RESUMO
Introdução: As úlceras no pé diabético surgem da interação complexa entreneuropatia periférica e doença arterial periférica, comprometendo a cicatrização após traumas. Objetivo: Explorar a diversidade de intervenções terapêuticas não farmacológicas que têm sido estudadas e avaliadas quanto à sua eficácia e segurança no tratamento de úlceras no pé diabético. Metodologia: Pesquisa do tipo revisão integrativa da literatura. Para obtenção dos resultados foi realizado um levantamento nas plataformas PubMed e Biblioteca Virtual em Saúde. Para elaboração dos resultados foram selecionados 21 artigos. Resultados: As intervenções encontradas foram oxigenoterapia hiperbárica, terapia de feridas por pressão negativa, uso de matriz dérmica, plasma rico em plaquetas, plasma atmosférico frio, tratamentos com curativos especiais e uso de solas rígidas, entre outros. Mostraram uma variabilidade na taxa de cicatrização e no tempo de fechamento da ferida, bem como na melhoria da regeneração tecidual. Conclusão: As pesquisas mostram uma diversidade de intervenções terapêuticas não farmacológicas utilizadas no tratamento de úlceras no pé diabético, ressaltando a necessidade de abordagens individualizadas e mais estudos para determinar a eficácia e segurança de cada intervenção (AU).
Introduction:Diabetic foot ulcers arise from the complex interaction between peripheral neuropathy and peripheral arterial disease, compromising wound healing after traumas. Objective:To explore the diversity of non-pharmacological therapeutic interventions that have been studied and evaluated for their effectiveness and safety in the treatment of diabetic foot ulcers. Methodology: An integrative literature review was conducted. The search for results was performed on the PubMed and Virtual Health Library platforms. Twenty-one articles were selected for result elaboration.Results:The identified interventions included hyperbaric oxygen therapy, negative pressure wound therapy, use of dermal matrix, platelet-rich plasma, cold atmospheric plasma, treatments with special dressings, and the use of rigid soles, among others. They exhibited variability in the healing rate and wound closure time, as well as improvement in tissue regeneration.Conclusion:The research demonstrates a diversity of non-pharmacological therapeutic interventions used in the treatment of diabetic foot ulcers, emphasizing the need for individualized approaches and further studies to determine the effectiveness and safety of each intervention (AU).
Introducción: Las úlceras en el pie diabético surgen de la interacción compleja entre neuropatía periférica y enfermedad arterial periférica, comprometiendo la cicatrización después de traumas.Objetivo: Explorar la diversidad de intervenciones terapéuticas no farmacológicas que han sido estudiadas y evaluadas en cuanto a su eficacia y seguridad en el tratamiento de úlceras en el pie diabético.Metodología: Investigación del tipo revisión integrativa de la literatura. Para obtener los resultados se realizó un estudio en las plataformas PubMed y Biblioteca Virtual en Salud. Para la elaboración de los resultados se seleccionaron 21 artículos. Resultados: Las intervenciones encontradas fueron oxigenoterapia hiperbárica, terapia de heridas por presión negativa, uso de matriz dérmica, plasma rico en plaquetas, plasma atmosférico frío, tratamientos con curativos especiales y uso de suelas rígidas, entre otros. Mostraron una variabilidad en la tasa de cicatrización y en el tiempo de cierre de la herida, así como en la mejora de la regeneración tisular. Conclusión: Las investigaciones muestran una diversidad de intervenciones terapéuticas no farmacológicas utilizadas en el tratamiento de úlceras en el pie diabético, resaltando la necesidad de enfoques individualizados y más estudios para determinar la eficacia y seguridad de cada intervención (AU).
Assuntos
Humanos , Avaliação de Resultado de Intervenções Terapêuticas , Pé Diabético/patologia , Modelos de Assistência à Saúde , Úlcera por Pressão/patologia , Doença Arterial PeriféricaRESUMO
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.
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Diabetes Mellitus , Pé Diabético , Hiperglicemia , Humanos , Cicatriz/patologia , Úlcera/patologia , Pé Diabético/patologia , Extremidade Inferior/patologia , Hiperglicemia/patologia , Recidiva , Diabetes Mellitus/patologiaRESUMO
Abstract Chronic type 2 diabetes mellitus (T2DM) and its associated diseases are major concern among human population and also responsible for significant mortality rate. Hence, the present study aims to evaluate and correlate the invertase inhibition, antioxidant activity and control against DFU causing bacterial pathogens by Pandanus odoratissimus flowers. Two dimensional preparative thin layer chromatography (2D PTLC) was adopted to purify the phenolic acid component and LC-MS2 was done to predict the phenolic acid structures. Standard spectrophotometry methods were adopted to investigate the in vitro invertase inhibitory and antioxidant (CUPRAC and ABTS) activities. Agar well diffusion and broth dilution assays were used to record the antibacterial property against DFU causing pathogens isolated from clinical samples. Statistical analyses were used to validate the experiments. A new and novel diferuloyl glycerate related phenolic acid (m/z 442) purified from PTLC eluate has recorded satisfactory cupric ion reducing power (ED50= 441.4±2.5 µg), moderate ABTS radical scavenging activity (IC50= 450.3±10 µg; 32.5±1.5%), and a near moderate, in vitro, invertase mixed type inhibition (24.5±4.5%; Ki: 400 µg). Similarly, bacterial growth inhibitory kinetics has showed a significant inhibition against E. coli and S. aureus.
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Humanos , Masculino , Feminino , Técnicas In Vitro/métodos , Pé Diabético/patologia , Pandanaceae/efeitos adversos , Flores/classificação , beta-Frutofuranosidase/isolamento & purificação , Diabetes Mellitus Tipo 2/patologia , Espectrofotometria/métodos , Cromatografia em Camada Fina/instrumentação , Antioxidantes/efeitos adversosRESUMO
OBJECTIVE: Diabetic foot wounds are a relevant diabetes complication and a major health problem. It has been described that propolis has health benefits due to its anti-inflammatory, antioxidant, and support in the healing process. The current study assessed the effect of propolis as an adjuvant in the healing of human diabetic foot ulcers. This was evaluated in a randomized placebo-controlled study of subjects receiving care in the Diagnostic and Treatment Centre from the Regional Hospital of Talca, Chile. RESEARCH DESIGN AND METHODS: Randomized subjects received ambulatory healing treatment for diabetes foot wounds with propolis spray (3%), which was applied to cover the entire wound surface each time it was dressed from week 0 until cicatrization or 8 weeks as a maximum. Two serum samples were taken (day 0 and end of the study) for cytokine and oxidative stress analyses. Also, macro- and microscopy were analyzed in the process of wound healing. RESULTS: The study comprised 31 subjects with type 2 diabetes in treatment for diabetic foot wounds in the Diagnostic and Treatment Centre from the Regional Hospital of Talca. Propolis promotes a reduction of the wound's area by an average of 4 cm2, related to an increase in the connective tissue deposit compared to the control. Also, propolis increased the glutathione (GSH) and GSH/glutathione disulfide (GSSG) ratio (p < 0.02), depleted tumor necrosis factor- (TNF-) α, and increased interleukin- (IL-) 10 levels. Topical propolis did not modify the biochemical parameters in the serum of the studied subjects. CONCLUSIONS: The topical use of propolis turned out to be an interesting therapeutic strategy as an adjuvant in the care of diabetes foot wounds due to its ability to improve and promote healing based on its anti-inflammatory and antioxidant profile. This trial is registered with NCT03649243.
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Anti-Inflamatórios/administração & dosagem , Antioxidantes/administração & dosagem , Pé Diabético/tratamento farmacológico , Hospitais , Própole/administração & dosagem , Pele/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Administração Cutânea , Aerossóis , Idoso , Anti-Inflamatórios/efeitos adversos , Antioxidantes/efeitos adversos , Biomarcadores/sangue , Chile , Citocinas/sangue , Pé Diabético/sangue , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo/efeitos dos fármacos , Própole/efeitos adversos , Pele/metabolismo , Pele/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: To identify the demographic and clinical characteristics of Dominican adults admitted to a diabetic foot clinic and compare these characteristics by sex to better characterize and understand the severity of diabetes in the Dominican Republic. METHODS: We conducted a retrospective medical chart review of Dominican adults admitted to the National Institute of Diabetes, Endocrinology, and Nutrition's (INDEN) diabetic foot clinic between January 1st, 2015 and December 31st, 2015. We generated descriptive statistics and compared results by sex. RESULTS: We assessed 447 medical charts of patients admitted in 2015. More men visited the clinic than women (65% vs. 35%). The average duration of diabetes was 14.4⯱â¯8.9 years. Abscess was the most common foot problem (74% in men, 68% in women, pâ¯=â¯0.164). A slightly smaller proportion of men received amputations than women (46% vs. 51%, pâ¯=â¯0.390). Women were older (pâ¯<â¯0.001), less educated (pâ¯=â¯0.004), and less likely to be married (pâ¯<â¯0.001). Women also exhibited higher rates of obesity (pâ¯=â¯0.003), hypertension (pâ¯=â¯0.005), cardiovascular disease (pâ¯=â¯0.011), ischemic foot (pâ¯=â¯0.008), and above the knee amputations (pâ¯=â¯0.002). CONCLUSION: Implementation of diabetes education programs, introduction of proper foot care, and improved resources for lifestyle management are needed to increase awareness and subsequently decrease diabetes and its negative impact on the health and economy of the Dominican Republic. Our findings suggest that various risk factors and comorbidities important to the development of diabetes may be disproportionately affecting women. Interventions should focus on women and their behaviors that increase risk for diabetes.
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Instituições de Assistência Ambulatorial/estatística & dados numéricos , Amputação Cirúrgica/estatística & dados numéricos , Pé Diabético/epidemiologia , Pé Diabético/patologia , Hospitalização/estatística & dados numéricos , Adulto , Idoso , Demografia , República Dominicana/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
This study analyzes the effects of the Rapha® system, which employs red light therapy (RLT) and a natural latex biomembrane in the healing of neuropathic ulcers associated with the diabetic foot. We conducted a randomized, controlled, blinded clinical trial with 15 participants that were divided into three groups (GI, GII and GIII): (i) Rapha® system application by the participant and a health professional at home, with clinical status evaluation every 2 weeks at the hospital (GI); (ii) standard protocol used in Brazil, performed by a health professional at the hospital (GII; control); and (iii) the Rapha® system applied by the participant at home and clinical status evaluation every 2 weeks at the hospital (GIII). We used image processing techniques on photographic recordings of the lesions, and several statistical tests were used to analyze the data, allowing for the comparison of the average results for all groups. The average healing rates of GI, GII, and GIII were 77.0, 51.4, and 80%, respectively. The granulation tissue evaluation indicated a higher efficacy in the tissue repair of lesions treated with the Rapha® system. In conclusion, the Rapha® system proved to be an effective healing system, even when self-applied at the patient's home.
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Bandagens , Pé Diabético/terapia , Látex , Membranas Artificiais , Fototerapia , Cicatrização , Idoso , Pé Diabético/patologia , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The present study aims at evaluating the correlation between the free radical formation and the healing action of lower limbs' ulcers in a randomized controlled trial with the use of an adhesive derived from natural latex associated with a light-emitting diode (LED) circuit. The sample consists of 15 participants with lower limb lesions divided into three groups: group 1 case (5 participants) received the proposed dressing system adhesive of the natural latex associated with the LED circuit; group 2 control (5 participants) received the dressings at home performed by nurses according to and established by the clinic of wounds (treated with calcium alginate or silver foam); and group 3 (5 participants) also received the dressing in their homes with the use of the dressing adhesive derived from the natural latex associated with the LED circuit. The collected data were analyzed qualitatively and quantitatively by electron paramagnetic resonance for determination of free radical formation. Kruskal-Wallis statistical test was used to evaluate the effect of treatment on the lower limb's ulcer cicatrization process and its correlation with free radical. The results obtained corroborated the hypothesis about the reduction of the quantity of these molecules in the end of treatment related to the healing wound.
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Bandagens , Cicatriz/metabolismo , Pé Diabético/terapia , Espécies Reativas de Oxigênio/metabolismo , Cicatrização/fisiologia , Idoso , Alginatos , Cicatriz/patologia , Pé Diabético/metabolismo , Pé Diabético/patologia , Feminino , Ácido Glucurônico , Ácidos Hexurônicos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
OBJECTIVE: To analyze the efficacy of the therapeutic use of Low-Level Laser Therapy (LLLT) on the tissue repair process of chronic wounds in patients with diabetic feet through the analysis of Pressure Ulcer Scale for Healing (PUSH) scales, pain and the measurement done using the ImageJ© software. METHODS: This clinical trial was carried out with 18 patients 30-59 years of age, who had chronic wounds on their foot due to complications of diabetes mellitus. The patients were randomly allocated in two different groups of equal numbers: Control and Laser Groups. The LLLT equipment used in the research has a wavelength of 660 nm, 30 mW power, continuous mode emission, 6 J/cm2 dosimetry, 48/48 h in a 4-week period. Measurement and the aspect of wounds were noted in the PUSH scale and the pain was evaluated weekly. The Mann-Whitney U nonparametric test was used to compare groups. RESULTS: The Laser Group presented a significant increase of the tissue repair index when compared with the Control Group, with a significant statistical difference (p < 0.013). There was no significant difference between the groups in all the weeks using the PUSH scale. CONCLUSIONS: The use of LLLT on chronic wounds in a diabetic foot demonstrated efficacy on the progression of the tissue repair process in a short period.
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Pé Diabético/radioterapia , Terapia com Luz de Baixa Intensidade , Cicatrização/efeitos da radiação , Adulto , Doença Crônica , Pé Diabético/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
NTRODUCTION Diabetic foot ulcers are a chronic complication in patients with diabetes mellitus. They appear as a result of the combination of diabetic polyneuropathy and angiopathy, and in many cases require amputation of the affected extremity. Clinical trials have demonstrated that repeated local infiltration with Heberprot-P can improve healing of chronic diabetic foot ulcers. Although there is evidence of its effects as a granulation stimulator and on cell migration and proliferation, genetic control mechanisms explaining its anti-inflammatory and oxidative stress reduction properties are not yet thoroughly understood. OBJECTIVE Analyze changes in expression of genes involved in healing after treatment of diabetic foot ulcers with Heberprot-P. METHODS Biopsies were collected from diabetic foot ulcers of 10 responding patients before and after 2 weeks' treatment with Heberprot-P (75-µg applied intralesionally 3 times per week). Total RNA was obtained and quantitative PCR used to determine expression of 26 genes related to inflammation, oxidative stress, cell proliferation, ngiogenesis and extracellular matrix formation. Genetic expression was quantified before and after treatment using REST 2009 v2.0.13. RESULTS After treatment, there was a statistically significant increase in expression of genes related to cell proliferation, angiogenesis and formation of extracellular matrix (PDGFB, CDK4, P21, TP53, ANGPT1, COL1A1, MMP2 and TIMP2). A significant decrease was observed in gene expression related to inflammatory processes and oxidative stress (NFKB1, TNFA and IL-1A). CONCLUSIONS Our findings suggest that Heberprot-P's healing action on diabetic foot ulcers is mediated through changes in genetic expression that reduce hypoxia, inflammation and oxidative stress, and at the same time increase cell proliferation, collagen synthesis and extracellular matrix remodeling. The kinetics of expression of two genes related to extracellular matrix formation needs further exploration. KEYWORDS Epidermal growth factor, EGF, diabetic foot ulcer, wound healing, quantitative real-time PCR, gene expression, Cuba.
Assuntos
Pé Diabético/tratamento farmacológico , Fator de Crescimento Epidérmico/uso terapêutico , Expressão Gênica/efeitos dos fármacos , Cicatrização/efeitos dos fármacos , Biópsia , Pé Diabético/metabolismo , Pé Diabético/patologia , Humanos , Reação em Cadeia da Polimerase em Tempo Real , Proteínas Recombinantes , TranscriptomaRESUMO
Lymphangioma-like Kaposi's sarcoma (LLKS) is a rare histologic variant of KS. Kaposi's sarcoma is also known as human herpesvirus type 8. The clinical presentation of the LLKS lesion is highly unusual and similar to that of classic KS but with multinodular vascular tumors and lymphedema. We present a 63-year-old native Haitian man with multiple slowly progressive exophytic ulcerated lesions covering more than 60% of his left lower extremity with no systemic involvement. Much confusion surrounded the clinical presentation of these wounds, and we postulated several differential diagnoses. Herein we describe the evaluation, clinical appearance, and progression of LLKS. Due to the rarity of LLKS, treating physicians need to be aware of the clinical presentation and diagnostic criteria of this variant. Despite being incurable, early diagnosis of LLKS can lead to long-term treatment options and a major reduction in symptoms.