Search

Leisure plays a key role in supporting psychological, social and emotional well-being in later life. This paper aims to explore the relationship between leisure, place and income from the perspectives of older adults in the UK and Brazil and how older adults’ participation in leisure supports the development of sense of place within their communities. The data presented in the paper was gathered through a case study approach involving three cities in Brazil (Pelotas, Belo Horizonte e Brasília) and three in the UK (Edinburgh, Manchester and Glasgow). The findings draw upon qualitative data collected through the following research methods: face-to-face interviews, go-along interviews and photo diaries. The results have shown the low-income neighbourhoods studied both in Brazil and the UK are likely to have less leisure opportunities which tend to be provided by facilities such as CRAS (Reference Centre for Social Assistance) and communities centres. The lack of leisure opportunities particularly in low-income areas can negatively impact on the way older adults experience the sense of place within their neighbourhoods.

Oesophageal cancer is among the ten most common types of cancer worldwide. More than 80% of the cases and deaths related to the disease occur in developing countries. Local socio-economic, epidemiologic and healthcare particularities led us to create a Brazilian guideline for the management of oesophageal and oesophagogastric junction (OGJ) carcinomas. The Brazilian Group of Gastrointestinal Tumours invited 50 physicians with different backgrounds, including radiology, pathology, endoscopy, nuclear medicine, genetics, oncological surgery, radiotherapy and clinical oncology, to collaborate. This document was prepared based on an extensive review of topics related to heredity, diagnosis, staging, pathology, endoscopy, surgery, radiation, systemic therapy (including checkpoint inhibitors) and follow-up, which was followed by presentation, discussion and voting by the panel members. It provides updated evidence-based recommendations to guide clinical management of oesophageal and OGJ carcinomas in several scenarios and clinical settings.

Spontaneous coronary artery dissection is an uncommon cause of myocardial ischemia. Although the first description dates from 1931, its diagnosis is sometimes made late and/or erroneously due to the lack of knowledge of its non-pathognomonic angiographic variations. Additionally, the proper management of this condition is not yet well established. Here we present a rare case of in-hospital recurrence of spontaneous dissection affecting both the left anterior descending and circumflex coronary arteries, with distinct clinical presentations. In-hospital recurrent spontaneous coronary [...]

RESUMO Introducao: A intervencao coronaria percutânea (ICP) em arterias de fino calibre corresponde a 30 a 40% dos procedimentos terapeuticos invasivos, e exibe taxas elevadas e persistentes de reestenose, a despeito da evolucao dos dispositivos empregados. O objetivo deste estudo foi avaliar a evolucao do perfil desta modalidade terapeutica no Brasil nos ultimos 10 anos. Metodos: Foram incluidos 24.895 pacientes do registro da Central Nacional de Intervencoes Cardiovasculares (CENIC) submetidos a 25.892 procedimentos com pelo menos um stent com diâmetro [...]

Background Risk stratification using scores is a valuable tool in cardiogenic shock after ST elevation myocardial infarction (STEMI). During pharmacoinvasive therapy (PIT) their use is unexplored in the literature. Objective: To validate the IABP-SHOCK II (Intra-aortic Balloon Pump in Cardiogenic Shock) score in patients treated with PIT and to analyze the influence of ischemia time on the different risk strata. Methods and results Of 2,143 STEMI patients seen between May 2010 and April 2017, 212 (9.9%) developed cardiogenic shock. Thirty-one patients (14.6%) with incomplete data were excluded from the analysis and the validation cohort included the remaining 181. Mortality rates were similar between the analyzed and excluded patients (42.5% and 45.1% respectively, p=0.77). The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62), and 76% for high-risk (n=25) (p 30-day mortality in scored strata Conclusion In patients with cardiogenic shock after STEMI treated with PIT, risk stratification using the IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterization times on the ability to the score model stratification.

ObjectiveTo validate the Intra-aortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) score in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI) treated with pharmacoinvasive strategy (PhIS) and to analyse the influence of ischaemia time on different risk strata.MethodsWe analysed 2143 patients with STEMI who underwent reperfusion with tenecteplase in primary health services between May 2010 and April 2017 and were transferred to a tertiary hospital for cardiac catheterisation and continuity of care. Those who evolved to cardiogenic shock were scored as low (0–2), moderate (3–4) or high (5–9) risk of death in 30 days and pairwise-log-rank test was used to compare strata. Time intervals between symptoms onset and lytic (pain-to-needle) and fibrinolytic-catheterisation were also compared.ResultsCardiogenic shock occurred in 212 (9.9%) individuals. The 30-day mortality using the IABP-SHOCK II score was 26.6% for low-risk (n=94), 53.2% for moderate-risk (n=62) and 76% for high-risk (n=25) analysed patients (pConclusionsIn patients with cardiogenic shock after STEMI treated with PhIS, risk stratification using IABP-SHOCK II score was adequate. There was no influence of pain-to-needle and fibrinolytic-catheterisation times on the ability to the score model stratification.

Background: Posterior subcapsular cataract is a tissue reaction commonly found among professionals exposed to ionizing radiation. Objective: To assess the prevalence of cataract in professionals working in hemodynamics in Brazil. Methods: Professionals exposed to ionizing radiation (group 1, G1) underwent slit lamp examination with a biomicroscope for lens examination and compared with non-exposed subjects (group 2, G2). Ophthalmologic findings were described and classified by opacity degree and localization using the Lens Opacities Classification System III. Both groups answered a questionnaire on work and health conditions to investigate the presence of risk factors for cataract. The level of significance was set at 5% (p < 0.05). Results: A total of 112 volunteers of G1, mean age of 44.95 (±10.23) years, and 88 volunteers of G2, mean age of 48.07 (±12.18) years were evaluated; 75.2% of G1 and 85.2% of G2 were physicians. Statistical analysis between G1 and G2 showed a prevalence of posterior subcapsular cataract of 13% and 2% in G1 and G2, respectively (0.0081). Considering physicians only, 38% of G1 and 15% of G2 had cataract, with the prevalence of posterior subcapsular cataract of 13% and 3%, respectively (p = 0.0176). Among non-physicians, no difference was found in the prevalence of cataract (by types). Conclusions: Cataract was more prevalent in professionals exposed to ionizing radiation, with posterior subcapsular cataract the most frequent finding. Resumo Fundamento: A catarata subcapsular posterior é uma reação tecidual encontrada com frequência nos profissionais expostos à radiação ionizante. Objetivo: Avaliar a prevalência de catarata nos profissionais que atuam na área de hemodinâmica no Brasil. Métodos: Profissionais expostos à radiação ionizante (grupo 1, G1) foram submetidos ao exame biomicroscópico com lâmpada de fenda para avaliação do cristalino, e comparados aos não expostos (grupo 2, G2). Os achados foram descritos e classificados quanto ao grau de opacidade e localização por meio do Lens opacities classification system III. Ambos os grupos responderam questionário sobre condições de trabalho e de saúde para afastar fatores de risco para catarata, e foram comparados quanto aos achados. Foi utilizado um nível de significância de 5% (p < 0,05). Resultados: Foram avaliados 112 voluntários (G1) com média de idade 44,95 (±10,23) anos e 88 voluntários (G2) com média de 48,07 (±12,18) anos. Desses, 75,2% (G1) e 85,2% (G2) eram médicos. A análise estatística entre os grupos G1 e G2 mostrou uma prevalência da catarata no grupo G1 de 33% comparada ao G2 de 16% (p = 0,0058), sendo a catarata subcapsular posterior presente em 13% no G1 e 2% no G2 (p = 0,0081). Considerando apenas os médicos, 38% no G1 e 15% no G2 (p = 0,0011) apresentaram catarata, sendo a subcapsular posterior 13% e 3% (p = 0,0176), respectivamente. No grupo dos profissionais não médicos, não houve diferença estatisticamente significativa na prevalência dos achados oftalmológicos. Conclusões: A catarata esteve mais presente no grupo de profissionais expostos à radiação ionizante, sendo que a catarata subcapsular posterior foi o dano tecidual mais encontrado.

Our goal was evaluate if cardiologists and their team are compromising with radiation protection. This survey intends to support a study about eyes lens opacity, also realized at SOLACI/2016-RJ-Brazil. An questionary about work conditions in cathlab, individual and colletive radioprotection, was applied for 127 professionals, being 95 cardiologists from several regions of Brazil, by means of personal interview. Among the responses, 38% said performed 50 procedures mensally while 43.7% between 50 and 100. Among them, 33.9% perform catheterims (CAT) and percutaneous coronary intervention (PCI), and 37% CAT, Ventriculography and Coronary Artery Bypass Graft. Around 70% of professionals reported that they have been working for more than 10 years and most have answered that they routinely use protective tools such as lead apron and thyroid shield. Cardiologists answered that they did not routinely wear lead glasses (46%) and a suspended ceiling shield (33%). In general, they justified that the glasses do not fit perfectly on face. Around 27.6% answered that the radiologic equipment don’t have protective side shields. We verify that 39.4% have never received a formal training in radioprotection. We estimated that 63.8% wear dosimeters over the apron at chest level for personal doses control. The professionals reported that they work in public and private institutions and 28.6% reported working in more than two services. About 52.8% associate the use of lead aprons with acquired ergonomic diseases. We conclude that strategies should be established to reinforce radiological protection practice and to guarantee better protection conditions for Cathlab professionals.

Background: Patients with ST-elevation acute myocardial infarction attending primary care centers, treated with pharmaco-invasive strategy, are submitted to coronary angiography within 2-24 hours of fibrinolytic treatment. In this context, the knowledge about biomarkers of reperfusion, such as 50% ST-segment resolution is crucial. Objective: To evaluate the performance of QT interval dispersion in addition to other classical criteria, as an early marker of reperfusion after thrombolytic therapy. Methods: Observational study including 104 patients treated with tenecteplase (TNK), referred for a tertiary hospital. Electrocardiographic analysis consisted of measurements of the QT interval and QT dispersion in the 12 leads or in the ST-segment elevation area prior to and 60 minutes after TNK administration. All patients underwent angiography, with determination of TIMI flow and Blush grade in the culprit artery. P-values < 0.05 were considered statistically significant. Results: We found an increase in regional dispersion of the QT interval, corrected for heart rate (regional QTcD) 60 minutes after thrombolysis (p = 0.06) in anterior wall infarction in patients with TIMI flow 3 and Blush grade 3 [T3B3(+)]. When regional QTcD was added to the electrocardiographic criteria for reperfusion (i.e., > 50% ST-segment resolution), the area under the curve increased to 0.87 [(0.78-0.96). 95% IC. p < 0.001] in patients with coronary flow of T3B3(+). In patients with ST-segment resolution >50% and regional QTcD > 13 ms, we found a 93% sensitivity and 71% specificity for reperfusion in T3B3(+), and 6% of patients with successful reperfusion were reclassified. Conclusion: Our data suggest that regional QTcD is a promising non-invasive instrument for detection of reperfusion in the culprit artery 60 minutes after thrombolysis. Resumo Fundamento: Pacientes com infarto do miocárdico com elevação do segmento-ST atendidos em centros de atendimento primário e tratados de acordo com a estratégia fármaco-invasiva são submetidos à fibrinólise seguida de coronariografia em período de 2-24h. Neste cenário, o conhecimento de marcadores de reperfusão como a redução em 50% do segmento-ST é fundamental. Objetivo: Analisar o desempenho da dispersão do intervalo QT em adição aos critérios clássicos, como marcador precoce de reperfusão pós-terapia trombolítica. Métodos: Estudo observacional com a inclusão de 104 pacientes tratados com tenecteplase (TNKase) e referenciados a hospital de atendimento terciário. A análise dos eletrocardiogramas (ECG) consistiu em mensuração do intervalo QT e sua dispersão nas 12 derivações, e também apenas na região com supradesnivelamento-ST antes e 60min pós-TNKase. A angiografia foi realizada em todos os pacientes com obtenção do fluxo TIMI e Blush da artéria culpada. Foram considerados significantes valores de p < 0,05. Resultados: Observamos aumento da dispersão do intervalo QT, corrigido pela frequência cardíaca, regional (dQTcR) 60min pós-lise (p = 0,006) em infartos de parede anterior nos casos com fluxo TIMI 3 e Blush 3 [T3B3(+)]. Adicionando a dQTcR ao critério ECG (redução do ST > 50%) de reperfusão, a área sob a curva aumentou para 0,87 [(0,78-0,96), IC95%, p < 0,001] em pacientes com fluxo coronário T3B3(+). Nos pacientes com critério de ECG para reperfusão e dQTcR > 13 ms a sensibilidade e especificidade foram 93% e 71%, respectivamente, para reperfusão em T3B3(+), possibilitando reclassificar 6% dos pacientes com sucesso de reperfusão. Conclusão: Os dados sugerem a dQTcR como instrumento promissor na identificação não invasiva de reperfusão na artéria coronária culpada, 60min pós-trombólise.

Introduction Atherosclerotic disease accounts for one-third of deaths annually, as it often leads to complications such as ST-elevation myocardial infarction (STEMI). Rescue percutaneous coronary intervention (PCI) is indicated in case of thrombolytic therapy failure administered in this scenario. However, the benefits regarding mortality rate reduction and the amount of myocardium that is actually salvaged are not well established. The development of new tools, including cardiac magnetic resonance imaging, to identify the myocardium at risk and the infarcted area has increased diagnostic accuracy. Differently from the context of primary PCI, little is known about the association between epicardial and microvascular coronary flow following rescue PCI and the salvaged myocardial area. The aim of this study is to evaluate whether there is an association between coronary flow and the salvaged myocardial area identified by magnetic resonance imaging. Methods This will be a prospective, open, single-center, intervention study. A total of 72 patients with STEMI who underwent rescue PCI after documented failure of the fibrinolytic therapy, and were transferred to our institution, will be selected, observing a pharmacoinvasive strategy. Conclusions At the end of this study, the authors expect to contribute to the knowledge about coronary flow and its association with the amount of salvaged cardiac muscle after rescue PCI. This type of information that can help to understand which cases can benefit the most from rescue PCI.

RESUMO Introducao A doenca aterosclerotica e responsavel por um terco dos obitos ocorridos anualmente, pois frequentemente leva a complicacoes como infarto do miocardio com supradesnivelamento do segmento ST (IMCST). A intervencao coronaria percutânea (ICP) de resgate e indicada caso ocorra falha da terapia trombolitica administrada neste cenario. No entanto, os beneficios, em termos de reducao da taxa de mortalidade e da quantidade de miocardio efetivamente salvo, nao sao bem estabelecidos. O desenvolvimento de novas ferramentas, entre elas a ressonância magnetica cardiaca, para identificar a area miocardica em risco e infartada, elevou a acuracia diagnostica. Diferentemente do contexto da ICP primaria, pouco se sabe sobre a relacao entre o fluxo coronario epicardico e microvascular apos a ICP de resgate e a area de miocardio salva. O objetivo deste estudo e avaliar se existe relacao entre tais fluxos e a area de miocardio salva identificada pela ressonância magnetica. Metodos Estudo prospectivo, aberto, unicentrico, de intervencao. Serao selecionados 72 pacientes com IMCST que tiverem realizado ICP de resgate apos falha documentada da terapia fibrinolitica transferidos para este servico, obedecendo uma estrategia farmaco‐invasiva. Conclusoes Ao termino desta pesquisa, esperamos contribuir para o conhecimento sobre o fluxo coronariano e sua relacao com a quantidade de musculo cardiaco salvo apos a ICP de resgate. Esta e uma informacao que pode ajudar a entender quais casos mais se beneficiam da ICP de resgate.

Pharmacoinvasive strategy in STEMI pts is an acceptable approach in situations in which primary percutaneous coronary intervention (pPCI) is not available. Nonetheless, fibrinolysis failure occurs in approximately 1/3 of pts. The mechanisms underlying fibrinolysis failure are poorly understood but

The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers. RESUMO O Grupo Brasileiro de Tumores Gastrointestinais desenvolveu diretrizes de tratamento cirúrgico e clínico de pacientes com tumores de vias biliares. O painel multidisciplinar foi composto de especialistas nas áreas radiologia, oncologia, cirurgia, radioterapia, endoscopia e anatomia patológica. O painel utilizou literatura atual para desenvolver recomendações baseadas em evidência científica para as diferentes estratégias terapêuticas e diagnósticas dos colangiocarcinomas e tumores de vesícula biliar.

Data regarding operator radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study sought to compare operator and patient radiation exposure during PCI with radial versus femoral access. This

ST elevation acute myocardial infarction (STEMI) and recent use of thrombolytics are risk factors for complications related to catheterism, especially in the femoral access. Our goal is to analyze predictors of major complications due to this invasive procedure in patients with STEMI undergoing

The pharmaco-invasive therapy (PIT) is an effective alternative in patients with acute ST-segment elevation myocardial infarction (STEMI), when primary percutaneous coronary intervention (PCI) is not available in a timely manner. One of the most feared complications of the use of fibrinolytics prior

Auto antigens such as oxidized LDL have been implicated as atherogenic agents found in atheromatous lesions. It has not been observed whether percutaneous coronary intervention (PCI) can modulate the natural or adaptive humoral immune response to auto antigens according to the degree of

Background In this paper we study the distribution of leukocyte populations and of cytokine-producing cells in the spleen of a patient with visceral leishmaniasis resistant to clinical treatment. It is the first attempt to compare the distribution of leukocyte populations and cytokine-producing cells in the splenic compartments of a patient with visceral leishmaniasis with those observed in patients without the disease. Case presentation A 25-year-old male, farmer, was hospitalized on several occasions with diagnosis of visceral leishmaniasis and received all recommended treatments for the disease with only transient improvement followed by relapse. He was eventually subjected to splenectomy in order to control the effects of hypersplenism and to potentially overcome infection. After surgery and combined chemotherapy, the disease evolved to cure. In comparison with the spleens of the other two patients without visceral leishmaniasis, an increase was observed in the CD4/CD8 ratio and in the number of IL-10- and FoxP3-producing cells, while the number of IL-17-producing cells was lower in the spleen of the patient with visceral leishmaniasis. Conclusion This report confirms previous data on changes in the CD4/CD8 ratio in the spleens of patients with visceral leishmaniasis. Additionally the data presented herein suggests that splenic FoxP3- and IL-17-producing cells are involved in the chronicity of visceral leishmaniasis. Electronic supplementary material The online version of this article (doi:10.1186/1471-2334-14-491) contains supplementary material, which is available to authorized users.