Avaliação do modelo de predição clínica de Wells et al. no diagnóstico da trombose venosa profunda dos membros inferiores Evaluation of a clinical prediction model by Wells et al. in the diagnosis of deep venous thrombosis of the lower limbs

CONTEXTO: A aplicação de uma estratégia baseada em um modelo clínico associado ao mapeamento dúplex (MD) pode permitir um diagnóstico da trombose venosa profunda (TVP) mais seguro, eficaz e custo-efetivo. OBJETIVO: Testar o modelo clínico de Wells et al. associado ao MD e verificar a ocorrência de TVP nos pacientes categorizados quanto à probabilidade de apresentar a doença, e determinar se, a partir dos resultados obtidos, seria possível reduzir o número de exames seriados com o MD. MÉTODOS: Os pacientes com suspeita clínica de TVP foram categorizados quanto à apresentação de TVP em baixa, moderada e alta probabilidade (BP, MP, AP) e, em seguida, submetidos ao MD. Pacientes com MD negativo repetiram o exame em 24-48 horas e em 7 dias. Pacientes com exame positivo para TVP foram tratados. Todos os pacientes sem TVP foram convocados para reavaliação clínica em 3 meses. RESULTADOS: A ocorrência de TVP entre os 489 pacientes avaliados foi de 39,1% (191), sendo 35,6% identificados no exame inicial e 3,5% no exame seriado. Os índices de pacientes que apresentaram TVP foram de 6,1% no grupo de BP, 26,9% no grupo de MP e 79,5% no grupo de AP. No exame seriado, o percentual de TVP foi de 2,4, 7,8 e 15,1% nos grupos BP, MP e AP, respectivamente. Dos pacientes com MD negativo, 62,4% compareceram após 3 meses, e piora dos sintomas foi apresentada por apenas um paciente. Neste, o MD mostrou TVP de veia poplítea. CONCLUSÃO: Os resultados obtidos sugerem que, para os pacientes com BP para TVP e MD negativo, seria possível prescindir do exame seriado, devido à baixa ocorrência de TVP neste grupo, tornando, assim, a abordagem diagnóstica mais simples.<br>BACKGROUND: The application of a diagnostic strategy based on a clinical model associated with duplex scanning (DS) may allow for a safer and more effective/cost-effective diagnosis of deep venous thrombosis (DVT). OBJECTIVE: To evaluate the clinical model proposed by Wells et al. associated with DS and verify the occurrence of DVT in patients divided into probability of presenting the disease, and assess the possibility of reducing the number of repeated DS based on the results obtained. METHODS: Suspected DVT patients were accordingly categorized into groups of low, moderate and high DVT probability (LP, MP and HP). The patients were then submitted to DS and those without DVT were rescheduled to repeat the examination in 24-48 hours and in 7 days. Patients positively diagnosed with DVT received proper treatment. All patients without DVT were summoned to return within 3 months. RESULTS: The incidence of DVT among all 489 patients was 39.1% (191); of these, 35.6% were identified in the first examination and 3.5% in the follow-up. Among patients categorized as LP the occurrence was 6.1%, 26.9% in the MP group and 79.5% in the HP group. On the follow-up exams the incidence of DVT in LP, MP and HP groups was 2.4, 7.8 e 13.2%, respectively. Among patients with negative DS, 62.4% attended the reevaluation in 3 months and only one presented worsening of symptoms. This patient was then diagnosed with popliteal DVT using DS. CONCLUSION:The results suggest that for patients with LP for DVT and negative DS, follow-up exams are not needed, since the occurrence of DVT was low in this group. This procedure simplifies the diagnostic process

Cytogenetic effects of nine Helichrysum taxa in human lymphocytes culture

Helichrysum Mill. (Asteraceae) species have been used in folk medicine for thousands of years in the world. The in vitro cytogenetic effects in human lymphocytes of nine Helichrysum taxa used in Turkey folk medicine were investigated. Blood samples were obtained from healthy donors, non-smoking volunteers, which were incubated and exposed to increasing concentrations of methanol extracts of Helichrysum taxa (0.01, 0.05, 0.1, 0.5 and 1 mg/mL). The inhibitory effects of H. stoechas (L.) Moench subsp. barrelieri (Ten.) Nyman, H. armenium DC. subsp. armenium, H. armenium DC. subsp. araxinum (Kirp.) Takht., H. plicatum DC. subsp. plicatum, H. compactum Boiss. and H. artvinense P.H.Davis & Kupicha on the mitotic index and replication index indicate that these taxa can have genotoxic and mutagenic effects. They should therefore not be used freely in alternative medicine although their antiproliferative activity may suggest anticarcinogenic properties. Increase effects of H. stoechas subsp. barrelieri, H. armenium subsp. armenium, H. armenium subsp. araxinum, H. chasmolycicum P.H.Davis, H. plicatum subsp. plicatum, H. compactum and H. artvinense on the micronucleus rates showed that these taxa can have genotoxic and carcinogenic effects