Increasing Transcutaneous Oxygen Pressure in Patients With Neuroischemic Diabetic Foot Ulcers Treated With a Sucrose Octasulfate Dressing: A Pilot Study.

Regarding the positive clinical outcomes of sucrose octasulfate impregnated dressing documented in neuroischemic diabetic foot ulcers (DFUs), we aimed to evaluate the microcirculatory status in patients with neuroischemic DFU through the use of sucrose octasulfate dressing. Eleven patients with neuroischemic DFU were included in a prospective pilot study between July 2019 and March 2020. We evaluated the effect in transcutaneous oxygen pressure (TcPO2; mm Hg) values within the use of a sucrose octasulfate dressing in the course of the healing process of neuroischemic DFUs (UrgoStart Contact, Laboratoires Urgo Medical). TcPO2 values were assessed at day 0 and monthly until wound healing was achieved. Additionally, wound healing process was evaluated using the Wollina score system and wound area surface, at day 0 and monthly until 20 weeks of follow-up or wound healing first occurred. TcPO2 values showed a significant increase between day 0 (29.45 ± 7.38 mm Hg) and wound closure (46.54 ± 11.45 mm Hg, P = .016), after dressing application. Wollina wound scores showed a significant improvement (4.2 ± 1.7 at day 0 to 5.4 ± 1.3 at the end of the study; P = .004). Median wound area at day 0 was 1.30 cm2, interquartile range [1.60-1] cm2, and 0.5 cm2 at week 4, interquartile range [1.1-0.1], P < .001. Median healing time was 8 weeks, interquartile range [8-5]. Treating a neuroischemic DFU with a sucrose octasulfate dressing in the standard of care showed an increase in skin oxygen pressure.

Medical Versus Surgical Treatment for the Management of Diabetic Foot Osteomyelitis: A Systematic Review.

A systematic review and quality assessment was performed to assess the management of diabetic foot osteomyelitis by medical or surgical treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used. All selected studies were evaluated using the Cochrane Risk of Bias Tool to assess the risk of bias for randomized controlled trials. The literature was revised using PubMed (Medline) and Embase (Elsevier) up to September 2020 to identify clinical trials assessing medical or surgical treatment to manage diabetic foot osteomyelitis. A total of six clinical trials that met our inclusion criteria, with a total of 308 participants. Healing rate, complete closure of the wound, and type of complications were the outcomes evaluated. Risk of bias assessment showed that only two of the six clinical trials included in the systematic review had a low risk of bias. Based on our findings, we believe that the management of diabetic foot osteomyelitis remains challenging. There are few high-quality clinical trials that both stratify clinical presentations and compare these treatments. We conclude that the available evidence is insufficient to identify the best option to cure diabetic foot osteomyelitis.

Evolution of the TcPO2 values following hyperoxygenated fatty acids emulsion application in patients with diabetic foot disease: results of a clinical trial.

OBJECTIVE: The use of emollients to lubricate dry skin to prevent diabetic foot ulcers (DFUs), especially in neuroischaemic feet, has been recommended. This study analyses the effect of daily topical application of hyperoxygenated fatty acids emulsion on transcutaneous oxygen pressure (TcPO2) in the feet of neuropathic and neuroischaemic patients with diabetes. METHOD: Patients with diabetes and no active foot ulcer were included in this longitudinal, prospective, non-comparative clinical trial. The evolution of TcPO2 (mmHg) values after the application of the tested emulsion (Corpitol Emulsion, Laboratoires Urgo Medical, France) was evaluated for a three-month period. Modifications of skin features (skin dryness, skin shedding and skin colour) were also analysed. TcPO2 was performed using a TCM400 device (Radiometer, Denmark). RESULTS: A total of 50 patients were included in the study. Patients with neuroischaemia showed a significant increase in TcPO2 values (35.69±13.88mmHg) after two months' application of the tested emulsion that remained at month three (day 60: 42.34±10.98mmHg; p=0.006; day 90: 41.62±10.88mmHg; p=0.011). Skin dryness and shedding showed an improvement from baseline to the end of the study in both groups, secondary to the use of the tested emulsion (p<0.001 and p<0.001, respectively). Skin colour also showed differences from baseline to the final visit in the neuroischaemic patients (p=0.029). Patients with neuropathy did not show any change in skin colour from baseline to the final visit. CONCLUSIONS: Analysis of the use of the tested emulsion showed an increase in TcPO2 and an improvement in skin trophism in patients with neuroischaemic foot.

[Epidemiological aspects, clinic and control mechanisms of SARS-CoV-2 pandemic: Situation in Spain]. / Aspectos epidemiológicos, clínica y mecanismos de control de la pandemia por SARS-CoV-2: situación en España.

In January 2020, the Chinese authorities confirmed the causative agent of an outbreak of cases with pneumonia of unknown etiology that appeared in December 2019. The World Health Organization (WHO) called SARS-CoV-2 is a new virus of the coronavirus family. On March 12, the WHO declared this outbreak as a pandemic as it spread worldwide. Human epidemics usually follow the start of exponential growth, this means that from a small number of cases in a few days, a large increase in the number of infected people is observed. The clinical manifestations and spectrum of symptomatic disease range from moderate to critical presentations. In cases with fatal progression, the most serious complications sometimes are cause of a multi-organ failure and patient death. SARS-CoV-2 has a high transmission rate, the route of transmission between humans is through the secretions of infected people, hands or contaminated objects. In general, the epidemic control measures used so far have been based on adoption of interventions from the classical epidemiology, identifying and isolating the cases, following the contacts and establishing restrictions, including quarantine, closure of educational centers, avoiding events in which crowds of people occur, limiting mobility. These measures have been effective in China, the original focus of the outbreak.

Cirugía de la pared abdominal después del SARS-CoV-2: ¿es hora de restablecer los procedimientos no esenciales pospuestos? / Abdominal Wall Surgery After SARS-CoV-2: Time to Reestablish Postponed Non-essential Procedures?

La pandemia por el COVID-19 nos ha encontrado desprotegidos ante la dificultad para dar una respuesta sanitaria adecuada y rápida. La red de hospitales del sistema sanitario público ha dispuesto la mayoría de los recursos para el tratamiento de los pacientes afectos por la infección. Las cirugías no esenciales (no prioritarias) han sido aplazadas. El reinicio óptimo y proporcionado de estas cirugías no prioritarias puede representar un problema. En el presente artículo se ofrece una perspectiva técnica y no técnica del reinicio de las cirugías no prioritarias desde la óptica de la cirugía de la pared abdominal

Pandemic by the COVID-19 has found us unprotected to provide an adequate and rapid sanitary response. The hospital network of our public health system has provided most of the resources for the treatment of patients affected by the infection. Non-essential (non-priority) surgeries have been postponed. The optimal and proportionate reestablishment of these non-priority surgeries can be a problem. This article offers a technical and non-technical view of reestablishment non-priority surgeries from the perspective of abdominal wall surgery

Uso de ácidos grasos hiperoxigenados para la protección cutánea durante la pandemia de COVID-19 en España: encuesta a profesionales / Use of hyperoxygenated fatty acids for skin protection during the COVID-19 pandemic in Spain: survey of professionals

Durante la pandemia de COVID-19, un elevado número de profesionales ha estado a riesgo de desarrollar lesiones en la piel, secundarias al uso de equipos de protección individual. Diversas guías de práctica recomiendan el uso de AGHO para reducir la aparición de úlceras por presión; se presentan los resultados de una encuesta realizada en el ámbito nacional a la que respondieron un total de 134 profesionales sobre el uso de AGHO para su prevención. El momento de la aplicación del ácido graso fue, en el 58,2 %, después de la retirada del EPI; en el 25,4 %, diez minutos antes de la colocación de los equipos de protección; en el 7,5 %, en el momento de la colocación de los equipos de protección; en el 6,7 %, entre 10-30 minutos antes de la colocación de los equipos de protección, y en el 2,2 %, treinta minutos antes de la aplicación de los equipos de protección. Los profesionales que respondieron refieren, en el 73,1 % de los casos, una mejora del eritema pre-existente; para el 56,7 %, proporciona hidratación de la piel; en el 50 % de los casos contribuye a la prevención de las lesiones cutáneas relacionadas con el uso de los sistemas de protección individuales; en el 26,1 %, aporta un efecto emoliente sobre la piel. A partir de los resultados se recomienda el uso de estas substancias tópicas (AGHO) en caso de uso de equipos de protección individual

During the Covid-19 pandemic, a high number of professionals have been at risk of developing skin lesions secondary to the use of personal protective equipment. The clinical practice guidelines recommend the use of fatty acids to reduce the appearance of pressure ulcers. Here are described the results of a survey conducted at the national level, that included a total of 134 professionals. The moment of the application of the fatty acid was, 58.2%, after the removal of the individual equipment protection; in 25.4%, ten minutes before the placement of the protective equipment; in 7.5%, at the time of the donning of the protective equipment; in 6.7%, between 10-30 minutes before putting on the protective equipment, and in 2.2%, thirty minutes before the application of the protective equipment. The professionals who responded referred, in 73.1% of the cases, an improvement of the pre-existing erythema; in 56.7%, this substance provides hydration of the skin; in 50% of the cases, it contributes to the prevention of related skin lesions with the use of individual protection systems; in 26.1%, it provides an emollient effect on the skin. Based on the results, the use of these topical substances (fatty acids) is recommended in the case of the use of personal protective equipment

Metatarsal Head Resections in Diabetic Foot Patients: A Systematic Review.

A systematic review and proportional meta-analysis were carried out to investigate the complications that occur after surgical metatarsal head resection in diabetic foot patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist recommendations were applied, and the selected studies were evaluated using a Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist. PubMed (Medline) and Embase (Elsevier) were searched in December 2019 to find clinical trials, cohort studies, or case series assessing the efficacy of the metatarsal head resection technique in diabetic foot patients. The systematic review covered 21 studies that satisfied the inclusion criteria and included 483 subjects. The outcomes evaluated were the time to heal, recurrence, reulceration, amputation, and other complications. The proportion of recurrence was 7.2% [confidence interval (CI) 4.0-10.4, p < 0.001], that of reulceration was 20.7% (CI 11.6-29.8, p < 0.001), and that of amputation was 7.6% (CI 3.4-11.8, p < 0.001). A heterogeneity test indicated I2 = 72.6% (p < 0.001) for recurrences, I2 = 94% (p < 0.001) for reulcerations, and I2 = 79% (p < 0.001) for amputations. We conclude that metatarsal head resections in diabetic foot patients are correlated with significant complications, especially reulceration.

[Abdominal Wall Surgery After SARS-CoV-2: Time to Reestablish Postponed Non-essential Procedures?] / Cirugía de la pared abdominal después del SARS-CoV-2: ¿es hora de restablecer los procedimientos no esenciales pospuestos?

Pandemic by the COVID-19 has found us unprotected to provide an adequate and rapid sanitary response. The hospital network of our public health system has provided most of the resources for the treatment of patients affected by the infection. Non-essential (non-priority) surgeries have been postponed. The optimal and proportionate reestablishment of these non-priority surgeries can be a problem. This article offers a technical and non-technical view of reestablishment non-priority surgeries from the perspective of abdominal wall surgery.

Revisiones sistemáticas con metaanálisis de ensayos clínicos: ¿es evidencia suficiente? / Systematic reviews with meta-analysis of clinical trials: Is there enough evidence?

Las revisiones sistemáticas con metaanálisis son pruebas esenciales para resumir de manera fiable la eficacia de las intervenciones sanitarias. Un metaanálisis basado exclusivamente en un pequeño número de ensayos a menudo no será concluyente o puede aportar resultados positivos falsos. La estimación del tamaño óptimo de la información (OIS) puede reducir el riesgo de obtener resultados falsos positivos y determinar si se requieren ensayos clínicos adicionales. El cálculo del OIS tiene similitudes con el realizado para calcular el tamaño de la muestra de un ensayo clínico. El número requerido de participantes para el metaanálisis debe ser al menos tan grande como un solo ensayo con la potencia adecuada. El concepto del OIS proporciona un marco estadístico en el que la información acumulada es convincente para indicar si se necesitan más ensayos clínicos para abordar los efectos de la intervención

Systematic reviews with meta-analysis are essential tools to reliably summarize the effectiveness of health interventions. A meta-analysis based exclusively on a small number of trials will often not be conclusive or may yield false positive results. The estimation of the optimal information size (OIS) can reduce the risk of obtaining false positive results and determine if additional clinical trials are required. The estimation of the OIS is very similar to that used to estimate the sample size of a clinical trial. The required number of participants for the meta-analysis should be at least as large as a single trial with adequate power. The OIS concept provides a statistical framework in which the accumulated information is convincing to indicate whether more clinical trials are needed to address the effects of the intervention

Systematic reviews with meta-analysis of clinical trials: Is there enough evidence? / Revisiones sistemáticas con metaanálisis de ensayos clínicos: ¿es evidencia suficiente?

Systematic reviews with meta-analysis are essential tools to reliably summarize the effectiveness of health interventions. A meta-analysis based exclusively on a small number of trials will often not be conclusive or may yield false positive results. The estimation of the optimal information size (OIS) can reduce the risk of obtaining false positive results and determine if additional clinical trials are required. The estimation of the OIS is very similar to that used to estimate the sample size of a clinical trial. The required number of participants for the meta-analysis should be at least as large as a single trial with adequate power. The OIS concept provides a statistical framework in which the accumulated information is convincing to indicate whether more clinical trials are needed to address the effects of the intervention.

Aspectos epidemiológicos, clínica y mecanismos de control de la pandemia por Sars-Cov-2: situación en España / Epidemiological aspects, clinic and control mechanisms of sars-cov-2pandemic: situation in spain

En enero de 2020, las autoridades chinas confirmaron el agente causante de un brote de casos con neumonía de etiología desconocida aparecido en diciembre de 2019. La Organización Mundial de la Salud (OMS) denominó COVID-19 a este nuevo virus de la familia coronavirus. El día 12 de marzo la OMS declaró este brote como pandemia al tener una propagación mundial. Las epidemias humanas suelen seguir al inicio un crecimiento exponencial, esto significa que a partir de un pequeño número de casos en pocos días se observa un gran incremento en el número de personas infectadas. Las manifestaciones clínicas y el espectro de la enfermedad por SARS-CoV-2 abarcan desde presentaciones leves a críticas. En los casos con una progresión fatal las complicaciones más graves llegan a ocasionar fallo multiorgánico y la muerte del paciente. El SARS-CoV-2 tiene una elevada tasa de transmisibilidad, la vía de transmisión entre humanos se da a través de las secreciones de personas infectadas, las manos o los fómites contaminados. En general, las medidas de control de la epidemia utilizadas hasta el momento se han basado enintervenciones adoptadas dela epidemiología clásica,identificando y aislando los casos, siguiendo a los contactos y estableciendo restricciones, incluyendo la cuarentena, cierre de los centros educativos, evitando eventos en los que se produzca aglomeraciones de personas, limitando la movilidad. Estas medidas han sido efectivas en China, el foco originario del brote

In January 2020, the Chinese authorities confirmed the causative agent of an outbreak of cases with pneumonia of unknown etiology that appeared in December 2019. The World Health Organization (WHO) called COVID-19 is a new virus of the coronavirus family. On March 12, the WHO declared this outbreak as a pandemic as it spread worldwide. Human epidemics usually follow the start of exponential growth, this means that from a small number of cases in a few days, a large increase in the number of infected people is observed. The clinical manifestations and spectrum of symptomatic disease range from moderate to critical presentations. In cases with fatal progression, the most serious complications sometimesare cause of amulti-organ failure and patient death. SARS-CoV-2 has a high transmission rate, the route of transmission between humans is through the secretions of infected people, hands or contaminated objects. In general, the epidemic control measures used so far have been based on adoption of interventions from the classical epidemiology, identifying and isolating the cases, following the contacts and establishing restrictions, including quarantine, closure of educational centers, avoiding events in which crowds of people occur, limiting mobility. These measures have been effective in China, the original focus of the outbreak

Practice Patterns and Attitudes of Surgeons on the Use of Prophylactic Mesh to Prevent Parastola Hernia: A Cross-sectional Survey.

Information about surgeons' attitudes toward using prophylactic mesh (PM) for parastomal hernia (PSH) prevention is limited. PURPOSE: A survey was conducted to assess attitudes/beliefs and surgical practice related to PM use for preventing PSH. METHODS: A cross-sectional email survey was conducted during April 2017 among members (surgeons) of the American Hernia Society, European Hernia Society, and International Hernia Collaboration. Survey items included participant demographic characteristics, knowledge about the incidence of PSH, number of permanent stomas created annually, beliefs/opinions (knowledge/interest) regarding the use of PM, and surgical practices (mesh type and position). Data were collected and tallied using SurveyMonkey. Descriptive statistics were used to analyze the data. RESULTS: Of the 5445 emails sent, 497 responses were received, 235 (47.3%) from the United States and 197 (39.6%) from Europe. The majority of participants were general surgeons (371, 74.6%); a small percentage were colorectal surgeons (37, 7.4%). Most respondents (353, 71.0%) reported at least 11 years of surgical experience, with 37.3% reporting >20 years' experience. The majority of respondents (340, 68.4%) created <15 ostomies per year, more than half (252, 50.7%) consider the incidence of PSH 30% or below, and 107 (22%) use PM. The most common reason for not using mesh was concern about mesh-related complications (141, 41.5%). When asked about type of mesh, most surgeons (153/245, 62.4%) preferred permanent mesh and an open retromuscular approach (97/278, 34.9%). CONCLUSION: Results of the present survey show ongoing ambiguity regarding the use of PM for PSH prevention. Education to increase awareness about the incidence of PSH and well-designed safety and effectiveness studies of preventive strategies are needed to help surgeons optimize PSH prevention strategies.

Quality Assessment and Risk of Bias of Systematic Reviews of Prophylactic Mesh for Parastomal Hernia Prevention Using AMSTAR and ROBIS Tools.

BACKGROUND: Systematic reviews play a crucial role in clinical decision making and resource allocation and are expected to be unbiased and consistent. The aim of this study is a review of systematic reviews on the use of prophylactic mesh to prevent parastomal hernia (PH) formation using ROBIS and AMSTAR tools to assess the risk of bias and methodological quality. METHODS: We included systematic reviews with or without meta-analysis of which the objective was to assess the use of a prophylactic mesh to prevent PH. A systematic search of the literature in five databases from inception until December 2017 was conducted. For each systematic review, methodologic quality and risk of bias were assessed using the AMSTAR and ROBIS tools, respectively. We estimated the inter-rater reliability for individual domains and for the overall methodological quality and risk of bias using Fleiss' k. RESULTS: We identified 14 systematic reviews that met the inclusion criteria. Using the AMSTAR scale with a cutoff value, six reviews showed high methodologic quality and eight were of low quality. Using the ROBIS tool, the overall risk of bias was low in 50% of the reviews analyzed. In the remaining studies, the risk of bias was unclear. CONCLUSIONS: The global evidence in favor of the use of a prophylactic mesh for preventing PH is not uniform regarding quality and risk of bias. Surgeons cannot be equally confident in the results of all systematic reviews published on this topic.