Point of care ultrasonography in the evaluation of myocardial dysfunction due to sepsis.

Background: Septic shock is commonly diagnosed in critically ill patients and is an important cause of mortality. Techniques used to assess fluid responsiveness and hemodynamic profile with physical examination and central venous pressure have been shown to be insufficient. Thus, the importance of other methods, such as bedside ultrasound (POCUS), is evident. The aim of this study was to analyze patients with septic shock who developed left ventricular dysfunction by POCUS. Methods: Prospective study involving 14 patients diagnosed with septic shock, over 18 years old, without previous cardiac pathologies. Clinical, laboratory and imaging data were collected. POCUS was applied by a cardiology resident; the results were compared with those found by an echocardiographer. Results: Variables were compared between patients with normal and depressed ventricular function (VF). Mean arterial pressure was significantly lower in patients with depressed VF (p = 0.01). Vasopressor drug dose and Pro-BNP value were significantly higher in patients with depressed VF (p = 0.01). Regarding the POCUS inter-rater comparison, the variables of left ventricular global systolic function, vena cava index and presence of B line were significantly concordant (p= 0.02; 0.003; 0.002). Conclusions: Patients with depressed VF had a greater severity of shock, suggesting refractoriness, with cardiac dysfunction as a possible aggravating factor, which was visualized only by POCUS and corroborated by higher Pro-BNP values. A short POCUS training is enough for the non-specialist physician to be able to use this resource in the management of these patients.Background: Septic shock is commonly diagnosed in critically ill patients and is an important cause of mortality. Techniques used to assess fluid responsiveness and hemodynamic profile with physical examination and central venous pressure have been shown to be insufficient. Thus, the importance of other methods, such as bedside ultrasound (POCUS), is evident. The aim of this study was to analyze patients with septic shock who developed left ventricular dysfunction by POCUS. Methods: Prospective study involving 14 patients diagnosed with septic shock, over 18 years old, without previous cardiac pathologies. Clinical, laboratory and imaging data were collected. POCUS was applied by a cardiology resident; the results were compared with those found by an echocardiographer. Results: Variables were compared between patients with normal and depressed ventricular function (VF). Mean arterial pressure was significantly lower in patients with depressed VF (p = 0.01). Vasopressor drug dose and Pro-BNP value were significantly higher in patients with depressed VF (p = 0.01). Regarding the POCUS inter-rater comparison, the variables of left ventricular global systolic function, vena cava index and presence of B line were significantly concordant (p= 0.02; 0.003; 0.002). Conclusions: Patients with depressed VF had a greater severity of shock, suggesting refractoriness, with cardiac dysfunction as a possible aggravating factor, which was visualized only by POCUS and corroborated by higher Pro-BNP values. A short POCUS training is enough for the non-specialist physician to be able to use this resource in the management of these patients

Complications in hospitalized patients with SARS-CoV2 infection

OBJECTIVES: The present study aimed to assess the prevalence of complications during hospitalization in patients diagnosed with COVID-19, as well as the association with mortality and prognosis. METHODS: A retrospective cohort study involved 306 patients admitted to a COVID ward and ICU aged 18 years or older with confirmed SARS-CoV2 infection admitted to a Brazilian Tertiary Hospital. Demographic, clinical, biochemical, radiological and outcome data were collected from the patients' charts. RESULTS: According to the data analyzed during hospitalization, 230 (75.2%) patients developed complications, 281 (91.8%) patients had comorbidities and 169 (55.2%) patients died. There are no differences regarding the sex of the patients. The most prevalent complication was ventilator-associated pneumonia, present in 130 (42.5%) patients, followed by acute kidney injury or chronic kidney disease requiring hemodialysis, presented by 100 (32.7%) patients. The calculation of the relative risk of death according to the occurrence of complications showed p<0.0001 for acute renal failure, p<0.0001 for orotracheal intubation and p=0.0434 for acute myocardial infarction. CONCLUSION: The relative risk of death in COVID-19 is significant, showing an increase in relation to age, length of hospital stay and complications. Prevention, early diagnosis and appropriate treatment are essential to reduce the mortality rate in patients with SARS-CoV-2 infection.OBJECTIVES: The present study aimed to assess the prevalence of complications during hospitalization in patients diagnosed with COVID-19, as well as the association with mortality and prognosis. METHODS: A retrospective cohort study involved 306 patients admitted to a COVID ward and ICU aged 18 years or older with confirmed SARS-CoV2 infection admitted to a Brazilian Tertiary Hospital. Demographic, clinical, biochemical, radiological and outcome data were collected from the patients' charts. RESULTS: According to the data analyzed during hospitalization, 230 (75.2%) patients developed complications, 281 (91.8%) patients had comorbidities and 169 (55.2%) patients died. There are no differences regarding the sex of the patients. The most prevalent complication was ventilator-associated pneumonia, present in 130 (42.5%) patients, followed by acute kidney injury or chronic kidney disease requiring hemodialysis, presented by 100 (32.7%) patients. The calculation of the relative risk of death according to the occurrence of complications showed p<0.0001 for acute renal failure, p<0.0001 for orotracheal intubation and p=0.0434 for acute myocardial infarction. CONCLUSION: The relative risk of death in COVID-19 is significant, showing an increase in relation to age, length of hospital stay and complications. Prevention, early diagnosis and appropriate treatment are essential to reduce the mortality rate in patients with SARS-CoV-2 infection

Avaliação funcional dos pés de portadoresde diabetes tipo II

Objetivo: Avaliar a ocorrência de alterações funcionais e o risco de desenvolver úlceras nos pacientes diabéticos tipo II atendidos em Unidades Básicas de Saúde (UBS). Métodos: Realizou-se estudo transversal, quantitativo e descritivo com 80 portadores de diabetes mellitus (DM) tipo II que apresentavam idade entre 41 e 85 anos e frequentavam as UBS do município de Parnaíba-PI. Os voluntários responderam ao questionário de identificação e ao Michigan Neuropathy Screening Instrument (MNSI), seguido da avaliação dos membros inferiores, sendo: reflexos aquileu e patelar; palpação dos pulsos arteriais (tibial posterior e pedioso); sensibilidade tátil (monofilamento 10g) e vibratória (diapasão 128 Hz); identificação da presença de alterações como unha encravada, calosidades, dedos em garra e queda de pelos. Por fim, utilizando as informações adquiridas na avaliação, os voluntários foram classificados quanto ao risco de desenvolver feridas. Resultados: A amostra foi composta por 76 diabéticos, com média de idade de 63,8±10,4 anos, sendo 63 (82,8%) do sexo feminino, com média de tempo de diagnóstico de 8,8±7,2 anos, média do índice de massa corpórea (IMC) de 28,2±5,4 Kg/m2, sendo 15,7% da amostra fumantes. Os reflexos miotáticos e pulsos arteriais apresentaram-se hiporreflexos e diminuídos, respectivamente. A sensibilidade tátil foi identificada em 81,5%, e 13,1% não sentiram a vibração do diapasão. A calosidade foi a alteração mais prevalente em 76,3% (n=58). O risco 2 de desenvolver úlceras se sobressaiu, 52,6% (n=40). Conclusão: Observaram-se alterações funcionais na amostra estudada e uma classificação de risco 2 para desenvolvimento de feridas em mais de 50% dos avaliados