Background Impact of heart disease (HD) on pregnancy is significant. Objective We aimed to evaluate the feasibility of integrating screening echocardiography (echo) into the Brazilian prenatal primary care to assess HD prevalence. Methods Over 13 months, 20 healthcare workers acquired simplified echo protocols, utilizing hand-held machines (GE-VSCAN), in 22 primary care centres. Consecutive pregnant women unaware of HD underwent focused echo, remotely interpreted in USA and Brazil. Major HD was defined as structural valve abnormalities, more than mild valve dysfunction, ventricular systolic dysfunction/hypertrophy, or other major abnormalities. Screen-positive women were referred for standard echo. Results At total, 1 112 women underwent screening. Mean age was 27 ± 8 years, mean gestational age 22 ± 9 weeks. Major HD was found in 100 (9.0%) patients. More than mild mitral regurgitation was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular dysfunction in 4 (0.4%), left ventricular hypertrophy in 2 (0.2%) and suspected rheumatic heart disease in 36 (3.2%): all, with mitral valve and two with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%): RHD findings in 12 patients (all with mitral valve and two with AV disease), mitral regurgitation in 40 (14 with morphological changes, 10 suggestive of rheumatic heart disease), other AV disease in two (mild/moderate regurgitation). Conclusions Integration of echo screening into primary prenatal care is feasible in Brazil. However, the low prevalence of severe disease urges further investigations about the effectiveness of the strategy.

Introduction: Authors describe human schistosomal granuloma in late chronic phase, from the morphological and evolutionary viewpoints. Methods: The study was based on a histological analysis of two fragments obtained from a surgical biopsy of peritoneum and large intestine of a 42-year-old patient, with a pseudotumoral form mimicking a peritoneal carcinomatosis associated to the schistosomiasis hepatointestinal form. Results: Two hundred and three granulomas were identified in the pseudotumor and 27 in the intestinal biopsy, with similar morphological features, most in the late chronic phase, in fibrotic healing. A new structural classification was suggested for granulomas: zone 1 (internal), 2 (intermediate) and 3 (external). Conclusions: Regarding granuloma as a whole, we may conclude that fibrosis is likely to be controlled by different and independent mechanisms in the three zones of the granuloma. Lamellar fibrosis in zone 3 seems to be controlled by matrix mesenchymal cells (fibroblasts and myoepithelial cells) and by inflammatory exudate cells (lymphocytes, plasmocytes, neutrophils, eosinophils). Annular fibrosis in zone 2, comprising a dense fibrous connective tissue, with few cells in the advanced phase, would be controlled by epithelioid cells involving zone 1 in recent granulomas. In zone 1, replacing periovular necrosis, an initialy loose and tracery connective neoformation, housing stellate cells or with fusiform nuclei, a dense paucicellular nodular connctive tissue emerges, probably induced by fibroblasts. In several granulomas, one of the zones is missing and granuloma is represented by two of them: Z3 and Z2, Z3 and Z1 or Z2 and Z1 and, ultimately, by a scar.

We describe a schistosomal polyp in the anus of a 24-year-old patient, born in Viçosa, State of Minas Gerais, and living in Belo Horizonte, State of Minas Gerais. From 8 to 13 years of age, he swam in the rivers that bathe Viçosa. The histopathological examination has shown a lesion, lined by a keratinized squamous epithelium, ulcerated, with granulomas, centered or not by Schistosoma mansoni egg, laid, in loco, by the female present in the vascular lumen of a vein of the hemorrhoidal plexus. There was also a diffuse, nonspecific inflammation in the dermis. The patient was treated with praziquantel. Four months after the treatment, sigmoidoscopy showed a normal rectal mucosa, and negative oogram and stool tests. Ultrasound of abdomen was normal.

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Purpose Cardiac involvement seems to impact prognosis of COVID-19, being more frequent in critically ill patients. We aimed to assess the prognostic value of right ventricular (RV) and left ventricular (LV) dysfunction, evaluated by bedside echocardiography (echo), in patients hospitalized with COVID-19. Methods Patients admitted in 2 reference hospitals in Brazil from Jul to Sept/2020 with confirmed COVID-19 and moderate/severe presentations underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid-IQ), at the earliest convenience, with remote interpretation. The association between demographics, clinical comorbidities and echo variables with all-cause hospital mortality was assessed, and factors significant at p < 0.10 were put into multivariable models. Results Total 163 patients were enrolled, mean age was 64 ± 16 years, 59% were men and 107 (66%) were admitted to intensive care. Comorbidities were present in 144 (88%) patients: hypertension 115 (71%), diabetes 61 (37%) and heart failure 22 (14%). In-hospital mortality was 34% (N = 56). In univariate analysis, echo variables significantly associated with death were: LV ejection fraction (LVEF, OR = 0.94), RV fractional area change (OR = 0.96), tricuspid annular plane systolic excursion (TAPSE, OR = 0.83) and RV dysfunction (OR = 5.3). In multivariate analysis, after adjustment for clinical and demographic variables, independent predictors of mortality were age (OR = 1.05, 95%CI 1.01–1.10, p = 0.023), LVEF (OR = 0.95, 95%CI 0.91–1.00, p = 0.48) and TAPSE (OR = 0.76, 95%CI 0.63–0.91, p = 0.005). The final model had good discrimination, with C-statistic = 0.78 (95%CI 0.68–0.88). Conclusion Markers of RV and LV dysfunction assessed by bedside echo are independent predictors of mortality in hospitalized COVID-19 patients, after adjustment for clinical variables.

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Introduction: Morbidity and mortality associated with advanced heart disease (HD) is significant in Brazil. Underserved populations often experience long delays in diagnosis, with long waiting lines for echocardiography (echo). We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the Brazilian primary care (PC), and to assess HD prevalence. Methods: In 36 months, 25 healthcare workers at 40 PC units were trained on simplified handheld (GE VSCAN) echo protocols. Screening (SC) groups, including patients aged 17-20, 35-40 and 60-65 years, and patients referred (RF) for clinical indications, in waiting lines, answered a clinical questionnaire and underwent focused echo, interpreted in US and Brazil by telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion or wall-motion abnormalities. A study-derived score including clinical variables (sex, body mass, hypertension, coronary disease, heart failure, heart surgery, valve disease and Chagas disease: low (<13%), intermediate (13% - 69%) and high-risk (≥70%)) was applied to predict HD in echo screening. Results: From January 2017 to November 2019, 4425 patients underwent echo; 1338 (30%) in SC group. Mean age was 54±18 years, 63.7% were females; 57.8% had hypertension and 20.1% diabetes. The most frequent symptoms were chest pain (32.3%), dyspnea (32.3%) and palpitations (25.6%). Significant HD was found in 1409 (31.8%) patients, (28.8% in SC vs. 33.2% in RF group, p=0.004). Comparing SC to RF, severe left ventricular dysfunction was observed in 2.6% vs. 3.1%, p=0.45, severe aortic or mitral regurgitation in 1.5% vs. 1.0%, p=0.17. Prevalence was higher in high-risk patients according to the clinical score, compared to intermediate/low risk (45.3% vs. 26.6%, p<0.001). The continuous risk score was strongly associated with HD (odds ratio=25.8, 95% IC 16.5 - 40.4, p<0.001), with area under ROC curve=0.61. Conclusions: Integration of screening echo into PC is feasible in Brazil as a strategy to prioritize cardiovascular care in low income areas through task-shifting. In association with clinical variables, this tool may improve early diagnosis and referrals.

Objetivo: Explanar e discutir criticamente a importância do uso do ultrassom point-of-care (POCUS) na parada cardiorrespiratória (PCR), elucidando particularidades de sua utilização. Revisão Bibliográfica: A ocorrência de PCR apresentando-se como ritmo não chocável tem aumentado nas últimas décadas. É importante atualizar as formas de atender esses pacientes, para melhor prognóstico. O uso do POCUS nos atendimentos de PCR como ferramenta para diagnóstico e prognóstico para pacientes graves tem sido abordado nos protocolos. O uso do ultrassom pode ser considerado durante tais manobras, desde que não interfira no protocolo de ressuscitação cardiopulmonar. O POCUS pode ser utilizado principalmente para a identificação de causas reversíveis, mas há discussões sobre outras utilizações. Um argumento apresentado contra o uso do POCUS durante a PCR é que ele pode afetar adversamente a qualidade da ressuscitação cardiopulmonar. É essencial utilizar o ultrassom no momento correto e seguir rígidos protocolos. Exame físico e histórico permanecem fatores importantes na tomada de decisões, não devendo ser negligenciados. Considerações Finais: O exame mostrou-se útil para identificação de causas reversíveis de PCR, o que causa impacto no prognóstico. Além disso, mostrou outras aplicabilidades como identificação de falsos ritmos não chocáveis, avaliação da qualidade das compressões torácicas e parâmetro para cessação de esforços.