RESUMO
Resumen Objetivo: El fin principal en el paciente con pie diabético es evitar la amputación, por ello, este estudio pretendió analizar el efecto que produjo la instauración de un protocolo de actuación para el pie diabético en nuestro departamento de salud. Materiales y Método: Se trata de un estudio retrospectivo. Se evaluó la edad, el sexo, la tasa de amputaciones y re-amputaciones en el primer mes, la estancia media y la añadida por reingreso para reamputación, la solicitud de pruebas analíticas y radiológicas complementarias específicas (analítica de sangre completa con hemoglobina glicosilada y angioTC/RWdoppler arterial de miembros inferiores), y pacientes derivados al centro de referencia para valorar revascularización. Todos estos datos se analizaron comparando los pacientes ingresados con diagnóstico de pie diabético en el periodo previo a la implantación del protocolo (años 2010 a 2013), con los del periodo posterior (años 2014 a 2018). Resultados: Se compararon grupos homogéneos en cuanto a edad y sexo. El resultado del análisis fue una reducción estadísticamente significativa de la tasa de amputaciones (172 frente a 111, media de 22,2 ± 9,9), reamputaciones (41 frente a 15) y de reingreso (18 frente a 7) por mala evolución en el primer mes. No se encontraron cambios en el número de pruebas complementarias radiológicas realizadas y el número de pacientes remitidos a hospital de referencia para valorar revascularización. Conclusiones: Dentro del manejo multidisciplinar, el cirujano general es uno de los pilares importantes. La implantación de un protocolo de actuación para el pie diabético reduce de forma significativa la tasa de amputaciones.
Aim: The main objective in the patient with diabetic foot is to avoid amputation, thus, this study pretended to analyze the effect produced by the introduction of a protocol for the diabetic foot in our Department of Health. Materials and Method: It is a retrospective study. Age, sex, amputation and re-amputations rate in the first month, the average stay and the hospital re-entry were evaluated, the request for specific complementary analytical and radiological tests (blood test analytics with glycosylated hemoglobin and CT/MR/doppler arterial limb angiography) and patients remitted to the reference center to assess revascularization. All these data were analyzed comparing the patients admitted with diagnosis of diabetic foot in the period before to the implementation of the protocol (years 2010 to 2013) with those of the subsequent period (years 2014 to 2018). Results: Homogeneous groups were compared by age and sex. The result of the analysis was a significant reduction in the rate of amputations (172 versus 111, average of 22.2 ± 9.9), re-amputations (41 versus 15) and re-entry due to poor evolution in the first month (18 versus 7). No changes were found in the number of complementary radiological tests performed and the number of patients remitted to the reference hospital to assess revascularization. Conclusions: In the multidisciplinary management, the general surgeon is one of the important pillars. The implementation of an action protocol for the diabetic foot significantly reduces the amputation rate.
Assuntos
Humanos , Protocolos Clínicos , Pé Diabético/cirurgia , Pé Diabético/terapia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Estudo Comparativo , Pé Diabético/diagnóstico , Amputação Cirúrgica/estatística & dados numéricosRESUMO
Trypanosoma cruzi parasite strains are classified into six lineages (discrete typing units TcI to TcVI). The broad genetic diversity of T. cruzi strains has an influence on the development of the host response and pathogenesis, as well as drug susceptibility. Here, the draft genome of the T. cruzi B. M. López strain (TcIa) is reported.
RESUMO
INTRODUCTION: During root formation, Smad-4 plays a key role during the epithelial-mesenchymal interactions and the Hertwig's epithelial root sheath (HERS) apical proliferation. The root formation and eruption of rat molars is impeded by alendronate treatment due to the inhibition of bone resortion by this drug. The present study aimed to examine the structures affected in the developing root and immunodetect the presence of Smad-4 in rats treated with alendronate. METHODS: Newborn Wistar rats were daily injected 2.5 mg/kg alendronate (ALN) during 9, 12 and 30 days. The controls (CON) were injected with saline. The maxillae were fixed and embedded in paraffin or Spurr resin. Paraffin sections were incubated in Smad-4 antibody that was labelled with DAB. The ultrathin sections were examined in a transmission electron microscope. RESULTS: In ALN, a short portion of root dentine was formed; the epithelial diaphragm (ED) and the dental follicle (DF) were disorganized by the contact of bone trabeculae. The (CON) molar roots developed normally. Smad-4 labelling was detected in the cytoplasm of fibroblasts and cementoblasts adjacent to the cementum in CON; in ALN group, few ED cells presented weak immunolabelling. Ultrastructurally, the ED and DF appeared disrupted due to the presence of thin bone trabeculae between its cells. It resulted in the lack of apical proliferation of HERS and, consequently, arrest of root formation. CONCLUSION: The immunodetection of Smad-4 in the DF cells of ALN specimens indicates that the signalling for the differentiation of these cells into cementum-forming fibroblasts and cementoblasts occurs, despite the impairment of root elongation.