Two-year diffusion capacity trajectory in COVID-19 pneumonia survivors.

Reduced diffusion capacity (DLCO) after COVID 19 pneumonia was reported in hospitalised patients after discharge. Here, we studied the restoration of DLCO over a 24 months period in COVID-19 pneumonia survivors (n = 317), who were categorised into "moderate" cases (no oxygen supply; no need for hospitalisation), "severe" cases (respiratory frequency > 30/min and/or peripheral oxygen SpO2 < 93%), and "critical" cases (respiratory failure and admission into the intensive care unit). COVID-19 pneumonia survivors with a decreased DLCO (<80%) at 3 months (n = 133) were invited for 6- and 24-months follow-up. At 3 months, impairment of DLCO was more severe in critical case (p < .01). Over time, the subgroups showed a similar level of improvement; and, there was no difference in recovery over time between the subgroups. At 24 months, the DLCO did not differ between the subgroups, with a mean DLCO of 73% for all patients. At 24 months, 65% of patients still had a DLCO < 80%, and in 40% of patients DLCO was <70% of predicted. Regardless the initial disease severity, all COVID-19 survivors showed improvement in DLCO during follow-up; however, DLCO had not normalised in the majority of patients with a DLCO <80% 3 months after hospital discharge.

Pulmonary function and Quality of Life in a prospective cohort of (non-) hospitalized COVID-19 pneumonia survivors up to six months.

OBJECTIVES: A decrease of both diffusion capacity (DLCO) and Quality of Life (QoL) was reported after discharge in hospitalized COVID-19 pneumonia survivors. We studied three and 6 month outcomes in hospitalized and non-hospitalized patients. METHODS: COVID-19 pneumonia survivors (n = 317) were categorized into non-hospitalized "moderate" cases (n = 59), hospitalized "severe" cases (n = 180) and ICU-admitted "critical" cases (n = 39). We studied DLCO and QoL (Short Form SF-36 health survey) 3 and 6 months after discharge. Data were analyzed using (repeated measures) ANOVA, Kruskal-Wallis or Chi-square test (p < .05). RESULTS: At 3 months DLCO was decreased in 44% of moderate-, 56% of severe- and 82% of critical cases (p < .003). Mean DLCO in critical cases (64±14%) was lower compared to severe (76 ± 17%) and moderate (81±15%) cases (p < .001). A total of 159/278 patients had a decreased DLCO (<80%), of whom the DLCO improved after 6 months in 45% (71/159). However the DLCO did not normalize in the majority (89%) of the cases (63 ± 10% vs 68±10%; p < .001). At 3 months, compared to critical cases, moderate cases scored lower on SF-36 domain "general health" (p < .05); both moderate and severe cases scored lower on the domain of "health change" (p < .05). At 6 months, there were no differences in SF-36 between the subgroups. Compared to 3 months, in all groups "physical functioning" improved; in contrast all groups scored significantly lower on "non-physical" SF-36 domains. CONCLUSION: Three months after COVID-19 pneumonia, DLCO was still decreased in the more severely affected patients, with an incomplete recovery after 6 months. At 3 months QoL was impaired. At 6 months, while "physical functioning" improved, a decrease in "non-physical" QoL was observed but did not differ between the moderate and severely affected patients.

Frequency and spectrum of incidental findings when using chest CT as a primary triage tool for COVID-19.

PURPOSE: To determine the prevalence and spectrum of incidental findings (IFs) identified in patients undergoing chest CT as a primary triage tool for COVID-19. METHODS: In this study 232 patients were triaged in our COVID-19 Screening Unit by means of a chest CT (March 25-April 23, 2020). Original radiology reports were evaluated retrospectively for the description of IFs, which were defined as any finding in the report not related to the purpose of the scan. Documented IFs were categorized according to clinical relevance into minor and potentially significant IFs and according to anatomical location into pulmonary, mediastinal, cardiovascular, breast, upper abdominal and skeletal categories. IFs were reported as frequencies and percentages; descriptive statistics were used. RESULTS: In total 197 IFs were detected in 126 patients (54 % of the participants). Patients with IFs were on average older (54.0 years old, SD 16.6) than patients without IFs (44.8 years old, SD 14.6, P < 0.05). In total 60 potentially significant IFs were detected in 53 patients (23 % of the participants). Most often reported were coronary artery calcifications (n = 23, 38 % of total potentially significant IFs/ 10 % of the total study population), suspicious breast nodules (n = 7, 12 % of total potentially significant IFs/ 3% of the total study population) and pulmonary nodules (n = 7, 12 % of total potentially significant IFs/ 3% of the total study population). CONCLUSION: A considerable number of IFs were detected by using chest CT as a primary triage tool for COVID-19, of which a substantial percentage (23 %) is potentially clinically relevant.

Chest computed tomography and alveolar-arterial oxygen gradient as rapid tools to diagnose and triage mildly symptomatic COVID-19 pneumonia patients.

BACKGROUND: In the coronavirus disease 2019 (COVID-19) pandemic, rapid clinical triage is crucial to determine which patients need hospitalisation. We hypothesised that chest computed tomography (CT) and alveolar-arterial oxygen tension ratio (A-a) gradient may be useful to triage these patients, since they reflect the severity of the pneumonia-associated ventilation/perfusion abnormalities. METHODS: A retrospective analysis was performed in 235 consecutive patients suspected for COVID-19. The diagnostic protocol included low-dose chest CT and arterial blood gas analysis. In patients with CT-based COVID-19 pneumonia, the association between "need for hospitalisation" and A-a gradient was investigated by a multivariable logistic regression model. The A-a gradient was tested as a predictor for need for hospitalisation using receiver operating characteristic curve analysis and a logistic regression model. RESULTS: 72 out of 235 patients (mean±sd age 55.5±14.6 years, 40% female) screened by chest CT showed evidence for COVID-19 pneumonia. In these patients, A-a gradient was shown to be a predictor of need for hospitalisation, with an optimal decision level (cut-off) of 36.4 mmHg (95% CI 0.70-0.91, p<0.001). The A-a gradient was shown to be independently associated with need for hospitalisation (OR 1.97 (95% CI 1.23-3.15), p=0.005; A-a gradient per 10 points) from CT severity score (OR 1.13 (95% CI 0.94-1.36), p=0.191), National Early Warning Score (OR 1.19 (95% CI 0.91-1.57), p=0.321) or peripheral oxygen saturation (OR 0.88 (95% CI 0.68-1.14), p=0.345). CONCLUSION: Low-dose chest CT and the A-a gradient may serve as rapid and accurate tools to diagnose COVID-19 pneumonia and to select mildly symptomatic patients in need for hospitalisation.

Methylphenidate significantly improves driving performance of adults with attention-deficit hyperactivity disorder: a randomized crossover trial.

Although patients with attention-deficit hyperactivity disorder (ADHD) have reported improved driving performance on methylphenidate, limited evidence exists to support an effect of treatment on driving performance and some regions prohibit driving on methylphenidate. A randomized, crossover trial examining the effects of methylphenidate versus placebo on highway driving in 18 adults with ADHD was carried out. After three days of no treatment, patients received either their usual methylphenidate dose (mean: 14.7 mg; range: 10-30 mg) or placebo and then the opposite treatment after a six to seven days washout period. Patients performed a 100 km driving test during normal traffic, 1.5 h after treatment administration. Standard deviation of lateral position (SDLP), the weaving of the car, was the primary outcome measure. Secondary outcome measurements included the standard deviation of speed and patient reports of driving performance. Driving performance was significantly better in the methylphenidate than in the placebo condition, as reflected by the SDLP difference (2.3 cm, 95% CI = 0.8-3.8, P = 0.004). Variation in speed was similar on treatment and on placebo (-0.05 km/h, 95% CI = -0.4 to 0.2, P = 0.70). Among adults with ADHD, with a history of a positive clinical response to methylphenidate, methylphenidate significantly improves driving performance.

The potency of clobetasol propionate: serum levels of clobetasol propionate and adrenal function during therapy with 0.05% clobetasol propionate in patients with severe atopic dermatitis.

BACKGROUND: Percutaneous absorption of topically applied 0.05% clobetasol propionate (CLO) can be assessed indirectly by measuring cortisol levels. A direct way is to measure systemic levels of topically applied CLO. METHODS: Serum concentrations of CLO were measured by liquid chromatography-tandem mass spectrometry (LC/MS/MS), and were related to serum cortisol levels in 25 patients with an exacerbation of atopic dermatitis (AD) before and after the first day of treatment with 0.05% CLO in hospital. The body surface area (BSA) affected by AD was measured. RESULTS: Before the start of 0.05% CLO treatment, normal cortisol levels were measured (0.47 ± 0.18 µmol/l) and CLO concentrations could not be detected. After the first day of treatment, cortisol levels decreased to 0.04 ± 0.05 µmol/l. Serum concentrations of CLO could be detected in all patients (0.112-4.504 ng/ml). Levels did not differ between patients who had received two applications versus one application of 0.05% CLO. There was no correlation between the affected BSA and serum concentrations of CLO. CONCLUSION: Serum levels of CLO can be measured by LC/MS/MS. When prescribing 0.05% CLO, one must bear in mind that, even after an application of 20-30 g, CLO is systemically available and potent enough to induce adrenal gland suppression.

Liquid chromatography-tandem mass spectrometric assay for clobetasol propionate in human serum from patients with atopic dermatitis.

A bioanalytical assay for the topical corticosteroid clobetasol propionate was developed and validated. For the quantitative assay 0.5 ml human serum samples, supplemented with clobetasone butyrate as internal standard, were extracted with hexane-ether. Evaporated and reconstituted extracts were injected on a polar embedded octadecyl silica column with isocratic elution using formic acid in water-methanol as mobile phase. The eluate was led into the electrospray interface with positive ionization and the analyte was detected and quantified using the selective reaction monitoring mode of a triple quadrupole mass spectrometer. The assay was validated in the range 0.04-10 ng/ml, the lowest level of this range being the lower limit of quantification. Precisions were 5-10% and accuracies were between 102 and 109%. The drug was stable under all relevant conditions. Finally, the assay was successfully applied on patients suffering from severe atopic dermatitis treated topically with clobetasol propionate.