A n acute lower respiratory tract infection caused by the 2019 novel coronavirus was first reported in China in December 2019 (1,2). The clinical spectrum of disease with coronavirus disease 2019 (COVID-19) infection is variable and ranges from an asymptomatic infection or mild upper respiratory tract illness to severe viral pneumonia with respiratory failure and occasionally death (2). Although the case fatality ratio has been as high as 15%, the incidence of critical illness has been reported to be 7%-26% (3). Patient factors that have been associated with a higher incidence of critical illness and death include male sex, age older than 60 years, obesity, diabetes, hypertension, cardiopulmonary comorbidities, and higher d-dimer and interleukin 6 values (3).At the time of writing this article, more than 8 million cases and 450 000 deaths worldwide have been reported. The COVID-19 pandemic has resulted in an unprecedented health care crisis with immense strain on health care resources and disruptions in both routine and emergency health care delivery (4). The lack of adequate diagnostic testing has resulted in suboptimal early detection and containment of this infection, which has contributed to rapid and widespread transmission by individuals with mild or no symptoms (5). The primary diagnostic test, reverse transcriptase polymerase chain reaction (RT-PCR) assay for COVID-19, has variable sensitivity ranging from 37% to 71% (5), depending on the rate of viral expression at the time of collection and the site of specimen collection (6). Obstacles to the use of RT-PCR testing include shortage of kits and extended processing period.Chest CT in COVID-19 pneumonia demonstrates bilateral, peripheral, and basal predominant ground-glass opacities (GGOs) and/or consolidation in nearly 85% of patients with superimposed irregular lines and interfaces; the imaging findings peak 9-13 days after infection (7,8) (Fig 1). Subsequently, a mixed pattern evolves with crazy paving, architectural distortion, and perilobular abnormalities superimposed on GGOs with slow resolution (7) (Fig 1). Importantly, CT scans may be normal in an infected patient, particularly early in the disease (8). Atypical chest CT findings include upper lobe or peribronchovascular distribution of GGOs, cavitation, tree in bud nodules, lymphadenopathy, and pleural thickening (9). Tables 1 and 2 summarize common and uncommon CT findings of COVID-19 (10-21). It is vitally important to remember
Infection with Trypanosoma cruzi, the etiologic agent in Chagas disease, may result in heart disease. Over the last decades, Chagas disease endemic areas in Latin America have seen a dietary transition from the traditional regional diet to a Western style, fat rich diet. Previously, we demonstrated that during acute infection high fat diet (HFD) protects mice from the consequences of infection-induced myocardial damage through effects on adipogenesis in adipose tissue and reduced cardiac lipidopathy. However, the effect of HFD on the subsequent stages of infection - the indeterminate and chronic stages - has not been investigated. To address this gap in knowledge, we studied the effect of HFD during indeterminate and chronic stages of Chagas disease in the mouse model. We report, for the first time, the effect of HFD on myocardial inflammation, vasculopathy, and other types of dysfunction observed during chronic T. cruzi infection. Our results show that HFD perturbs lipid metabolism and induces oxidative stress to exacerbate late chronic Chagas disease cardiac pathology.
Ocular melanoma is the most common adult primary intraocular tumour. Although ,1% of patients have metastatic disease at the time of initial diagnosis, most will develop metastasis at varying lengths of time. Metastasis surveillance is therefore critical in the follow-up of patients with ocular melanoma. Liver is the most common site of metastasis and prognosis is based on the treatment of liver metastasis. Hence, imaging of liver metastasis is vital. MRI is the most specific modality for imaging liver metastasis and is at least as sensitive as CT. Extrahepatic metastasis such as retroperitoneal nodules and bone metastases are also better evaluated on MRI. Gadolinium-based contrast agents are extremely helpful for detecting liver lesions. In particular, newer hepatobiliary contrast agents which offer an additional hepatobiliary phase of excretion help in the detection of even tiny liver metastases. Diffusion-weighted imaging is helpful when an i.v. contrast cannot be administered. Treated lesions are also better evaluated with MRI. CT is useful for evaluating lung nodules, large liver metastasis or in patients in whom MRI is medically contraindicated. The disadvantage lies in its inability to detect small liver metastasis and the radiation dose involved. The lesions treated with iodized oil as part of chemoembolization procedures can be followed on CT. Ultrasound can be used only for detecting hepatic metastases. However, it is heavily operator dependent, technically challenging and time consuming especially in patients who are large. Extrahepatic metastasis cannot be seen on ultrasound. Its utility is primarily for the biopsy of liver lesions. Positron emission tomography (PET)-CT can detect lung nodules and large liver lesions but is insensitive to small liver lesions. Moreover, the high radiation dose is a major disadvantage. IMAGING OF OCULAR MELANOMA METASTASISOcular melanoma is the most common adult primary intraocular tumour, with a stable incidence over the past 30 years of 5.1 per million. The overwhelming majority of those affected are Caucasian. In ocular melanoma, unlike most cancers, ,1% of patients have metastatic disease at the time of initial diagnosis. However, unfortunately, many do go on to develop metastases. The Collaborative Ocular Melanoma Study, one of the largest prospective studies, with a longitudinal follow-up of 2320 patients, found a 10-year cumulative metastatic rate of 34%.1 The most frequent site of ocular melanoma metastasis is the liver (90%), followed by the lung (30%), bone (23%) and skin (17%). Metastatic disease is identified on an average about 3 years after the diagnosis of the primary tumour. 2,3The median survival time after diagnosis of metastasis in the largest series of patients with metastatic uveal melanoma was 3.6 months, 4, although time to metastasis can be prolonged up to 42 years in some cases. 5 As liver metastases are the most common cause of death in these patients, this review focused largely on imaging of the liver.Given the prolonged time frame i...
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