Fernanda Silva

Predictors of steal syndrome in hemodialysis patients

Steal syndrome is a feared complication of dialysis vascular access in a population becoming older and frailer. The aim of this study was to determine the predictor factors of steal syndrome. All proximal arteriovenous fistulas (AVFs), patent at day 30, inserted between January 2008 and December 2009 were studied. Data on age, gender, diabetes mellitus (DM) status, presence of coronary or peripheral artery disease, date of initiation of renal replacement therapy, date of access construction, localization, type of anastomosis, previous interventions, and outcome for AVF and patients were analyzed. There were 324 AVFs placed into 309 individual patients. The mean age was 66.7 ± 15.3 years, and the majority (53.7%) of the patients was male. Mean follow‐up of all 324 fistulas was 18.6 ± 8.5 months. During follow‐up, steal syndrome occurred in 26 (8%) of the AVFs. Univariate analysis revealed correlations between steal syndrome and DM (P = 0.002), brachiomedian fistulas (P = 0.016), and side‐to‐side (STS) anastomosis (P = 0.003). However, in multivariate analysis, the presence of DM, STS anastomosis, and female gender were found to be the independent risk factors. The strongest predictive factor was DM (odds ratio: 6.7; 95% confidence interval: 2.5–17.9). Being diabetic is the factor most predictive of having steal syndrome. In diabetic women, with a proximal access, it seems preferable to construct fistulas with end‐to‐side anastomosis to minimize the risk.

Multiple robot operations for maritime search and rescue in euRathlon 2015 competition

This paper presents results of the INESC TEC participation in the maritime environment (both at surface and underwater) integrated in the ICARUS team in the euRathlon 2015 robotics search and rescue competition. These relate to the marine robots from INESC TEC, surface (ROAZ USV) and underwater (MARES AUV) autonomous vehicles participation in multiple tasks such as situation assessment, underwater mapping, leak detection or victim localization. This participation was integrated in the ICARUS Team resulting of the EU funded project aimed to develop robotic tools for large scale disasters. The coordinated search and rescue missions were performed with an initial surface survey providing data for AUV mission planning and execution. A situation assessment bathymetry map, sidescan sonar imaging and location of structures, underwater leaks and victims were achieved, with the global ICARUS team (involving sea, air and land coordinated robots) participating in the final grand Challenge and achieving the second place.

Overhydration prevalence in peritoneal dialysis – A 2 year longitudinal analysis

BACKGROUND AND OBJECTIVES Hypervolemia is a major concern in dialysis patients, and is associated with increased cardiovascular risk and death. Cross sectional analysis have previously demonstrated that peritoneal dialysis (PD) patients are not more overhydrated when compared to haemodialysiś ones. This study was designed to evaluate longitudinal trends in hydration status and corporal composition in a PD population. METHODS We conducted a 2 year prospective observational study of 58 PD patients from a single centre. Incident and prevalent patients were included. Yearly measurements were performed using multifrequency electric bioimpedance. Overhydration (OH) was defined as an extra-cellular water (ECW)/total body water (TBW) over 15%. Clinical and biochemical variables were also explored. RESULTS A total of 30 patients completed evaluation (female 63.3%, mean age 56.9 years, BMI 25.0 kg/m², diabetes 10.0%, APD-50.0%). Median PD vintage was 21.9 months, and 36.7% were anuric. At baseline 6.7% were overhydrated. On longitudinal analysis no significant changes were found in hydration status, systolic blood pressure, pro-BNP, nor albumin levels. Similar results were found among incident (n=11; APD- 45.5%; anuric- 9.1%) and prevalent (n=19; APD- 52.6%; anuric- 52.6%) patients (p>.05). However, at the second year, prevalent patients were moderately overhydrated compared to incident ones (median 10.2% vs 3.5%; p=.009). Nonetheless, no statistical difference was observed considering adequacy, TBW, or ECW. Moreover, nutritional parameters remained stable. CONCLUSIONS Peritoneal dialysis maintenance without increasing volume status, nor major deleterious corporal composition trends, is feasible under careful therapy strategies. Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Kt/V.

Two-Stage Basilic Vein Transposition: Second Stage Results: Basilic Transposition: 2nd Stage Results

The increasing survival of hemodialysis patients results in the depletion of superficial venous capital justifying the use of the basilic vein. Many groups still prefer an arteriovenous graft due to transposition complexity and the time needed to achieve maturation. In this work we review the results of our series of basilic vein transpositions (BVT). BVTs were performed in two stages: first, creation of the fistula; second, transposition of the vein using three small incisions in the arm. All patients had to have direct arterialization of the basilic vein, therefore, patients with previous ipsilateral wrist fistulas also followed a two‐stage protocol. Data were retrospectively revised from all transposition procedures made between September 2005 and November 2012. Patency and complication rates were the primary outcomes evaluated. A total of 276 basilic veins were transposed. Usage rate was 82.2%. 8% (N = 22) of the fistulas were never used due to thrombosis. Secondary patency rates at 1 and 2 years were, respectively, 84% and 66.3%. Complications occurred in 61.6% (N = 170) of fistulas and 65.9% (N = 112) of which had to undergo surgical or endovascular revision. The most frequent complication was vein stenosis (39.7% of late complications, N = 92). Albeit its greater technical complexity, the transposed basilic vein represents a hemodialysis access with good patency rates. Complication rates, although high, are less than those of CVC or prosthetic grafts. These results support the use of the transposed basilic vein as hemodialysis access after the brachiocephalic fistula.

Preoperative vessel mapping in chronic kidney disease patients - a center experience

Purpose Hemodialysis (HD) is the main treatment modality in stage 5 chronic kidney disease, and vascular access planning is a crucial step in the path to dialysis treatment. Beyond detailed patient history and physical examination, duplex ultrasound (DU) evaluation is essential in preoperative vascular mapping. Methods A retrospective descriptive nonrandomized study was performed and included 108 end-stage kidney disease patients referred from eight HD centers to be assessed for creation of an arteriovenous (AV) access (AV fistula or AV graft). We assessed primary failure, primary unassisted patency (PP) and primary assisted patency (PAP) rates and cumulative survival of AV accesses at 6 and 12 months. Results We created 86 AV accesses of which 79 (91.9%) were AV fistulas (AVFs) (29 distal AVFs, 49 proximal AVFs and 1 femorofemoral AVF) and 7 (8.1%) arteriovenous grafts (AVGs). Fifteen percent (15%) (n = 12) of primary failure occurred in the AVF group. Any case of primary failure was observed between AVGs. In the AVF group, PP at 6 months was 63.8% and at 12 months was 48.3%, PAP was 80.7% at 6 and 12 months. PP excluding primary failures was 73.0% and 55.3% at 6 and 12 months, respectively. The cumulative survival at 6 and 12 months was 80.7%. In the AVG group, PP at 6 months and 12 months was 66.7%, PAP and cumulative survival at 6 and 12 months were of 100%. Conclusions This study demonstrates that preoperative vascular mapping with a patient-centered approach may be critical to achieve good outcomes allowing the increase in AVF access.

Sustentabilidade de Barra do Garças sob a Ótica do Índice de Desenvolvimento Sustentável para Municípios

Um municipio e considerado sustentavel, na medida em que evita a degradacao do seu sistema ambiental, reduz as desigualdades sociais, propicia a seus habitantes um ambiente construido saudavel e seguro, bem como articula politicas publicas e acoes de cidadania que permitam enfrentar os desafios presentes e futuros. Portanto, as medidas mais apropriadas para a sustentabilidade local estao relacionadas as politicas publicas visando a integracao das dimensoes social, ambiental, economica e institucional Nessa perspectiva, essa pesquisa, desenvolvida de forma quantitativa, exploratoria e descritiva, teve como objetivo mensurar o grau de sustentabilidade de Barra do Garcas – MT, mediante aplicacao da ferramenta Indice de Desenvolvimento Sustentavel para Municipios (IDSM). No tocante aos resultados, Barra do Garcas apresenta um IDSM de 0,5461, um indice com desempenho aceitavel, conforme os parâmetros utilizados na metodologia. Contudo, nota-se que esse indice esta proximo de uma situacao de alerta, o que demonstra que politicas publicas devem ser implantadas para melhorar ainda mais a qualidade de vida dos municipes.

MANAGING NATURAL RESOURCES FOR NURSES IN PRIMARY CARE

It is a quantitative, descriptive, not documentary research, field, and simple random sampling aimed to analyze the management of natural resources by the primary care nurse in a municipality in the state of Mato Grosso, MT in 2013. The sample consisted of 28 nurses asked about the influence of the environment on population health. The results showed that 92.86% of respondents perceive that relationship; whereas 71.43% and 60.71% of nurses assistants perform practices on environmental health activities in the units. The most cited actions were lectures in units or in schools; individual counseling or group; task forces or trawlers. It is hoped that with this research it is possible to generate a reflection on the role of nurses in the management of natural resources and expand the view of the health and environment in primary health care.

Gestão de resíduos de uma indústria de produção de fios de linha através da aplicação da produção mais limpa

A producao de fios de algodao e mistos (algodao + poliester) que abastece a industria textil gera grande quantidade e variedade de residuos, que quando mal gerenciados poderao se transformar em um relevante problema ambiental. Foi escolhida uma ferramenta de gestao ambiental, a “Producao Mais Limpa” (PML) para avaliar o processo de gerenciamento dos residuos produzidos por uma industria local. Esta pesquisa objetivou analisar a gestao dos residuos gerados por uma industria com atividade de producao de fios de linha, atraves da ferramenta PML. A pesquisa e do tipo estudo caso desenvolvido em uma industria de medio porte com atividade de producao de linha, localizada em um municipio no interior do estado de Mato Grosso-MT, no mes de novembro do ano de 2014. Foram descritas as etapas da producao da industria, bem como a producao de residuo em cada etapa, a partir de uma visita tecnica das pesquisadoras, acompanhadas de um dos gestores da industria referida. Como resultado foi observada a nao utilizacao da ferramenta de gestao PML pela industria visitada, ficando sugerido o seu emprego a fim de minimizar a geracao de residuos, por meio do comprometimento dos gestores e treinamento correto dos funcionarios, atraves da conscientizacao ambiental.

New tunneled haemodialysis catheter placement preserving the vasculature.

Frequent dialysis line insertion can result in central venous occlusions rendering such access of difficult catheterization. New strategies to overcome this difficulty have been reported. This problem also occurs together with accidental loss of tunneled dialysis catheters, periodically observed in chronic hemodialysis patients. We developed a new technique to apply in these situations using the old tunnel. It is exposed close to the vein puncture site and opened to insert the guidewire, advancing the new catheter along it. A new subcutaneous tunnel is performed. We report three cases with successful catheter placement using this technique. Catheters functioned appropriately and no complications were recorded. We conclude that this maneuver can be used to resolve an extruded tunneled hemodialysis catheter while at the same time preserving other vascular access routes.