A predictive score for COVID-19 diagnosis using clinical, laboratory and chest image data

Abstract Objectives Differential diagnosis of COVID-19 includes a broad range of conditions. Prioritizing containment efforts, protective personal equipment and testing can be challenging. Our aim was to develop a tool to identify patients with higher probability of COVID-19 diagnosis at admission. Methods This cross-sectional study analyzed data from 100 patients admitted with suspected COVID-19. Predictive models of COVID-19 diagnosis were performed based on radiology, clinical and laboratory findings; bootstrapping was performed in order to account for overfitting. Results A total of 29% of patients tested positive for SARS-CoV-2. Variables associated with COVID-19 diagnosis in multivariate analysis were leukocyte count ≤7.7 × 103 mm-3, LDH >273 U/L, and chest radiographic abnormality. A predictive score was built for COVID-19 diagnosis, with an area under ROC curve of 0.847 (95% CI 0.77-0.92), 96% sensitivity and 73.5% specificity. After bootstrapping, the corrected AUC for this model was 0.827 (95% CI 0.75-0.90). Conclusions Considering unavailability of RT-PCR at some centers, as well as its questionable early sensitivity, other tools might be used in order to identify patients who should be prioritized for testing, re-testing and admission to isolated wards. We propose a predictive score that can be easily applied in clinical practice. This score is yet to be validated in larger populations.

Síndrome da veia cava superior / Superior vena cava syndrome

Introdução: A síndrome da veia cava superior (SVCS) é uma condição potencialmente grave, principalmente em pacientes acometidas por neoplasias malignas (2 a 4% dos pacientes com neoplasias pulmonares malignas desenvolverão SVCS em algum momento da doença). A obstrução normalmente é gradual, permitindo formação de circulação venosa colateral como fluxo alternativo do sangue ao encontro do átrio direito. Métodos: Revisão narrativa da literatura, a fim de elucidar os aspectos mais importantes sobre a síndrome da veia cava superior. Resultados: O diagnóstico é feito basicamente por sinais e sintomas da obstrução venosa central, tanto clínicos quanto radiológicos, sendo a dispneia o sintoma mais comum. A tomografia computadorizada é o exame de imagem geralmente utilizado para o diagnóstico. O tratamento é voltado para a causa base e alívio dos sintomas. O alívio sintomático pode ser conseguido tanto por terapia clínica quanto intervencionista. O tratamento definitivo é realizado pela terapia oncológica. Conclusão: Em paciente com SVCS por compressão extrínseca por câncer de pulmão não pequenas células, que é a causa mais comum, a SVCS é um forte preditor de mal prognóstico, com sobrevida mediana de cinco meses. Esse artigo visa fazer uma revisão sobre os aspectos clínicos e de diagnóstico e tratamento da SVCS.

Introduction: Superior vena cava syndrome (SVCS) is a potentially serious condition, especially in patients with malignancy, (2 to 4% of patients with malignant lung tumors will develop SVCS at some point in the disease). The obstruction is usually gradual, allowing formation of collateral venous circulation as an alternative blood flow to the right atrium. Methods: Narrative review of the literature in order to elucidate the most important aspects about superior vena cava syndrome. Results: The diagnosis is basically made by signs and symptoms of central venous obstruction, both clinical and radiological, with dyspnea being the most common symptom. Computed tomography is the imaging test usually used for diagnosis. The treatment is geared towards the underlying cause and symptoms relief. Symptomatic relief can be achieved by both clinical and interventional therapy. Definitive treatment is provided by oncologic therapy. Conclusion: In a patient with SVCS by extrinsic compression from non-small cell lung cancer, which is the most common cause, SVCS is a strong predictor of poor prognosis, with a median survival of five months. This article aims to review the clinical presentation, diagnosis and treatment of SVCS.

Imunização nos pacientes em tratamento oncológico / Immunization in patients under oncological treatment

Introdução: A vacinação representa importante impacto na saúde populacional. No paciente oncológico, a importância de um calendário vacinal completo faz-se ainda maior, visto que muitos pacientes tornam-se mais suscetíveis a infecções devido ao estado de imunossupressão facilitado pela neoplasia e pelos tratamentos impostos. Métodos: Revisão de literatura visando elucidar questionamentos relacionados à vacinação em pacientes oncológicos. Resultados: Em geral, as vacinas inativadas são seguras e incapazes de causar infecção, mesmo nos pacientes em vigência de tratamento oncológico. Já as vacinas de vírus vivos atenuados, em imunodeprimidos, são capazes de desencadear um processo infeccioso exacerbado e devem ser aplicadas seguindo algumas regras. Conclusão: Devido às peculiaridades relacionadas à vacinação de pacientes em tratamento oncológico, as orientações para sua implantação devem ser seguidas com atenção visando o benefício do paciente e a prevenção de danos.

Introduction: Vaccination represents an important impact on social health. In oncologic patients, the importance of a complete immunization schedule is even greater, since many patients become more susceptible to infections due to the immunosuppressed state facilitated by neoplasia and by the imposed treatments. Methods: Literature review in order to elucidate questions related to vaccination in cancer patients. Results: In general, inactivated vaccines are safe and unable to cause infection even in patients under oncological treatment. In contrast, live attenuated vaccines in immunosuppressed patient are likely to trigger an exacerbated infectious process and must be applied following a few rules. Conclusion: Due to the peculiarities related to vaccination in patients under oncological treatment, the guidelines for its application must be carefully followed aiming benefit and prevention of harm.