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2.
Enferm Clin ; 31 Suppl 2: S424-S427, 2021 04.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33849215

RESUMO

This research aims to analyze the relationship between diabetic foot ulcers profile and ankle brachial index (ABI) score. This quantitative research employed descriptive design with cross sectional method. 76 patients with diabetic foot ulcers were recruited purposively at three hospitals in Malang, Indonesia. The data collection includes patient characteristics; measurement of ABI score with foot Doppler device; measurements of granulation, necrosis, fibrin, and wound with the MowA. Data were analyzed using Pearson and Spearman correlation tests. Correlation test results show that ABI scores were significantly associated with granulation (p=0.015; r=0.278), necrosis (p=0.000; r=-0.516), fibrin (p=0.036; r=0.240) and the extent of diabetic foot ulcers (p=0.025; r=0.258). Necrosis has a strong relationship with ABI scores among all profiles of diabetic foot ulcers. Negative direction means that increasing ABI scores will reduce necrosis tissue in diabetic foot ulcers.


Assuntos
Diabetes Mellitus , Pé Diabético , Índice Tornozelo-Braço , Estudos Transversais , Pé Diabético/complicações , , Humanos , Indonésia
3.
Vasc Endovascular Surg ; 55(4): 382-388, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33576308

RESUMO

BACKGROUND: Medial arterial calcification (MAC) of the tibial and pedal arteries has been associated with an increased risk of amputation among people with diabetes. Endovascular interventions on infrageniculate vessels are frequently performed with the intent of treating peripheral artery disease (PAD) and decreasing the risk of amputation in those with diabetes. This study aimed to investigate how the extent of MAC impacts outcomes of endovascular procedures in people with diabetic foot ulcers (DFU). METHODS: We identified all patients who had undergone infrageniculate angioplasty in the setting of DFU at our institution between 2009 and 2019. Subjects were assigned a MAC score based on the severity of MAC in each vessel visualized on plain radiographs of the ankle and foot. We evaluated the relationship between MAC and the primary outcome, major adverse limb event (MALE), using stratified Cox proportional modeling. RESULTS: Among 99 subjects with DFU who had undergone infrageniculate angioplasty, MALE occurred in 50% (95% confidence interval [CI] 38%-61%) of patients within 1 year of intervention. On univariate Cox regression analysis, each 1 point increment in MAC score (hazard ratio [HR], 1.09; 95% CI 1.01-1.18), the third tertile of MAC score (HR, 2.27; 95% CI 1.01-5.11), age (HR 0.96; 95% CI 0.93-0.99), and wound grade (HR, 5.34; 95% CI 2.17-13.14), were significantly associated with increased risk of MALE. On adjusted analysis stratified by wound grade, MAC score was found to be associated with MALE only in patients with a low wound grade. CONCLUSION: Increased severity of MAC is associated with increased risk of MALE for subjects undergoing infrageniculate angioplasty with a low wound grade. Further research is needed to better understand the complex relationships of MAC, PAD, DFU, and interventions aimed at promoting healing of DFU.


Assuntos
Angioplastia , Pé Diabético/terapia , Doença Arterial Periférica/complicações , Calcificação Vascular/complicações , Idoso , Amputação , Angioplastia/efeitos adversos , Angioplastia/mortalidade , Pé Diabético/complicações , Pé Diabético/diagnóstico por imagem , Pé Diabético/mortalidade , Feminino , Humanos , Salvamento de Membro , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Intervalo Livre de Progressão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/mortalidade , Cicatrização
4.
Saudi Med J ; 42(2): 166-169, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33563735

RESUMO

OBJECTIVES: To avoid hospital spread of Coronavirus-2019 (COVID-19) and to analyze out of hospital outcomes after amputation. METHODS: Prospective analysis of data obtained from 60 diabetic patients in 2020 was performed at Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina. Personal protection equipment included double surgical mask, glasses, disposable surgical coats, and surgical masks for patients. Swabs were used to take samples from wounds. We randomly divided patients in 2 groups of 30 patients each. In pre-operative treatment, we used local anesthesia lidocaine hydrochloride 2% (Belupo, Koprivnica, Croatia) in group A and systemic analgesia intravenous tramadol chloride 100 mg intravenous (Krka, Novo Mesto, Slovenia) in group B. Wounds were surgically treated each day and heal spontaneously. Periodical control exams were performed. RESULTS: Wound healing did not present any statistically significant differences between groups (group A: 69±21.97 and B: 61±22.13 days, t=-1.22; p=0.11). No statistically significant differences (p<0.05) between groups A and B in wound healing regarding to gender or cigarette use was noted. CONCLUSION: No significant differences in amputation treatment between the 2 comparative groups were noted. No confirmed COVID-19 infections in medical staff who performed surgical interventions or in treated patients were detected.


Assuntos
Amputação , Pé Diabético/cirurgia , Controle de Infecções/métodos , Assistência Perioperatória/métodos , Bósnia e Herzegóvina/epidemiologia , /epidemiologia , Pé Diabético/complicações , Feminino , Humanos , Controle de Infecções/instrumentação , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Masculino , Pandemias , Equipamento de Proteção Individual , Estudos Prospectivos , Resultado do Tratamento , Cicatrização
5.
Infect Dis (Lond) ; 53(4): 255-273, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33423592

RESUMO

BACKGROUND: Diabetic foot is one of the common complications of diabetes mellitus. We report clinical and microbiological characteristics and outcomes of cases with distant metastatic foci of infection arising from diabetic foot. METHODS: Retrospective review of adult patients with diabetic foot infection or diabetic foot ulcer who demonstrated distant metastatic foci of infection between August 2017 and December 2019. We performed a literature search of similar cases published until June 2020. RESULTS: Twelve patients with diabetic foot infection or diabetic foot ulcer with distant metastatic foci of infection were identified. The median age of patients was 67.5 years (range 60.5-73.5 years) and 11 males. The most common distant metastatic foci of infection included endocarditis (n = 7) followed by septic arthritis (n = 3) and spine infections (n = 2). Five patients had multiple site and organ involvement. Staphylococcus aureus was the only organism isolated from blood (n = 11), diabetic foot (n = 7), and metastatic foci (n = 8) sources. Three patients died and three had a relapse of distant metastatic foci of infection. Thirty-eight cases were identified in the literature with similar characteristics. CONCLUSIONS: Prevalence of distant metastatic foci of infection in adult patients with diabetic foot and burden of illness, in terms of mortality, morbidity, and length of hospital stay, appears to be underreported in the literature. A large prospective study is needed to assess the true prevalence of complications, associated risk factors, outcomes and prognostic factors.


Assuntos
Diabetes Mellitus , Pé Diabético , Infecções Estafilocócicas , Adulto , Idoso , Pé Diabético/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus
6.
Methods Mol Biol ; 2193: 23-30, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32808255

RESUMO

Chronic nonhealing wounds impact nearly 15% of Medicare beneficiaries (8.2 million) in the United States costing $28-$32 billion annually. Despite advancement in wound management, approximately 8% of diabetic Medicare beneficiaries have a foot ulcer and 1.8% will have an amputation. The development of a regenerative approach is warranted to save these before-mentioned amputations. To this extent, herein, we describe the detailed methods in generating a type 1 diabetes mellitus (T1DM) condition in immunocompromised mice, inducing cutaneous wound, and application of dental pulp stem cell-derived secretory products for therapeutic assessment. This model helps in evaluating the efficacy of stem cell-based therapy and helps with the investigation of involved mechanisms in impaired cutaneous wound healing caused by hyperglycemic stress due to type 1 diabetes.


Assuntos
Polpa Dentária/transplante , Pé Diabético/terapia , Transplante de Células-Tronco/métodos , Cicatrização/genética , Animais , Polpa Dentária/citologia , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/patologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Pé Diabético/complicações , Pé Diabético/patologia , Humanos , Camundongos , Pele/lesões , Pele/patologia , Células-Tronco/citologia
7.
Angiol Sosud Khir ; 26(4): 33-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332304

RESUMO

The article deals with the use of a genetically engineered drug for stimulation of angiogenesis as a component of combined treatment of complications of ischaemic form of diabetic foot syndrome, showing comparative results of using therapeutic angiogenesis in patients in whom it was impossible to perform operative revascularization of the affected extremity, also providing a detailed description of the methodology of combined treatment of pyonecrotic complications of diabetic foot syndrome. The study included a total of 62 patients with pyonecrotic complications of Wagner grade III-IV diabetic foot syndrome. The patients were divided into two groups. Group One patients after minor amputation on the foot were assigned to receive conventional basic therapy and topical treatment of the foot wound with antiseptics and modern dressings. Group Two patients, besides basic therapy, additionally received combined treatment which was carried out in two stages and included urokinase, sulodexide, and a venotonic agent. Local treatment of the foot wound was performed with the help of two-stage vacuum therapy. Both groups were further subdivided into subgroups A and B. The patients in subgroups B of both groups in order to prevent progression of limb ischaemia were additionally given Neovasculgen, a genetically engineered drug for stimulation of angiogenesis. The patients of subgroups A of both groups did not receive this drug. The immediate results were assessed on the 1st, 7th and 14th days of treatment by the dynamics of changes in subjective symptoms, cytograms of the wound surface, level of partial pressure of oxygen in capillary blood of foot tissues, and the necessity to perform repeated necrectomy. The remote results were evaluated by the dynamics of changes in the pain-free walking distance, maximum distance walked, ankle-brachial index, linear velocity of blood flow through tibial arteries and partial pressure of oxygen in capillary blood of the affected limb at the 6th, 12th and 36th months after the performed treatment, as well as by the limb salvage and patients' survival during 3 years.


Assuntos
Diabetes Mellitus , Pé Diabético , Amputação , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/cirurgia , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/cirurgia , Salvamento de Membro , Período Pós-Operatório , Cicatrização
8.
Rev Med Suisse ; 16(719): 2446-2452, 2020 Dec 16.
Artigo em Francês | MEDLINE | ID: mdl-33325663

RESUMO

Despite a benign appearance, any foot injury occurring in a patient with diabetes requires multidisciplinary management if dreaded complications such as amputation are to be avoided. From a pathophysiological point of view, foot ulcer generally results from the combination of lower extremity neuropathy, mechanical overload, immunopathy and vascular insufficiency. The treatment associates in all cases an offloading and one or more debridements. Depending on the grade of the ulcer, adjuvant treatments, such as antibiotic therapy, revascularization, and hyperbaric oxygen therapy may be indicated.


Assuntos
Complicações do Diabetes , Pé Diabético/complicações , Pé Diabético/terapia , Amputação , Humanos , Oxigenação Hiperbárica , Procedimentos Cirúrgicos Vasculares
9.
J Diabetes Complications ; 34(9): 107622, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33051005

RESUMO

Diabetic foot ulcers are among the most serious complications of diabetes. If left untreated, these ulcers can lead to severe infection and gangrene; in some instances, they may result in death. Thus, timely treatment of diabetic foot ulcers is extremely important. However, timely patient treatment during the COVID-19 pandemic is particularly challenging, because of the higher volume of patients and the need to ensure safety of medical personnel. This article describes a proposed strategy for diagnosis and treatment of diabetic foot ulcers, based on experiences with infection and control strategies during the COVID-19 pandemic in China.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pé Diabético/diagnóstico , Pé Diabético/terapia , Pneumonia Viral/epidemiologia , China , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pé Diabético/complicações , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
10.
J Am Acad Orthop Surg ; 28(16): 684-691, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32769724

RESUMO

BACKGROUND: Diabetic foot ulcers with associated infection and osteomyelitis often lead to partial or complete limb loss. Determination of the appropriate level for amputation based on the patient's baseline physical function, extent of infection, vascular patency, and comorbidities can be challenging. Although Chopart amputation preserves greater limb length than more proximal alternatives such as Syme or below-the-knee amputations (BKA), challenges with wound healing and prosthesis fitting have been reported. We aimed to investigate the functional and clinical outcomes of Chopart amputation combined with tendon transfers. METHODS: We identified patients who underwent Chopart amputations for diabetic foot infections by an academic orthopaedic group between August 2013 and September 2018. Subjects completed three Patient-Reported Outcomes Measurement Information Systems (PROMIS) instruments. Incidence of postoperative complications and change in patient-reported outcomes before and after surgery were recorded. RESULTS: Eighteen patients with an average age of 60.8 (range, 44 to 79) years were identified. The mean follow-up was 22.8 months (range, 6.7 to 51.0). Seventeen of the 18 total patients developed postoperative wound complications. These lead to revision amputations in 10 Chopart amputees, consisting of two Syme and eight BKAs. Half of the Chopart patients never received a prosthesis because of delayed wound healing and revision amputation. PROMIS physical function (PF) (31.1 pre-op and 28.6 post-op), pain interference (63.1 pre-op and 59.4 post-op), and depression (53.0 pre-op and 54.8 post-op) did not show significant change (P-values = 0.38, 0.29, 0.72, respectively). Pre- and post-op the PROMIS physical function scores were well below the US average. DISCUSSION: In our patient cohort, 94% of patients developed postoperative wound complication. Only 44% of patients ever successfully ambulated with a prosthesis after Chopart amputation, and the others (56%) required revision amputations such as a BKA. Even after wound healing, Chopart amputees may struggle with obtaining a prosthesis suitable for ambulation. Surgeons should exercise judicious patient selection before performing Chopart amputation. LEVEL OF EVIDENCE: IV, Case Series.


Assuntos
Amputação/métodos , Pé Diabético/cirurgia , Adulto , Idoso , Amputação/efeitos adversos , Pé Diabético/complicações , Feminino , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Avaliação de Resultados da Assistência ao Paciente , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Ajuste de Prótese , Transferência Tendinosa , Resultado do Tratamento , Cicatrização
11.
Rev. cuba. angiol. cir. vasc ; 21(2): e135, mayo.-ago. 2020. tab, fig
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1126383

RESUMO

Introducción: El Heberprot-P® es un medicamento novedoso y único en su tipo, prescrito para la terapia de la úlcera del pie diabético. Objetivo: Evaluar la frecuencia y las características de la recidiva de úlcera del pie en pacientes diabéticos tratados con Heberprot-P®. Métodos: Se realizó una investigación descriptiva-retrospectiva. La población estuvo constituida por 16 pacientes con recidiva de úlcera de pie diabético de los 841 tratados con Heberprot-P® en policlínicos y hospitales de la provincia de Matanzas desde enero hasta diciembre de 2018. Las variables revisadas fueron llevadas a una base de datos, y los resultados obtenidos se tabularon y se expresaron en frecuencias absolutas y relativas. Se respetaron las consideraciones éticas requeridas para este estudio. Resultados: El grupo de edades 61-75 años y los diabéticos de tipo 2 fueron los más afectados, y no existieron diferencias entre ambos sexos. El pie diabético neuropático con una severidad Wagner 2 se manifestó con mayor frecuencia. Asimismo, a partir de la primera lesión y la recidiva se observó un gran número de pacientes con la enfermedad entre las 13 y 16 semanas, y al 56,2 por ciento de estos se les administró, durante la primera lesión, de 6 a 12 dosis de Heberprot-P®. El cierre total de la lesión en el desenlace fue lo más encontrado en la población de estudio, y el 1,9 por ciento de los pacientes tratados presentó una recidiva de esta. Conclusiones: Quedaron expuestas la frecuencia y las características de la recidiva de la úlcera del pie en los pacientes diabéticos tratados con Heberprot-P®(AU)


Introduction: Heberprot-P® is a novel medicine, unique among its kind, prescribed for diabetic foot ulcer therapy. Objective: To evaluate frequency and characteristics of foot ulcer recurrence among diabetic patients treated with Heberprot-P®. Methods: A descriptive-retrospective research was carried out. The study population consisted of 16 patients with diabetic foot ulcer recurrence from among the 841 treated with Heberprot-P® in polyclinics and hospitals in Matanzas Province from January to December 2018. The variables reviewed were taken to a database, and the results obtained were represented in charts and expressed in absolute and relative frequencies. The ethical considerations required for this study were respected. Results: The age group 61-75 years and type 2 diabetic patients were the most affected. There were no differences between both sexes. Neuropathic diabetic foot with Wagner 2 severity appeared more frequently. Likewise, after the first injury and recurrence, a large number of patients with the disease were observed at 13-16 weeks, 56.2 percent of whom, were administered, during the first injury, 6-12 doses of Heberprot-P®. The total closure of the lesion was the most found outcome in the study population, and 1.9 percent of the treated patients presented recurrence of this. Conclusions: The frequency and characteristics of foot ulcer recurrence in diabetic patients treated with Heberprot-P® were exposed(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Recidiva , Preparações Farmacêuticas , Úlcera do Pé/terapia , Pé Diabético/complicações , Diabetes Mellitus Tipo 2
12.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(4): 582-586, 2020 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-32691572

RESUMO

History and clinical findings: A 76 year-old woman with 8-year history of diabetes mellitus and hypertension was admitted with gangrene of left great toe, 3rd, 4th and 5th toes. Twenty months ago, She started to receive hemodialysis due to end-stage renal disease. She did not have any history of reactive airway disease nor bradycardia that would contraindicate the use of topical beta-blocker. The X-ray of left lower limb and foot showed calcification of left superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, dorsal foot artery and digital artery, as well as osteolytic destruction at distal end of metatarsal bone, and lateral dislocation of the 4th and 5th toes. Color Doppler ultrasound of bilateral lower extremity arteries showed obvious calcification of bilateral superficial femoral arteries, thrombosis of left popliteal artery, severe stenosis of left anterior tibial artery, occlusion of left posterior tibial artery, right anterior tibial artery and posterior tibial artery. Computed tomographic angiography (CTA) of bilateral lower limb arteries revealed moderate stenosis of left superficial femoral artery, occlusion of left popliteal artery, left posterior tibial artery and dorsal pedal artery, occulusion of right posterior tibial artery, but right dorsal pedal artery was visible. Diagnosis, treatment and follow-up: Diagnosis of diabetic foot (left, grade 4) and diabetic lower extremity arterial occlusion (left, stage 4) was made. Based on multidisciplinary team (MDT) discussion, the patient was unable to undergo vascular bypass surgery, and left lower extermity amputation also was not suitable because of right atrial thrombosis. Therefore, conservative treatment was recommended. The specific scheme used clopidogrel for antiplatelet agglutination, Low Molecular Weight Heparin (Clexane) and warfarin for anticoagulation, lipo-alprostadil for vasodilation, as well as local debridement and ultrasonic debridement. The treatments were given for up to 9 weeks, but with no significant clinical response. So the patient was treated with vacuum-assisted closure and autologous platelet-rich gel therapy for the next 7 weeks, then applied with 1 drop of timolol maleate 0.5% ophthalmic solution per cm 2 wound area every other day for another 6 weeks, the wound rapidly healed and re-epithelialized basically. The follow-up for 5 weeks showed that the wound healed completely without any discomfort. No side effect was found.


Assuntos
Plaquetas , Diabetes Mellitus , Pé Diabético , Géis , Timolol , Antagonistas Adrenérgicos beta/farmacologia , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Artérias/patologia , Pé Diabético/complicações , Pé Diabético/terapia , Feminino , Géis/farmacologia , Géis/uso terapêutico , Humanos , Isquemia/terapia , Timolol/farmacologia , Timolol/uso terapêutico , Resultado do Tratamento , Cicatrização/efeitos dos fármacos
13.
Diabetes Res Clin Pract ; 165: 108245, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497745

RESUMO

AIM: To define the outcomes of persons with diabetes and foot ulcers (DFUs) managed through a specific triage pathway during the COVID-19 crisis. METHODS: Patients who had an active DFU during the COVID-19 emergency were included. All participants were managed using a specific triage system driven both by ulcer'severity and concomitant co-diseases. Subjects with severely complicated DFUs were urgently referred to hospital regardless of the concomitant comorbidities. Subjects with complicated DFUs received outpatient evaluation (within 48-72 h) and were admitted to hospital if required (revascularization, surgical intervention, intravenous antibiotic therapy); after the first outpatient visit or hospitalization, patients were followed according to the number of comorbidities (in the case of 3 or more comorbidities patients were followed up by telemedicine). Patients with uncomplicated DFUs were managed by telemedicine after outpatient evaluation. Healing, major amputation, death and rate of COVID-19 infection were evaluated. The minimum follow-up was 1 month. RESULTS: The study group included 151 patients. The mean age was 69.9 ± 14.2 years, 58.9% were male and 91.4% had type 2 diabetes; 58.7% had severely complicated, 21% complicated and 20.3% uncomplicated DFUs. Among those, 78.8% presented with 3 or more comorbidities. One hundred and six patients had regular clinical follow-ups, while 45 were managed through telemedicine. Forty-one (27.1%) patients healed, 3 (1.9%) had major amputations and 3 (1.9%) died. One patient (0.6%) reported COVID-19 positivity due to infection acquired at home. CONCLUSION: The triage pathway adopted during the COVID-19 pandemic showed adequate management of DFUs and no cases of hospital virus exposure.


Assuntos
Infecções por Coronavirus/epidemiologia , Pé Diabético/terapia , Pneumonia Viral/epidemiologia , Triagem/métodos , Idoso , Idoso de 80 Anos ou mais , Amputação , Betacoronavirus , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/complicações , Serviços Médicos de Emergência , Feminino , Seguimentos , Hospitalização , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Telemedicina , Resultado do Tratamento , Cicatrização
15.
Medicine (Baltimore) ; 99(22): e20375, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481422

RESUMO

INTRODUCTION: The prevalence of diabetes continues to rise around the world. Diabetic foot is a serious complication of diabetes, and diabetic patients with diabetic foot osteomyelitis (DFO) have a fourfold increased risk of amputation, usually indicating death. Therefore, it is particularly important to seek a more effective treatment for DFO. The treatment of DFO varies from person to person, and antimicrobial therapies vary widely. A large number of clinical studies have shown that rifampicin adjuvant therapy can reduce the rate of amputation and mortality in DFO patients. However, there is no systematic summary of clinical evidence, which limits the clinical application of rifampicin. Therefore, we attempted to provide high-quality evidence for the clinical efficacy and safety of rifampin in the adjuvant treatment of DFO through this meta-analysis. METHODS: English literature is mainly searched in Cochrane Library, PubMed, EMBASE and Web of Science, while Chinese literature is from CNKI, CBM, VIP and Wangfang databases. At the same time, we will search clinical registration tests and gray literature. Two methodologically trained researchers will read the title, abstract, and full text, and independently select qualified literature based on inclusion and exclusion criteria. Binary data is expressed as relative risk, continuous data is expressed as mean difference or standard mean difference. The final data are synthesized using a fixed effect model or a random effect model, depending on the presence of heterogeneity. In the end, the patient's amputation rate and mortality were the main research indicators. Survival rate, HbA1c, serum creatinine, changes in ulcer area, and SF-36 quality of life assessment were used as secondary indicators. We will perform a sensitivity analysis to assess the stability of the results. Then the publication bias was evaluated by funnel plot analysis and Egger test. Finally, we will use a "recommendation grading, evaluation, formulation and evaluation" system to assess the quality of the evidence. All data analysis will be meta-analyzed by the statistical software RevMan software version 5.3. RESULTS: This study will provide a high-quality comprehensive report on the effectiveness and safety of rifampicin in the treatment of DFO, and our findings will be published in peer-reviewed journals. CONCLUSION: This systematic review and meta-analysis will provide a comprehensive summary and careful evaluation of rifampicin as an adjuvant treatment of DFO with a view to providing multiple options for clinical treatment of the disease. REGISTRATION NUMBER:: is INPLASY202040084.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Adjuvantes Farmacêuticos/uso terapêutico , Pé Diabético/complicações , Humanos , Osteomielite/etiologia
16.
Gerokomos (Madr., Ed. impr.) ; 31(2): 113-118, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193893

RESUMO

INTRODUCCIÓN: La presencia del pie diabético es una complicación frecuente en la persona que vive con diabetes. En su etiopatogenia confluyen factores conductuales, ambientales y el control de la enfermedad; no obstante, se reconoce la influencia de factores genéticos en su desarrollo y evolución. OBJETIVO: Sistematizar la asociación de los polimorfismos genéticos como riesgo para el desarrollo de pie diabético a través de la producción científica indexada. METODOLOGÍA: Revisión bibliográfica de los años 2010 a 2018; se realizó mediante la búsqueda sistemática en las bases de datos PubMed, Scopus, CONRICYT y WOS. Los descriptores fueron tres: "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic". Se incluyeron artículos a texto completo en inglés con metodología de casos y controles, y que midieran estadísticamente factores de riesgo mediante la odds ratio y los riesgos relativos. Se utilizó la plataforma FLC 2.0 para evaluar la calidad del estudio. RESULTADOS: 13 artículos cumplieron con los criterios de inclusión; se identificaron 9 polimorfismos como factores para la aparición de pie diabético: HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, gen FokI del receptor VDR, MMPs-1562C>T, TCF7L2, HIF-1α p582s y 4 como factores protectores: VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp y VEGF 2578 C/A. CONCLUSIÓN: La susceptibilidad, gravedad y aparición del pie diabético está asociado con factores genéticos implicados en distintos mecanismos fisiopatológicos


INTRODUCTION: Diabetic foot is a frequent complication in patients with diabetes. The risk factors associated with its development and evolution are related to the behavioral, environmental and disease control characteristics, however, the influence of genetic factors in the development of this complication has been recognized. OBJECTIVE: To analyze the available evidence on the association of genetic polymorphisms in the risk of presenting diabetic foot. METHODOLOGY: Articles were reviewed in English, not older than 10 years, with a methodology of cases and controls that statistically measure risk factors through odds ratio and relative risk. Therefore the search was performed in databases such as PubMed, Scopus, CONRICYT and WOS with maximum date until January 31, 2018. Controlled descriptors "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic" were applied. The FLC 2.0 platform was used to evaluate the quality of the study. RESULTS: Thirteen articles were selected, there being 9 polymorphisms with risk factors such as HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, FokI gene of the VDR receptor, MMPs-1562C>T, TCF7L2, HIF-1α p582s and 4 protective factors such as VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp and VEGF 2578 C/A. CONCLUSION: The susceptibility, severity and appearance of diabetic foot they are associated with genetic factors that are involved in different physiopathological mechanisms


Assuntos
Humanos , Polimorfismo Genético/fisiologia , Pé Diabético/enfermagem , Pé Diabético/complicações , Pé Diabético/etiologia , Pé Diabético/genética , Fatores de Risco , Razão de Chances
17.
Gerokomos (Madr., Ed. impr.) ; 31(2): 125-128, jun. 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-193895

RESUMO

La osteomielitis del pie diabético puede presentar al clínico grandes desafíos diagnósticos y terapéuticos. La infección en pacientes con úlceras de pie diabético ocasiona una gran morbimortalidad. Las tasas de mortalidad, sobre todo cardiovascular, tras una úlcera y la amputación son muy elevadas, casi un 60% de las personas fallecen en el transcurso de 5 años tras una amputación y casi un 40% en el caso de las úlceras. El objetivo del artículo es describir el procedimiento con el que se aborda la osteomielitis en pacientes con úlceras de pie diabético a través de un equipo multiprofesional. METODOLOGÍA: A través de dos casos clínicos, se expone el planteamiento quirúrgico y médico para el abordaje de la osteomielitis. RESULTADOS: La resolución tanto de la osteomielitis como de la cicatrización de la úlcera se apoya tanto en la especialización de los profesionales a nivel clínico como en garantizar la continuidad asistencial en los niveles de atención existentes, evitando la variabilidad y garantizando la prestación de los recursos necesarios de manera eficiente. CONCLUSIONES: El abordaje quirúrgico o médico de la osteomielitis precisa de un equipo cualificado que pueda plantear ambas estrategias de atención, consiguiendo la resolución del caso


Osteomyelitis of the diabetic foot can present the clinician with great diagnostic and therapeutic challenges. Infection in patients with diabetic foot ulcers causes great morbidity and mortality. Mortality rates, especially cardiovascular, after an ulcer and amputation are very high, almost 60% of people die within 5 years after amputation and almost 40% in the case of ulcers. The objective of the article is to describe the procedure with which osteomyelitis is approached in patients with diabetic foot ulcers through a multiprofessional team. METHODOLOGY: Through two clinical cases, the surgical and medical approach for the osteomyelitis approach is exposed. RESULTS: The resolution of both osteomyelitis and ulcer healing relies both on the specialization of professionals at a clinical level, and on ensuring continuity of care at existing levels of care, avoiding variability and guaranteeing the provision of Necessary resources efficiently. CONCLUSIONS: The surgical or medical approach of osteomyelitis requires a qualified team that can propose both strategies of care, obtaining the resolution of the case


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Comunicação Interdisciplinar , Úlcera do Pé/complicações , Pé Diabético/complicações , Pé Diabético/enfermagem , Osteomielite/complicações , Controle de Infecções , Neuropatias Diabéticas/complicações , Cicatrização
18.
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 , Ciprofloxacina/administração & dosagem , Ciprofloxacina/análogos & derivados , Ciprofloxacina/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
19.
PLoS One ; 15(4): e0232395, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353082

RESUMO

BACKGROUND: Diabetic foot ulcer (DFU) is a severe complication of diabetes and particularly susceptible to infection. DFU infection intervention efficacy is declining due to antimicrobial resistance and a systematic review of economic evaluations considering their economic feasibility is timely and required. AIM: To obtain and critically appraise all available full economic evaluations jointly considering costs and outcomes of infected DFUs. METHODS: A literature search was conducted across MedLine, CINAHL, Scopus and Cochrane Database seeking evaluations published from inception to 2019 using specific key concepts. Eligibility criteria were defined to guide study selection. Articles were identified by screening of titles and abstracts, followed by a full-text review before inclusion. We identified 352 papers that report economic analysis of the costs and outcomes of interventions aimed at diabetic foot ulcer infections. Key characteristics of eligible economic evaluations were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: 542 records were screened and 39 full-texts assessed for eligibility. A total of 19 papers were included in the final analysis. All studies except one identified cost-saving or cost-effective interventions. The evaluations included in the final analysis were so heterogeneous that comparison of them was not possible. All studies were of "excellent", "very good" or "good" quality when assessed against the CHEERS checklist. CONCLUSIONS: Consistent identification of cost-effective and cost-saving interventions may help to reduce the DFU healthcare burden. Future research should involve clinical implementation of interventions with parallel economic evaluation rather than model-based evaluations.


Assuntos
Análise Custo-Benefício , Pé Diabético/economia , Infecção dos Ferimentos/economia , Pé Diabético/complicações , Pé Diabético/microbiologia , Pé Diabético/terapia , Humanos , Resultado do Tratamento , Infecção dos Ferimentos/etiologia , Infecção dos Ferimentos/terapia
20.
Plast Reconstr Surg ; 145(5): 1302-1312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332556

RESUMO

BACKGROUND: Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS: A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS: One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS: This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Artérias/cirurgia , Retalhos de Tecido Biológico/transplante , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Salvamento de Membro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Doença Crônica/terapia , Estado Terminal/terapia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Perna (Membro)/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Resultado do Tratamento , Adulto Jovem
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