Background: Aortic stenosis is a disease of the elderly people, with multiple comorbidities and often with the frailty syndrome. Therefore, we decided that frailty as a clinical factor requires precise characterization as it is a valuable supplement to the risk stratification in transcatheter aortic Valve implantation (TAVI). Objective: The aim of our study was to evaluate the prognostic value of the Katz frailty scale in patients undergoing TAVI in relation to the risk of mortality assessed with the STS scale. Material and methods: The study included 105 patients with severe aortic stenosis (AS) treated with TAVI at the Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior. In our group, the Katz frailty syndrome confirmed in all patients, and 48% in the advanced stage. Results: Statistical analysis showed a significant difference between survival and Katz frailty score before TAVI. Analysis using Coxs model confirmed a significant prognostic value for the Katz frailty syndrome before TAVI. Patients with moderate to severe frailty on the Katz score (values = 4) had a 13,68 times higher risk of death per year compared to the group with Katz frailty syndrome = 5. Multivariate regression analysis indicated that Katz frailty score and STS score were prognostically significant factors of cardiovascular death in patients undergoing TAVI. Conclusion: The Katz frailty score had a significant prognostic value in the high- and intermediate risk patients. Katz frailty score and STS risk score significantly correlated with the risk of death from cardiovascular causes in frailty patients undergoing TAVI.

Pulmonary chronic heart (CPC) is an enlargement associated or not with dilation of the right ventricle. Objective: To recall the echocardiographic-Doppler aspects essential for the screening of pulmonary chronic heart. Patients and method: Retrospective study carried out between January 2009 and April 2019 interesting the cases of pulmonary chronic heart. Results: out of 124 cases of pulmonary chronic heart, 11 cases were included. These were four men and 7 women with a mean age of 63 ± 19 years (range: 20-84 years). The radiological and electrical semiology of pulmonary chronic heart was found, lacking specificity and sensitivity. Dilation of the right heart chambers, dyskinesia of the interventricular septum and hypertrophy of the free wall of the right ventricle ? 5 mm were observed. The mean maximum velocity of tricuspid insufficiency on continuous Doppler was 4.6 ± 1.32 ms / s (Extremes: 3.59-7.58 m / s) and the mean dilation of the inferior vena cava was 23.2 ± 3.9mm (Extreme: 21.2-27mm). Conclusion: CPC is uncommon and predominant in women. The EKG and chest X-ray are first-line exams without sensitivity or specificity. Screening for CPC is based on echocardiographic-Doppler criteria. The right cardiac catheterization remains the key examination.

Objectives: To compare the adequacy of drug therapy in STEMI in public and private hospitals. Methods: Prospective analysis of 471 patients admitted with STEMI in public and private hospitals in the state of Sergipe. Results: Clopidogrel usage fee (91% vs 36% ; p < 0.001 ) and ACE inhibitors (66% vs 22 %; p < 0.001 ) was higher among SUS patients, however, use of ticagrelor (61% vs 1% ; p < 0.001 ) and BRA II (24% vs 9 %, p = 0.002 ) was higher among those treated in the private sector. In the pooled analysis, SUS patients received more IECA and/or BRA II than those with indication an absolute for its use (76% vs 30%; p < 0.001). Conclusions: A significant difference was observed in the use of ACE inhibitors and/or ARBs among patients in both groups, a higher rate of use of these drugs was showed amongst SUS patients.

A dual right coronary artery (RCA) is a very rare coronary anomaly. This anomaly is often undetected and may be totally asymptomatic to presenting as an acute coronary syndrome. Here, we present a young diabetic male who presented with acute onset severe chest pain of 30 minutes duration which was managed as an acute coronary syndrome ( NSTE-ACS). His urgent coronary angiogram revealed a single ostial origin of the right coronary artery (RCA) with total occlusion from the proximal segment followed by double right coronary arteries with their respective distal branches.

Background: COVID-19 has emerged worldwide in less than 6 months, leaving millions of deaths behind. While scientist search for new drugs, an old arsenal has been proposed as a form of treatment. Objective: This article was designed as a literature review, scrutinizing antiparasitic chloroquine, ivermectin, nitazoxanide; and also glucocorticoids, as candidates to be applied in patients with COVID-19 in some Brazilian hospitals. Methodology: clinical evidence of COVID-infected patients and literature consultation have been accomplished for the construction of this article. On line searches and gray literature have also been consulted, whose database include PUBMED Central, BVS/BIREME, Web of Science, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), Periodic Door (Portal de Periódicos da CAPES, The Cochrane Library and PROSPERO). Results: chloroquine, ivermectin and nitazoxanide do present antiviral characteristics to support their usage in phase 1 of COVID-19 symptoms. Glucocorticoids, especially methylprednisolone and dexamethasone, seem to be efficient in patients with pulmonary symptoms, such as those present in phase 2B and 3 of the disease. Conclusion: After analyzing the literature, antiparasitic agents constitute a promising approach for patients with COVID-19. However, their usage seems to be efficient in the very beginning of the symptoms. Methylprednisolone and dexamethasone are best indicated for hospitalized patients with pulmonary commitment.