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BackgroundThe symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described.MethodsRetrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness.Results75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge.ConclusionsPatients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.

Background Patients discharged from hospital following treatment for COVID-19 infection, experience ongoing breathlessness during recovery 1 One minute sit-to-stand test (1MSTS) has been recommended to identify desaturation in these patients during acute and post-acute phase 2 We aimed to assess the feasibility of 1MSTS to monitor recovery in COVID-19 patients following hospital discharge Methods All patients admitted to our hospital, with COVID-19 were offered clinic review approximately 6-8 weeks post discharge This clinical assessment included 1MSTS, bloods and imaging If ongoing clinical concern, a second review was offered at 3 months We reviewed the 1MSTS in terms of (a) ability to complete test (b) oxygen desaturation >3%2 (c) longitudinal improvement in 1MSTS repetitions Fisher's exact and Mann-Whitney tests were used to compare variables Results 366/413(88%) COVID-19 patients reviewed at initial follow-up clinic completed a 1MSTS and 141 repeated 1MSTS at 3 months Those who were unable to complete a 1MSTS at initial clinic were older, frailer and had longer hospital admissions with COVID-19 (table 1) 77/366 (21%) patients had desaturation of >3% on 1MSTS at initial follow-up, which was associated with severe disease during admission (p=0 051) and persisting radiographic abnormalities (p=0 0018) No association between desaturation and symptom burden was noted Clinicians found 1MSTS with no desaturation to be helpful in the discharge process if other investigations were normal Desaturation during initial clinic was not predictive of abnormal cardiac and respiratory investigations at 3 month followup (p=0 317) An improvement in number of repetitions/minute between clinic visits did not correlate with an improvement in VAS breathlessness (p=0 099), MRC score (p=0 267) or imaging (p=0 448) Conclusion The majority of patients recovering from COVID-19 can perform 1MSTS at follow-up clinic Those unable were generally more frail, older and with co-morbidities 1MSTS helped with discharge decisions at 6-8 weeks However, the wider utility of the 1MSTS results is limited in COVID-19 follow-up Serial measurements were not helpful in predicting symptomatic or radiological improvement

Tuberculosis (TB) is an important cause of childhood death and morbidity worldwide. The diagnosis in the pediatric population remains challenging due to the paucibacillary nature of the disease. Intrathoracic lymphadenopathy is one of the most common manifestations of primary disease but is often difficult to sample. A retrospective case review was performed of children (younger than 16 years) suspected with intrathoracic TB lymphadenopathy who underwent an endobronchial ultrasound (EBUS)-transbronchial needle aspiration (TBNA) between January 2010 and 2020 in a London TB center. Ten children between 11 years 4 months and 15 years 9 months, with weights ranging from 48 to 95 kg, underwent EBUS-TBNA. All procedures were performed under conscious sedation with no reported complications. Six of 10 cases showed granulomas on rapid onsite histologic evaluation. Nine of 10 cases were confirmed to have Mycobacterium tuberculosis. Seven of 10 cases were culture positive with a mean turn-around time of 13.7 days; of these, 4 of 7 were smear positive. Six of 7 culture positive cases were also TB polymerase chain reaction (PCR) positive. TB PCR identified 2 further cases where microscopy and culture remained negative. One case had multidrug-resistant TB identified on TB PCR allowing early initiation of correct drug therapy. In our cohort, we show EBUS-TBNA is a safe and effective way of investigating intrathoracic TB lymphadenitis in children and a high diagnostic rate can be achieved. In high-resource settings, we should approach childhood TB with a standardized diagnostic approach and utilize EBUS-TBNA as a diagnostic modality. Samples should be sent for culture but also for molecular assays to timely identify TB and drug-resistant disease.