Background 15% of COVID-19 patients develop severe pneumonia. Non-invasive mechanical ventilation and high-flow nasal cannula can reduce the rate of endotracheal intubation in adult respiratory distress syndrome, although failure rate is high. Objective To describe the rate of endotracheal intubation, the effectiveness of treatment, complications and mortality in patients with severe respiratory failure due to COVID-19. Methods Prospective cohort study in a first-level hospital in Madrid. Patients with a positive polymerase chain reaction for SARS-CoV-2 and admitted to the Intermediate Respiratory Care Unit with tachypnea, use of accessory musculature or SpO2 <92% despite FiO2> 0.5 were included. Intubation rate, medical complications, and 28-day mortality were recorded. Statistical analysis through association studies, logistic and Cox regression models and survival analysis was performed. Results Seventy patients were included. 37.1% required endotracheal intubation, 58.6% suffered medical complications and 24.3% died. Prone positioning was independently associated with lower need for endotracheal intubation (OR 0.05; 95% CI 0.005 to 0.54, p = 0.001). The adjusted HR for death at 28 days in the group of patients requiring endotracheal intubation was 5.4 (95% CI 1.51 to 19.5; p = 0.009). Conclusions The rate of endotracheal intubation in patients with severe respiratory failure from COVID-19 was 37.1%. Complications and mortality were lower in patients in whom endotracheal intubation could be avoided. Prone positioning could reduce the need for endotracheal intubation.

Introduction The prevalence of bronchiectasis in the general population and in individuals undergoing lung cancer screening with low dose computed tomography (LDCT) is unknown. The aim of this study is to estimate the prevalence and impact of bronchiectasis in a screening lung cancer program. Methods 3028 individuals participating in an international multicenter lung cancer screening consortium (I-ELCAP) were selected from 2000 to 2012. Patients with bronchiectasis on baseline CT were identified and compared to selected controls. Detection of nodules, need for additional studies and incidence of cancer were analyzed over the follow-up period. Results The prevalence of bronchiectasis was 11.6%(354/3028). On the baseline LDCT, the number of subjects with nodules identified was 189(53.4%) in patients with bronchiectasis compared to 63(17.8%) in controls (p<0.001). The occurrence of false positives was higher in subjects with bronchiectasis (26%vs17%;p = 0.003). During follow-up, new nodules were more common among subjects with bronchiectasis (17%vs.12%; p = 0.008). The total number of false positives during follow-up was 29(17.06%) for patients with bronchiectasis vs. 88(12.17%) for controls (p = 0.008).The incidence rate of lung cancer during follow-up was 6.8/1000 and 5.1/1000 person-years for each group respectively (p = 0.62) Conclusions Bronchiectasis are common among current and former smokers undergoing lung cancer screening with LDCT. The presence of bronchiectasis is associated with greater incidence

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terine carcinosarcomas are uncommon malignant tumors, characterized histologically by the presence of both malignant glandular and sarcomatous components.1 They are also called malignant mixed müllerian tumors and usually appear in postmenopausal women.1 Most of them have a highly aggressive behavior, and their prognosis used to be very poor, even in stage I.2,3 Traditionally, these tumors have been considered a subtype of uterine sarcoma; however, recent data have shown that most carcinosarcomas have a monoclonal origin. 4Specific preoperative diagnosis is often very difficult because, in most instances, an endometrial biopsy specimen can indicate either carcinoma or sarcoma. 2 We report a case of uterine carcinosarcoma arising from an endometrial polyp in a postmenopausal woman evaluated by 3-dimensional (3D) power Doppler angiography and positron emission tomography/computed tomography (PET/CT). Case ReportA 60-year-old multiparous postmenopausal woman was admitted to the Department of Gynecology at the Caracas University Hospital with postmenopausal bleeding and uterine prolapse. Her medical history was unremarkable. Uterine prolapse was confirmed at physical examination. Transvaginal sonography was performed and showed a heterogeneous 24-mm-thick endometrial stripe. The cervix was apparently normal, and the myometrialendometrial interface was well defined (Figure 1). Threedimensional power Doppler angiography was performed subsequently and showed a highly vascularized lesion with a main feeding vessel arising from the uterine fundus with an abnormal branching pattern, aneurysmatic dilatations, and distribution of vessels inside the uterine lesion (Figure 2). A polypoid malignant lesion with no myometrial invasion was suspected.

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