ABSTRACT
Introduction: Secondary organizing pneumonia (OP) has been reported in the clinical course of SARS-CoV2 pneumonia. Based on data from cryptogenic OP, it might be treated with corticosteroids (CS) but there is no recommendation regarding the best steroid regimen and whether extending the duration of steroids could provide a benefit for patients with secondary OP after COVID-19. Aims and objectives: Our main objective was to evaluate the impact of a prolonged CS therapy in patients with COVID-19 secondary OP. Method(s): Between March 2020 and March 2021, we included patients hospitalized for COVID-19 pneumonia and for whom OP was described on CT scan. We collected data regarding steroid regimens and clinical, functional and radiological outcomes after 4 months of follow-up. Result(s): Among the 129 included patients, 26.4% received no CS (during to the beginning of the first COVID-19 wave), 38.0% had CS <=10 days and 35.7% had >10 days. The median follow-up time was 129.5 [101.2-151] days. The duration of CS was not different in patients hospitalized in intensive care units compared to those treated in conventional units (22.2 versus 22.8 days;p=0.94). At the time of follow-up, patients who received >10 days of CS had no improvement on dyspnea (p=0.33) and no significant change on pulmonary fibrosis features (p=0.09) but had a significantly more impaired diffusing capacity of lung for carbon monoxide (mean value 61.8%, p <0.005). Conclusion(s): Based on this retrospective analysis of a real-world cohort, the use of a prolonged corticosteroid regimen >10 days does not appear to provide any benefit on clinical, functional and radiological outcomes in patients with COVID-19 secondary OP.
ABSTRACT
Since the beginning of the Covid-19 pandemic, there has been a wave of research into the interaction between the coronavirus and housing. This study examines the experience of adult sharers, using qualitative evidence from an online survey, during the early months of the pandemic. This contributes to the evidence about housing quality, particularly the adaptability and flexibility of the dwelling and wellbeing under the pressures of lockdown. Few homes were built to perform the multiple functions leisure and work, particularly London homes—which are the smallest in the country in terms of floor area per inhabitant. As office-based work shifted to the home in the early stages of lockdown, adult sharers faced a range of practical and spatial challenges. Those working from home had to reconsider (and sometimes reconfigure) their homes as workspaces, and negotiate the use of space with fellow residents. Many ‘solutions’ were deemed inadequate and lockdown conditions generated interpersonal tensions in many sharer households, but strengthened bonds in others. The pandemic changed sharers’ aspirations for their future housing. The findings are relevant for planning and housing policy, including standards for new-build residential units and the requirements for existing houses in multiple occupation (HMOs). POLICY RELEVANCE New evidence is provided on how homes were used under conditions of stress: both the pandemic and the consequent shift of homes into workplaces were unexpected shocks. The effect of these shocks was magnified for adult sharers. Their experience underlines the importance of designing quality homes whose size and spatial configuration permits flexible arrangements of furniture and uses. Planning policy and design approaches should reflect this need for flexible and varied uses. The evidence also suggests the need to review overall space standards (not just bedroom sizes) in HMOs. © 2022, Web Portal Ubiquity Press. All rights reserved.
ABSTRACT
Introduction : Les inhibiteurs de points de contrôle immunitaire ont révolutionné la prise en charge de nombreux cancers et ont permis d’obtenir une efficacité et une réponse durable pour certains patients. L’immunothérapie est associée à des effets secondaires en lien avec l'infiltration de cellules immunitaires dans les tissus normaux pouvant entraîner des réactions dysimmunitaires disproportionnées. Ces effets secondaires peuvent toucher n’importe quel organe dont le poumon, pouvant parfois engager le pronostic vital. Ils peuvent ressembler à des événements de nature infectieuse, dont la COVID-19. Observations : Nous rapportons le cas de 3 patients ayant présenté des toxicités pulmonaires sévères secondaires à l’immunothérapie entre mars et mai 2020 avec hypothèse initiale d’une pneumopathie à SARS-CoV-2. Après investigations approfondies, le diagnostic de toxicité pulmonaire à l’immunothérapie fut retenu, avec une évolution clinique et radiologique favorable suite à l’instauration d’une corticothérapie. Conclusion : La toxicité pulmonaire secondaire à l’immunothérapie reste un effet indésirable rare mais pouvant engager le pronostic vital. La démarche diagnostique impose d’éliminer plusieurs diagnostics différentiels. Le tableau clinique est réversible et l’évolution habituellement favorable après instauration d’une corticothérapie.
ABSTRACT
The French-language Respiratory Medicine Society (SPLF) proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: (1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea; (2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit; (3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome…). These proposals may evolve over time as more knowledge becomes available.
ABSTRACT
The French-language Respiratory Medicine Society proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: 1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea;2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit;3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome..). These proposals may evolve over time as more knowledge becomes available.
ABSTRACT
Résumé La Société de Pneumologie de Langue Française propose un guide pour le suivi respiratoire des patients ayant présenté une pneumonie à SARS-CoV-2 à partir des données connues des précédentes épidémies, des lésions aiguës constatées chez ces patients et d’opinions d’experts. Ce guide propose une conduite à tenir selon le type de patients : 1) patient pris en charge en ville pour une infection à SARS-CoV-2 possible ou prouvée adressé par son médecin traitant pour dyspnée persistante, 2) patient hospitalisé pour pneumonie à SARS-CoV-2 en unité conventionnelle, 3) patient hospitalisé pour pneumonie à SARS-CoV-2 ayant fait un séjour en réanimation. Le suivi ultérieur sera à adapter au bilan initial. Ce guide insiste sur le fait qu’il ne faut pas méconnaitre les autres causes de dyspnée (cardiaques, thromboemboliques, syndrome d’hyperventilation, …). Ces propositions pourront évoluer dans le temps au fil des connaissances sur le sujet. The French-language Respiratory Medicine Society proposes a guide for the follow-up of patients who have presented with SARS-CoV-2 pneumonia. The proposals are based on known data from previous epidemics, on acute lesions observed in SARS-CoV-2 patients and on expert opinion. This guide proposes a follow-up based on three categories of patients: 1) patients managed outside hospital for possible or proven SARS-CoV-2 infection, referred by their physician for persistent dyspnoea;2) patients hospitalized for SARS-CoV-2 pneumonia in a medical unit;3) patients hospitalized for SARS-CoV-2 pneumonia in an intensive care unit. The subsequent follow-up will have to be adapted to the initial assessment. This guide emphasises the possibility of others causes of dyspnoea (cardiac, thromboembolic, hyperventilation syndrome..). These proposals may evolve over time as more knowledge becomes available.