Physical Exercise After Solid Organ Transplantation: A Cautionary Tale.

An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the 'gift of life' are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.

The one-minute sit-to-stand test: A practical tool for assessing functional exercise capacity in patients with COPD in routine clinical practice.

Background: Chronic obstructive pulmonary disease (COPD) is associated with a reduced exercise capacity. Although several field tests for exercise capacity have been modified for non-standard settings, i.e. outside the hospital clinic or pulmonary rehabilitation center, their uptake remains limited. Objectives: To assess the test-retest reliability, constuct validity and responsiveness of the one-minute sit-to-stand test (1'STST) adopted in clinical practice among patients with COPD and to confirm the earlier established minimal important difference (MID) of three repetitions. Methods: Patients with COPD performed two 1'STSTs, two 6-minute walk tests (6MWT), an isometric quadriceps force (QF) measurement, a cardiopulmonary exercise test (CPET), and a seven-day physical activity (PA) measurement before and after three months of pulmonary rehabilitation (PR). An Intraclass Correlation Coefficient (ICC) evaluated the agreement between two 1'STSTs. Pearson Correlation examined the association between the 1'STST and other physical measurements, and their changes following PR. A receiver operating characteristic (ROC) curve was constructed using a 30-meter increment in the 6MWT as cut-off to identify responders. Results: The 1'STST demonstrated good reliability (Δ0.9 ± 4.0 repetitions, p = .13; ICC = 0.79). The 1'STST was moderately correlated with the 6MWT (r = 0.57, p < .0001), VO2max (r = 0.50, p = .0006) and maximal work rate (r = 0.52, p = .0003). Weak correlations were observed with QF (r = 0.33, p = .03) and step count (r = 0.38, p = .013). The 1'STST improved after PR (∆ = 3.6 ± 6.4 repetitions, p = .0013) and changes correlated moderately with changes in the 6MWT (r = 0.57, p = .002), QF (r = 0.48, p = .003) and VO2max (r = 0.41, p = .014). A cut-off of three repetitions demonstrated a 71% accuracy in identifying responders to a rehabilitation program. Conclusion: The 1'STST is a valuable alternative to evaluate exercise capacity in patients with COPD when more expensive and time-consuming tests are unavailable.

COVID-19-Associated Eosinopenia in a Patient With Chronic Eosinophilia Due to Chronic Strongyloidiasis.

Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown Strongyloides stercoralis infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of Strongyloides hyperinfection syndrome, especially if this treatment is empirical.

Peripheral lung effect of elexacaftor/tezacaftor/ivacaftor in adult cystic fibrosis.

Despite being an important patient group, adult cystic fibrosis patients with an FEV1 below 40%predicted have been excluded from clinical trials with elexacaftor/tezacaftor/ivacaftor. We conducted a real-life 3 months follow-up study in 14 adult CF patients (median FEV1 34%predicted) demonstrating significant treatment effects in terms of FEV1 (an increase of 12%predicted at 4 weeks, remaining stable thereafter). Corresponding decreases in lung clearance index LCI (by 31%predicted, down from baseline 247%predicted) and ventilation heterogeneity in the acinar compartment (Sacin) (by 411%predicted, down from baseline 798%predicted) suggest a distinct peripheral lung effect. One patient had intermittent treatment interruptions because of drug-induced liver injury. Our real-life data confirm that treatment with elexacaftor/tezacaftor/ivacaftor is effective in severely obstructive patients, and this is the first study to show time evolution of ventilation distribution improvement, pointing to the peripheral lung as the main site of treatment effect.

Even if it looks like COVID-19, think again: the importance of differential diagnosis during a pandemic.

INTRODUCTION: Antisynthetase syndrome (ASSD) is a rare auto-immune condition that can present as interstitial lung disease (ILD) and progress into Acute Respiratory Distress Syndrome (ARDS). IMPORTANCE: The purpose of this clinical case is to highlight the importance of considering less prevalent causes of ARDS amid the COVID-19 pandemic. CASE REPORT: We present a 56-year-old Belgian female of African descent without past medical history who demonstrated typical signs of COVID-19 at the start of the pandemic. Based on the disease course as well as CT-scan findings, a diagnosis of COVID-19 was made. She progressed to ARDS for which she got intubated and was started on venovenous membrane oxygenation (VV-ECMO). Despite initial negative screening for antinuclear antibodies, further analysis revealed anti-Jo-antibodies. Diagnosis of ASSD was eventually retained and immunosuppressive therapy was started. However, pulmonary fibrosis had evolved too far and therapy was halted shortly after.

Healthcare-Associated SARS-CoV-2 Reinfection after 3 Months with a Phylogenetically Distinct Omicron Variant: A Case Report.

This case report describes a 60-year-old female patient suffering from systemic sclerosis, for which she received immunomodulatory drugs. Her first SARS-CoV-2-positive nasopharyngeal sample was obtained in the emergency department, on 31 January 2022. Whole genome sequencing confirmed infection with Omicron BA.1.1. Her hospital stay was long and punctuated by many complications, including admission to the intensive care unit. At the beginning of April 2022, she started complaining of increased coughing, for which another SARS-CoV-2 RT-qPCR test was performed. The latter nasopharyngeal swab showed a strongly positive result. To support the theory of healthcare-associated reinfection, whole genome sequencing was performed and confirmed reinfection with Omicron BA.2. Since this patient was one of ten positive cases in this particular ward, a hospital outbreak investigation was performed. Whole genome sequencing data were available for five of these ten patients and showed a cluster of four patients with ≤2 small nucleotide polymorphisms difference.

A woman and her breathtaking jewelry.

We present the case of a 45-year-old woman, working as a silver polisher since 11 years, complaining of dyspnea on exertion and dry cough. Intensive diagnostic workup, including high-resolution CT scan of the chest and lung biopsy by VATS led to the diagnosis of pulmonary siderosis. Pulmonary siderosis is a benign, non-fibrotic type of pneumoconiosis caused by inhalation of iron oxide, which is generally asymptomatic (except in concurrent smoking or concurrent silicosis). Combination of relevant exposure and the typical findings on CT-imaging (centrilobular nodules without cranio-caudal gradient) usually strongly suggest the diagnosis, but this should always be discussed at a multidisciplinary consultation. This includes discussing whether to perform a lung biopsy for histological confirmation. Cessation of the causative exposure is the only-treatment one can take and then radiological features can improve and even disappear of time. Unfortunately, this treatment has an enormous impact on patient's life because it implies changing profession. Preventive measures can be taken by employers (respiratory equipment and ventilation). This case illustrates that physicians should stay vigilant about occupational exposures in clinical practice as well as the need for multidisciplinary consult in patients suspected of having interstitial lung disease.

Clinical status and lung function 10 weeks after severe SARS-CoV-2 infection.

INTRODUCTION: Since studies about clinical status after COVID-19 are scarce, we conducted a cross sectional study with assessment of residual symptoms, lung function and chest CT. MATERIALS AND METHODS: During an outpatient follow-up visit, chest CT, pulmonary function and COVID-19 related symptoms were assessed approximately 10 weeks after diagnosis. Demographics, baseline (time of diagnosis) CT score and blood results were collected from patient files. Association between lung function and clinical characteristics (baseline), blood markers (baseline), chest CT (baseline and follow-up) and symptom score (followup) was analysed. Mann-Whitney U tests and Chi squared tests were used for statistical comparison between subgroups with and without restriction. RESULTS AND DISCUSSION: Two hundred-twenty subjects were evaluated at a median follow-up of 74±12 (SD) days. Median symptom and median CT score at follow-up were 1(IQR=0- 2) and 2(IQR=0-6) respectively. Forty-six percent of patients had normal lung function, while TLC and TLCO below the lower limit of normal were observed in 38% and 22% of subjects respectively. This restrictive pulmonary impairment was associated with length of hospital stay (8 vs 6 days; p=0.003), admission to the intensive care unit (27% vs 13%;p=0.009), and invasive mechanical ventilation (10% vs 0.7%;p=0.001), but not with symptom score or CT score at baseline and follow-up. CONCLUSIONS: Fifty-four percent of COVID-19 survivors had abnormal lung function 10 weeks after diagnosis. Restriction was the most prevalent pulmonary function, with the more critically ill patients being more prone to this condition. Yet, restriction could not be linked with abnormal imaging results or residual symptoms.

Evolution of lung function and chest CT 6 months after COVID-19 pneumonia: Real-life data from a Belgian University Hospital.

INTRODUCTION: Most post COVID-19 follow-up studies are limited to a follow-up of 3 months. Whether a favorable evolution in lung function and/or radiological abnormalities is to be expected beyond 3 months is uncertain. MATERIALS AND METHODS: We conducted a real-life follow-up study assessing the evolution in lung function, chest CT and ventilation distribution between 10 weeks and 6 months after diagnosis of COVID-19 pneumonia. RESULTS: Seventy-nine patients were assessed at 6 months of whom 63 had chest CT at both follow-up visits and 46 had multiple breath washout testing to obtain lung clearance index (LCI). The study group was divided into a restrictive (n = 39) and a non-restrictive subgroup (n = 40) based on TLC z-score. Restriction was associated with a history of intubation, neuromuscular blockade use and critical illness polyneuropathy. Restriction significantly improved over time, but was not resolved by 6 months (median TLC z-score of -2.2 [IQR: -2.7; -1.5] at 6 months versus -2.7 [IQR: -3.1; -2.1] at 10 weeks). LCI did not evolve between both follow-up visits. Symptoms and chest CT score improved irrespective of restriction. CONCLUSION: We observed a disconnect between the improvement of COVID-19 related symptoms, chest CT lesions, and corresponding lung function. While CT imaging is almost normalized at 6 months, a further reduction of pulmonary restriction may be hoped for beyond 6 months in those patients showing restriction at their first follow-up visit.

Pulmonary function patterns and their association with genotype and phenotype in adult cystic fibrosis patients.

Background: While cystic fibrosis (CF) lung disease is generally considered to be an obstructive disorder, other pulmonary function patterns (PFP) may occur. Furthermore, little is known about possible associations between PFP and genotype or phenotypical characteristics. Methods: Cross-sectional study including CF patients aged 16 years or more, identifying different PFP and exploring associations between PFP and genotype or phenotypical characteristics. Results: Obstructive PFP was most prevalent in our population (n = 80), comprising obstructive lung disease (62.5%), small airway (obstructive) disease (11.2%), and mixed obstructive-restrictive disorder (1.3%). However, one in four adult CF patients did not show any obstruction at all: normal (13.7%) or restrictive (8.8%) lung disease and isolated diffusion disorder (2.5%). Obstructive PFP was associated with a greater proportion of CF-related diabetes mellitus (CFRD) (P = 0.04), Pseudomonas aeruginosa colonization (P = 0.02) and frequent exacerbators (P = 0.04). We observed no association between PFP and genotype. Conclusions: Obstructive PFP remains the most common pulmonary function pattern in adult CF and is associated with CFRD, Pseudomonas aeruginosa colonization and frequent exacerbators.