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.
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:
The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers (NMB), focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of NMB. A questionnaire was sent to anesthesiologists inviting them to participate in the study. The online data collection remained open from March 2012 to June 2013. During the study period, 1296 responses were collected. Rocuronium, atracurium, and cisatracurium were the main neuromuscular blockers used in cases of elective surgery. Succinylcholine and rocuronium were the main NMB used in cases of emergency surgery. Less than 15% of anesthesiologists reported the frequent use of neuromuscular function monitors. Only 18% of those involved in the study reported that all workplaces have such a monitor. Most respondents reported using only the clinical criteria to assess whether the patient is recovered from the muscle relaxant. Most respondents also reported always using some form of neuromuscular blockade reversal. The major complications attributed to NMB were residual curarization and prolonged blockade. Eighteen anesthesiologists reported death attributed to NMB. Residual or prolonged blockade is possibly recorded as a result of the high rate of using clinical criteria to diagnose whether the patient has recovered or not from motor block and, as a corollary, the poor use of neuromuscular transmission monitors in daily practice.
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.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.