Positioning of the fixed dose combination of Rosuvastatin + Clopidogrel + Aspirin in the Treatment of Cardiovascular Diseases

Dual anti-platelet therapy (DAPT) and statins are recommended by guidelines for the management of cardiovascular diseases (CVDs), even though the duration of treatment is guided by ischemic and bleeding risk. Clopidogrel and aspirin are the most commonly used DAPT in CVDs. Adding a statin to DAPT is helpful in reducing the thrombosis risk. Fixed-dose combination (FDC) therapy in CVD can help to address the factors of convenience, compliance, control, cost, and complication better than free drug combinations. Therefore, the FDC of rosuvastatin (10 mg or 20 mg) + clopidogrel (75 mg) + aspirin (75 mg) is likely to improve compliance in CVD patients, thereby reducing adverse cardiovascular outcomes and cost of treatment. There is lack of awareness on long term benefits of this FDC in Indian patients.

High Risk Foot Among Type-2 Diabetes Mellitus Patients in a Tertiary Care Hospital

Background: Feet of diabetic persons are at a high risk of developing complications and their prevalence is very high. Uncontrolled diabetes i.e. hyperglycemia particularly chronic hyperglycemia plays the most critical role in developing all forms of macro and microvascular complications in foot. The 揾igh risk foot� can be identified by simple clinical examination. A structured screening program for 揌igh Risk Foot� integrated with all diabetic care units is essential. Objectives: The study was initiated to determine the frequency of 揾igh-risk foot� among Type 2 diabetic patients.Methods:It was a cross-sectional observational study, conducted among 324 Type 2 diabetic patients attending BIRDEM General Hospital, Dhaka, Bangladesh. All participants were interviewed by an administered questionnaire, underwent clinical examination and review of medical records from the diabetic guide book of the patients and hospital records.Results:Among a total of 324 patients, 198(61%) patients were having high-risk feet. Of the diabetics with high risk foot- loss of protective sensation 73.2%; absent pedal pulse 23.2%; history foot ulcer 25.3%; limited joint mobility 15.2%; foot deformity 11.1% and previous foot amputation 3.5%. The study population had poor glycemic status (HbA1c 10.81+5.23%). Other variables age 55.43 (� 11.062) years; BMI: 25.33+5.7 kg/m� duration of diabetes 14.24+7.25 years; sex ratio (M: F) 1.3:1; family history of DM 71.9%; hypertensive 53.1%; smoker 73.5%; dislipidemia 52.8%, albuminuria 58.6%, and retinopathy 53.7%. Males are significantly higher in the high-risk foot.Conclusion:This study documented a very high frequency of high risks foot in our diabetic population. Peripheral Neuropathy (PN) and PVD are two common forms of high risk foot and these are influenced by a longer duration of diabetes, the presence of albuminuria for PN, and retinopathy. Male sex, longer duration of diabetes, presence of hypertension and smoking for PVD. Regular foot examination and treatment to target patients will modify the modifiable risk factors and thereby prevent foot ulcers and amputation.

Caracterización de factores de riesgo aterosclerótico en pacientes con pie diabético en Ecuador / Characterization of atherosclerotic risk factors in patients with diabetic foot in Ecuador

Introducción: La diabetes mellitus tipo 2 se asocia con un alto riesgo cardiovascular. Los pacientes que la padecen triplican el riesgo de mortalidad cardiovascular y duplican el de mortalidad total, en comparación con los no diabéticos. La enfermedad cardiovascular constituye la principal causa de morbimortalidad de los pacientes con diabetes mellitus tipo 2. Los factores de riesgo y las enfermedades consecuentes de la aterosclerosis son prevenibles, mediante estrategias de prevención dirigidas a su control y un estilo de vida que promueva la salud desde edades tempranas. Objetivo: Describir las características clínico-epidemiológicas y demográficas, y los factores de riesgo aterogénico asociados a los pacientes atendidos en consulta de pie diabético del Hospital "León Becerra Camacho" de Ecuador. Métodos: Estudio observacional descriptivo en los servicios de consulta externa con diagnóstico de pie diabético en el Hospital "León Becerra Camacho". El período de estudio fue febrero-agosto de 2017. Se tuvieron en cuenta los pacientes con diabetes mellitus tipo 2 y los factores de riesgo presentes. Los resultados se expresaron en tablas con frecuencias absolutas y relativas. Resultados: Se encontró un predominio del sexo masculino, de la sexta década de la vida, del área urbana y de los factores de riesgo: hipertensión arterial, hábito de fumar, sedentarismo y alcoholismo, así como comorbilidades: cardiopatía isquémica y macroangiopatía diabética. La amputación mayor tuvo menor proporción. Conclusiones: Los factores de riesgo de mayor incidencia encontrados fueron: hipertensión arterial, hábito de fumar, dislipidemia y alcoholismo; así como la asociación de más de tres factores de riesgo(AU)

Introduction: Type 2 diabetes mellitus is associated with high cardiovascular risk. Patients with cardiovascular mortality triple the risk of cardiovascular mortality and double the risk of total mortality, compared to non-diabetic patients. Cardiovascular disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus. The risk factors and consequent diseases of atherosclerosis are preventable, through prevention strategies aimed at its control and a lifestyle that promotes health from an early age. Objective: Describe the clinical-epidemiological and demographic characteristics and the atherogenic risk factors associated with patients treated in the diabetic foot clinic of "León Becerra Camacho" Hospital in Ecuador. Methods: Descriptive observational study in outpatient services with a diagnosis of diabetic foot at "León Becerra Camacho" Hospital. The study period was February-August 2017. Patients with type 2 diabetes mellitus and present risk factors were taken into account. The results were expressed in tables with absolute and relative frequencies. Results: A predominance of the male sex, the sixth decade of life, the urban area and the risk factors were found: arterial hypertension, smoking habit, sedentary lifestyle and alcoholism; as well as comorbidities: ischemic heart disease and diabetic macroangiopathy. Major amputations had a lower proportion. Conclusions: The risk factors of greater incidence found were: arterial hypertension, smoking habit, dyslipidemia and alcoholism; as well as the association of more than three risk factors(AU)

Continuous peripheral nerve block for in-patients with lower limb ischemic pain

OBJECTIVES: Demonstrate that continuous peripheral nerve block (CPNB) may be an alternative with adequate analgesia and a lower incidence of side effects for ischemic pain due peripheral obstructive arterial disease (POAD). METHODS: Retrospective cohort study with 21 patients with POAD, Fontaine IV graded, with foot pain. Patients were submitted to continuous sciatic nerve block (CSNB), through a perineural catheter. Primary outcomes were pain intensity (by numerical rating scale) and opioid consumption (in oral morphine equivalents). RESULTS: During CSNB, pain scores markedly decreased in comparison to the pre-block period. CONCLUSIONS: CPNB may be a good option for ischemic pain treatment in in-patients, as it provides effective pain control with fewer adverse effects.

Expert consensus on Tongsaimai Tablets/Capsules in treatment of peripheral vascular diseases in clinical practice / 中国中药杂志

Tongsaimai Tablets/Capsules are composed of Lonicerae Japonicae Flos, Angelicae Sinensis Radix, Achyranthis Bidentatae Radix, Codonopsis Radix, Dendrobii Caulis, Astragali Radix, Scrophulariae Radix, and Glycyrrhizae Radix et Rhizoma, and are effective in promoting blood circulation, removing blood stasis, supplementing Qi, and nourishing Yin. It is widely used in the treatment of peripheral vascular diseases. With 40 years of clinical application, it has accumulated substantial research data and application experience. Its good clinical efficacy and pharmacoeconomic benefits in improving the clinical symptoms of peripheral vascular diseases have been confirmed by relevant research. Meanwhile, this drug has also been recommended by many expert consensus, guidelines, and teaching materials, serving as one of the most commonly used Chinese patent medicines in clinical practice. To further improve the understanding of the drug among clinicians and properly guide its clinical medication, the China Association of Chinese Medicine took the lead and organized experts to jointly formulate this expert consensus. Based on the questionnaire survey of clinicians and the systematic review of research literature on Tongsaimai Tablets/Capsules with clinical problems in the PICO framework, the consensus, combined with expert experience, concludes recommendations or consensus suggestions by GRADE system with the optimal evidence available through the nominal group technique. This consensus defines the indications, usage, dosage, course of treatment, medication time, combined medication, and precautions of Tongsaimai Tablets/Capsules in the treatment of peripheral vascular diseases, and explains the safety of its clinical application. It is recommended for clinicians and pharmacists in the peripheral vascular department(vascular surgery), traditional Chinese medicine surgery(general surgery), and endocrinology department of hospitals at all levels in China.

A five years retrospective study of factors influencing outcome of major lower limb amputations

Background: The word amputation is derived from Latin -Amputare - to cut away. The amputation is indicated when the limb is considered as dead limb/ deadly limb/ dead loss limb. Often cases are referred to tertiary centre late, resulting in complications which requires surgical management. Aim of the study was to compare the outcomes of major lower limb amputations and to identify risk factors associated with mortality and morbidity following major lower limb amputations.Methods: A retrospective observational study was done for 5 years between January 2014 to November 2019, comprising 276 patients undergoing major lower extremity amputations. Adult patients undergoing lower extremity amputations for ischemic, infected or gangrenous lower limb were included and patients who underwent amputations for trauma or tumours were excluded. The data regarding comorbidities, postoperative complications, outcome of major lower limb amputations were evaluated.Results: 276 patients underwent lower limb amputations (above knee amputations (AKA)-127, below knee amputations (BKA)-134, forefoot amputations-15). Male patients outnumbered females (6.7:1) and most of them were of elderly age group (mean age 60.56 years). The most common indications for amputations in our study were peripheral vascular disease (120), diabetes (87), necrotizing fasciitis (37). The 1 year mortality rates following lower limb amputations in our study were 14% (BKA) and 34% (AKA).Conclusions: Lower limb amputations are associated with high mortality rates. Mortality can be expected in both the early and the late postoperative periods and is most probably related to serious comorbidities, such as renal and heart disease, rather than the level of amputation.

Diabetes Mellitus and Peripheral Vascular Disease

Chronic complications or the long-term side effects ofdiabetes mellitus includes microvascular complications whichaffects smaller blood vessels such as retinopathy, nephropathy,neuropathy and macrovascular complications which affectslarger blood vessels supplying the heart, brain, and extremities.Prevalence of Peripheral Vascular Disease (PVD) in diabetesranges between 20% and 30%. Endothelial cell dysfunction,vascular smooth muscle cell dysfunction, inflammation,impaired platelet function and abnormal coagulation are theother key factors in progression of PVD in diabetes. AnkleBrachial Index can be used as a screening tool at regularintervals. Apart from the intensified multifactorial treatmentof all modifiable risk factors, intensive therapy targetedat glycemic control and other modifiable cardiovascularrisk factor is needed to prevent micro and macro vascularcomplications of diabetes, especially PVD.

Management of upper extremity peripheral vascular disease: a multimodality approach

Background: It is estimated that more than 200 million people suffer from peripheral vascular disease worldwide. However very few studies are available on upper extremity vascular disease, thus making it an under diagnosed and under treated condition.Methods: In the present study we included 20 participants suffering from upper limb peripheral vascular disease and managed them with multi-modality approach involving general surgeon, interventional radiologist and vascular surgeon for medical line of management, thrombolysis and thrombo-embolectomy procedures.Results: In the present study we observed that early management of these patients with medical management, interventional radiology and embolectomy procedures helped in limb salvage. However alarmingly high number of patients (35%) landed up in amputation because of low index of suspicion and delayed referral.Conclusions: A high level of suspicion and early referral to a tertiary care centre where multi-modality facilities like interventional radiology and vascular surgeon are available should be done.

​Screening for Peripheral Vascular Disease among Type 2 Diabetes Patients of Lower Socio Economic Status using Ankle Brachial Index - A Descriptive Cross Sectional Study

Introduction: Diabetes mellitus is one of the key importantnon-communicable diseases of this century in terms ofmortality and prevalence. Peripheral Vascular Disease (PVD)is one of the most common macrovascular complications ofType II DM. PVD in risky cases exhibits as claudication organgrene, but in maximum cases, manifests hidden symptoms.Early detection of vascular changes helps in effective handlingof Diabetes and its complications. Study objectives were toassess Ankle Brachial Index in all asymptomatic vasculopathyin type2 diabetic patients of low socio-economic status usinga hand-held doppler and to correlate the findings of AnkleBrachial Index with PVD.Material and methods: A descriptive cross sectional studydone among the patients with asymptomatic vasculopathyin Type 2 diabetes mellitus patients coming to outpatientdepartment as well as admitted as inpatients in Shri SathyaSai Medical College and Research Centre, Ammapettai,Tamilnadu, India. The study duration was 18 months. Samplesize was calculated to be 130.Results: In the study population of 130, using the anklebrachial index, 110 (84.6%) were normal (1 and above). 11(8.5%) and 9 (6.9%) were having asymptomatic claudication(0.9-0.99) and claudication (<0.9) respectively. The prevalenceof PVD is 15.4% in the study population.Conclusion: Ankle Brachial Index is a simple, easy toperform, rapid, reliable and accurate test which can beperformed especially among the high risk groups.

A comparative study of foot infections in diabetic and non-diabetic patients with reference to etiopathogenesis, clinical features and outcome

Background: Infections in the foot are more common with significant proportion of world’s population remaining bare foot, minor skin trauma is a frequent cause of local infection. The present study was conducted with an aim to study various foot infections and compare the findings in diabetic and non diabetic patients with reference to etiopathogenesis, clinical features, management, duration of hospital stay and outcome.Methods: The present study was conducted in Mamata General Hospital, Khammam, Telangana state from October 2016 to September 2018. A total of 50 cases were divided into 2 groups, Group A included 25 patients with diabetic foot infection and Group B included 25 patients with non diabetic foot infections.Results: In diabetics 6th decade and in non-diabetics 4th-6th decade was the most common age group presenting with foot infections. Cellulitis of the foot was the most common in both diabetics (40%) and non-diabetics (52%). Wagner’s grade 4 lesions were more common in diabetics (28%) than in non-diabetics (8%). The most common site of lesion in diabetics was dorsum (40%) and in non-diabetics was toes (40%). The incidence of neuropathy was significantly higher in diabetics (72%) than in non-diabetics (20%). Rate of amputation was high in diabetics (12%) compared to non-diabetics (8%). The average number days in a hospital stay in diabetics was 42.27 days and in non-diabetics it was 28.96 days.Conclusion: Diabetic patients have increased severity of infections, delayed healing process, need more active interventions. As compared to the non-diabetic patients, they do show high risk of amputations and prolonged hospital stay.

Lower Limb Amputations- A Necessary Evil- An Observational Study from a North Indian Tertiary Care Hospital

Limb loss to amputation is a major problem especially in developing countries where majority of the cases are preventable. It is a burden, not just for the patient, but also for their care givers which imposes tremendous financial and psychological burden upon them. The aim was to outline the patterns, indications and complications of lower limb amputations among patients admitted to MMIMSR, Mullana, Ambala, India, which is a tertiary care centre.METHODSThis was a prospective, observational study that was conducted at MMIMSR, Ambala, for a period of 18 months. 50 patients underwent lower limb amputations in our hospital during the study period.RESULTSThe age ranged between 23 to 85 years. Males outnumbered females by a ratio of 4.5:1. Toe disarticulations were the most common. Diabetes mellitus (DM) was the most common cause (62%) followed by Non-DM peripheral vascular disease (PVD) (22%). Two patients expired in the post-operative period. Infection of the stump was the most common local complication in the post-operative period. Hospital stay ranged from 6 days to 40 days.CONCLUSIONSAlthough trauma is still the most common cause of lower limb amputations (LLA) in the developing nations, amputations for complications of diabetes is on the rise and may be the leading aetiology in future. Diabetic gangrene followed by PVD were the common causes of amputation in our settings. The study shows that most of the causes are potentially avoidable. Community health education programmes that are primarily focussing on road safety measures, early presentation to the physician and good diabetic control are pivotal to decrease the incidence of amputations for preventable indications.

Perfil lipídico mínimo para el diagnóstico del riesgo de enfermedad vascular periférica de los miembros inferiores / Minimum lipid profile for the diagnostic of the peripheral vascular disease's risk

Introducción: El perfil lipídico mínimo está relacionado con la enfermedad vascular de tipo aterosclerótica, pero se desconoce cuál es el tipo de perfil más frecuente en los adultos y el tipo de riesgo que representan para la enfermedad vascular periférica de los miembros inferiores. Objetivo: Determinar si el perfil lipídico mínimo sirve para diagnosticar el riesgo de enfermedad vascular periférica de los miembros inferiores. Métodos: Se trabajó con 533 muestra sanguíneas de personas adultas de diferentes municipios de la provincia La Habana. Se cuantificaron las concentraciones de colesterol total y de triglicéridos. Se calculó la media y la desviación estándar. Se diagnosticó y clasificó la hiperlipemia, se identificó el riesgo de enfermedad vascular periférica de los miembros inferiores y su asociación con la hiperlipemia. Se trabajó con un nivel de confiabilidad del 95 por ciento (a=0,05). Resultados: Los perfiles lipídicos mínimos más frecuentes fueron: el hipercolesterolemia leve (46,0 por ciento) y la hipertrigliceridemia (22,6 por ciento). El 53,8 por ciento presentó riesgo de enfermedad vascular periférica de los miembros inferiores entre potencial (24,8 por ciento) y alto (29,0 por ciento). Existió una asociación entre la hiperlipemia y la presencia de enfermedades vasculares periféricas de los miembros inferiores (chi cuadrada= 120,4; p= 0,00000). Se detectó que el 50 por ciento de las personas requería de un tratamiento hipolipemiante. Conclusión: El perfil lipídico mínimo sirve para diagnosticar el tipo de riesgo de enfermedad vascular periférica de los miembros inferiores. Se observó una fuerte asociación de dicha enfermedad con la presencia de hiperlipemia(AU)

Introduction: The minimum lipid profile is related to atherosclerotic vascular disease, but it is not known what is the most common type in adults and the kind of risk it represent for peripheral vascular disease of the lower limbs. Objective: To determine if the minimum lipid profile is used to diagnose the risk of peripheral vascular disease of the lower limbs. Methods: It was carried out a study with 533 blood sample of adults from different municipalities in Havana province. Concentrations of total cholesterol and triglycerides were quantified. Average and standard deviation were calculated. Hyperlipidemia was diagnosed and classified, the risk of peripheral vascular disease of the lower limbs and the association of the latter with hyperlipidemia were identified. The level of reliability used was of 95 percent (a= 0.05). Results: The most common minimum lipid profiles were: mild hypercholesterolemia (46 percent) and hypertriglyceridemia (22.6 percent). 53.8 percent presented a risk of peripheral vascular disease of the lower limbs between potential (24.8 percent) and high (29 percent). There was a relation between the hyperlipidemia and the presence of peripheral vascular diseases of the lower limbs (chi-cudrada= 120.4, p= 0.00000). It was detected that 50 percent of the people required a hypolipidemic treatment. Conclusion: The minimum lipid profile is used to diagnose the risk's type of peripheral vascular disease of the lower limbs, observing a strong relation of the latter with the presence of hyperlipidemia(AU)

Comparative study of pulse oximetry and ankle-brachial index as a screening test for asymptomatic peripheral vascular disease in type 2 diabetes mellitus against color doppler ultrasonography as reference standard

Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.

Study of Peripheral Vascular Disease in Patients with Diabetic Foot using Doppler Ultrasound

Objective: The objective of the study was to determine the extent of vasculopathy in patients with diabetic foot using Dopplerultrasound scanning.Methodology: This descriptive study was carried out in surgical wards SS Medical College and SGMH Rewa from June 1,2017, to May 31, 2018. All patients having diabetic foot complications including abscess formation, cellulitis, ulceration, andgangrene were included in the study after taking informed consent. Peripheral pulses such as posterior tibial, dorsalis pedis,and popliteal arteries were checked. The presence of vasculopathy was checked with Doppler scanning of dorsalis pedis artery,posterior tibial artery, and popliteal artery. The data were collected on a pro forma that was especially designed for this study.Results: A total of 115 patients were included in this study. Out of total cases of the diabetic foot, 21% of cases peripheralpulses were not palpable, 30% of cases were weakly palpable, and in 50% of cases were palpable. In right affected limb outof 66 affected limb, peripheral pulses were palpable in 45% of cases, weakly palpable in 32% of cases, and absent in 23% ofcases and left affected limb out of 49 affected limb peripheral pulses were palpable in 55% of cases, weakly palpable in 26%of cases, and absent in 19% of cases, with a male preponderance.Conclusion: This study shows that vasculopathy is a strong independent risk factor in the development of diabetic foot lesions.The usual symptoms and signs of lower limb ischemia may not be present and indeed may be misleading in diabetic foot disease.

A Prospective Study on Incidence of Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Background: Diabetes levies a heavy toll on the vascular system, with both macrovascular and microvascular complications. PAD is one of the major microvascular complications of Type 2 DM [2]. PAD is highly prevalent in diabetes. It has a predilection for lower limbs. It has been assumed that the metabolic abnormality in the prediabetic phase predisposes to more distal and aggressive atherosclerosis. Methods: The duration of study was over a period of 6 month. Total 75 cases were included in this study with diabetic mellitus. This study was conducted in the Department of surgery in Krishna Mohan Medical College & Hospital, Mathura, U.P, India. Result: In our study 75 cases with diabetic mellitus were included. Out of 75 cases 64% male & 36% were female. Predominant age was >75 year followed by other age groups. In this present study, 15 cases of hypertensive & 2 cases of PVD out of hypertensive were found. Conclusion: This study suggested that incidence of PVD is about 10% in the present study. This has to be viewed seriously considering the huge diabetic population and due importance to be given for screening and prevention of PVD.

A study of association of diabetic foot ulcers and peripheral vascular disease

Background: Diabetic foot ulcers (DFU) are a common, costly, complex, and disabling complication of diabetes resulting in lower-extremity amputations. Diabetes Mellitus (DM) is associated with an increase in the incidence of peripheral vascular disease (PVD) compared to non-diabetic subjects. DFU are divided into two types: neuropathic ulcers (NPU) and neuro-ischemic ulcers (NIU). PVD in association with neuropathy leads to neuro-ischemic ulcers (NIU).Methods: A cross-sectional observational study was conducted for eighteen months period from October 2016 to March 2018, on 120 type-2 DM patients presenting with DFU at tertiary centre in central India. Informed written consent, detailed history was obtained from the patients including duration of diabetes, history of hypertension, smoking, presenting symptoms and other complications related to diabetes. Examination of foot and evaluation for peripheral pulses, ankle brachial pressure index (ABI), neuropathy and blood pressure were done. Laboratory tests for HbA1C, lipid profile, blood urea, serum creatinine and urine albumin creatine ratio (urine ACR) were done. Statistical analysis used: t test, fisher exact test and univariate analysis.Results: In our study, 1594 patients with T2DM were studied, out of which 120 patients presented with new DFU. Mean age of the patients was 61.5years with an M: F ratio of 1.78:1. NIU was present in 36 and NPU in 84 out of 120 DFU patients. Neuro-ischemic ulcers (NIU) were more common among males (28/78 males vs 8/42 females). NIU was found to have significant association with smoking (25/36 patients), hypertension (28/38 patients) and longer duration of diabetes (13.1 vs 9.2years). Other diabetic complications, retinopathy (26/36 patients) and nephropathy (18/36 patients) were more prevalent in patients with NIU. Dyslipidemia was also found in 58.33% (21/36) patients with NIU however the association was insignificant.Conclusions: Diabetic foot ulcers are very debilitating complication of diabetes, and a leading cause of amputations all over the world. Because of increased association of peripheral vascular disease with diabetic foot ulcers there is a rise in prevalence of neuro-ischaemic ulcers. Early management of peripheral vascular disease is important to prevent development of neuro-ischaemic ulcers.

Enfermedad arterial periférica determinada por índice tobillo-brazo en pacientes con síndrome metabólico

RESUMEN Introducción: el síndrome metabólico se asocia con un mayor riesgo cardiovascular, incluyendo la enfermedad arterial periférica. Objetivos: determinar la frecuencia de la enfermedad arterial periférica detectada por el método índice tobillo brazo en pacientes con síndrome metabólico, describir las características clínicas y laboratoriales del síndrome metabólico y detallar la sintomatología de los pacientes con EAP según la escala de Fontaine Metodología: estudio observacional prospectivo realizado en 100 pacientes adultos que cumplían con criterios para síndrome metabólico, según los criterios armonizados del año 2009 internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) en años 2016 y 2017. El índice tobillo-brazo derecho se calculó por el cociente de la presión arterial sistólica del tobillo derecho dividido la presión arterial sistólica más elevada de cualquier brazo y de forma similar para el índice tobillo-brazo izquierdo. Se consideró índice tobillo-brazo compatible con enfermedad arterial periférica todo valor ≤ 0,9. Resultados: se hallo 23% de insuficiencia vascular periférica, siendo 18% del lado derecho, 13% del lado izquierdo y 8% bilateral. Los criterios para síndrome metabólico fueron: hipertensión arterial (100%), circunferencia abdominal aumentada (89%), glicemia en ayunas elevada o diabetes mellitus tipo 2 (50%), colesterol HDL bajo (47%), triglicéridos elevados (35%). Solo 7/23 (30%) sujetos presentaron síntomas según la escala de Fontaine, 5 pacientes en estadio IIa y 2 en estadio IIb. Conclusión: la frecuencia de enfermedad arterial periférica fue 23%. La claudicación de miembros estaba presente en 30% de los afectados.

ABSTRACT Introduction: The metabolic syndrome is associated with an increased cardiovascular risk, including peripheral arterial disease. Objectives: To determine the frequency of peripheral arterial disease (PAD) detected by the ankle-brachial index method in patients with metabolic syndrome, to describe the clinical and laboratory characteristics of the metabolic syndrome and to detail the symptomatology of patients with PAD according to Fontaine scale. Methodology: A prospective observational study performed on 100 adult patients who met criteria for metabolic syndrome, according to the harmonized criteria of 2009, and admitted in the Medical Clinic Service of the Hospital Nacional (Itauguá, Paraguay) in 2016 and 2017. The right ankle-brachial index was calculated by the ratio of the systolic blood pressure of the right ankle divided by the higher systolic blood pressure of any arm and similarly for the left ankle-brachial index. The ankle-brachial index compatible with peripheral arterial disease was considered to be any value ≤0.9. Results: Twenty three percent of peripheral vascular insufficiency was found, being 18% of the right side, 13% of the left side and 8% bilateral. The criteria for metabolic syndrome were: arterial hypertension (100%), increased abdominal circumference (89%), high fasting blood sugar or type 2 diabetes mellitus (50%), low HDL cholesterol (47%), high triglycerides (35%). Only 7/23 (30%) subjects presented symptoms according to the Fontaine scale, 5 patients in stage IIa and 2 in stage IIb. Conclusion: The frequency of peripheral arterial disease was 23%. Claudication of limbs was present in 30% of those affected.

Ficha de avaliação clínica de membros inferiores para prevenção do pé diabético / Ficha de avaliação clínica de membros inferiores para prevención do pé diabético / Clinical evaluation form of lower members for diabetic foot prevention

Objetivo: Elaborar ficha de avaliação clínica (FAC) dos membros inferiores (MIs) para prevenção do pé diabético (PD). Métodos: Partindo de revisão da literatura, elaborou-se uma FAC com 4 fases: as fases 1 e 2 contemplam o exame clínico (anamnese e exame físico, respectivamente) com ênfase na avaliação dos pés e na pesquisa de fatores de risco para úlceras; a fase 3 avalia o autocuidado com os pés e a fase 4 descreve as principais orientações para este cuidado. Resultados: Após a realização das fases 1 e 2, segue uma classificação de risco de ulceração dos pés. A fase 3 avalia com dez questões os cuidados com os pés e a fase 4 apresenta dez orientações educacionais para prevenção do PD. Conclusão: A FAC proposta possibilita detectar e intervir precocemente no risco de ulceração nos pés.

Objective: To elaborate a clinical evaluation sheet (CES) of the lower limbs (LL) for diabetic foot (DF) prevention. Methods: Based on literature review, a four-phased CES has been elaborated: phases 1 and 2 contemplate clinical evaluation (anamnesis and physical evaluation, respectively) with emphasis on feet evaluation and search for soreness risk factors; phase 3 evaluates feet care and phase 4 describes the main guidelines for this care. Results: With the completion of phases 1 and 2, a feet soreness risk rating follows. Phase 3 evaluates feet care with ten questions and phase 4 presents ten educational guidelines for DF prevention. Conclusion: The proposed CES enables the detection and early intervention on foot soreness risk.

Objetivo: Desarrollar formulario de evaluación clínica (FEC) de los miembros inferiores (MIs) para la prevención del pie diabético (PD). Métodos: A partir de la revisión de la literatura, fue preparada una FEC con 4 fases: fases 1 y 2 incluyen examen clínico (anamnesis y la exploración física, respectivamente), con énfasis en la evaluación de los pies y los factores de riesgo para buscar úlceras; fase 3 se evalúa el auto-cuidado con sus pies y la fase 4 se describen las pautas principales para este tipo de atención. Resultados: Después de la terminación de las fases 1 y 2 sigue la clasificación de riesgo de la ulceración de los pies. Fase 3 evalúa con diez preguntas del cuidado de los pies y la fase 4 presenta diez directrices educativas para prevenir el PD. Conclusión: La propuesta FEC permite detectar e intervenir temprano en riesgo de ulceración de los pies.

Enfermedades vasculares periféricas y niveles de calidad de vida en el municipio Diez de Octubre / Peripheral vascular diseases and levels of quality of life in 10 of October municipality

Objetivo: Determinar la prevalencia de las enfermedades vasculares periféricas y los niveles de calidad de vida en el municipio "Diez de Octubre". Métodos: Estudio descriptivo en una muestra aleatorizada (n= 200) de los 201 586 habitantes del municipio. El diagnóstico de las enfermedades vasculares periféricas se realizó por examen físico-vascular confirmado por estudios hemodinámico, ultrasonográfico, y ecográfico. Se aplicó el cuestionario de "Calidad de vida" SF-36 a los mayores de 18 años sin discapacidad mental. Resultados: La tasa de enfermedades vasculares periféricas fue de 66 por 100 000 habitantes debida a las flebopatías (59,5 por ciento), la macroangiopatia diabética (13,9 por ciento), la enfermedad arterial periférica (8,4 por ciento) y la cerebrovascular (6,4 por ciento). Los factores de riesgo más frecuentes fueron: obesidad (48,5 por ciento), hipertensión arterial (37,5 por ciento) y tabaquismo (33,5 por ciento). Hubo un incremento de enfermedades vasculares periféricas a partir de los 50 años con la presencia de dos o más enfermedades en el 37,3 por ciento. De las personas. En aquellas con enfermedad vascular se encontró una disminución (p < 0,05) en todas las escalas de la calidad de vida con un deterioro en la medida sumaria "salud física", la que se encontró asociada a su presencia (χ2 = 27,11; p = 0,001). Conclusiones: En el municipio Diez de Octubre, hay una elevada tasa de enfermedades vasculares periféricas con un deterioro importante en los niveles de calidad de vida de las personas que la padecen(AU)

Objective: To determine the prevalence of peripheral vascular diseases and the levels of quality of life in 10 of October municipality. Methods: A descriptive study was conducted on a random sample (n=200) from 201 586 inhabitants of the municipality. The diagnosis of peripheral vascular diseases was performed by physical-vascular examination confirmed by hemodynamic, ultrasound, and echo-Doppler studies. The "Quality of life" questionnaire SF-36 was applied to people older than 18 years without mental disabilities. Results: The rate of peripheral vascular disease was 66 per 100 000 inhabitants due to phlebopathies (59.5 percent), diabetic macroangiopathy (13.9 percent), peripheral arterial disease (8.4 percent) and cerebrovascular disease (6.4percent). The most frequent risk factors were obesity (48.5 percent), hypertension (37.5 percent) and smoking (33.5 percent). There was an increase in peripheral vascular diseases after the age of 50 years with two or more types of diseases in 37.3 percent of the population. A decrease (p <0.05) in all the quality of life scales, with deterioration in the disease-related summary measure "physical health", was found in people with vascular disorders (χ2= 27.11; p= 0.001). Conclusions: In 10 of October municipality, there is a high rate of peripheral vascular diseases with a significant deterioration of the quality of life of people who suffer them(AU)