Is Serotonin the Missing Link between COVID-19 Course of Severity in Patients with Diabetes and Obesity?

COVID-19 is an intriguing infectious condition with multisystemic manifestations and variable outcomes that are influenced by the concomitant presence of non-communicable diseases, such as obesity, diabetes, and cardiovascular disease, which were previously well established epidemics and therefore are considered global syndemics. Although an enormous progress towards understanding mechanisms of SARS-CoV-2 infection leading to COVID-19 has been made, there are still many areas of uncertainty to clarify. Systemic diseases are characterized by common links that allow integrating apparently unrelated disease manifestations. The authors launch the provocative hypothesis that serotonin is the putative mediator linking the lung, gut, cardiac, neurological, and other systemic manifestations that characterize severe COVID-19 in individuals with diabetes and obesity. In support of a role for serotonin in the mechanisms leading to disease severity are the similarities between acute and post-acute COVID-19 manifestations and neuroendocrine tumors presenting with carcinoid syndrome. Scientific discussion is set by highlighting the available clues that support this working hypothesis to trigger future research aimed at unravelling the molecular pathways underlying SARS-CoV-2 infection that are still far from being fully disclosed.

Solitary fibrous tumor of the pleura: A giant finding, a benign entity?

Solitary fibrous tumor of the pleura (SFTP) is a rare tumor. The prognosis is relatively good, but up to 20% of the cases are malignant. We presented a case of a large mass of the thorax, showing malignant poor prognosis features. A 73-year-old male, former smoker, presented with a history of dry cough. Chest CT revealed a left bronchopulmonary mass (11 cm × 14 cm) extending from the costal pleura to the left hilum. Histopathologic examination of the transbronchial lung biopsy was consistent with SFTP. A left pneumonectomy was performed due to invasive nature of the lesion. According to features associated to poor prognosis (lung tumor ≥ 10 cm, hipercellularity, abundant intratumor blood vessels and areas of necrosis), and in spite of proliferation index (Ki67+) <1%, the case was discussed in a multidisciplinary meeting, and was assumed to be malignant. At the present time, the patient is his fifth month after surgery, in tight follow up. This case highlights a rare SFTP presenting bad prognosis features, that although completely resected should have long-term follow-up due to the high risk of recurrence.

DELAYED PRESENTATION OF FOREIGN BODY ASPIRATION IN ADULTS.

Foreign body (FB) aspiration in adults is usually associated with predisposing risk factors. Clinical manifestations are immediate but less frequently it could lead to insidious lung damage, as demonstrated by the presented case. We present a case of unsuspected FB aspiration, mimicking an infection vs lung tumour. After left lower lobectomy, pathology revealed a foreign body (animal bone) at the origin of the lingular bronchus.

Agenesia pulmonar / Pulmonary Agenesis

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Pulmonary Fibrosis Secondary to Oxaliplatin Treatment: From Rarity to Reality: A Case Study and Literature Review.

Oxaliplatin-based chemotherapy has been widely used to treat colorectal cancer. Here, we report a case of a 71-year-old man, former smoker (40 pack-years), with no history of relevant exposures such as occupational, environmental or drug exposure. The patient developed acute partial respiratory insufficiency concomitant with the eighth cycle of adjuvant chemotherapy with oxaliplatin and capecitabine for stage IIIA colorectal adenocarcinoma. After the exclusion of other causes, namely pulmonary thromboembolism, high-resolution chest computed tomography (CT) showed a usual interstitial pneumonia (UIP) pattern. After the discussion at the multidisciplinary meeting on interstitial lung diseases and considering the temporal association between clinical and imaging findings and chemotherapy treatment, along with exclusion of other potential causes, the most likely hypothesis was pulmonary fibrosis secondary to oxaliplatin. A literature review on this scope was also performed. We conclude that pulmonary fibrosis is a rare complication of oxaliplatin, but with the widespread use of oxaliplatin combinations in colorectal cancer, active assessment for interstitial lung disease is recommended.

Bilateral Isolated Phrenic Neuropathy: a Rare Cause of Dyspnoea.

Bilateral diaphragm paralysis due to bilateral isolated phrenic neuropathy (BIPN) is a very rare cause of unexplained respiratory failure. We present a 65-year-old patient with no relevant previous medical history who presented in the Pulmonology Clinic with mMRC1 dyspnoea and orthopnoea. After the medical work-up, diaphragmatic paresis was diagnosed. Inspiratory muscle training resulted in mild symptomatic improvement and treatment with noninvasive mechanical ventilation (NIV) was initiated. This condition is generally chronic and has a poorer prognosis, compared to other cases of phrenic nerve involvement. In this case, NIV restored near-normal daily function. LEARNING POINTS: Besides being a rare cause of dyspnoea, diaphragmatic dysfunction should be considered in the medical evaluation.Noninvasive mechanical ventilation is the mainstay of treatment for symptomatic patients.Neurologic and electrodiagnostic evaluation is essential, since the differential diagnosis of phrenic nerve dysfunction may imply different treatment strategies.

Primary Pulmonary MALT Lymphoma: A Case Report and Literature Review.

BACKGROUND: Primary pulmonary MALT (mucosa-associated lymphoid tissue) lymphoma is a rare entity that imposes a rigorous and demanding diagnostic work-up. CASE REPORT: We present the case of a 74-year-old female non-smoker with a previous healed pulmonary tuberculosis and a history of arterial hypertension and fibromyalgia. She was referred to the pulmonology clinic to investigate a right inferior lobe (RIL) rounded pulmonary opacity (4 × 3.4 cm) identified on a previous thoracic CT scan performed for unrelated reasons. The remaining findings were non-specific and included small calcified mediastinal and hepatic adenopathies and multiple calcified hepatosplenic foci. The 18F-FDG-PET revealed high 18F-FDG uptake at the RIL lesion (SUV 4.7), suspicious for neoplastic involvement. Flexible bronchoscopy and CT-guided transthoracic needle biopsy were non-diagnostic and she was submitted to videothoracoscopy with surgical biopsy. The histological and immunohistochemical examination of the clear margin RIL segmentectomy were in keeping with a MALT lymphoma. CONCLUSION: The authors present this case to highlight this rare entity, which is particularly challenging to diagnose due to non-specific multimodality imaging features, frequently implying more invasive procedures and surgical biopsy for a final diagnosis.

Brain extraction in partial volumes T2*@7T by using a quasi-anatomic segmentation with bias field correction.

BACKGROUND: Poor brain extraction in Magnetic Resonance Imaging (MRI) has negative consequences in several types of brain post-extraction such as tissue segmentation and related statistical measures or pattern recognition algorithms. Current state of the art algorithms for brain extraction work on weighted T1 and T2, being not adequate for non-whole brain images such as the case of T2*FLASH@7T partial volumes. NEW METHOD: This paper proposes two new methods that work directly in T2*FLASH@7T partial volumes. The first is an improvement of the semi-automatic threshold-with-morphology approach adapted to incomplete volumes. The second method uses an improved version of a current implementation of the fuzzy c-means algorithm with bias correction for brain segmentation. RESULTS: Under high inhomogeneity conditions the performance of the first method degrades, requiring user intervention which is unacceptable. The second method performed well for all volumes, being entirely automatic. COMPARISON WITH EXISTING METHODS: State of the art algorithms for brain extraction are mainly semi-automatic, requiring a correct initialization by the user and knowledge of the software. These methods can't deal with partial volumes and/or need information from atlas which is not available in T2*FLASH@7T. Also, combined volumes suffer from manipulations such as re-sampling which deteriorates significantly voxel intensity structures making segmentation tasks difficult. The proposed method can overcome all these difficulties, reaching good results for brain extraction using only T2*FLASH@7T volumes. CONCLUSIONS: The development of this work will lead to an improvement of automatic brain lesions segmentation in T2*FLASH@7T volumes, becoming more important when lesions such as cortical Multiple-Sclerosis need to be detected.

Tricobezoar gástrico gigante: relato de caso e revisão da literatura / Giant gastric trichobezoar: a case report and literature review

Os autores descrevem um caso de massa abdominal epigástrica palpável associada a sintomas dispépticos em uma paciente jovem sem antecedentes patológicos. Estudos por imagem evidenciaram corpo estranho gástrico de "aspecto enovelado". A paciente foi submetida a gastrotomia via laparotomia, com retirada de um tricobezoar de 1.950 gramas.

The authors describe the case of a palpable epigastric mass associated with dyspeptic symptoms in a young female patient with no previous pathologic history. Imaging studies demonstrated the presence of a gastric foreign body with an "entangled appearance". The patient underwent laparotomy and gastrotomy for removal of a trichobezoar weighing 1,950 grams.

Embolização arterial uterina para tratamento de miomas. Experiência preliminar do Hospital Semper / Uterine artery embolization for treatment of leomyomata uteri. A review of the literature and the initial results of Semper Hospital

A embolização arterial uterina (EAU) para tratamento de miomas através do cateterismo seletivo das artérias uterinas tem-se estabelecido como uma opção eficaz, segura e minimamente invasiva. Neste artigo, fazemos revisão bibliográfica sobre o assunto no período compreendido entre 1994 e 2003, tomando como base o banco de dados da LILACS/BIREME, e apresentamos a experiência preliminar inicial do Serviço de Hemodinântica do Hospital Semper em Belo Horizonte.

Purposes: to make a review of the literature on uterine arterial embolization for the treatment of symptomatic uterine, leiomyomata and present the initial results of Semper Hospital in Belo Horizonte, Brazil. Methods: medical publications on the subject were analized, from the first publication in 1996, until July 2003, considering the LILACS/BIREME database. We also made a retrospective study of the first 19 patients treated with this approach at Semper Hospital, in Belo Horizonte, analyzing the technical aspects recorded in CD and consulting the medical and ultrassonographic patient records. Results: technical success, defined as selective catheterization and embolization of both uterine arteries, was reached in 100% of patients (n=19). Sixteen of the seventeen patients with menorrhage (94,1%) recovered normal menstrual cycles. Pelviv pain and symptoms of organ compression disappeared in all the patients that presented these symptoms before the procedure. The hemoglobin levels rose from 6.0 - 11.2 g/dl on admission to 12.2 - 14.1 g/dl on the 6 month follow-up. Conclusion: Particulate uterine arterial embolization now constitutes a safe and effective alternative to hysterectomy or myomectomy for the treatment of uterine leiomyomata.