Preliminary report of in vitro and in vivo effectiveness of dornase alfa on SARS-CoV-2 infection.

Dornase alfa, the recombinant form of the human DNase I enzyme, breaks down neutrophil extracellular traps (NET) that include a vast amount of DNA fragments, histones, microbicidal proteins and oxidant enzymes released from necrotic neutrophils in the highly viscous mucus of cystic fibrosis patients. Dornase alfa has been used for decades in patients with cystic fibrosis to reduce the viscoelasticity of respiratory tract secretions, to decrease the severity of respiratory tract infections, and to improve lung function. Previous studies have linked abnormal NET formations to lung diseases, especially to acute respiratory distress syndrome (ARDS). It is well known that novel coronavirus disease 2019 (COVID-19) pneumonia progresses to ARDS and even multiple organ failure. High blood neutrophil levels are an early indicator of COVID-19 and predict severe respiratory diseases. Also it is reported that mucus structure in COVID-19 is very similar to that in cystic fibrosis due to the accumulation of excessive NET in the lungs. In this study, we showed the recovery of three individuals with COVID-19 after including dornase alfa in their treatment. We followed clinical improvement in the radiological analysis (two of three cases), oxygen saturation (Spo2), respiratory rate, disappearance of dyspnoea, coughing and a decrease in NET formation and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load after the treatment. Also here, we share our preliminary results suggesting that dornase alfa has an anti-viral effect against SARS-CoV-2 infection in a green monkey kidney cell line, Vero, and a bovine kidney cell line, MDBK, without determined cytotoxicity on healthy peripheral blood mononuclear cells.

Qt dispersion in soccer players during exercise testing.

Screening for cardiac health should involve relevant parameters or indices that are easy and inexpensive to obtain. Various cardiac adaptation mechanisms develop during regular exercise that are affected by many factors, and these are reflected on a surface electrocardiogram. QT dispersion has been considered a surrogate for heterogeneity of repolarization, leading to ventricular arrhythmias. We compared QT parameters between athletes and sedentary subjects. A total of 225 men were assessed, comprising a group of professional soccer players and sedentaries. Each subject underwent supine 12-lead electrocardiographic examinations and exercise testing by ergospirometry. QT parameters were taken at rest and at peak exercise. Peak oxygen consumption was considerably higher in the athletes than in the controls (59.3 +/- 5.6 vs. 44.3 +/- 2.4 ml/kg/min, mean +/- SD, p < 0.001). QT parameters at rest: There were significant differences in heart-rate-corrected rest maximal QT duration (413.9 +/- 50.5 vs. 445.3 +/- 45.7 ms, p < 0.001) and in heart-rate-corrected rest minimum QT duration (380.5 +/- 51.2 vs. 409.5 +/- 46.7 ms, p < 0.001). QT parameters at peak exercise: maximal QT duration at peak exercise (253.9 +/- 20.8 vs. 261.7 +/- 26.2, p = 0.02), QT dispersion at peak exercise (25.2 +/- 9.1 vs. 29.5 +/- 15.8 ms, p = 0.04), heart-rate-corrected QT dispersion at peak exercise (44.6 +/- 16.4 vs. 52.6 +/- 28.3 ms, p = 0.03) differed significantly between professional soccer players and controls. QT dispersion and corrected QT dispersion at peak exercise are lower in athletes than in controls. Athletes and other subjects identified with a long QT interval should be examined at regular intervals.

Hashimoto thyroiditis and obstructive sleep apnea syndrome: is there any relation between them?

Hashimoto thyroiditis (HT), which is an autoimmune disease of thyroid gland, has been declared to present with concomitant several systemic diseases. In this study, the coexistence of the Hashimoto disease with the sleep apnea syndrome has been examined. Seven female patients (33-66 year of age) with Hashimoto thyroiditis were evaluated for sleep apnea syndrome. The diagnosis of Hashimoto disease was based on the high titers of anti-thyroid antibodies and histological findings. None of the patients had any complaints of sleep disturbances. Seven healthy subjects with similar age and sex characteristics were taken as the control group. All the patients and the control subjects were undertaken a full polysomnography (PSG). Five patients with HT showed the characteristics of obstructive sleep apnea syndrome (one severe, one moderate and three mild OSAS), whereas no sleep breathing disturbance was found in the control group. These findings suggest that sleep related breathing problems may develop in the patients with autoimmune thyroiditis even if they are euthyroid.

Microscopic examination and treatment outcomes of new pulmonary tuberculosis cases in Istanbul dispensaries between 1998 and 2000.

SETTING: Twenty-four public tuberculosis dispensaries in Istanbul. OBJECTIVE: To investigate microscopic examination of new pulmonary tuberculosis (TB) cases and treatment outcomes of smear-positive cases. DESIGN: A retrospective analysis of 12572 new pulmonary tuberculosis cases between 1998 and 2000. METHODS: Microscopic examination of sputum smears of all patients and treatment outcomes of smear-positive cases were evaluated. RESULTS: Of 12572 new TB cases registered between 1998 and 2000, 78.1% (n = 9822) were pulmonary and 21.9% (n = 2750) were extra-pulmonary TB cases. Of 9822 new pulmonary TB cases, 5438 (55.4%) were sputum smear-positive and 2154 (21.9%) had no sputum examination. In smear-positive pulmonary cases, treatment outcomes were classified as follows: 2521 (46.4%) cured, 1926 (35.4%) treatment completed, 128 (2.4%) treatment failure, 514 (9.4%) default, 260 (4.8%) transfer out and 72 (1.3%) died. Treatment success was 81.8% (n = 4447). Between 1998 and 2000, the smear-positive case rate improved from 47.5% to 61.5% and the cure rate improved from 41.8% to 51.1%. CONCLUSION: The microscopic diagnosis and cure rates are low in Istanbul dispensaries. The laboratories should be re-organised and directly observed treatment should be performed.

The frequency of deep venous thrombosis and pulmonary embolus in acute exacerbation of chronic obstructive pulmonary disease.

Infection, pulmonary embolism caused by mostly deep venous thrombosis (DVT), hypoxaemia and drugs, used in the treatment of chronic obstructive pulmonary disease (COPD), related arrhythmia, aspiration are mostly responsible for acute exacerbations of COPD. The incidences of DVT and pulmonary embolus were investigated in 56 hospitalised cases with acute exacerbation of COPD. DVT was diagnosed in six (10.7%) cases with coloured doppler ultrasonography (CDU) and in two cases whose examinations were not sufficient enough to diagnose or refuse DVT. Diagnosis of pulmonary embolus was investigated with ventilation/perfusion scintigraphy in eight cases of clinically medium--high-probable pulmonary embolus. Pulmonary embolus was determined in five cases (8.9%). Age, weight, height, disease course, pulmonary function tests, arterial blood gases and haematocrit values of the cases did not predict the diagnosis of DVT and pulmonary embolus in our cases.

Role of Zafirlukast on skin prick test.

BACKGROUND: Some anti-allergic and anti-asthmatic drugs should be discontinued before skin prick test. But there is no knowledge about zafirlukast effects on skin prick test. We investigate the effects of zafirlukast on cutaneous response to histamine and specific allergens. MATERIAL AND METHODS: 9 patients suffering from allergic mild asthma or allergic rhinitis and 8 healthy individuals were recruited to the study. All of them took 20 mg zafirlukast twice daily for at least 5 days. Skin prick test was performed before and after treatment by histamine and specific allergens. There was no significant difference between pre- and post-treatment skin prick tests in spite of zafirlukast treatment. CONCLUSION: Zafirlukast does not affect skin reactions against histamine and specific allergens. Diagnostic skin prick test can be performed under zafirlukast treatment.

Evaluation of clinical parameters in patients with obstructive sleep apnea and possible correlation with the severity of the disease.

Obstructive sleep apnea (OSA) is a complex disease whose etiology is multifactorial and incompletely understood. This article focuses on upper airway anatomy evaluation and the standardization of different physical findings in patients with OSA and on the possible correlation of these physical findings with the severity of the disease. All patients underwent a physical examination and polysomnography. The physical examination included tonsil size, modified Mallampati grade, neck circumference, lateral clinical craniofacial assessment and body mass index (BMI). The study group consisted of 85 patients. A statistically significant correlation between tonsil size and BMI and with the respiratory disturbance index (RDI) was detected (P = 0.004 and 0.03 respectively). Also patients with a craniofacial anomaly have a higher RDI level than the patients without this anomaly (P = 0.03). This study has identified some standardized physical findings for predicting the severity of OSA. We aim to benefit from these findings in the selection of a rational treatment modality selection for patients with OSA.

Respiratory distress with acitretin, reversal by corticosteroid.

The retinoic acid derivatives are used for disorders of keratinization such as psoriasis. Acitretin, which is a synthetic, aromatic derivative of retinoic acid, is frequently used to treat psoriasis. The retinoic acid syndrome (RAS), described with all-trans-retinoic acid (ATRA) in patients with promyelocytic leukemia, is characterized by fever and respiratory distress. In this report we present a 32 year old male who developed high fever, dry cough and dyspnea while undergoing treatment with acitretin. During hospitalization, his acitretin was stopped and he was treated with corticosteroids. Significant improvement was observed within a few days.

Latex allergy in patients with spinal dysraphism: the role of multiple surgery.

OBJECTIVE: To investigate whether multiple surgery is responsible for the high prevalence of latex hypersensitivity in patients with spinal dysraphism by comparing the results of a skin-prick test in three groups of patients with different surgical histories. PATIENTS AND METHODS: An in vivo diagnostic kit was used to determine the sensitivity to latex using a skin-prick test in three groups of patients, 23 with spinal dysraphism who had undergone surgery, 20 patients who had undergone non-urological surgery and urological patients who had not undergone surgery (control). There was no history of latex allergy in any individual from the three groups. RESULTS: The skin-test was positive in six patients with spinal dysraphism, in one who had undergone previous non-urological surgery and in none of the control patients. The prevalence of latex hypersensitivity was significantly higher in patients with spinal dysraphism than in the other groups (non-urological surgery P < 0.05 and control P < 0.01). This difference occurred despite the patients in each surgical group having undergone a mean of less than two operations. There was no significant difference in latex sensitivity between control patients and those undergoing non-urological surgery. CONCLUSION: Despite having no history of latex hypersensitivity, about a quarter of patients with spinal dysraphism were sensitive to latex. Repeated surgery alone cannot be responsible for the greater incidence of latex hypersensitivity in these patients. Despite multiple surgery being accepted as playing a major role in the development of latex hypersensitivity, relatively fewer surgical episodes than reported previously seem to be sufficient to elicit latex allergy.