ABSTRACT
Background and Aim: PIMS-TS often affects the cardiovascular sys-tem resulting in myocarditis and coronary artery abnormalities (CAA). Immunosuppressive therapy is the primary treatment of PIMS-TS;however, controversies on the best regimen remain. The use of anakinra as a second-line treatment in children with cardiac involvement is often proposed lately. This prospective observational study aimed to determine the incidence of cardiac involvement in PIMS-TS and to evaluate the effectiveness and safety of anakinra in its treatment Methods: From July 2020 till December 2021, we have treated 22 children with PIMS-TS (12 boys, 10 girls;aged 0,3-15,75y (median-4y). Echocardiography assessing coronary arteries and systolic function was performed at admission, during the hospitalization, at discharge and 6-8 weeks after the onset. Result(s): Fourteen(63%) of the patients had coronary artery dilata-tion (z-score: 2,1-11,8;median:2,9), 6(27%) deterioration of sys-tolic function, 5(22%) both, 20(90%) had elevated NTproBNP. Only in 2 children (9%) there was no cardiac involvement;in 3(14%) the only cardiac sign was elevated NTproBNP. Two children required admission to ICU. In the first line immuno-suppressive treatment, we administered intravenous immunoglo-bulins (IVIG) in dose 2g/kg in all patients-of which in 16 as a monotherapy, in 6 together with glucocorticosteroids (GCS) because of their severe condition. Seven patients (32%) recovered after a single IVIG infusion, 3(14%) after repeated IVIG infusions. In this subgroup all CAA normalized or got significantly smaller with the change in the median z-score from 2,8 to 1,3. In 10 (45%) patients with cardiac involvment and insufficient response (4 with previous IVIG treatment, 6 with previous IVIG+GCS treatment) we administered anakinra obtaining clinical, laboratory and echo-cardiographic improvement in all of the patients (good systolic function and normalized or significantly smaller CAA: from z-score median = 2,8 (range: 2,1-11,8) to z-score median = 1,9 (range:0-3,2)), with no side effects. The median time to introduce anakinra (for median 9 days treatment) was 4 days after the first-line treatment. In 2 patients with suboptimal effect of first-line IVIG monotherapy, but no cardiac involvement, GCS as the second-line treatment were used. Median time of hospitalization was 18 days Conclusion(s): Cardiac involvement is common in PIMS-TS. Anakinra seems to be effective and safe in its treatment.
ABSTRACT
Pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS) is a new entity, occurring in children and young adults, associated with the SARS-CoV-2 infection. The first cases of PIMS were found in Poland in May 2020. Since October 2020, a signi-ficant increase in this new disease incidence has been observed in Poland, reflecting the increased incidence of COVID-19 in the pediatric population. PIMS development results from dysregulation of the immune system occurring after ca. 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on criteria: a set of clinical features (including fever and features of multiple organ damage) and elevated inflammatory markers, excluding other cau-ses. The most common complications involve the cardiovascular system: heart damage with decreased left ventricular ejection fraction, shock, and coronary artery abnormalities. Mortality is around 2%. Appropriate management, including vital functions support and immunomodulating treatment, allows for a quick recovery of the vast majority of patients. The following document is a guideline for the diagnostic and therapeutic management of children with suspected PIMS in Poland. © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.
ABSTRACT
The aim of this research is to investigate how learning through discovery can be achieved by Z generationpupils using the textbook and the online available sources. We have analyzed a lesson from the textbook Mathematics and Environment Exploration and an animated film from the point of view of learning through discovery, an activity performed into the virtual classroom based on these materials.Weidentified the difficulties and the problems both pupils and teachers cope with, and wehighlighted certain principles and advantages of learning through discovery performed by accessing web sources. We concluded that the film proposed by the teacher for viewing on YouTube represented a valuable information source that corresponded to the pupils' level of knowledge and, more than that, satisfied their curiosity. However, the success of the educational activities depended much on parents' supervision and support.
ABSTRACT
Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical entity occurring in children and young adults, which is associated with the SARS-CoV-2 infection. The first cases of MIS-C were diagnosed in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, reflecting the increased incidence of COVID-19 in the paediatric population. MIS-C develops as a result of dysregulation of the immune system occurring 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on the following criteria: a set of clinical features (including fever and signs of multiple organ damage) and elevated inflammatory markers, with exclusion of other causes. The most common complications involve the cardiovascular system: acute myocardial damage with reduced left ventricular ejection fraction, shock, and coronary artery abnormalities and arrhythmias. Mortality in Western Europe and the United States is around 1-2%. Appropriate management, including vital function support and immunomodulatory treatment, allows for a quick recovery in the vast majority of patients. This document is an updated guideline for the diagnostic and therapeutic management of children with suspected MIS-C in Poland. The most important changes concern treatment, steroid therapy, and antiplatelet therapy in particular.