Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 895
Filtrar
1.
Medicine (Baltimore) ; 99(17): e19841, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332634

RESUMO

BACKGROUND: Diabetic foot (DF) is among the most serious complications of type 2 diabetes. DF infection (DFI) is a key factor in the deterioration and development of DF, so controlling infection plays an important role in the treatment of the disease. Traditional Chinese medicine foot bath has been widely used in China as a complementary and alternative therapy to improve circulation and infection control of DF. However, the existing evidence shows that its efficacy and safety are still insufficient. We report a study protocol about a multicenter, double-blind, randomized, placebo controlled trial which aims to make well-designed clinical trials to evaluate the efficacy and safety of herbal medicine foot bath decoction (FBD) and explore the mechanism of external washing of Chinese herbs in DFI. METHODS: This study is a multicenter, double-blind, randomized, placebo controlled clinical trial in which 60 eligible participants were randomly divided into an experimental group and control group at a 1:2 ratio. Both groups received the same basic treatment for DF disease, the experimental group used FBD and ordinary dressing changes, while half of the patients in the control group received placebo and ordinary dressings, and the other half received placebo and silver ion dressings. Patients in both groups will be evaluated weekly for efficacy during the intervention. The primary efficacy indicators include the types of wound pathogens, interleukin 6 and tumor necrosis factor α. Secondary efficacy indicators included blood glucose, blood lipids, wound area, lower extremity blood vessel diameter, blood flow speed, walking speed, walking distance, and traditional Chinese medicine syndrome scores. We will also conduct a safety evaluation of the drug at the end of the trial. DISCUSSION: This multicenter, double-blind, randomized, placebo clinical trial not only provides data on the efficacy and safety of FBD, but also provides a novel treatment strategy for clinicians and DF patients.


Assuntos
Banhos , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/tratamento farmacológico , Medicamentos de Ervas Chinesas/administração & dosagem , Adolescente , Adulto , Idoso , Pé Diabético/fisiopatologia , Método Duplo-Cego , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Cicatrização , Adulto Jovem
2.
PLoS One ; 15(2): e0228704, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069293

RESUMO

Diabetic foot ulcers can become chronic and non-healing despite systemic antibiotic treatment. The penetration of systematically-administered antibiotics to the site of infection is uncertain, as is the effectiveness of such levels against polymicrobial biofilms. We have developed an in vitro model to study the effectiveness of different treatments for infected diabetic foot ulcers in a wound-like environment and compared the activity of systemic levels of antibiotics with that for topically applied antibiotics released from calcium sulfate beads. This is the first study that has harvested bacteria from diabetic foot infections and recreated similar polymicrobial biofilms to those present in vivo for individual subjects. After treatment with levels of gentamicin attained in serum after systemic administration (higher than corresponding tissues concentrations) we measured a 0-2 log reduction in bacterial viability of P. aeruginosa, S. aureus or a polymicrobial biofilm. Conversely, addition of gentamicin loaded calcium sulfate beads resulted in 5-9 log reductions in P. aeruginosa, S aureus and polymicrobial biofilms derived from three subjects. We conclude that systemically administered antibiotics are likely to be inadequate for successfully treating these infections, especially given the vastly increased concentrations required to inhibit cells in a biofilm, and that topical antibiotics provide a more effective alternative.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Pé Diabético/microbiologia , Administração Tópica , Antibacterianos/uso terapêutico , Sulfato de Cálcio/farmacologia , Pé Diabético/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/fisiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/fisiologia
3.
J Biol Regul Homeost Agents ; 34(1 Suppl. 1): 1-11, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32064830

RESUMO

Pathogenic biofilms are considered a potential major obstacle to healing chronic wounds. The six-month evaluation period in this study assessed the effect of a single treatment of the HYBENX® (HYB) Root Canal Cleanser on chronic wounds, especially its ease of use, safety, potential for shortening duration of Inflammatory Phase, and promotion of granulation. HYB gel was applied to the wound bed and periwound skin for 10 seconds. Gel was removed by cotton gauze pads and low-pressure saline rinsing. Standard wound dressings based on wound etiology, location, and exudate characteristics were applied. Duration of these seven HYB-treated wound cases (two pressure ulcers, one surgical wound, four lower extremity ulcers-a venous reflux-associated calf ulcer, one diabetic foot ulcer, and two animal-induced wounds-brown recluse spider and bovine bite) ranged from 12 days to 10 years. Three cases had sinus tracts. After HYB application, sinus tract closure occurred at 7, 16, and 21 days. The 10-year recalcitrant wound from brown recluse spider bite healed in 97 days. Diabetic foot ulcer responded to HYB treatment plus additional strategies and healed in six months. These data support the hypotheses that pathogenic biofilm actively prevents the healing of chronic wounds, and biofilm can be disrupted with a single HYB treatment.


Assuntos
Biofilmes/efeitos dos fármacos , Fenóis/uso terapêutico , Cicatrização , Animais , Mordeduras e Picadas/tratamento farmacológico , Aranha Marrom Reclusa , Bovinos , Pé Diabético/tratamento farmacológico , Humanos , Lesão por Pressão/tratamento farmacológico , Úlcera Varicosa/tratamento farmacológico
4.
Praxis (Bern 1994) ; 109(2): 109-115, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32019460

RESUMO

A Holiday Souvenir with Consequences - an Interdisciplinary Challenge Abstract. We describe a patient with a diabetic foot and challenging infectious complications. After a hospital stay in Sri Lanka due to a soft tissue infection of the foot he was relocated to Switzerland. After proof of multiple resistant bacteria, an amputation of the forefoot with a split skin cover was performed, followed by a short resistance-adapted antibiotic treatment, with good clinical results. This case illustrates the increase of multidrug-resistant bacteria, even in Switzerland. It emphasizes the importance of infection control measures in travellers returning from countries with high prevalence of multidrug-resistant bacteria (especially after a hospitalisation), and the need of a close interdisciplinary collaboration in these cases to guarantee the best treatment and to limit the spreading of multidrug-resistant bacteria.


Assuntos
Antibacterianos , Pé Diabético , Antibacterianos/uso terapêutico , Pé Diabético/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Humanos , Masculino , Suíça
5.
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
6.
Ann Vasc Surg ; 62: 442-451, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394225

RESUMO

Diabetic foot ulcer and its complications are becoming more and more serious problems threatening people's health. In the last decade, multiple growth factors and their combined applications have shown potentials in promoting the healing process of diabetic foot ulcers. The purpose of this study is to perform a meta-analysis of the efficacy and safety of topical recombinant human epidermal growth factor (rhEGF) on the treatment of diabetic foot ulcers. As of November 30, 2018, we had conducted a comprehensive review of PubMed, EMBASE, Cochrane Library databases, and Web of Science. Seven randomized controlled trials (RCTs) that involved 610 participants were included in this review. The pooled results showed that topical rhEGF could significantly promote the healing of diabetic foot ulcers (risk ratio [RR] 1.54, 95% confidence interval [CI] 1.30 to 1.83; I2 = 18%). Topical application of rhEGF could promote ulceration healing of diabetic feet of Wagner grade 1 or 2 significantly (RR, 1.61; 95% CI, 1.32 to 1.97; I2 = 0%), and intralesional injection of rhEGF appeared to promote the healing of more severe ulcers (RR, 2.06, 95%, CI 0.35 to 12.22; I2 = 50%). However, patients developed more shivering (RR, 4.67; 95% CI, 1.39 to 15.71; I2 = 0%), nauseas/vomiting (RR, 2.18; 95% CI, 0.72 to 6.55; I2 = 0%) in the group of intralesional injection of rhEGF compared with the control group, although these symptoms were not found with the topical application of rhEGF. No serious complications were found associated with topical rhEGF. Topical rhEGF treatment of diabetic foot ulcers has showed a broad application prospect, yet more relevant well-designed RCTs are needed in the future.


Assuntos
Pé Diabético/tratamento farmacológico , Fator de Crescimento Epidérmico/administração & dosagem , Cicatrização/efeitos dos fármacos , Administração Cutânea , Pé Diabético/diagnóstico , Fator de Crescimento Epidérmico/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Proteínas Recombinantes/administração & dosagem , Fatores de Tempo , Resultado do Tratamento
7.
Rev. Rol enferm ; 42(9): 568-575, sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187137

RESUMO

La úlcera del pie diabético (UPD) es una complicación frecuente de la Diabetes mellitus, que afecta aproximadamente al 19-34% de estos pacientes. La principal complicación es la pérdida de la extremidad, la cual suele estar precedida por un evento de infección o isquemia. El manejo de las UPD continúa siendo un desafío en la actualidad. Aproximadamente el 70% de las UPD no cicatrizan tras 20 semanas de tratamiento, en muchos casos a con-secuencia del padecimiento de enfermedad vascular periférica, presente en más del 50% de los pacientes. Las bases del manejo local de la UPD se centran en el desbridamiento y la gestión del exudado. Sin embargo, un número elevado de lesiones no responde al estándar de tratamiento y se estanca en su evolución, aumentando los tiempos de cicatrización y exponiendo al paciente al riesgo de desarrollo de complicaciones. Los apósitos de octosulfato de sacarosa, cuyo mecanismo de acción se fundamenta en la inhibición de las metaloproteinasas en el lecho de la úlcera y en el favorecimiento de la angiogénesis local, han demostrado un alto nivel de evidencia por los beneficios clínicos demostrados y por el ahorro de costes en estos procesos. Sin embargo, a pesar de la evidencia aportada, los profesionales sanitarios siguen teniendo dudas sobre cómo y cuándo utilizar este trata-miento en sus pacientes. El objetivo de este trabajo es establecer las pautas de implementación de la evidencia en el manejo de UPD mediante el uso de estos apósitos junto con el estándar de manejo de las UPD


Diabetic foot ulcer (DFU) is a frequent complication of Diabetes, that occurs in approximately 19-34% of these patients. The main complication is limb loss, which usually is preceded by infection or ischemia. Nowadays, the management of DFUs is a challenge. Approximately, 70% of DFUs do not healed after 20 weeks of treatment, and in many cases it is a result of peripheral arterial disease, present in more than 50% of the patients. The basis of the local management of DFU is focused in debridement and exudate management. However, a large number of ulcers do not respond to standard treatment and the evolution is stagnant, increasing healing time and the risk for the patient to develop complications. The action mechanism of sucrose octosulfate dressings is based on the inhibition of metalloproteinases in the wound bed and the promotion of local angiogenesis, which have demonstrated high level of evidence for the clinical benefits and cost savings. However, despite the evidence, health professionals continue having doubts about how and when use the treatment in their patients. The aim of this work is to establish guidelines of implementation of evidence in the management of DFU by the use of these dressings with the standard of treatament of DFUs


Assuntos
Humanos , Enfermagem Baseada em Evidências , Pé Diabético/tratamento farmacológico , Bandagens , Sacarose/análogos & derivados , Antiulcerosos/administração & dosagem , Fatores de Tempo
8.
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
9.
Rev Med Suisse ; 15(659): 1448-1452, 2019 Aug 21.
Artigo em Francês | MEDLINE | ID: mdl-31436060

RESUMO

The management of diabetic foot requires a rapid intervention in front of any type of wound, if possible by a multidisciplinary team. The daily diabetic foot screening is the best prevention. Peripheral neuropathy leads to articular deformations, loss of pain alert and skin dryness. Arteriopathy, which is also frequent, retards cicatrisation of wounds, with a higher risk of infection and amputation. Meticulous local care and foot pressure off-loading are essential, with, if needed, appropriate antimicrobial therapy. Surgery, with curative, preventive or even restorative interventions, occupies an increasing place. The evaluation, treatment and follow-up of the diabetic foot should follow new guidelines established by the IWGDF.


Assuntos
Anti-Infecciosos , Pé Diabético , Amputação , Pé Diabético/tratamento farmacológico , Pé Diabético/cirurgia , Pé Diabético/terapia , Guias como Assunto , Humanos
10.
Zhonghua Shao Shang Za Zhi ; 35(6): 464-466, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280542

RESUMO

Objective: To explore the clinical effects of antibiotic bone cement in the treatment of diabetic foot ulcers. Methods: According to the treatment methods, 18 patients with diabetic foot ulcers (11 males and 7 females, aged 53-79 years), who were conformed to the study criteria and admitted to our hospital from January 2016 to January 2017, were enrolled in traditional group; 18 patients with diabetic foot ulcers (11 males and 7 females, aged 55-80 years), who were conformed to the study criteria and admitted to our hospital from February 2017 to February 2018, were enrolled in bone cement group. Wounds of patients in traditional group were treated with vacuum sealing drainage after conventional debridement. Wounds of patients in bone cement group were covered with antibiotic bone cement after conventional debridement. The number of patients with positive bacterial culture in wound exudate in the 2 groups on admission and 3, 6, 9, and 15 days after surgery, the length of hospital stay, the number of operation, and the wound complete healing time were retrospectively recorded. Data were processed with Fisher's exact probability test and independent sample t test. Results: Compared with (29±10) d and (4.6±1.2) times of patients in traditional group, the length of hospital stay [(9±3) d] of patients was obviously shortened, the number of operation [(1.3±0.6) times] of patients was obviously reduced, the number of patients with positive bacterial culture in wound exudate at each time point post surgery was obviously reduced (t=8.177, 9.896, P<0.05 or P<0.01) in bone cement group. There were no statistically significant differences in the number of patients with positive bacterial culture in wound exudate on admission and wound complete healing time between patients in the 2 groups (t=0.175, P>0.05). Conclusions: The antibiotic bone cement treatment of diabetic foot ulcers can reduce the number of patients with positive bacterial culture in wound exudate and the number of operation, as well as shorten the length of hospital stay.


Assuntos
Antibacterianos/uso terapêutico , Cimentos para Ossos/uso terapêutico , Pé Diabético/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
11.
Medicina (B Aires) ; 79(3): 167-173, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31284250

RESUMO

Diabetic foot infections are related to severe complications and constitute the main reason for diabetes-related hospitalization and lower limb amputations. A diabetic foot infection requires prompt actions to avoid progression of the infected wound; a soft tissue sample has to be taken for microbiological culture and empiric antibiotic therapy must be started immediately. Empiric antibiotic schemes should be chosen based on the severity of the infection and the local prevalence of microbial causal agents. Therefore, it is important to monitor these indicators. The aim of this study was to determine which microorganisms were more prevalent in cultures of diabetic foot infections during 2018 and what antibiotic combination was better to cover local microbiology, compared with data available from 2015 for a similar cohort. A total of 68 positive cultures were obtained of 72 soft tissue specimens analyzed. The most frequent microorganisms were Gram negative (47.1%), and resulted significantly more frequent than in 2015 (24.6%) p = 0.01. These Gram negative germs also resulted more sensitive to ciprofloxacin than in 2015 (62.5% vs. 25.0%) p = 0.03. Amoxicillin-clavulanate plus ciprofloxacin was the optimal combination therapy in 2018, while in 2015 it was amoxicillin-clavulanate plus trimethoprim sulfamethoxazole. In agreement with these results, we recommend amoxicillin-clavulanate plus ciprofloxacin as the empiric antibiotic regimen of choice for soft tissue infections in diabetic foot. We consider surveillance of local microbiology to be an important tool in the management of diabetic foot infections.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Pé Diabético/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Pé Diabético/microbiologia , Quimioterapia Combinada , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia
12.
Zhongguo Zhong Yao Za Zhi ; 44(10): 2110-2117, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31355569

RESUMO

Chemical constituents of the Fufang Huangbai Ye( FFHB) were analyzed and identified by UPLC-ESI-LTQ-OrbitrapMS. The analysis was performed on an Waters HSS T3 reverse phase column( 2. 1 mm×100 mm,1. 8 µm). The mobile phase consisting of 0. 1% aqueous formic acid( A) and acetonitrile( B) was used with gradient elution,and the flow rate was 0. 3 mL·min~(-1).Based on the information of the accurate mass,the multistage fragment ions,the mass spectrometric data of the standard substance and the relative reference literature,the structure of the chemical constituents in FFHB were identified. Based on the identified compounds,network pharmacology study,including target prediction,functional enrichment,and molecular docking was applied to screen out the main active substances for treatment of diabetes foot and explore the potential mechanism. The results showed that a total of 138 compounds were identified,including 28 alkaloids,16 flavonoids,11 phenylethanoid glycosides,9 cycloolefins,11 cyclohexylethanol derivatives,28 phenolic acids and derivatives,3 lignans,4 terpenes,28 volatile oils and the others. Further,36 active substances for diabetes foot were screened out,and the functional enrichment showed the potential mechanism of FFHB were mainly seven functional items including inflammatory response,growth factor activity. This study combining the UPLC-LTQ-Orbitrap-MS technology and the network pharmacology provide a useful reference and basis for active compounds,quality control markers and the pharmacological mechanism of FFHB for diabetic foot treatment.


Assuntos
Pé Diabético/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Compostos Fitoquímicos/farmacologia , Cromatografia Líquida de Alta Pressão , Humanos , Espectrometria de Massas , Simulação de Acoplamento Molecular , Compostos Fitoquímicos/isolamento & purificação
13.
Khirurgiia (Mosk) ; (7): 63-70, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355817

RESUMO

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biguanidas/administração & dosagem , Pé Diabético/cirurgia , Necrose/cirurgia , Procedimentos Cirúrgicos Ultrassônicos , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/tratamento farmacológico , Pé Diabético/patologia , Humanos , Pessoa de Meia-Idade , Necrose/tratamento farmacológico , Necrose/patologia , Soluções/administração & dosagem
14.
Artigo em Inglês | MEDLINE | ID: mdl-31331038

RESUMO

Diabetic foot ulcers (DFUs) are one the common complications of diabetes mellitus. Many trials were performed to evaluate the effect of recombinant human epidermal growth factor (rhEGF) in healing DFUs. This meta-analysis was performed to synthesize the evidence of rhEGF treatment in DFUs in comparison to placebo. Databases included for the search were PubMed, EMBASE, the Cochrane Library, Web of Science, EBSCOhost, ScienceDirect, and Scopus (up to January 2019). The outcome of interest was the complete healing rate of DFUs. We performed random effects meta-analysis stratified by the types of administration route (intralesional injection and topical apply) by calculating the odds ratios (OR) and 95% confidence interval (95% CI). A total of six studies involving 530 patients were eligible for analysis. The combined OR (intralesional injection and topical apply) was 4.005 (95% CI: (2.248; 7.135), p < 0.001). The ORs for intralesional injection and topical application were 3.599 (95% CI: (1.213; 10.677), p = 0.021) and 4.176 (95% CI: (2.112; 8.256), p < 0.001), respectively. Statistical heterogeneity might not be important in overall treatment (I2 = 15.17, p = 0.317) and both of the subgroups (I2: 24.56, p = 0.25 and I2: 33.26, p = 0.213, respectively). Our results support the use of rhEGF in the treatment of DFUs.


Assuntos
Pé Diabético/tratamento farmacológico , Fator de Crescimento Epidérmico/uso terapêutico , Humanos , Razão de Chances , Ensaios Clínicos Controlados Aleatórios como Assunto , Proteínas Recombinantes/uso terapêutico , Cicatrização/efeitos dos fármacos
15.
Afr Health Sci ; 19(1): 1617-1627, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148991

RESUMO

Purpose: To determine the pattern and bacteriological characteristics of diabetic foot ulcers in patients attending a tertiary health care facility. Method: 160 Patients with Diabetes Mellitus foot syndrome were recruited, out of which 52 had diabetic foot ulcers. Relevant clinical, biochemical, and microbiological evaluations were carried out on the subjects. Data analysis was done using SPSS version 20. p value was set at <0.05. Results: 52 (32.5%) out of 160 subjects with Diabetes Mellitus Foot Syndrome (DMFS) had diabetic foot ulcers. Poor glycaemic control (mean HbA1c = 9.2 (2.7) %), and abuse of antibiotics (76.9%) characterized the subjects. Foot ulcers mainly involved the right lower limb and followed spontaneous blister formation (50%). Microbiological culture pattern was polymicrobial (71.2%); predominantly anaerobic organisms (53.3%). Gram positive and negative aerobic isolates yielded high sensitivity to common quinolones (76% - 87.8%). The gram positive and negative anaerobic isolates were highly sensitive to Clindamycin and Metronidazole respectively (80.2% - 97.8%). High sensitivity (>80%) yield for gram negative anaerobes was recorded for Imipinem and Ampicillin/Sulbactam. Conclusion: Diabetic foot ulcers (DFU) contribute about one-third of DMFS. The bacteriological isolates from these ulcers are mainly polymicrobial with high sensitivity to common antibiotics. The need for appropriate use of antibiotics should be advocated among the patients.


Assuntos
Infecções Bacterianas/microbiologia , Complicações do Diabetes/microbiologia , Pé Diabético/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Glicemia/metabolismo , Pé Diabético/tratamento farmacológico , Pé Diabético/epidemiologia , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Hospitais de Ensino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Nigéria/epidemiologia , Centros de Atenção Terciária
16.
Wounds ; 31(6): 158-162, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184594

RESUMO

OBJECTIVE: This cross-sectional study assesses the profile and antibiotic susceptibility of aerobic bacterial pathogens associated with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: Two swab samples from 140 DFUs with various Wagner grades were processed for identification using routine culture methods and antimicrobial susceptibility by Kirby-Bauer disc diffusion method. RESULTS: A total of 125 (89.29%) samples were found to be positive for bacteria on culture. A higher incidence of positive culture (94.32%) was found in individuals with a blood sugar level > 200 mg/dL. The highest number of culture-positive cases was observed in Wagner grade 2 DFUs (45%). Overall infection was monomicrobial in 83.20% (104) and polymicrobial in 16.80% (21) of samples. Staphylococcus aureus (21.09%) and Pseudomonas aeruginosa (19.05%) were the most common isolates. Linezolid (100%) and imipenem (75.70%) were the most effective antimicrobial agents against gram-positive and gram-negative isolates, respectively. CONCLUSIONS: The results show an overall increase in bacterial resistance to antimicrobial agents and emphasize the importance of an antimicrobial susceptibility pattern in the selection of appropriate antibiotic(s) to institute the rational antibiotic therapy.


Assuntos
Antibacterianos/farmacologia , Pé Diabético/tratamento farmacológico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Adulto , Antibacterianos/uso terapêutico , Estudos Transversais , Pé Diabético/microbiologia , Farmacorresistência Bacteriana , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Sensibilidade e Especificidade , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação
17.
Life Sci ; 233: 116525, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31158376

RESUMO

BACKGROUND: Impaired wound healing in diabetes foot ulcers (DFUs) brings a great burden to diabetic patients. Pro-angiogenesis through elevating nitric oxide (NO) is beneficial to the wound healing process. Ginsenoside Rg1, the main active in Notoginseng, is reported to regulate the angiogenesis in endothelial cells through modulating miR-23a. However, the effect of Rg1 in diabetes remains elusive. METHODS: High fat diet combined with streptozotocin-induced diabetic rats were treated with Rg1. Then incision area and tissue NO level were measured to evaluate the wound closure efficacy of Rg1. Then high glucose cultured HUVECs were employed to mimic diabetic environment in vitro. Overexpression and knockdown plasmids of miR-23a or IRF-1 were constructed and transfected in HUVECs. qPCR and western blot were used to determine the mRNA and protein level, respectively. Dual-luciferase reporter assay was utilized to determine the interaction of IRF-1/miR-23a. RESULTS: Rg1 accelerated the wound closure speed in diabetic rats and increased NO level through elevating iNOS expression. Knockdown of iNOS reversed Rg1-induced VEGF expression, cell proliferation, anti-apoptotic efficacy and cell migration ability in high glucose cultured HUVECs. Further investigation revealed that Rg1 mediated iNOS through miR-23a. miR-23a inhibited the expression of IRF-1, a protein which could directly bind to the iNOS mRNA 3'UTR. CONCLUSION: Rg1 promoted angiogenesis in diabetic wound healing process through NO signaling via miR-23a, providing a novel candidate for DFUs treatment.


Assuntos
Diabetes Mellitus Experimental/complicações , Pé Diabético/tratamento farmacológico , Ginsenosídeos/farmacologia , Fator Regulador 1 de Interferon/metabolismo , MicroRNAs/genética , Óxido Nítrico Sintase Tipo II/metabolismo , Cicatrização/efeitos dos fármacos , Animais , Apoptose , Movimento Celular , Proliferação de Células , Fármacos do Sistema Nervoso Central/farmacologia , Pé Diabético/etiologia , Pé Diabético/metabolismo , Pé Diabético/patologia , Regulação da Expressão Gênica , Células Endoteliais da Veia Umbilical Humana , Humanos , Fator Regulador 1 de Interferon/genética , Masculino , Óxido Nítrico Sintase Tipo II/genética , Ratos , Ratos Sprague-Dawley
18.
BMC Infect Dis ; 19(1): 485, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146691

RESUMO

BACKGROUND: Bordetella trematum is an infrequent Gram-negative coccobacillus, with a reservoir, pathogenesis, a life cycle and a virulence level which has been poorly elucidated and understood. Related information is scarce due to the low frequency of isolates, so it is important to add data to the literature about this microorganism. CASE PRESENTATION: We report a case of a 74-year-old female, who was referred to the hospital, presenting with ulcer and necrosis in both legs. Therapy with piperacillin-tazobactam was started and peripheral artery revascularization was performed. During the surgery, a tissue fragment was collected, where Bordetella trematum, Stenotrophomonas maltophilia, and Enterococcus faecalis were isolated. After surgery, the intubated patient was transferred to the intensive care unit (ICU), using vasoactive drugs through a central venous catheter. Piperacillin-tazobactam was replaced by meropenem, with vancomycin prescribed for 14 days. Four days later, levofloxacin was added for 24 days, aiming at the isolation of S. maltophilia from the ulcer tissue. The necrotic ulcers evolved without further complications, and the patient's clinical condition improved, leading to temporary withdrawal of vasoactive drugs and extubation. Ultimately, however, the patient's general condition worsened, and she died 58 days after hospital admission. CONCLUSIONS: Despite being a rare finding, B. trematum is typically associated with the clinical manifestation of disorders that predispose to ulcer development, which can be infected by microorganisms. The combination of antibiotic therapy and surgical debridement plays a key role in preventing systemic infections. Monitoring the appearance of new cases of B. trematum is essential, since it can be an emerging microorganism. Isolating and defining the clinical relevance of unusual bacteria yields a more accurate perspective in the development of new diagnostic tools and allows for assessment of proper antimicrobial therapy.


Assuntos
Infecções por Bordetella/diagnóstico , Bordetella , Idoso , Antibacterianos/uso terapêutico , Bordetella/isolamento & purificação , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Coinfecção , Pé Diabético/complicações , Pé Diabético/diagnóstico , Pé Diabético/tratamento farmacológico , Pé Diabético/microbiologia , Enterococcus faecalis/isolamento & purificação , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Necrose/diagnóstico , Necrose/microbiologia , Combinação Piperacilina e Tazobactam/uso terapêutico , Stenotrophomonas maltophilia/isolamento & purificação , Úlcera/diagnóstico , Úlcera/microbiologia
19.
Rev. cuba. angiol. cir. vasc ; 20(1)ene.-jun. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-991042

RESUMO

Introducción: El Heberprot-P® es un medicamento novedoso y único, prescrito para los pacientes con úlcera del pie diabético. El factor de crecimiento humano recombinante que contiene este fármaco induce el crecimiento de tejido de granulación útil. La ozonoterapia tiene propiedades como oxigenante, antioxidante, inmunomodulador, regenerador, antiinflamatorio y germicida y se utiliza para la desinfección de heridas desde la Primera Guerra Mundial. Objetivo: Determinar la evolución de las úlceras del pie diabético con el tratamiento mixto de Heberprot-P® y ozonoterapia. Métodos: Se realizó un estudio retrospectivo y descriptivo en todos los pacientes ingresados en el Instituto Nacional de Angiología y Cirugía Vascular con el diagnóstico de diabetes mellitus y úlcera de pie diabético que recibieron tratamiento mixto de Heberprot-P® y ozonoterapia. El período de estudio osciló de enero de 2016 hasta enero de 2017. Las variables estudiadas fueron: sexo, edad, tipo de diabetes, estadía hospitalaria, necesidad de ser reintervenido, tiempo de granulación y respuesta al tratamiento. Resultados: Se encontró que los pacientes tratados con el Heberprot-p® y ozonoterapia tuvieron una buena respuesta al tratamiento (60,5 por ciento), un tiempo de granulación entre 2 y 4 semanas (55,6 por ciento) con predominio de la estadía hospitalaria de 11 a 21 días. Conclusiones: Los pacientes con el tratamiento mixto de Heberprot-P® y ozonoterapia tienen una respuesta muy favorable(AU)


Introduction: Heberprot-P® is a novel and unique medication, prescribed for patients with diabetic foot ulcer. It is based on recombinant human growth factor that induces the growth of useful granulation tissue. The properties as oxygenating, antioxidant, immunomodulator, regenerator, anti-inflammatory and germicide of ozone therapy are used for the disinfection of wounds since the First World War. Objective: To determine the evolution of diabetic foot ulcers with the mixed treatment of Heberprot-P® and ozone therapy. Methods: A retrospective and descriptive study was conducted in all patients admitted to the National Institute of Angiology and Vascular Surgery (INACV) with the diagnosis of Diabetes Mellitus and diabetic foot ulcer who received mixed treatment of Heberprot-P® and ozone therapy. The study period ranged from January 2016 to January 2017. The studied variables were: sex, age, type of diabetes, hospital stay, need to be reoperated, granulation time and response to the treatment. Results: It was found that the highest percentage of patients who used the mixed treatment of Heberprot-P® and ozone therapy had a good response to treatment (60.5 percent) and a granulation time between 2 and 4 weeks (55.6 percent); and a hospital stay from 11 to 21 days. Conclusions: Patients with the mixed treatment of Heberprot-P® and ozone therapy have a very favorable response(AU)


Assuntos
Humanos , Masculino , Feminino , Ozônio/uso terapêutico , Pé Diabético/tratamento farmacológico , Medicamentos de Referência , Epidemiologia Descritiva , Estudos Retrospectivos
20.
J Wound Care ; 28(5): 284-290, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31067163

RESUMO

The omentum is a large peritoneal fold. Its main function is to protect abdominal organs, exerting a defensive action against infective agents. The tissue promotes repair after several types of injury. An extensive vascularisation is the key characteristic of this tissue and the omentum has the highest level of production and content of vascular endothelial growth factor (VEGF). A component of omentum is the lipid compound, which carries out important activities for the organism. Omentum is rich in neutral glycerides, phospholipids, glycolipids and gangliosides. Dermatological products containing purified omental lipids are commercially available and topical omental extracts have been useful in the softening, moisturising and smoothing of skin. Animal-derived omental lipids could be use in topical products with different textures (creams, fluids, emulsions and cleansers) and at different concentrations (10-25%) for the treatment of fragile skin or skin conditions causing risk of ulcer formation. This review summarises the pharmacological rationale of purified omental lipids in topical formulations for use in fragile skin conditions, the clinical efficacy data available in the scientific literature and the potential future perspectives. Efficacy of topical purified omental lipids have been demonstrated in numerous clinical controlled trials involving a total of 320 subjects. These studies demonstrated that this product helps prevent the formation of pressure ulcers (PU) in hospitalised high-risk subjects, improves wound healing process, normalises skin hydration in diabetic subjects with moderate-severe skin xerosis and improve the clinical evolution of diabetic foot. Therefore, purified omental lipid could be an effective tool for the management of fragile skin and the skin at high risk of PU formation.


Assuntos
Pé Diabético/tratamento farmacológico , Pé Diabético/prevenção & controle , Lipídeos/uso terapêutico , Omento/química , Fator A de Crescimento do Endotélio Vascular/uso terapêutico , Cicatrização/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA