Lung ultrasound : an economic solution to estimate the severity of SARS-COV2 pneumonia

Lung ultrasound: an economic solution to estimate the severity of SARS-COV2 pneumonia Introduction: Healthcare spendings increased worldwide since the beginning of the SARS-COV2 pandemic. Compared to CT scan generally performed to evaluate the severity of SARS-COV 2 pneumonia, lung ultrasound costs less. Aim(s): The aim of this study is to determine whether lung ultrasound can replace CT scan in evaluating the severity of SARS-COV 2 pneumonia. Method(s): Fifty five patients with positive RT-PCR were included. CT scan and lung ultrasound were realized on admission day. We compared the CT Scan severity score to the lung ultrasound score. Result(s): The studied group had 35 male and 20 female. Twenty five percent of the patients were active smokers. The most common comorbidities were hypertension, diabetes and dyslipidemia. According to the lung ultrasound score, the patients had a mild to moderate, severe and critical pneumonia in 43,6%, 36,4 % and 9,1% of the cases respectivally. Lung ultrasound score cut-of was 14 and 24. There was a significant correlation between the extent of SARS-COV2 parenchymal lesions evaluated by CT scan and lung ultrasound score. (R=0,318, p = 0,018). Conclusion(s): Lung ultrasound is a reliable and economic alternative to CT scan in the initial assessment of SARSCOV 2 severity.

COVID-19 patients : predictive factors for home therapy oxygen

Bakground COVID-19 patients mostly experience a favorable evolution of the disease. However patients without acute respiratory distress syndrome (ARDS) but in need of long term oxygen therapy have received much less attention. Aim(s): To determine the predictive factors of home therapy oxygen after hospital discharge for COVID19 pneumonia. Method(s): We conducted a retrospective study including with laboratory-confirmed COVID-19 infection hospitalized in the pulmonology department of the military hospital of Tunisia. We divided our patients into two groups : the first group (16 patients, 7%) requiring long term oxygen therapy (G1), the second group discharged without oxygen (G2). Result(s): A total of 245 patients were enrolled in the study. The median age was 61 years old. The majority of the population were male (77%). Home therapy oxygen needs were not correlated with the scanner degree impairment upon admission as well as the duration and posology of corticotherapy during hospitalization. It was significatively associated with an increased hospital stay (r=0,314;p=<0,001). Predictive home oxygen therapy factors were patients with extensive fibrotic-like changes on lung CT scan upon admission (r=0.223;p=0.04), heightened procalcitonin (PCT) level (p=0.009). No correlation was found with, intensive care transfer or other biomarkers levels. Independent predictive factors of long term oxygen therapy prescription were increased hospital stay (ORa = 1.092 [1.026-1.164], p = 0.006) and pulmonary fibrosis on lung CT scan upon admission (ORa = 17.405 [2.353-128.721], p = 0.005). Conclusion(s): Increased hospital stay and extensive fibrotic-like on lung CT scan initial should be used to identify patients in need for adjunctive therapy.

Prognostic value of Platelet-to-lymphocyte ratio in hospitalized patients with COVID-19 pneumonia

Platelet-to-lymphocyte ratio (PLR) is a simple biomarker of inflammation that can be measured from a routinely blood count. Various studies showed that PLR had a prognostic value in various conditions such us sepsis, acute pulmonary embolism and malignant tumors. We aimed to determine the prognostic value of the platelet-to-lymphocyte ratio (PLR) in moderate to severe COVID patients. We conducted a retrospective study including 245 patients with COVID-19 pneumonia hospitalized in the pulmonology department of the military hospital of Tunis between September 2020 and December 2021. The optimal cut-off value, sensitivity and specificity of PLR were determined by analysis of receiver operating characteristic (ROC) curve. The population was majority male (72,7 %) with a mean age of 63 +/- 13 years old. Obesity was the most common comorbidity (50%) followed by hypertension (39,6%) and diabetes (39, 2%). The common clinical manifestations were shortness of breath (79,2%), cough (72,4%) and fever (60,8%). The high PLR group had more severe form of the disease on admission (p=0,03). There were no association between PLR and mean hospital stay(p=0,2). Patients with high PLR had more complications (p=0,04), more intensive care unit referrals (p=0,04) and a higher incidence of mortality (p=0,02). A significant correlation between PLR and mortality was observed when a cut-off of 403 was considered as a differentiating benchmark with a sensitivity of 70% and a specificity of 84%, an area under the curve equal to 0.768 and p=0.009. In conclusion, PLR could be a valuable biomarker to predict disease progression in patients with moderate to severe COVID-19.

Contribution of muscular retraining in a post-COVID-19 exercise rehabilitation program

Introduction: After COVID-19 pneumonia, nearly two-thirds of patients have residual dyspnea and muscle deconditioning. This symptomatology is the main indication for exercise rehabilitation in these patients. Aim(s): To assess the impact of a post-COVID-19 muscle retraining program on the functional and clinical status. Method(s): Prospective study, including 17 patients declared cured of a Covid-19 infection, but who kept at least 1 month after the acute episode a state of tiredness and dyspnea affecting their daily quality of life. A functional and a muscular assessment (spirometry, six-minute walk test, measurement of thoracic amplification, muscle testing and impedancemetry) were carried out before and after the respiratory rehabilitation protocol. Result(s): We noted a reduction in the frequency of the pulmonary restriction from 49% to 19% and of the aireway obstruction from 10% to 7% (p=0.003). Six-minute walking distance increased from 260+/-70 meters to 360+/-120 meters (p=0.002). The mean Borg score decreased from 2.8 +/- 1.4 to 8.8 +/- 1.2 (p = 0.001) and the mean mMRC stage decreased from 2.8 to 1.9 (p = 0.001). We noted an increase in muscle mass (22% vs 33%;p = 0.04) and thoracic expansion (4.64 vs 6.12 cm;p = 0.001). Muscle testing revealed a significant improvement in strength (p=0.002) and movement (p=0.01) of upper and lower limb muscles. Conclusion : These results confirm the interest of muscle retraining as an essential therapeutic means for patients suffering from residual dyspnea post-Covid-19. this even in the absence of anterior respiratory pathology.