Journal of Clinical Medicine

Background/Objectives: A subset of individuals develops persistent symptoms following SARS-CoV-2 infection, including musculoskeletal (MSK) manifestations, a condition known as long COVID (LC). Emerging hypotheses suggest that chronic low-grade inflammation in LC may impair bone metabolism and compromise joint health. However, empirical evidence is limited, and the impact of LC on MSK health, particularly bone and joint integrity, is poorly understood. To determine the influence of LC on MSK function, including bone health, body composition, and joint integrity. Methods: A 12-month longitudinal prospective cohort feasibility study was conducted involving 45 adults with LC and 40 well-recovered (WR) post-COVID-19 controls. Baseline and follow-up assessments included dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) and total body composition (TBC), alongside ultrasound of the hand and knee joints to evaluate intra-articular changes. Results: The LC group had more fat in the gynoid, android, and leg regions at each assessment point compared to the controls (p < 0.01). LC showed a significantly lower knee synovial hypertrophy at the baseline, 13.3% compared to WR 45% (p = 0.001), and a marginal improvement in hand synovial hypertrophy, over 12 months, from a median of 2 (IQR 1;5) to 1 (IQR 0;3) (p = 0.012), as observed via MSK ultrasound. No notable differences were found between groups regarding BMD, either in the LC group compared to the control group or overtime. Conclusions: This cohort study of LC adults and controls found no evidence of rapid bone loss; however, adiposity and joint symptoms suggest the need for ongoing monitoring. Future research should focus on MSK markers, muscle function, advanced imaging, and improving MSK health.

Background: Non-cystic fibrosis bronchiectasis (BE) is a chronic lung condition characterized by irreversible bronchial dilation and presented with persistent respiratory symptoms, recurrent respiratory infections, and decreased quality of life. Inhaled corticosteroids (ICSs) are frequently prescribed in patients with bronchiectasis, despite limited evidence supporting their clinical efficacy. Inhaled corticosteroids have been associated with increased risk of respiratory infection with Haemophilus influenzae (H. influenzae) in other groups of lung diseases. We aimed to evaluate the association between ICS use and the risk of isolating H. influenzae from lower respiratory tract samples in patients with bronchiectasis. Methods: A retrospective cohort study was conducted using data from 2010 to 2018, encompassing all patients diagnosed with bronchiectasis in outpatient clinics in Eastern Denmark. ICS use was standardized in budesonide equivalent doses and categorized in tertiles: low (<210 μg/day), moderate (211–625 μg/day), and high (≥626 μg/day) based on cumulative budesonide equivalent doses redeemed in the 12 months before cohort entry. The primary outcome was the first isolation of H. influenzae from lower respiratory tract samples post-cohort entry. Cox proportional hazards models, adjusted for relevant confounders, estimated hazard ratios (HRs), and inverse probability-of-treatment weighting (IPTW) was used in sensitivity analyses. Results: Among 3663 patients (mean age 66 years; 61% female), 2175 (59.4%) did not use ICS, while 484 (13.2%), 508 (13.9%), and 496 (13.5%) were in the low-, moderate-, and high-dose ICS groups, respectively. Furthermore, 594 (16.22%) patients had a lower respiratory tract culture positive for H. influenzae during follow-up. High-dose ICS use was associated with an increased risk of H. influenzae; HR 1.63 (95% Cl, 1.19 to 2.12, p < 0.005) compared with no ICS use. No association for low or moderate ICS use was found: low-dose ICS HR 0.75 (95% Cl, 0.52 to 1.07, p = 0.11) and moderate-dose ICS HR 1.27 (95% Cl, 0.93 to 1.72, p = 0.12). IPTW analysis confirmed the main finding. Conclusions: High-dose ICS use in patients with bronchiectasis was associated with an increased risk of acquiring H. influenzae in the lower respiratory tract. Hence, patients with bronchiectasis should be cautiously prescribed high-dose ICS.

Background: Heart failure (HF) is highly prevalent among patients on maintenance hemodialysis (HD) and contributes substantially to morbidity and mortality. This study aimed to evaluate the prevalence, clinical characteristics, and prognostic impact of HF in a chronic HD population. Methods: A single-center observational study was conducted on 271 HD patients (January 2022–September 2024). HF was defined and classified according to 2021 ESC criteria using echocardiography and NT-proBNP. Clinical, laboratory, and dialysis parameters were compared between HF and non-HF patients. Predictors of HF were assessed using multivariable logistic regression, and survival analyses were performed using Cox regression and Kaplan–Meier curves. Results: HF was identified in 75% of patients: 45% had a preserved EF, 31% had a mildly reduced EF, and 24% had a reduced EF. HF patients were older, had higher NT-proBNP, lower EF, more atrial fibrillation, CAD, and increased interdialytic weight gain. In the multivariable analysis, a reduced EF (OR = 0.77, p = 0.001), older age (OR = 1.12, p = 0.001), and UF rate (OR = 1.31, p = 0.02) were found to independently predict HF. During the 34-month follow-up, HF was found to be associated with significantly higher all-cause and cardiac mortality and more frequent HF-related hospitalizations (log-rank p < 0.001). In the multivariable Cox regression, two variables were found to independently predict all-cause death, NT-proBNP (per 1000 pg/mL) (HR 1.030, p = 0.029) and a lower EF: (HR 0.97, p = 0.019). For cardiac death, a higher NT-proBNP (HR 1.038, p = 0.033) and a lower EF (HR 0.933, p = 0.001) together with a lower BMI (HR = 0.929, p = 0.028) persisted as independent predictors. Conclusions: HF is extremely common in HD patients and identifies a subgroup with distinct clinical characteristics and poor prognosis. NT-proBNP and left ventricular ejection fraction are key independent predictors of mortality, underscoring the importance of early cardiac evaluation and integrated volume and dialysis management to improve outcomes.