2016, Number 3
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Med Cutan Iber Lat Am 2016; 44 (3)
Epidemiology of cutaneous ulcers in Latin America
Sánchez-Cruz LY, Martínez-Villarreal AA, Lozano-Platonoff A, Cárdenas-Sánchez A, Contreras-Ruiz J
Language: Spanish
References: 117
Page: 183-197
PDF size: 365.33 Kb.
ABSTRACT
Introduction: Cutaneous ulcers represent a frequent cause for consultation and a public health concern in Latin America with scarce epidemiologic information.
Objective: To perform a systematic and comprehensive review of the existing literature on prevalence and incidence of the most common cutaneous ulcers in Latin America.
Material and methods: Between February and March 2015, we performed a search from 1995 up to date, in PubMed, Biblioteca Virtual en Salud, Inbiomed and Google Scholar of publications on prevalence and/or incidence of the main cutaneous ulcerative ailments.
Results: A total of 1,670 publications were found. 114 had epidemiologic information on ulcerative cutaneous diseases. Of these, 52 were of leishmaniasis, 29 pressure ulcers, 16 surgical dehiscence, 9 Buruli ulcer, 7 diabetic foot, 1 of other leg ulcers. The incidence and prevalence of these by etiology and country are presented in the body of this study.
Conclusions: There are very few studies, and of variable quality, on these conditions more and more frequent in Latin America. Of the most commonly seen, the literature is scarce in comparison with those that are less frequent but of mandatory notification. More studies on cutaneous ulcerative diseases are needed in Latin America.
REFERENCES
Ahmad N, Thomas GN, Gill P, Chan C, Torella F. Lower limb amputation in England: prevalence, regional variation and relationship with revascularisation, deprivation and risk factors. A retrospective review of hospital data. J R Soc Med. 2014; 107: 483-489.
Dowsett C, Bielby A, Searle R. Reconciling increasing wound care demands with available resources. J Wound Care. 2014; 23: 552, 554, 556-8 passim.
Hindley J. Clinical audit of leg ulceration prevalence in a community area: a case study of good practice. Br J Community Nurs. 2014; Suppl: S33-9.
Jiang Q, Li X, Qu X et al. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China. Int J Clin Exp Pathol. 2014; 7: 2587-2594.
Skerritt L, Moore Z. The prevalence, aetiology and management of wounds in a community care area in Ireland. Br J Community Nurs. 2014; Suppl: S11-7.
Daulatabad D, Singal A, Dhawan A, Pandhi D, Sharma S. Mucocutaneous leishmaniasis caused by Leishmania donovani infection in an Indian man. Int J Dermatol. 2015; 54: 680-684.
Guo RF, Gebreab FH, Tang EH, Piao Z, Lee SS, Perez ML. Cutaneous ulcer as leading symptom of systemic cytomegalovirus infection. Case Rep Infect Dis. 2015; 2015: 723962.
Hagstrom EL, Patel S, Karimkhani C, Boyers LN, Williams HC, Hay RJ et al. Comparing cutaneous research funded by the US National Institutes of Health (NIH) with the US skin disease burden. J Am Acad Dermatol. 2015; 73 (3): 383-391.
Landier J, Fontanet A, Texier G. Defining and targeting high-risk populations in Buruli ulcer. [letter]. Lancet Glob Health. 2014; 2 (11): e629.
Molodoi AD, Dimitriu A, Andronic CD, Stoleriu G, Bădescu A, Boda D et al. Pyoderma vegetans developed on chronic leg ulcer. Rev Med Chir Soc Med Nat Iasi. 2015; 119 (1): 107-111.
Silveira SLP, Freitas da Silva GR, Carvalho Moura EC, Leite Rangel EM, Rodriguez Barbosa de Sousa JE. Pressure ulcers assessment through the pressure ulcer scale for healing application (PUSH). Rev de Pesquisa Cuidado e Fundamental Online. 2013; 5: 3847-3855.
Gomes FS, Bastos MA, Matozinhos FP, Temponi HR, Velasquez-Melendez G. Factors associated to pressure ulcers in patients at adult Intensive Care Units. Rev Esc Enferm USP. 2010; 44: 1070-1076.
Queiroz AC, Mota DD, Bachion MM, Ferreira AC. Pressure ulcers in palliative home care patients: prevalence and characteristics. Rev Esc Enferm USP. 2014; 48 (2): 264-271.
Brito PA, de Vasconcelos Generoso S, Correia MI. Prevalence of pressure ulcers in hospitals in Brazil and association with nutritional status--a multicenter, cross-sectional study. Nutrition. 2013; 29: 646-649.
da Silva Cardoso JR, Blanes L, Augusto Calil J, Ferreira Chacon JM, Masako Ferreira L. Prevalence of pressure ulcers in a Brazilian hospital: results of a cross-sectional study. Ostomy Wound Manage. 2010; 56: 52-57.
Soares de Camargo A, Blanes L, Fernandes Cavalcante NJ. Prevalence of pressure ulcers in a hospital of infectology. Rev Estima. 2007; 5: 32-36.
Moro A, Maurici A, Barros do Valle J, Zaclikevis VR, Kleinubing Junior H. Avaliacao dos pacientes portadores de lesao por pressao internados em hospital geral. Rev Assoc Med Bras. 2007; 53: 300-304.
de Freitas MC, Medeiros AB, Guedes MV, de Almeida PC, de Galiza FT, Nogueira Jde M. Pressure ulcers in the elderly: analysis of prevalence and risk factors. Rev Gaucha Enferm. 2011; 32: 143-150.
Chacon JMF, Blanes L, Hochman B, Ferreira LM. Prevalence of pressure ulcers among the elderly living in long-stay institutions in São Paulo. São Paulo Med J. 2009; 127: 211-215.
Anna B, Elisa R. Pressure ulcer: Statistics analysis of an electronic database. Stud Health Technol Inform. 2006; 122: 548-551.
dos Santos CT, Oliveira MC, Pereira AG, Suzuki LM, Lucena Ade F. Pressure ulcer care quality indicator: analysis of medical records and incident report. Rev Gaucha Enferm. 2013; 34: 111-118.
Zambonato BP, de Assis MC, Beghetto MG. Association of Braden subscales with the risk of development of pressure ulcer. Rev Gaucha Enferm. 2013; 34: 21-28.
Costa IG. Incidence of pressure ulcer in regional hospitals of Mato Grosso, Brazil. Rev Gaucha Enferm. 2010; 31: 693-700.
Scarlatti KC, Michel JL, Gamba MA, de Gutierrez MG. Pressure ulcers in surgery patients: incidence and associated factors. Rev Esc Enferm USP. 2011; 45: 1372-1379.
de Araujo TM, de Araujo MF, Caetano JA. Using the braden scale and photographs to assess pressure ulcer risk. Rev Esc Enferm USP. 2012; 46: 858-864.
Oliveira-Povoa VC, Perez-Evangelista-Dantas SR. Pressure ulcer incidence in a university hospital Intensive Care Unit. Rev Estima. 2008; 6: 23-27.
Borghardt AT, Prado TN, Araujo TM, Rogenski NM, Bringuente ME. Evaluation of the pressure ulcers risk scales with critically ill patients: a prospective cohort study. Rev Lat Am Enfermagem. 2015; 23: 28-35.
Cremasco MF, Wenzel F, Zanei SS, Whitaker IY. Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk. J Clin Nurs. 2013; 22: 2183-2191.
Rogenski NM, Kurcgant P. The incidence of pressure ulcers after the implementation of a prevention protocol. Rev Lat Am Enfermagem. 2012; 20: 333-339.
Rogenski NM, Santos VL. Incidence of pressure ulcers at a university hospital. Rev Lat Am Enfermagem. 2005; 13: 474-480.
Bavaresco T, Medeiros RH, Lucena Ade F. Introduction of the Braden Scale in an intensive care unit of a university hospital. Rev Gaucha Enferm. 2011; 32: 703-710.
Dos Santos Soares DA, Spani Vendramin F, Montenegro Duarte Pereira L, Kowalewski Proenca P, Moreira Marques M. Analysis of the incidence of pressure ulcers at Hospital Metropolitano de Urgencia e Emergencia in Ananindeua, PA. Rev Brasil Cir Plast. 2011; 26: 578-581.
Chaves Freitas JP, Alberti LR. Application of the Braden scale in the home setting: incidence and factors associated with pressure ulcers. Acta Paul Enferm. 2013; 26: 515-521.
de Souza DM, de Gouveia Santos VL. Incidence of pressure ulcers in the institutionalized elderly. J Wound Ostomy Continence Nurs. 2010; 37: 272-276.
Galvan-Martinez IL, Narro-Llorente R, Lezama-de-Luna F et al. Point prevalence of pressure ulcers in three second-level hospitals in Mexico. Int Wound J. 2014; 11: 605-610.
Malvaez-Castillo MM, Hernández-Guerrero KL, Suarez-Ortega N, Pacheco-Sánchez VZ, Rodríguez-Madrigal BL, Dávalos-Alcazar AG. Efecto del índice enfermera-paciente en la calidad de atención: estudio realizado en pacientes con enfermedades crónico-degenerativas en el servicio de medicina interna. Enf Neurol (Mex). 2014; 13: 118-121.
Gonzalez-Consuegra RV, Cardona-Mazo DM, Murcia-Trujillo PA, Matiz-Vera GD. Prevalencia de úlceras por presión en Colombia: informe preliminar. Rev Fac Med. 2014; 62: 369-377.
Yepes D, Molina F, Leon W, Perez E. Incidence and risk factors associated with the presence of pressure ulcers in critically ill patients. Med Intensiva. 2009; 33: 276-281.
Blumel JE, Tirado K, Schiele C, Schonffeldt G, Sarra S. Prediction of the pressure ulcer development in elderly women using the Braden scale. Rev Med Chil. 2004; 132: 595-600.
Rezende KF, Ferraz MB, Malerbi DA et al. Predicted annual costs for in patients with diabetes and foot ulcers in a developing country-a simulation of the current situation in Brazil. Diabet Med. 2010; 27: 109-112.
Vieira-Santos IC, Souza WV, Carvalho EF, Medeiros MC, Nobrega MG, Lima PM. Prevalence of diabetic foot and associated factors in the family health units of the city of Recife, Pernambuco State, Brazil, in 2005. Cad Saude Publica. 2008; 24: 2861-2870.
Chacon Dde A, Chaves AD, Duarte RA, Garcia CA, Medeiros Ada C. Fundoscopic alterations and diabetic foot in patients of Hospital Universitario Onofre Lopes/UFRN. Acta Cir Bras. 2005; 20 Suppl 1: 3-7.
Hernández-Ávila M, Gutiérrez JP, Reynoso-Noveron N. Diabetes mellitus in Mexico. Status of the epidemic. Salud Publica Mex. 2013; 55 Suppl 2: S129-36.
Sabag-Ruiz E, Alvarez-Félix A, Celiz-Zepeda S, Gómez-Alcala AV. Chronic complications of diabetes mellitus. What is the prevalence of diabetes in a family medical unit? Rev Med Inst Mex Seguro Soc. 2006; 44: 415-421.
Padron-Arredondo G. Amputaciones en un hospital general en pacientes con pie diabético. Análisis de 3 años. Rev Salud Quintana Roo. 2013; jul-sep: 26-31.
Ministerio de Salud. Gobierno de Chile. Encuesta Nacional de Salud ENS Chile 2009-2010. Santiago: Ministerio de Salud. Gobierno de Chile.; 2012:150.
World Health Organization. Buruli ulcer disease. Mycobacterium ulcerans infection: an overview of report de cases globally. Weekly epidemiological record. 2004; 79: 193-200.
Reynaud Y, Millet J, Couvin D, Rastogi N, Brown C, Couppié P et al. Heterogeneity among Mycobacterium ulcerans from French Guiana revealed by multilocus variable number tandem repeat analysis (MLVA). PLoS One. 2015; 10: e0118597.
Morris A, Gozlan R, Marion E et al. First detection of Mycobacterium ulcerans DNA in environmental samples from South America. PLoS Negl Trop Dis. 2014; 8: e2660.
Ablordey A, Swings J, Hubans C et al. Multilocus variable-number tandem repeat typing of Mycobacterium ulcerans. J Clin Microbiol. 2005; 43: 1546-1551.
Faber WR, de Jong B, de Vries HJ, Zeegelaar JE, Portaels F. Buruli ulcer in traveler from Suriname, South America, to the Netherlands. Emerg Infect Dis. 2015; 21: 497-499.
Guerra H, Palomino JC, Falconi E et al. Mycobacterium ulcerans disease, Peru. Emerg Infect Dis. 2008; 14: 373-377.
Moyano LM, Chero JC, Gonzalvez GE. Buruli ulcer. Am J Trop Med Hyg. 2008; 79: 3.
Coloma JN, Navarrete-Franco G, Iribe P, Lopez-Cepeda LD. Ulcerative cutaneous mycobacteriosis due to Mycobacterium ulcerans: report of two Mexican cases. Int J Lepr Other Mycobact Dis. 2005; 73: 5-12.
Boleira M, Lupi O, Lehman L, Asiedu KB, Kiszewski AE. Buruli ulcer. An Bras Dermatol. 2010; 85: 281-298; quiz 299.
World Health Organization. Leishmaniasis. Burden and Distribution.
Cella W, Melo SC, Dell Agnolo CM, Pelloso SM, Silveira TG, Carvalho MD. Seventeen years of American cutaneous leishmaniasis in a Southern Brazilian municipality. Rev Inst Med Trop São Paulo. 2012; 54: 215-218.
D’Oliveira Junior A, Machado PR, Carvalho EM. Evaluating the efficacy of allopurinol for the treatment of cutaneous leishmaniasis. Int J Dermatol. 1997; 36: 938-940.
Salomon OD, Rossi GC, Spinelli GR. Ecological aspects of phebotomine (Diptera, Psychodidae) in an endemic area of tegumentary leishmaniasis in the northeastern Argentina, 1993-1998. Mem Inst Oswaldo Cruz. 2002; 97: 163-168.
Martins LM, Rebelo JM, dos Santos MC, Costa JM, da Silva AR, Ferreira LA. Eco-epidemiology of cutaneous leishmaniasis in Buriticupu, Amazon region of Maranhao State, Brazil, 1996-1998. Cad Saude Publica. 2004; 20: 735-743.
Goncalves Neto VS, Barros Filho AK, Santos AM et al. An analysis of the spatiotemporal distribution of American cutaneous leishmaniasis in counties located along road and railway corridors in the State of Maranhao, Brazil. Rev Soc Bras Med Trop. 2013; 46: 322-328.
Vieira-Gonçalves R, Pirmez C, Jorge ME, Souza WJ, Oliveira MP, Rutowitsch MS et al. Clinical features of cutaneous and disseminated cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis in Paraty, Rio de Janeiro. Int J Dermatol. 2008; 47: 926-932.
Coimbra Júnior CE, Santos RV, do Valle AC. Cutaneous leishmaniasis in Tupí-Mondé Amerindians from the Brazilian Amazonia. Acta Trop. 1996; 61: 201-211.
Soares L, Abad-Franch F, Ferraz G. Epidemiology of cutaneous leishmaniasis in central Amazonia: a comparison of sex-biased incidence among rural settlers and field biologists. Trop Med Int Health. 2014; 19: 988-995.
Oliveira CC, Lacerda HG, Martins DR et al. Changing epidemiology of American cutaneous leishmaniasis (ACL) in Brazil: a disease of the urban-rural interface. Acta Trop. 2004; 90: 155-162.
de Brito ME, Andrade MS, Dantas-Torres F et al. Cutaneous leishmaniasis in northeastern Brazil: a critical appraisal of studies conducted in State of Pernambuco. Rev Soc Bras Med Trop. 2012; 45: 425-429.
Silva NS, Viana AB, Cordeiro JA, Cavasini CE. American cutaneous leishmaniasis in the State of Acre, Brazil. Rev Saude Publica. 1999; 33: 554-559.
Costa JM, Balby IT, Rocha EJ et al. Comparative study of American tegumentary leishmaniasis between childhood and teenagers from the endemic areas Buriticupu, Maranhao and Corte de Pedra, Bahia, Brazil. Rev Soc Bras Med Trop. 1998; 31: 279-288.
Castellucci LC, Almeida LF, Jamieson SE, Fakiola M, Carvalho EM, Blackwell JM. Host genetic factors in American cutaneous leishmaniasis: a critical appraisal of studies conducted in an endemic area of Brazil. Mem Inst Oswaldo Cruz. 2014; 109: 279-288.
Guimaraes LH, Machado PR, Lago EL et al. Atypical manifestations of tegumentary leishmaniasis in a transmission area of Leishmania braziliensis in the state of Bahia, Brazil. Trans R Soc Trop Med Hyg. 2009; 103: 712-715.
Ampuero J, Macedo V, Marsden P. Clinical findings of tegumentary leishmaniasis in children under five years of age in an endemic area of Leishmania (Viannia) braziliensis. Rev Soc Bras Med Trop. 2006; 39: 22-26.
Follador I, Araujo C, Cardoso MA et al. Outbreak of American cutaneous leishmaniasis in Canoa, Santo Amaro, Bahia, Brazil. Rev Soc Bras Med Trop. 1999; 32: 497-503.
Nunes VL, Dorval ME, Oshiro ET et al. Epidemiologic study on tegumentary leishmaniasis in the municipality of Corguinho, Mato Grosso do Sul -- Studies in the human population. Rev Soc Bras Med Trop. 1995; 28: 185-193.
Machado-Coelho GL, Assuncao R, Mayrink W, Caiaffa WT. American cutaneous leishmaniasis in Southeast Brazil: space-time clustering. Int J Epidemiol. 1999; 28: 982-989.
Gontijo CM, da Silva ES, de Fuccio MB et al. Epidemiological studies of an outbreak of cutaneous leishmaniasis in the Rio Jequitinhonha Valley, Minas Gerais, Brazil. Acta Trop. 2002; 81: 143-150.
Nunes AG, Paula EV, Teodoro R, Prata A, Silva-Vergara ML. Epidemiological aspects of American tegumentary leishmaniasis in Varzelandia, Minas Gerais, Brazil. Cad Saude Publica. 2006; 22: 1343-1347.
Murback ND, Hans Filho G, Nascimento RA, Nakazato KR, Dorval ME. American cutaneous leishmaniasis: clinical, epidemiological and laboratory studies conducted at a university teaching hospital in Campo Grande, Mato Grosso do Sul, Brazil. An Bras Dermatol. 2011; 86: 55-63.
Pignatti MG, Mayo RC, Alves MJ, Souza SS, Macedo F, Pereira RM. American tegumentary leishmaniasis in the northeastern state of São Paulo-Brazil. Rev Soc Bras Med Trop. 1995; 28: 243-247.
Condino ML, Galati EA, Holcman MM, Salum MR, Silva DC, Novaes Junior RA. American cutaneous leishmaniasis on the northern coastline of the State of São Paulo, 1993 to 2005. Rev Soc Bras Med Trop. 2008; 41: 635-641.
Fonseca Eda S, D’Andrea LA, Taniguchi HH, Hiramoto RM, Tolezano JE, Guimaraes RB. Spatial epidemiology of American cutaneous leishmaniasis in a municipality of west São Paulo State, Brazil. J Vector Borne Dis. 2014; 51: 271-275.
de Oliveira-Neto MP, Mattos MS, Perez MA et al. American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics. Int J Dermatol. 2000; 39: 506-514.
de Bustamante MC, Pereira MJ, Schubach Ade O, da Fonseca AH. Epidemiological profile of cutaneous leishmaniasis in an endemic region in the State of Rio de Janeiro, Brazil. Rev Bras Parasitol Vet. 2009; 18: 34-40.
Silveira TG, Arraes SM, Bertolini DA et al. The laboratory diagnosis and epidemiology of cutaneous leishmaniasis in Parana State, southern Brazil. Rev Soc Bras Med Trop. 1999; 32: 413-423.
Pontello Junior R, Gon Ados S, Ogama A. American cutaneous leishmaniasis: epidemiological profile of patients treated in Londrina from 1998 to 2009. An Bras Dermatol. 2013; 88: 748-753.
de Castro EA, Soccol VT, Membrive N, Luz E. Epidemiological and clinical study of 332 cases of cutaneous leishmaniasis in the north of Parana State from 1993 to 1998. Rev Soc Bras Med Trop. 2002; 35: 445-452.
de Castro EA, Luz E, Telles FQ et al. Eco-epidemiological survey of Leishmania (Viannia) braziliensis American cutaneous and mucocutaneous leishmaniasis in Ribeira Valley River, Parana State, Brazil. Acta Trop. 2005; 93: 141-149.
Soccol VT, de Castro EA, Schnell e Schuhli G et al. A new focus of cutaneous leishmaniasis in the central area of Parana State, southern Brazil. Acta Trop. 2009; 111: 308-315.
Marlow MA, da Silva Mattos M, Makowiecky ME et al. Divergent profile of emerging cutaneous leishmaniasis in subtropical Brazil: new endemic areas in the southern frontier. PLoS One. 2013; 8: e56177.
Ferro C, Marin D, Gongora R et al. Phlebotomine vector ecology in the domestic transmission of American cutaneous leishmaniasis in Chaparral, Colombia. Am J Trop Med Hyg. 2011; 85: 847-856.
Munoz G, Davies CR. Leishmania panamensis transmission in the domestic environment: the results of a prospective epidemiological survey in Santander, Colombia. Biomedica. 2006; 26 Suppl 1: 131-144.
Rojas CA, Weigle KA, Tovar R, Morales AL, Alexander B. A multifaceted intervention to prevent American cutaneous leishmaniasis in Colombia: results of a group-randomized trial. Biomedica. 2006; 26 Suppl 1: 152-166.
Alexander B, Agudelo LA, Navarro JF et al. Relationship between coffee cultivation practices in Colombia and exposure to infection with Leishmania. Trans R Soc Trop Med Hyg. 2009; 103: 1263-1268.
Valderrama-Ardila C, Alexander N, Ferro C et al. Environmental risk factors for the incidence of American cutaneous leishmaniasis in a sub-Andean zone of Colombia (Chaparral, Tolima). Am J Trop Med Hyg. 2010; 82: 243-250.
Blanco VM, Cossio A, Martinez JD, Saravia NG. Clinical and epidemiologic profile of cutaneous leishmaniasis in Colombian children: considerations for local treatment. Am J Trop Med Hyg. 2013; 89: 359-364.
Salomon OD, Sosa Estani S, Dri L et al. Tegumental leishmaniasis in Las Lomitas, Province of Formosa, Argentina, 1992-2001. Medicina (B Aires). 2002; 62: 562-568.
Salomon OD, Acardi SA, Liotta DJ et al. Epidemiological aspects of cutaneous leishmaniasis in the Iguazu falls area of Argentina. Acta Trop. 2009; 109: 5-11.
Carme B. Human parasitoses in French Guiana. Presse Med. 2001; 30: 1601-1608.
Rodríguez-Morales AJ, Pascual-Gonzalez Y, Benitez JA et al. Association between cutaneous leishmaniasis incidence and the human development index and its components in four endemic states of Venezuela. Rev Peru Med Exp Salud Publica. 2010; 27: 22-30.
Gonzalez R, Devera R, Madrid C, Zghayer S. An evaluation of an outbreak of American cutaneous leishmaniasis in a rural community in Bolivar State, Venezuela. Rev Soc Bras Med Trop. 2000; 33: 31-37.
Carrada-Figueroa G del C, Leal-Ascencio VJ, Jimenez-Sastre A, Lopez-Alvarez J. Transmission of cutaneous leishmaniasis associated with cacao (Theobroma cacao) plantations in Tabasco. Gac Med Mex. 2014; 150: 499-508.
Secretaría de Salud de México. Reporte de Información Epidemiológica de Morbilidad. Sistema Único de Información para la Vigilancia Epidemiológica. 201597.
Monroy-Ostria A, Sosa-Cabrera T, Rivas-Sanchez B, Ruiz-Tuyu R, Mendoza-Gonzalez AR, Favila-Castillo L. Seroepidemiological studies of cutaneous leishmaniasis in the Campeche state of Mexico. Mem Inst Oswaldo Cruz. 1997; 92: 21-26.
Hernandez-Rivera MP, Hernandez-Montes O, Chinas-Perez A et al. Study of cutaneous leishmaniasis in the State of Campeche (Yucatan Peninsula), Mexico, over a period of two years. Salud Publica Mex. 2015; 57: 58-65.
Chaves LF, Cohen JM, Pascual M, Wilson ML. Social exclusion modifies climate and deforestation impacts on a vector-borne disease. PLoS Negl Trop Dis. 2008; 2: e176.
Christensen HA, de Vasquez AM, Petersen JL. Short report epidemiologic studies on cutaneous leishmaniasis in eastern Panama. Am J Trop Med Hyg. 1999; 60: 54-57.
Hotez PJ, Woc-Colburn L, Bottazzi ME. Neglected tropical diseases in Central America and Panama: review of their prevalence, populations at risk and impact on regional development. Int J Parasitol. 2014; 44: 597-603.
Armijos RX, Weigel MM, Izurieta R et al. The epidemiology of cutaneous leishmaniasis in subtropical Ecuador. Trop Med Int Health. 1997; 2: 140-152.
Rabe E, Guex JJ, Puskas A, Scuderi A, Fernandez Quesada F. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol. 2012; 31: 105-115.
Contreras-Ruiz J, Escotto-Sánchez I, Cobo-Morales JF. Capítulo 17. Úlceras venosas. Abordaje y manejo de las heridas. México: Intersistemas Editores; 2013. p. 272.
Labropoulos N, Manalo D, Patel NP, Tiongson J, Pryor L, Giannoukas AD. Uncommon leg ulcers in the lower extremity. J Vasc Surg. 2007; 45: 568-573.
Dassen T, Tannen A, Lahmann N. Pressure ulcer, the scale of the problem. In: Romanelli M, Clark M, Cherry GW, Colin D, Defloor T, editors. Science and practice of pressure ulcer management. London: Springer; 2006. p. 1-6.
Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther. 2008;88:1254-1264.
Guell C, Unwin N. Barriers to diabetic foot care in a developing country with a high incidence of diabetes related amputations: an exploratory qualitative interview study. BMC Health Serv Res. 2015; 15: 377.
McEwen LN, Ylitalo KR, Herman WH, Wrobel JS. Prevalence and risk factors for diabetes-related foot complications in Translating Research Into Action for Diabetes (TRIAD). J Diabetes Complications. 2013; 27: 588-592.
Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990; 13: 513-521.
Sheehan TP, Gondo GC. Impact of limb loss in the United States. Phys Med Rehabil Clin N Am. 2014; 25: 9-28.
Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005; 293: 217-228.