Organizing pneumonia in a patient with hodgkin's lymphoma and large B cell lymphoma: a rare association

Organizing Pneumonia (OP) is classified as an Idiopathic Interstitial Pneumonia (IIP).1 Clinically, the patients present dyspnea, cough, and low fever, and usually respond well to corticosteroids, reaching clinical and radiologic resolution in a short timeframe. However, sometimes infiltrates do recur and may not resolve. Radiologically, migratory consolidations are identified in high-resolution computed tomography (HRCT), sometimes associated with progressive fibrosis with reticulation and areas of persistent consolidation.1 The histology reveals “proliferation of fibroblastic tissue within small airways, alveolar ducts, and alveolar spaces”.2 OP can be secondary to other pathologies such as common variable immunodeficiency3 and malignant disease among others.4 At times no etiology is identified and the term Cryptogenic Organizing Pneumonia (COP) is used.1 Furthermore, OP could coexist or mimic a malignant disease.4,

Potential risk factors related to pig body weight variability from birth to slaughter in commercial conditions

The aim of this observational study is to identify risk factors associated with body weight (BW) variability in three data sets (DS) in commercial conditions. A total of 1,009 (DS1), 460 (DS2), and 1304 (DS3) male and female crossbreed pigs (Pietrain × [Landrace × Large White]), respectively, were included in each trial. Pigs were periodically weighed until slaughter. Then, variables such as length of gestation, length of lactation, parity, litter size, sex, birth BW, and ADG were considered. Pigs remaining on the farm after two loads to the slaughterhouse were defined as last group of animals sent to slaughterhouse (LGS). Descriptive statistics of variability were calculated, and a risk analysis approach was used to look for the factors related to LGS. A multiple logistic regression was performed to identify all variables that were significant (P < 0.05). The risk ratio (RR), odds ratio (OR), and population attributable risk (PAR) were calculated for all of the significant variables after transforming all of them into binary factors using the 25th percentile as the cut-off point. Results showed that the major part of the variability (as CV) comes from birth (20% to 25%) and increased only a little during lactation and 14-d post weaning. From this point onwards, CV tended to decrease, as pigs got closer to the marketing weight (down 11.5% to 12.7%). Regarding the indicators selected, RR, OR, and PAR presented similar trends in the three DS studied. Therefore, for the variables finally included, these indicators had their minimum values at the start of the cycle and then gradually increased at the end. Those results, based on an epidemiological approach, suggest that the closer to the end of the cycle the greater the probability for a light piglet of being/becoming LGS. It might be explained by the shorter available time to efficiently implement preventive measures aimed to improve the performance of delayed pigs and, thus, reducing variability.Those results, based on an epidemiological approach, make sense as the probability for a light piglet to be a LGS increases the closer to the end of the cycle, due to the short time to implement preventive measures and increase the performance of delayed pigs and reduce variability. The differential PAR associated with both, the nursery and the growing period, was 1.7% and 1.5% for DS1, 5.1% and 3.1% for DS2, and 3.7% and 2.8% for DS3. For the lactation period, the results were 4.3% for DS2 and 4.5% for DS3. Results suggest that the most critical periods, in relation to retardation of growth in swine, are lactation and nursery. Implementing measures that maintain risk factors under or above thresholds, especially in the initial phases of growth, will reduce the percentage of LGS pigs and positively affect the overall homogeneity of the batch

A New Approach to Detecting and Measuring Changes in the Feeding Behaviour Habits of Group-Housed Growing-Finishing Pigs

The present work aims to estimate the methods of repeatability and of a new non-parametric approach based on typifying individuals into classes and quantifying (%) the pigs in a group that show similar feeding behaviour habits (FBHs) in consecutive periods ("maintenance"). Both methods were estimated over six consecutive 14-day periods in two trials of group-housed growing-finishing pigs (n = 60 each). The first trial started in summer and ended in autumn, and pigs were fed a pelleted diet (HT-P). The second trial started in spring and ended in summer, and the same diet was fed mash (TH-M). The average daily feed intake obtained the lowest repeatability and maintenance values, and it progressively decreased as pigs grew, independent of environmental conditions or physical feed form, whereas the maintenance and repeatability of the number of feeder visits and the visit size decreased when environmental conditions changed from temperate to hot, and mash-fed pigs had higher maintenance and repeatability values for the time spent eating than pellet-fed pigs. In conclusion, the new approach (maintenance) is a tool that is complementary to the classic repeatability concept and is useful for analysing the evolution of FBHs across periods of time at the individual level

Beneficial effect of corticosteroids in preventing mortality in patients receiving tocilizumab to treat severe COVID-19 illness

Objectives: To assess the characteristics and risk factors for mortality in patients with severe coronavirus disease-2019 (COVID-19) treated with tocilizumab (TCZ), alone or in combination with corticosteroids (CS). Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis of consecutive hospitalized adult patients receiving TCZ to treat severe COVID-19 was conducted at our 750-bed university hospital. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 patients with COVID-19 were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186 patients, 155 (83.3 %) patients were receiving noninvasive ventilation when TCZ was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (±4.3) and 4.3 days (±3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR = 1.09, p < 0.001), chronic heart failure (HR = 4.4, p = 0.003), and chronic liver disease (HR = 4.69, p = 0.004). The use of CS, in combination with TCZ, was identified as a protective factor against mortality (HR = 0.26, p < 0.001) in such severe COVID-19 patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In patients with severe COVID-19 receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in addition to TCZ therapy, showed a beneficial effect in preventing in-hospital mortality

A randomized controlled trial: branched‐chain amino acid levels and glucose metabolism in patients with obesity and sleep apnea

There is evidence that changes in branched‐chain amino acid (BCAA) levels may correlate with the efficacy of therapeutic interventions for affecting improvement in metabolic control. The objective of this study was to evaluate whether serum concentrations of BCAAs (leucine, isoleucine, valine) could mediate in insulin sensitivity and glucose tolerance after continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA). A prospective randomized controlled trial of OSA patients with morbid obesity was conducted. Eighty patients were randomized into two groups: 38 received conservative treatment and 42 received CPAP treatment for 12 weeks. Plasma levels of BCAA, glucose tolerance and insulin resistance were evaluated at baseline and after treatment. After treatment, significant decreases of leucine levels were observed in both groups when compared with baseline levels (P < 0.005). With respect to patients with normal glucose tolerance (NGT), patients with impaired glucose tolerance (IGT) had higher baseline levels of isoleucine (78 ± 16 versus 70 ± 13 μmol L−1, P = 0.014) and valine (286 ± 36 versus 268 ± 41 μmol L−1, P = 0.049), respectively. Changes in levels of leucine and isoleucine after treatment were related negatively to changes in fasting plasma glucose and glycosylated haemoglobin values only in the conservative group (P < 0.05). In summary, we found that the treatment with CPAP for 12 weeks caused similar changes in circulating BCAAs concentrations to conservative treatment and a differential metabolic response of CPAP and conservative treatment was observed between the relationship of BCAAs and glucose homeostasis. Additional studies are needed to determine the interplay between branched‐chain amino acids and glucose metabolism in patients with sleep apnea

Outcomes of COVID-19 Patients Admitted to the Intermediate Respiratory Care Unit: Non-Invasive Respiratory Therapy in a Sequential Protocol

The intermediate respiratory care units (IRCUs) have a pivotal role managing escalation and de-escalation between the general wards and the intensive care units (ICUs). Since the COVID-19 pandemic began, the early detection of patients that could improve on non-invasive respiratory therapies (NRTs) in IRCUs without invasive approaches is crucial to ensure proper medical management and optimize limiting ICU resources. The aim of this study was to assess factors associated with survival, ICU admission and intubation likelihood in COVID-19 patients admitted to IRCUs. Observational retrospective study in consecutive patients admitted to the IRCU of a tertiary hospital from March 2020 to April 2021. Inclusion criteria: hypoxemic respiratory failure (SpO(2) = 25 rpm with FiO(2) > 50% supplementary oxygen) due to acute COVID-19 infection. Demographic, comorbidities, clinical and analytical data, and medical and NRT data were collected at IRCU admission. Multivariate logistic regression models assessed factors associated with survival, ICU admission, and intubation. From 679 patients, 79 patients (12%) had an order to not do intubation. From the remaining 600 (88%), 81% survived, 41% needed ICU admission and 37% required intubation. In the IRCU, 51% required non-invasive ventilation (NIV group) and 49% did not (non-NIV group). Older age and lack of corticosteroid treatment were associated with higher mortality and intubation risk in the scheme, which could be more beneficial in severe forms. Initial NIV does not always mean worse outcomes

Clinical Outcomes of Severe COVID-19 Patients Admitted to an Intermediate Respiratory Care Unit

Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU. Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality. Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31-7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61-5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p < 0.001). Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality

A multicenter, open-label, randomized, proof-of-concept phase II clinical trial to assess the efficacy and safety of icatibant in patients infected with SARS-CoV-2 (COVID-19) and admitted to hospital units without invasive mechanical ventilation: study protocol (ICAT-COVID)

Background: COVID-19 has quickly become a global pandemic with a substantial number of deaths and is a considerable burden for healthcare systems worldwide. Although most cases are paucisymptomatic and limited to the viral infection-related symptoms, some patients evolve to a second phase, with an impaired inflammatory response (cytokine storm) that may lead to acute respiratory distress syndrome and death. This is thought to be caused by increased bradykinin synthesis. Methods: ICAT-COVID is a multicenter, randomized, open-label, proof-of-concept phase II clinical trial assessing the clinical efficacy and safety of adding icatibant to the standard of care in patients hospitalized with COVID-19 without invasive mechanical ventilation. Patients hospitalized with a confirmed COVID-19 pneumonia diagnosis (RTPCR or antigen test <= 10 days prior to randomization, and radiographic evidence of pulmonary infiltrates), rated 4 or 5' on the WHO's clinical status scale, are eligible. Patients will be randomized on a 1:1 ratio to either standard of care-plus-icatibant (experimental group) or to standard of care alone (control group). The experimental group will receive 30 mg of icatibant subcutaneously 3 times a day for 3 days (for a total of 9 doses). The expected sample size is 120 patients (60 per group) from 2 sites in Spain. Primary outcomes are the efficacy and safety of Icatibant. The main efficacy outcome is the number of patients reaching grades 2 or 1 on the WHO scale within 10 days of starting treatment. Secondary outcomes include long-term efficacy: number of patients discharged who do not present COVID-19-related relapse or comorbidity up until 28 days after discharge, and mortality. Discussion: Icatibant, a bradykinin type 2 receptor antagonist with proven effectiveness and safety against hereditary angioedema attacks, may be beneficial for COVID-19 patients by inhibiting bradykinin's action on endothelial cells and by inhibiting the SARS-CoV-2 M protease. Our working hypothesis is that treatment with standard of care-plus-icatibant is effective and safe to treat patients infected with SARS-CoV-2 admitted to hospital for pneumonia without invasive mechanical ventilation

Impacte de la Sindrome d'Apnea-hipoapnea Obstructiva del Son en l'obesitat greu / Impact of Obstructive Sleep Apnea in Severe Obesity

El pacient obès mòrbid candidat a cirurgia bariàtrica (CB) és un model ideal extrem que permet estudiar la Síndrome d’apnea-hipoapnea obstructiva del Son (SAOS) i les seves conseqüències cardio-metabòliques, associades o no a la pròpia obesitat. Resulta també interessant investigar si existeix alguna manera d’optimitzar la detecció dels pacients que pateixen una SAOS greu abans de la cirurgia per agilitzar el seu maneig respiratori peri-operatori. I també falta per conèixer l’efecte de la CB sobre la resolució de la SAOS. PRIMER TREBALL: Hipòtesis: La presencia d’una SAOS se associa a un pitjor perfil metabòlic en els pacients amb obesitat mòrbida. Metodologia: Estudi prospectiu transversal de cohorts en 159 pacients inclosos de manera consecutiva en el programa de CB. La SAOS es defineix amb un índex d’apnea-hipoapnea (IAH) >=15 events/hora mitjançant una polisomnografia intrahospitalària (PSG). Les determinacions analítiques, antropomètriques i pressió arterial es van recollir el matí següent a la PSG. La síndrome metabòlica (MetS) es defineix en base als criteris modificats de la National Cholesterol Education Program Adult Treatment Panel III. Resultats: La SAOS es molt prevalent: 98% (IAH ≥5 events/h). Els pacients amb SAOS presenten més MetS que els pacients sense SAOS (70% vs 36%, p 0.001). A mesura que augmenta la gravetat de la SAOS, el perfil metabòlic progressivament empitjora. L’IAH se associa amb la majoria de components metabòlics independentment. La presencia de SAOS quasi triplica l’odds ratio de presentar MetS (2.8, 95% CI 1.3–6.2; p0.009) després d’ajustar per edat, sexe i IMC. SEGON TREBALL: Hipòtesis: En pacients candidats a CB es pot construir un model predictiu per detectar una SAOS greu basant-se en variables clíniques senzilles evitant la necessitat de realitzar un estudi reglat de son. Metodologia: igual que el primer treball. Variable dependent: SAOS greu definit com un IAH >= 30 events/hora mitjançant PSG. Variables independents potencialment predictives: antropomètriques i clíniques en el primer model i afegint dades de la pulsi-oximetria (índex de dessaturació d’oxigen >=3%, ODI3%) en el segon model. Resultats: La aplicació del model descarta el 45% dels pacients de forma ràpida i segura: el 15% amb paràmetres clínics (edat, diàmetre cintura, pressió arterial sistòlica e apnees nocturnes objectivades) i el 30% restant afegint l’ODI3%. Els valors predictius del model son: Se 91%, Sp 90%, VPP 92%, VPN 89% i precisió global 0.90 (95% CI 0.84 - 0.94). TERCER TREBALL Hipòtesis: En pacients amb obesitat mòrbida i SAOS, la pèrdua de pes post-quirúrgica no sempre determina la curació de la SAOS. Metodologia: Estudi de dades aparejades intra-subjecte: avaluar la presencia/gravetat de la SAOS pre i post-CB. Els pacients amb un IAH preCB >15 events/hora van ser revaluats 1 any post-CB (n=59). Resolució de la SAOS si IAH postCB = 0.5. Resultats: La pèrdua ponderal un any post-CB es relaciona amb una milloria significativa de la SAOS en la gran majoria dels pacients (88% presenten un IAH postCB <30); no obstant, la presencia d’una SAOS moderada (IAH postCB 30-15) persisteix en un 27% i la resolució completa només en un 19% (IAH postCB <5). Una reducció significativa de l’IMC postCB no reflecteix necessàriament una reducció significativa de l’IAH postCB en tots els casos. CONCLUSIONS La SAOS s’associa amb un pitjor perfil metabòlic en el pacient obès mòrbid candidat a CB independentment de l’edat, el sexe i l’adipositat central. El modelo de predicció proposat podria ser una eina inicial molt útil per detectar precoçment la SAOS greu en programes multidisciplinaris de CB. La pèrdua ponderal post-CB a l’any de seguiment suposa una milloria significativa de la gravetat de la SAOS en la majoria dels pacients. Però més de una tercera part continuen presentant una SAOS residual de caràcter lleu-moderada malgrat haver assolit la pèrdua ponderal optima. .Morbidly obese (MO) patients submitted to bariatric surgery (BS) can be an ideally extreme model to investigate the association between obstructive sleep apnea (OSA) and its cardio-metabolically consequences related or not to severe obesity. A systematic OSA screening before BS should be an optimal recommendation; however there is still no reliable way to detect this condition without an objective sleep study. It is also becoming a major healthcare challenge to better understand the specific BS outcomes on OSA severity after one-year follow-up. This thesis consists of 3 related works. The first 2 works were derived from a prospective multicentre cross-sectional study in 159 consecutive subjects before BS. OSA was defined as an apnoea/hypopnoea index(AHI) ≥15 events/hour by an overnight polysomnography. Anthropometrical, blood pressure and fasting blood measurements were obtained the morning after. Metabolic syndrome (MetS) was defined according to National Cholesterol Education Program Adult Treatment Panel III modified criteria. The first work analyzed the association between OSA and MetS regardless of severe obesity. The second work attempted to find a simple predictive model to detect those patients suffering from severe OSA before BS using clinical parameters and pulse oximeter data. The last work was obtained from a previous retrospective sleep database where 61 patients with OSA diagnosis done before BS were revaluated one year after surgery. The overall main results were the following: OSA was associated with a more severe metabolic profile in MO patients, independent of age, sex, and central adiposity and smoking. The proposed two-step predictive model based on clinical parameters +/- pulse oximeter data could be a useful first screening tool to detect those patients suffering from severe OSA before BS avoiding more complex sleep studies and optimizing sleep unit resources. Bariatric weight loss resulted in significant OSA improvement after medium-term follow-up in most patients, but some of them persisted having residual OSA although they achieved optimal weight loss

Interrelationships between sex and dietary lysine on growth performance and carcass composition of finishing boars and gilts

The main goals of this study were to determine whether boars and gilts respond differently to the standardized ileal digestible lysine to net energy ratio (SID Lys:NE) and model the response to optimize growth performance. A total of 780 finishing pigs, 390 boars and 390 gilts [Pietrain NN × (Landrace × Large White)], with an initial individual body weight of 70.4 ± 9.2 for boars and 68.7 ± 8.0 kg for gilts, were used in a 41-d dose-response experiment. Pens (13 pigs per pen) were randomly allocated to a dietary treatment (2.64, 3.05, 3.46, 3.86, 4.27 g SID Lys/Mcal NE) by block and sex, with six replicates per treatment and sex. Two isoenergetic diets (2,460 kcal NE/kg), representing the extreme SID Lys:NE, were formulated and then mixed. Pigs were individually weighed at days 0, 22, and 41, when the experiment finished. The differential effect of SID Lys:NE on growth performance and carcass composition between sexes was analyzed with orthogonal polynomial contrasts to compare the linear and quadratic trends in each sex. In addition, broken-line linear (BLL) models to optimize average daily gain (ADG), including average daily feed intake (ADFI) as a covariate, were fitted when possible. As expected, boars had a greater ADG and feed efficiency (G:F; P < 0.001) than gilts, but there was no evidence of differences in ADFI (P = 0.470). Increasing SID Lys:NE had a greater linear impact on boars ADG (P = 0.087), G:F (P = 0.003), and carcass leanness (P = 0.032). In contrast, gilts showed a greater linear increase in SID Lys intake per kg gain (P < 0.001) and feed cost per kg gain (P = 0.005). The best fitting BLL models showed that boars maximized ADG at 3.63 g SID Lys/Mcal NE [95% confidence interval (CI): (3.32 to 3.94)], although another model with a similar fit, compared with the Bayesian information criterion, reported the optimum at 4.01 g SID Lys/Mcal NE [95% CI: (3.60, 4.42)]. The optimum to maximize ADG for gilts was estimated at 3.10 g SID Lys/Mcal NE [95% CI: (2.74, 3.47)]. Thus, the present study confirmed that boars and gilts have a different linear response to SID Lys:NE, explained by the greater protein deposition potential of boars. Likewise, BLL models indicated that boars require a higher SID Lys:NE to maximize ADG from 70 to 89 kg. These results suggest that split feeding of finishing boars and gilts could be beneficial in terms of both performance and cost return