RESUMEN
Background and Aim: We aimed to evaluate cardiac manifestations of the multisystem inflammatory syndrome in children(MIS-C) and the changes in cardiac function during one year of follow-up. Method(s): All children diagnosed as MIS-C with cardiac involve-ment were enrolled in this prospective study. The diagnosis and severity of the disease of MIS-C was made according to the Centers for Disease Control and World Health Organization guidelines. Clinical findings, laboratory parameters including car-diac markers, electrocardiographic and echocardiographic findings at the time of diagnosis and during follow-up were evaluated. Cardiac magnetic resonance imaging (MRI) was performed on all children with echocardiographic abnormality. Result(s): Between April 1st 2020 and December 1st 2021,71 chil-dren were diagnosed with MIS-C and 44 of these patients had car-diac involvement (25 male and 19 female). 24 patients were followed up in the intensive care unit and all of these patients had myocardial involvement. All the patients had elevated NT-proBNP levels (median:5893pg/ml) whereas troponin-T levels were above upper limit in 13 patients. A significant positive cor-relation was found between troponin-T and NT-proBNP (plt;0.01). The NT-proBNP levels were also positively correlated with the severity of MIS-C (plt;0.05). On admission 22 patients had tachycardia and atrioventricular conduction disturbances and supraventricular tachycardia developed in 5 of these patients during follow-up. Bradycardia was observed in 18(40%) patients during hospitalization (4 of these occurred after tachycardia). Although 26 patients had an echocardiographic abnormality, only twelve patients had systolic dysfunction (9 with mild and 3 with moderate) and two patients had diastolic dysfunction. NT-proBNP and troponin-T were negatively correlated with ejection fraction ve fractional shortening (respectively, p = 0.003, p = 0.013). Cardiac MRI was normal in all patients except 3 patients who had myocardial late gadolinium enhancement of left ven-tricle. Pericardial effusion was observed in 14 patients. The echo-cardiographic abnormalities disappeared in 42 patients during follow-up, one patient died on the second day of hospitalization and and 1 patient has ongoing LV systolic dysfunction. Conclusion(s): Bradycardia and myocardial involvement is common during MIS-C. Although myocardial dysfunction can be observed during acute disease, commonly the disease does not cause perma-nent damage during one year of follow-up.
RESUMEN
Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
RESUMEN
Introduction: Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.