Clinical and epidemiological features of the course of the new coronavirus infection COVID-19 in children during periods of an increase in the incidence in Moscow in 2020-2021

Purpose: to identify the features of COVID-19 infection in children at different periods of the epidemiological rise in the incidence in the city of Moscow.Results. The article presents the observation of 1561 children hospitalized in the State Medical Institution «Children's City Clinical Hospital named after Z. A. Bash-lyaeva DZM» with a diagnosis of a new coronavirus infection COVID-19 during the periods of epidemiological rises in morbidity («2nd and 3rd waves of COVID-19»). An increase in the number of hospitalized children during the «3rd wave of COVID-19», early admission dates from the onset of the disease, due to the lack of treatment effect in outpatient settings, the predominance of school-age children and adolescents, the predominant course of infection with the development of viral pneumonia CT2-3, less often CT3-4, a 10-fold reduction in the number of children with MIS-syndrome, an elongation of the period of viral release in patients.

FORMAÇÃO DIFERENCIADA EM PESQUISA NOS EGRESSOS DE INICIAÇÃO CIENTÍFICA: implicações no mestrado acadêmico

O artigo discute as implicações da formação diferenciada em pesquisa, de estudantes egressos da iniciação científica (IC), para seu ingresso nos programas de mestrado. O termo formação diferenciada trata dos processos e resultados da aprendizagem partilhada entre integrantes de grupos de pesquisa e IC. Essa formação de habilidades para a pesquisa e reflexividade crítica é considerada essencial para a aprendizagem profissional e é exigência que recai nos programas de pós-graduação, pois se requer a capacidade de manejo da pesquisa, e a produção própria. O estudo buscou mapear como a seleção em uma instituição de ensino superior no Ceará, revela a presença de alunos oriundos de IC e como o seu desempenho realça a qualidade da formação em pesquisa. O estudo é descritivo, do tipo documental e a abordagem é predominantemente quantitativa. Os dados questionam se egressos de IC partem na seleção acumulando vantagens como currículo ou adequação de projetos de pesquisa às linhas de estudo disponíveis e diante disto, o ingresso precoce destes à pós-graduação parece ser um resultado natural. Esse panorama reclama mudanças e exige novas oportunidades para inclusão de estudantes a formações mais qualificadas em pesquisa.Palavras-chave: Formação Diferenciada; Formação para a pesquisa; Iniciação Científica; Mestrado Acadêmico.Special training in research among students who completed scientific research initiation: Implications for academic master’s degreeAbstractThis paper discusses the implications of special training in research, among students who completed scientific research initiation (SRI), for their admission to master’s degree programs. The term special training refers to learning processes and results shared among members of SRI and research groups. This development of skills for research and critical reflectiveness is considered essential for professional learning and is a recurrent requirement in graduate programs, since they demand the ability to manage research and independent production. The study aimed to map the way in which the selection process in a higher education institution in Ceará reveals the presence of students who came from SRI and how their performance reinforces the quality of research training. The method used was a descriptive, documentary study, and the approach is predominantly quantitative. The data investigate whether students who completed SRI accumulate advantages at the start of the selection, such as curriculum vitae or adjustment of research projects to the available study lines, and, consequently, their early admission to graduate programs seems to be a natural effect. This background calls for changes and requires new opportunities for the inclusion of students in more qualified training in research.Keywords: Special Training; Research Education; Scientific Research Initiation; Academic Master’s Degree.Formación diferenciada en investigación en los egresados de iniciación científica: implicaciones en la maestría académicaResumenEl artículo discute las implicaciones de la formación diferenciada en investigación de estudiantes egresados de la iniciación científica (IC) para su ingreso a programas de maestría. El término formación diferenciada se refiere a los procesos y resultados del aprendizaje compartido entre integrantes de grupos de investigación e IC. Se considera que esta formación de habilidades para la investigación y reflexividad crítica es esencial para el aprendizaje profesional y es una exigencia que recae en los programas de posgrado, dado que se requiere la capacidad de manejo de la investigación y la producción propia. El estudio buscó mapear cómo la selección en una institución de educación superior en Ceará revela la presencia de estudiantes procedentes de IC y cómo su desempeño acentúa la calidad de la formación en investigación. El estudio es descriptivo, del tipo documental, y el enfoque es predominantemente cuantitativo. Los datos cuestionan si egresados de IC empiezan la selección acumulando ventajas, como currículum o adecuación de proyectos de investigación a las líneas de estudio disponibles, y, frente a esto, el ingreso temprano de estos estudiantes al posgrado parece ser un resultado natural. Este escenario requiere cambios y exige nuevas oportunidades para la inclusión de estudiantes en formaciones más cualificadas en investigación.Palabras clave: Formación Diferenciada; Formación para la Investigación; Iniciación Científica; Maestría Académica.

Clinical features, demography and predictors of outcomes of SARS-CoV-2 infection in a tertiary care hospital in India-A cohort study

Background The second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 and more than 400,000 cases per day were reported in the country. We describe the clinical features, demography, treatment trends, baseline laboratory parameters of a cohort of patients admitted at the All India Institute of Medical Sciences, New Delhi with SARS-CoV-2 infection and their association with the outcome. Methods This was a retrospective cohort study describing the clinical, laboratory and treatment patterns of consecutive patients admitted with SARS-CoV-2 infection. Multivariate logistic regression models were fitted to identify the clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay and death. Findings A total of 2080 patients were included in the study. The case fatality rate was 19.5%. Amongst the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 Acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged 45-60 years [OR (95% CI): 1.8 (1.2-2.6)p =0.003] and those aged >60 years [OR (95%CI): 3.4 (2.3-5.2), p<0.001] had a higher odds of death as compared to the 18-44 age group. Vaccination reduced the odds of death by 30% [OR (95% CI): 0.7 (0.5-0.9), p=0.036]. Patients with hyper inflammation at baseline as suggested by leucocytosis [OR (95% CI): 2.1 (1.4-3.10), p <0.001], raised d-dimer >500 mg/dL [OR (95% CI): 3.2 (2.2-4.6), p <0.001] and raised C-reactive peptide >0.5 mg/L [OR (95% CI): 3.8 (1.1-13), p=0.037] had higher odds of death. Patients who were admitted in the second week had lower odds of death and those admitted in the third week had higher odds of death. Interpretation This is the largest cohort of patients admitted with COVID-19 from India reported to date and has shown that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Strategies should be made to improve vaccination rates and early admission of patients with moderate and severe COVID-19 to improve outcomes.

Gitelman Syndrome in Pregnancy: A Clinical Challenge

Purpose Disease progress may be affected by pregnancy-related changes, and underlying conditions may also affekt pregnancy outcomes in women with Gitelman syndrome (GS). Case presentation A 35-year-old woman with GS (gravida 2 para 1) was referred to our hospital to start routine antenatal care follow-up at 6 weeks of gestation. At the age of 31, she had been diagnosed with GS after her first uneventful pregnancy. Upon early admission, her serum Mg+level was 0.51 mmol/L and her serum K+level 2.7 mmol/L with normal kidney function tests. She was already taking oral combined potassium citrate and potassium bicarbonate supplementation once a day before pregnancy. At the eighth gestational week, the medication was changed to an oral potassium color sachet of 1.5 gram per day until labor because of the insufficient dosage to maintain optimum potassium levels. She was also taking 365 milligrams of oral magnesium oxide twice a day before and during pregnancy. In the third trimester of the pregnancy, her serum Mg+level was 0.48 mmol/L and serum K+level 2.8 mmol/L. Because of the previous uterine surgery history, she underwent an elective cesarean operation at 39 weeks’ gestation under spinal anesthesia and delivered a healthy 3090-gram female infant. Conclusion Increased need for potassium and magnesium supplementation should be the critical considerations when managing pregnant patients with GS.

The Efficacy of Chest X-Ray for the Diagnosis and Follow-up in Young Adult COVID-19 Patients with Mild Dyspnea No Comorbid Diseases

Purpose: We investigated whether Chest X-Ray (CXR) could replace CT modality in the diagnosis and during the treatment of young adult COVID-19 patients with mild dyspnea with no comorbid diseases. Materials and Method: This retrospective study involved an examination of the records of a total of 956 patients hospitalized between March 1 and May 15, 2020. The study included a total of 64 patients, aged 21–60 years with mild dyspnea with no comorbid diseases and with COVID-19 infection confirmed by a polymerase chain reaction, who underwent a CXR at admission and CT imaging within 24 hours. The first CXR and CT images at the time of admission were evaluated in terms of lesions and localization. The clinical-radiological course of the diseases with CXR were also statistically evaluated. Results: CT was normal in 18/64 (28.2%) patients, all of whom also had normal CXR. The rest of the patients 46/64 (71.8%) with an abnormal CT, the CXR was normal in 18/46 (39.1%) and abnormal in 28/46 (60.9%). The time between the onset of complaints and admission to the hospital in patients with abnormal and normal CXR was 3.5 ± 2.3 days and 2.1 ± 1.1, which was statistically significant (p = 0.004). The hospital stay duration of the patient with abnormal and normal CXR was 9.6 ± 3.5 and 9.5 ± 3.4 (p=0.928), respectively, and was not statistically significant. Conclusion: CXR could be used in the diagnosis and follow-up of young adult COVID 19 patients with mild dyspnea no comorbid disease. In the case of early admission to the hospital, there is not a significant difference between using CXR or CT in the management of these patients. Therefore, the use of CXR in these patients groups will reduce the burden of CT units in pandemic conditions with limited resources.

Comparison of oral anticoagulant users with non-users admission laboratory parameters, length of hospital stay and outcomes in COVID-19 infection

Introduction Oral anticoagulants (OAs) are not in routine use during Coronavirus disease (COVID-19). Studies that compare the COVID-19 infection outcome of chronic OA users with their peers of non-OA users are available. To the best of our knowledge, none of these studies evaluated the effect of OA use on the COVID-19 related early admission laboratory parameters and/or length of the hospital stay. So, we will study these here. Methods This retrospective study was included 2 groups; group 1 (n=62) consisted of OA users, and group 2 (n=75) of age, and sex-matched of OA non-users at the time of COVID-19 diagnosis. Early admission laboratory measures, numbers of comorbidities, length of hospital stay, and outcomes of these patients were recorded and analyzed Results Despite higher numbers of comorbidities in group 1, their serum CRP and D-dimer levels were significantly lower than the group 2. (p<0.05, all). The rate of mortality was higher in group 2 patients, but, it has not reached a statistical significance (p>0.05). Regression analysis showed that OA users (in comparison to non-OA users) had 0.980 and 0.520 times lower serum CRP and D-dimer levels, respectively. Conclusions This study showed a beneficial effect of OA use on early admission serum CRP, and D-dimer levels, which are important prognostic predictors in COVID-19. Additionally, OA use associated with lesser hospital stay days of COVID-19 patients. These beneficial effects of OA use might help in improving the management of this infection after further dedicated studies in this field.

Outpatient practice pattern and remote patient monitoring for axicabtagene ciloleucel CAR-T therapy in patients with aggressive lymphoma.

7554 Background: Chimeric antigen receptor T-cell therapy (CAR-T) are commonly administered inpatient due to concern for early onset cytokine release syndrome (CRS), especially with axicabtagene ciloleucel (axi-cel). We report Mayo Clinic Rochester experience for hospital-based outpatient (HBO) management of patients (pts) receiving axi-cel and identify opportunities for improvement. HBO is closely integrated with inpatient practice and includes the same specialty trained clinical team. It is the first point of contact 24/7 for pts and triage evaluations. Lymphodepletion chemotherapy and CAR-T infusion is given on HBO followed by daily monitoring till day 8 and thereafter, as clinically needed until admission criteria is met. Methods: We retrospectively analyzed database of pts who received axi-cel between 1/2018 and 1/2021. After 06/2020, remote patient monitoring (RPM) tools were implemented to collect patient-reported neurologic symptoms and vital signs via bluetooth-enabled devices 4 times daily through month 1. Adverse data trends are addressed by the HBO team. Results: Among 72 recipients, 89% received their cells outpatient; 8% remained outpatient for the entire month. CRS and neurotoxicity incidence were comparable to those reported from CIBMTR. Median time to first admission was 2 days (Table). Use of bridging therapy, increased CRP and LDH were associated with early admission (≤3 days). Median time to tocilizumab, steroid, oxygen support, vasopressor was 4 days after admission. Half of HBO visits required intervention such as blood transfusions, IV medications through the first month. Nine pts had enrolled in RPM to date; with 8 having evaluable data. With 4 scheduled entries/day, a median of 1 entry/day was skipped and 2 entries/day were answered incompletely. An average of 57 additional unscheduled entries were generated per pt. Among a median of 373 (range 91-522) readings per pt over the first month, 4% (2%-20%) of the readings generated alerts. An average of 4 alerts were seen within 48 hours prior to admission. Data including additional subjects will be presented at ASCO meeting. Conclusions: We report a feasible outpatient care model for management of axi-cel recipients with safe outcomes. Clinical characteristics associated with more aggressive disease are associated with likelihood of early admission. Early RPM experience suggest use of digital tools could improve monitoring compliance and may predict evolution to symptoms requiring escalation of care.[Table: see text]

THE UTILIZATION OF GOLDEN PERIOD OF ISCHEMIC STROKE IN PATIENTS IN PRODUCTIVE AGES

The 2007 Basic Health Survey shows the highest number of deaths in Indonesia rural and urban areas was caused by stroke. In 2007-2013, the stroke prevalence in productive age increased up to 22‰. Stroke that attacks productive age can impair individual’s ability to do activities, and thus they might have family financial constraint. Disabilities can be prevented and minimized if patients utilize a golden period of an ischemic stroke. This study identified the utilization of golden period of ischemic stroke in patients and analyzed causes of delayed patient admission to the Neurology Clinic of Sidoarjo Hospital. This study was a descriptive study conducted to 39 post-stroke ischemic patients in productive ages under further therapy at the Neurology Clinic of Sidoarjo Hospital in 2016. The data were collected through interview from January-February 2017. The results present 62% of stroke ischemic patients utilized the golden period of a ischemic stroke. The average respondents' admission took 29.87±47.46 hours after patients experienced first stroke ischemic attacks (ranging from 1-168 hours). The respondents were admitted to the hospital late or >4.5 hours after the stroke attacks because most of them did not know stroke signs and symptoms. Therefore, hospitals or health care providers have to provide counseling service to patients and family members about stroke signs and symptoms, as well as the importance of early admission for treatment as soon as patient gets the first stroke attack. Keywords: utilization of the golden period, ischemic stroke, productive age.