Histological findings and NAFLD/NASH Status in liver biopsies of patients subjected to bariatric surgery

ABSTRACT Objective: To investigate nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH) and hepatic fibrosis in biopsies of people with obesity who underwent bariatric surgery and examine the possible association of different variables with a diagnosis of NAFLD and NASH. Materials and methods: Epidemiological, clinical and laboratory data from 574 individuals with obesity of both genders seen by the same physician between 2003 and 2009 who had a liver biopsy during bariatric surgery were examined. Results: Of the 437 patients included, 39.8% had some degree of liver fibrosis, 95% had a histologic diagnosis of NAFLD, and the risk factors were age ≥ 28 years and Homeostatic Model Assessment (HOMA) ≥ 2.5 (p = 0.001 and p = 0.016, respectively). In the NAFLD group, NASH was present in 26% of patients and the associated factors were aspartate aminotransferase and alanine aminotransferase index (AST/ALT) > 1, high-density lipoprotein cholesterol (HDL-c) < 40 mg/dL, total cholesterol (TC) ≥ 200 mg/dL, gamma-glutamyl transferase (GGT) > 38 U/L and triglycerides (TG) levels > 150 mg/dL. The independent risk factors were low HDL-c, elevated AST/ALT and high TG. Conclusion: The variables associated with a diagnosis of NAFLD were HOMA ≥ 2.5 and age ≥ 28 years. NASH was associated with low HDL-c, high TG and AST/ALT ≤ 1.

Ultrasound techniques for the detection of developmental dysplasia of the hip: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Developmental dysplasia of the hip (DDH) encompasses a broad spectrum of hip pathologies, including femoral or acetabular dysplasia, hip instability, or both. According to the medical literature, ultrasonography is the most reliable diagnostic method for DDH. Several techniques for the assessment of hips in newborns and infants, using ultrasonography, have been described. OBJECTIVE: To compare the accuracy of the Graf technique and other diagnostic techniques for DDH. DESIGN AND SETTING: A systematic review of studies that analyzed ultrasound techniques for the diagnosis of DDH within an evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, and LILACS databases for articles published up to May 5, 2020, relating to studies evaluating the diagnostic accuracy of different ultrasound techniques for diagnosing DDH. The QUADAS 2 tool was used for methodological quality evaluation. RESULTS: All hips were analyzed using the Graf method as a reference standard. The Morin technique had the highest rate of sensitivity, at 81.12-89.47%. The Suzuki and Stress tests showed 100% specificity. The Harcke technique showed a sensibility of 18.21% and specificity of 99.32%. CONCLUSION: All the techniques demonstrated at least one rate (sensibility and specificity) lower than 90.00% when compared to the Graf method. The Morin technique, as evaluated in this systematic review, is recommended after the Graf method because it has the highest sensitivity, especially with the three-pattern classification of 89.47%. REGISTRATION NUMBER: Identifier: CRD42020189686 at the International Prospective Register of Systematic Reviews (identifier: CRD42020189686).

Hérnia muscular: relato de caso diagnosticado pela ultrassonográfico / Muscular herniation: case report diagnosed by ultrasonography / Herniación muscular: reporte de caso diagnosticado por ultrasonografía

A hérnia muscular em extremidades é uma condição incomum e subdiagnosticada. A maioria das massas é indolor e assintomática. No entanto, em alguns casos, podem se tornar dolorosas após exercícios físicos prolongados. Neste relato de caso temos um paciente de 18 anos, queixando-se de abaulamento na perna esquerda após atividade física, com suspeita inicial de lipoma de extremidade A ultrassonografia identificou uma hernia muscular, destacando a importância de uma detecção precoce para que haja um tratamento adequado sem complicações, gastos desnecessários e diagnósticos equivocados.

Muscular hernia in extremities is an uncommon and underdiagnosed condition. Most masses are painless and asymptomatic. However, in some cases, muscle hernia can become painful after prolonged physical exercise. In this case report, we present an 18-year-old patient complaining of bulging in the left leg after physical activity, with initial suspicion of lipoma of the extremity. Ultrasonography identified a muscle hernia, highlighting the importance of early detection and leading adequate treatment without complications, unnecessary expenses, and misdiagnoses.

La hernia muscular en extremidades es una patología poco frecuente e infradiagnosticada. La mayoría de las masas son indoloras y asintomáticas. Sin embargo, en algunos casos, la hernia muscular puede volverse dolorosa después de un ejercicio físico prolongado. En este reporte de caso, presentamos a un paciente de 18 años que consulta por abultamiento en la pierna izquierda después de la actividad física, con sospecha inicial de lipoma de la extremidad. La ecografía identificó una hernia muscular, destacando la importancia de la detección temprana y conducir un tratamiento adecuado sin complicaciones, gastos innecesarios y diagnósticos erróneos.

Síndrome de Herlyn-Werner-Wunderlich com hematométrio ­ Uma associação incomum / Herlyn-Werner-Wunderlich Syndrome with hematometrium - An unusual association

Contexto: A Síndrome de Herlyn-Werner-Wunderlich (SHWW) é uma variação congênita rara, determinada pelo útero didelfo associado à hemivagina obstruída e agenesia renal ipsilateral, podendo ser associada a situs inversus ou não. Descrição do caso: Paciente do sexo feminino, de 35 anos, com dor lombar que irradia para o hipogástrio há 10 dias. A ultrassonografia de abdome total e pélvica transabdominal não visualizou o rim direito, apresentando pequena efusão líquida na pelve e útero didelfo apresentando cavidade uterina direita distendida por conteúdo hemático ­ hematométrio/hematocolpo. A ressonância magnética demonstra útero didelfo, confirmando o achado de hematométrio/hematocolpo à direita, além da agenesia renal à direita. O conjunto de achados é compatível com a SHWW. Discussão: Portadoras da SHWW costumam ser assintomáticas e têm o ciclo menstrual normal, podendo ou não ser associada a dor abdominal de caráter intermitente. Tal manifestação clínica ocorre pelo fato de apenas um corno uterino estar obstruído, fazendo com que a paciente menstrue pelo outro corno. Na suspeita diagnóstica, o padrão-ouro é a ressonância magnética. Conclusão: O atraso no diagnóstico da SHWW dificulta o tratamento e possibilita o desenvolvimento de complicações. A SHWW pode ser diagnosticada pela ultrassonografia, exame acessível e de menor custo quando comparado aos outros métodos de diagnóstico por imagem.

Comparison of ultrasonography learning between distance teaching and traditional methodology. An educational systematic review

ABSTRACT BACKGROUND: Use of the web for radiological education is an obvious application. Many computer-based teaching materials have been developed over recent years, and e-learning is becoming increasingly popular in medical schools. OBJECTIVE: To assess whether the effectiveness of distance-learning and/or e-learning, m-learning and web-based methods are equivalent to traditional methods. DESIGN AND SETTING: Systematic review of comparative studies of teaching techniques guided by Best Evidence Medical Education. METHODS: A search was carried out in the MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS online databases in April 2020, for original publications in all languages. The following MeSH terms were used: Ultrasonography; Teleradiology; Telemedicine; Education, Medical; Teaching; and Simulation Training; along with the terms e-learning, m-learning and web-based. All eligible studies were assessed using the Kirkpatrick model and Buckley's quality indicators. RESULTS: The search in the databases and a manual search resulted in 4549 articles, of which 16 had sufficient methodological quality for their inclusion. From analysis of these data, it was observed that teaching of ultrasonography using telemedicine methods is similar to the traditional method, except for venous access procedures, for which the studies did not show agreement. CONCLUSION: We found that learning via telemedicine methodologies presents great acceptance among students, besides demonstrating quality similar to the traditional method. Thus, at least at the moment, this has the capacity to serve as an important adjunct in the teaching of ultrasonography. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/CGUPA at the OPENSCIENCE Framework.

Sarcoma de alto grau de partes moles em membros inferiores ­ Diagnóstico pela ressonância magnética: relato de caso / High-grade soft tissue sarcoma of the lower limbs ­ Diagnosis by magnetic resonance imaging: case report

Contexto: Os sarcomas de partes moles de extremidades compreendem um grupo de neoplasias raras com características histopatológicas variadas. A incidência anual exata dos sarcomas de parte moles é desconhecida. Embora os tecidos mesenquimais (incluindo o tecido ósseo) contribuam com dois terços do peso corporal humano, os sarcomas representam 1% das neoplasias sólidas nos adultos e 15% na infância. Descrição do caso: Paciente do sexo masculino, 65 anos, apresentando nódulo na coxa direita, realizou ressonância magnética (RM) que detectou lesão sarcomatosa, confirmada pelo estudo anatomopatológico. Foi realizada a extração tumoral com sucesso, sem necessidade de amputação de membro inferior direito. O paciente realizou 30 sessões de radioterapia e atualmente realiza acompanhamento ambulatorial após quatro anos de cirurgia, sem evidências de lesão residual ou recidiva local. Discussão: Os sarcomas de alto grau são mais invasivos localmente e com maior propensão a metástases. Um dos maiores problemas dos sarcomas é a demora no diagnóstico. Embora tenham prognóstico pior que o sarcoma de baixo grau, o sarcoma de alto grau diagnosticado sem metástases poderá ser curado com maior facilidade. As formas mais acuradas de diagnóstico são RM e ultrassonografia. Devido ao seu alto contraste e capacidade de geração de imagens de tecidos moles superficiais e profundos, a RM está sendo cada vez mais realizada para vigilância de recorrência local e diagnóstico no sarcoma de partes moles nas extremidades. Conclusão: Os sarcomas de partes moles nos membros inferiores, muitas vezes, não são incluídos como diagnóstico diferencial inicial. Logo, quando a lesão atinge um tamanho considerável, leva a um diagnóstico tardio e perigoso.

Augmented reality in interventional radiology education: a systematic review of randomized controlled trials

ABSTRACT BACKGROUND: Augmented reality (AR) involves digitally overlapping virtual objects onto physical objects in real space so that individuals can interact with both at the same time. AR in medical education seeks to reduce surgical complications through high-quality education. There is uncertainty in the use of AR as a learning tool for interventional radiology procedures. OBJECTIVE: To compare AR with other learning methods in interventional radiology. DESIGN AND SETTING: Systematic review of comparative studies on teaching techniques. METHODS: We searched the Cochrane Library, MEDLINE, Embase, Tripdatabase, ERIC, CINAHL, SciELO and LILACS electronic databases for studies comparing AR simulation with other teaching methods in interventional radiology. This systematic review was performed in accordance with PRISMA and the BEME Collaboration. Eligible studies were evaluated using the quality indicators provided in the BEME Collaboration Guide no. 11, and the Kirkpatrick model. RESULTS: Four randomized clinical trials were included in this review. The level of educational evidence found among all the papers was 2B, according to the Kirkpatrick model. The Cochrane Collaboration tool was applied to assess the risk of bias for individual studies and across studies. Three studies showed an improvement in teaching of the proposed procedure through AR; one study showed that the participants took longer to perform the procedure through AR. CONCLUSION: AR, as a complementary teaching tool, can provide learners with additional skills, but there is still a lack of studies with a higher evidence level according to the Kirkpatrick model. SYSTEMATIC REVIEW REGISTRATION NUMBER: DOI 10.17605/OSF.IO/ACZBM in the Open Science Framework database.

Telementored ultrasonography: a narrative review

ABSTRACT BACKGROUND: Teleradiology consists of electronic transmission of radiological images from one location to another, including between countries, for interpretation and/or consultation. It is one of the most successful applications of telemedicine. Combining this methodology with ultrasound (called telesonography) can accelerate the process of making diagnoses. Despite this rationale, the quality of the evidence about the effectiveness and accuracy of teleradiology remains unknown. OBJECTIVE: To review the literature on the evidence that exists regarding use of telemedicine for ultrasound in situations of synchronous transmission. DESIGN AND SETTING: Narrative review conducted within the evidence-based health program at a federal university in São Paulo (SP), Brazil. METHODS: A search of the literature was carried out in April 2020, in the online databases MEDLINE, EMBASE, Cochrane Library, Tripdatabase, CINAHL and LILACS, for original publications in all languages. The reference lists of the studies included and the main reviews on the subject were also evaluated. RESULTS: We included ten studies that assessed procedures performed by different healthcare professionals, always with a doctor experienced in ultrasound as a distant mentor. Among these, only one study assessed disease diagnoses in relation to real patients. CONCLUSIONS: Despite the promising position of telesonography within telemedicine, no studies with reasonable methodological quality have yet been conducted to demonstrate its effectiveness.

Indications for accurate and appropriate use of personal protective equipment for healthcare professionals. A systematic review

ABSTRACT BACKGROUND: The speed of the spread of coronavirus disease 2019 (COVID-19) has put enormous pressure on hospitals and other healthcare facilities. This, together with blockages in several countries, has hindered the availability and accessibility of the necessary personal protective equipment (PPE). OBJECTIVE: To identify, systematically evaluate and summarize the available scientific evidence on the efficacy, safety, safe use and reuse of PPE for healthcare professionals, for preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN AND SETTING: Systematic review of studies analyzing products for disinfecting and enabling reuse of PPE for coronavirus within the evidence-based health program of a federal university in São Paulo (SP), Brazil. METHODS: A systematic search of the relevant literature was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, SCOPUS, Web of Science and LILACS databases, for articles published up to November 30, 2020. RESULTS: Ten studies were selected. These analyzed the use of N95, surgical and cotton masks, face shields, flexible enclosures with plastic covers or polycarbonate intubation boxes and plastic curtains; and also PPE disinfection using several substances. CONCLUSION: Combined use of a face shield with a N95 mask proved to be superior to other associations for protecting healthcare workers. Some products are useful for disinfecting PPE, such as 70% ethanol, 0.1% sodium hypochlorite and a mixture of quaternary ammonium and H2O2, and hydrogen peroxide. Ultraviolet light and dry heat at 70 °C can be used to decontaminate N95 masks. REGISTRATION NUMBER: DOI: 10.17605/OSF.IO/4V5FD at the OPENSCIENCE Framework.