Background More than 20% of hospitalized patients with coronavirus disease 2019 (COVID-19) develop acute respiratory distress syndrome (ARDS) requiring intensive care unit (ICU) admission. The long-term respiratory sequelae in ICU survivors remain unclear. Research question what are the major long-term pulmonary sequelae in critical COVID-19 survivors? Study Design and Methods Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-minute walking test (6MWT)) and chest computed tomography (CT). Results 125 ICU patients with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%), and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median (IQR) distance in the 6MWT was 400 (362;440) meters. CT scans were abnormal in 70.2% of patients, showing reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT had worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT were age and length of invasive mechanical ventilation during the ICU stay. Interpretation Pulmonary structural abnormalities and functional impairment are highly prevalent in surviving ICU patients with ARDS secondary to COVID-19 3 months after hospital discharge. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months post discharge.

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Question We evaluated whether the time between first respiratory support and intubation of patients receiving invasive mechanical ventilation (IMV) due to COVID-19 was associated with mortality or pulmonary sequelae. Materials and methods Prospective cohort of critical COVID-19 patients on IMV. Patients were classified as early intubation if they were intubated within the first 48 h from the first respiratory support or delayed intubation if they were intubated later. Surviving patients were evaluated after hospital discharge. Results We included 205 patients (140 with early IMV and 65 with delayed IMV). The median [p25;p75] age was 63 [56.0; 70.0] years, and 74.1% were male. The survival analysis showed a significant increase in the risk of mortality in the delayed group with an adjusted hazard ratio (HR) of 2.45 (95% CI 1.29–4.65). The continuous predictor time to IMV showed a nonlinear association with the risk of in-hospital mortality. A multivariate mortality model showed that delay of IMV was a factor associated with mortality (HR of 2.40; 95% CI 1.42–4.1). During follow-up, patients in the delayed group showed a worse DLCO (mean difference of − 10.77 (95% CI − 18.40 to − 3.15), with a greater number of affected lobes (+ 1.51 [95% CI 0.89–2.13]) and a greater TSS (+ 4.35 [95% CI 2.41–6.27]) in the chest CT scan. Conclusions Among critically ill patients with COVID-19 who required IMV, the delay in intubation from the first respiratory support was associated with an increase in hospital mortality and worse pulmonary sequelae during follow-up.

OBJECTIVES: To evaluate the sleep and circadian rest-activity pattern of critical COVID-19 survivors 3 months after hospital discharge. DESIGN: Observational, prospective study. SETTING: Single-center study. PATIENTS: One hundred seventy-two consecutive COVID-19 survivors admitted to the ICU with acute respiratory distress syndrome. INTERVENTIONS: Seven days of actigraphy for sleep and circadian rest-activity pattern assessment; validated questionnaires; respiratory tests at the 3-month follow-up. MEASUREMENTS AND MAIN RESULTS: The cohort included 172 patients, mostly males (67.4%) with a median (25th–75th percentile) age of 61.0 years (52.8–67.0 yr). The median number of days at the ICU was 11.0 (6.00–24.0), and 51.7% of the patients received invasive mechanical ventilation (IMV). According to the Pittsburgh Sleep Quality Index (PSQI), 60.5% presented poor sleep quality 3 months after hospital discharge, which was further confirmed by actigraphy. Female sex was associated with an increased score in the PSQI ( p < 0.05) and IMV during ICU stay was able to predict a higher fragmentation of the rest-activity rhythm at the 3-month follow-up ( p < 0.001). Furthermore, compromised mental health measured by the Hospital Anxiety and Depression Scale was associated with poor sleep quality ( p < 0.001). CONCLUSIONS: Our findings highlight the importance of considering sleep and circadian health after hospital discharge. Within this context, IMV during the ICU stay could aid in predicting an increased fragmentation of the rest-activity rhythm at the 3-month follow-up. Furthermore, compromised mental health could be a marker for sleep disruption at the post-COVID period.

OBJECTIVEType 2 diabetes exerts a deleterious effect on lung function. However, it is unknown whether an improvement in glycemic control ameliorates pulmonary function. RESEARCH DESIGN AND METHODSProspective interventional study with 60 patients with type 2 diabetes and forced expiratory volume in 1 s (FEV1) £90% of predicted. Spirometric maneuvers were evaluated at baseline and after a 3-month period in which antidiabetic therapy was intensified. Those with an HbA 1c reduction of ‡0.5% were considered to be good responders (n = 35). RESULTSGood responders exhibited a significant improvement in spirometric values between baseline and the end of the study (forced vital capacity [FVC]: 78.5 6 12.6% vs. 83.3 6 14.7%, P = 0.029]; FEV1: 75.6 6 15.3% vs. 80.9 6 15.4%, P = 0.010; and peak expiratory flow [PEF]: 80.4 6 21.6% vs. 89.2 6 21.0%, P = 0.007). However, no changes were observed in the group of nonresponders when the same parameters were evaluated (P = 0.586, P = 0.987, and P = 0.413, respectively). Similarly, the initial percentage of patients with a nonobstructive ventilatory defect and with an abnormal FEV1 decreased significantly only among good responders. In addition, the absolute change in HbA 1c inversely correlated to increases in FEV1 (r = 20.370, P = 0.029) and PEF (r = 20.471, P = 0.004) in the responders group. Finally, stepwise multivariate regression analysis showed that the absolute change in HbA 1c independently predicted increased FEV1 (R 2 = 0.175) and PEF (R 2 = 0.323). In contrast, the known duration of type 2 diabetes, but not the amelioration of HbA 1c , was related to changes in forced expiratory flow between 25% and 75% of the FVC. CONCLUSIONSIn type 2 diabetes, spirometric measurements reflecting central airway obstruction and explosive muscle strength exhibit significant amelioration after a short improvement in glycemic control.The lungs are not conventionally included in the target list of organs that may be affected by type 2 diabetes. However, with its large vascularization and rich amount of collagen and elastin fibers, the lung parenchyma appears to be a potential target of chronic hyperglycemia (1-3). In fact, the same histological and physiologic disturbances that account for complications in other tissues may also be involved in the

A few studies showed that both adherence to Mediterranean diet (MedDiet) and physical activity practice have a positive impact on pulmonary function in subjects with lung disease. These associations are not well studied in subjects free from lung disease. In a cross-sectional study conducted in 3020 middle-aged subjects free of lung disease, adherence to the MedDiet using the Mediterranean Diet Adherence Screener, and physical activity practice using the International Physical Activity Questionnaire short form were recorded. Respiratory function was assessed using forced spirometry and the results were evaluated according to the Global initiative for Chronic Obstructive Lung Disease. Logistic regression models were used to analyze the associations between adherence to the MedDiet and physical activity practice with the presence of ventilatory defects. Participants with a high adherence to MedDiet, in comparison to those with low adherence, had both higher forced vital capacity (FVC; 100 (87–109) vs. 94 (82–105) % of predicted, p = 0.003) and forced expired volume in the first second (FEV1; 100 (89–112) vs. 93 (80–107) % of predicted, p < 0.001). According to their degree of physical activity, those subjects with a high adherence also had both higher FVC (100 (88–107) vs. 94 (83–105) % of predicted, p = 0.027) and FEV1 (100 (89–110) vs. 95 (84–108) % of predicted, p = 0.047) in comparison with those with low adherence. The multivariable logistic regression models showed a significant and independent association between both low adherence to MedDiet and low physical activity practice, and the presence of altered pulmonary patterns, with differences between men and women. However, no joint effect between adherence to MedDiet and physical activity practice on respiratory function values was observed. Low adherence to MedDiet and low physical activity practice were independently associated with pulmonary impairment. Therefore, the lung mechanics seem to benefit from heart-healthy lifestyle behaviors.

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Recibido el 18 de mayo de 2009; aceptado el 30 de junio de 2009 Disponible en Internet el 24 de septiembre de 2009 PALABRAS CLAVE Infecciones por nematodos; Strongyloides stercoralis; Paciente inmunodeprimido; Infecciones del tracto respiratorio ResumenEl Strongyloides stercoralis (Ss) es un nematodo end emico en países de clima tropical y subtropical, y en España se han descrito casos, sobre todo en la costa mediterr anea. La infección por Ss suele ser asintom atica o manifestarse por síntomas predominantemente digestivos, y en los casos de hiperinfestación produce una estrongiloidiasis diseminada con sobreinfecciones bacterianas sist emicas que provocan una disfunción multiorg anica con resultado letal. Los factores de riesgo m as importantes para que una infección en principio intestinal y en muchas ocasiones asintom atica adquiera características de gravedad son la inmunosupresión y la utilización de corticoides, por su capacidad de alterar la función eosinofílica. El caso que presentamos corresponde a la forma de síndrome de hiperinfección por Ss acompañado de neumonía bilateral que ocasionó síndrome de distr es respiratorio agudo, con demostración del par asito en muestras de esputo, jugo g astrico y heces en un paciente con enfermedad de Crohn y tratamiento crónico con corticoides. AbstractStrongyloides stercoralis (Ss) is an endemic nematode in tropical and subtropical countries. Cases have also been described in Spain, major mainly in the Mediterranean coast. Ss infection is usually asymptomatic or causes mild gastrointestinal symptoms. Spillover infection can cause widespread disseminated strongylodiasis associated to severe systemic bacterial infections which may lead to multiorgan failure and death. The most important risk factors that may convert an infection that is basically intestinal and often asymptomatic, to severe entity, are immunocompromised conditions and corticosteroids therapy, due to their effect on the eosinophil function. We report a case of a patient affected by Crohn's disease in chronic treatment with corticosteroids who developed a Ss hyperinfective condition with pulmonary involvement ARTICLE IN PRESS 0210-5691/$ -see front matter & 2009 Elsevier España, S.L. y SEMICYUC. Todos los derechos reservados.