Impacto da escleroterapia com espuma na qualidade de vida e nos achados fotopletismográficos na insuficiência venosa crônica : seguimento de 1 ano

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Ciências Médicas, 2019.Objetivos: Investigar os desfechos clínicos, ultrassonográficos e fotopletismográficos no seguimento de 1 ano após escleroterapia com espuma guiada por ultrassom (EGUS) para o tratamento da insuficiência venosa crônica (IVC). Materiais e métodos: Foram incluídas 29 pernas classificadas como C4, C5 e C6, segundo a classificação clinical manifestations, etiologic factors, anatomic distribution of disease, pathophysiologic findings (CEAP). Os pacientes responderam ao questionário de qualidade de vida e sintomas VEINES e seu tempo de enchimento venoso (TEV) foi mensurado utilizando fotopletismografia antes e 45, 180 e 360 dias após tratamento da IVC com EGUS. Resultados: Os resultados demonstraram uma melhora estatisticamente significativa nos escores de qualidade de vida e de sintomas do questionário VEINES e no TEV mensurado utilizando fotopletismografia e uma redução no diâmetro da veia safena (p < 0.0001) após 45, 180 e 360 dias do tratamento com EGUS. Conclusão: EGUS mostrou-se eficaz e resultou em maiores níveis de satisfação, confirmados pela melhora nos escores do questionário, TEV e achados ultrassonográficos.Objectives: To examine clinical, ultrasound, and photoplethysmography outcomes after a 1-year follow-up of ultrasound-guided foam sclerotherapy for chronic venous insufficiency. Materials and methods: Twenty-nine legs classified as C4, C5 or C6 of the CEAP classification were included. Patients answered the VEINES questionnaire on quality of life and symptoms and their venous filling time was measured using photoplethysmography before and 45, 180, and 360 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy. Results: The results showed statistically significant improvements in VEINES quality of life and symptom scores and in venous filling time measured by photoplethysmography and a reduction in great saphenous vein diameter (p<0.0001) at 45, 180, and 360 days after treatment with ultrasound-guided foam sclerotherapy. Conclusion: Ultrasound-guided foam sclerotherapy demonstrated efficacy and resulted in high satisfaction levels, confirmed by improvement in questionnaire scores, venous refilling time, and ultrasound findings

Escleroterapia com espuma guiada por ultrassom - impacto na qualidade de vida e sua relação com a fotopletismografia digital

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Médicas, 2014.OBJETIVOS: Avaliar a eficácia da escleroterapia com espuma guiada por ultrassom (EGUS) no tratamento de pacientes portadores de insuficiência venosa crônica grave (IVC) secundária a varizes utilizando a fotopletismografia digital como método objetivo através da mensuração do TEV antes e depois do tratamento e questionário de qualidade de vida e de sintomas específicos como método subjetivo, no período pré-operatório e 45 dias após tratamento. MÉTODOS: 32 pacientes classificados como C4, C5 e C6 foram submetidos a aplicação de questionário de qualidade de vida e de sintomas (VEINES QOL e VEINES SYM) e aferidos o tempo de enchimento venoso (TEV) por fotopletismografia digital antes e 45 dias depois do tratamento da IVC através de EGUS. O teste do sinal foi utilizado para análise estatística da melhora dos escores dos questionários e do TEV. O teste de McNemar foi utilizado para avaliação da melhora nos sintomas do impacto do tratamento nas atividades laborais e sociais dos pacientes. RESULTADOS: Após o tratamento com EGUS, houve melhora nos escores dos questionários de qualidade de vida e no tempo de enchimento venoso, com significância estatística (p < 0,0001). Também foi observado incremento na qualidade laboral e social, bem como melhora estatisticamente significativa nos sintomas: dor, cansaço, edema, queimação, pernas inquietas e latejamento (p < 0,0001).Não ocorreram complicações maiores ou efeitos adversos nesta série. CONCLUSÃO: A EGUS mostrou-se eficaz, apresentou alto índice de satisfação e com baixas taxas de complicações maiores, ratificada pelos escores do VEINES QOL e VEINES SYM, bem como pelos valores de TEV aferidos pela FPG. __________________________________________________________________________ ABSTRACTOBJECTIVE: To investigate the correlation between subjective data obtained using a questionnaire on quality of life and symptoms and objective data obtained by digital photoplethysmography before and after the treatment of severe chronic venous insufficiency with ultrasound-guided foam sclerotherapy. METHODS: Thirty-two patients classified as C4, C5 and C6 according to the Clinical Etiological, Anatomical, Pathophysiological classification answered the Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptom questionnaire and had their venous filling time measured by digital photoplethysmography before and 45 days after treatment of chronic venous insufficiency with ultrasound-guided foam sclerotherapy. The sign test was used for statistical analysis of the improvement in questionnaire scores and in venous filling time. The McNemar test was used to evaluate the impact of improvement in symptoms on patients' work and social activities. RESULTS: There was a statistically significant improvement in quality of life scores and in venous filling time, as well as in the following symptoms: aching legs, heavy legs, swelling, burning sensation, restless legs, and throbbing (P < .0001). A statistically significantly improvement was also observed in work and social quality of life after treatment (P < .0001). There were no major complications or adverse effects in this series of patients. CONCLUSIONS: Ultrasound-guided foam sclerotherapy showed to be efficient and had high levels of satisfaction and low rates of major complications, which was confirmed by the scores of the questionnaire on quality of life and symptoms and by values of venous refilling time as measured by photoplethysmography

Arteriovenous fistula after ultrasound guided foam sclerotherapy : case report

A escleroterapia com espuma guiada por ultrassom tem ganhado espaço no tratamento da insuficiência venosa crônica secundária a varizes dos membros inferiores. Trata-se de procedimento ambulatorial, de baixo custo e sem necessidade de afastamento das atividades habituais. Apresenta bons resultados clínicos, especialmente nos estágios mais avançados da doença. Quando bem aplicada, apresenta baixas taxas de complicações maiores. Porém, a técnica apresenta altas taxas de recanalização no médio e longo prazo, e seu mecanismo ainda não é totalmente compreendido. O presente artigo descreve um caso de fístula arteriovenosa em segmento de recanalização de veia safena magna, após escleroterapia com espuma guiada por ultrassom, e identificada por exame ultrassonográfico de vigilância pós-procedimento.Ultrasound-guided foam sclerotherapy has become widespread in the treatment of chronic venous insufficiency secondary to varicose veins. It is a low-cost, outpatient procedure that does not require medical leave. It has demonstrated good clinical results, especially in the more advanced stages of the disease. When employed correctly, it results in low rates of major complications. However, the technique exhibits high recanalization rates over mid and long-term follow up. Additionally, the recanalization mechanism has not yet been explained. This article describes an arteriovenous fistula in a recanalized segment of great saphenous vein previously treated with ultrasound-guided foam sclerotherapy that was detected during post-procedure follow-up with ultrasound

MECHANOCHEMISTRY APPLIED TO THE SYNTHESIS OF 2-PHENYLIMIDAZO[1,2-α]PYRIDINE AS A TEACHING TOOL FOR GREEN CHEMISTRY

In the present work, we developed an experimental class for undergraduate students concerning the linear synthesis of 2-phenylimidazo[1,2-α]pyridine through mechanochemical techniques. This approach aims to conceptualize the green chemistry principles through a safe, robust, atom-economic, energy-efficient, and solvent-free method for preparing these classes of compounds by manual grinding and vortex mixing. The methodology was easily applied in experimental classes for chemistry students and could be easily expanded to other courses such as pharmacy and biotechnology

Variáveis jurídicas e de saúde no deferimento de liminares por medicamentos em Minas Gerais

OBJECTIVE To investigate the factors related to the granting of preliminary court orders [injunctions] in drug litigations. METHODS A retrospective descriptive study of drug lawsuits in the State of Minas Gerais, Southeastern Brazil, was conducted from October 1999 to 2009. The database consists of 6,112 lawsuits, out of which 6,044 had motions for injunctions and 5,167 included the requisition of drugs. Those with more than one beneficiary were excluded, which totaled 5,072 examined suits. The variables for complete, partial, and suppressed motions were treated as dependent and assessed in relation to those that were independent – lawsuits (year, type, legal representation, defendant, court in which it was filed, adjudication time), drugs (level five of the anatomical therapeutic chemical classification), and diseases (chapter of the International Classification of Diseases). Statistical analyses were performed using the Chi-square test. RESULTS Out of the 5,072 lawsuits with injunctions, 4,184 (82.5%) had the injunctions granted. Granting varied from 95.8% of the total lawsuits in 2004 to 76.9% in 2008. Where there was legal representation, granting exceeded 80.0% and in lawsuits without representation, it did not exceed 66.9%. In public civil actions (89.1%), granting was higher relative to ordinary lawsuits (82.8%) and injunctions (80.1%). Federal courts granted only 68.6% of the injunctions, while the state courts granted 84.8%. Diseases of the digestive system and neoplasms received up to 87.0% in granting, while diseases of the nervous system, mental and behavioral disorders, and diseases of the skin and subcutaneous tissue received granting below 78.6% and showed a high proportion of suspended injunctions (10.9%). Injunctions involving paroxetine, somatropin, and ferrous sulfate drugs were all granted, while less than 54.0% of those involving escitalopram, sodium diclofenac, and nortriptyline were granted. CONCLUSIONS There are significant differences in the granting of injunctions, depending on the procedural and clinical variances. Important trends in the pattern of judicial action were observed, particularly, in the reduced granting [of injunctions] over the period.OBJETIVO Investigar fatores relacionados ao deferimento de liminares por medicamentos. MÉTODOS Estudo descritivo retrospectivo dos processos judiciais por medicamentos em Minas Gerais, de outubro de 1999 a 2009. A base de dados, constituída por 6.112 ações judiciais, teve 6.044 com pedido de liminar e 5.167 com requisição de medicamentos. Foram excluídas as ações que continham mais de um beneficiário, totalizando 5.072 ações analisadas. As variáveis deferimento total, parcial e suspensão foram tratadas como dependentes e avaliadas em relação às independentes: processo (ano, tipo de ação, representação judicial, réu, justiça de ajuizamento, tempo de decisão judicial), medicamentos (nível 5 da Anatomical Therapeutic Chemical) e doença (por capítulo da Classificação Internacional de Doenças. As análises estatísticas foram realizadas pelo teste Qui-quadrado. RESULTADOS Dentre as 5.072 ações com liminares, 4.184 (82,5%) foram deferidas. O deferimento variou de 95,8% em 2004 a 76,9% em 2008. Quando houve representação judicial, o deferimento superou 80,0%; nas ações sem representação, não ultrapassou 66,9%. Nas ações civis públicas (89,1%) o deferimento foi superior ao verificado em ações ordinárias (82,8%) e nos mandados de segurança (80,1%). A Justiça Federal deferiu apenas 68,6% das liminares, contra 84,8% da Justiça Estadual. Doenças do aparelho digestivo e neoplasias apresentaram deferimento acima de 87,0%, enquanto doenças do sistema nervoso, transtornos mentais e comportamentais e doenças da pele e do tecido celular subcutâneo tiveram deferimento inferior a 78,6% e apresentaram elevada proporção de liminares suspensas (10,9%). Os fármacos paroxetina, somatropina e sulfato ferroso tiveram 100% de deferimento. Escitalopram, diclofenaco de sódio e nortriptilina obtiveram deferimento inferior a 54,0%. CONCLUSÕES Há diferença significativa no deferimento das liminares a partir de variáveis processuais e clínicas. Tendências importantes no padrão de atuação judicial foram observadas, particularmente a redução do deferimento ao longo do período

Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report

Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of deat

Ensaio clínico randomizado prospectivo comparando a ablação por radiofrequência e a retirada completa de veia safena em pacientes com doença venosa crônica leve à moderada com seguimento de 3 anos

Objective: To compare the use of the radiofrequency thermoablation of the saphenous vein with the ligation technique, and complete removal of the saphenous vein, from the saphenofemoral junction to the ankle. Methods: A total of 49 patients with chronic venous disease in the Comprehensive Classification System for Chronic Venous Disorders (CEAP) classes 2 to 4 for clinical signs, etiology, anatomic distribution and pathophysiology, were assessed at baseline, after 4 weeks, and after 1 year. The parameters assessed were complications, period of absence from activities, Venous Clinical Severity Score (VCSS) and quality of life scores according to Aberdeen Varicose Veins Questionnaire (AVVQ). They were re-examined 1 and 3 years after treatment to evaluate recurrence rates. Results: The success rate per limb (p=0.540), VCSS (p=0.636), AVVQ (p=0.163), and clinical complications were similar in the two treatment groups. Nevertheless, the radiofrequency thermoablation group had significant shorter length of hospital stay (0.69±0.47) and absence from activities (8.62±4.53), p<000.1. Conclusion: Patients submitted to radiofrequency thermoablation had an occlusion rate, clinical recurrence and improvement in quality of life comparable to removal of the saphenous vein. However, these patients spent less time hospitalized and away from their daily activities during recovering

Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report

Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of deat