Differential trends of admissions in accident and emergency departments during the COVID-19 pandemic in Germany.

BACKGROUND: Recent studies have shown a decrease of admissions to accident and emergency (A&E) departments after the local outbreaks of COVID-19. However, differential trends of admission counts, for example according to diagnosis, are less well understood. This information is crucial to inform targeted intervention. Therefore, we aimed to compare admission counts in German A&E departments before and after 12th march in 2020 with 2019 according to demographic factors and diagnosis groups. METHODS: Routine data of all admissions between 02.12.2019-30.06.2020 and 01.12.2018-30.06.2019 was available from six hospitals in five cities from north-western, eastern, south-eastern, and south-western Germany. We defined 10 diagnosis groups using ICD-10 codes: mental disorders due to use of alcohol (MDA), acute myocardial infarction (AMI), stroke or transient ischemic attack (TIA), heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), cholelithiasis or cholecystitis, back pain, fractures of the forearm, and fractures of the femur. We calculated rate ratios comparing different periods in 12.03.2020-30.06.2020 with 12.03.2019-30.06.2019. RESULTS: Forty-one thousand three hundred fifty-three cases were admitted between 12.03.2020-30.06.2020 and 51,030 cases between 12.03.2019-30.06.2019. Admission counts prior to 12.03. were equal in 2020 and 2019. In the period after 12.03., the decrease of admissions in 2020 compared to 2019 was largest between 26.03. and 08.04. (- 30%, 95% CI - 33% to - 27%). When analysing the entire period 12.03.-30.06., the decrease of admissions was heterogeneous among hospitals, and larger among people aged 0-17 years compared to older age groups. In the first 8 weeks after 12.03., admission counts of all diagnoses except femur fractures and pneumonia declined. Admissions with pneumonia increased in this early period. Between 07.05. and 30.6.2020, we noted that admissions with AMI (+ 13%, 95% CI - 3% to + 32%) and cholelithiasis or cholecystitis (+ 20%, 95% CI + 1% to + 44%) were higher than in 2019. CONCLUSIONS: Our results suggest differential trends of admission counts according to age, location, and diagnosis. An initial decrease of admissions with MDA, AMI, stroke or TIA, heart failure, COPD, cholelithiasis or cholecystitis, and back pain imply delays of emergency care in Germany. Finally, our study suggests a delayed increase of admissions with AMI and cholelithiasis or cholecystitis.

Trajectories of cardio-metabolic health in successful aging.

Maximal oxygen uptake (V̇O2max ) and muscle mass decrease with age. The loss of cardiorespiratory fitness and muscle strength is accelerated with physical inactivity and has well-documented consequences for morbidity and all-cause mortality. Participation in exercise training programs will improve one or more of the cardio-metabolic risk factors, but the long-term effects of such programs are questionable. Here, we re-examined 25 old (72 ± 4 years.) men and women who considered him/herself as "success-full agers" and were participants in a 3-month alpine skiing training program 6 years earlier. The program focused on healthy aging and included health questionnaires, measurement of lipids and glycemic parameters in blood and a VO2max test. Thirteen and 12 subjects were in the intervention (IG) and the control group (CG), respectively. In response to the training program, subjects improved their cardio-metabolic risk factors. However, after 6 years all positive effects had disappeared. Approximately 80% of the subjects had total cholesterol and LDL cholesterol above and HDL cholesterol below the recommended values, but these subjects remained the most metabolically deteriorated, including an increase in fasting glucose concentrations. We conclude that people seem to follow their individual trajectory in terms of cardio-metabolic risk factors, and participation in a relatively short lasting exercise training program with emphasis on healthy aging does not change that. Long-lasting change in lifestyle probably requires a continued attentional focus, goal setting, and feedback.

Effect of aging on muscle and tendon properties in highly functioning elderly people.

This study analyzes long-term changes in muscle strength, muscle architecture, and patellar tendon mechanical properties in a specific sample of physically active elderly people. Twenty-two participants were re-examined from a former 12-week-long skiing intervention study: 11 from the intervention group (IG: 7 ♀, 4 ♂; 67 ± 3 years) and 11 from the control group (CG: 6 ♀, 5 ♂; 66 ± 4 years). Muscle architecture, strength endurance, maximum torque, and tendon properties were analyzed three times within 6 months, and again 6 years later in a follow-up test. No changes in either group could be observed between June 2009 and April 2015 in any parameter. This can be interpreted positively because no age-related decreases were found. Although our participants were physically active from the very beginning (>150 min/wk), it must be noted that the intensity of the physical activity was too low to provoke physiological improvements in leg strength or muscle/tendon morphology.

Aging-related changes in the relationship between the physical self-concept and the physical fitness in elderly individuals.

The paper focuses on long-term changes in parameters of self-perception (ie, physical self-concept, self-esteem, and self-efficacy), physical activity, and its relationship to physical fitness of healthy and active old adults. The sample of 22 physically active and healthy elderly (age Mt1  = 66.00) originates in an earlier skiing intervention study following a longitudinal study design with four time points of measurement over a period of 6 years. Self-reports on physical self-concept (PSK), general self-esteem and self-efficacy, and an activity index were assessed and compared to physical fitness data (VO2max and muscle strength). Significant time effects (over 6 years) were obtained with respect to global physical self-concept, endurance (PSK), and VO2max . Muscle strength turned out to be stable over time. The positive correlations between VO2max and the corresponding self-concept evaluation of endurance abilities diminished across the 6 years. Self-esteem correlated with the PSK scales and VO2max . In contrast to our expectation, self-esteem, self-efficacy, and activity level hardly predicted changes in the PSK scales, VO2max , and physical strength. Although VO2max and some parameters of the physical self-concept declined over the 6 years, results indicate that physical self-concept, self-esteem, self-efficacy, physical fitness, and physical activity display a complex pattern. The decrease in self-perception measured by the correlation of PSK and physical fitness suggests that self-concept of old adults is not sensitive to changes in physical fitness.

Aging-related changes of cognitive performance and stress regulation in high functioning elderly individuals.

This article aims to analyse long-term changes in cognitive performance and psychophysiological stress regulation in a specific sample of 10 young-old (age at pre-test: M ± SD = 63.2 ± 1.5) and 12 old-old (age at pre-test: M ± SD = 69 ± 2) persons possessing a high psychosocial status and a physically active lifestyle. Psychophysiological parameters were recorded prior to, during, and after the administration of a cognitive performance test battery. The measurements took place three times within a 6-month period, and again 6 years later in a follow-up test. Considering practice and habituation effects, findings provide no compelling evidence of an aging-associated cognitive decline in attention, multiple choice reaction performance, and information processing speed, either in the young-olds, or in the old-olds. Furthermore, psychophysiological stress regulation showed no long-term alteration regarding skin conductance level and heart rate. Based on these findings, it is assumed that psychosocial health and physical activity might contribute to the preservation of cognitive abilities and stress regulation into the 70s. Finally, this study demonstrated the significance of considering practice and habituation effects elicited through test repetitions in order to estimate long-term effects.

Aging in high functioning elderly persons: study design and analyses of behavioral and psychological factors.

This article aims to (a) describe the study design of a 6-year follow-up multidisciplinary research project on aging, (b) report the psychosocial characteristics of the sample in detail, and (c) evaluate aging-related changes of health, physical activity, and psychosocial characteristics in 10 young-old (age at pre-test: M ± SD = 63.2 ± 1.5) and 12 old-old (age at pre-test: M ± SD = 69 ± 2) individuals. Both age groups consist of individuals displaying a high health status, a high extent of physical activity, high levels of psychosocial properties in the dimensions of well-being, life satisfaction, self-concept, body image, self-esteem, and self-efficacy, as well as a low general depression index. Psychosocial characteristics demonstrated a stable pattern over a period of nearly 6 years in both age groups with the exceptions of physical activity, satisfaction with children, general depression, and self-efficacy. Furthermore, physical self-concept decreased in old-old adults, whereas the young-olds showed no change. We assume that a high psychosocial status and a physically active lifestyle play an important role for mastering aging successfully in two life phases, each of which has its own challenges for older individuals. The decline in the physical self-concept of old-olds is interpreted as a first sign of subjective aging. Its association with losses in physical performance should be addressed in future studies. Finally, aging-related changes should be monitored on an individual level in order to capture the complex dynamic of aging that is not considered in analyses of between-person differences or averages.

Temporal Dynamics of Varying Physical Loads on Speed and Accuracy of Cognitive Control.

The present study examined the effect of 4 physical-load conditions on interference control throughout a period of 45 min. A sample of 52 sport students was assigned to either a no, a low, an alternating low to moderate, or a moderate physical-load condition. A modified Eriksen-flanker task was administered in the preexercise period, 7 times during the exercise, and twice after completing the exercise. Significant interaction effects of time and condition, and significant time effects within condition on the reaction time of congruent stimuli and errors on incongruent stimuli, suggest a specific in-task effect of the alternating low to moderate and moderate physical-load conditions. Thus, it was concluded that moderate physiological arousal influences interference control by an increase of information-processing speed in tasks that require less cognitive control (congruent condition), which is at the expense of accuracy in cognitively more demanding tasks (incongruent condition).

Impact of maximal physical exertion on interference control and electrocortical activity in well-trained persons.

PURPOSE: The aim of this study was to examine the impact of a maximal physical load on cognitive control in twelve well-trained males focusing on the time course of changes in a 15 min post-exercise interval. METHODS: Prior to and three times after an incremental cycle ergometer task until exhaustion, behavioural performance and neurophysiological correlates using N2 and P3 event-related potentials (ERPs) were assessed during the execution of a modified flanker task. These data were compared to a control condition following the same protocol, however, without physical load between pre-test and post-tests. RESULTS: Regardless of compatibility (congruent, incongruent), behavioural findings revealed a significant interaction of Condition × Time with shorter reaction times in the post-exercise blocks as compared to the control condition. Neuroelectric measures demonstrated exercise induced effects of a reduced central N2 amplitude and shorter parietal P3 latency in the time course of post-exercise flanker blocks as compared to rest. CONCLUSIONS: It is concluded that a state of maximal physical exhaustion facilitates information processing speed in a cognitive control task in well-trained persons. This effect persists even after a recovery period of 15 min. The current findings contribute to a deeper understanding of the neuronal mechanisms of interference control following maximal physical load, suggesting a reduced conflict monitoring as indicated by a reduced N2 amplitude and an increased stimulus classification speed as reflected by P3 latency. The flanker task, however, might have been too simple to elicit monitoring conflicts on the behavioural level.

Individual and team performance in team-handball: a review.

Team handball is a complex sport game that is determined by the individual performance of each player as well as tactical components and interaction of the team. The aim of this review was to specify the elements of team-handball performance based on scientific studies and practical experience, and to convey perspectives for practical implication. Scientific studies were identified via data bases of PubMed, Web of Knowledge, SPORT Discus, Google Scholar, and Hercules. A total of 56 articles met the inclusion criteria. In addition, we supplemented the review with 13 additional articles, proceedings and book sections. It was found that the specific characteristics of team-handball with frequent intensity changes, team-handball techniques, hard body confrontations, mental skills and social factors specify the determinants of coordination, endurance, strength and cognition. Although we found comprehensive studies examining individual performance in team-handball players of different experience level, sex or age, there is a lack of studies, particularly for team-handball specific training, as well as cognition and social factors. Key PointsThe specific characteristics of team-handball with frequent intensity changes, specific skills, hard body confrontations, mental skills and social factors define the determinants of coordination, endurance, strength and cognition.To increase individual and team performance in team-handball specific training based on these determinants have been suggested.Although there are comprehensive studies examining individual performance in team-handball players of different experience level, sex, or age are published, there is a lack of training studies, particularly for team-handball specific techniques and endurance, as well as cognition and social factors.

Affective associations towards running: fuzzy patterns of implicit-explicit interaction in young female runners and non-runners.

Empirical evidence demonstrates that high concordance and low discrepancy of implicit and explicit affective processes facilitate consistent exercise behavior. Novice runners often have difficulties implementing their running behavior on a regular basis resulting in irregular running behavior. To investigate the potential value of affective associations 89 young female runners (regular and irregular) and non-runners were recruited. Affective associations towards running were measured through a Single-Target Implicit Association Test on the implicit level and by self-report on the explicit level. Implicit-explicit interaction (IEI) scores (i.e., implicit-explicit concordance and discrepancy) were derived from principal component analysis. Fuzzy k-means cluster analysis was used to identify patterns of interacting implicit-explicit affective associations. The resulting clusters were assessed for differences in previous running experience, current running behavior, motivational and intentional aspects. Four meaningful overlapping clusters were found and labeled according to their prevalent IEI patterns (i.e., "positive non-discrepant", "positive discrepant", "negative discrepant", "negative non-discrepant"). Significant differences between clusters were found for past running experience, current running behavior, motivational and intentional aspects. The results indicate that running behavior varies between and within patterns of affective associations. In line with previous findings, positive non-discrepant implicit and explicit affective associations are linked to more consistent running behavior, while negative non-discrepant affect is associated with non-runners. However, the occurrence of discrepant implicit-explicit affective associations in young women differing in running behavior, motivation, and intention broadens the view of the complex relationship between affective processes and exercise behavior. In conclusion, individualized interventions that take into account the implicit-explicit interaction of affective associations besides well-known cognitive self-regulatory resources may prove more effective for individuals who struggle to run regularly.

Influence of running on incidental and integral vitality and fatigue: An intensive longitudinal intervention in young Women's daily life.

Exercise intensity and perceived autonomy are important factors for the affective response toward exercise and adherence. Dual-mode theory suggests an inverted-J response curve of affect with increased exercise intensity, but little is known about how different running programs affect the affective response and subsequent incidental affect in daily life. This ambulatory assessment study examines the short- to long-term effects of two 8-week running interventions (affect-based vs. polarized-prescribed) on subjective vitality and perceived fatigue in young female novices. Participants engaged in 3 × 30 minute running sessions weekly in their natural environments and completed electronic diaries three times daily. Autoregressive multilevel models indicate small effects of training intensity on immediate affective subjective vitality (ß = -2.37; p = .03; f2 = 0.02) but negligible non-significant effects on fatigue (ß = 0.26; p = 0.12; f2 = 0.002). Novices experienced increased vitality throughout the day when their running was evaluated positively (ß = 0.23; p = .03; f2 = 0.04), with effects lasting over two days before returning to baseline (ß = -0.26; p < .001; f2 = 0.004). However, no significant long-term effects were observed over 8 weeks in vitality or fatigue. Results indicate between- and within-person variations, but limited sample power does not allow differentiating between programs. This study supports the dual-mode theory and highlights the importance of distinguishing affective response from incidental affect.

Novel application of T1-weighted BLADE sequences with fat suppression compared to TSE in contrast-enhanced T1-weighted imaging of the neck: cutting-edge images?

PURPOSE: To evaluate if the use of BLADE sequences might overcome some limitations of magnetic resonance imaging (MRI) in the extracranial head and neck, which is a diagnostically challenging area with a variety of artifacts and a broad spectrum of potential lesions. MATERIALS AND METHODS: After informed consent and Institutional Review Board approval, two different BLADE sequences with (BLADE IR) and without inversion pulse (BLADE) were compared to turbo-spin echo (TSE) with fat saturation for coronal T1-weighted postcontrast imaging of the extracranial head and neck region in 40 individuals of a routine patient collective. Visual evaluation of image sharpness, motion artifacts, vessel pulsation, contrast of anatomic structures, contrast of pathologies to surrounding tissue as well as BLADE-specific artifacts was performed by two experienced, independent readers. Statistical evaluation was done by using the Wilcoxon test. RESULTS: Both BLADE and BLADE IR were significantly superior to TSE regarding pulsation artifacts and delineation of thoracic structures. TSE provided better results concerning contrast muscle/fat tissue and contrast lymph nodes/fat. More important, it showed significantly better contrast of several lesions, facilitating the detection of patient pathology. CONCLUSION: T1-weighted coronal imaging of the extracranial head and neck region is demanding. T1-weighted BLADE sequences still have drawbacks in anatomical contrast and lesion detection but offer possibilities to achieve reasonable image quality in difficult cases with a variety of artifacts.

Step-adaptive sound guidance enhances locomotor-respiratory coupling in novice female runners: A proof-of-concept study.

Introduction: Many runners struggle to find a rhythm during running. This may be because 20-40% of runners experience unexplained, unpleasant breathlessness at exercise onset. Locomotor-respiratory coupling (LRC), a synchronization phenomenon in which the breath is precisely timed with the steps, may provide metabolic or perceptual benefits to address these limitations. It can also be consciously performed. Hence, we developed a custom smartphone application to provide real-time LRC guidance based on individual step rate. Methods: Sixteen novice-intermediate female runners completed two control runs outdoors and indoors at a self-selected speed with auditory step rate feedback. Then, the runs were replicated with individualized breath guidance at specific LRC ratios. Hexoskin smart shirts were worn and analyzed with custom algorithms to estimate continuous LRC frequency and phase coupling. Results: LRC guidance led to a large significant increase in frequency coupling outdoor from 26.3 ±â€…10.7 (control) to 69.9 ±â€…20.0 % (LRC) "attached". There were similarly large differences in phase coupling between paired trials, and LRC adherence was stronger for the indoor treadmill runs versus outdoors. There was large inter-individual variability in running pace, preferred LRC ratio, and instruction adherence metrics. Discussion: Our approach demonstrates how personalized, step-adaptive sound guidance can be used to support this breathing strategy in novice runners. Subsequent investigations should evaluate the skill learning of LRC on a longer time basis to effectively clarify its risks and advantages.

Acute visual loss after preoperative embolization of an ethmoidal metastasis.

An unintentional embolization of retinal arteries is rare and has been documented as a complication after embolization of arteries supplying head and neck tumors. However, occlusion of the central retinal artery with severe loss of vision has never been reported to be a complication from embolization of tumor-supplying ethmoidal branches of the ophthalmic artery. A 40 year-old male patient with a history of right nephrectomy for renal cell carcinoma underwent preoperative radiological embolization of an ethmoidal metastasis after having experienced a life-threatening sinus bleeding. Repeated probing of the ophthalmic artery with an endovascular microcatheter for particle embolization of the tumor-supplying arteries was performed under anticoagulation with heparin. Postoperatively, a standard ophthalmological examination including extended vascular evaluation by angiography was performed. After extended probing of the ophthalmic artery a marked reduction in its blood flow occurred. Despite post-interventional imaging showing persisting perfusion of the central retinal and ciliary arteries, the patient developed complete loss of vision on this side four days later. At this time fundoscopy and fluorescein angiography revealed a recanalized central artery occlusion, while indocyanin angiography showed infarctions of the choroid. Radiological intervention via the ophthalmic artery can result in complete loss of vision, even after limited and transient obstruction of the vessel.

Breath Tools: A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running.

Running is among the most popular sporting hobbies and often chosen specifically for intrinsic psychological benefits. However, up to 40% of runners may experience exercise-induced dyspnoea as a result of cascading physiological phenomena, possibly causing negative psychological states or barriers to participation. Breathing techniques such as slow, deep breathing have proven benefits at rest, but it is unclear if they can be used during exercise to address respiratory limitations or improve performance. While direct experimental evidence is limited, diverse findings from exercise physiology and sports science combined with anecdotal knowledge from Yoga, meditation, and breathwork suggest that many aspects of breathing could be improved via purposeful strategies. Hence, we sought to synthesize these disparate sources to create a new theoretical framework called "Breath Tools" proposing breathing strategies for use during running to improve tolerance, performance, and lower barriers to long-term enjoyment.

The modified German subjective vitality scale (SVS-GM): Psychometric properties and application in daily life.

Subjective vitality describes the positive feeling of experiencing physical and mental energy, which can lead to purposive actions, but no German instruments exist with action-oriented verbiage: This work supports the development and modification of already existing German Subjective Vitality Scales and provides further evidence for its psychometric properties. In a first step (N = 56) two modified (action-oriented) short-forms were developed. An extension of time perspectives (past, present, future) should also enrich the scale by enhancing the accuracy of self-reports. Study 1 (N = 183) then examined the psychometric properties for each time perspective. Study 2 (N = 27) was a 6-day diary study to identify the reliability of within- and between-person differences in vitality over time and working days with responses recorded three times per day. The exploratory factor analysis from study 1 revealed a three-factor solution with three items each. Test-retest reliability was moderate for the past and future time perspective and less stable for state subjective vitality. The modified German Subjective Vitality Scale (SVS-GM) showed divergent validity with fatigue, negative affect, and optimism, and convergent but distinguishable validity with life satisfaction, positive affect, and perceived self-efficacy. High reliability for daily vitality measures (with lower vitality rates in the morning) was found in study 2, but no substantial variation was found between working days and days off. The SVS-GM shows good psychometric properties in different settings and provides researchers with a 3-item (for cross-sectional or longitudinal studies) and 1-item (for short screenings) version to measure subjective vitality in German-speaking populations.

Effects of physical stress in alpine skiing on psychological, physiological, and biomechanical parameters: An individual approach.

Alpine skiing is an attractive winter sport that often includes mental and physical demands. Since skiing is often done for several hours, fatigue processes occur that might lead to action errors associated with a higher risk of accidents and injuries. The aim of this study was to investigate the timing of changes in subjective, physiological, and biomechanical parameters during a physically demanding, standardized, non-competitive alpine skiing session. A group of 22 experienced male skiers carried out 10 runs, each lasting between 150 and 180 s, at a turn rate of 80 turns per minute with their best skiing technique. Immediately after the run, skiers reported ratings of fatigue, and other affective states. During skiing, breathing pattern and biomechanical data of the ski turns as radial force, turn duration, edge angle symmetry, and a composed motion quality score were recorded. Analyses of variances on skiers showing signs of fatigue (n =16) revealed that only the subjective data changed significantly over time: fatigue and worry increased, vitality and calm decreased. Subsequently, individual change points analyses were computed to localize abrupt distribution or statistical changes in time series data. For some skiers, abrupt changes at certain runs in physiological and/or biomechanical parameters were observed in addition to subjective data. The results show general effects in subjective data, and individual fatigue-related patterns concerning the onset of changes in subjective, physiological, and biomechanical parameters. Individuality of response to fatigue should be considered when studying indicators of fatigue data. Based on the general effects in subjective data, it is concluded that focusing on self-regulation and self-awareness may play a key role, as subjective variables have been shown generally sensitive to the physical stress in alpine skiing. In the future, customized algorithms that indicate the onset of fatigue could be developed to improve alpine skiers' self-awareness and self-regulation, potentially leading to fewer action errors.

The Salzburg 10/7 HIIT shock cycle study: the effects of a 7-day high-intensity interval training shock microcycle with or without additional low-intensity training on endurance performance, well-being, stress and recovery in endurance trained athletes-study protocol of a randomized controlled trial.

BACKGROUND: Performing multiple high-intensity interval training (HIIT) sessions in a compressed period of time (approximately 7-14 days) is called a HIIT shock microcycle (SM) and promises a rapid increase in endurance performance. However, the efficacy of HIIT-SM, as well as knowledge about optimal training volumes during a SM in the endurance-trained population have not been adequately investigated. This study aims to examine the effects of two different types of HIIT-SM (with or without additional low-intensity training (LIT)) compared to a control group (CG) on key endurance performance variables. Moreover, participants are closely monitored for stress, fatigue, recovery, and sleep before, during and after the intervention using innovative biomarkers, questionnaires, and wearable devices. METHODS: This is a study protocol of a randomized controlled trial that includes the results of a pilot participant. Thirty-six endurance trained athletes will be recruited and randomly assigned to either a HIIT-SM (HSM) group, HIIT-SM with additional LIT (HSM + LIT) group or a CG. All participants will be monitored before (9 days), during (7 days), and after (14 days) a 7-day intervention, for a total of 30 days. Participants in both intervention groups will complete 10 HIIT sessions over 7 consecutive days, with an additional 30 min of LIT in the HSM + LIT group. HIIT sessions consist of aerobic HIIT, i.e., 5 × 4 min at 90-95% of maximal heart rate interspersed by recovery periods of 2.5 min. To determine the effects of the intervention, physiological exercise testing, and a 5 km time trial will be conducted before and after the intervention. RESULTS: The feasibility study indicates good adherence and performance improvement of the pilot participant. Load monitoring tools, i.e., biomarkers and questionnaires showed increased values during the intervention period, indicating sensitive variables. CONCLUSION: This study will be the first to examine the effects of different total training volumes of HIIT-SM, especially the combination of LIT and HIIT in the HSM + LIT group. In addition, different assessments to monitor the athletes' load during such an exhaustive training period will allow the identification of load monitoring tools such as innovative biomarkers, questionnaires, and wearable technology. TRIAL REGISTRATION: clinicaltrials.gov, NCT05067426. Registered 05 October 2021-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT05067426 . Protocol Version Issue date: 1 Dec 2021. Original protocol. Authors: TLS, NH.

COVID-19 in 28-Week Triplets Caused by Intrauterine Transmission of SARS-CoV-2-Case Report.

Since the beginning of the COVID-19 pandemic, in-utero transmission of SARS-CoV-2 remains a rarity and only very few cases have been proven across the world. Here we depict the clinical, laboratory and radiologic findings of preterm triplets born at 28 6/7 weeks to a mother who contracted COVID-19 just 1 week before delivery. The triplets showed SARS-CoV-2 positivity right after birth, developed significant leukopenia and early-onset pulmonary interstitial emphysema. The most severely affected triplet I required 10 days of high-frequency oscillatory ventilation due to failure of conventional invasive ventilation, and circulatory support for 4 days. Despite a severe clinical course in two triplets (triplet I and II), clinical management without experimental, targeted antiviral drugs was successful. At discharge home, the triplets showed no signs of neurologic or pulmonary sequelae. Placental immunohistology with SARS-CoV-2 N-protein localized strongly to syncytiotrophoblast cells and, to a lesser extent, to fetal Hofbauer cells, proving intrauterine virus transmission. We discuss the role of maternal viremia as a potential risk factor for vertical transmission. To the best of our knowledge, our report presents the earliest unequivocally confirmed prenatal virus transmission in long-term surviving children, i.e., at the beginning of the third trimester.