The Effect Of Rhabdomyomas On Underlying Cardiomyopathy: A Case Report

Case Presentation: Term male infant born to SARS-CoV-2 positive mother with infant testing negative. ECG for perinatal bradycardia revealed ventricular pre-excitation. Echocardiogram showed asymmetric LV hypertrophy with prominent trabeculations, subaortic narrowing with no pressure gradient, and normal biventricular systolic function. Rapid increase in RV pressure estimates and NT-proBNP in first week if life concerning for diastolic dysfunction. Anti-arrhythmic therapy initiated for SVT with subsequent resolution. Later, developed progressive LV dilation and systolic dysfunction. Myocardium showed regions resembling non-compaction and others concerning for infiltrative process. Cardiac MRI showed no obvious tumors, but rhabdomyomas could not be ruled out given similar appearance to myocardium. Due to worsening heart failure, everolimus therapy initiated to target potential rhabdomyomas while awaiting genetic testing for tuberous sclerosis. Subaortic narrowing and LV hypertrophy improved within days, and LV appearance became more consistent with non-compaction. Genetic testing revealed a TSC2 gene variant consistent with tuberous sclerosis. Systolic function improved, and patient discharged on afterload reduction. Echocardiogram 6 months post-discharge shows continued LV dilation and mild systolic dysfunction. Discussion(s): Although outflow obstruction and arrhythmias are common with cardiac rhabdomyomas and can cause dysfunction, our patient developed progressive dysfunction in the absence of outflow tract gradient or prolonged arrhythmia. As rhabdomyomas subsided, it became clearer that he had an underlying cardiomyopathy. We suspect that rhabdomyomas in the setting of abnormal myocardium led to abnormalities in myocardial contractility and compliance causing combined systolic and diastolic dysfunction. After complete resolution of rhabdomyomas, cardiac function has improved. However, he continues to have ventricular dilation and mild dysfunction attributable to cardiomyopathy. It is unlikely that mother's SARS-CoV-2 infection played a role as infant tested negative and clinical picture was not consistent with myocarditis.

Human Papillomaviruses in Adolescents: Knowledge, Attitudes, and Practices of Pharmacists Regarding Virus and Vaccination in France.

Human papillomaviruses (HPVs) are responsible for one of the most common sexually transmitted diseases in the world, and their oncogenic role has been well demonstrated in genital, anal, and oropharyngeal areas. However, a certain distrust and a lack of knowledge about this vaccine are perceptible among French adolescents and their parents. Thus, health professionals and, more particularly, pharmacists appear to be key persons to promote HPV vaccination and restore confidence in the target population. The present study aims to assess the knowledge, attitudes, and practices regarding HPV vaccination among pharmacists, particularly in boys, following the 2019 recommendation to vaccinate them. The present study was designed as a cross-sectional, quantitative, and descriptive survey that was conducted from March to September 2021 among pharmacists in France. 215 complete questionnaires were collected. Gaps in knowledge were found, only 21.4% and 8.4% obtained a high level of knowledge related to, respectively, HPV and vaccination. Pharmacists were confident in the HPV vaccine (94.4%), found it safe and useful, and felt that the promotion of the vaccine was part of their role (94.0%). However, only a few have already advised it, which they justify due to a lack of opportunity and forgetfulness. Faced with this, training, computerized reminders, or supportive materials could be implemented to improve the advice and thus the vaccination coverage. Finally, 64.2% were in favor of a pharmacy-based vaccination program. In conclusion, pharmacists are interested in this vaccination and the role of promoter. However, they need the means to facilitate this mission: training, computer alerts, supportive materials such as flyers, and the implementation of vaccination in pharmacies.

Comparison between First and Second Wave of Sars-Cov-2 Pandemic: Clinical Profiles and Predictors of Severe Covid-19 Children

BACKGROUND AND AIM: BACKGROUND: Indonesia has experienced two waves of SARS-CoV-2 infection during 2 years of pandemic. The first wave was October 2020 - February 2021 and the second was between May - July 2021. Only few studies comparing the clinical profiles and predictors of severe COVID-19 children between the waves. AIM: To compare the clinical profiles and predictors of severe COVID-19 children between the first and second wave of pandemic. METHOD(S): METHOD: There were 270 children hospitalized with SARSCoV- 2 infection confirmed by RT-PCR during the study period. Twelve children with severe COVID-19 in PICU of 3 hospitals in North Sumatera Indonesia during the first and second waves were enrolled. The data collected were related to clinical characteristics, interventions provided, laboratory findings, and outcomes. RESULT(S): RESULTS: Twelve (4.4%) patients developed severe and critical COVID-19. Eight children in the first wave and the others in the second wave, all of them had comorbidities. Male infants were 50% cases. Fever, cough, dyspnea, and SpO2 < 93% were the most prominent symptoms in first wave cases but neither in the second wave. Low platelet and lymphocyte count with markedly increased C-reactive protein and D-dimer were considered as the predictors of severity. All of the cases were at risk of PARDS with SF ratio below 150. Poor outcome was observed in 87,5% in the first wave versus 25% in the second wave. CONCLUSION(S): CONCLUSION(S): There were major differences comparing the clinical profiles and predictors of severe COVID-19 children between first and second wave of SARS-CoV-2 pandemic.

Aplastic Anemia Following SARS-COV-2 Infection

Introduction: COVID 19 is caused by a novel virus SARS-CoV-2.It has become a pandemic as declared by WHO with its first case being reported in China. Among children the intensity is usually mild and without any further impact. Aims & Objectives: Unusual presentation of aplastic anemia following SARS-CoV-2 infection: A rare case report. Material(s) and Method(s): A 6 year old male child presented with complaints of rashes and epistaxis for 2 weeks and also one episode of blood in stools.Two weeks prior to the onset of above complaints, the patient had a history of recovery from COVID -19.Blood investigations revealed pancytopenia with hemoglobin of 5.6 gm/dl,total leukocyte count of 2000/cumm and platelets were 43,000/cumm.The corrected reticulocyte count was 0.3%.Bone marrow examination done showed completely hemodilutedsmears.Bone marrow biopsy revealed a markedly hypocellular marrow with cellularity of 10% and the cellular components being replaced by fat spaces. Result(s): Based on the above findings, and other viral markers being negative a diagnosis of aplastic anaemia following SARS CoV-2 was made. Conclusion(s): COVID-19 being a relatively new disease,it's sequelae in children is not much studied.Aplasticanemia following an infection of SARS-CoV-2 is extremely rare with only two cases reported in literature till date.Hence this entity should be kept in mind by the treating physician encountering a case of pancytopenia following COVID-19.

Knowledge and Practices of Parents Regarding Safe Handling and Disposal of Alcohol-Based Hand Sanitizers and Surface Disinfectants in Urban Sri Lanka

Aims Hand sanitizers are increasingly used in most households since the onset of the COVID-19 pandemic. However, improper use and accidental and deliberate ingestion of sanitizer solutions have been associated with numerous health risks to children. This study aimed to assess knowledge and practices regarding safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants among a cohort of parents in urban Sri Lanka. Methods This observational cross-sectional study was performed including parents of children admitted to North Colombo Teaching Hospital for a period of six months from August 2021. Data were collected regarding parental knowledge regarding safe handling and disposal of hand sanitizers, and their health hazards by paediatric post-graduate trainees. Data were collected using a pre-tested interviewer administered questionnaire. All data were analysed using SPSS 17.0. Results Out of 153 children recruited to the study, the mean age was 5.3 years (range: 1 month - 14 years) and male children (92, 60.1%) outnumbered female children (61, 39.9%). The majority of mothers (126, 82.4%) and fathers (133, 86.9%) had received education at least up to secondary school. 124 parents (81%) had been using hand sanitizers at home regularly. Only 113(73.9%) parents believed that preschool children were the most vulnerable for accidental ingestion of sanitizers and 40 parents (26.1%) were unaware that sanitizer solutions can be accidentally inhaled by toddlers. Knowledge was poor regarding occurrence of potential symptoms and side effects such as sore throat (56, 36.6%), irritation of eyes (30, 19.6%), breathing difficulties (40, 26.1%), high heart rate (72, 47%), aspiration (43, 28.1%) and low blood sugar (108, 70.5%). Only 132 parents (86.2%) knew how to clean and disinfect their home premises safely and 29 parents (18.9%) didn't know how to store cleaning products safely. Sixty-four parents (41.8%) were unaware regarding how to get information on safe cleaning practices. Forty-two parents (27.4%) kept sanitizer bottles within easy access to children whilst 85 parents (55.5%) had been storing sanitizers in unlabeled bottles. Ninety-eight parents (64%) were not keen to read the signage alerts in sanitizer storage bottles. Only 25 parents (16.3%) safely disposed sanitizer bottles. Thirty-three parents (21.6%) put sanitizer bottles together with food items in carriage bags from super markets. Conclusion The findings of this study inform that knowledge in parents regarding safe use of sanitizers can further be improved specially, in areas of local and systemic effects of sanitizer poisoning and information resources of safe cleaning practices. As a number of parents use and dispose hand sanitizers unsafely, the effectiveness of awareness programs to improve safety practices among parents should be evaluated.

Disseminated TB in the Setting of COVID-19 Infection- a Cause or a Consequence?

Introduction: Tuberculosis is a deadly infection, which can lead to disseminated TB in children in the presence of risk factors like low host immunity, concurrent infections, etc. This led us to wonder about the relationship between a common killer infection like TB and Coronavirus disease 2019 (COVID-19) and how the disease pattern will present in the pediatric age group. Case Description: We report a case of a 14-year-old male child who was a known case of childhood TB meningitis and hydrocephalus;treated with VP shunt, who recently presented with disseminated TB/TB flare up, causing TB meningitis, TB peritonitis, and pulmonary TB. On investigation, the patient was positive for COVID antibodies, multisystem involvement, lymphopenia and highly raised inflammatory markers suggesting it to be a case of MIS-C induced TB dissemination. He was started on anti-tubercular treatment (ATT), steroids, and supportive treatment, while he never required intravenous immunoglobulin (IVIG). His condition subsequently improved over a few days and he was discharged on ATT and antiepileptics. Discussion: COVID-19 has been reported to be associated with other infections of the respiratory system. Few studies in adults have established a connection between the progression of TB following COVID-19 infection. The link between TB and COVID-19 is mostly bi-directional. The temporary immunosuppression caused by tuberculosis may lead to increased predisposition to COVID-19 infection, while COVID may, in turn, also increase susceptibility to TB infection due to substantial depletions in T-cell lymphocyte counts, promoting the development of active TB in patients with latent TB. Conclusion: In this case report, the child recovered only with corticosteroids and supportive care, with no requirement of immunoglobulins or intensive care after a few days and showing almost a complete recovery. This is an important point to be considered when exploratory therapy is considered for TB with MIS-C. Hence, a better understanding of the pathogenic mechanism of the disease may help in defining the appropriate interventions required for specific cases. USG abdomen showing moderate ascites with few thick internal septations (Red arrow) MRI Brain showing communicating hydrocephalus with dilated lateral and third ventricles (Red star) and an ill-defined area of non-diffusion restricting T2 FLAIR hyperintensity in the right ganglio-capsular region of the brain- likely gliosis (Red arrow).

Post Dengue Reactive Thrombocytosis-A Case Report

Dengue fever is common in tropical countries like India. Typically, dengue fever and dengue haemorrhagic fever is characterized by high grade fever with arthralgia, myalgia and headache. Leukopaenia, thrombocytopaenia, and fluid leak is the hallmark of dengue which normalises with recovery. However, it is very uncommon in these patients to progress to severe thrombocytosis. Authors hereby report an unusual case of dengue followed by severe reactive thrombocytosis. A 13-year-old male child was admitted with complaints of fever and headache for the past two days and vomiting for one day. There was right hypochondrium tenderness. Investigations revealed leucopaenia (total leucocyte count was 3500/μL), platelets count was 150×103/μL, haematocrit was 34.5%, and dengue virus antigen detection (NS1) was positive. Coronavirus Disease 2019 (COVID-19) Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was negative. The patient was managed conservatively with intravenous fluid ringer lactate, acetaminophen, antiemetics and antacids. After 72 hours of discharge, patient came back with thrombocytosis. He was medicated on aspirin and the platelet count was monitored on a daily basis. The platelet count kept on increasing, and on 4th day it reached 1350×103/μL, but declined to normal (450×103/μL) over the next 10 days. Hence, aspirin was stopped. The patient was later discharged, and on follow-up the blood counts were normal.

Dew drops on newborn skin - congenital miliaria crystallina in the context of maternal SARS-CoV2 infection

Objectives: To report a rare case of extensive congenital miliaria crystallina. Results: A male infant was born at term by Caesarian section due to warning signs of fetal distress. The pregnancy had been uneventful. However, a maternal SARS-CoV2-infection occurred 2 days before birth. Immediately at birth, the newborn presented with a striking appearance of disseminated pinpoint-sized vesicles filled with clear fluid. Preemptive antibiotic treatment was initiated On dermatology consult, a diagnosis of congenital miliaria crystallina was made due to the typical clinical presentation. Investigations for congenital infections (Herpes, Varicella) were negative as well as repeat sampling for SARSCoV2. Antibiotic treatment was stopped. Treatment included reduction of ambient temperature/humidity and disinfectant dressings leading to a quick resolution of miliaria within 2-3 days. Clinical follow-up on DOL 20 revealed normal skin with areas of flaky desquamation. Discussion: Miliaria is a benign, transient disorder caused by occlusion and disruption of eccrine sweat ducts and occasionally occurs in infants. Congenital presentation of extensive miliaria crystallina however is exceptional with only sporadic reports in the medical literature. The role of SARS-CoV2 in our case remains unclear as fetal infection was excluded. However, a few cases of congenital miliaria were reported in the context of other maternal infections, suggesting a role of maternal fever and increased temperature of amniotic fluid in the pathogenesis of congenital miliaria. Clinicians should be aware of this striking yet harmless congenital presentation, which may mimic a congenital disorder of cornification or another severe skin disease, causing unnecessary anxiety.

The burden of parents of children with atopic dermatitis during the pandemic

Objectives: Atopic dermatitis is a common pediatric cutaneous inflammatory disease. Moderate and severe cases are associated with a signed parental burden. Therapeutic parental education, regular follow-up, written treatment plans, and spending enough time with the patient have positively impacted burden reduction. In order to maintain social distancing during the COVID-19 pandemic, direct dermatological consultations were reduced. The survey focused on the mode of consultations done for Atopic Dermatitis during the pandemic and the satisfaction regarding the same, self-reported details regarding flares of the disease - frequency and duration, and parental-care giver burden during this socialdistancing demanding period. Method: An electronic survey was distributed among parents of children aged from 0 to 16 years with atopic dermatitis in Saudi Arabia between October 12 and December 12, 2020. The survey discusses the different burdens during and before the pandemic, including financial, number and period of flares, sleep quality, job quality, and the treatments used. The study also discusses the type of earned medical advice, including onsite visits, virtual consultation, others or none. Results: A total of 242 caregivers responded;103 female and 139 male children. Of these, 145 respondents had consultations during the pandemic, including 72 (49.7) onsite consultations. Out of the 73 (50.3%) online respondents, 53.4% were satisfied, than 35.6% were unsatisfied with the consultation, while the rest had a neutral opinion. Moreover, the parental burden before and during the pandemic seems similar. Discussion: Teledermatology represents an effective method in treating pediatric atopic dermatitis and avoiding the deterioration of the related parental quality of life in case of physically unreachable medical services.

PRENATAL MATERNAL STRESS NOT ASSOCIATED WITH BIRTH OUTCOMES IN BABIES BORN DURING COVID-19 RESTRICTIONS: THE AUSTRALIAN BITTOC STUDY

Background: Certain forms of prenatal maternal stress (PNMS) are risk factors for preterm birth and low birthweight. In the context of the COVID-19 pandemic, two components of PNMS, objective hardship and subjective distress, may be differentially associated with birth outcomes. We aimed to determine the association of pandemic-related objective hardship and subjective distress with birth outcomes, and we explored moderating factors of objective hardship. Methods: Australian women who delivered during the pandemic completed online questionnaires at baseline and at two months postpartum, including self-reports of pandemic-related objective hardship, subjective distress and birth outcomes. We conducted linear regressions with objective hardship and subjective distress controlled for objective hardship as predictor variables and gestational length and birthweight as outcome variables. Moderation of objective distress by subjective distress, infant sex, and change in diet was evaluated by adding two-way interaction terms. Results: The sample included 2285 women (51.6% male infants, 48.0% female and 0.4% unreported sex). Age 30-34 years was the most frequent maternal age category. No associations between maternal objective hardship or subjective distress with gestational age at birth or birthweight were identified. After controlling for objective hardship, female infant sex and self-reported improvement in maternal diet were significantly associated with lower birthweight (β = -0.090 and -0.069, respectively), but there were no significant interactions with objective hardship. Conclusions: Objective hardship and subjective distress were not associated with birth outcomes. Other factors such as change in diet and infant sex may be more important for risk stratification in this context.

RESPIRATORY DISTRESS IN A NEONATE - WHEN BOARDS MEET REAL LIFE

Case Report A male infant is born at 37w to a 34-year-old G3P2 mother by vaginal delivery after an uncomplicated pregnancy. Prenatal screens are negative. The patient had a birth weight of 2,620 g, with Apgar scores of 9 and 9. On day 2 after birth, had increased work of breathing which prompted transfer to a level II NICU for further management. On arrival to the unit, the infant is tachypneic with mild chest wall retractions and thick nasal secretions. A CBC and blood culture were collected and empiric antibiotic therapy was started. Respiratory viral panel and COVID test are negative. A chest radiograph shows a middle lobe opacity concerning for pneumonia (figure 1). His clinical status failed to improve and on day 4 after birth, supplemental oxygen was provided. The primary team consulted ENT and Pulmonology services. Flexible laryngoscopy showed a normal anatomy. Pulmonology recommended transferring to our NICU for a chest CT with bronchoscopy. Our differential diagnosis for this neonate with respiratory distress that fails to improve over time or with antibiotics was broad, but further testing revealed this infant's condition. A CBC, CRP and a blood gas were collected on admission and were normal. ID service was consulted. A Chest CT showed bilateral atelectasis. Bronchoscopy showed a normal anatomy. Bronchoalveolar lavage was sent. Umbilicus swab was positive for MRSA, nasal wash/sputum culture/bronchoalveolar fluid also grew moderate S. aureus. Nasal ciliary biopsy sent for electron microscopy. Positive umbilicus and nasal swab, and subsequently BAL for MRSA led to a diagnosis of MRSA neonatal rhinitis. Therapy with IV vancomycin was initiated and later changed to oral clindamycin to complete a total of 14 days of therapy. The neonate was weaned off oxygen support on day 11. His clinical symptoms improved. He was discharged on oral clindamycin with follow up appointments with pulmonology and ID clinics. His ciliary biopsy showed absence of outer and inner dynein arms, compatible with the diagnosis of primary ciliary dyskinesia (PCD) (figure 2). Genetic testing for PCD showed mutations in the DNAAF1 and CCDC40 genes. This neonate was diagnosed with primary ciliary dyskinesia (PCD) but his presentation at birth was nonspecific and the differential diagnosis was broad. There is no gold standard diagnostic test for PCD and high clinical suspicion is important. Since it is most likely an AR inheritance, screening of family members is essential. Initial management of neonates may include measures that manage the respiratory distress, airway clearance to prevent respiratory infections and treat bacterial infections. Chest physiotherapy may help if recurrent atelectasis. Flexible bronchoscopy and bronchoalveolar lavage may help both to diagnose and treat the underlying infection. Antibiotic therapy based on organism growth for exacerbations may prevent development of bronchiectasis. (Figure Presented).

Lockdown loss - An unfortunate conundrum in fungal diagnosis during COVID time

Background:Mucormycosis is uncommon among individuals with no underlying risk factors. In children a subcutaneous maxillofacial presentation is common with entomophthoromycosis. Establishing the correct etiology is essential as ther- apeutic management differs for entomophthoromycosis and mucormycosis. In this background establishing diagnosis in a 13 year old patient presenting with a maxillofacial swelling with erosion was a challenge. Methods:A 13 year old male child presented with a 3 year history. It progressed from dry discharging lesions on right side of the face to flattening of the dorsum of the nose and currently regurgitation of fluids from the nose after inges- tion. Biopsy from the facial lesions, middle meatus and anterior ethmoid were received for fungal culture. Results:KOH – calcofluor examination of samples revealed aseptate fungal hyphae. In view of the clinical presentation and the preliminary microscopic finding, a diagnosis of entomophthoromycosis, probably basidiobolomycosis was made. However the colony morphology on SDA and the preliminary LPCB was not suggestive of basidiobolomycosis. Final identification as M. circinelloides was established based on slide culture and confirmed by sequencing at PGIMER. What confused the diagnosis even further was reporting by pathologists as broad septate fungal hyphae with granulom- atous reaction. Empirical therapy with itraconazole was based on the preliminary microbiological diagnosis. He was dis- charged on oral itraconazole pending final microbiological confirmation. Unfortunately he was lost to follow up due to COVID. Conclusions:Establishing etiology and timely intervention, medical and/or surgical are key to the successful recovery of patients with deep fungal infections. It involves a team effort.

P.0029 Age and sex differences in the use of anxiolytics and antidepressant drugs during COVID-19 lockdown in The Netherlands

Background: The 2019 coronavirus disease (COVID-19) poses great demands on medical care and resulted in delayed prescribing. Objective: To evaluate the number of newly dispensed antidepressant and anxiolytic drugs among the Dutch population, before and during COVID-19. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended antidepressants and anxiolytics, covering 96% of the Dutch population. The number and week of first-time dispensed drugs were determined for the period January – June 2019 and 2020, and age and sex of patients was recorded. Using independent t-tests, data was compared between men and women, age groups, and between 2019 and 2020. Age groups considered were children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Three time periods were considered: week 1-11 (in 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (in 2020 corresponding to the COVID-19 lockdown), and week 20-26 (in 2020 corresponding to the post-COVID-19 lockdown). Results: An overall reduction was observed in 2020 for the number of newly dispensed antidepressants (139.186 in 2019 and 126.487 in 2020, respectively) and anxiolytics (200.661 in 2019 and 189.559 in 2020, respectively). In both 2019 and 2020, the drugs were significantly more often dispensed to women than men, and most were prescribed to adults followed by the elderly. For antidepressants, in both male and female adolescents, adults and elderly, for week 1-11 no significant differences were found between 2019 and 2020. Compared to 2019, a significant reduction in the number of dispensed antidepressants was seen in during 2020 COVID-19 lockdown in these groups (p<0.05). In adolescents, but not for the other age groups, a significant reduction in dispensing was also found post COVID-19 lockdown (p<0.001). For children, a general reduction in the number of dispensed antidepressant drugs was seen in 2020 before and during COVID-19 lockdown (p<0.001). In male children there was a significant reduction in dispensing during COVID-19 lockdown (p=0.04), which was not significant among female children. For anxiolytics, in both male and female children and adolescents, a general reduction of dispensing was seen throughout 2020 (p<0.05). In male adults, in 2020 a significant reduction in dispensing was found during COVID-19 lockdown (p=0.01), and for both male and female adults post-COVID-19 lockdown (p<0.05). For elderly, no significant differences in dispending were found between 2019 and 2020. Conclusions: Across all age groups a significant reduction was seen for the number of newly dispensed antidepressant drugs. For all age groups except the elderly a significant reduction in dispensed anxiolytic drugs was seen during COVID-19 lockdown. This data corresponds with reports of delayed care. However, in elderly no reduction was found for dispensed anxiolytics during COVID-19 lockdown. Future research should determine if the continued dispensing of anxiolytics among elderly during lockdown may reflect the fact that fear of COVID-19 may be greater among this age group, as they are over-represented in COVID-19 related hospital admissions and have the highest mortality rates. No conflict of interest

P.0444 The use of prescription analgesics during COVID-19 lockdown in the Netherlands

Background: The 2019 coronavirus disease (COVID-19) poses great demands on hospitals and resulted in delayed care. It can be hypothesized that this delayed professional health care is reflected in a reduction of pharmacy dispensed analgesics. Objective: The purpose of this study was to investigate the possible impact of COVID-19 lockdown on the dispensing rates of analgesics drugs by Dutch pharmacies. Methods: Pharmacy dispensing data was obtained from Stichting Farmaceutische Kentallen on newly dispended analgesics (ATC2 N02), covering 1890 pharmacies and 96% of the Dutch population. Over-the-counter (OTC) painkillers were not considered. Age and sex of the patient were recorded, as well as the week of first-time dispensed drugs. Data were collected for the first half year of 2019 and the first half year of 2020. Patients were allocated to one of the following age groups: children (0-9 years old), adolescents (10-19 years old), adults (20-64 years old), and elderly (65 year and older). Further, data was combined into three time periods: week 1-11 (for 2020 corresponding to the pre-COVID-19 lockdown period), week 12-19 (for 2020 corresponding to the COVID-19 lockdown), and week 20-26 (for 2020 corresponding to the post-COVID-19 lockdown). Using independent t-tests, dispensing data was compared between males and females, age groups, and between 2019 and 2020. Results: An overall reduction was observed in the first half of 2020 for the number of newly dispensed analgesics (379.657 in 2019 and 360.094 in 2020, respectively). In both years, analgesics were significantly more often dispensed to females than to males, and most were prescribed to adults followed by the elderly. In addition, significantly more analgesics were dispensed in week 1-11 compared to the other time periods. In male children, compared to 2019 the reduction was only significant during the COVID-19 lockdown in 2020. For female children, no significant differences were found. For adolescents of both sexes, compared to 2019, a significantly reduced number of dispensed analgesics was found for all three time periods (p<0.001). In adults of both sexes, the reduction in dispensed analgesics in 2020 was only significant during the COVID-19 lockdown. In elderly, a reduction in dispensed analgesics in 2020 was found for pre- and during the COVID-19 lockdown (p<0.001), but not post-COVID-19 lockdown. In elderly males, a significant reduction in 2020 was found for pre-COVID lockdown, but not thereafter. For elderly females, the reduction in 2020 was significant for both week pre- (p<0.001) and during COVID-19 lockdown (p=0.02), but not thereafter. Conclusions: These findings show that the number of dispensed analgesics was significantly lower in 2020 compared to 2019. The reduction in dispensed analgesics was most consistently seen for the 2020 COVID-19 lockdown period, reflecting delayed professional health care across all age groups. Future research should investigate whether, due to delayed care, a substantial number of patients may have suffered from untreated pain complaints during the 2020 COVID-19 lockdown, or whether they have established pain relief via non-prescription painkillers. No conflict of interest

What is known in male gender, comorbidity and age during CoViD-19 pandemia?

Background: On March 2020, WHO declares the world pandemic by CoViD-19. In this report we report the CoViD-19 infection, related to male gender, comorbidity and special population. Methods: We describe the published studies by PubMed, Medscape and Scopus between December 2019 to May 2020. Keywords used: male/man gender, sex differences, CoViD-19, comorbidity, diabetes, hypertension, elderly, pregnancy, children. Results: The elderly population and infants are a population at higher risk. The comorbidities are risk factors for the development of a more severe form of disease. There may be a sex predisposition to CoViD-19 infection, with men more prone to be affected. 83.9% of CoViD-19 patients with chronic kidney disease (CKD) and 57.3% of CoViD-19 patients with liver diseases, have a severe disease. Conclusions: Older age, infants, male gender and comorbidity describe a crucial role for severity of CoViD-19 disease. Future studies are need for the management of these patients.