IMPACTO EN LA CALIDAD DE VIDA EN PACIENTES CON DERMATITIS ATÓPICA

Resumen Introducción: la dermatitis atópica es una enfermedad inflamatoria crónica de la piel de etiología multifactorial que produce un impacto en la vida del paciente. Resulta de interés conocer cómo valorar la calidad de vida del paciente relacionada con la salud (CVRS), cuando está en tratamiento de mantenimiento para el control de la DA. Objetivo: evaluar la calidad de vida en pacientes con Dermatitis Atópica durante el tratamiento de mantenimiento y el cumplimiento del mismo. Materiales y Métodos: se realizó un estudio epidemiológico, observacional, multicéntrico y transversal. Se analizó a pacientes con diagnóstico clínico de DA, se realizó cuestionarios de calidad de vida (DLQI, CDLQI y IDQOL) y de cumplimiento de tratamiento (Test de Morisky-Green). Resultados: se encuestaron a 41 pacientes. Se observó afección severa el 29%, moderada el 34%, y solo una minoría (5%) no afecto su calidad de vida; casi el 10% presento extremada afectación en calidad de vida. Los niños menores de 5 años tuvieron como predominio gran afectación en la calidad de vida, mientras que en los grupos etarios mayores de 6 años esta afectación resultó moderada. Al evaluar el cumplimiento del tratamiento, el 76% resulto NO cumplidor. De los cumplidores, el 75% presentó gran afectación en la calidad de vida (p:0,05), sin predominio de sexo. Conclusión: en la población estudiada la mayoría presentó una afectación en la calidad de vida moderada a grave. El 76% de la población se consideró como NO cumplidora de tratamiento. De los cumplidores, el 75% presentaba extremada afectación de la calidad de vida.

Summary Introduction: Atopic dermatitis is a chronic inflammatory skin disease of multifactorial etiology that has an impact on the patient's life. It is interesting to know how the patient value their health related quality of life (HRQoL), when they are in maintenance treatment for the control of AD. Objective: to evaluate the quality of life in patients with Atopic Dermatitis during maintenance treatment and its compliance. Materials and Methods: an epidemiological, observational, multicenter and cross-sectional study was carried out. We analyzed patients with a clinical diagnosis of AD, quality of life questionnaires (DLQI, CDLQI and IDQOL) and compliance with treatment (Morisky-Green test). Results: 41 patients were surveyed. A severe condition was observed in 29%, moderate in 34%, and only a minority (5%) did not affect their quality of life; almost 10% presented extreme affectation in quality of life. Children under 5 years of age had a high prevalence of quality of life, whereas in age groups older than 6 years, this affectation was moderate. When evaluating the compliance of the treatment, 76% was NOT compliant. Of the compliers, 75% presented a great impact on the quality of life (p: 0.05), without predominance of sex. Conclusion: in the studied population, the majority presented moderate to severe quality of life. 76% of the population was considered non-compliant of treatment. Of the compliers, 75% presented extreme affectation of the quality of life.

Modeling Cardiac Hemodynamic Response During Exercise in Health and Hypertrophic Cardiomyopathy.

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) is associated with altered hemodynamics in the left ventricular outflow tract and tissue abnormalities. Exercise testing has become an integral and powerful tool for the noninvasive evaluation of HCM and, in some patients, it could define a treatment strategy. Obiective: To model the hemodynamic alterations during exercise in healthy and HCM patients, obtained by noninvasive methods. METHODS: Cardiac output (CO), heart rate (HR), arterial blood pressure (ABP) and Total Peripheral Resistance (TPR) were assessed during exercise. The evaluation included a curve-fitting approach (sigmoidal model) that allowed a quantitative comparison of CO profiles. RESULTS: When compared to controls, patients with HCM showed reduced peak exercise cardiac output and demonstrated high peripheral resistance during exercise. Analysis of modeled it CO curves revealed a higher maximum rate of recovery in healthy individuals than in HCM patients. CONCLUSION: The application of the sigmoidal model showed to be efficient in the characterization of CO dynamics for the different studied groups.

Flow Mediated Dilation in Cirrhosis: A Pilot Study in Different Stages of the Disease.

INTRODUCTION: Cirrhosis is associated with changes in the cardiovascular system, where the circulatory dysfunction is compensated by the development of a hyperdynamic circulation. Endothelial function can be understood as the endothelium capability to release Nitric Oxide (NO) where an impairment in the normal development of this process constitutes a main step in the genesis and progression of atherosclerosis, a major cause of cardiovascular events. In recent years, non-invasive measurements have gained attention, due to the potential complications associated to invasive procedures. OBJECTIVE: To evaluate endothelial function (EF) in patients with cirrhosis, in different stages of the disease, complemented with hemodynamic measurements. METHODS: Individuals were divided in three age groups, according to the severity of their disease. EF was assessed by using the flow mediated dilation technique (FMD), jointly with noninvasive determination of cardiac output (CO), total peripheral resistance (TPR) and arterial compliance (AC). RESULTS: TPR showed a decrease in advanced severity while AC had an increase. Particularly, EF was found to be higher in CHC group, decreasing in CHB and more pronounceably in CHA. Concomitantly, an inverse behavior was observed regarding CO evolution. CONCLUSION: EF was noninvasively evaluated in cirrhosis, in terms of the progression of the disease. Hyperdynamic states in the more advanced condition were accompanied by a higher vascular reactivity, probably associated with higher peripheral NO release and increased AC.

Modeling young and adult patients with cirrhosis through a three element windkessel (WK3e).

INTRODUCTION: Measurement of hemodynamic parameters constitutes an important tool in the management of patients with cirrhosis. In recent years, non-invasive measurements have gain attention, due to the potential complications associated to invasive procedures. OBJECTIVE: To characterize the hemodynamic alterations of cirrhosis in young and adult subjects, through a three element windkessel (WK3e). METHODS: Individuals were divided in three age groups: Young Healthy group (control, CG), Young Cirrhotic Group (YCG) and Adult Cirrhotic Group (ACG). A Finapres® Nova device was used to obtain cardiac output (CO), heart rate and arterial blood pressure. Systemic arterial compliance (C), peripheral resistance (R) and characteristic impedance (Zc) were also provided. Effective arterial elastance (Ea), left ventricular work (LVW), input impedance, efficiency and model cutoff frequency (WKCF) were assessed based on the provided data. RESULTS: CO resulted to be higher in ACG than in CG and YGC. LVW, C and WKcf showed an increase, while R and Ea showed a decrease. However, this behavior was not observed in YCG. CONCLUSION: Cirrhosis was properly modeled in young and adult subjects in terms of non-invasive measurements and a WK3e.