Notes

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Severe asthma commonly affects 5-10% of the asthmatic population and accounts for approximately 50% of the overall asthma costs.

This analysis investigated how severe asthma is diagnosed, treated, and managed by specialists and general practitioners (GPs) in Switzerland.

Two surveys, one each among specialists (N = 44) and GPs (N = 153), were conducted to understand their self-perception on diagnosis, treatment, and management of severe asthma.

Fifty-five percent of the specialists felt very confident and 43% confident in recognizing the symptoms of severe asthma and diagnosing severe asthma. In contrast, 9% of the GPs were very confident and 59% confident in diagnosing severe asthma. More specific diagnostic tests for severe asthma, like total and specific immunoglobulin E levels and measurement of the fraction of exhaled nitric oxide, were run by specialists (χ2 = 171.4; df = 15, p < 0.001). GPs and specialists were using different measurements to assess severe asthma (χ2 = 385.2; df = 13, p < 0.001) and their prescribing patterns differed significantly (χ2 = 189.8; df = 10, p < 0.001). GPs referred patients with severe asthma if the diagnosis was unclear (24%), if treatment failure occurred (26%), and if the patients were at high risk (41%).

Oral corticosteroids (OCSs) are considered as background therapy for severe asthma by GPs and specialists. In order to reduce the OCS burden, there is a need to improve the awareness for other add-on therapies. A joint collaboration between GPs and specialists is the key to leverage therapeutic strategies together.
Oral corticosteroids (OCSs) are considered as background therapy for severe asthma by GPs and specialists. In order to reduce the OCS burden, there is a need to improve the awareness for other add-on therapies. A joint collaboration between GPs and specialists is the key to leverage therapeutic strategies together.
The Acoustic Voice Quality Index (AVQI) is a correlate of dysphonia. It has been found to differentiate between dysphonic and normophonic speakers and to indicate the effects of voice therapy. This study investigates how the AVQI reacts towards creak and strain, which are common in normophonic speakers.

The material was obtained from an earlier study on 104 Finnish female university students (mean age 24.3 years, SD 6.3 years) with no known pathology of voice or hearing and a perceptually normal voice (G = 0 in GRBAS), who were recorded while reading aloud a standard text and sustaining the vowel [a]. Perceptual analysis for the amount of creak and strain was carried out by 2 expert listeners. In this study, the AVQI v03.01 was analyzed and correlated with perceptual evaluations. Samples with low and high amounts of creak and strain were compared with t tests.

On average, the AVQI was below the threshold value of dysphonia in the Finnish population. The AVQI (ρ = 0.35, p = 0.000) and its subparameters, smoothed cepstral peak prominence (CPPS; ρ = -0.35, p = 0.000) and harmonics-to-noise ratio (HNR; ρ = -0.30, p = 0.002) showed low but significant correlations with creak. Strain had low but significant correlations with spectral Slope (ρ = 0.38, p = 0.000) and Tilt (ρ = -0.40, p = 0.009). The AVQI was lower (better) in samples that were evaluated as having a high amount of strain, but the difference was not significant. Only CPPS differentiated significantly between low and high amounts of creak.

The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.
The AVQI does not seem to differentiate between high and low amounts of creak and strain in normophonic speakers.
The objective of this study was to assess the predictive performance of preoperative cervical length (CL) for delivery within 1 week after pleuroamniotic shunting (PAS) in fetuses with severe hydrothorax.

A prospective cohort of fetuses with severe hydrothorax referred to our fetal surgery center in Querétaro, Mexico from January 2012 to July 2020. Severe fetal hydrothorax was diagnosed as an accumulation of fluid within the fetal pleural space accompanied with severe bilateral lung compression, mediastinal shift, polyhydramnios, and/or hydrops. Transvaginal CL was measured immediately before PAS, and a short cervix was defined as that <25 mm. The interval from fetal intervention to delivery, prevalence of preterm prelabor rupture of membranes (PPROMs), and associations with delivery within the first week after PAS according to a short or a normal CL, were evaluated.

Thirty-five pregnancies with severe fetal hydrothorax treated with PAS were evaluated. Median gestational age at PAS was (weeks + days) cervix before fetal intervention can predict delivery within 1 week after the surgical procedure.
The coronavirus disease 2019 (COVID-19) pandemic has drastically affected hospital and operating room (OR) workflow around the world as well as trainee education. Many institutions have instituted mandatory preoperative SARS-CoV-2 PCR nasopharyngeal swab (NS) testing in patients who are low risk for COVID-19 prior to elective cases. This method, however, is challenging as the sensitivity, specificity, and overall reliability of testing remains unclear.

The objective of this study was to assess the concordance of a negative NS in low risk preoperative patients with lower airway bronchoalveolar lavage (BAL) specimens obtained from the same patients.

We prospectively sent intraoperative lower airway BAL samples collected within 48 h of a negative mandatory preoperative NS for SARS-CoV-2 PCR testing. All adult patients undergoing a scheduled bronchoscopic procedure for any reason were enrolled, including elective and nonelective cases.

One-hundred eighty-nine patients were included. All BAL specimens were negative for SARS-CoV-2 indicative of 100% concordance between testing modalities.

These results are promising and suggest that preoperative nasopharyngeal SARS-CoV-2 testing provides adequate screening to rule out active COVID-19 infection prior to OR cases in a population characterized as low risk by negative symptom screening. This information can be used for both pre-procedural screening and when reintroducing trainees into the workforce.
These results are promising and suggest that preoperative nasopharyngeal SARS-CoV-2 testing provides adequate screening to rule out active COVID-19 infection prior to OR cases in a population characterized as low risk by negative symptom screening. selleckchem This information can be used for both pre-procedural screening and when reintroducing trainees into the workforce.
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