RESUMEN
Background: COVID-19 causes a hypercoagulable state leading to thrombosis. Many of these thrombotic complications occur in those with severe disease and late in the disease course. COVID-19 has recently been associated with cerebral venous thrombosis (CVT). Objective: To study the onset of CVT in relation to COVID-19 and compare their characteristics and outcomes with non-COVID CVT patients admitted during the same period. Materials and Methods: This multicentric, retrospective study conducted between April 4 and October 15, 2020, included adult patients with CVT who were positive for the SARS-CoV-2 virus and compared them with CVT patients who were negative for the SARS-CoV-2 virus hospitalized during the same period. We studied their clinical profile, risk factors for CVT, and markers of COVID coagulopathy, imaging characteristics, and factors influencing their outcomes. Results: We included 18 COVID-19-infected patients and compared them with 43 non-COVID-19 CVT patients. Fourteen patients in the COVID-19 group presented with CVT without the other typical features of COVID-19. Thirteen patients had non-severe COVID-19 disease. Twelve patients had a good outcome (mRS ≤2). Mortality and disability outcomes were not significantly different between the two groups. Conclusion: Our study suggests a possible association between COVID-19 and CVT. CVT can be the presenting manifestation of an underlying COVID-19, occurring early in the course of COVID-19 and even in those with mild disease. Patients with worse GCS on admission, abnormal HRCT chest, severe COVID-19, and need for invasive ventilation had a poor outcome.
Asunto(s)
COVID-19 , Trombosis Intracraneal , Trombosis de la Vena , Adulto , COVID-19/complicaciones , Humanos , Trombosis Intracraneal/complicaciones , Estudios Retrospectivos , SARS-CoV-2 , Trombosis de la Vena/etiologíaRESUMEN
FDG-PET imaging, which is routinely used to assess recurrent breast cancer, is nonspecific for malignancies and can detect several inflammatory lesions. Costochondritis following breast reconstructive surgery, presenting with excruciating chest pain or "chondrodynia," is a rare variant of Tietze's syndrome thought to occur due to traction exerted by large breast implants. Diagnosis is usually clinical because no abnormalities are identified on conventional imaging. Two cases have been reported in the literature, but none with FDG-PET. We report a patient with treated breast cancer, presenting with chest pain where FDG-PET to assess for recurrence was consistent with costochondritis and peri-implant inflammation.
Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Recurrencia Local de Neoplasia/diagnóstico por imagen , Tomografía de Emisión de Positrones/métodos , Esternón/diagnóstico por imagen , Síndrome de Tietze/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , RadiofármacosRESUMEN
This article presents the results of a systematic review of the effectiveness and economic efficiency of individual-, group-, and community-level behavioral interventions intended to reduce the risk of acquiring sexually transmitted HIV in adult men who have sex with men (MSM). These results form the basis for recommendations by the Task Force on Community Preventive Services on the use of these interventions. Sexual risk behavior and condom use were the outcomes used to assess effectiveness. Intervention effectiveness on biological outcomes could not be assessed because too few studies of adequate quality have been published. The evidence found in our review shows that individual-level, group-level, and community-level HIV behavioral interventions are effective in reducing the odds of unprotected anal intercourse (range 27% to 43% decrease) and increasing the odds of condom use for the group-level approach (by 81%). The Task Force concluded that the findings are applicable to MSM aged 20 years or older, across a range of settings and populations, assuming that interventions are appropriately adapted to the needs and characteristics of the MSM population of interest. Based on findings from economic evaluation studies, the Task Force also concluded that group- and community-level HIV behavioral interventions for adult MSM are not only cost effective but also result in actual cost savings. Additional information about other effects, barriers to implementation, and research gaps is provided in this paper. The recommendations based on these systematic reviews are expected to serve the needs of researchers, planners, and other public health decision makers.