RESUMEN
An impaired healing response underlies diabetic foot wound chronicity, frequently translating to amputation, disability, and mortality. Diabetics suffer from underappreciated episodes of post-epithelization ulcer recurrence. Recurrence epidemiological data are alarmingly high, so the ulcer is considered in "remission" and not healed from the time it remains epithelialized. Recurrence may result from the combined effects of behavioral and endogenous biological factors. Although the damaging role of behavioral, clinical predisposing factors is undebatable, it still remains elusive in the identification of endogenous biological culprits that may prime the residual scar tissue for recurrence. Furthermore, the event of ulcer recurrence still waits for the identification of a molecular predictor. We propose that ulcer recurrence is deeply impinged by chronic hyperglycemia and its downstream biological effectors, which originate epigenetic drivers that enforce abnormal pathologic phenotypes to dermal fibroblasts and keratinocytes as memory cells. Hyperglycemia-derived cytotoxic reactants accumulate and modify dermal proteins, reduce scar tissue mechanical tolerance, and disrupt fibroblast-secretory activity. Accordingly, the combination of epigenetic and local and systemic cytotoxic signalers induce the onset of "at-risk phenotypes" such as premature skin cell aging, dysmetabolism, inflammatory, pro-degradative, and oxidative programs that may ultimately converge to scar cell demise. Post-epithelialization recurrence rate data are missing in clinical studies of reputed ulcer healing therapies during follow-up periods. Intra-ulcer infiltration of epidermal growth factor exhibits the most consistent remission data with the lowest recurrences during 12-month follow-up. Recurrence data should be regarded as a valuable clinical endpoint during the investigational period for each emergent healing candidate.
Asunto(s)
Diabetes Mellitus , Pie Diabético , Hiperglucemia , Humanos , Cicatriz/patología , Úlcera/patología , Pie Diabético/patología , Extremidad Inferior/patología , Hiperglucemia/patología , Recurrencia , Diabetes Mellitus/patologíaRESUMEN
INTRODUCTION: Chronic ulcers pose a public health challenge. Thus, it is imperative to be aware of and assess new management strategies that contribute to patient quality of life and optimize health resources. This study evaluated the efficacy of a new protocol for chronic wound management that includes porcine intestine ECM. MATERIALS AND METHODS: Twenty-one patients with chronic wounds of different etiologies were included in this study. A new healing protocol that incorporates the use of porcine ECM was initiated for a maximum period of 12 weeks. Follow-up included a weekly visit to photograph the ulcers and record their size. RESULTS: Wounds ranged in size from 0.5 cm2 to 10 cm2 at the outset of the study. Two of the 21 patients who started the protocol withdrew, 1 for nonadherence to the protocol and 1 for health complications unrelated to the study. Most lesions occurred in the lower limbs. All patients who completed the treatment protocol achieved wound regeneration and total wound closure within an average of 4.5 weeks. The average percentage closure rate was 100% at 8 weeks, with no AEs. CONCLUSIONS: The findings of this study demonstrate the efficacy of an evidence-based wound management protocol in achieving safe, complete tissue regeneration in a short period of time.
Asunto(s)
Úlcera de la Pierna , Úlcera , Porcinos , Animales , Calidad de Vida , Úlcera de la Pierna/patología , Matriz Extracelular/patología , Extremidad Inferior/patología , Resultado del TratamientoRESUMEN
Mujer de 59 años, con antecedentes de diverticulosis de colon, que acude por dolor en la región inguinal y en el miembro inferior izquierdo de dos meses de evolución. En una primera instancia, la paciente se presentó con clínica de sepsis y se objetivó un eritema en el miembro inferior izquierdo, asociado a celulitis y crepitación subcutánea. La TC mostraba una colección hidroaérea en psoas y retroperitoneal que asciende hasta la cavidad abdominal hallándose una diverticulitis perforada. El tratamiento quirúrgico se basó en el drenaje de la colección retroperitoneal y sigmoidectomía, seguido de una fasciotomía, desbridamiento y lavado del muslo. La perforación de un divertículo puede formar un absceso intraperitoneal desarrollando una peritonitis o un absceso retroperitoneal, derivando en una translocación bacteriana hacia la extremidad inferior, debido a la comunicación existente en el anillo crural, generando una fascitis necrotizante del miembro.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Fascitis Necrotizante/terapia , Extremidad Inferior/patología , Desbridamiento , Diverticulitis del Colon/diagnóstico por imagen , Fasciotomía , Irrigación Terapéutica , Fascitis Necrotizante/etiología , Diverticulitis del Colon/complicacionesRESUMEN
A vasculopatia livedoide é uma doença cutâneo-vascular que surge devido à oclusão trombogênica de vasos da derme. Apresenta-se por meio de máculas ou pápulas eritematosas e purpúricas, em membros inferiores, que podem levar à ulceração dolorosa crônica e recorrente. Com a evolução, pode haver cicatrização, o que leva ao aparecimento de áreas de fibrose e cicatrizes atróficas, irregulares e esbranquiçadas, dando nome à patologia. Relata-se o caso de uma paciente com vasculopatia livedoide de acometimento de membros inferiores. (AU)
Livedoid vasculopathy is a vascular skin disease resulting from thrombogenic occlusion of dermal blood vessels. It presents with erythematous, purpuric macules or papules on the lower limbs, which can lead to chronic and recurrent painful ulceration. With its progression, there may be scarring leading to the appearance of areas of fibrosis and atrophic, irregular, and whitish scars, which gave this name to the pathology. The case of a patient with livedoid vasculopathy affecting the lower limbs is reported. (AU)
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Vasculopatía Livedoide/diagnóstico , Úlcera Cutánea/diagnóstico , Inmunoglobulinas/uso terapéutico , Talasemia beta/complicaciones , Extremidad Inferior/patología , Eritema/diagnóstico , Factores Inmunológicos/uso terapéuticoRESUMEN
INTRODUÇÃO: O linfedema é uma doença crônica progressiva, ocasionada por insuficiência do processo de drenagem linfática, que causa edema tecidual. Não há nenhum tratamento curativo para o linfedema e no âmbito do Sistema Único de Saúde (SUS), estão listados dois procedimentos de manejo do linfedema: o atendimento fisioterapêutico e o tratamento cirúrgico do linfedema. As meias elásticas de compressão seriam uma opção de tratamento autogerido, o que pode reduzir a sobrecarga do sistema por procedimentos eletivos. PERGUNTA: O uso de meias elásticas de compressão é eficaz, efetivo, seguro e custo-efetivo para o tratamento de pacientes com linfedema primário ou secundário? EVIDÊNCIAS CIENTÍFICAS: A busca recuperou duas coortes prospectivas. O estudo de Brambilla et al., 2006 demonstrou diferença estatisticamente significante na redução do volume dos membros inferiores (mensurada por uso de fita métrica em vários pontos dos membros inferiores) entre os pacientes que utilizaram as meias elásticas de compressão em relação aos pacientes do grupo controle (que não usaram as meias). Contudo, as circunferências dos membros inferiores foram reduzidas de maneira irregular, 40% dos pacientes tratados com as meias elásticas de compressão apresentaram aumento do volume do membro e apenas 16,67% das reduções foram consideradas satisfatórias. Já o estudo de Godoy et al., 2017, uma coorte do tipo antes e depois, demonstrou diferença estatisticamente significante entre as meias de compressão de 30/40 mmHg e as de 20/30 mmHg, sendo esta última não efetiva na manutenção do volume dos membros após quatro semanas em relação a linha de base. Porém, nessa última coorte, as meias elásticas de compressão foram utilizadas para manutenção do volume dos membros após redução completa do edema por outros procedimentos terapêuticos. Não foram encontrados estudos referentes à adesão das meias elásticas de compressão na população com linfedema. Nenhum dos estudos incluídos relatou dados de segurança. As duas coortes apresentaram baixa qualidade metodológica, uma vez que receberam 5 estrelas ou menos nas ferramentas de Newcastle-Ottawa. A certeza da evidência de todos os desfechos, avaliada pelo Grading of Recommendations Assessment, Development and Evaluation, foi muito baixa. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: Para um horizonte temporal de 5 anos, a incorporação das meias elásticas de compressão para linfedema ocasionaria um aumento de gastos estimados, em cinco anos, de R$117.900.922,59 a R$136.039.526,07, a depender da prevalência. CONSIDERAÇÕES FINAIS: As evidências disponíveis acerca da efetividade das meias elásticas de compressão em indivíduos com linfedema de membros inferiores são escassas e, de forma geral, de qualidade baixa. A avaliação econômica estimou uma RCEI R$ 2.155,87, ao passo que análise de impacto orçamentário estima um custo acumulado em cinco anos de até R$ 136 milhões no cenário de incorporação das meias elásticas de compressão. Não foram identificadas recomendações sobre o uso de meias elásticas no tratamento do linfedema em agências internacionais de ATS. Dessa forma, recomendações sobre o uso da tecnologia são permeadas de incertezas e devem ser realizadas com cautela. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A Conitec, em sua 92ª reunião ordinária, realizada nos dias 04 de novembro de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar não favorável à incorporação no SUS das meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores. Considerou-se, entre outros fatores, que, há escassez de evidências sobre o uso das meias elásticas de compressão no tratamento do linfedema de membros inferiores. Além disso, as poucas evidências disponíveis foram consideradas frágeis, com baixo número amostral e baixa qualidade, sendo, portanto, insuficientes para determinar com robustez a efetividade, a segurança, a custo-efetividade e o impacto orçamentário decorrente da incorporação das meias de compressão. CONSULTA PÚBLICA: O relatório de recomendação inicial da CONITEC foi disponibilizado para contribuições por meio da consulta pública nº 64/2020 entre os dias 25/11/2020 e 14/12/2020. Foram recebidas 163 contribuições, sendo 93 contribuições de cunho técnico-científico e 70 contribuições de experiência pessoal ou opinião, destas 84,7% discordavam com a recomendação preliminar da Conitec. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 94ª reunião ordinária, no dia 03 de janeiro de 2021, deliberaram por unanimidade recomendar a não incorporação das meias elásticas de compressão para o tratamento de pacientes com linfedema. Os membros presentes entenderam que não houve argumentação suficiente para alterar a recomendação inicial. Foi assinado o registro de deliberação nº 585. DECISÃO: Não incorporar as meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores, do Sistema Único de Saúde - SUS, conforme Portaria nº 03, publicada no Diário Oficial da União nº 34, seção 1, página 93, em 22 de fevereiro de 2021.
Asunto(s)
Humanos , Extremidad Inferior/patología , Medias de Compresión/provisión & distribución , Linfedema/terapia , Evaluación de la Tecnología Biomédica , Análisis Costo-Eficiencia , Sistema Único de SaludRESUMEN
AIM: To identify and map studies that have assessed the effect of interventions on lower-limb macroscopic muscle-tendon morphology in children with spastic cerebral palsy (CP). METHOD: We conducted a literature search of studies that included pre- and post-treatment measurements of lower-limb macroscopic muscle-tendon morphology in children with spastic CP. Study quality was evaluated and significant intervention effects and effect sizes were extracted. RESULTS: Twenty-eight articles were identified. They covered seven different interventions including stretching, botulinum neurotoxin A (BoNT-A), strengthening, electrical stimulation, whole-body vibration, balance training, and orthopaedic surgery. Study quality ranged from poor (14 out of 28 studies) to good (2 out of 28). Study samples were small (n=4-32) and studies were variable regarding which muscles and macroscopic morphological parameters were assessed. Inconsistent effects after intervention (thickness and cross-sectional area for strengthening, volume for BoNT-A), no effect (belly length for stretching), and small effect sizes were reported. INTERPRETATION: Intervention studies reporting macroscopic muscle-tendon remodelling after interventions are limited and heterogeneous, making it difficult to generalize results. Studies that include control groups and standardized assessment protocols are needed to improve study quality and data synthesis. Lack or inconclusive effects at the macroscopic level could indicate that the effects of interventions should also be evaluated at the microscopic level. WHAT THIS PAPER ADDS: Muscle-targeted interventions to remodel muscle morphology are not well understood. Studies reporting macroscopic muscle remodelling following interventions are limited and heterogeneous. Passive stretching may preserve but does not increase muscle length. The effects of isolated botulinum neurotoxin A injections on muscle volume are inconsistent. Isolated strengthening shows no consistent increase in muscle volume or thickness.
Asunto(s)
Toxinas Botulínicas/uso terapéutico , Parálisis Cerebral/terapia , Terapia por Estimulación Eléctrica/métodos , Extremidad Inferior/patología , Espasticidad Muscular/terapia , Modalidades de Fisioterapia , Vibración/uso terapéutico , Parálisis Cerebral/tratamiento farmacológico , Parálisis Cerebral/patología , Niño , Humanos , Espasticidad Muscular/tratamiento farmacológico , Espasticidad Muscular/patología , Fármacos Neuromusculares/uso terapéutico , Equilibrio PosturalRESUMEN
Equine-assisted therapy uses the horse in rehabilitation and/or education of people, such as Down syndrome(SD), cerebral palsy(PC)and intellectual disability(DI). In context, the rehabilitation program and horse riding equipment should be usedaccording to the specific characteristics of each individual, becoming an ally in the quest for excellence in equine-assisted therapy programs. The aim was to evaluate the effect of riding equipment used in equine-assisted therapy on the muscular activityof trunk and lower limb of individuals with SD, PC and DI. The study included 15 individuals equally assigned to each group: SD, PC and DIwith a mean age of 16.2 (±1.10), 16 (±1.22)e 16 (±0) years,respectively. The analysis of muscle activity was performed through surface electromyography, using four variations of horse riding equipment: saddle with and without feet supported on the stirrups and blanket with and without feet supported on the stirrups. Sigma Stat 3.5®software was used for statistical analysis.The Shapiro Wilk's test was used for normality of the data, the Bartlett test for homogeneity of the variances and the Kruskal-Wallis test for repeated measures with no normal distribution.Statistically significant differences were observed forp<0.05.The SDgroup presented a greater muscular activity of trunk and lower limbs with blanket equipment without the feet supported in the stirrups (H = 15.078, p = 0.002), as in the DI group (H=8.302, p = 0.040), while inPCgroup was the saddle with feet supported in the stirrups (H=11.137,p = 0.011). The choice of riding equipment used in equine-assisted therapy interferes differently in the pattern of muscular activation of the trunk and the lower limbs, according to the pathological processes of the practitioners. It should be an important aspect to consider when planninga treatment.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Extremidad Inferior/patología , Terapía Asistida por Caballos/instrumentación , Torso/patología , Anomalías Musculoesqueléticas/terapia , Programas Informáticos/provisión & distribución , Daño Encefálico Crónico/terapia , Parálisis Cerebral/terapia , Adolescente , Síndrome de Down/terapia , Electromiografía/instrumentación , Discapacidad Intelectual/terapiaRESUMEN
OBJECTIVE: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. METHODS: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. RESULTS: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). CONCLUSION: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.
OBJETIVO: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. MÉTODOS: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. RESULTADOS: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). CONCLUSÃO: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores.
Asunto(s)
Vendajes , Biopolímeros/uso terapéutico , Celulosa/uso terapéutico , Isquemia/complicaciones , Isquemia/terapia , Extremidad Inferior/patología , Cicatrización de Heridas/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Angioplastia , Femenino , Geles/uso terapéutico , Humanos , Isquemia/patología , Extremidad Inferior/irrigación sanguínea , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.
Asunto(s)
Enfermedades de las Arterias Carótidas/complicaciones , Grosor Intima-Media Carotídeo/efectos adversos , Pie Diabético/etiología , Extremidad Inferior/irrigación sanguínea , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/patología , Estudios Transversales , Femenino , Humanos , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
BACKGROUND: Endothelial growth factor receptor (EGFR) mutations are an essential driver of personalized therapy for patients with lung cancer and are detected in approximately 15% of Caucasian and 50% of Asian patients. EGFR tyrosine kinase inhibitors have been developed and used for this set of patients. T790M mutation in exon 20 is usually associated with secondary resistance to EGFR tyrosine kinase inhibitors therapy but is also present in treatment-naïve patients. The frequency for baseline T790M mutation varies from 4 to 35% according to the detection method used. Newer techniques have yielded higher rates, but concerns about false-positive results have been raised. Compound mutations account for 4-14% of all EGFR-mutated tumors, with no studies yet to provide a frequency rate for T790M + 19 deletion association due to the small number of cases. However, there are reports that pretreatment T790M + L858R association is significantly more frequent compared to T790M + exon 19 deletion mutations. Diagnostic challenges, current knowledge on the subject, and therapeutic decisions are discussed. CASE PRESENTATION: We present the case of a 43-year-old Hispanic woman, a treatment-naïve patient, with metastasized lung cancer adenocarcinoma harboring a T790M deletion along with the classic 19 mutation. The initial symptoms were monoparesis of her left leg, associated with hyperreflexia, and hypoesthesia. In the absence of third-generation tyrosine kinase inhibitors, a platinum-based therapy was initiated with no response and she died 4 months after diagnosis. CONCLUSIONS: Osimertinib seems to be a suitable therapy for treatment-naïve patients with sensitizing and resistant compound EGFR mutations. More studies regarding the clinical characteristics of these patients and the appropriate management of this condition are needed to provide the highest standard of care.
Asunto(s)
Adenocarcinoma del Pulmón/patología , Neoplasias Óseas/secundario , Hipoestesia/patología , Extremidad Inferior/patología , Neoplasias Pulmonares/patología , Adenocarcinoma del Pulmón/diagnóstico por imagen , Adenocarcinoma del Pulmón/tratamiento farmacológico , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Análisis Mutacional de ADN , Receptores ErbB/genética , Receptores ErbB/uso terapéutico , Exones , Resultado Fatal , Femenino , Humanos , Hipoestesia/diagnóstico por imagen , Hipoestesia/etiología , Extremidad Inferior/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/tratamiento farmacológico , Imagen por Resonancia Magnética , Inhibidores de Proteínas Quinasas/uso terapéutico , Reflejo Anormal , Eliminación de SecuenciaRESUMEN
INTRODUCTION: Soft tissue sarcomas (SFT) are a group of rare and heterogeneous neoplasms (representing less than 1% of cancer in adults and 15% in pediatric patients), for which there is no updated records in the Latin American population. This study aims to describe the current situation of patients treated at a cancer institute in Latin America. METHODS: We obtained records from 250 patients with a diagnosis of SFT, treated at the National Institute of Neoplastic Diseases of Peru (INEN) during the period 2009-2013, with a mean follow-up of 62 months. The following data were recorded: epidemiological, clinical, treatment and follow-up. The analysis of global survival was done with the Cox proportional hazards model. RESULTS: SFT showed a greater frequency in males (60.8%), with a peak incidence after 50 years of age (69.6%). Tumor location was predominantly in the lower extremities (64.4%), and the most frequent histologic subtypes were: undifferentiated pleomorphic sarcoma (34%) and liposarcomas (25.6%); clinical stage iii was the most frequent (30.8%). The 5-year overall survival rate was 63.9%, while the statistical analysis found a significant association between global survival and the variables: age (>50 years), tumor size (>5cm), depth (subfascial), histologic grade (G3), local and distant recurrence, showing shorter survival times in these groups. CONCLUSIONS: This study has clarified the epidemiology, treatment and prognosis, as well as the variables that have an impact on the survival of the Latin American patients with SFT studied.
Asunto(s)
Sarcoma/epidemiología , Sarcoma/mortalidad , Neoplasias de los Tejidos Blandos/epidemiología , Neoplasias de los Tejidos Blandos/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , América Latina/epidemiología , Liposarcoma/patología , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Perú/epidemiología , Pronóstico , Sistema de Registros , Estudios Retrospectivos , Sarcoma/patología , Sarcoma/cirugía , Neoplasias de los Tejidos Blandos/patología , Neoplasias de los Tejidos Blandos/cirugía , Adulto JovenRESUMEN
RESUMO Objetivo: avaliar o uso do curativo de filme e gel de biopolímero de celulose bacteriana no tratamento de pacientes com feridas isquêmicas submetidos à revascularização dos membros inferiores. Métodos: ensaio clínico randomizado realizado no ambulatório de Angiologia e Cirurgia Vascular do Hospital das Clínicas da Universidade Federal de Pernambuco, entre janeiro de 2017 e dezembro de 2018. Foram acompanhados 24 pacientes após revascularização de membros inferiores, divididos em dois grupos: Experimental, tratado com filme e gel de biopolímero de celulose bacteriana, e Controle, tratado com ácidos graxos essenciais. Os pacientes foram acompanhados em consultas semanais para troca dos curativos e o processo de cicatrização das feridas foi avaliado em um período de 90 dias. Resultados: a redução da área das feridas isquêmicas no período de 30 dias foi de 4,3cm2 (55%), em média, para o grupo experimental, e de 5,5cm2 (48,5%) para o grupo controle (p>0,05). A taxa de cicatrização completa, em 90 dias, foi de 34,8%, sendo 50% no grupo experimental e 18,2% no grupo controle (p=0,053). Conclusão: o filme de biopolímero de celulose bacteriana associada a gel pode ser utilizado como curativo no tratamento de feridas isquêmicas de pacientes submetidos à revascularização de membros inferiores
ABSTRACT Objective: to evaluate the use of a bacterial cellulose biopolymer film and gel dressing in the treatment of patients with ischemic wounds submitted to lower limb revascularization. Methods: we conducted a randomized clinical trial in the Angiology and Vascular Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco, between January 2017 and December 2018. We followed 24 patients after lower limb revascularization, divided into two groups: Experimental, treated with bacterial cellulose biopolymer film and gel, and Control, treated with essential fatty acids. Patients attended weekly appointments to change dressings and had their wound healing processes evaluated over a period of 90 days. Results: the reduction of the ischemic wounds' areas after 30 days was 4.3cm2 (55%) on average for the experimental group, and the 5.5cm2 (48.5%) for the control group (p>0.05). The complete healing rate at 90 days was 34.8%, 50% in the experimental group and 18.2% in the control group (p=0.053). Conclusion: the bacterial cellulose biopolymer film associated with gel can be used as a dressing in the treatment of ischemic wounds of patients undergoing revascularization of the lower limbs.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Vendajes , Cicatrización de Heridas/efectos de los fármacos , Biopolímeros/uso terapéutico , Celulosa/uso terapéutico , Extremidad Inferior/patología , Isquemia/complicaciones , Isquemia/terapia , Factores de Tiempo , Resultado del Tratamiento , Angioplastia , Extremidad Inferior/irrigación sanguínea , Geles/uso terapéutico , Isquemia/patología , Persona de Mediana EdadRESUMEN
Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/complicaciones , Pie Diabético/etiología , Extremidad Inferior/irrigación sanguínea , Grosor Intima-Media Carotídeo/efectos adversos , Enfermedades de las Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Estudios Transversales , Valor Predictivo de las Pruebas , Estudios Prospectivos , Extremidad Inferior/patologíaRESUMEN
PURPOSE: To evaluate the effect of the cilostazol on the evolution of partially avulsed flaps, using experimental model of cutaneous degloving in rat limbs. METHODS: A controlled and randomized experimental study was carried out in which the blood flow and the percentage of flap necrosis were evaluated. We compared the study group, which received cilostazol, and the control group, which received enteral saline solution in the postoperative period. The blood flow in the flap was evaluated through Laser Doppler flowmetry, and a planimetry using the IMAGE J® software was employed for the calculation of the area of necrosis. RESULTS: Enteral administration of cilostazol was associated with a higher mean blood flow in all regions of the flap, with a statistically significant difference in the proximal and middle regions (p<0.001) and a lower percentage of necrotic area in the flap (p<0.001). CONCLUSION: Postoperative enteral administration of cilostazol increased blood flow and decreased the total area of necrosis of avulsed cutaneous flaps of rat limbs.
Asunto(s)
Lesiones por Desenguantamiento/tratamiento farmacológico , Modelos Animales de Enfermedad , Inhibidores de Fosfodiesterasa 3/uso terapéutico , Tetrazoles/uso terapéutico , Animales , Cilostazol , Lesiones por Desenguantamiento/patología , Lesiones por Desenguantamiento/cirugía , Humanos , Flujometría por Láser-Doppler , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/lesiones , Extremidad Inferior/patología , Masculino , Necrosis/tratamiento farmacológico , Inhibidores de Fosfodiesterasa 3/farmacología , Distribución Aleatoria , Ratas Wistar , Valores de Referencia , Flujo Sanguíneo Regional/efectos de los fármacos , Reproducibilidad de los Resultados , Colgajos Quirúrgicos , Tetrazoles/farmacología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Objective To analyze the combined effects of the silk protein sericin and swimming exercise on histomorphometry of the plantar muscle in Wistar rats. Methods Forty adult rats were randomly allocated into 5 groups comprising 8 animals each, as follows: Control, Injury, Sericin, Swim, and Swim plus Sericin. Three days after crushing of the sciatic nerve the rats in the Swim and Swim plus Sericin Groups were submitted to swimming exercise for 21 days. Rats were then euthanized and the plantar muscle harvested and processed. Results Cross-sectional area, peripheral nuclei and muscle fiber counts, nucleus/fiber ratio and smallest muscle fiber width did not differ significantly between groups. Morphological analysis revealed hypertrophic fibers in the Swim Group and evident muscle damage in the Swim plus Sericin and Injury Groups. The percentage of intramuscular collagen was apparently maintained in the Swim Group compared to remaining groups. Conclusion Combined treatment with sericin and swimming exercise did not improve muscle properties. However, physical exercise alone was effective in maintaining intramuscular connective tissue and preventing progression of deleterious effects of peripheral nerve injury.
Asunto(s)
Extremidad Inferior/inervación , Músculo Esquelético/inervación , Condicionamiento Físico Animal/fisiología , Sericinas/farmacología , Natación/fisiología , Animales , Modelos Animales de Enfermedad , Extremidad Inferior/lesiones , Extremidad Inferior/patología , Músculo Esquelético/lesiones , Músculo Esquelético/patología , Compresión Nerviosa , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
ABSTRACT Objective: To validate calf circumference as a technology for assessing muscle mass in the elderly. Method: Cross-sectional study with 132 elderly people from Goiânia, Goiás, Brazil. Decreased muscle mass was determined by the skeletal muscle mass index (IME) using Dual Energy X-Ray Absortometry (DEXA). The cutoff circumferences (CC) cutoff points to indicate muscle mass decrease were estimated by ROC curve, sensitivity, specificity and accuracy. Results: The most accurate cut-off points for detecting decreased muscle mass in the elderly were 34 cm for men (sensitivity: 71.5%, specificity: 77.4%) and 33 cm for women (sensitivity: 80.0%; specificity: 84.6%). Conclusion: CC can be used as a measure for early identification of muscle mass decrease in routine evaluations of the elderly in primary care.
RESUMEN Objetivo: Validar la circunferencia de la pantorrilla como tecnología de evaluación de masa muscular en mayores. Método: Estudio transversal con 132 mayores de Goiânia, Goiás, Brasil. La disminución de masa muscular fue determinada por el índice de masa muscular esquelética (IME) por medio de la Absorciometría por Rayos-X de Dupla Energía (DEXA). Los puntos de corte de la medida de circunferencia de la pantorrilla (CP) para indicar disminución de masa muscular fueron estimados por medio de curva ROC, sensibilidad, especificidad y precisión. Resultados: Los puntos de corte con mejor precisión para detección de masa muscular disminuida en mayores fue 34 cm para hombres (sensibilidad: 71,5%; especificidad: 77,4%) y 33 cm en mujeres (sensibilidad: 80,0%; especificidad: 84,6%). Conclusión: La CP puede ser utilizada como medida para identificación precoz de disminución de masa muscular en evaluaciones de rutina de mayores en la atención primaria.
RESUMO Objetivo: Validar a circunferência da panturrilha como tecnologia de avaliação de massa muscular em idosos. Método: Estudo transversal com 132 idosos de Goiânia, Goiás, Brasil. A diminuição de massa muscular foi determinada pelo índice de massa muscular esquelética (IME) por meio da Absorciometria por Raios-X de Dupla Energia (DEXA). Os pontos de corte da medida de circunferência da panturrilha (CP) para indicar diminuição de massa muscular foram estimados por meio de curva ROC, sensibilidade, especificidade e acurácia. Resultados: Os pontos de corte com melhor acurácia para detecção de massa muscular diminuída em idosos foi 34 cm para homens (sensibilidade: 71,5%; especificidade: 77,4%) e 33 cm em mulheres (sensibilidade: 80,0%; especificidade: 84,6%). Conclusão: A CP pode ser utilizada como medida para identificação precoce de diminuição de massa muscular em avaliações de rotina de idosos na atenção primária.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Pesos y Medidas Corporales/instrumentación , Reproducibilidad de los Resultados , Músculo Esquelético/patología , Extremidad Inferior/patología , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Composición Corporal/fisiología , Brasil , Antropometría/instrumentación , Antropometría/métodos , Estudios Transversales , Curva ROC , Músculo Esquelético/anatomía & histología , Extremidad Inferior/anatomía & histología , Persona de Mediana EdadRESUMEN
Abstract Purpose: To evaluate the effect of the cilostazol on the evolution of partially avulsed flaps, using experimental model of cutaneous degloving in rat limbs. Methods: A controlled and randomized experimental study was carried out in which the blood flow and the percentage of flap necrosis were evaluated. We compared the study group, which received cilostazol, and the control group, which received enteral saline solution in the postoperative period. The blood flow in the flap was evaluated through Laser Doppler flowmetry, and a planimetry using the IMAGE J® software was employed for the calculation of the area of necrosis. Results: Enteral administration of cilostazol was associated with a higher mean blood flow in all regions of the flap, with a statistically significant difference in the proximal and middle regions (p<0.001) and a lower percentage of necrotic area in the flap (p<0.001). Conclusion: Postoperative enteral administration of cilostazol increased blood flow and decreased the total area of necrosis of avulsed cutaneous flaps of rat limbs.