Approach to a child with pediatric inflammatory multisystem syndrome with COVID-19 recommendations by the Polish pediatric society expert group and the national consultant in the field of pediatrics

Pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS) is a new entity, occurring in children and young adults, associated with the SARS-CoV-2 infection. The first cases of PIMS were found in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, which reflects the increased incidence of COVID-19 in adults. PIMS development results from dysregulation of the immune system occurring after 2-4 weeks after the SARS-CoV-2 in-fection. Diagnosis is based on a set of clinical features (including fever and features of mul-tiple organ damage) and laboratory abnormalities, with the exclusion of other causes. Most common complications involve cardiovascular system: myocarditis with decreased left ven-tricular ejection fraction, shock and/or coronary artery aneurysms. Mortality is around 2%. Appropriate management, including vital functions support and immunomodulating treat-ment, allows for a quick recovery of the vast majority of patients. The following document is a proposal for diagnostic and therapeutic management of children with suspected PIMS in Poland. Copyright © 2020, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Three dimensional echocardiography and global longitudinal strain in the assessment of left ventricular function in children after PIMS-TS

Background and Aim: Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) is a new dis-ease affecting children, almost alwaysinvolving cardiovascular system and with potential long-term effects still unknown. Method(s): Prospective study enclosed 80 children aged 1-17 years (mean 8.2 years) diagnosed with PIMS-TS between June 2020 and June 2021 who were controlled 6 weeks and 6 months after the disease. In patients with severe cardiac involvement during acute phase (deteriorated left ventricular ejection fraction (LVEF) lt;55% and significantly elevated concentration of NT-pro-BNP (gt;5000 pg/ml) or troponine (gt;500 ng/ml)) the addi-tional check-up after 3 months was scheduled. In all patients at control points three dimensional echocardiography (3D-ECHO) and average global longitudinal strain (GLS) were used to assess left ventricular function. Result(s): In all patients the means of LVEF and average GLS were within normal limits at the time of all check-up points. For the whole group LVEF after 6 weeks was 60.5% (SD: 3.1;51-69%) and GLS 21.2% (SD: 3.9;12.4-29.4%). After 6 months LVEF increased to 63% (SD: 2.4;58-69%) and GLS to 23.6% (SD: 3.2;17.3-33.3%)-both significantly (plt;0.001). In the subgroup of 54 patients with originally mild cardiac involvement LVEF after 6 weeks was 60.7% (SD: 2.6;57-69%) and GLS 21.8% (SD: 3.4;17.3-29.4%). In the subgroup of 26 patients with severe cardiac involvement LVEF after 6 weeks was 59.6% (SD: 3.1;55-67%) and was not significantly different than in subgroup with mild car-diac involvement (p = 0.175) while GLS was significantly lower (19.3%, SD: 3.8;12.4-24.8%;p = 0.009). After 3 months in this group LVEF and GLS did not increase (respectively, 59.9%, 56-67%;p = 0.794 and 20.2%, 13.7-26.9%;p = 0.149). After 6 months LVEF in this subgroup increased to 62.8% (60-68%) and GLS to 22.6% (17.7-27%)-like in patients with mild cardiac involvement (plt;0.001). Conclusion(s): 3D-ECHO and GLS are highly applicable tools for the assessment of cardiac function in children after PIMS-TS. Patients with originally severe cardiovascular involvement have lower average GLS after 6 weeks. 6 months after PIMS-TS patients present significant improvement of left ventricular function. Average GLS seems to be more sensitive test for functional assess-ment than LVEF.

Psychometric evaluation of the Mental Health Quality of Life (MHQoL) instrument in seven European countries.

INTRODUCTION: To make efficient use of available resources, decision-makers in healthcare may assess the costs and (health) benefits of health interventions. For interventions aimed at improving mental health capturing the full health benefits is an important challenge. The Mental Health Quality of Life (MHQoL) instrument was recently developed to meet this challenge. Evaluating the pyschometric properties of this instrument in different contexts remains important. METHODS: A psychometric evaluation of the MHQoL was performed using existing international, cross-sectional data with 7155 respondents from seven European countries (Denmark, France, Germany, Italy, Portugal, The Netherlands, Portugal and the United Kingdom). Reliability was examined by calculating Cronbach's alpha, a measure of internal consistency of the seven MHQoL dimensions, and by examining the association of the MHQoL sum scores with the MHQoL-VAS scores. Construct validity was examined by calculating Spearman's rank correlation coefficients between the MHQoL sum scores and EQ-5D index scores, EQ-VAS scores, EQ-5D anxiety/depression dimension scores, ICECAP-A index scores and PHQ-4 sum scores. RESULTS: The MHQoL was found to have good internal consistency for all seven countries. The MHQoL sum score and the MHQoL-VAS had a high correlation. Spearman's rank correlation coefficients were moderate to very high for all outcomes. CONCLUSION: Our results, based on data gathered in seven European countries, suggest that the MHQoL shows favourable psychometrical characteristics. While further validation remains important, the MHQoL may be a useful instrument in measuring mental health-related quality of life in the Western European context.

The impact of COVID-19 on Children and Adolescents with Pulmonary Arterial Hypertension. Data from the Polish Registry of Pulmonary Hypertension

Introduction: COVID-19 has had a significant impact on all aspects of pulmonary arterial hypertension (PAH), from diagnosis and management to an increased risk of death in patients with PAH. Pandemic made it necessary to revisit the manner in which patients receive care to decrease risk of contracting the virus. Methods: Eight Tertiary Paediatric Centres participating in the paediatric arm of the registry Database of Pulmonary Hypertension in the Polish Population (BNP-PL) took part in this multi-centre cross-sectional observational study. Eligible children were diagnosed with PAH before March 20, 2020, the day the pandemic was officially announced by the Polish government. All parents of children with PAH in the BNP-PL were invited to take part in an anonymous electronic questionnaire. It comprised of several question panels: demographic data, fear of COVID-19 and other pandemic related problems, standard anxiety scale (GAD-7), presence of alarming symptoms, which had appeared or exacerbated since March 20, 2020. Data collection was seized on the September 09, 2020. Results: We have received 62 responses (response rate 77%), 4 were incomplete. The remaining 58 were further analysed. Ninety-five percent of the responders were women (n=55) at a median age of 41 years. Ninety-five percent of the parents were afraid of possible negative consequences of the SARS-CoV-2 on their children's health including death in 77%. Sixty to 71% of the parents were also afraid of various potential problems resulting from re-organising health-care system. As a result, 72% of parents had symptoms of anxiety as assessed by GAD-7, noticeably 34% in moderate-tosevere degree. No cases of COVID-19 were reported in the studied group of children. Conclusions: The impact of COVID-19 on health care delivery and on society at large is going to be felt for years to come. This information is vital to provide prognostic information on cardiac health after COVID-19, to inform long-term clinical care pathways, and to guide lifestyle recommendations. COVID-19 pandemic had an overall negative impact on children with PAH and their families. Several risk factors for poor outcome were identified. Long-term strategies should be validated and implemented to deliver quality care for children with PAH, with emphasis on psychosocial well-being.

Approach to a child with pediatric inflammatory multisystem syndrome with covid-19 recommendations by the Polish pediatric society expert group update february 2021

Pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS) is a new entity, occurring in children and young adults, associated with the SARS-CoV-2 infection. The first cases of PIMS were found in Poland in May 2020. Since October 2020, a signi-ficant increase in this new disease incidence has been observed in Poland, reflecting the increased incidence of COVID-19 in the pediatric population. PIMS development results from dysregulation of the immune system occurring after ca. 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on criteria: a set of clinical features (including fever and features of multiple organ damage) and elevated inflammatory markers, excluding other cau-ses. The most common complications involve the cardiovascular system: heart damage with decreased left ventricular ejection fraction, shock, and coronary artery abnormalities. Mortality is around 2%. Appropriate management, including vital functions support and immunomodulating treatment, allows for a quick recovery of the vast majority of patients. The following document is a guideline for the diagnostic and therapeutic management of children with suspected PIMS in Poland. © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Productivity of Working at Home and Time Allocation Between Paid Work, Unpaid Work and Leisure Activities During a Pandemic.

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic and the measures taken by governments to contain it have affected many aspects of the daily lives of citizens. This study aimed to describe changes in the productivity of paid work and time allocation to paid and unpaid work and leisure resulting from working at home during the pandemic. METHODS: A sample of 851 people from the Netherlands who had paid work (≥ 24 h/week) and worked at least 4 hours per week extra at home because of lockdown measures completed a questionnaire during the first COVID-19 lockdown (April 2020). Respondents reported time spent on paid and unpaid work and leisure before and during the lockdown. Productivity was measured in terms of quantity and quality of paid work. RESULTS: On average, respondents spent less time (14%) on paid work and productivity decreased 5.5%. Changes in productivity were associated with the age of children, net income and having a separate home office. Respondents spent more time on unpaid work (27%) and leisure (11%). Women spent more time on unpaid work in absolute but not in relative terms. People with a partner and with children spent more time on unpaid work and less time on leisure. CONCLUSIONS: Productivity of paid work decreased, and people reallocated time between paid and unpaid work and leisure during the first COVID-19 lockdown. Changes in time allocation and productivity differed across subgroups. If working at home becomes more common, future research should focus on the long-term impact on productivity and mental and physical health.

Approach to a child with Multisystem Inflammatory Syndrome associated with COVID-19. Recommendations by the Polish Paediatric Society Expert Group. Update - February 2021

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical entity occurring in children and young adults, which is associated with the SARS-CoV-2 infection. The first cases of MIS-C were diagnosed in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, reflecting the increased incidence of COVID-19 in the paediatric population. MIS-C develops as a result of dysregulation of the immune system occurring 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on the following criteria: a set of clinical features (including fever and signs of multiple organ damage) and elevated inflammatory markers, with exclusion of other causes. The most common complications involve the cardiovascular system: acute myocardial damage with reduced left ventricular ejection fraction, shock, and coronary artery abnormalities and arrhythmias. Mortality in Western Europe and the United States is around 1-2%. Appropriate management, including vital function support and immunomodulatory treatment, allows for a quick recovery in the vast majority of patients. This document is an updated guideline for the diagnostic and therapeutic management of children with suspected MIS-C in Poland. The most important changes concern treatment, steroid therapy, and antiplatelet therapy in particular.