Early diagnosis of diabetic neuropathy and prophylaxis of diabetic foot / Diagnóstico precoce da neuropatia diabética e profilaxia do pé diabético

Introduction: the diabetic foot is one of the most serious complications of diabetes mellitus. About 50% of non-traumatic amputations occur in these patients. In addition, it is an important public health problem and constitutes a chronic and complex metabolic disorder that is characterized by impaired metabolism of glucose and other complications in essential organs for the maintenance of life. Objective: to evaluate the sensitivity and specificity of diabetic neuropathy using the Michigan self-assessment and physical examination in type 1 and type 2 diabetics. Methods: this is a cross-sectional study. The "Michigan Neuropathy Screening Instruments" classification was used to assess the degree of peripheral neuropathy, in which participants answered the questionnaire and were evaluated for the presence of foot lesions. All participants were stratified by the risk of developing foot ulcers according to the IWGDF protocol. Results: the sample had 200 participants. Regarding the IWGDF classification, 23 patients were classified as moderate risk (11.50%) and 61 as high risk for developing foot ulcers (30.50%). Using a cutoff of 2.5 on the physical examination score to diagnose neuropathy, a sensitivity of 97.62% and a specificity of 47.41% were obtained. Using a score greater than or equal to 6 in the self-assessment for the diagnosis of neuropathy, a sensitivity of 50.00% and a specificity of 94.83% were found. Conclusion: the association of the Michigan physical examination (high sensitivity) with self-assessment (high specificity) increases the accuracy for the diagnosis of diabetic neuropathy

Introdução: o pé diabético é uma das complicações mais sérias do diabetes mellitus. Cerca de 50% das amputações não traumáticas ocorrem nesses pacientes. Além disso, é um importante problema de saúde pública por ser um distúrbio metabólico crônico e complexo que se caracteriza pelo comprometimento do metabolismo da glicose associada a outras complicações em órgãos essenciais para manutenção vital. Objetivo: avaliar a sensibilidade e especificidade para neuropatia diabética da autoavaliação e do exame físico de Michigan nos diabéticos tipo 1 e tipo 2. Método: trata-se de um estudo transversal. Foi utilizada a classificação "Michigan Neuropathy Screening Instruments" para avaliação do grau de neuropatia periférica, em que os participantes responderam ao questionário e foram avaliados quanto a presença de lesões nos pés. Todos os participantes foram estratificados quanto ao risco de desenvolver úlcera nos pés de acordo com o protocolo do IWGDF. Resultados: a amostra contou com 200 participantes. Quanto à classificação do IWGDF, 23 pacientes foram classificados como risco moderado (11,50%) e 61 como alto risco para o desenvolvimento de úlceras nos pés (30,50%). Utilizando-se um corte de 2,5 na pontuação do exame físico para diagnosticar a neuropatia, foi obtida uma sensibilidade de 97,62% e uma especificidade de 47,41%. Utilizando-se uma pontuação maior ou igual a 6 na autoavaliação para o diagnóstico de neuropatia, foi obtida uma sensibilidade de 50,00% e uma especificidade de 94,83%. Conclusão: a associação do exame físico de Michigan (alta sensibilidade) com a autoavaliação (alta especificidade) tem melhor acurácia para o diagnóstico de neuropatia diabética.

Vascular Calcification in Chronic Kidney Disease Patients on Hemodialysis: Prevalence and Correlation with Vascular Disease Events

Introduction: With declining kidney function, the prevalence of vascular calcifications increases and calcification occurs years earlier and is more severe in chronic kidney disease (CKD) patients than in general population. We did this study to find the prevalence of vascular calcification in patients on maintenance hemodialysis using simple and inexpensive radiological method and to find out the correlation of vascular calcification score with vascular disease events, cardiovascular and all-cause mortality over a follow-up period of 1 year. Materials and methods: This prospective, observational, comparative, follow-up, single-center study of maintenance hemodialysis patients was performed at a tertiary care center in Haryana. Seventy-one patients on maintenance hemodialysis for more than 3 months were included in the study. Patients who were 18 years of age or below, CKD stage 5 patients not on dialysis and those who had previous history of parathyroidectomy were excluded. Adragao score for vascular calcification was calculated by evaluating bilateral iliac, femoral and radial arteries in plain radiographic films of pelvis and hands. Statistical analyses were performed with the SPSS System 10.0. Results: Seventy-one patients were enrolled in this study out of which, 45 were male and 26 were female. Mean age of patients was 61.92 ± 10.77 years. Majority of patients were elderly (age group ?60 years). Out of 71 patients, 66 (92.9%) were hypertensive and 26 (36.6%) patients were diabetic. Twenty-two (30.9%) patients had cardiovascular disease (CVD) at baseline. Coronary artery disease (CAD) was present in 20 (28.1%) patients, cerebrovascular disease was present in 2 (2.8%) patients and peripheral artery disease (PAD) was present in only 1 patient at baseline. Average dialysis duration received by patients was 21.35 ± 21.17 months. Out of 71 patients, 16 (22.5%) received calcium-containing phosphate binder, 51 (71.8%) received noncalcium-containing phosphate binder and 4 patients received no phosphate binder. Fifty-five (77.4%) patients received therapeutic or prophylactic vitamin D3 therapy during the study period. Vascular calcification detected with plain X-ray of pelvis and both wrists was found in 56.3% of patients on maintenance hemodialysis. The prevalence and severity of vascular calcification was higher with increasing age. Diabetes was found to be significantly associated with the presence of vascular calcification (p < 0.0005). CAD at the time of enrollment was significantly associated with vascular calcification (p = 0.009). Serum levels of calcium, phosphate, vitamin D3, intact parathyroid hormone (PTH), calcium-phosphate product or use of phosphate binders or the types or vitamin D therapy did not correlate clinically with presence of vascular calcification. Hemodialysis duration did not correlate with the presence of vascular calcification (p = 0.113). Presence of vascular calcifications in hemodialysis patients predicted future vascular disease events over 1 year follow-up (p = 0.013) but did not correlate with cardiovascular and all-cause mortality. Conclusion: There is a high prevalence of vascular calcification in maintenance hemodialysis patients in our center. The risk factors of vascular calcification were higher age, diabetes and CAD. These patients should be followed-up regularly for vascular events. We also want to reiterate with this study that plain X-ray is sufficient to rule out vascular calcification in CKD patients and should be employed regularly in dialysis clinics.

Is there a correlation between dizziness and intracranial artery calcification?

SUMMARY OBJECTIVE: This study aimed to investigate the correlation between dizziness and intracranial artery calcification. METHODS: A total of 107 consecutive patients were recruited for this study. These patients were categorized into first (case) and second (control) groups. The first and second groups had complaints of dizziness and headache, respectively. All the patients had noncontrast cranial computed tomography images. Bilateral internal carotid arteries, bilateral vertebral arteries, and basilar arteries were evaluated for detecting burden of intracranial artery calcification. Finally, demographic characteristics, stroke risk factors, and burden of intracranial artery calcification of these two groups were compared. The Mann-Whitney U test, chi-square test, and Spearman's correlation were performed to analyze the study. RESULTS: It was found that the first and second groups included 39 and 68 patients, respectively. The mean age of the first group was significantly higher than that of the second group. The mean burden of intracranial artery calcification of the posterior circulation in the first and second groups were not statistically different from each other (p=0.555). The mean burden of intracranial artery calcification of the anterior circulation in the first group was found to be significantly higher than the second group (p=0.005). However, no significant difference was found between the two groups in terms of burden of intracranial artery calcification of anterior or posterior circulation, when the age variable was synchronized in both groups. CONCLUSION: Although this study found a limited correlation between dizziness and intracranial artery calcification, this situation was basically related to aging.

Urological, vascular, and infectious implications of kidney transplant: a single-center experience / Complicaciones urológicas, vasculares e infecciosas del trasplante renal: experiencia en un solo centro

Introduction: Kidney transplant has improved in the last decades due to new technologies and surgical techniques. However, there are still multiple complications associated with this procedure, which can affect the function and viability of the kidney graft. Our aim was to describe the incidence of urological, vascular, and infectious complications in the 1st month after the procedure. Methods: A cross-sectional and retrospective study was carried out. Records of all patients who underwent kidney transplant from 2007 to 2017 were reviewed and data of demographic and surgical variables as well as information of vascular, urological, and infectious complications during the 1st post-operative month were registered and analyzed. Results: A total of 243 patients that required kidney transplant were assessed. The most common chronic kidney disease etiologies were: idiopathic (25.5%), glomerulopathies (24.7%), and hypertension (23.5%). Seventy patients (28.8%) presented a complication, of which 31 were urological, 27 were infectious, and 12 were vascular. In each category, the most frequent complications were the perirenal hematoma, the urinary tract infection, and renal artery stenosis, respectively. Conclusions: The prevalence of complications found in our center is similar to that reported in the literature and it is significant. It is important for medical personnel to be aware of this data to have a high level of suspicion and make an active search, as an early diagnosis and treatment of these pathologies are crucial to avoid graft loss

Introducción: El trasplante renal ha mejorado en las últimas décadas gracias a las nuevas tecnologías y técnicas quirúrgicas. Sin embargo, aún existen múltiples complicaciones asociadas a este procedimiento, que pueden afectar la función y viabilidad del injerto renal. Nuestro objetivo fue describir la incidencia de complicaciones urológicas, vasculares e infecciosas en el primer mes tras el procedimiento. Métodos: Se realizó un estudio retrospectivo de corte transversal. Se revisaron los expedientes de todos los pacientes que se sometieron a trasplante renal desde 2007 hasta 2017 y se registraron y analizaron datos de variables demográficas y quirúrgicas, así como información de complicaciones vasculares, urológicas e infecciosas durante el primer mes postoperatorio. Resultados: Se evaluaron un total de 243 pacientes que requirieron trasplante renal. Las etiologías de enfermedad renal crónica (ERC) más frecuentes fueron: idiopática (25,5%), glomerulopatías (24,7%) e hipertensión arterial (23,5%). 70 pacientes (28,8%) presentaron alguna complicación, de los cuales 31 fueron urológicos, 27 infecciosos y 12 vasculares. En cada categoría las complicaciones más frecuentes fueron el hematoma perirrenal, la infección del tracto urinario y la estenosis de la arteria renal respectivamente. Conclusiones: La prevalencia de complicaciones encontrada en nuestro centro es similar a la reportada en la literatura y es significativa. Es importante que el personal médico conozca estos datos para tener un alto nivel de sospecha y realizar una búsqueda activa, ya que el diagnóstico y tratamiento precoz de estas patologías es fundamental para evitar la pérdida del injerto.

Ocorrência de depressão e avaliação da capacidade funcional em pacientes com doenças vasculares internados em um serviço de cirurgia vascular / Occurrence of depression and assessment of functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service

Resumo Contexto As doenças vasculares estão associadas a importantes sequelas e repercussões clínicas nas vidas dos pacientes acometidos e, em maior relevância, entre os idosos. Consequências da doença vascular como a perda de um membro, dor crônica, internamentos prolongados e a polifarmácia geram, nesses pacientes, perda de autonomia e um grau de dependência, que vão influenciar o bem-estar e a qualidade de vida. Objetivos Determinar a ocorrência de depressão e avaliar a capacidade funcional em pacientes com doenças vasculares internados em um serviço de cirurgia vascular. Métodos Trata-se de um estudo observacional, transversal, prospectivo, realizado no serviço de cirurgia vascular de um hospital terciário, com uma amostra não aleatória selecionada de forma consecutiva. Para avaliar a depressão, foi utilizada a escala de depressão geriátrica resumida e, para a avaliação funcional do indivíduo, foi utilizada a escala de Katz. Resultados A prevalência de depressão nesses pacientes foi de 60,6%. Foi observada associação entre depressão e: consulta com médico do Programa de Estratégia de Saúde da Família nos últimos 12 meses, etilismo, claudicação, diabetes e indivíduos que sofreram amputação. Já em relação à capacidade funcional do indivíduo avaliado através do índice de Katz, ocorreram associações significativas entre variáveis sociodemográficas, condições relacionadas a doença vascular e internamento. Conclusões Existem uma alta prevalência de depressão em pacientes com doenças vasculares internados em um serviço de cirurgia vascular e uma redução importante da capacidade funcional em alguns grupos, como os indivíduos de baixa escolaridade, os que sentiam dor crônica nos membros inferiores, os diabéticos e aqueles que sofreram amputação.

Abstract Background Vascular diseases are associated with significant sequelae and clinical repercussions for the lives of affected patients, which are more serious among the elderly. The consequences of vascular disease, such as limb loss, chronic pain, prolonged hospitalization, and polypharmacy, reduce these patients' autonomy and independence, influencing their wellbeing and quality of life. Objectives To determine the prevalence of depression and assess functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service. Methods This is a descriptive, cross-sectional study, carried out at the Vascular Surgery Service of a tertiary hospital with a non-random sample of patients selected consecutively. The geriatric depression scale short form (GDS-15) was used to assess depression and the Katz scale was used for functional assessment. Results The prevalence of depression in these patients was 60.6%. Associations were observed between depression and consultation with a family doctor in the last 12 months, alcoholism, claudication, diabetes, and individuals who had had an amputation. Individuals' Katz index functional capacity scores were significantly associated with sociodemographic variables, conditions related to vascular disease, and hospitalization. Conclusions There was a high prevalence of depression in patients with vascular diseases admitted to a vascular surgery service and important reductions in functional capacity in some groups, such as individuals with low educational levels, those who had chronic pain in the lower limbs, patients with diabetes, and those who had had an amputation.

Vascular complications in 305 severely ill patients with COVID-19: a cohort study

ABSTRACT BACKGROUND: Although an association has been made between coronavirus disease 2019 (COVID-19) and microvascular disease, data on vascular complications (other than venous thromboembolism) are sparse. OBJECTIVE: To investigate the vascular complications in severely ill patients hospitalized with COVID-19 and their association with all-cause mortality. DESIGN AND SETTING: This cohort study was conducted at the Universidade Federal de São Paulo, Brazil. METHODS: All 305 consecutive patients diagnosed with COVID-19 and hospitalized in the intensive care unit (ICU) of a tertiary university hospital from April 2 to July 17, 2021, were included and followed up for 30 days. RESULTS: Of these, 193 (63.3%) were male, and the mean age was 59.9 years (standard deviation = 14.34). The mortality rate was 56.3% (172 patients), and 72 (23.6%) patients developed at least one vascular complication during the follow-up period. Vascular complications were more prevalent in the non-survivors (28.5%) than in the survivors (17.3%) group and included disseminated intravascular coagulation (DIC, 10.8%), deep vein thrombosis (8.2%), acrocyanosis (7.5%), and necrosis of the extremities (2%). DIC (adjusted odds ratio (aOR) 2.30, 95% confidence interval (CI) 1.01-5.24, P = 0.046) and acrocyanosis (aOR 5.21, 95% CI 1.48-18.27, P = 0.009) were significantly more prevalent in the non-survivors than in the survivors group. CONCLUSION: Vascular complications in critically ill COVID-19 patients are common (23.6%) and can be closely related to the mortality rate (56.3%) until 30 days after ICU admission. Macrovascular complications have direct implications for mortality, which is the main outcome of the management of COVID-19. REGISTRATION: RBR-4qjzh7 (https://ensaiosclinicos.gov.br/rg/RBR-4qjzh7).

A comparison of gynecological qisu syndromes in previous reports / Монголын эм зүй, эм судлал

Introduction@#Women’s disease slows down and becomes chronic, causing diseases that spread throughout the body and affect the organs.@*Objective@#To compare and contrast the treatment of gynecological “Qisu” syndromes in previous reports.@*Methods@#“Four medical tantras” and other sources were the main material. The article was written using search methods, comparison methods, and analysis-synthesis methods. The topic and methodology of the research was approved at the Inner Mongolia University for Nationalities. No conflict of interest.@*Conclusion@#</br>1. In the “Four medical tantras”, the general symptoms and each category of gynecological “Qisu” syndromes, the prescriptions for each treatment are described in detail, and the treatment is clearly written. </br>2. In the “Four medical tantras”, Lhantav, Durvun Rashaan, Khukh Binderiiya, Jiduininnor, and the Encyclopedia of Chinese Medicine /Mongolian Medicine/, the gynecological “Qisu” syndromes are described by each category, and the treatment prescriptions are analyzed and written in detail. In other sources, treatment is based on general symptoms. The treatment of gynecological “Qisu” syndromes includes 33 names of drugs medicines. In the general treatment gynecological “Qisu” syndromes in most of the reports, Chatsargana-17, Gishuune-6, 14, 17, Basberuu-7, Zomshin-4, 6, 7, Oyyu-13, Yaanag nukhur-13, Jonsh-11, Melreg tsetseg-7, Braisum-17, Rashnamjil, Dedbon-14, Agshirga-3, Jambrai-6 drugs are mentioned and the treatment of each category is coordinated with the condition. </br>3. Gynecological “Qisu” syndromes is a disease of the whole body characterized by the majority of blood and bile /mkhris pa/. Dispersing the disease with blood, the internal organs vascular diseases is damaged in a different way, and the blood characteristic is predominant, and the bile/mkhris pa/ is combined, internal organs vascular diseases.

Research progress of treatment options on spontaneous isolated superior mesenteric artery dissection based on computed tomography imaging classification / 中华消化外科杂志

Because of the low incidence rate, spontaneous isolated superior mesenteric artery dissection (SISMAD) is once considered as a rare disease. In recent years, with the widespread application of enhanced computed tomography (CT), reports of SISMAD have increased. At present, there is no consensus on the optimal treatment of SISMAD, and there are various imaging classifica-tions based on CT. However, clinical management strategy for SISMAD according to any imaging classification based on CT has not yet been acknowledged. Foreign scholars believe that conservative treatment can improve symptoms in most SISMAD patients, while Chinese scholars prefer endo-vascular intervention. The authors review the research progress of treatment options on SISMAD based on computed tomography imaging classification.

Application and prospect of gene therapy for fundus vascular diseases / 国际眼科杂志(Guoji Yanke Zazhi)

Fundus vascular diseases, including neovascular age-related macular degeneration(nAMD)and diabetic retinopathy(DR), are the leading causes of visual impairment worldwide. With the accelerated aging and increased incidence of diabetes, the prevalence of these two fundus diseases will continue to rise. Currently, intraocular injection of anti-vascular endothelial growth factor(anti-VEGF)remains the first-line treatment for fundus vascular diseases, but disadvantages exist, such as frequent intraocular injections, high cost and poor compliance, thus more durable and effective therapeutic strategies need to be explored. The successful application of gene therapy in inherited retinal diseases(IRDs)provides a new idea for the treatment of fundus vascular diseases. With the ongoing of several clinical trials, gene therapy for fundus vascular diseases is expected to be employed in the clinical setting. But there still remain some concerns, including the optimal therapeutic targets selection, administration route and safety issues. This review focuses on the application and prospect of gene augmentation and gene editing-mediated anti-VEGF therapy for the treatment of nAMD and DR.

Comparação das alterações angiográficas entre pacientes diabéticos e não diabéticos com doença arterial periférica / Comparative study of angiographic changes in diabetic and non-diabetic patients with peripheral arterial disease

Resumo Contexto Os diabéticos possuem risco de 5 a 15 vezes maior para o desenvolvimento de doença arterial periférica (DAP), e poucos estudos compararam fatores de risco e a distribuição e gravidade de alterações arteriais angiográficas entre diabéticos e não diabéticos. Objetivos Comparar alterações angiográficas entre pacientes diabéticos e não diabéticos com DAP avançada, correlacionando-as com demais fatores de risco. Métodos Trata-se de um estudo transversal retrospectivo de pacientes consecutivos submetidos a arteriografia de membros inferiores por DAP (Rutherford de 3 a 6), usando os escores angiográficos TASC II e de Bollinger et al. Os critérios de exclusão incluíram arteriografias de membros superiores, exames incompletos ou sem nitidez e cirurgias prévias. A análise estatística incluiu o teste do qui-quadrado ou exato de Fisher para variáveis discretas e o teste t para variáveis contínuas (significância: p < 0,05). Resultados Foram estudados 153 pacientes com idade média de 67 anos, sendo 50,9% do sexo feminino e 58,2% diabéticos. Um total de 91 pacientes (59%) tinha lesão trófica (Rutherford 5 ou 6), enquanto 62 (41%) tinham dor em repouso ou claudicação limitante (Rutherford 3 e 4). Entre os diabéticos, 81,7% eram hipertensos, 29,4% nunca fumaram e 14% tinham antecedente de infarto do miocárdio. Pelo escore de Bollinger et al., as artérias infrapoplíteas foram as mais comprometidas, em especial a tibial anterior (p = 0,005) nos diabéticos, enquanto a femoral superficial foi mais acometida nos não diabéticos (p = 0,008). Pelo TASC II, as alterações arteriográficas mais graves ocorreram no segmento fêmoro-poplíteo nos pacientes não diabéticos (p = 0,019). Conclusões Os setores infrapoplíteos foram os mais comprometidos nos diabéticos, enquanto o setor femoral foi o mais acometido nos não diabéticos.

Abstract Background Diabetics are at 5-15 times greater risk of developing peripheral arterial disease (PAD) and few studies have compared risk factors and distribution and severity of arterial changes in diabetics compared with non-diabetics. Objectives To compare angiographic changes between diabetic and non-diabetic patients with advanced PAD and correlate them with risk factors. Methods A retrospective cross-sectional study was conducted of consecutive patients undergoing lower limb arteriography for PAD (Rutherford 3-6) using TASC II and Bollinger et al. angiographic scores. Exclusion criteria were upper limb angiographies, unclear images, incomplete laboratory test results, and previous arterial surgeries. Statistical analyses included chi-square tests, Fisher's test for discrete data, and Student's t test for continuous data (significance level: p < 0.05). Results We studied 153 patients with a mean age of 67 years, 50.9% female and 58.2% diabetics. A total of 91 patients (59%) had trophic lesions (Rutherford 5 or 6) and 62 (41%) had resting pain or limiting claudication (Rutherford 3 and 4). Among diabetics, 81.7% were hypertensive, 29.4% had never smoked, and 14% had a history of acute myocardial infarction. According to the Bollinger et al. score, infra-popliteal arteries were more affected in diabetics, especially the anterior tibial artery (p = 0.005), while the superficial femoral artery was more affected in non-diabetics (p = 0.008). According to TASC II, the most severe angiographic changes in the femoral-popliteal segment occurred in non-diabetic patients (p = 0.019). Conclusions The most frequently affected sectors were the infra-popliteal sectors in diabetics and the femoral sector in non-diabetics.

Dissecção espontânea da artéria coronária, uma doença multifatorial: perspectivas da experiência de um centro / Spontaneous coronary artery dissection, a multifactorial disease: insights from a center experience

Introdução: Embora seja uma doença pouco conhecida, a dissecção espontânea da artéria coronária é uma causa importante e frequentemente subdiagnosticada da síndrome coronariana aguda não aterosclerótica, principalmente em mulheres. O objetivo deste estudo foi caracterizar uma amostra consecutiva de pacientes diagnosticados com dissecção espontânea da artéria coronária quanto a fatores predisponentes e desencadeadores; quadro clínico e angiográfico; abordagem terapêutica; ocorrência de eventos cardíacos adversos; recorrência e dissecção espontânea de artéria coronária de novo. Métodos: Estudo retrospectivo observacional longitudinal, unicêntrico, que incluiu pacientes diagnosticados com dissecção espontânea da artéria coronária (n=60) admitidos entre janeiro de 2010 e dezembro de 2020. Resultados: A mediana da idade foi de 55 anos, e 83% eram mulheres. A maioria dos pacientes (60%) não apresentava nenhum ou tinha apenas um fator de risco cardiovascular. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico em 67% dos casos. A artéria coronária mais frequentemente envolvida foi a descendente anterior (47%). A maioria das lesões (77%) aparecia na angiografia como dissecção espontânea da artéria coronária tipo 2. O tratamento conservador foi selecionado como abordagem inicial na maioria dos pacientes (72%). A incidência geral de dissecção espontânea da artéria coronária de novo não foi significativamente diferente entre os pacientes tratados primeiramente com revascularização, em comparação com os que receberam tratamento conservador (p=0,953). No entanto, a recidiva da dissecção espontânea da artéria coronária ocorreu no vaso originalmente envolvido em 3 dos 15 pacientes tratados com revascularização, em comparação com apenas um entre os 43 pacientes que foram tratados de forma conservadora (p<0,05). Conclusão: A dissecção espontânea da artéria coronária é mais frequente em mulheres jovens. O infarto agudo do miocárdio sem supradesnivelamento do segmento ST foi o quadro clínico mais observado, envolvendo principalmente a artéria descendente anterior. A revascularização não protegeu da recorrência.

Background: Although it is a poorly known disease, spontaneous coronary artery dissection is an important and frequently underdiagnosed cause of non-atherosclerotic acute coronary syndrome, particularly in women. The objective of this study was to characterize a consecutive sample of patients diagnosed with spontaneous coronary artery dissection with respect to predisposing and precipitating factors; clinical and angiographic presentation; management; occurrence of adverse cardiac events; recurrence; and de novo spontaneous coronary artery dissection. Methods: Longitudinal, observational, retrospective, single-centre study, including patients diagnosed with spontaneous coronary artery dissection (n=60) admitted between January 2010 and December 2020. Results: Median age was 55 years, and 83% were women. Most patients (60%) presented without any or just one cardiovascular risk factor. Non-ST-segment elevation acute myocardial infarction accounted for 67% of clinical presentations. The most frequently affected coronary artery was the left anterior descending (47%). Most lesions (77%) appeared on angiography as type 2 spontaneous coronary artery dissection. Conservative management was chosen as the initial approach in most patients (72%). The overall incidence of de novo spontaneous coronary artery dissection was not significantly different among patients initially managed with revascularization as compared to conservative treatment (p=0.953). However, spontaneous coronary artery dissection recurrence occurred in the originally involved vessel in 3 of 15 patients initially managed with revascularization, as compared to only one among 43 patients treated conservatively (p<0.05). Conclusion: Spontaneous coronary artery dissection occurs more often in young women. Non- ST-segment elevation acute myocardial infarction was the most frequent clinical presentation involving mainly the left anterior descending artery. Revascularization did not protect from recurrence.

Proposed public policies to improve outcomes in vascular surgery: an experts' forum

ABSTRACT Objective To evaluate outcomes of vascular surgeries and identify strategies to improve public vascular care. Methods This was a descriptive, qualitative, and cross-sectional survey involving 30 specialists of the Hospital Israelita Albert Einstein via Zoom. The outcomes of vascular procedures performed in the Public Health System extracted through Big Data analysis were discussed, and 53 potential strategies to improve public vascular care to improve public vascular care. Results There was a consensus on mandatory reporting of some key complications after complex arterial surgeries, such as stroke after carotid revascularization and amputations after lower limb revascularization. Participants agreed on the recommendation of screening for diabetic feet and infrarenal abdominal aortic aneurysms. The use of Telemedicine as a tool for patient follow-up, auditing of centers for major arterial surgeries, and the concentration of complex arterial surgeries in reference centers were also points of consensus, as well as the need to reduce the values of endovascular materials. Regarding venous surgery, it was suggested that there should be incentives for simultaneous treatment of both limbs in cases of varicose veins of the lower limbs, in addition to the promotion of ultrasound-guided foam sclerotherapy in the public system. Conclusion After discussing the data from the Brazilian Public System, proposals were defined for standardizing measures in population health care in the area of vascular surgery.

Symptomatic Upper Extremity Deep Venous Thrombosis After Laser Lead Extraction

ABSTRACT Introduction: Laser lead extraction is a well-established method for removing unwanted leads with low morbidity and mortality. In this small series of cases, we documented our experience with venous thrombosis after laser lead extraction. Methods: Retrospective data of patients who underwent laser lead extraction with postoperative axillo-subclavian vein thrombosis between May 2010 and January 2020 were analyzed. Demographic, operative, clinical, and follow-up characteristics of those patients were collected from our medical database. Results: Six patients underwent percutaneous laser lead extraction. Mean age of the patients was 64±7 years. And four of them were male. A total of 11 leads with a mean age of 92±43.8 months were extracted. Patients presented with painful arm swelling postoperatively. Conclusion: Laser lead extraction may lead to symptomatic upper extremity deep venous occlusion.

Programa de superación profesional para angiólogos sobre tratamiento de enfermedades vasculares periféricas con técnicas novedosas

Introducción: La superación profesional es un conjunto de acciones de carácter educativo vinculadas con la actualización de conocimientos y el desarrollo de habilidades y actitudes profesionales en correspondencia con la identificación de problemas profesionales. En Ciego de Ávila, Cuba, los especialistas de Angiología y Cirugía Vascular carecen de actividades de superación profesional de forma general, sistemática y de participación colectiva, dirigidas u orientadas desde la Universidad de Ciencias Médicas. Objetivo: Elaborar un programa de superación profesional del especialista en Angiología y Cirugía Vascular para el tratamiento de las enfermedades vasculares periféricas con técnicas novedosas, a partir de insuficiencias identificadas. Método: Se realizó una investigación cualitativa con un estudio descriptivo en especialistas de Angiología y Cirugía Vascular de la provincia de Ciego de Ávila, vinculada directamente con la atención a pacientes, en el año 2020. Se trabajó con toda la población compuesta por 19 especialistas. Fue aplicada una encuesta y se utilizó la estadística descriptiva para organizar y clasificar los indicadores cuantitativos obtenidos. Resultados: La preparación para la aplicación de tratamiento con técnicas novedosas en las enfermedades vasculares periféricas se encontró como insuficiencia en nivel de Poco adecuado y No adecuado en más del 90 % de los especialistas. Conclusiones: Se aporta un programa de superación profesional como sistema abierto, de carácter flexible, que facilita su rediseño constante para adaptarse a condiciones específicas de los contextos de aplicación.

Introduction: Professional development is a set of educational actions linked to update knowledge and professional skills and attitudes in correspondence with the professional problems met. In Ciego de Avila, Cuba, specialists in Angiology and Vascular Surgery lack professional improvement activities in general, systematic and collective participation way, straightly performed or oriented from the University of Medical Sciences. Objective: To design a professional development program for specialists in Angiology and Vascular Surgery on the treatment of peripheral vascular diseases with the use of novel techniques based on the professional problems met. Method: A qualitative research with descriptive study was carried out in Angiology and Vascular Surgery specialists linked directly to the patient care service in 2020. It worked with the whole population comprised of 19 specialists. A survey was applied and descriptive statistics were used to organize and classify the quantitative indicators obtained. Results: Knowledge on how to use the novel techniques in peripheral vascular diseases treatment proved to be inadequate at a pointed level of Less adequate and Inadequate in more than 90% of studied specialists. Conclusions: The professional development program is provided with characteristics of an open system and flexibility, which facilitates its constant redesign to adapt to the specific conditions of the contexts required.

Introdução: O aperfeiçoamento profissional é um conjunto de ações educativas vinculadas à atualização de conhecimentos e desenvolvimento de habilidades e atitudes profissionais em correspondência com a identificação de problemas profissionais. No Ciego de Ávila, Cuba, os especialistas em Angiologia e Cirurgia Vascular carecem de atividades de aperfeiçoamento profissional de forma geral, sistemática e de participação coletiva, dirigidas ou orientadas pela Universidade de Ciências Médicas. Objetivo: Desenvolver um programa de aperfeiçoamento profissional do especialista em Angiologia e Cirurgia Vascular para tratamento de doenças vasculares periféricas com técnicas inovadoras, a partir das insuficiências identificadas. Método: Foi realizada uma investigação qualitativa com estudo descritivo em especialistas de Angiologia e Cirurgia Vascular na província de Ciego de Ávila, diretamente vinculados ao atendimento ao paciente, no ano de 2020. Trabalhamos com toda a população composta por 19 especialistas. Aplicou-se um survey e utilizou-se estatística descritiva para organizar e classificar os indicadores quantitativos obtidos. Resultados: A preparação para a aplicação do tratamento com novas técnicas nas doenças vasculares periféricas revelou-se insuficiente ao nível de Pouco adequado e Pouco adequado em mais de 90% dos especialistas. Conclusões: Um programa de aperfeiçoamento profissional é fornecido como um sistema aberto, de natureza flexível, o que facilita seu redesenho constante para se adaptar às condições específicas dos contextos de aplicação.

Prevalência de eventos vasculares associados a pacientes com COVID-19 em um hospital público* / Prevalencia de eventos vasculares asociados a pacientes con COVID-19 en un hospital público / Prevalence of vascular events associated with COVID-19 patients in a public hospital

Objetivo: verificar a prevalência dos principais eventos vasculares associados a pacientes com COVID-19 admitidos em um hospital público do Recife. Método: trata-se de um estudo transversal descritivo, realizado por meio das bases de dados epidemiológicos e prontuários eletrônicos de pacientes, no período de março de 2020 a agosto de 2021. Resultados: analisaram-se 1122 pacientes, (58,8%) com diagnóstico positivo para COVID-19. Os principais eventos vasculares evidenciados foram: Tromboembolismo Venoso Profundo (4,55%); Tromboembolismo Pulmonar (2,5%); Oclusão Arterial Aguda (0,98%) e Isquemia Crítica de Membro Inferior a mais prevalente, sendo 17,64% dos casos. Conclusão: foi possível apontar a prevalência de eventos vasculares associados a pacientes com COVID-19, admitidos em um hospital público do Recife, tal como classificar os principais eventos vasculares, sua repercussão e evolução. Assim, o conhecimento acerca do perfil desses pacientes no contexto da pandemia pode contribuir para o desenvolvimento de novas pesquisas na área de saúde.

Objective: to verify the prevalence of the main vascular events associated with patients with COVID-19 admitted to a public hospital in Recife. Method: this is a descriptive cross-sectional study, carried out through epidemiological databases and electronic patient records, from March 2020 to August 2021. Results: 1122 patients (58.8%) with a positive diagnosis for COVID-19 were analyzed. The main vascular events evidenced were: Deep Venous Thromboembolism (4.55%); Pulmonary Thromboembolism (2.5%); Acute Arterial Occlusion (0.98%) and Critical Lower Limb Ischemia, the most prevalent, being 17.64% of the cases. Conclusion: it was possible to point out the prevalence of vascular events associated with patients with COVID-19, admitted to a public hospital in Recife, as well as to classify the main vascular events, their repercussion and evolution. Thus, knowledge about the profile of these patients in the context of the pandemic can contribute to the development of new research in the health area.

Objetivo: verificar la prevalencia de los principales eventos vasculares asociados a pacientes con COVID-19 ingresados en un hospital público de Recife. Método: se trata de un estudio descriptivo transversal, realizado a través de bases de datos epidemiológicas y registros electrónicos de pacientes, de marzo de 2020 a agosto de 2021. Resultados: se analizaron 1122 pacientes (58,8%) con diagnóstico positivo para COVID-19. Los principales eventos vasculares evidenciados fueron: Tromboembolismo Venoso Profundo (4,55%); Tromboembolismo Pulmonar (2,5%); Oclusión Arterial Aguda (0,98%) e Isquemia Crítica de Miembros Inferiores el más prevalente, con el 17,64% de los casos. Conclusión: fue posible señalar la prevalencia de eventos vasculares asociados a pacientes con COVID-19, ingresados en un hospital público de Recife, así como clasificar los principales eventos vasculares, sus repercusiones y evolución. Así, el conocimiento del perfil de estos pacientes en el contexto de la pandemia puede contribuir para el desarrollo de nuevas investigaciones en el área de salud.

Buerger's disease with cerebral involvement in a middle-aged woman with diabetes mellitus. a case report

Introduction: Buerger's disease (BD) generally affects men, young people, and smokers, but it can also affect women. Its incidence is rare in Latin America. Case report: A 40-year-old Colombian woman, active smoker and user of psychoactive substances, attended the emergency department of a tertiary care center due to symptoms of 3 days consisting of retraction of the corner of the mouth, drooling, and involuntary tongue movements. The patient, who had a history of uncontrolled diabetes and recent acute ischemia of the right upper limb due to acute thrombosis, required surgical management and subsequent use of oral anticoagulation. She later developed necrotic changes in the distal phalanges of the right hand that required ablative therapy. Since age, sex and limb involvement were not typical for BD, collagenosis, vasculitis or thrombophilia were ruled out, but after excluding these disorders, BD with atypical features was considered. The patient was discharged with oral anticoagulation, aspirin, combined analgesia, physiotherapy, and recommendation for smoking cessation. Conclusions: Age, sex, smoking and comorbidities such as diabetes are risk factors for BD. Imaging and histopathology are the gold standard for the definitive diagnosis of this entity. Multidisciplinary management, lifestyle changes, smoking cessation, pain control, good wound healing and social support are key aspects for better clinical outcomes in patients with BD.

Introducción. La enfermedad de Buerger (EB) afecta generalmente a hombres, jóvenes y fumadores, y aunque también puede afectar a mujeres, su incidencia es rara en Latinoamérica. Presentación del caso. Mujer colombiana de 40 años, fumadora activa y consumidora de sustancias psicoactivas, quien acudió al servicio de urgencias de una institución de tercer nivel por síntomas de 3 días de evolución consistentes en retracción de la comisura bucal, babeo y movimientos involuntarios de la lengua. La paciente, que tenía antecedente de diabetes no controlada y reciente isquemia aguda de miembro superior derecho por trombosis aguda, requirió manejo intervencionista y subsecuente uso de anticoagulación oral. Posteriormente, desarrolló cambios necróticos en falanges distales de mano derecha y requirió terapia ablativa. Dado que la edad, el género y la afectación de las extremidades no eran típicos para EB, se procedió a descartar colagenosis, vasculitis o trombofilia, pero tras excluir estas patologías se consideró EB con características atípicas. La paciente fue dada de alta con anticoagulación oral, aspirina, analgesia combinada, fisioterapia y recomendación de suspender el consumo de tabaco. Conclusiones. La edad, el género, el tabaquismo y las comorbilidades como diabetes son factores de riesgo para EB. La imagenología e histopatología son estándar de oro en el diagnóstico definitivo de esta entidad. El manejo multidisciplinario, los cambios en el estilo de vida, la cesación del tabaquismo, el control del dolor, la buena cicatrización de heridas y el apoyo social son aspectos importantes para obtener mejores resultados clínicos en pacientes con EB.

The effect of vitamin D deficiency on the retinal microvasculature: an observational case-control study / O efeito da deficiência de vitamina D nos microvasos da retina: um estudo caso-controle observacional

ABSTRACT Purpose: To determine the effects of vitamin D deficiency on retinal microvascularity using optical coherence tomography angiography. Methods: This study was designed as an observational case-control study. Ninety-eight eyes of patients with vitamin D deficiency and 96 eyes of healthy participants with serum vitamin D level >30 ng/mL were studied. Macula centered, 6.00 × 6.00 mm scan size images were taken. The vessel densities in the superficial and deep retinal capillary plexus, foveal avascular zone area, and choriocapillaris flow area were measured. Results: The groups were comparable in terms of best-corrected visual acuity, sex, axial length, refractive error, age, and adjusted intraocular pressure. The average vitamin D level was significantly lower in the study group (p=0.021). The whole, parafoveal, and perifoveal vessel densities in the deep capillary plexus were considerably higher in the study group than in the control group (p=0.012, p=0.014, and p=0.023, respectively). The foveal avascular zone area and the choriocapillaris flow area were similar in both groups (p=0.37 and p=0.27, respectively) there was a strong negative correlation between the serum vitamin D level and vessel density in the whole image, parafoveal, and perifoveal regions of the deep capillary plexus in the study group (Spearman's rho=-0.71, p=0.043; Spearman's rho= -0.79, p=0.011; and Spearman's rho = -0.74, p=0.032; respectively). Conclusion: An increase in vessel density might originate from vascular structural changes caused by vitamin D deficiency. The increased vessel density, especially in the deep capillary plexus, can enable early diagnosis of vitamin D-associated vasculopathy.

RESUMO Objetivo: Determinar os efeitos da deficiência de vitamina D nos microvasos da retina usando angiotomografia de coerência óptica. Métodos: Este estudo foi planejado para ser do tipo caso-controle observacional. Foram avaliados 98 olhos de pacientes com deficiência de vitamina D e 96 olhos de participantes saudáveis com nível sérico de vitamina D superior a 30 ng/mL. Foram adquiridas imagens de varredura centralizadas na mácula, com um tamanho de 6,00 × 6,00 mm. Mediram-se a densidade dos vasos nos plexos capilares superficial e profundo da retina, a área da zona avascular foveal e a área do fluxo coriocapilar. Resultados: Os grupos mostraram-se semelhantes em relação à melhor acuidade visual corrigida, ao gênero, ao comprimento axial, ao erro refrativo, à idade e à pressão intraocular ajustada. O nível médio de vitamina D foi significativamente menor no grupo de estudo (p=0,021). As densidades total, parafoveal e perifoveal do plexo capilar profundo foram significativamente maiores no grupo de estudo que no grupo controle (respectivamente, p=0,012, p=0,014 e p=0,023). As áreas da zona avascular foveal e do fluxo coriocapilar foram semelhantes nos dois grupos (respectivamente, p=0,37 e p=0,27). Além disso, houve uma forte correlação negativa do nível sérico de vitamina D com as densidades vasculares medidas em toda a imagem e nas regiões parafoveais e perifoveais do plexo capilar profundo no grupo de estudo (respectivamente, ρ de Spearman = −0,71, p=0,043; ρ de Spearman = −0,79, p=0,011; e ρ de Spearman = −0,74, p=0,032). Conclusão: Pode ocorrer um aumento na densidade vascular da retina devido a alterações estruturais dos vasos causadas pela deficiência de vitamina D. O aumento da densidade vascular, especialmente no plexo capilar profundo, pode ser usado para o diagnóstico precoce da vasculopatia associada à deficiência de vitamina D.

Caracterización de gestantes con enfermedad tromboembólica venosa atendidas en el Hospital General Docente "Abel Santamaría Cuadrado" / Characterization of pregnant women with venous thromboembolic disease attended at the General Teaching Hospital "Abel SantamaríaCuadrado"

RESUMEN Introducción: la enfermedad tromboembólica venosa constituye una de lascomplicacionesdelembarazo, que puede evolucionar tórpidamente y causar la muerte. Objetivo: caracterizar a las gestantes con enfermedad tromboembólica venosa atendidas en el Hospital General Docente "Abel Santamaría Cuadrado". Métodos: se realizó un estudio observacional, descriptivo y transversal en gestantes atendidas en el Hospital General Docente "Abel Santamaría Cuadrado" entre mayo de 2018 y marzo de 2021. La muestra quedó conformada por 26 pacientes. Se empleó estadística descriptiva. Resultados: el 0,09 % de las 27 500 gestantes atendidas presentaronenfermedad tromboembólica venosa, conmayorincidenciaen el grupo etario de gestantes de 35 años o más (0,06 %). El 76,92 % desarrolló la enfermedad tromboembólica venosa durante elpuerperio, la mayor incidencia durante el puerperio se observó en pacientes sometidas a cesárea (80 %). El 57,69 % de las pacientes conenfermedad tromboembólica venosa durante la gestaciónpresentaronvárices en miembros inferiores y el 69,23 % refirieron antecedentes de trombosis venosa profunda. La enfermedad tromboembólica venosa fuecomún (57,69 %) en gestantes con un índice de masa corporal mayor de 28,6. Conclusiones: el tromboembolismo venoso presentó una baja incidencia, la cualfuemayor durante elpuerperio, se presentócomúnmente en esa etapa en aquellas que fuenecesariorealizarles cesárea. En las gestantes con antecedentes de trombosis venosa profunda fuecomún la recurrencia. La enfermedad tromboembólica venosa fue más frecuente en gestantes conun índice de masa corporal elevado.

ABSTRACT Introduction: venous thromboembolic disease constitutes one of the complications of pregnancy, which can evolve torpidly and cause death. Objective: to characterize pregnant women with venous thromboembolic disease attended at the "Abel SantamaríaCuadrado" General Teaching Hospital. Methods: an observational, descriptive and cross-sectional study was conducted in pregnant women attended at the "Abel SantamaríaCuadrado" General Teaching Hospital between May 2018 and March 2021. The sample consisted of 26 patients. Descriptive statistics were used. Results: 0,09 % of the 27,500 pregnant women attended presented venous thromboembolic disease, with a higher incidence in the age group of pregnant women aged 35 years or older (0,06 %). A total of 76,92 % developed venous thromboembolic disease during the puerperium, with the highest incidence during the puerperium being observed in patients who underwent cesarean section (80 %). Of the patients with venous thromboembolic disease during pregnancy, 57,69% presented varicose veins in the lower limbs and 69,23 % reported a history of deep vein thrombosis. Venous thromboembolic disease was common (57,69 %) in pregnant women with a body mass index greater than 28,6. Conclusions: Venous thromboembolism presented a low incidence, which was higher during the puerperium, occurring commonly at that stage in those who had to undergo cesarean section. In pregnant women with a history of deep vein thrombosis, recurrence was common. Venous thromboembolic disease was more frequent in pregnant women with a high body mass index.

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.

Telemedicina en cirugía vascular y endovascular: experiencia en un centro universitario

Background: Telemedicine became a relevant means to provide healthcare without face-to-face medical evaluation during the COVID-19 pandemic. Aim: To describe the effectiveness of telemedicine in vascular surgery. Materials and Methods: Review of medical records of all vascular surgery consultations carried out in a clinical hospital between April and October 2020. The main outcome measured was the resolution of the reason for consultation. Secondary outcomes were the need to request laboratory tests or imaging, the need to evaluate the patient in person, and the need for referral to hospitalization or emergency service. Results: One hundred-six new consultations and their follow-up (remotely or in person) were analyzed. A definitive diagnosis could be reached in 74% of consultations, treatment could be instituted or modified in 69% of them, and the reason for consultation could be resolved in 74% of cases. Laboratory and imaging tests were requested in 36 and 63% of consultations, respectively. Four percent of patients were referred to the emergency department or hospitalization. Conclusions: In the vast majority of consultations, it was possible to achieve a definitive diagnosis, prescribe a treatment and resolve the reason for consultation without the need for a face-to-face medical evaluation.