RESUMO
INTRODUCTION: The quality of life of patients with periprosthetic fracture is complex; it interacts with the severity of the lesion, their independence level, and available resources, all of which could cause alterations secondary to their condition. OBJECTIVE: To know the quality of life and clinical course of patients after periprosthetic hip fracture surgery. MATERIAL AND METHODS: Patients with periprosthetic hip fracture were assessed. Physical exam was performed and the SF-36 questionnaire was applied. RESULTS: A total of 15 patients were included, 8 (53.3%) females and 7 (46.7%) males, with mean age 74 years (SD 12.51). Concerning underlying conditions, 5 patients had none (33.3%), one had hypertension (6.7%), one had a neoplasia (epidermoid), and 8 had more than one underlying condition. A predictive variable model was designed. In the overall score a 75.6% positive correlation was found, and a 57.2% determination coefficient. There was no statistical significance (p = 0.162). The same variables as in the previous model were included. Correlation was 0.678 and determination 45.9%, without statistical significance, p = 0.332. CONCLUSIONS: Patients reported feeling fair from the perspective of their overall health, physical function, physical role, emotional role, and social function; mental health wise, 50% reported feeling calm and full of life, and 50% reported anxiety and fear.
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Fraturas do Quadril/cirurgia , Prótese de Quadril , Fraturas Periprotéticas/cirurgia , Qualidade de Vida , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
BACKGROUND AND STUDY AIMS: Spontaneous intracerebral hemorrhage (ICH) represents the most fatal kind of stroke, and there is still no treatment available that improves the outcome. Statins are cholesterol reducers, and during the last few years many additional effects have been demonstrated that might be neuroprotective. We designed a pilot clinical study in order to evaluate whether the administration of statins is associated with a better outcome. PATIENTS AND METHODS: From August to December 2006 we carried out a prospective/retrospective non-randomized clinical study. The prospective group was treated with rosuvastatin (20 mg) and the retrospective control group was taken from our clinical records with a relation of 1:3. We included patients of both sexes, aged > or =15 years with proven ICH in CT-scan. Exclusion criteria were a history of neoplasm, head injury four weeks before admission, non-hypertensive reasons, brainstem hemorrhage, steroid administration, cranial surgery, initial hydrocephalus, and NIHSS > or =30. RESULTS: We analyzed 18 patients treated with rosuvastatin and 57 controls with similar basic characteristics. The mortality rate during hospitalization was 1 (5.6%) patient in the statin group and 9 (15.8%) in the control group; the hazard ratio adjusted by the initial Glasgow Coma Scale (GCS), intubation, admission in intensive care unit, disruption into the subarachnoid space was 0.20 (95% CI 0.02-1.67). The odds ratio for NIHSS > or =15 at release was 0.04 (95% CI 0.003-0.93). CONCLUSIONS: The use of statins during the acute phase of ICH could be associated with a better outcome. Further clinical trials are necessary to confirm a possible therapeutic effect and evaluate the toxicity of statins.
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Hemorragia Cerebral/tratamento farmacológico , Fluorbenzenos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pirimidinas/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Idoso , Anti-Hipertensivos/uso terapêutico , Hemorragia Cerebral/mortalidade , Feminino , Escala de Coma de Glasgow , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Projetos Piloto , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estudos Retrospectivos , Rosuvastatina Cálcica , Tamanho da Amostra , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/mortalidade , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
INTRODUCTION: Intracerebral hemorrhage (ICH) is the most lethal type of stroke. There are some clinical and radiological factors related to mortality. The time for obtaining medical care could be related with poor prognosis, but there are not available studies in Hispanics that evaluated this one. AIM: To determinate the association between epidemiological factors, time to obtain medical care, origin, and clinical characteristics with hospital mortality due to ICH. SUBJECTS AND METHODS: Study of cases and controls in a regional third level center, between January 2000 and December 2006 with patients of both sexes, older than 15 years with tomographic diagnosis of ICH. We excluded patients with NIHSS undetermined or traumatic head injury 4 weeks before. We studied demographic variables, time between beginning of symptoms and medical care, origin in kilometers until hospital, clinical characteristics at admission, including Glasgow and NIHSS. RESULTS: We analyzed 74 men and 101 women with mean age of 65 years. The etiology was hypertension in 77.4% and localization lobar in 39.4%. Eighty-five percent receipt medical care after 3 hours and 75.4% came from a radius < 100 km. Mortality in hospital was 16.6% with an explicative model of regression that included blood pressure < 130/80 mmHg, intubation, Glasgow < 9 at admission or NIHSS > 15, and hospitalization days. CONCLUSIONS: Demographic characteristics, causes, and localization are similar to previously informed series. The time for obtaining medical care is far from ideal, this could delay treatment; allow progression of disease, and then worse prognosis.
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Hemorragia Cerebral/mortalidade , Hemorragia Cerebral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Feminino , Mortalidade Hospitalar , Hospitais , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
INTRODUCTION: The 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitors or statins are drugs used in the treatment of dyslipidemies. The clinical trials performed for evaluation of the efficacy observed a reduced incidence of stroke and other trials have demonstrated a better outcome after stroke and subrachnoid hemorrhage. DEVELOPMENT: In the last years, new actions of statins have been described (pleiotropics). The statins seem to originate neuroprotector effects, such as up-regulation of endothelial nitric oxide synthase; creation of a fibrinolytic profile with suppression of the intravascular stability of the clot; immunomodulation by regulation of cytokines and cellular adhesion molecules; anti-oxidation by reduction of lipidic peroxidation; induction of neuroplasticity by increment of neurotrophic factors and protection of neuroexcitotoxicity, maybe by regulation of intracellular calcium or depletion of intracellular sterols. All these actions can be explained by decreament of isoprenoids synthesis. CONCLUSION: The pleiotropic properties of the statins offer the possibility to consider them as possible neuroprotectors, which should be evaluated in pathologies where the molecular ways interfered are involved, for example head injury and stroke.