Thromboelastography profiles in critically ill children with multisystem inflammatory syndrome.

OBJECTIVES: To describe critically ill children's coagulation profile with the multisystem inflammatory syndrome (MIS-C) related to coronavirus. STUDY DESIGN: Single-center, observational study at a tertiary, pediatric intensive care unit (PICU) in children aged 1 month to 18 years. MEASUREMENTS AND MAIN RESULTS: Sixteen children, with a median age of 5.4 years (interquartile range [IQR] 2.1, 11.75), 56% female, admission Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score of 3.5 (IQR 2, 5), and median PICU length of stay 3 days (IQR 1.5, 4), met criteria of MIS-C. All patients received acetylsalicylic acid (80-100 mg/kg) and none received anticoagulation. Sixty-three percent (10/16) of children had out-of-normal range values on thromboelastography (TEG) (44% [7/16] with hypercoagulability and 19% [3/16] with hypocoagulability). Of those with hypercoagulability, 19% (3/16) had rapid clot formation, and 25% (4/16) had increased clot strength. In 69% (11/16) of children, there was impaired fibrinolysis (0% lysis at 30 minutes) on TEG. Seventy-five percent (12/16) of children had out-of-normal range value on standard coagulation assays (37.5% [6/16] with hypocoagulability and 37.5% [6/16] with hypercoagulability). TEG-G (clot strength as measured by TEG) value (ρ -.553, p = .033) and platelet count (ρ -.840, p < .0001) were correlated with admission PELOD-2 score. TEG-G value (ρ -.506, p = .04) and platelet count (ρ -.539, p = .03) were correlated with the duration of intensive care unit stay. CONCLUSIONS: Coagulation abnormalities are frequent in children with MIS-C. TEG parameter and platelet count are correlated with the severity of multiorgan dysfunction and the duration of intensive care stay. Multicenter studies are needed to confirm the clinical implications of these coagulation abnormalities.

Posttraumatic Stress among Pediatric Critical Care Physicians in the United States in Association with Coronavirus Disease 2019 Patient Care Experiences.

Posttraumatic stress among pediatric critical care physicians in the United States in association with coronavirus disease 2019 patient care experiences. Our objective was to assess the prevalence of posttraumatic stress (PTS) and its association with COVID-19 patient care experiences among pediatric critical care physicians. Our study was a cross-sectional study of pediatric critical care physicians in the United States. We measured PTS which included posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (SubPTSD) using validated PTSD Checklist- 5 survey tool. Association of PTS with COVID-19 patient care experiences was analyzed using regression analysis. Prevalence of PTS was noted in 120 among 294 pediatric critical care physicians (41%; 95% CI, 35-47%). The predominant symptoms were that of hyperarousal and feelings of negative cognition and mood. Among our physicians with PTS, 19% had PTSD and 81% had SubPTSD. Demographic and practice characteristics were not significant for increased PTS on regression analysis. Posttraumatic stress was significantly associated with physicians testing positive or taking time off for COVID-19 illness, self-isolation, fear of infecting their loved ones, families scared of being infected, feeling helpless, patients expressing fears of dying, having pre-existing depression, anxiety, or insomnia, working beyond comfort level of training and having thoughts of quitting (p < 0.05). Thoughts of quitting was associated with the highest significant increase in PTS scores (coefficient:11.643; 95% CI:8.551,14.735; P < 0.01) followed by feeling of helplessness (coefficient:11.055; 95% CI: 8.484,13.624; P < 0.01) and need for additional medications for depression, anxiety and insomnia (coefficient: 10.980; 95% CI: 4.970, 16.990; P < 0.01). Posttraumatic stress is high in pediatric critical care physicians and is associated with various COVID-19 patient care experiences. Thoughts of quitting was associated with highest increase in posttraumatic stress score which could have major implications for the workforce in the future. Subthreshold posttraumatic stress disorder should be recognized, and mental health issues of pediatric critical care physicians addressed.

Abdominal Imaging Findings in Critically Ill Children With Multisystem Inflammatory Syndrome Associated With COVID-19.

We report findings on abdominal imaging in critically ill children admitted with MIS-C. On sonography, hepatomegaly, nephromegaly, gallbladder wall edema, ascites, intestinal inflammation and mesenteric lymphadenopathy were seen, while CT showed fluid-filled small bowel loops, mural thickening of the terminal ileum, diffuse lymphadenopathy, and moderate ascites.

[Overweight and obesity in schoolchildren from Brandsen and its relationship with socio-environmental characteristics of residence]. / Sobrepeso y obesidad en escolares de Brandsen en relación a las condiciones socioambientales de residencia.

INTRODUCTION: Environmental factors play an important role in the etiology of overweight (S) and obesity (O), constituting the "obesogenic environment". The objectives of the present study are: a) to estimate overweight and obesity prevalences in 3 to 14 years-old schoolchildren from Brandsen (Provincia de Buenos Aires), and b) to analyze the probability of occurrence of overweight and obesity in relation to the socioenvironmental conditions of resident. POPULATION AND METHODS: Weight and height were measured in 989 boys and girls aged 3 to 14 years. S and O were estimated following the criteria suggested by the International Obesity Task Force. The prevalences of S and O were compared between genders and ages. The socio- environmental information was gathered according to surveys and processed by Categorical Principal Components Analysis (catPCA). Generalized Linear Model (link logit) against the variables S and O was employed. RESULTS: S was found in 15,8% of schoolchildren and O in 7,2%. None significative statistics differences between both genders and ages, were found. The first axis of the catPCA discriminated the cases that presented better socio-environmental conditions with positive values and those with more unfavorable conditions with negatives values. Higher probability of obese children was associated with better socio-environmental conditions (higher educational level of parents, higher income and better access to public services), and higher probability of overweight children was associated with less favored environments. CONCLUSIONS: The schoolchildren population of Brandsen presents high overweight and obesity prevalences. The chance of presenting overweight is higher in children from households with adverse socio-environmental conditions. On the contrary, obese children are to be more found in households which have more favorable socio-environmental conditions.

Sobrepeso y obesidad en escolares de Brandsen en relación a las condiciones socioambientales de residencia / Overwweight and obesity in schoolchildren from Brandsen and its relationship with socio environmental characteristics of residence

Introducción. Los factores socioambientales desempeñan un papel esencial en la etiología del sobrepeso (S) y la obesidad (O) y constituyen elllamado “entorno obesogénico”. Los objetivos del presente trabajo son: a) estimar las prevalencias de sobrepeso y obesidad en escolares de 3 a 14 años del partido de Brandsen (Provincia deBuenos Aires) y b) analizar la probabilidad de ocurrencia de sobrepeso y obesidad en relación a las condiciones socioambientales de residencia. Población y métodos. Se relevaron peso y talla de 989 escolares, de ambos sexos, de 3-14 años de edad. Se determinaron S y O según los criterios de la International Obesity Task Force. Las prevalencias fueron comparadas entre sexos y edades. Los datos socioambientales, obtenidos apartir de encuestas, fueron procesados mediante Análisis de Componentes Principales (catPCA). Se empleó un Modelo Lineal Generalizado (link logit) para las variables S y O. Resultados. El 15,8% de los escolares presentó S yel 7,2% O, encontrándose diferencias estadísticas no significativas entre sexos y edades. El primer eje del análisis catPCA, discriminó con valorespositivos los casos que presentaron las mejores condiciones socioambientales y negativos las más desfavorables. Hubo mayor probabilidad de niños obesos asociada a condiciones socioambientalesadecuadas (mayor nivel educativo depadres, mayores ingresos y mejor acceso a servicios públicos), en tanto que se observó mayor probabilidad de niños con sobrepeso asociada a ambientes menos favorecidos. Conclusiones. Se concluye que la población escolar de Brandsen presenta elevadas prevalencias de sobrepeso y obesidad. La probabilidad de presentar sobrepeso es mayor en los niñosprovenientes de hogares con condiciones socioambientalesdesfavorables. La obesidad, en cambio, lo es en aquellos hogares que reúnencondiciones socioambientales favorables.

Introduction. Environmental factors play an important role in the etiology of overweight (S) and obesity (O), constituting the "obesogenic environment”. The objectives of the present study are: a) to estimate overweight and obesity prevalences in 3 to 14 years-old schoolchildrenfrom Brandsen (Provincia de Buenos Aires), and b) to analyze the probability of occurrence of overweight and obesity in relation to the socioenvironmentalconditions of resident. Population and methods. Weight and height were measured in 989 boys and girls aged 3 to 14 years. S and O were estimated following the criteria suggested by the International Obesity Task Force. The prevalences of S and O were compared between genders and ages. The socio-environmental information was gatheredaccording to surveys and processed by Categorical Principal Components Analysis (catPCA). Generalized Linear Model (link logit) against the variables S and O was employed. Results. S was found in 15,8% of schoolchildren and O in 7,2%. None significative statisticsdifferences between both genders and ages, were found. The first axis of the catPCA discriminated the cases that presented better socio-environmental conditions with positive values and those with more unfavorable conditions with negatives values. Higher probability of obese children was associated with better socio-environmental conditions (higher educational level of parents, higherincome and better access to public services), and higher probability of overweight children was associated with less favored environments.Conclusions. The schoolchildren population of Brandsen presents high overweight and obesity prevalences. The chance of presenting overweight is higher in children from householdswith adverse socio-environmental conditions. On the contrary, obese children are to be more found in households which have more favorablesocio-environmental conditions.