ERS International Congress 2022: highlights from the Thoracic Surgery and Lung Transplantation Assembly.

The thoracic surgery and lung transplantation assembly (Assembly 8) of the European Respiratory Society (ERS) is delighted to present the highlights from the 2022 ERS International Congress that took place in a hybrid version in Barcelona, Spain. We have selected the four main sessions that discussed recent advances across a wide range of topics including the effects of coronavirus disease 2019 on thoracic surgery and the challenges regarding lung transplantation in connective tissue diseases and common variable immunodeficiency. The sessions are summarised by early career members in close collaboration with the assembly faculty. We aim to provide the reader with an update and enhanced insight into the highlights of the conference in the fields of thoracic surgery and lung transplantation.

Has the pandemic changed the test quality of the pulmonary function test laboratory?

Introduction: Pulmonary function tests are used in the evaluation of the respiratory system. Maneuvers during spirometry can create aerosols and spread viruses such as SARS-CoV-2. Measures due to the pandemic can negatively affect both the number and the quality of the spirometry tests. There are no comparative studies on this subject. Materials and Methods: The tests conducted in the spirometry laboratory between November 2019 and November 2021 were evaluated. Result: Four hundred forty patients were included in the study. 50.5% of the patients were male and the mean age was 61.8 ± 16.5 years. The age, gender, height, and weight of the patients were similar. 75.2% (331) of the tests were evaluated as successful. The most common errors in tests were early termination (84.1%), uncooperative patients (29%), and poor effort (22.4%). The types of errors were not different between the two periods. The median number of tests performed for each patient was six. The total number of spirometry tests performed were 262 and 178 for 2019 and 2021 (p= 0.011), but test success remained unchanged over the years (p= 0.513). There was no significant difference between the three operators and the test success (p= 0.909), which was similar for both periods. However, the number of tests performed until the successful maneuver varied significantly (p= 0.009), and fewer maneuvers were required before the pandemic. Conclusions: According to this study, the measures taken during the pandemic did not affect the quality of spirometry, but they did lead to more tests being done up until the successful maneuver was performed.

Post-COVID syndrome: pulmonary complications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worlwide and caused a pandemic that is still ongoing. The virus can cause a disease named as COVID-19, which is composed of multi systemic manifestations with a pulmonary system predominance. As the time passes, we are dealing more and more with a wide variety of effects and complications of the disease in survivors as far as with concerns about the clinical outcome and the timeline of symptoms in different patients. Since the lungs are the most involved organs and the post-COVID prolonged and persistent effects are mainly related to the pulmonary system, it is crucial to define and predict the outcome and to determine the individuals that can progress to fibrosis and loss of function of lungs. This review summarizes the current literature regarding the pulmonary complications in post-COVID syndrome and the management of these conditions.

New challenges for management of COVID-19 patients: Analysis of MDCT based "Automated pneumonia analysis program".

PURPOSE: The aim of this study is to define the role of an "Automated Multi Detector Computed Tomography (MDCT) Pneumonia Analysis Program'' as an early outcome predictor for COVID-19 pneumonia in hospitalized patients. MATERIALS AND METHODS: A total of 96 patients who had RT-PCR proven COVID-19 pneumonia diagnosed by non-contrast enhanced chest MDCT and hospitalized were enrolled in this retrospective study. An automated CT pneumonia analysis program was used for each patient to see the extent of disease. Patients were divided into two clinical subgroups upon their clinical status as good and bad clinical course. Total opacity scores (TOS), intensive care unit (ICU) entry, and mortality rates were measured for each clinical subgroups and also laboratory values were used to compare each subgroup. RESULTS: Left lower lobe was the mostly effected side with a percentage of 78.12 % and followed up by right lower lobe with 73.95 %. TOS, ICU entry, and mortality rates were higher in bad clinical course subgroup. TOS values were also higher in patients older than 60 years and in patients with comorbidities including, Hypertension (HT), Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and malignancy. CONCLUSION: Automated MDCT analysis programs for pneumonia are fast and an objective way to define the disease extent in COVID-19 pneumonia and it is highly correlated with the disease severity and clinical outcome thus providing physicians with valuable knowledge from the time of diagnosis.

COVID-19 Treatment at a Glance.

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.

What We Learned about COVID-19 So Far? Notes from Underground.

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.

Covid-19: The Biggest Threat of the 21st Century: In Respectful Memory of the Warriors All Over the World.

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers.

Nowadays COVID underestimates the other suspects.

The whole world has been facing the pandemic of SARS-CoV-2 infection and every day we still find out new knowledge regarding the disease. COVID-19 which is the name given to the clinical syndrome related to this infection has been shown to own a wide diversity of clinical presentations which challenges the healthcare workers and makes difficult the diagnosis and management of patients. Pulmonary embolism is also an entity that accompanies this type of infection and sometimes it is difficult to differentiate between the two. Here we present a patient who was admitted inward with typical lesions on chest tomography for COVID-19, but that turned out to be a submassive pulmonary embolism case without any infection. This case is remarkable because it shows that patients suspected for COVID-19 should be carefully examined and that pulmonary embolism can per se mimick the parenchymal lesions caused by viral infections.

Unclear Issues Regarding COVID-19.

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.