CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO “ SAN ELIAN “
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Transcript of CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO “ SAN ELIAN “
CENTRO DE PREVENCION Y SALVAMENTOCENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICODEL PIE DIABETICO
“ “ SAN ELIAN “SAN ELIAN “
A new software-controlled voltage impulse generator A new software-controlled voltage impulse generator
(PBK(PBK ) as adjuvant in improving diabetic foot wound clinical conditions
A presentation of 3 cases
Fermin Martínez De Jesus MDFermin Martínez De Jesus MD
Veracruz-Mexico
BackgroundBackground
Diabetic Foot it is a complex disease, Diabetic Foot it is a complex disease, where many variables interact where many variables interact continuously. Several treatment continuously. Several treatment modalities are currently developing and modalities are currently developing and under assessment. The use of tissue under assessment. The use of tissue electrical stimulation is another newer electrical stimulation is another newer field to be explored.field to be explored.
Source World Health Source World Health OrganizationOrganization
The dimension of the problem
Country Country 2000 2000 2030 2030
Antigua and Barbuda Antigua and Barbuda 3,000 3,000 5,000 5,000
Argentina Argentina 1,426,000 1,426,000 2,457,000 2,457,000
Bahamas Bahamas 12,000 12,000 26,000 26,000
Barbados Barbados 11,000 11,000 22,000 22,000
Belize Belize 5,000 5,000 15,000 15,000
Bolivia Bolivia 207,000 207,000 562,000 562,000
Brazil Brazil 4,553,000 4,553,000 11,305,000 11,305,000
Canada Canada 2,006,000 2,006,000 3,543,000 3,543,000
Chile Chile 495,000 495,000 1,047,000 1,047,000
Colombia Colombia 883,000 883,000 2,425,000 2,425,000
Costa Rica Costa Rica 76,000 76,000 237,000 237,000
Cuba Cuba 480,000 480,000 855,000 855,000
Dominica Dominica 3,000 3,000 4,000 4,000
Dominican Republic Dominican Republic 245,000 245,000 594,000 594,000
Ecuador Ecuador 341,000 341,000 921,000 921,000
El Salvador El Salvador 103,000 103,000 320,000 320,000
Grenada Grenada 4,000 4,000 7,000 7,000
Guatemala Guatemala 139,000 139,000 447,000 447,000
Guyana Guyana 19,000 19,000 36,000 36,000
Haiti Haiti 161,000 161,000 401,000 401,000
Honduras Honduras 81,000 81,000 269,000 269,000
Jamaica Jamaica 81,000 81,000 189,000 189,000
Mexico Mexico 2,179,000 2,179,000 6,130,000 6,130,000
Nicaragua Nicaragua 68,000 68,000 246,000 246,000
Panama Panama 59,000 59,000 155,000 155,000
Paraguay Paraguay 102,000 102,000 324,000 324,000
Peru Peru 754,000 754,000 1,961,000 1,961,000
Saint Kitts and Nevis Saint Kitts and Nevis 2,000 2,000 2,000 2,000
Saint Lucia Saint Lucia 5,000 5,000 11,000 11,000
Saint Vincent and the Grenadines Saint Vincent and the Grenadines 5,000 5,000 9,000 9,000
Suriname Suriname 9,000 9,000 20,000 20,000
Trinidad and Tobago Trinidad and Tobago 60,000 60,000 125,000 125,000
United States of America United States of America 17,702,000 17,702,000 30,312,000 30,312,000
Uruguay Uruguay 154,000 154,000 224,000 224,000
Venezuela Venezuela 583,000 583,000 1,606,000 1,606,000
Total Total 33,016,000 33,016,000 66,812,000 66,812,000
15 % of diabetic people will 15 % of diabetic people will have an ulcer in their lifetimehave an ulcer in their lifetimeDiabete = leading cause of Diabete = leading cause of non-traumatic amputations non-traumatic amputations (80 (80 % of total)% of total)About 50 % can be prevented About 50 % can be prevented with a good lower extremities with a good lower extremities skin careskin careThe cost for the sanitary The cost for the sanitary system is impressive system is impressive – (USA $ 5 billion/year,(USA $ 5 billion/year,– in Italy 25 % of the cost of a patient)in Italy 25 % of the cost of a patient)
Every 30 seconds a Every 30 seconds a leg is lost to leg is lost to
diabetes somewhere diabetes somewhere in the world.in the world.
Lancet – novembre 2005Lancet – novembre 2005
The LancetThe Lancet
L’epidermide - strutturaL’epidermide - struttura
Mechanism of impaired Mechanism of impaired function of skin is not function of skin is not fully understoodfully understood In diabetes all the age-In diabetes all the age-related changes of collagen related changes of collagen appear to be acceleratedappear to be acceleratedAltered glycemic levels Altered glycemic levels are affecting also skin are affecting also skin functionalityfunctionality
Among factors that Among factors that lead to ulcers lead to ulcers modification of skin modification of skin capability to recover capability to recover from minimal damagesfrom minimal damagesMinor small lesions are Minor small lesions are understimated by the understimated by the patient and very often patient and very often by the pysicianby the pysician
glucose and some specific cells glucose and some specific cells such as fibroblastssuch as fibroblasts glucose affect cellular morphology glucose affect cellular morphology of keratinocytes,of keratinocytes,high glucose concentrations high glucose concentrations inhibit keratinocytes proliferation.inhibit keratinocytes proliferation.Keratinocytes cells with high Keratinocytes cells with high glucose concentrations have glucose concentrations have decreased proliferation ratedecreased proliferation rateglucose was shown to inhibit glucose was shown to inhibit proliferation in other cell types, proliferation in other cell types, including fibroblastsincluding fibroblasts
human fibroblast in diabetic human fibroblast in diabetic patients shown an impairment in patients shown an impairment in migration, migration, diabetes is accompanied by diabetes is accompanied by delayed wound healing and delayed wound healing and insufficient granulation tissue insufficient granulation tissue formation,formation,Fibroblast derived chronic Fibroblast derived chronic diabetic patients have lower diabetic patients have lower proliferationproliferation
Lerman et al Lerman et al AJP January 2003, Vol. 162, No. 1AJP January 2003, Vol. 162, No. 1
A sample of typical ulcerA sample of typical ulcer
Causes of foot ulceration and Causes of foot ulceration and infectioninfection
x Friction in ill fitting or new shoesx Friction in ill fitting or new shoesx Untreated callous - Self treated callusx Untreated callous - Self treated callusx Foot injuries (ex, unnoticed trauma in shoes or x Foot injuries (ex, unnoticed trauma in shoes or when walking barefoot)when walking barefoot)x Burns (for example, excessively hot bath, hot x Burns (for example, excessively hot bath, hot water bottle, hot radiators, hot sand on holiday)water bottle, hot radiators, hot sand on holiday)x Corn plasterx Corn plasterx Nail infections (paronychia)x Nail infections (paronychia)x Heel friction in patients confined to bedx Heel friction in patients confined to bedx Foot deformities ( hammer toe, Charcot’s foot)x Foot deformities ( hammer toe, Charcot’s foot)
Current Clinical UsesCurrent Clinical Usesof PBK Therapyof PBK Therapy
Pain reliefPain reliefSpasms or muscular damageSpasms or muscular damageArthritisArthritisNeuropathic painNeuropathic painVascular pathologiesVascular pathologiesBack painBack pain
Standard Electro-therapy SystemsStandard Electro-therapy Systems
Use galvanic or faradic Use galvanic or faradic currentscurrentsSquare waves in a simple Square waves in a simple manner OF-ONmanner OF-ONUseful for short term pain Useful for short term pain control orcontrol orRelaxing musclesRelaxing muscles
PBK SystemPBK System
Does not use currentDoes not use currentExtremely short volts Extremely short volts impulsesimpulsesBillionths of a secondBillionths of a secondTiming and powerTiming and power
PBK effectsPBK effects
Cell and tissue alarm statusCell and tissue alarm statusLocal release of Local release of TNFTNFάά & & IL-IL-B1B1Local release of VEGF & Local release of VEGF & increase of NOincrease of NO
In BriefIn BriefStandard Electro-therapyStandard Electro-therapy1. Relaxes muscle1. Relaxes muscle2. Removes pain for a short time2. Removes pain for a short time PBK TherapyPBK Therapy 1. Relaxes muscle1. Relaxes muscle2. Stimulates VEGF2. Stimulates VEGF
Dilates vessels – more blood flowDilates vessels – more blood flow3.3. Grows new vesselsGrows new vessels3. Stimulates anti-inflammatories which reduces pain 3. Stimulates anti-inflammatories which reduces pain immediatelyimmediately4. Attacks 4. Attacks the cause of the painthe cause of the pain, not just the symptoms, not just the symptoms5. Removes pain for a long time5. Removes pain for a long time6. Improves muscle strength, mobility and flexibility6. Improves muscle strength, mobility and flexibility
BackgroundBackground
A In Vivo Journal published paperA In Vivo Journal published paperFerroni P. Roselli M. Martini F, et al. Biological effects Ferroni P. Roselli M. Martini F, et al. Biological effects of a software-controlled Voltage Pulse Generator of a software-controlled Voltage Pulse Generator (PhyBack PBK-2C) on the Release of Vascular (PhyBack PBK-2C) on the Release of Vascular Endothelial Growth Factor. In vivo 2005;19:949-958.Endothelial Growth Factor. In vivo 2005;19:949-958.
Debreceni L, Gyulai M, Debreceni A, Szabo K. Debreceni L, Gyulai M, Debreceni A, Szabo K. Results of transcutaneous electrical stimulation (TES) Results of transcutaneous electrical stimulation (TES) in cure of lower extremity arterial disease. Angiology in cure of lower extremity arterial disease. Angiology 1995;46:613-8.1995;46:613-8.
EthicsEthics
Because there is no reported side effects with Because there is no reported side effects with the use of controlled electrical stimulation the use of controlled electrical stimulation (PBK), and there is published basic research (PBK), and there is published basic research showing a release of VEGF and good showing a release of VEGF and good proinflammatory response. We start to use proinflammatory response. We start to use PBK in some selected patients within a PBK in some selected patients within a comprehensive care in our center.comprehensive care in our center.
ObjectiveObjective
To explore if PBK play a role as To explore if PBK play a role as adjuvant therapy for improving the adjuvant therapy for improving the diabetic foot wound conditions.diabetic foot wound conditions.