Detection of subsolid nodules on chest CT scans during the COVID-19 pandemic.

OBJECTIVE: To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. METHODS: This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. RESULTS: A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. CONCLUSIONS: Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.

Retrospective Analysis of Subsolid Nodules' Frequency Using Chest Computed Tomography Detection in an Outpatient Population.

INTRODUCTION: The study was designed to evaluate the frequency of detection and the characteristics of subsolid nodules (SSNs) in outpatients' chest computed tomography (CT) scans from a private hospital in Southern Brazil. METHODS: A retrospective analysis of all chest CT scans was performed in adult patients from ambulatory care (non-lung cancer screening population) over a thirty-day period. Inclusion criteria were age > 18 years and lung-scanning protocols, including standard-dose high-resolution chest CT (HRCT), enhanced CT, CT angiography, and low-dose chest CT (LDCT). SSNs main features collected were mean diameter, number, density (pure or heterogenous ground glass nodules and part-solid), and localization. TheLungRADS system and the updated Fleischner Society's pulmonary nodules recommendations were used for categorization only for study purposes, although not specifically fitting the population. The presence of emphysema, as well as calcified and solid nodules were also addressed. Statistical analysis was performed using R software, categorial variables are shown as absolute or relative frequencies, and continuous variables as mean and interquartile ranges. RESULTS: Chest computed tomography were performed in 756 patients during the study period (September 2019), and 650 met the inclusion criteria. The IQR for age was 53/73 years; most participants were female (58.3%) and 10.6% had subsolid nodules detected. CONCLUSIONS: The frequency of SSNs detection in patients in daily clinical practice, not related to screening populations, is not negligible. Regardless of the final etiology, follow-up is often indicated, given the likelihood of malignancy for persistent lesions.

Detection of subsolid nodules on chest CT scans during the COVID-19 pandemic / Detecção de nódulos subsólidos na TC de tórax durante a pandemia de COVID-19

ABSTRACT Objective: To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. Methods: This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. Results: A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. Conclusions: Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.

RESUMO Objetivo: Investigar a detecção de nódulos subsólidos na TC de tórax de pacientes ambulatoriais antes e durante a pandemia de COVID-19, bem como correlacionar os achados de imagem com dados epidemiológicos. Nossa hipótese foi a de que nódulos não sólidos (pré) malignos foram subdiagnosticados durante a pandemia de COVID-19 em virtude da sobreposição de achados de imagem de nódulos subsólidos e pneumonia por COVID-19. Métodos: Estudo retrospectivo no qual foram incluídas todas as imagens de TC de tórax realizadas em pacientes ambulatoriais adultos (com idade > 18 anos) em setembro de 2019 (antes da pandemia de COVID-19) e em setembro de 2020 (durante a pandemia de COVID-19). As imagens foram reavaliadas por um radiologista torácico, e os dados epidemiológicos foram extraídos de questionários preenchidos pelos pacientes e de encaminhamentos clínicos. Modelos de regressão foram usados para controlar fatores de confusão. Resultados: Foram reavaliadas 650 e 760 imagens de TC de tórax nas amostras de 2019 e 2020, respectivamente. Foram encontrados nódulos subsólidos em 10,6% dos pacientes que compuseram a amostra de 2019 e em 7,9% daqueles que compuseram a amostra de 2020 (p = 0,10). Nódulos subsólidos múltiplos foram encontrados em 23 e 11 dos pacientes que compuseram as amostras de 2019 e 2020, respectivamente. As mulheres constituíram a maioria da população do estudo. A média de idade foi de 62,8 ± 14,8 anos na amostra de 2019 e de 59,5 ± 15,1 anos na amostra de 2020 (p < 0,01). A COVID-19 foi responsável por 24% de todos os encaminhamentos para a realização de TC em 2020. Conclusões: Foram detectados menos nódulos subsólidos na TC de tórax de pacientes ambulatoriais durante a pandemia de COVID-19 do que antes da pandemia, embora a diferença não tenha sido significativa. Além da COVID-19, a principal diferença entre as amostras de 2019 e 2020 foi o fato de que a amostra de 2020 era mais jovem. Podemos supor que menos nódulos subsólidos serão detectados numa população com maior proporção de suspeita ou diagnóstico de COVID-19.

Usefulness of radiological signs of pulmonary congestion in predicting failed spontaneous breathing trials / Utilidade de sinais radiológicos de congestão pulmonar para predizer o fracasso do teste de respiração espontânea

ABSTRACT Objective: Inspiratory fall in intrathoracic pressure during a spontaneous breathing trial (SBT) may precipitate cardiac dysfunction and acute pulmonary edema. We aimed to determine the relationship between radiological signs of pulmonary congestion prior to an SBT and weaning outcomes. Methods: This was a post hoc analysis of a prospective cohort study involving patients in an adult medical-surgical ICU. All enrolled individuals met the eligibility criteria for liberation from mechanical ventilation. Tracheostomized subjects were excluded. The primary endpoint was SBT failure, defined as the inability to tolerate a T-piece trial for 30-120 min. An attending radiologist applied a radiological score on interpretation of digital chest X-rays performed before the SBT. Results: A total of 170 T-piece trials were carried out; SBT failure occurred in 28 trials (16.4%), and 133 subjects (78.3%) were extubated at first attempt. Radiological scores were similar between SBT-failure and SBT-success groups (median [interquartile range] = 3 [2-4] points vs. 3 [2-4] points; p = 0.15), which, according to the score criteria, represented interstitial lung congestion. The analysis of ROC curves demonstrated poor accuracy (area under the curve = 0.58) of chest x-rays findings of congestion prior to the SBT for discriminating between SBT failure and SBT success. No correlation was found between fluid balance in the 48 h preceding the SBT and radiological score results (ρ = −0.13). Conclusions: Radiological findings of pulmonary congestion should not delay SBT indication, given that they did not predict weaning failure in the medical-surgical critically ill population. (ClinicalTrials.gov identifier: NCT02022839 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: A queda inspiratória da pressão intratorácica durante o teste de respiração espontânea (TRE) pode provocar disfunção cardíaca e edema pulmonar agudo. Nosso objetivo foi determinar a relação entre sinais radiológicos de congestão pulmonar antes do TRE e desfechos do desmame. Métodos: Análise post hoc de um estudo prospectivo de coorte envolvendo pacientes em uma UTI medicocirúrgica de adultos. Todos os indivíduos incluídos preencheram os critérios de elegibilidade para liberação da ventilação mecânica. Pacientes traqueostomizados foram excluídos. O desfecho primário foi o fracasso do TRE, cuja definição foi a incapacidade de tolerar o teste de tubo T durante 30-120 min. Um radiologista assistente usou um escore radiológico na interpretação de radiografias de tórax digitais realizadas antes do TRE. Resultados: Foram realizados 170 testes de tubo T; o TRE fracassou em 28 (16,4%), e 133 indivíduos (78,3%) foram extubados na primeira tentativa. Os escores radiológicos foram semelhantes nos grupos fracasso e sucesso do TRE [mediana (intervalo interquartil) = 3 (2-4) pontos vs. 3 (2-4) pontos; p = 0,15] e caracterizaram, segundo os critérios do escore, congestão pulmonar intersticial. A análise das curvas ROC revelou que os achados de congestão na radiografia de tórax antes do TRE apresentavam baixa precisão (área sob a curva = 0,58) para discriminar entre fracasso e sucesso do TRE. Não houve correlação entre o balanço hídrico nas 48 h anteriores ao TRE e os resultados do escore radiológico (ρ = −0,13). Conclusões: Achados radiológicos de congestão pulmonar não deveriam atrasar o TRE, já que não previram o fracasso do desmame na população médico-cirúrgica em estado crítico. (ClinicalTrials.gov identifier: NCT02022839 [http://www.clinicaltrials.gov/])

Avaliação dos mecanismos de defesa em pacientes com fobia social: um estudo de caso-controle / Evolution of defense mechanisms in social phobic patients: a case-control study

Diversos estudos demonstram que o conhecimento de fatores psicodinâmicos é importante na avaliação e tratamento dos transtornos psiquiátricos. O objeivo desse estudo foi avaliar os mecanismos de defesa utilizados por pacientes adultos com fobia social comparados a um grupo de controle. Material e métodos: Trata-se de um estudo de caso-controle em que 35 pacientes com fobia social e 35 controles foram avaliados através do M.I.N.I. Os mecanismos de defesa foram aferidos através do DSQ-40. Resultados: Os pacientes com fobia social usam mais frequentemente defesas neuróticas e imaturas comparadas ao grupo controle (p<0,001). As defesas mais usadas por esses pacientes foram somatização e pseudo-altruísmo, seguidas de antecipação, cisão, fantasia, anulação, sublimação, racionalização e desvalorização. Conclusão: Os pacientes com fobia social possuem um perfil de mecanismos de defesas mais mal-adaptivo camparados aos controles, o que pode dificultar o tratamento dos mesmos.

Resultado do tratamento da tuberculose com estreptomicina, isoniazida e etambutol (esquema SHM) / Results of tuberculosis treatment with streptomycin, isoniazid, and ethambutol (scheme SHM)

Objetivo: Avaliar o desempenho do esquema SHM (estreptomicina, isoniazida e etambutol), na rotina de trabalho de uma unidade ambulatorial de tratamento da tuberculose. Método: Setenta e oito pacientes tuberculosos, cujo tratamento prévio com o esquema RHZ (seis meses de rifampicina, isoniazida e pirazinamida) teve de ser interrompido devido a efeitos adversos, ou que não puderam receber o esquema RHZ por serem de alto risco para hepatotoxicidade a esse esquema, foram tratados ambulatorialmente com o esquema de 12 meses de SHM, de 1986 a 1994, em Porto Alegre, Rio Grande do Sul, Brasil. Resultados: Em três pacientes houve necessidade de troca de esquema por toxicidade (3,8 por cento). Nos 75 restantes observaram-se 58 curas (77,3 por cento), oito abandonos (10,7 por cento), cinco falências (6,7 por cento) e quatro óbitos (5,3 por cento). A taxa teórica de cura, que é o percentual de cura entre os bacilíferos que fizeram tratamento regular, foi de 95,3 por cento. Reações adversas ocorreram em 32 pacientes (41 por cento), sendo as mais freqüentes as manifestações de dano vestibular, em 18 (23,1 por cento). Esses resultados foram comparados com os obtidos no mesmo ambulatório com o esquema de 12 meses de RHM (rifampicina, isoniazida e etambutol) e de seis meses de RHZ. Conclusão: O esquema SHM pode ser recomendado como alternativa para o tratamento da tuberculose quando o esquema RHZ não pode ser indicado