Pulmonary function in non-hospitalized adults and children after mild Covid-19

Objective Asesmentof lung function impairment after mild SARS-CoV-2 infection in non-hospitalized children and adults. Additionally focusing on previous and persistent symptoms due to Covid-19 as well as current respiratory tract infection status. Methods Patients aged 6-60 years were recruited by telephone after laboratory-confirmed positive PCR result for SARS-CoV-2. Excluding criteria were hospitalization during Covid-19, pre-existing lung diseases (bronchial asthma, COPD) and smoking within the last five years. Pulmonary function testing was performed 4-12 weeks after infection, including Multiple-breath washout (LCI), spirometry (FEV?, FVC, Tiffeneau-Index) and diffusion capacity testing (DLCO, TLC;Hb corrected). All patients answered a questionnaire regarding previous and persistent symptoms. To gather information about the current infection status, a pharyngeal swab was taken to detect common respiratory bacterial and viral pathogens using a multiplex PCR approach. Patients with abnormalities in pulmonary function were invited to a follow up testing three months later. Results 110 patients, 90 adults and 20 children, were included. 44 adults and 17 children had at least one abnormal value in pulmonary function tests after an average of 7.7 weeks (range 4.3-11.3) to confirmed SARS-Cov-2 infection. Among these 44 adults, 33 reported pulmonary symptoms during Covid-19 and 19 persistent respiratory symptoms. No abnormalities in DLCO were found in adults. At the second pulmonary function testing 12.5 weeks (range 11.0-16.7) on average after the first appointment, improvement was shown in 61,7% ( n=29 of 47) with previous abnormal LCI, in 69,2% (n=9 of 13) with prior abnormal FVC and in 4 of 5 children with abnormal DLCO. No large correlation was detected between impaired pulmonary function and multiplex PCR results. Conclusion Mild lung function impairment was shown at the first appointment, particularly in LCI, but not equally measured in the entirety of lung function tests. Pulmonary function results were not affected by current infection status and partially mismatching with stated persisting symptoms. Within 3 months, most initially abnormal values improved, and self- perceived health status increased. Long term pulmonary function impairment was rarely detected after mild, non-hospitalized Covid-19 course. .

CLINICAL AND GENETIC DETERMINANTS OF SEVERE COURSE OF COVID-19 IN PREGNANT WOMEN.

Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets. Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction;polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants. Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients;thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III-IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios - 52.4%, ahydramnios - 14.3%, fetal growth retardation syndrome - 33.3%, circulatory disorders - 57.1%, fetal distress - 47.6%, preeclampsia - 14.3%), labor (caesarean section - 57.1%, premature birth - 28.6%), disorders of newborns state (asphyxia - 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%). Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.Copyright © 2022 Trylyst. All rights reserved.

Influencing factors and clinical significance of liver function damage in patients diagnosed with COVID-19.

Objective: To invetigate the influencing factors and clinical significance of liver function damage (LFD) in patients diagnosed with Corona Virus Disease 2019 (COVID-19). Method(s): The retrospective case-control study was conducted. The clinicopathological data of 51 patients with COVID-19 who were admitted to the Sino-French New City Branch of Tongji Hospital Affiliated to Huazhong University of Science and Technology by the 5th group assisting team from the First Hospital of Jilin University from February 9th to 27th in 2020 were collected. There were 27 males and 24 females, aged from 36 to 86 years, with an average age of 68 years. The treatment modality was according to the diagnostic and therapeutic guideline for COVID-19 (Trial 6th edition) issued by National Health Commission. Observation indicators: (1) clinical data of patients;(2) analysis of liver function index and treatment of LFD;(3) analysis of influencing factors for LFD. Measurement data with normal distribution were represented as Mean+/-SD, and measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Logistic regression method was used for univariate analysis. Result(s): (1) Clinical data of patients: of the 51 patients, 21 were classified as ordinary type of COVID-19, 19 as severe type and 11 as critical type. In terms of medical history, 31 patients suffered from more than or equal to one kind of chronic disease, 20 had no history of chronic disease. Thirteen patients had the drinking history and 38 had no drinking history. Seven patients were hepatitis positive and 44 were hepatitis negative. Five patients had septic shock at admission, 5 had systemic inflammatory response syndrome (SIRS), and 41 had neither shock nor SIRS. The body mass index (BMI), time from onset to admission, temperature, heart rate, respiratory rate of the 51 patients were (24+/-3)kg/m2, (13+/-5)days, 36.5 (range, 36.0-38.1 ), 82 times/minutes (range, 50-133 times/minutes), 20 times/minutes (range, 12-40 times/minutes). The white blood cell count, level of creatinine, and level of b-type natriuretic peptide within 24 hours after admission were 6.3x109/L [range, (2.2-21.7)x109/L], 75 mumol/L (range, 44-342 mumol/L), 214 ng/L (range, 5-32 407 ng/L). (2) Analysis of liver function index and treatment of LFD: the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), direct bilirubin (DBil), indirect bilirubin (IBil), activated partial thromboplastin time (APTT) and prothrombin time (PT) were 31 U/L (range, 7-421 U/L), 29 U/L (range, 15-783 U/L), 36 U/L (range, 13-936 U/L), 76 U/L (range, 41-321 U/L), 4.9 mumol/L (range, 2.6-14.3 mumol/L), 5.8 mumol/L (range, 2.6-23.9 mumol/L), 37.2 s (range, 30.9-77.1 s), 13.9 s (range, 12.5-26.7 s), respectively. The percentages of cases with abnormal ALT, AST, GGT, ALP, DBil, IBil, APTT and PT were 47.1%(24/51), 47.1%(24/51), 35.3%(18/51), 13.7%(7/51), 7.8%(4/51), 2.0%(1/51), 21.6%(11/51), and 19.6%(10/51), respectively. Of the 51 patients, LFD was detected in 10 patients classified as ordinary type, in 9 patients as severe type, and in 10 as critical type, respectively. In the 51 patients, 1 of 22 patients with normal liver function developed respiratory failure and received mechanical ventilation within 24 hours after admission, while 9 of 29 patients with abnormal liver function developed respiratory failure and received mechanical ventilation, showing a significant difference between the two groups (chi2=5.57, P<0.05). (3) Analysis of influencing factors for LFD. Results of univariate analysis showed that clinical classification of COVID-19 as critical type was a related factor for LFD of patients (odds ratio=10.000, 95% confidence interval: 1.050-95.231, P<0.05). Conclusion(s): COVID-19 patients with LFD are more susceptible to develop respiratory failure. The clinical classification of COVID-19 as critic l type is a related factor for LFD of patients.Copyright © 2020 by the Chinese Medical Association.

Ambroxol therapy for patients with Gaucher disease type 1, either poor responders to enzyme replacement therapy/substrate reduction therapy (ERT/SRT) or untreated

Ambroxol hydrochloride is an oral mucolytic drug, available over-the-counter for many years as cough medicine, which was found to also act as a pharmacological chaperone for mutant glucocerebrosidase, albeit in a several-fold higher dose. Proof-of-concept reports have been published over the past decade in all three forms of Gaucher disease (GD). The current study aimed to assess the safety and efficacy of 12-months ambroxol 600 mg/day in 3 groups of type 1 GD patients with sub-optimal response, after a minimum of 3 years, to enzyme replacement therapy (ERT)/substrate reduction therapy (SRT) defined as lumbar spine bone density <−2.0 t-score, or platelet count<100 × 10−3/L, or LysoGb1 > 200 ng/ml, and for a group of naïve patients, i.e., never treated or stopped therapy >12 months prior to enrollment, who had abnormal values in 2 of the 3 above-mentioned parameters. Forty patients were enrolled: 28 ERT/SRT treated and 12 naïve;21 (52%) males, mean age 52 years (range 24–84). Safety aspects included several adverse effects (mainly gastrointestinal, excessive saliva, and vertigo) all mild and transient in nature, but led to drug discontinuation in 14 patients, additional dropouts were 7 patients due to COVID19 pandemic and 3 due to personal reasons. Of the remaining 16 patients, 14 have completed 12 months, and 2 are ongoing. Of the 14 completers, 5 (~36%) achieved significant improvement in at least one of the three parameters, and nine did not demonstrate any improvement nor deterioration. The interpretation of the results must take into account the fact that most of the enrolled patients have had poor response to ERT/SRT (including 10 of the 12 naïve patients) and therefore may not represent the majority of the patients. Further studies are needed in never-treated patients as well as an oral, less expensive, alternative to unselected stable patients currently treated with ERT/SRT with a favorable response.

Clinical and Laboratory Evaluations of Patients Diagnosed as Having Multisystem Inflammatory Syndrome Associated with Coronavirus Disease 2019 in Children: A Single Center Experience from Konya

Objective Multisystem inflammatory syndrome in children (MIS-C), characterized by fever, inflammation, and multiorgan dysfunction, was newly defined after severe acute respiratory syndrome coronavirus 2 infection. The clinical spectrum of MIS-C can be classified as mild, moderate, and severe. We aimed to evaluate demographics, clinical presentations, laboratory findings, and treatment modalities of patients with MIS-C according to clinical severity. Methods We performed a retrospective study of patients who were diagnosed as having MIS-C between September 2020 and October 2021 in the Necmettin Erbakan University Meram Faculty of Medicine, Türkiye. Results A total of 48 patients (24 females and 24 males) with a median age at diagnosis of 10.3 years (range: 42 months-17 years) were enrolled, the most common clinical severity of MIS-C was moderate. The common presentations of patients were fever (97%), nonpurulent conjunctivitis (89.6%), rashes (81.3%), fatigue (81.3%), strawberry tongue (79.2%), and myalgia (68.8%). The most common laboratory findings were lymphopenia (81.2%), thrombocytopenia (54.1%), elevated D-dimer levels (89.5%), C-reactive protein (CRP;100%), procalcitonin (97%), erythrocyte sedimentation rate (87.5%), ferritin (95.8%), interleukin 6 (IL-6) (86.1%), and probrain natriuretic peptide (pro-BNP) (97%). High levels of CRP, procalcitonin, pro-BNP, and urea were associated with the severity of MIS-C (p < 0.05). Fifteen of the patients were found to have pulmonary involvement. Ascites were the most common finding on abdominal ultrasonography (11 patients) and were not seen in a mild form of the disease. During the study period, two patients died. Conclusion It is important to make patient-based decisions and apply a stepwise approach in treating patients with MIS-C due to the increased risk of complications and mortality. © 2022. Thieme. All rights reserved.

SARS-CoV-2 pandemic and GH treatment: new strategies to abate the distance

SARS-CoV- 2 pandemic induced to develop new strategies to abate the distance between patients, families and paediatricians, especially in cases of patients who need long-term therapies. Furthermore, the need to minimize the inflow of children and adolescents affected by chronic diseases into the hospitals induced paediatric endocrinologists to limit visits and to consider a new setting to assist children in treatment with growth hormone (GH). Telemedicine and smart-working could contribute to maintain a good standard of care in the follow-up of children with GH deficiency, still in treatment with GH. Patients were assisted by telephonic consultations guaranteed by the paediatricians of free choice and by the paediatric specialists. However, patients frequently needed a direct specialistic evaluation in the case of flares, abnormal laboratory parameters and adverse reactions to drugs. We enrolled 85 children (50 M;35 F);Medium age: 12.4 (4-16) years, with GH deficiency, in treatment with GH. A questionnaire were proposed to their parents, with questions about the assistance and problems linked to the disease. The questionnaire highlighted many points: - the central role of the follow-up by the paediatricians of free choice;- the useful digital support strategies (pc, smart phone app, tele consult, etc);- the worsening of dietary intake and increased caloric intake, associated with a decreased regular physical activity. These life style increased BMI in most patients. - the important role of the paediatric endocrinologist consults in important decisions as vaccinations. The new scenario induced paediatric endocrinologists to create new strategies to support patients with special needs, as GHD children and adolescents. However, these strategies can be maintained even beyond the end of the pandemic, as a good assistance practice.

Pathophysiologic Mechanism of Hematological Abnormalities in COVID-19 Patients and its Implication in the Prognosis and Disease Severity: A Retrospective Study in a Tertiary Care COVID Hospital

Introduction: Worldwide there was recent outbreak of a novel Corona Virus infection i.e. SARS COV19. Although it involves primarily the pulmonary system other systems like Cardiovascular, renal, neurological, hematological systems are also significantly involved by SARS COV19 infection. Aim(s): In this study our aim was to analyze the pathophysiologic mechanism of hematological abnormalities in COVID-19 patients and its role in risk stratification, severity & prognosis of the disease. Material(s) and Method(s): In this study we have analyzed the clinical presentation and pathological laboratory results of hematological abnormalities retrospectively from previous records of COVID-19 patients admitted to our hospital. All the hematological parameters i.e. changes in Hb%, WBC Count, Platelet Count and Coagulation Profile parameters i.e. PT-INR, aPPT& D-dimer were analyzed and correlated with the disease severity and its prognosis. Statistical analysis was done be x2 test. Result(s): In our study the most common hematological abnormality was Lymphopenia followed by Leukocytosis and majority of the patient were >60 Yrs. age with male predominance. Conclusion(s): Among all the hematological abnormalities coagulation parameter D-dimer (elevated levels) are most significantly associated with disease severity. Among the other hematological abnormalities the most common abnormality was Lymphopenia which along with combined features of Anemia, Leukocytosis andNeutrophilia were also significantly associated with disease severity. So, monitoring & evaluation of hematological parameters could be a crucial step towards risk stratification & management of COVID-19 patients. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.

Multi-system Inflammatory Syndrome Presentation to the Pediatric Emergency Department

Background: In April 2020, the emergence of Multi-system Inflammatory Syndrome in Children (MIS-C) was first recognized. Existing studies have been mostly descriptive of the clinical characteristics associated with MIS-C. Studies concerning how MIS-C patients present to the Emergency Department (ED) are scarce. There are also few studies describing the progression of the disease during hospitalization and outcomes and comparing those who have severe versus non severe MIS-C. Our study sought to confirm prior findings as well as investigate if abnormal laboratory values were associated with worse outcomes based on hospital placement (not requiring admission, admission to pediatric floor, and admission to pediatric intensive care unit [PICU]) as well outcomes at time of disposition. Methods: This was a retrospective case-control study at a tertiary care pediatric children's hospital in a metropolitan area. Medical records of patients diagnosed with MIS-C per the Center for Disease Control's (CDC) or World Health Organization (WHO) criteria from March 2020 to June 2020 were reviewed. Control cases were defined as patients who met criteria for diagnosis of MIS-C but were found to be negative on COVID polymerase chain reaction (PCR) testing. To assess the differences between MIS-C patients discharged home from the ED and those admitted to the PICU regarding obesity neutrophilia, lymphopenia and elevated troponins, a Pearson's Chi-square test was conducted. The total MISC population was studied to see if associated obesity, neutrophilia, lymphopenia or elevated troponins were associated with a worse outcome, a Fisher's Exact test was conducted. Results: There were no differences between those with MIS-C and controls in reference to age, gender and race. Comparing those who were admitted to the PICU versus that were discharged from the ED, or admitted to a non-PICU bed, we found a significant increase in neutrophilia and troponin I. A significant association with elevated troponin and obesity occurred when comparing the MIS-C group and controls. There was no association of obesity, neutrophilia, lymphopenia, and elevated troponin with poor outcome. Conclusion: Children with neutrophilia and increased troponin I were associated with more severe illness requiring PICU admission. Despite these findings, their outcomes were not affected. When controls were compared to those with MIS-C there was a significant increase in elevated troponin and obesity. With these findings, ER physicians can expect worse illness based on neutrophilia and increased troponin I helping one to decide if a child needs to be admitted to the PICU.

Multiparametric CMR Findings in Mrna COVID-19 Vaccine-induced Myocardit is: A Case Series

Introduction: Within weeks of the pediatric coronavirus disease 2019 (COVID-19) vaccination campaign beginning, reports of acute myocarditis after adolescents' second vaccination began. The present research describes the clinical and cardiovascular magnetic resonance (CMR) imaging characteristics of three adolescents recently vaccinated with a mRNA vaccine and admitted for myopericarditis treatment. Case Description: This retrospective case-series investigated adolescents admitted within a week of their second mRNA COVID-19 vaccination. The electronic medical record was queried for all patients ≥12 years old, admitted for acute myocarditis or pericarditis (International Classification Diseases-Version 10;I30.xx, I40.xx respectively) since April 1, 2021. Patients were included if they had a documented mRNA vaccination in the prior seven days. Three patients met inclusion criteria. All three had acute onset chest pain within 48 hours of receiving their second mRNA vaccine. All had elevated troponins, all were eventually admitted and had mild clinical courses. All met Lake Louise criteria for acute myocarditis despite only one patient having mild depression of cardiac function on echocardiography. All patients were negative for COVID-19 and none had a clinical history or immunologic evidence of prior COVID-19. The patient with the most diffuse pattern of late gadolinium enhancement on CMR (Figure 1) developed ventricular tachycardia three weeks after discharge. Discussion: Vaccine induced myopericarditis is rare in inactivated vaccines, but is a known entity with live vaccines, especially the smallpox vaccine. Since the 1950's, cases of myocarditis and pericarditis have been reported in association with vaccination. Research using VAERS has previously found that from 1990- 2018, 0.1% of reports were for myopericarditis associated with vaccination. The rates of mRNA vaccine-induced myocarditis are currently unknown, but our clinical findings are similar to other recently published case series of pediatric mRNA associated myopericarditis. We have observed differences in CMR patterns between our patients from this series and previous reports of patients with cardiac involvement from COVID-19 (Table 1). We remain uncertain regarding the precise pathophysiology in these patients with myocardial inflammation following mRNA vaccine administration. However, the relatively focal pattern of involvement, and the relative preservation of global function, suggest a milder involvement of the myocardium-in most of these patients-than has previously been observed in classic viral and COVID-19 myocarditis. Conclusion: Three adolescent males developed acute myocarditis within days of their second mRNA COVID-19 vaccination. CMR in combination with serum troponin measurements was critical for diagnosis, and arrythmia monitoring was critical in their follow up. Repeat CMR studies over the six months following diagnosis will be important to rule out development of post-inflammatory fibrosis and long-term arrhythmias. Legend: A and B: LGE (Magnitude IR) and PSIR (Phase sensitive IR), respectively, showing patchy epicardial enhancement at the basal inferolateral and inferior segments;C: Abnormal ECV at basal anterolateral, inferolateral and inferior segments;D and E: ECV and T1 bullseye maps with abnormal values;F and G: Patchy visible edema at basal inferolateral, anterolateral and inferior segments on the T2 and T2 color map;H: Bullseye map showing T2 values;I: Asymmetric Right axillary lymphadenopathy secondary to vaccination in the right arm.

Unpacking BMI Significance: Prevalence of Metabolically Healthy Obesity and Metabolic Profile Predictors Among Adolescents Enrolled in a Weight Management Program

Purpose: Adolescent obesity continues to rise, with body mass index (BMI) commonly used as an adiposity surrogate. While obesity correlates with metabolic syndrome risk, individuals with the same BMI do not have equivalent health risks. In 2018, the first pediatric consensus definition for metabolically healthy obesity (MHO) was proposed. Identifying MHO patients is clinically relevant for personalizing interventions by cardiometabolic phenotype. The objective of this study was to examine baseline MHO and metabolically unhealthy obesity (MUO) prevalence and identify metabolic and anthropomorphic predictors among adolescents enrolled in weight management. Methods: This study uses baseline data from 1,316 patients ≥ 11 years of age enrolled in a weight management program for obese adolescents in Baltimore, Maryland between 2005-2018. Anthropometric measures (including body fat by bioimpedance (%fat)), vital signs, and fasting labs were performed at intake. MHO definition was: glucose <100, HDL > 40, triglycerides < 150, systolic blood pressure < 120, diastolic blood pressure < 80. MUO was defined as ≥ 1 abnormal value among MHO variables. Independent samples t-tests were used to compare mean %fat and BMI z-score of MHO and MUO groups. Bivariate logistic regression was performed to determine effects of age, sex, %fat, BMI, and BMI z-score on likelihood of MHO. Results: Mean age in the MHO group was 13.48 years (SD 1.88);mean age in the MUO group was 13.98 years (SD 2.03). 444 (33.7%) patients met criteria for MHO;872 patients had MUO. MHO teens had statistically significantly lower mean %fat (46.7% +/- 8.0% SD) vs. MUO (47.8% +/- 8.2% SD) (p = 0.034) and lower BMI z-score (2.37 +/- 0.33 SD vs 2.51 +/- 0.34 SD;p < 0.001) vs MUO. The MHO group was 66.9% female vs 54.5% females in MUO, with 38.9% lower odds of MHO for males vs. females (OR 0.611;CI 0.467 - 0.800). For every 1% increase in %fat, odds of MHO increased by 3.1%, (OR 1.031;CI 1.008 - 1.053). Each 1-year age increase led to 10.9% decrease in MHO odds (OR 0.891;CI 0.823 - 0.965). In addition, each 1 unit increase in BMI z-score was associated with a 64.5% decrease in odds of MHO (OR 0.355;CI 0.166 - 0.759). BMI change did not significantly change MHO odds. Conclusions: Among this cohort of obese adolescents enrolled in weight management, one-third had MHO. Factors associated with higher likelihood of MHO include: female sex, younger age, and lower BMI z-score. Notably, BMI was not predictive of metabolic phenotype. These findings suggest potential for risk prediction for MUO profile to tailor interventions and resources accordingly. Next, we will evaluate metabolic profiles of patients enrolled during the COVID-19 pandemic. Sources of Support: NICHD T32HD052459 (PI: Trent), The Mount Washington Foundation.

SELF-ASSESSMENT OF VITAL SIGNS AND SYMPTOMS OF COVID-19: BLOOD PRESSURE MEASUREMENTS RESULTS FROM THE HYTECC STUDY

Objective: Little is known about the impact of a positive SARS-CoV-2 PCR test and self-isolation at home on blood pressure (BP) values. Moreover, the association between BP values and COVID-19 symptoms is poorly described. The objective of this study was to assess the feasibility of a remote initiation of home health surveillance, including home blood pressure monitoring (HBPM), carried out by confined hypertensive adults diagnosed with COVID-19. Design and method: Individuals included in the study were between 40 and 69 years old with a known diagnosis of hypertension and a recent positive SARSCoV- 2 PCR test. After initial phone contact, each participant received at home the equipment needed for vital signs assessment, including a LifeSourceâ UA- 651BLE BP monitoring device and access to a web-based platform. The Sphygmoâ mobile app was used by the participants for the electronic transmission of results. Participants had to assess their symptoms and complete vital signs including two BP measurements, twice a day, for 14 consecutive days. Abnormally low BP was defined as a systolic BP < 100 mm Hg. Written guidance was provided to participants on the correct method to perform the various vital signs measurements and data collection. Correlation test was calculated between the proportions of abnormal values of vital signs and severe symptoms. Results: A total of 46 participants completed the study. The mean age was 54.1 ± 6.9 years and 54% of participants were men. On average, participants performed 54 BP measurements, 12.3 days of measurements, and 4.4 BP measurements per day. 30.4% (n = 14) of participants had at least 1 systolic BP measurement that was abnormally low (mean of 2.5 abnormally low systolic BP, range 1 to 6). Ab- normally low systolic BP was not significantly correlated with the severity of COVID-19 symptoms. Conclusions: In a pandemic context, among hypertensive participants with a positive SARS-CoV-2 PCR test, the remote initiation of HBPM with electronic transmission of results is feasible. Moreover, participants were able to perform nearly fourteen days of BP measurements including self-assessment of symptoms, twice a day, and transmit their data using a mobile app and a web-based platform.

Index of cardiac electrophysiological balance (iCEB) in patients with COVID-19

Aims: We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non- TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group. Methods and Results: This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5mm in all limb leads and less than 10mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR=10.435;95%CI 4.015 - 27.123;p=0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR=1.041;95%CI 0.485 - 2.235;p=0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR=2.622;95%CI 0.743 - 9.257, p=0.123). Conclusion: In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non- TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

Pediatric COVID-19-associated hyper-inflammation score: The virus registry predictive analytic study

INTRODUCTION: Several adult and pediatric studies demonstrate a correlation between elevated inflammatory markers and COVID-19 disease severity. The Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry was used to develop Pediatric COVID Hyperinflammation Syndrome (PcHIS) score and evaluate the association between PcHIS and severe COVID illness in children. METHODS: Children under 18 years of age hospitalized due to COVID-19 were filtered from VIRUS registry (NCT 04323787). Neonates and children incidentally positive for COVID were excluded. For the development of PcHIS score we used 7 variables: fever, hematologic dysfunction (platelet, leucocyte count), elevated ferritin, elevated D-dimer, cytokinemia (CRP, procalcitonin, IL-6), hepatic injury (ALT, AST, albumin) and elevated cardiac enzymes (BNP, Troponin). ROC curves were generated for each variable to choose the best discriminatory (J point of Youden Index) value for identification of severe disease (anyone requiring respiratory support more than O2 by NC, vasoactive meds, ECMO, or dialysis). Each abnormal value got one point and the additive PcHIS score was calculated for the best discriminatory score for identification of severe disease (using ROC). RESULTS: Out of a total of 1123 patients aged < 18 years with COVID-19 in the registry, 722 were included for PcHIS development;rest had missing data. A 1/3rd in the cohort had severe COVID disease. Odds of severe disease were higher with fever > 39°C (OR1.5;CI1.05-2.14), presence of any hematologic dysfunction (platelets < 250k/μL or WBC > 6650/μL) (OR 7.12;CI 2.52-20.05), cytokinemia (CRP >6.7 mg/dL or procalcitonin > 3.4) (OR 4.99;CI 3.05-8.17), ferritin level > 270 mg/dL (OR 3.87;CI 2.38-6.28), elevated cardiac enzymes (BNP > 685 or Troponin > 0.03) (OR 3.08;CI1.96-4.85), hepatic injury (AST >50 or ALT >40 or albumin< 3.5 g/dL) (OR 3.25;CI 2.16-5.0), D-dimer > 2000 ng/ml (OR 2.46;CI1.59-3.8). A PcHIS score of 2.5 had a sensitivity of 69.2% and a specificity of 62.1% with ROC area under curve of 0.70 (95% CI: 0.66-0.74;p< 0.001). CONCLUSIONS: PcHIS score may be calculated from early laboratory data and is useful in predicting severe disease in children with COVID-19. Its role in clinical practice needs to be determined in a prospective study.

Comparison of Leukocyte, Neutrophil, and Lymphocyte Levels in Child Patients that Experienced Breathlessness with COVID-19 and Non-COVID-19 (2020–2021) in Medan, Indonesia

BACKGROUND: COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus-2. Various risk factors affect the morbidity and mortality of COVID-19, such as age, gender, ethnicity, comorbid conditions, and laboratory parameters. Clinical manifestations of COVID-19 in children are asymptomatic mild degrees or with acute upper respiratory tract symptoms and moderate degrees with clinical pneumonia. In the course of the COVID-19 pandemic, several biomarkers are needed that can be useful in risk stratification to predict the severity and fatality of COVID-19. Several biomarkers are used as markers of disease progression to a critical degree, such as leukocytes, lymphocytes, platelets, interleukin-6, and serum ferritin. Increased leukocytes and neutrophils and decreased lymphocytes are associated with severity and mortality in COVID-19. Laboratory findings in children with COVID-19 include decreased lymphocytes, leukopenia, and increased procalcitonin. In severe COVID-19, children often have abnormal laboratory parameters that suggest a systemic inflammatory response. AIM: This study aims to compare leukocytes, neutrophils, and lymphocytes levels in children with the complaints of shortness of breath with COVID-19 and non-COVID-19 pediatric patients. MATERIALS AND METHODS: This study is an analytic study with a cross-sectional approach to pediatric patients treated in Haji Adam Malik General Hospital Medan with the complaints of shortness of breath. Patient data were assessed based on the characteristic values of hemoglobin, leukocytes, neutrophils, lymphocytes, and COVID-19 polymerase chain reaction results and then analyzed using SPSS for Windows software. The study samples were 276 patients, with 43 confirmed positive COVID-19 patients and 233 negative patients. The source of this research data is data from the patient’s medical record for 1 year (2020–2021). RESULTS: The statistical analysis results found differences in the levels of leukocytes, neutrophils, and lymphocytes in children diagnosed with COVID-19 and non-COVID-19 (p < 0.05). However, there was no difference in hemoglobin levels in children who were congested with COVID-19 and non-COVID-19 (p > 0.05). CONCLUSION: These results are consistent with several cases and previous studies where the levels of leukocytes, neutrophils, and lymphocytes can be used as a detection tool and a diagnostic and prognostic tool in COVID-19 patients.

Ferritin and Neutrophil Lymphocyte Ratio in Assessingthe Severity of Disease in COVID 19 Positive Pregnancy

Introduction: The pandemic of coronavirus disease 2019 caused bythe SARS-CoV-2 is affecting many women during pregnancy and inthe postpartum period worldwide. A peculiar characteristic ofCOVID-19 is the release of a large amount of inflammatory cytokines. Some biomarkers have been considered as tools to monitor theevaluation of COVID-19, namely CRP, LDH, D-dimer and ferritin.Currently the neutrophil lymphocyte ratio constitutes a new stronginflammatory marker for the detection of inflammation. Neutrophillymphocyte ratio has also been used as a predictor of complication ofpregnancy, such as pre-eclampsia, gestational diabetes mellitus,hyperemesis gravidarum, premature labour and ectopic pregnancy.Aims &Objectives: To study the neutrophil lymphocyte ratio (NLR)and ferritin levels in COVID-19 positive pregnancy and correlate itwith the severity of the disease.Materials &Methods: This is an observational study conducted inthe obstetrics ward of a tertiary care center. The inclusion criteriawere all the pregnant females admitted in the obstetrics ward with adiagnosis of COVID-19 by RT PCR in the period of 3 months. Theexclusion criteria were patients with non reactive rapid test results.Clinical and demographic data were extracted from electronic medical records.Result: In our study, 32 out of 70 patients showed ferritin valuesabove 400 ng/ml. Lymphocytopenia, increased neutrophil lymphocyte ratio and increased ferritin had all been linked with diseaseseverity or mortality. Decreased lymphocyte value was associatedwith an increased likelihood of receiving oxygen supplementationduring hospitalization. These markers show abnormal values inobstetrics patients and reflects the course of the disease. It suggestedthat additional care should be reserved to patients presenting withdecreased value of these blood cells. Pregnancy is a physiologicanemic state and high levels of ferritin, especially in third trimesterare associated with negative outcomes like preterm delivery andgestational diabetes mellitus.Conclusions: Both neutrophil lymphocyte ratio and ferritin levels canact as independent markers in assessing the disease severity ofCOVID-19 in obstetrics patients.

Discriminatory accuracy of the SOFA score for determining clinical decompensation in patients presenting with COVID-19

Introduction: While the global dissemination of vaccines targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a decline in the incidence of infections, the case fatality rates have remained relative stable. A major objective of managing hospitalized patients with documented or suspected COVID-19 infection is the rapid identification of features associated with severe illness using readily available laboratory tests and clinical tools. The sequential organ failure assessment (SOFA) score is a validated tool to facilitate the identification of patients at risk of dying from sepsis. Purpose: The aim of this study was to assess the discriminatory accuracy of the SOFA score in predicting clinical decompensation in patients hospitalized with COVID-19 infection. Methods:We conducted a retrospective analysis at a three-hospital health system, comprised of one tertiary and two community hospitals, located in the Chicago metropolitan area. All patients had positive SARS-CoV-2 testing and were hospitalized for COVID-19 infection. The primary outcome was clinical decompensation, defined as the composite endpoint of death, ICU admission, or need for intubation. We utilized the most abnormal laboratory values observed during the admission to calculate the SOFA score. Receiver Operating Curves (ROC) were then constructed to determine the sensitivity and specificity of SOFA scores. Results: Between March 1st and May 31st 2020, 1029 patients were included in our analysis with 367 patients meeting the study endpoint. The median SOFA score was 2.0 IQR (Q1, Q3 1,4) for the entire cohort. Patients who had in-hospital mortality had a median SOFA score of 4.0 (Q1,Q3 3,7). In patients that met the primary composite endpoint, the median SOFA score was 3.0, IQR (Q1, Q3 2,6). The ROC was 0.776 (95% CI 0.746-0.806, p<0.01). Conclusion: The SOFA score demonstrates strong discriminatory accuracy for prediction of clinical decompensation in patients presenting with COVID-19 at our urban hospital system. (Figure Presented).