ABSTRACT
Introduction: The long-term impact of severe COVID-19 on the physical activity (PA) of patients is unknown. Method(s): Forty-nine patients (63% male, 47% ICU stay, mean+/-SD 61+/-10 y, BMI 29.6+/-4.5 kg/m2) were assessed 1 year after hospital discharge for severe COVID-19. PA was objectively measured with the Dynaport Movemonitor for 1 week. Pulmonary function (FEV1, diffusion capacity (DL,co)), physical functioning (6 minute walking distance (6MWD), quadriceps force (QF)) and symptoms of dyspnea were assessed. Pearson correlations were used, to explore the association between PA (mean step count) and these outcomes. Low PA levels was defined as a mean step count of <7500 steps/day. Result(s): Patients had a mean daily total walking time of mean+/-SD 80+/-41 min/day and a mean movement intensity of 1.99+/-0.35 m/s2. They performed 6817+/-3567 steps/day. One year after discharge 65% of patients retained low PA levels. PA was not different between patients who had an ICU stay and those who did not (6667+/-4650 steps/day vs. 6943+/-2408 steps/day, p=0.80;71% vs 64% with low PA levels, p=0.29). 20% of patients reported mMRC dyspnea scale scores >1;90% of them had low PA levels. PA was associated with 6MWD, but not with QF, FEV1 and DL,co (figure 1). Conclusion(s): A significant proportion of patients was inactive 1 year after severe COVID-19 with no difference between patients with or without ICU stay. PA was positively associated with exercise capacity.
ABSTRACT
Multisystem Inflammatory Syndrome in Adult (MIS-A) is a rare COVID-19 complication, presenting as fever with laboratory evidence of inflammation, severe illness requiring hospitalization and multisystem organ involvement. We report on a 25-year-old man presenting with fever, rash, abdominal pain, diarrhoea and vomiting following prior asymptomatic COVID-19 infection. He developed refractory shock and type 1 respiratory insufficiency requiring mechanical ventilation. Diagnostic testing revealed significant inflammation, anemia, thrombocytopenia, acute kidney injury, hepatosplenomegaly, colitis, lymphadenopathy and myocarditis necessitating inotropy. Ventilatory, vasopressor and inotropic support was weaned following pulse corticosteroids and intravenous immunoglobulins. Heart failure therapy was started. Short-term follow-up shows resolution of inflammation and cardiac dysfunction.
ABSTRACT
INTRODUCTION: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. RESULTS: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. CONCLUSION: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.