Cuerpo extraño endobronquial. Cuando la broncoscopia no siempre es la solución / Endobronchial foreign body. When bronchoscopy is not always the answer

La aspiración de cuerpos extraños es una entidad poco común en el adulto. El diagnóstico se basa en la sospecha clínica y la realización de pruebas de imagen, siendo la revisión endoscópica de la vía aérea la que permite el diagnóstico definitivo, así como la extracción del cuerpo extraño. Esto es importante por las posibles complicaciones derivadas de ello, entre las que se incluyen la muerte del paciente. Presentamos el caso de un paciente joven con aspiración de una chincheta que desarrolla una neumonía obstructiva con empiema y que finaliza en cirugía con decorticación pleural.(AU)

Foreign body aspiration is an uncommon entity in adults. Diagnosis is based on clinical suspicion and imaging tests, with endoscopic examination of the airway, allowing definitive diagnosis and removal of the foreign body. This is important because of the potential complications, including death of the patient. We present the case of a young man with aspiration of a drawing pin who developed obstructive pneumonia with empyema and ended up in surgery with pleural decortication.(AU)

Immunity After Vaccination Against SARS-CoV-2 in Lung Transplant?

BACKGROUND: SARS-CoV2 infection causes high morbidity and mortality in lung transplant (LT) recipients. Vaccination with messenger RNA vaccines has been shown to play a key role in controlling the severity of infection in the general population. The aim of our study is to analyze whether vaccination with 2 doses of SARS-Cov2 provides immunity in LT recipients. METHODS: Retrospective descriptive and analytical study of LT recipients vaccinated with 2 doses of SARS-CoV2. We analyzed the vaccine received, if they had COVID-19, antibody levels (antispike and antinucleoprotein), anticalcineurin levels, infections in the last year, and presence of neoplasias. RESULTS: The most commonly administered vaccine was from Moderna, with 27% of patients showing immunity with a median antibody levels of 4.81 binding antibody units/mL, far from the values considered protective (> 34 binding antibody units/mL). Thirteen patients were infected with SARS-CoV2, 7 post vaccination (5 of them were antispike-positive). No relationship was demonstrated between generation of immunity and age and level of immunosuppression. CONCLUSIONS: Vaccination against SARS-CoV2 in LT recipients generates limited and ineffective immunity with only 2 doses.

Intranasal epidermal growth factor treatment rescues neonatal brain injury.

There are no clinically relevant treatments available that improve function in the growing population of very preterm infants (less than 32 weeks' gestation) with neonatal brain injury. Diffuse white matter injury (DWMI) is a common finding in these children and results in chronic neurodevelopmental impairments. As shown recently, failure in oligodendrocyte progenitor cell maturation contributes to DWMI. We demonstrated previously that the epidermal growth factor receptor (EGFR) has an important role in oligodendrocyte development. Here we examine whether enhanced EGFR signalling stimulates the endogenous response of EGFR-expressing progenitor cells during a critical period after brain injury, and promotes cellular and behavioural recovery in the developing brain. Using an established mouse model of very preterm brain injury, we demonstrate that selective overexpression of human EGFR in oligodendrocyte lineage cells or the administration of intranasal heparin-binding EGF immediately after injury decreases oligodendroglia death, enhances generation of new oligodendrocytes from progenitor cells and promotes functional recovery. Furthermore, these interventions diminish ultrastructural abnormalities and alleviate behavioural deficits on white-matter-specific paradigms. Inhibition of EGFR signalling with a molecularly targeted agent used for cancer therapy demonstrates that EGFR activation is an important contributor to oligodendrocyte regeneration and functional recovery after DWMI. Thus, our study provides direct evidence that targeting EGFR in oligodendrocyte progenitor cells at a specific time after injury is clinically feasible and potentially applicable to the treatment of premature children with white matter injury.