COVID-19 findings in chest computed tomography

SUMMARY OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.

COVID-19 findings in chest computed tomography.

OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.

Ectopic ovary with torsion: uncommon diagnosis made by ultrasound.

Ultrasound is an important diagnostic tool in inguinal hernia and in the evaluation of the contents of the hernia sac. This report presents a case in which ultrasound revealed a herniated ectopic ovary, complicated by torsion of its vascular pedicle, in the right labia majora. We also present a brief discussion of ovarian hernia, its potential complications, and the treatments available.

A ultrassonografia é uma importante ferramenta diagnóstica no quadro de hérnia inguinal e na avaliação do conteúdo do saco herniário. Neste relato será apresentado um caso com diagnóstico ultrassonográfico de ovário ectópico herniado na região do grande lábio vulvar direito, complicado com torção de seu pedículo vascular, assim como será feita uma breve discussão sobre herniação ovariana, suas complicações e tratamentos.

Ectopic ovary with torsion: uncommon diagnosis made by ultrasound / Ovário ectópico torcido: diagnóstico incomum definido por ultrassonografia

Abstract Ultrasound is an important diagnostic tool in inguinal hernia and in the evaluation of the contents of the hernia sac. This report presents a case in which ultrasound revealed a herniated ectopic ovary, complicated by torsion of its vascular pedicle, in the right labia majora. We also present a brief discussion of ovarian hernia, its potential complications, and the treatments available.

Resumo A ultrassonografia é uma importante ferramenta diagnóstica no quadro de hérnia inguinal e na avaliação do conteúdo do saco herniário. Neste relato será apresentado um caso com diagnóstico ultrassonográfico de ovário ectópico herniado na região do grande lábio vulvar direito, complicado com torção de seu pedículo vascular, assim como será feita uma breve discussão sobre herniação ovariana, suas complicações e tratamentos.

TENDINOPATHY AND OBESITY.

Introduction: Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective: To review the literature about tendinopathies and obesity association. Methods: This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results: The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion: The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.

Introdução: As tendinopatias e as fissuras em tendões respondem por 30% de todas as consultas médicas. A obesidade, que está se tornando um dos problemas de saúde pública mais prevalentes no mundo, pode estar associada com esta condição. Objetivo: Revisar a literatura acerca da associação entre obesidade e tendinopatias. Métodos: Este é um estudo exploratório e descritivo utilizando artigos em língua inglesa do portal médico Medline, do período de 2006 a 2014. Resultados: Na patogênese das tendinopatias incluem-se elementos inflamatórios, regenerativos e degenerativos que aparecem de maneira simultânea em todos os estágios da doença. O estresse mecânico sobre os tendões parece ser um dos mais importantes na promoção do processo inflamatório inicial. Todavia não é o único. Existem fatores ambientais, genéticos e metabólicos atuando de maneira ativa. Portanto, as tendinopatias em indivíduos obesos podem se dever à sobrecarga mecânica pelo excesso de peso, mas, também, pelo aumento na produção de mediadores pró-inflamatórios relacionados ao tecido adiposo, como as adipocinas. O estado pró-inflamatório existente no indivíduo obeso é conhecido como adiposopatia ou síndrome da "gordura doente". A perda de peso está associada com decréscimo das adipocinas e diminuição da sintomatologia musculoesquelética. Conclusão: A associação da obesidade com tendinopatias tem sido fundamentada em estudos recentes como os desta revisão de literatura.

TENDINOPATHY AND OBESITY / TENDINOPATIA E OBESIDADE

ABSTRACT Introduction: Tendinopathies and tendon tears account for over 30% of all musculoskeletal consultations. Obesity, which is becoming one of the world´s most prevalent public health issues, may be associated with this condition. Objective: To review the literature about tendinopathies and obesity association. Methods: This is a descriptive exploratory study using the portal Medline. Literature in English language from 2006 to 2014 were reviewed. Results: The pathogenesis of tendinopathies includes inflammatory, regenerative and degenerative processes that happen simultaneously from early to late phases of the disease. Mechanical stress upon tendons seems to be one of the most important factors to initiate the inflammatory response, but it´s not the only one that can deflagrate it: there are other extrinsic, genetic and metabolic factors that may be involved. Therefore, tendinopathies in obese patients can be due to tendon overload because of the excess of weight, but also because of increased production of pro-inflammatory mediators related to fat tissue such as adipokines. This pro-inflammatory state that obese people can suffer is known as adiposopathy, or sick fat syndrome. Weight loss is associated with decrease in adipokines and improvement of musculoskeletal symptoms. Conclusion: The relation of obesity and tendinopathies is supported by evidences of recent studies, exemplified in this review of literature.

RESUMO Introdução: As tendinopatias e as fissuras em tendões respondem por 30% de todas as consultas médicas. A obesidade, que está se tornando um dos problemas de saúde pública mais prevalentes no mundo, pode estar associada com esta condição. Objetivo Revisar a literatura acerca da associação entre obesidade e tendinopatias. Métodos: Este é um estudo exploratório e descritivo utilizando artigos em língua inglesa do portal médico Medline, do período de 2006 a 2014. Resultados: Na patogênese das tendinopatias incluem-se elementos inflamatórios, regenerativos e degenerativos que aparecem de maneira simultânea em todos os estágios da doença. O estresse mecânico sobre os tendões parece ser um dos mais importantes na promoção do processo inflamatório inicial. Todavia não é o único. Existem fatores ambientais, genéticos e metabólicos atuando de maneira ativa. Portanto, as tendinopatias em indivíduos obesos podem se dever à sobrecarga mecânica pelo excesso de peso, mas, também, pelo aumento na produção de mediadores pró-inflamatórios relacionados ao tecido adiposo, como as adipocinas. O estado pró-inflamatório existente no indivíduo obeso é conhecido como adiposopatia ou síndrome da "gordura doente". A perda de peso está associada com decréscimo das adipocinas e diminuição da sintomatologia musculoesquelética. Conclusão: A associação da obesidade com tendinopatias tem sido fundamentada em estudos recentes como os desta revisão de literatura.

Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers.

OBJECTIVE: To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations. MATERIALS AND METHODS: Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm(2) was considered to be diagnostic of carpal tunnel syndrome. RESULTS: Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel's test (p < 0.0001), Phalen's test (p < 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24). CONCLUSION: The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

OBJETIVO: Descrever a prevalência da síndrome do túnel do carpo em amostra de 200 trabalhadores hospitalares sem comorbidades conhecidas e suas associações epidemiológicas. MATERIAIS E MÉTODOS: Duzentos indivíduos foram submetidos a ultrassonografia de punhos para mensuração da área da secção transversa do nervo mediano. Eles foram questionados e examinados sobre dados epidemiológicos, índice de massa corporal, sinais e sintomas da síndrome do túnel do carpo e submetidos ao Boston carpal tunnel questionnaire (BCTQ) para avaliação da gravidade da síndrome do túnel do carpo. A área da secção transversa do nervo mediano ≥ 9 mm2 foi considerada diagnóstica de síndrome do túnel do carpo. RESULTADOS: A síndrome do túnel do carpo foi diagnosticada por ultrassonografia em 34% da amostra estudada. Foi observada associação desta síndrome com idade (p < 0,0001), parestesia (p < 0,0001), teste de Tinel (p < 0,0001), teste de Phalen (p < 0,0001), escore do BCTQ (p < 0,0001) e anos de educação formal (p < 0,0001). Anos de educação formal foi a única variável identificada como fator de risco independente para síndrome do túnel do carpo (IC 95%: 1,03 a 1,24). CONCLUSÃO: A prevalência da síndrome do túnel do carpo na amostra de trabalhadores hospitalares estudada foi 34%. O número de anos de educação formal foi o único fator de risco independente para síndrome do túnel do carpo.

Sonographic diagnosis of carpal tunnel syndrome: a study in 200 hospital workers / Diagnóstico ultrassonográfico da síndrome do túnel do carpo: um estudo em 200 trabalhadores hospitalares

AbstractObjective:To describe the prevalence of carpal tunnel syndrome in a sample of 200 healthy hospital workers, establishing the respective epidemiological associations.Materials and Methods:Two hundred individuals were submitted to wrist ultrasonography to measure the median nerve area. They were questioned and examined for epidemiological data, body mass index, carpal tunnel syndrome signs and symptoms, and submitted to the Boston carpal tunnel questionnaire (BCTQ) to evaluate the carpal tunnel syndrome severity. A median nerve area ≥ 9 mm2 was considered to be diagnostic of carpal tunnel syndrome.Results:Carpal tunnel syndrome was diagnosed by ultrasonography in 34% of the sample. It was observed the association of carpal tunnel syndrome with age (p < 0.0001), paresthesia (p < 0.0001), Tinel's test (p < 0.0001), Phalen's test (p< 0.0001), BCTQ score (p < 0.0001), and years of formal education (p < 0.0001). Years of formal education was the only variable identified as an independent risk factor for carpal tunnel syndrome (95% CI = 1.03 to 1.24).Conclusion:The prevalence of carpal tunnel syndrome in a population of hospital workers was of 34%. The number of years of formal education was the only independent risk factor for carpal tunnel syndrome.

ResumoObjetivo:Descrever a prevalência da síndrome do túnel do carpo em amostra de 200 trabalhadores hospitalares sem comorbidades conhecidas e suas associações epidemiológicas.Materiais e Métodos:Duzentos indivíduos foram submetidos a ultrassonografia de punhos para mensuração da área da secção transversa do nervo mediano. Eles foram questionados e examinados sobre dados epidemiológicos, índice de massa corporal, sinais e sintomas da síndrome do túnel do carpo e submetidos ao Boston carpal tunnel questionnaire (BCTQ) para avaliação da gravidade da síndrome do túnel do carpo. A área da secção transversa do nervo mediano ≥ 9 mm2foi considerada diagnóstica de síndrome do túnel do carpo.Resultados:A síndrome do túnel do carpo foi diagnosticada por ultrassonografia em 34% da amostra estudada. Foi observada associação desta síndrome com idade (p < 0,0001), parestesia (p < 0,0001), teste de Tinel (p < 0,0001), teste de Phalen (p < 0,0001), escore do BCTQ (p < 0,0001) e anos de educação formal (p < 0,0001). Anos de educação formal foi a única variável identificada como fator de risco independente para síndrome do túnel do carpo (IC 95%: 1,03 a 1,24).Conclusão:A prevalência da síndrome do túnel do carpo na amostra de trabalhadores hospitalares estudada foi 34%. O número de anos de educação formal foi o único fator de risco independente para síndrome do túnel do carpo.

Ultrassonografia no diagnóstico da síndrome do túnel do carpo / Ultrasonography as a tool in diagnosis of carpal tunnel syndrome

RESUMOObjetivoDeterminar a importância da ultrassonografia (US) no diagnóstico da síndrome do túnel do carpo (STC).MétodosDuzentos pacientes (400 mãos) foram submetidos a uma US do punho para medir a área do nervo mediano (ANM). Foram perguntados quanto à presença de parestesia e dor no território do nervo mediano e submetidos aos testes de Tinel e Phalen. Uma ANM > 9 mm2 foi considerada diagnóstica de STC.ResultadosO valor da ANM medida pela US foi > 9 mm2 em 27% das mãos. Foram encontrados uma boa associação com a dor (p < 0,0001), parestesia (p < 0,0001), teste de Tinel (p < 0,0001) e teste de Phalen (p < 0,0001). De acordo com os critérios clínicos para a classificação da STC da American Academy of Neurology, a ANM medida pela US teve 64,8% de sensibilidade e 77% de especificidade nessa amostra.ConclusãoA mensuração da ANM pela US é adequada e pode ser usada como primeira opção para a investigação de pacientes com STC.

ABSTRACTObjectiveWe aimed to determine the value of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS).MethodsTwo hundred patients (400 hands) were submitted to wrist US to measure median nerve area (MNA), questioning on paresthesia and pain in the median nerve territory, Tinel and Phalen maneuvers. An MNA >9 mm2 was considered diagnostic of CTS.ResultsMeasurement of MNA by US was >9 mm2 in 27% of the hands. A good association with pain (p < 0.0001), paresthesia (p < 0.0001), Tinel test (p < 0.0001) and Phalen test (p < 0.0001) was found. According to the clinical criteria for classification of CTS from American Academy of Neurology the MNA by US had 64.8% of sensibility and 77.0% of specificity in this sample.ConclusionMeasurement of MNA by US performs well and can be used as first option for the investigation of patients with CTS.

[Ultrasonography as a tool in diagnosis of carpal tunnel syndrome]. / Ultrassonografia no diagnóstico da síndrome do túnel do carpo.

OBJECTIVE: We aimed to determine the value of ultrasonography (US) in the diagnosis of carpal tunnel syndrome (CTS). METHODS: Two hundred patients (400 hands) were submitted to wrist US to measure median nerve area (MNA), questioning on paresthesia and pain in the median nerve territory, Tinel and Phalen maneuvers. An MNA > 9 mm(2) was considered diagnostic of CTS. RESULTS: Measurement of MNA by US was > 9 mm(2) in 27% of the hands. A good association with pain (p < 0.0001), paresthesia (p < 0.0001), Tinel test (p < 0.0001) and Phalen test (p < 0.0001) was found. According to the clinical criteria for classification of CTS from American Academy of Neurology the MNA by US had 64.8% of sensibility and 77.0% of specificity in this sample. CONCLUSION: Measurement of MNA by US performs well and can be used as first option for the investigation of patients with CTS.

Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery / Avaliação ultrassonográfica da síndrome do túnel do carpo antes e após cirurgia bariátrica

Objective: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods: We studied three groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work. Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers. .

Objetivo: verificar a prevalência da STC em pacientes obesos candidatos à cirurgia bariátrica comparada com a prevalência em indivíduos não obesos e em pacientes já submetidos ao procedimento cirúrgico para verificar se as medidas de perda de peso influem na prevalência e gravidade dos sintomas. Métodos: três grupos de indivíduos foram estudados: 1) candidatos à cirurgia bariátrica (pré-operatório); 2) já submetidos ao tratamento cirúrgico bariátrico (pós-operatório) e 3) grupo controle. Foram coletados dados demográficos e clínicos referentes à síndrome do túnel do carpo. Foi realizada ultrassonografia para medição da área da secção transversa do nervo mediano para o diagnóstico da síndrome. Resultados: foram incluídos 329 indivíduos (114 no grupo pré-operatório, 90 no grupo pós-operatório e 125 controles). Houve maior prevalência de parestesias quando se comparou o grupo pré-operatório com o controle (p<0,00001). Houve diminuição das parestesias (p=0,0002) e da área da secção transversa do nervo mediano (p=0.04) nos pacientes do pós-operatório, mas não houve diferença significativa na prevalência geral da síndrome do túnel do carpo. Foi observada diferença significativa entre os grupos pré e pós-operatório (p=0,05) nos indivíduos que realizavam trabalho não manual. Conclusão: houve maior prevalência da síndrome do túnel do carpo entre o grupo pré-operatório comparado com o controle, mas não se observou diferença significativa entre os grupos pré e pós-operatório no geral. Houve diferença entre os grupos pré e pós-operatório dentre os trabalhadores não manuais. .

Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery.

OBJECTIVE: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. METHODS: We studied three groups of individuals: 1) patients waiting for bariatric surgery (preoperative); 2) individuals who had already undergone the procedure (postoperative); and 3) control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. RESULTS: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls). There was a higher prevalence of paresthesias (p=0.0003), clinical tests (p=0.0083) on the preoperative group when compared with controls (p<0.00001). There were lowe levels of paresthesias (p=0.0002) and median nerve area (p=0.04) in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05) in those who performed non-manual work. CONCLUSION: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.