Funcionalidad antes y después de fisioterapia en pacientes post Covid-19

Introducción: El COVID-19 es una enfermedad que desde su aparición en 2019 ha representado un reto para los servicios sanitarios. Las secuelas son consecuencia de un deterioro de la calidad de vida, fatiga, disnea y dolor articular. Objetivo: Comparar parámetros funcionales físicos, respiratorios, cognitivos y de independencia funcional en pacientes post COVID-19, con secuelas respiratorias antes y después de un programa de terapia física y ocupacional respiratoria. Métodos: Se realizó un estudio comparativo, cuasiexperimental, prospectivo en pacientes ambulatorios egresados de hospitalización por COVID-19 en un Hospital de 3er nivel de atención del Instituto Mexicano del Seguro Social en Puebla, México durante 2020-2021. Se aplicaron escalas antes y después del programa de rehabilitación. Se utilizó estadística analítica. Resultados: Se incluyeron 116 pacientes, 57,7% hombres, edad media de 47,32 años (min. 20, máx. 79); 77 (66,3%) pacientes presentaron síntomas moderados en hospitalización. Se obtuvo un valor de p significativa (p <0,001). Conclusión: Se observa una mejoría significativa en los pacientes post COVID-19 tras recibir terapia física y ocupacional respiratoria.

Introduction. COVID-19 is a disease that since its emergence in 2019 has represented a challenge for healthcare services. The sequelae result from impaired quality of life, fatigue, dyspnea and joint pain. Objective. To compare physical, respiratory, cognitive and functional independence functional parameters in post-COVID-19 patients with respiratory sequelae before and after a respiratory physical and occupational therapy program. Methods. A comparative, quasi-experimental, prospective study was conducted in outpatients discharged from hospitalization for COVID-19 in a 3rd level of care Hospital of the Mexican Institute of Social Security in Puebla, Mexico during 2020-2021. Scales were applied before and after the rehabilitation program. Analytical statistics were used. Results. We included 116 patients, 57.7% men, mean age 47.32 years (min. 20, max. 79); 77 (66.3%) patients presented moderate symptoms in hospitalization. A significant p-value was obtained (p <0.001). Conclusion. Significant improvement is observed in post-COVID-19 patients after receiving respiratory physical and occupational therapy.

Interactions among the mycobiome, bacteriome, inflammation, and diet in people living with HIV.

While the intestinal microbiome seems a major driver of persistent immune defects in people with HIV (PWH), little is known about its fungal component, the mycobiome. We assessed the inter-kingdom mycobiome-bacteriome interactions, the impact of diet, and the association with the innate and adaptive immunity in PWH on antiretroviral therapy. We included 24 PWH individuals and 12 healthy controls. We sequenced the Internal Transcribed Spacer 2 amplicons, determined amplicon sequence variants, measured biomarkers of the innate and adaptive immunity in blood and relations with diet. Compared to healthy controls, PWH subjects exhibited a distinct and richer mycobiome and an enrichment for Debaryomyces hansenii, Candida albicans, and Candida parapsilosis. In PWH, Candida and Pichia species were strongly correlated with several bacterial genera, including Faecalibacterium genus. Regarding the links between the mycobiome and systemic immunology, we found a positive correlation between Candida species and the levels of proinflammatory cytokines (sTNF-R2 and IL-17), interleukin 22 (a cytokine implicated in the regulation of mucosal immunity), and CD8+ T cell counts. This suggests an important role of the yeasts in systemic innate and adaptive immune responses. Finally, we identified inter-kingdom interactions implicated in fiber degradation, short-chain fatty acid production, and lipid metabolism, and an effect of vegetable and fiber intake on the mycobiome. Therefore, despite the great differences in abundance and diversity between the bacterial and fungal communities of the gut, we defined the changes associated with HIV, determined several different inter-kingdom associations, and found links between the mycobiome, nutrient metabolism, and systemic immunity.

Relationship of Diet to Gut Microbiota and Inflammatory Biomarkers in People with HIV.

While changes in microbiome composition have been associated with HIV, the effect of diet and its potential impact on inflammation remains unclear. Methods: Twenty-seven people living with HIV (PWH) on antiretroviral therapy (ART) were studied. A comprehensive dietary analysis was performed and two types of dietary patterns were determined. We explored the associations of each dietary pattern with gut microbiota and plasma inflammatory biomarkers. Results: We appreciated two dietary patterns, Mediterranean-like (MEL) and one Western-like (WEL). Compared to participants with the WEL pattern, participants with MEL pattern showed higher abundance of Lachnospira (p-value = 0.02) and lower levels of the inflammatory biomarkers D-dimer (p-value = 0.050) and soluble TNF-alpha receptor 2 (sTNFR2) (p-value = 0.049). Men who have sex with men (MSM) with MEL pattern had lower abundance of Erysipelotrichaceae (p-value < 0.001) and lower levels of D-dimer (p-value = 0.026) than MSM with WEL pattern. Conclusion: MEL pattern favours Lachnospira abundance, and protects against Erysipelotrichaceae abundance and higher levels of the inflammatory biomarkers D-dimer and sTNFR2, precursors of inflammatory processes in HIV-infected patients. Our study contributes to understanding the determinants of a healthier diet and its connections with gut microbiota and inflammation.

Fecal microbiota transplantation in HIV: A pilot placebo-controlled study.

Changes in the microbiota have been linked to persistent inflammation during treated HIV infection. In this pilot double-blind study, we study 30 HIV-infected subjects on antiretroviral therapy (ART) with a CD4/CD8 ratio < 1 randomized to either weekly fecal microbiota capsules or placebo for 8 weeks. Stool donors were rationally selected based on their microbiota signatures. We report that fecal microbiota transplantation (FMT) is safe, not related to severe adverse events, and attenuates HIV-associated dysbiosis. FMT elicits changes in gut microbiota structure, including significant increases in alpha diversity, and a mild and transient engraftment of donor's microbiota during the treatment period. The greater engraftment seems to be achieved by recent antibiotic use before FMT. The Lachnospiraceae and Ruminococcaceae families, which are typically depleted in people with HIV, are the taxa more robustly engrafted across time-points. In exploratory analyses, we describe a significant amelioration in the FMT group in intestinal fatty acid-binding protein (IFABP), a biomarker of intestinal damage that independently predicts mortality. Gut microbiota manipulation using a non-invasive and safe strategy of FMT delivery is feasible and deserves further investigation. Trial number: NCT03008941.