ABSTRACT
Introduction: Italy was the first EU country to be affected by COVID-19 outbreak. The sudden change in everyday life was challenging for children and young people (CYP) who rely heavily on peer connections for emotional and social support. Concerns for consequences in CYP with type 1 diabetes (T1D) rose. Objective(s): To compare the diabetes-specific health-related quality of life (D-HRQOL) of CYP with T1D and their parents and the glycemic control before and after COVID-19-related lockdown. Method(s): The Pediatric Quality of Life InventoryTM 3.0 Diabetes Module (PedsQLTM 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (December 2019-February 2020;T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (June 2020;T1) during a routine outpatient or telemedicine visit. Data on diabetic ketoacidosis (DKA), severe hypoglycemic events, insulin therapy [dose and delivery method (MDI/CSII)], glucose monitoring method (SBGM/isCGM/rtCGM), glycosylate hemoglobin (HbA1c), physical activity (h/week), and SARS-CoV-2 infection were also collected. Continuous and categorical data are reported as median and percentage, respectively. Result(s): Sixty-two CYP (males 48.4%;age: 12.6 [5.25-17.8] years;T1D duration 4.23 [0.45- 16.4] years;MDI 71%;rtCGM 52%, SBGM 29%, and isCGM 19%;telemedicine visit 56.5%) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' and fathers' scales scores did not significantly change from T0 to T1. Mothers' 'Diabetes symptoms' scale score increased (67.0 vs. 70.4;p=0.007). According to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), D-HRQOL data were longitudinally comparable and no differences was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded in patients. Despite the significant decrease of exercise from T0 to T1 (3.25 vs. 0.50 h/week;p<0.0001), glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' 'Diabetes symptoms' (R=-0.41, p<0.001), 'Worry' (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusion(s): During COVID-19 pandemic-related lockdown the D-HRQOL did not change in CYP with T1D and their parents. During visits we stressed the importance to keep a balanced nutritional program, according to new time spent on exercise, making diabetes managements easier and allowing the maintenance of good glycemic control without acute complications.
ABSTRACT
Introduction: Since the beginning of the coronavirus disease 2019, (COVID-19) pandemic concerns for consequences on auxological data and glycemic control in patients with type 1 diabetes (T1D) were raised. Objective(s): To investigate the 2-years effects of the COVID-19 pandemic on body mass index (BMI) and glycemic control in children and adolescents with T1D. Method(s): Data on type and number of annual visit, auxological parameters [height (Ht), weight, and waist circumference (W)], insulin total daily dose (TDD), glycemic control (HbA1c), and weekly physical activity were collected during the annual routine outpatient visit between Dec 2021-Feb 2022 (T2) and were compared with those during the same period in 2019-20 (T0;before lockdown) and in 2020-21 (T1). Result(s): A 83 children and adolescents with T1D [65% male;median age 14.3 years (range 6.3-18.5);T1D duration 7.09 years (range 2.9-16.3)] were enrolled. The annual number of outpatient visits decreased (4 vs. 3 vs. 3;chi2 = 74.2;p < 0.0001), while frequency of patient using telemedicine increased (0 vs. 55.4 vs. 33.7%;chi2 = 48.1;p < 0.0001). BMI z-score significantly changed between periods, remaining within normal range values (0.19 vs. 0.08 vs. 0.23 SDS;chi2 = 15.9;p < 0.001). Height and WHt ratio were comparable. Physical activity was significantly different between periods (4 vs. 0 vs. 5 h/week;chi2 = 128.4;p < 0.0001) as well as insulin TDD (0.84 vs. 0.92 vs. 0.92 IU/kg/day;chi2 = 8.19;p = 0.017). Average of annual HbA1c values significantly improved (62.1 vs. 60.5 vs. 60.6 mmol/mol;X2 = 12.8;p = 0.002). Rate of secondary DKA remained comparable and no severe hypoglycemic event was recorder during follow-up. Conclusion(s): In our patients, BMI z-score was unchanged and glycemic control remained improved in the 2-years after COVID-19 pandemic spread. Our data may be possibly related to both the resuming of regular exercise and the increased use of sensor during T1 that allowed to continue with telemedicine visits in T2, adjusting patients' insulin TDD and avoiding acute complications.
ABSTRACT
Introduction: Since the beginning of the COVID-19 pandemic, concerns for consequences in patients with type 1 diabetes (T1D) were raised. Objectives: To compare the diabetes-specific health-related quality of life (D-HRQOL) of youths with T1D and their parents before and after the COVID-19-related lockdown. Methods: The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Patients who filled the D-HRQOL before lockdown (Dec-19-Feb-20;T0) were recruited in the study and filled the same survey immediately after the lockdown was stopped (Jun-20;T1) during a routine outpatient or telemedicine visit. Results: Sixty-two patients (median age: 12.6 [5.25-17.8] yrs;T1D duration 4.23 [0.45- 16.4] yrs) with T1D and their parents (60 mothers, 10 fathers) were enrolled. Patients' scales scores did not significantly change from T0 to T1. Mothers significantly increased their Diabetes symptoms scale score (median 67.0 vs. 70.4;p=0.007). Data were also analyzed according to visit type (outpatient vs. telemedicine), glucose monitoring (SBGM vs. isCGM vs. rtCGM), and insulin therapy (MDI vs. CSII), but D-HRQOL data were longitudinally comparable and no difference was found between groups. During lockdown no DKA, severe hypoglycemic events, and SARS-CoV-2 were recorded. Despite the significant decrease of exercise (median 3.25 vs. 0.50 h/week;p<0.0001), median glycemic control (HbA1c 58.5 vs. 57.9 mmol/mol) and total daily insulin dose (0.86 vs. 0.82 IU/kg/day) were unchanged. At T1, the lower the HbA1c, the better patients' Diabetes symptoms (R=-0.41, p<0.001), Worry (R=-0.27, p=0.032) scales, and total scores (R=-0.33, p=0.009). Similar results were found in parents. Conclusions: During COVID-19 pandemic-related lockdown the D-HRQOL did not change in children and adolescents with T1D and their parents. Our data may be possibly related to staying at home, making diabetes managements easier and also allowing the maintenance of good glycemic control without acute complications.
ABSTRACT
Objective Kocuria species (KS) are gram-positive, coagulase-negative coccoids. Reports about KS infection in children are limited. We performed a short-review of literature and described a case of catheter related-bloodstream infection (CR-BSI) caused by KS. Methods and procedures Electronic search through PubMed was conducted using the keywords: “Kocuria” AND “children” AND “sepsis”. The earliest publication date was of 2008, the latest of 2017 Results We analyzed 7 articles with 15 cases described. KS were responsible of endocarditis in 1 child, CR-BSI in 13 children and spontaneous bacterial peritonitis in 2 children. Most were immunocompromised hosts and CVC-carriers (2 short-bowel syndrome, 2 tumor, 1 congenital tufting-enteropathy, 1 Hirschsprung's disease, 1 methylmalonic-aciduria, 6 prematurity). Only 1 was an otherwise healthy child. Case report: during the COVID-19 lockdown, a 17yeas-old boy affected by Hirschsprung's disease and CVC-carrier developed fever, chills, vomit and hematuria. Due to “hospital fear”, he began empirical therapy with ceftriaxone at home, without symptoms resolution. Once admitted to the department, blood exams showed: normal lymphocyte immunophenotyping, thrombocytopenia, increased CRP and hyperbilirubinaemia. Haematuria, proteinuria and glycosuria also occurred. Culturing blood samples showed KS infection. Echocardiography was normal. Basing on the antibiogram, we started treatment with vancomycin with rapid patient recovery. Conclusion The use of CVCs in immunocompromised patients represents the most important risk factor for KS-BSI. Due to the limited number of reports about this infection, there are no guidelines to manage it.In patients with a chronic disease, opportunistic pathogens as KS must be considered, also because symptoms and complications are still unknown.