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Recalde-Zamacona B, Tomás-Velázquez A, Campo A, Satrústegui-Alzugaray B, Fernández-Alonso M, Iñigo M, Rodríguez-Mateos M, Di Frisco M, Felgueroso C, Bertó J, Marín-Oto M, Alcaide AB, Zulueta JJ, Seijo L, Landecho MF. Chronic rhinosinusitis is associated with prolonged SARS-CoV-2 RNA shedding in upper respiratory tract samples: A case-control study. J Intern Med 2021; 289:921-925. [PMID: 33372300 DOI: 10.1111/joim.13237] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/15/2020] [Accepted: 12/21/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND SARS-CoV-2, the COVID-19 causative agent, has infected millions of people and killed over 1.6 million worldwide. A small percentage of cases persist with prolonged positive RT-PCR on nasopharyngeal swabs. The aim of this study was to determine risk factors for prolonged viral shedding amongst patient's basal clinical conditions. METHODS We have evaluated all 513 patients attended in our hospital between 1 March and 1 July. We have selected all 18 patients with prolonged viral shedding and compared them with 36 sex-matched randomly selected controls. Demographic, treatment and clinical data were systematically collected. RESULTS Global median duration of viral clearance was 25.5 days (n = 54; IQR, 22-39.3 days), 48.5 days in cases (IQR 38.7-54.9 days) and 23 days in controls (IQR 20.2-25.7), respectively. There were not observed differences in demographic, symptoms or treatment data between groups. Chronic rhinosinusitis and atopy were more common in patients with prolonged viral shedding (67%) compared with controls (11% and 25% respectively) (P < 0.001 and P = 0.003). The use of inhaled corticosteroids was also more frequent in case group (P = 0.007). Multivariate analysis indicated that CRS (odds ratio [OR], 18.78; 95% confidence interval [95%CI], 3.89-90.59; P < 0.001) was independently associated with prolonged SARS-CoV-2 RNA shedding in URT samples, after adjusting for initial PCR Ct values. CONCLUSION We found that chronic rhinosinusitis and atopy might be associated with increased risk of prolonged viral shedding. If confirmed in prospective trials, this finding might have clinical implications for quarantine duration due to increased risk of pandemic spread.
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Affiliation(s)
- B Recalde-Zamacona
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - A Tomás-Velázquez
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Dermatology Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - A Campo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | | | - M Fernández-Alonso
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Iñigo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Rodríguez-Mateos
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Microbiology and Infectious Diseases Division, Clinica, Pamplona, Spain
| | - M Di Frisco
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - C Felgueroso
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - J Bertó
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - M Marín-Oto
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - A B Alcaide
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - J J Zulueta
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - L Seijo
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Pulmonary Medicine Department, Clinica, Pamplona, Spain
| | - M F Landecho
- From the, Covid19 Department, Clinica, Pamplona, Spain.,Internal Medicine department, Clinica Universidad de Navarra, Pamplona, Spain
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Landecho MF, Yuste JR, Gándara E, Sunsundegui P, Quiroga J, Alcaide AB, García-Layana A. COVID-19 retinal microangiopathy as an in vivo biomarker of systemic vascular disease? J Intern Med 2021; 289:116-120. [PMID: 32729633 DOI: 10.1111/joim.13156] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Abstract
IMPORTANCE COVID-19 is caused by SARS-CoV-2, a betacoronavirus that uses the angiotensin-converting enzyme-related carboxypeptidase (ACE2) receptor to gain entry into cells. ACE2 receptor is widely expressed in multiple organs, including the retina, an extension of the central nervous system. The ACE2 receptor is involved in the diabetic and hypertensive retinopathy. Additionally, coronaviruses cause ocular infections in animals, including retinitis, and optic neuritis. OBJECTIVE To assess whether there is any retinal disease associated with COVID-19. DESIGN We have evaluated 27 asymptomatic subjects, with retinal fundoscopic, optical coherence tomography (OCT) and OCT angiography fourteen days after hospital discharge due to COVID-19 bilateral pneumonia. RESULTS Cotton wool exudates were evident in six out of 27 patients evaluated, a 22%. Cotton wool exudates are a marker vascular disease severity in other medical context, that is diabetes and hypertension, and are associated with increased risk for acute vascular events. Whether antiaggregation therapy may play a role on fundoscopic-selected patients with COVID-19 requires prospective trials.
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Affiliation(s)
- M F Landecho
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J R Yuste
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Microbiology and Infectious Diseases Division, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - E Gándara
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - P Sunsundegui
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - J Quiroga
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,CIBEREHD
| | - A B Alcaide
- From the, Covid19 Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain.,Pulmonary Medicine Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - A García-Layana
- Ophtalmology Department, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
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Abstract
Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.
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Affiliation(s)
- U Montes
- Pulmonary Medicine, Clinical University, University of Navarra, Avenida Pio XII 36, 31008 Pamplona, Spain
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Campo A, Frühbeck G, Zulueta JJ, Iriarte J, Seijo LM, Alcaide AB, Galdiz JB, Salvador J. Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients. Eur Respir J 2007; 30:223-31. [PMID: 17459895 DOI: 10.1183/09031936.00115006] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance to leptin has been consistently associated with obesity. Raised leptin levels have been reported in subjects with sleep apnoea or obesity-hypoventilation syndrome. The aim of the present study was to assess, by multivariate analysis, the possible association between respiratory centre impairment and levels of serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2)) underwent the following tests: sleep studies, respiratory function tests, baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute ventilation), fasting leptin levels, body composition and anthropometric measures. Subjects with airways obstruction on spirometry were excluded. Out of the 346 subjects undergoing testing, 245 were included in the current analysis. Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension, percentage body fat and minimal nocturnal saturation were predictors for baseline P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin levels were predictors for hypercapnic response in males, but not in females. Hyperleptinaemia is associated with a reduction in respiratory drive and hypercapnic response, irrespective of the amount of body fat. These data suggest the extension of leptin resistance to the respiratory centre.
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Affiliation(s)
- A Campo
- Pulmonary Medicine, Clinica Universitaria de Navarra, Avda. Pío XII, 36, 31008 Pamplona, Spain.
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