COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

A Successful Treatment of a Critically Patient with SARS-CoV2

Background: The role of inflammatory cytokines is known in the pathogenesis of organ damage and is also confirmed in the context of COVID-19 disease. The modulation of the cytokine storm seems to determine endothelial protection, which can translate into a reduction of the "capillary leak syndrome", and, consequently, in a better control of the formation of edema and pulmonary infiltrates. CytoSorb stands in this context as a cartridge capable of adsorbing cytokines and allowing a better clinical course. Case Report: A 69 years-old woman with a history of arterial hypertension, diabetes mellitus and CKD, was admitted to ICU for SARS Cov 2 related critical illness staged with chest CT, blood gas analysis and PCR. At the admission, the patient presented with ubiquitous interstitial pneumonia, PaO2 60 mmHg with 90% Airvo2 and PCR 36.67. Therefore, in order to remove inflammatory cytokines, the patient underwent hemoperfusion treatment with the CytoSorb adsorbent cartridge. Method(s): The protocol used is approved by the FDA for the treatment of covid patients and consists of the use of 4 cartridges 12h, 12h, 24h, 24h with measurement for each cycle of PCR, PaO2 and chest CT control. Result(s): During the hemoperfusion whit CytoSorb, respiratory failure improved until the patient was discharged from the ICU on the tenth day, with oxygen support via simple facial mask. Below the progressive values of the PCR, PaO2 and the chest CT control on the twelfth day. Conclusion(s): The hemoperfusion treatment with the CytoSorb adsorbent cartridge proved to be a valid adjuvant therapy in determining a better clinical course both in terms of the need for invasive mechanical ventilation and survival.

Viral Myopericarditis and Viral Encephalitis as Manifestations of Covid-19 Infection: A Case Report

Intro: Coronavirus disease (COVID-19) is currently a global health crisis and is caused by a new strain of coronavirus. However, emerging literature of case reports noted possible extrapulmonary manifestations of the disease. Because COVID 19 is a relatively new disease, at present, little existing literature tackles the diagnosis and therapeutic management of COVID-19-related conditions outside the pulmonary system. Method(s): This is a case of a 24-year-old male presented with the chief complaint of sudden stiffening of all extremities. Non-contrast computed tomography (CT) scan was unremarkable. Chest X-ray revealed interstitial pneumonia and SARS-CoV-2 RT-PCR (OPS/NPS) was positive. Electrocardiogram (ECG) findings showed supraventricular tachycardia and had elevated Troponin I levels. Pertinent physical findings noted were slurring of speech, dysmetria, and vertical nystagmus. Finding(s): The patient was initially treated as a case of Bacterial Abscess versus Viral encephalitis. Pericardial ultrasound revealed small pericardial effusion and was started on Colchicine. Repeat cranial CT scan noted unremarkable results but due to persistence of symptoms, the patient was started with Dexamethasone. On Day 16 of illness, the patient was noted to have full resolution of symptoms. Rapid antibody testing was done which revealed positive for both IgG and IgM hence the patient was discharged with the final diagnosis of Viral Myopericarditis resolved, Viral encephalitis resolved, COVID-19 pneumonia recovered. Conclusion(s): Extrapulmonary manifestations have been reported increasingly as an atypical presentation of COVID 19 infection. Early recognition of viral myopericarditis and viral encephalitis as a manifestation of COVID 19 can lead to the initiation of proper treatment and management. More reports on these cases can aid future studies on diagnostics and therapeutic approaches during the COVID-19 pandemic.Copyright © 2023

On the pathogenesis of destructive pneumonia during COVID-19: a clinical case.

Community-acquired pneumonia is a potentially serious infection in children with high morbidity rate, risk of severe course and unfavorable outcomes. Specialists have noted the increased incidence of the destructive forms in the recent years. Aim. To present a clinical case of destructive pneumonia in a 1 year 2 month old child, hospitalized in the State Budgetary Healthcare Institution "Children's City Clinical Hospital of St. Vladimir Moscow Healthcare Department", and analyze it in terms of current understanding on the disease pathogenesis. Conclusion. During COVID-19 (COronaVIrus Disease 2019) pandemic, pulmonologists and pediatric surgeons encountered an unconventional course of destructive pneumonia. A large number of studies of pathophysiological processes in acute viral interstitial pneumonias have recently allowed to expand our understanding of the role of coagulation system. At the same time, new questions arose concerning the clinical course and development of the pathological infectious process.Copyright © Zaytseva O.V. et al., 2023.

COVID-19 in tobacco users.

Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.

COVID-19 in children with severe aplastic anemia

Introduction: Coronavirus disease 2019 (COVID-19) affects children but mostly has mild course. There is meagre published data on the impact of COVID-19 illness in children with Severe Aplastic anemia (SAA). We describe our experience of managing COVID-19 in children with SAA. Method: Three children of SAA who developed SARS-CoV-2 infection are included in this study. Results: Patient 1 was post Immunosuppressive therapy (IST) for SAA and had an asymptomatic course and uneventful recovery. Patient 2 was several months post IST with no response and had an asymptomatic COVID-19 illness but had delayed viral clearance, however he succumbed to bacterial sepsis soon after. Patient 3 was awaiting IST and while he contracted severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2) infection, he had symptomatic COVID-19 illness followed by bacterial and fungal sepsis to which he succumbed. Conclusion: COVID-19 in children with SAA can be mild to fatal course and virus may have delayed clearance. It can lead to delay in therapy of SAA. © 2022 Pediatric Hematology Oncology Chapter of Indian Academy of Pediatrics

Pulmonary sarcoidosis

The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.

Mental health outcomes in patients discharged after COVID-19 hospitalization: the case report of a male nurse in the context of occupational surveillance program of health care workers

This case study draws attention on mental health sequelae that emerged in the context of the COVID-19 outbreak after recovery from hospitalization, even in subjects without personal psychiatric history. The case involves a 65-year-old male shift nurse who took SARS-COV-2 infection through a co-worker and that had been hospitalized for interstitial pneumonia from April 6 to April 17. After recovery, he developed psychiatric symptoms overlapping between different dimensions of psychiatric disorders and started to be followed by the Occupational Health Department of a Major University Hospital in central Italy. He reported a score of 28 at the Peritraumatic Distress Inventory and of 39 at the Self-Rating Anxiety State. He was treated with a combination therapy of SSRI and NaSSA antidepressants with clinical remission. In this case study, authors discuss the possible overlapping role of post-traumatic stress and anxiety symptoms in patients discharged after COVID-19 hospitalization that may deserve appropriate classification, treatment and follow up with the future goal to refine clinical management of post and long COVID syndromes of subjects who present low abnormalities in other specialty investigations.Copyright © 2022 EDIZIONI MINERVA MEDICA.

COVID-19 and acute heart failure among patients with cancer

Background: Patients with cancer represent a uniquely vulnerable population not only with higher susceptibility to COVID-19 but also at increased risk for death. However, detailed information on causes of death and the contribution of pre-existing health conditions to death yet is missing. Purpose(s): This study focuses on the implications of COVID-19 in the cardiovascular health of patients with cancer by assessing the relation between cancer and de novo acute heart failure (AHF) with in-hospital mortality. Method(s): The initial population consisted of 3968 patients included in the ISACS COVID-19 registry between March 2020 and February 2022. Of these, 546 patients with chronic HF were excluded, leaving a final population of 3422. Patients were divided in two groups according to the presence or absence of a cancer diagnosis at the time of hospitalization for COVID- 19. Primary outcomes were incidence of in-hospital mortality or AHF during hospitalization. Association between cancer and outcomes was estimated using multivariable logistic regression analyses. Subsidiary analysis was conducted to evaluate differences between patients with prior vs active cancer. Result(s): Of the 3422 patients included in the study, 468 patients had cancer (8.2% active, 5.5% past cancer). Cancer patients were older (68.9+/-13.4 vs 63.3+/-15.6, p-value <0.001) and more likely to be female (50.4% vs 39.1%, p-value <0.001). They presented more frequently with a history of chronic obstructive pulmonary disease (12.3% vs 7.6%, p-value = 0.001). When considering outcomes, cancer patients had a significantly higher incidence of in-hospital mortality (27.7% vs 19.2%;p-value <0.001). This despite the presence of a numerically higher mean PiO2/FiO2 (281+/-108.8 vs 267.05+/-122.5, p-value = 0.11) on admission and a lower rate of X-ray findings of interstitial pneumonia (60% vs 70.5%, p-value <0.001) than their non-oncological counterparts, as well as similar use of mechanical ventilation (30.6% vs 35.0%, p value=0.14). The association between cancer and death persisted when adjusting for demographic, laboratory findings and in-hospital treatment (OR: 1.46;95% CI: 1.11-1.94;p value=0.01). Cancer patients also had higher rates of AHF (9.6% vs 4.7%, p-value <0.001) during hospitalization. This association was independent from presence of cardiovascular risk factors or comorbidities (OR: 1.61;95% CI: 1.07-2.43;p value=0.02). When restricting the analysis to the cancer population, AHF appeared to be significantly associated with death (OR: 2.41;95% CI 1.18- 4.95;p-value = 0.01), but this correlation persisted only in patients affected by active cancer in age and sex adjusted analyses (OR: 4.27;95% CI: 1.51-12.07;p value=0.01 vs 1.20;95% CI: 0.38-3.76;p-value = 0.75). Conclusion(s): The incidence of AHF in cancer patients with COVID-19 is high. Patients with active cancer are also at high risk for mortality. This has implications for cardiac monitoring and chemotherapy administration during COVID-19.

Pulmonary artery resection and reconstruction in locally advanced lung cancer with moderate hemoptysis

Lobectomy with pulmonary artery (PA) angioplasty in locally advanced lung cancer is an alternative to pneumonectomy. It is feasible, oncologically effective and the procedure of choice in patients with recurrent hemoptysis and limited pulmonary reserves. We present a case of a successful left upper lobectomy with PA resection and reconstruction by an autologous pericardial patch.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Patients with Myositis Contract Sars-Cov2 Infection: Two Different Cases

Background. Mortality risk of the COVID-19 is marked elevated in high-risk patients. In our series of 78 patients with inflammatory myopathies (IIM), we documented two patients who died after being infected with SARS-CoV2: we here describe our experience in these unfortunate cases. Case 1: A 45-years-old Caucasian man was diagnosed with PM in 2012 and was treated with prednisone (PDN) associated with intravenous (IVIg) and subcutaneous (SCIg) immunoglobulin. In January 2020, when in remission with a low-dose PDN, he performed a routine control, including a completely negative echocardiogram. In March 2020, he presented with fever and headache from occult SARS-CoV2 infection. Although myositis was in remission, and home treatment had given him with paracetamol and NSAIDs, after two days he had a sudden death. The cause was an acute myocardial ischemia in COVID-19 interstitial pneumonia revealed by autopsy investigation. Case 2: An 87-years-old Caucasian woman came to our attention with severeonset PM in 2017. She responded well at treatment with high-dose IVIg, PDN and methotrexate. In April 2020, she presented with SARS-CoV2 infection, who slowly complicated with an interstitial lung disease until the death due to respiratory failure 25 days after the COVID-19 infection. Conclusions. The two cases are opposite: the man, who had an acute thrombotic event during SARS-CoV2 infection, was in remission since 2012 and he did not have comorbidities. Unlikely, the woman, who had respiratory failure, was a high-risk patient due to old age, high cardiovascular risk, chronic obstructive pulmonary disease (COPD) and intraductal papillary mucinous neoplasms.

A flare of EGPA after vaccination for COVID-19, description and follow-up of a clinical case

Background: Although rarely, vaccines can stimulate the immunological mechanisms underlying immune-mediated inflammatory diseases. in patients with COVID-19 there is also evidence that high titers of autoantibodies, with variable clinical relevance, can be detected. Method(s): We describe the case of a 71-year- old lady diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) in 2010 with paraesthesia, myalgia, eosinophilia and severe asthma. After induction of remission, the patient has shown regression of the vasculitis but persistence of the uncontrolled asthma. For this reason, since February 2019 she started Mepolizumab 100 mg/month. In December 2020 she tested positive for the SARS-CoV- 2 virus, manifesting a mild form then she tested negative in January 2021. In April 2021 she was vaccinated with a single dose of BNT162b2 mRNA vaccine. After about 10 days, she started to complain arthromyalgia and after a week of gait alteration, paraesthesia, dyspnoea and worsening cough associated with chest pain. Blood tests showed an increase in creatinephosphokinase (CPK 955 U/L) and hypereosinophilia (4.3x10

Rituximab in the Treatment of Idiopathic Inflammatory Myopathies with Interstitial Lung Disease, Long-Term Follow-Up

Background. Interstitial lung disease (ILD) is the common internal organ manifestation of idiopathic inflammatory myopathies (IIM) that can severely affect the course and prognosis of the disease. Rituximab (RTX) has been used to treat IIM, including variants with ILD. Objectives. To describe the course of disease in IIM patients with ILD, treated with RTX in long-term follow-up. Methods. Our prospective study included 35 pts with IIM fulfilling Bohan and Peter criteria and having ILD. The mean age was 51.8+/-11.9 years, female-26 pts (74%);24 (68.5%) with antisynthetase syndrome, 5 (14.3%) dermatomyositis (DM), 5 (14.3%) with a-Pm/Scl overlap myositis and 1 (2,9%) with a-SRP necrotizing myopathy were included. 25 (71,4% ) patients had nonspecific interstitial pneumonia, 9 (25,7%) organizing pneumonia (OP) and 1 (2,9%) OP, transformed to diffuse alveolar damage. All pts had the standard examination including manual muscle testing (MMT), creatinkinase (CK) anti-Jo-1 antibodies (anti-Jo-1) assay;forced vital capacity (FVC) and carbon monoxide diffusion capacity (DLCO) evaluation as well as high-resolution computed tomography (HRCT) scanning of the chest were performed at baseline, and 36 and more months. The median disease duration was 3.2 [0.16-18] years, 21 (60%) of pts were positive for a-Jo-1 antibody. All pts received prednisolone at a mean dose of 24.3+/-13 mg/day, immunosupressants at inclusion received 25 (71%) pts: cyclophosphamide 18 , mycophenolate mofetil 6 and comdination 1;Rituximab (RTX) was administered in case of severe course of disease and intolerance or inadequate response to GC and other immunosuppressive drugs. Results. The mean follow-up period after the first infusion of RTX was 47.2+/-11.9 months. Pts received 1-11 courses of RTX . The cumulative mean dose of RTX was 4.6 +/-2.5g. MMT 8 increased from 135.8+/-13.5 to 148.75+/-3.5 (p=0.000001). CK level decreased DELTACK - 762 u/l(median 340;25th% 9;75th% 821). anti-Jo-1 decreased from 173.4+/-37 to 96.5+/-79 u/ml (p=0.00002), FVC increased from 82+/-22.6 to 96,9+/-22% (p=0.00011). DLCO increased from 51.4+/-15.2 to 60+/-77.8% (p=0.0001). The mean prednisone dose was reduced from 24.3+/-13 to 5.7+/-2.4 mg/day. 3 pts died: ILD progression was the cause of death in 1 case, 1 bacterial pneumonia and COVID19 pneumonia. Conclusions. The results of this study confirm the positive effect of RTX in IIM patients with ILD (increase of muscle strength and improve lung function, decrease in anti-Jo-1 levels) and also its good steroid-sparing effect. RTX could be considered as an effective drug for the complex therapy of IIM patients with ILD when standard therapy is ineffective or impossible.

Interstitial pneumonia as a manifestation of COVID-19: case report [Version 1, Peer Review-In Progress]

Idiopathic interstitial pneumonia is a group of progressive diseases affecting the lower respiratory tract of unknown origin, characterized by diffuse alveolitis and disorders in the alveolar structures. We present a case of a 52-year-old male patient with a history of pulmonary nodule with suspected tuberculosis and a positive PCR test, who came to the clinic for a 15-day evolution, which is characterized by high termination and general malaise. Physical examination revealed dyspneic facies with semi fowler attitude and preserved psychomotor activity as well as the presence of dry oral mucosa, the other parameters were within normal. After several studies, a diagnosis of COVID-19 viral pneumonia and acute respiratory distress syndrome was made, given the severity of the patient, he was transferred to the ICU and treatment was started with oxygen therapy by mask with reservoir for SAT > 90 %, ringer's lactate 1000 cubic centimeters + 2 grams of vitamin C + 5 cubic centimeters of B complex (40 milliliters per hour) and antibiotic therapy with Piperacillin Tazobactam 4,5 grams in slow dilution over 3 hours every 6 hours. © Este es un artículo en acceso abierto, distribuido bajo los términos de una licencia Creative Commons.

Acute ischemic stroke due to floating thrombus of ascending aorta: An acute and subacute complication of SARS-CoV-2 infection

Objective: To describe ischemic stroke due to floating thrombus of ascending aorta occurring as acute and subacute complication of SARS-CoV-2 infection. Material(s) and Method(s): consecutive identification in clinical practice of ischemic strokes secondary to aortic arch thrombosis and history of acute or recent Covid-19 infection. Result(s): two patients had ischemic stroke with evidence of aortic arch thrombosis. The first case had concomitant acute Covid-19 infection, the second had recent Covid-19 infection. Both patients underwent intravenous thrombolysis, and subsequent anticoagulation. One patient died due to cerebral hemorrhage. Discussion and Conclusion(s): aortic arch thrombosis can be an incidental finding in acute ischemic stroke in patients with concomitant and recent COVID-19 disease. However, the infection may lead to thrombosis in non-atherosclerotic vessels and to cerebral embolism. Our findings support active radiological search for aortic thrombosis during acute stroke in patients with acute or recent COVID-19 disease.Copyright © 2022

Placenta histological features in three cases of supposed SARS-CoV-2 vertical transmissions in second and third trimester of pregnancy

Objective. We described three cases of SARS-CoV-2 positive new-borns with both symptomatic and asymptomatic mothers. Materials and Methods. Placentas were analyzed in the pathology department and showed chronic histiocytic intervillositis with presence of CD68+ macrophages, syncytiotrophoblast necrosis and positivity of the syncytiotrophoblast for SARS-CoV-2 antigen or RNA. Results. The first case dates back to March 2020, when a symptomatic COVID-19 positive patient gave birth to a healthy neonate at 37.6 weeks of gestation. Skin to skin contact was not permitted but breastfeeding with a face mask was allowed. The newborn, that remained asymptomatic throughout the entire hospital stay, resulted positive to SARS-CoV-2 immediately after birth, at 24 hours of life and after 7 days. The second was delivered at 35.1 weeks of gestation by caesarean section for non-reassuring fetal status. The mother presented with fever, cough and a positive COVID-19 swab test. The newborn resulted positive on day 7, despite not having contact with the mother. No neonatal complications were observed. The third positive mother was admitted asymptomatic to the obstetric department in September 2021 due to preterm premature rupture of membranes at 20 weeks of gestation in a high-risk twin pregnancy. At 21.4 weeks of gestation her clinical conditions deteriorated, and she delivered two stillborn fetuses: SARSCoV- 2 was detected in all tissues samples. The lung of the first fetus only showed interstitial pneumonia features. Conclusions. We detected SARS-CoV-2 in placentas of both the second and third trimester, implying the passage of the virus through the placenta to the fetuses as the presence of SARSCoV- 2 RNA was demonstrated in swabs and foetal tissues.

Post COVID Lung function after mild to moderate disease: Good prognosis, but high prevalence of hyperventilation (HV)

Background: There is evidence of persistent symptoms after COVID-19 disease in more than 50 %. of patients (pts.). We hereby report our experience with lung function tests in Post-COVID pts. in an outpatient clinic. Method(s): Since spring 2020, we offered ambulatory control of lung function and imaging after COVID-19 disease. Lung function tests (LFT) including blood gas analysis were performed. Result(s): 66 consecutive pts. (39M, 27F, age 50+/-15.1 Y, BMI 29+/-6 kg/m2) without pulmonary pre-existing condition presented with persistent symptoms 168+/-122 days after COVID. 41 pts. were treated ambulatory and 25 pts. were hospitalized (none with prolonged ventilation). LFT's were normal (TLC 99+/-18 %, VC 91+/-20 %, FEV1/VC 80+/-10 %, pO2 86+/-10 mmHg, pCO2 37+/-4 mmHg), except in 6 pts., where LFT was slightly impaired: 2 showed moderate obstruction and 4 a restrictive pattern. Interestingly 22 pts. (34.9%) presented with a low pCO2, indicating different degrees of HV, inclining in F (M 7/39 vs. F 15/27, p=0.004). Also, 12 pts. with known pulmonary precondition diagnoses (6 sarcoidosis, 2 chronic hypersensitivity pneumonitis (HP), 1 non-specific interstitial pneumonia, 1 CTD-ILD, 1 asthma, 1 organizing pneumonia (OP) by primary biliary cirrhosis) presented after COVID-19 disease. In 8 of these pts. the LFT was comparable as before COVID-19 disease. One patient with HP showed prolonged recovery, one asthmatic needed intensified treatment, and one presented with a new episode of OP. Discussion(s): Our pts., who recovered from mild to moderate COVID-19 disease, presented with good prognosis with regard to LFT. HV could be one pathophysiologic mechanism for Post-COVID symptoms, particularly in F.

Safety and efficacy of pamrevlumab (FG-3019)in patients with COVID-19 pneumonia: an open-label, randomized, parallel-arm phase 2 study

Background: Pamrevlumab (FG-3019), a recombinant monoclonal antibody binding connective tissue growth factor (CTGF), has shown antifibrotic effects in idiopathic pulmonary fibrosis. Inhibition of CTGF could ameliorate the pathobiological consequences of interstitial pneumonia induced by coronavirus SARS-CoV-2. Aims and objectives: To assess efficacy and safety of standard of care (SOC) plus intravenous pamrevlumab as compared to SOC alone in hospitalized patients with COVID-19 pneumonia. Method(s): Hospitalized patients with documented SARS-CoV-2 infection, evidence of interstitial pneumonia and respiratory distress requiring supplemental oxygenation were randomized in a 1:1 ratio to either SOC plus pamrevlumab, or SOC only. Pamrevlumab at the dose of 30 mg/kg was administered as IV infusion on Day 1, Day 7 and Day 14. All patients were followed up to 12 weeks. Primary efficacy endpoint was the proportion of patients alive and who never received mechanical ventilation at day 15. Result(s): A predefined interim analysis was performed in 42 patients randomized to SOC plus pamrevlumab (n=19) or SOC alone (n=23) between June 2020 and May 2021. No new side effects emerged as compared to previous trials. The proportion of patients alive and who never received mechanical ventilation at day 15 was numerically higher in the pamrevlumab group as compared to SOC group (84% and 74% respectively), however the difference was not significant (p=0.4, 95% CI:-14% to 35%). Conclusion(s): Pamrevlumab did not provide significant benefit in a population of hospitalized patients with COVID19 pneumonia. No new safety signals emerged.

COVID-19 in interstitial lung diseases: are fibrotic ILDs associated with worse outcomes?

Introduction: Few studies have evaluated the impact of COVID-19 on interstitial lung diseases (ILDs). Our aim was to compare outcomes in patients with fibrotic-ILDs (F-ILDs) and non-fibrotic-ILDs (NF-ILDs) after COVID-19. Method(s): We reviewed patients with ILD followed in a Portuguese university hospital. Patients' features and COVID- 19 outcomes were compared between F-ILDs and NF-ILDs groups. We used Kaplan-Meyer analysis to estimate overall survival (OS) and cox-proportional-hazards regression models to identify factors associated with OS. Result(s): A total of 103 patients (49.5% were male;mean age of 61.5+/-14.5 years) were included. The most prevalent ILDs were sarcoidosis (26.2%), HP (14.6%), CTD-ILD (14.6%), OP (8.7%), IPF (7.8%) and unclassifiable idiopathic interstitial pneumonia (7.8%). 47.6% of patients had F-ILD, and they had a higher prevalence of dyslipidemia (p=0.006) and immunosuppressive therapy (p<.001). Regarding the severity of COVID-19, 64.7% had mild, 11.7% moderate and 24.3% severe disease. There was a higher proportion of severe disease among F-ILDs patients (34.7% vs 14.8%, p=0.019). Post-COVID-19 mortality (median follow-up of 44 weeks) was significantly higher in FILD than NF-ILD cases (30.6% vs 5.6%, p=0.001). The median OS was significantly lower for patients who had severe disease (18.0 vs 45.5 weeks;p<.001) and F-ILD (41 vs 45 weeks;p=0.001). According to multivariate analysis, F-ILD (HR:4.00, p=0.042) and severe disease (HR:6.98, p=0.008) were the factors associated with worse OS. Concluding: In our analysis, COVID-19 was associated with worse outcomes in patients with F-ILDs and severe COVID-19, regardless of cardiovascular risk factors.