The Role of Malnutrition on Outocomes of Multisystem Inflammatory Syndrome Due to Covid-19 in Children (preprint)

Background Malnutrition increases the complications and mortality in critically-ill children. A retrospective study was performed to define the role malnutrition on outcomes of multisystem inflammatory syndrome (MIS-C) due to COVID-19 in children.Methods Patients with MIS-C due to COVID-19 were evaluated for demographic features, anthropometric parameters, clinical findings and outcomes. Patients with z scores of body mass index (> 5 years-of-age) and weight-for-age (< 5 years-of-age) < -2 were considered as malnourished. Sarcopenia was defined by total psoas muscle area (tPMA), calculated on abdominal computed tomography (CT) at the level of L3 and L4 vertebrae. The z scores <- 2 for tPMA were considered as sarcopenia. The results of patients with (M+) and without (M-) were compared.Results Twenty-seven patients were included. Forty-four percent (n = 12) of patients had malnutrition. Malnutrition was classified as mild to moderate (1/3), severe (1/3) and overweight (1/3). Eighty-two cases had acute malnutrition. Among MIS-C symptom criteria, rash was significantly higher in M + children (p<0.05). Laboratory investigations showed higher ferritin levels in M + patients (p<0.05). The median tPMA and sarcopenia is significantly higher in M + when compared to M- group (42% vs 7%, p<0.05). The oral feeding time, complication rates and length of hospital stay were similar in both groups (p>0.05).Conclusion Children with MIS-C due to COVID-19 already have mild to severe malnutrition at admission. Rash and higher ferritin levels are more common in patients with malnutrition. In addition to anthropometric parameters, sarcopenia calculated using tPMA can be used to predict malnutrition in critically-ill children.

Effect of COVİD-19 Pandemic on General Surgery Practice and Resident Education (preprint)

Background Sudden change in general surgery practice during pandemic caused a detrimental effect on residency training. The main objective of this study is to reveal the effect of Covid-19 pandemic on general surgery practice and surgical residency education.Methods This retrospective cross sectional study included all patients operated at a tertiary university hospital, general surgery department between 11-March 2019/ 11- January-2019 (Pre-Covid 19 Period) and 11-march 2020- 11- January − 2020 (Covid 19 period). Two period compared in terms of case volume, complexity difference and effect of this difference on residents training.Results Overall 2740 cases included to study. Elective case volume significantly decreased during pandemic (p = 0.001). This decrease is much more obvious for B-C category operations. Intermediate seniority resident’s case volumes and complexity of the cases they performed decreased during pandemic.Conclusion Surgical residency programs must be revised urgently in order to provide adequte training which altered due to Covid-19 pandemic.