Breast Cancer Management During COVID-19 Pandemic in Madrid: Surgical Strategy

BackgroundFrom the first case of SARS-CoV-2 infection in Wuhan (China), the infection spread all around the world causing a pandemic of coronavirus disease-2019 (COVID-19). Spain has been one of the most severely affected countries, and Madrid has reported a high number of cases and deaths. We discuss our strategies for optimal breast cancer management during COVID-19 pandemic.Patients and MethodsThis was a retrospective observational study at Clínico San Carlos Hospital to analyze the management of patients with breast cancer during the pandemic outbreak and the surgical strategy after the pandemic outbreak. We created a practical and dynamic tool based on a “traffic light” system for prioritizing surgical time. Every patient was contacted by telephone with a preoperative COVID-19 protocol. After surgical procedures, patient satisfaction was assessed using the European Organisation for Research and Treatment of Cancer in-patient satisfaction with cancer care questionnaire (EORTC IN-PATSAT32).ResultsPatients with breast cancer actively treated with surgical procedures were put on a waiting list and received systemic therapy. Telemedicine was used to evaluate any side effects and to avoid unnecessary hospital visits. Surgery was only considered after the pandemic outbreak, and then, only those procedures designed to minimize surgical complications and, therefore, reduce hospital stay. We also measured patients’ satisfaction with medical and nursing scales that resulted in a “very good” evaluation tending to “excellent”.ConclusionIt is necessary to adapt management of oncology treatment and surgical strategy to optimize resources during the COVID-19 pandemic. Patients’ perception of care quality and the degree of patients’ satisfaction with health services has potential relevance in the absence of outcome data.     

Comparative study of the effects of different glucocorticosteroids on eosinophil survival primed by cultured epithelial cell supernatants obtained from nasal mucosa and nasal polyps.

BACKGROUND--Supernatants from epithelial cell cultures enhance eosinophil survival in vitro, this effect being abrogated by previous incubation of eosinophils with glucocorticosteroids. This property has resulted in the development of an in vitro test to compare the potency of these drugs. A comparative study was performed with dexamethasone, methylprednisolone, deflazacort, and budesonide. METHODS--Human epithelial cell conditioned media (HECM) was generated from cultured epithelial cells obtained from healthy nasal mucosa and polyps. Eosinophils isolated from the peripheral blood were incubated with different corticosteroids for one hour before the addition of HECM. The inhibitory potency of the four steroids on the eosinophil survival index was compared using the concentration of steroid causing 50% inhibition (IC50). RESULTS--Eosinophil survival was increased by HECM from both healthy nasal mucosa and polyps. All four steroids blocked HECM-induced eosinophil survival in a dose-dependent manner. On healthy nasal mucosa methylprednisolone was the least potent (IC50 = 536 nM), deflazacort (IC50 = 264 nM) was twice as potent as methylprednisolone, while budesonide and dexamethasone were approximately nine times as potent (both IC50 = 58 nM). When potency was evaluated on the promoting effects of the HECM obtained from nasal polyps, the inhibitory potencies were lower and consequently the IC50 values were higher when compared with HECM generated from healthy nasal mucosa: methylprednisolone (IC50 = 546 nM), deflazacort (IC50 = 390 nM), dexamethasone (IC50 = 76 nM), and budesonide (IC50 = 78 nM). CONCLUSIONS--The potencies of glucocorticosteroids can be compared by evaluating their effects on the survival of eosinophils previously primed by supernatants obtained from epithelial cell culture. The different effects of steroids on eosinophils primed by HECM obtained from healthy nasal mucosa compared with HECM obtained from nasal polyps suggest that polyps might represent more active tissue which is relatively resistant to treatment with corticosteroids.     

Pregnancy and adolescence entail similar neuroanatomical adaptations: A comparative analysis of cerebral morphometric changes

Mapping the impact of pregnancy on the human brain is essential for understanding the neurobiology of maternal caregiving. Recently, we found that pregnancy leads to a long‐lasting reduction in cerebral gray matter volume. However, the morphometric features behind the volumetric reductions remain unexplored. Furthermore, the similarity between these reductions and those occurring during adolescence, another hormonally similar transitional period of life, still needs to be investigated. Here, we used surface‐based methods to analyze the longitudinal magnetic resonance imaging data of a group of 25 first‐time mothers (before and after pregnancy) and compare them to those of a group of 25 female adolescents (during 2 years of pubertal development). For both first‐time mothers and adolescent girls, a monthly rate of volumetric reductions of 0.09 mm³ was observed. In both cases, these reductions were accompanied by decreases in cortical thickness, surface area, local gyrification index, sulcal depth, and sulcal length, as well as increases in sulcal width. In fact, the changes associated with pregnancy did not differ from those that characterize the transition during adolescence in any of these measures. Our findings are consistent with the notion that the brain morphometric changes associated with pregnancy and adolescence reflect similar hormonally primed biological processes.     

Erratum to: Unresectable Hepatocellular Carcinoma: Radioembolization Versus Chemoembolization: A Systematic Review and Meta-analysis

CardioVascular and Interventional Radiology -     

Inflammatory Response of Rapid Onset Asthma Exacerbation

The association between onset of asthma exacerbations and inflammatory response has not been sufficiently studied.ObjectiveTo determine the inflammatory mechanisms of rapid onset (RO) asthma exacerbations.MethodWe designed a prospective, multicentre study that included 34 patients from accident and emergency departments who suffered from asthma exacerbations. They were distributed into three groups, depending on the asthma onset speed: fast (<24 h), intermediate (25–144 h) and slow (>145 h). Clinical data was collected from sputum, blood and urine samples when first treated and after 24h, so as to determine the inflammatory cell counts and soluble markers.ResultsThe asthmatics who suffered a RO exacerbation showed higher elastase [1.028 (1.140); 310 (364); 401 (390) ng/ml] (P<.05) and albumin [46.2 (4.3); 42 (3.4); 39.9 (4.8 g/l)] (P<.05) concentrations in the blood sample. Neutrophils, eosinophils (blood or sputum), eosinophil cationic protein (ECP) (blood), interleukin 8 (IL8) (blood) and leukotriene E4 (LTE4) (urine) were high in the three groups (P>.05). An association was shown between the onset of exacerbation and the severity of obstruction (FEV₁) (r=?0.360; P=.037), eosinophils in sputum (r=?0.399; P=.029), albumin (r=?0.442; P=.013), and IL8 in sputum (r=0.357; P=.038).ConclusionsThe results suggest early activation of neutrophilic and eosinophilic responses in asthma exacerbations. However, bronchial swelling may play an important role in the initial inflammatory response in the exacerbations depending on the speed of the onset.     

Development of an enzyme-linked immunosorbent assay to identify host-feeding preferences of Phlebotomus species (Diptera: Psychodidae) in endemic foci of visceral leishmaniasis in Nepal

Anthroponotic visceral leishmaniasis, transmitted by Phlebotomus argentipes Annandale & Brunetti (Diptera: Psychodidae) sand flies, is regarded as a major problem of public health importance in the Indian subcontinent. Understanding the feeding behavior of the vector can be used to investigate changes in human-vector contact during intervention programs. An enzyme-linked immunosorbent assay (ELISA) was modified to make it suitable to identify the origin of P. argentipes and Phlebotomus papatasi Scopoli (Diptera: Psychodidae) blood meals. The sensitivity and specificity of the precipitin ring test and ELISA were compared, as well as the stability of the tests across different stages of blood meal digestion. The ELISA was more sensitive and specific than the precipitin test for identifying the sources of blood meals. When using the ELISA method with a plate reader, it was possible to obtain 100% sensitivity and specificity. When comparing the techniques across digestion stages, it was found that there was a drop in sensitivity, 48 and 72 h postblood meal for precipitin and visually read ELISA, respectively. However, the sensitivity of the ELISA using a plate reader was not altered by the digestion time. The feeding habits of P. argentipes and P. papatasi from the Terai region of Nepal, determined by the ELISA developed, showed P. papatasi to be highly anthropophilic, and P. argentipes appeared to feed both on humans and animals, in particular bovines.