Given the high incidence of confirmed infection by SARS-CoV-2 and mortality by COVID-19 in the Spanish population, its impact was analysed among persons with Cystic Fibrosis (CF) as a group at risk ...of a worse evolution. The possible causes of the incidence observed in them are explained and how CF Units have faced this health challenge is detailed.
Retrospective descriptive observational study, for which a Spanish CF Patients with Confirmed COVID-19 Registry is created, requesting information on number of people affected between 8 March–16 May 2020 and their clinical-demographic characteristics from the CF Units participating in the European Cystic Fibrosis Society Patient Registry (ECFSPR). The accumulated incidence is calculated, compared with that of the general population. Additionally, a survey (CF-COVID19-Spain) is carried out on prevention of SARS-CoV-2 infection, workings of CF Units and possible reasons for the incidence observed.
COVID-19 was diagnosed in eight CF patients, one of whom had received a lung transplant. The accumulated incidence was 32/10000 in CF patients and 49/10000 in the general population. General death rate was 5.85/10000 while no CF patients included in the ECFSPR died. The characteristics of those affected and the results of the survey are described.
Despite being considered a disease at high risk of severe COVID-19, the low incidence and mortality in CF patients in Spain contrasts with the figures for the general population. The possible factors that would explain such findings are discussed, with the help of the results of the CF-COVID19-Spain survey.
•SARS-CoV-2 pandemic is severely hitting Spain.•Cumulative incidence among Spanish CF patients is being lower than expected.•No fatal cases were reported in our CF patients with COVID-19 included in ECFSPR.•CF-COVID19-Spain survey was useful to explain its low incidence and mild course.
Oxygen therapy has become a major tool for infants with acute and chronic respiratory failure. Appropriate goals when prescribing supplemental oxygen are reduction and prevention of hypoxemia, ...prevention and treatment of pulmonary hypertension and decrease in respiratory and cardiac overload. This is commonplace in the acute setting and is also becoming widespread in chronic pathologies. However, there is a lack of consensus on many fundamental issues, such as appropriate indications, desirable targets and outcome measures amongst centres, reflecting a variety of clinical practices. The Techniques Group of the Spanish Society of Pediatric Pneumology undertook to design recommendations for a rational approach to oxygen therapy, reviewing the existing literature in order to establish its indications, benefits and potential risks as well as its cost-effectivenes. General aspects of oxygen treatment are reviewed including physiological mechanisms, indications, delivery systems and assessment methods. Management of patients on home oxygen therapy is also addressed with discussion of benefits and potential risks of supplemental oxygen use.
La oxigenoterapia es una herramienta fundamental para el tratamiento de la insuficiencia respiratoria, tanto aguda como crónica. Los objetivos principales que llevan a su empleo son tratar o prevenir ...la hipoxemia, tratar la hipertensión pulmonar y reducir el trabajo respiratorio y miocárdico. En situaciones agudas, su utilidad está ampliamente aceptada y en situaciones crónicas se ha extendido de forma importante. Sin embargo, sigue sin haber consenso en puntos fundamentales y son pocos los aspectos en los que la actuación entre los diferentes centros esté estandarizada.
El Grupo de Trabajo de Técnicas de la Sociedad Española de Neumología Pediátrica acordó elaborar unas recomendaciones avaladas por esta Sociedad sobre el empleo de este tratamiento, e incorporó las diferentes formas de actuación recogidas en revisiones recientes para intentar establecer sus indicaciones, disminuir los efectos colaterales y procurar una correcta adecuación del gasto económico. Se han incluido aspectos generales del tratamiento con oxígeno, como los mecanismos fisiológicos, las indicaciones para su empleo, tanto en situaciones agudas como crónicas, y los medios disponibles para su correcta administración. Se aborda asimismo el tratamiento del paciente con oxigenoterapia en domicilio y las situaciones especiales que pueden producirse.
Oxygen therapy has become a major tool for infants with acute and chronic respiratory failure. Appropriate goals when prescribing supplemental oxygen are reduction and prevention of hypoxemia, prevention and treatment of pulmonary hypertension and decrease in respiratory and cardiac overload. This is commonplace in the acute setting and is also becoming widespread in chronic pathologies. However, there is a lack of consensus on many fundamental issues, such as appropriate indications, desirable targets and outcome measures amongst centres, reflecting a variety of clinical practices.
The Techniques Group of the Spanish Society of Pediatric Pneumology undertook to design recommendations for a rational approach to oxygen therapy, reviewing the existing literature in order to establish its indications, benefits and potential risks as well as its cost-effectivenes. General aspects of oxygen treatment are reviewed including physiological mechanisms, indications, delivery systems and assessment methods. Management of patients on home oxygen therapy is also addressed with discussion of benefits and potential risks of supplemental oxygen use.
Latinos are less likely to seek health care for eating disorders and more likely to drop out of treatment than members of other ethnic groups, highlighting existing challenges to engagement in ...traditional mental health care. This study explored the role of family in the treatment of adult Latinas with eating disorders through content analysis of family sessions adjunctive to cognitive behavioral therapy. This study yielded insight into the experiences of 10 Latinas with eating disorders (M age = 39.90 years) and 10 relatives (M age = 39.50) from the Promoviendo una Alimentación Saludable trial who were randomly selected to receive six family enhancement sessions. Data from 53 sessions were analyzed using a qualitative content analysis approach. Family intervention might serve as a valuable adjunct to conventional treatment by positively influencing social, family, and emotional support for Latinas with eating disorders.
NKX2 homeobox family proteins have a role in cancer development. Here we show that NKX2-3 is overexpressed in tumour cells from a subset of patients with marginal-zone lymphomas, but not with other ...B-cell malignancies. While Nkx2-3-deficient mice exhibit the absence of marginal-zone B cells, transgenic mice with expression of NKX2-3 in B cells show marginal-zone expansion that leads to the development of tumours, faithfully recapitulating the principal clinical and biological features of human marginal-zone lymphomas. NKX2-3 induces B-cell receptor signalling by phosphorylating Lyn/Syk kinases, which in turn activate multiple integrins (LFA-1, VLA-4), adhesion molecules (ICAM-1, MadCAM-1) and the chemokine receptor CXCR4. These molecules enhance migration, polarization and homing of B cells to splenic and extranodal tissues, eventually driving malignant transformation through triggering NF-κB and PI3K-AKT pathways. This study implicates oncogenic NKX2-3 in lymphomagenesis, and provides a valid experimental mouse model for studying the biology and therapy of human marginal-zone B-cell lymphomas.
► The consistency of quasi-induced exposure methods to assess the risk of involvement in a crash remains uncertain. We tried to shed light on this issue by comparing this approach with a method based ...on direct estimation of exposure (in driver-km) to estimate the effect of driver's age and sex on the risk of involvement in a road crash. ► Both direct measurement of exposure and the quasi-exposure method detected an association of high risk of involvement in a crash with younger age (compared to middle-aged drivers) and with the young male driver subgroup (compared to same-aged women). ► However, excess risk in the youngest drivers was much more pronounced in direct estimates of exposure than in estimates obtained with the quasi-induced method. Furthermore, direct estimation showed an excess risk for middle-aged female drivers (compared to male drivers) that was not observed with the quasi-induced exposure method. These differences between the two methods merit additional study.
This study was designed to compare two methods (direct measurement of exposure and quasi-induced exposure) for assessing the effect of age and sex on the risk of being involved in a car crash in Spain.
Spanish crash rates (per 10,000,000 driver-km) for age and sex groups of drivers aged 18–64 years old were obtained for 2004–2007, using information from the Spanish General Traffic Office (census of reported car crashes) and the Spanish Household Survey on Alcohol and Drugs (estimate of the mean km driven for each car driver). The rate ratios estimated by direct exposure estimates were compared to those obtained with the quasi-induced exposure method, which compares the age and sex of responsible and non-responsible drivers involved in the same clean collision (in which only one of the drivers committed a driving infraction).
Both methods detected an increased risk of involvement in a crash for the youngest (18–20 years) and the oldest drivers (60–64 years), compared to middle-aged drivers (45–49 years). However, the rate ratios obtained with the quasi-induced method for the youngest group (2.0 for men, 1.6 for women) were much lower than those obtained with crash rates (13.4 for men, 5.7 for women). Both methods detected a similar increase in the risk of involvement of male drivers compared to women in the youngest age group. This excess risk for men was maintained with increasing age up to 45–49 years when the quasi-induced method was used. However, direct comparisons of crash rates revealed an increased risk of involvement in women compared to men of the same age from 25–29 years onward.
Both direct measurement of driving exposure and the quasi-induced exposure method detected some well-known patterns of risk associated with driver's age and sex. However, factors that could explain important differences between the two methods deserve attention, especially those related with the excess risk for the youngest drivers as well as sex-related risk.
The HAWC Collaboration released the 2HWC catalogue of TeV sources, in which 19 show no association with any known high-energy (HE; E ≳ 10 GeV) or very-high-energy (VHE; E ≳ 300 GeV) sources. This ...catalogue motivated follow-up studies by both the Major Atmospheric Gamma-ray Imaging Cherenkov (MAGIC) and Fermi-LAT (Large Area Telescope) observatories with the aim of investigating gamma-ray emission over a broad energy band. In this paper, we report the results from the first joint work between High Altitude Water Cherenkov (HAWC), MAGIC, and Fermi-LAT on three unassociated HAWC sources: 2HWC J2006+341, 2HWC J1907+084*, and 2HWC J1852+013*. Although no significant detection was found in the HE and VHE regimes, this investigation shows that a minimum 1° extension (at 95 per cent confidence level) and harder spectrum in the GeV than the one extrapolated from HAWC results are required in the case of 2HWC J1852+013*, whilst a simply minimum extension of 0.16° (at 95 per cent confidence level) can already explain the scenario proposed by HAWC for the remaining sources. Moreover, the hypothesis that these sources are pulsar wind nebulae is also investigated in detail.
Introduction
The association between viral infections and pulmonary exacerbations in children with cystic fibrosis (cwCF) is well established. However, the question of whether cwCF are at a higher ...risk of COVID‐19 or its adverse consequences remains controversial.
Methods
We conducted an observational, multicenter, cross‐sectional study of cwCF infected by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) between March 2020 and June 2022, (first to sixth COVID‐19 pandemic waves) in Spain. The study aimed to describe patients' basal characteristics, SARS‐CoV‐2 clinical manifestations and outcomes, and whether there were differences across the pandemic waves.
Results
During study time, 351 SARS‐CoV2 infections were reported among 341 cwCF. Median age was 8.5 years (range 0–17) and 51% were female. Cases were unevenly distributed across the pandemic, with most cases (82%) clustered between November 2021 and June 2022 (sixth wave, also known as Omicron Wave due to the higher prevalence of this strain in that period in Spain). Most cwCF were asymptomatic (24.8%) or presented with mild Covid‐19 symptoms (72.9%). Among symptomatic, most prevalent symptoms were fever (62%) and increased cough (53%). Infection occurring along the sixth wave was the only independent risk factor for being symptomatic. Just eight cwCF needed hospital admission. No multisystem inflammatory syndrome, persisting symptoms, long‐term sequelae, or deaths were reported.
Conclusions
Spanish current data indicate that cwCF do not experience higher risks of SARS‐CoV‐2 infection nor worse health outcomes or sequelae. Changes in patients' basal characteristics, clinical courses, and outcomes were detected across waves. While the pandemic continues, a worldwide monitoring of COVID‐19 in pediatric CF patients is needed.
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