Initial findings in chest X-rays as predictors of worsening lung infection in patients with COVID-19: correlation in 265 patients.

BACKGROUND AND AIMS: We aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. MATERIAL AND METHODS: This retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients' comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6A, 6B, and 8) to quantify lung involvement in each patient's initial pathological chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. RESULTS: In the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (P = .009 in 6A, P = .001 in 6B, and P = .001 in 8) and with death (P = .02 in 6A, P = .01 in 6B, and P = .006 in 8). In the regression analysis, the most significant associations were 6B with alveolar involvement (OR 2.3; 95%CI 1.1.-4.7; P = .025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.-4.25; P = .046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. CONCLUSION: Moderate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first pathologic X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.

[Initial findings in chest X-rays as predictors of worsening lung infection in patients with COVID-19: correlation in 265 patients]. / Hallazgos iniciales en la radiografía de tórax como predictores de empeoramiento en la infección pulmonar por SARS-CoV-2. Correlación en 265 pacientes.

Background and aims: We aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings. Material and methods: This retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients' comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6 A, 6 B, and 8) to quantify lung involvement in each patient's initial abnormal chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings. Results: In the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (p = 0.009 in 6 A, p = 0.001 in 6 B, and p = 0.001 in 8) and with death (p = 0.02 in 6 A, p = 0.01 in 6 B, and p = 0.006 in 8). In the regression analysis, the most significant associations were 6 B with alveolar involvement (OR 2.3; 95%CI 1.1.-4.7; p = 0.025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.-4.25; p = 0.046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe. Conclusion: Moderate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first abnormal X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.

Effect of DPYD, MTHFR, ABCB1, XRCC1, ERCC1 and GSTP1 on chemotherapy related toxicity in colorectal carcinoma.

ABCB1, DPYD, MHTFR, XRCC1, ERCC1, GSTP1 and UGT1A1 genetic variants affect proteins related to CRC chemotherapy toxicity. A retrospective cohort study was conducted in 194 CRC patients. In first line treatment, DPYD rs17376848 AG genotype was associated with hematological toxicity (OR = 4.85; p = 0.03); GSTP1 G-allele (OR = 3.01; p = 0.005) and MTHFR rs1801133 T allele (OR = 2.51; p = 0.03) with respiratory toxicity; GSTP1 G-allele with cardiovascular toxicity (OR = 4.05; p = 0.01); ERCC1 rs11615 GG genotype with neurological toxicity (OR = 3.98; p = 0.01) and with asthenia (OR = 2.91; p = 0.08); XRCC1 rs1799782 T allele (OR = 0.31; p = 0.03) and GSTP1 G-allele (OR = 1.81; p = 0.01) with cutaneous toxicity. In second line treatment, XRCC1 rs1799782 T-allele was associated with asthenia (OR = 0.17; p = 0.03) and XRCC1 rs25487 T-allele with gastrointestinal toxicity (OR = 3.03; p = 0.005). After stratifying by treatment, in the 5-Fluorouracil group, the DPYD rs17376848 AG genotype was associated with hematological toxicity (OR = 2.76; p = 0.003), ABCB1 rs1045642 T-allele with the need of treatment adjustment due to toxicity (OR = 3.06; p = 0.01), and rs1045642 CC genotype with gastrointestinal toxicity (OR = 5.80; p = 0.03). In the capecitabine group, the MTHFR rs1801131 CC genotype was associated with asthenia (OR = 3.48; p = 0.009). In the oxaliplatin group, rs1045642 TT genotype was associated with the need to adjust treatment (OR = 0.32; p = 0.02), ERCC1 rs11615 GG genotype with asthenia (OR = 3.01; p = 0.01) and rs1615 GSTP1 GG genotype with respiratory toxicity (OR = 5.07; p = 0.009). ABCB1 rs1045642 T-allele reduces the need for treatment modification with both 5FU and oxaliplatin. Although several biomarkers predicted different toxic effects, they cannot be considered as risk factors for severe toxicity.

Evaluation of panoramic radiomorphometric indices related to low bone density in sickle cell disease.

SUMMARY: In sickle cell disease, erythroid hyperplasia causes trabecular destruction leading to low bone density. This condition could be suspected by the radiomorphometric indices and your diagnosis becomes relevant in a multidisciplinary context of health care for sickle cell subjects, providing prognostics and contributing to determine adequate therapeutic and preventive actions. INTRODUCTION: The aim of this study was to assess the risk of low bone density in subjects with sickle cell disease (SCD) through analysis of panoramic radiographic exams by radiomorphometric indices. METHODS: Seventy-eight Brazilian subjects with SCD took part in this study and were subdivided into four groups: (I) 31 SCD subjects aged under 40 years; (II) 13 SCD subjects aged 40 years or more; (III) 12 normal subjects aged under 40 years; and (IV) 22 normal subjects aged 40 years or more. In the panoramic radiographs, the mandibular cortical index (MCI) classification, increased spacing of the trabecular bone, panoramic mandibular index (PMI), and mental index (MI) were evaluated. Exact Fisher's test was used to compare age between the different groups. Descriptive analysis of the data was performed to evaluate the simple visual estimation of low bone density (increased bone trabecular space and MCI), and a one-way analysis of variance (Bonferroni criteria) was used to compare the means of the quantitative indices (PMI and MI). The significance level was p < 0.05. RESULTS: In the MCI classification, C2 was more prevalent, especially in groups I and IV. Increased spacing of the trabecular bone was more frequent in groups I and II. MI did not show a statistically significant difference among the groups. PMI showed a statistically significant difference only between groups III and IV. CONCLUSIONS: The radiomorphometric indices applied in the present study can be used on panoramic radiographs to detect the presence of low bone density in SCD subjects.

Analysis of magnetic resonance imaging characteristics and pain in temporomandibular joints with and without degenerative changes of the condyle.

The aim of this study was to investigate temporomandibular joint (TMJ) pain and magnetic resonance imaging characteristics in 104 TMJs with and 58 without degenerative changes of the condyle, such as osteophytes, erosion, avascular necrosis, subcondral cyst and intra-articular loose bodies. TMJ images were also assessed for flattening, retropositioning and hypomobility of condyle and disc displacement. Comparison of the TMJ side-related data showed a significant relationship between disc displacement without reduction (DDwoR) and the presence of degenerative bony changes (p=0.00). Flattening, retropositioning and hypomobility of condyle showed no significant difference in relation to the presence or absence of degenerative bony changes. Retropositioning of the condyle was significantly associated to disc displacement with reduction (DDwR) (p=0.00), while condylar hypomobility was significantly more frequent in TMJ with DDwoR (p<0.05). Independent of the presence or type of DD, TMJ pain was more frequent in the presence of degenerative bony changes. When considering only DDwR, TMJ pain was significantly associated to a degenerative condition (p=0.03). When there were no degenerative bony changes, TMJ pain was significantly more frequent in DDwoR (p=0.04). Despite the present findings, the absence of symptoms in some patients with condylar bony changes suggests that the diagnosis of osteoarthritis should be established by evaluation of magnetic resonance images in association with clinical examination.

Hemispheric specialization in partial epilepsy. Role of dichotic listening CV task and central audiological evaluation in the neuropsychological assessment.

We studied 49 patients with partial epilepsy divided into lesional cases (i.e. with lesions on CT scan) and non-lesional cases (i.e. without CT scan lesions), in relation to the Wechsler Intelligence Scale subtests (Coding, Digit span), dichotic listening CV task and Central Auditory Test (SSI, PSI). The aim of this paper was to study the hemispheric prevalence in dichotic listening task with regard to cognitive performance, as well as the presence or absence of central auditory dysfunction. Lesional cases presented a hemisphere prevalence in dichotic listening task with regard to cognitive performance, as well as the non-lesional cases tend to report the stimuli in the same side of EEG focus. Significant differences were found among the lesional and non lesional cases in relation to the digit span score and Coding subtest in right lesional cases versus right non-lesional cases. Both lesional and non-lesional group showed signs of central auditory dysfunction. We suggest that the dichotic listening and SSI and PSI test can be useful for a best comprehension of asymmetric neuropsychological performance in partial epilepsy.

The contribution of the rectus abdominis and rectus femoris in twelve selected abdominal exercises. An electromyographic study.

The influence of twelve selected abdominal exercises on the muscle action potentials (MAP) of the rectus abdominis--upper and lower portions--and rectus femoris was investigated. Twenty physical education students executed twelve exercises. The results showed that the elevation of the lower limbs from the long lying and from the forearm supported positions elicited significantly lower MAP for the upper rectus abdominis than all other exercises. Elevation of the lower limbs with the body suspended by hands and the V-sit exercises elicited significantly higher MAP for the lower rectus abdominis than all other exercises. The use of extended or flexed knees with supported or unsupported feet in a horizontal or inclined plane did not affect the MAP of the upper and lower rectus abdominis. The results for the rectus femoris showed five significantly different groups of exercises. The curl-up elicited the lowest MAP. The elevation of the lower limbs with the body suspended by hands and the sit-ups--with extended and also with flexed knees--in an inclined plane elicited the highest MAP for the rectus femoris. The results suggested that sit-ups executed with supported feet required higher MAP of the rectus femoris than sit-ups with unsupported feet, no matter whether hips and knees were extended or flexed. This trend was observed for exercises performed in an horizontal and in an inclined plane.

Auditory extinction and dichotic listening CV task in cerebral infarction: preliminary report.

Six stroke patients were studied using a dichotic listening CV task, 4 with left hemisphere infarction, 2 with right hemisphere infarction. It was observed a "lesion-effect", a shift of hemisphere prevalence to the side opposite a brain lesion. The authors suggest that the lesion-effect can be explained by the auditory extinction phenomenon at the linguistic level.

Da frequencia nistagmica do nistagmo espontaneo e semi-espontaneo em individuos normais, sindromes vestibulares perifericas e do sistema nervoso central. Pesquisa vecto-electronistagmografica. / Nystagmus frequence of spontaneous and semi-spontaneous nystagmus in normal subjects, peripheral and central nervous system vestibular syndromes. Electronystagmographic study

Foram examinados 40 individuos normais, 44 casos de sindromes vestibulares perifericas e 46 casos de sindromes do sistema nervoso central a VENG, com o objetivo de analisar a ocorrencia e o numero de batimentos do nistagmo espontaneo e semi-espontaneo. Verificou-se a ocorrencia esporadica em normais e frequente nas sindromes perifericas, so com os olhos fechados.Nas sindromes centrais a ocorrencia foi muito frequente, com os olhos fechados e/ ou abertos. Em relacao ao numero de batimentos, os valores limites encontrados em normais somente foram ultrapassados em alguns casos centrais. Ainda em relacao ao numero de batimentos, verificou-se a ausencia do efeito inibidor de fixacao ocular nos casos com nistagmo espontaneo e na maioria das posicoes cardinais do olhar, nos casos com nistagmo semi-esponaneo