Three Zone Scanning Protocol For Lung Ultrasound: An Anatomical Basis.

Lung ultrasound is rapidly gaining popularity based on point of care ease of use, diagnostic fidelity and lack of ionising radiation. This was particularly notable at the beginning of the COVID-19 pandemic, where concerns of contamination of the x-ray department led to a reluctance to order frequent chest x-rays. Early COVID-19 lung involvement is of a bronchopneumonia, and patches of consolidation adjacent to the chest wall were easily detectable by ultrasound. A large number of proposed scanning protocols were advocated and are often complex and largely based on traditional stethoscope examination or access points on the chest wall rather than the underlying lung anatomy. A surgical understanding of lung anatomy and related surface anatomy has led us to develop a simplified three zone scanning protocol in 2013. The anterior zone corresponds to the upper lobe, and the posterior zone is divided between upper lobe and lower lobe. The relationship between lung lobes and the surface of the chest wall provides the anatomical basis for a simple three scanning zone lung ultrasound protocol.

[Constrictive pericarditis as a serious and rare presentation of systemic lupus erythematosus: Report of one case]. / Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura.

Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery.

[Esophageal aspergillosis in a patient with acute myelogenous leukemia and febrile neutropenia]. / Aspergilosis esofágica en una paciente con leucemia mieloide aguda y neutropenia febril.

Aspergillosis usually compromises the respiratory system, but can also affect others. We report a 46 yo female with acute myeloid leukemia, developed febrile neutropenia and dysphagia. Endoscopy revealed esophageal cytomegalovirus-like ulcers, but biopsies showed Aspergillus spp. It's important to consider aspergillosis in the differential diagnosis of esophageal lesions in high-risk patients.

Impact of point-of-care ultrasound on the hospital length of stay for internal medicine inpatients with cardiopulmonary diagnosis at admission: study protocol of a randomized controlled trial-the IMFCU-1 (Internal Medicine Focused Clinical Ultrasound) study.

BACKGROUND: Point-of-care ultrasound (POCUS) is emerging as a reliable and valid clinical tool that impacts diagnosis and clinical decision-making as well as timely intervention for optimal patient management. This makes its utility in patients admitted to internal medicine wards attractive. However, there is still an evidence gap in all the medical setting of how its use affects clinical variables such as length of stay, morbidity, and mortality. METHODS/DESIGN: A prospective randomized controlled trial assessing the effect of a surface POCUS of the heart, lungs, and femoral and popliteal veins performed by an internal medicine physician during the first 24 h of patient admission to the unit with a presumptive cardiopulmonary diagnosis. The University of Melbourne iHeartScan, iLungScan, and two-point venous compression protocols are followed to identify left and right ventricular function, significant valvular heart disease, pericardial and pleural effusion, consolidation, pulmonary edema, pneumothorax, and proximal deep venous thrombosis. Patient management is not commanded by the protocol and is at the discretion of the treating team. A total of 250 patients will be recruited at one tertiary hospital. Participants are randomized to receive POCUS or no POCUS. The primary outcome measured will be hospital length of stay. Secondary outcomes include the change in diagnosis and management, 30-day hospital readmission, and healthcare costs. DISCUSSION: This study will evaluate the clinical impact of multi-organ POCUS in internal medicine patients admitted with cardiopulmonary diagnosis on the hospital length of stay. Recruitment of participants commenced in September 2018 and is estimated to be completed by March 2020. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ACTRN12618001442291. Registered on 28 August 2018.

Point-of-care lung ultrasound in the assessment of patients with COVID-19: A tutorial.

The adoption of point-of-care lung ultrasound for both suspected and confirmed COVID-19 patients highlights the issues of accessibility to ultrasound training and equipment. Lung ultrasound is more sensitive than chest radiography in detecting viral pneumonitis and preferred over computed tomography for reasons including its portability, reduced healthcare worker exposure and repeatability. The main lung ultrasound findings in COVID-19 patients are interstitial syndrome, irregular pleural line and subpleural consolidations. Consolidations are most likely found in critical patients in need of ventilatory support. Hence, lung ultrasound may be used to timely triage patients who may have evolving pneumonitis. Other respiratory pathology that may be detected by lung ultrasound includes pulmonary oedema, pneumothorax, consolidation and large effusion. A key barrier to incorporate lung ultrasound in the assessment of COVID-19 patients is adequate decontamination of ultrasound equipment to avoid viral spread. This tutorial provides a practical method to learn lung ultrasound and a cost-effective method of preventing contamination of ultrasound equipment and a practical method for performing and interpreting lung ultrasound.

Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura / Constrictive pericarditis as a serious and rare presentation of systemic lupus erythematosus: Report of one case

Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery.

[Serum homocysteine in children and adolescents. Relation with family history of cardiovascular disease]. / Homocisteína en niños y adolescentes. Relación con historia familiar de enfermedad cardiovascular.

BACKGROUND: Hyperhomocysteinemia is an independent cardiovascular risk factor that depends on folate and vitamin B12 nutrition. AIM: To measure homocysteine, folic acid and vitamin B12 serum levels in healthy children with and without a family history of cardiovascular disease. SUBJECTS AND METHODS: Forty children aged 6 to 15 years with a family history of cardiovascular disease, and 40 age and sex matched children without such history were studied. Serum homocysteine, folic acid and vitamin B12 were measured in a fasting blood sample. Homocysteine was measured by a fluorescence polarization immunoassay (FPIA), vitamin B12 by enzymatic microparticle assay, covered with intrinsic factor and folic acid by ionic capture, using commercial kits. RESULTS: Children with family history of cardiovascular disease had higher homocysteine levels than their counterparts without family history (7.9 +/- 3 and 5.8 +/- 2 mumol/l respectively, p < 0.03), but similar folic acid (5.2 +/- 1.8 and 5.5 +/- 1.4 pg/ml respectively) and vitamin B12 levels (431 +/- 213 and 445 +/- 209 ng/ml respectively). There was a negative and significant correlation between homocysteine and folic acid and vitamin B12 levels. CONCLUSIONS: Children with a family history of cardiovascular disease have higher levels of serum homocysteine than those without such history, despite having similar levels of folic acid and vitamin B12.

Estudio piloto sobre uso de internet en adolescentes de Santiago: resumen / Pilot study about internet use in adolescent of santiago: summary

A partir del año 2006, el equipo docente de la unidad de psiquiatría infanto juvenil de la Clínica psiquiátrica Universitaria de la Universidad de Chile (PCUCh) introduce en el programa de formación de los especialistas el desarrollo de un trabajo de investigación a realizarse en el periodo de los tres años de especialización, con el fin de realizar investigación clínica y aportar en el avance del entendimiento de la salud mental de los niños y adolescentes. El presente artículo muestra un marco teórico sobre la magnitud del problema y parte de los avances del trabajo de investigación realizado durante la formación. El objetivo es evaluar y caracterizar, a través de una muestra que representa de forma parcial a jóvenes pertenecientes a establecimientos educacionales de la Región Metropolitana, la penetración del uso de Internet, el perfil de su uso y la presencia de uso problemático a través de la utilización de la escala de adicción a Internet de Young. Este trabajo pretende dar inicio a una nueva área de investigación en la población chilena, ya que si bien hay estudios internacionales sobre el uso de Internet, en Chile aún no hay ninguna investigación que evalúe cómo afecta este recurso tecnológico en los adolescentes de nuestra población.

In year 2006 an academic team from the child-youth Psychiatric Unit - Psychiatric Clinic of the Universidad de Chile (PCUCh) begins an investigation in the Specialties Training Program, in order to be finished by the end of the three years of specialization. The objectives of this studies were both doing clinic research and contributing to the understanding of children and young people’s mental health. This article shows the theoretical framework concerning this issue and is a part of the work done during those years. The aim of the research is to assess and characterize the internet penetration, user profile and the presence of troubling use, measuring this last variable through Young’s Internet Addiction Scale. With a sample that partially represents young people from Region Metropolitan, the major district of Chile’s capital. This article looks forward to start a new researching topic in Chilean people, due to the fact that, even though there is some international evidence, Chilean researchers have not raise the issue before.