Discordant SARS‐CoV

OBJECTIVES/HYPOTHESIS: Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS‐CoV‐2 testing. Our goal was to evaluate for discordance in SARS‐CoV‐2 detection in hospitalized patients with COVID‐19 and tracheostomies based on the site analyzed. STUDY DESIGN: Retrospective chart review METHODS: This single‐institution study evaluated hospitalized patients with COVID‐19 who had tracheostomies placed during their treatment. We analyzed SARS‐CoV‐2 RNA nucleic acid amplification test (NAAT) results after tracheostomy. All included patients had nasopharyngeal (NP) and tracheal (TR) samples taken within a 48‐hour period, allowing us to characterize rate of test concordance. RESULTS: Forty‐five patients met our inclusion criteria. Thirty‐two (71.1%) patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive. There were no statistically significant differences in demographic or clinical variables, including time to tracheostomy and time to testing, among patients with concordant versus discordant SARS‐CoV‐2 results. CONCLUSION: This represents the first study to examine SARS‐CoV‐2 RNA NAAT concordance between NP and TR sites in hospitalized patients with COVID‐19 and tracheostomies. One‐third of patients demonstrated discordant testing when NP and TR specimens were collected within a 48‐hour time period. Thus, patients with tracheostomies may have a higher false‐negative rate if only one site is assessed for SARS‐CoV‐2. We recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist. LEVEL OF EVIDENCE: IV Laryngoscope, 202

Innate immunity in inflammation

A fine balance between prompt response to pathogens and avoidance of unregulated inflammation, as well as that between protection and self-damage drives the complexity of the immune system, at the same time pointing out the challenge for effective and safe immunopharmacological intervention. A wide variety of clinically relevant drugs are currently used in the treatment of human inflammatory and immune-system associated disorders. Classical therapeutic approaches are now integrated with emerging strategies that largely derive from advances in signalling and regulatory networks and the pathological consequences of their dysregulation in the field of innate immunity. This chapter provides an account of: (i) the interplay between innate immunity and inflammation; (ii) main immune signalling molecules in inflammation including cytokines, prostanoids and cancer-related immune response, and the main aspects of pharmacological control thereof; and (iii) emerging options for therapeutic interventions on cells of innate immunity