Quasi-randomized trial of solution-focused brief therapy intervention for readiness to change and alcohol and other drug use in a Brazilian community-based treatment center.

OBJECTIVE: Strategies to increase readiness to change may enhance community-based substance use treatment outcomes. This study evaluated the effect of solution-focused brief therapy (SFBT) on readiness to change and substance use compared to treatment as usual (TAU) in a Brazilian community-based substance use treatment center. METHODS: One hundred two adults (M = 36.79, SD = 10.29) were quasi-randomized into SFBT or TAU groups. Assessments were completed at baseline, post-test, and 1-month follow-up. The primary outcome was the changes in readiness to change at post-test and 1-month follow-up. The secondary outcome was the change in substance use at 1-month follow-up. RESULTS: Through Quade non-parametric analysis of covariance (ANCOVA), both groups decreased tobacco, alcohol, and cocaine/crack use at 1-month follow-up, but SFBT had greater reductions in alcohol use (p = .05). ANCOVA analysis demonstrated no differences between groups on readiness to change at any time point. However, among participants who used multiple substances (n = 59), SFBT showed higher readiness to change at post-test (p = .05). CONCLUSIONS: These findings strengthen the evidence that SFBT holds promise for positive community-based substance use treatment outcomes.

The joy and pain of being a harm reduction worker: a qualitative study of the meanings about harm reduction in Brazil.

BACKGROUND: Although harm reduction is highlighted as an effective intervention for alcohol and drug use, a funding gap for harm reduction interventions has been identified, mainly in low- and middle-income countries. In these countries, tensions between abstinence and harm reduction models have impaired the shift from punitive practices to evidence-based interventions committed to guaranteeing the human rights of people who use drugs. Since 2015, the Brazilian government has adopted a more punitive and abstinence-focused drug policy that jeopardizes the care of people who use alcohol and other drugs and the comprehension of the harm reduction workers' perspective in relation to their practice. Therefore, this study aimed to comprehend the meanings constructed by Brazilian harm reduction workers regarding their practices with vulnerable populations amidst a context of political tension. METHODS: We conducted 15 in-depth semi-structured qualitative interviews with harm reduction workers employed in public health services for at least 6 months. Data were analyzed using thematic analysis. RESULTS: The thematic axis "The joy and pain of being a harm reduction worker in Brazil" was constructed and divided into four major themes: (1) Invisibility of harm reduction work; (2) Black, poor, and people who use drugs: identification with the service users; (3) Between advocacy and profession: harm reduction as a political act; (4) Small achievements matter. Despite the perceived invisibility of harm reduction workers in the public health and alcohol and drug fields, valuing small achievements and advocacy were important resources to deal with political tension and punitive strategies in Brazil. The findings also highlight the important role of harm reduction workers due to their personal characteristics and understanding of drug use behavior, which bring the target audience closer to actions within the public health system. CONCLUSION: There is an urgent need to acknowledge harm reduction based on peer support as a professional category that deserves adequate financial support and workplace benefits. Additionally, expanding evidence-based harm reduction interventions and community-based voluntary drug use treatment centers should be prioritized by public policies to address the human rights violations experienced by people who use drugs.

Implications of deficit discourse in the conversations of a mother who requests forced treatment / Implicações do discurso do déficit nas conversas de uma mãe que solicita tratamento forçado / Implications du discours déficitaire sur les conversations d'une mère qui demande traitement forcé / Implicaciones del discurso del déficit en las conversaciones de una madre que solicita tratamiento forzado

Abstract This case study analyzes the implications of deficit discourse on the daily conversations of a mother who requested forced treatment for her son. Data were analyzed drawing on social construction, with an emphasis on positioning theory and deficit discourse. Two episodes displaying deficit discourse were analyzed: one about the son as someone who is powerless, coping with drug use and another about the mother as someone unable to help her son. A sample letter was constructed using relational discourse, which provided new understandings for practice. Results support the benefits of collaborative and relational approaches for people who use drugs and for the emotional support of families.

Resumo Este estudo de caso analisa as implicações do discurso do déficit nas conversas cotidianas de uma mãe que solicitou tratamento forçado para seu filho. Os dados foram analisados a partir da construção social, com ênfase na teoria do posicionamento e do discurso do déficit. Dois episódios foram analisados a partir do discurso do déficit: um sobre o filho como alguém que é impotente no enfrentamento do uso de drogas e outro sobre a mãe como alguém incapaz de ajudar seu filho. Foi construída uma carta ilustrativa a partir do discurso relacional, que proporcionou novos entendimentos para a prática. Os resultados corroboram os benefícios das abordagens colaborativas e relacionais para o suporte emocional de pessoas que usam drogas e suas famílias.

Résumé Cette étude de cas analyse les implications du discours déficitaire sur les conversations quotidiennes d'une mère qui a demandé traitement forcé pour son fils. Les données ont été analysées en s'appuyant sur la construction sociale, en mettant l'accent sur la théorie du positionnement et le discours déficitaire. Deux épisodes ont été analyses utilisant le discours déficitaire: l'un sur le fils en tant que personne impuissante face à l'usage de drogue, et l'autre sur la mère en tant que personne incapable d'aider son fils. Une lettre illustrative a été construit utilisant le discours relationnel, qui a fourni de nouvelles compréhensions pour la pratique. Les résultats confirment les avantages des approches collaboratives et relationnelles pour le soutien émotionnel des personnes qui consomment des drogues et leurs familles.

Resumen Este estudio de caso analiza las implicaciones del discurso del déficit en las conversaciones diarias de una madre que solicitó tratamiento forzado para su hijo. Los datos fueron analizados a partir de la construcción social, con énfasis en la teoría del posicionamiento y el discurso del déficit. Se analizaron dos episodios a partir del discurso del déficit: uno sobre el hijo como alguien que es impotente frente al uso de drogas y otro sobre la madre como alguien incapaz de ayudar a su hijo. Se construyó una carta ilustrativa utilizando el discurso relacional, que proporcionó nuevas comprensiones para la práctica. Los resultados respaldan los beneficios de los enfoques colaborativos y relacionales para el soporte emocional de las personas que usan drogas y sus familias.

Percepção do familiar sobre o tratamento de usuários de drogas: revisão integrativa / Perception of the family regarding the treatment of drug users: integrative review / Percepción del familiar sobre el tratamiento de usuarios de drogas: revisión integrativa

OBJETIVO: realizar revisão integrativa da literatura nacional sobre os tratamentos de usuários de álcool e outras drogas a partir da perspectiva de seus familiares. MÉTODO: trata-se de um estudo de revisão integrativa da literatura nacional, nos portais Biblioteca Virtual em Saúde e Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior e nas bases de dados Web of Science, The Cumulative Index to Nursing and Allied Health Literature e PsycINFO. Após o processo de análise dos estudos recuperados, foram selecionados 21 estudos. RESULTADOS: na literatura demonstrou-se que os familiares reconheceram os serviços extra-hospitalares como importantes para melhorar as relações familiares e as condições de saúde do usuário, sendo importante a inclusão dos familiares nos espaços de tratamento para ajudar os usuários de drogas. Contudo, foram apontados, em estudos, fatores como a insuficiência desses serviços em atender a demanda apresentada, as barreiras no acesso ao tratamento e o desconhecimento desses serviços, contribuindo para a busca de internações - algumas, inclusive, forçadas. CONCLUSÃO: é necessária a ampliação dos serviços extrahospitalares, com o oferecimento de apoio aos familiares de usuários de drogas.

OBJECTIVE: to carry out an integrative review of national literature regarding the treatment of users of alcohol and other drugs from the perspective of their family members. METHOD: an integrative review of the national literature was performed in the Virtual Health Library, and Portal of Periodicals of the Coordination of Improvement of Higher Level Personnel portals, Web of Science, The Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases. After analysis of the studies retrieved, 21 studies were selected. RESULTS: the literature showed that outpatient services were recognized by family members as important for improving family relationships and the health conditions of the drug user. They also felt it was important to include the family members in the treatment to help drug users. However, studies demonstrated the difficulties of these services to fulfill the present requirements, barriers to treatment access, and lack of knowledge regarding these services, contributing to them seeking internments, including compulsory ones. CONCLUSION: it is necessary to expand the outpatient services and provide support for the family members of drug users.

OBJETIVO: realizar una revisión integrativa de literatura nacional sobre los tratamientos de usuarios de alcohol y otras drogas desde la perspectiva de sus familiares. MÉTODO: se trata de un estudio de revisión integrativa de la literatura nacional, en los portales BVS y Portal de Periódicos Capes y en las bases de datos Web of Science, CINAHL y PsycINFO. Después del proceso de análisis de los estudios recuperados fueron seleccionaron 21 estudios. RESULTADOS: la literatura demostró que servicios extrahospitalarios fueron reconocidos por familiares como importantes para mejorar relaciones familiares y condiciones de salud del usuario, siendo importante incluir los familiares en espacios de tratamiento para ayudar a los usuarios. Sin embargo, estudios apuntaron la insuficiencia de esos servicios en atender la demanda presentada, barreras en el acceso al tratamiento y desconocimiento de esos servicios, contribuyendo a la búsqueda de internaciones, incluso forzadas. CONCLUSIÓN: es necesaria una ampliación de los servicios extrahospitalarios y que éstos ofrezcan apoyo para familiares de usuarios de drogas.

Apicotomy: surgical management of maxillary dilacerated or ankylosed canines.

This clinical article reports a technique, apicotomy, for managing dilacerated or ankylosed canines. The records of 3 patients successfully treated with apicotomy are presented. Orthodontists observe clinically significant incidences of impacted maxillary canines in their daily practices. Several procedures have been described to bring an ankylosed, impacted tooth into occlusion. Luxation is the most widely used solution, but there are risks involved with that approach, and the success rate is low. Surgical repositioning has also been used, but morbidity is high, and the aggressiveness of the procedure might also contraindicate it. Ankylosis might be related to the anatomic position of the canine's root apex and its adjacent anatomic structures. Apicotomy is a guided fracture of a canine root apex, followed by its orthodontic traction. It is a conservative surgical alternative for treating impacted canines with dilacerations or apical root ankylosis.

Oligodontia: o problema e alguns caminhos para tratá-los / Oligodontia: the problem and treatment alternatives

Em nossa clínica diária, frequentemente recebemos pacientes com ausência congênita (agenesia) de dentes. São casos que requerem cuidados especiais, o que justifica uma revisão do assunto. Como abordar ortodonticamente o problema da ausência de múltiplos dentes? Como lidar com os aspectos emocionais do paciente e seus familiares? Quais as condutas da equipe interdisciplinar? A proposta deste artigo é fazer uma revisão de conceitos e protocolos com ênfase em um de seus aspectos mais extremos - a Oligodontia. Pretende-se igualmente avaliar soluções para estes desvios não tão incomuns em nosso dia a dia.

In our daily orthodontic practices, we often deal with patients with congenitally missing teeth. These cases require special care and a review of this condition is warranted. How to approach missing teeth cases in orthodontics? How to deal with patients and families anxieties and expectations? How does the interdisciplinary team work? The purpose of this article is to review principles and approaches related to this condition with emphasis in one of the extreme situations – the Oligodontia. It is also an objective of this article to discuss treatment protocols and alternatives for these complicated but not so rare situations.

Fatores associados à adiposidade em adolescentes do sexo feminino eutróficas com adequado e elevado percentual de gordura corporal: elaboração de um modelo de risco / Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model

O objetivo deste estudo foi avaliar os fatores associados com adiposidade em adolescentes eutróficas com adequado e elevado percentual de gordura corporal. Foram avaliadas 118 adolescentes do sexo feminino, de 1419 anos, estudantes de escolas públicas do município de Viçosa (Minas Gerais)/Brazil, que já haviam apresentado menarca. As adolescentes foram divididas em 2 grupos: G1 com elevado percentual de gordura corporal e G2 com adequado percentual de gordura corporal. Avaliou-se variáveis antropométricas e de composição corporal, de estilo de vida e história familiar de doenças crônicas não transmissíveis. Em subamostra determinou-se o gasto energético basal por calorimetria indireta. As adolescentes do G1 apresentaram maiores valores da maioria das variáveis antropométricas e de composição corporal (p<0,001). Não se observou diferença (p>0,05) do metabolismo basal e metabolismo de massa magra, hábito de fumar, consumo energético total, de proteínas e de lipídeos entre os grupos. Ao comparar o nível de atividade física, verificou-se que adolescentes do G1 gastaram mais tempo com atividades sedentárias de nível 1 e as do G2 apresentaram maior gasto calórico total com atividades diárias (p<0,001). De acordo com os fatores de risco analisados, as variáveis relacionadas ao estilo de vida, com destaque para uso de adoçantes (OR=13,47), foram as que mais contribuíram para o excesso de adiposidade nas adolescentes eutróficas. A análise detalhada da composição corporal assim como dos fatores de risco envolvidos com excesso de adiposidade, possibilita diagnóstico precoce e elaboração de medidas de intervenção mais adequadas.

This study was carried out to evaluate the factors associated with adiposity in normal weight adolescents presenting appropriate or high percent body fat, who attended the public schools in Viçosa county- Minas Gerais/Brazil. A total of 118 female adolescents at age range from 14 to 19 years and have already presented the menarche were evaluated. The adolescents were divided into 2 groups: G1 with high percent body fat and G2 with appropriate percent body fat. The following variables were evaluated: anthropometric, body composition, lifestyle and the family history of non-communicable chronic diseases. In subsample, the basal energy consumption was determined by indirect calorimetry. The G1-grouped adolescents showed higher values for most anthropometric and body composition variables (p<0.001). No differences were observed (p>0.05) for basal metabolism and metabolism of lean body mass, smoking habit, total energy consumption and protein and lipid as well between groups. When comparing the physical activity level, the G1 adolescents spent more time with 1-level sedentary activities whereas the G2 ones showed higher total caloric consumption with daily activities (p <0.001). According to risk factors under analysis, the variables related to lifestyle, as distinguishing the use of sweeteners (OR=13.47), provided higher contribution to excessive adiposity in the normal weight adolescents. The detailed analysis of the body composition as well as the risk factors associated with excessive body fat makes possible the early diagnosis and the development of more appropriate intervention means.

[Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model]. / Fatores associados à adiposidade em adolescentes do sexo feminino eutróficas com adequado e elevado percentual de gordura corporal: elaboração de um modelo de risco.

Factors associated with adiposity in normal weight female adolescents with adequate and high percent body fat: elaborating a risk model. This study was carried out to evaluate the factors associated with adiposity in normal weight adolescents presenting appropriate or high percent body fat, who attended the public schools in Viçosa county-Minas Gerais/Brazil. A total of 118 female adolescents at age range from 14 to 19 years and have already presented the menarche were evaluated. The adolescents were divided into 2 groups: G1 with high percent body fat and G2 with appropriate percent body fat. The following variables were evaluated: anthropometric, body composition, lifestyle and the family history of non-communicable chronic diseases. In subsample, the basal energy consumption was determined by indirect calorimetry. The G1-grouped adolescents showed higher values for most anthropometric and body composition variables (p < 0.001). No differences were observed (p > 0.05) for basal metabolism and metabolism of lean body mass, smoking habit, total energy consumption and protein and lipid as well between groups. When comparing the physical activity level, the G1 adolescents spent more time with 1-level sedentary activities whereas the G2 ones showed higher total caloric consumption with daily activities (p < 0.001). According to risk factors under analysis, the variables related to lifestyle, as distinguishing the use of sweeteners (OR = 13.47), provided higher contribution to excessive adiposity in the normal weight adolescents. The detailed analysis of the body composition as well as the risk factors associated with excessive body fat makes possible the early diagnosis and the development of more appropriate intervention means.

Evidence that the degree of obstructive sleep apnea may not increase myocardial ischemia and arrhythmias in patients with stable coronary artery disease.

UNLABELLED: There is controversy regarding whether obstructive sleep apnea is responsible for triggering myocardial ischemia, arrhythmias and heart rate variability in patients with coronary artery disease. OBJECTIVE: The objective of this study was to identify relationships between sleep apnea, myocardial ischemia and cardiac arrhythmia in patients with coronary artery disease. METHODS: Fifty-three patients with stable coronary disease underwent simultaneous polysomnography and electrocardiographic Holter recording. The apnea-hypopnea index (AHI) was defined as the number of apneas/hypopneas per hour of sleep. Patients were divided into a Control group (AHI15, n=23 pts) and an Apnea group (AHI>15, n=30 pts). A subgroup of 13 patients with an AHI>30 (Severe Apnea group) was also studied. We analyzed ischemic episodes (ST-segment depressions >1 mm, > 1 min), heart rate variability and the occurrence of arrhythmias during wakefulness and sleep. RESULTS: Baseline clinical characteristics among the groups were similar except for higher blood pressure in the Apnea groups (p<0.05). Myocardial ischemia was recorded in 39 (73.6%) patients. The number and duration of ischemic episodes significantly decreased during sleep in all groups; during wakefulness, patients with severe apnea exhibited fewer and shorter episodes in comparison with the controls. There were no significant differences in heart rate variability or in the occurrence of arrhythmias among the groups. Malignant ventricular arrhythmias, atrial fibrillation/flutter, bradycardia and high-degree atrioventricular blocks were not detected. CONCLUSION: Obstructive sleep apnea was not related to myocardial ischemia, heart rate variability or arrhythmias in patients with stable coronary artery disease and did not alter the circadian pattern of myocardial ischemia.

Evidence that the degree of obstructive sleep apnea may not increase myocardial ischemia and arrhythmias in patients with stable coronary artery disease

There is controversy regarding whether obstructive sleep apnea is responsible for triggering myocardial ischemia, arrhythmias and heart rate variability in patients with coronary artery disease. OBJETIVE: The objective of this study was to identify relationships between sleep apnea, myocardial ischemia and cardiac arrhythmia in patients with coronary artery disease. METHODS: Fifty-three patients with stable coronary disease underwent simultaneous polysomnography and electrocardiographic Holter recording. The apnea-hypopnea index (AHI) was defined as the number of apneas/hypopneas per hour of sleep. Patients were divided into a Control group (AHI15, n=23 pts) and an Apnea group (AHI>15, n=30 pts). A subgroup of 13 patients with an AHI>30 (Severe Apnea group) was also studied. We analyzed ischemic episodes (ST-segment depressions >1 mm, > 1 min), heart rate variability and the occurrence of arrhythmias during wakefulness and sleep. RESULTS: Baseline clinical characteristics among the groups were similar except for higher blood pressure in the Apnea groups (p<0.05). Myocardial ischemia was recorded in 39 (73.6 percent) patients. The number and duration of ischemic episodes significantly decreased during sleep in all groups; during wakefulness, patients with severe apnea exhibited fewer and shorter episodes in comparison with the controls. There were no significant differences in heart rate variability or in the occurrence of arrhythmias among the groups. Malignant ventricular arrhythmias, atrial fibrillation/flutter, bradycardia and high-degree atrioventricular blocks were not detected. CONCLUSION: Obstructive sleep apnea was not related to myocardial ischemia, heart rate variability or arrhythmias in patients with stable coronary artery disease and did not alter the circadian pattern of myocardial ischemia.

Abordagem clínica não-cirúrgica no tratamento da má oclusão de Classe III / Non-surgical approaches to Class III malocclusions treatment

A abordagem clínica não-cirúrgica da Classe III coloca-se entre os grandes desafios da Ortodontia e vem, desde sempre, gerando controvérsia entre clínicos e pesquisadores. Alguns defendem a tese de que o crescimento e o desenvolvimento do complexo craniofacial são determinados geneticamente e, portanto, inalteráveis. Para esses, a correção da grande maioria de casos de Classe III passará por intervenções orto-cirúrgicas, devendo a terapia ser realizada assim que cessar o período mais ativo do crescimento. Por outro lado, há aqueles que, mesmo concordando com o peso da hereditariedade na etiologia da Classe III, acreditam ser possível modificar o padrão e a direção do crescimento e, através de uma abordagem não-cirúrgica, minimizar a má oclusão ou até mesmo tratá-la com sucesso. Em face da controvérsia, quais seriam as possibilidades ortodônticas? Inúmeros são os relatos de que uma intervenção adequada, em momento adequado, acompanhada de um estudo do padrão familiar, pode, muitas vezes, minimizar o desenvolvimento de uma Classe III. Procedimentos selecionados com critério podem reduzir a indicação de intervenções cirúrgicas e proporcionar resultados positivos e duradouros. Há evidências clínicas e científicas de que algumas decisões terapêuticas podem mudar o curso de muitos prognósticos sombrios.

Orthodontic management of the Class III malocclusion has been a constant challenge to the orthodontic profession and remains a controversial issue among clinicians and researches. Some support the belief that growth and size of the craniofacial complex are genetically predetermined and cannot be changed. They assume that the great majority of Class III cases are "untreatable" and that they are due to surgical intervention after growth has been completed. Even agreeing that heredity plays a major role in this type os deviation, others support the contention that the pattern and direction of growth can be modified and that forces generated in orthodontic treatment are able to minimize and even successfully correct some Class III. The controversy is real and one question is still to be answered: How much can orthodontics really do? The literature provides enough support that appropriate interventions at the adequate time, accompanied by a family growth study may very well minimize or camouflage the Class III to acceptable and stable results without a surgical intervention. There are clinical and scientific evidences that selected procedures can change questionable prognosis.

Middle cerebral artery aneurysms: challenges for microsurgical approach

The authors present their series about middle cerebral artery (MCA) aneurysms. They discuss anatomical aspects as well as the results and complications of surgical treatment. Besides, they defend the idea that for having good results, it is necessary an extent Sylvian´s cistern dissection, permitting an adequate exposure of the aneurysms and their relationships not only with the MCA but with its branches, emphasizing too the not usefulness of temporary clipping in the approach of this pathology.

Relação entre apnéia do sono, isquemia miocárdica, variabilidade da frequência cardíaca e arritmias em portadores de doença arterial coronária / Relation between sleep apnea, myocardial ischemia, heart rate variability and arrhythmias in patients with coronary artery disease

O objetivo deste estudo foi avaliar se a isquemia miocárdica, variabilidade da freqüência cardíaca (VFC) e arritmias de portadores de doença arterial coronária (DAC) sofrem alteração na presença da apnéia do sono (AS). Cinqüenta e três pacientes foram submetidos à monitorização ambulatorial eletrocardiográfica e ao estudo do sono simultâneo; e divididos de acordo com o índice de apnéia e hipopnéia (AHI) em grupos: Controle (AHI≤15) e Apnéia (AHI>15). Subanálise apenas com portadores de apnéia grave (IAH>30) foi realizada e comparada ao grupo Controle. Isquemia miocárdica ocorreu em 39 (73,58 por cento) pacientes; sem diferença entre os grupos no período do sono. Também não houve diferença nas medidas da VFC e arritmias. A AS não apresentou relação direta com isquemia miocárdica, VFC e arritmias em pacientes portadores de DAC.

The objective of this study was to determine whether sleep apnea is associated with nocturnal myocardial ischemia, abnormal heart rate variability (HRV) and arrhythmias, in patients with coronary artery disease (CAD). Fifty-three patients with CAD underwent ambulatory electrocardioghaphic monitoring and a simultaneous overnight sleep study; classified according to apnea-hypopnea index (AHI) in groups: Control (AHI <15) and Apnea (AHI >15). Other analyze only with severe apnea (AHI>30) were made and compared with Control group. Thirty-nine (73,58 per cent) patients had myocardial ischemia; nighttime episodes were not different between the groups. Also arrhythmias and heart rate were not changed with sleep apnea. Sleep apnea may not influence myocardial ischemia, heart rate variability and arrhythmias in patients with CAD.

Qualidade do uso de medicamentos por idosos: uma revisão dos métodos de avaliação disponíveis / Quality assessment of drug use in the elderly: a review of available evaluation methods

O artigo apresenta diferentes métodos de avaliação da adequação da terapia farmacológica para idosos, a partir da revisão da literatura no período de 1990 a 2003. Na década de 1990, foi criada uma variedade de métodos os quais são classificados, de acordo com a utilização de critérios, em implícitos, explícitos e aqueles que combinam ambos. São apresentadas as vantagens e desvantagens de cada método e observa-se que os métodos que utilizam combinação de critérios permitem uma melhor avaliação, uma vez que incorporam um maior número de elementos envolvidos no processo de utilização de medicamentos. A adequação ou adaptação destes métodos à realidade brasileira e a incorporação dos mesmos às práticas avaliativas em saúde podem se constituir em um passo fundamental na promoção do uso racional de medicamentos no país.

Intervenção percutânea coronária nos multiarteriais: análise crítica dos estudos randomizados / Multivessel percutaneous coronary intervention: critical analysis of randomized trials

Pacientes portadores de doença coronária miltiarterial apresentam evolução clínica com maior risco de eventos cardíacos. Nessa população, o restabelecimento do fluxo coronário, além de melhorar os sintomas, possibilita aumento da sobrevida. Independentemente do tratamento escolhido, determinados fatores interferem com o prognóstico, como: idade, diabetes melito, disfunção de ventrículo esquerdo, extensão da doença arterial coronária, angina instável, isquemia em testes funcionais e revascularização incompleta em portadores de disfunção ventricular esquerda. Anteriormente, a única forma de tratamento invasivo era a revascularização cirúrgica, entretanto, com o desenvolvimento da angioplastia coronária transluminal, surgiu uma nova opção terapêutica. A intervenção coronária percutânea, inicialmente apenas com o uso do cateter-balão, pelo fato de ser menos invasiva, proporcionou menor tempo de internação e menor custo. No seguimento clínico, as taxas de óbito e infarto agudo do miocárdio foram similares às do grupo percutâneo, em decorrência da reestenose coronária. A evolução do tratamento percutâneo verificada com os stents convencionais e, recentemente, com os farmacológicos proporcionou resultados progressivamente melhores, sendo hoje um método seguro e efetivo para o tratamento de pacientes multiarteriais no subgrupo de diabéticos....

[Batimastat-eluting stent implantation for the treatment of coronary artery disease: results of the Brazilian pilot study]. / Implante de stent eluído com batimastat para o tratamento da doença arterial coronariana: resultados do estudo piloto brasileiro.

OBJECTIVE: The excellent results obtained with sirolimus (rapamicin)-eluting stents for preventing restenosis have motivated the evaluation of other substances with that property. Batimastat is a highly effective metalloproteinase enzyme blocker, with the potential to reduce the degradation of extracellular matrix and to inhibit the migration of smooth muscle cells, with the consequent capacity to control coronary restenosis. METHODS: From October 2001 to April 2002, 34 patients were prospectively selected with de novo lesions in a native coronary artery > 50% and < 100%, which could be treated with stents of 3 to 4 mm in diameter and 18 mm in length. The primary outcome of the study was to assess the occurrence of major cardiovascular events (death of cardiac origin, acute myocardial infarction, and the need for revascularizing the target vessel) by the 30th day and fourth month; the secondary outcome of the study was to assess the rate of coronary restenosis 4 months after implantation and subacute thrombosis by the 30th day. RESULTS: The success rate of the procedure was 97.1%. The primary outcome occurred in 2.9% and 27.2% of the patients by the 30th day and fourth month, respectively. The binary restenosis rate on angiography was 39.3%. No episode of subacute thrombosis occurred. The comparative analysis between groups with and without restenosis showed no significant difference between both, except for late luminal loss, which was greater in G-I. CONCLUSION: Batimastat-eluting stents had a good safety profile; however, they were not effective in controlling coronary restenosis.

Implante de stent eluído com batimastat para o tratamento da doença arterial coronariana: resultados do estudo piloto brasileiro / Batimastat-eluting stent implantation for the treatment of coronary artery disease: results of the Brazilian pilot study

OBJETIVO: Os excelentes resultados obtidos com os stents eluídos com sirolimus (rapamicina) na prevenção da reestenose motivaram a avaliação de outras substâncias que também apresentassem esta propriedade. O batimastat é um bloqueador de alta eficácia da enzima metaloproteinase, com potencial para reduzir a degradação da matriz extracelular e inibir a migração das células musculares lisas, com conseqüente capacidade de controlar a reestenose coronariana. MÉTODOS: De outubro/2001 a abril/2002, foram selecionados prospectivamente, 34 pacientes com lesões "de novo", em artéria coronária nativa, >50 por cento e < 100 por cento, passíveis de tratamento com stents de 3 a 4 mm de diâmetro e de 18 mm de comprimento. O desfecho primário do estudo foi verificar a ocorrência de eventos cardiovasculares maiores (morte de origem cardíaca, infarto agudo do miocárdio e necessidade de revascularização do vaso alvo) aos 30 dias e aos 4 meses e o secundário avaliar a taxa de reestenose coronariana após 4 meses do implante e de trombose subaguda aos 30 dias. RESULTADOS: A taxa de sucesso do procedimento foi de 97,1 por cento. O desfecho primário ocorreu em 2,9 por cento e 27,2 por cento dos pacientes aos 30 dias e aos 4 meses respectivamente. A taxa de reestenose binária ao estudo angiográfico foi de 39,3 por cento. Não houve episódio de trombose subaguda. A análise comparativa entre os grupos que apresentaram ou não reestenose não mostrou diferenças significativas entre ambos, exceto na perda luminal tardia, maior no G-I. CONCLUSAO: Os stents eluídos com batimastat apresentaram bom perfil de segurança, entretanto, não se mostraram efetivos no controle da reestenose coronariana.

Pneumotorax e pneumoperitonio: uma associacao rara / Pneumothorax and pneumoperitonium: a rare association

A associacao de pneumotorax e pneumoperitonio e rara devido a diferenca de pressao entre o torax e o abdomen que e maior que 40cm H2O, tanto na inspiracao como na expiracao. Neste trabalho, apresentaremos dois casos desta associacao ocorridos na UTI do Hospital d Pronto Socorro de Porto Alegre (HPS), revisando sua fisiopatogenia, diagnostico e terapeutica