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1. Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital
Fink, Thais T. ; Marques, Heloisa H.S. ; Gualano, Bruno ; Lindoso, Livia ; Bain, Vera ; Astley, Camilla ; Martins, Fernanda ; Matheus, Denise ; Matsuo, Olivia M. ; Suguita, Priscila ; Trindade, Vitor ; Paula, Camila S.Y. ; Farhat, Sylvia C.L. ; Palmeira, Patricia ; Leal, Gabriela N. ; Suzuki, Lisa ; Odone Filho, Vicente ; Carneiro-Sampaio, Magda ; Duarte, Alberto José S. ; Antonangelo, Leila ; Batisttella, Linamara R. ; Polanczyk, Guilherme V. ; Pereira, Rosa Maria R. ; Carvalho, Carlos Roberto R. ; Buchpiguel, Carlos A. ; Latronico, Ana Claudia ; Seelaender, Marilia ; Silva, Clovis Artur ; Pereira, Maria Fernanda B. ; Sallum, Adriana M. E. ; Brentani, Alexandra V. M. ; Neto, Álvaro José S. ; Ihara, Amanda ; Santos, Andrea R. ; Canton, Ana Pinheiro M. ; Watanabe, Andreia ; Santos, Angélica C. dos ; Pastorino, Antonio C. ; Franco, Bernadette D. G. M. ; Caruzo, Bruna ; Ceneviva, Carina ; Martins, Carolina C. M. F. ; Prado, Danilo ; Abellan, Deipara M. ; Benatti, Fabiana B. ; Smaria, Fabiana ; Gonçalves, Fernanda T. ; Penteado, Fernando D. ; Castro, Gabriela S. F. de ; Gonçalves, Guilherme S. ; Roschel, Hamilton ; Disi, Ilana R. ; Marques, Isabela G. ; Castro, Inar A. ; Buscatti, Izabel M. ; Faiad, Jaline Z. ; Fiamoncini, Jarlei ; Rodrigues, Joaquim C. ; Carneiro, Jorge D. A. ; Paz, Jose A. ; Ferreira, Juliana C. ; Ferreira, Juliana C. O. ; Silva, Katia R. ; Bastos, Karina L. M. ; Kozu, Katia ; Cristofani, Lilian M. ; Souza, Lucas V. B. ; Campos, Lucia M. A. ; Silva Filho, Luiz Vicente R. F. ; Sapienza, Marcelo T. ; Lima, Marcos S. ; Garanito, Marlene P. ; Santos, Márcia F. A. ; Dorna, Mayra B. ; Aikawa, Nadia E. ; Litvinov, Nadia ; Sakita, Neusa K. ; Gaiolla, Paula V. V. ; Pasqualucci, Paula ; Toma, Ricardo K. ; Correa-Silva, Simone ; Sieczkowska, Sofia M. ; Imamura, Marta ; Forsait, Silvana ; Santos, Vera A. ; Zheng, Yingying .
OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19.
2. Differences in children and adolescents with SARS-CoV-2 infection: a cohort study in a Brazilian tertiary referral hospital
Marques, Heloisa Helena de Sousa ; Pereira, Maria Fernanda Badue ; Santos, Angélica Carreira dos ; Fink, Thais Toledo ; Paula, Camila Sanson Yoshino de ; Litvinov, Nadia ; Schvartsman, Claudio ; Delgado, Artur Figueiredo ; Gibelli, Maria Augusta Bento Cicaroni ; Carvalho, Werther Brunow de ; Odone Filho, Vicente ; Tannuri, Uenis ; Carneiro-Sampaio, Magda ; Grisi, Sandra ; Duarte, Alberto José da Silva ; Antonangelo, Leila ; Francisco, Rossana Pucineli Vieira ; Okay, Thelma Suely ; Batisttella, Linamara Rizzo ; Carvalho, Carlos Roberto Ribeiro de ; Brentani, Alexandra Valéria Maria ; Silva, Clovis Artur ; Eisencraft, Adriana Pasmanik ; Rossi Junior, Alfio ; Fante, Alice Lima ; Cora, Aline Pivetta ; Reis, Amelia Gorete A. de Costa ; Ferrer, Ana Paula Scoleze ; Andrade, Anarella Penha Meirelles de ; Watanabe, Andreia ; Gonçalves, Angelina Maria Freire ; Waetge, Aurora Rosaria Pagliara ; Silva, Camila Altenfelder ; Ceneviva, Carina ; Lazari, Carolina dos Santos ; Abellan, Deipara Monteiro ; Santos, Emilly Henrique dos ; Sabino, Ester Cerdeira ; Bianchini, Fabíola Roberta Marim ; Alcantara, Flávio Ferraz de Paes ; Ramos, Gabriel Frizzo ; Leal, Gabriela Nunes ; Rodriguez, Isadora Souza ; Pinho, João Renato Rebello ; Carneiro, Jorge David Avaizoglou ; Paz, Jose Albino ; Ferreira, Juliana Carvalho ; Ferranti, Juliana Ferreira ; Ferreira, Juliana de Oliveira Achili ; Framil, Juliana Valéria de Souza ; Silva, Katia Regina da ; Kanunfre, Kelly Aparecida ; Bastos, Karina Lucio de Medeiros ; Galleti, Karine Vusberg ; Cristofani, Lilian Maria ; Suzuki, Lisa ; Campos, Lucia Maria Arruda ; Perondi, Maria Beatriz de Moliterno ; Diniz, Maria de Fatima Rodrigues ; Fonseca, Maria Fernanda Mota ; Cordon, Mariana Nutti de Almeida ; Pissolato, Mariana ; Peres, Marina Silva ; Garanito, Marlene Pereira ; Imamura, Marta ; Dorna, Mayra de Barros ; Luglio, Michele ; Rocha, Mussya Cisotto ; Aikawa, Nadia Emi ; Degaspare, Natalia Viu ; Sakita, Neusa Keico ; Udsen, Nicole Lee ; Scudeller, Paula Gobi ; Gaiolla, Paula Vieira de Vincenzi ; Severini, Rafael da Silva Giannasi ; Rodrigues, Regina Maria ; Toma, Ricardo Katsuya ; Paula, Ricardo Iunis Citrangulo de ; Palmeira, Patricia ; Forsait, Silvana ; Farhat, Sylvia Costa Lima ; Sakano, Tânia Miyuki Shimoda ; Koch, Vera Hermina Kalika ; Cobello Junior, Vilson .
OBJECTIVES: To compare demographic/clinical/laboratory/treatments and outcomes among children and adolescents with laboratory-confirmed coronavirus disease 2019 (COVID-19). METHODS: This was a cross-sectional study that included patients diagnosed with pediatric COVID-19 (aged <18 years) between April 11, 2020 and April 22, 2021. During this period, 102/5,951 (1.7%) of all admissions occurred in neonates, children, and adolescents. Furthermore, 3,962 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection samples were processed in patients aged <18 years, and laboratory-confirmed COVID-19 occurred in 155 (4%) inpatients and outpatients. Six/155 pediatric patients were excluded from the study. Therefore, the final group included 149 children and adolescents (n=97 inpatients and 52 outpatients) with positive SARS-CoV-2 results. RESULTS: The frequencies of sore throat, anosmia, dysgeusia, headache, myalgia, nausea, lymphopenia, pre-existing chronic conditions, immunosuppressive conditions, and autoimmune diseases were significantly reduced in children and adolescents (p<0.05). Likewise, the frequencies of enoxaparin use (p=0.037), current immunosuppressant use (p=0.008), vasoactive agents (p=0.045), arterial hypotension (p<0.001), and shock (p=0.024) were significantly lower in children than in adolescents. Logistic regression analysis showed that adolescents with laboratory-confirmed COVID-19 had increased odds ratios (ORs) for sore throat (OR 13.054; 95% confidence interval [CI] 2.750-61.977; p=0.001), nausea (OR 8.875; 95% CI 1.660-47.446; p=0.011), and lymphopenia (OR 3.575; 95% CI 1.355-9.430; p=0.010), but also had less hospitalizations (OR 0.355; 95% CI 0.138-0.916; p=0.032). The additional logistic regression analysis on patients with preexisting chronic conditions (n=108) showed that death as an outcome was significantly associated with pediatric severe acute respiratory syndrome (SARS) (OR 22.300; 95% CI 2.341-212.421; p=0.007) and multisystem inflammatory syndrome in children (MIS-C) (OR 11.261; 95% CI 1.189-106. 581; p=0.035). CONCLUSIONS: Half of the laboratory-confirmed COVID-19 cases occurred in adolescents. Individuals belonging to this age group had an acute systemic involvement of SARS-CoV-2 infection. Pediatric SARS and MIS-C were the most important factors associated with the mortality rate in pediatric chronic conditions with COVID-19.
3. Prevalence of anti-SARS-CoV-2 antibodies in outpatients of a large public university hospital in Sao Paulo, Brazil
Oliveira, Luanda Mara da Silva ; Tiyo, Bruna Tiaki ; Silva, Lais Teodoro da ; Fonseca, Luiz Augusto Marcondes ; Rocha, Rosana Coura ; Santos, Vera Aparecida dos ; Ceneviva, Carina ; Bedin, Anderson Aparecido ; Almeida, Alexandre de ; Duarte, Alberto José da Silva ; Oshiro, Telma Miyuki .
Revista do Instituto de Medicina Tropical de São Paulo 2020, Volume 62 elocation e91
ABSTRACT Coronavirus disease 19 (COVID-19) is caused by SARS-Cov-2 and the manifestations of this infection range from an absence of symptoms all the way up to severe disease leading to death. To estimate the prevalence of past infection in a population, the most readily available method is the detection of antibodies against the virus. This study has investigated the prevalence of anti-SARS-CoV-2 antibodies in outpatients of the Hospital das Clinicas, in Sao Paulo city (Brazil), which is a large university hospital belonging to the public health system that cares for patients with complex diseases who need tertiary or quaternary medical care. Our serological inquiry was carried out for 6 weeks, with once-a-week blood sampling and included 439 patients from several outpatient services. Overall, 61 patients tested positive for anti-SARS-CoV-2 IgG (13.9%); 56.1 % of the patients live in Sao Paulo city, with the remaining living in other towns of the metropolitan area; 32.8% of the patients testing positive for IgG antibodies to SARS-CoV-2 were asymptomatic, 55.7% developed mild or moderate disease and 11.5% had to be hospitalized. The prevalence of SARS-CoV-2 positive serology was lower among patients who had received the seasonal influenza vaccine compared to the ones who did not. These findings may indicate that those individuals care more about health issues, and/or that they have a better access to health care and/or a better quality of health care service. The large proportion of patients who were unaware of having had contact with SARS-CoV-2 deserves attention, reflecting the scarcity of tests performed in the population.
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