Multisystem inflammatory syndrome associated with COVID-19 in children: Risk factors of severe life-threatening course of the disease

Background/Purpose: Multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19 infection is a life-threatening condition, required intensive care. The aim of this study was to determine risk factors for severe/life-threatening course of MIS-C. Method(s): The retrospective study included 166 children (99 male, 67 female), aged from 4 months to 17 years (median 8.2 years), who met the WHO criteria for MIS-C. The criterion of severity was the fact of the ICU admission. The analysis of the obtained data was performed using the STATISTICA software package, version 10.0 (StatSoft Inc., USA). Result(s): To assess the factors associated with the severe course of MIS-C, patients were divided into two groups: those who were hospitalized in the ICU (n = 84;50.6%), and those who did not (n = 82;49.4%). Patients with a more severe course of MIS-C were significantly older. They had a high frequency of signs such as rash, edema, hepatomegaly, splenomegaly, neurological and respiratory symptoms. Hypotension/shock and myocardial damage were much more common in patients hospitalized in the ICU. Among the laboratory changes there were significant differences in the levels of hemoglobin, leukocytes and platelets, CRP, creatinine, troponin and D-dimer. The presence of macrophage activation syndrome was higher in patients, admitted in the ICU. Children, required intensive care required high dose corticosteroids and IVIG more often (table 1). FIGURE: 1) The first symptoms of progeria in infancy: scleroderma-like changes in the skin of the lower extremities and stiffness of knee joints at the age of 2 months. 2) Girl at the age of 3 years 5 months. Almost total alopecia with the absence of eyebrows and eyelashes. Pronounced venous pattern in the forehead, nasal bridge and nasolabial triangle. Conclusion(s): MIS-C is potentially a severe life-threatening condition, in which more than half (50.6%) of patients needed the ICU admission. The main factors determining the severity of MIS-C were: cardiovascular, resiratory and central nervous system disorders. It has been found that factors such as hepatomegaly, splenomegaly, D-dimer >2568 ng/ml, troponin >10 pg/ml, make it possible to identify a group of patients with high risk of severe MIS-C who may potentially need hospitalization in the ICU.

Using HScore for the evaluation of the signs of hemophagocytosis in multisystem inflammatory syndrome associated with covid-19 in children

Background/Purpose: Multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C) is a rare but severe disease associated with coronavirus infection, in which various systems and organs are affected, including the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal tract. One of the most severe features of this disease can be hemophagocytosis. The aim of this study is to assess the features of hemophagocytosis in MIS-C. Method(s): The retrospective study included 166 children (99 male, 67 female), aged from 4 months to 17 years (median 8.2 years), who met the WHO criteria for MIS-C. The analysis of the obtained data was performed using the STATISTICA software package, version 10.0 (StatSoft Inc., USA). Result(s): To study the signs of hemophagocytosis in patients with MIS-C they were divided into 2 equal groups: with HScore<=91 (n = 79) and with a HScore value >91 (n = 79). This division was done, since this value was associated with the severe life-threatening course of MIS-C and need in ICU admission (70.9% vs. 32.3%, P = 0.000002). Patients with HScore > 91 were more likely to have symptoms such as cervical lymphadenopathy (80.6% vs 54.1%, P = 0.0007), red dry cracked lips (63% vs 34.3%, P = 0.0007), face swelling (66.7% vs 34.7%, P = 0.001), hepatomegaly (84.2% vs 43.1%, P = 0.000000), splenomegaly (54.7% vs 43.1%, P = 0.0003), hypotension/shock (63.3% vs 25.3%, P = 0.000002), had higher levels of ESR (47 mm/h vs 34 mm/h, P = 0.0001), CRP (175.5 mg/L vs 125.8 mg/L, P = 0.01), D-dimer (2135 ng/mL vs. 1079 ng/mL, P = 0.0003), but lower levels of fibrinogen (3.1 g/L vs 5.6 g/L, P = 0.000002) erythrocytes (3.6 x 1012/L vs 4.0 x 1012/L, P = 0.000005), hemoglobin (98 g/L vs 112 g/L, P = 0.000000), and a tendency to thrombocytopenia (110 x 109/l vs 192 x 109/L, P = 0.0002) in 63.3% of patients. According to EchoCG data, signs of myocardial (45.5% vs 15.6%, P = 0.00006) and pericardial (45.5% vs 14.3%, P = 0.00002) lesions were more common in patients with HScore > 91. Patients with HScore > 91 more often needed treatment with IVIG (66.2% vs 24%, P = 0.000000), acetylsalicylic acid (65.7% vs. 47.1%, P = 0.027) and biological drugs (9.1% vs. 1.6%, P = 0.061). The average duration of hospitalization was also much longer in patients with HScore > 91 (23 days vs 14 days, P = 0.000000). Also, the identification of clinical and laboratory signs that were more common in the group of patients with HScore > 91 was performed using sensitivity and specificity analysis, and calculation of odds ratio. Results are presented in Table 1. Conclusion(s): Hemophagocytic syndrome is one of the most severe manifestations of MIS-C occuring in 35.4% of patients. It was found that HScore > 91 is associated with such a severe signs of MIS-C as myocarditis, pericarditis, hypotension/shock, and ICU admission. HScore is a simple tool that can also be used to assess the severity of MIS-C and dynamic monitoring.

Emotional reactions and hardiness among Russian students during the first wave of the COVID-19 pandemic

Introduction: The COVID-19 pandemic provoked emotional reactions in Russian student populations. Hardiness is seen as a personality predisposition that increases individuals' resilience to stress. Objective(s): The study aimed to determine the severity of depression, anxiety, stress, and various components of hardiness in Russian students. In addition, the correlations between emotional reactions and hardiness components were also analysed. Method(s): Data collectionwas carried out between 29May and 06 July 2020.Atotal of 129medical and non-medical students participated in the study. TheDASS-21was used tomeasure depression, anxiety, and stress levels, while the Personal Views Survey-III examined hardiness. Both questionnaires were adapted for use in Russia. Result(s): We found that medical students were less likely to be depressed than non-medical students (M = 4.03 and M = 6.01 respectively, p < 0.05). Medical students had higher levels of the component of hardiness such as commitment (M = 20.95 and M = 18.43 respectively, p < 0.05). In both groups, all hardiness components have negative relationshipswith depression, anxiety, and stress, but inthemedical group control is associated onlywith depression (rx =-0.446, p < 0.01), whereas the other group also has associationswith anxiety (rx = -0.356, p < 0.01) and stress (rx = -0.407, p < 0.01). Conclusion(s): Hardiness was negatively related to depression, anxiety, and stress in a pandemic setting. Medical students were more adaptable to the pandemic than non-medical students.

Meaningful orientations and asthenia in pregnant women and young mothers during the first COVID-19 pandemic wave

Introduction: Pregnancy and childcare are naturally stressful for women, often accompanied by the asthenic syndrome. In a pandemic situation, this type of stress may be potentiated by external conditions. Objective(s): The study aimed to investigate the life-state orientations and asthenia levels of pregnant women and young mothers in the context of a pandemic. We also analyzed the correlations between the life-state orientations and the different types of asthenias. Method(s): Data collection was carried out in June 2020 using a Google form that we developed. Pregnant women and young mothers with children under seven years of age participated in the study with 47 respondents. We used the Purpose-in-Life Test to investigate the meaningful orientations and the MFI-20 to determine the level of asthenia. Both questionnaires were adapted for use in Russia. Result(s): We found that the mean overall MFI-20 score (M = 58.0+/-5.9) exceeded the mean values in our sample, indicating the presence of the asthenic syndrome. Physical asthenia (M = 12.9+/-1.4) and decreased activity (M = 12.0+/-1.7) were the strongest, with the lowest score on the general asthenia scale (M = 10.6+/-1.8). Correlation analysis showed that all components of meaningful orientations had multiple positive correlations with different types of asthenias, and the overall asthenia score was 100 % related to life meaningfulness (p < 0.01). Conclusion(s): Pregnant women and young mothers are at risk for asthenia in the COVID-19 pandemic. This is obviously due to many responsibilities of mothers raising children.

Dynamics of emotional reactions among Russian students during the COVID-19 pandemic

Introduction: The pandemic of a new coronavirus infection can be considered as a long-term traumatic event. It is known that chronic stress is characterized by dynamics of emotional state caused by processes of adaptation and maladaptation. Objective(s): Our study aimed to investigate the dynamics of depression, anxiety, and stress levels among Russian students during the COVID-19 pandemic. Method(s): Data were collected from May to July 2020 (the first pandemic wave) and from October 2020 to April 2021 (the second wave). A total of 170 non-medical university students participated in the study. We used the DASS-21 to determine levels of depression, anxiety, and stress. Result(s): We found that during the first wave of the pandemic, 57 % of students showed no symptoms of depression, 77 % had no symptoms of anxiety, and 76 % showed no signs of stress. In the second wave, 50 % of students showed no depression, 65 % no anxiety and 67%no stress. Analysis of mean values showed that the second pandemic wave provoked higher levels of anxiety (M = 3.32+/-4.25 vs M = 4.71+/-4.71, p < 0.05) and stress (M = 6.50+/-4.50 vs M = 7.99+/-4.97, p < 0.05) . Conclusion(s): The second wave of the new coronavirus pandemic provoked more severe emotional reactions among Russian students than the first. By these results we suggest that the duration of the pandemic harms the emotional state of the general population. Therefore, it is essential to develop and implement psychotherapeutic programs to restore the mental health of Russian citizens.

Russian medical students in the first wave of the COVID-19 pandemic: emotional reactions and baseline beliefs

Introduction: During the pandemic of new coronavirus infection, some medical students were actively recruited to work with infected patients, which could provoke depression, anxiety, and stress. The concept of baseline beliefs predicts characteristics of individuals' experience of trauma. Objective(s): The study aimed to determine depression, anxiety, and stress levels in medical students and examine their baseline beliefs, as well as the relationship between baseline beliefs and emotional reactions. Method(s): Data were collected in the spring and summer of 2020 using a Google form that we developed. Thirty-seven medical students participated in the study. The WAS-37 questionnaire was used to examine baseline beliefs and the DASS-21 to measure depression, anxiety, and stress. Both questionnaires were adapted for use in Russia. Result(s): We found that 78 % of the respondents had no depression, 86 % had no manifestations of anxiety, and 83 % felt stressfree. The mean values on the "Benevolence in the World" scale (M = 32.3+/-8.0) were within the average normative values, those on the "Justice" scale (M= 19.8+/-5.0) were below them, and those on the "Self-Image" scale (M = 29.6+/-5.9), "Luck" (M = 32.5+/-6.9) and "Controlling Beliefs" (M = 27.3+/-4.1) were above the average normative values. We found only one statistically significant relationship between emotional reactions and baseline beliefs, a negative correlation between depression and luck (rx = -0.360, p < 0.05). Conclusion(s): In pandemic medical students, beliefs about one's luck were associated with lower levels of depression.

Baseline beliefs, depression, anxiety, and stress in humanities students in the context of the COVID-19 pandemic

Introduction: The COVID-19 pandemic can be seen as mental trauma. The concept of baseline beliefs helps to explain the extent to which mental trauma affects individuals. Objective(s): The study aimed to investigate baseline beliefs in humanities students in Russian universities and analyse the relationship between baseline beliefs and emotional reactions. Method(s): Data collection was carried out between May and July 2020 using a Google form that we developed. A total of 92 humanities students participated in the study. The WAS-37 was used to examine baseline beliefs, and the DASS-21 was used to determine depression, anxiety, and stress levels. Result(s): We found that the mean values of the scales "Benevolence in the World" (M = 34.8+/-6.5), "Self-image" (M = 27.2+/-4.4), "Luck" (M = 32.7+/-5.7) and "Controlling beliefs" (M = 27.9+/-4.0) were above the normative mean values for the Russian population and only the values of the scale "Justice" (M=20.8+/-3.8) were below these. All components of baseline beliefs had negative associations with depression, anxiety, and stress;only "Benevolence in the World" was associated exclusively with anxiety (rs = -0.223, p < 0.05), and "Justice" with depression (rs = -0.223, p < 0.05). Conclusion(s): In a pandemic, the world around them is perceived by humanities students as less fair. Trust in the world, beliefs about the fairness of the world and a positive self-image are correlated with a more favourable emotional state. By this, we support the view that individuals' implicit beliefs (baseline beliefs) are related to the severity of the traumatic event.

Predictors of death in severe new coronavirus infection in children

Currently, in pandemic settings, the new coronavirus infection is the leading cause of adult fatalities and may cause death of children with comorbidities. The objective of the study is to identify predictors of the fatality of the new coronavirus infection in children. Subjects and Methods. 230 patients with the new coronavirus infections were examined. The main group of 94 patients with severe COVID-19, the fatal outcome occurred in 25 (26.6%) children. The comparison group consisted of 126 children with a moderate degree of severity, and there were no lethal outcomes. Results. Children older than 10 years of age (43%) prevailed in the study cohort. Every fifth patient in the main group suffered from shock, and 79 (84%) children had failure of two or more systems/organs. The presence of pronounced manifestations of the disease was associated with a 20-fold increase in the probability of a severe course of COVID-19 (OR = 0.04). Involvement of two organs and systems doubled the risk of death. An acceptable discriminatory ability of the pSOFA score for predicting COVID-19 outcomes in children was identified: sensitivity 83%, specificity 61%, cut-off point 5.6 points. Conclusion. Predictors of death in severe new coronavirus infection in children include failure of two or more organs and systems, acute renal injury and the pSOFA score above 5. © 2021 Tomsk Polytechnic University, Publishing House. All rights reserved.

Specific parameters of the thromboelastographic profile of patients with COVID-19 in the intensive care unit

The objective: To study the hemostatic system of patients diagnosed with the novel new coronavirus infection and compare the data obtained with hemostatic system parameters in patients with advanced deep vein thrombosis/pulmonary embolism without COVID-19. Subjects and methods. A single-center prospective study with retrospective control was conducted in Anesthesiological and Intensive Care Department No. 1 of Kuvatov State Medical University (Ufa) in April-May 2020, the objective of the study was to investigate the hemostatic system of patients with confirmed new coronavirus infection, patients diagnosed with venous thrombosis in 2012-2014, and a group of healthy volunteers. Results. Evaluation of the hemostasis system in patients with thrombosis and patients with COVID-19 demonstrates the same type of changes: MA, Angle, G indices increase according to thromboelastography results, as well as D-dimer and fibrinogen levels increase, while antithrombin III activity decreases. Conclusion. Thus, TAG may be crucial for accurate identification of patients with advanced increased risk of thrombosis and thus possibly avoid unnecessary anticoagulation in patients at low risk of thrombosis. © 2020 Messenger of Anesthesiology and Resuscitation. All rights reserved.