Global Impact of Peripheral Obstructive Arterial Disease in Portugal: An Eight Year Study.

INTRODUCTION: Peripheral arterial disease has an important impact on morbidity/mortality. The objective of this study was to quantify the impact of this disease in Portugal during the last eight years, expressed by the volume of admissions, treatment strategies and associated morbidity and mortality. MATERIAL AND METHODS: We collected data from the Diagnosis Related Group national database on primary diagnosis, procedures codes, demographic variables, a number of risk factors, and mortality of all cases admitted from 2009 to 2016 with a primary diagnosis of peripheral arterial disease coded according to the 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-9). RESULTS: In this study, peripheral arterial disease led to 27 684 hospitalisations, which corresponded to 26.7% of all admissions for vascular disease in this period. Approximately 49.9% of patients were admitted to the emergency department. The volume of procedures in patients with claudication decreased over the eight years, unlike patients with critical ischaemia, in which the number of procedures increased. DISCUSSION: Age and the presence of cardiovascular risk factors have been associated with the severity of disease, as observed in our series. Overall hospital mortality varied, being significantly higher in patients with more advanced severity of the disease. CONCLUSION: Peripheral arterial disease represents an important burden in the overall volume of admissions in Portuguese public hospitals. A large number of patients was admitted in the context of emergency.

Introdução: A doença arterial obstrutiva periférica tem um importante impacto a nível de morbi/mortalidade. O objetivo deste trabalho é quantificar o impacto desta doença em Portugal, ao longo dos últimos oito anos, expresso pelo volume de internamento, tratamento e pela morbi-mortalidade respetiva. Material e Métodos: Foram analisados os registos de internamento no Serviço Nacional de Saúde entre 2009 e 2016 da base de dados dos grupos de diagnósticos homogéneos utilizando os códigos 9th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-9) de diagnóstico e procedimentos. Verificámos o número de casos em cada ano por estadio de doença, dados demográficos, fatores de risco, tratamento e morbi-mortalidade. Resultados: No período de estudo a doença arterial periférica conduziu a 27 684 internamentos o que correspondeu a cerca de 26,7 % do total de internamentos por patologia vascular neste período. Cerca de 49,9 % dos doentes foram admitidos em contexto de urgência. Os procedimentos em doentes claudicantes diminuíram ao longo dos oito anos ao contrário dos doentes com isquémia crítica em que os procedimentos aumentaram. Discussão: A idade e a presença de fatores de risco cardiovasculares têm sido associadas à gravidade da doença, tal como na nossa série. A mortalidade hospitalar global varia, sendo mais significativa nos doentes com doença mais avançada. Conclusão: A doença arterial periférica é uma patologia com importante representação no internamento dos hospitais do Serviço Nacional de Saúde. Há ainda um importante volume de doentes admitidos no contexto de urgência o que sugere eventual falta de reconhecimento/referenciação atempada por parte dos cuidados saúde primários, devendo mais esforços ser realizados no sentido de aumentar a interação entre os cuidados de saúde primários e os hospitais terciários.

A national progress report on diabetes: successes and challenges.

Over the last few decades, numerous public health agencies and other private and public organizations have sought to prevent and delay the disabling complications of diabetes by increasing the use of preventive care practices and reducing risk factors for complications among people with diabetes. Now, federal diabetes surveillance activities are yielding encouraging reports that progress is being made in increasing the use of preventive care practices, reducing risk factors for complications, and preventing or delaying diabetes complications. However, although several gains have been noted, levels of preventive care practices remain suboptimal, risk factors for diabetes complications are too prevalent, and diabetes complications are too pervasive. Furthermore, with compelling evidence that the onset of diabetes can be prevented or delayed among adults at high risk, prevention of diabetes has become a major new challenge. Additional efforts are needed to address the growing problems of obesity and physical inactivity, to identify the most efficacious and cost-effective prevention strategies and interventions, and to implement surveillance activities that allow us to gauge our success. Although progress has been made against diabetes complications, the current epidemic of diabetes increases the urgency of primary prevention efforts.

Transcutaneous oxygen tension measurements in the assessment of limb ischaemia.

The measurement of transcutaneous oxygen tension (TcPO2) has been adapted for the assessment of the blood supply of the lower limb. This study was undertaken to determine the most useful means of expressing TcPO2 measurements. We studied 176 patients with peripheral vascular disease and/or diabetes and 34 normal volunteers. Approximately++ half of the patients studied had ulceration or gangrene of the foot. A comparison of three methods of expressing TcPO2 measurement for predicting presence of ulceration was made using ROCA analysis. The absolute value of TcPO2 on the dorsum of the foot was the best predictor of the presence of ulceration or gangrene. An absolute value of TcPO2 of 30 mmHg on the dorsum of the foot had a sensitivity of 42% and specificity of 91%. The sensitivity of the test was as good in diabetic patients as in non-diabetic patients.