[Frequency of chest X-ray suggestive of SARS-CoV-2 involvement from March to May 2020 in the population of an urban health area]. / Frecuencia de Rx de tórax indicativas de afectación por SARS-CoV-2 de marzo a mayo de 2020 en la población de un área de salud urbana.

OBJECTIVE: Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020. MATERIAL AND METHODS: Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern. RESULTS AND CONCLUSIONS: Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic.

Frecuencia de Rx de tórax indicativas de afectación por SARS-CoV-2 de marzo a mayo de 2020 en la población de un área de salud urbana / Frequency of chest X-ray suggestive of SARS-CoV-2 involvement from March to May 2020 in the population of an urban health area

OBJETIVO: Conocer el número y el porcentaje de radiografías de tórax (RxT) derivadas a un centro de diagnóstico por imagen de Atención Primaria y al Centro de Urgencias de Atención Primaria para descartar afectación pulmonar por SARS-CoV-2 desde el 16 de marzo al 15 de mayo de 2020, en un área de salud urbana de unos 400.000 habitantes de población de referencia. Determinar el porcentaje de casos indicativos de afectación pulmonar por RxT por SARS-CoV-2 y el porcentaje de casos sin afectación pulmonar del total de RxT derivadas en la población de referencia desde el 16 de marzo al 15 de mayo de 2020. MATERIAL Y MÉTODOS: Diseño: estudio descriptivo observacional. Los criterios radiológicos para catalogar de probable infección pulmonar por SARS-CoV-2 (RxT[+]) son: 1) opacidad focal; 2) tenue opacidad focal; 3) tenue aumento de densidad difuso; 4) patrón intersticial focal o difuso, y 5) patrón alveolointersticial focal o difuso. RESULTADOS Y CONCLUSIONES: Mantener la RxT como método útil de cribado en las etapas medias de la enfermedad, cuando la RxT es más sensible para detectar afectación pulmonar por SARS-CoV-2. Nuestra gráfica de afectación por SARS-CoV-2 no presenta diferencias valorables con la curva esperada en una epidemia

OBJECTIVE: Know the number and percentage of chest X-rays (CXR) referred to a Primary Care Imaging Center and Primary Care Emergency Center to rule out lung involvement due to SARS-CoV-2 from March 16 to May 15, 2020, in an urban health area of about 400,000 reference population inhabitants. To determine the percentage of cases suggestive of pulmonary involvement due to SARS-CoV-2 CXR and the percentage of cases without pulmonary involvement of the total CXR derived in the reference population from March 16 to May 15, 2020. MATERIAL AND METHODS: Design observational descriptive study. The radiological criteria to classify probable pulmonary infection by SARS-CoV-2 (RxT[+]) are: 1) focal opacity; 2) faint focal opacity; 3) faint diffuse increase in density; 4) focal or diffuse interstitial pattern, and 5) focal or diffuse interstitial alveolus pattern. RESULTS AND CONCLUSIONS: Maintain CXR as a useful screening method in the middle stages of the disease, when CXR is more sensitive to detect lung involvement due to SARS-CoV-2. Our graph of affectation by SARS-CoV-2 does not present assessable differences with the expected curve in an epidemic

FDG-PET parameters predicting mediastinal malignancy in lung cancer.

BACKGROUND: Staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) is mandatory. The maximum Standard Uptake Value (SUVmax) obtained using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures. METHOD: A multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration (EBUS-NA) was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures. RESULTS: One hundred and twenty-one NSCLC patients, of whom 94 (72%) had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 (SD 6.3), and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 (IQR 2.4-7). Variability of FDG-PET measures between hospitals was statistically significant (p = 0.016 and p < 0.001 respectively), but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor (SUVmax mediastinum/tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively). SUVmax mediastinum/tumor showed higher accuracy in the ROC analysis (AUC 0.77 CI 0.68-0.85, p < 0.001), and showed predictive power for mediastinal malignancy when using a 0.4 cutoff (OR 6.62, 95%CI 2.98-14.69). Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and/or a SUVmax mediastinum/tumor ratio >0.4. CONCLUSION: The SUVmax mediastinum/tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.

Increased lung neutrophil apoptosis and inflammation resolution in nonresponding pneumonia.

Neutrophil activation state and its relationship with an inflammatory environment in community-acquired pneumonia (CAP) remain insufficiently elucidated. We aimed to evaluate the neutrophil apoptosis and cytokine pattern in CAP patients after 72 h of treatment, and their impact on infection resolution. Apoptosis of blood and bronchoalveolar lavage (BAL) neutrophils was measured in nonresponding CAP (NCAP), in responding CAP (blood only) and in patients without infection (control). Pro-inflammatory (interleukin (IL)-6, IL-8) and anti-inflammatory (IL-10) cytokines were measured. Main outcomes were clinical stability and days of hospitalisation. Basal neutrophil apoptosis was higher in the BAL and blood of NCAP, whereas spontaneous apoptosis (after 24 h culture) was lower. Cytokines in NCAP were higher than in responding CAP and control: IL-6 was increased in BAL and blood, IL-8 in BAL and IL-10 in blood. An increased basal apoptosis (≥20%) in BAL of NCAP was associated with lower systemic IL-10 (p<0.01), earlier clinical stability (p=0.05) and shorter hospital stay (p=0.02). A significant correlation was found for systemic IL-6 and IL-10 with days to reach stability and length of stay. After 72 h of treatment, an increased basal alveolar neutrophil apoptosis might contribute to downregulation of inflammation and to faster clinical stability.

Determinants of hospital costs in community-acquired pneumonia.

Community-acquired pneumonia (CAP) has a high incidence and involves an important consumption of healthcare resources. The present authors analysed the influence of comorbidity, initial severity and complications upon the direct costs associated with hospitalised CAP patients. Direct hospitalisation costs (room cost, treatment, laboratory and diagnostic tests) were assessed in a prospective, observational study of 271 patients admitted to a hospital ward due to CAP. The mean+/-SD patient age was 70+/-15 yrs. The mortality rate was 11.1%. Complications were found in 72.3% and comorbidities in 74.9%. The median (interquartile range) total cost was 1,683 euros (1,291-2,471 euros) and the component costs were: room cost 1,286 euros (857-1,714 euros); laboratory tests 212 euros (171-272 euros); treatment 187 euros (114-304 euros); and diagnostic procedures 58 euros (29-122 euros). Complications and higher Pneumonia Severity Index increased the costs, but age and comorbidity did not. A logistic regression analysis to predict high cost (>1,683 euros) showed that infectious (odds ratio 6.8, 95% confidence interval 1.3-36), digestive (5.9 (1.5-22.8)), pulmonary (2.6 (1.4-4.7)) and other complications (3.9 (1.8-8.4)) were independent risk factors, as were previous hospitalisation (2.3 (1.2-4.3)) and hypoalbuminaemia (2 (1.1-3.6)). Complications, hypoalbuminaemia and previous hospitalisation were the main determinants of high direct costs of hospitalisation due to community-acquired pneumonia. Neither age nor comorbidities were independently associated with cost.

Interfacial properties of acidified skim milk.

The purpose of this study is to investigate the tension properties and dilatational viscoelastic modulus of various skim milk proteins (whole milk, EDTA-treated milk, beta-casein, and beta-lactoglobulin) at an oil/water interface at 20 degrees C. Measurements are performed using a dynamic drop tensiometer for 15,000 s. The aqueous bulk phase is a skim milk simulated ultrafiltrate containing 11 x 10(-3) g L(-1) milk protein. At pH 6.7, beta-casein appears as the best to decrease the interfacial tension, whereas beta-lactoglobulin leads to the highest interfacial viscoelastic modulus value. Whole milk was almost as surface-active as individual beta-casein in terms of the final (steady-state) lowering of the interfacial tension, but the rate of tension lowering was smaller. EDTA treatment improved the rate of tension lowering of whole milk. The acidification of milk, from previous measurements, would lead to the enhancement of surface activity. At t=15,000 s, the order of effectiveness is pH 4.3 > pH 5.3 = pH 5.6 > pH 6.7 whole milk, suggesting that pH 4.3 whole milk is the best surface active. As compared to pH 6.7 whole milk, the use of pH 5.3 and pH 5.6 milk as surface active would result in the use of milk containing more free beta-casein born of pH-dissociated casein micelles.

[Prognostic features of residual pleural thickening in metapneumonic pleural effusion]. / Factores predictivos del engrosamiento pleural residual en el derrame pleural metaneumónico.

Residual pleural thickening (RPT) develops in some patients after metapneumonic pleural effusion (MPE). Our aim was to identify factors that predict the development of RPT by retrospectively analyzing patients with MPE secondary to bacterial pneumonia in our practice from 1992 through April 1997. Patients were assigned to groups based on the presence or not of RPT (> 10 mm) three months or more after diagnosis of MPE. One hundred twenty-eight patients were included in the analysis. Seventy-nine patients (62%) developed RPT and 49 (38%) did not. Patients with RPT had significantly lower glucose levels and pH and higher LDH levels in pleural fluid. A higher percentage of patients with RPT had loculate pleural effusions and empyema, and they more often required insertion of drains. Logistic regression analysis showed that only glucose < 40 mg/dl (OR: 3.4; CI 95%: 2.3 to 4.5; p < 0.05) and the presence of pus collected from the initial thoracocentesis (OR: 3.6; CI 95%: 2.6 to 4.5; p < 0.01) were significantly associated with increased risk of developing residual pachypleuritis in subjects with MPE.

Nontraumatic bilateral diaphragmatic myopathy: an unusual disturbance.

Bilateral diaphragmatic paralysis (BDP) is an uncommon entity among neuromuscular diseases. We present a young female with no triggering factors who developed progressive dyspnea with respiratory failure. Further studies led to the diagnosis of BDP.

Increased responsiveness of human pulmonary arteries in patients with positive bronchodilator response.

1. The effects of noradrenaline, endothelin-1, acetylcholine and sodium nitroprusside were studied in isolated pulmonary arteries obtained from 14 patients undergoing lobectomy for lung carcinoma. Seven patients had shown increased response to a bronchodilator test prior to operation. In the remaining patients (control) the bronchodilator test was negative. 2. Artery rings from patients with a positive bronchodilator response showed greater contraction to noradrenaline (pD2 = 6.44 +/- 0.1; Emax = 93 +/- 9% of response to 100 mM KCl) and endothelin-1 (pD2 = 8.92 +/- 0.1; Emax = 130 +/- 16%) than the rings from control patients (pD2 = 6.04 +/- 0.08; Emax = 56 +/- 8% for noradrenaline; pD2 = 8.29 +/- 0.1; Emax = 78 +/- 10% for endothelin-1). There was no significant difference in the contractile responses to 100 mM KCl between arteries from either group of patients. 3. Arterial rings from patients with a positive bronchodilator test achieved 96 +/- 3% of maximal relaxation in response to acetylcholine, whereas rings from control patients achieved a maximal relaxation of 72 +/- 5%. Rings from both the controls and the patients with a positive bronchodilator test achieved complete relaxation in response to sodium nitroprusside but pD2 values were significantly higher in patients with a positive bronchodilator test. 4. Removal of endothelium or treatment with NG-nitro-L-arginine methyl ester of artery rings from both the control and the patients with a positive bronchodilator test reduced the relaxation to acetylcholine (P < 0.05) but did not modify relaxation to sodium nitroprusside. 5. It is concluded that responsiveness of pulmonary arterial smooth muscle to dilator and constrictor agents is increased in patients showing reversibility of airway constriction. Thus hyperresponsiveness of airway smooth muscle may be associated with a similar phenomenon in the surrounding vascular smooth muscle.

Evaluation of intercostal cryoanalgesia versus conventional analgesia in postthoracotomy pain.

The objective of the study was to evaluate the effects of cryoanalgesia in patients undergoing posterolateral thoracotomy. A double-blind randomized and prospective study was performed in 100 patients undergoing thoracotomy. They were randomized into two groups: Group A, 55 patients, who had undergone an intercostal cryoanalgesia and group B, control, 45 patients treated only with pharmacological analgesia ad libitum. In both groups we assessed pain in the first 7 postsurgical days, the amount of analgesia required, electromyography of the intercostal muscles involved and recording of maximal static respiratory pressures. Postsurgical pain was significantly lower (p < 0.001) in group A. No patient in group A needed major analgesia and the amount of aminopyrines required was significantly lower (p < 0.001) than those used in group B. Maximal static inspiratory pressure (PImax) showed no significant changes and no significant differences were found between the two groups. Maximal static expiratory pressure (PEmax) significantly decreased (p < 0.001) in the 1st and 2nd week and it was not related to the type of analgesia used. We advocate the use of cryoanalgesia since it significantly reduces pain as well as the doses of analgesia.

Influence of endothelial nitric oxide on neurogenic contraction of human pulmonary arteries.

The present study was designed to investigate the contribution of the endothelium and that of the L-arginine pathway on the contractile responses of isolated human pulmonary arteries to electrical field stimulation (EFS) and noradrenaline. Isometric tension was measured in artery rings obtained from portions of human lung after thoracic surgery for removal of lung carcinoma (18 patients). Electrical field stimulation (EFS) induced frequency-dependent contractions of isolated human pulmonary arteries which were abolished by tetrodotoxin, guanethidine and prazosin (all at 10(-6) M). The increases in tension were of greater magnitude in arteries denuded of endothelium. NG-nitro-L-arginine methyl ester (L-NAME) (10(-4) M) potentiated the contractile response to EFS in artery rings with endothelium but not in endothelium-denuded arteries. The potentiation induced by L-NAME was completely reversed by L-arginine (10(-4) M) but not by D-arginine (10(-4) M). Indomethacin (3 x 10(-6) M) had no significant effect on the contractile response to EFS. Contractile responses to noradrenaline were similar in arteries with and without endothelium. Our results suggest that electrical field stimulation releases endothelium-derived nitric oxide, which inhibits the contractile responses of human pulmonary arteries. Although adrenergic nerves seem to be responsible for the contraction, the transmitter involved in the release of nitric oxide does not appear to be noradrenaline.