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PERIPHERAL ARTERIAL DISEASEPeripheral arterial disease is caused mainly by atherosclerosis, which leads to arterial stenosis and occlusions in the major vessels that supply the lower limbs.The classic symptom is intermittent claudication, which is characterized by muscle discomfort in the lower limb, caused by exercise and relieved by rest.An accurate diagnosis of peripheral arterial disease is achieved by obtaining the patient's vascular history and physical examination. The ankle brachial index can complement the evaluation.Peripheral arterial disease is a marker of cardiovascular risk, so the most important aspect of the therapy is the correction of the risk factors for atherosclerosis.The Family Doctor thus plays a crucial role, not only on the correct diagnosis and referral of the patient but mainly in the detection and control of the risk factors that lead to atherosclerosis. This intervention reduces the global cardiovascular risk and allows for the improvement of the prognosis, both on the lower limb and of the general condition.

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Research was conducted in multiple database (MEDLINE from 1965 to 2011, Cochrane Library, and LILACS), and in crossed references with the surveyed material aiming the identification of articles with the best methodological design. Following the findings, critical evaluation of the contents and classification according to the strenght of evidence were performed. The research was conducted between December 2010 and April 2011. For PubMed, were used the following strategies:

An experiment was carried out to evaluate the effect of environmental enrichment in a free-range chicken production system on live performance as a function of microclimate, physiological parameters, and performance parameters. Four production modules were divided into four pens with 10 birds each, totaling 60 birds. The following treatments were applied: access to a paddock (TEST), access to a paddock with perches (PER), access to a paddock with artificial shade (SHA), and access to the paddock with perches and artificial shade (PESH). The PESH production module presented the best globe temperature (Tbg,°C) and enthalpy (h, kJ/kg), and thereby, the best thermal environmental conditions, which ensured the longest permanence time of the birds in the paddock. The SHA and PESH modules promoted the lowest respiratory rate and shank and comb temperatures. Live performance was influenced by the presence of environmental enrichment (modules SHA and PESH), with the highest live weight (LW) and weight gain (WG) and the lowest feed conversion ratio (FCR) and metabolizable energy intake (MEI). Parts yield, such as giblets, were not influenced by production modules, except for PESH, which promoted higher offal weight. In general, chickens reared in enriched production modules presented greatest performance and comfort results and were considered close to optimal rearing conditions.

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RESUMODuarte NMC, Caetano AMM, Lima LC, Chagas AS -Estudo Comparativo entre Bupivacaína Racêmica (S50-R50) a 0,125% e Bupivacaína em Excesso Enantiomérico de 50% (S75-R25) a 0,125% e 0,25% em Anestesia Peridural para Analgesia de Parto. JUSTIFICATIVA E OBJETIVOS:A peridural contínua é utilizada para alívio da dor do trabalho de parto e associada a baixos índices de complicações. Estudos com enantiômeros levógiros dos anestésicos locais demonstraram maior segurança em função de menor cardiotoxicidade. O objetivo deste estudo foi comparar a analgesia e o bloqueio motor entre a bupivacaína (S50-R50) a 0,125% e a bupivacaína em excesso enantiomérico de 50% (S75-R25) a 0,125% e 0,25% em peridural contínua para analgesia de parto. MÉTODO:Realizou-se ensaio clínico duplamente encoberto, com distribuição aleatória de 75 participantes em trabalho de parto, distribuídas em três grupos: GI -bupivacaína (S50-R50) a 0,125%; GII -bupivacaína (S75-R25) a 0,125%; e GIII -bupivacaína (S75-R25) a 0,25%. A inclusão no estudo foi feita após assinatura do Consentimento Livre e Esclarecido. RESULTADOS:Não foram encontradas diferenças estatísticas significativas quanto à latência da analgesia, nível sensorial do bloqueio, volume de anestésico local, duração do trabalho de parto e da analgesia, freqüência de parto instrumental, escores de Apgar ou pH do cordão umbilical. O intervalo para a primeira dose resgate foi maior e os escores de dor em 45 min foram menores no grupo bupivacaína (S75-R25) a 0,25%. A intensidade do bloqueio motor foi maior no grupo bupivacaína (S50-R50) a 0,125%. CONCLUSÕES:A bupivacaína (S75-R25) determinou um bloqueio motor menos intenso, mesmo quando utilizada em maior concentração (0,25%), resultando em melhor qualidade de analgesia, sem interferir na evolução do trabalho de parto ou na vitalidade dos recém-nascidos.Unitermos: ANALGESIA: parto; ANESTÉSICOS, Local: bupivacaína racêmica, bupivacaína em excesso enantiomérico, levobupivacaína; TÉCNICAS ANESTÉSICAS, Regional: peridural contínua. SUMMARYDuarte NMC, Caetano AMM, Lima LC, Chagas AS -A Comparative Study of 0.125% Racemic Bupivacaine (S50-R50) and 0.125% and 0.25% 50% Enantiomeric Excess Bupivacaine (S75-R25) in Epidural Anesthesia for Labor Analgesia. BACKGROUND AND OBJECTIVES:Continuous epidural block is used for relief of labor pain and it is associated with a low incidence of complications. Studies with the levorotatory isomer of local anesthetics demonstrated that they are safer regarding the cardiotoxicity. The objective of this study was to compare analgesia and motor blockade of 0.125% bupivacaine (S50-R50) and 0.125% and 0.25% 50% enantiomeric excess bupivacaine (S75-R25) in continuous epidural block for labor analgesia. METHODS:Seventy-five patients in labor participated in this randomized, double-blind study after signing an informed consent. Patients were divided in three groups: GI -0.125% bupivacaine (S50-R50); GII -0.125% bupivacaine (S75-R25) and GIII -0.25% bupivacaine (S75-R25). RESULTS:The latency of analgesia, levels of sensorial blo...

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