Long term clinical and lung function test assessment in critically ill covid-19 patients: a 1-year follow-up

Introduction: patients with severe interstitial Sars-CoV-2-related pneumonia may experience residual symptoms and impaired quality of life after being discharged. In our Hospital we planned a long-term follow-up protocol that has currently evaluated over 1400 inpatients. Aim(s): to monitor a subset of critical COVID-19 patients (need for ICU admittance or non-invasive ventilation) after discharge using clinical parameters and lung function tests (LFT) and evaluate long-term consequences on lung performance. Method(s): we monitored LFT, DLCO and 6MWT of 93 critically ill COVID-19 patients 1 month after discharge and up to 12 months later. No patient received any additional treatment. Follow-up is still ongoing. Result(s): we noted altered DLCO 1 month after discharge (T0). At T0 no patient showed desaturation at the 6MWT. Assessment of long-term follow-up (T1 - on average 10.2 months) showed significant improvement in LFT parameters, notably DLCO (table 1). 6MWT was not repeated. Conclusion(s): Altered LFT parameters are confirmed as consequences of severe ventilated Sars-CoV-2 pneumonia. Our work additionally demonstrates that these alterations are at least partially spontaneously reversible and do not seem to imply clinical consequences.

Bronchiolitis vs. COVID-19: epidemiologic correlations from a single Pediatric Unit experience

Introduction: The spread of SARS-CoV-2 pandemia in Europe has been socially counteracted with the aid of nonpharmaceutical interventions (NPIs). This rapidly changed the epidemiology of viral respiratory diseases other than the COVID-19. Thus a sharp decrease in bronchiolitis patients has been recorded all over Europe since 2020. Aims and Objectives: Due to the looser NPIs and to the increased accesses to hospitals than the year before we chose to analyze the series of admissions to our Unit either for bronchiolitis or for COVID-19, from 2021 October, 1st to 2022 January, 31st. Method(s): Data were obtained from the hospital database. Overall 2582 patients accessed the Pediatric Emergency Room (PER). Of them 228 (8.8%) were admitted to the Pediatric Unit (PU). All admissions were tested for SARSCoV-2 by nasopharyngeal molecular swab. Result(s): Overall we recorded 71 bronchiolitis and 26 COVID-19. Data are reported in the table herein. View inline In January 2022 the COVID-19 impacted overall admissions more significantly than did the bronchiolitis in November plus December 2021 (chi2, p<0.01). Conclusion(s): By our limited experience we tried to describe the relationships that seemingly regulate the epidemiology of respiratory viruses. As a matter of fact, when one virus promptly emerged the other seemed to find no space in the ecosystem despite the rules for NPIs did not change meanwhile. Epidemiology of viruses looking for the same habitat maybe needs furher evaluations.

[Possible vaccine-induced immune thrombotic thrombocytopenia in a patient with diabetes and chronic kidney disease or random association?]

We report the case of a 75-year-old man who developed acute myocardial infarction 12 hours after the first dose of ChAdOx1 nCov-19 vaccine. The event was associated with a transient decrease of platelet count and the detection of anti-PF4 antibodies approximately 45 days after the event. Vaccine-induced thrombotic thrombocytopenia (VITT) is characterized by the onset of venous or arterial thrombosis in temporal relationship to the administration of anti-Sars-Cov-2 viral vector vaccines (ChAdOx1 nCov-19 and Ad26.COV2.S), thrombocytopenia and the production of anti-PF4 antibodies. It occurs mainly at a young age, even if the median age is 54 years;it is often associated with thrombosis in atypical sites, such as the cerebral sinus. Our reported case does not present all the diagnostic criteria of VITT. However, the close temporal relationship between ChAdOx1 nCov-19 vaccine administration, thrombosis, and concomitant anti-PF4 antibodies positivity makes the case suggestive of a possible slight form of VITT.

Urban outdoor movement education: A playground to promote physical activity. the case of the “primo sport 0246”playground

Problem Statement Adequate levels of physical activity (PA) have important effects on mental and physical health;the positive consequences of PA during childhood influence the quality of life and health of children, and also have an impact on the future adults. The movement restrictions imposed by Covid-19 pandemic has resulted in a substantial decrease in levels of PA and an increase in mental and health-related problems. Environments in the open air have been recommended as sites PA;together with mask use, frequent hand washing, and social distancing, outdoor activities should have been performed to maintain adequate levels of PA in children. However, opportunities for outdoor activities are usually limited in urban contexts, where most of the population in Western countries live. Inside the cities, playgrounds represent the most common children opportunities for outdoor activities. Very little is known about the use of playgroundsas tools for increasing levels of PA and promoting motor competences. In this study, we focus on "Primo Sport 0246", a playground dedicated to the promotion of motor development in preschool children. By reviewing the scientific literature on this playground, we identify the conditions that should be taken into consideration when designing new playgrounds in urban spaces dedicated to the development of motor competences in children. Approach In this article, we review the scientific literature on the "Primo Sport 0246" playground. Located in Treviso, northern Italy, the playground was designed and built in 2011. The design was based on available scientific knowledge on factors that promote the acquisition of motor competences in children. In the following years, the playground became the object of scientific studies addressing questions related to motor and cognitive development of children. In this review, we describe the most relevant findings that may guide teachers, instructors or parents in their difficult task of educating children toward the acquisition of healthy lifestyles. Purpose The major questions addressed when studying the efficacy of the playground and the teaching methodologies to be used, have been the following: Which is the best way to use the park to promote the development of motor skills and executive functions in pre-schoolers? How much do children move in the playground? Can the "Primo Sport 0246" playground model and the teaching methodologies be transferred to kindergartens? Results Studies at the "Primo Sport 0246" playground demonstrated that structured physical activity combined with free play was more effective than free activity alone in promoting thedevelopment of motor skills and executive functions in preschool children;well organized, structured activities also induced a larger and longer participation to physical activities of moderate/intense levels, i.e., the levels considered necessary for generating persisting beneficial effects on health.Development and potentiation of executive functions were found to occur when children were involved in difficult activities and games in the zone of proximal development associated with scaffolding by the teacher or an experienced partner. Teachers considered the outdoor activities performed in the park a unique opportunity for pre-schooler development. Conclusions The Primo Sport playground is an excellent tool for promoting physical activity, development of motor skills and executive functions in preschool children. The design, that considers specific areas for training manual dexterity, mobility and balance, facilitate this generation of significant benefits in terms of acquisition and potentiation of motor competences and executive functions. The use of the playground in an educational context should consider a combination of moments of free play and structured activities. The presence of difficult tasks (in the area of proximal development) associated with scaffolding by teachers/parents/educators, facilitates the development of motor competences and has positive effects on levels of executive functions. © JPES.