Complicaciones clínicas en los pacientes ingresados por pie diabético en el Instituto de Angiología / Clinical complications in patients admitted for diabetic foot in the Institute of Angiology

Introducción: El pie diabético se considera un grave problema de salud global por ser la principal causa de amputación no traumática y de las elevadas tasas de morbimortalidad, y por tener consecuencias socioeconómicas negativas en el paciente. Objetivo: Identificar las complicaciones clínicas en los pacientes ingresados por pie diabético en el Instituto Nacional de Angiología y Cirugía Vascular. Métodos: Se realizó un estudio descriptivo-retrospectivo de corte transversal en 102 pacientes diabéticos de tipo 2, ingresados en 2019 en el Servicio de Angiopatía Diabética del Instituto Nacional de Angiología y Cirugía Vascular por tener diagnosticado pie diabético. Las variables en estudio fueron: edad, sexo, tipo de diabetes mellitus y su tiempo de evolución, tipo de pie diabético, cirugía realizada, y presencia y tipo de complicaciones clínicas. Se calcularon las frecuencias absolutas y relativas. Resultados: Prevaleció el sexo masculino, el grupo etáreo entre 61 y 70 años, y los pacientes con más de 10 años de evolución de la diabetes mellitus. El pie diabético con grado 2 y 3 de Wagner y el pie diabético neuroinfeccioso resultaron los más frecuentes. La cirugía más realizada fue la amputación de dedos, por lo que predominó el nivel de amputación menor, seguido de los desbridamientos quirúrgicos. Las complicaciones que mostraron frecuencias de más del 20 por ciento fueron la anemia, la hiperglucemia y la bronconeumonía. Conclusiones: Las complicaciones más frecuentes en los pacientes ingresados por pie diabético resultaron la anemia, la hiperglucemia y la bronconeumonía(AU)

Introduction: Diabetic foot is considered a critical health concern worldwide, as long as it is the leading cause of nontraumatic amputation and the increased rates of mobility and mortality, as well as for having negative socioeconomic consequences to the patient. Objective: To identify clinical complications in patients admitted for diabetic foot to the National Institute of Angiology and Vascular Surgery. Methods: A cross-sectional descriptive-retrospective study was carried out in 102 patients with type 2 diabetes and admitted in 2019 to the diabetic angiopathy service of the National Institute of Angiology and Vascular Surgery, for having a diagnosis of diabetic foot. The variables under study were age, sex, type of diabetes mellitus and its time of evolution, type of diabetic foot, surgery performed, and presence and type of clinical complications. The absolute and relative frequencies were calculated. Results: There was a prevalence of the male sex, the age group between 61 and 70 years, and the patients with more than ten years of evolution of diabetes mellitus. Wagner's grades 2 and 3 diabetic foot and neuroinfectious diabetic foot were the most frequent. The most performed surgery was finger amputation, so the level of minor amputation predominated, followed by surgical debridements. The complications that showed frequencies of more than 20 percent were anemia, hyperglycemia, and bronchopneumonia. Conclusions: The most frequent complications in patients admitted for diabetic foot were anemia, hyperglycemia, and bronchopneumonia(AU)

High levels of proinflammatory cytokines IL-6 and IL-8 are associated with a poor clinical outcome in sickle cell anemia.

Sickle cell anemia (SCA) pathophysiology is characterized by the activation of sickle red blood cells, reticulocytes, leukocytes, platelets, and endothelial cells, and with the expression of several inflammatory molecules. Therefore, it is conceivable that variations in levels of proinflammatory cytokines may act as a signaling of differential clinical course in SCA. Here, we evaluated the clinical impact of proinflammatory cytokines interleukin 1-ß (IL-1ß), interleukin 6 (IL-6), and interleukin 8 (IL-8) in 79 patients with SCA, followed in a single reference center from northeastern Brazil. The main clinical/laboratory data were obtained from patient interview and medical records. The proinflammatory markers IL-1ß, IL-6, and IL-8 were evaluated by using commercially available enzyme-linked immunosorbent assay kits. According to levels of the proinflammatory markers, we observed that patients who had a higher frequency of VOC per year (P = 0.0236), acute chest syndrome (P = 0.01), leg ulcers (P = 0.0001), osteonecrosis (P = 0.0006), stroke (P = 0.0486), and priapism (P = 0.0347) had higher IL-6 levels compared with patients without these clinical complications. Furthermore, increased levels of IL-8 were found in patients who presented leg ulcers (P = 0.0184). No significant difference was found for IL-1ß levels (P > 0.05). In summary, the present study emphasizes the role of inflammation in SCA pathophysiology, reveals an association of IL-8 levels and leg ulcer occurrence, and indicates that IL-6 levels can be used as a useful predictor for poor outcomes in SCA.

Hospitalization costs and their determining factors among patients undergoing kidney transplantation: a cross-sectional descriptive study

ABSTRACT BACKGROUND: Cost evaluation is a key tool in monitoring expenditure for budget management. It increases the efficiency of possible changes through identifying potential savings and estimating the resources required to make such changes. However, there is a lack of knowledge of the total cost of hospitalization up to the clinical outcome, regarding patients admitted for kidney transplantation. Likewise, there is a lack of data on the factors that influence the amounts spent by hospital institutions and healthcare systems. OBJECTIVES: To describe the costs and determining factors relating to hospitalization of patients undergoing kidney transplantation. DESIGN AND SETTING: Cross-sectional descriptive study with a quantitative approach based on secondary data from 81 patients who were admitted for kidney transplantation at a leading transplantation center in southern Brazil. METHODS: The direct costs of healthcare for patients who underwent kidney transplantation were the dependent variable, and included personnel, expenses, third-party services, materials and medicines. The factors that interfered in the cost of the procedure were indirect variables. The items that made up these variables were gathered from the records of the internal transplantation committee and from the electronic medical records. The billing sector provided information on the direct costs per patient. RESULTS: The estimated total cost of patients' hospitalization was R$ 1,257,639.11 (US$ 571,010.44). Out of this amount, R$ 1,237,338.31 (US$ 561,793.20) was paid by the Brazilian National Health System and R$ 20,300.80 (US$ 9,217.24) by the transplantation center's own resources. The highest costs related to the length of hospital stay and clinical complications such as sepsis and pneumonia. CONCLUSIONS: The costs of hospitalization for kidney transplantation relate to the length of hospital stay and clinical complications.

Clinical complications in renal biopsy using two different needle gauges: The impact of large hematomas, a random clinical trial study.

OBJECTIVE: To compare complications of ultrasound-guided percutaneous renal biopsy using two needle gauges (16-G and 18-G). METHODS: A total of 238 individuals with renal biopsy indication were included and randomly separated into two groups: ultrasound-guided percutaneous renal biopsy procedure carried out with a 16-G or 18-G needle. The adequacy of biopsy samples and post-procedure complications were compared between the two groups. RESULTS: The procedures carried out with a 16-G needle collected fragments with a mean of 22.1 ± 10.8 glomeruli, and those carried out with an 18-G needle had a mean of 17.5 ± 9.4 glomeruli. Patients submitted to renal biopsies with a 16-G needle had a higher likelihood of having a complication (OR5.1, 95% CI 1.7-15.4, P = 0.001). The overall mean volume of post-biopsy hematoma in patients with complications was significantly larger than those without complications (44 ± 56.1 mL vs 5.9 ± 6.6 mL; P < 0.001). CONCLUSIONS: Renal biopsies carried out by ultrasonography using an 18-G needle provide adequate histological analysis, showing a lower amount of glomeruli but with similar clinical quality as a 16-G needle. Furthermore, it is associated with a lower risk of procedure-related complications.

Caracterización anatomoclínica de elevaciones sinusales en pacientes implantológicos / Anatomo-clinical characterization of sinus elevations in implatologic patients

Introducción: Las elevaciones del seno maxilar traen consigo modificaciones anatómicas, que pueden influir en su funcionabilidad. Objetivo: Caracterizar clínica y anatómicamente las elevaciones sinusales realizadas y su repercusión en el éxito de los implantes posicionados. Material y Método: Se realizó un estudio descriptivo, prospectivo en 56 pacientes sometidos a elevaciones sinusales en el período comprendido desde enero 2013-enero 2015 con criterios de inclusión debidamente establecidos, en la Facultad de Estomatología Raúl González Sánchez. Cada paciente se sometió a interrogatorio, examen clínico y al análisis ortopantomográfico previo al tratamiento, y a los 6, 12, 18 y 24 meses de la intervención. Se analizaron las variables edad, sexo, distribución topográfica, técnica quirúrgica implementada, material de relleno, altura sinusal, nivel óseo y complicaciones. Resultados: Predominaron pacientes del sexo femenino (60,7 por ciento), con edades comprendidas entre 30-39 años (60,7 por ciento). La tasa total de éxito a 2 años de implantación dental fue 92,1 por ciento. La reducción final en altura sinusal promedio en técnica de ventana lateral fue la mayor (10,1 mm). La mejor relación altura injerto-longitud de implante se obtuvo con beta fosfato tricálcico (1,66). La perforación de membrana menor de 5mm fue la complicación transoperatoria más registrada (28,6 por ciento). Conclusiones: La técnica de ventana lateral exhibe mejores resultados en la reducción de la altura sinusal. El relleno con betafosfato tricálcico muestra mejor relación altura de injerto-longitud del implante. Los resultados de reducción en altura se mantienen estables tras 12 meses y la perforación de membrana sinusal es la complicación más usual(AU)

Introduction: Elevations of the maxillary sinus lead to anatomical modifications, which can influence on its function. Objective: To characterize sinus elevations from the clinical and anatomical point of view, and comment on their impact on the success of positioned implants. Material and Method: A descriptive prospective study was conducted in 56 patients who underwent sinus elevations with very well established inclusion criteria in Raúl González Sánchez Faculty of Odontology from January 2013 to January 2015. Each patient was interviewed, and submitted to a clinical exam. Also, an orthopantomography analysis was made before treatment, and 6, 12, 18, and 24 months after the intervention. Variables such as age, sex, topographic distribution, implemented surgical technique, padding material, sinus height, bone level, and complications were analyzed. Results:Female patients predominated (60,7 percent), aging from 30-39 years (60,7 percent). The overall success rate at 2 years following implantation was 92,1 percent. The final reduction of average sinus height with the lateral window technique was the highest (10,1 mm). The best relationship in terms of height and length of graft was obtained with beta-tricalcium phosphate (1,66). Membrane perforation smaller than 5mm was the most recorded intraoperative complication (28,6 percent). Conclusions: The lateral window technique exhibits better results in the reduction of sinus height. Padding with beta-tricalcium phosphate shows a better relationship in terms of height and length of graft. The results in height reduction are stable after 12 months, and sinus membrane perforation is the most common complication(AU)

Somatic Hypermutation Defects in Common Variable Immune Deficiency.

Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by impaired antibody production and recurrent infections. In the last 20 years, several groups have reported that B cells from CVID patients have an impaired somatic hypermutation (SHM). The reported frequency of this defect among CVID patient cohorts is highly variable and so is the methodology used to evaluate this process. Interestingly, the low level of SHM on B cells from CVID patients has been correlated with the presence of infectious and non-infectious complications. In this review, an overview of the studies regarding SHM in CVID patients is presented. We highlight the importance of SHM studies in CVID patients as a clinical tool due to the reported association with clinical complications by several groups. We also considered SHM measurement useful to guide future investigations in order to identify genetic defects involved in the development of the disease.