Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay / Diagnósticos diferenciais de opacidade em vidro fosco aguda na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

RESUMO A opacidade em vidro fosco é uma alteração muito frequente e pouco específica na tomografia computadorizada de tórax. Ela admite grande leque de diagnósticos diferenciais no contexto agudo, desde pneumonias virais, como as causadas pelo vírus influenza, pela doença do coronavírus 2019 e pelo citomegalovírus, até mesmo lesões de origem não infecciosa, como vaping , infarto pulmonar, hemorragia alveolar e edema pulmonar. Para essa diferenciação diagnóstica, deve-se correlacionar o vidro fosco com os demais achados nos exames de imagem, exames laboratoriais e quadro clínico do paciente. É de suma importância, no contexto de pandemia, recordar as demais patologias com os achados semelhantes aos da doença do coronavírus 2019 nos exames de imagem.

Abdominal symptoms as initial manifestation of COVID-19: a case series / Sintomas abdominais como manifestação inicial da COVID-19: uma série de casos

ABSTRACT The COVID-19 became a pandemic in early 2020. It was found, at first, that the main manifestations of this new virus occur through respiratory and constitutional symptoms. Therefore, chest tomography was elected as the best imaging test to assess the extent of pulmonary involvement and as a good prognostic predictor for the disease. However, as new studies were produced, the gastrointestinal involvement of COVID-19 becomes more evident, with reports from patients who manifested mainly or only gastrointestinal symptoms in the course of the disease. Thus, in some cases, the initial investigation is carried out at the emergency department with an abdominal computed tomography. We report a case series of ten patients who came to the emergency department of our institution with a chief gastrointestinal complaint, and were initially submitted to an abdominal computed tomography as the first investigation. Although most of the patients did not have significant changes in the abdominal images, most reported patients had pulmonary findings visualized at the lung bases, which were later designated as typical COVID-19 pulmonary findings on chest computed tomography. Only one patient had atypical COVID-19 lung changes on chest computed tomography. All patients had a positive real-time polymerase chain reaction for COVID-19. It is imperative to alert radiologists, especially abdominal radiologists, with the possibility of COVID-19 isolated gastrointestinal symptoms. Besides, it must become a habit to radiologists to assess the pulmonary basis on abdominal scans, a site commonly affected by the new coronavirus.

RESUMO A COVID-19 foi declarada uma pandemia no início de 2020. Constatou-se, inicialmente, que as principais manifestações desse novo vírus ocorrem por meio de sintomas respiratórios e constitucionais. A tomografia do tórax foi eleita o exame de imagem para avaliar a extensão do comprometimento pulmonar e como um fator preditivo do prognóstico para a doença. No entanto, à medida que novos estudos são produzidos, o envolvimento gastrointestinal da COVID-19 torna-se mais evidente, com relatos de pacientes que manifestaram principalmente ou apenas sintomas gastrointestinais no decorrer da doença. Em alguns casos, a investigação inicial é realizada no pronto-socorro, com tomografia computadorizada do abdome. Relatamos uma série de casos de dez pacientes que compareceram ao serviço de emergência da instituição com uma queixa principal gastrointestinal e foram submetidos inicialmente a uma tomografia computadorizada de abdome como primeira investigação. Embora a maioria dos pacientes não tenha apresentado alterações significativas nas imagens abdominais, eles apresentaram achados pulmonares visualizados nas bases pulmonares, que depois foram caracterizadas como achados pulmonares típicos de COVID-19 nas tomografias de tórax subsequentes. Apenas um paciente apresentou achados atípicos para COVID-19 na tomografia. Todos os pacientes tiveram reação em cadeia da polimerase em tempo real positiva para o novo coronavírus. É muito importante alertar os radiologistas, principalmente os radiologistas abdominais, da possibilidade de sintomas gastrointestinais isolados no contexto da COVID-19. Além disso, deve ser um hábito para todos os radiologistas avaliar as bases pulmonares nas tomografias de abdome, local comumente afetado pela COVID-19.

COVID-19 findings identified in chest computed tomography: a pictorial essay / Achados da COVID-19 identificados na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT The disease caused by the new coronavirus, or COVID-19, has been recently described and became a health issue worldwide. Its diagnosis of certainty is given by polymerase chain reaction. High-resolution computed tomography, however, is useful in the current context of pandemic, especially for the most severe cases, in assessing disease extent, possible differential diagnoses and searching complications. In patients with suspected clinical symptoms and typical imaging findings, in which there is still no laboratory test result, or polymerase chain reaction is not available, the role of this test is still discussed. In addition, it is important to note that part of the patients present false-negative laboratory tests, especially in initial cases, which can delay isolation, favoring the spread of the disease. Thus, knowledge about the COVID-19 and its imaging manifestations is extremely relevant for all physicians involved in the patient care, clinicians or radiologists.

RESUMO A doença causada pelo novo coronavírus, ou COVID-19, foi descrita recentemente e tornou-se uma questão de saúde mundial. Seu diagnóstico de certeza é dado pela reação em cadeia da polimerase. A tomografia computadorizada de alta resolução, entretanto, mostra-se útil no contexto atual de pandemia, especialmente nos casos mais graves, na avaliação da extensão da doença, em possíveis diagnósticos diferenciais e na pesquisa de complicações. Em pacientes com quadro clínico suspeito e achados de imagem típicos, nos quais ainda não há resultado laboratorial ou a reação em cadeia da polimerase não se encontra disponível, ainda se discute o papel desse exame. Importante ressaltar que parte dos pacientes apresenta exames laboratoriais falsos-negativos, notadamente em casos iniciais, o que pode retardar medidas de isolamento, favorecendo a propagação da doença. Dessa forma, o conhecimento da COVID-19 e de suas manifestações nos exames de imagem é de extrema importância para os médicos envolvidos no atendimento, sejam clínicos ou radiologistas.

Technological Aspect of Basic Clinical Training in Primary Care Medicine / 医学教育

The main purpose of basic clinical training for housestaff is to acquire the ability to be a primary physician who can properly manage acute medical problems, develop intimate bonds with patients, and provide them with continuous care. We emphasize the importance of training in the office, clinic, or patients' homes. Although residents have so far spent most of their clinical rotations in an inpatient setting, a training program that devotes substantial time to ambulatory care is indispensable to improve basic clinical training in primary care medicine.

Studies on the Physical Fitness of Farmers / 日本農村医学会雑誌

A questionnaring was conducted on farmers in Akita Prefecture who went in for sports in the intervals of farming. Notably one group of farmers who answered that they took regular exercise showed the following results:<BR>1. The self-consciousness of being healthy and having good physical fitness is by far more intense in this group than in the groups of farmers who took irregular or occasional excercises.<BR>2. The chief reasons why they continued to practice sports were:<BR>a. that they had developed closer friendship among them through sporting activities.<BR>b. that they obtained a good understanding and cooperation from the rest of the family members.<BR>c. that they had leisure time.<BR>3. To find time for sports they saved, above all else, their farming hours, indoor leisure time and homekeeping hours.<BR>4. General endurance, agility and balance were the top three qualities of physical fitness that the greatest number of the farmers referred to as essential to modern farming. Further inquiry will be required into sports which might help to develop these qualities.

STUDIES ON THE PHYSICAL FITNESS OF FARMERS / 日本農村医学会雑誌

After our comparative investigation of the farmers' and non-farmers' consciousness of their physical fitness, exercises and health in Aomori Prefecture, the following results were obtained:<BR>(1) As to the cognitive level for their state of health, no marked difference was found between the two groups.<BR>(2) There was also no notable difference between the two as to the cognitive level for their physical fitness. There was, however, a contradiction among the weak farmers, many of whom answered that they were satisfied with their present physical fitness.<BR>(3) As compared with the number of non-farmers, significantly greater number of farmers identified the physical fitness with the endurance of physical labor and the holding ability of the weight. In other words, many farmers simply regarded their physical fitness as their muscular ability.<BR>(4) The number of farmers who really understand the necessity of exercises was significantly smaller than the non-farmer.<BR>(5) In order to strengthen the physical fitness, it is fundamentally necessary for farmers to get more leisure through the improvement of liveng conditions, to be well equipped with facilities for physical culture and to have good physical training leaders properly chosen.

Studies on the Physical Fitness of Farmers / 日本農村医学会雑誌

Recently a deep concern has been shown for the decline of physical fitness of Japanese people. There are many studies on physical fitness of the common people but few on farmers in Japan. The purpose of this study was to take the steps towards establishing the physical fitness norms for Japanese farmers. The statistical analysis was conducted using the records on their physique and motor ability measured on 3, 452 persons aged 20-70, during 1972-1974 years, in the agricultural regions designated by the Ministry of Agriculture and Forestry.<BR>The results obtained were as follows:<BR>1) In stature, the males were nearly equal to that of a standard from Japanese people while the female were slightly inferior. In weight, both males and females were inferior to that of the standard. This tendency is remarkable in the following order: mountain farmers>flatland farmers>suburban farmers. Farmers in Tohoku District were generally short of stature and broad of chest.<BR>2) Farmers were inferior to that of the standard in foot-balance and side steps but were superior in push-ups and endurance walk, the capacities of which lower less with their ages than in the cases of other persons. This tendency is exhibited in the same order as mentioned in 1).<BR>3) Since such tests involving pain as endurance walk have a problem as to their reliability, further investigation should be required.

STUDIES ON JAPANESE FOLK-DANCE / 体力科学

In order to study the relative metabolic rate and its relations with the heart rate in Japanese folk-dance “Min-Yo”, nine popular varieties of “Min-Yo” of Akita and Aomori, composed from the recreational point of view, were selected and examined by Douglas Bag method, and at the same time the appearance frequency of the movement of the dances was analyzed from the physiological point of view.<BR>Results obtained were as follows :<BR>1) The degrees of the relative metabolic rate of the dances were middle or heavy, and among them “Akita Ondo” showed the highest valve, 3.95±0.89, and “Hachinohe-Kouta” showed the lowest, 2.39 ± 0.24. Individual variations were noticed even with the same dance, and skillful dancers showed higher values than less skillful ones.<BR>2) As for the changes in heart rate, dances with higher relative metabolic rate show higher heart level in exercise, and those with lower rate showed lower changes. The coefficient of correlation of relative metabolic rate (heart rate in exercise/heart rate at rest × 100) with heart rate index showed a high value, r=0.973 (p<0.01) . The regression line of the latter (y) against the former (x) was, y=0.065x-5.75.<BR>3) Analysis of the movement showed that regardless of the dancing time, dances with high relative metabolic rates involved more intense bodily movement and greater motions, and that those with lower rates involved lighter movement and smaller motions even when the appearance frequency of movement was high.