ABSTRACT Objectives: To assess the efficacy of hydroxychloroquine in combination with azithromycin in terms of clinical and biochemical outcomes in adult patients with COVID-19 hospitalized for acute respiratory distress syndrome (ARDS), and to describe the occurrence of adverse events. Method: Retrospective comparative study, based in a quaternary private hospital in Rio de Janeiro, Brazil, involving 193 adult patients hospitalized for mild and moderate COVID-19 related ARSD, analyzing treatment efficacy based on clinical and biochemical outcomes. Results: The active group comprised 101 (52.3%) patients using hydroxychloroquine associated with azithromycin and the control group 92 (47.7%) patients who did not take these medications. Median age was 59 (47–70) in the active group and 65 (47−77) in the control group (p < 0.05). Patients in the control group had greater extent of pulmonary involvement on baseline chest CT scans (p < 0.05). All other baseline variables (BMI, comorbidities, previous use of medications and biochemical assessments) were similar between groups. In the medication group, 25% (25 out of 101) were admitted to the ICU, compared to 21% (19 out of 92) in the control group (p > 0.05). No difference in mortality, duration of non-invasive oxygen use or duration of hospitalization was seen between groups. The therapeutic regimen was well tolerated, with only eight (7.9%) patients presenting gastrointestinal symptoms and eight (7.9%) patients withdrawn treatment due to QTc prolongation. Conclusions: Patients treated with hydroxychloroquine combined with azithromycin and the control group had similar clinical outcomes. This therapeutic regimen was considered ineffective in hospitalized patients with mild to moderate COVID-19 related ARDS and was associated with few non-severe adverse events.

OBJETIVO: Caracterizar, por meio da tomografia computadorizada de alta resolução, as principais alterações pulmonares da histiocitose de células de Langerhans. MATERIAIS E MÉTODOS: Foram avaliadas, retrospectivamente, as tomografias computadorizadas de alta resolução de oito pacientes com diagnóstico comprovado da doença a partir de biópsia pulmonar a céu aberto, biópsia transbrônquica, estudos de imuno-histoquímica e/ou lesões extrapulmonares associadas. RESULTADOS: Pequenas lesões císticas, arredondadas e de paredes finas foram observadas em todos os pacientes. Nódulos, com distribuição predominantemente periférica no parênquima pulmonar, estavam presentes em 75% dos exames estudados. As lesões apresentaram distribuição difusa, com predomínio nos terços superior e médio dos pulmões em todos os casos, mas acometimento dos recessos costofrênicos foi observado em 25% dos pacientes. CONCLUSÃO: A comparação das tomografias computadorizadas de alta resolução com radiografias de tórax mostrou que cistos de paredes finas e pequenos nódulos não podem ser avaliados satisfatoriamente por radiografias convencionais. A tomografia computadorizada de alta resolução, por sua capacidade de detectar e caracterizar cistos e nódulos pulmonares, permite o diagnóstico de histiocitose de células de Langerhans pulmonar com alta probabilidade.

OBJECTIVE: The present study was aimed at characterizing main lung changes observed in pulmonary Langerhans cell histiocytosis by means of high-resolution computed tomography. MATERIALS AND METHODS: High-resolution computed tomography findings in eight patients with proven disease diagnosed by open lung biopsy, immunohistochemistry studies and/or extrapulmonary manifestations were retrospectively evaluated. RESULTS: Small rounded, thin-walled cystic lesions were observed in the lung of all the patients. Nodules with predominantly peripheral distribution over the lung parenchyma were observed in 75% of the patients. The lesions were diffusely distributed, predominantly in the upper and middle lung fields in all of the cases, but involvement of costophrenic angles was observed in 25% of the patients. CONCLUSION: Comparative analysis of high-resolution computed tomography and chest radiography findings demonstrated that thin-walled cysts and small nodules cannot be satisfactorily evaluated by conventional radiography. Because of its capacity to detect and characterize lung cysts and nodules, high-resolution computed tomography increases the probability of diagnosing pulmonary Langerhans cell histiocytosis.

Foram individualizados 17 pacientes com distrofia muscular congênita (DMC) por critérios clínico-laboratoriais e biópsia muscular com estudo histoquímico do músculo deltóide superficial. São descritas e ilustradas, com detalhes, as alterações histológicas observadas nas respectivas biópsias e que compõem seu substrato anátomo-patológico: proliferação conjuntiva, alteração na arquitetura interna, necrose, involução gordurosa, macrofagia, regeneração, segmentação, centralizações nucleares e predominância de fibras tipo I. Destacamos a intensa proliferação conjuntiva endomisial ,que tende a isolar cada fibra muscular separadamente, e as importantes alterações na arquitetura, interna, com formação de fibras bizarras, que constituem dois importantes sinais que devem ser ressaltados tendo em vista um diagnóstico histológico diferencial com a distrofia muscular de Duchenne e Becker (DMD/ B) e com a distrofia forma cintura-membros. A importância de se individualizar a DMC das outras formas de distrofias musculares reside principalmente em seu prognóstico que, na maioria das vezes, é mais favorável que na DMD.

A thorough histological description of 17 patients with congenital muscular dystrophy (CMD) is presented. The biopsies were performed in the left superficial deltoid muscle and processed with histochemical techniques. All samples showed connective tissue proliferation, changes in the internal architecture, necrosis, increase of adipose tissue, ma-crophagia, fiber regeneration and segmentation, central nuclei, and type I fiber predominance. The histological hallmarks of this entity are the marked endomysial connective tissue proliferation that frames one fiber from the other, and the important changes in the fiber's internal architecture. Those two abnormalities are extremely helpful to differentiate, on histological grounds, CMD from limb girdle muscular dystrophy and Duchenne/Becker muscular dystrophy. CMD presents a particular natural course and should be individualized apart from other muscular dystrophies.