Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum and soft tissue emphysema as complication in patients with COVID-19, series of cases.

Spontaneous pneumomediastinum, pneumothorax, pneumoperitoneum, and soft tissue emphysema have been recently described in several sources as possible complications in patients with severe COVID-19 and lung damage. This clinical case is dedicated to demonstrarte the development of these lesions in 3 male patients with comorbid conditions. The putative pathophysiological mechanism of these complications is air leakage due to extensive diffuse alveolar damage followed by rupture of the alveoli. All presented patients had a favorable outcome of the disease without lethal cases, their laboratory data and clinical dynamics were described. It should be noted that such conditions are not rare complications of COVID-19, and are observed mainly in male patients with severe form of the disease and the presence of comorbid conditions. Such complications are associated with long hospitalization and a severe prognosis. In some cases, with a mild course of the disease and positive dynamics in a decrease of the percentage of pulmonary lesions, the outcome is favorable, not requiring additional invasive interventions.Copyright © 2022 Medical Visualization. All rights reserved.

Potential role of Pancreatic Stone Protein (PSP) as early marker of bacterial infection in COVID-19 patients

Background: Sepsis is a life-threatening condition that needs immediate diagnosis and treatment to maximize the chances of survival. Bacterial superinfection is a severe and frequent complication among COVID-19 patients and its diagnosis is challenging. Previous reports suggested that Pancreatic Stone Protein (PSP) may be a predictive biomarker for sepsis in critically ill patients. We report a case series of three COVID- 19 patients admitted to our intensive care unit (ICU) with risk of sepsis. Method(s): We daily monitored PSP, procalcitonin (PCT), and C-reactive protein (CRP) levels in three COVID- 19 patients admitted to our ICU. Microbiological sampling and antibiotic treatment were performed according to the ward organization and in case of clinical suspects for infection. Positive cultures and antibiotic treatment were retrieved from clinical charts and patients were followed from ICU admission up to a maximum of 20 days. Result(s): Patient 1 (male, 55 years-old, overweight, no other comorbidity) was admitted to the ICU in treatment with Ceftriaxone then interrupted on day 7. On day 2 he was intubated and piperacillin/tazobactam was started on day 12 for suspected hospital acquired pneumonia. PSP levels markedly increased on day 10 with no significant changes in CRP and PCT levels. On day 13 a positive bronchospirate for Klebsiella pneumoniae was found. Similarly, patient 2 (male, 70 years-old, mild emphysema and diabetes) was admitted to ICU without antibiotic and with a PSP level of 287 ng/ml. His conditions rapidly worsened in severe septic shock requiring intubation. CRP markedly raised 48-72 hours after PSP with only mild increase of PCT. Patient 3 (male, 78 years-old, no comorbidities) was admitted to ICU with high levels of PSP and piperacillin/tazobactam therapy was started. After 48-72 hours CRP levels increased with no significant changes of PCT. A positive bronchospirate for Ps. aeruginosa was collected on day 3. Conclusion(s): Our findings suggest a potential role of PSP as early biomarker of sepsis in critically ill COVID-19 patients. Daily PSP monitoring may anticipate an appropriate treatment of COVID-19 patients with a septic complication in comparison with the actual laboratory markers. Further studies are needed to confirm our hypothesis.

Clinical characteristics and risk factors of patients with COVID-19 developing barotrauma

Background: At our hospital, people with COVID-19 (coronavirus disease 2019) had a high rate of pulmonary barotrauma. Therefore, the current study looked at barotrauma in COVID-19 patients getting invasive and non-invasive positive pressure ventilation to assess its prevalence, clinical results, and features. Methodology: Our retrospective cohort study comprised of adult COVID-19 pneumonia patients who visited our tertiary care hospital between April 2020 and September 2021 and developed barotrauma. Result(s): Sixty-eight patients were included in this study. Subcutaneous emphysema was the most frequent type of barotrauma, reported at 67.6%;pneumomediastinum, reported at 61.8%;pneumothorax, reported at 47.1%. The most frequent device associated with barotrauma was CPAP (51.5%). Among the 68 patients, 27.9% were discharged without supplemental oxygen, while 4.4% were discharged on oxygen. 76.5% of the patients expired because of COVID pneumonia and its complications. In addition, 38.2% of the patients required invasive mechanical breathing, and 77.9% of the patients were admitted to the ICU. Conclusion(s): Barotrauma in COVID-19 can pose a serious risk factor leading to mortality. Also, using CPAP was linked to a higher risk of barotrauma.Copyright © 2021 Muslim OT et al.

Incidence of barotrauma in an intensive care unit: new data from COVID-19?

Introduction: During COVID-19 pandemic, the massive use of ventilatory support made its complications even more common. This study aimed to analyse the incidence of barotrauma in COVID-19 patients as well as its consequences. Method(s): Retrospective cohort study. All patients undergoing mechanical ventilation in an intensive care unit (ICU) during 2020- 2021 were included. The time of both noninvasive and invasive ventilation was considered together. Statistical analysis was performed using IBM SPSS Statistics 28.0. Result(s): A total of 967 patients were included, with 42 cases of barotrauma being reported (28 men and 14 women, median age 69 years [interval 22-94] and median APACHE 13). Out of those, 40 had severe COVID-19. Regarding patients with and without COVID-19, the incidence of barotrauma (episodes/1000 days of ventilation) was 0.64 and 9.22 (RR 14.86, p < 0.001) and the barotrauma rate (episodes/number of patients) was 0.4% and 8.5% (RR 21.25, p < 0.001), respectively. The most common type of barotrauma was subcutaneous emphysema (52.4%, CI 95% 37.3-67.5%), followed by pneumomediastinum (47.6%, CI 95% 32.5-62.7%) and pneumothorax (35.7%, IC 95% 21.2-50.2%). The median time to diagnosis was 11.5 days after initiation of ventilatory support [interval 1-67]. In the COVID-19 group, barotrauma was associated with longer ventilation (14.06 vs 7.91 days, p < 0.001), longer ICU stay (16.74 vs 8.17 days, p < 0.001) e higher mortality rates (45.0% vs 26.2%, RR 1.72, p 0.011). Conclusion(s): We found a higher susceptibility to developing barotrauma as a potential complication of COVID-19 patients undergoing mechanical ventilation. From those, subcutaneous emphysema and pneumomediastinum seem to be more prevalent than pneumothorax. Barotrauma seems to be associated with longer periods undergoing mechanical ventilation, longer ICU stays and higher hospital mortality rates.

Incidental tomographic findings in patients with a Confirmed Diagnosis of COVID-19: An Observational Study

Objective: Describe incidental tomographic in the sample, correlating them with risk factors for chest diseases and sociodemographic data. Method(s): This is a retrospective and observational study covering 162 patients admitted to the COVID sector of the HU/UFJF, from April 1, 2020, to July 7, 2021, with a confirmed laboratory diagnosis of COVID-19. The variables were described in absolute and relative frequencies. The comparison of the correlation between the outcome variable (the tomographic findings) for independent samples was performed using Pearson's chi-square test (without correction) or Fisher's test when relevant. Result(s): Of the 162 patients, 15.4% had a solitary pulmonary nodule;14.8% had multiple pulmonary nodules;1.8%, lung mass;3.1%, mediastinal mass, and 9.3% had mediastinal adenomegaly. Findings such as excavations, pleural effusion, emphysema, PTE, pneumothorax, chronic interstitial disease, cavitation, aneurysms, and significant atheromatosis, classified in this study in the "Other" category showed impressive results, with an overall prevalence of 81.5%. This study demonstrated that 34% of patients had two or more types of incidental CT findings and that 88.3% of patients had at least some type of incidental CT finding. Conclusion(s): The pandemic of SARS-CoV-2 infections has brought a series of challenges and lessons learned to healthcare teams around the world. The massive implementation of highly sensitive diagnostic methods, such as chest tomography, ends up bringing an additional challenge, which is to deal with incidental findings, making good clinical reasoning necessary to avoid unnecessary investigations and not leave without diagnosis and treatment of diseases in early and asymptomatic stages.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.

Synergistic effects of COVID-19 and Pseudomonas aeruginosa in chronic obstructive pulmonary disease: a polymicrobial perspective.

This article discusses the connection between the novel coronavirus disease 2019 (COVID-19) caused by the coronavirus-2 (SARS-CoV-2) and chronic obstructive pulmonary disease (COPD). COPD is a multifaceted respiratory illness that is typically observed in individuals with chronic exposure to chemical irritants or severe lung damage caused by various pathogens, including SARS-CoV-2 and Pseudomonas aeruginosa. The pathogenesis of COPD is complex, involving a variety of genotypes and phenotypic characteristics that result in severe co-infections and a poor prognosis if not properly managed. We focus on the role of SARS-CoV-2 infection in severe COPD exacerbations in connection to P.  aeruginosa infection, covering pathogenesis, diagnosis, and therapy. This review also includes a thorough structural overview of COPD and recent developments in understanding its complicated and chronic nature. While COVID-19 is clearly linked to emphysema and chronic bronchitis at different stages of the disease, our understanding of the precise interaction between microbial infections during COPD, particularly with SARS-CoV-2 in the lungs, remains inadequate. Therefore, it is crucial to understand the host-pathogen relationship from the clinician's perspective in order to effectively manage COPD. This article aims to provide a comprehensive overview of the subject matter to assist clinicians in their efforts to improve the treatment and management of COPD, especially in light of the COVID-19 pandemic.

Case report: Severe pneumonia and pneumomediastinum in a previously robust adolescent caused by Omicron BA.5.2.

The manifestation of severe pneumonia is only occasional, and pneumomediastinum is a condition that occurs rarely in Coronavirus disease 2019 (COVID-19) patients, especially in those patients who are infected with the Omicron variant. In addition, whether severe pneumonia or pneumomediastinum often occurs in patients in older age, in poor physical condition, or with underlying diseases remains to be ascertained. To date, severe pneumonia and pneumomediastinum due to Omicron infection had not been reported in a young patient with an excellent physical condition. In this study, we report such a case with the aforementioned manifestations in a robust adolescent infected with Omicron BA.5.2.

Incidence and outcomes following pulmonary barotrauma in COVID-19 ventilated and non-ventilated patients with acute respiratory failure: A retrospective study.

Background and Objectives: : Alveolar rupture following increased transalveolar pressure on positive pressure ventilation is associated with pulmonary barotrauma (PB). The spectrum varies from pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, retro-pneumoperitoneum and subcutaneous emphysema. We studied the incidence of PB and their clinical characteristics in patients with coronavirus disease 19 (COVID-19)-associated acute respiratory failure. Methods: Patients aged >18 years with COVID-19-associated acute respiratory distress syndrome were included in the study. We recorded demographics (age, gender, comorbidities), severity scores (APACHE II on admission, SOFA on the day of barotrauma), type of PB and outcomes at discharge from the hospital. Patient characteristics are descriptively reported. Survival analysis was done using Kaplan-Meier survival tests after classifying by various factors. Survival was compared using the log-rank test. Results: Thirty-five patients experienced PB. Eighty per cent of patients in this cohort were males with mean age of 55.89 years. The commonest comorbidities were diabetes mellitus and hypertension. Twelve spontaneously breathing patients developed barotrauma. Eight patients experienced sequential events. In all, 18 patients required insertion of pigtail catheters. The median survival time in patients was 37 days (95% CI: 25-49 days). The overall survival rate was 34.3%. Mean serum ferritin levels were six times upper limit of normal in deceased, reflecting the severity of lung involvement. Conclusion: A high incidence of PB was noted following severe acute respiratory syndrome coronavirus (SARS CoV-2) infection even in the non-ventilated patients, a consequence of SARS CoV-2 effects on the pulmonary parenchyma causing widespread lung injury.

Dermatomyositis with Specific Autoantibodies Appearing after Sars-Cov-2 Infection or Mrna Vaccination: Hints at a Shared Pathogenetic Mechanism

Background. Environmental factors such as infections and vaccines are known to trigger dermatomyositis (DM), and during the recent SARS-CoV-2 pandemic this has become even clearer. SARS-CoV-2 infection may share features with anti-MDA5 DM, such as rapidly progressive lung involvement, cutaneous lesions and cytokine release syndrome. A few case reports of DM following SARSCoV-2 vaccination have been published, suggesting the onset of an aberrant immune response leading to DM with specific autoantibody signatures and severe organ impairment. Methods. Clinical and laboratory data of the 2 case reports were obtained from electronic clinical charts in Humanitas Research Hospital (Rozzano, Milan, Italy). Autoantibody analysis was performed by protein-immunoprecipitation for anti-MDA5 and immunoblot for anti-Ro52 and TIF1gamma antibodies as per protocol. Results. Case report 1 is a 71-year-old woman who developed fever, cough, and anosmia, which resolved spontaneously in two weeks, but did not undergo a nasopharyngeal swab, while her relatives were diagnosed with SARS-CoV-2 infection. When symptoms improved, she developed arthralgia and skin lesions on her face, chest, and hands for which she started topical treatment, with negative SARSCoV-2 nasopharyngeal swab and positive serum test for IgG against SARS-CoV-2 spike protein. For the persistence of the skin rash and arthralgia, she was admitted to our Department in March 2021. Blood tests showed mild elevation of C reactive protein (2.1 mg/L -normal value NV<5), aspartate (84 UI/L) and alanine aminotransferase (133 UI/L -NV<35), ferritin (595 ng/ml -NV<306), troponin I (19 ng/L -NV<14), and BNP (251 pg/ml -NV<100) with normal complete blood cell count, creatine kinase, C3 and C4. IgG antibodies for SARS-CoV-2 spike protein were confirmed to be elevated (96 AU/ml -NV<15). Autoantibodies associated with connective tissue diseases were tested and only anti-MDA5 antibodies were positive at immunoprecipitation. A punch biopsy of a Gottron-like lesion on the left hand showed leukocytoclastic vasculitis. We observed reduced capillary density with neoangiogenesis and ectasic capillaries at the nailfold capillaroscopy. EKG and ecocardiography were normal, while cardiac magnetic resonance detected abnormalities in the parametric sequences, consistent with signs of previous myocarditis. A lung CT scan revealed pulmonary emphysema while respiratory function tests demonstrated reduced volumes (FVC 82%, FEV1 64%, inadequate compliance CO diffusion test). Based on the biochemical and clinical findings, a diagnosis of anti-MDA5-associated DM with skin and heart involvement was made and treatment with low-dose methylprednisolone (0.25 mg/kg daily) and azathioprine 100 mg was started, then switched to mycophenolate because not effective on skin lesions. Case report 2 is an 84-year-old woman with history of colon cancer (surgical treatment) and oral lichen treated with low doses steroids in the last 2 years. After the 2nd dose of SARS-CoV-2 mRNA vaccination, in March 2021 she developed skin rash with V-sign, Gottron's papules, periungueal ulcers, muscle weakness and fatigue, thus she performed a rheumatologic evaluation. Blood tests showed mild elevation of creatine kinase (484 UI/L, NV <167), CK-MB (9.6ng/ml, NV <3.4), BNP (215 pg/ml -NV<100) with normal values of complete blood cell count, C3 and C4. Anti-Ro52kDa and TIF1gamma were positive at immunoblot, thus we confirmed a diagnosis of DM. The clinical evaluation also showed active scleroderma pattern at nailfold capillaroscopy, normal echocardiography, bronchiectasia but not interstitial lung disease at lung CT, and normal respiratory function tests (FVC 99%, FEV1 99%, DLCO 63%, DLCO/VA 81%). A PET-CT scan was performed to exclude paraneoplastic DM, and treatment with steroids and mycophenolate was started. Conclusions. SARS-CoV-2 may induce mechanisms for escaping the innate immunity surveillance and causing autoimmune diseases, but more clinical and functional studies are needed to demonstrate this possible association.

Mediastinal Pigtail Catheterization for Treatment of Pneumomediastinum in a COVID-19 Patient: A Case Report

Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.

Pneumomediastinum (PM) as a complication of COVID-19 disease

Case report Introduction: PM is a rare, but potentially life-threatening complication during COVID 19 pandemic, being reported in patients affected by COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. Case details: We reported the clinical data of 4 cases affected by COVID-19 pneumonia complicated with PM. Chest CT scan showed multiple confluent areas of ground-glass opacities, crazy paving pattern, PM, cervical subcutaneous emphysema, and pneumothorax in one case. Management included pharmacological treatment, oxygen supplementation and no acute intervention recommended by cardiothoracic surgery. Case 1: 50-year- old male without past medical history, non-smoker, hypoxic on the day of admission. During the hospital stay, he continued to require increasing levels of oxygen and was subsequently flown to a tertiary care center for higher level of care. Case 2: 38-year- old male admitted with a 7-day history of fever, dyspnea and cought. He continues to be symptomatic with neurological manifestations (COVID19 Encephalopathy). Finally whose dyspnea regressed during hospitalization, he was discharged at his own request to come for control. Case 3: 73-year- old male with a history of hypertension, non-smoker, presented with complaints of shortness of breath for 1 week. He did not receive non invasive positive pressure ventilation. The pneumothorax and PM were managed conservatively. Case 4: 53-year- old lady with no significant past medical history, presented with fever and cough for 10 days and worsening shortness of breath for two days. Progressive deterioration of respiratory function transferred her to the intensive care unit. In view of worsening hypoxia and increased work of breathing, she was intubated on the same day and was started on volume control ventilator support. Despite the support measures she developed multiple organ failure and passed 35 days after the symptoms initiated. Conclusion(s): PM is usually self-limiting and is managed conservatively. Treatment of the underlying causes and least damaging ventilator settings possible to achieve adequate oxygenation are the mainstays in managing PM. COVID-19 patients with PM seem to have a more complicated clinical course and poor outcome.

Dermatological manifestations associated with the severity of COVID-19 infection: A retrospective cross-sectional observational study in 144 patients

Introduction: COVID-19 infection is a disease caused by the type 2 coronavirus that causes severe acute respiratory syndrome (SARS-CoV-2) that affects the respiratory mucosa and all those organs that present the type 2 angiotensin receptor (ACE2), within them the skin. Several authors have mentioned the importance of reporting and carrying out databases on skin lesions caused by this virus, since it is related to the detection, severity and prognosis of the systemic condition. Material(s) and Method(s): A retrospective cross-sectional observational study was carried out on the cases of patients who presented dermatological manifestations due to COVID-19, registered in the physical database of the National Specialized Hospital of Villa Nueva, Guatemala, from January 1st to December 31, 2021. Result(s): A total of 144 patients presented dermatological manifestations due to COVID-19, which were: acral lesions (42%), rash (21%), subcutaneous emphysema (12%), oral mucosal lesions (7%), necrosis (6%), erythema multiforme (5%), telogen effluvium (2%), vesicular lesions (2%), urticaria (1%), pityriasis rosea Gibert (1%) and livedo-type lesion (1%). A statistically significant association (p = 0,00) was found in patients who presented dermatological manifestations with vasculonecrotic damage as they were more likely to suffer from severe to critical disease (OR 2,91;95% CI 1063-3083). Conclusion(s): Early identification of cutaneous semiology is essential for timely management of complications associated with COVID-19 disease.Copyright © 2022 Elsevier Espana, S.L.U.

Clinical Approaches to Minimize Readmissions of Patients with COPD: A Narrative Review

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease and also a lead-ing cause of morbidity and mortality worldwide. The frequent readmissions of patients with COPD may reduce lung function, mental health, and quality of life;it also increases the cost of treatment and mortality rate. Some common factors that may increase the readmission frequency of COPD patients include delay of diagnosis, advanced lung function decline, lack of adherence for COPD treatment, ineffective management of comorbidities, acute exacerbation or stable COPD, and infec-tions. However, these factors might be well controlled with appropriate approaches to minimize the readmission of patients with COPD. In this review, we propose a strategy with a seven-step approach to reduce the readmission in COPD patients, including early diagnosis of COPD, optimal treatment for stable COPD, targeted management of comorbidities, adequate therapy for acute ex-acerbations, individualized action plans for COPD patients, effective prevention of bacterial and viral infections, and adaptive program of pulmonary rehabilitation. Thus, implementing this approach may reduce the risk of readmission in patients with COPD.Copyright © 2023 Bentham Science Publishers.

A Case of Pneumothorax Ex Vacuo Associated with COVID-19.

Pneumothorax is a known complication of coronavirus disease 2019 (COVID-19). The concept of pneumothorax ex vacuo has also been proposed to describe pneumothorax that occurs after malignant pleural effusion drainage. Herein, we present the case of a 67-year-old woman who had abdominal distension for 2 months. A detailed examination led to the suspicion of an ovarian tumor and revealed an accumulation of pleural effusion and ascitic fluid. Thoracentesis was performed, raising the suspicion of metastasis of high-grade serous carcinoma arising from the ovary. An ovarian biopsy was scheduled to select subsequent pharmacotherapy, and a drain was inserted preoperatively into the left thoracic cavity. Thereafter, a polymerase chain reaction analysis revealed that the patient was positive for COVID-19. Thus, the surgery was postponed. After the thoracic cavity drain was removed, pneumothorax occurred, and mediastinal and subcutaneous emphysema was observed. Thoracic cavity drains were then placed again. The patient's condition was conservatively relieved without surgery. This patient may have developed pneumothorax ex vacuo during the course of a COVID-19 infection. Since chronic inflammation in the thoracic cavity is involved in the onset of pneumothorax ex vacuo, careful consideration is required for the thoracic cavity drainage of malignant pleural effusion and other fluid retention.

Case report: Spontaneous pneumomediastinum (SPM) and intestinal perforation secondary to COVID-19 in the same patient

Case History:A 73-year old male patient with Hypertensive Cardiomyopathy, pulmonary emphysema, dyslipidemia,presented to our Pulmonary Department for COVID-19 pneumonia associated with respiratory failure. He was started on medical therapy and high flow oxygen reduced during hospitalization,he was not treated with noninvasive ventilation. During hospitalization,he developed before SPM,showed chest CT scan,and we achieved good results with conservative management, consisting of bed rest with oxygen inhalation or supportive pain control. After ten days,as the patient complained of continued abdominal pain, computed tomography(CT)abdomen was ordered and revealed sigmoid colonic diverticular and intestinal perforation. He underwent to resected sigmoid colon but few days after surgery the patient died. Spontaneous pneumomediastinum (SPM),unrelated to positive pressure ventilation and intestinal perforation (IP)have been recently reported as an unusual complications in cases of COVID19 pneumonia. For SPM, the presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak, for GP is unclear,the perforation could result from altered colonic motility due to neuronal damage in addition to local ischemia resulting from hypercoagulable state caused by the virus. We present a case of COVID-19 pneumonia complicated both SPM and IP in the same patient,not yet described in literature. On this basis,we believe it is vital to institute SARS-CoV-2 precautions in patients who present with either respiratory or gastrointestinal symptoms,therefore high index of suspicion is needed to further manage those patients and,thus,improve their outcome.

Machine Learning analysis of human pulmonary extracellular matrix architecture identifies disease-specific remodeling patterns

Background: Normal organ function is critically dependent on an intact three-dimensional architecture. Structural abnormalities induced by pathological situations instruct cells to behave abnormally and promoting disease progression oftentimes leading to organ failure. Current approaches do not allow for high-resolution (HR) threedimensional (3D) visualisation and analysis of human organ structure. Method(s): Here, we develop a method to perfuse human tissue segments to remove cells and study the 3D structural scaffold, which could be applied to any organ. Our approach enables HR-3D imaging of organ architecture, which we apply to study healthy and diseased human lung, specifically emphysema, usual interstitial pneumonia, pulmonary sarcoidosis, and COVID-19. Result(s): Our imaging reveals major structural abnormalities previously unseen by existing methodologies. Furthermore, we identify disease-specific patterns of structural remodelling using machine learning, including the altered spatial relationship between extracellular matrix (ECM) proteins collagen type IV, elastin and fibrillar collagen present across all diseases. Conclusion(s): Given the importance of organ structure on function, our approach opens the possibility to understand human physiology in a new way, which may assist in future disease diagnosis and explain the detrimental pulmonary effects of the diseases studied here.

Impact of pre-existing respiratory disease on radiological outcomes in COVID -19 pneumonia

Introduction: COVID-19 pneumonia usually presents as multifocal infiltrates or consolidation. The British Thoracic Society proposes a Chest X Ray based follow up. We looked at the radiological outcomes of patients admitted with COVID-19 pneumonia to our District General Hospital. Aim and Objectives: To investigate the radiological outcomes of COVID pneumonia and explore if pre-existing respiratory disease affected these outcomes Methods: A retrospective analysis of COVID 19 pneumonia patients admitted between 03/03/2020 & 22/03/2021 was performed. Study cohort identified using Radiology reporting software and clinical coding data. Information collected of repeat imaging, medical comorbidities and categorised as per Fleischer society glossary Results: 293 patients with follow up imaging were included with a mean age of 66.1 years, (17.1 to 99.8 years). Males 50.8% and females 49.2%. 106 (36%) patients had persistent lung opacities (PLO) including consolidation, ground glass opacification or residual changes, 25 (8%) had fibrotic changes and 15 (5%) had atelectasis. Of 106 patients with PLO, 38 (35%) patients had respiratory co-morbidities i.e., 6 emphysema, 14 COPD, 14 asthma, 2 bronchiectasis and 1 fibrosis. 147 (50%) patients who had complete resolution, out of these 30 (20%) patients had respiratory comorbidities i.e., 2 emphysema, 8 COPD, 18 asthma & 2 had bronchiectasis. Out of 25 patients with fibrotic changes 6 (24%) had respiratory co-morbidities. Conclusion(s): The prevalence of PLO in repeat imaging of COVID pneumonia patients in our centre was 36%, out of those 35% patients had pre-existing respiratory disease. COPD patients were at higher risk of having PLO compared to asthma patients.

One year overview of follow-up in a post-covid consultation of critical patients with covid-19

Introduction: Long-term clinical management and evolution of a cohort of critical COVID-19 survivors has not been well described. Method(s): We report a prospective observational study of COVID-19 patients admitted to ICU between March to August 2020. The follow-up comprised symptoms, pulmonary function test, 6-minute walking test (6MWT, and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-covid19 syndrome was performed at 1-year. Result(s) and Conclusion(s): A total of 181 patients were admitted at the ICU during the study period. They were predominantly middle-aged (median [IQR] of 61 [52;67] years old) male (66.9%) with a median of ICU stay of 9 (5- 24.2) days. Twenty percent of them died in the hospital and 39 were not able to be included, a final cohort of 105 patients initiated the follow-up. At one year, 32.2% persist with respiratory alterations and needed to continue the follow-up. 10% still had severe lung diffusing (DLCO) involvement (<60%) and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) of symptoms of 5.77 (4.66) and 61.3% meet criteria for post-covid syndrome at one-year. During the follow-up 46 patients were discharge and 16 were transfer to others consultations. Other conditions such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%) and lung cancer (1%) have been identified. A high use of healthcare resources is observed in the first year of these critical survivors after hospital discharge.