Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience.

INTRODUCTION: Commonly used chronic limb-threatening ischemia (CLTI) classifications lack granularity and detail to precisely stratify patients according to risk of limb loss, expected revascularization benefit and mortality. The aim of this study is to evaluate in a Portuguese population the prognostic value of an updated CLTI classification based on Wound, Ischemia, and foot Infection (WIfI) proposed by the Society for Vascular Surgery. MATERIALS AND METHODS: Single-center retrospective evaluation of prospectively collected data of consecutive patients with CLTI submitted to lower limb revascularization from January to December of 2017. All consecutive patients with chronic peripheral artery disease with ischemic rest pain or tissue loss were included. The exclusion criteria were patients with intermittent claudication, vascular trauma, acute ischemia, non-atherosclerotic arterial disease and isolated iliac intervention. The primary end-point was major limb amputation, mortality and amputation-free survival (AFS) at 30 days, 1 year and 2 year follow-up. Secondary end-points were minor amputation, wound healing time (WHT) and rate (WHR). RESULTS: A total of 111 patients with CLTI were submitted to infra-inguinal revascularization: 91 endovascular and 20 open surgery. After categorizing them according to the WIfI: 20 had stage 1 (18.52%), 29 stage 2 (26.85%), 38 stage 3 (35.19%) and 21 stage 4 (19.44%). Overall mortality rate was 1.8%, 17% and 22.3% at 30 days, 1 year and 2 years follow-up. Major amputation rate was 0.9%, 2.7% and 2.7% at 30 days, 1 year and 2 years follow-up. AFS rate was 97.3%, 82.1%, and 76.8% at 30 days, 1 year, 2 years follow-up. In multi-variable analysis, higher WIfI score was the only predictive factor for mortality and AFS. WIfI 3 and 4 were also associated with increased risk of non-healing ulcer. CONCLUSION: This study proved the prognostic value of the WIfI classification in a Portuguese population by showing an association between higher scores and increased mortality, lower AFS and non-healing ulcer.

Evaluation of the Cytotoxic and Antiviral Effects of Small Molecules Selected by In Silico Studies as Inhibitors of SARS-CoV-2 Cell Entry.

The spike protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relies on host cell surface glycans to facilitate interaction with the angiotensin-converting enzyme 2 (ACE-2) receptor. This interaction between ACE2 and the spike protein is a gateway for the virus to enter host cells and may be targeted by antiviral drugs to inhibit viral infection. Therefore, targeting the interaction between these two proteins is an interesting strategy to prevent SARS-CoV-2 infection. A library of glycan mimetics and derivatives was selected for a virtual screening performed against both ACE2 and spike proteins. Subsequently, in vitro assays were performed on eleven of the most promising in silico compounds to evaluate: (i) their efficacy in inhibiting cell infection by SARS-CoV-2 (using the Vero CCL-81 cell line as a model), (ii) their impact on ACE2 expression (in the Vero CCL-81 and MDA-MB-231 cell lines), and (iii) their cytotoxicity in a human lung cell line (A549). We identified five synthetic compounds with the potential to block SARS-CoV-2 infection, three of them without relevant toxicity in human lung cells. Xanthene 1 stood out as the most promising anti-SARS-CoV-2 agent, inhibiting viral infection and viral replication in Vero CCL-81 cells, without causing cytotoxicity to human lung cells.

Predicting and explaining absenteeism risk in hospital patients before and during COVID-19.

In order to address one of the most challenging problems in hospital management - patients' absenteeism without prior notice - this study analyses the risk factors associated with this event. To this end, through real data from a hospital located in the North of Portugal, a prediction model previously validated in the literature is used to infer absenteeism risk factors, and an explainable model is proposed, based on a modified CART algorithm. The latter intends to generate a human-interpretable explanation for patient absenteeism, and its implementation is described in detail. Furthermore, given the significant impact, the COVID-19 pandemic had on hospital management, a comparison between patients' profiles upon absenteeism before and during the COVID-19 pandemic situation is performed. Results obtained differ between hospital specialities and time periods meaning that patient profiles on absenteeism change during pandemic periods and within specialities.

PERCUTANEOUS MECHANICAL THROMBECTOMY IN PHLEGMASIA CERULEA DOLENS: CASE REPORT AND LITERATURE REVIEW.

INTRODUCTION: Phlegmasia cerulea dolens is a potentially life-threatening complication of deep venous thrombosis, causing marked swelling and sudden severe pain in the limb, associated with cyanosis, edema and compartment syndrome that together compromise arterial supply. There is no consensus on its treatment. CASE REPORT: A 36-year-old woman, with a history of cosmetic surgery 8 days before admission (abdominal liposuction), was admitted to the emergency department with edema, cyanosis, severe pain, decreased temperature and tenderness of the left lower limb. At physical exam, no distal pulses on the left lower limb were found. Angio-CT was performed, showing occlusion of left femoral vein, external and common iliac veins. The patient started treatment with enoxaparin (80 mg, subcutaneous, bid) and percutaneous mechanical thrombectomy (PMT) of the left iliac vein sector was performed, followed by balloon angioplasty and stenting of the left iliac vein sector. It was also deployed a temporary filter in the inferior vena cava. Thrombophilic workup was negative. The patient presented thorough clinical remission after the procedure (Villalta score 0). Two years after surgery, the patient is asymptomatic, and the Doppler ultrasound is unremarkable concerning morphologic changes throughout the left iliac vein sector. CONCLUSION: The treatment of phlegmasia cerulea dolens is challenging due to its severity and poor prognosis. Minimally invasive procedures, such as PMT can be an alternative to open surgery. It can also avoid the use of thrombolytics in patients with relative / absolute contraindications to its use.

ENDOVASCULAR PROCEDURES FOR LOWER LIMB PERIPHERAL ARTERIAL DISEASE IN AN AMBULATORY UNIT.

OBJECTIVES: To analyse the safety and outcomes of endovascular procedures in an ambulatory practice. METHODS: Data were collected from a cohort of patients admitted in an ambulatory unit for an endovascular procedure for lower limb (LL) arterial occlusive disease during a one year period. RESULTS: A total of 168 procedures were carried out in 134 patients. Patients' mean age was 67 (39-91) years and 78% were male. Most patients presented with lower limb ulcer or gangrene (43%) or disabling claudication (40%). Most frequent comorbidities included hypertension (75.4%), dyslipidemia (72.4%) and diabetes mellitus (57.5%). The preferred vascular access for the procedures was the common femoral artery (52%), superficial femoral artery (24%) and humeral artery (21%). Global complication rate was 19% but only one major, non-fatal complication was identified. The most common complication was arterial dissection (8.3%), none compromising blood flow. One-year amputation rate was 6.7%, and one-year mortality was 3.0%. Factors significantly associated with procedure complications were female sex, hypertension and dyslipidemia. CONCLUSION: Ambulatory endovascular procedures for PAD are safe and effective in selected patients. Both the low rate and low severity of complications make them an attractive option in the prospect of diminishing the burden of these patients on the health-care system while improving patient comfort.

SUPERFICIAL FEMORAL ARTERY OPPORTUNISTIC STUMP.

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Xanthenes in Medicinal Chemistry - Synthetic strategies and biological activities.

BACKGROUND: Xanthenes are a special class of oxygen-incorporating tricyclic compounds. Structurally related to xanthones, the presence of different substituents in position 9 strongly influences their physical and chemical properties, as well as their biological applications. This review explores the synthetic methodologies developed to obtain 9H-xanthene, 9-hydroxyxanthene and xanthene-9-carboxylic acid, as well as respective derivatives, from simple starting materials or through modification of related structures. Azaxanthenes, bioisosteres of xanthenes, are also explored. Efficiency, safety, ecological impact and applicability of the described synthetic methodologies are discussed. Synthesis of multi-functionalized derivatives with drug-likeness properties are also reported and their activities explored. Synthetic methodologies for obtaining (aza)xanthenes from simple building blocks are available, and electrochemical and/or metal free procedures recently developed arise as greener and efficient methodologies. Nonetheless, the synthesis of xanthenes through the modification of the carbonyl in position 9 of xanthones represents the most straightforward procedure to easily obtain a variety of (aza)xanthenes. (Aza)xanthene derivatives displayed biological activity as neuroprotector, antitumor, antimicrobial, among others, proving the versatility of this nucleus for different biological applications. However, in some cases their chemical structures suggest a lack of pharmacokinetic properties being associated with safety concerns, which should be overcome if intended for clinical evaluation.

[Deep Venous Thrombosis as the First Manifestation of Hibernoma - Clinical Case]. / Trombose Venosa Profunda como Primeira Manifestação de Hibernoma - Caso Clínico.

We present a 36 year-old female patient with a popliteo-femoral deep vein thrombosis whose further workup revealed a thigh tumor later diagnosed as hibernoma. Hibernoma is a very rare benign tumor stemming from vestigial remnants of fetal brown adipose cells, usually disclosed as a slow and painless growing, mass. It is impossible to distinguish it on clinical grounds from the more aggressive and ominous liposarcoma.

Mulher de 36 anos referenciada à consulta de Cirurgia Vascular por trombose venosa profunda poplíteo-femoral a quem, no seguimento do estudo, foi detetada uma neoplasia da coxa depois diagnosticada como sendo um hibernoma. O hibernoma é um tumor muito raro, benigno, com origem em tecido embrionário remanescente adiposo castanho, com um crescimento lento e indolor.¹ As suas características tornam-no impossível de diferenciar de outra entidade mais agressiva denominada lipossarcoma.².

BACE-1 and γ-Secretase as Therapeutic Targets for Alzheimer's Disease.

Alzheimer's disease (AD) is a growing global health concern with a massive impact on affected individuals and society. Despite the considerable advances achieved in the understanding of AD pathogenesis, researchers have not been successful in fully identifying the mechanisms involved in disease progression. The amyloid hypothesis, currently the prevalent theory for AD, defends the deposition of ß-amyloid protein (Aß) aggregates as the trigger of a series of events leading to neuronal dysfunction and dementia. Hence, several research and development (R&D) programs have been led by the pharmaceutical industry in an effort to discover effective and safety anti-amyloid agents as disease modifying agents for AD. Among 19 drug candidates identified in the AD pipeline, nine have their mechanism of action centered in the activity of ß or γ-secretase proteases, covering almost 50% of the identified agents. These drug candidates must fulfill the general rigid prerequisites for a drug aimed for central nervous system (CNS) penetration and selectivity toward different aspartyl proteases. This review presents the classes of γ-secretase and beta-site APP cleaving enzyme 1 (BACE-1) inhibitors under development, highlighting their structure-activity relationship, among other physical-chemistry aspects important for the successful development of new anti-AD pharmacological agents.

Characterization of Eucalyptus, Chestnut and Heather Honeys from Portugal Using Multi-Parameter Analysis and Chemo-Calculus.

The present study was conducted to evaluate the quality and bio-functional properties of Portuguese honeys of different botanical and geographical origins. Quality parameter analyses included the determination of palynological (predominant, secondary, minor and isolated pollen percentage), physicochemical (°Brix, moisture content, pH, electrical conductivity, free acidity, total dissolved solids, salinity, vitamin C content and specific weight) including colour-metrics (CIELAB, Pfund and colour intensity determinations), along with volatile compounds identification using solid phase micro-extraction coupled to gas chromatography mass spectrometry. Bio-activity parameter analysis included the determination of in vitro antioxidant activity and total phenolic content using the 2,2-diphenyl-1-picryl-hydrazyl and Folin-Ciocalteu assays, respectively. Melissopalynological analysis showed that Portuguese honeys were classified as eucalyptus, chestnut and heather, recording significant variations (p < 0.05) among physicochemical, volatile and bio-activity parameter analyses according to both: botanical and geographical origin. Based on the multi-parameter analysis data Portuguese honeys could be characterized by a distinctive colour, a characteristic aroma, whereas conform to the European legislation relating to honey identity and quality. Specific attention should be given in the case of heather honey which showed the highest in vitro antioxidant activity and total phenolic content. Parameters that were also highly correlated using bivariate statistics.

[Benign Presentation of a Potentially Fatal Disease]. / Ateroembolismo cutâneo: relato de três casos clínicos.

Atheroembolism is a rare multisystemic disorder that is characterized by release of cholesterol crystals and particles from atheromatous plaques, which can occlude distal vessels and induce an inflammatory response. Most affected individuals are males, older than 60 years of age, with advanced atherosclerotic disease. The abdominal aorta is the most common origin of cholesterol emboli, being the peripheral arteries a rarer source. Cholesterol embolization syndrome is often associated with invasive vascular procedures, although, more rarely, it may occur spontaneously. In this paper, the authors present three cases of spontaneous atheroembolism with cutaneous manifestations and their clinical management. Being an underdiagnosed pathology, knowledge about its clinical manifestations is essential in order to allow an early diagnosis and treatment, to ensure a better prognosis for the patient.

O ateroembolismo é uma doença multissistémica rara caraterizada pela libertação de cristais de colesterol e partículas de placas ateroscleróticas, que podem ocluir vasos sanguíneos periféricos e induzir uma resposta inflamatória. A maioria dos indivíduos afetados é do sexo masculino, com idade superior a 60 anos e doença aterosclerótica avançada. A origem mais frequente de embolização de colesterol é a aorta abdominal, sendo as artérias periféricas uma fonte mais rara. A síndrome de embolização por colesterol surge frequentemente associada a procedimentos vasculares invasivos, embora, mais raramente, possa ocorrer de forma espontânea. Neste artigo os autores apresentam três casos clínicos de ateroembolismo espontâneo com envolvimento cutâneo e respetiva abordagem clínica. Sendo uma patologia subdiagnosticada, torna-se fundamental o conhecimento acerca das suas manifestações clínicas, para permitir um diagnóstico e tratamento precoces de forma a garantir um melhor prognóstico para o doente.

Dynamic flow-through approach to evaluate readily bioaccessible antioxidants in solid food samples.

Release of bioactive compounds from food matrices is regarded as the first step towards their human bioavailability. The objective of this work was the implementation of an affordable and robust flow-through device for expedient dynamic leaching experiments aiming at the assessment of readily bioaccessible antioxidant compounds in solid food commodities. A simple configuration is proposed using commercially available devices containing regenerated cellulose filters placed in polypropylene holders to entrap the solid sample, featuring a disposable, single use extraction chamber. The kinetic extraction profile of fast leachable antioxidants from different food matrices was evaluated using the ABTS (2,2'-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid)) assay, fitting a first-order reaction model for readily bioaccessible compounds (R>0.9). The leaching rate constant values associated to the fast leachable antioxidant compounds were 0.060-0.446min-1 and 0.105-0.210min-1 for water and ethanol/water (1:1, v/v) applied as extractants, respectively. Furthermore, no statistically significant differences were found between the estimated values of bioaccessible antioxidant compounds by the kinetic model and the values attained using conventional batch-wise extraction methodology, ranging from 3.37 to 60.3 µmol of Trolox ((±)-6-hydroxy-2,5,7,8-tetramethylchromane-2-carboxylic acid) per g of sample. Extension of the method using U. S. Pharmacopeia surrogate biological media (stomach (pH 1.2) and intestinal (pH 7.5) fluids without enzymes) to NIST-1570a spinach leaves provided gastrointestinal compartment-dependent kinetic leaching rates (0.120 and 0.198min-1, respectively) and total antioxidant content (45.5 and 52.5µmol of Trolox per g of sample, respectively).

Deep Vein Thrombosis as First Manifestation of Hibernoma - A Case Report.

INTRODUCTION: Hibernoma is a very rare benign tumor that arises from vestigial remnants of fetal brown adipose cells and usually manifests as a slowly growing, painless soft-tissue mass. It mainly occurs in adults, in the third and fourth decade of life, slightly more in women and is commonly seen in the subcutaneous regions of the back, neck, thighs and retroperitoneum. It was originally described in 1906 by Merkel, who named it "pseudolipoma". In 1914, Gery derived the name hibernoma from the tumor's histological similarity to brown fat in hibernating animals. A hibernoma may be confused with a lipoma clinically and cannot be completely distinguished from hypervascular lesions such as lipossarcoma. METHODS: A 36-year-old woman presented with pain and edema of the left leg. It was diagnosed with non-recent femoro- -popliteal venous thrombosis, was medicated with rivaroxaban and prescribed compression stocking. RESULTS: The edema subsided after 2 weeks but she still complained of pain in the thigh several weeks after first visit along with subtle localized soft enlargement in the upper thigh. It was requested a CT scan that showed a nodular image with 60X 47 mm medially to vastus intermedius and beneath the sartorius and rectus femoris muscles, which was suspected to be a lipossarcoma. In this context, a magnetic ressonance imaging was requested and showed contact with femoral vessels with no cleavage plan, suspected to be a mixoid lipossarcoma. The biopsy didn't show malignancy. She was operated with local excision of the mass and preservation of adjacent structures. Pathologic evaluation revealed a hibernoma with 11.5 cm, PS100 positive and MDM2 negative. The patient was evaluated at outpatient clinic 6 months after surgery and had no evidence of relapse. CONCLUSION: The first clinical manifestation of this patient was a deep vein thrombosis and the diagnosis of the lipomatous tumor was delayed. Clinical awareness of less frequent causes of DVT is a key point to timely detection of this lesions that are rare and curable. The increased vascularity of this lesion raised suspicion of malignancy. Malignancy potential is perhaps the most difficult aspect to ascertain in this patient, being only completely disclosed after surgical excision. Optimal treatment is complete surgical resection. Local recurrence does not occur with complete excision. No reports of metastases of malignant transformation have been identified in the reviewed literature.

[Endovascular Revascularization for Diabetic Foot Ulcer - Experience from a Dedicated Clinic]. / Revascularização Endovascular na Úlcera de Pé Diabético ­ experiência de uma Consulta Multidisciplinar.

OBJECTIVES: We aimed to assess the outcome of endovascular revascularization in Diabetic patients with Fontaine stage IV chronic ischaemia, at our Diabetic Foot Clinic. Primary outcomes were ulcer healing, major amputation and limb salvage. METHODS: Retrospective single center analysis of patients treated between January 2009 and May 2015. Time-dependent event rates were estimated by the Kaplan-Meier method. The differences between groups were evaluated with the chi-square test. A P value below 0,05 was considered statistically significant. RESULTS: There were 106 limbs (93 patients) revascularized during the study. The average age was 71 years, and PEDIS 3 or 4 infection was present in 45.3% on admission. 56.6% were treated for femoropopliteal injurie only, 17% infrapopliteal, and 26.4% for both levels. Technical success was achieved in 77.4%, and haemodynamic success in 58.3%. Ulcer healing was attained in 53.8%, with an average healing time of 8.4 months. The major amputation rate was 7.5%, with a limb salvage rate of 90.4% at 6, 12 and 24 months. Chronic pulmo- nary disease decreased the likelihood of healing (p=0,012). Restenosis was more likely to occur in patients with nephropathy (p=0,008) or insulin-treated diabetes (p=0,033). CONCLUSIONS: Dedicated multidisciplinary teams are key to successful treatment in diabetic foot disease. The good results achieved in our series arise from best medical treatment combined with timely revascularization in those ischemic.

Objetivos: Avaliar os resultados da revascularização endovascular em diabéticos com isquemia crónica grau IV de Lériche- -Fontaine, seguidos em Consulta Multidisciplinar de Pé Diabético na nossa instituição, relativamente a taxa de cicatrização, amputação major e salvamento de membro. Material e Métodos: Análise retrospetiva dos doentes tratados no período de janeiro de 2009 até maio de 2015. As taxas de eventos dependentes do tempo foram estimadas com recurso a curvas de Kaplan-Meier e as diferenças entre grupos investigadas pelo teste de qui-quadrado. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados: No período analisado foram revascularizados 106 membros (93 doentes). A idade média foi 71 anos, sendo que 45,3% apresentavam infeção PEDIS 3 ou 4 na apresentação. Das lesões intervencionadas, 56,6% eram suprageniculares, 17% infrageniculares, e 26,4% foram intervencionados nos dois setores. Foi obtido sucesso técnico em 77,4% e sucesso hemodinâmico em 58,3%. Foi conseguido o encerramento da úlcera em 53,8%, com tempo médio de cicatrização de 8,4 meses. A taxa de amputação major foi de 7,5%, verificando-se uma taxa de salvamento de membro de 90,4% aos 6, 12 e 24 meses. A doença pulmonar crónica influenciou negativamente a probabilidade de cicatrização (p=0,012). A reestenose foi mais frequente em doentes com nefropatia (p=0,008) ou DM insulino-tratada (p=0,033). Conclusões: A existência de equipas multidisciplinares dedicadas ao Pé Diabético são fundamentais para o sucesso do tratamento. Os bons resultados obtidos resultam da melhor otimização do tratamento médico combinada com a revasculari- zação no doente isquémico, associado a um seguimento apertado e à reintervenção precoce quando clinicamente justificado.

[Deep vein thrombosis in the pediatric population - a rare entity of uncertain prognosis]. / Trombose Venosa Profunda na População Pediátrica ­ Entidade Rara de Prognóstico Incerto.

Deep vein thrombosis, whose prevalence remains unknown in the pediatric population, is an increasingly common diag- nosis in this age group. This increased incidence makes the post-thrombotic syndrome a likely long-term complication, so there is a critical need to establish high quality evidence over its suitable approach in this population. We present two cases of deep vein thrombosis in children and their management in a hospital of the northern region of Portugal, reviewing the literature on this under researched subject. In conclusion, further investigation is needed to assess the incidence, the prevalence, the predictors and the safety and efficacy of therapies for the prevention and appropriate treatment of deep vein thrombosis in children and eventual post- -thrombotic syndrome.

A trombose venosa profunda, cuja prevalência permanece desconhecida na população pediátrica, é um diagnóstico cada vez mais frequente neste grupo etário. Este aumento de incidência faz da síndrome pós-trombótica uma complicação provável a longo prazo, existindo uma necessidade crítica em estabelecer evidência de alta qualidade sobre a sua adequada abordagem nesta população. São apresentados dois casos clínicos pediátricos de trombose venosa profunda, e respetiva abordagem, num hospital da região Norte de Portugal. Em seguida, procede-se à discussão e revisão da literatura sobre o assunto. Em conclusão, são necessários estudos que avaliem a incidência, a prevalência, os fatores preditivos e a segurança e a eficácia de terapias para a prevenção e o tratamento adequados da trombose venosa profunda e da possível futura síndrome pós-trombótica associada em crianças.

[An uncommon cause of lower limb oedema - Case report]. / Causa Incomum De Edema Do Membro Inferior - Caso Clínico.

The authors report the clinical case of a 50-year-old man who was observed in the emergency department because of a one week long, painless left lower limb swelling. At presentation, a gross edema was evident and peripheral pulses were present and symmetrical. The ultrasound scan findings suggested short occlusion in the transition of the common femoral (CFV) to the external iliac veins. A venography confirmed a filling defect in the above mentioned location, with normal findings throughout proximal and distal veins. On CT scans a cyst measuring 20mm of maximal diameter was disclosed, medial to the common femoral artery, compressing the CFV and seemingly continuous to the hip joint. He underwent surgical correction through open inguinal approach that allowed to confirm a complete compression of the CFV by the cyst against the inguinal ligament. The CFV recovered its normal aspect after cyst, removal and the patient was discarded home at day 2 after surgery, with complete regression of the oedema wich is maintained one year after the event, as well as absence of local ultrasound abnormalities. The hip joint is a rare location for synovial cysts. Synovial or adventitial cysts in that area may compress de CFV. The histological tests are useless for distinguishing between the two diagnosis. The clinical presentation consists of an inguinal mass or lower limb oedema due to CFV compression. Given its location underneath the vein, these masses are often difficult to detect. Vein decompression is suggested to avoid deep vein thrombosis. When a synovial cyst is present it is possible to find a dissecting plane between the two anatomical structures. Though feasible, percutaneous cyst aspiration is linked to high recurrence rates.

[Aneurysmal degeneration of a saphenous vein graft - Case report]. / Degenerescência Aneurismática De Conduto De Veia Safena - Caso Clínico.

Non-anastomotic degeneration of venous conduits is a rare condition, and its etiology is not fully understood. We report the clinical a case of an aneurysmal degeneration of a femoropopliteal bypass vein graft, undertook 19 years earlier for traumatic injury of the popliteal artery of the left lower limb. Following the resection of the aneurysm, a new femoro-tibioperoneal trunk vein graft was implanted. The choice of a new autologous graft was made based on the young age of the patient and the best outcomes in the long term, related to this conduits.

Qual a potência do apoio institucional no campo da saúde pública? / What is the potential of institutional support for the public health field? / Cual es la potencia del apoyo institucional en el campo de la salud pública?

O presente artigo discute o “apoio institucional” como um dispositivo para promover políticas públicas de saúde. Dialogando com as ferramentas conceituais formuladas por Deleuze, Guattari, Foucault e Spinoza, distinguimos apoio extensivo e intensivo, postulando o último como uma escolha ético-política de apoio aos movimentos coletivos de produção de processos instituintes. Para isso, propomos interferir nas formas de viver por meio das ferramentas-conceitos de “interferência” e “vida”. Procuramos infundir a potência de invenção de dispositivos coletivos no apoio institucional...

The present paper discusses ‘institutional support’ as a device for fostering public health policies. In dialogue with the conceptual tools formulated by Deleuze, Guattari, Foucault and Spinoza, we distinguish extensive and intensive support, and argue that the latter is an ethical-political choice to support collective movements that produce instituting processes. To this end, we propose to meddle in the ways of living through the concept-tools of ‘interference’ and ‘life’. We seek to infuse the power of invention of collective devices into institutional support...

El presente artículo discute el “apoyo institucional” como un dispositivo para promover políticas públicas de salud. Dialogando con las herramientas conceptuales formuladas por Deleuze, Guattari, Foucault y Spinoza, distinguimos apoyo extensivo e intensivo, postulando el último como una elección ético-política de apoyo a los movimientos colectivos de producción de procesos instituentes. Para eso, proponemos interferir en las formas del vivir por medio de las herramientas-conceptos de “interferencia” y “vida”. Buscamos infundir la potencia de invención de los dispositivos colectivos en el apoyo institucional...

Recurrent carotid body tumors: embolization as a treatment option.

INTRODUCTION: We report a clinical case where transcatheter embolization was selected as the primary treatment for a large recurrent carotid body tumor CLINICAL CASE: A 55 year-old female presented with a painful left cervical mass, with progressive growth, for the past 12 months. She complained of jaw stiffness, odynophagia and dysphonia. She had a former history of bilateral carotid body tumor resection. The patient underwent carotid ultrasound examination that showed a recurrent left carotid body tumor with 7x5 cm in dimension, and occlusion of the left internal carotid artery. Magnetic resonance imaging confirmed the presence of a Shamblin type III tumor. The patient underwent transcatheter embolization of the tumor with 300-500 µm and 500-700 µm Bead-Block®. At 1 year of follow-up, the patient was found asymptomatic. DISCUSSION: The carotid body is located at the bifurcation of the common carotid artery. With increased size, carotid body tumors can induce significant symptoms and are usually detected by clinical examination. Confirmation of diagnosis is usually given by vascular ultrasound. For highly symptomatic, recurrent and frequently unresectable tumors--in patients unfit for surgery--transcatheter embolization can also be used as an effective palliative treatment.

[Deep Venous Thrombosis in Emergency Care: From Clinical Suspicion to Correct Diagnosis]. / Trombose Venosa Profunda dos Membros Inferiores no Serviço de Urgência: Da Suspeita Clínica ao Diagnóstico.

AIM: Retrospective analysis of suspected deep venous thrombosis (DVT) of the lower limbs admitted to an emergency unit and subsequently scanned in the vascular lab. METHODS: Clinical and demographic details of patients were retrieved from clinical files and collected in a database. The statistical software SPSS was used for statistical analysis. RESULTS: Between January 2011 and September 2013, 407 venous scans were performed for ruling out DVT. Two hundred sixty-nine (66%) patients were female. Average age was 60.1 years-old (16-93). One hundred thirty-four scans (32.9%) were positive for the diagnosis of recent DVT (simultaneous DVT and superficial thrombophlebitis in six patients of this group). In 194 exams (47.6%) there was any sign of venous thrombosis, whether recent or remote. The remaining cases showed up signs of remote DVT in 22 (5.4%) patients, and superficial thrombophlebitis in 50 (12.2%) patients. CONCLUSION: Suspected DVT was confirmed in only a third of patients, using ultrasound scan. Local implementation of guidelines for the evaluation of patients with suspected DVT may reduce the amount of unnecessary scans.