Tackling cardiovascular prevention after coronary disease settled: the challenges of guideline implementation

Funding Acknowledgements

Type of funding sources: None.

Purpose

Cardiovascular disease (CVD) as it is known, is a multifactorial disease that needs to be addressed exactly in that way. Knowledge deficit regarding symptoms and unadjusted lifestyles are still the most relevant nursing diagnoses identified as main causes for readmissions in patients with CVD (1). Recent guidelines evidenced that after a CVD event, patients should attend to their lifestyle choices and health behaviors, in order to avoid future events, as this works in a cardioprotective way (2). Having programs structured in a way that makes it possible to involve both population and person-centered strategies all teamed up, could be a way of involving patients in their own care, tackling several recommendations at the same time. Our aim is to describe the implementation of a cardiovascular disease prevention program with a multidisciplinary approach and identify the most prevalent CVD risk factors during the first trimester of its implementation.

Methods

In order to improve patient outcomes post-discharge, the program was outlined as follows: firstly. a Multidisciplinary Appointment was structured, with a Cardiologist and a Nurse, where also family is invited, to assess risk factors, therapeutic adherence and quality of life. According to the patient's needs and preferences they can be assigned to the Cardiac Rehabilitation Lab, to the Education Group Sessions on CVD risk factors where a Nutritionist, Psychiatrist and Physiatrist also participate according to the sessions' topic. For more personalized approach it also comprises: Therapeutic Groups and Mental Health Appointment; Nutrition Appointment; and Nursing Counseling at Outpatient clinics for family and person-centered approach. To assess the program at its third month baseline the focus group method was used for patients and professionals perspectives.

Results

The program was implemented from October to December 2021. During that time 24 patients were admitted. Nursing Counseling was needed for almost all patients for different reasons. Out of those, 50% were assigned to the group sessions, 33.33% were assigned to the Cardiac Rehab, 12.5% were oriented to the Nutrition consults and 20,83% to the Mental Health consults. Even though we offered therapeutic groups as an option for some patients, none of them were willing to go. Regarding the modifiable risk factors, 70% of patients had 3 or more risk factors, showing that we do have a high risk population to tackle. Putting it into perspective, the most prevalent risk factors were dyslipidemia (70.83%), tobacco use (70.83%), obesity (54.17%) and hypertension (50%).

Conclusions

Managing a multidisciplinary program can be demanding, and there were several challenges to this program’s implementation such as: short-staffing, structural issues, covid-19 prevention issues, digital systems, agendas, etc.). But focusing on patients' needs and preferences, helped us to do our utmost to make this program happen.

Esthetic perception of asymmetric canines treated with space closure in maxillary lateral incisor agenesis

OBJECTIVE

This article assesses the esthetic opinion of the experts involved in dental restoration (general dentists, orthodontists, prosthodontists) and laypeople. Differences in esthetic opinion among the studied groups are assessed.

MATERIAL AND METHODS

A questionnaire was constructed based on four photographs. A quantitative esthetic appreciation using a numerical scale was requested from four groups of observers. The final sample consisted of 434 participants: 142 laypeople, 141 general dentists, 100 orthodontists, and 51 prosthodontists. The photographs presented were based on the same lips and modified from the same intraoral photograph with asymmetric canines: the right canine was smaller than the left canine and had a lower gingival margin. A mirror image of the right canine was digitally made to create symmetry.

RESULTS

There were statistically significant differences (P < 0.05) in the assessments made across the different groups of observers. For all questions, the laypeople assigned significantly higher scores (P < 0.05) than the orthodontists and prosthodontists. However, there was no significant difference between groups, and all the groups considered the photograph with the larger canines to be more esthetic. The dental professionals and the laypeople disagreed the most regarding their assessment of the least esthetic image.

CONCLUSION

There were differences between the four observer groups in their scoring of the photographs from 0 to 10 relative to the more pleasing esthetics of closure of space with asymmetric canines. However, there were no differences in the results when evaluating each type of canine relative to the form. The canine with the most prominent shape was considered to be more esthetic by all the groups.

Rhipicephalus microplus (Acarina, Ixodidae) in Angola: evidence of its establishment and expansion

Livestock constitutes a fundamental asset for the livelihood of rural communities in Angola. Rhipicephalus microplus (Acarina, Ixodidae) is considered to be the most important external parasite impacting the cattle industry in the world. The present work used a cross-sectional study on tick species infesting cattle in smallholder and commercial farms, to investigate the presence of R. microplus in Angola. This species was found to be recently established in certain areas of Cuanza-Sul and Benguela provinces. Furthermore, taking the current understanding of the pattern of dispersal of R. microplus into account, it is probable that this species is already present in other areas of the country. Animal movement without the necessary control measures facilitates the dispersal of this tick species. Consequently, R. microplus is causing rapid displacement of the native tick species, Rhipicephalus decoloratus. The presence of R. microplus in Angola constitutes a serious problem and poses a potential threat to the livestock sector as well as being an important risk factor for the sustainability of the livelihood strategies developed by smallholders.

Western blot seroindeterminate individuals for human T-lymphotropic virus I/II (HTLV-I/II) in Fortaleza (Brazil): a serological and molecular diagnostic and epidemiological approach

How to handle Western blot (WB) seroindeterminate individuals for Human T-lymphotropic Virus 1/2 (HTLV-1/2) constitutes a challenge for blood banks and families. We made a cross-sectional study of 191 enzyme linked immunoassay (EIA) reactive individuals from the hematological center (HEMOCE) of Fortaleza (Brazil), examining their serological (WB) and molecular (PCR) diagnosis, and demographic profiles, as well as a possible association of their condition with other infectious pathologies and risk factors. Ethical institutional approval and personal consent were obtained. Out of 191 EIA reactive individuals, 118 were WB seroindeterminate and 73 were seropositive for HTLV-1/2. In the PCR analysis of 41 WB seroindeterminate individuals, 9 (22%) were positive and 32 (78%) were negative for HTLV-1/2. The demographic analysis indicated a trend towards a predominance of males among the seroindeterminate individuals and females in the seropositive ones. The seroindeterminate individuals were younger than the seropositive ones. We did not find any association of these conditions with syphilis, Chagas disease or HIV or hepatitis, and with risk factors such as breast-feeding, blood transfusion, STD (syphilis) and IDU.

[Cerebral arterial aneurysm in a child with acquired immunodeficiency syndrome: case report]

Cerebral aneurysmal arteriopathy of the circle of Willis is an uncommon manifestation of acquired human immunodeficiency virus (HIV) infection and up to now only 15 cases have been published in the literature. For this reason we add our experience of this rare case, and review the most important aspects related to this entity. The patient is a 6 year old male with perinatal transmitted AIDS, tetraparethic, developed symptoms characterized by episodes of dystonic postures. The computed tomography of the brain showed aneurismal arteriopathy of the circle of Willis. He had a previous normal examination. The review of the literature shows the pathological abnormalities of the affected vessels are mainly medial fibrosis, with destruction of the internal elastic lamina and intimal hyperplasia. The etiology for the vasculitis is unknown. Varicela zoster virus, as well as HIV by itself, can be related to the physiopathology of the vasculitis. On conclusion, it can be said that although uncommon, such complications are of great importance by the fact that the patients with vascular aneurismal arteriopathy are in high risk for vascular accidents, and once a diagnosis was made, death occurs in less than 6 months, according to the literature.

Activities in other European countries

This paper comprises a compilation of five papers, originating from Austria, Belgium, Denmark, Portugal and the United Kingdom. It describes the actions and measures taken for the transposition of the medical devices directives as well as the implementation of a vigilance system. It also includes aspects of the implementation of a trans-European system for data exchange in the field of medical device vigilance system.

Some ectoparasites of commensal rodents from Huambo, Angola

Eight species of ectoparasites were collected from 166 commensal rodents, including Rattus rattus (L.), Rattus norvegicus (Berkenhout), and Mus musculus (L.), from January to December 1986, in Huambo, Angola. The oriental rat flea, Xenopsylla cheopis (Rothschild), was the predominant species with respect to mean intensity and prevalence. Other fleas collected were Ctenophthalmus (Ethioctenophthalmus) machadoi Ribeiro, Dinopsyllus (Dinopsyllus) smiti Ribeiro, and Echidnophaga gallinacea (Westwood). The mite Laelaps (Echinolaelaps) muricola Trägärdh, the louse Polyplax spinulosa (Burmeister), one species of Ixodes Latreille, and one species of Ornithonyssus Sambon were also recorded. The following represent new host records: C. machadoi from R. rattus and R. norvegicus, D. smiti from M. musculus, and L. muricola from R. rattus and M. musculus. For the first time, the monthly flea indices throughout the year are presented for Angola.

Observations on cattle ticks in Huila Province (Angola)

In Huila Province of Angola, 3864 ticks were collected during a parasitological survey carried out in the rainy season from October 1990 to April 1991. The samples were collected from cattle gathered for the annual vaccination campaign against contagious bovine pleuropneumonia, anthrax and blackleg in 18 veterinary stations of six municipalities. After tick classification, the following proportions of ticks were obtained: Rhipicephalus evertsi mimeticus (27.1%), Amblyomma pomposum (26.4%), Boophilus decoloratus (19.0%), Rhipicephalus zambesiensis (9.4%), Rhipicephalus duttoni (8.3%), Hyalomma marginatum rufipes (3.8%), Hyalomma truncatum (3.0%), Rhipicephalus punctatus (2.5%) and Ixodes cavipalpus, Rhipicephalus lunulatus, Rhipicephalus turanicus, Rhipicephalus evertsi evertsi, Rhipicephalus simus, each less than 1%. These ticks are well known in southern Africa as vectors of diseases caused by protozoa and rickettsiae (babesiosis, theileriosis, anaplasmosis and cowdriosis). Control programmes against ticks and tick-borne diseases should be based on critical studies regarding costs/risks/benefits in relation to socio-economic and ecological frameworks.