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1.
Medicine (Baltimore) ; 99(40): e22536, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019461

RESUMO

RATIONALE: Paroxysmal autonomic instability with dystonia (PAID) is an underdiagnosed syndrome that describes a collection of symptoms following diverse cerebral insults, such as traumatic brain injury, hydrocephalus, hemorrhagic stroke, or brain anoxia. It is manifested by systemic high blood pressure, hyperthermia, tachycardia, tachypnea, diaphoresis, intermittent agitation, and certain forms of dystonia. PATIENT CONCERNS: A semi-comatose 46-year-old man was transferred from the regional rehabilitation hospital with various complaints involving fluctuating vital signs, including uncontrolled hyperthermia, hypertension, tachycardia, and tachypnea, and dystonia in all extremities. The patient underwent brain surgery for astrocytoma in 1996. The patient also had a history of first ischemic stroke on the basal ganglia in 2008 and a second one in the same area in 2017. DIAGNOSIS: The laboratory, electrocardiography, and radiologic findings were normal. Brain imaging indicated an old infarction on the basal ganglia with hydrocephalus. Tractography using diffusion tensor imaging showed discontinuity of multiple tracts, and electrophysiologic tests, such as evoked potentials, displayed an absent response. Based on the dysautonomic symptoms and brain evaluations, the physiatrist diagnosed the patient with PAID. INTERVENTIONS: Bromocriptine, propranolol, and clonazepam were administered sequentially, but autonomic instability persisted. Then, intravenous opioid was administered, and fluctuations in body temperature, heart rate, and respiratory rate, as well as decerebrate-type dystonia were improved. However, simultaneously, drug-induced severe hypotension developed (systolic blood pressure, 57 mm Hg). Subsequently, a transdermal opioid (fentanyl) patch for PAID was applied once every 3 days. OUTCOMES: Ultimately, all vital signs and dystonia were managed without further complications, and the patient was discharged. LESSONS: A patient diagnosed with PAID following multiple cerebral insults was observed, whose condition was controlled by application of opioid patch rather than by intravenous or oral routes. A transdermal opioid patch, such as fentanyl patch, can thus be effective in the treatment of patients with PAID following multiple cerebral insults.


Assuntos
Analgésicos Opioides/uso terapêutico , Doenças do Sistema Nervoso Autônomo/tratamento farmacológico , Distonia/diagnóstico , Fentanila/uso terapêutico , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Gânglios da Base/patologia , Isquemia Encefálica/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Distonia/etiologia , Febre/diagnóstico , Febre/etiologia , Humanos , Hidrocefalia/etiologia , Hipertensão/diagnóstico , Hipertensão/etiologia , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Síndrome , Taquicardia/diagnóstico , Taquicardia/etiologia , Taquipneia/diagnóstico , Taquipneia/etiologia , Adesivo Transdérmico/efeitos adversos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(41): e22491, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031283

RESUMO

RATIONALE: Coronary chest pain is usually ischemic in etiology and has various electrocardiographic presentations. Lately, it has been recognized that myocardial bridging (MB) with severe externally mechanical compression of an epicardial coronary artery during systole may result in myocardial ischemia. Such a phenomenon can be associated with chronic angina pectoris, acute coronary syndromes (ACS), coronary spasm, ventricular septal rupture, arrhythmias, exercise-induced atrioventricular conduction blocks, transient ventricular dysfunction, and sudden death. PATIENT CONCERNS: We report the case of a 58-year-old woman presenting with recurrent episodes of constrictive chest pain during exercise within the last 2 weeks. Except for obesity, general and cardiovascular clinical examination on admission were normal. DIAGNOSES: The resting 12 lead electrocardiogram (ECG) revealed changes typically for Wellens syndrome. High-sensitive cardiac troponin I was normal. We established the diagnosis of low-risk non-ST-segment elevation acute coronary syndrome with a Global Registry of Acute Coronary Events risk score of 92 points. INTERVENTIONS: The patient underwent coronary angiography, who showed subocclusive dynamic obstruction of the left anterior descending artery due to MB. OUTCOMES: The patient was managed conservatively. Her hospital course was uneventful and she was discharged on pharmacological therapy (clopidogrel, bisoprolol, amlodipine, atorvastatin, and metformin) with well-controlled symptoms on followup. LESSONS: MB is an unusual cause of myocardial ischemia. Wellens syndrome is an unusual presentation of ACS. We present herein a rare case of Wellens syndrome caused by MB. This case highlights the importance of subtle and frequently overseen ECG findings when assessing patients with chest pain and second, the importance of considering nonatherosclerotic causes for ACS.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Oclusão Coronária/diagnóstico por imagem , Ponte Miocárdica/diagnóstico por imagem , Dor no Peito/etiologia , Angiografia Coronária , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Ponte Miocárdica/fisiopatologia , Síndrome
3.
Praxis (Bern 1994) ; 109(13): 1033-1034, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33050808

RESUMO

CME Answers: Crowned Dens Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.


Assuntos
Cervicalgia , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Humanos , Pescoço , Cervicalgia/diagnóstico por imagem , Cervicalgia/etiologia , Síndrome
4.
Praxis (Bern 1994) ; 109(13): 1017-1025, 2020.
Artigo em Alemão | MEDLINE | ID: mdl-33050815

RESUMO

CME: Left Bundle Branch Block and Painful Left Bundle Branch Block Syndrome Abstract. Left bundle branch block (LBBB) is the electrocardiographic correlate of a pathologic transmission of the electrical signals in the myocardium which can lead to a dyssynchronous left ventricular activation and thus to an inefficient contraction of the ventricles. It is usually the expression of an underlying cardiopathy and represents an independent risk factor of cardiovascular mortality, therefore further examination is indicated in each case. Besides the treatment of an underlying disease, a specific therapy has been available since the introduction of cardiac resynchronization therapy (CRT). A rarer phenomenon is the painful left bundle branch block in structurally healthy hearts.


Assuntos
Bloqueio de Ramo , Terapia de Ressincronização Cardíaca , Eletrocardiografia , Ventrículos do Coração , Humanos , Síndrome
5.
Rev Med Suisse ; 16(709): 1891-1893, 2020 Oct 07.
Artigo em Francês | MEDLINE | ID: mdl-33026734

RESUMO

Eagle's syndrome is an unknown disease. Its suspicion is first and foremost clinical and his symptoms are diverse. The diagnosis is confirmed by imaging. Its management is surgical: resection of the styloid process by trans-oral or trans-amygdala route. Patients often consult several specialists and there are many investigations before the right diagnosis is made.


Assuntos
Cervicalgia/complicações , Cervicalgia/diagnóstico , Ossificação Heterotópica/complicações , Ossificação Heterotópica/diagnóstico , Osso Temporal/patologia , Humanos , Cervicalgia/cirurgia , Ossificação Heterotópica/cirurgia , Síndrome , Osso Temporal/cirurgia
8.
Zhonghua Yi Xue Za Zhi ; 100(38): 3005-3009, 2020 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-33086452

RESUMO

Objective: To summarize and compare clinicopathological features of Caroli disease and Caroli syndrome. Methods: A total of 21 patients diagnosed with Caroli disease or Caroli syndrome in Beijing Friendship Hospital, Capital Medical University, from January 2015 to December 2018 were included. Through the clinical manifestations and comparative analysis of the differences between different clinical types, the liver pathological features of these patients were described. Results: Of all patients included, 8 were male and 13 were female, and the medium age was 13.5 year old. The initial symptom was fever in 6 cases (28.6%), gastrointestinal bleeding in 6 cases (28.6%) and hepatosplenomegaly in 9 cases (42.8%). Caroli disease accounted for 6 cases (28.6%) and Caroli syndrome 15 cases (71.4%). The total bilirubin [6.7 (4.7, 15.0) vs 16.0(10.9, 33.0)µmol/L] and direct bilirubin [1.3(0.9,6.4)vs 3.5(2.7, 16.2)µmol/L] were significantly lower in Caroli disease group in comparison to those in Caroli syndrome group(both P<0.05). The hemoglobin [117.0 (106.0, 126.2) vs 85.0 (74.0, 103.0) g/L] and platelet count [286.0 (149.8, 467.5)×10(9)/L vs 76.1(55.0,123.0)×10(9)/L] in Caroli disease group were significantly higher than those in Caroli syndrome group (both P<0.05). There were 10 patients (47.6%) who underwent liver transplantation. Child-Pugh-Turcotte Score (liver function reserve) were significantly higher than that in the non-liver transplantation group[8.0(8.0, 10.2)vs 5.0 (5.0, 6.0), P<0.05]. Conclusions: Early symptoms of Caroli disease/Caroli syndrome are atypical and prone to misdiagnosis and misdiagnosis. The diagnosis is usually based on pathology and may be supplemented by laboratory examination and imaging analysis.


Assuntos
Doença de Caroli , Transplante de Fígado , Adolescente , Criança , Feminino , Humanos , Cirrose Hepática , Masculino , Síndrome
10.
Praxis (Bern 1994) ; 109(12): 939-943, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32933384

RESUMO

CME: Crowned-Dens-Syndrome - the Chameleon of Neck Pain Abstract. Crowned Dens Syndrome (CDS) is a rare, under-diagnosed differential diagnosis of acute neck pain. Diagnosis is a challenge in clinical practice due to the similarity of symptoms to other diseases. Knowing this differential diagnosis of acute neck pain, unnecessary examinations and expensive therapy attempts can be avoided with a targeted approach. With this article we would like to sensitize colleagues accordingly.


Assuntos
Condrocalcinose , Cervicalgia , Processo Odontoide , Diagnóstico Diferencial , Humanos , Cervicalgia/etiologia , Síndrome
11.
Medicine (Baltimore) ; 99(35): e21001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871860

RESUMO

BACKGROUND: Previous literature on epidural pneumatosis (pneumorrhachis, or air in epidural cavity) associated with forceful vomiting in a patient with diabetic ketoacidosis (DKA) has consisted of individual case reports without comprehensive syndrome characterization due to syndromic rarity, with the largest previous literature review comprising 6 cases. Presumed pathophysiology is air escaping from alveolar rupture from forceful vomiting via tissue planes to cause epidural pneumatosis. AIM: Systematically review literature to facilitate syndromic diagnosis, evaluation, and treatment. A new illustrative case is reported. METHODS: Systematic review of literature using 2 independent readers, 2 computerized databases, and the following medical terms/keywords: ["epidural pneumatosis" OR "pneumorrhachis"] AND ["diabetes" OR "diabetic ketoacidosis" or "DKA"]. Discrepancies between 2 readers were resolved by consensus using prospectively developed study inclusion criteria. Two readers independently abstracted case report. Prospective review protocol and patients, problems, intervene, comparison group, outcomes discussed in Methods section of paper. RESULTS-SYSTEMATIC-LITERATURE-REVIEW: Revealed 10 previously reported cases plus 1 new case (see below) that shows this syndrome presents rather stereotypically with the tentatively proposed following pentad (% of patients fulfilling individual criterion): 1-forceful vomiting (100%), 2-during DKA (100%), 3-pneumomediastinum from forceful alveolar rupture (100%), 4-epidural pneumatosis from air escape from pneumomediastinum (100%), and 5-no complications of Boerhaave syndrome or of focal neurological deficits (100%). Pentad is pathophysiologically reasonable because forceful vomiting can cause alveolar rupture, pneumomediastinum, and air entry into epidural space. RESULTS-ILLUSTRATIVE-CASE-REPORT: Epidural pneumatosis occurred in a 33-year-old-male with poorly controlled diabetes mellitus type 1 who presented with forceful vomiting while in DKA. Radiologic findings also included subcutaneous emphysema, pneumomediastinum, and small pneumothorax. The patient rapidly improved while receiving acute therapy for DKA, and was discharged after 2 hospital days. STUDY LIMITATIONS: Limited number of analyzed, retrospectively reported cases. Case reports subject to reporting bias. Specificity, positive predictive value, and negative predictive value not meaningfully analyzed in this homogeneous population. CONCLUSIONS: Based on systematic review, syndrome is tentatively proposed as a pentad with: 1-forceful vomiting, 2-during DKA, 3- pneumomediastinum, 4-epidural pneumatosis, and 5-no complications of Boerhaave syndrome or focal neurological deficits. Proposed pentad should be prospectively tested in a larger population including patients with this versus closely related syndromes.


Assuntos
Cetoacidose Diabética/complicações , Perfuração Esofágica/complicações , Doenças do Mediastino/complicações , Pneumorraque/diagnóstico , Radiografia Torácica/métodos , Vômito/complicações , Adolescente , Adulto , Tratamento Conservador/métodos , Feminino , Humanos , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Mediastínico/etiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/fisiopatologia , Pneumorraque/fisiopatologia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Valor Preditivo dos Testes , Estudos Prospectivos , Alvéolos Pulmonares/patologia , Estudos Retrospectivos , Ruptura/complicações , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Síndrome , Resultado do Tratamento , Adulto Jovem
12.
Medicine (Baltimore) ; 99(33): e21497, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871995

RESUMO

Selective serotonin reuptake inhibitors (SSRIs), commonly used to treat depression, are associated with loss of motivation, anergy, and lack of curiosity often referred collectively as apathy. However, this association has not been systematically assessed using a specific rating scale for measuring apathy syndrome. Our objective was to study the association between SSRI use and apathy syndrome.We conducted a retrospective chart review of 125 patients enrolled in an outpatient psychiatry clinic. The prevalence of apathy syndrome and its clinical significance (based on standardized assessment) were compared between patients treated and not treated with SSRIs. Apathy was assessed using the Apathy Evaluation Scale-clinician version with a score ranging 18-72 with higher score for worse apathy. A score of greater than 30 is considered clinically significant apathy.Among 119 patients, the mean apathy scores were significantly higher in those treated with SSRIs compared to those not treated with SSRIs (42.5 ±â€Š9.2 vs 31.3 ±â€Š6, P < .0001). The SSRI group also had a significantly higher percentage of patients with clinically significant apathy (92% vs 61%, P < .0001). Use of all SSRIs was associated with the presence of apathy. Apathy was seen in all mental health diagnostic categories with highest Apathy evaluation scale-clinician version scores in those with dementia.SSRI use may be associated with higher rates of apathy syndrome. Clinicians should specifically inquire about iatrogenic apathy syndrome when evaluating patients on an SSRI if there is suspicion of loss of motivation. Limitations of this study included retrospective nature of this study, and that majority of the sample was males. Prospective studies are needed to elucidate information regarding the prevalence, etiology, and treatment response for SSRI-associated apathy syndrome.


Assuntos
Apatia/efeitos dos fármacos , Transtorno Depressivo/tratamento farmacológico , Inibidores de Captação de Serotonina/efeitos adversos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome
13.
Rev Med Liege ; 75(9): 598-603, 2020 Sep.
Artigo em Francês | MEDLINE | ID: mdl-32909412

RESUMO

Penetration syndrome is common and dangerous. In front of any suspicion of inhalation of foreign bodies, an endoscopy is necessary and the anesthesia that accompanies this gesture is a real challenge given the complexity of the management and exposure of the airways. The anaesthesiologist is confronted with unsafe, partially obstructed airways and will have to share his workspace with surgeon colleagues while ensuring efficient ventilation and oxygenation. This is a real teamwork requiring close and permanent collaboration with the surgical team. Jet ventilation is a technique that is particularly useful and adapted to this type of operation. It offers undeniable advantages, such as continuity of the gesture, better visualization of the laryngeal structures and a clear operating field. Its use is constantly increasing. It is nevertheless a technique that requires regular training and is reserved for experienced anaesthesiologists in this field. This article covers the main principles of anaesthetic management of the penetration syndrome, highlighting the advantages of jet ventilation.


Assuntos
Obstrução das Vias Respiratórias , Anestesia , Manuseio das Vias Aéreas , Humanos , Respiração Artificial , Síndrome
14.
J Rehabil Med ; 52(9): jrm00100, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32896863

RESUMO

OBJECTIVE: We present a case report that complements the conclusion of Stam et al. in their call to rehabilitation facilities to anticipate and prepare to address post intensive care syndrome in post-Covid-19 patients. METHODS: The case report presented here provides insight into treating mechanically ventilated post-Covid-19 patients. RESULTS: Early intervention with dysphagia therapy and speech therapy and ventilator-compatible speak-ing valves, provided within an interprofessional collaborative team, can mitigate the potentially negative consequences of prolonged intubation, long-term use of cuffed tracheostomy, and post intensive care syndrome resulting from Covid-19. CONCLUSION: Such a treatment approach can be used to address what is important to patients: to be able to speak with family and friends, eat what they want, and breathe spontaneously.


Assuntos
Infecções por Coronavirus/reabilitação , Transtornos de Deglutição/reabilitação , Terapia da Linguagem/métodos , Pneumonia Viral/reabilitação , Pneumologia/métodos , Fonoterapia/métodos , Betacoronavirus , Infecções por Coronavirus/virologia , Cuidados Críticos , Transtornos de Deglutição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Equipe de Assistência ao Paciente , Pneumonia Viral/virologia , Respiração , Respiração Artificial/efeitos adversos , Fala , Síndrome , Traqueostomia/efeitos adversos , Traqueostomia/métodos
15.
Clin Dermatol ; 38(4): 399-407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972599

RESUMO

Genodermatoses are heritable skin diseases that can cause significant morbidity and mortality. Most of them show characteristic cutaneous findings. Genodermatoses can be associated with extracutaneous system abnormalities. Diagnosing hereditary skin disorders is still a challenging task due to their rarity and diversity, due to diseases evolving over many years, and the initial manifestations not always being diagnostic; therefore, ongoing evaluation and surveillance is often required to make the accurate diagnosis. The algorithm for the diagnosis depends on a combination of thorough clinical and family history clinical examination, laboratory findings, consultation of multiple medical specialists, and molecular analysis. Diagnostic testing targeted at differentiation of similar genodermatoses may be required. Recognition is crucial for the initiation of the treatment for skin manifestations and detection of other extracutaneous abnormalities, including malignancy. Diagnostic accuracy and molecular diagnosis may help in providing a template for ongoing management, testing, and education and prognostication for families of children with genodermatoses.


Assuntos
Técnicas e Procedimentos Diagnósticos , Doenças Raras , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/patologia , Pele/patologia , Algoritmos , Diagnóstico Precoce , Feminino , Testes Genéticos , Humanos , Masculino , Síndrome
16.
Clin Dermatol ; 38(4): 421-431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32972601

RESUMO

Café au lait spots are common birthmarks seen sporadically and in association with several genetic syndromes. Dermatologists are often asked to evaluate these birthmarks both by other physicians and by parents. In some cases, it is challenging to know when and how to pursue further evaluation. Diagnostic challenges may come in the form of the appearance of the individual lesions, areas and patterns of cutaneous involvement, and associated features (or lack thereof). In this review, we aim to clarify when and how to evaluate the child with multiple or patterned café au lait spots and to explain some emerging concepts in our understanding of the genetics of these lesions.


Assuntos
Manchas Café com Leite/congênito , Manchas Café com Leite/diagnóstico , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/genética , Dermatopatias Genéticas/diagnóstico , Dermatopatias Genéticas/genética , Pele/patologia , Proteínas Adaptadoras de Transdução de Sinal/genética , Manchas Café com Leite/genética , Manchas Café com Leite/patologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Deleção de Genes , Estudos de Associação Genética , Mutação em Linhagem Germinativa , Humanos , Lactente , Recém-Nascido , Masculino , Neurofibromatose 1/patologia , Neurofibromina 1/genética , Dermatopatias Genéticas/patologia , Síndrome
17.
Maturitas ; 140: 49-54, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32972635

RESUMO

OBJECTIVE: To compare the effects of a 12-week course of 5%Pueraria mirifica gel and placebo gel on the prevalence of bacterial vaginosis, vaginal fungi, vaginal pH, vaginal health index (VHI), and genitourinary symptoms in postmenopausal women. STUDY DESIGN: In a randomized, double-blinded, placebo-controlled study (TCTR20160517002), 60 postmenopausal women were randomly assigned to a 12-week course of eitherP. mirifica gel or identical placebo gel. MAIN OUTCOME MEASURE: Vaginal Nugent score, fungal culture, pH, VHI, and genitourinary symptoms were evaluated at baseline and after 12 weeks of treatment. RESULTS: After 12 weeks of treatment, the proportion of participants with an abnormal Nugent score in the P. mirifica and the placebo groups were 6.7 % (2/30) and 23.3 % (7/30), respectively (p =  0.006). The mean changes in Nugent scores and VHI were significantly higher in the P. mirifica group (p <  0.05). There were no significant decreases in the prevalence of symptoms between the two groups after treatment (p > 0.05). CONCLUSION: A 12-week course of treatment with 5 % P. mirifica vaginal gel in postmenopausal women with GSM has been proved to be effective in reducing indicators of bacterial vaginosis compared with placebo gel. Nevertheless, the effect on alleviating genital symptoms was not demonstrated.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Doenças Urogenitais Femininas/tratamento farmacológico , Micoses/tratamento farmacológico , Extratos Vegetais/uso terapêutico , Pueraria , Método Duplo-Cego , Feminino , Humanos , Concentração de Íons de Hidrogênio , Pessoa de Meia-Idade , Fitoterapia , Pós-Menopausa , Síndrome , Vagina/química , Vagina/efeitos dos fármacos , Cremes, Espumas e Géis Vaginais/uso terapêutico
19.
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
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