COVID-19 pneumonia in the emergency department: correlation of initial chest CT findings with short-term outcome.

PURPOSE: Evaluate chest computed tomography (CT) findings of laboratory-confirmed Coronavirus Disease 2019 (COVID-19) cases and correlate it with clinical and laboratorial signs of severe disease and short-term outcome. METHODS: Chest CTs of 61 consecutive cases of COVID-19 disease that attended in our emergency department (ED) were reviewed. Three groups of patients classified according to the short-term follow-up were compared: (1) early-discharged from ED, (2) hospitalized on regular wards, and (3) admitted to intensive care unit (ICU). CT findings were also correlated with clinical and laboratorial features associated with severe disease. RESULTS: Median age was 52 years (IQR 39-63) with male predominance (60.7%). Most of the patients that did not require hospitalization had parenchymal involvement of less than 25% on CT (84.6%). Among hospitalized patients, interlobular septal thickening and extensive lung disease (> 50% of parenchyma) were significantly more frequent in ICU-admitted patients (P = 0.018 and P = 0.043, respectively). Interlobular septal thickening also correlated with longer ICU stay (P = 0.018). Low oxygen saturation (SpO2 ≤ 93%) was associated with septal thickening (P = 0.004), diffuse distribution (P = 0.016), and pleural effusion (P = 0.037) on CT. All patients with > 50% of parenchymal involvement showed SpO2 ≤ 93%. Elevated C-reactive protein (CRP) levels (> 5.0 mg/dL) correlated with consolidation (P = 0.002), septal thickening (P = 0.018), diffuse distribution (P = 0.020), and more extensive parenchymal involvement (P = 0.017). CONCLUSION: Interlobular septal thickening on CT was associated with ICU admission and longer stay on ICU. Diffuse distribution, septal thickening, and more extensive lung involvement correlated with lower SpO2 and higher CRP levels. Patients that needed hospitalization and ICU admission presented more extensive lung disease on CT.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. MATERIALS AND METHODS: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). RESULTS: Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. CONCLUSIONS: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Paracoccidioidomycosis in a liver transplant recipient.

Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.

Paracoccidioidomycosis in a liver transplant recipient

ABSTRACT Paracoccidioidomycosis is a granulomatous systemic mycosis that is endemic in Latin America; it is an extremely rare infection following solid organ transplantation. In this study, we describe the first report of disseminated paracoccidioidomycosis in a 3-year-old girl who underwent liver transplantation 2 years previously. The radiologic diagnosis and patient follow-up are described. In addition, we review the clinical evolution and treatment regimens for this infection.

Identificando vulnerabilidade para complicações cardiovasculares em idosos: uma estratégia para o cuidado / Identifying vulnerabilities for cardiovascular changes in the elderly: a estrategy for care / Identificando vulnerabilidad para complicaciones cardiovasculares en ancianos: uma estrategia para el cuidado

A temática deste estudo situa-se no âmbito da promoção da saúde voltada para o envelhecimento populacional, diante da prevalência dos agravos cardiovasculares. Objetivou identificar os elementos da vulnerabilidade que contribuem para complicações cardiovasculares na população idosa e caracterizar as estratégias de ação para o cuidado. Estudo descritivo e exploratório desenvolvido com 28 idosos que participaram de feiras de saúde no município do Rio de Janeiro, em 2010. Os dados foram coletados por meio de entrevista semiestruturada e submetidos à análise de conteúdo, gerando as categorias: relação dos idosos no contexto social, relação dos idosos com alterações de saúde e acesso aos recursos terapêuticos. Conclui-se que a identificação de vulnerabilidades em idosos mostrou-se como uma estratégia promissora para o cuidado e ao mesmo tempo desafiadora, pois envolve análise conjunta dos componentes individuais, sociais e programáticos, favorecendo o vínculo, o acolhimento às demandas e o atendimento das necessidades da população.

This study lies within the scope of health promotion, as the population aging process faces a raise as regards cardiovascular chronic conditions. It aimed at identifying the vulnerability elements that contribute to cardiovascular complications among the elderly, and characterizing the action strategies for care. A descriptive and exploratory study, developed with 28 elders who participated in health fairs in the municipality of Rio de Janeiro in 2010. The data were collected through partially-structured interviews, and submitted to content analysis, generating the categories: relationship of the elderly in the social context, relationship of the elderly with health changes and access to therapeutic resources. The conclusion is, the identification of vulnerabilities among the elderly posed as a promising – and challenging – strategy for care, since it involves the joint analysis of individual, social and planning components, thus enabling the connection, the fulfillment of the demands and needs of the population, and motivating care.

El tema de este estudio se radica en la promoción de la salud frente al envejecimiento de la población, dada la prevalencia de las enfermedades cardiovasculares. El objetivo fue identificar los elementos de vulnerabilidad que contribuyen para complicaciones cardiovasculares en los ancianos y caracterizar las estrategias de cuidado. Estudio descriptivo y exploratorio desarrollado con 28 ancianos que participaron en actividades de salud en la ciudad de Rio de Janeiro - Brasil en 2010. Los dados fueron colectados a través de entrevistas semiestructuradas y sometidos al análisis de contenido, generando las categorías: relación de los ancianos en el contexto social, relación de los ancianos con alteraciones de salud y acceso a los recursos terapéuticos. Se concluye que la identificación de vulnerabilidades en ancianos se reveló como una estrategia promisoria para el cuidado y al mismo tiempo desafiante por envolver análisis conjunto de los componentes individuales, sociales y programáticos, favoreciendo el vínculo, el acogimiento a las demandas y el atendimiento de las necesidades de la población.