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Highlights • The vitamin D endocrine system have a variety of actions on cells and tissues involved in COVID-19 progression. • Early calcifediol (25-hydroxyvitamin D) treatment to hospitalized COVID-19 patients significantly reduced intensive care unit admissions-Calcifediol seems to be able to reduce severity of the COVID-19. • Calcifediol seems to be able to reduce severity of the disease., Objective The vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression especially by decreasing the Acute Respiratory Distress Syndrome. Calcifediol can rapidly increase serum 25OHD concentration. We therefore evaluated the effect of calcifediol treatment, on Intensive Care Unit Admission and Mortality rate among Spanish patients hospitalized for COVID-19. Design Parallel pilot randomized open label, double-masked clinical trial. Setting University hospital setting (Reina Sofia University Hospital, Córdoba Spain.) Participants 76 consecutive patients hospitalized with COVID-19 infection, clinical picture of acute respiratory infection, confirmed by a radiographic pattern of viral pneumonia and by a positive SARS-CoV-2 PCR with CURB65 severity scale (recommending hospital admission in case of total score > 1). Procedures All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 h on the first day, and 200 mg every 12 h for the following 5 days), azithromycin (500 mg orally for 5 days. Eligible patients were allocated at a 2 calcifediol:1 no calcifediol ratio through electronic randomization on the day of admission to take oral calcifediol (0.532 mg), or not. Patients in the calcifediol treatment group continued with oral calcifediol (0.266 mg) on day 3 and 7, and then weekly until discharge or ICU admission. Outcomes of effectiveness included rate of ICU admission and deaths. Results Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %) p value X2 Fischer test p < 0.001. Univariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment versus without Calcifediol treatment: 0.02 (95 %CI 0.002−0.17). Multivariate Risk Estimate Odds Ratio for ICU in patients with Calcifediol treatment vs Without Calcifediol treatment ICU (adjusting by Hypertension and T2DM): 0.03 (95 %CI: 0.003-0.25). Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged. Conclusion Our pilot study demonstrated that administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.

Objectives: Comparison of adherence to nebulized sodium colistimethate (Promixin) and agreement between the multidimensional FACED, E-FACED and BSI scales in a cohort of patients with non-cystic fibrosis BQ and chronic bronchial infection (CBI) by PsA. Patients and Methods: A multicenter, observational, longitudinal prospective study of a cohort of adults with non-CF BQ, all with PsA CBI and treated with Promixin. FACED, EFACED and BSI scales in the previous year, their modification after a year of treatment with the nebulized therapy and the concordance between them are collected. Results: 99 patients were started average age 63±14.7 years. In the year prior to treatment FEV1 was 55±19%, exacerbations 3.8±2.6 and 0.5±0.7 hospital admissions/year. At the end FEV1 was 59±22%, exacerbations/year 1.4±1.2 and hospital admissions/year 0.26±0.6. In the pretreatment assessment there is a low concordance between the EFACED and BSI scales (R=0,248; p Conclusions: In our cohort there is good adherence to nebulized treatment with Promixin® and good nebulizer management, regardless of the severity of BQ. These results have their clinical impact in terms of functional improvement, reduction of exacerbations and changes in the level of severity prior to treatment. Given the concordance between the prognostic scales, both could be applicable to assess sensitivity to change in a therapeutic intervention with nebulized antibiotics.

Objective: To assess the clinical and economic impact, in terms of reduction of costs associated with exacerbations, in a cohort of patients with non-cystic fibrosis (non-CF) BQ and PsA CBI treated with Promixin. Patients and Methods: A multicenter, observational, longitudinal prospective study of a cohort of adults with non-CF BQ and PsA CBI treated with Promixin. Data were collected in the year before and after nebulized treatment (pulmonary function, exacerbations without hospital admission, mean per pat/y and total number of admissions and per pat/y). Results: 86 pat, 45 males, 62±15 y. Results are shown in the following data table. Conclusions: Adherence to nebulized treatment is excellent in our patients. In clinical terms, this situation has allowed an improvement in lung function and a significant reduction in the number and severity of exacerbations and hospital admissions. Regarding this issue, the average cost per patient and year of treatment has been reduced by more than €1500 after onset of nebulized therapy.

Resumen Esta revision pretende exponer de forma sucinta aquellas circunstancias clinicas previas al trasplante pulmonar que pueden repercutir negativamente en el pronostico del trasplante a corto y largo plazo. Se plantean los metodos de rastreo y diagnostico de comorbilidades comunes de impacto pronostico negativo sobre el trasplante, tanto de patologias pulmonares como extrapulmonares, y se proponen medidas dirigidas a su correccion. La coordinacion y el intercambio de informacion entre los centros que remiten a los candidatos y los centros trasplantadores permitiran detectar y corregir estas comorbilidades con el fin de minimizar los riesgos y de mejorar las expectativas de supervivencia de los pacientes trasplantados.

The aim of this review is to give an overview of the clinical circumstances presenting before lung transplant that may have negative repercussions on the long and short-term prognosis of the transplant. Methods for screening and diagnosis of common comorbidities with negative impact on the prognosis of the transplant are proposed, both for pulmonary and extrapulmonary diseases, and measures aimed at correcting these factors are discussed. Coordination and information exchange between referral centers and transplant centers would allow these comorbidities to be detected and corrected, with the aim of minimizing the risks and improving the life expectancy of transplant receivers.

Resumen La linfangioleiomiomatosis (LAM) es una enfermedad rara caracterizada por la proliferacion anormal de celulas musculares lisas inmaduras y una destruccion quistica del pulmon, que condiciona el pronostico de la enfermedad. Los angiomiolipomas renales suelen ser muy frecuentes en esta enfermedad, generalmente de curso asintomatico, salvo complicaciones. Ante la ausencia de un tratamiento curativo, las ultimas publicaciones reflejan resultados esperanzadores en la terapia molecular para evitar el deterioro funcional y el control del tamano de los angiomiolipomas. Entre estas terapias destacan los inhibidores del complejo mTOR, sobre todo sirolimus. Presentamos un caso clinico de una paciente diagnosticada de LAM sometida a trasplante pulmonar con reduccion del tamano del angiomiolipoma renal tras el tratamiento con el inhibidor mTOR everolimus.

a b s t r a c t Lymphangioleiomyomatosis (LAM) is a rare disease characterized by abnormal proliferation of immature smooth muscle cells and cystic lung destruction, which determines the prognosis of the disease. The kidney angiomyolipomas are usually very common in this disease and are usually asymptomatic unless complications arise. In the absence of a curative treatment, recent publications show promising results in molecular therapy to prevent functional decline and to control the size of the angiomyolipomas. These therapies include mTOR complex inhibitors, especially sirolimus. We report a case of a patient diagnosed with LAM who underwent lung transplantation with reduction of renal angiomyolipoma size after treatment with the mTOR inhibitor everolimus.