Coronavirus disease 2019 (COVID) primarily affects the lung and can lead to chronic/post-COVID syndrome. Some insights about late pulmonary changes occurring in patients recovering from COVID have been published, but the evidence of detailed pathologic changes coming from follow-up care patients with long COVID is limited.

To evaluate tissue morphologic and viral features in transbronchial biopsies of long COVID patients (immunocompetent and immunocompromised).

This retrospective observational study included 18 patients (9 immunocompetent and 9 immunocompromised) who were consecutively referred to our outpatient clinic for post-COVID pneumonia, undergoing transbronchial biopsy. Several histologic changes were analyzed by computer-assisted morphometric analysis. As organizing pneumonia (OP) was consistently detected, fibrosis and inflammation were also evaluated in transbronchial biopsies from 28 control patients with histologic confirmation of OP. Tissue SARS-CoV-2 and the subgenomic transcripts were investigated. Morphologic findings were correlated with clinical and radiologic data.

Long COVID patients showed lower inflammation than controls (P < .001) despite a similar fibrotic extension. When considering separately the 2 long COVID groups, the same inflammatory infiltrate extension was found, whereas a higher fibrotic remodeling characterized the immunocompetent subgroup (P = .05). Molecular investigation showed that SARS-CoV-2 was present in tissue samples obtained from 3 long COVID patients.

Long COVID patients showed a peculiar OP pattern, with more vascular and fibrotic changes. SARS-CoV-2 RNA, even in replicative status, can be detected in lung biopsies of both immunocompetent and immunocompromised patients. This pilot study is a forerunner of more in-depth lung tissue investigations to gain a better understanding of long COVID pathobiology.

Little research has been conducted on new-onset myasthenia gravis (MG) patients following the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 surged in China on December 7th, 2022. This study aimed to explore the clinical characteristics of new-onset MG patients after COVID-19 and analyze factors affecting their disease improvement.

All new-onset MG patients before (December 1st, 2021 to December 7th, 2022) and after COVID-19 outbreak (December 8th, 2022 to November 30th, 2023) were included in this study. Data was collected through the electronic medical record system and follow-up. Multivariate logistic regression was used to identify independent predictors of clinical improvement in patients with new-onset MG.

359 new-onset MG patients (165 before COVID-19 outbreak and 194 after COVID-19 outbreak) were enrolled in this study. After COVID-19 outbreak, there was an increase in new-onset MG patients, with more cases occurring within the first three months. The rates of pulmonary inflammation (40.28%), COVID-19 vaccination (88.14%), and treatment with tacrolimus (15.98%) and MG duration (15 weeks, IQR: 5.75, 32) were higher, while rates of thymectomy (13.92%), baseline MG-ADL (3, IQR: 3, 6), and QMGS (7, IQR: 5,8) were lower compared to new-onset MG patients before COVID-19 outbreak. Multivariate logistic regression analysis showed that age at onset (OR 0.964, p < 0.001), baseline MG-ADL (OR 1.611, p < 0.001), and ocular MG (OR 0.401, p = 0.041) were independent predictors of clinical improvement in new-onset MG after the COVID-19 outbreak.

In this single-center cross-sectional study, new-onset MG patients following the COVID-19 outbreak showed altered seasonal onset patterns, milder disease severity, and higher OMG onset age. Age at onset is an independently negative predictor of improvement in new-onset MG patients after the COVID-19 outbreak. Whereas baseline MG-ADL is an independently positive predictor.

Lung damage in post-acute COVID-19 is a common clinical finding. Lung water density (LWD) imaging using ultrashort echo time (UTE) MRI with proton-density weighting is sensitive to edema and fibrosis.

To characterize LWD in COVID-19 survivors, compared with a healthy cohort.

Retrospective cohort.

185 COVID-19 survivors (63 male; age [median (interquartile range, IQR)]: 51 (25-83) years; 160 (66-363) days from COVID-19 infection to MRI) and 109 healthy controls (64 male; age: 52 (27-76) years) with no history of COVID-19 infection.

2.89T; Yarnball UTE pulse sequence.

Free-breathing three-dimensional LWD images were acquired in both cohorts. Clinical demographics (age, sex, body mass index [BMI]), presence of comorbidities (hypertension, dyslipidemia, diabetes, obesity), COVID-19 hospitalization, pulmonary function, six-minute walking distance, and plasma biomarkers were recorded.

Student's t-tests or Mann-Whitney U tests were used to compare lung water metrics between cohorts. The effect of comorbidities was assessed using Kruskal-Wallis tests followed by pairwise Wilcoxon tests with Bonferroni correction. Categorical variables were compared using chi-squared tests. p < 0.05 was considered significant.

LWD (median (IQR)), was significantly greater in the post-COVID-19 cohort than in the healthy cohort, 31.3 (6.6)% versus 27.9 (6.5)% in men and 30.3 (7.4)% versus 27.5 (4.9)% in women. 37% of men and 24% of women in the post-COVID-19 cohort had LWD above the healthy cohort 95% confidence limit. Participants with elevated LWD had significantly higher BMI (kg/m2) (32 (5) versus 26 (4) in men, 33 (9) versus 26 (7) in women), incidence of comorbidities (78% vs. 50% in men, 72% vs. 38% in women), rates of COVID-19 hospitalization (52% vs. 23% in men, 38% vs. 18% in women), and elevated CRP (mg/L) (2.2 (3.4) vs. 1.1 (1.4) in men, 1.8 (4.2) vs. 1.2 (2.1) in women).

MRI-derived LWD is elevated in COVID-19 survivors and is related to high BMI, COVID-19 hospitalization, inflammatory plasma biomarkers, and the presence of comorbidities.

2.

Stage 3.

The emergence of coronavirus disease 2019 (COVID-19) has triggered research into its impact on male reproductive health. However, studies exploring the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on semen quality in infertile men remain limited. Herein, we enrolled 781 male infertile patients who recovered from COVID-19 and analyzed their semen and blood samples collected at different time points. We found that SARS-CoV-2 RNA was undetectable in semen samples. Compared with pre-COVID-19 status, total sperm count, sperm concentration, vitality, motility, and percentage of sperm cells with normal morphology decreased significantly in the first month post-COVID-19. However, these alterations were reversed in the third month. Furthermore, seminal plasma samples exhibited reduced proinflammatory cytokine levels and notable changes in amino acid, nucleic acid, and carbohydrate metabolism by the third month compared with those in the first month. By contrast, no significant alterations in reproductive hormone levels were found. Vitality, progressive motility, and total motility negatively correlated with body temperature when it was above 38°C. In conclusion, semen quality initially decreases post-COVID-19 but reverses after approximately 3 months, with a decline related to inflammatory and fever. These findings may provide guidance to infertile male patients who need assisted reproductive technology.

For patients with chronic dyspnea of noncardiovascular origin, chest radiography is usually appropriate as the first-line imaging modality. Chest CT without contrast is either usually appropriate or may be appropriate as a second-line option for conditions of unclear etiology or suspected chronic obstructive pulmonary disease, small airways disease, and post-COVID-19 complications. Chest CT with contrast may have a role in patients with pleura/chest wall disease or diaphragm dysfunction. Although MRI, fluoroscopy, and FDG-PET/CT have limited roles, special imaging techniques such as inspiratory/expiratory CT and hyperpolarized xenon gas MRI are noted for their specific uses. This document aims to help clinicians choose the most suitable imaging tests, enhancing diagnostic accuracy and patient care. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Chronic bronchitis (CB) patients' excessive mucus and airway changes may worsen viral pneumonia severity, but there is a lack of objective clinical/imaging assessment criteria. This study used quantitative computed tomography (CT) to link CB pathology with pneumonia severity/prognosis, guiding early interventions for high-risk groups.

This retrospective cohort study included 42 patients with CB diagnosed with viral pneumonia and 208 non-CB viral pneumonia controls. Baseline demographic, clinical, and laboratory parameters were collected alongside thoracic CT-derived metrics, including mucus plugging score (a bronchopulmonary segment-based scoring system quantifying mucus obstruction severity), CT severity score (range, 0-25 per lobe), and emphysema quantification. Follow-up CT imaging was performed at 3 months post-diagnosis to assess pulmonary structural remodeling, with longitudinal documentation of CT severity scores. Participants were stratified into two cohorts by mucus plugging score: high mucus burden (≥4, group 1) and low mucus burden (<4, group 2). Intergroup comparisons utilized Fisher's exact test for categorical variables, with continuous variables analyzed via independent t-tests (normally distributed) or Mann-Whitney U tests (non-parametric distributions). Multivariate logistic regression modeling identified independent predictors of disease progression.

This study enrolled 260 patients who were categorized into group 1 (n=42; CB prevalence: 35.70%) and group 2 (n=218; CB prevalence:19.70%). Comparative analysis demonstrated that CB patients in group 2 were significantly older [70, interquartile range (IQR) (62, 77) vs. 79, IQR (74.5, 86.5) years; P<0.001] and exhibited a higher female predominance (74.4% vs. 25.6%; P=0.03), alongside lower red blood cell count (RBC) [3.73, IQR (3.39, 4.29)×1012/L vs. 4.05, IQR (3.81, 4.53)×1012/L; P=0.02] and hemoglobin levels [119, IQR (105.5, 131) vs. 124, IQR (115.5, 136) g/L; P=0.04] compared to non-CB counterparts. Imaging analysis revealed that non-CB patients had greater thoracic reticular patterns [6.02, IQR (1.42, 10.08) vs. 2.50, IQR (0.57, 6.19) cm3; P=0.02] and emphysema severity [0.21, IQR (0.04, 0.73) vs. 0.05, IQR (0.01, 0.19) cm3; P<0.001], whereas CB patients across both groups showed marked bronchial wall thickening [group 1: 21.60, IQR (10.30, 37.69) vs. 6.28, IQR (1.54, 15.71) cm3, P=0.03; group 2: 35.08, IQR (13.38, 51.59) vs. 18.90, IQR (3.43, 45.53) cm3, P=0.01]. Notably, CB patients in group 2 displayed larger bronchial lumen volumes [13.63, IQR (5.19, 25.29) vs. 5.00, IQR (0.67, 13.46) cm3; P<0.001]. Multivariate analysis of the low mucus burden group identified female sex [odds ratio (OR) =3.39], age (OR =1.06), and emphysema (OR =1.56) as independent risk factors for disease progression (all P<0.05). Longitudinal CT follow-up indicated stable severity scores in non-CB patients, whereas high mucus-secreting CB patients (group 1) demonstrated significant reductions in mucus plugging scores over time.

CB features-mucus hypersecretion, emphysema, and airway thickening-worsen viral pneumonia severity and prognosis. Key predictors include advanced age (OR =1.06), female sex (OR =3.39), and emphysema (OR =1.56). High-risk CB patients, especially with emphysema, need enhanced CT monitoring and therapies improving mucociliary clearance and airway repair.

Patients with severe SARS-CoV-2 omicron variant pneumonia pose a serious challenge. This study aimed to develop a nomogram for predicting survival using chest computed tomography (CT) imaging features and laboratory test results based on admission data.

A total of 436 patients with SARS-CoV-2 pneumonia (323 and 113 in the training and validation groups, respectively) were enrolled. Pneumonitis volume, assessed on chest CT scans at admission, was used to identify low- and high-risk groups. Risk analysis was performed using clinical symptoms, laboratory findings, and chest CT imaging features. A predictive algorithm was developed using Cox multivariate analysis.

The high-risk group had a shorter survival duration than the low-risk group. Significant differences in mortality rate, neutrophil and lymphocyte counts, C-reactive protein (CRP) concentration, and urea nitrogen level were observed between the two groups. In the training group, age, pneumonia volume, total bilirubin, and blood urea nitrogen were independent prognostic factors. In the validation group, age, pneumonia volume, neutrophil count, and CRP were independent prognostic factors. A personalized prediction model for survival outcomes was developed using independent predictors.

A personalized prediction model was created to forecast the 5-, 10-, 15-, 20-, and 30-day survival rates of patients with COVID-19 omicron variant pneumonia based on admission data, and can be used to determine the survival rate and early treatment of severe patients.

Background: This study aims to systematically evaluate the findings from computed tomography (CT) examinations conducted at least three months post-diagnosis of COVID-19 in patients diagnosed between 2020 and 2024. Objective: To determine the frequency and characteristics of CT findings in the post-COVID-19 period, analyze long-term effects on lung parenchyma, and contribute to the development of clinical follow-up and treatment strategies based on the collected data. Materials and Methods: Ethical approval was obtained for this retrospective study, and individual consent was waived. A total of 76 patients were included in the study, aged 18 and older, diagnosed with COVID-19 between March 2020 and November 2024, who underwent follow-up chest CT scans at 3-6 months, 6-12 months, and/or 12 months post-diagnosis. CT images were obtained in the supine position without contrast and evaluated by two experienced radiologists using a CT severity score (CT-SS) system, which quantifies lung involvement. Statistical analyses were performed using IBM SPSS 23.0, with significance set at p < 0.05. Results: The results indicated a mean CT-SS of 10.58 ± 0.659. Significant associations were found between age, CT scores, and the necessity for intensive care or mechanical ventilation. The most common CT findings included ground-glass opacities, reticular patterns, and traction bronchiectasis, particularly increasing with age and over time. Conclusion: This study emphasizes the persistent alterations in lung parenchyma following COVID-19, highlighting the importance of continuous monitoring and tailored treatment strategies for affected patients to improve long-term outcomes.

Following recovery from COVID-19, there is evidence for pulmonary sequelae and functional impairment. Data regarding the immunopathological mechanisms are limited. This study aimed to investigate the relationship between bronchoalveolar lavage fluid (BALF) cellularity, lung function impairment and high-resolution computed tomography (HRCT) changes in post-COVID syndrome patients.

Patients with post-COVID syndrome were enrolled in this Austrian single-center prospective observational cohort study. All patients underwent a pulmonary function test (PFT) and chest HRCT. Those with pathological HRCT findings underwent bronchoscopy with BALF sampling for differential cell count and fluorescence-activated cell sorting analysis.

In this study 26 patients with post-COVID syndrome underwent bronchoscopy with BAL. The HRCT showed ground-glass opacifications (69.2%), organizing pneumonia (7.7%) or both (11.5%). The PFT revealed restrictive lung disease in 38.5% and reduced diffusion capacity in 68%, 19.2% showed a pathological BAL cell pattern predominantly consisting of CD4+ T‑cells. The BALF lymphocyte count was associated with reduced forced vital capacity (p = 0.016) and an elevated alveolar-arterial oxygen gradient (p = 0.04).

A notable percentage of patients with post-COVID syndrome with persistent HRCT changes showed T‑helper lymphocytic inflammation in the lungs. The degree of alveolar lymphocytosis was associated with lung function impairment. This could suggest that a prolonged inflammatory response in the alveolar compartment contributes to the pathogenesis of post-COVID syndrome.

The resolution of the recent COVID-19 pandemic still requires attention, since the consequences of having suffered the infection, even in mild cases, are associated with several acute and chronic pathological conditions referred to as post-COVID syndrome (PCS). PCS often manifests with pulmonary disease and, in up to 9% of cases, a more serious complication known as post-COVID-19 pulmonary fibrosis (PC19-PF), which has a similar clinical course as idiopathic pulmonary fibrosis (IPF). Generating knowledge to provide robust evidence about the clinical benefits of different therapeutic strategies to treat the pulmonary effects of PCS can provide new insights to amplify therapeutic options for these patients. We present evidence found after a scoping review, following extended PRIMSA guidelines, for the use of immunomodulators in pulmonary PCS. We start with a brief description of the immunomodulatory properties of the relevant drugs, their clinically proven efficacy for viral infections and chronic inflammatory conditions, and their use during the COVID-19 pandemic. We emphasize the need for well-designed clinical trials to improve our understanding the physiopathology of pulmonary PCS and PC19-PF and also to determine the efficacy and safety of candidate treatments.

Patients with severe COVID-19 may develop lung fibrosis. Pirfenidone is an anti-fibrotic drug approved for idiopathic pulmonary fibrosis. The efficacy and safety of pirfenidone in patients with fibrotic interstitial lung changes after recovery from severe COVID-19 pneumonia were evaluated.

This was a phase 2, double-blind, placebo-controlled, Spanish multicentre clinical trial. Patients were randomised to receive pirfenidone or placebo (2:1) for 24 weeks. The primary end-point was the proportion of patients that improved, considered when percentage change in forced vital capacity (FVC) was ≥10% and/or any reduction in the fibrotic score on chest high-resolution computed tomography (HRCT). Secondary end-points included health-related quality of life (HRQoL), exercise capacity and drug safety profile.

From 119 eligible patients, 113 were randomised and 103 were analysed (pirfenidone n=69 and placebo n=34). Most patients were male (73.5%) and were receiving low-dose prednisone; mean age was 63.7 years and mean body mass index was 29 kg·m-2. The percentage of patients that improved was similar in the pirfenidone and placebo groups (79.7% versus 82.3%, respectively). The mean predicted FVC increased by 12.74±20.6% with pirfenidone and 4.35±22.3% with placebo (p=0.071), and the HRCT (%) fibrotic score decreased by 5.44±3.69% with pirfenidone and 2.57±2.59% with placebo (p=0.52). Clinically meaningful improvement in HRQoL was not statistically different (55.2% in the pirfenidone group and 39.4% in the placebo group). Exercise capacity, adverse events and hospitalisations were similar between groups. No deaths were reported.

The overall improvements in lung function and HRCT fibrotic score after 6 months with pirfenidone were not significantly different than with placebo.

COVID-19 patients may have residual pulmonary alterations after the acute disease, with fibrotic-like alterations. Since metalloproteinases (MMP) and their regulators may be involved in inflammation and abnormal repair processing, we aimed to investigate the correlations between MMP-9, a tissue inhibitor of metalloproteinases (TIMP-1) and chest CT abnormalities in acute phase and mid-term follow-up.

COVID-19 patients with plasma analyses and CT scans performed at acute onset and 3 months after discharge (T post) were evaluated. MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio were analyzed. CT extents of COVID-19 pneumonia and fibrotic-like alterations were visually scored (score range 0-25). Spearman rank correlation analysis (p-value <.05) was computed between acute and mid-term plasma analyses and CT scores.

39 patients were enrolled. At hospital admission, MMP-9, TIMP-1, and MMP-9/TIMP-1 had a median of 240.5 ng/mL, 258.8 ng/mL, and 0.9. The median CT global and fibrotic-like scores were 9 and 6. At T post, MMP-9 and TIMP-1 were not statistically different (p-value <.05). There was a reduction of CT global score (p-value = .00007). A significant correlation was found between MMP-9 and CT global score at hospital admission (ρ = 0.456, p-value = .003) and between MMP-9/TIMP-1 ratio and CT global score at hospital admission (ρ = 0.406, p-value = .009). No other significant correlations were found between plasma enzymes and CT alterations, both in acute and mid-term follow-up.

MMP-9 plasma levels and MMP-9/TIMP-1 ratio correlate with lung involvement during the acute phase. None of the levels of MMP-9, TIMP-1, and MMP-9/TIMP-1 ratio may be adopted as predictors of residual pulmonary alterations in mid-term follow-up.

We investigated the prevalence of new or persistent manifestations experienced by COVID-19 survivors at 3 or more months after their initial infection, collectively known as post-COVID-19 condition (PCC).

We searched four electronic databases and major grey literature resources for prospective studies, systematic reviews, authoritative reports and population surveys. A random-effects meta-analysis pooled the prevalence data of 22 symptoms and outcomes. The GRADE approach was used to assess the certainty of evidence. PROSPERO CRD42021231476.

Of 20 731 identified references, 194 met our inclusion criteria. These studies followed 483 531 individuals with confirmed COVID-19 diagnosis over periods of up to 2 years. Most focused on adults, nearly two-thirds were conducted in Europe and 63% were of high or moderate quality. The supplementary search identified 17 systematic reviews, five authoritative reports and four population surveys that reported on PCC prevalence. Our analysis revealed that more than half of COVID-19 survivors experienced one or more symptoms more than a year after their initial infection. The most common symptoms were fatiguedyspneamemory, sleep or concentration disturbances; depressionand pain. Limitation in returning to work was the most common outcome. Prevalence tended to be higher among females, individuals hospitalized during their initial infection and those who experienced severe COVID-19 illness.

PCC presents a significant health burden, affecting some groups more than others. This information will help inform health care system policies and services for people living with PCC and those caring for them.

This study aimed to assess chest CT abnormalities and pulmonary function at 6-month and 1-year follow-ups in coronavirus disease 2019 (COVID-19) pneumonia patients of the China epidemic in the turn of 2022-2023.

A total of 156 hospitalized patients with COVID-19 pneumonia admitted between 29 November 2022 and 10 February 2023 were prospectively assessed at 6-month and 1-year follow-ups. Characteristics and CT scores of pulmonary abnormalities and pulmonary function were compared between different follow-up time points. The correlation of CT abnormalities and pulmonary function at 1-year were evaluated.

Over 1 year, the proportion of pulmonary abnormalities gradually decreased (initial, 100%, 156/156; 6-month, 57.1%, 89/156; and 1-year, 37.8%, 59/156; P < 0.001), whereas fibrotic changes increased (initial, 6.4%, 10/156; 6-month, 14.1%, 22/156; and 1-year, 14.7%, 23/56; P < 0.001). Compared to participants of the subgroup with nonfibrotic changes, diffusion capacity of the lung for carbon monoxide (DLCO)(P = 0.01) and DLCO less than 80% predicted (P < 0.001) showed significantly decrease in participants of the subgroup with fibrotic changes. The extent of fibrotic changes was strongly correlated with lower DLCO (r = -0.734, P < 0.001).

Fibrotic changes might show a tendency to persist over time and correlate strongly with impairment of diffusion function, thus requiring more attention in future follow-ups.

Background and Objectives: The pulmonary sequelae of COVID-19 and their evolution are of interest to the scientific community. We aimed to determine the radiological changes at 6 and 12 months after COVID-19 pneumonia, its evolution and its risk factors. Materials and Methods: This retrospective longitudinal study included adults admitted for COVID-19 pneumonia from 1 March 2020 to 30 April 2021 who had a high-resolution computed tomography (HRCT) scan at 6 months and 12 months after hospital discharge. The primary outcome was the appearance of radiological abnormalities on HRCT and the number of lung segments affected by them at 6 and 12 months, while the main explanatory variables were about the disease course, analytical parameters and treatment. Results: This study included n = 108 patients, with a mean age of 64 years. There was a decrease in the percentage of patients presenting parenchymal (93.5% to 88.9%, p < 0.001) and reticular (63% to 62%, p < 0.001) patterns on HRCT at 12 months compared to 6, and an increase in those presenting a fibrotic pattern (62% to 63.9%, p < 0.001). Ground-glass opacities were the most frequent radiological change at 6 and 12 months (91.7% and 87%, respectively). There was a significant reduction in the total number of lung segments with ground-glass opacities (445 to 382, p < 0.001) and consolidation (158 to 136, p = 0.019) and an increase in those with bronchiectasis (66 to 80, p = 0.033) between the two moments. After multivariate analysis, high-flow oxygen therapy (HFOT), highest ferritin levels, hypertension and ≥71 years showed an association with the development of subpleural parenchymal bands, consolidation, bronchiectasis and septal thickening at 6 and 12 months. Conclusions: Parenchymal patterns seem to be more frequent than reticular and fibrotic patterns after COVID-19 pneumonia. The fibrotic pattern was the only one that worsened significantly over time, with bronchiectasis being the only change that increased at 12 months. Older age, hypertension, the need for HFOT, and high levels of ferritin may be directly associated with worse radiological outcomes after COVID-19 pneumonia.

The coronavirus disease pandemic brought unknown challenges to patients with idiopathic inflammatory myopathy, who are often heavily immunosuppressed and have comorbidities. We aimed to investigate the outcomes and risk factors of coronavirus disease in Chinese patients with idiopathic inflammatory myopathy during the Omicron wave.

This observational study included patients with idiopathic inflammatory myopathy who visited the China-Japan Friendship Hospital. Data on baseline characteristics and coronavirus disease-related information were collected through medical records and surveys, and subsequently analysed.

Overall, 204 patients with idiopathic inflammatory myopathy were identified; dermatomyositis was the most common idiopathic inflammatory myopathy subtype. Data were collected from 185 patients with idiopathic inflammatory myopathy who tested positive for severe acute respiratory syndrome coronavirus 2 via polymerase chain reaction or antigen tests; of these, 20 experienced a severe course of the disease, and 9 died. All patients with severe coronavirus disease had idiopathic inflammatory myopathy-associated interstitial lung disease, and the most common antibodies observed in patients with mortality were anti-aminoacyl tRNA synthetase and anti-MDA-5 antibodies. Furthermore, 45.0% of patients in the severe disease group took > 15.0 mg of prednisone daily before infection, a significantly higher proportion than that in the non-severe disease group. Advanced age, mechanics' hands, dyspnoea, chronic cough and fever during the course of myositis, low lymphocyte count, low serum albumin level, and high D-dimer and ferritin levels before infection were prominent in patients with severe coronavirus disease. Albumin levels below 35.0 g/L and ferritin levels above 306.8 ng/mL were independent risk factors of severe coronavirus disease.

Omicron did not worsen the overall outcomes of coronavirus disease for patients with idiopathic inflammatory myopathy; however, specific risk factors were identified, highlighting the need for targeted management strategies.

A novel method was proposed based on gold immune chromatography assay (GICA) including the detection of antibodies targeting different severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epitopes to improve the SARS-CoV-2 IgM and IgG detection performance. Sera from 282 confirmed Coronavirus Disease 2019 (COVID-19) patients were obtained at different times as the SARS-CoV-2 IgM or IgG experimental group. Sera from 148 uninfected and unvaccinated individuals were used as the control. The serum single-epitope IgM and IgG antibodies against SARS-CoV-2 were detected via GICA; the two epitope antibodies with high detection performance were used to construct a novel method, and then compared with the chemiluminescence immunoassay (CLIA). The diagnostic specificity and screening sensitivity of S2-IgM and N-IgM combined detection of serum SARS-CoV-2 IgM antibodies based on GICA were 99.32% and 98.81%, respectively, which were higher than those of the CLIA test (83.78% and 82.14%; P < 0.001). The diagnostic specificity of RBD-IgG and N-IgG combined detection in the serum was 100.00%, the same as that of CLIA. The novel method showed excellent screening sensitivity and diagnostic specificity for serum SARS-CoV-2 IgM and IgG, effectively avoiding omissions and misdiagnoses in the early clinical stages of screening and diagnosing COVID-19.

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.

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.

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.

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.

Long COVID (LC) represents a chronic, systemic, and often disabling condition that poses a significant ongoing threat to public health. Foundational scientific studies are needed to unravel the underlying mechanisms, with the ultimate goal of developing effective preventative and therapeutic strategies. Therefore, there is an urgent demand for animal models that can accurately replicate the clinical features of LC. This review integrates clinical epidemiological data to summarize the pathological changes in extrapulmonary systems involved in LC. Additionally, it critically examines the capacity of existing animal models, including nonhuman primates, genetically modified mice, and Syrian hamsters, to exhibit enduring postinfection symptoms that align with human clinical manifestations, and identifies key areas requiring further development. The objective is to offer insights that will aid in the development of next-generation animal models, thereby accelerating our understanding of how acute respiratory viral infections transition into chronic conditions, and ensuring preparedness for future pandemics.

Currently, the usefulness of lung ultrasound in the follow-up of patients after hospital discharge for SARS-CoV-2 pneumonia is not well known. The main objective of this systematic review is to investigate the persistence of alterations in lung ultrasound of patients who have had COVID-19 pneumonia.

A systematic review has been carried out following the PRISMA regulations in the PubMed, EMBASE, Web of Science and Google Scholar database from January 2020 to May 2023 using the combination of MeSH terms: "lung ultrasound", "ultrasonography", "lung alterations", "persistence", "follow-up", "consequences", "hospital discharge", "COVID", "COVID-19", "SARS-CoV-2". Studies were selected that described alterations in the lung ultrasound of patients after having suffered from COVID-19 pneumonia. The JBI Critical Appraisal Tools were used to assess the risk of bias of the studies. No meta-analysis techniques were performed, the results being compared narratively.

From two to six months after COVID-19 pneumonia, pulmonary ultrasound abnormalities appear frequently and are proportional to the intensity of the initial episode. The most frequent anomalies are irregularities in the pleural line, the presence of B lines and/or subpleural consolidations, predominantly in the basal regions of the thorax. These findings seem to correlate with those of the chest CT.

Lung ultrasound offers technical and economic advantages that should be considered for the study of patients after hospital discharge for COVID-19.

Objectives: We aimed to describe the cardiopulmonary function during exercise and the health-related quality of life (HRQoL) in patients with a history of COVID-19 pneumonia, stratified by chest computed tomography (CT) findings at baseline. Methods: Among 77 consecutive patients with COVID-19 who were discharged from the Pulmonology Ward between March 2020 and April 2021, 28 (mean age 54.3 ± 8.6 years, 8 females) agreed to participate to the current study. The participants were analyzed in two groups based on pulmonary involvement (PI) at baseline chest CT applying a threshold of 25%. A consequent artificial intelligence (AI)-guided total opacity score (TOS) was calculated in a subgroup of 22 patients. A cardiopulmonary exercise test (CPET) was conducted on average 8.4 (±1.9) months after discharge from the hospital. HRQoL was defined using the short-form (SF-36) questionnaire. The primary outcome was exercise intolerance that was defined as a peak oxygen uptake (V'O2peak) < 80% predicted. Secondary outcomes were ventilatory limitation, defined as breathing reserve < 15%, circulatory limitation, defined as oxygen pulse predicted below 80%, and deconditioning, defined as exercise intolerance in the absence of ventilatory and circulatory limitations. Other secondary outcomes included the SF-36 domains. Results: In all, 15 patients had at least 25% PI (53.6%) at baseline chest CT. Exercise intolerance was observed in ten patients (35.7%), six due to deconditioning and four due to circulatory limitation; none had ventilatory limitation. AI-guided TOS was 30.1 ± 24.4% vs. 6.1 ± 4.8% (p < 0.001) at baseline, and 1.7 ± 3.0% vs. 0.2 ± 0.7% (nonsignificant) at follow-up in high and low PI groups, respectively. The physical functioning (PF) domain score of the SF-36 questionnaire was 66.3 ± 19.4 vs. 85.0 ± 13.1 in high and low PI groups, respectively (p = 0.007). Other SF-36 domains did not differ significantly between the groups. A high PI at baseline was inversely correlated with V'O2peak (standardized β coefficient = -0.436; 95% CI -26.1; -0.7; p = 0.040) and with PF scores (standardized β coefficient -0.654; 95% CI -41.3; -7.6; p = 0.006) adjusted for age, sex, body mass index and lung diffusion capacity. Conclusions: One-third of participants experienced exercise intolerance eight months after COVID-19 pneumonia. A higher PI at baseline was significantly associated with exercise intolerance and PF. Notwithstanding, the radiological PI was resolved, and the exercise intolerance was mainly explained not by ventilatory limitation but by circulatory limitation and deconditioning.

Introduction: Long-term lung sequelae in severe COVID-19 survivors, as well as their treatment, are poorly described in the current literature. Objective: To investigate lung fibrotic sequelae in survivors of severe/critical COVID-19 pneumonia and their fate according to a "non-interventional" approach. Methods: Prospective study of the above COVID-19 survivors after hospital discharge from March 2020 to October 2022. Re-evaluation lasted 3-12 months and included chest HRCT, PFTs, dyspnea, and overall health evaluation by modified Medical Research Council (mMRC) and St. George's Respiratory Questionnaire (SGRQ), respectively. Results: In this study, 198 patients (61.1% male) with a median age of 57 years (IQR 49-66). After 3 months, 187 (94.4%) patients were assessed; after 6 months, 82 (41.1%) patients were assessed; and after 12 months, 16 (8%) patients were assessed. At each time point, a significant reduction was observed in the extent of COVID-19-associated opacities (p < 0.001 and p = 0.002) and of parenchymal bands (p = 0.014 and p = 0.025). Persisting fibrotic-like changes were observed in 18 (9%) patients (apical findings in 2 patients, fibrotic non-specific interstitial pneumonia-like changes in 14 patients, minimal fibrotic changes in 2 patients). At 3 months, the predicted median FVC% was 93% (80-100%) and the predicted DLCO% was 65% (58-78%) with a statistically significant improvement at 6 months in both (p = 0.001). Moreover, 81.1% had mMRC ≤ 1 and the median SGRQ was 11.65 [0-24.3] with a significant reduction at 6 months in both dyspnea (p < 0.001) and SGRQ (p = 0.027) persisting at 12 months. Conclusions: This prospective study, including only survivors of severe/critical COVID-19 pneumonia, documented the significant improvement in all imaging, functional, and clinical parameters by applying the "non-interventional" approach. These data do not indicate any post-COVID-19 severe/critical pneumonia and "epidemic of widespread pulmonary fibrosis".

Patients with asthma do not present more respiratory sequelae than a control population after SARS-CoV-2 pneumonia. However, patients with asthma do seem to present more symptoms and a distinct involvement of the airway https://bit.ly/47E6Hze.

As the final stage of disease-related tissue injury and repair, fibrosis is characterized by excessive accumulation of the extracellular matrix. Unrestricted accumulation of stromal cells and matrix during fibrosis impairs the structure and function of organs, ultimately leading to organ failure. The major etiology of fibrosis is an injury caused by genetic heterogeneity, trauma, virus infection, alcohol, mechanical stimuli, and drug. Persistent abnormal activation of "quiescent" fibroblasts that interact with or do not interact with the immune system via complicated signaling cascades, in which parenchymal cells are also triggered, is identified as the main mechanism involved in the initiation and progression of fibrosis. Although the mechanisms of fibrosis are still largely unknown, multiple therapeutic strategies targeting identified molecular mechanisms have greatly attenuated fibrotic lesions in clinical trials. In this review, the organ-specific molecular mechanisms of fibrosis is systematically summarized, including cardiac fibrosis, hepatic fibrosis, renal fibrosis, and pulmonary fibrosis. Some important signaling pathways associated with fibrosis are also introduced. Finally, the current antifibrotic strategies based on therapeutic targets and clinical trials are discussed. A comprehensive interpretation of the current mechanisms and therapeutic strategies targeting fibrosis will provide the fundamental theoretical basis not only for fibrosis but also for the development of antifibrotic therapies.

We aimed to characterize the fibrosis following COVID-19 pneumonia, using quantitative analysis, after three months and subsequently, after two years of patients' release from the hospital, and to identify the risk factors for pulmonary fibrosis.

We performed a retrospective, observational cohort study on 420 patients with severe forms of COVID-19. For all patients, we registered demographic, inflammatory and biochemical parameters, complete blood count and D-dimers; all patients underwent three computed tomography scans (at admittance, at 3 months and at 2 years).

We found fibrosis in 67.9% of patients at the 3-month evaluation and in 42.4% of patients at the 2-year evaluation, registering a significant decrease in the severe and moderate fibrosis cases, with a slight increase in the mild fibrosis cases. The risk of fibrosis was found to be proportional to the values of age, duration of hospital stay, inflammatory markers (ESR, fibrinogen), cytolytic markers (LDH, AST) and D-dimers. The highest correlations with lung fibrosis were registered for interstitial pulmonary involvement (for the 3-month evaluation) and total pulmonary involvement (for the 2-year evaluation).

Lung fibrosis represents a significant post-COVID-19 complication found in 42% of patients with severe forms of pneumonia at the 2-year evaluation. A significant overall decrease in the severity of lung fibrosis was registered at the 2-year evaluation compared to the 3-month evaluation. We consider that the amount of interstitial pulmonary involvement represents the optimal parameter to estimate the risk of lung fibrosis following SARS-CoV-2 pneumonia.

The pandemic COVID-19 (coronavirus disease 2019) is caused by the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2), which devastated the global economy and healthcare system. The infection caused an unforeseen rise in COVID-19 patients and increased the mortality rate globally. This study gives an overall idea about host-pathogen interaction, immune responses to COVID-19, recovery status of infection, targeted organs and complications associated, and comparison of post-infection immunity in convalescent subjects and non-infected individuals. The emergence of the variants and episodes of COVID-19 infections made the situation worsen. The timely introduction of vaccines and precautionary measures helped control the infection's severity. Later, the population that recovered from COVID-19 grew significantly. However, understanding the impact of healthcare issues resulting after infection is paramount for improving an individual's health status. It is now recognised that COVID-19 infection affects multiple organs and exhibits a broad range of clinical manifestations. So, post COVID-19 infection creates a high risk in individuals with already prevailing health complications. The identification of post-COVID-19-related health issues and their appropriate management is of greater importance to improving patient's quality of life. The persistence, sequelae and other medical complications that normally last from weeks to months after the recovery of the initial infection are involved with COVID-19. A multi-disciplinary approach is necessary for the development of preventive measures, techniques for rehabilitation and strategies for clinical management when it comes to long-term care.

The long-term effects of COVID-19 on lung function are not understood, especially for periods extending beyond 1 year after infection. This observational, longitudinal study investigated lung function in Mexican Hispanics who experienced severe COVID-19, focusing on how the length of recovery affects lung function improvements. At a specialized COVID-19 follow-up clinic in Yucatan, Mexico, lung function and symptoms were assessed in patients who had recovered from severe COVID-19. We used z-scores, and Wilcoxon's signed rank test to analyse changes in lung function over time. Lung function was measured twice in 82 patients: the first and second measurements were taken a median of 94 and 362 days after COVID-19 diagnosis, respectively. Initially, 61% of patients exhibited at least one of several pulmonary function abnormalities (lower limit of normal = -1.645), which decreased to 22% of patients by 390 days post-recovery. Considering day-to-day variability in lung function, 68% of patients showed improvement by the final visit, while 30% had unchanged lung function from the initial assessment. Computed tomography (CT) scans revealed ground-glass opacities in 33% of patients. One year after infection, diffusing capacity of the lungs for carbon monoxide z-scores accounted for 30% of the variation in CT fibrosis scores. There was no significant correlation between the length of recovery and improvement in lung function based on z-scores. In conclusion, 22% of patients who recovered from severe COVID-19 continued to show at least one lung function abnormality 1 year after recovery, indicating a prolonged impact of COVID-19 on lung health.

COVID-19 vaccines reduced mortality, hospitalizations and ICUs admissions. Conversely, the impact of vaccination on Long COVID-19 syndrome is still unclear. This study compared the prevalence of post-acute sequelae at short and long-term follow-up among hospitalized unvaccinated and vaccinated COVID-19 survivors through a multidisciplinary approach.

After 2 months from discharge, unvaccinated and vaccinated COVID-19 survivors underwent a follow-up visit at a dedicated "post-COVID-19 Outpatient Clinic". The follow-up visit included a cardiovascular evaluation, blood tests, chest computed tomography, 6-min walking test (6MWT), spirometry. A one-year telephone follow-up was performed to assess re-hospitalizations, death and long-lasting symptoms. An additional 1:1 case-control matching analysis adjusted for baseline characteristics was performed.

Between June 2020 and June 2022, a total of 458 unvaccinated and vaccinated patients (229 per group) underwent the follow-up visit. Vaccinated patients had lower rates of ICU admissions (1.7 % vs 9.6 %, p= <0.001) and severe respiratory complications requiring intubation (1.3 % vs 7 %, p = 0.002) or non-invasive ventilation such as high-flow nasal oxygen therapy (1.7 % vs 7.9 %, p = 0.02), CPAP (1.3 % vs 20.1 %, p= < 0.001), and low-flow oxygen therapy (3.5 % vs 63.3 %, p= <0.001) compared to unvaccinated ones. At 2-month follow-up, vaccinated patients had fewer persistent ground-glass opacities (2.6 % vs 52.8 %, p= <0.001) or consolidations (0.9 % vs 8.3 %, p= <0.001). Additionally, unvaccinated patients experienced more frequent myocarditis (4.8 % vs 0.9 %, p = 0.013) and pulmonary embolism (1.8 % vs 0 %, p = 0.042) and exhibited more significant respiratory impairment as evidenced by desaturation during the 6MWT(10.2 % vs 3.5 %, p = 0.005) and altered spirometry (14 % vs 8.7 %, p = 0.043) compared to vaccinated ones. At one-year, unvaccinated patients reported more symptoms such as dyspnea (20.5 % vs 10 %, p = 0.002), psychological symptoms (10 % vs 3.5 %, p = 0.005) and chronic rhinosinusitis/cough (6,6 % vs 2,6 %, p = 0.04) as compared to vaccinated ones. The 1:1 case-control matching analysis also confirmed these results.

COVID-19 vaccines improve short-term outcomes and may reduce Long COVID-19 prevalence.

Documented radiological and physiological anomalies among coronavirus disease 2019 survivors necessitate prompt recognition of residual pulmonary parenchymal abnormalities for effective management of chronic pulmonary consequences. This study aimed to devise a predictive model to identify patients at risk of such abnormalities post-COVID-19. Our prognostic model was derived from a dual-center retrospective cohort comprising 501 hospitalized COVID-19 cases from July 2022 to March 2023. Of these, 240 patients underwent Chest CT scans three months post-infection. A predictive model was developed using stepwise regression based on the Akaike Information Criterion, incorporating clinical and laboratory parameters. The model was trained and validated on a split dataset, revealing a 33.3% incidence of pulmonary abnormalities. It achieved strong discriminatory power in the training set (area under the curve: 0.885, 95% confidence interval 0.832-0.938), with excellent calibration and decision curve analysis suggesting substantial net benefits across various threshold settings. We have successfully developed a reliable prognostic tool, complemented by a user-friendly nomogram, to estimate the probability of residual pulmonary parenchymal abnormalities three months post-COVID-19 infection. This model, demonstrating high performance, holds promise for guiding clinical interventions and improving the management of COVID-19-related pulmonary sequela.

To evaluate the clinical significance of low-field MRI lung opacity severity.

Retrospective cross-sectional analysis of post-acute Covid-19 patients imaged with low-field MRI from 9/2020 through 9/2022, and within 1 month of pulmonary function tests (PFTs), 6-min walk test (6mWT), and symptom inventory (SI), and/or within 3 months of St. George Respiratory Questionnaire (SGRQ) was performed. Univariate and correlative analyses were performed with Wilcoxon, Chi-square, and Spearman tests. The association between disease and demographic factors and MR opacity severity, PFTs, 6mWT, SI, and SGRQ, and association between MR opacity severity with functional and patient-reported outcomes (PROs), was evaluated with mixed model analysis of variance, covariance and generalized estimating equations. Two-sided 5 % significance level was used, with Bonferroni multiple comparison correction.

81 MRI exams in 62 post-acute Covid-19 patients (median age 57, IQR 41-64; 25 women) were included. Exams were a median of 8 months from initial illness. Univariate analysis showed lung opacity severity was associated with decreased %DLCO (ρ = -0.55, P = .0125), and lung opacity severity quartile was associated with decreased %DLCO, predicted TLC, FVC, and increased FEV1/FVC. Multivariable analysis adjusting for sex, initial disease severity, and interval from Covid-19 diagnosis showed MR lung opacity severity was associated with decreased %DLCO (P < .001). Lung opacity severity was not associated with PROs.

Low-field MRI lung opacity severity correlated with decreased %DLCO in post-acute Covid-19 patients, but was not associated with PROs.