Use of shockwave intravascular lithotripsy for the treatment of calcified renal artery stenosis in a symptomatic subject

Aim: The use of shockwave lithotripsy for the treatment of heavily calcified atherosclerotic plaques before stenting showed great results in terms of feasibility and safety with favorable initial success. Evidence suggests that it is a useful tool to treat calcified lesions in peripheral and coronary arteries. Here, we describe the case of a patient with calcified renal artery stenosis successfully treated with the shockwave lithotripsy system. Case Report: We present a 76-year-old man with a known significant atherosclerotic renal artery stenosis and refractory hypertension. The patient received an angioplasty of the right renal artery in the first session and he was admitted for a second session to intervene in the left renal artery. The lesion was successfully treated with the lithotripsy system. Final angiography demonstrated an excellent position of the stent and good wall apposition. Conclusion: Our clinical case demonstrates that lithotripsy is safe and effective also for the treatment of the renal artery.

Tuberculose: os futuros profissionais de saúde são preparados para o atendimento adequado do paciente?

Introduction: According to the World Health Organization (WHO), one third of the world’s population is infected with Mycobacterium tuberculosis(1). The literature shows that the multiprofessional team responsible for managing tuberculosis is not able to dealing with re-emergence of the disease, in addition acting in non-integral and humanized way. Objective: To check if university students that will be inserted in primary care are able to identify and manage patients with tuberculosis. Methods and materials: Semi-structured questionnaires were applied to students of the last periods of health courses. Data were analyzed through descriptive statistics. Results: Most of the interviewees said they have already had contact with the topic tuberculosis during graduation. Regarding the manifestations, 65 (38.24%) considered cough, weight loss, fever, loss of appetite, nocturnal sweating and weakness as the main symptoms of pulmonary tuberculosis. In contrast, 97 (57.06%) considered the presence of hemoptoic sputum as the main manifestation. The minority of the interviewees knew how to correctly define a respiratory symptomatic subject. Conclusion: Through the analysis of the results it is possible to notice that the university is the main source of knowledge of the university students about tuberculosis. One had identified gaps to be filled, as in relation to the manifestations of the disease, the difficulty in identifying a respiratory symptomatic subject, the lack of knowledge of the change in the vaccination schedule and mandatory rapid HIV testing. In addition, it is noticed that there is difficulty in the adequate management of the patients. In view of the results, there is a need to improve teaching in relation to tuberculosis.

Conformance contrast testing between rates of pulmonary tuberculosis in Ecuadorian border areas

Objective. To estimate rates of cases of respiratory symptomatic subjects and the incidence rate of pulmonary tuberculosis in two border areas of Ecuador, and contrast them with official figures. Materials and methods. Cross-sectional survey in the southeastern (SEBA), and the Andean southern Ecuadorian border areas (ASBA), which were conducted, respectively, in 1 598 and 2 419 persons aged over 15 years recruited over periods of three weeks. In identified respiratory symptomatic cases, a sputum sample was taken for smear testing. The results (odds ratios and their respective 95% confidence intervals), were compared with local and national official figures using maximum likelihood contrasts. Results. The rates of respiratory symptomatic subjects (7.7% and 5.9% in the SEBA, and ASBA, respectively) and of pulmonary tuberculosis (cumulative incidence rates of 125 and 140 per 100 000 inhabitants, in the same order) were significantly greater than the official figures (of 0.98 and 0.99% for respiratory symptomatic subjects in the SEBA and ASBA, respectively; and of 38.23 per 100 000 inhabitants for pulmonary tuberculosis in Ecuador as a whole) (p<0.001). Conclusion. It is necessary to reinforce both active case finding for respiratory symptomatic subject cases, and epidemiological surveillance of pulmonary tuberculosis in Ecuadorian border regions.