DISE with CPAP: a useful procedure to evaluate upper airway collapsibility.

PURPOSE: Drug-induced sleep endoscopy (DISE) is commonly performed in patients suffering obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) intolerance. We aimed to evaluate the effects of adding CPAP to DISE to provide understanding of the reason of its failure and better guidance in future therapeutic decisions. METHODS: A retrospective observational descriptive study was conducted on CPAP-intolerant patients with moderate-severe OSA. DISE was used to evaluate upper airway collapsibility, and CPAP was tested to better describe anatomical sites of obstruction and to measure the opening pharyngeal pressure. RESULTS: Sample size consisted of 38 patients with a mean age of 49 ± 9 years. Mean BMI was 28.4 ± 2.4 kg/m2, mean apnea-hypopnea index (AHI) was 35.4 events per hour ± 20.1, and mean saturation under 90% (TSat90) was 14.5%. In DISE we found a collapse at Velum in 92% of patients, at Oropharyngeal level in 89%, at tongue in 42%, and at epiglottis in 36%. In the subgroup of patients with clinical failure with CPAP, we observed 100% of epiglottic collapse and 50% of tongue obstruction. In this specific population, we recommended personalized surgery and myofunctional therapy. CONCLUSION: DISE-CPAP is a useful tool to select the treatment that better fits to each patient taking care all information available. It improves our ability to prescribe a multilevel treatment with an exhaustive topographic evaluation of upper airway collapsibility that complements CPAP classic titration, and it can be helpful to distinguish better candidates for surgery, myofunctional therapy or CPAP.

Antibacterial activity of plant extracts against Streptococcus equi subsp. zooepidemicus isolates from guinea pigs with lymphadenitis in Ecuador.

Lymphadenitis is a commonly occurring and contagious disease in guinea pigs caused by different pathogens, including Streptococcus sp., Staphylococcus sp., and Corynebacterium sp. This study aimed to characterize the bacteria isolated from pus extracted from abscessed mandibular lymph nodes of diseased guinea pigs in Ecuador in 2019 and evaluate the in vitro antibacterial activity of the total extracts of three plant species. Isolates were recovered from three diseased guinea pigs with Lymphadenitis on a farm in Imbabura, Ecuador province. The bacteria were characterized through microbiological, biochemical, and molecular tests as Streptococcus equi subsp. zooepidemicus. Furthermore, the susceptibility of S. equi subsp. zooepidemicus to three plant extracts belonging to the Asteraceae family, Acmella ciliata, Bidens andicola, and Gazania splendens collected in Ecuador, were assessed in vitro by the microdilution method. Our data indicate that all the evaluated extracts showed activity, with a Minimum Inhibitory Concentration (MIC) of 22.50 mg/mL for Acmella ciliata, 11.25 mg/mL for Bidens andicola, and 5.60 mg/mL for Gazania splendens. Bidens andicola extract showed the highest efficacy with a % inhibition of 63.90 at the highest tested concentration (45 mg/mL). This is the first report on the bioactivity of these plant species against S. equi subsp. zooepidemicus.

Transoral Flexible Laser Surgery of the Larynx with Blue Laser.

INTRODUCTION: Laser surgery of the larynx is currently the standard of clinical practice in a multitude of procedures. Lasers with photoangiolytic properties have a wide application in endolaryngeal lesions. One of their most prominent features is the ability to coagulate blood vessels, reducing unwanted tissue damage. Our objective is to expose the uses of the blue laser (445 nm) in the larynx. MATERIAL AND METHODS: A retrospective study was carried out including 47 patients treated with blue photoangiolytic laser from October 2021 to January 2023 at a university hospital. Demographic data, type of lesion presented, date of intervention and scope of the procedure, as well as the parameters of the laser used, were recorded. The number of sessions received per patient, the result and complications were also collected. RESULTS: A total of 47 patients with laryngeal lesions were treated, including vascular angiomas, laryngeal sulcus vocali, vocal cord polyps, Reinke's edemas, laryngeal papillomatoses, subglottic stenosis, laryngeal synechiae, subglottic granulomas, glottic scars, vocal fold leukoplakias, laryngeal dysplasias and tracheostomal granulomas. The mean age was 52.5 years, and 64.3% of the patients were women. The range of power used in the resective surgeries was 2-10 Watts with a 20-millisecond window. The average number of sessions received was 2.1 (range 1-4). A satisfactory situation was obtained in 45 of the 47 patients treated (95.75%), and an evident decrease in lesions was seen in the remaining two. There was no evidence of any complications directly derived from the use of the blue laser. Twenty-seven cases (54%) were treated exclusively in-office. CONCLUSIONS: The blue laser is safe and effective in the treatment of a wide range of laryngeal pathologies. Its advantages include its portability, its photoangiolytic qualities as well as its ability to vaporize tissue in contact mode, which can treat subepithelial vessels or resect lesions.

Citopatología y bioquímica del líquido pleural reumatoideo. A propósito de un caso / Cytopathology and biochemistry of the rheumatoid pleural fluid. Presentation of a case

Entre las distintas complicaciones pleuropulmonares de la artritis reumatoide, la pleuresía reumatoidea es la más comúnmente observada, sucediendo hasta en el 5% de los pacientes afectos de artritis reumatoide. La mayoría de estos, corresponden a un subtipo compuesto fundamentalmente por varones de edad media con altos títulos de factor reumatoide, nódulos reumatoideos y HLA-B8 y Dw3. Si bien el derrame pleural reumatoideo se presenta generalmente como un exudado inespecífico, se han descrito características de laboratorio, que aunque infrecuentes, nos pueden ser de gran utilidad, en el diagnóstico del mismo

Among the various pleuropulmonary complications of rheumatoid arthritis, rheumatoid pleurisy is the most commonly observed1, occurring in up to 5% of patients with rheumatoid arthritis. The majority of these correspond to a subtype composed mainly of middle-aged men with high rheumatoid factor titres, rheumatoid nodules, and presence of HLA-B8 and Dw3. Although rheumatoid pleural effusion generally presents as a non-specific exudate, laboratory characteristics have been described that, although infrequent, can be very useful in its diagnosis

Markers for the validation of reported dietary intake in adults with cystic fibrosis.

OBJECTIVE: To identify different markers in order to validate the assessment of dietary intake in adults with cystic fibrosis (CF). DESIGN: Cross-sectional survey. SETTING: Tertiary care. SUBJECTS: We assessed 37 adults with CF whose nutritional and respiratory condition was stable and 37 healthy adults, matched for age, sex, and nutritional status. INTERVENTIONS: A consecutive, 7-day, prospective dietary survey was given to all the participants. Anthropometric variables were measured and a fasting blood sample was drawn to measure the composition of the serum phospholipid fatty acids by gas chromatography. We also measured fecal fat and nitrogen at 72 hours and 24-hour urine nitrogen. RESULTS: The ratio of energy intake to basal metabolic rate expenditure was significantly greater in the patients (2.1+/-0.4) than the controls (1.79+/-0.4) and the percentage of patients with the ratio of energy intake to basal metabolic rate lower than 1.55 was 24% in the controls (n=9) vs 8% in the patients (n=3). Fecal nitrogen correlated significantly with total energy and the intake of carbohydrates, lipids, and proteins. In the patients, total dietary energy and fat and protein intake correlated positively with fecal fat. The protein and fat intake and fecal nitrogen and fat correlated significantly with urine nitrogen. In the controls, significant correlations were seen between different parameters of intake and the percentage of certain serum phospholipid fatty acids. These correlations in the patients were either absent or less marked. CONCLUSIONS: Use in persons with CF of the energy intake to basal metabolic rate ratio, measurement of fecal fat and nitrogen at 72 hours and of urine nitrogen may be useful to validate dietary surveys. The serum phospholipid fatty acid profile, however, may be less useful for this purpose in these patients.