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1.
Orv Hetil ; 161(18): 747-755, 2020 05 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32338478

RESUMO

Introduction and aim: Peripheral artery disease and lower extremity artery disease occur in 4 to 6% of the population. In Hungary, the number of major amputations was 6798 in the observed period. With timely and appropriate treatment, the number of leg amputations (30-day mortality: 20%, 2-year mortality: 40-60%) can be effectively reduced. The purpose of this study is to identify the territorial differences within Hungary with regard to the care pathways of these diseases. Method: We performed a retrospective data analysis of the peripheral vascular treatment using 2015-2017 claim data of the National Health Insurance Fund of Hungary. Territorial differences in mortality rates were examined by descriptive statistics. Correlation analysis was performed to describe any relationship between mortality rates and other factors. Results: The subregional level analysis (n = 175) revealed 4 times differences across the country proving that high domestic amputation rates are partially due to the extreme amputation rates in 30 percent of the subregions. Multiple stratified regression analysis revealed that the proportion of districts where endovascular therapy is not available (n = 159), the university education level of the population (ß1 = -0.13, 95% CI: -0.18 to -0.09) and the proportion of those over 65 years of age (ß1 = 0.14, 95% CI: 0.03-0.24) were significantly associated with amputation rate. In districts with available endovascular therapy (n = 14), age distribution of population (ß1 = 0.7, 95% CI: 0.42-0.98) was associated with the frequency of amputations. Conclusion: Regional and social disparities in incidence, prevalence and mortality rates significantly vary greatly across Hungary, but also provider capacities (with relevant competencies) influence strongly the development and progression of the disease. Orv Hetil. 2020; 161(18): 744-755.


Assuntos
Amputação/mortalidade , Amputação/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Idoso , Geografia , Humanos , Hungria/epidemiologia , Revisão da Utilização de Seguros , Doença Arterial Periférica/terapia , Estudos Retrospectivos , Fatores Socioeconômicos
2.
BMC Public Health ; 20(1): 212, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046698

RESUMO

BACKGROUND: To assess the prevalence of urban-rural disparity in lower extremities amputation (LEA) among patients with diabetes and to explore whether patient-related or physician-related factors might have contributed to such disparity. METHODS: This was a population-based study including patients with diabetes aged ≥55 years from 2009 to 2013. Among them, 9236 received LEA. Data were retrieved from Taiwan's National Health Insurance (NHI) claims. A multiple Poisson regression model was also employed to assess the urban-rural difference in LEA prevalence by simultaneously taking into account socio-demographic variables and density of practicing physicians. RESULTS: Between 2009 and 2013, the annual prevalence of LEA declined from 30.4 to 20.5 per 10,000 patients. Compared to patients from urban areas, those who lived in sub-urban and rural areas suffered from a significantly elevated prevalence of LEA, with a prevalence rate ratio (PRR) of 1.47 (95% CI, 1.39-1.55) and 1.68 (95% CI, 1.56-1.82), respectively. The density of physicians who presumably provided diabetes care can barely explain the urban-rural disparity in LEA prevalence. CONCLUSIONS: Although the universal health insurance has largely removed financial barriers to health care, the urban-rural disparity in LEA prevalence still exists in Taiwan after nearly two decades of the NHI program.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus/terapia , Disparidades nos Níveis de Saúde , Extremidade Inferior , População Rural/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Taiwan/epidemiologia , Fatores de Tempo
3.
Rev Med Suisse ; 16(682): 366-369, 2020 Feb 19.
Artigo em Francês | MEDLINE | ID: mdl-32073772

RESUMO

In 2010 the canton of Vaud has innovated by launching the Cantonal Diabetes Program (PcD) aimed at reducing the impact of diabetes on the population. The evaluation after 7 years shows that some clinical examinations are performed more regularly and lower limb amputations tend to decrease. The contributions and interprofessional collaborations resulting from the PcD provide concrete guidelines for the implementation of a more comprehensive strategy of prevention and management of non-communicable diseases. It should be developed according to a chronicity model integrating social vulnerability.


Assuntos
Diabetes Mellitus/prevenção & controle , Diabetes Mellitus/terapia , Doenças não Transmissíveis/prevenção & controle , Doenças não Transmissíveis/terapia , Saúde Pública/educação , Amputação/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Humanos , Doenças não Transmissíveis/epidemiologia , Suíça/epidemiologia
4.
BMC Infect Dis ; 20(1): 23, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914940

RESUMO

BACKGROUND: The prevalence of diabetes mellitus continues to inexorably rise in the United States and throughout the world. Lower limb amputations are a devastating comorbid complication of diabetes mellitus. Osteomyelitis increases the risk of amputation fourfold and commonly presages death. Antimicrobial therapy for diabetic foot osteomyelitis (DFO) varies greatly, indicating that high quality data are needed to inform clinical decision making. Several small trials have indicated that the addition of rifampin to backbone antimicrobial regimens for osteomyelitis outside the setting of the diabetic foot results in 28 to 42% higher cure rates. METHODS/DESIGN: This is a prospective, randomized, double-blind investigation of the addition of 6 weeks of rifampin, 600 mg daily, vs. matched placebo (riboflavin) to standard-of-care, backbone antimicrobial therapy for DFO. The study population are patients enrolled in Veteran Health Administration (VHA), ages ≥18 and ≤ 89 years with diabetes mellitus and definite or probable osteomyelitis of the foot for whom an extended course of oral or intravenous antibiotics is planned. The primary endpoint is amputation-free survival. The primary hypothesis is that using rifampin as adjunctive therapy will lower the hazard rate compared with the group that does not use rifampin as adjunctive therapy. The primary hypothesis will be tested by means of a two-sided log-rank test with a 5% significance level. The test has 90% power to detect a hazard ratio of 0.67 or lower with a total of 880 study participants followed on average for 1.8 years. DISCUSSION: VA INTREPID will test if a rifampin-adjunctive antibiotic regimen increases amputation-free survival in patients seeking care in the VHA with DFO. A positive finding and its adoption by clinicians would reduce lower extremity amputations and their associated physical and emotional impact and reduce mortality for Veterans and for the general population with diabetic foot osteomyelitis. Given that rifampin-adjunctive regimens are currently employed for therapy for the majority of DFO cases in Europe, and only in a small minority of cases in the United States, the trial results will impact therapeutic decisions, even if the null hypothesis is not rejected. TRIAL REGISTRATION: Registered January 6, 2017 at ClinicalTrials.gov, NCT03012529.


Assuntos
Amputação , Pé Diabético/tratamento farmacológico , Osteomielite/tratamento farmacológico , Rifampina/uso terapêutico , Veteranos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Pé Diabético/cirurgia , Método Duplo-Cego , Feminino , Pé/microbiologia , Pé/patologia , Pé/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Osteomielite/cirurgia , Placebos , Estudos Prospectivos , Prevenção Secundária/métodos , Veteranos/estatística & dados numéricos , Adulto Jovem
5.
BMC Public Health ; 20(1): 54, 2020 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937275

RESUMO

BACKGROUND: To analyze the trend of lower extremity major amputations (MA) among patients with type 2 diabetes mellitus (T2DM) in the Regions of Spain from year 2001 until 2015. METHODS: Descriptive study of 40,392 MA. Data were obtained from the national hospital discharge database in patients with T2DM. The incidence rate was calculated in each Region, in addition to the incidence ratios (IR) between annual incidence and incidence of the year 2001. The length of hospital stay and mortality risks were analyzed using regression models adjusted for sex, age and smoking. RESULTS: The major amputations incidence rate per 100,000 person-years was 0.48 in Spain; Canary Islands showed the highest incidence (0.81). The trend was a slight decrease or stability of the incidence in all Regions except in the Canary Islands (IR2015 = 2.0 [CI95% = 1.5, 2.6]) and in Madrid (IR2015 = 0.1 [CI95% = 0.1, 0.2]). Mortality after major amputations was 10% in Spain; Cantabria suffered the highest risk of death [1.7 (CI95% = 1.4; 2.1), p < 0.001] and La Rioja the lowest risk (0.5 [CI95% = 0.2; 0.9]; p = 0.026). The longest hospital stay was registered in the Canary Islands [(CI95% = 11.4;13.3], p < 0.001)], and the shortest in the Valencian Community [(CI95% = - 7.3; - 5.8), p < 0.001)]. CONCLUSION: MA in T2DM followed a growing trend in the Canary Islands, which diverged from the downward trend in Spain. The variability of mortality and hospital stay, suggest to review the clinical management in some Regions. Sudden incidence decrease in Madrid suggests checking the record procedures of hospital discharges.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Extremidade Inferior/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia
6.
Eur J Vasc Endovasc Surg ; 59(2): 265-275, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31889657

RESUMO

OBJECTIVE: The aim was to review and analyse the literature on clinical outcomes of drug coated balloon (DCB) vs. standard percutaneous transluminal angioplasty (PTA) for the treatment of infrapopliteal arterial disease. METHODS: This is a systematic review and meta-analysis. The MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for studies published between January 2008 and November 2018. Two authors independently performed the search, study selection, assessment of methodological quality and data extraction. Studies were eligible when reporting PTA and DCB outcomes in infrapopliteal arteries, published in English, human studies, and full text was available. Methodological quality was determined by MINORS and Cochrane risk of bias tool. GRADE methodology was used to rate the evidence for observed outcomes. The primary outcome was the 12 month limb salvage rate. Secondary outcomes were 12 month survival, amputation free survival (AFS), restenosis, and target lesion revascularisation (TLR) rates. Inclusion criteria for pooling data were randomised controlled trials and comparative studies with 12 month outcomes. RESULTS: Ten studies representing 1593 patients met the inclusion criteria. The quality was assessed as moderate or low. Data from five studies were pooled, and 12 month outcomes for DCB vs. PTA were limb salvage rate, 94.0% vs. 95.7% (odds ratio (OR), 0.92; 95% confidence interval (CI), 0.39-2.21); and survival rate, 89.8% vs. 92.9% (OR 0.69; 95% CI 0.39-1.21). Data from four studies were pooled, and 12 month outcomes for PTA vs. DCB were restenosis rate, 62.0% vs. 32.9% (OR 2.87; 95% CI 0.83-9.92); and TLR rate, 27.8% vs. 14.0% (OR 2.76; 95% CI 0.90-8.48). Pooled data from two studies showed 12 month AFS rate for DCB vs. PTA; 82.5% vs. 88.7% (OR 0.79; 95% CI 0.23-2.75). No statistically significant differences were found. CONCLUSION: Based on this systematic review and meta-analysis no significant differences in limb salvage, survival, restenosis, TLR, and AFS rates were found when DCB angioplasty was compared with standard PTA.


Assuntos
Angioplastia com Balão/instrumentação , Materiais Revestidos Biocompatíveis , Salvamento de Membro/métodos , Doença Arterial Periférica/cirurgia , Amputação/estatística & dados numéricos , Angioplastia com Balão/métodos , Stents Farmacológicos , Artéria Femoral/cirurgia , Humanos , Salvamento de Membro/instrumentação , Paclitaxel/administração & dosagem , Doença Arterial Periférica/mortalidade , Artéria Poplítea/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Grau de Desobstrução Vascular
7.
Eur J Vasc Endovasc Surg ; 59(2): 255-264, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31917126

RESUMO

OBJECTIVE: Acute lower limb ischaemia (ALI) as a result of popliteal artery aneurysm (PAA) thrombosis represents a significant problem. The aim of this study was to investigate outcome of intra-operative intra-arterial thrombolysis in the treatment of acute ischaemia due to PAA thrombosis in terms of major adverse limb events (MALE), overall survival, and intrahospital complications, especially those associated with bleeding. METHODS: A total of 156 patients with Rutherford grade IIa and IIb acute ischaemia resulting from PAA thrombosis were admitted between 1 January 2011 and 1 January 2017. The patients were divided into two groups, those who underwent additional treatment with intra-operative intra-arterial thrombolysis (20 patients), and those who did not (136 patients). By using covariables from baseline and angiographic characteristics, a propensity score was calculated for each patient. Each patient who underwent intra-operative thrombolysis was matched to four patients from the non-thrombolysis group. Thus, comparable patient cohorts (20 in the thrombolysis and 80 in the non-thrombolysis group) were identified for further analysis. The primary end point was MALE and the secondary endpoint all cause mortality. RESULTS: After a median follow up of 55 months, the estimated MALE rate was significantly lower in the thrombolysis group (30% vs. 65%, chi square = 10.86, p < .001, log rank test). Also, patients in the thrombolysis group had a significantly lower mortality rate (20% vs. 42.65%, chi square = 3.65, p = .05, log rank test). The thrombolysis group had wound/haematoma related interventions performed more commonly (25% in thrombolysis vs 8%, in non-thrombolysis group), but the difference was not significant (p=.013). There were no cases of major (intracranial and gastrointestinal) bleeding in either group. CONCLUSION: The data suggest that intra-operative thrombolysis in the treatment of selected patients with ALI due to PAA thrombosis has long term MALE and overall survival benefits, without a significant risk of major, life threatening bleeding complications.


Assuntos
Aneurisma/cirurgia , Arteriopatias Oclusivas/terapia , Artéria Poplítea/patologia , Terapia Trombolítica/métodos , Trombose/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Aneurisma/complicações , Aneurisma/mortalidade , Arteriopatias Oclusivas/etiologia , Arteriopatias Oclusivas/mortalidade , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/epidemiologia , Isquemia/etiologia , Isquemia/terapia , Estimativa de Kaplan-Meier , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Trombose/complicações , Trombose/mortalidade , Resultado do Tratamento , Grau de Desobstrução Vascular
8.
Ann R Coll Surg Engl ; 102(1): 14-17, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31155915

RESUMO

INTRODUCTION: Infra-inguinal vascular reconstruction with active groin infection is a concerning issue. Using resistant grafts to infection is the most adopted approach. However, in absence of these materials in acute situations, the trans-obturator approach allows for limb revascularisation avoiding the infected site. We evaluated the effectiveness of this approach in patients who needed lower limb revascularisation with an ipsilateral groin infection. MATERIALS AND METHODS: A retrospective study was conducted over a four-year period. RESULTS: Over this period, 13 patients underwent trans-obturator reconstructions (13 external iliac-popliteal above-knee and one aortobipopliteal above-knee bypass). Seven patients had been previously revascularised and were admitted for graft infection (six infra-inguinal bypasses, one axillo-bifemoral bypass). Four presented with acute limb ischaemia, three with groin haematoma and one with a groin abscess. The remaining cases consisted of drug-addicted patients with injury of femoral vessels due to self-injection of drugs. The patients underwent reconstructions with autologous grafts which complicated early with groin haematoma. After transobturator revascularisation, the groin underwent debridement with applying vacuum-assisted wound closure device. CONCLUSION: The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound.


Assuntos
Abscesso Abdominal/complicações , Infecções Bacterianas/complicações , Perna (Membro)/irrigação sanguínea , Reperfusão/métodos , Idoso , Amputação/estatística & dados numéricos , Anastomose Cirúrgica/métodos , Prótese Vascular , Feminino , Virilha , Humanos , Isquemia/cirurgia , Masculino , Cuidados Pós-Operatórios , Estudos Retrospectivos , Terapia de Salvação/estatística & dados numéricos
9.
J Trauma Acute Care Surg ; 88(2): 197-206, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31804418

RESUMO

BACKGROUND: Traumatic popliteal arterial injury (TPAI) is associated with a risk of both limb loss and long-term morbidity due to prolonged ischemia and the often-associated musculoskeletal injuries. Long-term functional outcome following this injury has not been adequately studied. We evaluated patients with TPAI to determine if there was an improvement in functional outcome over time. We hypothesized that both the initial severity of ischemia and the associated injuries limited the ability of patients to improve functional outcome. METHODS: Patients with TPAI for 20 years were identified. All patients had at least a 2-year follow-up. Functional outcomes were measured using the Boston University Activity Measure for Post-Acute Care to assess basic mobility (BM) and daily activity (DA). Multiple linear regression, adjusted for age, severity of injury and shock, operative complexity, associated injuries, ischemic time, and length of follow-up were used to identify predictors of functional outcome after TPAI. RESULTS: A total of 214 patients were identified: 123 penetrating (57%) and 91 blunt (43%). Overall mortality was 1.9% (all in-hospital), and amputation occurred in 10%. Of the 210 survivors, follow-up was obtained in 145 patients (69%). Median follow-up was 9.2 years (interquartile range, 5.7-15.7 years). Mean Activity Measure for Post-Acute Care scores for BM and DA were 78 and 75, respectively, both signifying mild impairment (normal, >84). Multiple linear regression failed to identify increasing length of follow-up as a predictor of improved functional outcomes. Only age, lower extremity fracture, and ischemic time were identified as predictors of decreased BM and DA. CONCLUSION: Increasing age, lower extremity fracture, and prolonged ischemic time worsened long-term functional outcomes. Functional outcome did not improve over time, suggesting that maximal recovery may be achieved within the first 2 years postinjury. Thus, early and effective revascularization remains the only potentially modifiable risk factor for improving functional outcomes following TPAI. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Amputação/estatística & dados numéricos , Procedimentos Endovasculares , Isquemia/cirurgia , Traumatismos da Perna/cirurgia , Extremidade Inferior/irrigação sanguínea , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Isquemia/etiologia , Isquemia/mortalidade , Traumatismos da Perna/complicações , Traumatismos da Perna/mortalidade , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/lesões , Artéria Poplítea/cirurgia , Prognóstico , Sobreviventes/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
10.
Am J Surg ; 219(1): 38-42, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31604488

RESUMO

INTRODUCTION: Major venous injury (MVI) affecting the lower extremity can result in subsequent amputation. The contribution of intraoperative resuscitation efforts on the need for amputation is not well defined. We hypothesized that intraoperative large volume crystalloid resuscitation (LVCR) increases the risk of amputation after MVI, while massive transfusion (MT) does not. METHODS: We performed a retrospective review of patients with infrarenal MVI from 2005 to 2015 at seven urban level I trauma centers. The outcome of interest was the need for secondary amputation. RESULTS: 478 patients were included. 31 (6.5%) patients with MVI required amputation. LVCR(p < 0.001), combined arterial/venous injury (p = 0.001), and associated fracture (p = 0.001) were significant risk factors for amputation. MT did not significantly increase amputation risk (p = 0.44). Multivariable logistic regression model demonstrated that patients receiving ≥5L LVCR(aOR (95% CI): 9.7 (2.9, 33.0); p < 0.001), with combined arterial/venous injury (aOR (95% CI):3.6 (1.5, 8.5); p = 0.004), and with an associated fracture (aOR (95% CI):3.2 (1.5, 7.1); p = 0.004) were more likely to require amputation. CONCLUSION: Patients with MVI who receive LVCR, have combined arterial/venous injuries and have associated fractures are more likely to require amputation. MT was not associated with delayed amputation.


Assuntos
Amputação/estatística & dados numéricos , Transfusão de Sangue , Soluções Cristaloides/uso terapêutico , Cuidados Intraoperatórios , Perna (Membro)/irrigação sanguínea , Ressuscitação/métodos , Veias/lesões , Veias/cirurgia , Adulto , Soluções Cristaloides/efeitos adversos , Feminino , Humanos , Escala de Gravidade do Ferimento , Cuidados Intraoperatórios/efeitos adversos , Masculino , Estudos Retrospectivos , Medição de Risco , Adulto Jovem
11.
BMC Surg ; 19(1): 170, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722699

RESUMO

BACKGROUND: We aimed to explore the surgical outcomes of major lower extremity amputation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan. METHODS: Clinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent amputations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of amputation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of amputation), and cumulative mortality rate at 1 year. The impact of the operating surgeon's specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated. RESULTS: The study cohort comprised 140 patients who underwent MLEA (110 below-knee amputations [BKA] and 30 above-knee amputations [AKA]; ratio: 3:1; 86 men; 54 women; mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients (p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA (p = 0.006). LOS was considerably longer for AKA (p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA. CONCLUSIONS: In developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries.


Assuntos
Amputação/estatística & dados numéricos , Isquemia/cirurgia , Extremidade Inferior/cirurgia , Centros de Atenção Terciária , Idoso , Feminino , Seguimentos , Humanos , Isquemia/epidemiologia , Jordânia/epidemiologia , Tempo de Internação , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
12.
Pan Afr Med J ; 33: 103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31489081

RESUMO

Introduction: Foot deformities and amputations are parameters that have been studied as risk factors for diabetic foot ulceration (DFU). However, inclusion of "foot deformities" and "amputations" in a single, broad variable and with reference to the severity of these deformities, may better characterize subjects who are prone to develop DFU. Methods: The objective of the study was the examination of amputative and non-amputative foot deformities severity as risk factor for DFU in relation with the other established risk factors. A cross-sectional and case-control study was conducted from October 2005 to November 2016. One hundred and thirty-four subjects with type 1 and 2 diabetes, with and without active foot ulcers, participated. A structured quantitative interview guide was used. Univariate logistic regression analysis for the literature's established risk factors was performed, as well as for two versions of the "amputative and non-amputative foot deformities severity" variable. Subsequently, multivariate logistic regression analysis (MLRA) for three models and receiver operating characteristic (ROC) curve analysis were carried out. Results: From the MLRA, only PAD (peripheral arterial disease) was significant (OR 3.56, 95% CI 1.17-10.82, P=0.025 and OR 3.33, 95% CI 1.02-10.08, P=0.033). Concerning the ROC curve analysis of the models, the one with the three categories amputative and non-amputative foot deformities severity variable, had the greatest area under the ROC curve (0.763, P<0.001). Conclusion: A united variable for lower extremity amputations and other foot deformities with reference to their severity, could be more helpful to the clinicians in identifying patients with diabetes at risk for foot ulceration.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Deformidades do Pé/epidemiologia , Idoso , Estudos de Casos e Controles , Estudos Transversais , Pé Diabético/etiologia , Feminino , Humanos , Modelos Logísticos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Projetos Piloto , Curva ROC , Fatores de Risco , Índice de Gravidade de Doença
13.
J Surg Res ; 243: 531-538, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31377494

RESUMO

BACKGROUND: Although New York's Medicaid expansion increased coverage in 2001, little is known regarding changes in surgical care utilization among patients with vascular disease. We sought to measure the impact of expansion on the rates of both vascular procedures and amputations. MATERIALS AND METHODS: A retrospective analysis was performed using the State Inpatient Databases of New York and Arizona, 1998-2006. Patients aged 18-64 who underwent lower extremity vascular surgery procedures or amputations between 1998 and 2006 were included. Outcomes included rates of total vascular, open vascular, and endovascular procedures, in addition to rates of amputation. A difference-in-difference analysis measured changes in the rates of procedure types, while adjusting for temporal trends in both states. RESULTS: In this cohort (n = 112,624), Medicaid expansion was not associated with a change in mortality (odds ratio 0.92, P = 0.5). Expansion was associated with a lower incidence of total vascular procedures (incidence rate ratio [IRR] 0.65, P < 0.001) and open vascular procedures (IRR 0.92, P = 0.002), but a higher incidence of endovascular procedures (IRR 1.13, P < 0.001). There was no change in the rate of amputations (IRR 1.02, P = 0.58). In patients with chronic limb-threatening ischemia (n = 12,668), expansion was associated with a lower incidence of total procedures (IRR 0.59, P < 0.001) and endovascular procedures (IRR 0.59, P < 0.001) but a higher incidence of amputations (IRR 1.43, P = 0.001) and higher odds of mortality (odds ratio 2.21, P = 0.032). CONCLUSIONS: After Medicaid expansion, the rates of total vascular procedures decreased, with no impact on amputations rates. Furthermore, the utilization of limb-saving procedures in patients with chronic limb-threatening ischemia did not increase.


Assuntos
Amputação/estatística & dados numéricos , Procedimentos Endovasculares/estatística & dados numéricos , Salvamento de Membro/estatística & dados numéricos , Arizona , Feminino , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , New York , Estudos Retrospectivos , Estados Unidos
14.
Ulus Travma Acil Cerrahi Derg ; 25(4): 389-395, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297775

RESUMO

BACKGROUND: The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. METHODS: A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). RESULTS: In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84+-1.84 h in the TVS group and 5.95+-1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. CONCLUSION: We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.


Assuntos
Artérias/lesões , Traumatismos da Perna/cirurgia , Extremidade Inferior/irrigação sanguínea , Lesões do Sistema Vascular/cirurgia , Adulto , Idoso , Amputação/estatística & dados numéricos , Conflitos Armados , Artérias/diagnóstico por imagem , Artérias/cirurgia , Embolectomia com Balão , Angiografia por Tomografia Computadorizada , Constrição , Feminino , Humanos , Escala de Gravidade do Ferimento , Traumatismos da Perna/diagnóstico por imagem , Traumatismos da Perna/etiologia , Ligadura , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síria , Trombose/cirurgia , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/complicações , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/diagnóstico por imagem , Veias/lesões , Veias/cirurgia , Adulto Jovem
15.
Pan Afr Med J ; 32: 209, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312321

RESUMO

Introduction: This study aims to determine the clinical and evolutionary profile of skin and soft tissue lesions in diabetics followed up at the dressing room. Methods: We conducted an observational descriptive and analytical study in the dressing room of the Marc Sankalé Diabetes Center, Dakar from 1 January to 31 December 2017. Our study focused on diabetics who were examined in the dressing room. Results: A total of 37.173 procedures were recorded at the Marc Sankalé Diabetes Center; 16.418 patients were treated in the dressing room, representing a prevalence of 14.16%. The average age of patients was 56,6 ±12 years, the sex ratio (M/F) was 0,88. Type 2 diabetes predominated (78,97%) and the average disease duration was 8.06 ± 7.9 years. The mean capillary blood glucose concentration was 2.4±1 g/l. Diabetic neuropathy was found in 72.33% of patients. Limb lesions were found in 93,98% of patients(1185 cases). The most common lesions included: ulcer (46,76%), abscess (13.46%), phlegmon (13.20%), gangrene (8.41%), erysipelas (3.78%), perforating ulcer (3.53%), intertrigo (3.95%). The lesions were be divided into infectious lesions (61,41), non-infectious lesions(33,50%), pure vascular lesions (1.57%) and mixed lesions (3.70%). Out of 1189 patients 7.57% had had osteitis. The germs found were Gram-positive bacteria (12.70%), Gram-negative bacteria (23.80%). Amputation was performed according to the topographical features of the lesion (p=0.00), the type of lesion (p=0.000), the seniority of diabetes (p=0.02), the type of diabetes (p=0.008), the presence of osteitis (p=0.006). Minor amputation was performed in 43,33% of cases, major amputation in 37.43% of cases; 70 deaths were recorded (5.89%). Conclusion: Skin and soft tissue lesions were dominated by diabetic foot. Mortality is not negligible and the risk of amputation was statistically related to the topographical features of the lesion, the type of lesion, the seniority and the type of diabetes and the presence of osteitis.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Dermatopatias/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Amputação/estatística & dados numéricos , Glicemia/análise , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Neuropatias Diabéticas/epidemiologia , Feminino , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Senegal/epidemiologia , Dermatopatias/patologia , Infecções dos Tecidos Moles/patologia , Adulto Jovem
16.
J Plast Surg Hand Surg ; 53(6): 341-346, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31287352

RESUMO

Domestic cat bites are common and are often treated by simple wound care with good outcome. However, delayed presentation may lead to significant morbidity or even mortality. Twenty cases of cat bites to the hand and wrist were retrospectively reviewed between 2014 and 2018. Data included patient demographics, anatomical site of injury, microbiology results, method of treatment and surgical outcome. The subjects were 18 females and two males aged 27-86 years (mean age of 58 years). Eleven patients (Group A) were presented within 48 hours of their injury. Nine patients (Group B) presented later than 48 hours. Of these, 78% (n = 7) underwent multiple operations secondary to septic arthritis, osteomyelitis, necrotising fasciitis and deep collection. Mean length of hospital stay was 3.4 days in Group A, and 9.2 days in Group B, (p < .01). Four patients underwent digital or ray amputations. The index finger was the most common site of injury (45%). Almost 40% of cases had flexor tendon sheath infection of the fingers. Pasteurella species was isolated from 35% of infected wounds. Mean duration of antibiotic treatment and length of hospital stay were significantly longer in Group B (p < .05). Delayed presentation of infected cat bites increased the likelihood of more complicated surgeries such as amputation. Diabetic fingers with established peripheral neuropathy were more likely to undergo amputation. We recommend that any symptomatic cat bites to the upper limb, especially hand and wrist, must be treated promptly, essentially within 48 hours of injury, particularly in immunocompromised population.


Assuntos
Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Animais , Antibacterianos/uso terapêutico , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Gatos , Complicações do Diabetes , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/epidemiologia , Osteomielite/microbiologia , Osteomielite/terapia , Pasteurella/isolamento & purificação , Infecções por Pasteurella/epidemiologia , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/terapia , Tempo para o Tratamento , Reino Unido/epidemiologia , Infecção dos Ferimentos/epidemiologia , Infecção dos Ferimentos/microbiologia , Infecção dos Ferimentos/terapia
17.
Ann Surg Oncol ; 26(11): 3526-3534, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31338771

RESUMO

BACKGROUND: The benefits of systematic re-excision (RE) after initial unplanned excision (UE) of soft tissue sarcoma (STS) are unknown. OBJECTIVE: The aim of this study was to evaluate the impact of delayed RE versus systematic RE after UE on overall survival (OS), metastatic relapse-free survival (MRFS), local relapse-free survival (LRFS), and rate of amputation. METHODS: Patients who underwent complete UE, without metastasis or residual disease, for primary extremity or superficial STS between 2007 and 2013 were analyzed. The amputation rate, LRFS, MRFS, and OS were assessed in cases of systematic RE in sarcoma referral centers (Group A), systematic RE outside of community centers (Group B), or without RE (Group C). RESULTS: Groups A, B, and C included 300 (48.2%), 71 (11.4%), and 251 (40.4%) patients, respectively. Median follow-up was 61 months and 5-year OS was 88.4%, 87.3%, and 88% in Groups A, B, and C, respectively (p = 0.22), while 5-year MFRS was 85.4%, 86.2%, and 84.9%, respectively (p = 0.938); RE (p = 0.55) did not influence MRFS. The 5-year LRFS was 83%, 73.5%, and 63.8% in Groups A, B and C, respectively (p = 0.00001). Of the 123 local recurrences observed, 0/28, 1/15, and 5/80 patients in Groups A, B, and C, respectively, required amputation (p = 0.41). Factors influencing LRFS were adjuvant radiotherapy [hazard ratio (HR) 0.21; p = 0.0001], initial R0 resection (HR 0.24, p = 0.0001), and Group A (HR 0.44; p = 0.01). CONCLUSION: Systematic RE in sarcoma centers offers best local control but does not impact OS. Delayed RE at the time of local relapse, if any, could be an option.


Assuntos
Amputação/estatística & dados numéricos , Extremidades/cirurgia , Recidiva Local de Neoplasia/mortalidade , Neoplasia Residual/mortalidade , Reoperação/estatística & dados numéricos , Sarcoma/mortalidade , Extremidades/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neoplasia Residual/patologia , Neoplasia Residual/cirurgia , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgia , Taxa de Sobrevida
18.
Diabetes Metab Syndr ; 13(2): 905-912, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336544

RESUMO

BACKGROUND: Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION: In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.


Assuntos
Amputação/estatística & dados numéricos , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/epidemiologia , Complicações do Diabetes/etiologia , Pé Diabético/etiologia , Guiana/epidemiologia , Humanos , Incidência , Fatores de Risco
19.
Diabetes Metab Syndr ; 13(2): 953-958, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336550

RESUMO

BACKGROUND: Due to poor blood circulation, the prevalence of foot ulcer is extensively reported among diabetic patients. Diabetic neuropathy is the critical factor of diabetes that can affect the nerves. OBJECTIVE: To examine the outcomes and correlation between TcPO2 and ulcer outcomes among diabetic patients. MATERIAL AND METHODS: A prospective cohort design has been employed to compare and correlate TcPO2 group with ulcer outcomes. A total of 192 patients were enrolled, who underwent diagnosis for ulcer outcome. Descriptive analysis and Pearson Correlation were used for data analysis via SPSS version 20. RESULTS: The prevalence of minor amputation among diabetic patients in 25-40 mmHg 75 (85.22%) and >40 mmhG 73 (84.88%) group is reported for ulcer outcome. Mostly diabetic patients were healed with intact skin (male = 36, female = 73), and improved ulcer healing (male = 23, female = 43). Correlation between ulcer size (p = .016), ABI (p = .044), TBI (p = .000), Adiponectin (p = .009), HbA1c (p = .033), and S. creatinine (p = .025) was significant with TcpO2 group. CONCLUSIONS: The study concluded that there is a positive and significant correlation between TcPO2 group and ulcer outcome. There is a positive association between TcPO2 baseline and degree of ulcer healing with intact skin.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus/fisiopatologia , Pé Diabético/terapia , Oxigênio/sangue , Cicatrização , Pé Diabético/sangue , Pé Diabético/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
20.
Diabetes Metab Syndr ; 13(2): 959-963, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31336551

RESUMO

BACKGROUND AND AIM: Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene. METHODS: We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation. RESULTS: One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up. CONCLUSION: Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Gangrena/cirurgia , Osteomielite/fisiopatologia , Qualidade de Vida , Dedos do Pé/cirurgia , Idoso , Feminino , Seguimentos , Gangrena/epidemiologia , Gangrena/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Arábia Saudita/epidemiologia , Cicatrização
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