Cardiopulmonary resuscitation in prone position and COVID-19 / Reanimación cardiopulmonar en decúbito prono y COVID-19

Patients with severe COVID-19 infection frequently require to be in prone position. 1 Furthermore, these patients with mechanical ventilation need additional vasopressor support (95.4 % vs. 1.5 %) and exhibit a higher risk of developing atrial arrhythmias (17.7 % vs. 1.9 %). 2 A study conducted in Wuhan, China, reported that 17.9 % of the patients experienced intrahospital cardiac arrest; the arrest rhythms were asystole (89.7 %), pulseless electrical activity (4.4 %) and defibrillatable rhythms (5.9 %). 3 In order to reduce the hemodynamic effects secondary to changes in position 4 cardiopulmonary resuscitation (CPR) maneuvers in prone position are recommended (inverted CPR) 5; this technique was described in 1989 by McNeil, and has proven to be successful 6,7 doing the inverse precordial compressions at the usual rate and amplitude. 8 86 % of the patients have the largest left ventricular area localized between 0 and 2 vertebral segments below the line that crosses the two inferior angles of the scapulae. In this location, the maneuver may be done as shown in Figure 1

Los pacientes con infección grave por COVID-19 requieren con frecuencia estar en posición prona. 1 Además, estos pacientes con ventilación mecánica necesitan apoyo vasopresor adicional (95,4 % frente a 1,5 %) y presentan un mayor riesgo de desarrollar arritmias auriculares (17,7 % frente a 1,9 %). 2 Un estudio realizado en Wuhan, China, informó de que el 17,9% de los pacientes experimentaron una parada cardiaca intrahospitalaria; los ritmos de parada fueron asistolia (89,7%), actividad eléctrica sin pulso (4,4%) y ritmos desfibrilables (5,9%). 3 Para reducir los efectos hemodinámicos secundarios a los cambios de posición 4 se recomiendan las maniobras de reanimación cardiopulmonar (RCP) en decúbito prono (RCP invertida) 5; esta técnica fue descrita en 1989 por McNeil, y ha demostrado ser exitosa 6,7 realizando las compresiones precordiales inversas a la frecuencia y amplitud habituales. 8 El 86% de los pacientes tienen la mayor área ventricular izquierda localizada entre 0 y 2 segmentos vertebrales por debajo de la línea que cruza los dos ángulos inferiores de las escápulas. En esta localización, la maniobra puede realizarse como se muestra en la figura 1

Reporte de dos casos de trauma vascular / Two Parallel Case Reports of Vascular Trauma

Los traumas vasculares periféricos poseen una frecuencia elevada en relación con las lesiones vasculares y conllevan a una incapacidad significativa a pacientes relativamente jóvenes. La identificación oportuna y el manejo inicial adecuado de este tipo de lesión son muy importantes para su posterior evolución. Este artículo tuvo como objetivo exponer la importancia del tratamiento oportuno del trauma vascular en dos pacientes llegados el mismo día al servicio de urgencias del Hospital Militar Central "Dr. Luis Díaz Soto". Se presenta como primer caso a un paciente masculino de 44 años de edad, con antecedentes de salud aparente. Sufrió una herida de aproximadamente 12 cm en el brazo izquierdo, que se acompañó de sangramiento e hipotensión arterial. Se le colocó injerto protésico y se le realizó anastomosis término-terminal en la arteria humeral porque presentaba sección completa de esta; su evolución fue favorable. El segundo caso se trata de un paciente masculino de 60 años de edad, con antecedentes de salud aparente. Sufrió un trauma en el antebrazo izquierdo que le provocó una herida de alrededor de 8 cm, con sangramiento, palidez y frialdad del tercio distal del antebrazo, cianosis reversible de la mano, impotencia funcional, ausencia de pulso radial e hipotensión arterial. Se le realizó anastomosis término-terminal de arteria radial porque presentaba sección completa de esta y su evolución resultó favorable. El tratamiento oportuno y acertado del trauma vascular evitó la pérdida de la vida de los pacientes, disminuyó la presencia de complicaciones, aseguró una evolución rápida y redujo incapacidades en estos(AU)

Peripheral vascular traumas have a high frequency in relation to vascular lesions, and lead to significant disability in relatively young patients. Timely identification and adequate initial management of this type of lesion are very important for its subsequent evolution. This article aimed to show the importance of timely treatment of vascular trauma in two patients who arrived on the same day at the emergency service of Dr. Luis Díaz Soto Central Military Hospital. The first case presented corresponds to a 44-year-old male patient apparently without previous heath conditions. He had a wound of approximately twelve centimeters on the left arm, which was accompanied by bleeding and arterial hypotension. The patient was placed a prosthetic graft and performed an end-to-end anastomosis in the brachial artery because it was completely sectioned. The patient's evolution was favorable. The second case corresponds to a 60-year-old male patient with an apparent health history. He suffered a trauma to his left forearm that caused a wound of about 8 cm, with bleeding, paleness and coldness of the distal third of the forearm, reversible cyanosis of the hand, functional impotence, absence of radial pulse and arterial hypotension. End-to-end anastomosis of the radial artery was performed because the patient presented complete section of the artery and his evolution was favorable. Timely and correct treatment of vascular trauma prevented the loss of life in both patients, reduced the presence of complications, ensured a rapid evolution, and reduced their disabilities(AU)

Full-information Force Sensor for Pulse Condition Diagnose / 中国医疗器械杂志

According to the collection principles and characteristics of the pulse physiological signals of traditional Chinese medicine, combined with the international standard requirements of the pulse graph force transducer (ISO 19614:2017-05), a special force sensor component that can be used for a complete and objective collection of pulse signals has been developed, this sensor meets the requirements of industrialization. The sensor can measure the pulse amplitude and width signals of the cunpart of the human body. In addition, three sensors can be placed at the cun, guan, chi part at the same time, so that the "three body parts and nine pulse-taking sites" can be realized synchronously. After the sensor has been verified, the results meet the relevant requirements of international standard. The consistency of the result can be reached to 92.3% compared with the diagnosis result of clinical TCM experts.

Princípios analíticos da gasometria arterial / Analytical principles of arterial gasometry

Gasometria arterial (GA) é um exame que permite avaliar a condição respiratória e metabólica do paciente, sendo uma das formas mais comuns de investigação clínica em casos emergenciais e de cuidados críticos. É utilizada para medir as concentrações de oxigênio e também para avaliação do distúrbio do equilíbrio ácido-base, da oxigenação do sangue arterial e da ventilação alveolar. O presente estudo tem como objetivo apontar e avaliar os princípios da técnica de gasometria arterial, fases analíticas, principais doenças em que se utiliza o exame e inovações da técnica ao longo dos anos, baseado em dados de artigos científicos e banco de dados do Scielo (Scientific Eletronic Library Online) e Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde). A coleta de sangue arterial para gasometria ocorre através de um procedimento invasivo realizado por intermédio de uma punção arterial. Tal procedimento é executado pelo profissional enfermeiro e exige qualificações técnicas e científicas. O estudo mostrou que as informações acerca do exame constituem uma importante ferramenta para que se possam compreender a complexidade da técnica bem como os distúrbios ácido-base envolvidos na clínica do paciente.

Arterial blood gas (GA) is an exam that allows the assessment of respiratory and metabolic condition, being one of the most common forms of clinical investigation in emergency cases and critical care. It is used to measure oxygen concentrations, as well as for evaluation of acid-base balance disorder, arterial blood oxygenation and alveolar ventilation. This study aims to point out and evaluate the principles of arterial blood gas technique, analytical phases, main diseases in which the examination is used and innovations of the technique over the years, based on data from scientific articles and SciELO database (Scientific Electronic Library Online) and Lilacs (Latin American and Caribbean Health Sciences Literature). The collection of arterial blood for blood gas analysis occurs through an invasive procedure in which an arterial puncture is performed. Such procedure is performed by the professional nurse and requires technical and scientific qualifications. The study showed that the information about the exam is an important tool to understand the complexity of the technique, as well as the acid-base disorders involved in the patient's clinic.

Monitoreo de pulsioximetría en extracciones dentales bajo protocolo de exodoncia simple y quirúrgico / Pulse oximetry measure in dental extractions under simple and surgical exodoncy protocol

INTRODUCCIÓN. El uso de un oxímetro como método de monitoreo no invasivo para el paciente permite al profesional odontólogo detectar, evaluar y prevenir situaciones de urgencia. OBJETIVO. Analizar la pulsioximetría en pacientes atendidos por extracciones dentales en el Centro Quirúrgico de la Facultad de Odontología de la Universidad Central del Ecuador. MATERIALES Y MÉTODOS. Estudio observacional, descriptivo realizado a 30 pacientes bajo protocolo de exodoncia quirúrgica y 30 bajo protocolo de exodoncia simple; a los cuales se monitoreó constantes vitales con pulsioxímetro, los datos se pro-cesaron con el programa estadístico International Business Machines Statistical Package for the Social Sciences Versión 2.0 para determinar varianza a través de distribución de frecuencias, medias, desviación estándar, pruebas de T Student y Anova. RESULTADOS. Existió mayor alteración en pulso durante la fase de exodoncia en ambos protocolos de atención, mientras que la saturación de oxígeno aumentó desde la fase de anestesia, sin tener varianzas significativas. Las mujeres presentaron valores elevados de saturación de oxígeno 95,5% y pulso (87,07 ± 1,39 latidos por minuto) en comparación con los hombres durante todas las fases de ambos protocolos. Existieron variaciones significativas de pul-so en pacientes sometidos a exodoncias quirúrgicas con ansiedad leve o nula mientras que en exodoncia simple existió mayor varianza de pulso en aquellos con ansiedad mode-rada según la Escala de Ansiedad de Corah. Se presentaron cuatro urgencias 6,66% (4; 60). CONCLUSIÓN. El monitoreo constante mediante el pulsioxímetro durante la atención odontológica permitió identificar a tiempo eventos que hubiesen comprometido la integri-dad del paciente y evitar que se conviertan en emergencia.

INTRODUCTION. The use of an oximeter as a non-invasive monitoring method for a pa-tient, allows dentist to detect, evaluate and prevent emergency situations. OBJECTIVE. Analyze the pulse oximetry in patients attended for dental extractions in the Faculty of Dentistry ́s Surgical Center at the Universidad Central del Ecuador. MATERIALS AND ME-THODS. Observational, descriptive study of 30 patients treated under surgical exodontics protocol and 30 under simple exodontics protocol.Vital signs were measured with pulse oximeter and the data was processed with the International Business Machines Statistical Package for the Social Sciences Version 2.0 to determine the variance through distribution of frequencies, means, standard deviation, Student T tests and Anova. RESULTS. The-re was a greater alteration in pulse, during the exodontic phase in both protocols, while oxygen saturation increased at the anesthesic phase, without having relevant variances. Women patients have increased values of oxygen saturation (95,5%) and pulse (87,07 ± 1,39 beats per minute) compared to men during all phases of both protocols. There were significant pulse variations in patients who had surgical extractions with mild level anxiety. In the other hand, in simple extractions, there was greater pulse variance in patients who have moderate anxiety according to the Corha Anxiety Scale. During the study four ur-gencies 6,66% (4; 60) were identified. CONCLUSION. Constant monitoring by the pulse oximeter during dental care, allowed to identify events that might have compromised the integrity of the patient, in order to prevent and avoid they become an emergency situation.

Initial experience of cardiac catheterization through distal radial access in a femoralist center / Experiencia inicial de cateterización cardiaca mediante acceso radial distal en un centro femoralista

Objective: to share our experience in the radial distal approach to perform coronary angiography and / or dilation of coronary stenosis. The initial results are exposed in the access of the distal radial artery or in the so-called anatomical "snuff box". Methods: The left or right radial distal artery was used as an access site in 6 patients admitted to the Institute of Cardiology and Cardiovascular Surgery for coronary angiography and dilatation of coronary stenosis between May 6 and June 6 of 2019. All with pulse present in their distal radial artery. In the laboratory, they had the access arm flexed with respect to the homolateral shoulder so that the hand was placed on their contralateral groin. In all cases, the operator was placed on the right side of the patient, to perform coronary angiography and / or dilation of coronary stenosis. During the hospital stay, the main demographic characteristics and complications were recorded. Results: the average age of the patients was 72 +/- 10 years and 83.3 percent were men. We use the Judkins and Amplatz 6 and 5 French catheters for the procedures. Five admitted with the diagnosis of angina and one with severe aortic valve stenosis. In 5 patients, distal transradial coronary angiography was successfully performed. Only one patient experienced distal radial spasm, using in this case the ipsilateral proximal radial access, without making it necessary to approach the femoral artery. In total, 4 patients had coronary intervention, performing successfully in the 4 patients. The right coronary artery was the artery that required most of the intervention (3 patients). There were no cases of occlusion of the radial arteries, no hematoma of the hand, of the B.A.R.C scale greater than 1 was observed in any patient. Numbness of the hand was documented in none. The radial introducer was removed at the end of the procedure. Hemostasis was achieved with manual compression. Conclusion: the distal radial approach is feasible in a selected group of patients as a procedure for coronary angiography and dilatation of coronary stenosis(AU)

Objetivo: compartir nuestra experiencia en el abordaje radial distal para realizar la angiografía coronaria y/o la dilatación de la estenosis coronaria. Se exponen los resultados iniciales en el acceso de la arteria radial distal o en la llamada "tabaquera" anatómica. Métodos: se utilizó la arteria radial distal izquierda o derecha como sitio de acceso en 6 pacientes ingresados en el Instituto de Cardiología y Cirugía Cardiovascular para angiografía coronaria y dilatación de estenosis coronaria del 6 de mayo al 6 de junio de 2019. Todos los pacientes tenían pulso en la arteria radial distal. En el laboratorio, se les flexionó el brazo de acceso con respecto al hombro homolateral de modo que la mano descansara sobre la ingle contralateral. En todos los casos, el técnico se situó a la derecha del paciente para realizar la angiografía coronaria y/o dilatación de la estenosis coronaria. Durante la estancia de los pacientes en el hospital, se registraron sus principales características demográficas y complicaciones. Resultados: la edad promedio de los pacientes fue de 72 +/- 10 años y 83,3 por ciento eran hombres. Usamos catéteres franceses Judkins y Amplatz 6 y 5 para los procedimientos. Cinco pacientes habían sido ingresados con un diagnóstico de angina y uno con estenosis valvular aórtica severa. La angiografía coronaria transradial distal fue exitosa en 5 pacientes. Solo un paciente experimentó un espasmo distal radial, usándose en ese caso el acceso radial proximal ipsilateral sin que fuera necesario abordar la arteria femoral. Un total de 4 pacientes se sometieron a intervención coronaria, la que fue exitosa en los 4. La arteria coronaria derecha fue la que requirió la mayor parte de la intervención (3 pacientes). No hubo ningún caso de oclusión de las arterias radiales ni de hematoma de la mano. Tampoco se observó un valor de la escala BARC mayor de 1 en ningún paciente. No se documentó entumecimiento de la mano en ningún paciente. El introductor radial se retiró al final del procedimiento. La hemostasia se alcanzó mediante compresión manual. Conclusión: el abordaje radial distal es factible en un grupo seleccionado de pacientes como procedimiento para la angiografía coronaria y la dilatación de la estenosis coronaria(AU)

Desarrollo de un sistema biomédico para monitoreo local y remoto de signos vitales de pacientes, utilizando tecnología de Internet de las Cosas, IoT / Development of a biomedical system for local and remote monitoring of vital signs of patients, using Internet of Things technology, IoT

Se desarrolló el prototipo y pruebas de verificación del funcionamiento necesarias en un equipo médico, con el fin de obtener información confiable de dicho dispositivo. Se enfocó la investigación en el área de la tecnología aplicada en el sector de la salud, desarrollando un sistema de monitoreo local y remoto de signos vitales de pacientes utilizando como base la tecnología IoT y dispositivos inteligentes Smartphone. Para ello se diseñó una App Android, un dispositivo electrónico biomédico a partir de la tarjeta electrónica MySignals HW, así como la integración y programación de sensores biométricos con el controlador y periféricos de visualización de la información. El sistema cuenta con la capacidad necesaria de comunicación para que, a través de la red se envíen los datos obtenidos como resultado del proceso de lectura de los sensores a la base de datos en el servidor IoT, lo que permite saber desde cualquier lugar, las lecturas medicas tomadas del paciente por medio de dispositivos inteligentes a través de la App o portal web. Los sensores utilizados y probados en esta investigación son: Oximetría (SpO2 y Pulso), Temperatura corporal, frecuencia respiratoria y tensión o presión arterial.

The prototype and verification tests of the necessary operation in a medical equipment were developed, in order to obtain reliable information from said device. Research was focused on the area of ​​applied technology in the health sector, developing a local and remote monitoring system of vital signs of patients using IoT technology and Smartphone smart devices as a basis. For this, an Android App was designed, a biomedical electronic device based on the MySignals HW electronic card, as well as the integration and programming of biometric sensors with the controller and information display peripherals. The system has the necessary communication capacity so that, through the network, the data obtained as a result of the sensor reading process are sent to the database on the IoT server, which allows to know from anywhere, the Medical readings taken from the patient through smart devices through the App or web portal. The sensors used and tested in this investigation are: Oximetry (SpO2 and Pulse), Body temperature, respiratory rate and blood pressure or pressure.

Acute effects of strength exercise with blood flow restriction on the arterial resistance index / Efeitos agudos do exercício de força com restrição do fluxo sanguíneo sobre o índice de resistência arterial

ABSTRACT The present study aimed to evaluate the acute behavior of the brachial artery resistance index (BARI) and popliteal artery resistance index (PARI) in response to low intensity strength exercises involving small (SMG) and large muscle groups (LMG) performed with and without blood flow restriction. Eleven men (age 23 ± 3.29 years) underwent a four-arm, randomized, cross-over experiment: Small muscle group exercise (SMG), small muscle groups with blood flow restriction (SMG+BFR), large muscle groups (LMG) and large muscle groups with blood flow restriction (LMG+BFR). The behavior of BARI and PARI was evaluated at rest, immediately after exercise, and at 15 and 30 minutes during recovery. Data analysis showed a significant reduction of the BARI from rest to post-exercise only in the protocols involving SMG, regardless of the BFR (p <0.05). Protocols involving LMG, with or without BFR, did not affect PARI (p> 0.05), but were efficient to promote significant increases in BARI (p <0.05) immediately after exercise. Our findings indicate that the exercises involving SMG, regardless of BFR, are efficient to promote local vasodilatation (brachial artery), but without systemic effects. None of the analyzed protocols affected the PARI behavior.

RESUMO O presente estudo objetivou avaliar o comportamento agudo do índice de resistência da artéria braquial (IRAB) e da artéria poplítea (IRAP) em resposta a exercícios de força de baixa intensidade envolvendo pequenos (PGM) e grandes grupos musculares (GGM), realizado com e sem restrição de fluxo sanguíneo. Onze homens (idade 23 ± 3,29 anos) realizaram um experimento randomizado, cruzado, com quatro braços: Exercício para pequenos grupos musculares (PGM), pequenos grupos musculares com restrição de fluxo sanguíneo (PGM+RFS), grandes grupos musculares (GGM) e grandes grupos musculares com restrição de fluxo sanguíneo (GGM+RFS). O comportamento de IRAB e IRAP foi avaliado em repouso, mediatamente após o exercício, e aos 15 e 30 minutos da recuperação. A análise dos dados mostrou uma redução significativa do IRAB do repouso para o pós-exercício apenas nos protocolos de PGM com ou sem RFS (p <0,05). Protocolos envolvendo GGM, independentemente do BFR, não afetaram o IRAP (p> 0,05), porém, foram eficientes para promover aumentos significativos do IRAB (p <0,05) imediatamente após o exercício. Nossos achados indicam que os exercícios envolvendo PGM, independentemente da BFR, são capazes de promover a vasodilatação local (artéria braquial), porém, sem efeitos sistêmicos. Nenhum dos protocolos analisados afetou o comportamento do IRAP.

A Retrospective Analysis of Peroperative Risk Factors Associated with Posttonsillectomy Reactionary Hemorrhage in a Teaching Hospital

Introduction: Tonsillectomy is one of the most common otolaryngology procedures performed worldwide. It is also one of the first procedures learnt by residents during their training period. Although tonsillectomy is viewed relatively as a low-risk procedure, it can be potentially harmful because of the chance of posttonsillectomy hemorrhage. Objective: The objective of the present study is to analyze the effects of peroperative factors and experience of the surgeon on the incidence and pattern of posttonsillectomy reactionary hemorrhage. Methods: A retrospective review of medical charts was performed from 2014 to 2017 in a tertiary care hospital. A total of 1,284 patients who underwent tonsillectomy and adenoidectomy were included in the study. The parameters assessed were experience of the surgeon, operating time, intraoperative blood loss, difference in mean arterial pressure (MAP) and pulse rate. Results: A total of 23 (1.79%) out of the 1,284 patients had reactionary hemorrhage. Out of those 23, 16 (69.5%) patients had been operated on by trainees, while 7 (30.5%) had been operated on by consultants (p = 0.033, odds ratio [OR] = 0.04). Operating time, intraoperative blood loss, difference in MAP and pulse rate were significantly higher in the reactionary hemorrhage group, and showed a positive association with risk of hemorrhage (p < 0.05; OR >1). Re-exploration to control the bleeding was required in 10 (76.9%) out of the 23 cases. Conclusion: The experience of the surgeon experience and peroperative factors have an association with posttonsillectomy hemorrhage. Close surveillance and monitoring of the aforementioned peroperative factors will help in the identification of patients at risk of hemorrhage (AU)

Medición de la saturación arterial de oxígeno en enfermedad pulmonar obstructiva crónica / Measurement of blood oxygen saturation in chronic obstructive pulmonary disease

Resumen La terapia con oxígeno a largo plazo mejoró la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica. Las medidas propuestas en las guías clínicas para evaluar la indicación y seguimiento de esta terapia son la presión arterial de oxígeno y la saturación arterial de oxígeno. Se ha generalizado el uso de la oximetría de pulso, pero la información para determinar si estas medidas son intercambiables es insuficiente. El objetivo es revisar los fundamentos fisiológicos de las variables relacionadas con la oxigenación y sus formas de medición. En la evaluación del paciente con patología respiratoria, la saturación de pulso es una ayuda clínica valiosa, sin embargo, sus limitaciones no le permiten, en ciertos rangos, reemplazar la valoración directa en sangre arterial (gasometría arterial) de la saturación arterial y la presión arterial de oxígeno, para determinar la indicación de la oxigenoterapia. MÉD.UIS.2019;32(3):19-25

Abstract Long-term oxygen therapy improves the survival of patients with chronic obstructive pulmonary disease. Measures proposed in clinical clinics to evaluate the indication and monitoring of arterial blood pressure therapy and arterial oxygen saturation. The use of pulse oximetry has been widespread, but the information to determine if these measures are interchangeable is insufficient. The objective is to review the physiological foundations of variables related to oxygenation and their forms of measurement. In the assessment of the patient with respiratory pathology, pulse saturation is a valuable clinical aid., however, its limitations do not allow, in certain ranges, to replace direct arterial blood pressure (arterial blood gas) measurement of arterial saturation and arterial oxygen pressure, to determine the indication of oxygen therapy. MÉD.UIS.2019;32(3):19-25

Conceptos actuales de interpretación de los signos vitales en odontología y su aplicación clínica / Current concepts of interpretation of vital signs in dentistry and its clinical application

La medición de los signos vitales es de gran importancia en el consultorio dental, de esta forma podemos obtener una visión objetiva y anticipada del estado funcional del paciente. Según la información obtenida, se tomarán decisiones terapéuticas. El odontólogo debe saber que el seguimiento clínico y el uso de la técnica adecuada para sus mediciones representan un aspecto muy relevante para prevenir emergencias en el consultorio dental. El odontólogo debe medir los signos vitales antes, durante y después del procedimiento dental y, del mismo modo, debe estar involucrado en la situación individual de cada paciente y proporcionar medidas higiénicodietéticas para mejorar su calidad de vida. La evaluación continua de los signos vitales durante el procedimiento quirúrgico dental, en el que se usan anestésicos locales, es particularmente relevante en este caso, ya que puede ayudarnos a prevenir complicaciones como arritmias cardiacas, crisis hipertensivas o angina de pecho. El objetivo de este artículo es promover en toda la profesión odontológica, el monitoreo de los signos vitales, su técnica de medición correcta y su correlación con otros datos de un historial completo médico y dental (AU)

The measurement of vital signs is of great importance in the dental office, this way we can obtain an objective and anticipated vision of the functional state of the patient. According to the information obtained, therapeutic decisions will be made. The dentist must know that monitoring and using the appropriate technique for its measurements, represents a very relevant aspect for the emergency in the dental office. The dentist must measure the vital signs before, during and after the dental procedure, likewise, they must be involved in the individual situation of each patient and provide hygienic-dietetic measures to improve their quality of life. The continuous assessment of vital signs during the dental surgical procedure, in which local anesthetics are used, is particularly relevant in this case since it can help us prevent complications such as cardiac arrhythmias, hypertensive crisis or angor pectoris. The objective of this article is to promote throughout the dental profession, the monitoring of vital signs, their correct measurement technique and their correlation with other data from a complete medical and dental history (AU)

Aplicabilidade dos marcadores de rigidez arterial na doença arterial periférica / Applications of arterial stiffness markers in peripheral arterial disease

A análise de rigidez arterial tem sido feita em vários grupos populacionais com o objetivo de identificar precocemente o risco cardiovascular e realizar medidas terapêuticas específicas. O aumento da rigidez arterial leva à perda de capacidade de adaptação da aorta e das artérias elásticas às variações de pressão durante o ciclo cardíaco. Os principais marcadores de rigidez arterial são a velocidade de onda de pulso (VOP), o índice de aumentação (AIx) e a pressão aórtica central. Esses índices podem ser obtidos de maneira não invasiva. Ocorre aumento da mortalidade em pacientes com doença coronariana ou em hemodiálise que apresentam aumento da VOP ou do AIx. A associação com a doença arterial periférica é pouco estudada. O objetivo desta revisão é mostrar a aplicabilidade e a utilidade de realizar medidas de rigidez arterial em pacientes com doença arterial periférica

Arterial stiffness has been analyzed in many different population groups with the objective of identifying cardiovascular risk early and performing specific therapeutic interventions. Increased arterial stiffness affects the capacity of the aorta and elastic arteries to adapt to pressure variations during the cardiac cycle. The main markers of arterial stiffness are pulse wave velocity (PWV), augmentation index (AIx) and central aortic pressure. They can be measured noninvasively. Patients with coronary disease or on hemodialysis who have elevated PWV or AIx have increased mortality. The association with peripheral arterial disease has been studied little. The objective of this review is to demonstrate the applicability and utility of assessing measures of arterial stiffness in patients with peripheral arterial disease

The study on extraction method of pulse rate variability in daily unsupervised state / 生物医学工程学杂志

The extraction of pulse rate variability(PRV) in daily life is often affected by exercise and blood perfusion. Therefore, this paper proposes a method of detecting pulse signal and extracting PRV in post-ear, which could improve the accuracy and stability of PRV in daily life. First, the post-ear pulse signal detection system suitable for daily use was developed, which can transmit data to an Android phone by Bluetooth for daily PRV extraction. Then, according to the state of daily life, nine experiments were designed under the situation of static, motion, chewing, and talking states, respectively. Based on the results of these experiments, synchronous data acquisition of the single-lead electrocardiogram (ECG) signal and the pulse signal collected by the commercial pulse sensor on the finger were compared with the post-auricular pulse signal. According to the results of signal wave, amplitude and frequency-amplitude characteristic, the post-ear pulse signal was significantly steady and had more information than finger pulse signal in the traditional way. The PRV extracted from post-ear pulse signal has high accuracy, and the accuracy of the nine experiments is higher than 98.000%. The method of PRV extraction from post-ear has the characteristics of high accuracy, good stability and easy use in daily life, which can provide new ideas and ways for accurate extraction of PRV under unsupervised conditions.

Analysis of Pulse Signals Based on Array Pulse Volume / 中国结合医学杂志

OBJECTIVE@#To collect and analyze multi-dimensional pulse diagram features with the array sensor of a pressure profile system (PPS) and study the characteristic parameters of the new multi-dimensional pulse diagram by pulse diagram analysis technology.@*METHODS@#The pulse signals at the Guan position of left wrist were acquired from 105 volunteers at the Shanghai University of Traditional Chinese Medicine. We obtained the pulse data using an array sensor with 3×4 channels. Three dimensional pulse diagrams were constructed for the validated pulse data, and the array pulse volume (APV) parameter was computed by a linear interpolation algorithm. The APV differences among normal pulse (NP), wiry pulse (WP) and slippery pulse (SP) were analyzed using one-way analysis of variance. The coefficients of variation (CV) were calculated for WP, SP and NP.@*RESULTS@#The APV difference between WP and NP in the 105 volunteers was statistically significant (6.26±0.28 vs. 6.04±0.36, P=0.048), as well as the difference between WP and SP (6.26±0.28 vs. 6.07±0.46, P=0.049). However, no statistically significant difference was found between NP and SP (P=0.75). WP showed a similar CV (4.47%) to those of NP (5.96%) and SP (7.58%).@*CONCLUSION@#The new parameter APV could differentiate between NP or SP and WP. Accordingly, APV could be considered an useful parameter for the analysis of array pulse diagrams in Chinese medicine.

The importance of intra-aortic pulse pressure after anterior ST-segment elevation myocardial infarction

Abstract Objective: To evaluate the association of pulse pressure (PP) with mortality and major adverse cardiac events (MACE) in one-year period after anterior ST-elevation myocardial infarction (A-STEMI). Methods: A total of 261 consecutive patients whose blood pressure was measured with the aid of a catheter before primary percutaneous coronary intervention (PPCI) between August 2016 and February 2017 were included in the study. The patients were divided into three groups according to pulse pressure (PP) (Group 1, PP<35 mmHg; Group 2, 35≤PP≤50 mmHg; Group 3, PP>50 mmHg). Results: The mean age of the patients was 63.4±14.1 years, and 206 of them were male. The groups were similar in terms of age and diastolic blood pressure (DBP). The ratio of female patients in Group 1 was higher, and their systolic blood pressure (SBP) was lower than those from the other groups (P=0.005 vs. P=0.042). The rates of MACE and mortality were higher in Group 1. The predictive PP values were calculated to be 42.5 mmHg for development of MACE and 41.5 mmHg for mortality. One-year survival ratio was worse in Group 1 than in the others according to Kaplan-Meier analysis (P<0.001). Conclusion: The values of PP which was measured intra-aortically in patients with A-STEMI were associated with mortality and MACE in the one-year follow-up period.

Relación entre la presión de pulso y la enfermedad cerebrovascular aterotrombótica / Relation between pulse pressure and atherothrombotic cerebrovascular disease

Introducción: la presión de pulso es un importante marcador y/o predictor de riesgo de complicaciones ateroscleróticas agudas, donde está incluida la enfermedad cerebrovascular. Objetivos: determinar la relación entre la presión de pulso y la enfermedad cerebrovascular aterotrombótica en pacientes hipertensos y no hipertensos. Métodos: estudio explicativo, analítico, caso/control. El grupo de casos fue de 226 pacientes con diagnóstico de enfermedad cerebrovascular aterotrombótica, ingresados en la Sala de Ictus del Hospital General Docente Enrique Cabrera entre 2014-2016 y el grupo control de 226 sin enfermedad cerebrovascular. Se formaron dos grupos, uno con presión de pulso 60 mmhg y otro con presión de pulso < 60 mmHg en pacientes hipertensos y no hipertensos. Resultados: la media de la edad fue de 69,65 años y el 61,45 por ciento eran masculinos; la frecuencia de hipertensión arterial fue de 70,4 por ciento y la de fumadores, 35,4 por ciento y con PP≥ 60 mmHg, 62,0 por ciento. La asociación de la presión de pulso 60 mmHg con enfermedad cerebrovascular aterotrombótica en pacientes hipertensos resultó significativa con odds-ratio 4,72, Intervalo de Confianza 95 por ciento(2,79-7,98) y en pacientes no hipertensos también resultó significativa con odds-ratio 6,86 Intervalo de Confianza 95 por ciento (3,33-14,07). El riesgo atribuible en expuestos fue de 88,6 por ciento y el riesgo atribuible en la población de 50,4 por ciento. Conclusiones: la presión de pulso se asoció de forma significativa a la enfermedad cerebrovascular aterotrombótica en pacientes hipertensos y no hipertensos(AU)

Introduction: Pulse pressure is an important marker or predictor of risk for acute atherosclerotic complications, including cerebrovascular disease. Objectives: To determine the relationship between pulse pressure and atherothrombotic cerebrovascular disease in hypertensive and nonhypertensive patients. Methods: Explanatory, analytical, case control study. The case group consisted of 226 patients diagnosed with atherothrombotic cerebrovascular disease admitted to the Ictus Room at Enrique Cabrera General Teaching Hospital between 2014 and 2016, and the control group consisted of 226 patients without cerebrovascular disease. Two groups were formed, one with a pulse pressure higher than or equal to 60 mmHg and one with a pulse pressure under 60 mmHg in hypertensive and nonhypertensive patients. Results: Mean age was 69.65 years and 61.45 percent were male. The frequency of hypertension was 70.4 percent and that of smokers was 35.4 percent, and with PP≥60 mmHg, which represented 62.0 percent. The association of pulse pressure higher than or equal to 60 mmHg with atherothrombotic cerebrovascular disease in hypertensive patients was significant with odds ratio of 4.72, and confidence interval of 95 percent (2.79-7.98), while in nonhypertensive patients it was also significant with odd ratios of 6.86, and confidence interval of 95 percent CI (3.33-14.07). The attributable risk in exposed people was 88.6 percent and the attributable risk in the population was 50.4 percent. Conclusions: Pulse pressure was significantly associated with atherothrombotic cerebrovascular disease in both hypertensive and nonhypertensive patients(AU)

Is Chinese herbal medicine effective for elderly isolated systolic hypertension? A systematic review and meta-analysis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the efficacy of Chinese medicine (CM) on isolated systolic hypertension.</p><p><b>METHODS</b>Seven electronic databases were searched for randomized controlled trials (RCTs) published until August 2015. Subgroup analyses and meta-analysis were performed to assess the efficacy and safety of the included studies.</p><p><b>RESULTS</b>A total of 24 studies, including 2,096 patients (1,058 patients in the intervention group and 1,038 in the control group), were evaluated in the final analysis. Compared with a conventional therapy used alone, CM as additional intervention was more effective on systolic blood pressure [mean difference (MD)=-0.66, 95% confidence interval (CI)=(-0.97,-0.36), P<0.00001] and significantly diminished the pulse pressure [MD=-7.49, CI=(-12.69,-2.29), P<0.00001]. However it showed no additional benefit on diastolic blood pressure [MD=1.16, CI=(0.02, 2.29), P=0.87]. Adverse events were not explicitly reported in most RCTs.</p><p><b>CONCLUSIONS</b>CM might be a promising approach for the elderly with isolated systolic hypertension, while the evidence for CM employed alone was insufficient. Considering the inherent limitations of the included studies, larger high-quality RCTs with extensive follow-up should be performed to validate our findings in the future.</p>

Sevoflurane preconditioning during myocardial ischemia-reperfusion reduces infarct size and preserves autonomic control of circulation in rats

ABSTRACT PURPOSE: To investigate the myocardial ischemia-reperfusion with sevoflurane anesthetic preconditioning (APC) would present beneficial effects on autonomic and cardiac function indexes after the acute phase of a myocardial ischemia-reperfusion. METHODS: Twenty Wistar rats were allocated in three groups: control (CON, n=10), myocardial infarction with sevoflurane (SEV, n=5) and infarcted without sevoflurane (INF, n=5). Myocardial ischemia (60 min) and reperfusion were performed by temporary coronary occlusion. Twenty-one days later, the systolic and diastolic function were evaluated by echocardiography; spectral analysis of the systolic arterial pressure (SAPV) and heart rate variability (HRV) were assessed. After the recording period, the infarct size (IS) was evaluated. RESULTS: The INF group presented greater cardiac dysfunction and increased sympathetic modulation of the SAPV, as well as decreased alpha index and worse vagal modulation of the HRV. The SEV group exhibited attenuation of the systolic and diastolic dysfunction and preserved vagal modulation (square root of the mean squared differences of successive R-R intervals and high frequency) of HRV, as well as a smaller IS. CONCLUSION: Sevoflurane preconditioning better preserved the cardiac function and autonomic modulation of the heart in post-acute myocardial infarction period.

Estudios arteriales no-invasivos para detección temprana o valoración de cambios arteriales en niños y jóvenes expuestos a factores de riesgo cardiovascular y/o patologías sistémicas / Non-invasive arterial studies for the early detection of vascular changes in children and young people exposed to cardiovascular risk factors and/or systemic diseases

En la última década, con el objetivo de detectar tempranamente y/o evaluar el grado de extensión de alteraciones arteriales, se han desarrollado nuevos estudios seguros, no invasivos, rápidos, de bajo costo y de elevada sensibilidad y especificidad. Recientemente se ha incluido su empleo en recomendaciones internacionales para la prevención cardiovascular en niños y adolescentes. Con el objetivo de que niños uruguayos accedan a estos estudios se ha implementado recientemente un servicio de evaluación arterial no invasivo destinado a la población pediátrica (CUiiDARTE-Pediátrico) en el Centro Hospitalario Pereira Rossell. Allí se aplica un abordaje de evaluación arterial con fines diagnósticos, preventivos, y de valoración de daño y/o de evaluación de acciones terapéuticas en niños y adolescentes. Se realiza determinación no invasiva e innocua de parámetros complementarios de estructura y función arterial: (1) evaluación de presencia/composición histológica (“histología virtual”) de placas de ateroma; (2) espesores parietales; (3) rigidez arterial global, regional y local; (4) reactividad vascular (función endotelial); (5) presión aórtica central; (6) parámetros derivados de la onda del pulso asociados a reflexiones de onda; (7) índice tobillo-brazo; (8) parámetros ecográficos vasculares estándar, y (9) monitorización no invasiva (consultorio y ambulatoria) de presión arterial, rigidez arterial, resistencias periféricas y/o gasto cardíaco. Habiendo evaluado más de 450 niños, el presente artículo tiene como objetivo presentar los estudios (marcadores) arteriales allí realizados.

Non-invasive, secure, fast and inexpensive systems and studies have been developed in the past decade allowing for early detection of vascular disorders with high sensitivity and specificity. International guidelines aimed at cardiovascular prevention, risk stratification and/or target organ damage assessment in adults recommend non-invasive vascular studies. Recently, vascular evaluation has also been considered in guidelines for cardiovascular prevention in children. Within this context, an arterial evaluation Center (CUiiDARTE-Pediátrico) has been developed and implemented in Pereira-Rossell Hospital to allow children access to non-invasive vascular studies in our country. In the Center, a multi-parameter approach is applied to assess the vascular health condition of children and adolescents by joint analysis of complimentary structural and functional arterial indexes and parameters: (1) detection and evaluation of atherosclerotic plaque composition ("Virtual histology"), (2) arterial wall thickness, (3) global, regional and local arterial stiffness, (4) vascular reactivity (endothelial function), (5) central aortic pressure, (6) pulse wave and waved reflection analysis, (7) ankle-brachial index, (8) arterial blood flow velocities and patterns (arterial Doppler), (9) ambulatory (or hospital) arterial pressure, stiffness and cardiac output monitoring. This study aimed to introduce our vascular approach and non-invasive studies.