Respiratory function in patients post-infection by COVID-19: a systematic review and meta-analysis

Long-term alveolar-capillary diffusion impairments after severe SARS-CoV-2 pneumonia

BACKGROUND

Persistent respiratory symptoms and impaired gas exchange are common in patients recovering from COVID-19 pneumonia. The Lung Diffusing Capacity for Carbon Monoxide (DLCO) and Carbon Monoxide Transfer Coefficient (KCO) do not adequately distinguish alveolar membrane dysfunction from vascular abnormalities. This study aimed to characterize persistent diffusion impairment in post-ICU patients with prior SARS-CoV-2 pneumonia and reduced DLCO.

METHODS

After hospital discharge, patients underwent spirometry, DLCO measurement, and a 6-minute walking test every six months. If DLCO remained impaired at 18-24 months, a combined Lung Diffusing Capacity for Nitric Oxide (DLNO) and DLCO assessment was performed to differentiate alveolar-capillary membrane (DmCO) and pulmonary capillary blood volume (Vc) alterations.

RESULTS

Among 20 patients with persistent DLCO reduction, 3 had an obstructive ventilatory pattern, 6 had restriction, and 12 had low KCO. In restrictive cases, KCO was reduced but remained within normal limits without compensation. The DLNO/DLCO ratio exceeded 113.5% predicted in all patients. DmCO was impaired in 7 patients, while Vc was reduced in 16.

CONCLUSION

Both DLCO determinants were affected, with vascular impairment predominating. Vc reduction was present in most patients, with mean values below the lower limit of normality, whereas DmCO was less affected and often normal. The elevated DLNO/DLCO ratio suggests that persistent DLCO reduction is primarily driven by prolonged pulmonary capillary circulation dysfunction rather than alveolar membrane alterations, highlighting the vascular component as the primary site of long-term impairment.

Increased risk of hospitalization for various disorders after COVID-19 infection: A Cohort study of the UK biobank spanning over a hundred disease categories

BACKGROUND

COVID-19 is one of the most pressing public health issues worldwide. The sequelae of COVID-19 however remains unclear. We performed a systematic assessment of sequelae across all body systems, focusing on whether COVID-19 is associated with increased risk of hospitalization for various diseases.

METHODS

In this cohort study, we examined 135 disorders in UK biobank (UKBB) (N = 412,096; age: 50-87). We also conducted analysis for new-onset and recurrent cases, and employed the prior event rate adjustment (PERR) approach to minimize effects of unmeasured confounders. Time-dependent effects were also tested.

RESULTS

Compared to individuals with no known COVID-19 history, those with severe COVID-19 (hospitalized) exhibited increased hazards of hospitalization due to multiple disorders (median follow-up = 261 days), including disorders of respiratory, cardiovascular, neurological, gastrointestinal, genitourinary, musculoskeletal systems, as well as injuries, infections and non-specific symptoms. Notably, severe COVID-19 was associated with increased hospitalization risks in 77 out of the 107 disease categories with ≥ 5 events in both groups. These results remained largely consistent in sensitivity analyses. Mild (non-hospitalized) COVID-19 was associated with increased risk of hospitalization for several disorders: aspiration pneumonitis, musculoskeletal pain and other general signs/symptoms. The risk of hospitalizations following infection was generally higher during the pre-vaccination era.

CONCLUSION

This study revealed increased risk of hospitalization from a wide variety of pulmonary and extra-pulmonary diseases after COVID-19, especially for severe infections. The findings may have important clinical implications, such as the need for closer monitoring and risk assessment of relevant sequelae, and allocating more resources toward prevention and treatment of such sequelae.

Exploring manual therapy in the management of irritable bowel syndrome in adults: A scoping review

INTRODUCTION

IBS is a prevalent gut-brain interaction disorder characterized by abdominal pain and altered bowel habits, significantly affecting quality of life (QoL). IBS contributes to substantial work absenteeism and economic burdens and often coexists with other somatic and psychiatric conditions, with psychological well-being being a critical determinant of QoL. IBS sufferers often turn to MT due to dissatisfaction with conventional treatments. However, no comprehensive review has assessed the evidence for MT in treating IBS.

OBJECTIVE

The objective of this review is to identify and map the available evidence on the effects of various manual therapy (MT) techniques on the biopsychosocial functioning, well-being, and QoL of individuals with irritable bowel syndrome (IBS).

METHODS

A comprehensive search was conducted in PubMed, Embase, and Scopus. Studies involving adults with IBS and investigating the effects of MT on biological, psychological, and social outcomes, well-being, or QoL were included. A scoping review was conducted following PRISMA-ScR guidelines. Study quality was assessed using The National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tools. The protocol for this review was registered with the Open Science Framework and is available at https://doi.org/10.17605/OSF.IO/QN4WU.

RESULTS

Of 730 records identified, 30 studies met the inclusion criteria (9 trials, 21 reviews). The interventions reviewed included osteopathic manipulative treatment (OMT), acupuncture, acupressure, reflexology, traditional Chinese spinal orthopaedic manipulation, and Tuina. The most frequently assessed outcomes were biological and psychological variables, as well as QoL, with well-being being the least commonly examined.

CONCLUSIONS

Although the results suggest potential benefits of MT in IBS treatment, they should be interpreted with caution due to the lack of robust trials, inconsistent findings, and occasional adverse events. High-quality randomized controlled trials and standardized outcome measures are necessary to validate these therapies and improve IBS management.

Longitudinal assessment of lung function in patients following COVID-19

BACKGROUND

While effects of COVID-19 on lung function are commonly described in those with severe illness, less is known about those with less severe illness, and most studies do not extend beyond 6 months following initial presentation.

RESEARCH QUESTION

What are the effects of COVID-19 on lung function in a cohort of participants that included those with more severe and less severe disease over a 1 year period from time of enrollment?

STUDY DESIGN

We enrolled 52 participants who included those with more severe (had been hospitalized) and less severe (not hospitalized) illness and measured spirometry, lung volumes, diffusing capacity, oscillometry, maximal muscle pressures, inspiratory drive, exercise capacity, and symptom and quality of life surveys at presentation, and repeated the measurements 6 and 12 months later.

RESULTS

While participants who had been hospitalized had consistently lower lung function in all measures, all values were within normal reference ranges. The pattern of lung function change suggested a predominant restrictive physiologic defect with reduced exercise capacity. Over 1 year, there was no significant improvement in lung function. Similar findings were seen when participants were stratified by whether they had shortness of breath at presentation.

INTERPRETATION

In our cohort of participants with both more severe and less severe disease, there were only minor differences in lung function associated with severe illness or whether participants had shortness of breath. COVID-19 resulted in subtle changes related to physiologic restriction, but overall lung function remained in the normal range with little change over time, suggesting that other factors besides lung function contribute to shortness of breath in participants following COVID-19.

Uncomplicated SARS-CoV-2 Infections with Preserved Lung Function in Pediatric Patients with Cystic Fibrosis: A Three-Year Single-Centre Experience

Background/Objectives: Patients with chronic lung diseases, such as cystic fibrosis, were considered a risk group for a severe course of coronavirus disease 2019 at the beginning of the pandemic. However, mounting evidence suggests that this group may not face an elevated risk for a severe SARS-CoV-2 infection. Methods: Here, we present data on the incidence and clinical course of SARS-CoV-2 infections in a single pediatric CF centre in Austria. Clinical variables were analyzed for their potential impact on disease acquisition and severity. A total of 135 young people with CF were assessed from February 2020 until December 2022. Results: Eighty-four patients were infected with SARS-CoV-2, out of which nine patients reported re-infection, resulting in 93 SARS-CoV-2 infections. Most infections, 76/93 (82%), occurred during the period of omicron variant predominance. Higher body mass index and respiratory colonization with Haemophilus influenzae before the beginning of the pandemic were significantly associated with the risk of acquiring SARS-CoV-2 infection. All patients had an uncomplicated COVID-19 course, regardless of the SARS-CoV-2 variant and COVID-19 vaccine status at infection. The most frequent symptoms were rhinitis (53%), fatigue (49%), cephalea (43%), and fever (38%). Neither oxygen therapy nor hospitalization were needed for any of the patients. Lung function parameters (FEV1, FVC, FEF50, LCI), both in the early post-viral as well as late post-viral stages, were not significantly impacted by SARS-CoV-2 infections. No long-term post-COVID-19 effects were reported. Conclusions: Our single-centre experience suggests that the course of SARS-CoV-2 infections in children and adolescents with CF is primarily mild and uncomplicated.

Prevalence and Cardiopulmonary Characteristics of Post-COVID Syndrome at a Hungarian Tertiary Referral Hospital

Background: After an acute COVID-19 infection, many patients suffered from various complaints called as post-COVID syndrome. Methods: Our post-COVID outpatient department was operational for 19 months, where patients (n = 252) underwent a detailed cardiopulmonary examination within a 3-month-long follow-up period. Results: Most patients (69.9%) had mild acute symptoms with a higher hospitalization risk with preexisting hypertension (p < 0.05) and diabetes (p < 0.001). Most common post-COVID symptoms were fatigue (29.4%) and dyspnea (19.1%). Echocardiographic parameters showed no abnormalities and did not change during the follow-up period. Exercise capacity was also generally normal with no change over time; however, 9.9% of patients showed significant desaturation during a 6 min walk test. This finding showed correlation (p < 0.01) with decreased diffusion capacity (DLCO). Generally, DLCO improved slightly but significantly (p < 0.05) by the end of the follow-up period (from 72.4% to 74.1%). Our key finding was a 10× higher prevalence (24.6%) of lupus anticoagulant positivity among post-COVID patients compared to the normal population (estimated at 2-4%). Conclusions: In conclusion, post-COVID syndrome is a common consequence even after a mild infection. Severe infections tend to lead to worse cardiopulmonary outcomes. Higher prevalence of lupus anticoagulant positivity may underline the importance of autoimmunity in the pathomechanism of post-COVID syndrome.

A comparison of pulmonary function pre and post mild SARS-CoV-2 infection among healthy adults

BACKGROUND

SARS-CoV-2 infection frequently involves the respiratory system and may impact on pulmonary function tests (PFT) of recovered individuals. Studies which compare post-COVID-19 PFT to pre-illness measurements are scarce. The primary objective of this study was to assess the effect of COVID-19 on PFT soon after infection.

METHODS

In this prospective observational study, PFT were measured early following recovery from COVID-19 among healthy military aircrew. Spirometry values were compared to pre-COVID-19 measurements, and abnormality rates of lung volumes and diffusion capacity for carbon monoxide (DLCO) were assessed.

RESULTS

The study included 252 aviators, 97.6% males, mean age 34.9-years, following recovery from SARS-CoV-2 infection. Participants manifested mild symptoms (79.4%) or were asymptomatic (20.6%). Post-COVID-19 spirometry results 10.79 ± 5.67 days following infection were compared to measurements performed 41.3 ± 28.59 months earlier. Pre- and post-COVID-19 results were comparable, with similar minimal abnormalities rates (2% and 4.4%, respectively). In addition, there were no restrictive abnormalities following infection, and just 7.7% of individuals had a marginally low DLCO of 70-80% of predicted.

CONCLUSION

Among vaccinated, healthy adults, mild COVID-19 had no significant impact on PFT early post-infection. The data suggest that systematic PFT testing might not be necessary for asymptomatic healthy individuals who recovered from mild COVID-19.

A multidisciplinary review of long COVID to address the challenges in diagnosis and updated management guidelines

Long COVID has emerged as a significant challenge since the COVID-19 pandemic, which was declared as an outbreak in March 2020, marked by diverse symptoms and prolonged duration of disease. Defined by the WHO as symptoms persisting or emerging for at least two months post-SARS-CoV-2 infection without an alternative cause, its prevalence varies globally, with estimates of 10-20% in Europe, 7.3% in the USA, and 3.0% in the UK. The condition's etiology remains unclear, involving factors, such as renin-angiotensin system overactivation, persistent viral reservoirs, immune dysregulation, and autoantibodies. Reactivated viruses, like EBV and HSV-6, alongside epigenetic alterations, exacerbate mitochondrial dysfunction and energy imbalance. Emerging evidence links SARS-CoV-2 to chromatin and gut microbiome changes, further influencing long-term health impacts. Diagnosis of long COVID requires detailed systemic evaluation through medical history and physical examination. Management is highly individualized, focusing mainly on the patient's symptoms and affected systems. A multidisciplinary approach is essential, integrating diverse perspectives to address systemic manifestations, underlying mechanisms, and therapeutic strategies. Enhanced understanding of long COVID's pathophysiology and clinical features is critical to improving patient outcomes and quality of life. With a growing number of cases expected globally, advancing research and disseminating knowledge on long COVID remain vital for developing effective diagnostic and management frameworks, ultimately supporting better care for affected individuals.

Insights into Long COVID: Unraveling Risk Factors, Clinical Features, Radiological Findings, Functional Sequelae and Correlations: A Retrospective Cohort Study

BACKGROUND

The long-term symptomatology of COVID-19 has yet to be comprehensively described. The aim of the study was to describe persistent COVID-19 symptoms in a cohort of hospitalized and home-isolated patients.

METHODS

A retrospective cohort study was conducted on long COVID patients. Long COVID symptoms were identified, and patients were divided into hospitalized (in-patients) and home-isolated (out-patients), as well as according to the number of symptoms. Patients were examined by a multidisciplinary medical team. Blood tests, high resolution chest computed tomography (CT), and physical and infectious examinations were performed. Finally, in-patients were evaluated at 2 time-points: on hospital admission (T0) and 3 months after discharge (Tpost).

RESULTS

There were 364 COVID-19 patients enrolled; 82% of patients reported one or more symptoms. The most reported symptom was fatigue. Chest CT showed alteration in 76% of patients, and pulmonary function alterations were observed in 44.7% of patients. A higher risk of presenting at least one symptom was seen in patients treated with corticosteroid, and a higher risk of presenting chest CT residual lesion was observed in hospitalized patients and in patients that received hydroxychloroquine treatment. Moreover, a higher risk of altered pulmonary function was observed in older patients.

CONCLUSION

Long-term sequelae are present in a remarkable number of long COVID patients and pose a new challenge to the health care system to identify long-lasting effects and improve patients' well-being. Multidisciplinary teams are crucial to develop preventive measures, and clinical management strategies.

Clinically Significant Functional Impairments and Symptoms in COVID-19 Survivors: Empirical Research Quantitative

BACKGROUND

COVID-19 survivors may experience complex, distressing and persistent symptoms, referred to as long COVID, lasting months or years after diagnosis. More evidence is needed for effective long COVID screening and management.

AIM

To explore the clinical profile of long COVID and factors associated with its development.

DESIGN

A multicentre correlational study using a cross-sectional design.

METHODS

Adults diagnosed with COVID-19 6-9 months earlier were recruited via social media and referrals from three facilities. Participants provided demographic data and assessed their symptoms and functional status using validated questionnaires. Data were analysed using descriptive statistics and binomial logistic regression.

RESULTS

Among 102 participants, 13%-30% reported significant impairments in cognitive, emotional and physical functioning. Over 10% experienced symptoms such as diarrhoea, sleep problems, dyspnoea, nausea, fatigue and pain. These impairments and symptoms were associated with acute symptom severity, chronic disease, overweight status, regular exercise and living without partners.

CONCLUSION

This study adds to the literature by examining long-term functional status and symptoms in omicron survivors using comprehensive, validated tools. The findings highlight the prevalence and clinical significance of long COVID symptoms, aiding in the identification of functional impairments requiring medical and nursing interventions.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Nurses should recognise these symptoms and educate survivors about potential challenges. Policies addressing long-term issues, including research, health services and education, are essential.

REPORTING METHOD

This study follows the STROBE guideline (Table S1).

PATIENT OR PUBLIC CONTRIBUTION

Patients self-reported symptoms for this study.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05303103).

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Effects of physical rehabilitation interventions on exercise performance, dyspnea, and health-related quality of life in acute and post-acute COVID-19 patients: Systematic review and meta-analysis

OBJECTIVE

To analyze the published randomized controlled trials (RCTs) that investigated the effects of physical rehabilitation interventions provided directly (face to face) and by telerehabilitation on exercise performance, dyspnea, and health-related quality of life (HRQoL) in acute and post-acute COVID-19 patients.

METHODS

For this systematic review and meta-analysis, different electronic databases were searched up to January 2023. Mean difference (MD), (standardized mean difference (SMD) were calculated.

RESULTS

34 studies (2214 patients) met the study criteria. Physical interventions may improve aerobic capacity in acute COVID-19 (SMD 1.7; 95% CI 0.37, 2.8) and in post-acute COVID-19 participants (MD 0.4; 95% CI 0.1, 07) compared to usual care for acute and pos-acute COVID-19 patients, respectively. Physical interventions may also improve dyspnea in acute (SMD -1.4; 95% CI -0.8, -0.01) and in post-acute COVID-19 participants (MD -0.4; 95% CI -0.7, -0.2) compared to usual care. Physical interventions may result in an improvement in HRQoL (physical domain) (SMD 0.6; 95% CI 0.3) in post-acute COVID-19 participants compared to usual care in pos-acute COVID-19 patients.

DISCUSSION

The results support that physical rehabilitation interventions improve aerobic capacity and dyspnea in acute and post-COVID-19 patients. Moreover, physical interventions improve physical domain in HRQoL.

Acute lung injury induced by recombinant SARS-CoV-2 spike protein subunit S1 in mice

BACKGROUND

The intricacies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing acute lung injury (ALI) and modulating inflammatory factor dynamics in vivo remain poorly elucidated. The present study endeavors to explore the impact of the recombinant SARS-CoV-2 spike protein S1 subunit (S1SP) on ALI and inflammatory factor profiles in mice, aiming to uncover potential therapeutic targets and intervention strategies for the prevention and management of Coronavirus Disease 2019 (COVID-19).

METHODS

To mimic COVID-19 infection, K18-hACE2 transgenic mice were intratracheally instilled with S1SP, while C57BL/6 mice were administered LPS to form a positive control group. This setup facilitated the examination of lung injury severity, inflammatory factor levels, and alterations in signaling pathways in mice mimicking COVID-19 infection. Histopathological assessment through HE staining, along with analysis of lung wet/dry ratio and ultrasound imaging, revealed severe lung injury.

RESULTS

After molding, K18-hACE2 mice exhibited a pronounced reduction in body weight and showed more significant lung injury (P < 0.05). Notably, there was a significant elevation in vascular permeability, total protein, and total white blood cells in bronchoalveolar lavage fluid (BALF) (P < 0.05), indicative of tissue damage. Additionally, the tight junction of lung tissue was compromised (P < 0.05), accompanied by intense oxidative stress marked by decreased SOD activity and elevated MDA content (P < 0.05). Cytokine levels, including IL-6, IL-1β, TNF-α, and MIG, were significantly upregulated in both BALF and serum of S1SP + K18 mice (P < 0.05). Furthermore, S1SP prominently augmented the expression of p-p65/P65 and attenuated IκBα expression in the NF-κB signaling pathway of humanized mice (P < 0.05), corroborating a heightened inflammatory response at the tissue level (P < 0.05).

CONCLUSION

The administration of S1SP to K18-hACE2 mice resulted in severe lung injury, enhanced vascular permeability, and compromised epithelial barrier function in vivo. This was accompanied by disruption of lung tight junctions, the manifestation of severe oxidative stress and a cytokine storm, as well as the activation of the NF-κB signaling pathway, highlighting key pathological processes underlying COVID-19-induced lung injury.

Functional Capacity Impairment in Long COVID After 17 Months of Severe Acute Disease

Long COVID represents a significant challenge in understanding the prolonged impact of the disease. Despite its increasing recognition, detailed insights into the long-term cardiopulmonary consequences remain sparse. This study aimed to evaluate the functional capacity of individuals with persistent symptoms after severe COVID-19 infection compared to control individuals without symptomatic COVID or mild COVID after 17 months. This is a case-control study assessing 34 individuals divided into two groups regarding functional capacity by distance in a 6-min walk test (D6MWT) associated with gas analysis, spirometry, respiratory muscle strength, and quality of life. During the 6 MWT, an important lower heart rate (HR) was observed for the COVID group (106 ± 10 bpm, difference mean: 21.3; p < 0.001), with greater exertional perception (Borg dyspnea: 4.5 [2.0-9.0], p < 0.001 and Borg fatigue: 4.0 [2.0-7.0], p = 0.01), a significant decrease in the distance covered (416 ± 94 m, difference mean: 107; p = 0.002), and a low value of O2 uptake (V˙O2) (11 ± 5.0 mL/(kg min), difference mean: 8.3; p = 0.005) and minute ventilation (22 ± 8 L/min, difference mean: 18.6; p = 0.002), in addition to very low quality of life scores. Regression analysis showed a significant association between D6MWT and Borg fatigue and Borg dyspnea at rest (p = 0.003; p = 0.009). V˙O2 and HR were also significantly associated with the outcomes of the D6MWT (p = 0.04 and p = 0.004, respectively). In conclusion, individuals who have severe COVID-19 and persist with symptoms have low functional capacity, low V˙O2, low HR behavior, and low quality of life.

Genetics of Long COVID: Exploring the Molecular Drivers of Persistent Pulmonary Vascular Disease Symptoms

Background/ Objectives: Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC) are symptoms that manifest despite passing the acute infection phase. These manifestations encompass a wide range of symptoms, the most common being fatigue, shortness of breath, and cognitive dysfunction. Genetic predisposition is clearly involved in the susceptibility of individuals to developing these persistent symptoms and the variation in the severity and forms. This review summarizes the role of genetic factors and gene polymorphisms in the development of major pulmonary vascular disorders associated with long COVID. Methods: A comprehensive review of current literature was conducted to examine the genetic contributions to pulmonary complications following SARS-CoV-2 infection. Studies investigating genetic polymorphisms linked to pulmonary hypertension, pulmonary thromboembolism, and pulmonary vascular endothelialitis were reviewed and summarized. Results: Findings show that specific genetic variants contribute to increased susceptibility to pulmonary vascular complications in long COVID patients. Variants associated with endothelial dysfunction, coagulation pathways, and inflammatory responses have been implicated in the development of pulmonary hypertension and thromboembolic events. Genetic predispositions influencing vascular integrity and immune responses appear to influence disease severity and progression. Conclusions: Understanding these mechanisms and genetic predispositions could pave the way for targeted therapeutic interventions to alleviate the burden on patients experiencing long COVID.

Comparative Analysis of Submaximal and Maximal Effort Capacities in Patients Post-COVID-19 and Individuals with Chronic Restrictive Lung Diseases

Whether impairments in submaximal and maximal effort capacities in individuals following acute COVID-19 infection resemble those found in patients with chronic pulmonary disease remains unclear. We aimed to analyze the submaximal and maximal effort capacities of patients after COVID-19 infection and those with alterations in lung mechanics similar to those observed in patients with chronic respiratory diseases. This retrospective cross-sectional observational study paired a group of post-COVID-19 individuals with another group of patients with chronic respiratory disease, using spirometric patterns similar to those observed post-COVID-19. Data from Spirometry, 6 min walk test (6-MWT), and cardiopulmonary exercise test (CPET) variables were compared, and correlations between spirometric variables and 6-WT/CPET were examined. The final sample comprised 20 patients, including 10 post-COVID-19 patients with a restrictive lung disease (RLD) pattern identified using spirometry and 10 patients with RLD. Both groups presented similar patterns of the analyzed variables, with significant correlations observed between forced vital capacity (FVC) the distance and speed achieved during the 6-MWT, and a negative correlation between FVC and V' E max. The degree of restriction in the overall sample influenced the covered distance and speed during the 6-MWT as well as the maximum minute ventilation during maximal effort.

Patient Satisfaction with CAD/CAM 3D-Printed Complete Dentures: A Systematic Analysis of the Clinical Studies

Objectives: This systematic review compares computer-aided design and computer-aided manufacturing (CAD/CAM) 3D-printed complete dentures (CDs) with conventional ones in terms of patient satisfaction. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting criteria for systematic reviews were followed in conducting this systematic review. The study question was "What are the patient satisfaction outcomes of 3D-printed versus conventional CDs in edentulous patients?" according to the population, intervention, comparison, and outcome (PICO) framework. A comprehensive electronic search was conducted across three databases (PubMed/Medline, Web of Science core collection, and Scopus; last update: 18 August 2024) to obtain clinical trials that compared traditional and 3D-printed CDs. The retrieved articles were screened, their data were extracted, and their quality was evaluated. Results: The initial search retrieved 803 publications; 12 were chosen for a thorough review, and 5 of them-4 randomized cross-over studies and 1 randomized three-parallel arm study-met the requirements for this systematic review. One study showed significant differences in five of nine patient denture satisfaction domains, positively favoring the conventional CDs. Two studies showed non-significant differences in satisfaction domains between the conventional and 3D-printed groups, except for aesthetics and pronunciation. On the contrary, the satisfaction scores in two other studies showed no significant difference between the conventional and 3D-printed denture groups. Conclusions: The analysis of the included studies and evidence gathered demonstrates that CAD/CAM 3D-printed CDs seem to be comparable with conventional CDs in terms of overall patient satisfaction; however, 3D-printed CDs generate some concerns related to aesthetics and speech.

Radiological abnormalities persist following COVID-19 and correlate with impaired health-related quality of life: a prospective cohort study of hospitalised patients

BACKGROUND

The radiological trajectory of post-COVID-19 is uncertain. We present a prospective, observational, multicentre cohort study using multimodality imaging to describe the pulmonary sequelae of patients hospitalised with COVID-19, predictors of persistent abnormal radiology and implications on health status.

METHODS

In survivors of COVID-19, we performed convalescent CT pulmonary angiogram and high-resolution CT imaging as part of the CISCO-19 study (ClinicalTrials.gov ID NCT04403607). This included serial blood biomarkers and patient-reported outcomes 28-60 days following discharge from hospital.

RESULTS

Of the COVID-19 cohort, 88 (56%) patients of the COVID-19 cohort (n = 159; mean age, 55 years; 43% female) had persisting radiological abnormalities at 28-60 days postdischarge. This included ground-glass opacification (45%), reticulation/architectural distortion (30%) or mixed pattern (19%). These features were very infrequent among a group of age-matched, sex-matched and cardiovascular risk factor-matched controls (n=29). The majority of COVID-19 cohort (68%) had less than 20% persisting radiological abnormalities, with 67% demonstrating overall improvement compared with admission imaging. Older age, premorbid performance status, typical acute COVID-19 radiological features, markers of severe acute COVID-19, convalescent ICAM-1 and P-selectin were associated with persisting lung abnormalities (all p<0.05). Patients with persisting abnormalities were shown to have lower levels of physical activity and predicted maximal oxygen utilisation (derived VO2) (both p<0.05). Higher percentage of abnormal lung parenchyma was associated with lower patient-assessed quality of life (EQ-5D-5L) score (p=0.03).

CONCLUSIONS

Persistent radiological abnormalities post-COVID-19 were common at 28-60 days postdischarge from hospital, although most improved. Patients with persisting radiological abnormalities 28-60 days postdischarge are at risk of persisting health impairment in the longer term and represent a population for targeted intervention.

TRIAL REGISTRATION NUMBER

NCT04403607.

SARS-CoV-2 vaccination influence in the development of long-COVID clinical phenotypes

Although SARS-CoV-2 vaccination reduces hospitalization and mortality, its long-term impact on Long-COVID remains to be elucidated. The aim of the study was to evaluate the different development of Long-COVID clinical phenotypes according to the vaccination status of patients. Clinical and demographic characteristics were assessed for each patient, while Long-COVID symptoms were self-reported and later stratified into distinct clinical phenotypes. Vaccination was significantly associated with the avoidance of hospitalization, less invasive respiratory support, and less alterations of cardiopulmonary functions, as well as reduced lasting lung parenchymal damage. However, no association between vaccination status and the development of at least one Long-COVID symptom was found. Nevertheless, clinical phenotypes were differently associated with vaccination status, as neuropsychiatric were more frequent in unvaccinated patients and cardiorespiratory symptoms were reported mostly in vaccinated patients. Different progression of disease could be at play in the different development of specific Long-COVID clinical phenotypes, as shown by the different serological responses between unvaccinated and vaccinated patients. A higher anti-Spike (S) antibody titre was protective for vaccinated patients, while it was detrimental for unvaccinated patients. A better understanding of the mechanism underlying the development of Long-COVID symptoms might be reached by standardized methodologies and symptom classification.

COVID-19 pulmonary phenotypes and longitudinal patterns in the first wave of the pandemic

BACKGROUND

The long-term evolution of COVID-19 in patients hospitalized during the pandemic's first wave remains largely unexplored. This study aimed to identify COVID-19 pulmonary phenotypes and their longitudinal patterns over a 12-month follow-up.

METHODS

COVID-19 patients discharged from Pisa University Hospital (Italy) between March-September 2020, were evaluated at T3, T12, and T24 months post-discharge. Assessments included spirometry, lung volumes, DLCO, and chest CT for those with persistent pneumonia signs (PS). Latent transition analysis (LTA) identified COVID-19 phenotypes and longitudinal patterns based on PS and lung function (PFTs). Risk factors for these patterns were evaluated using multinomial logistic regression.

RESULTS

Of 307 discharged patients, 175, 136, and 33 were followed-up at T3, T12, and T24, respectively. At T12, 21.6 % had impaired DLCO, 4.4 % a restrictive ventilatory pattern, and 31,6 % still had PS, persisting until T24. LTA identified three cross-sectional phenotypes at both T3 and T12 (no PS with normal PFTs; PS with normal PFTs; PS with impaired PFTs), and four longitudinal patterns from T3 to T12: persistence of no PS with normal PFTs (47.9 %); resolution of both PS and PFTs (15.4 %); persistent PS (36.7 %), either with (11 %) or without (25.7 %) impaired PFTs. The last two patterns correlated significantly with longer hospitalization, more comorbidities, and severe COVID-19.

CONCLUSIONS

In our cohort of COVID-19 patients hospitalized during the pandemic's first wave, we observed distinct pulmonary phenotypes and longitudinal recovery patterns. More comorbidities and severe acute disease correlated with worse progression up to 24 months, suggesting long-term monitoring for such patients.

Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement

INTRODUCTION

Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise.

OBJECTIVE

This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement.

METHODS

Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET.

RESULTS

Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively.

CONCLUSIONS

In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.

Recent advances in TGF-β signaling pathway in COVID-19 pathogenesis: A review

The coronavirus disease 2019 (COVID-19) has resulted in approximately 7.0 million fatalities between 2019 and 2022, underscoring a pressing need for comprehensive research into its underlying mechanisms and therapeutic avenues. A distinctive feature of severe COVID-19 is the dysregulated immune response characterized by excessive activation of immune cells and the consequent cytokine storms. Recent advancements in our understanding of cellular signaling pathways have illuminated the role of Transforming Growth Factor Beta (TGF-β) as a pivotal signaling molecule with significant implications for the pathogenesis of infectious diseases, including COVID-19. Emerging evidence reveals that TGF-β signaling, when activated by viral components or secondary pathways, adversely affects diverse cell types, particularly immune cells, and lung tissue, leading to complications such as pulmonary fibrosis. In our review article, we critically evaluate recent literature on the involvement of TGF-β signaling in the progression of COVID-19. We discuss a range of pharmacological interventions, including nintedanib, pirfenidone, corticosteroids, proton pump inhibitors, and histone deacetylase inhibitors, and their potential to modulate the TGF-β pathway in the context of COVID-19 treatment. Additionally, we explore ongoing clinical trials involving mesenchymal stem cells, low-dose radiation therapy, and artemisinin derivatives to assess their impact on TGF-β levels and subsequent clinical outcomes in COVID-19 patients. This review is particularly relevant at this juncture as the global health community continues to grapple with the ramifications of the COVID-19 pandemic, highlighting the urgent need for targeted therapeutic strategies aimed at TGF-β modulation to mitigate disease severity and improve patient outcomes.

Cholesterol, triglycerides, HDL, and nitric oxide as determinants of resting heart rate variability in non-hospitalized mild post-COVID individuals: a cross-sectional study

BACKGROUND

The association between plasma lipids, nitric oxide (NO) and cardiovascular risk has been well documented in the literature, however, the association between these outcomes and heart rate variability (HRV) in COVID-19 remains incipient as there is no scientific evidence that has investigated this outcome.

OBJECTIVE

Investigate whether metabolic outcomes may be associated with cardiac autonomic behavior arising from short-term HRV variables in non-hospitalized mild post-COVID individuals.

METHODS

This is a cross-sectional study. Individuals of both sexes, aged ≥ 18 years, who tested positive for SARS-CoV-2 according to the RT-PCR test, without the need for hospitalization, were included. The HRV was collected in the supine position for at least 10 min for later analysis in the Kubios software. Metabolic outcomes [high density lipoprotein (HDL) (mg/dL), cholesterol (mg/dL), triglycerides (mg/dL) and NO (µmol/L)] were collected through a blood sample.

RESULTS

Seventy-three individuals were included (post-COVID = 32; control = 41). HRV was worse in the post-COVID group when compared to the control group (p < 0.05). Cholesterol, HDL, triglycerides and NO showed significant correlations with HRV indices. Regression models indicated that cholesterol and triglycerides, as well as NO, explain up to 30.3% of the variations in certain HRV indices, suggesting an impact of metabolic outcomes on autonomic modulation.

CONCLUSION

There is a relationship between plasma lipids, NO and HRV in non-hospitalized individuals with mild COVID-19. Metabolic outcomes are associated and explain between 16.6% and 30.30% of certain variables of resting HRV in post-COVID individuals.

CLINICAL TRIAL NUMBER

Not applicable.

Real-world evidence of remdesivir in formerly hospitalized COVID-19 patients: patient-reported and functional outcomes

BACKGROUND

Post-COVID condition (PCC) is characterized by persisting symptoms after the resolution of acute COVID-19. Remdesivir (RDV), a broad-spectrum antiviral drug, has been widely used in patients hospitalized with COVID-19 requiring oxygen therapy. We aimed to evaluate the effects of RDV on PCC by assessing patient-reported and functional outcomes.

METHODS

We used the data from a single-center registry, including formerly hospitalized post-COVID patients (N = 293). Propensity score matching (PSM) was used (16 criteria, 1:1 ratio) to obtain two comparable groups: those who received standard-of-care (SOC, N = 94) and those treated with RDV in addition to SOC (SOC + RDV, N = 94). Primary outcomes were asymptomatic status and at least 50% symptom score reduction at post-COVID follow-up. Secondary outcomes included results of pulmonary function (PF) tests, 6-minute walk test (6MWT), and quality-of-life (QoL) questionnaires.

RESULTS

After PSM, baseline patient characteristics showed no significant differences between the two groups. Most patients were still symptomatic (60% vs. 66%). In the SOC + RDV group, the use of oxygen supplementation (94 vs. 80%, p = 0.005) and steroids (97 vs. 88%, p = 0.027) during infection were higher, while patients presented at their post-COVID visits earlier (median 68 vs. 97 days, p = 0.003). Complete or at least 50% symptom resolution were reported at a significantly earlier stage after infection in the SOC + RDV group compared to the SOC group (multivariable-adjusted HR = 2.28, 95% CI = 1.33-3.92, p = 0.003; and HR = 2.08, 95% CI = 1.43-3.02, p < 0.001; respectively). In the SOC + RDV group, fewer patients experienced sleep disturbances at PCC, and sleep-related questionnaires (Pittsburg Sleep Quality Index, PSQI) results showed significantly better sleep quality (14 vs. 27% and 5.9 vs. 7.7 points, respectively). There were no notable differences in results of PF tests, 6MWT, and other QoL questionnaires.

CONCLUSION

In this propensity score matched cohort, the use of RDV was associated with earlier patient reported symptom resolution during the PCC period, while there were no notable differences in functional outcomes. Our results indicate a possible beneficial effect of RDV in terms of faster symptom resolution after COVID19 infection.

Retrospective Study of the Impact of SARS-CoV-2 Infection on Asthma Control in Children

Asthmatic children who tested positive for COVID-19 experienced changes in lung function and persistent symptoms following SARS-CoV-2 infection, even for several months after diagnosis, and with the same features as in an acute phase. This study aimed to analyze a pediatric age group (between 0 and 17 years old) diagnosed with asthma, and SARS-CoV-2 infection attending regular monitoring visits in a Pediatric Department of a Regional Tertiary Hospital (Filantropia Clinical Municipal Hospital Craiova, Romania) during the COVID-19 pandemic and post-pandemic time interval (i.e., March 2020-July 2024), and identify how the infection influenced their long-term symptoms and treatment. Materials and Methods. The following variables were recorded: demographic data (gender, age group, residence), data related to allergies (allergic rhinitis, atopic dermatitis, and food allergies), the presence of exacerbations, the fraction of exhaled nitric oxide, the ventilatory function, the asthma phenotype (allergic or non-allergic), as well as the GINA assessment of asthma control at clinical visits were analyzed. SARS-CoV-2 infections were evaluated in terms of year of infection, symptoms, cough presence and persistence, and modifications of the asthma treatment during and after COVID-19 disease. The data were statistically analyzed with SPSS, using the Mann-Whitney U, Kruskal-Wallis H, and Chi-Square tests. Results. A lower incidence of COVID-19 cases was recorded in the first pandemic of asthmatic patients (2020 and 2021), but an increase in the rate of cases was observed at the beginning of the second pandemic, in 2022. The nitric oxide values in asthmatic children who were infected with SARS-CoV-2 were statistically significantly increased (p < 0.0005), especially for children with persistent cough for more than 4 weeks. A significant increase in the number of exacerbations was also observed in patients who tested positive for SARS-CoV-2 infection (p < 0.0005). Ventilatory function values were statistically significantly different in asthmatic children with and without SARS-CoV-2 infection (p < 0.05). Conclusions. The persistence of cough after the acute phase of SARS-CoV-2 infection as well as the changes in ventilatory tests emphasize the need of periodic medical check-ups, as well as the implementation of a therapeutic regimen appropriate for each pediatric patient.

Exercise-Driven Comprehensive Recovery: Pulmonary Rehabilitation's Impact on Lung Function, Mechanics, and Immune Response in Post-COVID-19 Patients

Introduction: We sought to evaluate the effects of a 12-week pulmonary rehabilitation (PR) program on lung function, mechanics, as well as pulmonary and systemic inflammation in a cohort of 33 individuals with moderate to severe post-COVID-19. Material and Methods: The pulmonary rehabilitation (PR) program employed a combination of aerobic and resistance exercises. Thirty minutes of treadmill training at 75% of the maximum heart rate, combined with 30 min resistance training consisting of 75% of one maximum repetition, three times a week throughout 12 weeks. Results: PR improved the lung function, FVC (p < 0.02), FEV1 (p < 0.02), FEV1/FVC (p < 0.01), MEF25% (p < 0.006), MEF50% (p < 0.03), and MEF75% (p < 0.02). PR also positively influenced lung mechanics, reducing respiratory impedance (Z5Hz, p < 0.03), respiratory reactance (X5Hz, p < 0.01), resistance of the entire respiratory system (R5Hz, p < 0.03), central airway resistance (RCentral, p < 0.03), and peripheral airway resistance (RPeripheral, p < 0.02). Moreover, muscle strength gains were evident, with significant improvements observed in hand grip strength for both the right (p < 0.02) and left (p < 0.01) hands, as well as maximal inspiratory (p < 0.02) and expiratory (p < 0.03) pressures. Additionally, PR exhibited anti-inflammatory effects by reducing the pro-inflammatory cytokines IL-1β (p < 0.0001) and IL-6 (p < 0.0001) and increasing the anti-inflammatory IL-1RA (p < 0.0004) and IL-10 (p < 0.003) and anti-viral IFN-γ (p < 0.0002) and IFN-β (p < 0.008) cytokines in breath condensate and serum samples. Conclusions: Collectively, these findings highlight the effectiveness of PR in ameliorating COVID-19 sequel across respiratory system, skeletal muscle, and immune responses. This highlights its promising potential as a therapeutic intervention for individuals recovering from COVID-19.

Impact of previous COVID-19 infection on postoperative complications and functional recovery: a 1-year follow-up ambispective cohort study

BACKGROUND

It's necessary to reassess the patients' short-term and long-term postoperative outcomes in the post-COVID-19 era. This study aims to provide more comprehensive evidence regarding the timing of surgery after COVID-19 infection among the vaccinated population upon Omicron variant, considering the duration after acute COVID-19 infection, the severity of COVID-19, patients' comorbidities, and the full course quality of postoperative recovery.

MATERIALS AND METHODS

This is a single-center cohort study. Patients diagnosed with preoperative COVID-19 infection were consecutively included before surgery. Patients' demographics, surgical characteristics, and COVID-19-related factors were documented. Exposure was the time interval from COVID-19 infection to surgery. The primary outcome was postoperative complications within 30 days. The secondary outcomes included postoperative mortality within 30 days, functional disability at 6 and 12 months after surgery.

RESULTS

A total of 4953 patients were included, and postoperative complications occurred in 353 patients (7.1%) within 30 days after surgery. Time interval from COVID-19 infection to surgery was associated with postoperative complications within 30 days after surgery [adjusted odds ratio (aOR) per day: 0.99; 95% CI, 0.99-1.00; P <0.01], as well as postoperative 6- and 12-month functional disability [(aOR): 1.00; 95% CI, 0.99-1.00; P <0.01; and (aOR) 0.99; 95% CI, 0.98-1.00; P =0.01, respectively). Delaying surgery beyond a time interval of 2 weeks was associated with reduced postoperative 30-day complications [(aOR): 0.63; 95% CI, 0.43-0.91; P =0.01] and mortality [(aOR): 0.07; 95% CI, 0.01-0.38; P <0.01]. Meanwhile, delaying surgery beyond a time interval of 7 weeks was associated with reduced functional disability at both 6-month [(aOR): 0.67; 95% CI, 0.58-0.79; P <0.01] and 12-month postoperatively [(aOR): 0.71; 95% CI, 0.53-0.95; P =0.02].

CONCLUSION

A 2 weeks delay after COVID-19 infection is necessary for decreasing short-term postoperative risks, and a longer waiting period could be beneficial for long-term functional recovery.

Effectiveness of physiotherapy modalities on persisting dyspnoea in long COVID: A systematic review and meta-analysis

BACKGROUND

Dyspnoea is often found months and years later in the "long-covid" syndrome, impairing quality of life and further perpetuating anxiety and post-traumatic stress disorders. Physiotherapy was recommended as a treatment in long-covid, but there is still insufficient evidence on its effectiveness.

METHODS

We conducted a systematic literature search on MEDLINE, PEDro, WOS, Scopus, VHL and the Cochrane Library until July 2023 (PROSPERO registration number: CRD42023427464). We selected comparative trials including adults with persistent breathlessness following COVID-19, regardless of the initial severity, for whom physiotherapy was implemented as a treatment for dyspnoea. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed the study quality using the PEDro Scale.

RESULTS

19 studies that included 1292 adults fulfilled the inclusion criteria, of which 15 were randomised controlled trials and 4 non-randomised controlled trials. As for the rehabilitation modalities, 6 studies used respiratory muscle training, 6 studies used low to moderate intensity rehabilitation, 6 used high intensity rehabilitation and one used passive rehabilitation. The methods used between and within each group differed greatly, leading to an expected high heterogeneity of results. Nethertheless the random-effects model found a significant difference favouring physiotherapy (SMD -0.63, 95 CI [-1.03; -0.24], p < 0.001, I2 = 88 %). Subgroup analysis showed a significant effect in the high intensity rehabilitation group alone, with null heterogeneity.

CONCLUSION

In people suffering from dyspnoea following a SARS-CoV-2 infection, physiotherapy and especially pulmonary rehabilitation may help alleviate respiratory symptoms. Future studies will need to provide more consistent rehabilitation methods and better descriptions of them so as to reveal clear effects and avoid the confusion caused by using too many rehabilitation modalities.

Effects of acute-phase COVID-19-related indicators on pulmonary fibrosis and follow-up evaluation

BACKGROUND

Post-COVID-19 pulmonary fibrosis is a significant long-term respiratory morbidity affecting patients' respiratory health. This exploratory study aims to investigate the incidence, clinical characteristics, and acute-phase risk factors for pulmonary fibrosis in COVID-19 patients. Additionally, it evaluates pulmonary function and chest CT outcomes to provide clinical evidence for the early identification of high-risk patients and the prevention of post-COVID-19 pulmonary fibrosis.

METHODS

We retrospectively analyzed 595 patients hospitalized for COVID-19 from January 2022 to July 2023. Patients were divided into fibrosis and nonfibrosis groups on the basis of imaging changes. Baseline data, including demographics, disease severity, laboratory indicators, and chest imaging characteristics, were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for pulmonary fibrosis. Pulmonary function and chest CT follow-ups were conducted for the fibrosis group. The data were processed via SPSS 26.0, with P < 0.05 considered statistically significant.

RESULTS

The incidence of pulmonary fibrosis was 4.37%, with 2.08% in moderate cases and 8.22% in severe cases. Significant differences were found between the fibrosis and nonfibrosis groups in sex; disease severity; NLR; ALB and LDH levels; and percentages of lung reticular lesions, consolidations, and GGOs (P < 0.05). Multivariate analysis revealed LDH (OR = 1.004, 95% CI 1.000-1.007, P = 0.035), ALB (OR = 0.871, 95% CI 0.778-0.974, P = 0.015), lung reticular lesion volume (OR = 1.116, 95% CI 1.040-1.199, P = 0.002), and lung consolidation volume (OR = 1.131, 95% CI 1.012-1.264, P = 0.030) as independent risk factors. The follow-up results revealed significant improvements in pulmonary function, specifically in the FVC%, FEV1%, and DLCO%, but not in the FEV1/FVC. Quantitative chest CT analysis revealed significant differences in lung reticular lesions, consolidation, and GGO volumes but no significant difference in honeycomb volume.

CONCLUSIONS

The incidence of pulmonary fibrosis post-COVID-19 increases with disease severity. LDH, ALB, lung reticular lesions, and consolidation volume are independent risk factors for patients with fibrosis.

Long-term trends and comparison of the burden of lower respiratory tract infections in China and globally from 1990 to 2021: an analysis based on the Global Burden of Disease study 2021

Background

This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs.

Methods

This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years.

Results

From 1990 to 2021, China's age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China.

Conclusions

Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

Follow-Up of Cardiopulmonary Responses Using Submaximal Exercise Test in Older Adults with Post-COVID-19

BACKGROUND

Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (1-min-STST) results at 3, 6, and 12 months in older adults with and without COVID-19.

METHODS

This study included 59 older adults aged ≥60 with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments.

RESULTS

Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (p<0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (p<0.001).

CONCLUSION

While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Intermittent Hypoxic-Hyperoxic Training During Inpatient Rehabilitation Improves Exercise Capacity and Functional Outcome in Patients With Long Covid: Results of a Controlled Clinical Pilot Trial

INTRODUCTION

Long COVID-19 illness is a severely disabling disease with shortness of breath, weakness and fatigue as leading symptoms, resulting in poor quality of life and substantial delay in return to work. No specific respiratory therapy has been validated for patients with long COVID. The intermittent hypoxia-hyperoxia training (IHHT) is a respiratory therapeutic modality to improve exercise performance via controlled respiratory conditioning. The purpose of the present study is to investigate the therapeutic effect of IHHT on functional and symptomatic recovery of patients with long COVID syndrome.

METHODS

A prospective, controlled, open-treatment interventional study was conducted in patients with long COVID who were admitted to an inpatient rehabilitation programme. Patients were assigned nonrandomized to receive IHHT in addition to the standardized rehabilitation programme (IHHT group) or standard rehabilitation alone (control group). The IHHT group received supervised sessions of intermittent hypoxic (10-12% O2) and hyperoxic (30-35% O2) breathing three times per week throughout the rehabilitation period. Primary endpoint was improved walking distance in a 6-min walk test (6MWT) between study groups. Secondary endpoints were change in stair climbing power, dyspnoea (Borg dyspnoea Scale), fatigue assessment scale (FAS) and change in health-related quality of life (HRQoL) assessed by patient global assessment (PGA), EQ-5D analogue scale and the MEDIAN Corona Recovery Score (MCRS). Further assessments included maximum handgrip strength, nine hole peg test, timed up-and-go, respiratory function and functional ambulation category (FAC), serum analyses and safety of the intervention.

RESULTS

A total of 145 patients were included in the study (74% female, mean age 53 ± 12 years) and assigned to IHHT (n = 70) or standard care (n = 75). The 6MWT distance improved 2.8-fold in the IHHT group compared to the control group (91.7 ± 50.1 m vs. 32.6 ± 54.2 m, ANCOVA p < 0.001). Stair climbing power improved 3.7-fold in the IHHT group compared to controls (-1.91 ± 2.23 s vs. -0.51 ± 1.93 s, p < 0.001). Secondary endpoints on dyspnoea, fatigue and HRQoL (PGA, EQ-5D and MCRS) improved significantly in the IHHT group compared to controls. The IHHT group exhibited a significant decrease in blood pressure, heart rate and increase in haemoglobin levels that was not observed in the control group. No adverse events were observed.

CONCLUSION

Respiratory treatment with IHHT in addition to a multidisciplinary rehabilitation programme improves functional capacity, symptomatic status and quality of life in patients with disabling long COVID. IHHT has been demonstrated to be safe, well tolerated and feasible to be integrated in an inpatient rehabilitation programme to improve outcome in long COVID.

Evaluation of the long-term effects of COVID-19 on pulmonary functions in recovered patients

Background

It is documented that COVID-19 survivors have prolonged morbidity and functional impairment for many years. Data regarding post-COVID-19 lung functions is lacking from the Indian population. We aim to evaluate the lung functions in such patients after 3-6 months of hospital discharge.

Methods

In this prospective observational study, patients were assessed 3 to 6 months post-discharge and underwent standardized pulmonary function tests (PFTs) and CT Thorax if required. The following parameters were measured and correlated with the disease severity: Forced Vital Capacity (FVC), Forced Expiratory Volume in the First Second (FEV1), Forced Expiratory Flows at 25 and 75% of FVC (FEF25%-75%), Peak Expiratory Flow (PEF) and FEV1/FVC.

Results

A total of 52 post-COVID-19 patients were enrolled in the study, with a median age of 43 years (78.8% males). 44.2% of patients had mild disease, 26.9% had moderate disease and 23.1% had severe disease at hospital admission. A restrictive pattern was seen in 20.8% of patients. The mean value of FEV1 and FVC decreased as the disease severity increased. FEV1: mild-3.21 ± 0.71, moderate-2.62 ± 0.61 and severe- 2.51 ± 0.72, P = 0.02; FVC: mild-3.69 ± 0.81, moderate-3.04 ± 0.71 and severe- 2.93 ± 0.87, P = 0.02. After adjusting the confounding factors, the mean pulmonary function values were lower in the patients who required oxygen support, with a significant difference in FEV1, FVC, PEF and FEF 25-75% with P values of 0.025, 0.046, 0.028 and 0.007, respectively. 66.67% had abnormal HRCT findings. Age and high LDH were correlated with HRCT abnormality with P values of 0.015 and 0.024. Age >50 years was found to be an independent predictor of the subsequent development of abnormality on the HRCT thorax.

Conclusions

Patients with COVID-19 pneumonia, which required oxygen, especially severe disease at the time of hospitalization, had a higher rate of abnormal spirometry than patients with mild symptoms. Follow-up CT scans obtained within six months of disease onset showed abnormalities in more than half of patients, particularly elderly patients.

Correlation between oxygenation function and laboratory indicators in COVID-19 patients based on non-enhanced chest CT images and construction of an artificial intelligence prediction model

Objective

By extracting early chest CT radiomic features of COVID-19 patients, we explored their correlation with laboratory indicators and oxygenation index (PaO2/FiO2), thereby developed an Artificial Intelligence (AI) model based on radiomic features to predict the deterioration of oxygenation function in COVID-19 patients.

Methods

This retrospective study included 384 patients with COVID-19, whose baseline information, laboratory indicators, oxygenation-related parameters, and non-enhanced chest CT images were collected. Utilizing the PaO2/FiO2 stratification proposed by the Berlin criteria, patients were divided into 4 groups, and differences in laboratory indicators among these groups were compared. Radiomic features were extracted, and their correlations with laboratory indicators and the PaO2/FiO2 were analyzed, respectively. Finally, an AI model was developed using the PaO2/FiO2 threshold of less than 200 mmHg as the label, and the model's performance was assessed using the area under the receiver operating characteristic curve (AUC), sensitivity and specificity. Group datas comparison was analyzed using SPSS software, and radiomic features were extracted using Python-based Pyradiomics.

Results

There were no statistically significant differences in baseline characteristics among the groups. Radiomic features showed differences in all 4 groups, while the differences in laboratory indicators were inconsistent, with some PaO2/FiO2 groups showed differences and others not. Regardless of whether laboratory indicators demonstrated differences across different PaO2/FiO2 groups, they could all be captured by radiomic features. Consequently, we chose radiomic features as variables to establish an AI model based on chest CT radiomic features. On the training set, the model achieved an AUC of 0.8137 (95% CI [0.7631-0.8612]), accuracy of 0.7249, sensitivity of 0.6626 and specificity of 0.8208. On the validation set, the model achieved an AUC of 0.8273 (95% CI [0.7475-0.9005]), accuracy of 0.7739, sensitivity of 0.7429 and specificity of 0.8222.

Conclusion

This study found that the early chest CT radiomic features of COVID-19 patients are strongly associated not only with early laboratory indicators but also with the lowest PaO2/FiO2. Consequently, we developed an AI model based on CT radiomic features to predict deterioration in oxygenation function, which can provide a reliable basis for further clinical management and treatment.

Ultra-low-dose vs. standard-of-care-dose CT of the chest in patients with post-COVID-19 conditions-a prospective intra-patient multi-reader study

OBJECTIVES

To conduct an intrapatient comparison of ultra-low-dose computed tomography (ULDCT) and standard-of-care-dose CT (SDCT) of the chest in terms of the diagnostic accuracy of ULDCT and intrareader agreement in patients with post-COVID conditions.

METHODS

We prospectively included 153 consecutive patients with post-COVID-19 conditions. All participants received an SDCT and an additional ULDCT scan of the chest. SDCTs were performed with standard imaging parameters and ULDCTs at a fixed tube voltage of 100 kVp (with tin filtration), 50 ref. mAs (dose modulation active), and iterative reconstruction algorithm level 5 of 5. All CT scans were separately evaluated by four radiologists for the presence of lung changes and their consistency with post-COVID lung abnormalities. Radiation dose parameters and the sensitivity, specificity, and accuracy of ULDCT were calculated.

RESULTS

Of the 153 included patients (mean age 47.4 ± 15.3 years; 48.4% women), 45 (29.4%) showed post-COVID lung abnormalities. In those 45 patients, the most frequently detected CT patterns were ground-glass opacities (100.0%), reticulations (43.5%), and parenchymal bands (37.0%). The accuracy, sensitivity, and specificity of ULDCT compared to SDCT for the detection of post-COVID lung abnormalities were 92.6, 87.2, and 94.9%, respectively. The median total dose length product (DLP) of ULDCTs was less than one-tenth of the radiation dose of our SDCTs (12.6 mGy*cm [9.9; 15.5] vs. 132.1 mGy*cm [103.9; 160.2]; p < 0.001).

CONCLUSION

ULDCT of the chest offers high accuracy in the detection of post-COVID lung abnormalities compared to an SDCT scan at less than one-tenth the radiation dose, corresponding to only twice the dose of a standard chest radiograph in two views.

CLINICAL RELEVANCE STATEMENT

Ultra-low-dose CT of the chest may provide a favorable, radiation-saving alternative to standard-dose CT in the long-term follow-up of the large patient cohort of post-COVID-19 patients.

Effects of sulphur thermal water inhalations in long-COVID syndrome: Spa-centred, double-blinded, randomised case-control pilot study

BACKGROUND

The long-COVID syndrome is characterised by a plethora of symptoms. Given its social and economic impact, many studies have stressed the urgency of proposing innovative strategies other than hospital settings. In this double-blinded, randomised, case-control trial, we investigate the effects of sulphur thermal water inhalations, rich in H2S, compared to distilled water inhalations on symptoms, inflammatory markers and nasal microbiome in long-COVID patients.

METHODS

About 30 outpatients aged 18-75 with positive diagnosis for long-COVID were randomised in two groups undergoing 12 consecutive days of inhalations. The active group (STW) received sulphur thermal water inhalations whereas the placebo group received inhalations of sterile distilled non-pyrogenic water (SDW). Each participant was tested prior treatment at day 1 (T0), after the inhalations at day 14 (T1) and at 3 months follow-up (T2). At each time point, blood tests, nasal swabs for microbiome sampling, pulmonary functionality tests (PFTs) and pro-inflammatory marker measure were performed.

RESULTS

The scores obtained in the administered tests (6MWT, Borg score and SGRQ) at T0 showed a significant variation in the STW group, at T1 and T2. Serum cytokine levels and other inflammatory biomarkers reported a statistically significant decrease. Some specific parameters of PFTs showed ameliorations in the STW group only. Changes in the STW nasopharyngeal microbiota composition were noticed, especially from T0 to T2.

CONCLUSIONS

Inhalations of sulphur thermal water exerted objective and subjective improvements on participants affected by long-COVID. Significant reduction of inflammatory markers, dyspnoea scores and quantitative and qualitative changes in the nasopharyngeal microbiome were also assessed.

Effects of pulmonary rehabilitation in survivors of severe acute respiratory syndrome coronavirus 2. Role of vaccination

Survivors of severe COVID-19 requiring hospital admission may suffer from short- and long-term sequelae, including disability and reduced physical performance. Vaccination and pulmonary rehabilitation (PR) are effective tools against COVID-19 effects. While the beneficial effect of each of these treatments is known, there are no data about their combined effect. In people admitted to PR hospitals after severe COVID-19 disease, we retrospectively analyzed whether PR outcome might be influenced by vaccination status. Ninety-six individuals were studied (46 vaccinated, 50 unvaccinated). Unvaccinated individuals were younger and less comorbid than vaccinated ones and had needed more intensive care support during the previous hospitalization. Measures of disability and physical performance did not differ between groups at the beginning and at the end of the PR program. However, each group showed a statistically significant improvement in all outcome measures (6-minute walking test, short physical performance battery, Barthel Index). We conclude that vaccination status does not influence the outcome of in-patient PR programs for survivors of severe COVID-19.

The impact of mild COVID-19 on medium-term respiratory function

Background

There is a paucity of evidence on the impact of mild COVID-19 on the respiratory system, particularly in non-healthcare seeking individuals.

Objectives

To investigate the effects of mild COVID-19 on respiratory function and to identify indicators of decreased lung function.

Methods

We conducted a cross-sectional study in 175 non-healthcare-seeking individuals with confirmed acute SARS-CoV-2 infection who did not require hospitalisation. Participants were divided into three groups: those who had pulmonary function tests (PFTs) within 6 months, between 6 and 12 months, and between 12 and 24 months after infection. Each participant underwent spirometry, measurement of the diffusing capacity of the lungs for carbon monoxide (DLCO ), a 6-minute walking distance test (6MWD) and plethysmography.

Results

The mean age of the participants was 44.3 years, and the mean body mass index (BMI) 32.7 kg/m². Forty-six participants had PFTs within 6 months, 64 between 6 and 12 months, and 65 between 12 and 24 months. Lower than expected DLCO was the most commonly detected abnormality (57%). Spirometry anomalies were noted in 23%, 10% showing an obstructive impairment and 13% a restrictive impairment, confirmed by a total lung capacity <80%. An increased BMI was the only variable that was significantly and independently linearly associated with lower than predicted (<80%) forced vital capacity, forced expiratory volume in the 1st second, DLCO and 6MWD.

Conclusion

DLCO was low in a considerable proportion of non-healthcare-seeking individuals 2 years after mild COVID-19. A high BMI was found to be significantly and independently associated with lower than predicted PFT results and 6MWD.

Study synopsis

What the study adds. We found that pulmonary function, particularly diffusing capacity, was lower than predicted in a significant proportion of non-healthcare-seeking individuals up to 2 years after mild COVID-19. A high body mass index (BMI) was found to be significantly and independently associated with decreased lung function.Implications of the findings. There is a paucity of evidence on the medium-term effects of mild COVID-19 on the respiratory system in non-healthcare-seeking individuals. We investigated the medium-term effects of mild COVID-19 on the respiratory system, showed lower than predicted lung function, and identified one independent predictor, BMI. Even individuals classified as having 'mild' COVID-19 could have medium-term respiratory sequelae.

Tele-rehabilitation in COVID-19 survivors (TERCOV): An investigator-initiated, prospective, multi-center, real-world study

INTRODUCTION

Center-based rehabilitation is limited by COVID-19 infectivity and social distancing policy. We hypothesized that discharged patients benefit from 8-week home-based tele-rehabilitation (tele-PR) using mobile phones and low-cost instruments.

METHODS

The TERCOV (Tele-rehabilitation in COVID-19 survivors) is an investigator-initiated, prospective, multi-center, real-world study. After proper assessment, 186 discharge patients received tele-PR by smartphone, including breathing exercise, respiratory muscle training, aerobic exercise, and resistance training. Physicians, physiotherapists, and nurses provided guidance through smartphone applications. The primary outcome was six-minute walk distance (6MWD). The secondary outcomes included hand grip, short physical performance battery, maximal inspiratory pressure, maximal expiratory pressure, self-rating anxiety/depression scale (SAS/SDS), 36-item short-form health survey (SF-36) and international physical activity questionnaire.

RESULTS

Dyspnea subgroups were more functionally impaired. After tele-PR, improvements were observed in exercise capacity(∆6MWD: 16.80 m, 95% CI 1.18-32.42, p < 0.0001), limb muscle function (∆SPPB 0.25 points, 95% CI 0.05-0.46), respiratory muscle strength (∆MIP 16.50 cm H2O, 95% CI 9.22-23.78, p < 0.0001; ∆MEP: 12.09 cm H2O, 95% CI 3.48-20.70, p = 0.0002), health-related quality of life (∆SF-36 49.85, 95% CI: 21.01-78.69, p < 0.0001), physical activity(∆HEPA 13.01%, p = 0.0029). Anxiety reduced in patients with mMRC ≥ 2 (∆SAS = -4.19 points, CI -8.16 to -0.22, p = 0.03). Greater change was seen in dyspnea patients.

IMPLICATIONS ON PHYSIOTHERAPY PRACTICE

Supervised/semi-supervised tele-PR is a promising option during the pandemic. Patients with Dyspnea benefit more.

Pulmonary Function, Functional Capacity, Respiratory, and Locomotor Muscle Strength after Severe to Critically Ill COVID-19: A Long-Term Study

BACKGROUND

The sequelae of post-coronavirus disease 2019 (COVID-19) pneumonia on lung function, exercise capacity, and quality of life were observed in both shortterm and long-term. However, the study about the respiratory and locomotor muscle strength in severe and critically ill COVID-19 survivors are still limited. Therefore, we aimed to examine long-term pulmonary function, functional capacities, and respiratory and locomotor body muscle strength in severe to critically ill post-COVID-19 survivors.

METHODS

A prospective observational study was conducted in 22 post-COVID-19 pneumonia and healthy adults. Clinical characteristics during admission, pulmonary function, functional capacity, respiratory muscles, and locomotor muscles strength were examined at 1, 3, and 6 months after discharge from the hospital.

RESULTS

The generalized linear mixed model showed that percent predicted of forced expiratory volume in the 1 second (%FEV1), percent predicted of forced vital capacity (%FVC), maximum inspiratory pressure (MIP), handgrip strength, 6-minute walk distance, and five times sit to stand (5TSTS) were significantly lower in post-COVID-19 pneumonia patients than in healthy subjects during the follow-up period. The percent predicted of maximal voluntary ventilation (%MVV), and locomotor muscle strength were not different between the two groups throughout the follow-up period. Among post-COVID-19 pneumonia patients, %FEV1, %FVC, %MVV, 5TSTS, locomotor muscle strength significantly improved at three months compared to baseline at 1 month.

CONCLUSION

Pulmonary function, functional capacity, respiratory, and locomotor muscle strength of survivors from COVID-19 were impaired and recovery was observed after three to six months. These emphasized the need to evaluate the long-term consequences of COVID-19.

Dyspnea and long COVID patients

Patients with prior COVID-19 infections often develop chronic post-COVID symptoms, such as fatigue and dyspnea. Some patients have residual pulmonary disorders with abnormal pulmonary function tests and/or chest radiographs to explain their dyspnea. However, other patients appear to have dyspnea that is out of proportion to any measurable change in lung function. Some of these patients have abnormal cardiopulmonary exercise testing with definite cardiac or respiratory limits. However, others have normal cardiopulmonary exercise testing based on VO2 measurement but pronounced dyspnea during this testing. These patients often have abnormal respiratory patterns, referred to as dysfunctional breathing, with irregular and variable respiratory rates and/or tidal volumes. Consequently, their control of breathing is impaired, and this may represent residual effects from prior COVID-19 infection involving the central nervous system. Alternatively, patients may have acquired "a memory" of respiratory symptoms during their infection which persists post-infection. These patients should participate in pulmonary rehabilitation and breathing retraining.

Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach

The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.

Effects of a cardiopulmonary rehabilitation programme on submaximal exercise in Tunisian patients with long-COVID19: A randomized clinical trial

There is a lack of randomized clinical trials (RCTs) exploring the outcomes of cardiopulmonary rehabilitation programmes (CPRPs) on submaximal aerobic capacity of long COVID-19 patients (LC19Ps). This RCT aimed to evaluate the effect of an ambulatory CPRP on the 6-min walk test (6MWT) data (main outcome: 6-min walk distance (6MWD)) of LC19Ps. Conducted as a single-blinded RCT, the study included Tunisian LC19Ps with persistent dyspnoea (i.e. modified medical research council (mMRC) level ≥2) at least three months postdiagnosis. LC19Ps were randomly assigned to the intervention (IG, n = 20) or control (CG, n = 10) groups. Pre- and post-CPRP evaluations included dyspnoea assessments (Borg and mMRC scales), anthropometric data, spirometry, and 6MWT. The CPRP (i.e. 18 sessions over six weeks) encompassed warm-up, aerobic training, resistance training, respiratory exercises, and therapeutic education. The CPRP significantly improved i) dyspnoea, i.e. IG exhibited larger reductions compared to the CG in Borg (-3.5 ± 2.0 vs. -1.3 ± 1.5) and mMRC (-1.5 ± 0.8 vs. -0.1 ± 0.3) scales, and ii) 6MWD, i.e. IG demonstrated larger improvements compared to the CG in 6MWD (m, %) (168 ± 99 vs. 5 ± 45 m, 28 ± 8 vs. 1 ± 8%, respectively), and resting heart rate (bpm, % maximal predicted heart rate) (-9 ± 9 vs. 1 ± 7 bpm; -5 ± 6 vs. 0 ± 4%, respectively), with small effect sizes. In the IG, the 1.5-point decrease in mMRC and the 168 m increase in 6MWD exceeded the recommended minimal clinical important differences of 1 point and 30 m, respectively. CPRP appears to be effective in enhancing the submaximal exercise capacity of LC19Ps, particularly in improving 6MWD, dyspnoea, and resting heart rate. RCT registration: www.pactr.org; PACTR202303849880222.

Bacterial co-infection in COVID-19: a call to stay vigilant

Co-infection with diverse bacteria is commonly seen in patients infected with the novel coronavirus, SARS-CoV-2. This type of co-infection significantly impacts the occurrence and development of novel coronavirus infection. Bacterial co-pathogens are typically identified in the respiratory system and blood culture, which complicates the diagnosis, treatment, and prognosis of COVID-19, and even exacerbates the severity of disease symptoms and increases mortality rates. However, the status and impact of bacterial co-infections during the COVID-19 pandemic have not been properly studied. Recently, the amount of literature on the co-infection of SARS-CoV-2 and bacteria has gradually increased, enabling a comprehensive discussion on this type of co-infection. In this study, we focus on bacterial infections in the respiratory system and blood of patients with COVID-19 because these infection types significantly affect the severity and mortality of COVID-19. Furthermore, the progression of COVID-19 has markedly elevated the antimicrobial resistance among specific bacteria, such as Klebsiella pneumoniae, in clinical settings including intensive care units (ICUs). Grasping these resistance patterns is pivotal for the optimal utilization and stewardship of antibiotics, including fluoroquinolones. Our study offers insights into these aspects and serves as a fundamental basis for devising effective therapeutic strategies. We primarily sourced our articles from PubMed, ScienceDirect, Scopus, and Google Scholar. We queried these databases using specific search terms related to COVID-19 and its co-infections with bacteria or fungi, and selectively chose relevant articles for inclusion in our review.

Metabolomic characterization of COVID-19 survivors in Jilin province

BACKGROUND

The COVID-19 pandemic has escalated into a severe global public health crisis, with persistent sequelae observed in some patients post-discharge. However, metabolomic characterization of the reconvalescent remains unclear.

METHODS

In this study, serum and urine samples from COVID-19 survivors (n = 16) and healthy subjects (n = 16) underwent testing via the non-targeted metabolomics approach using UPLC-MS/MS. Univariate and multivariate statistical analyses were conducted to delineate the separation between the two sample groups and identify differentially expressed metabolites. By integrating random forest and cluster analysis, potential biomarkers were screened, and the differential metabolites were subsequently subjected to KEGG pathway enrichment analysis.

RESULTS

Significant differences were observed in the serum and urine metabolic profiles between the two groups. In serum samples, 1187 metabolites were detected, with 874 identified as significant (457 up-regulated, 417 down-regulated); in urine samples, 960 metabolites were detected, with 39 deemed significant (12 up-regulated, 27 down-regulated). Eight potential biomarkers were identified, with KEGG analysis revealing significant enrichment in several metabolic pathways, including arginine biosynthesis.

CONCLUSIONS

This study offers an overview of the metabolic profiles in serum and urine of COVID-19 survivors, providing a reference for post-discharge monitoring and the prognosis of COVID-19 patients.

Impact of a 12-week high-intensity interval training intervention on cardiac structure and function after COVID-19 at 12-month follow-up

In patients previously hospitalised for COVID-19, a 12-week high-intensity interval training (HIIT) intervention has previously been shown to increase left ventricular mass (LVM) immediately after the intervention. In the present study, we examined the effects of the same HIIT scheme on LVM, pulmonary diffusing capacity, symptom severity and functional capacity at 12-month follow-up. In this investigator-blinded, randomised controlled trial, 12 weeks of a supervised HIIT scheme (4 × 4 min, three times a week) was compared to standard care (control) in patients recently discharged from hospital due to COVID-19. At inclusion and at 12-month follow-up, LVM was assessed by cardiac magnetic resonance imaging (cMRI, primary outcome), while pulmonary diffusing capacity for carbon monoxide (DLCOc, secondary outcome) was examined by the single-breath method. Symptom severity and functional status were examined by the Post-COVID-19 Functional Scale (PCFS) and King's Brief Interstitial Lung Disease (KBILD) questionnaire score. Of the 28 patients assessed at baseline, 22 completed cMRI at 12-month follow-up (12.4 ± 0.6 months after inclusion). LVM was maintained in the HIIT but not the standard care group, with a mean between-group difference of 9.68 [95% CI: 1.72, 17.64] g (P = 0.0182). There was no differences in change from baseline to 12-month follow-up between groups in DLCOc % predicted (-2.45 [-11.25, 6.34]%; P = 0.578). PCFS and KBILD improved similarly in the two groups. In individuals previously hospitalised for COVID-19, a 12-week supervised HIIT scheme resulted in a preserved LVM at 12-month follow-up but did not affect pulmonary diffusing capacity or symptom severity.

Six and twelve-month respiratory outcomes in a cohort of severe and critical COVID-19 survivors: A prospective monocentric study in Latin America

Introduction

Severe COVID-19 can result in long-term sequelae known as "chronic COVID," characterized by a wide range of persistent physical and mental symptoms. Chest imaging and pulmonary function test alterations have been observed in recovered patients. Most studies focus on up to a 3-month follow-up after symptom onset or hospital discharge, with few reports on long-term follow-up and limited evidence regarding disease progression in Latin America.

Methods

This study aims to describe the clinical characteristics and changes in pulmonary function, imaging, and quality of life in severe and critical COVID-19 patients requiring ICU admission in a high-complexity hospital in Latin America. A prospective cohort of survivors underwent clinical, radiological, pulmonary function, and quality of life assessments 6 and 12 months post-discharge.

Results

One hundred twelve patients were included, all of whom attended the 6-month follow-up, and 99 returned for the 12-month follow-up. Most subjects had no previous respiratory symptoms or significant medical history. At the end of the follow-up period, 74% of the patients showed interstitial infiltrates in chest tomography and a higher frequency of fibroatelectatic tracts and parenchymal bands. Pulmonary function tests returned to normal ranges, except for carbon monoxide diffusion, but no altered scores were reported in the questionnaires.

Conclusion

Despite residual radiological findings, most parameters studied in severe and critical COVID-19 survivors improved over the 12-month follow-up period. Regardless of the imaging abnormalities, the improvement in variables such as symptomatic relief and normal pulmonary function suggests that these alterations are transient. Carbon monoxide diffusion did not normalize by the end of the follow-up, which is consistent with the abnormalities reported in multiple studies, indicating a potential disease-related pattern.

Postinfectious Pulmonary Complications: Establishing Research Priorities to Advance the Field: An Official American Thoracic Society Workshop Report

Continued improvements in the treatment of pulmonary infections have paradoxically resulted in a growing challenge of individuals with postinfectious pulmonary complications (PIPCs). PIPCs have been long recognized after tuberculosis, but recent experiences such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have underscored the importance of PIPCs following other lower respiratory tract infections. Independent of the causative pathogen, most available studies of pulmonary infections focus on short-term outcomes rather than long-term morbidity among survivors. In this document, we establish a conceptual scope for PIPCs with discussion of globally significant pulmonary pathogens and an examination of how these pathogens can damage different components of the lung, resulting in a spectrum of PIPCs. We also review potential mechanisms for the transition from acute infection to PIPC, including the interplay between pathogen-mediated injury and aberrant host responses, which together result in PIPCs. Finally, we identify cross-cutting research priorities for the field to facilitate future studies to establish the incidence of PIPCs, define common mechanisms, identify therapeutic strategies, and ultimately reduce the burden of morbidity in survivors of pulmonary infections.