PERCUTANEOUS TRANSAXILLARY TRANSCATHETER AORTIC VALVE IMPLANTATION.

The transaxillary (TAX) approach for transcatheter aortic valve implantation (TAVI) results in comparable short and long-term clinical results compared to the transfemoral (TF) approach. However, adequate closure of the axillary artery is the most critical issue when performing the percutaneous approach. Compared to surgical transaxillary approach, the percutaneous approach was used only in selected cases due to this closure limitation. In the present paper, we aim to demonstrate the feasibility of implanting the CoreValve Evolut Pro transcatheter heart valve via percutaneous transaxillary approach and make a literature review of procedure particularities and outcome. We describe the case of a patient with severe aortic stenosis in the presence of small calibre and severely calcified femoral arteries. A CoreValve Evolut Pro 26 was successfully implanted percutaneously through the left axillary artery. Percutaneous transaxillary transcatheter aortic valve implantation is a feasible and safe alternative in patients who have suboptimal iliofemoral vessels.

Efectividad de la ventilación de los diversos dispositivos extraglóticos durante las maniobras de reanimación. Revisión sistemática / Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review

INTRODUCCIÓN: El uso de dispositivos extraglóticos se ha difundido ampliamente en urgencias pre e intrahospitalarias debido a la facilidad de inserción y la reducción de las interrupciones en las maniobras de reanimación cardiopulmonar. Sin embargo, la mayoría de estos estudios no especifica si dichos dispositivos aseguran una ventilación adecuada durante la reanimación cardiopulmonar. Esta revisión sistemática tiene como objetivo principal determinar si existe evidencia que demuestre que los dispositivos extraglóticos permiten una ventilación efectiva durante la reanimación. MÉTODOS: Se han utilizado las bases de datos de MEDLINE y COCHRANE para buscar estudios elegibles publicados en inglés hasta el 30 de noviembre de 2018. Los estudios considerados elegibles fueron todos aquellos que han evaluado objetivamente el volumen tidal durante las maniobras de reanimación, en diversos dispositivos extraglóticos y en pacientes mayores de 18 años. RESULTADOS: Se identificaron 3.734 artículos, de los cuales 252 eran duplicados. Solo uno evaluó objetivamente la ventilación durante las maniobras de reanimación y presentó datos relevantes para esta revisión. En este ensayo de 470 pacientes, se realizó una espirometría en 51 pacientes. Solo el 4,48% de los pacientes sobrevivieron hasta el alta hospitalaria, sin embargo, no se evaluó la relación con la efectividad de la ventilación. CONCLUSIÓN: No existe evidencia científica que demuestre que los dispositivos extraglóticos proporcionan una ventilación efectiva durante las maniobras de reanimación. La evaluación mediante espirometría, impedancia torácica y ultrasonido podría ayudar a discernir la eficacia ventilatoria de los dispositivos extraglóticos durante la reanimación cardiopulmonar y aclarar si este factor está contribuyendo de manera negativa en las dificultades experimentadas para revertir el paro cardiorrespiratorio en los pacientes

INTRODUCTION: Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS: The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS: A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION: There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest

Effectiveness of different supralottic airways during resuscitation manoeuvres. A systematic review. / Efectividad de la ventilación de los diversos dispositivos extraglóticos durante las maniobras de reanimación. Revisión sistemática.

INTRODUCTION: Supraglottic airways, which are easily inserted and minimize interruptions in cardiopulmonary resuscitation manoeuvres, are now widely used in pre- and in-hospital emergencies. However, most studies in these devices do not specify whether they ensure good ventilation during CPR. This systematic review aims to determine whether there is evidence that supraglotic airways enable effective ventilation during resuscitation. METHODS: The MEDLINE and COCHRANE databases were searched for studies published in English up to 30 November 2018. Eligible studies were all those that objectively evaluated tidal volume during resuscitation maneuvers in patients over 18 years of age using various supraglottic airways. RESULTS: A total of 3734 articles were identified, of which 252 were duplicates. Only 1 objectively evaluated ventilation during resuscitation maneuvers and presented data relevant to this review. The study included 470 patients, 51 of which underwent spirometry. Only 4.48% of patients survived to hospital discharge; however, the correlation with ventilation effectiveness was not assessed. CONCLUSION: There is no scientific evidence that supraglottic airways provide effective ventilation during resuscitation maneuvers. Evaluation by spirometry, chest impedance and ultrasound may help to determine the ventilatory efficacy of supraglottic airways during CPR, and clarify whether this factor contributes to the difficulties experienced in reversing cardiorespiratory arrest.

Chronic utilization of agents acting on the renin-angiotensin system and intraoperative arterial pressure.

BACKGROUND: There has been concern that taking agents acting on the renin-angiotensin system (ARAS) in surgery day, may predispose patients to higher risk of intraoperative hypotension during surgery. Therefore, the European Society of Cardiology and the European Society of Anesthesiology recommend transient discontinuation of ARAS before non-cardiac surgery in hypertensive patients. As the existent evidence is limited, this recommendation remains debated. AIM: The objectives of the study were to evaluate the effects of ARAS chronic utilization on intraoperative arterial pressure. PATIENTS AND METHODS: This historical cohort consisted in recruitment of surgery patients over 12 months, at "Cova da Beira Hospital Center". The data were gathered from an interview to the patient and by postoperative review of the medical record. RESULTS: The study consisted of 756 patients. Of those, 589 did not take antihypertensive medication and 176 were taking chronic ARAS. In univariate analysis, only the appearance of intraoperative hypertension was significantly greater in ARAS group. In logistic regression analysis, age, diabetes mellitus and taking ARAS were the only significant risk factors to the appearance of intraoperative hypertension. In ARAS group, 123 patients stopped the ARA before surgery and 53 continued it until the surgery day. The frequency of the two outcomes did not differ between the two groups. CONCLUSIONS: In our study hypotension episodes during non-cardiac surgery could not be attributed to ARAS chronic utilization and taking ARAS on surgery morning when compared with withdrawal was not associated with hypotension episodes.

Determination of biomarkers of tobacco smoke exposure in oral fluid using solid-phase extraction and gas chromatography-tandem mass spectrometry.

A new, simple and sensitive method was described for the simultaneous determination of nicotine, cotinine and trans-3'-hydroxycotinine in oral fluid samples using solid-phase extraction and gas chromatography/tandem mass spectrometry (GC-MS/MS). This technique was developed using only 0.2 mL of sample, and deuterated analogues were used as internal standards. The method was found to be linear between 0.5 and 1000 ng/mL, with determination coefficients higher than 0.996 for all analytes. Intra- and interday precision and accuracy were in conformity with the criteria normally accepted in bioanalytical method validation. All analytes were stable in the samples for at least 24h at room temperature, for at least 72 h at 25°C in processed samples and for at least three freeze/thaw cycles. Absolute recoveries ranged from 89 to 92% for all analytes. GC-MS/MS has demonstrated to be a powerful tool for the simultaneous quantitation of the analytes, providing adequate selectivity and sensitivity. In addition, its performance characteristics allow its routine use in the analysis of biomarkers of tobacco smoke exposure, extending the window of analyte detection in nicotine cessation programs, using a sample amount as low as 0.2 mL of human oral fluid.

Exposición de niños a la contaminación ambiental por humo del tabaco en el domicilio. Un estudio transversal en Portugal / Exposition of children to environmental contamination due to tobacco smoke in the home. A cross-sectional study in Portugal

En la introducción y en el articulado del Convenio Marco de la OMSpara el Control del Tabaco se reconoce que la ciencia demostró de formainequívoca que el consumo y la exposición al humo del tabaco soncausas de mortandad, morbidez e incapacidad1.El hecho de que varios estudios demostrasen que el humo ambientaldel tabaco causa cáncer en humanos condujo al InternationalAgency for Research on Cancer (IARC) a clasificarlo en el Grupo Ade carcinógenos, es decir, con efecto reconocido para la especie humana.Además de tener en cuenta la gravedad de la exposición al humoambiental del tabaco especialmente en niños y adolescentes son prácticamenteinexistentes los estudios realizados en Portugal sobre la exposiciónde los niños al humo procedente de terceros. Estos hechosllevaron a los autores a realizar un estudio para determinar la prevalenciade niños expuestos pasivamente al humo del tabaco en el domicilio.Para alcanzar este objetivo se realizó, al final del año escolar de2002/2003, una encuesta a una muestra representativa constituida por1.141 alumnos de 7 escuelas del 3º ciclo de Educación Básica de Braga– Portugal (562 niñas y 579 niños, de 11-16 años).Los datos muestran que un elevado porcentaje (38%) de alumnosestán expuestos al humo ambiental del tabaco (19% diariamente y 19%ocasionalmente) debido al hecho de que los parientes más próximos fumanen casa (padre, madre o hermano/a).Ante los resultados observados y la evidencia científica disponible,se puede concluir que un elevado porcentaje de padres fumadores quefuman diaria y/u ocasionalmente en casa colocan en serio riesgo la saludde sus hijos

The WHO Framework Convention on Tobacco Control acknowledges that science has shown that smoking as well as exposition to second-hand smoke cause mortality, morbidity and incapacity1. The fact that several studies show that the Environmental Tobacco Smoke causes cancer to humans, led the International Agency for Research on Cancer (IARC) to classify it in Group Aof cancerigeneous substances. Despite the seriousness of the consequences in people (specially children and teenagers) exposure to environmental tobacco smoke, studies on the exposure of Portuguese children to second-hand smoke are rare. Thus, a piece of research focusing on the study of children’s exposure to second-hand smoke at home was carried out. To fulfill the objectives of the research, in 2003 a questionnaire was handed out to 1141 portuguese students (562 girls and 579 boys) from seven junior high secondary schools (12-16 years students) located in the area of Braga. The results show that a high percentage (38%) of students is exposed to environmental tobacco smoke due to the fact that close relatives (father, mother or sibling) smoke at home. The results of this study, together with the scientific evidence available, indicate that a high percentage of parents who smoke daily or occasionally at home put their children at serious health risk

Childhood lead exposure in Oporto, Portugal.

The study aims were to evaluate childhood lead poisoning in Oporto, Portugal, characterize childhood exposures, find solutions to reduce them, and call the community's attention to the need for preventive measures. Children aged 1-5 years living in Oporto Historical Center, were the target population. Data were gathered by means of a questionnaire and blood lead analyses for 240 children who attended four randomly selected kindergartens. The geometric mean blood lead concentration was 13.9 microg/dl and lead poisoning prevalence (blood lead levels > 10 microg/dL) was 85.8%. Important sources of lead poisoning were father's occupation, mother's smoking habits, and poor hygiene and pica associated with contaminated soils and lead paint. Families were unaware of the problem of lead exposure and its harmful effects. The data indicate that high levels of childhood lead exposures still prevail in Oporto City, an important public health finding that deserves authorities' attention.

[Prevalence of cutaneous lesions in Freixo de Espada à Cinta]. / Prevalência das lesôes cutâneas em Freixo de Espada à Cinta.

Incidence or prevalence studies on cutaneous lesions in general populations are not available. The community observed by the authors (Freixo de Espada à Cinta, North-Eastern Portugal) is relatively closed. A pre-tested questionnaire for socio-demographic and clinical information was used and a physical observation was conducted in January and February 1994 by the Dermatology Team of Santo António General Hospital, Oporto. The analysis was supported by independent tests (Pearson and Fisher chi 2, Student-t, Mann-Whitney and Kruskall-Wallis). The Spearman correlation coefficient was also used. The results indicated that 51.9% of 1000 subjects analysed were in phototype III. Concerning specific pathologies, the following percentages were observed: melanocytic nevi 81.2; hemangiomas 26.5; androgenetic alopecia 20.5; deshydrotic eczema 12.7; seborrheic keratosis 11; solar keratosis 9.6; acne vulgaris 9.5; seborrheic dermatitis 6.9; superficial mycosis 6.4; other dermatitis 5.5; vascular spiders 4.4; vulgar psoriasis 1.9; vulgar warts 1.5; pediculosis and scabiosis 1.2.; herpes simplex 0.9; impetigo 0.7; tumours (neoplasias) 0.7; dysplastic nevi 0.6; urticaria 0.3. More than nine nevi were counted in 50% of the subjects observed. A difference was observed (p < 0.05) concerning the presence of nevi, mycosis, hemangiomas, non-specific dermatitis, vascular spider and solar keratosis according to sex. The females had more nevi in number than males (Mann-Whitney, p = 0.03). According to age there was a difference concerning the presence of nevi, superficial mycosis, deshydrotic eczema, seborrheic dermatitis, acne, psoriasis, tumours, hemangiomas, non-specific dermatitis, vascular spider, solar keratosis (with linear augmentation by age) and seborrheic keratosis. Nevi increased with ageing (Rs = 0.10 p < 0.001) and a greater number were observed in age groups 0-9 and 60 or more years. Acne was observed in 9.4% of the females and 9.7% of the males, 46.2% in the 15-29 year-old age group. This study indicated that the population had a mean of nine nevi. Psoriasis was similar to that mentioned in other studies: about 1% in the United States of America. Atopic dermatitis (5.5%) is below the values for the northern population (> = 15%), but above that indicated for the English and American population. Nevertheless, the values of the present study were higher than those in the latter populations, when children until seven years old were considered. The Freixo de Espada à Cinta population above 60 years had solar keratosis in 30.6%, a value three times higher than the previous decade (10.9%); reference values were not found. Contrary to the literature, an association was not established between phototype and solar keratosis. Cutaneous tumours were observed in 0.7% of the cases.

Post-natal depression in an urban area of Portugal: comparison of childbearing women and matched controls.

The point prevalence of depression measured on one occasion between 2 and 5 months after childbirth was estimated to be 13.1% in 352 mothers living in urban Portugal; the criterion was a score of 13 or more on a translated version of the Edinburgh Post-natal Depression Scale (EPDS). More detailed comparisons were made between a subgroup of 118 mothers and 118 matched controls who had not borne a child in the previous 2 years. Post-natal women were twice as likely as non-childbearing controls to meet the EPDS criterion for depression In comparison with controls, they were also more severely depressed as judged by their total scores on another questionnaire, the Zung Scale. Comparisons of individual symptom scores (Zung Scale) showed that childbearing women, as a whole, reported more somatic symptoms than controls, but when only those women judged to be depressed or dysphoric by the EPDS were compared, this difference disappeared. Stepwise logistic analyses of symptoms contributing to the categorization of a 'case' of post-natal versus non-post- natal depression did not reveal any very clear divergences in self-reported psychopathology. In childbearing women, two factors were found significantly to contribute to higher depression scores; women with more children and those from lower socio-economic groups were most at risk.

[Children and lead exposure. Preliminary study]. / A criança e a exposição a chumbo. Inquérito preliminar.

UNLABELLED: Lead poisoning is one of the most common and preventable childhood illness. The authors believe that the present study is the first evaluation of this problem in Portugal. OBJECTIVES: a) to characterize blood lead levels in children aged 1 to 6 years living in the Oporto area; b) to identify risk groups and develop screening strategies. MATERIAL AND METHODS: The authors studied an opportunistic sample of children that were observed at the Hospital Maria Pia and the Instituto Nacional de Saúde Dr. Ricardo Jorge (Porto) to whom blood testing was requested. All children with neurological or digestive symptoms were excluded (October-December 1991; n = 113). RESULTS: One child had a blood lead level of 46.6 micrograms/dl (class-IV, CDC); 32% (n = 36) were between 20 e 44 micrograms/dl (class-III), while only four children (3.2%) presented values < = 9 micrograms/dl (class-I). Class II included the remainder (n = 73). The results clearly point out that lead poisoning is a real problem among Portuguese children, since the proportion of children not considered to be lead-poisoned is very small. Children in the other classes are at risk of developing acute and chronic toxicity.

Headaches in medical school students.

Medical students of the Instituto de Ciências Biomédicas 'Abel Salazar' at the University of Oporto were interviewed using a structured headache questionnaire in order to assess the prevalence and characteristics of headaches in a young adult university population. This was the first population-based study of headaches in Portugal. 491 students were questioned. The parameters evaluated included age, sex, headache characteristics (frequency, localization, severity, duration), premonitory and associated symptoms and family history. Headaches were classified using the Ad Hoc Committee (1962) and the International Headache Society (1988) criteria. There was a high prevalence of overall headaches in this young population. The results of the application of these two types of criteria to the same population showed for the most prevalent forms, migraine and tension-type headaches, a prevalence that depends on the classification adopted and the number of criteria items considered. If all (9 items) were used, the statistics obtained for migraine were 6.9% (Ad Hoc) and 6.1% (IHS), an insignificant difference, and for tension-type headache 14.3% (Ad Hoc) and 16.0% (IHS), which corresponds to a significant difference (p = 0.0129, McNemar test). It is concluded that IHS classification criteria identify less cases of migraine and more cases of tension-type headaches, which means a higher specificity for migraine and a higher sensitivity for tension-type headache.

[Incidence of and mortality from malignant tumors inthe municipality of++Vila Nova de Gaia: 1981-1987]. / Incidência e mortalidade por tumores malignos no Concelho de Vila Nova de Gaia: 1981-1987.

Data from the population based Cancer Registry of Vila Nova de Gaia for the 1981-1987 period are presented. Cancer is becoming a disease increasingly frequent in Portugal, causing progressively higher mortality rates. Population and geographic characteristics of Vila Nova de Gaia country is presented. Information sources of this Registry are hospitals, pathology labs, Health Authority files and death certificates. Net (229.2, 216.6) and standardized for european population (369.9, 245.9) incidence rates are presented for respectively men and women. Comparisons with registries from other countries (e.s.) are made.