Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial.

Background: Although great progress has been made over the past 2 years in the scientific understanding of the biology, epidemiology, and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), case morbidity and fatality rates remain a great concern and continue to challenge the healthcare resources worldwide as novel variants emerge. There is therefore an urgent need for affordable and readily available strategies to reduce viral transmission. Previous studies in non-COVID-19 patients have demonstrated that administration of low-salt (isotonic but 0.0375% Na) and isotonic saline (0.9% Na) solutions has been associated with an immediate, significant reduction in the microbial antigens and a related decline of microbial burden. The aim of the present study was to determine the effect of nasal washes with normal saline 0.9% on nasopharyngeal viral load and outcome in hospitalized patients with COVID-19 pneumonia. Methods: We performed a prospective, randomized, pilot, controlled trial in 50 patients with confirmed COVID-19 disease. Patients were randomized into two groups, the normal saline group (received normal saline 0.9% solution for nasopharyngeal wash) and the control group (no treatment). In the normal saline group, nasopharyngeal wash was performed every 4 hours for a 16-hour period. Twenty-four hours after the baseline nasopharyngeal swab (and 8 hours after the last wash in the normal saline group), a second nasopharyngeal swab was collected for the semiquantitative estimation of the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values. Results: In the normal saline group, mean N gene Ct values increased significantly 24 hours after the baseline measurement [ΔCtday2-day1 = 1.87 ± 3.11 cycles, p = 0.007 (95% CI: 0.55 to 3.18)], indicating a decline in SARS-CoV-2 nasopharyngeal viral load by 8.9%. A significant decrease in mean N gene Ct values was observed in the control group, indicating an increase in viral load [ΔCtday2-day1 = -2.12 ± 2.66, p < 0.001 (95% CI: -3.20 to -1.05)] by 9.7%. The difference between the two groups 24 hours after admission and nasopharyngeal wash was 3.09 cycles (p = 0.005, 95% CI: 0.97 to 5.20). Conclusion: Nasal washes with normal saline effectively decreased the viral load during hospitalization and at follow-up.

Prognostic role of simple inflammatory biomarkers in patients with severe COVID-19: an observational study.

BACKGROUND/AIM: Simple inflammatory biomarkers, such as neutrophil to lymphocyte ratio (NLR), could serve as prognosis indicators in patients with Coronavirus disease 2019 (COVID-19). The utility of on-admission inflammatory biomarkers in predicting outcomes was investigated in patients suffering from severe COVID-19 infection. METHODS: We performed a retrospective study to assess the role of white blood count (WBC), neutrophils (N), lymphocyte (L), platelets (PLTs), C-reactive protein (CRP), reverse transcription polymerase chain reaction (RT-PCR), NLR (N/L), PLR (P/L), dv (derived variation of)-NLR (N/WBC-L), LNR (L/N), dv (derived variation of)-LNR (L/WBC-N), and CLR (CRP/L), in predicting the need for high-flow nasal cannula (HFNC) use, admission to Intensive Care Unit (ICU), and death in adult patients with severe COVID-19 admitted to the Department of Respiratory Medicine from April to September 2021. RESULTS: One hundred and fifteen patients (60 % males) with a mean age of 57.7 ± 16.3 years were included. Thirty-seven patients (32.2 %) required escalation with HFNC, eight patients (7 %) were admitted to the ICU, and nine patients (7.8%) died. Based on univariate analysis, CRP [odds ratio (OR): 1.25, 95 % confidence interval (CI): 1.1-1.42), LNR (OR: 0.015, 95 % CI: 0.00-0.35), dv-NLR (OR: 5*106, 95 % CI: 26.7-9*109), CLR (OR: 7*1058, 95 % CI: 3*1025-2*1092), length of hospitalization (LOH; OR: 1.44, 95 % CI: 1.22-1.63), dyspnea at presentation (OR: 2.83, 95 % CI: 1.23-6.52), and ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) on admission (OR: 0.967, 95 % CI: 0.952-0.983) were independent predictors for oxygen requirements. However, the multivariate analysis showed that LNR (OR: 1.686e0-4, 95 % CI: 6.441e00-8-0.441), PaO2/FiO2 on admission (OR: 0.965, 95 % CI: 0.941-0.989), and LOH (OR: 1.717, 95 % CI: 1.274-2.314) were the most important predictor for HFNC use. Nasal congestion at presentation (OR: 11.5, 95 % CI: 1.61-82.8) was a unique and independent predictor for ICU admission. As far as death is concerned, the univariate analysis identified elevated CRP (OR: 1.11, 95 % CI: 1.0-1.24), low RT-PCR (OR: 0.829, 95 % CI: 0.688-0.999), high CLR (OR: 3.2*1033, 95 % CI: 5.8-1.8*1066), age (OR: 1.08, 95 % CI: 1.02-1.14), body mass index (BMI) over 30 (OR: 5.25, 95 % CI: 1.26-21.96), the chronic use of angiotensin-converting enzyme inhibitors (OR: 5.72, 95 % CI: 1.35-24.09), nitrates (OR: 14.85, 95 % CI: 1.81-121.8), diuretics (OR: 8.21, 95 % CI: 1.97-34.32), PaO2/FiO2 on admission (OR: 0.983, 95 % CI: 0.970-0.998), and nasal congestion at presentation (OR: 9.81, 95 % CI: 1.40-68.68) as independent predictors. However, the multivariate analysis pinpointed that obesity (BMI >30) (OR: 10.498, 95 % CI: 1.107-99.572) remained the most important predictor for death. CONCLUSION: LNR and PaO2/FiO2 on admission could be used to timely identify patients requiring HFNC during hospitalization, while obesity (BMI >30) could be an independent predictor of death. Nasal congestion emerges as a unique predictor for ICU admission. HIPPOKRATIA 2022, 26 (2):70-77.

Data on expectations, perceived quality, satisfaction with hospital care and financial ability of patients who suffer from acute and chronic respiratory diseases, in Central Greece.

The research article presents the data collected from a questionnaire based survey that aimed to evaluate patients' expectations, perceived quality, satisfaction with hospital care and financial ability of 202 hospitalized patients suffering from acute or chronic respiratory diseases. The anonymous and self-completed questionnaire was divided in two parts. The first part included questions to elicit information on social and demographic characteristics (gender, age group, education level, categorization of respiratory disease, evaluation of the current hospitalization, nationality and way of living with). The second part included the 26-items Elderly Patient Satisfaction Scale and the 12-items Financial Ability Scale, which are validated in the Greek language with a high internal consistency. Data were collected from February 2016 to December 2018.

The mast cell - neurofibromatosis connection.

Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder affecting 1/3000 individuals worldwide. It results from germline mutations of the neurofibromin gene and it is fully penetrant by the age of 5. Neurofibromin is a 2818 amino acid protein that is produced in many cell types, but its levels are especially high in the nervous system.

Evaluation of respiratory parameters in finswimmers regarding gender, swimming style and distance.

AIM: The purpose of our study was to investigate the differences in the finswimmers' physiological characteristics, as far as gender, the swimming style and the different swimming distance are concerned. METHODS: 52 finswimmers participated in our study (Age: 17.4 ±â€¯2.1yrs, BMI: 21.8 ±â€¯2.3, body fat: 12.2 ±â€¯4.7%) and were allocated into groups [Gender: Female vs. Male, swimming style: Bifin vs. Surface, and swimming distance: <200 m vs. ≥200 m]. Anthropometric characteristics, handgrip, estimated strength of inspiratory muscles (PImax) and pulmonary function parameters (FEV1, FVC and PEF) were measured. The Independent T-test was used for statistical comparisons between groups. Multivariate analyses were performed via binary logistic regression. RESULTS: The results showed differences between groups in gender in PEF (p < 0.05), PImax (p < 0.05) and handgrip (p < 0.001) in swimming style in handgrip (p < 0.05), FEV1 (p < 0.05) and FVC (p < 0.05) and in swimming distance (p < 0.05) in hours/day spent at the gym (p < 0.05) and FVC (p < 0.05). In multivariate analyses handgrip remained an independent predictor of style (OR: 1.154; 95%CI: 1.022-1.303, p = .021), and hours/day spent at the gym was retained as an independent predictor of distance (OR: 131.607; 95%CI: 3.655-4739.441, p = .008). CONCLUSION: The data from the present study reveal that handgrip was associated with style, and hours per day spent at the gym were associated with distance.

A M. avium complex spondylodiscitis in a middle-aged woman with diabetes.

Spondylodiscitis, the inflammation of the vertebral bodies and the intervertebral disk space, is the reason for low back pain in a minority of cases. This is caused by various pathogens. Mycobacterium tuberculosis is responsible for 17-39% of all the cases of spondylodiscitis. On the contrast, spondylodiscitis from non tuberculous mycobacteria is extremely rare in literature. We describe a 68 -year old diabetic woman which is the first case of bone marrow involvement by M. intracellulare (member of M avium complex)with spondylodiscitis.

Association between TLR2/TLR4 gene polymorphisms and COPD phenotype in a Greek cohort.

BACKGROUND: Considering that the innate immune system plays a pivotal role in the pathogenesis of chronic obstructive pulmonary disease (COPD), we hypothesized that functional single-nucleotide polymorphisms (SNPs) of innate immune genes affect the disease phenotype and prognosis. AIM: To elucidate the contribution of common functional TLR2 and TLR4 SNPs and genotypic deficiency of the mannose-binding lectin (MBL) protein, both as single parameters and in combination, in Greek COPD patients. RESULTS: In a cohort of 114 Greek COPD patients, we confirmed that the presence of TLR4-D299G or TLR4-T399I SNPs was significantly associated with an earlier COPD stage (p = 0.003 and p = 0.009, respectively). In comparison, the absence of any analyzed polymorphism, including those of TLR2-R753Q and genotypic MBL deficiency, was significantly associated with a more severe disease phenotype, characterized by more frequent exacerbations (p = 0.045). CONCLUSION: Our findings support the notion that the presence of innate immune SNPs, such as functional polymorphisms of TLRs along with MBL deficiency, might exert a protective effect on the COPD phenotype, similar with other immune-mediated disorders.

Prediction of particle deposition in the lungs based on simple modeling of alveolar mixing.

A simplified model of particle deposition in the lungs has been developed and implemented, based on the hypothesis that perfect mixing takes place in the alveolar volume of each airway generation. This key idea is combined with purely convective transport along airways, driven by steady alveolar expansion and contraction, and results in an analytically tractable model. Predictions of the model, and in particular pulmonary deposition, are found in very good agreement with detailed benchmark data in the literature for particle diameters d ≥ 0.1 µm. The success of this simple model provides indirect evidence in favor of the role of alveolar mixing in the deposition process.

Psychological profile of Greek doctors: differences among five specialties.

The aim of the present study was to explore the differences in the psychological profiles between genders and different specialties among Greek doctors. Five-thirty nine doctors in five different specialties, namely 115 general practitioners, 168 internists, 81 surgeons, 108 microbiologists and 67 anesthesiologists, participated in the study. 253 participants were specialized doctors and 286 participants were medical residents. The sample consisted of 280 women and 259 men. The mean age of the sample was 38.75(±7.98) years. A cross sectional survey study was conducted. Symptom Check List 90-Revised (SCL-90-R) was used to collect the data. Multivariate Analysis of Variance indicated the significant effect of specialty (Wilks' Lambda = .20, p = .000), the effect of gender (Wilks' Lambda = .90, p = .000) as well as their interaction (Wilks' Lambda = .68, p = .000) on participants' scores in SCL-90-R subscales. Internists reported high scores in 8 out of 9 subscales of SCL-90-R. Surgeons scored significantly higher compared to all other specialties in hostility(HS) subscale. Women reported statistically higher scores in almost all subscales of the SCL-90-R test compared to men, apart from HS (p = .191). Gender and specialty choice play role in the psychological profile of Greek doctors. Women and internists seem to be more prone to psychopathology. These findings should be taken into account in future studies and interventions.

Disseminated Bacillus Calmette-Guerin infections after intravesical therapy.

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the treatment of choice for superficial bladder carcinoma. Disseminated BCG infection presenting as granulomatous hepatitis or pneumonitis is a very rare complication of this treatment. Here we report a case series of seven patients previously treated with BCG presenting with pneumonitis. In two of the cases, identification of Mycobacterium bovis was achieved with molecular methods.

Polymorphisms and haplotypes in MyD88 are associated with the development of sarcoidosis: a candidate-gene association study.

Sarcoidosis is considered as a disorder of protracted immune response to an as yet unidentified causative agent that leads to granuloma formation. Material from M. tuberculosis and P. acne has been repeatedly detected in the sarcoidosis lesions, implying the involvement of the Toll-like receptor2 (TLR2) gene that responds to these intracellular pathogens. Since TLR2 association studies have produced controversial results, we sought to investigate whether the downstream signalling molecule MyD88 could be linked to disease susceptibility. We analyzed a total of 93 cases with sarcoidosis and of 89 controls for the most common MyD88 SNPs: -938C>A (rs4988453) and 1944C>G (rs4988457). There is evidence that the genotype distributions of both variants are associated with the development of sarcoidosis (p = 0.038 for -938C>A and p = 0.026 for 1944C>G). In particular, -938A and 1944G carriers were associated with risk of sarcoidosis [OR = 2.48 (1.23-5.02) and OR = 0.33 (0.14-0.76)], respectively, indicating dominance of the mutant alleles; however, the adjustment of the effect size for age and sex diminished the significance. The haplotype analysis showed association for the -938A/1944G haplotype (p < 0.001). Since genetic association studies have linked MyD88 to Hodgkin's lymphoma it is tempting to speculate that MyD88 may contribute to the granuloma formation that characterizes sarcoidosis.

Work-related respiratory symptoms and airway disease in hairdressers.

BACKGROUND: Hairdressers are occupationally exposed to a number of agents in their workplace that result in respiratory symptoms and changes in pulmonary function. OBJECTIVE: To evaluate associations between occupational exposure and respiratory function and reported symptoms in a group of hairdressers compared to a control group. METHODS: A questionnaire on respiratory symptoms and workplace characteristics was completed by 94 hairdressers and 39 age- and sex-matched controls. Spirometry and exhaled nitric oxide (FeNO) measurements were also performed. RESULTS: Hairdressers reported more severe dyspnea (p=0.03) and eye (p=0.001) and throat (p=0.007) irritation, compared to the control group, at the workplace; no differences were noted at home. Lower FEV1/FVC (p<0.001) and higher FeNO values (p=0.012) were observed in hairdressers. A larger working area and presence of window ventilation were associated with better pulmonary function. CONCLUSION: Worsening of symptoms and pulmonary function at workplace, and alleviating the symptoms at home, indicate that they may be related to occupational exposure.

Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome.

The objective of this study was to evaluate the female sexual function in relation to hormonal status in pre- and postmenopausal women with obstructive sleep apnea (OSA). A total of 43 premenopausal (mean age 42.1±4.9) and 58 postmenopausal (mean age 59.9±4.8) women were included in the study. All women filled out the Epworth sleepiness scale (ESS), the Beck Depression Inventory (BDI) and the Female Sexual Function Index (FSFI). Testosterone, estradiol and progesterone were measured. After polysomnography, women were allocated to a not-severe OSA group (Apnea-Hypopnea Index (AHI) 10-30) and a severe OSA group (AHI >30). Healthy subjects comprised the control group. Severe OSA women in both pre- and post-menopausal group were found to have significantly lower mean FSFI score (16.5±4.0 and 16.9±4.7, respectively) compared with not-severe OSA (23.4±5.5, P<0.01 and 21.8±7.5, P<0.05) and control subjects (27.0±5.5, P<0.01 and 24.0±6.7, P<0.01). Progesterone, which was significantly lower in severe OSA premenopausal women (0.26±0.2) compared with not-severe OSA (0.55±0.14, P<0.01) and control group (0.62±0.16, P<0.01), correlated significantly with FSFI (r=0.39, P<0.01). Our study demonstrated that OSA is associated with sexual dysfunction in both premenopausal and postmenopausal women in a dose-related fashion. Regarding premenopausal women, our results indicated that progesterone may play a role in the association between OSA and female sexual dysfunction.

Cytokines and growth factors promote airway smooth muscle cell proliferation.

Chronic airway diseases, such as asthma or chronic obstructive pulmonary disease, are characterized by the presence in the airways of inflammation factors, growth factors and cytokines, which promote airway wall remodelling. The aim of this study was to investigate the effect of cytokines and growth factors on airway smooth muscle cell (ASMC) proliferation, phenotype and responsiveness. Incubation of serum starved human bronchial ASMCs with TNF- α , TGF, bFGF, and PDGF, but not IL-1 ß , increased methyl-[(3)H]thymidine incorporation and cell number, mediated by the PI3K and MAPK signalling pathways. Regarding rabbit tracheal ASMC proliferation, TNF- α , IL-1 ß , TGF, and PDGF increased methyl-[(3)H]thymidine incorporation in a PI3K- and MAPK-dependent manner. bFGF increased both methyl-[(3)H]thymidine incorporation and cell number. Moreover, incubation with TGF, bFGF and PDGF appears to drive human ASMCs towards a synthetic phenotype, as shown by the reduction of the percentage of cells expressing SM- α actin. In addition, the responsiveness of epithelium-denuded rabbit tracheal strips to carbachol was not significantly altered after 3-day treatment with bFGF. In conclusion, all the tested cytokines and growth factors increased ASMC proliferation to a different degree, depending on the specific cell type, with bronchial ASMCs being more prone to proliferation than tracheal ASMCs.

Association of tumor necrosis factor-α gene polymorphism (-308) and obstructive sleep apnea-hypopnea syndrome.

BACKGROUND AND AIM: Elevated serum tumor necrosis factor-α (TNF-α) concentra-tion and a polymorphism of the TNF-α gene at the position -308 in the promoter region are associated with obstructive sleep apnea-hypopnea syndrome (OSAHS). We aimed to determine the association of this polymorphism with OSAHS in Greek patients. PATIENTS AND METHODS: A blood sample was obtained from 220 patients clinicaly diagnosed with OSAHS and 319 normal controls. TNF-α genotype was determined from nucleus-containing cells from whole blood using a PCR method. RESULTS: The results demonstrated that the distribution of alleles was significantly dif-ferent when comparing the OSAHS patients group to the healthy controls. The appearance of AA (p=0.04) and AG (p<0.001) genotypes was significantly greater in OSAHS patients (8.6% and 32.7%, respectively) compared to the healthy control group (4.4% and 26.3%, respectively). Correspondingly, the appearance of the GG genotype was significantly lower in OSAHS patients compared to healthy controls (53.6% vs 69.3%). The A and G allele appeared at a frequency of 27.5% and 72.5% respectively in the OSAHS groups, and 17.6% and 82.4% in the control group respectively. CONCLUSIONS: The distribution of genotypes and alleles of the single nucleotide polymorphism of TNF-α (-308) of OSAHS patients varies from healthy controls.