Lung Ultrasound as a Triage Tool in an Emergency Setting during the Covid-19 Outbreak: comparison with CT Findings

Abstract Background Lung ultrasound (LUS) can detect interstitial alveolar changes confined to the subpleural region, like those described in Covid-19. Objetive To evaluate how LUS findings correlate with chest computed tomography (CT) in patients admitted to the emergency department (ED) with suspicion of Covid-19. Methods Cross-sectional study of 20 patients (median age 43 years; interquartile range, 37-63 years; 50% male). All patients underwent LUS and chest CT on the day of ED admission. Each hemithorax was divided into 6 segments with similar landmarks, and equivalent scores (sc) of lesion severity were defined for both methods. The number of affected segments on LUS (LUSseg) was divided into tertiles (0-1, 2-5, and ≥6), and compared with number of affected segments on CT (CTseg), LUSsc, CTsc, and percentage of affected lung parenchyma through visual analysis (CTvis). ANOVA or Kruskal-Wallis test for continuous variables, chi-square test for categorical variables, and receiver operating characteristic (ROC) curve analysis to define optimal cutoff points were performed. P<0.05 was considered statistically significant. Results Median LUSsc, CTsc, CTseg, and CTvis were significantly different between groups. A clear separation between groups was demonstrated; patients with <2 affected segments on LUS were defined as low risk. The ROC curve showed good discriminative power to predict ≥6 affected segments on CT, with an area under the curve (AUC) of 0.97 and 0.98 for >7 LUSsc and >3 LUSseg, respectively. Conclusion LUS findings correlate with chest CT, and can help identify patients with normal lung or minor pulmonary involvement secondary to Covid-19. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Ecocardiografia na triagem e seguimento da hipertensão pulmonar / Echocardiography in screening and follow up in pulmonary hypertension

O ecocardiograma é principal exame de triagem dos pacientes com hipertensão pulmonar por ser de fácil acesso, não invasivo, permitindo a estimativa das pressões arteriais pulmonares, avaliação das repercussões sobre o ventrículo direito, bem como detectar possíveis etiologias para hipertensão pulmonar. Parâmetros obtidos da hemodinâmica pulmonar pelo ecocardiograma ajudam na diferenciação etiológica, bem como podem servir de dados prognósticos. Novas tecnologias vêm sendo incorporadas na realização de ecocardiograma. A análise dos volumes do VD, bem como sua fração de ejeção pelo ecocardiograma tridimensional é promissora. A análise do Strain longitudinal do ventrículo direito tem sido uma ferramenta útil na avaliação da função. O uso do ecocardiograma é ferramenta importante nos pacientes com suspeita de hipertensão pulmonar, tendo papel no diagnóstico, avaliação etiológica, bem como determinação de suas complicações sobre o ventrículo direito...

Echocardiogram is the main screening test for patients with pulmonary hypertension being widely avaible, non invasive, allowing pulmonary arterial pressure estimation, evaluation of right ventricle repercussions, as well as detect possible etiologies for pulmonary hypertension. Parameters obtained from pulmonary hemodynamics by echocardiogram aid in etological differentiation, as well as serve as prognostic data. New Technologies are being incorporated in echocardiogram. Analisys of right ventricle volumes, and ejection fraction by three-dimensional echocardiogram is promising. Right ventricle longitudinal Strain analisys is a good tool for function evaluation.Echocardiogram uses is an important tool for patients with pulmonary hypertension suspicion, used for diagnosis, etiological evaluation, as well as in determination of right ventricle complications...

Acidente vascular cerebral: da epidemiologia à melhoria da prática clínica / Stroke: epidemiology to improve clinical practice

Introdução: O acidente vascular cerebral (AVC) é considerado a terceira causa mais comum de morte em países desenvolvidos e a segunda causa da morte no mundo. Atualmente, os fatores de risco independentemente associados com AVC foram identificados, havendo necessidade de implementação de estratégias preventivas para redução eficiente do ônus relacionado ao AVC...