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1.
Wounds ; 31(5): E39-E41, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31184591

RESUMO

OBJECTIVE: The aim of this study is to evaluate how treatment with total contact cast (TCC) affects the balance of proteases in diabetic foot ulcers (DFUs) as they heal. MATERIALS AND METHODS: This was a prospective observational study of 22 eligible patients with neuropathic plantar DFUs in a hospital-based wound care center. All patients treated with TCC had adequate arterial circulation (ankle-brachial index > 0.75), no sign of infection, and all DFUs were grade 1A according to the University of Texas Diabetic Wound Classification System. Patients had weekly follow-up visits for wound evaluation and reapplication of the TCC. Wound tissues were obtained at baseline (week 0 prior to initial treatment), week 3, week 6, and week 12. Tissue homogenates were analyzed for matrix metalloprotease (MMP) 2, MMP-9, tissue inhibitor matrix metalloproteinase (TIMP) 1, and TIMP-2. Wound measurements were obtained at weekly follow-up visits, and healing rates were calculated by photodigital planimetry. RESULTS: Treatment with TCC for 3 weeks resulted in a 20% decrease in MMP-2 (P = .031) and 44% decrease in MMP-9 (P = .018). By week 6, MMP-2 and MMP-9 levels were reduced by 37% and 55%, respectively. Tissue inhibitor matrix metalloproteinase 1 increased by 42% (P = .033) and TIMP-2 by 44% (P = .04) after 6 weeks of therapy with TCC. CONCLUSIONS: This significant and rapid drop of both MMP-2 and MMP-9 strongly suggests a decline of the inflammatory phase and initiation of the proliferation phase.

2.
Palmas ; 39(1): 69-85, 2018. tab
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-982138

RESUMO

El déficit de agua es uno de los factores más limitantes para la obtención de altos rendimientos en los cultivos. Junto con esto, se debe mencionar que el agua se está convirtiendo en un ecurso escaso debido a condiciones relacionadas con el cambio climático, lo cual implica que cuando un productor decide regar sus cultivos, la eficiencia del sistema para el uso de agua debe ser un factor a considerar. Este artículo presenta los resultados de una investigación que pretende evaluar desde un punto de vista económico dos sistemas de riego empleados en plantaciones de palma de aceite de Colombia: el sistema de riego por aspersión (ra) y el sistema de riego por inundación (ri). Además, dentro del análisis se consideró un escenario en el que el productor no utiliza ningún sistema de riego (sr). Con respecto a los métodos de evaluación económica se utilizaron: la tasa interna de retorno, el costo unitario, el ingreso neto y el periodo de recuperación de la inversión. Los resultados indican que, a un precio de $ 365.000 por tonelada de rff, 70 Revista Palmas. Bogotá (Colombia) vol. 39 (1) 69 - 85, enero - marzo 2018 Introducción El rendimiento potencial de la palma de aceite se ve limitado, entre otros factores, por el déficit de agua. Esta situación se traduce en una brecha entre el potencial que ofrecen los materiales genéticos desarrollados y el rendimiento que en realidad obtienen los productores de sus cultivos. En ese sentido, la oferta hídrica determina el potencial de producción de un cultivo (Van Ittersum et al., 2013). En el caso de la palma de aceite, Corley & Tinker (2014) refieren que el déficit de agua es el factor climático que probablemente más afecta los rendimientos de este cultivo. A partir de lo anterior, se podría afirmar que el rendimiento esperado de un cultivo en regiones con déficit de este recurso, estará principalmente en función de las soluciones que se adopten para superar esta condición limitante. Entre estas se encuentran la adopción de materiales genéticos con tolerancia a la sequía, la implementación de sistemas de riego que permitan suplir el déficit (Lobell, Cassman & Field, 2009), y/o la adopción de otras prácticas que contribuyan a mitigar el efecto de la sequía en el suelo y que a su vez favorezcan la retención de la humedad existente, tal como el uso de residuos orgánicos (Beltrán, Pulver, Guerrero & Mosquera, 2015). De acuerdo con Woittiez et al. (2017), el rendimiento de la palma de aceite se reduce con precipitaciones inferiores a 2.000 mm/año, o si se presentan meses con precipitaciones inferiores a 100 mm. En el caso de las regiones palmeras de Colombia ambas condiciones son ciertas. Por ejemplo, en la Figura 1 se puede ver la precipitación mensual de cuatro plantaciones de la Zona Norte durante cuatro años. Es posible observar que al menos durante cuatro meses del año se registran precipitaciones que no superan los 100 mm. Establecer cultivos de palma aceitera con un sistema de riego por aspersión es la mejor alternativa desde el punto de vista económico. De esta manera, la tir resulta ser 4 % mayor con ra comparado con ri, y un 8 % superior en comparación con sr. Así mismo, el costo unitario es 7 % menor con ra comparado con ri, y 9 % más bajo en comparación con sr. Por su parte, los ingresos netos son 20 % más altos en ra comparado con ri, y 63 % superiores en comparación con sr. Por último, la amortización llega antes en ra en comparación con ri y sr. Este trabajo presenta además resultados para el análisis de sensibilidad que se llevó a cabo sobre el precio del agua y el precio pagado por rff


Water deficit is among the most limiting factors for obtaining high yields in agricultural crops. Along with this, water is becoming a scarce resource due to climate change, which implies that whenever a grower de-cides to irrigate their crops, the efficiency of the system for water usage must be a factor to be considered. This paper presents the results of a research undertaken in order to assess two irrigation systems used at oil palm plantations in Colombia from an economic perspective, they were: sprinklers irrigation (-*) and, f lood irrigation (2*). A scenario in which the grower does not use any irrigation system (K*) was also con-sidered. Regarding the economic assessment methods we used: internal rate of return (*&&), unit cost, net income, net present value (OQS), and payback period (QU). Results indicate that at a price of XYQ 365.000 per ton of 22U, establishing oil palm crops with sprinklers irrigation systems is the best alternative from an economic angle. With this method, the *&& is 4% higher at -* compared to 2*, and 8% higher compared to K*. The unit cost is 7% lower at -* compared to 2*, and 9% lower compared to K*. Besides, net income is 20% higher at -* than at 2*, and 63% higher compared to K*. Finally, the payback period comes earlier at -*, compared to 2* and K*. This study also provides results for sensitivity analyses carried out for the price of water and for the price paid for 22U.


Assuntos
História do Século XXI , Compostos Químicos , Abastecimento Rural de Água , Indicadores Econômicos
3.
Wounds ; 29(7): E51-E54, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28759431

RESUMO

Diabetic foot ulcers (DFUs) are a severe and costly complication of diabetes and may result in foot amputation. CASE REPORT: A 69-year-old man with a 10-year history of type 2 diabetes, who was undergoing routine care for diabetes in the authors' clinic, developed a DFU of his right foot of 4 years' duration. The wound did not respond to conventional treatments, and imaging studies were normal. His 2 biopsies tested negative for malignancy. The DFU was fully removed surgically. Following surgical removal, squamous cell carcinoma (SCC) was diagnosed in the histologic study of the wound. CONCLUSION: Clinicians should consider a diagnosis of SCC in any chronic, nonhealing DFU. Early surgical resection of a chronic, nonhealing DFU may prevent development of SCC in an ulcer.


Assuntos
Bandagens Compressivas , Matriz Extracelular/efeitos dos fármacos , Matriz Extracelular/fisiologia , Ácido Hialurônico/administração & dosagem , Úlcera Varicosa/terapia , Cicatrização/efeitos dos fármacos , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/farmacologia , Idoso , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/farmacologia , Relação Dose-Resposta a Droga , Matriz Extracelular/imunologia , Feminino , Humanos , Ácido Hialurônico/farmacologia , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Úlcera Varicosa/imunologia , Úlcera Varicosa/patologia , Cicatrização/fisiologia
4.
Wounds ; 2017 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-28267677

RESUMO

OBJECTIVE: To evaluate the effectiveness of a porcine urinary bladder-derived extracellular matrix (UBM) for the treatment of recalcitrant, neuropathic diabetic foot ulcers (DFUs). MATERIALS AND METHODS: This prospective, parallel, randomized, single-center study involving 17 subjects was performed in an outpatient wound care center setting. Each subject with a DFU was randomized (2:1) to receive the urinary bladder matrix (UBM) plus offloading with a total contact cast (TCC) or standard care (nonadherent dressing plus TCC). All DFUs were on the plantar surface of the foot and all were Grade I-A according to the University of Texas Wound Classification System. A traditional TCC was used in all patients and consisted of a minimally padded, well-molded, and rigid (plaster plus fiberglass) construct that maintains contact with the entire plantar surface of the foot and lower leg. The endpoints of the study were wound healing at 12 and 16 weeks and ulcer recurrence at 1 year. Wound evaluations were performed weekly and wound surface area was measured by photo-digital planimetry. RESULTS: In the UBM group, the incidence of wound healing at 12 and 16 weeks was 90% and 100%, respectively, compared with 33% and 83.3% in the control (P = .062). The mean time to healing in the UBM-treated group was 62.4 days compared with 92.8 days in the control group (P = .031). The incidence of ulcer recurrence at 1 year was 10% (1/11) in the UBM-treated group and 50% (3/6) in the control. CONCLUSION: Results of this interim analysis suggest treatment of DFUs with a UBM could significantly reduce the time to healing and improve the rate of recurrence.

5.
J Wound Ostomy Continence Nurs ; 43(5): 455-63, 2016 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27509367

RESUMO

This article reports the findings of the Unavoidable Pressure Ulcer Committee (of the VCU Pressure Ulcer Summit) that was tasked with addressing key issues associated with pressure injuries that are unavoidable or unpreventable. Our goals were (1) to clarify nomenclature and descriptions surrounding "terminal ulceration," (2) to describe the medical complications and comorbid conditions that can lead to skin failure and/or terminal ulceration, (3) to describe the variable possible causes of unavoidable pressure injuries, and (4) to present clinical cases to exemplify pressure injuries considered to be unavoidable.


Assuntos
Lesão por Pressão/classificação , Índice de Gravidade de Doença , Pele/lesões , Humanos , Insuficiência de Múltiplos Órgãos/complicações , Lesão por Pressão/etiologia , Medição de Risco/métodos , Assistência Terminal
6.
Wounds ; 27(11): 293-301, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26574751

RESUMO

UNLABELLED: Thirty-four subjects with symptomatic peripheral arterial disease (PAD) or critical limb ischmeia (CLI) who were experiencing claudication pain, chronic resting pain, numbness, and ischemic lower leg/foot ulceration were randomized into 2 treatment groups. MATERIALS AND METHODS: Eighteen of these patients received treatment with high-pressure, intermittent pneumatic compression (HPIPC) 60 minutes twice daily for 16 weeks, and 16 subjects received standard care consisting of an exercise regimen of walking for 20 minutes twice daily for 16 weeks. The HPIPC device delivers bilateral pressures of 120 mm Hg. Cycle times provide sequential compression for 4 seconds (+/- 0.5 seconds) followed by a 16-second rest period (+/- 3.0 seconds), resulting in a 20-second cycle or 3 cycles per minute. The study was designed to measure patient-centered outcomes. The primary endpoint was peak walking time (PWT), defined as time to maximally tolerated claudication pain. Secondary endpoints included change in resting ankle brachial index, ulcer healing, relief of resting/wound pain, and quality of life (QoL) index. Age (73.7 years vs 72.7 years), baseline PWTs (1-6 minutes), and risk factors were similar in both treatment groups. RESULTS: At 4 weeks, the percent change from baseline in PWT did not vary significantly between treatment groups (17.8% for HPIPC and 17% for standard care). After 8 weeks, the percent change in PWT for the HPIPC group was 41% compared to 32% for the group receiving standard care (P = 0.062). At the 16-week time point the percent change from baseline in PWT was significantly different between treatment arms (35.5% for the standard care group and 54.7% for the group receiving HPIPC [P = 0.043]). The mean reduction in wound surface area was 57% and 71% at 12 weeks and 16 weeks, respectively, for the HPIPC group, compared to 45% and 56% for the control group. The HPIPC group reported significantly greater pain relief at the 12-week (P = 0.044) and 16- week (P = 0.038) time points. Compared to the control group, the HPIPC group reported improvement in patient-centered outcomes such as physical function and bodily pain. These differences were statistically significant (P less than 0.05) at the 16- week evaluation period. CONCLUSION: Therapy consisting of HPIPC for 2 hours daily for a period of 16 weeks significantly improved PWT, reduced resting pain, and improved healing rates, physical function, and bodily pain. There were no devicerelated complications, allowing for long-term use. This study further supports that HPIPC is safe and effective and should be considered for patients who are not candidates for endovascular or surgical procedures. Furthermore, HPIPC offers an excellent alternative for the palliative care of patients with PAD and CLI symptoms.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Úlcera do Pé/terapia , Claudicação Intermitente/terapia , Dispositivos de Compressão Pneumática Intermitente , Isquemia/terapia , Dor/prevenção & controle , Doença Arterial Periférica/terapia , Caminhada , Índice Tornozelo-Braço , Estado Terminal , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Seguimentos , Úlcera do Pé/complicações , Úlcera do Pé/fisiopatologia , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/fisiopatologia , Isquemia/etiologia , Isquemia/fisiopatologia , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/fisiopatologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Fluxo Sanguíneo Regional , Pele/irrigação sanguínea , Fatores de Tempo , Resultado do Tratamento , Cicatrização
7.
Int J Low Extrem Wounds ; 10(4): 190-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22184750

RESUMO

Ultrasound as a therapeutic agent in chronic wound healing has been studied extensively. This systematic review and meta-analysis specifically examines low-frequency (20-30 kHz) ultrasound delivered at either low or high intensity. The objective of this review was to determine whether low-frequency ultrasound used as an adjunctive therapy improves the outcomes of complete healing and reduction of size of chronic lower limb wounds. PubMed, Cochrane/CENTRAL, technical assessment, relevant wound-related journals, and clinical guidelines were searched along with contacting manufacturers and authors of relevant randomized controlled trials were completed. Searches focused on the use of low-frequency ultrasound in randomized controlled trials. Data were collected via a data collection form and was adjudicated independently via coauthors. Meta-analyses and heterogeneity checks were performed using Mantel-Haenszel and inverse variance (fixed and random effects) statistical methods on studies with similar outcomes (complete healing and percent wound area reduction) over similar time periods. Single study results were reported via the statistical methods used in the study. Eight randomized controlled trials were identified. Results demonstrated that early healing (at ≤5 months) in patients with venous stasis and diabetic foot ulcers was favorably influenced by both high- and low-intensity ultrasound delivered at a low frequency-either via contact or noncontact techniques. However, the quality of the data may be suspect, especially for low-frequency low-intensity noncontact ultrasound because of significant biases. In patients presenting with either venous stasis or diabetic foot ulcers (Wagner classification 1-3), early healing appears to be facilitated by either low-frequency low-intensity noncontact ultrasound or low-frequency high-intensity contact ultrasound.


Assuntos
Desbridamento/métodos , Terapia por Ultrassom/métodos , Cicatrização , Ferimentos e Lesões/diagnóstico por imagem , Doença Crônica , Intervalos de Confiança , Desbridamento/instrumentação , Humanos , Risco , Fatores de Tempo , Ultrassonografia , Ferimentos e Lesões/cirurgia
8.
Wounds ; 23(9): 267-75, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25879267

RESUMO

UNLABELLED:  Traditional wound tracing technique consists of tracing the perimeter of the wound on clear acetate with a fine-tip marker, then placing the tracing on graph paper and counting the grids to calculate the surface area. Standard wound measurement technique for calcu- lating wound surface area (wound tracing) was compared to a new wound measurement method using digital photo-planimetry software ([DPPS], PictZar® Digital Planimetry). METHODS: Two hundred wounds of varying etiologies were measured and traced by experienced exam- iners (raters). Simultaneously, digital photographs were also taken of each wound. The digital photographs were downloaded onto a PC, and using DPPS software, the wounds were measured and traced by the same examiners. Accuracy, intra- and interrater reliability of wound measurements obtained from tracings and from DPPS were studied and compared. Both accuracy and rater variability were directly related to wound size when wounds were measured and traced in the tradi- tional manner. RESULTS: In small (< 4 cm2), regularly shaped (round or oval) wounds, both accuracy and rater reliability was 98% and 95%, respectively. However, in larger, irregularly shaped wounds or wounds with epithelial islands, DPPS was more accurate than traditional mea- suring (3.9% vs. 16.2% [average error]). The mean inter-rater reliabil- ity score was 94% for DPPS and 84% for traditional measuring. The mean intrarater reliability score was 98.3% for DPPS and 89.3% for traditional measuring. In contrast to traditional measurements, DPPS may provide a more objective assessment since it can be done by a technician who is blinded to the treatment plan. Planimetry of digital photographs allows for a closer examination (zoom) of the wound and better visibility of advancing epithelium. CONCLUSION: Measurements of wounds performed on digital photographs using planimetry software were simple and convenient. It was more accurate, more objective, and resulted in better correlation within and between examiners. .

9.
J Palliat Med ; 10(5): 1161-89, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17985974

RESUMO

BACKGROUND: Palliative wound care should be centered on symptom management and is a viable option for patients whose chronic wounds do not respond to standard interventions, or when the demands of treatment are beyond the patient's tolerance or stamina. Palliative wound care is the incorporation of strategies that prioritize symptomatic relief and wound improvement ahead of wound healing (total closure). Palliative wound care strategies must also work in conjunction with curative treatment objectives as wounds often heal completely in spite of serious illness and advanced disease. Palliative wound care is much more than pain, exudate and odor management. Common curative treatment goals such as physical correction of the underlying pathology, addressing nutrition and other supportive aspects of care, and sensible (nonharmful) local wound treatments should never be ignored. OBJECTIVE: (1) To provide a fresh and effective approach to palliative wound care by integrating individual clinical expertise with clinical and laboratory evidence from the (curative) wound healing literature and (2) to share our (Calvary Hospital) experience and approach to palliative wound care in an inpatient, home, and outpatient setting. This approach can be summarized with the mnemonic S-P-E-C-I-A-L (S = stabilizing the wound, P = preventing new wounds, E = eliminate odor, C = control pain, I = infection prophylaxis, A = advanced, absorbent wound dressings, L = lessen dressing changes). Throughout this paper we will offer rationale, principles and recipes, for each of the steps of the "SPECIAL" approach in an effort to facilitate the caring for chronic wounds in palliative medicine. CONCLUSIONS: A practical marriage of wound palliation (symptom management) with current wound healing concepts to provide options for the palliative care provider and improve the practice of palliative medicine.


Assuntos
Dor/prevenção & controle , Cuidados Paliativos/métodos , Cicatrização , Artérias/patologia , Doença Crônica , Humanos , Incidência , Lesão por Pressão/prevenção & controle , Prevalência , Medição de Risco , Fatores de Risco , Úlcera Varicosa/prevenção & controle
10.
J Foot Ankle Surg ; 42(1): 30-5, 2003 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12567365

RESUMO

This is the interim analysis of a prospective, randomized, controlled study comparing diabetic foot ulcer healing in patients being treated with either noncontact normothermic wound therapy (Warm-UP; Augustine Medical Inc. Eden Prairie, MN) applied for 1 hour 3 times daily until healing or 12 weeks, or standard care (saline-moistened gauze applied once a day). Surgical debridement and adequate foot off-loading was provided to both groups. Evaluations were performed weekly and consisted of acetate tracings, wound assessment, and serial photography. Twenty patients have completed the trial and both treatment groups were distributed evenly (N = 10). Ulcers treated with noncontact normothermic wound therapy had a greater mean percent wound closure than control-treated ulcers at each evaluation point (weeks 1-12). After 12 weeks, 70% of the wounds treated with noncontact normothermic wound therapy were healed compared with 40% for the control group. In this subset of patients there have been no adverse events associated with noncontact normothermic wound therapy.


Assuntos
Bandagens , Pé Diabético/terapia , Temperatura Alta/uso terapêutico , Cicatrização , Adulto , Idoso , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
11.
Maryland; U. S. Department of Health and Human Services; 1994. x,154 p. tab.
Monografia em Inglês | Sec. Munic. Saúde SP, HSPM-Acervo | ID: sms-6674
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