Testosterone Therapy and Diaphragm Performance in a Male Patient with COVID-19: A Case Report.

Low levels of testosterone may lead to reduced diaphragm excursion and inspiratory time during COVID-19 infection. We report the case of a 38-year-old man with a positive result on a reverse transcriptase-polymerase chain reaction test for SARS-CoV-2, admitted to the intensive care unit with acute respiratory failure. After several days on mechanical ventilation and use of rescue therapies, during the weaning phase, the patient presented dyspnea associated with low diaphragm performance (diaphragm thickness fraction, amplitude, and the excursion-time index during inspiration were 37%, 1.7 cm, and 2.6 cm/s, respectively) by ultrasonography and reduced testosterone levels (total testosterone, bioavailable testosterone and sex hormone binding globulin (SHBG) levels were 9.3 ng/dL, 5.8 ng/dL, and 10.5 nmol/L, respectively). Testosterone was administered three times 2 weeks apart (testosterone undecanoate 1000 mg/4 mL intramuscularly). Diaphragm performance improved significantly (diaphragm thickness fraction, amplitude, and the excursion-time index during inspiration were 70%, 2.4 cm, and 3.0 cm/s, respectively) 45 and 75 days after the first dose of testosterone. No adverse events were observed, although monitoring was required after testosterone administration. Testosterone replacement therapy led to good diaphragm performance in a male patient with COVID-19. This should be interpreted with caution due to the exploratory nature of the study.

Royal sun medicinal mushroom Agaricus brasiliensis (higher Basidiomycetes) and the attenuation of pulmonary inflammation induced by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).

Agaricus brasiliensis currently is one of the most studied fungi because of its nutritional and therapeutic properties as an anti-inflammatory agent and an adjuvant in cancer chemotherapy. The effects of orally administered aqueous A. brasiliensis extract (14.3- and 42.9-mg doses) on parenchymal lung damage induced by carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) were observed in Wistar rats. NNK treatment induced pulmonary inflammation, but not lung cancer, in the rats. The lungs of animals treated with NNK showed a higher level of inflammation than those of the control group according to histopathologic examinations (P < 0.01) and kurtosis analysis (P < 0.001) of a global histogram generated from thoracic computed tomography scans. There was no significant difference in the alveolar and bronchial exudates between animals treated with a 14.3-mg dose of A. brasiliensis extract and the control without NNK. However, a significant difference was found between animals treated with NNK, received a 42.9-mg dose of A. brasiliensis (P < 0.05), and the controls not treated with NNK. We did not observe a significant difference between the kurtoses of the A. brasiliensis (14.3 mg) and control groups. However, a 42.9-mg dose of A. brasiliensis resulted in lower kurtosis values than those observed in the control group (P < 0.001). In conclusion, a low dose of A. brasiliensis was more effective in attenuating pulmonary inflammation. Similar to the histopathological results, the computed tomography scans also showed a protective effect of A. brasiliensis at the lower dose, which prevented gross pulmonary consolidation.

Relationship between the phase angle and volume of tumours in patients with lung cancer.

BACKGROUND/AIMS: The phase angle (PA) obtained by bioelectrical impedance has been used as a predictor of nutritional status in cancer. This study aimed to verify the association between the PA and tumour volume in non-small cell lung cancer (NSCLC) patients. METHODS: Volumetric determination of the tumour mass was performed using a computerised image analysis system incorporated in helical tomography. Lesion segmentation was performed by a semi-automatic process using a region growth algorithm with voxel aggregation. The PA was measured by bioelectrical impedance. RESULTS: A total of 30 male patients with a mean age of 65.6 years were evaluated. The mean values observed for body mass index, PA and tumour volume were 22.5 ± 4.19, 5.66 ± 0.9° and 163.2 ± 207.5 ml, respectively. The tumour volumes were negatively correlated with the PA (r = -0.55; p < 0.001) and positively correlated with the ratio between the extracellular mass and the body cell mass (ECM/BCM) (r = 0.59; p < 0.001). In multivariate analysis, independent predictors for both PA and ECM/BCM were tumour volume and Karnofsky performance status score. CONCLUSIONS: In NSCLC, the PA is closely associated with tumour volume, which may be important in early nutritional intervention.

High-resolution computed tomography in silicosis: correlation with chest radiography and pulmonary function tests.

OBJECTIVE: To correlate tomographic findings with pulmonary function findings, as well as to compare chest X-ray findings with high resolution computed tomography (HRCT) findings, in patients with silicosis. METHODS: A cross-sectional study was conducted in 44 non-smoking patients without a history of tuberculosis. Chest X-ray findings were classified according to the International Labour Organization recommendations. Using a semiquantitative system, the following HRCT findings were measured: the full extent of pulmonary involvement; parenchymal opacities; and emphysema. Spirometry and forced oscillation were performed. Pulmonary volumes were evaluated using the helium dilution method, and diffusing capacity of the lung for carbon monoxide (DLCO) was assessed. RESULTS: Of the 44 patients studied, 41 were male. The mean age was 48.4 years. There were 4 patients who were classified as category 0 based on X-ray findings and as category 1 based on HRCT findings. Using HRCT scans, we identified progressive massive fibrosis in 33 patients, compared with only 23 patients when X-rays were used. Opacity score was found to correlate most closely with airflow, DLCO and compliance. Emphysema score correlated inversely with volume, DLCO and airflow. In this sample of patients presenting a predominance of large opacities (75% of the individuals), the deterioration of pulmonary function was associated with the extent of structural changes. CONCLUSIONS: In the early detection of silicosis and the identification of progressive massive fibrosis, HRCT scans are superior to X-rays.

Tomografia computadorizada de alta resolução na silicose: correlação com radiografia e testes de função pulmonar / High-resolution computed tomography in silicosis: correlation with chest radiography and pulmonary function tests

OBJETIVO: Correlacionar os parâmetros tomográficos com os de função pulmonar em portadores de silicose, bem como comparar os resultados da tomografia computadorizada de alta resolução (TCAR) com os da radiografia de tórax. MÉTODOS: Foi realizado um estudo de corte transversal, em que foram avaliados 44 pacientes não-tabagistas e sem história pregressa de tuberculose. As radiografias foram classificadas de acordo com a proposta da Organização Internacional do Trabalho. Utilizando um sistema de escore semiquantitativo, os seguintes achados na TCAR foram quantificados: extensão total do envolvimento pulmonar, opacidades parenquimatosas e enfisema. Foram realizados espirometria, oscilações forçadas, avaliação dos volumes pulmonares pela técnica de diluição com hélio e medida da diffusing capacity of the lung for carbon monoxide (DLCO, capacidade de difusão do monóxido de carbono). RESULTADOS: Dos 44 pacientes estudados, 41 eram homens, com média de idade de 48,4 anos. Na análise comparativa, 4 pacientes classificados na categoria 0 pela radiografia foram reclassificados na categoria 1 pela TCAR e, enquanto a radiografia diagnosticou 23 casos de fibrose maciça progressiva, a TCAR estabeleceu esse diagnóstico em 33 doentes. Para o escore de opacidades, as maiores correlações foram observadas com as medidas de fluxo, DLCO e complacência. Já o enfisema correlacionou-se negativamente com as medidas de volume, DLCO e fluxo. Nesta amostra com predomínio de grandes opacidades (75 por cento dos indivíduos), a deterioração da função pulmonar associou-se com a extensão das alterações estruturais. CONCLUSÕES: Na silicose, a TCAR é superior à radiografia tanto na detecção precoce da doença quanto na identificação de fibrose maciça progressiva.

OBJECTIVE: To correlate tomographic findings with pulmonary function findings, as well as to compare chest X-ray findings with high resolution computed tomography (HRCT) findings, in patients with silicosis. METHODS: A cross-sectional study was conducted in 44 non-smoking patients without a history of tuberculosis. Chest X-ray findings were classified according to the International Labour Organization recommendations. Using a semiquantitative system, the following HRCT findings were measured: the full extent of pulmonary involvement; parenchymal opacities; and emphysema. Spirometry and forced oscillation were performed. Pulmonary volumes were evaluated using the helium dilution method, and diffusing capacity of the lung for carbon monoxide (DLCO) was assessed. RESULTS: Of the 44 patients studied, 41 were male. The mean age was 48.4 years. There were 4 patients who were classified as category 0 based on X-ray findings and as category 1 based on HRCT findings. Using HRCT scans, we identified progressive massive fibrosis in 33 patients, compared with only 23 patients when X-rays were used. Opacity score was found to correlate most closely with airflow, DLCO and compliance. Emphysema score correlated inversely with volume, DLCO and airflow. In this sample of patients presenting a predominance of large opacities (75 percent of the individuals), the deterioration of pulmonary function was associated with the extent of structural changes. CONCLUSIONS: In the early detection of silicosis and the identification of progressive massive fibrosis, HRCT scans are superior to X-rays.

A tomografia computadorizada de alta resolução na esclerose sistêmica / High resolution computed tomography in systemic sclerosis

Introdução: A tomografia computadorizada de alta resolução do tórax (TCAR) representa atualmente a principal técnica diagnóstica na avaliação do envolvimento pulmonar pela esclerose sistêmica (ES). Os objetivos deste estudo foram descrever os achados tomográficos e compará-los com os da radiografia de tórax. Metodologia: Foi realizado um estudo de corte transversal, em que foram avaliados 49 pacientes não tabagistas, portadores de ES. Todos os pacientes realizaram radiografia de tórax e tomografia computadorizada de alta resolução (TCAR). Os seguintes achados tomográficos foram avaliados: opacidades em vidro fosco, infiltrado reticular, faveolamento, bronquiectasias de tração, envolvimento pleural e linfonodomegalias mediastinais. Resultados: Dos 49 pacientes estudados, 47 eram mulheres, com média de idade de 47,2 anos. Foram observadas alterações intersticiais em 42 (85,7%) das TCAR, enquanto 32 (65,3%) das radiografias de tórax se apresentavam alteradas. Os achados mais freqüentes à TCAR foram: infiltrado reticular (85,7%) e bronquiectasias de tração (57,1%). A radiografia convencional do tórax e a TCAR demonstraram o faveolamento em 11 (22,4%) e 26 (53,1%) casos, respectivamente. Houve boa concordância entre os dois métodos na capacidade de mostrar esse tipo de anormalidade (φ = 0,51; p<0,001). Conclusão: A ES acarreta fibrose pulmonar na maioria dos pacientes. A TCAR é mais sensível que a radiografia de tórax para a investigação do envolvimento intersticial nesta doença.

Fibrose pulmonar idiopática: comparação de dados clínicos e funcionais em pacientes com e sem faveolamento / Idiopathic pulmonary fibrosis: comparison of clinical and functional findings in patients with anda without honeycombing

Introdução: faveolamento é um importante fator preditivo de mortalidade na fibrose pulmonar idiopática (FPI). O objetivo deste estudo foi comparar os achados clínicos e funcionais em pacientes com e sem faveolamento. Metodologia: foi realizado um estudo de corte transversal, em que foram avaliados 41 pacientes não tabagistas, portadores de FPI. Todos os pacientes responderam um questionário padronizado (incluindo avaliação de tempo de sintomas e dispnéia) e realizaram radiografia de tórax, tomografia computadorizada de alta resolução (TCAR), espirometria, oscilações forçadas, diluição com hélio e difusão com monóxido de carbono (DCO). Para uma análise mais específica das radiografias e dos exames de TCAR, os pacientes foram divididos em dois grupos: grupo A (presença de faveolamento) e grupo B (ausência de faveolamento). Resultados: dos 41 pacientes estudados, 26 eram mulheres e 15 eram homens, com média de idade de 70,8 anos. A radiografia convencional do tórax e a TCAR demonstraram o faveolamento em 26 e 34 casos, respectivamente. Houve razoável concordância entre os dois métodos na capacidade de mostrar esse tipo de anormalidade (φ=0,59; p<0,001). Foram observadas diferenças significativas na complacência dinâmica do sistema respiratório (Crs,dyn), DCO e capacidade pulmonartotal (CPT) entre os pacientes com e sem faveolamento, tanto na radiografia convencional do tórax quanto na TCAR. Para as variáveis clínicas, apenas a dispnéia associou-se ao grupo com faveolamento na radiografia de tórax. Conclusão: em portadores de FPI, os parâmetros funcionais refletem a intensidade do processo morfológico subjacente mais acuradamente queas manifestações clínicas da doença.

A tomografia computadorizada de alta resolução na sarcoidose pulmonar / The high resolution computed tomography in pulmonary sarcoidosis

Introdução: a tomografia computadorizada de alta resolução (TCAR) representa atualmente a principal técnica diagnóstica na avaliação da sarcoidose pulmonar. Os objetivos deste estudo foram descrever os achados tomográficos e compará-los com os da radiografia de tórax. Metodologia: foram estudados 32 pacientes não tabagistas portadores de sarcoidose pulmonar por meio da radiografia de tórax e TCAR. As radiografias foram classificadas em tipos 0, 1, 2, 3 ou 4. Os seguintes achados tomográficos foram avaliados: espessamento peribroncovascular, espessamento dos septos interlobulares, nódulos, micronódulos, opacidades em vidro-fosco, consolidação, faveolamento, bronquiectasias de tração e distorção estrutural. Resultados: na TCAR, os locais predominantes de lesões pulmonares foram as zonas média (68,8%) e superior (65,6%) e espessamento peribroncovascular (56,2%). Alterações pulmonares foram notadas pela TCAR em nove casos em que o parênquima aparecia normal nas radiografias. Sinais de fibrose pulmonar foram detectados pela TCAR em dois casos em que esses achados não eram visíveis nas radiografias de tórax. Conclusão: a TCAR foi significativamente mais sensível que a radiografia convencional na avaliação dos pacientes com sarcoidose pulmonar.