ABSTRACT
BACKGROUND: The coronavirus disease (COVID-19) pandemic has already affected more than 400 million people, with increasing numbers of survivors. These data indicate that a myriad of people may be affected by pulmonary sequelae of the infection. The aim of this study was to evaluate pulmonary sequelae in patients with bilateral COVID-19 pneumonia according to severity 1 year after hospital discharge. METHODS: COVID-FIBROTIC is a multicenter prospective observational cohort study for admitted patients with bilateral COVID-19 pneumonia. Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and we classified patients into three groups according to severity. A post hoc analysis model was designed to establish how functional test changed between groups and over time. A multivariable logistic regression model was created to study prognostic factors for lung diffusion impairment and radiological fibrotic-like changes at 12 months. RESULTS: Among 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ± 11.9 and 55.3% were men. We found between-group differences in male sex, length of hospital stay, radiological involvement and inflammatory laboratory parameters. The functional evaluation of pulmonary sequelae showed that severe patients had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls. At 12-month follow up, however, we found impaired lung diffusion in 39.8% unrelated to severity. Radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55, 95% CI 1.06-2.38; p = 0.02) and LDH (OR: 0.99, 95% CI 0.98-0.99; p = 0.046). CONCLUSION: Our data suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process. Trial registration clinicaltrials.gov NCT04409275 (June 1, 2020).
Subject(s)
COVID-19 , Pneumonia , Aged , COVID-19/diagnostic imaging , Female , Follow-Up Studies , Humans , Lung/diagnostic imaging , Male , Middle Aged , Pneumonia/complications , Prospective StudiesABSTRACT
This study analyzes the relationship between the mycobiome of the Lower Respiratory Tract (LRT) and the fungi in the domestic environment. Samples studied consisted of Broncho-Alveolar Lavage (BAL) from 45 patients who underwent bronchoscopy for different diagnostic purposes, and dust and air from the houses (ENV) of 20 of them (44.4%). Additionally, five bronchoscopes (BS) were also analyzed and negative controls were included for every procedure. All samples were processed for DNA extraction and cultures, which were performed in Sabouraud Dextrose and Potato Dextrose Agar. The fungal Internal Transcribed Spacer (ITS2) was sequenced by the Solexa/Illumina system and sequences were analyzed by QIIME 1.8.0 and compared with the UNITE Database for identification. The similarity between the two fungal communities (BAL and ENV) for a specific patient was assessed via the percentage of coincidence in the detection of specific operational taxonomic units (OTUs), and about 75% of co-occurrence was detected between the mycobiome of the LRT and the houses. Cultures confirmed the presence of the core mycobiome species. However, the low rate of isolation from BAL suggests that most of its mycobiome corresponds to non-culturable cells. This likely depends on the patient's immune system activity and inflammatory status.
ABSTRACT
El tratamiento endoscópico establecido de las estenosis traqueobronquiales tipo web-like es el láser. La aparición en el mercado de un nuevo modo de corte con un menor efecto coagulante se ha postulado como una alternativa al láser debido a un menor daño en los tejidos afectados. Objetivos: Estudiar las consecuencias clínicas, funcionales y los efectos secundarios de esta técnica y posteriormente compararla con un grupo similar de pacientes tratados con láser ND-YAG. Pacientes y método: Entre marzo del 2005 y julio del 2007 se incluyeron 22 pacientes que fueron sometidos a 34 procedimientos de broncoscopia intervencionista mediante el sistema de radiofrecuencia VIO-300-D, usando un modo el programa Endo-cut I en combinación con el electrodo de cuchilla reutilizable. Resultados: El 100% de los pacientes tratados presentaron mejorías de los síntomas, del diámetro de la luz traqueobronquial y de la función pulmonar que fueron estadísticamente significativas. El tiempo libre de síntomas fue de 157±93 días, y menos del 50% de los pacientes necesitaron una segunda intervención. Retrospectivamente, se compararon estos pacientes con un grupo similar de 22 pacientes tratados con el láser Nd-YAG. El análisis de seguimiento mostró que solo el 18% (4/22) de los pacientes tratados con esta nueva técnica presentaron fibrina, en comparación con el 41% (9/22) de los tratados con láser (p<0,001). Conclusión: El uso de esta técnica es eficaz en el tratamiento de las estenosis benignas traqueobronquiales tipo web-like ya que todos los pacientes mostraron mejoría clínica y funcional, requiriendo menos del 50% una segunda intervención. En comparación con el láser, una ventaja de esta técnica es la menor producción de fibrina, probablemente debido a su menor efecto anticoagulante(AU)
The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. Objectives: To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. Patients and methods: Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. Results: All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157±93 days. There was an overall decrease observed in mean obstruction (P<.001). Improvements in FVC (P=.01), Raw (P=.0016) and RV/TLC (P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy (P<.001). Conclusion: The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anticoagulation effect(AU)
Subject(s)
Humans , Tracheal Stenosis/surgery , Bronchoscopy/methods , Electrosurgery/methods , Prospective Studies , /methods , Laser Therapy/methods , FibrinABSTRACT
UNLABELLED: The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. OBJECTIVES: To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. PATIENTS AND METHODS: Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. RESULTS: All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157 ± 93 days. There was an overall decrease observed in mean obstruction (P<.001). Improvements in FVC (P=.01), Raw (P=.0016) and RV/TLC (P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy (P<.001). CONCLUSION: The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anti-coagulation effect.
Subject(s)
Airway Obstruction/surgery , Bronchial Diseases/surgery , Bronchoscopy/methods , Electrosurgery/instrumentation , Tracheal Stenosis/surgery , Adult , Aged , Bronchial Diseases/therapy , Catheterization , Combined Modality Therapy , Constriction, Pathologic/surgery , Constriction, Pathologic/therapy , Electrosurgery/methods , Female , Humans , Male , Middle Aged , Prospective Studies , Reoperation , Tracheal Stenosis/therapy , Treatment Outcome , Young AdultABSTRACT
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