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The aim of this study was to describe gender-related differences in characteristics and mortality in heart failure (HF) patients managed in primary care (PC). We included 1802 hF patients aged 77.5 ± 8.8 years (47% women) with ejection fraction (EF) ≥ 40% from the Swedish Heart Failure (SwedeHF) registry. The patients were divided by gender, and by heart failure with mildly reduced ejection fraction (HFmrEF; EF 40–49%) or heart failure with preserved ejection fraction (HFpEF; EF ≥ 50%). Men included in the study were younger (mean-age 76.4 vs 78.7 years, p

Resumo Pacientes com doença arterial periférica e aterosclerose generalizada apresentam alto risco de complicações cardiovasculares e nos membros, o que afeta sua qualidade de vida e longevidade. A doença aterosclerótica das extremidades inferiores está associada à alta morbimortalidade cardiovascular, sendo necessário para sua adequada terapia realizar o tratamento dos fatores dependentes do paciente, como a modificação no estilo de vida, e dos fatores dependentes do médico, como o tratamento clínico, tratamento endovascular ou cirurgia convencional. A abordagem médica para a doença arterial periférica é multifacetada, e inclui como principais medidas a redução do nível do colesterol, a terapia antitrombótica, o controle da pressão arterial e do diabetes e a cessação do tabagismo. A adesão a esse regime pode reduzir as complicações relacionadas aos membros, como a isquemia crônica que ameaça o membro e pode levar à sua amputação, e as complicações sistêmicas da aterosclerose, como o acidente vascular cerebral e infarto do miocárdio.

Resumo Contexto O aneurisma da aorta abdominal (AAA) afeta 4-6 vezes mais frequentemente os homens do que as mulheres, porém nas mulheres o prognóstico costuma ser pior. Objetivo Comparar os procedimentos endovasculares para correção de AAA infrarrenal em homens e mulheres, usando dados de um registro prospectivo. Métodos Esse registro foi feito em cinco hospitais universitários do estado de São Paulo entre 2012 e 2022. Foi realizado um estudo transversal, compilando dados demográficos, anatômicos (diâmetro do aneurisma, colo curto, angulado, calcificado ou com trombo; colo distal < 1,5 cm e artérias ilíacas tortuosas, alteradas), complicações (vazamentos, conversões, perviedade ou estenoses de ramos) e insuficiência renal e mortalidade em 30 dias. Foram utilizados o teste de qui-quadrado e teste t de Student, com significância de 5%. O estudo foi aprovado pelo Comitê de Ética (processo 4040-2011). Resultados Um total de 152 (15,9%) dos pacientes eram mulheres e 799 (84,0%) eram homens (p < 0,05). A maior parte eram brancos (80,2% das mulheres e 87,4% dos homens). Diabetes e hipertensão foram significativamente mais frequentes nas mulheres. O formato foi fusiforme, principalmente nas mulheres (95,39% versus 89,86% nos homens). O diâmetro médio foi menor nas mulheres (5,96 cm versus 6,49 cm; p = 0,0056). As artérias ilíacas foram menos envolvidas nas mulheres (89,40% versus 73,58%; p = 0,00001). A perda sanguínea foi maior nos homens (321,40 ml versus 168,84 ml nas mulheres; p < 0,05). A mortalidade operatória foi similar entre os sexos, mas as obstruções foram mais frequentes nas mulheres (15,2% versus 13,51%; p = 0,017296). Conclusões Nas mulheres, o diâmetro aneurismático foi menor e as complicações obstrutivas foram mais frequentes.

A persistent sciatic artery (PSA) is a rare congenital vascular anomaly, with an estimated prevalence ranging from 0.01% to 0.05%. This condition can cause ischemic events in the lower limbs and sciatic artery aneurysms but can also be asymptomatic. A PSA can complicate the treatment of other coexistent vascular diseases due to the thin caliber of the external iliac and femoral arteries. We report a case of a patient with bilateral PSAs and an infrarenal aortic aneurysm. The aneurysm was successfully treated by the endovascular approach. An ultra-low profile endograft associated with access incisions slightly above the usual position was used to overcome this challenging access.

Abstract Background Centralized management of queues helps to reduce the surgical waiting time in the publicly funded healthcare system, but this is not a reality in the Brazilian Unified Healthcare System (BUHS). We describe the implementation of the “Patients with Surgical Indication” (PSI) in a Brazilian public tertiary hospital, the impact on waiting time, and its use in rationing oncological surgeries during the COVID-19 Pandemic. Methods Retrospective observational study of elective surgical requests (2016–2022) in a Brazilian general, public, tertiary university hospital. We recovered information regarding the inflows (indications), outflows and their reasons, the number of patients, and waiting time in queue. Results We enrolled 82,844 indications in the PSI (2016–2022). The waiting time (median and interquartile range) in days decreased from 98(48;168) in 2016 to 14(3;152) in 2022 (p

При отеке легких скопление тканевой жидкости в интерстициальных пространствах, а также в полостях альвеол препятствует выполнению дыхательной системой функции газообмена. Неэффективность различных терапевтических подходов, предложенных для борьбы с коронавирусом SARS-CoV-2, оправдывает поиск новых средств, которые способны улучшить исход заболевания. Одним из альтернативных методов лечения данной патологии может стать крайне высокочастотная (КВЧ) терапия. Цель исследования − оценить иммунометаболический статус крыс при моно-КВЧ-терапии отека легких. Материалы и методы. Оценивались концентрация циркулирующих иммунных комплексов в сыворотке крови и активность лактатдегидрогеназы в легочной ткани на фоне экспериментального отека легких и курсовой КВЧ-терапии. Исследование проводилось на 60 половозрелых самцах крыс линии Вистар массой 150–200 г. В ходе эксперимента животных разделили на три группы (интактная, контрольная и опытная). В контрольной и опытной группах моделировали отек легких путем внутрибрюшинного введения адреналина гидрохлорида. Курсовая КВЧ-терапия крыс опытной группы проводилась в течение 10 дней с применением биокорректора CEM-TECH (40−43 ГГц, Россия) путем воздействия на три акупунктурные точки. Результаты. Показано, что отек легких повышал уровень циркулирующих иммунных комплексов в крови и активность лактатдегидрогеназы в легочной ткани. Воздействие КВЧ-излучения возвращало данные параметры к нормальным значениям. Доказано, что КВЧ-терапия – перспективное средство лечения отека легких и реабилитации после перенесенного заболевания. Выбранные маркеры оценки иммунометаболического статуса могли бы служить дополнением к традиционным методам диагностики исследуемой патологии, в т. ч. и в условиях эксперимента.

Resumo A doença cerebrovascular extracraniana tem sido intensamente investigada em todo o mundo, sendo tema de suma importância para os cirurgiões vasculares. A presente Diretriz foi elaborada pela Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV) em sucessão à Diretriz de 2015. As doenças de etiologia não ateroscleróticas não foram incluídas nesse documento. O objetivo desta Diretriz é congregar as evidências mais robustas nessa área para auxiliar os especialistas no processo decisório do tratamento. Foi utilizada a metodologia AGREE II e o sistema da Sociedade Europeia de Cardiologia para as recomendações e níveis de evidências. As recomendações foram graduadas de I a III, e os níveis de evidência classificados em A, B e C. A presente Diretriz foi dividida em 11 capítulos, que tratam dos vários aspectos da doença cerebrovascular extracraniana: diagnóstico, tratamentos e complicações, de forma atualizada e com as recomendações propostas pela SBACV.

Circulating follicular helper T cells (cTfh) can show phenotypic alterations in disease settings, including in the context of tissue-damaging autoimmune or anti-viral responses. Using severe COVID-19 as a paradigm of immune dysregulation, we have explored how cTfh phenotype relates to the titre and quality of antibody responses. Severe disease was associated with higher titres of neutralising S1 IgG and evidence of increased T cell activation. ICOS, CD38 and HLA-DR expressing cTfh correlated with serum S1 IgG titres and neutralising strength, and interestingly expression of TIGIT by cTfh showed a negative correlation. TIGIT+cTfh expressed increased IFNγ and decreased IL-17 compared to their TIGIT-cTfh counterparts, and showed reduced capacity to help B cells in vitro. Additionally, TIGIT+cTfh expressed lower levels of CD40L than TIGIT-cTfh, providing a potential explanation for their poor B-helper function. These data identify phenotypic changes in polyclonal cTfh that correlate with specific antibody responses and reveal TIGIT as a marker of cTfh with altered function.

Resumo Contexto A abordagem cirúrgica para estenose carotídea sintomática está consolidada na literatura para a prevenção de eventos neurológicos, devendo seguir padrões ótimos de qualidade. Entretanto, há uma crescente preocupação relacionada à possibilidade ou não de replicar os dados dos trabalhos controlados no mundo real. Objetivos Avaliar a população com estenose carotídea sintomática submetida a cirurgia e seus desfechos de curto prazo em um contexto de mundo real em um centro de formação profissional. Métodos Tratou-se de um estudo observacional realizado por meio de coleta de dados em prontuário de janeiro de 2012 a janeiro de 2023. Foram excluídos pacientes operados por outras etiologias e com cirurgia cardíaca concomitante. Resultados Foram incluídos 70 pacientes submetidos a angioplastia ou endarterectomia carotídea. Os subgrupos populacionais submetidos a angioplastia ou endarterectomia foram semelhantes. Houve diferença estatisticamente relevante quanto à modalidade anestésica e ao tempo cirúrgico maior para o subgrupo de endarterectomia carotídea. Houve quatro casos de acidente vascular encefálico isquêmico, e três deles estavam relacionados à lesão, sendo dois menores e um maior. Dessa forma, a taxa de acidente vascular encefálico maior relacionado à lesão foi de 1,43% e de qualquer acidente vascular encefálico relacionado à lesão, de 4,29%. A taxa total de eventos adversos cardiovasculares maiores foi de 5,71%. Houve um caso de infarto agudo do miocárdio no grupo angioplastia e nenhum óbito. Não houve diferença estatística entre os grupos de endarterectomia e angioplastia quanto aos desfechos principais. Conclusões Os desfechos acidente vascular encefálico isquêmico, infarto agudo do miocárdio, óbito e eventos adversos cardiovasculares maiores neste centro são semelhantes aos encontrados em estudos clínicos randomizados, demonstrando viabilidade da manutenção deste tratamento em centros com programas de ensino.

Abstract Background Anaesthesia in rabbits is associated with a high mortality rate, compared to that in cats and dogs. Total intravenous anaesthesia (TIVA) with drugs that provide cardiovascular stability and are rapidly metabolised could be of benefit for use in rabbits. The aim was to evaluate cardiorespiratory effects of TIVA with sufentanil-midazolam in eight New Zealand White rabbits. Subcutaneous premedication with medetomidine (0.1 mg/kg BW) was followed by IV administration of a mixture of 2.5 μg/mL sufentanil and 0.45 mg/mL midazolam at a rate of 0.3 mL/kg BW/h for anaesthetic induction. Additionally, intravenous boluses of 0.1 mL of the mixture were administered every 20 s until the righting reflex was lost. Following endotracheal intubation, anaesthesia was maintained for 60 min with an infusion rate adjusted to supress the pedal withdrawal reflex. Air and oxygen (1:2) were delivered at 3 L/min. Physiological variables were recorded before induction and at predefined time points during and after anaesthesia. Results Righting and pedal withdrawal reflexes were lost within 3 and 5 min, respectively. Doses of sufentanil and midazolam were 0.48 μg/kg BW and 0.09 mg/kg BW for induction, and 0.72 μg/kg BW/h and 0.13 mg/kg BW/h for maintenance. Apnoea occurred in two rabbits. Induction of anaesthesia caused a significant increase in heart rate, cardiac output and arterial CO2 partial pressure and a decrease in mean arterial pressure, respiratory rate and pH. Mean time from stopping the infusion to endotracheal extubation was 5 min, and to return of the righting reflex 7 min. Anaesthesia was characterized by induction and recovery without excitation, with muscle relaxation, and absence of the pedal withdrawal reflex. Conclusions TIVA with sufentanil-midazolam provided smooth induction and recovery of anaesthesia in rabbits but with marked hypotension and respiratory depression, requiring mechanical ventilation. Further evaluation is needed to establish if the protocol is useful for rabbits undergoing surgery.

Abstract Background Sedation with α2-agonists in the horse is reported to be accompanied by impairment of arterial oxygenation. The present study was undertaken to investigate pulmonary gas exchange using the Multiple Inert Gas Elimination Technique (MIGET), during sedation with the α2-agonist detomidine alone and in combination with the opioid butorphanol. Methods Seven Standardbred trotter horses aged 3–7 years and weighing 380–520 kg, were studied. The protocol consisted of three consecutive measurements; in the unsedated horse, after intravenous administration of detomidine (0.02 mg/kg) and after subsequent butorphanol administration (0.025 mg/kg). Pulmonary function and haemodynamic effects were investigated. The distribution of ventilation-perfusion ratios (VA/Q) was estimated with MIGET. Results During detomidine sedation, arterial oxygen tension (PaO2) decreased (12.8 ± 0.7 to 10.8 ± 1.2 kPa) and arterial carbon dioxide tension (PaCO2) increased (5.9 ± 0.3 to 6.1 ± 0.2 kPa) compared to measurements in the unsedated horse. Mismatch between ventilation and perfusion in the lungs was evident, but no increase in intrapulmonary shunt could be detected. Respiratory rate and minute ventilation did not change. Heart rate and cardiac output decreased, while pulmonary and systemic blood pressure and vascular resistance increased. Addition of butorphanol resulted in a significant decrease in ventilation and increase in PaCO2. Alveolar-arterial oxygen content difference P(A-a)O2 remained impaired after butorphanol administration, the VA/Q distribution improved as the decreased ventilation and persistent low blood flow was well matched. Also after subsequent butorphanol no increase in intrapulmonary shunt was evident. Conclusion The results of the present study suggest that both pulmonary and cardiovascular factors contribute to the impaired pulmonary gas exchange during detomidine and butorphanol sedation in the horse.

Abstract Background Muscle metabolism in horses has been studied mainly by analysis of substances in blood or plasma and muscle biopsy specimens. By using microdialysis, real-time monitoring of the metabolic events in local tissue with a minimum of trauma is possible. There is limited information about muscle metabolism in the early recovery period after anaesthesia in horses and especially in the colic horse. The aims were to evaluate the microdialysis technique as a complement to plasma analysis and to study the concentration changes in lactate, pyruvate, glucose, glycerol, and urea during anaesthesia and in the recovery period in colic horses undergoing abdominal surgery and in healthy horses not subjected to surgery. Methods Ten healthy university-owned horses given anaesthesia alone and ten client-owned colic horses subjected to emergency abdominal surgery were anaesthetised for a mean (range) of 230 min (193–273) and 208 min (145–300) respectively. Venous blood samples were taken before anaesthesia. Venous blood sampling and microdialysis in the gluteal muscle were performed during anaesthesia and until 24 h after anaesthesia. Temporal changes and differences between groups were analysed with an ANOVA for repeated measures followed by Tukey Post Hoc test or Planned Comparisons. Results Lactate, glucose and urea, in both dialysate and plasma, were higher in the colic horses than in the healthy horses for several hours after recovery to standing. In the colic horses, lactate, glucose, and urea in dialysate, and lactate in plasma increased during the attempts to stand. The lactate-to-pyruvate ratio was initially high in sampled colic horses but decreased over time. In the colic horses, dialysate glycerol concentrations varied considerably whereas in the healthy horses, dialysate glycerol was elevated during anaesthesia but decreased after standing. In both groups, lactate concentration was higher in dialysate than in plasma. The correspondence between dialysate and plasma concentrations of glucose, urea and glycerol varied. Conclusion Microdialysis proved to be suitable in the clinical setting for monitoring of the metabolic events during anaesthesia and recovery. It was possible with this technique to show greater muscle metabolic alterations in the colic horses compared to the healthy horses in response to regaining the standing position.

Abstract Background Many colic horses are compromised due to the disease state and from hours of starvation and sometimes long trailer rides. This could influence their muscle energy reserves and affect the horses' ability to recover. The principal aim was to follow metabolic parameter before, during, and up to 7 days after anaesthesia in healthy horses and in horses undergoing abdominal surgery due to colic. Methods 20 healthy horses given anaesthesia alone and 20 colic horses subjected to emergency abdominal surgery were anaesthetised for a mean of 228 minutes and 183 minutes respectively. Blood for analysis of haematology, electrolytes, cortisol, creatine kinase (CK), free fatty acids (FFA), glycerol, glucose and lactate was sampled before, during, and up to 7 days after anaesthesia. Arterial and venous blood gases were obtained before, during and up to 8 hours after recovery. Gluteal muscle biopsy specimens for biochemical analysis of muscle metabolites were obtained at start and end of anaesthesia and 1 h and 1 day after recovery. Results Plasma cortisol, FFA, glycerol, glucose, lactate and CK were elevated and serum phosphate and potassium were lower in colic horses before anaesthesia. Muscle adenosine triphosphate (ATP) content was low in several colic horses. Anaesthesia and surgery resulted in a decrease in plasma FFA and glycerol in colic horses whereas levels increased in healthy horses. During anaesthesia muscle and plasma lactate and plasma phosphate increased in both groups. In the colic horses plasma lactate increased further after recovery. Plasma FFA and glycerol increased 8 h after standing in the colic horses. In both groups, plasma concentrations of CK increased and serum phosphate decreased post-anaesthesia. On Day 7 most parameters were not different between groups. Colic horses lost on average 8% of their initial weight. Eleven colic horses completed the study. Conclusion Colic horses entered anaesthesia with altered metabolism and in a negative oxygen balance. Muscle oxygenation was insufficient during anaesthesia in both groups, although to a lesser extent in the healthy horses. The post-anaesthetic period was associated with increased lipolysis and weight loss in the colic horses, indicating a negative energy balance during the first week post-operatively.

ABSTRACT The global consumption of mineral fertilizers has increased in the last 60 years. However, these fertilizers can negatively affect the soil and the atmosphere. The application of soil amendments focusing on sustainable farming practices can reduce the effects of mineral fertilization. In this study, we investigated the effects of increasing the dose of a commercial amendment using poultry litter enriched with Bacillus (SMARTGRAN) in different types of soils in Brazil under microcosm conditions. These different types of soils were classified as Nitossolo, Argissolo arênico, Argissolo alumínico, Latossolo distroférrico, and Latossolo distrófico. The biological activity in the soil was quantified by measuring the enzymes arylsulfatase, beta-glucosidase, and acid phosphatase. Additionally, bacterial diversity was evaluated by amplicon sequencing of the 16S rRNA gene and conducting phylogenetic analyses of three types of soils, which were selected because of their occurrence and fertility profiles. The results showed an increase in those enzyme activities under all conditions. The results of the analysis of the bacterial community in Nitossolo, Argissolo arênico, and Latossolo distrófico soil types showed a direct relationship between the bacterial composition in the soil and the increase in the amendment dosage. The alpha diversity indices decreased considerably because some plant-growth-promoting bacteria, such as Bacillus, Massilia, Paenibacillus, and Rhizobium, increased in relative abundance. The results indicated that an organic amendment enriched with Bacillus had a beneficial effect on different types of soil in Brazil.

Abstract The Brazilian Society of Angiology and Vascular Surgery has set up a committee to provide new evidence-based recommendations for patient care associated with chronic venous insufficiency. Topics were divided in five groups: 1. Classification, 2. Diagnosis, 3. Conservative or non-invasive treatment, 4. Invasive treatment and 5. Treatment of small vessels. This last series is closely related to the activities of Brazilian angiologists and vascular surgeons, who are heavily involved in the treatment of small superficial veins. These guidelines are intended to assist in clinical decision-making for attending physicians and health managers. The decision to follow a guideline recommendation should be made by the responsible physician on a case-by-case basis taking into account the patient's specific condition, as well as local resources, regulations, laws, and clinical practice recommendations.

Abstract Chronic kidney disease is a worldwide public health problem, and end-stage renal disease requires dialysis. Most patients requiring renal replacement therapy have to undergo hemodialysis. Therefore, vascular access is extremely important for the dialysis population, directly affecting the quality of life and the morbidity and mortality of this patient population. Since making, managing and salvaging of vascular accesses falls within the purview of the vascular surgeon, developing guideline to help specialists better manage vascular accesses for hemodialysis if of great importance. Thus, the objective of this guideline is to present a set of recommendations to guide decisions involved in the referral, evaluation, choice, surveillance and management of complications of vascular accesses for hemodialysis.

Abstract The Brazilian Society of Angiology and Vascular Surgery, through the Guidelines Project, presents new Abdominal Aortic Aneurysm Guidelines, on the subject of care for abdominal aortic aneurysm patients. Its development prioritized descriptive guidelines, using the EMBASE, LILACS, and PubMed databases. References include randomized controlled trials, systematic reviews, meta-analyses, and cohort studies. Quality of evidence was evaluated by a pair of coordinators, aided by the RoB 2 Cochrane tool and the Newcastle Ottawa Scale forms. The subjects include juxtarenal aneurysms, infected aneurysms, and new therapeutic techniques, especially endovascular procedures. The current version of the guidelines include important recommendations for the primary topics involving diagnosis, treatment, and follow-up for abdominal aortic aneurysm patients, providing an objective guide for medical practice, based on scientific evidence and widely available throughout Brazil.

Resumo Trauma é uma causa importante de morbimortalidade, que acomete principalmente jovens. A hemorragia incoercível é o principal mecanismo de óbito precoce nessas vítimas, e as lesões vasculares não compressíveis representam grandes desafios para os cirurgiões. O traumatismo vascular impacta diretamente a viabilidade de membros traumatizados, aumentando o risco de amputação. Nas últimas décadas, muitas condutas de diagnóstico e tratamento de lesões vasculares traumáticas foram modificadas. A angiotomografia suplantou a angiografia como padrão ouro para diagnóstico, as técnicas endovasculares foram incorporadas ao arsenal terapêutico e o conceito de “controle de danos” foi estabelecido. No entanto, há lacunas na literatura nacional sobre a normatização de condutas em trauma vascular, principalmente considerando as limitações do Brasil. Por isso, a Sociedade Brasileira de Angiologia e de Cirurgia Vascular e a Sociedade Brasileira de Atendimento Integrado ao Traumatizado revisaram a literatura disponível sobre trauma vascular e organizaram diretrizes sobre o diagnóstico e tratamento dessas lesões.

The great saphenous vein is the optimal conduit for infrapopliteal bypass surgery in chronic limb-threatening ischemia. A prosthetic bypass graft is an acceptable option when the autologous vein is unavailable and the anatomy is not favorable for endovascular therapy. However, the low patency rate of prosthetic grafts calls for adjunct strategies to improve the outcomes. Tapered reinforced grafts and vein cuffs are proposed measures. We herein present a case of a 78-year-old man with chronic limb-threatening ischemia and an extensive necrotic lesion on the dorsum of the left foot. He was successfully treated with a prosthetic bypass using two adjunct strategies to help improve patency: a tapered reinforced graft and a vein cuff in the distal anastomosis. After debridement and partial skin grafting, the wound healed completely in 2 months. The bypass graft was patent for 1 year.

Abstract Blockade of CD28 costimulation with CTLA-4-Ig/Abatacept is used to dampen effector T cell responses in autoimmune and transplantation settings. However, a significant drawback of this approach is impaired regulatory T cell homeostasis that requires CD28 signaling. Therefore, strategies that restrict the effects of costimulation blockade to effector T cells would be advantageous. Here we probe the relative roles of CD28 and IL-2 in maintaining Treg. We find provision of IL-2 counteracts the regulatory T cell loss induced by costimulation blockade while minimally affecting the conventional T cell compartment. These data suggest that combining costimulation blockade with IL-2 treatment may selectively impair effector T cell responses while maintaining regulatory T cells. Using a mouse model of autoimmune diabetes, we show combined therapy supports regulatory T cell homeostasis and protects from disease. These findings are recapitulated in humanised mice using clinically relevant reagents and provide an exemplar for rational use of a second immunotherapy to offset known limitations of the first.

Resumo Contexto O tromboembolismo venoso (TEV) é a terceira doença cardiovascular mais comum e a principal causa de óbito evitável em pacientes internados. Apesar de diretrizes bem estabelecidos na literatura, a profilaxia dessa afecção ainda é subutilizada. Estudos apontam taxa de adequação da profilaxia próxima de 50% mundialmente. Objetivos Avaliar a adequação da estratificação de risco e da prescrição de medidas de profilaxia do TEV em um hospital universitário terciário. Métodos Estudo transversal observacional realizado através da coleta de dados de prontuário. Foram incluídos pacientes adultos internados em diferentes especialidades e divididos em grupos cirúrgico e clínico. A estratificação de risco de TEV realizada pelos médicos assistentes foi comparada com a realizada pelos médicos pesquisadores, com base nas diretrizes recentes. A prescrição de medidas de profilaxia realizadas pelos médicos assistentes foi comparada com as recomendações das diretrizes, obtendo assim a taxa de adequação da profilaxia. Resultados Foram avaliados 400 pacientes, sendo 169 (42,3%) cirúrgicos e 231 (57,7%) clínicos. A taxa geral de adequação da estratificação foi de 50,8%. Nos grupos cirúrgico e clínico, as taxas de adequação foram respectivamente 39,1% e 59,3% (p < 0,0001). A taxa geral de adequação da profilaxia foi de 71,5%, enquanto no grupo cirúrgico foi de 78,1% e no grupo clínico de 66,7% (p = 0,0137). Conclusões A adequação da estratificação de risco para TEV foi baixa, demonstrando a pouca conscientização dos médicos assistentes sobre esse problema. No entanto, as taxas de adequação da prescrição de medidas de profilaxia estão superiores às de dados globais.

The development of bioplastic composites holds significant importance in addressing the escalating environmental concerns associated with conventional plastic materials, also referred to as traditional plastics. Traditional plastics are derived from [...]

A ruptured abdominal aortic aneurysm after endovascular aneurysm repair with an arteriovenous fistula between the aneurysm sac and a retroaortic left renal vein is an extremely rare complication. This case describes an 81-year-old man who developed an aorto-left renal vein fistula owing to a type IB endoleak 2 years after endovascular aneurysm exclusion. The leak was repaired with a left endograft limb extension. Endovascular techniques are attractive and feasible alternatives and can play an essential role in reinterventions. This report is the first of an aorto-left renal vein fistula owing a type IB endoleak after an endovascular aneurysm repair.

A avaliação da vulnerabilidade de aquíferos é uma ferramenta importante para avaliar a contaminação das águas subterrâneas. O emprego de técnicas inadequadas do preparo do solo e o crescimento populacional ocasionam severas complicações ambientais, indagando a correta gestão de recursos hídricos, sejam superficiais ou subterrâneos. Essa pesquisa teve como objetivo avaliar localmente a vulnerabilidade natural à contaminação do Sistema Aquífero Serra Geral em Panambi, localizado no noroeste do estado do Rio Grande do Sul. Os resultados demonstraram que o aquífero, em sua maior parte, apresentou classes de vulnerabilidade que variaram de insignificante à baixa. Entretanto, na área são realizadas atividades com potencial poluidor, como agricultura intensiva, além do polo metal mecânico, que podem alterar a qualidade do meio subterrâneo, caso ocorra negligência de normativas ambientais.