Abstract Objective To evaluate the diagnostic accuracy of the Radiological Society of North America (RSNA) classification system for coronavirus disease 2019 (COVID-19) pneumonia compared to pre-pandemic chest computed tomography (CT) scan images to mitigate the risk of bias regarding the reference standard. Materials and methods This was a retrospective, cross-sectional, diagnostic test accuracy study. Chest CT scans, carried out from May 1 to June 30, 2020, and from May 1 to July 17, 2017, were consecutively selected for the COVID-19 (positive reverse transcription-polymerase chain reaction [RT-PCR] for severe acute respiratory syndrome coronavirus 2 result) and control (pre-pandemic) groups, respectively. Four expert thoracic radiologists blindly interpreted each CT scan image. Sensitivity and specificity were calculated. Results A total of 160 chest CT scan images were included: 79 in the COVID-19 group (56 [43.5–67] years old, 41 men) and 81 in the control group (62 [52–72] years old, 44 men). Typically, an estimated specificity of 98.5% (95% confidence interval [CI] 98.1%–98.4%) was obtained. For the indeterminate classification as a diagnostic threshold, an estimated sensitivity of 88.3% (95% CI 84.7%–91.7%) and a specificity of 79.0% (95% CI 74.5%–83.4%), with an area under the curve of 0.865 (95% CI 0.838–0.895), were obtained. Conclusion The RSNA classification system shows strong diagnostic accuracy for COVID-19 pneumonia, even against pre-pandemic controls. It can be an important aid in clinical decision-making, especially when a typical or indeterminate pattern is found, possibly advising retesting following an initial negative RT-PCR result and streamlining early management and isolation.

RESUMO Objetivo: Avaliar a apresentação radiológica de pacientes com tuberculose pulmonar diagnosticada no serviço de emergência e investigar sua associação com o tempo para o diagnóstico. Métodos: Estudo observacional prospectivo envolvendo pacientes diagnosticados com tuberculose pulmonar no serviço de emergência de um hospital universitário terciário no sul do Brasil. As radiografias de tórax realizadas na admissão foram avaliadas por um radiologista. Foram descritos os diferentes padrões de achados radiológicos e as localizações das lesões. O desfecho principal do estudo foi o tempo total decorrido entre o exame radiológico inicial e o diagnóstico de tuberculose. Resultados: Um total de 78 pacientes foi incluído no estudo. A mediana de tempo entre a radiografia de tórax e o diagnóstico foi de 2 dias, sendo os diagnósticos precoce e tardio definidos como tempo para o diagnóstico < 2 dias e ≥ 2 dias, respectivamente. A positividade da baciloscopia de escarro associou-se ao diagnóstico precoce (p = 0,005), e a cultura positiva associou-se ao diagnóstico tardio (p = 0,005). O diagnóstico precoce associou-se à presença de escarro (p = 0,03), perda de peso (p = 0,047), cavitação (p = 0,001) e consolidação (p = 0,003). A cavitação pulmonar foi um preditor independente de diagnóstico precoce (OR = 3,50; p = 0,028). Conclusões: Há necessidade de protocolos específicos para tuberculose nos serviços de emergência, não apenas para evitar atrasos no diagnóstico e no tratamento, mas também para modificar a dinâmica de transmissão da doença.

ABSTRACT Objective: To evaluate the radiological presentation of patients with pulmonary tuberculosis diagnosed in the emergency department and to investigate its association with the time to diagnosis. Methods: This was a prospective observational study involving patients diagnosed with pulmonary tuberculosis in the emergency department of a tertiary university hospital in southern Brazil. Chest X-rays taken on admission were evaluated by a radiologist. The various patterns of radiological findings and locations of the lesions were described. The main study outcome was the total time elapsed between the initial radiological examination and the diagnosis of tuberculosis. Results: A total of 78 patients were included in the study. The median time from chest X-ray to diagnosis was 2 days, early and delayed diagnosis being defined as a time to diagnosis < 2 days and ≥ 2 days, respectively. Sputum smear positivity was associated with early diagnosis (p = 0.005), and positive culture was associated with delayed diagnosis (p = 0.005). Early diagnosis was associated with the presence of sputum (p = 0.03), weight loss (p = 0.047), cavitation (p = 0.001), and consolidation (p = 0.003). Pulmonary cavitation was found to be an independent predictor of early diagnosis (OR = 3.50; p = 0.028). Conclusions: There is a need for tuberculosis-specific protocols in emergency departments, not only to avoid delays in diagnosis and treatment but also to modify the transmission dynamics of the disease.

Resumo É apresentado o caso de uma rara anomalia da aorta torácica - arco aórtico à direita associado a artéria inominada esquerda aberrante com origem em divertículo de Kommerell -, com diagnóstico apenas na vida adulta.

Abstract We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum-that went undiagnosed until adulthood.

ABSTRACT Objective Ultrasound-guided fine-needle aspiration (US-FNA) biopsy has proven to be an accurate and efficient tool in thyroid nodule evaluation. We evaluated whether cell block adds to the diagnostic accuracy of US-FNA. Subjects and methods Three hundred twenty-eight consecutive patients underwent US-FNA, cytology and cell block evaluation. Six slides were prepared for each patient and stained by Papanicolaou and Giemsa techniques. The residual hemorrhagic aspirate in the syringe and needle was fixed in 10% formalin and paraffin-embedded (cell block). The histological sections were examined as a complementary diagnostic tool to US-FNA. Results The study population comprised 89% females and the mean age was 57.4 ± 13.7 years. The mean nodule size was 2.3 ± 1.2 cm. US-FNA cytological results were as follows: Bethesda I, 17.1% (n = 56); Bethesda II, 61.6% (n = 202); Bethesda III, 9.5% (n = 31); Bethesda IV, 5.8% (n = 19); Bethesda V, 2.4% (n = 8), and Bethesda VI, 3.6% (n = 12). Cell blocks were obtained in 100% of cases and were considered diagnostic in 89.6%. Combined cytological and cell block (cyto-cell block) results were as follows: unsatisfactory, 4.3% (n = 14); benign, 72.6% (n = 238); indeterminate, 11.3% (n = 37); follicular lesion, 5.8% (n = 19); suspicious for malignancy, 2.4% (n = 8), and malignant, 3.6% (n = 12). The sensitivity and specificity for cyto-cell block was 100% and 90%, respectively, and the accuracy was 94%. Cyto-cell block analysis reduced the rate of unsatisfactory samples (p < 0.001). Conclusions The cyto-cell block interpretation improved the efficiency of US-FNA. This simple, fast and low-cost technique should be used as an adjunctive test in thyroid nodule evaluation. Arch Endocrinol Metab. 2016;60(4):367-73

BACKGROUND: Cystic fibrosis (CF) is a disease marked by airway inflammation and airflow obstruction, resulting in air trapping in the lungs. OBJECTIVE: To assess the associations between airflow limitation, pulmonary volume and X-ray findings in patients with cystic fibrosis. METHOD: A cross-sectional retrospective study. Review of spirometric, plethysmographic, and chest X-ray findings of outpatients (age ³ 16 years). The airflow findings were classified as within normal limits or as airflow obstruction: mild, moderate or severe obstructive alteration. RESULTS: A total of 23 patients (15 male and eight female; mean age, 21 ± 5.9 years) were studied. Six of them were within normal limits, four had a mild, five had a moderate, and eight had a severe obstructive alteration. There was an association between airflow limitation and the increase of residual volume (p = 0.006) and also with the Brasfield score (p = 0.001), but not with the total lung capacity (p = 0.33). There was a correlation between residual volume and Brasfield score (r = 0,73, p = 0,002), but not with the total pulmonary capacity. Moreover, according to X-ray criteria, the air trapping was correlated only with the residual volume (p = 0.006). CONCLUSION: In patients with cystic fibrosis (age ³ 16 years), the progressive airflow limitation is accompanied by an increase in residual volume, while the total pulmonary capacity remains normal or tends to decrease. The X-ray score was associated with airflow limitation and residual volume, but not with total lung capacity.

OBJECTIVE: To determine the characteristics associated with the dropout of patients followed up in a Brazilian out patient clinic specializing in hypertension. METHODS: Planned prospective cohort study of patients who were prescribed an antihypertensive treatment after an extensive initial evaluation. The following parameters were analyzed: sex, age, educational level, duration of disease, pressure level used for classifying the patient, previous treatment, physical activity, smoking, alcohol consumption, familial history of hypertension, and lesion in a target organ. RESULTS: We studied 945 hypertensive patients, 533 (56%) of whom dropped out of the follow-up. The mean age was 52.3±12.9 years. The highest probabilities of dropout of the follow-up were associated with current smoking, relative risk of 1.46 (1.04-2.06); educational level equal to or below 5 years of schooling, relative risk of 1.52 (1.11-2.08); and hypertension duration below 5 years, relative risk of 1.78 (1.28-2.48). Age increase was associated with a higher probability of follow-up with a relative risk of 0.98 (0.97-0.99). CONCLUSION: We identified a group at risk for dropping out the follow-up, which comprised patients with a lower educational level, a recent diagnosis of hypertension, and who were smokers. We think that measures assuring adherence to treatment should be directed to this group of patients.

Objetivos: Identificar o nível de risco e a prática de profilaxia para TEV em pacientes hospitalizados em um centro de tratamento intensivo (CTI). Métodos: A amostra foi constituída por pacientes admitidos no CTI-HCPA entre dezembro de 1997 e fevereiro de 1998. Foram excluídos pacientes em tratamento com anticoagulantes ou que apresentavam contra-indicações para uso de heparina. Os critérios utilizados para determinação dos fatores de risco para TEV e sua estratificação em níveis de risco seguiram parâmetros estabelecidos em consensos internacionais. O estudo não foi de conhecimento do pessoal médico da unidade. Resultados: Foram analisados 180 pacientes, com média de idade de 58 anos (± 16,5). Os fatores de risco mais freqüentes foram: idade ³ 40 anos (85,0%), grande cirurgia (47,8%), infecção torácica ou abdominal (22,8%). Dois ou mais fatores de risco simultâneos estiveram presentes em 146 (81%) casos. Na avaliação do risco para TEV, 142 (79%) foram classificados como risco moderado/alto. Medidas profiláticas foram prescritas para 102 pacientes (57%), sendo a heparina utilizada em 60% dos casos de risco moderado ou alto. Evidenciou-se uma associação significativa entre o aumento do nível de risco e do número de fatores de risco com o aumento do uso de profilaxia (p < 0,05). Conclusão: Fatores de risco para TEV foram freqüentes na amostra estudada. No entanto, 40% dos pacientes com risco moderado/alto não receberam profilaxia farmacológica para TEV.

Objectives: To identify the degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in an intensive care unit (ICU). Methods: The subjects were patients admitted to the ICU between December 1997 and February 1998. Patients were excluded if they were in anticoagulant therapy or presented contra-indication to heparin. Determination of risk factors and classification of the degree of risk for VTE were done according to international consensus. The ICU medical staff did not know about the study. Results: The authors evaluated one hundred and eighty patients with a mean age of 58 years (±16.5). Risk factors more frequently found were: age ³ 40 years (85.0%), surgery (47.8%), thoracic or abdominal infection (22.8%). Two or more risk factors were present in 146 (81%) cases. In the evaluation of VTE risk, 142 (79%) patients were classified as moderate/high risk. Prophylactic measures were prescribed to 102 patients (57%), and heparin was used in 60% of moderate/high risk cases. There was a significant association between risk level and the number of risk factors with the use of prophylaxis (p < 0.05). Conclusion: VTE risk factors were frequent in the sample analyzed. However, 40% of patients considered moderate/high risk did not receive pharmacological prophylaxis for VTE.