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1.
Khirurgiia (Mosk) ; (4): 81-87, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352675

RESUMO

OBJECTIVE: Of study is improving the results of treatment of patients with pyo-necrotic complications of diabetic foot syndrome by including the method of negative pressure wound treatment in the complex treatment program in combination with using of the combined antibacterial drug Cifran ST and immunocorrective therapy. MATERIAL AND METHODS: The results of examination and treatment of 184 patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome were analyzed. According to choice of treatment methods in the postoperative period all patients were divided into two groups. In 95 patients (group I), iodine-containing ointments based on polyethylene glycol were used for local treatment of purulent foot wounds and standard systemic antibacterial therapy was performed. In 89 patients (group II), negative pressure wound treatment (NPWT) was used to treat wounds in the postoperative period. In addition to standard parenteral antimicrobial therapy, these patients also received an oral combined antibacterial drug Cifran ST and immunocorrective cytokine therapy (Leukinferon). The analysis of the dynamics of the wound process was carried out based on the clinical picture and the results of cytological, bacteriological and immunological studies of the wound exudate. RESULTS: The presented strategy of complex treatment of pyo-necrotic complications of the neuropathic form of diabetic foot syndrome allowed group II patients to significantly reduce the degree of microbial contamination of wounds, to achieve a faster regression of the content of proinflammatory and inflammatory cytokines in the wound exudate, as well as to reduce the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage in comparison with group I patients. This allowed group II patients to reduce the time of plastic closure of the wound from 24.3±0.5 to 15.6±1.7 days, to avoid generalization of infection, death and high level amputation of the limb. At the same time, 11.6% of patients in group I had high level limb amputation due to generalization of infection. The mortality rate in group I was 5.3%. CONCLUSIONS: Adding of vacuum therapy of wounds, systemic antimicrobial therapy using the combined antibacterial drug Cifran ST and immunocorrective cytokine therapy in the complex treatment program for patients with neuropathic form of diabetic foot syndrome after radical surgical treatment of the pyo-necrotic lesion allows reducing the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage. On the other hand, this makes it possible for this category of patients to perform plastic closure of the wound at an earlier date, avoid generalization of infection and high level amputation of the limb.


Assuntos
Pé Diabético/terapia , Adjuvantes Imunológicos/administração & dosagem , Adjuvantes Imunológicos/uso terapêutico , Amputação , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Ciprofloxacino/administração & dosagem , Ciprofloxacino/análogos & derivados , Ciprofloxacino/uso terapêutico , Terapia Combinada , Pé Diabético/complicações , Pé Diabético/patologia , Combinação de Medicamentos , Humanos , Interferon Tipo I/administração & dosagem , Interferon Tipo I/uso terapêutico , Necrose/etiologia , Necrose/terapia , Tratamento de Ferimentos com Pressão Negativa , Supuração/tratamento farmacológico , Supuração/etiologia , Síndrome
2.
Medicine (Baltimore) ; 99(12): e19502, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195951

RESUMO

BACKGROUND: Diabetic foot (DF) problems are common throughout the world, about one-fourth of them develop a foot ulcer and serious cases would suffer from amputation, which seriously affects the patient's work and life. Previous studies indicated that acupuncture as adjuvant therapy would be effective in treating DF. However, these studies have no consistent results. Therefore, the aim of our study was to explore the efficacy and safety of acupuncture as adjuvant therapy for DF. METHODS: The randomized controlled trials associated with acupuncture therapy (or as adjuvant therapy) for DF will be included. We will search 6 electronic databases relevant to health sciences, including PubMed, Embase, the Cochrane Library, the Chinese databases Sino-Med, CNKI, and WANFANG database. All searches were from databases inception to March 30, 2019. The primary outcomes are the total curative effective rate, and the hemodynamic parameter and adverse events will be deemed as secondary outcomes. The Stata15.1 software and Review Manager (RevMan 5.3; Cochrane Collaboration, Copenhagen, Denmark) will be used for analysis, to assess the bias risk, subgroup analysis, and data synthesis. RESULTS: In this systematic review and meta-analysis, we will synthesize the studies to assess the safety and efficacy of acupuncture as adjuvant therapy for DF. CONCLUSION: The summary of our study will clarify whether acupuncture as adjuvant therapy could be an efficient method for DF.


Assuntos
Terapia por Acupuntura/métodos , Pé Diabético/complicações , Pé Diabético/terapia , Úlcera do Pé/complicações , Amputação , Complicações do Diabetes/patologia , Diabetes Mellitus/epidemiologia , Pé Diabético/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
3.
PLoS One ; 15(1): e0227006, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31978071

RESUMO

Diabetic foot ulcers (DFUs) lead to nearly 100,000 lower limb amputations annually in the United States. DFUs are colonized by complex microbial communities, and infection is one of the most common reasons for diabetes-related hospitalizations and amputations. In this study, we examined how DFU microbiomes respond to initial sharp debridement and offloading and how the initial composition associates with 4 week healing outcomes. We employed 16S rRNA next generation sequencing to perform microbial profiling on 50 samples collected from 10 patients with vascularized neuropathic DFUs. Debrided wound samples were obtained at initial visit and after one week from two DFU locations, wound bed and wound edge. Samples of the foot skin outside of the wounds were also collected for comparison. We showed that DFU wound beds are colonized by a greater number of distinct bacterial phylotypes compared to the wound edge or skin outside the wound. However, no significant microbiome diversity changes occurred at the wound sites after one week of standard care. Finally, increased initial abundance of Gram-positive anaerobic cocci (GPAC), especially Peptoniphilus (p < 0.05; n = 5 subjects), was associated with impaired healing; thus, GPAC's abundance could be a predictor of the wound-healing outcome.


Assuntos
Desbridamento/métodos , Pé Diabético/complicações , Úlcera do Pé/microbiologia , Cocos Gram-Positivos/isolamento & purificação , Microbiota , Cicatrização , Idoso , Bactérias Anaeróbias , Pé Diabético/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Resultado do Tratamento
4.
BMC Infect Dis ; 20(1): 23, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914940

RESUMO

BACKGROUND: The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. METHODS/DESIGN: This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. DISCUSSION: VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. TRIAL REGISTRATION: Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.


Assuntos
Amputação , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Veteranos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Método Duplo-Cego , Feminino , Pé/microbiologia , Pé/patologia , Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Osteomielite/cirurgia , Placebos , Estudos Prospectivos , Prevenção Secundária/métodos , Veteranos/estatística & dados numéricos , Adulto Jovem
5.
Radiol Med ; 125(2): 177-187, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31650327

RESUMO

Bone and soft tissue infection involving the foot is a serious complication of diabetes mellitus and represents a major public health and socioeconomic burden to National Health Services worldwide. Research in the past decade has improved diagnosis and treatment of these frequent and potentially devastating complications of diabetic foot which often remain difficult to be diagnosed and treated despite the availability of various clinical, serological, and imaging modalities. Furthermore, neuropathic osteoarthropathy can share many clinical and imaging features of osteomyelitis, and infection is often superimposed in patients with neuropathic disease. Thus, distinguishing between the two abnormalities is further complicated. Although the reference standard for diagnosis remains microbiologic analysis of bone specimens, in most clinical practice, soft tissue and bone infection involving the diabetic foot is diagnosed solely on the basis of a combination of clinical evaluation, serum inflammatory markers, and imaging modalities. Correlation between imaging findings and clinical features is very important as well as a common knowledge base for treatment team members rather than a compartmentalized view. Thus, the primary purpose of this review article was to provide radiologist and clinician with important clinical knowledge and relevant radiological semiotics, respectively, in order to facilitate a prompt diagnosis and personalised treatment of diabetic foot infections.


Assuntos
Pé Diabético/complicações , Osteomielite/diagnóstico por imagem , Osteomielite/etiologia , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/etiologia , Diagnóstico Diferencial , Humanos
6.
PLoS One ; 14(12): e0226226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31846473

RESUMO

BACKGROUND: Diabetes is a life-long and debilitating disease that is fraught with both acute and chronic complications. Of particular concern to sufferers of the disease is the development of foot problems. These problems range from foot deformities to slowly healing or non-healing ulcers (that may necessitate amputation) and in the worst-case scenario, to death. Identification and prompt treatment of comorbid conditions, such as anemia may improve outcome in patients with diabetic foot ulcers (DFU). We determined the prevalence of anemia in Nigerians with DFU and its impact on disease outcome. METHODS: We prospectively followed 336 patients with diabetes hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. We evaluated each patient for neuropathy, vasculopathy and medical co-morbidities. Relevant laboratory and imaging studies were performed. We present the results of the sub-group analysis of patients with anemia to determine its prevalence and impact on disease outcome in patients with DFU in the MEDFUN study. RESULTS: Anemia was detected in 180(53.6%) subjects with 88(48.9%) of them requiring blood transfusion. Significant demographic and clinical determinants of anemia were ulcer duration more than one month prior to hospitalization (p<0.009), PAD (p<0.001) and presence of gangrene (p<0.001). The comorbid conditions that were significantly associated with anemia included proteinuria (p<0.003), osteomyelitis (p<0.006), moderate (p<0.002) as well as severe (p<0.001) vascular stenosis, history of stroke (p<0.014) and renal impairment (p<0.002). Anemia was significantly associated with poor wound healing (p<0.009), amputation (p<0.036) and risk of death (p<0.034). CONCLUSION: We detected anemia in more than half of our cohort with DFU. We found significant association between anemia and poor wound healing, amputation and mortality among our studied subjects. Future studies should explore whether prompt correction of anemia in subjects hospitalized for DFU would improve outcome.


Assuntos
Anemia/complicações , Pé Diabético/complicações , Adulto , Idoso , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Prognóstico
7.
J Am Podiatr Med Assoc ; 109(6): 471-476, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31755775

RESUMO

Verrucous skin lesions on the feet of diabetic patients in conjunction with a neuropathic foot ulcer is an uncommon incident. Currently, there are approximately 20 reported cases in the literature. Herein we report two cases of verrucous lesions superimposing a chronic diabetic ulcer. Patients failed several conservative treatments, and several biopsies were performed with inconclusive results, suggesting possible underlying verrucous carcinoma. Given the possibility of underlying malignancy, both patients were treated with wide excision, and both were negative for malignancy, thus confirming verrucous skin lesions on the feet in diabetic neuropathy. We also summarize the current literature on verrucous skin lesions on the feet in diabetic neuropathy.


Assuntos
Pé Diabético/complicações , Doenças do Pé/complicações , Verrugas/complicações , Idoso , Carcinoma Verrucoso/diagnóstico , Neuropatias Diabéticas/complicações , Diagnóstico Diferencial , Doenças do Pé/diagnóstico , Doenças do Pé/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Verrugas/diagnóstico , Verrugas/patologia
8.
J Am Podiatr Med Assoc ; 109(4): 305-307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31762305

RESUMO

Streptococcus anginosus (SAG) is a known human pathogen and member of the Streptococcus milleri group. SAG is a known bacterial cause of soft-tissue abscesses and bacteremia and is an increasingly prevalent pathogen in infections in patients with cystic fibrosis. We describe a rare case of SAG as an infectious agent in a case of nonclostridial myonecrosis with soft-tissue emphysema. This is the only case found in the literature of SAG cultured as a pure isolate in this type of infection and was associated with a prolonged course of treatment in an otherwise healthy patient.


Assuntos
Pé Diabético/complicações , Gangrena Gasosa/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus anginosus/isolamento & purificação , Amputação , Pé Diabético/microbiologia , Gangrena Gasosa/etiologia , Gangrena Gasosa/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Streptococcus anginosus/patogenicidade
9.
Rev Prat ; 69(6): 620-625, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626417

RESUMO

Lower limb arteriopathy is a frequent and potentially serious complication of diabetes. In fact, it largely explains the high incidence of lower limb amputations in diabetic patients as well as a significant impairment of quality of life in the case of intermittent claudication or decubitus pain. The severity of the disease is also based on the associated cardiovascular morbidity and mortality. The diagnosis is primarily made by the clinical examination, completed by functional hemodynamic tests (ankle/brachial index, transcutaneous oxygen pressure and toe pressure) and possibly imaging tests (arterial Doppler and arteriography of the lower limbs). The treatment of lower limbs arterial disease will depend on the vascular symptomatology, the severity of the vascular lesions evaluated by the hemodynamic tests and by the anatomical characteristics of the vascular lesions.


Assuntos
Diabetes Mellitus , Pé Diabético/complicações , Pé/irrigação sanguínea , Claudicação Intermitente/complicações , Doenças Vasculares Periféricas/complicações , Amputação , Pé Diabético/cirurgia , Humanos , Extremidade Inferior , Qualidade de Vida
10.
Medicine (Baltimore) ; 98(38): e17217, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567978

RESUMO

Diabetic foot is a macrovascular complication of diabetes mellitus (DM). In the literature, the relationship between diabetic foot and another macrovascular complication of DM is not clear. The aim of this study was to determine the current left ventricular (LV) systolic function in patients with diabetic foot and to investigate the effect of diabetic foot treatment on LV systolic functions.In this study, 54 patients with diabetic foot and 22 patients without diabetic foot were included. Routine anamnesis, physical examination, echocardiography, and laboratory examinations were performed. In addition, LV global longitudinal strain (LV-GLS) was measured by strain echocardiography technique. LV ejection fraction (LV-EF) and LV-GLS measurements were repeated with echocardiography at the 3rd month of diabetic foot treatment.The incidence of cardiovascular risk factors such as smoking, hypertension, and coronary artery disease was found to be higher in patients with diabetic foot. (P < .05 for each one). Similarly, in patients with diabetic foot, glucose, Hemoglobin A1c, neutrophil, sedimentation, urea, creatinine, potassium, uric acid, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, and brain natriuretic protein were higher; high-density lipoprotein cholesterol level was found to be significantly lower. LV wall thicknesses and diameters were higher and LV-EF was lower in patients with diabetic foot (P < .05 each one). LV-GLS values were significantly lower in patients with diabetic foot (P < .05). Although no significant change was found in the LV-EF value at the 3rd-month follow-up echocardiography (48.6% ±â€Š7.0% vs 48.5% ±â€Š5.9% and P = .747), it was detected that LV-GLS values (17.3 ±â€Š2.1 vs 18.4 ±â€Š2.3) were significantly increased (P < .001).LV systolic function was significantly affected in patients with diabetic foot. This may be related to the increased frequency of cardiovascular risk factors in these patients. However, the significant improvement in LV-GLS values after the diabetic foot treatment showed that diabetic foot itself was an important cause of LV systolic dysfunction.


Assuntos
Pé Diabético/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Estudos de Casos e Controles , Estudos Transversais , Pé Diabético/complicações , Pé Diabético/terapia , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia
11.
Infez Med ; 27(3): 225-238, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545766

RESUMO

Diabetic foot infection (DFI), a multi-facetted disease requiring a multidisciplinary approach for successful treatment, mostly affects the forefoot. Calcaneal osteomyelitis (CO) is an uncommon presentation of DFI with a somewhat different epidemiology, clinical features, and approach to management. These patients, compared to those with non-calcaneal DFI, more often require special surgical techniques and off-loading approaches. In this narrative review targeted to non-surgical clinicians, we explore how CO differs from other types of DFI affecting other anatomical locations. Based on our review of the literature and personal experience, we also highlight important issues regarding the management of CO osteomyelitis, including the need for specialized surgical approaches.


Assuntos
Calcâneo , Pé Diabético/complicações , Osteomielite/etiologia , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/terapia , Diagnóstico por Imagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Osteomielite/diagnóstico , Osteomielite/epidemiologia , Osteomielite/terapia , Análise de Regressão , Resultado do Tratamento
12.
J Diabetes Res ; 2019: 7395769, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380446

RESUMO

The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI ≥ 35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI < 35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI < 35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.


Assuntos
Diabetes Mellitus/fisiopatologia , Neuropatias Diabéticas/epidemiologia , Deformidades Adquiridas do Pé/fisiopatologia , Pé/fisiologia , Pressão , Caminhada/fisiologia , Idoso , Calo Ósseo/fisiopatologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Pé Diabético/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Feminino , Deformidades Adquiridas do Pé/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/métodos , Estudos Retrospectivos
13.
Med Arch ; 73(2): 131-133, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31391704

RESUMO

Introduction: Diabetic foot ulcer (DFU) is a common lower-extremity complication in patients with diabetes mellitus. A novel DFU treatment is tested by using an ointment containing as healing agent olive oil isopod Ceratothoa oestroidesextract. Case report: A 58 years old obese man,smoker, with a history of unregulated Type 2 Diabetes Mellitus, peripheral neuropathy and Hodgkin lymphoma was referred to Athens-Greece university hospital Laikon. The patient presented clinically with a lower extremity DFU and peripheral neuropathy with dysesthesia and disturbed sensation of hot and cold. He was treated with an ointment containing C. oestroides extract for five months, without any antimicrobial treatment. Therapy was evaluated by measurement of the transepidermal water loss, skin hydration, photo documentation and planimetry. At each patient's visit, DFU presented a satisfactory healing process. Five months after treatment initiation the patient had complete healing of his DFU. Blood tests after treatment revealed a significant reduction of the levels of the inflammatory markers. Ulcer cultures did not reveal any microbial development neither before nor after treatment. Conclusion: The administration of the C. oestroides extract ointment proved to be effective in this case. Although these results should be further investigated, the reported case suggests a novel option for the management of neuropathic diabetic foot ulcers, especially in patients with severe co-morbidities.


Assuntos
Pé Diabético/terapia , Isópodes , Pomadas/uso terapêutico , Extratos de Tecidos/uso terapêutico , Animais , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Pé Diabético/imunologia , Neuropatias Diabéticas/complicações , Doença de Hodgkin/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Fumar , Resultado do Tratamento , Cicatrização
14.
Rev Esp Quimioter ; 32 Suppl 3: 29-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364339

RESUMO

Ceftobiprole is a fifth-generation cephalosporin approved for the treatment of adult community-acquired pneumonia and non-ventilator associated hospital-acquired pneumonia. However, its microbiological and pharmacokinetic profile is very attractive as armamentarium for empirical monotherapy treatment in other infections too. Among these, the following scenarios could be considered complicated skin and soft tissue infections, moderate-severe diabetic foot infections without bone involvement, vascular-catheter-associated-bloodstream infections, and fever without apparent focus in the hospitalized patient without septic shock or profound immunosuppression.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecção Hospitalar/microbiologia , Pé Diabético/complicações , Pé Diabético/tratamento farmacológico , Febre de Causa Desconhecida/tratamento farmacológico , Humanos , Pacientes Internados , Pneumonia Bacteriana/microbiologia , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico
15.
Metabolism ; 100: 153956, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31394109

RESUMO

To systematically review clinical practice guidelines (CPGs) on diabetes foot and assess the consistency of recommendations, quality of CPGs and to present an evidence-map for explicating research trends and gaps. We performed a literature search on PubMed, Embase, and Web of Science, guideline databases and websites of diabetes society to include the diabetic CPGs. The basic information, recommendations for the diabetic foot, methodological quality and reporting quality of diabetic CPGs were exacted by the Excel. Four researchers evaluated the methodological and reporting quality of diabetic foot CPGs by AGREE II instrument and RIGHT checklist. R3.5.1 software was used to create all bubble plots. A total of 22 diabetic CPGs were included, eight CPGs were from different professional diabetes societies. Recommendations on diabetic foot complications involve Diabetic foot ulcer (DFU), Charcot neuropathy (CN) and Osteomyelitis (OM). Eight DFU diagnostic systems presented in 22 CPGs. According to the recommendations of diabetic CPGs, the treatment of DFU can be summarized in four major items; six recommendations on CN diagnosis and six recommendations on treatment of CN were consistent among studies. However, there were inconsistencies in three OM diagnosis recommendations and four OM treatment recommendations. Some recommendations in CPGs were not very specific and clear, and hence they were not reliable for OM diagnosis and treatment. Once these inconsistencies are resolved, validated, accurate and effective diagnosis and treatment of diabetes foot will lead to reduced costs and adverse complications. The results of this review add to our knowledge and promote the development of trustworthy CPGs on diabetes.


Assuntos
Pé Diabético/diagnóstico , Pé Diabético/terapia , Guias de Prática Clínica como Assunto , Pé Diabético/complicações , Humanos
16.
Am J Case Rep ; 20: 1245-1247, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31439827

RESUMO

BACKGROUND Pancytopenia is a hematological condition which is characterized by decreases in all three cellular elements: RBC, WBC, and platelets. As a result, patients with pancytopenia are more prone to anemia, infections, and excessive bleeding. Pancytopenia can be caused by medications or drug interactions that suppress the bone marrow. This case report highlights a drug interaction between allopurinol and mercaptopurine which led to pancytopenia and septic infection, resulting in the patient's death. This could easily have been avoided if a clinical pharmacist had been consulted. CASE REPORT A 55-year-old female patient with a past medical history of gout, depression, back pain, and type 2 diabetes was recently diagnosed with ulcerative colitis and was discharged with a new prescription of mercaptopurine. After 2 months of concurrent use of allopurinol and mercaptopurine, she developed infected foot ulcers, which progressed rabidly to sepsis. At the time, her laboratory findings confirmed pancytopenia. Despite treatment, the patient died. CONCLUSIONS This case illustrates the importance of consulting a clinical pharmacist in order to avoid such medical error. The dose of mercaptopurine should be reduced to 25% of the recommended dose when it is given concurrently with allopurinol to reduce the risk of pancytopenia. Health care providers should think about the significant role of clinical pharmacy services. In our case, there were no clinical pharmacist involved in the care of this patient, and as a result of such negligence, the patient lost her life.


Assuntos
Alopurinol/efeitos adversos , Mercaptopurina/efeitos adversos , Pancitopenia/induzido quimicamente , Sepse/etiologia , Colite Ulcerativa/tratamento farmacológico , Pé Diabético/complicações , Interações Medicamentosas , Evolução Fatal , Feminino , Gota/tratamento farmacológico , Supressores da Gota/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Pessoa de Meia-Idade , Farmacêuticos , Serviço de Farmácia Hospitalar , Encaminhamento e Consulta
17.
J Surg Res ; 243: 509-514, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377491

RESUMO

BACKGROUND: The goal of our study was to evaluate risk factors for wound complications in patients with diabetes mellitus undergoing transmetatarsal amputations (TMAs), given the paucity of research on this subject. MATERIALS AND METHODS: We used the American College of Surgeons National Surgical Quality Improvement Program database. In this retrospective analysis, all surgical cases with a primary Current Procedural Terminology code for TMA from 2009 to 2015 were reviewed. RESULTS: A total of 2316 patients with diabetes mellitus who underwent TMA were identified. Overall wound complications occurred in 276 (11.9%) of patients. Univariate analysis showed that the operative time was significantly longer in patients who developed complications than those who did not (58.3 ± 39.5 versus 50.6 ± 39.4; P = 0.003). Furthermore, the rate of obesity was significantly higher among patients who developed wound complications than those who did not (47.1% versus 41.5%; P = 0.04). Multivariate analysis demonstrated that a longer operative time (odds ratio = 1.02; 95% confidence interval: 1.01-1.04; P = 0.01) and obesity (odds ratio = 1.60; 95% confidence interval: 1.06-2.40; P = 0.03) were independent risk factors for wound complications in our cohort. CONCLUSIONS: These findings emphasize the importance of having heightened clinical vigilance in obese patients with diabetes mellitus undergoing this procedure, close postoperative follow-up, and limiting operative time when possible.


Assuntos
Amputação/efeitos adversos , Pé Diabético/cirurgia , Ossos do Metatarso/cirurgia , Deiscência da Ferida Operatória/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Pé Diabético/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia
18.
J Foot Ankle Surg ; 58(4): 713-716, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256899

RESUMO

To compare the incidence of osteomyelitis based on different operational definitions using the gold standard of bone biopsy, we prospectively enrolled 35 consecutive patients who met the criteria of ≥21 years of age and a moderate or severe infection based on the Infectious Diseases Society of America classification. Bone samples were obtained from all patients by percutaneous bone biopsy or intraoperative culture if the patient required surgery. Bone samples were analyzed for conventional culture, histology, and 16S ribosomal RNA genetic sequencing. We evaluated 5 definitions for osteomyelitis: 1) traditional culture, 2) histology, 3) genetic sequencing, 4) traditional culture and histology, and 5) genetic sequencing and histology. There was variability in the incidence of osteomyelitis based on the diagnostic criteria. Traditional cultures identified more cases of osteomyelitis than histology (68.6% versus 45.7%, p = .06, odds ratio [OR] 2.59, 95% confidence interval [CI] 0.98 to 6.87), but the difference was not significant. In every case that histology reported osteomyelitis, bone culture was positive using traditional culture or genetic sequencing. The 16S ribosomal RNA testing identified significantly more cases of osteomyelitis compared with histology (82.9% versus 45.7%, p = .002, OR 5.74, 95% CI 1.91 to 17.28) and compared with traditional cultures but not significantly (82.9% versus 68.6%, p = .17, OR 2.22, 95% CI 0.71 to 6.87). When both histology and traditional culture (68.6%) or histology and genetic sequencing cultures (82.9%) were used to define osteomyelitis, the incidence of osteomyelitis did not change. There is variability in the incidence of osteomyelitis based on how the gold standard of bone biopsy is defined in diabetic foot infections.


Assuntos
Pé Diabético/complicações , Erros de Diagnóstico , Ossos do Pé/microbiologia , Ossos do Pé/patologia , Osteomielite/diagnóstico , Adulto , Biópsia , Técnicas de Cultura , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Diabetes Mellitus Tipo 2/complicações , Feminino , Histologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/microbiologia , Análise de Sequência de DNA
19.
Foot Ankle Int ; 40(1_suppl): 15S-16S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322950

RESUMO

RECOMMENDATION: Several studies support the effect of peripheral vascular disease (PVD) on wound healing and surgical site infection (SSI). Despite this, there have been no specific studies proving the beneficial effect of revascularization on SSI prior to operative intervention in the setting of traumatic or elective foot and ankle surgery. The majority of studies on revascularization are in the setting of diabetic foot infection or established ischemia. We recommend that in the presence of an inadequate vascularization in the foot and ankle, vascular optimization should be undertaken prior to elective surgery. LEVEL OF EVIDENCE: Limited. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Tornozelo/irrigação sanguínea , Pé/irrigação sanguínea , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Vasculares , Tornozelo/cirurgia , Consenso , Pé Diabético/complicações , Pé/cirurgia , Humanos , Cuidados Pré-Operatórios , Fatores de Risco , Cicatrização
20.
J Korean Med Sci ; 34(26): e178, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31269542

RESUMO

BACKGROUND: Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea. Thus, the purpose of this study was to investigate trends of amputation involving diabetic foot based on vascular interventions for PAD in Korea. METHODS: This study was conducted using six-year data obtained from Health Insurance Review and Assessment Service from January 1, 2011 to December 31, 2016. Our study included data pertaining to diabetic foot, PAD, and vascular intervention codes (percutaneous transluminal angioplasty [PTA, M6597], percutaneous intravascular installation of stent-graft [PIISG, M6605], and percutaneous intravascular atherectomy [PIA, M6620]). We analyzed the number of vascular interventions and minor and major amputations each year. The relationship between annual amputation and vascular intervention was analyzed using χ² test. RESULTS: The overall number of vascular interventions increased from 253 (PTA, 111; PIISG, 140; and PIA, 2) in 2011 to 1,230 (PTA, 745; PIISG, 470; and PIA, 15) in 2016. During the same period, the number of minor amputations increased from 2,534 to 3,319 while major amputations decreased from 980 to 956. The proportion of minor amputations among patients who underwent vascular intervention was significantly increased from 19.34% in 2011 to 21.45% in 2016 while the proportion of major amputations among these patients was significantly reduced from 9.88% to 4.27%. In addition, the association between vascular intervention and amputation increased from 0.56 (spearman correlation coefficient) in 2011 to 0.62 in 2016. CONCLUSION: In diabetic foot patients, increase in vascular intervention resulted in a change in amputation pattern, showing statistically significant correlation.


Assuntos
Amputação/tendências , Pé Diabético/patologia , Extremidade Inferior/cirurgia , Doença Arterial Periférica/diagnóstico , Angioplastia , Aterectomia , Bases de Dados Factuais , Pé Diabético/complicações , Pé Diabético/cirurgia , Humanos , Doença Arterial Periférica/complicações , Doença Arterial Periférica/terapia , República da Coreia
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