Health Care Spending in Patients With Stage 3 and Stage 4 Pressure Injuries and Patients With Diabetic Foot Ulcers Treated Early With Clostridial Collagenase Ointment: A Retrospective Data Review.

INTRODUCTION: Clostridial collagenase ointment (CCO) is the only enzymatic agent indicated for debriding chronic dermal ulcers that is approved by the United States Food and Drug Administration. OBJECTIVE: The objective of this study is to estimate health care spending among patients with Stage 3 and Stage 4 pressure injuries (PIs) and patients with diabetic foot ulcers (DFUs) who experienced early (ie, within 30 days of index diagnosis) versus late (31 to 90 days of index diagnosis) initiation of CCO. METHODS: Patients with PIs and DFUs between January 2007 and March 2017 were identified. One-to-one matched cohorts were used to compare all-cause health care spending and disease-related health care spending between the early initiation and late initiation groups. RESULTS: Compared to the early CCO initiation group, all-cause health care spending for the late CCO initiation group was higher in both patients with PIs and in patients with DFUs within the 12-month follow-up period. Compared to the early CCO initiation group, disease-related health care spending for the late CCO initiation group was higher in both patients with PIs and in patients with DFUs within the 12-month follow-up period. All computations were statistically significant. CONCLUSIONS: Early initiation of CCO provides both all-cause and disease-related health care savings to payers and persons managing patients with PIs or DFUs. Payers, providers, and facilities should consider mechanisms to encourage the early use of CCO to lower costs.

Colagenase óvulos na pós-cauterizaçäo do colo uterino / Collagenase ovules in post-cauterization of uterine cervix

O autor estudou a colagenase sob a forma de óvulos vaginais na pós-cauterizaçäo do colo uterino. O estudo foi duplo-cego e constou de 40 pacientes, sendo que 20 receberam placebo e 20 a substância ativa. Os óvulos eram fornecidos às pacientes aleatóriamente. Foi observada uma melhora acentuada na cicatrizaçäo do colo uterino das pacientes que usaram a substância ativa. A tolerabilidade do medicamento, a evoluçäo da cicatrizaçäo e a eficácia do medicamento foram muito boas. A citologia e a bacterioscopia foram melhores na fase final. Näo houve efeitos colaterais. Aconselha o autor o uso de Colagenase com Clorafenicol óvulos no tratamento do colo uterino após a cauterizaçäo

[Drug combinations in the care of bed sores]. / Atenção nos cuidados de enfermagem das escaras quanto às associações terapêuticas.

The present study aims at discussing the types of prescriptions and caring bedsores related to IRUXOL ointment use, as well as bandages practice reports performed by the nursing team in care units. Nineteen patient files from three School Hospitals ins Rio de Janeiro city have been analyzed. The results presented eight different kinds of drug prescription for bedsore treatment in which four of them were related to IRUXOL. The most frequent formulation was: cleaning with PVP-I + Physiologic Solution 0.9% and IRUXOL. It has also been observed that the nursing professional had used seventeen different combinations with several substances in which ten of them were associated to IRUXOL. They have also reported the use of 24 different products/substances when performing bedsores bandages. The indiscriminated use of products which alters injury pH (acid-base contents) such a factor which interferes debridant action of IRUXOL, has been verified.

Cicatrizaçäo de lesöes cutâneas com o uso de colagenase associada a cloranfenical em pomada / Cutaneous wounds cicatrization with the use of colagenases associated with chloranfenicol in ointment form

Foram estudados 20 indivíduos com lesöes cutâneas, sendo oito com lesöes actínicas, quatro com dermatite química por fármacos antineoplásicos, dois com úlcera varicosa e seis com lesöes metastáticas ulceradas e infectadas. Usou-se, localmente, associaçäo de clostridiopeptidase A + proteases e cloranfenicol, precedido de limpeza com líquido de Dakin e água oxigenada, duas vezes ao dia. O critério usado para a obtençäo dos resultados foi o seguinte: + (cura de lesäo inicial); ++ (melhora em cerca de 50% da lesäo inicial); +++ (inalteraçäo da lesäo) e ++++ (progressäo da lesäo). Os resultados obtidos foram os seguintes: a. oito actínicas: + para cada; b. quatro dermatites químicas: uma com + e três com + + +; c. duas úlceras varicosas: + para cada uma; d. seis lesöes metastáticas: quatro com + + + + e duas com + + + (com melhora da infecçäo subjacente em todos)

Discos intervertebrales lumbares extruidos / Extruded lumbar disks

La discolisis percutanea con colagenasa produce resultados altamente satisfactorios en pacientes con discos lumbares protruidos, pero no actua cuando el disco esta extruido, caso en el cual esta indicada la excision quirurgica del tejido herniado. Con el objeto de establecer este diagnostico diferencial se hizo el estudio retrospectivo de las historias clinicas y las mielografias de los archivos del Instituto Neurologico de Colombia. El cuadro clinico clasico de dolor lombociatico continuo producico por el disco extruido no aliviado con reposo en cama, con signos de compresion radicular fue observado en 10 a 30 casos seleccionados de discos extruidos. En 19 enfermos la mielografia fue concluyente. Al combinar los hallazgos clinicos y mielograficos se pudo establecer el diagnostico con certeza en solo dos terceras partes de los casos. En esta serie no se utilizo la discografia, procedimiento que podria ser adicionado para incrementar nuestra capacidad de distinguir los discos lumbares extruidos de los protruidos.