Respiratory outcomes 3-month following COVID-19- related hospitalisation: a Tunisian prospective study

Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.

Bronchiolitis 2021-2022: the other viruses revenge

Background: bronchiolitis is a common lung infection in young children and infants. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months. During covid pandemic, the incidence of bronchiolitis had drastically decreased but this winter, cases of this airway inflammation increased and were more severe. Objective(s): to study the prevalence of bronchiolitis during the winter season and describe its epidemiology, clinical features and outcome. Method(s): retrospective study in a general pediatric ward from november 2021 till january 2022. Result(s): we collected 207 cases admitted for bronchiolitis, in compraison with 162 cases in 2020. Le The hospitalization peak was in november 2021 (36.7%). The sex ratio was 1.43. The mean age was 88 days, the younger than 3 months represented 69.5% of cases. A viral contat was noted in 84.5% of cases. The bronchiolitis was mild in 20.2% of cases, moderate in 57.9% of cases and severe in 21.7% of cases. RSV was isolated in 25 case, Influenza A in 20 cases, viral co-infection was noted in 14 cases while bacterial co-infection was observed in 25 patients. Oxygenotherapy was indicated in 64.7% of patients with a mean duration of 5.6 days. Twenty-two patients were transferred in ICU with the use of non-invasive ventilation in 14 cases and mecahnical ventilation in 13 cases. The mean hospital stay was about 6.7 days. Conclusion(s): although the decrease of the incidence of bronchiolitis during covid 19 pandemic, an important incerease in incidence and intensity of this airway pathology was noted after the 4th wave, explained by the loss of the collective immunity in the younger infants less than 3 months.

Post COVID syndrome in health care workers in Tunisia: is there any correlation with SARS-CoV-2 IgG level?

Introduction: The correlation between the level of IgG titers and disease severity during the acute phase of COVID19 is well described. However, rare data are available on possible association between IgG titre and post COVID syndrome (PCS). Method(s): It was a prospective study. HCW who presented to the post-COVID outpatient clinic, 3 months after recovery were included. HCW were asked about the acute phase of COVID-19 and PCS symptoms and had serum samples for SARS-CoV-2 IgG. Aim(s): analyse the incidence of PCS among health care workers (HCW) and correlation with SARS-COV2 IgG level. Result(s): 108 HCW were included (mean age: 42.12+/- 10.31 years, sex ratio was 0,4). Initially, 4.6% experienced severe disease. PCS was detected in 63% of cases. Main symptoms were memory impairment (36.8%), fatigue (35.3%), dry cough (32.4%), dyspnea (32.4%) and asthenia (29.4%). The incidence was 100%, 57,1% and 62,7% in patients with severe pneumonia, mild pneumonia and without pneumonia, respectively (p=0,079, p=0,45 and p=0,92) (The incidence was 7,4%, 23,5% and 69,1% in patients with severe pneumonia, mild pneumonia and without pneumonia, respectively (p=0,079, p=0,45 and p=0,92)). At Follow up, the IgG level was positive in 70.4% of cases with an average rate of 8.44. HCW with PCS, were more likely to have a positive IgG level (67% vs 32%;p=0,41). Moreover, IgG rate was higher in this population (9.06 vs 7,48;p=0,38). Patients with no IgG had 40% less possibility to have PCS symptoms. Conclusion(s): The present study confirmed a high incidence of PCS in HCW. These symptoms were associated to a higher level of IgG suggesting immunological mecanisms. Further studies are needed to confirm these data.

Predictive factors of mechanical ventilation among critically ill adults with COVID-19

Introduction: Acute respiratory failure is the main indication for ICU admission in COVID-19 patients. Most of these patients will require invasive mechanical ventilation (IMV). Aim(s): Identify predictive factors for IMV in Tunisian patients with COVID19 hospitalized in intensive care unit (ICU). Method(s): Cross sectional comparative study conducted in Rabta hospital in Tunis, Tunisia from January 2021 and December 2021. Patients with laboratory confirmed COVID-19 admitted in ICU department were enrolled. Clinical, biological and radiological features of all patients were assessed. Patients requiring MV (G1) and those no (G2) were compared. Result(s): A total of 95 patients were included (61 in G1;34 in G2). There was no significant difference between the 2 groups regarding to age or gender. However, comorbidities such as dyslipidemia, stroke and hypertension were more frequent in G1. Among symptoms, anosmia and confusion were predictive for IMV. Patients with anosmia and confusion had respectively 45% and 25% higher risk for IMV. C-reactive protein (CRP) level (95% in G1 VS 89% in G2;p=0.003), D-dimer rate (86.5% in G1 VS 60% in G2;p=0.008) and severe radiological extension (>50%) (64% in G1 VS 35% in G2;p=0.08) were significantly higher in G1. Conclusion(s): Among ICU admitted patients, comorbidities, neurological symptoms, elevated rate of D-dimer and CRP and important radiological damage are the main risk factors for requiring IMV.

Vaccination and hospitalization of COVID-19:what difference does it make?

Background: The world is currently facing the coronavirus disease(COVID-19)pandemic which places great pressure on health care systems. Global vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. Aim(s): To evaluate the impact of COVID-19 vaccination on the length of hospital stay,admission to an intensive care unit (ICU)and deaths from covid-19 infection in patients hospitalized with severe Covid-19 pneumonia. Method(s): Retrospective comparative study between September 2021 and February 2022 including patients hospitalized with severe Covid-19 pneumonia. Patients were divided according to their covid-19 vaccination status into two groups:G1:Vaccinated patients(n=30);G2:Non vaccinated patients(n=100). Result(s): We enrolled 130 patients. Among vaccinated patients,19 were received a messenger RNA vaccine and 11 were received a viral vector vaccine. There was no difference between the two groups in the mean age(62.7 vs 62.2 years,p=0.1),sex ratio(1.75 vs 1.15,p=0.5)and smoking history(22.7% vs 32%,p=0.5). Hypertension, diabetes,obesity and chronic renal failure were the most frequent comorbidities observed in the two groups without significant difference. Non-vaccinated Patients showed significant increase in admission to intensive care unit(17.9% Vs 4.5% in G1,p=0.01)and mortality(11% Vs 4.8% in G1,p=0.02)compared to G1. The median length of hospital stay was shorter in the vaccinated patients(5 [3-12] days vs 8.5[1-15] days,p=0.01).the average oxygen requirements were higher in patients without vaccination (7.5 vs 11 Liter/minute,p=0.01). Conclusion(s): Vaccination can reduce the length of hospital stay and can ovoid the admission to intensive care unit and reduces covid-19 mortality.

Facteurs influencant la duree d'hospitalisation au cours du COVID-19

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022

Impact du tabagisme sur la presentation radioclinique et evolutive de l'infection COVID

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022

Impact de la pandémie COVID-19 sur le suivi des patients asthmatiques

Introduction Les deux dernières années ont été marquées par la perturbation de système sanitaire partout dans le monde à cause de la pandémie au virus SARS-CoV-2. Le suivi des patients ayants une maladie chronique dont l’asthme a été perturbé. Notre objectif est de voir l’impact de la pandémie COVID-19 sur le suivi des patients asthmatiques et leurs attitudes au cours de cette pandémie. Méthodes Il s’agit d’une étude descriptive, transversale menée au service de pneumo-allergologie du CHU la Rabta, durant le mois d’août 2021 intéressant les patients asthmatiques. Tous les patients ont été interrogés par téléphone sur l’impact du COVID sur leurs maladie, les données cliniques, paracliniques, le contrôle ancien de la maladie et l’observance avant la COVID ont été recueillis à partir du dossier médical. Résultats Quarante-quatre patients ont été recensés. L’âge moyen des patients était 49±14,5 ans. Le sex-ratio femme/homme était à 2,66. Tous les patients avaient un phénotype allergique avec atopie. L’observance thérapeutique, évaluée par le score de Morisky avant la pandémie, était mauvaise dans 54,5 % avec une moyenne des exacerbations par mois de 3,05±1,64 (p=0,00). Pendant la pandémie COVID-19, les patients avaient une meilleure observance thérapeutique dans 77,3 %. Le nombre des exacerbations par mois a diminué avec une moyenne de 2,54±2,12 (p=0,00). Par contre, la COVID-19 paraît avoir un impact péjoratif sur le suivi des patients puisque seulement 45,5 % des patients ont maintenu un suivi régulier. En plus, 56,8 % des asthmatiques ont raté leurs rendez-vous pour des différentes causes. La cause la plus fréquente était la crainte de la contamination à l’hôpital dans 52,3 %. Au cours des exacerbations, 40,9 % des patients préféraient l’automédication que le recours aux urgences. Conclusion La pandémie à la COVID-19 a limité l’accès aux soins pour ceux ayant des pathologies chroniques. Cette situation paraît avoir un impact péjoratif sur le suivi des patients asthmatiques. Par conséquent, cela a modifié leurs attitudes devant les exacerbations.

Évolution de l’atteinte pulmonaire au scanner thoracique 6 mois après une pneumonie à COVID-19

Introduction Certains patients gardent des symptômes plus longtemps en particulier les formes sévères de pneumonie COVID-19 mais les conséquences pulmonaires à long terme n’ont pas encore été bien élucidées. Trois mois après l’infection aiguë, un sous-ensemble de patients présente des anomalies tomodensitométriques résiduelles. Les données évolutives à 6 mois sont moins nombreuses. Le but de notre étude est d’évaluer les séquelles radiologiques à 6 mois et rechercher les facteurs qui y sont associés. Méthodes Il s’agit d’une cohorte de 300 patients hospitalisés entre septembre 2020 et mars 2021 pour pneumonie COVID-19, avec recueil rétrospective de données. Tous les patients ont consulté à 1 puis 3 à mois. Parmi eux, 60 patients ont bénéficié d’une TDM thoracique à 3 mois. Les patients symptomatiques ou présentant une atteinte radiologique persistante ont été revus à 6 mois. Deux groupes ont été comparés G1 et G2. G1 regroupe les patients présentant des anomalies radiologiques en faveur de fibrose pulmonaire. Les patients n’ayant pas de lésions sont inclus dans le groupe G2. Résultats Trois cent patients étaient revus à 3 mois, seuls 60 patients ont bénéficié d’une TDM thoracique à 3 mois montrant une atteinte interstitielle pulmonaire persistante chez 20 patients. À 6 mois, 9 patients avaient des lésions persistantes (G1). Tous les patients ont gardé une asthénie et une dyspnée d’effort (stade 3 mMRC chez 2 patients et stade 2 mMRC chez le reste). Les lésions radiologiques les plus fréquentes étaient les opacités en verre dépoli (75 %) suivies des bronchiolectasies (45 %) et épaississement septal (35 %) et distorsion scissurale (30 %) et bronchique (20 %). Comparativement à G2, G1 avaient une moyenne d’âge plus élevée (p=0,037), une durée d’hospitalisation plus longue (p=0,03), un score de gravité tomodensitométrique plus élevé lors de l’examen initial (sept patients ont une atteinte parenchymateuse supérieure à 75 %) et un taux plus élevé d’admission en unité de soins intensifs (6 patients) (p=0,04). Il n’y avait pas de différence significative concernant les paramètres biologiques le taux de leucocytes, taux de lymphocytes, CRP et LDH (p>0,05). Conclusion À 6 mois du suivi, certains patients garderaient les anomalies radiologiques pouvant cadrer avec fibrose pulmonaire débutante. Une atteinte initiale étendue à l’admission en soins intensifs, une longue durée d’hospitalisation seraient associées à une plus grande prévalence de séquelles pulmonaires de COVID-19.