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au:LOUREIRO, DANIEL

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Extra-cranial internal carotid aneurysm repair - the importance of technical details
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Pinelo, Andreia

; Mendes, Daniel

; Rego, Duarte

; Loureiro, Luís

; Machado, Rui

Angiologia e Cirurgia Vascular

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dec 2023, Volume 19 N. 4 Pages 239 - 243

Abstract: En | Text: En | PDF: En

Abstract Background: Extracranial internal carotid aneurysms are extremely rare and usually diagnosed as incidental findings although thromboembolic events or rupture can occur. Historically treated by open surgery, endovascular repair is emerging as an alternative. We present our center’s experience with both approaches. Case reports: Four internal carotid aneurysm cases are presented: Case 1 - 60-year-old male presented with an asymptomatic 20mm saccular aneurysm of the carotid bifurcation. He underwent arterial reconstruction with a bypass using a 6mm ePTFE graft and reimplantation of the external carotid artery. Case 2 - 61-year-old female presents with an asymptomatic 17mm saccular aneurysm of the internal carotid artery. Aneurismectomy and direct reconstruction through an end-to-end anastomosis was possible due to artery redundancy. Case 3 - 36-year-old patient with a history of Cushing's syndrome due to a secretory adenoma of the pituitary gland presented with an 19mm fusiform aneurysm of the internal carotid artery. After pituitary gland tumor recession, he underwent arterial reconstruction with an inlay saphenous vein bypass. Case 4 - 77-year-old female presents with a 27mm saccular aneurysm of the internal carotid artery. Endovascular aneurysm exclusion using a self-expandable covered stent was performed through a cervical carotid surgical approach. Stent occlusion was observed in the postoperative period but without neurological symptoms. Conclusion: Existing data on endovascular treatment’s short- and medium-term outcomes are comparable to surgery, but long-term results are unknown and high rates of technical failure have been associated to artery tortuosity. There are no specific guidelines to guide decision-making and treatment decisions must be individualized according to the morphology and location of the aneurysm and patient's comorbidities.

https://doi.org/10.48750/acv.555

Endoscopic lumbar sympathectomy as a treatment option for primary erythromelalgia - case report and review
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Loureiro, Marcelo de Paula

; Novais, Pietro Maran

; Paulin, João Augusto Nocera

; Almeida, Daniel Benzecry de

; Lemos Junior, Arlindo Nascimento de

Jornal Vascular Brasileiro

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2023, Volume 22 elocation e20220095

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Erythromelalgia is a rare disease, involving pain, edema, redness, and hyperthermia in the limbs. It is extremely refractory to drugs, has no defined treatment, and causes psychological comorbidities in the patient. We describe a case of erythromelalgia involving a 17-year-old boy who had been suffering from the disease for almost 4 years prior to finding an effective treatment. A bilateral endoscopic lumbar sympathectomy was performed, limited to L2 and L3 resections. Four weeks after the procedure, the patient’s symptoms were significantly mitigated and at 8 months follow-up he remained almost asymptomatic. Endoscopic lumbar sympathectomy was an effective treatment for primary erythromelalgia in this teenager, with exceptional reduction of his symptoms.

Resumo Eritromelalgia é uma doença rara caracterizada por dor, edema, eritema e hipertermia nos membros. É extremamente refratária a medicamentos e não tem um tratamento definido, causando comorbidades psicológicas para o paciente. Descrevemos o caso de um menino de 17 anos que possuía eritromelalgia há quase 4 anos antes de ser submetido a um tratamento efetivo. Foi realizada simpatectomia lombar endoscópica bilateral limitada à ressecção dos gânglios L2 e L3. Após 4 semanas do procedimento, o paciente teve diminuição significativa dos seus sintomas e, com 8 meses de seguimento, permanece praticamente assintomático. A simpatectomia lombar endoscópica foi um tratamento eficaz para eritromelalgia primária em um adolescente, com redução excepcional dos seus sintomas.

https://doi.org/10.1590/1677-5449.202200952

Phosphorus spatial distribution and mass balance in the Itaipu lagoon (Rio de Janeiro, Brazil)
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Lobo, Marcelo

; Loureiro, Daniel

; Nepomuceno, Aguinaldo

; Alves, Leandro

; Lamego, Fernando

Ocean and Coastal Research

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2023, Volume 71 elocation e23012

Abstract: En | Text: En | PDF: En

Abstract The degradation of tropical coastal lagoon systems in urban areas of the least developed countries has been associated with an increase in impermeable areas and poor domestic sewage treatment, increasing land-based runoff of nutrients and suspended solids from catchments. This study aimed to assess the biogeochemical changes caused by human interventions through the analysis of the spatial distribution of sedimentary phosphorus (P) and its mass balance in the Itaipu lagoon, located on the east coast of the state of Rio de Janeiro. Human intervention in the Itaipu lagoon system has caused severe imbalances in biogeochemical cycles over the past decades. Watercourses have been channeled to normalize the hydrological regime and increase hydraulic energy, improving sediment transport capacity. In this context, the increase in runoff from the coastal urban basin into the Itaipu lagoon has buried an increasing amount of phosphorus in the sediment. Recently, a regional increase in storm events caused a series of landslides and floods, which have been reported as possible consequences of global climate change. In recent decades, the synergy between landslides and river channeling has increased TP loads, accelerating phosphorus settling and changing P spatial distribution in surface sediments. This has accelerated siltation of the lagoon with an accumulation of nutrients and organic matter, leading in some cases to sediment anoxia. The lagoon has undergone strong eutrophication, changing its trophic state from meso- to hypertrophic in less than 30 years, even though P loads are not as high as in other coastal lagoons. Our findings confirm that human intervention impacts nutrient loads, which in turn disrupt the balance of biogeochemical cycles, compromising coastal water resources. This leads to the collapse of ecosystem services, another step towards degrading planetary boundaries.

https://doi.org/10.1590/2675-2824071.21092ml

Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household
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Loureiro, Rafaela Borge

; Guidoni, Leticia Molino

; Fregona, Geisa Carlesso

; Oliveira, Sandra Maria do Valle Leone de

; Sacramento, Daniel

; Pinheiro, Jair dos Santos

; Gomes, Denise

; Maciel, Ethel Leonor Noia

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 4 elocation e20220368

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. Methods: This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). Results: A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). Conclusions: Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.

RESUMO Objetivo: Avaliar as implicações da proporção da renda familiar anual gasta nos períodos pré e pós-diagnóstico em pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose no Brasil. Métodos: Estudo transversal com pacientes com tuberculose acompanhados durante pelo menos um ano após o término do tratamento da tuberculose em cinco capitais brasileiras (uma em cada região do país). Resultados: Foram incluídos na análise 62 pacientes. O custo médio global da tuberculose foi de R$ 283,84 no período pré-diagnóstico e de R$ 4.161,86 no período pós-diagnóstico. Após os custos da doença tuberculosa, 71% dos pacientes ficaram desempregados, com um aumento global do desemprego; além disso, o número de pacientes não pobres diminuiu 5%, o número de pacientes pobres aumentou 6% e o número de pacientes extremamente pobres aumentou 5%. A maior proporção de renda familiar anual para cobrir os custos totais da tuberculose foi observada nos pacientes extremamente pobres (40,37% vs. 11,43% nos menos pobres). Conclusões: As políticas para mitigar os custos catastróficos devem incluir intervenções planejadas pelo sistema de saúde e medidas de proteção social para pacientes de baixa renda com tuberculose, a fim de eliminar a epidemia global de tuberculose até 2035, uma meta da OMS alinhada com os Objetivos de Desenvolvimento Sustentável propostos pela Organização das Nações Unidas.

https://doi.org/10.36416/1806-3756/e20220368

The SISBIOTA-Diptera Brazilian Network: A long-term survey of Diptera from unexplored Brazilian Western Arc of Amazon, Cerrado, and Pantanal
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Lamas, Carlos José Einicker

; Fachin, Diego Aguilar

; Falaschi, Rafaela Lopes

; Alcantara, Daniel Máximo Correa de

; Ale-Rocha, Rosaly

; Amorim, Dalton de Souza

; Araújo, Maíra Xavier

; Ascendino, Sharlene

; Baldassio, Letícia

; Bellodi, Carolina Ferraz

; Bravo, Freddy

; Calhau, Julia

; Capellari, Renato Soares

; Carmo-Neto, Antonio Marcelino do

; Cegolin, Bianca Melo

; Couri, Márcia Souto

; Carvalho, Claudio José Barros de

; Dios, Rodrigo de Vilhena Perez

; Falcon, Aida Vanessa Gomez

; Fusari, Livia Maria

; Garcia, Carolina de Almeida

; Gil-Azevedo, Leonardo Henrique

; Gomes, Marina Morim

; Graciolli, Gustavo

; Gudin, Filipe Macedo

; Henriques, Augusto Loureiro

; Krolow, Tiago Kütter

; Mendes, Luanna Layla

; Limeira-de-Oliveira, Francisco

; Maia, Valéria Cid

; Marinoni, Luciane

; Mello, Ramon Luciano

; Mello-Patiu, Cátia Antunes de

; Morales, Mírian Nunes

; Oliveira, Sarah Siqueira

; Patiu, Claudemir

; Proença, Barbara

; Pujol-Luz, Cristiane Vieira de Assis

; Pujol-Luz, José Roberto

; Rafael, José Albertino

; Riccardi, Paula Raile

; Rodrigues, João Paulo Vinicios

; Roque, Fabio de Oliveira

; Sallum, Maria Anice Mureb

; Santis, Marcelo Domingos de

; Santos, Charles Morphy Dias dos

; Santos, Josenilson Rodrigues dos

; Savaris, Marcoandre

; Shimabukuro, Paloma Helena Fernandes

; Silva, Vera Cristina

; Schelesky-Prado, Daniel de Castro

; Silva-Neto, Alberto Moreira da

; Camargo, Alexssandro

; Sousa, Viviane Rodrigues de

; Urso-Guimarães, Maria Virginia

; Wiedenbrug, Sofia

; Yamaguchi, Carolina

; Nihei, Silvio Shigueo

Revista Brasileira de Entomologia

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2023, Volume 67 N. 4 elocation e20230051

Abstract: En | Text: En | PDF: En

ABSTRACT The SISBIOTA-BRASIL was a three-year multimillion-dollar research program of the Brazilian government to document plants and animals in endangered/understudied areas and biomes in Brazil. Distributional patterns and the historical events that generated them are extensively unknown regarding Brazilian fauna and flora. This deficiency hinders the development of conservation policies and the understanding of evolutionary processes. Conservation decisions depend on precise knowledge of the taxonomy and geographic distribution of species. Given such a premise, we proposed to research the diversity of Diptera of the Brazilian western arc of Amazon, Cerrado, and Pantanal in the states of Mato Grosso, Mato Grosso do Sul, and Rondônia. Three important biomes of the South American continent characterize these Brazilian states: Amazon forest, Cerrado (Brazilian Savannah), and Pantanal. Besides their ecological relevance, these biomes historically lack intensive entomological surveys. Therefore, they are much underrepresented in the Brazilian natural history collections and in the scientific literature, which is further aggravated by the fact that these areas are being exponentially and rapidly converted to commercial lands. Our project involved over 90 collaborators from 24 different Brazilian institutions and one from Colombia among researchers, postdocs, graduate and undergraduate students, and technicians. We processed and analyzed nearly 300,000 specimens from ~60 families of Diptera collected with a large variety of methods in the sampled areas. Here, we provide a detailed overview of the genera and species diversity of 41 families treated. Our results point to a total of 2,130 species and 514 genera compiled and identified for the three states altogether, with an increase of 41% and 29% in the numbers of species and genera known for the three states combined, respectively. Overall, the 10 most species-rich families were Tachinidae, Cecidomyiidae, Tabanidae, Psychodidae, Sarcophagidae, Stratiomyidae, Bombyliidae, Syrphidae, Tephritidae, and Asilidae. The 10 most diverse in the number of genera were Tachinidae, Stratiomyidae, Asilidae, Mycetophilidae, Syrphidae, Tabanidae, Muscidae, Dolichopodidae, Sarcophagidae, and Chloropidae. So far, 111 scientific papers were published regarding taxonomic, phylogenetic, and biogeographical aspects of the studied families, with the description of 101 new species and three new genera. We expect that additional publications will result from this investigation because several specimens are now curated and being researched by specialists.

https://doi.org/10.1590/1806-9665-rbent-2023-0051

Light induced amaurosis: a rare symptom of carotid stenosis
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Almeida, Henrique Andrade de

; Teixeira, Sérgio

; Loureiro, Luís

; Veiga, Carlos

; Mendes, Daniel

; Veterano, Carlos

; Rocha, Henrique Guedes da

; Castro, João Diogo

; Pinelo, Andreia

; Almeida, Rui de

Angiologia e Cirurgia Vascular

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dec 2022, Volume 18 N. 3 Pages 209 - 211

Abstract: En | Text: En | PDF: En

Abstract Introduction: Light induced amaurosis refers to a transient monocular or binocular vision loss triggered by bright lights. Like amaurosis fugax, light induced amaurosis is associated with carotid artery stenosis but they differ from each other in presentation and pathophysiology. It is thought to be an impairment in the regeneration of retinal visual pigments caused by the inability of carotid circulation to sustain the increased metabolic activity occurring when the retina is exposed to bright lights. With this report we aim to present a case of light induced amaurosis and its management. Case report: We describe a 74-year-old man with the isolated complaint of monocular visual loss from his left eye when exposed to bright lights. These episodes were self-limited and lasted for several minutes. His vision was reportedly good between episodes. He also complained of headache and dizziness. There were no other focal neurological deficits present. The patient had a history of peripheral artery disease, chronic heart failure, hypertension, dyslipidaemia, permanent atrial fibrillation and had a history of heavy smoking in the past. Chronic medical therapy included anticoagulation with rivaroxaban, antiplatelet therapy with acetylsalicylic acid and atorvastatin. Imaging studies (doppler ultrasonography and Computed tomography angiography) revealed a significant morphologic stenosis of the left common carotid artery, left internal carotid artery with sub occlusive disease and right internal carotid artery with 70-75% stenosis (North American Symptomatic Carotid Endarterectomy Trial - NASCET). The vertebral arteries study did not reveal significant morphologic disease. The patient was submitted to left common and internal carotid artery endarterectomy and Dacron patch angioplasty. The visual symptoms progressively improved after surgical treatment. The dizziness and headache were completely gone. Conclusion: Light induced amaurosis is a rare and less known symptom associated with severe carotid artery stenosis. Its timely recognition is important to not deprive patients of timely treatment.

https://doi.org/10.48750/acv.428

Endovascular approach as first-line therapy for congenital arteriovenous malformations - a case series
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Pinelo, Andreia

; Loureiro, Luís

; Almeida, Paulo

; Mendes, Daniel

; Veterano, Carlos

; Castro, João

; Rocha, Henrique

; Almeida, Rui

Angiologia e Cirurgia Vascular

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dec 2022, Volume 18 N. 3 Pages 176 - 181

Abstract: En | Text: En | PDF: En

Abstract Introduction: Congenital vascular malformations are entities with a broad spectrum of presentations and variable prognosis. They typically present at a young age and are historically associated with extensive resection surgeries and with high morbidity. This study aims to evaluate the results of arteriovenous malformations (AVMs) embolization as a first-line approach in lesions which are not suitable for surgical resection. Methods: A retrospective analysis of the clinical records of patients with infiltrative arteriovenous malformations who underwent embolization at our center between 2019 and 2021 was performed. The Schobinger Classification was applied to categorize the clinical stage. Angiographic findings were reported according to the Yakes classification. The decrease in the Schöbinger grade after treatment, the need for reintervention and the associated complications were the main outcomes. A descriptive statistical analysis was performed. Results: Nine patients undergoing embolization of infiltrative arteriovenous malformations were evaluated, accounting for a total of seventeen interventions. There was a preponderance of females (n=6; 66.7%) and the mean age of referral to the Vascular Surgery consultation and the first treatment was 16.8 (±12.9) and 20.9 (± 14.5) years, respectively. All patients were in stage II (n=4; 44.4%) or III (n=5; 55.6%) of Schöbinger. The angiographic pattern of the AVMs was classified according to the Yakes Classification, which guided the approach. Yakes type IIa was found most frequently (n=6; 55.6%), followed by type IV (n=2; 22.2%) and type IIb (n=1; 1.1%). Patients underwent AVM embolization via transarterial, transvenous or direct nidus puncture with sclerosing agents, liquid embolizers, microparticles and microcoils, separately or in combination. The median number of interventions per patient was 1 (1 - 5) and Yakes type IV appears to be associated with a higher rate of reintervention. Reduction of the Schöbinger stage was achieved in 7 (77.8%) patients with clinical resolution in 3 (33.3%). Tissue necrosis was the only complication reported in this series (n=2; 11,8%). Conclusion: The endovascular approach of arteriovenous malformations through nidus and/or afferent/efferent embolization requires a detailed angiographic characterization but seems to be an effective strategy with a low risk of complications. The Yakes classification, can be useful both in guiding the approach and in predicting the need for reintervention.

https://doi.org/10.48750/acv.488

USE OF THE INTERNET AND SOCIAL NETWORKS IN ORTHOPEDICS AND TRAUMATOLOGY AND PERSPECTIVE OF POST COVID TELEMEDICINE
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ESTANISLAU, ALEXANDRE RAMOS

; NOBRE, DANIEL MAGALHÃES

; NABACK, FILIPE DIAS NASSAR

; BARROS, TOMÁS SANTOS VASCONCELOS

; SOUZA, LUIZ FELIPE MUNDIM DE

; PENIDO, PEDRO CID LOUREIRO

Acta Ortopédica Brasileira

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2022, Volume 30 N. 5 elocation e252728

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A internet vem alterando a relação médico-paciente na área ortopédica, principalmente nos últimos meses, em função da pandemia da COVID-19. Objetivo: Reunir informações sobre o uso de redes sociais na ortopedia e traumatologia, assim como opiniões de pacientes sobre telemedicina. Métodos: Estudo do tipo transversal. 237 pacientes egressos do ambulatório de ortopedia do Hospital Odilon Behrens, de uso exclusivo do SUS, responderam a um questionário contendo questões relacionadas ao uso da internet, das redes sociais e da telemedicina no contexto atual. Resultados: A maioria dos participantes nunca ou raramente buscam informações na internet antes ou depois da consulta; mas, quando o fazem, os resultados da pesquisa raramente são esclarecedores. Houve uma menor procura de informações entre os homens quando comparados às mulheres. Não houve diferenças significativas quanto à idade dos participantes que concordaram que grande parte das consultas serão realizadas pela internet no futuro. Conclusão: A busca por informações médicas nas redes sociais é uma realidade mundial, mas ainda gera divergências referentes à sua eficácia e abrangência. São necessários mais estudos em serviços ortopédicos distintos para maior análise sobre o uso das redes sociais nesse segmento. Nível de Evidência IV, Série de Casos.

ABSTRACT The internet has been changing the doctor-patient relationship in the orthopedic area, especially in recent months, due to the COVID-19 pandemic. Objective: To gather information on the use of social networks regarding orthopedics and traumatology, as well as patient opinions on telemedicine. Methods: Cross-sectional study with 237 patients discharged from the orthopedics outpatient clinic of the Odilon Behrens Metropolitan Hospital, in service exclusively for the SUS, answered a questionnaire containing questions related to the use of the internet, social networks, and telemedicine in the current context. Results: Most participants never or rarely look for information on the internet before or after the medical appointment; but when they do, the search results are rarely enlightening. There was a lower demand for information among men when compared with women. There were no significant differences regarding the age of the participants who agreed that most appointments will be carried out over the internet in the future. Conclusion: The search for medical information on social networks is a global reality, but it still generates disagreements regarding its effectiveness and scope. More studies are needed in different orthopedic services for further analysis on the use of social networks within this field. Level of Evidence IV, Case Series.

https://doi.org/10.1590/1413-785220223005e252728

Digital Planning on Guided Endodontics Technology
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Decurcio, Daniel A

; Bueno, Mike R

; Silva, Julio A

; Loureiro, Marco A Zaiden

; Sousa-Neto, Manoel Damião

; Estrela, Carlos

Brazilian Dental Journal

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sep 2021, Volume 32 N. 5 Pages 23 - 33

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O objetivo desta revisão é discutir o planejamento digital e o uso da tecnologia guiada em Endodontia. A complexidade e variabilidade da anatomia dos canais radiculares, em conjunto com o desafio no processo de sanificação e controle de micro-organismos representam fatores de risco ao fracasso após o tratamento dos canais radiculares infectados. O aprimoramento técnico-científico e os avanços tecnológicos tem possibilitado uma melhor previsibilidade de resultados nos procedimentos terapêuticos. O desenvolvimento de ferramentas de trabalho eficientes e modernas proporcionou tratamentos endodônticos seguros, com menor tempo clínico operacional e maior conforto ao paciente. A endodontia digital incorporou diferentes ferramentas e desenvolveu suas próprias, avançando ainda mais na resolução de casos complexos. A cópia fiel da anatomia interna proporcionada pelo avanço dos aparelhos e softwares de TCFC, associada aos recursos digitais de planejamento e impressão 3D possibilitaram o surgimento da endodontia guiada. Esta técnica é utilizada em diferentes etapas do tratamento endodôntico, com indicações específicas e maior previsibilidade de resultados. Este estudo revisou criticamente o potencial de aplicação clínica da técnica de acesso guiado, e os passos operatórios para sua realização de forma segura no manejo de casos endodônticos complexos. As principais indicações da Endodontia Guiada incluem o acesso a canais radiculares calcificados; as cirurgias parendodônticas em áreas de difícil acesso; a remoção de pinos de fibra de vidro; e o acesso a dentes com anomalias de desenvolvimento. Em síntese, a endodontia guiada é uma técnica precisa, eficaz e de fácil aplicação clínica. Esta técnica representa a incorporação dos recursos tecnológicos e planejamentos digitais do Endodontista, dando maior previsibilidade aos casos em que é aplicada na prática clínica.

Abstract The aim of this review is to discuss the digital planning and the use of guided technology in Endodontics. The complexity of the root canals anatomy and the challenges in the microorganism’s control represent risk factors for failure after the infected root canal’s treatment. Scientific improvements associated with technological advances have enabled better predictability of therapeutic procedures results. The development of efficient and modern devices provided safer root canal treatments, with shorter clinical visits and greater patient comfort. Digital endodontics incorporated different tools and developed its own, advancing even further in resolving complex cases. The faithful copy of the internal anatomy provided by the advancement of CBCT devices and software’s, associated with the digital resources of 3D planning and printing, enabled the advent of guided endodontics. This technique is used at different stages of endodontic treatment, with specific indications and greater result predictability. Therefore, this study critically reviewed the potential clinical application of this guided access technique, and the operative steps for its safe performance in managing complex endodontic cases. The main indications are accessing calcified root canals, performing endodontic surgeries in difficult access areas, removing fiberglass posts, and accessing teeth with developmental anomalies. In summary, guided endodontics has been a precise strategy, effective, safe, and clinically applicable. This procedure represents incorporating technological resources and digital planning in the Endodontist clinical practice, increasing predictability to complex cases.

https://doi.org/10.1590/0103-6440202104740 1 downloads

10.

Chest computed tomography in the diagnosis of COVID-19 in patients with false negative RT-PCR
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Fonseca, Eduardo Kaiser Ururahy Nunes

; Ferreira, Lorena Carneiro

; Loureiro, Bruna Melo Coelho

; Strabelli, Daniel Giunchetti

; Farias, Lucas de Pádua Gomes de

; Queiroz, Gabriel Abrantes de

; Garcia, José Vitor Rassi

; Teixeira, Renato de Freitas

; Gama, Victor Arcanjo Almeida

; Chate, Rodrigo Caruso

; Assunção Júnior, Antonildes Nascimento

; Sawamura, Márcio Valente Yamada

; Nomura, Cesar Higa

einstein (São Paulo)

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2021, Volume 19 elocation eAO6363

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Avaliar o papel da tomografia computadorizada de tórax em pacientes com COVID-19 que apresentaram reação em cadeia da polimerase via transcriptase reversa (RT-PCR) inicial falsamente negativa. Métodos Estudo retrospectivo de centro único que avaliou 39 pacientes com RT-PCR negativa para COVID-19, submetidos à tomografia computadorizada de tórax e que tiveram diagnóstico final clínico ou serológico de COVID-19. A classificação tomográfica visual foi avaliada de acordo com o Consenso da Radiological Society of North America e o software desenvolvido com inteligência artificial para detecção automática de achados e estimativa de probabilidade de COVID-19. Resultados Na análise tomográfica visual, somente um deles (3%) apresentou tomografia computadorizada classificada como tendo resultado negativo, 69% foram classificados como típicos e 28% como indeterminados. Na avaliação com uso de software, somente quatro (cerca de 10%) tiveram probabilidade de COVID-19 <25%. Conclusão A tomografia computadorizada pode desempenhar papel importante no manejo de casos suspeitos de COVID-19 com RT-PCR inicialmente negativa, principalmente levando-se em consideração os pacientes que estão fora da janela ideal para coleta de amostra para RT-PCR.

ABSTRACT Objective To evaluate the role of chest computed tomography in patients with COVID-19 who presented initial negative result in reverse transcriptase-polymerase chain reaction (RT-PCR). Methods A single-center, retrospective study that evaluated 39 patients with negative RT-PCR for COVID-19, who underwent chest computed tomography and had a final clinical or serological diagnosis of COVID-19. The visual tomographic classification was evaluated according to the Consensus of the Radiological Society of North America and software developed with artificial intelligence for automatic detection of findings and chance estimation of COVID-19. Results In the visual tomographic analysis, only one of them (3%) presented computed tomography classified as negative, 69% were classified as typical and 28% as indeterminate. In the evaluation using the software, only four (about 10%) had a probability of COVID-19 <25%. Conclusion Computed tomography can play an important role in management of suspected cases of COVID-19 with initial negative results in RT-PCR, especially considering those patients outside the ideal window for sample collection for RT-PCR.

https://doi.org/10.31744/einstein_journal/2021ao6363 40 downloads

11.

Sinus computed tomography findings in patients with COVID-19
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Sumi, Daniel Vaccaro

; Loureiro, Rafael Maffei

; Collin, Simon Michael

; Deps, Patrícia Duarte

; Bezerra, Lorena Lima

; Gomes, Regina Lúcia Elia

; Daniel, Mauro Miguel

einstein (São Paulo)

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2021, Volume 19 elocation eAO6255

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Analisar imagens de tomografia computadorizada de seios paranasais de pacientes com a doença por coronavírus 2019, e correlacionar os achados com a doença. Métodos: Foram analisadas imagens de tomografia computadorizada de 95 pacientes submetidos a teste de reação em cadeia da polimerase para coronavírus 2 da síndrome respiratória aguda grave. Os dados clínicos foram obtidos por meio dos prontuários dos pacientes e de ligações telefônicas. A opacificação dos seios paranasais foi graduada e comparada entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave. Resultados: Vinte e oito (29,5%) dos pacientes tiveram resultado positivo para coronavírus 2 da síndrome respiratória aguda grave (idade mediana de 52 [26-95] anos) e 67, resultado negativo (idade mediana de 50 [18-95] anos). O espessamento mucoso estava presente em 97,4% dos seios maxilares, 80% das células etmoidais anteriores, 75,3% das células etmoidais posteriores, 74,7% dos seios frontais e em 66,3% dos seios esfenoidais. Mínimo ou discreto espessamento mucoso (pontuação 1) e seios com aeração normal (pontuação 0) corresponderam a 71,4% e 21,3% de todos os seios paranasais, respectivamente. A nota média de cada seio paranasal entre pacientes positivos e negativos para coronavírus 2 da síndrome respiratória aguda grave foi de 0,85±0,27 e 0,87±0,38, respectivamente (p=0,74). A nota mediana de opacificação dos seios paranasais entre pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave foi de 9 (intervalo interquartil de 8 a 10), comparada a 9 (intervalo interquartil de 5 a 10) em pacientes negativos (p=0,89). Não houve diferença na nota média ajustada para idade e sexo. A congestão nasal foi mais frequente em pacientes positivos para coronavírus 2 da síndrome respiratória aguda grave que naqueles com resultados negativos (p=0,05). Conclusão: A infecção pelo coronavírus 2 da síndrome respiratória aguda grave apresentou associação com congestão nasal, mas não mostrou correlação com espessamento mucoso dos seios paranasais.

ABSTRACT Objective: To analyze computed tomography scans of paranasal sinuses of a series of patients with coronavirus disease 2019, and correlate the findings with the disease. Methods: Computed tomography scans of 95 adult patients who underwent a polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 were analyzed. Clinical data were obtained from patients’ records and telephone calls. Paranasal sinus opacification was graded and compared according to severe acute respiratory syndrome coronavirus 2 positivity. Results: Of the patients 28 (29.5%) tested positive for severe acute respiratory syndrome coronavirus 2 (median age 52 [range 26-95] years) and 67 were negative (median age 50 [range 18-95] years). Mucosal thickening was present in 97.4% of maxillary sinuses, 80% of anterior ethmoid air cells, 75.3% of posterior ethmoid air cells, 74.7% of frontal sinuses, and 66.3% of sphenoid sinuses. Minimal or mild mucosal thickening (score 1)and normally aerated sinuses (score 0) corresponded to 71.4% and 21.3% of all paranasal sinuses, respectively. The mean score of each paranasal sinus among severe acute respiratory syndrome coronavirus 2 positive and negative patients was 0.85±0.27 and 0.87±0.38, respectively (p=0.74). Median paranasal sinus opacification score among severe acute respiratory syndrome coronavirus 2 positive patients was 9 (interquartile range 8-10) compared to 9 (interquartile range 5-10) in negative patients (p=0.89). There was no difference in mean score adjusted for age and sex. Nasal congestion was more frequent in severe acute respiratory syndrome coronavirus 2 positive than negative patients (p=0.05). Conclusion: Severe acute respiratory syndrome coronavirus 2 infection was associated with patient recall of nasal congestion, but showed no correlation with opacification of paranasal sinuses.

https://doi.org/10.31744/einstein_journal/2021ao6255 846 downloads

12.

Evaluation of the RSNA and CORADS classifications for COVID-19 on chest computed tomography in the Brazilian population
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Fonseca, Eduardo Kaiser Ururahy Nunes

; Loureiro, Bruna Melo Coelho

; Strabelli, Daniel Giunchetti

; Farias, Lucas de Pádua Gomes de

; Garcia, José Vitor Rassi

; Gama, Victor Arcanjo Almeida

; Ferreira, Lorena Carneiro

; Chate, Rodrigo Caruso

; Assunção Júnior, Antonildes Nascimento

; Sawamura, Marcio Valente Yamada

; Nomura, Cesar Higa

Clinics

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2021, Volume 76 elocation e2476

Abstract: En | Text: En | PDF: En

OBJECTIVE: To determine the correlation between the two tomographic classifications for coronavirus disease (COVID-19), COVID-19 Reporting and Data System (CORADS) and Radiological Society of North America Expert Consensus Statement on Reporting Chest Computed Tomography (CT) Findings Related to COVID-19 (RSNA), in the Brazilian population and to assess the agreement between reviewers with different experience levels. METHODS: Chest CT images of patients with reverse transcriptase-polymerase chain reaction (RT-PCR)-positive COVID-19 were categorized according to the CORADS and RSNA classifications by radiologists with different levels of experience and who were initially unaware of the RT-PCR results. The inter- and intra-observer concordances for each of the classifications were calculated, as were the concordances between classifications. RESULTS: A total of 100 patients were included in this study. The RSNA classification showed an almost perfect inter-observer agreement between reviewers with similar experience levels, with a kappa coefficient of 0.892 (95% confidence interval [CI], 0.788-0.995). CORADS showed substantial agreement among reviewers with similar experience levels, with a kappa coefficient of 0.642 (95% CI, 0.491-0.793). There was inter-observer variation when comparing less experienced reviewers with more experienced reviewers, with the highest kappa coefficient of 0.396 (95% CI, 0.255-0.588). There was a significant correlation between both classifications, with a Kendall coefficient of 0.899 (p<0.001) and substantial intra-observer agreement for both classifications. CONCLUSION: The RSNA and CORADS classifications showed excellent inter-observer agreement for reviewers with the same level of experience, although the agreement between less experience reviewers and the reviewer with the most experience was only reasonable. Combined analysis of both classifications with the first RT-PCR results did not reveal any false-negative results for detecting COVID-19 in patients.

https://doi.org/10.6061/clinics/2021/e2476 531 downloads

13.

Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience
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Fonseca, Eduardo Kaiser Ururahy Nunes

; Assunção Júnior, Antonildes Nascimento

; Araujo-Filho, Jose de Arimateia Batista

; Ferreira, Lorena Carneiro

; Loureiro, Bruna Melo Coelho

; Strabelli, Daniel Giunchetti

; Farias, Lucas de Pádua Gomes de

; Chate, Rodrigo Caruso

; Cerri, Giovanni Guido

; Sawamura, Marcio Valente Yamada

; Nomura, Cesar Higa

Clinics

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2021, Volume 76 elocation e3503

Abstract: En | Text: En | PDF: En

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality.

https://doi.org/10.6061/clinics/2021/e3503

14.

Técnica de CRISS-CROSS no tratamento de trombose venosa profunda do membro inferior - a propósito de um caso clínico
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Veterano, Carlos

; Loureiro, Luís

; Teixeira, Gabriela

; Antunes, Inês

; Veiga, Carlos

; Mendes, Daniel

; Rocha, Henrique

; Castro, João

; Pinto, Pedro Sá

; Almeida, Rui

Angiologia e Cirurgia Vascular

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sep 2020, Volume 16 N. 3 Pages 172 - 175

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Introdução: A técnica criss-cross combina acesso vascular anterógrado e retrógrado da veia poplítea, de modo a obter recanalização venosa em doentes com trombose venosa profunda (TVP) ileofemoral associada a trombose das veias poplítea e gemelares. Caso clínico: Doente do sexo feminino de 57 anos, com antecedentes de histerectomia radical e linfadenectomia de nódulos linfáticos pélvicos em 2013, devido a neoplasia uterina, com consequente linfedema crónico do membro inferior direito. Admitida na urgência por edema grave do membro inferior direito, com 7 dias de evolução. À observação, a paciente apresentava edema da coxa e perna, cianose da perna, dor gemelar, extremidades quentes e pulsos distais palpáveis. Estudo com ecodoppler a objetivar trombose dos eixos venosos do membro inferior direito. Estudo com TC contrastado excluiu extensão proximal do trombo para a veia ilíaca comum direita ou veia cava; excluiu tromboembolismo pulmonar e evidenciou clips cirúrgicos em proximidade com a veia ilíaca externa direita, causando uma respetiva redução luminal superior a 50%. A doente foi submetida a trombectomia e fibrinólise dirigida por cateter. Obteve-se acesso vascular através de punção ecoguiada da veia poplítea. Após colocação de introdutores em sentido retrógrado e anterógrado, realizou-se trombectomia das veias gemelares até à veia femoral comum, com recurso a aspiração por cateter. Instituiu-se perfusão de alteplase e heparina não fracionada por via periférica, mantidas durante 72 horas, com controlo angiográfico a cada 24h. Após recanalização satisfatória, realizou-se angioplastia com balão 14x40mm, seguida de stent 14x80mm na veia ilíaca externa. Não ocorreram complicações hemorrágicas major. O tratamento invasivo foi complementado com drenagem postural e meia elástica compressiva, permitindo melhoria clínica imediata e progressiva. Após dois dias, a doente recebeu alta medicada com heparina de baixo peso molecular. Em consulta de follow-up após um mês, constatou-se melhoria clínica progressiva e alterada hipocoagulação para rivaroxabano ad aeternum. Conclusão: A técnica de criss-cross permite recanalização do inflow e outflow, restaurando patência venosa e mantendo a função valvular, aspetos com eventual papel crítico nos resultados após TVP ileofemoral extensa.

Introduction: The criss cross technique combines antegrade and retrograde vascular access to the popliteal vein in order to achieve venous recanalization in patients with acute iliofemoral deep venous thrombosis (DVT) with concomitant popliteal and calf vein thrombosis. Case report: We report a 57-year-old female, with a background of radical hysterectomy and pelvic lymphadenectomy in 2013 due to uterine tumour, resulting in right lower limb chronic lymphedema. Admitted in the emergency service due to severe right lower limb oedema, beginning 7 days before. Upon observation the patient presented severe leg and thigh oedema, leg cyanosis, swollen and painful calf, warm extremities and palpable peripheral pulses. Venous ultrasound exposed thrombosis of the lower limb veins. Contrast CT confirmed the ultrasound findings, excluded proximal extension of the thrombus to the right common iliac vein or the vena cava, excluded pulmonary thromboembolism and exposed surgical staples in close relation with the right external iliac vein causing a >50% luminal reduction. The patient underwent thrombectomy and catheter directed thrombolysis. Venous access was obtained with ultrasound-guided popliteal vein puncture. After anterograde and retrograde sheaths placed in the popliteal vein, thrombectomy using catheter aspiration was performed in the calf veins and up to the common femoral vein. Thrombolytic infusion with alteplase and peripheral unfractionated heparin infusion was initiated and maintained for 72 hours with a control phlebography performed every 24 hours. We achieved satisfactory recanalization and performed an angioplasty with a 14x40mm balloon followed by a 14x80mm stent deployment on the external iliac vein. There were no major haemorrhagic complications. The invasive treatment was complemented with postural drainage and compressive stockings, leading to an immediate and progressive clinical improvement. Two days later the patient was discharged and prescribed a low molecular weight heparin. A month later, on a scheduled appointment, progressive clinical improvement was reported and life-long rivaroxaban prescribed. Conclusion: The criss-cross technique allows for inflow and outflow thrombus removal, restoring venous patency and maintenance of valve function which may play a critical part on the outcome after iliofemoral DVT.

458 downloads

15.

Thoracic tomographic manifestations in symptomatic respiratory patients with COVID-19
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Farias, Lucas de Pádua Gomes de

; Strabelli, Daniel Giunchetti

; Fonseca, Eduardo Kaiser Ururahy Nunes

; Loureiro, Bruna Melo Coelho

; Nomura, Cesar Higa

; Sawamura, Márcio Valente Yamada

Radiologia Brasileira

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aug 2020, Volume 53 N. 4 Pages 255 - 261

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo A doença pelo novo coronavírus (COVID-19) teve epicentro na China e rapidamente se espalhou pelos demais países asiáticos e, posteriormente, para os países ocidentais, sendo definida como pandemia pela Organização Mundial da Saúde. O diagnóstico da COVID-19 é primariamente dependente da pesquisa do vírus nas vias aéreas superiores, mas os kits para sua confirmação ainda são limitados, não apresentam sensibilidade elevada e os resultados são demorados. Nesse cenário, a tomografia computadorizada surge como método eficiente e disponível e com alta sensibilidade, cabendo a nós radiologistas reconhecer prontamente os achados relacionados a essa doença. O objetivo deste artigo é demonstrar os principais achados tomográficos de tórax em pacientes sintomáticos respiratórios infectados pela COVID-19, de modo a auxiliar os colegas nesse momento crítico.

Abstract China was the epicenter for the novel coronavirus disease (COVID-19), which quickly spread to other Asian countries and later to Western countries; subsequently, COVID-19 was categorized as a pandemic by the World Health Organization. Diagnosis primarily depends on viral detection in respiratory samples; however, available kits are limited, lack high sensitivity, and have a long turnaround time for providing results. In this scenario, computed tomography has emerged as an efficient and available high-sensitivity method, allowing radiologists to readily recognize findings related to COVID-19. The objective of this article is to demonstrate the main tomographic findings in symptomatic respiratory patients with COVID-19 to assist medical professionals during this critical moment.

https://doi.org/10.1590/0100-3984.2020.0030 19851 downloads

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