Approach to Paroxysmal Atrial Fibrillation Type Arrhythmia in a Cardiology Service:A Case Report

Atrial fibrillation is a cardiac arrhythmia of high prevalence in the population, especially in the elderly. Its main electrical characteristics are the interval between two successive irregular R waves, absence of P waves and presence of f waves between QRS complexes. The most common symptoms of atrial fibrillation are irregular palpitations associated with dyspnea, dizziness, feeling tired, fatigue and general malaise, but not all patients have any symptoms. The present report presents the history of an elderly patient who arrived at the hospital’s emergency department with irregular heart rhythm and palpitations. The patient’s symptoms, associated with the electrocardiogram results, indicated paroxysmal atrial fibrillation. Electrical cardioversion was performed, and after, cardiac ablation via the femoral vein at the hospital’s cardiology service. There were no complications during the procedure. As a routine imaging exam after ablation, control esophagogastroduodenoscopy was requested to verify that there was no formation of atrio-esophageal fistula developed by the invasive ablation procedure and electrocardiogram, which showed normal sinus rhythm. The patient remained in the cardiac intensive care unit for observation for 24 hours. After the electrical cardioversion and catheter ablation procedures, the patient improved his clinical picture of atrial fibrillation and was discharged after 24 hours of hospitalization. He received treatment to perform at home, to reduce acid reflux into the esophagus and to prevent thrombosis. He did not present pulmonary thromboembolism after hospital discharge. It is believed, therefore, that this form of treatment and management of paroxysmal atrial fibrillation is effective for the solution of the proposed problem and can also serve as a reference for other professionals within the cardiology service.

Use of the Scar Acceleration Method - Mac^®in the Treatment of Vulvovaginal Candidiasis: A Proposal for Treatment in Public Health in Sus, Brazil

Vulvovaginal candidiasis is an infection of the genital mucosa, which involves the vulva and vagina caused by yeast. It is considered a recurrent pathology and a public health problem that causes discomfort by the triggers and that, when left untreated, can lead to health problems. The present study is a report of two cases treated with the MAC® - Scar Acceleration Method - (MAC®) methodology at the Physiotherapy School Clinic of Teaching Center of Campos Gerais (CESCAGE) as a pilot for the proposal to implement the protocol at the Municipal Center for Women’s Health—CMM in the municipality of Ponta Grossa—PR, Brazil. The patients were referred by Basic Health Units in the city with complaints of pruritus, vaginal discharge and local burning with the diagnosis of candidiasis evidenced by culture and antibiogram. Patients were treated with photodynamic therapy using the MAC® method for 14 consecutive days with 660 nm red laser phototherapy, 100 mW of power, 9 joules of energy, photosensitizing the drug Turmeric Long in one of the participants and propolis in the other, using 1% methylene blue dye. Both patients and researchers did not have access to which drug was being used for each participant. Photodynamic therapy potentiated the effects of drugs considering that patients showed gradual improvement with the applied application, which was proven in the analysis of sample secretions performed before and after treatment. The MAC® method had a positive effect in the protocol used and is strengthened as a possibility for treatments aimed at women’s health with regard to vulvovaginal diseases. It is suggested and intended to carry out further research with a greater number of patients using the referred method.

Effects of Semi-Ablative Fractional Radiofrequency Associated with Growth Factors in Stretch Marks: A Randomized Controlled Trial

Background: To investigate the effects of the association of semi-ablative fractional radiofrequency (RFF) with growth factors in stretch marks. Methods: This is a randomized controlled trial. The sample consisted of 28 female patients with complaints of gluteus or abdomen striae and divided into 2 equitable groups, named G1 (semi-ablative RFF without active principle association) and G2 (semi-ablative RFF with active principle association), being subdivided into G-1A and G-2A (abdominal applications) and G-1B and G-2B (gluteus applications). A photographic and histological analysis was performed using questionnaires about inflammation, presence of adverse effects and satisfaction of volunteers. Photographic analysis showed a reduction in the amount of striae alba in all groups. Results: The histological analysis showed an increase in fibroblast activity, collagen type I, and blood vessels, especially in the groups that associated the RFF with the active principle. In the inflammation analysis, the groups that performed intervention with active ingredients showed lower inflammatory signal. All groups had a reasonable level of satisfaction after the interventions;however, the group that used active ingredients reported greater results. Conclusion: The association of semi ablative RFF with growth factors showed a reduction in clinical inflammatory signs, mainly in the first 15 days, as well as higher collagen production, verified in 30 days, with satisfactory clinical results in all groups.

Scar Acceleration Method—MAC® in the Treatment of Chronic Wounds in Lymphedema: Case Report

Wounds are a serious public health problem in our country. Access to effective, low-cost treatment is still far from the reality for many patients leading to a chronic and serious condition. They interfere in the quality of life of these individuals who isolate themselves socially constrained by the appearance of their wounds. The report shows the case of a patient with type II diabetes mellitus, with chronic wounds in lymphedema in the lower limbs who was treated with the Scar Acceleration Methodology associated with Complex Decongestive Therapy, leading to an improvement in her social participation and quality of life.

Neuromuscular Electrical Stimulation in Intensive Care Unit Patients:Integrative Review

Intensive care units’ acquired muscle weakness is present in approximately 50% of the patients. Although active muscle training can attenuate weakness, a large proportion of critical patients cannot participate in any active mobilization. Neuromuscular electrical stimulation may be an alternative strategy to reverse muscle weakness. The objective of the study was to review the scientific publications on the use of neuromuscular electrical stimulation and its parameters and the main results in patients hospitalized in intensive care units. This is an integrative review surveying studies in online databases. The studies were selected from the following descriptors: neuromuscular electrical stimulation AND parameters AND intensive care units AND muscle weakness. The inclusion criteria included articles that addressed the topic of neuromuscular electrical stimulation and the parameters used in patients admitted to intensive care units, aged 18 years or older. Exclusion criteria were studies involving animals, case reports, letters to the editor and book chapters. The search comprised articles in the Portuguese, English and Spanish languages from January 2013 to March 2019. Of the 185 articles identified, nine met the eligibility criteria. The studies were evaluated assessing the level of evidence, and the relevant information was presented in the table and discussed. The parameters of the neuromuscular electrical stimulation employed in the studies showed positive results for the maintenance of strength and muscle mass. There was evidence of benefits in the local and systemic microcirculation, potentially mobilizing endothelial stem cells, to prevent atrophy, to reduce mechanical ventilation time and stay in intensive care unit;and when incorporated into the usual physiotherapy care, proved to be more effective than usual care. Its use is safe and viable in critically ill patients.

Advanced Stage Stuck Gland Adenocarcinoma:Case Report

Parotid gland adenocarcinoma is commonly a tumor of low malignancy and low incidence worldwide. The reported case shows the rapid progression of this tumor in an elderly patient and infrequent effects, such as a presentation of facial edema not commonly described in the medical literature. Patient was admitted to hospital in November 2019 with secretion and partial hearing loss in the right ear and infiltrative and stone lesion with initial skin ulceration in the right cervical region. After 42 days, he returned and was admitted to the intensive care unit with significant swelling of the face, hardened and hyperemic neck, difficulty in speech and inability to open the eye. He presented changes in the mobility of the speech and hearing organs, reduced laryngeal mobility, vocal changes, speech with altered articulation and severe oropharyngeal dysphagia with risk of bronchoaspiration. The patient was diagnosed in September 2019 with a parotid tumor (salivary gland adenocarcinoma T4). The medical team requested computed tomography, computed tomography angiography of the chest and cervical vessels and computed tomography of the neck, in addition to evaluation by the head and neck surgery service and general surgery. After analyzing the results, the medical team suggested a hypothesis of tumor invasion that could result in obstruction of local lymphatic drainage, something unusual in the evolution of this type of tumor. In addition, it was not possible to adhere to radiotherapy treatment due to the extent of the lesion and there was also no confirmation of metastases. The reported case shows us that parotid gland adenocarcinoma, when diagnosed in an advanced stage, can limit the approach to treatment. It was chosen in agreement with the family to proceed with palliative care without invasive measures. Palliative care may be the best option for cases like this, bringing some comfort to the patient and his family.