ABSTRACT
It is known that the SARS-CoV-2 virus may cause neurologic damage. Rapid-onset obesity, hypoventilation, hypothalamus dysfunction, and autonomic dysregulation (ROHHAD) syndrome is a disease of unknown etiology with a progressive course and unclear outcomes. The etiology of ROHHAD syndrome includes genetic, epigenetic, paraneoplastic, and immune-mediated theories, but to our knowledge, viral-associated cases of the disease have not been described yet. Here we present the case of a 4-year-old girl who developed a ROHHAD syndrome-like phenotype after a COVID-19 infection and the results of 5 months of therapy. She had COVID-19 pneumonia, followed by electrolyte disturbances (hypernatremia and hyperchloremia), hypocorticism and hypothyroidism, central hypoventilation-requiring prolonged assisted lung ventilation-bulimia, and progressive obesity with hypertriglyceridemia, dyslipidemia, hyperuricemia, and hyperinsulinemia. The repeated MRI of the brain and hypothalamic-pituitary region with contrast enhancement showed mild post-hypoxic changes. Prader-Willi/Angelman syndrome as well as PHOX2B-associated variants was ruled out. Treatment with non-steroidal anti-inflammatory drugs and monthly courses of intravenous immunoglobulin led to a dramatic improvement. Herein the first description of ROHHAD-like syndrome is timely associated with a previous COVID-19 infection with possible primarily viral or immune-mediated hypothalamic involvement.
ABSTRACT
The rapid spread of COVID-19 and the large number of cases put a significant burden on the health systems of any developed country. Specialists in natural disasters and military medicine should be involved in the provision of medical care and observance of anti-epidemic measures. In some countries, including Italy, they were involved only after the situation was dramatically worsening with many clinical units and hospitals overloaded by infected patients. To curb the spread of COVID-19, most countries declared a state of emergency, and unprecedented measures have been taken to strengthen quarantine in suspected or positive symptomatic subjects. Nevertheless, the crisis associated with the unexpectedly global scale and tragedy of the pandemic and the inconsistency of actions of both society and individuals and specialized medical services, lead to insufficient effectiveness of the measures taken in a number of regions. In the present day, it is vital for every person to change its mindset - relying on personal responsibility to comply with all recommendations of quarantine and anti-epidemic measures, and to reorganize departments and resources of medical institutions at all levels in order to withstand the spread of infection and at the same time provide all those in need with the necessary and appropriate medical care. Particular attention should be paid to the obstetric care service, given that even in “normal” times, the obstetric hospital is an area of increased responsibility for the life and health of mother and child and future mankind. Fulfillment of existing orders, instructions of national and regional committees, international and national protocols and clinical protocols should undoubtedly lead to a positive result, but this requires additional training of medical personnel at all levels. The purpose of this review is to propose quick key strategies for reassessing the maternity and neonatal wards/ hospitals based on the experience of health systems and organizations which faced the spread of this new coronavirus;this advice may be applied along with binding tight instructions in obstetric hospitals in order to proactively respond to a likely wave of growth in COVID-19. Актуальность. Быстрое распространение COVID-19 и большое количество заболевших накладывает значительную нагрузку на системы здравоохранения развитых государств. В ряде стран к оказанию медицинской помощи и соблюдению противоэпидемических мероприятий привлекаются специалисты по стихийным бедствиям и военной медицине, однако в некоторых странах, в том числе в Италии, они были задействованы после того, как многие клинические подразделения и стационары были перегружены. Для сдерживания распространения COVID-19 большинство стран объявили чрезвычайное положение, были приняты беспрецедентные меры по усилению карантинных мероприятий. Тем не менее кризис, связанный с неожиданно глобальным масштабом и трагичностью пандемии, и несогласованность действий как общества и отдельных граждан, так и специализированных медицинских служб приводят к недостаточной эффективности проводимых мероприятий в ряде регионов. Особое внимание следует уделить службе родовспоможения, учитывая, что и в спокойное время акушерский стационар является зоной повышенной ответственности за жизнь и здоровье матери и ребенка. Исполнение действующих приказов, указаний национальных и региональных комитетов, международных/национальных и клинических протоколов, несомненно, приведет к положительному результату, но требует дополнительного обучения и тренировки медицинского персонала всех уровней. Цель обзора - предложить ключевые стратегии, основываясь на опыте регионов, ранее столкнувшихся с распространением нового коронавируса, которые могут быть быстро применены наряду с обязательными к исполнению действующими приказами и распоряжениями в акушерских стационарах, чтобы превентивно отреагировать на вероятную волну роста заболеваемости и носительства COVID-19.