In-depth cardiovascular and pulmonary assessments in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a case series study

Objective To perform an in-depth assessment of cardiovascular and pulmonary outcomes in a series of 5 post discharged multisystem inflammatory syndrome (MIS-C) survivors. Methods Data were collected ≅1.9 month after hospital discharge at a tertiary hospital in São Paulo, Brazil. All patients (7-18 years; 3 females) fulfilled the MIS-C diagnosis according to CDC. The battery of tests included: 13 N-ammonia PET-CT imaging, standard echocardiography, brachial flow-mediated dilation using a Doppler ultrasound, cardiopulmonary exercise test, and blood markers. Results Upon PET-CT scans, two patients exhibited severe perfusion defect developed in the left ventricular cavity suggesting extensive myocardial ischemia, and one patient showed persistent mild pericardial effusion. Other two patients had endothelial dysfunction. All patients exhibited abnormal cardiopulmonary reserve during exercise (e.g., low VO2peak). Three patients had abnormal values for D-dimer and fibrinogen. Conclusion This study reveals novel pathological findings in MIS-C patients, which may help optimize treatment protocols in this condition.

Efficacy and safety of convalescent plasma therapy for severe COVID-19 patients：case series study and literature review

Background Coronavirus disease 2019 (COVID-19) is a new acute respiratory infectious disease which can lead to multiple organ dysfunction in severe patients. However, it is still a lack of effective antiviral drugs for COVID-19. Herein we investigated the efficacy and safety of convalescent plasma (CP) in the treatment of severe COVID-19, with an attempt to explore new therapeutic method. Methods Clinical data of three imported severe COVID-19 patients with CP treatment, who were under quarantine and treated in a designated COVID-19 hospital from March 2020 to April 2020, were collected and analyzed. Results The three patients were clinically classified as severe type, including one male and two females, aged 57, 59 and 65 years old, respectively. The main underling diseases included hypertension, diabetes, sequela of cerebral infarction and postoperative thyroid adenoma. The common symptoms included cough, fever and short of breath. All the patients received antiviral drugs and other supportive treatments. Additionally, CP treatment was also administrated for them. Forty-eight to seventy-two hours after CP transfusion, all the patients improved with alleviated symptoms, elevated arterial oxygen saturation, decreased C-reactive protein and interleukin-6 markers. And the total lymphocytes, T lymphocytes (CD3+) and their subsets (CD4+, CD8+) also obviously increased. Repeated chest CTs also showed obvious absorption of lesions in bilateral lung. Only one patient had mild allergic reaction during CP infusion, but no severe adverse reactions were found. Conclusions The early application of CP for severe COVID-19 patients can improve the condition rapidly, and the therapy is generally effective and safe.