Pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro / Patients with amputation of lower limbs due to vascular causes in Cerro municipality

Introducción: La amputación provoca discapacidad física e invalidez como consecuencia de la enfermedad vascular periférica. Objetivo: Caracterizar a los pacientes amputados de miembros inferiores por causas vasculares en el municipio Cerro. Métodos: Se realizó un estudio descriptivo en los 114 amputados de miembros inferiores que estaban registrados, entre 2016 y 2018, en la Dirección Municipal de Salud del municipio Cerro. La muestra quedó constituida por los 64 amputados de causa vascular. Las variables de estudio fueron: edad, sexo, factores de riesgo, tipo de amputación y su nivel, miembro más afectado y causa vascular de amputación. Se estimaron las frecuencias absolutas y relativas, y la prueba de chi cuadrado, para identificar la asociación entre las variables. Resultados: Hubo predominio de los amputados de causa vascular (56,1 por ciento), el sexo femenino (54,7 por ciento), el grupo etáreo de 60 años y más (84,4 por ciento), y la HTA y el tabaquismo (ambos con 60,9 por ciento). La amputación supracondílea fue la más realizada (64,1 por ciento). El pie diabético isquémico y la aterosclerosis obliterante resultaron las causas vasculares que provocaron los mayores porcentajes de amputación. Se halló asociación altamente significativa entre el sexo masculino y la ateroesclerosis obliterante (X2 = 5,4; p = 0,113, OR = 2,68 y RR = 1,81), lo que señaló a este como un factor de riesgo de amputación. Conclusiones: Las amputaciones aparecieron con mayor frecuencia en las mujeres mayores de 60 años, del tipo supracondílea y por pie diabético como causa vascular. La ateroesclerosis obliterante en los hombres constituyó un factor de riesgo de amputación(AU)

Introduction: Amputation as a result of peripheral vascular disease causes physical disability and impairment. Objective: Characterize amputee patients of lower limbs due to vascular causes in Cerro municipality. Methods: A descriptive study was carried out in the 114 lower limbs amputee patients that were registered, between 2016 and 2018, in the Municipal Health Division of Cerro municipality. The sample consisted of the 64 vascular-cause amputees. The study variables were: age, sex, risk factors, type of amputation and its level, most affected limb and vascular cause of amputation. Absolute and relative frequencies were estimated, and the chi square test was used to identify the association between variables. Results: There was predominance of vascular-cause amputees (56.1 percent), the female sex (54.7 percent), the 60-year-old and older age group (84.4 percent), and HTA and smoking having (both 60.9 percent). Supracondylar amputation was the most performed one (64.1 percent). Ischemic diabetic foot and obliterating atherosclerosis resulted in the vascular causes that produce the highest percentages of amputation. A highly significant association was found between the male sex and obliterating atherosclerosis (X2 = 5.4; p = 0.113; OR = 2.68 and RR = 1.81), which pointed to this as an amputation risk factor. Conclusions: Amputations most often appeared in women over the age of 60, as supracondyle type and diabetic foot as a vascular cause. Obliterating atherosclerosis in men was a risk factor for amputation(AU)

Experiencia de trabajo en cirugía vascular en Ecuador / Experiences working in vascular surgeries in Ecuador

Introducción: Las enfermedades vasculares periféricas comprenden un variado número de entidades nosológicas que afectan a los sistema arterial (excluidos los vasos del corazón, e intracraneales) y venolinfáticos del organismo. Objetivo: Describir las características de los pacientes que necesitaron ser atendidos por un cirujano vascular por presentar algún tipo de enfermedad vascular periférica. Métodos: Estudio descriptivo realizado en el total de pacientes atendidos por consulta externa y hospitalizados en el Servicio de Cirugía Vascular del Instituto Ecuatoriano de Seguridad Social; Hospital Manuel Ignacio Montero Valdivieso. El período de estudio fue de dos años (septiembre de 2014 a octubre de 2016). Se tuvieron en cuenta las siguientes enfermedades vasculares periféricas: enfermedades vasculares periféricas, insuficiencia venosa crónica, pie diabético, trombosis venosa profunda y trombosis arterial aguda Los resultados se expresaron en trabajo con las frecuencias absolutas y relativas. Resultados: La insuficiencia venosa crónica fue la causa más frecuente de hospitalización y consulta externa. Se encontró un predominio del sexo femenino. La úlcera del pie diabético se ubicó en orden decreciente de frecuencia entre las enfermedades consideradas. El desbridamiento quirúrgico o limpieza quirúrgica fue el procedimiento más empleado. La amputación mayor se realizó en todos los pacientes que tuvieron una trombosis arterial aguda de extremidades inferiores. Conclusiones: Se describen las características de los pacientes atendidos por el cirujano vascular en Ecuador, así como las enfermedades vasculares periféricas más frecuentes atendidas que son motivo de consulta externa y de hospitalización(AU)

Introduction: Peripheral vascular diseases include a varied number of nosologic entities that affect the arterial (excluding heart and intracranial vessels) and venolymphatic systems of the organism. Objective: To characterize patients who needed to be treated by a vascular surgeon after presenting some type of peripheral vascular disease. Method: A descriptive and prospective study was carried out in all the patients treated by external consultation and to the patients hospitalized in the service of Vascular surgery of the Ecuadorian Institute of Social Security and Manuel Ignacio Montero Valdivieso Hospital. The study lasted two years ( from September 2014 to October 2016). The following peripheral vascular diseases were taken into account: peripheral vascular diseases, chronic venous insufficiency, diabetic foot, deep-vein thrombosis and acute arterial thrombosis. The results were expressed in this paper with absolute and relative frequencies. Results: Chronic venous failure was the most frequent cause of hospitalization and outpatient consultation. A prevalence of female sex was found. The diabetic foot ulcer was observed in a decreasing order of frequency. Surgical debridement and/or surgical cleaning were the most used procedures. Major amputations were performed in all patients who had an acute arterial thrombosis of the lower limbs. Conclusions: It was possible to characterize the patients treated by the vascular surgeon in Ecuador, as well as the most frequent peripheral vascular diseases attended that needed outpatient consultation and hospitalization(AU)

Enfermedades vasculares periféricas y niveles de calidad de vida en adultos mayores del municipio Boyeros / Peripheral vascular diseases and life quality levels in elderly adults of Boyeros municipality

Objetivo: Determinar la prevalencia de las enfermedades vasculares periféricas y los niveles de calidad de vida en los adultos mayores. Métodos: Se realizó un estudio prospectivo y analítico en una muestra aleatorizada (n= 200) de los residentes del municipio Boyeros. Se analizaron solo los adultos mayores (n= 58). Las enfermedades vasculares periféricas se diagnosticaron por examen físico-vascular, estudio hemodinámico y ultrasonográficos. Se aplicó el cuestionario genérico de calidad de vida SF-36. Resultados: La tasa de enfermedades vasculares periféricas fue de 12 por 10 000; donde las más prevalentes fueron: las flebopatías (9,3), la enfermedad arterial periférica de los miembros inferiores (5,7) y la enfermedad carotidea (4,4). El porcentaje se incrementó en el grupo entre 70 y 79 años. El 31,8 por ciento presentaron dos o más enfermedades. En más del 80 por ciento el diagnóstico fue precoz. La hipertensión arterial (85,2 por ciento) fue el factor de riesgo más frecuente. No se halló diferencias (p < 0,05) en ninguna de las escalas de calidad de vida al comparar los adultos mayores con y sin enfermedad vascular. En los enfermos las medidas sumarias salud mental y salud física oscilaron entre moderada y baja. Los enfermos fueron remitidos a sus áreas de salud para recibir el tratamiento oportuno. Conclusiones: El municipio Boyeros presentó elevadas tasas de prevalencia de enfermedades vasculares periféricas en los adultos mayores con una afectación importante en las medidas sumarias de niveles de calidad Salud mental y Salud física(AU)

Objective: To determine the prevalence of peripheral vascular diseases and the life quality levels in elderly. Methods: A prospective and analytical study was conducted in a randomized sample (n = 200) of the residents of Boyeros municipality in Havana, analyzing only the elderly (n = 58). Peripheral vascular diseases were diagnosed by physical-vascular examination, hemodynamic and ultrasonographic studies. The SF-36 generic life quality questionnaire was applied. Results: The rate of peripheral vascular diseases was of 12 by 10 000, where the most prevalent were: flebopathy (9.3), peripheral arterial disease of the lower limbs (5.7) and carotid disease (4.4). The percentage increased in the group from 70 to 79 years old. 31.8 percent showed two or more diseases. In more than the 80 percent, the diagnosis was precocious. Arterial hypertension (85.2 percent), obesity (59.3 percent) and hyperlipidemia (42.6 percent) were the most common risk factors. No differences (p< 0.05) were found in any of the quality of life scales when comparing elderly with and without vascular disease. In ill patients, the summary measures mental health and physical health oscillated between moderate and low. The ill patients were referred to their health areas to receive timely treatment. Conclusions: Boyeros municipality presented high rates of prevalence of peripheral vascular diseases in elderly with an important impact on the summary measures of quality levels called mental health and physical health(AU)

Enfermedades vasculares periféricas y niveles de calidad de vida en el municipio Diez de Octubre / Peripheral vascular diseases and levels of quality of life in 10 of October municipality

Objetivo: Determinar la prevalencia de las enfermedades vasculares periféricas y los niveles de calidad de vida en el municipio "Diez de Octubre". Métodos: Estudio descriptivo en una muestra aleatorizada (n= 200) de los 201 586 habitantes del municipio. El diagnóstico de las enfermedades vasculares periféricas se realizó por examen físico-vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Se aplicó el cuestionario de "Calidad de vida" SF-36 a los mayores de 18 años sin discapacidad mental. Resultados: La tasa de enfermedades vasculares periféricas fue de 66 por 100 000 habitantes debida a las flebopatías (59,5 por ciento), la macroangiopatia diabética (13,9 por ciento), la enfermedad arterial periférica (8,4 por ciento) y la cerebrovascular (6,4 por ciento). Los factores de riesgo más frecuentes fueron: obesidad (48,5 por ciento), hipertensión arterial (37,5 por ciento) y tabaquismo (33,5 por ciento). Hubo un incremento de enfermedades vasculares periféricas a partir de los 50 años con la presencia de dos o más enfermedades en el 37,3 por ciento. De las personas. En aquellas con enfermedad vascular se encontró una disminución (p < 0,05) en todas las escalas de la calidad de vida con un deterioro en la medida sumaria "salud física", la que se encontró asociada a su presencia (χ2 = 27,11; p = 0,001). Conclusiones: En el municipio Diez de Octubre, hay una elevada tasa de enfermedades vasculares periféricas con un deterioro importante en los niveles de calidad de vida de las personas que la padecen(AU)

Objective: To determine the prevalence of peripheral vascular diseases and the levels of quality of life in 10 of October municipality. Methods: A descriptive study was conducted on a random sample (n=200) from 201 586 inhabitants of the municipality. The diagnosis of peripheral vascular diseases was performed by physical-vascular examination confirmed by hemodynamic, ultrasound, and echo-Doppler studies. The "Quality of life" questionnaire SF-36 was applied to people older than 18 years without mental disabilities. Results: The rate of peripheral vascular disease was 66 per 100 000 inhabitants due to phlebopathies (59.5 percent), diabetic macroangiopathy (13.9 percent), peripheral arterial disease (8.4 percent) and cerebrovascular disease (6.4percent). The most frequent risk factors were obesity (48.5 percent), hypertension (37.5 percent) and smoking (33.5 percent). There was an increase in peripheral vascular diseases after the age of 50 years with two or more types of diseases in 37.3 percent of the population. A decrease (p <0.05) in all the quality of life scales, with deterioration in the disease-related summary measure "physical health", was found in people with vascular disorders (χ2= 27.11; p= 0.001). Conclusions: In 10 of October municipality, there is a high rate of peripheral vascular diseases with a significant deterioration of the quality of life of people who suffer them(AU)

Prevalencia de enfermedades vasculares periféricas en el municipio de Arroyo Naranjo / Prevalence of vascular peripheral diseases in Arroyo Naranjo municipality

Objetivo: Determinar la prevalencia de enfermedades vasculares periféricas en el municipio de Arroyo Naranjo según edad y sexo, su distribución en las personas detectadas enfermas y factores de riesgo asociados. Métodos: Se realizó un estudio descriptivo en una muestra aleatorizada (n= 200) de los 208 554 habitantes del municipio de Arroyo Naranjo. El diagnóstico de la enfermedad vascular periférica se realizó por examen físico­vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Los datos de interés se obtuvieron del interrogatorio. Resultados: Se halló una elevada frecuencia del sexo femenino (80,5 por ciento) y del grupo mayor de 60 años (33,5 por ciento). La tasa de enfermedades vasculares periféricas fue de 77,2 por 100 000 habitantes contribuyó a esta cifra las flebopatías. Se observó un predominio de la obesidad (45 por ciento), la hipertensión arterial (44,5 por ciento) y el tabaquismo (41 por ciento). Se encontró que el 47,8 por ciento de las personas enfermas tenían más de tres factores de riesgo. Las mujeres mayores de 50 años, a diferencia de los hombres, presentaban más enfermedad carotidea (80,8 por ciento) y macroangiopatía diabética (65,7 por ciento). Conclusiones: En el municipio de Arroyo Naranjo, hay una elevada tasa de enfermedades vasculares periféricas sobre todo en las mujeres mayores de 50 años, más aún cuando tienen tres o más factores de riesgo, lo que indica la importancia del diagnóstico precoz, ya que estas personas desconocían que estaban enfermas y que requerían de un tratamiento oportuno(AU)

Objective: To determine the prevalence of peripheral vascular diseases in Arroyo Naranjo municipality by sex and age, their distribution in the detected sick persons and the associated risk factors. Methods: A descriptive study was conducted in a randomized sample (n= 200) of 208 554 inhabitants of Arroyo Naranjo municipality. Peripheral vascular diseases were diagnosed through physical-vascular examination and confirmed with hemodynamic, ultrasonografic and echographic studies. Questioning of patients provided the necessary information. Results: There was high frequency of females (80.5 percent) and of the age group over 60 years (33.5 percent). The rate of peripheral vascular diseases was 77.2 per 100 000 inhabitants in which phlebopathies influence. Obesity (45,0 percent), arterial hypertension (44.5 percent) and smoking (41,0 percent) predominated. It was found that 47.8 percent of the sick persons had more than three risk factors. Unlike men, women older than 50 years were more affected by carotid disease (80.8 percent) and diabetic macroangiopathy (65.7 percent). Conclusions: In Arroyo Naranjo municipality, there is a high rate of peripheral vascular disease mainly in women older than 50 years, even more when they have three or more risk factors, which points to the importance of early diagnosis since these persons did not know that they were sick and required timely treatment(AU)

Prevalencia de las anomalías vasculares en niños menores de cinco años del municipio Cerro / Prevalence of vascular anomalies in children aged less than five years in Cerro municipality

Introducción: las anomalías vasculares son motivo frecuente de consultas en la infancia; en Cuba se desconoce su prevalencia de las mismas, así como las conductas tomadas y las complicaciones que aparecen en la edad pediátrica. Objetivo: determinar la prevalencia de las anomalías vasculares en niños menores de cinco años del municipio Cerro. Métodos: estudio descriptivo exploratorio intencionado de corte transversal con técnica de muestreo aleatorio simple, en el período entre septiembre de 2013 a febrero de 2014. Se requirió una muestra de 312 niños de los 5 343 que conformaron el universo de estudio. La tasa de prevalencia se expresó por cada 1 000 niños. Resultados: se identificaron tres pacientes del sexo femenino con antecedentes patológicos familiares y personales de hemangioma. Se encontró que la tasa de prevalencia fue de 9,6 × 1 000 niños. El cuero cabelludo fue el sitio más afectado con el 66,7 por ciento (n= 2). No se constataron complicaciones en ninguno de los casos. Solo una paciente recibió tratamiento con esteroides sistémicos (n= 1; 33,4 por ciento). Conclusión: la tasa de prevalencia encontrada (9,6 × 1 000) de las anomalías vasculares en niños menores de cinco años pertenecientes al municipio Cerro es similar a la registrada mundialmente. Su mayor frecuencia se encuentra en el sexo femenino(AU)

Introduction: vascular anomalies are frequent reason for going to the doctor's in children, but their prevalence, behaviors to be followed and the complications at pediatric ages barely known in Cuba. Objective: to determine the prevalence of vascular anomalies in children aged less than five years in Cerro municipality. Methods: intentional cross-sectional, exploratory and descriptive study performed with simple random sampling technique, in the period from September 2013 to February 2014. The final sample was 312 children out of a study universe of 5 343 ones. The prevalence rate was estimated per 1 000 children. Results: three female patients were found to have personal and family history of hemangioma, the prevalence rate was 9.6 per 1 000 children. The scalp was the most affected area with 66.7 percent (n= 2). No complications were observed. Just one patient was treated with systemic steroids (n= 1; 33.4 percent). Conclusions: the prevalence rate for vascular anomalies in children less than five years old was 9.6 per 1 000 children in Cerro municipality, which is similar to that reported worldwide. It is more frequent in females(AU)

Comportamiento del ácido úrico en una casuística general y en pacientes con enfermedad vascular periférica / Behaviour of the uric acid in the general casuistic and in patients with peripheral vascular disease

Objetivo: determinar el comportamiento del ácido úrico en una casuística general y en los pacientes con enfermedad vascular periférica y calcular la prevalencia de hiperuricemia. Métodos: estudio descriptivo en 464 pacientes que asistieron al Laboratorio de Bioquímica del Instituto de Angiología y Cirugía Vascular durante el mes de mayo de 2013, y en un grupo de 85 ingresados con enfermedad vascular periférica. El ácido úrico se cuantificó en todos con un juego de reactivo enzimático comercial. La hiperuricemia se determinó tomando como referencia los valores internacionales de 415,4 µmol/L para hombres y 339 µmol/L para las mujeres. Se calculó la prevalencia de hiperuricemia total y ajustada según sexo. Resultados: la concentración de ácido úrico en la muestra fue de 320,3 µmol/L (IC: 310 a 330,6 µmol/L, 95 por ciento); con diferencia entre hombres y mujeres (354,1 vs. 291,3 µmol/L respectivamente, p= 3,74 x 10-9). Se encontró que los pacientes con macroangiopatía diabética mostraron valores elevados de ácido úrico (339,5 µmol/L), sin diferencias significativas al compararlo con la casuística general. Se halló una prevalencia de hiperuricemia de 27,6 por ciento, de ella el 24,8 por ciento para el sexo masculino y el 30 por ciento para el femenino. Conclusiones: se llama a la reflexión sobre este parámetro, tiene una alta prevalencia y no debe ser indicado como rutina, ya que puede ser un biomarcador de enfermedades vasculares como lo es para la hipertensión arterial, función renal y gota(AU)

Objective: to determine the behaviour of the uric acid in a general casuistic and in the patients with vascular periphery disease and calculating the prevalence of hyper-uricaemia. Methods: a descriptive study in 464 patients assisted at aboratory of Biochemistry of the Institute of Angiology and Vascular Surgery during the month of may of 2013 and in the 85 patients with vascular periphery disease was analyzed. Uric acid quantified in alls with a commercial game of enzymatic reagent. The hyper-uricaemia determined itself when taking the following values into account: 415.4 µmol/ L for man and 339.0 µmol/L for woman. Was calculated the total prevalence of hyper-uricaemia and tight-fitting according to sex. Results: the concentration of uric acid in the sample was of 320.3 µmol/L (95 percent CI: 310; 330,6) With difference between man and woman (354.1 vs. 29,3 µmol/L, p= 3,74 x 10-9). The patients with diabetic macroangiopathy had high concentration of uric acid (339.5 µmol/L) within significant difference with general casuistic. The prevalence of hyper-uricaemia was of the 27.6 percent; of her the 24.8 percent for the masculine sex and the 30.0 percent for the feminine. Conclusion: it is done called the reflection on this parameter, what has high prevalence, which must not be indicated like routine; since it can be a biomarker of vascular periphery disease as it is for the arterial hypertension, renal function and gout.

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts / Programas e centros de atenção a asmáticos no Brasil; uma oficina de trabalho: revisitando e explicitando conceitos

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. .

Objetivo: Relatar os resultados de uma oficina de trabalho sobre programas e centros de atenção a asmáticos (PCAAs) no Brasil para que possam servir como instrumento para melhoria e avanço dos PCAAs existentes e criação de novos. Métodos: A oficina de trabalho constituiu-se de cinco apresentações e discussões em grupos. Os grupos de trabalho discutiram os seguintes temas: implementação de uma linha de cuidado em asma; recursos humanos necessários para os PCAA; recursos necessários para financiar os PCAA; e manutenção do funcionamento dos PCAAs. Resultados: A oficina envolveu 39 participantes de todas as regiões do país, representando associações de asmáticos (n = 3), centros universitários (n = 7) e PCAAs (n = 29). Evidenciou-se uma relação direta entre a ausência de planejamento e o insucesso dos PCAAs. Com base nas experiências brasileiras elencadas durante a oficina, as premissas comuns foram a importância da sensibilização do gestor, maior participação da comunidade, interdependência entre a atenção primária e a especializada, observação da regionalização e utilização dos medicamentos disponíveis no sistema público de saúde. Conclusões: O Brasil já tem um núcleo de experiências na área programática da asma. A implementação de uma linha de cuidado em doenças respiratórias crônicas e sua inclusão nas redes de saúde parecem ser o caminho natural. Porém, a experiência nessa área ainda é pequena. Agregar pessoas com experiência nos PCAAs na elaboração da linha de cuidado em asma encurtaria tempo na criação de redes de atenção com possível efeito multiplicador, evitando que se partisse do zero em cada local isolado. .

Base eletrônica de dados clínicos e cirúrgicos em isquemia cronica de membros inferiores / Electronic clinical and surgical database in chronic lower limb ischemia

CONTEXTO: Um sistema eletrônico de protocolo seria capaz de armazenar dados clínicos e possibilitar futuras pesquisas, visando a rapidez, eficiência de cruzamentos e análise de tais dados. OBJETIVO: a) criar uma base de dados clínicos cirúrgicos em doenças vasculares e, a partir desta, uma base em Isquemia Crônica de Membros Inferiores; b) informatizar essa base sob forma de um protocolo eletrônico; c) incorporar ao SINPE(c) (Sistema Integrado de Protocolos Eletrônicos); d) realizar um projeto piloto. MÉTODOS: Criou-se uma base teórica de dados clínicos sobre as doenças vasculares. O protocolo específico foi criado considerando-se as características individuais das doenças causadoras de Isquemia Crônica de Membros Inferiores. Após seu término, essa base eletrônica e informatizada seria incorporada ao SINPE(c). RESULTADOS: O usuário, previamente cadastrado, realizará o cadastro do paciente e selecionará, dentro do protocolo mestre, o protocolo específico em Isquemia Crônica de Membros Inferiores, para acesso aos seus respectivos dados clínicos. Orientado pelas alternativas diretas de preenchimento, o usuário seleciona apenas os dados pertencentes ao seu paciente. Estes podem ser resgatados para pesquisa, mostrando o número de coletas que satisfazem os parâmetros escolhidos e informações estatísticas sobre a mesma. CONCLUSÃO: a) a criação da base teórica de dados clínicos e cirúrgicos em doenças vasculares e, a partir desta, em Isquemia Crônica de Membros Inferiores, foi factível; b) a informatização da base teórica sob forma de protocolo eletrônico foi exequível; c) o protocolo eletrônico mestre e específico poderá ser incorporado ao SINPE(c), d) o projeto piloto foi criado ...

BACKGROUND: Electronic medical record systems may optimize future studies by improving speed, as well as data comparison and analysis. OBJECTIVE: (a) To create a general database of clinical and surgical vascular diseases and select data from it to create a specific database of chronic lower limb ischemia; b) to store this database in the form of an electronic system; c) to incorporate this database into the Brazilian integrated electronic medical record system (SINPE(c)); and (d) to conduct a pilot study to test the system. METHODS: A general database of clinical vascular disease was created, and a specific system was developed to record the individual characteristics of the diseases that cause chronic ischemia of lower limbs. When completed, the database was incorporated into SINPE(c). RESULTS: For data collection, an authorized user enters patient data and creates a medical record for that patient. After that, chronic ischemia of lower limbs is selected in the master system to access clinical data. Aided by the autofill tool, the user selects only the data for that specific patient. Data may be retrieved for studies, to find out the number of entries that meet the chosen parameters, and to provide statistical information about them. CONCLUSION: (a) The theoretical database of clinical and surgical vascular diseases and the derived database of chronic lower limb ischemia were created; (b) the theoretical electronic database was created; c) the electronic medical records in both the master and the specific database were incorporated into SINPE(c), (d) the pilot study was successfully created and tested using the parser module of SINPE(c). .

Perfil epidemiológico de pacientes submetidos a tratamento cirúrgico de varizes de membros inferiores / Epidemiologic profile of the patients underwent varicose vein surgery of the lower limbs

CONTEXTO: A Doença Venosa Crônica (DVC) dos membros inferiores apresenta uma alta prevalência, estando a cirurgia para cura das varizes dos membros inferiores entre as mais frequentemente realizadas pelos cirurgiões vasculares. Apesar disso, não foi estabelecido, na cidade de Recife e zona metropolitana, o perfil epidemiológico dos pacientes que são submetidos a essa modalidade terapêutica. OBJETIVOS: O objetivo deste trabalho foi avaliar o perfil epidemiológico dos pacientes suubmetidos à cirurgia para a cura das varizes dos membros inferiores. MATERIAL E MÉTODOS: Foram avaliados 201 pacientes submetidos ao tratamento cirúrgico de varizes dos membros inferiores, no Serviço de Cirurgia Vascular no Instituto de Medicina Integral Professor Fernando Figueira (IMIP), no período de agosto de 2006 a abril de 2007. Foram avaliados os seguintes parâmetros: sexo, idade, sedentarismo, sobrepeso e obesidade, e presença de ortostatismo prolongado durante atividade laboral. RESULTADOS: Do total de pacientes avaliados, 175 (87,1%) eram do sexo feminino e 26 (12,9%) do masculino. A faixa etária mais acometida foi a de 41 a 50 anos (32,3%), o sobrepeso estava presente em 38,8% dos pacientes, e a obesidade em 7,5% dos casos. O ortostatismo prolongado, durante a atividade laboral, estava presente em 82,1% dos pacientes avaliados. O grau de escolaridade mais comum, observado em 83,2% dos pacientes, foi de até oito anos de tempo de estudo. O sedentarismo foi encontrado em 69,2% dos pacientes. CONCLUSÃO: A maioria dos pacientes avaliados no presente estudo era do sexo feminino com idade maior que 40 anos, era sedentária e não apresentava sobrepeso ou obesidade, e desenvolvia atividades laborais com ortostatismo prolongado.

BACKGROUND: The Chronic Venous Insufficiency of lower limbs has a high prevalence, and its surgical treatment is one of the most performed. Even so, it has not been reported the epidemiologic profile of the patients that has been underwent to this surgery in the city of Recife. OBJECTIVE: The aim of this report was evaluate the epidemiologic profile of the patients underwent to varicose vein surgery of the lower limbs. MATERIAL AND METHODS: They were evaluated 201 patients underwent to varicose vein surgery of the lower limbs at the Vascular Surgery Service at the Instituto de Medicina Integral Professor Fernando Figueira (IMIP) from august 2006 to april 2007. All the patients were evaluated considering the gender, age, sedentarism, overweight, obesity and the report of long-time in a standing position during work shift. RESULTS: Over all patients evaluated, 175 (87.1%) were females and 26 (12.9%) males. The majority of them (32.3%) were aged from 41 to 50 years, overweight was found in 38.8% of the patients, and obesity in 7.5% of the cases. Long time standing during work shift was reported by 82.1% of the patients, and the time at the school, found in 83.2% of the patients, was eight or less years. Sedentarism was found in 69.2% of the patients. CONCLUSION: The majority of the patients evaluated in the present study was female and more than 40 years-old, reported sedentarism, did not have overweight or obesity and reported to stay a long-time in a standing position during work shift.

Blood pressure measurement: One arm or both arm.

Guidelines for measuring blood pressure includes measurement of blood pressure on both arms but it is often ignored. Our case report aims at highlighting the need follow the guidelines. A 60 year old 59 kg weighing male asymptomatic patient without any comobidities was posted for bilateral inguinal hernia repair. The interarm blood pressure difference was discovered incidentally during his preanaesthetic evalution. On further evaluation patient was found to be having subclavian stenosis on left side which was asymptomatic. Intraoperative and post operative period was uneventful. Blood pressure measurement should be done in accordance with the stipulated guidelines. Inter arm blood pressure difference should be noted in all patients as not only for diagnosis and treatment of hypertension but also as a tool to diagnose asymptomatic peripheral vascular disesase.

Enfermedad arterial periférica: índice tobillo/brazo: segunda parte / Peripheral arterial disease: ankle-arm index: part 2

En esta parte del artículo se describe la importancia del índice tobillo/brazo en el diagnóstico de ateromatosis arterial en territorios vasculares alejados de los miembros inferiores, y su utilidad en pacientes diabéticos.

Enfermedad arterial periférica: índice tobillo/brazo: primera parte / Peripheral arterial disease: ankle-arm index: part 1

En esta primera parte se presenta la epidemiología de esta enfermedad, fisiopatología, factores de riesgo, manifestación clínica, diagnóstico, y obtención del índice tobillo-brazo, considerado el mejor método diagnóstico no invasivo para su estudio.

Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil / Prevalence and risk factors associated with peripheral arterial disease in the hearts of Brazil project

FUNDAMENTO: A doença arterial obstrutiva periférica (DAOP) está associada ao maior índice de risco cardiovascular. No Brasil, faltam dados sobre sua prevalência e fatores de risco. OBJETIVO: Avaliar prevalência e fatores de risco associados à DAOP nas cidades brasileiras com > cem mil habitantes. MÉTODOS: Estudo transversal, multicêntrico, que avaliou 1.170 indivíduos (>18 anos), em 72 centros urbanos, participantes do Projeto Corações do Brasil. O diagnóstico de DAOP baseou-se na medida do índice tornozelo-braquial (ITB) < 0,90. A análise estatística utilizou teste Qui-quadrado (Pearson) corrigido para amostras complexas e intervalos de confiança. P < 0,05 foi considerado significativo. RESULTADOS: A prevalência de DAOP foi de 10,5 por cento e apenas 9 por cento dos portadores da doença apresentaram claudicação. A DAOP esteve associada à presença de diabetes, obesidade total e abdominal, acidente vascular cerebral (AVC) e doença isquêmica do coração (DIC). Houve tendência a maior prevalência de DAOP na presença de hipertensão, insuficiência cardíaca, insuficiência renal dialítica e tabagismo >20 anos/maço. Mulheres coronariopatas apresentaram risco 4,9 vezes maior de ter DAOP, do que aquelas sem coronariopatia e, entre homens diabéticos, o risco de DAOP foi 6,6 maior em comparação aos não diabéticos. CONCLUSÃO: A prevalência de DAOP foi elevada, considerando-se a baixa média de idade da população avaliada (44±14,7 anos). A minoria dos portadores apresentava claudicação, o que denota o grande contingente de indivíduos assintomáticos. Os fatores mais fortemente associados à doença foram diabetes, obesidade, AVC e DIC. Os autores concluíram que a medida do ITB deve ser considerada na avaliação de pacientes de moderado e alto risco cardiovascular.

BACKGROUND: Peripheral arterial disease (PAD) is associated with increased cardiovascular risk. In Brazil, data on PAD prevalence and risk factors are scarce. OBJECTIVE: To assess prevalence and risk factors related to PAD in Brazilian urban centers with more than 100,000 inhabitants. METHODS: National, multicenter, cross-sectional study of 1,170 individuals (>18 years), from 72 major Brazilian urban centers participating in the "Hearts of Brazil Project". PAD diagnosis was based on ankle-brachial index (ABI) < 0.90. The statistical analysis used the corrected Chi-square (Pearson) test for complex samples and confidence intervals. P< 0.05 was considered statitically significant. RESULTS: PAD prevalence was 10.5 percent. Intermittent claudication (IC) was present in only 9 percent of PAD patients. A significant association was found between PAD and the following factors: diabetes, total and abdominal obesity, stroke and ischemic heart disease (IHD). There was a trend of higher PAD prevalence among individuals with hypertension, heart failure, chronic renal failure on dialysis, as well as those who had smoked over 20 pack-years. For females, presence of IHD was associated with a 4.9-fold greater risk of PAD. Among males, a 6.6-fold increased risk of PAD was found for diabetic in comparison to non-diabetic individuals. CONCLUSION: PAD prevalence was markedly high, considering the low mean age of the studied population (44±14.7 yrs). IC was detected in a minority of PAD subjects, indicating a considerable number of asymptomatic individuals. Diabetes, obesity, stroke and IHD were the stronger predictors of PAD. The authors concluded that ABI measurement should be considered in the evaluation of moderate to high cardiovascular risk patients.

Prevalence of peripheral arterial occlusive disease in patients referred to a tertiary care hospital in Salvador, Bahia, Brazil, for coronary angiography

The presence of peripheral arterial occlusive disease increases the morbidity and mortality of patients with coronary artery disease. The objective of the present study was to calculate the prevalence of peripheral arterial occlusive disease in patients referred for coronary angiography. This prevalence study was carried out at the Hemodynamics Unit of Hospital Santa Isabel, Salvador, Brazil, from December 2004 to April 2005. After approval by the Ethics Committee of the hospital, 397 patients with angiographic signs of coronary artery disease were enrolled. Diagnosis of peripheral arterial occlusive disease was made using the ankle-brachial blood pressure index (£0.90). Statistical analyses were performed using the z test and a level of significance of a = 5 percent, 95 percentCI, the chi-square test and t-test, and multiple logistic regression analysis. The prevalence of peripheral arterial occlusive disease was 34.3 percent (95 percentCI: 29.4-38.9). Mean age was 65.7 ± 9.4 years for patients with peripheral arterial occlusive disease, and 60.3 ± 9.8 years for patients without peripheral arterial occlusive disease (P = 0.0000003). The prevalence of peripheral arterial occlusive disease was 1.57 times greater in patients with hypertension (P = 0.007) and 2.91 times greater in patients with coronary stenosis ³50 percent (P = 0.002). Illiterate patients and those with little education had a 44 percent higher chance of presenting peripheral arterial occlusive disease probably as a result of public health prevention policies of limited effectiveness. The prevalence of peripheral arterial occlusive disease in patients referred to a tertiary care hospital in Salvador, Bahia, for coronary angiography, was 34.3 percent.

Onychomycosis: Clinico-mycologic study of 130 patients from Himachal Pradesh, India.

BACKGROUND: Onychomycosis is a common nail infection caused by dermatophytes, yeast or other nondermatophyte molds and has diverse clinical presentations. Although common in this part of the country, no significant clinico-mycologic data is available. OBJECTIVES: This study was carried out to document the clinico-mycologic pattern of onychomycosis in Himachal Pradesh (India). METHODS: All consecutive patients of onychomycosis diagnosed clinically during March 2005 to February 2006 were studied for clinical forms, number of nails involved and severity of infection. The clippings from the most severely affected nails were subjected to potassium hydroxide (KOH) mounts for direct microscopy and fungal culture on Sabouraud's dextrose agar. RESULTS: These 130 patients (M:F 98:32) were between 8-76 years of age (mean 41.35 +/- 14.98 years). The prevalence of onychomycosis was higher among farmers and office workers (20% each). Finger or toe nails were exclusively involved in 56.9 and 32.3% patients respectively while these were involved concurrently in the rest of the 10.8% patients. Distal and lateral subungual onychomycosis seen in 73.1% of the specimens was the most common clinical type. KOH- and culture-positivity were recorded in 59.2 and 37.6% cases respectively. Dermatophytes and yeast (Candida albicans) were isolated in 40.8% each of the cultured nail specimens while nondermatophytic molds (NDM) were cultured in 18.6% of the samples. Various dermatophytes cultured were Trichophyton rubrum (32.6%), T. mentagrophytes (6.1%) and T. verrucosum (2.1%) respectively. Aspergillus spp. (6.1%) was the most commonly isolated NDM while other detected molds were Acremonium spp, Fusarium spp,, Scopulariopsis spp, Curvularia spp. and Penicillium marneffei. Peripheral vascular disorders (7.69%), occupational trauma (13.8%), close association with animals (60.78%) and a family history of onychomycosis (26.15%) were a few of the predisposing factors identified. CONCLUSION: Onychomycosis is not uncommon in this part of the country and has similar clinico-mycologic profiles in the different cases detected.

A clinical and mycological study of onychomycosis in HIV infection.

BACKGROUND: Onychomycosis is one of the early manifestations of HIV infection with a prevalence of 15-40%. Multiple nail involvement, isolation of both common and rare species and resistance to treatment are the characteristics of onychomycosis in HIV. AIM: To study the epidemiology, clinical manifestations of onychomycosis in HIV-infected individuals and to identify the various causative fungi microbiologically. METHODS: A total of 250 HIV infected patients, diagnosed by ELISA, were screened for nail involvement; of which 60 patients i.e, 40 males and 20 females, who had clinically suspected untreated fungal infection were included in this study. RESULTS: Of the 60 respondents, 34 (56.66%) were from the 31-40 years age group. Amongst the 40 males, there were 20 manual laborers and 14 farmers; while 18 of 20 females were housewives. Toenail involvement was seen in 38 patients (63.33%), fingernail in 12 patients (20%) while 10 (16.66%) patients had involvement of both. Twenty eight (46.66%) patients gave history of some trauma, 6 (10%) had diabetes mellitus and only 1 patient (1.66%) had history of peripheral vascular disease. Nineteen (31.66%) patients had associated tinea pedis, 5 (8.33%) had tinea manuum, 10 (16.66%) had tinea corporis and 7 (11.66%) had tinea cruris. Twenty one (35%) respondents had distal and lateral superficial onychomycosis (DLSO), 5 (8.33%) had proximal subungual onychomycosis (PSO), 1 (1.66%) had superficial white onychomycosis (SWO), while 33 (55%) had total dystrophic onychomycosis (TDO). Fungal elements were demonstrated by KOH mount in 49 patients (81.66%) and growth was seen in 32 (53.33%) cultures. Dermatophytes were isolated in 13 (21.66%) and nondermatophytic molds (NDM) in 19 (31.66%). Out of the 13 positive dermatophyte cultures, Trichophyton rubrum was isolated on 11 and Trichophyton mentagrophytes on 2 cultures. Of the 19 non-dermatophytic cultures, Aspergillus niger was isolated on 3 and Candida spp. on 12 while Cladosporium spp, Scytalidium hyalinum, Penicillium spp. and Gymnoascus dankaliensis on 1 each. CONCLUSIONS: Total dystrophic onychomycosis was the most common clinical type and NDM were the predominant causative organisms.

Infra-inguinal arterial reconstruction for peripheral arterial disease: the Curaçao experience / Reconstrucción arterial infrainguinal en la enfermedad arterial periférica: la experiencia de Curazao

BACKGROUND: The prevalence and treatment of peripheral arterial disease in the Caribbean is not well documented. The aim of this study was to review the results from a small hospital in the Caribbean. METHODS: One-hundred and eight infra-inguinal arterial reconstructions on 90 patients were retrospectively reviewed Patients were classified according to the categories suggested by the Ad Hoc Committee on Reporting Standards of the Joint Councils of the Society for Vascular Surgery. Follow-up ranged from 0 to 103.1 months. The Kaplan-Meier method was used to visualize survival, limb salvage rates and primary and secondary patency rates. Cox regressions were used to identify potential risk factors. RESULTS: The limb salvage rates were 74.5% after one year and 71.4% after five years. Overall primary patency rates were 67.0 % after one year, 63.4% after three years and 50.8 % after five years. Overall secondary patency rates were 86.4% after one year and 75.1% after five years. The primary patency rate for autologous saphenous vein was 82.4% (SE 7.5%) after five years. The primary patency rates for prosthetic grafts were 62.1% (SE 8.5%) after one year; 56.9% (SE 9.2%) at three years and 37.9% (SE 16.7%) after five years. CONCLUSION: Infra-inguinal arterial bypass surgery is feasible in small Caribbean hospitals showing results comparable to major studies.

ANTECEDENTES: La prevalencia y el tratamiento de enfermedad arterial periférica en el Caribe no están bien documentados. El objetivo de este estudio fue examinar los resultados de un pequeño hospital en el Caribe. MÉTODOS: Se examinaron retrospectivamente ciento reconstrucciones arteriales infrainguinales en 90 pacientes. Los pacientes eran clasificados según las categorías sugeridas por el Comité Ad Hoc para el Reporte de Normas de los Consejos Unidos de la Sociedad de Cirugía Vascular. El seguimiento tuvo un rango de 0 a 103.1 meses. Se usó el método Kaplan-Meier con el objeto de ver las tasas de super-vivencia, salvamento de la extremidad, y tasas primarias y secundarias de permeabilidad. Se usaron regresiones de Cox para identificar los factores de riesgo potencial. RESULTADOS: Las tasas de salvamento de miembro fueron 74.5% después de un año y 71.4% después de cinco años. Las tasas generales de permeabilidad primaria fueron 67.0% después de un año, 63.4% después de tres años y 50.8% después de cinco años. Las tasas generales de permeabilidad secundaria fueron 86.4% después de un año y 75.1% después de cinco años. La tasa de permeabilidad primaria para la vena safena autóloga fue 82.4% (SE 7.5%) después de cinco años. Las tasas de permeabilidad primaria para los injertos prostéticos fueron 62.1% (SE 8.5%) después de un año, 56.9% (SE 9.2%) a los tres años y 37.9% (SE 16.7%) después de cinco años. CONCLUSIÓN: La cirugía de bypass arterial infrainguinal es factible en hospitales caribeños pequeños que muestran resultados comparables a los de estudios importantes.

Prevalence of peripheral arterial disease by ankle-brachial index and its correlation with carotid intimal thickness and coronary risk factors in Nepalese population over the age of forty years.

OBJECTIVES: Noninvasive measures of subclinical atherosclerosis such as the ankle brachial index (ABI) and common carotid artery intima-media thickness (CCA IMT) could improve risk prediction and provide more focused primary prevention strategies. This report describes the prevalence of subclinical atherosclerotic vascular disease in a Nepalese population over the age of forty years as measured by ABI and CCA IMT and their association with established cardiovascular risk factors. MATERIALS AND METHODS: Ultrasonic evaluation of ABI and CCA IMT was done in 195 individuals of age 40 years and above who had presented to an outpatient department. Patients with established diagnosis of coronary artery disease or symptomatic for peripheral arterial disease were excluded from the study. RESULTS: The prevalence of atherosclerotic disease as measured by ABI was 18.5% and there was a statistically significant correlation between ABI and CCA IMT and other established cardiovascular risk factors such as smoking, diabetes mellitus and hypertension. CONCLUSIONS: We recommend that ABI as measured by sphygmomanometer be incorporated into routine cardiovascular screening and when found to be abnormal further confirmed by Doppler assessment of ABI and CCA IMT as surrogate markers of atherosclerotic vascular disease.

Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study

Although epidemiological studies have persistently shown a high prevalence of diabetes in Arabs, the control of diabetes is still poor and complications of diabetes are common. We examined the prevalence of diabetic peripheral neuropathy [DN], neuropathic foot ulceration [FU] and peripheral vascular disease [PVD], and potential risk factors for these complications among patients attending primary care diabetes clinics in Bahrain. We studied 1477 diabetic patients [Type 2 diabetes 93%]; to, including 635 men and 842 women, with ages ranging from 18-75 years in a cross-sectional study. The main predictor variables were demographic and clinical data, including assessment of foot and blood parameters. Mean age of the patients and duration of diabetes were 57.3 +/- 6.32 and 9.5 +/- 8.4 years, respectively. DN was present in 36.6% of the population, FU in 5.9%, and PVD in 11.8%. Diabetic patients with neuropathy were older than patients without neuropathy [P=0.001] and had had diabetes longer [P=0.002]. Diabetic patients with foot ulcers had more severe neuropathy and higher vibration perception thresholds values than patients without foot ulcers [P<0.05]. Older age, poor glycemic control, longer duration of diabetes, elevated cholesterol levels, current smoking, obesity defined by body mass index, large waist circumference, elevated triglycerides levels and hypertension but not gender, were significant risk factors for DN in both the univariate and the multivariate analyses [P< 0.05]. DN and PVD also remained significant risk factors for foot ulceration in the multiple logistic regression analysis. Rates of DN and PVD are high among diabetic patients in Bahrain. Implementation of strategies for prevention, early detection, and appropriate treatment at the primary health care level are urgently needed