Longitudinal Anthropometry and Body Composition in Children With SARS-CoV-2-Associated Multisystem Inflammatory Syndrome.

OBJECTIVES: Acute coronavirus disease 2019 infection has been shown to negatively affect body composition among adult and malnourished or obesity children. Our aim is to longitudinally evaluate body composition in children affected by the Multisystem Inflammatory Syndrome (MIS-C). METHODS: In this cohort study, we recruited 40 patients affected by MIS-C, aged 2-18 years old, who were admitted in our clinic between December 2020 and February 2021. Physical examination for each participant included weight, height, body mass index (BMI) z score, circumferences, and skinfolds assessment. The same measurements were repeated during outpatient follow-up at 10 (T2), 30 (T3), 90 (T4), and 180 (T5) days after hospital discharge. Fat mass and fat free mass were calculated according to skinfolds predictive equations for children and adolescents. A control group was randomly selected among patients attending a pediatric nutritional outpatient clinic. RESULTS: BMI z score significantly decrease between preadmission and hospital discharge. Similarly, arm circumference z score, arm muscular area z score, and arm fat area z score significantly decreased, during hospital stay. Fat mass index (FMI) significantly increased over time, peaking at T3. Fat free mass index decreased during hospitalization. CONCLUSIONS: To the best of our knowledge, this is the first study to assess body composition in a numerically large pediatric MIS-C population from acute infection to 6 months after triggering event. FMI and anthropometric parameters linked to fat deposits were significantly higher 6 months after acute event. Thus, limiting physical activity and having sedentary lifestyle may lead to an accumulation of adipose tissue even in healthy children who experienced MIS-C and long hospitalization.

Weight Loss Management and Lifestyle Changes during COVID-19 Lockdown: A Matched Italian Cohort Study.

During the COVID-19 lockdown, lifestyle deterioration had a negative impact on weight, and yet no study has focused on patients already undergoing dietary therapy. We performed a cohort study among adults to evaluate the effect of lockdown on weight loss programs, and we investigated changes in eating habits and chronotype. We matched confined cases with non-confined cases among individuals who followed the same diet in 2017-2019. At baseline, all patients underwent a clinical examination and completed questionnaires on lifestyle. At follow-up, patients of the confined group were interviewed by a web call, and questionnaires were re-evaluated. We recruited 61 patients. The confined sample was mainly composed of middle-aged (52 (43,58) years) females (46 (75%)) with overweight (27 (44%)) or obesity (24 (39%)) and a moderate physical activity level (48 (81%)). Body weight at follow-up was significantly higher (1.1 (95% CI: 0.14, 2.1) kg) in the confined group adjusting for all matching variables. Adherence to the Mediterranean diet and eating behavior generally improved. Concerning chronotype, patients differentiated from Neither-types to Evening- and Morning-types. A well-monitored dietary therapy maintains weight loss during lockdown. Improvement in eating habits was observed; however, a shift of the circadian typology occurred.

Are People with Obesity Attracted to Multidisciplinary Telemedicine Approach for Weight Management?

The forced isolation due to the COVID-19 pandemic interrupted the lifestyle intervention programs for people with obesity. This study aimed to assess: (1) the behaviors of subjects with obesity towards medical care during the pandemic and (2) their interest in following a remotely delivered multidisciplinary program for weight loss. An online self-made survey addressed to subjects with obesity was linked to the official website of our institute. Four hundred and six subjects completed the questionnaire (90% females, 50.2 ± 11.6 years). Forty-six percent of the subjects cancelled any scheduled clinical assessments during the pandemic, 53% of whom had chronic disease. Half of the subjects were prone to following a remotely delivered lifestyle intervention, especially with a well-known health professional. About 45% of the respondents were favorable towards participating in remote psychological support and nutritional intervention, while 60% would practice physical activity with online tools. Male subjects and the elderly were more reluctant than those female and younger, especially for online psychological support. Our survey showed an interest on the part of the subjects with obesity to join a multidisciplinary weight loss intervention remotely delivered. Male subjects and the elderly seem less attracted to this intervention, and this result highlights that, even with telemedicine, the approach to weight management should be tailored.

Prevalence of symptoms in 1512 COVID-19 patients: have dizziness and vertigo been underestimated thus far?

The relationship between SARS-CoV-2 infection and dizziness is still unclear. The aim of this study is to assess the prevalence and characteristics of dizziness and vertigo among patients with mild-to-moderate COVID-19. Patients discharged from the emergency rooms with a confirmed SARS-CoV-2 diagnosis were assisted by daily telephone calls until nasopharyngeal swab negativization, and specific symptoms concerning balance disorders were investigated through targeted questions posed by experienced physicians. The study included 1512 subjects (765 females, 747 males), with a median age of 51 ± 18.4 years. New-onset dizziness was reported by 251 (16.6%) patients, among whom 110 (43.8%) complained of lightheadedness, 70 (27.9%) of disequilibrium, 41 (16.3%) of presyncope, and 30 (12%) of vertigo. This study analyzed in detail the prevalence and pathophysiological mechanisms of the different types of balance disorders in a large sample, and the results suggest that dizziness should be included among the main symptoms of COVID-19 because one-sixth of patients reported this symptom, with females being significantly more affected than males (20.3 vs 12.9%, P < 0.001). Most cases of dizziness were attributable to lightheadedness, which was probably exacerbated by psychophysical stress following acute infection and mandatory quarantine. Vertigo should not be underestimated because it might underlie serious vestibular disorders, and disequilibrium in elderly individuals should be monitored due to the possible risk of falls.

Long-Term Coronavirus Disease 2019 Complications in Inpatients and Outpatients: A One-Year Follow-up Cohort Study.

BACKGROUND: As the coronavirus pandemic spreads, more and more people are infected with severe acute respiratory syndrome coronavirus 2. The short- and medium-term effects of the infection have been described, but the description of the long-term sequelae is lacking in the literature. METHODS: Patients healed from coronavirus disease 2019 (COVID-19) from February 2020 to May 2020 were considered for inclusion in this study, regardless of the severity of the disease during the acute phase. Eligible patients were consecutively contacted and a semistructured interview was administered between February and March 2021 by trained medical staff. RESULTS: Three hundred three patients were eligible and accepted to participate in the study and were enrolled. Of those surveyed, most patients (81%) reported at least 1 symptom, and the most prevalent symptoms were fatigue (52%), pain (48%), and sleep disorders (47%). Sensory alterations were present in 28% of surveyed patients, but in most of these cases (74% of those affected by sensory alterations or 20% of the overall sample) symptoms reported were either anosmia or dysgeusia. Higher prevalence was generally observed with increasing age, although the most relevant differences were observed when comparing young versus middle-aged adults. CONCLUSIONS: At 12 months after acute infection, COVID-19 survivors were still suffering from symptoms identified at shorter follow-up, and the most frequent symptoms included fatigue, pain, and sleep disorders. A more severe impairment in the acute phase did not seem to predict more severe complications.

Patients with Severe Obesity during the COVID-19 Pandemic: How to Maintain an Adequate Multidisciplinary Nutritional Rehabilitation Program?

BACKGROUND: The COVID-19 pandemic is spreading all over the world, particularly in developed countries where obesity is also widespread. There is a high frequency of increased BMI in patients admitted to intensive care for SARS-CoV-2 infection with a major severity in patients with an excess of visceral adiposity. Patients at risk of severe SARS-CoV-2 acute respiratory syndrome are characterised by the high prevalence of pre-existing diseases (high blood pressure and cardiovascular disease, diabetes, chronic respiratory disease, or cancer), most of them typically present in severely obese patients. Indeed, the biological role of adipose tissue in sustaining SARS-CoV-2 infection is not completely elucidated. SUMMARY: The forced isolation due to pandemic containment measures abruptly interrupted the rehabilitation programs to which many patients with severe obesity were enrolled. People affected by obesity, and especially those with severe obesity, should continue clinical rehabilitation programs, taking extra measures to avoid COVID-19 infection and reinforcing the adoption of preventive procedures. In this review, the available data on obesity and COVID-19 are discussed along with evidence-based strategies for maintaining the necessary continuous rehabilitation programs. Key Messages: Greater attention is needed for obese and severely obese patients in the face of the current COVID-19 pandemic, which represents a huge challenge for both patients and healthcare professionals. The adoption of new strategies to guarantee adequate and continuous multidisciplinary nutritional rehabilitation programs will be crucial to control the severity of SARS-CoV-2 infection in high-risk populations as well as the worsening of obesity-linked complications. Health authorities should be urged to equip hospitals with tools for the diffusion of telemedicine to maintain physician-patient communication, which is fundamental in chronic and complicated obese patients.

Prevalence of Dysphonia in Non hospitalized Patients with COVID-19 in Lombardy, the Italian Epicenter of the Pandemic.

INTRODUCTION: Dysphonia has been described in patients affected by coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the prevalence of dysphonia, and its severity and extent, of voice fatigue and of dysphagia in non hospitalized patients affected by COVID-19 in Lombardy, the Italian region most hit by the first explosive outbreak of COVID-19 in Europe. METHODS: Demographic and clinical data of 160 consecutive patients, with COVID-19 diagnosis confirmed by nasal swabs processed by reverse transcription polymerase chain reaction, were gathered by means of telephone interviews performed by physicians in charge of daily follow-up. General and specific symptoms concerning voice and swallowing impairment were investigated. Dysphonia grade and duration were graded on 4-point scales, while voice fatigue was graded on a 5-point scale. RESULTS: Dysphonia was reported by 70 (43.7%) patients and was positively associated with voice fatigue (P < 0.001), cough (P = 0.005), rhinitis (P = 0.01), and dyspnea (P = 0.06); it was mild and/or moderate in 69 patients, but its duration was > 2 weeks in 33/70 (47.1%) patients and >1 month in 11/70 (15.7%). Grade and duration of dysphonia were positively associated with cough and rhinitis (all P values < 0.01). Voice fatigue was reported by 43/160 patients (26.8%) and its severity was correlated with dysphonia (P < 0.0001), cough (P = 0.02), rhinitis (P = 0.02), dyspnea (P < 0.001), and loss of appetite (P = 0.01). Dysphagia was encountered in 27/160 patients (16.9%) and was associated with dysgeusia, cough, arthralgia, myalgia and loss of appetite but not with dysphonia. CONCLUSIONS: Dysphonia was a highly prevalent and long-lasting symptom in this series; it has been underestimated to date. Further studies might shed light on the pathophysiology of voice disorders in COVID-19 patients.

Effects of wearing a FFP2 mask on indirect calorimetry measurements: A pilot study.

BACKGROUND & AIMS: During the coronavirus disease 2019 (COVID-19) pandemic the use of Indirect calorimetry (IC) during nutritional rehabilitation program requires special precautions due to possible contagions for patients and health professionals. We evaluated in a sample of healthy subjects the agreement between oxygen consumption (VO2 mL/min), carbon dioxide production (VCO2 mL/min), respiratory quotient (RQ) and resting energy expenditure (REE kcal/24 h/day) measured by IC with and without a filtering facepiece mask. MATERIALS: 10 subjects with a mean (SD) age of 43 (10) years and a body mass index of 25.2 (5.8) kg/m2 underwent indirect calorimetry both with and without a class 2 filtering facepiece mask (FFP2), in random order. The limits of agreement (LOA) and the concordance correlation coefficient (CCC) were used to evaluate the interchangeability of the measurement conditions. RESULTS: The LOA between REE measured with and without FFP2 (-111 to 189 kcal/day) were comparable to those for repeated IC tests without wearing masks and CCC (0.95) showed substantial agreement. CONCLUSIONS: We observed high agreement between REE measured by IC with and without FFP2 mask. These procedures are interchangeable in clinical practice.

COD19 and COD20: An Italian Experience of Active Home Surveillance in COVID-19 Patients.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic found Italy unprepared to cope with the large concentrated numbers of patients infected with coronavirus disease 2019 (COVID-19) who often required hospital admission and in many cases intensive care. This pandemic very quickly overwhelmed the Italian Healthcare System. This paper describes the Active Home Surveillance System (Operations Center for Discharged Patients; COD19) and the Home Hospital Care System (COD20) and presents the clinical data collected and the level of user satisfaction with the service. The Operations Center for Discharged Patients (COD19) is an active surveillance service for home-care patients which involves: (1) monitoring critical clinical conditions; (2) recognizing social and health issues; (3) and providing necessary clinical services in the form of a telemedicine service. COD20 is a patient-specialist video consultation service that allows to perform an assessment of clinical conditions and any need to visit; defining the priority of access to specialist outpatient visits in the presence or manageable with the new video consultation model. This service was immediately necessary during the COD19 monitoring. COD19 and COD20 are based on the Amazon Web Services Serverless certified platform. The COD19 and COD20 platform can be intrinsically utilized for future epidemic outbreaks; also those with non-respiratory transmission; and is sufficiently flexible to adapt to natural catastrophes.