Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11 / Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades no transmitibles (ENT) diabetes, cardiovasculares y cáncer. No. 11

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Width of sulcus and thickness of gyrus in patients with cerebral atherosclerosis: a new tool for the prevention of vascular cognitive impairment

SUMMARY BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.

RESUMO INTRODUÇÃO E OBJETIVO A aterosclerose cerebral é a principal causa de lesões que contribuem para o comprometimento cognitivo vascular (CCV) e demência vascular, seguida da arteriosclerose de pequenos vasos e da angiopatia amiloide cerebral. Sendo assim, este estudo comparou as alterações radiológicas post mortem de adultos autopsiados com as alterações macroscópicas na região posterior desses encéfalos a fim de estabelecer uma relação entre as duas formas de análise e discutir sobre a relevância da prevenção do CCV em pacientes com aterosclerose encefálica. MATERIAL E MÉTODOS Treze encéfalos foram analisados macroscopicamente para avaliar o grau de aterosclerose das artérias basilar e cerebral posterior. Os pacientes foram autopsiados na disciplina de Patologia Geral no HC-UFTM em Uberaba, Minas Gerais, Brasil. A análise qualitativa da aterosclerose foi realizada com as classificações discreta, moderada ou acentuada. A espessura dos giros e a largura dos sulcos na região posterior dos encéfalos foram analisadas macroscopicamente e por tomografia computadorizada. RESULTADOS E CONCLUSÃO Houve diminuição na largura do sulco calcarino e aumento na espessura do giro occipital temporal medial de acordo com o aumento do grau de aterosclerose macroscopicamente e por tomografia, respectivamente. A baixa oxigenação causada pela aterosclerose provoca a inflamação do parênquima encefálico, provavelmente levando à hipertrofia das células da micróglia e ao consequente aumento dos giros e estreitamento dos sulcos, como observado no presente estudo.

Nuevos términos clínicos, prevención y tratamiento del trastorno cognitivo vascular: revisión de literatura basada en la evidencia / New clinical terms, prevention and treatment of vascular cognitive impairment: a review of evidence-based literature

El trastorno cognitivo vascular agrupa todas las instancias donde el compromiso cognitivo puede ser atribuidoa enfermedad vascular cerebral, es mayor que el esperado para el envejecimiento normal y que, cuando llega aafectar las actividades de la vida diaria, se denomina demencia vascular. En esta revisión, se actualizan los términos relacionados a trastorno cognitivo vascular y se plantean estrategias de prevención y tratamiento basadas en revisiones sistemáticas y meta-análisis. En la primera parte se definen diversos términos relacionados a trastorno cognitivo vascular; en la segunda, se plantea el tratamiento del trastorno cognitivo vascular/demencia vascular, que incluyeun manejo orientado a prevención primaria, controlando los factores de riesgo; un tratamiento secundario paraprevenir la exacerbación o la extensión de las lesiones producidas por la injuria vascular cerebral y, finalmente, untratamiento terciario o sintomático de los problemas cognitivos y/o conductuales. Damos especial énfasis y se fundamenta la conveniencia y beneficios de los tratamientos primario y secundario.

Vascular cognitive impairment is a label ascribed to cases in which the cognitive impairment can be attributed to cerebral vascular disease, is greater than the expected for normal aging and, when affecting the activities of daily life, is called vascular dementia. In this review, the terms related to vascular cognitive impairment, are updated, and strategies for prevention and treatment, based on systematic reviews and meta-analyses are outlined. In the first part, various vascular cognitive impairment-related terms are defined; in the second part, the treatment of vascular cognitive impairment / vascular dementia is described: it includes, management steps oriented towards primary prevention, controlling risk factors; a secondary treatment aimed at the prevention of exacerbation or extension of lesions produced by the vascular brain injuries and, finally, the tertiary or symptomatic treatment of cognitive and / or behavioral manifestations. Special emphasis is placed on, and the convenience and benefits of the primary and secondary treatments are substantiated.

Use of biological Glue (Bioglue®) in laparoscopic partial nephrectomy: a study in pigs

Introduction Partial nephrectomy is the standard of care for localized renal tumors. However, bleeding and warm ischemia time are still controversial when laparoscopic surgeries are carried out. Herein, we aim to compare the outcomes from laparoscopic partial nephrectomy with and without the use of biological glue with purified bovine albumin and glutaraldehyde (BioGlue®). Materials and Methods Twenty-four kidneys of 12 pigs were used in this study. A pre-determined lower pole segment was resected (3 cm x 1 cm) and one of two different hemostatic techniques was performed. In one kidney, hemostatic “U suture” (poliglecaprone 3.0) was performed and in the contra-lateral kidney, only the biological glue was applied. Data recorded was comprised of warm ischemia time (seconds) and estimated blood loss (mL) for each procedure. In cases of bleeding after glue administration, a complementary suture was done. Results Mean warm ischemia time was 492.9±113.1 (351-665) seconds and 746±185.3 (409-1125) seconds for biological glue and suture groups, respectively. There was a positive significant difference in terms of warm ischemia favoring the biological glue group over the suture group (p<0.001). Mean blood loss was 39.4 (0-115) mL for the biological glue group and 39.1 (5-120) mL for the suture group (p=0.62). Conclusion Biological glue is an important tool for laparoscopic partial nephrectomies. It is effective for hemostatic control in selected cases, and it can be used in combination with the traditional suture techniques. .

Demencia vascular / Vascular dementia

Debido al acelerado envejecimiento de la población han cambiado las frecuencias de las enfermedades y causas de mortalidad. Las demencias se han incrementando de manera exponencial, siendo su principal causa la enfermedad de Alzheimer. La patología cardiovascular en general y los accidentes cerebro vasculares también aumentan con la edad. La comorbilidad de lesiones vasculares y enfermedad de Alzheimer es muy frecuente en ancianos demenciados siendo difícil atribuir la causalidad del deterioro cognitivo a una u otra. La importancia en el estudio y pesquisa precoz de la demencia de causa vascular se debe a que esta es prevenible, por lo que se hace esencial su estudio en población de riesgo. Se presenta una breve reseña de las formas clínicas de demencia vascular.