Clinical and laboratory characteristics in outpatient diagnosis of COVID-19 in healthcare professionals in Rio de Janeiro, Brazil.

AIMS: This study aimed to identify the symptoms associated with early stage SARS-CoV-2 (COVID-19) infections in healthcare professionals (HCPs) using both clinical and laboratory data. METHODS: A total of 1297 patients, admitted between 18 March and 8 April 2020, were stratified according to their risk of developing COVID-19 using their responses to a questionnaire designed to evaluate symptoms and risk conditions. RESULTS: Anosmia/hyposmia (p<0.0001), fever (p<0.0001), body pain (p<0.0001) and chills (p=0.001) were all independent predictors for COVID-19, with a 72% estimated probability for detecting COVID-19 in nasopharyngeal swab samples. Leucopenia, relative monocytosis, decreased eosinophil values, C reactive protein (CRP) and platelets were also shown to be significant independent predictors for COVID-19. CONCLUSIONS: The significant clinical features for COVID-19 were identified as anosmia, fever, chills and body pain. Elevated CRP, leucocytes under 5400×109/L and relative monocytosis (>9%) were common among patients with a confirmed COVID-19 diagnosis. These variables may help, in the absence of reverse transcriptase PCR tests, to identify possible COVID-19 infections during pandemic outbreaks. SUMMARY: From 19 March to 8 April 2020, 1297 patients attended the Polyclinic Piquet Carneiro for COVID-19 detection. HCP data were analysed, and significant clinical features were anosmia, fever, chills and body pain. Elevated CRP, leucopenia and monocytosis were common in COVID-19.

Changes in lung ultrasound of symptomatic healthcare professionals with COVID-19 pneumonia and their association with clinical findings.

PURPOSE: To evaluate ultrasound signs of coronavirus disease-19 (COVID-19) pneumonia in symptomatic healthcare professionals and to correlate those changes with clinical findings. METHODS: All patients underwent real-time polymerase chain reaction (RT-PCR), lung ultrasound (LUS) and clinical evaluation on the same day. In each of the 12 areas evaluated in the LUS, the LUS signs were scored to generate the aeration score. RESULTS: A total of 409 participants had positive PCR, with a median age of 41 (35-51) years. All participants had clinical symptoms, with cough in 84.1%, fever in 69.7%, and dyspnea in 36.2% of cases. In the LUS, 72.6% of participants had B-lines >2, 36.2% had coalescent B-lines, and 8.06% had subpleural consolidations. The median aeration score was 3 (2-7). The aeration score differed significantly regarding the presence of cough (P = .002), fever (P = .001), and dyspnea (P < .0001). The finding of subpleural consolidations in the LUS showed significant differences between participants with or without dyspnea (P < .0001). CONCLUSIONS: In healthcare professionals with COVID-19, LUS plays a key role in the characterization of lung involvement. Although B-lines are the most common ultrasound sign, subpleural consolidations are those that most impact the respiratory condition.

Translation and cultural adaptation of the Sleep Apnea Clinical Score for use in Brazil.

OBJECTIVE: To translate the Sleep Apnea Clinical Score (SACS) into Brazilian Portuguese and adapt it to the cultural setting, validating it for use as a screening method for polysomnography and as a tool to quantify the risk of obstructive sleep apnea syndrome in individuals in Brazil. METHODS: The translation was performed by two professionals, with subsequent synthesis of the translations. From that version, a back-translation was prepared, revised, and compared with the original by a team of experts. As a pre-test, a consensus version was applied in 20 patients randomly selected from among those under treatment at outpatient clinics at the Piquet Carneiro Polyclinic of the State University of Rio de Janeiro, in the city of Rio de Janeiro, to assess their understanding of the questions. In the validation phase, the Brazilian-Portuguese version of the SACS was applied in 86 patients who subsequently underwent polysomnography, regardless of the SACS result. RESULTS: The analyses of the pre-test phase showed that the SACS was easily understood by the patients. In the validation phase, the SACS showed a sensitivity of 45.3% (95% CI: 32.8-58.2%), a specificity of 90.9% (95% CI: 70.8-98.9%), a positive predictive value of 93.5% (95% CI: 79.0-98.2%), a negative predictive value of 36.4% (95% CI: 30.6-42.5%), and an accuracy of 57.0% (95% CI: 45.8-67.6%). CONCLUSIONS: The Brazilian-Portuguese version of the SACS can be used in order to assess the risk of obstructive sleep apnea syndrome.

Translation and cultural adaptation of the Sleep Apnea Clinical Score for use in Brazil / Tradução e adaptação cultural do questionário Sleep Apnea Clinical Score para uso no Brasil

ABSTRACT Objective: To translate the Sleep Apnea Clinical Score (SACS) into Brazilian Portuguese and adapt it to the cultural setting, validating it for use as a screening method for polysomnography and as a tool to quantify the risk of obstructive sleep apnea syndrome in individuals in Brazil. Methods: The translation was performed by two professionals, with subsequent synthesis of the translations. From that version, a back-translation was prepared, revised, and compared with the original by a team of experts. As a pre-test, a consensus version was applied in 20 patients randomly selected from among those under treatment at outpatient clinics at the Piquet Carneiro Polyclinic of the State University of Rio de Janeiro, in the city of Rio de Janeiro, to assess their understanding of the questions. In the validation phase, the Brazilian-Portuguese version of the SACS was applied in 86 patients who subsequently underwent polysomnography, regardless of the SACS result. Results: The analyses of the pre-test phase showed that the SACS was easily understood by the patients. In the validation phase, the SACS showed a sensitivity of 45.3% (95% CI: 32.8-58.2%), a specificity of 90.9% (95% CI: 70.8-98.9%), a positive predictive value of 93.5% (95% CI: 79.0-98.2%), a negative predictive value of 36.4% (95% CI: 30.6-42.5%), and an accuracy of 57.0% (95% CI: 45.8-67.6%). Conclusions: The Brazilian-Portuguese version of the SACS can be used in order to assess the risk of obstructive sleep apnea syndrome.

RESUMO Objetivo: Traduzir o questionário Sleep Apnea Clinical Score (SACS) para a língua portuguesa do Brasil, adaptá-lo a nossa cultura e validá-lo para que seja utilizado como método de rastreio para a realização de polissonografia e como ferramenta para quantificar o risco de síndrome da apneia obstrutiva do sono no indivíduo. Métodos: A tradução foi realizada por dois profissionais, com posterior conciliação em uma síntese das traduções. A partir dessa versão, foi elaborada uma tradução reversa, revisada e comparada com o original por uma equipe de especialistas. A versão de consenso foi aplicada em 20 pacientes aleatoriamente selecionados de ambulatórios da Policlínica Piquet Carneiro da Universidade do Estado do Rio de Janeiro, na cidade do Rio de Janeiro (RJ), para avaliar sua compreensão (pré-teste). Posteriormente, a versão brasileira do SACS foi aplicada em 86 pacientes que realizaram polissonografia, independentemente do resultado apresentado no SACS (fase de validação). Resultados: As análises da fase pré-teste demonstraram que o questionário era facilmente compreendido pelos pacientes. Na fase de validação, o questionário demonstrou sensibilidade de 45,3% (IC95%: 32,8-58,2%), especificidade de 90,9% (IC95%: 70,8-98,9%), valor preditivo positivo de 93,5% (IC95%: 79,0-98,2%), valor preditivo negativo de 36,4% (IC95%: 30,6-42,5%) e acurácia de 57,0% (IC95%: 45,8-67,6%). Conclusões: A versão do questionário SACS traduzida para a língua portuguesa do Brasil pode ser utilizada para avaliar o risco de síndrome da apneia obstrutiva do sono.

Sleep Apnea Clinical Score, Berlin Questionnaire, or Epworth Sleepiness Scale: which is the best obstructive sleep apnea predictor in patients with COPD?

INTRODUCTION: The Sleep Apnea Clinical Score (SACS) and the Berlin Questionnaire (BQ) are used to predict the likelihood of obstructive sleep apnea (OSA). The Epworth Sleepiness Scale (ESS) is used to assess daytime sleepiness, a common OSA symptom. These clinical tools help prioritize individuals with the most severe illness regarding on whom polysomnography (PSG) should be performed. It is necessary to check the applicability of these tools in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to compare SACS, BQ, and ESS performance in patients with COPD. METHODS: The SACS, BQ, and ESS were applied to 91 patients with COPD. From this group, 24 underwent PSG. In this transversal study, these three tests were compared regarding their likelihood to predict OSA in patients with COPD using receiver-operating characteristic curve statistics. RESULTS: In this sample, 58 (63.7%) patients were men, and their mean age was 69.4±9.6 years. Fourteen patients (15.4%) had a high probability of OSA by SACS, 32 (32.5%) had a high probability by BQ, and 37 (40.7%) had excessive diurnal somnolence according to the ESS. From the 24 patients who underwent PSG, OSA diagnosis was confirmed in five (20.8%), according to the American Academy of Sleep Medicine criteria. BQ and ESS did not accurately predict OSA in this group of patients with COPD, with a receiver-operating characteristic curve area under the curves of 0.54 (95% CI: 0.329-0.745, P=0.75) and 0.69 (95% CI: 0.47-0.860, P=0.10), respectively. SACS performance was significantly better, with an area under the curve of 0.82 (95% CI: 0.606-0.943, P=0.02). CONCLUSION: SACS was better than BQ and ESS in predicting OSA in this group of patients with COPD.

The obstructibe sleep apnea screening in patients with epilepsy / Triagem da síndrome da apneia obstrutiva do sono em pacientes com eplepsia

Objectives: To estimate the accuracy of some obstructive sleep apnea (OSA) screening clinical methods in patients with epilepsy (PWE), besides to report OSA screening issues by literature review. Methods: 98 adult PWE were prospectively screened for OSA. The Berlin questionnaire (BQ) performance was compared to the Epworth sleepiness scale (ESS), as well as with some questions about snore from Basic Nordic Sleep Questionnaire (BNSQ), anthropometrical characteristics (BMI, neck circumference-NC), besides variables related to epilepsy by means of the diagnostic odds ratio (OR). Results: It was found a remarkable OR for OSA regarding snore frequency (OR=11.2/CI95%=4.2-30/p<0.001), loud snoring (OR=10.7/ CI95%=3.6-28.6/p<0.001) and time of snoring in years (OR=14.4 /CI95%=1.6-127.6/p<0.000), BMI(OR=4.1/CI95%=1.8- 9.7/p=0.001), male neck circumference (NC) (OR=4.7/CI95%=1.5-14.9/p=0.006), female NC (OR=5.5 /CI95%=1.3-22.7/ p=0.015) and generalized epilepsy (OR=3.1/CI95%=1.3-7.1/ p=0.009). Conclusions: These questions may help clinicians identify OSA in PWE and the selection of the patients for carrying out polysomnography registration. They can be used for the construction of a predictive rule for the diagnosis of OSA in PWE.The generalized seizure is important for OSA's screening and there is necessity of the better study of this relationship...

Objetivos: Estimar acurácia de alguns métodos clínicos de triagem para Síndrome de Apneia Obstrutiva do Sono (SAOS) em pessoas com epilepsia (PCE) e rever literatura sobre assunto. Métodos: 98 PCE adultas foram prospectivamente triadas para SAOS. O Questionário Clínico de Berlim (QB) foi comparado através da razão de chances (RC) a: Escala de Sonolência de Epworth (ESE), algumas questões sobre ronco do Questionário Escandinavo Básico do Sono (QEBS), características antropométricas (IMC, circunferência do pescoço (CP), além de variáveis relacionadas a epilepsia. Resultados: Foram encontradas RC significativas para o diagnóstico de SAOS em: frequência de roncos (RC=11.2/IC95%=4.2-30/p<0.001), volume de ronco (RC=10.7/IC95%=3.6-28.6/p<0.001), tempo de ronco em anos (RC=14.4/IC95%=1.6-127.6/p<0.000), IMC(RC=4.1/IC95%=1.8-9.7/p=0.001), CP masculina (RC=4.7/IC95%=1.5-14.9/p=0.006), CP feminina (RC=5.5/ IC95%=1.3-22.7/p=0.015) e epilepsia generalizada (RC=3.1/IC95%=1.3-7.1/p=0.009). Conclusões: Estas questões ajudam o clínico no diagnóstico de SAOS e a seleção dos pacientes para a realização de polissonografia. Elas podem colaborar para construção de uma regra preditiva para diagnóstico de SAOS em PCE. O tipo de crise generalizada é relevante e pode servir para o rastreamento de SAOS e há necessidade de melhor avaliação desta relação...

Síndrome da apnéia-hipopnéia obstrutiva do sono (SAHOS) e síndrome de resistência de vias aéreas superiores (SRVAS): duas entidades distintas ou duas apresentações de uma mesma doença? / Upper airway resistance syndrome: a continuum between primary snoring and obstructive sleep apnea syndrome or a distinct syndrome?

A Síndrome de Resistência de Vias Aéreas Superiores (SRVAS) pode ser considerada uma nova entidade associada aos Distúrbios Respiratórios do Sono. No entanto, alguns autores consideram este evento como parte do espectro de alterações da Síndrome da Apnéia-Hipopnéia Obstrutiva do Sono (SAHOS), que vai do ronco à apnéia. Reconhecer a presença destas alterações durante o sono torna-se fundamental para que seja realizada uma correta orientação terapêutica.

Empiema de necessidade doze anos após trauma torácico por arma de fogo / Empyema necessitatis twelve years after thoracic trauma for gunshot wounds

Os autores descrevem o caso de um homem de 45 anos com empiema crônico adquirido após trauma torácico por arma de fogo. O paciente evoluiu durante doze anos com drenagem espontânea através da parede torácica. Submetido a tratamento cirúrgico, recebeu alta em boas condições clínicas. A partir do caso relatado, é feita uma breve discussão sobre os principais aspectos para o diagnóstico e tratamento do empiema de necessidade.