Tratamiento conservador del hallux valgus juvenil mediante ortesis nocturnas

Se presentan los resultados obtenidos con tratamiento conservador del hallux valgus juvenil con el uso de ortesis nocturnas confeccionadas a medida, con material termoplástico, en 18 pacientes con edades de 8 a 15 años (media: 12 años). El tiempo medio de tratamiento fue de 18 meses y los pacientes fueron seguidos después del tratamiento por igual período de tiempo. Debe destacarse el alto abandono del método que alcanzó la cifra del 44%. Fueron utilizados como parámetros de valoración de resultados las medidas radiográficas de los ángulos de valguismo del hallux (AVH) e intermetatarsiano l-II (AIM), obtenidas antes y después de terminado el período de observación. El valor medio inicial del AVH fue de 22° y al final fue de 20°. Las medidas de los valores del AIM fueron 11 y 10,7°, respectivamente. Ambas medidas no se diferencian entre sí desde el punto de vista estadístico, lo que lleva a concluir que el tratamiento utilizado no fue capaz de corregir las deformidades básicas del hallus valgus infantil, pero evita la progresión de esas deformidades.The results of conservative treatment of adolescent hallux valgus using custom made nocturnal splints in 18 patients ranging in age from 8 to 15 years (mean 12) are presented. The average period of treatment and follow-up was 18 months. There was a high rate (44%) of treatment abandon. As assessment parameters were used radiographic measures of the hallux valgus angle and the intermetatarsal I-II angle. Measures were obtained before treatment and at the end of follow-up. The initial mean valgus angle was 22° and the last mean value 20°. The mean valus of the intermetatarsal angle were respectively 11° and 10,7°. There were no significant statistical differences, indicating that the treatment of hallux valgus using nocturnal splintage do not correct the deformity but avoid its progression

Baseline characteristics and risk factors for ulcer, amputation and severe neuropathy in diabetic foot at risk: the brazupa study

CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOStudies on diabetic foot and its complications involving a significant and representative sample of patients in South American countries are scarce. The main objective of this study was to acquire clinical and epidemiological data on a large cohort of diabetic patients from 19 centers from Brazil and focus on factors that could be associated with the risk of ulcer and amputation. Methods: This study presents cross sectional, Baseline results of the BRAZUPA Study. A total of 1455 patients were included. Parameters recorded included age, gender, ethnicity, diabetes and comorbidity-related records, previous ulcer or amputation, clinical symptomatic score, foot classification and microvascular complications. Results: Patients with ulcer had longer disease duration (17.2 +/- 9.9 vs. 13.2 +/- 9.4 years; p < 0.001), and poorer glycemic control (HbA1c 9.23 +/- 2.03 vs. 8.35 +/- 1.99; p < 0.001). Independent risk factors for ulcer were male gender (OR 1.71; 95 % CI 1.2-3.7), smoking (OR 1.78; 95 % CI 1.09-2.89), neuroischemic foot (OR 20.34; 95 % CI 9.31-44.38), region of origin (higher risk for those from developed regions, OR 2.39; 95 % CI 1.47-3.87), presence of retinopathy (OR 1.68; 95 % CI 1.08-2.62) and absence of vibratory sensation (OR 7.95; 95 % CI 4.65-13.59). Risk factors for amputation were male gender (OR 2.12; 95 % CI 1.2-3.73), type 2 diabetes (OR 3.33; 95 % CI 1.01-11.1), foot at risk classification (higher risk for ischemic foot, OR 19.63; 95 % CI 3.43-112.5), hypertension (lower risk, OR 0.3; 95 % CI 0.14-0.63), region of origin (South/Southeast, OR 2.2; 95 % CI 1.1-4.42), previous history of ulcer (OR 9.66; 95 % CI 4.67-19.98) and altered vibratory sensation (OR 3.46; 95 % CI 1.64-7.33). There was no association between either outcome and ethnicity. Conclusions: Ulcer and amputation rates were high. Age at presentation was low and patients with ulcer presented a higher prevalence of neuropathy compared to ischemic foot at risk. Ischemic disease was more associated with amputations. Ethnical differences were not of great importance in a miscegenated population825CNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOCNPQ – CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOsem informaçã