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1.
Cochrane Database Syst Rev ; 11: CD003229, 2020 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-33141449

RESUMO

BACKGROUND: Chronic venous insufficiency (CVI) is a condition in which veins are unable to transport blood unidirectionally towards the heart. CVI usually occurs in the lower limbs. It might result in considerable discomfort, with symptoms such as pain, itchiness and tiredness in the legs. Patients with CVI may also experience swelling and ulcers. Phlebotonics are a class of drugs often used to treat CVI. This is the second update of a review first published in 2005. OBJECTIVES: To assess the efficacy and safety of phlebotonics administered orally or topically for treatment of signs and symptoms of lower extremity CVI. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the World Health Organization International Clinical Trials Registry Platform and Clinicaltrials.gov trials register up to 12 November 2019. We searched the reference lists of the articles retrieved by electronic searches for additional citations. We also contacted authors of unpublished studies. SELECTION CRITERIA: We included randomised, double-blind, placebo-controlled trials (RCTs) assessing the efficacy of phlebotonics (rutosides, hidrosmine, diosmine, calcium dobesilate, chromocarbe, Centella asiatica, disodium flavodate, French maritime pine bark extract, grape seed extract and aminaftone) in patients with CVI at any stage of the disease. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the quality of included RCTs. We estimated the effects of treatment by using risk ratios (RRs), mean differences (MDs) and standardized mean differences (SMDs), according to the outcome assessed. We calculated 95% confidence intervals (CIs) and percentage of heterogeneity (I2). Outcomes of interest were oedema, quality of life (QoL), assessment of CVI and adverse events. We used GRADE criteria to assess the certainty of the evidence. MAIN RESULTS: We identified three new studies for this update. In total, 69 RCTs of oral phlebotonics were included, but only 56 studies (7690 participants, mean age 50 years) provided quantifiable data for the efficacy analysis. These studies used different phlebotonics (28 on rutosides, 11 on hidrosmine and diosmine, 10 on calcium dobesilate, two on Centella asiatica, two on aminaftone, two on French maritime pine bark extract and one on grape seed extract). No studies evaluating topical phlebotonics, chromocarbe, naftazone or disodium flavodate fulfilled the inclusion criteria. Moderate-certainty evidence suggests that phlebotonics probably reduce oedema slightly in the lower legs, compared with placebo (RR 0.70, 95% CI 0.63 to 0.78; 13 studies; 1245 participants); and probably reduce ankle circumference (MD -4.27 mm, 95% CI -5.61 to -2.93 mm; 15 studies; 2010 participants). Moderate-certainty evidence shows that phlebotonics probably make little or no difference in QoL compared with placebo (SMD -0.06, 95% CI -0.22 to 0.10; five studies; 1639 participants); and similarly, may have little or no effect on ulcer healing (RR 0.94, 95% CI 0.79 to 1.13; six studies; 461 participants; low-certainty evidence). Thirty-seven studies reported on adverse events. Pooled data suggest that phlebotonics probably increase adverse events slightly, compared to placebo (RR 1.14, 95% CI 1.02 to 1.27; 37 studies; 5789 participants; moderate-certainty evidence). Gastrointestinal disorders were the most frequently reported adverse events. We downgraded our certainty in the evidence from 'high' to 'moderate' because of risk of bias concerns, and further to 'low' because of imprecision. AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that phlebotonics probably reduce oedema slightly, compared to placebo; moderate-certainty evidence of little or no difference in QoL; and low-certainty evidence that these drugs do not influence ulcer healing. Moderate-certainty evidence suggests that phlebotonics are probably associated with a higher risk of adverse events than placebo. Studies included in this systematic review provided only short-term safety data; therefore, the medium- and long-term safety of phlebotonics could not be estimated. Findings for specific groups of phlebotonics are limited due to small study numbers and heterogeneous results. Additional high-quality RCTs focusing on clinically important outcomes are needed to improve the evidence base.


Assuntos
Fármacos Hematológicos/uso terapêutico , Extratos Vegetais/uso terapêutico , Insuficiência Venosa/tratamento farmacológico , Ácido 4-Aminobenzoico/uso terapêutico , Angioedemas Hereditários/tratamento farmacológico , Dobesilato de Cálcio/uso terapêutico , Centella , Doença Crônica , Diosmina/análogos & derivados , Diosmina/uso terapêutico , Edema/tratamento farmacológico , Humanos , Perna (Membro) , Úlcera da Perna/tratamento farmacológico , Pessoa de Meia-Idade , Fitoterapia/métodos , Pinus , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Rutina/uso terapêutico , para-Aminobenzoatos/uso terapêutico
2.
Medicine (Baltimore) ; 99(37): e22164, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925780

RESUMO

This study was aimed to evaluate whether silver-containing dressings were superior to other types of dressings in the treatment of venous leg ulcers (VLU) and their specific advantages.Eight databases (Cochrane Library, PubMed, Web of Science, Ovid-Medline, Wanfang, VIP, China Biology Medicine, and China National Knowledge Infrastructure) were systematically reviewed from inception to May 2019 for randomized controlled trials (RCTs). The primary outcome was complete wound healing, and the secondary outcomes included absolute wound size changes (change of cm area since baseline), relative changes (percentage change of area relative to baseline), and healing rate. Two reviewers independently evaluated the risk of bias using the Cochrane Collaboration assessment tool and extracted the data according to the predesigned table. All analyses were performed using the latest Review Manager Software (version 5.3).A total of 8 studies qualified and were included in the meta-analysis, including 1057 patients (experiment: 526, control: 531). Both complete wound healing and wound healing rates were reported in 5 studies. Two and 3 studies reported the effect of silver dressings on absolute and relative wound size changes, respectively. Most of the studies used intention-to-treat analysis.There was sufficient evidence that silver-containing dressings can accelerate the healing rate of chronic VLU and improve their healing in a short duration of time. However, compared with other dressings, clinical trials with long-term follow-up data are needed to confirm whether silver dressings have advantages regarding complete wound healing.


Assuntos
Bandagens , Úlcera da Perna/tratamento farmacológico , Prata/uso terapêutico , Cicatrização/fisiologia , Humanos , Estudos Observacionais como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Prata/administração & dosagem
3.
Med. paliat ; 27(2): 141-145, abr.-jun. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194838

RESUMO

Una paciente frágil afecta de úlceras crónicas en piernas sobreinfectadas por Staphylococcus aureus resistente a meticilina y Pseudomonas aeruginosa sensible, y causantes de dolor somático y neuropático refractario a los analgésicos sistémicos, aceptó ser tratada con sevoflurano tópico como terapia fuera de indicación. La primera irrigación se siguió de un control completo e inmediato del dolor que persistía entre las irrigaciones diarias, por lo que la paciente pudo descansar y dormir ya desde el primer día. Los cultivos del exudado de las heridas tomados al cuarto día de tratamiento con sevoflurano ya resultaron negativos. Al alta hospitalaria tres semanas después la herida izquierda estaba ya cerrada y la derecha cerró dos semanas después aplicando sevoflurano como tratamiento extrahospitalario. El sevoflurano ejerció efectos analgésico, antimicrobiano y cicatrizante, sin efectos adversos severos, por lo que aparece como una nueva estrategia de futuro muy interesante para el ámbito de los cuidados paliativos


A frail patient was suffering from chronic leg ulcers superinfected by methicillin-resistant Staphylococcus aureus and sensitive Pseudomonas aeruginosa, and causing severe somatic and neuropathic pain, which was refractory to conventional systemic analgesics. The patient accepted to be treated with topical sevoflurane as off-label treatment. Pain completely disappeared after the first irrigation with sevoflurane and the analgesic effect persisted between daily irrigations, so that the patient could regain night resting. Cultures of the ulcer exudate taken after 4 days with sevoflurane yielded negative results. The patient was discharged 3 weeks later with the left ulcer healed; the right ulcer healed after 2 more weeks of outpatient treatment with sevoflurane. Therefore, sevoflurane caused analgesic, antimicrobial, and pro-healing effects without noticeable adverse effects, making this new alternative very promising for the care of palliative patients


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Úlcera da Perna/tratamento farmacológico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Sevoflurano/administração & dosagem , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções por Pseudomonas/tratamento farmacológico , Administração Tópica , Idoso Fragilizado , Cicatrização/efeitos dos fármacos , Manejo da Dor
5.
Geriatr Gerontol Int ; 19(11): 1118-1123, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31746528

RESUMO

AIM: An investigator-initiated clinical study was carried out to evaluate the therapeutic potency of SR-0379 for the treatment of leg ulcers in patients with Werner syndrome. METHODS: A multicenter, open-label study was carried out from September 2017 to February 2018. The inclusion criteria for leg ulcers were: (i) leg ulcers in patients with Werner syndrome, diabetes or critical limb ischemia/venous stasis; and (ii) a wound size of >1 cm and <6 cm in diameter. Four individuals with Werner syndrome and diabetic ulcers, respectively, were enrolled. SR-0379 (0.1%) was sprayed on skin ulcers once per day for 4 weeks. Efficacy was evaluated by determining the rate of wound size reduction as a primary end-point at 4 weeks after the first treatment compared with the pretreatment wound size. As secondary end-points, the DESIGN-R score index, the 50% wound size reduction ratio, time to wound closure and quantification of wound bacteria were also evaluated. The safety of SR-0379 was evaluated during the study period. RESULTS: The reduction rate of ulcer size treated with 0.1% SR-0379 was 22.90% (mean) in the Werner syndrome ulcers group (n = 4) and 35.70% (mean) in the diabetic ulcers group (n = 4), respectively. The DESIGN-R score decreased by 4.0 points in the Werner syndrome ulcers group and 4.3 points in the diabetic ulcers group. Two mild adverse events were reported in two patients, and causal relationships were denied in any events. CONCLUSION: Treatment with SR-0379 was safe, well-tolerated, and effective for leg ulcers of both Werner syndrome and diabetes patients. Geriatr Gerontol Int 2019; 19: 1118-1123.


Assuntos
Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Úlcera da Perna/complicações , Úlcera da Perna/tratamento farmacológico , Síndrome de Werner/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisadores
6.
Pediatr Dermatol ; 36(6): 926-928, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31588604

RESUMO

Prolidase deficiency is a rare autosomal recessive disorder characterized by cutaneous ulcers, facial dysmorphism, recurrent infections, and intellectual disability. We report a unique case of a 6-year-old boy with prolidase deficiency and Crohn's disease who presented with lower extremity ulcers. Cutaneous ulcers due to prolidase deficiency are historically resistant to treatment, and we report success with the novel use of topical tacrolimus.


Assuntos
Inibidores de Calcineurina/uso terapêutico , Úlcera da Perna/tratamento farmacológico , Deficiência de Prolidase/complicações , Tacrolimo/uso terapêutico , Administração Tópica , Criança , Humanos , Úlcera da Perna/genética , Masculino , Pomadas
8.
Angiol. (Barcelona) ; 71(4): 160-163, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-190299

RESUMO

Presentamos el caso de un varón de 76 años, con antecedentes de hipertensión arterial (HTA), enfermedad pulmonar obstructiva crónica (EPOC), dislipemia, insuficiencia cardiaca, taquicardia paroxística supraventricular y septoplastia, con úlcera dolorosa en cara posterior de la pierna izquierda de dos semanas de evolución, sin clínica previa de claudicación ni pulsos distales en extremidades inferiores (EEII). Se descartaron úlceras mediante anamnesis, claudicometría, arteriografía y biopsia. Se diagnosticó de déficit mixto de inmunoglobulinas e infección sistémica por Aspergillus. Se estableció tratamiento con itraconazol e inmunoglobulinas y mejoró el estado general y de la úlcera


We present the case of a 76-year-old man, with a history of arterial hypertension (AHT), chronic obstructive pulmonary disease (COPD), dyslipidemia, heart failure, supraventricular paroxysmal tachycardia, septoplasty, with a painful ulcer on the left leg (two weeks of evolution), no previous clinical manifestation of claudication and no distal pulses in lower extremities. Ulcers were ruled out by anamnesis, claudicometry, arteriography and biopsy. Then, a mixed immunoglobulin deficit was diagnosed with a systemic infection by Aspergillus. Treatment with itraconazole andm immunoglobulins was established, improving the general condition and the ulcer


Assuntos
Humanos , Masculino , Idoso , Itraconazol/uso terapêutico , Antifúngicos/uso terapêutico , Imunoglobulinas Intravenosas , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/microbiologia
9.
Wounds ; 31(9): 236-241, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31298659

RESUMO

INTRODUCTION: Venous leg ulcers (VLUs), the most common leg ulceration worldwide, are caused by venous hypertension due to venous reflux, the failure of the calf muscle to pump, and venous flow obstruction. They are associated with a reduced quality of life, particularly in relation to pain and physical function. Hibiscus rosa-sinensis is commonly employed because of its many medicinal properties, and studies have shown Hibiscus contains phytochemicals that have antimicrobial, antioxidant, and anti-inflammatory properties that promote wound healing. OBJECTIVE: The authors evaluate the efficacy and safety of 4% gumamela leaf extract ointment in the closure of VLUs among patients seen in a dermatology outpatient department in the Philippines. MATERIALS AND METHODS: The study included male or female patients with leg ulcers confirmed by duplex scan to be venous in origin and willing to have elastic compression therapy. Patients were instructed to clean the wound with normal saline solution and to apply the extract twice daily. The study was conducted for 12 weeks or until wound closure. Wounds were evaluated and photographed at baseline and every subsequent 2 weeks. Efficacy of therapy was evaluated based on ulcer area size using planimetry method at each visit. Safety was assessed using a 4-point grading system to monitor possible adverse reactions, namely pruritus, rash, burning, and urticaria. RESULTS: Twelve patients were included in the study; 5 patients had an initial ulcer area of ⟩ 10 cm2 and 7 had an initial ulcer area of ≤ 10 cm2. By the end of the study, 10 patients (83.3%) achieved complete ulcer closure in ⟨ 12 weeks, 1 patient (8.3%) had a decrease in ulcer area ⟩ 50% by week 12, and 1 patient (8.3%) had ⟨ 50% decrease in ulcer area at the end of the study. CONCLUSIONS: Data showed compression stockings with 4% gumamela leaf extract ointment application could close VLUs in ⟨ 12 weeks. Applied with compression stockings, the ointment shows potential use in VLU management.


Assuntos
Hibiscus/química , Úlcera da Perna/patologia , Extratos Vegetais/farmacologia , Rosa/química , Úlcera Varicosa/patologia , Cicatrização/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens Compressivas , Feminino , Humanos , Úlcera da Perna/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pomadas , Projetos Piloto , Extratos Vegetais/administração & dosagem , Meias de Compressão , Resultado do Tratamento , Úlcera Varicosa/tratamento farmacológico , Adulto Jovem
10.
Int J Low Extrem Wounds ; 18(2): 186-191, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31111752

RESUMO

The aim of this study was to observe the curative effect and mechanism of Shengji Yuhong ointment in the healing of chronic ulcer of lower limbs. 400 patients were equally divided into treatment group and control group. The treatment group was covered with a piece of Shengji Yuhong ointment gauze, while the control group was covered with a piece of Vaseline gauze. Both groups changed dressings every other day for 4 weeks. On the 3rd, 7th, 14th, 21st, and 28th days of treatment, the reduction rate of wound area and the growth of wound granulation were observed and the levels of hydroxyproline and hemoglobin in wound granulation tissue were measured. The total effective rate was 99.00% in the treatment group and 71.00% in the control group. The treatment group was significantly better than the control group (P < .01). The ulcer area reduction rate of the treatment group was significantly higher than that of the control group (P < .01). The scores of ulcer depth, granulation color, and coverage area on the 7th, 14th, 21st, and 28th days after treatment in the treatment group were significantly lower than those before treatment (P < .05). After treatment, the levels of hydroxyproline and hemoglobin in granulation tissue of wounds in both groups were significantly higher than those before treatment (P < .01), and the levels in the treatment group were significantly higher than those in the control group (P < .01). Shengji Yuhong ointment can improve the healing rate of chronic ulcer of lower limbs.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Tecido de Granulação/efeitos dos fármacos , Úlcera da Perna/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Doença Crônica , Estudos de Coortes , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Úlcera da Perna/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Valores de Referência , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Cicatrização/fisiologia , Adulto Jovem
14.
Trop Doct ; 49(1): 44-45, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30322350

RESUMO

Chronic leg ulcers in children in tropical developing countries are common. They are difficult to diagnose clinically and to manage. Our case illustrates that even in areas where yaws is endemic and point of care testing is available, the diagnosis remains difficult.


Assuntos
Úlcera da Perna/diagnóstico , Treponema pallidum/isolamento & purificação , Bouba/diagnóstico , Adolescente , Feminino , Humanos , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/parasitologia , Úlcera da Perna/patologia , Testes Imediatos , Resultado do Tratamento , Treponema pallidum/efeitos dos fármacos , Vanuatu , Bouba/tratamento farmacológico , Bouba/parasitologia , Bouba/patologia
15.
J Pain Palliat Care Pharmacother ; 32(2-3): 71-81, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30589375

RESUMO

Prevalence of leg ulcers increases with age due to an increase in risk factors, including immobility and venous disease. With an increasingly aging population, therefore, the number of older adults with leg ulcers is increasing. Older adults with leg ulcers experience frequent pain and discomfort, and yet pain in this population is poorly managed. The aim of this study was to explore the feasibility of the use of analgesic dressings in older adults with leg ulcers, including their perception of current pain management, feasibility of an analgesic dressing, and potential challenges. The overriding objective was to use the information to design a novel advanced dressing that is highly effective and acceptable to patients and health professionals at affordable cost. Focus groups involving nurses, with experience of leg ulcers, were conducted. Participants were asked their opinion on pain from leg ulcers, including perception of current pain management, feasibility of an analgesic dressing, and potential challenges of using analgesia in this format. Focus groups and interviews were recorded and transcribed verbatim and analyzed using a framework approach. Fifteen nurses attended two focus groups and one older adult completed a telephone interview. The overall opinion of an analgesic dressing were very positive; the key themes relating to the use of an analgesic dressing in practice include duration of pain relief; when pain occurs; type of analgesic; skin integrity; training/experience; compliance; and dressing practicalities. Leg ulcers are well known to be painful and often associated with social stigma. A dressing that deals with absorption issues and can help to manage pain, particularly during dressing changes (when pain is highest), would be welcomed by nurse professionals. This preliminary study provides a basis upon which future research can be based.


Assuntos
Analgésicos/administração & dosagem , Bandagens , Úlcera da Perna/tratamento farmacológico , Dor/tratamento farmacológico , Idoso , Doença Crônica , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Úlcera da Perna/patologia , Dor/etiologia
16.
J Wound Care ; 27(12): 816-821, 2018 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-30557114

RESUMO

OBJECTIVE: To assess the tolerability and efficacy of photodynamic therapy (PDT) with RLP068, a novel phthalocyanine-derived photosensitiser, in controlling the bacterial load in different leg ulcers, due to vascular pathophysiology. METHOD: An observational study of patients with infected leg ulcers of different pathophysiology, admitted to the hospital for a skin grafting procedure, were included. All patients underwent two sessions of PDT at time zero and after 72 hours. A semi-quantitative swab was taken before and 30 minutes after both sessions of PTD. During the time interval between the two treatments the ulcer was covered with foam dressing and compression therapy was applied to all patients. No systemic or topical antibiotics were administered. Statistical analysis of results was performed. RESULTS: A total of 36 patients (13 males, 23 females; aged 72.4±8.6 years, range: 55-85 years) were recruited; two had ulcers on both legs. PDT was shown to be effective in reducing bacterial load after the first treatment. Before the second PDT treatment (72 hours after first PDT treatment), a slight increase of the bacterial load was observed in all ulcers. However, after the second PDT session, bacterial swab results were negative in all but two ulcers. The procedure was well tolerated in all but four patients, who reported a very severe pain at baseline, which increased during treatment. CONCLUSION: In this study, PDT was effective in reducing bacterial load in patients with infected vascular leg ulcers, and allowed successful skin grafting to take place in all patients. The treatment was generally well tolerated. Studies with a greater number of patients and a control group are planned to confirm these results.


Assuntos
Carga Bacteriana/efeitos dos fármacos , Indóis/uso terapêutico , Úlcera da Perna/tratamento farmacológico , Fotoquimioterapia/métodos , Radiossensibilizantes/uso terapêutico , Úlcera Varicosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
17.
Medicine (Baltimore) ; 97(46): e12614, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30431560

RESUMO

Cutaneous ulceration from sickle cell disease negatively impacts quality of life. Topical sodium nitrite has previously been shown to reduce the size of sickle leg ulcers. This study examined how topical sodium nitrite impacted the quality of life scores in patients with sickle leg ulcers.We prospectively collected data in patients enrolled in a leg ulcer study (n = 17) or an allogeneic hematopoietic cell transplant study (nonulcer group, n = 15). Both groups completed a pretreatment Short Form-36 questionnaire; the ulcer group completed a second questionnaire after 4 weeks of topical sodium nitrite applications. Data were analyzed by age, sex, >50% area improvement postintervention, and sickle-related complications (vaso-occlusive crises, pulmonary hypertension, or avascular necrosis). Physical and mental component summary scores were analyzed with Student t test.Physical summary scores were lower than mental summary scores in all groups, indicating leg ulcers among other sickle related complications negatively impacted physical quality of life measures. After sodium nitrite use, physical summary scores improved in the leg ulcer group (34.5 ±â€Š9.4 to 39 ±â€Š10.3, P = .03), and mental summary scores improved more in ulcerated patients ≤35 years old (40.7 ±â€Š6.9 to 51.7 ±â€Š9.7, P = .01).Brief topical sodium nitrite has the potential to improve quality of life, especially in younger individuals. Longer treatment duration and randomized-controlled trials are needed to confirm the efficacy of this topical therapy.


Assuntos
Anemia Falciforme/complicações , Úlcera da Perna/tratamento farmacológico , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Nitrito de Sódio/administração & dosagem , Administração Tópica , Adolescente , Adulto , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Úlcera da Perna/etiologia , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Prospectivos , Resultado do Tratamento , Cicatrização/efeitos dos fármacos , Adulto Jovem
18.
Int J Low Extrem Wounds ; 17(3): 151-160, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30222081

RESUMO

Flammacerium is a topical treatment composed of silver sulfadiazine and cerium nitrate initially used in burns. The objective was to assess the effectiveness of silver sulfadiazine and cerium nitrate on ischemic necrosis wounds of the lower limb as an alternative to amputation for a period of 12 weeks. Patients were prospectively randomized to receive silver sulfadiazine and cerium nitrate or standard care. Patients included adults with an ischemic wound of the lower limb, with necrosis covering over at least 50%. Critical ischemia limb was confirmed by an ankle-brachial index <0.7 or >1.3 with radiological confirmation. Patient demographic data, amputations procedures, wound area, Visual Analogue Scale pain rating, clinical infection, and adverse events were recorded. Fifty patients, 34 males and 16 females, were recruited between January 2010 and April 2014, 25 in each group. The mean age was 75.14 years (±11.64). Nine amputations (36%) occurred in each group. Amputation-free survival was superior in the active treatment group versus the standard group (169 393 days, 95% confidence interval = 134.926-203.861, vs 169 393 days, 95% confidence interval = 134.926-203.861). It was not statistically significant (log-rank, P = .958). Wound area reduction between both groups was not statistically different ( P = .651). Less adverse events of the lower limb occurred in the active treatment group ( P = .001). Our study showed that silver sulfadiazine and cerium nitrate is not inferior to standardized care on ischemic necrotic wounds of the lower extremity. Further studies are still needed to confirm its effectiveness.


Assuntos
Cério , Isquemia , Úlcera da Perna/tratamento farmacológico , Sulfadiazina de Prata , Pele , Cicatrização/efeitos dos fármacos , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/efeitos adversos , Cério/administração & dosagem , Cério/efeitos adversos , Combinação de Medicamentos , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Úlcera da Perna/diagnóstico , Úlcera da Perna/etiologia , Masculino , Pessoa de Meia-Idade , Necrose , Sulfadiazina de Prata/administração & dosagem , Sulfadiazina de Prata/efeitos adversos , Pele/irrigação sanguínea , Pele/patologia , Resultado do Tratamento
19.
Int Wound J ; 15(6): 958-965, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30079579

RESUMO

Gram-negative germs with and without multi-resistance are garnering more and more importance. The aim of this study was to investigate the frequency and rate of resistance against antibiotics and to clarify the impact of Gram-negative bacteria, especially with high rates of resistance, for the treatment of venous leg ulcers. This is a retrospective, monocentric, non-randomised open study. Included were all data within 1 year of bacterial swabs of venous leg ulcers. We performed summarization, pooling, and descriptive analysis for frequencies and crossover. We analysed 679 swabs of 285 patients with venous leg ulcers. The mean patient age was 69.78 years. There were 76.1% Gram-positive and 58.2% Gram-negative germs detected; 56.5% of the swabs showed multi-resistance. Gram-negative bacteria were associated with more pain. Exacerbation and relevant aggravation of wounds that led to stationary treatment occurred more frequently. With polihexanid treatment, we saw less Gram-negative flora. This study showed an immediate impact of Gram-negative germs on the patient's pain, the risk for aggravation, and the choice of treatment. Further studies for prophylaxis and treatment of Gram-negative germs in venous leg ulcer therapy are needed.


Assuntos
Antibacterianos/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Úlcera da Perna/tratamento farmacológico , Úlcera da Perna/microbiologia , Úlcera Varicosa/tratamento farmacológico , Úlcera Varicosa/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Cicatrização/fisiologia , Adulto Jovem
20.
J Wound Ostomy Continence Nurs ; 45(5): 425-431, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29939885

RESUMO

PURPOSE: The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period. METHODS: Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm. RESULTS: The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions. CONCLUSIONS: The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.


Assuntos
Carga Bacteriana/estatística & dados numéricos , Biguanidas/farmacologia , Úlcera da Perna/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/uso terapêutico , Biguanidas/uso terapêutico , Biofilmes/efeitos dos fármacos , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica/métodos , Irrigação Terapêutica/normas , Úlcera Varicosa/tratamento farmacológico , Ferimentos e Lesões/tratamento farmacológico
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