Complicações em Serviços de Hemodinâmica ­ como agir / Complications in Cath Lab ­ how to bail out

Vários fatores, incluindo intervenções terapêuticas aprimoradas e tecnologias avançadas, levaram a melhores desfechos clínicos nas intervenções coronárias percutâneas complexas. No entanto, ainda podem ocorrer complicações capazes de impactar negativamente na sobrevida do paciente e nos custos de saúde. O risco dessas complicações pode ser reduzido, por meio de operadores experientes e procedimentos preventivos. Este artigo discute uma série de casos de cinco pacientes com problemas específicos relacionados aos procedimentos, como perfuração coronária, dissecções, fechamento abrupto das coronárias e fenômeno de no-reflow.

Various factors, including improved therapeutic interventions and advanced technologies, have led to better clinical outcomes for complex percutaneous coronary interventions. However, complications can still occur and have a negative impact on patient survival and healthcare costs. The risk of these complications can be reduced through experienced operators and preventative procedures. This article discusses a case series of five patients with specific periprocedural issues, such as coronary perforation, dissections, abrupt closure of the coronaries, and no-reflow phenomenon.

Meta-analysis of ProGlide versus MANTA vascular closure devices for large-bore access site management

Introduction: The comparative effectiveness of ProGlide® compared with MANTA® vascular closure devices (VCDs) in large-bore access site management is not entirely certain, and has only been evaluated in underpowered studies. This meta-analysis aimed to evaluate the outcomes of ProGlide® compared with MANTA® VCDs. Methods: PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched systematically for relevant articles from the inception of the database until August 27, 2021. The outcomes of interest were all bleeding events, major bleeding, major and minor vascular complications, pseudoaneurysm, stenosis or dissection, and VCD failure. Risk ratios were used as point estimates of endpoints. All statistical analyses were carried out using R version 4.0.3. Results: Four observational studies and 1 pilot randomized controlled trial (RCT) were included in the final analysis. There was no significant difference between the ProGlide® and MANTA® groups in the risk of all bleeding events, major/life-threatening bleeding, major vascular complications, minor vascular complications, pseudoaneurysms, and/or stenosis or dissection of the entry site vessel. However, the incidence of VCD failure was higher in the ProGlide® group compared with the MANTA® group (RR 1.94; 95% CI 1.31e2.84; I2 ¼ 0%). Conclusion: In conclusion, both VCDs (ProGlide® and MANTA®) have comparable outcomes with regard to risk of bleeding, vascular complications, pseudoaneurysms, and/or stenosis or dissection of entry vessel. ProGlide® was however associated with higher device failure.

Neonatal mid upper arm circumference as surrogate of birth weight

Background: Recording an accurate birth weight by primary health worker has been a problem in rural areas, leading to search for an alternative, inexpensive, age independent and noninvasive method to predict newborn birth weight and wellbeing. With this background I aimed to found out whether the neonatal-MUAC is associated with birth weight or not?Methods: This hospital based prospective observational study was conducted in SNCU and postnatal ward, Kamla Raja Hospital, G.R. Medical College, and Gwalior (M.P). A total of 1303 newborns were included in the study. The Mid upper arm circumference (MUAC) of newborns were taken and Birth weight recorded were filled in a proforma.Results: Total 1303 neonates were evaluated. The mean MUAC and birth weight in preterm was found to be 1854.80'387.3 and 7.47'0.9 as compared to full term newborn having mean birth weight(2818.95'328.1) and mean MUAC (9.58+0.7).The Pearson coefficient of correlation between neonatal MUAC (N-MUAC) and birth weight was found to be r= 0.987 and p<0.01. Birth weight can be predicted from regression equation: Birth weight (gms)=422.99 (N-MUAC) + (-1272.66). Cut-off value of neonatal mid upper arm circumference (N-MUAC) was found to be 8.85cm to predict low birth weight newborn.Conclusions: Birth weight of newborn can be predicted from neonatal mid upper arm circumference (N-MUAC) in areas where the conventional scale are not easily available for measuring the birth weight of newborn.

Correlation of Clinical Parameters with Spirometry Findings in Patients of Chronic Obstructive Pulmonary Disease (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is major cause of mortality & morbidity all over the world significantly affecting Quality of life of all the affected individuals and it also causes economic as well as social burden on society. COPD at present is the 4th leading cause of death worldwide, and is suspected to become 3rd leading cause of death worldwide by 2020. COPD diagnosis is confirmed by post bronchodilator FEV1 / FVC ratio < 0.70. In the present study, we wanted to examine the relationship between the history, clinical indices and spirometry in patients of COPD. Methods: Study was done in the department of pulmonary medicine on 50 patients of COPD, randomly selected after taking inclusion and exclusion criteria under consideration. Results: >80% of the patients were in age group of 40-70 years and mean age of presentation was 57.6 years. Smoking was present as risk factor in 62%. Most of the patients (42%) were under GOLD stage 3 followed by stage 4 (36%), stage 2 (22%) and no patients in stage 1. Duration of illness among patients ranged from 1 month to 40 years, with a mean of 7.4 years. As per new GOLD 2019 grouping criteria, maximum participants were in group B (78%), followed by group D (20%) and group A (2%). 24 out of 50 patients were in 19-25 BMI (normal) group, followed by 20 patients under <19 (low BMI) group and then 6 in >25 BMI group. We found statistically significant correlations between: FEV1/FVC ratio, MEF 25-75 and Age; between FVC and sexual difference;FEV1, FVC and MMRC Grading. Conclusion: PFT is an important tool for measuring degree of involvement of lung parenchyma in cases of COPD. It is affected by various factors, therefore a thorough history is important for assessment of level of involvement as well as for planning further management of patients.