Diagnostic accuracy of multiorgan point-of-care ultrasound compared with pulmonary computed tomographic angiogram in critically ill patients with suspected pulmonary embolism

Background: Critically ill patients have a higher incidence of pulmonary embolism (PE) than non-critically ill patients, yet no diagnostic algorithm has been validated in this population, leading to the overuse of pulmonary artery computed tomographic angiogram (CTA). This study aimed to comparatively evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) combined with laboratory data versus CTA in predicting PE in critically ill patients. Methods: A prospective diagnostic accuracy study. Critically ill patients with suspected acute PE undergoing CTA were prospectively enrolled. Demographic and clinical data were collected from electronic medical records. Blood samples were collected, and the Wells and revised Geneva scores were calculated. Standardized multiorgan POCUS and CTA were performed. The discriminatory power of multiorgan POCUS combined with biochemical markers was tested using ROC curves, and multivariate analysis was performed. Results: A total of 88 patients were included, and 37 (42%) had PE. Multivariate analysis showed a relative risk (RR) of PE of 2.79 (95% CI, 1.61-4.84) for the presence of right ventricular (RV) dysfunction, of 2.54 (95% CI, 0.89-7.20) for D-dimer levels >1000 ng/mL, and of 1.69 (95% CI, 1.12-2.63) for the absence of an alternative diagnosis to PE on lung POCUS or chest radiograph. The combination with the highest diagnostic accuracy for PE included the following variables: 1- POCUS transthoracic echocardiography with evidence of RV dysfunction; 2- lung POCUS or chest radiograph without an alternative diagnosis to PE; and 3- plasma D-dimer levels >1000 ng/mL. Combining these three findings resulted in an area under the curve of 0.85 (95% CI, 0.77-0.94), with 50% sensitivity and 96% specificity. Conclusions: Multiorgan POCUS combined with laboratory data has acceptable diagnostic accuracy for PE compared with CTA. The combined use of these methods might reduce CTA overuse in critically ill patients

Well-being at work, productivity, and coping with stress during the COVID-19 pandemic

This study aims to analyze the mechanisms through which the coronavirus disease (COVID-19) pandemic impacts on well-being at work and on productivity. The secondary objective is to identify stress management strategies for the work environment during the pandemic. This is an integrative review. Phase 1 consisted of searches of open access electronic databases (MEDLINE, SciELO, Bireme, and LILACS) for papers published in 2020 addressing mental health, work, and pandemics. Phase 2 consisted of selecting literature recommended by specialists in occupational psychiatry and positive psychology. These materials were read and critically analyzed. Forty references were included in the literature review. The articles reviewed were classified into the following categories: articles concerning work relationships in Brazil; articles describing the impact of pandemics on mental health and work; articles focusing on the work of health professionals during pandemics; articles about well-being at work; and papers proposing strategies to improve well-being and productivity and to promote mental health. The COVID-19 pandemic can have a significant impact on workers’ mental health and productivity. Most professionals face a need to adapt to changes, which can decrease their feeling of well-being. Consequently, strategies to promote well-being and mental health in the work environment should be a priority. Work routines were modified after the COVID-19 pandemic set in and assessing these changes is essential to maintain workers’ mental health. By so doing, it is possible to promote general well-being and post-traumatic recovery and reduce stress levels

Resultados da terapia dupla (interferon e ribavirina) para hepatite C em um centro de referência no sul do Brasil: um estudo da vida real

Introdução: A Hepatite C tem uma prevalência estimada em cerca de 170 milhões de pessoas mundialmente e cursa com grande morbimortalidade. O tratamento deste vírus tem se alterado significativamente nos últimos anos, porém, no Brasil, ainda imperam os tratamentos baseados em interferon convencional ou interferon-peguilado associado à ribavirina.Métodos: estudo de coorte, retrospectivo, conduzido no Hospital de Clínicas de Porto Alegre. Foram incluídos 237 pacientes com Hepatite C tratados com interferon e ribavirina ou interferon-peguilado e ribavirinaResultados: A taxa global de resposta virológica sustentada obtida foi de 33,33%, sendo 37,93% nos pacientes com regime baseado no interferon convencional e 32,69% nos com interferon-peguilado. A análise demonstrou uma maior taxa de resposta virológica sustentada entre os pacientes que apresentaram, à análise genética, expressão CC do polimorfismo da IL 28B.Palavras-chave: Hepatite C; interferon; resposta virológica sustentad

Resultados da terapia dupla (interferon e ribavirina) para hepatite C em um centro de referência no sul do Brasil: um estudo da vida real

Introdução: A Hepatite C tem uma prevalência estimada em cerca de 170 milhões de pessoas mundialmente e cursa com grande morbimortalidade. O tratamento deste vírus tem se alterado significativamente nos últimos anos, porém, no Brasil, ainda imperam os tratamentos baseados em interferon convencional ou interferon-peguilado associado à ribavirina. Métodos: estudo de coorte, retrospectivo, conduzido no Hospital de Clínicas de Porto Alegre. Foram incluídos 237 pacientes com Hepatite C tratados com interferon e ribavirina ou interferon-peguilado e ribavirina Resultados: A taxa global de resposta virológica sustentada obtida foi de 33,33%, sendo 37,93% nos pacientes com regime baseado no interferon convencional e 32,69% nos com interferon-peguilado. A análise demonstrou uma maior taxa de resposta virológica sustentada entre os pacientes que apresentaram, à análise genética, expressão CC do polimorfismo da IL 28B. Palavras-chave: Hepatite C; interferon; resposta virológica sustentad