Soft tissue infection in a diabetic foot with an ulcer is often clinically obvious but the diagnosis of osteomyelitis underlying a diabetic foot ulcer is challenging. It has been calculated that there are over 1 million amputations worldwide for diabetes related complications every year, many preceded by an ulcer complicated by osteomyelitis. <br /> This research encompasses two studies attempting to add to the ways in which osteomyelitis is diagnosed. <br /> The first was examining the role of inflammatory blood markers in recognising and separating ulcers with cutaneous infection from both suspected and proven osteomyelitis. The response of the body to produce these markers when an injury occurs is well known but arguments exist as to the capacity of the individual with diabetes to do so. Despite the recognition and allowance for common confounding factors no trend was found. This study may have been more difficult than originally thought due to the many interactions of the diseased state of diabetes, the drugs used to control it and the many other confounders that would have influenced the inflammatory process and as such the level of the markers. <br /> The second study was comparing a new form of scanning technique (SPECT/CT) to the technique most commonly used as a ‘gold standard’ – MRI. The results of each type of scan were compared to the clinical diagnosis and each other. The SPECT/CT scan appears to show some good results and may be a more suitable scan for individuals who are unable to have a MRI for example due to the need to introduce a renally excreted drug to help make the images clearer but it does mean introducing a small amount of radiation into the individual.

Submitted by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-08-08T14:26:09Z No. of bitstreams: 1 DahandaCunhaNascimentoDissertacao2015.pdf: 2333475 bytes, checksum: e3be1599bee31093a1f4cfdee83483dc (MD5) / Approved for entry into archive by Sara Ribeiro (sara.ribeiro@ucb.br) on 2018-08-08T14:26:16Z (GMT) No. of bitstreams: 1 DahandaCunhaNascimentoDissertacao2015.pdf: 2333475 bytes, checksum: e3be1599bee31093a1f4cfdee83483dc (MD5) / Made available in DSpace on 2018-08-08T14:26:16Z (GMT). No. of bitstreams: 1 DahandaCunhaNascimentoDissertacao2015.pdf: 2333475 bytes, checksum: e3be1599bee31093a1f4cfdee83483dc (MD5) Previous issue date: 2015-03-04 / Matrix metalloproteinases (MMPs) belong to a group of endopeptidases which regulate the composition of the extracellular matrix (ECM) and its imbalance contributes to the development of many pathological conditions. Among them, obesity. Aging is associated with several degenerative processes and physiological changes. Body fat increment in elderly women is also responsible for increased systemic concentrations of matrix metalloproteinases 2 and -9 and also by the upregulation of proinflammatory cytokines. In another hand, studies that analyzed the effects of physical exercise on MMPs concentrations. Aerobic training was effective in decreasing plasma concentrations of MMP-2 and MMP-9 in obese, type 2 diabetes mellitus, metabolic syndrome and elderly with cardiovascular disease, indicating transient cardioprotective effect. However, strength training also shows conflicting results. Considering its importance in aging, especially eccentric training method and its effects on functional capacity when compared to the traditional method, there is evidence that this type of resistance training method is able to decrease the activity of MMPs 48 hours after an acute exercise session of eccentric training in elderly obese women, indicating a transitory cardioprotective effect. However, there are still many challenges to a better understanding of its importance on muscle adaptation or indicative of a pro-inflammatory profile on obesity. Therefore, more studies should be conducted and measures such as muscle biopsy should also be included because they might explain the process of muscle adaptation to exercise. / As metaloproteinases da matriz extracelular (MMPs) pertencem a um grupo de enzimas endopeptidases que regulam a composição da matriz extracelular (MEC) e seu desequilíbrio contribui para o desenvolvimento de muitas condições patológicas, dentre elas, a obesidade. Como o envelhecimento está associado a vários processos degenerativos e mudanças fisiológicas, o aumento da gordura corporal em mulheres idosas é também responsável pelo aumento das concentrações sistêmicas das metaloproteinases da matriz extracelular tipo 2 e 9 (MMPs) e também pelo desequilíbrio nas concentrações de citocinas pró-inflamatórias. Apesar dessas modificações, estudos sobre o efeito do exercício físico, especificamente o treinamento aeróbio demonstraram sua efetividade na diminuição das concentrações plasmáticas das MMP-2 e MMP-9 em indivíduos obesos, diabetes mellitus tipo 2, síndrome metabólica e idosos com problemas cardíacos, indicando um efeito cardioprotetor. No entanto, o treinamento de força ainda demonstra resultados conflitantes. Considerando a sua importância no envelhecimento, principalmente o treinamento excêntrico, além de seus benefícios sobre a capacidade funcional já reportados na literatura quando comparado ao método tradicional, há indícios na literatura de que esse tipo de método é capaz de diminuir a atividade das MMPs 48 horas após uma sessão aguda em mulheres idosas obesas, indicando um efeito cardioprotetor transitório. No entanto, ainda existem muitos desafios para o melhor entendimento de sua importância na adaptação muscular ou indicativo de um estado inflamatório característico na obesidade. Por isso, mais estudos devem ser conduzidos e outras medidas como biópsia muscular também devem ser incluídas, pois as mesmas podem explicar o processo de adaptação ao exercício físico.