The Impact of Nailfold Capillaroscopy in the Approach of Microcirculation

Nailfold capillaroscopy (NFC) is a simple, validated, and noninvasive method to assess the microcirculation, through direct visualization of the capillaries. Main patterns are classified, according to Cutolo et al., as scleroderma, further divided into early, active, or late patterns, or nonscleroderma. NFC findings include dilated loops, tortuosities, meandering or bushy capillaries, hemorrhage, or architectural distortion. NFC use has been indicated for the evaluation of Raynaud’s phenomenon (RP), once it permits the distinction between primary and secondary RP. NFC results accounts for diagnostic criteria of systemic sclerosis, but they can also be useful in staging other connective tissue autoimmune diseases, like systemic lupus erythematosus, inflammatory myositis, or vasculitis. The CSURI index uses NFC for prediction of digital ulcer relapse. Recent evidence revealed NFC can also be applied in systemic disorders with vascular involvement.

Medidas para prevenção de recidivas de úlceras venosas

Identificar e analisar evidências científicas adotadas na prevenção de recidivas de úlceras venosas. Trata-se de um estudo de revisão integrativa da literatura, descritivo, de abordagem qualitativa, realizado entre outubro e novembro de 2017, a partir de consulta de bases de dados nacionais e internacionais. Os descritores utilizados foram “úlcera venosa”, “úlcera varicosa”, “recidiva” associados à palavra chave “prevenção”. Recorreu análise temática de conteúdo, emergindo duas categorias. Dos 305 artigos encontrados, 10 foram selecionados atendendo aos critérios de seleção. As principais evidências observadas foram “medidas para a prevenção de recidivas de úlceras venosas” e “facilidades e dificuldades da implementação de medidas preventivas”. Evidenciou-se que as medidas são diversas para prevenir as recidivas de úlcera venosa, no entanto, a adesão ainda é fator limitador as práticas devido à complexidade que a envolve.Descritores: Úlcera Venosa, Recidiva, Prevenção. Measures to prevent recurrence of venous ulcersAbstract: To identify and analyze scientific evidences adopted in the prevention of venous ulcers recurrences. It is an integrative literature review study, descriptive, with a qualitative approach, carried out between October and November 2017, based on consultation of national and international databases. The descriptors used were "venous ulcer", "varicose ulcer", "relapse" associated with the key word "prevention". It resorted to thematic analysis of content, emerging two categories. Of the 305 articles found, 10 were selected according to the selection criteria. The main evidences observed were "measures for the prevention of relapses of venous ulcers" and "facilities and difficulties of the implementation of preventive measures". It was evidenced that the measures are diverse to prevent the recurrence of venous ulcer, however, adherence is still a limiting factor to the practices due to the complexity that involves it.Descriptors: Venous Ulcer, Relapse, Prevention. Medidas para la prevención de recidivas de úlceras venosasResumen: Identificar y analizar evidencias científicas adoptadas en la prevención de recidivas de úlceras venosas. Este es un estudio integrador de revisión de literatura, descriptivo, con un enfoque cualitativo, realizado entre octubre y noviembre de 2017, basado en la consulta de bases de datos nacionales e internacionales. Los descriptores utilizados fueron "úlcera venosa", "úlcera varicosa", "recidiva" asociados a la palabra clave "prevención". Se recurrió análisis temático de contenido, emergiendo dos categorías. De los 305 artículos encontrados, 10 fueron seleccionados atendiendo a los criterios de selección. Las principales evidencias observadas fueron "medidas para la prevención de recidivas de úlceras venosas" y "facilidades y dificultades de la aplicación de medidas preventivas". Se evidenció que las medidas son diversas para prevenir las recidivas de úlcera venosa, sin embargo, la adherencia todavía es factor limitante en las prácticas debido a la complejidad que la envuelve.Descriptores: Úlcera Varicosa, Recurrencia, Prevención.

Fast and sustained healing of resistant corneal ulcers using corneal scrubbing and matrix regenerating therapy

Aim The aim of this study was to assess the efficacy and safety of corneal scrubbing associated with matrix regenerating agent on corneal wound healing in patients with persistent corneal ulcers. Methods This was a retrospective case study in patients with difficult-to-treat corneal ulcer. Corneal scrubbing was performed with a sterile dry cotton bud to eliminate damaged epithelial cells and corneal deposits, promoting epithelial renewal. Regenerating agent was then administered as one eye drop every 2 days in addition to preservative-free ocular lubricants. A bandage contact lens was applied in case of moderate-to-severe corneal pain. Corneal ulcers were regularly assessed until healing. Results In total, 17 patients with a chronic corneal ulcer of various etiologies for several months on average were enrolled. Corneal scrubbing combined with regenerating agent administration led to a rapid corneal ulcer size reduction from 26.4 ± 20.6 mm2 after scrubbing (before regenerating agent) to 7.2 ± 7.1 mm2 at day 5, 3.3 ± 6.0 mm2 at day 10, and 0.9 ± 2.3 mm2 at day 18. Complete corneal ulcer healing was observed in 35.2% of patients within 10 days, in 70.4% within 18 days, and in all patients within 25 days. Corneal ulcer relapse was observed in two (11.8%) patients after 6 weeks and 5 months, respectively; both were successfully treated using the same procedure. The regenerating agent was well tolerated in all patients. Conclusion In this study, combined corneal scrubbing and matrix regenerating therapy (with or without bandage contact lens) led to a rapid healing and successful resolution of persisting corneal ulcers, including large and deep corneal ulcers.

Surgical correction of foot deformities as a method for prevention and treatment of diabetic foot syndrome

Purpose: to study the potentialities of orthopaedic surgery in foot deformities as a method for prevention and treatment of diabetic foot syndrome (DFS). Patients and methods. During the period from 2014 to 2017 thirty seven patients (13 men and 24 women aged 47 - 75 years) with DFS were operated on for feet deformity. According to Texas University classification 4 patients had grade 0, 7 - grade 3 and 26 patients - grade 4a pathology. Primary deformities were observed in 13 cases, secondary deformities resulting from DFS - in 24 cases. Forty seven different surgical interventions were performed. All interventions were grouped according to D.G. Armstrong classification for DFS surgical treatment. The surgical task was the correction of biomechanics, unloading of foot segments that were subjected to high mechanical effect caused by the deformity. Results. The follow up period was from 2 moths to 3 years. Primary healing of the ulcers was observed after 32 surgical interventions. In 2 cases revision (more radical) surgical intervention was performed. No deformity relapse was noted. Postoperative wound suppuration was recorded in 1 case. Ulcer relapse was observed in 1 case. Conclusion. The study results allow suggesting a significant role and wide-ranging potentialities of surgical orthopaedics for the effective and functional treatment of patients with DFS.

STUDY ON EFFICACY OF QUADRUPLE THERAPY RACM IN PATIENTS WITH HP- POSITIVE GASTRIC ULCER

Objectives: Gastric ulcer is a chronis disease with a lot of dangerous complications and H. pylori is a major cause of gastric ulcer. Eradicating H. pylori helps reducing ulcer relapse and preventing cancer. The aim of study: to evaluate the rate of H. pylori infection in gastric ulcer and efficacy of quadruple therapy RACM for 5 days in patients with gastric ulcer with H. pylori positive. Materials and methods: Total 98 patients with gastric ulcer have been performed the endoscopy and CLO-Test, treated with quadruple therapy RACM for 5 days and evaluate efficacy 4 weeks after ending treatment. Results: The rate of H. pylori in gastric ulcer is 82.65%. The rate of H. pylori eradication is 88.71%. The effect of reducing pain of therapy is 90.32%; and the rate of reducing pain: 96.37% in successfully H. pylori-eradicated group and in the other group 42.85% (p < 0.05). The effect of healing ulcer of therapy is 77.41%; and the rate of healing gastric ulcer: 83.63% in successfully H. pylori-eradicated group and in the other group 28.57% (p < 0.05). The adverse effects of therapy included tiredness: 11.29%, lose appetite: 8.06% and diarrhea: 6.45%. Conclutions: Quadruple therapy RACM for 5 days showed an effective, safe and simple regime for eradicating H. pylori and should be considered to apply as the first lines treatment for H. pylori.

Ten-years comparative study after surgical treatment of perforated peptic ulcer according to ulcer relapse between H. Pylori positive, after eradication, and negative patients

BACKGROUND: The surgical treatment for perforated peptic ulcer is still a matter of discussion. The surgeons, for many years, made their options between acid-reducing procedures with some morbi-mortality and simpler procedures like closure of the perforation. But, in these cases, were faced with a high chance of ulcer relapse. Since the proved link between peptic ulcer and gastroduodenal infection caused by H. pylori, a recommendation for a change in their attitudes going back to simpler procedures with eradication of the bacteria was done. AIM: To analyse ulcer recurrence in patients treated with the same surgical procedure but belonging to two different groups: positive and negative to H. pilori. METHODS: A total of 144 patients were treated with simple closure of their perforated pre-pyloric, pyloric and duodenal ulcers. Thirty days after operation they were submitted to upper endoscopy and tested for the bacteria by urease and histopathological exams and divided into two groups according to the results of the tests: positive and negative. The positive ones were eradicated and, together with the negative group, were followed through six months interval endoscopies and detection tests looking for ulcer relapses and reinfection in the eradicated group. The positive group consisted of 25 patients, with two patients considered non eradicable according to the treatment protocol. They were followed for an average period of 38,21 months. RESULTS: Relapse was detected in four patients (17,39%), half of them (8,69%) were reinfected. The negative group consisted of 26 patients, with a median follow-up of 38,28 months and eight (30,76%) relapses were detected. There was no statistical significant difference due probably to the high dropout of patients. CONCLUSION: Simple suture with H. pilori eradication is the gold standard for the positive group, leaving the question of acid-reducing procedures open for the negative ones.