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1.
Journal of Clinical and Diagnostic Research ; 16(9):LC06-LC12, 2022.
Article in English | EMBASE | ID: covidwho-2067203

ABSTRACT

Introduction: Frontline Healthcare Workers (F-HCWs) are at the front position for medical care against Coronavirus Disease 2019 (COVID-19) pandemic which has life-threatening potentials. Poor level of knowledge, practices and negative attitudes as well as high-risk of psychological distress among F-HCWs can directly lead to delayed diagnosis, treatment and poor infection control practices. Aim: To assess the level of Knowledge, Attitude and Practices (KAP) as well as risk of psychological distress among F-HCWs for COVID-19 pandemic. Materials and Methods: This descriptive, hospital-based, cross-sectional study was conducted at Government Medical College, Azamgarh, Uttar Pradesh, India, located in tertiary care centre in rural area) from October 2021 to December 2021 among 223 F-HCWs using convenient sampling technique. To assess the level of KAP as well as risk of psychological distress among F-HCWs a prevalidated structured questionnaire was used consisting 15 knowledge questions, six attitude questions, 15 practices questions and six questions on risk of psychological distress. Chi-square test was performed to examine the association between risk of psychological distress and level of KAP as well as with demographic characteristics of F-HCWs. Results: Out of total 223 participants more than half of physicians (52.9%) and one-third of staff nurses (35.9%) were from age group of 25-35 years, respectively. Majority of both physicians (57.1%) and staff nurses (87.6%) were married and had nuclear type of family as of 64.3% and 74.5%, respectively. Most of the physicians (92.9%) had good level of knowledge but they had less positive attitude (84.3%) compare to staff nurses (92.8%). Majority of both physicians (64.3%) and staff nurses (58.2%) had no or low risk of psychological distress while only few of them had its high level. Conclusion: In this study majority of F-HCWs reported overall 'good' level of knowledge, attitude and practices for prevention of COVID-19. As for as risk of psychological distress was concerned, majority of F-HCWs had its no or low risk.

2.
Turkiye Klinikleri Journal of Medical Sciences ; 42(3):204-212, 2022.
Article in English | EMBASE | ID: covidwho-2067037

ABSTRACT

Objective: To investigate the attitudes of health care professionals involved within the coronavirus disease-2019 (COVID-19) pandemic process towards the COVID-19 vaccine in line with their demographic characteristics. Material(s) and Method(s): A questionnaire consisting of 16 questions was conducted to 510 healthcare professionals working in Inegol State Hospital between December 2021-January 2022 and who agreed to participate in the study, to determine their approach to the COVID-19 vaccine. The data were collected with Student's t-test and Mann-Whitney U Test. Chi-square test was used in comparison of categorical variables. Result(s): While 54.3% of the respondents said that they don't want to have the COVID-19 vaccine, 69% answered that "Since there is not any adequate research on the vaccine, the vaccine is not reliable". Were observed that vaccine rejection was most common in the 20-29 age group (72.7%) and pregnant women (100%). In addition, as the education level increased, the number of people considering vaccination increased. The desire to be vaccinated was seen more in married, and it was noted that non-smokers had more COVID-19 (80.3%). Conclusion(s): Healthcare professionals who participated in study were found to have a negative attitude towards COVID-19 vaccine. Although healthcare professionals have hesitations about vaccine, in fact, noteworthy that they're afraid of the disease (43.8%). Despite of the pandemic, more than half (54.3%) of healthcare professionals working in Inegol State Hospital stated that they didn't think about getting a COVID-19 vaccine. Providing hospital staff with more education about the safety, efficacy, and value of currently available COVID-19 vaccines is critical to vaccine acceptance in this population. Copyright © 2022 by Turkiye Klinikleri.

3.
Open Access Macedonian Journal of Medical Sciences ; 10:1698-1705, 2022.
Article in English | EMBASE | ID: covidwho-2066674

ABSTRACT

BACKGROUND: The rapid worldwide spread of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) or COVID-19 pandemic from its epicenter;Wuhan was first reported in December 2019. Egypt reported its first COVID-19 case on February 14, 2020. Thereafter, Egypt scaled-up preventive measures, with a partial lockdown starting on March 25. Several therapeutic agents along with convalescent plasma transfusion (CPT) are under investigation and data from CPTs have been receiving a lot of attention, after Emergency approvals from the Food and Drug Administration suggesting that it may provide a clinical effect in the treatment of SARS-COV-2. IMPORTANCE: Early and effective treatment of COVID-19 is vital for control of SARS-CoV-2 infection. METHODS: Designs: An interventional, single-arm, and non-randomized clinical trial conducted in Egypt from April 15 to July 21, 2020. Settings: This was a multi-center study conducted in three hospitals in Egypt. Participants: A total of 94 COVID-19 laboratory-confirmed patients using quantitative real-time polymerase chain reaction were enrolled in the study. Intervention: All patients were administered with two plasma units (each unit is 200 cc). The volume of donated plasma was 800 cc. Main Outcome and measures: Primary measure was the degree of clinical improvement among the COVID-19 patients who received CPT within 7 days. RESULTS: A total of 94 patients were enrolled who received CPT either within 7 days or after 7 days of hospitalization. 82 were severely ill and 12 were critically ill. The average age remained 58 years (±standard deviation 15.1 years). Male were 69% and 49% patients got cured while 51% died with case fatality rate 51%. Seventy-five percent deaths were above 45 years of age. The symptoms were dyspnea (55%), fever (52%), cough (46%), and loss of taste and smell (21%), and cyanosis (15%). The most common co-morbidities among the <40 years remained diabetes mellitus (21%) and asthma (14%). Among 40–60 years hypertension (56%), diabetes mellitus (39%) and among >60 years age group hypertension (57%), and chronic heart disease (24%) were reported. CPT within 7 days remained significant as compared with the CPT after 7 days with the number of days to cure (p=0.007) and ICU stay (p = 0.008) among severely ill cured cases. CONCLUSIONS: Among patients with COVID-19 and severe or critical illness, the use of CPT along with routine standard therapy resulted in a statistically significant improvement when administered within seven days of hospital admission. However, plasma transfusion, irrespective of days to transfusion may not help treat critically ill patients. The overall mean time to cure in severely ill patients was 15 days if CPT provided within 7 days with 65% cure rate. TRIAL REGISTRATION: Clinical Intervention identifier: MOHP_COVID-19_Ver1.1 registered April 2020.

4.
Open Ophthalmology Journal ; 16(1) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2065271

ABSTRACT

Background: A substantial increase in using digital devices was observed among the population due to staying at home as a result of the quarantine during the coronavirus pandemic. Consequently, ocular symptoms appeared due to spending several hours of screen time per day. Objective(s): The current study aimed to assess the impact of excessive use of digital devices during the pandemic of coronavirus among the Saudi population. Method(s): A community-based cross-sectional study was carried out from November 2020 to January 2021 among the Saudi population. Data were collected by using Ocular Surface Disease Index (OSDI) questionnaires for the assessment of symptoms related to dry eye and their effect on vision. A logistic regression model was used to evaluate the association between the risk factors and the symptoms of dry eye. SPSS 22nd edition was used, any p-value <0.05 was considered significant. Result(s): Out of 1573 participants, 93.8% used mobile, 42.4% experienced uncomfortable sensitivity to the light. There were 49.15% of the participants who showed that none of the time they felt blurry vision, 54.8% did not report double vision, and 30.5% who felt a headache recently after quarantine. About 48% of the participants did not have any ocular symptoms, while 52% had dry eye symptoms (mild 22.3%, moderate 13.7%, and severe 15.9%). When the logistic regression model of risk factors associated with severe symptoms of dry eye was applied, wearing a contact lens was the most significant variable (p<0.0001). Conclusion(s): Dry eye symptoms increased during the quarantine, which indicated that the digital device users need to learn more about the preventive measures from practitioners in eye healthcare. More studies are warranted to assess the impact of digital device usage on all age groups starting from children up to the elderly population. Copyright © 2022 Almuhwwis et al.

5.
Pharmaceutical Journal ; 308(7959), 2022.
Article in English | EMBASE | ID: covidwho-2065025
6.
Pharmaceutical Journal ; 306(7949), 2022.
Article in English | EMBASE | ID: covidwho-2064952
7.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P113, 2022.
Article in English | EMBASE | ID: covidwho-2064496

ABSTRACT

Introduction: The SARS-CoV-2 pandemic killed over 6 million people worldwide. Children were described to have predominantly mild or asymptomatic infections and to be less exposed to the virus, at least for the initial variants. In the present study, we describe how SARS-CoV-2 can silently infect tonsils and adenoids in children undergoing adenotonsillectomy. Method(s): In this cross-sectional study we assessed children who underwent adenotonsillectomy between October 2020 and September 2021 in a secondary hospital in Brazil. All the caregivers denied any symptom of acute viral upper airway infection in the month prior to surgery. Briefly, nasal cytobrush (NC), nasal wash (NW) and tonsillar tissue fragments posttonsillectomy were tested by RT-PCR, immunohistochemistry (IHC), in situ immunofluorescence (IF), and flow cytometry. Result(s): A total of 48 children (18 females, median age 5.5 years) were enrolled. None of them had been vaccinated against COVID-19 at the time of surgery. Only 2 had a history of previous COVID-19 diagnosis, 3 and 5 months, respectively, before surgery. SARS-CoV-2 RNA was detected in 25% (12) of patients-20% in palatine tonsils, 16.27% in the adenoids, 10.41% in NC, and 6.25% in NW. IHC labeling showed viral nucleoprotein presence in both adenoids and palatine tonsils, in epithelial surface and lymphoid cells from extrafollicular and follicular regions. In 5 out of 7 patients, in situ IF showed the expression of ACE2 and TMPRSS2 and viral spike protein in the tonsillar tissue. Flow cytometry revealed that SARS-CoV-2 is predominantly observed in CD123+ dendritic cells (10.57% of all tested sites), followed by CD14+ monocytes (6.32%). Conclusion(s): According to these results, the prevalence of SARS-CoV-2 infection seems to be higher than expected and underdiagnosed in children at this age group. Palatine tonsils and adenoids are important sites of infection and may be a reservoir for the virus. Nevertheless, it is still unclear the impact of these results on virus transmission.

8.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P36-P37, 2022.
Article in English | EMBASE | ID: covidwho-2064488

ABSTRACT

Introduction: With the relaxation of pandemic-related operative restrictions, there has been an increase in elective facial plastic surgical cases in comparison with 2018, prior to the COVID-19 pandemic. The objective of this study is to compare the surgical volume of pre-COVID-19 pandemic cosmetic facial plastic surgery (FPS) in 2018 with the postpandemic volume in 2021, in both a tertiary care academic practice and community practice. Method(s): This is a retrospective chart review of adult patients undergoing cosmetic FPS at an academic tertiary care center and community practice: Louisiana State University Health Shreveport (LSU) and Kenneth Sanders Facial Plastic Surgery in Louisiana, respectively. Information assessed included demographics, surgical date, and surgical procedure performed during the first 6 months of 2018 and 2021. Categorical variables were compared using 2-proportion z test and Pearson chi2 test. Odds ratio (OR) was used to calculate the likelihood of procedural year predicting subsequent FPS. Result(s): One hundred thirty-nine patients were identified: 58 (41.7%) patients in 2018 and 81 (58.3%) patients in 2021. The number of patients having FPS in the <30-year-old age group increased by 13.6% from 2018 to 2021 (P=.02). The number of septorhinoplasties increased by 20.5% from 2018 to 2021 (P=.01). Furthermore, the odds of one having a septorhinoplasty in 2021 increased 144% compared with 2018 (OR: 2.44 [95% CI, 1.19, 5.11]). The only cosmetic surgery to significantly decrease in volume during the postpandemic time period was rhytidectomy (OR: 0.33 [95% CI, 0.12, 0.82]). Conclusion(s): The COVID-19 pandemic has seen a significant rise in FPS in patients younger than 30 years and those electing to have septorhinoplasty. The etiology of this increase is not clear;however, possible explanations include the following: increased disposable income, "Zoom dysmorphia," and the ability for conspicuous recovery behind a mask.

9.
Archives of Disease in Childhood ; 107(Supplement 2):A359-A360, 2022.
Article in English | EMBASE | ID: covidwho-2064045

ABSTRACT

Aims To describe a case of 3 weeks old neonate presenting with severe pulmonary hemorrhage due to COVID-19 infection and its outcome. Methods We report an interesting case of pulmonary hemorrhage presenting at a young age of 3 weeks, in a previously healthy neonate who was infected with COVID-19 virus;Literature review and investigation results are included. This is a 3-week-old female, a product of full-term pregnancy and an uneventful perinatal course. She was admitted from the emergency department initially as a case of late neonatal sepsis, where a full septic workup was done. Her presenting complaints were low-grade fever and a blocked nose for one day. She was hemodynamically stable in the emergency department except for tachycardia secondary to fever, which improved once the fever was controlled. Her initial blood workup, including blood gas and CSF study, was reassuring (table 1a). Her COVID PCR was positive with a CT value of 17.77. She was treated with IV antibiotics and supportive management. Later that day, the patient developed cardiopulmonary arrest, CPR was initiated, and the patient was intubated. The patient was found to have pulmonary hemorrhage as evident by the fresh blood coming out of the endotracheal tube and the chest X-Ray findings of ground-glass opacities and dense consolidation (figure 1). After initial brief stabilization, the patient started deteriorating requiring escalation of respiratory support to HFOV. The patient continued to deteriorate and developed bilateral pneumothorax requiring bilateral chest tube insertion. After chest tube insertion, there was a mild transient improvement in oxygenation. The patient was put on the maximum ventilatory settings, but she kept having frequent desaturation, requiring frequent manual bag to tube ventilation. Later, she started developing progressive hypotension, that required support with maximum doses of inotropes. Her urine output started decreasing, for which frusemide were started with no response. Blood investigations showed severe DIC picture (table 1b and 1c). She was empirically covered with Meropenem and Vancomycin along with Remdesivir and Dexamethasone for COVID 19 pneumonia. Eventually, the child developed progressive desaturation, hypotension, and poor perfusion. Shortly after that, she developed cardiac arrest and was declared dead. Results The clinical picture of COVID 19 infection is more indistinct in children than in adults, with the most common symptoms being fever, cough, dyspnea, and malaise. In the few published cases of COVID-19 in the neonate, the presentation was that of late neonatal sepsis;interestingly, the lung involvement was not described as frequently as in older age groups. Pulmonary hemorrhage has been reported in adults but rarely in children. Some reports in adults suggested that patients with COVID infection had an increased inflammatory state that led to the development of vasculitis and pulmonary hemorrhage. Up to our knowledge, this is the youngest age at which a patient with COVID-19 infection developed pulmonary hemorrhage with no other underlying cause of it. Conclusion While many of the cases of COVID infection in children are mild, fatal complications like pulmonary hemorrhage can be present. Adding new challenges to the management of this viral infection.

10.
Archives of Disease in Childhood ; 107(Supplement 2):A203-A204, 2022.
Article in English | EMBASE | ID: covidwho-2064028

ABSTRACT

Aims Multisystem inflammatory syndrome in children (MIS-C) secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected not only the older children, adolescents and adults but also infants, more so during the second wave of the global pandemic. Thus, this study was done to describe the profile of infants presenting with multisystem inflammatory syndrome (MIS) with the aim to alert clinicians regarding the need for its early diagnosis and timely management in this vulnerable age group to prevent the morbidity, mortality and long term complications associated with MIS-C. Methods All sequentially admitted infants hospitalized during a period of 6months from,who fulfilled the WHO/CDC/RPCH criteria for MIS-C were included in the study. The data was recorded in a semi-structured pre-tested self-designed proforma regarding the demographic profile, presenting symptoms, clinical signs, laboratory parameters and treatment received. The data was analysed using appropriate statistical tools. Results A total of 19 infants were studied. Of these, 68.3% (13) had an evidence of recent COVID-19 infection. The median age of presentation was 2 months. The male:female ratio was 1.1:1. The most common presenting symptoms were fever (68.4%), gastrointestinal complaints (63.1%) and edema (36.8%) (figure 1). Other predominant signs were shock (78.9%), myocarditis (52.6%) and neurological complaints (26.3%). Incomplete Kawasaki disease was present in 21% patients. Elevated CRP, ferritin, D-Dimer, NT pro BNP and reduced fibrinogen were markers of severe illness. All subjects received IVIG (100%), 31.5% received a second dose of IVIG and 63.1% received pulse intravenous methylprednisolone. (table 1) A total of 5(26.3%) died as a result of the disease process. Conclusion MIS-C in infants is usually under-diagnosed and under-reported due to the considerable overlap between sepsis and MIS-C especially due to the higher incidence of sepsis in developing countries. The spectrum of this illness can be varied and is different from the overt clinical signs seen in older children and adolescents. Thus, these investigations should be done early in the course for optimal therapy with immunomodulators and favourable outcome.. (Figure Presented).

11.
Archives of Disease in Childhood ; 107(Supplement 2):A65-A66, 2022.
Article in English | EMBASE | ID: covidwho-2064017

ABSTRACT

Aims By necessity, our trust was unable to complete gold standard ADOS (Autism Diagnostic Observation Schedule) assessments as part of the ASD diagnostic pathway during the Coronavirus pandemic. We, therefore, implemented the BOSA as a stop-gap. This retrospective audit compares the need for further assessments and the outcomes from BOSA assessments against those achieved by our unit when the 'gold standard' ADOS was in use. Our audit standard was to achieve equivalent results pre- and during the pandemic. Methods Data from a random sample of 120 children who completed an ADOS assessment August - December 2019 was compared with data from a random sample of 118 children who completed a BOSA August 2020 - January 2021. Statistical analysis was performed using the 2 tailed Fisher's exact test. Results In school age children, further assessment was significantly more likely to be required when a BOSA assessment was used (25.6% vs. 8.9%, p=0.01). There was a less significant difference between the need for further assessment in the pre-school age group between the ADSO and BOSA groups (14.3% vs. 0%, p=0.048). In this audit, the wait time for a BOSA assessment was 372 days vs. for an ADOS assessment 278 days. However, due to the complex disruption caused by the pandemic, any difference in pathway duration could not meaningfully be evaluated by this audit. An additional ADOS was needed in 14.3% of cases undergoing the BOSA assessment. This will have affected the duration of the assessment process due to delays in arranging and completing further assessments. Children were slightly more likely to receive a positive autism diagnosis using the BOSA. However, this was not statistically significant (p=0.31 for school age, p= 1.0 for preschool age). Conclusion The BOSA assessment seems to be effective when used with pre-school children, with a minimally significant difference in rates of children requiring further assessment and no significant difference in final diagnosis rates. BOSA assessment appears to be less useful in school age children - with a greater proportion then requiring a subsequent ADOS assessment, but, again, with no significant difference in final diagnosis rates. This audit supports the recommendation that the BOSA assessment is not intended to be used long-term or to replace the ADOS, which remains the gold standard assessment. However, in the context of a pandemic, where ADOS assessments were not possible, the BOSA assessment allowed 86% of preschool age and 74% of school age children to receive a confirmed diagnosis (positive or negative), using an assessment method whose diagnosis rates were similar to the ADOS assessment.

12.
Archives of Disease in Childhood ; 107(Supplement 2):A60, 2022.
Article in English | EMBASE | ID: covidwho-2064016

ABSTRACT

Aims Covid testing and primary care data for Children and Young People (CYP) has not yet been linked at the national level in England. However, such linkage has been established using the Discover Whole System Integrated Care (WSIC) database in Northwest London (NWL). We describe pattern of primary care utilisation, among CYP of 0 - 24 years of age in NWL before and after testing positive for Covid-19 infection. The insights are needed in understanding the impact of Covid-19 infection on both the patient and the health care system. Methods We conducted a retrospective cohort study using routinely collected primary care health care data in NWL from the Discover WSIC de-identified database. It is a local warehouse of electronic patient records for research, the database is de-identified. Four cohorts were studied to represent CYP at various key Covid-19 vaccination focused age groups of 0-4 years, 5-11 years, 12-15 years and 16-24 years. Their GP events 180 days preceding and following the confirmed PCR positive test result were analysed. GP events were counted as number of distinct days with one recorded activity. Results By 16th February 2022, positive PCR results were obtained for 104,702 CYP, 14% (d=745,268) of registered CYP population in NWL. The frequency of GP events in the first seven days of the post-test period was similar to the frequency in the seven days preceding, however outside this period they differed substantially, from 279 per 1,000 pre-test to 92 per 1,000 post-test. The 16-24 year age group showed the largest decrease at 150 to 180 days after a confirmed positive PCR test result, from 1,290 GP events pre-test to 195 post-tests. There was no increase in GP events for any age group from two weeks post confirmed PCR positive test. Conclusion Our analyses showed that there is evidence of increase GP activity by CYP a week before and after a Covid- 19 infection diagnosis. However, we did not find any evidence at population level of prolonged post Covid-19 infection symptoms for which GPs were contacted.

13.
American Journal of Transplantation ; 22(Supplement 3):863-864, 2022.
Article in English | EMBASE | ID: covidwho-2063472

ABSTRACT

Purpose: Despite several policy reforms over the years, disparities in the access to solid organ transplantation continues to exist remains a significant barrier to liver transplant. The MELD Allocation system and subsequently the Share-35 policy (adopted June 2013) were implemented to address the inequitable access to liver transplantation (LT). The implication of these changes on adult and pediatric LT among ethnic groups is uncertain. Therefore the aim of this study, is to explore the factors associated with access to LT across ethnic groups of all age groups. Method(s): The study period (2014 -2019) included the period after Share-35 policy (June 2013) implementation and prior to implantation of Acuity Circle and COVID pandemic (Feb/March 2020). Using the UNOS database, we identified all candidates (Pediatrics and Adults), who received liver Transplant during the study period. Data extracted included type of transplant, liver diagnosis, age, MELD/PELD score, gender and race/ethnicity. Chi square test and anova were used for comparative analysis. Result(s): During the study period, 46,926 candidates received liver transplant of which 96% were Adults, living donor LT (5%) and ethnic distribution (White 69%, Hispanic 15%, Black 9%, Asian 4% and others 3%). In contrast to the Adult recipients in which there is a gender variation with male predominance (65%), among pediatric group there was similar distribution (Male 51% and Female 49%). There was significant ethnic variation in type of insurance payor (Figure 1) and proportion of LT (Figure 2) across age groups. Among pediatric recipients, no significant difference in LT trends across ethnic groups. In contrary, among the adult recipients, though there was no change among White (71% in 2014 and 71% in 2019) and Asian (4% in 2014 and 4% in 2019), there was slight increase among Hispanic ( 13 % in 2014 and 16% in 2019) and a steady decline among Blacks ( 10% in 2014 and 7.3% in 2019). Conclusion(s): Ethnic Variation in Access to Liver Transplantation exists in both Adult and Pediatric Candidates. Future studies to explore the observed difference in Insurance payors, gender gaps among ethnic groups will provide useful insights to the non-medical factors contributing to inequitable LT access irrespective of age. Identification and understanding the key social determinants that impact LT access will be key in developing strategies to reduce and eliminate these barriers across age groups.

14.
Cardiology in the Young ; 32(Supplement 2):S103, 2022.
Article in English | EMBASE | ID: covidwho-2062128

ABSTRACT

Background and Aim: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a postim-munological reaction after SARS-CoV-2 infection. Various car-diac manifestations of PIMS-TS have been reported, namely pericardial effusion, ventricular arrhythmia, myocarditis, valvular regurgitation, and pericarditis. The aim of this study was to analyze clinical and laboratory features to distinguish any possible predic-tion for cardiac involvement in children with PIMS. Method(s): The PIMS patients under 18 years old treated in our center between July 2020 and December 2021 were included. Data of the patients were retrospectively obtained from their medical records. Result(s): A total of 46 patients with PIMS were examined during the study period. The mean age of study group was 9.4 +/- 4.6 years, 18/46 were female and 3 groups were formed according to their age ranges. Among them, seventeen patients (37%) had cardiac involvement with mean age was 8.7 years. Impaired cardiac func-tions were seen more in male patients (n: 10/17). Coronary artery dilatation seen in seven patients especially with mean age of 5.2 years (Age group 1,2,3;%36.4,%14.3,%0;p = 0.033;respectively) and especially related to high troponin T levels (p = 0.006). In our study group, cardiac involvement was shown more related to ProBNP and Troponin T (p = 0.008;p = 0.003). The cut-off val-ues of proBNP and troponin T for predicting in cardiac dysfunc-tion were 2759 pg/mL (95% confidence interval (CI), 0,83-1;sensitivity, 0.86;specificity, 0.93;AUC:0.92, p lt;0,001). Conclusion(s): Although there is a wide variability of symptoms, MIS-C is a rare, severe, less understood complication of COVID-19 that may cause multisystemic involvement in the patients. Clinicians should be aware of this condition in children with persistent fever and a family history of COVID-19. Cardiac involvement in chil-dren with PIMS may strongly be predicted by levels of Troponin T and ProBNP. Further more younger age and high Troponin T levels are the independent predictors for the coronary artery dila-tation among children with PIMS.

15.
Cardiology in the Young ; 32(Supplement 2):S107-S108, 2022.
Article in English | EMBASE | ID: covidwho-2062098

ABSTRACT

Background and Aim: The Coronavirus disease 2019/COVID-19/exerts an unprecedented global impact on public health and health care delivery. The aim of this study was to evaluate the knowledge on SARS-CoV-2, epidemiology, clinical presentation including cardiovascular and immunological status in postCovid children. Method(s): A group of 70 children/previously healthy or with no pre-existing heart disease/from Sarajevo with positive postcovid history, formed this study. Patients were evaluated at the Polyclinic Eurofarm in Sarajevo, from October 2020 till April 2021. Following history and epidemiological data, a detailed cardio-vascular examination has been performed including oxygen satu-ration, pulse, blood pressure, electrocardiogram/ECG/, values of polymerase chain reaction (PCR), serological tests for corona, lab-oratory blood tests and echocardiography. Result(s): The group consisted of 70 children/40 boys/: infants: 10, 1-5 years: 20;6-10:12;11-15:21;16-18 years: 7;forming five groups. Symptoms differ depending on age group, younger chil-dren had no or mild symptoms in comparison to the older group of children. The values of immunoglobulin G were significantly higher in the older group of children with (p lt;0.05;p = 0.043) indicating that the immune system with age is more responsive to the virus. PCR test was negative in 9/70 children. The majority of children/64.3 %/were asymptomatic. Two boys aged 14 years, had palpitation on exertion, shortness of breath, ECG changes, lower oxygen saturation/91% and 94%/, elevated creatinine phosphokinase miofibrilae/CPKMB/: 38 and 45, in one patient the diameter of left coronary artery/LCA/was enlarged up do 3.8mm, no aneurysm, no skin changes, with normal ejection frac-tion of left ventricle. They were on short period/10-15days/of treatment with nonsteroids including low doses of Aspirin, vita-mins/C and D/, rest and no sport activities. After treatment and a regime of no activities, they were fully recovered, free of symptoms, with normal oxygen saturation, normal values of CPKMB, diameter of LCA was within a normal range according to age and body weight of the patient. Conclusion(s): Practitioners should consider the possibility of COVID-19 in children with atypical symptomatology and posi-tive or suspicious epidemiological survey, paying special attention to coronary and immunological status.

16.
Cardiology in the Young ; 32(Supplement 2):S239, 2022.
Article in English | EMBASE | ID: covidwho-2062096

ABSTRACT

Background and Aim: Cardiac involvement in multisystem inflam-matory syndrome in children (MIS-C) associated with Coronavirus 2019 disease (COVID-19) is often observed with high risk of hearth failure. Early diagnosis and treatment are man-datory for a good outcome. The aim is to describe cardiovascular involvement, management and early outcome for patients with MIS-C and to analyze the differences in cardiovascular manifesta-tions between two groups: younger and older than 6 years old. Method(s): This retrospective observational study describes cardio-vascular clinical manifestations, laboratory findings, cardiac imag-ing, according to different age groups, and treatment in patients with diagnosis of MIS-C admitted to the Pediatric Istitute Giannina Gaslini between March 2020 and September 2021. Result(s): We collected 25 patients. Median age at onset of symptoms was 5 years old (interquartile range IQR, 3-12 y), 12 boys (56%). Immunoglobulin G antibodies were positive in 70% cases, Polymerase chain reaction (PCR) nasal/throat swab test for COVID-19 was positive in 15% cases, at the admission. The remaining cases had close contacts of COVID-19 positive cases. Predominant coronary artery abnormalities were observed in age group up to 6 years old (n.13) with development of small and medium aneurysms in half of cases and low rate of mild ventricular dysfunction. While children between 7-18 years of age present myopericardial involvement with ventricular dysfunction in 67% cases, from mild to moderate. Only two cases of transient coronary dilatation. Frequent electrocardiogram abnormalities: ventricular repolarization anomalies and reversibile QTc prolon-gation interval. Laboratory findings showed rised inflammatory markers and only mild elevation of cardiac enzymes compared to an early and significant NT-pro-BNP increase. All patients were treated with intravenous immunoglobulin and corticosteroids. Some cases needed anakinra. Aspirin and heparin was adminis-trated. No inotropes requied but only cardioprotective therapy. No need of Intensive Care Unit. Conclusion(s): This case-series shows the frequent cardiovascular involvement in MIS-C with a peculiar distribution, according to differents age's group: coronary artery anomalies in young ones, myopericardial disease in old ones. Prompt multi target anti-inflammatory therapy could have an effect to favorable outcome.

17.
Cardiology in the Young ; 32(Supplement 2):S40-S41, 2022.
Article in English | EMBASE | ID: covidwho-2062094

ABSTRACT

Background and Aim: With the progressive spread of the coronavi-rus among the youngest and the need for a safe resumption of physical activity, several protocols have been proposed for healed athletes. The aim of the present study is to evaluate the presence of cardio-respiratory complications in the pediatric population after mild or asymptomatic SARS-CoV-2 infection. Method(s): From January 2021 the protocols of the Italian Sports Medical Federation were applied to all the children and adoles-cents who came to our observation for return-to-play after covid infection. The protocols take into account the severity of the infection. In case of mild or asymptomatic infection echocardiogram, electrocardiogram, treadmill ECG test and pul-monary function tests were performed. Result(s): From January 2021 to November 2021, 169 children and adolescents (mean age 14+3 ys;male = 92) with previous SARS-CoV-2 infection were evaluated according to the protocols in force after an average time of 48 + 13 days from SARS-CoV-2 swab negativity. 60,3% of the subjects (N = 102) reported an asymptomatic infection;39,7 % reported a mild symptomatic infection. Results of lung function test have exceeded the limit of 80% of the theoretical value in all patients. No subject presented evidence of cardiovascular function impairment. Conclusion(s): The data obtained showed that, in the pediatric pop-ulation, mild coronavirus infection does not cause cardiorespira-tory complications in the short and medium term. This reinforce the evidence from preliminary studies that return to play after Coronavirus infection seems to be safe and must be strongly recommended. It will therefore be possible to assess the possibility of lightening or even suspending these evaluations in the cases of mild coronavirus infection in the pediatric age groups.

18.
Chest ; 162(4):A2587, 2022.
Article in English | EMBASE | ID: covidwho-2060968

ABSTRACT

SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: This population-based study describes the changing demographic trends of Lung Transplants (LT) across the United States (U.S.) over the last two decades (2001 vs 2021). METHODS: We utilized the Organ Procurement and Transplantation Network (OPTN) registry to gather data on LT recipients across the U.S. for the year 2001 and 2021. Total yearly lung transplant numbers were recorded from 1988 to 2021. The recipients were categorized into subgroups based on age (<1, 1-5, 6-10, 11-17, 18-49, 50-64 and >65 years), race (Whites, Blacks, Hispanic/Latino, Asians, and Others) and most common diagnosis, and data was tabulated to compare for the years 2001 and 2021. RESULTS: From 1988 to 2021, 46,109 LTs were performed in the U.S. The yearly LT recipients increased from 1,059 in 2001 to 2,524 in 2021. The most common reason for LT was Emphysema/COPD (Chronic Obstructive Pulmonary Disease) in 2001 (n=464) and IPF (Idiopathic Pulmonary Fibrosis) in 2021 (n=899). In both 2001 and 2021, most LT recipients were in the age group 50-64 years (45.8% vs 58.1%) but the proportion of patients > 65 years receiving LT increased noticeably from 3.4% in 2001 to 36.9% 2021. Most LT recipients in both 2001 vs 2021, had “O” blood group (~ 45%). White patients comprised the majority of those registered for and those who underwent LT in both 2001 (n=940;88.80%) and 2021 (n=1,778;70.40%), although the relative percentage reduced by 18.40%. The relative percentages for Blacks, Asians, Hispanics receiving LTs increased from 2001 to 2021 by 2%, 3.3% and 11.8% respectively. In both 2001 and 2021, the states where maximum LTs were performed included– California (10.8% vs 12.6%), Pennsylvania (9.6% vs 9.3%) and Texas (7.3% vs 10.7%) while the states with the least LTs included– Connecticut, Mississippi, Oregon. CONCLUSIONS: There has been a general uptrend in the total number of LTs year-on-year, and the likely drop in LT recipients in 2020 and 2021 was due to the COVID-19 pandemic. The most common diagnosis for transplant changed from Emphysema/COPD in 2001 to IPF in 2021. There are appreciable racial and geographical disparities in receiving LTs in the United States but there are encouraging improvements in 2021 compared to 2001. There is an increasing trend of LTs in elderly patients (> 65 years), likely due to increased supportive care and improved life expectancy. CLINICAL IMPLICATIONS: Changes in socio-demographic trends in lung transplant recipients help us understand existing disparities and access to advanced lung disease centers so that we can better address these with equitable healthcare delivery tailored to changing transplant trends. DISCLOSURES: No relevant relationships by FNU Amisha No relevant relationships by Perminder Gulani No relevant relationships by Manuel Hache Marliere No relevant relationships by paras malik No relevant relationships by Divya Reddy

19.
Chest ; 162(4):A2407, 2022.
Article in English | EMBASE | ID: covidwho-2060943

ABSTRACT

SESSION TITLE: Racial Disparities in Pulmonary Embolism Risk Factors and Mortality in the SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 1:30 pm - 2:30 pm PURPOSE: Racial disparities in pulmonary embolism (PE) related mortality rates have been reported for decades in the United States (US). The risk factors contributing to the observed disparity remain unclear. Our objective is to examine recent PE-related mortality trends and PE risk factors by race. We hypothesize racial disparity gap in PE-related mortality and risk factors has persisted and might have widened with the COVID 19 pandemic. METHODS: The Centers for Disease Control and Prevention (CDC) wide-ranging online data for epidemiologic research for both underlying cause of death (UCOD) and multiple causes of death (MCOD) in the US between the years 1999-2020 was used for this study. Non-Hispanic black (NHB) and non-Hispanic white (NHW) decedents aged 25 years and older with an ICD-10 code for PE (I26) were included. Age-adjusted mortality rates (AAMR) with 95% Confidence Intervals (CIs) were computed by race for age groups, year, Health & Human Services (HHS) regions, and urbanization and PE risk factors. Risk factors examined were trauma, cancer, cardiovascular diseases, obesity, sepsis, chronic lower respiratory diseases, and COVD-19 among PE decedents. RESULTS: Between the years 1999-2020, PE was the UCOD in 168,540 decedents, with 137,128 (81.4%) NHWs and 31,412 (18.6%) NHBs. The overall age-adjusted mortality rate (AAMR) decreased from 1999(5.3;95% CI, 5.2 - 5.4) to 2009(3.6;95% CI, 3.5 - 3.7), and then increased from 2010(3.8;95% (3.7 - 3.8) to 2020(4.2;95% CI, 4.1 - 4.3).There was a steep rise in the overall AAMR for 2020 (4.2;95% CI, 4.1 - 4.3) compared to the year prior 2019 (3.9;95% CI, 3.8 - 4.0) with highest annual % change among NHBs when compared to NHWs (NHB men (13%), NHB women (15%), NHW men (8.3%), NHW women (6%).) NHB men (AAMR 7.2;95% CI, 7.1-7.4) and NHB women (AAMR 6.6;95% CI, 6.5-6.7) had 2-fold higher AAMR compared to NHW men (AAMR 3.8;95% CI, 3.8-3-9) and NHW women (AAMR 3.7;95% CI, 3.7-3.7). Similar trends were also noted in geographical regions. The highest AAMRs were in HHS regions 3, 4, 5,6, 7, and 8. Within these HHS regions, NHBs and NHWs who resided in small metro and non-metropolitan areas had the highest AAMRs. However, NHB-NHW disparity in AAMR was seen in all 10 HHS regions and Urbanization. When risk factors such as trauma, cancer, obesity, cardiovascular diseases, sepsis, and chronic lower respiratory diseases were each mentioned as MCOD with PE decedents, rates varied by risk factor but NHBs had consistently higher AAMR than NHWs. CONCLUSIONS: We showed that PE-related mortality has increased over the past decade and racial disparities persisted and varied by gender, region, urbanization, and risk factors. The decades-long disparity observed in PE-related mortality may be narrowed by allocating resources to the management of common comorbidities. CLINICAL IMPLICATIONS: Racial disparity in PE-related mortality is related to comorbidities listed in MCOD data. DISCLOSURES: No relevant relationships by Isaac Ikwu No relevant relationships by Alem Mehari No relevant relationships by Lamiaa Rougui

20.
Chest ; 162(4):A2032, 2022.
Article in English | EMBASE | ID: covidwho-2060888

ABSTRACT

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Two years into the COVID-19 pandemic, knowledge about how infection affects children is still lacking. Unlike adults, prior to the recent surge widespread symptomatic childhood illness has not been seen, likely due to school shutdowns, strict social distancing, and less severe illness course. During the omicron surge in NYC, an increase in pediatric cases was noted likely due to reinstatement of in-person learning and relaxing of social distancing. Though vaccines were available, only 9% of children aged 5-11 years and 35% of adolescents aged 12-17 years were vaccinated. During omicron surge, a large proportion of adult patients positive for COVID-19 were asymptomatic. We aimed to explore incidence of ED visits, hospital admissions, vaccine status and presenting complaints in pediatric population who tested positive for COVID-19 during the omicron surge in NYC. METHODS: A retrospective chart review was conducted of patients <18 years who tested positive for COVID-19 at two multiethnic community hospitals during the Omicron wave (Nov 1, 2021-Feb 28, 2022). Demographics, vaccine status, reason for visit, diagnosis and disposition were extracted from EHR. Data were analyzed according to age group: 0 to <5 years (G1), 5 to <12 years (G2) and 12 to <18 years (G3). RESULTS: During this time, close to 2800 patients tested positive for COVID-19 at presentation to the ED or during hospitalization. Of these, 343 were <18 years of age (~10%). Overall, 53% of these pediatric patients were male. Ethnic make-up mirrored that of our community (approx. 60% Hispanic, 20% Asian, 10% Black). Admission status included 27 (7.8%) admitted to our hospitals, 18 (5.2%) transferred to other hospitals from our ED, and 298 (87%) treated and released from the ED. By age group, 183 (59%) were in G1, 76 (24%) in G2 and 51 (17%) in G3. Patients in G1 were <5 years and therefore ineligible for vaccine. Only 5% of G2 and 33% of G3 were fully vaccinated. In all groups, majority of patients presented for symptoms of viral infection (G1>80%, G2>90%, G3>90%). Symptoms of upper respiratory infection were most frequent in all groups (>80%). Convulsions (4.3%, 1.3%), croup (8.2%, 2.6%) and otitis media (3.3%, 1.3%) were noted in G1 and G2, respectively. In G3, acute appendicitis, diabetic ketoacidosis, and otitis media were present on admission in 2% each. Majority of patients requiring admission were from G1 (74%). CONCLUSIONS: Though adults during the recent surge often presented with asymptomatic COVID-19, pediatric patients in our sample typically presented for viral illness. It is difficult to interpret vaccine data except to say that there was a small group of pediatric patients who were symptomatic despite vaccination. CLINICAL IMPLICATIONS: We present early descriptive data from the Omicron surge in NYC in a pediatric sample. DISCLOSURES: No relevant relationships by Won Baik-Han No relevant relationships by Tamana Bismillah No relevant relationships by Kelly Cervellione no disclosure on file for Gagan Gulati;No relevant relationships by LOCHANA KC No relevant relationships by Lily Lew

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