Abordaje global del paciente con pie diabético: Una revisión / Global approach to the patient with diabetic foot: A review

RESUMEN El artículo de revisión destaca la importancia de la planta del pie en la deambulación y su adaptación a las necesidades humanas. Se enfoca en el pie diabético (PD), definido por signos, síntomas o úlceras en el pie debido a complicaciones crónicas de la diabetes. El PD afecta a alrededor del 25% de los pacientes con diabetes mellitus (DM), con úlceras que pueden derivar en infecciones graves y riesgo de amputación. El manejo del PD es complejo y requiere un enfoque multidisciplinar. Este artículo propone un "Sistema de Evaluación y Tratamiento del Pie Diabético", aplicable en diversos entornos clínicos, que clasifica las úlceras según su profundidad e infección y ofrece guías claras para su tratamiento. Se discuten también la epidemiología de la neuropatía diabética (ND), destacando su alta prevalencia y morbilidad, y la necesidad de un diagnóstico y tratamiento adecuados. Se analiza en detalle la neuropatía de Charcot, una complicación severa del PD, incluyendo sus causas y métodos diagnósticos. Además, se enfatiza la importancia del enfoque multidisciplinar en el tratamiento de las úlceras del PD para reducir amputaciones y mejorar la calidad de vida de los pacientes. También se abordan las infecciones del PD y la antibioticoterapia, recomendando el uso de antibióticos adecuados según la gravedad de la infección y la realización de cultivos microbiológicos precisos. Finalmente, se presenta una visión global del manejo del PD, destacando la importancia de un enfoque multidisciplinar y proponiendo un sistema de evaluación y tratamiento eficaz que puede ser implementado en diversos contextos clínicos.

ABSTRACT The review article highlights the importance of the sole of the foot in ambulation and its adaptation to human needs. It focuses on diabetic foot (DF), defined by signs, symptoms, or ulcers on the foot due to chronic complications of diabetes. DF affects approximately 25 % of patients with diabetes mellitus (DM), with ulcers that can lead to severe infections and risk of amputation. Managing DF is complex and requires a multidisciplinary approach. This article proposes a "Diabetic Foot Evaluation and Treatment System," applicable in various clinical settings, which classifies ulcers according to their depth and infection and provides clear treatment guidelines. The epidemiology of diabetic neuropathy (DN) is also discussed, highlighting its high prevalence and morbidity, and the need for adequate diagnosis and treatment. The article provides a detailed analysis of Charcot neuropathy, a severe complication of DF, including its causes and diagnostic methods. Furthermore, the importance of a multidisciplinary approach in the treatment of DF ulcers is emphasized to reduce amputations and improve patients' quality of life. DF infections and antibiotic therapy are also addressed, recommending the use of appropriate antibiotics according to the severity of the infection and the performance of precise microbiological cultures. Finally, a comprehensive view of DF management is presented, highlighting the importance of a multidisciplinary approach and proposing an effective evaluation and treatment system that can be implemented in various clinical contexts.

Exoprotease exploitation and social cheating in a Pseudomonas aeruginosa environmental lysogenic strain with a noncanonical quorum sensing system.

Social cheating is the exploitation of public goods that are costly metabolites, like exoproteases. Exoprotease exploitation in Pseudomonas aeruginosa has been studied in reference strains. Experimental evolution with reference strains during continuous growth in casein has demonstrated that nonexoprotease producers that are lasR mutants are selected while they behave as social cheaters. However, noncanonical quorum-sensing systems exist in P. aeruginosa strains, which are diverse. In this work, the exploitation of exoproteases in the environmental strain ID4365 was evaluated; ID4365 has a nonsense mutation that precludes expression of LasR. ID4365 produces exoproteases under the control of RhlR, and harbors an inducible prophage. As expected, rhlR mutants of ID4365 behave as social cheaters, and exoprotease-deficient individuals accumulate upon continuous growth in casein. Moreover, in all continuous cultures, population collapses occur. However, this also sometimes happens before cheaters dominate. Interestingly, during growth in casein, ID4565's native prophage is induced, suggesting that the metabolic costs imposed by social cheating may increase its induction, promoting population collapses. Accordingly, lysogenization of the PAO1 lasR mutant with this prophage accelerated its collapse. These findings highlight the influence of temperate phages in social cheating.

Risk Factors Control After an Acute Coronary Syndrome and Association with Major Adverse Cardiovascular Events: A Single Center Experience in Latin-America.

INTRODUCTION: An important challenge in the secondary prevention of cardiovascular diseases is the optimization of risk factors (RFs) after hospital discharge. These have been shown to be insufficiently controlled in clinical practice. AIM: To evaluate whether secondary prevention goals were met at our institution at 12 months after an acute coronary syndrome (ACS) index event, as well as analyzing if achieving these goals was associated with a lower incidence of major adverse cardiovascular events (MACE). METHODS: Retrospective cohort of patients with a former diagnosis of ACS over a period of 4 years. To evaluate the proportion of patients who met RF control goals at 12 months after the index event, we used two sets of preestablished goals: stringent and lenient. During follow-up we evaluated the occurrence of MACE, defined by the following: ACS, coronary revascularization, stroke, hospitalization because of acute heart failure and cardiovascular death. RESULTS: We included 468 patients during the study period. The mean age of the patients was 60 ± 10.76 years, 20.5% were women, and mean follow-up was 41.8 ± 22.0 months. The proportion of patients that met all secondary prevention stringent and lenient goals accounted for 5.5% and 17.2%, respectively, and 8% did not achieve any target. Overall, 9.6% presented the composite of MACE during follow-up. The number of RFs in control at 12 months was associated with a lower rate of MACE, both with stringent and lenient goals. CONCLUSION: Achieving established goals for modifiable RFs can lower the incidence of MACE during long-term follow-up.

Resistance against two lytic phage variants attenuates virulence and antibiotic resistance in Pseudomonas aeruginosa.

Background: Bacteriophage therapy is becoming part of mainstream Western medicine since antibiotics of clinical use tend to fail. It involves applying lytic bacteriophages that self-replicate and induce cell lysis, thus killing their hosts. Nevertheless, bacterial killing promotes the selection of resistant clones which sometimes may exhibit a decrease in bacterial virulence or antibiotic resistance. Methods: In this work, we studied the Pseudomonas aeruginosa lytic phage φDCL-PA6 and its variant φDCL-PA6α. Additionally, we characterized and evaluated the production of virulence factors and the virulence in a Galleria mellonella model of resistant mutants against each phage for PA14 and two clinical strains. Results: Phage φDCL-PA6α differs from the original by only two amino acids: one in the baseplate wedge subunit and another in the tail fiber protein. According to genomic data and cross-resistance experiments, these changes may promote the change of the phage receptor from the O-antigen to the core lipopolysaccharide. Interestingly, the host range of the two phages differs as determined against the Pseudomonas aeruginosa reference strains PA14 and PAO1 and against nine multidrug-resistant isolates from ventilator associated pneumonia. Conclusions: We show as well that phage resistance impacts virulence factor production. Specifically, phage resistance led to decreased biofilm formation, swarming, and type III secretion; therefore, the virulence towards Galleria mellonella was dramatically attenuated. Furthermore, antibiotic resistance decreased for one clinical strain. Our study highlights important potential advantages of phage therapy's evolutionary impact that may be exploited to generate robust therapy schemes.

A low-cost, portable 32-channel EIT system with four rings based on AFE4300 for body composition analysis.

A proposed low-cost, portable, 32-channel (4 rings of 8-channel) Electrical Impedance Tomography (EIT) system based on the AFE4300 analog front-end for body composition measurement. Each ring allows obtaining the conductivity distribution of 4 cross sections, 4 cm apart; to analyze the behavior of conductivity in a volume. The switching of the 4 rings and the current injection and voltage measurement patterns are done with three Texas Instruments 74HC4067 multiplexers, which are managed by an ESP32 board. The proposed system has an average signal-to-noise ratio of 74.71 dB and a frame rate of 50 fps. The sensitivity tests to impedance and volume changes consisted of introducing 4 tubes of different diameters (2 steel and 2 polyvinyl chloride) into a tank with saline solution; then conductivity distribution images were generated in 4 cross-sections of the tank, using the algorithms Gauss-Newton and Noser. Finally, the global impedance index (GI) is calculated to estimate the volume of each tube inside the tank. The results show that the proposed system is highly sensitive to impedance and volume changes, being a promising system for monitoring tissues, and fluids biological.

Correlación de la distancia recorrida en la caminata de 6 minutos y puntajes de comorbilidad Charlson y Elixhauser / Correlation of distance traveled in the 6 minute walk and Charlson and Elihauser comorbidity scores

Introduction: The walking test of 6 minutes (6MW) is a test that merges the answer of different systems (respiratory, cardiovascular, metabolic, skeletal muscle and neurosensorial) and offers an useful objective result to lead therapeutic measurements and stablish a prognosis, it's possible that the comorbid patient lowers their functional reserve and alters the result of the test not only because of the presence of pathologies cardiorespiratory, nevertheless, information about the correlation between the scores of comorbidity and the traveled distance in the 6MW is limited. Objective: Determine the correlation between the traveled distance in the 6MW and the scores of comorbidities of Charlson and Elixhauser. Methods: A cross-sectional study was made, in patients taken to the 6MW made between 2006 until March 2020, in a hospital of high complexity; there were included patients older than 18 years old, whose clinic history record and walk of 6 minutes were available. The index of Charlson and Elixhauser were calculated in the 6MW, a bivariate analysis was made between the antecedents of pathologies and the traveled distance, independently and adjusted, the spearman correlation coefficient was calculated for the different scores and the distance in meters of the 6MW, was considerate a significative p: <0,05. Results: to the final analysis 491 subjects entered, the average age was of 69 years old (sd: 14,9), 54% male, the 15,3% had an abnormal walk less than the 80% of the expected, the diseases that were considered had a statistically significant relation with the decrease of the distance in the 6MW were arterial hypertension (p: <0,001), chronic heart failure (p=0,037), heart arrhythmia (p=0,003), smoking (p=0,022), chronic pulmonary obstruction disease (p: <0,001), dementia (p=0,03diabetes mellitus with target organ damage (p=0,01), moderate to severe chronic kidney disease (p=0,012), obesity (p=0,036) y lymphoma (p=0,038 the spearman correlation coefficient between the traveled distances and Charlson was of -0,343 (IC95%:-0,420 -0,264)(p: < 0,001) and -0,213(IC95%:-0,285 -0,116)(p: <0,001) with the Elixhauser index. Conclusion: The distances walked in meters in the 6MW has a reverse low correlation with the comorbidity index, the diseases that were not cardiopulmonary and that related independently with changes in the traveled dist ance are smoking, dementia, diabetes mellitus, chronic kidney disease, obesity, and lymphoma. Key words: Comorbidities, Walk, Test, Cardiopulmonary, Charlson, Elixhauser

Synthesis and Characterization of Poly(Vinyl Alcohol)-Chitosan-Hydroxyapatite Scaffolds: A Promising Alternative for Bone Tissue Regeneration.

Scaffolds can be considered as one of the most promising treatments for bone tissue regeneration. Herein, blends of chitosan, poly(vinyl alcohol), and hydroxyapatite in different ratios were used to synthesize scaffolds via freeze-drying. Mechanical tests, FTIR, swelling and solubility degree, DSC, morphology, and cell viability were used as characterization techniques. Statistical significance of the experiments was determined using a two-way analysis of variance (ANOVA) with p < 0.05. Crosslinked and plasticized scaffolds absorbed five times more water than non-crosslinked and plasticized ones, which is an indicator of better hydrophilic features, as well as adequate resistance to water without detriment of the swelling potential. Indeed, the tested mechanical properties were notably higher for samples which were undergone to crosslinking and plasticized process. The presence of chitosan is determinant in pore formation and distribution which is an imperative for cell communication. Uniform pore size with diameters ranging from 142 to 519 µm were obtained, a range that has been described as optimal for bone tissue regeneration. Moreover, cytotoxicity was considered as negligible in the tested conditions, and viability indicates that the material might have potential as a bone regeneration system.

What Does 'Information' Mean in Integrated Information Theory?

Integrated Information Theory (IIT) intends to provide a principled theoretical approach able to characterize consciousness both quantitatively and qualitatively. By starting off identifying the fundamental properties of experience itself, IIT develops a formal framework that relates those properties to the physical substratum of consciousness. One of the central features of ITT is the role that information plays in the theory. On the one hand, one of the self-evident truths about consciousness is that it is informative. On the other hand, mechanisms and systems of mechanics can contribute to consciousness only if they specify systems' intrinsic information. In this paper, we will conceptually analyze the notion of information underlying ITT. Following previous work on the matter, we will particularly argue that information within ITT should be understood in the light of a causal-manipulabilist view of information (López and Lombardi 2018), conforming to which information is an entity that must be involved in causal links in order to be precisely defined. Those causal links are brought to light by means of interventionist procedures following Woodward's and Pearl's version of the manipulability theories of causation.

La formación de pregrado de terapia ocupacional en Chile vista desde la perspectiva de los estudiantes: ¿cuál es la percepción de necesidades que tienen los estudiantes de terapia ocupacional en relación a su proceso de formación? / Occupational therapy undergraduate education in Chile seen from the students' perspective: what are the students' perceptions of their undergraduate education?

Introducción: la comprensión de la percepción que tienen los estudiantes de terapia ocupacional hacia su formación de pregrado representa una parte esencial en el desarrollo y mejoramiento curricular de la profesión. Objetivo: explorar las percepciones que tienen los estudiantes de terapia ocupacional hacia los contenidos y la formación de pregrado en Chile. Metodología: en este estudio cualitativo y fenomenológico, los datos se recolectaron a través de cuestionarios electrónicos autoaplicados. Los cuestionarios fueron suministrados a través de las tecnologías de la información y comunicación, en donde los entrevistados respondieron y remitieron sus respuestas anónimamente a través de internet. Los participantes son estudiantes de la carrera de terapia ocupacional de distintas universidades a lo largo del país, de ambos géneros y pertenecientes al rango entre los 18-40 años de edad. En correlación con el enfoque interpretativo-descriptivo de este estudio, el análisis de los datos se realizó a través del método de comparación constante propuesto por Glaser y Strauss y el software ATLAS.ti 5.0. Resultados: como resultado de los hallazgos de esta investigación, 3 temáticas fueron identificadas; (1) malla curricular y programas, (2) metodologías docentes y (3) relación entre docentes-estudiantes. Discusión: una mayor participación de los estudiantes en su propia formación de pregrado facilitaría su comprensión de los contenidos y objetivos curriculares, así como les proporcionaría una mejor visión de éstos y sus conexiones a través de los años de estudio de la profesión. Además de proporcionarles una mirada reflexiva y crítica acerca de los contenidos aprendidos y de las herramientas que necesitan desarrollar para la adquisición de éstos.

Introduction: understanding the occupational therapy students’ perception of their undergraduate training is an essential part for the development and improvement of the program. Aim: to explore the occupational therapy students’ perception of the content and undergraduate education in Chile. Methodology: in this phenomenological and qualitative study, data were collected through self-administered electronic questionnaires. The questionnaires were provided using information and communication technology, where the respondents submitted their answers anonymously through Internet. The participants are occupational therapy students between 18-40 years old of both genders from various universities across the country. In correlation with the interpretive-descriptive approach of this study, data analysis was performed using the constant comparison method proposed by Glaser and Strauss and the software ATLAS.ti 5.0. Results: as a result of the findings of this research, three themes were identied: (1) programme of study, (2) teaching methods, and (3) student-teacher relationship. Discussion: a greater student participation in their own undergraduate education could facilitate the understanding of the content and program aims, as well as provide a better view of the connections between them through the years of study. In addition, this study aims to provide the students with a reactive and critical thinking about the learning contents and the tools that they need to develop in order to reach the learning goals of the program. Relevance for the OT: the results of this study aim to open a dialogue and discussion between students and scholars from different universities regarding the needs of the undergraduate programs as perceived by students of different years of study. Furthermore, this study aims to discuss the methodologies and teaching methods used to provide the set of courses to the students in order to encourage the development and review of these...

Occurrence and enumeration of Campylobacter spp. during the processing of Chilean broilers.

BACKGROUND: Thermotolerant Campylobacter is among the more prevalent bacterial pathogens that cause foodborne diseases. This study aimed at evaluating the occurrence of thermotolerant Campylobacter contamination in chicken carcasses and processing plant stations (chilling water, scalding water, defeathering machinery, evisceration machine, and transport crates) in two of the Chilean main slaughterhouses. In addition, the isolation rates of thermotolerant Campylobacter during evisceration and following chiller processing were compared. RESULTS: The overall slaughterhouse contamination with thermotolerant Campylobacter was 54%. Differences were evident when the results from each plant were compared (plant A and plant B was 72% and 36%, respectively). The sampling points with the greatest contamination rates in both plants were after evisceration (90% and 54%, for plants A and B respectively). The decrease of thermotolerant Campylobacter contamination after chilling was significant (2 and 1.6 logs for plant A and B respectively P < 0.05). CONCLUSION: Our findings indicate that chilling process has a limited effect in the final products Campylobacter contamination because poultry enter the slaughter processing with high counts of contamination. This may represent a health risk to consumers, if proper cooking practices are not employed. The levels and frequencies of Campylobacter found during the processing of Chilean poultry appear to be similar to those reported elsewhere in the world.

[Brain natriuretic peptide in primary pulmonary hypertension]. / Niveles de péptido natriurético cerebral y su relación con capacidad funcional y hemodinamia pulmonar en pacientes con hipertensión pulmonar primaria: Correlation with functional capacity and hemodynamic parameters.

BACKGROUND: Primary pulmonary hypertension (PPH) is a progressive disease leading to right heart failure and death. Right heart catherization and maximal or submaximal tests are employed to assess the course of the disease. A neurohormonal parameter such as pro-brain natriuretic peptide (BNP) would be helpful in the assessment of these patients. AIM: To study the correlation of BNP with functional status and non-invasive hemodynamic determinations in patients with PPH. MATERIAL AND METHODS: Twelve patients (mean age: 48 years; 58% female) were evaluated with 6 minutes walk distance test (6-min WT), plasma BNP, systolic pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and cardiac output (CO) determined by echocardiogram. Plasma BNP levels were compared with normal subjects. RESULTS: BNP levels were increased in PPH patients (1270+/-547 vs 48+/-8 pg/ml, p-value <0.01). Mean PAPs was 82+/-27 mmHg and the mean distance walked in 6 minutes was 407+/-113 meters. BNP levels were positively correlated with PVR (r=0.58, p-value=0.006) and negatively correlated with 6-min WT (r=-0.83, p-value <0.001). No correlation was found between BNP levels, PAPs and CO. CONCLUSIONS: In PPH patients, BNP levels are increased and correlate with functional class and PVR. Follow-up studies are needed to evaluate the role of BNP as a marker of progression and therapeutic response in PPH patients.

Niveles de péptido natriurético cerebral y su relación con capacidad funcional y hemodinamia pulmonar en pacientes con hipertensión pulmonar primaria: Correlation with functional capacity and hemodynamic parameters / Brain natriuretic peptide in primary pulmonary ypertension

Background: Primary pulmonary hipertension (PPH) is a progressive disease leading to right heart failure and death. Right heart catherization and maximal or submaximal tests are employed to assess the course of the disease. A neurohormonal parameter such as pro-brain natriuretic peptide (BNP) would be helpful in the assessment of these patients. Aim: To study the correlation of BNP with functional status and non-invasive hemodynamic determinations in patients with PPH. Material and methods: Twelve patients (mean age: 48 years; 58% female) were evaluated with 6 minutes walk distance test (6-min WT), plasma BNP, systolic pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and cardiac output (CO) determined by echocardiogram. Plasma BNP levels were compared with normal subjects. Results: BNP levels were increased in PPH patients (1270±547 vs 48±8 pg/ml, p-value <0.01). Mean PAPs was 82±27 mmHg and the mean distance walked in 6 minutes was 407±113 meters. BNP levels were positively correlated with PVR (r=0.58, p-value=0.006) and negatively correlated with 6-min WT (r=-0.83, p-value <0.001). No correlation was found between BNP levels, PAPs and CO. Conclusions: In PPH patients, BNP levels are increased and correlate with functional class and PVR. Follow-up studies are needed to evaluate the role of BNP as a marker of progression and therapeutic response in PPH patients.