O impacto do ultrassom point-of-care transtorácico no tempo de pausa entre as compressões torácicas durante a reanimação cardiopulmonar: revisão sistemática e metanálise

Objective: To value the impact of transthoracic point-of-care ultrasound (POCUS) on pause time between chest compressions during CPR. Methods: Systematic literature review in PubMed, Embase, Scopus, and Biblioteca Virtual em Saúde databases. The primary outcome of the meta-analysis was the difference in pause time between chest compressions in CPR with and without transthoracic POCUS. The secondary outcome was the return of spontaneous circulation of the manual verification and transthoracic POCUS groups. We used software R version 4.1.3 to perform all statistical analyses. Results: The search in the databases resulted in 6177 publications. However, only five met all inclusion criteria. Most of the studies were prospective cohorts. The mean age ranged from 56.5 to 66 years, and males were predominant in all studies. All showed longer pauses in the POCUS group. There was a statistical association between the use of POCUS and longer pauses between chest compressions with an MD of 3.88 (95% CI 2.76; 5.01; p-value < 0.0001). The additional exclusion of any of the five studies did not change the result, i.e., DM between the two groups continued to be statistically significant. Conclusion: The combined analysis of the data suggests that using the POCUS increases the pause time between chest compressions by an average of 3.88 seconds. However, further studies evaluating the impact on return to spontaneous circulation and mortality are necessary.Objetivo: Avaliar o impacto do ultrassom point-of-care (POCUS) transtorácico no tempo de pausa entre as compressões torácicas durante a reanimação cardiopulmonar. Métodos: Revisão sistemática da literatura nas bases de dados PubMed, Embase, Scopus e Biblioteca Virtual em Saúde. O desfecho primário da metanálise foi a diferença no tempo de pausa entre as compressões torácicas. O desfecho secundário foi o retorno da circulação espontânea dos grupos de verificação manual e POCUS transtorácicos. O software R versão 4.1.3 foi utilizado para realizar todas as análises estatísticas. A diferença no tempo de pausa foi expressa por meio da diferença de média (MD) com intervalo de confiança de 95% e o retorno à circulação espontânea por meio do risco relativo. O p-valor foi considerado estatisticamente significativo quando < 0,05. Resultados: A pesquisa nas bases de dados resultou em 6177 publicações, no entanto, apenas cinco foram incluídas. Houve uma associação estatística entre o uso de POCUS e pausas mais longas entre compressões torácicas com uma MD de 3,88 (95% CI 2,76; 5,01; p-valor < 0,0001). A exclusão adicional de qualquer um dos cinco estudos não alterou o resultado, ou seja, o DM entre os dois grupos continuou a ser estatisticamente significativo. Conclusão: A análise combinada dos dados sugere que a utilização do POCUS aumenta o tempo de pausa entre as compressões torácicas numa média de 3,88 segundos. Contudo, são necessários estudos randomizados controlados que avaliem o impacto no retorno à circulação espontânea

Epidemiological Aspects of the Initial Evolution of COVID-19 in Microregion of Uberlândia, Minas Gerais (MG), Brazil

COVID-19 is considered by the World Health Organization to be a global public health emergency, which presents regional divergences that affect the epidemiological profile of the disease and are associated with political, economic, social and behavioral aspects. We aimed to analyze the epidemiological characteristics of the disease in the microregion of Uberlândia, Brazil, in order to determine risk factors that contributed to progression of SARS-CoV-2 virus. A cross-sectional study was conducted about micro- and macro-determinants combined with the significance analysis of suspected and confirmed cases in 18 municipalities during the epidemiological weeks (EW) 9 to 26. There were 34,046 notifications, of which 4935 (14.49%) people were diagnosed with COVID-19. Of these, 282 (5.71%) required hospital care and 40 (0.81%) died. Age and presence of associated comorbidities were decisive in the variations of incidence and lethality rates. In general, young people were the most affected and the elderly people, the most exposed to the serious and lethal form (p < 0.0001). Comorbidities such as diabetes and cardiopathies increased 33.5 times the death risk. The dispersion of the virus was centrifugal, in the inter as well as in the intra-municipal level. The disorderly implementation of municipal decrees applied in a decentralized manner in the municipalities seems to have contributed for the incidence rates increasing in the EW 25 and 26

Phylogeny and Virulence Factors of <i>Escherichia coli</i> Isolated from Dogs with Pyometra

We aimed to investigate the occurrence, phylogeny, and virulence of E. coli in the uterine contents and urine of female dogs with pyometra, through the presence of virulence genes and their genetic similarity. Uterine secretions and urine samples from 52 female dogs with pyometra were collected and cultured. Strains identified as E. coli from 25 uterine and 7 urine samples were tested for virulence genes by PCR. Genetic similarity between the isolates was studied using RAPD-PCR. E. coli was observed in 48.07% uterine samples with pyometra and 20.0% urine samples. The strains showed high percentages for the presence of virulence genes: 96.9% had the gene sfa, 59.4% afa, 46.9% pap, 53.1% hly, and 68.75% cnf. Even with the high prevalence of virulence genes, the samples were not submitted to DNA sequencing to confirm the results. Analysis showed high genetic diversity in E. coli, however, strains isolated from the same animal indicate that cystitis and pyometra could be related. Our study indicated the association between E. coli in dogs with pyometra and cases of urinary tract infection and the pathogenic potential of strains increasing with animal age