Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P = 0.025). Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P = 0.081). By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P = 0.011). By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P = 0.050). The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.
La enfermedad por coronavirus 2019 (COVID-19) se ha convertido en una pandemia que ha ocasionado la muerte de centenares de miles de personas en el mundo, afectando principalmente a sujetos con enfermedades cronicodegenerativas y/o con un sistema inmunitario deprimido, que los hace susceptibles de padecer y presentar complicaciones por la enfermedad. El confinamiento para evitar el contagio de la COVID-19 puede generar el desarrollo de malos hábitos de alimentación, inactividad física y alteraciones en el estado de ánimo, lo que afecta directamente a la salud de la población, especialmente a las personas que viven con diabetes u obesidad, que tienen mayor riesgo de presentar formas más graves y mortalidad por COVID-19. Existe evidencia científica de que ciertos nutrimentos como las vitaminas A, C, D, E, los ácidos grasos poliinsaturados omega-3 y el zinc podrían generar efectos benéficos frente a la COVID-19 actuando como inmunomoduladores, reduciendo el estrés oxidativo y la respuesta inflamatoria. La alimentación juega un papel primordial en la prevención y/o disminución de los efectos producidos por la COVID-19, ya que el tener una dieta adecuada durante la cuarentena contribuye a controlar las comorbilidades presentes, reducir el estrés y aminorar algunos de los síntomas gastrointestinales que se han relacionado con la COVID-19.
Background: Diabetes educators are an important element in the multidisciplinary treatment team of diabetes. Diabetes education interventions are recommended throughout the course of the disease since they have a favorable impact in glucose control. Objective: The objective of the study was to evaluate the baseline status and at follow-up of patients participating in diabetes education sessions. Methods: Retrospective cohort study based on the review of clinical records of patients from a National Health Institute in Mexico. A total of 153 subjects that attended individual sessions were included in the study. Changes were assessed in 48 participants that had a second evaluation. The outcomes included clinical, anthropometric, and biochemical parameters, along with variables related to diabetes education. Results: The knowledge about tools for diabetes self-management was poor. Significant changes were found in different components that promote self-management of diabetes including knowing glycemic targets, performing an adequate insulin injection, and practicing self-monitoring of blood glucose. Conclusions: The knowledge of patients with diabetes about their disease is inadequate. Interventions related to diabetes education could promote better adherence to self-care behaviors in patients with diabetes.
Background: neo-adjuvant therapy is usually indicated in locally advanced tumors, the aim is to decrease the tumoral burden and enhance overall survival. Renal cell carcinoma is a chemo and radio resistant neoplasm and this type of approach is not as effective as in other solid tumors. On the other hand immunotherapy is indicated in metastatic disease, demonstrating a better overall survival. Sorafenib is an antiangiogenic drug approved for locally advanced or metastatic RCC. We postulated that it can be used in a neoadjuvant way to decrease the vascularization of selected tumors. Report of the Case: 57 years old male referred to our service with a right renal mass and metastatic disease to lumbar spine and suprarenal gland. He was treated with three months of sorafenib previous to the surgery. Results: the patient went into surgery three months after initiating the antiangiogenic drug, during the surgery we found less neo-formance vessels; the dissection was subjectively easier, due to peri-renal edema. The pathologic analysis of the specimen was renal cell carcinoma. Interestingly, 40% of central ischemic (coagulative) necrosis was found. Conclusion: there are no neoadjuvant drugs accepted for the treatment of renal cell carcinoma; using an antiagiogenic drug to decrease the vascular burden characteristic of this type of tumors could be a viable option in selected cases. We used a lower dose of the drug with an acceptable safety profile.
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