Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia.

Background: Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives: To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods: A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results: A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions: In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

Abstract Background Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Programa Mais Médicos e a formação dos estudantes de medicina no Brasil / Mais Médicos Program and the training of medical students in Brazil

Em 2013 foi aprovada a Lei 12.871, que instituiu o Programa Mais Médicos no Brasil. O presente estudo objetivou avaliar o grau de conhecimento dos acadêmicos de medicina acerca do programa e os efeitos das novas determinações políticas. Pesquisa do tipo transversal, de natureza quantitativa, realizada com uma amostra de 407 estudantes. 62,9% desconhecem a Lei 12.871 que institui o Programa Mais Médicos e apenas 28,3% tem conhecimento das reformas curriculares propostas. 78,9% se posicionaram contra a obrigatoriedade do Programa de Residência de Medicina Geral da Família e Comunidade. 45,9% optariam por essa modalidade, levando em consideração a possibilidade de obter o título de especialista em menor tempo, mas apenas 12,5% afirmaram ter mudado os objetivos pessoais. 20,1% acreditam que o Programa será efetivo e 99,5% afirmaram que não será suficiente para melhorar a saúde pública do Brasil. A maior parte dos alunos entrevistados desconhece a Lei 12.871, a qual terá maior impacto nos estudantes dos últimos períodos da graduação. É necessário suprir lacunas da lei, ampliando a infraestrutura no SUS e adequando o gerenciamento dos investimentos.

In 2013, Law 12,871 was approved, which established the Mais Médicos Program in Brazil. This study aimed to evaluate the degree of knowledge of medical students about the program and the operations of the new political determinations. A cross-sectional type research, of a quantitative nature, performed with a sample of 407 students. 62.9% are unaware of law 12,871 that establishes the Programa Mais Médicos and only 28.3% are aware of the curricular reforms proposed. 78.9% were against the obligation of the Program of Residence of Medicina Geral da Família e Comunidade. 45.9% would opt for this type of access, taking into account the possibility of obtaining the title of specialist in a shorter time, but only 12.5% stated that they had changed their personal objectives. 20.1% believe that the Program will be effective and 99.5% affirmed that it will not be enough to improve public health in Brazil. Most of the students interviewed are not aware of law 12,871, which will have a greater impact on students who are currently attending the last graduation periods. It is necessary to fill gaps in Law 12,871, such as expanding infrastructure in the SUS, and adjusting the management of investments.

Leachability of major and minor elements from soils and sediments of an abandoned coal mining area in Southern Brazil.

Leachability of major and trace elements from sediment and soil samples of an abandoned coal mining area in southern Brazil was assessed by titration and pH-stat tests according to the SR002.1 and CEN/TS 14429 protocols. Major (Al, Fe, Ca, Mg, and Mn) and trace (Cu, Zn, As, Ni, Pb, Cd, and Hg) elements were quantified in aqueous extracts. Acid and base neutralizing capacity values and pH changes after the addition of certain acid/base amounts were estimated. In general, a decrease in the major metal leaching at pH < 4.0 and an increase at pH > 8.0 was observed. The response to the acid and base additions confirmed that strong acids can cause an effect on Ca- and Mg-bearing silicate phases and Mn oxides, and strong bases can only affect Ca silicates. At pH < 5.0, higher extractability was found for Cu, Zn, Ni, Pb, and Cd. Considering that the samples showed sharp pH changes after acid additions and released major and trace metal into the solution at greater rates, high metal contamination risks can be assumed for the studied area.

Testamento vital: o que pensam profissionais de saúde? / Living will: What do healthcare professionals think about it?

O testamento vital é um documento em que os pacientes expõem suas vontades acerca de quais tratamentos serão realizados caso se encontrem em estado terminal. Por ser tema recente, tem gerado dúvidas em relação à sua difusão, aceitação social e princípios éticos. Nosso objetivo foi verificar o grau de conhecimento dos profissionais de saúde a respeito desse documento e analisar aspectos de sua regulamentação legal e aplicabilidade. Tratou-se de pesquisa transversal, descritiva e quantitativa, com 351 profissionais de saúde, mediante entrevista composta de 29 questões de múltipla escolha, 9 abrangendo o perfil sociodemográfico da amostra e 20, a opinião sobre o testamento vital. Entre os entrevistados, 7,98% declararam saber redigi-lo, 73,79% se sentiriam mais seguros com sua regulamentação e 61,82% o fariam para si próprios (p < 0,05). A maioria amostral declarou-se favorável ao documento e à sua regulamentação, apesar de desconhecê-lo previamente, o que sugere a necessidade de maior discussão e divulgação sobre o tema na área de saúde...

The living will is a document in which the patients specify their wishes regarding what treatments should be carried out if they are in terminal condition. As it is a new subject, it has been generating doubts in relation to its diffusion, social acceptance and ethical principles. Our study is aimed at verifying the knowledge of healthcare professionals about this document, and analyzing different aspects related to its legal regulation and applicability. A cross-sectional, descriptive and quantitative study was performed in a sample of 351 healthcare professionals, through the application of a survey containing 29 multiple-choice questions, 9 about the sociodemographic profile and 20 about the opinion of the interviewees regarding the document. Among the respondents, 7.98% declared they knew how to write the document, 73.79% felt safer with its regulation, and 61.82% would do it for themselves (p < 0.05). Despite not previously knowing what a living will was, the majority of the sample stated they were in favour of the document and its regulation. This result suggests a need for further discussion and disclosure on the subject in the health sector...

El testamento vital es un documento en el cual los pacientes exponen sus deseos acerca de qué tratamientos se realizarán si se encuentran en estado terminal. Por ser un tema reciente, ha generado dudas sobre su difusión, aceptación social y principios éticos. Nuestro objetivo consiste en verificar el grado de conocimiento de los profesionales de la salud sobre este documento y analizar aspectos de su regulación legal y aplicabilidad. Se trata de una investigación transversal, descriptiva y cuantitativa, con 351 profesionales de la salud, a través de una entrevista que consta de 29 preguntas de opción múltiple, 9 relativas al perfil sociodemográfico de la muestra y 20 a la opinión sobre el testamento vital. Un 7,98% afirmaron saber redactarlo. Un 73,79% demostraron más seguridad con respecto a su regulación y un 61,82% lo harían para ellos mismos (p < 0,05). La mayoría de la muestra resultó favorable al documento y a su regulación, aunque lo desconocía anteriormente, lo que sugiere la necesidad de continuar el debate y la divulgación sobre el tema en el área de la salud...

Cadmium mobility in sediments and soils from a coal mining area on Tibagi River watershed: environmental risk assessment.

The risk of cadmium contamination in the Tibagi River watershed (Parana State, Brazil) affected by past coal mining activities was assessed through sorption-desorption modeling for sediment and soil samples. The acidic character of the samples resulted in more competition between the cadmium ions and protons, thereby influencing the cadmium sorption-desorption. The sorption isotherms were fitted to the Langmuir and Freundlich single models and to the dual-site Langmuir-Freundlich (or Sips) model. The single-site models indicated a low-energy character of sorption sites on the sample sorption sites, whereas the dual-site model explained the availability of higher-affinity and lower-affinity non-specific sites. The correlation of the sorption and desorption constants with the physicochemical and mineralogical characteristics of the samples showed that the cadmium sorption behavior was significantly affected by the pH, point of zero charge, and also by the magnesium, aluminum, calcium and manganese amounts. Besides, the desorption rate and hysteresis index suggested a high risk of cadmium mobilization along the Tibagi River basin.

Spectroscopic investigation of the interaction of p-benzoquinone with casein in the solid state.

The reaction between p-benzoquinone (PBQ) and casein (protein) in the solid state was studied. After reaction with protein, the FT-IR spectra showed a new band at 1215 cm(-1), with an intense sign attributed for casein/PBQ product. An optimum amount of PBQ for determination of the product when mixed with casein was 100mg and a reaction time of 30 min. The product was stable for a period of 24h after the reacting by heating. The interaction of PBQ with casein was investigated by FT-IR, reflectance, Raman and EPR spectroscopies. The reaction between PBQ and casein in the solid state yields a radical species (p-benzosemiquinone) that it is stabilized by the presence of p-biphenolate and p-benzoquinone species in the solid state.