Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors

Objectives. To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting ?de novo? post-COVID pain. Methods. Seventy-seven (n?=?77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. Results. Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score?12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, ?<?0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. Conclusion. This study found that almost 25% of previously hospitalized COVID-19 survivors with ?de novo? post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.Acknowledgments: This work was supported by Fundación Instituto de Investigación Marqués de Valdecilla (IDIVAL) (NVAL21/26)

Lack of concordance between the different exercise test measures used in the risk stratification of patients with pulmonary arterial hypertension

In pulmonary arterial hypertension (PAH) patients it is essential to perform a prognostic assessment to optimize the treatment. The aim of this study is to evaluate the risk stratification concordance assessed with different exercise test variables in a cohort of PAH patients. A retrospective analysis was performed using patient data registered in the PAH unit. Only those patients in whom the mean time elapsed between the 6-min walking test (6MWT) and the cardiopulmonary exercise test (CPET) was a maximum of 6 months were selected. A total of 140 records from 40 patients were finally analyzed. When it came to assessing the concordance between the two exercise tests in the guidelines (CPET and 6MWT), up to 84.3% of the records did not coincide in terms of the risk stratification. Exclusively considering the CPET parameters, most of the records (75%) failed to include all three variables in the same risk category. When analyzing the VO2 alone, up to 40.7% of the tests yielded different risk classifications depending on whether the parameter was expressed. In conclusion, there is a low concordance between the two proposed exercise tests. These results should be a call for reflection on whether the cut-off points set for the exercise tests proposed for the current risk stratification are adequate to achieve a correct risk stratification or whether they require an appropriate revision

Early onset of azithromycin to prevent clad in lung transplantation: promising results of a retrospective single centre experience

Introduction: Azithromycin (AZI) may be an effective immune modulator in lung transplant (LT) recipients, and can decrease chronic lung allograft dysfunction (CLAD) rates, the leading cause of mortality after the first year post-LT. The aim of the study is to assess the effect of AZI initiation and its timing on the incidence and severity of CLAD in LT recipients. Methods: Single-center retrospective study, including LT recipients from 01/01/2011 to 30/06/2020. Four groups were established: those who started AZI at the 3rd week post-LT (group A), those who received AZI later than the 3rd week post-LT and had preserved FEV1 (B), those who did not receive AZI (C) and those who started AZI due to a decline in FEV1 (D). The dosage of AZI prescribed was 250 mg three times per week. CLAD was defined and graduated according to the 2019 ISHLT criteria. Results: We included 358 LT recipients: 139 (38.83%) were in group A, 94 (26.25%) in group B, 91 (25.42%) in group C, and 34 (9.50%) in group D. Group A experienced the lowest CLAD incidence and severity at 1 (p = 0.01), 3 (p < 0.001), and 5 years post-LT, followed by Group B. Groups C and D experienced a higher incidence and severity of CLAD (p = 0.015). Initiation of AZI prior to FEV1 decline (groups A and B) proved to be protective against CLAD after adjusting for differences between the treatment groups. Conclusions: Early initiation of AZI in LT recipients could have a role in decreasing the incidence and severity of CLAD. In addition, as long as FEV1 is preserved, initiating AZI at any time could also be useful to prevent the incidence of CLAD and reduce its severity. This article is protected by copyright. All rights reserved.Funding Sources: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Gastroesophageal Reflux in Lung Transplantation

Gastroesophageal reflux disease (GERD) in lung transplant recipients has been associated with chronic lung allograft dysfunction (CLAD). CLAD is a leading cause of mortality in lung transplant recipients, and it is probably the result of a variety of immune, infectious, and inflammatory injuries. GERD may contribute to CLAD since it is associated with a higher risk for post-transplant aspiration. Aspiration induces an inflammatory cascade in the lung allograft, thereby causing acute rejection. Recurrent episodes of acute rejection and allograft injury may then contribute to chronic rejection, resulting in graft failure. Poorer outcomes after transplantation, including early allograft injury, early rehospitalization, and chronic rejection are potentially modifiable risk factors for post-transplant mortality. In patients with GERD, antireflux surgery may help preserve post-transplant lung function, improve immune response, and reduce the incidence of bronchiolitis obliterans syndrome and mortality. Early fundoplication improves survival and reduces the incidence of CLAD in lung transplant recipients

Exacerbation of chronic renal failure because of inhaled tobramycin in a lung transplant patient

61-year-old man, with a history of years of unknown etiology bronchiectasis, with chronic bronchial infection by Burkholderia multivorans, who received treatment with a double lung transplant on 08/20/2020. Persistent positive cultures of Burkholderia multivorans after transplant in respiratory samples was observed, and treatment with inhaled tobramycin 300 mg/12 hours was started. One month after treatment, a significant worsening of renal function was observed, which was already altered, and toxic levels of tobramycin were measured in blood samples 12 hours after the last inhaled administration. After stopping treatment, kidney function returned to its baseline values