2 research outputs found
Color doppler ultrasound assessment of activity in keloids
BACKGROUND The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated. OBJECTIVE To assess the sonographic activity of keloids in comparison with clinical scoring. MATERIALS AND METHODS A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement). RESULTS Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU. CONCLUSION Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU
Association between socioeconomic status and survival after a first episode of myocardial infarction
Background: A low socioeconomic status is associated with higher overall
mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival
of patients hospitalized with a first myocardial infarction. Material and
Methods: Analysis of hospital discharge and mortality databases of the Ministry
of Health. Patients aged over 15 years discharged between 2002 and 2011 with
a first myocardial infarction (code I-21, ICD-10) were identified. Their survival
was verified with the mortality registry. Survival from 0 to 28 and from 29 to
365 days was analyzed. Socioeconomic status was determined using the type of
health insurance, stratified as public insurance (low and medium status) and
private insurance (high status). Prais-Winsten trend (P-W) and Cox survival
analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty
three percent were of low socioeconomic status, 19% medium and 18% high.
Between 2002 and 2011 the increase in survival was higher among patients of low
socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men
and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men
and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However,
age and year of hospitalization adjusted analysis showed a higher mortality risk
among patients of low socioeconomic status at 0-28 days ( HR 1.67:1.53-1.83 for
men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30: 1.75-2.71 for
men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial
infarction improved in the last decade especially in patients of low socioeconomic
status. However, subjects of this stratum continue to have a higher mortality.Fondo
concursable para el apoyo a la
investigación, Insituto de Salud
Poblacional - Escuela de Salud
Pública, Facultad de Medicina,
Universidad de Chile