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1.
J Wound Care ; 30(Sup2): S12-S17, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33573492

RESUMO

COVID-19 is highly contagious and its rapid spread burdens the healthcare system. As the number of confirmed cases goes up, the shortage of medical resources has become a challenge. To avoid the collapse of the healthcare system during the fight with COVID-19, all healthcare workers, including wound care practitioners, should adapt to new roles and use any appropriate methods available to slow the spread of the virus. Integrating telemedicine into wound care during the outbreak helps maintain social distancing, preserve personal protective equipment and medical resources, and eliminate unnecessary exposure for both vulnerable patients and high-risk healthcare workers.


Assuntos
Assistência Ambulatorial , Pé Diabético/terapia , Telemedicina , Triagem , Ferimentos e Lesões/terapia , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Hospitalização , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle
2.
BMC Surg ; 21(1): 87, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588807

RESUMO

BACKGROUND: Diabetic foot ulcer is a complication with multiple aetiological factors which has a significant impact to patients' lives and costs to the healthcare system. The potential of human amniotic membrane to act as an allograft has been studied in relation to this condition. Aim of this study is to evaluate the current scientific evidence on its effectiveness in healing diabetic foot ulcers. METHODS: Pubmed, Cochrane library, and Google scholar were searched using the search terms, "Amnion" OR "Placenta" AND "Diabetic foot". (MeSH terms) in the title or the abstract field from 1st of January 2000 to 30th March 2020. The quality of published reports was assessed using standard methods. We searched for experimental and observational studies in terms of randomized control trials, prospective cohort, retrospective cohort studies and case series. RESULTS: When searched with Mesh terms, 12 citations in PubMed, 22 citations in Cochrane library and 30 in other data bases were found. After screening the studies and their reference lists, 12 studies met the inclusion criteria and the others were excluded. There were 8 randomized control trials (RCTs), 2 prospective studies and 2 retrospective studies employing different preparation methods of the amniotic membranes. A wide variation in study end points were noted. Majority of the RCTs (n = 7) were concluded with significantly higher wound closure rate compared to the conventional treatment groups. In prospective and retrospective studies, it was shown that large chronic ulcers which were resistant to closure with standard therapy achieved wound closure with amniotic membrane allografts. A meta-analysis could not be performed due to study heterogeneity, and publication bias was not assessed due to the small number of available studies which was not sufficient for accurate comparison. CONCLUSION: Even though, the studies had some inherent heterogeneity due to different preparation methods, different study end points and outcome measurements. According to our review the current studies using amniotic membrane allografts give reliable evidence of reduction in healing time over conventional methods.


Assuntos
Aloenxertos/transplante , Âmnio/transplante , Diabetes Mellitus , Pé Diabético/terapia , Cicatrização/fisiologia , Curativos Biológicos , Humanos , Coleta de Tecidos e Órgãos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(5): e23984, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592853

RESUMO

BACKGROUND: Diabetic foot ulcer (DFU) is one of the serious complications of diabetes. It is the result of a joint effect of lower extremities vascular lesions, neuropathy, and infection, which require amputation and even threaten the life of the patient. At present, the conventional treatment for DFU includes infection control, wound care, wound reduction, reduction of foot pressure, use of dressings that are beneficial to wound surface healing, etc, but the effectiveness is not satisfactory. Recombinant human growth hormone and alginate dressing have been used in clinical, but there is lack of the relevant evidence of its effectiveness and safety, so this study evaluates the clinical effectiveness and safety of recombinant human growth hormone combined with alginate dressing in the treatment of DFU by systematic evaluation, the purpose is to provide a theoretical basis for the treatment of diabetic foot ulcer. METHODS: This study mainly retrieves the randomized controlled trial of recombinant human growth hormone combined alginate dressing in the treatment of DFU in 7 electronic databases, such as PubMed, EMbase, Cochrane Library, SinoMed, CNKI, WANGFANG database, and VIP database. All the retrieval dates of database are from the establishment of the database until May 31, 2020. At the same time, searching the related degree papers, conference papers, and other gray literature by manual. The original literature data are independently screened and extracted by 2 researchers on the basis of inclusion and exclusion criteria and literature information sheets, and cross-checked and resolved through group discussions and consultations when there are differences of the opinion. Assessing the methodological quality of inclusion in the study based on the "Bias Risk Assessment Form" of the Cochrane Collaboration Network. Using the software of RevMan 5.3.3 and STATA 13.0 for statistical analysis. RESULTS: This study compares the main and secondary outcome indicators by systematic evaluation and it will provide strong evidence of recombinant human growth hormone combined alginate dressing in the treatment of DFU. ETHICS AND DISSEMINATION: All data in this study are obtained through the web database and do not involve humans, so ethical approval is not suitable for this study. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/W6P24. CONCLUSION: This study will give positive conclusions about the effectiveness and safety of recombinant human growth hormone combined alginate dressing in the treatment of DFU.


Assuntos
Alginatos/uso terapêutico , Bandagens , Pé Diabético/terapia , Hormônio do Crescimento Humano/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Terapia Combinada , Humanos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Cicatrização
4.
Medicina (Kaunas) ; 57(2)2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33499251

RESUMO

Throughout 2020, the COVID-19 pandemic has had a major impact on the care of non-communicable diseases across the world and diabetes is no exception. Whereas many branches of medicine have adapted to telemedicine, this is difficult and challenging for the diabetic foot which often requires "hands on" treatment. This review covers the challenges that have faced clinicians across the world in the management of complex diabetic foot problems and also includes some illustrative case vignettes which show how it is possible to manage foot ulcers without the usual access to laboratory and radiological testing. There is no doubt that the COVID-19 experience when handling diabetic foot problems will likely transform our approach to the management of diabetic foot disease especially in the areas of digital health and smart technology.


Assuntos
Pé Diabético/terapia , Saúde Global/tendências , Padrões de Prática Médica/tendências , Telemedicina/métodos , Humanos
5.
Adv Exp Med Biol ; 1307: 391-415, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32124412

RESUMO

Charcot Neuroarthropathy (CN) is an uncommon, debilitating and often underdiagnosed complication of chronic diabetes mellitus though, it can also occur in other medical conditions resulting from nerve injury. Till date, the etiology of CN remains unknown, but enhanced osteoclastogenesis is believed to play a central role in the pathogenesis of CN, in the presence of neuropathy. CN compromises the overall health and quality of life. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, infection and in the worst case, can lead to limb loss. In an early stage of CN, immobilization with offloading plays a key role to a successful treatment. Medical therapies seem to have limited role in the treatment of CN.In case of severe deformity, proper footwear or bracing may help prevent further deterioration and development of an ulcer. In individuals with a concomitant ulcer with osteomyelitis, soft tissue infection and severe deformity, where conservative measures fall short, surgical intervention becomes the only choice of treatment. Early diagnosis and proper management at an early stage can help prevent the occurrence of CN and amputation.


Assuntos
Artropatia Neurogênica , Diabetes Mellitus , Osteomielite , Artropatia Neurogênica/diagnóstico , Artropatia Neurogênica/terapia , Pé Diabético/diagnóstico , Pé Diabético/terapia , Humanos , Qualidade de Vida
6.
Wounds ; 32(10): 291-293, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33370247

RESUMO

A person with a diabetic foot ulcer (DFU) requires multidisciplinary care, including moist wound healing, consistent offloading of insensate areas, glycemic control, and adequate circulation. This is especially important during the COVID-19 pandemic, as patients with diabetes are at a higher risk of mortality.1 Reviewed in a 2018 installment of Evidence Corner,2 a double-blind, randomized clinical trial (RCT) reported that topical oxygen continuously diffused to DFU tissue resulted in nonhealing DFUs healing more than 20 days faster than those that were similarly treated with standard therapy and a sham device.3 More than twice the DFUs closed in patients receiving continuously diffused topical oxygen in comparison with the sham arm completely healed in 12 weeks (P = .02). It has been hypothesized that intervals of hyperbaric oxygen (HBO)-breathing 100% oxygen at atmosphere absolute (ATA) greater than the 1.0 normal at sea level-may similarly improve lower extremity ulcer healing outcomes. This month's Evidence Corner summarizes 2 studies regarding patients receiving HBO. The first study focused on patients with a DFU on a non-ischemic limb.4 The second studied the effects of HBO on lower extremity ulcers on ischemic limbs in patients with or without diabetes mellitus (DM).5 Read on to discover how informative and beneficial each of these studies can be in furthering best practice as well as which patients may experience improved lower limb ulcer healing in response to interventions that increase tissue oxygenation.


Assuntos
/epidemiologia , Pé Diabético/terapia , Oxigenação Hiperbárica/métodos , Pandemias , Cicatrização , Comorbidade , Pé Diabético/epidemiologia , Humanos , Resultado do Tratamento
7.
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
8.
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
9.
Medicine (Baltimore) ; 99(43): e22758, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120781

RESUMO

BACKGROUND: Since the outbreak of novel coronavirus in 2019, the number of new coronavirus infections worldwide has been increasing, there is no effective treatment or vaccine. Novel coronavirus infection is closely related todiabetes, the mortality of diabetes with novel coronavirus pneumonia is significantly higher than that of non diabetic with novel coronavirus pneumonia, Diabetic foot is one of the common and serious complications of diabetes, however, no systematic study on novel coronavirus pneumonia adverse effects on diabetic foot has been found at home and abroad, however, this is a problem that can not be ignored. METHODS: We will search each database from the built-in until April 2021. The English literature mainly searches Cochrane Library, PubMed, EMBASE, and Web of Science, while the Chinese literature comes from CNKI, CBM, VIP, and Wangfang database. Simultaneously we will retrieval clinical registration tests and grey literatures, and he researches related to the adverse effects of novel coronavirus on diabetic foot were collected, The 2 researchers worked independently on literature selection, data extraction, and quality assessment. The dichotomous data is represented by relative risk, and the continuous is expressed by mean difference or standard mean difference, eventually the data is synthesized using a fifixed effect model or a random effect model depending on whether or not heterogeneity exists. The primary outcome was clinical response rate, C-reactive protein and procalcitonin. Secondary outcomes are mainly including mortality, amputation rate, wound healing time and nerve conduction velocity. Finally, meta-analysis was conducted by RevMan software version 5.3. RESULTS: The results of our research will be published in a peer-reviewed journal. INPLASY REGISTRATION NUMBER: 202080113.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pé Diabético/virologia , Pneumonia Viral/complicações , Protocolos Clínicos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Pé Diabético/mortalidade , Pé Diabético/terapia , Saúde Global , Humanos , Modelos Estatísticos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Hautarzt ; 71(11): 835-842, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33044558

RESUMO

Diabetes mellitus (DM) is a paramount and rising medical challenge in both industrial and emerging nations. For Germany, 6.9 million out of 64.9 million insured persons in 2010 were reported to suffer from DM and approximately 5.8 million suffered from type 2 DM. The prevalence of diabetic foot ulcer (DFU) or diabetic foot syndrome (DFS) is 2-10% and the incidence is 2-6%. In addition, patients with DM present associated skin disorders with chronic wound healing, e.g., pyoderma gangrenosum or lecrobiosis lipoidica. Knowledge of the pathogenesis and skills for treatment of chronic wounds in diabetic patients are important for dermatologists. Patients with diabetes and wound healing disorders and accompanied unspecific skin disorders like eczema, cellulitis or contact dermatitis are often primarily or secondarily treated by dermatologists. In this article, practical hints for the treatment of DFS and other chronic wound in patients with DM are presented.


Assuntos
Diabetes Mellitus , Pé Diabético , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/terapia , Alemanha/epidemiologia , Humanos , Incidência , Pele , Cicatrização
11.
Medicina (B Aires) ; 80(5): 523-530, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-33048798

RESUMO

Diabetic foot attack has an acute and severe presentation that threatens the affected limb and the patient's life. It is a term that arises from the need to identify those patients that require urgent intervention; it conveys a sense of urgency and severity, reminding the term of "time is tissue". The classic presentation is that of a severe infected foot with rapidly progressive necrosis that requires urgent surgery to debride all necrotic tissue and purulent collections, providing an adequate antibiotic treatment. Ischemic diabetic foot attack that demands urgent revascularization and the acute Charcot neuroarthropathy for which primacy is given to diagnostic confirmation and off-loading are also consid ered atypical presentations of diabetic foot attack. The aim of identifying these diabetic foot presentations is to promote rapid intervention to provide adequate and effective treatment, avoiding the most feared complication which is the limb amputation. In the present review, a description of the pathophysiology, clinical presentation, treatment and evolution of the three types of diabetic foot attack is made.


Assuntos
Diabetes Mellitus , Pé Diabético/terapia , Amputação , Pé Diabético/diagnóstico , , Humanos , Necrose , Resultado do Tratamento
12.
Ther Umsch ; 77(7): 339-346, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32996425

RESUMO

Diabetic foot syndrome Abstract. Although a common and relevant complication of diabetes mellitus, diabetic foot syndrome still remains underdiagnosed. As major risk factors, diabetic peripheral neuropathy and peripheral artery disease play a central role. Prevention of diabetic foot ulceration and diabetic foot infection is the cornerstone of care, pointing to the importance of patients and care givers education in regularly inspecting and examining the "foot at risk". In addition to already well implemented screening programs for retinopathy and nephropathy in patients with diabetes mellitus, guidelines must also focus on diabetic foot care. The Swiss guidelines help identifying the patient at risk and direct adequate management. Management of the diabetic foot is complex. The appropriate and immediate treatment involves healthcare professionals of different specialties. Therefore, a multidisciplinary team approach is highly recommended. The major objectives are to reduce complications, such as amputations, morbidity and mortality - and, last but not least, the economic burden of the disease.


Assuntos
Diabetes Mellitus , Pé Diabético/diagnóstico , Pé Diabético/terapia , Doença Arterial Periférica , Amputação , Humanos , Fatores de Risco , Síndrome
13.
Hautarzt ; 71(11): 855-862, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-32997219

RESUMO

BACKGROUND: Besides acute wounds (through trauma or surgical interventions), chronic wounds comprise a relatively large and heterogeneous group of diseases. These include leg ulcers with venous disease greatly prevailing arterial disease, diabetic foot syndrome, and pressure ulcers. Due to a considerable treatment resistance against such therapies, new and effective, additive treatment options especially for chronic wounds are needed. Wound treatment with cold atmospheric plasma (CAP) constitutes such an innovative option. OBJECTIVES: Current research regarding the efficacy of cold plasma for healing of acute and chronic wounds is summarized. MATERIALS AND METHODS: The literature on CAP applications in wound healing has been screened and reviewed. RESULTS: With CAP, several effects that promote wound healing can be simultaneously applied in one application. On the one hand, CAP exerts a strong and broad antimicrobial activity against biofilm. On the other hand, the plasma cocktail, which consists of reactive nitrogen and oxygen species, UV, and charged particles (electrical current), mediates tissue-stimulating, blood flow-promoting, and anti-inflammatory effects. Marked germ reduction on wounds and accelerated wound healing have already been convincingly demonstrated in controlled clinical studies. CONCLUSIONS: The comprehensive CAP study landscape with structured case report summaries and randomized case-control studies allows the conclusion that CAP is safe, effective, and easy to handle for wound treatment. The utilization of CAP in addition to standard wound treatments is starting to enter routine clinical practice.


Assuntos
Pé Diabético , Úlcera da Perna , Gases em Plasma , Pressão Atmosférica , Pé Diabético/terapia , Humanos , Gases em Plasma/uso terapêutico , Cicatrização
14.
J Wound Ostomy Continence Nurs ; 47(5): 445-449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925589

RESUMO

BACKGROUND: Prior to the COVID-19 pandemic, the Cardiovascular Surgery (CV) service of an academic medical center conducted a quality improvement project to decrease readmissions to the hospital from 2 rehabilitation facilities using telehealth via video calling. This initiative became of great importance with the COVID-19 pandemic because it helped the CV service better navigate and more efficiently meet the patient care needs associated with patient care restrictions. The CV service had to quickly evaluate and implement measures to reduce the rate of transmission of the coronavirus, which included adapting the clinic workflow to comply with state and federal recommendations. To minimize the interruption of clinical services and the associated revenue, a rapid transition from outpatient clinic visits to telehealth visits was implemented. CASES: Two cases reports of patients with wounds managed with 2 different telehealth platforms are described. Doxy.me platform allows the provider to e-mail or text a link to their personal waiting room for patients to join the video call. The second platform is Cisco Jabber platform to connect directly to the nursing unit at a skilled nursing or rehabilitation facility. CONCLUSION: Health care systems have had to adjust the manner in which they triage, evaluate, and care for patients using telehealth platforms that do not rely on in-person clinic visits during the COVID-19 pandemic. There are multiple telehealth platforms that require careful planning and treatment implementation. Each health care agency needs to choose the one or ones that function the best in their care setting.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/patologia , Pé Diabético/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pé Diabético/etiologia , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
15.
Vnitr Lek ; 66(2): 92-97, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32942883

RESUMO

Diabetic foot (DF) is a serious late complication of diabetes associated with high morbidity and mortality, often leading to lower limb amputation. Risk factors for DF include neuropathy, infection, and ischemia. The prevention of ulceration is essential for reducing amputation rate. Effective follow-up of patients and application of preventive approaches such as using of appropriate shoes and foot care can reduce the incidence of ulcerations by up to 50 %. DF treatment is very expensive and includes offloading of the affected foot, treatment of infection and revascularization. Local treatment and satisfactory diabetes control are also very important. Professional care for these patients should be directed to specialized podiatric clinics due to the need for a multidisciplinary approach.


Assuntos
Diabetes Mellitus , Pé Diabético , Amputação , Pé Diabético/terapia , Humanos , Isquemia , Fatores de Risco , Procedimentos Cirúrgicos Vasculares
16.
Life Sci ; 259: 118246, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-32791151

RESUMO

BACKGROUND: Diabetic foot ulcer (DFU), one of the diabetic complications, brings high burden to diabetic patients. Hyperbaric oxygen therapy (HBOT) has been proven to be an effective clinical method for the treatment of DFU. However, the mechanisms still to be elucidated. METHODS: Diabetic foot mice model was established, and treated with hyperbaric oxygen. Haematoxylin & eosin (H&E) staining and Masson's trichrome staining were used for the analysis of wound healing. Human skin fibroblast (HSF) and human umbilical vein endothelial cell (HUVECS) were exposed to high glucose and hyperbaric oxygen for studying the mechanism of hyperbaric oxygen promoted wound healing in vitro. Wound healing assay, reactive oxygen species (ROS) assay, cell proliferation assay and tube formation assay were used for the analysis of wound healing. Quantitative-polymerase chain reaction (Q-PCR), Western blotting and enzyme-linked immunosorbent assay (ELISA) were used for the analysis of gene expression. RESULTS: HBOT facilitated wound healing in DFU mice model, and promoted the expression of HIF-1α, NF-κB, VEGFA, SDF-1, VEGFR2 and CXCR4. Hyperbaric oxygen promoted the proliferation, migration and ROS production, as well as the expression of SDF-1 and VEGFA in HSF. HBOT stimulated the proliferation, migration and tube formation, as well as the expression of CXCR4 and VEGFR2 in HUVECS. CONCLUSION: Hyperbaric oxygen potentiates angiogenesis and diabetic wound healing by activating HIF-1α signaling, so as to promote the expression of VEGF/SDF-1 in HSF and the expression of VEGFR/CXCR4 in HUVECS, ultimately to promote the proliferation of HSF and the angiogenesis of HUVECS.


Assuntos
Diabetes Mellitus Experimental/terapia , Pé Diabético/terapia , Cicatrização/efeitos dos fármacos , Animais , Proliferação de Células/efeitos dos fármacos , Diabetes Mellitus Experimental/fisiopatologia , Pé Diabético/metabolismo , Células Endoteliais/efeitos dos fármacos , Células Endoteliais/metabolismo , Feminino , Fibroblastos/metabolismo , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Oxigenação Hiperbárica/métodos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Neovascularização Patológica/metabolismo , Neovascularização Fisiológica/efeitos dos fármacos , Neovascularização Fisiológica/fisiologia , Transdução de Sinais , Pele/metabolismo , Estreptozocina/farmacologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
17.
Angiology ; 71(9): 853-863, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32723090

RESUMO

This review provides an outline of the use of adipose-derived mesenchymal stem cells (AMSCs) in the treatment of diabetic foot ulcers (DFUs). A systematic search of PubMed and the Cochrane database was performed on October 2, 2019. Eighteen studies were identified (14 preclinical and 4 clinical). Studies in animal models have demonstrated that AMSCs enhance diabetic wound healing, accelerate granulation tissue formation, and increase reepithelialization and neovascularization. Only 1 randomized control trial has been published so far. Patients (n = 25) with DFUs were treated using an allogeneic AMSC directly on the wound bed as a primary dressing, and improvements were found in complete wound closure in the treatment group (n = 16). Three clinical studies showed that autologous AMSC might be a safe alternative to achieve therapeutic angiogenesis in patients with diabetes and peripheral arterial disease. Based on the available evidence, AMSCs hold promise in the treatment of DFUs. However, this evidence requires confirmation by well-designed trials. Additional studies are also required to understand some issues regarding this treatment for DFUs. For example, the potential application of autologous or allogeneic AMSCs in different types of DFUs, optimal dose/infusion schedules, safety evaluations, and cost-effectiveness.


Assuntos
Pé Diabético/terapia , Transplante de Células-Tronco Mesenquimais , Humanos
18.
Eur J Vasc Endovasc Surg ; 60(2): 282-292, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32660807

RESUMO

OBJECTIVE: This review aims to assess the evidence supporting the impact of patient foot care education on self efficacy, self care behaviour, and self care knowledge in individuals with diabetes. METHODS: This systematic review was registered prospectively on the PROSPERO database (CRD42019106171). Ovid EMBASE and MEDLINE databases were searched from 1946 to the end of March 2019, using search terms related to the domains diabetic foot, patient education, self efficacy, self care behaviour, and self care knowledge. All included studies were prospective, randomised controlled trials that assessed foot care education interventions in individuals with diabetes and recorded an outcome related to self efficacy, self care behaviour, and/or self care knowledge. RESULTS: Thirteen randomised controlled trials were included, reporting on a total of 3948 individuals. The risk of bias was high or unclear in 11 of the 13 included studies, and low in two studies. Both the education interventions delivered, and the outcome assessment tools used were heterogenous across included studies: meta-analysis was therefore not performed. Eight of 11 studies identified significantly better foot self care behaviour scores in individuals randomised to education compared with controls. Self efficacy scores were significantly better in education groups in four of five studies reporting this primary outcome. Foot care knowledge was significantly better in intervention vs. control in three of seven studies. In general, studies assessing secondary endpoints including quality of life and ulcer/amputation incidence tended not to identify significant clinical improvements. CONCLUSION: The available evidence is of inadequate quality to reliably conclude that foot care education has a positive impact on foot self care behaviour and self efficacy in individuals with diabetes. Quality data supporting accompanying benefits on quality of life or ulcer/amputation incidence are also lacking and should be considered as an important outcome measure in future studies.


Assuntos
Pé Diabético/terapia , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Educação de Pacientes como Assunto , Autocuidado , Autoeficácia , Idoso , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Cicatrização
19.
Eur J Vasc Endovasc Surg ; 60(2): 274-281, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32636064

RESUMO

OBJECTIVE: Diabetic foot syndrome (DFS) contributes to significant morbidity in diabetic patients. Diagnostic and therapeutic approaches to DFS may be summarised in clinical practice guidelines (CPGs) to aid clinical practice but may only benefit patients if the CPG is of high quality. This study determines the methodological quality of DFS CPGs using a validated assessment tool to identify CPGs adequate for use in clinical practice. METHODS: Medline, EMBASE, and CPG databases were searched to 31 May 2019. Reference lists were also searched. Full text English evidence based DFS CPGs were included. CPGs based on expert consensus, guideline summaries, or those only available if purchased were excluded. Four reviewers independently assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II instrument. An overall guideline assessment scaled score of ≥80% was considered to be of adequate quality to recommend use. RESULTS: Sixteen CPGs were identified. Good inter-reviewer reliability (ICC 0.985, 95% CI 0.980-0.989) was achieved. Poor scores were noted in domains 2 (stakeholder involvement), 5 (applicability), and 6 (editorial independence). Significant methodological heterogeneity was observed in all domains with the most noted in domain 6 (mean scaled score 43.2 ± 32.1%). Four CPGs achieved overall assessment scores of ≥80%. CONCLUSION: Four CPGs were considered to be adequate for clinical practice based on methodological quality. However, elements of methodological quality were still lacking, and all CPGs had areas for improvement, potentially through increased multidisciplinary team involvement and trial application of recommendations. Methodological rigour may be improved using structured approaches with validated CPG creation tools in the future. Future work should also assess recommendation accuracy using available validated assessment tools.


Assuntos
Pé Diabético/diagnóstico , Pé Diabético/terapia , Medicina Baseada em Evidências/normas , Guias de Prática Clínica como Assunto/normas , Consenso , Humanos , Valor Preditivo dos Testes , Participação dos Interessados , Síndrome
20.
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
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