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1.
Salud Colect ; 20: e4779, 2024 Jun 25.
Artigo em Espanhol | MEDLINE | ID: mdl-39001847

RESUMO

We reconstruct the life path of the Argentine nurse and popular activist Irma Carrica, understood as a political-professional experience tied to her social networks and marked by conflicts and contradictions inherent to her historical context. From this analytical perspective and considering the precautions suggested by the biographical method of social sciences, we delve into the political and health debates of the 1960s and 1970s, particularly concerning disputes over the meaning of "community" in the health field. Specifically, we focus on the contributions of a collective historical actor - heterogeneous and plural, yet identifiable in its various forms - that we have termed the Peronist Left in health. By analyzing their professional and intellectual networks, we emphasize the role played by Irma Carrica as a representative of this Peronist Left in health, in constructing alternative dynamics for community health approaches, which challenged the dominant epistemological and pedagogical paradigms.


Reconstruimos la trayectoria de vida de la enfermera y militante popular argentina Irma Carrica, entendida como una experiencia político-profesional ligada a sus redes de sociabilidad y atravesada por conflictos y contradicciones inherentes a su contexto histórico. Desde ese recorte analítico y teniendo en cuenta los recaudos sugeridos por el método biográfico de las ciencias sociales, nos adentramos en los debates político-sanitarios de las décadas de 1960 y 1970, principalmente en lo relativo a las disputas por el sentido de la "comunidad" en el campo de la salud. En particular, nos enfocamos en las contribuciones de un actor histórico colectivo ­heterogéneo y plural, pero identificable en sus distintas modulaciones­ que hemos denominado izquierda peronista en salud. Al analizar sus redes profesionales e intelectuales, hicimos hincapié en el rol que desempeñó Irma Carrica como referente de esa izquierda peronista en salud, a la hora de construir dinámicas alternativas para el abordaje comunitario en salud, que pusieron en tela de juicio los paradigmas epistemológicos y pedagógicos dominantes.


Assuntos
Política , Argentina , História do Século XX , Humanos , História da Enfermagem
2.
Port J Card Thorac Vasc Surg ; 31(1): 29-32, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38743517

RESUMO

INTRODUCTION: Ankle-Brachial Index (ABI) is a well-established diagnostic tool for evaluating peripheral arterial disease (PAD). Limitations in its application led to the development of alternative diagnostic methods, including Toe-Brachial Index (TBI) and Transcutaneous Pressure of Oxygen (TcPO2), yet these are not as widely available as ABI. Recently, Pedal Acceleration Time (PAT), has gained popularity as a new tool to assess PAD, requiring only an ultrasound. This study seeks to further establish the correlation between ABI and PAT, determining whether PAT can be a reliable alternative for diagnosing and assessing the severity of PAD. METHODS: ABI and PAT were measured in patients attending our consult with no history of vascular or endovascular surgery. Limbs with unmeasurable ABI were excluded. Patients were categorized into groups based on their PAD stage according to the Fontaine classification. Patient demographics, comorbidities and respective ABI and PAT were analysed. RESULTS: Sixty-nine patients (114 limbs) were included in the study. Mean age 68 ± 11.7 years, 78.3% male and 33.3% diabetic patients. Fifty-three claudicant limbs (46.5%) and 26 limbs (22.8%) with chronic limb threatening ischemia. Pearson correlation coefficient between ABI and PAT, showed a strong negative correlation (r= -0.78; p<0.01). Mean ABI and PAT for limbs in Fontaine stage I were 0.94 ± 0.17 and 82.0 ± 27.4 ms; Fontaine stage IIa 0.69 ± 0.21 and 141.3 ± 57.8 ms; Fontaine stage IIb 0.54 ± 0.14 and 173.4 ± 65.1 ms; Fontaine stage III 0.43 ± 0.15 and 216 ± 33.2 ms; Fontaine stage IV 0.49 ± 0.17 and 206.7 ± 78.1 ms, respectively. CONCLUSION: Our study suggests an inverse correlation between ABI and PAT, in accordance with the findings published in the literature, thus supporting the use of PAT as an easily reproducible and efficient alternative to ABI for evaluating the severity of PAD.


Assuntos
Índice Tornozelo-Braço , Doença Arterial Periférica , Humanos , Masculino , Doença Arterial Periférica/fisiopatologia , Doença Arterial Periférica/diagnóstico , Índice Tornozelo-Braço/métodos , Feminino , Idoso , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Pé/irrigação sanguínea , Idoso de 80 Anos ou mais , Aceleração , Reprodutibilidade dos Testes
3.
Vascular ; : 17085381241236575, 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38391289

RESUMO

INTRODUCTION: Thoracic aortic aneurysms (TAAs) are an increasingly prevalent pathology with significant associated morbidity and mortality. Thoracic endovascular aortic repair (TEVAR) is the primary line of treatment. The purpose of this study was to analyse a single center's experience in the treatment of TAAs and identify possible risk factors for worse outcomes. METHODS: A retrospective review of our institutional database was done to identify all patients treated for TAAs in a 10-year period, from 1 January 2012 to 31 December 2022. Data were extracted from patients' medical records. Primary outcome was all-cause mortality and secondary outcomes were procedure related morbidity (vascular access complications, medullary ischaemia, stroke, endoleaks, migration, aneurysm sac enlargement >5 mm) and need for reintervention at 1-, 6- and 12-month follow-up. A descriptive and inferential analysis of the data was performed. Statistical analyses were conducted using the IBM Statistical Package for Social Sciences (SPSS) software. RESULTS: We identified 34 patients treated for TAAs in this period. Mean age was 68 years [47-87] and 79.4% of patients were male. Mean aneurysm diameter was 63 mm [35-100], 55.9% fusiform and 44.1% saccular. The majority (91.2%) were located at the descending thoracic aorta and 3 (8.8%) of them extended to the aortic arch. The most common aetiology was degenerative in 22 patients (64.7%), followed by aortic dissection in 8 patients (23.5%). Elective surgery was performed in 19 (61.3%) patients and 12 (38.7%) had urgent repair. TEVAR was the treatment of choice in 24 (77.4%) patients, and the remaining 7 (22.6%) were treated with hybrid surgery. Mean length of hospital stay was 10 days [2-80] (6 days for elective repair versus 16 days for urgent repair, p = .016). Follow-up period ranged from 1 month to 10 years. At 1 year follow-up, all-cause mortality was 15%, morbidity was 30% (with 6 (22%) patients having a type Ia endoleak) and need for reintervention was 22%. Aneurysm diameter was a significant risk factor for procedure related morbidity (median diameter of 73.5 mm versus 56.0 mm in patients with no morbidity; p = .027). The presence of type Ia endoleak was significantly associated with higher reintervention rates (p = .001), but not with higher mortality rates (p = .515). Age, female sex, aetiology and urgent repair weren't associated with any significant differences in the outcomes. CONCLUSIONS: TEVAR proved to be effective in the treatment of TAAs, with good outcomes at short and mid-term follow-up. TAAs should be diagnosed earlier and be promptly treated when meeting criteria to prevent worse outcomes.

4.
Ann Vasc Surg ; 98: 374-387, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37454898

RESUMO

BACKGROUND: Coral reef aorta (CRA) is defined by the presence of heavily calcified exophytic plaques that protrude into the aortic lumen. However, the exact causes and development of this condition are still not fully understood. When the aortic branches are affected, it can result in various symptoms. Despite ongoing research, there is currently no established consensus on the best treatment for CRA. This review aims to examine the latest findings regarding the clinical presentation and approach to treating patients with CRA. METHODS: We conducted a systematic electronic search of the literature using the PubMed and Embase databases. Throughout the search, we adhered to the guidelines outlined in the PRISMA framework. From the identified publications, we extracted information pertaining to patients' characteristics, symptoms, and types of treatment from a total of 124 cases reported over the past 20 years. The primary focus of our analysis was to assess the improvement of signs and symptoms, as well as to evaluate any postoperative complications. To achieve this, we performed both descriptive and inferential analyses on the collected data. Additionally, we conducted subgroup analyses based on treatment types and symptoms observed at presentation, presenting the findings in the form of odds ratios (ORs). RESULTS: After removing duplicate articles, we carefully screened the titles of 67 retrieved articles and excluded those that did not align with the purpose of our study. Subsequently, we thoroughly analyzed the remaining 41 articles along with their references, ultimately including 29 studies that were deemed most relevant for our systematic review. We examined a total of 124 cases of patients diagnosed with CRA, comprising 77 (62.1%) females and 48 (38.7%) males, with a mean age of 59 years (range: 37-84). The predominant signs and symptoms observed were intermittent claudication, reported in 57 (46.0%) patients, followed by refractory hypertension in 45 (36.3%) patients, intestinal angina in 28 (22.6%) patients, and renal insufficiency in 15 (12.1%) patients. Among the treated patients, 110 (88.7%) underwent open surgery repair (OSR), 11 (8.9%) received endovascular treatment, and 3 (2.4%) underwent laparoscopy. Postoperatively, a significant number of patients experienced substantial relief or complete resolution of their symptoms, as well as improved control of hypertension and renal function. In the group of patients treated with OSR, the inhospital stay mortality rate was 10.9%, the morbidity rate was 28.2%, and the reintervention rate was 15.5%. The high mortality rate during hospital stays in this group may be associated with such invasive procedures performed on patients who have substantial cardiovascular burden and multiple comorbidities. Conversely, no postoperative complications were reported in the group of patients treated with endovascular procedures or laparoscopic surgery. CONCLUSIONS: While coral reef aorta (CRA) is considered a rare condition, it is crucial for the medical community to remain vigilant about its diagnosis, particularly in patients presenting with symptoms such as intermittent claudication, refractory hypertension, renal impairment, or intestinal angina. Based on the findings of this review, both OSR and endovascular treatment have shown promise as viable therapeutic options. Although endovascular therapies may not always be feasible or may have reduced durability in these calcified bulky lesions, they should be considered in patients with multiple comorbidities, due to the high postoperative mortality rates associated with more invasive approaches. Additionally, these endoluminal procedures have demonstrated good patency rates during the 18-month follow-up period. It is essential to emphasize that the treatment strategy should be determined on a case-by-case basis, involving a multidisciplinary team to tailor it to the specific needs of each individual patient.


Assuntos
Hipertensão , Insuficiência Renal , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Claudicação Intermitente , Recifes de Corais , Resultado do Tratamento , Aorta/diagnóstico por imagem , Aorta/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Isquemia/cirurgia
6.
Ann Vasc Surg ; 96: 125-131, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37088360

RESUMO

BACKGROUND: Approximately 1.4 million strokes/year causing about 1.1 million deaths annually occur in Europe and 10%-15% of those strokes are result of thromboembolism from a previously significant asymptomatic carotid stenosis (ACS). Medical treatment has improved considerably in the last 15 years; however, its success depends on patient compliance. The aim of our study was to evaluate, in patients with ACS, the implementation and patient adherence to best medical treatment (BMT). Additionally, we sought to determine the "real-world" incidence of cerebrovascular/coronary events in a cohort of nonoperated ACS patients and weighing this risk against surgical complications in patients with ACS undergoing surgical treatment at our Department. METHODS: Patients with ACS ≥ 60% identified by a carotid ultrasound performed at our Department were retrospectively evaluated. Patients selected to BMT were excluded if the follow-up period was inferior to 2 years, as well as patients lost in follow-up, with missing clinical information and submitted to carotid stenting. Patients' data collection was supported by hospital reporting system and data were introduced into a database created for the purpose. Statistical analysis was performed using SPSS-25 software. RESULTS: After exclusion criteria were applied, the last 120 consecutive patients (60 with ACS submitted do carotid endarterectomy and 60 with ACS under BMT) were retrospectively evaluated. Twenty one patients had ipsilateral events for more than 6 months. Most patients had hypertension (n = 107; 89%), dyslipidemia (n = 101; 84%), 40% had diabetes, 33% diagnosed coronary disease, 32% were overweight or obese, and 17% were current smokers. Blood pressure control, normal weight, statin with/without ezetimibe association, and antiaggregant therapy were only achieved in 33 patients and only 5 had additionally low-density lipoprotein levels < 70 mg/dL, hemoglobin A1c < 7%, and were nonsmokers. Of the 60 patients assigned to medical treatment, 3 (5%) had a stroke at 2 years of follow-up, which was fatal in 1 patient. Among patients submitted to carotid endarterectomy, perioperative stroke was documented in 3% of the patients, none of them disabling or fatal. CONCLUSIONS: Although some recent studies report a risk of ipsilateral stroke of only 0.34% per year in patients with ACS ≥ 50% under BMT therapy in our everyday practice strict compliance to medical treatment fails in most patients. In consequence, we think that a "one-size-fits-all" guideline policy may not be appropriate for all patients and the management of specific ACS patients may need to be individualized.


Assuntos
Estenose das Carótidas , Endarterectomia das Carótidas , Humanos , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/terapia , Estudos Retrospectivos , Resultado do Tratamento , Endarterectomia das Carótidas/efeitos adversos , Pressão Sanguínea
7.
Multimed Tools Appl ; 82(8): 11619-11661, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36035324

RESUMO

One of the main challenges in CBIR systems is to choose discriminative and compact features, among dozens, to represent the images under comparison. Over the years, a great effort has been made to combine multiple features, mainly using early, late, and hierarchical fusion techniques. Unveiling the perfect combination of features is highly domain-specific and dependent on the type of image. Thus, the process of designing a CBIR system for new datasets or domains involves a huge experimentation overhead, leading to multiple fine-tuned CBIR systems. It would be desirable to dynamically find the best combination of CBIR systems without needing to go through such extensive experimentation and without requiring previous domain knowledge. In this paper, we propose ExpertosLF, a model-agnostic interpretable late fusion technique based on online learning with expert advice, which dynamically combines CBIR systems without knowing a priori which ones are the best for a given domain. At each query, ExpertosLF takes advantage of user's feedback to determine each CBIR contribution in the ensemble for the following queries. ExpertosLF produces an interpretable ensemble that is independent of the dataset and domain. Moreover, ExpertosLF is designed to be modular, and scalable. Experiments on 13 benchmark datasets from the Biomedical, Real, and Sketch domains revealed that: (i) ExpertosLF surpasses the performance of state of the art late-fusion techniques; (ii) it successfully and quickly converges to the performance of the best CBIR sets across domains without any previous domain knowledge (in most cases, fewer than 25 queries need to receive human feedback).

8.
Ann Vasc Surg ; 88: 199-209, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36116744

RESUMO

BACKGROUND: A retrospective analysis of neck hematoma, stroke, and mortality after symptomatic and asymptomatic carotid endarterectomy (CEA) was conducted, to determine the most appropriate perioperative medication for these patients. Thirty-day outcomes of moderate and severe neck bleeding were also investigated. METHODS: Patients undergoing CEA in a Vascular Surgery department were analyzed (2015-2019). Preprocedure antithrombotic medication (from the 5 days prior to surgery) was identified. End point predictors were identified by univariate and multivariable analyses and adjusted for confounders. RESULTS: A total of 304 CEA were included. Almost half of the included patients (49.67%) were under low-dose aspirin, 17.55% other single antiplatelet agent, 12.59% dual antiplatelet therapy, 8.61% anticoagulation, and 10.92% no antithrombotic therapy. There was a 8.22% rate of important hematoma, including 4.93% severe (requiring surgical exploration) hematomas and a 30-day all-stroke incidence of 2.94% in symptomatic and 1.79% asymptomatic patients (P = 0.51). When compared to aspirin, severe hematoma was more prevalent with single clopidogrel or triflusal (relative risk [RR] 4.25, P = 0.11), dual antiplatelet group (RR 11.84, P = 0.002), and anticoagulation (RR 8.604, P = 0.02). Dual antiaggregation and anticoagulation did not confer postoperative stroke protection compared to single aspirin in either symptomatic or asymptomatic patients. Nonsignificant higher intrahospital mortality was noted in no medication, dual antiplatelet, and anticoagulation groups in contrast to aspirin. Severe neck bleeding was associated with increased congestive heart failure (9.26-fold, P = 0.03) and longer hospital stay (11.20 ± 24.69 days vs. 3.18 ± 4.79 with no bleeding, P < 0.001), with a tendency for higher hospital readmission at 30 days (4.66-fold, P = 0.13). Mortality and stroke rates were similar. CONCLUSIONS: Double antiaggregation and anticoagulation did not confer better perioperative outcomes after elective CEA in our study. These regimens were associated with an increased risk of neck hematoma, especially severe bleeding, with similar rates of neurologic events in both symptomatic and asymptomatic patients and no mortality benefit. Monotherapy with aspirin appears to be the safest perioperative antithrombotic regimen for elective CEA.


Assuntos
Endarterectomia das Carótidas , Acidente Vascular Cerebral , Humanos , Endarterectomia das Carótidas/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Fatores de Tempo , Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Hemorragia/etiologia , Hematoma/etiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle
9.
Proc Natl Acad Sci U S A ; 119(42): e2121105119, 2022 10 18.
Artigo em Inglês | MEDLINE | ID: mdl-36215474

RESUMO

Among mammals, the order Primates is exceptional in having a high taxonomic richness in which the taxa are arboreal, semiterrestrial, or terrestrial. Although habitual terrestriality is pervasive among the apes and African and Asian monkeys (catarrhines), it is largely absent among monkeys of the Americas (platyrrhines), as well as galagos, lemurs, and lorises (strepsirrhines), which are mostly arboreal. Numerous ecological drivers and species-specific factors are suggested to set the conditions for an evolutionary shift from arboreality to terrestriality, and current environmental conditions may provide analogous scenarios to those transitional periods. Therefore, we investigated predominantly arboreal, diurnal primate genera from the Americas and Madagascar that lack fully terrestrial taxa, to determine whether ecological drivers (habitat canopy cover, predation risk, maximum temperature, precipitation, primate species richness, human population density, and distance to roads) or species-specific traits (body mass, group size, and degree of frugivory) associate with increased terrestriality. We collated 150,961 observation hours across 2,227 months from 47 species at 20 sites in Madagascar and 48 sites in the Americas. Multiple factors were associated with ground use in these otherwise arboreal species, including increased temperature, a decrease in canopy cover, a dietary shift away from frugivory, and larger group size. These factors mostly explain intraspecific differences in terrestriality. As humanity modifies habitats and causes climate change, our results suggest that species already inhabiting hot, sparsely canopied sites, and exhibiting more generalized diets, are more likely to shift toward greater ground use.


Assuntos
Evolução Biológica , Primatas , América , Animais , Cercopithecidae , Haplorrinos , Humanos , Madagáscar , Mamíferos , Árvores
10.
Sci Rep ; 12(1): 14364, 2022 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-35999220

RESUMO

Primates are very selective in the foods they include in their diets with foraging strategies that respond to spatial and temporal changes in resource availability, distribution and quality. Colombian woolly monkeys (Lagothrix lagotricha lugens), one of the largest primate species in the Americas, feed mainly on fruits, but they also eat a high percentage of arthropods. This differs from closely related Atelid species that supplement their diet with leaves. In an 11 month study, we investigated the foraging strategies of this endemic monkey and assessed how resource availability affects dietary selection. Using behavioural, phenological, arthropod sampling and metabarcoding methods, we recorded respectively foraging time, forest productivity, arthropod availability in the forest and arthropod consumption. Scat samples and capturing canopy substrates (i.e. moss, bromeliads, aerial insects) were used for assigning arthropod taxonomy. The most important resource in the diet was fruits (54%), followed by arthropods (28%). Resource availability predicted feeding time for arthropods but not for fruits. Further, there was a positive relationship between feeding time on fruits and arthropods, suggesting that eating both resources during the same periods might work as an optimal strategy to maximize nutrient intake. Woolly monkeys preferred and avoided some fruit and arthropod items available in their home range, choosing a wide variety of arthropods. Geometrid moths (Lepidoptera) were the most important and consistent insects eaten over time. We found no differences in the type of arthropods adults and juveniles ate, but adults invested more time foraging for this resource, especially in moss. Although woolly monkeys are generalist foragers, they do not select their food items randomly or opportunistically.


Assuntos
Artrópodes , Atelinae , Animais , Colômbia , Dieta , Comportamento Alimentar , Frutas , Insetos
11.
Port J Card Thorac Vasc Surg ; 28(4): 73, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-35334167

RESUMO

A 85 year-old, female patient, with an active colon neoplasm, was diagnosed with extensive ilio-femoro-popliteal deep vein thrombosis. She presented with severe oedema of the left lower limb and a cyanotic foot. Pedal pulses were palpable. Despite immediate anticoagulation, the patient expired at 72h.


Assuntos
Gangrena , Veias , Idoso de 80 Anos ou mais , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea
12.
Ann Vasc Surg ; 85: 253-261, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35339602

RESUMO

BACKGROUND: Chronic post-thrombotic syndrome (PTS) may develop in up to 50% of patients after deep vein thrombosis (DVT), and may reduce patients' quality of life (QoL). We aimed to evaluate the association of PTS severity with QoL in patients with proximal DVT submitted for medical treatment and also to identify modifiable and non-modifiable risk factors related to PTS. METHODS: Patients with iliac or femoropopliteal DVT observed in Vascular Surgery consultation in our institution from 1 year period with unilateral DVT were selected. Patients with total vein recanalization were excluded. Villalta scale was applied to assess PTS degree and VEINES-QoL/Sym questionnaire was used as a disease-specific QoL measure. Correlation between PTS degree and VEINES-QoL/Sym score and predictors of PTS were determined. RESULTS: Fifty-six patients were accepted to enter the study. From those, 66.1% were female, 64.3% (n = 36) had iliac and 35.7% (n = 20) femoropopliteal DVT. PTS was present in 52.8% of iliac and 65.0% of femoropopliteal DVT patients observed for consultation (P = 0.41). There was a significant correlation with PTS degree and both VEINES-QoL and VEINES-Sym scores (P < 0.01). Major depression (odds ratio OR = 5.63, P = 0.04) and regular wear of compressing stockings (OR = 4.69, P = 0.04) were the only independent factors associated with PTS. Patients with depression had lower QoL scores, while patients with PTS who wear compression stockings had similar QoL scores compared to patients without PTS. Ultrasound alterations (OR = 3.28, P = 0.17), age, gender, iliac DVT, multiple DVT and time after DVT (P > 0.20) were not associated with PTS syndrome. CONCLUSIONS: VEINES-QoL/Sym had moderate inverse correlation with PTS degree. Depression was associated with both PTS and lower QoL scores. Patients with PTS criteria compliant to wearing compressing stockings had similar QoL scores to patients without PTS.


Assuntos
Síndrome Pós-Trombótica , Trombose Venosa , Feminino , Humanos , Masculino , Síndrome Pós-Trombótica/etiologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Trombose Venosa/diagnóstico , Trombose Venosa/diagnóstico por imagem
13.
Vascular ; 30(1): 176-180, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33761809

RESUMO

BACKGROUND/OBJECTIVE: Temporary intravascular shunts are widely used in military surgery, representing a bridging until definitive vascular reconstruction. In civilian practice, shunts are mainly used as damage control and as a temporary measure until orthopaedic fixation. The objective of this report is to illustrate a new approach to the temporary restoration of perfusion during open management of extremity arterial injury. METHODS: The authors present a technique that uses sheaths introducers, instead of commercial or purpose-built shunts, which can be used through surgical or percutaneous approaches. Three clinical cases are presented where this technique was performed.Results/Conclusion: In the presented cases, this technique reduced time of shunt construction by avoiding artery surgical approach. This technique can facilitate the creation of an intravascular shunt among other than vascular surgeons.


Assuntos
Lesões do Sistema Vascular , Extremidades/irrigação sanguínea , Humanos , Estudos Retrospectivos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia
14.
J Med Cases ; 12(9): 377-379, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34527110

RESUMO

Abdominal aortic aneurysms (AAAs) secondary to Coxiella burnetii infections are rare but carry important implications. The diagnosis is difficult due to unspecific symptoms. To the authors' knowledge, this is the first AAA caused by chronic Q fever treated with an endoprosthesis.

15.
Sensors (Basel) ; 21(10)2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34068895

RESUMO

Recognition of emotions from physiological signals, and in particular from electroencephalography (EEG), is a field within affective computing gaining increasing relevance. Although researchers have used these signals to recognize emotions, most of them only identify a limited set of emotional states (e.g., happiness, sadness, anger, etc.) and have not attempted to predict exact values for valence and arousal, which would provide a wider range of emotional states. This paper describes our proposed model for predicting the exact values of valence and arousal in a subject-independent scenario. To create it, we studied the best features, brain waves, and machine learning models that are currently in use for emotion classification. This systematic analysis revealed that the best prediction model uses a KNN regressor (K = 1) with Manhattan distance, features from the alpha, beta and gamma bands, and the differential asymmetry from the alpha band. Results, using the DEAP, AMIGOS and DREAMER datasets, show that our model can predict valence and arousal values with a low error (MAE < 0.06, RMSE < 0.16) and a strong correlation between predicted and expected values (PCC > 0.80), and can identify four emotional classes with an accuracy of 84.4%. The findings of this work show that the features, brain waves and machine learning models, typically used in emotion classification tasks, can be used in more challenging situations, such as the prediction of exact values for valence and arousal.


Assuntos
Nível de Alerta , Ondas Encefálicas , Eletroencefalografia , Emoções , Aprendizado de Máquina
16.
Ann Vasc Surg ; 76: 417-425, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33951526

RESUMO

INTRODUCTION: Charlson Comorbidity Index (CCI) is commonly used in outcome studies to adjust for patient comorbid conditions but has not been specifically validated for use in acute embolic lower limb ischaemia (AELLI). OBJECTIVES: The aim of this study was to access whether a high CCI score unadjusted (CCIu) and adjusted (CCIa) by age relates to major amputation and mortality after a first episode of AELLI. METHODS: The last 100 patients presenting with the first event of AELLI submitted to embolectomy at our Vascular Surgery Department were retrospectively evaluated. Patient characteristics, pre- and post-operative period variables were collected and CCIu and CCIa calculated. Survival predictors were analyzed using Cox regression. The area under the curve of the receiver operating characteristic curves was calculated to validate and determine the discriminating ability of CCIu and CCIa in predicting amputation rate and 30-day mortality. Youden index was used to determine the critical value. Survival analysis was performed with Kaplan-Meier method and differences between survival curves were tested with Log-Rank test. A P value of <0.05 was considered statistically significant. RESULTS: The mean age was 80.03±10.776 years and the mean follow-up 19.28±7.929 months. Amputation rate was 16%, 30-day mortality 21% and long-term mortality 42%. Patients with CCIu≥3 compared with patients with CCIu<3 had higher amputation rate (37.5% vs. 1.7%; OR:35.400), 30-day mortality (47.5% vs. 3.3%; OR:35.400) and global mortality (P=0.00). Also, patients with CCIa≥6 compared with patients with CCIa<6 had higher amputation rate (34.1% vs. 1.8%; OR:28.488), 30-day mortality (47.7% vs. 0.0%) and global mortality (P=0.00). Multivariate analysis showed that both CCIu and CCIa were independent predictors of amputation rate and 30-day mortality. CONCLUSION: CCIu and CCIa have proven to be good predictors of amputation rate and survival, thus being a valuable prognostic factor in patients presenting with the first event of AELLI.


Assuntos
Técnicas de Apoio para a Decisão , Embolia/diagnóstico , Isquemia/diagnóstico , Extremidade Inferior/irrigação sanguínea , Idoso , Idoso de 80 Anos ou mais , Amputação Cirúrgica , Tomada de Decisão Clínica , Comorbidade , Embolectomia , Embolia/mortalidade , Embolia/cirurgia , Feminino , Humanos , Isquemia/mortalidade , Isquemia/cirurgia , Salvamento de Membro , Masculino , Portugal , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Interact Cardiovasc Thorac Surg ; 33(5): 829-831, 2021 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-34027554

RESUMO

Isolated innominate artery trauma after blunt thoracic contusion is rare and occurs mostly at its origin. We report a case of a post-traumatic distal innominate artery pseudoaneurysm presenting with Horner's syndrome treated by conventional surgical approach.


Assuntos
Falso Aneurisma , Síndrome de Horner , Traumatismos Torácicos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Tronco Braquiocefálico/diagnóstico por imagem , Tronco Braquiocefálico/cirurgia , Síndrome de Horner/etiologia , Humanos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/cirurgia
18.
Ann Vasc Surg ; 72: 479-487, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32949746

RESUMO

BACKGROUND: Sarcopenia has assumed growing relevance as a morbimortality predictor after major abdominal surgery. The aim of this study is to access total psoas muscle area (TPA) and lean muscle area (LMA) impact in morbimortality after elective endovascular abdominal aortic aneurysm repair (EVAR). METHODS: Asymptomatic patients submitted to aortic endoprosthesis implantation between January 1, 2014 and December 31, 2018 at our vascular surgery department were retrospectively evaluated. After exclusion criteria were applied, 105 patients were included in the study; preoperative computed tomography scans were evaluated using OSIRIX software (Bernex, Switzerland). Two observers independently calculated TPA at the most caudal level of the L3 vertebra and respective density, therefore calculating LMA. Patients were separated by tertiles with the lowest being considered sarcopenic and with higher muscle steatosis and compared with the higher tertiles. Patient demographics and intraoperative and postoperative period variables were collected. Charlson comorbidity index was calculated and surgical complications classified according to Clavien-Dindo. The intraclass correlation coefficient and Bland-Altman plot were made to characterize interobserver variability. Survival analysis was performed with the Kaplan-Meier method, and differences between survival curves were tested with the log-rank test. The effect of sarcopenia on patient survival was assessed using Cox proportional hazard models. RESULTS: Considering TPA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.03), whereas multivariate analyses showed increased likelihood of mortality (P = 0.039, hazard ratio (HR) 3.829). For LMA, univariate analyses revealed that patients in the lower tertile had inferior survival (P = 0.013), whereas multivariate analyses showed increased likelihood of mortality (P = 0.026, HR 4.153). When analyzing patients in the lowest tertile of both TPA and LMA, both univariate (P = 0.002) and multivariate (P = 0.018, HR 4.166) analyses reveled inferior survival. CONCLUSIONS: Our study reveals reduced survival in patients with low TPA and low LMA submitted to elective EVAR; these factors should probably be taken into consideration in the future for preoperative risk evaluation and surgical planning.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Fragilidade/diagnóstico por imagem , Músculos Psoas/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Composição Corporal , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Idoso Fragilizado , Fragilidade/mortalidade , Fragilidade/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/mortalidade , Músculos Psoas/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Sarcopenia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
Ann Vasc Surg ; 69: 100-104, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32791192

RESUMO

BACKGROUND: On March 2020, the World Health Organization declared the coronavirus disease 2019 outbreak a pandemic. During this period, surgical activity and admission to the Emergency Department (ED) decreased globally. The aim of this article is to understand how the admission of a patient to the ED for vascular surgery changed in our center in Portugal and if this situation prevented urgent surgical procedures. METHODS: Through a retrospective study, we compared the volume of patients admitted to the ED during the emergency state (ES) in Portugal with the same period in 2019. In addition, we analyzed the urgent surgical activity during the ES and in the correspondent period of the previous 10 years, regarding limb acute ischemia, acute aortic pathology, and vascular trauma. Two groups of patients were formed-patients operated during the ES and during the non-ES, for control. Statistical analysis was performed using IBM SPSS® Statistics, version 25. RESULTS: In the ES, 115 patients were observed at the ED and 179 in the 2019 corresponding period. During the ES, patients significantly recurred less to the ED directly from home (P < 0.001) and were less referred to the ED by primary care doctors (P < 0.001). Patients observed at the ED were significantly more urgent-required urgent surgery or were admitted to the department-than those in 2019 (40% vs. 24%). However, there were no differences when only considering urgent surgery (14% in ES vs. 10% in 2019). In the ES, 38% of patients observed at the ED were discharged with no follow-up related to vascular surgery against 60% in 2019, although this difference was not significant. Compared with the preceding 10 years, there are not significant differences in the number of patients who underwent urgent surgery in both ES and non-ES periods. In patients with acute limb ischemia, we did not find an increase in the time between onset of symptoms and ED admission, during the ES. CONCLUSIONS: Fewer patients were admitted at the ED during the ES, and those admitted were significantly more urgent. We did not find a decrease in the number of urgent surgeries when compared with the preceding 10 years. Therefore, we cannot assume that coronavirus pandemic precluded urgent surgical procedures.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Vasculares , Idoso , Betacoronavirus , COVID-19 , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pandemias , Portugal/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
20.
J Vasc Access ; 21(6): 1023-1028, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32340550

RESUMO

INTRODUCTION: Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant. PATIENTS AND METHODS: Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment. RESULTS: Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months. CONCLUSION: Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.


Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/terapia , Extremidade Superior/irrigação sanguínea , Doenças Vasculares/cirurgia , Idoso , Velocidade do Fluxo Sanguíneo , Implante de Prótese Vascular/efeitos adversos , Constrição Patológica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia , Grau de Desobstrução Vascular
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