Avaliação do risco cardiovascular em pacientes com lipodistrofia secundária a terapia antirretroviral: critérios de framingham, índice tornozelo-braço e medida da espessura da camada medio-intimal da carótida

The use of combination antiretroviral therapy has significantly reduced mortality and morbidity in patients infected by HIV virus. However, this treatment may cause metabolic alterations such as dyslipidemia, glucose intolerance, insulin resistance and lipodystrophy. The clinical and laboratorial consequences that follow these alterations may raise the risk for cardiovascular diseases. This research aimed to investigate the epidemiological, clinical and laboratorial aspects of patients with lipodystrophy associated to raise cardiovascular risk, ankle-brachial index (ABI) and measurement of the carotid intima-media thickness (cIMT). For so, it was performed a Transversal analytical study with 62 patients with lipodystrophy using highly active antiretroviral therapy (HAART) with ages varying from 29 to 68, followed up in the outpatient unit of lipodystrophy of João de Barros Barreto University Hospital. The patients were submitted to anamnesis with clinical examination, blood collection for laboratorial tests with glycemia dosage, total cholesterol and its fractions, triglycerides and ultrasensitive PCR, measurement of the ankle-brachial index and measurement of the carotid intima-media thickness through mode B ultrasonography. The patients were classified according to their cardiovascular risks through the criteria of the Framingham Score. The variables were analyzed by the study of the measurements of central trend and the hypotheses were analyzed by the chi-square Test and/or the Fisher exact Test. The prevalence of alteration of the ABI in the studied sample was 21% and of the patients with a increase of the cIMT was 48.4%. According to the Framingham score, 53.2% of the patients presented low risk to a cardiovascular event in a 10 year range, 16.1% of moderate risk and 30.7% of high risk. A patient with a increase of the cIMT presented a larger cardiovascular risk through the Framingham score. Male, age, increase of the abdominal circumference have presented a significant association with the carotid intima-media thickness cIMT.O uso da terapia antirretroviral reduziu significativamente a mortalidade e a morbidade nos pacientes infectados pelo HIV. Entretanto, este tratamento pode causar alterações metabólicas como dislipidemia, intolerância à glicose, resistência insulínica e lipodistrofia. As consequências clínicas e laboratoriais que acompanham estas alterações podem aumentar o risco para desenvolvimento de doenças cardiovasculares. Este estudo teve o intuito de investigar os aspectos epidemiológicos, clínicos e laboratoriais dos pacientes com lipodistrofia associados ao aumento do risco cardiovascular com ênfase à medida da camada média-intimal e índice tronozelobraço. Para tanto foi conduzido um estudo Transversal analítico com 62 paciente com lipodistrofia em uso de Terapia antirretroviral ativa (TARV) com idades variando de 29 a 68 anos acompanhados no ambulatório de lipodistrofia do Hospital Universitário João de Barros Barreto. Os pacientes foram submetidos a anamnese com exame clínico, coleta de sangue para exames laboratoriais com dosagem de glicemia, colesterol total e suas frações, triglicerídeos e PCR ultra-sensível, medida do índice de pressão tornozelo-braço (ITB) e medida da espessura da camada médio-intimal da carótida (CMI) através de ultra-sonografia modo B. Os pacientes foram classificados quanto ao risco cardiovascular através dos critérios do escore de Framingham. As variáveis foram analisadas pelo estudo de medidas de tendência central e as hipóteses foram avaliadas pelos testes qui-quadrado e e/ou exato de Fisher. A prevalência de alteração do ITB na amostra estudada foi de 21% e os pacientes com aumento da CMI foi de 48,4%. De acordo com o escore de Framingham, 53,2% dos pacientes apresentaram risco baixo para evento cardiovascular em 10 anos, 16,1% risco moderado e 30,7% risco alto. Paciente com aumento da CMI apresentaram maior risco cardiovascular através do escore de Framingham O sexo masculino, idade, aumento da circunferência abdominal apresentaram uma associação significante com o aumento da espessura da camada médio-intimal da carótida

Ultrasound-guided distal radial access for abdominopelvic transarterial interventions

Introdução: Procedimentos intervencionistas transarteriais do território abdominopélvico têm habitualmente sido realizados por meio de acesso femoral. O acesso radial já vem sendo utilizado para realização de procedimentos diagnósticos e terapêuticos, tanto no território coronariano como abdominopélvico com baixas taxas de complicações. O acesso radial distal à tabaqueira anatômica apresenta vantagens sobre o acesso radial convencional, como maior conforto ao paciente e ao operador, menores taxas de complicações no sítio de punção e menores taxas de oclusão da artéria radial. Objetivos: Avaliar a segurança e reprodutibilidade do acesso radial distal guiado por ultrassonografia para procedimentos intervencionistas abdominopélvicos. Método: Foram coletados dados prospectivos de 42 procedimentos intervencionistas transarteriais abdominopélvicos onde foi utilizado o acesso radial distal em 37 pacientes. Os pacientes com diâmetro da artéria radial distal menor que 1,7 mm não foram incluídos no estudo. Os pacientes foram avaliados clinicamente após 2 horas e 30 dias para avaliação de possíveis complicações relacionadas ao sítio de punção. Resultados: Trinta e sete pacientes foram submetidos a 42 procedimentos transarteriais abdominopélvicos com a intenção de acesso radial distal. O diâmetro médio da artéria radial distal foi 2,32 mm, variando entre 1,7 mm e 3,2 mm. A artéria radial esquerda foi utilizada em 88,1% dos casos. A taxa de sucesso técnico obtido foi 97,6%. Não houve complicações relacionadas ao sítio de punção. Conclusão: Este estudo sugere que o acesso radial distal guiado por ultrassonografia para procedimentos intervencionistas abdominopélvicos é seguro e factível, com taxas altas de sucesso técnico e reprodutibilidade.Introduction: Transarterial interventional procedures in the abdominopelvic territory have usually been performed through femoral access. Radial access has already been used to perform diagnostic and therapeutic procedures in both the coronary and abdominopelvic areas with low rates of complications. The distal radial access to the anatomical snuffbox has advantages over conventional radial access, such as greater comfort for the patient and the operator, lower rates of complications at the puncture site and lower rates of radial artery occlusion. Objectives: To evaluate the safety and reproductibility of ultrasound-guided distal radial access for abdominopelvic interventional procedures. Method: Prospective data were collected from forty-two abdominopelvic transarterial interventional procedures using 37 distal radial access. Patients with distal radial artery diameter less than 1.7 mm were not included in the study. The patients were evaluated after 2 hours and 30 days to search for possible complications related to the puncture site. Results: Thirty-seven patients underwent 42 abdominopelvic transarterial procedures with the intention of distal radial access. The average diameter of the distal radial artery was 2.32 mm, ranging from 1.7 mm to 3.2 mm. The left radial artery was used in 88.1% of cases. The technical success rate obtained was 97.6%. There were no complications related to the puncture site. Conclusion: This study suggests that ultrasound-guided distal radial access for abdominopelvic interventional procedures is safe and feasible, with high rates of technical success and reproducibility

Vascular injuries in the state of Pará, Brazil, 2011-2013 and their relation with demographic and clinical variables

BACKGROUND:Vascular traumas are associated with high morbidity rates.OBJECTIVE: To report the characteristics of vascular traumas in the Brazilian state of Pará, in trauma victims treated at the Hospital Metropolitano de Urgência e Emergência (HMUE), from 2011 to 2013.METHOD: This was a descriptive, cross-sectional, retrospective and quantitative study that analyzed data on sex, age group, geographical origin, time waiting for care, mechanism of trauma, clinical status, anatomic site of injury, prevalence of associated fractures, vascular structures injured, types of vascular injury, principal types of surgery, early postoperative outcomes, level of amputation, number of deaths, length of hospital stay and multidisciplinary care for 264 medical records.RESULTS: The majority of victims were male and the most common age group was from 16 to 30 years. The majority of cases were from towns other than the state capital, accounting for 169 cases (64.02%). The principal mechanism of injury was firearm wounding - 110 (41.67%) followed by cold weapon wounds - 65 (24.62%) and traffic accidents - 42 (15.91%). The segments of the body and the vascular structures most often injured were lower limbs - 120 (45.45%) and injuries to the popliteal and femoral arteries and veins. The most common clinical presentation at admission was hemorrhage - 154 (58.33%). The most common surgeries were ligatures of veins and arteries. There were 163 (61.74%) hospital discharges and 33 (12.5%) deaths.CONCLUSIONS: The greatest prevalence observed was related to traumas caused by urban violence. Victims were most frequently male, of working age and from towns other than the capital of the state of Pará