RESUMO
OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80 per cent) of these major amputations were performed on Type 2 diabetics, of which 352 (68 per cent) were AKA and 163 (32 per cent) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47 per cent) were septicemia cases and 14 (21 per cent) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51 per cent). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study.
Assuntos
Humanos , Pé Diabético , Amputação Cirúrgica , Diabetes Mellitus Tipo 2 , Trinidad e TobagoRESUMO
OBJECTIVES: To determine the age-standardized rate of lower limb amputations among Type 2 diabetics admitted to the Port of Spain General Hospital (POSGH), San Fernando General Hospital (SFGH) and Sangre Grande County Hospital (SGCH) for the period 2000-2004. To determine in-hospital mortality following amputation, for the same period. To determine the risk factors that contributed to diabetic foot complications. DESIGN AND METHODS: All patients who had a lower limb amputation at the three major public health institutions in Trinidad during the study period were enrolled. In addition patients attending the surgical out-patient clinic and currently admitted to the ward with a diabetic septic foot was selected for the administration of a questionnaire to determine the major contributing factors. Data on the type of amputation, age, sex, ethnicity, from which an age-standardized mortality rate, was determined for the age group 30-60. RESULTS: Of 822 patient files examined, 515 (80%) of these major amputations were performed on Type 2 diabetics, of which 352 (68%) were AKA and 163 (32%) were BKA. The AKA:BKA ratio for the period 2000-2004 was 2.2:1. There was a significant difference between the mean ages at which females had a major amputation to males (p=0.001). The overall ratio of Africans to South East Asians was 1.5:1 amongst the Type 2 diabetic amputees. For major amputations the average length of stay was found to be 22.5 (0-192) days. The age-standardized rate for the age group 30-60 was 13.85 per 100,000 for 2004. Of 66 deaths, 31 (47%) were septicemia cases and 14 (21%) cardio-respiratory failure cases. Finally, of 97 persons interviewed, the major causative agent for diabetic foot complications and amputations was foot trauma (51%). CONCLUSION: Type 2 diabetic amputation status of Trinidad would seem to have improved as shown by this study. However, steps must be taken to improve patient awareness about prevention and care of the diabetic foot. Doctors must also seek to increase their vigilance when screening diabetic patient in the primary care setting in order to prevent the late detection and treatment of the septic lower limb.
Assuntos
Amputação Cirúrgica , Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica/efeitos adversos , Amputação Cirúrgica/mortalidade , Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/mortalidade , Pé Diabético/etnologia , Pé Diabético/etiologia , Pé Diabético/mortalidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Trinidad e Tobago/epidemiologiaRESUMO
To determine whether steroids could be of clinical benefit in the treatment of the hemolytic uremic syndrome (HUS), we conducted a randomized, double-blinded, placebo-controlled trial of methylprednisone (5 mg/kg per day in four oral doses over 7 days), in children with HUS during the acute phase. Ninety-two patients with typical HUS (47 receiving placebo and 45 receiving steroids) were investigated for neurological, hematological, and nephrological variables. There were no differences between groups in the number of convulsive episodes or transfusion requirements during the hospital stay. Serum creatinine levels were slightly increased on day 10 in the placebo group compared with the steroid group (P = 0.06) and declined significantly between days 1 and 10 only in the steroid group (P = 0.001). In the 51 patients with anuria (24 placebo, 27 steroids), median serum creatinine levels were reduced in the steroid group compared with the placebo group on the 10th day (P = 0.01). Differences in median days of oliguria [11.5 versus 8 (P = 0.28)], anuria [5 versus 7 (P = 0.20)], and dialysis [12 versus 10 (P = 0.26)] for the placebo and the steroid group respectively were not significant. Our data suggest that oral steroids are not able to modify hematological, neurological, or nephrological clinical parameters during the acute phase of childhood HUS, even though they do seem to be associated with a more rapid decline in serum creatinine levels.
Assuntos
Corticosteroides/uso terapêutico , Síndrome Hemolítico-Urêmica/tratamento farmacológico , Doença Aguda , Adolescente , Corticosteroides/efeitos adversos , Adulto , Criança , Método Duplo-Cego , Feminino , Síndrome Hemolítico-Urêmica/sangue , Síndrome Hemolítico-Urêmica/fisiopatologia , Humanos , Testes de Função Renal , Masculino , Convulsões/induzido quimicamente , Convulsões/fisiopatologia , alfa 1-Antitripsina/metabolismoRESUMO
From January 1968 to December 1984, 312 infants and children with hemolytic uremic syndrome were admitted to our unit; 8 patients died (2.5%) during the acute phase; 118 children were followed as outpatients at yearly intervals for at least 10 years (mean follow-up 13 years, range 10-19.8 years). Four evolution patterns at the end of the follow-up were defined: group 1, complete recovery, 74 (62.7%); group 2, proteinuria with/without hypertension, 21 (17.7%); group 3, reduced creatinine clearance, often in conjunction with proteinuria and hypertension, 19 (16.1%); group 4, end-stage renal failure, 4 (3.4%). We investigated the association between several variables of the acute stage and the long-term evolution. Most non-anuric patients recovered completely (92.5%), while 38.4% of those with 1-10 days and 69.2% of those with 11 or more days of anuria had chronic renal sequelae. Similar results were found when analyzing the requirement for peritoneal dialysis. Of the patients with proteinuria at the 1-year control, 86% had renal abnormalities at the end of the follow-up. In our experience, although the final outcome was not predictable in every instance, the severity of acute renal failure-as determined by the days of anuria- and the presence of proteinuria 1 year after the acute phase were the most useful prognostic indicators.
Assuntos
Síndrome Hemolítico-Urêmica/mortalidade , Anuria/etiologia , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Síndrome Hemolítico-Urêmica/diagnóstico , Síndrome Hemolítico-Urêmica/fisiopatologia , Humanos , Lactente , Testes de Função Renal , Masculino , Prognóstico , Proteinúria/etiologia , Diálise Renal , Fatores de Risco , Sobrevida , Resultado do TratamentoRESUMO
An 11-year-old girl with an abdominal desmoplastic round cell tumor, treated with chemotherapy, presented with gross hematuria and proteinuria. Renal biopsy revealed type I membranoproliferative glomerulonephritis (MPGN). The association of a malignant tumor and MPGN is extremely unusual in children, and the pathogenesis of the renal lesion under these circumstances is unknown.
Assuntos
Neoplasias Abdominais/complicações , Glomerulonefrite Membranoproliferativa/etiologia , Sarcoma de Células Pequenas/complicações , Neoplasias Abdominais/tratamento farmacológico , Neoplasias Abdominais/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Feminino , Glomerulonefrite Membranoproliferativa/patologia , Humanos , Rim/patologia , Sarcoma de Células Pequenas/tratamento farmacológico , Sarcoma de Células Pequenas/patologiaRESUMO
Se analizan las modificaciones clincohumorales e histologicas operadas en nueve pacientes con nefritis lupica proliferativa difusa, tras la administracion de seis "pulsos" de metilprednisona intravenosa en dosis de 30 mg/kg. Se observo rapida remision de la sintomatologia sistemica.La depuracion de creatina basal media en siete pacientes con disminucion del filtrado glomerular fue de 29.6 ml/m/1.73 m2 s.c., de 58.4 al mes y de 122 ml a los tres meses. La proteinuria, masiva en todos los pacientes, disminuyo de 6.7 g/24 horas +/- 2.4 a 2.7 +/- 0.7 y a 1.4 +/- 0.3 al mes y a los 3 meses respectivamente.Ocho pacientes fueron seguidos 37.2 meses en promedio La filtracion glomerular actual promedio es de 127.8 ml/m/1.73 m2 s.c. +/- 15.1 y la proteinuria promedio es de 237 mg/24 horas. Las biopsias renales alejadas mostraron cambios notables en la actividad lesional, presentando cierta proliferacion mesangial con grado variable de esclerosis segmentaria o global relacionada con la mejoria funcional. En conclusion, los pacientes lupicos con glomerulonefritis proliferativa difusa mostraron una marcada y sostenida mejoria de la funcion renal y de las alteraciones histopatologicas siguiendo a la administracion de "pulsos" de metilprednisona endovenosa. Se senala la necesidad de estudios controlados con mayor numero de pacientes y seguimientos mas prolongados
Assuntos
Criança , Adolescente , Humanos , Masculino , Feminino , Lúpus Eritematoso Sistêmico , Metilprednisolona , Nefrite , Injeções IntravenosasRESUMO
Se efectuo el analisis clinicopatologico de 23 casos pediatricos de LES asistidos en los ultimos 10 anos. El diagnostico se baso en la conjuncion de afectacion multisistemica y en la demostracion de titulos elevados de factores antinucleares, antiADN y descenso de fraccion C3 del complemento. Hubo una alta incidencia de compromiso articular (91,3%), cutaneo (86,9%) y renal (95,6%). La actividad de la enfermedad fue vigilada mediante valoracion clinica periodica, proteinuria y clearance de creatinina y con elementos humorales como C3, FAN y antiADN. La valoracion histologica fue de suma utilidad para guiar la terapeutica inicial, como asimismo para conocer el grado de actividad de la nefropatia lupica. Descensos del filtrado glomerular y proteinurias masivas se correspondieron, en general, con nefritis lupicas proliferativas difusas en actividad.El empleo de regimenes terapeuticos mas agresivos parece haber mejorado el pronostico de la afectacion renal y del sistema nervioso central. La mortalidad global fue del 28%, la que puede considerarse aceptable teniendo en cuenta el alto porcentaje de formas con grave compromiso renal en esta serie
Assuntos
Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Lúpus Eritematoso SistêmicoRESUMO
Se efectuo el analisis clinicopatologico de 23 casos pediatricos de LES asistidos en los ultimos 10 anos. El diagnostico se baso en la conjuncion de afectacion multisistemica y en la demostracion de titulos elevados de factores antinucleares, antiADN y descenso de fraccion C3 del complemento. Hubo una alta incidencia de compromiso articular (91,3%), cutaneo (86,9%) y renal (95,6%). La actividad de la enfermedad fue vigilada mediante valoracion clinica periodica, proteinuria y clearance de creatinina y con elementos humorales como C3, FAN y antiADN. La valoracion histologica fue de suma utilidad para guiar la terapeutica inicial, como asimismo para conocer el grado de actividad de la nefropatia lupica. Descensos del filtrado glomerular y proteinurias masivas se correspondieron, en general, con nefritis lupicas proliferativas difusas en actividad.El empleo de regimenes terapeuticos mas agresivos parece haber mejorado el pronostico de la afectacion renal y del sistema nervioso central. La mortalidad global fue del 28%, la que puede considerarse aceptable teniendo en cuenta el alto porcentaje de formas con grave compromiso renal en esta serie