Medicine service of the Hospital Nacional (Itauguá, Paraguay) during the years 2022 and 2023. Results: the mean age was 58 ± 12 years, with a predominance of the female sex (51 %). The most frequently diagnosed complication was foot disease related to diabetes with 83 patients (49 %), followed by diabetic retinopathy 23 (14 %). The average value of glycosylated hemoglobin was 10 ± 2 %. Only 6 (4 %) of the total patients had an HbA1C value ≤7 %. The most frequent associated comorbidity was arterial hypertension 87 (51 %). 91 % of the patients knew they were carriers of the disease, 80 % received some type of treatment. Conclusions: diabetic foot was the most frequently diagnosed vascular complication, especially in patients with HbA1C ≥7.1 %.

[Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. / Factores de riesgo asociados a osteomielitis por Corynebacterium striatum en pacientes con pie diabético.

OBJECTIVE: Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS: A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS: Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS: Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.

Escala de conocimientos sobre úlceras de pie diabético CUPD-35: elaboración y propiedades psicométricas en enfermeras de Colombia / Diabetic Foot Ulcer Knowledge Scale CUPD-35: development and psychometric properties on Colombian nurses

Introducción: Las enfermeras tienen un papel esencial en la prevención y en el manejo de las úlceras de pie diabético, por lo que es importante su formación para que tengan conocimientos actualizados. Disponer de escalas para medir de forma fiable estos conocimientos es de utilidad para los programas formativos. Objetivo: Elaborar y obtener propiedades psicométricas de una escala para medir los conocimientos de enfermeras sobre prevención y tratamiento de úlceras de pie diabético. Metodología: Primera fase de elaboración de los ítems de la escala y validación de contenido por panel de expertos. Segunda fase de prueba de campo mediante encuesta a una muestra de 500 enfermeras de hospital y clínicas de heridas en Colombia. Se realizó un análisis mediante modelos de Rasch y validación de constructo mediante test en grupos conocidos. Resultados: La versión inicial de la escala con 48 ítems tuvo adecuada validez de contenido. Tras la prueba de campo y el análisis Rasch se obtuvo la versión final con 35 ítems (CUPD-35) con buenos índices de ajuste y alta fiabilidad (0,97). La puntuación media de conocimientos en esta muestra de enfermeras fue de 28,2 (un 80,2% de la máxima puntuación), lo que indica un buen nivel de conocimientos. Conclusiones: La escala CUPD-35 es un instrumento fiable y válido para medir conocimientos sobre úlceras de pie diabético en enfermerashispanohablantes.(AU)

Introduction: Nurses play an essential role in the prevention and treatment of diabetic foot ulcers, so it is important that they are trained to achieve up-to-date knowledge. Appropriate and reliable tools to measure knowledge are useful for planning training programmes. Objective: To develop and obtain the psychometric properties of a new scale to measure nurses’ knowledge of diabetic foot ulcers prevention and treatment. Methodology: A first phase of item development and content validation by an expert panel. A second phase with a survey of a sample of 500 nurses in Colombia working in hospitals or wound clinics. Analysis using Rasch models and assessment of construct validity by a test of known groups. Results: The initial 48-item version of the scale showed adequate content validity. The survey and Rasch analysis resulted in the final version with 35 items (CUPD-35) with good fit indices and high reliability (0.97). The mean knowledge score of this sample of nurses was 28.2 (80.2% of the maximum score), which means a good level of knowledge. Conclusions: The CUPD-35 scale is a reliable and valid tool for measuring knowledge of diabetic foot ulcers in Spanish-speaking nurses.(AU)

Pé diabético: o cuidado de enfermeiras / Diabetic foot: nurses' care / Pie diabético: cuidados de enfermeira

Objetivo: Descrever o cuidado para prevenção do pé diabético realizado por enfermeiras. Método:revisão integrativa da literatura a partir do levantamento realizado em janeiro de 2024 através da biblioteca virtual da PubMed. Foram incluídos artigos nos idiomas inglês e português, artigos originais relacionados ao tema e disponíveis na íntegra com acesso gratuito, publicados entre os anos de 2012 até o ano de 2024. Como critérios de exclusão: artigos que não atendam o objeto de estudo, duplicados, teses, livros, revisões e artigos não originais.Resultados:O levantamento resultou na seleção de 15 artigos que evidenciaram que o cuidado para prevenção do pé diabético se desenvolvem a partir da atuação do enfermeiro, e por meio da aplicação de cuidados, como avaliação do paciente, educação em saúde para os pacientes e a educação permanente para os profissionais de saúde, controle glicêmico, verificação do Índice tibial braquial-ITB para diagnóstico de doença arterial obstrutiva periférica (DAOP), uso de termometria cutânea ou imagem infravermelha, criação de software e exames laboratoriais. Conclusão:O estudo poderá contribuir para melhoria da qualidade de vida dos pacientes diabéticos através do conhecimento dos profissionais de enfermagem acerca dos cuidados elencados para melhor atender aos pacientes bem como contribuir com a diminuição de casos de úlceras em pé diabético.

Objective: To describe the care to prevent diabetic foot provided by nurses. Method:integrative literature review based on the survey carried out in January 2024 through the PubMed virtual library. Articles in English and Portuguese were included, original articles related to the topic and available in full with free access, published between 2012 and 2024. Exclusion criteria were: articles that do not meet the object of study, duplicates, theses, books, reviews and non-original articles. Results:The survey resultedin the selection of 15 articles that showed that care to prevent diabetic foot develops from the role of nurses, and through the application of care, such as patient assessment, health education for patients and continuing education for health professionals, glycemic control, verification of the brachial tibial index-ABI for diagnosing peripheral arterial obstructive disease (PAOD), use of skin thermometry or infrared imaging, creation of software and laboratory tests. Conclusion:The study may contribute to improving the quality of life of diabetic patients through the knowledge of nursing professionals about the care provided to better serve patients as well as contributing to the reduction of cases of diabetic foot ulcers.

Objetivo: Describir los cuidados para la prevención del pie diabético brindados por enfermeras. Método:revisión integrativa de la literatura a partir de la encuesta realizada en enero de 2024 a través de la biblioteca virtual PubMed. Se incluyeron artículos en inglés y portugués, artículos originales relacionados con el tema y disponibles íntegramente con acceso gratuito, publicados entre 2012 y 2024. Los criterios de exclusión fueron: artículos que no cumplan con el objeto de estudio, duplicados, tesis, libros, reseñas y artículos no originales. Resultados:La encuesta resultó en la selección de 15 artículos que mostraron que los cuidados para prevenir el pie diabético se desarrollan desde el rol del enfermero, y a través de la aplicación de cuidados, como la evaluación del paciente, la educación en salud de los pacientes y la educación continua de los profesionales de la salud, la glucemia. control, verificación del índice braquial tibial-ITB para el diagnóstico de enfermedad arterial obstructiva periférica (EAP), uso de termometría cutánea o imágenes infrarrojas, creación de software y pruebas de laboratorio. Conclusión:El estudio puede contribuir a mejorar la calidad de vida de los pacientes diabéticos a través del conocimiento de los profesionales de enfermería sobre los cuidados brindados para atender mejor a los pacientes, así como contribuir a la reducción de casos de úlceras del pie diabético.

Evaluación funcional tras SARS-CoV-2 crítico. Estudio de cohortes de la unidad de rehabilitación en un hospital de tercer nivel / Functional evaluation in patient with critical SARS-CoV-2 disease: Cohort study in a third level hospital rehabilitation unit

Introducción: La neumonía por SARS-CoV-2 es una enfermedad infecciosa respiratoria altamente contagiosa que causa disfunción respiratoria, física y psicológica. Presentamos resultados de los pacientes valorados por el Servicio de Rehabilitación al alta de UCI por SARS-CoV-2. Material y método: Estudio de cohortes de pacientes ingresados en UCI por neumonía por SARS-CoV-2 desde el 01/10/2020 al 31/07/2021. Recogemos datos sociodemográficos, antecedentes personales, estancia media en UCI y hospital, Barthel, marcha (FAC) y mMRC (preingreso/valoración inicial/alta), desarrollo de patología osteomuscular y/o neurológica y necesidad de tratamiento rehabilitador. Resultados: Muestra de 341 pacientes de los cuales 224 cumplen criterios. Edad media: 63 años (68,75% hombres). Estancia media UCI/hospital: 27/44 días. Valorados por médicos rehabilitadores, facilitamos a los pacientes una guía elaborada por el equipo médico resolviendo dudas del proceso y pautando ejercicios de intensidad y dificultad progresiva, a realizar durante el ingreso y en el domicilio. El 42,86% desarrolló patología neurológica (83,33% del sistema nervioso periférico). El 100% ha realizado fisioterapia respiratoria y el 72,32% ha precisado fisioterapia motora. Conclusiones: En nuestro estudio, un elevado número de pacientes han precisado tratamiento rehabilitador para su recuperación funcional, destacando el desarrollo de patología neurológica post-COVID. El SARS-CoV-2 genera otras complicaciones, no solo respiratorias, subsidiarias de valorarse y tratarse por los Servicios de Rehabilitación para una recuperación integral que minimice las secuelas.(AU)

Introduction: SARS-COV-2 pneumonia is a highly contagious respiratory disease that causes respiratory, physical and psychological dysfunctions. We present the results of patient assessment when they were discharged from the ICU. Material and method: Cohort study of patients affected by SARS-COV-2 pneumonia admitted to the intensive care unit from 01/10/2020 to 31/07/2021. We collect sociodemographic data, personal history, ICU and hospital stay, Barthel, FAC and mMRC (pre-admission/initial assessment/discharge), development of osteomuscular and/or neurological pathology and need for rehabilitation treatment. Results: A total of 341 patients were evaluated, of which 224 met criteria. The average age was 63 years (68.75% men). Mean ICU/hospital stay were 27/44 days. They were assessed by physiatry, after that, we provide a guide developed by physiatry, solving doubts about the disease and setting exercises of intensity and progressive difficulty, to be carried out during the admission and at home. Neurological pathology was present at 42.86% patients, of whom a 83.33% were peripheral nervous system disease. The total of the sample needed respiratory physiotherapy and a 72.32% motor physiotherapy. Conclusions: In our study, a high number of patients have needed rehabilitation treatment in order to get functional recovery, highlighting the development of post-COVID neurological pathology. SARS-COV-2 generates other complications, not only respiratory, subsidiary to be assessed and treated by rehabilitation services for a comprehensive recovery that minimizes sequelae.(AU)

Trasplante articular vascularizado de dedo de pie a mano en paciente pediátrico. Caso clínico / Vascularized toe-to-hand joint transplantation in pediatric patient. Case report

Los traumatismos de la mano tienen alta frecuencia e impacto en la funcionalidad de quienes los padecen, por lo que su correcto abordaje inicial y la adecuada elección de las opciones reconstructivas requieren una atención especial. Presentamos el caso de una paciente de 6 años de edad con lesión ósea y de la articulación interfalángica proximal en el segundo dedo de la mano derecha por proyectil de arma de fuego, reconstruida mediante trasplante articular vascularizado. Las ventajas fueron una buena funcionalidad articular, con rangos de movilidad aceptables y ausencia de dolor; crecimiento digital uniforme al preservar los núcleos de osificación, ausencia de reabsorción ósea o degeneración articular y secuelas de bajo impacto en el sitio donante.(AU)

Hand injuries have a high frequency and impact on the functionality of those who suffer from them, so their correct initial approach and the appropriate choice of reconstructive options require special attention. We present the case of a 6-year-old patient with bone and proximal interphalangeal joint injury of the second finger of the right hand due to a firearm projectile, reconstructed by vascularized joint transplantation. The advantages were obtaining good joint functionality, acceptable ranges of mobility and absence of pain; uniform digital growth due to preserved ossification nuclei; no bone resorption or joint degeneration, and low impact sequelae at the donor site.(AU)

Costos directos en el tratamiento del pie diabético Unidad de Pie Diabético. Hospital de Clínicas. Universidad de la República

En el mundo un paciente diabético gasta entre dos y tres veces más que el no diabético. El pie diabético disminuye la calidad de vida, aumenta la morbimortalidad y la carga económica del sistema de salud. Objetivo: comunicar la investigación realizada sobre costos directos en el tratamiento de la úlcera del pie diabético. Material y método: estudio observacional, descriptivo, retrospectivo de pacientes asistidos en la Unidad de Pie del Hospital de Clínicas, Universidad de la República, entre octubre de 2014 y septiembre de 2016. Se estimaron gastos directos del tratamiento ambulatorio e internación a través de información de la historia clínica. El horizonte de tratamiento fue de tres meses. Se calcularon los gastos en unidades reajustables (UR), pesos y dólares. Los gastos se actualizaron a octubre del 2022 utilizando el índice de precios al consumo (IPC), ajustado a la tasa de inflación acumulada. Resultados: incluimos 49 pacientes, 11 mujeres y 38 hombres, edad promedio 61,5 años. El gasto general fue mayor a 400.000 dólares, con el mayor costo en gastos de internación. El gasto total promedio por paciente fue de 8.799 dólares. El tratamiento convencional fue 3.707,93 dólares, la amputación mayor 32.003,61 dólares y amputación menor 12.385,34 dólares. El gasto en internación fue muy superior al del paciente ambulatorio. En emergencia, 28 pacientes gastaron 4.396 dólares. El incremento de costos al año 2022 fue de 37,45%, suponiendo un gasto general de 16.682.993,4 pesos o 410.830,2 dólares. Conclusión: primera evaluación en nuestro país de estimación de gastos en pie diabético. El costo de la úlcera genera una carga económica notoria y en aumento. La gravedad inicial de la úlcera determina ingresos con elevados costes. Los gastos de internación y amputaciones representan la mayor erogación económica.

On a global scale, a diabetic patient incurs healthcare expenses that are 2 to 3 times higher than those of a non-diabetic individual. Diabetic foot syndrome reduces the quality of life, increases morbidity and mortality, and places an economic burden on the healthcare system. Objective: Communicating the research conducted on direct costs in the treatment of diabetic foot ulcers. Method: Observational, descriptive, retrospective study of patients treated at the Foot Unit of the Hospital de Clínicas (UDELAR) between October 2014 and September 2016. Direct treatment costs for outpatient care and hospitalization were estimated using information from the medical records. The treatment horizon extended over a period of 3 months. Expenses were calculated in readjustable units, Uruguayan pesos (UYU), and United States dollars (USD). Expenses were updated to October 2022 using the Consumer Price Index (IPC) adjusted for the cumulative inflation rate. Results: 49 patients were included in the study: 11 women and 38 men, average age was 61.5 years old. The overall expenditure exceeded 400,000 USD, with the highest cost attributed to hospitalization expenses. The average total expenditure per patient amounted to 8,799 USD. The cost of conventional treatment was 3,707.93 USD, major amputation represented USD 32,003.61, and minor amputation USD 12,385.34. Hospitalization expenses significantly exceeded those of outpatient care. In the emergency department, 28 patients spent USD 4,396. The increase in costs by the year 2022 amounted to 37.45%, resulting in a total expenditure of UYU 16,682,993.4 (Uruguayan pesos) or USD 410,830.2. Conclusions: It was the first assessment in our country to estimate diabetic foot costs. The cost of ulcer management imposes a significant and increasing economic burden. The initial severity of the ulcer results in hospitalization which implies high associated costs. Hospitalization and amputation costs constitute the most substantial economic expenditure.

Em todo o mundo, um paciente diabético gasta entre 2 e 3 vezes mais do que um paciente não diabético. O pé diabético reduz a qualidade de vida, aumenta a morbimortalidade e a carga económica no sistema de saúde. Objetivos: Comunicar os resultados da pesquisa realizada sobre os custos diretos no tratamento das úlceras do pé diabético. Materiais e métodos: Estudo observacional, descritivo e retrospectivo de pacientes atendidos na Unidade de Pie do Hospital de Clínicas (UDELAR), entre outubro de 2014 e setembro de 2016. Foram estimados gastos diretos com tratamento ambulatorial e internação, por meio de informações do prontuário do paciente. O período de tratamento estudado foi de 3 meses. As despesas foram calculadas em Unidades Ajustáveis, em pesos uruguaios (UYU) e em dólares norte-americanos (USD). As despesas foram atualizadas para outubro de 2022 pelo Índice de Preços ao Consumidor (IPC) ajustado à inflação acumulada. Resultados: Foram incluídos 49 pacientes: 11 mulheres e 38 homens com idade média de 61,5 anos. A despesa global foi superior a US$ 400.000, com o maior custo em despesas de hospitalização. A despesa total média por paciente foi de US$ 8.799. Os custos por tratamento foram: Tratamento convencional US$ 3.707,93 USD, amputação maior US$ 32.003,61 e amputação menor US$ 12.385,34. O gasto com internação foi muito superior ao do ambulatório. No atendimento de emergência 28 pacientes gastaram US$ 4.396. O aumento dos custos até 2022 foi de 37,45%, assumindo uma despesa geral de UY$ 16.682.993,4 ou US$ 410.830,2 USD. Conclusão: Esta é a primeira avaliação de estimativa de gastos com pé diabético realizada no Uruguai. O custo das úlceras gera uma carga económica notável e crescente. A gravidade inicial da úlcera determina internações com custos elevados. As despesas com hospitalização e amputação representam o maior gasto financeiro.

Diagnóstico prenatal, síndrome Freeman-Sheldon mediante ultrasonido y estudio genético. Reporte de caso / Prenatal diagnosis of Freeman-Sheldon syndrome using ultrasound and genetic testing. Case report

Objetivos: Describir un caso de diagnóstico prenatal de síndrome de Freeman-Sheldon mediante hallazgos ecográficos y secuenciación completa del exoma fetal. Materiales y métodos: Mujer de 33 años, con antecedentes de hipotiroidismo en tratamiento, a quien en semana 19 se realizó ecografía de detalle anatómico, en la cual se observaron deformidades en el feto en más de dos áreas corporales (extremidades superiores e inferiores), sugiriendo el diagnóstico de artrogriposis. Posteriormente, se brindó asesoría genética y se realizó amniocentesis en semana 20 de gestación, con análisis de la hibridación in situ por fluorescencia, seguido de secuenciación completa del exoma fetal. Este último examen permitió identificar una variante patogénica heterocigota en el gen MYH3, la cual se asocia con la artrogriposis distal tipo 2A. Conclusiones: La realización de la secuenciación completa de exoma fetal es un factor clave para identificar la mutación del gen MYH3, y confirma que las deformidades evidenciadas por ultrasonido estaban relacionadas con la artrogriposis distal tipo 2A. Es importante hacer la secuenciación de exoma fetal en fetos que muestren hallazgos de malformaciones articulares en el ultrasonido prenatal.

Objectives: To describe a case of prenatal diagnosis of Freeman-Sheldon syndrome based on ultrasound findings and complete fetal exome sequencing. Materials and methods: A 33-year-old woman currently on treatment for hypothyroidism in whom a 19-week detailed anatomical ultrasound scan showed fetal deformities in more than two body areas (upper and lower limbs), suggesting a diagnosis of arthrogryposis. Genetic counseling was provided and amniocentesis was performed at 20 weeks for fluorescence in situ hybridization (FISH) analysis and complete fetal exome sequencing, with the latter allowing the identification of a heterozygous pathogenic variant of the MYH3 gene which is associated with type 2A distal arthrogryposis. Conclusions: Complete fetal exome sequencing was a key factor in identifying the MYH3 gene mutation and confirmed that the deformities seen on ultrasound were associated with type 2A distal arthrogryposis. It is important to perform complete fetal exome sequencing in cases of joint malformations seen on prenatal ultrasound.