Predictors of prostate cancer detection in MRI PI-RADS 3 lesions - Reality of a tertiary center.

INTRODUCTION AND OBJECTIVES: The Prostate Imaging Reporting and Data System (PI-RADS) score reports the likelihood of a clinically significant prostate cancer (CsPCa) based on various multiparametric prostate magnetic resonance imaging (mpMRI) characteristics. The PI-RADS category 3 is an intermediate status, with an equivocal risk of malignancy. The PSA density (PSAD) has been proposed as a tool to facilitate biopsy decisions on PI-RADS category 3 lesions. The objective of this study is to determine the frequency of CsPCa, assess the diagnostic value of targeted biopsy and identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. METHODS: Between 1st January 2017 and 31st December 2022, a total of 1661 men underwent a prostate biopsy at our institution. Clinical and mpMRI data of men with PI-RADS 3 lesions was reviewed. The study population was divided into two groups: target group, including those submitted to systematic plus targeted biopsy versus non-target group when only systematic or saturation biopsy were performed. Patients with PI-RADS 3 lesions were divided into three categories based on pathological biopsy results: benign, clinically insignificant disease (score Gleason = 6 or International Society of Urologic Pathologic (ISUP) 1) and clinically significant cancer (score Gleason ≥ 7 (3+4) or ISUP ≥ 2) according to target and non-target group. Univariate and multivariate analyses were performed to identify clinical predictors to improve the CsPCa detection rate in PI-RADS category 3 lesions. RESULTS: A total of 130 men with PIRADS 3 index lesions were identified. Pathologic results were benign in 77 lesions (59.2%), 19 (14.6%) were clinically insignificant (Gleason score 6) and 34 (26.2%) were clinically significant (Gleason score 7 or higher). Eighty-seven of the patients were included in the target group (66.9%) and 43 in the non-target group (33.1%). The CsPCa detection was higher in the non-target group (32.6%, n = 14 vs 23.0%, n = 20 respectively). When systematic and target biopsies were jointly performed, if the results of systematic biopsies are not considered and only the results of target biopsies are taken into account, a CsPCa diagnosis would be missed on 9 patients. The differences of insignificant cancer and CsPCa rates among the target or non-target group were not statistically significant (p = 0.50 and p = 0.24, respectively). on multivariate analysis, the abnormal DRE and lesions localized in Peripheral zone (PZ) were significantly associated with a presence of CsPCa in PI-RADS 3 lesions (oR = 3.61, 95% CI [1.22,10.72], p = 0.02 and oR = 3.31, 95% CI [1.35, 8.11], p = 0.01, respectively). A higher median PSAD significantly predisposed for CsPCa on univariate analyses (p = 0.05), however, was not significant in the multivariate analysis (p = 0.76). In our population, using 0.10 ng/ml/ml as a cut-off to perform biopsy, 41 patients would have avoided biopsy (31.5%), but 5 cases of CsPCa would not have been detected (3.4%). We could not identify any statistical significance between other clinical and imagiological variables and CsPCa detection. CONCLUSIONS: PI-RADS 3 lesions were associated with a low likelihood of CsPCa detection. A systematic biopsy associated or not with target biopsy is essential in PI-RADS 3 lesions, and targeted biopsy did not demonstrate to be superior in the detection of CsPCa. The presence of abnormal DRE and lesions localized in PZ potentially predict the presence of CsPCa in biopsied PI-RADS 3 lesions.

Protocolo de transfusão maciça: experiência no atendimento ao trauma / Massive transfusion protocol: experience in trauma care

Introdução: O trauma é uma das principais causas de morte no mundo e a hemorragia é responsável por 30% a 40% da mortalidade relacionada ao trauma. O estabelecimento de um protocolo de transfusão maciça (PTM) oferece oportunidade de medidas preventivas de controle de danos ao doente com choque hemorrágico grave. Objetivo: analisar dados epidemiológicos dos pacientes submetidos ao PTM em instituição de referência em trauma. Métodos: estudo quantitativo, envolvendo pacientes submetidos ao PTM no período de janeiro a dezembro de 2018. Dados sanguíneos, identificação do paciente, local do trauma, tipo de acidente, informações clínicas e desfecho foram obtidos por meio de revisão de prontuários e informações coletadas no núcleo transfusional do hospital. A análise estatística foi feita com o programa Statistical Package for the Social Sciences (SPSS) versão 23. Resultados: 306 pacientes foram avaliados, houve predominância do sexo masculino e idade de 18 a 30 anos. 55,9% dos pacientes eram procedentes de Fortaleza. O grupo sanguíneo predominante foi O, a maioria fator Rh positivo. O tórax foi o local mais comum de trauma. A maioria dos casos foi relacionada a trauma penetrante, sendo 53,6% por armas de fogo e 8,5% por armas brancas. As medianas do Escore ABC, de concentrado de hemácias e de plasma fresco usados foram de 2. 29,7% tiveram óbito em 24 horas e apenas o local do trauma - abdome - revelou-se como fator protetor para esse desfecho. Conclusão: observou-se a inexistência de associações significativas entre as variáveis do protocolo e o desfecho clínico de óbito.

Introduction: Trauma is one of the main causes of death in the world and hemorrhage is responsible for 30% to 40% of trauma-related mortality. The establishment of a massive transfusion protocol (TMP) offers the opportunity for preventive measures to control damage to the patient with severe hemorrhagic shock. Objective: to analyze epidemiological data of patients submitted to the MTP in a trauma reference institution. Methods: this is a study retrospective with a quantitative approach, involving patients undergoing MTM from January to December 2018. Blood data, patient identification, trauma site, accident type, clinical information and outcome were obtained through review of medical records and information collected at the hospital transfusion center. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) version 23. Results: 306 patients were evaluated, there was a predominance of males and ages from 18 to 30 years. 55.9% of the patients were from Fortaleza. The predominant blood group was O, being the majority with Rh positive factor. The thorax was the most common site of trauma. Most cases were related to penetrating trauma, being 53.6% for firearms and 8.5% for white weapons. Median ABC score, concentration of red blood cells and fresh plasma used were 2. 29.7% were dead in 24 hours and only the trauma site - abdomen - was revealed as a protective factor for this outcome. Conclusion: it was observed, after completing the study, the inexistence of significant associations between the protocol variables and the clinical death outcome.

Predictors of In-Hospital Mortality after Recovered Out-of-Hospital Cardiac Arrest in Patients with Proven Significant Coronary Artery Disease: A Retrospective Study.

INTRODUCTION: Recovered Out-of-Hospital Cardiac Arrest (rOHCA) population is heterogenous. Few studies focused on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). We aimed to characterize this subgroup and study the determinants of in-hospital mortality. METHODS: Retrospective study of consecutive rOHCA patients submitted to coronary angiography. Only patients with SigCAD were included. RESULTS: 60 patients were studied, 85% were male, mean age was 62.6 ± 12.1 years. In-hospital mortality rate was 43.3%. Patients with diabetes and history of stroke were less likely to survive. Significant univariate predictors of in-hospital mortality were further analysed separately, according to whether they were present at hospital admission or developed during hospital evolution. At hospital admission, initial non-shockable rhythm, low-flow time>12min, pH<7.25mmol/L and lactates >4.75mmol/L were the most relevant predictors and therefore included in a score tested by Kaplan-Meyer. Patients who had 0/4 criteria had 100% chance of survival till hospital discharge, 1/4 had 77%, 2/4 had 50%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. During in-hospital evolution, a pH<7.35 at 24h, lactates>2mmol/L at 24h, anoxic brain injury and persistent hemodynamic instability proved significant. Patients who had 0/4 of these in-hospital criteria had 100% chance of survival till hospital discharge, 1/4 had 94%, 2/4 had 47%, 3/4 had 25%. Patients with all 4 criteria had 0% survival. Contrarily, CAD severity and ventricular dysfunction didn't significantly correlate to the outcome. CONCLUSION: Classic prehospital variables retain their value in predicting mortality in the specific group of OHCA with SigCAD. In-hospital evolution variables proved to add value in mortality prediction. Combining these simple variables in risk scores might help refining prognostic prediction in these patients's subset.

Chronic equine proliferative pododermatitis: case report / Pododermatite proliferativa crônica equina: relato de caso

Chronic equine proliferative pododermatitis (canker) is a chronic hypertrophic disease of the hoof, denoted by an excessive proliferation of the horn-producing tissues, which results from a dyskeratosis of the keratinocytes. It occurs mainly at the frog and sulci regions, but can sometimes also affect the heels, sole, bulbs or hoof wall. The etiology still remains unclear. Infectious agents such as anaerobic bacteria, viruses, spirochetes and fungi have been isolated from diseased tissues, but, moreover, an immune cause has been suggested, possibly related to a genetic predisposition. This report shows a case of a Brazilian Sport Horse, 10 years old, that had been affected on the right hindlimb for more than two years without a concise diagnosis. Success was achieved with the treatment consisting of oral prednisolone and topical Purple Mush(AU)

Pododermatite proliferativa crônica equina (cancro) é uma doença hipertrófica dos cascos, caracterizada por uma proliferação excessiva dos tecidos produtores de túbulos, o que resulta de uma disqueratose dos queratinócitos. Concentra-se principalmente na região da ranilha e seus sulcos, mas algumas vezes pode afetar também talões, bulbos, sola e parede do casco. A etiologia ainda não foi confirmada. Agentes infecciosos como bactérias anaeróbias, vírus, espiroquetas e fungos já foram isolados de tecidos afetados, mas cada vez mais uma hipótese imune vem sido discutida, possivelmente relacionada a uma predisposição genética. Este relato traz o caso de um Brasileiro de Hipismo, 10 anos, afetado no membro pélvico direito há mais de dois anos sem um diagnóstico conciso. O êxito foi obtido com o tratamento consistindo em Prednisolona oral e Purple Mush tópico.(AU)