RESUMO
Hip fractures (HF) are prevalent and involve high morbidity and mortality so improving their management is important. HF registries are a good way to improve knowledge about this condition and its quality of care, while at the same time reducing clinical variability, optimizing efficiency, improving outcomes, and reducing costs. INTRODUCTION: Hip fractures (HF) are a prevalent fragility fracture secondary to osteoporosis that involves high morbidity and mortality. They are low-impact fractures, resulting from a fall from a standing or sitting height. Despite numerous Clinical Practice Guidelines that establish uniform recommendations for their care, great variability persists regarding clinical and healthcare outcomes. Fracture registries can help detect deficits and establish measures to improve care. The objective of this work is to analyze the contents that a HF registry should have and to compare the characteristics of some national HF registries. METHODS: A literature search was conducted on several national hip fracture registries, and those that contain relevant information on the variables and their outcomes were selected. RESULTS: The selected HF registries were compared using the parameters they measure as well as the outcomes in the different countries. The variables collected in the majority of the databases and those that give useful information are as follows: sociodemographic variables (age, sex, place of residence), clinical variables (function before and after HF, anesthesia risk as measured by the ASA score, type of fracture, type of surgery and anesthesia, and in-hospital and 1-month mortality), and healthcare variables (pre-operative and overall stay, presence of collaboration with orthogeriatrics or with any clinician in addition to the surgeon, secondary prevention of new fractures by assessing the fall risk, and need for osteoporosis treatment). CONCLUSION: The recording of HF cases in different countries improves knowledge about handling this condition and its quality of care, while at the same time reducing clinical variability, optimizing efficiency, improving outcomes, and reducing costs. The debate on the variables that should be recorded is timely, such as organizing how to collect each measurement, and even trying to unify the national and international registries or using a current proposal such as the one from the Fragility Fracture Network.
Assuntos
Fraturas do Quadril/epidemiologia , Fraturas por Osteoporose/epidemiologia , Qualidade da Assistência à Saúde , Sistema de Registros , Bases de Dados Factuais , Fraturas do Quadril/terapia , Humanos , Fraturas por Osteoporose/terapia , Avaliação de Resultados em Cuidados de Saúde , Melhoria de QualidadeRESUMO
PURPOSE: The medical morbidity and mortality associated with neck of femur fractures is well-documented, whereas there is limited data for patient-reported outcomes. The aim of this study was to characterize the impact of neck of femur fractures on activities of daily living and patient-reported health-related quality of life. METHODS: Design and participants: Multicentric prospective cohort study. Consecutive sample patients with fragility hip fracture over 50 years old admitted in 48 hospitals in Spain. OUTCOMES: daily living activity function (Barthel Index) and health-related quality of life (EQ-5D) pre-fracture, admission to hospital and at 1- and 4-month follow-up post-fracture. STATISTICS: Barthel and EQ-5D over time are described as mean (SD) and median (interquartile range). RESULTS: A total of 997 patients were recruited at baseline with 4-month outcomes available for, and 856 patients (89.5%). Barthel Index fell from 78.77 (23.75) at baseline to 43.62 (19.86) on admission to hospital with the fracture. Scores partially recovered to 54.89 (25.40) and 64.09 (21.35) at 1- and 4-month post-fracture, respectively. EQ-5D fell from a median of 0.75 (0.47-0.91) to - 0.01 (- 0.03 to 0.51) on admission. Partial recovery was observed again to (0.51 (- 0.06 to 0.67)) and (0.60 (0.10 to 0.80)) at 1- and 4-month post-fracture, respectively. CONCLUSIONS: Hip fracture results in a large decline in the ability to perform activities of daily living and patient-reported health-related quality of life with only partial recovery amongst survivors 4-month post-fracture.
Assuntos
Atividades Cotidianas , Fraturas do Colo Femoral/psicologia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Feminino , Fraturas do Colo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , EspanhaRESUMO
This case report describes an atypical case of duodenal leishmaniasis in an elderly patient not infected with human immunodeficiency virus. Investigation of this 84 year old woman with a constitutional syndrome and dysphagia revealed anaemia of chronic disorder, a high erythrocyte sedimentation rate, and polyclonal hypergammaglobulinaemia. Abdominal ultrasonography revealed thickening of the stomach wall, which was seen to be inflamed during gastroscopy. Duodenal histology revealed numerous leishmania amastigotes within macrophages. This was confirmed by bone marrow biopsy and leishmania serology. This case report stresses the importance of atypical symptoms and the unusual location of visceral leishmaniasis, not only in immunodepressed patients, but also in elderly immunocompetent patients.
Assuntos
Duodenopatias/patologia , Enteropatias Parasitárias/patologia , Leishmaniose Visceral/patologia , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Giant cell (temporal) arteritis (GCA) is the most common systemic vasculitis in Western countries. It involves large and medium-sized vessels with predisposition to the cranial arteries in the elderly. Cranial ischemic complications, in particular permanent visual loss, constitute the most feared aspects of this vasculitis. Although the use of corticosteroids and a higher physician awareness may have contributed to a decrease in the frequency of severe ischemic complications, permanent visual loss is still present in 7%-14% of patients. To investigate further the incidence, trends, and clinical spectrum of visual manifestations in patients with GCA, we examined the features of patients with biopsy-proven GCA diagnosed at the single reference hospital for a defined population in northwestern Spain during an 18-year period. Predictive factors for the development of any visual manifestation, not only permanent visual loss, were also examined. Between 1981 and 1998, 161 patients were diagnosed with biopsy-proven GCA. Visual ischemic complications were observed in 42 (26.1%), and irreversible blindness, mainly due to anterior ischemic optic neuropathy and frequently preceded by amaurosis fugax, was found in 24 (14.9%). Despite a progressive increase in the number of new cases diagnosed, there was not a significant change in the proportion of patients with visual manifestations during the study period (p = 0.37). Patients with visual ischemic complications had lower clinical and laboratory biologic markers of inflammation. Indeed, during the last years of the study, anemia was associated with a very low risk of visual complications. Also, HLA-DRB1*04-positive patients had visual manifestations more commonly. Patients with other ischemic complications developed irreversible blindness more frequently. The best predictors of any visual complication were HLA-DRB1*04 phenotype (odds ratio [OR] 7.47) and the absence of anemia at the time of admission (OR for patients with anemia = 0.07). The best predictors of irreversible blindness (permanent visual loss) were amaurosis fugax (OR 12.63) and cerebrovascular accidents (OR 26.51). The present study supports the claim that ocular ischemic complications are still frequent in biopsy-proven GCA patients from southern Europe. The presence of other ischemic complications constitutes an alarm for the development of irreversible blindness. In contrast, a higher inflammatory response may be a protective factor against the development of cranial ischemic events.
Assuntos
Arterite de Células Gigantes/complicações , Transtornos da Visão/etiologia , Idoso , Biópsia , Cegueira/etiologia , Feminino , Arterite de Células Gigantes/imunologia , Arterite de Células Gigantes/patologia , Antígenos HLA-DR/análise , Cadeias HLA-DRB1 , Humanos , Masculino , Análise Multivariada , Neuropatia Óptica Isquêmica/etiologia , Curva ROC , Oclusão da Artéria Retiniana/etiologia , Estudos Retrospectivos , Fatores de Risco , Artérias Temporais/patologiaRESUMO
INTRODUCTION: Spontaneous mesencephalic hemorrhages are very unusual, specially those located in the tectal region. Hypertension is a less important factor that in other classical locations. Other etiologies reported are arteriovenous malformations, coagulation disorder and trauma. We describe two patients with spontaneous hemorrhage of the quadrigeminal plate. CLINICAL CASE: Case 1: a non-hypertensive 30 year-old man who suddenly presented headache, nausea, diplopia and left hemisensory deficit. Twenty-four hours later he lost consciousness but was again alert within five hours. Examination revealed upward and downward gaze palsy and limited convergence. The patient recovered completely within six weeks. Case 2: a 38 year-old man without hypertension, who suddenly developed dizziness, occipital headache, nausea and diplopia. On examination, there was impaired upward and downward gaze, limitation of convergence and right arm hyposthesia. After eight weeks examination showed a mild limitation of upward voluntary gaze. CT and MR imaging studies revealed a small quadrigeminal hemorrhage in both cases. CONCLUSIONS: Hemorrhages located at mesencephalic tectal region are infrequent. They have a typical clinical presentation and outcome is usually favourable. Hypertension is less common than in hemorrhages of other locations. A significant proportion of cases can be attributed to occult vascular malformations.
Assuntos
Hemorragia Cerebral/diagnóstico , Teto do Mesencéfalo , Adulto , Humanos , Imageamento por Ressonância Magnética , Masculino , Teto do Mesencéfalo/diagnóstico por imagem , Teto do Mesencéfalo/patologia , Tomografia Computadorizada por Raios XRESUMO
Transient global amnesia (AGT) is a well-defined syndrome of unknown aetiology. It is generally believed to be of vascular origin. Other theories suggest epilepsy or migraine as the cause. We studied the clinical features and associated risk factors in 24 patients with AGT, comparing them with two control groups with 24 people in each group, paired for age and sex. The first control group contained healthy individuals (CN) and the second patients with transient ischaemic attacks (AIT). Of the patients with AGT, 70% were women and 30% men. Their average age was 60 (range 14-76). The attacks were abrupt in onset in 100%. In 8% there was a recognisable trigger factor (driving, physical exercise, etc). The average duration was 7 hours. On study of the cardiovascular risk factors, it was found that 36% were hypertensive, 24% had cardiopathy, 12% had diabetes mellitus, 8% were smokers, 4% had polycythaemia, 16% had hyperlipidaemia, 4% were alcoholics. There was a history of migraine in 29%. No patient had a past history of epilepsy. Further investigation showed ECG changes in 12%. In 24% there were non-specific changes in the EEG. On cerebral CT scan there were lesions compatible with ischaemia in 12.5% of the patients. Levels of arterial hypertension were significantly higher in the AGT group as compared to the normal control group (Odds ratio 7.86; CI. 1.29-11.38). A past history of migraine was seen to be a risk factor associated with AGT as compared with both groups of controls (AGT/CN Odds ratio 9.47; CI 1.01-444.92; AGT/AIT Odds ratio > 1.72).
Assuntos
Amnésia/fisiopatologia , Encéfalo/fisiopatologia , Adolescente , Adulto , Idoso , Amnésia/diagnóstico , Amnésia/etiologia , Feminino , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/fisiopatologia , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/complicações , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: Cervical myelopathy is a common disorder of the spinal cord. The most frequent symptoms are muscle weakness and spasticity starting in the legs. Occasionally the sensory levels are several spinal cord segments below the cervical lesion which makes diagnosis difficult. CLINICAL CASE: We present the case of a 31 year old man who presented (after exercise) with paresthesia and numbness below the left costal margin in the left hemiabdomen and the left leg. On physical examination there was painful superficial tactile thermic hypoaesthesia at the level of D10 on the left side, together with brisk myotatic reflexes of the legs and indifferent bilateral plantar reflexes. Blood and CSF studies were normal. On cervical MR there was a large hernia of the intervertebral disk at C5-C6 and marked involvement of the spinal cord. Progress after surgery was good. Two months after operation he was symptom free and neurological examination was normal. CONCLUSIONS: Diagnosis of cervical myelopathy may be difficult because of the varied symptoms. There may be a dorsal or lumbar sensory level acting as a false localizing sign. The physiopathological mechanism for this is not clear. Different hypotheses have been put forward based on anatomical distribution of the spino-thalamic tract and on indirect factors (vascular, demyelinization, etc.). In a patient with a dorsal sensory level and normal radiological findings at this level, it is important to study levels above this as well to avoid errors of diagnosis and treatment.
Assuntos
Vértebras Cervicais/patologia , Deslocamento do Disco Intervertebral/diagnóstico , Espasticidade Muscular/diagnóstico , Transtornos da Percepção/diagnóstico , Adulto , Vértebras Cervicais/cirurgia , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/cirurgia , Imageamento por Ressonância Magnética , Masculino , Espasticidade Muscular/complicações , Transtornos da Percepção/etiologiaRESUMO
Four patients diagnosed with Behçet's disease developing neurologic manifestation are described. Central nervous system findings were observed in three of them and peripheral neuropathy in ther other patient. All the patients were treated with chlorambucil, 0.1-0.2 mg/kg/day as initial dose. Three of them ended the immunosuppressive therapy after a period of treatment between 12-18 months. None of the four patients suffered neurologic relapses once that the therapy with chlorambucil was started. In a similar way to other authors, we think that treatment with chlorambucil in neuro-Behçet's disease may be useful to reduce morbility related to neurologic relapses.
Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Síndrome de Behçet/complicações , Síndrome de Behçet/tratamento farmacológico , Encefalopatias/etiologia , Clorambucila/uso terapêutico , Doenças do Sistema Nervoso Periférico/etiologia , Adulto , Antineoplásicos Alquilantes/administração & dosagem , Clorambucila/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Fatores de TempoRESUMO
BACKGROUND: Ninety percent of hip fractures (HF) occur in people older than 64 years. We describe the epidemiological data (age, sex, date of admission and discharge and mortality) of elderly with hip fracture in the different regions of Spain. METHOD: Data obtained from the Minimum Data Set of the Ministry of Health were used to analyse hip fracture incidence (Identified by codes 820.0 through 820.9 of the International Classification of Diseases) from 1996 through 1999. Demographic data of Spanish population were obtained from the National Institute of Statistics. HF rates were calculated using crude and age-and-sex adjusted density of incidence. Factors associated with in-hospital mortality were assessed by multivariate analyses. RESULTS: 89% (130.414) of 146.383 HF cases studied were in elderly patients with a mean age of 82 years old, being 78% females. The results showed a great variability through the different regions. Length of hospital stay was 16 days, and in-hospital mortality was 5%. Global HF rate was 517 cases per 100.000 elderly per year (270 cases/100.000 elderly males and 695/100.000 elderly females). In-hospital mortality was higher in males than females (8.1% vs 4.2%, respectively), increases progressively with age and it is higher during winter months. Factors associated with mortality were old age, male gender, fractured in winter, and living in Regions others than Mediterranean and Canary Islands. CONCLUSIONS: Hip fracture is a condition that occurs more commonly in elderly people. It is more frequent in females and shows a great variation in incidence, mortality and length of hospital stay through different Spanish regions.
Assuntos
Fraturas do Quadril/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Fatores de Risco , Estações do Ano , Espanha/epidemiologiaAssuntos
Arterite de Células Gigantes/diagnóstico , Neuralgia/diagnóstico , Lobo Occipital/patologia , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Neuralgia/etiologia , Lobo Occipital/irrigação sanguínea , Prednisona/uso terapêutico , Artérias Temporais/patologia , Resultado do TratamentoAssuntos
Arterite de Células Gigantes/diagnóstico , Religião , Idoso , Artérias/patologia , Aspirina/uso terapêutico , Face/irrigação sanguínea , Dor Facial/tratamento farmacológico , Dor Facial/etiologia , Dor Facial/patologia , Feminino , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Humanos , Doenças Maxilomandibulares/tratamento farmacológico , Doenças Maxilomandibulares/etiologia , Doenças Maxilomandibulares/patologia , Prednisolona/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the frequency and clinical manifestations of Behçet's disease (BD) during the past 10 years in a defined area of Northwestern Spain. METHODS: The charts of all the patients diagnosed as having BD at the Hospital Xeral-Calde from 1988 through 1997 were reviewed. All the patients were residents of Lugo. Patients were followed from the time of diagnosis until either the patient's death or July 1, 1998. By that time patients were classified as having complete BD if they fulfilled the International Study Group Criteria (ISG) for BD. Patients with recurrent oral ulcerations plus one of the remaining 4 criteria of the ISG were classified as having an incomplete form of BD. RESULTS: Sixteen patients (9 men/7 women) were diagnosed as having complete BD and 7 (3 men) as having incomplete BD. The average annual incidence rate of complete BD in the Lugo region of Northwestern Spain was 0.66/100,000. Oral ulcerations with or without genital ulcerations were the most common initial manifestations. Neurological involvement was relatively frequent in men with complete BD. In contrast, a positive pathergy test was less common. Two patients with neurological involvement and 3 with uveitis had severe sequelae. However, there was a single death, apparently not related to BD. CONCLUSION: In Northwestern Spain, BD is more common than was expected and is a nonfatal disease. However, central nervous system involvement and severe ocular complications overshadow the good prognosis observed in the majority of patients.