Relationship between functional status and fatigue after COVID-19 infection: a multicenter study from Türkiye.

Background/aim: Symptoms of COVID-19 may persist for months. One of the persistent symptoms of COVID-19 is fatigue, which reduces functional status. The relationship between fatigue, functional status, and various other factors has received little attention, which this study aims to address.. Materials and methods: Patients with COVID-19 infection were included in this multicenter cross-sectional study. Age, sex, body mass index (BMI), marital status, smoking status, presence and duration of chronic disease, comorbidity index, regular exercise habits, time since COVID-19 diagnosis, hospitalization status, length of hospital stay, intubation status, home oxygen therapy after discharge, participation in a pulmonary rehabilitation program, presence of dyspnea, presence of cough, presence of sputum, and modified Medical Research Council, Post-COVID Functional Status (PCFS), Fatigue Severity Scale (FSS), and EQ-5D-5L Questionnaire scores were recorded. Results: We enrolled 1095 patients, including 603 (55%) men and 492 (45%) women with a mean age of 50 ± 14 years. The most common chronic lung disease was COPD (11%) and 266 (29%) patients had nonpulmonary disease. The median time elapsed since COVID-19 diagnosis was 5 months; the hospitalization rate was 47%. The median PCFS grade was 1 (0-4) and the median FSS score was 4.4 (1-7). The PCFS and FSS were positively correlated (r = 0.49, p < 0.01; OR: 1.88, 95% CI: 1.68-2.10). Both functional status and fatigue were associated with quality of life, which was lower in older patients, those with higher BMI, those with systemic disease, those not exercising regularly, and those with more severe COVID-19 infection (defined by dyspnea, pneumonia as indicated by computed tomography, hospitalization, length of stay, ICU admission, intubation, and the need for home oxygen after discharge). Conclusion: Fatigue may cause poorer functional status regardless of the time since COVID-19 diagnosis. In this study, patients with FSS scores of >4.78 showed moderate to severe functional limitations. It is important to address modifiable patient risk factors and reduce the severity of COVID-19 infection.

Memory B cells and serum immunoglobulins are associated with disease severity and mortality in patients with COVID-19.

PURPOSE OF THE STUDY: The aim of this study was to investigate the relationship of B cell-mediated immunity with disease severity and mortality in patients with COVID-19. STUDY DESIGN: In this retrospective cohort and single-centre study, 208 patients with laboratory-confirmed COVID-19 were recruited. A COVID-19 severity score, ranging from 0 to 10, was used to evaluate associations between various factors. Serum immunoglobulin levels and the number of cells in B lymphocyte subsets were measured and their association with disease severity and mortality in patients with COVID-19 examined. RESULTS: The median age of the patients was 50 (35-63) years and 88 (42%) were female. The number of deceased patients was 17. The median COVID-19 severity score was 8 (6-8) in deceased patients and 1 (0-2) in survivors. Deceased patients had significantly lower levels of total B lymphocytes, naive B cells, switched memory B cells, and serum IgA, IgG, IgG1 and IgG2 than recovered patients (all p<0.05). In addition, a significant negative correlation was found between the number of these parameters and COVID-19 severity scores. Decrease in the number of total B cells and switched memory B cells as well as lower serum IgA, IgG and IgG1 levels were independent risk factors for mortality in patients with COVID-19. CONCLUSION: In the present study, the prognosis of patients with COVID-19 was shown to be associated with the B cell subset and serum immunoglobulin levels.

Abnormal quantitative pupillary light responses following COVID-19.

PURPOSE: To characterize alterations in pupillary light reflex responses in subjects following coronavirus disease 2019 (COVID-19), especially those with long-COVID. METHODS: Thirty-five subjects with previous COVID-19 and 30 healthy control participants were enrolled in this cross-sectional comparative study. An infrared dynamic pupillometry system (MonPack One; Metrovision, France) was used to quantify pupillary light responses. The National Institute for Health and Care Excellence (NICE) long-COVID questionnaire was used to identify persisting symptoms at least 4 weeks after acute COVID-19. RESULTS: The median time after the diagnosis of acute COVID-19 was 4.0 (2.0-5.0) months. There was an increase in the latency of pupil contraction (P = 0.001) and a reduction in the duration of pupil contraction (P = 0.039) in post-COVID-19 subjects compared to healthy controls. No significant differences were observed in the initial pupil diameter, amplitude and velocity of pupil contraction or latency, velocity and duration of pupil dilation. Long-COVID was present in 25/35 (71%) subjects and their duration of pupil contraction was reduced compared to subjects without long-COVID (P = 0.009). The NICE long-COVID questionnaire total score (ρ = - 0.507; P = 0.002) and neurological score (ρ = - 0.412; P = 0.014) correlated with the duration of pupil contraction and the total score correlated with the latency of dilation (ρ = - 0.352; P = 0.038). CONCLUSION: Dynamic pupillometry reveals significant alterations in contractile pupillary light responses, indicative of parasympathetic dysfunction after COVID-19.

Apoptosis-induced T-cell lymphopenia is related to COVID-19 severity.

Increased levels of acute-phase reactants and lymphopenia are predictors of disease severity in coronavirus disease 2019 (COVID-19). This study aimed to investigate the role of apoptosis in the etiology of lymphopenia in patients with COVID-19. This multicentered, prospective, and case-control study was conducted with polymerase chain reaction (+) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, and an age-gender-matched control group. Samples were taken at the time of diagnosis and analyzed via flow cytometry within 24 h. The participants' demographic data and initial laboratory tests were also recorded. In total, 33 patients with COVID-19 (mean age = 45.4 ± 17.2) and 25 controls (mean age = 43.4 ± 17.4) participated in the study. All patients were identified as having mild (16), moderate (5), or severe (12) disease severity. Both early and late apoptotic cells in B and T lymphocytes were increased in all patients with COVID-19 (p < .05). Early apoptotic (EA) B and T lymphocytes were also higher in severe cases compared to mild cases (p = .026). There was no significant difference between lymphopenia and apoptosis in patients with COVID-19. However, patients with lymphopenia (n = 14) and severe COVID-19 (p = .013) had increased EA T lymphocytes. This study's results show that B and T lymphocytes' apoptosis increases in patients with COVID-19. In addition, enhanced T lymphocyte apoptosis is associated with disease severity in lymphopenic patients with COVID-19.

An association between immune status and chest CT scores in COVID-19 patients.

BACKGROUND: The characteristic features of the immune responses of COVID-19 patients and how they reflect lung involvement have not been clearly elucidated. AIM: The aim of this study was to examine the immune status and the correlations thereof with chest CT scores and lung involvement of patients with COVID-19. METHODS: In this retrospective and single-center study, 72 patients with laboratory-confirmed COVID-19 were recruited. The counts of peripheral lymphocyte subsets (CD3+ T cells, CD4+ T cells, CD8+ T cells, CD19+ B cells and CD16+ 56+ NK cells) and those of serum immunoglobulins (IgA, IgG, IgM) were measured and their associations with chest CT scores analysed. RESULTS: The proportions of lymphopenia in patients with extensive lung involvement were twice that in the general study population. In the severe disease group, the levels of total lymphocytes, T cells, B cells, NK cells; and serum IgA levels, were significantly lower than in the mild disease group (all P < .05). We found that the numbers of lymphocyte subsets and the IgA level negatively correlated with the chest CT scores. On multivariate regression analysis, pretreatment decreases in total lymphocytes, CD3+ T cells, CD4+ T cells, and CD19+ B cells, and serum IgA levels, were independent predictors of severe lung involvement. CONCLUSIONS: The cell numbers of peripheral lymphocyte subsets and the serum IgA level were negatively correlated with the chest CT scores in COVID-19 patients. These parameters tended to independently predict severe lung involvement in such patients.

[Inflammatory myofibroblastic tumor of the lung: histopathology and imaging findings]. / Akcigerin inflamatuvar miyofibroblastik tümörü: histopatoloji ve görüntüleme bulgulari.

Inflammatory myofibroblastic tumor is a neoplasia of unknown clinical etiology that clinically and radiologically tends to mimic a malignant neoplasm. The tumor is histologically composed of a mixture of inflammatory cells, myofibroblastic spindle cells and plasma cells. It can occur in any part of the body. Although pulmonary inflammatory myofibroblastic tumor is the most common primary lung mass especially in childhood, this entity is usually not considered in differential diagnosis of lung nodules or masses. In this article, we aimed to disscus the pathology and imaging findings of the pulmonary inflammatory myofibroblastic tumor and increase the familiarity of radiologists and clinicians to this entity.

[Computed tomography findings in pulmonary involvement of Wegener's granulomatosis: pictorial review]. / Wegener granülomatozis akciger tutulumunda bilgisayarli tomografi bulgulari: resimlerle bir konu.

Wegener's granulomatosis is a necrotising granulomatous vasculitis which has a variable manifestations in the chest that are best described on computed tomography. Imaging findings may include masses or nodules, which may cavitate; consolidations and ground-glass opacities. Wegener's granulomatosis can mimic pneumonia, malignancy, and noninfectious inflammatory diseases. The purpose of this pictorial essay is to demonstrate the characteristic computed tomography findings of pulmonary Wegener's granulomatosis.

Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID.

BACKGROUND/AIMS: Long COVID is characterised by a range of potentially debilitating symptoms which develop in at least 10% of people who have recovered from acute SARS-CoV-2 infection. This study has quantified corneal sub-basal nerve plexus morphology and dendritic cell (DC) density in patients with and without long COVID. METHODS: Forty subjects who had recovered from COVID-19 and 30 control participants were included in this cross-sectional comparative study undertaken at a university hospital. All patients underwent assessment with the National Institute for Health and Care Excellence (NICE) long COVID, Douleur Neuropathique 4 (DN4) and Fibromyalgia questionnaires, and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), corneal nerve branch density (CNBD), corneal nerve fibre length (CNFL), and total, mature and immature DC density. RESULTS: The mean time after the diagnosis of COVID-19 was 3.7±1.5 months. Patients with neurological symptoms 4 weeks after acute COVID-19 had a lower CNFD (p=0.032), CNBD (p=0.020), and CNFL (p=0.012), and increased DC density (p=0.046) compared with controls, while patients without neurological symptoms had comparable corneal nerve parameters, but increased DC density (p=0.003). There were significant correlations between the total score on the NICE long COVID questionnaire at 4 and 12 weeks with CNFD (ρ=-0.436; p=0.005, ρ=-0.387; p=0.038, respectively) and CNFL (ρ=-0.404; p=0.010, ρ=-0.412; p=0.026, respectively). CONCLUSION: Corneal confocal microscopy identifies corneal small nerve fibre loss and increased DCs in patients with long COVID, especially those with neurological symptoms. CCM could be used to objectively identify patients with long COVID.

Relationship between Selective IgA Deficiency and COVID-19 Prognosis.

The prevalence and mortality rates of coronavirus disease 2019 (COVID-19) widely vary among populations. Mucosal immunity is the first barrier to the pathogen's entry into the body. Immunoglobulin A (IgA) is the primary antibody responsible for mucosal immunity. We explored the relationship between selective IgA deficiency (SIgAD) and COVID-19 severity. We included 424 patients (203 women) with COVID-19. Eleven patients had SIgAD. Laboratory data of patients with SIgAD and normal IgA levels were compared. The relationship between SIgAD and severe COVID-19 infection was explored using logistic regression analysis. In the univariate logistic regression analysis, the risk of severe COVID-19 disease in patients with SIgAD was approximately 7.7-fold higher than that in other patients (odds ratio [OR], 7.789; 95% confidence interval [CI], 1.665-36.690, P = 0.008), while it was 4-fold (OR, 4.053; 95% CI, 1.182-13.903, P = 0.026) higher in the multivariate logistic regression analysis. Serum IgA levels were positively correlated with total lymphocyte counts and negatively correlated with C-reactive protein levels, which was a risk factor for severe COVID-19. In patients with SIgAD, the number of severe acute respiratory coronaviruses 2 that pass through mucosal membranes may be increased, leading to complications such as cytokine storm syndrome and acute respiratory distress syndrome.

Unexplained acute respiratory distress syndrome after varicocele surgery; report of a case.

Acute respiratory distress syndrome (ARDS) is a syndrome of acute respiratory failure that is associated with several clinical disorders including direct pulmonary injury and indirect pulmonary injury. Vascular surgical patients are at risk for ARDS. A 23-year old man was admitted to our respiratory intensive care unit with short of breath, cyanosis and agitation which was developed acutely after varicocele operation under epidural anesthesia lasted for one hour. Bupivacain, fentanyl, remifentadyl and midazolam were used for epidural anesthesia. Oxygen saturation was 81% while breathing oxygen at FiO(2) of 0.5. Arterial blood gas analysis showed hypoxemia with respiratory alkalosis with a PaO(2)/FiO(2) score of 100. A chest radiograph demonstrated bilateral alveolar opacities. Bedside echocardiography was performed which revealed no evidence of global hypokinesia, all the chambers were normal, left ventricular ejection fraction was 65%. A diagnosis of ARDS was made and the patient was initiated on noninvasive mechanical ventilation. He was gradually weaned off the NIMV and discharged after a total hospital stay of four days. We report an ARDS case due to unexplained etiology after varicocele operation under epidural anesthesia and managed successfully with noninvasive mechanical ventilation.

The value of endobronchial ultrasound-guided transbronchial needle aspiration, 18-fluorodeoxyglucose positron emission tomography/computed tomography, and ultrasonography imaging techniques in the diagnosis of mediastinal and/or hilar malignant, anthracotic, and other benign lymph nodes.

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. MATERIAL AND METHOD: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ±â€Š2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ±â€Š7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. CONCLUSION: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.

The Association of Neutrophil/Lymphocyte and Platelet/Lymphocyte Ratios and Hematological Parameters with Diagnosis, Stages, Extrapulmonary Involvement, Pulmonary Hypertension, Response to Treatment, and Prognosis in Patients with Sarcoidosis.

Sarcoidosis is a rare disease characterized by granulomatous inflammation in affected organs, primarily in lungs. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) are easy and practical methods providing valuable information in diagnosis, severity, and prognosis of various diseases. Here, we aimed to investigate the association between NLR, PLR, and hematological parameters in sarcoidosis. The study was performed with 75 sarcoidosis patients and 92 controls. Patients' NLR, PLR, and hematological parameters were compared with those of controls. Additionally, while differences between NLR and PLR were investigated in sarcoidosis patients, differences of extrapulmonary involvement, pulmonary hypertension (PH), and spontaneous remission between those with and without responses to treatment concerning stages were also assessed. NLR and PLR were significantly higher in sarcoidosis patients than controls. For NLR, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found as 68, 61, 58, and 70% respectively, while sensitivity, specificity, PPV, and NPV for PLR were found as 72, 67, 63, and 74%, respectively. In sarcoidosis patients, NLR and PLR were significantly higher at stage-2 and -3 than at stage -1 and -4. There was a significant weak positive correlation between C-reactive protein (CRP) and NLR and PLR. Mean platelet volume (MPV), hemoglobin (Hgb), and mean corpuscular volume (MCV) were lower among patients than controls. A positive moderate correlation was detected between NLR and CD4/CD8 in blood, while there was a strong positive correlation between CD4/CD8 in bronchoalveolar lavage (BAL) and positive moderate correlation between PLR and CD4/CD8 in BAL. High NLR and PLR values were not significantly associated with pulmonary PH, spontaneous remission, response to treatment, and prognosis. The increase in PLR and NLR may be a guide for diagnoses of both sarcoidosis and lung parenchymal involvement. To use these entities as markers, our findings should be supported with prospective studies with larger samples.

Evaluation of Serum Resistin, Visfatin, and Chemerin Levels in Patients with Lung Cancer and Chronic Obstructive Pulmonary Disease.

OBJECTIVES: Cachexia is an important problem in lung cancer and chronic obstructive pulmonary disease (COPD). Some studies report an association between adipokines and cachexia. Our study aimed to investigate the association of three novel adipokines, resistin, visfatin, and chemerin, with lung cancer and COPD. MATERIALS AND METHODS: 30 patients with non-smallcell lung cancer, 30 patients with COPD, and 30 healthy volunteers were included in the study. Statistically significant weight loss was found in COPD and lung cancer groups compared with that in the control group (p<0.001). Among the biomarkers, only resistin levels were significantly higher in patients with cachexia than in patients without weight loss in all groups (p=0.006). Resistin level was significantly higher in patients with COPD (p=0.002). Visfatin level was significantly higher in the control group (p=0.001). We found that a higher biomass exposure resulted in a significant increase and decrease in resistin (p=0.007) and visfatin levels (p=0.001), respectively, in the patient groups. For all groups, no statistically significant relationship was found between chemerin levels and weight loss or other variables. RESULTS: No significant relationship was found between the biomarkers and lung cancer type, tumor stage, lymph node stage, and metastasis stage. There was no relationship between the biomarkers by tumor, node, and metastasis and COPD stages (p>0.05). We observed no findings strong enough to support the use of these molecules as markers of disease stage or cachexia. CONCLUSION: Resistin, visfatin, and chemerin cannot be used as potential biomarkers for lung cancer or COPD or for disease stage or cachexia.

Thoracic Complications in Behçet's Disease: Imaging Findings.

Behçet's disease (BD) causes vascular inflammation and necrosis in a wide range of organs and tissues. In the thorax, it may cause vascular complications, affecting the aorta, brachiocephalic arteries, bronchial arteries, pulmonary arteries, pulmonary veins, capillaries, and mediastinal and thoracic inlet veins. In BD, chest radiograph is commonly used for the initial assessment of pulmonary symptoms and complications and for follow-up and establishment of the response to treatment. With the advancement of helical or multislice computed tomography (CT) technologies, such noninvasive imaging techniques have been employed for the diagnosis of vascular lesions, vascular complications, and pulmonary parenchymal manifestations of BD. CT scan (especially, CT angiography) has been used to determine the presence and severity of pulmonary complications without resorting to more invasive procedures, in conjunction with gadolinium-enhanced three-dimensional (3D) gradient-echo magnetic resonance (MR) imaging with the subtraction of arterial phase images. These radiologic methods have characteristics that are complementary to each other in diagnosis of the thoracic complications in BD. 3D ultrashort echo time (UTE) MR imaging (MRI) could potentially yield superior image quality for pulmonary vessels and lung parenchyma when compared with breath-hold 3D MR angiography.

Pulmonary Embolism Originating from a Hepatic Hydatid Cyst Ruptured into the Inferior Vena Cava: CT and MRI Findings.

Pulmonary embolism due to hydatid cysts is a very rare clinical entity. Hydatid pulmonary embolism can be distinguished from other causes of pulmonary embolism with contrast-enhanced computed tomography (CECT) and magnetic resonance imaging (MRI). MRI especially displays the cystic nature of lesions better than CECT. Here we report a 45-year-old male patient with the pulmonary embolism due to ruptured hydatid liver cyst into the inferior vena cava.

Cigarette smoke and bleomycin-induced pulmonary oxidative stress in rats.

Bleomycin causes pulmonary fibrosis by increasing free oxygen radicals. Cigarette smoke is a strong oxidant which adversely affects pulmonary tissue. We evaluated the effects of cigarette smoke administered with intratracheal bleomycin on pulmonary tissue. We studied 3 groups of rats (n=10): one group received intratracheal saline and served as a control; one received intratracheal bleomycin (IT) (0.5 U/100 g body weight, single dose on the first day), and one group received intratracheal bleomycin (single dose on first day) and tobacco smoke (two times per day) (IT-S). After 4 weeks, the levels of malondialdehyde (MDA) and nitric oxide (NO) and the activities of superoxide dismutase (SOD) and xanthine oxidase (XO) were assayed in the homogenate of the lung tissue samples. The severity of interstitial fibrosis was assessed using the grading system described by Ashcroft. There was more intensive fibrosis in the IT and IT-S than in the control samples (P<0.001). The levels of MDA, NO and activity of XO were significantly increased (P<0.001, <0.002 and <0.002, respectively), and SOD activity (P<0.001) was significantly decreased in the IT group when compared to these values in the control group. The concentration of NO was significantly decreased (P<0.002), and SOD activity was significantly increased (P<0.05) in the lung tissue samples of the IT-S group. Theoretically, the combination of cigarette smoke and bleomycin may have a synergistic effect on oxidative lung injury. In conclusion, we showed that inhalation of cigarette smoke provides protection against oxidative stress in the lung tissue of rats with bleomycin-induced pulmonary fibrosis.