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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At the moment&#44; the best therapeutic hope available for leaving behind the global pandemic produced by the SARS-COV-2 virus is mass vaccination of the world&#39;s population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Now&#44; More than 150 million individuals infected and more than 3&#46;2 million individuals have died&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> and a significant percentage of survivors of pneumonic episodes will have severe pulmonary <span class="elsevierStyleItalic">sequelae</span> at clinical&#44; functional&#44; radiological and psychological levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The first data on infection by this new SARS-COV-2 coronavirus dates back approximately one year&#44; and we have now some evidence of its long-term pulmonary impact&#44; particularly radiological <span class="elsevierStyleItalic">sequelae</span>&#46; Several authors have published their results&#44; based primarily on computed tomography &#40;CT&#41; images of the chest performed weeks or months after the viral pneumonia episode and some of them are already irreversible including&#58; chronic ground-glass opacities&#44; several types of consolidations&#44; reticulation patterns&#44; interlobular septal thickening&#44; crazy paving&#44; honeycombing&#44; adjacent pleural thickening and traction&#44; pulmonary destruction patterns&#44; bronchial wall thickening and pulmonary fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Bronchiectasis&#44; defined as bronchial dilatations with or without associated bronchial wall thickening has been also described as a possible <span class="elsevierStyleItalic">sequelae</span> of pneumonia&#46; Although the appearance of bronchial dilatations has been described in patients who have suffered a COVID-19 pneumonic episode &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; even in the acute phase of the disease&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> in most of the cases have been observed months after the COVID-19 infection&#46; One very recent study that analyzed the radiological changes &#40;according to CT scan&#41; at six months of 114 survivors of severe pneumonia due to COVID-19 observed that approximately one third of the patients developed fibrotic-like changes in the post-pneumonic lung&#44; and that bronchiectasis was present in 24&#37; of the patients at follow-up&#44; compared with only 7&#37; in the acute stage of the disease&#46; These findings suggest that bronchiectasis &#40;at least from a radiological point of view&#41; can appear in up to a quarter of patients who suffered from severe COVID-19 pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Although this is a relevant finding since it probably implies a permanent alteration to the lung parenchyma&#44; different circumstances should be highlighted&#46; On the one hand&#44; the percentage of patients who already had bronchiectasis prior to COVID-19 pneumonia&#44; as well as the role of the viral infection in determining them are not known&#46; On the other hand&#44; the etiology of these dilated airways is also relatively unknown&#44; in many cases may be due to traction in the context of pulmonary fibrosis&#46; This hypothesis is supported by the results obtained by Han et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> who observed that the majority of patients who develop bronchiectasis also present with pulmonary fibrotic changes presumably secondary to the COVID-19 pneumonia&#46; In this respect&#44; the nature of the inflammatory component of this bronchiectasis&#44; its potential to lead to recurrent bronchial infection and inflammation by potentially pathogenic microorganisms and&#44; therefore&#44; its potential to worsen prognosis&#44; are unknown&#46; Likewise&#44; it is unknown whether this bronchiectasis is merely a radiological finding or whether it can be associated to respiratory symptoms requiring and progressive change over time&#46; Finally&#44; the specific prognostic factors for the development of bronchiectasis are also unknown&#44; although in this same study the authors observed that the following were prognostic factors for subsequent fibrotic <span class="elsevierStyleItalic">sequelae</span>&#58; age greater than 50 years&#59; heart rate at admission higher than 100<span class="elsevierStyleHsp" style=""></span>bpm&#59; more than 17 days of hospitalization&#59; a need for non-invasive mechanical ventilation&#59; presence of an acute respiratory distress syndrome&#44; and a greater initial involvement on CT scan&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> We can speculate that some of these risk factors could be also considered as relevant for the development of bronchiectasis in these patients but this question requires additional investigation&#46; However&#44; the potential of these findings should not be underestimated given the known association between a history of viral infections&#44; including measles&#44; respiratory syncytial virus&#44; influenza virus and human immunodeficiency virus and permanent bronchiectasis&#46; In this sense&#44; Chen et al&#46; reported that 25&#37; of survivor patients developed bronchiectasis 12 months after the epidemic influenza A &#40;H7N9&#41; virus infection&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Surprisingly&#44; there is no information about the development of bronchiectasis up to 15 years after the infection by the CoV-1&#44; although the fibrotic changes on CT scan have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Thus&#44; although the causal relationship between the COVID-19 pneumonia and the subsequent production of clinically relevant bronchiectasis has not yet proven&#44; it provided an important breeding ground for research&#44; which should undoubtedly be based on the large national and international longitudinal registries of COVID-19 and bronchiectasis now in existence throughout the world&#46; The findings and questions presented so far in the literature support the need for longitudinal monitoring&#44; including by serial CT scan&#44; of those patients who have suffered severe COVID-19 pneumonia&#46;</p></span>"
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Editorial
Bronchiectasis as a Long-Term Consequence of SARS-COVID-19 Pneumonia: Future Studies are Needed
Bronquiectasias como secuela crónica de la neumonía por SARS-COVID-19: son necesarios estudios
Miguel Angel Martinez-Garciaa,b,
Corresponding author
mianmartinezgarcia@gmail.com

Corresponding author.
, Timothy R. Aksamitc, Stefano Alibertid,e
a Respiratory Department, La Fe University and Polytechnic Hospital, Valencia, Spain
b CIBERES de Enfermedades Respiratorias, Madrid, Spain
c Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
d Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Milan, Italy
e University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">At the moment&#44; the best therapeutic hope available for leaving behind the global pandemic produced by the SARS-COV-2 virus is mass vaccination of the world&#39;s population&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> Now&#44; More than 150 million individuals infected and more than 3&#46;2 million individuals have died&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> and a significant percentage of survivors of pneumonic episodes will have severe pulmonary <span class="elsevierStyleItalic">sequelae</span> at clinical&#44; functional&#44; radiological and psychological levels&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The first data on infection by this new SARS-COV-2 coronavirus dates back approximately one year&#44; and we have now some evidence of its long-term pulmonary impact&#44; particularly radiological <span class="elsevierStyleItalic">sequelae</span>&#46; Several authors have published their results&#44; based primarily on computed tomography &#40;CT&#41; images of the chest performed weeks or months after the viral pneumonia episode and some of them are already irreversible including&#58; chronic ground-glass opacities&#44; several types of consolidations&#44; reticulation patterns&#44; interlobular septal thickening&#44; crazy paving&#44; honeycombing&#44; adjacent pleural thickening and traction&#44; pulmonary destruction patterns&#44; bronchial wall thickening and pulmonary fibrosis&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Bronchiectasis&#44; defined as bronchial dilatations with or without associated bronchial wall thickening has been also described as a possible <span class="elsevierStyleItalic">sequelae</span> of pneumonia&#46; Although the appearance of bronchial dilatations has been described in patients who have suffered a COVID-19 pneumonic episode &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; even in the acute phase of the disease&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">6&#44;7</span></a> in most of the cases have been observed months after the COVID-19 infection&#46; One very recent study that analyzed the radiological changes &#40;according to CT scan&#41; at six months of 114 survivors of severe pneumonia due to COVID-19 observed that approximately one third of the patients developed fibrotic-like changes in the post-pneumonic lung&#44; and that bronchiectasis was present in 24&#37; of the patients at follow-up&#44; compared with only 7&#37; in the acute stage of the disease&#46; These findings suggest that bronchiectasis &#40;at least from a radiological point of view&#41; can appear in up to a quarter of patients who suffered from severe COVID-19 pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Although this is a relevant finding since it probably implies a permanent alteration to the lung parenchyma&#44; different circumstances should be highlighted&#46; On the one hand&#44; the percentage of patients who already had bronchiectasis prior to COVID-19 pneumonia&#44; as well as the role of the viral infection in determining them are not known&#46; On the other hand&#44; the etiology of these dilated airways is also relatively unknown&#44; in many cases may be due to traction in the context of pulmonary fibrosis&#46; This hypothesis is supported by the results obtained by Han et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> who observed that the majority of patients who develop bronchiectasis also present with pulmonary fibrotic changes presumably secondary to the COVID-19 pneumonia&#46; In this respect&#44; the nature of the inflammatory component of this bronchiectasis&#44; its potential to lead to recurrent bronchial infection and inflammation by potentially pathogenic microorganisms and&#44; therefore&#44; its potential to worsen prognosis&#44; are unknown&#46; Likewise&#44; it is unknown whether this bronchiectasis is merely a radiological finding or whether it can be associated to respiratory symptoms requiring and progressive change over time&#46; Finally&#44; the specific prognostic factors for the development of bronchiectasis are also unknown&#44; although in this same study the authors observed that the following were prognostic factors for subsequent fibrotic <span class="elsevierStyleItalic">sequelae</span>&#58; age greater than 50 years&#59; heart rate at admission higher than 100<span class="elsevierStyleHsp" style=""></span>bpm&#59; more than 17 days of hospitalization&#59; a need for non-invasive mechanical ventilation&#59; presence of an acute respiratory distress syndrome&#44; and a greater initial involvement on CT scan&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> We can speculate that some of these risk factors could be also considered as relevant for the development of bronchiectasis in these patients but this question requires additional investigation&#46; However&#44; the potential of these findings should not be underestimated given the known association between a history of viral infections&#44; including measles&#44; respiratory syncytial virus&#44; influenza virus and human immunodeficiency virus and permanent bronchiectasis&#46; In this sense&#44; Chen et al&#46; reported that 25&#37; of survivor patients developed bronchiectasis 12 months after the epidemic influenza A &#40;H7N9&#41; virus infection&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> Surprisingly&#44; there is no information about the development of bronchiectasis up to 15 years after the infection by the CoV-1&#44; although the fibrotic changes on CT scan have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> Thus&#44; although the causal relationship between the COVID-19 pneumonia and the subsequent production of clinically relevant bronchiectasis has not yet proven&#44; it provided an important breeding ground for research&#44; which should undoubtedly be based on the large national and international longitudinal registries of COVID-19 and bronchiectasis now in existence throughout the world&#46; The findings and questions presented so far in the literature support the need for longitudinal monitoring&#44; including by serial CT scan&#44; of those patients who have suffered severe COVID-19 pneumonia&#46;</p></span>"
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ISSN: 03002896
Original language: English
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