Ultrasonographic evaluation of optic nerve sheath diameter in patients severe traumatic brain injury: a comparison with intraparenchymal pressure monitoring.

OBJECTIVE: Increased intracranial pressure (ICP) can worsen the clinical condition of traumatic brain injury (TBI) patients. One non-invasive and easily bedside-performed technique to estimate ICP is ultrasonographic measurement of optic nerve sheath diameter (ONSD). This study aimed to analyze ONSD and correlate it with ICP values obtained by intraparenchymal monitoring to establish the ONSD threshold value for elevated ICP and reference range of ONSD in severe TBI patients. METHODS: Forty severe TBI patients (Glasgow Coma Scale Score ≤ 8) were included. Ultrasonographic measurement of ONSD was performed and compared with intraparenchymal ICP monitoring to assess their association and determine the ONSD threshold value. Exclusion criteria included individuals under eighteen years old, penetrating TBI, or direct ocular trauma. RESULTS: Fifty-three ONSD measurements were conducted in all patients. The mean ONSD value in the group with intracranial pressure < 20 mmHg was 5.4 mm ± 1.0, while in the group with intracranial pressure ≥ 20 mmHg, it was 6.4 mm ± 0.7 (p = 0.0026). A positive and statistically significant correlation, albeit weak (r = 0.33), was observed between ultrasonographic measurement of ONSD and intraparenchymal ICP monitoring. The statistical analysis of the ROC curve identified the best cut-off as 6.18 mm, with 77.8% sensitivity and 81.8% specificity. CONCLUSION: Our results reveal a positive, albeit weak, correlation between ultrasonographic measurement of ONSD and intraparenchymal ICP monitoring, with an ONSD threshold value of 6.18 mm. Achieving only 77.8% sensitivity and considering the substantial variability between ONSD measurements (standard deviation at 1.0) might limit the reliability of ICP assessment based solely on ONSD measurements.

Surgical approach to a biliary tract cyst in an elderly cat.

Choledochal cyst or biliary tract cyst is a pathological condition characterized by abnormal dilation of the hepatobiliary system. In veterinary medicine, case descriptions and histological characterizations of this biliary malformation are scarce, requiring reliance on data from human medicine. A presumptive diagnosis typically involves imaging studies, with histopathological examination required for confirmation. Treatment often involves surgical intervention to remove the cyst and restore normal biliary function. A 15-year-old mixed-breed domestic female cat presented with vomiting and anorexia. Ultrasonographic examination revealed a dilation adjacent to the caudal aspect of the gallbladder. The patient underwent surgical intervention, during which a sacculation in the cystic duct region was identified and completely excised. Histopathological analysis confirmed the diagnostic suspicion of a biliary tract cyst. Despite the limited veterinary literature, the success of the surgical intervention, involving complete cyst removal, was evident. The patient remains stable and fully recovered twelve months post-surgery.

Predicting extubation failure in neonates: The role of lung ultrasound and corrected gestational age in safe weaning in the NICU.

To evaluate the accuracy of the lung ultrasound score (LUS) in predicting ventilatory weaning failure during neonatal hospitalization in the NICU and to identify factors associated with weaning failure, including corrected gestational age (CGA). This prospective, longitudinal, pragmatic and observational cohort study included neonates on mechanical ventilation for at least 48 h. The primary outcome was the accuracy of lung ultrasound in predicting 3-day weaning failure, with the ROC curve used to determine the best LUS cutoff (sensitivity and specificity). Among 55 neonates, the pre-extubation LUS did not show statistical significance in predicting weaning failure (AUC 0.61; 95% CI: 0.46-0.76, p = 0,169). In the subgroup analysis, a score ≥ 4 suggests the need for ventilatory support after extubation (area under the curve [AUC] = 0.91, 95% CI: 0.80-1.0, p < 0.001) in neonates with GA ≥ 28 weeks. In extremely preterm infants, the pre-extubation LUS was not statistically significant in predicting weaning failure (AUC = 0.38, 95% CI: 0-0.77, p = 0.535). In contrast, CGA ≥ 28.7 weeks at extubation was predictor of successful weaning within 3 days (AUC = 0.95, 95% CI: 0.85-1.0, p < 0.001). CONCLUSION: LUS show promise in predicting weaning failure, though its accuracy may be limited in extremely preterm infants, highlighting the need for further well-powered studies. CGA at extubation also emerges as a key consideration in this population, warranting confirmation through robust future research. WHAT IS KNOWN: • Identifying the optimal timing for extubation is crucial, as both prolonged mechanical ventilation and failed extubation are linked to increased morbidity. • Lung ultrasound plays a well-established role in diagnosing various neonatal lung pathologies, allowing clinicians to make rapid, bedside decisions for the treatment of newborns. WHAT IS NEW: • LUS appears to be accurate in predicting weaning failure, though its accuracy may be lower in extremely preterm infants. • In extremely preterm infants, CGA may play an important role in extubation decision-making. • These findings are hypothesis-generating and warrant further investigation in future studies.

Sensitivity of ultrasound for the evaluation of trauma. Experience in Cuba / Sensibilidad de la ecografía para la evaluación del trauma. Experiencia en Cuba

Introduction. Ultrasound is now an essential tool in assessing trauma patients. It is the preferred initial imaging method for trauma care and is included in the Advanced Trauma Life Support guidelines established by the American College of Surgeons. Methods. A prospective, cross-sectional, observational study was conducted to determine the sensitivity and specificity of E-FAST (Extended Focused Assessment with Sonography in Trauma) performed by general surgeons at Hospital Universitario "Miguel Enríquez", in Havana, Cuba. Results. The diagnostic accuracy (AUC) for E-FAST was 0.964 (0.909 - 0.990), with a sensitivity in the detection of free fluid and pneumothorax of 96.4% (87.8-99.5%), and a specificity of 96.2% (87.0-99.5%). The confidence interval (CI) for these measures was 95%. Conclusions. The E-FAST test performed by general surgeons presents diagnostic values that make it a fast, reliable tool for the evaluation of trauma patients. It is a feasible method with high sensitivity, specificity and positive and negative predictive values.

Introducción. La ecografía es actualmente una herramienta esencial en la evaluación de los pacientes con trauma. Es el método de imagen inicial preferido para la atención del trauma y está incluido en las guías de soporte vital avanzado en trauma establecidas por el Colegio Americano de Cirujanos. Métodos. Se realizó un estudio observacional, transversal y prospectivo para determinar la sensibilidad y especificidad de la prueba E-FAST (Extended Focused Assessment with Sonography in Trauma) realizada por cirujanos generales en el Hospital Universitario "Miguel Enríquez", en La Habana, Cuba. Resultados. La precisión diagnóstica (AUC) de la prueba E-FAST fue de 0,964 (0,909 - 0,990), con una sensibilidad en la detección de líquido libre y neumotórax del 96,4 % (87,8-99,5 %) y una especificidad del 96,2 % (87,0-99,5 %). El intervalo de confianza (IC) para estas medidas fue del 95 %. Conclusiones. La evaluación ecográfica del trauma realizada por cirujanos generales presenta valores diagnósticos que la convierten en una herramienta rápida y confiable para la valoración de los pacientes con trauma. Es un método factible, con alta sensibilidad, especificidad y valores predictivos positivos y negativos.

Lung ultrasound score and diaphragm ultrasound in weaning from mechanical ventilation: are they different in patients with and without COVID-19?

OBJECTIVE: To compare pre-extubation physiological characteristics and ultrasound variables between patients intubated for COVID-19 compared to a clinical population and those intubated for other reasons. METHODS: This was a secondary analysis of a prospective cohort study of patients undergoing invasive mechanical ventilation (IMV) for more than 48 h. Patients were divided into two groups: those intubated for COVID-19-induced ARDS and those intubated for other clinical reasons. Ultrasound assessment of lung and diaphragm function was performed before extubation. The results were compared between the two groups of patients. RESULTS: In comparison with the patients without COVID-19, those with the disease were younger (a median age of 58 [46-76] years vs. a median age of 75 [69-85] years; p = 0.01), had fewer comorbidities (a median Charlson Comorbidity Index of 2 [1-4] vs. a median Charlson Comorbidity Index of 5 [4-6]; p < 0.01), and were less severely ill at admission (a median APACHE II score of 9 [8-14] vs. a median APACHE II score of 18 [13-22]; p < 0.01). In addition, the median duration of IMV was longer in the COVID-19 patients (11 [9-23] days vs. 6 [3-8] days; p < 0.01). Although extubation success rates were similar between the COVID-19 and non-COVID-19 groups (22 [71%] vs. 35 [77.8%]), median lung ultrasound score differed between the two groups (23 [18-25] vs. 15 [11-18]; p < 0.01), as did median diaphragmatic excursion (2.1 [1.7-2.4] vs. 1.7 [1.2-2.0]; p < 0.01). CONCLUSIONS: Although patients with COVID-19 requiring ventilatory support are younger and have fewer comorbidities than those intubated for other clinical reasons, they experience longer hospital stays. Although lung ultrasound score can differ between patients with and without COVID-19, these differences do not significantly translate into extubation success rates. Therefore, the utility of ultrasound scores in weaning COVID-19 patients from IMV needs further study.

Cesarean scar dehiscence in early puerperium and influence of barbed suture: tridimensional ultrasound evaluation in a randomized clinical study.

PURPOSE: This study investigated the hypothesis of early dehiscence of hysterorrhaphy as the initial stage of post-cesarean uterine scar defects, examining the possible influence of barbed suture in this process. METHODS: This longitudinal, prospective, double-blind study included 54 pregnant women with no history of cesarean section, randomized into two suture groups: #0 polyglactin or #1 barbed PDS threads. Sutures were continuous, unlocked, involved the entire myometrium in a single layer, and included the endometrium. Tridimensional transvaginal ultrasonography was performed on the second day postpartum to investigate scar dehiscence and measure its maximal width. RESULTS: The groups had 29 and 25 participants, respectively. Ages: 18-37 (mean 25.80 ± standard error of the mean 0.69) years old. Groups were homogeneous for labor duration, cervical thickness, edge-to-os distance, retroversion, amniotic sac rupture, and additional hemostatic sutures required. Uterine retroversion accounted for 7.4% of cases. Dehiscence was observed in 68.5% (3.98 ± 0.57 mm). The only factor correlating (positively) with dehiscence width was myometrial thickness, whether proximal or distal. CONCLUSIONS: Suture type had no influence on early dehiscence, which occurred at the same rate as published niche formation rates. Tridimensional ultrasound proved effective for evaluating dehiscence.

Comparison of subclavian vein and inferior vena cava collapsibility index in the intensive care unit.

OBJECTIVE: The aim of this study was to evaluate the correlation between changes in the inferior vena cava collapsibility index and subclavian vein collapsibility index in patients undergoing passive leg raising tests in the intensive care unit, considering that respiratory changes affecting the inferior vena cava may similarly affect the subclavian vein. METHODS: This single-center observational study was conducted on patients aged between 18 and 85 years who underwent passive leg raising in the intensive care unit. When the patient was 45° above the bed, the inferior vena cava and subclavian vein were displayed using ultrasonography; subclavian vein collapsibility index and inferior vena cava collapsibility index values were calculated. After the initial values were recorded, passive leg raising was performed, and the initial measurements were repeated. The CI values measured after passive leg raising were subtracted from those calculated before passive leg raising to determine the changes (Δ) in inferior vena cava and subclavian vein collapsibility indices. RESULTS: The study was conducted with a total of 64 patients. The mean±standard deviation values for ΔIVC-CI% and ΔSCV-CI% variables were found as 8.97±8.89 and 10.31±10.81, respectively. There were no statistically significant differences in values of ΔIVC-CI% and ΔSCV-CI% (p=0.297). In the Bland-Altman plot, because there were only two values exceeding the +1.96 SD and -1.96 SD limits, it can be said that the agreement between ΔIVC-CI% and ΔSCV-CI% was adequate. CONCLUSION: ΔSCV-CI% values are compatible and correlated with ΔIVC-CI% values. Inferior vena cava and subclavian vein responded similarly to fluid changes during passive leg raising.

Tumor necrosis factor-alpha inhibitors may increase the need for fine-needle aspiration cytology in axial spondyloarthritis patients.

OBJECTIVE: Tumor necrosis factor alpha inhibitors are frequently used in the treatment of axial spondyloarthritis. While tumor necrosis factor alpha is associated with some malignancies, studies on its effects on thyroid functions and thyroid nodules are limited. This study aimed to assess the effect of tumor necrosis factor alpha inhibitors treatments on the evaluation of thyroid nodules and thyroid function tests in axial spondyloarthritis patients. METHODS: A total of 106 patients with axial spondyloarthritis, 48 receiving nonsteroidal antiinflammatory drugs and 58 receiving tumor necrosis factor alpha inhibitors, were included in the study. All cases were screened by ultrasound for the presence of nodules, European Thyroid Association - Thyroid Imaging Reporting and Data System classification category, thyroid volume, and thyroid function tests. RESULTS: The prevalence of patients with multiple nodules in the tumor necrosis factor alpha inhibitors treatment group was significantly higher compared to the nonsteroidal antiinflammatory drug group (68.2 vs. 38.1%, p=0.033). Furthermore, the prevalence of nodules measuring ≥1 cm in the tumor necrosis factor alpha inhibitors treatment group was higher compared to the only nonsteroidal antiinflammatory drug treatment group (56 vs. 19.05%, p=0.011). In the tumor necrosis factor alpha inhibitors treatment group, the proportion of patients with nodules requiring fine-needle aspiration cytology was higher compared to the nonsteroidal antiinflammatory drug group (34.5 vs. 16.7%, p=0.038). No significant difference was found between thyroid-stimulating hormone and free thyroxine values before and during treatment in both groups (p>0.005). CONCLUSION: The number of nodules requiring fine-needle aspiration cytology according to the European Thyroid Association - Thyroid Imaging Reporting and Data System classification seems higher in nonsteroidal antiinflammatory drugs users than Tumor necrosis factor-alpha inhibitor users. Therefore, it may be rational to examine the thyroid gland while administering Tumor necrosis factor-alpha inhibitor treatment in axial spondyloarthritis patients.

Bladder ultrasound: evidence of content validity of a checklist for training nurses.

OBJECTIVES: to develop and analyze evidence of content validity of a checklist for training nurses in measuring bladder volume through ultrasound. METHODS: a methodological study, consisting of three stages: literature review; instrument item preparation; and analysis of evidence of content validity. The Content Validity Index (CVI) and Gwet's AC2 were used for content validity analyses. RESULTS: the checklist consisted of 23 items. The CVIs for clarity, relevance and dimensionality were 0.99, 0.99 and 0.98 respectively, and the CVIs for Gwet's AC2 with coefficients for clarity, relevance and dimensionality were 0.89, 0.97 and 0.95, respectively, with p<0.001. CONCLUSIONS: the checklist developed for training nurses in measuring bladder volume through ultrasound achieved adequate evidence of content validity, and can be used to train nurses in clinical practice and future research.

APENDIC-RADS: an ultrasound reporting system for the diagnosis of acute appendicitis.

OBJECTIVE: Abdominal ultrasonography is widely used to evaluate suspected cases of appendicitis. Objective descriptions of the direct and indirect signs of appendicitis result in varied assessments of its likelihood. This study introduces the Appendix Imaging Reporting and Data System (APENDIC-RADS) to standardize the reporting of appendix ultrasound findings. METHODS: This single-center retrospective study included consecutive patients of all ages who underwent abdominal ultrasonography for the investigation of acute appendicitis. The primary outcome was histopathological confirmation of acute appendicitis post-surgery. The imaging findings were classified into five categories: APENDIC-RADS 0, where the appendix cannot be visualized; APENDIC-RADS 1, indicating a normal appendix; APENDIC-RADS 2, describing an appendix that is likely normal but only partially visualized; APENDIC-RADS 3, appendicitis cannot be ruled out due to uncertain features and APENDIC-RADS 4, acute appendicitis. RESULTS: A total of 747 patients were assessed for suspected acute appendicitis using ultrasonography. Of the diagnosed patients, 52% were male, primarily exhibiting symptoms such as nausea and/or vomiting (60%), right iliac fossa pain (54%), and sudden decompression in the right iliac fossa (24%). Stratification into APENDIC-RADS categories revealed a significant variation in the incidence of acute appendicitis, with incidence rates of 4.5% for category 0 and 0.7%, 2.2%, 11.5%, and 93.5% for categories 1 to 4, respectively (p<0.001). The APENDIC-RADS showed excellent discriminative ability, evidenced by an area under the receiver operating characteristic curve of 0.950 (95%CI=0.899-1). CONCLUSION: APENDIC-RADS categorization demonstrated excellent performance in standardizing the ultrasound-determined probability of acute appendicitis. Its implementation could improve physician communication and standardization of patient management.

Point-of-care ultrasonography for diagnosis of purulent pericarditis postappendectomy: a case report.

Purulent pericarditis is rare condition in the modern era of antibiotics. However, it is a serious condition as it has an accelerated progression and is difficult to diagnose due to its nonspecific clinical presentation, resulting in high mortality. Herein, we present a case in which a 36-year-old male patient with otherwise unremarkable medical history developed abdominal sepsis complicated by purulent pericarditis post-appendectomy. While the initial clinical presentation was not compatible with the classic signs of purulent pericarditis, the diagnosis was made using electrocardiography (ST elevation/PR depression) and point-of-care ultrasonography (pericardial effusion). The condition was successfully managed with pericardial drainage and broad-spectrum antibiotics. The present case reinforces and reiterates the need for high diagnostic suspicion and careful clinical reasoning in the diagnosis of purulent pericarditis. Furthermore, it highlights the applicability of point-of-care ultrasonography in the diagnosis of the same.

The relationship between serum uric acid levels and liver stiffness in patients with type II diabetes mellitus and fatty liver disease.

OBJECTIVE: High serum uric acid levels are associated with metabolic syndrome and diabetes mellitus. Several observational studies have shown the association between metabolic dysfunction-associated fatty liver disease and high serum uric acid. However, this association is controversial due to reverse causality. We aimed to investigate the relationship between the serum uric acid level and "aspartate aminotransferase-platelet ratio index score," which noninvasively shows the possible changes of metabolic dysfunction-associated fatty liver disease in the liver in patients diagnosed with type II diabetes mellitus. METHODS: This retrospective study was conducted with a total of 94 patients, 36 females and 58 males, who were hospitalized in the gastroenterohepatology outpatient clinic and diagnosed with hepatosteatosis and type II diabetes mellitus between January 2023 and January 2024. Laboratory tests, height, weight, body mass index, presence of fatty liver disease on ultrasound, and aspartate aminotransferase-platelet ratio index scores of the patients were examined. RESULTS: The mean serum uric acid level of the patients was 5.26±1.52 mg/dL, and the mean aspartate aminotransferase-platelet ratio index score was 0.26±0.13. The serum uric acid level was found to be associated with the hemoglobin A1c value (p=0.001; p<0.01). However, the aspartate aminotransferase-platelet ratio index scores of the patients did not show a statistically significant difference according to serum uric acid levels (p>0.05). CONCLUSION: No significant association was observed between serum uric acid and the noninvasive liver test aspartate aminotransferase-platelet ratio index score. Although a causal relationship between metabolic dysfunction-associated fatty liver disease and serum uric acid has been demonstrated in several studies, further research is needed to evaluate possible mechanisms in the liver.

Median nerve impairment in leprosy: how does it differ from the classic carpal tunnel syndrome?

BACKGROUND: Carpal tunnel syndrome (CTS) has already been described as a possible form of neural leprosy presentation. However, the median nerve can be involved in this neuropathy in proximal segments and, sometimes, with an asymmetric impairment of the digital branches. OBJECTIVE: To detail the pattern of median nerve impairment through nerve conduction study (NCS) and ultrasound evaluation. METHODS: This cross-sectional study comprises 15 primary neural leprosy (PNL) patients and 14 patients with CTS who underwent peripheral nerve ultrasonography and NCS evaluation. RESULTS: From the total, 92.8% of patients with CTS and 80% with PNL had bilateral impairment of the median nerve, with 27 nerves in each group. Considering the cross-sectional area (CSA) of the tunnel (Mt) segment, 63% of the nerves in the CTS and 74.1% in the PNL groups were found to be thickened, with an average CSA of 13.4 ± 4.4 and 12.4 ± 4.6, respectively (p = 0.18). The CSA of the proximal tunnel (Mpt) segment showed thickening in only 3.7% in the CTS group and 96.3% in the PNL (p < 0.0001), with an average of 6.6 ± 1.3 and 17.0 ± 6.7, respectively (p < 0.001). Finally, 88.9% of the nerves in the PNL group and only 7.4% in the CSA (p < 0.0001) showed a reduction in conduction velocity in the distal forearm, with an average of 41.0 ± 6.3 and 53.2 ± 5.2, respectively (p < 0.0001). CONCLUSION: The presence of neural thickening and demyelinating impairment in the segments proximal to the carpal tunnel favors the diagnosis of leprosy.

ANTECEDENTES: A síndrome do túnel do carpo (STC) já foi descrita como uma possível forma de apresentação da hanseníase neural. No entanto, o nervo mediano pode estar envolvido nesta neuropatia em segmentos proximais e, por vezes, com comprometimento assimétrico dos ramos digitais. OBJETIVO: Detalhar o padrão de comprometimento do nervo mediano através da avaliação eletroneuromiográfica e ultrassonográfica. MéTODOS: Este estudo transversal é composto por 15 pacientes com hanseníase neural primária (HNP) e 14 pacientes com STC que foram submetidos à avaliação ultrassonográfica e eletroneuromiográfica dos nervos periféricos. RESULTADOS: Do total, 92,8% dos pacientes com STC e 80% com HNP apresentaram comprometimento bilateral do nervo mediano, com 27 nervos em cada grupo. Considerando a área de secção transversa (AST) do segmento do túnel (Mt), verificou-se que 63% dos nervos com STC e 74,1% com PNL estavam espessados, com AST média de 13,4 ± 4,4 e 12,4 ± 4,6, respetivamente (p = 0,18). A AST do segmento do túnel proximal (Mpt) apresentou espessamento em apenas 3,7% no grupo STC e 96,3% no grupo HNP (p < 0,0001), com uma média de 6,6 ± 1,3 e 17,0 ± 6,7, respetivamente (p < 0,001). Por fim, 88,9% dos nervos do grupo PNL e apenas 7,4% do AST (p < 0,0001) apresentaram redução da velocidade de condução no antebraço distal, com média de 41,0 ± 6,3 e 53,2 ± 5,2, respetivamente (p < 0,0001). CONCLUSãO: A presença de espessamento neural e comprometimento desmielinizante nos segmentos proximais ao túnel do carpo favorece o diagnóstico de hanseníase.

Functional ultrasound and brain connectivity reveal central nervous system compromise in Trembler-J mice model of Charcot-Marie-Tooth disease.

The Charcot-Marie-Tooth-1E (CMT1E) disease is typically described as a peripheral neuropathy in humans, causing decreased nerve conduction, spastic paralysis, and tremor. The Trembler-J (TrJ) mice serve as a high fidelity model of this disease. Here, we use functional ultrasound (fUS) and functional connectivity (FC) to analyze TrJ mice's brain activity during sensory stimulation and resting state experiments against wild type (WT) mice - the healthy counterpart. fUS is an imaging technique that measures cerebral blood volume (CBV) temporal changes. We study these changes in the primary somatosensory cortex barrel field (S1BF) of both mice populations during periodic vibrissae stimulation, measuring the number of pixels that correlate to the stimulation (i.e., the size of the activation area), the average correlation of these pixels (i.e., the response strength), and the CBV's rate of change for each stimulation (i.e., the hemodynamic response). Then, we construct a FC matrix for each genotype and experiment by correlating the CBV signals from the eight cortical regions defined by the Paxinos and Franklin atlas. Our results show that TrJ mice have significantly diminished neurovascular responses and altered brain connectivity with respect to WT mice, pointing to central nervous system effects that could shift our understanding of the CMT1E disease.

Abordagem de lesões de tronco de coronária esquerda tratadas na rotina de um serviço de referência de cardiologia invasiva / Approach to left main coronary artery lesions routinely treated at an invasive cardiology reference service

INTRODUÇÃO: O tratamento percutâneo de lesões no Tronco de Coronária Esquerda (TCE) tem se demonstrado uma opção segura ao tratamento cirúrgico. O procedimento quando envolve a bifurcação, denota maior grau de complexidade e influencia a escolha da técnica, via de acesso, número de stents e utilização de imagem intracoronária para orientar o procedimento. OBJETIVO: Esse levantamento tem por objetivo reportar a taxa de abordagem percutânea de lesões de Tronco de Coronária Esquerda em um serviço de referência terciário em seus mais diversos cenários. MÉTODOS: Estudo observacional em que foi realizado levantamento de dados no período de 36 meses, entre os dias 01/03/2021 até 29/02/2024 baseado em revisão de prontuário e avaliação das imagens realizadas durante o procedimento de intervenção, em que se identificou os pacientes submetidos à ICP de Tronco da Coronária Esquerda (TCE) nos seus diversos contextos. Foi identificado as principais características relacionadas ao procedimento ­ apresentação clínica, via de acesso, técnica utilizada, taxa de utilização de método de imagem intracoronária, taxa de complicações e a taxa de óbito relacionada aos procedimentos. RESULTADOS: Foram realizados 267 procedimentos de ICP de TCE no período, dos quais 213 envolviam a bifurcação (79%). O cenário clínico mais frequentemente encontrado foi a doença coronária estável (53,9%). Em 132 casos (49%) foi utilizado algum método de imagem, em que a ultrassonografia intracoronária (USIC) foi realizada em 116 casos (88%) e a tomografia de coerência óptica (OCT) em 16 (12%). Em 42 casos houve modificação da conduta após o controle como: pós-dilatação, técnica de otimização proximal ou kissing balloon. A técnica provisional foi a estratégia inicial utilizada para a maioria dos casos de bifurcação (94%). Em 19 dos casos, houve indicação de intervenção decorrente a complicações de outros procedimentos (cateterismo diagnóstico, intervenção valvar, angioplastia de outros vasos). A taxa de óbito foi de 1,8%. CONCLUSÃO: Nessa análise, foi evidenciado um cenário de intervenção de maior complexidade, refletido na utilização considerada elevada de imagem intracoronária em relação ao demais tipos de intervenção. Apesar da maior complexidade, a via de acesso radial ainda foi a mais utilizada. O cenário clínico mais frequentemente encontrado foi a doença coronária estável. A taxa de óbitos relacionou-se à maior complexidade dos casos (SCA, bifurcação, instabilidade hemodinâmica).

Assessment of Pulmonary Congestion According to Ultrasound and Remote Dielectric Sensing (ReDS) in Patients Hospitalized With Heart Failure. / Avaliação da Congestão Pulmonar por Ultrassom e Sensoriamento Dielétrico Remoto (ReDS) em Pacientes Hospitalizados com Insuficiência Cardíaca.

BACKGROUND: The reduction of pulmonary congestion is an essential clinical target in the management of chronic heart failure. The remote dielectric sensing (ReDS) system is a recently introduced non-invasive technology used to easily estimate the degree of lung fluid volume without any expert techniques. OBJECTIVE: To conduct a comparative assessment of pulmonary congestion according to ultrasound and ReDS technology in patients hospitalized with decompensation of chronic heart failure (CHF). METHODS: The pilot single-center study included patients hospitalized with CHF decompensation. On admission and upon discharge, lung ultrasound and ReDS technology were simultaneously performed. Ultrasound of the lungs was performed according to the protocol with an assessment of 8 zones and calculation of the sum of B-lines. Pulmonary congestion was confirmed with a sum of B-lines ≥5, ReDS congestion if >35%. A p<0.05 was considered statistically significant. RESULTS: 35 patients were included in the study; 40% (n=14) were men, the average age was 71 (65.5; 78.5) years. Pulmonary congestion, according to ultrasound, was 57.1% (n=20), and according to ReDS, 62,9% (n=22). A moderate correlation was found between ReDS (%) and lung ultrasound (sum of B-lines) upon admission (Spearman correlation coefficient = 0.402; p=0.017). There was no correlation between the two methods at discharge (p=0.613). CONCLUSION: There was a moderate correlation between ReDS and lung ultrasound in relation to the detection of pulmonary congestion at admission.

FUNDAMENTO: A redução da congestão pulmonar é um alvo clínico essencial no tratamento da insuficiência cardíaca crônica (ICC). O sistema de sensoriamento dielétrico remoto ( Remote Dielectric Sensing ReDS) é uma tecnologia não invasiva recentemente introduzida, usada para estimar facilmente o grau de volume de fluido pulmonar sem nenhuma técnica especializada. OBJETIVO: Realizar uma avaliação comparativa da congestão pulmonar de acordo com a tecnologia de ultrassom e ReDS em pacientes hospitalizados com descompensação de ICC. MÉTODOS: O estudo piloto de centro único incluiu pacientes hospitalizados com descompensação de ICC. Na admissão e na alta, a ultrassonografia pulmonar e a tecnologia ReDS foram realizadas simultaneamente. A ultrassonografia dos pulmões foi realizada de acordo com o protocolo com uma avaliação de 8 zonas e cálculo da soma das linhas B. A congestão pulmonar foi confirmada com uma soma de linhas B ≥5, congestão ReDS se >35%. Um p<0,05 foi considerado estatisticamente significativo. RESULTADOS: Foram incluídos no estudo 35 pacientes; 40% (n=14) eram homens, a média de idade foi de 71 (65,5; 78,5) anos. A congestão pulmonar, segundo a ultrassonografia, foi de 57,1% (n=20), e segundo o ReDS, 62,9% (n=22). Foi encontrada correlação moderada entre o ReDS (%) e a ultrassonografia pulmonar (soma das linhas B) na admissão (coeficiente de correlação de Spearman = 0,402; p=0,017). Não houve correlação entre os dois métodos na alta (p=0,613). CONCLUSÃO: Houve correlação moderada entre ReDS e ultrassonografia pulmonar em relação à detecção de congestão pulmonar na admissão.

Relationship of female pelvic floor muscle function and body composition: cross-sectional study.

PURPOSE: Investigate the relationship between female pelvic floor muscle (PFM) function and body composition. METHODS: Cross-sectional study-participants answered sociodemographic and urogynecological questions. The amount of fat mass was measured by dual-emission X-ray densitometry (DXA), and subcutaneous fat thickness was assessed by abdominal ultrasound. PFM assessment was performed using the Modified Oxford Scale and vaginal manometry. Descriptive analysis, independent t test, spearman correlation, and univariate regression were performed. RESULTS: Ninety-nine women were included. All body composition variables evaluated, except subcutaneous fat thickness, indicated that women with a higher concentration of fat in the pelvic, android, and visceral region have lower maximum voluntary PFM contraction strength assessed by Modified Oxford Scale and manometry. The univariate model pointed out that the fat concentration increases the chances of reduced PFM strength in the entire body (0.6%), android (5.4%), visceral region (25.3%), and pelvic (89.9%). There was a correlation between the concentration of total, pelvic, and android fat with MVC/average peak. CONCLUSION: The accumulation of "total", "pelvic", "android", and "visceral" fat mass is correlated with reduction in PFM strength, and there is an association between MVC and the variables of total and segmented fat. However, pelvic fat concentration is predictive in 89.9% of cases.

Efficacy and safety of ultrasound renal denervation on office blood pressure of patients with resistant arterial hypertension: a systematic review and meta-analysis

INTRODUCTION: Resistant arterial hypertension (RAH) is one of the main causes of increased cardiovascular risk around the world. The benefits of ultrasound renal denervation (uRDN) as a non-invasive treatment are still not fully clear. AIM: We aim to demonstrate the efficacy of uRDN in reducing office blood pressure of patients in treatment for RAH. METHODS: PubMed, Embase, and Cochrane were searched for randomized trials comparing uRDN to sham or medical control groups in RAH patients undergoing renal denervation. Mean Differences (MD) with 95% confidence intervals (CIs) were calculated, and I2 statistics assessed heterogeneity. Statistical significance was set at p < 0.05. Statistical analysis was performed using R software version 4.2.3. RESULTS: It was included 5 studies with 709 patients, of which 395 (55.71%) received uRDN treatment and 314 (44.29%) in the sham group. Mean follow-up time ranged from 2 to 48 months and mean age ranged from 52.3 to 62 years. The uRDN decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) in all measures significantly, including reductions in Office SBP (MD - 4.459 mmHg; 95% CI - 7.710 to - 1.208; p = 0.007; I2 = 47%) and Office DBP (MD - 2.039 mmHg; 95% CI - 3.975 to - 0.102; p = 0.039; I2 = 27%). CONCLUSIONS: This meta-analysis highlights uRDN's superiority over the sham group in controlling SBP and DBP in RAH. However, further studies are needed to fully understand the efficacy of uRDN procedure in the management of RAH.

The optic nerve sheath in hypertensive disorders of pregnancy and perinatal outcomes: a cohort study.

BACKGROUND: Preeclampsia is implicated in 14% of maternal deaths worldwide, mostly due to complications such as intracranial hemorrhage and cerebral edema. Cerebral edema increases intracranial pressure, which can be predicted by ultrasonographic measurement of the optic nerve sheath diameter (ONSD). Greater diameters have been reported in women with preeclampsia and eclampsia; however, data are lacking on the possible association with maternal and neonatal adverse outcomes. This study aimed to determine whether there is an association between hypertensive disorders of pregnancy and the ONSD, and between this measurement and maternal and neonatal adverse outcomes. METHODS: This was a cohort study involving 183 women in the third trimester of pregnancy or within 24 h following childbirth, distributed as follows: control group (n = 30), gestational hypertension (n = 14), chronic hypertension (n = 12), preeclampsia without severe features (n = 12), preeclampsia with severe features (n = 62), superimposed preeclampsia (n = 23) and eclampsia (n = 30). The participants underwent ocular ultrasonography, and data on maternal and neonatal outcomes were collected from the medical records. To compare the groups, analysis of variance was used for the normally distributed numerical variables and the Kruskal-Wallis test was used for variables with non-normal distribution. Two-tailed p-values ≤ 0.05 were considered statistically significant. RESULTS: Overall comparison between the seven groups showed no statistically significant difference in the mean ONSD (p = 0.056). Nevertheless, diameters were significantly greater in the eclampsia group compared to the control group (p = 0.003). Greater diameters were associated with maternal admission to the intensive care unit (ICU) (p < 0.01) and maternal near miss (p = 0.01). There was no association between ONSD and admission to the neonatal ICU (p = 0.1), neonatal near miss (p = 0.34) or neonatal death (p = 0.26). CONCLUSIONS: No association was found between ONSD and the hypertensive disorders of pregnancy in the overall analysis; however, ONSD was greater in women with eclampsia compared to controls. Greater diameters were associated with maternal admission to the ICU and maternal near miss. These findings suggest a potential use for bedside ultrasound as an additional tool for stratifying risk in patients with hypertensive disorders of pregnancy.