Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants' adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness.

Malaysian pharmacy students’ perspectives on the virtual objective structured clinical examination during the coronavirus disease 2019 pandemic / 보건의료교육평가

Purpose@#This study investigated pharmacy students’ perceptions of various aspects of virtual objective structured clinical examinations (vOSCEs) conducted during the coronavirus disease 2019 pandemic in Malaysia. @*Methods@#This cross-sectional study involved third- and fourth-year pharmacy students at the International Islamic University Malaysia. A validated self-administered questionnaire was distributed to students who had taken a vOSCE a week before. @*Results@#Out of the 253 students who were approached, 231 (91.3%) completed the questionnaire. More than 75% of the participants agreed that the instructions and preparations were clear and helpful in familiarizing them with the vOSCE flow. It was found that 53.2% of the respondents were satisfied with the flow and conduct of the vOSCE. However, only approximately one-third of the respondents believed that the tasks provided in the vOSCE were more convenient, less stressful, and easier to perform than those in the conventional OSCE. Furthermore, 49.7% of the students favored not having a vOSCE in the future when conducting a conventional OSCE becomes feasible again. Internet connection was reported as a problem hindering the performance of the vOSCE by 51.9% of the participants. Students who were interested in clinical pharmacy courses were more satisfied than other students with the preparation and operation of the vOSCE, the faculty support, and the allocated time. @*Conclusion@#Students were satisfied with the organization and operation of the vOSCE. However, they still preferred the conventional OSCE over the vOSCE. These findings might indicate a further need to expose students to telehealthcare models.

Malaysian pharmacy students’ perspectives on the virtual objective structured clinical examination during the coronavirus disease 2019 pandemic / 보건의료교육평가

Purpose@#This study investigated pharmacy students’ perceptions of various aspects of virtual objective structured clinical examinations (vOSCEs) conducted during the coronavirus disease 2019 pandemic in Malaysia. @*Methods@#This cross-sectional study involved third- and fourth-year pharmacy students at the International Islamic University Malaysia. A validated self-administered questionnaire was distributed to students who had taken a vOSCE a week before. @*Results@#Out of the 253 students who were approached, 231 (91.3%) completed the questionnaire. More than 75% of the participants agreed that the instructions and preparations were clear and helpful in familiarizing them with the vOSCE flow. It was found that 53.2% of the respondents were satisfied with the flow and conduct of the vOSCE. However, only approximately one-third of the respondents believed that the tasks provided in the vOSCE were more convenient, less stressful, and easier to perform than those in the conventional OSCE. Furthermore, 49.7% of the students favored not having a vOSCE in the future when conducting a conventional OSCE becomes feasible again. Internet connection was reported as a problem hindering the performance of the vOSCE by 51.9% of the participants. Students who were interested in clinical pharmacy courses were more satisfied than other students with the preparation and operation of the vOSCE, the faculty support, and the allocated time. @*Conclusion@#Students were satisfied with the organization and operation of the vOSCE. However, they still preferred the conventional OSCE over the vOSCE. These findings might indicate a further need to expose students to telehealthcare models.

Phytochemical studies and anti-ulcerative colitis effect of Moringa oleifera seeds and Egyptian propolis methanol extracts in a rat model

Objective: To analyze the phytochemical constituents, and to explore potential protective effect of the methanol extract of Moringa oleifera (M. oleifera) seeds and Egyptian propolis, each alone or concurrently administered on acetic acid-induced ulcerative colitis in rats. Methods: Eight groups of 5 rats each were used: normal control group with distilled water, model group, two groups with M. oleifera seeds (100 and 200 mg/kg), two groups with propolis (50 and 100 mg/kg), one group with concurrent administration of both, and one group with prednisolone (reference drug). Macro-and microscopic picture, ulcer index and lesion scores, oxidative markers, inflammatory mediators, in vitro activity of the inflammatory enzymes and 1, 1-diphenyl-2-picrylhydrazyl free radicals scavenging activity were evaluated. The phytochemical constituents of both extracts were explored by GC-MS analysis. Results:Both treatments modulated the macro-and microscopic picture, decreased the ulcerative index, lesion score, oxidative markers and inflammatory mediators, and inhibited the COX-1 and COX-2 enzymes. Propolis appeared to be powerful free radicals scavenger. A powerful synergistic effect of both treatments in modulating the course of the disease was reported. GC-MS analysis of methanol extract of M. oleifera seeds and propolis revealed the presence of 50 and 34 compounds, respectively. Conclusions: M. oleifera seeds and propolis methanol extracts have modulated the course of acetic acid-induced ulcerative colitis. Moreover, both treatments induce a good synergistic effect against the disease. Isolation of the active constituents is recommended.

role of topical nasal steroid in treatment of otitis media with effusion in children: systematic review

Background: otitis media with effusion is common in children and the treatment is still controversial issue

Objective: this study aimed to evaluate the role of topical nasal steroid in treatment of otitis media with effusion in children

Patients and Method: this was a systematic review of the literature to collect data through searching the Medoline data base [www.pubmed .com] until March 2017 concerning the effectiveness of topical nasal steroids in treatment of otitis media with effusion in children using the different keywords in different combination

Results: meta analysis by relative risk for persistence of OME of 0.551 with 95% CI of 0.314 to 0.966, meta analysis by risk difference for persistence of OME of -0.229 with a 95% CI of -0.569 to -0.030 and meta analysis by odds ratio for persistence of OME of 0.214 with a 95% CI of 0.049 to 0.936, which was statistically significant favoring topical steroid over control

Conclusion: topical nasal steroid is an effective treatment for otitis media with effusion without the complications of oral steroid , nasal steroid spray can be used for longer period, with much greater safety. It can also be helpful in controlling nasal allergy and the adenoid size, which are contributing factors in developing and recurring otitis media with effusion

Anemia: its prevalence, causes, and management

Background: Nutritional anemia or anemia due to dietary causes is the most common form, yet the easiest to manage compared to other forms of anemia. Some of the most common nutritional deficiencies are iron, cobalamin, folate, and also other elements like copper. Anemia due to diet is mostly asymptomatic in the initial phase until the stores are depleted, which can take a few months to several years, depending upon the cause

Methodology: We conducted this review using a comprehensive search of MEDLINE, PubMed, and EMBASE from January 1987 to March 2017. The following search terms were used: nutritional anemia, dietary anemia, iron deficiency anemia, cobalamin deficiency, folic acid deficiency anemia, dietary anemia treatment

Aim of the work: In this study we aimed to understand about the different types of anemia caused as a result of dietary deficiency. We will also briefly study about their presentation, pathophysiology, and treatment

Conclusion: Various causes, presentations, and complications are associated with different types of nutritional anemia, but they still are the easiest to treat and manage. Most cases are due to an underlying occult disorder rather than simple dietary insufficiency, making diagnosis more difficult in some cases, and requiring thorough history and investigations integration to reach an accurate diagnosis and treat the underlying cause

Role of MRI in assessment of hepatocellular carcinoma [HCC] after TACE [Trans-arterial Chemoembolization] with persistent high alfa fetoprotein [AFP]

Background: evaluation of treatment success after TACE is essential for making therapeutic decisions, e.g., to repeat, interrupt or completely terminate TACE. An understanding of the various therapeutic strategies and their post therapy imaging appearance is essential for accurately assessing treatment response. Evaluation of tumor response should include not only tumor markers, but also imaging modalities. Evaluation of the therapeutic effect of HCC after TACE is primarily based on the findings of imaging studies. CT is the standard imaging technique for monitoring the effectiveness of TACE. MRI is complementary to CT in the evaluation of the therapeutic response. To know the advantages and limitations of each imaging technique in the evaluation of the therapeutic effect of HCC is important in determining if the treated tumor is completely necrotic or requires additional treatment

Objective: the purpose of this work was to study the MRI appearance of the HCC lesion after TACE in patients with high persistent AFP in cases when hyper-attenuating iodized oil impairs the assessment of residual tumor enhancement on contrast enhanced CT

Patients and Methods: the age of patients ranged between 50 to 73 years with a mean age 58 years. All patients were diagnosed as HCC patients on a background of liver cirrhosis. Twelve patients were positive for HCV and three patients were positive for HBV infection

Results: our study included 15 patients, 12 males and 3 females with age 51 and 73 years with a mean age of 58years. All patients included were diagnosed with HCC by a previous triphasic CT and alfa feto protein. The patients underwent TACE and the patient's response to embolization was assessed by AFP and CT or MRI within 1-3 months post chemoembolization. All the selected candidates showed persistent elevation of alfa feto protein after the procedure and within the 1-3 months post TACE. MRI was performed to these patients and their MRI results were either negative or positive explaining the persistent rise of AFP where 13 patients showed positive results and 2 patients showed negative MRI findings. The positive patients were further categorized into groups according to their post tace MRI findings. 4 patients had de novo new lesions, 6 patients had recurrence and 3 residual tumor patients

Conclusion: diffusion-weighted MR imaging was found to be a reliable predictor along with contrast enhanced MR imaging when CT was not conclusive

Human Umbilical Cord Blood CD34-Positive Cells as Predictors of the Incidence and Short-Term Outcome of Neonatal Hypoxic-Ischemic Encephalopathy: A Pilot Study

BACKGROUND AND PURPOSE: Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the leading causes of neurological handicap in developing countries. Human umbilical cord blood (hUCB) CD34-positive (CD34⁺) stem cells exhibit the potential for neural repair. We tested the hypothesis that hUCB CD34⁺ stem cells and other cell types [leukocytes and nucleated red blood cells (NRBCs)] that are up-regulated during the acute stage of perinatal asphyxia (PA) could play a role in the early prediction of the occurrence, severity, and mortality of HIE. METHODS: This case-control pilot study investigated consecutive neonates exposed to PA. The hUCB CD34⁺ cell count in mononuclear layers was assayed using a flow cytometer. Twenty full-term neonates with PA and 25 healthy neonates were enrolled in the study. RESULTS: The absolute CD34⁺ cell count (p=0.02) and the relative CD34⁺ cell count (CD34+%) (p<0.001) in hUCB were higher in the HIE patients (n=20) than the healthy controls. The hUCB absolute CD34⁺ cell count (p=0.04), CD34⁺% (p<0.01), and Hobel risk scores (p=0.04) were higher in patients with moderate-to-severe HIE (n=9) than in those with mild HIE (n=11). The absolute CD34⁺ cell count was strongly correlated with CD34⁺% (p<0.001), Hobel risk score (p=0.04), total leukocyte count (TLC) (p<0.001), and NRBC count (p=0.01). CD34+% was correlated with TLC (p=0.02). CONCLUSIONS: hUCB CD34⁺ cells can be used to predict the occurrence, severity, and mortality of neonatal HIE after PA.

Conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate

Background: otitis media with effusion [OME] is a collection of non-purulent fluid in the middle ear space; it is almost universal in children with cleft palate. Cleft palate [CP] is among the most common congenital malformations, with an overall incidence of around 1 in 700 individuals. Surgical closure of the cleft palate may lead to improvement in the audiological status of the patients, but whether early surgical correction can improve the middle ear status in CP children remains open for debate

Aim: a meta-analytical study to evaluate and compare the outcome of ventilation tube insertion versus conservative management in management of otitis media with effusion accompanying cleft palate

Methods: a review process was used to assess eligible studies drawn from included published medical articles about conservative management versus ventilation tube insertion in children with otitis media with effusion accompanying cleft palate through searching the Medline data base [www.pubmed.com] and Cochrane library. Then Data were extracted and analyzed from the included studies

Results: 30 relevant articles were found, by application of inclusion criteria 8 articles were found meeting the inclusion criteria and could undergo Meta-analysis. Our results have shown that OME in children with repaired cleft palate can be managed satisfactorily without routine use of ventilation tube [VT]. The presence of OME does not lead to long term complications in all patients. Hearing impairment due to OME can be satisfactorily treated with hearing aid [HA] in a majority of children. VT need to be inserted only if the child is not compliant with using a HA or develops recurrent supportive otitis media. Patients should be followed-up closely for OME to prevent complications

Conclusion: routine use of ventilation tube in CP patients should be discouraged; instead Treatment should be based on the need and willingness of the children and their parents. Also with respect to individual bases such when the child is proved to have OME and hearing loss that affect child language and speech development. Insertion of ventilation tubes should be offered as an alternative to hearing aids or conservative management by close ontological and audiological follow up

Anatomical variations of nasal structures in chronic rhinosinusitis as detected by computed tomography scan

Background: there is a wide range of anatomical variations affecting the nose, paranasal sinuses [PNS] best diagnosed by Computed Tomography [CT]. These variations may cause impairment of mucociliary drainage of the PNS resulting in sinusitis

Objectives: in this paper, the aim is to study the relationship of the anatomical variations of the lateral nasal wall, nasal septum and paranasal sinuses with the occurrence of chronic rhinosinusitis

Methods: the study included two groups of patients; the first has chronic rhinosinusitis while the second was without chronic rhinosinusitis. Anatomical variations of nose and paranasal sinuses which are nasal septal variations, concha bullosa, agger nasi cells, haller cells, paradoxical middle turbinatesand uncinate process variations were detected in both groups to investigate the relation between the anatomical variations and chronic rhinosinusitis

Results: a case control study was done which showed that there a significant statistical relation between nasal septal deviation and chronic rhinosinusitis

Conclusion: there was a significant relation between nasal septal deviation and chronic rhinosinusitis

Comparison of pregnancy outcome between Ultrasound- Guided tubal recanalization and office-based Microhysteroscopic Ostial Dilatation in patients with Proximal Blocked Tubes

Background: The current research to the best of my knowledge is the first to compare the pregnancy outcome between ultrasound-guided tubal recanalization [UGTR] using a special fallopian tubal catheter, and office-based micrhysteroscopic ostial dilatation [MHOD] using the same tubal catherter in infertile women with previously diagnosed bilateral proximal tubal obstruction [PTO]

Materials and Methods: This prospective study reported the pregnancy outcomes for 200 women in private infertility care center in Arafa hospital in Fayoum and in El Minya University Hospital in the period between January 2010 and October 2013 treated as outpatients for their bilateral PTO after the routine hysterosalpingography [HSG]. A Cook's catheter, special fallopian tubal catheter, were used to recanalize the blocked tubes in 100 women [group A] under UGTR, and the same Cook's tubal catheter was used through 2mm microhysteroscope to cannulate both ostia using MHOD in another 100 women [group B]. Pregnancy outcome was determined after the procedures for a 12-month period follow-up

Results: The number of the recanalization of PTO was not significantly different between two groups. As of the 200 blocked fallopian tubes in group A, 140 tubes [70%] were successfully recanalized by passing the ultrasound-guided special cannula, while 150 tubes [75%] were successfully recanalized in group B, using the same tubal catheter through a 2mm microhysteroscope. The cumulative pregnancy rate after the two procedures was not statistically different between two groups. It was 25.9% in group A, while it was 26.3% in group B, after a 12-month period follow-up

Conclusion: UGTR is highly recommended as the first step to manage infertile women due to PTO, as it is easier procedure; however, there is possible to obtain nearly similar results after MHOD

Comparative study of vitamin [D] Status in Full Term and Preterm Infants and Their Respective Mothers

Background: Vitamin D Is important for maintenance of calcium and phosphorus homeostasis and bone mineralization. Vitamin D deficiency in the mothers has possible adverse effects on the fetus and contributes to low vitamin D in infancy

Objectives: To assess vitamin D status, calcium, phosphorus and alkaline phosphate in preterm infants and their mothers

Patients and Methods: A cross sectional study was conducted on 46 neonates, and their mothers

The study was conducted between July and December 2013. The following had been done for all patients: Full medical history and clinical examination for mothers and their neonates, Laboratory investigation: Maternal blood And cord blood samples were collected at Delivery to measure vitamin D [vit. D], Calcium [Ca], phosphorus [P] and alkaline phosphate [ALP]

Results: Maternal hypovitaminosis D [vitamin D [25 [OH] D] <10 ng//ML was found in 89.% of pregnant women at the time of delivery and neonatal hypovitaminosis D [vitamin D <10 ng//mL] was found in 93.5% of studied neonates

Maternal vit D did not correlate to maternal dietary vit D, but it correlated to cord blood vit D was correlated to cord blood vit D but not cord blood Ca, Phosphorus, or alkaline phosphates

Conclusion: Vitamin D levels in Egyptian mothers delivery is deficient and it correlates well to cord blood Vitamin D levels

Is suturless and gluelesslimbal conjunctival autograft for primary pterygium surgery efficient and safe?

Aim of the study: evaluate the safety and efficacy of sutureless glue free limbal conjunctival autograft for the management of primary pterygium surgery

Material and method: This prospective, interventional randomized,non comparative study was held at AlZahraa University Hospital between May, 2013 and June, 2015. It included 20 eyes of 17 patients, 12 males [70.6%], and 5 females [29.4%]. Their mean age +/- SD was 52.50 +/- 18.31 years [Range: 30-75 years]. They were presented to the outpatient clinic of Al Zahraa University Hospital with primary pterygium. Inclusion criteria included primary pterygium,non atrophic, with healthy conjunctiva. Exclusion criteria included atrophic pterygium, pseudopterygium, ocular surface pathology, infection, previous limbal surgery or double head pterygium. Surgeries were done under local anesthesia. Simple pterygium excision was done leaving a bare sclera. The size of bare sclera was measured. A conjunctival graft 2 mm larger in width and length than the recipient bed was created from the superior temporal quadrantand was extended to the limbus to include limbal stem cells. The graft was gently moved to the recipient bed with the epithelial side up and keeping the limbal edge toward the limbus.Hemostasis was allowed to occur spontaneously without use of cautery to provide autologous fibrin to glue the conjunctival autograft naturally in position without tension. All patients were followed up after 48 hours, weekly for one month then monthly for 12 months

Results: terygia were located nasally in all cases. Pterygia were presented right eye in 10 [50%] and left eye 10 [50%]. Mean graft size +/- SD was 5.5 +/- 1.5 millimeter [Range: 5-7 mm]. Mean duration of graft fixation +/- SD was 10 +/- 2.82 minutes [Range: 10­12 minutes].Mean operative time +/- SD was 25 +/- 1.41 minutes [Range: 24-26 minutes] with good cosmetic outcome in all cases. There was minimal postoperative pain and discomfort, without graft dislocation or dehiscence and without recurrence of pterygia during the follow up period

Conclusion: Sutureless and glueless conjunctival limbal autograft following primary pterygium excision is safe, easy, effective and economic technique in primary pterygium surgery

Early detection of left atrial dysfunction by speckle tracking echocardiography in hypertensive patients with normal left atrial size

Background: Arterial hypertension adversely affects LA size and function, effect on function may precede effect on size. This effect is reflected on patient's morbidity and mortality risks. Many techniques were used to assess LA function but with many pitfalls

The objectives: early detection of left atrial dysfunction with speckle tracking echocardiography in hypertensive patients with normal left atrial size

Patients And Methods: The study was conducted on 50 hypertensive patients and 50 age matched normotensive controls, all with normal LA size and free from any other cardiovascular disease that may affect the LA size or function. They were all subjected to history taking, clinical examination and echocardiographic study, both the conventional measures and speckle tracking then both groups were compared regarding LA strain representing LA function

Results: Our study found that hypertensive patients had significantly reduced LA function as measured by speckle tracking when compared to normotensive controls [P-value < 0.001]. Also, many factors were associated with worse LA function in hypertensive patients as old age, high BMI, DM, LV diastolic dysfunction, high LV mass index, larger LA size, lower LA expansion index and higher systolic BP

Conclusion: Speckle tracking echocardiography is a useful novel technique in detecting LA dysfunction in hypertension even before LA enlargement occurs

Resultados do uso de stents de nitinol superflexíveis na artéria femoral superficial / Outcomes after implantation of superflexible nitinol stents in the superficial femoral artery

As intervenções endovasculares na artéria femoral superficial para o tratamento da doença arterial oclusiva periférica têm crescido nas últimas décadas. A primeira e a segunda geração de stents na artériafemoral superficial falharam em demonstrar a melhora da perviedade do vaso tratado, devido às altas taxas defratura. O objetivo deste estudo foi avaliar os desfechos clínicos no curto prazo com o uso de stents de nitinolsuperflexíveis de terceira geração no tratamento de lesões ateroscleróticas na artéria femoral superficial. Métodos: Trata-se de um estudo retrospectivo, realizado em único centro, no período de junho de 2013 a maio de 2014. Um total de 27 pacientes foi submetido à angioplastia com stents de nitinol superflexíveis de terceira geração em lesões ateroscleróticas da arterial femoral superficial. Resultados: A média de idades foi de 68 ± 12 anos, 55,6% eram do sexo feminino e 74,1%, diabéticos. Os pacientes foram classificados em TASC B e C em 77,7% dos casos. O sucesso técnico foi de 100%. Houve aumento do índice tornozelo-braquial de 0,35 ± 0,1 pré-intervenção para 0,75 ± 0,2 na alta hospitalar. O seguimento médio dos pacientes foi de 6,7 ± 2,3 meses. A taxa de patência primária foi de 96,3%. A taxa de salvamento de membro foi de 100%. Não ocorreram fraturas de stent documentadas por raios X. Conclusões: A angioplastia com uso de stent de nitinol superflexível de terceira geração demonstrou ser efetiva no tratamento das lesões ateroscleróricas da artéria femoral superficial...

Endovascular interventions in the superficial femoral artery for the treatment of peripheral arterial occlusive disease have increased over the last decades. The first- and second-generation stents in the superficial femoral artery have failed to demonstrate improved patency of the treated vessel due to high fracture rates. The aim of this study was to evaluate the clinical, short-term outcomes of using third-generation superflexible nitinol stents in the treatment of atherosclerotic lesions in the superficial femoral artery. Methods: This was a retrospective study carried out in a single center, from June 2013 to May 2014. A total of 27 patients underwent angioplasty with third-generation superflexible nitinol stents in atherosclerotic lesions of the superficial femoral artery. Results: The mean age was 68 ± 12 years, 55.6% were females, and 74.1% were diabetics. Patients were classified as TASC B and C in 77.7% of cases. Technical success was 100%. There was an increase in the anklebrachial index from 0.35 ± 0.1 before the intervention to 0.75 ± 0.2 at hospital discharge. The mean followupof patients was 6.7 ± 2.3 months. The primary patency rate was 96.3%. The limb salvage rate was 100%. There were no stent fractures documented by X-rays. Conclusions: Angioplasty with third-generation superflexible nitinol stent placement was shown to beeffective in the treatment of atherosclerotic lesions of the superficial femoral artery...

Doppler ecografia das artérias carótidas: critérios de velocidade validados pela arteriografia / Doppler Ultrasonography of Carotid Arteries: Velocity Criteria Validated by Arteriography

Introdução: Doppler Ecografia (DE) é largamente utilizada no diagnóstico das estenoses carotídeas. Em 2003, a Sociedade Americana de Radiologia divulgou um consenso propondo critérios para graduação das estenoses da Artéria Carótida Interna (ACI). Em 2009, um grupo do Reino Unido apresentou recomendações para realização da DE das artérias carótidas.Objetivo: Avaliar a acurácia dos critérios velocimétricos utilizados na graduação das estenoses da artéria carótidainterna por Doppler Ecografia comparados à arteriografia.Métodos: Em 73 pacientes (146 ACI), foram avaliados: Pico de Velocidade Sistólica (PVS), Velocidade DiastólicaFinal (VDF) da ACI e razão PVS ACI/Artéria Carótida Comum (ACC), para detecção de estenoses < 50%, 50% - 69% (PVS: 125 - 230 cm/s), 70% - 99% (PVS > 230 cm/s). A correlação entre DE e arteriografia foi feita pelo método de Spearman e p < 0,05 considerado estatisticamente significativo. Resultados: A idade média dos pacientes foi 69 anos, 47 (64%) homens, 27 (37%) com acidente vascular encefálico, e 13 (18%)ataque isquêmico transitório. O melhor critério para estenoses de 50% - 69% foi PVS ACI ≥ 141 cm/s (sensibilidade: 94%, especificidade: 90%, acurácia: 93%) (AUC 0,97). Para estenoses entre 70% ‑ 99%, PVS ACI ≥ 176 cm/s mostrou sensibilidade: 92%; especificidade: 87%; acurácia: 90%; PVS ACI ≥ 230 cm/s teve sensibilidade: 89%; especificidade: 89%; acurácia:89% (AUC 0,96); e a razão PVS ACI/ACC≥ 4,0 teve sensibilidade: 70%; especificidade: 100%; e acurácia: 81% (AUC 0,96). Seis oclusões de ACI foram detectadas à DE e arteriografia. A correlação DE e arteriografia foi: PVS (0,81 – p < 0,001); VDF (0,78 – p < 0,001) e razão PVS ACI/ACC (0,81 – p < 0,001). Conclusões: Doppler Ecografia é um método confiável na detecção das estenoses carotídeas, correlacionando-se bem com a arteriografia, sendo importante validar os critérios DE que melhor se aplicam a cada serviço.

Introduction: The Doppler Ultrasonography (DU) is largely used to diagnose carotid stenoses. In 2003, the American Society of Radiology issued a consensus establishing criteria for gradating the stenoses of the Internal Carotid Artery (ICA). In 2009, a group in the United Kingdom presented recommendations for performing DU of carotid arteries. Objective: Evaluating the accuracy of the velocimetric criteria used to gradate internal carotid artery stenoses by Doppler Ultrasonographycompared to arteriography. Methods: We evaluated 73 patients (146 ICA): Peak Systolic Velocity (PSV), End-Diastolic Velocity (EDV) of ICA and the ICA/Common Carotid Artery (CCA) PSV ratio to detect stenoses < 50%, 50% - 69% (PSV: 125-230 (cm/s), 70% - 99% (PSV > 230 (cm/s). The correlation between DU and arteriography was ascertained with the Spearman’s method and p < 0.05 deemed statistically significant.Results: The patients’ average age was 69 years, 47 (64%) men, 27 (37%) with cerebrovascular accident, and 13 (18%), transient ischemic attack.The best criterion for stenoses of 50% - 69% was ICA PSV ≥ 141 cm/s (sensitivity: 94%, specificity: 90%, accuracy: 93%) (AUC 0.97). For stenoses between 70% - 99%, ICA PSV ≥ 176 cm/s presented sensitivity: 92%; specificity: 87%; accuracy: 90%; ICA PSV ≥ 230 cm/s presented sensitivity:89%; specificity: 89%; accuracy: 89% (AUC 0.96); and ICA/CCA PSV ratio ≥ 4.0 presented sensitivity: 70%; specificity: 100%; and accuracy:81% (AUC 0.96). Six ICA occlusions were detected by DU and arteriography. The DU and arteriography correlation was: PSV (0.81 – p < 0.001);EDV (0.78 – p < 0.001) and ICA/CCA PSV ratio (0.81 – p < 0.001).Conclusions: The Doppler Ultrasonography is a reliable method for detecting carotid stenoses, having a good correlation with arteriography.In this respect, validating the DU criteria which better suit each service is important.

Tratamento endovascular dos aneurismas de artéria poplítea / Endovascular treatment of popliteal artery aneurysms

Introdução: Com os recentes avanços nas técnicas endovasculares e com o surgimento de endopróteses mais flexíveis, o tratamento das lesões aneurismáticas da artéria poplítea tem se tornado mais frequente. O objetivo desse estudo foi avaliar os desfechos clínicos a curto e médio prazos do tratamento de lesões aneurismáticas da artéria poplítea com o uso de endopróteses flexíveis. Métodos: Estudo retrospectivo, longitudinal, realizado em dois centros, no período de janeiro de 2011 a fevereiro de 2014. Foram avaliados características populacionais, dados do procedimento e imagens radiológicas no seguimento médio de 1 ano, sendo obtidas as taxas de morbimortalidade, complicações e perviedade da endoprótese. Resultados: Treze pacientes do sexo masculino, com idade de 66 ± 9 anos, foram submetidos ao tratamento de aneurismas de artéria poplítea em 15 membros. Na avaliação do leito de deságue, a maior parte dos pacientes possuía pelo menos duas artérias da perna pérvias (92,3%). O implante do stent ocorreu no segmento médio em 57,1% e, no segmento distal da artéria poplítea, em 42,9% dos procedimentos. Foi possível realizar a revascularização da lesão-alvo em todos os casos, sendo que, em quatro membros, foi necessário o uso de dois stents. Foram utilizados 17 stents Viabahn® e 2 stents Multilayer®. Durante o seguimento de 12 meses, não ocorreram fraturas de stents. A taxa de perviedade primária foi de 53,3% e a de salvamento de membro de 100%. Conclusões: O tratamento endovascular do aneurisma de artéria poplítea demonstrou ser eficaz no seguimento de médio prazo...

Background: With the recent advances in endovascular techniques and the emergence of more flexible endoprosthesis, the treatment of popliteal artery aneurysms has become more frequent. The objective of this study was to evaluate the short and mid-term clinical outcomes of the treatment of popliteal artery aneurysms with the use of a flexible endoprosthesis. Methods: Retrospective longitudinal study conducted in two sites from January of 2011 to February of 2014. Populational characteristics, procedure-related data, and radiologic imaging were evaluated at a mean follow-up of 1 year. Morbidity and mortality rates, complication rates, and stent patency rates were obtained. Results: A total of 13 male patients, mean age 66 ± 9 years, were submitted to popliteal artery aneurysm treatment in 15 limbs. Run-off vessel evaluation showed that most patients had at least two patent arteries in the legs (92.3%). Stents were implanted in the middle segment in 57.1% and in the distal segment of the popliteal artery in 42.9% of the procedures. Target lesion revascularization was achieved in all of the cases and two stents were required in four limbs. Seventeen ViabahnTM and two MultilayerTM stents were used. During the 12-month follow-up there were no stent fractures. The primary patency rate was 53.3% and limb salvage rate was 100%. Conclusions: Endovascular treatment of popliteal artery aneurysm was shown to be effective in the mid-term follow-up...

Resultados do Uso de Stent de Nitinol Superflexível em Artérias Poplíteas / Outcomes of the Use of a Superflexible Nitinol Stent in the Popliteal Artery

Introdução: As taxas de patência primária no longo prazo para a angioplastia transluminal percutânea, com implante de stents de primeira e segunda gerações, no tratamento da artéria poplítea, têm sido desapontadoras. No entanto, resultados com novos stents de nitinol parecem promissores. Nosso objetivo foi avaliar desfechos clínicos no curto prazo do uso de stents de nitinol superflexíveis no tratamento de lesões ateroscleróticas nos segmentos poplíteos. Métodos: Estudo retrospectivo, longitudinal, realizado no período de abril a dezembro de 2013. Foram avaliados as características populacionais, os dados do procedimento e os exames de imagem aos 6 meses, sendo obtidas as taxas de patência do stent e de salvamento de membro. Resultados: Incluímos, nesta análise, 14 pacientes, com idade de 73 ± 11 anos, 50% do sexo masculino e 64,3% diabéticos. Todos os pacientes apresentavam lesão trófica nos membros tratados. As lesões arteriográficas foram classificadas pelo critério Trans-Atlantic Inter-Society Consensus (TASC) em B e C em igual proporção. Na avaliação do leito de escoamento, 78,6% dos pacientes possuíam apenas uma artéria pérvia, sendo a artéria fibular a mais frequentemente observada. As zonas de aterrissagem dos stents foram o segmento médio da artéria poplítea em 57,1% dos casos e, nos demais, o segmento distal da artéria, cruzando a articulação do joelho. Durante o seguimento de 6 meses, não foram observadas fraturas dos stents. A taxa de patência primária foi de 85,7% e a de salvamento do membro foi de 100%. Conclusões: A angioplastia com uso de stent de nitinol superflexível demonstrou ser segura e efetiva no tratamento das lesões ateroscleróticas da artéria poplítea...

Background: The long-term primary patency rates for percutaneous transluminal angioplasty using first and second generation stents for the treatment of the popliteal artery have been disappointing. However, results with the new nitinol stents seem promising. Our objective was to evaluate short-term clinical outcomes using the superflexible nitinol stent in the treatment of atherosclerotic lesions in popliteal segments. Methods: Retrospective longitudinal study conducted from April to December 2013. Population characteristics, procedure-related data and imaging tests were assessed at 6 months. Stent patency and limb salvage rates were obtained. Results: A total of 14 patients with mean age of 73 ± 11 years were included, of which 50% were male and 64.3% diabetic. All patients had trophic lesions in the treated limbs. The arteriographic lesions were classified according to the criteria of the Trans-Atlantic Inter-Society Consensus (TASC) criteria as TASC B and C inequal proportions. In the assessment of below-the-knee runoff, 78.6% of the patients had only one distal pervious artery, of which the fibular artery was the most frequently observed. The stent landing zone was the mid segment of the popliteal artery in 57.1% of the cases and the distal segment, crossing the knee joint, in the remaining patients. During the 6 month follow-up there were no stent fractures. The primary patency rate was 85.7% and the limb salvage rate was 100%. Conclusions: In our study, angioplasty using the super flexible nitinol stent demonstrated to be safe and effective for the treatment of atherosclerotic lesions of the popliteal artery...