Background
Different skin manifestations of COVID‐19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the ...COVID‐19 pandemic.
Material and methods
A retrospective review of 22 children and adolescents with chilblain‐like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID‐19 in Madrid, Spain.
Results
All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D‐dimer results, but without systemic symptoms or other laboratory anomalies. SARS‐CoV‐2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow‐up, all cases showed spontaneous marked improvement or complete healing.
Conclusion
Acute chilblains were observed during COVID‐19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers ...for EM. One of them had a positive PCR for SARS‐CoV‐2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS‐CoV/SARS‐CoV‐2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID‐19, and the positivity for SARS‐CoV/SARS‐CoV‐2 spike protein by immunohistochemistry strongly suggest a link between EM‐like lesions and SARS‐CoV‐2.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background A video-assisted thoracoscopic approach to lobectomy varies among surgeons. Typically, 3 to 4 incisions are made. Our approach has evolved from a 3-port to a 2-port approach to a single 4- ...to 5-cm incision with no rib spreading. We report results with single-incision video-assisted thoracic major pulmonary resections during our first 2 years of experience. Methods In June 2010, we began performing video-assisted thoracoscopic lobectomies through a uniportal approach (no rib spreading). By July 12, 2012, 102 patients had undergone this single-incision approach. Results Of 102 attempted major resections, 97 were successfully completed with a single incision (operations in 3 patients were converted to open surgery and 2 patients needed 1 additional incision). Five uniportal pneumonectomies were not included in the study. We have analyzed early outcomes of successful uniportal lobectomies (92 patients studied). Right upper lobectomy was the most frequent resection (28 cases). Mean surgical time was 154.1 ± 46 minutes (range, 60–310 minutes), mean number of lymph nodes was 14.5 ± 7 (range, 5–38 nodes), and mean number of explored nodal stations was 4.6 ± 1.2 (range, 3–8 stations). The mean tumor size was 2.8 ± 1.5 cm (0–6.5 cm). The median duration of time a chest tube was in place was 2 days and the median length of hospital stay was 3 days. There were complications in 14 patients; no postoperative 30-day mortality was reported. Conclusions Single-incision video-assisted thoracoscopic anatomic resection is a feasible and safe procedure with good perioperative results, especially when performed by surgeons experienced with the double-port technique and anterior thoracotomy.
The video-assisted thoracoscopic surgery (VATS) approach to lobectomy for non-small cell lung cancer varies among hospitals. Although three to four incisions are usually made, the operation may be ...successfully carried out using only two incisions with similar results. We observed that for lower lobes the second incision could be eliminated in selected cases. We describe a case report of a 74-year-old female operated by a single-port approach for a lower-lobe VATS lobectomy.
Aim
This study analysed the association between a positive nitrite dipstick test and an invasive bacterial infection (IBI) in infants younger than 90 days of age with fever without source (FWS).
...Methods
We performed a secondary analysis of data from a prospective multicentre study of infants up to 90 days of age with FWS undergoing care in 19 paediatric EDs between October 2011 and September 2013. Invasive bacterial infection was defined as a positive blood or cerebrospinal fluid culture.
Results
The dipstick urinalysis was positive for nitrite or leucocyte esterase in 766 (22.5%) of the 3401 infants we studied, and 270 (35.2%) had a dipstick test that was just positive for nitrite. Overall, 107 were diagnosed with an IBI (3.1%). The IBI prevalence was 2.2% among patients with a normal urine dipstick, 4.4% if they had positive leucocyte esterase test results, 8.3% where the nitrite test was positive and 10.6% when both tests were positive. After multivariate analysis, a positive nitrite test remained an independent risk factor for IBI (odds ratio 2.7, 95% confidence interval 1.4‐4.9).
Conclusion
In infants under 90 days of age with FWS, a positive nitrite urine dipstick test was an independent risk factor for IBI.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most ...pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated patients may be needed. Surgical techniques and various regional anaesthesia techniques as well as indications, contraindications, criteria to conversion of sedation to general anaesthesia in non-intubated patients are reviewed and discussed.
Adult development throughout a lifetime implies a series of changes in systems, including cognitive and linguistic functioning. The aim of this article is to study the effect of foreign language ...training on linguistic processing, particularly the frequency of the tip-of-the-tongue (TOT) phenomenon and on other cognitive processes such as processing speed and working memory in adults aged 40 to 60 years. Sixty-six healthy Colombian teachers were enrolled in this study. They were then randomly divided into an experimental group (33 healthy adults who underwent a four-week training period) and a passive control group (33 healthy adults who did not undergo any training). All participants performed induction tasks for the TOT phenomenon, working memory and processing speed before and after the four weeks. Results showed more of an effect in the semantic access, phonological access and processing speed measures with a better performance in the experimental group than in the control group. In Colombia, this type of training is still new and little is known to date about programs to prevent cognitive impairments. The need to conduct more studies confirming or refuting these findings is discussed, thus raising awareness about the extent of this type of training to increase the linguistic and cognitive performance of adults.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
There is broad consensus on the health benefits that
neonatal screening has provided in Spain, since Professor
Mayor Zaragoza began his research project for the early
detection of phenylketonuria and ...other aminoacidopathies
in 1968, to date. In these decades there has been
a great evolution and development of Neonatal Screening
Programs (NSP) in Spain.
This paper presents the effect on the development of the
NSPs of the decentralization of Public Health responsibilities
in the Autonomous Communities, creating differences
among them by atomizing the decisions on the expansion
of the diseases to be screened. The availability of effective
detection and treatment methods was the justification, often
unique, for the inclusion of new diseases in an NSP. On
rare occasions, neonatal screening was assumed as a public
health program that should offer guarantees of effectiveness,
from information for informed consent to the correct
treatment and follow-up of detected cases.
This situation of enormous inequality in access to neonatal
screening has changed with the introduction of appropriate
legislation to guaranty the correct development
of NSP within the National Health System. Forums coordinated
by the Ministry of Health with the participation of
those responsible for public health from the Autonomous
Communities and scientific societies have been fundamental.
An example of the convergence of research and
science for the benefit of a basic Public Health program.
Existe un amplio consenso sobre los beneficios en salud
que ha aportado el cribado neonatal en España, desde
que el Profesor Mayor Zaragoza iniciara en 1968 su proyecto
de investigación para la detección precoz de la fenilcetonuria
y otras aminoacidopatías hasta la fecha. En estas
décadas se ha producido una gran evolución y desarrollo
de los Programas de Cribado Neonatal (PCN) en España.
En este trabajo se presenta el efecto de la descentralización
de las responsabilidades de Salud Pública en las
comunidades autónomas (CCAA) sobre el desarrollo de
los PCN, creando diferencias entre ellas al atomizarse las
decisiones sobre la ampliación de las enfermedades a cribar.
La disponibilidad de métodos de detección y tratamiento
eficaces era la justificación, muchas veces exclusiva,
para la inclusión de nuevas enfermedades en un PCN.
En raras ocasiones se asumía el cribado neonatal como un
programa de Salud Pública que debía ofrecer garantías de
efectividad, desde la información para el consentimiento
informado hasta el correcto tratamiento y seguimiento de
los casos detectados.
Esta situación de enorme desigualdad en el acceso al
cribado neonatal ha cambiado con la introducción de legislación
apropiada que garantiza el correcto desarrollo de
los PCN dentro del Sistema Nacional de Salud. Los foros
coordinados por el Ministerio de Sanidad, con la participación
de los responsables de Salud Pública de las CCAA
y las sociedades científicas, han sido fundamentales. Un
ejemplo de convergencia de la investigación y la ciencia
en beneficio de un programa básico de Salud Pública.
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