COVID-19 is a multisystem disease that presents acute and persistent symptoms, the postacute sequelae (PASC). Long-term symptoms may be due to consequences from organ or tissue injury caused by ...SARS-CoV-2, associated clotting or inflammatory processes during acute COVID-19. Various strategies are being chosen by clinicians to prevent severe cases of COVID-19; however, a single treatment would not be efficient in treating such a complex disease. Mesenchymal stromal cells (MSCs) are known for their immunomodulatory properties and regeneration ability; therefore, they are a promising tool for treating disorders involving immune dysregulation and extensive tissue damage, as is the case with COVID-19. This study aimed to assess the safety and explore the long-term efficacy of three intravenous doses of UC-MSCs (umbilical cord MSCs) as an adjunctive therapy in the recovery and postacute sequelae reduction caused by COVID-19. To our knowledge, this is one of the few reports that presents the longest follow-up after MSC treatment in COVID-19 patients.
This was a phase I/II, prospective, single-center, randomized, double-blind, placebo-controlled clinical trial. Seventeen patients diagnosed with COVID-19 who require intensive care surveillance and invasive mechanical ventilation-critically ill patients-were included. The patient infusion was three doses of 5 × 10
cells/kg UC-MSCs, with a dosing interval of 48 h (n = 11) or placebo (n = 6). The evaluations consisted of a clinical assessment, viral load, laboratory testing, including blood count, serologic, biochemical, cell subpopulation, cytokines and CT scan.
The results revealed that in the UC-MSC group, there was a reduction in the levels of ferritin, IL-6 and MCP1-CCL2 on the fourteen day. In the second month, a decrease in the levels of reactive C-protein, D-dimer and neutrophils and an increase in the numbers of TCD3, TCD4 and NK lymphocytes were observed. A decrease in extension of lung damage was observed at the fourth month. The improvement in all these parameters was maintained until the end of patient follow-up.
UC-MSCs infusion is safe and can play an important role as an adjunctive therapy, both in the early stages, preventing severe complications and in the chronic phase with postacute sequelae reduction in critically ill COVID-19 patients. Trial registration Brazilian Registry of Clinical Trials (ReBEC), UTN code-U1111-1254-9819. Registered 31 October 2020-Retrospectively registered, https://ensaiosclinicos.gov.br/rg/RBR-3fz9yr.
The coronavirus pandemic is one of the most significant public health events in recent history. Currently, no specific treatment is available. Some drugs and cell-based therapy have been tested as ...alternatives to decrease the disease’s symptoms, length of hospital stay, and mortality. We reported the case of a patient with a severe manifestation of COVID-19 in critical condition who did not respond to the standard procedures used, including six liters of O2 supplementation under a nasal catheter and treatment with dexamethasone and enoxaparin in prophylactic dose. The patient was treated with tocilizumab and an advanced therapy product based on umbilical cord-derived mesenchymal stromal cells (UC-MSC). The combination of tocilizumab and UC-MSC proved to be safe, with no adverse effects, and the results of this case report prove to be a promising alternative in the treatment of patients with severe acute respiratory syndrome due to SARS-CoV-2.
Background. Identifying the inferior laryngeal nerve is one of the main concerns in thyroid surgery. The typical recurrent position occurs due the relative position between the vagus nerve and the ...larynx during the last 3 branchial arches development. In rare cases, this nerve does not loop under the right subclavian artery or the aortic arch. This abnormality is present in 0.7% of patients and is associated with the presence of anatomical vascular anomalies. The left non-recurrent inferior laryngeal nerve is an even rarer abnormality, with only six cases described in the literature to date. Method. A 46- years old female patient referred to total thyroidectomy for symptomatic multinodular benign goiter. Results. A left non-recurrent inferior laryngeal nerve was found with difficulty and then a partial thyroidectomy was performed. CT scan showed dextroposition of the vessels of the base of the heart and an aberrant left subclavian artery. Conclusion. An association of a right-sided aortic arch and aberrant left subclavian artery, or the presence of situs inversus, although rare anatomical variations, are associated to a non-recurrent inferior left laryngeal nerve. Proper identifying these abnormalities may help to properly identify and salvage this structure.
Bronchiectasis are abnormal permanently dilated bronchi which lead to chronic cough and other respiratory symptoms. Though tuberculosis (TB) is a common cause of bronchiectasis, data on this ...association are scarce. The objective of this study was to describe the profile of patients with post-TB bronchiectasis at a tertiary hospital in the southern region of Brazil. This was a retrospective study with data from patients in follow-up at our hospital from January 2005 to December 2020. We included patients 14 years of age or older who had bronchiectasis on chest computed tomography and a history of pulmonary TB. We excluded patients with bronchiectasis due to other causes or with confirmed non-tuberculous mycobacteria infection. We included 54 of the 204 non-cystic fibrosis bronchiectasis patients seen at our hospital during the study period. Most of the patients were female, older, and non-smokers. Less than a third had chronic bronchial infection by some agent. More than two thirds had some type of ventilatory defect, the most common being obstruction. More than half had upper-lobe impairment. Severity of the disease seemed to be equally distributed from mild to severe. Treatment was varied, including bronchodilators, inhaled corticosteroids, and azithromycin. We found that the profile of patients in our hospital is similar to that described in other studies, with slight differences in regard to microbiology and treatment.
Background and Purpose
Precise evaluation of brain computerized tomography (CT) is a crucial step in acute ischemic stroke evaluation. Electronic Alberta Stroke Program Early CT Score (E‐ASPECTS) ...helps in the selection of patients who may be eligible for thrombolysis. This paper seeks to assess the performance of emergency physicians (EPs) in the evaluation of ASPECTS scores with and without the use of E‐ASPECTS and to compare their results with neuroradiologists.
Methods
A total of 116 patients were selected. Initially, two EPs and two neuroradiologists evaluated the admission nonenhanced CT without E‐ASPECTS. Then, after 30 days, they re‐evaluated the images using E‐ASPECTS. Sensitivity, specificity, Matthew's correlation coefficients (MCC), and receiver operating characteristic curves were generated for analysis before and after the software use.
Results
Eps’ performances improved when they used E‐ASPECTS, with their results closer to those obtained by neuroradiologists. In the initial evaluation, MCC values for the two EPs were –0.01 and 0.04, respectively. After the software assistance, they obtained 0.38 and 0.43, respectively, which was closer to the scores obtained by the neuroradiologists (0.53 and 0.39, respectively).
Discussion
This is the first study that has specifically compared neuroradiologists’ and EPs’ performances before and after using E‐ASPECTS. E‐ASPECTS assisted and improved the evaluation of the images of patients with acute ischemic stroke.
Conclusion
Artificial intelligence in the emergency room may increase the number of patients treated with tissue‐type plasminogen activators.
Background. The effects of dose reduction in lung nodule detection need better understanding. Purpose. To compare the detection rate of simulated lung nodules in a chest phantom using different ...computed tomography protocols, low dose (LD), ultralow dose (ULD), and conventional (CCT), and to quantify their respective amount of radiation. Materials and Methods. A chest phantom containing 93 simulated lung nodules was scanned using five different protocols: ULD (80 kVp/30 mA), LD A (120 kVp/20 mA), LD B (100 kVp/30 mA), LD C (120 kVp/30 mA), and CCT (120 kVp/automatic mA). Four chest radiologists analyzed a selected image from each protocol and registered in diagrams the nodules they detected. Kruskal–Wallis and McNemar’s tests were performed to determine the difference in nodule detection. Equivalent doses were estimated by placing thermoluminescent dosimeters on the surface and inside the phantom. Results. There was no significant difference in lung nodules’ detection when comparing ULD and LD protocols (p=0.208 to p=1.000), but there was a significant difference when comparing each one of those against CCT (p<0.001). The detection rate of nodules with CT attenuation values lower than −600 HU was also different when comparing all protocols against CCT (p<0.001 to p=0.007). There was at least moderate agreement between observers in all protocols (κ-value >0.41). Equivalent dose values ranged from 0.5 to 9 mSv. Conclusion. There is no significant difference in simulated lung nodules’ detection when comparing ULD and LD protocols, but both differ from CCT, especially when considering lower-attenuating nodules.
The rapid evaluation of non-contrast-enhanced computed tomography (NCCT) brain scans in patients with anterior stroke symptoms saves time and favors optimal and prompt treatment. e-ASPECTS is a tool ...that automatically calculates the Alberta Stroke Program Early CT Score (ASPECTS) values, leading to a more accurate and timely image evaluation.
To determine the ability of e-ASPECTS in differentiating images with and without injury.
One-hundred sixteen patients admitted to a stroke unit in a Brazilian tertiary hospital underwent a CT scan at admission and at least one control brain imaging (NCCT or magnetic resonance imaging - MRI) 24 hours after admission. ASPECTS evaluation was performed by three neuroradiologists, three neurologists, and three neurology residents, all blinded to the symptoms and the injury side. The scores were compared to the ground truth, and an ASPECTS score was provided by two independent non blinded evaluators. Sensitivity and specificity were analyzed, and receiver operating characteristic curves, Bland-Altman plots with mean error score, and Matthews correlation coefficients (MCCs) were obtained for ASPECTS scores, assuming values equal to 10 for images without injury and values other than 10 for images with ischemic injury.
e-ASPECTS demonstrated similar performance to that of neuroradiologists and neurologists, with an area under the curve of 0.78 and an MCC value of 0.48 in the dichotomous analysis. The sensitivity and specificity of e-ASPECTS were 75% and 73%, respectively.
e-ASPECTS is a validated and reliable tool for determining early signs of ischemia in NCCT.
Resumo Objetivo: Testar o desempenho do ChatGPT em questões de radiologia formuladas pelo Colégio Brasileiro de Radiologia (CBR), avaliando seus erros e acertos. Materiais e Métodos: 165 questões da ...avaliação anual dos residentes do CBR (2018, 2019 e 2022) foram apresentadas ao ChatGPT. Elas foram divididas, para análise estatística, em questões que avaliavam habilidades cognitivas de ordem superior ou inferior e de acordo com a subespecialidade, o tipo da questão (descrição de um achado clínico ou sinal, manejo clínico de um doente, aplicação de um conceito, cálculo ou classificação dos achados descritos, associação entre doenças ou anatomia) e o ano da residência (R1, R2 ou R3). Resultados: O ChatGPT acertou 53,3% das questões (88/165). Houve diferença estatística entre o desempenho em questões de ordem cognitiva inferior (64,4%; 38/59) e superior (47,2%; 50/106) (p = 0,01). Houve maior índice de acertos em física (90,0%; 18/20) do que em questões clínicas (48,3%; 70/145) (p = 0,02). Não houve diferença significativa de desempenho entre subespecialidades ou ano de residência (p > 0,05). Conclusão: Mesmo sem treinamento dedicado a essa área, o ChatGPT apresenta desempenho razoável, mas ainda insuficiente para aprovação, em questões de radiologia formuladas pelo CBR.
Abstract Objective: To test the performance of ChatGPT on radiology questions formulated by the Colégio Brasileiro de Radiologia (CBR, Brazilian College of Radiology), evaluating its failures and successes. Materials and Methods: 165 questions from the CBR annual resident assessment (2018, 2019, and 2022) were presented to ChatGPT. For statistical analysis, the questions were divided by the type of cognitive skills assessed (lower or higher order), by topic (physics or clinical), by subspecialty, by style (description of a clinical finding or sign, clinical management of a case, application of a concept, calculation/classification of findings, correlations between diseases, or anatomy), and by target academic year (all, second/third year, or third year only). Results: ChatGPT answered 88 (53.3%) of the questions correctly. It performed significantly better on the questions assessing lower-order cognitive skills than on those assessing higher-order cognitive skills, providing the correct answer on 38 (64.4%) of 59 questions and on only 50 (47.2%) of 106 questions, respectively (p = 0.01). The accuracy rate was significantly higher for physics questions than for clinical questions, correct answers being provided for 18 (90.0%) of 20 physics questions and for 70 (48.3%) of 145 clinical questions (p = 0.02). There was no significant difference in performance among the subspecialties or among the academic years (p > 0.05). Conclusion: Even without dedicated training in this field, ChatGPT demonstrates reasonable performance, albeit still insufficient for approval, on radiology questions formulated by the CBR.
Abstract Objective: To test the performance of ChatGPT on radiology questions formulated by the Colégio Brasileiro de Radiologia (CBR, Brazilian College of Radiology), evaluating its failures and ...successes. Materials and Methods: 165 questions from the CBR annual resident assessment (2018, 2019, and 2022) were presented to ChatGPT. For statistical analysis, the questions were divided by the type of cognitive skills assessed (lower or higher order), by topic (physics or clinical), by subspecialty, by style (description of a clinical finding or sign, clinical management of a case, application of a concept, calculation/classification of findings, correlations between diseases, or anatomy), and by target academic year (all, second/third year, or third year only). Results: ChatGPT answered 88 (53.3%) of the questions correctly. It performed significantly better on the questions assessing lower-order cognitive skills than on those assessing higher-order cognitive skills, providing the correct answer on 38 (64.4%) of 59 questions and on only 50 (47.2%) of 106 questions, respectively (p = 0.01). The accuracy rate was significantly higher for physics questions than for clinical questions, correct answers being provided for 18 (90.0%) of 20 physics questions and for 70 (48.3%) of 145 clinical questions (p = 0.02). There was no significant difference in performance among the subspecialties or among the academic years (p > 0.05). Conclusion: Even without dedicated training in this field, ChatGPT demonstrates reasonable performance, albeit still insufficient for approval, on radiology questions formulated by the CBR.
Resumo Objetivo: Testar o desempenho do ChatGPT em questões de radiologia formuladas pelo Colégio Brasileiro de Radiologia (CBR), avaliando seus erros e acertos. Materiais e Métodos: 165 questões da avaliação anual dos residentes do CBR (2018, 2019 e 2022) foram apresentadas ao ChatGPT. Elas foram divididas, para análise estatística, em questões que avaliavam habilidades cognitivas de ordem superior ou inferior e de acordo com a subespecialidade, o tipo da questão (descrição de um achado clínico ou sinal, manejo clínico de um doente, aplicação de um conceito, cálculo ou classificação dos achados descritos, associação entre doenças ou anatomia) e o ano da residência (R1, R2 ou R3). Resultados: O ChatGPT acertou 53,3% das questões (88/165). Houve diferença estatística entre o desempenho em questões de ordem cognitiva inferior (64,4%; 38/59) e superior (47,2%; 50/106) (p = 0,01). Houve maior índice de acertos em física (90,0%; 18/20) do que em questões clínicas (48,3%; 70/145) (p = 0,02). Não houve diferença significativa de desempenho entre subespecialidades ou ano de residência (p > 0,05). Conclusão: Mesmo sem treinamento dedicado a essa área, o ChatGPT apresenta desempenho razoável, mas ainda insuficiente para aprovação, em questões de radiologia formuladas pelo CBR.
BackgroundIdentifying the inferior laryngeal nerve is one of the main concerns in thyroid surgery. The typical recurrent position occurs due the relative position between the vagus nerve and the ...larynx during the last 3 branchial arches development. In rare cases, this nerve does not loop under the right subclavian artery or the aortic arch. This abnormality is present in 0.7% of patients and is associated with the presence of anatomical vascular anomalies. The left non-recurrent inferior laryngeal nerve is an even rarer abnormality, with only six cases described in the literature to date. MethodA 46- years old female patient referred to total thyroidectomy for symptomatic multinodular benign goiter. ResultsA left non-recurrent inferior laryngeal nerve was found with difficulty and then a partial thyroidectomy was performed. CT scan showed dextroposition of the vessels of the base of the heart and an aberrant left subclavian artery. ConclusionAn association of a right-sided aortic arch and aberrant left subclavian artery, or the presence of situs inversus, although rare anatomical variations, are associated to a non-recurrent inferior left laryngeal nerve. Proper identifying these abnormalities may help to properly identify and salvage this structure.
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