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1.
Cureus ; 15(4): e37312, 2023 Apr.
Article in English | MEDLINE | ID: covidwho-20238969

ABSTRACT

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.

2.
Infektsionnye Bolezni ; 21(1):152-161, 2023.
Article in Russian | EMBASE | ID: covidwho-20234226

ABSTRACT

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.

3.
Curr Drug Saf ; 2022 May 18.
Article in English | MEDLINE | ID: covidwho-2326160

ABSTRACT

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.

4.
Journal of Investigative Medicine ; 71(1):7, 2023.
Article in English | EMBASE | ID: covidwho-2318616

ABSTRACT

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.

5.
Online Information Review ; 47(3):469-485, 2023.
Article in English | Academic Search Complete | ID: covidwho-2316937

ABSTRACT

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.)

6.
Medicina Interna de Mexico ; 39(1):46-65, 2023.
Article in Spanish | EMBASE | ID: covidwho-2316817

ABSTRACT

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.

7.
Journal of Cystic Fibrosis ; 21(Supplement 2):S57, 2022.
Article in English | EMBASE | ID: covidwho-2315359

ABSTRACT

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

8.
Pneumologie ; 77(Supplement 1):S105, 2023.
Article in English | EMBASE | ID: covidwho-2291639

ABSTRACT

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.

9.
J Clin Invest ; 133(12)2023 06 15.
Article in English | MEDLINE | ID: covidwho-2295322

ABSTRACT

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.


Subject(s)
COVID-19 , Pneumonia, Ventilator-Associated , Respiratory Insufficiency , United States , Humans , Prospective Studies , COVID-19/therapy , Pneumonia, Ventilator-Associated/drug therapy , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/prevention & control , Bronchoalveolar Lavage
10.
Allergy: European Journal of Allergy and Clinical Immunology ; 78(Supplement 111):599, 2023.
Article in English | EMBASE | ID: covidwho-2302573

ABSTRACT

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.

11.
National Journal of Physiology, Pharmacy and Pharmacology ; 13(4):714-719, 2023.
Article in English | ProQuest Central | ID: covidwho-2302038

ABSTRACT

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.

12.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2257690

ABSTRACT

Background: Lockdowns and mask wearing have impacted infectious disease patterns during the COVID-19 pandemic. We investigated changes in the use of bronchoscopy and the results of routine microbiology in bronchial lavage. Method(s): We included bronchoscopies from 2017-2021 at the LMU University Department of Pulmonology. In this we present an initial cohort comparing bronchoscopies in 2017-2018 to the initial phase of the COVID-19 pandemic in 2020. Comparisons used chi-squared and Fischer's exact tests in SPSS. Result(s): We analysed 480 bronchoscopies from before and 85 during the COVID-19 pandemic. Mean age: 62.6 y (+/-14.1) before vs. 55.2 y (+/-16.3) during the pandemic (p<0.001). Indication for bronchoscopy: secretions/atelectasis (n=122), suspected tumor (n=89) and intervention/therapy (n=80) before;suspected tumor (n=30), respiratory deterioration after lung transplant (n=19) and infection (n=7) during the pandemic. Staphylococcus aureus and Pseudomonas aeruginosa were common in both groups. Frequencies of EBV (p<0.001), CMV (p=0.003) and HHV6 (p<0.001) differed significantly. Conclusion(s): There were clinically relevant differences in the use of bronchoscopy before vs. during the COVID-19 pandemic: pandemic patients were younger and interventions such as bronchial stenting and recanalisation less common. Bacterial results were similar but the frequency of common viruses differed. The effect of lockdowns, mask wearing and social distancing on bronchial microbiology in patients with lung cancer or chronic lung disease will be investigated in further detail in this cohort. Clinical relevant differences may support continued mask wearing in some high-risk situations post-pandemic.

13.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2257424

ABSTRACT

MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA IN POSTCOVID PATIENTS REFERRED TO PULMONARY REHABILITATION In patients who suffer sequels after severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV2), dyspnea is the most prevalent respiratory symptom. We aimed to analyze a subgroup of patients under follow-up in the pulmonology rehabilitation units after hospitalization for moderate-severe SARS-CoV2 pneumonia. We prospectively studied 455 patients until November 2021. We analyzed: dyspnea by mMRC scale, grade of fatigue by FACIT-F (0 without fatigue-4 intense fatigue), spirometry and DLCO, 6-minute walk test (Osses'equations), isometric strength of dominant quadriceps (weakness threshold <70%), maximal sniff nasal inspiratory pressure test (weakness thresholds <70 cmH2O for men and <60 cmH2O for women), body composition and physical activity IPAQ-7. We grouped our sample according to the severity of the mMRC dyspnea (>= 2 vs < 2) and results were compared for the global sample and separately for men and women. Table 1 shows the baseline characteristics. 41.5% of women and 19.5% of men showed inspiratory muscle weakness. 52.7% of the patients reported dyspnea mMRC >= 2 and studied variables were significantly worse (Table 2). In the women group, only the 6-minute walk distance, the level of physical activity and the fatigue grade were significantly worse in patients with greater dyspnea (Table 2). Conclusion(s): In our sample, multifactorial moderate-intense dyspnea becomes a good marker of functional capacity, muscle function, grade of fatigue and physical activity in patients who have suffered from moderate-severe Covid-19 pneumonia.

14.
Am J Transplant ; 23(2): 294-297, 2023 02.
Article in English | MEDLINE | ID: covidwho-2278883

ABSTRACT

Lung transplant candidates who are highly sensitized against human leucocyte antigen present an ongoing challenge with regards to finding immunologically acceptable donors. Desensitization strategies aimed at reducing preformed donor-specific antibodies have a number of limitations. Imlifidase, an IgG-degrading enzyme derived from Streptococcus pyogenes, is a novel agent that has been used to convert positive crossmatches to negative in kidney transplant candidates, allowing transplantation to occur. We present the first case of imlifidase use for antibody depletion in a highly sensitized lung transplant candidate who went on to undergo a successful bilateral lung transplant.


Subject(s)
Kidney Transplantation , Lung Transplantation , Humans , Antibodies , Immunosuppressive Agents , Kidney Transplantation/adverse effects , Tissue Donors , HLA Antigens , Lung Transplantation/adverse effects , Histocompatibility Testing , Desensitization, Immunologic , Graft Rejection/drug therapy , Graft Rejection/etiology
15.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2289153

ABSTRACT

Introduction: Lymphopenia is defined as a peripheral blood lymphocyte count <1500/mm3. It may be a predictive factor for clinical outcomes of COVID-19, including mortality. This study aims to explore the relationship between lymphocyte count and the severity of COVID-19. Method(s): Retrospective study of hospitalized patients with COVID-19 (Moderate and Severe COVID-19 Pneumonia) in pneumology department D of Abderahman Mami hospital. We compared 2 groups: (G1) 197 patients with lymphopenia versus (G2): 100 patients without lymphopenia Results: The two groups were comparable with regard to the frequency of dyspnea (70% G1 vs 63%, p=0.05). Among the 197 patients in G1, 69.3% of patients were >=60 years old vs 38% in G2, p=0.3. Comorbidities were similar between G1 and G2 (cardiovascular comorbidites: 43% G1 vs 52%G2 and respiratory comorbidites 21.8% G1 vs20% in G2). No significant difference was found between oxygen requirements (6.7L/min in G1 vs 5.1L/min in G2, p=0.2). There was a trend toward higher serum CRP and D-dimer levels in G1 (96% in G1 vs. 92% in G2, p=0.05 and 51% in G1 vs. 43% in G2, p=0.2 respectively). The prevalence of lung involvement >50% was 28.5% G1 vs 20.8%, p=0.1. Patients in groups G1 and G2 required non invasive ventilation and transfer to an intensive care unit in a comparable manner (30% in group 1 vs 22% in group 2, p=0.1). No significantly higher mortality rate was associated with lymphopenia (8.2% in G1 vs 6.8% in G 2, p=0.6). Conclusion(s): lymphopenia was not predictive of disease severity in COVID-19 patients in this study.

16.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2288283

ABSTRACT

Introduction: Although a SARS-CoV-2 infection resolves completely in most cases, in some patients it can progress to pneumonia with associated severe respiratory distress. Some of them will suffer persistent symptoms, impairment of the quality of life, deterioration of the pulmonary function and/or a worse exercise capacity. Objective(s): To observe the evolution of the quality of life and the dyspnoea grade in patients with severe SARS-CoV2 pneumonia during a 12-month follow-up. Method(s): Observational prospective cohort study started between March and June 2020 at Dr. Josep Trueta Hospital of Girona and Santa Caterina Hospital of Salt. Patients with severe pneumonia who required hospitalization at the Pulmonology Department were included. A twelve-month follow-up with controls at the third- and sixth- month was performed. Clinical characteristics, radiological data (high resolution CT), quality of life (Saint George's Respiratory Questionnaire-SGRQ and mMRC dyspnoea scale), pulmonary function and exercise capacity (6-meter walking test) were assessed. Result(s): 94 patients were analysed. In a year span, there was an improvement in the SGRQ of 3.9 points in the total score (p = 0.019). At the third month, there were 21.50% of patients with severe dyspnoea (mMRC 2-3), decreasing progressively to only 9.50% at the twelfth month. The walking test showed an improvement in distance walked without showing desaturation while making effort. Lung function analysis only showed a DLCO alteration, which was corrected at 6 months. Conclusion(s): After one-year post severe SARS-CoV-2 pneumonia, there is a significant improvement in quality of life as well as in dyspnoea grade and exercise capacity.

17.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2285190

ABSTRACT

Introduction: SARS-COV-2 is mainly transmitted through respiratory droplets. The standard diagnostic procedure is based on a reverse transcription polymerase chain reaction (RT-PCR). Aim(s): 1) To develop a safe and easy to perform breath test for the detection of COVID-19 in hospitalised patients based on the analysis of volatile organic compounds (VOCs) in exhaled breath. 2) To differentiate in hospitalised patients with respiratory symptoms those with and without COVID-19. Method(s): We performed a monocenter, cross-sectional, case-control study in 38 subjects (63% males, age 62+/-12.7 yrs) admitted at the pulmonology ward. Breath samples were taken using a home-made sampling system. Analysis of breath samples was performed by proton transfer high resolution mass spectrometry (PTR-HRMS). A lassoregression with leave-one-out cross-validation was performed to differentiate the groups and designate the most differentiating VOCs. Result(s): COVID-19 positive (n=22) and control respiratory patients (n=16) were similar with respect to baseline characteristics, except for lower blood neutrophil and lymphocyte counts and higher ferritin level in COVID+ve patients (p<0.05). Lasso-regression revealed 6 VOCs as potential biomarkers that differentiated between both groups with 84% accuracy, 100% specificity and 100% positive predictive value based on PTR-HRMS data. Conclusion(s): Breath analysis could identify a breathprint differentiating between hospitalised COVID-19 and nonCOVID-19 patients with respiratory symptoms with a good accuracy. Therefore, VOCs profiling could be integrated in sensors allowing a fast breathalyzer for COVID-19 for large-scale screening.

18.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2284726

ABSTRACT

The value of (A-a)DO2 (alveolar-arterial oxygen gradient) is a simple way to measure alterations of the alveolarcapillary unit and could represent a reference of respiratory worsening. The aim of our study was to establish if the (A-a)DO2 values in patients with moderate/severe forms of COVID-19 could predict the evolution of the patients. We enrolled 41 adult patients with confirmed SARS-CoV-2 infection and respiratory failure, evaluated in the Hospital of Pneumology over three months. Considering only patients with available data from arterial blood gases analysis: three representative samples - between days 1-3, 4-7 and 8-10 on the same FiO2 (fraction of inspired oxygen), the (A-a)DO2 was measured and compared to the expected values for age. From a final population of 24 patients, 12 under RM (reservoir mask) and 12 under NIV (non-invasive ventilation), 9 died (55% under NIV). The gradient curves showed that in the group of the deceased, the (A-a)DO2 average values remained high (RM: 447- 470- 482 mmHg;NIV: 136- 171- 198 mmHg), whereas in the survivors' group, the values of the gradient described an ascending-decreasing slope (RM: 467- 458- 426 mmHg;NIV: 151- 167- 119 mmHg) that corresponds to the improvement of the pulmonary damage. The (A-a)DO2 resulted to be a good predictor of severity and mortality in patients with SARS-COV-2 infection and also for the need of oxygen therapy and NIV. Therefore we decided to use (A-a)DO2 instead of PaO2 (partial pressure of oxygen) in the surveillance of patients with COVID-19 because of its better capability to underline the presence of ventilatory/perfusion mismatch, mechanism underlying in the pathophysiology of hypoxemia in COVID19.

19.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2283209

ABSTRACT

Introduction: Significant portion of the patients manifest symptoms, like coughing, dyspnoea, fatigue, exercise intolerance, sleep disorders or neuropsychological symptoms in post-COVID condition. It has influence on patients' quality of life and workability. Pulmonary rehabilitation (PR) has favourable effect on the cardiovascular system, metabolism, respiratory and peripheral muscles, lung mechanics and psychological condition of the patient. Aim(s): Our aim was to assess the effectiveness of a post-COVID PR program in terms of the improvement of patients' functional condition and quality of life. Method(s): 50 patients were involved (female:male=26:24, age 55+/-12 years, BMI: 31+/-8 kg/m2) at the Department of Pulmonology, Semmelweis University, Budapest, Hungary. At the onset of the program we measured lung function, 6-minute walking distance (6MWD), chest wall expansion (CWE), lung function and quality of life (EQ5D and postCovid Functional Scale (PCFS). The post-COVID rehabilitation included controlled breathing techniques, chest wall mobilization, strengthening of respiratory and peripheral muscle, endurance training for cycle and treadmill, dietetic, psychological health assessment and counselling. Result(s): Rehabilitation resulted in improvement in 6MWD (496.16 (80-780) vs. 526.32 (328-744) m;p<0.05), CWE (39.4 (15.2-98.9) vs. 47.4 (20.1-100.5) cm;p<0.05) and quality of life (EQ5D, PCFS). Statistically significant improvement was detected in IVC and FVC. No side effect was observed related to the PR program. Conclusion(s): There is an urgent need of an available PR for patients who suffer from post-COVID pulmonary symptoms to avoid serious medical, social and economic complications and it is safe for the patients.

20.
European Respiratory Journal Conference: European Respiratory Society International Congress, ERS ; 60(Supplement 66), 2022.
Article in English | EMBASE | ID: covidwho-2279305

ABSTRACT

Introduction: Owing to post-Covid 19 pulmonary sequelae, there are a considerable number of COVID-19 survivors requiring respiratory rehabilitation. We aim to reveal the impact of pulmonary rehabilitation as an effective intervention in these patients. Method(s): Prospective study of hospitalized patients with COVID-19 in pneumology department D of Abderahman Mami hospital. We evaluated symptoms and pulmonary function tests assessments in patients (N = 28) who participated in the pulmonary rehabilitation program,including respiratory muscle training and breathing exercises (twice a week for 6 weeks) at one month after discharge and 6 weeks after training. Result(s): The average age was 58.7 years. A severe lung involvement (>50%) was revealed in 25% (n=7). The most common comorbidities were hypertension (n=11) and diabetes (n=6). Common persistent symptoms post COVID 19pneumonia were: breathlessness (19cases with mean mMRC scale 1.82), fatigue (n=19) and cough (n=12). This study showed a significant decrease of persistent symptoms after 6 weeks: 2 cases of persistent dyspnea (mMRC scale 1 vs 1.82, p=0.03), 1 case of cough and 1 case of fatigue. Pulmonary function revealed statistically significant improvement after this program: TLC (73.2% vs 86.1%, p<0.01), FEV1 (93.4% vs 98.6%, p<0.01), FVC (89.4% vs 95.8%, p<0.01) and DLCO (63.9% vs 75.3%, p<0.01). A significant increase in distance traveled after the six-minute walk test was found (473 vs 517 meter, p<0.01). Respiratory muscle training improved maximum inspiratory pressure (PImax 70.5cmH20 vs 81.3, p<0.01) and maximum expiratory pressure (PEmax 80.4 cmH20 vs 87, p<0.01) Conclusion(s): Respiratory rehabilitation improve symptoms and pulmonary function after COVID-19 pneumonia.

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