Rate of complications due to carotid angioplasty in a tertiary university hospital

Introduction: Stenoses greater than 50% in the cervical internal carotid artery cause up to 8% of all ischemic strokes. Carotid artery stenting (CAS) is an effective alternative to prevent cerebrovascular events to occur. According to recommendations from the American Heart Association/American Stroke Association, CAS is indicated for symptomatic patients with internal carotid stenosis greater than 70% (measured by non-invasive methods), as long as the risk for periprocedural stroke or death is less than 6%. There is few information about complication rates of CAS in developing countries. Objectives: The primary goal of this study was to evaluate the frequency of any stroke or death until hospital discharge after CAS in symptomatic patients with carotid stenosis in a tertiary university hospital. Other complication rates were also assessed as secondary aims. Methods: A single-center retrospective study based on the analysis of charts from patients submitted to CAS between April 2011 and March 2016. Inclusion criteria were: age ≥ 18 years old, admission and follow-up by neurologists from the Neurology Ward, performance of CAS according to the hospital´s protocol (carotid stenosis ≥70%, patients with transient ischemic attack (TIA), amaurosis fugax or minor stroke in the last 180 days, and life expectancy greater than a year). Patients not followed by neurologists after CAS were excluded. Results: A total of 65 patients were included: 3 (4.6%) suffered stroke or death after CAS. Two of these patients presented ischemic strokes and one, an hemorrhagic stroke that lead to death. Myocardial infarctions were not identified, as well as carotid ruptures or dissections, hyperperfusion syndrome, artery perforations, stent thrombosis or encephalopathy. Minor complication rates were: 12.3% for hypotension, 9.2% for bradycardia, 1.5% for TIA, 3.1% for carotid vasospasm and 6.2% for acute kidney injury. The total rate of minor complications was 23.1%, and none of then led to permanent harm. Conclusions: The rate of stroke or death in a reference tertiary service in a developing country was in line with international recommendations

Rate of complications due to carotid angioplasty in a tertiary university hospital

Introduction: Stenoses greater than 50% in the cervical internal carotid artery cause up to 8% of all ischemic strokes. Carotid artery stenting (CAS) is an effective alternative to prevent cerebrovascular events to occur. According to recommendations from the American Heart Association/American Stroke Association, CAS is indicated for symptomatic patients with internal carotid stenosis greater than 70% (measured by non-invasive methods), as long as the risk for periprocedural stroke or death is less than 6%. There is few information about complication rates of CAS in developing countries. Objectives: The primary goal of this study was to evaluate the frequency of any stroke or death until hospital discharge after CAS in symptomatic patients with carotid stenosis in a tertiary university hospital. Other complication rates were also assessed as secondary aims. Methods: A single-center retrospective study based on the analysis of charts from patients submitted to CAS between April 2011 and March 2016. Inclusion criteria were: age ≥ 18 years old, admission and follow-up by neurologists from the Neurology Ward, performance of CAS according to the hospital´s protocol (carotid stenosis ≥70%, patients with transient ischemic attack (TIA), amaurosis fugax or minor stroke in the last 180 days, and life expectancy greater than a year). Patients not followed by neurologists after CAS were excluded. Results: A total of 65 patients were included: 3 (4.6%) suffered stroke or death after CAS. Two of these patients presented ischemic strokes and one, an hemorrhagic stroke that lead to death. Myocardial infarctions were not identified, as well as carotid ruptures or dissections, hyperperfusion syndrome, artery perforations, stent thrombosis or encephalopathy. Minor complication rates were: 12.3% for hypotension, 9.2% for bradycardia, 1.5% for TIA, 3.1% for carotid vasospasm and 6.2% for acute kidney injury. The total rate of minor complications was 23.1%, and none of then led to permanent harm. Conclusions: The rate of stroke or death in a reference tertiary service in a developing country was in line with international recommendations

Inferior petrosal sinus catheterization: technical aspects

OBJETIVO: O cateterismo dos seios petrosos inferiores (SPI) ajuda a diferenciar as formas hipofisária e ectópica na síndrome de Cushing (SC). O objetivo desse trabalho é descrever a técnica empregada em nosso serviço, discutir a solução de dificuldades e verificar o índice de sucesso atingido. CASUÍSTICA E MÉTODO: Foram submetidos a cateterismo bilateral dos SPI 42 pacientes com SC, entre setembro de 2000 e setembro de 2005. As dificuldades para o posicionamento do cateter foram correlacionadas com as soluções empregadas. RESULTADOS: As variações anatômicas, a semelhança entre o SPI e a veia emissária do plexo basilar e a dificuldade de contrastar as estruturas a contrafluxo para localizá-las foram os principais problemas. Foram utilizados cateter pré-moldado, fio-guia semicurvo e dirigível, road-maping e venografia por injeção contralateral, além de critérios para diferenciar o SPI da veia emissária. Dos 84 SPI abordados, um apresentava trombose, e dos 83 possíveis, 80 (96,4%) foram cateterizados. Não se observaram complicações. CONCLUSÃO: A cateterização dos SPI pode ser feita na maioria dos pacientes. A identificação da veia emissária do plexo basilar e o uso de flebografia por injeção contralateral melhoraram o desempenho do método.PURPOSE: Inferior petrosal sinus catheterization and sampling for corticotropin dosage helps to differentiate hypophisary and ectopic forms of Cushing syndrome. The aim of this paper is to describe the technique used in inferior petrosal sinus catheterization in our service, emphasizing the solution found for frequent difficulties, and verify the success rate achieved. PATIENTS AND METHODS: Between September/2000 and September/2005, forty-two (eighty-four sinuses) patients were submitted to inferior petrosal sinus sampling. The difficulties for correct catheter positioning were identified and correlated with their solutions. RESULTS: Anatomical variations, similarity between IPS and emissary vein of the basilar plexus and unfavorable flow to the contrastation of the structures (retrograde catheterization) were the main problems. Using pre-shaped catheters, curved, steerable guide-wires, road-maping and venography by contalateral injection, besides criteria to differentiate IPS from the emissary vein. Of the 84 sinuses approached, one was thrombosed, and 80 (96.4%) of 83 possible were selectively catheterized. No clinical complication occurred. CONCLUSION: IPSC can be safe and successfully performed in most cases. The identification of the emissary vein of the basilar plexus and use of venography by contralateral injection, improved the method performance

O valor e a autenticidade da marca influenciados pelos canais de distribuição

Brands, being ubiquitous, can provide different perceptions of brand equity and brand authenticity among consumers. This paper aims to identify the impact of the fit between a brand, premium positioned, placed in premium channels, in contrast with popular channels placement. A product of an identical brand may have its brand value (brand equity) altered by the fit of the channel option, i.e. a channel consistent in image and brand positioning (high fit) would impact on a higher end consumer based brand equity (CBBE). We intend to contribute to enhancing the understanding of the role of channel strategy in brand value as well as the mediating effect of brand authenticity. As a methodological proposal, a couple of experiments were conducted and it was found that the consistency between brand positioning and channel (fit) leads consumers to evaluate differently the CBBE. In addition, the study found that the fit between channel and brand has a direct effect on consumer purchase intent, the higher the fit, the greater purchase intent. Likewise, it was found that the perception of brand authenticity is affected by the fit between the channel and the brands, the higher the fit with the channel, the greater the perception of brand authenticity.As marcas, onipresentes, podem proporcionar percepções diferentes do valor e autenticidade de marca entre os consumidores. Este artigo tem como objetivo identificar o impacto do ajuste entre uma marca premium posicionada, colocada em canais premium, em contraste com a colocação em canais populares. Um produto de uma marca idêntica pode ter seu valor de marca (valor da marca) alterado pelo ajuste da opção de canal, ou seja, um canal consistente em imagem e posicionamento de marca (high fit) impactaria um valor maior baseado no consumidor final (CBBE). Pretendemos contribuir para melhorar a compreensão do papel da estratégia de canal no valor da marca. Como proposta metodológica foram realizados experimentos e constatou-se que a consistência entre o posicionamento da marca e o canal (fit) leva os consumidores a avaliarem de forma diferenciada a equidade de marca baseada no consumidor (CBBE). O estudo constatou que o ajuste entre canal e marca tem efeito direto na intenção de compra do consumidor, isto é, quanto maior o ajuste, maior a intenção de compra. Dessa forma, constatou-se que a percepção de autenticidade da marca é afetada pelo ajuste entre o canal e as marcas. Quanto maior o ajuste com o canal, maior a percepção de autenticidade da marca

In vitro phosphorylation as tool for modification of silk and keratin fibrous materials

An overview is given of the recent work on in vitro enzymatic phosphorylation of silk fibroin and human hair keratin. Opposing to many chemical "conventional" approaches, enzymatic phosphorylation is in fact a mild reaction and the treatment falls within "green chemistry" approach. Silk and keratin are not phosphorylated in vivo, but in vitro. This enzyme-driven modification is a major technological breakthrough. Harsh chemical chemicals are avoided, and mild conditions make enzymatic phosphorylation a real "green chemistry" approach. The current communication presents a novel approach stating that enzyme phosphorylation may be used as a tool to modify the surface charge of biocompatible materials such as keratin and silk

Atuação da equipe multiprofissional frente à parada Cardiorrespiratória na Unidade de Terapia Intensiva / Performance of the multiprofessional team front of Cardiorespiratory arrest in the Intensive Care Unit

Objetivo: O objetivo deste estudo é conhecer e identificar por meio da literatura científica a atuação dos profissionais durante a ocorrência de parada cardiorrespiratória no setor de urgência e emergência.  Metodologia: Trata-se de uma revisão integrativa realizada partir das seguintes etapas: escolha do tema, construção da pergunta de pesquisa através do acrônimo PICo (paciente, interesse, contexto), escolha dos Descritores em Ciências da Saúde (DeCS), definição dos critérios de inclusão/exclusão dos artigos científicos; coleta, análise e discussão dos dados dos estudos selecionados, exposição da síntese das evidências encontradas. A questão norteadora foi definida a partir do PICo. A população estudada foram os adultos, com interesse na atuação da equipe multiprofissional frente à parada cardiorrespiratória no setor de urgência e emergência. Dessa forma, questiona-se como é realizada a atuação da equipe multiprofissional frente à parada cardiorrespiratória?  Resultados e Discussão: A atuação da equipe multiprofissional frente à parada cardiorrespiratória é indispensável para reversão do quadro clínico do paciente, de modo que possibilite uma reanimação rápida e diminuição dos riscos de óbito. Destaca-se que durante a realização da manobra de reanimação, os profissionais sofrem desgaste físico e mental. Considerações Finais: A equipe multidisciplinar precisa ter conhecimento sobre a atuação de cada de acordo com a sua categoria e mantendo a sincronização nesses casos, permitindo que aja uma boa comunicação para eficácia das condutas referente a reanimação. Enfatiza-se a importância da sistematização no atendimento para divisão de funções e o momento certo de cada especialidade intervir