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2.
Medicina (B.Aires) ; 82(5): 777-780, Oct. 2022. graf
Article in English | LILACS-Express | LILACS | ID: biblio-1405737

ABSTRACT

Abstract The World Health Organization has declared the novel coronavirus disease 2019 (COVID-19) a global public health emergency. Despite the predominating respiratory symptoms occurring in COVID-19, thrombosis can occur in some patients, with morbidity and mortality increase due to the respiratory worsening. This article reports the case of a 62-year-old man with a flu-like illness that was diagnosed as CO VID-19 by RT-PCR of SARS-CoV-2. After three weeks, he subsequently developed abdominal pain in addition to bloating, nausea, and vomiting. He underwent exploratory laparotomy after imaging tests suggested mesenteric ischemia. Intestinal ischemia was evident, due to the absence of flow in the superior mesenteric artery and jejunal branches. Embolectomy and enterectomy were performed and they resulted in a favorable outcome, with clinical improvement. This case adds data to the limited literature on extrapulmonary complications of COVID-19, notably those related to thromboembolic events.


Resumen La Organización Mundial de la Salud ha declarado la enfermedad del nuevo coronavirus 2019 (COVID-19) una emergencia de salud pública mundial. A pesar de los síntomas respiratorios predominantes en COVID-19, la trombosis puede ocurrir en algunos pacientes, con un aumento de la morbimortalidad debido al empeoramiento respiratorio. Presentamos el caso de un hombre de 62 años con enfermedad similar a la gripe que fue diagnosticada como COVID-19 por RT-PCR de SARS-CoV-2. Después de tres semanas, de sarrolló dolor abdominal además de hinchazón, náuseas y vómitos. Fue sometido a laparotomía exploradora luego de que las pruebas de imagen sugirieran isquemia mesentérica. Se evidenció isquemia intestinal por ausencia de flujo en la arteria mesentérica superior y ramas yeyunales. Se realizó embolectomía y enterec tomía con evolución favorable, con mejoría clínica. Este caso añade datos a la limitada literatura sobre las complicaciones extrapulmonares del COVID-19, en particular las relacionadas con eventos tromboembólicos.

4.
Rev. colomb. cardiol ; 29(4): 457-466, jul.-ago. 2022. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1408007

ABSTRACT

Resumen Introducción: La cardiopatía isquémica es un problema de salud pública y puede tratarse por medio de la revascularización miocárdica. Objetivo: Estructurar el primer perfil epidemiológico y clínico de los pacientes intervenidos en Tolima. Materiales y método: Es un estudio de corte transversal, de 183 pacientes mayores de 18 años programados para revascularización miocárdica entre septiembre de 2018 y septiembre de 2019. Se eligieron variables clínicas y demográficas. Se realizó un análisis descriptivo, un análisis bivariado para mortalidad y circulación extracorpórea, y una regresión logística para la mortalidad intrahospitalaria. Resultados: La edad media de los pacientes fue de 66.7 años y un 68.85% correspondió a la población femenina. Se presentó HA en 80.33%, tabaquismo en 49.18%, dislipidemia en 44.81% y DM en 40.98%. Se registró mayor proporción de complicaciones en los pacientes intervenidos sin CEC, como complicaciones pulmonares, FA de novo y una estancia intrahospitalaria y posoperatoria mayor. Los pacientes que fallecieron tuvieron mayor proporción de complicaciones, mayor estancia hospitalaria, mayor cantidad de reintervenciones y tiempo de ventilación mecánica. El modelo de regresión reveló una relación con mortalidad para los pacientes que tuvieron requerimiento de diálisis (OR = 8.7) complicaciones pulmonares (OR = 10.5) y desarrollo de FA de novo (OR = 11.3). Conclusiones: Este estudio caracteriza a la población para generar marcos de referencia en un grupo poco estudiado como el tolimense. De modo adicional, se presentaron mejores desenlaces en los pacientes llevados a revascularización miocárdica con circulación extracorpórea, y unas relaciones claras de mortalidad y complicaciones posoperatorias.


Abstract Introduction: The ischemic cardiopathy is a public health issue, that can be treated with a coronary artery bypass grafting (CABG). Objective: To present the first clinical and epidemiological profile of CABG treated patients in Tolima, Colombia. Materials and method: We conduct a cross sectional study, including 183 patients driven to a CABG procedure, between September 2018-2019. We chose clinical and demographic variables. And posteriorly, performed a descriptive and bivariate analysis, including mortality and extracorporeal circulation. Besides, we completed a logistic regression for intrahospital mortality. Results: The average age of our patients was 66,7 years, and 68.85% were female. They presented in an 80.33% arterial hypertension, smoked an 49.18%, had dyslipidemia and diabetes 44.81% and 40.95% respectively. There were more complications in patients who were drove into on pump CABG, primarily pulmonary complications, atrial fibrillation, mayor intrahospital and post-operatory stay. The patients who died, present more complications, intrahospital stay, reinterventions and mechanic ventilation time. Our regression model evidenced mortality association with post-operatory dialysis (OR = 8.7), pulmonary complications (OR = 10.5) and new atrial fibrillation (OR = 11.3). Conclusions: This study aim to characterize the Tolima's population, creating a reference in this less studied population. On the other side, the study discuss the better outcomes in patients taken to myocardial bypass with extracorporeal membrane oxygenation. And the association between dead and certain postoperative complications.

5.
Rev. bras. ter. intensiva ; 34(3): 367-373, jul.-set. 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1407753

ABSTRACT

RESUMO Objetivo: Avaliar possíveis mecanismos atribuídos ao valor prognóstico da reserva microvascular isquêmica periférica em pacientes com sepse. Métodos: Este estudo de coorte observacional incluiu 46 pacientes consecutivos com sepse em uma unidade de terapia intensiva entre novembro de 2020 e outubro de 2021. Após a ressuscitação volêmica com fluidos, avaliou-se a reserva microvascular isquêmica periférica mediante a associação dos testes hiperemia reativa pós-oclusão e índice de perfusão periférica. Adicionalmente, amostras de sangue venoso periférico foram coletadas para avaliar os níveis dos neuropeptídeos substância P e peptídeo relacionado ao gene da calcitonina no membro superior do paciente antes e imediatamente após o teste de hiperemia reativa pós-oclusão. Resultados: Não houve correlação estatisticamente significativa (p > 0,05) entre os valores basais ou variações dos níveis de neuropeptídeos e a reserva microvascular isquêmica periférica. Conclusão: Embora o peptídeo relacionado ao gene da calcitonina e a substância P possam desempenhar papel prognóstico na sepse, esses neuropeptídeos não parecem contribuir para a reserva microvascular isquêmica periférica.


ABSTRACT Objective: To evaluate the mechanisms attributed to the prognostic value of peripheral ischemic microvascular reserve in patients with sepsis. Methods: This observational cohort study enrolled 46 consecutive septic patients in the intensive care unit between November 2020 and October 2021. After fluid resuscitation, the peripheral ischemic microvascular reserve was evaluated using the association of postocclusion reactive hyperemia with the peripheral perfusion index. Additionally, peripheral venous blood samples were used to evaluate the neuropeptide calcitonin gene-related peptide and substance P levels in the upper limb before and immediately after postocclusion reactive hyperemia Results: There was no statistically significant correlation (p > 0.05) between basal values (pg/mL) or variations from neuropeptide levels (%) and the peripheral ischemic microvascular reserve (%). Conclusion: Although calcitonin gene-related peptide and substance P may have a prognostic role in sepsis, these neuropeptides do not appear to contribute to peripheral ischemic microvascular reserve.

6.
Braz. j. otorhinolaryngol. (Impr.) ; 88(3): 381-389, May-June 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1384182

ABSTRACT

Abstract Introduction Cochlear ischemia is hypothesized as one of the major etiologies of idiopathic sudden sensorineural hearing loss. Therefore, anticoagulant therapies are designed to be beneficial in certain patients with this condition. Objective This study aimed to determine which patients with idiopathic sudden sensorineural hearing loss would benefit from heparin treatment as adjuvant therapy. Methods In total, 134 patients who underwent magnetic resonance imaging for unilateral idiopathic sudden sensorineural hearing loss at a tertiary referral hospital between January 2014 and December 2018 were included in this retrospective study. All patients received Intratympanic steroid injections or heparin therapy plus oral corticosteroids. Radiological parameters of the vertebrobasilar system and clinical data from pre- and post-treatment assessments were analyzed. Results Most patients (71.6%) had a tortuous basilar artery The 65 patients with severe-to-profound idiopathic sudden sensorineural hearing loss showed a significant relationship between idiopathic sudden sensorineural hearing loss laterality and basilar artery displacement to the opposite side (p= 0.036), while the 69 patients with mild-to-moderate idiopathic sudden sensorineural hearing loss did not (p= 0.950). Additionally, the degree of basilar artery tortuosity was significantly associated with the degree of hearing impairment in the severe-to-profound idiopathic sudden sensorineural hearing loss group (p= 0.015). When idiopathic sudden sensorineural hearing loss occurred on the opposite side to basilar artery displacement, the improvement of hearing was significantly greater in patients treated with heparin than in those treated with intratympanic steroids (p= 0.041). Conclusion In a subset of patients with severe-to-profound idiopathic sudden sensorineural hearing loss, basilar artery tortuosity had a significant directional relationship with idiopathic sudden sensorineural hearing loss laterality. In these selected patients, a significant effect of heparin therapy on improving hearing was observed.


Resumo Introdução A isquemia coclear é considerada uma das principais etiologias da perda auditiva neurossensorial súbita idiopática. Portanto, espera-se que as terapias anticoagulantes sejam benéficas em certos pacientes com esse diagnóstico. Objetivo Determinar quais pacientes com perda auditiva neurossensorial súbita idiopática se beneficiariam do tratamento com heparina como terapia adjuvante. Método Foram incluídos neste estudo retrospectivo 134 pacientes submetidos à ressonância magnética por perda auditiva neurossensorial súbita idiopática unilateral em um hospital de referência terciário entre janeiro de 2014 e dezembro de 2018. Todos os pacientes receberam injeções intratimpânicas de corticosteroides ou terapia com heparina juntamente com corticosteroides orais. Os parâmetros radiológicos do sistema vertebro-basilar e os dados clínicos das avaliações pré e pós-tratamento foram analisados. Resultados A maioria dos pacientes (71,6%) apresentava uma artéria basilar tortuosa. Os 65 pacientes com perda auditiva neurossensorial súbita idiopática grave a profunda mostraram uma relação significativa entre a lateralidade da perda auditiva e o deslocamento da artéria basilar para o lado oposto (p = 0,036), enquanto os 69 pacientes com perda auditiva neurossensorial súbita idiopática leve a moderada não apresentaram esse deslocamento (p = 0,950). Além disso, o grau de tortuosidade da artéria basilar foi significativamente associado ao grau de deficiência auditiva no grupo com perda auditiva neurossensorial súbita idiopática grave a profunda (p = 0,015). Quando a perda auditiva neurossensorial súbita idiopática ocorreu no lado oposto ao deslocamento da artéria basilar, a melhoria da audição foi significativamente maior nos pacientes tratados com heparina do que naqueles tratados com injeções intratimpânicas de corticosteroide (p = 0,041). Conclusão Em um subgrupo de pacientes com perda auditiva neurossensorial súbita idiopática grave a profunda, a tortuosidade da artéria basilar mostrou uma relação direcional significativa com a lateralidade da perda auditiva. Nesses pacientes selecionados, foi observado um efeito significante da terapia com heparina na melhoria da audição.

8.
Medicina (B.Aires) ; 82(4): 621-625, 20220509. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1405710

ABSTRACT

Resumen Actualmente existen múltiples métodos invasivos y no invasivos que pueden emplearse para establecer el diagnóstico de disfunción microvascular (DMV) en pacientes con INOCA (por sus siglas en inglés: Ischemia with Non-Obstructive Coronary Arteries) y angina microvascular (AMV). No obstante, todavía no contamos con un enfoque de tratamiento específico para este grupo de pacientes. La tendencia act ual es ajustar el tratamiento al mecanismo fisiopatológico implicado, añadiendo antagonistas del calcio en aquellos pacientes en los que se demuestre disfunción endotelial, o bien bloqueadores beta en aquellos que presenten disfunción músculo liso dependiente. Presentamos tres casos clínicos de INOCA con sospecha de AMV. A dos de ellos se les realizó diagnóstico no invasivo de DMV mediante CZT-SPECT, utilizando como apremio dipiridamol para evaluar el mecanismo músculo liso dependiente y test de frío para evaluar el mecanismo endotelio dependiente. Según los resultados obtenidos se ajustó el tratamiento, se realizó seguimiento clínico y valoración de la angina por la escala de Seattle, con nueva valoración de la función microvascular a los 6 meses. El tercer caso clínico, en cambio, es una paciente que inició tratamiento empírico para ambos mecanismos y posteriormente abandonó el tratamiento instaurado, evaluándose la función microvascular bajo tratamiento farmacológico y sin el mismo.


Abstract There are currently multiple invasive and non-invasive methods that can be used to establish the diagnosis of microvascular dysfunction (MVD) in patients with INOCA (Ischemia with Non-Obstructive Coronary Arteries) and microvascular angina. However, we still do not have a specific treatment approach for this group of patients. The current trend is to adjust the treatment to the pathophysiological mechanism involved, adding calcium blockers in those patients where endothelial dysfunction is demonstrated or beta blockers in those patients who present smooth muscle-dependent dysfunction. We present three clinical cases of INOCA with suspected microvascular angina. Two of them underwent a non-invasive diagnosis of MVD by CZT-SPECT, using dipyridamole to evaluate the smooth muscle-dependent mechanism and cold pressor test to evaluate the endothelium-dependent mecha nism. According to the results obtained, the treatment was adju sted, clinical follow-up was carried out and angina was assessed using the Seattle scale, with a new microcirculation assessment at 6 months. The third clinical case, on the other hand, was a patient who began empirical treatment for both mechanisms and subsequently abandoned the established treatment. Microvascular function was evaluated under pharmacological treatment and without it.

10.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409047

ABSTRACT

RESUMEN Introducción: En los últimos años la anestesia local sin torniquete y con el paciente despierto, técnica conocida por WALANT (por sus siglas en inglés), ha ganado mucha popularidad en las cirugías de la mano y la muñeca. Objetivo: Reportar nuestra experiencia con el uso de la técnica WALANT, a fin de prescindir del uso del torniquete en las cirugías de la mano. Métodos: En noviembre del 2020 fueron intervenidos 30 pacientes por diversas enfermedades ortopédicas, entre las que figuraron: dedos en resorte, síndrome del túnel carpiano, tenovaginitis estenosante del pulgar, gangliones del carpo y amputación del tercer radio por rigidez en extensión postraumática, entre otras. Para la evaluación de la técnica tuvimos en cuenta: tiempo quirúrgico, magnitud del sangrado, dolor durante la infiltración anestésica, la intervención, y en las primeras 24 horas del postoperatorio, la necesidad de refuerzo anestésico, uso de isquemia, complicaciones y nivel de satisfacción del paciente. Resultados: Los resultados obtenidos con esta técnica anestésica son semejantes a otras, con las ventajas que el sangrado es leve, no hay que utilizar isquemia, el tiempo quirúrgico es menor y el efecto anestésico duró entre 10 y 12 horas en todos los pacientes. En ninguno de los pacientes hubo necesidad de refuerzo anestésico. Conclusiones: Se demuestra la efectividad de la técnica WALANT en las cirugías de mano. Con ella se disminuye el gasto de materiales para el acto quirúrgico, así como de personal, es de fácil aplicación y disminuyen las sensaciones desagradables y los peligros del uso de isquemia en los pacientes.


ABSTRACT Introduction: Currently, the use of local anaesthetic with no tourniquet and wide awake patient (Wide Awake Local Anaesthetic No Tourniquet - WALANT) has gained popularity in surgeries of the hand and wrist. Objective: To report our experience in the use of WALANT technique in order to discard the use of tourniquet in hand surgeries. Method: In November 2020, thirty patients underwent surgery due to different orthopaedic conditions, among them trigger fingers, carpal tunnel syndrome, stenosing tenovaginitis of the thumb, carpal ganglion and amputation of the third radius due to post trauma stiffness, among others. In order to assess this technique, we considered surgical time, volume of bleeding, pain during anesthetic infiltration, intervention and the need for additional anesthetic during the first 24 hours after surgery; we considered also ischemia, complications and level patient´s satisfaction. Results: This technique had similar results to others; however, the bleeding is mild, there is no need for ischemia, the surgical time is lesser and the anesthetic effect lasted 10 to 12 hours in all patients. None of them required additional anesthetic. All subjects felt the initial infiltration but none complained of pain during the rest of the anesthetic injection or during the surgical act. There were no complications. Conclusions: The effectiveness of WALANT technique in hand surgeries is shown. The cost of materials for the surgical act is reduced with it, as well as the surgical staff, it is easy to use and unpleasant sensations and dangers of the use of ischemia in patients are reduced.

11.
Rev. méd. hered ; 33(2): 122-127, abr.-jun. 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1409886

ABSTRACT

SUMMARY Objective : To describe clinical, surgical and post-operative characteristics of patients with the diagnosis of malignant infarction of the middle cerebral artery who underwent decompressive craniectomy. Methods : Descriptive, retrospective case series study, performed between March 2017 and March 2020. Data from consecutive patients with the diagnosis of malignant middle cerebral artery infarction were collected. Results : Ten cases were reviewed. Eighty percent of the patients were men, the mean age was 64 years and 60% of the patients were older than 60 years. At admission, the mean Glasgow was 11 points and the mean mRS was 4. The mean time from diagnosis to surgery was 89.7 hours. The anterior cerebral artery was comprised in two cases. Hemorrhagic transformation occurred in three cases. The mean anterior-posterior diameter of the skull flap was 116 mm. The mean ICU and hospital length of stay were 14.1 and 27.5 days, respectively. Three patients died. Conclusions : Decompressive craniectomy is a life-saving procedure in an emergency hospital-setting with an acceptable in-hospital mortality rate within one-month follow-up.


RESUMEN Objetivo : Describir las características clínicas, quirúrgicas y postoperatorias en pacientes con diagnóstico de infarto maligno de la arteria cerebral media sometidos a craniectomía descompresiva. Material y métodos : Estudio observacional, descriptivo, retrospectivo, tipo serie de casos, realizado entre marzo 2017 y marzo 2020. Se recolectaron los datos de pacientes consecutivos con diagnóstico de infarto maligno de arteria cerebral. Resultados : Diez casos fueron revisados. Ochenta por ciento fueron hombres, la edad promedio fue 64 años y 60% de los pacientes fueron mayores de 60 años. En la admisión, el Glasgow promedio fue de 11 puntos y el mRS fue de 4. El tiempo promedio desde el diagnostico hasta la cirugía fue de 89,7 horas. La arteria cerebral anterior estuvo comprometida en dos casos. La transformación hemorrágica ocurrió en tres casos. El diámetro anteroposterior promedio de la plaqueta ósea fue de 116 mm. El tiempo promedio de estancia en UCI y estancia hospitalaria fueron de 14,1 días y 27,5 días, respectivamente. Tres pacientes murieron. Conclusiones : La craniectomía descompresiva es un procedimiento que salva vidas en un ambiente hospitalario de emergencia con una aceptable mortalidad intrahospitalaria dentro del primer mes de seguimiento.

12.
Rev. chil. obstet. ginecol. (En línea) ; 87(2): 152-157, abr. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388721

ABSTRACT

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.


Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.


Subject(s)
Humans , Female , Pregnancy , Adult , Uterine Neoplasms/complications , Intestines/blood supply , Ischemia/complications , Leiomyoma/complications , Pregnancy Complications, Neoplastic , Intestinal Volvulus/etiology
13.
Rev. bras. med. esporte ; 28(2): 103-106, Mar-Apr. 2022. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1365684

ABSTRACT

ABSTRACT Introduction: This article studies the echocardiographic images of patients and observes the changes in diastolic cardiac function after exercise. Objective: This article tries to find the relationship between cardiac images during exercise and the diagnosis of myocardial ischemia. Methods: Samples of people with equal fitness for the same exercise area were selected with specific equipment to measure the sample ventricular strain curve before and after 5 minutes to exercise with a load. The diastolic strain index (SDI) ratio before and after exercise assesses the relationship between myocardial ischemia and exercise load. Results: The test results showed no significant difference in the range of motion of the cardiac atrioventricular annulus both before and after subjects were subjected to intense exertion exercise. A significant change in slope was noted in the ECG data curve about the exercise index, in addition to a reduction in the diastolic period. Conclusion: When the exercise load increases, it can easily cause changes in the ventricular wall. This can make local myocardial dysfunction more prone. Level of evidence II; Therapeutic studies - investigation of treatment results.


RESUMO Introdução: Este artigo estuda as imagens ecocardiográficas de pacientes e observa as mudanças na função cardíaca diastólica após o exercício. Objetivo: Este artigo questiona alguma relação entre as imagens cardíacas durante o exercício e o diagnóstico de isquemia miocárdica. Métodos: Amostras de pessoas com igual adequação para a mesma área de exercício foram selecionadas com equipamento específico para medir a curva de tensão ventricular da amostra antes e depois de 5 minutos ao exercício com carga. A relação do índice de tensão diastólica (SDI) antes e depois do exercício avaliou a relação entre a isquemia miocárdica e a carga do exercício. Resultados: Os resultados do teste não mostraram diferença significativa na amplitude de movimento do anel atrioventricular cardíaco, tanto antes quanto depois dos sujeitos terem sido submetidos a um exercício de esforço intenso. Uma mudança significativa na inclinação foi notada na curva de dados do ECG sobre o índice de exercício, além de uma redução no período diastólico. Conclusão: Quando a carga de exercício aumenta, ela pode facilmente causar alterações na parede ventricular. Isto pode propiciar uma disfunção local do miocárdio. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.


RESUMEN Introducción: Este artículo estudia las imágenes ecocardiográficas de los pacientes y examina los cambios en la función cardíaca diastólica después del ejercicio. Objetivo: Este artículo cuestiona cualquier relación entre las imágenes cardíacas durante el ejercicio y el diagnóstico de isquemia miocárdica. Métodos: Se seleccionaron muestras de personas con igual aptitud para la misma zona de ejercicio con equipos específicos para medir la curva de tensión ventricular de la muestra antes y después de 5 minutos de ejercicio con carga. La relación del índice de tensión diastólica (SDI) antes y después del ejercicio evaluó la relación entre la isquemia miocárdica y la carga de ejercicio. Resultados: Los resultados de la prueba no mostraron diferencias significativas en la amplitud del movimiento del anillo auriculoventricular cardíaco, tanto antes como después de que los sujetos se sometieran a un ejercicio de esfuerzo intenso. Un cambio significativo en la inclinación fue notado en la curva de datos del ECG a lo largo del índice de ejercicio, además de una reducción del periodo diastólico. Conclusión: Cuando la carga de ejercicio aumenta, puede provocar fácilmente cambios en la pared ventricular. Esto puede provocar una disfunción miocárdica local. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

14.
Rev. colomb. cardiol ; 29(2): 263-267, ene.-abr. 2022.
Article in English | LILACS-Express | LILACS | ID: biblio-1376889

ABSTRACT

Abstract Background: Ischemic reperfusion injury (IRI) is a common hazard involved in many human diseases, such as cerebral stroke, myocardial infarction, solid organ transplant dysfunction or failure, and vascular diseases. Understanding the molecular bases of this injury is essential for the prevention and control of these life-threatening conditions. Ischemic and remote ischemic preconditioning techniques (IPC and RIPC, respectively) have gained increasing importance in the clinical practice to protect against the IRI; however, the exact mechanisms of these techniques are not fully understood, which renders their clinical application query. Possible effectors: Nitric oxide (NO) has been reported by multiple studies to be an important mediator of the protective effects of those techniques. While the physiological concentrations of NO and fibrinogen (FB) are known to antagonize each other, the circulating levels of both effectors increase in response to RIPC. Hypothesis: While NO has potential anti-inflammatory effects, non-soluble fibrinogen (sFB) shows pro- inflammatory effects. However, the sFB may have the potential to act synergistically rather than antagonistically with NO toward the attenuation of the IRI. Conclusion: While increased FB is considered a risk factor for cardiovascular and inflammatory conditions that is also able to decrease the efflux of NO, and increase the NO oxidative metabolits and S- nitroglutathione, the increased sFB during the acute phase reaction might have other protective aspects that should be carefully investigated.


Resumen Antecedentes: La lesión por isquemia-reperfusión (LIR) es un riesgo común involucrado en muchas enfermedades humanas tales como derrame cerebral, infarto del miocardio, disfunción o falla de trasplante de órgano sólido, y enfermedades vasculares. Una comprensión de la base molecular de esta lesión es fundamental para la prevención y el control de estas enfermedades potencialmente mortales. Las técnicas de preacondicionamiento isquémico y preacondicionamiento isquémico remoto (PIR) han cobrado una creciente importancia en la práctica clínica para la protección contra la LIR, sin embargo, los mecanismos precisos de estas técnicas no se entienden plenamente, lo cual pone en duda su aplicación clínica. Posibles efectores: El óxido nítrico (ON) ha sido reportado por varios estudios como un importante mediador de los efectos protectores de estas técnicas. Si bien se sabe que las concentraciones fisiológicas del ON y fibrinógeno son antagónicas, los niveles circulantes de ambos efectores aumentan en respuesta al PIR. Hipótesis: Aunque el ON tiene posibles efectos anti-inflamatorios, el fibrinógeno insoluble muestra efectos proinflamatorios. Sin embargo, el fibrinógeno soluble puede tener el potencial de actuar de manera sinérgica en lugar de antagónica con el ON hacia la atenuación de la LIR. Conclusión: Aunque el fibrinógeno elevado se considera un factor de riesgo para las enfermedades cardiovasculares e inflamatorias, que también puede disminuir la descarga de ON y aumentar los niveles de metabolitos oxidantes del ON y de S-nitrosoglutatión, el aumento de fibrinógeno soluble durante la reacción de fase aguda puede tener otros aspectos protectores que deben ser cuidadosamente investigados.

15.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1408196

ABSTRACT

RESUMEN La pandemia por COVID-19, ocasionada por el virus SARS-CoV-2, ha producido una alta incidencia de coagulopatía asociada a un aumento en la morbi-mortalidad en los pacientes que la padecen. La coagulopatía resulta principalmente trombótica, determinada por daño endotelial, inflamación, trampas extracelulares de neutrófilos, activación de macrófagos y tormenta de citocinas que mantienen el círculo vicioso de la inflamación y la trombosis. Los eventos trombóticos observados durante la COVID-19 fueron principalmente tromboembólicos venosos e infarto del miocardio; sin embargo, la evidencia mostró el incremento de una complicación vascular que no había sido descrita: la trombosis arterial periférica aguda. El objetivo de este artículo fue exponer la infrecuencia de la isquemia arterial aguda como forma de presentación clínica de la COVID-19. Se presenta un paciente masculino de 54 años, con dolor intenso localizado a nivel de la extremidad inferior derecha, gradiente térmico, palidez, cianosis distal e impotencia funcional, con diagnóstico clínico y ecográfico de isquemia arterial aguda de causa trombótica del sector arterial femoral e ilíaco externo derechos. La evolución del paciente resultó satisfactoria y se mantiene bajo seguimiento médico para evaluar la permeabilidad del sector arterial desobstruido.


ABSTRACT The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has produced a high incidence of coagulopathy associated with an increase in morbidity and mortality in patients suffering from it. Coagulopathy is mainly thrombotic, determined by endothelial damage, inflammation, extracellular neutrophil traps, macrophage activation and cytokine storm that maintain the vicious cycle of inflammation and thrombosis. The thrombotic events observed during COVID-19 were mainly venous thromboembolic and myocardial infarction; however, the evidence showed an increase in a vascular complication that had not been described: acute peripheral arterial thrombosis. The objective of this article was to expose the infrequency of acute arterial ischemia as a form of clinical presentation of COVID-19. A 54-year-old male patient with severe pain located at the level of the right lower extremity, thermal gradient, pallor, distal cyanosis and functional impotence, with a clinical and ultrasound diagnosis of acute arterial ischemia of thrombotic cause of the right femoral and iliac arterial sector is presented. The evolution of the patient was satisfactory and he is kept under medical follow-up to evaluate the permeability of the unobstructed arterial sector.

16.
Rev. Assoc. Méd. Rio Gd. do Sul ; 66(1): 01022105, 20220101.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1395318

ABSTRACT

Introdução: A doença cardíaca isquêmica é a principal causa de morbi/mortalidade no Brasil. O sucesso da terapêutica é inversamente proporcional ao tempo de admissão, diagnóstico e tratamento. Este trabalho teve como objetivo avaliar o tempo entre o início dos sintomas de um infarto agudo do miocárdio e a procura no atendimento médico, além do perfil dos pacientes. Métodos: Estudo observacional, retrospectivo, descritivo, com coleta de dados secundários e abordagem quantitativa. Resultados: Foram analisados 238 prontuários, 76,5%, homens e 23,5%, mulheres. A média de idade foi de 61,74 ± 11,45 anos, com maior acometimento entre 55-65 anos (35,3%). Os pacientes se apresentaram, em sua maioria, com delta T de 2 a 6 horas (47,3%), sendo que 20% das mulheres se apresentaram com um delta T >24h (vs 7,4% dos homens), e 34% das mulheres (vs 50,9%) apresentaram delta T entre 2 e 6h (p= 0,049). Dos pacientes com delta T <2h, 75% estavam a < 10km (p= 0,001). Nos pacientes com tempo <2h, a trombólise foi realizada em 10% e, nos casos com >12h, o tratamento de escolha foi o conservador, sem terapia de reperfusão específica (38,8%) (p=0,001). Conclusão: Os pacientes mais prevalentes foram homens com média de 63 anos. Distância menor que 10 km e o sexo masculino (nos tempos de apresentação maiores do que 2 horas) foram fatores de apresentação precoce. A idade não se associou a atraso no atendimento.


Introduction: Ischemic heart disease is the main cause of morbidity and mortality in Brazil. Therapeutic success is inversely proportional to time to admission, diagnosis, and treatment. This study aimed to evaluate the time from start of acute myocardial symptoms to search for medical care, in addition to investigate patients' profile. Methods: This is a quantitative, descriptive, observational, retrospective study of secondary data. Results: A total of 238 medical records were analyzed, of which 76.5% belonged to men and 23.5% to women. Mean age was 61.74 ± 11.45 years, and the most affected age group was 55-65 years (35.3%). Most patients had a delta T from 2 to 6 hours (47.3%), 20% of women had a delta T >24h (vs. 7.4% of men), and 34% of women (vs. 50.9%) had a delta T from 2 to 6 hours (p= 0.049). Of patients with a delta T <2h, 75% were < 10km distant from hospital care (p= 0,001). Thrombolysis was performed in 10% of patients with time of presentation <2h, and, in cases with time of presentation >12h, the treatment of choice was conservative, with no specific reperfusion therapy (38.8%) (p=0.001). Conclusion: There was a high prevalence of male patients with mean age of 63 years. Distance from hospital below 10 km and male sex (in times of presentation greater than 2 hours) were factors of early presentation. Age was not associated with delayed care.

17.
Rev. Assoc. Méd. Rio Gd. do Sul ; 66(1): 01022105, 20220101.
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1400267

ABSTRACT

Introdução: A doença cardíaca isquêmica é a principal causa de morbi/mortalidade no Brasil. O sucesso da terapêutica é inversamente proporcional ao tempo de admissão, diagnóstico e tratamento. Este trabalho teve como objetivo avaliar o tempo entre o início dos sintomas de um infarto agudo do miocárdio e a procura no atendimento médico, além do perfil dos pacientes. Métodos: Estudo observacional, retrospectivo, descritivo, com coleta de dados secundários e abordagem quantitativa. Resultados: Foram analisados 238 prontuários, 76,5%, homens e 23,5%, mulheres. A média de idade foi de 61,74 ± 11,45 anos, com maior acometimento entre 55-65 anos (35,3%). Os pacientes se apresentaram, em sua maioria, com delta T de 2 a 6 horas (47,3%), sendo que 20% das mulheres se apresentaram com um delta T >24h (vs 7,4% dos homens), e 34% das mulheres (vs 50,9%) apresentaram delta T entre 2 e 6h (p= 0,049). Dos pacientes com delta T <2h, 75% estavam a < 10km (p= 0,001). Nos pacientes com tempo <2h, a trombólise foi realizada em 10% e, nos casos com >12h, o tratamento de escolha foi o conservador, sem terapia de reperfusão específica (38,8%) (p=0,001). Conclusão: Os pacientes mais prevalentes foram homens com média de 63 anos. Distância menor que 10 km e o sexo masculino (nos tempos de apresentação maiores do que 2 horas) foram fatores de apresentação precoce. A idade não se associou a atraso no atendimento.


Introduction: Ischemic heart disease is the main cause of morbidity and mortality in Brazil. Therapeutic success is inversely proportional to time to admission, diagnosis, and treatment. This study aimed to evaluate the time from start of acute myocardial symptoms to search for medical care, in addition to investigate patients' profile. Methods: This is a quantitative, descriptive, observational, retrospective study of secondary data. Results: A total of 238 medical records were analyzed, of which 76.5% belonged to men and 23.5% to women. Mean age was 61.74 ± 11.45 years, and the most affected age group was 55-65 years (35.3%). Most patients had a delta T from 2 to 6 hours (47.3%), 20% of women had a delta T >24h (vs. 7.4% of men), and 34% of women (vs. 50.9%) had a delta T from 2 to 6 hours (p= 0.049). Of patients with a delta T <2h, 75% were < 10km distant from hospital care (p= 0,001). Thrombolysis was performed in 10% of patients with time of presentation <2h, and, in cases with time of presentation>12h, the treatment of choice was conservative, with no specific reperfusion therapy (38.8%) (p=0.001). Conclusion: There was a high prevalence of male patients with mean age of 63 years. Distance from hospital below 10 km and male sex (in times of presentation greater than 2 hours) were factors of early presentation. Age was not associated with delayed care.

18.
Rev. colomb. anestesiol ; 50(1): e300, Jan.-Mar. 2022. tab, graf
Article in English | LILACS | ID: biblio-1360948

ABSTRACT

Abstract Adult In-hospital Cardiac Arrest (IHCA) is defined as the loss of circulation of an in-patient. Following high-quality cardiopulmonary resuscitation (CPR), if the return of spontaneous circulation (ROSC) is achieved, the post-cardiac arrest syndrome develops (PCAS). This review is intended to discuss the current diagnosis and treatment of PCAS. To approach this topic, a bibliography search was conducted through direct digital access to the scientific literature published in English and Spanish between 2014 and 2020, in MedLine, SciELO, Embase and Cochrane. This search resulted in 248 articles from which original articles, systematic reviews, meta-analyses and clinical practice guidelines were selected for a total of 56 documents. The etiologies may be divided into 56% of in-hospital cardiac, and 44% of non-cardiac arrests. The incidence of this physiological collapse is up to 1.6 cases/1,000 patients admitted, and its frequency is higher in the intensive care units (ICU), with an overall survival rate of 13% at one year. The primary components of PCAS are brain injury, myocardial dysfunction and the persistence of the precipitating pathology. The mainstays for managing PCAS are the prevention of cardiac arrest, ventilation support, control of peri-cardiac arrest arrythmias, and interventions to optimize neurologic recovery. A knowledgeable healthcare staff in PCAS results in improved patient survival and future quality of life. Finally, there is clear need to do further research in the Latin American Population.


Resumen El paro cardiaco intrahospitalario en el adulto (IHCA) se define como el cese de circulación ocurrido dentro de las instalaciones hospitalarias. Después de la reanimación cardiopulmonar (RCP) de alta calidad, si se logra el retorno de circulación espontánea (ROSC), aparece entonces el síndrome posparo cardiaco (SPPC). En esta revisión se pretende presentar el estado actual del diagnóstico y tratamiento del SPPC. Para abordar este tema, se realizó una búsqueda bibliográfica mediante la consulta digital directa de la literatura científica publicada entre 2014 y 2020 en inglés y español recogida en las bases de datos MedLine, SciELO, Embase y Cochrane. La búsqueda inicial arrojó 248 artículos, de los cuales se eligieron artículos originales, revisiones sistemáticas, metaanálisis y guías de práctica clínica, para una selección final de 56 documentos. Las etiologías del paro cardiaco intrahospitalario se pueden dividir en cardiacas y no cardiacas, en el 56 % y 44 %, respectivamente. El colapso fisiológico tiene incidencias de hasta 1,6 casos/1.000 pacientes admitidos, y es más frecuente en las unidades de cuidado intensivo (UCI), con una tasa de supervivencia general de 1 año del 13 %. Los componentes principales del SPPC son la lesión cerebral, la disfunción miocárdica y la persistencia de la patología precipitante. Los pilares del manejo del SPPC son la prevención del paro cardiaco, soporte ventilatorio, control de arritmias periparo cardiaco y las intervenciones para optimizar la recuperación neurológica. El conocimiento del SPPC por parte del personal de la salud ofrece mejor sobrevida y futura calidad de vida a los pacientes. Finalmente, se resalta la clara necesidad de ahondar en mayores investigaciones en la población latinoamericana.

19.
J. Transcatheter Interv ; 30: eA20210008, 20220101. tab; ilus
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1411358

ABSTRACT

A avaliação fisiológica invasiva da circulação coronariana emergiu nos últimos anos como uma abordagem diagnóstica valiosa no manejo de pacientes com síndrome coronariana crônica, contornando limitações importantes como avaliar função a partir da anatomia e a baixa resolução espacial associada à angiografia ou testes não invasivos. O valor das medidas de fluxo hiperêmico para estimar a relevância funcional das estenoses coronárias é suportado por um grande número de estudos. O objetivo do presente artigo é rever as principais bases fisiológicas, aplicações clínicas e limitações do fluxo fracionado de reserva do miocárdio, o principal índice utilizado na avaliação funcional invasiva da circulação coronariana.


Invasive physiological assessment of the coronary circulation has emerged in recent years as a valuable diagnostic approach in the management of patients with chronic coronary syndrome, overcoming important limitations such as evaluating function from the anatomy and the low spatial resolution associated with angiography or non-invasive tests. The value of hyperemic flow measurements to estimate the functional relevance of coronary stenoses is supported by many studies. The aim of this paper is to review the physiological bases, clinical applications and limitations of myocardial fractional flow reserve, the main index used in the invasive functional assessment of the coronary circulation.

20.
J. vasc. bras ; 21: e20220010, 2022. graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1405490

ABSTRACT

Resumo A isquemia aguda de extremidades é um evento raro na população pediátrica, com incidência estimada em 26 a cada 100.000 internações, sendo a maioria associada a trauma ou iatrogenia. O tratamento ideal para esses quadros não está bem estabelecido pela literatura, havendo a tendência ao tratamento não invasivo. Relatamos o caso de uma lactente que apresentou isquemia dos quatro membros secundária a complicações hemodinâmicas após realização de cirurgia cardíaca complexa, apresentando preservação tecidual expressiva com o tratamento conservador.


Abstract Acute limb ischemia is a rare event in the pediatric population, with an estimated incidence of 26 per 100,000 admissions, the majority of which are associated with trauma or iatrogeny. The ideal treatment for these cases is not well-established in the literature, although there is a tendency to choose noninvasive treatment. We report the case of an infant who suffered ischemia to all four limbs secondary to hemodynamic complications after complex heart surgery and in whom significant tissue preservation was achieved with conservative treatment.

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