Hipertensión portal no cirrótica por enfermedad vascular porto-sinusoidal: presentación de un caso y revisión de la literatura / Non-cirrhotic portal hypertension due to porto-sinusoidal vascular disease: Case presentation and literature review

La enfermedad vascular porto-sinusoidal es una causa infrecuente de hipertensión portal no cirrótica, fue descrita recientemente y es poco diagnosticada por el desconocimiento entre los médicos. Se considera en casos de hipertensión portal clínicamente significativa, en ausencia de cirrosis. El diagnóstico se basa en los hallazgos de la biopsia. El pronóstico de la enfermedad es mejor que el de los pacientes cirróticos, y el tratamiento es similar al de la hipertensión portal y al de las complicaciones que presentan los pacientes con cirrosis. Se presenta el caso de una paciente con várices esofágicas con estudios de imágenes no compatibles con cirrosis y hallazgos específicos en la biopsia de enfermedad vascular porto-sinusoidal. Este caso muestra el ejercicio diagnóstico en un caso de enfermedad vascular porto-sinusoidal de una paciente de Colombia, así como el resultado de las intervenciones terapéuticas y la evolución en el tiempo.

Porto-sinusoidal vascular disease is an uncommon cause of non-cirrhotic portal hypertension. It was recently described and is rarely diagnosed due to lack of knowledge among doctors. It is considered in cases of clinically significant portal hypertension in the absence of cirrhosis, and the diagnosis is based on biopsy findings. The prognosis of the disease is better than that of cirrhotic patients, and the treatment is similar to that of portal hypertension, including the management of complications associated with cirrhosis. We present the case of a patient with esophageal varices, whose imaging studies were not compatible with cirrhosis, alongside specific biopsy findings of porto-sinusoidal vascular disease. This case illustrates the diagnostic process in a patient from Colombia with portosinusoidal vascular disease, as well as the outcomes of therapeutic interventions and the patient´s evolution over time.

Research advances in porto-sinusoidal vascular disease / 临床肝胆病杂志

Porto-sinusoidal vascular disease （PSVD） is a new disease nomenclature proposed in recent years， which is an important supplement to idiopathic non-cirrhotic portal hypertension. PSVD includes the patients with specific pathological conditions， but without portal hypertension symptoms， and the patients with portal vein thrombosis or viral hepatitis. This article elaborates on the naming， epidemiology， etiology， clinical manifestations， prognosis， and treatment of PSVD， in order to improve the understanding of this disease among clinicians.

Interpretation of key points of International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy(OMT)Intervention:International IFOMPT Cervical Framework / 中国组织工程研究

BACKGROUND:The evaluation and management of cervical vascular pathologies before orthopedic manual therapy have great significance for reducing risks,ensuring patients'interests and promoting optimal clinical decision-making.However,the research and exploration of this field in China are still in its infancy.In 2020,the International Federation of Orthopaedic Manipulative Physical Therapists(IFOMPT)released the International Framework for Examination of the Cervical Region for potential of vascular pathologies of the neck prior to Orthopaedic Manual Therapy(OMT)Intervention:International IFOMPT Cervical Framework(2020).This framework has important references and guiding values for the clinical practice of cervical manipulation in China. OBJECTIVE:To integrate and interpret the core content of the framework,to provide a reference for the clinical practice of cervical manual therapy in China. METHODS:On the basis of a full study of the framework,the authors interpret the core content of the framework from eight aspects including clinical reasoning,patient history,planning the physical examination,physical examination,risk and benefit.Meanwhile,seven databases including PubMed,EMbase,Cochrane Library,CNKI,WanFang,VIP and China Biomedical Literature Service System databases were searched by computer to screen clinical practice guidelines and expert consensus on neck pain.Through longitudinal comparison of multiple high-quality guidelines and consensus,the authors combine with the clinical practice in China to carry out discussion and analysis. RESULTS AND CONCLUSION:This framework expounds the management strategy and implementation path of cervical vascular disease evaluation before cervical manipulation from multiple dimensions,suggesting that we should improve clinicians'attention to cervical vascular disease evaluation before manipulation,and construct evaluation criteria and implementation path with Chinese clinical characteristics.Meanwhile,we should further carry out basic scientific research with multidisciplinary techniques and promote shared decision-making and teaching model innovation to achieve the best clinical decision.

MRI study of the relationship between the cerebral small vessel disease total burden and imaging markers and degree of middle cerebral artery stenosis / 中华放射学杂志

Objective:To investigate the relationship between the cerebral small vascular disease (CSVD) total burden and the imaging markers and the degree of unilateral middle cerebral artery (MCA) stenosis.Methods:The study was a cross-sectional study. Clinical and imaging data of patients with chronic unilateral MCA stenosis who underwent multimodal MRI from October 2015 to January 2019 in the First Medical Center of PLA General Hospital were retrospectively analyzed. A total of 261 patients were included, 187 males and 74 females. According to the degree of MCA stenosis, the patients were divided into 102 cases in severe stenosis-occlusion group (stenosis degree ≥70%) and 159 cases in mild-moderate stenosis group (stenosis degree <70%). CSVD imaging marker scores (including white matter hyperintensity, perivascular space, cerebral microbleed, and lacune of presumed vascular origin) were assessed according to the ?standards for reporting vascular changes on neuroimaging 1 in the 2 groups, and the CSVD total burden score was calculated. Mann-Whitney U test was used to compare the indicators between the two groups, and the CSVD total burden score and imaging marker scores were ultimately included in a multifactorial binary logistic regression to assess the association of CSVD imaging markers with severe stenosis-occlusion of the MCA after adjusting for vascular risk factors (age, gender, drinking, smoking, hypertension, hyperlipidemia, atrial fibrillation and coronary heart disease). Results:There were significant differences in the CSVD total burden, centrum semiovale perivascular space and lacune of presumed vascular origin score between the mild-to-moderate stenosis group and the severe stenosis-occlusion group (all P<0.05), and none of the differences in the remaining imaging marker scores were statistically significant (all P>0.05). Multivariate binary logistics regression analysis showed CSVD total burden score ( OR=1.300, 95% CI 1.047-1.613, P=0.017), centrum semiovale perivascular space score ( OR=2.099, 95% CI 1.540-2.860, P<0.001) and lacune of presumed vascular origin score ( OR=2.609, 95% CI 1.294-5.261, P=0.007) were independent associated with severe stenosis-occlusion of MCA. Conclusion:The higher CSVD total burden score, centrum semiovale perivascular space score and lacune of presumed vascular origin score are associated with severe stenosis-occlusion of MCA.

Comorbidity Mechanism of Vertebrobasilar Dolichoectasia and Cerebral Small Vessel Disease Based on Collateral Disease Theory / 中国实验方剂学杂志

The comorbidities of vertebrobasilar dolichoectasia（VBD） and cerebral small vessel disease（CSVD） increase the poor prognosis of patients，and elucidating the mechanism underlying their comorbidities helps to explore effective treatment strategies. Therefore，based on the collateral disease theory and combining with the pathogenesis and research progress of traditional Chinese and Western medicine on the understanding of the two，this study proposes that both the disease locations are in the brain collaterals and the pathogenesis is deficiency in foundation and excess in symptoms. The main pathogenesis roots in the deficiency of original Qi and the emptiness of brain collaterals，which corresponds to the dysfunction of endothelial cells and neuro-endocrino-immune networks in modern medicine. The symptoms are cerebral blood stasis，occlusion of cerebral arteries and toxic lesion of cerebral arteries，corresponding to cerebrovascular atherosclerosis，hemodynamic changes，hypoperfusion and toxic metabolites-induced injury of white matter in modern medicine. Based on the collateral disease theory，exploring the common pathogenesis of the VBD and CSVD is expected to facilitate the establishment of TCM treatment scheme including the principles，methods and medicines，and improve the clinical prognosis of patients.

Pharmacoeconomics study of rosuvastatin single daily dose versus alternate day dosing in hyperlipidemia patients

Background: In country like India, therapy with rosuvastatin recommended dose may cost between Rs. 400.00 and Rs. 800.00/month. The lower and middle income groups of Indian society are rapidly becoming major sufferers of cardiovascular disease, among all non-communicable diseases, the economic burden of rosuvastatin therapy may be substantial for this large section of population. Aims and Objectives: The aim of the study was to study the cost-effectiveness of rosuvastatin on alternate day versus daily dosing regimen in hyperlipidemia patients. Materials and Methods: The research was carried out at MNR Medical College and Hospital’s department of pharmacology in association with general medicine. According to the inclusion criteria, 50 patients aged 30–60 years of both sexes were included in this prospective open label trial. The research lasted 6 weeks. All the participants were included in study after obtaining the informed consent and approval of the Institutional Ethics Committee was obtained before enrolment of participants. All patient data were obtained using a pre-designed proforma and put into an excel spreadsheet. Results: A total of 42 patients are included with 16 females (38%) and 26 men (62%). Cost of daily rosuvastatin for 6 weeks is Rs. 1087.80 (yearly daily dosing expenses 9453.50%) accounting for mean reduction of LDL-cholesterol (LDL-C) of 33.50% and for alternate day rosuvastatin for 6 weeks is 543.90% (yearly alternate day dosing expense 4713.80%) accounting for mean reduction of LDL-C of 31%. Conclusion: Treatment with alternate day dose of rosuvastatin is comparably cost-effective when compared to currently practicing daily dose rosuvastatin therapy.

Research progress on the role of macrophages in post-transplantation chronic rejection / 器官移植

Organ transplantation is the optimal treatment for end-stage organ failure. Nevertheless, rejection remains an important factor affecting the allograft survival. At present, acute rejection may be effectively treated, whereas no effective interventions are available for post-transplantation chronic rejection. Long-term chronic rejection may lead to graft failure and severely affect long-term survival rate of allografts. In recent years, the role of macrophages in post-transplantation chronic rejection has gradually captivated increasing attention. In this article, main pathological changes of chronic rejection, the diversity and functional differences of macrophages involved in chronic rejection, and the role and mechanism of macrophages in chronic rejection were reviewed, and research progresses on macrophage-related treatment for chronic rejection were summarized, aiming to provide reference for the study of macrophages in post-transplantation chronic rejection.

Imaging findings and related risk factors of small vessel cerebral vascular disease in patients with systemic lupus erythematosus / 中华风湿病学杂志

Objective:To explore the characteristics of imaging findings and related risk factors of small vessel cerebral vascular disease (CSVD) in patients with systemic lupus erythematosus (SLE) with different disease activity.Methods:One hundred and ninty four SLE patients were included. Patients were divided into three groups according to systemic lupus erythematosus disease activity index (SLEDAI): stable or mild active disease group (0~9 points) ( n=107), moderate active group (10~14 points) ( n=41), severe active group (≥ 15 points) ( n=46). Imaging findings, general clinical information laboratory tests of all patients were collected, and the imaging data were scored according to the small cerebral vessel score scale. CSVD-related risk factors of SLE patients in the three groups were analyzed by using ordered Logistic regression. Results:There were significant differences in TWMH score, TPVS score and CSVD score among the three groups ( H=6.07, 6.00, 9.63, P<0.05). Orderly logistic regression showed that age [ OR(95% CI)=1.119 (1.051, 1.891), P<0.001], HCT [ OR (95% CI)=1.531 (1.158, 2.026), P=0.003], anti-PM-Scl antibody [ OR (95% CI)=17.271 (1.442, 206.851), P=0.025] were risk factors for CSVD in the severe active disease group. RBC [ OR(95% CI)=0.011 (0.001, 0.155), P=0.001]、anti-Rib.p antibody [ OR(95% CI)=0.093 (0.018,0.047), P=0.004] were protective factors for CSVD. Conclusion:The manifestations of CSVD in SLE patients with different disease activity are different, and are affected by age, part of blood indicators and lupus antibodies.

Study on the correlation between sleep disturbances and cognitive impairment-associated cerebral small vascular disease in elderly people / 中华老年医学杂志

Objective:To investigate the clinical characteristics and correlation of sleep disturbances(SD)with cognitive impairment-associated cerebral small vascular disease(CSVD-CI)in elderly patients.Methods:In this cross-sectional study, 261 elderly CSVD-CI patients admitted to the Department of Neurology, Second Hospital of Tianjin Medical University between December 2019 and December 2021 were continuously enrolled.The Pittsburgh Sleep Index Scale(PSQI)was used to evaluate the overall sleep quality.Those with a PSQI score ≥7 was assigned to the CSVD-CI with sleep disturbances(CSVD-CI-SD)group, while those with a PSQI score <7 was assigned to the CSVD-CI without SD(CSVD-CI-NSD)group.The Montreal Cognitive Assessment(MoCA)was used to evaluate the cognitive function of patients with CSVD-CI, and scores on the overall cognitive function and various cognitive domains were compared between the CSVD-CI-SD group and the CSVD-CI-NSD group.Results:There were no significant differences between the CSVD-CI-SD group and the CSVD-CI-NSD group in sex ratio, age, education level and comorbidities( P>0.05). Compared with the CSVD-CI-NSD group, patients in the CSVD-CI-SD group took longer to fall asleep, had worse sleep efficiency, a shorter sleep duration, more obvious SD at night, worse sleep quality, more use of sleeping drugs, and more obvious daytime dysfunction(all P<0.05). Compared with the CSVD-CI-NSD group, the total MoCA score, attention score and orientation score in the CSVD-CI-SD group were significantly decreased( P<0.01). Correlation analysis results showed that the total MoCA score and attention in the CSVD-CI-SD group were negatively correlated with SD at night( r=-0.198, r=-0.115, P<0.05 for both), and orientation was negatively correlated with sleep quality( r=-0.170, P<0.05). Conclusions:The prevalence of SD is high in CSVD-CI patients, with CSVD-CI-SD patients showing more obvious overall cognitive, attention and orientation impairment in MoCA.Additionally, the total MoCA score and attention are negatively correlated with nighttime SD, and orientation is negatively correlated with sleep quality in CSVD-CI-SD patients.

Association between the overall burden of cerebral small vascular disease and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis / 中风与神经疾病杂志

@#Objective To investigate the association between the overall burden of cerebral small vascular disease （CSVD） and the hemorrhagic transformation of acute ischemic stroke after intravenous thrombolysis. Methods A retrospective analysis was performed for 268 patients with acute ischemic stroke who received rt-PA intravenous thrombolysis in our hospital from January 2019 to October 2022, and according to the presence or absence of hemorrhagic transformation after thrombolysis, they were divided into hemorrhagic transformation group and non-hemorrhagic transformation group. Related data were collected for both groups, including demographic information （sex, age）, smoking history, medical history （hypertension, diabetes, hyperlipidemia, coronary heart disease, atrial fibrillation, and ischemic stroke）, and clinical data after onset, such as onset-to-treatment time （OTT）, systolic pressure/diastolic pressure/blood glucose at baseline, laboratory findings within 24 hours after onset [fasting blood glucose, glycated hemoglobin, homocysteine, creatinine, triglyceride, total cholesterol, high-density lipoprotein cholesterol （HDL-C）, low-density lipoprotein cholesterol （LDL-C）, uric acid, platelet, prothrombin time （PT）, international normalized ratio （INR）, fibrinogen, fibrinogen, C-reactive protein （CRP）], location of infarction （anterior circulation or posterior circulation）, TOAST typing, and the overall burden of CSVD （mild, moderate or severe）. The two groups were compared in terms of baseline data, clinical data, and CSVD score, and the logistic regression analysis was used to investigate the association between the overall burden of CSVD and hemorrhagic transformation after intravenous thrombolysis. Results A total of 268 patients with acute ischemic stroke who received intravenous thrombolysis were enrolled, with an age of 23-97 years （mean 65.5 years）, and male patients accounted for 70.5% （189/268）. The baseline NIHSS score was 7.5 （0, 27） points, and OTT was 151.2 （20, 270） minutes. Among these patients, 138 （51.4%） had moderate to severe WMH, 193 （72.0%） had lacunar infarction, 56（20.8%） had cerebral microbleeds,and 106（39.5%） had perivascular spaces. There were 115 patients（42.9%） in the mild CSVD group,65（24.2%） in the moderate CSVD group,and 88 （32.8%） in the severe CSVD group. There were 29 patients with hemorrhagic transformation （10.3%）. Atrial fibrillation （odds ratio OR=5.628,95%CI 1.862-17.009,P=0.002）,cerebral microbleeds （OR=4.062,95%CI 1.437-11.485,P=0.008）, and baseline NIHSS score （OR=1.182,95%CI 1.082-1.292,P<0.001） were independent risk factors for hemorrhagic transformation after thrombolysis, and with mild CSVD as the reference, severe CSVD（OR=0.694,95%CI 1.458-9.360,P=0.006） was independently associated with hemorrhagic transformation. Conclusion The overall burden of CSVD in patients with acute ischemic stroke is closely associated with hemorrhagic transformation after intravenous thrombolysis, and severe CSVD is an independent risk factor for hemorrhagic transformation after intravenous thrombolysis.

Characteristics analysis of families of retinal vascular disease with leukoencephalopathy and systemic damage / 中国神经精神疾病杂志

Objective To investigate the clinical data,brain pathology and molecular genetic characteristics of retinal vascular disease families with leukoencephalopathy and systemic damage.Methods The clinical data of two families of RVCL-S(retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations,RVCL-S)were collected and family maps were drawn to analyze the clinical manifestations,imaging,brain pathology and molecular genetic characteristics.Results Family 1:there were 3 male cases and the age of onset was 10 years,29 years and 40 years,respectively.Family 2:there was one male case and the age of onset was 32 years.Both families presented with retinal vascular disease,leukoencephalopathy and multi-system damage,the latter including liver,kidney and digestive tract involvement.There were 4 asymptomatic carriers in two families.The cranial CT of family 1-Ⅱ2 showed lamellar low density near the posterior corner of the left ventricle with multiple intracranial high density calcification.Brain MRI plain scan showed lateral ventricle lesions.The brain MRI plain and enhancement scans of family 1-I5 showed frontotemporal cortex lesions with peripheral edema and space occupying effect,and the ring enhancement was remarkable.The brain MRI plain scan and enhancement scan of family 2-Ⅱ1 showed the right and left frontal lobe lesions,accompanied by peripheral edema and enhancement,and the occupying effect was obvious.The operative pathology of brain tissue from family 1-I5 showed endothelial cell hyperplasia.The pathological manifestations of family 2-Ⅱ1 encephalopathy were consistent with"cerebral infarction"after two operations.The small blood vessels in the small intestinal wall showed endothelial cell proliferation.Molecular genetics:TREX1 D272Rfs heterozygous mutation was present in family 1-Ⅱ2,and his offspring including two daughters and one son were asymptomatic mutation carriers.TREX1 S246Ifs heterozygous mutation was detected in the 2-Ⅱ1 gene of the family which was not found in either the father or the mother found the mutation,and the son was asymptomatic carrier of the mutation.Conclusion The main clinical manifestations of RVCL-S are retinal vascular disease,nervous system involvement and multi-system damage.Imaging findings showed that intracranial lesions were space-occupying,accompanied by peripheral edema and enhancement.The pathological features were small vessel endothelial cell proliferation and lumen stenosis.Genetic results confirmed the presence of TREX1 gene mutation.

Clinical application of excimer laser ablation in lower extremity arterial ischemic diseases / 国际外科学杂志

Objective:To evaluate the therapeutic effect of excimer laser ablation (ELA) in the treatment of lower extremity arterial ischemic diseases.Methods:The clinical data of 44 patients with lower extremity ischemic diseases treated with ELA in the People′s Hospital of Xinjiang Uygur Autonomous Region from December 2020 to April 2021 were analyzed retrospectively. Among the 44 patients, there were 29 patients in lower extremity arteriosclerosis obliterans (ASO), including 3 patients with femoral artery stent occlusion. 8 patients of diabetes foot (DF) and 7 patients of thromboangiitis obliterans (TAO). Observation indicators include target vascular patency rate, amputation rate, vascular reintervention rate and mortality rate. The measurement data were expressed as mean ± standard deviation ( ± s), one-way analysis of variance was used for inter-group comparison, and paired sample t-test was used for intra-group comparison. The Chi-square test was used for comparison between count data. Results:The success rate of operation was 100% in 44 patients. The rate of major amputation in ASO group was 10.3%, while the other two groups had a major amputation rate of 0. The minor amputation rates of the three groups were 6.9%, 25.0% and 28.6%, respectively. The vascular reintervention rate was 10.3% in ASO group, 12.5% in DF group and 0 in TAO group. The 1-year mortality rate in the ASO group was 10.3%, while the other two groups had a mortality rate of 0. The 2-year mortality rate of the three group were 31.0%, 12.5% and 0, respectively.Conclusion:For the treatment of lower extremity arterial ischemic diseases, ELA is safe and effective, but the curative effect need to further clarify by large sample and long-term clinical follow-up observation.

The prevalence of vascular and metabolic complications after lung transplant in people with cystic fibrosis in a Dutch cohort

Abstract Background With improvements in care for people with Cystic Fibrosis (pwCF), total survival after Lung Transplantation (LTx) will be longer. Therefore, this population's up-to-date analysis of late-onset post-transplant metabolic and vascular complications will be more relevant in current clinical practice. Methods We studied 100 pwCF who underwent an LTx between 2001 and 2020 at the University Medical Centre Utrecht, the Netherlands. The median age at transplant was 31 years and 55 percent was male. We assessed survival, the prevalence of metabolic complications (diabetes, renal damage, dyslipidemia, and metabolic syndrome), and vascular complications (hypertension, heart rhythm disease, micro-, and macrovascular disease). In addition, differences in risks for developing complications based on sex and overall survival were analyzed. Results The prevalence of macrovascular disease raised to 15.9 percent 15 years post-LTx. The prevalence of diabetes increased from 63 percent at LTx to over 90 percent 15 years post-LTx and the prevalence of dyslipidemia increased from 21 percent to over 80 percent. Survival 1-, 2-, 5-, and 10 years post-transplant were 84, 80, 76, and 58 percent respectively. No significant differences were found based on sex. Conclusion This study shows that the prevalence of cardiovascular risk factors increases after LTx for CF, potentially leading to major complications. These data emphasize the necessity of regular check-ups for metabolic and vascular complications after LTx with specific attention to renal damage. Early recognition of these complications is crucial and will lead to earlier intervention, which could lead to improved prognosis after lung transplantation.

Manifestaciones pulmonares de la artritis reumatoide, una revisión en tiempos de pandemia por SARS-CoV-2 / no

La artritis reumatoide (AR) es una de las patologías crónicas de origen autoinmune más frecuentes. Su prevalencia varía del 0,5 al 1%, con un compromiso primario a nivel articular, generando gran discapacidad por las deformidades secundarias derivadas de un estado inflamatorio persistente. Considerando el alto impacto en la calidad de vida de quienes la padecen, sumado al alto costo de las intervenciones terapéuticas, se vuelve imperativo para el personal de salud sumar todos los esfuerzos para promover un diagnóstico temprano y reconocer las potenciales complicaciones con el fin de impactar positivamente en los desenlaces clínicos. Alrededor del 50% de los pacientes con AR pueden tener compromiso extra articular, siendo el pulmón uno de los órganos más afectados. En época de pandemia por el virus SARS-CoV-2 es necesario recordar los tipos de compromiso pulmonar en pacientes con AR y tener en cuenta la susceptibilidad de estos pacientes a cuadros infecciosos que pueden generar una gran morbimortalidad.

Rheumatoid arthritis (RA) is one of the most frequent chronic autoimmune pathologies. It's prevalence varies from 0.5 to 1%, with a primary involvement at the joint, generating disability due to deformities secondary to persistent inflammation. Considering the high impact on the quality of life of those who suffer it, added to the high cost of therapeutic interventions, it becomes imperative for health personnel to join forces to promote early diagnosis and recognize potential complications, in order to impact positively on clinical outcomes. Around 50% of patients with RA may have extra-articular involvement, the lung being one of the most affected organs. In times of SARS-CoV-2 pandemic, it's necessary to remember the types of lung involvement in patients with RA and take into account the susceptibility of these patients to infectious conditions that can generate great morbidity and mortality.

Valor pronóstico de la glicemia en la evolución neurológica de pacientes diabéticos con enfermedad cerebrovascular / Prognostic value of glycemia in the neurological evolution of diabetic patients with cerebrovascular disease

Introducción: La diabetes mellitus es una de las enfermedades que aumenta el riesgo de una persona de sufrir un accidente cerebrovascular. Las personas con diabetes tienen tres veces el riesgo de un accidente cerebrovascular y peor pronóstico cuando las cifras de glucemia son altas. Objetivo: Describir la evolución neurológica en pacientes diabéticos con enfermedad cerebrovascular isquémica aguda. Métodos: Se realizó un estudio descriptivo, en pacientes diabéticos que ingresan en el Hospital Enrique Cabrera con enfermedad cerebrovascular isquémica aguda. Resultados: Se estudiaron una totalidad de 118 pacientes. El sexo masculino, color de piel blanca y las edades comprendidas entre los 60 y 69 años fueron los más afectados. Se evidenció, con una relación estadísticamente significativa, que los valores de glicemia elevados al momento del diagnóstico de la enfermedad cerebrovascular isquémica estuvieron asociados con la evolución neurológica tórpida de la enfermedad (p=0,0007). Conclusiones: La hiperglucemia al ingreso se asocia con un peor pronóstico neurológico en pacientes diabéticos ingresados por un accidente cerebrovascular isquémico agudo(AU)

Introduction: Diabetes mellitus is one of the diseases that increase a person's risk of suffering a stroke. People with diabetes have three times the risk of stroke and a worse prognosis when blood glucose levels are high. Objective: To describe the neurological evolution in diabetic patients with acute ischemic cerebrovascular disease. Methods: A descriptive study was carried out in diabetic patients admitted to Hospital Enrique Cabrera with acute ischemic cerebrovascular disease. Results: A total of 118 patients were studied. The male sex, white skin color and the ages between 60 and 69 years were the most affected. It was evidenced, with a statistically significant relationship, that elevated blood glucose values at the time of ischemic cerebrovascular disease diagnosis were associated with the torpid neurological evolution of the disease (p = 0.0007). Conclusions: Hyperglycemia on admission is associated with a worse neurological prognosis in diabetic patients admitted for an acute ischemic stroke(AU)

Positioning of the fixed dose combination of Rosuvastatin + Clopidogrel + Aspirin in the Treatment of Cardiovascular Diseases

Dual anti-platelet therapy (DAPT) and statins are recommended by guidelines for the management of cardiovascular diseases (CVDs), even though the duration of treatment is guided by ischemic and bleeding risk. Clopidogrel and aspirin are the most commonly used DAPT in CVDs. Adding a statin to DAPT is helpful in reducing the thrombosis risk. Fixed-dose combination (FDC) therapy in CVD can help to address the factors of convenience, compliance, control, cost, and complication better than free drug combinations. Therefore, the FDC of rosuvastatin (10 mg or 20 mg) + clopidogrel (75 mg) + aspirin (75 mg) is likely to improve compliance in CVD patients, thereby reducing adverse cardiovascular outcomes and cost of treatment. There is lack of awareness on long term benefits of this FDC in Indian patients.

Actuación de enfermería en el infarto cerebral agudo / Nursing performance in acute cerebral stroke

La enfermedad vascular cerebral (EVC) es una patología caracterizada por un déficit neurológico súbito, secundario a oclusión o ruptura de un vaso sanguíneo cerebral; se divide en isquémica o infarto cerebral (IC) y hemorrágica. La EVC es reconocida como la primera causa de discapacidad y la quinta causa de muerte en México, registrándose cerca de 170 mil casos nuevos al año. Existe amplia evidencia que demuestra una reducción en los desenlaces negativos, como muerte y discapacidad, al realizar intervenciones rápidas, incluyendo la administración de trombolisis intravenosa con rt-PA (activador tisular de plasminógeno recombinante) y trombectomía mecánica. La coordinación multidisciplinaria del equipo de salud y los cuidados efectivos de enfermería, son vitales durante todas las etapas de atención de la EVC. Esta revisión da a conocer un panorama general del manejo del infarto cerebral e identificar las intervenciones indispensables del profesional de enfermería realiza durante las etapas prehospitalarias, pretrombolisis, durante trombolisis y postrombolisis.

Cerebralvascular disease (CVD) is a pathology characterized by a sudden neurological deficit secondary to occlusion or rupture of a cerebral blood vessel; it is divided into ischemic or cerebral infarction (CI) and hemorrhagic. CVD is recognized as the first cause of disability and the fifth cause of death in Mexico, with nearly 170,000 new cases registered each year. There is ample evidence that shows a reduction in negative outcomes, such as death and disability, with rapid interventions, including the administration of intravenous thrombolysis with rt-PA (recombinant tissue plasminogen activator) and mechanical thrombectomy. Multidisciplinary coordination of the health care team and effective nursing care are vital during all stages of CVD care. This review provides an overview of the management of cerebral infarction and identifies essential nursing interventions during the prehospital, prethrombolysis, during thrombolysis, and postthrombolysis stages.

Estrategias para enseñar sobre autocuidado a personas con úlceras vasculares venosas: una revisión integrativ / Strategies for Teaching Self-care to People with Venous Ulcers: An Integrative Review / Estratégias para o ensino do autocuidado a pessoas com úlceras vasculares venosas: uma revisão integrativa

Introducción: las úlceras vasculares son lesiones que se desarrollan principalmente en miembros inferiores, se acompañan de dolor continuo e incapacitante, dificultan la movilidad, alteran la propia imagen corporal y pueden interferir en las actividades de la vida diaria. Las úlceras venosas son graves, ocasionadas por insuficiencia venosa crónica e hipertensión venosa permanente, y la persona que las padece debe recibir cuidados de enfermería integrales, que contribuyan al autocuidado. Objetivo:describir las estrategias que debe tener en cuenta el profesional de enfermería para la promoción del autocuidado en personas con úlceras vasculares venosas. Metodología: revisión integrativa de la literatura. Se realizó búsqueda en bases de datos y recursos electrónicos: Medline a través de PubMed Health, Epistemonikos y SciELO. Se incluyeron artículos de investigación y de revisión relacionados con el problema en estudio, publicados en inglés, portugués o español en el periodo 2010-2020. Estudio sin riesgo, se respetan los derechos de autor. Resultados: se analizó una muestra constituida por 41 publicaciones. Los temas principales producto del análisis fueron: proceso de atención de enfermería y autocuidado, familiarizándose con la úlcera venosa y las opciones terapéuticas, conocimiento de la terapia de compresión, práctica de los estilos de vida saludables. Conclusiones: el cuidado de enfermería al paciente con úlcera venosa debe comenzar por reconocer a la persona desde una perspectiva holística y en reciprocidad con su entorno, lo que implica un proceso de atención integral que va más allá de la úlcera y valora al paciente como un sujeto activo en el cuidado, para que se familiarice con su herida y esté en capacidad de detectar señales de mejoría o de alarma, así como de conocer la terapia de compresión y opciones terapéuticas y de llevar a su cotidianidad la práctica de estilos de vida saludables

Introduction: Venous ulcers are lesions developed mainly on the lower limbs. They cause continuous and disabling pain, impair mobility, alter self-image, and interfere with daily life activities. Venous ulcers are serious. They are caused by chronic venous insufficiency and permanent venous hypertension. People suffering from venous ulcers should receive comprehensive nursing care that contributes to self-care. Objective: To describe the strategies nursing professionals should consider for promoting self-care in people with venous ulcers. Method: Integrative review of the literature. Databases and electronic resources were searched: Medline using PubMed, Health, Epistemonikos, and SciELO. Research and review articles related to the study problem, published in English, Portuguese, or Spanish between 2010 and 2020, were included. This is a risk-free study, and copyrights were respected. Results: A sample of 41 publications was analyzed. The main themes derived from the analysis were the nursing care process and self-care, getting familiar with venous ulcers and therapeutic options, knowledge of compression therapy, and practice of healthy lifestyles. Conclusions: Nursing care for patients with venous ulcers should begin by recognizing a person from a holistic perspective and reciprocally with their environment. This approach implies a comprehensive care process that goes beyond the ulcer and values patients as active subjects of care so that they become familiar with their wounds and detect signs of improvement or warning. They can also know about compression therapy and therapeutic options and take the practice of healthy lifestyles into their daily lives.

Introdução: As úlceras vasculares são lesões que se desenvolvem principalmente nos membros inferiores, são acompanhadas de dor contínua e incapacitante, dificultam a mobilidade, alteram a própria imagem corporal e podem interferir nas atividades da vida diária. As úlceras venosas são graves, causadas pela insuficiência venosa crônica e hipertensão venosa permanente, e a pessoa que as sofre deve receber cuidado de enfermagem integral que contribua para o autocuidado. Objetivo: Descrever as estratégias que o profissional de enfermagem deve levar em consideração para promover o autocuidado em pessoas com úlceras vasculares venosas. Metodologia: Revisão integrativa da literatura. Realizou-se busca nas bases de dados e recursos eletrônicos: Medline por meio do PubMed Health, Epistemonikos SciELO. Foram incluídos artigos de pesquisa e revisão relacionados ao problema em estudo, publicados em inglês, português ou espanhol, no período 2010-2020. Estudo sem risco, os direitos autorais são respeitados. Resultados: Foi analisada uma amostra de 41 publicações. Os principais tópicos resultantes da análise foram: processo de atenção de enfermagem e autocuidado, familiarização com a úlcera venosa e as opções terapêuticas, conhecimento da terapia compressiva, prática de estilos de vida saudáveis. Conclusões: O cuidado de enfermagem ao paciente com úlcera venosa deve começar por reconhecer à pessoa desde uma perspectiva holística e em reciprocidade com seu meio, o que implica um processo de atendimento integral que vai além da úlcera e valoriza ao paciente como sujeito ativo no cuidado para que ele se familiarize com sua ferida e seja capaz de detectar sinais de melhora ou alarme, bem como aprender sobre terapia compressiva e as opções terapêuticas e praticar estilos de vida saudáveis em sua vida diária.

High Risk Foot Among Type-2 Diabetes Mellitus Patients in a Tertiary Care Hospital

Background: Feet of diabetic persons are at a high risk of developing complications and their prevalence is very high. Uncontrolled diabetes i.e. hyperglycemia particularly chronic hyperglycemia plays the most critical role in developing all forms of macro and microvascular complications in foot. The 揾igh risk foot� can be identified by simple clinical examination. A structured screening program for 揌igh Risk Foot� integrated with all diabetic care units is essential. Objectives: The study was initiated to determine the frequency of 揾igh-risk foot� among Type 2 diabetic patients.Methods:It was a cross-sectional observational study, conducted among 324 Type 2 diabetic patients attending BIRDEM General Hospital, Dhaka, Bangladesh. All participants were interviewed by an administered questionnaire, underwent clinical examination and review of medical records from the diabetic guide book of the patients and hospital records.Results:Among a total of 324 patients, 198(61%) patients were having high-risk feet. Of the diabetics with high risk foot- loss of protective sensation 73.2%; absent pedal pulse 23.2%; history foot ulcer 25.3%; limited joint mobility 15.2%; foot deformity 11.1% and previous foot amputation 3.5%. The study population had poor glycemic status (HbA1c 10.81+5.23%). Other variables age 55.43 (� 11.062) years; BMI: 25.33+5.7 kg/m� duration of diabetes 14.24+7.25 years; sex ratio (M: F) 1.3:1; family history of DM 71.9%; hypertensive 53.1%; smoker 73.5%; dislipidemia 52.8%, albuminuria 58.6%, and retinopathy 53.7%. Males are significantly higher in the high-risk foot.Conclusion:This study documented a very high frequency of high risks foot in our diabetic population. Peripheral Neuropathy (PN) and PVD are two common forms of high risk foot and these are influenced by a longer duration of diabetes, the presence of albuminuria for PN, and retinopathy. Male sex, longer duration of diabetes, presence of hypertension and smoking for PVD. Regular foot examination and treatment to target patients will modify the modifiable risk factors and thereby prevent foot ulcers and amputation.

Comparison of Ranibizumab and Conbercept combined with photodynamic therapy in the treatment of polypoid choroidal vascular disease / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the effects of ranibizumab and conbercept combined with photodynamic therapy(PDT)on vision and hemorheology of polypoid choroidal vascular(PCV)lesions. <p>METHODS: Prospective research. A total of 120(120 eyes)PCV patients who were admitted to our hospital from 2017-02/2020-06 were enrolled and divided into 61 cases(61 eyes)in the ranibizumab combined with PDT treatment group according to the random number table. Conbercept combined with PDT treatment group of 59 patients(59 eyes), compared the intraocular pressure, best corrected visual acuity(BCVA), central retinal thickness(CRT), blood flow, and the incidence of complications within 3mo of follow-up between the two groups before and after treatment.<p>RESULTS: There was no difference in intraocular pressure, CRT, and BCVA at 1 and 3mo after treatment between the two groups(all <i>P</i>>0.05). The whole blood high shear viscosity and whole blood of the ranibizumab combined with PDT treatment group were 1 and 3mo after treatment. The low-shear viscosity was lower than the conbercept combined with PDT treatment group(all <i>P</i><0.05). At the same time, the complication rate in the ranibizumab combined with PDT treatment group during the follow-up period of 3mo was lower than that in the conbercept combined with PDT treatment group(3.3% <i>vs</i> 16.9%, <i>P</i><0.05). <p>CONCLUSION: The treatment of ranibizumab combined with PDT for patients with PCV disease is more conducive to hemorheological stability and reduces the incidence of complications.