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Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers-lesions that can appear at the plantar and extra-plantar levels-are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.

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The characterization of the temperature of skin ulcers may provide preliminary diagnostic evidence. The aim of this study was to characterize cutaneous ulcers of different etiologies by infrared thermography. 122 cutaneous ulcers of 87 patients (age 60.1 ± 15.7 years) were evaluated, allocated into five groups: venous ulcers (VU) n = 26, arterial ulcers (AU) n = 20, mixed ulcers (MU) n = 25, pressure ulcers (PU) n = 29, and neuropathic ulcers (NU) n = 22. The cutaneous temperature was recorded by infrared thermography (FLIR-450™); we also evaluated the ulcer area, the ankle brachial index (ABI), the range of motion (ROM) of the ankle, and pain. For the different variables, the statistical analysis was performed using the Kruskal Wallis test, ANOVA, the chi-squared test, and the Spearman test (SPSS™ software version 20, p < 0.05). A significant difference was found between the temperatures of PU and NU. The ABI was significantly lower in the MU and AU groups, and pain was also higher in these groups. The ROM was decreased in all groups, and the MU and VU groups had the lowest ROM. There was no correlation between temperature and the clinical findings (ABI, ROM, and pain). There was a moderate correlation in the analysis between the temperature and the area of the ulcer in the PU group, as larger ulcers had lower temperatures. It is possible to characterize cutaneous ulcers by infrared thermography, and there are temperature differences among ulcers with different etiologies.

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RESUMEN Introducción: El envejecimiento poblacional es un problema demográfico a nivel mundial, esto trae consigo el aumento de enfermedades crónicas no trasmisibles, como la diabetes mellitus, con complicaciones asociadas por daño en los nervios periférico como la úlcera neuropática. Por todo esto, es responsabilidad del personal de enfermería de buscarle solución a las necesidades de estos pacientes utilizando las teorías de Sor Callista Roy y Dorothea E. Orem para mejorar del estado de salud y adaptarse a la situación de cronicidad del padecimiento, para continuar con el diario vivir con el mayor grado de independencia posible y el menor grado de discapacidad. Objetivo: Analizar los puntos de encuentro entre las teorías de Roy y Orem en la atención al anciano con úlcera neuropática. Métodos: Revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de artículos originales y de revisión. La estrategia de búsqueda adoptada fue la utilización de las palabras clave o descriptores, conectados por intermedio del operador booleano AND, en las bases de datos SciELO, (Scientific Electronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Literatura Latino-Americana e do CaribeemCiências da Saúde); y MEDLINE/Pubmed (Medical Literature Analysis and Retrieval System Online); durante el mes de enero de 2017. Conclusiones: La meta de la enfermería es promocionar modos de adaptación que apoyen la integridad psicofísica, identidad grupal de autoconcepto, función de rol e interdependencia para lograr la salud global de los ancianos con úlcera neuropática(AU)

ABSTRACT Introduction: Population aging is a demographic concern worldwide and causes the increase of chronic noncommunicable diseases, such as diabetes mellitus, with complications associated with peripheral nerve damage such as neuropathic ulcer. Because of all this, it is the responsibility of the nursing staff to find a solution to the needs of these patients, by using the theories of Sister Callista Roy and Dorothea E. Orem, in order to improve the state of health and make them adapt to the chronicity of the condition, to continue with their daily live with the highest possible degree of independence and the lowest degree of disability. Objective: To analyze the coinciding points between Roy and Orem's theories in the care of the elderly with neuropathic ulcer. Methods: Systematic bibliographic review for carrying out a critical reflexive analysis of the content of original and review articles. The search strategy adopted was the use of keywords or descriptors, connected through the Boolean operator AND, in the SciELO, Ebsco, LILACS and MEDLINE/Pubmed databases, during the month of January 2017. Conclusions: The purpose of nursing is to promote ways of adaptation that support psychophysical integrity, group identity for self-concept, the function of role and interdependence to achieve the overall health of the elderly with neuropathic ulcer(AU)

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RESUMEN Introducción: Las actividades de autocuidado se aprenden conforme el individuo madura, y son afectadas por creencias culturales, hábitos, costumbres de la familia y la sociedad. La edad, las etapas del desarrollo y el estado de salud, pueden afectar la capacidad del individuo para realizar actividades de autocuidado. Objetivo: Mostrar la adaptación de la teoría del déficit de autocuidado de Dorothea E. Orem a personas con diabetes mellitus complicada con úlcera neuropática. Métodos: Revisión bibliográfica sistemática para desarrollar un análisis crítico reflexivo del contenido de artículos originales y de revisión. La estrategia de búsqueda adoptada fue la utilización de las palabras clave o descriptores, conectados por intermedio del operador booleano AND. La búsqueda fue realizada en las bases de datos SciELO, (ScientificElectronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Literatura Latino-Americana e do CaribeemCiências da Saúde); y MEDLINE/Pubmed (Medical LiteratureAnalysis and RetrievalSystem Online); durante el mes de enero de 2017. Conclusiones: Se fundamenta la relevancia del autocuidado de personas diabéticas complicadas con úlcera neuropática en la comunidad y se pone de manifiesto la carencia de estudios específicos de este tipo desde la perspectiva de Enfermería. El logro de la toma de conciencia del autocuidado que requiere la persona afectada con diabetes mellitus complicadas con úlcera neuropática en función de mejorar o mantener el estado de salud, a través de las posibilidades que le brinda al enfermero de la comunidad(AU)

ABSTRACT Introduction: Self-care activities are learned as the individual matures, and are affected by cultural beliefs, habits, customs within the family and the society. Age, stages of development and health status can affect the individual's ability to perform self-care activities. Objective: To describe Dorothea E. Orem's self-care deficit theory's adaptation to people with diabetes mellitus complicated by neuropathic ulcer. Methods: Systematic bibliographic review for carrying out a reflexive critical analysis of the content of original and review articles. The search strategy adopted was the use of keywords or descriptors, connected through the Boolean operator AND. The search was carried out in the databases SciELO (Scientific Electronic Library Online), Ebsco (Elton Bryson Stephens Company), LILACS (Latin American Literature and Caribeem Ciências da Saúde), and MEDLINE/Pubmed (Medical Literature Analysis and Retrieval System Online), during the month of January 2017. Conclusions: The relevance is supported regarding the self-care of diabetic people with complicated neuropathic ulcer in the community. The lack is shown of specific studies of this type from the nursing perspective. The achievement represented by raising awareness about self-care as required by the person affected with diabetes mellitus with complicated neuropathic ulcer for improving or maintaining the state of health, through the possibilities offered to the community nurse(AU)

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