Bioimpedância Torácica: Aplicação da hemodinâmica não-invasiva no tratamento da hipertensão

Introdução: As doenças cardiovasculares são a maior causa de morte a nível mundial, muitas vezes por complicação da hipertensão arterial. Observa-se uma alta prevalência da sua forma primária e baixas taxas de controlo devidas, na sua maioria, à adesão terapêutica insuficiente ou à prescrição subótima da medicação, baseada nos valores de pressão arterial, geralmente sem ter em conta o estado hemodinâmico do paciente. Neste trabalho explora-se a possibilidade da avaliação não-invasiva do estado hemodinâmico poder ser realizada através da bioimpedância torácica avaliando a sua eficácia e utilidade na escolha/titulação da terapêutica anti hipertensora. Objetivos: Verificar se a bioimpedância torácica é um método fiável e analisar a sua utilidade na orientação do tratamento da hipertensão arterial. Métodos: Pesquisa bibliográfica na base de dados Pubmed e uso de referências bibliográficas de artigos selecionados. Resultados: 5 estudos validam a bioimpedância torácica como um método fiável na obtenção de dados hemodinâmicos quando comparados a métodos já utilizados na prática clínica. 7 estudos analisam a sua utilidade na orientação da terapia anti hipertensora em vários contextos, alguns em comparação com a abordagem empírica: todos eles mostram uma maior descida da pressão arterial, com taxas de controle superiores verificando-se maior recurso a politerapia. 3 estudos de caso mostram uma evolução favorável do estado hemodinâmico de pacientes com hipertensão arterial avaliados e tratados com recurso à bioimpedância torácica. Conclusão: Esta análise sugere a bioimpedância torácica como um método fiável e útil na orientação terapêutica da hipertensão arterial com ganhos superiores aos da abordagem convencional, sem complicações atribuíveis à técnica, diminuição de efeitos adversos medicamentosos e com controle da pressão arterial na maior parte dos casos.Introduction: Cardiovascular diseases are the most common cause of death worldwide, often as a complication of arterial hypertension. There is a high prevalence of its primary form and low control rates mostly given to a medication noncompliance or an inappropriate medical regimen, based only on the values of blood pressure, without accounting of the hemodynamic state of the patient. This work explores the possibility of a non-invasive evaluation of the hemodynamic state being realized by the use of thoracic bioimpedance, evaluating its accuracy and utility in the choice/titration of anti hypertensive treatment. Objective: Assess the reliability and utility of thoracic bioimpedance as a guide to anti hypertensive treatment prescription. Methods: Research of scientific articles in the Pubmed database and use of bibliographic references. Results: 5 studies validate thoracic bioimpedance as a reliable method for measure of hemodynamic data when compared to methods already used in clinical practice. 7 studies evaluate its utility in the choice of anti hypertensive medication in various contexts, some compare it to the empiric treatment: all of them show a higher reduction of blood pressure, higher control rates and a more frequent use of polytherapy. 3 case studies show a favorable evolution of the hemodynamic state of hypertensive patients when evaluated and treated with use of thoracic bioimpedance. Conclusion: This analysis suggests that thoracic bioimpedance is a reliable and useful method in guiding anti hypertensive therapy with better outcomes than the conventional treatment, without any complications given to this technique, reduction in adverse effects caused by medication and control of blood pressure in most cases

IoT-Based Monitoring System for Photovoltaic Battery Management

As number of photovoltaic systems being installed is increasing, also many users are deciding to include batteries, and postpone the consumption of that energy when it is most needed. Moreover,a crucial issue can keep undetected for long time causing dangerous situation which can lead to a potential disaster. However, the chemical nature of batteries makes them unreliable and dangerous. In this risky scenario, it becomes essential to monitor their behaviour in order to avoid accidents. In that purpose, a enabled Internet of Things (IoT) framework is proposed for monitoring the batteries values for temperature and voltage through the use of sensors. If these values becomes abnormal, a notification is triggered to the responsible person. Based on experimental results, the proposed framework to detect and notify hazard situations caused by battery faults.info:eu-repo/semantics/publishedVersio

PROXIMAL EXTENSION OF JUXTA-RENAL AORTIC THROMBOSIS: AN UNDERESTIMATED COMPLICATION?

Aorto-iliac occlusive disease sometimes extends proximally with involvement of the renal arteries and visceral aorta, with loss of renal functional mass and intestinal ischemia. In this article we report the case of a patient presenting with progressive disabling intermittent claudication caused by chronic juxtarenal aortic thrombosis with proximal progression and involvement of the left renal artery, with a functional kidney preserved by the collateral circulation. This imagiologic finding led to a change in the usual surgical procedure, needing a supraceliac aortic clamp. Simultaneously, we choose to revascularize the left renal artery while perfunding the right renal artery with cold Ringer’s lactate solution during clamping period. No complications occurred during the surgery and post-operative period. Renal involvement in aortic juxtarenal thrombosis occurs in 3 to 15% of the cases but demands a more complex surgical approach with more proximal aortic clamping level as well as the use of intraoperative strategies to protect the visceral and renal territories

CIRURGIA HÍBRIDA NA ROTURA CONTIDA DE ANEURISMA TORÁCICO: UMA ALTERNATIVA EFICAZ NUM CASO SEM COLO DISTAL

O tratamento endovascular dos aneurismas da aorta torácica descendente (AATD) está associado a baixas taxas de morbi- -mortalidade e é atualmente a primeira linha de intervenção terapêutica.. Os endoleaks são uma complicação bem conhecida desta técnica, sendo consensual que a identificação de endoleak tipo I implica a sua correção celere. Apresentamos o caso de uma doente submetida a TEVAR para tratamento de AATD, com exclusão do aneurisma no controlo angiográfico final. A angioTC de controlo mostrou endoleak tipo Ib com crescimento do saco aneurismático pelo que foi proposto tratamento, que a doente recusou. Admitida posteriormente de urgência, em rotura do aneurisma, a doente foi submetida de imediato a debranching dos troncos viscerais, seguido de extensão distal do TEVAR. O tratamento híbrido dos aneurismas torácicos sem landing zone distal através do debranching dos troncos viscerais e de TEVAR é uma alternativa à cirurgia convencional e à cirurgia endovascular complexa que apresenta bons resultados em doentes com risco cirúrgico elevado e permite ainda tratar doentes em regime urgente uma vez que não dependem da manufatura de endoprótese fenestradas e/ou ramificadas

ENDOVASCULAR MANAGEMENT OF TRANSPLANT RENAL ARTERY STENOSIS: EARLY AND MID-TERM RESULTS

OBJECTIVE: Renal graft dysfunction or worsened hypertension in renal transplanted patients may be a manifestation of graft hypoperfusion due to transplant renal artery stenosis (TRAS) or stenosis of iliac arteries proximal to renal transplant (pseudo-TRAS). Endovascular management of TRAS has been increasingly used to preserve renal graft function. With this study, we aim to evaluate the impact of endovascular treatment of TRAS on renal function in the short to medium term. MATERIAL AND METHODS: This is an observational, retrospective, single-center study that included all adult renal transplant patients who underwent endovascular intervention on TRAS between September 2017 and June 2020. Renal graft function was monitored by serum Creatinine (sCr) levels. RESULTS: Thirteen patients were included (53.8% female), with a median age of 57 (21-70) years. Eleven patients (84.6%) presented with graft dysfunction. Ten subjects (76.9%) underwent transluminal angioplasty and stenting of renal artery and three (23,1%) of donor iliac arteries. Most cases (69.2%) were interventioned in the first-year post-transplant. Overall technical success was 100%, with no periprocedural deaths. Overall 30-day morbidity was 15.4%. Median follow-up time was 20.2 (1,3 – 36,3) months. One patient died during follow up and other worsened graft dysfunction, requiring hemodi- alysis and nephrectomy. Reduction in sCr levels was statistically significant in the first postoperative month, compared to preoperative values, but sCR levels were still increased when compared to baseline levels (pre-TRAS diagnosis). CONCLUSIONS: The majority (12/13) of patients showed improvement or stabilization of renal graft function compared to the preoperative period, during the follow-up period, supporting the procedure’s safety. Despite this, most patients did not recover baseline sCr levels, reinforcing the importance of prompt graft revascularization. Delayed diagnosis of TRAS may compromise the benefit of revascularization and prevent full recovery of renal function

Adaptações no Serviço de Cirurgia Vascular do CHULN durante a pandemia de COVID-19 e impacto na atividade global

© SPACVWith the onset of the SARS-CoV-2 pandemic in early 2020, health services and personnel adapted their resources to mitigate and control the outbreak. These needs inevitably led to adaptations in most medical and surgical departments, including in our Vascular Surgery department. As we are facing a second outbreak of this pandemic, with unpredictable outcomes and repercussions in health services, it is crucial to learn from previous experiences and share strategies to perform the best care to our patients, despite the restrictions that have been imposed. Through this paper, we review the adaptations in Centro Hospitalar Universitário Lisboa Norte and particularly in our department to overcome the pandemic. We also assess the impact of these changes in our activity and compare with the experience of other fellow surgeons. With an upcoming second outbreak, it is crucial to learn from this and other departments’ experiences to overcome a potential health crisis.info:eu-repo/semantics/publishedVersio

Selênio plasmático e sua relação com parâmetros de risco cardiovascular em mulheres obesas

The present study aims to evaluate the relationship between selenium plasma concentration and cardiovascular risk in obese women. This is a case-control study, involving 67 women, aged between 20 and 50 years, and divided into two groups: control group (eutrophic women, n = 42) and case group (obese women n = 25). Plasma selenium and lipid profile (total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and VLDL-cholesterol) were analyzed. Data were analyzed using the SPSS for Windows 22.0 statistical program. The project was approved by the Research Ethics Committee of the Federal University of Piauí, under opinion number 2.014.100. Regarding the results, lower concentrations of plasma selenium were observed for the obese group, with a statistically significant difference between the groups (p <0.001). At the same time, higher concentrations of total cholesterol, HDL-cholesterol, LDL-cholesterol, and Castelli I and II indices were found among obese women compared with eutrophic women, with a statistically significant difference (p <0.05). For the result of the correlation analysis between the variables, it was found that there was a moderate negative correlation between plasma selenium, total cholesterol and LDL-cholesterol (p <0.05). Before the results obtained, the study shows the likely influence of selenium on lipid profile parameters and, consequently, on the reduction of cardiovascular risk, such as the inverse relationship evidenced between plasma mineral concentration, total cholesterol and LDL-cholesterol.El presente estudio tiene como objetivo evaluar la relación entre la concentración plasmática de selenio y el riesgo cardiovascular en mujeres obesas. Este es un estudio de casos y controles que involucra a 67 mujeres, con edades entre 20 y 50 años, y dividido en dos grupos: grupo de control (mujeres eutróficas, n = 42) y grupo de casos (mujeres obesas n = 25). Se analizaron el perfil de lípidos y selenio en plasma (colesterol total, triglicéridos, colesterol HDL, colesterol LDL y colesterol VLDL). Los datos se analizaron utilizando el programa estadístico SPSS para Windows 22.0. El proyecto fue aprobado por el Comité de Ética en Investigación de la Universidad Federal de Piauí, con el número de opinión 2.014.100. Con respecto a los resultados, se observaron concentraciones más bajas de selenio en plasma para el grupo obeso, con una diferencia estadísticamente significativa entre los grupos (p <0.001). Al mismo tiempo, se encontraron concentraciones más altas de colesterol total, colesterol HDL, colesterol LDL y de Castelli I y II entre las mujeres obesas en comparación con las mujeres eutróficas, con una diferencia estadísticamente significativa (p <0.05). Para el resultado del análisis de correlación entre las variables, se encontró que había una correlación negativa moderada entre el selenio en plasma, el colesterol total y el colesterol LDL (p <0.05). Dados los resultados obtenidos, el estudio muestra la probable influencia del selenio en los parámetros del perfil lipídico y, en consecuencia, en la reducción del riesgo cardiovascular, como la relación inversa evidenciada entre la concentración mineral en plasma, el colesterol total y el colesterol LDL.O presente estudo tem por objetivo avaliar a relação entre a concentração plasmática de selênio e o risco cardiovascular em mulheres obesas. Trata-se de um estudo caso-controle, envolvendo 67 mulheres, com idade entre 20 e 50 anos, sendo distribuídas em dois grupos: grupo controle (mulheres eutróficas, n=42) e grupo caso (mulheres obesas n=25). Foram analisados selênio plasmático e perfil lipídico (colesterol total, triglicerídeos, HDL-colesterol, LDL-colesterol e VLDL-colesterol). Os dados foram analisados no programa estatístico SPSS for Windows 22.0. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal do Piauí, sob número de parecer 2.014.100. Quanto aos resultados, observou-se concentrações menores de selênio plasmático para o grupo composto pelas obesas, com diferença estatística significativa entre os grupos (p<0,001). Paralelamente, encontrou-se concentrações maiores de colesterol total, HDL-colesterol, LDL-colesterol e índices de Castelli I e II entre as mulheres obesas, em comparação com as eutróficas, com diferença estatística significativa (p<0,05). Para o resultado da análise de correlação entre as variáveis, verificou-se que houve correlação moderada negativa entre o selênio plasmático, colesterol total e LDL-colesterol (p<0,05). Diante dos resultados obtidos, o estudo mostra a provável influência do selênio sobre parâmetros do perfil lipídico e, consequentemente, na redução do risco cardiovascular, a exemplo da relação inversa evidenciada entre a concentração plasmática do mineral, colesterol total e LDL-colesterol

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A catastrophic seronegative anti-phospholipid syndrome: case and literature review

© The Author(s). 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.Background: Antiphospholipid Syndrome (APS) is a multisystemic autoimmune disease characterized by arterial and venous thrombosis and / or obstetric morbidity in the presence of at least one circulating anti-phospholipid antibody. The spectrum of vascular events varies from deep venous thrombosis to catastrophic APS, a rare form characterized by acute multiorgan thrombosis and high mortality. Case report: We present the case of a 32-week pregnant woman arriving in the hospital emergency room with bilateral acute lower limb ischemia. In the obstetric evaluation, fetal death was declared. Computerized Tomography angiography showed pulmonary embolism of both pulmonary arteries, areas of splenic and right renal infarction and multiple arterial and venous thrombosis. The patient underwent urgent caesarean section and axillary-bifemoral bypass. No events registered. In the postoperative period, in an intensive care unit, treatment with rituximab and plasmapheresis were added to anticoagulant therapy. The laboratorial investigation was negative for thrombophilia and autoimmune diseases. Conclusion: Catastrophic APS develops quickly, with multiorgan involvement and high mortality rate. The presented case poses a multidisciplinary challenge, with the surgical approach of extra-anatomical revascularization being less invasive and guaranteeing immediate perfusion of the lower limbs. Although the serological tests were negative for anti-phospholipid antibodies, this case hardly fits into another diagnosis. Therefore, it was treated as a catastrophic APS, having shown a favorable evolution.info:eu-repo/semantics/publishedVersio

Room temperature magnetoelectric coupling in a molecular ferroelectric ytterbium(III) complex

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