ABSTRACT
RESUMO: Introdução: A dissecção da artéria carótida (DAC) tem como uma das principais repercussões o Acidente Vascular Cerebral isquêmico (AVCi) em indivíduos jovens previamente saudáveis. É comum que nas DAC traumáticas, como em acidentes automobilísticos, o paciente seja submetido à investigação mais complexa com exames de imagem. Estes permitem um diagnóstico precoce e, portanto, um tratamento, reduzindo as chances de sequelas. Todavia, cau-sas não traumáticas com desfecho de DAC já foram relatadas, como as causas odontológicas. Objetivo: Contribuir para valorização diagnóstica da DAC não traumática e profilaxia de AVC subsequente. Métodos: Relatamos um caso de dissecção não aneurismática das artérias carótidas internas (ACI) pós-procedimento odontológico com desfecho de AVC bilateral em paciente de 52 anos. Resultados: Devido à forte associação de DAC a fatores traumáticos, em um primeiro contato com a paciente não foram levantadas suspeitas da ocorrência de DAC nem de AVC (ausência de déficit focal). Porém, tardiamente, foi identificada oclusão da ACI à esquerda e estenose na ACI direita, resultando em dois AVCs e incapacidade funcional severa na alta. Conclusão: O diagnóstico da DAC é um desafio, em especial por tratar-se de uma lesão de etiologia multifatorial. No entanto, seu reconhecimento precoce afetará diretamente o desfecho do paciente. Portanto, na presença de eventuais sintomas de alerta, faz-se necessário um meticuloso ques-tionamento sobre as últimas atividades do indivíduo. Este estudo alerta para a adoção de condutas profiláticas na ocorrência de fatores causais como hiperextensão cervical prolongada ou movimentos súbitos da cervical. (AU)
ABSTRACT: Introduction: Carotid artery dissection (CAD) has the ischemic stroke as one of the main repercussions in pre-viously healthy young individuals. It is common that in traumatic CAD, as in automobile accidents, the patient is subjected to a more complex investigation with imaging exams. These, allow an early diagnosis and, therefore, a treatment, reducing the chances of sequelae. However, non-traumatic causes with CAD outcomes have already been reported, such as dental causes. Objective: To contribute to the diagnostic valuation of non-traumatic CAD and subsequent stroke prophylaxis. Methods: We report a case of non-aneurysmatic dissection of the internal carotid arteries (ICA) after a dental procedure with evolution to bilateral stroke outcome in a 52-year-old patient. Results: Due to the strong association of CAD with traumatic factors, in a first contact with the patient there was no suspicion of CAD or stroke (absence of focal deficit). However, late, ICA occlusion on the left and stenosis on the right ICA were identified, resulting in two strokes and severe functional disability at discharge. Conclusion:The diagnosis of CAD is a challenge, especially since it is a multifactorial lesion. However, its early recognition will directly affect the patient's outcome. Therefore, in the presence of any warning symptoms, meticulous questioning about the individual's latest activities is necessary. This study alerts to the adoption of prophylactic conducts in the occurrence of causal factors such as prolonged cervical hyperextension or sudden movements of the cervical. (AU)
Subject(s)
Humans , Female , Middle Aged , Carotid Artery, Internal, Dissection , Stroke , Dental Implantation , Ischemic StrokeABSTRACT
In this study, we evaluated the monitoring of tick fever (TF) in a Brazilian dairy farm in the Minas Gerais state, Brazil, from July 10 to August 4, 2018. We aimed to identify diagnostic and treatment flaws in the protocol adopted by the farm, and to establish a novel and accurate TF monitoring protocol based on precision dairy farming and rational use of antimicrobials and antiparasitic drugs, while evaluating the economic benefits of the proposed strategy. We monitored TF in 395 heifer calves aged between 3 and 14 mo. According to the farm's standard protocol, all calves with an increase of 0.5°C in rectal temperature compared with the previous week's measurement were treated for Anaplasma spp. and Babesia spp. Blood smears were collected from the tail tip of the treated calves. During the last week of the study, we prepared blood smears of all calves regardless of treatment indication. Economic analysis was performed. The results indicated that at least 56.86% (261/459) of the calves did not require treatment for TF, whereas only 23.09% (106/459) had treatment indications. Negative blood smears (45.97%; 211/459) indicated the possibility of calves being affected by another disease or a condition that was not being adequately treated or those not necessarily sick. These results demonstrate the excessive use of medications, representing a direct economic loss, in addition to potentially favoring the occurrence of resistance to antimicrobials. In contrast, 9.42% (26/276) of calves had no treatment indication based on rectal temperature but had treatment indications based on blood smears. Only 5.73% (42/735) of blood smears had co-infection with hemopathogens, and none had triple co-infection. Therefore, we proposed the monitoring of TF using rectal temperature and microscopic analysis. If implemented, this strategy would result in a direct annual savings of approximately $22,638.96 (77.99%) related to medication for the treatment of TF. Therefore, implementing the proposed protocol would be cheaper than treatment based only on rectal temperatures. The currently implemented TF protocols overestimate the occurrence of TF, resulting in overtreatment. Thus, implementing a TF monitoring protocol based on a microscopy tool is justified, with benefits including rational use of medication, potential to generate savings, and reduced morbidity and mortality rates, in addition to enabling other diagnoses.
