RESUMO
Objetivos: Descrever fatores de risco, perfil do recém-nascido, alterações ecocardiográficas, tratamento e desfecho da Hipertensão Pulmonar Persistente Neonatal em uma unidade de cuidados terciários na cidade de Joinville/SC, Brasil. Métodos: Estudo descritivo observacional transversal envolvendo a avaliação dos prontuários dos neonatos com sinais clínicos de hipertensão pulmonar, comprovação ecocardiográfica e internação em Unidade de Terapia Intensiva no período de um ano. Foram coletados dados fetais, maternos, ecocardiográficos, tratamentos e desfechos. Resultados: Foram estudados 29 recém-nascidos. A mediana da idade gestacional foi de 37,4 semanas, 65,5% dos partos foram realizados por via alta e 48,3% das mães realizaram acompanhamento pré-natal de alto risco. O peso de nascimento variou de 585 a 4270g, 58,6% dos pacientes eram do sexo feminino, 48,3% dos recém-nascidos apresentaram Índice de Apgar <7 no 1º minuto. Ao estudo ecocardiográfico, 62,1% dos pacientes apresentaram shunt cardíaco direito-esquerdo e a pressão pulmonar média calculada foi de 40,5 mmHg (26,3-66,0). As drogas mais utilizadas foram Milrinona, Óxido Nítrico Inalatório e Alprostadil. A amostra contou com 6 óbitos. Não houve valor de p significativo nas variáveis devido a limitação na quantidade da amostra estudada. Conclusão: O perfil do RN encontrado foi de neonatos do gênero feminino, a termo, com nascimento por via alta. Os sinais clínicos de hipertensão pulmonar foram observados na maioria dos pacientes sendo demonstrado grau leve pelas alterações ecocardiográficas. Não houve diferença significativa na comparação das medicações utilizadas e o tempo de suporte ventilatório comparado a severidade da doença. A taxa de mortalidade foi semelhante a outros estudos.
Objectives: To describe risk factors, newborn profile, echocardiographic changes, treatment and outcome of Persistent Pulmonary Hypertension of Newborn diagnosed in a hospital in the South of Brazil. Methods: This was a cross-sectional descriptive study. The research was performed with medical records of newborns presenting clinical signs of pulmonary hyperterion, echocardiographic changes and neonatal ICU for one year. Our variables included neonatal data, maternal data, echocardiographic data, treatments and outcomes. Results: We studied 29 newborns. The median gestational age was 37.4 weeks, 65.5% of deliveries were cesarean and 48.3% of mothers underwent high-risk prenatal care. Birth weight ranged from 585 to 4270 g, 58.6% were female patients, 48.3% of newborns had Apgar score <7 in the first minute. Among the echocardiographic changes, we found 62.1% of patients with right-to-left cardiac shunt and mean pulmonary pressure calculated was 40.5 mmHg (26.3-66.0). The main prescribed drugs were Milrinone, Inhaled Nitric Oxide and Alprostadil (Prostaglandin E1 agonist). The total sample had 6 deaths. Due the limitation of the amount of the sample studied, an insignificant p-value was obtained in all variables. Conclusion: The profile of the newborn was female genre, with term pregnancy, by cesarian. Clinical signs of pulmonary hypertension were observed in most of patients, and mild levels were demonstrated by echocardiographic changes. There was no significant difference in the comparison between the medications used and the duration of ventilatory support associated with the severity of the disease. The mortality rate was similar to other studies.
RESUMO
Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%). Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%). Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome.