Squamous cell carcinoma on an arteriovenous fistula scar: case report.

The main type of access used for hemodialysis is the arteriovenous fistula (AVF) because it offers superior patency and lower complication rates when compared to other hemodialysis accesses. We report the case of a 69-year-old female patient with chronic kidney disease on dialysis secondary to hypertensive nephrosclerosis with a radiocephalic AVF in the left upper limb created 9 years previously. Two years previously, she had undergone a kidney transplant and was taking immunosuppressants. A crusted lesion developed on her left forearm with onset 3 months before presentation and she underwent an excisional biopsy that revealed a well-differentiated and superficially invasive squamous cell carcinoma, with lateral and deep surgical margins free from neoplasia. At 1-year follow-up, the patient showed no signs of neoplastic recurrence.

True isolated deep femoral artery aneurysm associated with peripheral artery disease: case report.

True deep femoral artery aneurysms are extremely rare, accounting for about 0.5% of all peripheral aneurysms. In this report, we describe a 79-year-old male patient with a history of prior abdominal aortic aneurysm surgery via a conventional approach who was admitted to the vascular surgery service at the Hospital das Clínicas with intermittent claudication of the lower limbs. Arterial color-Doppler ultrasonography of the right lower limb was performed, revealing peripheral arterial disease of the femoral--popliteal and infrapatellar segments. Computed tomography angiography identified aortoiliac and bifurcated graft occlusion from the infrarenal segment of the aorta, in addition to a deep femoral artery aneurysm with diameters of 3.7 cm x 3.5 cm and length of 7 cm. Resection of the aneurysm was followed by revascularization of the deep femoral artery by interposition of a Dacron® graft and reimplantation of the superficial femoral artery into the graft. In cases of deep femoral artery aneurysms with concomitant peripheral arterial disease, it is important to ensure revascularization and adequate perfusion of the lower limb.

Quantitative analysis validation for sclerotherapy treatment of lower limb telangiectasias.

BACKGROUND: The evaluation of sclerotherapy efficacy for lower limb telangiectasias, which is the standard treatment for such condition, is commonly assisted by scores based on before and after pictures. This method is marked by its subjectivity, which impairs the precision of studies on the subject, making it unfeasible to evaluate and compare different interventions. We hypothesize that a quantitative method for evaluating the effectiveness of sclerotherapy for lower limb telangiectasias may present more reproducible results. Reliable measurement methods and new technologies may become part of the clinical practice in the near future. METHODS: Before and after treatment photographs were analyzed using a quantitative method and compared with a validated qualitative method based on improvement scores. Reliability analysis of the methods was performed, applying the intraclass correlation coefficient (ICC) and kappa coefficient with quadratic weights (Fleiss Cohen), for analysis of inter-examiner and intra-examiner agreement in both evaluation methods. Convergent validity was evaluated by applying the Spearman test. To assess the applicability of the quantitative scale, the Mann-Whitney test was used. RESULTS: A better agreement between examiners is shown for the quantitative scale, with a mean kappa of .3986 (.251-.511) for qualitative analysis and a mean kappa of .788 (.655-.918) for quantitative analysis (P < .001 for all examiners). Convergent validity was achieved by correlation coefficients of .572 to .905 (P < .001). The quantitative scale results obtained between the specialists with different degrees of experience did not show statistical difference (seniors: 0.71 [-0.48/1.00] × juniors: 0.73 [-0.34/1.00]; P = .221). CONCLUSIONS: Convergent validity between both analyses has been achieved, but quantitative analysis has been shown to be more reliable and can be applied by professionals of any degree of experience. The validation of quantitative analysis is a major milestone for the development of new technology and automated, reliable, applications.

Nebulized enriched heparin to treat no critical patients with Sars-Cov-2: Triple-blind clinical trial.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a viral respiratory disease that spreads rapidly, reaching pandemic status, causing the collapse of numerous health systems, and a strong economic and social impact. The treatment so far has not been well established and there are several clinical trials testing known drugs that have antiviral activity, due to the urgency that the global situation imposes. Drugs with specific mechanisms of action can take years to be discovered, while vaccines may also take a long time to be widely distributed while new virus variants emerge. Thus, drug repositioning has been shown to be a good strategy for defining new therapeutic approaches. Studies of the effect of enriched heparin in the replication of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in vitro assays justify the advance for clinical tests. METHODS AND ANALYSIS: A phase I/II triple-blind parallel clinical trial will be conducted. Fifty participants with radiological diagnosis of grade IIA pneumonia will be selected, which will be allocated in 2 arms. Participants allocated in Group 1 (placebo) will receive nebulized 0.9% saline. Participants allocated in Group 2 (intervention) will receive nebulized enriched heparin (2.5 mg/mL 0.9% saline). Both groups will receive the respective solutions on a 4/4 hour basis, for 7 days. The main outcomes of interest will be safety (absence of serious adverse events) and efficacy (measured by the viral load).Protocols will be filled on a daily basis, ranging from day 0 (diagnosis) until day 8.

Carcinoma espinocelular sobre cicatriz de fístula arteriovenosa: relato de caso / Squamous cell carcinoma on an arteriovenous fistula scar: case report

Resumo A fístula arteriovenosa (FAV) é o principal acesso para hemodiálise devido à sua patência superior e menores índices de complicação quando comparada aos demais acessos para hemodiálise. Relatamos o caso de uma paciente do sexo feminino, de 69 anos, com doença renal crônica dialítica secundária a nefroesclerose hipertensiva com FAV radio-cefálica no membro superior esquerdo realizada há 9 anos. Há 2 anos, foi submetida a transplante renal e fazia uso de imunossupressores. Evoluiu com aparecimento de lesão crostosa em antebraço esquerdo há 3 meses, foi submetida a biópsia excisional, e foi evidenciado carcinoma espinocelular bem diferenciado e superficialmente invasivo, com margens cirúrgicas laterais e profundas livres de neoplasia. No seguimento de 1 ano, a paciente não apresentava sinais de recidiva neoplásica.

Abstract The main type of access used for hemodialysis is the arteriovenous fistula (AVF) because it offers superior patency and lower complication rates when compared to other hemodialysis accesses. We report the case of a 69-year-old female patient with chronic kidney disease on dialysis secondary to hypertensive nephrosclerosis with a radiocephalic AVF in the left upper limb created 9 years previously. Two years previously, she had undergone a kidney transplant and was taking immunosuppressants. A crusted lesion developed on her left forearm with onset 3 months before presentation and she underwent an excisional biopsy that revealed a well-differentiated and superficially invasive squamous cell carcinoma, with lateral and deep surgical margins free from neoplasia. At 1-year follow-up, the patient showed no signs of neoplastic recurrence.

Proteína anexina a1: alvo terapêutico nos processos inflamatórios / Annexin a1 protein: therapeutic target in inflammatory processes

Introdução: A inflamação é uma importante resposta do hospedeiro contra agentes invasores. Contudo, precisa ser regulada paranão causar danos nos tecidos e órgãos. Entre os mediadores anti-infl amatórios está a proteína Anexina A1, uma proteína de 37kDaque apresenta sítios de ligação ao cálcio e aos fosfolipídios de membrana e está envolvida na inibição das sínteses de eicosanoides efosfolipase A2, induzidas por glicocorticoides. A ANXA1 é amplamente distribuída no organismo, especialmente em células relacionadasaos processos de defesa. Esta proteína exerce diferentes funções e pode ser relacionada a várias condições patológicas, como câncer edoenças autoimunes, além dos processos infl amatórios. Por essa razão, termo “anexinopatias” tem sido usado para defi nir as doençashumanas nas quais os níveis anormais de anexina contribuem para a patogênese. Objetivo: Diante da importância da ANXA1, o objetivodeste trabalho foi realizar uma revisão sobre o papel da proteína em processos infl amatórios. Método: Pesquisa bibliográfi ca realizadaem sites especializados...

Introduction: Inflammation is an important host response against invading agents. However, it must be regulated to avoid causing damageto tissues and organs. Among the anti-infl ammatory mediators there is the protein A1 Annexin, a 37kDa protein which exhibits calcium andphospholipid membrane binding sites and is involved in inhibition of glucocorticoids induced synthesis of eicosanoid and phospholipaseA2. ANXA1 is widely distributed in the body, especially in defense processes related cells. This protein exerts different functions and maybe related to several pathological conditions such as cancer and autoimmune diseases, beyond infl ammatory processes. Therefore, theterm "annexinopathy" has been used to defi ne human disease in which abnormal levels of annexin contribute to pathogenesis. Objective:Given the importance of ANXA1, the aim of this work was to perform a review about the role of this protein in infl ammatory processes.Method: Bibliographic research carried out in specialized sites...

Introducción: Una inflamación es una importante respuesta del huésped contra los agentes invasores. Sin embargo, debe ajustarse parano dañar los tejidos y los órganos. Entre los mediadores anti-infl amatorios está una proteína Anexina A1, una proteína de 37kDa que sepresentan en el calcio y los fosfolípidos de la membrana y se encuentra en la inibición de las síntesis de eicosanoides y fosfolipasa A2,induzidas por glicocorticoides. A ANXA1 é amplamente distribuida en el organismo, especialmente en las células relacionadas con losprocesos de defensa. Esta proteína ejerce diferentes funciones y puede ser relacionada a varias condiciones patológicas, como cáncer yenfermedades autoinmunes, además de los procesos infl amatorios. Por esta razón, el término "anexinopatias" se ha utilizado para defi nirlas enfermedades humanas en las que los niveles anormales de anexina contribuyen a la patogénesis. Objetivo: Ante la importancia dela ANXA1, el objetivo de este...