Resolution Consensus Statement Neutralizing monoclonal antibodies for treatment of COVID-19 - a role in the treatment of vulnerable categories of patients.

In December 2022, the Council of Experts was held. It purpose was to determine the place of virus-neutralizing monoclonal antibodies (NMA) in the ethiotropic treatment of COVID-19 in vulnerable categories of patients. The main issues were identified and their solutions were proposed. At the first visit of pregnant women due to COVID-19, proactive identification of risk factors and early prescription of NMA are recommended, preferably - with published safety data in this category of patients (casirivimab + imdevimab). In patients with oncological and other chronic (rheumatology, pulmonology, gastroenterology) diseases, prophylactic use of NMA is recommended. regardless of the severity of the disease. For patients with chronic pathology regardless of the severity of the disease an early prescription of ethiotropic therapy must be provided, combating the long-term circulation of the virus. To solve the problem of late treatment prescription, it is necessary to: use rapid tests, prescribe NMA if indicated, even if the patient presents late, introduce digital technologies to transfer information about COVID-19 cases between healthcare institutions (HI), create call centers for primary triage of patients, daily hospitals to reduce the burden on the HI. The issue of NMA using related to changes in their activity against new variants of SARS-CoV-2 remains relevant. Among the proposed solutions are: priority of indications over information about the activity of NMA, the diversification of the choice of NMA in HI, taking into account clinical experience, indications for use and prognosis of NMA activity, the use of combined forms of NMA (for example, casirivimab + imdevimab) or a combination of NMA with other means of ethiotropic therapy.Copyright © 2023, Dynasty Publishing House. All rights reserved.

Acute Recreational Cannabis-Induced Hypersensitivity Pneumonitis: A Case Report.

Hypersensitivity pneumonitis (HP) is a lung disease in which foreign matter is inhaled and exposed to lung parenchymal and interstitial tissue. Such matter may include pollen, molds, chemicals, and smoke. HP leads to widespread inflammation and even fibrosis in chronic forms; the main route of treatment usually involves corticosteroids and antifibrotics as needed. We describe a patient case in which HP was diagnosed after using recreational marijuana, and her chest x-ray had a complete resolution after one day of a corticosteroid regimen. As recreational marijuana use increases, clinicians need to keep HP on the differential diagnosis in patients that frequently utilize recreational marijuana obtained through illicit business.

Critical Clinical Evaluation of Covid-19 Patients with Tuberculosis in the Indian Sub-Continent.

BACKGROUND: COVID-19 and tuberculosis (TB) are infectious diseases that predominantly affect the respiratory system with common symptoms such as cough, fever, and shortness of breath, making them dual burdens. METHODS: This review will discuss the characteristics of the coexistence of TB and new infectious illnesses to provide a framework for addressing the current epidemic. Currently, there are no clear and significant data on COVID-19 infection in TB patients, they may not respond appropriately to drug therapy and may have worse treatment outcomes, especially if their TB treatment is interrupted. Due to emergence, measurements should be taken to minimize TB and COVID-19 transmission in communal settings and health care institutions were created. For both TB and COVID-19, accurate diagnostic testing and well-designed, and established therapeutic strategies are required for effective treatment. RESULTS: Several health care organizations and networks have specimen transit methods that can be utilized to diagnose and monitor the etiology and progression of COVID 19 and perform contact tracing in developed and underdeveloped nations. Furthermore, patients and health care programs could benefit from increased use of digital health technology, which could improve communication, counseling, treatment, and information management, along with other capabilities to improve health care. CONCLUSIONS: Patients with COVID-19 pulmonary/respiratory problems may seek treatment from respiratory physicians, pulmonologists, TB experts, and even primary health care workers. To have prophylactic and therapeutic strategies against COVID-19, TB patients should take the appropriate health care measures recommended by health care professionals/government officials and maintain their TB therapy as indicated.

Fostering the Next Generation of Healthcare Leaders in a Pandemic World

Purpose of Study: Since the COVID pandemic began, there have been a dearth of opportunities for pre-medical students to work with practicing physicians. This is even truer in health care shortage areas such as California's impoverished San Joaquin Valley where the majority of its residents live below the poverty line and face a number of socioeconomic and educational hardships. Inequitable educational opportunities, lack of STEM identity, as well as lack of access to local mentors contribute to underrepresentation of individuals with diverse racial and ethnic backgrounds in STEM professions, including medicine. In partnership with the UCSF Fresno Department of Pediatrics we created a summer virtual Medical Education Apprentice Fellowship to help address some of these issues. Methods Used: This seven-week summer program was directed towards disadvantaged high school and undergraduate students living in the San Joaquin Valley. Four pediatric subspecialists, 4 medical students, 64 undergraduate students, and 4 high school students participated in the program. Participants were divided into specialty teams based on their interests, with each team (burn surgery, endocrinology, gastroenterology, or pulmonology) led by a medical student and faculty. Overall, this program had three primary components: (1) creating animated medical education videos for use in clinics, (2) hosting patient case study series, and (3) providing mentorship and professional development. Summary of Results: Forty-seven percent of students reported being the first in their family to pursue a STEM-related field. Prior to entering this program, only 50% of students felt strongly confident in their ability to be successful in a STEM-related field, and only 30% had a mentor that they fully trusted for guidance and resources. After completing the seven week program, 93% of students reported that they felt the program allowed them to explore medicine in innovative ways, 88% reported that they had made fruitful connections and now have a mentor and resources to guide them, and nearly 75% of students indicated a desire to address the social and health needs of the San Joaquin Valley as a healthcare professional. Conclusion(s): Our Medical Education Apprentice Fellowship provided disadvantaged students in the San Joaquin Valley with an opportunity to improve their digital literacy skills and medical knowledge while receiving mentorship from medical students and physicians. Grassroots programs such as this that form collaborative partnerships between students and health care professionals can be used to foster future healthcare leaders in order to address the health provider shortage in the San Joaquin Valley while providing underrepresented youth the chance to become healthcare champions.

Egyptian physicians' information-seeking behavior while serving in public isolation hospitals for coronavirus patients

Purpose: The purpose of this study is to explore the information-seeking behavior of Egyptian physicians serving in COVID-19 isolation hospitals. Design/methodology/approach: A sample of 91 physicians serving in Egyptian isolation hospitals answered the study questionnaire. Findings: Demographically, more than half of respondents were males. Over one-third of them are holding Doctor of Medicine (M.D), followed by one-third holding Master of Medicine (MMed). Respondents' age ranged from 30 to 60 years. Internal medicine is the most common specialty, accounting for nearly half of all physicians, followed by chest medicine and intensive care medicine. The information-seeking behavior of these three groups in their regular work is believed to be different, but since all of the participants are working in COVID-19 isolation hospitals, they should have the same information resources, Internet access and the same needs relevant to COVID-19 in order to make accurate clinical decisions. The physicians used traditional and electronic information sources to fulfill their information needs, the most important of which were to make a specific research, find an answer to a specific case, and deliver a medical lecture. Colleagues, coworkers, nurses and pharmacists were the most important channels pursued by Egyptian physicians to obtain information. Originality/value: This study is the first study that focuses on investigating the information-seeking behavior of Egyptian physicians serving in isolation hospitals. Any findings resulted from this study may serve as a noteworthy reference that may be useful to the Egyptian health sector, experts, researchers, as well as policymakers in establishing strategic decisions for making the understating much better. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-08-2020-0350 [ FROM AUTHOR] Copyright of Online Information Review is the property of Emerald Publishing Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19: Delphi analysis for the evaluation of the transition from pandemic to endemic in Mexico.

OBJECTIVE: To review and analyze the available information about the COVID-19 pandemic in Mexico and the determining factors for its transition to an endemic phase. MATERIALS AND METHODS: Prospective study based on the Delphi Method with the participation of a panel made up by specialists in infectious diseases, immunology, internal medicine, pulmonology, pediatrics and public health. RESULT(S): 2270 bibliographic sources were identified;after excluding those that offered repetitive information, 454 were included in the final analysis. The main factors that obstruct the transition from a COVID-19 pandemic to an endemic one were defined as the high capacity of SARS-CoV-2 to mutate (since the efficacy of anti-COVID-19 vaccines depends to a large extent on the genetic presentations of the virus) and the high prevalence in the country of comorbidities that make the population more vulnerable against the disease. Strengthening primary care and promoting a culture of surveillance and prevention are essential. CONCLUSION(S): It was concluded, by consensus, that there are factors that obstruct the passage of the COVID-19 pandemic to an endemic phase, including the intrinsic nature of disease control and the unpredictability of virus mutations.Copyright © 2023 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Developing a sustainable team model in uncertain times

Background: Medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become more important and more challenging. Focused attention on teamwork is required. Cystic fibrosis clinical research programs across the country have struggled with team dynamics during the pandemic, and attention to how the team interacts is important. The clinical research program in pediatric pulmonary disease at Rainbowconsisted of two teams (cystic fibrosis (CF), asthma and other pulmonary disease). We identified the struggle during the pandemic of losing touch with our team because of staggered schedules, the way studies were assigned, and separation of the teams in the program. Research coordinators (RCs) were working in silos that led to one RC being very busy while others might not be busy. A survey of four RCs revealed that the top four challenges they faced as individuals were completing tasks effectively, work distribution, communication, and lack of transparency. The top three challenges they faced as a team were communication, doing things "on the fly" (not planning ahead), and workload equity between team members. Method(s): The objective was to create an environment in which everyone worked together for a common goal: advancing clinical trials to support our patients through improved team dynamics with a shared vision. To accomplish this goal, we adapted our research program to include staff from all of the Pediatric Pulmonology Disease Division, allowing us to have six RCs who can move between multiple studies. The clinical research operations manager (CROM) assigns the teams during study startup. Teams of three RCs and one regulatory coordinator are assigned to each study. During startup, delegation of responsibilities is decided with the aid of a startup and implementation checklist. The three-person teams rotate to allowall team members to work with and support each other. The RCs have no regulatory responsibilities, and the Support Services team meets most processing needs. Weekly huddles are held to review visits and discuss coverage and logistics for the upcoming week. To further develop the team dynamic, a huddle is reservedweekly to reviewa study or logistics of a new or ongoing study. The entire team also meetsweekly, including the primary investigators, to review the status of studies at various stages of the clinical research cycle. Result(s): The pediatric pulmonary team model was implemented in September 2021;since then, 13 studies have migrated to the team-based approach. This model has helped the team dynamic significantly by taking a team-based approach rather than working in silos within the program. It has allowed work to be spread more evenly across the team and enhanced the ability to work from home or take time off with short notice. It has also allowed the RCs to focus on areas of research that play to their strengths. Some team members prefer to recruit or do data entry for studies, whereas others prefer to participate in patient-facing visits. Conclusion(s): Team dynamics is an essential consideration for the success of clinical research programs. During a time of isolation and uncertainty, teams can overcome hurdles and become stronger by developing a shared vision and shared responsibilities across several studies. The team model has allowed individuals to work across teams using their strengths and talents.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Potential Predictors for Disease Severity in Hospitalised COVID-19 Patients

Background and Objectives Several studies have shown that SARS-CoV-2 can induce a cytokine release storm which is a major cause of disease severity and death. Therefore, cytokine levels in the serum may predict disease severity and survival in patients with COVID-19. Methods We included 88 COVID-19 patients who were hospitalised at the Division of Pulmonology of the Vienna General Hospital between January and May 2021 in this observational trial. Blood samples for serum peptide measurements were drawn at the time closest to hospitalisation, at day 5, 9 and 13( +/- 1). We correlated the type of ventilation (nasal oxygen therapy, high flow nasal canula, non-invasive ventilation or mechanical ventilation), occurrence of consolidations on chest X-ray or if available HRCT and the level of care (general ward, IMCU or ICU) with serum peptide values. We assessed the concentration of cytokines (IL-1a, IL-1b, IL-1RA, IL-6, L-7, L-10, IFN- gamma and TNF-alpha), chemokines (CCL-3, CCL-4 and CCL-7) and growth factors (G-CSF, GM-CSF and VEGF). Results Patients were 68 years of age (median) and stayed in hospital between 5-171 days. The peak inspiratory pressure in patients receiving non-invasive ventilation or mechanical ventilation was significantly associated with IL-1RA, G-CSF and IFN-gamma and the fraction of inspired oxygen in patients receiving highflow nasal canula oxygen therapy was significantly associated with IL-6, IL-7, IFN-gamma, and CCL-7. Results are shown in Table 1. No investigated cytokine correlated with the type of ventilation, occurrence of consolidations on imaging and in-hospital mortality. Conclusions In conclusion, concentrations of IL-1RA, G-CSF, IL-6, IL-7, IFN-gamma, and CCL-7 were associated with more severe disease progression in hospitalised COVID-19 patients.

Impact of COVID-19 pandemic on BMI among Spanish allergic children

Background: The COVID-19 pandemic has been associated with weight gain among adults and children, and obesity is a risk factor and disease modifier for asthma. The objective of this study was to determine if there was a change in the body mass index (BMI) in pediatric patients with respiratory and allergic diseases, comparing their BMI in 2021 with the one in 2019. Method(s): A retrospective cohort study was performed using the database of the Hospital's Information System, including children under 15 years old from the Pediatric Pneumology and Allergy Unit in the year 2021 who had at least one anthropometric measurement done before March 2020, when lockdown and social distancing measures were enacted in Spain. The main variable was the variation of the BMI, weight, and height of patients before and after lockdown. To prove if the trend was higher or lower than the one detected before the pandemic, these measurements were compared with those obtained during the 5 years prior to 2019 in the same population. Subsequently, a secondary outcome was to evaluate the relationship between the different allergic diseases with weight gain. Result(s): A total of 291 patients were recruited, 37.46% female. 54.98% suffered from asthma, and the most frequent diagnosis was allergic rhinitis. The mean age at the start of the pandemic was 8.67 years old (DT 3.15). The percentage of patients with obesity grew significantly during the pandemic: 10.31% versus 16.15%. Therefore, significant increases of BMI were observed with p < 0.05 in patients with obesity, compared to patients with normal weight and overweight. Nevertheless, no differences were found with the increases of BMI that were already detected before the start of the pandemic: previous DELTABMI percentile 1.86 (DT 16.32) -DELTA BMI percentile during pandemic 2.71 (DT 15.89), p = 0.477. Children between 5 and 11 years were the most affected group, with an increase of BMI percentile from -2.25 (DT 19.86) to 1.27 (DT 5.43), p = 0.003 after de lockdown. With the Fisher's non-parametric independent test, the relationship between allergic diseases and BMI increase was studied, finding a relationship with the presence of asthma (DELTABMI p = 0.026). Conclusion(s): The pandemic has caused an increase of the obesity rates, especially among children between 5 to 11 years old, and those with asthma. Nevertheless, the BMI increase in the pediatric population was already a reality taking place before the pandemic, without finding changes in this trend in the study.

Post-COVID-19 pulmonary function tests in young health care workers in South Indian population – An observational study

Lungs being the earliest organ to be affected carry more risk of long-term morbidity. [...]pulmonary function tests (PFTs) on post-COVID young health care workers provide a better view on the impact, recovery and residual effects. [2] Till date, no pharmacological intervention has found to be completely effective in such cases. [...]it is important to follow-up patients with pulmonary function tests (PFT) even after the infective period. The improvement or deterioration in PFT along with sequelae can be adequately tested only with a routine follow-up. [...]the novelty of the project lies in focusing on health care workers with regards to COVID exposure, assessing the lung function tests. MATERIALS AND METHODS This observational and cross-sectional study was done in the department of pulmonary medicine of a tertiary care teaching hospital in Madurai for a period of 4 months between January and April 2021 after obtaining Institutional Ethical committee clearance.

Machine learning links unresolving secondary pneumonia to mortality in patients with severe pneumonia, including COVID-19.

BACKGROUNDDespite guidelines promoting the prevention and aggressive treatment of ventilator-associated pneumonia (VAP), the importance of VAP as a driver of outcomes in mechanically ventilated patients, including patients with severe COVID-19, remains unclear. We aimed to determine the contribution of unsuccessful treatment of VAP to mortality for patients with severe pneumonia.METHODSWe performed a single-center, prospective cohort study of 585 mechanically ventilated patients with severe pneumonia and respiratory failure, 190 of whom had COVID-19, who underwent at least 1 bronchoalveolar lavage. A panel of intensive care unit (ICU) physicians adjudicated the pneumonia episodes and endpoints on the basis of clinical and microbiological data. Given the relatively long ICU length of stay (LOS) among patients with COVID-19, we developed a machine-learning approach called CarpeDiem, which grouped similar ICU patient-days into clinical states based on electronic health record data.RESULTSCarpeDiem revealed that the long ICU LOS among patients with COVID-19 was attributable to long stays in clinical states characterized primarily by respiratory failure. While VAP was not associated with mortality overall, the mortality rate was higher for patients with 1 episode of unsuccessfully treated VAP compared with those with successfully treated VAP (76.4% versus 17.6%, P < 0.001). For all patients, including those with COVID-19, CarpeDiem demonstrated that unresolving VAP was associated with a transitions to clinical states associated with higher mortality.CONCLUSIONSUnsuccessful treatment of VAP is associated with higher mortality. The relatively long LOS for patients with COVID-19 was primarily due to prolonged respiratory failure, placing them at higher risk of VAP.FUNDINGNational Institute of Allergy and Infectious Diseases (NIAID), NIH grant U19AI135964; National Heart, Lung, and Blood Institute (NHLBI), NIH grants R01HL147575, R01HL149883, R01HL153122, R01HL153312, R01HL154686, R01HL158139, P01HL071643, and P01HL154998; National Heart, Lung, and Blood Institute (NHLBI), NIH training grants T32HL076139 and F32HL162377; National Institute on Aging (NIA), NIH grants K99AG068544, R21AG075423, and P01AG049665; National Library of Medicine (NLM), NIH grant R01LM013337; National Center for Advancing Translational Sciences (NCATS), NIH grant U01TR003528; Veterans Affairs grant I01CX001777; Chicago Biomedical Consortium grant; Northwestern University Dixon Translational Science Award; Simpson Querrey Lung Institute for Translational Science (SQLIFTS); Canning Thoracic Institute of Northwestern Medicine.

The role of Trans-thoracic ultrasonography for rapid detection of Covid-19 pandemic-pneumonia(262cases)?

Background: Corona virus pandemic pneumonia has caused unmatchable damage to humanity. Early detection and prompt treatment is the only answer for effective control. RT-PCR is the gold standard diagnostic test but displays high false-negative rate. A large number of undetected patients remain a constant source of inadvertent disease dissemination in community, potentiating the ongoing pandemic. Objective(s): To determine the usefulness of transthoracic ultrasonography for early detection of covid-19 pulmonary infection during a pandemic. Methodology: This cross-sectional study was conducted in Pulmonology-OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan, from April 21, 2020 to September 30, 2020. Total 262 patients with dry cough, fever and shortness of breath of sudden onset were included. Patients were investigated with chest x-ray/HRCT, transthoracic ultrasonography, covid-19-PCR and hematological tests. Sensitivity, Specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy was calculated with clinical diagnosis as reference. Data was analyzed by SPSS-24-software. Result(s): Of 262-patients, 248 were detected as covid-19 pneumonia by ultrasound. Bilateral, multifocal, posteriolateral involvement and B-lines were common features. Ultrasound displayed sensitivity 99.60%, specificity, 69.23%, PPV 98.41%, NPV 90.0% and diagnostic accuracy 98.09%. PCR diagnosed 155/228(59.16%) cases. The P-value was 0.00001-significant at P<.05. Conclusion(s): Transthoracic ultrasonography is a tremendous tool furnishing instant detection of covid-19 pneumonia with high sensitivity and provides foundations for evidence based management during pandemic.

Radiological findings of severe SARS-CoV-2 pneumonia: 1-year follow-up

Introduction: Patients who were affected by severe SARS-CoV2 pneumonia are now presenting respiratory sequelae. High resolution CT (HRCT) offers information about the evolution of the disease and its possible progression in form of pulmonary fibrosis. Aim(s): To assess the radiological findings during 1-year follow-up in patients affected by severe SARS-CoV-2 pneumonia, to determine the incidence of pulmonary fibrosis and its possible risk factors. Method(s): A prospective cohort study was conducted at Dr. Josep Trueta Hospital and Santa Caterina Hospital, including patients with severe SARS-CoV-2 pneumonia hospitalized at the Pulmonology service between March and June 2020. A 1-year follow-up was done, with controls in the 3rd and 6th months. We analysed clinical data, radiological findings, quality of life, grade of dyspnoea, pulmonary function testing and exercise capacity. Pulmonary fibrosis was defined by traction bronchiectasis/bronchiolectasis, pulmonary distortion or honeycomb pattern. Result(s): 94 patients were analysed. In a year span, 47.9% of HRCT were pathological, showing pulmonary fibrosis in 25.8% of them. Ground-glass opacities (GGO) were found in 66.5% of HRCT at the 3rd month, showing an improvement at the 6th month and a practical resolution at the 12th month. However, the fibrotic disease remained stable from the 6th month. The multivariant analysis showed a significant major incidence of pulmonary fibrosis among elderly patients. Conclusion(s): A practical resolution of the GGO is seen in most patients at the 6th month. Up to a quarter of patients develop fibrotic changes at the 1-year follow-up, however it remains stable from the 6th month onwards. Old age would be considered as a risk factor.

Predictive factors for Long COVID in adults previously hospitalized for COVID-19

Introduction: Long COVID was defined by the persistence or development of symptoms beyond 4 weeks from the onset of the disease. The aim of our study is to describe the prevalence of Long COVID in survivors after discharge and to determine predictive factors for Long COVID. Method(s): It was a retrospective study of hospitalized patients with COVID-19 in pneumology department D of Abderahman Mami hospital. We divided patients in 2 groups: G1: 94 patients with Long COVID and G2: 43 asymptomatic patients after discharge. Result(s): The prevalence of Long COVID was 68%. Female sex was associated with persistent symptom (53.2% vs 30.2%, p=0.01). The risk of persistent symptoms was higher in patients with moderate or severe obesity (51.6% vs 33%;p=0.04). Comorbidities were more frequent in G1 (73% G1 vs 65%, p=0.3). Asthma and Obstructive Sleep Apnea were associated with persistent symptoms (73% vs 65%, p=0.03 and 8% vs 0%, p=0.04, respectively). Patients in G1 had a higher frequency of fatigue than those in G2 (80% vs 58%, p=0.005). Most cases were mild, but 17% of patients required ventilatory support. Long COVID showed a strong correlation with Length of stay (r2= 0.18, p=0.03). The most common persistent symptoms reported were: fatigue (75.8%), shortness of breath (70.8%) and join pain (38.5%). Conclusion(s): We have observed that long COVID affected especially women and patients with respiratory comorbidities and those requiring prolonged hospital stay.

Lung changes after COVID-19: What are the functional differences across the spectrum of disease severity?

The pulmonary limitations after COVID-19 are still not completely known. Lung function test (LFT) and 6-minute walk test (6MWT) are accessible and safe tests to access them. Aim(s): To evaluate the differences between non-severe and severe COVID-19 patients regarding LFT and 6MWT. Method(s): This study included patients with previous COVID-19 assessed in Pulmonology Department at 2 hospitals during 7 months who performed LFT and 6MWT. Baseline and immediately pos-6MWT heart rate (HR), SpO2, respiratory rate (RR) and perceived symptoms using a modified BORG scale were collected. We compared nonsevere and severe patients. Result(s): We included 151 patients, 69 (45.7%) with severe disease. LFT was performed 116.8+/-68.3days and the 6MWT 129.1+/-72.3days after COVID-19, without statistical difference between groups. We documented lower %FVC (94.4+/-14.7vs101.1+/-12.6%, p=0.003), %TLC (95.4+/-15.3vs107.1+/-12.3%, p=0.000) and %DLCO (68.8+/-16.5vs78.9+/-15.9%, p=0.000) in the severe group, without statistical differences in FEV1, FEV1/FVC and KCO. The 6MWT distance (m: 426.5+/-110.9vs498.2+/-93.5m, p=0.000;%:77.3+/-16.8%vs86.1+/-13.4%, p=0.001), estimated metabolic equivalents (3.03+/-0.5vs3.4+/-0.4, p=0.000) and minimal SpO2 (92.0+/-3.3vs93.8+/-3.1%, p=0.000) were lower in the severe group. The time spent below 90%SpO2 (5.6+/-19.4vs2.6+/-13.6%, p=0.039), %age-predicted maximal HR (68.5+/-10.5vs64.9+/-8.8%, p=0.023) and initial RR (19.1+/-5.1vs18.7+/-9.3 cpm, p=0.014) were higher. We did not document differences regarding the differential (maximal-initial) HR, final RR, differential (final-initial) RR and symptoms. Conclusion(s): Severe group showed higher functional limitation, mainly in lung volumes and in submaximal exercise evaluation.

Predictive factors of mortality in hospitalized patients with 2019 novel coronavirus pneumonia

Hospitalized COVID-19 patients had variable clinical progression. Identifying factors associated with mortality is necessary to improve use of medical resources in order to reduce in-hospital death. We aimed to identify factors associated with mortality in patients admitted with severe SARS-CoV-2 pneumonia. We conducted a retrospective study including patients with laboratory-confirmed COVID-19 infection hospitalized in the pulmonology department B of Abderrahmen Mami hospital between October, 2020 and August 2021. Of the 577 patients included, 457were discharged (79,2%) and 93 died (16,1%). The median age was 63 years (range 18 - 98 years). Male gender and age>65 years were associated with mortality (p<0.001 and p=0,01 respectively). A third of patients had oxygen requirements> 10 liters per minute in admission (75% in the worsening group, p<0.001). Admission lab values related with mortality were higher C-reactive protein (p=0.003), white blood cell count(p=0.02), neutrophil to lymphocyte ratio (NLR)(p<0.001), acute renal injury(p<0.001)and rhabdomyolysis(p<0.001). Multivariate analysis showed that male gender (OR: 1.8, CI: 1.02-3.1, p=0.04), high oxygen requirements in admission (OR:8.6, CI: 4.6-16, p<0.001), high NLR (OR:1.05, CI:1.01-1.1, p=0.02) and acute renal injury (OR:2.2, CI:1.2-4.1, p=0.001) were independent factors associated with mortality. Male gender, high oxygen requirements in admission, high NLR and acute renal injury were associated with greater risk of death from COVID-19 pneumonia. These findings could help clinicians to identify patients with poor prognosis at an early stage.

Intermediate Respiratory Care Units: Questions and Answers

The intermediate respiratory care units (UCRI) are areas of monitoring and specialized care of patients with acute or chronic-exacerbated respiratory failure, whose severity does not require admission to an intensive care unit, but which due to their complexity cannot be treated in conventional hospitalization. Although the COVID-19 pandemic has proven its usefulness in the management of critical respiratory patients, the historical trajectory of the UCRI comes from many years ago, in which its cost-effectiveness has been demonstrated by far. This document presents a series of questions and answers on the history of the UCRI, in addition to the criteria for admission, infrastructure, human and technical resources, and the types of existing Units. Within the UCRI year 2021-2022 designated by the Spanish Society of Pneumology and Thoracic Surgery, any scientific dissemination linked to the in-depth knowledge of these units is timely, where multidisciplinarity and the work of professionals related to the care of critical respiratory patients converge.Copyright © 2022

Respiratory muscle strength in patients post infection by COVID-19

The persistence of symptoms in post-COVID patients, such as dyspnea and fatigue, has been common. Our objective was to determine the prevalence of respiratory and palmar muscles weakness in patients post-COVID-19 infection and compare with those without weakness. Method(s): A prospective study carried out with individuals of post-COVID-19 outpatient clinic of the Pulmonology Department of Hospital Sao Paulo/Brazil. Assessment of maximal respiratory pressures and maximal handgrip strength (HGS) were performed in the first assessment after hospital discharge (60+/-20 days after the onset of symptoms). Individuals with maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) lower than 80% of predicted were considered respiratory muscle weakness. Result(s): 269 patients were evaluated, most were male (55%), 55+/-14 years, BMI 30+/-7 Kg/m , average length of stay for hospital 14+/-10 days, of which 138 (51%) were referred to the ICU (11+/-9 days) and 49 (87%) required invasive mechanical ventilation. Inspiratory and expiratory muscle weakness was verified in 85 (32%) and 72 (27%) patients, respectively. Patients with inspiratory muscle weakness had MIP of 67+/-22 vs 110+/-26 cmH2O (p<0.001), MIP 2 %predicted 65+/-13 vs 108+/-18 cmH2O (p<0.001), sustained MIP of 60+/-21 vs 110+/-26 cmH2O (p<0.001), MEP of 73+/-32 vs 104+/-34 cmH2O (p<0.001), MEP%predicted of 72+/-23 vs 94+/-25 cmH2O (p<0.001). The HGS of patients with inspiratory muscle weakness was 17+/-10 vs 22+/-12 KgF (p<0.05). Conclusion(s): After hospital discharge for COVID-19, 32% of patients had inspiratory muscle weakness and 27% had expiratory muscle weakness. Patients with inspiratory muscle weakness had lower maximal HGS when compared to patients without inspiratory muscle weakness.

Prognosis for ICU Admission in hospitalized patients with Coronovirus diseases -19 (COVID-19)

Introduction: Anew respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analyzing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Many clinical reports focused on laboratory parameters have been reported on COVID-19, as indicators of systemic inflammation, such as neutrophil to lymphocyte ratio (NLR), may be used to predict disease severity and outcome. Method(s): Prospective observational study of PCR-confirmed COVID-19 patients hospitalized in a pulmonology department in Athens, from January 2021- February 2022. We evaluated the accuracy of clinical signs, symptoms, laboratory tests and biomarkers at clinical presentation in predicting ICU admission. Result(s): Of 534 included patients with COVID-19, mean age 58 years old, 267 were women (50%), 400(75%) had comorbidities, 67(12%) were smokers and 102(19%) of them were fully vaccinated. The most common comorbidities were cardiac (18%), DM (16%), pulmonological (12%) and neurological (14%) diseases. 220 (41%) patients hospitalized with severe disease in terms of acute respiratory failure, 86 (16%) admitted to ICU, 72 (14%) received High Flow Nasal Canula and 25 (5%) died. We found that obesity, age, high level of C-reactive protein (CRP), lactate dehydrogenase (LDH), Ferritin, NLR and decreased PO2/FIO2 ratio (PAFI) are associated with ICU admission. After multivariate analysis only LDH, NLR and PAFI were significantly associated with the need of mechanical ventilation. Conclusion(s): In hospitalized patients with COVID-19, PAFI, NLR and LDH at admission are progonostic factors for ICU admission.

The impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in developing countries

Introduction: The COVID-19 pandemic has caused an overload within health care structures in Tunisia, impacting negatively on the management of other pathologies. In this study, we estimated the impact of the COVID-19 pandemic on delay in diagnosis and management of lung cancer in a Department of Pulmonology in Tunisia. Method(s): A retrospective study including patients with lung cancer managed between January 2019 and December 2021 in the Pulmonology IV Department of Abderrahmane Mami Hospital. The patients were divided into two groups: Group 1(G1):(n= 59) included patients diagnosed before Covid-19 pandemic (January/December 2019). Group 2 (G2): (n =71) diagnosed during the Covid-19 pandemic (march 2020/December 2021). Result(s): One hundred and thirty male patients were included with an average age of 60.8 years. The mean delay between the onset of symptoms and the first consultation was 43.27 days in G1 versus 39.92 in G2 . The mean delay between first consultation and the histological diagnosis was significantly longer in G2 (34.3 days vs 31.85 days in G1;p = 0.037). The most common histological type in both groups was adenocarcinoma. Sixty point six percent of patients of G2 were diagnosed at metastatic stage (vs 47.5 % in G1 ). The mean delay between histological diagnosis and initiation of specific treatment was significantly longer in G2 (60.34 days vs 41.67 days in G1 ;p = 0.014). Conclusion(s): The study demonstrates the significant impact of COVID-19 on diagnostic and therapeutic delays for lung cancer patients in our department. A specific care pathway needs to be created in order to ensure treatment within the optimal deadlines.