糖尿病患者足溃疡减压指南(2023年更新版)——《国际糖尿病足工作组:糖尿病相关的足病预防与管理指南(2023)》的一部分

减轻组织的机械性压力在治愈糖尿病相关的足溃疡所需的多种干预措施中最为重要。本文是2023年国际糖尿病足工作组(IWGDF)发布的减压治疗促进糖尿病相关的足溃疡愈合的循证指南,也是对2019年IWGDF指南的更新。我们遵循推荐、评估、发展和评价分级(GRADE)方法学,以患者-干预-比较-结局(patient-intervention-control-outcome,PICO)模式设计临床问题和重要结果,进行系统评价和Meta分析,制定评判表汇总,为每个问题编写推荐和理由。每项推荐都是基于系统综述中发现的证据,在无证据情况下则采用专家意见,以及对判断项目的GRADE等级总结进行仔细权衡,包括可预期和不可预期的影响、证据的确定性、患者价值、所需资源、成本效益、公平性、可行性和可接受性。为了治愈糖尿病患者神经性前足底或中足底溃疡,要使用不可拆卸的齐膝高减压装置作为首选减压干预措施。如果患者存在对不可拆卸减压装置的禁忌证或不能耐受,考虑使用可拆卸齐膝(或踝)高减压装置作为减压干预措施的第二选择。如果无可用的减压装置,考虑使用合适的鞋具结合毡制泡沫作为减压干预措施的第三选择。如果这种非手术减压治疗不能治愈前足底溃疡,可以考虑跟腱延长术、跖骨头切除术、关节置换术或跖骨截骨术。为了治疗继发于屈趾畸形的神经性足底或小趾远端溃疡,可行趾屈肌腱切开术。为了促进后足、非足底或并发感染或缺血的溃疡的愈合,提出了进一步的推荐。所有推荐都已在减压临床路径中进行了总结,以帮助促进本指南在临床实践中的实施。这些减压推荐将帮助医务人员为糖尿病相关的足溃疡患者提供最佳的治疗和预后,降低患者感染、住院和截肢的风险。

Aerobic Training Impacts on Blood Cholesterol of Women with Gestational Diabetes

Gestational diabetes mellitus has been identified as a major complication of pregnancies and has remained a major cause of perinatal morbidity and mortality, as well as maternal morbidity. Lipid abnormalities significantly contribute to the increased risk of cardiovascular disease and other morbidities in diabetics. One of the benefits of regular exercise is a reduction in cardiovascular risk factors through the improvement of the lipid profile and reduction of hypertension. This study investigated the effect of aerobic training on the cholesterol level of women with gestational diabetes. Thirty-four (34) women who met the inclusion criteria for this study were randomized into Exercise and Control groups. Exercise group participated in structured exercise programme, 3 sessions a week for 8 weeks with each session lasting a maximum of 60 minutes while the Control group did not participate in any form of structured exercise programme for the period of the study. Data were collected at baseline, at 4th week and at 8th week into the exercise programme. Thirty (30) of the participants completed the study and so only their data were analysed using Repeated Measure ANOVA and Independent t-test. The result showed significant changes in the total cholesterol (F[2, 28]) = 268.316, P = 0.001), of the Exercise group compared to the control. Independent t-test used to compare the lipid profile of the Experimental and Control groups showed significant difference between the means of the 2 groups at week 4 (total cholesterol (t(28) 2.164, P = 0.039, triglyceride [t(28) 3.146 P = 0.004] and week 8 (total cholesterol t(28) 4.596, P = 0.001, triglyceride t(28) 5.534, P = 0.001) but not at baseline (total cholesterol t(28) -901, P = 0.375, triglyceride t(28) 1.612, P = 0.118). It was concluded that structured aerobic exercises may have positive effect on the components of lipid profile in women with gestational diabetes.

Revisiting the Evaluation of the Effectiveness of Artemether-Lumefantrine Combination in the Treatment of Uncomplicated Malaria in Elele, a Malaria Endemic Area in Rivers State Nigeria

Background: The World Health Organization adopted Artenisinin based combination therapy (ACT) for the treatment of uncomplicated malaria in endemic regions. The efficacy of ACT in malaria treatment must have prompted this choice. There’s need to protect the ACT from plasmodial resistance. Hence, clinical scaling up of ACT program is needed. This entails continued assessment, monitoring and evaluation of the effectiveness of component drugs in endemic areas. Purpose: This study revisited the evaluation of the effectiveness of artemether-lumefantrine combination (ALC) in the treatment of uncomplicated malaria in Elele, Nigeria. Method: The study was conducted in Elele, a malaria endemic area in Rivers State, Nigeria. This was a facility based descriptive, cross sectional study at Madonna University Teaching Hospital (MUTH) Elele using simple sampling technique. Qualitative and quantitative data were collected. 100 patients who consented to the study were recruited in the outpatient clinic using semi structured questionnaires as part of study instrument. Inclusion criteria were having a body temperature of ≥37.5&deg;C, symptoms of malaria, positive parasitemia, non ingestion of antimalarial in the past 2 weeks, etc. MUTH ethics committee gave ethical clearance. Patient recruitment following consent commenced with their symptoms and signs recorded at presentation while disappearance of the same was determined following drug ingestion on days 2/4/6/8/10 and 14. The data gotten was analyzed by tallying the responses to get the frequencies using SPSS 16.0 version and Microsoft excel tools. The student t-test was used to calculate the P-value, values < 0.05 was considered statistically significant. Results: Most of the patients knew mosquitoes as the mode of malaria transmission (70%). The ACT is known and used by these patients: artesunate/amodiaquine: 41 (41%);artesunate/lumefantrine: 40 (40%);artesunate/sulphadoxine-pyrimethamine: 38(38%);artesunate/mefloquine: 20 (20%). Fever was the predominant presenting symptom, 92% followed by body weakness (90%);headache (85%);malaise (80%);loss of appetite (80%);nausea (72%);vomiting (70%);abdominal pains (50%). Others were: pallor (30%);hepatomegally (20%);splenomegally (20%);chills (20%);rigor (20%). By day 10 of therapy, fever, vomiting and abdominal pains had disappeared in all patients, some patients still had mild: body weakness 40%;headache 2%;malaise 24%;loss of appetite 20% and nausea 10%. Day 14 recorded no symptoms in all patients. There was effective clinical response (ECR) by day 14. Conclusion: This study hereby reaffirms the efficacy and effectiveness of Artemether-lumefantrine Combination in the treatment of uncomplicated malaria in Elele, Nigeria. The need to fill the existing knowledge gap of monitoring and evaluation of ACT in rural endemic areas has been done by this study.

Examination of Common Occupational Hazards among Healthcare Workers in a University Healthcare Center in Southeastern Nigeria

Background: Healthcare workers are challenged by an imposing group of occupational hazards. These hazards include exposure to biological and non-biological hazards like ionizing radiation, stress, injury, infectious agents, and chemicals. The aim of this study was to assess common occupational hazards among health workers at the Department of Health Services (DHS), Federal University of Technology, Owerri. Methods: A hospital-based cross-sectional study design was employed for the study, and a self-administered questionnaire was used for data collection. The SPSS Version 22.0 software was used for the analysis of the descriptive statistics obtained from the study. This study included both clinical and non-clinical health workers. A purposive sampling technique was used in recruiting a total of 94 respondents who participated in the study from September 2020 to April 2021. Results: A total of 94 respondents who participated in the study and among the participants, 33.3% (31) of the respondents were aged 31 - 40 years, and the majority of the health workers, 43.6% (41) had stayed between 1 - 5 years. Also, 92.6% (87) of the health workers have heard of occupational hazards. The study showed that 84.0% (79) of health workers had good knowledge of common occupational hazards. Biological hazards among health workers are 47.9% (45) cuts and wounds, 29.8% (28) direct contact with contaminated specimens/hazardous materials, and 26.6% (26) sharp related injuries, while for non-biological hazards, 44.7% (42) have slipped, tripped or fallen, and 35.1% (33) have been stressed. Common safety measures include 86.2% (81) washing their hands regularly;78.7% (74) using hand gloves;and 85.1% (80) agreeing they use face masks. Conclusion: Despite good knowledge of occupational hazards, participants at DHS were faced with certain hazards. It is recommended that the university, government, and policymakers revise and implement actions to provide health workers at DHS with equipment to encourage safety in work activity.

Sex Hormones Secretion Pattern in Pregnant Sickle Cell Subjects in Niger Delta Region, South of Nigeria

Sickle cell anemia (SCA) patients are reported with infertility and low rate of pregnancies. This is associated with wide range of reproductive issues that are still relevant because of the complications and problems of the disease that still persist till date. This study was carried out to establish the secretion pattern of the sex hormones (Progesterone and Estradiol) in the three trimesters of pregnant sickle cell disease subjects in the Niger Delta Region, south of Nigeria. The study included twenty (20) pregnant sickle cell anemia subjects with average age of 27.4 years and twenty (20) apparently healthy (Hemoglobin AA) subjects with average age of 28.2 years. Their samples collection started when they registered for antenatal care at the clinics within the first trimester of pregnancy. The Enzyme Linked Immunosorbent assay (ELISA) method was used in the measurement of the hormones in the plasma of the subjects. The result showed a statistical significant reduction (P < 0.05) in the values of the hormones in the three trimesters obtained for the sickle cell disease (SCD) subjects when compared with apparently healthy subjects with the same age range. Statistical analysis showed a strong positive correlation ((r = 0.8151 for Estradiol and r = 0.8793) for Progesterone) between the secretion of the sex hormones, in the sickle cell subjects and the control. The result is attributed to the sickle cell gene abnormality and the treatment of SCA that affects the endocrine system by inhibiting the production of gonadotropins from the pituitary gland. The SCD itself does not directly damage the reproductive system;however it can affect other systems which will eventually cause harm to the reproductive system. The study concluded that the sickle cell anemia patients require the administration of the hormone drugs during pregnancy to prevent to a certain extent, complications arising from hormonal imbalance.

Acute Response of Heart Rate of Pregnant Women to Aerobic Dance Exercise

This was a Pre-test/Post-test research designed to study the acute heart rate response of pregnant women to aerobic dance exercise. Twenty four (24) pregnant women with no complications participated in this study. HR increased significantly after 30 minutes exercise [7.292, P = 0.004 (P < 0.05)] and then decreased significantly again after 30 minutes rest, post exercise [10.00, P = 0.0001 (P < 0.05)]. The heart rate normalised after 30 minutes rest, showing no significant difference from the pre-exercise value [2.708, P = 0.517 (P > 0.05)]. Moderate intensity Aerobic Dance Exercise may not precipitate adverse acute cardiorespiratory response in pregnant women with no complications.

X-reality for phantom limb management for amputees:A systematic review and meta-analysis

Phantom limb is a disabling neuropsychiatric condition among amputees resulting in pain and disturbance that impact their functions,quality of life,and autonomy.While pharmacological approaches appeared to be ineffec-tive,the emergence and integration of X-reality,including virtual reality,augmented reality,and mixed reality,might elevate the effectiveness of mirror therapy in managing phantom limb.The objective of this study is to review X-reality for managing phantom pain.A systematic search was conducted on PubMed,Scopus,Web of Science,PsycINFO,Embase,and CINAHL.Sixteen(n=16)studies containing 66 lower-limb and 53 upper-limb amputees were included for the review over the thematic framework of amputee characteristics and intervention designs,while thirteen(n=13)studies were further proceeded for the meta-analysis.We found eleven studies on virtual reality(n=11),four studies on marker-based augmented reality(n=4)and one study on mixed reality(n=1)with a total of 40 game/task themes involving,motor skills,motor control,and stimulus-sensing.Regardless,all these interventions adopted the movement representation strategies with different techniques.Overall,the X-reality interventions reduced the pain level of the amputees(mean difference:-2.30,95%CI,-3.38 to-1.22),especially the virtual reality subgroup(mean difference:-2.83,95%CI,-4.43 to-1.22).However,there were substantial heterogeneity and partially explained by the subgroup analysis on publication year.The strength of evidence was limited by case reports and case series in this review.