ABSTRACT
Background. Classification of MIS-C, COVID-19, and other pediatric inflammatory conditions is challenged by phenotypic overlap and absence of diagnostic laboratory evidence. Due to public health need and based on limited data from early cases, CDC developed a necessarily broad MIS-C surveillance case definition in May 2020. Studies have since shown that some criteria do not distinguish between MIS-C and other conditions and may contribute to misclassification. To inform planned revision to the CDC definition, we evaluated the impact of narrowing these criteria on case inclusion in national MIS-C surveillance. Methods. Of state and local health-department reported cases meeting the current MIS-C case definition as of 04/14/2022, we describe the proportion that met revised criteria under consideration including fever duration, C-reactive protein (CRP) elevation using a defined cutoff, and organ involvement represented by specific criteria. We also evaluated cases identified using potential combinations of revised criteria. Results. Of 8,096 MIS-C cases fulfilling the original case definition, 6,332 (78%) had sufficient data for evaluation of criteria. Of these, 96% had fever for >=2 days and 94% had a CRP >= 3.0 mg/dL (Table 1). Cardiac involvement defined by key features of MIS-C was present in 84% of cases (62% if BNP/proBNP elevation was excluded);43% had shock. Dermatologic, gastrointestinal (GI) and hematologic involvement were present in 75%, 89% and 37% of cases, respectively. Neurologic (excluding headache), renal, and respiratory involvement were present in 16%, 20%, and 63% of cases, respectively. The number of cases with >= 2 of cardiac (without BNP/proBNP elevation), shock, dermatologic, GI, or hematologic involvement was 5,733 (91%). SARS-CoV-2 testing results are shown in Table 2. Conclusion. The CDC MIS-C case definition is intentionally broad. Using national surveillance data, we evaluated case inclusion under narrower criteria, prioritizing features of MIS-C that distinguish it from similar pediatric inflammatory conditions. A surveillance case definition may not capture all cases and is not intended to replace clinical judgment. We plan to assess additional criteria combinations, describe potentially excluded cases, and incorporate findings into a revised definition.
ABSTRACT
Covid-19 struck a hard blow to the globalisation process that has been preparing for reconstructional changes since the Brexit issue has become a reality. As the Brexit negotiations were not finalised in a predetermined time range, the United Kingdom had to face the desired reality and cope with the situation hardened by the EU dissatisfaction from their decision. Existing variety of predictions of what scenarios were the most probable may now be analysed;in what aspect they were correct in predicitons. Consequences of the Brexit reality still cannot be clearly seen due to the Pandemic of Covid-19 with ongoing appearance and problems, but Post Brexit reality is, as well as, Pre Brexit reality used to be, a focus of the research object of many scholars and economists. The scientific study presents an overview of the resulting (possible) consequences of a “hard Brexit” scenario and compares them to contemporary results. The changes that were occuring before Brexit and are occuring after Brexit in the United Kingdom‘s economy and financial sector, complicated moreover by the Covid-19 pandemic situation, can be observed in economic indicators, financial and investment variables. This study concentrates on a historical evaluation of key variables that may have an impact on the economy and financial sector in order to demonstrate the evolution of the changes and relationships that exist due to the Brexit. Results of this research have led to contributing and clarifying certain essential facts having an impact on investment decisions of foreign investors throughout the world and for the EU member states. Copyright © 2022. Darina SAXUNOVA, Corlise Liesl LE ROUX AND Manuel OSTER.