119 research outputs found
The effect of insulin and sulodexide (Vessel Due F) on diabetic foot syndrome. Pilot study in elderly patients
Celem pracy była ocena skuteczności stosowania insuliny wraz z sulodeksydem (mieszanina
80% pochodnych heparyny i 20% siarczanu dermatanu) w leczeniu owrzodzeń stóp oraz
określenie ich wpływu na mikrokrążenie skórne i neuropatię cukrzycową. Chorzy
z zaawansowaną neuropatią cukrzycową i owrzodzeniem stopy losowo przydzielono
do grupy leczonej insuliną (I) z sulodeksydem (S) (n = 12) lub do grupy kontrolnej
leczonej insuliną z placebo (P) (n = 6) przez 10 tygodni. Za pomocą metody dopplerowskiego
lasera oceniano skórny przepływ krwi w stopach (LDF, laser doppler flow)
w spoczynku oraz po 30- i 60-sekundowym niedokrwieniu. Ocenie poddano również
przewodnictwo nerwowe
na podstawie czuciowych i ruchowych potencjałów wywołanych. U chorych na cukrzycę
skórny przepływ po niedokrwieniu był 2,5 raza krótszy w kończynie z owrzodzeniem niż w stopie zdrowej. Obserwowano
znamienny wzrost przepływów skórnych po 30-
i 60-sekundowym niedokrwieniu po zakończeniu terapii
(grupa IS, owrzodzenie stopy, LDF - 60 s; od
99,1 ± 14,3 do 218,6 ± 28,6 PU, p < 0,001, grupa
od 110,5 ± 13,0 do 164,8 ± 15,4 PU, p < 0,05). Czas
przekrwienia reaktywnego uległ wydłużeniu w grupie
IS (IS: od 30,3 ± 2,9 do 43,9 ± 2,2 s, p < 0,001; IP:
od 28,7 ± 3,0 do 33,3 ± 3,3 s, NS). W grupie IS 92%
owrzodzeń stóp uległo zagojeniu w ciągu 46,4 dnia,
natomiast w grupie IP 83% w ciągu 63,0 dnia. Badania
przewodnictwa nerwowego nie wykazały różnic
nasilenia neuropatii w obrębie grup i pomiędzy
grupami. W stopach z owrzodzeniami sulodeksyd i
insulina poprawiają przepływ skórny w odpowiedzi
na niedokrwienie, nie wpływając na przewodnictwo
nerwowe. Kliniczne efekty działania sulodeksydu, sumując
się z działaniami insuliny, mogą istotnie skracać
czas niezbędny do całkowitego wyleczenia
owrzodzenia. Ostateczne potwierdzenie przedstawionych
wstępnych wyników wymaga dalszych badań
klinicznych.To assess the efficacy of insulin plus sulodexide
(a mixture of 80% heparin-like substances and 20%
dermatan sulphate) on diabetic ulcers, and its influence
on foot skin microcirculation and diabetic neuropathy.
Two groups of diabetic patients, suffering
from severe neuropathy and ulceration, were randomly
assigned to insulin (I) plus sulodexide (S)
(n = 12) or insulin plus placebo (P) (n = 6) therapy,
for 10 weeks. Laser Doppler assessment of foot skin
flow (LDF), at rest and 30 or 60 s after arterial occlusion,
and nerve conduction tests (sensorial evoked
and motoric conduction potentials) have been evaluated
in both groups. Postischaemic flow was 2.5
times shorter in ulcerated vs. non-ulcerated feet in
diabetic patients. A significant increase in flows after
30 and 60 s ischaemia was detected in both groups
at the end of therapy (IS group, ulcerated foot, LDF
= 60 s: from 99.1 ± 14.3 to 218.6 ± 28.6 PU, P <
0.001. IP group = from 110.5 ± 13.0 to 164.8 ± 15.4
PU, P < 0.05). The length of reactive hyperaemia was
higher in IS vs. IP group (IS: from 30.3 ± 2.9 to 43.9
± 2.2 s, P < 0.001; IP: from 28.7 ± 3.0 to 33.3 ± 3.3 s,
ns). Ninety-two percent of ulcers heals in a mean time
of 46.4 days (IS group) vs. 83% and 63.0 days, respectively,
in IP group. Nerve conduction studies have
not demonstrated within- and between-group differences.
Sulodexide and insulin improve the postischaemic
skin flow in ulcerated feet, without affecting
nerve conduction tests. The effect of sulodexide results
additive to insulin; it is clinically relevant, in the
view of the possibility of reducing the time needed
to completely heal ulcers. The ultimate validation of
these preliminary results requires extensive trials
Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.
BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)
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