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The outbreak of Coronavirus Disease 19 (COVID-19) following the Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) viral infection has placed particular pressure on occidental health systems, especially in terms of acute care resources and critical care skills. A number of affected patients subsequently required a rehabilitation process, due to multiple functional limitations, either as a result of an extended stay in intensive care or the consequences of the infection itself. The aim of this article is to report on the Geneva experience in post COVID19 rehabilitation, through 2 clinical vignettes, illustrating the heterogeneity of symptoms and deficits that may be encountered following this disease.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.
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Background: Clinical outcome and parenchymal lung abnormalities (PLA) data from hospitalized patients with COVID 19 pneumonia are limited. Objective(s): (1) Understand and compare the patterns of PLA on high resolution computed tomographic (HRCT) at admission, 4-8 weeks post-admission in all patients and 10-12 weeks post-admission in a subgroup of patients (2) follow up their general health status on phone 6 months post admissionMethods: Prospective, observational study of consecutive adult patients hospitalized with RT-PCR confirmed COVID-19 pneumonia in a tertiary centre, India. Clinical data and HRCT image patterns and distribution of PLA at admission, 4-8 weeks in all patients and at 10-12 weeks in a subgroup of patients were analysed using a novel, composite radiological score (CRS). Surviving patients were followed up telephonically 6 months later. Finding(s): Of 179 patients, HRCT features were ground glass opacity (144, 80.4%), consolidation (23, 12.8%) and reticulation (7, 4%) at admission. 74% demonstrated resolving PLA with 14% showing complete resolution at 4-8 weeks. Fine reticulations were seen in 12% at 8 weeks and 20% in a subgroup of 44 patients who had persisting symptoms at 10-12 weeks. CRS correlated well with clinical severity and recovery (p=0.003). At 6 months, 144 responded to the phone follow up, reported no functional impairment and had returned to their pre-COVID health status. Conclusion(s): PLA resolved in 88% at 8 weeks and all the 144 patients who were followed up at 6 months reported return to pre-COVID 19 health status. This is quite reassuring amidst concerns of 'long COVID'.
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COVID-19 is often associated with long-lasting pulmonary symptoms. Data are scarce about interstitial lung disease(ILD) in patients following COVID-19 hospitalization with persistent symptoms.We retrospectively reviewed all cases sent to pulmonary post-COVID evaluation due to persistent symptomsbetween February 2021 and February 2022 (N=318). All patients with suspected ILD (N=44) were reviewed at theMDD. Patient characteristics, symptoms, time since hospitalization, lung function, PI and PE, and 6-minutewalk test (6MWT) were evaluated.The post-COVID-ILD included more men (male: 68%, age: 64.0+/-12.3 years, time since hospitalization: 2.4+/-2.3months) with overweight (BMI 29.1+/-4.2 kg/m2). Persisting symptoms included tiredness (30%), dyspnea (20%),cough (20%), sleep disorders (20%). Spirometry confirmed a mild restrictive ventilatory pattern (FVC: 76.7+/-18.1,FEV1: 83.5+/-19.1 TLC: 85.6+/-28.1 %pred) while average PI and PE was normal. 6MWT confirmed desaturationin 41% of cases.maxmaxmaxmax Our data indicate that suspected post-COVID ILD is affecting 13.8% of symptomatic patients. Functional impairment, especially desaturation during 6MWT is an important factor when ILD is suspected. Longitudinal follow-up of these patients is in progress.
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Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.
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Background: After 4 months we have shown, that DLCO is lower in severe COVID-19 patients compared to nonsevere (Guler SA, et al. Eur Respir J. 2021 Apr 29;57(4):2003690). Contributing factors are unclear. Calprotectin is an inflammatory marker released by activated neutrophils and is increased in acute severe COVID-19. Aim(s): We hypothesized that circulating calprotectin correlates with persistent lung functional impairment after COVID-19. Method(s): Calprotectin serum levels were measured in 124 patients (50% male) 4 months after COVID-19 (NCT04581135). Calprotectin was correlated with clinical parameters (Spearman's correlation). Multivariate linear regression (MLR) was performed to evaluate the independent association of calprotectin in different models. Result(s): Post-ICU patients (72% male) compared to non-ICU were significantly older (age 59.4 +/- 13.6 vs 49.2 +/- 13.1 years) and more obese (BMI 28.7 +/- 4.5 vs 25.2 +/- 6.0 kg/m2) (p=0.001, each) compared to non-ICU. DLCO was lower in post-ICU patients (75.96 +/- 19.05 %-predicted) compared to non-ICU (p<0.01). Calprotectin was significantly higher in post-ICU patients (2.74 +/- 1.15 mug/ml) compared to non-ICU (1.81 +/- 0.94 mug/ml, p<0.001). In unadjusted analysis, calprotectin correlated with DLCO (r=-0.350, p<0.001) and FVC (r=-0.417, p<0.001). In MLR adjusted for age, sex and BMI, calprotectin correlates with DLCO (R2=0.276, p<0.001). Calprotectin significantly predicted DLCO (beta=-6.463, p=0.001). Conclusion(s): Serum calprotectin is higher in post-ICU patients compared with non-ICU 4 months after COVID-19. The relationship between calprotectin levels and DLCO suggests a potential role for calprotectin in persisting lung functional impairment.
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Respiratory symptoms and functional disorders are registered in patients who suffered from COVID-19 (COronaVIrus Disease 2019). Aim. Clinical and functional evaluation of the respiratory system during 6-month follow-up in patients who had moderate and severe COVID-19. Methods. 80 patients were included in the cohort observational prospective study. Patients were examined in 46 (36 - 60) days from the onset of symptoms of COVID-19 and in 93 (89 - 103) and 180 (135 - 196) days at the 2nd and 3rd stages respectively. At all stages, symptoms, dyspnea level, and quality of life were analyzed using validated questionnaires, and a 6-minute step test was performed. At the 2nd and 3rd stages, we assessed spirometric parameters, total lung capacity, carbon monoxide diffusing capacity (DLCO), and high resolution computed tomography scans of chest organs. Results. At the 1st stage of the study, 62% of patients complained of fatigue, muscle weakness, 61% of patients had dyspnea of variable severity. At the 3rd stage of the study, 43% and 42% of patients had the same complaints respectively. The prevalence of moderate COVID-19 form in patients with 35 (25 - 45)% lung damage and severe COVID-19 form with 75 (62 - 75)% of lung damage was established. At the 2nd stage, a DLCO < 80% level was recorded in 46% of patients with 35 (25 - 45)% lung damage and in 54% of patients with 75 (62 - 75)%. At the 3rd stage, DLCO < 80% was diagnosed in 51.9% and 48.1% of patients with of 35 (25 - 45)% and 75 (62 - 75)% lung damage respectively. The level of DLCO < 60% was found in 38,5% and 35,5% of patients with moderate and severe lung damage at the 2nd and 3rd stages of the study respectively. Conclusion. The symptoms were reported less frequently during the 6-month follow-up after COVID-19. 77% and 87% of patients had DLCO < 80% in 93 (89 - 103) and 180 (135 - 196) days after the disease onset, respectively. 38.5% and 35.5% of those patients, predominantly having suffered COVID-19 in severe form, had DLCO < 60% at 93 (89 - 103) and 180 (135 - 196) days, respectively. This calls for a continuous observation and regular examinations after COVID-19.Copyright © 2022 Leshchenko I.V., Glushkova T.V.
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Background: People following hospital discharge for COVID-19 may experience persisting negative effects of the disease. Investigation of the short and long-term effects are necessary to refer people to appropriate rehabilitation services for functional recovery. Aim(s): To evaluate physical and respiratory function of people with COVID-19 shortly after hospital discharge. Method(s): Assessments were undertaken at three time points: (i) within three weeks following hospital discharge (A1);(ii) at three months (A2);and (iii) six months following discharge (A3). Measures were collected of: fatigue (Fatigue Severity Scale;FSS), lower-limb function (1 minute sit-to-stand test;1-STS), pulmonary function (spirometry), dyspnea (MRC Scale) and physical activity in daily life (PADL) (accelerometry). Result(s): Forty people were included (18[45%] men;55[51-60] years;length of hospital stay: 8+/-6 days;FSS: 54.5[44.2-59];1-STS: 21+/-7;FVC %pred: 87+/-15;FEV1 %pred: 88+/-15;FEV1/FVC (%): 83+/-6;4,284+/-2,460 steps/day;MRC: 3+/-1). There was a: reduction in fatigue from A1 to A2 (mean difference [95% CI] -1.8 [-2,5;-1.2])] and from A1 to A3 (-2.2 [-2.9;-1.4]);an improvement in lower-limb function from A1 to A2 (5.1 [2.2;7,9]) and from A1 to A3 (5.6 [3.18;8]);an improvement in FVC %pred from A1 to A3 (5.9 [1.5;10.2]);and a reduction on dyspnea from A1 to A2 (-1.2 [-0.6;-0.3]) and from A1 to A3 [-1.2 (-0.6;-1,8)]. No change in PADL was found. Conclusion(s): People with COVID-19 post-hospital discharge present fatigue, functional impairment, dyspnea, poor PADL and normal lung function. Improvements in dyspnea, fatigue and lower-limb function were observed at three and six-months follow-up.
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Introduction: Post-Covid-19 functional status scale (PCFS) is a validated tool to estimate the functional status of hospitalized covid patients. The aim of the study is to evaluate the differences in clinical and functional outcomes between covid-19 hospitalized and outpatients. Method(s): We compared the ventilatory and the functional status of 474 patients admitted to hospital for Covid between March 2020 and March 2021, to that of a positive control group of 465 outpatients infected with Covid and matched them for sex and age. The ventilatory status was collected according to spontaneous ventilation or the need of oxygen requirements, ventilation assistance and tracheostomy. The functional status was assessed using the PCFS score. The data were collected at discharge/two weeks (S2) and two months (M2) after infection. Result(s): 23.6% of the outpatients (age 59 +/- 17, 66.9% male) had a PCFS >= 3 at S2 and 2.5% at M2 compared to 22.1% and 5.5% respectively for the hospitalized patients (age 64 +/- 16, 67.5% male). 11.4% of the outpatients needed oxygen at S2 and 3.1% at M2 compared to 21.3% and 6.3% for the hospitalized group. No difference was noted between both groups in the PCFS at S2 (related-samples sign test;p=0.705) and at M2 (p=0.940). However, the ventilatory status was significantly different between both groups at S2 (p=0.021) and M2 (p=0.015). Conclusion(s): Being hospitalized did not seem to be a risk factor for pure functional impairment after recovering from Covid-19. However, recovered hospitalized patients are more oxygen dependent at hospital discharge which will be maintained even 2 months later.
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Assessment of health-related physical fitness (PF) and body composition (BC) may yield relevant information on body function in patients who have been affected by Coronavirus disease-2019 (COVID-19). Aim of our study was to evaluate the short-term effects of COVID-19 on physical fitness in a real-life cohort of outpatients including hospitalized and home-treated patients. Sixty-four patients (M=36;mean age 56+/-13.5 yrs) previously affected by COVID-19 (25 hospitalized vs. 39 hometreated) in the 3-6 months preceding the study measurements were enrolled. PF was evaluated with the following tests: handgrip strength (HGS), gait speed (GAIT), sit-to-stand (STS), timed up and go (TUG) and Short physical performance battery (SPPB). Phase angle (PhA) was measured by bioelectrical impedance analysis (BIA) as a proxy marker of fat-free mass composition in terms of body cell mass and cell integrity. Poor PF performance was observed in 38% of subjects for HGS, 55% for GAIT, 30% for STS, 38% for TUG, and 70% for SPPB, while low values of PA were observed in 42% of the study sample in comparison with international cut-offs. The presence of 3-5 impaired values out of five was observed in 38% of patients. All PF tests (and even more the number of abnormal PF tests) consistently correlated with PhA. No differences were reported between hospitalized and home-treated patients. In the short-run, COVID-19 causes a worsening of physical fitness regardless of baseline disease severity. More research is required to systematically measure the extent of functional impairments in COVID-19 and to address whether and how rehabilitation can promote post-infection recovery.
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Aim/Introduction: Knowledge about COVID-19's physiopathology is still scarce, mainly with respect to the recovery phase. Nonetheless, its association with an increased incidence of thromboembolic phenomena is well established. Ventilation/Perfusion single-photon emission computed tomography (VP-SPECT) plays a major role in the evaluation of pulmonary embolism (PE) and microvascular disease, given its high sensibility and low radiation burden. We aim, with this study, to review the contribution of VP-SPECT in these patients' follow-up, with a particular focus on those with long-COVID-19. Material(s) and Method(s): We performed a retrospective study with COVID-19 patients that underwent VP-SPECT in our Department, until march-2022. Functional impairment of global pulmonary perfusion (FIGPP) was quantified by assigning points for each segment with a mismatch defect (a total of 36 points in 18 segments). PE was defined by the presence of segmental or subsegmental pleural-based mismatch defect(s) assessed at least 2 points. All relevant demographic/clinical data were collected. Result(s): Sixty patients (mean age 54.8+/-12.8 years, 51.3% female) with a history of COVID-19 underwent VP-SPECT on average 285.6+/-127.2 days after infection. There was a high prevalence of severe infections (58%, N=29) and admitted patients (64.9%, N=37), with a mean length of stay in the hospital of 22.5+/-17.2 days. Six patients (10.2%) had acute PE associated. The main reason for VPSPECT was post-infection fatigue/dyspnoea (71.7%;N=43). Only 6.9% of patients underwent VP-SPECT during acute disease (N=4). Median FIGPP was 6% (0-47). Patients who were hospitalized (p=0.066) or who had severe disease (p=0.161) showed no statistically significant differences in FIGPP. Management change after VP-SPECT occurred in 11.9% (N=7). Patients who did not start anticoagulant therapy (N=46) showed a median FIGPP of 6% (0-18). Conclusion(s): Our findings suggest that, although clinically relevant, persistent post-COVID-19 fatigue/dyspnoea symptoms do not appear to be justified by a FIGPP associated with significant thromboembolism and are unrelated to disease severity and need for hospitalisation. However, VP-SPECT played an important role both in excluding serious sequelae of thromboembolism and in identifying patients at higher risk of developing pulmonary hypertension.
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Aim/Introduction: Knowledge about COVID-19's physiopathology is still scarce, mainly with respect to the recovery phase. Nonetheless, its association with an increased incidence of thromboembolic phenomena is well established. Ventilation/Perfusion single-photon emission computed tomography (VP-SPECT) plays a major role in the evaluation of pulmonary embolism (PE) and microvascular disease, given its high sensibility and low radiation burden. We aim, with this study, to review the contribution of VP-SPECT in these patients' follow-up, with a particular focus on those with long-COVID-19. Material(s) and Method(s): We performed a retrospective study with COVID-19 patients that underwent VP-SPECT in our Department, until march-2022. Functional impairment of global pulmonary perfusion (FIGPP) was quantified by assigning points for each segment with a mismatch defect (a total of 36 points in 18 segments). PE was defined by the presence of segmental or subsegmental pleural-based mismatch defect(s) assessed at least 2 points. All relevant demographic/clinical data were collected. Result(s): Sixty patients (mean age 54.8+/-12.8 years, 51.3% female) with a history of COVID-19 underwent VP-SPECT on average 285.6+/-127.2 days after infection. There was a high prevalence of severe infections (58%, N=29) and admitted patients (64.9%, N=37), with a mean length of stay in the hospital of 22.5+/-17.2 days. Six patients (10.2%) had acute PE associated. The main reason for VPSPECT was post-infection fatigue/dyspnoea (71.7%;N=43). Only 6.9% of patients underwent VP-SPECT during acute disease (N=4). Median FIGPP was 6% (0-47). Patients who were hospitalized (p=0.066) or who had severe disease (p=0.161) showed no statistically significant differences in FIGPP. Management change after VP-SPECT occurred in 11.9% (N=7). Patients who did not start anticoagulant therapy (N=46) showed a median FIGPP of 6% (0-18). Conclusion(s): Our findings suggest that, although clinically relevant, persistent post-COVID-19 fatigue/dyspnoea symptoms do not appear to be justified by a FIGPP associated with significant thromboembolism and are unrelated to disease severity and need for hospitalisation. However, VP-SPECT played an important role both in excluding serious sequelae of thromboembolism and in identifying patients at higher risk of developing pulmonary hypertension.
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The worldwide medical systems are still being severely impacted by the coronavirus disease-2019 (COVID-19) pandemic, which is responsible for catastrophic mortality and morbidity. It becomes more and more obvious that this unique respiratory virus's impacts go beyond the respiratory system as time goes on and our comprehension of it deepens. The transmembrane serine protease 2 (TMPRSS2) protein is necessary for the severe acute respiratory syndrome coronavirus 2, which is the cause of COVID-19, to gain cellular entry through the angiotensin-converting enzyme 2 (ACE2) receptor. Most endocrine glands exhibit high levels of expression for ACE2 and TMPRSS2. This pays the attention to the effect of COVID-19 on the endocrine system. Besides its capability to pass to the central nervous system especially the hypothalamus inducing a lot of functional disorders in COVID-19 individuals. Although effective vaccines became widely available, and mortality declined but attention is shifting more and more to the lengthy health impacts on COVID-19 survivors. To inform suitable research and effective management, this review provides an overview of the data examining the impacts of COVID-19 on the endocrine glands besides the hypothalamus. In addition, we reported if the endocrinal and thalamic disorders could affect the incidence and progress of COVID-19. Copyright© by the Egyptian Association of Immunologists.
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Background and/or Objectives: Elevated levels of inflammatory laboratory markers have been shown to be associated with increased severity of acute COVID- 19 infection, and may have prognostic value in predicting mortality. However, the relationship between inflammatory markers and functional outcomes in inpatient rehabilitation has not yet been studied. Our study examines this relationship, with the goal of investigating if there is prognostic value of these labs for rehabilitation potential. Design(s): Retrospective cohort study Setting: Acute inpatient rehabilitation at Shirley Ryan AbilityLab, Chicago IL Participants: N=182 patients admitted to an inpatient rehabilitation facility (IRF) for functional impairment secondary to acute COVID-19 infection. Intervention(s): Not applicable Main Outcome Measure(s): The relationship between change in mobility, self-care, and cognition functional independence measures from admission to discharge, and selected laboratory values on admission: leukocyte count, platelet count, erythrocyte sedimentation rate (ESR), and c-reactive protein (CRP). Statistical analysis was performed using Spearman's rank correlation for lab values as continuous variables and two-sample t-tests for labs as categorical values (normal vs abnormal). Result(s): There were no statistically significant associations between change in functional outcomes and selected inflammatory laboratory values. However, the baseline laboratory values of ESR and CRP trended towards an association with change in self-care (p=0.09 and p=0.08, respectively), and baseline CRP trended towards an association with change in mobility (p=0.07). An abnormal platelet count trended towards less improvement in self-care scores in IRF from admission to discharge (p=0.08). Conclusion(s): Inflammatory laboratory markers do not show a clear association with functional improvement through inpatient rehabilitation for COVID-19-related debility. However, given the near significance of several lab values, a larger sample size may elucidate prognostic value of several of these markers, which would provide utility for expected rehabilitation needs after infection with acute COVID-19.
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Aims Describe an interdisciplinary hub and spoke healthcare model for children and young people (CYP) with Post COVID-19 Syndrome Methods From November 2020, with NHS London and NHS England support, clinicians and AHP chief with backgrounds in infectious disease, adolescent medicine and psychiatry from across trusts in London collaborated to set up a hub and spoke model for delivering care to CYP with post COVID-19 syndrome. This was an iterative process with involvement of patient cohort. CYP are referred into a central weekly virtual multi-disciplinary 'hub' meeting for discussion with specialists across infectious disease;respiratory;rheumatology;neurology;chronic conditions (including ME/CFS );mental health;and allied health practitioners (AHP) with experience of rehabilitation including occupational therapists, and physiotherapists, dieticians, safeguarding practitioners. The groups has a diversity lead.The group has regular evidence-based CPD. Referrers (local paediatricians or GPs for 17-18 year olds) present patient to the MDT for discussion of diagnosis, investigation and management. Website-housed referral pathways including recommended baseline assessments are provided for referrers. A developing group of local integrated care service paediatric and AHP champions support local management, pathways and education around post COVID-19 syndrome. Patients follow one of two pathways: 1. Local management, using already available services which the MDT support 2. Face-to-face interdisciplinary consultation and rehabilitation for severe or complex cases. Local support MDT discussion, and advice to local team with letters to patients outlining impression and advice;school adjustments letters;leaflets for health professionals and CYP/ family across a range of known Post COVID symptoms and difficulties. AHP delivered virtual groups and webinars include pacing;emotional wellbeing;symptom management;eating, and sleep. As the first established post- COVID-19 service for CYP in England, we have led and supported the development of 14 other MDTs nationally. Results Between 1st April 2021 and 1st February 2022 89 patients were referred to the virtual MDT. All have received information leaflets to aid recovery. 25 CYP/families have attended the virtual groups so far. 57 CYP have received an interdisciplinary consultation and received bespoke MDT input. (see table 1) Conclusion In response to the clinical need of CYP with post COVID symptoms, the collaborative development of a Pan London service across 2 clinical sites, and 3 NHS trusts is an example of how specialist clinical care can be delivered virtually using a hub and spoke model for a proportion of patients with a complex disorder. The service development element is applicable to other future emerging diseases as well as a possible model for conditions that require multiple specialist inputs and can have confused pathways or delays in diagnosis (such as functional disorders or multi-organ pathology).
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SESSION TITLE: Autoimmune Diffuse Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Interstitial lung disease (ILD) associated with connective tissue diseases (CTD) present with varying degrees of severity and functional impairment. Patients with CTD-ILD may often initially present for pulmonary evaluation. Pulmonologists must be familiar with the spectrum of CTD syndromes, the associated serologic testing, and referral criteria to rheumatology. CASE PRESENTATION: A 62-year-old never-smoking female with prior mild COVID-19 infection, previously vaccinated, presented to clinic with a diagnosis of pulmonary fibrosis. She endorsed three years of progressive shortness of breath and dyspnea on exertion walking only eight blocks and with light household chores. The patient had worked as a professional chef in poorly ventilated kitchens. Review of systems was notable for morning stiffness and pain in bilateral hand joints with associated difficulty opening medication bottles secondary to symptoms. Previous computed tomography (CT) of the chest demonstrated peripheral, subpleural, and basal predominant reticulations accompanied by bronchiectasis and bronchioloectasis consistent with probable usual interstitial pneumonia (UIP). Envisia® genomic testing was performed and results were negative for idiopathic pulmonary fibrosis. Extensive serologic testing for CTD was performed, including rheumatoid factor and anti-cyclic citrullinated peptides which were normal. The patient was referred to rheumatology, and hand x-rays demonstrated diffuse MCP joint narrowing. The patient was diagnosed with seronegative rheumatoid arthritis (RA) with RA-ILD and started on treatment. DISCUSSION: Multiple society guidelines recommend serologic testing to rule out CTD-ILD in patients with new ILD. ILD has been reported to occur in 20-60% of patients with RA with multiple patterns. Patients with seronegative RA are more likely to develop extraarticular manifestations of RA including fibrotic lung disease. Patients who are asymptomatic from RA-ILD may be monitored clinically for worsening RA-ILD. The selection of patients for treatment with an immunosuppressive agent or glucocorticoids should be done with a multidisciplinary team. Patients with RA-ILD and a UIP pattern may not respond to immunosuppressive medications but are typically trialed on treatment for worsening lung disease. Randomized controlled trials that included patients with RA-ILD with fibrosis have suggested a role for nintedanib, an anti-fibrotic agent, in slowing the progression of forced vital capacity decline. CONCLUSIONS: CTD-ILD is a common diagnosis in pulmonary clinics, and ILD symptoms may be the chief complaint at presentation. Providers must be familiar with diagnostic criteria for CTD and obtain a detailed review of systems that might suggest the diagnosis of CTD. Early diagnosis of CTD-ILD and monitoring of disease activity is important to prevent progression of CTD-ILD. Reference #1: Yoo H, Hino T, Han J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management. Eur J Radiol Open. 2020;8:100311. Published 2020 Dec 16. doi:10.1016/j.ejro.2020.100311 Reference #2: Sahatciu-Meka V, Rexhepi S, Manxhuka-Kerliu S, Rexhepi M. Extra-articular manifestations of seronegative and seropositive rheumatoid arthritis. Bosn J Basic Med Sci. 2010;10(1):26-31. doi:10.17305/bjbms.2010.2729 Reference #3: Cottin V. Pragmatic prognostic approach of rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2010 Jun;35(6):1206-8. doi: 10.1183/09031936.00008610. PMID: 20513909. DISCLOSURES: No relevant relationships by Brenda Garcia No relevant relationships by Zein Kattih No relevant relationships by Priyanka Makkar No relevant relationships by Jonathan Moore
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Given the increase in the provision of telehealth services during the COVID-19 pandemic, it is important for medical and psychology providers to promote evidence-based treatments that can also demonstrate clinical utility through telehealth (1). This proof-of-concept study provides preliminary support for the clinical utility of the Williams and Zahka Cognitive Behavioral Therapy (CBT, 2) approach in reducing functional impairment and pain for pediatric patients with a Disorder of Gut-Brain Interaction (DGBI) when delivered through telehealth. A retrospective chart review was completed to examine psychological treatment duration and response among pediatric patients with DGBIs including functional abdominal pain and irritable bowel syndrome. CBT was delivered via telehealth with a licensed psychologist or supervised psychology trainee embedded in a pediatric gastroenterology clinic. Participants were 24 youth who completed initial evaluations between February and July of 2021 during the COVID-19 pandemic. Demographics, treatment characteristics, and statistical analyses are presented in Tables 1 and 2 (3,4). The Williams and Zahka CBT (2) approach utilizes a biopsychosocial framework that includes an initial focus on psychoeducation and function. Consistent with study hypotheses, non-parametric statistical analyses demonstrated statistically significant reductions in functional disability and pain with large effect sizes following treatment via telehealth. On average, patients attended approximately five sessions, including one initial evaluation and four treatment sessions, and this was not substantially different depending upon initial severity of impairment. These findings are in line with average treatment duration reported as 3 to 5 sessions in prior studies (5,6). Given the average length of treatment, patient care involved predominately psychoeducation on somatic symptoms and DGBIs along with a strong focus on functional restoration through behavioral activation, including a daily schedule and gradual return to routines and meaningful activities independent of school term status. Findings are similar to prior studies reporting reductions in functional impairment and pain following evidence-based treatment through a biopsychosocial framework for pediatric patients with DGBIs delivered in-person (5). (Table Presented).
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The COVID-19 pandemic has led to significant disruptions in medical care and initially elective medical procedures were put on hold. Patients avoided medical facilities, deferring care for non-acute conditions. One study found an 86% decrease in colorectal cancer screening volumes after COVID, and research has shown that adult gastroenterology (GI) admissions for conditions such as bleeds and cholecystitis decreased during the pandemic. There is sparse literature documenting pediatric GI procedures and medical utilization during the pandemic. This study analyzes data from five New York City hospitals comprising the INSIGHT Clinical Research Network (CRN) to evaluate procedural patterns during the COVID-19 pandemic. We extracted demographic and clinical data on 18177 GI procedures for children <21 years from the INSIGHT CRN, available from 3/2019 to 11/2021 (27 months). GI procedures were categorized using the card sort method, in which clinicians independently sorted procedures into predefined categories that were then harmonized across clinician results. Daily procedure frequencies from March to July 2020 were plotted to assess early-pandemic trends. Changes in weekly procedure frequency from 2019 to 2021 were also analyzed by year, using 2019 as a baseline against which data from 2020 and 2021 were compared. Specifically, changes across years in weekly mean procedure frequency were assessed using a separate analysis of variance (ANOVA) model for each procedure category, and post-hoc Tukey tests were used for pairwise comparisons of year-specific means for ANOVA models with significant overall differences at a Type I error rate of 0.05. Percent changes in procedure frequency compared to 2019 were plotted by category and year, with post-hoc adjusted statistical significance noted. All races except Pacific Islander showed a decline in procedures during 2020 and a rise in 2021. Median age at procedure was stable. Though literature shows Hispanic and African American communities to be more affected by COVID, they did not have the greatest decline in procedure frequency relative to 2019 (25% and 20% respectively vs Asian decline 41%). During the pandemic period in 2020 (Figure 1), EGD/colonoscopies comprised the majority of procedures taking place. However, overall pediatric GI procedures declined precipitously during this period, from a mean daily procedure count of 23.5 from March to November of 2019 to 0.77 in April 2020 (Figure 1). We noted a >40% decline in more invasive procedures such as liver and rectal suction biopsies. Procedures used in more acute settings, such as foreign body removal and bleeding control, had a smaller percent change during the pandemic (11% for both, see Figure 2). Compared to 2019, we noted a significant increase in motility procedures in 2021, potentially indicating a rise in functional illness. Further, there was an increase in foreign body removal during the same period, possibly due to circumstances of less supervision, and ERCP and EUS also increased. The COVID-19 pandemic led to multiple changes in pediatric GI procedures, however EGD/colonoscopies continued in the pediatric population contrary to what has been seen in adult literature. More invasive procedures requiring procedural rooms and admission were delayed, while more urgent procedures continued as expected. Additionally, it is noted after the initial pandemic wave that motility procedures increased. This phenomenon follows research showing increases in functional and mental health illnesses post pandemic. More research is needed to assess the health ramifications of the significant decline in procedures during the pandemic.
ABSTRACT
Background: Multimodal rheumatologic complex treatment (MRCT) is a treatment concept for patients with rheumatologic diseases requiring acute inpatient care suffering from exacerbated pain and/or functional impairment. A rheumatol-ogist directs the treatment program including multimodal assessments and treatment from three of the following: ergotherapy, physiotherapy, pain medicine and cognitive behavioural treatment. Most studies evaluated data from a two-week inpatient MRCT program.1 Available data on the effectiveness of a one-week inpatient multimodal treatment program are scarce. However, whether a shorter program might also be effective has not been studied so far. Objectives: To evaluate the effectiveness of a one-week inpatient multimodal and interprofessional treatment program on musculoskeletal pain and function of patients with rheumatologic disorders. Methods: 59 consecutive patients were entered into a program of multimodal treatment courses (MRCT) from January 2021 until December 2021. All patients completed a total of 11 hours of therapy in one week. Two patients were excluded for evaluation (one patient acquired COVID 19 during hospitalization and one patient was excluded due to missing data). Pain was assessed via visual analogue scale (VAS) and functional impairment via the 'Funktionsfragebogen Hanover (FFbH)' and the 'Health Assessment Questionnaire (HAQ)' at admission, at discharge and at 12 weeks of follow up. Paired t-test analyses for all treatment episodes were performed. Results: The mean treatment duration (days, ±SD) was 8.1 ± 0.8. Mean age (years, ±SD) of the 57 patients treated in the MRCT program was 57.2 ± 12.5, with 72% female and 28% male patients. Of all patients, 40% had an underlying infammatory disorder, 60% a non-infammatory rheumatic disease. 23% of all patients had 'back pain', 14% 'spondyloarthritis' and 11 % 'rheumatoid arthritis'. Overall, VAS (pain) mean at admission was 6.9 ± 1.0 (SD), HAQ mean 0.57 ± 0.23 (SD) and FFbH mean 81.44 ± 7.95 (SD), respectively. Signifcant improvements in VAS, HAQ and FFbH were demonstrated at discharge (day 8), with a mean improvement of VAS of-2.86 (95% CI:-3.07 to-2.64, P value: <0.0001), a mean improvement of HAQ of-0.24 (95% CI:-0.28 to-0.20, P value: <0.0001) and a mean improvement of FFbH of 5.38 (95% CI: 3.78 to 6.98, P value: <0.0001). Follow up assessment at week 12 was recorded in 22 patients (39%) with a signifcant mean improvement in VAS of-2.23 (95% CI:-2.98 to-1.48), P value < 0.0001) (Table 1 and Figure 1). Conclusion: Signifcant improvement of pain and function was demonstrated at discharge and at week 12 in patients with rheumatologic diseases and mus-culoskeletal pain completing a one-week inpatient multimodal interprofessional treatment program. A multimodal therapeutic approach may provide an effective treatment strategy superior to unimodal standard management.
ABSTRACT
Background: Complex regional pain syndrome type-1 (CRPS-1) is a severely disabling pain syndrome characterized by sensory and vasomotor disturbance, swelling, and functional impairment. Persistence of signs and symptoms has been observed in up to 64% of cases until 5.8 yrs after the onset of manifestations. Long-term disability, such as irreversible functional limitation, has been reported in up to 28% of cases with severe consequences on workability. No scores are validated to evaluate residual disability. Bisphosphonates have the best efficacy profile, compared with other therapeutic approaches, but data on long-term effectiveness are lacking. Objectives: To retrospectively evaluate long-term residual disability in patients with CRPS-1 of hand or foot after treatment with IV Neridronate (IVNer). To identify predictors of residual disability. To quantify disease outcomes, such as patient's subjective perception and residual pain. To assess long-term safety profile. Methods: We retrospectively collected data of patients affected by CRPS-1, treated with IVNer, referred to a tertiary Rheumatology Centre between Feb 2013 and Dec 2020. Visual analogue scale (VAS) and McGill Questionnaire (McGQ) were used for pain assessment. Disabilities of the Arm, Shoulder and Hand (DASH) and American Orthopaedic Foot and Ankle Society's (AOFAS) ankle-hindfoot scale for hand and foot involvement, respectively, were administered to explore disability through a phone survey. This kind of investigation was preferred for Covid pandemic. Results: 106 patients with definite diagnosis of CRPS-1 were included, mean age±standard deviation 55.6±13 yrs, 67% females, mean follow up duration 56.3 months (range 14-94), 46.2% with hand involvement. The mean VAS score before treatment onset was 55.8±23.4mm, while the McGQ was 12.9±6.7 in the sensory domain, 4.9±3.3 in the affective domain and 17.8±9.2 on the total score. Based on the patient's subjective perception and the proposed semi-quantitative scale, 77.4% described themselves as fully recovered (FR), 15% partially recovered (PR), and 7.6% with persistent disease (PD). Comparison between baseline and follow-up VAS shows a significant reduction (55.8±23.4 vs 15.1±26.4, p<0.00001). Pain assessment by McGQ showed a significant improvement in global score (baseline vs follow-up 17.8±9.2 vs 3.9±7.8, p<0.00001), sensory (12.9±6.7 vs 2.7±5.7, p<0.00001) and affective (4.9±3.3 vs 1.2±2.3, p<0.00001) domains. According to DASH score, 79.2% of the patients were FR, 3.8% had some difficulties, but with overall preserved use of the upper limb, and 17.0% had permanent functional disability. According to AOFAS ankle-hindfoot scale 76.4% of patients were FR, 16.0% had partial recovery, and 7.6% had severe functional impairment. Percentages of DASH and AOFAS scores showed a complete accordance with patients' subjective perception (Figure 1a and b). The only predictor of long-term functional impairment for CRPS-1 in the hand was a delayed treatment compared to symptoms onset (p=0.02). No predictors were found for foot localization. No patients reported the occurrence of osteonecrosis of the jaw or atraumatic fractures/atypical fracture features. Conclusion: IVNer maintained a good long-term effectiveness and safety profile in the treatment of CRPS-1. The effectiveness of IVNer is maintained on both pain symptoms and function, in terms of reductions in the VAS, McGQ and in hand and foot disability scores.
ABSTRACT
Background: Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on health-related quality of life (HRQoL) and sleep despite effective treatment. Objectives: To assess sleep and HRQoL in SpA and determine associated factors. Methods: Monocentric questionnaire-based assessment of HRQoL, function, sleep and depression in 314 SpA patients (n=168 PsA, n=146 axSpA). Results: Under effective treatment 138 SpA patients (46.5%) demonstrated abnormal sleep behaviour. 49.3% reported not being able to sleep through the night, with 6.1 % needing sleeping pills. 11.9% indicated feeling unrefreshed most mornings. Abnormal sleep behaviour was associated with female sex (p=0.005), HLAB27 (p=0.034), functional impairment (p=0.001) and depression (p<0.001). Patients reporting unrestful sleep had signifcantly more depressive symptoms (p<0.001) and highly reduced physical and mental HRQoL (p<0.001). Satisfaction with health was rated signifcantly lower (p<0.001). Patients with axial involvement (axSpA/axPsA) reported worse sleep quality (p=0.002) and waking too early (p=0.038) despite 73.7% receiving biologics. Sleep quality and early awakening correlated with BASDAI (p<0.001). Smokers had a reduced HRQoL (p=0.018) despite younger age (p=0.008). Female patients had worse sleep quality (p<0.001), needing more time to fall asleep (p=0.022), not being able to sleep through the night (p=0.026) and feeling unrefreshed in the morning (p<0.001). They had a reduced physical (p=0.019) and mental HRQoL (p=0.003), more depressive symptoms (p=0.040) and lower functional capacity (p=0.002). Functional capacity was associated with younger age (p<0.001), sex (p=0.042), smoking (p=0.008), sleep quality (p<0.001) and depression (p<0.001). 66.2% of patients have been assessed longitudinally, before and 3y later during COVID19 pandemic. Physical and mental HRQoL were stable over time. Functional capacity had decreased slightly. Subjective QoL during the COVID19 pandemic was not reduced compared to before. Regarding depressive symptoms, there was a mild but signifcant improvement over time (p=0.019). Furthermore, we observed an improvement of environmental QoL (p=0.034) during COVID pandemic. Overall subjective QoL as well as satisfaction with health did not change signif-cantly. Patients who had changed therapy (37% of the cohort) still had a reduced physical HRQoL (p=0.022) as well as signifcantly more depressive symptoms (p=0.010) and perceived their overall QoL as being worse (p=0.016). Conclusion: Despite treatment many SpA patients have a reduced HRQoL and impaired sleep quality with signifcant differences between male and female patients. Impact of COVID19 pandemic was low.