Guillain Barré syndrome in the paediatric population. Consequence of active infection or long Covid?

Background: Guillain-Barré syndrome is a polyradiculoneuropathy that has been associated with infectious diseases as triggers. There is currently little medical evidence exploring the relationship between the development of Guillain-Barré syndrome caused by SARS-CoV-2 infection and long Covid. Objective: To synthesize the medical evidence that describes the relationship between post Covid syndrome and Guillain-Barré syndrome in the paediatric population. Methodology: A scoping review was developed using Scopus and PubMed databases, including analytical and/or descriptive experimental and observational studies. Results: The main clinical manifestations presented by paediatric patients were distal and ascending weakness in the lower limbs and myalgia. The diagnostic approach was based on clinical findings, imaging findings on spinal magnetic resonance and electromyography. The therapeutic strategy is based on the use of intravenous human immunoglobulins. Conclusion: Guillain-Barré syndrome is a frequent disease in the paediatric population with active SARS-CoV-2 infection or in survivors, however, it is necessary to encourage further clinical studies that increase the medical literature that describes this association.

Randomized, Controlled Phase 3 Study of anti-C5a Vilobelimab's Effect on Mortality in Critically Ill COVID-19 Patients: A Therapy for Viral Pneumonia

Background. SARS-CoV-2 induces endothelial damage and activates the complement system. In severe COVID-19 patients, complement split factor C5a is highly elevated leading to inflammation that contributes to multiorgan failure. The anti-C5a monoclonal antibody, Vilobelimab (Vilo), which preserves the membrane attack complex (MAC), was investigated in an adaptively designed, randomized doubleblind, placebo (P)-controlled Phase 3 international multicenter study for survival in critically ill COVID-19 patients (pts). Methods. COVID-19 pneumonia pts (N=368;Vilo n=177, P n=191), mechanically ventilated within 48 hrs before treatment, received up to 6, 800 mg infusions of Vilo or P on top of standard of care. The primary and main secondary endpoints were 28-day (d) and 60-d all-cause mortality. Results. Pts enrolled in the study were on corticosteroids (97%) and anticoagulants (98%) as standard of care. A smaller proportion (20%) were either continuing or had taken immunomodulators such as tocilizumab and baricitinib prior to receiving Vilo. The 28-d all-cause mortality was 31.7% with Vilo vs 41.6% with P (Kaplan-Meier estimates;Cox regression site-stratified, HR 0.73;95% CI:0.50-1.06;P=0.094), representing a 23.8% relative mortality reduction. In predefined primary outcome analysis without site stratification, however, Vilo significantly reduced mortality at 28 (HR 0.67;95% CI:0.48-0.96;P=0.027) and 60 days (HR 0.67;95% CI:0.48-0.92;P=0.016). Vilo also significantly reduced 28-d mortality in more severe pts with baseline WHO ordinal scale score of 7 (n=237, HR 0.62;95% CI:0.40-0.95;P=0.028), severe ARDS/PaO2/FiO2 <= 100 mmHg (n=98, HR 0.55;95% CI:0.30-0.98;P=0.044) and eGFR < 60 mL/min/1.73m2 (n=108, HR 0.55;95% CI:0.31-0.96;P=0.036). Treatment-emergent AEs were 90.9% Vilo vs 91.0% P. Infections were comparable: Vilo 62.9%, P 59.3%. Infection incidence per 100 Pt days were equal. No meningococcal infections were reported. Serious AEs were 58.9% Vilo, 63.5% P. Conclusion. Vilo significantly reduced mortality at 28 and 60 days in critically ill COVID-19 pts with no increase in infections suggesting the importance of targeting C5a while preserving MAC. Vilo targets inflammation which may represent an approach to treat sepsis and ARDS caused by other respiratory viruses. (Figure Presented).

SARS-CoV-2 and post-COVID-19 syndrome in paediatric rheumatology: A scoping review

Introduction: An increasing number of musculoskeletal clinical manifestations, the onset of diseases and rheumatological manifestations have been seen in the paediatric population surviving COVID-19, however, the medical literature on the subject is limited. Objective(s): To explore the available evidence on musculoskeletal symptoms and autoimmune diseases in the paediatric population with post-COVID syndrome. Methodology: Scoping systematic review in PubMed and Scopus through search strategies. Observational and experimental studies are included in populations under 21 years of age with and without autoimmune diseases, without time limit in English and Spanish. Result(s): The 28 documents included: case reports (n = 6), cross-sectional studies (n = 5), prospective cohort studies (n = 5), retrospective cohort (n = 6), case series (n = 6), ambidirectional section (n = 1), randomized controlled trial (n = 1), and longitudinal section study (n = 1). The total study population was 56,738 patients. The most frequent symptoms presented in long COVID-19 are myalgias and arthralgias. The evidence showing a relationship between SARS-CoV-2 infection in the development of musculoskeletal symptoms and autoimmune diseases in the convalescent period is limited. Conclusion(s): Myalgias and arthralgias are the most frequent symptoms in long COVID. patients with SARS-CoV-2 infection and a history of rheumatic disease who are undergoing immunomodulatory treatment do not have a dangerous risk of developing severe presentations and/or complications of the disease. Copyright © 2022 Asociacion Colombiana de Reumatologia

Guillain Barre syndrome in the paediatric population. Consequence of active infection or long Covid?

Background: Guillain-Barre syndrome is a polyradiculoneuropathy that has been associated with infectious diseases as triggers. There is currently little medical evidence exploring the relationship between the development of Guillain-Barre syndrome caused by SARS-CoV-2 infection and long Covid. Objective(s): To synthesize the medical evidence that describes the relationship between post Covid syndrome and Guillain-Barre syndrome in the paediatric population. Methodology: A scoping review was developed using Scopus and PubMed databases, including analytical and/or descriptive experimental and observational studies. Result(s): The main clinical manifestations presented by paediatric patients were distal and ascending weakness in the lower limbs and myalgia. The diagnostic approach was based on clinical findings, imaging findings on spinal magnetic resonance and electromyography. The therapeutic strategy is based on the use of intravenous human immunoglobulins. Conclusion(s): Guillain-Barre syndrome is a frequent disease in the paediatric population with active SARS-CoV-2 infection or in survivors, however, it is necessary to encourage further clinical studies that increase the medical literature that describes this association. Copyright © 2022 Asociacion Colombiana de Reumatologia

Levels of stress perception in the time of COVID-19, due to virtuality in university students, Barranquilla-Colombia

In order to establish the perception of stress in first-semester students of the Metropolitan University-Barranquilla, a Likert questionnaire was used as a data collection instrument, structured with 27 questions about stressors related to virtual classes, where the student, according to their perception, should respond to stress levels: Normal, Mild, Moderate and Severe. Obtaining that the stressors with the highest levels of perception were the excess of academic activities, the unstable Internet network and the interruption in the electrical flow;also, it was observed that the level of perception of severe stress was slightly higher in women, compared to men;It was also found that some academic programs present a higher level of stress perception, which would be explained by the number of women enrolled in the programs, and as stated above, the levels of stress perception in women are higher, compared to men. On the other hand, the level of perceived stress did not show dependence on age (p: 0.1471). Finally, strategies are proposed to reduce stress levels, which can be implemented at the Metropolitan University and other educational institutions.

A COVID-19 PATIENT SEVERITY STRATIFICATION USING A 3D CONVOLUTIONAL STRATEGY ON CT-SCANS

This work introduces a 3D deep learning methodology to stratify patients according to the severity of lung infection caused by COVID-19 disease on computerized tomography images (CT). A set of volumetric attention maps were also obtained to explain the results and support the diagnostic tasks. The validation of the approach was carried out on a dataset composed of 350 patients, diagnosed by the RT-PCR assay either as negative (control - 175) or positive (COVID-19 - 175). Additionally, the patients were graded (0-25) by two expert radiologists according to the extent of lobar involvement. These gradings were used to define 5 COVID-19 severity categories. The model yields an average 60% accuracy for the multi-severity classification task. Additionally, a set of Mann Whitney U significance tests were conducted to compare the severity groups. Results show that patients in different severity groups have significantly different severity scores (p < 0.01) for all the compared severity groups.

Connections Before Curriculum: The Role of Social Presence During COVID-19 Emergency Remote Learning for Students

This study examined the student experience (n=507) during emergency remote learning at a medium-sized private southeastern university during the COVID-19 pandemic, leveraging the Social Presence Model (SPM) as a guiding framework. Tensions were high at this critical time as students were stressed with financial burdens, supply shortages, overlapping work and educational schedules, and shared technological resources and physical spaces. Therefore, this study helps educators better understand students' emotional needs and experiences during the March 2020 lockdown transition to remote learning. Specifically, examining the student experience in a time of crisis offers critical lessons about the importance of connectedness, online readiness, cultivating relationships, adaptability during transitions, and class interaction. The data revealed the depth of anxiety felt by students and suggests the need for increased empathy, communication, interaction, and flexibility from their instructor and course community to proceed with academic coursework, particularly for first-year college students. The findings elevate the importance of social presence as a literacy for learning in any modality, underscore the need to support the mental health of our students, and stress the urgency for online and remote learning readiness for current and future public emergencies.

Mavrilimumab improves outcomes in phase 2 trial in non-mechanically-ventilated patients with severe covid-19 pneumonia and systemic hyperinflammation

Background: Granulocyte/macrophage-colony stimulating factor (GM-CSF) is a cytokine both vital to lung homeostasis and important in regulating inflammation and autoimmunity1,2,3 that has been implicated in the pathogenesis of respiratory failure and death in patients with severe COVID-19 pneumonia and systemic hyperinflammation. 4-6 Mavrilimumab is a human anti GM-CSF receptor α monoclonal antibody capable of blocking GM-CSF signaling and downregulating the inflammatory process. Objectives: To evaluate the effect of mavrilimumab on clinical outcomes in patients hospitalized with severe COVID-19 pneumonia and systemic hyperinflammation. Methods: This on-going, global, randomized, double-blind, placebo-controlled seamless transition Phase 2/3 trial was designed to evaluate the efficacy and safety of mavrilimumab in adults hospitalized with severe COVID-19 pneumonia and hyperinflammation. The Phase 2 portion comprised two groups: Cohort 1 patients requiring supplemental oxygen therapy without mechanical ventilation (to maintain SpO2 ≥92%) and Cohort 2 patients requiring mechanical ventilation, initiated ≤48 hours before randomization. Here, we report results for Phase 2, Cohort 1: 116 patients with severe COVID-19 pneumonia and hyperinflammation from USA, Brazil, Chile, Peru, and South Africa;randomized 1:1:1 to receive a single intravenous administration of mavrilimumab (10 or 6 mg/kg) or placebo. The primary efficacy endpoint was proportion of patients alive and free of mechanical ventilation at Day 29. Secondary endpoints included [1] time to 2-point clinical improvement (National Institute of Allergy and Infectious Diseases COVID-19 ordinal scale), [2] time to return to room air, and [3] mortality, all measured through Day 29. The prespecified evidentiary standard was a 2-sided α of 0.2 (not adjusted for multiplicity). Results: Baseline demographics were balanced among the intervention groups;patients were racially diverse (43% non-white), had a mean age of 57 years, and 49% were obese (BMI ≥ 30). All patients received the local standard of care: 96% received corticosteroids (including dexamethasone) and 29% received remdesivir. No differences in outcomes were observed between the 10 mg/kg and 6 mg/ kg mavrilimumab arms. Results for these groups are presented together. Mavrilimumab recipients had a reduced requirement for mechanical ventilation and improved survival: at day 29, the proportion of patients alive and free of mechanical ventilation was 12.3 percentage points higher with mavrilimumab (86.7% of patients) than placebo (74.4% of patients) (Primary endpoint;p=0.1224). Mavrilimumab recipients experienced a 65% reduction in the risk of mechanical ventilation or death through Day 29 (Hazard Ratio (HR) = 0.35;p=0.0175). Day 29 mortality was 12.5 percentage points lower in mavrilimumab recipients (8%) compared to placebo (20.5%) (p=0.0718). Mavrilimumab recipients had a 61% reduction in the risk of death through Day 29 (HR= 0.39;p=0.0726). Adverse events occurred less frequently in mavrilimumab recipients compared to placebo, including secondary infections and thrombotic events (known complications of COVID-19). Thrombotic events occurred only in the placebo arm (5/40 [12.5%]). Conclusion: In a global, diverse population of patients with severe COVID-19 pneumonia and hyperinflammation receiving supplemental oxygen therapy, corticosteroids, and remdesivir, a single infusion of mavrilimumab reduced progression to mechanical ventilation and improved survival. Results indicate mavrilimumab, a potent inhibitor of GM-CSF signaling, may have added clinical benefit on top of the current standard therapy for COVID-19. Of potential importance is that this treatment strategy is mechanistically independent of the specific virus or viral variant.

Diabetes as a risk factor for in-hospital mortality in patients with covid-19: A systematic review

Diabetes mellitus has been directly related to an increase in mortality associated with COVID-19, for which reason it was decided to carry out this analysis. Objective: to systematically examine the available empirical studies that report on diabetes as a risk factor for in-hospital mortality in patients with COVID-19. Methodology: A systematic review of publications indexed in the following browsers were performed: Pubmed, Scielo, Hindawi, Latindex, Redalyc, Scopus, Taylor and Francis, Springer Link, Web of Science, EBSCO, in a period between the end of 2019 and the beginning of 2021, choosing those that were related to the topic to be treated, in a complementary way this search was made using the keywords mentioned below: “coronavirus disease 2”, “COVID-19”, “SARS-CoV2”, “Coronavirus”, “Mortality”, “Prediction”, “Predictor”, “adults”, “diabetes”, “hyperglycemia”, “death”, and the connections of these with Boolean connectors” AND” and “OR” were made. Results: 23 articles were studied that met the selection criteria, where most of the publications were retrospective with distribution according to the sex of 56.6% for males and 43.4% for females, with a prevalence of diabetes in patients with COVID-19 on average of 20.71% with 54.41% in men and 45.59% for women, at an average age of 66.57 years. Conclusion: in general, this comorbidity has a higher incidence in people infected by the type of coronavirus, in the same way, in almost all of the articles evaluated it was identified that diabetes was an independent risk factor for mortality from COVID-19.

COVID-19 related pancreatic cancer surveillance disruptions amongst high-risk individuals

BACKGROUND: COVID-19 pandemic-related disruptions to EUS-based pancreatic cancer surveillance in high-risk individuals remain uncertain. METHODS: Analysis of enrolled participants in the CAPS5 Study, a prospective multicenter study of pancreatic cancer surveillance in high-risk individuals. RESULTS: Amongst 693 enrolled high-risk individuals under active surveillance, 108 (16%) had an EUS scheduled during the COVID-19 pandemic-related shutdown (median length of 78 days) in the spring of 2020, with 97% of these procedures being canceled. Of these canceled surveillance EUSs, 83% were rescheduled in a median of 4.1 months, however 17% were not rescheduled after 6 months follow-up. Prior history of cancer was associated with increased likelihood of rescheduling. To date no pancreatic cancer has been diagnosed among those whose surveillance was delayed. CONCLUSIONS: COVID-19 delayed pancreatic cancer surveillance with no adverse outcomes in efficiently rescheduled individuals. However, 1 in 6 high-risk individuals had not rescheduled surveillance, indicating the need for vigilance to ensure timely surveillance rescheduling.

Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic.

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.