Covid-19 infection in patients with sarcoidosis: clinical course and outcome - single center experience

Aims: Knowing that patients with underlying chronic lung disease may have worse outcome after SARS CoV2 infection, our aim was to analyze if patients with sarcoidosis are at higher risk of developing severe or critical Covid 19 disease and if using immunosuppressive agents affected the clinical course. Method(s): We retrospectively collected data on patients diagnosed with sarcoidosis who are treated and controlled in our Clinic and who were tested positive for SARS CoV-2 from Jan 2020 until Jan 2022. Result(s): A total of 56 patients were included (33 females, 23 males), median age 54 years (30+/-78). 30 (54%) patients were without immunosuppressive therapy in the time of Covid 19 infection, 18 (32%) were treated with prednisone and 8 (14%) patients were treated with combination of prednisone and methotrexate. 2 (3%) patients had asymptomatic infection, 44 (79%) patients had mild form of disease, 6 (11%) patients had moderate disease, severe form of disease had 4 (7%) patients and none of our patients developed critical disease. The patients who developed critical Covid 19 disease had underlying medical conditions that are classified as risk factors for severe disease (cardiomyopathy, diabetes mellitus, arterial hypertension and obesity). The average FVC before Covid 19 infection was 97% (72+/-131%), average FEV1 was 91% (49+/-125%) and DLCO 87% (57+/-127%). The average FVC after Covid 19 was 93% (63+/-123%), FEV1 was 88% (43+/-123%) and average DLCO was 88% (56+/-133%). Conclusion(s): Our patients mostly developed mild form of Covid 19 disease and immunosuppressive therapy had no impact on course of Covid 19. There was no significant decrease in lung function tests after Covid-19 infection.

Mechanical ventilation for COVID19 - new patient cluster in risk for postintubation tracheal stenosis

Introduction: Postintubation tracheal stenosis (PITS) is a rare complication of mechanical ventilation (MV). Risk factors for PITS include prolonged MV, reintubation and poor endotracheal tube cuff management, all of which are common in severe COVID19 patients during pandemic surges. Aims and objectives: to describe the patient characteristics and outcomes of PITS after MV for COVID19. Method(s): we conducted a retrospective review of all patients referred to our tertiary teaching hospital for endoscopic PITS treatment after COVID19 during 2021. Result(s): 60% of the 15 referred patients were female with a mean age of 60.1 years. Median duration of MV was 11.5 (8.5 - 16) days. 13.3% of patients were reintubated and 26.7% required tracheostomy during their ICU stay. 86.7% presented with stridor after a median of 32 (16.5-60) days after extubation with a further delay of 14 (2-42) days until the diagnosis of PITS. 73.3% had simple PITS with a mean diameter of 5.73+/-1.53 mm. 12 patients were successfully treated endoscopically with serial dilatation and electrocautery. Restenosis after treatment was observed in 66.7% of patients after a median of 30 (22.5-35) days. 5 patients required surgery while 2 patients required further endoscopic dilatation after surgery. Interestingly, 13 of the 15 patients were referred from a single tertiary hospital, after treatment in the same ICU. Conclusion(s): We observed an increase in referrals for PITS treatment during the study period with a cluster of patients from a single ICU. The high restenosis rate emphasizes the importance of multidisciplinary management as well as the prevention of PITS with high quality ICU care during the COVID19 pandemic.

Weight gain in lung transplantation patients during the COVID-19 pandemic in Croatia

Background: To determine the effect of lockdown measures on lung transplant patients during the COVID-19 pandemic. Subjects and methods: We collected data from Croatian lung transplant patients before and after the lockdown and analyzed changes in weight, BMI, lung function and blood lipid status. Result(s): An average increase of 3.74 kg (+4.92%) body weight during the 4 month lockdown period was observed. Lung function values and blood lipid status remained stable. Conclusion(s): Such weight gain could have detrimental effects on the morbidity and mortality of lung transplant patients. Further follow up is needed to determine the long term impacts of this observation. Copyright © Medicinska naklada - Zagreb, Croatia.

Quality of life in adult and children with cystic fibrosis during the COVID-19 pandemic in Croatia

Objectives: The aim of this study is to examine the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on quality of life among cystic fibrosis (CF) patients in Croatia. Methods: The study was conducted on a sample of 30 adults patients older than 19 years (17/30 female) and 42 paediatric patients with cystic fibrosis, from preschool children to 18 years (25/42 female). The patients were recruited from our CF Centre. Patients answered 15 short questions regarding their subjective perception of quality of life during the second wave of the SARS-CoV-2 pandemic in Croatia. Results: None of the patients answered they were positive to SARS-CoV-2 during the second wave of the pandemic. Half of adult CF patients were concerned about the virus, but only one (3.3%) neglected a control visit to the doctor. 18/30 of adult were less active during the pandemic. 5/30 (16.7%) had more frequent exacerbations of the disease. Around one quarter (26.7%) lost weight, while half gained weight. Half of adult CF patients feel that their quality of life is significantly impaired during this pandemic. In paediatric patients, almost half of the questionnaires were answered by parents or guardians. In CF children (N = 42), about three quarters were concerned about the virus and one fifth neglected control. Three fifths of children were less active, and 2/42 had more frequent exacerbations. Weight loss was recorded in 5/42 (12%), and more than half gained weight. Half of paediatric patients have a poorer quality of life than before the pandemic. Conclusion: In our survey, we have shown both adults and children were less active and had more frequent CF exacerbations and a substantial number of them lost weight. To conclude, the overall quality of life in adults and children with cystic fibrosis was significantly impaired.

Regularity of check-ups at the cystic fibrosis centre in the time of COVID-19 pandemic

Objectives: At our Cystic Fibrosis Centre (CF Centre) for children and adults it is the policy to see patients at least quarterly/year and have at least 4 respiratory samples cultured. We analysed the adherence to this regime in pandemic and regular circumstances. Methods: We compared the number of check-up visits, hospitalisations and respiratory samples taken in the pre-pandemic 2019 and the pandemic year 2020. Descriptive statistics and t-test (paired two sample for means) were used. Results: The sample consists of 93 patients (40 males, 52 adults), age range 2–36 yrs, median age in 2020: 19,5 yrs. Our goal of at least 4 visits/yr was not achieved for 29/93 patients in 2019. vs. 43/93 in the pandemic year. Although some patients visited the CF Centre more frequently in the pandemic year (15/93), most of them came less often. From a total of 93 patients seen in 2019, 12 did not have a check-up in 2020. Altogether, during the COVID-19 pandemic 2020. year we noticed a convincing, statistically significant trend in declining routine check-ups, as well as hospital admissions among cystic fibrosis patients in relation to pre-pandemic 2019 year (M = 5,20 ± 3,19 vs. M = 3,87 ± 2,88;t = 4,77, p < 0.001). This phenomenon, of course, entails a reduced, also statistically significant, number of respiratory cultures performed in pandemic 2020 year (M = 4,88 ± 4,22 vs. M = 3,34 ± 3,20;t = 5,29, p < 0.001). Conclusion: We definitely observed a negative trend in follow-ups of CF patients in the pandemic year. In our case it could also be partially caused by two serious earthquakes in the Zagreb area. Avoiding hospital arrivals and dropping out of usual follow-up practice due to fear of COVID-19 contagion may be responsible for more frequent CF exacerbations and poorer outcome for our patients in the future. Whether the observed lower compliance rate during the pandemic 2020 year result in more significant threat to our patients than COVID-19 itself remains to be seen.