Tomographic score (RAD-Covid Score) to assess the clinical severity of the novel coronavirus infection

ABSTRACT Objectives: The severity of pulmonary Covid-19 infection can be assessed by the pattern and extent of parenchymal involvement observed in computed tomography (CT), and it is important to standardize the analysis through objective, practical, and reproducible systems. We propose a method for stratifying the radiological severity of pulmonary disease, the Radiological Severity Score (RAD-Covid Score), in Covid-19 patients by quantifying infiltrate in chest CT, including assessment of its accuracy in predicting disease severity. Methods: This retrospective, single-center study analyzed patients with a confirmed diagnosis of Covid-19 infection by real-time reverse-transcriptase polymerase chain reaction, who underwent chest CT at hospital admission between March 6 and April 6, 2020. CT scans were classified as positive, negative, or equivocal, and a radiological severity score (RAD-Covid Score) was assigned. Clinical severity was also assessed upon hospital admission. Results: 658 patients were included. Agreement beyond chance (kappa statistic) for the RAD-Covid Score was almost perfect among observers (0.833), with an overall agreement of 89.5%. The RAD-Covid Score was positively correlated with clinical severity and death, i.e., the higher the RAD-Covid Score, the greater the clinical severity and mortality. This association proved independent of age and comorbidities. Accuracy of this score was 66.9%. Conclusions: The RAD-Covid Score showed good accuracy in predicting clinical severity at hospital admission and mortality in patients with confirmed Covid-19 infection and was an independent predictor of severity.

Estudo da disposição anatômica da veia jugular interna, nervos glossofaríngeo, vago e acessório, na abertura inferior do forame jugular / Study of the anatomical arrangement of the internal jugular vein, glossopharyngeal, vagus and accessory nerves at the lower opening of the jugular foramen

Introdução: O forame jugular é uma abertura na base do crânio, entre os ossos occipital e temporal, por onde saem do crânio a veia jugular interna, os nervos cranianos glossofaríngeo, vago e acessório e, eventualmente, o seio petroso inferior. Objetivo: Estudar a disposição dessas estruturas anatômicas na abertura inferior do forame jugular. Métodos: Foram estudados 60 espécimes não formolizados. Resultados: Baseando-se em dados de literatura, foi criada uma classificação com quatro tipos de disposições, encontrando-se em 66,7% o tipo 1, com o nervo acessório cruzando a veia jugular interna pela parede anterior; em 28,3% o tipo 2, com o nervo cruzando a veia por trás; e em 5% o tipo 3, com o seio petroso presente abaixo do forame. O tipo 4, com um canal próprio para o nervo glossofaríngeo, não foi encontrado nesse estudo.

Introduction: The jugular foramen is an opening between the occipital and the temporal bones. Through it the internal jugular vein, the glossopharyngeal nerve, the vagal nerve, and the accessory nerve emerge from the skull, as well as sometimes the inferior petrosal sinus. Objective: To investigate the anatomical disposition of those structures in the exit of the foramen. Methods: Studies of 60 sides of not formalised corpses were made. Results: It was classified in four types, 1, 2, 3, and 4. Type 1 was the most common with the XI cranial nerve crossing the front of the internal jugular vein. It incidence was 66.7%. In type 2 with accessory nerve posterior to the vein the incidence was 28.3%. In type 3 with the inferior petrosal sinus draining in the internal jugular vein below the inferior opening of the jugular foramen the incidence it was 5% of cases, and type 4, with an own canal to the IX cranial nerve, was not observed in this study.