Pulmonary thrombosis associated with COVID-19 pneumonia: Beyond classical pulmonary thromboembolism.

BACKGROUND: Classical pulmonary thromboembolism (TE) and local pulmonary thrombosis (PT) have been suggested as mechanisms of thrombosis in COVID-19. However, robust evidence is still lacking because this was mainly based on retrospective studies, in which patients were included when TE was suspected. METHODS: All patients with COVID-19 pneumonia underwent computed tomography and pulmonary angiography in a prospective study. The main objective was to determine the number and percentage of thrombi surrounded by lung opacification (TSO) in each patient, as well as their relationship with percentage of lung involvement (TLI), to distinguish classical TE (with a random location of thrombi that should correspond to a percentage of TSO equivalent to the TLI) from PT. We determined TLI by artificial intelligence. Analyses at patient level (TLI and percentage of TSO) and at thrombi level (TLI and TSO) were performed. RESULTS: We diagnosed TE in 70 out of 184 patients. Three (2-8) thrombi/patient were detected. The percentage of TSO was 100% (75-100) per patient, and TLI was 19.9% (4.6-35.2). Sixty-five patients (92.9%) were above the random scenario with higher percentage of TSO than TLI. Most thrombi were TSO (n = 299, 75.1%). When evaluating by TLI (<10%, 10%-20%, 20%-30% and >30%), percentage of TSO was higher in most groups. Thrombi were mainly in subsegmental/segmental arteries, and percentage of TSO was higher in all locations. CONCLUSIONS: Thrombi in COVID-19 were found within lung opacities in a higher percentage than lung involvement, regardless of TLI and clot location, supporting the hypothesis of local PT rather than "classic TE".

Polysomnographic Characteristics of Snoring Children: A Familial Study of Obstructive Sleep Apnea Syndrome / Características polisomnográficas de los niños que roncan: un estudio familiar del síndrome de apnea obstructiva del sueño

Background and objectives: Available evidence suggests a familial basis for OSA. The aim of the present study was to assess the potential influences of parental OSA in predicting the diagnosis and severity of OSA in snoring children.Methods: Observational study, we prospectively enrolled 84 children and their parents. A complete nocturnal polysomnography was performed. Children were categorized into 3 severity groups according to the apnea–hypopnea index (AHI<1h−1, AHI≥1h−1 to AHI<5h−1, and AHI≥5h−1). Adults were grouped according two criteria (AHI≥5h−1 and ≥10h−1).Results: There were no significant differences in age, gender, BMI and BMI z-score among groups. Among the children, 54.7% had an AHI≥1h−1 and 21.4% had an AHI≥5h−1. Overall, we observed that 60.7% of fathers and 23.8% of mothers of our population had OSA (AHI≥5h−1). The prevalence of fathers with OSA increases with the children's severity (83% in the group of children with moderate-severe OSA, p=0.035). The odds of having moderate-severe pediatric OSA (AHI≥5h−1) were more than 4 times higher among children with a father with AHI≥5h−1 (OR: 4.92, 95% CI: 1.27–19.06; p=0.021). There was no evidence of any maternal influence on OSA severity among the children studied.Conclusions: Our findings suggest a high prevalence of OSA among the family members studied with an increased association of childhood OSA with paternal OSA. Prediction of OSA risk among children can be significantly improved by adding data on paternal OSA status. (AU)

Contexto y objetivos: La evidencia disponible sugiere una base familiar para la AOS. El objetivo del presente estudio fue evaluar las posibles influencias de la AOS de los padres para predecir el diagnóstico y la gravedad de la AOS en los niños que roncan.Métodos: Estudio observacional en el que incluimos prospectivamente a 84 niños y sus padres. Se realizó una polisomnografía nocturna completa. Los niños se clasificaron en 3 grupos de gravedad según el índice de apnea-hipopnea (IAH <1h−1, IAH ≥1h−1 a IAH <5h−1y IAH ≥5h−1). Los adultos se agruparon según dos criterios (IAH ≥5 h-1 y ≥10 h-1).Resultados: No había diferencias significativas en la edad, el sexo, el IMC y la puntuación z del IMC entre los grupos. Entre los niños, el 54,7% tenía un IAH ≥1h−1 y el 21,4% tenía un IAH ≥5h−1. En general, observamos que el 60,7% de los padres y el 23,8% de las madres de nuestra población tenían AOS (IAH ≥5h−1). La prevalencia de padres con AOS aumenta con la gravedad de la AOS en los niños (83% en el grupo de niños con AOS moderada-grave, p=0,035). La probabilidad de tener AOS pediátrica moderada-grave (IAH ≥5h−1) fue más de 4 veces mayor en los niños con un padre con IAH≥5h−1 (OR: 4,92, IC 95%: 1,27-19,06; p=0,021). No hubo evidencia de que hubiera alguna influencia materna en la gravedad de la AOS en los niños estudiados.Conclusiones: Nuestros hallazgos sugieren una alta prevalencia de AOS entre los miembros de la familia estudiados con una mayor asociación de la AOS infantil con la AOS paterna. La predicción del riesgo de AOS entre los niños puede mejorarse significativamente al incluir información sobre el estado de la AOS paterna. (AU)

Derrame pleural leucémico: aproximación diagnóstica y controversias en pleurodesis / Leukemic Pleural Effusion: Diagnostic Approach and Controversies in Pleurodesis

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