Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study.

BACKGROUND: SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS: We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS: Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION: We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.

[Overdiagnosis in cancer screening]. / Sobrediagnóstico en cribado de cáncer.

In screening programs, overdiagnosis is defined as the detection of a disease that would have gone undetected without screening when that disease would not have resulted in morbimortality and was treated unnecessarily. Overdiagnosis is a bias inherent in screening and an undesired effect of secondary prevention and improved sensitivity of diagnostic techniques. It is difficult to discriminate a priori between clinically relevant diagnoses and those in which treatment is unnecessary. To minimize the effects of overdiagnosis, screening should be done in patients at risk.

Perception of patients with retinal pathology on aspects of visual function and their management.

BACKGROUND AND OBJECTIVE: Age-related macular degeneration (AMD) and diabetic retinopathy (DR) are highly prevalent. OBJECTIVE: To explore perceptions of patients with AMD or DR about the impact of the disease and treatment on their daily living activities. MATERIALS AND METHODS: Semi-structured interviews with a questionnaire developed from validated patient reported outcomes questionnaires. The questionnaire consisted of 19 questions about the disease and 9 about the treatment. The questions (items) were answered on a scale from 1 to 9. In addition, the patient interviewed was invited to make free comments on each question. Nine patients with AMD and 9 with DR were interviewed by videoconference or telephone call. A quantitative analysis of the responses and a qualitative analysis of the comments were carried out. RESULTS: The most relevant item for patients with AMD or DR is "Recognize people when they are nearby", and "Read text in normal size font in a newspaper or book", followed, in patients with AMD, by "Do things what you would like" and, in patients with DR, "Feeling frustrated by the vision problems." Regarding the treatment, the most relevant aspects for both groups is that the treatment works and receiving appropriate information before and after the treatment. The qualitative comments were focused to the disease, the treatment, and to the role of doctors and the health system. CONCLUSION: Quantitative responses and free comments can be useful to improve the care of patients with AMD or DR by physicians and the health system.

Diagnostic accuracy of visual analysis versus dual time-point imaging with 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules with low uptake. / Precisión diagnóstica del análisis visual frente al protocolo de imagen tardía con 18F-FDG PET/TC para la caracterización de nódulos pulmonares indeterminados con baja captación.

OBJECTIVE: To determine the accuracy of visual analysis and the retention index (RI) with dual-time point 18F-FDG PET/CT for the characterization of indeterminate pulmonary nodules (IPN) with low FDG uptake. MATERIALS AND METHODS: A retrospective analysis was performed on 43 patients (28 men, 64 ± 11 years old, range 36-83 years) referred for IPN characterization with 18F-FDG-PET/CT and maximum standard uptake value ≤ 2.5 at 60 minutes post-injection (SUVmax1). Nodules were analyzed by size, visual score for FDG uptake on standard (OSEM 2,8) and high definition (HD) reconstructions, SUVmax1, SUVmax at 180 minutes post-injection (SUVmax2), and RI was calculated. The definitive diagnosis was based on histopathological confirmation (n = 28) or ≥ 2 years of follow-up. RESULTS: Twenty-four (56%) nodules were malignant. RI ≥ 10% on standard reconstruction detected 18 nodules that would have been considered negative using the standard SUVmax ≥ 2.5 criterion for malignancy. RI ≥ 10% had a sensitivity, specificity, PPV, NPV and accuracy of 75, 73.7, 78.3, 70, and 74.4%, respectively, while for FDG uptake > liver on HD these were 79.1, 63.2, 73.1, 70.6, and 72.1%, respectively. SUVmax1 ≥ 2, SUVmax2 > 2.5 and FDG uptake > liver on standard reconstruction had a PPV of 100%. FDG uptake > mediastinum on HD had a NPV of 100%. CONCLUSIONS: RI ≥ 10% was the most accurate criterion for malignancy, followed by FDG uptake > liver on HD reconstruction. On standard reconstruction, SUVmax1 ≥2 was highly predictive of malignancy, as well as SUVmax2 > 2.5 and FDG uptake > liver. FDG uptake < mediastinum on HD was highly predictive of benign nodules.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography.

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64±9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2±7.6mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n=39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n=17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Regulation of bovine endothelial constitutive nitric oxide synthase by oxygen.

Oxygen (O2) may regulate pulmonary vascular resistance through changes in endothelial nitric oxide (NO) production. To determine whether constitutive NO synthase (cNOS) is regulated by O2, we assessed cNOS expression and activity in bovine pulmonary artery endothelial cells exposed to different concentrations of O2. In a time-dependent manner, changes in O2 concentration from 95 to 3% produced a progressive decrease in cNOS mRNA and protein levels resulting in 4.8- and 4.3-fold reductions after 24h, respectively. This correlated with changes in cNOS activity as determined by nitrite measurements. Compared with 20% O2, cNOS activity was increased 1.5-fold in 95% O2 and decreased 1.9-fold in 3% O2. A decrease in O2 concentration from 94 to 3% shortened cNOS mRNA half-life from 46 to 24 h and caused a 20-fold repression of cNOS gene transcription. Treatment with cycloheximide produced a threefold increase in cNOS mRNA at all O2 concentrations, suggesting that cNOS mRNA expression is negatively regulated under basal condition. We conclude that O2 upregulates cNOS expression through transcriptional and post-transcriptional mechanisms. A decrease in cNOS activity in the presence of low O2 levels, therefore, may contribute to hypoxia-induced vasoconstriction in the pulmonary circulation.

The cause of death of Emperor Charles V.

Abstract. Plasmodium falciparum malaria was the cause of death of Emperor Charles V. This confirmation was achieved by microscopy analysis of the Emperor's remnants.

[Lung transplant]. / Trasplante pulmonar.

A lung transplant is usually the final therapeutic option for patients with respiratory insufficiency. In spite of the many advances in immunology and the management of complications, mortality and morbidity associated with this transplant are far higher than with others. Acute rejection is an almost universal problem in the first year, while obliterative bronchitis reduces long term survival. Respiratory infections also play a significant role in the complications associated with lung transplants due to the constant exposure of the graft to the outside. However, the success of this therapeutic option, which basically depends on a suitable selection of donor and recipient, are evident, above all with respect to quality of life.

Coagulación de plexo coroideo como procedimiento aislado en el tratamiento de la hidrocefalia / Choroid plexus coagulation as an isolated procedure in the treatment of hydrocephalus

La coagulación de plexo coroideo (CPC) es un procedimiento que nace del intento histórico de tratar la hidrocefalia. Desarrollado en la primera mitad del siglo XX, pero posteriormente abandonado por su baja tasa de éxito y alta tasa de complicaciones. Con el advenimiento de la neuroendoscopía moderna se adapta la idea de la CPC en un intento de dar cabida a alternativas a la derivación de líquido cefalorraquídeo (LCR) como procedimiento estándar para tratar la hidrocefalia. Actualmente su uso se ha difundido mayormente en conjunto con la tercer ventriculostomía endoscópica como una opción eficaz, más barata y exenta de los riesgos inherentes de una derivación de LCR. No obstante, se ha reportado su éxito como procedimiento aislado en casos seleccionados como en hidrocefalia comunicante lentamente progresiva, hidranencefalia y un posible rol en el tratamiento de la hiperplasia de plexo coroideo. El objetivo de esta revisión es determinar la efectividad de la CPC aislada como tratamiento para la hidrocefalia en diversos escenarios clínicos e identificar las variables asociadas a su éxito.

Choroid plexus coagulation (CPC) is a procedure born of historic attempts to treat hydrocephalus. Developed in the first half of the 20th century, it was later abandoned because of its low success rate and high rate of complications. With the advent of modern neuro-endoscopy the CPC was adapted in an attempt to open the way for alternatives to CSF shunt as the standard procedure for treating hydrocephalus. Its use has spread mainly in conjunction with endoscopic third ventriculostomy as an option which is effective, cheaper and without the risks inherent in a CSF shunt. However, there have been reports of its success as an isolated procedure in selected cases such as chronic progressive communicating hydrocephalus, hydranencephaly and it has a possible role in the treatment of choroid plexus hyperplasia. The objective of this review is to determine the effectiveness of isolated CPC as treatment for hydrocephalus in various clinical setti ngs and identify the variables associated with its success.

Surgical Outcomes in a Lung Cancer-Screening Program Using Low Dose Computed Tomography / Resultados quirúrgicos de un programa de cribado de cáncer de pulmón utilizando tomografía computarizada de baja dosis

OBJECTIVE: Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. METHODS: We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. RESULTS: Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64 ± 9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2 ± 7.6 mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n = 39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n = 17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%-98%) and 83% (95% CI: 65%-92%), respectively. CONCLUSION: Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively

OBJETIVO: El cáncer de pulmón (CP) es la principal causa de muerte por cáncer en todo el mundo. En España se diagnostican anualmente más de 27.000 CP y la mayoría son irresecables. La detección y el tratamiento tempranos reducen la mortalidad por CP. Este estudio describe los resultados quirúrgicos en una cohorte de cribado de CP de larga duración en España. MÉTODOS: Llevamos a cabo un estudio retrospectivo de los resultados quirúrgicos de un programa de cribado de CP (CCP) usando tomografía computarizada de baja dosis (LDCT, por sus siglas en inglés) en marcha desde el año 2000. Se realizó un análisis descriptivo de los parámetros clínicos y radiológicos, presencia o ausencia de un diagnóstico preoperatorio, estadificación patológica, morbilidad, mortalidad y supervivencia. RESULTADOS: Se diagnosticaron 97 (2,5%) CP entre 3.825 sujetos cribados. Veinte personas con CP no se sometieron a cirugía debido a un estado avanzado de la enfermedad o a una histología de células pequeñas. Se llevaron a cabo 87 procedimientos quirúrgicos por sospecha de CP o CP demostrado mediante biopsia, detectados en la LDCT. La mayoría de los pacientes operados fueron varones (57 [85%]) de 64 años ± 9,1 años. Nueve pacientes se sometieron a una segunda operación por un cáncer de pulmón primario metacrónico. El tamaño medio del tumor fue de 15,2 ± 7,6 mm. Ocho nódulos fueron benignos (9,2%). Se realizó lobectomía en 56 casos (83,6%). El adenocarcinoma (n = 39; 58,2%) fue el tipo histológico más frecuente seguido por el carcinoma de células escamosas (n = 17; 25,4%); 59 (88%) tumores se encontraban en estadio I. Trece pacientes (15,4%) tuvieron 16 complicaciones. Las tasas de supervivencia estimadas a los 5 y 10 años para el estadio I fueron del 93% (IC 95%: 79 al 98%) y del 83% (IC 95%: 65 al 92%), respectivamente. CONCLUSIÓN: El CCP se asoció con excelentes resultados quirúrgicos y con tasas de supervivencia a los 5 y 10 años superiores al 90 y al 80%, respectivamente

Effect of vitamin E on hydrogen peroxide production by human vascular endothelial cells after hypoxia/reoxygenation.

Changes in oxidative stress status play an important role in tissue injury associated with ischemia -- reperfusion events such as those that occur during stroke and myocardial infarction. Endothelial cells (EC) from human saphenous vein and aorta were incubated for 22 h and found to take up vitamin E from media containing 0-60 mM vitamin E in a dose-dependent manner. EC supplemented with 23 or 28 mM vitamin E in the media for 22 h were maintained at normoxia (20% O2, 5% CO2, and balance N2) or exposed to hypoxic conditions (3% O2, 5% CO2, and balance N2) for 12 h, followed by reoxygenation (20% O2) for 30 min. Saphenous EC supplemented with 23 mM vitamin E produced less (p < 0.05) H2O2 than unsupplemented controls, both at normoxic condition (supplemented: 4.9 +/- 0.05 vs. control: 10.9 +/- 1.3 pmol/min/10(6) cells) and following hypoxia/reoxygenation (supplemented: 6.4 +/- 0.78 vs. control: 17.0 +/- 2.7 nmol/min/10(6) cells). In contrast, aortic EC, which were found to have higher superoxide dismutase and catalase activity than EC from saphenous vein, did not produce any detectable levels of H2O2. Following hypoxia/reoxygenation, the concentration of vitamin E in supplemented saphenous EC was 62% lower than cells maintained at normoxia (0.19 +/- 0.03 vs. 0.5 +/- 0.12 nmoles/10(6) cells, p < 0.001); in aortic EC vitamin E content was reduced by 18% following reoxygenation (0.86 +/- 0.16 vs. 0.70 +/- 0.09 nmoles/10(6) cells, p < 0.05). Therefore, enrichment of vitamin E in EC decreases H2O2 production and thus may reduce the injury associated with ischemia-reperfusion events.

Upper airway obstruction due to inhalation of a tracheal T-tube resulting in pulmonary edema.

Acute upper airway obstruction may present with pulmonary edema. Following is a report of pulmonary edema secondary to acute upper airway obstruction due to inhalation of a Montgomery tracheal T-tube. The principal factor causing pulmonary edema is the generation of large negative transpulmonary pressures. This may be enhanced by changes in the cardiovascular function due to the Müller maneuver.

Malaria control and long-term periodicity of the disease in Pakistan.

The classic investigations of the malaria epidemics in the Punjab led to the conclusion that in this most populous and most malarious province of the present-day Pakistan, epidemics occurred regularly at intervals of approximately eight years. Against this background, the results of a Malaria Control Programme launched in 1975 are examined. The Programme, supported by USAID and WHO, represents in economic terms the greatest effort made against malaria in the country. Malathion, the main attack weapon of the Programme, was used on an unprecedented scale. This created logistic and--unexpectedly--toxicity problems among the spraying workers. Despite these difficulties, an over-all reduction of 76% in the slide positivity rate was observed in the first two years of operations of the Programme. The authors warn against measures which may curtail the activities of the Programme when, according to the cyclical periodicity of malaria in the Punjab, an epidemic wave can be expected in 1980-81, with inevitable repercussions all over the country.

Respiratory dysfunction in myasthenia gravis.

Myasthenia gravis can affect the respiratory system, causing respiratory muscle weakness, an abnormal breathing pattern, and blunted ventilatory responses. Specific treatment can reverse most of these effects and prevent the development of respiratory failure.

Forty years of malaria eradication in Sardinia. A new appraisal of a great enterprise.

The campaign against malaria in Sardinia carried out by the Ente Regionale per la Lotta Anti-Anofelica in Sardegna (ERLAAS), appears today as one of the greatest efforts against malaria since the discovery of its aetiology and mode of transmission. The disease was eradicated without achieving the eradication of the vector, Anopheles labranchiae, the main objective of the campaign. This species eradication failure had been at first attributed to the indigenous character of A. labranchiae and its long standing in the island. A more recent analysis, based on paleoclimatological information, makes virtually impossible the presence of A. labranchiae during the last (Würm) glacial period and indicates a comparatively recent introduction of the species in the island. It was the absence of A. atroparvus, with which it has usually to compete in Southern Europe, what permitted the wide distribution of A. labrianchiae in the island. Four decades after the events the concept of species eradication as an anti-malaria weapon appears as basically wrong, the results of Sardinia as well as those obtained in the Italian mainland having demonstrated that the eradication of the vector was not required for the successful eradication of the disease.

Malaria and ecosystems: from prehistory to posteradication.

Human malaria originated in tropical areas of the Old World but the Pleistocene glaciations delayed its spread in the Northern Hemisphere. The last glaciation produced temperatures 9 degrees C lower than those prevailing today in Southern Europe, making the transmission of malaria there virtually impossible. When temperatures approximately equal to those of today were reached 10,000 years ago, the disease and some of its most effective vectors, Anopheles labranchiae and A. sacharovi, spread to the North although the refractoriness of the European vectors to Pasmodium falciparum probably delayed the spread of the malignant tertian parasites. Malaria may have spread earlier in the Levant and parts of Asia, due to a less marked drop of temperature during the last glaciation but we have witnessed in contemporary times the spread of A. stephensi, one of the most effective vectors in the area. The first noticeable decline of malaria was seen in Europe during the nineteenth century due to new agricultural practices and changed social conditions. The final disappearance of the disease in Europe and North America was due more to those changed conditions than to the use of DDT and other residual insecticides which were going to fall in so-called eradication campaigns in the Third World.

Changes in the geographical distribution of malaria throughout history.

Climatic changes must have greatly affected the distribution of malaria in prehistoric times. Paleobotanical evidence, snowline depression studies and information obtained from deep sea sediment cores, indicate that southern Europe must have suffered a drop of summer temperatures of approximately 9 degrees C during the last glacial maximum, 18,000 years ago. Such a drop would have been decisive as regards the distribution of malaria and its vectors. If present at all, the disease would have been confined to the southernmost parts of the continent but P. falciparum and today's most effective vectors--A. labranchiae and A. sacharovi--would have been excluded from Europe. In western Asia, summer temperatures 6 degrees C lower than those of today would have had less effect on the malaria situation. The introduction of falciparum malaria in southern Europe is placed in Hellenistic and Early Imperial Roman times, based on paleoclimatological evidence and historical and medical data. In America P. falciparum is also considered a late entrant but vivax and quartan malaria may have been introduced in pre-Columbian times. In the Pacific, the disease is known to have been spread by man since the Age of Discovery until contemporary times.

Dealing with malaria in the last 60 years. A personal experience.

Dealing with malaria in the last 60 years is seen by the author in the perspective of his own experience. His malaria work, which began in 1941, covered the study of the habits of the mosquitoes dwelling in the savanna country of Eastern Colombia and the effect on malaria transmission of the newly introduced DDT residual spraying. The success of the campaign he later directed in Sarawak and Brunei contributed to the launching by WHO of its global malaria eradication campaign. Further successful work in Uganda showed the possibility of effective control and even eradication in highland country but left unsolved the problem of how to interrupt transmission of holoendemic malaria in Africa. The author's work with WHO in the Middle East showed to what extent social and economic conditions could influence the course of a malaria campaign. This was also the experience in America, both in Colombia in the author's early work and later in Mexico during an evaluation of the national malaria programme. Development of insecticide resistance was also encountered in his career and the refractoriness of the European vectors was also observed in his work as a malariologist.

The end of malaria in Europe: an eradication of the disease by control measures.

The success of the campaigns against malaria in Europe, the USA and other countries in the temperate zone, prompted WHO to launch its global eradication campaign in 1955. It failed to achieve eradication in tropical countries due to climatic, social and economic conditions different from those prevailing in the temperate zone, where eradication had been achieved using control measures.