Aicha Ben Tekaya, Salma Mokaddem, Selma Athimini, Hela Kamoun, Ines Mahmoud, Leila Abdelmoula
Background: The objective of this study was to assess clinical and imaging features of rheumatoid arthritis (RA) associated with interstitial lung disease (ILD), (RA-ILD) group, in comparison to RA without ILD (RA-C) and to identify the associated factors to ILD.
Methods: This was a retrospective comparative study (from June 2015 to March 2022) including RA patients aged ≥18 years. The RA-C control group was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, ILD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of ILD.
Results: A total of 104 patients were included (52 RA-ILD and 52 RA-C); sex ratio was 0.36. Mean age was 66.3±11 years (RA-ILD) versus 65.6±10.8 years (RA-C) (p=0.72). In comparison to RA-C, RA-ILD patients were significantly higher smokers (p=0.01) and physically inactive (p=0.01). Regarding RA features, RA-ILD patients have significantly increased positive anti-citrullinated peptide antibody (ACPA) (p=0.01), ACPA rate (p<0.001), erosive disease (p<0.001), and disease activity score (p<0.001). Mean time to ILD diagnosis was 5.85±7.16 years. Chest high-resolution computed tomography (HRCT) patterns of disease were identified: nonspecific interstitial pneumonia (NSIP) (28.8%), usual interstitial pneumonia (UIP) (17.3%), organizing pneumonia (OP) (25%), acute interstitial pneumonia (13.5%), and respiratory bronchiolitis (3.8%). Multivariate analysis identified smoking, high baseline DAS28 (disease activity score 28) and ACPA positivity as predictive factors of ILD.
Conclusion: Our results confirmed the reported associated factors of ILD in RA (smoking, higher disease activity, ACPA positivity). Thus, we need to target the modifiable factors by supporting and educating RA patients to quit smoking and intensify disease modifying anti-rheumatoid drugs (DMARD) to reach remission.
{"title":"Risk factors for rheumatoid arthritis-associated interstitial lung disease: a retrospective study.","authors":"Aicha Ben Tekaya, Salma Mokaddem, Selma Athimini, Hela Kamoun, Ines Mahmoud, Leila Abdelmoula","doi":"10.4081/mrm.2022.877","DOIUrl":"https://doi.org/10.4081/mrm.2022.877","url":null,"abstract":"<p><strong>Background: </strong>The objective of this study was to assess clinical and imaging features of rheumatoid arthritis (RA) associated with interstitial lung disease (ILD), (RA-ILD) group, in comparison to RA without ILD (RA-C) and to identify the associated factors to ILD.</p><p><strong>Methods: </strong>This was a retrospective comparative study (from June 2015 to March 2022) including RA patients aged ≥18 years. The RA-C control group was matched according to age (±2 years), gender, and RA duration (±2 years). General data, RA characteristics, ILD features, and treatment modalities were recorded. Statistical analysis was performed to determine the predictive factors of ILD.</p><p><strong>Results: </strong>A total of 104 patients were included (52 RA-ILD and 52 RA-C); sex ratio was 0.36. Mean age was 66.3±11 years (RA-ILD) <i>versus</i> 65.6±10.8 years (RA-C) (p=0.72). In comparison to RA-C, RA-ILD patients were significantly higher smokers (p=0.01) and physically inactive (p=0.01). Regarding RA features, RA-ILD patients have significantly increased positive anti-citrullinated peptide antibody (ACPA) (p=0.01), ACPA rate (p<0.001), erosive disease (p<0.001), and disease activity score (p<0.001). Mean time to ILD diagnosis was 5.85±7.16 years. Chest high-resolution computed tomography (HRCT) patterns of disease were identified: nonspecific interstitial pneumonia (NSIP) (28.8%), usual interstitial pneumonia (UIP) (17.3%), organizing pneumonia (OP) (25%), acute interstitial pneumonia (13.5%), and respiratory bronchiolitis (3.8%). Multivariate analysis identified smoking, high baseline DAS28 (disease activity score 28) and ACPA positivity as predictive factors of ILD.</p><p><strong>Conclusion: </strong>Our results confirmed the reported associated factors of ILD in RA (smoking, higher disease activity, ACPA positivity). Thus, we need to target the modifiable factors by supporting and educating RA patients to quit smoking and intensify disease modifying anti-rheumatoid drugs (DMARD) to reach remission.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"17 ","pages":"877"},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f0/f5/mrm-17-1-877.PMC9728125.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10337805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Lahmer, J. Erber, R. Schmid, J. Schneider, C. Spinner, P. Luppa, F. Sörgel, M. Kinzig, S. Rasch
The relationship between SARS-CoV-2 quantitative viral load and risk of disease progression, morbidity such as long- COVID or mortality in immunosuppressed, remains largely undefined in COVID-19 patients. Critically ill immunosuppressed patients potentially benefit from remdesivir treatment because of the prolonged course of their infection. Four critically ill immunocompromised patients and the impact of remdesivir on viral dynamics in lower respiratory samples were studied. Bronchoalveolar lavage (BAL) samples were assessed to measure SARS-CoV-2 quantitative viral load using real-time PCR. Corresponding plasma levels of remdesivir and its metabolite GS-441524 were determined. Mean virus load of 39.74 x 107 geq/ml (±33.25 x 107 geq/ml) on day 1 dropped significantly (p<0.008) to 3.54 x 106 geq/ml (±6.93 x 106 geq/ml) on day 3 and to 1.4 x 105 geq/ml (±2.35 x 105 geq/ml) on day 5 of remdesivir treatment. Mean virus load dropped below <1% between day 1 and 5 of remdesivir treatment. Parent prodrug remdesivir and also GS441524 metabolite levels of antiviral activity in our patients were far in excess of EC 50. Our data present that remdesivir treatment potentially reduces the SARS-CoV-2 viral load in immunosuppressed critically ill patients. However, the implication of viral load reduction on morbidity and mortality needs further investigation.
在新冠肺炎患者中，SARS-CoV-2定量病毒载量与疾病进展风险、长期COVID等发病率或免疫抑制患者死亡率之间的关系在很大程度上仍不明确。危重免疫抑制患者可能受益于瑞德西韦治疗，因为他们的感染过程延长。研究了四名免疫功能受损的危重患者以及瑞德西韦对下呼吸道样本中病毒动力学的影响。评估支气管肺泡灌洗（BAL）样本，以使用实时PCR测量严重急性呼吸系统综合征冠状病毒2型的定量病毒载量。测定了瑞德西韦及其代谢产物GS-441524的相应血浆水平。瑞德西韦治疗第1天的平均病毒载量39.74 x 107 geq/ml（±33.25 x 107 geq/ml）显著下降（p＜0.008），第3天降至3.54 x 106 geq/ml（±6.93 x 106 geq/ml），第5天降至1.4 x 105 geq/ml。瑞德西韦治疗的第1天至第5天，平均病毒载量降至<1%以下。我们患者的母体前药瑞德西韦和GS441524代谢产物的抗病毒活性水平远远超过EC50。我们的数据表明，瑞德西韦治疗可能降低免疫抑制危重患者的严重急性呼吸系统综合征冠状病毒2型病毒载量。然而，病毒载量减少对发病率和死亡率的影响需要进一步研究。
{"title":"SARS-CoV-2 viral load dynamics in immunocompromised critically ill patients on remdesivir treatment","authors":"T. Lahmer, J. Erber, R. Schmid, J. Schneider, C. Spinner, P. Luppa, F. Sörgel, M. Kinzig, S. Rasch","doi":"10.4081/mrm.2022.825","DOIUrl":"https://doi.org/10.4081/mrm.2022.825","url":null,"abstract":"The relationship between SARS-CoV-2 quantitative viral load and risk of disease progression, morbidity such as long- COVID or mortality in immunosuppressed, remains largely undefined in COVID-19 patients. Critically ill immunosuppressed patients potentially benefit from remdesivir treatment because of the prolonged course of their infection. Four critically ill immunocompromised patients and the impact of remdesivir on viral dynamics in lower respiratory samples were studied. Bronchoalveolar lavage (BAL) samples were assessed to measure SARS-CoV-2 quantitative viral load using real-time PCR. Corresponding plasma levels of remdesivir and its metabolite GS-441524 were determined. Mean virus load of 39.74 x 107 geq/ml (±33.25 x 107 geq/ml) on day 1 dropped significantly (p<0.008) to 3.54 x 106 geq/ml (±6.93 x 106 geq/ml) on day 3 and to 1.4 x 105 geq/ml (±2.35 x 105 geq/ml) on day 5 of remdesivir treatment. Mean virus load dropped below <1% between day 1 and 5 of remdesivir treatment. Parent prodrug remdesivir and also GS441524 metabolite levels of antiviral activity in our patients were far in excess of EC 50. Our data present that remdesivir treatment potentially reduces the SARS-CoV-2 viral load in immunosuppressed critically ill patients. However, the implication of viral load reduction on morbidity and mortality needs further investigation.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43145162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Chérrez-Ojeda, E. Vanegas, M. Félix, M. J. Farfán Bajaña, A. Sarfraz, Z. Sarfraz, Genesis Camacho, A. Barrios-Ruiz, Jack Michel
Despite the uncertainty about the follow up of COVID-19 survivors, there is a growing body of evidence supporting specific interventions including pulmonary rehabilitation, which may lead to a reduced hospital stay and improved overall respiratory function. The aim of this short report was to assess the attitudes toward pulmonary rehabilitation following COVID-19 among Ecuadorian physicians. A cross-sectional study was conducted, in which a 5-question survey was used to assess the level of agreement to specific statements with a 5-point Likert scale. Out of the 282 participants, 48.2% (n=136) were male, with a mean of 12.6 (SD=11.3) years of experience. More than half of physicians (63.8%, n=180; χ2(2) = 139.224, p=0.000) considered that diagnosis and treatment of patients with sub-acute and chronic COVID-19 pulmonary sequelae is not clear. Additionally, 94.3% (n=266; χ2(2) = 497.331, p=0.000) agreed that pulmonary rehabilitation must be considered as a relevant strategy in long-term care following an acute infection, with 92.6% (n=261; χ2(2) = 449.772, p=0.000) stating it will improve the likelihood of survival and return to baseline health. In conclusion, we found that considerable majority of physicians held positive attitudes to the role of pulmonary rehabilitation and considered it as a relevant strategy in long-term care following COVID-19. However, most of them also conveyed that the diagnosis and treatment of chronic pulmonary sequalae is unclear, and that guidelines for assessing pulmonary function should be established.
{"title":"Physician’s attitudes on pulmonary rehabilitation following COVID-19: a brief perspective from a developing country","authors":"I. Chérrez-Ojeda, E. Vanegas, M. Félix, M. J. Farfán Bajaña, A. Sarfraz, Z. Sarfraz, Genesis Camacho, A. Barrios-Ruiz, Jack Michel","doi":"10.4081/mrm.2022.837","DOIUrl":"https://doi.org/10.4081/mrm.2022.837","url":null,"abstract":"Despite the uncertainty about the follow up of COVID-19 survivors, there is a growing body of evidence supporting specific interventions including pulmonary rehabilitation, which may lead to a reduced hospital stay and improved overall respiratory function. The aim of this short report was to assess the attitudes toward pulmonary rehabilitation following COVID-19 among Ecuadorian physicians. A cross-sectional study was conducted, in which a 5-question survey was used to assess the level of agreement to specific statements with a 5-point Likert scale. Out of the 282 participants, 48.2% (n=136) were male, with a mean of 12.6 (SD=11.3) years of experience. More than half of physicians (63.8%, n=180; χ2(2) = 139.224, p=0.000) considered that diagnosis and treatment of patients with sub-acute and chronic COVID-19 pulmonary sequelae is not clear. Additionally, 94.3% (n=266; χ2(2) = 497.331, p=0.000) agreed that pulmonary rehabilitation must be considered as a relevant strategy in long-term care following an acute infection, with 92.6% (n=261; χ2(2) = 449.772, p=0.000) stating it will improve the likelihood of survival and return to baseline health. In conclusion, we found that considerable majority of physicians held positive attitudes to the role of pulmonary rehabilitation and considered it as a relevant strategy in long-term care following COVID-19. However, most of them also conveyed that the diagnosis and treatment of chronic pulmonary sequalae is unclear, and that guidelines for assessing pulmonary function should be established.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42299932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
On January 4th, 2022 Professor Carlo Grassi died at home in Milan, at the age of 95 years...
2022年1月4日，卡洛·格拉西教授在米兰的家中去世，享年95岁……
{"title":"In memory of Prof. Carlo Grassi","authors":"L. Casali, Stefano Nardini","doi":"10.4081/mrm.2022.836","DOIUrl":"https://doi.org/10.4081/mrm.2022.836","url":null,"abstract":"On January 4th, 2022 Professor Carlo Grassi died at home in Milan, at the age of 95 years...","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48501084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Panayiotis Kouis, Maria G Kakkoura, Stavria Artemis Elia, Phivos Ioannou, Pinelopi Anagnostopoulou, Louiza Potamiti, Maria A Loizidou, Mihalis I Panayiotidis, Kyriacos Kyriacou, Andreas Hadjisavvas, Panayiotis K Yiallouros
Background: Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales.
Methods: Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU.
Results: Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R2= 0.419) and EQ5D (R2= 0.538) variability.
Conclusions: Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.
{"title":"Observational study of health utilities in adult primary ciliary dyskinesia patients: preliminary data on associations with molecular diagnosis, clinical phenotype and HRQOL measures.","authors":"Panayiotis Kouis, Maria G Kakkoura, Stavria Artemis Elia, Phivos Ioannou, Pinelopi Anagnostopoulou, Louiza Potamiti, Maria A Loizidou, Mihalis I Panayiotidis, Kyriacos Kyriacou, Andreas Hadjisavvas, Panayiotis K Yiallouros","doi":"10.4081/mrm.2022.881","DOIUrl":"https://doi.org/10.4081/mrm.2022.881","url":null,"abstract":"<p><strong>Background: </strong>Primary ciliary dyskinesia (PCD) is a congenital disorder characterized by chronic respiratory morbidity. To date, there is no information on PCD-specific preference-based quality of life measures such as health utilities (HU). We cross-sectionally assessed HU in adult PCD patients and explored relationships with genotype, phenotype and quality of life (QOL)-PCD scales.</p><p><strong>Methods: </strong>Diagnostic testing was performed according to international guidelines, while participants completed the visual analog scale (VAS), time trade off (TTO), standard gamble (SG), and EuroQol 5 dimensions (EQ5D) HU instruments, as well as the QOL-PCD questionnaire. Hierarchical regression was used to identify the QOL-PCD scales that are most predictive of HU.</p><p><strong>Results: </strong>Among 31 patients, median HU are 0.75 (VAS), 0.86 (EQ5D), 0.91 (TTO) and 0.99 (SG). The underlying genotype is not associated with HU measures. VAS and EQ5D are associated with lung function, while TTO and SG values are not sensitive to any of the examined factors. Among the QOL-PCD scales, physical functioning and lower respiratory symptoms explained much of VAS (R<sup>2</sup>= 0.419) and EQ5D (R<sup>2</sup>= 0.538) variability.</p><p><strong>Conclusions: </strong>Our study demonstrates that HU elicitation in PCD is feasible using both direct and indirect methods. Overall, HU scores are relatively high among adult patients, with higher scores observed in SG and TTO, followed by EQ5D and VAS. VAS and EQ5D HU values are sensitive to lung function as well as to QOL-PCD physical functioning and lower respiratory symptom scores.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"17 ","pages":"881"},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/db/mrm-17-1-881.PMC9830407.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10581903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Chiang, Yen-Chang Lin, Hsiao-Chen Yu, Chih-Ming Lu, Yee-Hsin Kao
Background Snoring constitutes a worldwide public health concern that may be associated with daytime fatigue, endothelial dysfunction, vascular injury, stroke, cardiovascular diseases, and diabetes among female patients. This study explored the effects of the so-called Lin Oral Appliance (LOA) on Taiwanese adults’ snoring rates. Methods A time series analysis was conducted to examine the associations between LOAs’ tongue compressors of different lengths, and snoring rates were calculated using the SnoreClock app. The LOA comprises 2 components: custom- made dental braces and tongue compressors of adjustable lengths; different versions had different-length compressors. Results Our multiple linear regression time-series model revealed the effects of the LOA on snoring rates. The results indicated the following: i) LOA tongue compressor lengths of 1 and 2.5 cm (LOA-1 and LOA-2.5, respectively) were associated with reduced snoring rates; ii) sleep durations of 5.5-7.5 h and daytime sleepiness were associated with increased snoring rates; and iii) among participants with snoring rates above 10%, the snoring rates observed 1-7 days before a given day constituted a significant factor influencing snoring rates on the given day. Conclusions We discovered that the LOA could reduce snoring rates and that the 2.5-cm compressor length in the LOA produced the best results.
{"title":"Long-term benefits of a new oral appliance on adult snoring: a trend analysis","authors":"J. Chiang, Yen-Chang Lin, Hsiao-Chen Yu, Chih-Ming Lu, Yee-Hsin Kao","doi":"10.4081/mrm.2022.824","DOIUrl":"https://doi.org/10.4081/mrm.2022.824","url":null,"abstract":"Background Snoring constitutes a worldwide public health concern that may be associated with daytime fatigue, endothelial dysfunction, vascular injury, stroke, cardiovascular diseases, and diabetes among female patients. This study explored the effects of the so-called Lin Oral Appliance (LOA) on Taiwanese adults’ snoring rates. Methods A time series analysis was conducted to examine the associations between LOAs’ tongue compressors of different lengths, and snoring rates were calculated using the SnoreClock app. The LOA comprises 2 components: custom- made dental braces and tongue compressors of adjustable lengths; different versions had different-length compressors. Results Our multiple linear regression time-series model revealed the effects of the LOA on snoring rates. The results indicated the following: i) LOA tongue compressor lengths of 1 and 2.5 cm (LOA-1 and LOA-2.5, respectively) were associated with reduced snoring rates; ii) sleep durations of 5.5-7.5 h and daytime sleepiness were associated with increased snoring rates; and iii) among participants with snoring rates above 10%, the snoring rates observed 1-7 days before a given day constituted a significant factor influencing snoring rates on the given day. Conclusions We discovered that the LOA could reduce snoring rates and that the 2.5-cm compressor length in the LOA produced the best results.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47781490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Fuest, J. Erber, Wiebke Berg-Johnson, M. Heim, D. Hoffmann, B. Kapfer, Silja Kriescher, B. Ulm, R. Schmid, S. Rasch, T. Lahmer
Background To assess the prevalence of Herpes simplex and Cytomegalovirus infection in respiratory samples of critically-ill COVID-19 patients, its role in outcome and mortality and the influence of dexamethasone treatment in the early stage of SARS-CoV-2 infection. Methods All mechanically ventilated COVID-19 patients treated on ICU between March 2020 and January 2021 were included. Respiratory specimens were tested for Herpes simplex virus (HSV) type 1, 2 and Cytomegalovirus (CMV) by quantitative real-time PCR. Clinical parameters were compared in the cohorts with and without HSV-1- infection. Results 134 patients with a median age of 72.5 years (73.0% male, n=98) were included. HSV-1 reactivation occurred in 61 patients (45.5%), after median 9 (7-13) days of mechanical ventilation. The main factor for reactivation was length of stay on ICU (24 days vs 13 days, p<0.001) and duration of mechanical ventilation (417 vs 214 hours, p<0.001). Treatment with dexamethasone and a history of immunosuppression did not associate with HSV-infection in the univariate analysis (39 vs 41, p=0.462 and 27.9% vs 23.3%, p=0.561, respectively). Both ICU and hospital mortality were not significantly different in the cohorts with and without HSV-infection (57.4% vs 45.2%, p=0.219). Conclusions Our study shows a high prevalence of HSV-infection in critically-ill COVID-19 patients which was unexpectedly higher than the prevalence of CMV-infections and unrelated to dexamethasone treatment. The main risk factors for HSV and CMV in the studied cohorts were the length of ICU stay and duration of mechanical ventilation. Therefore, we recommend routine monitoring of critically ill COVID-19 patients for these viral co-infections and consider treatment in those patients.
背景评估重症新冠肺炎患者呼吸系统样本中单纯疱疹病毒和巨细胞病毒感染的流行率、其在结果和死亡率中的作用以及地塞米松治疗在SARS-CoV-2感染早期的影响。方法纳入2020年3月至2021年1月期间在ICU接受机械通气治疗的所有新冠肺炎患者。通过实时定量PCR检测呼吸道标本中的1型、2型单纯疱疹病毒（HSV）和巨细胞病毒（CMV）。比较了有和无HSV-1感染的队列的临床参数。结果纳入134例患者，中位年龄72.5岁（73.0%为男性，n=98）。61名患者（45.5%）在机械通气中位9（7-13）天后出现HSV-1再激活。再激活的主要因素是ICU的住院时间（24天vs 13天，p＜0.001）和机械通气的持续时间（417小时vs 214小时，p＜001）。在单变量分析中，地塞米松治疗和免疫抑制史与HSV感染无关（分别为39 vs 41，p＝0.462和27.9%vs 23.3%，p＝0.561）。在有和无HSV感染的队列中，ICU和医院死亡率没有显著差异（57.4%对45.2%，p=0.219）。结论我们的研究表明，危重新冠肺炎患者中HSV感染率很高，出乎意料地高于CMV感染率，与地塞米松治疗无关。研究队列中HSV和CMV的主要危险因素是ICU住院时间和机械通气持续时间。因此，我们建议对重症新冠肺炎患者进行常规监测，以了解这些病毒合并感染，并考虑对这些患者进行治疗。
{"title":"Risk factors for Herpes simplex virus (HSV) and Cytomegalovirus (CMV) infections in critically-ill COVID-19 patients","authors":"K. Fuest, J. Erber, Wiebke Berg-Johnson, M. Heim, D. Hoffmann, B. Kapfer, Silja Kriescher, B. Ulm, R. Schmid, S. Rasch, T. Lahmer","doi":"10.4081/mrm.2022.815","DOIUrl":"https://doi.org/10.4081/mrm.2022.815","url":null,"abstract":"Background To assess the prevalence of Herpes simplex and Cytomegalovirus infection in respiratory samples of critically-ill COVID-19 patients, its role in outcome and mortality and the influence of dexamethasone treatment in the early stage of SARS-CoV-2 infection. Methods All mechanically ventilated COVID-19 patients treated on ICU between March 2020 and January 2021 were included. Respiratory specimens were tested for Herpes simplex virus (HSV) type 1, 2 and Cytomegalovirus (CMV) by quantitative real-time PCR. Clinical parameters were compared in the cohorts with and without HSV-1- infection. Results 134 patients with a median age of 72.5 years (73.0% male, n=98) were included. HSV-1 reactivation occurred in 61 patients (45.5%), after median 9 (7-13) days of mechanical ventilation. The main factor for reactivation was length of stay on ICU (24 days vs 13 days, p<0.001) and duration of mechanical ventilation (417 vs 214 hours, p<0.001). Treatment with dexamethasone and a history of immunosuppression did not associate with HSV-infection in the univariate analysis (39 vs 41, p=0.462 and 27.9% vs 23.3%, p=0.561, respectively). Both ICU and hospital mortality were not significantly different in the cohorts with and without HSV-infection (57.4% vs 45.2%, p=0.219). Conclusions Our study shows a high prevalence of HSV-infection in critically-ill COVID-19 patients which was unexpectedly higher than the prevalence of CMV-infections and unrelated to dexamethasone treatment. The main risk factors for HSV and CMV in the studied cohorts were the length of ICU stay and duration of mechanical ventilation. Therefore, we recommend routine monitoring of critically ill COVID-19 patients for these viral co-infections and consider treatment in those patients.","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44817211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto W Dal Negro, Paola Turco, Massimiliano Povero
<p><strong>Background: </strong>Pulmonary microvascular occlusions can aggravate SARS-CoV-2 pneumonia and result in a variable decrease in capillary blood volume (Vc). Dyspnoea may persist for several weeks after hospital discharge in many patients who have "radiologically recovered" from COVID-19 pneumonia. Dyspnoea is frequently "unexplained" in these cases because abnormalities in lung vasculature are understudied. Furthermore, even when they are identified, therapeutic options are still lacking in clinical practice, with nitric oxide (NO) supplementation being used only for severe respiratory failure in the hospital setting. Nebivolol is the only selective β<sup>1</sup> adrenoceptor antagonist capable of inducing nitric oxide-mediated vasodilation by stimulating endothelial NO synthase <i>via</i> β<sub>3</sub> agonism. The purpose of this study was to compare the effect of nebivolol <i>versus</i> placebo in patients who had low Vc and complained of dyspnoea for several weeks after COVID-19 pneumonia.</p><p><strong>Methods: </strong>Patients of both genders, aged ≥18 years, non-smokers, who had a CT scan that revealed no COVID-related parenchymal lesions but still complaining of dyspnoea 12-16 weeks after hospital discharge, were recruited. Spirometrical volumes, blood haemoglobin, SpO<sub>2</sub>, simultaneous diffusing capacity for carbon monoxide (CO) and NO (DL<sub>CO</sub> and DL<sub>NO</sub>, respectively), DL<sub>NO</sub>/DL<sub>CO</sub> ratio, Vc and exhaled NO (eNO) were measured together with their dyspnoea score (DS), heart frequency (HF), and blood arterial pressure (BAP). Data were collected before and one week after both placebo (P) and nebivolol (N) (2.5 mg od) double-blind cross-over administered at a two-week interval. Data were statistically compared, and p<0.05 assumed as statistically significant.</p><p><strong>Results: </strong>Eight patients (3 males) were investigated. In baseline, their mean DS was 2.5±0.6 SD, despite the normality of lung volumes. DL<sub>CO</sub> and DL<sub>NO</sub> mean values were lower than predicted, while mean DL<sub>NO</sub>/DL<sub>CO</sub> ratio was higher. Mean Vc proved substantially reduced. Placebo did not modify any variable (all p=ns) while N improved DLco and Vc significantly (+8.5%, p<0.04 and +17.7%, p<0.003, respectively). eNO also was significantly increased (+17.6%, p<0.002). Only N lowered the dyspnoea score (-76%, p<0.001). Systolic and diastolic BAP were slightly lowered (-7.5%, p<0.02 and -5.1%, p<0.04, respectively), together with HF (-16.8%, p<0.03).</p><p><strong>Conclusions: </strong>The simultaneous assessment of DL<sub>NO</sub>, DL<sub>CO</sub>, DL<sub>NO</sub>/DL<sub>CO</sub> ratio, and Vc confirmed that long-lasting dyspnoea is related to hidden abnormalities in the lung capillary vasculature. These abnormalities can persist even after the complete resolution of parenchymal lesions regardless of the normality of lung volumes. Nebivolol, but not placebo, improves DS and Vc
{"title":"Nebivolol: an effective option against long-lasting dyspnoea following COVID-19 pneumonia - a pivotal double-blind, cross-over controlled study.","authors":"Roberto W Dal Negro, Paola Turco, Massimiliano Povero","doi":"10.4081/mrm.2022.886","DOIUrl":"https://doi.org/10.4081/mrm.2022.886","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary microvascular occlusions can aggravate SARS-CoV-2 pneumonia and result in a variable decrease in capillary blood volume (Vc). Dyspnoea may persist for several weeks after hospital discharge in many patients who have \"radiologically recovered\" from COVID-19 pneumonia. Dyspnoea is frequently \"unexplained\" in these cases because abnormalities in lung vasculature are understudied. Furthermore, even when they are identified, therapeutic options are still lacking in clinical practice, with nitric oxide (NO) supplementation being used only for severe respiratory failure in the hospital setting. Nebivolol is the only selective β<sup>1</sup> adrenoceptor antagonist capable of inducing nitric oxide-mediated vasodilation by stimulating endothelial NO synthase <i>via</i> β<sub>3</sub> agonism. The purpose of this study was to compare the effect of nebivolol <i>versus</i> placebo in patients who had low Vc and complained of dyspnoea for several weeks after COVID-19 pneumonia.</p><p><strong>Methods: </strong>Patients of both genders, aged ≥18 years, non-smokers, who had a CT scan that revealed no COVID-related parenchymal lesions but still complaining of dyspnoea 12-16 weeks after hospital discharge, were recruited. Spirometrical volumes, blood haemoglobin, SpO<sub>2</sub>, simultaneous diffusing capacity for carbon monoxide (CO) and NO (DL<sub>CO</sub> and DL<sub>NO</sub>, respectively), DL<sub>NO</sub>/DL<sub>CO</sub> ratio, Vc and exhaled NO (eNO) were measured together with their dyspnoea score (DS), heart frequency (HF), and blood arterial pressure (BAP). Data were collected before and one week after both placebo (P) and nebivolol (N) (2.5 mg od) double-blind cross-over administered at a two-week interval. Data were statistically compared, and p<0.05 assumed as statistically significant.</p><p><strong>Results: </strong>Eight patients (3 males) were investigated. In baseline, their mean DS was 2.5±0.6 SD, despite the normality of lung volumes. DL<sub>CO</sub> and DL<sub>NO</sub> mean values were lower than predicted, while mean DL<sub>NO</sub>/DL<sub>CO</sub> ratio was higher. Mean Vc proved substantially reduced. Placebo did not modify any variable (all p=ns) while N improved DLco and Vc significantly (+8.5%, p<0.04 and +17.7%, p<0.003, respectively). eNO also was significantly increased (+17.6%, p<0.002). Only N lowered the dyspnoea score (-76%, p<0.001). Systolic and diastolic BAP were slightly lowered (-7.5%, p<0.02 and -5.1%, p<0.04, respectively), together with HF (-16.8%, p<0.03).</p><p><strong>Conclusions: </strong>The simultaneous assessment of DL<sub>NO</sub>, DL<sub>CO</sub>, DL<sub>NO</sub>/DL<sub>CO</sub> ratio, and Vc confirmed that long-lasting dyspnoea is related to hidden abnormalities in the lung capillary vasculature. These abnormalities can persist even after the complete resolution of parenchymal lesions regardless of the normality of lung volumes. Nebivolol, but not placebo, improves DS and Vc","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"17 ","pages":"886"},"PeriodicalIF":2.3,"publicationDate":"2022-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/db/e8/mrm-17-1-886.PMC9830396.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10528022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-29eCollection Date: 2021-01-15DOI: 10.4081/mrm.2021.807
Safwat Eldaboussi, Ahmed Qabil, Ahmed Lotfi, Amgad Awad, Eman Abdel Salam, Abdullah Alkhamis, Usama E Abuelhassan
Background: Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.
Methods: This multicenter observational study enrolled a cohort of 97 patients from March 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV1 before and during biologic therapy.
Results: Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV1 improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.
Conclusions: Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.
{"title":"Saudi Arabian real-life experience with biologic therapy in severe asthma.","authors":"Safwat Eldaboussi, Ahmed Qabil, Ahmed Lotfi, Amgad Awad, Eman Abdel Salam, Abdullah Alkhamis, Usama E Abuelhassan","doi":"10.4081/mrm.2021.807","DOIUrl":"10.4081/mrm.2021.807","url":null,"abstract":"<p><strong>Background: </strong>Severe asthma (SA) is a common health problem associated with increased morbidity and mortality and high medical costs. Biological therapies have emerged in recent decades as promising treatment options for patients with high type 2 (T2) SA. This retrospective observational study from Saudi Arabia aimed to investigate the effects of additional biologics therapy on reducing oral corticosteroid (OCS) consumption, frequency of asthma exacerbations, improvement in lung function, and asthma control.</p><p><strong>Methods: </strong>This multicenter observational study enrolled a cohort of 97 patients from March 2019 to February 2021. Outcomes of anti-IgE, anti-IL5/IL5R, and anti-IL4R therapies in severe type 2 asthma were recorded and analyzed in terms of number of exacerbations (emergency visits or hospitalizations required), asthma symptoms, and use of oral corticosteroids, blood eosinophil count, asthma control according to GINA classification, and FEV<sub>1</sub> before and during biologic therapy.</p><p><strong>Results: </strong>Ninety-seven patients were included in the analysis The mean age was 46.7±14.1 years, and 69.1% of them were female. The average duration of biological treatment was 16.4±6.8 months. At the time of data collection, the four biologic therapies reduced the exacerbation rate per year from 82/97 (84.5%) to 14/97 (14.4%) with a percent improvement of 83% from 2.9 per year in the year before biologic treatment to 1.6 per year (p<0.001). OCS was reduced from 75/97 (77.3%) to 10/97 (10.3%) for a percent improvement of 86.7%, and the average OCS dose decreased from 7.12 mg to 6.8 mg. Mean blood eosinophil count also decreased after biologic therapy from 750.5±498.5 to 188.0±122.4 cells/μl, most significant result achieved with benralizumab, and mean FEV<sub>1</sub> improved from 59.0±12.9% to 76.0±10.2%, most significant result achieved with omalizumab. ll patients had uncontrolled asthma before biologics therapy, but asthma control improved by 91.8% after treatment.</p><p><strong>Conclusions: </strong>Biologic as add-on therapy for high T2 SA was found to reduce asthma exacerbations, systemic glucocorticoid doses, and SA symptoms.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"807"},"PeriodicalIF":2.3,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/f3/mrm-16-1-807.PMC8743612.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39962756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-22eCollection Date: 2021-01-15DOI: 10.4081/mrm.2021.811
Abdulaziz Alrabiah, Khaled Alhussinan, Mohammed Alyousef, Ahmed Alsayed, Abdullah Aljasser, Shatha Alduraywish, Ahmed Alammar
Background: This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.
Methods: A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.
Results: Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%).
Conclusions: The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.
{"title":"Microbiological profiles of tracheostomy patients: a single-center experience.","authors":"Abdulaziz Alrabiah, Khaled Alhussinan, Mohammed Alyousef, Ahmed Alsayed, Abdullah Aljasser, Shatha Alduraywish, Ahmed Alammar","doi":"10.4081/mrm.2021.811","DOIUrl":"https://doi.org/10.4081/mrm.2021.811","url":null,"abstract":"<p><strong>Background: </strong>This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.</p><p><strong>Methods: </strong>A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.</p><p><strong>Results: </strong>Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated <i>Pseudomonas aeruginosa</i>, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, <i>P. aeruginosa</i> was the most common (35%), followed by methicillin-resistant <i>Staphylococcus aureus</i> (MRSA; 23.5%).</p><p><strong>Conclusions: </strong>The most common post-tracheostomy microorganism was <i>P. aeruginosa</i>. MRSA showed a strong association with tracheostomy for obstructive indications.</p>","PeriodicalId":51135,"journal":{"name":"Multidisciplinary Respiratory Medicine","volume":"16 1","pages":"811"},"PeriodicalIF":2.3,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/18/mrm-16-1-811.PMC8743611.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39962757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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