Application of artificial intelligence in predicting malignancy risk in breast masses on ultrasound / Aplicação de inteligência artificial na predição de risco de malignidade em nódulos mamários na ultrassonografia

Abstract Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Resumo Objetivo: O objetivo deste trabalho foi avaliar os resultados de um software baseado em algoritmo de inteligência artificial para predição do risco de malignidade em nódulos mamários. Materiais e Métodos: Estudo retrospectivo e unicêntrico que avaliou 555 nódulos mamários submetidos a biópsia percutânea em um centro de referência oncológico. Os achados ultrassonográficos foram classificados de acordo com o léxico do BI-RADS. As imagens foram analisadas pelo software Koios DS Breast e divididas em benigna ou provavelmente benigna, suspeita baixa ou intermediária, suspeita alta ou provavelmente maligna. O resultado histopatológico foi considerado como padrão ouro. Resultados: A média de idade das pacientes foi de 51 anos e o tamanho médio dos nódulos foi de 16 mm. A sensibilidade e a especificidade foram de 99,1% e 34,0% para o radiologista e 98,2% e 39,0% para o software, respectivamente. O valor preditivo positivo para malignidade para as categorias BIRADS foi semelhante para o radiologista e para o software. Foram identificados dois resultados falso-negativos na avaliação pelo radiologista que foram classificados como suspeitos pelo software, e quatro resultados falso-negativos na avaliação pelo software que foram classificados como suspeitos pelo radiologista. Conclusão: Na nossa amostra, o software de inteligência artificial demonstrou resultados comparáveis à avaliação pelo radiologista.

Application of artificial intelligence in predicting malignancy risk in breast masses on ultrasound.

Objective: To evaluate the results obtained with an artificial intelligence-based software for predicting the risk of malignancy in breast masses from ultrasound images. Materials and Methods: This was a retrospective, single-center study evaluating 555 breast masses submitted to percutaneous biopsy at a cancer referral center. Ultrasonographic findings were classified in accordance with the BI-RADS lexicon. The images were analyzed by using Koios DS Breast software and classified as benign, probably benign, low to intermediate suspicion, high suspicion, or probably malignant. The histological classification was considered the reference standard. Results: The mean age of the patients was 51 years, and the mean mass size was 16 mm. The radiologist evaluation had a sensitivity and specificity of 99.1% and 34.0%, respectively, compared with 98.2% and 39.0%, respectively, for the software evaluation. The positive predictive value for malignancy for the BI-RADS categories was similar between the radiologist and software evaluations. Two false-negative results were identified in the radiologist evaluation, the masses in question being classified as suspicious by the software, whereas four false-negative results were identified in the software evaluation, the masses in question being classified as suspicious by the radiologist. Conclusion: In our sample, the performance of artificial intelligence-based software was comparable to that of a radiologist.

Objetivo: O objetivo deste trabalho foi avaliar os resultados de um software baseado em algoritmo de inteligência artificial para predição do risco de malignidade em nódulos mamários. Materiais e Métodos: Estudo retrospectivo e unicêntrico que avaliou 555 nódulos mamários submetidos a biópsia percutânea em um centro de referência oncológico. Os achados ultrassonográficos foram classificados de acordo com o léxico do BI-RADS. As imagens foram analisadas pelo software Koios DS Breast e divididas em benigna ou provavelmente benigna, suspeita baixa ou intermediária, suspeita alta ou provavelmente maligna. O resultado histopatológico foi considerado como padrão ouro. Resultados: A média de idade das pacientes foi de 51 anos e o tamanho médio dos nódulos foi de 16 mm. A sensibilidade e a especificidade foram de 99,1% e 34,0% para o radiologista e 98,2% e 39,0% para o software, respectivamente. O valor preditivo positivo para malignidade para as categorias BIRADS foi semelhante para o radiologista e para o software. Foram identificados dois resultados falso-negativos na avaliação pelo radiologista que foram classificados como suspeitos pelo software, e quatro resultados falso-negativos na avaliação pelo software que foram classificados como suspeitos pelo radiologista. Conclusão: Na nossa amostra, o software de inteligência artificial demonstrou resultados comparáveis à avaliação pelo radiologista.

Pityriasis rosea-like rash after COVID-19 vaccination with Oxford-AstraZeneca: a possible trigger?

Scholars around the world have dedicated themselves to developing an effective vaccine against SARS-CoV-2. However, vaccines have produced adverse effects in some patients. We report the case of a 44-year-old man who developed a pruritic papulosquamous rash on the trunk with a characteristic pattern known as Christmas tree after receiving the first dose of the Oxford-AstraZeneca COVID-19 vaccine, similar to pityriasis rosea (PR). He had no previous symptoms of viral infection and tested negative for neutralizing antibodies (enzyme immunoassay) against COVID-19. There are few reports in the literature about the relationship between the onset of cutaneous adverse reactions and the Oxford-AstraZeneca vaccine, therefore, the dissemination of this case is of paramount importance.

Translation and validation of the Simplified Psoriasis Index (SPI) into Brazilian Portuguese

Abstract: Background: The Simplified Psoriasis Index is a tool that assesses the current severity, psychosocial impact, past history and interventions in patients with psoriasis through separate components. Two versions are available, one in which the current severity of the disease is evaluated by the patient themselves and another by the physician. Objectives: Translate the Simplified Psoriasis Index into Brazilian Portuguese and verify its validity. Methods: The study was conducted in two stages; the first stage was the translation of the instrument; the second stage was the instrument's validation. Results: We evaluated 62 patients from Complexo Hospitalar Santa Casa de Porto Alegre and Hospital Universitário de Brasília. The Simplified Psoriasis Index translated into Portuguese showed high internal consistency (Cronbach test 0.68). Study limitations: Some individuals, because of poor education, might not understand some questions of the Simplified Psoriasis Index. Conclusions: The Brazilian Portuguese version of the Simplified Psoriasis Index was validated for our population and can be recommended as a reliable instrument to assess the patients with psoriasis.

Translation and validation of the Simplified Psoriasis Index (SPI) into Brazilian Portuguese.

BACKGROUND: The Simplified Psoriasis Index is a tool that assesses the current severity, psychosocial impact, past history and interventions in patients with psoriasis through separate components. Two versions are available, one in which the current severity of the disease is evaluated by the patient themselves and another by the physician. OBJECTIVES: Translate the Simplified Psoriasis Index into Brazilian Portuguese and verify its validity. METHODS: The study was conducted in two stages; the first stage was the translation of the instrument; the second stage was the instrument's validation. RESULTS: We evaluated 62 patients from Complexo Hospitalar Santa Casa de Porto Alegre and Hospital Universitário de Brasília. The Simplified Psoriasis Index translated into Portuguese showed high internal consistency (Cronbach test 0.68). STUDY LIMITATIONS: Some individuals, because of poor education, might not understand some questions of the Simplified Psoriasis Index. CONCLUSIONS: The Brazilian Portuguese version of the Simplified Psoriasis Index was validated for our population and can be recommended as a reliable instrument to assess the patients with psoriasis.

Management of complications of injectable silicone.

Soft tissue augmentation is a common procedure, and a wide variety of injectable fillers are used. Liquid injectable silicone (LIS) was the first highly popularized injectable filler. LIS is a permanent filler and can be used in the correction of facial furrows and wrinkles. Some complications are inherent to the procedure and can resolve spontaneously, such as redness, swelling, and immediate hypersensitivity reactions. Unintended reactions, such as granulomas, infections, vascular occlusion, can also follow the treatment with LIS and may appear several years after the injections. These can be difficult to manage, show little or no tendency to spontaneous resolutions, and rarely resolve completely. Injecting physicians must be aware of these potential complications caused by LIS because early medical care and treatment, including psychological support for these patients, can minimize the consequences for patients and physicians, and may also help obtaining better outcomes when treating complications.

Phaeohyphomycosis of the ungual apparatus - case report.

Phaeohyphomycosis is a disease caused by dematiaceous fungi with a worldwide geographic distribution and broad spectrum. It is most commonly found in adult individuals of both genders and all races. We report the case of a 57-year-old woman with phaeohyphomycosis in the ungual apparatus.

Phaeohyphomycosis of the ungual apparatus - Case report

Phaeohyphomycosis is a disease caused by dematiaceous fungi with a worldwide geographic distribution and broad spectrum. It is most commonly found in adult individuals of both genders and all races. We report the case of a 57-year-old woman with phaeohyphomycosis in the ungual apparatus.

Late reaction to ustekinumab infusion.

Psoriasis is a chronic inflammatory disease that directly affects the quality of life. Biologics are prescribed for patients unresponsive to conventional treatments and with severe forms of the disease. Ustekinumab is a fully human monoclonal antibody against the p40 subunit of interleukins 12/23 that is being used with satisfactory responses, achieving an improvement in the baseline Psoriasis Area and Severity Index of approximately 75% after 12 weeks of treatment. It has few side effects, including grater susceptibility to infections and development of reactions to the drug. Our report discusses a case of a cutaneous reaction to the use of ustekinumab in a 27 year-old male patient after the third dose of the medication. No similar case has been reported in the literature.

Aortic isthmus blood flow in fetuses of diabetic mothers.

OBJECTIVE: To test the hypothesis that the aortic isthmus flow index (IFI) is lower in fetuses of diabetic mothers than in fetuses of nondiabetic mothers. STUDY DESIGN: We performed a cross-sectional observational study to assess the IFI in fetuses, with (n = 13) and without (n = 37) myocardial hypertrophy, of mothers with diabetes mellitus and in fetuses of nondiabetic mothers (n = 23). Analysis of variance and Tukey test were used to assess differences among the groups. RESULTS: There were no differences in maternal or gestational age among the groups. In fetuses of diabetic mothers, the mean IFI in fetuses with myocardial hypertrophy was 1.19 ± 0.06, and in fetuses without it was 1.18 ± 0.09. The mean IFI in fetuses of nondiabetic mothers was 1.32 ± 0.07 (P < 0.001). CONCLUSIONS: The IFI in fetuses of diabetic mothers is lower than in fetuses of nondiabetic mothers, possibly as a result of a decreased left ventricular compliance.

Tropical pyomyositis in a patient with systemic lupus erythematosus and HTLV 1/2 infection.

Tropical pyomyositis (TP) is an unusual infectious disease of skeletal muscles, caused by bacteria, and often associated with immunodeficiency conditions. The involvement of deep pelvic muscles, such as the iliac muscle, is even rarer. The association of systemic lupus erythematosus (SLE) and PT is seldom reported in the literature. Because SLE involves a state of immunosuppression resulting from both the disease itself and its medicamentous treatment, SLE patients are at higher risk for developing infections, such as PT. Infection by HTLV 1/2 is increasingly identified and associated with autoimmune diseases, such as SLE. This is a case report of PT in the pelvic muscles of a female patient with SLE, chronic kidney failure, on hemodialysis, and HTLV1/2 infection, admitted to the Hospital Heliópolis, in the city of São Paulo, Brazil.

Piomiosite tropical em paciente com lúpus eritematoso sistêmico e infecção por HTLV 1/2 / Tropical pyomyositis in a patient with systemic lupus erythematosus and HTLV 1/2 infection

A piomiosite tropical (PT) é uma doença infecciosa da musculatura esquelética, de etiologia bacteriana, incomum, e muitas vezes associada a situações de imunodeficiência. O envolvimento de musculatura pélvica profunda, como o músculo ilíaco, é uma condição ainda mais incomum. A associação de lúpus eritematoso sistêmico (LES) e PT é pouco relatada na literatura. Como o LES é uma situação de imunodepressão tanto pela doença em si como pelas medicações utilizadas no seu tratamento, esses pacientes tornam-se grupo de risco para o desenvolvimento de infecções, como PT. A infecção pelo HTLV está cada vez sendo mais identificada e associada a patologias nas quais autoimunidade está implicada, como é o caso do LES. Os autores descrevem um caso de PT de localização no músculo ilíaco em paciente portadora de LES, insuficiência renal crônica, em hemodiálise, além de portadora do vírus HTLV 1/2, internada no Hospital Heliópolis, em São Paulo, Brasil.

Tropical pyomyositis (TP) is an unusual infectious disease of skeletal muscles, caused by bacteria, and often associated with immunodeficiency conditions. The involvement of deep pelvic muscles, such as the iliac muscle, is even rarer. The association of systemic lupus erythematosus (SLE) and PT is seldom reported in the literature. Because SLE involves a state of immunosuppression resulting from both the disease itself and its medicamentous treatment, SLE patients are at higher risk for developing infections, such as PT. Infection by HTLV 1/2 is increasingly identified and associated with autoimmune diseases, such as SLE. This is a case report of PT in the pelvic muscles of a female patient with SLE, chronic kidney failure, on hemodialysis, and HTLV1/2 infection, admitted to the Hospital Heliópolis, in the city of São Paulo, Brazil.

Impacto do diabetes melito na eficácia e na segurança dos stents farmacológicos: registro com até cinco anos de seguimento / Impact of diabetes mellitus in the efficacy and safety of drug-eluting stents: a five-year follow-up registry

INTRODUÇÃO: Diabéticos possuem risco aumentado para ocorrência de eventos cardiovasculares. Estudos revelam que os stents farmacológicos reduzem a reestenose e a revascularização da lesão-alvo em pacientes diabéticos e não-diabéticos. Entretanto, poucos estudos avaliam a segurança e a eficácia dos stents farmacológicos em diabéticos no longo prazo. O objetivo deste trabalho foi avaliar os desfechos clínicos tardios nessa população de alto risco. MÉTODO: No período de maio de 2002 a abril de 2007, todos os pacientes submetidos a intervenção coronária com stents farmacológicos em dois hospitais foram incluídos no estudo e acompanhados por até cinco anos. RESULTADOS: No total, 611 pacientes com média de idade de 63,5 ± 11,2 anos foram incluídos neste registro. Os diabéticos (n = 204, 33,4%) apresentaram menor proporção de pacientes do sexo masculino, maior prevalência de hipertensão arterial e insuficiência renal crônica, e menor diâmetro de referência do vaso em comparação aos não-diabéticos. Durante o seguimento, os diabéticos mostraram maior probabilidade de eventos cardíacos adversos combinados (19,7% vs. 13,4%; P = 0,04), em decorrência de óbito (7,4% vs. 2,3%; P = 0,003), infarto agudo do miocárdio (5,9% vs. 3,1%; P = 0,10) e trombose do stent definitiva/provável (3,9% vs. 1,3%; P = 0,04). A revascularização do vaso-alvo e a revascularização da lesão-alvo, entretanto, não diferiram entre os grupos (10,9% vs. 9,8%; P = 0,68 e 3,4% vs. 5,1%; P = 0,35, respectivamente). A presença de diabetes melito foi preditora independente de óbito [odds ratio (OR) 2,42; intervalo de confiança de 95% (IC 95%) 1,02-5,78; P = 0,05], mas não de trombose de stent (OR 2,41; IC 95% 0,76-7,61; P = 0,13), em nossos pacientes. CONCLUSÕES: Os resultados deste estudo demonstraram que, em pacientes submetidos a implante de stents farmacológicos, a presença de diabetes esteve associada a maiores taxas de mortalidade, infarto agudo do miocárdio e trombose do stent, comparativamente aos não-diabéticos. A presença de taxas similares de revascularização da lesão-alvo em diabéticos e não-diabéticos é promissora e sugere a eficácia da revascularização percutânea com implante de stents farmacológicos nessa população.

BACKGROUND: Diabetic patients are at high risk of recurrent coronary events. Drug eluting stents (DES) reduce restenosis and target lesion revascularization in both diabetic and non-diabetic patients. However, there are limited data on the long-term safety and efficacy of DES in diabetic patients. The objective of this study was to evaluate the long-term clinical outcome in this high risk population. METHOD: From May 2002 to April 2007, all patients undergoing coronary intervention with DES in two hospitals were included in the study and were followed-up for up to 5 years. RESULTS: A total of 611 patients with mean age of 63.5 ± 11.2 years were included in the registry. Diabetic patients (n = 204, 33.4%) included a smaller proportion of males, greater prevalence of hypertension, chronic renal failure, and smaller coronary reference diameter when compared to non-diabetic patients. During the follow-up, diabetics had a higher probability of combined adverse cardiac events (19.7% vs. 13.4%; P = 0.04), as a result of death (7.4% vs. 2.3%; P = 0.003), acute myocardial infarction (5.9% vs. 3.1%; P = 0.10) and definitive/probable stent thrombosis (3.9% vs. 1.3%; P = 0.04). Target vessel and target lesion revascularization, however, were not different between the groups (10.9% vs. 9.8%; P = 0.68 and 3.4% vs. 5.1%; P= 0.35, respectively). The presence of diabetes mellitus was an independent predictor of death [odds ratio (OR) 2.41; 95% confidence interval (95% CI) 1.02-5.78; P = 0.05) but not of stent thrombosis (OR 2.41; 95% CI 0.76-7.61; P = 0.13) in our patients. CONCLUSIONS: The outcomes of this study show that in patients undergoing DES implantation, the presence of diabetes was associated to higher mortality rates, acute myocardial infarction and stent thrombosis when compared to non-diabetics. The finding of similar target lesion revascularization rates in diabetic and non-diabetic patients is promising and suggests the efficacy of percutaneous revascularization with DES implantation in this population.

Behavior of pulmonary venous flow during fetal respiratory movements.

OBJECTIVE: To test the hypothesis that fetal pulmonary venous flow pulsatility index is lower during fetal respiratory movements than in apnea. DESIGN: Case control. SETTINGS/PATIENTS: Twenty-two normal fetuses of mothers without systemic disease were examined in apnea (controls) and in the presence of fetal respiratory movements (cases). Fetuses were examined by prenatal Doppler echocardiography with color flow mapping. The pulsatility index of the pulmonary vein was obtained by placing the pulsed Doppler sample volume over the right upper or left lower pulmonary vein, and calculating the ratio (maximum velocity [systolic or diastolic]-presystolic velocity/mean velocity). RESULTS: Mean gestational age was 28.9 +/- 2.9 weeks. During fetal apnea, mean systolic, diastolic, and presystolic velocities were, respectively, 0.35 +/- 0.08 m/s, 0.26 +/- 0.07 m/s, and 0.09 +/- 0.03 m/s. In the presence of fetal respiratory movements, mean systolic, diastolic, and presystolic velocities were, respectively, 0.33 +/- 0.1 m/s, 0.28 +/- 0.08 m/s, and 0.11 +/- 0.04 m/s. Pulsatility index pulmonary vein in apnea was 1.25 +/- 0.23 (1.69 to 0.82), and during fetal respiratory movements it was 0.97 +/- 0.2 (1.53 to 0.61). CONCLUSION: We showed a significant reduction in impedance of pulmonary venous flow, represented by pulmonary vein pulsatility index, during fetal respiratory movements, reflecting modifications of the left atrial dynamics and enhancement of left ventricular compliance.