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1.
Rev. cuba. endocrinol ; 32(1): e220, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289388

ABSTRACT

La creciente epidemia de diabetes impone la necesidad de implementar estrategias para la detección de complicaciones diabéticas en etapas tempranas cuando aún están en estadio preclínico. La enfermedad arterial periférica es una de ellas, con consecuencias devastadoras para el paciente, la familia y la sociedad. Su frecuencia aumenta con la edad y el tiempo de evolución de la diabetes. La mayoría de los pacientes son asintomáticos lo que dificulta el diagnóstico, además, las limitaciones del examen físico exigen complementarlo con estudios no invasivos. El índice de presiones tobillo-brazo es el principal método para su detección pero es necesario conocer sus limitaciones en las personas con diabetes para interpretar correctamente los resultados. Los pacientes con enfermedad arterial periférica asintomática tienen más rápida declinación funcional con probabilidad de progresar a formas mas graves de la enfermedad como la isquemia crítica y la amputación, así como, mayor riesgo de eventos cardiovasculares isquémicos en otros territorios arteriales y de mortalidad. La detección sistemática de enfermedad arterial periférica asintomática en las personas con diabetes identificaría los pacientes que se beneficiarían con intervenciones más intensivas por lo que constituye una fuerte recomendación en la actualidad. Con este trabajo nos proponemos debatir sobre la importancia de la búsqueda de esta complicación en las personas con diabetes, así como, los retos actuales para su detección y diagnóstico(AU)


The growing diabetes epidemic demands the need to implement strategies for the identification of diabetic complications in early stages, when they are still in the preclinical stage. Peripheral arterial disease is one of them, with devastating consequences for the patient, the family, and society. Its frequency of occurrence increases with age and with the time of evolution of diabetes. Most of the patients are asymptomatic, which makes diagnosis difficult. In addition, due to the limitations of physical examination, complementary tests are required, always with noninvasive studies. The ankle-brachial pressure index is the main method for detecting it, but it is necessary to know its limitations in people with diabetes, in order to interpret the results correctly. Patients with asymptomatic peripheral arterial disease have a faster functional decline with the probability of progressing to more serious forms of the disease, such as critical ischemia and amputation, as well as a higher risk of ischemic cardiovascular events in other arterial territories and of mortality. Screening for asymptomatic peripheral arterial disease in people with diabetes would permit identifying patients who would benefit from more intensive interventions; therefore, it is strongly recommended nowadays. With this work, we intend to discuss the importance of screening for this complication in people with diabetes, as well as the current challenges for its detection and diagnosis(AU)


Subject(s)
Humans , Diabetes Complications/etiology , Peripheral Arterial Disease/diagnosis , Amputation/methods , Health Strategies
2.
Rev. cuba. med ; 60(1): e1509, tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1156555

ABSTRACT

Introducción: La enfermedad arterial periférica es bien conocida como predictor de morbilidad y mortalidad cardiovascular y cerebrovascular, de ahí la importancia de reconocer sus factores de riesgo. Objetivo: Determinar los factores de riesgo asociados a la enfermedad arterial periférica en pacientes diagnosticados por el índice tobillo brazo. Métodos: Se realizó un estudio observacional analítico transversal, entre el 1ro de septiembre y 30 de noviembre de 2019. El universo fue de 290 pacientes, se trabajó con una muestra de 120, determinada por un muestreo aleatorio simple. Se emplearon estadígrafos descriptivos e inferenciales: prueba t de Student, el odds ratio de prevalencia y la regresión logística binomial. Resultados: Fueron categorizados con índice tobillo brazo < 0,9 un total de 43 pacientes (35,8 por ciento). La media de edad de la población fue de 58,43 ± 16,69. El sexo femenino predominó con 61 pacientes (50,8 por ciento). El índice de masa corporal promedio fue de 24,29 ± 3,29 kg/m2. La hipertensión arterial fue el factor de riesgo más frecuente presentándose en 67,5 por ciento de los pacientes. Se identificaron como factores de riesgo de índice tobillo brazo < 0,9 a la edad ≥ 60 años (OR: 6,41; IC 95 por ciento: 2,04-20,1; p=0,001); la hipertensión arterial (OR: 2,99; IC 95 por ciento: 1,02-8,73; p=0,045); la diabetes mellitus (OR: 3,89; IC 95 por ciento: 1,34-11,3; p=0,012) y la dislipidemia (OR: 4,35; IC 95 por ciento: 1,27-14,8; p=0,019). Conclusiones: La edad avanzada, la hipertensión arterial, la diabetes mellitus y la dislipidemia constituyeron factores de riesgo asociados a la enfermedad arterial periférica(AU)


Introduction: Peripheral arterial disease is well known as a predictor of cardiovascular and cerebrovascular morbidity and mortality, hence the importance of recognizing its risk factors. Objective: To determine the risk factors associated with peripheral arterial disease in patients diagnosed by the ankle brachial index. Methods: A cross-sectional analytical observational study was carried out from September 1 to November 30, 2019. The universe consisted of 290 patients, a sample of 120 was used, determined by simple random sampling. Descriptive and inferential statistics were used: Student's t test, prevalence odds ratio, and binomial logistic regression. Results: A total of 43 patients (35.8%) were categorized with ankle brachial index <0.9. The mean age of the population was 58.43 ± 16.69. The female sex predominated with 61 patients (50.8 percent). The average body mass index was 24.29 ± 3.29 kg / m2. Hypertension was the most frequent risk factor in 67.5 percent of the patients. Risk factors were identified in ankle brachial index <0.9 at age ≥60 years (OR: 6.41; 95 percent CI: 2.04-20.1; p = 0.001); arterial hypertension (OR: 2.99; 95 percent CI: 1.02-8.73; p = 0.045); diabetes mellitus (OR: 3.89; 95 percent CI: 1.34-11.3; p = 0.012) and dyslipidemia (OR: 4.35; 95 percent CI: 1.27-14.8; p = 0.019). Conclusions: Advanced age, arterial hypertension, diabetes mellitus and dyslipidemia were risk factors associated with peripheral arterial disease(AU)


Subject(s)
Humans , Male , Female , Risk Factors , Dyslipidemias/epidemiology , Ankle Brachial Index/methods , Peripheral Arterial Disease/diagnosis , Arterial Pressure , Cross-Sectional Studies , Observational Study
3.
Rev. cuba. angiol. cir. vasc ; 21(3): e115, sept.-dic. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156376

ABSTRACT

Introducción: La enfermedad arterial periférica es una complicación frecuente y devastadora en personas con diabetes. Esta puede evidenciarse desde los estadios de prediabetes; sin embargo, no está establecido cuándo realizar la pesquisa de los pacientes adultos jóvenes asintomáticos y con poco tiempo de evolución de la enfermedad. Objetivo: Caracterizar la enfermedad arterial periférica asintomática en pacientes con diabetes de tipo 2 con menos de 10 años de evolución. Métodos: Se realizó un estudio analítico-transversal en 190 pacientes con diabetes de tipo 2 entre 40 y 60 años y menos de 10 años de evolución de la diabetes. La selección tuvo en cuenta, a partir de septiembre de 2017, a los pacientes ingresados en el Centro de Atención al Diabético del Instituto de Endocrinología sin diagnóstico previo de enfermedad arterial periférica; y este se realizó a partir del índice de presiones tobillo-brazo. Resultados: El 6,3 por ciento (n = 12) presentaba una enfermedad arterial periférica asintomática. No hubo diferencias significativas entre las variables estudiadas (edad, sexo, color de la piel y tiempo de evolución de la diabetes; también aquellas a partir de los resultados del ITB) y la presencia de la enfermedad arterial periférica asintomática, que se relacionó de forma significativa con la presencia de cardiopatía isquémica. La afectación arterial fue ligera en todos los pacientes identificados y se asoció con la cardiopatía isquémica; no sucedió así con otras variables clínicas en estudio. Tampoco la combinación de estas últimas aumentó el riesgo de aparición de la enfermedad. Conclusiones: La enfermedad arterial periférica asintomática constituye una complicación poco frecuente en las personas menores de 60 años y con menos de 10 años de evolución de la diabetes(AU)


Introduction: Peripheral arterial disease is a frequent and devastating complication in people with diabetes. This condition can appear from prediabetes stages; however, it is not established when to carry out the screening of asymptomatic young adult patients with short time of evolution of the disease. Objective: To characterize asymptomatic peripheral arterial disease in patients with type 2 diabetes. Methods: An analytical cross-sectional study was carried out with 190 diabetic patients with type 2 diabetes aged 40-60 years and with less than ten years of evolution of the disease. The selection included, as of September 2017, the patients admitted to the Diabetic Care Center of the Institute of Endocrinology without prior diagnosis of peripheral arterial disease. The diagnosis was done based on the ankle/arm pressure index. Results: 6.3 percent (n=12) had asymptomatic peripheral arterial disease. There were no significant differences between the variables studied and the occurrence of asymptomatic peripheral arterial disease, which was significantly related to the presence of ischemic heart disease. Arterial involvement was slight in all the patients identified and was associated with ischemic heart disease; this was not the case with other clinical variables under study. Neither did the combination of these variables increase the risk for the onset of the disease. Conclusions: Asymptomatic peripheral arterial disease is a rare complication in diabetic people under 60 years of age and with less than ten years of evolution of the disease(AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Myocardial Ischemia , Diabetes Mellitus, Type 2/complications , Peripheral Arterial Disease/complications , Cross-Sectional Studies , Peripheral Arterial Disease/diagnosis
4.
Rev. cuba. angiol. cir. vasc ; 20(2): e385, jul.-dic. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1003858

ABSTRACT

Introducción: La coordinación entre niveles asistenciales centrada en las enfermedades frecuentes, graves y vulnerables, constituye un elemento esencial para incrementar la eficiencia del sistema sanitario con la ayuda del uso de instrumentos diagnósticos. Objetivo: Validar el Cuestionario de Edimburgo modificado para el diagnóstico de la claudicación arterial periférica en la atención primaria de salud. Métodos: Estudio de evaluación de instrumentos diagnósticos a través de un estudio explicativo observacional de corte transversal, en una muestra de 100 pacientes provenientes de la atención primaria de salud. El período de estudio fue el segundo semestre (julio-diciembre) de 2016. A todos los participantes se les realizó un examen físico vascular, se midieron los índices de presiones tobillo-brazo, se identificó la topografía de las lesiones arteriales de los miembros inferiores, se les aplicó el Cuestionario de Edimburgo modificado y se calculó su sensibilidad, especificidad, valores predictivos positivos y negativos y exactitud diagnóstica. Resultados: El examen físico vascular constató un predominio de la afección fémoro-poplítea (54,8 por ciento) seguido de la aorta-ilíaco (29,9 por ciento). Se obtuvo en la validación del Cuestionario una sensibilidad de 98 por ciento, una especificidad de 31,5 por ciento con alta probabilidad de tener falsos negativos. El valor predictivo positivo fue de 70 por ciento y el negativo de 92 por ciento. La exactitud de las pruebas diagnósticas fue de 73 por ciento, para cada prueba. Conclusiones: El uso del Cuestionario de Edimburgo modificado en la atención primaria de salud es de gran utilidad para establecer el diagnóstico clínico positivo de una claudicación intermitente por enfermedad arterial periférica(AU)


Introduction: Coordination between care levels centered in the severe, frequently and vulnerable diseases constitutes an essential element to increase the efficiency of the health system with the help of diagnostic means. Objective: To validate the modified Edinburgh Questionnaire for the diagnostic of arterial claudication in the primary health care. Methods: An assessment study of diagnostic instruments was done through of a cross-sectional, observational explicative study in a sample of 100 patients from primary health care. The study was conducted in the second semester (July-December) of 2016. A vascular physical exam was performed to all the participants where ankle- brachial pressure index was measured, the topography of the arterial occlusions of the lower limbs was identified, the modified Edinburgh Questionnaire was carried out; and the sensitivity, specificity, positive and negative predictive values and the diagnostic exactitude were calculated. Results: The vascular physical exam exhibited a predominant femoro-popliteal affectation (54,8 percent) followed of the aorta-iliac (29,9 percent). In the validation of the modified Edinburgh Questionnaire it was obtained a sensitivity of 98 percent and an specificity of 31,5 percent with high probabilities of false negative. The positive predictive value was 70 percent and the negative 92 percent. The exactitude of the diagnostic test was 73 percent for each test. Conclusions: The use of the modified Edinburgh Questionnaire in the primary health care is useful to establish the positive clinical diagnostic of an intermittent arterial claudication by Peripheral Arterial Disease(AU)


Subject(s)
Humans , Male , Female , Primary Health Care , Surveys and Questionnaires/standards , Cross-Sectional Studies , Peripheral Arterial Disease/diagnosis , Observational Study , Intermittent Claudication/diagnosis
6.
Med. leg. Costa Rica ; 36(1): 84-90, ene.-mar. 2019.
Article in Spanish | LILACS | ID: biblio-1002561

ABSTRACT

Resumen La Enfermedad arterial periférica se desarrolla por la obstrucción a nivel arterial. La resultante reducción en el flujo sanguíneo puede ser asintomática o producir síntomas de insuficiencia arterial como claudicación intermitente, dolor en reposo en el grupo muscular afectado, así como la presencia de diversos grados de pérdida tisular, como úlceras, siendo éste uno de los signos más evidentes de isquemia de la extremidad. Debido a que la mayoría de los casos de Enfermedad arterial periférica tiene como etiología la ateroesclerosis resultante de la acumulación de lípidos y material fibroso entre las capas de la pared arterial en miembros inferiores, el presente artículo se centra en esta etiología como causa de la Enfermedad arterial periférica en miembros inferiores.


Abstract Peripheral artery disease is developed for an arterial obstruction. The reduction in blood flow can be asymptomatic or produce symptoms of arterial insufficiency such as intermittent claudication or rest pain in the affected muscle group, as well as the presence of different degrees of tissue loss, such as ulcers, being one of the most obvious signs of ischemia in the limb. Because the majority of cases of peripheral artery disease are caused for the atherosclerosis resulted for the accumulation of lipids and fibrous material between the layers of the artery in the lower limbs, the present article is focus on this etiology as the cause of peripheral artery disease in lower extremity.


Subject(s)
Humans , Lower Extremity , Endothelium , Atherosclerosis , Ankle Brachial Index , Peripheral Arterial Disease/diagnosis , Intermittent Claudication
7.
J. vasc. bras ; 18: e20180084, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1002489

ABSTRACT

O índice tornozelo-braquial (ITB) utiliza a razão entre a pressão arterial sistólica do tornozelo e do braço para diagnosticar de forma não invasiva a doença arterial periférica (DAP). A fotopletismografia (photoplethysmography, PPG) faz a medição e o registro das modificações de volume sanguíneo do corpo humano por meio de técnicas ópticas. Objetivos O objetivo deste estudo foi comparar o ITB com parâmetros de rigidez arterial e resistência periférica avaliados pela PPG em idosos e propor um modelo de predição para o ITB. Métodos Foi realizado um estudo transversal quantitativo. A amostra foi composta por idosos atendidos no ambulatório médico de especialidades da Universidade do Sul de Santa Catarina (UNISUL). Foram verificados: idade, sexo, índice de massa corporal (IMC), presença de comorbidades, tabagismo e atividade física. Para comparação das variáveis obtidas com a PPG com o ITB, foi realizada regressão linear bivariada e multivariada, considerando erro α = 0,05. Resultados Foram avaliados 93 idosos, sendo 63,4% mulheres. Em 98,9% dos casos, o ITB apresentou-se dentro da normalidade. Na comparação do ITB e variáveis derivadas da PPG em relação à idade, foram demonstradas associações significativas. Contudo, não foram observadas associações significativas entre ITB e PPG. O modelo multivariado indicou que apenas idade, sexo e tabagismo foram associados ao ITB. Conclusões Como conclusão, o ITB e a PPG demonstraram associação com o envelhecimento arterial, tendo em vista sua correlação com a idade; contudo, o ITB foi relacionado apenas com idade, sexo e tabagismo. Mais estudos são necessários para avaliar o potencial uso da PPG como rastreio de doenças vasculares em rotinas ambulatórias


The ankle-brachial index (ABI) uses the ratio between systolic blood pressures at the ankle and the arm to diagnose peripheral arterial disease (PAD) noninvasively. Photoplethysmography (PPG) measures and records changes to the blood volume in the human body using optical techniques. Objectives The objective of this study was to compare ABI with arterial stiffness and peripheral resistance parameters assessed using PPG in elderly patients and to propose a model for prediction of ABI. Methods A cross-sectional, quantitative study was conducted. The sample comprised elderly patients seen at a medical specialties clinic at the Universidade do Sul de Santa Catarina (UNISUL), Brazil. Age, sex, body mass index (BMI), comorbidities, smoking, and physical activity were recorded. The variables obtained using PPG and ABI were compared using bivariate and multivariate linear regression, with an α error of 0.05. Results A total of 93 elderly patients were assessed, 63.4% of whom were women. In 98.9% of cases, ABI was within normal limits. Comparison of ABI with variables acquired by PPG revealed significant associations with age. However, no significant associations were observed between ABI and PPG. The multivariate model indicated that only age, sex, and smoking were associated with ABI. Conclusions In conclusion, ABI and PPG exhibited associations with arterial aging, considering its correlation with age. However, ABI was only related to age, sex, and smoking. More studies are needed to evaluate the potential uses of PPG for screening for vascular diseases in ambulatory settings


Subject(s)
Humans , Male , Female , Aged , Aged , Risk Factors , Photoplethysmography/methods , Ankle Brachial Index/methods , Peripheral Arterial Disease/diagnosis , Tobacco Use Disorder/complications , Body Mass Index , Comorbidity , Sex Factors , Chronic Disease , Cross-Sectional Studies , Data Collection , Age Factors , Diabetes Mellitus/diagnosis , Heart Rate , Hypertension , Motor Activity
8.
Med. interna (Caracas) ; 35(1): 32-41, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1005804

ABSTRACT

La enfermedad arterial periférica (EAP) es usualmente subdiagnosticada. El índice tobillobrazo (ITB) es un método diagnostico sencillo y no invasivo que permite hacer detección temprana de EAP y de aquellos pacientes con alto riesgo de desarrollar ECV. Objetivo: determinar la relación entre ITB y obesidad visceral mediante la medición de la circunferencia abdominal (CA) en pacientes que acudieron a la consulta externa de Medicina Interna. Otras mediciones: índice de masa corporal (IMC), relación cintura cadera (RCC). Se registró la presencia de hipertensión arterial (HTA), dislipidemia, sedentarismo y tabaquismo. Métodos: Investigación de carácter exploratorio. Muestra no probabilística, intencional de 34 pacientes que acudieron a la consulta de Medicina Interna en tres meses. Se aplicó una encuesta y se realizaron mediciones de los índices antropométricos: CA, RCC, IMC, se calculó el ITB y se determinaron glicemia, colesterol total, HDL, LDL y triglicéridos (TGC). Resultados: El promedio de edad fue 56,14 años ± 11.46. 52,9% mujeres y 47,1% hombres. El 70% tenían IMC elevado, 64,7% dislipidemia, 52,9% HTA, 38.23% sedentarismo y 17,6% fumaban. 5 pacientes masculinos tuvieron un ITB alterado: ITB bajo: 2; ITB elevado: 3. La correlación entre ITB y CA; ITB y RCC e ITB y glicemia, TGC y el LDL fue negativa débil. La correlación entre ITB e IMC, colesterol total y HDL fue positiva. Conclusiones: Una CA y RCC alteradas como marcadores de obesidad visceral se asocian con un ITB bajo(AU)


Peripheral arterial disease (PAD) is associated to high cardiovascular morbidity and mortality. Risk factors related to this pathology do not differ from other cardiovascular diseases (CVD). This disease manifests clinically in advanced stages of the atherothrombotic process, therefore, it is usually underdiagnosed. The ankle-brachial index (ABI) is a simple, inexpensive and non-invasive diagnostic method that allows an early detection of PAD, and, because it is considered atherosclerotic predictor, it helps us detect those patients who have a high risk of developing CVD. Hence, it should be a routine method in clinical practices. Objectives: This study was performed in order to determine the relationship between ABI and visceral obesity by means of waist circumference (WC) measurement and hip to waist ratio (HWR) in patients who attended the internal medicine outpatient clinic. Methods: Exploratory research. Non-probabilistic, intentional sample of 34 patients who attended the Internal Medicine outpatient clinic in three months. A survey was applied and measurements were made of the anthropometric indexes: CA, RCC, BMI, ITB was calculated and glycemia, total cholesterol, HDL, LDL and triglycerides were determined. Results: The average age was 56.14 years ± 11.46. 52.9% women and 47.1% men. 70% had high BMI, 64.7% dyslipidemia, 52.9% HBP, 38.23% sedentary lifestyle and 17.6% smoked. 5 male patients had an altered ABI: low ABI: 2; High ITB: 3. The correlation between ITB and CA; ITB and RCC and ITB and glycemia, TGC and LDL were weak negative. The correlation between ITB and BMI, total cholesterol and HDL was positive. Conclusions: A CA and RCC altered as markers of visceral obesity are associated with a low ABI(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Mid-Upper Arm Circumference , Peripheral Arterial Disease/diagnosis , Hypertension/physiopathology , Obesity/complications , Cardiovascular Diseases , Body Mass Index
9.
Rev. latinoam. enferm. (Online) ; 27: e3122, 2019. graf
Article in English | LILACS, BDENF | ID: biblio-978638

ABSTRACT

ABSTRACT Objective: to describe the development of a prototype mobile educational application for nursing follow-up aimed at patients diagnosed with peripheral arterial disease. Method: a prototype-based technological production study. The construction followed the contextualized instructional design model using two steps: analysis and design and development. Results: the pedagogical content of the application was based on a survey of needs of patients with Peripheral Arterial Disease and treatments recommended in the literature. The prototype developed contained concepts, risk factors, signs and symptoms, treatment, importance of medications and their side effects, frequent doubts, necessary health care, and follow-up of patients by monitoring the evolution of the cicatricial process of lesions and possible complications, clarification of doubts and stimulus for continuation of treatment. Conclusion: the use of health applications is a technological tool with the potential to improve the follow-up of patients regarding the progress of the disease and self-care, monitoring of risk factors, co-participation of the patient in the treatment, family participation, as well as planning of individualized care, and cost reduction for the health system.


RESUMO Objetivo: descrever o desenvolvimento de um protótipo de aplicativo móvel educativo e de follow up de enfermagem para pacientes com diagnóstico de doença arterial periférica. Método: estudo de produção tecnológica do tipo prototipagem, a construção seguiu o modelo do design instrucional contextualizado, utilizando duas etapas: análise e design e desenvolvimento. Resultados: o conteúdo pedagógico do aplicativo baseou-se no levantamento das necessidades dos pacientes com Doença Arterial Periférica e nos tratamentos recomendados pela literatura. O protótipo desenvolvido foi composto por conceitos, fatores de risco, sinais e sintomas, tratamento, importância dos medicamentos e seus efeitos colaterais, dúvidas frequentes, cuidados necessários com a saúde e o follow up dos pacientes por meio da monitorização da evolução do processo cicatricial das lesões e possíveis complicações, esclarecer dúvidas e estimular a continuidade do tratamento. Conclusão: o uso do aplicativos em saúde é uma ferramenta tecnológica com potencial para melhorar o acompanhamento de pacientes quanto à evolução da doença e autocuidado, no acompanhamento dos fatores de risco, coparticipação no seu tratamento, a participação familiar, bem como planejar um cuidado individualizado e redução de custos para o sistema de saúde.


RESUMEN Objetivo: describir el desarrollo de un prototipo de aplicativo móvil educativo y de follow up de enfermería para pacientes con diagnóstico de enfermedad arterial periférica. Método: estudio de producción tecnológica del tipo prototipación, la construcción siguió el modelo del design instruccional contextualizado, utilizando dos etapas: análisis y design y desarrollo. Resultados: el contenido pedagógico del aplicativo se basó en el levantamiento de las necesidades de los pacientes con Enfermedad Arterial Periférica y en los tratamientos recomendados por la literatura. El prototipo desarrollado fue compuesto por conceptos, factores de riesgo, señales y síntomas, tratamiento, importancia de los medicamentos y sus efectos colaterales, dudas frecuentes, cuidados necesarios con la salud y el follow up de los pacientes por medio del monitoreo de la evolución del proceso cicatricial de las lesiones y posibles complicaciones, aclarar dudas y estimular la continuidad del tratamiento. Conclusión: el uso de aplicativos en salud es una herramienta tecnológica con potencial para mejorar el acompañamiento de pacientes como a la evolución de la enfermedad y autocuidado, en el acompañamiento de los factores de riesgo, coparticipación en su tratamiento, la participación familiar, así como planificar un cuidado individualizado y reducción de costos para el sistema de salud.


Subject(s)
Peripheral Arterial Disease/diagnosis , Mobile Applications/statistics & numerical data , Nursing Care/statistics & numerical data , Educational Technology/methods , Continuity of Patient Care/organization & administration , Information Technology
10.
Int. j. cardiovasc. sci. (Impr.) ; 31(4): 405-413, jul.-ago. 2018. tab
Article in English, Portuguese | LILACS | ID: biblio-910632

ABSTRACT

A identificação da doença arterial periférica (DAP) pode atenuar a progressão e suas complicações adicionais, uma vez que a DAP é um fator de risco para mortalidade geral e cardiovascular. Avaliar a prevalência de DAP na população do Estudo Corações de Baependi e investigar fatores de risco associados em diferentes grupos etários. Foram selecionados 1.627 indivíduos (ambos os sexos e idade entre 18 e 102 anos) residentes no município de Baependi (Minas Gerais, Brasil). Os parâmetros antropométricos e bioquímicos foram avaliados por meio de protocolos padrões. O nível de atividade física foi determinado pelo Questionário Internacional de Atividade Física - Versão Curta (IPAQ-SF). A triagem da DAP foi realizada pelo índice tornozelo-braço (ITB). O nível de significância estatística adotado nas análises foi de 5%. Na população total, a prevalência de DAP foi de 1,05% e atingiu 5,2% após os 70 anos de idade. A frequência e intensidade do tabagismo foram maiores nos indivíduos com DAP. Uma história prévia de infarto do miocárdio e maior prevalência de hipertensão, diabetes, obesidade e sedentarismo também estiveram associados à DAP. Além disso, a DAP foi mais frequente em negros que em brancos. Após análise multivariada, a idade, diabetes, tabagismo e inatividade física permaneceram independentemente associados à DAP. A prevalência de DAP foi baixa e claramente aumentou com a idade em nossa amostra de uma população rural brasileira. Além disso, os principais fatores de risco para DAP foram tabagismo, sedentarismo, diabetes e idade


The identification of peripheral artery disease (PAD) can help prevent further progression of the disease and additional complications, considering that this condition is a risk factor for all-cause mortality and cardiovascular death. To assess the prevalence of PAD in the Baependi Heart Study and investigate associated risk factors in different age groups. A total of 1,627 individuals (of both genders and aged 18 - 102 years) residing in the municipality of Baependi (Minas Gerais, Brazil) were selected for this study. Anthropometric and biochemical parameters were evaluated by standard techniques. Physical activity level was determined by the International Physical Activity Questionnaire - Short Form (IPAQ-SF). The screening of PAD was performed by determination of the ankle-brachial index (ABI). The level of statistical significance was set at 5%. In the overall sample, the prevalence of PAD was 1.05%, and reached 5.2% after the age of 70 years. The frequency and intensity of smoking were higher in individuals with PAD. A prior history of myocardial infarction and a higher prevalence of hypertension, diabetes, obesity, and sedentary lifestyle were also associated with PAD. In addition, PAD was more frequent in blacks than whites. In multivariable analysis, age, diabetes, smoking, and physical inactivity remained independently associated with PAD. The prevalence of PAD was low and increased clearly with age in our sample from a Brazilian rural population. Furthermore, the main risk factors for PAD in the investigated sample were smoking, sedentary lifestyle, diabetes mellitus, and age


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Rural Population , Prevalence , Risk Factors , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Tobacco Use Disorder/complications , Cardiovascular Diseases/mortality , Epidemiologic Studies , Body Mass Index , Anthropometry/methods , Statistical Analysis , Surveys and Questionnaires , Cohort Studies , Diabetes Mellitus/diagnosis , Ankle Brachial Index , Sedentary Behavior , Arterial Pressure , Hypertension
11.
Rev. cuba. angiol. cir. vasc ; 19(1)ene.-jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-960325

ABSTRACT

Introducción: La enfermedad arterial periférica de miembros inferiores representa un problema de salud por su repercusión sobre la calidad de vida de los individuos afectados y en el alto costo de su atención. Objetivo: Describir el estado de la calidad de vida de los pacientes con enfermedad arterial periférica de miembros inferiores en los estadios iníciales.nMétodos: Se realizó un estudio descriptivo-retrospectivo en 51 pacientes con diagnóstico de enfermedad arterial periférica de los miembros inferiores atendidos por consultas externas de arteriología entre enero y diciembre de 2012. Las variables estudiadas fueron: edad, tabaquismo, índices de presiones tobillo/ brazo, escalas de calidad de vida, salud mental y física. A todos los enfermos se les aplicó el cuestionario genérico de calidad de vida SF-36, que informa acerca de la salud física y mental del paciente.nResultados: La enfermedad arterial fue más frecuente en el sexo masculino (78,4 por ciento ), con predomino en el grupo de edad de 60 a 70 años (68,8 por ciento), donde el 100 por ciento fumaban y un 80,4 por ciento no trabajaba. El 50,9 por ciento tenía valores de índice tobillo/ brazo en el rango de moderado (0,4-0,6). El nivel de calidad de vida que predominó fue el moderado (72,5 por ciento). El 58,8 por ciento de los pacientes en estadio lla de la enfermedad mostraron alteración en la salud física y mental.nConclusiones: Se constató que los pacientes con enfermedad arterial periférica de los miembros inferiores en estadios iníciales presentan un nivel de calidad de vida moderada con deterioro en la salud física y mental(AU)


Introduction: Peripheral arterial disease of lower limbs is a health problem because of its impact on the quality of life of individuals and the high cost of care. Objective: To describe the state of the quality of life of patients with peripheral arterial disease of limbs in stages starting them. Methods: A descriptive-retrospective study was conducted in 51 patients diagnosed with peripheral arterial disease of lower limbs and treated in the outpatient arteriology service of the Institute of Angiology during January to December 2012. The studied variables were: age, smoking, indexes of ankle / arm pressures, quality of life scales and physical and mental health. The SF-36 generic quality of life questionnaire was administered to all the patients, which provides information about the physical and mental health of the patient. Results: We found that arterial disease was more frequent in males (78.4 percent), mainly in the 60-70 y age group (68.8 percent) in which 100 percent smoked and 80.4 percent did not work. In the study group, 50.9 percent showed moderate range of ankle / arm index values (0.4- 0.6). The prevailing level of quality was moderate (72.5 percent). The staging of disease was present in 58.8 percent of patients, who also showed altered physical and mental health. Conclusions: It was found that patients with peripheral arterial disease of the lower limbs at early stages have moderate level of quality of life with deterioration in their physical and mental health(AU)


Subject(s)
Humans , Male , Female , Quality of Life , Peripheral Arterial Disease/diagnosis , Epidemiology, Descriptive , Retrospective Studies
12.
Med. interna (Caracas) ; 34(1): 3-25, 2018. ilus, tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1007870

ABSTRACT

La enfermedad arterial periférica (EAP) es la afectación de la circulación arterial especialmente a nivel de las extremidades inferiores. Su prevalencia aumenta con la edad. La mayoría de los afectados estarán asintomáticos, lo que supone un reto, ya que debemos hacer un esfuerzo activo para diagnosticarla. Al diagnosticar la EAP, debemos hacer entender a nuestros pacientes que el riesgo no es perder la extremidad, sino presentar complicaciones cardiovasculares mayores o incluso, la muerte. Debemos orientar al paciente para realizar un cambio en su estilo de vida y a la vez concientizar al médico de atención primaria para realizar prevención y diagnóstico precoz de la EAP para así evitar progresión de la enfermedad con consecuencias irreversibles(AU)


Peripheral arterial disease (PAD) is the involvement of the arterial circulation especially in the lower limbs. The prevalence of this pathology increases with age. The majority of those affected will be asymptomatic, which is a challenge, since we have to make an active effort to diagnose them. When diagnosing PAD, we must make our patients understand that the risk is not to lose the limb, but to suffer major cardiovascular complications or death. We must guide the patient to make a change in lifestyle and at the same time. raise awareness of the primary care physician to perform prevention or early diagnosis of PAD and thus prevent progression of the disease with irreversible consequences(AU)


Subject(s)
Humans , Male , Female , Lower Extremity/blood supply , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/physiopathology , Atherosclerosis/complications , Internal Medicine
13.
Arq. neuropsiquiatr ; 75(8): 533-538, Aug. 2017. tab
Article in English | LILACS | ID: biblio-888305

ABSTRACT

ABSTRACT Objective To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically significant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI.


RESUMO Objetivo Avaliar dor neuropática e doença vascular periférica em diabéticos e comparar com, tempo de diagnóstico de diabetes tipo 1(DM 1) e diabetes tipo 2(DM2). Métodos Estudo de corte transversal onde, 225 diabéticos responderam ao questionário (DN4) sendo submetidos ao índice tornozelo-braquial (ITB). Resultados predomínio de dor neuropática foi em pacientes acima de 60 anos com (DM2), com um ITB > 1,3 nesta população; assim a dor neuropática foi relacionada com o ITB anormal em 144 pacientes, total de 64,2%. Um valor estatisticamente significativo foi com (DM2).Um ITB alterado (< 0,9) em 33% no (DM 1) e em 67% (DM 2). Totalizando 132 indivíduos com alterações no ITB. Conclusão O teste ITB é útil em pacientes com DM 1 e DM 2 quando a dor neuropática é suspeita, mesmo em assintomáticos. E o tempo prolongado de diabetes (> 10 anos), independentemente da presença de dor ou sinais isquêmicos, alterou o ITB.


Subject(s)
Humans , Male , Female , Middle Aged , Diabetes Mellitus, Type 1/diagnosis , Diabetes Mellitus, Type 2/diagnosis , Diabetic Neuropathies/diagnosis , Ankle Brachial Index , Peripheral Arterial Disease/diagnosis , Time Factors , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Diabetic Neuropathies/diet therapy , Diabetic Neuropathies/etiology , Peripheral Arterial Disease/etiology , Arterial Pressure
14.
J. vasc. bras ; 16(1): f:31-l:34, Jan.-Mar. 2017. tab, ilus
Article in Portuguese | LILACS | ID: biblio-841404

ABSTRACT

Resumo Contexto A reestenose intra-stent por hiperplasia miointimal pós-angioplastia é uma intercorrência frequente e que limita a perviedade do procedimento a longo prazo. A terapia com balões revestidos de droga com ação antiproliferativa pode ser uma alternativa no tratamento dessa complicação. Objetivos Demonstrar eficácia e as complicações (óbito, grandes amputações, etc.) do balão farmacológico no tratamento da reestenose intra-stent de segmento femoropoplíteo. Métodos Estudo de coorte retrospectivo de 32 pacientes consecutivos tratados entre os anos de 2012 e 2016, submetidos a terapia de reestenose intra-stent de segmento femoropoplíteo com angioplastia com balão farmacológico revestido com paclitaxel. A taxa de sucesso foi mensurada pela ocorrência de sucesso do procedimento e reestenose inferior a 50% em avaliação por eco-Doppler colorido 30, 90 e 180 dias após o procedimento. Resultados Quatro pacientes (12,5%) apresentaram reestenose superior a 50%, sendo um (3,1%) após 90 dias e três (9,4%) após 180 dias, conferindo uma taxa de sucesso de 87,5% ao procedimento. Após 180 dias, todos os pacientes referiam melhora ou cessação dos sinais e/ou sintomas apresentados antes do procedimento. Não houve óbitos, e complicações ocorreram apenas em dois casos, no pós-operatório imediato. Conclusões Os resultados a curto prazo da terapia com balão farmacológico são promissores, com redução na taxa de reestenose e baixo índice de complicações. Ainda precisam ser apresentados estudos demonstrando os efeitos a longo prazo dessa terapia, assim como seu impacto econômico quando comparada a outros procedimentos.


Abstract Background In-stent restenosis due to myointimal hyperplasia after angioplasty is common and limits long-term patency. Treatments using balloons coated with antiproliferative drugs may offer an alternative option for this pathology. Objectives To demonstrate the efficacy and complications (death, major amputations, etc.) of drug-coated balloons for treatment of in-stent restenosis in femoropopliteal segments. Methods This was a retrospective cohort study of 32 consecutive patients treated between 2012 and 2016 who underwent treatment to correct in-stent restenosis in the femoropopliteal segment using paclitaxel-coated balloons. The success rate was measured in terms of technical success and restenosis of less than 50% on Doppler ultrasonography at 30, 90, and 180 days after the procedure. Results Four patients (12.5%) exhibited restenosis greater than 50%, one (3.1%) after 90 days and three (9.4%) after 180 days, equating to a success rate of 87.5% of procedures, and by 180 days all patients experienced improvement or cessation of the signs and/or symptoms they had presented prior to the procedure. There were no deaths and complications occurred in just 2 cases in the immediate postoperative period. Conclusions Short-term results are promising, with reductions in the magnitude of restenosis and a low rate of complications. Further studies are needed that can demonstrate the long-term effects and the economic impacts in comparison to other procedures.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Angioplasty, Balloon/methods , Femoral Vein/surgery , Graft Occlusion, Vascular/complications , Graft Occlusion, Vascular/therapy , Paclitaxel/therapeutic use , Popliteal Vein/surgery , Stents , Cohort Studies , Echocardiography, Doppler, Color/methods , Graft Occlusion, Vascular/diagnosis , Graft Occlusion, Vascular/therapy , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/therapy , Treatment Outcome
15.
J. vasc. bras ; 15(3): 176-181, jul.-set. 2016. tab
Article in Portuguese | LILACS | ID: lil-797966

ABSTRACT

Resumo Contexto O índice tornozelo-braquial (ITB) é um exame de rastreamento da doença arterial obstrutiva periférica, sendo também utilizado para avaliar o risco cardiovascular. Em diabéticos, a interpretação do exame é difícil pela possibilidade de índice aberrante devido à calcificação da camada média arterial. Objetivo Encontrar a frequência de ITB aberrante em diabéticos e verificar sua associação com variáveis sociodemográficas. Métodos Estudo descritivo com entrevista e aferição de ITB de 309 pacientes diabéticos tipo 2, acompanhados no centro de referência Centro de Diabetes e Endocrinologia da Bahia (CEDEBA), Salvador, BA, Brasil. Foi estudada a frequência e a relação entre o ITB aberrante e variáveis sociodemográficas, como sexo, idade e renda familiar. Utilizou-se um ponto de corte para ITB aberrante de 1,3. As variáveis contínuas foram dicotomizadas. Para a análise estatística, utilizou-se o teste do qui-quadrado, considerando significante um p ≤ 0,05. Resultados Entre os 309 pacientes entrevistados, 65% eram mulheres, 26% haviam cursado ensino médio completo e 77% tinham renda familiar igual ou menor que três salários mínimos. A frequência de ITB aberrante ≥ 1,3 foi 16,5%. Não foram encontradas correlações estatisticamente significantes nas análises bivariadas entre o ITB aberrante (≥ 1,3) e as variáveis sociodemográficas estudadas (sexo, idade, tempo de duração de diabetes melito, renda familiar e escolaridade). Conclusões A frequência de ITB aberrante entre diabéticos foi de 16,5%. Não encontramos correlação entre as variáveis sociodemográficas (sexo, idade, tempo de DM, escolaridade e renda familiar) e a ocorrência de ITB aberrante.


Abstract Background The ankle-brachial index (ABI) is a screening test for peripheral arterial occlusive disease and it can also be used to assess cardiovascular risk. However, in diabetics it can be difficult to interpret because the index may be excessively high because of calcification of the arterial tunica media. Objective To determine the frequency of high ABI in diabetics and to test for associations with sociodemographic variables. Methods This was a descriptive study in which 309 type 2 diabetes patients were interviewed and had their ABI measured. The sample was recruited at a referral center for diabetes and endocrinology (CEDEBA) in Salvador, BA, Brazil. The frequency of excessively high ABI and its relationships with sociodemographic variables such as sex, age and family income were studied. The cutoff point chosen for excessively high ABI was 1.3. Continuous variables were dichotomized. The chi-square test was used for statistical analysis and results with p ≤ 0.05 were considered significant. Results A total of 309 patients were interviewed, 65% were women, 26% had graduated from secondary education and 77% had a family income equal to or less than three times the minimum salary. The frequency of excessively high ABI (≥ 1.3) was 16.5%. Bivariate analyses detected no statistically significant correlations between excessively high ABI (≥ 1.3) and the sociodemographic variables studied (sex, age, time since diagnosis of diabetes mellitus, family income and educational level). Conclusions The frequency of high ABI among this sample of diabetics was 16.5%. We did not detect correlations between the sociodemographic variables (sex, age, duration of DM, educational level and family income) and high ABI.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Ankle Brachial Index/history , Diabetic Angiopathies/diagnostic imaging , Peripheral Arterial Disease/diagnosis , Vascular Calcification/pathology , Epidemiology, Descriptive
16.
J. vasc. bras ; 14(4): 311-318, out.-dez. 2015. tab, graf
Article in English | LILACS | ID: lil-767702

ABSTRACT

O relato de sintoma claudicante em pacientes com doença arterial periférica é utilizado como modulador da intensidade de exercício físico para o tratamento clínico, entretanto os valores de oxigenação tecidual nesse momento são desconhecidos. Objetivo Descrever o suprimento tecidual de oxigênio por meio da espectroscopia de luz próxima ao infravermelho ou Near-Infrared Spectroscopy (NIRS) nos momentos em que o paciente relata sintoma claudicante inicial e máximo em testes de exercício. Métodos Nove pacientes, oito homens com 65,63 ± 6,02 anos de idade, previamente diagnosticados com doença arterial periférica, realizaram teste de exercício de carga constante e de carga incremental com monitorização do nível de oxigenação tecidual através da NIRS. As saturações de oxigênio obtidas no momento em que o paciente relata sintoma claudicante inicial e no momento em que relata sintoma claudicante máximo foram comparadas com os valores de saturação da manobra de oclusão arterial por meio do intervalo de confiança de 95% da diferença. Resultados Verificou-se que os valores de saturação nos momentos de sintoma claudicante inicial e máximo são estatisticamente distintos quando comparados àqueles obtidos na manobra de oclusão arterial, entretanto, através da análise percentual do quão distante esses valores encontram-se é possível observar que, do ponto de vista clínico, eles estão próximos. Conclusões A saturação no momento em que o paciente relata sintomas claudicantes inicial e máximo é bastante próxima do valor de saturação no momento de oclusão e do ponto de vista clínico o relato subjetivo de sintoma do paciente é adequado como parâmetro para a prescrição do exercício físico.


The time at which claudication symptoms are reported is used to modulate exercise intensity in clinical treatment of patients with peripheral arterial disease, but tissue oxygenation values at that point are unknown. Objective To describe tissue oxygen supply measured using Near-Infrared Spectroscopy (NIRS) when patients report initial and maximum claudication symptoms during exercise tests. Methods Nine patients (eight men) aged 65.63 ± 6.02 years and previously diagnosed with peripheral arterial disease performed constant load exercise testing and incremental load exercise testing while tissue oxygenation levels were monitored by NIRS. Oxygen saturation values at the times at which each patient reported initial onset of claudication symptoms and maximum claudication symptoms were compared with values obtained during the arterial occlusion maneuver, using the 95% confidence interval of the difference. Results It was found that saturation values at the time of both initial and maximum claudication symptoms were statistically different from saturation during the arterial occlusion maneuver, but on the basis of percentage analysis they were similar from a clinical point of view. Conclusions Oxygen saturations at the time patients report initial and maximum claudication symptoms are very close to saturations during arterial occlusion. From a clinical perspective, subjective patient report of symptoms is an appropriate parameter on which to base exercise prescription.


Subject(s)
Humans , Male , Aged , Peripheral Arterial Disease/diagnosis , Exercise , Intermittent Claudication , Surveys and Questionnaires , Spectroscopy, Near-Infrared/methods , Exercise Test/methods
17.
J. vasc. bras ; 14(1): 55-61, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-744457

ABSTRACT

Resistance training has been used for the treatment of patients with peripheral artery disease (PAD). However, cardiovascular responses during this type of exercise have not been fully elucidated in these patients. OBJECTIVES: To analyze the cardiovascular responses during resistance exercise and to verify whether there are any correlations between these responses and disease severity or blood pressure levels in patients with PAD. METHODS: Seventeen PAD patients performed one set of 10 repetitions of knee extension exercise with an intensity of 50% of one repetition maximum. The responses of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were continuously monitored using the finger photoplethysmography technique. The rate-pressure product (RPP) was obtained by multiplication of SBP and HR. RESULTS: During the resistance exercises there were significant increases in SBP (126 ± 14 vs. 184 ± 20 mmHg, p<0.001), DBP (68 ± 8 vs. 104 ± 14 mmHg, p<0.001), HR (76 ± 18 vs. 104 ± 30 bpm, p<0.001) and RPP (9523 ± 2115 vs. 19103 ± 6098 mmHg x bpm, p<0.001). A negative correlation was observed between relative change (Δ) in SBP and SBP at rest (r =-0.549, p=0.022). On the other hand, there was no relationship between Δ SBP and the ankle-brachial index (r=0.076, p=0.771). CONCLUSION: Increases in cardiovascular variables were observed during resistance exercise in PAD patients. The highest increases occurred in patients with lower SBP levels at resting...


O treinamento de força vem sendo utilizado para o tratamento de pacientes com doença arterial periférica (DAP). No entanto, as respostas cardiovasculares durante a realização desse tipo de exercício ainda não são claras nesses pacientes. OBJETIVOS: Analisar as respostas cardiovasculares durante a realização do exercício de força e verificar se existe alguma correlação entre essas respostas e a severidade da doença e o nível de pressão arterial em pacientes com DAP. MÉTODOS: Dezessete pacientes com DAP realizaram uma série de dez repetições com intensidade de 50% de uma repetição máxima do exercício extensão do joelho. As respostas da pressão arterial sistólica (PAS) e diastólica (PAD), e da frequência cardíaca (FC) foram continuamente registradas pela técnica de fotopletismografia de dedo. O duplo produto (DP) foi obtido pela multiplicação da PAS pela FC. RESULTADOS: Durante a realização do exercício de força, houve aumento significante dos seguintes parâmetros: PAS (126 ± 14 vs. 184 ± 20 mmHg; p < 0,001); PAD (68 ± 8 vs. 104 ± 14 mmHg; p < 0,001); FC (76 ± 18 vs. 104 ± 30 bpm; p < 0,001), e DP (9523 ± 2115 vs. 19103 ± 6098 bpm x mmHg; p < 0,001). Foi observada correlação negativa entre o delta (Δ) relativo da PAS com a PAS de repouso (r = -0,549; p = 0,022). Por outro lado, não foi observada relação entre o Δ relativo da PAS e o índice tornozelo braço (r = 0,076; p = 0,771). CONCLUSÃO: Foram observados aumentos das variáveis cardiovasculares durante o exercício de força em pacientes com DAP. Os maiores aumentos ocorreram nos pacientes com menor nível de PAS em repouso...


Subject(s)
Humans , Male , Female , Middle Aged , Peripheral Arterial Disease/diagnosis , Exercise , Hospitals, Private/classification , Hospitals, Public/methods , Intermittent Claudication , Arterial Pressure , Heart Rate , Risk Factors
18.
J. vasc. bras ; 14(1): 46-54, Jan-Mar/2015. tab, graf
Article in English | LILACS | ID: lil-744461

ABSTRACT

Diabetes mellitus (DM) is a risk factor for peripheral arterial disease (PAD). Neither the prevalence of PAD in type 2 (T2) DM nor its detrimental effects on quality of life (QoL) or physical activity (PA) have been well described in the Brazilian population. OBJECTIVES: To evaluate the prevalence of newly diagnosed PAD and its associations with QoL, PA and body composition in a sample of T2DM patients from a University Hospital. METHODS: Seventy-three (73) T2DM patients without previous diagnoses of major complications related to T2DM were enrolled. PAD was assessed using the ankle-brachial index (ABI); QoL was measured using a translated and validated SF-36 questionnaire; PA was measured using a modified Baecke questionnaire; and body composition was measured by segmental multi-frequency bioelectrical impedance. RESULTS: PAD prevalence was 13.7%, predominantly of mild severity (ABI between 0.8-0.9). The ABI results correlated with age (ρ=-0.26, P=0.03), DM duration (ρ=-0.28, P=0.02) and systolic and diastolic blood pressure (ρ=-0.33, P=0.007 and ρ=-0.28, P=0.02; respectively). Scores for the SF-36 physical component summary (PCS) were below the normal range, but no negative impact from PAD was identified by the PCS scores (normal-ABI 42.9±11.2 vs. PAD-ABI 38.12±11.07) or the Baecke PA results. Body composition analysis detected excessive body fat, especially in women, but there was no difference between groups. CONCLUSIONS: The prevalence of previously undiagnosed PAD in this population of T2DM patients was 13.7%, predominantly mild and asymptomatic forms, and was not yet associated with worsened QoL, PA levels or body composition variables...


O Diabetes Mellitus (DM) é fator de risco para a doença arterial obstrutiva periférica (DAOP). A prevalência de DAOP no DM tipo 2 (T2) e o prejuízo adicional causado por esta na qualidade de vida (QoL) e na atividade física (AF) não são bem descritos na população brasileira. OBJETIVOS: Avaliar a prevalência e a associação da DAOP recém-diagnosticada com a QoL, a AF e a composição corporal em pacientes T2DM provenientes de um hospital universitário. MÉTODOS: Setenta e três pacientes T2DM, sem complicações maiores relacionadas ao T2DM, foram incluídos. A DAOP foi avaliada pelo índice tornozelo-braquial (ITB); a QoL, pelo questionário traduzido e validado SF-36, e a AF, pelo questionário modificado de Baecke. A composição corporal foi avaliada pela impedância bioelétrica segmentar multifrequencial. RESULTADOS: A prevalência de DAOP foi 13,7%, predominantemente de severidade leve (ITB entre 0,8-0,9). O ITB correlacionou-se com a idade (ρ= -0,26; P= 0,03), a duração do DM (ρ=-0,28; P=0,02) e a pressão arterial sistólica e diastólica (ρ= -0,33; P= 0,007 e ρ= -0,28; P= 0,02; respectivamente). O sumário de saúde física (PCS) do questionário SF-36 estava abaixo da variação normal; contudo, nenhum impacto negativo da DAOP foi identificado no PCS (ABI normal = 42,9±11,2 vs. ABI-DAOP = 38,12±11,07) ou no nível de AF. A análise da composição corporal demonstrou gordura corporal excessiva, especialmente em mulheres; contudo, sem diferenças entre grupos. CONCLUSÃO: A prevalência de DAOP sem diagnóstico prévio nesta amostra de pacientes T2DM foi de 13,7%, predominantemente assintomática e leve, e ainda não associada com piores índices de QoL, nível de AF e composição corporal...


Subject(s)
Humans , Male , Female , Body Composition/genetics , /complications , Peripheral Arterial Disease/diagnosis , Quality of Life , Ankle Brachial Index/methods , Prevalence , Unified Health System
19.
Rev. guatem. cardiol. (Impresa) ; 24(2): 2-4, jun.-dic. 2014. tab
Article in Spanish | LILACS | ID: biblio-869908

ABSTRACT

Objetivo: Determinar la utilidad diagnóstica del índice Tobillo-Brazo por el método palpatorio comparado conel método Doppler en la detección de la enfermedad arterial periférica en pacientes hospitalizados en el Departamento de Medicina Interna del Hospital General San Juan de Dios, durante julio-agosto de 2013.Métodos: Estudio descriptivo transversal de concordancia, en 186 pacientes en el Departamento de Medicina Interna del Hospital General San Juan de Dios, sin diagnóstico previo de enfermedad arterial periférica. Secalculó a cada participante el índice Tobillo-Brazo por método palpatorio y luego con sonda Doppler portátilde 8 mHz. Se analizaron los datos utilizando el índice de Kappa. Resultados: Encontramos 31 pacientes positivos por ambos métodos (palpatorio y Doppler), 5 falsos positivos (solo por método palpatorio), 145negativos por ambos métodos y 6 positivos únicamente por Doppler. Se obtuvo un índice de Kappa de 0.8085el cual corresponde a una adecuada fuerza de concordancia. Conclusiones: La utilidad diagnóstica delíndice Tobillo-Brazo por método palpatorio es apropiada para el diagnóstico de enfermedad arterial periférica,con sensibilidad de 83.3% y especificidad de 96.6% y una apropiada fuerza de la concordancia determinada por el índice de Kappa.


Objective: Determine the diagnostic value of ankle-arm index by palpatory method compared to the Dopplermethod in the detection of peripheral arterial disease in patients hospitalized in the Internal Medicine Department, of Hospital General San Juan de Dios, during July-August 2013. Methods: A cross-matching, descriptive and transversal study in 186 patients at the Department of Internal Medicine, of Hospital GeneralSan Juan de Dios, previously undiagnosed peripheral arterial disease. Each participant Ankle-arm index wascalculated by palpatory method and then with portable 8 MHz Doppler probe. Data using the Kappa indexwere analyzed. Results: We found 31 patients positive by both methods (palpatory and Doppler), 5 falsepositives (just palpatory method), 145 negative by both methods and only 6 positive Doppler. Kappa index of0.8085 which corresponds to a suitable strength of agreement was obtained. CONCLUSIONS: The diagnosticvalue of ankle-arm index palpatory method is suitable for the diagnosis of peripheral arterial disease, withsensitivity of 83.3% and specificity of 96.6% and an appropriate strength of agreement determined by Kappa.


Subject(s)
Humans , Echocardiography, Doppler , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnosis , Ankle Brachial Index
20.
J. vasc. bras ; 13(3): 182-191, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-727134

ABSTRACT

Background: Atherosclerosis is a multifactorial disease with an inflammatory pathophysiological basis. Cytokines released during the atherosclerotic process induce production of C-reactive protein (CRP) in the liver, which is an important marker of inflammation. Objective: We tested whether inflammatory biomarkers were associated with deterioration of peripheral arterial occlusive disease (PAOD) in a population at high cardiovascular risk. Methods: 1,330 subjects ≥30 years of age underwent clinical and laboratory examinations as part of a population-based study of the prevalence of diabetes. PAOD was defined as an ankle-brachial index (ABI) ≤0.90. After application of exclusion criteria, the sample comprised 1,038 subjects. Traditional risk factors, CRP and interleukin 6 (IL-6) were also compared across three ABI categories (≤0.70; 0.71-0.90; ≥0.90). Mean values for these variables were compared by presence/absence of DAOP (Student's t test) and by ABI categories (ANOVA). Poisson regression and logistic regression models were used to test for associations between risk factors and DAOP and between risk factors and the ABI categories. Pearson's linear correlation coefficients were calculated for the relationship between CRP and IL-6 levels. Results: Mean age was 56.8±12.9 years, 54% of the sample were women and the prevalence of DAOP was 21.0% (95%CI 18.4-24.1). Individuals with ABI ≤0.70 had higher concentrations of CRP-us (2.1 vs. 1.8) and of IL-6 (1.25 vs. 1.17). Concentrations of CRP and IL-6 were only correlated in patients with DAOP, (p=0.004). Conclusions: The finding that CRP and IL-6 levels were only elevated among people with advanced DAOP may suggest that these biomarkers have a role to play as indicators of more severe disease. Prospective studies are needed to test this hypothesis...


Contexto: Aterosclerose é doença multifatorial, cuja base fisiopatológica é um processo inflamatório. Estudos são controversos quanto ao papel dos biomarcadores como fatores de risco. A liberação de citoquinas durante aterogênese promove síntese hepática de proteína C-reativa (PCR), importante marcador inflamatório. Objetivo: Avaliamos se biomarcadores inflamatórios estavam associados à deterioração da doença arterial obstrutiva periférica (DAOP), em população de risco cardiovascular. Métodos: Estudo populacional sobre prevalência de diabetes, em que 1.330 indivíduos com ≥30 anos foram submetidos a exames clínico-laboratoriais. Diagnóstico de DAOP foi feito pelo índice tornozelo-braço (ITB) ≤0,90. Após exclusões, 1.038 indivíduos foram analisados. Fatores de risco tradicionais, PCR e interleucina 6 (IL-6) foram comparados também segundo três categorias de ITB (≤0,70; 0,71-0,90; ≥0,90). Valores médios das variáveis foram comparados segundo presença de DAOP (teste t Student) e categorias do ITB (ANOVA). Utilizou-se modelo de Poisson e regressão logística para avaliar associações da DAOP e categorias do ITB com fatores de risco. Estimou-se coeficiente de correlação linear de Pearson para relação entre os valores de PCR e IL-6. Resultados: A idade média foi 56,8±12,9 anos, 54% mulheres e prevalência de DAOP 21,0% (IC95% 18,4-24,1). Indivíduos com ITB ≤0,70 apresentaram maiores valores de PCR-us (2,1 vs. 1,8) e IL-6 (1,25 vs. 1,17. Apenas em portadores de DAOP, valores de PCR e IL-6 mostraram-se correlacionados (p=0,004). Conclusão: O achado de concentrações mais elevadas de PCR e IL-6 apenas em indivíduos com DAOP avançada pode sugerir um...


Subject(s)
Humans , Male , Female , Middle Aged , Atherosclerosis/complications , Peripheral Arterial Disease/diagnosis , Comorbidity , Cholesterol, LDL/blood , Prevalence , Risk Factors , Triglycerides/blood
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