Non-facetoface consultations , due to current life circumstances and favored today by many different technical means, are gaining wide popularity. But in addition, the conditions imposed by the current pandemic have contributed to speeding up the use of the various means of communication at our disposal : fixed and mobile telephony, short messages, e-mail ... etc. New technologies are bringing improvements in communication between doctor and patient [1]. The consultations by telemedicine have been satisfactory for the patients and the investment of time less than with the face-to-face consultation [2]. The increasing expansion of these methods should lead to the inclusion of appropriate computer skills in the studies of medical schools in order to adequately respond to the reality of new information and communication techniques [3,4].
{"title":"The Telephone Consultation (TC) in the pain unit","authors":"P. Cia-Blasco, P. Cía-Gómez","doi":"10.15761/HPC.1000194","DOIUrl":"https://doi.org/10.15761/HPC.1000194","url":null,"abstract":"Non-facetoface consultations , due to current life circumstances and favored today by many different technical means, are gaining wide popularity. But in addition, the conditions imposed by the current pandemic have contributed to speeding up the use of the various means of communication at our disposal : fixed and mobile telephony, short messages, e-mail ... etc. New technologies are bringing improvements in communication between doctor and patient [1]. The consultations by telemedicine have been satisfactory for the patients and the investment of time less than with the face-to-face consultation [2]. The increasing expansion of these methods should lead to the inclusion of appropriate computer skills in the studies of medical schools in order to adequately respond to the reality of new information and communication techniques [3,4].","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"111 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72885079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Ingravalle, G. Casella, A. Ingravalle, C. Monti, E. Santambrogio, F. Bonetti, A. Limonta
Introduction: The Covid-19 epidemic started in late 2019 from China. Since then, it has spread all over the world. SARS-CoV-2 infection poses a new challenge for the health systems of the countries involved, which have diverted all efforts to contain the pandemic spread, penalizing the management of patients with chronic diseases. Also, the activity of IBD units was limited and restricted to severe patients to avoid virus spreading. Aim: The aim of the present review is to summarize and to report the earliest evidence regarding the novel managing strategies for IBD patients, in primary care. Method: A review of the main database of scientific publications was conducted, regarding Covid-19 and the management of the patient with IBD in primary care. Results: Several strategies have proven their efficacy. Among these, the most promising are telehealth and patient education (“shielding education”). These two interventions can monitor safely patient’s health and reduce the infection risk in IBD patient. Discussion: Nowadays, limited data in present scientific literature does not show that IBD patients have an increased risk of SARS-CoV-2 infection and a worst disease evolution than general population. The primary care practitioner can play a fundamental role in promoting the correct management of the IBD patient during the pandemic spread.
{"title":"The role of Primary Care Practitioner (PCP) in managing Inflammatory Bowel Disease (IBD) patients during COVID 19 Era","authors":"F. Ingravalle, G. Casella, A. Ingravalle, C. Monti, E. Santambrogio, F. Bonetti, A. Limonta","doi":"10.15761/HPC.1000201","DOIUrl":"https://doi.org/10.15761/HPC.1000201","url":null,"abstract":"Introduction: The Covid-19 epidemic started in late 2019 from China. Since then, it has spread all over the world. SARS-CoV-2 infection poses a new challenge for the health systems of the countries involved, which have diverted all efforts to contain the pandemic spread, penalizing the management of patients with chronic diseases. Also, the activity of IBD units was limited and restricted to severe patients to avoid virus spreading. Aim: The aim of the present review is to summarize and to report the earliest evidence regarding the novel managing strategies for IBD patients, in primary care. Method: A review of the main database of scientific publications was conducted, regarding Covid-19 and the management of the patient with IBD in primary care. Results: Several strategies have proven their efficacy. Among these, the most promising are telehealth and patient education (“shielding education”). These two interventions can monitor safely patient’s health and reduce the infection risk in IBD patient. Discussion: Nowadays, limited data in present scientific literature does not show that IBD patients have an increased risk of SARS-CoV-2 infection and a worst disease evolution than general population. The primary care practitioner can play a fundamental role in promoting the correct management of the IBD patient during the pandemic spread.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"15 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80690236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muharrem Said Coşgun, Hüsnü Değirmenci, Eftal Murat Bakırcı, H. Ölmez
According to The Seventh Report published in 2003 by the Joint National Committee ( JNC 7), patients with systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg are diagnosed with prehypertension. Prehypertension defined in different terms in different guidelines. Prehypertension often coexists with comorbidities such as ischemic heart disease, stroke and diabetes Early detection of hypertension, which is an important public health problem, is very important in both economically developing and developed countries. That's why we wrote this article to draw attention to prehypertension. *Correspondence to: Hüsnü Değirmenci, Department of Cardiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey, E-mail: husnudr1982@gmail.com
{"title":"Prehypertension","authors":"Muharrem Said Coşgun, Hüsnü Değirmenci, Eftal Murat Bakırcı, H. Ölmez","doi":"10.15761/hpc.1000202","DOIUrl":"https://doi.org/10.15761/hpc.1000202","url":null,"abstract":"According to The Seventh Report published in 2003 by the Joint National Committee ( JNC 7), patients with systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg are diagnosed with prehypertension. Prehypertension defined in different terms in different guidelines. Prehypertension often coexists with comorbidities such as ischemic heart disease, stroke and diabetes Early detection of hypertension, which is an important public health problem, is very important in both economically developing and developed countries. That's why we wrote this article to draw attention to prehypertension. *Correspondence to: Hüsnü Değirmenci, Department of Cardiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey, E-mail: husnudr1982@gmail.com","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"33 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81459795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Herminia Castán Urbano, Mª. Adolfina Ruiz Martínez, M. Rodriguez, Elena Ortega Martínez y, M. E. M. Hernández
Melatonin is a hormone with multiple actions, one of which, with proper administration, is the ability to control weight and prevent cardiovascular illnesses associated with obesity and diabetes. So, this work focuses on the design and creation of bilayer tablets which, through the top layer, permit a faster melatonin release after administration and, through the other layer, offer an extended release over time. The tablets are characterized from a technological perspective and have been subjected to disintegration and release tests to help determine their biopharmaceutical profile.
{"title":"Bilayer melatonin tablet formulation: a novel approach to therapeutic efficacy","authors":"Herminia Castán Urbano, Mª. Adolfina Ruiz Martínez, M. Rodriguez, Elena Ortega Martínez y, M. E. M. Hernández","doi":"10.15761/HPC.1000192","DOIUrl":"https://doi.org/10.15761/HPC.1000192","url":null,"abstract":"Melatonin is a hormone with multiple actions, one of which, with proper administration, is the ability to control weight and prevent cardiovascular illnesses associated with obesity and diabetes. So, this work focuses on the design and creation of bilayer tablets which, through the top layer, permit a faster melatonin release after administration and, through the other layer, offer an extended release over time. The tablets are characterized from a technological perspective and have been subjected to disintegration and release tests to help determine their biopharmaceutical profile.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"371 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85478264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. BeridzeVaktangova, R. RodriguezAguilar, S. GarciaCastanon, M. Gago, Garcia Moreira
The Lyme disease produced by Borrelia burgdorferi generates a multiorgan affectation. Mainly dermatological, rheumatic, neurological and cardiac lesions. The detection and treatment in the first stages are basic to prevent its progression. This presentation is based on a clinical case of the patient with Lime disease, late diagnosis, not diagnosed in the acute phase. Patient currently presents skin lesion compatible with chronic erythema migrans, arthralgias. Current Serology: Borrelia IgG Immunoblot Positive pattern; Ac. Anti- Borrelia burgdorferi (IgG) Positive; Ac. Anti-Borrelia burgdorferi (IgM) Negative. In addition, the patient suffers from depression as side effects of treatment used before the definitive diagnosis.
{"title":"The Clinical case about Borrelia Burgdorferi","authors":"N. BeridzeVaktangova, R. RodriguezAguilar, S. GarciaCastanon, M. Gago, Garcia Moreira","doi":"10.15761/hpc.1000182","DOIUrl":"https://doi.org/10.15761/hpc.1000182","url":null,"abstract":"The Lyme disease produced by Borrelia burgdorferi generates a multiorgan affectation. Mainly dermatological, rheumatic, neurological and cardiac lesions. The detection and treatment in the first stages are basic to prevent its progression. This presentation is based on a clinical case of the patient with Lime disease, late diagnosis, not diagnosed in the acute phase. Patient currently presents skin lesion compatible with chronic erythema migrans, arthralgias. Current Serology: Borrelia IgG Immunoblot Positive pattern; Ac. Anti- Borrelia burgdorferi (IgG) Positive; Ac. Anti-Borrelia burgdorferi (IgM) Negative. In addition, the patient suffers from depression as side effects of treatment used before the definitive diagnosis.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"1 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75430789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Received: October 13, 2020; Accepted: October 20, 2020; Published: October 23, 2020 Presently, much of the world’s media and social focus is, understandably, dominated by the COVID-19 pandemic. With the backdrop of high-speed developments and the evolving global situation, we are all experiencing changes to daily routines, social and financial infrastructures and direct health consequences due to the virus. These changes can often be accompanied by increased stress and fear. Importantly, the impact on sleep is a pressing public health concern [1,2].
{"title":"COVID-19: The Importance of Sleep","authors":"Jonathan Sunkersing, David Sunkersing","doi":"10.15761/HPC.1000198","DOIUrl":"https://doi.org/10.15761/HPC.1000198","url":null,"abstract":"Received: October 13, 2020; Accepted: October 20, 2020; Published: October 23, 2020 Presently, much of the world’s media and social focus is, understandably, dominated by the COVID-19 pandemic. With the backdrop of high-speed developments and the evolving global situation, we are all experiencing changes to daily routines, social and financial infrastructures and direct health consequences due to the virus. These changes can often be accompanied by increased stress and fear. Importantly, the impact on sleep is a pressing public health concern [1,2].","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"11 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74432633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Since “nothing in biology makes sense except in the light of evolution” (Dobzhansky T) and it develops through the interrelationships between living beings and their environment; the biological factors in the etiology of human infections can only be explained based on Darwin’s evolutionary theory. In this sense, environment as different as communities and hospitals originate diverse evolutionary processes in the causal agents of community and nosocomial infections; mainly in the development of resistance to antimicrobials. Methods: To validate the possible significant qualitative and quantitative differences between the causal agents of nosocomial and community-acquired urinary tract infections, and their respective antimicrobial resistances; a clinical-epidemiological, descriptive, transversal, comparative and retrospective study was conducted; based on every urine culture and antibiogram performed during a one-year period in a family medicine unit and a regional general hospital in Chihuahua, Mexico. For verification of the statistical significance of these differences, χ2, odds ratio, confidence interval and p-value were calculated with a 95% reliability limits for all cases. Results: Qualitative differences (genera, species and strains) were verified between the 27 causal agents of nosocomial and community urinary tract infections; with the most evolved bacteria and yeasts located in the hospital, having a 1.9 times higher resistance against almost every antibiotic, especially for Gram-negative bacteria and Escherichia coli. In all cases, these differences were statistically significant. For Gram-positive bacteria, less resistant in general, community strains had a 1.2 times higher resistance for two of four types of antimicrobials; but not significantly. Conclusion: Regarding antimicrobial sensitivity, important differences were evidenced as for the clinical practice guides recommendations; based on research from environments, societies and medical attention quite different from Mexico. Even if bacterial evolutionary processes and antibiotic resistance are global, they do not run in parallel nor are contemporary everywhere; and although similarities eventually prevail, they occur with local peculiarities; therefore, their consideration is decisive for a suitable and effective prevention and therapy of infectious diseases and their epidemic outbreaks.
{"title":"Bacterial evolution of urinary tract infections acquired in the community and in the hospital. A case of Mexico","authors":"H. D. Salazar-Holguín, E. P. Salazar-Fernandez","doi":"10.15761/hpc.1000178","DOIUrl":"https://doi.org/10.15761/hpc.1000178","url":null,"abstract":"Introduction: Since “nothing in biology makes sense except in the light of evolution” (Dobzhansky T) and it develops through the interrelationships between living beings and their environment; the biological factors in the etiology of human infections can only be explained based on Darwin’s evolutionary theory. In this sense, environment as different as communities and hospitals originate diverse evolutionary processes in the causal agents of community and nosocomial infections; mainly in the development of resistance to antimicrobials. Methods: To validate the possible significant qualitative and quantitative differences between the causal agents of nosocomial and community-acquired urinary tract infections, and their respective antimicrobial resistances; a clinical-epidemiological, descriptive, transversal, comparative and retrospective study was conducted; based on every urine culture and antibiogram performed during a one-year period in a family medicine unit and a regional general hospital in Chihuahua, Mexico. For verification of the statistical significance of these differences, χ2, odds ratio, confidence interval and p-value were calculated with a 95% reliability limits for all cases. Results: Qualitative differences (genera, species and strains) were verified between the 27 causal agents of nosocomial and community urinary tract infections; with the most evolved bacteria and yeasts located in the hospital, having a 1.9 times higher resistance against almost every antibiotic, especially for Gram-negative bacteria and Escherichia coli. In all cases, these differences were statistically significant. For Gram-positive bacteria, less resistant in general, community strains had a 1.2 times higher resistance for two of four types of antimicrobials; but not significantly. Conclusion: Regarding antimicrobial sensitivity, important differences were evidenced as for the clinical practice guides recommendations; based on research from environments, societies and medical attention quite different from Mexico. Even if bacterial evolutionary processes and antibiotic resistance are global, they do not run in parallel nor are contemporary everywhere; and although similarities eventually prevail, they occur with local peculiarities; therefore, their consideration is decisive for a suitable and effective prevention and therapy of infectious diseases and their epidemic outbreaks.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"1 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75264385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dragan Piljic, M. Tabaković, A. C., Dilista Piljić, N. Sehic, Tarik Bakalovic, A. Skakić, Mirza Tokic, Fahrudin Sabanovic, M. Petricevic
A 78-year old man with a medical history of smoking, hyperlipidemia and hypertension was admitted to our department with ruptured abdominal aortic aneurysm (AAA) diagnosed by ultrasonography of the abdomen. The blood pressure was 60/20 mm Hg. An emergent computed tomography scan of the abdomen revealed a rupture of a giant infrarenal AAA of 16 cm in diameter with extensive intraluminal thrombus, evidence of rupture and large intraabdominal hematoma. The patient underwent a successful open surgical repair with placement of a Dacron tube graft 18 mm. The patient was transferred to the intensive care unit following successful surgical repair. Patient was transferred to the Department of cardiovascular surgery on postoperative day 2. Postoperative recovery resulted in hospital discharge at postoperative day 12.
{"title":"A successful repair of a ruptured giant abdominal aortic aneurysm","authors":"Dragan Piljic, M. Tabaković, A. C., Dilista Piljić, N. Sehic, Tarik Bakalovic, A. Skakić, Mirza Tokic, Fahrudin Sabanovic, M. Petricevic","doi":"10.15761/hpc.1000172","DOIUrl":"https://doi.org/10.15761/hpc.1000172","url":null,"abstract":"A 78-year old man with a medical history of smoking, hyperlipidemia and hypertension was admitted to our department with ruptured abdominal aortic aneurysm (AAA) diagnosed by ultrasonography of the abdomen. The blood pressure was 60/20 mm Hg. An emergent computed tomography scan of the abdomen revealed a rupture of a giant infrarenal AAA of 16 cm in diameter with extensive intraluminal thrombus, evidence of rupture and large intraabdominal hematoma. The patient underwent a successful open surgical repair with placement of a Dacron tube graft 18 mm. The patient was transferred to the intensive care unit following successful surgical repair. Patient was transferred to the Department of cardiovascular surgery on postoperative day 2. Postoperative recovery resulted in hospital discharge at postoperative day 12.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"120 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73640755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dragan Piljic, M. Petricevic, Dilista Piljić, Gordan Galić, M. Tabaković, Alen Hajdarević, N. Sehic, Tarik Bakalovic, A. Skakić, Mirza Tokic, Fahrudin Sabanovic, Almir Kusturica
We report a case of chronic total occlusion of the aorta with critical limb ischemia (CLI) of the lower limbs due to chronic total occlusion (CTO) of infrarenal aorta and extensive bilateral iliac disease. This case was treated by open surgical revascularization, after unsuccessful attempt of percutaneous endovascular stenting treatment. *Correspondence to: Dragan Piljic, M.D., Ph.D, Department of Cardiovascular Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina, Tel: +38735303202; E-mail: dragan.piljic@dr.com Received: November 11, 2019; Accepted: November 25, 2019; Published: November 28, 2019 Case presentation A 46-year-old male, with a history of hypertension and peripheral vascular disease (including previous unsuccessful attempt endovascular stenting) was referred to our hospital for conventional open surgical treatment. The patient underwent a computed tomographic angiography, which showed complete occlusion of the infrarenal abdominal aorta, as well as both common and external iliac artery (Figure 1). He was a heavy smoker (60 cigarettes/day) and had an untreated hyperlipidemia. The operation was performed using the transperitoneal approach with limited thrombectomy through infrarenal aortotomy without transecting the aorta. The patient underwent aortic bifemoral revascularisation, with placement of a Dacron bifurcation graft of 12/6 mm. The Piljic – method was used (restricted intraoperative and postoperative fluid regime and mini-laparotomy, including surgical approach trough 8 to 10 cm paraumbilical incision. The small and large bowels were retracted to the side without being elevated out of the abdominal cavity) [1]. The patient was transfered to the intensive care unit following successful surgical repair. The patient was transfered to the department of cardiovascular surgery on the postoperative day one. Uneventful postoperative recovery resulted in hospital discharge on postoperative day four. Postoperative CTA with contrast showed a neat flow (Figure 2). Patient postoperative period has been followed up for 12 months, which ended with satisfactory general clinical and local state of both legs. Discussion In patients presenting with aortoiliac occlusive disease (AIOD), the total occlusion of the infrarenal aorta has been seen in 3 to 8.5% of cases [2]. Common causes of chronic infrarenal aortic occlusion (CIAO) include: a) atherosclerotic occlusive disease; b) middle aortic syndrome; c) Takayasu arteritis; d) fibromuscular dysplasia; e) neurofibromatosis; and f) coral reef aorta [2]. Although standardized infrarenal aortobifemoral bypass (AoBFB) remains the surgical procedure of choice for CIAO, operative decisions may proceed beyond AoBFB in complicated cases. Different therapeutic strategies include axillo-(bi) femoral bypass (AxBFB), aortoiliac endarterectomy (AIE), or hybrid procedures. AxBFB grafting usually refers to patients of high risk for aortic clamping, or patients with many comorbidities that prohibit an
我们报告一例慢性主动脉全闭塞并下肢严重肢体缺血(CLI)的病例，这是由于慢性肾下主动脉全闭塞和广泛的双侧髂疾病引起的。在尝试经皮血管内支架治疗失败后，采用开放手术重建术治疗。*通讯:Dragan Piljic, M.D, Ph.D .，波黑图兹拉大学临床中心心血管外科，电话:+38735303202;邮箱:dragan.piljic@dr.com收稿日期:2019年11月11日;录用日期:2019年11月25日;患者男，46岁，高血压病史伴周围血管疾病(包括既往血管内支架置入失败)，转至我院行常规开放手术治疗。患者行计算机断层血管造影，显示肾下腹主动脉、髂总动脉和髂外动脉完全闭塞(图1)。他是一个重度吸烟者(60支/天)，患有未经治疗的高脂血症。手术采用经腹膜入路，经肾下主动脉切开术有限取栓，不横切主动脉。患者接受了主动脉双侧血管重建术，植入了12/6毫米的涤纶分叉移植物。采用Piljic -方法(限制术中和术后输液和小剖腹手术，包括通过8至10 cm的脐旁切口手术入路)。小肠和大肠均向一侧收缩，未将其抬出腹腔)[1]。手术修复成功后，患者转至重症监护病房。患者于术后第一天转至心血管外科。术后恢复顺利，术后第四天出院。术后CTA造影剂显示血流整齐(图2)。患者术后随访12个月，总体临床和局部下肢状态满意。在表现为主动脉髂闭塞性疾病(AIOD)的患者中，3% - 8.5%的病例出现了肾下主动脉完全闭塞[2]。慢性肾下主动脉阻塞(CIAO)的常见原因包括:a)动脉粥样硬化性闭塞性疾病;B)中主动脉综合征;c)高须动脉炎;D)纤维肌肉发育不良;e)神经纤维瘤;f)珊瑚礁主动脉[2]。尽管标准的肾下主动脉-股动脉旁路手术(AoBFB)仍然是CIAO的首选手术方法，但在复杂病例中，手术决定可能超出AoBFB。不同的治疗策略包括腋窝-(双)股动脉旁路(AxBFB)，主动脉-髂动脉内膜切除术(AIE)或混合手术。AxBFB移植通常是指主动脉夹持风险高的患者，或有许多合并症的患者，这些患者禁止进行广泛的经腹腔手术[3]。图1。计算机断层血管造影显示肾下腹主动脉、髂总动脉和髂外动脉完全闭塞。侧位图显示侧支血从胸内动脉经腹上皮下血管流向股总动脉Piljic D(2019)慢性肾下主动脉全闭塞的开放手术血运重建术vol . 3: 2-2 Health Prim Car, 2019 doi: 10.15761/HPC。1000176可以挽救生命。使用开放手术血运重建术可导致快速临床恢复和较低的死亡率和发病率。患者提供了公布数据的书面知情同意书。利益冲突声明作者声明不存在利益冲突。这项工作没有得到任何公共、商业或非营利部门的资助机构的具体资助。引用1。李建军，李建军，李建军，等。(2015)选择性小切口腹主动脉修复术的临床研究。胸心外科64:296-303。2. 沙M, Patnaik S, Sinha R, Opoku-Asare I, Chaudhry K，等。(2017)血管内入路治疗慢性肾下主动脉全闭塞患者血运重建1例报告。病例代表Cardiol 2017: 7983748。3.Indes JE, Pfaff MJ, Farrokhyar F, Brown H, Hashim P，等。(2013)5358例动脉闭塞性疾病行直接搭桥或血管内治疗的临床结果:系统回顾和meta分析。[J]中国内窥镜医学杂志，20(3):444 - 444。(Crossref) 4。Illuminati G, Calio FG, Mangialardi N, Bertagni A, Vietri F，等。(1996)腋股旁通术治疗主动脉-髂闭塞性疾病的结果。Langenbecks拱门，381:212-217。5.
{"title":"Open Surgical Revascularization of Chronic Total Occlusion of the Infrarenal Aorta","authors":"Dragan Piljic, M. Petricevic, Dilista Piljić, Gordan Galić, M. Tabaković, Alen Hajdarević, N. Sehic, Tarik Bakalovic, A. Skakić, Mirza Tokic, Fahrudin Sabanovic, Almir Kusturica","doi":"10.15761/hpc.1000176","DOIUrl":"https://doi.org/10.15761/hpc.1000176","url":null,"abstract":"We report a case of chronic total occlusion of the aorta with critical limb ischemia (CLI) of the lower limbs due to chronic total occlusion (CTO) of infrarenal aorta and extensive bilateral iliac disease. This case was treated by open surgical revascularization, after unsuccessful attempt of percutaneous endovascular stenting treatment. *Correspondence to: Dragan Piljic, M.D., Ph.D, Department of Cardiovascular Surgery, University Clinical Center Tuzla, Bosnia and Herzegovina, Tel: +38735303202; E-mail: dragan.piljic@dr.com Received: November 11, 2019; Accepted: November 25, 2019; Published: November 28, 2019 Case presentation A 46-year-old male, with a history of hypertension and peripheral vascular disease (including previous unsuccessful attempt endovascular stenting) was referred to our hospital for conventional open surgical treatment. The patient underwent a computed tomographic angiography, which showed complete occlusion of the infrarenal abdominal aorta, as well as both common and external iliac artery (Figure 1). He was a heavy smoker (60 cigarettes/day) and had an untreated hyperlipidemia. The operation was performed using the transperitoneal approach with limited thrombectomy through infrarenal aortotomy without transecting the aorta. The patient underwent aortic bifemoral revascularisation, with placement of a Dacron bifurcation graft of 12/6 mm. The Piljic – method was used (restricted intraoperative and postoperative fluid regime and mini-laparotomy, including surgical approach trough 8 to 10 cm paraumbilical incision. The small and large bowels were retracted to the side without being elevated out of the abdominal cavity) [1]. The patient was transfered to the intensive care unit following successful surgical repair. The patient was transfered to the department of cardiovascular surgery on the postoperative day one. Uneventful postoperative recovery resulted in hospital discharge on postoperative day four. Postoperative CTA with contrast showed a neat flow (Figure 2). Patient postoperative period has been followed up for 12 months, which ended with satisfactory general clinical and local state of both legs. Discussion In patients presenting with aortoiliac occlusive disease (AIOD), the total occlusion of the infrarenal aorta has been seen in 3 to 8.5% of cases [2]. Common causes of chronic infrarenal aortic occlusion (CIAO) include: a) atherosclerotic occlusive disease; b) middle aortic syndrome; c) Takayasu arteritis; d) fibromuscular dysplasia; e) neurofibromatosis; and f) coral reef aorta [2]. Although standardized infrarenal aortobifemoral bypass (AoBFB) remains the surgical procedure of choice for CIAO, operative decisions may proceed beyond AoBFB in complicated cases. Different therapeutic strategies include axillo-(bi) femoral bypass (AxBFB), aortoiliac endarterectomy (AIE), or hybrid procedures. AxBFB grafting usually refers to patients of high risk for aortic clamping, or patients with many comorbidities that prohibit an","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"12 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86984722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In the past two decades, the prevalence of obesity has increased significantly and became one of the important issues of public health and medical care in the world [1-3]. About 27.5% of adults and 47.1% of children are overweight or obese in 2013 worldwide [2]. Obesity and its related co-morbidities, such as type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease, degenerative arthritis, respiratory and sleep disorders, and certain cancers, are common chronic diseases in both developed and developing countries [4]. For example, the risk for obese subjects to develop T2DM and hypertension is 27.6 times and 3.9 times greater than normal weight subjects, respectively [4]. Furthermore, as the medical expenses of these diseases increase, the costs of obesity and its related co-morbidities make up 2-20% of total medical expenditure and become a major economic burden worldwide.
{"title":"Cost and cost-effectiveness of obesity treatment: a mini review","authors":"N. Chu, W. Chu","doi":"10.15761/HPC.1000163","DOIUrl":"https://doi.org/10.15761/HPC.1000163","url":null,"abstract":"In the past two decades, the prevalence of obesity has increased significantly and became one of the important issues of public health and medical care in the world [1-3]. About 27.5% of adults and 47.1% of children are overweight or obese in 2013 worldwide [2]. Obesity and its related co-morbidities, such as type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, coronary heart disease, degenerative arthritis, respiratory and sleep disorders, and certain cancers, are common chronic diseases in both developed and developing countries [4]. For example, the risk for obese subjects to develop T2DM and hypertension is 27.6 times and 3.9 times greater than normal weight subjects, respectively [4]. Furthermore, as the medical expenses of these diseases increase, the costs of obesity and its related co-morbidities make up 2-20% of total medical expenditure and become a major economic burden worldwide.","PeriodicalId":48703,"journal":{"name":"Primary Health Care Research and Development","volume":"6 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73522563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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