Evaluating diagnosis and treatment of oral and esophageal candidiasis in Ugandan AIDS patients.

A randomized cross-over clinical and endoscopic evaluation of 85 Ugandan patients showed that esophageal candidiasis in AIDS patients with oral candidiasis could be managed without endoscopy and biopsies. Oral lesions, especially when accompanied by esophageal symptoms, were sufficient for diagnosis. Miconazole was more effective than nystatin in treating esophageal candidiasis and could be a valid alternative to more expensive azolic drugs in developing countries

Rare malignant anomalous right coronary artery incidentally detected by dual source computed tomography angiography in an adult referred for transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is a safe treatment option for elderly patients with aortic stenosis (AS) with high or intermediate surgical risk. The anomalous origin of coronaries from a single Valsalva sinus has a higher risk of coronary obstruction during the TAVI procedure, so prior knowledge of these anatomical variants is of paramount importance as it can change the surgical strategy. In this report, we present the case of an adult patient suffering from severe aortic stenosis and incidentally diagnosed with an anomalous malignant variant of right coronary artery (RCA) by pre-procedural Computed Tomography (CT) Angiography. In TAVI planning, the use of electrocardiography (ECG) gated Dual Source CT (DSCT) enables accurate coronary and aorto-iliac vascular study, useful for detecting congenital coronary anomalies

Third generation dual source CT with ultra-high pitch protocol for TAVI planning and coronary tree assessment: feasibility, image quality and diagnostic performance

Purpose: To evaluate the feasibility, image quality (IQ) and diagnostic performance of third generation 192 × 2 dual source computer tomography (DSCT) with ultra-high pitch acquisition for trans-catheter aortic valve implantation (TAVI) planning and coronary tree assessment. Method: In this prospective study, 223 patients underwent to DSCT for TAVI. Coronary calcium scoring (CCS) was calculated. Attenuation values were measured at aortic levels, femoral and coronary arteries. IQ was evaluate with a 4-point scale. The CT performance, in the assessment of coronary stenosis ≥50 % and ≥70 %, was compared with invasive coronary angiography (ICA), served as reference standard. Aortic annulus (AoA) CT derived area and implanted prosthesis size were correlate with Spearman's test. Results: Attenuation values >400HU were obtain in all segments. IQ median value was ≥ 3. In the assessment of stenosis ≥50 %, on a segment-based analysis, CT sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were 97.6 %, 87.6 %, 64.2 %, 99.0 % and 89.6 %, on patient-based analysis were 97.8 %, 88.8 %, 68.8 %, 99.4 % and 90.6 %, respectively. In the assessment of stenosis ≥70 %, on segment-based analysis, were 88.5 %, 83.8 %, 54.7 %, 96.8 % and 84.8 %, and on patient-based analysis were 92.5 %, 85.8 %, 58.7 %, 98.1 % and 87.0 %, respectively. The CT performed better in the group with lower CCS. A direct correlation was found between AoA CT derived area and prosthesis size. Conclusion: DSCT, using a single prospective ECG-triggered ultra-high pitch acquisition, is feasible for TAVI planning and in the assessment of coronary stenosis. CT performed worse in patients with severe coronary calcifications

The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach

Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit–risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose