RESUMEN
Na hanseníase, a presença de sintomas dermatoneurológicos com potencial evolução para incapacidades físicas pode comprometer a qualidade de vida (QV) e a imagem corporal do paciente. Objetivo: Avaliar as possíveis associações entre a QV, o Grau de Incapacidade (GI) e o Desenho da Figura Humana (DFH) em indivíduos com neuropatia hansênica. Método: Este estudo consiste em um estudo descritivo, com abordagem quanti-qualitativa. Foram utilizados quatro instrumentos de avaliação: Questionário sociodemográfico, NeuroQol (Neuropathy Specific Quality of Life Questionnaire), DFH e Formulário de avaliação do GI. Foram incluídos pacientes com GI 1 ou 2 nos pés e idade igual ou superior a 18 anos. Resultados: Foram avaliados 100 indivíduos. Entre aqueles com GI 2, houve uma tendência à omissão do nariz (p=0,050) e DFH no tamanho pequeno (p=0,047). Houve associação entre o DFH e o domínio QV Sintomas difuso sensitivo-motores (p=0,035), sugerindo que a omissão dos pés no DFH pode representar perda da QV. Conclusão: Indivíduos com neuropatia hansênica apresentam QV boa à moderada. A omissão de segmentos do corpo pode indicar conflitos e sentimentos de insegurança. Há indícios de perda de autonomia quando o paciente omite ou corta os pés no DFH
In Leprosy, the presence of dermatoneurological symptoms with potential evolution to physical disabilities may influence the quality of life (QoL) and the patient's body image. Objective: To evaluate possible associations between the QoL, degree of disability (DoD) and human figure drawing (HFD) in individuals with leprosy neuropathy. Method: This is a descriptive study with a quanti-qualitative approach. Four evaluation instruments were used: a sociodemographic questionnaire, quality of life in neurological disorder questionnaire (Neuro-QoL), HFD and DoD evaluation form. Patients with DoD grades 1 or 2 of the feet and age equal to or greater than 18 were included in this study. Results: One hundred individuals were evaluated. Individuals with DoD grade 2 tended to omit the nose (p=0.050) and the HFD was small (p=0.047). An association was identified between the HFD and the QoL with dominance of diffuse sensory-motor symptoms (p=0.035) suggesting that omission of the feet in the HFD may represent a loss of QoL. Conclusion: Individuals with leprosy neuropathy have a good to moderate QoL but the omission of body segments may indicate conflicts and feelings of uncertainty. There is evidence of loss of autonomy when the subject omits or cuts off the feet in the HFD
Asunto(s)
Humanos , Calidad de Vida , Imagen Corporal , Personas con Discapacidad , Lepra/rehabilitación , Epidemiología DescriptivaRESUMEN
BACKGROUND: Diabetic foot ulcers are a major cause of morbidity and mortality. This study evaluated the clinical outcomes in Canadian non-Aboriginal and Aboriginal diabetic patients with foot ulcers managed at a multidisciplinary, tertiary care diabetic foot clinic. METHODS: A retrospective review of medical records was done for 325 patients receiving care during a 2-year period. All patients were followed at least 1 year after the initial visit. RESULTS: There were 224 (69%) non-Aboriginal and 101 (31%) Aboriginal patients with 697 foot ulcers. At the initial office visit, 204 (63%) patients had lesions in Wagner grades 2-4. At the most recent evaluation (average, 79+/-73 weeks after initial clinic visit), 190 (58%) patients were rated as having a good outcome (either healed or healing), but a poor outcome (static, progression, amputation, or death) was noted in 135 (42%) patients. At the most recent evaluation, the majority of the 697 ulcers that were noted at the initial or subsequent clinic visits were healed. Aboriginal patients had a shorter average time from initial clinic visit to major lower extremity amputation (Aboriginal, 50+/-64 weeks; non-Aboriginal, 62+/-56 weeks; P<0.01). Residence in a rural or reserve community also correlated with shorter average time from initial clinic visit to major lower extremity amputation (rural or reserve, 45+/-56 weeks; urban, 66+/-61 weeks; P<0.002). When controlled for non-urban residence, Aboriginal ethnicity was not associated with poorer clinical outcome. Earlier major lower extremity amputation was significantly associated with non-urban residence, Aboriginal ethnicity, and arterial insufficiency. Poor clinical outcome was significantly associated with being referred with a lesion present, age greater than 60 years, prior lower extremity amputation or revascularization, arterial insufficiency, more than one lesion on initial presentation, longer duration of type 2 diabetes, and a higher initial Wagner grade for the most advanced lesion. CONCLUSIONS: A multidisciplinary diabetic foot clinic may be successful in treating diabetic foot ulcers in Aboriginal and non-Aboriginal people. However, the frequency of poor outcome is high, consistent with the high prevalence of associated significant risk factors in this population.
Asunto(s)
Pie Diabético/etnología , Pie Diabético/terapia , Adulto , Anciano , Amputación Quirúrgica/estadística & datos numéricos , Pie Diabético/clasificación , Pie Diabético/mortalidad , Femenino , Humanos , Indígenas Norteamericanos , Masculino , Manitoba , Persona de Mediana Edad , Grupo de Atención al Paciente , Estudios Retrospectivos , Resultado del Tratamiento , Población Blanca , Cicatrización de HeridasRESUMEN
We present eight patients with larynx involvement in leprosy. Seven were classified as lepromatous and one was borderline leprosy in reversal reaction. One patient required an emergency tracheostomy and one had an almost complete uppe airway obstruction.
Asunto(s)
Eritema Nudoso/complicaciones , Enfermedades de la Laringe/diagnóstico , Lepra Lepromatosa/complicaciones , Adulto , Anciano , Obstrucción de las Vías Aéreas/complicaciones , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/patología , Obstrucción de las Vías Aéreas/terapia , Diagnóstico Diferencial , Tratamiento de Urgencia , Femenino , Humanos , Enfermedades de la Laringe/complicaciones , Enfermedades de la Laringe/patología , Enfermedades de la Laringe/terapia , Masculino , Persona de Mediana Edad , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Osteomyelitis in the foot of a diabetic individual is a common complication of peripheral neuropathy, peripheral vascular disease, and infection. Operative facilities and home intravenous antibiotic therapy programs may not be available in remote or rural communities. Limited data are available regarding the treatment results of oral antimicrobial therapy, with or without limited office debridement for diabetic foot osteomyelitis. METHODS: This retrospective medical record review of 325 consecutive diabetic patients who were evaluated at a multidisciplinary foot clinic identified 94 (29%) patients with 117 episodes of osteomyelitis. The most common group of organisms isolated were aerobic gram-positive cocci, and the single most frequent organism was Staphylococcus aureus. A mean of 1.6 +/- 0.8 (range 1 to 4) pathogens were recovered per episode of osteomyelitis. Therapy was guided by culture results. There were 93 episodes of osteomyelitis (79 patients) that were treated with a mean of 3 +/- 1 oral antimicrobial agents (with or without an initial short course of intravenous antimicrobial agents) and had adequate followup to evaluate outcome of treatment; office treatment included bone debridement in 26 (28%) and toe amputation in nine (10%) of the 93 episodes (79 patients). RESULTS: Of the 93 episodes treated with oral antimicrobial agents (with or without an initial short course of intravenous antimicrobial agents), 75 (80.5%) episodes were put into remission. Mean duration of oral antimicrobial therapy was 40 +/- 30 weeks. Mean relapse-free followup duration was 50 +/- 50 weeks. CONCLUSIONS: Diabetic foot osteomyelitis was effectively managed with oral antimicrobial therapy with or without limited office debridement in most patients. This regimen may be especially useful in communities where infectious disease specialists and operative resources are limited.
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Antibacterianos/uso terapéutico , Pie Diabético/microbiología , Huesos del Pie/microbiología , Osteomielitis/tratamiento farmacológico , Administración Oral , Amputación Quirúrgica , Antibacterianos/administración & dosificación , Desbridamiento , Pie Diabético/tratamiento farmacológico , Pie Diabético/cirugía , Combinación de Medicamentos , Femenino , Estudios de Seguimiento , Huesos del Pie/cirugía , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/cirugía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/cirugía , Humanos , Inyecciones Intravenosas , Masculino , Huesos Metatarsianos/microbiología , Huesos Metatarsianos/cirugía , Persona de Mediana Edad , Osteomielitis/microbiología , Osteomielitis/cirugía , Recurrencia , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/cirugía , Factores de Tiempo , Falanges de los Dedos del Pie/microbiología , Falanges de los Dedos del Pie/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Canadian Aboriginal subjects have a higher prevalence of diabetes, renal disease, and lower extremity amputation than non-Aboriginal subjects. However, limited information is available about patient outcomes for arterial bypass surgery in Canadian Aboriginal compared with non-Aboriginal subjects. METHODS: A retrospective study of all patients undergoing revascularization for peripheral vascular disease at a tertiary care referral center was performed. RESULTS: A total of 828 procedures were performed on 678 patients between 1995 and 2002: 108 (13%) procedures on 84 (12%) Aboriginal patients and 720 (87%) procedures on 594 (88%) non-Aboriginal patients. Aboriginal patients had a higher prevalence of diabetes, chronic renal failure, and end-stage renal disease than non-Aboriginal patients. Aboriginal patients presented with more serious complications (gangrene [Aboriginal, 63 [58%] of 108 patients; non-Aboriginal, 112 [16%] of 720 patients; P < .0001] and nonhealing ulcer [Aboriginal, 29 [27%] of 108 patients; non-Aboriginal, 131 [18%] of 720 patients; P < .05]) and required urgent or emergency revascularization (Aboriginal, 47 [49%] of 95 patients; non-Aboriginal, 228 [36%] of 634 patients; P < .02) more frequently than non-Aboriginal patients. The 60-month patient mortality was similar for both groups (Aboriginal, 20 [24%] of 84 patients; non-Aboriginal, 160 [27%] of 594 patients; not significant), but Aboriginal patients had loss of limb more frequently (Aboriginal, 19 [18%] of 108 patients; non-Aboriginal, 62 [9%] of 720 patients; P < .0001) and had loss of primary graft patency more frequently (Aboriginal, 39 [36%] of 108 patients; non-Aboriginal, 155 [22%] of 720 patients; P < .0001) than non-Aboriginal patients. CONCLUSIONS: Canadian Aboriginal subjects had worse outcomes with revascularization than non-Aboriginal subjects, but ethnicity and diabetes were not independent risk factors for poor outcome. Multivariate analysis showed that the poor outcomes in mortality, limb salvage, and primary graft patency among Aboriginal patients undergoing revascularization may be attributed to renal disease and a more advanced mode of presentation of peripheral vascular disease complications at the time of intervention.
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Indígenas Norteamericanos/estadística & datos numéricos , Enfermedades Vasculares Periféricas/etnología , Enfermedades Vasculares Periféricas/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Angiografía , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Probabilidad , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , Tasa de Supervivencia , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
BACKGROUND: Limited access to basic foot care and protective footwear may contribute to diabetic foot complications. The purpose of this study was to determine the prevalence of foot complications, ongoing foot care, and footwear use in diabetic subjects in a remote northern Canadian Aboriginal community. METHODS: This was a cross-sectional cohort study of 169 diabetic people, including interview, physical examination, and retrospective chart review. RESULTS: The mean age of the 169 diabetic individuals in the study was 56 +/- 12 years and their duration of diabetes 10 +/- 7 years. There were 139 (82%) individuals who had 418 diabetic foot complications (average, 3.0 complications per subject with complications), including toenail pathology, foot and ankle deformities, calluses, impaired pulses, neuropathy, past or present ulcer, amputation, and Charcot arthropathy. Risk classification showed that 69 (41%) individuals were at risk for future ulceration. Fifty-five (33%) individuals had inadequate footwear for their foot risk category, and only 11 (17%) of 66 individuals in the higher risk categories (categories 2 and 3) had suitable footwear. In a 7-year period, only 0.7 screening foot examinations per diabetic subject per year were documented. However, during this period, foot problems accounted for 498 (18%) local emergency room visits, 359 (16%) hospitalization days, 109 (11%) nonemergency transfers, and 4 (6%) emergency transfers to a tertiary care hospital. CONCLUSIONS: Foot and ankle complications of diabetes in this remote Aboriginal community were common and associated with substantial morbidity. Preventive diabetic foot screening examinations and footwear were inadequate. The results suggest that programs for prevention and early detection of complications are needed, including foot screening, provision of appropriate footwear, and foot care.
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Pie Diabético/prevención & control , Indígenas Norteamericanos , Estudios de Cohortes , Estudios Transversales , Pie Diabético/etnología , Pie Diabético/patología , Femenino , Humanos , Masculino , Manitoba/epidemiología , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , ZapatosRESUMEN
OBJECTIVE: To compare and contrast disability and quality of life (QOL) in Aboriginal and non-Aboriginal subjects with diabetes who had lower-extremity amputation (LEA) and were living in urban and rural communities in Canada. DESIGN: Descriptive study using an interviewer-administered questionnaire and hospital medical record review. SETTING: Tertiary care center. PARTICIPANTS: Forty-four diabetic subjects (minimum age, 18 y) not receiving dialysis, including 21 Aboriginal (8 urban, 13 rural) and 23 non-Aboriginal (16 urban, 7 rural) subjects. Subjects were living in their current residence and had undergone LEA above the level of the ankle 6 months or more before interview. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Qualitative and quantitative data about symptoms, impairment, and QOL. RESULTS: Aboriginal subjects were younger than non-Aboriginal subjects at the time of diabetes diagnosis (Aboriginal, 42+/-10 y; non-Aboriginal, 52+/-14 y; P<.005) and first major LEA (Aboriginal, 57+/-7 y; non-Aboriginal, 64+/-11 y; P<.015). All subjects received rehabilitation after amputation. More rural non-Aboriginal subjects (83%) used their prosthesis both in and outside the home for all movements than other subjects (P<.048). Rural non-Aboriginal subjects had the lowest and urban non-Aboriginal subjects had the highest frequency of walking-aid use outside the home. Assistance with personal care was required by a minority of subjects, but assistance with daily housework was required by the majority of subjects. Qualitative analysis revealed that participants were, in most cases, comfortable with their postamputation life. CONCLUSIONS: Although the majority of participants in this study generally felt satisfied with their current status, major functional changes were noted after LEA that had a large negative impact on QOL.
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Amputados , Pie Diabético/cirugía , Personas con Discapacidad , Indígenas Norteamericanos , Calidad de Vida , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Amputados/psicología , Canadá , Distribución de Chi-Cuadrado , Pie Diabético/etnología , Personas con Discapacidad/psicología , Femenino , Humanos , Extremidad Inferior , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Población BlancaRESUMEN
Este trabalho apresenta os resultados da avaliçäo da técnica cirúrgica de transferência do músculo fibular longo, descrita por Duerksen (1997), para dorsiflexäo do pé eqüino móvel realizada em 10 portadores de seqüelas de hanseníase. Estes pacientes foram submetidos a um protocolo de avaliaçäo médica e fisioterápica pré e pós-operatório por 12 semanas, com resultados que subsidiam a recomentaçäo desta técnica cirúrgica.