Ethmoidal silent sinus syndrome after nasal swab test.

This study reported the case of a healthy male in his 40s who presented with a 3-month history of frontal headache and post-nasal drip, which did not improve with oral antibiotics. One month prior to the onset of the symptoms, he underwent a nasopharyngeal swab testing for SARS-CoV-2 (which yielded a negative result) for a history of malaise and cough. The patient claimed that the swab insertion into the nasal cavity was particularly painful on the left side. Sinus computed tomography (CT) scan showed deformity of the left middle nasal turbinate with occlusion of the osteomeatal complex, resulting in ethmoid silent sinus syndrome. This study makes a significant contribution to the literature because nasopharyngeal, midturbinate and anterior nasal swabs have been recommended as initial diagnostic specimen collection methods by the US Centers for Disease Control and Prevention (CDC) for the coronavirus disease 2019. These methods require introducing an instrument into the nasal cavity, potentially leading to adverse effects due to the delicate and complex nasal anatomy. However, complications related to swab testing for respiratory pathogens have not yet been fully discussed in the literature.

DIAGNOSTIC VALUE OF C-REACTIVE PROTEIN AND THE INFLUENCE OF VISCERAL FAT IN PATIENTS WITH OBESITY AND ACUTE APPENDICITIS.

BACKGROUND: The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. AIM: To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. METHOD: This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. RESULTS: CRP values increased according to patients' BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. CONCLUSIONS: Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.

Diagnostic value of c-reactive protein and the influence of visceral fat in patients with obesity and acute appendicitis / Valor diagnóstico da proteína c-reativa e a influência da gordura visceral em pacientes com obesidade e apendicite aguda

ABSTRACT Background: The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. Aim: To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. Method: This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. Results: CRP values increased according to patients' BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. Conclusions: Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.

RESUMO Racional: A proteína C reativa (PCR) é um dos marcadores inflamatórios com maior acurácia na apendicite aguda (AA). A obesidade leva a um estado pró-inflamatório com PCR aumentada, o que pode interferir na interpretação deste teste de laboratório na AA. Objetivo: Avaliar a sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) da PCR em pacientes com AA e sua correlação com o índice de massa corporal (IMC) e a composição da gordura corporal. Métodos: Este é um estudo retrospectivo baseado em registros clínicos e estudos de imagem de 191 indivíduos histopatologicamente confirmados com AA em comparação com 249 controles que foram submetidos à tomografia computadorizada abdominal (TC). Dados clínicos e epidemiológicos, valores de IMC e PCR foram extraídos de registros médicos. As TC foram avaliadas para achados de AA e medidas de composição corporal. Resultados: Os valores da PCR aumentaram de acordo com o IMC dos pacientes, com sensibilidade variável de 79,78% em indivíduos com IMC normal ou magro, 87,87% em excesso de peso e 93,5% em indivíduos com obesidade. Um padrão semelhante foi observado para o VPN: um aumento com o aumento do IMC, 69,3% em indivíduos com IMC normal ou magro, 84,3% em excesso de peso e 91,3% em indivíduos com obesidade. Houve uma correlação positiva entre a PCR e a área de gordura visceral em pacientes com AA. Conclusão: Existem variações quanto à sensibilidade, especificidade, VPP e valores VPN da PCR em pacientes com AA, estratificados pelo IMC. Um aumento na área de gordura visceral está associado à PCR elevada em todo o espectro do IMC.

Granular cell tumor of rectal submucosa: case report / Tumor de células granulares da submucosa rectal: relato de caso

This is a case report of granular cell tumor of rectal submucosa in a female, 35-years-old patient complaining of hematochezia. We describe the histological and immunohistochemical features of the lesion responsible by this clinical find. Following that, we present a discussion of the case based on the literature review, which allowed to proving the infrequency of the tumor in the rectal area and confirms the benign nature of the tumor in this case. (AU)

Este artigo relata o caso de um tumor de células granulares da submocosa retal, em paciente de 35 anos, com queixa de hematoquezia. Fazemos a descrição dos achados histológicos e imuno-histoquímicos da lesão. Além disso, apresenta-se uma discussão do caso com base na revisão da literatura, que permitiu comprovar a infrequência do tumor na região retal e corroborar a benignidade do tumor no presente caso. (AU)

Disgenesia gonadal pura XX: relato de caso / Pure gonadal dysgenesis XX: case report

Objetivo: relatar um caso de Disgenesia Gonadal Pura XX (DGP XX), acompanhado naFundação Santa Casa de Misericórdia do Pará (FSCMPA). Relato do caso: paciente do sexofeminino, 22 anos, com queixa de amenorreia primária e ausência de desenvolvimento mamário.O diagnóstico de DGP XX foi confirmado através de dosagens hormonais, que apontaram umhipogonadismo hipergonadotrófico; ultrassonografia pélvica e cariotipagem. Consideraçõesfinais: a DGP é uma nosologia rara, porém, deve ser lembrada em pacientes com amenorreiaprimária, sendo fundamental a realização de cariotipagem para o diagnóstico final. É necessáriauma adequada assistência médica a tais pacientes em virtude das possíveis complicaçõespsicossociais e médicas que podem decorrer de tal quadro.

Objetive: to report a case of XX pure gonadal dysgenesis, assisted in the Santa Casa deMisericordia do Pará (FSCMPA). Case report: a female patient, 22 years, complaining ofprimary amenorrhea and absence of breast development. The diagnosis of pure gonadaldysgenesis XX (PGD XX) was confirmed by hormonal measurements, which showed ahypergonadotropic hypogonadism, pelvic ultrasound and karyotyping. Final considerations:the pure gonadal dysgenesis is a rare condition, but should be considered in patients withprimary amenorrhea. It is fundamental to perform karyotyping for the final diagnosis. Thispatients need a proper medical care because of possible psychosocial and medical complicationsthat may arise from this condition.