Histopathological and immunohistochemical differentiation of epithelial alterations in vocal nodule comparing to polyps and to laryngeal edema

AIM: To evaluate by histological and immunohistochemical methods the epithelial lesions in vocal nodule and correlate with polyp, laryngeal edema and vocal folds without macroscopic lesions. STUDY DESIGN: Chart review. MATERIAL AND METHOD: In a retrospective analysis of medical records, twenty-six patients, who underwent microsurgical excision of laryngeal inflammatory lesions (nodules, polyps and laryngeal edema), were identified. Vocal folds without macroscopic lesions were obtained from autopsy. To evaluate epithelial lesions, specimens were stained with H&E, PAS, and with antibodies against laminin and collagen type IV. These specimens were analyzed by light microscopy. RESULTS: Lesions diagnosed as nodules showed more collagen type IV and laminin deposition when compared to polyps (p=0,034 and p=0,036, respectively) and to vocal folds without macroscopic lesions (p=0,019 and p=0,021, respectively). Nodules showed basement membranes thicker than polyps on PAS stain (p=0,102). Laryngeal edema could not be differentiated from nodules, polyps or vocal folds without macroscopic lesions by PAS, laminin or collagen type IV stain (p>0,10). CONCLUSION: By histological and immunohistochemical techniques to evaluate epithelium of laryngeal inflammatory lesions we conclude that vocal fold nodule differentiate from polyps on the three techniques used to stain basement membrane (PAS, laminin, collagen IV) and from vocal folds without macroscopic lesions on two techniques used (laminin, collagen IV). Laryngeal edema cannot be differentiated from the others laryngeal lesions, neither from vocal folds without macroscopic lesions, when the techniques before described are used.OBJETIVO: Avaliar, por meio de técnicas histológicas e imunoistoquímicas, o epitélio nos nódulos vocais em relação aos pólipos, ao edema de laringe e às pregas vocais sem lesões macroscópicas. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Por meio de levantamento de prontuário, foram identificados vinte e seis pacientes com lesões laríngeas inflamatórias (nódulos, pólipos e edema de laringe), que haviam sido submetidos à cirurgia. Pregas vocais sem alterações macroscópicas foram obtidas a partir de autópsia de cadáveres. Para análise do epitélio, foram realizadas colorações pela técnica da hematoxilina-eosina e do ácido periódico de Schiff e técnicas de imunoistoquímica com anticorpos dirigidos contra laminina e colágeno IV. A leitura das lâminas foi realizada por meio de microscopia óptica. RESULTADOS: Houve maior imunoexpressão de laminina e colágeno IV nos nódulos quando comparados aos pólipos (p=0,034 e p=0, 036, respectivamente), assim como quando comparados às pregas vocais sem lesões macroscópicas (p=0,019 e p=0, 021, respectivamente). Nódulos tendem a apresentar maior espessura da membrana basal, quando utilizamos coloração pela técnica do PAS, em relação aos pólipos (p=0,102). O edema de laringe não se diferenciou das demais nas técnicas utilizadas (p> 0,10). CONCLUSÕES: O Nódulo Vocal diferencia-se dos pólipos, nas três técnicas utilizadas para detecção da membrana basal (PAS, laminina, colágeno IV), e das pregas vocais sem lesões macroscópicas em duas das técnicas utilizadas (laminina e colágeno IV). Edema de laringe não se diferencia das demais lesões, nem de pregas vocais sem lesões macroscópicas, quando utilizadas as técnicas anteriormente descritas, para estudo da membrana basal.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Distúrbios da Comunicação HumanaUniversidade de São Paulo Faculdade de OdontologiaUNIFESP, EPM, Depto. de Otorrinolaringologia e Distúrbios da Comunicação HumanaSciEL

Human immunoglobulin G levels of viruses and associated glioma risk

Few consistent etiological factors have been identified for primary brain tumors. Inverse associations to asthma and low levels of varicella-zoster virus, immunoglobulin (Ig) levels in prevalent cases have indicted a role for the immune system in the development of glioma. Because samples from prevalent cases of glioma could be influenced by treatments such as steroids and chemotherapy, we investigated pre-diagnostic samples from three large Scandinavian cohorts. To test the hypothesis that immune response levels to these viruses are associated etiologically with glioma risk, we investigated pre-diagnostic immunoglobulin levels for cytomegalovirus (CMV), varicella-zoster virus (VZV), adenovirus (Ad), and Epstein-Barr virus (EBV) including the nuclear antigen (EBNA1) using plasma samples from 197 cases of adult glioma and 394 controls collected from population-based cohorts in Sweden and Denmark. Low VZV IgG levels were marginally significantly more common in glioma cases than the controls (odds ratio (OR) = 0.68, 95% CI 0.41–1.13) for the fourth compared with the first quartile (p = 0.06 for trend). These results were more prominent when analyzing cases with blood sampling at least 2 years before diagnosis (OR = 0.63, 95% CI 0.37–1.08) (p = 0.03). No association with glioma risk was observed for CMV, EBV, and adenovirus

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men