published_or_final_version / Nursing Studies / Master / Master of Nursing

Tetracycline molecules including doxycycline (DOX), consist of a group of broad-spectrum antibiotics. In addition, tetracyclines inhibit matrix metalloproteinase (MMPs) that contribute to tissue remodeling, inflammation, angiogenesis and are over-expressed in certain pathologies - such as Alzheimer’s disease, metastasis and diabetic foot ulcers (DFUs). Tetracyclines are hypothesized to inhibit MMPs through the chelation and sequestration of catalytic divalent ions such zinc and calcium. This inhibitory duality may be beneficial in pathologies that are characterized by MMP over-expression and prone to infection, such as DFUs. Compared to oral administration, topical DOX is an attractive route of administration for chronic wound healing as it may minimize the risks: associated antibiotic resistance; is being targeted directly to the wound bed. However, DOX is notoriously unstable in aqueous solution and common topical formulations. Liquid chromatography and mass spectrometry (LCMS) were employed to monitor stability using an in vitro MMP assay and an applicable E. coli anti-bacterial assay was assessed to quantify drug activity. 2 % (w/w) topical DOX demonstrated an acceptable stability 30 day when stored at 4 ºC. DOX inhibited MMP9 activity with an IC50 value of 48.27 μM. With respect to anti-bacterial activity, using cultured BL21 E.Coli and quantification of drug activity as an expression of colony forming units (CFUs) successfully reproduced the antimicrobial IC50 of doxycycline as 4.3 µM. Transdermal DOX has the potential to improve standard of care for DFUs, quality of life for the patient and reduce costs to the healthcare system. / Thesis / Master of Science (MSc) / Tetracyclines comprise of a group of broad-spectrum antibiotics; whose primary mechanism of action is inhibition of protein synthesis through binding of the bacterial ribosome. In addition, tetracyclines inhibit matrix metalloprotease (MMPs), zinc-dependent proteases that contribute to tissue remodeling, angiogenesis and are over-expressed in certain pathophysiologies such as diabetic foot ulcers (DFUs). The antibacterial mechanism of DOX on MMPs is reported and understood, however the inhibition is hypothesized to involve cation chelation. Thus, investigating this interaction is warranted to assist in developing a therapeutic for DFUs. A more logical product would involve direct topical application, such as a stable transdermal formulation of DOX.

Estudo descritivo cujo objetivo foi traçar o perfil dos pacientes com diabetes mellitus (DM) que possuem úlcera no pé, atendidos no Ambulatório de Especialidades Mario Covas de Marília-SP. A amostra foi constituída por 60 pacientes atendidos no período de agosto a setembro de 2003. Para coleta de dados utilizou-se entrevista, consulta ao prontuário e avaliação dos pés. Os resultados mostraram maior freqüência no sexo masculino (51,7%), destacando a faixa etária de 50 a 70 anos (64,4%). Em relação ao tipo de diabetes, 95% eram do tipo 2; o tempo médio referido do diagnóstico foi de 12,6 anos e do tratamento 12,1 anos; 63% referiram realizar dieta, 56,7% faziam uso de antidiabético oral e 61,7% de insulina. Considerando os parâmetros de controle do diabetes, 79,6% apresentavam mau controle glicêmico e 56,6% sobrepeso. As complicações crônicas mais freqüentes foram retinopatia (31,7%) e pé diabético associado à doença vascular periférica ( 31,7%). Todos apresentavam hipertensão arterial e em 26,6% estava associada à obstrução arterial crônica. O diagnóstico de obstrução arterial crônica estava presente em 51,7% dos pacientes. Na avaliação dos pés, 53,3% deambulavam; 55% possuíam alteração na marcha; 55% amputação prévia; 48% história de úlceras anteriores; 65% corte de unhas inadequado; 31,7% dedos em garra; 23,3% dedos sobrepostos; 18,3% proeminência do primeiro metatarso; 45% usavam sapatos e meias inadequados. Na avaliação circulatória identificou-se entre os pacientes, pulsos não palpáveis em 27% do tibial posterior direito e 23% do esquerdo; em 26% do pedioso direito e 21% do esquerdo; 35% possuíam edema; 45% rubor na pendência e empalidecimento à elevação; a sensibilidade tátil pressórica estava ausente em 38,3% dos pacientes. Quanto as características das úlceras, 36,6% relataram como causa de maior freqüência bolha infectada e 26,6% trauma mecânico; a localização mais freqüente foi na região plantar (23,3%) e nos dedos (21,7%); o tempo médio das úlceras foi de 0,9 anos; dimensões de 1 a 10 cm2 (65%); 41,7% das úlceras possuíam leito de cor vermelha; 53,3% exsudato4 seroso; 38,3% dor moderada; 58,3% odor discreto e 46,7% grau 2 segundo a classificação de Wagner. O tratamento mais referido para as úlceras foi soro fisiológico e óleo de girassol (81,7% ).Os resultados deste estudo mostraram a gravidade das complicações relacionadas aos pés dos pacientes com diabetes, destacando a história de úlcera e amputação anterior, complicações vasculares e neuropatia como importante fatores de risco para as lesões em pés e trauma extrínseco como principal desencadeante destas lesões, reiterando que intervenções básicas podem contribuir para a sua redução. Apontaram também para a necessidade de elaboração de um protocolo de atendimento; com ênfase no processo educativo junto a pessoa, familiares e profissionais, visando uma maior adesão ao tratamento e controle do DM bem como intensificando medidas preventivas no cuidado aos pés. / This descriptive study aimed to establish the profile of diabetes mellitus (DM) patients with foot ulcers, attended at the Ambulatório de Especialidades Mario Covas in Marília-SP, Brazil. The sample consisted of 60 patients, attended in August and September 2003. Data were collected by means of interviews, patient files and foot evaluation. Research results disclosed higher frequency among men (51.7%), especially in the age range from 50 to 70 years (64.4%). 95% of the patients suffered from type 2 diabetes; average reported diagnosis time was 12.6 years and average reported treatment time 12.1 years. 63.3% mentioned a diet, 56.7% took oral antidiabetic drugs and 61.7% took insuline. In view of diabetes control parameters, 79.6% of the patients demonstrated bad glycemic control and 56.6% were overweight. The most frequent chronic complications were retinopathy (31.7%) and diabetic foot associated with peripheric vascular disease (31.7%). All patients demonstrated arterial hypertension, associated with chronic arterial obstruction in 26.6% of the cases. The chronic arterial obstruction diagnosis applied to 51.7% of the patients. With respect to foot evaluation, 53.3% of all patients displayed instability; 55% claudication; 55% previous amputation; 48% ulcer antecedents; 65% inappropriate nail cutting; 31.7% claw toes; 23.3% hammer toes; 18.3% prominence of the metatarsus and 45% used inadequate shoes and socks. During circulatory evaluation, pulse could not be palpated in 27% of the right posterior tibial and 23% of the left one; in 26.6% of the right pedal and 21% of the left one; 35% of the patients had edema; 45% dependent redness and blanching on elevation; tactile sensitivity to pressure was absent in 38.3% of the patients. With respect to ulcer characteristics, 36.6% mentioned an infected blister as the most frequent cause and 26.6% a mechanical trauma; the most frequent locations were the plantar (23.3%) and toe (21.7%) region; average ulceration time was 0.9 years, dimensions ranged from 1 to 10 cm2; 41.7% of the ulcers involved redness, 53.3% serous discharge 38.3% moderate pain; 58.3% discrete smell and 46.7% Wagner classification level 2. The most frequently mentioned treatment for ulcers was physiological serum and sunflower oil (81.7%). Study results displayed the seriousness of complications related to diabetic foot, highlighting ulcer antecedents and previous amputation, vascular complications and neuropathy as important risk factors for foot injuries and extrinsic trauma as the main factor leading to this kind of injury, reiterating that basic interventions can contribute to its reduction. Results also indicated the need to elaborate a care protocol, emphasizing the education of patients, family members and professionals with a view to greater treatment adhesion and control of DM, as well as intensifying preventive measures in foot care.

Estudo descritivo cujo objetivo foi traçar o perfil dos pacientes com diabetes mellitus (DM) que possuem úlcera no pé, atendidos no Ambulatório de Especialidades Mario Covas de Marília-SP. A amostra foi constituída por 60 pacientes atendidos no período de agosto a setembro de 2003. Para coleta de dados utilizou-se entrevista, consulta ao prontuário e avaliação dos pés. Os resultados mostraram maior freqüência no sexo masculino (51,7%), destacando a faixa etária de 50 a 70 anos (64,4%). Em relação ao tipo de diabetes, 95% eram do tipo 2; o tempo médio referido do diagnóstico foi de 12,6 anos e do tratamento 12,1 anos; 63% referiram realizar dieta, 56,7% faziam uso de antidiabético oral e 61,7% de insulina. Considerando os parâmetros de controle do diabetes, 79,6% apresentavam mau controle glicêmico e 56,6% sobrepeso. As complicações crônicas mais freqüentes foram retinopatia (31,7%) e pé diabético associado à doença vascular periférica ( 31,7%). Todos apresentavam hipertensão arterial e em 26,6% estava associada à obstrução arterial crônica. O diagnóstico de obstrução arterial crônica estava presente em 51,7% dos pacientes. Na avaliação dos pés, 53,3% deambulavam; 55% possuíam alteração na marcha; 55% amputação prévia; 48% história de úlceras anteriores; 65% corte de unhas inadequado; 31,7% dedos em garra; 23,3% dedos sobrepostos; 18,3% proeminência do primeiro metatarso; 45% usavam sapatos e meias inadequados. Na avaliação circulatória identificou-se entre os pacientes, pulsos não palpáveis em 27% do tibial posterior direito e 23% do esquerdo; em 26% do pedioso direito e 21% do esquerdo; 35% possuíam edema; 45% rubor na pendência e empalidecimento à elevação; a sensibilidade tátil pressórica estava ausente em 38,3% dos pacientes. Quanto as características das úlceras, 36,6% relataram como causa de maior freqüência bolha infectada e 26,6% trauma mecânico; a localização mais freqüente foi na região plantar (23,3%) e nos dedos (21,7%); o tempo médio das úlceras foi de 0,9 anos; dimensões de 1 a 10 cm2 (65%); 41,7% das úlceras possuíam leito de cor vermelha; 53,3% exsudato4 seroso; 38,3% dor moderada; 58,3% odor discreto e 46,7% grau 2 segundo a classificação de Wagner. O tratamento mais referido para as úlceras foi soro fisiológico e óleo de girassol (81,7% ).Os resultados deste estudo mostraram a gravidade das complicações relacionadas aos pés dos pacientes com diabetes, destacando a história de úlcera e amputação anterior, complicações vasculares e neuropatia como importante fatores de risco para as lesões em pés e trauma extrínseco como principal desencadeante destas lesões, reiterando que intervenções básicas podem contribuir para a sua redução. Apontaram também para a necessidade de elaboração de um protocolo de atendimento; com ênfase no processo educativo junto a pessoa, familiares e profissionais, visando uma maior adesão ao tratamento e controle do DM bem como intensificando medidas preventivas no cuidado aos pés. / This descriptive study aimed to establish the profile of diabetes mellitus (DM) patients with foot ulcers, attended at the Ambulatório de Especialidades Mario Covas in Marília-SP, Brazil. The sample consisted of 60 patients, attended in August and September 2003. Data were collected by means of interviews, patient files and foot evaluation. Research results disclosed higher frequency among men (51.7%), especially in the age range from 50 to 70 years (64.4%). 95% of the patients suffered from type 2 diabetes; average reported diagnosis time was 12.6 years and average reported treatment time 12.1 years. 63.3% mentioned a diet, 56.7% took oral antidiabetic drugs and 61.7% took insuline. In view of diabetes control parameters, 79.6% of the patients demonstrated bad glycemic control and 56.6% were overweight. The most frequent chronic complications were retinopathy (31.7%) and diabetic foot associated with peripheric vascular disease (31.7%). All patients demonstrated arterial hypertension, associated with chronic arterial obstruction in 26.6% of the cases. The chronic arterial obstruction diagnosis applied to 51.7% of the patients. With respect to foot evaluation, 53.3% of all patients displayed instability; 55% claudication; 55% previous amputation; 48% ulcer antecedents; 65% inappropriate nail cutting; 31.7% claw toes; 23.3% hammer toes; 18.3% prominence of the metatarsus and 45% used inadequate shoes and socks. During circulatory evaluation, pulse could not be palpated in 27% of the right posterior tibial and 23% of the left one; in 26.6% of the right pedal and 21% of the left one; 35% of the patients had edema; 45% dependent redness and blanching on elevation; tactile sensitivity to pressure was absent in 38.3% of the patients. With respect to ulcer characteristics, 36.6% mentioned an infected blister as the most frequent cause and 26.6% a mechanical trauma; the most frequent locations were the plantar (23.3%) and toe (21.7%) region; average ulceration time was 0.9 years, dimensions ranged from 1 to 10 cm2; 41.7% of the ulcers involved redness, 53.3% serous discharge 38.3% moderate pain; 58.3% discrete smell and 46.7% Wagner classification level 2. The most frequently mentioned treatment for ulcers was physiological serum and sunflower oil (81.7%). Study results displayed the seriousness of complications related to diabetic foot, highlighting ulcer antecedents and previous amputation, vascular complications and neuropathy as important risk factors for foot injuries and extrinsic trauma as the main factor leading to this kind of injury, reiterating that basic interventions can contribute to its reduction. Results also indicated the need to elaborate a care protocol, emphasizing the education of patients, family members and professionals with a view to greater treatment adhesion and control of DM, as well as intensifying preventive measures in foot care.

Aims: The intravenous application of the chlorite-based drug solution WF10 is known to improve wound healing in patients with diabetic foot syndrome. In this retrospective study, we addressed the question, which effects are caused by this drug in patients with diabetic foot ulcers on the hemoglobin A1c value. Methods: Patients received five consecutive daily infusions of WF10. Three patients received a second cycle of WF10, and one patient a third cycle. Results: On a group of twelve patients with diabetic foot syndrome, WF10 gradually reduced the HbA1c values from a high-risk range (9.1 ± 1.6% (76 ± 13 mmol/mol)) into a low-risk range in all patients but one. These values remain low over at least 8 to 12 weeks after the administration of WF10. This drug improved also considerably wound healing processes in eleven patients. Conclusions: The chlorite component of WF10 is known to inactivate efficiently free cytotoxic hemoglobin forms that might accumulate in peripheral blood after hemolysis and induces the removal of predamaged red blood cells from circulation. By these mechanisms WF10 diminished toxic effects of hemolysis, improved microcirculation and glucose consumption in affected tissues, and prevented, thus, below knee amputation.

Chan Chak Ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 178-202). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract in Chinese 摘耍 --- p.iii / Acknowledgements --- p.v / Table of contents --- p.vi / List of tables --- p.xii / List of figures --- p.xiii / Abbreviations --- p.xvi / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Definition of diabetes mellitus --- p.1 / Chapter 1.2 --- Classification of diabetes mellitus --- p.4 / Chapter 1.2.1 --- Type 1 diabetes --- p.4 / Chapter 1.2.2 --- Type 2 diabetes --- p.5 / Chapter 1.2.3 --- Other forms of diabetes --- p.9 / Chapter 1.3 --- Complications of diabetes mellitus --- p.11 / Chapter 1.4 --- Current treatment of diabetes mellitus --- p.12 / Chapter 1.4.1 --- Type 1 diabetes --- p.12 / Chapter 1.4.2 --- Type 2 diabetes --- p.13 / Chapter 1.4.2.1 --- Diet and exercise --- p.13 / Chapter 1.4.2.2 --- Medication --- p.13 / Chapter 1.5 --- The use of herbal medicines in diabetes treatment --- p.18 / Chapter 1.6 --- "Hypothesis, objectives and design of the project" --- p.22 / Chapter Chapter 2: --- Preparation and authentication of traditional Chinese medicines --- p.23 / Chapter 2.1 --- Introduction --- p.23 / Chapter 2.1.1 --- Background information of the formulae --- p.23 / Chapter 2.1.2 --- Component herbs of formula1 --- p.26 / Chapter 2.2 --- Objectives --- p.29 / Chapter 2.3 --- Materials --- p.30 / Chapter 2.3.1 --- Raw herbal materials and formula 1 extract --- p.30 / Chapter 2.3.2 --- Thin layer chromatography --- p.35 / Chapter 2.3.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.38 / Chapter 2.4 --- Methods --- p.41 / Chapter 2.4.1 --- Thin layer chromatography of the component herbs --- p.41 / Chapter 2.4.2 --- Raw herbal materials water extraction --- p.46 / Chapter 2.4.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.46 / Chapter 2.5 --- Results --- p.49 / Chapter 2.5.1 --- Thin layer chromatography of the component herbs --- p.49 / Chapter 2.5.2 --- Raw herbal materials water extraction --- p.56 / Chapter 2.5.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.57 / Chapter 2.6 --- Discussion --- p.62 / Chapter Chapter 3: --- The anti-diabetic effects of formula 1 and its component herbs in vitro --- p.67 / Chapter 3.1 --- Introduction --- p.67 / Chapter 3.1.1 --- Glycaemic control in type 2 diabetes --- p.67 / Chapter 3.1.2 --- Type 2 diabetes and peripheral tissues --- p.70 / Chapter 3.1.3 --- Type 2 diabetes and liver --- p.73 / Chapter 3.1.4 --- Type 2 diabetes and intestinal glucose absorption --- p.76 / Chapter 3.2 --- Objectives --- p.79 / Chapter 3.3 --- Materials --- p.80 / Chapter 3.3.1 --- Cell lines --- p.80 / Chapter 3.3.2 --- "Cell culture media, buffers, reagents and culture wares" --- p.81 / Chapter 3.3.3 --- "Chemicals, media and reagents for 3T3-L1 differentiation" --- p.83 / Chapter 3.3.4 --- Chemicals and reagents for 3T3-L1 and Hs68 2-deoxy-D- glucose (2-DG) uptake assay --- p.84 / Chapter 3.3.5 --- Chemicals and buffers for H4IIE glucose production assay and phosphoenolpyruvate carboxykinase (PEPCK) assay --- p.85 / Chapter 3.3.6 --- "Animal, buffers and reagents for preparation and glucose uptake assay of brush border membrane vesicles (BBMV)" --- p.87 / Chapter 3.3.7 --- Reagents for bicinchoninic acid (BCA) protein assay --- p.88 / Chapter 3.4 --- Methods --- p.89 / Chapter 3.4.1 --- Cell culture --- p.89 / Chapter 3.4.2 --- Studies on glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.90 / Chapter 3.4.2.1 --- Differentiation of 3T3-L1 cells --- p.90 / Chapter 3.4.2.2 --- Oil red O staining of the 3T3-L1 cells --- p.90 / Chapter 3.4.2.3 --- 2-DG uptake assay of 3T3-L1 adipocytes and Hs68 fibroblasts --- p.91 / Chapter 3.4.3 --- Studies on gluconeogenesis in H4IIE hepatoma cells --- p.93 / Chapter 3.4.3.1 --- Glucose production assay --- p.93 / Chapter 3.4.3.2 --- PEPCK assay --- p.94 / Chapter 3.4.4 --- Studies on BBMV glucose uptake --- p.95 / Chapter 3.4.4.1 --- Preparation of BBMV --- p.95 / Chapter 3.4.4.2 --- Preparation of the chloroform extract of the herbal water extract --- p.96 / Chapter 3.4.4.3 --- Glucose uptake assay of BBMV --- p.97 / Chapter 3.4.5 --- BCA (Bicinchoninic acid) protein assay --- p.99 / Chapter 3.4.6 --- Statistical analysis --- p.100 / Chapter 3.5 --- Results --- p.101 / Chapter 3.5.1 --- Glucose uptake assay in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.101 / Chapter 3.5.2 --- Glucose production and PEPCK assay in H4IIE hepatoma cells --- p.108 / Chapter 3.5.3 --- Glucose uptake assay in BBMV --- p.113 / Chapter 3.6 --- Discussion --- p.119 / Chapter 3.6.1 --- Glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.119 / Chapter 3.6.2 --- Glucose production and PEPCK activity in H4IIE hepatoma cells --- p.123 / Chapter 3.6.3 --- Glucose absorption in BBMV --- p.125 / Chapter 3.6.4 --- Conclusion --- p.128 / Chapter Chapter 4: --- The anti-diabetic effects of formula 1 and Rhizoma Smilacis Chinensis in vivo --- p.131 / Chapter 4.1 --- Introduction --- p.131 / Chapter 4.1.1 --- Diabetic animal models --- p.131 / Chapter 4.1.2 --- Neonatal streptozotocin-induced diabetic rat model --- p.133 / Chapter 4.2 --- Objective --- p.136 / Chapter 4.3 --- Materials --- p.137 / Chapter 4.3.1 --- Animals --- p.137 / Chapter 4.3.2 --- Chemicals and reagent kit --- p.137 / Chapter 4.4 --- Methods --- p.139 / Chapter 4.4.1 --- Induction of diabetes in rats --- p.139 / Chapter 4.4.2 --- Oral glucose tolerance test --- p.139 / Chapter 4.4.3 --- Basal glycaemia test --- p.141 / Chapter 4.4.4 --- Plasma glucose level determination --- p.142 / Chapter 4.4.5 --- Statistical analysis --- p.142 / Chapter 4.5 --- Results --- p.143 / Chapter 4.5.1 --- Oral glucose tolerance test --- p.143 / Chapter 4.5.2 --- Basal glycaemia test --- p.147 / Chapter 4.6 --- Discussion --- p.151 / Chapter Chapter 5: --- The effects of the TCM treatment on glucose homeostasis in diabetic foot ulcer patients --- p.155 / Chapter 5.1 --- Introduction --- p.155 / Chapter 5.2 --- Objective --- p.156 / Chapter 5.3 --- Materials --- p.157 / Chapter 5.3.1 --- Study subjects --- p.157 / Chapter 5.3.2 --- Blood sample --- p.158 / Chapter 5.3.3 --- Chemicals and reagents for erythrocyte glucose uptake assay --- p.158 / Chapter 5.4 --- Methods --- p.160 / Chapter 5.4.1 --- Preparation of blood sample --- p.160 / Chapter 5.4.2 --- Zero-trans influx of 3-OMG uptake in erythrocytes --- p.160 / Chapter 5.4.3 --- Statistical analysis --- p.161 / Chapter 5.5 --- Results --- p.162 / Chapter 5.6 --- Discussion --- p.166 / Chapter Chapter 6: --- General discussion and conclusion --- p.168 / Chapter 6.1 --- Overview of the project and analysis of research findings --- p.168 / Chapter 6.2 --- Limitations of the study --- p.173 / Chapter 6.3 --- Future directions --- p.174 / Chapter 6.4 --- Conclusion --- p.177 / Chapter Chapter 7: --- References --- p.177 / Appendices --- p.203 / Appendix I The determination of the sugar contents in the herbal water extracts by high performance liquid chromatography --- p.203 / Appendix II Basal glycaemia test of formula 1 (822mg/kg) on nO-STZ rats --- p.206

Bakgrund: Diabetes mellitus är en kronisk folksjukdom som drabbar miljoner människor över hela världen. Denna långvariga sjukdom kan leda till komplikationer som svårläkta fotsår som medför lidande för patienten, begränsar vardagen och sänker livskvaliten, vilket i svåra fall kan leda till amputation. Dessa svårläkta fotsår kostar samhället massor vilket är ett bekymmer. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskans arbete i förebyggandet av fotsår hos personer med diabetes mellitus samt att beskriva de ingående artiklarnas undersökningsgrupp. Metod: En beskrivande litteraturstudie som baserats på tio vetenskapliga artiklar, åtta med kvantitativ ansats, en med kvalitativ ansats samt en med mixad ansats. Artiklarna söktes i sökmotorn PubMed samt databasen Cinahl. Resultat: Det finns några punkter som spelar stor roll i förebyggandet av diabetes fotsår. Detta är att sjuksköterskor ska identifiera risker hos personer med diabetes. Detta görs med hjälp av olika instrument för att upptäcka neutrovaskulärpati. Det andra sättet i förebyggandet är att öka kunskap hos personer med diabetes och vägleda dem till egenvård. Detta möjliggörs genom att ge fotvårdsutbildning till patienter för att sköta sina fötter och på så sätt förhindra uppkomsten av fotsår och fotkomplikationer. Det sista resultatet som kom fram i den här litteraturstudien är att ett samarbete mellan olika vårdprofessioner krävs i det förebyggande arbetet. Framför allt är ett bra samarbete mellan sjuksköterskor och undersköterskor som är angeläget.   Slutsats: Olika faktorer kan påverka positivt på förebyggandet av fotsår hos personer med diabetes. Dessa faktorer är att identifiera risker, upptäcka neurovaskulärpati i tid, öka kunskap hos dessa personer och vägleda dem till egenvård samt skapa en bra kommunikation mellan olika vårdprofessioner. / Background: Diabetes mellitus is a chronic disease that affects millions of people worldwide. This long-lasting disease may have bad complications like chronic foot ulcers that causes suffering for the patient, limits the everyday life and lowers quality of life and severe cases can lead to amputations. The slow-healing foot ulcers costs society a lot, which is a concern. Purpose: The purpose of this study was to describe the nurse's work in the prevention of foot ulcers in people with diabetes mellitus and to describe the depth of the articles study group. Method: A descriptive literature study based on ten scientific articles, eight of the quantitative approach, a qualitative approach and a mixed approach. Articles were searched in the databases CINAHL and PubMed. Results: There are some points that play a major role in the prevention of diabetic foot ulcers. This is nurses to identify risks in people with diabetes. This is done using a variety of instruments to detect neutrovaskulärpati. The other way of prevention is to increase the knowledge of the person with diabetes and to guide the self-care. This made real by providing foot care training patients to manage their feet and so prevent the formation of ulcers and foot complications. The final results came in this literature is that cooperation between different health care professions needed in preventive work. Above all, a good collaboration between nurses and assistant nurses are set location. Conclusion: Various factors can affect positively on the prevention of foot ulcers in people with diabetes. These factors are to identify risks and detect neurovaskulärpati in time, increase the knowledge of these people and guide them to self-care and good communication between various health care professions.

Staphylococcus aureus est l’un des principaux agents étiologiques des infections suppuratives superficielles et profondes ainsi que des syndromes liés à l’action de toxines. Paradoxalement, cette bactérie est un agent commensal qui est présent sur la peau ainsi que dans les cavités nasales notamment. Cela permet de considérer cette bactérie comme un organisme colonisant commensale. Les bases génétiques expliquant la différence entre une bactérie pathogène et une bactérie commensale reste inconnues. En utilisant la technique Optical Maps sur des souches de S. aureus isolées de plaies de pieds diabétiques avec différents niveau de virulence, nous avons pu montrer l’existence d’un prophage insérés dans le génome des souches colonisantes et absent des souches infectantes. Le phage, nommé ROSA, est localisé dans un hotspot d’insertion de phage NM2. Il est aussi localisé en amont du locus isd qui est requis pour l’assimilation du fer essentiel à la bactérie dans sa phase pathogène. Le phage ROSA inactive la voie isd en dérégulant l’activité du régulateur transcriptionnel majeur Fur en absence de fer. Il réduit aussi la virulence de ces souches sur les 2 modèles de virulence (Le ver C. elegans et le Zebrafish). L’expulsion du phage ROSA restaure la régulation du locus isd par Fur et la production de sidérophores en absence de Fer, la formation du biofilm et la virulence des souches. La mutation du gène Fur nous a permis de déduire que le phage ROSA affectait les bactéries de manière indépendante de Fur. Enfin, nous avons étudié la prévalence des souches colonisantes sur les plaies de pieds diabétiques. Nous avons observé que 20% des souches présentait l’insertion ROSA et 89% appartenait au complexe clonal CC8. Les souches colonisantes, avec leur niveau bas de virulence, devraient faire l’objet de détection dans le but de rationnaliser l’utilisation des antibiotiques et ainsi lutter contre l’apparition de bactéries multirésistantes aux antibiotiques. / Staphylococcus aureus is an opportunistic bacterium capable of causing a wide range of severe diseases when it gains access to underlying tissues. Paradoxically, this causative pathogen is a common inhabitant of the skin microflora and colonizes the nares and other human mucosa, and as such, may be considered as a commensal colonizing organism. The genetic basis for the differences in pathogenic/colonizing potential is unknown. By performing optical maps comparisons of a collection of S. aureus strains of defined virulence potential isolated from diabetic foot ulcers at different stages, we brought to light a prophage present in colonizing-causing bacteria. The phage, namely ROSA, was localized in a hotspot region NM2 near the locus isd, the main iron surface determinant that transport iron across the bacterial wall. It induces a deregulation of the activity of the transcriptional regulator Fur involving the biofilm formation of the bacteria in response to low iron environment. It reduced also significantly the virulence of the strain in two in vivo models (the nematode C. elegans and the zebrafish). The expulsion of the phage restored the regulation of the locus isd, the siderophore production, the biofilm formation and the virulence of the strain. The mutation of the fur gene within the colonizing strain enabled us to determine that the phage ROSA affect the the bacteria in a Fur-independent manner. Finally we determined the prevalence of these colonizing strains in skin and soft tissue infections (diabetic foot ulcers). We observed that 20% (39/195) of the strains harboured this insertion and 89% belonged to the clonal complex CC8. This colonizing strain by its low virulence potential must be detected in the aim to contribute to a sounder use of antibiotic treatment, an important point in front of the increase of multidrug resistant bacteria.

Bakgrund: Fotsår är en vanlig komplikation vid diabetes typ 2. För att minska risken för fotsår och amputationer ska sjuksköterskan med hjälp av styrdokument och lagar arbeta tillsammans med personen för en bättre vård. Syfte: Att beskriva sjuksköterskeledda fotvårdsinterventioner och dess effekter för personer med diabetes typ 2. Metod: Studien är gjord som en litteraturstudie med elva vetenskapliga originalartiklar. Resultat: Resultatet utgår ifrån tre huvudkategorier. Dessa var Sjuksköterskans olika interventioner vid fotvård, där sjuksköterskans olika interventioner i arbetet mot att förhindra fotsår hos personer med diabetes typ 2 beskrivs i samtal och undersökning. Primära effekter av interventioner, där vikten av kunskap gällande sjukdomen och vikten av stöd i vardagen beskrivs. Samt Sekundära effekter av interventioner, som beskriver hur personerna kan undvika komplikationer och öka livskvaliteten. Diskussion: Utifrån resultatet framkom tre fynd. Dessa var Brist på fotundersökningar, då brister fanns gällande fotundersökningar inom vården. En utbildning passar inte alla, varje människa är unik och tar åt sig av information på olika sätt. Samt Delaktighet i vården, då relevansen för personens engagemang och delaktighet i vården lyfts fram. Slutsats: Genom att individualisera vården och öka kunskapen hos personer med diabetes typ 2 kan komplikationer undvikas och känsla av hälsa infinna sig. / Background: Foot ulcers are a common complication of type 2-diabetes.To reduce the risk of foot ulcers and amputations should the nurse with the help of policy documents and laws, work with the person for a better health care. Purpose: To describe the nurse-led foot care interventions and its effect for people with type 2-diabetes. Method: The study is designed as a literature review with eleven original scientific articles. Results: The result is based on three main categories. These were The nurse's various interventions in foot care, where the nurse's various interventions in the work to prevent foot ulcers in people with type 2-diabetes are described in conversations and examinations. Primary effects of interventions, which describes the importance of knowledge regarding the disease and the importance of support in everyday life. And Secondary effects of interventions, which describes how people can avoid complications and improve quality of life. Discussion: Based on the results three key findings were revealed. These were Lack of examinations, where deficiencies existed regarding foot examinations in health care. An education is not for everyone, each person is unique and learning in different ways. And Participation in care, the relevance of personal commitment and involvement in health care are highlighted. Conclusion: By individualize the care and to increase the knowledge in people with type 2-diabetes, complications can be avoided and the feeling of health can appear.

Made available in DSpace on 2017-07-10T17:48:07Z (GMT). No. of bitstreams: 1 Talita_Vitoria_Giron.pdf: 1198918 bytes, checksum: 4c86034c70c5b810eec4aaf5a4261ca1 (MD5) Previous issue date: 2014-09-29 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The objective of this study was to evaluate microbiological and histopathological effects of using foot ulcers remover machine in varying degrees of foot pad dermatitis in broilers. The injured and uninjured legs were collected in a poultry slaughterhouse and separated by degrees of foot ulcers. Grades were defined according to the compromised ratio existing in the plantar surface macroscopically visible: 0 - no lesion, 1 - less than 25% damage, 2 - injury between 25 and 50% and 3 - more than 50%. Following selection of 60 feet each type, 30 samples went through the process of the foot ulcer removal using the machine. All samples were evaluated histopathologically and microbiologically totaling 240 experimental units. Inside the microbiological evaluation, swabs from the footpads of the samples were collected and from these seven successive dilutions were performed, sown on plates for counting of mesophilic aerobic and total coliforms with differentiation for Escherichia coli and incubated in chamber (B.O.D. type) emissions at 35 °C for 48 hours to count. For histopathological analysis, the samples were fixed in 10% buffered formalin for approximately 24 hours and submitted to three sections of each footpad: top (next to the digits), central and bottom. The resulting fragments were processed to derive the blades evaluated in accordance with the presence and quantification of inflammatory infiltrate. Data were analyzed using the F test and submitted to Tukey test to compare averages. The samples which underwent the removal procedure showed better results when compared with samples that have not undergone the procedure and even better than samples with no macroscopically evidence of foot pad dermatitis, demonstrating the effectiveness of the equipment in the lesions removal. Microbiological analyzes showed no correlation with pododermatite scores evaluated.Presence of microbiological contamination exceeding the acceptable levels in accordance with the standards established by Brazilian law were not detected in the analyzed products under the conditions studied, indicating good hygiene and product safety / O objetivo do presente trabalho foi avaliar o efeito da utilização da máquina removedora de calos microbiologicamente e histopatologicamente em diferentes graus de pododermatite de frangos de corte. No presente estudo, foram coletados pés com e sem lesão em um frigorífico comercial após os procedimentos de escaldagem e remoção de cutícula, e separados por graus de lesão de pododermatite. Os graus foram definidos de acordo com a proporção de comprometimento existente na superfície plantar visível macroscopicamente: 0 - sem lesão, 1 - lesão menor que 25%, 2 lesão entre 25 e 50% e 3 mais de 50%. Após seleção de 60 pés de cada tipo, 30 amostras passaram pelo processo de remoção de calos através da utilização da máquina removedora de calos. Todas as amostras coletadas foram avaliadas histopatologicamente e microbiologicamente totalizando 240 unidades experimentais. Na avaliação microbiológica, foram coletados swabs dos coxins plantares das amostras e a partir destes foram realizadas sete diluições sucessivas que foram semeadas em Placas para contagem de aeróbios mesófilos e coliformes totais com diferenciação para Escherichia coli e incubadas em estufa B.O.D. à 35ºC por 48 horas. Para a análise histopatológica, as amostras coletadas foram fixadas em formol 10% tamponado durante aproximadamente 24 horas e submetidas a três secções de cada coxim plantar. Os fragmentos resultantes foram processados para derivar as lâminas avaliadas de acordo com a presença e quantificação do infiltrado inflamatório. Os dados foram submetidos ao teste F de análise de variância e submetidas ao teste de médias Tukey (P=0,05). As amostras que passaram pelo procedimento de lixa apresentaram melhores resultados quando comparadas com as amostras que não passaram pelo procedimento e até mesmo superiores às amostras que não apresentavam indícios de pododermatite macroscopicamente, demonstrando a eficácia do equipamento para remoção de lesões. Não foi detectada nos produtos analisados e nas condições estudadas a presença de contaminação microbiológica superior aos níveis aceitáveis de acordo com os padrões estabelecidos pela legislação sanitária brasileira, indicando boas condições de higiene e segurança dos produtos