Diabetic foot

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Sustitutos dermoepidérmicos en el tratamiento de úlceras de pie diabético
    
      Dermoepidermical substitutes in the treatment of diabetic foot ulcers

Sustitutos dermoepidérmicos en el tratamiento de úlceras de pie diabético Dermoepidermical substitutes in the treatment of diabetic foot ulcers

7. Otero-Vinas M, Falanga V. Mesenchymal Stem Cells in Chronic Wounds: The Spectrum from Basic to Advanced Therapy. Adv Wound Care (New Rochelle). 2016[Cited 2019 Jan 28]; 5(4):149-63. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817558/ 8. Santema TB, Poyck PP, Ubbink DT. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2016[Cited 2019 Jan 30];2:CD011255. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26866804 9. Zelen CM, Serena TE, Gould L, Le L, Carter MJ, Keller J, et al. Treatment of chronic diabetic lower extremity ulcers with advanced therapies: a prospective, randomised,

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Diagnóstico de osteomielitis en úlceras de pie diabético
    
      Diagnosis of osteomyelitis in diabetic foot ulcers

Diagnóstico de osteomielitis en úlceras de pie diabético Diagnosis of osteomyelitis in diabetic foot ulcers

La evidencia disponible en la literatura sostiene que la evaluación de una muestra de hueso es el estándar de oro o prueba de referencia para el diagnóstico de la OM en UPD y para proporcionar datos sobre los agentes patógenos que causan la infección ósea y su susceptibilidad ante los diferentes antibióticos. Varios estudios indican que las muestras de tejido blando no son adecuadas para predecir los patógenos a nivel óseo. Las muestras de tejido óseo pueden obtenerse mediante biopsia transulcerosa o biopsia percutánea. La guía publicada en 2016 por el IWGDF por sus siglas en inglés (International Working Group of the Diabetic Foot), sostiene que las tomas de muestra óseas deben realizarse pasando por piel intacta no infectada, porque si se realiza a través de una herida, se corre el riesgo de contaminar la muestra con los agentes patógenos de los tejidos blandos. Sin embargo, otros autores sostienen que la biopsia percutánea es un método diagnóstico agresivo y defienden que la toma de muestra de tejido óseo a través de la úlcera es una alternativa fiable, siempre que previamente se haya realizado un desbridamiento adecuado de la herida y siempre hay que tener en cuenta un período de lavado previo de antibióticos de al menos 48-72 horas (21, 24) .

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Prueba diagnóstica de disfunción sudomotora en la detección precoz de la neuropatía diabética

Prueba diagnóstica de disfunción sudomotora en la detección precoz de la neuropatía diabética

Background: Sudomotor dysfunction may appear in early stages of diabetic neuropathy. Aim: To evaluate the diagnostic capacity of the Neuropad test, ba- sed on the detection of sudomotor dysfunction, as an early indicator of diabetic neuropathy. Material and Methods: In Forty-two type 2 diabetic patients, the Neuropad test was compared with the 10 g monofilament test (proposed in the technical orientation of diabetic foot of the Ministry of Health of Chile), deep and thermal sensitivity. Results: The surface sensitivity assessed with a brush had a sensitivity and specificity of 18.8 and 100% respectively when compared with the 10 g monofilament. When compared with the Neuropad, the figures were 9 and 100%, respectively. Pain perception sensitivity and specificity were 13 and 100% respectively when compared with the 10 g monofilament. The figures were 6 and 100%, when compared with the Neuropad. Thermal discrimination had a sensitivity and specificity of 88 and 33% respectively when compared with the 10 g monofilament. The figures were 75 and 25% respectively when compared with the Neuropad. The deep sensitivity evaluated with a 128 Hz tuning fork had a sensitivity and specificity of 31 and 100% respectively when compared with the 10 g monofilament. The figures were 16 and 31% respectively when compared with the Neuropad. The Neuropad had a sensitivity and specificity of 94 and 29% respectively were compared with the 10 g monofilament. Conclusions: Neuropad had a good diagnostic yield for the early detection of sudomotor dysfunction.

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UNA NUEVA ALTERNATIVA EN EL MANEJO DE LA ÚLCERA VASCULAR COMPLEJA CON FACTOR DE CRECIMIENTO EPIDERMICO RECOMBINANTE, EPIPROT® (NEPIDERMINA)

UNA NUEVA ALTERNATIVA EN EL MANEJO DE LA ÚLCERA VASCULAR COMPLEJA CON FACTOR DE CRECIMIENTO EPIDERMICO RECOMBINANTE, EPIPROT® (NEPIDERMINA)

1. Fernandez - Montequín JL, Valenzuela Silva CM, Diaz OG, et al. Intra-lesional injections of recombinant human epidermal growth factor promote granulation and healing in advanced diabetic foot ulcers: multicenter randomised, placebo controlled. Double-blind study. Int wound J 2009; 6(6): 432-43. 2. Cardona C, Ceballos O, Guerra M, Monsalve F. Prevalencia de alteraciones sensitivas y factores asociados en pacientes con amputación que consultan en una empresa de medicina física de la ciudad de Medellín. [Tesis de grado en internet] [Medellín]: Universidad CES - Universidad de Manizales. [Citado 10 de febrero de 2019]. 2011. Disponible en: http://bdigital.ces.edu.co:8080/repositorio/bitstream/ 10946/1394/2/Prevalencia_alteraciones_sensitivas.pdf 3. Tamayo D. Diabetes en Colombia: Descripción de la epidemiología actual. [Internet] Observatorio de Diabetes de Colombia. [Bogotá]. Organización para la excelencia en salud. 2012. (citado en febrero 10 de 2019 Disponible en:

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Cierre primario diferido en las amputaciones parciales del pie diabtico

Cierre primario diferido en las amputaciones parciales del pie diabtico

amputation: a safe, reliable, and cost-effective treatment of diabetes-related tip of toe ulcers complicated by osteomyelitis. J Foot Ankle Surg. 2014;53(6):720-6. 3. Stasch T, Hoehne J, Huynh T, Bardemaeker R, Grandel S, Herold C. Debridement and autologous lipotransfer for chronic ulceration of the diabetic foot and lower limb improves wound healing. Plast Reconstr Surg. 2015;136(6):1357-66.

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Un dispositivo de presión negativa para el tratamiento del pie diabético

Un dispositivo de presión negativa para el tratamiento del pie diabético

The groups were randomized and both groups, after metabolic control, received the best treatment available for diabetic foot: antibiotics, wound cleansing with neu- tral soap three times a day, and debridement of necrotic tissue every other day. The experimental group also re- ceived negative pressure treatment. The size of the ulcer, the healing time, and the amputation level were recor- ded. Resolution of the ulcer in a period of months was considered wound healing, and failure was considered when there was no healing after six months of treatment.

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TítuloEfectividad de la terapia hiperbárica en los distintos tipos de úlceras en pie diabético

TítuloEfectividad de la terapia hiperbárica en los distintos tipos de úlceras en pie diabético

- Treatment of diabetic foot complications with hyperbaric oxygen therapy: a retrospective experience (25) : el objetivo de este estudio es evaluar el papel de la oxígenoterapia como tratamiento para las ulceras diabéticas, para ello se realizo un estudio retrospectivo.se analizaron 26 pacientes con ulceras Wagner grado 2 o mayor. De estos, 23 lesiones del pie finalizaron el tratamiento y la epitelización completa de la lesión primaria se logró en 15 (65%). El tiempo medio de curación desde la primera sesión fue de 16 semanas. Por encima de los tobillos

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Factor de crecimiento epidrmico: aplicacin clnica en dermatologa

Factor de crecimiento epidrmico: aplicacin clnica en dermatologa

14. Tuyet HL, Nguyen Quynh TT, Vo Hoang Minh H, et al. “The efficacy and safety of epidermal growth factor in treatment of diabetic foot ulcers: the preliminary results”. Int Wound J. 2009; 6: 159-166. 15. Hong JP, Jung HD, Kim YW. “Recombinant human epidermal growth

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Effect of static foot posture on the dynamic stiffness of foot joints during walking

Effect of static foot posture on the dynamic stiffness of foot joints during walking

Before analysing the differences in the dynamic stiffnesses with the static foot posture, it is advisable to first look at the variation of joint angle and moment during the stance phase. A significant smaller ROM was found for HP feet in both ankle and metatarsophalangeal joints, accordingly to previous works [15], [16]. These differences were due basically to the differences in the evolution of the dorsiflexion angles during propulsion (Figure 2). The ROM used during the propulsion phase was smaller in HP feet for all foot joints considered, with significantly reduced final plantarflexion angle, which might be related with the shorter length of the triceps surae muscle reported in HP feet [26], [27], which could be studied in future works. Conversely, the dorsiflexion angle curves for HS feet during the stance phase were quite close to those of normal FPI feet. Dorsiflexion moment curves during the stance phase (Figure 3) followed a bell-shaped profile in all foot types considered, with similar peak values except for the metatarsophalangeal joint. Moment ranges (which corresponded approximately to moment peak values) were significantly larger at the midtarsal joint in HP feet when compared to HS feet (although differences were small), and were significantly smaller at the metatarsophalangeal joint in HS feet. Pronation seemed to generate larger peak values of dorsiflexion moment, especially at the metatarsophalangeal joint, favoured by a larger distance between the COP and the joint centres (about 1.5 times that of the HS feet) because of a smaller dorsiflexion joint angle at this time. This might explain the higher incidence of hallux limitus in HP feet [28].

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Impact of the quality of life related to foot health in a sample of pregnant women: A case control study

Impact of the quality of life related to foot health in a sample of pregnant women: A case control study

Health System and the Clinic of Podiatric Medicine and Surgery that provides treatment of diseases and disorders of the foot at University of A Coruña (Ferrol, Spain) between January and September 2016. The selection of the investigation women’s was conducted by a non-randomized and consecutive sampling method to 178 participants in the age range of 19 to 44 years, of which 159 gave consent and were enrolled into the study. The exclusion criteria were as the following: being under 18 years of age, smokers or alcoholic patients, women participating in vitro fertilization, multiple gestation or women with gestation before the twentieth week, immunocompromised subjects, previous trauma and a history of foot surgery, musculoskeletal problems, general discomfort neurological disorders, lack of autonomy/ semi-autonomy in daily activities, the refusal to sign an informed consent form, and the inability to understand and carry out the instructions in the research.

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Diabetic Shoes "La salud desde tus pies"

Diabetic Shoes "La salud desde tus pies"

Diabetic shoes está conformado por 5 jóvenes multidisciplinarios que están por egresar la carrera de Ingeniería Industrial en la Universidad San Ignacio de Loyola, la formación y experiencia de nuestros vendedores vinculada con la actividad nos hace tener el control sobre las ventajas que brindamos sobre otros zapatos sustitutos. La elección del municipio de Santiago de Surco para la ubicación de la empresa responde a una estrategia que situará la tienda con la planta en un mismo inmueble, y a la vez, estaremos cerca de las Oficinas de Adiper lo cual nos hace tener más llegadas a las personas que sufren de Diabetes, ya que Adiper es la asociación Nacional de Diabéticos en el Perú, en el cual se brindan charlas informativas de diferentes temas relacionados con la Diabetes.

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DISENO Y DESARROLLO DE UNA PROTESIS FLEX-FOOT

DISENO Y DESARROLLO DE UNA PROTESIS FLEX-FOOT

Existe un número de diversos dispositivos prostéticos del pie y de la pierna actualmente funcionando. La meta fundamental de estos dispositivos es extender una pierna amputada hasta que toque el piso para que el portador pueda apoyarse. En un principio una prótesis era simplemente una clavija asegurada a la amputación que proporciona movilidad mínima al portador. Más adelante, un pie fue agregado al fondo de la clavija. Un ejemplo de una prótesis básica del pie más moderna conocida como el “pie de Sach” es un pie de madera tallado con un puntal de aluminio que une el pie al zócalo del amputación. Mejoras adicionales llevadas a cabo al dispositivo básico por las bisagras o las articulaciones de rótula del tobillo, mejoran movilidad pero el resto de la prótesis era rígida y pesada y como tal resultó incómoda al portador. Los estudios recientes indican que tales sistemas rígidos contribuyen a la deterioración de la cadera prematuramente debido a las cargas axiales severas transmitidas al empalme de la cadera del portador. Las mejoras recientes a las configuraciones de la prótesis del pie utilizan tecnología moderna del material compuesto para impartir almacenamiento de energía y para liberarla durante uso. Los ejemplos de éstos son el “pie Seattle,” que es un pie moldeado con plásticos y la prótesis Flex-Foot, que proporciona una configuración compuesta del puntal y del pie. El resorte impartido por los materiales proporcionó movilidad y comodidad adicionales al portador. Sin embargo, este tipo de prótesis conserva ciertas características del diseño que limitan su utilidad potencial y que prevengan la optimización ideal posible con los materiales compuestos modernos del alto rendimiento. Todos los dispositivos conocidos dentro de este grupo se componen de las partes individuales que se deben sujetar juntos, sea el talón al pie o la extensión de la pierna que conecta al pie. Estos empalmes se deben construir rígidamente para ser bastante fuertes y soportar las cargas concentradas transmitidas a través de ellas. El resultado es que al ocurrir la tensión local interfiere con la suavidad, incluso la flexión de los componentes durante un paso largo. Incluso con los empalmes rígidos construidos, estos dispositivos con fatiga y fractura propensas en los empalmes producen que el portador corra el riesgo de lesión. Además, los materiales compuestos exhiben la fuerza pobre del cojinete donde los sujetadores penetran la construcción. El desgaste y la erosión acumulativos de sujetadores circundantes de los materiales estructurales dan lugar a la pérdida de posición o de los componentes unidos después de un período del uso continuo. Para prevenir fractura, la acumulación de los materiales requeridos para la resistencia hace difícil dar un acabado cosmético atractivo del área del tobillo.

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Effects of ankle-foot orthosis in children with cerebral palsy: a systematic review of literature

Effects of ankle-foot orthosis in children with cerebral palsy: a systematic review of literature

characterized by the damage to CNS (central nervous system), for example, rectus femoris and hamstring co-spasticity. Secondary anomalies, refer to abnormal bone/muscle growth. Tertiary abnormalities, are those compensations that the individual uses to circumvent the primary and secondary anomalies of gait, and they can be thought of as “coping responses”( abnormal temporal-distance parameters [12]). For example, we take the case explained in primary anomalies, and we know that commonly produces a stiff knee in the swing phase of gait. This leads to problems with foot clearance. Circumduction (coping response) of the swinging limb, by abducting the hip, is a frequent compensation. The “coping responses” will disappear spontaneously when they are no longer required. [10g]Another example of gait anomalies: equinus may be present in swing and stance phase. Anterior tibialis weakness, dysfunction, or premature gastrosoleus contraction causes swing phase drop foot with resultant dragging of the foot, tripping, and proximal joint kinematic compensations. [7]

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Nitrosative Stress in Retinal Pathologies: Review

Nitrosative Stress in Retinal Pathologies: Review

A great number of studies have shown that the antioxidant administration in animal models of diabetes can reduce retinal cell death by apoptosis, and can thus contribute to the improvement in DR progression [35–37]. However, the results of clinical trials that have used antioxidants in DR therapy are inconclusive [38]. Consequently, new studies and approaches using antioxidants as adjuvant therapies in DR treatment should be performed. In this sense, the possible use of antioxidants and/or NOS inhibitors and NO scavengers has been suggested [39]. It has been reported that aminoguanidine, a pharmacological inhibitor of iNOS and an inhibitor of advanced glycated end products, prevents the histological changes induced by diabetes in rats and that it is safe when administered intravitreally [40]. Other NOS inhibitors, such as N(G)-nitro- l -arginine methyl ester ( l -NAME), are able to reduce the increase in oxidized proteins observed in diabetic rat retinas [41]. Moreover, it is known that in diabetic retinas, iNOS and the bradykinin type 1 receptor contribute to inflammation, oxidative stress, and vascular dysfunction and that the administration of a selective iNOS inhibitor for diabetic rats decreases these alterations [42]. Conversely, a large septic shock trial was terminated prematurely because of a trend toward harm among patients receiving NO inhibitors [43].

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Propuesta de formalización desde una perspectiva legal, estructural, administrativa, y contable de una micro empresa familiar para convertirse en compañía limitada con miras a aperturar franquicias a nivel nacional caso: Foot & Foot

Propuesta de formalización desde una perspectiva legal, estructural, administrativa, y contable de una micro empresa familiar para convertirse en compañía limitada con miras a aperturar franquicias a nivel nacional caso: Foot & Foot

El poder de negociación de los compradores depende de las características de cada mercado, en el caso de Foot & Foot sus ventas no están concentradas en grandes clientes que compran mucho, por el contrario sus ventas están repartidas entre muchos de ellos que compran poco; sin embargo los servicios que se ofrecen son estándar esto quiere decir que no se diferencian en gran medida con los de la competencia y ya que los clientes son sensibles al precio y siempre pueden encontrar otros proveedores con mejores ofertas, lo que ocasiona guerra de precios que erosionan la rentabilidad de las organizaciones de este sector, esto representa una amenaza muy grande para este sector de la industria.

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Repensando el minimalismo silábico  en el truncamiento en español

Repensando el minimalismo silábico en el truncamiento en español

On the other hand, Piñeros (1998, 2000a, 2000b, 2002) support a trochaic (bimoraic or disyllabic) template and analyze the data from an optimality theoretic standpoint. For instance, Piñeros (2002) offers an optimality theoretic analysis of mainly Type B truncatory process in Spanish that relies on the ranking of different constraints to ob- tain binary trochaic truncated words. For his analysis, Piñeros (2002) follows Benua (1995) in applying some truncation-specific correspondence constraints. In Piñeros’ (2002) analysis, the undominated hierarchy F OOT B IN , P ARSE -σA LIGN -F T -R (also known as R ESTRICTOR , responsible for delimiting or “restricting” the size of the prosodic word, McCarthy and Prince 1995) is responsible for a prosodic word of exactly two syllables or two moras long in Spanish. On the other hand, foot-sensitive Type B truncation is treated in a different manner. Piñeros assumes a constraint M AX F T BT that in the out- put form preserves the integrity of the foot already present in the base.

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Valuación Foot Locker, Inc.

Valuación Foot Locker, Inc.

internacionalmente. Esta experiencia del cliente incluye también un fuerte seguimiento de las tendencias del momento no solo en el ámbito del deporte sino en la vida diaria con productos de moda. Siendo el consumidor de este tipo de productos muy particular, Foot Locker customiza sus tiendas según cada tipo de segmento. La fuerte relación con sus proveedores permite que las tiendas estén creadas en conjunto para mejorar la experiencia del cliente. Además, la relación con los proveedores, que son las marcas más reconocidas mundialmente (Nike, Adidas, Puma, entre otras), se mantiene hace muchos años y es recíproca, ambos se benefician de esta relación. Esta relación resulta crucial para Foot Locker en tanto que siga consiguiendo los mejores productos de estas marcas. Otros grandes retailers, no tienen la variedad de productos que ofrece Foot Locker, quien se caracteriza por tener todos los productos premium.

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Evaluation of foot health related quality of life in individuals with foot problems by gender: A cross-sectional comparative analysis study

Evaluation of foot health related quality of life in individuals with foot problems by gender: A cross-sectional comparative analysis study

A total of 1647 patients took part in an observational study carried out at the Clinic of Podiatric Medicine and Surgery that provides treatment for diseases and disor- ders of the foot at the University of A Coruña in the city of Ferrol (Galicia, North-Western Spain) during the period January 2012 and June 2016. The selection of the cases subject to the research was made by a consecutive sampling technique. The ages of the people included in the study ranged from 18 years to 96 years. Disregarded and excluded cases included: patients who had experi- enced acute pathological fracture; previous trauma and feet surgery records; active systemic neoplastic condi- tions; infectious, autoimmune or neurological alter- ations; lack of or partial autonomy in daily activities; the refusal to sign an informed consent form or those who were incapable of understanding the instructions neces- sary to carry out the present study; and participants of other nationalities (non-Spanish) who did not adequately understand Spanish.

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La carga financiera y de salud de las hospitalizaciones sensibles a la atencin ambulatoria relacionadas con diabetes en Mxico

La carga financiera y de salud de las hospitalizaciones sensibles a la atencin ambulatoria relacionadas con diabetes en Mxico

analysis may over-estimate the hospitalisation costs in some areas and under-estimate them in others. For this reason, figures are reported at the national level such that, on average, these over-and underestimations are balanced. Third, this analysis does not estimate the indirect costs of diabetic ACSH that would include the productivity implications of premature mortality, per- manent and temporary disability. Fourth, given that the hospital discharge database does not record the severity of the condition for which patients were hospitalised, and also owing to the lack of disability weights for different severity levels of certain conditions, such as kidney failure and retinopathy, all kidney failure and retinopathy admissions were assumed to have the same severity level: stage IV and blindness, respectively. This assumption clearly overestimates the associated DALYs and, therefore, should be taken as an upper bound of the health burden associated with ACSH due to diabetic complications, a sensitivity analysis of this assumption is available upon request. Fifth, since it is not possible to identify when a patient was discharged more than once in the same year or during the study period, DALYs will be double-counted when patients are admitted more

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Retinopata diabtica simplificada: la escala clnica internacional

Retinopata diabtica simplificada: la escala clnica internacional

Modifications of the diagnostic criteria of diabetes and arterial hypertension require an accessible clinical tool to evaluate their impact on microvascular complications. The International Diabetic Retinopathy Clinical Disease Severity Scale represents a unification of previous classifications of the disease, in a simplified way to be applied clinically, regardless of medical specialty. The scale features five categories of diabetic retinopathy; a diabetic macular scale has also been developed. As the scale usage increases both in ophthalmic and non-ophthalmic practice, it would be advisable to incorporate it to clinical practice, in order to make comparisons of treatment and prognosis of diabetic retinopathy with international series.

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