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Purpose: We aimed to investigate risk factors for COVID-19 pneumonia in patients with hematological malignancies (HM) after Omicron infection. Methods: Data from a registered multi-center, prospective, observational study (ChiCTR2300071830) during the latest Omicron BA.5.2 wave in Chongqing, China was used for analysis. Results: A total of 475 HM patients enrolled in this study. COVID-19 pneumonia was observed in 15.8% (75/475) of patients, with a median age of 58 years (interquartile range [IQR], 48-69 years) and males accounting for 61.3%. Risk factors associated with COVID-19 pneumonia included: 1) Active disease status of HM at infection, with an odds ratio (OR) of 3.42 (95% confidence interval [CI]: 1.59-7.37, P=0.002) compared to complete remission (CR); 2) Incomplete COVID-19 vaccination, 1-2 doses of the vaccine (OR=2.55, 95% CI: 1.28-5.10, P=0.008) or no vaccination (OR=4.81, 95% CI: 2.45-9.43, P<0.001), as opposed to 3 doses (booster); 3) chemotherapy prior to infection, <6 months (OR=2.58, 95% CI: 1.12-5.96, P=0.027) or ≥ 6 months (OR=2.93, 95% CI: 1.31-6.53, P=0.009) compared to no chemotherapy history; 4) NK-cell reduction (< 150/μL) (OR=2.19, 95% CI: 1.27-3.79, P=0.005) versus a normal range of NK cells. During the 6-week follow-up period, 12 patients (2.5%) died, accounting for 16% of COVID-19 pneumonia patients. Conclusions: Our study investigated risk factors for COVID-19 pneumonia in HM patients after Omicron BA.5.2 infection. Highlights that HM patients with these risk factors may be susceptible to lung involvement after Omicron BA.5.2 infection and need to be taken seriously in clinical practice. Clinical Trial Registration: https://www.chictr.org.cn/bin/project/edit?pid=195998 , identifier ChiCTR2300071830. [ABSTRACT FROM AUTHOR]

Hypoxic pulmonary vasoconstriction (HPV) rapidly and reversibly matches lung ventilation (V) and perfusion (Q), optimizing oxygen uptake and systemic oxygen delivery. HPV occurs in small pulmonary arteries (PA), which uniquely constrict to hypoxia. Although HPV is modulated by the endothelium the core mechanism of HPV resides in PA smooth muscle cells (PASMC). The PASMC’s mitochondrial oxygen sensor lies within the electron transport chain (ETC) and includes NDUFS2 in ETC Complex-I. PASMC mitochondria respond to hypoxia by varying production of reactive oxygen species (ROS) and hydrogen peroxide in proportion to alveolar oxygen tension. Hypoxic ROS inhibition results in a state of reduction which triggers a redox-mediated inhibition of oxygen-sensitive, voltage-gated, potassium channels, including Kv1.5 and Kv2.1. Kv channel inhibition depolarizes the PASMC, opening of large-conductance calcium channels (CaL), elevating cytosolic calcium and activating the contractile apparatus. HPV is strongest in small PAs where sensors (hypoxia-responsive mitochondria) and effectors (oxygen-sensitive K+ channels) are enriched. Oxygenation at birth reverses fetal HPV, contributing to the rapid neonatal drop in pulmonary vascular resistance (PVR). A similar mitochondrial-K+ channel sensor-effector mechanism exists in the ductus arteriosus (DA), however in DASMC it is oxygen-induced increases in mitochondrial ROS that inhibit DASMC K+ channels, causing DA constriction. Atelectasis and pneumonia elicit HPV, which optimises V/Q matching, increasing systemic oxygenation. Whilst HPV in response to localized hypoxia in a single lung lobe does not increase PA pressure; global airway hypoxia, as occurs with altitude or sleep apnea, causes pulmonary hypertension. HPV can be inhibited by drugs, including calcium channel blockers, or used to maintain a dry operative field during single lung anesthesia for lung surgery. HPV does not normally cause lung edema but excessive, heterogenous HPV contributes to high altitude pulmonary edema. HPV is suppressed in COVID-19 pneumonia by a SARS-CoV-2 mitochondriopathy. HPV is a component of the body’s homeostatic oxygen sensing system. [ABSTRACT FROM AUTHOR]

Background: Even after the development of vaccines, SARS-CoV-2 continues to cause severe pneumonia all over the world. Consequently, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia are urgently needed. Blood cell count is an easily available and reproducible biomarker. With this study, we aimed to explore the role of eosinophils in predicting disease behavior and pulmonary sequelae at first follow-up with computed tomography (CT). Methods: we evaluated blood cell count and other inflammatory markers, both at baseline and during hospitalization, in a large population of hospitalized COVID-19 patients. Results: 327 patients were finally enrolled, 214 were classified as low-intensity medical care (LIMC) and 113 as high-intensity medical care. Eosinophils were higher at discharge in the HIMC group [0.1 (0–0.72) vs. 0.05 (0–0.34) × 109/L; p < 0.0001]. Moreover, in the multivariable analysis, age ≥ 62 years (OR 1.76 (1.05–2.8) p = 0.03) and Δ eosinophils ≥ 0.05 (OR 1.75 (1.05–2.9) p = 0.03) were two independent predictors of residual lung abnormalities in the whole patient population at first follow-up. Conclusions: an eosinophil increase during hospitalization could be a potential predictor of pulmonary sequelae in surviving patients after COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spontaneous pneumomediastinum is an unusual pulmonary complication of SARS-CoV-2 pneumonia. It is mostly described as a benign finding with spontaneous resolution. Some authors mention that cases with adverse outcomes (increased mortality) have been reported. Clinical experience shows a similar trend; therefore, the scientific evidence is equivocal; hence the need to document what happened in the pandemic. CLINICAL CASES: Five clinical cases of hospitalized patients aged 39 and 76 years with the following risk factors are described: smoking, asthma, chronic obstructive pulmonary disease, and obesity. Diagnosis was made by chest computed tomography and physical examination. CONCLUSIONS: Spontaneous pneumomediastinum is a complication associated with increased severity and mortality in COVID-19. A systematic review with a higher level of evidence is needed to update clinical care guidelines and reduce morbidity and mortality in COVID-19. [ABSTRACT FROM AUTHOR]

Kridsanai Gulapa, Dararat Eksombatchai, Tananchai Petnak, Viboon Boonsarngsuk Division of Pulmonary Medicine and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Dararat Eksombatchai, Division of Pulmonary Medicine and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Bangkok, 10400, Thailand, Email Dararat.eks@mahidol.ac.thBackground: COVID-19 infection is associated with an increased risk of severe illness and adverse outcomes in individuals with immunocompromising conditions. Immunocompromised patients may have difficulty with viral clearance, which can lead to persistent infection and potential relapses in viral replication.Case Presentation: Herein, we present four cases of persistent COVID-19 pneumonia in immunocompromised patients, including those with diffuse large B-cell lymphoma, polyarteritis nodosa, and end-stage renal disease post-kidney transplant. Three patients had previously received rituximab. Notably, all patients in this cohort demonstrated positive anti-receptor binding-domain immunoglobulin G (IgG) and negative anti-nucleocapsid IgG values.Conclusion: Persistent COVID-19 infection should be considered in the differential diagnosis of immunocompromised patients who exhibit ongoing symptoms or lack of improvement in chest X-ray findings following initial COVID-19 treatment. Early recognition, beyond the diagnosis of post-COVID organizing pneumonia, may significantly improve clinical outcomes with timely and appropriate treatment.Keywords: COVID-19 pneumonia, persistent COVID-19, immunocompromised patients, SAR-CoV-2

Coronavirus coronavirus-related (severe acute respiratory syndrome-corona virus-2) global pandemic has caused significant mortality and morbidity globally in the last 3 years. Although the pandemic has weaned off since last year, we are not in great peace of relief due to lingering effects of COVID-19 persisted even after 2 years of illness. These long COVID-19 manifestations are documented selected cases of COVID-19 pneumonia in pulmonary and extrapulmonary systems with variable impact on quality of life. In the present case report, a 57-year-old male, presented in the outdoor unit for shortness of breath on exertion, on oxygen supplementation at home during ambulation with a history of severe COVID-19 pneumonia resulted in acute respiratory distress syndrome with hospitalization in the intensive care unit 12 months back and required high flow nasal cannula with noninvasive ventilatory support for 3 weeks. His clinical and radiological severity were very well correlated with highly raised inflammatory markers such as C-reactive protein, interleukin-6, ferritin, lactate dehydrogenase, and D-Dimer. He was offered oxygen supplementation at home with antifibrotics for 3 months and observed significant improvement in clinical and radiological outcomes with persistent requirement of oxygen during ambulation and persistent respiratory symptoms even after 1 year of discharge from hospital. Rheumatological workup documented antinuclear antibody (ANA) and rheumatoid factor positive with inconclusive ANA profile reports. His high-resolution computerized tomography thorax documented at 1 year of discharge from the hospital revealed typical interstitial opacities labeled as progressive residual lung abnormalities (PRLAs) which are predominantly reticular and linear opacities in peripheral parts of lungs with honeycombing within typical pleural-based areas with parenchymal bands and altered lung architecture and decreased lung volume in both lungs. Honeycombing is a typical feature of progressive type of RLAs. We recommend these radiological outcome phenotypes as progressive radiological abnormalities (RLAs) at 1 year should be considered pulmonary fibrosis of unclassified type from a pulmonologist perspective due to pattern and presentation after COVID-19 which is not enrolled into interstitial lung disease classification as of now and progressive pulmonary fibrosis as per radiologists’ perspective due to progressive nature of the disease.

Yanting Hao,1 Hua Zhang,2 Fan Zhang1 1Department of Geriatrics, Peking University Third Hospital, Beijing, 100191, People’s Republic of China; 2Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, 100191, People’s Republic of ChinaCorrespondence: Fan Zhang, Department of Geriatrics, Peking University Third Hospital, 49 North Garden Road, Beijing, 100191, People’s Republic of China, Email zfpuh3@126.comPurpose: It has been shown that lower Barthel’s index (BI) at admission is associated with a higher in-hospital mortality. There is a lack of evidence regarding the association between the change in BI during hospitalization and mortality after discharge. Our purpose was to determine whether the BI change during hospitalization is associated with all-cause mortality in older adults with COVID-19 pneumonia.Patients and Methods: We conducted a retrospective cohort study of 330 participants at Peking University Third Hospital during the COVID-19 pandemic period. In order to analyze the time to death data, a Kaplan-Meier survival curve was used. We used restricted cubic splines to analyze the association between BI change and all-cause mortality among COVID-19 pneumonia patients aged over 80 years old. Threshold effect analysis was used to assess the ability of BI change score to predict all-cause mortality.Results: Our study included 330 patients aged over 80 years with COVID-19 pneumonia. The Kaplan-Meier curve for mortality showed significantly worst survival with reduced BI among three groups (χ2= 6.896, P < 0.05). There was a non-linear association between the BI change and all-cause mortality (P for all over < 0.001). The effect sizes on the left and right sides of the inflection point were 0.958 (HR: 0.958, 95% CI 0.932– 0.958, P < 0.05) and 1.013 (HR: 1.013, 95% CI 0.967– 1.062, P > 0.05), respectively.Conclusion: Reduced BI during hospitalization was associated with the highest mortality risk. It is crucial to monitor BI change among COVID-19 pneumonia patients aged over 80 years old.Keywords: COVID-19 pneumonia, activities of daily living, mortality, older adult

Background: Mental health issues among COVID-19 survivors can have broader public health implications, including decreased quality of life, impaired functional recovery, increased healthcare utilization, and higher mortality rates. Aims and Objectives: The aim of this study was to evaluate the psychiatric morbidities among the persons treated and recovered from COVID-19. Materials and Methods: A cross sectional telephonic survey was undertaken in hundred patients infected with COVID-19 pneumonia, treated and discharged from a tertiary care centre. Depression, anxiety, PTSD symptoms were assessed using PHQ-2, GAD-2, PTSD screen for DSM-5 respectively. Sleep quality was assessed using single item sleep quality scale. Overall quality of life and health satisfaction was assessed using WHOQOL-BREF. Results: Mean age of study participants is 46.15 years and study sample included 62% of males. Admitted patients had mean CT severity score of 40% lung involvement. On the measures of sleep quality, twelve were having fair range and two participants had poor sleep quality. 24% and 31% of participants had anxiety and depressive symptoms respectively while 14% had symptoms of PTSD. Conclusion: Post covid sequelae is an important concern to be addressed, larger studies are required to assess the psychiatry morbidity accurately. Further sequential assessments would help to delineate the natural course of post covid psychiatric sequalae.

Background: In susceptible hosts, SARS-CoV2-induced hyperinflammation accounts for an increased mortality. The search of adjuvant immunomodulatory therapies has been ongoing ever since the pandemic outbreak. Aim: Our purpose was to evaluate the efficacy of cyclosporin A (CsA) as an add-on therapy to the standard of care (SoC) in patients with severe COVID-19 pneumonia. Methods: We conducted a randomized clinical trial in patients admitted to eight Spanish tertiary hospitals. Patients were stratified into two severity categories and randomized in a 1:1 ratio to receive a corticosteroid-based standard therapy with or without CsA. The primary endpoint was FiO2 recovery by Day 12 without relapses. Results: 109 patients were included and randomized, and 98 of them considered for the mITT population (51 assigned to the CsA + SoC group and 47 to the SoC group). A total of 35 (68.6%) patients from the CsA + SoC group and 32 (71.1%) patients from the SoC group reached the primary endpoint in the mITT analysis. No differences were found after stratification into age groups, in the severity level at admission, or in a combination of both. Overall, the time to FiO2 normalization was 7.4 days vs. 7.9 days in the experimental and control groups, respectively. Global mortality was 8.2%. Severe adverse events were uncommon and equally distributed between arms. Conclusion: The addition of CsA did not show differences over a corticosteroid-based treatment in the clinical course of the included patients. A better identification of candidates who will benefit from receiving immunomodulatory drugs is necessary in future studies. [ABSTRACT FROM AUTHOR]

Objective: This retrospective cohort study aimed to assess the clinical features, treatment outcomes, and short-term prognosis in kidney transplant recipients (KTRs) with concurrent coronavirus disease 2019 (COVID-19) pneumonia. Methods: KTRs with COVID-19 pneumonia who were admitted to our hospital from December 28, 2022, to March 28, 2023 were included in the study. Their clinical symptoms, responses to antiviral medications, and short-term prognosis were analyzed. Results: A total of 64 KTRs with initial diagnosis of COVID-19 pneumonia were included in this study. The primary symptoms were fever, cough, and myalgia, with an incidence of 79.7%, 89.1%, and 46.9%, respectively. The administration of antiviral drugs (paxlovid or molnupiravir) within 1-5 days and for over 5 days demonstrated a statistically significant reduction in viral shedding time compared to the group without antiviral medication (P=0.002). Both the paxlovid and molnupiravir treatment groups exhibited a significantly shorter duration of viral shedding time in comparison to the group without antiviral drugs (P=0.002). After 6 months of recovery, there was no significantly negative impact on transplant kidney function (P=0.294). Conclusion: Fever, cough, and myalgia remain common initial symptoms of concurrent COVID-19 pneumonia in KTRs. Early use of antiviral drugs (paxlovid or molnupiravir) is associated with better therapeutic outcomes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a limited impact on the short-term renal function of the KTRs with concurrent moderate or severe COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Pulmonary infections contribute substantially to emergency department (ED) visits, posing a considerable health burden. Lower respiratory tract infections are prevalent, particularly among the elderly, constituting a significant percentage of infectious disease-related ED visits. Timely recognition and treatment are crucial to mitigate morbidity and mortality. Imaging studies, primarily chest radiographs and less frequently CT chests, play a pivotal role in diagnosis. This article aims to elucidate the imaging patterns of both common and rare pulmonary infections (bacterial and viral) in the post COVID-19 era, emphasizing the importance of recognizing distinct radiological manifestations. The integration of clinical and microbiological evidence aids in achieving accurate diagnoses, and guiding optimal therapeutic interventions. Despite potential overlapping manifestations, a nuanced understanding of radiological patterns, coupled with comprehensive clinical and microbiological information, enhances diagnostic precision in majority cases. [ABSTRACT FROM AUTHOR]

Purpose: Antibodies against SARS-CoV-2 spike (anti-S) may confer protection against symptomatic COVID-19. Whether their level predicts progression among those with COVID-19 pneumonia remains unclear. Methods: We conducted a retrospective cohort study to assess predictors of anti-S levels and whether anti-S titer is associated with death or mechanical ventilation (MV). Adults hospitalized for COVID-19 pneumonia between July 2021 and July 2022 were enrolled if anti-S had been measured within 72 h of admission. Predictors of anti-S level were explored using multivariable quantile regression. The association between anti-S levels and 30-day death/MV was investigated via multivariable logistic regression. Analyses were stratified by vaccine status. Results: The median anti-S level was 1370 BAU/ml in 328 vaccinated and 15.5 BAU/ml in 206 unvaccinated individuals. Among the vaccinated, shorter symptom duration (p = 0.001), hematological malignancies (p = 0.002), and immunosuppressive therapy (p = 0.004) were associated with lower anti-S levels. In the unvaccinated group, symptom duration was the only predictor of anti-S levels (p < 0.001). After 30 days, 134 patients experienced death or MV. Among vaccinated individuals, higher anti-S levels correlated significantly with lower death/MV risk (per log2 increase, OR 0.88, 95%CI 0.81–0.97), irrespective of age and solid malignancies. Among unvaccinated, a marginally protective effect was observed (OR 0.86, 95%CI 0.73–1.01), independent of age, immunosuppressive therapy, and diabetes. Adjustment for monoclonal antibody treatment strengthened the association (OR 0.81, 95%CI 0.68–0.96). Conclusion: This study suggests that levels of anti-S antibodies can predict critical or fatal outcomes in COVID-19 pneumonia patients, regardless of vaccination. Whether anti-S Ab could guide risk assessment and vaccination boosting merits further evaluation. [ABSTRACT FROM AUTHOR]

In forensic cases, detailed identification of pneumonia is important. Our objective was to statistically determine the applicability of three interstitial lung disease (ILD) markers for forensic diagnosis using serum collected from dead bodies with various postmortem intervals (PMIs). We retrospectively analyzed the levels of postmortem serum Krebs von den Lungen-6 (KL-6) and pulmonary surfactant–associated proteins A and D (SP-A and SP-D) using 221 samples obtained during forensic autopsy at our facility from 2019 to 2023. We evaluated the diagnostic efficacy of ILD markers for various pneumonias against the pathological diagnosis, and examined the assessment of the severity of ILD. When comparing the ILD group with bacterial pneumonia (BP) versus the control group, there was a significant increase in KL-6 in the ILD group. When comparing the severe ILD (SILD) group with the mild ILD (MILD) group, there was a significant increase in KL-6 and SP-D in the SILD group. The optimal cutoff values for differentiating SILD were 607.0 U/mL for KL-6, 55.5 ng/mL for SP-A, and 160.0 ng/mL for SP-D, and the sensitivity/specificity (%) of KL-6, SP-A, and SP-D for SILD were 84.1/95.2, 55.6/85.7, and 66.7/74.6, respectively. This is the first study to examine KL-6 in postmortem serum in forensic medicine. By analyzing dead bodies with various PMIs, our results confirmed statistically that postmortem serum KL-6 specifically detects ILD, postmortem serum SP-A has high sensitivity to lung injury, and postmortem serum SP-D is potentially useful in assessing the severity of ILD. [ABSTRACT FROM AUTHOR]

Introduction: Infection with SARS-CoV-2 virus may result in long COVID, a syndrome characterized by symptoms such as dyspnea, cardiac abnormalities, cognitive impairment, and fatigue. One potential explanation for these symptoms is hypocortisolism. Objective: To evaluate the prevalence of hypocortisolism in patients with a history of COVID-19 pneumonia. Methods: Cross-sectional study of patients who were aged ≥18 years and had a 3-month history of radiography-confirmed COVID-19 pneumonia. Exclusion criteria included current or previous treatment with glucocorticoids and use of an oral contraceptive. Adrenal function was evaluated using a low dose (1ug) corticotropin stimulation test (CST). Serum cortisol levels were measured at 0, 30, and 60 minutes, and baseline plasma ACTH was also measured. Results: Of the 41 patients enrolled, the median age was 62 years, 17 (42%) were female, and all 41 (100%) had severe pneumonia at baseline. Eleven patients (27%) had hypocortisolism, as evidenced by peak cortisol of less than 402.81 nmol/l after low dose (1 μg) CST. Of these 11 patients, 10 (91%) had secondary hypocortisolism (median ACTH 6.27 pmol/L, range 4.98–9.95 pmol/L) and one had primary hypocortisolism (mean ACTH 32.78 pmol/L). Six of the 11 patients with hypocortisolism (54.5%) reported symptoms of persistent fatigue and 5 (45.5%) required regular glucocorticoid replacement. Conclusions: Our results suggest that hypocortisolism, predominantly caused by pituitary disruption, may emerge after SARS-CoV-2 infection and should be considered in patients with a history of COVID-19 pneumonia with or without clinical hypocortisolism. [ABSTRACT FROM AUTHOR]

Background COVID-19 is a prothrombotic disease that can cause thromboembolism and microthrombi, which could lead to multiorgan failure and death. Since COVID-19 is a relatively new disease, there are guidelines for anticoagulation dosing for COVID-19 patients without consensus on the dosing. We studied the effects of different doses of anticoagulation in hospitalized patients with COVID-19 pneumonia and hypoxemia on any differences in need for high-flow oxygen, mechanical ventilation, and mortality. We also analyzed the patient population who benefited most from anticoagulation. Methodology We performed a retrospective chart review of all patients who were admitted with the diagnosis of COVID-19 infection with positive polymerase chain reaction, pneumonia (confirmed either by chest X-ray or CT chest), and hypoxemia (oxygen saturation of

PurposeWe aimed to investigate risk factors for COVID-19 pneumonia in patients with hematological malignancies (HM) after Omicron infection.MethodsData from a registered multi-center, prospective, observational study (ChiCTR2300071830) during the latest Omicron BA.5.2 wave in Chongqing, China was used for analysis.ResultsA total of 475 HM patients enrolled in this study. COVID-19 pneumonia was observed in 15.8% (75/475) of patients, with a median age of 58 years (interquartile range [IQR], 48-69 years) and males accounting for 61.3%. Risk factors associated with COVID-19 pneumonia included: 1) Active disease status of HM at infection, with an odds ratio (OR) of 3.42 (95% confidence interval [CI]: 1.59-7.37, P=0.002) compared to complete remission (CR); 2) Incomplete COVID-19 vaccination, 1-2 doses of the vaccine (OR=2.55, 95% CI: 1.28-5.10, P=0.008) or no vaccination (OR=4.81, 95% CI: 2.45-9.43, P

Abstract Background The antiviral drug Nirmatrelvir was found to be a key drug in controlling the progression of pneumonia during the infectious phase of COVID-19. However, there are very few options for effective treatment for cancer patients who have viral pneumonia. Glucocorticoids is one of the effective means to control pneumonia, but there are many adverse events. EGCG is a natural low toxic compound with anti-inflammatory function. Thus, this study was designed to investigate the safety and efficacy of epigallocatechin-3-gallate (EGCG) aerosol to control COVID-19 pneumonia in cancer populations. Methods The study was designed as a prospective, single-arm, open-label phase I/II trial at Shandong Cancer Hospital and Institute, between January 5, 2023 to March 31,2023 with viral pneumonia on radiographic signs after confirmed novel coronavirus infection. These patients were treated with EGCG nebulization 10 ml three times daily for at least seven days. EGCG concentrations were increased from 1760-8817umol/L to 4 levels with dose escalation following a standard Phase I design of 3–6 patients per level. Any grade adverse event caused by EGCG was considered a dose-limiting toxicity (DLT). The maximum tolerated dose (MTD) is defined as the highest dose with less than one-third of patients experiencing dose limiting toxicity (DLT) due to EGCG. The primary end points were the toxicity of EGCG and CT findings, and the former was graded by Common Terminology Criteria for Adverse Events (CTCAE) v. 5.0. The secondary end point was the laboratory parameters before and after treatment. Result A total of 60 patients with high risk factors for severe COVID-19 pneumonia (factors such as old age, smoking and combined complications)were included in this phase I-II study. The 54 patients in the final analysis were pathologically confirmed to have tumor burden and completed the whole course of treatment. A patient with bucking at a level of 1760 umol/L and no acute toxicity associated with EGCG has been reported at the second or third dose gradients. At dose escalation to 8817umol/L, Grade 1 adverse events of nausea and stomach discomfort occurred in two patients, which resolved spontaneously within 1 hour. After one week of treatment, CT showed that the incidence of non-progression of pneumonia was 82% (32/39), and the improvement rate of pneumonia was 56.4% (22/39). There was no significant difference in inflammation-related laboratory parameters (white blood cell count, lymphocyte count, IL-6, ferritin, C-reactive protein and lactate dehydrogenase) before and after treatment. Conclusion Aerosol inhalation of EGCG is well tolerated, and preliminary investigation in cancer population suggests that EGCG may be effective in COVID-19-induced pneumonia, which can promote the improvement of patients with moderate pneumonia or prevent them from developing into severe pneumonia. Trial registration ClinicalTrials.gov Identifier: NCT05758571. Date of registration: 8 February 2023.

Abstract Background COVID-19 pneumonia causes hyperinflammatory response that culminates in acute respiratory syndrome (ARDS) related to increased multiorgan dysfunction and mortality risk. Antiviral-neutralizing immunoglobulins production reflect the host humoral status and illness severity, and thus, immunoglobulin (Ig) circulating levels could be evidence of COVID-19 prognosis. Methods The relationship among circulating immunoglobulins (IgA, IgG, IgM) and COVID-19 pneumonia was evaluated using clinical information and blood samples in a COVID-19 cohort composed by 320 individuals recruited during the acute phase and followed up to 4 to 8 weeks (n = 252) from the Spanish first to fourth waves. Results COVID-19 pneumonia development depended on baseline Ig concentrations. Circulating IgA levels together with clinical features at acute phase was highly associated with COVID-19 pneumonia development. IgM was positively correlated with obesity (ρb = 0.156, P = 0.020), dyslipemia (ρb = 0.140, P = 0.029), COPD (ρb = 0.133, P = 0.037), cancer (ρb = 0.173, P = 0.007) and hypertension (ρb = 0.148, P = 0.020). Ig concentrations at recovery phase were related to COVID-19 treatments. Conclusions Our results provide valuable information on the dynamics of immunoglobulins upon SARS-CoV-2 infection or other similar viruses.

The fact that some SARS-CoV-2 pneumonia patients benefit from changing body position, and some from continuous positive airways pressure (CPAP), indicates the functional character of hypoxia. We hypothesize that such effects could be explained by the closure of small airways. To prove the hypothesis, we evaluated the patency of small airways in 30 oxygen-dependent, spontaneously breathing patients with SARS-CoV-2 pneumonia during their hospital stay using the FOT method and then compared the results with data obtained three months later. During the acute period, total resistance (R5) and peripheral resistance (R5-20) rose above the upper limit of normal (ULN) in 28% and 50% of all patients, respectively. Reactance indices X5, AX and Fres exceeded ULN in 55%, 68% and 66% of cases. Significant correlations were observed between PaO2/FiO2, the time spent in the hospital and R5, X5, AX and Fres. After 3 months, 18 patients were re-examined. During the hospital stay, 11 of them had risen above the upper limit of normal (ULN), for both resistance (R5-20) and reactance (X5, AX) values. Three months later, ULN for R5-20 was exceeded in only four individuals, but ULN for X5 and AX was exceeded in five individuals. Lung function examination revealed a combined restrictive/obstructive ventilatory failure and reduced CO transfer factor. We interpret these changes as lung tissue remodeling due to the process of fibrosis. We conclude that during acute period of SARS-CoV-2 pneumonia, dilated pulmonary blood vessels and parenchymal oedema induce functional closure of small airways, which in turn induce atelectasis with pulmonary right-to-left shunting, followed by the resulting hypoxemia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Amidst the COVID-19 pandemic, concerns about the psychological impact of disease-related anxiety on public health have risen. This study aims to compare general and death anxiety levels between acute coronary artery syndrome and COVID-19 pneumonia patients. Materials and Methods: A cross-sectional study of 132 individuals, including acute myocardial infarction (MI), COVID-19 pneumonia patients, and healthy volunteers from Trakya University Hospital (Turkey), was analyzed. Validated scales like the Beck Anxiety Inventory (BAI), Coronavirus Anxiety Scale Short Form, and Thorson–Powell Death Anxiety Scale (TPDAS) were employed. Demographic data such as age, gender, income levels, employment status, presence of a close relative with COVID-19, and whether participants followed COVID-19-related news were collected and compared across groups with significance level of 0.05 set for all analyses. Results: Among 41 COVID-19, 41 MI, and 50 healthy subjects, the pneumonia group showed highest COVID-19 anxiety (p = 0.01) and BAI scores (p = 0.008). Both COVID-19 and MI patients had significantly higher BAI and TPDAS scores compared to healthy controls (p < 0.001). Factors like female gender (p = 0.004), low education (p = 0.003), current employment (p = 0.008), and low income (p = 0.002) correlated with higher BAI scores. Low income (p = 0.001) and COVID-19 news exposure (p = 0.002) correlated with higher TPDAS scores. Males and married patients had lower anxiety scores (p = 0.008). High income, education, and employment reduced anxiety levels (p = 0.008). TPDAS scores decreased with higher income (p = 0.001), but increased in the MI group (p = 0.002) with COVID-19 news exposure. The multivariate linear regression analysis found that MI and COVID-19 pneumonia were associated with TPDAS; female gender, university education, and COVID-19 pneumonia with the Beck scale; and COVID-19 pneumonia with anxiety scores on the COVID-19 Anxiety scale. Conclusions: This research showcases differing anxiety patterns between illnesses such as MI and COVID-19 pneumonia amidst the pandemic, emphasizing the amplifying influence of media coverage on death-related anxieties. It underscores the imperative of targeted interventions and socioeconomic considerations in managing psychological consequences and formulating responsive public health strategies. [ABSTRACT FROM AUTHOR]

Background: The antiviral drug Nirmatrelvir was found to be a key drug in controlling the progression of pneumonia during the infectious phase of COVID-19. However, there are very few options for effective treatment for cancer patients who have viral pneumonia. Glucocorticoids is one of the effective means to control pneumonia, but there are many adverse events. EGCG is a natural low toxic compound with anti-inflammatory function. Thus, this study was designed to investigate the safety and efficacy of epigallocatechin-3-gallate (EGCG) aerosol to control COVID-19 pneumonia in cancer populations. Methods: The study was designed as a prospective, single-arm, open-label phase I/II trial at Shandong Cancer Hospital and Institute, between January 5, 2023 to March 31,2023 with viral pneumonia on radiographic signs after confirmed novel coronavirus infection. These patients were treated with EGCG nebulization 10 ml three times daily for at least seven days. EGCG concentrations were increased from 1760-8817umol/L to 4 levels with dose escalation following a standard Phase I design of 3–6 patients per level. Any grade adverse event caused by EGCG was considered a dose-limiting toxicity (DLT). The maximum tolerated dose (MTD) is defined as the highest dose with less than one-third of patients experiencing dose limiting toxicity (DLT) due to EGCG. The primary end points were the toxicity of EGCG and CT findings, and the former was graded by Common Terminology Criteria for Adverse Events (CTCAE) v. 5.0. The secondary end point was the laboratory parameters before and after treatment. Result: A total of 60 patients with high risk factors for severe COVID-19 pneumonia (factors such as old age, smoking and combined complications)were included in this phase I-II study. The 54 patients in the final analysis were pathologically confirmed to have tumor burden and completed the whole course of treatment. A patient with bucking at a level of 1760 umol/L and no acute toxicity associated with EGCG has been reported at the second or third dose gradients. At dose escalation to 8817umol/L, Grade 1 adverse events of nausea and stomach discomfort occurred in two patients, which resolved spontaneously within 1 hour. After one week of treatment, CT showed that the incidence of non-progression of pneumonia was 82% (32/39), and the improvement rate of pneumonia was 56.4% (22/39). There was no significant difference in inflammation-related laboratory parameters (white blood cell count, lymphocyte count, IL-6, ferritin, C-reactive protein and lactate dehydrogenase) before and after treatment. Conclusion: Aerosol inhalation of EGCG is well tolerated, and preliminary investigation in cancer population suggests that EGCG may be effective in COVID-19-induced pneumonia, which can promote the improvement of patients with moderate pneumonia or prevent them from developing into severe pneumonia. Trial registration: ClinicalTrials.gov Identifier: NCT05758571. Date of registration: 8 February 2023. [ABSTRACT FROM AUTHOR]

Background: COVID-19 pneumonia causes hyperinflammatory response that culminates in acute respiratory syndrome (ARDS) related to increased multiorgan dysfunction and mortality risk. Antiviral-neutralizing immunoglobulins production reflect the host humoral status and illness severity, and thus, immunoglobulin (Ig) circulating levels could be evidence of COVID-19 prognosis. Methods: The relationship among circulating immunoglobulins (IgA, IgG, IgM) and COVID-19 pneumonia was evaluated using clinical information and blood samples in a COVID-19 cohort composed by 320 individuals recruited during the acute phase and followed up to 4 to 8 weeks (n = 252) from the Spanish first to fourth waves. Results: COVID-19 pneumonia development depended on baseline Ig concentrations. Circulating IgA levels together with clinical features at acute phase was highly associated with COVID-19 pneumonia development. IgM was positively correlated with obesity (ρb = 0.156, P = 0.020), dyslipemia (ρb = 0.140, P = 0.029), COPD (ρb = 0.133, P = 0.037), cancer (ρb = 0.173, P = 0.007) and hypertension (ρb = 0.148, P = 0.020). Ig concentrations at recovery phase were related to COVID-19 treatments. Conclusions: Our results provide valuable information on the dynamics of immunoglobulins upon SARS-CoV-2 infection or other similar viruses. [ABSTRACT FROM AUTHOR]

Since the outbreak of coronavirus (COVID-19) in December 2019, understanding regarding coronavirus symptoms has been evolving. Medical issues in pregnancy usually resolve after delivery. Similarly, pregnant ladies with COVID-19 pneumonia had improvement in their condition after giving birth. However, in this case, the patient tested positive for "SARS-Cov-19 antigen PCR" and intended for vaginal birth, which was unsuccessful and resulted in a caesarean surgery. After the healthy baby was delivered, she experienced a life-threatening cytokine storm that necessitated elective intubation and mechanical breathing, as well as anti-viral medication. She was extubated after two weeks and then discharged on recovery. Previously, the Middle Eastern Respiratory Syndrome Coronavirus (MERS-SARS) and the Influenza virus (H1N1) were the most well-known viruses for generating potentially fatal results in pregnancy. This is first reported instance in Pakistan of a pregnant lady developing severe COVID-19 pneumonia. This research fills a vacuum in the medical literature and alerts obstetricians and clinicians to the likelihood of life-threatening postpartum, COVID-19 pneumonia complications.

BACKGROUND. Presently actively new direction develops in digital treatment of CТ images – radiomics, that presents the result of co-operation on verge of different sciences (radiology, computer sciences and mathematical statistics). Inaccessible for the unarmed eye additional information of CT images can be got by means of their mathematical treatment and creation of the segmented histograms. Last it is possible to compare and analyse both isolated and with regard to the dynamics of physiopathology descriptions of organs and fabrics at the different human diseases. OBJECTIVE. To define the roentgenologic and morphological features of development of vanishing lung syndrome for patients with non-hospital viral pneumonia. MATERIALS AND METHODS. Data of CТ are analysed in a dynamics for patients with non-hospital viral pneumonia of COVID-19, that were on treatment in SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” or were directed from other medical establishments. The Dragonfly program from Object Research Systems (Montreal, Canada), which performs micro-X-ray structural analysis of the examined tissues, was used to analyze CT images of chest. Pathomorphological examination was performed in the laboratory of pathomorphology of the institute. RESULTS. Monitoring of CT is conducted in the group, that consisted of 90 patients with non-hospital viral pneumonia of COVID-19. 27 (30,0 %) patients (18 men and 9 women in age from 23 to 68) are educed with the roentgenologic signs of vanishing lung syndrome. 12 from them (9 men and 3 women in age from 23 to 56) were on treatment in the institute in an acute period of disease. Other 15 patients (9 men and 6 women in age from 26 to 68) directed from other curative establishments, where they treated oneself 3-4 months ago. CONCLUSIONS. Micro-X-ray structural analysis of data of CT allows to educe the features of changes of parenchima at development of vanishing lung syndrome. These changes are confirmed by the educed changes at pathomorphological research of postoperative preparations of lungs.

Introduction/Objective. Chest X-ray (CXR) is a common diagnostic procedure for monitoring the course and outcome of pneumonia. The aim of the study was to examine the frequency, type and degree of CXR changes in COVID-19 pneumonia and compare it with demographic data and the presence of comorbidities. Methods. In this retrospective study, CXRs taken on the day of admission were analyzed for 620 patients with COVID-19. CXR were defined as ground-glass opacification (GGO), consolidation, reticular changes, pulmonary nodules, and pleural effusions. CXR severity score (CXR-SS) was determined based on the adjusted Radiographic Assessment of Lung Edema score. SPSS version 17.0 was used for statistical analyses. Results. The average age was 62.75 ± 14.8 years 66.5% of analyzed patients had comorbidities. CXR changes were bilateral in 53.2%, dominant in the lower lung in 68.1% and diffuse in 24.5%. GGO were present in 55%, reticular changes in 37.3%, and consolidations in 24% of patients. Based on CXR-SS, 47.2% of patients had mild pneumonia, 40.2% moderate, 7.9% severe, and 4.6% very severe. Severe/very severe pneumonia was in 71.8% of older than 65 years. Bilateral changes were found in 97.4% of people with severe/very severe pneumonia, diffuse in 56.4%, and consolidation in 66.7% of the patients. GGO were in 58.1% of subjects with mild/moderate pneumonia. Conclusion. CXR in patients with COVID-19 pneumonia are more frequently bilateral, dominantly peripheral, in the lower lung zone. The degree of diffuse changes is proportional to older age and more frequent comorbidities. In a severe form of the disease, consolidation and reticular opacification dominate.

Abstract Background With the widespread use of the vaccine and the predominance of the Omicron strain, the number of patients presenting with typical coronavirus-infection disease 2019 (COVID-19) pneumonia on computed tomography (CT) has decreased dramatically. This has also been true for hemodialysis patients. Case report A 72-year-old female maintenance hemodialysis patient with hypogammaglobulinemia was diagnosed with COVID-19 based on a nasopharyngeal swab severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) polymerase chain reaction (PCR) test. She had previously received five doses of COVID-19 BNT162b2 vaccine. Initially, the patient had only a slight fever, mild sore throat and sputum, and molnupiravir 1600 mg/day was administered for 5 days. No high fever was observed during that period. On day 11 after diagnosis, bloody sputum was observed, and by day 13 the cough had worsened and her CRP level had increased to 13.10 mg/dL. Chest CT performed on the same day showed multiple subpleural ground-glass-like shadows typical of COVID-19 pneumonia predominantly in the right lung. She was immediately admitted to the hospital, where her temperature rose to 38.4 °C. Intravenous remdesivir 100 mg/day was administered for 5 days. This resolved her fever and the bloody sputum disappeared. She was discharged from the hospital without sequelae on the 21st day after diagnosis. Conclusion We experienced a case of typical COVID-19 pneumonia in a patient on maintenance hemodialysis who had received five doses of COVID-19 BNT162b2 vaccine. There was a flare-up of symptoms after administration of molnupiravir, suggesting that a hypogammaglobulinemia complication was involved. This highlights the need for attention to its potential transition to severe disease when patients with hypogammaglobulinemia or other highly immunocompromised conditions are affected by COVID-19.

Introduction: Maternal mortality is a critical event. Maternal mortality rates over the last century had reduced significantly, at least until the COVID-19 pandemic. Methods: We retrospectively analyzed three pregnant women who succumbed to severe COVID-19. Results: Despite trying all available known therapies for COVID-19 at the time they presented, such as remdesivir, favipravir, steroid, hydroxychloroquine, pegylated interferon, N-acetyl cysteine, anticoagulants, prone positioning, mechanical ventilation, extracorporeal membrane oxygenation, and early delivery by cesarean, these young women in the reproductive age group could not be saved. Pregnancy was the factor that aggravated COVID-19 pneumonia. Although the patients were given extensive multidisciplinary care, they were not able to survive. However, all three neonates were delivered alive. Conclusion: Three cases of catastrophic fatal maternal outcomes occurred due to severe COVID-19 pneumonia, even though all available treatments were provided.

Background: Even after the development of vaccines, SARS-CoV-2 continues to cause severe pneumonia all over the world. Consequently, in order to improve the management of patients and optimize the use of resources, predictors of disease severity and lung complications after COVID-19 pneumonia are urgently needed. Blood cell count is an easily available and reproducible biomarker. With this study, we aimed to explore the role of eosinophils in predicting disease behavior and pulmonary sequelae at first follow-up with computed tomography (CT). Methods: we evaluated blood cell count and other inflammatory markers, both at baseline and during hospitalization, in a large population of hospitalized COVID-19 patients. Results: 327 patients were finally enrolled, 214 were classified as low-intensity medical care (LIMC) and 113 as high-intensity medical care. Eosinophils were higher at discharge in the HIMC group [0.1 (0–0.72) vs. 0.05 (0–0.34) × 109/L; p < 0.0001]. Moreover, in the multivariable analysis, age ≥ 62 years (OR 1.76 (1.05–2.8) p = 0.03) and Δ eosinophils ≥ 0.05 (OR 1.75 (1.05–2.9) p = 0.03) were two independent predictors of residual lung abnormalities in the whole patient population at first follow-up. Conclusions: an eosinophil increase during hospitalization could be a potential predictor of pulmonary sequelae in surviving patients after COVID-19 pneumonia.

Background: The COVID-19 pandemic caused by SARS-CoV-2 continues to pose a significant threat worldwide, with severe cases leading to hospitalization and death. This study aims to evaluate the potential use of serum nucleocapsid antigen (NAg) and Krebs von den Lungen-6 glycoprotein (KL-6) as biomarkers of severe COVID-19 and to investigate their correlation with clinical, radiological, and biochemical parameters. Methods: This retrospective study included 128 patients with confirmed SARS-CoV-2 infection admitted to a Neapolitan hospital in Italy between October 2020 and July 2021. Demographic, clinical, and laboratory data were collected, including serum levels of NAg and KL-6. The Chung et al. Computed Tomography Severity Score (TSS) was used to assess the severity of pneumonia, and outcomes were classified as home discharge, rehabilitation, and death. Statistical analyses were performed to compare Group I (home discharge and rehabilitation) and Group II (death, sub-intensive care, and ICU stay) based on demographic data, laboratory parameters, and TSS. Results: Group II patients showed worse outcomes with higher levels of NAg, KL-6, and inflammatory markers, including interleukin-6 (IL-6), interleukin-2 receptor (IL-2R), and adrenomedullin. TSS was also significantly higher in Group II, with a positive correlation between TSS and NAg and KL-6 levels. Group I patients had higher values of hemoglobin (Hb) and platelets (PLT), while Group II patients had higher values of C-reactive protein (CRP), procalcitonin (PCT), D-Dimer, and glycemia. No significant difference was observed in gender distribution. Conclusions: Serum NAg and KL-6 levels are potential biomarkers of severe COVID-19 pneumonia, with higher levels indicating greater inflammation and organ damage. NAg may help identify infected patients at an increased risk of severe COVID-19 and ensure their admission to the most appropriate level of care. KL-6 may help predict interstitial lung damage and the severity of clinical features. Further studies are needed to establish a decision-making cut-off for these biomarkers in COVID-19. [ABSTRACT FROM AUTHOR]

Unlike normal pneumonia, in COVID-19 pneumonia, the shortfall of oxygen occurs without any noticeable breathing difficulties leads to multiple organ failure and death. The early detection of silent hypoxia in COVID-19 pneumonia is the key to save many lives from this deadly disease. This paper has proposed an e-health solution for early detection of the hypoxia condition of COVID-19 patients using internet of things (IoT) and deep learning techniques. The proposed solution has implemented an IoT framework to collect the percentage of oxygen saturation level in the blood (SpO2) of the patient on real-time basis. It has proposed a time-series forecasting model with deep learning, that being trained with the collected data, forecasts two upcoming SpO2readingsefficiently. The model is validated with the SpO2 level data of 261 hospitalized COVID-19 infected patients with varying level of criticality updated in each 2 hours, and the absolute percentage of errors (APE) in the prediction process has been observed around ~1.56%. The proposed methodology has great potential to control fatality rate in COVID-19 as the early detection of hypoxia helps to initiate the necessary course of action at appropriate time. [ABSTRACT FROM AUTHOR]

Background: To quantitatively evaluate CT lung abnormalities in COVID-19 survivors from the acute phase to 24-month follow-up. Quantitative CT features as predictors of abnormalities' persistence were investigated. Methods: Patients who survived COVID-19 were retrospectively enrolled and underwent a chest CT at baseline (T0) and 3 months (T3) after discharge, with pulmonary function tests (PFTs). Patients with residual CT abnormalities repeated the CT at 12 (T12) and 24 (T24) months after discharge. A machine-learning-based software, CALIPER, calculated the CT percentage of the whole lung of normal parenchyma, ground glass (GG), reticulation (Ret), and vascular-related structures (VRSs). Differences (Δ) were calculated between time points. Receiver operating characteristic (ROC) curve analyses were performed to test the baseline parameters as predictors of functional impairment at T3 and of the persistence of CT abnormalities at T12. Results: The cohort included 128 patients at T0, 133 at T3, 61 at T12, and 34 at T24. The GG medians were 8.44%, 0.14%, 0.13% and 0.12% at T0, T3, T12 and T24. The Ret medians were 2.79% at T0 and 0.14% at the following time points. All Δ significantly differed from 0, except between T12 and T24. The GG and VRSs at T0 achieved AUCs of 0.73 as predictors of functional impairment, and area under the curves (AUCs) of 0.71 and 0.72 for the persistence of CT abnormalities at T12. Conclusions: CALIPER accurately quantified the CT changes up to the 24-month follow-up. Resolution mostly occurred at T3, and Ret persisting at T12 was almost unchanged at T24. The baseline parameters were good predictors of functional impairment at T3 and of abnormalities' persistence at T12. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. PATIENTS AND METHODS: This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. RESULTS: Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. CONCLUSIONS: The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone. [ABSTRACT FROM AUTHOR]

• To implement an antibiotic stewardship program in critically ill COVID-19 patients is feasible, safe and associated with significant decrease in antibiotic consumption. • In critically ill COVID-19 patients, empirical antibiotic therapy should be initiated based on clinical judgement among patients with severe hypoxemia. • Currently, the use of inflammatory biomarkers cannot be recommended to discriminate patients with bacterial co-infection. • A change in the etiology of respiratory nosocomial infections was documented during the pandemics with a decline in potentially resistant pathogens. To evaluate the implementation of an antibiotic stewardship program in critically ill COVID-19 patients and to establish risk factors for coinfection. Secondary objective was to analyze the evolution of the etiology of respiratory nosocomial infections. Single-center observational cohort study of consecutive patients admitted to ICU due to COVID-19 pneumonia from March 2020 to October 2022. An antibiotic stewardship program was implemented at the end of the second wave. A total of 878 patients were included during 6 pandemic waves. Empirical antibiotic consumption decreased from the 96% of the patients during the first pandemic wave, mainly in combination (90%) to the 30% of the patients in the 6th pandemic wave most in monotherapy (90%). There were not differences in ICU and Hospital mortality between the different pandemic periods. In multivariate analysis, SOFA at admission was the only independent risk factor for coinfection in critically ill COVID-19 patients (OR 1,23 95%CI 1,14 to 1,35). Differences in bacterial etiology of first nosocomial respiratory infection were observed. There was a progressive reduction in Enterobacteriaceae and non- fermentative Gram Negative Bacilli as responsible pathogens, while methicillin-sensitive Staphylococcus aureus increased during pandemic waves. In the last wave, however, a trend to increase of potentially resistant pathogens was observed. Implementation of an antibiotic stewardship program was safe and not associated with worse clinical outcomes, being severity at admission the main risk factor for bacterial coinfection in covid-19 patients. A decline in potentially resistant pathogens was documented throughout the pandemic. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most frequently found primary malignancy of the liver, showing an accelerated upward trend over the past few years and exhibiting an increasing relationship with metabolic syndrome, obesity, dyslipidemia and type 2 diabetes mellitus. The connection between these risk factors and the occurrence of HCC is represented by the occurrence of non-alcoholic fatty liver disease (NAFLD) which later, based on genetic predisposition and various triggers (including the presence of chronic inflammation and changes in the intestinal microbiome), may evolve into HCC. HCC in many cases is diagnosed at an advanced stage and can be an incidental finding. We present such a scenario in the case of a 41-year-old male patient who had mild obesity and mixed dyslipidemia, no family or personal records of digestive pathologies and who recently developed a history of progressive fatigue, dyspepsia and mild upper abdominal discomfort initially thought to be linked to post-COVID syndrome, as the patient had COVID-19 pneumonia a month prior. The abdominal ultrasound revealed a mild hepatomegaly with bright liver aspect of the right lobe (diffuse steatosis), a large zone of focal steatosis (segments IV, III and II) and a left lobe tumoral mass, highly suggestive of malignancy. Point shear wave elastography at the right lobe ruled out an end-stage chronic liver disease. Additional laboratory investigations, imaging studies (magnetic resonance imaging) and histopathological examination of liver fragments confirmed a highly aggressive HCC, with poorly differentiation-G3, (T4, N 1M 0) and stage IVA, associated with nonalcoholic steatohepatitis (NASH). A sorafenib course of treatment was attempted, but the patient discontinued it due to severe side effects. The subsequent evolution was extremely unfavorable, with rapid degradation, a few episodes of upper digestive bleeding, hepatic insufficiency and mortality in a couple of months. Conclusions: Diagnosis of NASH-related HCC is either an accidental finding or is diagnosed at an advanced stage. In order to earn time for a proper treatment, it becomes important to diagnose it at an early stage, for which regular check-ups should be performed in groups having the risk factors related to it. Patients suffering from obesity and mixed dyslipidemia should undergo periodic abdominal ultrasound examinations. This should be emphasized even more in the cases showing NASH. Complaints of any kind post-COVID-19 should be dealt with keenly as little is yet known about its virulence and its long-term side effects. [ABSTRACT FROM AUTHOR]

Introduction: Radiological phenotypes are radiological patterns or observable characteristics of COVID-19 pneumonia. Various phenotypic classifications have been reported in literature. CT severity radiological phenotypes are widely used and universally accepted radiological phenotypic methods. Robust data is available regarding role of HRCT in COVID-19 pneumonia and we have evaluated role of CT severity in assessing natural course of COVID-19 illness during its evolution sand follow-up. Methods: Prospective, Observational study, included 3000 COVID-19 RT-PCR confirmed cases with lung involvement documented and radiological severity phenotypes categorized on HRCT thorax as mild, moderate and severe as per lung segment involvement bilaterally (scoring tool 0-25 score, mild 1-7, moderate 8-15 and severe 16-25). Radiological CT severity phenotypes were evaluated in correlation with interventions such as oxygen support and oxygen plus ventilatory support requirement during hospitalization. Age, gender, comorbidity, laboratory parameters and use of BIPAP/NIV in COVID-19 cases and outcome as with or without lung fibrosis were key observations. Final radiological outcome documented in follow up CT thorax imaging done at six months of discharge from hospital. Statistical analysis is done by using Chi square test. Results: In study of 3000 cases, 'mild, moderate and severe' radiological CT severity phenotypes were documented as 13.33%, 48.33% & 38.34 % respectively. CT severity has documented significant association with duration of illness at entry point [p<0.00001] Duration of illness (<7 days, 7-14 days and >14 days) plays a crucial role in predicting radiological CT severity phenotypes. CT severity has documented significant association with laboratory parameters at entry point (d-dimer, CRP, IL-6) [p<0.00001] and interventions required in indoor unit. [p<0.00001] Post COVID-19 lung fibrosis or sequelae has significant association with radiological CT severity phenotypes. [p<0.00001] Covariates such as age, gender, diabetes mellitus, IHD, Hypertension, COPD, Obesity has significant association with radiological CT severity phenotypes. [p<0.00001] Conclusion: Radiological CT severity phenotypic differentiation has documented very crucial role in initial assessment and during triaging of these cases in indoor and outdoor setting. Although CT severity is best predictor of severity it has showed 'inconstancy' in predicting disease severity, targeting interventions and predicting early and long-term outcomes in COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

The Omicron variant of COVID-19 is less severe than the ancestral strain, leading to the potential for deaths in patients infected with the virus but who die of other causes. This study evaluated the difference in rates of pneumonia among patients who died with SARS-CoV-2 infection in the ancestral vs Omicron eras. We identified patients who died within 30 days of a positive SARS-CoV-2 test, from March 2020 through December 2022; variants were assigned based on the prevalent variant in the US at that time. We also obtained a control group from patients who died within 30 days of a negative SARS-CoV-2 test in January 2022. The first CT after the test was reviewed in a blinded fashion and assigned a category from the RSNA Consensus Reporting Guidelines. The primary outcome was the difference in rates of positive (typical or indeterminate) COVID-19 findings in the ancestral vs Omicron eras. A total of 598 patients died during the ancestral era and 400 during the Omicron era, and 347 decedents comprised the control group. The rate of positive COVID-19 findings was 67/81 (83%) in the ancestral era and 43/81 (53%) in the Omicron era (P <.001), an absolute difference of 30% (95% CI 16%-43%). The rate of positive findings in the control group was 23/76 (30%). During the Omicron era, 30% fewer SARS-CoV-2-associated deaths were associated with COVID-19 pneumonia and were caused either by nonpulmonary effects of the infection or were unrelated to the infection. [ABSTRACT FROM AUTHOR]

In the aftermath of the COVID-19 pandemic, post-COVID-19 syndrome (PCS) remains a challenge and may continue to pose a major health problem in the future. Moreover, the influences of type 2 diabetes and being overweight on PCS remain unclear. This study aimed to assess these influences. We performed an observational study from October 2020 to July 2022, which included 466 patients (269 males and 197 females) with a median age of 65. They were hospitalized due to COVID-19 pneumonia and had persistent symptoms after 1 month of COVID-19 infection. The patients were divided into four groups according to the study objectives: patients with type 2 diabetes, overweight patients, overweight patients with type 2 diabetes, and average-weight patients without type 2 diabetes. The clinical and demographic data collected during hospitalization and regular visits to the Community Healthcare Center dr. Adolf Drolc Maribor were analyzed. Our results showed that type 2 diabetes patients had more difficult courses of treatment and longer hospitalizations. Moreover, more type 2 diabetes patients underwent rehabilitation than the other study groups. The prevailing symptoms of our patients with PCS were dyspnea and fatigue, mostly among female patients with type 2 diabetes. Our study also showed that more women with type 2 diabetes and overweight women with type 2 diabetes suffered from secondary infections. Furthermore, more overweight patients were treated in the intensive care unit than patients from the other groups. However, our study showed an interesting result: patients with type 2 diabetes had the shortest PCS durations. Type 2 diabetes and being overweight are risk factors for PCS onset and prolonged duration. Therefore, our data that revealed a shorter duration of PCS in type 2 diabetes patients than the other investigated groups was unexpected. We believe that answering the questions arising from our unexpected results will improve PCS treatment in general.

Abstract Background Immune checkpoint inhibitors (ICIs) are commonly used to treat lung cancer patients, but their use can lead to immune-related adverse events (irAEs), which pose a challenge for treatment strategies. The impact of irAEs on the incidence of COVID-19 pneumonia in lung cancer patients during the ongoing COVID-19 pandemic is unclear. This study aims to investigate the association between irAEs and COVID-19 pneumonia in lung cancer patients receiving ICIs. Methods We conducted a cross-sectional study of lung cancer patients who received ICIs and were infected with COVID-19 due to the Omicron variant between December 2022 and February 2023 in China. We collected data on irAEs and COVID-19 outcomes. Logistic regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between irAEs and the incidence of COVID-19 pneumonia. Results A total of 193 patients were enrolled, with 72 patients (37.30%) in the irAEs group and 121 patients (62.70%) in the non-irAEs group. Twenty-six patients (13.47%) developed COVID-19 pneumonia and 6 patients (3.11%) progressed to severe cases after COVID-19 infection. Multivariate logistic regression showed that the lung cancer patients who experienced irAEs was significantly associated with a higher incidence rate of COVID-19 pneumonia (OR = 9.56, 95%CI: 2.21–41.33; P = 0.0025). Conclusion Our study suggests that lung cancer patients receiving ICIs and experiencing irAEs may have a higher risk of developing COVID-19 pneumonia due to the Omicron variant. Therefore, close monitoring of these patients during the COVID-19 pandemic is necessary to mitigate this risk.

Abstract Background Pulmonary valve (PV) infective endocarditis is a rare pathology. Association between acute endocarditis and Covid pneumonia is equally poorly investigated. Case presentation We present the case of a 50-year-old male active drug-abuser admitted for native PV endocarditis with huge and mobile vegetations and a concomitant interstitial SARS-Cov2 pneumonia. Surgical timing was carefully evaluated, and the patient was first treated with Remdesivir to prevent ARDS evolution. After 5 days he underwent PV replacement with bioprosthesis via patch enlargement of RVOT and a tricuspid valve De-Vega annuloplasty. The postoperative course was uneventful with complete resolution of sepsis and viremia. Conclusions The association between infective endocarditis and Covid pneumonia is emerging in the recent months. The reorganization in cardiac surgery hub centers resulted in an increase of urgencies referral, with consequent relative observation of some pathologies (i.e., endocarditis). The widespread administration of antibiotics and corticosteroids during the first phase of the pandemic could have contributed to the development of a moderate immunodepression of the general population and, during the pandemic, patients have been reluctant to access to hospital care, and this diagnostic delay could contribute to misdiagnosis or late presentation. We believe that in the present case, the strategy of immediate viral and respiratory stabilization, followed by a timely surgical procedure, allowed an excellent outcome in a very complicated situation.

Abstract Background Chest radiography (CXR) is an adjunct tool in treatment planning and monitoring of the disease course of COVID-19 pneumonia. The purpose of the study was to describe the radiographic patterns and severity scores of abnormal CXR findings in children diagnosed with COVID-19 pneumonia. Methods This retrospective study included children with confirmed COVID-19 by reverse transcriptase-polymerase chain reaction test who underwent CXR at the arrival. The CXR findings were reviewed, and modified radiographic scoring was assessed. Results The number of abnormal CXR findings was 106 of 976 (10.9%). Ground-glass opacity (GGO) was commonly found in children aged > 9 years (19/26, 73.1%), whereas peribronchial thickening was predominantly found in children aged 9 years, whereas peribronchial thickening was predominant in children aged

Introduction: Coronavirus disease-2019 (COVID-19) infection is a viral disease characterized by fast transmission and heterogeneous clinical manifestations in people. Cardiac complications with different clinical presentations are observed during the disease course. In this study, we aimed to determine the importance of the N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) level to predict the prognosis in severe COVID-19 pneumonia and its optimal cut-off value. Methods: A total of 131 patients who were admitted to a hospital with severe COVID-19 pneumonia and who did not have a history of heart failure, chronic obstructive pulmonary disease, or chronic renal disease were included in the study. Diabetes mellitus and hypertension rates were recorded. Inflammatory markers (ferritin, C-reactive protein, procalcitonin, interleukin-6) and proBNP levels were measured. In-hospital mortality and recovery rates were recorded. The relationship between proBNP levels and chronic disease existence, inflammatory markers, and in-hospital mortality was evaluated using SPSS. Results: ProBNP levels were significantly higher in the non-survivor group than in the survivor group. The cut-off value of proBNP to predict in-hospital mortality was 650 pg/mL with 87% sensitivity and 62% specificity. The ProBNP >650 pg/mL group had higher hypertension rates, procalcitonin levels, intensive care unit admittance rates, and in-hospital mortality than ProBNP ≤650 pg/mL group (p

Background Since late 2019, COVID-19 has been a major health issue worldwide. Older patients seemed more susceptible to severe forms and complications with higher mortality rates. This study aimed to identify the clinical features and outcomes of SARS-Cov-2 pneumonia in elderly patients. Methods Retrospective monocentric study in the internal medicine Covid-19 unit of the Ben Arous regional hospital, enrolling admitted patients with confirmed SARS-CoV-2 pneumonia, aged 65 years and above from September 2020 to September 2021. Results The study group counted 222 women (55.5%). The mean age was 74 years. At least one chronic disease was found in 84.75% of patients. The most common comorbidities were high blood pressure (55.75%), and diabetes mellitus (50%). The most frequent symptoms were dyspnoea (69.8%), fatigue (66.8%) and dry cough (65.8%). Corrected Qt interval was prolonged in 24.2% of cases. Chest computed tomography were performed in 277 cases (69.3%). Ground glass opacities (93.86%), consolidations (73.3%) and crazy paving (36%) were the main findings. Assessment of pulmonary extent found important involvement (41.87%), sever lesions (23.82%), moderate involvement (21.29%) and critical involvement (1.8%). C-reactive protein (CRP) was elevated in 94.25% of patients. Elevated D-dimer levels were common (68.8%). Antinuclear antibodies were positive in 22.85% cases, and lupus anticoagulant in 35.41%. Acute kidney failure was noted in 25% of patients. The incidence of pulmonary embolism in the current study was 12.99%. The death rate was 8%. According to multivariate logistic regression: older age (odds ratio:1.11, 95% CI: 1.058-1.167; P P< .005), elevated C-reactive protein levels (odds ratio: 1.008, 95% CI: 1.003-1.013; P< .005) and duration of hospital stay (odds ratio: 1.131, 95% CI: 1.062-1.204; P< .005) were predictive factors of mortality. Conclusions Clinical presentation of covid-19 pneumonia in elderly patients is particular due to pre-existing comorbidities and frailty. Mortality risk factors are age, elevated CRP and length of hospitalization.