Recurrence of multisystem inflammatory syndrome associated with Covid-19 infection: case report.

The COVID-19 pandemic has left millions of cases and deaths worldwide, in children the infection is less severe and has low mortality. A post-infectious entity called Systemic Multiinflammatory Syndrome (MIS-C) associated with COVID-19 infection is described, which has a mortality rate ten times higher than acute infection in children. MIS-C is characterized by sustained systemic inflammatory manifestations associated with fever and multiple system involvement. We present the case of a schoolgirl who presented a diagnosis of MIS-C with a good response to management and 11 months later, she presented a second episode that also responded to treatment. To date, we have not found in the literature the report of recurrence of MIS-C in children, such as the case presented by us, it marks an important precedent, inviting us to consider recurrence as a possibility in the case of a similar clinical presentation.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Primary Cardiac Lymphoma with an Aggressive Hostile Take-Over

Background Primary cardiac lymphoma (PCL) is an extranodal lymphoma involving only the heart and/or pericardium. PCL accounts for 2% of primary cardiac tumors and 0.5% of extranodal lymphomas. Its diagnosis is usually delayed due to rarity and non-specific findings. Case A 77-year-old man with Alzheimer dementia, atrial fibrillation on apixaban, and COVID-19 illness 3-weeks prior, who presented to the hospital with diffuse abdominal discomfort, fatigue, anorexia, and hypoactivity. Patient was tachycardic and normotensive with pronounced jugular venous distention, non-collapsing with respiration. ECG revealed sinus tachycardia, first degree atrioventricular (AV) block and chronic LBBB. Cardiac troponins were mildly elevated without significant delta. An abdominopelvic CT revealed an incidental, large pericardial effusion (PE). Bedside echocardiogram confirmed a large hemodynamically significant PE as well as a mass-like echogenicity encasing and infiltrating the pericardium and myocardium at the basal aspect of the right ventricle free wall. Decision-making In view of recent COVID-19 infection, he was started on indomethacin and colchicine for suspected viral or neoplastic pericarditis. Pericardiocentesis drained 900ml of amber to serosanguineous fluid with quick hemodynamic improvement. Fluid analysis was non-diagnostic for neoplasia. Subsequently, he developed symptomatic bradycardia with an intermittent complete AV block with junctional escape rhythm, transitioning to a second-degree AV block after removal of beta-blocker. Awaiting permanent pacemaker implant, he developed ventricular fibrillation with sudden cardiac death that required prolonged unsuccessful ACLS. Autopsy revealed an extensive infiltrative tumor, predominantly right-sided, consistent with primary cardiac B-cell lymphoma. Conclusion PCL should be part of the working diagnosis in patients presenting with a pericardial effusive process in combination with a right sided myocardial mass. Early cardiac MRI/PET scan or biopsy should be considered when the diagnosis is not certain. Prompt diagnosis could allow for treatment that potentially prolongs survival.Copyright © 2023 American College of Cardiology Foundation

Skeletal muscle symptoms and their relationship with burnout syndrome in the work activities of administrative personnel of a university in Ecuador

Covid-19 pandemic changed the manner on how people work, forcing administrative staff of a public university to adopt biosecurity measures, modify job positions, increase working hours, which caused employees to be exposed to psychosocial and ergonomic risks, among others. For this reason, the aim of this research is to analyze musculoskeletal symptoms and their relationship with Burnout Syndrome in the administrative staff of the Technical University of Babahoyo during the year 2021. Research with a descriptive-correlational approach. The participant population was 119 people. The Nordic Kuorinka and Maslach Burnout Inventory questionnaires were used for the variable's musculoskeletal symptoms and Burnout Syndrome respectively. The results show that all the collaborators show musculoskeletal symptoms at different levels of affectation, the highest percentage being found in the back, then the neck, followed by the shoulder and in a lower proportion the hand-wrist and elbow-forearm segments. The prevailing level of Burnout Syndrome in the administrative personnel is low with 55, 5%, followed by a medium level of 34, 5%. To conclude, the investigation reveals that there is a correlation between the two variables;therefore, one of the causes of the prevalence of musculoskeletal symptoms in university workers is Burnout Syndrome, which can affect the health of collaborators over time. © 2022 Latin American and Caribbean Consortium of Engineering Institutions. All rights reserved.

SCREEN TIME AND SLEEP IN YOUNG ADOLESCENTS BEFORE AND ACROSS THE FIRST YEAR OF THE COVID-19 PANDEMIC

Introduction: The COVID-19 pandemic has been associated with profound biopsychosocial changes for children, potentially affecting their health and wellbeing. Among these changes are altered sleep patterns and screen time use, however, no work has examined interactions between these two behaviors in the context of the pandemic. Here, we used longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study® to investigate changes in both sleep and screen time, and their relationship, from before and across the first year of the COVID-19 pandemic in young adolescents. Methods: More than 5000 adolescents (11-14 years;48% girls) completed digital surveys about their sleep and daily screen time use before the pandemic and across six timepoints during 2020- 2021, as part of the ongoing ABCD Study®. Random intercept linear mixed effect models (LMMs) were used to examine longitudinal associations between bedtime, wake-up time, and daily screen time use (social media, gaming), considering age, sex, and school effects. Results: Adolescents' wake up time was delayed (R2 = 0.51;~1.5 hour) during May-August 2020 relative to the pre-pandemic assessment (p<0.01), which was partially related to the summer break (p<0.01), before advancing to earlier times in October 2020. Bedtimes also delayed at all pandemic assessments (R2=0.62;~1 hour), even after starting the new school year (p<0.01), particularly in older adolescents (p<0.01) and girls (p<0.01). Recreational screen time was dramatically higher across the first year of the pandemic, relative to pre-pandemic (p<0.01;~45min social media, ~20min video gaming). More time spent with screen related activities was associated with later bedtimes and wake up times (p<0.01), across the pandemic, with effects being evident in male and female adolescents. Conclusion: Our findings show profound changes in sleep timing and screen time use across the pandemic in young adolescents, and critically, that excessive screen time negatively impacts sleep. As adolescents increasingly turn to more screen usage, these data highlight the need to promote their balanced and informed use of social media platforms, video games, and other digital technology to ensure adequate opportunity to sleep and maintain other healthy behaviors during this critical period of developmental change.

Chlorpheniramine maleate nasal spray in COVID-19 patients: Case Series (preprint)

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) posted a devastating global health crisis for almost a year already. Very little is known about this virus that scientists, physicians and the medical community struggled to find treatments of this novel virus. The vaccine that can potentially combat this virus is still an unknown reality hence, the repurposing of existing medical treatments such as chlorpheniramine maleate (CPM) could be a possible treatment and is being widely utilized. CPM is a safe and effective antihistamine with potent antiviral activity against various strains of influenza A/B, thus highlighting its great antiviral potential. We tested the virucidal potential of chlorpheniramine maleate (CPM) in a nasal spray composition currently in development as an anti-allergy medication. The coronavirus disease 2019 (COVID-19) has a droplet mode transmission with a notably high viral load in the upper respiratory tract, especially the nose. Several studies had already postulated that the nose is possibly the primary route of entry of SARS-CoV-2 owing to the high expression of Angiotensin 2 converting enzyme receptors. We hypothesize that utilizing (CPM) nasal spray as an adjunct treatment to COVID-19 positive patients and reduce their clinical course and hasten their time to negativization via RT-PCR via nasopharyngeal swab. We present a series of four symptomatic patients with mild-moderate risks. CPM nasal spray was added to their current supportive treatment. All four patients showed rapid improvement of their clinical symptoms with a shorter than average time to negativization on repeat nasopharyngeal swab via RT-PCR. No safety issues were encountered during the course of treatment. Given its years of excellent safety profile with remarkable clinical results as shown in this case series, we conclude that CPM nasal spray may be a potential adjunct treatment option in patients with mild to moderate COVID-19 symptoms.