Frequency of Pathological MRI Findings in Suspected Myocarditis during the COVID-19Pandemic

Background: COVID-associated and vaccine-triggered myocarditis in young people have received much attention over the course of the pandemic due to early results of vaccination associated myocarditis. This may have led to an increase in myocarditis suspicions. In this study we wanted to examine the actual amount of COVID-associated myocarditis in ourtertiary center. Method(s): We included all cardiac MRIs performed in our institution for the indication of suspected myocarditis between 2020and 2022. We excluded patients with primary cardiomyopathy. We divided the patients into three groups: Group 1 had noCOVID infection or COVID-vaccine associated with their suspected myocarditis, group 2 had received a COVID vaccination prior to developing symptoms, group 3 had had an acute COVID infection and group 4 had a clinical diagnosis of Pediatric inflammatory multisystem syndrome (PIMS). Result(s): Overall, 28 patients had MRIs for suspected myocarditis performed at our center in the investigated time frame. They were 10 to 18 years of age (mean: 15.1 years). Symptoms included chest pain, fatigue, palpitations and reduction in exercise tolerance. Nineteen patients were in group one, 4 patients had symptoms associated with COVID vaccination, three had acute infection and two had a clinical diagnosis of PIMS. Late gadolinium enhancement (LGE) was found in 7 patients. None of these were in groups 2 or 3. Both patients with PIMS(n = 2) had myocarditis on biopsy but only one on MRI. Myocardial biopsy was performed in 8 patients. They showed myocarditis in 6 patients. Apart from the PIMS cases, none of them were associated with Corona infection or COVID vaccine. Three patients had parvovirus B19 on biopsy and one also had EBV. One of the PIMS patients also had HHV6. Theother four biopsies did not yield any viral DNA on PCR. Conclusion(s): Myocarditis associated with acute COVID infection or vaccination was not found in our cohort. Exercise intolerance or chest pain was not reliable indicators of cardiac causes. Even in the pandemic, coronavirus and COVID-19vaccines are unlikely causes of myocarditis. Most cases were associated with classic cardiotropic viruses. However, in cases of PIMS, cardiac involvement is likely and should be investigated accordingly.

Impact of wearing a FFP2 mask on cardiopulmonary fitness in school-aged children

Background and Aim: Wearing face masks to detain the COVID 19 pandemic in schools has become an integral part of fighting the virus. The most effective mask is the FFP2 mask. There is a lot of public concern, especially regarding wearing a face mask at school and especially during school sports. It is therefore important to determine whether wearing a FFP2-mask during physical activ-ity leads to changes measurable in cardiopulmonary exercise test-ing in children. Method(s): Cardiopulmonary exercise testing was performed two times by children aged 8-10 years as an incremental step test on a treadmill with and without a FFP2 within an interval of 2 weeks. A general questionnaire included medical history and sports par-ticipation since childhood. Result(s): We included 10 children (mean age 8.4 +/- 0.7 years, 6 males, 4 females). The mean parameters measured at peak exercise were comparable between both examinations (mean Peak VO2 = 39.3 +/- 3.4 vs 45.6 +/- 13.9 ml/min/kg;mean Peak HR 192/min +/- 9 vs 188/min +/- 12, mean O2pulse 6 +/- 1.4 ml/min vs. 7 +/- 1.8, mean VE 43.2 +/- 12.9 ml/min vs. 41.5 +/- 12.7 ml/min). Neither did the respiratory gases (O2 and CO2) measured 1 min into each step differ significantly (s. figure). This study is cur-rently ongoing. Conclusion(s): Since there were no significant differences with respect to peak parameters as well as with respect to the respiratory param-eters measured during each step, there is no indication to withhold physical activity even at peak capacity from children during a pan-demic which makes wearing face masks mandatory.

Impact of lockdown on cardiopulmonary function in children with heart disease

Background and Aim: The COVID-19 lockdown in Germany has led to the closure of sports facilities and to the closure of schools with their curricular physical activities (PA). However, physical activity is essential for improving or at least maintaining cardiopulmonary function assessed by VO2peak. VO2peak represents the best pre-dictor for mortality and morbidity in patients with congenital heart disease (CHD). It is therefore essential to evaluate the effect of lock-downs on this important parameter in children with heart disease. Method(s): We evaluated data from cardiopulmonary exercise data from before lockdown with twin-paired data from during lockdown. The statistically approved twin-pairing was achieved by matching patients with similar heart disease, age, sex, and test method. The subjects con-sisted of a variety of patients who had received cardiopulmonary exer-cise testing in our department in the past 3 years. Result(s): We were able to twin-pair 52 tests leading to 27 twins. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function (VO2peak: 35.7 +/- 9.8 vs.30.4 +/- 10.6) in our patient cohort along with a significant decrease in peak O2pulse (13.3 +/- 4.1 vs. 11.4 +/- 4.5), a surrogate parameter for stroke volume and most pronounced in peak minute ventilation (VE: 83.05 +/- 29.08 vs.71,49 +/- 24.96). Conclusion(s): We observed a significant decline of V O-2peak during lockdown. This involved a loss of cardiac function assessed by O2pulse as well as a loss of pulmonary function assessed by V E. We believe that the decline of these important predictive param-eters could be explained by the limited access to sports facilities as well as the restriction of regular daily movement as a consequence of closing schools and thus curricular PA. Measures need to be established to ensure access to physical activity for children suffer-ing from heart disease during lockdowns.

The congenital cardiology cloud-proof of feasibility of the first telemedical network for pediatric cardiology in germany

Background and Aim: Recent technological developments offer a multitude of new options for innovative approaches in patient care. Especially during COVID-19-pandemic, use of telemedical infrastructure has worldwide become a crucial part of pandemic containment. For an optimate interplay based on data secure exchange of diagnostical data (DD) between patients with com-plex congenital heart disease, ambulatory care and hospital care, we successfully implemented the first telemedical network for pediatric cardiology in Germany, the Congenital Cardiology Cloud (CCC). This study proofs the CCCs feasibility and analyses its technical characteristics as well as its implementation in routine clinical work. Method(s): Analysis of implementation and technical characteristics comprised numbers of incoming/outgoing data, related file types, treatment options for tele medically processed patients and patient classification with respect to severity of disease. Proof of feasibility was made by the analysis of successful telemedical transmissions of discharge documents at the end of observation period (03/2020-10/2020). Result(s): Analysis of bilateral telemedical traffic showed a number of 1178 files for a total of 349 patients, favouring transmissions towards the clinic (782 files). Incoming traffic was predominantly characterised by diagnostical data (88%), consisting of a multitude of file types, whereas 94% of the dispatched data corresponded to discharge letters. Number of teleconsultations counted up to 61 during observation period, with a necessary subsequent treatment in 90% of the presented cases. Tele medically processed patients generally showed to be more complex (severe chronic heart dis-ease 42% vs. 24%). From a total number of 422 discharged patients, 323 had a successful telemedical transmission of their discharge documents, resulting in a rate of success of 97,6% at the end of observation period (pic 1). Conclusion(s): Implementation of the first telemedical network for pediatric cardiology in Germany proofs recent technological developments to successfully enable innovative patient care, con-necting the ambulatory and hospital sector for a joint patient advice. Transferred diagnostical data facilitates mutual assessment and predominantly involves more complex cases, resulting in a subsequent necessary hospitalization. The introduction of possible governmentally guided refinancing concepts will show its long-term feasibility.

Corona-consequences: The impact of lockdown on cardiopulmonary function of children with congenital heart disease

Background: As a consequence of the COVID-19 lockdown physical activity (PA) was difficult to access. PA is essential for improving and maintaining cardiopulmonary function, assessed by cardiopulmonary exercise testing (CPET) as VO2 peak. VO2 peak is the best predictor for mortality and morbidity in patients with congenital heart disease (CHD). The question arises whether the COVID-19-lockdown led to a loss of cardiopulmonary function in typical cardiopediatric patients. Method: We conducted a retrospective study in which CPETs from before lockdown were compared with twin-paired tests during lockdown. The matching of the twins consisted of similar heart disease, comparable age, sex, and test method. The patients consisted of typical patients from our hospital. All tests were performed on either a treadmill or a bicycle. Results: We were able to twin-pair 90 tests leading to 45 twins. Overall, there were 38 healthy and 52 patients with CHD. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function in patients with CHD along with peak O2pulse and peak VEs ([Table]). Healthy children showed a nonsignificant increase of cardiopulmonary function. Conclusion: During lockdown cardiopulmonary function declined in our patients with CHD. Causes for this decline could be the lack of availability of sports facilities, restriction of regular daily movement, and the closing of schools and curricular PA. Interestingly, healthy children did not show this loss of cardiopulmonary function. Maybe this could point to more movement-oriented school concepts in the future.

Accuracy of routine laboratory tests to predict mortality and deterioration to severe or critical COVID-19 in people with SARS-CoV-2

Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:. To assess the accuracy of routine blood-based laboratory tests to predict mortality and deterioration to severe or critical (from mild or moderate) COVID-19 in people with SARS-CoV-2 infection. Secondary objectives Where data are available, we will investigate whether prognostic accuracy varies according to a specific measurement or test, reference standard, timing of outcome verification, sample type, study design, and setting, including prevalence of the target condition (either by stratified analysis or meta-regression).

Applied Biosecurity in the Face of Epidemics and Pandemics: The COVID-19 Pandemic

Biosecurity as a discipline remains largely defined by institutional-level practices unbounded by the guidelines and checklists prevalent in the field of biosafety. The result is a high-level of interpretation at the individual and institutional level of defining and implementing biosecurity. At its core, biosecurity frameworks are largely anchored to a mirrored process of risk assessment and management. Therefore, biosecurity is still rooted in the fields of threat and vulnerability assessment, analysis, and management. The aperture of threat and vulnerability management may at first seem contrary to the overall field of public health where emerging infectious disease, and the negative consequences, are more commonly perceived as risks. However, in the spectrum of threat to vulnerability to risk (see Chaps. “ Redefining Biosecurity by Application in Global Health, Biodefense, and Developing Technologies ” and “ The Biothreat Assessment as a Foundation for Biosecurity ”) infectious disease as an entity emerges as a threat. The ability or inability to respond and defend from infectious disease can be characterized as vulnerabilities. The negative consequences (e.g., spread of, infection, mortality, economic impacts) exist as a probability of occurrence, or simply, a risk. This is increasingly evident at the time of composition of this chapter and this book during the global COVID-19 pandemic. This chapter explores the parallels and distinctions of biosecurity-related concepts as they apply to the COVID-19 pandemic, lessons learned from previous epidemics and pandemics, and offers suggestions of stronger connectivity to threat and vulnerability management concepts as we inevitably prepare for future epidemics and pandemics. © 2021, Springer Nature Switzerland AG.

Clinical characterization of respiratory large droplet production during common airway procedures using high-speed imaging.

During the COVID-19 pandemic, a significant number of healthcare workers have been infected with SARS-CoV-2. However, there remains little knowledge regarding large droplet dissemination during airway management procedures in real life settings. 12 different airway management procedures were investigated during routine clinical care. A high-speed video camera (1000 frames/second) was for imaging. Quantitative droplet characteristics as size, distance traveled, and velocity were computed. Droplets were detected in 8/12 procedures. The droplet trajectories could be divided into two distinctive patterns (type 1/2). Type 1 represented a ballistic trajectory with higher speed large droplets whereas type 2 represented a random trajectory of slower particles that persisted longer in air. The use of tracheal cannula filters reduced the amount of droplets. Respiratory droplet patterns generated during airway management procedures follow two distinctive trajectories based on the influence of aerodynamic forces. Speaking and coughing produce more droplets than non-invasive ventilation therapy confirming these behaviors as exposure risks. Even large droplets may exhibit patterns resembling the fluid dynamics smaller airborne aerosols that follow the airflow convectively and may place the healthcare provider at risk.

Diagnosis of SARS-CoV-2 infection and COVID-19: accuracy of signs and symptoms;molecular, antigen, and antibody tests;and routine laboratory markers

Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:. To assess the diagnostic accuracy of laboratory real-time polymerase chain reaction (RT-PCR) and other laboratory molecular tests to determine if a person presenting in the community or in secondary care has SARS-CoV-2 infection. To assess the diagnostic accuracy of each rapid PCR and antigen test to determine if a person presenting in the community or in secondary care has SARS-CoV-2 infection. To assess the diagnostic accuracy of each antibody test to determine if a person presenting in the community or in secondary care has SARS-CoV-2 infection, or has previously had SARS-CoV-2 infection. To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in the community, general practice, or at the emergency department has SARS-CoV-2 infection, COVID-19 pneumonia, or severe COVID-19 pneumonia/ARDS requiring hospital admission. To assess the diagnostic accuracy of routine laboratory testing to determine if a person has COVID-19 pneumonia or SARS-CoV-2 infection. Secondary objectives Where data are available, for reviews #1 to #5, we will investigate the accuracy (either by stratified analysis or meta-regression) according to: laboratory method, days of symptoms, severity of symptoms, reference standard, sample type, study design, setting;test brand and version, days of symptoms, severity of symptoms, reference standard, sample type, study design, setting;current infection or past infection, test brand and version, days of symptoms or days since symptoms resolved, reference standard, study design, setting;days of symptoms, reference standard, study design, setting;specific measurement or biomarker, days of symptoms, severity of symptoms, reference standard, sample type, study design, setting.