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2.
J Clin Med ; 9(4)2020 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-32218232

RESUMO

We aimed to identify if any differences existed in spatiotemporal parameters during gait among different densities of rocker soles in patients with a history of neuropathic ulcerations and the differences in comfort between shoe conditions. This study was a cross-sectional study of 24 patients with diabetes and a history of neuropathic diabetic foot ulcers (DFUs). Spatiotemporal parameters (duration of stance phase (ms), stride length (cm), and step velocity (m/s)) were analyzed in barefoot, semirigid outsole, and rigid outsole footwear conditions. A dynamic pressure measurement system (Footscan® system, RSscan International, Belgium) was used to assess shoe conditions. We also analyzed differences in comfort between the shoe conditions using a visual analog scale. A Wilcoxon test for paired samples was used to assess gait differences. Result showed that a rigid outsole causes changes in the subphases of the stance phase (p < 0.001; Cohen d = 0.6) compared to a semirigid outsole. Stride length (p < 0.001; Cohen d = 0.66) and step velocity were significantly longer (p < 0.001; Cohen d = 2.03) with the use of rigid outsole footwear. A rigid rocker sole reduces the time of the stance phase, in addition to increasing the stride length and velocity of step in patients with a previous history of DFUs.

3.
J Diabetes Res ; 2019: 9038171, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30729135

RESUMO

AIMS: To evaluate the factors that predict reulceration beneath the hallux in people with a history of diabetic foot ulceration. METHODS: A prospective study conducted between January 2012 and December 2014 was performed in a diabetic foot unit to assess the risk factors associated with hallux reulceration. Sixty patients with diabetic neuropathy and a history of previous ulcer were consecutively included. Sociodemographic factors and comorbidities plus the biomechanical and radiographic factors were obtained. Follow-up on participants was conducted every month, and they wore offloading therapeutic footwear and custom-made insoles. Hallux reulceration during the follow-up period was assessed as the main outcome measure in the study. RESULTS: Patients were followed up during 29 (14.2-64.4) months. Twenty-nine patients (52%) developed a new ulceration: 9 patients (31%) in the hallux and 20 (69%) in other locations. Functional hallux limitus (p = 0.005, 95% CI (2.097-73.128), HR 12.384) and increased body mass index (p = 0.044, 95% CI (1.003-1.272), HR 1.129) were associated with the hallux ulceration-free survival time in the multivariate Cox model. CONCLUSIONS: Obesity and the presence of functional hallux limitus increase the probability of developing hallux reulceration in patients with diabetic neuropathy and a history of ulcers.


Assuntos
Pé Diabético/diagnóstico , Hallux/patologia , Idoso , Índice de Massa Corporal , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Sapatos
5.
Diabetes Res Clin Pract ; 114: 93-8, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26810268

RESUMO

AIMS: To stratify the ulceration risk according to the foot morphology in people with diabetes and a history of forefoot neuropathic ulceration. METHODS: A cross-sectional study was performed on 139 neuropathic individuals with diabetes and previous forefoot ulcers between January 2012 and February 2014. Foot position of the participants was evaluated by using the foot-posture index. A multivariate analysis adjusted for confounding variables was performed with the ulceration risk factors that were found in the univariate analysis. RESULTS: Two hundred and fifty-eight feet were analysed, 104 (40.3%) feet had a history of ulceration on the forefoot and 154 (59.7%) feet had no previous ulceration. Two positive tests of neuropathy (p<0.001; CI[1.961-6.249] OR 3.500), presence of deformities (p=0.043; CI[1.020-3.599] OR 1.916) and foot type (p=0.039) showed an association with ulceration risk in multivariate analyses. Pronated feet showed a higher risk of ulceration than supinated feet (p=0.011; CI[1.253-5.708] OR 2.675), while significant differences between neutral and supinated feet were not found (p=0.221; CI[0.719-2.753] OR 1.476). CONCLUSIONS: A pronated foot has a higher risk of ulceration on the forefoot in neuropathic people with deformities and diabetes mellitus. Foot type should be evaluated in people at risk of ulceration.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Neuropatias Diabéticas/complicações , Deformidades do Pé/complicações , Úlcera do Pé/etiologia , Pronação/fisiologia , Adulto , Idoso , Estudos Transversais , Pé Diabético/fisiopatologia , Feminino , Deformidades do Pé/fisiopatologia , Humanos , Masculino , Postura , Fatores de Risco
6.
Diabet Med ; 31(9): 1069-77, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24867069

RESUMO

AIMS: Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and ß-hydroxy-ß-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. METHODS: Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and ß-hydroxy-ß-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. RESULTS: Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of < 1.0, a significantly greater proportion of subjects in the arginine, glutamine and ß-hydroxy-ß-methylbutyrate group healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. CONCLUSIONS: While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and ß-hydroxy-ß-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and ß-hydroxy-ß-methylbutyrate in these high-risk subgroups might prove clinically valuable.


Assuntos
Arginina/administração & dosagem , Pé Diabético/fisiopatologia , Suplementos Nutricionais , Glutamina/administração & dosagem , Valeratos/administração & dosagem , Cicatrização , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Pé Diabético/dietoterapia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
9.
Rev. Rol enferm ; 36(11): 741-746, nov. 2013. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-119165

RESUMO

Introducción. Niveles altos de carga bacteriana han demostrado una influencia negativa en la cicatrización de las úlceras. El uso de apósitos antimicrobianos con plata puede controlar el nivel de carga bacteriana de las heridas. El objetivo de este estudio fue evaluar la respuesta terapéutica de un apósito de fibra de alginato e hidrocoloide, con plata, en úlceras infectadas de pie diabético. Material y métodos. Se analizó una serie de casos de 6 pacientes con úlceras de pie diabético, sin enfermedad vascular periférica y diagnosticadas de colonización crítica y/o infección local mediante la recogida de signos clínicos inflamatorios. Los pacientes fueron tratados durante un período mínimo de 2 semanas. Se analizó el porcentaje de reducción del área de la úlcera desde el día de la inclusión hasta la retirada del apósito antimicrobiano. Resultados. El tratamiento tuvo una mediana de 5 semanas con una duración mínima de 2 y máxima de 6. La mediana del porcentaje de reducción de la superficie de las heridas fue de 47,7% (rango: 0,5%-90%). La media del porcentaje de reducción de la lesión a las 2 semanas fue del 58% y a la tercera semana del 67,14%. Todos los pacientes habían disminuido sus dimensiones a las 3 semanas de tratamiento de forma significativa (p<0,05). Conclusión. El uso de un apósito de fibra de alginato e hidrocoloide, con plata, favorece la cicatrización de las úlceras de pie diabético con infección local, reduciendo los signos clínicos inflamatorios de forma significativa en un período de 3 semanas (AU)


Introduction: High levels of bacterial load have shown a deleterious influence on wound healing. Using antimicrobial dressings can control ulcers’ bioburden. The aim of our study was to evaluate the improving of infected diabetic foot ulcers due an alginate’s fiber and hydrocolloid silver dressing. Material and Methods: We analysed a case series of 6 patients with diabetic foot ulcers without peripheral vascular disease and diagnosed from critical colonization and / or local infection according the presence of inflammation clinical signs. Patients were treated for a minimum period of two weeks. We analysed the percentage reduction in ulcer area from the day of enrolment to antimicrobial dressing removal. Results: The duration of treatment had a median of 5 weeks with a minimum of 2 weeks and up to 6. The median percentage of area reduction of the wounds was 47.7% (range: 0.5%-90%). The mean percentage reduction on the lesion was 58% from 2 weeks and 67.14% at 3 weeks. All patients had reduced significantly their size at 3 weeks from beginning of treatment (p<0.05). Conclusion: The use of an alginate’s fiber and hydrocolloid silver dressing promotes healing on diabetic foot ulcers with local infection, reducing the inflammatory clinical signs significantly over a period of three weeks (AU)


Assuntos
Humanos , Pé Diabético/enfermagem , Cicatrização , Infecção dos Ferimentos/tratamento farmacológico , Curativos Hidrocoloides , Úlcera Cutânea/enfermagem , Úlcera do Pé/enfermagem , Compostos de Prata/uso terapêutico , Alginatos/uso terapêutico , Inflamação/tratamento farmacológico
11.
Diabet Med ; 30(8): 973-6, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23600614

RESUMO

AIMS: To analyse the risk of reulceration caused by the transfer of lesions in patients with diabetes, undergoing resection of at least one metatarsal head. METHODS: A total of 119 patients with diabetes from the Diabetic Foot Unit (Complutense University, Madrid, Spain), who underwent resection of at least one metatarsal head were analysed prospectively from November 2006 to December 2011 to assess reulceration in the other metatarsal head. RESULTS: Seven patients were excluded for being subjected to a pan-metatarsal head resection and 11 patients dropped out. During a median follow-up period of 13.1 months (interquartile range 6.1-22.8 months), 41% of patients suffered from reulcerations. Reulceration frequency in patients operated on the 1st, 2nd, 3rd, 4th, 5th and several metatarsal heads was 9 (69%), 8 (44%), 12 (52%), 2 (25%), 6 (19%) and 4 (50%) events, respectively. The Cox regression model showed hazard ratios that were significant for the location of the metatarsal resection. The first metatarsal showed the highest risk for reulceration (hazard ratio 3.307; 1.472-7.430) and the fifth metatarsal showed the lowest risk (hazard ratio 0.339; 0.138-0.832). CONCLUSIONS: Reulceration is a frequent event following resection of a metatarsal head and should be regarded as an implicit complication of the intervention. The location of the resection determines the risk of reulceration, which is highest for patients operated on the first metatarsal head and lowest for patients operated on the fifth metatarsal head.


Assuntos
Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/diagnóstico , Pé Diabético/fisiopatologia , Feminino , Seguimentos , Hospitais Universitários , Humanos , Masculino , Metatarso , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária , Índice de Gravidade de Doença , Espanha/epidemiologia
12.
Diabet Med ; 30(6): e229-32, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23590722

RESUMO

BACKGROUND: Charcot neuroarthropathy is a severe complication in the feet of patients with diabetes, which can lead to a major amputation. Osteomyelitis and surgery for osteomyelitis have been reported as trigger mechanisms of developing Charcot neuroarthropathy. However, the development of acute Charcot neuroarthropathy triggered by osteomyelitis during conservative antibiotic treatment is not well outlined in the medical literature. CASE REPORTS: Two patients apparently developed mid and rear foot Charcot neuroarthropathy, which was clinically suspected while being treated with antibiotics for osteomyelitis. One of them presented osteomyelitis of the navicular bone and subsequently developed acute Charcot neuroarthropathy of the tarsometatarsal joints. The other presented calcaneal osteomyelitis with pathological fracture and developed Charcot neuroarthropathy of the transverse tarsal joint. No offloading had been implemented in either case. A major amputation had been indicated in both cases in their teaching hospitals. Limb salvage was achieved in both cases by means of surgery, culture-guided post-operative antibiotics, intraosseus instillation of super-oxidized solution, bed rest before placing a total contact cast and stabilization of the unstable foot with a total contact cast with an opening for checking the healing course and to detect any complications. The mechanisms of the development of acute Charcot neuroarthropathy in a patient with osteomyelitis are discussed. CONCLUSIONS: Osteomyelitis in the feet of patients with diabetes and neuropathy may trigger the development of acute Charcot neuroarthropathy. Fractures and dislocated joints may subsequently become infected from the index focus, producing a severe infected and unstable foot that may require a major amputation. Limb salvage can be achieved in specialized departments.


Assuntos
Artropatia Neurogênica/cirurgia , Pé Diabético/fisiopatologia , Salvamento de Membro , Osteomielite/cirurgia , Doença Aguda , Adulto , Artropatia Neurogênica/complicações , Artropatia Neurogênica/etiologia , Artropatia Neurogênica/terapia , Terapia Combinada , Ossos do Pé , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/fisiopatologia , Osteomielite/terapia , Articulações Tarsianas , Resultado do Tratamento
13.
Exp Clin Endocrinol Diabetes ; 121(4): 239-43, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23329582

RESUMO

AIMS: The aim is to define the association of forefoot deformity and limited joint mobility in the ankle and hallux joints in patients with diabetes mellitus subject to different diagnostic tests for diabetic neuropathy. Prospective study with 118 type 2 diabetic patients (68 men, mean age of 65.6±9.9 years) enrolled consecutively from the Diabetic Foot Unit of the Complutense University of Madrid subject to evaluation of plantar surface sensitivity by 10-g Semmes-Weinstein Monofilament, vibratory threshold by biothesiometer, and sudomotor dysfunction by Neuropad®. The patients presented with limited joint mobility of the ankle and the first metatarsophalangeal joints, and forefoot deformities were registered. Statistical analysis was done through a univariate model to test the association between neurological and biomechanical alteration. There was an association of abnormal Monofilament (p=0.01; OR=3.9) and biothesiometer tests (p=0.01; OR=2.6) with the presence of forefoot deformity. Furthermore, a relation was found between abnormal Monofilament (p=0.02; OR=4.8) and biothesiometer (p<0.00; OR=12.8) tests with limited mobility of the first metatarsophalangeal joint both in loading and off-loading. Abnormal sudomotor function test was related with limited joint mobility of the ankle joint with the knee flexed (p=0.04; OR=2.8). CONCLUSIONS: The results of this study show discordance between biomechanical abnormalities and neuropathy depending on the diagnostic test used. Tests that assess large myelinated nerve fibers are associated with the presence of deformities. Abnormal sudomotor function test is associated with limited joint mobility and this test has a greater capacity for selecting patients at risk.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Neuropatias Diabéticas/diagnóstico , Deformidades do Pé/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Idoso , Articulação do Tornozelo/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/fisiopatologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/fisiopatologia , Feminino , Hallux/fisiopatologia , Humanos , Masculino , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Exame Neurológico , Estudos Prospectivos
14.
Rev Enferm ; 36(11): 29-34, 2013 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-24404714

RESUMO

INTRODUCTION: High levels of bacterial load have shown a deleterious influence on wound healing. Using antimicrobial dressings can control ulcers' bioburden. The aim of our study was to evaluate the improving of infected diabetic foot ulcers due an alginate's fiber and hydrocolloid silver dressing. MATERIAL AND METHODS: We analysed a case series of 6 patients with diabetic foot ulcers without peripheral vascular disease and diagnosed from critical colonization and/or local infection according the presence of inflammation clinical signs. Patients were treated for a minimum period of two weeks. We analysed the percentage reduction in ulcer area from the day of enrolment to antimicrobial dressing removal. RESULTS: The duration of treatment had a median of 5 weeks with a minimum of 2 weeks and up to 6. The median percentage of area reduction of the wounds was 47.7% (range: 0.5%-90%). The mean percentage reduction on the lesion was 58% from 2 weeks and 67.14% at 3 weeks. All patients had reduced significantly their size at 3 weeks from beginning of treatment (p < 0.05). CONCLUSION: The use of an alginate's fiber and hydrocolloid silver dressing promotes healing on diabetic foot ulcers with local infection, reducing the inflammatory clinical signs significantly over a period of three weeks.


Assuntos
Alginatos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Bandagens , Materiais Biocompatíveis/uso terapêutico , Coloides/uso terapêutico , Pé Diabético/complicações , Compostos de Prata/uso terapêutico , Idoso , Feminino , Ácido Glucurônico/uso terapêutico , Ácidos Hexurônicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização
15.
Diabet Med ; 29(6): 813-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22151429

RESUMO

AIMS/HYPOTHESIS: The aim of this study was to determine the rate of recurrence, reulceration and new episodes of osteomyelitis and the duration of postoperative antibiotic treatment in a prospective cohort of patients with diabetes who underwent conservative surgery for osteomyelitis. METHODS: The prospective cohort included patients with diabetes and a definitive diagnosis of osteomyelitis who were admitted to the Diabetic Foot Unit (Surgery Department, La Paloma Hospital, Las Palmas de Gran Canaria, Spain) and underwent surgical treatment from 1 November 2007 to 30 May 2010. RESULTS: Eighty-one patients were operated on for osteomyelitis during the study period. Seven patients were lost to follow-up at different stages of the study. The median duration of follow-up was 101.8 weeks (quartile 1 = 56.6, quartile 3 = 126.7). Forty-eight patients (59.3%) underwent conservative surgery, 32 (39.5%) had minor amputations and there was one (1.2%) major amputation. Twenty patients (24.7%) required reoperation because of persistent infection. Postoperative antibiotic treatment over a median period of 36 days was provided. Wound healing was achieved by secondary intention for a median of 8 weeks. Sixty-five patients were available for follow-up after healing. The percentage of recurrence, reulceration, and new episodes of osteomyelitis was 4.6% (3/65), 43% (28/65) and 16.9% (11/65), respectively. Mortality during follow-up (excluding in-hospital deaths and patients lost to follow-up) was 13% (9/69). CONCLUSION: A low rate of recurrence of osteomyelitis after surgical treatment for osteomyelitis was achieved. Despite new episodes, our approach to managing this cohort of patients with diabetes and foot osteomyelitis achieved 98.8% limb salvage.


Assuntos
Pé Diabético/cirurgia , Osteomielite/cirurgia , Amputação Cirúrgica/estatística & dados numéricos , Antibacterianos/uso terapêutico , Estudos de Coortes , Complicações do Diabetes , Pé Diabético/epidemiologia , Pé Diabético/etiologia , Feminino , Seguimentos , Humanos , Salvamento de Membro/estatística & dados numéricos , Masculino , Osteomielite/epidemiologia , Osteomielite/etiologia , Estudos Prospectivos , Recidiva , Reoperação/estatística & dados numéricos , Espanha/epidemiologia , Resultado do Tratamento , Cicatrização
16.
Diabet Med ; 28(10): 1238-40, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21395675

RESUMO

AIMS: The objectives of our study were (i) to analyse the inter-observer reproducibility or diagnostic variability of the probing-to-bone test, depending on the training of the professional involved, and (ii) to assess whether the probing-to-bone test can be extrapolated to any professional specialty that deals with these patients. METHODS: This was a cross-sectional study, involving 75 patients with diabetic foot ulcer and clinical suspicion of osteomyelitis. A registration sheet was completed for all patients involved in the research study, gathering data relative to the results of the probing-to-bone test performed by three observers. Observer 1 was a very experienced professional with several years of experience in the treatment of the diabetic foot; observer 2 was a medium-experienced professional whose experience ranges from 6 to 12 months in the treatment of the diabetic foot; observer 3 was a healthcare professional without experience in the treatment of the diabetic foot. Data were gathered confidentially by a fourth researcher. RESULTS: The results showed a kappa index of 0.593 (95% CI 0.407-0.778) between observer 1 and observer 2, 0.397 (95% CI 0.188-0.604) between observer 1 and observer 3 and 0.53 (95% CI 0.335-0.725) between observer 2 and observer 3. CONCLUSIONS: The probing-to-bone test demonstrated moderate to fair concordance with an experienced examiner, although the degree of concordance is not significant between groups.


Assuntos
Osso e Ossos/patologia , Diabetes Mellitus Tipo 1/patologia , Diabetes Mellitus Tipo 2/patologia , Angiopatias Diabéticas/complicações , Pé Diabético/complicações , Osteomielite/diagnóstico , Idoso , Amputação Cirúrgica/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/patologia , Pé Diabético/epidemiologia , Pé Diabético/patologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Osteomielite/epidemiologia , Osteomielite/etiologia , Osteomielite/patologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
17.
Int J Low Extrem Wounds ; 10(1): 6-11, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21444605

RESUMO

The diabetic foot reduces the health-related quality of life (HRQoL) in patients with diabetes mellitus. This study aims at ascertaining the impact of the etiological factors of the diabetic foot on the various aspects of HRQoL. This is a comparative study involving type 1 or type 2 (n = 421) diabetic patients divided into 2 groups. Group 1 (n = 258) includes diabetic patients without foot lesions and group 2 (n = 163) includes patients suffering from a diabetic foot ulcer. The HRQoL of the sample was assessed by using the SF-36 Health Questionnaire. The overall HRQoL score was 68.58 ± 18.24 in group 1 and 50.99 ± 18.98 in group 2 (P < .001). The diabetic foot-related etiological factors that significantly reduce these patients' HRQoL are neuropathy, amputation history, and poor metabolic control (P < .001). Quality of life was lower in women with diabetic foot than in men. Neuropathy--regarded as the main etiological factor in the diabetic foot--also proved to be a variable that reduces the HRQoL. Paradoxically, peripheral vascular disease did not prove to have a negative impact on the quality of life.


Assuntos
Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus/psicologia , Pé Diabético/psicologia , Qualidade de Vida/psicologia , Idoso , Glicemia , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Pé Diabético/epidemiologia , Progressão da Doença , Feminino , Hemoglobinas Glicadas , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Psicometria , Fatores de Risco , Espanha/epidemiologia , Estatística como Assunto , Inquéritos e Questionários
18.
Diabet Med ; 28(2): 191-4, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21219428

RESUMO

AIMS: To investigate the accuracy of the sequential combination of the probe-to-bone test and plain X-rays for diagnosing osteomyelitis in the foot of patients with diabetes. METHODS: We prospectively compiled data on a series of 338 patients with diabetes with 356 episodes of foot infection who were hospitalized in the Diabetic Foot Unit of La Paloma Hospital from 1 October 2002 to 31 April 2010. For each patient we did a probe-to-bone test at the time of the initial evaluation and then obtained plain X-rays of the involved foot. All patients with positive results on either the probe-to-bone test or plain X-ray underwent an appropriate surgical procedure, which included obtaining a bone specimen that was processed for histology and culture. We calculated the sensitivity, specificity, predictive values and likelihood ratios of the procedures, using the histopathological diagnosis of osteomyelitis as the criterion standard. RESULTS: Overall, 72.4% of patients had histologically proven osteomyelitis, 85.2% of whom had positive bone culture. The performance characteristics of both the probe-to-bone test and plain X-rays were excellent. The sequential diagnostic approach had a sensitivity of 0.97, specificity of 0.92, positive predictive value of 0.97, negative predictive value of 0.93, positive likelihood ratio of 12.8 and negative likelihood ratio of 0.02. Only 6.6% of patients with negative results on both diagnostic studies had osteomyelitis. CONCLUSIONS: Clinicians seeing patients in a setting similar to ours (specialized diabetic foot unit with a high prevalence of osteomyelitis) can confidently diagnose diabetic foot osteomyelitis when either the probe-to-bone test or a plain X-ray, or especially both, are positive.


Assuntos
Osso e Ossos/patologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/diagnóstico , Diabetes Mellitus Tipo 2/patologia , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/patologia , Pé Diabético/fisiopatologia , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/diagnóstico por imagem , Osteomielite/patologia , Valor Preditivo dos Testes , Radiografia , Risco , Sensibilidade e Especificidade
19.
Diabet Med ; 27(7): 844-7, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20636967

RESUMO

BACKGROUND: The purpose of this study was to raise awareness and stimulate discussion of the possible triggering factors of Charcot neuroarthropathy by presenting the case of one patient who had both undergone surgery and was suffering from osteomyelitis. CASE REPORT: We have extracted one case from our data set for a patient who underwent conservative surgery for osteomyelitis and subsequently developed acute Charcot in the midfoot. We present the clinical findings, photographs and X-ray studies. Preoperative X-ray showed irregular severe bone destruction in the fourth metatarsal head and a fracture of the fourth metatarsal bone. No signs of midfoot Charcot neuroarthropathy were found in this preoperative X-ray. The third and fourth metatarsal bones were both removed and the surgical wound was left open to heal by second intention. Histopathological study confirmed osteomyelitis in the bone sample. Twenty-five days after surgery, the surgical wound showed no signs of infection and healing progressed in a satisfactory way. However, the foot was swollen, erythematous and warm. Skin temperature was two degrees higher than the contralateral foot. X-ray was taken and acute neuroarthropathy of the tarso-metatarsal joints was diagnosed. CONCLUSIONS: Charcot neuroarthropathy appears to have been triggered by bone infection and/or surgery. We believe that the pivotal factor in the development of acute Charcot neuroarthropathy in this case was the weight bearing in the deformed foot so soon after the operation. Immobilization of the foot is critical as it serves to decrease the inflammation which has a key role in the development of Charcot neuroarthropathy.


Assuntos
Artropatia Neurogênica/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Osteomielite/fisiopatologia , Complicações Pós-Operatórias/etiologia , Suporte de Carga/fisiologia , Artropatia Neurogênica/etiologia , Artropatia Neurogênica/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/cirurgia
20.
Int J Low Extrem Wounds ; 8(4): 187-93, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19825855

RESUMO

The aim of this study was to examine changes in the skin over the feet of patients with diabetic foot syndrome after local application of a product containing hyperoxygenated fatty acids (HOFAs) by measuring transcutaneous oxygen. In 64 patients, transcutaneous oxygen pressure (TcPo(2)) was measured on days 0, 7, 30, 60, and 90 of the study. Foot skin dryness, shedding, and skin color were also assessed using a clinical score. The patients were grouped on the basis of initial levels of transcutaneous oxygen; group 1 comprised patients with TcPo( 2) >30 mm Hg and group 2 comprised patients with TcPo(2) <30 mm Hg on the skin over the dorsum of the feet. Increases in local oxygenation values were observed at a local level in group 2 patients after 30 days of treatment. Skin trophism showed clinical improvement in all patients and these observations may be attributed to improved local microcirculation.


Assuntos
Monitorização Transcutânea dos Gases Sanguíneos , Pé Diabético/terapia , Ácidos Graxos/administração & dosagem , , Extratos Vegetais/administração & dosagem , Pele/irrigação sanguínea , Administração Cutânea , Idoso , Angiopatias Diabéticas/fisiopatologia , Pé Diabético/sangue , Pé Diabético/patologia , Emulsões , Feminino , Humanos , Masculino , Microcirculação , Pele/patologia
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