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We describe the case of a 9-year-old patient who presented with inability to walk due to lower extrem-ity pain in the follow-up of infection by SARS-CoV-2. Since the manifestations and findings of the examination were compatible with myositis, a blood test was performed that evinced elevation of cre-atine phosphokinase. The patient had a favourable outcome with symptomatic treatment. In the context of this case, we conducted a literature review of paediatric cases of myositis associated with SARS-CoV-2 infection. © 2022, Spanish Association of Primary Care Pediatrics. All rights reserved.
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Introduction. MPN-COVID is a European LeukemiaNet cohort study, launched in March 2020 in patients with myeloproliferative neoplasms (MPN) with COVID-19. The first cohort of 175 cases was analyzed at the end of first wave (July 2020) and results provided estimates and risk factors of overall mortality (Barbui T. Leukemia, 2021), thrombosis incidence (Barbui T. Blood Cancer J, 2021), and post-COVID outcomes (Barbui T. Blood Cancer J, 2021). In the second wave of pandemic (June 2020 to June 2021), case-fatality risk in the general population has been found variable across different countries, and no information is available in MPN patients with COVID-19 diagnosed during the second wave in comparison with those of the first wave. Methods. In an electronic case report form, we registered a total of 479 cases of ET (n=161, 34%), PV (n=135, 28%), pre-PMF (n=49, 10%) and overt MF (n=134, 28%), from 39 European hematology units (Italy, Spain, Germany, France, UK, Poland, Croatia). Of these, 304 were diagnosed COVID-19 during the second wave. Results. Patients in the second wave were significantly different from those in the first wave, including parameters such as age (median: 63 vs. 71 years, p<.001), sex (females: 52% vs. 42%, p=0.037), MPN category (MF 24% vs. 34%, p=0.020), comorbidity (at least one comorbidity 63% vs. 74%, p=0.012), disposition (home: 68% vs. 23%, regular ward: 29% vs. 66%, ICU: 3% vs. 11%, p<.001), need of respiratory support (28% vs. 59%, p<.001) and degree of systemic inflammation (C-Reactive Protein: 51% vs. 74%, p=0.008;Neutrophil to Lymphocyte Ratio: 4.1 vs. 5.4, p=0.038). In regard to COVID-19-directed therapy, in the second wave steroids were more frequently prescribed (28% vs. 40%, p=0.007), while the use of antibiotics, antivirals, hydroxychloroquine and experimental therapies was significantly less frequent (p<.001 for all the differences). Interestingly, only 4 out of 46 patients (8.7%) discontinued Ruxolitinib during second-wave acute COVID (all MF admitted to regular ward). In the two waves, distribution probability of COVID-19 incidence by Kernel method showed a substantially similar shape, whereas the two incidence peaks were associated with very different mortality, as reported in Fig. 1A. The difference between the probability of death was highly significant during the first (n=175) vs. second (n=304): 31% vs. 9% at 60 days from COVID-19 diagnosis, respectively (p<.001) (Fig. 1B). Of note, among 26 deaths, 4 (15%) occurred at home, 19 (73%) on regular wards and 3 (12%) in the ICU, and death more frequently afflicted patients with (n=17, 65%) than ET (n=5, 19%) and PV (n=4. 15%) (p<.001). Independent risk factors for death in a multivariate Cox regression model fitted on the whole cohort and adjusted for the wave to which patients belonged, were age over 70 years (HR=5.2, 95% CI 1.8-15.1, p=0.002), male sex (HR=1.9, 95% CI 1.1-3.1, p=0.016), COVID-19 severity revealed by the need for respiratory support (HR=4.5, 95% CI 1.9-10.7, p=0.001), and Ruxolitinib discontinuation (HR=3.0, 95% CI 1.3-6.9, p=0.011). Conversely, in patients who continued this drug, no risk was documented (HR=1.21, p=0.566). Taking into account death as competing event, the second outcome of interest was the incidence of thrombosis, wich occurred in a significantly lower proportion of patients in the second wave compared to the first one (n=5 [1.6%] vs. n=14 [8.0%] at +60 days, respectively, SHR=0.20, p=0.002) (Fig. 1C). All the events, but one (n=4/5) were venous and were reported in patients with ET (SHR=4.4, 95% CI 1.8-10.7, p=0.001). Conclusions. This is the largest series of MPN patients who incurred COVID-19 from June 2020 onward, namely during the 'second COVID-19 wave'. Compared to the first wave, the second one recorded a lower overall COVID-19 severity, but Ruxolitinib discontinuation still remained a risk factor for a dismal outcome. Greater vulnerability of ET than PV in developing venous thrombosis was confirmed also during the second wave. This finding suggests that ET warrants a specific antithrombo ic prophylaxis in addition to heparin.
ABSTRACT
In Wuhan, China, at the end of 2019 it was reported for the first time, declared by the World Health Organization (WHO) as an international health emergency in January 2020 and classified as a pandemic in March of the same year, the Covid-19, is undoubtedly the topic of greatest clinical and research interest globally, nationally and locally.. The pandemic has not stopped and the social, economic, as well as health ravages have continued even with research, scientific advances in medicine, as well as research devoted entirely to studying the novel coronavirus, have affected all levels and social strata. a community intervention was developed through an explanatory, experimental, longitudinal and prospective study with deliberate intervention, conducting 381 surveys in indigenous people of the communities of Ambato, to identify the determinants that favor the increase in the transmissibility of SARS-Cov-2 in the indigenous population,.analyze the impact of COVID-19 on mortality and morbidity according to the comorbidities of indigenous peoples, identify the psychological impact of periods of confinement. It was concluded that the indigenous communities showed the overcrowding of families with few resources that are forced to live together more than a generation and favors the contagion, this made them see themselves in quarantine for contacts with patients, comorbidities were also a cause of predisposition to infections and severe form of COVID-19 including death, they were also psychologically affected by confinement and little family interaction, poor access to technological elements, poor information and poor leadership of their leaders favored a low dissemination of preventive measures.
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The Medical College of Wisconsin (MCW) COVID-19 Vaccination Program facilitated early vaccination efforts in metro Milwaukee, Wisconsin from December, 2020 through April, 2021. Goals of the program were to work with clinical partners to ensure rapid vaccination availability for the institution's frontline workforce, to support state public health agencies in offering a vaccination opportunity for underserved and higher education community members, and to train vaccinators. A key component of the program was the MCW COVID-19 Vaccination Clinic, and 88% of MCW's workforce was fully immunized against COVID-19 with the 2-dose, mRNA vaccine by April 30, 2021. Within the MCW clinic, 219 pharmacy and medical students learned to administer vaccinations, and 12,450 community vaccinations were administered.
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The objective of the research was to analyze the situation of tour guides in Latin America, particularly in Colombia, Ecuador, Mexico, Costa Rica and Peru, in relation to the presence of the covid-19 pandemic. The study was carried out by means of the non-experimental exploratory method with a mixed approach, using three research instruments: the virtual forum, which made it possible to identify the vision of the guides regarding the pandemic;the survey, validated by Cronbach's Alpha statistic, directed at tourist guides belonging to federations and official associations;and the interview applied to key representatives of the countries involved in the study. The results are presented in four dimensions: work situation;job security;associativity and future prognosis, highlighting the economic, emotional and psychological crisis that tourist guides went through due to the pandemic.
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The current COVID-19 pandemic has generated a series of changes in the daily routines of people, including children and teenagers, in an unprecedented way, which constitutes a global challenge in public health. Social isolation has been a prophylactic measure to prevent the spread of the virus, however, it has generated negative impacts on the physical and emotional health of parents, caregivers, children, and teenagers around the world. Our objective was to evaluate the effects of confinement caused by the COVID19 pandemic at the level of nutritional status, dietary and behavioral patterns of elementary school children and teenagers in a small town of Colombia. Anthropometric parameters such as BMI Z score, waist circumference and waist / height ratio were evaluated in 266 school children and teenagers. A questionnaire with sociodemographic, clinical and lifestyle characteristics and the KIDMED were applied to learn about nutritional aspects. A total of 102 students (38.3%) were classified as having altered nutritional status, being 39 (14.7%) classified with overweight, and 36 (13.5%) with obesity. The prevalence of high adherence to the Mediterranean diet was 12%, 95% CI (0.08-0.16). Overweight was more prevalent in women (26/39, 66.7%) (p = 0.0439), and obesity was discreetly more frequent in men (19/36, 52.7%) (p = 0.7193). We observed a worrying nutritional, dietary and behavioral situation in the children and teenagers studied during the confinement associated with the covid 19 pandemic. This unveils the need to establish strategies and / or public policies in our town that help to promote an adequate biopsychosocial development of the pediatric patient and their family group.
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PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.