Assessment of Cardio-pulmonary function in children and adolescents with suspected long COVID

IntroductionPersistent respiratory symptoms and exercise intolerance following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents is common.1 Our aim was to review the clinical data on patients who had been referred with suspected long COVID (LC). Unfortunately, there is a lack of an agreed definition for LC. The patient cohort were referred with persistent respiratory symptoms/signs (cough, exertional dyspnoea or wheeze) for at least 3 months following confirmed (PCR or antigen test positive) mild SARS-CoV-2 infection that did not require hospitalisation.MethodsThis was a retrospective analysis of clinical data obtained during clinical assessment. Patients had undergone pulmonary function tests (PFTs) including;spirometry, Single breath transfer factor (TLCO) and static lung volume measurements (Vyntus Body – VyaireTM Medical) followed by an incremental maximal ramp cardiopulmonary exercise testing (CPET) performed on a cycle ergometer (Jaeger CPX & Vyntus ONE – VyaireTM Medical).ResultsSeven patients (four male) with suspected LC had undergone PFTs and CPET. Demographics and summary data are presented (table 1). Five had normal PFT results. Of the two that had abnormal PFTs both had co-existing morbidities. One had mild airflow obstruction (previous pneumothorax) and the other had a restrictive defect (Di-George syndrome and obesity). Three patients had a reduced peak Oxygen uptake (VO2peak < 85% predicted). The cardiovascular and gas exchange response to incremental exercise were normal and there was no evidence of ventilatory limitation or dysfunctional breathing in any of the patients.ConclusionsAlthough only a small cohort was examined, this study suggests that SARS-CoV-2 infection does not seem to be causing any longstanding cardiopulmonary function impairment in children and adolescents. Whilst there may be pathophysiological changes following SARS-CoV-2 infection, as previously reported in adults,2 a reduced aerobic capacity is seen in some of these patients and this may due to physical de-conditioning rather than any physiological impairment caused by SARS-CoV-2 infection.ReferencesDobkin S et al. (2021) Protracted respiratory findings in children post-SARS-CoV-2 infection Pediatr Pulmonol.Rinaldo RF et al. (2021). Deconditioning as main mechanism of impaired exercise response in COVID-19 survivors. ERJ 2021 58:2100870.

THE UK FIREBALL ALLIANCE: LESSONS LEARNED FROM TWO METEORITE FIELD SEARCHES IN THE UK

Introduction: The UK currently has six meteor camera networks that are coordinated through the UK Fireball Alliance (UKFAll) [1]. Together, these networks currently image much of the UK's night sky. Since its formal establishment in 2020, the UKFAll has organised field searches following two detected fireball events that dropped meteorites in the UK: one at 21:54 (UTC) 28th February 2021 in Gloucestershire, England, and another at 23:45 (UTC) 14th April 2022 in Shropshire, England. The former fireball detection led to the recovery of the Winchcombe CM chondrite, the first UK meteorite in 30 years [2-4], whilst our search for the Shropshire meteorite have not yet located any stones. Here, we report some lessons learned as a citizen-science and academic collaboration, and from engaging with both local and national communities in searching for meteorites in Gloucestershire and Shropshire, UK. Camera Networks: UKFAll includes the UK Meteor Network (UKMON), Network for Meteor Triangulation and Orbit Determination (NEMETODE), the UK Fireball Network (UKFN), the Fireball Recovery and InterPlanetary Observation Network (FRIPON), the Global Meteor Network (GMN), and the AllSky7 network. Orbital calculations and dark flight modelling are a collaborative effort by researchers from the Global Fireball Observatory based at Curtin University, Australia, as well as the University of Western Ontario, Canada, and FRIPON, France. Winchcombe: Since the Winchcombe meteorite fell during a national lockdown, we issued a press release asking residents in Gloucestershire to report possible meteorite finds following the fireball, as opposed to sending a search party immediately. This approach was successful, with the Wilcock family waking to find a pile of dark rocks and powder on their driveway, and having seen the news, collecting the material and contacting the UKMON. Following verification of the meteorite fall, and additional refinement of the strewn field, a small (~15 scientists) search party assembled in Gloucestershire on 4th March 2021. This led to the recovery of the largest 152 g stone at Rushbury House farm on 6th March 2021. Field Experience: Members of UKFAll with meteorite searching experience led small teams of 4 - 8 people. The search was conducted in a unique situation due to COVID. Care was taken to remain socially distanced at all times, which made coordination of the search efforts challenging. Positive engagement with the local community was prioritised from the outset, with team leaders contacting landowners for permission to search and emphasising our safety precautions and risk assessments. News of the meteorite fall spread quickly, and residents were very hospitable and enthusiastic about our activities. The UK countryside is full of "meteorwrongs", and the rural terrain was difficult to search due to long grass, bushes etc. A game was devised to help boost morale - and to see if a meteorite would be found in that field - where a convincing meteorwrong was thrown into each new area by one team member to be found by the search team. During the field search, we also received many enquiries. These were managed by dedicated UKFAll team members, who replied to emails and visited potential meteorite finds in the area. The press interest in the story following the announcement that the meteorite had been found was significant, with journalists soon arriving in Winchcombe. This press release came after the main UKFAll search had ended, and there were many requests from the the media for interviews. Following several busy days, a key lesson learned was to the need to have a designated media liaison for any future press releases. Shropshire: This meteorite search was carried out over six days by ~20 scientists in an agricultural area south of Shrewsbury that included grazing land for sheep, wheat and rapeseed fields, and woodland. Searching in mid-April proved more challenging due to the increased vegetation cover. In order to train more people in meteorite hunting strategy, search line leaders were alternated each day. An initial small team arrived for the first two days to engage with the community. This "recon" was used to assess the terrain, identify key areas, and obtain permissions, and to avoid inundating small communities with search teams without advance notice. Early on, we engaged with a business owner, who helped to spread the word using local social media groups. Within 24 hours, most residents in the strewn field were aware of the meteorite fall and our presence, with many families conducting their own searches of public land. On 18th April 2022, a press release with an approximate strewn field was issued to local journalists. As with Winchcombe, there was significant national media interest, despite no stone being found to date. This helped us to gain access to search areas, as several landowers were aware of the meteorite before we contacted them. [ FROM AUTHOR] Copyright of Meteoritics & Planetary Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Exercise performance before and after introduction of elexacaftor/tezacaftor/ivacaftor (Kaftrio®) in Scottish children with cystic fibrosis: a 2-centre retrospective study

Objectives: Elexacaftor/tezacaftor/ivacaftor (ETI) combination therapy - Kaftrio® was approved for use in the UK in August 2020 for those aged >12 years. Our study aimed to study the effects of ETI therapy on lung function and exercise performance. Methods: Two-centre retrospective analysis of clinical data obtained during patients’ annual review assessments. Patients had undergone spirometry and static lung volume measurements followed by an incremental maximal ramp cardiopulmonary exercise testing (CPET) performed on a cycle ergometer. Data were analysed using a paired sample t-test. Results: Lung function improvement did not reach statistical significance. Of note, four patients had a baseline (pre-ETI) FEV1 belowthe lower limit of normal (LLN <-1.64 Z scores), and one improved their FEV1 from 41% predicted to 87% with Kaftrio®. Five had a VO2peak% predicted below the LLN (< 85% predicted) prior to treatment and 8 post treatment. Therewas a significant fall in VO2peak % predicted, p = 0.03. However, this was not seen in the VO2peak relative to bodyweight, p = 0.07. There was also a significant fall in VO2 at anaerobic threshold (AT) as a % of predicted VO2peak, p = 0.01. Table 1. (Table Presented) (Table Presented) Conclusions: This real-world study suggests Kaftrio® does not improve exercise capacity in the majority of CF patients. It is hypothesised that the lack of improvement may be due to a reduced physical activity over the study period as a result of feeling better on Kaftrio® and also the SARSCoV2 pandemic. The decrease in VO2 at AT would support the hypothesis of physical deconditioning. The reasons for not seeing statistical differences in lung function are likely to represent the relatively high baseline FEV1 alongside small study numbers. In summary, whilst having the potential to be a performance-enhancing drug, performance gains on Kaftrio® can only occur if matched by training, and studies to investigate the training potential of Kaftrio® are required.

Experiences of the SARS-CoV-2 pandemic amongst Australian healthcare workers: from stressors to protective factors.

BACKGROUND: The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimizing ongoing and future pandemic responses. OBJECTIVES: In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS: Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS: Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognized clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organizational preparedness. CONCLUSIONS: This study provides insights into the key organizational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognized expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organizational levels, provision of psychological support, and consideration of the potential negative effects of centralizing control, would assist in ameliorating the extreme pressures of working within a pandemic environment.

Determining the effect of postage on the recovery of cystic fibrosis pathogens from respiratory samples

Objectives: Regular microbiological surveillance of sputum to detect pathogens is a cornerstone of CF care. In many CF centres, patients may be required to post samples to the clinic, due to difficulty producing sputum on demand or for enhanced surveillance outside of routine clinics. This is increasingly important in light of the COVID-19 pandemic where many CF patients are unable to come into clinic due to shielding. However, these samples may experience fluctuations in temperature and hence altering the microbiology of a sample before processing. Here we report the impact of posting on the detection of common CF pathogens, and hence reliability of the culture reports. Methods: Ninety-two sputum samples were collected from 72 adults with CF. Samples were weighed, mixed and split. One part was sent immediately to the microbiology lab and another was posted back to the lab through the post. Postal samples were returned and processed after a mean of 5 days. Aliquots at each stage were stored at -80oC for subsequent PCR-based analysis. In this study, we compared clinical microbiology reporting for the paired-sputum samples. Results: Overall prevalence for all organisms present in >10% of samples is shown in the Table. Sensitivity of the different sample types to each species is given as percent positive samples compared to all positive samples. Postal samples detected all Burkholderia cepacia complex, 92% of P. aeruginosa (versus 93% for the clinic sample) and 74% of Aspergillus spp. (versus 78% for the clinic sample). All other organisms were detected in postal samples at the same or higher rate as clinic samples. Conclusions: Despite being in the post for a median of 5 days, there was little difference in the culture-based microbiology results. Posting sputum samples therefore does not appear to reduce the identification of key CF microorganisms, which remain viable for several days after collection. PCR-based analyses of these same samples is ongoing.