Riesgo de pie diabético y déficit de autocuidados en pacientes con Diabetes Mellitus Tipo 2 / Diabetic foot risk and self-care shortfalls among Type 2 Diabetes Mellitus patients / Risco de pé diabético e déficit de autocuidados em pacientes com Diabetes Mellitus Tipo 2

Objetivo: Conocer los factores de riesgo de pie diabético y el nivel de conocimientos sobre autocuidados en una muestra de pacientes con diabetes mellitus tipo 2 (DM2), de un centro de salud urbano. Método: Estudio observacional descriptivo en Atención Primaria. Intervención de enfermería relacionada con pie diabético en una muestra de usuarios diagnosticados de DM2. Recogida de datos de historia clínica, valoración clínica y aplicación de un cuestionario ad hoc sobre factores de riesgo y conocimiento de autocuidados. Análisis estadístico descriptivo e inferencial. Resultados: 42 hombres y 31 mujeres. Media de edad de 69.1 años. El 65.8% fueron diagnosticados de DM2 hace más de 10 años. El valor medio de la HbA1c fue de 6.9%, el cual fue más elevado en los hombres (p=0.02). También, se observó mayor riesgo de complicaciones vasculares y neuropáticas en los hombres (p=0.04); y una mayor presencia de deformidades (helomas y hallux valgus) en las mujeres (p<0.01). Déficit de conocimientos en más de la mitad de los pacientes, relacionado con la hidratación diaria de los pies (p<0.01) y el uso de calzado adecuado (p<0.01). Conclusiones: El control de los factores de riesgo de pie diabético debe ser mejorado por parte de los pacientes de nuestro estudio. El déficit de conocimientos se relacionó con un bajo nivel informativo y con la aplicación inadecuada de las recomendaciones. Se hace necesario formar a los pacientes en estos aspectos y realizar una valoración clínica, según la práctica basada en la evidencia, lo que posiblemente influya en un mejor control del riesgo de pie diabético.

To explore the risk factors associated with diabetic foot, and the level of knowledge on self-care, in a sample of type 2 Diabetes Mellitus patients (DM2) from an urban health center. Method: This is an observational and descriptive study in the area of nursing interventions in Primary Attention. Collected data included clinical history, clinical assessment, and the results of an ad hoc questionnaire on DM2 associated risk factors, and the self-care knowledge level. Descriptive and inferential statistics were calculated. Results: There were 42 male and 31 female patients with a mean age of 69.1 years old. 65.8% had been diagnosed with DM2 longer than 10 years ago. The median value of HbA1c was 6.9%, which was higher among males (p = 0.02). A higher risk of suffering vascular and kidney-related complications was observed among males as well (p = 0.04), whereas a higher presence of deformities such as calluses and hallux valgus was observed among females (p <0.01). Shortfalls in knowledge, including those on daily feet hydration (p < 0.01) and the use of adequate shoes (p<0.01) were observed in more than half of these patients. Conclusions: The control of the related risk factors must be improved by the patients in our study. Moreover, their knowledge shortfalls were related to the inadequate fulfillment of the corresponding recommendations. Thus, and considering the Evidence-Based Practice, it is necessary to better prepare these patients so that they can better control their diabetic foot risks.

Objetivo: Conhecer os fatores de risco de pé diabético e o nível de conhecimentos sobre autocuidados em uma amostra de diabéticos mellitus tipo 2 (DM2), de um centro de saúde urbano. Método: Estudo observacional descritivo em Atenção Primária. Intervenção de enfermagem relacionada com pé diabético em uma amostra de usuários diagnosticados de DM2. Coleta de dados de história clínica, avaliação clínica e aplicação de um questionário ad hoc sobre fatores de risco e conhecimento de autocuidados. Análise estatística descritiva e inferencial. Resultados: 42 homens e 31 mulheres. Média de idade de 69.1 anos. O 65.8% foram diagnosticados de DM2 até mais de 10 anos. A média da HbA1c foi de 6.9%, a qual foi mais elevada nos homens (p=0.02). Também, se observou maior risco de complicações vasculares e neuropáticas nos homens (p=0.04); e uma maior presença de deformidades (helomas e hallux valgus) nas mulheres (p0<.01). Déficit de conhecimentos em mais da metade dos pacientes, relacionado com a hidratação diária dos pés (p<0.01) e o uso de calçado adequado (p<0.01). Conclusões: O controle dos fatores de risco de pé diabético deve ser melhorado por parte dos pacientes de nosso estudo. O déficit de conhecimentos relacionou-se com um baixo nível informativo e com a aplicação inadequada das recomendações. Faz-se necessário formar aos pacientes nestes aspectos e realizar una avaliação clínica, segundo a prática baseada na evidencia, o que possivelmente influencie em um melhor controle do risco de pé diabético.

Inhibition of Trypanosoma cruzi by plant extracts used in Chinese medicine.

In this work, we assessed the effect of extracts obtained from 17 plants used in traditional Chinese medicine. These extracts were tested in vitro with the epimastigote form of Trypanosoma cruzi, clone Bra C(15) C(2), at 27 degrees C in F-29 medium at a concentration of 100 microg/ml in axenic cultures. Allopurinol was used as reference drug. Seven plant extracts showed inhibitory activities lower than 25%. Pueraria lobata, Mahonia beaei, Dictamus dasycarpus, Kochia scoparia, Sophora flavescens and Ligustrum lucidum showed effects with inhibition values between 25% and 60%, whereas Lithospermum erythrorhizon, Saussurea lappa, Melia toosendan and Cinnamomum cassia showed the greatest inhibitory activity of 100%. The IC(50) of these extracts were: 0.4, 2.4, 1.8 and 3.9 microg/ml, respectively. The MTT assay was made and did not show cytotoxic activity. These results allowed us to suggest that L. erythrorhizon, S. lappa, M. toosendan and C. cassia could be a source of new compounds against T. cruzi.

Inhibition of Trypanosoma cruzi growth by medical plant extracts.

This study describes the screening of extracts obtained from 18 plants and two fungi used in the Chinese and Mediterranean traditional medicines on epimastigote forms of Trypanosoma cruzi. The extracts were tested against epimastigote of T. cruzi Bra C15C2 clone in vitro at 27 degrees C and at a concentration of 250 microg/ml in axenic culture. Angelica dahurica, A. pubescens, A. sinensis, Astragalus membranaceus, Coptis chinensis, Haplophyllum hispanicum, Phellodendron amurense, Poria cocos, Ranunculus sceleratus and Scutellaria baicalensis showed significant effects against the parasite with a percentage of growth inhibition between 20 and 100%. C. chinensis and R. sceleratus showed the greatest activity with IC(50) values of 1.7 microg/ml for C. chinensis and 10.7 microg/ml for R. sceleratus. These activities are greater than that of allopurinol. C. chinesis and R. sceleratus extracts did not show cytotoxic effects on rat polimorphonuclear cells using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and lactic dehydrogenase assays. These results allowed us to suggest that R. sceleratus and C. chinensis could be a source of new compounds clinically active against T. cruzi.

Antioxidant activity of anti-inflammatory plant extracts.

The antioxidant properties of twenty medical herbs used in the traditional Mediterranean and Chinese medicine were studied. Extracts from Forsythia suspensa, Helichrysum italicum, Scrophularia auriculata, Inula viscosa, Coptis chinensis, Poria cocos and Scutellaria baicalensis had previously shown anti-inflammatory activity in different experimental models. Using free radical-generating systems H. italicum. I. viscosa and F. suspensa protected against enzymatic and non-enzymatic lipid peroxidation in model membranes and also showed scavenging property on the superoxide radical. All extracts were assayed at a concentration of 100 microg/ml. Most of the extracts were weak scavengers of the hydroxyl radical and C. chinensis and P. cocos exhibited the highest scavenging activity. Although S. baicalensis inhibited the lipid peroxidation in rat liver microsomes and red blood cells, the extract showed inhibitory actions on aminopyrine N-demethylase and xanthine oxidase activities as well as an pro-oxidant effect observed in the Fe3+-EDTA-H2O2 system. The results of the present work suggest that the anti-inflammatory activities of the same extracts could be explained, at least in part, by their antioxidant properties.