Background Steroid use for COVID-19 is based on the possible role of these drugs in mitigating the inflammatory response, mainly in the lungs, triggered by SARS-CoV-2. This study aimed at evaluating at evaluating the efficacy of methylprednisolone (MP) among hospitalized patients with suspected COVID-19. Methods Parallel, double-blind, placebo-controlled, randomized, phase IIb clinical trial was performed with hospitalized patients aged ≥ 18 years with clinical, epidemiological and/or radiological suspected COVID-19, at a tertiary care facility in Manaus, Brazil. Patients were randomly allocated (1:1 ratio) to receive either intravenous MP (0.5 mg/kg) or placebo (saline solution), twice daily, for 5 days. A modified intention-to-treat (mITT) analysis was conducted. The primary outcome was 28-day mortality. ClinicalTrials Identifier NCT04343729. Findings From April 18 to June 16, 2020, 647 patients were screened, 416 randomized, and 393 analyzed as mITT, MP in 194 and placebo in 199 individuals. SARS-CoV-2 infection was confirmed by RT-PCR in 81.3%. Mortality at day 28 was not different between groups. A subgroup analysis showed that patients over 60 years in the MP group had a lower mortality rate at day 28. Patients in the MP arm tended to need more insulin therapy, and no difference was seen in virus clearance in respiratory secretion until day 7. Conclusion The findings of this study suggest that a short course of MP in hospitalized patients with COVID-19 did not reduce mortality in the overall population.

Dengue fever is the most important arthropod-borne viral infection worldwide. Secondary prevention to reduce mortality through improved clinical case management has substantially lowered the mortality rate for severe dengue during the past two decades. Gallbladder wall thickening (GBWT) is a nonspecific finding often associated with more severe cases of dengue infection. This study had the aim to describe the ultrasonographic findings in hospitalized patients with dengue infection from Manaus (in the Western Brazilian Amazon) and to correlate the GBWT with dengue severity, symptoms and laboratorial analysis. Patients from 13–84 years admitted to the emergency department at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) were enrolled in this study. Patients’ selection occurred during the most recent and huge dengue outbreak within the first semester of 2011. All enrolled subjects were systematically tested in order to rule out other possible etiologies for gallbladder inflammation. Abdominal ultrasound was performed by a single physician through bedside portable equipment and all other clinical and laboratorial information were retrieved from patients’ electronic files. 54 subjects were considered for analysis, with confirmed dengue infection by NS1 and/or RT-PCR positivity. From all enrolled patients, 50 (42.4%) presented GBWT. GBWT was significantly and independently related to: age under 31 years, pregnancy, presence of bleeding, presence of any cavitary effusion, DHF classification and severe dengue classifications. During dengue outbreaks, the GBWT identification through a non-invasive and bedside procedure is a confident marker for prompt recognition of potential severe cases.

No abstract

A infecção pelo Mycobacterium tuberculosis é uma enfermidade clínica em países em desenvolvimento, estando em declínio em nações desenvolvidas. Contudo, nas décadas de 80 e 90, tivemos um retorno da prevalência da doença pela epidemia de HIV/AIDS associado a sua multirresistência. As manifestações extrapulmonares acontecem em poucos casos. A tuberculose mamária é uma condição rara tendo importância pelo diagnóstico diferencial com outras patologias deste orgão 1 .Apresenta uma incidência menor que 0,1% das lesões mamárias analisadas histologicamente 2 4 . A forma nodular pode simular um carcinoma ou abscesso piogênico 3 . A presença de reação granulomatosa pode ter várias hipóteses histológicas, tais como: aspergilose e esquistossomose 3 .O diagnóstico de tuberculose extrapulmonar é feito pelas evidências clínicas, achados laboratoriais sugestivos das formas ativas em pacientes com pelo menos uma cultura positiva para Mycobacterium tuberculosis de material extrapulmonar 4 .De acordo com a literatura, os achados de tuberculose mamária são raros e os relatos na área radiológica não são Aspectos radiológicos da tuberculose primária da mama: relato de caso e revisão de literatura RESUMOA tuberculose mamária é uma enfermidade equivalente a menos que 0,1% das lesões deste órgão. Apresentamos a seguir um caso de nosso serviço discutindo os achados radiológicos da mamografia, ultrassonografia e ressonância magnética, incluindo curvas cinéticas. A tuberculose mamária é uma condição ímpar, sendo importante o relato pelos diagnósticos diferenciais com carcinoma mamário e o abscesso piogênico. Palavras-chaves:Tuberculose. Mama. Infecção. Radiologia. ABSTRACTMammary tuberculosis is an illness accounting for less than 0.1% of breast lesions. We present a case from our service and discuss the radiological findings from mammography, ultrasound scan and magnetic resonance, including kinetic curves. Mammary tuberculosis is an unusual condition and such reports are important in relation to the differential diagnoses versus breast cancer and pyogenic abscess. Key-words:Tuberculosis. Breast. Infection. Radiology.muito extensos. Procuramos neste relato analisar e descrever os achados de imagem na mamografia (MMG), ultrassonografia (US) e ressonância magnética (RM) em paciente acometida de tuberculose primária da mama. A paciente foi submetida a exame clínico, teste do derivado purificado da proteína (PPD), biópsia das lesões com exame histopatológico e exames de imagem incluindo radiografia de tórax, MMG, US e RM, neste último incluindo seqüências ponderadas em T1 e T2 com e sem supressão de gordura no plano sagital e por fim uma seqüência dinâmica pós-contraste de 1 a 5 minutos. Esta enfermidade foi suspeitada pelo quadro clínico insidioso, não tendo sido encontrados outros focos de infecção de tuberculose. A paciente recebeu esquema tríplice tuberculostático com a terapêutica sendo iniciada empiricamente. O seguimento foi feito durante 6 meses por meio de consulta ambulatorial mensal na Fundação de Medicina Tropical do Amazonas. R...