Functional Gastrointestinal Disorders as a Post-Covid Infection Sequel in Pediatric Patients in Mexico

INTRODUCTION: The rate of pediatric patients diagnosed with Sars Cov 2 has increased since the early stages of the pandemic. Gastrointestinal symptoms have been demonstrated to be relatively common in pediatric COVID-19 patients as well as severe complications like PIMS syndrome because of the expression of ACE II in different areas of the digestive tract which serves as a receptor for their entry and infection in the body. During the last months of the omicron variant wave, we observed some gastrointestinal conditions in pediatric patients days after the resolution of the Sars Cov 2 acute infection period, sparking our interest to execute further research and analysis. OBJECTIVE(S): Describe the presence of functional gastrointestinal disorders as a post-covid infection sequel METHODS: We performed a descriptive, cross-sectional, observational, retrospective study, were we recollected the clinical and epidemiological data from the medical records of pediatric patients with a history of Sars cov-2 infection confirmed with positive PCR or antigen (sars cov-2) tests at Hospital Angeles Lomas, Mexico City. We included children from 6 months up to 16 years of age, who presented functional gastrointestinal disorders at a minimum 15 days after the infection that fulfilled Rome IV criteria. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution RESULTS: We included data from 30 patients with confirmed covid 19 diseases by positive pcr or antigen (sars cov-2) tests, with a mean age 5.327 +/- 3.8 years Min: 7 months Max: 16 years, with a female predominance of 56.7% vs 43% male patients. During the acute infection by covid, 20% presented respiratory symptoms, 13.3% gastrointestinal symptoms, 36.7% only fever, 3.3% dysgeusia and 26.7% were asymptomatic. Adequate nutritional status was detected in 93% of the patients. The mean days the patients presented manifestations was 32 +/- 14 days, at a minimum 15 days, with a maximum of 63 days, being the most frequent functional gastrointestinal disorders: abdominal pain 90%, bloating 76%, vomit and reflux 33%, diarrhea 30%, constipation 26.7%. There was no weight loss in the patients, the appropriate treatment was given for each case. There was no complication in 90% of the patients, 10% presented acute abdominal pain and were transferred to the emergency room, 1 patient was diagnosed with appendicitis and 2 patients with mesenteric lymphadenitis. CONCLUSION Special attention must be paid to toddler and preschooler patients with Sars Cov 2 infection, regardless of the clinical manifestation in acute infections, mild or asymptomatic, functional gastrointestinal disorders may occur in the first 2 months after a positive PCR test. The ileum and the colon are places in which there is a greater expression of the ACE II, so when the enterocytes are invaded by SARS CoV-2, they may produce alterations in absorption and other mechanisms that could be the cause of these consequences. It is of vital importance that all pediatricians are aware of the consequences of the disease to prevent misdiagnosis.

Submassive pulmonary thromboembolism, post-COVID sequelae;with mechanical thrombus aspiration and accelerated thrombolysis by Ekos ultrasound with successful resolution

Introduction: Acute pulmonary thromboembolism is a pulmonary pathology that is becoming more frequent nowadays, the use of new mechanical and thrombolytic therapies has a significant impact on the cardiopulmonary prognosis. Case: A 41-year-old male, a retired military man, smoking, overweight, dyslipidemia, alcoholic liver disease, who attended the emergency department due to abrupt dyspnea, with tachycardia, chest pain, and syncope;the patient had tachycardia of 120 bpm, BP 90/60 mmHg and SO2 of 82%, with a history of COVID-19 infection, suspected of massive pulmonary embolism, it was decided to carry out computed tomography where a bilateral submassive pulmonary embolism was documented (Fig. 1A), it was proposed to perform systemic thrombolysis, however due to the risk of bleeding, it was decided to perform EKOS ultrasound directed thrombolysis. Baseline pulmonary angiography was performed with a large number of thrombi (Fig. 1B), distributed in both main right and left branches and deficient pulmonary filling of distal vessels, due to the large amount of thrombus, it was decided to perform manual thrombus aspiration, obtaining a large amount of thrombus (Fig. 1C), as well as thrombolysis in situ with Alteplase a dose of 1 mg/catheter/hour for 12 hours, with a total dose of 24 mg;Ultrasound probe was placed in both pulmonary arteries with the EKOS system (Fig. 1D). Results: Pulmonary angiography was performed 24 hours after the procedure, where no bleeding occurred and almost complete resolution of the thrombus was observed. The patient later with 92% SO2, without oxygen requirements, with HR 90 bpm, with no evidence of ventricular dysfunction, was discharged home with anticoagulation. Conclusion: Low dose fibrinolysis and thromboaspiration are considered, as well as the use of EKOS endovascular ultrasound, a safe and effective procedure, in the context of a patient with high-risk of bleeding, with favorable results that condition clinical and prognostic improvement.

Stress tolerance and life satisfaction as predictors of the perceived impact of confinement by COVID-19

Introduction and Objectives: In Mexico, the indication to shelter in place due to COVID-19 began on March 14, 2020. To date, there are few studies on risk factors and protectors of the impact of this confinement. The aim was to evaluate a structural model of the perceived impact in different areas of the person's life due to confinement by COVID-19, including stress tolerance and life satisfaction as predictors. Patients or Materials and Methods: This was a longitudinal paired groups study, seeking to identify the effect of the independent variables with two months between evaluations (evaluation 1: stress tolerance and life satisfaction) on the dependent one (evaluation 2: impact). Were included 158 people with mean age of 31.8 years (SD = 11.1), 65.2% women. Results: The structural model confirms the effect of stress tolerance and life satisfaction on the perceived impact of confinement in the areas of emotional well-being, physical condition, health, happiness and tranquility. Conclusions: It is concluded that stress tolerance and life satisfaction can be protectors of the impact of confinement in those areas in which the person can modify their behavior or thoughts.

Longitudinal Study of the Psychological Impact of the Contingency Response to COVID-19 in Mexico

Due to the COVID-19 pandemic, many countries have implemented prevention and care measures, among which voluntary confinement stands out. The purpose of this study was to evaluate the psychological impact of the contingency response due to COVID-19 in Mexico, considering time and level of confinement, participation in pleasurable activities during confinement, and responses derived from the economic recovery plan of the government. The study had a longitudinal design with two evaluations involving 158 people from 17 to 76 years of age who answered the questionnaires within 9 weeks. People with high confinement levels showed significant differences in positive affect, stress, and depression;people with low confinement levels and those who continued to work showed greater affection. Those who reported not having participated in pleasant activities during their confinement showed low results, and those who reported having been more worried about the economic recovery plan had a higher score in worry and a lower score in life satisfaction. It can be concluded that although psychological support interventions should focus on people in confinement, greater efforts that contribute to improving quality of life and well-being should be directed to those who work during public health contingency responses.

Impact of SARS CoV2 on newborns weight from infected mothers

Introduction: During the present Sars cov-2 pandemic, pregnant women are considered high-risk group population due to a state of immune compromise. Previous knowledge regarding pregnant women and their newborns is rapidly changing as new covid discoveries are unraveled, paying special attention on newborns evolution during their first days of life. Objectives: To determine impact of Sars Cov2 infection on the expected birth weight of newborns of infected mothers. Methods: It is a descriptive, cross-sectional, observational and retrospective study involving the analysis of clinical records of patients from the infectiology service of the Hospital Español Mexico. The study includes newborns from mothers between the ages of 18 to 48 infected with Sars Cov2, confirmed by a PCR test. The study excludes patients with incomplete records. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution. Results: Data included 36 patients from the infectology service between the months of March 2020 to April 2021, with positive PCR for sars cov 2, with a mean age of 34.28 ± 5.86 years, mainly presented the following comorbidities: : obesity in 27.8%, hypothyroidism 11.1%, diabetes 13.9%, gestational hypertension 13.9%. The principal symptoms presented by the mothers were respiratory in 19.4%, gastrointestinal 13.9%, asymptomatic presentation 47.2%. Newborns results were obtained with a mean gestational age of 37.3 ± 2.6, with a male predominance of 52.8%, with a mean birth weight of 2811.1 ± 616.7, height 47.64 ± 3.7. About 16.4% of the patients were premature, only 4 were admitted to the neonatal intensive care unit, due to sepsis, pediatric inflamatory multisystemic syndrome, and an intrauterine growth restriction. All the newborns had a negative PCR test despite the positive PCR of all the mothers Conclusion: Newborns from mothers infected with Sars cov 2, were born with appropriate weight for their gestational age. The immune system of newborn babies protects to have adequate nutrition during the gestational period, however, some presented inflammatory and vascular complications. Special emphasis should be done on maternal metabolic clinical history, such as obesity, metabolic syndrome, and hypothyroidism since these comorbidities can impact negatively in the prognosis of the infected mother and the newborn. It is very important to perform a nutritional screening during prenatal care for an adequate metabolic programming in early life in children.

PSYCHOLOGICAL REACTIONS DURING THE FIRST WEEK OF ISOLATION BY COVID-19 IN MEXICO

Quarantine or poor social isolation, can have negative implications for people's physical and emotional health. Therefore, to know the psychological and emotional reactions as a result of voluntary isolation based on the reason and number of home exits, the routine and the performance of pleasant activities during voluntary isolation at home by COVID-19 in the general population of Mexico is important. People who went out only what was necessary got the best scores in the different variables. In addition, a significant difference was found in most of the variables, in favor of those who reported having done pleasant activities in the last week, which they had not done for a long time. Developing interventions and promoting pleasant activities to cope with psychological distress is suggested.