Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy.

OBJECTIVES: To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS: We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS: We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS: Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

Histopathological and virological features of lung, heart and liver percutaneous tissue core biopsy in patients with COVID-19: A clinicopathological case series.

INTRODUCTION: Data on pathological changes in COVID-19 are scarce. The aim of this study was to describe the histopathological and virological findings of postmortem biopsies, and the existing clinical correlations, in people who died of COVID-19. MATERIALS AND METHODS: We performed postmortem needle core biopsies of the chest in 11 people who died of COVID-19 pneumonia. Tissue examination was done by light microscopy and real-time polymerase chain reaction (RTPCR). RESULTS: The age of the patients were between 61 to 94 years. Of the 11 postmortem chest biopsies, lung tissue was obtained in 8, myocardium tissue in 7, and liver tissue in 5. Histologically of lung, the main findings pertaining to the lung were diffuse alveolar damage in proliferative phase (n = 4, 50%), diffuse alveolar damage in exudative and proliferative phase (n = 3, 37.5%), diffuse alveolar damage in exudative (n=1; 12.5%) and acute pneumonia (n = 2, 25%). Necrotising pneumonia, acute fibrinous and organising pneumonia, and neutrophils were detected in one sample each (12.5%). Another case presented myocarditis. RT-PCR showed RNA of SARS-CoV-2 in 7 of the 8 lung samples (87.5%), 2 of the 7 myocardial tissue samples (28.6%), and 1 of the 5 liver tissue samples (20%). CONCLUSION: The postmortem examinations show diffuse alveolar damage, as well as acute or necrotising pneumonia. RT-PCR of SARS-CoV-2 was positive in most lung samples.

Silicosis: una antigua enfermedad profesional con nuevos escenarios de exposición laboral / Silicosis: a former occupational disease with new occupational exposure scenarios

Introducción: recientes estudios evidencian un aumento de la prevalencia de la silicosis por el uso de conglomerados artificiales de cuarzo (CAC). El objetivo de este trabajo es la valoración de los casos de silicosis declarados al Sistema de Información Sanitaria de Vigilancia Epidemiológica Laboral de la Comunidad Valenciana en nuestra área, para detectar: nuevos agentes de exposición al sílice y condiciones de trabajo que favorecen su aparición. Material y método: estudio descriptivo de casos de silicosis declarados al Sistema de Información Sanitaria de Vigilancia Epidemiológica Laboral de la Comunidad Valenciana desde enero de 2009 hasta septiembre de 2016. Las fuentes de datos incluyen encuestas epidemiológico-laborales e informes médicos. Resultados: se declaran 19 casos de silicosis. El 74% fue diagnosticado mediante tomografía computarizada de alta resolución. El 68,4% estaba relacionado con manipulación de CAC, en puestos de montador/cortador/lijador de encimeras. La edad media de este subgrupo fue de 46,62±13,33 años y la media de exposición, de 11,00±3,58 años. El resto trabajó en empresas sin exposición a CAC, con una edad media de 62,33±16,22 años y un tiempo de exposición de 27,16±8,44 años (p<0,05). Presentaron formas complicadas 4 casos (3 expuestos a CAC). Conclusiones: el trabajo de montador/cortador/lijador de encimeras de CAC presenta un alto riesgo de desarrollar la enfermedad. La edad media de presentación y el tiempo de exposición en este grupo es menor y el porcentaje de formas clínicas complicadas, mayor. Es necesario establecer mejoras en la planificación preventiva de empresas con exposición a estos nuevos agentes

Background: recent studies have shown an increase in the prevalence of silicosis due to the use of artificial quartz aggregates (AQA). The aim of this study was to assess the cases of silicosis in our area reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia to detect new agents of exposure to silica and working conditions that promote its onset. Material and method: a descriptive study was conducted of cases of silicosis reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia from January 2009 to September 2016. The data sources include epidemiological-occupational surveys and medical reports. Results: nineteen cases of silicosis were reported, 74% of which were diagnosed using high-resolution computed tomography. Some 68.4% of the cases were related to the handling of AQA, as assemblers/cutters/sanders of countertops. The subgroup's mean age was 46.62±13.33 years, and the mean exposure was 11.00±3.58 years. The rest of the patients worked in companies with no AQA exposure, with a mean age of 62.33±16.22 years and a mean exposure of 27.16±8.44 years (P<.05). Four cases presented complicated forms (3 exposed to AQA). Conclusions: the work of assembling/cutting/sanding AQA countertops presents a high risk of developing the disease. The mean age at onset and the exposure time for this group is lower, and the percentage of complicated clinical forms is higher. Improvements need to be made in preventive planning for companies with exposure to these new agents

Silicosis: A former occupational disease with new occupational exposure scenarios. / Silicosis: una antigua enfermedad profesional con nuevos escenarios de exposición laboral.

BACKGROUND: Recent studies have shown an increase in the prevalence of silicosis due to the use of artificial quartz aggregates (AQA). The aim of this study was to assess the cases of silicosis in our area reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia to detect new agents of exposure to silica and working conditions that promote its onset. MATERIAL AND METHOD: A descriptive study was conducted of cases of silicosis reported to the Healthcare Information System for Occupational Epidemiological Surveillance of the Autonomous Community of Valencia from January 2009 to September 2016. The data sources include epidemiological-occupational surveys and medical reports. RESULTS: Nineteen cases of silicosis were reported, 74% of which were diagnosed using high-resolution computed tomography. Some 68.4% of the cases were related to the handling of AQA, as assemblers/cutters/sanders of countertops. The subgroup's mean age was 46.62±13.33 years, and the mean exposure was 11.00±3.58 years. The rest of the patients worked in companies with no AQA exposure, with a mean age of 62.33±16.22 years and a mean exposure of 27.16±8.44 years (P<.05). Four cases presented complicated forms (3 exposed to AQA). CONCLUSIONS: The work of assembling/cutting/sanding AQA countertops presents a high risk of developing the disease. The mean age at onset and the exposure time for this group is lower, and the percentage of complicated clinical forms is higher. Improvements need to be made in preventive planning for companies with exposure to these new agents.

[Value of the determination of CA 15-3 in the diagnosis of malignant pleural effusion]. / Valor de la determinación del CA 15-3 en el diagnóstico de los derrames pleurales malignos.

In 160 consecutive patients with pleural shedding, antigen CA 15-3 values in pleural fluid were determined, in a prospective way using monoclonal antibodies (115D8 and DF3). In 49 patients with malignant pleural shedding, the mean value of CA 15-3 (47.6 U/ml) was significantly higher (p less than 0.01) to the values in the 111 benign ones (12.9 U/ml). Its sensibility for malignity, with a trough level of 27 U/ml, was of 37% with an specificity of 96%. When a specificity of 100% was required its sensibility (18%) was significantly lower to the carcinoembryonic antigen (CEA) (33%), measured simultaneously with comparative purposes. The simultaneous determination of both markers raised sensibility to 39%, without reaching statistical signification. In the ten patients whose pleural sheddings was secondary to breast carcinoma, both minimum (15 U/ml) as medium (110 U/ml) values, as well as CA 15-3 sensibility (80%), were higher to the ones found in the rest of patients with shedding of malignant origin, but without a clear superiority over the values obtained with CEA. Based on these results, we conclude that the usefulness of the determination, as a tumoral marker, in pleural fluid, of CA 15-3 is lower than CEA and that its simultaneous determination seems not justified. We think that its specific usefulness in pleural sheddings secondaries to breast carcinomas deserves a study with a bigger sample.

[Diagnostic usefulness of the determination of serum neuron-specific enolase in small cell bronchial carcinoma]. / Utilidad diagnóstica de la determinación sérica de la enolasa neuroespecífica en el carcinoma bronquial de células pequeñas.

The plasma level of neuron-specific enolase (NSE) was measured in 55 patients with small cell bronchial carcinoma (SCC) with cytohistological confirmation to evaluate its diagnostic usefulness. As a control group, 132 patients with non-small cell bronchial carcinoma, 81 with non-neoplastic disease and 37 healthy individuals were used. The sensitivity of the test was 84% with a specificity of 79% when values below 13 ng/mg were considered as normal. To achieve a specificity of 95% and 99% cutoff values had to be increased to 25 and 50 ng/ml, respectively, and then the sensitivity was reduced to 51% and 38%. There were false positive findings in the three control groups, although they were more common (28%) and had higher values in patients with widespread disease the sensitivity was significantly higher (p less than 0.005) than in those with limited disease. Carcinoembryonic antigen, which was measured with comparative purposes, had a lower sensitivity. In our area, a NSE level over 50 ng/ml is closely correlated with the diagnosis of SCC, whereas values over 13 ng/ml select a wider group of individuals where most patients with this type of carcinoma are included.