Auto-brewery syndrome may be considered in a patient with chronic obstruction or hypomotility presenting with elevated serum ethanol levels in the setting of high carbohydrate intake. Although treatment algorithms lack validation, judicious use of antibiotic therapy, carbohydrate control, and short courses of antifungal therapy have all been reported in the literature. Importantly, clinical consideration of 'auto-brewery' should be undertaken with substantial caution, given the lack of validated mechanisms linking endogenous ethanol production to peripheral blood ethanol.
The FCS, a pattern of focal or disproportionate inflammation and/or fibrosis involving the bilateral anterolateral upper lobes and posterosuperior lower lobes, is specific for SSc-ILD when readers are confident of its presence.
Background Mycotic and oncotic aneurysms may result in devastating neurologic sequelae if undetected. The objectives of this study were to examine interobserver variability and accuracy of cross-sectional imaging for the detection of distal territory mycotic and oncotic aneurysms. Methods We searched our institutional database for all radiology reports from 2005 to 2015 with an indication or diagnosis of mycotic or oncotic aneurysm. Patients who underwent DSA and either CTA or MRA within 12 weeks of each other were identified. The cross-sectional images from each study were blinded and reviewed by two radiologists. If positive for aneurysm, location and number of aneurysms were reported. Sensitivity, specificity, positive predictive value, negative predictive value, and interobserver variability were determined for MRA and MRA/CTA. Results Twenty-five patients were included in this study. Ten (40%) harbored distal aneurysms. Cross-sectional imaging had a sensitivity of 45.5%, specificity of 90.0%, and kappa value of 0.29 (0.00–0.69) for the detection of cerebral mycotic and oncotic aneurysms. Conclusions Because of the low sensitivity and high interobserver variability of cross-sectional imaging, DSA should remain the gold standard for evaluation of suspected oncotic and mycotic aneurysms. In cases in which cross sectional imaging is negative and there is a high clinical suspicion for mycotic aneurysm, DSA should be strongly considered.
Objective:
At present, there is a paucity of evidence guiding clinicians on the optimal approach to safely screen patients for SARS-CoV-2 (COVID-19) infection prior to a non-emergent hospital procedure. In this report we describe our experience in screening for SARS-CoV-2 (COVID-19) prior to semi-urgent and urgent hospital procedures.
Design:
Retrospective case series.
Setting:
Single tertiary medical center.
Participants:
Patients ≥ 18 years of age who had semi-urgent or urgent hospital procedures or surgeries.
Methods:
625 patients were screened for SARS-CoV-2 (COVID-19) using a combination of phone questionnaire (7 days prior to the anticipated procedure), RT-PCR and chest CT, between 3/1/2020 and 4/30/2020.
Results:
Of the 625 patients, 520 scans (83.2%) were interpreted as normal, 1 (0.16%) as having typical features, 18 scans (2.88%) as having indeterminate features, and 86 (13.76%) as having atypical features of SARS-CoV-2 (COVID-19). A total of 640 RT-PCRs were performed, with 1 positive result (0.15%) in a patient with CT scan read as atypical. Out of 18 patients with chest CTs categorized as indeterminate, 5 underwent repeat negative RT-PCR nasopharyngeal swab one week after their initial swab. 1 patient with chest CT categorized as typical had a follow up repeat negative RT-PCR, indicating that the chest CT was likely a false positive. None of the patients, after surgery, developed signs or symptoms suspicious of COVID-19, needing repeat RT-PCR or CT scan.
Conclusion:
In our experience, chest CT scanning did not prove provide valuable information in detecting asymptomatic cases of SARS-CoV-2 (COVID-19) in our low prevalence population.
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