Life after lower extremity amputation in diabetics / La vida tras la amputación de las extremidades inferiores por diabetes

Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. OBJECTIVE: To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. METHOD: A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. RESULTS: Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p < 0.05) and functional independence (p < 0.0001) compared to the above knee amputees. The result also showed that females had a significantly higher average score than males among the four domains for QOL. Similar results were obtained from the FIM where women again had significantly higher scores than males (p < 0.0001). The majority of females across the age groups reported average to high QOL (p < 0.0001) compared to the males. A positive correlation (r = 0.5999, p < 0.0001) was found between functional independence and quality of life of all participants. CONCLUSION: The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

Los amputados de las extremidades inferiores enfrentan el cuadro típico de la reducción de su movilidad, lo cual afecta su capacidad para realizar las tareas cotidianas y reintegrarse con éxito a la vida de la comunidad. Uno de los objetivos principales de la rehabilitación de los amputados es mejorar la calidad de vida (CDV). En concordancia con ello, este estudio centra su atención en la CDV y la independencia funcional de personas con amputación de las extremidades inferiores a consecuencia de diabetes secundaria. OBJETIVO: Determinar la CDV y la independencia funcional de diabéticos amputados de las extremidades inferiores, de uno a tres años tras la amputación, a partir de variables tales como la edad, el género, y el nivel de amputación. MÉTODO: Un total de 87 participantes fueron seleccionados de los archivos de fisioterapia de 2006- 2009 en el Hospital Saint Ann Bay. Estos participantes completaron las evaluaciones de la Escala de Calidad de Vida de la Organización Mundial de la Salud (WHO QOL-BREF) y la Medida de Independencia Funcional (MIF). Se analizaron los datos usando SPSS (versión 12) y se calcularon los valores promedios de la CDV y la independencia funcional. Las relaciones entre las variables - edad, género y nivel de amputación - con respecto a la CDV y la independencia funcional, fueron analizadas usando técnicas estadísticas descriptivas e inferenciales. RESULTADOS: Entre los 35 varones y 52 hembras que participaron en el estudio, los amputados por debajo de la rodilla registraron puntuaciones más altas para la CDV (p < 0.05) y la independencia funcional (p < 0.0001) en comparación con los amputados por arriba de la rodilla. El resultado también mostró una puntuación promedio significativamente más alta en las hembras que en los varones, en los cuatro dominios de la CDV. Se obtuvieron resultados similares del MIF, en los que de nuevo las mujeres tenían puntuaciones significativamente más altas que los varones (p < 0.0001). La mayoría de las hembras en todos los grupos etarios reportaron desde una CDV promedio a una CDV alta (p < 0.0001) en comparación con los varones. Se halló una correlación positiva (r = 0.5999, p < 0.0001) entre la independencia funcional y la calidad de vida de todos los participantes. CONCLUSIÓN: Los resultados mostraron que los amputados por debajo de las rodillas funcionaban mejor que aquéllos con amputaciones por encima de la rodilla, y que las mujeres presentaban una mayor probabilidad de lidiar y funcionar exitosamente con la discapacidad en comparación con los hombres.

Anaphylaxis: an analysis of cases evaluated at the Puerto Rico Medical Center over a ten-year period

OBJECTIVE: To examine the clinical characteristics of patients with anaphylactic reactions evaluated at the Puerto Rico Medical Center over a ten year period. BACKGROUND: Anaphylaxis, an immunologic reaction classically initiated by the combination of an antigen and a mast cell fixed antibody (usually IgE), still carries a fatality rate of 500 to 1000 cases per year in the United States. It constitutes a medical emergency that needs to be identified promptly in order to install appropriate treatment. No studies of this condition have been conducted in Puerto Rico, specifically to assess the clinical presentation, main causes and outcome. METHODS: Eighty-three records of patients with a diagnosis of anaphylaxis were screened by retrospective and concurrent analysis. Of these, only 51 fulfilled the diagnostic criteria of anaphylaxis. Specific data gathered from those records assessed the clinical characteristics of each case, precipitating factors, severity of the reaction and outcome. A standard form was used for data gathering. A grading system was utilized to classify the severity of the clinical episodes. RESULTS: Cutaneous features were the most commonly found manifestations of anaphylactic reactions in the studied group. Only reactions graded 2 and 3 were identified. Reactions to medications were the most frequent identifiable causes of the entity. Multiple sensitivities to different allergens were not predictive of this clinical condition. CONCLUSIONS: The identification in this study that only cases with the more severe grades of anaphylaxis were evaluated and treated at our center, the inability to recognize an inciting cause in about one third of the patient sample and the fact that a minority of the treated patients received subsequent follow-up by an allergist, reflect the need to promote the training of physicians in the field of allergy in Puerto Rico and the continued education of all physicians in the Island regarding this clinical disorder.

Rheumatologic manifestations in patients with selected primary immunodeficiencies evaluated at the University Hospital

OBJECTIVE: To characterize an IgA deficient and common variable immunodeficiency (CVI) group of patients in terms of the presence of rheumatologic manifestations. BACKGROUND: Although the molecular basis of some of the primary immunodeficiencies has been elucidated, it has not been possible to explain why in most cases these conditions are often associated with autoimmune manifestations, besides infections. The concomitant inability to fight infections adequately (immunodeficiency) and an inordinate reaction of the immune system to self components (autoimmunity) has been a perplexing situation. METHODS: The clinical and immunological profile of 71 patients fulfilling the diagnostic criteria of selective IgA deficiency (n=38) and common variable immunodeficiency (n=33) were evaluated for concurrent rheumatologic manifestations after a thorough medical history, physical examination and pertinent immunological parameters. RESULTS: The most common autoimmune conditions identified in patients with selective IgA deficiency were Crohn's disease and systemic lupus erythematosus (SLE); while immune thrombocytopenic purpura and Crohn's disease were the most common disorders associated to CVI. Anti-IgA antibodies were only found in 26.6(95C.I. 10.1-51.4) of patients with selective IgA deficiency but were present in all patients with that condition and SLE. Fifty per cent patients with CVI and ITP exhibited ANA positivity. CONCLUSIONS: The IgA-deficient group of patients in this study showed a higher prevalence of autoimmune conditions and greater positivity for ANA as compared to patients with CVI. In contrast to other reports with around 44positivity of anti-IgA antibodies in selective IgA patients these were only present in 263of patients with that disorder in this study. The high prevalence of antinuclear antibodies not associated with any clinical autoimmune condition in the IgA-deficient patients in this study will need to be further explored to ascertain why IgA-deficient patients may be at an increased risk of autoimmunity. Inflammatory bowel disease (Crohn's disease and ulcerative colitis) constituted the most common clinical autoimmune manifestations in both groups of patients studied. ITP was the commonest organ-specific autoimmune condition identified in the CVI group, as reported in previous publications. The limited number of patients studied does not allow a reliable estimate of the prevalence of SLE in the IgA-deficient population analyzed.