Hypozincemia in Mexican patients with diabetic foot ulcer treated out of hospital

OBJECTIVE

To know the frequency of people with hypozincemia in a group of Mexican patients with Diabetic Foot Ulcers (DFU)m and its relationship with metabolic and clinical profile.

MATERIAL AND METHODS

Cross-sectional, analytical, and observational study in patients with and without DFU, treated in Family Medicine Units from Instituto Mexicano del Seguro Social (IMSS) in Mérida, Yucatán, México. Frequency of hypozincemia (Zn serum < 70 g/ml) and its relationship with the levels of Glycosylated Hemoglobin (HbA1c), cholesterol and triglycerides was analyzed.

RESULTS

70% of patients with DFU and 25% without DFU had hypozincemia (OR = 5.2, 95% CI 2.139-12.65, p = 0.0004). Patients with hypozincemia were older and the highest prevalence was between 50 and 60 years. The average area of the DFU showed no differences in patients with and without hypozincemia. Patients with DFU reported higher levels of HbA1c, cholesterol, triglycerides, BMI, and blood pressure compared to patients without DFU. Hypozincemia was associated with higher BMI values.

CONCLUSION

The frequency of hypozincemia in diabetic patients with UPD is high and is behaving as a risk factor for presenting UPD, so its identification should be routine.

Nurses' and physicians' knowledge and skills in non-invasive ventilation: Equipment and contextual influences

OBJECTIVES

To assess non-invasive ventilation knowledge and skills among nurses and physicians in different contexts: equipment and contextual influences.

METHOD

Cross-sectional, descriptive study in 4 intensive care units (ICU) (1 surgical, 3 medical-surgical), 1 postsurgical recovery unit, 2 emergency departments (ED) and 3 wards, in 4 hospitals (3 university, 1 community) with 407 professionals. A 13-item survey, validated in the setting, was applied (Kappa index, 0.97 (95% CI [.965-.975]).

RESULTS

Nurses (63.7% response); physicians (39% response). The overall percentage of correct responses was 50%. Scored from 1 to 5, with lower scores reflecting more knowledge, nurses scored 3.27±.5 vs 2.62±.5 physicians, respectively (mean difference,.65 (95% CI: .48-.82, P<.001). There were no differences between hospitals or units (P=.07 and P=.09). A notable percentage of respondents incorrectly identified the patient-ventilator synchronization strategy as "covering the expiratory port" (intentional leaks) and pressing the mask against the patient's face (unintentional leaks) (28.2% ICU, 22.5% ED, 8.3% postoperative resuscitation, 61.5% wards), with no difference between nurses and physicians (27.9% vs 23.4%, P=.6). Only 50% of nurse respondents correctly answered a question about measuring mask size and just 11.7% of the nurses knew the "2-finger fit" adjustment.

CONCLUSIONS

There was no difference in nurses' and physicians' knowledge according to the setting studied. The lack of knowledge regarding NIV therapy depended on training received and material available. To reduce the existent confusion between intentional and nonintentional leak, the use of a single type of NIV supply and providing an appropriate level of training for nurses is recommended.

Clinical characteristics and mortality in patients treated in a Multidisciplinary Diabetic Foot Unit

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.