Could pulmonary low-dose radiation therapy be an alternative treatment for patients with COVID-19 pneumonia? Preliminary results of a multicenter SEOR-GICOR nonrandomized prospective trial (IPACOVID trial).

PURPOSE: To evaluate the efficacy and safety of lung low-dose radiation therapy (LD-RT) for pneumonia in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: Inclusion criteria comprised patients with COVID-19-related moderate-severe pneumonia warranting hospitalization with supplemental O2 and not candidates for admission to the intensive care unit because of comorbidities or general status. All patients received single lung dose of 0.5 Gy. Respiratory and systemic inflammatory parameters were evaluated before irradiation, at 24 h and 1 week after LD-RT. Primary endpoint was increased in the ratio of arterial oxygen partial pressure (PaO2) or the pulse oximetry saturation (SpO2) to fractional inspired oxygen (FiO2) ratio of at least 20% at 24 h with respect to the preirradiation value. RESULTS: Between June and November 2020, 36 patients with COVID-19 pneumonia and a mean age of 84 years were enrolled. Seventeen were women and 19 were men and all of them had comorbidities. All patients had bilateral pulmonary infiltrates on chest X­ray. All patients received dexamethasone treatment. Mean SpO2 pretreatment value was 94.28% and the SpO2/FiO2 ratio varied from 255 mm Hg to 283 mm Hg at 24 h and to 381 mm Hg at 1 week, respectively. In those who survived (23/36, 64%), a significant improvement was observed in the percentage of lung involvement in the CT scan at 1 week after LD-RT. No adverse effects related to radiation treatment have been reported. CONCLUSIONS: LD-RT appears to be a feasible and safe option in a population with COVID-19 bilateral interstitial pneumonia in the presence of significant comorbidities.

Use of barley straw as a support for the production of conidiospores of Trichoderma harzianum.

In this work was to evaluate the conidiospores production of Trichoderma harzianum using barley straw as substrate. Four growth conditions were used; washed and unwashed barley straw and washed and unwashed barley straw supplemented with mineral salts. The highest spore production was observed when washed barley straw supplemented with mineral salts with 1.56 × 1010 conidiospores/gram of dry matter (gdm) at 216 h of cultivation was used. The effect of substrate moisture on spore production was studied, three initial moisture levels of the substrate were tested and it was observed that a humidity of 80 % of the substrate improves the production of conidiospores reaching a concentration of 2.35 × 1010 conidiospores/gdm at 136 h. Finally, conidiospores viability was evaluated for 12 months by keeping them on the conidia and substrate, and viability of 71 % of the conidiospores was observed, so this maintenance method is an excellent means of conserving the conidiospores viability.

Comparative study on properties of starch films obtained from potato, corn and wheat using 1-ethyl-3-methylimidazolium acetate as plasticizer.

Starch films are gaining attention as substitutes of synthetic polymers due to their biodegradability and low cost. Some ionic liquids have been postulated as alternatives to glycerol, one of the best starch plasticizers, due to their great capacity to form hydrogen bonds with starch and hence great ability of preventing starch retrogradation and increasing film stability. In this work, [emim+][Ac-]-plasticized starch films were prepared from potato, corn and wheat starch. The effect of starch molecular structure in terms of granular composition (amylose and phosphate monoester contents) and molecular weight (Mw) on film properties was evaluated. Potato starch films were the most amorphous because of the higher Mw and phosphate monoester content of potato starch, both contributing to a lower rearrangement of the starch chains making the crystallization process difficult. In contrast, corn and wheat starches lead to more crystalline films because of their lower Mw, which may imply higher mobility and crystal growth rate, and lower phosphate monoester content. This more crystalline structure could be the responsible of their better mechanical properties. [emim+][Ac-] can be considered suitable for manufacturing starch films showing corn and wheat starch films similar properties to synthetic low-density polyethylene, but involving a simple and environmentally-friendly process.

Analysis of tissue bioimpedance as a measurement of liver steatosis: experimental model in large animals.

BACKGROUND: Electrical bioimpedance (BI) has been used to indirectly measure steatosis. This method has not yet been established in the clinics thus experimental studies are needed in big animals. We assessed BI to measure liver steatosis in porcine animals. METHODS: Twelve large-white × Landrace pigs weighing 35 kg were allocated to a study (n = 9) and a control group (n = 3). A special diet was used to promote steatosis among the study group: methionine deficient and choline-restricted diet that contains supplements of cholesterol, collate and excess of saturated fat. Control group animals were fed a normal diet. A new tetrapolar electrode model was used for BI measurement, which were performed during open laparotomy by inserting a probe into one of the lobes. Measurements were done in the third and fourth segments of the pig liver, placing the probe either on the surface or inserted into the parenchyma of the liver. Open biopsies were obtained at the end of the measurements. Histological samples were processed and stained with hematoxylin-eosin to estimate macrosteatosis. Pearson correlation coefficient between BI and percentage steatosis were calculated at different frequencies. RESULTS: After 4 months of the special diet all the animals in the study group developed steatosis (90% to 20%), whereas none of the control group was affected. Pearson correlation coefficients between BI and percentage of steatosis were significant (0.877-0.878) with the best correlations obtained with a probe placed on the fourth segment of the liver surface and the best frequency to perform the measurements being 50 and 75 kHz. CONCLUSIONS: BI is an accurate, fast method for steatosis measurements, that is easier and cheaper than either open or needle biopsy.

[Measuring patient satisfaction and identifying opportunities for improvement in the preparation of bariatric surgery patients]. / Medida de la satisfacción del paciente e identificación de oportunidades de mejora en la preparación de pacientes de cirugía bariátrica.

OBJECTIVE: To evaluate the satisfaction of patients candidates for bariatric surgery with the performance of a group training program prior to surgery, identifying opportunities for improvement in the program and evaluating participants satisfaction following their implementation. METHOD: An "ad hoc" designed survey was used, addressed to assess opinions on different aspects of the program, overall satisfaction and identification of areas for improvement. The survey was administered to two groups of patients: the first after one year of implementation of the program to identify suggestions for improvement, and the second after one year of the implementation of the improvement. A total of 112 patients were assessed, 66 in the first pass of the questionnaire and 46 in the second. Both groups were homogeneous in demographic variables RESULTS: The main improvement detected was expert patients in the preparation of the program. After implantation, slight changes in the ratings of the questions were produced, that were not significant. Overall satisfaction rose from 9.5 to 9.74 out of 10. The other proposals for improvement were to improve audiovisuals and to fit the room furniture to the characteristics of the patients. CONCLUSIONS: The very high satisfaction levels obtained are usual in studies on hospital satisfaction, our results still being above the studies consulted, as well as in levels of excellence. This prevents statistically significant differences being found. There were no significant differences in the results before and after implementation of improvement. Continuous assessment allows new possibilities for improvement.

Natural pollen exposure increases the response plateau to adenosine 5'-monophosphate and bronchial but not alveolar nitric oxide in sensitized subjects.

BACKGROUND: The effect of allergen exposure on airway responsiveness and exhaled nitric oxide (NO) has been well documented, but no information is available on allergen-induced changes in the response plateau to adenosine 5'-monophosphate (AMP) and in bronchial NO flux (J'aw(NO)) and alveolar NO (CA(NO)). OBJECTIVES: To determine the effect of natural allergen exposure, a proinflammatory stimulus, on the shape of the concentration-response curve to AMP and NO production in airway and alveolar sites. METHODS: Airway responsiveness to high concentrations of methacholine and AMP, J'aw(NO) and CA(NO) values were obtained in 31 subjects with pollen allergy and in 11 healthy controls. Subjects with pollen allergy were studied before and at the height of the pollen season whereas healthy controls were tested on one occasion only. RESULTS: In the group with pollen allergy, natural pollen exposure increased J'aw(NO) (p = 0.03), but had no effect on CA(NO) (p = 0.12). In the 18 subjects with pollen allergy who showed a response plateau to AMP in at least one period, the response plateau to AMP increased from a mean of 13.4% (95% CI: 8.2-18.5) out of season to 22.5% (95% CI: 15.5-29.4, p = 0.004) during the pollen season. Similar results were obtained with methacholine. Compared with healthy controls, subjects with pollen allergy had a higher response plateau and higher J'aw(NO) values. CONCLUSIONS: These findings suggest that inflammatory changes induced by natural allergen exposure in sensitized subjects are predominantly located in the airways and associated with modifications in the shape of the concentration-response curve to direct and indirect agonists.

Dietary intake and iron status of institutionalized elderly people: relationship with different factors.

OBJECTIVES: Aims of the study were to investigate iron status in institutionalized elderly subjects and to determine its association with different factors including: age, gender, body mass index, dietary intake, consumption of iron supplements, functional status and disease. DESIGN: A cross-sectional study. SETTING: Seven public nursing homes. PARTICIPANTS: 252 subjects, aged 65-96 years. MEASUREMENTS: Food intake was assessed by a 4-day weighed-food record. Iron status indices were measured. Barthel' s Index was used to evaluate functional status. Illnesses were ascertained from medical records. RESULTS: Anemia was found in 25.4% of subjects studied. Average dietary intakes fulfilled the amounts of Recommended Dietary Intake for Spanish elderly population, except for folate. A substantial percentage of subjects exhibited folate dietary deficit (89.2%). Mean (SD) BMI was 27.8 (6.4) kg/m2, and functional status 78.1 (26.5). Taking into account hematocrit, red blood cell count and serum iron concentration values, poor iron status was significantly more common in men (59.4, 61.4 and 16.8%, respectively) than in women (36.4, 36.4 and 6.0%, respectively). Hemoglobin concentration was positively associated with the energy and nutrient dietary intake, and negatively with age, BMI and functional status. CONCLUSIONS: Based on World Health Organization criteria, anemia was found in 25.4% of elderly subjects studied. Iron deficiency seems to be the main cause of anemia, and chronic disease the second cause of anemia. Dietary intake is not one of the principal causes of anemia in the study population, except for folate intake.

Dietary virgin olive oil reduces oxidative stress and cellular damage in rat brain slices subjected to hypoxia-reoxygenation.

We investigated how virgin olive oil (VOO) affected platelet and hypoxic brain damage in rats. Rats were given VOO orally for 30 days at 0.25 or 0.5 mL kg(-1) per day (doses A and B, respectively). Platelet aggregation, thromboxane B2, 6-keto-PGF(1alpha), and nitrites + nitrates were measured, and hypoxic damage was evaluated in a hypoxia-reoxygenation assay with fresh brain slices. Oxidative stress, prostaglandin E2, nitric oxide pathway activity and lactate dehydrogenase (LDH) activity were also measured. Dose A inhibited platelet aggregation by 36% and thromboxane B2 by 19%; inhibition by dose B was 47 and 23%, respectively. Virgin olive oil inhibited the reoxygenation-induced increase in lipid peroxidation (57% in control rats vs. 2.5% (P < 0.05) in treated rats), and reduced the decrease in glutathione concentration from 67 to 24% (dose A) and 41% (dose B). Brain prostaglandin E2 after reoxygenation was 306% higher in control animals, but the increases in treated rats were only 53% (dose A) and 45% (dose B). The increases in nitric oxide production (213% in controls) and activity of the inducible isoform of nitric oxide synthase (175% in controls) were both smaller in animals given VOO (dose A 84%; dose B 12%). Lactate dehydrogenase activity was reduced by 17% (dose A) and 42% (dose B). In conclusion, VOO modified processes related to thrombogenesis and brain ischemia. It reduced oxidative stress and modulated the inducible isoform of nitric oxide synthase, diminishing platelet aggregation and protecting the brain from the effects of hypoxia-reoxygenation.

Pathological features in marine birds affected by the prestige's oil spill in the north of Spain.

A total of 2,465 seabirds, mainly common murres (Uria aalge), razorbills (Alca torda), and puffins (Fratercula arctica) that beached in the northwestern part of Spain after the "Prestige" oil spill on 19 November 2002 were examined by pathological methods. Birds were divided into three groups: dead birds with the body covered (group 1) or uncovered (group 2) by oil and birds recovered alive but which died after being treated at a rescue center (group 3). The main gross lesions were severe dehydration and emaciation. Microscopically, hemosiderin deposits, related to cachexia and/or hemolytic anemia, were observed in those birds harboring oil in the intestine. Severe aspergillosis and ulcers in the ventriculus were found only in group 3 birds, probably because of stress associated with attempted rehabilitation at the rescue center. The mild character of the pathological changes suggests that petroleum oil toxicosis causes multiple sublethal changes that have an effect on the ability of the birds to survive at sea, especially weak and young, inexperienced animals. Dehydration and exhaustion seem to be the most likely cause of death.

Bioremediation of oil refinery sludge by landfarming in semiarid conditions: influence on soil microbial activity.

Bioremediation of a refinery sludge containing hydrocarbons in a semi-arid climate using landfarming techniques is described. The objective of this study was to assess the ability of this technique to reduce the total hydrocarbon content added to the soil with the refinery sludge in semiarid climate (low rain and high temperature). In addition, we have evaluated the effect of this technique on the microbial activity of the soil involved. For this, biological parameters (carbon fractions, microbial biomass carbon, basal respiration and ATP) and biochemical parameters(different enzymatic activities) were determined. The results showed that 80% of the hydrocarbons were eliminated in eleven months, half of this reduction taking place during the first three months. The labile carbon fractions, MBC, basal respiration and ATP of the soils submitted to landfarming showed higher values than the control soil during the first months of the process, although these values fell down by the end of the experimental period as the hydrocarbons were degraded by mineralisation. All the enzymatic activities studied: oxidoreductases such as dehydrogenase activity, and hydrolases of C(beta-glucosidase activity) and N Cycle (urease and protease) showed higher values in the soils amended with the refinery sludge than in the control. As in the case of the previous parameters, these value fell down as the bioremediation of the hydrocarbons progressed, many of them reaching levels similar to those of the control soil after eleven months.

Anaerobic biodegradability of water separated from extracted crude oil.

A study of the anaerobic biodegradability of the three categories of water separated from extracted crude oil (Venezuelan oilfields)--light, medium or heavy crude--was carried out at laboratory scale using UASB reactors working at mesophilic conditions. Chemical oxygen demand (COD) removal in a low loaded UASB reactor fed with water separated from extracted light crude was high, with an average 87% purification efficiency. The remaining COD was made up of the nonbiodegradable and the very slowly biodegradable fractions of the organic matter in the water. During a second period, the hydraulic retention time was reduced in stages, thus increasing the loading rate. In the experimental conditions used, COD concentration at the outlet remained below the Venezuelan standard limit for discharge into the environment (350 mg COD l(-1)) when the hydraulic retention time (HRT) was above 10 hours and the OLR under 3 g COD l(-1) d(-1). For HRT less than 10 hours, or organic loading rate (OLR) greater than 3 g COD l(-1) d(-1), COD at the outlet of the reactor rose as a consequence both of increased volatile fatty acids (VFA) concentrations (indicating an overloading of the methanogenic population) and, also, of the increase in the non-VFA COD (indicating a decrease in the acidification efficiency). On the other hand, results with UASB reactors operated at a low loading rate and fed with water separated from extracted medium and heavy crude oil showed that purification efficiency was low, with only 20% and 37% COD removal respectively. Continuing the operation of the UASB reactor fed with water separated from medium oil over a prolonged period did not bring any improvement, indicating that no adaptation of the sludge occurred.

Effect of protein hydrolysis on the dialysability of amino acids and minerals in infant formulas.

The objectives of this study were to evaluate the dialysed quantities of amino acids and minerals (calcium, phosphorus, magnesium, iron and zinc) in two types of infant formulas, one with a basis of native cow milk proteins and the other highly hydrolysed, to evaluate the possible application of Miller's in vitro method in amino acid and mineral availability studies. The percentage of dialysis differed between proteins. The hydrolysis treatment applied to the proteins significantly increased the dialysis percentage of almost all the amino acids. The dialysability of all the minerals was statistically greater in the formula made with a basis of hydrolysed proteins. Miller's method was seen to be of use for showing the effect which the hydrolysis treatment has on the availability of amino acids. Despite its limitations of having to be carried out in vitro, the study suggests that the nutritional value in relation with amino acids, minerals and trace elements differs between the both types of formulas.

[In vitro availability of minerals in infant foods with different protein source]. / Disponibilidad in vitro de minerales en fórmulas infantiles con distinta fuente proteica.

As the result of the digestion process, it is produced at gastrointestinal level interactions between proteins-minerals and minerals-minerals that might modify the bioavailability of the nutrients initially designed for an adequate nutrition in infant formulas. The aim of the present study is to compare the in vitro availability of some minerals and trace elements (calcium, phosphorus, magnesium, iron and zinc) in infant formulas of initiation elaborated with different protein sources: formulas based on cow milk protein (whey-casein) versus vegetal protein (soy-based infant formulas). Also, for evaluating the effects of the different mineral supplementation in the availability of minerals, it was used infant formulas from two different manufacturers. Milk-protein based infant formulas showed for both manufacturers higher dialysis percentage (%) of phosphorus and zinc than the soy-protein based formulas. The availability of iron in the soy formula of the manufacturer A lowered significantly (P < 0.05) respect to the whey-casein based formula (9.6 +/- 2.3 versus 4.6 +/- 0.8), but not respect to the whey-casein formula of manufacturer B (9.6 +/- 1.1 versus 9.0 +/- 0.7), which might be due to the lowest proportion of phytic acid in this last commercial formula. Dialysability of all the minerals analysed from soy-protein based formulas showed significant differences depending on the manufacturer. The purification processes of the soy protein have a high repercussion in the mineral availability of soy-based infant formulas. It could be more interesting to use soy proteins more purified, with low level of phytic acid, in the elaboration of soy infants formulas, than the supplementation them with high amounts of minerals.

Low in vivo toxicity of a novel cisplatin-ursodeoxycholic derivative (Bamet-UD2) with enhanced cytostatic activity versus liver tumors.

Cisplatin-bile acid derivatives belonging to the Bamet-family maintain both liver organotropism and cytostatic activity. "In vivo" toxicity and usefulness as chemotherapeutic agent versus liver tumors of a novel drug, Bamet-UD2 [cis-diamminechlorocholylglycinate platinum (II)], with enhanced "in vitro" cytostatic activity was investigated. Using orthotopically implanted mouse Hepa 1-6 hepatoma in the liver of Nude mice, the antitumor effect of Bamet-UD2 was compared with that of a previously characterized compound of this family, Bamet-R2 [cis-diamminebis-ursodeoxycholate platinum(II)], and cisplatin. Life span was significantly prolonged in mice treated with both Bamets (Bamet-UD2 > Bamet-R2), compared with animals receiving saline or cisplatin. All these drugs inhibit tumor growth (Bamet-UD2 = cisplatin > Bamet-R2). However, toxicity-related deaths only occurred under cisplatin treatment. Using rats maintained in metabolic cages, organ-specific toxicity and drug accumulation in tissues were investigated. The amount of both Bamets in the liver was severalfold higher than that of cisplatin. By contrast, a significantly higher amount of cisplatin in kidney and nerve was found. In lung, heart, muscle, brain, and bone marrow the amount of drug was small and also significantly lower in animals receiving Bamets. Signs of neurotoxicity (altered nerve conduction velocity), nephrotoxicity (increased serum urea and creatinine concentrations and decreased creatinine clearance), and bone marrow toxicity (decreased platelet and white blood counts) in animals treated with cisplatin but not with the Bamets were found. These results indicate that, owing to strong antitumor activity together with absence of side effects, Bamet-UD2 may be useful in the treatment of liver tumors.

[Susac syndrome: clinical and diagnostic approach. A new case report]. / Síndrome de Susac: actitud diagnóstica y terapéutica. Presentación de un nuevo caso.

INTRODUCTION: The Susac syndrome is made up of the clinical triad: encephalopathy, visual and hearing defects. It is caused by microangiopathy of unknown origin affecting the small arteries of the brain, retina and cochlea. It is very uncommon. It mainly affects young women. The course of the illness is usually monophasic and self-limiting. The deficit of visual acuity is caused by occlusion of tributaries of the retinal artery. The auditory defect is bilateral and symmetrical, and particularly affects medium and low frequencies. NMR is of great diagnostic value, showing multiple lesions in the grey and white matter. Our case gives more data regarding the evolution of this condition and the contribution of cerebral SPECT to diagnosis, the results of systemic treatment, use of hyperbaric oxygen and reflections on the physiopathology of the process. CLINICAL CASE: We present the clinical case of a young woman who presented with psychiatric symptoms and migraine followed by clinical encephalopathy and acute/subacute coma. There were also visual and auditory deficits. Other types of systemic disease were ruled out. CONCLUSIONS: Findings on SPECT suggested the presence of a microangiopathic disorder of the brain. The patient responded to systemic treatment with cortico-steroids. The encephalopathy resolved in a few days and two months later she had resumed her former daily activities. Treatment with hyperbaric oxygen definitely reduced visual sequelae.

[Treatment of solitary toxic thyroid nodule with 131I: results in 43 patients]. / Tratamiento del nódulo tiroideo solitario tóxico con 131I: resultados en 43 pacientes.

BACKGROUND: Evaluation of the therapy with high-dose 131I in solitary toxic thyroid adenoma, with particular attention to the effects on thyroid function and on the nodular size. METHODS: A retrospective study of 43 patients with solitary thyroid nodule treated with radioactive iodine (mean dose 26.6 mCi, range 10-35) and followed up for 49.7 +/- 36.6 months (range 6-186) with periodical clinical, laboratory and echographic evaluations. RESULTS: Thirty-two patients (74.4%) had a normal thyroid function during follow-up. Five (11.6%) remained with hyperthyroidism and in 6 (13.9%) hypothyroidism developed 6-30 months after the administration of radioactive iodine. Three of these 6 had subclinical hypothyroidism, with mild increases in serum thyrotropin (TSH). Neither the development of hypothyroidism nor its persistence were significantly correlated with the initial thyroxin (T4) or triiodothyronine (T3) levels, the nodular size, the 131I dose, the incomplete inhibition of the extranodular thyroid parenchyma or the previous therapy with antithyroid drugs. The nodule diminished in size in 15 cases (38.4%), it disappeared in 9 (23%), it remained unchanged in 12 (30.7%) and it increased in 3 (7.7%). CONCLUSIONS: The treatment of the solitary toxic thyroid nodule with relatively high 131I doses is a safe and effective procedure, with a prevalence of residual hypothyroidism which is lower than previously reported. The disappearance of the nodule was only achieved in a minority of cases.

Nifedipine in exercise-induced asthma.

The calcium entry blockers may inhibit EIA in patients with bronchial asthma, but it is not demonstrated that they produced bronchodilation once the crisis is established. Nine patients with exercise induced asthma were studied. We carried out an exercise test for ten minutes with constant load and the following were measured; FVC, PEF, MEF25 and sGaw before and after test. All the values fell 20% or more than the initial values. A 20 mg was administered without modifying the studied parameters and only the administration of 400 micrograms of metaproterenol by inhalation made the sensation of dyspnea recur in all patients.