Tophaceous Gout at the Popliteal Sulcus.

Teaching point: Popliteal sulcus erosion with soft tissue mass: when in doubt, think of gout.

Xanthogranulomatous and Emphysematous Pyelonephritis: Two Rare Entities Occurring in One Kidney.

Teaching point: Both xanthogranulomatous and emphysematous pyelonephritis are severe renal inflammatory disorders, occurring simultaneously in extremely rare cases.

Chest CT Diagnosis of COVID-19: Accuracy using CO-RADS and CT-Involvement Scoring.

OBJECTIVES: Both Reporting and Data System (CO-RADS) and CT-involvement scores (CTIS) have been proposed for evaluation of COVID-19 on chest CT. The purpose of this single-center, retrospective study was to evaluate both scoring systems to diagnose COVID-19 infection in a high-prevalence area. MATERIALS AND METHODS: Chest CT datasets (n = 200) and available reverse transcription polymerase chain reaction (RT-PCR) on nasopharyngeal swab were included. CT scans were assigned to four 'imaging groups' after scoring for both CO-RADS and CTIS. Diagnostic accuracy of chest CT was calculated respectively using RT-PCR and clinical diagnosis as gold standards: False-negatives and false-positives of chest CT regarding RT-PCR were studied in more depth using the medical files. RESULTS: The 'imaging group' including CO-RADS 4/5 scores reached the highest diagnostic values for COVID-19 considering either the initial RT-PCR or the final clinical diagnosis as the standard of reference: accuracies of 172/200 (86%) to 181/200 (90.5%), sensitivities of 60/80 (88.2%) to 70/79 (88.6%), specificities of 112/132 (84.9%) to 111/121 (91.7%), negative predictive values (NPV) of 112/120 (93.3%) to 111/120 (92.5%), respectively. False-negative CTs regarding RT-PCR were mainly explained by imaging very early in the disease course (5 out of 8 cases) or COVID-19 infection with no/minor respiratory symptoms (3 out of 8 cases). CONCLUSION: Assessing chest CT using CO-RADS is a valuable diagnostic approach for COVID-19 infection in a high-prevalence area, with a higher accuracy than CTIS.

Spatial mapping of city-wide PBDE levels using an exponential decay model.

Passive air samplers (PAS) consisting of polyurethane foam (PUF) disks were deployed at 6 outdoor air monitoring stations in different land use categories (commercial, industrial, residential and semi-rural) to assess the spatial distribution of polybrominated diphenyl ethers (PBDEs) in the Brisbane airshed. Air monitoring sites covered an area of ~1143 km(2) and PAS were allowed to accumulate PBDEs in the city's airshed over three consecutive seasons commencing in the winter of 2008. The average sum of five (∑(5)) PBDEs (BDEs 28, 47, 99, 100 and 209) levels were highest at the commercial and industrial sites (12.7 ± 5.2 ng PUF(-1)), which were relatively close to the city center and were a factor of 8 times higher than residential and semi-rural sites located in outer Brisbane. To estimate the magnitude of the urban 'plume' an empirical exponential decay model was used to fit PAS data vs. distance from the CBD, with the best correlation observed when the particulate bound BDE-209 was not included (∑(5)-209) (r(2) = 0.99), rather than ∑(5) (r(2) = 0.84). At 95% confidence intervals the model predicts that regardless of site characterization, ∑(5)-209 concentrations in a PAS sample taken between 4-10 km from the city centre would be half that from a sample taken from the city centre and reach a baseline or plateau (0.6 to 1.3 ng PUF(-1)), approximately 30 km from the CBD. The observed exponential decay in ∑(5)-209 levels over distance corresponded with Brisbane's decreasing population density (persons/km(2)) from the city center. The residual error associated with the model increased significantly when including BDE-209 levels, primarily due to the highest level (11.4 ± 1.8 ng PUF(-1)) being consistently detected at the industrial site, indicating a potential primary source at this site. Active air samples collected alongside the PAS at the industrial air monitoring site (B) indicated BDE-209 dominated congener composition and was entirely associated with the particulate phase. This study demonstrates that PAS are effective tools for monitoring citywide regional differences however, interpretation of spatial trends for POPs which are predominantly associated with the particulate phase such as BDE-209, may be restricted to identifying 'hotspots' rather than broad spatial trends.

Assessing dioxin precursors in pesticide formulations and environmental samples as a source of octachlorodibenzo-p-dioxin in soil and sediment.

An as yet unidentified origin of elevated concentrations of polychlorinated dibenzo-p-dioxins (PCDDs) in soil and sediment has repeatedly been described from different locations around the world, including Australia. Natural sources have been hypothesized to account for such contamination, which is characterized by a distinctive dioxin profile, in particular, elevated levels of octachlorodibenzo-p-dioxins (OCDD) as well as relatively low contributions of polychlorinated dibenzofurans (PCDFs). The present study investigated whether OCDD formation via anthropogenically derived precursors represents a possible source in such samples. Soil and sediment from Australia and Hawaii were screened for known pesticide derived dioxin precursors. Two pesticide formulations containing pentachlorophenol (PCP), which are well-known to contain predominantly OCDD impurities, were also analyzed. Polychlorinated phenoxyphenols (PCPPs), common byproducts of pesticide production, were detected at parts-per-billion (ppb) levels in two PCP formulations and in five environmental samples. Of particular interestwasthe presence of the PCPP isomer 3,4,5,6-tetrachloro-2-(2,3,4,5,6-pentachlorophenoxy)phenol (nonaC2PP), often also termed predioxin, in these samples. This compound readily undergoes ring closure to form OCDD under a range of conditions and environments. In addition, the pesticide PCP itself, which also represents a potent precursor to OCDD formation and is known to contain OCDD impurities, was detected in some environmental samples. The evidence from this study indicates that pesticides and their impurities play an important role in the dioxin contamination of Australian soils and sediments, as well as other locations with similar PCDD/F patterns. The results further suggest that formation of OCDD from pesticide derived precursors may be a possible past, present, and future pathway for contamination of environmental samples.