Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial.

PURPOSE: To assess the efficacy of lung low-dose radiotherapy (LD-RT) in the treatment of patients with COVID-19 pneumonia. MATERIALS AND METHODS: Ambispective study with two cohorts to compare treatment with standard of care (SoC) plus a single dose of 0.5 Gy to the whole thorax (experimental prospective cohort) with SoC alone (control retrospective cohort) for patients with COVID-19 pneumonia not candidates for admission to the intensive care unit (ICU) for mechanical ventilation. RESULTS: Fifty patients treated with LD-RT were compared with 50 matched controls. Mean age was 85 years in both groups. An increase in arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (PAFI) in the experimental LD-RT-treated group compared to the control group could not be found at 48 h after LD-RT, which was the primary endpoint of the study. However, PAFI values significantly improved after 1 month (473 vs. 302 mm Hg; p < 0.0001). Pulse oxymetric saturation/fraction of inspired oxygen (SAFI) values were also significantly higher in LD-RT-treated patients than in control patients at 1 week (405 vs. 334 mm Hg; p = 0.0157) and 1 month after LD-RT (462 vs. 326 mm Hg; p < 0.0001). All other timepoint measurements of the respiratory parameters were similar across groups. Patients in the experimental group were discharged from the hospital significantly earlier (23 vs. 31 days; p = 0.047). Fifteen and 26 patients died due to COVID-19 pneumonia in the experimental and control cohorts, respectively (30% vs. 48%; p = 0.1). LD-RT was associated with a decreased odds ratio (OR) for 1­month COVID-19 mortality (OR = 0.302 [0.106-0.859]; p = 0.025) when adjusted for potentially confounding factors. Overall survival was significantly prolonged in the LD-RT group compared to the control group (log-rank p = 0.027). No adverse events related to radiation treatment were observed. CONCLUSION: Treatment of frail patients with COVID-19 pneumonia with SoC plus single-dose LD-RT of 0.5 Gy improved respiratory parameters, reduced the period of hospitalization, decreased the rate of 1­month mortality, and prolonged actuarial overall survival compared to SoC alone.

Abdominal tumors in patients with neurofibromatosis type I: Genotype-phenotype relationships.

BACKGROUND: Gastrointestinal stromal tumors have been detected in 25% of the necropsies performed on NF1 patients, but have been reported only in 7% of NF1 patients in the largest series. Such data imply an important gap between the true presence of tumors and those diagnosed. Few genotype-phenotype relationships have been described but to date none referring to abdominal tumors. OBJECTIVES: Evaluate retrospectively the efficacy of a regular and proactive follow-up of NF1 patients to early diagnose abdominal tumors and report their mutations. METHODS: Cohort study performed between 2010 and 2020, with 43 NF1 adult patients followed at our Dermatology department. RESULTS: Eight abdominal tumors were diagnosed in six patients, meaning that 14% of the followed patients developed an abdominal tumor. Five patients (83%) were asymptomatic. Five (83.3%) had a family history of NF1 with abdominal tumors (patients 1,2 and 3,4,5 were relatives). CONCLUSIONS: Although currently gastrointestinal routine screening investigations for asymptomatic patients are not recommended in the guidelines, the family aggregation in our series suggests it should be considered a close follow-up of the relatives of a patient with an NF1-related abdominal tumor. Also, for the first time, two mutations [c.2041C > T (p.Arg681Ter) and c.4537C > T (p.Arg1513*)] have been associated with family aggregation of abdominal tumors in NF1 patients.

Paraoxonase-1 activity in patients with cancer: A systematic review and meta-analysis.

PURPOSE: Paraoxonase-1 (PON1) is a lipolactonase implicated in the elimination of carcinogenic free radicals and in the scavenging mechanisms to maintain oxidative balance. The objective of the present systematic review and meta-analysis was to evaluate possible alterations in serum PON1 activity in patients with cancer. METHODS: A systematic search of the observational studies in humans published in the last 15 years was performed through Medline databases following the PRISMA and STARLITE statements. Further, a keyword-based computerized search with restrictions on publication date, and a meta-analysis of case-control studies was performed. RESULTS: In total, 23 studies were included most of which reported decreased PON1 activity in patients with cancer. This could indicate impaired defense ability against oxidative stress with potential implications in cell proliferation, promotion of genetic instability, and alterations in cellular sensitivity to chemotherapy. CONCLUSION: This systematic review and meta-analysis confirms a consistent association between cancer and decreased serum PON1 activities. These findings may open fruitful lines of research with clinical relevance, and an understanding of molecular alterations underlying carcinogenesis.

Intraoperative molecular analysis of sentinel lymph nodes following neoadjuvant chemotherapy in patients with clinical node negative breast cancer: An institutional study.

Sentinel lymph node biopsy (SLNB) is an accurate, safe method for determining the axillary lymph node status. However, insufficient evidence exists to support the recommendation of SLNB in patients who have had neoadjuvant chemotherapy (NAC) to downsize tumours and allow for breast conservation surgery. The present study aimed to use molecular approaches to evaluate the feasibility and accuracy of SLNB in patients treated with NAC prior to SLN mapping and surgery. A total of 50 consecutive patients with operable invasive breast carcinomas who had received prior NAC were assessed using the one-step nucleic acid amplification (OSNA) method. The rate of SLN identification was 100%. The OSNA assay showed that 29 patients (58%) were negative for SLN and 21 patients (42%) were positive. In 19 of these 21 patients (90.48%), the SLN was the only positive lymph node. No axillary lymph nodes metastases were observed in patients with isolated tumour cells or with micrometastases. The OSNA assay is a highly sensitive, specific and reproducible diagnostic technique that can be used to analyse SLNs following NAC. The total tumoral load may assist with predicting additional non-SLN metastases.

[Incidence and characteristics of clinical and sub-clinic hyperthyroidism]. / Incidencia y características del hipertiroidismo clínico y subclínico.

OBJECTIVES: Estimate the incidence of hyperthyroidism in the region of Lleida and compare patients with clinic and subclinic hyperthyroidism. DESIGN: Descriptive retrospective. LOCALIZATION: City of Lleida and the towns of the provinces of Lleida and Huesca. PATIENTS: 190 people diagnosed of hyperthyroidism detected from a sample of 1885 patients with different pathologies, belonging to first visits to de Service of Endocrinology of the Hospital Arnau de Vilanova, during the period from 1999 to 2000. MAIN MEASUREMENTS: The following clinic and demographical variables related to the thyroid pathology were recorded: TSH, T(4), T(3), anti-Tg antibodies, anti-TPO antibodies, age, gender, consumption of salt with iodine and the incidence tax of hyperthyroidism. RESULTS: The incidence tax of hyperthyroidism in the province of Lleida was 46.2 ×10(5) people/year (95% CI, 33.5-61.0). For the 190 patients, the 85% (95% CI, 79.4-90) of them were women; the 38% (95% CI, 31%-45.2%) and the 62% (95% CI, 54.8-69) were diagnosed of clinic and subclinic hyperthyroidism respectively. The subclinic profile was characteristically for had a superior mean of age (P<.003), double of TSH level (P<.03) and half of T(4) level of (P<.001). CONCLUSION: Our study shows a high incidence of hyperthyroidism, and a difference of the two hyperthyroidisms. The detection of this pathology by professionals of primary care can help to improve their therapeutic control.

Fiebre prolongada en una mujer de 78 años con leucemia mieloide crónica / Long lasting fever in a 78-year-old woman with chronic myeloid leukemia

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Gastric carcinoid tumour. A clinicopathologic and immunohistochemical study of four cases.

Over the last decade a great increase in the frequency of Gastric Carcinoid Tumours has been detected being considered by some authors as the most frequent digestive carcinoid. These have been divided into three types: I) those associated with chronic atrophic gastritis; II) associated with Zollinger-Ellison syndrome, and III) sporadic lesions. We present four cases of gastric carcinoid type I (3 women and 1 man) two of them associated with pernicious anemia and another two with iron deficiency anemia. Three patients were operated upon, and an endoscopy removal was carried out on the fourth patient. The clinical course has been favourable during the follow-up. Multiple lesions were detected in 3 patients, with tumours less than 2 cm in size, except for a 4.5 cm polyp, which invaded the submucous layer. This case presented carcinoid syndrome without evidence of liver metastasis. Argyrophilia. Chromogranin A and Neuronal Specific Enolase tintions were located in the tumor and in the hyperplastic endocrine cells of the mucous.

[Severe tricuspid insufficiency as main manifestation of hyperthyroidism]. / Insuficiencia tricuspídea severa como manifestación principal de un hipertiroidismo.

The cardiac manifestations of the hyperthyroidism (HT) are diverse and frequent. However, sometimes, the initial symptoms are atypical and are difficult to diagnose. We present the case of a patient whose HT began with heart failure secondary to a severe tricuspid regurgitation (IT). This data suggests that when confronted with IT of unclear etiology, a possible HT must be investigated.

[Acute pancreatitis in newly diagnosed type I diabetes mellitus with diabetic ketoacidosis and hypertriglyceridemia]. / Pancreatitis aguda en el inicio de una diabetes mellitus tipo I con cetoacidosis diabética e hipertrigliceridemia.

A 19 years old patient who presented grade D acute pancreatitis by abdominal CT with marked hypertriglyceridemia during a diabetic ketoacidosis (DKA) in the onset of a type I diabetes mellitus is described. The pancreatitis and DKA were resolved with the usual treatment, and the levels of triglycerides became normal within one week. Hyperamylasemia is frequent in DKA although of uncertain significance. Acute pancreatitis coinciding with DKA has been described, in this case radiologic findings demonstrated the diagnosis. No other bibliographic references have been found in which pathologic imaging in abdominal CT are described in a situation of DKA with hyperamylasemia. Moderate hypertriglyceridemia is common upon initiation of diabetes mellitus and likewise it usually presents during the course of acute pancreatitis. Pancreatitis could be secondary to hypertriglyceridemia and the latter to the insulin deficiency.