Distal Transradial Access in the Anatomical Snuffbox for Interventional Coronary Procedures: Analysis of Access Site Pain and Complications.

INTRODUCTION: A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures. METHODS: This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site. RESULTS: Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded. CONCLUSION: The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.

Distal transradial access in the anatomical snuffbox for interventional coronary procedures: analysis of access site pain and complications

INTRODUCTION: A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures. METHODS: This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site. RESULTS: Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded. CONCLUSION: The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.

Low-Load Resistance Training With Blood-Flow Restriction in Relation to Muscle Function, Mass, and Functionality in Women With Rheumatoid Arthritis.

OBJECTIVE: To evaluate the effects of a low-load resistance training program associated with partial blood-flow restriction in patients with rheumatoid arthritis (RA). METHODS: Forty-eight women with RA were randomized into 1 of 3 groups: high-load resistance training (HL-RT; 70% 1 repetition maximum [1RM]), low-load resistance training (30% 1RM) with partial blood-flow restriction training (BFRT), and a control group. Patients completed a 12-week supervised training program and were assessed for lower-extremity 1RM, quadriceps cross-sectional area (CSA), physical function (timed-stands test [TST], timed-up-and-go test [TUG], and Health Assessment Questionnaire [HAQ]), and quality of life (Short Form 36 health survey [SF-36]) at baseline and after the intervention. RESULTS: BFRT and HL-RT were similarly effective in increasing maximum dynamic strength in both leg press (22.8% and 24.2%, respectively; P < 0.0001 for all) and knee extension (19.7% and 23.8%, respectively; P < 0.0001 for all). Quadriceps CSA was also significantly increased in both BFRT and HL-RT (9.5% and 10.8%, respectively; P < 0.0001 for all). Comparable improvements in TST (11.2% and 14.7%; P < 0.0001 for all) and TUG (-6.8% [P < 0.0053] and -8.7% [P < 0.0001]) were also observed in BFRT and HL-RT, respectively. Improvements in both groups were significantly greater than those of the control group (P < 0.05 for all). SF-36 role physical and bodily pain and HAQ scores were improved only in BFRT (45.7%, 22.5%, and -55.9%, respectively; P < 0.05 for all). HL-RT resulted in 1 case of withdrawal and several cases of exercise-induced pain, which did not occur in BFRT. CONCLUSION: BFRT was effective in improving muscle strength, mass, function, and health-related quality of life in patients with RA, emerging as a viable therapeutic modality in RA management.

Managing the Aesthetic Patient

wide variety of therapeutic options, some challenges have arisen: designing an adequate treatment plan, electing the most suitable procedures for the patient, taking into consideration the rheological characteristics of the products, considering the amount needed to achieve a natural look, but also defining the safest way to deliver the treatment. Aging of the facial structural tissue layers occurs at a different pace and the requirements for the aesthetic approach of a 30-year-old patient are different from a 60-year-old patient. A group of twelve experts in minimally invasive injectable procedures sought to identify common changes observed in different age groups in order to help in establishing a plan of treatment for patients of different ages. The individualized aesthetic plan should consider the main pillars of the aesthetic treatment -- aging process, facial assessment, and facial anatomy, to identify and systematize common changes observed in different age groups, as well as the safest and most reproducible techniques, especially for new injectors. J Drugs Dermatol. 2019;18(1):92-102.

Degradation of Hylauronic Acid Fillers Using Hyaluronidase in an In Vivo Model.

INTRODUCTION: Soft tissue fillers manufactured with hyaluronic acid (HA) dominate the filler market around the world and the fact that HA can be dissolved using hyaluronidase contributes to its popularity. Degradation of cross-linked HA products can be performed in situ and access to hyaluronidase is therefore essential for health care professionals (HCP) to perform safe filler treatments. The aim of the present study was to develop an in vivo model where hyaluronidase degradation of HA fillers can be studied in a standardized manner and then secondly, to explore the degradation of marketed HA fillers with different product characteristics. METHODS: Intradermal injections of HA fillers were performed and the injection sites were treated with hyaluronidase. The degradation was evaluated by measuring the heights of the injection site bumps during 5-7 days and with histology at day 7 post injection. RESULTS: The results showed that there was a correlation between the hyaluronidase dose and HA filler degradation. The onset of the degradation was fast for all products and the products were easily degraded. DISCUSSION: This standardized animal model proved efficient in the study of in vivo degradation of HA fillers using injected hyaluronidase where products manufactured with different technologies were evaluated. J Drugs Dermatol. 2018;17(5):548-553.

Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis.

PURPOSE: Evaluate the effects of a low-intensity resistance training (LI-RT) program associated with partial blood flow restriction on selected clinical outcomes in patients with knee osteoarthritis (OA). METHODS: Forty-eight women with knee OA were randomized into one of the three groups: LI-RT (30% one repetition maximum [1-RM]) associated (blood flow restriction training [BFRT]) or not (LI-RT) with partial blood flow restriction, and high-intensity resistance training (HI-RT, 80% 1-RM). Patients underwent a 12-wk supervised training program and were assessed for lower-limb 1-RM, quadriceps cross-sectional area, functionality (timed-stands test and timed-up-and-go test), and disease-specific inventory (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) before (PRE) and after (POST) the protocol. RESULTS: Similar within-group increases were observed in leg press (26% and 33%, all P < 0.0001), knee extension 1-RM (23% and 22%; all P < 0.0001) and cross-sectional area (7% and 8%; all P < 0.0001) in BFRT and HI-RT, respectively, and these were significantly greater (all P < 0.05) than those of LI-RT. The BFRT and HI-RT showed comparable improvements in timed-stands test (7% and 14%, respectively), with the latter showing greater increases than LI-RT. Timed-up-and-go test scores were not significantly changed within or between groups. WOMAC physical function was improved in BFRT and HI-RT (-49% and -42%, respectively; all P < 0.05), and WOMAC pain was improved in BFRT and LI-RT (-45% and -39%, respectively; all P < 0.05). Four patients (of 16) were excluded due to exercise-induced knee pain in HI-RT. CONCLUSIONS: Blood flow restriction training and HI-RT were similarly effective in increasing muscle strength, quadriceps muscle mass, and functionality in knee OA patients. Importantly, BFRT was also able to improve pain while inducing less joint stress, emerging as a feasible and effective therapeutic adjuvant in OA management.

A new tool to improve delivery of patient-engaged care and satisfaction in facial treatments: the Aesthetic Global Ranking Scale.

BACKGROUND: Physicians face the challenge of individualizing aesthetic treatments in order to match the aesthetic needs of patients with their expectations. OBJECTIVE: To review issues underlying patient satisfaction with minimally invasive aesthetic treatment and to present a patient-centric assessment tool (the Global Ranking Scale [GRS]) designed to set higher standards for patient consultation and treatment experience; ensure a comprehensive patient-centric aesthetic consultation process; and raise patient satisfaction with facial rejuvenation treatment. METHODS: A review of the design and content of the GRS and its use as part of the wider Galderma Harmony Program. Results of a small survey of clinicians who have switched to the GRS, and case studies of patients who have used the tool, are also presented. RESULTS: The GRS is used in ~500 clinics around the world. In a small survey, physicians who have used the GRS report that it has changed the way that patients are assessed and treated. While no patient survey was conducted, anecdotal evidence suggests that patients are satisfied with the GRS procedure and the outcomes of treatment. CONCLUSIONS: The GRS is a new patient assessment tool that is designed as a guide for clinicians to help ensure consistency in the quality of patient assessment and consultation in their clinics offering minimally invasive facial cosmetic procedures. Qualitative research suggests that it gives patients a better chance to achieve results aligned with their needs resulting in a higher level of satisfaction with aesthetic treatments, but this needs to be confirmed in a formal patient survey.

Safety and feasibility of maximal physical testing in rheumatic diseases: a cross-sectional study with 5,910 assessments.

The purpose of the study was to report on the safety and feasibility of the application of maximal physical tests in a heterogeneous cohort of rheumatic patients. This is a 5-year retrospective descriptive report on the incidence of events associated with maximal physical testing from 536 patients, totalizing 5,910 tests. Tests were classified as cardiopulmonary, muscle strength, and physical functioning tests. Any adverse events during the tests and limiting factors incurring in tests cancellation were reported. Eighteen out of 641 cardiopulmonary exercise tests had an adverse occurrence, with cardiac disturbance (1.4% of total tests) being the most prevalent. Moreover, 14 out of 641 tests were not feasible. Out of 3,478 tests comprising leg press, bench press, knee extension, and handgrip tests, 15 tests had an adverse event. The most common occurrence was joint pain (0.4% of total tests), which was also the most frequent factor precluding testing (0.5% of total tests). Forty-five out of 3,478 (1.3%) of the tests were not feasible. There was a very low incidence of events (0.2%) during the physical functioning tests. Joint pain was the only adverse event during the tests, whereas physical limitations were the most important barriers for the execution of the tests (1.1% of total tests). The incidence of limiting events in this test was 1.6% (n = 29). This report brings new data on the safety and feasibility of maximal physical testing in rheumatic patients. The physical tests described in this study may be applied for testing rheumatic patients both in research and clinical setting.

Case for diagnosis

Descrição de um caso de paciente do sexo feminino, 26 anos de idade, parda, solteira, telefonista, natural do Rio de Janeiro, queixando-se de machucado na face, paciente negava trauma no local. Em relação a história patológica pregressa , familiar, social e epidemiológica, não existiam dados relevantes. Ao exame dermatológico, observou-se lesão crostosa, acastanhada, com halo eritematoso, na região infrapalperal esquerda

Conhecimento, atitudes e comportamentos frente ao risco ocupacional de exposiçäo ao HIV entre estudantes de Medicina da Faculdade de Medicina da Universidade Federal de Minas Gerais / Knowledge, attitudes and behavior in relation to occupational risk for HIV among medical students of the School of Medicine Universidade Federal de Minas Gerais

Os objetivos deste trabalho säo avaliar risco ocupacional de exposiçäo ao HIV entre estudantes de medicina, avaliar o conhecimento e o uso das medidas de biossegurança e a cobertura da vacinaçäo contra hepatite B. Questionário específico foi aplicado a 136 estudantes de medicina da Universidade Federal de Minas Gerais. A maioria da populaçäo avaliada, 87 (64 por cento estudantes relataram participar de procedimentos cirúrgicos, 68 (50 por cento) já sofreram algum tipo de exposiçäo a sangue, 90 (66,2 por cento) afirmaram conhecer as medidas universais de biossegurança e 33 (24,3 por cento) relataram conhecer os procedimentos em caso de exposiçäo a sangue contaminado. A populaçäo avaliada apresenta alto risco de exposiçäo a material biológico e cerca de um terço desta tem baixo nível de conhecimento das medidas de biossegurança, apesar de fazer uso delas. Torna-se necessário a utilizaçäo de estratégias como ensino formal, treinamento em serviço e criaçäo de serviçs especializados em biossegurança para a modificaçäo desta realidade