Riscos de nefropatia em pacientes submetidos ao procedimento de cateterismo cardíaco e os benefícios do protocolo de hidratação oral

De acordo com Guyton, no tratado de fisiologia médica, em geral a nefropatia crônica e a insuficiência renal aguda podem ocorrer a partir de distúrbios nos vasos sanguíneos. A nefropatia causada a partir do uso de contrastes gera complicações graves, seu uso se dá pela necessidade de procedimentos terapêuticos e diagnósticos que envolvem contrastes de administração parenteral. Mesmo com as distintas definições de nefropatia de contrastes entre os estudos, o consenso refere-se a um aumento relativo da creatinina basal igual ou superior a 25%, 48 horas após a administração intravascular. Procedimentos de cateterismo e angioplastia, dentro da cardiologia intervencionista precisam da utilização e administração do meio de contraste iodado (MCI) e raio-x, para que aconteça uma melhor visualização das artérias coronárias e câmaras cardíacas. Na cardiologia, o exame diagnóstico considerado padrão-ouro, é o cateterismo cardíaco, pois permite uma melhor visualização e avaliação das coronárias, podendo perceber obstruções presentes. A etiologia da nefropatia induzida por contraste (NIC) pode estar associada nas características do quadro clínico do paciente quanto às características do contraste utilizado. Portanto a hidratação via oral vem sendo utilizada como uma sugestão em comparação à infusão endovenosa por conta da sua fácil administração e diminuição de recursos hospitalares, além do conforto e praticidade para o paciente, este método vem sendo eficaz e utilizado

Desafios e Avanços no Manejo da Hemorragia Pós-Parto: Estratégias Emergentes e Melhores Práticas

This article presents a literature review on the management of postpartum hemorrhage (PPH), focusing on emerging strategies and best practices. PPH is a significant obstetric complication that continues to pose a challenge for healthcare professionals. The review encompasses guidelines and recommendations from organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO), as well as highlighting studies on arterial embolization and other innovative interventions. The results emphasize the importance of a multidisciplinary approach and early identification of PPH to prevent serious complications. It is concluded that arterial embolization emerges as a valuable option in the management of refractory PPH, but its use should be carefully considered in conjunction with other therapeutic and preventive approaches.Este artigo apresenta uma revisão da literatura sobre o manejo da hemorragia pós-parto (HPP), com foco em estratégias emergentes e melhores práticas. A HPP é uma complicação obstétrica significativa que continua a representar um desafio para os profissionais de saúde. A revisão abrange diretrizes e recomendações de organizações como o Colégio Americano de Obstetras e Ginecologistas (ACOG) e a Organização Mundial da Saúde (OMS), além de destacar estudos sobre embolização arterial e outras intervenções inovadoras. Os resultados destacam a importância da abordagem multidisciplinar e da identificação precoce da HPP para prevenir complicações graves. Conclui-se que a embolização arterial surge como uma opção valiosa no manejo da HPP refratária, mas que seu uso deve ser cuidadosamente considerado em conjunto com outras abordagens terapêuticas e preventivas

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Freqüência de anticorpos IgG anti-Toxoplasma gondii em soros de cães errantes da cidade de Salvador-Bahia, Brasil

O Toxoplasma gondii é um coccídio intestinal intracelular obrigatório dos felídeos, de distribuição cosmopolita, descoberto em 1908 por Nicolle &amp; Manceaux. O primeiro relato na espécie canina ocorreu em 1910, na Itália e, no Brasil em 1911. Objetivando-se avaliar a freqüência deste parasito, na população de cães errantes da cidade de Salvador-Ba, foram coletadas 225 amostras de sangue, de animais provenientes de 10 distritos sanitários. Os soros foram submetidos a reação de imunofluorescência indireta (RIFI) para detecção de anticorpos IgG anti-Toxoplasma gondii, utilizando-se a cepa AS28. Foram detectados 143 amostras positivas, representando uma freqüência de 63,55.00%. As freqüências nos distritos sanitários foram as seguintes: Itapagipe 33,33%; São Caetano/Valéria 46,15.00%; Brotas 42,11%; Barra/Rio Vermelho 64,28%; Boca do Rio 80,00%; Itapuã 65,38%; Cabula/Beiru 80,64%; Pau da Lima 73,91%; Cajazeiras 64,70% e Subúrbio Ferroviário 73,33%. Os títulos encontrados variaram de 1:16 à 1:16384, sendo 1:16 (28,67%), 1:64 (44,76%), 1:256 (21,68%), 1:1024 (4,20%) e 1:16384 (0,70%). Dos 123 machos e 102 fêmeas, 67,48% e 58,82% foram sororeagentes, respectivamente. Com relação à idade, dos 198 adultos e 27 jovens, 70,20% e 14,80% apresentaram-se soropositivos, respectivamente. As variáveis idade e distrito sanitário apresentaram associação estatisticamente significativa (p&lt;0,05).The Toxoplasma gondii is an obligate intestinal intracelular coccidian protozoan of felidae, being considered cosmopolitan, discovered in 1908 by Nicolle &amp; Manceaux. The first report in the canine species happened in 1910, in Italy and, in Brazil in 1911. With the objective of evaluating the frequency of this parasite in the population of dogs of the city of Salvador-Ba, 225 samples of blood from animals of 10 sanitary districts were collected for the accomplishment of the reaction of indirect fluorescent antibody (IFA) for detection of IgG antibodies against-Toxoplasma gondii, using the strain AS28. 143 positive samples were detected, representing a frequency of 63.55.00%. The frequencies for sanitary districts were distributed as follow: Itapagipe 33.33%; São Caetano/Valéria 46.15.00%; Brotas 42.11%; Barra/Rio Vermelho 64.28%; Boca do Rio 80.00%; Itapuã 65.38%; Cabula/Beiru 80.64%; Pau da Lima 73.91%; Cajazeiras 64.70.00% e Subúrbio Ferroviário 73.33%. The serum titers found ranged from 1:16 to 1:16384, being 1:16 (28.67%), 1:64 (44.76%), 1:256 (21.68%), 1:1024 (4.20%) and 1:16384 (0.70.00%). Of the 123 males and 102 females, 67.48% and 58.82% were positive, respectively. Concerned to the age, of the 198 adults and 27 youngs, 70,20% and 14,80% were positive, respectively. The age and sanitary districts presented significant statistical result (p&lt;0,05)

Freqüência de anticorpos IgG anti-Toxoplasma gondii em soros de cães errantes da cidade de Salvador-Bahia, Brasil

O Toxoplasma gondii é um coccídio intestinal intracelular obrigatório dos felídeos, de distribuição cosmopolita, descoberto em 1908 por Nicolle & Manceaux. O primeiro relato na espécie canina ocorreu em 1910, na Itália e, no Brasil em 1911. Objetivando-se avaliar a freqüência deste parasito, na população de cães errantes da cidade de Salvador-Ba, foram coletadas 225 amostras de sangue, de animais provenientes de 10 distritos sanitários. Os soros foram submetidos a reação de imunofluorescência indireta (RIFI) para detecção de anticorpos IgG anti-Toxoplasma gondii, utilizando-se a cepa AS28. Foram detectados 143 amostras positivas, representando uma freqüência de 63,55.00%. As freqüências nos distritos sanitários foram as seguintes: Itapagipe 33,33%; São Caetano/Valéria 46,15.00%; Brotas 42,11%; Barra/Rio Vermelho 64,28%; Boca do Rio 80,00%; Itapuã 65,38%; Cabula/Beiru 80,64%; Pau da Lima 73,91%; Cajazeiras 64,70% e Subúrbio Ferroviário 73,33%. Os títulos encontrados variaram de 1:16 à 1:16384, sendo 1:16 (28,67%), 1:64 (44,76%), 1:256 (21,68%), 1:1024 (4,20%) e 1:16384 (0,70%). Dos 123 machos e 102 fêmeas, 67,48% e 58,82% foram sororeagentes, respectivamente. Com relação à idade, dos 198 adultos e 27 jovens, 70,20% e 14,80% apresentaram-se soropositivos, respectivamente. As variáveis idade e distrito sanitário apresentaram associação estatisticamente significativa (p<0,05)

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology