Risk factors for worsening of somatic symptom burden in a prospective cohort during the COVID-19 pandemic

Aims: Little is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence. This study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection. Method(s): German healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires at baseline and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up. Result(s): Seven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden. Conclusion(s): This study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates.Copyright © 2023

The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda.

INTRODUCTION: This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. METHODS: The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. RESULTS: In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. CONCLUSIONS: The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.

Ecmo utilization in multisystem inflammatory syndrome in children (mis-c)

Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is an entity described in children after infection with SARS-CoV-2. Current literature reports wide variability of extracorporeal membrane oxygenation (ECMO) utilization (2-28%) and mortality (0-28%). Details of the ECMO course, including duration, complications, and outcomes have been limited. We present a case series of 5 patients successfully managed with ECMO for MIS-C. Methods: A retrospective chart review of all patients requiring ECMO for MIS-C was performed at a single center tertiary pediatric institution between June 2020 and March 2021. Demographics, complications, and outcomes were analyzed. Results: Five patients required ECMO (median age 12.6 years, range 4-17). Venoarterial ECMO (5/5) was initiated for acute decompensated heart failure (n=4) or arrhythmia (n=1) with 2/5 patients requiring ECPR. Median ECMO duration was 6 days. Anticoagulation included heparin only (n=2), direct thrombin inhibitor only (n=1), or combination (n=2). ECMO courses were complicated by extensive systemic thrombosis in 1/5, intracardiac thrombus in 3/5, compartment syndrome requiring fasciotomy in 1 (complete recovery of limb function). Tissue plasminogen activator (t-PA) was utilized for extensive thrombosis in 2/5 patients. All patients survived to hospital discharge with excellent neurologic outcomes. Cardiac function normalized in 5/5 patients with only moderate mitral regurgitation in 1 patient. Conclusion: ECMO can be successfully employed to support cardiac function in patients with MIS-C. Anticoagulation in this population remains challenging with thrombotic complications being common;however, outcomes are encouraging with 100% survival in this case series with complete recovery of cardiac function and return to neurologic baseline.

Ground-penetrating radar prospections at the Roman Domus of Mdina (Malta)

Ground-penetrating radar (GPR) mapping provides a three-dimensional analysis of archaeological features within the context of landscape studies. The method’s ability to measure the intensity of radar reflections from deep in the ground can produce images and maps of buried features not visible on the surface. A study was conducted in some areas near the Domus Romana in Rabat (Malta) in order to investigate the still uncovered archaeological structures. The purpose of the GPR survey was to guide the excavation operations (planned but postponed due to Covid-19) and to allow us to understand the development of the defensive walls of the city and any other structures related to the Roman mansion. The choice of the areas to be investigated was therefore guided both by previous archaeological excavations and by the considerations made above. The results obtained through the GPR made it possible to shed light on some of the aspects related to the questions posed by the archaeologists, highlighting part of the structures related to the defensive walls, part of the structures related to water supply and conservation and part of the wall structures related to the Roman mansion itself. © 2020 Australian Society of Exploration Geophysicists.