Pulmonary rehabilitation outcome in patients recovering from COVID-19 disease

In patients who have recovered from COVID-19, the functional impairment and prolonged symptoms of dyspnea, cough, weakness and fatigue can persist for a long period. The aim of this study was to evaluate functional capacity, respiratory muscle and hangrip strenght, pulmonary function tests and pulmonary rehabilitation outcome in patients recovering from COVID-19 disease. Study included patients recovering from COVID-19 diasese who attended standard in-person pulmonary rehabilitation program (PRP) five days a week, for three weeks. Patients were recruited during six months period, mainly treated on an outpatient basis for acute COVID-19 disease without previously recorded lung disease, and the reason for referral to PRP was dyspnea and exercise intolerance. Pulmonary function testing (spirometry, diffusing lung capacity for carbon monoxide, body pletysmography), maximum static inspiratory pressure (Pi max), maximum static expiratory pressure (Pe max), 6-minute walking test (6MWT) and handgrip musle strength were performed. There where 87 patients (40 male and 47 female), with mean age of 52,3 years. Average results of pulmonary function tests and Pe max prior to PRP showed no limitations, with reduced Pi max (73 cmH2O, 68%) and 6MWT distance (435m, 77%). There were statistically significant difference in 6MWT distance, Pi max and Pe max, hand grip muscle strength prior and after PRP (p<0.05). Patients in our study had exercise intolerance and decreased inspiratory muscle strength prior PRP with significant improvement after PRP. Our study shows that pulmonary rehabilitation is effective and important in patients recovering from COVID-19 disease.

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.

Overview of symptoms of ongoing symptomatic and post-COVID-19 patients who were reffered to pulmonary rehabilitation - First single-centre experience in croatia

Background: Coronavirus-2 pandemic has changed the functioning of health systems worldwide. It is not yet fully known which symptoms of the disease are most commonly presented in patients referred for pulmonary rehabilitation. Our aim was to investigate the profile ofpatients referred for pulmonary rehabilitation;what symptoms they had during the acute phase of the disease and what symptoms were still present at the start ofpulmonary rehabilitation. Subjects and methods: Study included ongoing symptomatic and post-COVID patients who attended standard, in person pulmonary rehabilitation program. Patients had COVID-19 disease at least four weeks before attending pulmonary rehabilitation. Patients completed questionnaires of self-reported somatic deficits during acute and post-COVID-19 stage as well as questionnaires regarding their psychological symptoms. Pulmonary function test, expiratory and inspiratory muscle strenght, hand grip strenght and six-minute walk test was performed prior and after pulmonary rehabilitation. Result(s): Study included 63 patients (32 male, 31 female), with mean age of 52.9 years. During acute COVID-19, majority of patients complained of fatigue, cough, dyspnea, myalgia and headache. More than 85% of patients reported pulmonary deficits during ongoing symptomatic and post-COVID-19 stage. Emotional distress and anxiety levels were significantly elevated in acute stage, while depression, anger and the need for help was not significantly elevated. All reported symptoms were significantly reduced in post-COVID-19 stage. There was statistically significant difference in six-minute walk distance, inspiratory and expiratory muscle strenght and hand grip strenght between first and final testing. Conclusion(s): Results of our study are similar with previous studies, the most common symptoms during acute phase were fatigue, cough and dyspnea and fatigue and respiratory problems during ongoing symptomatic and post-COVID stage. Emotional distress diminishes signifiacantly in post-COVID stage. Further larger studies are needed to clarify which acute disease symptoms are predominant in patients referred to pulmonary rehabilitation and cause prolongued discomfort. Copyright © Medicinska naklada - Zagreb, Croatia

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.

Risk factors and severity of functional impairment in long COVID: a single-center experience in Croatia

AIM: To determine the frequency of common symptoms in long COVID and their effect on the quality of life, and to determine the factors contributing to a more severe long COVID. METHODS: The study enrolled 266 patients who were either referred to long-COVID outpatient clinic or were inpatients undergoing rehabilitation. The data were collected between December 2020 and May 2021. We evaluated the symptoms experienced during acute and long COVID and comorbidities. Functional status was assessed with Post Covid Functional Status (PCFS). RESULTS: The final sample consisted of 261 patients. After acute COVID-19 period (>4 weeks), almost 80% of patients had impaired functional status. Only 21.5% reported no functional impairment (0 on PCFS scale). A higher PCFS score was associated with female sex (P<0.001) and oxygen therapy requirement during acute disease (P=0.001). However, it was not associated with having a pre-existing lung disease (P=0.749). Disease severity did not pose a risk for developing a more severe long COVID. CONCLUSION: Women were at greater risk for developing greater functional impairment in long COVID, although we have no explanation why. Malignant disease and hypertension also presented a risk factor for greater functional impairment. More studies are warranted to determine if patients with certain lung disease are more susceptible to long COVID.

Comorbidities and Syndemics in the COVID-19 Age: Challenges and Opportunities for Bringing Separated Branches of Medicine Closer to Each Other

The Corona Virus Disease 2019 (COVID-19) as a unique disaster has stressed the extreme importance of the three issues for medicine, society and humanity in general: comorbidity, pandemic and syndemic. There are many reasons why the study of comorbidities and syndemics of COVID-19 is of great importance for researchers, clinicians and health policy makers who are responsible for health care organization and funding in a bid to develop more effective and efficient prevention and treatment. Thinking about COVID-19 through a syndemics concept and taking biological, psychological, social and spiritual dimensions into account, physicians could be more effective in clinical practice and community-based interventions. The outcome of SARS-CoV-2 infection is determined by the virus-host interaction, with pathogenicity of SARS-CoV-2 being related to the presence of comorbid diseases. The risk for severe COVID-19 clinical manifestations and death increases with age of patients and comorbidity. General mechanisms of multi-system dysfunction and multi-organ damage reported in COVID-19 are probably related to ubiquitous expression of ACE2 in many tissues and its important role in the renin-angiotensin-aldosterone system (RAAS) functioning. Physicians all over the world should be aware of COVID-19 related comorbidities, multisystem disorders and syndemics, as well as treatment and preventive strategies. COVID-19 age is a right time to reconsider the state of science and practice in comorbidity medicine field from the both epistemological and treatment perspective. Comorbidities and multimorbidities are indifferent to medical specializations, so the integrative and complementary medicine is an imperative in the both education and practice. Shifting the paradigm from vertical and mono-morbid interventions to comorbidity, multimorbidity and multi-system disease approaches enhances effectiveness and efficiency of human resources utilization. The aim of this review is to summarize the theoretical concepts and clinical experience and research regarding comorbidity in general, and specifically related to the COVID-19 pandemic, syndemics and infodemic.