Introduction: Diabetic foot (DF) is a common complication in patients with diabetes mellitus. Due to arterial abnormalities and diabetic neuropathy, as well as a tendency to delayed wound healing, infection or gangrene of the foot is relatively common. Early study indicated Si-Miao-Yong-An (SMYA) decoction is the most chosen Chinese herbal formulae in the treatment of DF. The aim of this study is to assess the quality of current evidence, and systematic review the effectiveness and safety of SMYA decoction for the treatment of DF. Method: (1) Search strategy: a special protocol was designed, and electronic databases and hand-search materials were used for screening eligible trials. (2) Inclusive criteria: randomized controlled trials (RCTs) to examine the efficacy and/or safety of SMYA decoction in DF treatments were valid. (3)Data analysis: the Jadad’s scale was used to assess the quality of eligible trials. Result: Total 23 RCTs met the inclusion criteria. Among those, 1341 patients are involved, 702 patients were treated by SYMA decoction. 22 trails using SMYA decoction combined WM claimed that they showed a statistically significant advantages over the treatments using WM alone in reducing DF symptoms. Only 1 RCT reported adverse events related to SMYA decoction, but less than WM treatment. Conclusion: All available evidence points to the fact that SMYA decoction may benefit to those diabetes patients with foot problem. However, due to the poor quality of included trials, more high-quality trials are required to substantiate or refute these early findings.

Made available in DSpace on 2014-06-11T19:22:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-11-13Bitstream added on 2014-06-13T18:08:38Z : No. of bitstreams: 1 camargo_mr_me_prud.pdf: 1247007 bytes, checksum: e62a69e293f9af935953a6b7044c49bb (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques. / Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks.

Made available in DSpace on 2014-06-11T19:29:35Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-05-16Bitstream added on 2014-06-13T19:17:56Z : No. of bitstreams: 1 doine_mq_me_botfm.pdf: 382775 bytes, checksum: 0acf616a47c656373cf76d88dece2d58 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Diabetes Mellitus é uma síndrome decorrente da falta de insulina ou da incapacidade desta de exercer adequadamente seus efeitos metabólicos. Sua prevalência vem aumentando nos últimos anos, decorrente de fatores envolvidos com hábitos de vida, e também com o aumento da longevidade. Em idosos esta prevalência se eleva. As complicações crônicas do DM subdividem-se em vasculares e neurológicas. São elas: retinopatia; nefropatia; eventos cardiovasculares como infarto do miocárdio, acidente vascular cerebral e arteriopatia periférica; neuropatias e a síndrome do pé diabético. O presente estudo avaliou uma série de casos de idosos diabéticos, que foram examinados a partir de uma avaliação multidimensional representativa de todos os idosos do município de Botucatu – SP. Teve como objetivo descrever a presença de complicações crônicas instaladas, bem como os fatores de risco presentes para o aparecimento das mesmas. A prevalência do DM encontrada para essa faixa etária no inquérito domiciliar foi de 16%. Para os idosos examinados foi de 18,4%. Analisando-se estes últimos, detectou-se que 37,8% deles tinham pelo menos 10 anos de evolução da doença e que 84,7% apresentavam retinopatia diabética. O percentual de idosos diabéticos que referiram ser portadores de HAS foi de 80,4%. Níveis de pressão arterial elevados foram encontrados em 57,1% dos mesmos no momento do exame clínico. Sobrepesos e obesos corresponderam a 61,4%. Obesidade abdominal alcançou percentuais de 96,7% em mulheres e de 64,3% em homens. Cinqüenta e cinco por cento dos idosos diabéticos que coletaram amostra de sangue, apresentaram nível de Hemoglobina A1c acima do limite tolerável. Para colesterol-HDL, 63,3% dos que coletaram amostras Mauro Queiroz Doine 10 tiveram níveis abaixo do valor recomendado. Os achados não diferem daquilo que é citado na bibliografia... / Lacky of insulin or its incapacity to adequately exerts its metabolic actions results in the syndrome of DM. Its prevalence has been increasing in the last years due to factors related either to people life style or to the aging of the population. The prevalence of DM increases in elder people. Chronic complications of the DM subdivide in cardiovascular and neurological ones. They are: retinopathy; nephropathy; cardiovascular events such as myocardium infartaction, cerebral vascular accidents, peripheral arteriopathy; neuropathies and the syndrome of diabetic foot. The present study evaluated a series of cases of diabetic aged, which was examined from a multidimensional evaluation representative of all aged people of Botucatu city – SP. It had like object describe the presence of chronic complications already installed, as well as the presence of factors of risk that may lead to the onset of them. Prevalence of DM for the people inquired at home was of 16%. For the examined old people was of 18,4%. When analised the last ones, it showed that 37,8% of the aged diabetics had at least 10 years of DM going on and 84,7% had diabetic retinopathy. Aged diabetics percentage who referred Sistemic Arterial Hipertension was 80,4%. High levels of blood pressure were found in 57,1% of them at the clinical examination. Fat people and overweighted ones were up to 61,4%. Abdominal obesity was observed in 96,7% of old women and in 64,3% of old men. Of Hemoglobin A1c evaluation, 55% of diabetic old people showed higher levels than tolerable values. Blood sample of 63,3% old diabetic people had lower values for cholesterol-HDL than the recommended. These data are similar to those found in the related literature, but Mauro Queiroz Doine 12 claims special attention the high percentage of old female people with abdominal obesity, very expression data in the population of Botucatu – SP... (Complete abstract click electronic access below)

Orientador: Cristina Elena Prado Teles Fregonesi / Banca: Claudia Regina Sgobbi de Faria / Banca: José Angelo Barela / Resumo: O Diabetes mellitus é uma enfermidade crônica que leva a alterações sensitivas e motoras. Tais alterações comprometem o equilíbrio e a deambulação predispondo seus portadores à ocorrência de quedas. Esta revisão teve por objetivo levantar, na literatura recente, estudos que visassem avaliar parâmetros da marcha e aspectos envolvidos com a deambulação. Para isso, foi realizada uma busca nas bases de dados MEDLINE, SciELO, LILACS e PEDro, cruzando as palavras-chaves: Neuropatias Diabéticas x Marcha; Diabetes Mellitus x Marcha e Pé Diabético x Marcha. Após passarem pelos critérios de seleção, foram obtidos 15 artigos, os quais foram sintetizados e discutidos, sendo, portanto, incluídos nesta revisão. Ficou claro que a neuropatia diabética leva a déficits na amplitude do passo, velocidade e cadência da marcha em superfícies planas, sem mudanças bruscas de direção ou paradas, e, déficits de equilíbrio e coordenação em aclives, declives e terrenos irregulares. Acarreta, também, aumento dos índices de pressão plantar e, devido à alteração de ativação do tríceps sural, dificuldade na fase de apoio terminal e prébalanço. Assim, o próximo contato inicial ocorrerá de maneira inadequada, com o antepé e sem absorção de choques. / Abstract: Diabetes mellitus is a chronic disease that leads to sensory-motor changes. These changes affect balance and walking predisposing their patients to falls occurrence. This review aimed to investigate, in recent literature, assessing gait parameters and walking studies involved aspects. For this, a search was conducted in databases MEDLINE, SciELO, LILACS and PEDro, crossing the keywords: Diabetic neuropathies x Gait; Diabetes Mellitus x Gait and Diabetic Foot x Gait. After passing by selection criteria, it was remainder 15 articles, which were synthesized, discussed and is therefore included in this review. It was clear that diabetic neuropathy leads to deficits in the step amplitude, gait velocity and gait cadence on flat surfaces, without sudden changes of direction or stops, and balance and coordination deficits in slopes and uneven terrain. Diabetic neuropathies, provide, also increase plantar pressure rates due to the triceps sural activation change, difficulty in the terminal phase of support and pre-assessment. Thus, the next initial contact occurs in an inadequate way, with the forefoot and without absorption of shocks. / Mestre

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Revisión por pares / INTRODUCCIÓN: Los pacientes con diabetes mellitus tipo 2 son más propensos a una baja calidad de vida, discapacidad e incluso muerte. También, tienen una mayor predisposición a la depresión en comparación con los pacientes no diabéticos; así como una evolución favorable producto de la evaluación e intervención de su salud mental. OBJETIVOS: El objetivo de este estudio fue explorar la presencia de síntomas depresivos en una población ambulatoria con diagnóstico de diabetes mellitus tipo 2 y filiación militar. También examinar los factores asociados a la presencia de síntomas depresivos. MÉTODOS: Realizamos un estudio transversal en 108 personas con diabetes mellitus tipo 2, durante enero de 2012 en una muestra ambulatoria de un hospital de las fuerzas armadas. Los síntomas depresivos se evaluaron con el test autoaplicado de Zung. Usamos la prueba de Chi-cuadrado para examinar las asociaciones entre síntomas depresivos y los factores asociados de interés. Usamos modelos lineales generalizados crudos y ajustados para estimar las Razones de Prevalencia (RP) de la asociación entre las características clínicas y sociodemográficas con la presencia de síntomas depresivos. RESULTADOS: La prevalencia de sintomatología depresiva fue de 56,5% (intervalo de confianza 95%: 46,6-66,0%). El análisis bivariado mostró como significativa la asociación entre la presencia de síntomas depresivos con las variables: sexo, edad y complicaciones clínicas de la diabetes. En los análisis ajustados, la retinopatía diabética [RP: 1,3; intervalo de confianza 95%: 1,1-1,7], y la neuropatía diabética [RP: 1,4; intervalo de confianza 95%: 1,1-1,7] se asociaron a una mayor presencia de síntomas depresivos luego de considerar el sexo de los participantes. CONCLUSIONES: Observamos una elevada presencia de síntomas depresivos en la población de estudio, especialmente en los pacientes geriátricos o del sexo femenino. También en aquellos con complicaciones tardías de la diabetes mellitus tipo 2, y que probablemente representen la repercusión de la enfermedad en la calidad de vida del paciente. Un abordaje multidisciplinario, con enfoque físico y mental, debe ser considerado ya que podría beneficiar a la evolución de los pacientes con esta concomitancia en Perú.

Class of 2014 Abstract / Specific Aims: To assess appropriate use or cessation of metformin therapy in the presence of renal impairment. Methods: A retrospective chart review was conducted on 785 charts of patients at El Rio Community Health Center between June 2011 and December 2012. Eligibility criteria were adults aged 18 years or older with a diagnosis of Type 2 Diabetes Mellitus (DM), a history of metformin therapy, and renal function data. Data was accessed through the electronic medical record (EMR) at El Rio and metformin history, presence of contraindications, renal function, weight, age, gender, and race/ethnicity were collected. Group 1 were patients who were currently taking metformin and Group 2 were patients with a history of taking metformin. Main Results: A larger proportion of patients had renal impairment (eGFR 30-60 ml/min/1.73 m2) in Group 1 than Group 2 (Yates’ p = 0.002). Only one patient in the entire study had severe renal impairment (eGFR < 30 ml/min/1.73 m2). There was a greater proportion of inappropriate cessation in Group 2 than inappropriate use or cessation in Group 1 (Yates’ p < 0.001). Conclusion: Most patients were found to have normal renal function. Group 2 had a greater proportion of inappropriate metformin cessation than inappropriate use or cessation in Group 1.

Class of 2016 Abstract / Objectives: 1. To compare appropriateness of therapy and the time it takes for appropriate empiric antibiotic therapy to be given from when patients are first admitted for treatment of diabetic foot infection. 2. To compare the time it takes for physicians to “streamline” therapies or switch from empiric antibiotic therapy to specific antibiotics after culture results are obtained 3. To Compare the incidence of readmission within 30 days to the hospital after initial discharge. Methods: In this IRB approved, retrospective study, antibiotic therapy prescribing patterns before and after the distribution of a health network specific empiric antibiotic reference material were compared in patients admitted for diabetic foot infection. Patients were excluded if no antibiotic therapy prescribed, if under the age of 18 years, or if admitted for less than 48 hours (including time spent in the emergency department). The following data were collected and analyzed between the two groups: number of appropriate antibiotic therapy administered, timing of appropriate therapies relative to when appropriate culture samples were obtained if applicable, time it takes to streamline antimicrobial therapy, and the incidence of 30-day readmission. Results: A total of 400 patients were evaluated with 17 pre-intervention and 10 post-intervention patients who meet the inclusion criteria. The pre- and post- intervention groups did not show significant difference in demographics except for comorbid conditions (p=0.055). Overall, there was no significant difference between the pre- and post-intervention group on appropriate empiric therapy given (p=0.382), timing to streamline therapy (p=0.4035), and readmission rates (p=0.401). Conclusions: The health network specific empiric antibiotic recommendations reference material did not influence the timing and appropriateness of empiric antibiotic therapy in treatment of diabetic foot infections and the patient 30-day readmission rates.

M.Phil. (Optometry) / Despite many years of research, diabetic retinopathy (DR), and diabetic macular edema (DME) remain difficult to diagnose, prevent, and treat. The complicated nature of the disease, the limited information on DR and DME and the increasing prevalence of diabetes mellitus (DM) in South Africa, provided motivation for this study. To the best of my knowledge, this is the first study in our country to identify demographic, medical and visual aspects ofDR and DME collectively. A further incentive was the availability in optometry of recently developed computer software based upon multivariate statistics, which provided a unique opportunity to analyze, for example, tri-variate contrast sensitivity acuities using stereo-pair scatter plots. All refractive status measurements were also analyzed and compared with the same method. Together, the results from this study provide a broader clinical and research perceptive on DR and DME. In this cross-sectional study, 202 diabetic patients at the Helen Joseph Hospital in Johannesburg were recruited. Demographic variables included age, gender, race, age of diagnosis, duration of DM, and social habits. Medical variables included systemic conditions present, blood pressures, body mass index (BMI), lipid profiles, glycerated haemoglobin (HbAlc), and other available biochemical data (for example cholesterol, urea and creatinine levels). Visual variables included, distance, pinhole and near visual acuities, contrast sensitivity acuities, refractive status measured with autorefraction, colour vision, Amsler grid, intraocular pressures (lOP), and fundus photography. Administration of the Impact of Visuallmpainnent (IVI) questionnaire provided new information concerning the restrictions in daily living participation caused by DR or DME. The predominant characteristics of the study population consisted of Type 1DM among female Coloured subjects. Approximately 66% of all subjects had also been diagnosed with hypertension. The mean age ofthe subjects was 52 (± 14) years, age of diagnosis 41 (± 13) years, and duration ofDM 10.8 (± 9.7) years. Mean blood pressures (136/81 ± 20.5/11 mmHg) and glycated haemoglobin (HbAlc, 9.9 ± 3.4%) values were slightly higher than the recommended control levels (BP= 120/80 mmHg and HbAlc = 6 to 7%).

The accurate detection and quantification of human diabetic somatic polyneuropathy (DSPN) are important to define at risk patients, anticipate deterioration, and assess new therapies. Current methods lack sensitivity, require expert assessment and have major shortcomings when employed to define therapeutic efficacy. In recent years, in vivo corneal confocal microscopy (IVCCM) has shown potential as a surrogate endpoint for DSPN.This study aims to investigate fundamental aspects of IVCCM such as repeatability and optimal scanning methodology and establish changes in corneal nerve morphology in relation to the severity of DSPN and regeneration in response to normalisation of hyperglycaemia. Furthermore, it aims to provide a novel fully automated image analysis algorithm for the quantification of corneal nerve morphology and establish the diagnostic ability of CCM.IVCCM shows high repeatability which is enhanced with more experienced observers. Central corneal innervation is comparable to adjacent peripheral innervation in mild diabetic neuropathy but the central cornea may be more sensitive to change. Corneal nerve loss is symmetrical and progressive with increasing neuropathic severity and corneal nerves show significant regenerative capacity following rapid normalisation of glycaemic control after simultaneous pancreas and kidney transplantation. The novel image analysis algorithm strongly correlates with human expert annotation and therefore represents a rapid, objective and repeatable means of assessing corneal nerve morphology. Automated image quantification may replace human manual assessment with high diagnostic validity for DSPN.

Thromboxane receptor (TPr) activity is elevated in diabetes and contributes to complications of diabetic kidney disease (DKD). TPr blockade appears to have therapeutic potential. Several rodent models of DKD show attenuation of renal damage and proteinuria upon administration of the TPr antagonist, S18886. However, the cellular targets that underlie the injurious effects of TPr activation in DKD remain to be elucidated. A pilot study in our laboratory subjected a conditionally-immortalized mouse podocyte cell line to high glucose (25 mM D-glucose) and equibiaxial mechanical stretch (an in vitro simulator of increased glomerular capillary pressure associated with glomerular hyperfiltration in early diabetes). qRT-PCR revealed that exposure of podocytes to mechanical stretch (10% elongation) and high glucose for 6 hours yielded a 9-fold increase in TPr mRNA levels vs. controls (non-stretch, 5mM D-glucose + 25mM L-glucose) (p<0.05, n=5). We hypothesized that TPr expression and activity are increased in podocytes during the onset of DKD resulting in maladaptive effects on this key glomerular filtration barrier cell type. We showed that enhanced TPr signaling threatens podocytes viablility. Cultured podocytes treated with the TPr agonist, U-46619 (1 μM) for 24 hours are more vulnerable to apoptosis as quantified by Hoescht 33342 (20% cell death p<0.001, n=3) , TUNEL (30-fold increase, ns, n=3) and Annexin-V labeling (3-fold increase, p <0.001, n=3). To further support these in vitro findings, we developed a transgenic mouse with podocyte-specific overexpression of TPr. A construct consisting of a desensitization resistant mutant of the human TPr with both N- and C-terminal HA-epitope tags under the control of an 8.3 kb fragment of the immediate 5’ mouse NPHS1 promoter was cloned, isolated and injected into FVB/n oocytes that were implanted into pseudopregnant CD1 females. Founders were characterized for TPr transgene expression, and TPr transgene mRNA levels were detected by qRT-PCR. Our in vitro results suggest that increased TPr expression in podocytes of diabetic mice may contribute to filtration barrier damage and have important implications in the development and progression of DKD.