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Introducción: la diabetes mellitus es reconocida como una amenaza mundial. La identificación temprana de los factores de riesgos asociados con la aparición de úlceras en personas con diabetes mellitus es crucial para evitar las futuras amputaciones. Objetivo: describir los resultados del Programa de atención integral al pie diabético. Método: se realizó en el Policlínico “Manuel Piti Fajardo” de Santo Domingo, entre enero de 2010 y diciembre de 2017, un estudio descriptivo, retrospectivo, transversal a 567 pacientes diabéticos que asistieron a la consulta; la muestra quedó conformada por dos grupos: 225 llevaron tratamiento con heberprot-p y 342 presentaron pie de riesgo. Resultados: en el período comprendido entre los años 2010 y 2017 se logró aumentar lo propuesto por el programa en un 69,3%. De los 225 pacientes que llevaron tratamiento con heberprot-p el 87,1% tuvieron una evolución satisfactoria. La proporción de amputación en el período fue de 19,15% (en los años 2016 y 2017 fue de cero). Los pacientes con recaídas comparten factores de riesgos modificables. Las úlceras de pie diabético son detectadas en estadios iniciales, lo que disminuye el número de aplicaciones de heberprot-p por pacientes (entre seis y siete bulbos); también disminuyó el costo promedio. Los pacientes con pie de riesgo fueron 342: 16,2% bajo riesgo, 26,4% riesgo moderado, 20,6% alto riesgo y 36,8% sin riesgo. Conclusiones: la terapia con heberprot-p fue efectiva, así como el tratamiento oportuno a los pacientes diabéticos con pie de riesgo para la reducción de la incidencia de lesiones.

Introduction: diabetes is considered an epidemic in the world. Diabetic foot is a serious health problem in Cuba. Heberprot-p is a novel drug that can solve a medical need not covered worldwide. Objective: to determine the complication that occurred during therapy with heberprot-p. Method: a descriptive longitudinal study was performed in 108 patients treated with heberprot-p in “Manuel Piti Fajardo” Policlinic in Santo Domingo between January 2012 and December 2015, the sample consisted of 14 patients who had a non-satisfactory evolution. The information was obtained by the survey method and through the review of medical records and treatment registration cards. Results: 87% of the patients who received heberprot-p treatment had a satisfactory outcome; of patients with unsatisfactory outcome the main complication was local infection (100%); 64,3% were males and 78,6% were older than 60 years, 64,3% had more than 10 years of diabetes and the most prevalent risk factors were hyperglycemia, overweight and obesity (or both), followed by dyslipidemia and depression, respectively. Conclusions: it was determined that local infection was the most frequent complication and hyperglycemia was the main risk factor.

Background: Quality of life (QoL) decreases as heart failure worsens, which is one of the greatest worries of these patients. Physical exercise has been shown to be safe for people with heart failure. Previous studies have tested heterogeneous exercise programs using different QoL instruments and reported inconsistent effects on QoL. The aim of this study is to evaluate the effectiveness of a new exercise program for people with heart failure (EFICAR), additional to the recommended optimal treatment in primary care, to improve QoL, functional capacity and control of cardiovascular risk factors. Methods/Design: Multicenter clinical trial in which 600 patients with heart failure in NYHA class II-IV will be randomized to two parallel groups: EFICAR and control. After being recruited, through the reference cardiology services, in six health centres from the Spanish Primary Care Prevention and Health Promotion Research Network (redIAPP), patients are followed for 1 year after the beginning of the intervention. Both groups receive the optimized treatment according to the European Society of Cardiology guidelines. In addition, the EFICAR group performs a 3 month supervised progressive exercise program with an aerobic (high-intensity intervals) and a strength component; and the programme continues linked with community resources for 9 months. The main outcome measure is the change in health-related QoL measured by the SF-36 and the Minnesota Living with Heart Failure Questionnaires at baseline, 3, 6 and 12 months. Secondary outcomes considered are changes in functional capacity measured by the 6-Minute Walking Test, cardiac structure (B-type natriuretic peptides), muscle strength and body composition. Both groups will be compared on an intention to treat basis, using multi-level longitudinal mixed models. Sex, age, social class, co-morbidity and cardiovascular risk factors will be considered as potential confounding and predictor variables. Discussion: A key challenges of this study is to guarantee the safety of the patients; however, the current scientific evidence supports the notion of there being no increase in the risk of decompensation, cardiac events, hospitalizations and deaths associated with exercise, but rather the opposite. Safety assurance will be based on an optimized standardised pharmacological therapy and health education for all the participants. Trial Registration: Clinical Trials.gov Identifier: NCT01033591 [ABSTRACT FROM AUTHOR]