Physical and respiratory function of people following hospital discharge for COVID-19

Background: People following hospital discharge for COVID-19 may experience persisting negative effects of the disease. Investigation of the short and long-term effects are necessary to refer people to appropriate rehabilitation services for functional recovery. Aim(s): To evaluate physical and respiratory function of people with COVID-19 shortly after hospital discharge. Method(s): Assessments were undertaken at three time points: (i) within three weeks following hospital discharge (A1);(ii) at three months (A2);and (iii) six months following discharge (A3). Measures were collected of: fatigue (Fatigue Severity Scale;FSS), lower-limb function (1 minute sit-to-stand test;1-STS), pulmonary function (spirometry), dyspnea (MRC Scale) and physical activity in daily life (PADL) (accelerometry). Result(s): Forty people were included (18[45%] men;55[51-60] years;length of hospital stay: 8+/-6 days;FSS: 54.5[44.2-59];1-STS: 21+/-7;FVC %pred: 87+/-15;FEV1 %pred: 88+/-15;FEV1/FVC (%): 83+/-6;4,284+/-2,460 steps/day;MRC: 3+/-1). There was a: reduction in fatigue from A1 to A2 (mean difference [95% CI] -1.8 [-2,5;-1.2])] and from A1 to A3 (-2.2 [-2.9;-1.4]);an improvement in lower-limb function from A1 to A2 (5.1 [2.2;7,9]) and from A1 to A3 (5.6 [3.18;8]);an improvement in FVC %pred from A1 to A3 (5.9 [1.5;10.2]);and a reduction on dyspnea from A1 to A2 (-1.2 [-0.6;-0.3]) and from A1 to A3 [-1.2 (-0.6;-1,8)]. No change in PADL was found. Conclusion(s): People with COVID-19 post-hospital discharge present fatigue, functional impairment, dyspnea, poor PADL and normal lung function. Improvements in dyspnea, fatigue and lower-limb function were observed at three and six-months follow-up.

Contemporaneity of Rabindranath Tagore's Ideals of Rural Reconstruction and Ecological Harmony

India witnessed a mass exodus of migrants to the countryside during the lockdown that was enforced as one of the major COVID-19 pandemic control strategies. With workplaces and transportation shut down, the migrant labourers were forced to walk hundreds of kilometres back to their villages to survive the sudden economic crisis. This COVID-19 induced reverse migration problematizes the fact that rural India, largely, remains economically dependent on income from migration and daily-wage labour in the urban areas. This brings forth the urgency to revive village systems for sustenance. Villages are the soul of India and need to be transformed to initiate the prosperity of humanity in the context of Nature. One of the prominent Indian thinkers to stress Village Reconstruction was the Nobel Laureate, Rabindranath Tagore. This study, with the framework of Deep Ecology, Ecological Humanism, and Tagore's own ideologies of ecological harmony, seeks to draw a parallel between Tagore's ideas put forth in his essay "City and Village," (Palli-prakritil and his Sriniketan Experiment of 1922, in understanding the relevance of his ideas in the current context of COVID-19 pandemic.

SARS-CoV-2 in pediatric age group: Multiple clinical presentations and broad spectrum of severity

INTRODUCTION: Since the new coronavirus began to spread throughout the world children and adolescents were affected on a smaller scale than adults, being mostly asymptomatic carriers or having mild to moderate symptoms, with lower risk of developing serious complications. When infected, patients in the pediatric age group presented a range of varied symptoms associated with the virus, different from adults where the main clinical symptom was respiratory. METHODS: Eight patients were admitted to our pediatric intensive care unit with a diagnosis of SARS-CoV-2, confirmed by PCR or serology;of these 3 were asymptomatic or presented mild flu symptoms, 2 had clinical presentation typical of severe acute respiratory distress syndrome, 1 presented abdominal pain associated with multisystemic inflammatory syndrome, 1 had clinical presentation of acute respiratory distress syndrome and later admitted again to our service fulfilling criteria for multisystemic inflammatory syndrome and 1 presented ischemic stroke after SARSCoV- 2. Four patients with severe symptoms required ventilatory support through mechanical ventilation due to respiratory failure, in most cases, difficult to manage and with shock requiring vasoactive drugs. Unlike adults, none of the 8 patients required renal replacement therapy. No outcome evolved to death. RESULTS: The diagnosis and management of SARS-CoV-2 in pediatrics is a challenge, due to this varied clinic and little experience of professionals due to a small number of cases, making this study important for better knowledge about the disease, thus improving care.

Ischemic stroke on multisystem inflammatory syndrome associated with SARS-CoV-2

INTRODUCTION: The World Health Association declared at match 2020 that the disease caused by nCoV-2019, the SARS-Cov-2, became a pandemic infection. The majority of patients infected by this new virus presented fever, cough and dyspnea, but also were reported cases of pneumonia leading to acute distress respiratory syndrome, acute kidney injury and encephalitis. Also, some patients presented a transient ischemic attack or a brain stroke as a complication of the infection. We will report a case of a pediatric patient that evolved with ischemic stroke after infection by nCoV-2019. METHODS: An 8 years old female patient, with previous asymptomatic infection by nCoV-2019 and no past medical history, started headache, abdominal pain and persistent fever for seven days evolving to left hemiparesis. At clinical assessment presented with ocular opening only when called (Glasgow coma scale of 14), tachypnea, dyspnea, hypotension, grade 3 muscular strength on left leg and grade 0 on left arm. Due to hypotension, at emergency sector, were initiated treatment with fluid resuscitation, but patient evolved to refractory shock needing vasoactive drugs and transference to intensive care unit. Performed cranial CT scan that showed recent extensive ischemic injury on territory supplied by left middle cerebral artery and occlusion of right internal carotid artery bifurcation. On laboratory tests patient presented increased C-reactive protein (35,8 mg/dL), ferritin (807 mg/ dL), D-dimer (13,69 μg/mL), ESR (50 mm/h) and troponin (0,097 ng/mL) with negative RT-PCR for SARS-CoV-2 and serology for SARS-CoV-2 with negative IgM, negative IgA and positive IgG. Towards this clinical case, patient fulfilled criteria for Pediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), so were initiated treatment with human immunoglobulin 2g/Kg at the 3rd day after the admission of the patient on the intensive care unit. Patient evolved hemodynamically stable, being possible to suspend vasoactive drugs at the 4th day after admission. RESULTS: Although PIMS-TS is still considered a rare outcome, recognize its clinical and laboratorial manifestations and its possible complications, like the ischemic stroke, is essential to make an adequate and a timely management during patient hospitalization.