Physical activity practice during COVID-19 pandemic in patients with intermittent claudication

SUMMARY OBJECTIVE: To describe physical activity habits and barriers for physical activity practice in patients with peripheral artery disease and claudication symptoms during Coronavirus 2019 (COVID-19) pandemic. METHODS: In this cross-sectional survey study, 127 patients with peripheral artery disease (59.8% men; 68±9 years old; and 81.9% had the peripheral artery disease diagnosis ≥5 years old) were included. The physical activity habits and barriers for physical activity practice were assessed through telephone interview using a questionnaire with questions related to: (a) COVID-19 personal care; (b) overall health; (c) physical activity habits; (d) for those who were inactive, the barriers for physical activity practice. RESULTS: Only 26.8% of patients reported practicing physical activity during the COVID-19 pandemic. Exercise characteristics more common among these patients include walking, performed at least 5 days a week, during 31-60 min at light intensity. In contrast, among physically inactive patients, pain, injury or disability (55%), the COVID-19 pandemic (50%), the need to rest due to leg pain (29%), and lack of energy (27%) were the most frequent barriers to physical activity practice. CONCLUSION: The physical activity level of patients with peripheral artery disease is impacted by the COVID-19 pandemic.

Self-administered versus interview-based questionnaires among patients with intermittent claudication: Do they give different results? A cross-sectional study / Questionários autoadministrados versus administrados por entrevistador para pacientes com claudicação intermitente: Os resultados são diferentes? Um estudo transversal

CONTEXT AND OBJECTIVE: Many clinical investigations use generic and/or specific questionnaires to obtain information about participants and patients. There is disagreement about whether the administration method can affect the results. The aim here was to determine whether, among patients with intermittent claudication (IC), there are differences in the Walking Impairment Questionnaire (WIQ) and European Quality of Life-5 Dimension (EQ-5D) scores with regard to: 1) the questionnaire administration method (self-administration versus face-to-face interview); and 2) the type of interviewer (vascular surgeon, VS, versus general practitioner, GP). DESIGN AND SETTING: Cross-sectional observational multicenter epidemiological study carried out within the Spanish National Health Service. METHODS: 1,641 evaluable patients with IC firstly completed the WIQ and EQ-5D questionnaires and then were interviewed by their doctor on the same day. Pearson correlations and Chi-square tests were used. RESULTS: There was a strong correlation (r > 0.800; P < 0.001) between the two methods of administering the WIQ and EQ-5D questionnaires, and between the VS and GP groups. Likewise, there was a high level of concordance (P > 0.05) between the different dimensions of the WIQ-distance and EQ-5D (self-administration versus face-to-face) in the VS and GP groups. CONCLUSION: There was no difference between the different methods of administering the WIQ and EQ-5D questionnaires, among the patients with IC. Similarly, the two types of interviewers (VS or GP) were equally valid. Therefore, it seems unnecessary to expend effort to administer these questionnaires by interview, in studies on IC.

RESUMO CONTEXTO E OBJETIVO: Muitas investigações clínicas usam questionários genéricos e/ou específicos para obter informações sobre os participantes e pacientes. Não se sabe se o modo de administração pode afetar os resultados. O objetivo foi determinar se, nos pacientes com claudicação intermitente (CI), existem diferenças nas pontuações do Walking Impairment Questionnaire (WIQ) e do European Quality of Life-5 Dimension (EQ-5D) no que diz respeito a: 1) a forma de administrar o questionário (autoadministrado versus entrevista presencial); e 2) o tipo de entrevistador: cirurgião vascular (CV) ou médico generalista (MG). TIPO DE ESTUDIO E LOCAL: Estudo epidemiológico observacional, transversal, multicêntrico realizado no Serviço Nacional de Saúde espanhol. METODO: 1.641 pacientes avaliáveis com CI completaram inicialmente o WIQ e questionários EQ-5, e depois, no mesmo dia, foram entrevistados pelo seu médico. Foram utilizados correlações de Pearson e testes de qui-quadrado. RESULTADOS: Houve forte correlação (r > 0,800; P < 0,001) entre os dois métodos de administração do WIQ e EQ-5D; e entre os grupos CV e MG. Também houve alto nível de concordância (P > 0,05) entre as diferentes dimensões do WIQ-distância e EQ-5D (autoadministrado versus entrevista presencial), nos grupos CV e MG. Conclusão: Em pacientes com CI, não há diferenças entre as diferentes formas de administrar os questionários WIQ e EQ-5D. Da mesma forma, os dois tipos de entrevistador (CV ou MG) foram igualmente válidos. Portanto, não parece necessário despender esforço para administrar esses questionários através de entrevista, em estudos de CI.

Aspectos clínicos, cirúrgicos e epidemiológicos da luxação de patela em cães atendidos no Hospital Veterinário, no período de janeiro de 2000 a julho de 2010: estudo retrospectivo / Clinical, surgical and epidemiological aspects of the patella luxation in dogs examined at the Veterinary Hospital in the period from January 2000 to July 2010: A retrospective study

Avaliaram-se, por meio de estudo retrospectivo, o perfil epidemiológico, os sinais clínicos, as técnicas cirúrgicas utilizadas e a recuperação de cães apresentados para tratamento de luxação de patela no Hospital Veterinário da UFMG, no período de 2000 a 2010. Utilizaram-se as fichas clínico-cirúrgicas dos cães e registraram-se os dados referentes a cada animal. Foram estudadas 342 articulações nos registros de 210 animais. A luxação medial congênita bilateral foi a apresentação mais frequente, e as fêmeas foram mais acometidas. A idade dos animais variou de 32 dias a 16 anos, com maior ocorrência da luxação nos animais com até um ano de idade e massa corporal inferior a 9,1kg. Em 11,7% dos membros, a luxação era de grau I, em 39,8% grau II, em 20,5% grau III e em 28% grau IV. A frequência de claudicação pré-operatória foi maior nos cães com luxações graus III e IV. Das 342 articulações, 218 foram submetidas à cirurgia. Na avaliação pós-operatória, os animais com luxação grau IV mostraram maior frequência de claudicação. A luxação patelar acomete principalmente fêmeas, sendo a luxação congênita bilateral a apresentação mais comum, e animais jovens e de pequeno porte são mais susceptíveis. A recuperação funcional pós-operatória nas luxações grau IV é lenta e parcial.

The epidemiological profile, clinical signs, and surgical techniques used and the recovery of dogs presented for treatment of patellar luxation in the Veterinary Hospital of UFMG in the period from 2000 to 2010 were evaluated through a retrospective study. The clinical and surgical records of dogs and the data recorded for each animal were used. 342 joints in the records of 210 animals were studied. The congenital bilateral medial luxation was the most frequent occurrence and females were more affected. The age of the animals ranged from 32 days to 16 years, with higher incidence of luxation in animals under one year of age and body mass below 9.1kg. In 11.7% of the members had grade I luxation, 39.8% were grade II, 20.5% were grade III and 28% were grade IV. The frequency of preoperative claudicating was higher in dogs with luxation grades III and IV. Of the 342 joints, 218 underwent surgery. In the postoperative evaluation of animals, those with grade IV luxation showed higher claudicating frequency. The patellar luxation mainly affects females, and the bilateral congenital luxation is the most common occurrence, and young and small animals are more likely to have it. Functional recovery postoperative luxation in grade IV is slow and partial.

Actividades de prevención del pie diabético en pacientes de consulta externa de primer nivel / Primary-care prevention activities in outpatients suffering from diabetic foot care

Objetivo Determinar la frecuencia de actividades de prevención del pie diabético recomendadas por el médico y efectuadas por pacientes de consulta externa en medicina general, para autocuidado de los pies y describir los hábitos alimentarios. Metodología Estudio descriptivo de corte transversal, realizado en dos instituciones de salud de Bogotá, marzo-octubre 2008; muestra ponderada, por conveniencia, 307 pacientes diabéticos mayores de 18 años. Resultados Antecedente de úlceras en pies 13 por ciento, amputaciones en miembros inferiores 1,6 por ciento. Refirieron: disestesias 65,5 por ciento y claudicación intermitente 33,6 por ciento; no habían recibido educación sobre el cuidado del pie por parte del médico 78,2 por ciento. Su médico no le había examinado los pies en el último año al 76,2 por ciento; a pesar de presentar disestesias y claudicación intermitente no se indagó sobre estos síntomas al 89 por ciento y 93 por ciento de pacientes respectivamente. Actividades de pacientes: no revisaban diariamente los pies 63,1 por ciento, no realizaban automonitoreo 93,4 por ciento, consumían más de dos fuentes de carbohidratos en comidas principales 38,1 por ciento; adicionaban a las preparaciones azúcar, panela, miel de abejas 38,8 por ciento. Conclusiones La prevalencia de actividades de prevención del pie diabético recomendadas por médicos y efectuadas por pacientes fue deficiente. Es necesario crear y fortalecer programas interdisciplinarios para la prevención de la diabetes mellitus y del pie diabético a nivel primario de atención, además de formación del equipo de profesionales en salud.

Objective Determining the prevalence of prevention activities regarding diabetic foot recommended by doctors and carried out by out-patients attending general medicine self-care foot control and describing food habits. Methods This was a descriptive and cross-sectional studywhich was carried out in two health-care institutions in Bogotá, from March to October 2008, by weightedconveniencesampling of 307 diabetic patients, aged over 18 years. Results Some patients had a background of foot ulcers (13.0 percent) and amputations of the lower limbs(1.6 percent). Some patients referredto dysesthesia(65.5 percent) and intermittent claudication (33.6 percent)whilst many stated that they had received no education about foot care from their doctors(78.2 percent). Many stated that the doctor had not checked their feet during the last year (76.2 percent)and others that, despite presenting dysesthesia and intermittent claudication(89.0 percent and 93.0 percent, respectively), the patients had not been asked about these symptoms. Regarding patient activities,some did not checktheir feet each day (63.1 percent), did not perform self-monitoring (93.4 percent), consumed more than two sources of carbohydrateduring the main meals (38. percent)and/or added sugar, "panela" or honey to preparations (38.8 percent). Conclusions The prevalence of diabetic foot prevention practices recommended by doctors and carried out by patients was poor. Interdisciplinary programmes must thus be created and strengthenedfor preventing diabetes mellitus and diabetic foot, at primary- attention out-patient level, besides providing pertinent trainingfor health teams.

Prevalência e fatores de risco associados à doença arterial periférica no projeto corações do Brasil / Prevalence and risk factors associated with peripheral arterial disease in the hearts of Brazil project

FUNDAMENTO: A doença arterial obstrutiva periférica (DAOP) está associada ao maior índice de risco cardiovascular. No Brasil, faltam dados sobre sua prevalência e fatores de risco. OBJETIVO: Avaliar prevalência e fatores de risco associados à DAOP nas cidades brasileiras com > cem mil habitantes. MÉTODOS: Estudo transversal, multicêntrico, que avaliou 1.170 indivíduos (>18 anos), em 72 centros urbanos, participantes do Projeto Corações do Brasil. O diagnóstico de DAOP baseou-se na medida do índice tornozelo-braquial (ITB) < 0,90. A análise estatística utilizou teste Qui-quadrado (Pearson) corrigido para amostras complexas e intervalos de confiança. P < 0,05 foi considerado significativo. RESULTADOS: A prevalência de DAOP foi de 10,5 por cento e apenas 9 por cento dos portadores da doença apresentaram claudicação. A DAOP esteve associada à presença de diabetes, obesidade total e abdominal, acidente vascular cerebral (AVC) e doença isquêmica do coração (DIC). Houve tendência a maior prevalência de DAOP na presença de hipertensão, insuficiência cardíaca, insuficiência renal dialítica e tabagismo >20 anos/maço. Mulheres coronariopatas apresentaram risco 4,9 vezes maior de ter DAOP, do que aquelas sem coronariopatia e, entre homens diabéticos, o risco de DAOP foi 6,6 maior em comparação aos não diabéticos. CONCLUSÃO: A prevalência de DAOP foi elevada, considerando-se a baixa média de idade da população avaliada (44±14,7 anos). A minoria dos portadores apresentava claudicação, o que denota o grande contingente de indivíduos assintomáticos. Os fatores mais fortemente associados à doença foram diabetes, obesidade, AVC e DIC. Os autores concluíram que a medida do ITB deve ser considerada na avaliação de pacientes de moderado e alto risco cardiovascular.

BACKGROUND: Peripheral arterial disease (PAD) is associated with increased cardiovascular risk. In Brazil, data on PAD prevalence and risk factors are scarce. OBJECTIVE: To assess prevalence and risk factors related to PAD in Brazilian urban centers with more than 100,000 inhabitants. METHODS: National, multicenter, cross-sectional study of 1,170 individuals (>18 years), from 72 major Brazilian urban centers participating in the "Hearts of Brazil Project". PAD diagnosis was based on ankle-brachial index (ABI) < 0.90. The statistical analysis used the corrected Chi-square (Pearson) test for complex samples and confidence intervals. P< 0.05 was considered statitically significant. RESULTS: PAD prevalence was 10.5 percent. Intermittent claudication (IC) was present in only 9 percent of PAD patients. A significant association was found between PAD and the following factors: diabetes, total and abdominal obesity, stroke and ischemic heart disease (IHD). There was a trend of higher PAD prevalence among individuals with hypertension, heart failure, chronic renal failure on dialysis, as well as those who had smoked over 20 pack-years. For females, presence of IHD was associated with a 4.9-fold greater risk of PAD. Among males, a 6.6-fold increased risk of PAD was found for diabetic in comparison to non-diabetic individuals. CONCLUSION: PAD prevalence was markedly high, considering the low mean age of the studied population (44±14.7 yrs). IC was detected in a minority of PAD subjects, indicating a considerable number of asymptomatic individuals. Diabetes, obesity, stroke and IHD were the stronger predictors of PAD. The authors concluded that ABI measurement should be considered in the evaluation of moderate to high cardiovascular risk patients.

Claudicação na infância / Claudication in infancy

Este artigo discore sobre a claudcação na infância, sua etiologia nas diversas faixas etárias e as rotinas diagnósticas. Apresenta também conceitos básicos sobre marcha, servindo como um guia para o estabelecimentode uma linha de racioncínio clínico para a investigação dessas crianças.

Frequência de problemas de equilíbrio nos cascos de cavalos crioulos em treinamento / Frequency of hoof balance problems in training crioulo horses

O desequilíbrio dos cascos como fator causador de claudicação em cavalos atletas é bastante documentado na literatura e pode ser dividido em geométrico, dinâmico e natural. O presente estudo verificou o equilíbrio geométrico nos cascos de 97 cavalos crioulos adultos, em treinamento, em 16 estabelecimentos, para determinar a incidência de alterações nos cascos. Foram registradas nove medidas nos cascos dos membros anteriores: ângulo da pinça, circunferência na banda coronária, comprimento lateral e medial dos talões e quartos, comprimento da pinça, comprimento e largura da ranilha. As mensurações permitiram a identificação das seguintes alterações: 85 dos 97 cavalos (87.62%) apresentaram talões contraídos, 48 (49.48%) desequilíbrio médio-lateral, 23 (23.71%) ângulos dos cascos contralaterais diferentes e 11 (11.34%) tinham o eixo quebrado para trás. A incidência de ângulos dos cascos contralaterais diferentes variou entre os cinco grupos de idade (p<0.05). O ângulo do casco variou entre 45° e 58° (52.71 ± 0.15°). O comprimento médio da pinça foi 8.7 ± 0.6 cm e foi considerado excessivo para cavalos com 411.4 ± 34.80 kg de peso. A grande freqüência de alterações de casco nesta população de cavalos sugere que as práticas de casqueamento e ferrageamento adotadas devem ser revistas e melhoradas.

The role of improper hoof balance causing lameness in sport horses is well documented in the literature. Hoof balance can be divided into geometric, dynamic and natural balance. This study assessed the geometric balance of 97 adult Crioulo horses in training at 16 different training centers to determine the incidence of poor hoof conformation. Nine measurements of the hoof were taken: angle at the toe, circumference at the coronary band, lateral and medial quarter and heel length, toe length, frog length and width. From these measurements the following hoof problems could be identified: 85 out of 97 horses (87.62%) had contracted heels, 48 (49.48%) had medial to lateral hoof imbalance, 23 (23.71 %) had mismatched hoof angles and 11 (11.34%) had a broken back hoof axis. The frequency of mismatched hoof angles was different between the five age groups (p<0.05). The hoof angle varied from 45° to 58° (52.71 ± 0.15°). The average toe length was 8.7 ± 0.6 cm and was considered to be excessive for horses with 411.4 ± 34.80 Kg body weight. The high frequency of hoof abnormalities in this population of horses suggests that trimming and shoeing practices employed should be reviewed and improved.