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Imre E, Imre E, Ozturk S. Initial handgrip strength as a predictive factor for amputation risk in diabetic foot patients. Rev Clin Esp 2024:S2254-8874(24)00058-4. [PMID: 38643901 DOI: 10.1016/j.rceng.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND We aimed to analyze the prognostic significance of handgrip strength as predictor of lower extremity amputation at 1 year follow up in patients with type 2 diabetes. METHODS We evaluated 526 patients with type 2 diabetes between August 2020, and, June 2022. We collected from the electronic medical records demographic variables, laboratory data and history of amputation. The handgrip strength was assessed using a handheld Smedley digital dynamometer following the NHANES Muscle Strenght/Grip Test Procedure. Low handgrip strength was defined for women as less than 16 kg and for men less than 27 kg. Outcome variable was major or minor lower extremity amputation. RESULTS A total of 205 patients with complete data entered the study. Patients mean age was 59 years old, 37% were women and the mean diabetes disease duration was 14 years. Seventy-seven (37%) patients suffered from lower extremity mputations (26 major and 51 minor amputations). After controlling for age, gender, presence of peripheral artery disease, body mass index and white cell counts as confounder variables, patients with low handgrip had an increased risk for amputations (Odds Ratio 2.17; 95% confidence Interval: 1.09-4.32; <0.001). CONCLUSION Low handgrip stregth is an independent prognostic marker for lower limb amputation at one year in patients with diabetes.
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Affiliation(s)
- E Imre
- Marmara University Medical Faculty, Endocrinology and Metabolism Department.
| | - E Imre
- Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Orthopaedics and Traumatology.
| | - S Ozturk
- Gaziantep Dr. Ersin Arslan Training and Research Hospital, Endocrinology and Metabolism.
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Bermejo Olano MDM, Campelo Gutierrez C, Hervas Gómez R, Alfayate García JM, Sánchez Ríos JP, Moreno Núñez L. [Risk factors associated with osteomyelitis due to Corynebacterium striatum in patients with diabetic foot]. Med Clin (Barc) 2024; 162:15-18. [PMID: 37981483 DOI: 10.1016/j.medcli.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Corynebacterium striatum (CS) is an emerging micro-organism in diabetic foot infection for which there are currently few studies. The objective was to analyze the risk factors (RF) related to CS osteomyelitis in patients with diabetic foot. METHODS A case-control study was conducted in the Diabetic Foot Unit between 2015 and 2021. Forty-four patients with osteomyelitis due to CS (cases) and 44 patients with osteomyelitis due a different micro-organism (controls) were included. RESULTS Peripheral artery disease (OR: 2.8, p = 0.037), atrial fibrillation (OR: 3.7, p = 0.034), ischemic diabetic foot (OR: 3.3, p = 0.020) and previous prolonged antibiotic therapy more than 14 days (OR: 3.4, p = 0.012) were identified as RF for osteomyelitis due to CS. When performing the multivariate analysis antibiotic therapy >14 days was independent RF (OR: 3.46; p = 0.017). CONCLUSIONS Previous antibiotic therapy received more than 14 days is an independent and statistically significant RF for CS osteomyelitis in patients with diabetic foot.
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Affiliation(s)
| | | | - Rafael Hervas Gómez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España
| | | | | | - Leonor Moreno Núñez
- Unidad de Infecciosas, Hospital Universitario Fundación Alcorcón, Madrid, España.
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Piñar-Gutiérrez A, Gros-Herguido N, Losada-Viñau F, Farfán-Díaz F, Enríquez-Macías M, Pérez-Morales A, González-Navarro I, Acosta-Delgado D, Guerrero-Vázquez R, Martínez-Ortega AJ, Pumar-López A, Mangas-Cruz MÁ, Bataller-de Juan E, Tallón-Aguilar L, Soto-Moreno A. Outcomes of a multidisciplinary Diabetic Foot Day Unit. ENDOCRINOL DIAB NUTR 2023; 70:381-388. [PMID: 37356875 DOI: 10.1016/j.endien.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/29/2021] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To analyse the main characteristics of patients and the health outcomes obtained and to evaluate the impact of peripheral artery disease (PAD) in patients treated in our multidisciplinary Diabetic Foot Unit. RESEARCH DESIGN AND METHODS Observational prospective study. 273 patients from two different populations (with and without PAD - classified according to the presence of distal pulses) treated over a 14-month period in the multidisciplinary Diabetic Foot Unit were included. The data on patient characteristics and outcomes were analysed for the purpose of comparison. For the inference study, a comparison of medians with the non-parametric test for independent samples for the quantitative variables and a χ2 test for the comparison of proportions in qualitative variables were performed. RESULTS Patients with PAD ulcers were older (60 (54-67) vs. 64 (75-81), p=0.000) and had a higher macrovascular burden (8.1% vs. 29% for ischaemic heart disease history, p=0.000; 6.7% vs. 18.1% for cerebrovascular disease history, p=0.004). Their Texas Score was higher (p=0.000) and their major amputation rate was higher (1.4% vs. 12.3%, p=0.001). They had less background of previous ulcers (52.6% vs. 26.8%, p=0.000), their episode duration was shorter (4 (0-10) vs. 0 (0-3) weeks, p=0.000), and their proportional need for antibiotic therapy was lower (64.4% vs. 51.4%, p=0.03). CONCLUSIONS The differences found between ulcers with and without vascular involvement support the need for a different approach and for the inclusion of vascular surgeons on the team. The multidisciplinary care model for diabetic foot patients could be effective and improve health outcomes.
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Affiliation(s)
- Ana Piñar-Gutiérrez
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Noelia Gros-Herguido
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fernando Losada-Viñau
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Fátima Farfán-Díaz
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Ana Pérez-Morales
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | - Alfonso Pumar-López
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | - Luis Tallón-Aguilar
- UGC Cirugía General, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Alfonso Soto-Moreno
- UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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4
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Iruela Sánchez M, García-Sierra R, Lladó Blanch M, Naveros Almenara F, Seda G, Torán-Monserrat P. [Typology of wounds treated in primary care: Multicenter cross-sectional study]. Semergen 2023; 49:101964. [PMID: 37075519 DOI: 10.1016/j.semerg.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The care of people with skin wounds is an important health problem, that affect the quality of life of patients and their families, and has a great socioeconomic impact. Knowing the situation of the problem is the first step for different health approaches. In our territory since 2010 no type of follow-up has been carried out on the wounds that we are treating, we propose to know the typology and characteristics of active wounds in the population assisted by Primary Care. METHODS Multicenter cross-sectional descriptive study carried out in a metropolitan area of Catalonia in Primary Care Teams and residences. Participants were all patients with active wounds. A record made by the patient's referring nurses was used. A descriptive analysis of the data was performed. RESULTS About 1,978 people participated, presenting 2,471 injuries. The overall prevalence was 0.22%. At home patients, the prevalence was 3.58% and in nursing homes, 6.56%. Of all the lesions, 46.5% were acute and 53.4% chronic, the mean size was 3.13cm. Of the chronic wounds, 345 (26.2%) had an evolution of more than 1year. The most prevalent injuries were venous ulcers in Primary Care Teams and categoryII pressure injuries in residential centers. CONCLUSIONS The results of this study present an objective reality about the injuries that are treated in primary care, both in Primary Care Centers, homes or residences, as well as their description.
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Affiliation(s)
- M Iruela Sánchez
- Direcció d'Atenció Primària Metropolitana Nord, Institut Català de la Salut, Barcelona, España; Grup de Recerca Multidisciplinar en Salut i Societat 2021 SGR 01484, Mataró, Barcelona, España
| | - R García-Sierra
- Grup de Recerca Multidisciplinar en Salut i Societat 2021 SGR 01484, Mataró, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Barcelona, España; Departamento de Enfernería, Facultad de Medicina, Campus Bellaterra, Universitat Autònoma de Barcelona, Barcelona, España; Grupo de Atención Primaria, Instituto Germans Trias i Pujol, Badalona, Barcelona, España.
| | - M Lladó Blanch
- Direcció d'Atenció Primaria Metropolitana Nord, Servei d'Atenció Primaria Barcelonès Nord-Maresme, Institut Català de la Salut
| | - F Naveros Almenara
- Direcció d'Atenció Primaria Metropolitana Nord, Servei d'Atenció Primària Vallès Occidental, EAP Sant Quirze del Vallès, Institut Català de la Salut, Sant Quirze del Vallès, Barcelona, España
| | - G Seda
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Barcelona, España
| | - P Torán-Monserrat
- Grup de Recerca Multidisciplinar en Salut i Societat 2021 SGR 01484, Mataró, Barcelona, España; Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Barcelona, España; Grupo de Atención Primaria, Instituto Germans Trias i Pujol, Badalona, Barcelona, España; Facultad de Medicina, Universitat de Girona, Girona, España
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Bonilla-Carrasco MI, Rasero-Fernández E, Aguayo-González M, Rafael-Gutiérrez SS. "Self-care of the feet in people with type 2 diabetes. A qualitative study". Enferm Clin (Engl Ed) 2023:S2445-1479(23)00021-8. [PMID: 37060942 DOI: 10.1016/j.enfcle.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 01/25/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVE To understand the experiences of adults over 65 years of age with type 2 diabetes mellitus, regarding foot self-care. METHOD Qualitative phenomenological study with a descriptive approach. It is carried out in the facilities of the Primary Care Center of Les Planes de Sant Joan Despí, Barcelona, belonging to the Catalan Institute of Health. For the data collection, a semi-structured and individual interview was used, with a script of basic aspects to be explored, not closed and focused on the objectives of the research. The interviews were carried out between June 2019 and December 2020. A thematic analysis was carried out concomitantly with the collection of these. RESULTS A final sample of 13 persons (4 men and 9 women) participated in the study. Adherence to diabetic foot self-care recommendations is irregular. Participants explain risky behaviours despite knowing that they can cause injury to feet previously considered high risk. The evaluation of the podiatrist supposes an economic cost that some people cannot afford. CONCLUSIONS The nurse has to do an exhaustive follow-up of how persons with diabetes take care of her feet, insisting on preventive recommendations not only in the annual review but every time the person attends the diabetes follow-up consultation. Effective nurse-podiatrist communication is needed to improve prevention and follow-up of people at risk of diabetic foot disease.
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Affiliation(s)
- María Isabel Bonilla-Carrasco
- Enfermera Asistencial CAP Les Planes, Sant Joan Despí. Profesora asociada del Departamento de Enfermería de la Facultad de Medicina de la Universidad Autónoma de Barcelona (UAB). Bellaterra. Spain.
| | - Elisabeth Rasero-Fernández
- Enfermera Asistencial CAP Les Planes, Sant Joan Despí. Profesora asociada del departamento de Enfermería de la Universidad de Barcelona (UB), Spain
| | - Mariela Aguayo-González
- Profesora asociada del Departamento de Enfermería de la Facultad de Medicina de la Universidad Autónoma de Barcelona (UAB). Bellaterra, Spain
| | - Sabiniana San Rafael-Gutiérrez
- Profesora colaboradora permanente del Departamento de Enfermería de la Facultad de Medicina de la Universidad Autónoma de Barcelona (UAB). Bellaterra, Spain
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6
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Navarro-Jiménez G, Fuentes-Santos C, Moreno-Núñez L, Alfayate-García J, Campelo-Gutierrez C, Sanz-Márquez S, Pérez-Fernández E, Velasco-Arribas M, Hervás-Gómez R, Martín-Segarra O, Losa-García JE. Experience in the use of dalbavancin in diabetic foot infection. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:296-301. [PMID: 35490091 DOI: 10.1016/j.eimce.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate is estimated at 90 days after finishing the treatment. RESULTS A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000 mg followed by 500 mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.
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Affiliation(s)
- Gema Navarro-Jiménez
- Servicio de Medicina interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | | | - Leonor Moreno-Núñez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Jesús Alfayate-García
- Servicio de Cirugía Vascular, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | | | - Sira Sanz-Márquez
- Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Elia Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - María Velasco-Arribas
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Rafael Hervás-Gómez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Oriol Martín-Segarra
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Juan Emilio Losa-García
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Jesus FRMD, Ibrahim A, Rodriguez-Ramirez N, Zambrano-Loaiza E. The latin american Saint Elian wound score system (sewss) for the triage of the diabetic foot attack. CIR CIR 2021; 89:679-685. [PMID: 34665181 DOI: 10.24875/ciru.20000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To review the global and regional contributions of the Saint Elian Wound Score System (SEWSS) for the diabetic foot syndrome are the aim of this report. The update includes definitions, classification, diagnosis, treatment, prognosis, and prevention to reduce amputations and mortality. From its local use in Mexico to their global spread as part of the Clinical Practice Recommendations of the Diabetic Foot - International Diabetes Federation-2017, the SEWSS has achieved a significant acceptance for the diabetic foot problem care in Latin America. The concept includes the triage of severity grades system for the five types of Diabetic Foot Attack (DFA) due to ischemia, infection, edema, neuropathy (Charcot), or a mixed combination. Persons with Diabetes Mellitus may progress from the low-risk stage to foot attack that may remite to a high risk stage or conversely, evolve to a major amputation or death. The DFA progressive stages (I-III) are described in this review. The clinical details provided by the assessment of the 10 Saint Elian factors permit a rationale therapeutic approach with relevance in prevention and medical treatment and not focused only on wound care avoiding bias originated by specialty-related preferences.
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Affiliation(s)
- Fermín R Martínez-De Jesus
- Academia Mexicana de Cirugía, Mexico City, Mexico.,Diabetic Foot Unit, Saint Elian Center for Prevention and Salvage of the Diabetic Foot, Veracruz, Mexico.,Scientific Committee. The Latin American Diabetic Foot Society, Veracruz, Mexico
| | - Ammar Ibrahim
- Scientific Committee. The Latin American Diabetic Foot Society, Veracruz, Mexico
| | - Neftalí Rodriguez-Ramirez
- Diabetic Foot Unit, Saint Elian Center for Prevention and Salvage of the Diabetic Foot, Veracruz, Mexico.,Scientific Committee. The Latin American Diabetic Foot Society, Veracruz, Mexico.,General direction, Instituto Nacional de Diabetes, Endocrinología y Nutrición (INDEN), Santo Domingo,Dominican Republic; 5Vascular Surgery Department, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Elizabeth Zambrano-Loaiza
- Diabetic Foot Unit, Saint Elian Center for Prevention and Salvage of the Diabetic Foot, Veracruz, Mexico.,Scientific Committee. The Latin American Diabetic Foot Society, Veracruz, Mexico
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Moreno Carrillo MA, Martínez Gómez DA, Martínez González-Moro I, Lozano Guadalajara JV. [Multidisciplinary unit specialized in the treatment of diabetic foot: Evaluation and results]. Rehabilitacion (Madr) 2021; 56:56-63. [PMID: 34521549 DOI: 10.1016/j.rh.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/05/2021] [Accepted: 08/05/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In this study the evaluation of the care process of the diabetic foot will be carried out after the implementation of an intra-hospital clinical pathway and a multidisciplinary consultation. OBJECTIVES Evaluate the influence on factors related to the care, amputations, and rehabilitation of the amputee patient. METHODOLOGY Retrospective study, in which the comparison of three periods has been made. First (3years): Before the implantation of the pathway. Second (5years): After the implementation of the pathway. Third (10years): After the implementation of the consultation. RESULTS A specialized consultation in diabetic foot care contributes to a reduction in femoral and minor amputations. The assessment and treatment by rehabilitation of patients undergoing major amputation has been optimized. CONCLUSION The implantation of the pathway and consultation contributes to the preservation of the lower limb. However, the incidence remains high, suggesting that diabetic foot care remains suboptimal.
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Affiliation(s)
- M A Moreno Carrillo
- Servicio de Rehabilitación, Hospital Universitario Morales Meseguer, Murcia, España.
| | - D A Martínez Gómez
- Servicio de Cirugía, Hospital Universitario Morales Meseguer, Murcia, España
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Lázaro Martínez JL, Almaraz MC, Álvarez Hermida Á, Blanes Mompó I, Escudero Rodríguez JR, García Morales EA, March García JR, Rivera San Martín G, Rodríguez Sáenz de Buruaga V, Rosendo Fernández JM, Rubio García JA, Mauricio D. Consensus document on actions to prevent and to improve the management of diabetic foot in Spain. ENDOCRINOL DIAB NUTR 2021; 68:509-513. [PMID: 34863416 DOI: 10.1016/j.endien.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/21/2020] [Indexed: 06/13/2023]
Affiliation(s)
| | - María Cruz Almaraz
- Servicio de Endocrinología y Nutrición del Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | - Ignacio Blanes Mompó
- Servicio de Angiología y Cirugía Vascular del Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - José Ramón March García
- Servicio de Angiología y Cirugía Vascular del Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Gabriel Rivera San Martín
- Unidad de Pie Diabético. Servicio de Angiología y Cirugía Vascular del Hospital Universitario de Donostia, País Vasco, Spain
| | | | | | - José Antonio Rubio García
- Unidad Funcional de Pie Diabético. Servicio de Endocrinología y Nutrición del Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Didac Mauricio
- Servicio de Endocrinología y Nutrición. CIBERDEM. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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10
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Herraiz-Adillo Á, Cervera-Monteagudo B, Cruz-López MV, Molina-Morate Á, Romero-Parrilla JJ. Prevalence of leg ulcers in the province of Cuenca: A study in Primary Care. Enferm Clin (Engl Ed) 2021; 31:371-380. [PMID: 34116977 DOI: 10.1016/j.enfcle.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment. METHOD Observational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the "Gerencia de Atención Integrada de Cuenca" (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected. RESULTS In total, 152 professionals (response rate = 98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5 ± 12.6 years old) with 75 ulcers were identified, finding an overall prevalence of .480‰ (CI 95%: .375-.614), distributed as: venous ulcer .274‰ (n = 36), diabetic foot .145‰ (n = 19), and arterial ulcer .061‰ (n = 8). The prevalence was similar regarding gender (.535‰ vs .426‰, respectively, p = .365), but men exhibited more diabetic foot (.214‰ vs .076‰, p = .037). In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64+ age group. The median of the leg ulcer duration and corrected area were 190.0 ± 340.0 days and 5.0 ± 13.7 cm2, respectively, with a recurrence rate of 74.7%. CONCLUSIONS The prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.
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Affiliation(s)
- Ángel Herraiz-Adillo
- Centro de Salud de Tragacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, Spain
| | - Beatriz Cervera-Monteagudo
- Servicio de Formación, Docencia e Investigación, Gerencia de Atención Integrada de Cuenca, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, Spain.
| | - María Victoria Cruz-López
- Gerencia de Atención Integrada de Cuenca, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, Spain
| | - Ángeles Molina-Morate
- Centro de Salud Cuenca I, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, Spain
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11
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Herraiz-Adillo Á, Cervera-Monteagudo B, Cruz-López MV, Molina-Morate Á, Romero-Parrilla JJ. Prevalence of leg ulcers in the province of Cuenca: a study in Primary Care. Enferm Clin (Engl Ed) 2021; 31:S1130-8621(21)00039-5. [PMID: 33685779 DOI: 10.1016/j.enfcli.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/18/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence of leg ulcers, and to describe the affected patients, wounds, and treatment. METHOD Observational, cross-sectional prevalence study. An ad hoc online questionnaire was sent to all nurses attending Primary Care centres of the "Gerencia de Atención Integrada de Cuenca" (Integrated Care Management of Cuenca, Spain). Data regarding patient sociodemographic and clinical variables, lesion characteristics and the type of intervention (concerning prevention and treatment) were collected. RESULTS In total, 152 professionals (response rate=98.1%) completed the questionnaire, collecting data from 131,190 inhabitants. A total of 63 patients (75.5±12.6 years old) with 75 ulcers were identified, finding an overall prevalence of 0.480‰ (CI 95%: 0.375-0.614), distributed as: venous ulcer 0.274‰ (n=36), diabetic foot 0.145‰ (n=19), and arterial ulcer 0.061‰ (n=8). The prevalence was similar regarding gender (0.535‰ vs. 0.426‰, respectively, p=.365), but men exhibited more diabetic foot (0.214‰ vs. 0.076‰, p=.037). In all three types of lesions prevalence increased with age, reaching 1.743‰ in 64+age group. The median of the leg ulcer duration and corrected area were 190.0±340.0 days and 5.0±13.7cm2, respectively, with a recurrence rate of 74.7%. CONCLUSIONS The prevalence of chronic leg ulcers was lower than that reported in other studies, although with high recurrence rates. Overall estimators from previous studies may have overestimated the prevalence, especially in regions with a high rural component.
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Affiliation(s)
- Ángel Herraiz-Adillo
- Centro de Salud de Tragacete, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, España
| | - Beatriz Cervera-Monteagudo
- Servicio de Formación, Docencia e Investigación, Gerencia de Atención Integrada de Cuenca, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, España.
| | - María Victoria Cruz-López
- Gerencia de Atención Integrada de Cuenca, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, España
| | - Ángeles Molina-Morate
- Centro de Salud Cuenca I, Servicio de Salud de Castilla-La Mancha (SESCAM), Cuenca, España
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Martínez-Escalante JE, Romero-Ibargüengoitia ME, Plata-Álvarez H, López-Betancourt G, Otero-Rodríguez R, Garza-Cantú AA, Corral-Guerrero ME. Pie diabético en México: factores de riesgo para mortalidad posterior a una amputación mayor, a 5 años, en un hospital de salud pública de segundo nivel. CIR CIR 2021; 89:284-290. [PMID: 34037604 DOI: 10.24875/ciru.20000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJETIVO Investigar de manera retrospectiva a 5 años el porcentaje de mortalidad en los pacientes operados de amputación mayor por pie diabético e identificar los factores de riesgo asociados que aumentan la mortalidad en la población mexicana. MÉTODO Estudio retrospectivo de pacientes sometidos a amputación mayor por pie diabético del 1 de enero al 31 de diciembre de 2009 en un hospital de segundo nivel. RESULTADOS Se incluyeron en el protocolo de estudio 37 pacientes que cumplían los criterios de inclusión, y se encontró que 10 (27.03%) continuaban con vida y 27 (72.97%) habían fallecido. Los pacientes a quienes se realizó una amputación y tenían tres o más enfermedades concomitantes mostraron un riesgo 1.6 veces más alto de morir (p = 0.018). Cuanto mayor era la glucemia previa al momento de la amputación, mayor fue la probabilidad de muerte a 5 años (p = 0.015). CONCLUSIONES En México hacen falta estudios con seguimiento prospectivo, de carácter multicéntrico, con una muestra heterogénea, que permitan tener un panorama nacional. OBJECTIVE To investigate retrospectively at 5 years the mortality rate in postoperative patients of major amputation secondary to diabetic foot and to identify the associated risk factors that increase mortality in the Mexican population. METHOD Retrospective study that included patients who underwent major amputation secondary to diabetic foot from January 1 to December 31, 2009 in a second-level hospital. RESULTS 37 patients who met the inclusion criteria were included in the study protocol, finding that 10 patients (27.03%) were still alive and 27 patients (72.97%) had died. Observing In patients who undergo an amputation and have three or more comorbidities, they have a 1.6 times higher risk of dying (p = 0.018) and that the higher the glycemia prior to the amputation, the greater the probability of dying at 5 years (p = 0.015). CONCLUSIONS Studies are needed in Mexico with prospective follow-up, multicenter in nature, with a heterogeneous sample, which allows us to have a National panorama.
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Affiliation(s)
| | | | | | | | | | - Alan A Garza-Cantú
- Servicio de Coloproctología, Hospital General de México, Ciudad de México, México
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13
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Navarro-Jiménez G, Fuentes-Santos C, Moreno-Núñez L, Alfayate-García J, Campelo-Gutierrez C, Sanz-Márquez S, Pérez-Fernández E, Velasco-Arribas M, Hervás-Gómez R, Martín-Segarra O, Losa-García JE. Experience in the use of dalbavancin in diabetic foot infection. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(20)30416-X. [PMID: 33451810 DOI: 10.1016/j.eimc.2020.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the clinical experience with dalbavancin in the treatment of diabetic foot infection in a multidisciplinary unit of a second level hospital. METHODS A retrospective, descriptive study was made with all patients with diabetic foot infection treated with dalbavancin in the Diabetic Foot Unit of Hospital Universitario Fundación Alcorcón, covering the period from September 2016 to December 2019. Demographic parameters and comorbidities, characteristics of the infection and treatment with dalbavancin were recorded. The cure rate was estimated at 90 days after finishing the treatment. RESULTS A total of 23 patients with diabetic foot infection (osteomyelitis) started treatment with dalbavancin, 19 were men and the mean age was 65 years. The microorganisms most frequently isolated for the indication of treatment with dalbavancin were Staphylococcus aureus (11) and Corynebacterium striatum (7). Dalbavancin was used as a second choice therapy in 22 cases, in 11 due to toxicity from other antibiotics. The median duration of treatment was 5 (4-7) weeks; the most frequent dose of dalbavancin (8 patients) was 1000mg followed by 500mg weekly for 5 weeks. 3 patients presented mild side effects (nausea and gastrointestinal discomfort). At 90 days after completion of dalbavancin therapy, 87% (20) of the patients were cured (95% CI: 65.2%-94.52%). CONCLUSION Patients with osteomyelitis due to gram-positive microorganisms who received as part of the multidisciplinary antibiotic treatment with dalbavancin, had a high rate of cure with adequate tolerance and few side effects. Dalbavancin offers a safe alternative in treating deep diabetic foot infection.
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Affiliation(s)
- Gema Navarro-Jiménez
- Servicio de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | | | - Leonor Moreno-Núñez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Jesús Alfayate-García
- Servicio de Cirugía Vascular, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - Sira Sanz-Márquez
- Servicio de Farmacia, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Elia Pérez-Fernández
- Unidad de Investigación, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - María Velasco-Arribas
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Rafael Hervás-Gómez
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Oriol Martín-Segarra
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Juan Emilio Losa-García
- Sección de Enfermedades Infecciosas, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Martínez-Alberto CE, Brito-Brito PR, Fernández-Gutiérrez DA, Cabrera-García P, García-Hernández AM, Darias-Curvo S, Aguirre-Jaime A. Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure. Enferm Clin (Engl Ed) 2019; 30:89-98. [PMID: 31515153 DOI: 10.1016/j.enfcli.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 06/20/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. METHODS The study was carried out in three phases. 1)Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2)Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3)Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. RESULTS The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. CONCLUSIONS NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use.
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Affiliation(s)
- Carlos E Martínez-Alberto
- Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
| | - P Ruymán Brito-Brito
- Gerencia de Atención Primaria de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | | | - Patricia Cabrera-García
- Servicio de Endocrinología, Complejo Hospitalario Universitario de Canarias, Servicio Canario de la Salud, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España
| | - Alfonso M García-Hernández
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de la Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España
| | - Sara Darias-Curvo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de la Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España
| | - Armando Aguirre-Jaime
- Departamento de Salud Pública de la Universidad Europea de Canarias, miembro de Laureate International Universities, Instituto de Investigación en Cuidados del Ilustre Colegio de Enfermeros de Santa Cruz de Tenerife, Santa Cruz de Tenerife, España
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15
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González-de la Torre H, Quintana-Lorenzo ML, Lorenzo-Navarro A, Suárez-Sánchez JJ, Berenguer-Pérez M, Verdú-Soriano J. Diabetic foot self-care and concordance of 3diabetic foot risk stratification systems in a basic health area of Gran Canaria. Enferm Clin (Engl Ed) 2020; 30:72-81. [PMID: 31500959 DOI: 10.1016/j.enfcli.2019.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 07/19/2019] [Accepted: 07/30/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the level of self-care in the population with diabetes and determine the risk of diabetic foot lesions through the use of 3stratification systems as well as to establish the degree of concordance between these systems. METHOD Observational, cross-sectional and descriptive study carried out in the Basic Health Area of Santa Brígida (Gran Canaria-Canary Islands-Spain) in people diagnosed with diabetes (DM Type 1/DM Type 2) (n=182). Interview, physical examination, review of clinical history and completion of the Diabetic Foot Self-Care questionnaire of the University of Malaga were carried out. The risk stratification was then calculated using 3systems (System of the National Institute for Health Care Excellence, Classification of the International Working Group on the Diabetic Foot and High-Risk Diabetic Foot-60-Second Tool©-2012). The Kappa index was calculated to study the concordance between systems, the relative risk of negative screening of one method against another was estimated and the exact Fisher test to establish whether there were differences. RESULTS 30.2% of diabetics had a low level of self-care, 45.1% a medium level and 24.7% a high level. The risk levels calculated were: National Institute for Health Care Excellence Classification (Negative Risk 71.4%-Positive Risk 28.6%), International Working Group on the Diabetic Foot Classification (Negative Risk 67.0%-Positive Risk 33.0%) and High-Risk Diabetic Foot-60-Second Tool© (Negative Risk 62.6%-Positive Risk 37.4%). CONCLUSIONS All 3systems have good concordance with each other. The High-Risk Diabetic Foot-60-Second Tool© only distinguishes 2levels of risk but detects a higher percentage of people at risk. The Diabetic Foot Self-Care questionnaire of the University of Malaga may be useful in the context of Primary Care to assess the level of self-care of people with diabetes.
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16
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Noriega-Álvarez E, Domínguez Gadea L, Orduña Diez MP, Peiró Valgañón V, Sanz Viedma S, García Jiménez R. Role of Nuclear Medicine in the diagnosis of musculoskeletal infection: a review. Rev Esp Med Nucl Imagen Mol 2019; 38:397-407. [PMID: 31488365 DOI: 10.1016/j.remn.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/02/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Inflammatory and infectious osteoarticular diseases can cause serious consequences for the patient if they are not diagnosed on time. In the last decades, different modalities of nuclear medicine have allowed to study the physiopathology of these processes, and nowadays, they play an important role in diagnosis, characterization and monitoring of musculoskeletal infectious diseases. Therefore, it is essential that every nuclear medicine physician have a vision of the advantages and disadvantages of each method and know how to use them correctly in the diagnosis of the patient. This article highlights the role of nuclear medicine in standardizing the diagnostic approach in patients with infectious/inflammatory diseases, in particular in peripheral osteomyelitis, septic arthritis, prosthetic joint infections, infected diabetic foot and spinal infections. The authors reveal the role of the most common radionuclides tests, with their advantages and clinical indications, to achieve an adequate diagnosis of infection and inflammation.
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Affiliation(s)
- E Noriega-Álvarez
- Servicio de Medicina Nuclear, Hospital General Universitario de Ciudad Real, Ciudad Real, España; Grupo de Patología Musculoesquelética de la SEMNIM.
| | - L Domínguez Gadea
- Grupo de Patología Musculoesquelética de la SEMNIM; Servicio de Medicina Nuclear, Hospital Universitario La Paz, Madrid, España
| | - M P Orduña Diez
- Grupo de Patología Musculoesquelética de la SEMNIM; Servicio de Medicina Nuclear, Hospital Universitario Ramón y Cajal, Madrid, España
| | - V Peiró Valgañón
- Grupo de Patología Musculoesquelética de la SEMNIM; Diagnóstico por Imagen, Hospital Universitario de Fuenlabrada, Madrid, España
| | - S Sanz Viedma
- Grupo de Patología Musculoesquelética de la SEMNIM; Servicio de Medicina Nuclear, Hospital Universitario Virgen de la Victoria, Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)
| | - R García Jiménez
- Grupo de Patología Musculoesquelética de la SEMNIM; Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España
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Astasio-Picado Á, Escamilla Martínez E, Gómez-Martín B. Comparative thermal map of the foot between patients with and without diabetes through the use of infrared thermography. Enferm Clin (Engl Ed) 2019; 30:119-123. [PMID: 30630674 DOI: 10.1016/j.enfcli.2018.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study is to analyze, through the use of infrared thermography, the variability of foot temperature in diabetic and non-diabetic patients by segmenting the sole of the foot in four study areas. METHOD A cross-sectional study was proposed on a sample of 479 subjects divided into two groups, a group of people with diabetes and a group of people without diabetes. The diabetes group comprised a total of 277 people, with an average age of 63.41 years, [138 men (49.8%) and 139 women (50.2%)], and the group without diabetes comprised 202 individuals, with an average age of 61.92 years, [99 men (49%) and 103 women (51%)]. The images were taken using the FLIR E60bx® camera. IBM SPSS Statistics 22 software was used for the statistical data analysis. RESULTS The results show temperature variability in the different areas of study of the sole of the foot bilaterally and there were also differences according to whether the patient belonged to the diabetic or the non-diabetic group. CONCLUSIONS The use of infrared thermography in the evaluation of the foot at risk could demonstrate the variability of temperature by study area, which could be useful in the area of healthcare for the diagnosis and prevention of injuries to compromised areas of the foot.
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Affiliation(s)
- Álvaro Astasio-Picado
- Departamento de Enfermería y Fisioterapia, Universidad de Castilla-La Mancha, Talavera de la Reina, España.
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Doria M, Viadé J, Palomera E, Pérez R, Lladó M, Costa E, Huguet T, Reverter JL, Serra-Prat M, Franch-Nadal J, Mauricio D. Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain. ACTA ACUST UNITED AC 2018; 65:479-485. [PMID: 30108031 DOI: 10.1016/j.endinu.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
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Affiliation(s)
- Montserrat Doria
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Diabetic Foot Unit, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jordi Viadé
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Ricard Pérez
- Department of Radiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Melcior Lladó
- Diabetic Foot Unit, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Elisabet Costa
- Department of Endocrinology and Nutrition, University Hospital Josep Trueta, Girona, Spain
| | - Teresa Huguet
- Diabetic Foot Unit, University Hospital Mutua, Terrassa, Spain
| | - Jordi Lluís Reverter
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Josep Franch-Nadal
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
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Hinojosa CA, Boyer-Duck E, Anaya-Ayala JE, Núñez-Salgado AE, Laparra-Escareno H, Lizola R. Impact of revascularization and factors associated with limb salvage in patients with diabetic foot. GAC MED MEX 2018; 154:190-197. [PMID: 29733065 DOI: 10.24875/gmm.18002772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Diabetic foot is a common cause of hospitalization. Objective To examine the impact of revascularization on lower limb salvage. Method Retrospective study of diabetic patients with foot ulcers. The extent of tissue loss was assessed according to the PEDIS and Wagner classifications, and revascularization indications and techniques were evaluated. Factors involved with major amputation and limb salvage were assessed with Fisher's and chi-square tests. Results A total of 307 patients with a mean age of 61 years were included in the study; 198 (64%) were males; 53 (17%) underwent limb revascularization, 26 (8%) with endovascular techniques and 27 (9%) with open surgery; 27 belonged to PEDIS grade 3 (51%) and 21 (41%) to Wagner's classification grade 4; 52% of revascularized patients required major amputation versus 25% of those without revascularization. Comorbidities, demographic variables, complications and mortality showed no differences when patients who required major amputation were compared with those who didn't. Conclusion Despite revascularization, the limb was preserved in less than 50% of patients. Early referral to vascular surgery and appropriate patient-selection criteria might increase limb salvage.
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Affiliation(s)
- Carlos A Hinojosa
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
| | - Estefanía Boyer-Duck
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
| | - Javier E Anaya-Ayala
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
| | - Ana E Núñez-Salgado
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
| | - Hugo Laparra-Escareno
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
| | - René Lizola
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Dirección de Cirugía, Sección de Angiología y Cirugía Vascular. Ciudad de México, México
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García Jiménez R, García-Gómez FJ, Noriega Álvarez E, Calvo Morón C, Martín-Marcuartu JJ. Hybrid imaging in foot and ankle disorders. Rev Esp Med Nucl Imagen Mol 2017; 37:191-202. [PMID: 29221678 DOI: 10.1016/j.remn.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/24/2017] [Accepted: 10/09/2017] [Indexed: 11/29/2022]
Abstract
Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients' quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease.
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Affiliation(s)
- R García Jiménez
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - F J García-Gómez
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - E Noriega Álvarez
- Medicina Nuclear, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
| | - C Calvo Morón
- Medicina Nuclear, Hospital Universitario Virgen Macarena, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM.
| | - J J Martín-Marcuartu
- Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, España; Grupo de Patología Músculo-Esquelética de la SEMNIM
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21
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Rodríguez GJ, Córdoba-Doña JA, Escolar-Pujolar A, Aguilar-Diosdado M, Goicolea I. [Family, socioeconomic status and health services: Clues to health care in diabetic patients with lower limb amputations in Andalusia. A qualitative study]. Aten Primaria 2018; 50:611-20. [PMID: 29150148 DOI: 10.1016/j.aprim.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022] Open
Abstract
Objetivo Explorar la vivencia de los cuidados diabéticos en pacientes sometidos a amputación de miembros inferiores por pie diabético. Diseño Estudio cualitativo con perspectiva fenomenológica. Emplazamiento Área hospitalaria de Cádiz. Participantes Dieciséis participantes (11 hombres y 5 mujeres) con diabetes tipo 2 y amputación no traumática de miembros inferiores. Métodos Entrevistas semiestructuradas individuales y análisis de contenido de la información usando el método propuesto por Graneheim y Lundman. Resultados Se identificaron 4 categorías: 1. La familia es la piedra angular de los cuidados; 2. Los aspectos socioeconómicos y laborales determinan la calidad de los autocuidados; 3. La interacción paciente-personal de salud dinamiza los cuidados; y 4. Las limitaciones en la provisión de servicios sanitarios. Conclusión La familia, la situación económica y laboral y los factores del sistema sanitario constituyen los elementos más relevantes en los cuidados de pacientes con diabetes y amputación de miembros inferiores. Los determinantes sociales, económicos y laborales deben ser tomados en especial consideración y de manera más personalizada desde los servicios sanitarios para aumentar el impacto de los cuidados proporcionados en la prevención de las complicaciones de la diabetes mellitus.
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Rubio JA, Jiménez S, Álvarez J. Clinical characteristics and mortality in patients treated in a Multidisciplinary Diabetic Foot Unit. ACTA ACUST UNITED AC 2017; 64:241-249. [PMID: 28495319 DOI: 10.1016/j.endinu.2017.02.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE This study reviews the clinical characteristics of patients with diabetic foot ulcer treated in a Multidisciplinary Diabetic Foot Unit (MDFU) and analyzes the mortality and factors associated with its survival. MATERIAL AND METHODS Data from all patients who attended the MDFU for the first time for a diabetic foot ulcer during the 2008-2014 period were analized. The patients were followed until their death or until June 30, 2016, for up to 8 years. RESULTS A total of 345 patients were included, with a median age (P25-P75) of 71 (61.5-80) years, and 321 (93%) had type 2 diabetes. They were characterized as patients with inadequate glycemic control, 48% had HbA1c ≥ 8% and high prevalence of chronic complications: 60.2% retinopathy, 43.8% nephropathy and 47.2% ischemic heart disease and/or cerebrovascular disease. A total of 126 (36.5%) patients died and 69 (54.8%) were due to cardiovascular disease. Survival measured by Kaplan-Meier declined over time to 69, 60 and 45% at 3, 5 and 7 years respectively. Cox's multivariate regression analysis showed the following variables associated with mortality, HR (95% CI): age 1.08 (1.05-1.11); previous amputation 2.24 (1.34-3.73); active smoking 2.10 (1.12-3.97); cerebrovascular disease 1.75 (1.05-2.92); renal dysfunction 1.65 (1.04-2.61) and ischemic heart disease 1.60 (1.01-2.51). CONCLUSIONS Patients with diabetic foot ulcer are characterized by high morbidity and mortality, with cardiovascular disease being the most frequent cause of death. It is necessary to pay more attention to this risk group, tailoring objectives and treatments to their situation and life expectancy.
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Affiliation(s)
- José Antonio Rubio
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, España.
| | - Sara Jiménez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España
| | - Julia Álvarez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, España
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23
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Jiménez S, Rubio JA, Álvarez J, Ruiz-Grande F, Medina C. Trends in the incidence of lower limb amputation after implementation of a Multidisciplinary Diabetic Foot Unit. ACTA ACUST UNITED AC 2017; 64:188-197. [PMID: 28417873 DOI: 10.1016/j.endinu.2017.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS AND OBJECTIVE Incidence of lower extremity amputations (LEA) in the population with and without diabetes mellitus (DM) was assessed after implementation of a Multidisciplinary Diabetic Foot Unit (MDFU) during 2008. MATERIAL AND METHODS Non-traumatic LEA were analyzed, and those performed before (2001-2007) and after (2008-2014) introduction of the MDFU were compared. LEA were grouped by age and sex. Their incidence was expressed as a rate per 100,000 population per year, adjusted to the standard European population. RESULTS A total of 664 LEA were performed during the 2001-2014 period, 486 (73%) of them in patients with DM. Total LEA incidence was 11.2/105 population in DM versus 3.9/105 in the population without DM. Incidence of major LEA in patients with DM significantly decreased from 6.1/105 population in the 2001-2007 period to 4.5/105 in the 2008-2014 period (p=.03). Joinpoint regression analysis also showed a reduction in the trend of incidence of major LEA in patients with DM, with an annual percentage change of -3.3% [95% CI, -6.2-0.3] (p=.025). No significant differences were found for all other incidences and trends in the diabetic and non-diabetic populations. CONCLUSIONS Implementation of a MDFU has been shown to be associated with a significant reduction in major amputation rate in the diabetic population, although the results are not optimal yet. Both results and work at the MDFU should be improved.
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Affiliation(s)
- Sara Jiménez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España.
| | - José Antonio Rubio
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Ciencias Biomédicas, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Julia Álvarez
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Endocrinología y Nutrición, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Alcalá de Henares, Madrid, España
| | - Fernando Ruiz-Grande
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Cirugía Vascular, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - Carlos Medina
- Unidad de Pie Diabético, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España; Departamento de Cirugía General, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, España
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Lázaro-Martínez JL, Tardáguila-García A, García-Klepzig JL. Diagnostic and therapeutic update on diabetic foot osteomyelitis. ACTA ACUST UNITED AC 2017; 64:100-8. [PMID: 28440774 DOI: 10.1016/j.endinu.2016.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/17/2016] [Accepted: 10/26/2016] [Indexed: 12/28/2022]
Abstract
Diabetic foot osteomyelitis (DFO) is the most common infection associated to diabetic foot ulcers (DFU). This review is designed to provide an update on the diagnosis and treatment of DFO based on an analysis of MEDLINE through PubMed using as search criterion "Diabetic Foot Osteomyelitis". Authors have included in this review the most relevant manuscripts regarding diagnosis and treatment of DFO. After review and critical analysis of publications, it may be concluded that diagnosis of DFO is not simple because of its heterogeneous presentation. Clinical inflammatory signs, probe-to-bone test, and plain X-rays are postulated as the basic tests for clinical diagnosis when DFO is suspected. Diagnosis should be supported by laboratory tests, of which ESR (>70mm/h) has been shown to be most precise. MRI is the most accurate imaging test, especially for differential diagnosis with Charcot foot. Pathogen isolation by bone culture is essential when the patient is treated with ATB only. Medical or surgical treatment should be based on the clinical characteristics of the patient and the lesion. Surgery should always be an option if medical treatment fails.
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Rodríguez Reyes G, Núñez Carrera L, Alessi Montero A, Solís Vivanco A, Quiñones Uriostegui I, Pérez Sanpablo AI. Effect of mechanical vibration on transcutaneous oxygen levels in the feet of type 2 diabetes mellitus patients. Med Clin (Barc) 2017; 148:16-19. [PMID: 27871769 DOI: 10.1016/j.medcli.2016.09.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Foot conditions in patients with diabetes mellitus (DM) are major causes of morbidity and disability. Whole body vibration may promote blood circulation in the lower limbs, hence facilitating perfusion and promoting the supply of nutrients and oxygen to comprised tissues. Transcutaneous oxygen levels (TcPO2)>40mmHg in cases of diabetic foot syndrome are associated with a good prognosis in the resolution of ulcers. The objective of this study was to determine whether whole body vibration favors some parameters of interest related to complications associated with the diabetic foot syndrome. PATIENTS AND METHODS Fifty-four patients with DM were included in a 12-week exercise program based on whole body vibration. Glycemic control was determined on the basis of the patients' levels of glycated hemoglobin (HbA1c); sensitivity and TcPO2 levels of each foot were also recorded. Assessments were performed prior to initiating the whole body vibration program and at the end of it. RESULTS No significant changes were observed in the patients' HbA1c (P=.442) levels or sensitivity (P=.07). A significant 7mmHg increase (P<.0001; effect size: d=0.53) was observed in the concentration of TcPO2. CONCLUSIONS Whole body vibration may increase TcPO2 levels with useful implications for the prevention or management of complications associated with restricted blood perfusion in the diabetic foot syndrome.
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Affiliation(s)
- Gerardo Rodríguez Reyes
- Laboratorio de Ortesis y Prótesis, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México.
| | - Lidia Núñez Carrera
- Laboratorio de Análisis de Movimiento Humano, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México
| | - Aldo Alessi Montero
- Laboratorio de Ingeniería de Rehabilitación, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México
| | - Adriana Solís Vivanco
- Servicio de Oftalmología-Retina y Vítreo, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México
| | - Ivett Quiñones Uriostegui
- Laboratorio de Análisis de Movimiento Humano, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México
| | - Alberto Isaac Pérez Sanpablo
- Laboratorio de Análisis de Movimiento Humano, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra (INRLGII), Ciudad de México, México
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