Understanding pediatric long COVID using a tree-based scan statistic approach: An EHR-based cohort study from the RECOVER Program

STRUCTURED ABSTRACTO_ST_ABSObjectivesC_ST_ABSPost-acute sequalae of SARS-CoV-2 infection (PASC) is not well defined in pediatrics given its heterogeneity of presentation and severity in this population. The aim of this study is to use novel methods that rely on data mining approaches rather than clinical experience to detect signals associated with PASC. Materials and MethodsWe used a propensity-matched cohort design comparing children identified using the new PASC ICD10CM diagnosis code (U09.9) (N=1250) to children with (N=6250) and without (N=6250) SARS-CoV-2 infection. We used a tree-based scan statistic to identify potential condition clusters co-occurring more frequently in cases than controls. ResultsWe found significant enrichment among children with PASC in cardiac, respiratory, neurologic, psychological, endocrine, gastrointestinal, and musculoskeletal systems, the most significant related to circulatory and respiratory such as dyspnea, difficulty breathing, and fatigue and malaise. DiscussionOur study addresses methodological limitations of prior studies that rely on pre-specified clusters of potential PASC-associated diagnoses driven by clinician experience. Future studies are needed to identify patterns of diagnoses and their associations to derive clinical phenotypes. ConclusionWe identified multiple conditions and body systems associated with pediatric PASC. Because we rely on a data-driven approach, several new or under-reported conditions and symptoms were detected that warrant further investigation.

Impact of SARS-CoV-2 infection on disease trajectory in youth with T1D: An EHR-based cohort study from the RECOVER program

BackgroundPost-acute sequelae of SARS-Co-V-2 infection (PASC) is associated with worsening diabetes trajectory. It is unknown whether PASC in children with type 1 diabetes (T1D) manifests as worsening diabetes trajectory. ObjectiveTo explore the association between SARS-CoV-2 infection (COVID-19) and T1D-related healthcare utilization (for diabetic ketoacidosis [DKA] or severe hypoglycemia [SH]) or Hemoglobin (Hb) A1c trajectory. MethodsWe included children <21 years with T1D and [≥]1 HbA1c prior to cohort entry, which was defined as COVID-19 (positive diagnostic test or diagnosis code for COVID-19, multisystem inflammatory syndrome in children, or PASC) or a randomly selected negative test for those who were negative throughout the study period (Broad Cohort). A subset with [≥]1 HbA1c value from 28-275 days after cohort entry (Narrow Cohort) was included in the trajectory analysis. Propensity score-based matched cohort design followed by weighted Cox regression was used to evaluate the association of COVID-19 with healthcare utilization [≥]28 days after cohort entry. Generalized estimating equation models were used to measure change in HbA1c in the Narrow cohort. ResultsFrom 03/01/2020-06/22/2022, 2,404 and 1,221 youth met entry criteria for the Broad and Narrow cohorts, respectively. The hazard ratio for utilization was (HR 1.45 [95%CI,0.97,2.16]). In the Narrow Cohort, the rate of change (slope) of HbA1c increased 91-180 days after cohort entry for those with COVID-19 (0.138 vs. -0.002, p=0.172). Beyond 180 days, greater declines in HbA1c were observed in the positive cohort (-0.104 vs. 0.008 per month, p=0.024). ConclusionWhile a trend towards worse outcomes following COVID-19 in T1D patients was observed, these findings were not statistically significant. Continued clinical monitoring of youth with T1D following COVID-19 is warranted. Authorship StatementAuthorship has been determined according to ICMJE recommendations DisclaimerThe content is solely the responsibility of the authors and does not necessarily represent the official views of the RECOVER Program, the NIH or other funders. Funding SourceThis research was funded by the National Institutes of Health (NIH) Agreement OT2HL161847-01 as part of the Researching COVID to Enhance Recovery (RECOVER) program of research.

An Unusual Association between Sweet's Syndrome and Metastatic Papillary Follicular Thyroid Carcinoma

Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, is marked by fever, leukocytosis, and painful erythematous papules/plaques resulting from neutrophil migration and accumulation in the dermis. This condition has been associated with underlying hematologic as well as solid malignancies. We describe a unique case of SS in a patient with metastatic papillary follicular thyroid carcinoma and group A streptococcal pharyngitis. The distribution of the patient's SS rash was similar to the rash of neutrophilic dermatosis (pustular vasculitis) of the dorsal hands.

An Unusual Association between Sweet's Syndrome and Metastatic Papillary Follicular Thyroid Carcinoma

Sweet's syndrome (SS), or acute febrile neutrophilic dermatosis, is marked by fever, leukocytosis, and painful erythematous papules/plaques resulting from neutrophil migration and accumulation in the dermis. This condition has been associated with underlying hematologic as well as solid malignancies. We describe a unique case of SS in a patient with metastatic papillary follicular thyroid carcinoma and group A streptococcal pharyngitis. The distribution of the patient's SS rash was similar to the rash of neutrophilic dermatosis (pustular vasculitis) of the dorsal hands.

Overcoming ERISA as an obstacle: the Ninth Circuit's approval of San Francisco's fair share legislation.

State and local legislatures in more than twenty states have considered enacting fair share laws. Fair share laws typically require employers of a certain size either to spend a designated percentage of their total payroll costs on health insurance for their employees or pay into a state fund for uninsured individuals. Such laws have been challenged in the federal courts, ultimately resulting in differing decisions. In 2007, the Fourth Circuit Court of Appeals affirmed the lower court's decision to strike down the Maryland Fair Share Act, holding it was preempted by the Employee Retirement Income Security Act (ERISA). The Fair Share for Health Care Act in Suffolk County, NewYork succumbed to a similar fate. However, in the Ninth Circuit, San Francisco's Health Care Security Ordinance survived ERISA preemption. This article analyzes the Fourth and Ninth Circuit decisions and explores the potential effects of the differing outcomes on healthcare reform.