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Background: The aim of this study was to describe the prevalence of persistent symptoms of COVID in hospitalized pediatric population one year after admission compared to a control group. Method(s): Prospective observational study conducted in 2 hospitals. We included patients aged 0-18 years hospitalized for acute COVID-19 more than a year ago and controls, matched by age and sex, hospitalized for causes other than COVID-19, and who had never COVID-19 at recruitment or during the follow-up. Families were contacted and a standardized survey was conducted. Persistent COVID/disease was defined as the presence of symptoms with onset in the first 3 months after COVID-19 and with persistence for more than 2 months. Result(s): 50 cases and 46 controls were analyzed, 58.3% male, 36% <5 years. Families were interviewed a median of 1.89 years (interquartile range;1.25-2.07) after hospitalization. The definition of persistent COVID-19/disease was met in 34% of cases vs. 37% of controls (p=0.767). Symptoms persisted >=11 months in 24% (12/50) of cases vs. 13% (6/46) of controls (p=0.182), with no differences by age group. The most frequent symptoms at 1 year in cases were fatigue (8%), headache (6%), poor appetite (6%), abdominal pain (6%) and variations in heart rate (6%). In controls, persistent symptoms were mostly abdominal pain (6%) and poor appetite (6%). The number of readmissions was 11/50 (22%) and 6/46 (13%) (p=0.267), respectively. On emotional/behavioral items, 16/50 (32%) of cases reported that their emotional state was worse or much worse than before admission, compared to 16/46 (34.7%). No risk factors associated with the development of persistent symptoms were found, except the length of hospital admission (p=0.043). Conclusion(s): In this study, the prevalence of persistent symptoms was not different in patients with and without COVID-19. 1-year persistence was higher in COVID-19 cases but did not reach significance. Persistence correlated with length of hospitalization.
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Background: Long term evolution of Multisystem Inflammatory Syndrome in children (MIS-C) is poorly understood. In this report, we described the frequency of persistent symptoms and sequels after one-year monitoring in a cohort of MIS-C patients. Method(s): This is a prospective observational study in under-18-aged patients diagnosed with MIS-C between October 2020 and April 2021 in a tertiary hospital. Data from initial episode was obtained from the Spanish national database and the medical history. A standardized phone questionnaire was done one year after the acute episode. As patients pared by age and sex were included with i) history of acute COVID-19, from the same national database, and ii) with peritonitis diagnosis in the electronic medical record. Data was collected using REDCap and analysed with R. Ethics committee approval was obtained. Result(s): A total of 48 patients were included in the study, 16 in each group. Average age at hospitalization was 11,2 years old [IQR: 6,6-14,4] and 52% (23/48) were male. MIS-C patients presented high frequently 94% (15/16) cardiological complications during hospitalization, in contrast with 19% (3/16) of acute COVID-19 patients and 25% (4/16) of peritonitis group (p< 0.01). All of them resolved after a year except the ones associated to hypoxic ischemic encephalopathy in a patient with MIS-C that need ECMO assistance. Summary characteristics during acute episode are shown in Table 1. After one-year follow-up, 88% MIS-C patients suffered one or more symptoms, more frequently: headache (44%), fatigue (38%), insomnia (38%) and concentration problems (38%). A total of 56% of COVID-19 patients presented persisted symptoms, mainly fatigue and concentration problems (19%), and 31% in peritonitis group (19% loss of appetite and abdominal pain), (p< 0.001). MIS-C patients visited more frequently the medical professionals due to emotional change, behaviour or interpersonal relationships after the disease [4/16 (25%) in MIS-C vs. 0/16 (0%) in both control groups, p= 0.028]. Conclusion(s): Majority of MIS-C patients have persistent symptoms one year after acute episode, even with the resolution of cardiological complications. Frequency of long term symptoms in MIS-C patients is significantly higher than in COVID-19 hospitalized and than in a control group of surgical peritonitis patients. Summary characteristics during acute episode.
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Aim To analyze a sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out suspicion of pulmonary embolism (PE) during the acute COVID-19 infection hospitalization period in our hospital. Material and methods SPECT scintigraphy with a reduced dose (111 MBq) of 99mTc-macroaggregated albumin was performed in all the patients (n = 5). The images obtained were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. Results Only one of the 5 patients was diagnosed with PE. Two patients showed pathological scintigraphy findings attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfusion. Conclusion Given the non-specific features of the clinical manifestations and D-dimer values in COVID-19, as well as their similarity to those of PE, pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance due to the absence of scientific publications in this group of patients within the exceptional context of the COVID-19 pandemic.
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AIM: To analyze a sample of pregnant patients who underwent pulmonary perfusion scintigraphy to rule out suspicion of pulmonary embolism (PE) during the acute COVID-19 infection hospitalization period in our hospital. MATERIAL AND METHODS: SPECT scintigraphy with a reduced dose (111MBq) of 99mTc-macroaggregated albumin was performed in all the patients (n=5). The images obtained were interpreted by comparing the findings with the radiological images according to the PISAPED criteria. RESULTS: Only one of the 5 patients was diagnosed with PE. Two patients showed pathological scintigraphy findings attributable to radiological alterations due to COVID-19 pneumonia, and the other two had normal pulmonary perfusion. CONCLUSION: Given the non-specific features of the clinical manifestations and d-dimer values ââin COVID-19, as well as their similarity to those of PE, pulmonary perfusion scintigraphy plays a crucial role in the screening of PE in these patients due to its high sensitivity and lower irradiation compared to CT. Despite the limited number of patients, the results obtained have special relevance due to the absence of scientific publications in this group of patients within the exceptional context of the COVID-19 pandemic.
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Background: We aimed to analyse the effects of steroids, intravenous immunoglobulin (IVIG), and their combination on the probability of discharge over time, probability of switching to second-line treatment over time, and persistent fever after 2 days of treatment. Methods: We did a retrospective study to investigate the effect of treatments (IVIG plus steroids, steroids alone or IVIG alone) of children with MIS-C in a nationwide study, from 1 March to 1 June 2021. We used a Markovian multi-state model with the clock-forward approach and unidirectional arrows to build a multi-state model. Three transitions were defined: initiation of treatment to hospital discharge (t1), initiation of treatment to second-line therapy (t2), and second-line therapy to hospital discharge (t3). A treatment was considered as second-line if initiated >2 days after the first therapy. We estimated the time-to-event probability using a Cox model weighted by the propensity score to balance the baseline characteristics. Results: 30/132 (22.7%) patients were initially treated with steroids alone, 29/132 (21.9%) with IVIG alone, and 73/132 (55%) with IVIG plus steroids. The probability of early discharge was higher with IVIG than with IVIG plus steroids (hazard ratio [HR] 1.65, 95% CI 1.11-2.45, p=0.013), but with a higher probability of needing second-line therapy versus IVIG plus steroids (HR 3.05, 95% CI 1.12-8.25, p=0.028). Patients on steroids had a lower probability of persistent fever after 2 days of treatment (odds ratio [OR] 0.55, 95% CI, 0.28-1.05, p=0.081) versus patients on IVIG plus steroids, and those on the combination had with a lower probability versus IVIG alone (OR 0.21, 95% CI, 0.09-0.46, p=0.0001). We also directly compared the IVig-and steroid-alone treatments. The probability of early discharge of the patients on steroids and on IVig were not different (HR 0·58, 95% CI 0·27-1·24, p=0·166). The probability of transition second-line therapy was also similar (HR 0·71, 95% CI 0·29-1·74, p=0·456). IVIG had a 4-fold higher probability of persistent fever after treatment initiation than steroids (OR 4·23 95% CI 1·43-13·5, p=0·011). Conclusion: IVIG seemed to increase the probability of discharge over time but increased the probability of needing second-line treatment over time. Steroids seemed to reduce persistent fever after 2 days of treatment, and combination therapy reduced the need for escalating treatment.
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Background: Testing using nasopharyngeal swabs (NPS) samples is the cornerstone for the control of the COVID-19 pandemic, but the procedure is uncomfortable and generates anxiety, especially in children. We aimed to evaluate the adequacy of oral saliva swab analysis using RT-PCR comparing to NPS by RT-PCR and Antigen Rapid Test (AgRT) on NPS in children. Methods: Cross-sectional multicenter diagnostic study nested in a prospective, observational cohort (EPICO-AEP) carried out between February and March 2021 at 10 hospitals in Spain. Participants were children 0 to 18 years old with symptoms compatible with SARS-CoV-2 infection of ≤5 days of duration attending at emergency departments. Three samples were collected, two NPS (for AgRT and for RT-PCR) and one oral saliva swab for RT-PCR. In patients with discordant results, new NPS was collected for viral culture and original samples were tested for viral RNA subgenomic (sgRNA) study. Results: 1174 children were included in the analysis, aged 3.8 years (IQR, 1.7-9.0), 647/1174 (55.1%) were male and 760/1174 (64.7%) presented fever 1 day before emergency department admission (IQR 1.0-2.0). Overall, 73/1174 (6.2%) patients tested positive in at least one of the techniques. Sensitivity for RT-PCR in oral saliva swab was 72.1% (95%CI, 59.7-81.9) and specificity 99.6% (95%CI, 99.0-99.9);AgRT in NPS was 61.8% (95%CI, 49.1-73.0) and 99.9% (95%CI, 99.4-100). Kappa index for RT-PCR oral saliva swab was 0.80 (95%CI, 0.72-0.88), and for AgRT was 0.74 (95%CI, 0.65-0.84) vs RT-PCR in NPS. A Bayesian model was used to estimate the accuracy assuming that RT-PCR in NPS is not a perfect gold standard. In this model, sensitivity for RT-PCR oral saliva swab was 84.8% (95%Cr 71.5-93.6), and for AgRT, it was 72.5% (95%Cr, 58.8-83.6). Specificity for RT-PCR oral saliva swab was 99.7% (95%Cr, 99.2-99.9), and for AgRT it was 99.9% (95% Cr, 99.6-100). The Cts were higher in oral saliva swabs compared with NPS;being Ct (NPS)=0.5 x (Ct saliva) + 4.5 (p=0.027). Overall, 4 (10.8%) patients with discordant results had a positive culture. In 3 of the 4 patients, the discordance consisted of positive result on oral saliva swab and nasopharyngeal swabs RT-PCR but negative by antigen rapid diagnostic test. No patient had (+) culture, (+)NP, (-)oral swab. Conclusion: RT-PCR on oral saliva swab is an accurate option for SARS-CoV-2 testing in children. A friendlier technique for younger patients, who must be tested very frequently, may help to increase the number of patients tested.
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BACKGROUND: Viral pandemics have had catastrophic consequences on population health and economies. The Philippine government intends to establish the Virology Institute of the Philippines, one of the key areas of which will be virology research. This project aimed to develop the institute's research agenda across the fields of human, plant, and animal virology. METHODOLOGY: Key considerations for the prioritization methodology were (1) the imminent establishment of the Virology Institute of the Philippines, (2) mobility restrictions caused by the coronavirus disease 2019 (COVID-19) pandemic, (3) the timeline to develop the research agenda, and (4) the need to separate the research agenda for the three fields of human, plant, and animal virology. The process was fully conducted online in four steps: stakeholder identification, soliciting research priorities, generating initial research priorities, and final prioritization consultations conducted on Zoom Pro. RESULTS: Twenty-eight participants attended three online consultations between 21 and 27 July 2020 through Zoom Pro. Participants selected the research prioritization criteria and its weights, and used these to evaluate the research priorities. The final research agenda covers topics in epidemiology, diagnostics, surveillance, biosafety, and genomics. CONCLUSION: This initiative resulted in the first research agenda for the Virology Institute of the Philippines across the three fields of human, plant, and animal virology. An expert-driven process which places a premium on consensus-building facilitated through online platforms was the most feasible approach to develop the research agenda. This process resulted in an agenda aligned with the mandates of national research councils but leaves gaps on areas such as emerging infectious diseases. Pre-COVID-19 literature expressed apprehensions on the online medium that weakens social ties necessary for consensus. Our experience with changing the mode of consensus-building shows that users will continually adapt to technology. Online tools are currently able to address the limitations of the virtual space.
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Statement of purposeTo use data from a state-wide opioid overdose surveillance system in Michigan to evaluate changes in opioid overdose frequency during the COVID-19 pandemic.Methods/ApproachThe System for Opioid Overdose Surveillance (SOS) is a near real-time overdose surveillance system in the state of Michigan run out of the University of Michigan Injury Prevention Center, in collaboration with the Michigan HIDTA. SOS receives daily data feeds containing all EMS encounters involving naloxone administration, and daily data on suspected fatal overdoses from medical examiners covering ∼80% of the state’s population. We used SOS data to compare spatial and temporal changes in suspected opioid overdoses after 3/1/20, the approximate timing of the intensification of the COVID-19 pandemic, and compared those changes to those seen at the same time in 2019.ResultsFrom 3/1/20–9/16/20, suspected fatal overdoses were 15.0% higher than during the same time in 2019, and naloxone administrations by EMS were 28.8% higher;a majority of counties and cities saw analogous changes, though the magnitude varied. Rates of both suspected fatal overdoses and EMS naloxone administrations were higher in 2020 prior to March, but the difference increased following the start of the pandemic. By late August, rates of suspected fatal overdoses returned to 2019 levels, but EMS naloxone administration rates remained nearly 40% higher than the same time in 2019.ConclusionsEvidence suggests that overdose and the COVID-19 pandemic are interwoven crises, and resources are required to address both the isolation and stress of the pandemic, and the medical system excess burdens, which all may intensify substance use, and reduce the likelihood of seeking treatment.SignificanceOverdose remains a leading cause of death, and that burden has increased during the pandemic in Michigan. Approaches are needed to address secondary effects of the COVID-19 pandemic.