Persistent pulmonary abnormalities after 18 months of SARS-CoV-2 pneumonia.

OBJECTIVE: To describe persistent pulmonary abnormalities detected on HRCT after 18 months of SARS-CoV-2 pneumonia, and to determine their extension and correlation with pulmonary function. PATIENTS AND METHODS: A prospective cross-sectional study with an initial cohort of 90 patients in follow-up due to persisting lung abnormalities on imaging, functional respiratory impairment and/or respiratory symptoms. Of these, 31 (34%) were selected for analysis due to the persistence of their lung abnormalities on HRCT at 18 months after infection. A double reading was performed for each HRCT (62 observations). RESULTS: Of the 31 patients included: 20 (65%) were men; mean age was 67 years; 17 (55%) were smokers/ex-smokers. The mean hospitalisation time was 38 days. Eighteen (58%) patients were admitted to intensive care units. Five patients (16%) suffered an acute pulmonary thromboembolism and three (9.7%) had a pneumothorax. The mean time between the onset of pneumonia and the follow-up HRCT was 20.34 months. Nineteen percent of patients suffered from total lung function abnormalities; and ground-glass opacities and reticulation were present in 12% and 4.5% respectively. The findings of the 62 readings were: ground-glass opacities (100%), reticulation (83%), subpleural curvilinear lines (62%), parenchymal bands (34%), traction bronchiectasis (69%), displacement of vessels/fissures (46%) and honeycombing (4.9%). Pulmonary function 18 months after the acute episode revealed a mean FVC of 92% of predicted value, with an FVC < 80% of predicted value in 11 patients (35.4%). Mean DLCO was 71% of predicted value, with a DLCO < 80% in 22 patients (70%). We observed a statistically significant relationship between total lung function abnormalities on HRCT and FVC (P < 0.05), and a trend towards statistical significance with DLCO (P = 0.051); there was a statistically significant relationship between the presence of ground-glass opacities and FEV1/FVC (P < 0.01). The relationships between reticulation and FVC, FVC%, FEV1, FEV1% and DLCO% were also considered statistically significant (P < 0.05). CONCLUSION: Persistent interstitial lung abnormalities are seen on HRCT for a subset of patients infected with SARS-CoV-2 pneumonia. Seventy percent of these patients suffered a slight decrease in DLCO.

Seroprevalence of IgM and IgG anti-SARS-COV-2 and associated factors among agricultural workers in Colombia.

Background: The population of South America has been severely affected by the COVID-19 pandemic. In this region, during the year 2020, high seroprevalence percentages were reported, which have been associated with the socioeconomic characteristics of the population, mainly in urban areas. However, a relative lack of information on the dynamics of the pandemic in rural areas of these countries, where the population is more vulnerable, is still present. This study determined antibody prevalence against SARS-CoV-2 in urban and rural food producing workers in Colombia. Methods: A total of 1242 workers, urban and rural, linked to poultry, dairy, and meat production and supply chains, were analyzed through a sociodemographic survey and two serological tests against S and N proteins of SARS-CoV-2. Results: 78.7% were male. 50.9% of the participants were rural inhabitants, with an average age of 40.9 years old. 39.2% had IgM and IgG against SARS-CoV-2 S protein and 31.3% against N protein for the same virus; 83.6% had not been tested with an RT-PCR test for COVID-19 and 75.7% did not report symptoms related to the disease. The associated risk factors were low education, OR: 1.46, greater number of cohabitants, OR: 1.36, and contact with people infected with COVID-19, OR: 2.03. Conclusions: The seroprevalences found suggest an important interconnectivity between rural and urban areas, where asymptomatic subjects and sociodemographic factors facilitate the virus' spread in the population.

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.

[Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. / Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera.

AIMS: To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD: A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS: Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS: In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.

Gender differences in right ventricular function in patients with non-ischaemic cardiomyopathy.

AIM: To evaluate sex-related differences in right ventricular (RV) function, assessed with cardiac magnetic resonance imaging, in patients with stable non-ischaemic dilated cardiomyopathy. METHODS: Prospective multicentre study. We included 71 patients (38 men) and 14 healthy volunteers. RESULTS: Mean age was 60.9 ± 12.2 years. Men presented higher levels of haemoglobin and white blood cell counts than women, and performed better in cardiopulmonary stress testing. A total of 24 patients (12 women) presented severe left ventricular (LV) systolic dysfunction, 32 (13 female) moderate and 15 (8 women) mild LV systolic dysfunction. In the group with severe LV systolic dysfunction, average right ventricular ejection fraction (RVEF) was normal in women (52 ± 4 %), whereas it was reduced in men (39 ± 3 %) p = 0.035. Only one woman (8 %) had severe RV systolic dysfunction (RVEF < 35 %) compared with 6 men (50 %) p < 0.001. In patients with moderate and mild LV dysfunction , the mean RVEF was normal in both men and women. In the 14 healthy volunteers, the lowest value of RVEF was 48 % and mean RVEF was normal in women (56 ± 2 %) and in men (51 ± 1 %), p = 0.08. CONCLUSIONS: In patients with dilated cardiomyopathy, RV systolic dysfunction is found mainly in male patients with severe LV systolic dysfunction.

[Evaluation of immediate post-operative pain in heart surgery using the Behavioural Pain Scale]. / Valoración del dolor durante el postoperatorio inmediato de cirugía cardiaca mediante la Behavioural Pain Scale.

INTRODUCTION: Patients in the immediate postoperative period of cardiac surgery have abolished communication skills and therefore can not express pain. Pain produces significant adverse effects that alter the patients' course. Therefore, identifying and controlling them will lead to increased quality of care for the critical patient. OBJECTIVE: To measure the degree of pain in patients in the immediate postoperative period of cardiac surgery by scaling Behavioural Pain Scale. MATERIAL AND METHOD: An observational, prospective and longitudinal. Patients over 18 years in the first 24 hours of admission with no communication problems who were under sedation and subjected to mechanical ventilation were included. Twenty patients were enrolled in the study. The Behavioural Pain Scale (BPS) was used during two procedures usually considered as a painful practice in the literature, that is, mobilization and/or postural changes and aspiration of secretions. RESULTS: Twenty-seven measurements were made of procedures considered as painful. The results obtained by applying the scale BPS showed that 70.4% of patients had no pain, 22.2% had mild to moderate pain and 7.4% had unacceptable pain. CONCLUSION: This study has identified that the patients suffer pain during the postoperative period. Within these patients, there is a small, but not insignificant number whose pain is unacceptable during this period. This finding serves as a beginning for a line of research to improve the handling of the postoperative pain during immediate post-operative cardiac surgery.

[Cystic fibrosis in adults: inter- and intraobserver agreement for the Brasfield and Chrispin-Norman chest radiography scoring systems and correlation with clinical data and spirometry]. / Fibrosis quística en adultos: acuerdos inter e intraobservador para las escalas de puntuación de Brasfield y Chrispin-Norman en la radiografía de tórax y relación con datos clínicos y espirométricos.

OBJECTIVE: Most chest radiography scoring systems for patients with cystic fibrosis have been developed for children but are also used for adults. Our aim was to evaluate the intra- and interobserver variability of 2 radiographic scoring systems in adults with cystic fibrosis and to assess the correlation of these systems with clinical and spirometric parameters. PATIENTS AND METHODS: The chest x-rays of 24 adult patients with cystic fibrosis were compared using 2 scoring systems (Brasfield and Chrispin-Norman). The x-rays were scored by 2 radiologists and reevaluated 4 months later by 1 of the 2 observers. Intra- and interobserver agreement was assessed using the intraclass and Pearson's correlation coefficients. The radiographic scores were compared to lung function tests and other clinical data. RESULTS: Both intra- and interobserver agreement were high (r > or = 0.9 and the intraclass correlation coefficient > or = 0.85 with both systems for both samples). Both scoring systems correlated with spirometry results: forced expiratory volume in the first second (FEV1) (r = 0.64 and r = 0.55), FEV1% (r = 0.75 and r = 0.72), and the percentage of forced vital capacity in relation to the predicted value (r = 0.63 and r = 0.056). We found no association between scoring system and sex, age, or body mass index. CONCLUSIONS: Assessment of chest radiographs of adult patients with cystic fibrosis by the Brasfield and Chrispin-Norman scoring systems shows good intra- and interobserver agreement. Both systems correlate well with lung function variables, especially FEV1.

[Pleural empyema associated with endobronchial lipoma]. / Empiema pleural asociado a lipoma endobronquial.

Bronchial benign tumors comprise fewer than 4% of pulmonary neoplasms. Endobronchial lipoma is an extremely rare benign neoplasm accounting for only 0.1% to 0.5% of all lung tumors. Clinical symptoms of lipoma depend on the location of the tumor, the severity of bronchial obstruction, and the functional and anatomical effects on the parenchyma distal to the obstruction. Computed axial tomography usually reveals the adipose composition of the lipomatous tumor. We report the case of an 83-year-old man diagnosed with community-acquired pneumonia that led to complications: pleural empyema caused by Haemophilus influenzae infection and atelectasis of the right middle and lower lobes secondary to a lipomatous endobronchial obstruction. Removal of the bronchial lipoma was performed by laser resection.

[Hookwire localization of pulmonary nodules for video-thorascopic surgical resection]. / Localización mediante arpón de nódulos pulmonares para su resección por cirugía videotoracoscópica.

OBJECTIVES: To assess the usefulness of a technique for inserting hookwires guided by computed tomography to locate and resect pulmonary nodules by video-assisted thoracoscopy. To describe the procedure and its complications. PATIENTS AND METHODS: Nine pulmonary nodules were located in nine patients. All were

[Bullous emphysema and neurofibromatosis]. / Enfisema bulloso y neurofibromatosis.

Clinical and image findings in a 43 year-old smoker man with advanced lung bullous emphysema and von Recklinhausen's neurofibromatosis are presented. Bullous emphysema and subpleural neurofibromas were detected in a chest computed tomographic study. The possible association or independence of these two conditions is discussed.

Case report: organic brain syndrome due to multiple tumour emboli.

A case of rapid neurological deterioration in a 60-year-old man with oesophageal carcinoma is reported. He suffered two episodes of global cerebral dysfunction following traumatic endoscopic manipulation. Autopsy findings showed multiple tumour emboli which occluded medium and small-sized vessels in cortical and subcortical areas, resulting in multiple microinfarcts.