Pulmonary function and health-related quality of life after COVID-19 pneumonia.

BACKGROUND: The COVID-19 pandemic has led to many cases of pneumonia with extensive lung abnormalities on CT-scans. The consequences of COVID-19 pneumonia on survivors' pulmonary function and quality of life are unknown. The purpose of this study is to examine the impact of COVID-19 pneumonia on pulmonary function, health-related quality of life (HRQoL) and perceived dyspnoea. METHODS: A prospective longitudinal cohort study regarding patients discharged from our hospital after PCR-proven, non-critical COVID-19 pneumonia was conducted. Cases were classified as moderate or severe pneumonia according to WHO definitions. Six weeks post-discharge subjects underwent interviews and pulmonary function tests, and completed questionnaires to assess their HRQoL, perceived dyspnoea (Borgscale and mMRC), and symptoms of depression and anxiety (HADS). RESULTS: 101 patients were included. Twenty-eight (27.7%) pneumonias were classified as moderate cases of COVID-19 pneumonia and 73 (72.3%) were classified as severe cases. Diffusion limitation (DLCOc < 80% of predicted value) was found in 66 (71.7%) of 92 cases, obstruction in 26 (25.7%) of 101, and restriction in 21 (21.2%) of 99. Diffusion capacity was significantly lower in cases after severe pneumonia. In the entire group, HADS scores ≥8 for depression were found in 16.6% and in 12.5% for anxiety. Across all SF-36 domains, except for bodily pain, significant impairment was found. FEV1 and DLCOc showed significant positive correlations with mMRC scores and multiple SF-36 domains, especially physical functioning. CONCLUSION: COVID-19 non-critical pneumonia survivors have significant impairment in diffusion capacity and HRQOL six weeks after being discharged from hospital.

[The first 29 COVID-19-patients in a clinic: early experiences from a Dutch hospital]. / De eerste 29 COVID-19-patiënten in de kliniek.

The SARS-CoV-2 virus and COVID-19 disease is of pandemic proportions and reached the Netherlands on February 27 2020. Here we present the first Dutch cohort of 29 hospitalized patients during the first two weeks of the epidemic in the Netherlands. Demographic characteristics of patients, clinical presentation and course of disease up to the moment of analysis showed similarity with what has been described in Chinese and Italian literature. However the higher proportion of patients presenting with gastro-intestinal symptoms and the high number of patients with overweight and obesity stood out. Based on the experience in our hospital very early on in the epidemic COVID-19 impresses as a severe illness with risk of acute respiratory deterioration.

Induction chemotherapy followed by surgery for advanced oesophageal cancer.

BACKGROUND: Patients with locoregionally advanced oesophageal tumours or disputable distant metastases are referred for induction chemotherapy with the aim to downstage the tumour before an oesophagectomy is considered. STUDY DESIGN: Patients who underwent induction chemotherapy between January 2005 and December 2012 were identified from an institutional database. Treatment plan was discussed in the multidisciplinary team. Response to chemotherapy was assessed by CT. Survival was calculated using the Kaplan Meier method. Uni- and multivariable analyses were performed to identify prognostic factors for survival. RESULTS: In total 124 patients received induction chemotherapy mainly for locoregionally advanced disease (n = 80). Surgery was withheld in 35 patients because of progressive disease (n = 16) and persistent unresectability (n = 19). The median overall survival of this group was 13 months (IQR: 8-19). The remaining 89 patients underwent surgery of which 13 still had unresectable tumour or distant metastases. Of the 76 patients that underwent an oesophagectomy, 50 patients had tumour free resection margins (66%) with an estimated 5-year survival of 37%. A positive resection margin (HR 4.148, 95% CI 2.298-7.488, p < 0.0001) was associated with a worse survival in univariable analysis, but only pathological lymph node status with increasing hazard ratio's (6.283-10.283, p = 0.001) remained significant after multivariable analysis. CONCLUSION: Induction chemotherapy downstages the tumour and facilitates a radical oesophagectomy in patients with advanced oesophageal cancer. Pathological lymph node status is an independent prognostic factor for overall survival.