Medical treatment of coronavirus 19 disease (COVID-19) is a therapeutic challenge. The available data strongly suggest that calcifediol treatment may reduce the severity of COVID-19, and corticosteroids are the treatment of choice worldwide for severe COVID-19. Both have a very similar action profile, and their combined use in patients may modify the contribution of each administered compound. Objective: To evaluate how treatment with calcifediol and/or corticosteroids in medical practice modified the need for ICU admission, death, or poor prognosis of patients hospitalized with COVID-19 during the first outbreaks. Design, patients and setting: A retrospective observational cohort study of patients admitted for COVID-19 to the Pneumology Unit of the Hospital Universitario Reina Sofía (Córdoba, Spain). Interventions: Patients were treated with calcifediol or/and corticosteroids with the best available therapy and standard care, according to clinical practice guidelines. Measurements: Admission to the intensive care unit (ICU) or death during hospitalization and poor prognosis. Results: Seven hundred and twenty-eight patients were included. According to the treatment received, they were included in four groups: calcifediol (n = 68), glucocorticoids (n = 112), both (n = 510), or neither (n = 38). Of the 578 patients treated with calcifediol, 88 were admitted to the ICU (15%), while of the 150 not treated with calcifediol, 39 required ICU admission (26%) (p < 0.01). Among the patients taking calcifediol without glucocorticoids, only 4 of 68 (5.8%) required ICU admission, compared to 84 of 510 (16.5%) treated with both (p = 0.022). Of the 595 patients who had a good prognosis, 568 (82.01%) had received treatment with calcifediol versus the 133 patients with a poor prognosis, of whom 90 (67.66%) had received calcifediol (p < 0.001). This difference was not found for corticosteroids. Interpretation: The treatment of choice for hospitalized patients with moderate or mild COVID-19 could be calcifediol, not administering corticosteroids, until the natural history of the disease reaches a stage of hyperinflammation.

ALS patients present risk factors associated with an increased incidence of VTE such as age or reduced mobility. Aims: To analyze the incidence of deep vein thrombosis(DVT) and pulmonary thromboembolism(PE) in a cohort of ALS patients. To evaluate risk factors involved in VTE in ALS patients. To determine which subgroup of ALS patients could benefit from thromboembolic prophylaxis or VTE screening by monitoring D-dimer levels. Methods: Observational and retrospective study in which 218 ALS patients of an ALS Multidisciplinary Unit were included from 2011 to 2021.Anthropometric variables, comorbidities,use of non-invasive mechanical ventilation(NIV),existence of tracheostomy, existence of thrombotic events or need for anticoagulant treatment were collected. Results: In our cohort, 8 patients(3,9%)were diagnosed with VTE, of which 6 were DVT(2,8%)and 2 were PE (1,1%).Average age was 67 years, mean BMI 25.6 kg/m2,with 100% being sporadic ALS.Male/female ratio was 1:1.Continuous NIV was required in 50%(4).88% of the patients had been recently admitted for intercurrent infection. None of them had a tracheostomy. The use of continuous NIV was associated with VTE(p<0.001)as well as the presence of high blood pressure(HBP)(p<0.001)and obesity(p<0.001).No association was found with other described risk factors for VTE.Mortality in this group was 75%(6)due to disease progression(4)and sudden death in 2 of them. Conclusions: The incidence of VTE in our cohort was 3,9%,higher than in the general population. There was a significant association between VTE and the use of continuous NIV as well as the presence of HBP and obesity. This subgroup of patients could benefit from closer monitoring of thrombotic risk and the indication of prophylaxis.

The development of CMV-specific immunity monitoring techniques enables the exploration of personalized, immuno-guided prevention strategies. The aim of the study was to investigate the efficacy and safety of immuno-guided prevention in CMV-seropositive lung transplant recipients. The CYTOCOR clinical trial, phase III randomised, multicentre, non-inferiority, was designed to assess the efficacy and safety of directing valganciclovir prophylaxis using the QF-CMV. During the initial 3 months, patients in both groups received prophylaxis. From month 4 to 12, patients randomized to the experimental arm were monitored monthly with QF-CMV. If the result was reactive(interferon-gamma production≥0.2 IU/ml),prophylaxis was discontinued;if non-reactive or indeterminate, prophylaxis was restarted. Control group patients were given prophylaxis for 6 months, followed by preventive therapy with ganciclovir adjusted based on CMV-PCR results through month 12. The primary efficacy endpoint was the presence of CMV disease, and the secondary endpoint was clinically significant asymptomatic CMV replication. Safety was assessed by the presence of neutropenia(<1500 cells/μl). Group differences were calculated using the Mantel-Haenszel method. Cumulative incidence curves for CMV disease were compared using the Log-rank test.CMV disease and neutropenia were jointly analyzed using a DOOR analysis.A total of 150 patients were randomized,75 in each arm.52.5% with a 95%CI(44.47-60.45%)of patients had a better DOOR in the experimental group. The combination of reduced duration prophylaxis followed by immuno-guided prophylaxis using QF-CMV is as effective and safe as standard prevention in CMV seropositive lung transplant recipients

Background: To examine the effects of continuous positive airway pressure (CPAP) therapy on central corneal thickness (CCT) in patients with obstructive sleep apnea (OSA) followed for 12 months. Methods: Participants were patients with OSA and an indication for CPAP who were enrolled after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Each subject underwent a full ophthalmologic examination including ultrasound pachymetry (USP) with an SP3000 USP (Tomey Inc) at the time points just before CPAP onset, and after 3 and 12 months of CPAP treatment. Results: The study sample comprised 40 eyes of 20 patients. Adherence to CPAP was adequate (5.23 ± 1.77 h/night). After receiving 12 months of CPAP, positive correlation was observed between hours of CPAP use and CCT (r = 0.382, p = 0.015). Intermittent hypoxemia pre-CPAP or hypoxia severity pre-CPAP were also positively correlated with the CCT recorded after 12 months of CPAP (r = 0.394, p = 0.012; r = 0.324, p = 0.041). Significant correlations were, however, not observed after only 3 months of CPAP treatment. In addition, compared to measurements at 3 months, intraocular pressure was higher after 12 months of treatment. Conclusions: Our findings indicate that 12 months of correct adherence to CPAP are needed to detect significant CCT thickening, and that the greater the pre-CPAP hypoxemia, the greater the capacity for an increase in CCT to be produced in response to 12 months of this therapy.