RESUMO
Objetivo: Indentificar el delirium en pacientes con insuficiencia cardiaca (IC) descompensada (ICD) atendidos en urgencias y analizar las características clínicas y la evolución a largo plazo. Método: Estudio prospectivo y observacional en 60 pacientes que acudieron a urgencias por ICD. Evaluamos la presencia de delirium y subsíndrome de delirium mediante el Confusional Assessment Method. Se realizó un seguimiento telefónico al año. Resultados: La edad media fue de 80,5 ± 11 años, el 61,7% fue mujer. El 11,7% reunía criterios de delirium y 3,3% de subsíndrome de delirium. Los pacientes con delirium tenían mayor edad (p = 0.004), mayor dependencia para las actividades de la vida diaria instrumentales (AVDi) (p = 0,001) y básicas (Barthel) (p = 0,001), demencia (p = 0,007)y vasculopatía periférica (p = 0,029). No se observó diferencias estadísticamente significativas en la etiología y las características de la IC. Durante el ingreso fallecieron 2 pacientes con delirium (p = 0,23). Sólo 2 de los pacientes con delirium sobrevivieron al año del ingreso (p = 0,4), ambos con alteración cognitiva y dependencia funcional grave. Conclusión: La presencia de delirium en pacientes con ICD parece relacionarse más con la edad avanzada, la situación basal de dependencia funcional y el deterioro cognitivo de los pacientes que con la gravedad o el estadio de la IC (AU)
Objective: To analyze the clinical characteristics of patients with decompensated heart failure who are brought to a hospital emergency department and to describe the long-term clinical course in these patients. Methods: Prospective observational study of 60 emergency patients with decompensated heart failure. We used the Confusional Assessment Method to assess the presence of delirium and subsyndromal delirium. The patients were followed by means of telephone interviews for 1 year. Results: The mean (SD) age was 80.5 (11); 61.7% were women. Delirium was detected in 11.7% and subsyndromal deliriumin 3.3%. Patients with delirium were older (P=.004), showed greater dependency with respect to both instrumental activities of daily living (ADLs) (P=.001) and basic ADLs (Barthel index) (P=.001), and had higher rates of dementia (P=.007) and peripheral vascular disease (P=.029). No significant differences were detected in the causes or characteristics of heart failure between the patients with and without delirium. Two patients with delirium died in hospital (P=.23). Only 2 patients with delirium survived the year of follow-up (P=.4); both showed cognitive dysfunction and high levels of functional dependency. Conclusions: Delirium in patients with decompensated heart failure seems to be more associated with older age, a baseline situation of functional dependency, and cognitive decline than with the seriousness or stage of heart failure (AU)
Assuntos
Humanos , Delírio/epidemiologia , Insuficiência Cardíaca/epidemiologia , Confusão/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Fatores de RiscoRESUMO
The authors propose a new model to estimate the forces of the intrinsic equilibrium of the segment. Based on the theory of the so-called transient pole, it became possible to describe the momentary movement of an angle relative to its neighbour and to define the way of the intrinsic equilibrium. This transient pole fixes the centre of rotation around which the upper angle moves relative to the lower vertebral body. Normal and pathological cases can be diagnosed at once by use of a special röntgenological appliance in connection with the statistical experience. It becomes possible to calculate the forces and movements acting on a segment.
Assuntos
Coluna Vertebral/fisiologia , Fenômenos Biomecânicos , Humanos , Métodos , Prognóstico , Radiografia , Coluna Vertebral/diagnóstico por imagemRESUMO
The body's equilibrium is possible thanks to the integration of skeletal structure, vertebrae, ligaments and muscles to form one functional unity. The forces which determine posture are composed of two complementary systems, the ligamentary and the muscular systems, which together determine a dynamic act of balance. The ligaments operate mainly against the visco-hydraulic pressure of the nucleus pulposus and bind the vertebral bodies together, whereas the muscles exhibit an antigravity function and support spinal stability. A mathematical model based on a mixed theory of directed and oriented curves is proposed. Through this model it is possible to develop an exact theory governing the deformation of the ligamentous spine. This theory should be universal in the sense that it can be used to supply the spine in any of its environments.
Assuntos
Modelos Biológicos , Coluna Vertebral , Fenômenos Biomecânicos , Humanos , Ligamentos , Ligamentos Articulares , PosturaRESUMO
Up to now, lacking a bio-mechanical model, human posture has only been examined morphologically, although the physics of posture respond to simple laws. With the help of a physical model, based on the hypothesis of a minimal rotating movement of the trunk and head from the spine, this report gives a description of a normal posture. The model can be extended mathematically to establish a computer simulation of each case examined by X-ray, showing which posture would use the smallest amount of ligamentary and muscular force. The above bio-mechanical analyses of the spine as a whole is being further examined and improved mathematically.
Assuntos
Fenômenos Biomecânicos , Postura , Cabeça/fisiologia , Humanos , Cifose/fisiopatologia , Lordose/fisiopatologia , Modelos Biológicos , Coluna Vertebral/fisiologiaRESUMO
The position of the head depends on the function of the neck-muscles. Once the power of stabilization has been exhausted, the ligaments, particularly the superficial posterior, are stressed. A mathematical model has been developed for measuring the power of the muscles. This enables us to find out when and to which degree stress on the ligaments contributes to stabilization.
