Factors that influence healing of chronic venous leg ulcers: a retrospective cohort

BACKGROUND: Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates.OBJECTIVES: To identify clinical and therapeutic factors that influence healing of venous ulcers.METHODS: Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects.RESULTS: Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95% CI 31.9 to 48.4%) at T6 and 49.6% (95% CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95% CI 10.5 to 23.1%) at T6 and 27% (95% CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95% CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95% CI 1.31 to 12.41), and infection episodes (RR=0.42; 95% CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95% CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95% CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95% CI 0.40 to 0.99).CONCLUSIONS: Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates.Univ Estadual Paulista, UNESP, Botucatu, SP, BrazilUniv Estadual Paulista, UNESP, Botucatu, SP, Brazi

A new Eocaiman (Alligatoridae, Crocodylia) from the Itaboraí Basin, Paleogene of Rio de Janeiro, Brazil

A new small species of Eocaiman is described on the basis of three anterior left mandibular rami and one isolated tooth. The specimens came from the middle-upper Paleocene Itabora ́ı Basin (Rio de Janeiro State, Brazil; Itaboraian South American Land Mammal Age). The new taxon differs from the other two Eocaiman species, such as its small size, likely participation of the splenial in the mandibular symphysis, a reduced angle between the longitudinal axis of the symphysis and the mandibular ramus, and enlarged ninth and tenth dentary teeth (in addition to the large first and fourth dentary teeth). The participation of the splenial in the mandibular symphysis is a unique character among caimanines (with the only possible exception being Tsoabichi greenriverensis). The new taxon provides new information on the taxonomic and anatomical diversity of the genus Eocaiman, a taxon of prime importance to understand the evolutionary origins of caimans given its position as the basalmost member of Caimaninae. Furthermore, the new taxon has a relatively small body size in comparison with other species of Eocaiman, a case paralleled by other Itaboraian reptilian groups (e.g. snakes), suggesting that this ecosystem provides critical data to test the relationship between reptilian body size and climate.Fil: Pinheiro, André E. P.. Universidade Federal do Rio de Janeiro. Departamento de Geologia. Laboratório de Macrofósseis; BrasilFil: Fortier, Daniel C.. Universidade Federal do Rio Grande do Sul; Brasil. Universidade Federal de Minas Gerais. Intituto de Geociências; BrasilFil: Pol, Diego. Museo Paleontológico Egidio Feruglio; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Nacional Patagónico; ArgentinaFil: Campos, Diógenes A.. Museu de Ciências da Terra. Departamento Nacional de Produção Mineral; BrasilFil: Bergqvist, Lílian P.. Universidade Federal do Rio de Janeiro. Departamento de Geologia. Laboratório de Macrofósseis; Brasi