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Introduction: The coronavirus disease 19 (COVID19) pandemic urged to develop new vaccines to reduce the morbidity and mortality associated with this disease. Recognition and report of potential adverse effects of these novel vaccines (especially the urgent and life-threatening ones) is therefore essential. Case Presentation: A 16-year-old boy presented to the Paediatric Emergency Department with polyuria (9 liters per day), polydipsia and concomitant weight loss (- 6 Kg) over the last four months. His past medical history was unremarkable. Onset of symptoms was referred to be few days after second dose of anti- COVID19 BNT162b2 Comirnaty vaccine. The patient was admitted to the Paediatric Department. The physical exam was normal, without neurological abnormalities. Auxological parameters were within normal limits (height -0.12 SDS, weight +0.35 SDS). Daily fluid balance monitoring confirmed polyuria and polydipsia (IN 6,250 L / OUT 7,100 L). Biochemistry laboratory analysis and urine culture were normal (Sodium levels 141 mEq/L). Serum osmolality was 297 mOsm/Kg H2O (normal values 285-305), whereas urine osmolality was 80 mOsm/Kg H2O (normal values 100-1100), suggesting diabetes insipidus. Hormonal tests showed no significant impairment of anterior pituitary function. Test with Desmopressin was performed and confirmed the diagnosis of central diabetes insipidus. Brain MRI revealed pituitary stalk enlargement (4 mm) with contrast enhancement, and loss of posterior pituitary bright spot on T1 weighted imaging. Even in absence of pituitary enlargement, those signs were consistent with neuroinfundibulohypophysitis. Immunoglobulin levels were normal. Low doses of oral Desmopressin were sufficient to control patient's symptoms, normalizing serum and urinary osmolality values and daily fluid balance at discharge. Brain MRI after 2 months showed stable thicken pituitary stalk and detectable small posterior pituitary. Due to persistence of polyuria and polydipsia, therapy with Desmopressin was adjusted by increasing dosage and number of daily administrations. Clinical and neuroradiological follow-up is still ongoing. Conclusion(s): Hypophysitis is a rare disorder characterized by lymphocytic, granulomatous, plasmacytic, or xanthomatous infiltration of the pituitary gland and stalk. Common manifestations are headache, hypopituitarism, and diabetes insipidus. To date, only time correlation between SARS-CoV-2 infection and development of hypophysitis and subsequent hypopituitarism has been reported. Further studies will be needed to deepen a possible causal link between anti-COVID19 vaccine and diabetes insipidus.
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Introduction: It is currently not well known if the incidence of type 1 diabetes (T1D) changed during COVID-19 pandemic. Objective(s): Basing on two population-based registries collecting data of new cases in Italy since 1989, we analyzed changes on incidence in a long and short period. Method(s): All new cases of T1D in children aged between 0.5 and 14, recruited by the Piedmont and Marche registries during 1989- 2021, were considered. Poisson regression was used to estimate the incidence trend, adjusted for age and sex, for the period 1989-2019 and to predict the incidence in the years 2020 and 2021. The observed rates in the years of the pandemic were compared with those predicted by the model and with those of the three-year prepandemic period 2017-2019. Result(s): Between 1989 and 2021, 4009 children diagnosed with T1D were observed, 2144 males (53.5%). The standardized incidence for the entire period was 16.9 (95%CI 14.4-17.5) per 100,000 personyears, 17.6 and 16.2 for males and females respectively. The incidence over time increased from 12.0 (95% CI 9.6-14.4) in 1989 to 20.9 (95% CI 17.5-24.9) in 2019, with an annual increasing trend of 1.9% (95% CI 1.5-2.2). The observed incidence rates in 2020 and 2021 were 21.6 (95% CI: 18.3-25.3) and 26.7 (95% CI 23.0-30.9) respectively, not significantly different from the ones predicted by the model, 21.6 (95%CI 20.3-23.0;p = 0.995) and 22.0 (95%CI 20.5- 26.6;p = 0.074). The mean incidence rate of T1D in the pre-pandemic 3 years, equal to 20.5 (95%CI 18.6-22.5), was not different from that of 2020, but significantly lower than that observed in 2021 (<0.001). Conclusion(s): The incidence of T1D < 15 years continues to increase over time. During 2020-2021, the observed incidence was in line with the expected trend 1989-2019. However, narrowing the analysis to 2017-2021, there was a higher incidence in 2021. Continuous observation of T1D in children is critical to better understanding the role of COVID-19 in influencing the disease.
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Introduction: Multisystem inflammatory syndrome in children (MISC), or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), is a newly described pediatric syndrome, partially overlapping with Kawasaki Disease (KD) and Macrophage Activation Syndrome. According to the literature, MIS-C requires ICU admission in 73,3% of cases, with 1.9% overall mortality. Patients may develop coronary artery anomalies (CAA), either dilatations (11,6%) or aneurysms (10,3%). Most physicians have been treating MIS-C like KD, so far. Conversely, based on our experience, since April 2020 we have been treating MIS-C patients with IV methylprednisolone (MP) as a first-tier monotherapy: herein, we present the outcome of the first 23 consecutive patients treated according to our treatment protocol. Objectives: To evaluate the outcome (ICU admission, inotropic support, coronary abnormalities) of a cohort of consecutive MIS-C patients treated with MP as first-line monotherapy. Methods: Patients satisfying the WHO preliminary case definition of MIS-C, with no need of inotropic support at admission, have been treated with fluid restriction and MP monotherapy, the dose depending on the presence/absence of myocardial involvement: if hypotension according to age, gender, and height adjusted chart, or Ejection Fraction (EF) <50%, or NT-proBNP ≥1500 pg/ml are present, the patient receives high-dose pulse IV MP 10 mg/ Kg/day for 3-5 days, otherwise low dose IV MP 2 mg/Kg/day is administered. After 48 hours, if CRP increases and/or fever persists, the treatment is intensified either with a MP dose increase or with subcutaneous Anakinra 5 mg/ Kg/day. IVIG is reserved for patients with suspected CAA at any ultrasound evaluation (defined according to American Heart Association 2017 Guidelines for KD), or presenting persistent symptoms despite defervescence and CRP reduction. We retrospectively collected and analyzed clinical data of a cohort of consecutive MIS-C patients treated with MP mono-therapy between the 1st of April and the 31st of January 2021, at Regina Margherita Children Hospital (Turin, Italy). Clinical data were retrospectively collected;as primary outcomes we considered: rate of ICU admission, rate of inotropic support need, and incidence of CAA. As secondary outcomes we evaluated: CRP halving time, MP and NT-proBNP halving time, and days between first pathological echocardiogram and EF normalization. Results: Twenty-three MIS-C patients were included. 18 patients (78,3%) showed myocardial involvement and were treated with highdose pulse MP (Group A), 4 needed anakinra due to persistent fever. 5 patients with no cardiac damage (21,7%) were treated with low dose MP (Group B), in 2 of these (40,0%) MP dose was intensified due to persistent fever. All of the patients recovered;1 (4.3%) needed ICU admission with inotropic support, 1 developed a CAA six days after MP start. Median CRP halving time was 2 days (2 days in Group A and 5 days in Group B), NT-pro-BNP halved in 3 days in Group A, while EF normalized in 4.5 days. One patient needed ICU admission and inotropic support (4.3%), 1 patient of group A developed a small coronary aneurysm (5 mm, z score 4). Conclusion: Despite some limitations, including the sample size and the absence of a control group treated with IVIG, our data suggest that early administration of MP together with fluid restriction can rapidly decrease the inflammation and restore myocardial contractility in MIS-C, considerably reducing the need of ICU admission and/or inotropic support. Encouragingly enough, the incidence of CAA in our cohort is low compared to published cohorts (4.3% vs 20%). Further studies in bigger cohorts are needed to confirm our findings.
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BACKGROUND In response to the COVID-19 pandemic, drastic measures for social distancing have been introduced also in Italy, with a substantial impact in delicate conditions like pregnancy and puerperium. The study aimed to investigate the changes in lifestyle, access to health services, and mental wellbeing during the first Italian lockdown in a sample of Italian pregnant women and new mothers. METHODS We carried out a web-based survey to evaluate how pregnant women and new mothers were coping with the lockdown. We collected data about healthy habits (physical exercise and dietary habits), access to health services (care access, delivery and obstetric care, neonatal care, and breastfeeding), and mental wellbeing (psychological wellbeing and emotive support). Descriptive analysis was performed for both groups of participants, whereas a Poisson analysis was used to measure the association between some structural variables (age, education, socio-economic data, partner support, contact, free time, previous children, and pregnancy trimester) and anxiety or depression, difficulties in healthy eating and reduction in physical activity after lockdown started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant women. RESULTS We included 739 respondents (response rate 85.8 %), 600 were pregnant (81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % of new mothers. During the lockdown, 61.8 % of pregnant women reduced their physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new mothers reported to have breastfed their babies during the hospital stay. Regarding the perceived impact of restrictive measures on breastfeeding, no impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %. CONCLUSIONS The high prevalence of anxiety and depressive symptoms in pregnant women and new mothers should be a public health issue. Clinicians might also recommend and encourage 'home' physical exercise. On the other hand, about half of the sample improved their approach towards healthy eating and a very high breastfeeding rate was reported soon after birth: these data are an interesting starting point to develop new strategies for public health.
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Objectives: From 23rd February 2020, to limit viral spreading during Coronavirus Disease (COVID-19) outbreak in Piedmont (one of the most affected area in Italy), schools were shut down for every age group. Likewise, recreational activities such as gyms and pools, as well as outpatients' clinics, were closed. From the same day, children were forced to stay at home and school lessons were provide remotely. We sought to determine the impact of school closure and lockdown on children with type 1 diabetes (T1D), measuring metrics from continuous glucose monitoring (CGM). Methods: The Regional Pediatric Diabetes network randomly selected patients (0-18 years) with T1D from every age group in Piedmont, between those using a CGM from at least 6 months. Time spent in range 70-180 mg/dL (TIR), below range (TBR), above range (TAR) as well as coefficient of variation (CV) and glucose management index (GMI) were measured during 90 days of lockdown and compared (paired t-test, 95%) with 90 days before. Patients also reported physical activity and total daily insulin dose (TDD) in the same study period. Results: Data of our study population are showed in Table. Mean TIR from 90 days before was 59.7%, while during lockdown was 62.5% (p = 0.018). To the same extent, TBR went from 2.6% to 2.4% (p = 0.152), and TAR went from 39.5% to 36.7% (p = 0.004), respectively. CV moved from 35.9% to 34.9% during lockdown (p = 0.003), and GMI decreased from 7.5% to 7.4% (p = 0.05). Physical activity dropped from 6.1 to 2.7 hours per week (p < 0.001), while TDD increased from 36.4 to 40.3 UI/day (p = 0.005). Sensor usage increased from 86.5% to 91.5% of time. Conclusions: The presented data on children and adolescents with T1D show an improvement of glucose metrics (especially TIR and TAR) with less variability during lockdown. An increased CGM use might have helped families in adjusting insulin therapy despite lifestyle changes and decreased physical activity. (Table Presented).
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Introduction: On February 202,020, so-called Italian Patient 1 was admitted to the ICU of his local hospital due to a deteriorating clinical condition from SARS-CoV-2/COVID-19 infection. As of June 26th, 239,961 COVID-19 cases have been confirmed in Italy (children = 3805), including deaths (n = 34,708) and who have recovered (n = 187,615). Although children are generally less prone to COVID- 19 and have a milder disease course, children with existing comorbidities could remain at higher risk of complications. Objective: Aim of this study is to document clinical characteristics of children and adolescents with T1D affected with COVID-19. Methods: Starting from the week after lockdown was initiated (March 9th), ISPED started a weekly surveillance for COVID-19 infection on all children with diabetes. Cases with suspected symptoms (n = 1) or children living with positive tested relatives (n = 7), or because hospitalized (n = 3) were undergone to swab test. The surveillance is still ongoing. Results: Eleven patients were diagnosed with COVID-19 (range 6-17 years of age, 7 females);two at T1D onset and nine in patients with established diabetes (diabetes for 1-11 years), all of whom were asymptomatic (n = 7) or had only mild symptoms (n = 4). All had nasopharyngeal swabs positive for SARS-CoV-2 by RT-PCR. Three had mild hyperglycemia, 1 had mild DKA and 2 were admitted for T1D onset, 1 with DKA and 1 without. The remnant children had no disglycemia. Conclusions: In Italy, overall 11 children with T1D had laboratory COVID-19 confirmation. These patients were tested due to having mild COVID-19 symptoms or because they lived close to a known positive patient. These data seem to support the hypothesis that children with T1D are not at higher risk for COVID-19 than general population and have a mild disease course. As the pandemic continues, further work is necessary to assess how this disease affects children and to develop best-evidence-based guidelines for our vulnerable patients.