CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO “ SAN ELIAN “

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CENTRO DE PREVENCION Y SALVAMENTO CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO DEL PIE DIABETICO SAN ELIAN “ SAN ELIAN “ A new software-controlled voltage A new software-controlled voltage impulse generator impulse generator (PBK (PBK ) as adjuvant in improving diabetic foot wound clinical conditions A presentation of 3 cases Fermin Martínez De Jesus MD Fermin Martínez De Jesus MD Veracruz-Mexico

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CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO “ SAN ELIAN “ A new software-controlled voltage impulse generator (PBK ) as adjuvant in improving diabetic foot wound clinical conditions A presentation of 3 cases Fermin Martínez De Jesus MD. Veracruz-Mexico. Background. - PowerPoint PPT Presentation

Transcript of CENTRO DE PREVENCION Y SALVAMENTO DEL PIE DIABETICO “ SAN ELIAN “

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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

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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.

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Source World Health Source World Health OrganizationOrganization

The dimension of the problem

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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

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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

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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)

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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

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The LancetThe Lancet

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L’epidermide - strutturaL’epidermide - struttura

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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

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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

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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

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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

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A sample of typical ulcerA sample of typical ulcer

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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)

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Current Clinical UsesCurrent Clinical Usesof PBK Therapyof PBK Therapy

Pain reliefPain reliefSpasms or muscular damageSpasms or muscular damageArthritisArthritisNeuropathic painNeuropathic painVascular pathologiesVascular pathologiesBack painBack pain

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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

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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

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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

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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

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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.

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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.

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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.