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Advisor(s)
Abstract(s)
Introdução: A Doença de Dupuytren (DD) consiste no espessamento fibrĂłtico da fĂĄscia palmar que, inicialmente, se manifesta por nĂłdulos e, subsequentemente, progride para a formação de uma corda, que resulta em contractura e flexĂŁo progressiva e irreversĂvel de um ou mais dedos. A sua prevalĂȘncia oscila entre 0,2% e 56%, variando amplamente em diferentes ĂĄreas geogrĂĄficas. A etiologia da doença ainda se encontra desconhecida, porĂ©m esta tem sido associada a factores genĂ©ticos e ambientais, nomeadamente consumo de ĂĄlcool, consumo de tabaco, dislipidemia, trabalho manual, epilepsia e diabetes mellitus. Em Portugal, nenhum estudo foi conduzido para calcular a prevalĂȘncia da DD. Numa população cada vez mais envelhecida e sabendo-se que a prevalĂȘncia da DD aumenta com a idade, torna-se premente o conhecimento das taxas de prevalĂȘncia, de forma a ponderar o custo-eficĂĄcia de novos tratamentos.
Objectivo: Determinar a prevalĂȘncia de DD em doentes com idades superiores a 70 anos, assim como avaliar a existĂȘncia de possĂveis factores de risco para o desenvolvimento da doença.
MĂ©todos: Foi realizado um questionĂĄrio anĂłnimo e observadas as mĂŁos de 148 doentes que se encontravam internados no Hospital PĂȘro da CovilhĂŁ, do Centro Hospitalar Cova da Beira (CHCB), entre os meses de Outubro a Dezembro de 2014. ApĂłs confirmação da presença de DD avaliou-se a funcionalidade da mĂŁo atravĂ©s do questionĂĄrio Disabilities of the Arm, Shoulder and Hand (DASH) validado para portuguĂȘs. Na presença de contractura efectuou-se a medição do grau de DĂ©fice de ExtensĂŁo Passiva Total (DEPT) com auxĂlio de um goniĂłmetro. O estudo integra todos os doentes com mais de 70 anos internados nos serviços em que se obteve autorização, excluindo todos os que apresentaram algum grau de desorientação, naturalidade nĂŁo nacional e os que se recusaram a participar no estudo.
Resultados: Dos 148 idosos entrevistados, 54,1% eram mulheres, 45,9% eram homens e a faixa etĂĄria mais representada foi a faixa compreendida entre os 80-84 anos (33,1%). A doença teve maior prevalĂȘncia no sexo masculino (59,5%) (razĂŁo M:F de 1,5:1) e na faixa etĂĄria dos 80-84 anos (35,1%), tendo sido possĂvel verificar que a idade de apresentação da doença ocorreu sempre em idades superiores aos 50 anos. Averiguou-se que a DD era predominantemente bilateral (59,5%), embora a mĂŁo dominante fosse a direita em 89,2% dos casos, e que o raio afectado com mais frequĂȘncia foi o 4Âș raio. No que concerne Ă gravidade das lesĂ”es, verificou-se que a corda palpĂĄvel foi a deformidade mais encontrada, seguida do DEPT<90Âș. A histĂłria familiar positiva para DD foi relatada em apenas 8 inquiridos, enquanto que a historia cirĂșrgica foi positiva em apenas 4 doentes e destes, 3 apresentavam recidiva ou extensĂŁo. A doença esteve presente em 37 indivĂduos (25%) tendo-se obtido uma correlação significativa (para ?? <0,05) entre a DD e o consumo de ĂĄlcool (?? =0,015), contudo, nĂŁo se obteve significĂąncia estatĂstica entre a patologia e os restantes factores de risco para o mesmo grau de significĂąncia. Ainda foi possĂvel aferir que a variĂĄvel consumo de ĂĄlcool (??=0,026) apresentou um efeito significativo sobre o logit da probabilidade de um indivĂduo desenvolver DD.
ConclusĂŁo: A prevalĂȘncia da DD na amostra em anĂĄlise, assemelha-se Ă descrita na literatura. Estabeleceu-se relação entre a DD e o consumo de ĂĄlcool, porĂ©m nĂŁo foi possĂvel correlacionar a doença com mais nenhum factor de risco em estudo.
Introduction: Dupuytren's Disease (DD) consists of fibrotic thickening of the palmar fascia initially manifested by nodes and, subsequently, progresses to the formation of a cord which results in a contracture and in a progressive and irreversible flexion of one or more fingers. Its prevalence ranges between 0,2% and 56%, varying widely in different geographical areas, ranging. The origin of the disease is still unknown, but it has been associated with genetic and environmental factors such as alcohol consumption, tobacco consumption, dyslipidaemia, manual labour, diabetes mellitus and epilepsy. In Portugal, no study was conducted to estimate the prevalence of DD. In an increasingly aged population and given that the prevalence of DD increases with age, it is becoming more relevant to know the prevalence rates, in order to consider the cost-effectiveness of new treatments. Objective: The objective of this study is to determine the prevalence of DD in patients with age above 70 years, as well as, to assess the existence of possible risk factors for the development of the disease. Methods: It was conducted an anonymous questionnaire and the observation of the hands of 148 patients who were admitted in the Hospital PĂȘro da CovilhĂŁ, of the Centro Hospitalar da Cova da Beira, between the months of October to December 2014. After confirmation of DD, hand function was evaluated by the questionnaire Disabilities of the Arm, Shoulder and Hand (DASH) validated for Portuguese. In the presence of a contracture, it was carried out the measurement of the degree of Total Passive Extension Deficit (DEPT) using a goniometer. The study integrates all patients over 70 years admitted in the services where authorization was obtained, and excludes those who had some degree of disorientation, non-Portuguese citizens or those who refused to participate in the study. Results: Of the 148 elderly respondents, 54.1% were women and 45.9% were men and the most represented age group was the range between 80-84 years (33.1%). The disease was most prevalent in males (59.5%) (ratio M: F ratio of 1.5: 1) and in the age group of 80-84 years (35.1%). It was possible to verify that the age of presentation of the disease has always occurred at ages above 50 years old. It was found that the DD was predominantly bilateral (59.5%), while the right hand was dominant in 89.2% of cases, and that most often affected was the 4 radius. Regarding the severity of the lesions, it was found that the palpable cord was the deformity most commonly found, followed by the DEPT <90Âș. A positive family history for DD was reported in only 8 respondents while, surgical history was positive in only 4 patients and of those, 3 had recurrence or extension. The disease was present in 37 patients (25%), and yielded a significant correlation (p <0.05) between the DD and alcohol consumption (p = 0.015), however, it was not obtained statistical significance between the pathology and other risk factors for the same degree of significance. It was also possible to assess that the alcohol consumption variable (??=0.026) had a significant effect on the logit of the probability of an individual developing DD. Conclusion: The prevalence of DD in the sample was identical to that described in the literature. It was established a relationship between DD and alcohol consumption, but it was not possible to correlate the disease with any other risk factor under study.
Introduction: Dupuytren's Disease (DD) consists of fibrotic thickening of the palmar fascia initially manifested by nodes and, subsequently, progresses to the formation of a cord which results in a contracture and in a progressive and irreversible flexion of one or more fingers. Its prevalence ranges between 0,2% and 56%, varying widely in different geographical areas, ranging. The origin of the disease is still unknown, but it has been associated with genetic and environmental factors such as alcohol consumption, tobacco consumption, dyslipidaemia, manual labour, diabetes mellitus and epilepsy. In Portugal, no study was conducted to estimate the prevalence of DD. In an increasingly aged population and given that the prevalence of DD increases with age, it is becoming more relevant to know the prevalence rates, in order to consider the cost-effectiveness of new treatments. Objective: The objective of this study is to determine the prevalence of DD in patients with age above 70 years, as well as, to assess the existence of possible risk factors for the development of the disease. Methods: It was conducted an anonymous questionnaire and the observation of the hands of 148 patients who were admitted in the Hospital PĂȘro da CovilhĂŁ, of the Centro Hospitalar da Cova da Beira, between the months of October to December 2014. After confirmation of DD, hand function was evaluated by the questionnaire Disabilities of the Arm, Shoulder and Hand (DASH) validated for Portuguese. In the presence of a contracture, it was carried out the measurement of the degree of Total Passive Extension Deficit (DEPT) using a goniometer. The study integrates all patients over 70 years admitted in the services where authorization was obtained, and excludes those who had some degree of disorientation, non-Portuguese citizens or those who refused to participate in the study. Results: Of the 148 elderly respondents, 54.1% were women and 45.9% were men and the most represented age group was the range between 80-84 years (33.1%). The disease was most prevalent in males (59.5%) (ratio M: F ratio of 1.5: 1) and in the age group of 80-84 years (35.1%). It was possible to verify that the age of presentation of the disease has always occurred at ages above 50 years old. It was found that the DD was predominantly bilateral (59.5%), while the right hand was dominant in 89.2% of cases, and that most often affected was the 4 radius. Regarding the severity of the lesions, it was found that the palpable cord was the deformity most commonly found, followed by the DEPT <90Âș. A positive family history for DD was reported in only 8 respondents while, surgical history was positive in only 4 patients and of those, 3 had recurrence or extension. The disease was present in 37 patients (25%), and yielded a significant correlation (p <0.05) between the DD and alcohol consumption (p = 0.015), however, it was not obtained statistical significance between the pathology and other risk factors for the same degree of significance. It was also possible to assess that the alcohol consumption variable (??=0.026) had a significant effect on the logit of the probability of an individual developing DD. Conclusion: The prevalence of DD in the sample was identical to that described in the literature. It was established a relationship between DD and alcohol consumption, but it was not possible to correlate the disease with any other risk factor under study.
Description
Keywords
Contractura de Dupuytren Epidemiologia Estudo Observacional Etiologia PrevalĂȘncia