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Brodosi L, Stecchi M, Mita D, Marchignoli F, Guarneri V, Agnelli G, Osti V, Perazza F, Sacilotto F, Pession A, Pironi L. Symptoms of SARS-CoV-2 infection and vaccine status of sixty-seven adult patients affected by inherited metabolic diseases: a phone survey. Orphanet J Rare Dis 2023; 18:286. [PMID: 37700355 PMCID: PMC10496155 DOI: 10.1186/s13023-023-02905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND The Covid pandemic seems to have had several detrimental effects on managing patients affected by inherited metabolic diseases (IMD), although published data about the impact of COVID-19 on patients suffering from IMD are very scarce. The scope of our work was to evaluate adherence to the vaccination plan, the side effects experienced by our adult IMD patients, and the symptoms of the SARS-CoV-2 infection. RESULTS Sixty-seven patients agreed to respond to a phone interview. The mean age was 36.5 (± 11.6 SD). Regarding the vaccination campaign, fifty-five patients (82%) joined it, of whom ten had received two doses and the remaining forty-five, three. Forty-two patients (76%) reported adverse events following vaccination, the most frequent being local reaction, fever, and asthenia, which lasted an average of two days and resolved without sequelae. Regarding SARS-CoV-2 infection, twenty-seven out of sixty-seven patients (40%) tested positive for the virus; seven of them were not vaccinated at the time of infection; on the other hand, twenty had already had at least two doses. Regarding the prevalence of long-Covid, as many as 12 patients (44%) reported symptoms that persisted after the nasopharyngeal swab tested negative and lasted an average of 81 (± 74 SD) days. There were no statistically significant differences in BMI of patients who contracted the infection and patients who did not (25.15 vs. 25.20, p = .861), between those who had adverse reactions to the vaccine and those who did not (24.40 vs. 25.75, p = .223), between those who had long-Covid and those who did not (25.9 vs. 27.7, p = .183). No relation was observed between metabolic inherited disease, SARS-CoV-2 infection symptoms and adverse vaccine reactions. CONCLUSIONS The data indicate that IMD patients adhered to the vaccination campaign comparably to the general Italian population. Adverse events to the vaccine were negligible. SARS-CoV-2 infection, which occurred in most cases after receiving at least two doses of the vaccine, did not cause serious symptoms and never required hospitalisation. A non-negligible share of patients suffered from long-Covid symptoms.
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Affiliation(s)
- Lucia Brodosi
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy.
- Clinical Nutriti on and Metabolism Unit, IRCCS AOUBO, Via Albertoni, 15, Bologna, 40138, Italy.
| | - Michele Stecchi
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Dorina Mita
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Francesca Marchignoli
- Clinical Nutriti on and Metabolism Unit, IRCCS AOUBO, Via Albertoni, 15, Bologna, 40138, Italy
| | - Valeria Guarneri
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Giulio Agnelli
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Valentino Osti
- Department of Public Health, Azienda USL di Bologna, Via Gramsci, 12, Bologna, 40121, Italy
| | - Federica Perazza
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Federica Sacilotto
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
- Pediatric Unit, IRCCS AOUBO, Via Albertoni, 15, Bologna, 40138, Italy
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Via Zamboni, 33, Bologna, 40126, Italy
- Clinical Nutriti on and Metabolism Unit, IRCCS AOUBO, Via Albertoni, 15, Bologna, 40138, Italy
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2
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Zuñiga Vinueza AM. Recent Advances in Phenylketonuria: A Review. Cureus 2023; 15:e40459. [PMID: 37456395 PMCID: PMC10349532 DOI: 10.7759/cureus.40459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/18/2023] Open
Abstract
This article highlights the significance of inborn errors of metabolism and focuses specifically on phenylketonuria (PKU), a well-known inheritance disorder caused by the deficiency or absence of phenylalanine hydroxylase (PAH). This review discusses associated mutations in the PAH gene and their impact on phenylalanine metabolism. A total of 40 articles were analyzed between 2019 and 2023, covering diagnostic innovations, advancements in treatment and management strategies, and the long-term implications of PKU. This study emphasizes the importance of early diagnosis and highlights the ongoing need for advancements in screening methods and treatment approaches to optimize patient outcomes in PKU patients. This review provides valuable insights for healthcare professionals involved in the care of children with PKU and contributes to the enhancement of clinical practice in this field.
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Mlinaric M, Bonham JR, Kožich V, Kölker S, Majek O, Battelino T, Torkar AD, Koracin V, Perko D, Remec ZI, Lampret BR, Scarpa M, Schielen PCJI, Zetterström RH, Groselj U. Newborn Screening in a Pandemic-Lessons Learned. Int J Neonatal Screen 2023; 9:ijns9020021. [PMID: 37092515 PMCID: PMC10123726 DOI: 10.3390/ijns9020021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023] Open
Abstract
The COVID-19 pandemic affected many essential aspects of public health, including newborn screening programs (NBS). Centers reported missing cases of inherited metabolic disease as a consequence of decreased diagnostic process quality during the pandemic. A number of problems emerged at the start of the pandemic, but from the beginning, solutions began to be proposed and implemented. Contingency plans were arranged, and these are reviewed and described in this article. Staff shortage emerged as an important issue, and as a result, new work schedules had to be implemented. The importance of personal protective equipment and social distancing also helped avoid disruption. Staff became stressed, and this needed to be addressed. The timeframe for collecting bloodspot samples was adapted in some cases, requiring reference ranges to be modified. A shortage of essential supplies and protective equipment was evident, and laboratories described sharing resources in some situations. The courier system had to be adapted to make timely and safe transport possible. Telemedicine became an essential tool to enable communication with patients, parents, and medical staff. Despite these difficulties, with adaptations and modifications, some centers evaluated candidate conditions, continued developments, or began new NBS. The pandemic can be regarded as a stress test of the NBS under real-world conditions, highlighting critical aspects of this multidisciplinary system and the need for establishing local, national, and global strategies to improve its robustness and reliability in times of shortage and overloaded national healthcare systems.
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Affiliation(s)
- Matej Mlinaric
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, UMC Ljubljana, Bohoričeva Ulica 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - James R Bonham
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands
- Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield S10 2TH, UK
| | - Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University-First Faculty of Medicine, and General University Hospital in Prague, Ke Karlovu 455/2, 128 08 Praha, Czech Republic
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Center for Child and Adolescent Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Ondrej Majek
- National Screening Centre, Institute of Health Information & Statistics of the Czech Republic, 128 01 Prague, Czech Republic
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, UMC Ljubljana, Bohoričeva Ulica 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Ana Drole Torkar
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, UMC Ljubljana, Bohoričeva Ulica 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
| | - Vanesa Koracin
- Department of Dermatovenerology, General Hospital Novo Mesto, 8000 Novo Mesto, Slovenia
| | - Dasa Perko
- Clinical Institute for Special Laboratory Diagnostics, University Children's Hospital, UMC Ljubljana, 1000 Ljubljana, Slovenia
| | - Ziga Iztok Remec
- Clinical Institute for Special Laboratory Diagnostics, University Children's Hospital, UMC Ljubljana, 1000 Ljubljana, Slovenia
| | - Barbka Repic Lampret
- Clinical Institute for Special Laboratory Diagnostics, University Children's Hospital, UMC Ljubljana, 1000 Ljubljana, Slovenia
| | - Maurizio Scarpa
- Regional Coordinating Center for Rare Diseases, European Reference Network for Hereditary Metabolic Diseases (MetabERN), Udine University Hospital, Piazzale Santa Maria Della Misericordia 15, 33100 Udine, Italy
| | - Peter C J I Schielen
- Office of the International Society for Neonatal Screening, Reigerskamp 273, 3607 HP Maarssen, The Netherlands
| | - Rolf H Zetterström
- Center for Inherited Metabolic Diseases, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 141 86 Stockholm, Sweden
| | - Urh Groselj
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, UMC Ljubljana, Bohoričeva Ulica 20, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov Trg 2, 1000 Ljubljana, Slovenia
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Niederau C, Regenbogen C, Fruehauf HM, Merkel M, Ziagaki A, Mengel E, Baerwald C, Muschol N, Staufner C, Lampe C, Gillessen A, Koehler JP, Vom Dahl S. Management, vaccination status and COVID-19 morbidity of patients with Gaucher disease in Germany during the COVID-19 pandemic. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:375-380. [PMID: 37040780 DOI: 10.1055/a-1821-9009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND Continuation of standard management of Gaucher disease (GD) has been challenging during the COVID-19 pandemic, resulting in infrequent/missed infusions and follow-up appointments. Little data are available on the consequences of these changes and on the SARS-CoV-2 vaccinations in German GD patients. METHODS A survey with 22 questions about GD management during the pandemic was sent to 19 German Gaucher centres. It was answered by 11/19 centres caring for 257 GD patients (almost ¾ of the German GD population); 245 patients had type 1 and 12 had type 3 GD; 240 were ≥ 18 years old. RESULTS Monitoring intervals were prolonged in 8/11 centres from a median of 9 to 12 months. Enzyme replacement therapy (ERT) was changed to home ERT in 4 patients and substituted by oral substrate reduction therapy (SRT) in 6 patients. From March 2020 to October 2021, no serious complications of GD were documented. Only 4 SARS-CoV-2 infections were reported (1.6%). Two infections were asymptomatic and two mild; all occurred in adult type 1, non-splenectomized patients on ERT. Vaccination rate in adult GD was 79.5% (95.3% mRNA vaccines). Serious vaccination complications were not reported. CONCLUSIONS The COVID-19 pandemic has lowered the threshold for switching from practice- or hospital-based ERT to home therapy or to SRT. No major GD complication was documented during the pandemic. Infection rate with SARS-CoV-2 in GD may rather be lower than expected, and its severity is mild. Vaccination rates are high in GD patients and vaccination was well tolerated.
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Affiliation(s)
| | - Claudia Regenbogen
- Department of Nephrology, Technical University of Munich, School of Medicine, München, Germany
| | - Hans-Martin Fruehauf
- Klinik f. Innere Medizin und Geriatrie, AMEOS Klinikum St. Marien, Oberhausen, Germany
| | | | - Athanasia Ziagaki
- Medizinische Klinik f. Endokrinologie und Stoffwechselmedizin, Charité Campus Virchow, Berlin, Germany
| | - Eugen Mengel
- Clinical Science for LSD, SphinCS, Hochheim, Germany
| | - Christoph Baerwald
- Klinik f. Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Nicole Muschol
- Department of Pediatrics, International Center for Lysosomal Disorders (ICLD), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Staufner
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Christina Lampe
- Zentrum für seltene Erkrankungen Gießen (ZSEGI), Abteilung Kinderneurologie, Sozialpädiatrie u. Epileptologie. Zentrum Kinderheilkunde u. Jugendmedizin, Univ.-Klinikum Giessen/Marburg; Standort Giessen, Giessen, Germany
| | - Anton Gillessen
- Klinik für Innere Medizin, Herz-Jesu-Krankenhaus Hiltrup GmbH, Münster-Hiltrup, Germany
| | - Jan Philipp Koehler
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Stephan Vom Dahl
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Mütze U, Gleich F, Barić I, Baumgartner M, Burlina A, Chapman KA, Chien Y, Cortès‐Saladelafont E, De Laet C, Dobbelaere D, Eysken F, Gautschi M, Santer R, Häberle J, Joaquín C, Karall D, Lindner M, Lund AM, Mühlhausen C, Murphy E, Roland D, Ruiz Gomez A, Skouma A, Grünert SC, Wagenmakers M, Garbade SF, Kölker S, Boy N. Impact of the SARS-CoV-2 pandemic on the health of individuals with intoxication-type metabolic diseases-Data from the E-IMD consortium. J Inherit Metab Dis 2023; 46:220-231. [PMID: 36266255 PMCID: PMC9874390 DOI: 10.1002/jimd.12572] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023]
Abstract
The SARS-CoV-2 pandemic challenges healthcare systems worldwide. Within inherited metabolic disorders (IMDs) the vulnerable subgroup of intoxication-type IMDs such as organic acidurias (OA) and urea cycle disorders (UCD) show risk for infection-induced morbidity and mortality. This study (observation period February 2020 to December 2021) evaluates impact on medical health care as well as disease course and outcome of SARS-CoV-2 infections in patients with intoxication-type IMDs managed by participants of the European Registry and Network for intoxication type metabolic diseases Consortium (E-IMD). Survey's respondents managing 792 patients (n = 479 pediatric; n = 313 adult) with intoxication-type IMDs (n = 454 OA; n = 338 UCD) in 14 countries reported on 59 (OA: n = 36; UCD: n = 23), SARS-CoV-2 infections (7.4%). Medical services were increasingly requested (95%), mostly alleviated by remote technologies (86%). Problems with medical supply were scarce (5%). Regular follow-up visits were reduced in 41% (range 10%-50%). Most infected individuals (49/59; 83%) showed mild clinical symptoms, while 10 patients (17%; n = 6 OA including four transplanted MMA patients; n = 4 UCD) were hospitalized (metabolic decompensation in 30%). ICU treatment was not reported. Hospitalization rate did not differ for diagnosis or age group (p = 0.778). Survival rate was 100%. Full recovery was reported for 100% in outpatient care and 90% of hospitalized individuals. SARS-CoV-2 impacts health care of individuals with intoxication-type IMDs worldwide. Most infected individuals, however, showed mild symptoms and did not require hospitalization. SARS-CoV-2-induced metabolic decompensations were usually mild without increased risk for ICU treatment. Overall prognosis of infected individuals is very promising and IMD-specific or COVID-19-related complications have not been observed.
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Affiliation(s)
- Ulrike Mütze
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Florian Gleich
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Ivo Barić
- University of Zagreb, School of Medicine and Department of PediatricsUniversity Hospital Center ZagrebZagrebCroatia
| | - Mathias Baumgartner
- University Children's Hospital and Children's Research Center, University of ZurichZurichSwitzerland
| | - Alberto Burlina
- Division of Inherited Metabolic DiseaseUniversity Hospital PadovaPadovaItaly
| | | | - Yin‐Hsiu Chien
- Department of Medical Genetics and PediatricsNational Taiwan University HospitalTaipeiTaiwan
| | - Elisenda Cortès‐Saladelafont
- University Hospital Germans Trias i Pujol, Department of Paediatrics, Unit of Inherited Metabolic Diseases and NeuropediatricsUniversitat Autònoma de BarcelonaBadalonaSpain
| | - Corinne De Laet
- Hôpital Universitaire des Enfants Reine Fabiola‐Université Libre de BruxellesBrusselsBelgium
| | - Dries Dobbelaere
- Medical Reference Center for Inherited Metabolic DiseasesJeanne de Flandre University Hospital and RADEME Research Team for Rare Metabolic and Developmental Diseases, CHRU LilleLilleFrance
| | - Francois Eysken
- Department of Pediatric Inherited Metabolic DiseasesUniversity Hospital of Antwerp UZAAntwerpBelgium
| | - Matthias Gautschi
- Department of Paediatrics, Division of Paediatric Endocrinology, Diabetology and Metabolism, InselspitalUniversity Hospital BernBernSwitzerland
| | - Rene Santer
- University Children's Hospital, University Medical Centre Hamburg‐EppendorfHamburgGermany
| | - Johannes Häberle
- University Children's Hospital and Children's Research Center, University of ZurichZurichSwitzerland
| | - Clara Joaquín
- Endocrinology and Nutrition DepartmentHospital Universitari Germans Trias i PujolBadalonaSpain
| | - Daniela Karall
- Clinic for PediatricsMedical University of InnsbruckInnsbruckAustria
| | - Martin Lindner
- Goethe University Frankfurt/Main, Uni.‐Children's HospitalFrankfurt/MainGermany
| | - Allan M. Lund
- Centre Inherited Metabolic Diseases, Departments of Paediatrics and Clinical GeneticsCopenhagen University HospitalCopenhagenDenmark
| | - Chris Mühlhausen
- Universitätsmedizin Göttingen, Georg‐August‐UniversitätGöttingenGermany
| | - Elaine Murphy
- National Hospital for Neurology and Neurosurgery, Charles Dent Metabolic UnitLondonUK
| | - Dominique Roland
- Institute of Pathology and Human Genetics (IPG)CharleroisBelgium
| | | | - Anastasia Skouma
- Institouto Ygeias Tou Paidiou, Institute of Child HealthAthensGreece
| | - Sarah C. Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical CentreUniversity of Freiburg, Faculty of MedicineFreiburgGermany
| | | | - Sven F. Garbade
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Stefan Kölker
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
| | - Nikolas Boy
- Centre for Child and Adolescent Medicine, Division of Neuropaediatrics and Metabolic Medicine, Department of General PaediatricsUniversity Hospital HeidelbergHeidelbergGermany
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Tummolo A, Dicintio A, Paterno G, Carella R, Melpignano L, De Giovanni D. COVID-19 Vaccine in Inherited Metabolic Disorders Patients: A Cross-Sectional Study on Rate of Acceptance, Safety Profile and Effect on Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12227. [PMID: 36231528 PMCID: PMC9566545 DOI: 10.3390/ijerph191912227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Vaccines for COVID-19 have had a significant impact on the spread of COVID-19 infection, reducing the incidence and mortality of the infection in several countries. However, hesitancy toward this vaccine is a global health issue for the general population The Vaccine acceptance rate among patients affected with inherited metabolic disorders (IMD), as well as safety profile, has not been described. METHODS We conducted a cross-sectional study, based on a telephone survey, investigating the COVID-19 vaccination rate, the incidence and type of adverse effects (AEs), the reasons for vaccine refusal and the effects on the underlying disease in a cohort of IMD patients followed at a single center and invited directly to vaccination by specialistic team. RESULTS Seventy-four patients were included in the study, the median age was 23.4 years (min 12.1-max 61.7), 47% (n = 85) were females and 61% (107) were affected from impaired metabolism of phenylalanine. By October 2021, 94% (n = 163) of them had received at least one dose of the vaccine, which was, in 98% of cases, mRNA-based vaccine, given at the referral hospital in 65% of cases. Overall, 72% of patients with IMD reported AE to the vaccine: 60% after the first dose, 81% after the second. The highest rate of adverse events at the first dose was reported in patients with amino acids related disorders other than impaired phenylalanine metabolism (PKU/HPA) (88%). For the second dose, the PKU/HPA group reported the highest rate of AEs (89% of cases). There was no effect on the underlying disease or acute decompensation after the vaccine. Eleven patients (6%) were not vaccinated because they considered it dangerous. CONCLUSION Among individuals with IMD, the vaccination rate was high, the incidence and severity of AEs were comparable to those in the general population with no effects on the disease. Direct contact with the specialist medical team, has proven to reassure patients and effectively contrast hesitancy.
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Affiliation(s)
- Albina Tummolo
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
| | - Annamaria Dicintio
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
| | - Giulia Paterno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
| | - Rosa Carella
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
| | - Livio Melpignano
- Medical Direction, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
| | - Donatella De Giovanni
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy
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Loh TP, Greaves RF, Mak CM, Salomons GS, Bonham JR, Lang T. Impact of COVID-19 on Pediatric Laboratory Medicine: An IFCC C-ETPLM, SSIEM, ISNS Global Survey. EJIFCC 2022; 33:194-208. [PMID: 36313903 PMCID: PMC9562476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Pediatric laboratory medicine is a unique practice serving a vulnerable group of patients including highly specialized testing aiming to detect and treat inherited conditions early to avoid adverse outcomes. Data on the actual impact of COVID-19 pandemic on this speciality is lacking. METHODS A survey was conducted by the IFCC Committee on Emerging Technologies in Pediatric Laboratory Medicine in partnership with the Society for the Study of Inborn Errors of Metabolism and International Society for Neonatal Screening, to assess the impact on the clinical service provision during the initial wave (January to July 2020) of the COVID-19 pandemic and to gather experiences learned in order to improve laboratory preparedness for future outbreaks. RESULTS 217 survey responses were received from 69 regions. Sixty-three laboratories (29%) reported a restriction or suspension of service for a median period of four months. The common tests/ services suspended were new-born screening program, body fluids and sweat testing. The reasons for the suspension were related to bio-safety risks of COVID-19 transmission, manpower constraints and supplies disruption. A minority (9-10%) of laboratories did observe delayed/missed diagnoses or a more severe presentation of a clinical disorder. The critical operational decisions that helped manage the initial wave of COVID-19 included modifying work shift patterns, split-teams arrangement, use of personal protection equipment and social distancing. CONCLUSION The provision and delivery of pediatric laboratories services were affected during the initial wave of the COVID-19 pandemic. Manpower preparedness for future potential disruptions to pediatric laboratory services is a key finding and recommendation from this survey.
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Affiliation(s)
- Tze Ping Loh
- Department of Laboratory Medicine, National University Hospital, Singapore,Corresponding authors: Dr. Tze Ping Loh 5 Lower Kent Ridge Road Singapore 119074 Phone: (+65) 67724345 Fax: (+65) 67771613 E-mail:
| | - Ronda F. Greaves
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Victoria, Australia
| | - Chloe M. Mak
- Division of Chemical Pathology, Hong Kong Children’s Hospital, Hong Kong SAR, China
| | - Gajja S. Salomons
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center & Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - James R. Bonham
- Pharmacy, Diagnostics and Genetics, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Tim Lang
- Department of Clinical Biochemistry, University Hospital of North Durham, United Kingdom
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8
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Chenbhanich J, Slavotinek A, Tam A. Impact of the COVID-19 pandemic on medical genetics and genomics training: Perspective from clinical trainees. Am J Med Genet A 2022; 188:1997-2004. [PMID: 35338572 PMCID: PMC9082060 DOI: 10.1002/ajmg.a.62736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/02/2022] [Accepted: 03/15/2022] [Indexed: 12/30/2022]
Abstract
We sought to understand how the coronavirus disease 2019 (COVID-19) pandemic has affected the well-being, clinical training, and medical education for clinical trainees in medical genetics and genomics residency and fellowship programs. All clinical genetics trainees in the Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs were invited to complete a survey. 31 out of 174 trainees completed the survey. With regards to well-being, 18 trainees reported increased anxiety, 10 had increased depression, 3 increased financial strain, 13 worsening work-life balance, and 13 worsening physical health. There was increased telehealth utilization in both outpatient (3% before the pandemic vs. 67% during the pandemic) and inpatient clinical encounters (0% vs. 29%). The most commonly reported challenges in telehealth use were inadequate physical examination and technical problems during visits. Twenty trainees believed that the pandemic has negatively impacted overall clinical training while none reported a positive impact. We concluded that the COVID-19 pandemic has negatively impacted most clinical genetics trainees in ACGME-accredited training programs. Telehealth has been increasingly used with some challenges. Further studies are needed on how to optimally integrate what we have learned into the training of medical genetics and genomics in the post-pandemic era.
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Affiliation(s)
- Jirat Chenbhanich
- Division of Medical Genetics, Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Anne Slavotinek
- Division of Medical Genetics, Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Allison Tam
- Division of Medical Genetics, Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
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Olety P, Safwan GM, Shenoy RD. Inborn error of metabolism precipitated by COVID-19: challenges in the absence of an expanded newborn screening as state health programmes. BMJ Case Rep 2022; 15:15/6/e248001. [PMID: 35672054 PMCID: PMC9174768 DOI: 10.1136/bcr-2021-248001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Inborn errors of metabolism constitute a differential diagnosis in infants presenting with encephalopathy in developing countries where expanded newborn screening is not a state health programme. Acute neurological presentation with encephalopathy is documented in paediatric COVID-19. The pandemic has also altered parents' healthcare-seeking behaviour, leading to delays in emergency care. We illustrate the challenges faced in diagnosing and managing an 18-month-old child who presented with acute metabolic crisis due to methylmalonic acidaemia on the background of the COVID-19 pandemic. We discuss the current global status of expanded newborn screening services for inborn error of metabolism and the impact of the pandemic on the healthcare of children.
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Affiliation(s)
- Priyanka Olety
- Pediatrics, KS Hegde Medical Academy, Mangalore, Karnataka, India
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10
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Koç Yekedüz M, Doğulu N, Sürücü Kara İ, Öncül Ü, Bakirarar B, Kullu P, Ar Y, Köse E, Eminoğlu FT. Pros and Cons of Telemedicine for Inherited Metabolic Disorders in a Developing Country During the COVID-19 Pandemic. Telemed J E Health 2022; 28:1604-1612. [PMID: 35363077 DOI: 10.1089/tmj.2021.0610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: The COVID-19 pandemic has led to considerable changes in the health care system. Experts suggested that individuals protect themselves through social isolation during the pandemic, and consequently, the importance of telemedicine came to be understood for patients with chronic diseases. Telemedicine started to be used in developing countries where the appropriate infrastructure was lacking earlier. The present study investigates the level of satisfaction of patients with inherited metabolic disorders (IMDs) with telemedicine. Methods: This prospective study was conducted by making use of a new video appointment program that ensures the privacy of the patients in video-based consultations. The sociodemographic characteristics of the patients, their clinical status, their views on the telemedicine system, and their levels of satisfaction were questioned. Results: Overall, 174 patients were included in the study. The most common diagnoses were aminoacidopathies, lipid metabolism disorders, biotinidase deficiency, and lysosomal/peroxisomal diseases. More than half of the parents (67.6%) who lived in another city reported accommodation issues when coming to the hospital, and most believed telemedicine would save them time (93.1%) and money for travel (81.6%). The lack of laboratory and radiological tests (83.9%) was stated as the main disadvantage by most parents. Almost all the parents (96.6%) stated that they would opt for telemedicine if it became available in daily practice. The overall satisfaction rate was 94.6 (±10.1)/100. Conclusions: The present research is the most extensive cohort study to date assessing telemedicine in patients with IMDs and it highlights the importance of telemedicine, especially in developing countries during the COVID-19 pandemic.
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Affiliation(s)
- Merve Koç Yekedüz
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Neslihan Doğulu
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İlknur Sürücü Kara
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ümmühan Öncül
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Pinar Kullu
- Department of Computer Engineering, Ankara University, Ankara, Turkey
| | - Yilmaz Ar
- Department of Computer Engineering, Ankara University, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism Faculty of Medicine, Ankara University, Ankara, Turkey
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11
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Koracin V, Loeber JG, Mlinaric M, Battelino T, Bonham JR, Groselj U. Global impact of COVID-19 on newborn screening programmes. BMJ Glob Health 2022; 7:bmjgh-2021-007780. [PMID: 35236661 PMCID: PMC8895417 DOI: 10.1136/bmjgh-2021-007780] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The global COVID-19 pandemic has presented extraordinary disruption to healthcare services and exposed them to numerous challenges. Newborn screening (NBS) programmes were also affected; however, scarce data exist on the impact of COVID-19 on NBS. Methods We conducted an international survey to assess the global impact of COVID-19 on NBS, with the main aim of gathering the experiences of the COVID-19 pandemic from a large and representative number of NBS centres worldwide. Results The results of our study showed that COVID-19 impacted the NBS programmes, at least partially, in 29 out of 38 responding countries. Majority of the screening centres experienced a broad spectrum of difficulties and most were affected more in the second wave of the pandemic. Delays and unreliability with the postal service as well as flight cancellations caused delays in samples arriving to screening centres and with the provision of laboratory equipment and reagents. The availability of laboratory staff was sometimes reduced due to infection, quarantine or reassignment within the healthcare facility. Sample collection at home, second-tier tests and follow-up were also affected. Social restrictions and interruptions in public transport added to these difficulties. Only a limited number of centres managed to retain a fully functioning NBS programme. Conclusion As the pandemic might continue or could recur in future years, it would be useful to develop guidelines to protect these valuable services.
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Affiliation(s)
- Vanesa Koracin
- Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J Gerard Loeber
- International Society for Neonatal Screening (ISNS) Office, Bilthoven, The Netherlands
| | - Matej Mlinaric
- Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - James R Bonham
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Urh Groselj
- Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital Ljubljana; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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12
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Mortensen A, Raebel EM, Wiseman S. Impact of the COVID-19 pandemic on access to the cerliponase alfa managed access agreement in England for CLN2 treatment. Orphanet J Rare Dis 2022; 17:19. [PMID: 35045884 PMCID: PMC8767529 DOI: 10.1186/s13023-021-02147-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerliponase alfa, an enzyme replacement therapy for neuronal ceroid lipofuscinosis type 2 (CLN2), is currently available in England through a managed access agreement (MAA). It is administered every 2 weeks via an intracerebroventricular device. Here we report qualitative research with families of children with CLN2 disease and healthcare professionals (HCPs) who run the MAA, to understand how access to cerliponase alfa via the MAA at Great Ormond Street Hospital (GOSH) in London, and the overall management of CLN2 disease, was affected during the coronavirus disease 2019 (COVID-19) pandemic. METHODS Telephone interviews were conducted with nine families, representing 11 children with CLN2 disease, and two HCPs in November and December 2020. RESULTS Children had received cerliponase alfa treatment for a mean (SD) of 23.1 ± 24.7 months (7.1 ± 4.6 months in the MAA). Families travelled 7-398 km for treatment (mean 210 ± 111 km). Treatment with cerliponase alfa was designated "essential" by GOSH and continued as normal during the pandemic but with extra safety precautions, and no children missed any treatments. Families were highly motivated to continue treatment, despite considerable anxiety about the risk of coronavirus infection from travelling and staying overnight but were reassured by communications from GOSH and the safety precautions put in place. Support therapy services were widely compromised, causing families concern about deterioration in their children's condition. Families were confused about COVID-19 testing and shielding, and were unclear whether children with CLN2 disease were vulnerable to COVID-19. CONCLUSIONS Looking forward, advice for children with CLN2 disease should be specific and tailored, taking into account the family unit. Support therapies should be considered essential alongside cerliponase alfa treatment.
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Affiliation(s)
- Amanda Mortensen
- Batten Disease Family Association, Hamilton House, Mabledon Place, London, WC1H9BB, UK.
| | - Eva M Raebel
- Rare Disease Research Partners, MPS House, Amersham, HP7 9LP, UK
| | - Samantha Wiseman
- Rare Disease Research Partners, MPS House, Amersham, HP7 9LP, UK
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13
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Zubarioglu T, Hopurcuoglu D, Ahmadzada S, Uzunyayla-Inci G, Cansever MS, Kiykim E, Aktuglu-Zeybek C. Inborn errors of metabolism and coronavirus disease 2019: Evaluation of the metabolic outcome. Pediatr Int 2022; 64:e14938. [PMID: 34329521 PMCID: PMC8447071 DOI: 10.1111/ped.14938] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Infectious diseases can result in a catabolic state and possibly trigger an acute metabolic decompensation in inborn errors of metabolism (IEM), which could be life threatening. Studies regarding the course of severe acute respiratory syndrome coronavirus 2 infections in patients with IEM are generally limited to case reports. Here, we aimed to evaluate the clinical findings of coronavirus disease 2019 (COVID-19) and describe the impact of severe acute respiratory syndrome coronavirus 2 infections on metabolic outcomes in IEM patients. METHODS Patients who were diagnosed with different types of IEM and developed microbiologically confirmed COVID-19 infection were included. Clinical findings and laboratory results were recorded retrospectively in terms of both IEM and COVID-19. RESULTS Eleven patients with diagnosis of intoxication type metabolic disorders, five patients with energy metabolism disorders, and six patients with complex molecular disorders were enrolled. The most frequent clinical finding was fever (52.1%) followed by fatigue/myalgia (47.8%). None of the patients was younger than 1 year. None of the patients presented severe or critical disease. In terms of metabolic decompensation, two patients diagnosed with propionic acidemia, one patient with methylmalonic acidemia and one patient with 3-hydroxy-3-methylglutaryl-CoA lyase deficiency presented clinical and biochemical findings of an acute metabolic attack. CONCLUSIONS Based on our results, IEM are not found to be an additional risk factor for severe COVID-19 infection. However, patients with intoxication type and energy metabolism disorders should be considered as a vulnerable population for COVID-19 and have a major risk of developing acute metabolic decompensation that can lead to life-threatening complications.
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Affiliation(s)
- Tanyel Zubarioglu
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Duhan Hopurcuoglu
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Saffa Ahmadzada
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gözde Uzunyayla-Inci
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Serif Cansever
- Division of Medical Laboratory Techniques, Department of Medical Documentation and Techniques, The Vocational School of Health Services, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ertugrul Kiykim
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Aktuglu-Zeybek
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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14
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Sebastião FM, Michelin-Tirelli K, Bender F, Lopes FF, Moraes I, Kubaski F, Giugliani R, Burin M. COVID-19 impact on the diagnosis of Inborn Errors of Metabolism: Data from a reference center in Brazil. Genet Mol Biol 2021; 45:e20210253. [PMID: 34927665 PMCID: PMC8691104 DOI: 10.1590/1678-4685-gmb-2021-0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic led to the reorganization of health care in several countries, including Brazil. Inborn Errors of Metabolism (IEM) are a group of rare and difficult to diagnose genetic diseases caused by pathogenic variants in genes that code for enzymes, cofactors, or structural proteins affecting different metabolic pathways. The aim of this study was to evaluate how COVID-19 affected the diagnosis of patients with IEM during the first year of the pandemic in Brazil comparing two distinct periods: from March 1st, 2019 to February 29th, 2020 (TIME A) and from March 1st, 2020 to February 28th, 2021 (TIME B), by the analysis of the number of tests and diagnoses performed in a Reference Center in South of Brazil. In the comparison TIME A with TIME B, we observe a reduction in the total number of tests performed (46%) and in the number of diagnoses (34%). In both periods analyzed, mucopolysaccharidoses (all subtypes combined) was the most frequent LD suspected and/or confirmed. Our data indicates a large reduction in the number of tests requested for the investigation of IEM and consequently a large reduction in the number of diagnoses caused by the COVID-19 pandemic leading to a significant underdiagnosis of IEM.
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Affiliation(s)
| | | | - Fernanda Bender
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Franciele Fátima Lopes
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Inamara Moraes
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Francyne Kubaski
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Roberto Giugliani
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Departamento de Genética, Porto Alegre, RS, Brazil
| | - Maira Burin
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Genética Médica, Porto Alegre, RS, Brazil
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15
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Tobór-Świętek E, Sykut-Cegielska J, Bik-Multanowski M, Walczak M, Rokicki D, Kałużny Ł, Wierzba J, Pac M, Jahnz-Różyk K, Więsik-Szewczyk E, Kieć-Wilk B. COVID-19 Pandemic and Patients with Rare Inherited Metabolic Disorders and Rare Autoinflammatory Diseases-Organizational Challenges from the Point of View of Healthcare Providers. J Clin Med 2021; 10:jcm10214862. [PMID: 34768381 PMCID: PMC8584872 DOI: 10.3390/jcm10214862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 01/12/2023] Open
Abstract
COVID-19 pandemic is an organisational challenge for both healthcare providers and patients. People with rare inherited metabolic disorders (IMD) and rare autoinflammatory diseases (AD) are vulnerable patients whose well-being is deeply connected with regular follow-ups. This study aimed to assess how e one year of coronavirus pandemic has impacted the treatment of patients with IMD and AD in Poland. Surveys were distributed to all healthcare providers that coordinate the treatment of IMD and AD patients. Thirty-two responders (55%) answered the survey. They provide care to 1726 patients with IMD/AD, including 246 patients on dedicated treatment. In 35% of units, the regular appointments were disrupted, primarily because of patient infection. In 18 hospitals, remote visits were implemented, but only 66.6% of patients used this form of consultation. In 14/32 hospitals, administration of the therapy was delayed (median: 17.4 days). Forty-four patients suffered from SARS-COV-2 infection, in majority with mild symptoms. However, four adult patients developed complications, and one died following a SARS-COV-2 infection. Although most hospitals managed to maintain regular visits during the pandemic, more comprehensive implementation of telemedicine and switch to oral therapy or home infusions would be a reasonable solution for the current epidemic situation.
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Affiliation(s)
- Ewa Tobór-Świętek
- Department of Metabolic Diseases, Jagiellonian University Medical College, 31-008 Cracow, Poland;
- Department of Metabolic Diseases, University Hospital, Jakubowskiego 2 Street, 30-688 Cracow, Poland
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, Institute of Mother and Child, Kasprzaka 17a Street, 01-211 Warsaw, Poland;
| | - Mirosław Bik-Multanowski
- Department of Medical Genetics, Medical College, Jagiellonian University, Wielicka 265 Street, 30-633 Cracow, Poland;
| | - Mieczysław Walczak
- Department of Pediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Unii Lubelskiej 1 Street, 71-242 Szczecin, Poland;
| | - Dariusz Rokicki
- Department of Paediatrics, Nutrition and Metabolic Diseases, Institute “Children’s Memorial Health Institute”, al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | - Łukasz Kałużny
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Szpitalna 27/33 Street, 60-572 Poznan, Poland;
| | - Joanna Wierzba
- Department of Paediatrics, Hematology and Oncology Medical University of Gdansk, Debniki 7, 80-752 Gdansk, Poland;
| | - Małgorzata Pac
- Department of Immunology, Institute “Children’s Memorial Health Institute”, al. Dzieci Polskich 20, 04-730 Warsaw, Poland;
| | - Karina Jahnz-Różyk
- Department of Internal Diseases, Pneumology, Allergology and Clinical Immunology, Military Medical Institute, Szaserów 128 Street, 04-141 Warsaw, Poland; (K.J.-R.); (E.W.-S.)
| | - Ewa Więsik-Szewczyk
- Department of Internal Diseases, Pneumology, Allergology and Clinical Immunology, Military Medical Institute, Szaserów 128 Street, 04-141 Warsaw, Poland; (K.J.-R.); (E.W.-S.)
| | - Beata Kieć-Wilk
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases Jagiellonian University, Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Cracow, Poland
- Correspondence: ; Tel.: +48-12-400-29-50
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16
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Rovelli V, Zuvadelli J, Paci S, Ercoli V, Re Dionigi A, Selmi R, Salvatici E, Cefalo G, Banderali G. Telehealth and COVID-19: Empowering Standards of Management for Patients Affected by Phenylketonuria and Hyperphenylalaninemia. Healthcare (Basel) 2021; 9:1407. [PMID: 34828453 PMCID: PMC8622759 DOI: 10.3390/healthcare9111407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Phenylketonuria (PKU) and Hyperphenylalaninemia (HPA) are inborn errors of metabolism (IEM) due to mutations in the PAH gene resulting in increased blood phenylalanine (Phe) concentrations. Depending on the Phe levels, a lifelong dietary intervention may be needed. During the COVID-19 pandemic, finding new strategies to ensure follow-up and metabolic control for such patients became mandatory and telehealth was identified as the most eligible tool to provide care and assistance beyond barriers. The aim of this study was to evaluate how telehealth use may have impacted disease follow-ups. Seven hundred and fifty-five patients affected by PKU/HPA in follow-ups at the Clinical Department of Pediatrics (San Paolo Hospital, ASST Santi Paolo e Carlo, University of Milan, Italy) were included in this study. The data regarding the used telehealth model, type of performed consultations and patients' perspectives were retrospectively collected and analyzed after a one-year experience of implemented follow-ups. The results demonstrated that telehealth seemed to be a useful tool to improve the adherence to treatment and that it could guarantee continuous assistance and care beyond the surrounding epidemiological status. Patients expressed great satisfaction with the offered services and requested that they were implemented in standards of care on a long-term basis. Our results suggested the implementation of telehealth in the management guidelines for PKU/HPA patients.
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Affiliation(s)
- Valentina Rovelli
- Clinical Department of Pediatrics, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, 20142 Milan, Italy; (J.Z.); (S.P.); (V.E.); (A.R.D.); (R.S.); (E.S.); (G.C.); (G.B.)
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17
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Elmonem MA, van den Heuvel LP. Editorial: Newborn Screening for Inborn Errors of Metabolism: Is It Time for a Globalized Perspective Based on Genetic Screening? Front Genet 2021; 12:758142. [PMID: 34589119 PMCID: PMC8473867 DOI: 10.3389/fgene.2021.758142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mohamed A Elmonem
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Lambertus P van den Heuvel
- Department of Pediatric Nephrology & Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology, Radboud University Medical Centre, Nijmegen, Netherlands
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18
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COVID-19 and Inherited Metabolic Disorders: One-Year Experience of a Referral Center. CHILDREN-BASEL 2021; 8:children8090781. [PMID: 34572213 PMCID: PMC8464704 DOI: 10.3390/children8090781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022]
Abstract
Understanding the potential risks of patients with inherited metabolic disorder (IMD) exposed to the COVID-19 pandemic is an unmet need for those involved in their management. Here, we report on the incidence of COVID-19 in a cohort of patients with IMD treated at a children’s hospital and compare them with a matched control group. Among the total number of 272 patients actively followed at a referral center, 19 (7%) tested positive for SARS-CoV-2 between March 2020 and March 2021. Their median age was 16.2 years (range 1.4–32.8 years). In two-thirds of the cases, the source of infection was a family member; 12/19 patients (63%) were asymptomatic, only one required hospitalization, and none of them died. In our single-center experience, COVID-19 had a moderate impact on a relatively large cohort of patients with IMD, including children and young adults. The clinical course was very mild in all but one case. The proportion of symptomatic cases and the clinical course were comparable in patients with IMD and in a group of matched, non-IMD COVID-19 controls from the general population.
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19
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Herle M, Brunner-Krainz M, Karall D, Goeschl B, Möslinger D, Zobel J, Plecko B, Scholl-Bürgi S, Spenger J, Wortmann SB, Huemer M. A retrospective study on disease management in children and adolescents with phenylketonuria during the Covid-19 pandemic lockdown in Austria. Orphanet J Rare Dis 2021; 16:367. [PMID: 34412683 PMCID: PMC8374407 DOI: 10.1186/s13023-021-01996-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/12/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In classical phenylketonuria (PKU) phenylalanine (Phe) accumulates due to functional impairment of the enzyme phenylalanine hydroxylase caused by pathogenic variants in the PAH gene. PKU treatment prevents severe cognitive impairment. Blood Phe concentration is the main biochemical monitoring parameter. Between appointments and venous blood sampling, Austrian PKU patients send dried blood spots (DBS) for Phe measurements to their centre. Coronavirus disease-19 (COVID-19), caused by the SARS CoV-2 virus, was classified as a pandemic by the World Health Organization in March 2020. In Austria, two nationwide lockdowns were installed during the first and second pandemic wave with variable regional and national restrictions in between. This retrospective questionnaire study compared the frequency of Phe measurements and Phe concentrations during lockdown with the respective period of the previous year in children and adolescents with PKU and explored potential influencing factors. RESULTS 77 patients (30 female, 47 male; mean age 12.4 [8-19] years in 2020) from five centres were included. The decline of venous samples taken on appointments in 2020 did not reach significance but the number of patients with none or only one DBS tripled from 4 (5.2%) in 2019 to 12 (15.6%) in 2020. Significantly more patients had a decline than a rise in the number of DBS sent in between 2019 and 2020 (p < 0.001; Chi2 = 14.79). Especially patients ≥ 16 years sent significantly less DBS in 2020 (T = 156, p = 0.02, r = 0.49). In patients who adhered to DBS measurements, Phe concentrations remained stable. Male or female sex and dietary only versus dietary plus sapropterin treatment did not influence frequency of measurements and median Phe. CONCLUSION During the COVID pandemic, the number of PKU patients who stopped sending DBS to their metabolic centre increased significantly, especially among those older than 16 years. Those who kept up sending DBS maintained stable Phe concentrations. Our follow-up system, which is based on DBS sent in by patients to trigger communication with the metabolic team served adherent patients well. It failed, however, to actively retrieve patients who stopped or reduced Phe measurements.
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Affiliation(s)
- Marion Herle
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Michaela Brunner-Krainz
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Daniela Karall
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernadette Goeschl
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Dorothea Möslinger
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria
| | - Joachim Zobel
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Barbara Plecko
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Sabine Scholl-Bürgi
- Department of Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Spenger
- University Children's Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Saskia B Wortmann
- University Children's Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.,Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Martina Huemer
- Division of Metabolism and Children's Research Center, University Children's Hospital Zürich, Zürich, Switzerland. .,Department of Paediatrics, Landeskrankenhaus Bregenz, Carl-Pedenz-Str. 2, 6900, Bregenz, Austria.
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20
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Provider Perspectives on the Impact of the COVID-19 Pandemic on Newborn Screening. Int J Neonatal Screen 2021; 7:ijns7030038. [PMID: 34287223 PMCID: PMC8293089 DOI: 10.3390/ijns7030038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022] Open
Abstract
The onset of the COVID-19 pandemic caused significant changes in healthcare delivery. Telemedicine rapidly and unexpectedly became the primary vehicle for ambulatory management. As newborn screen (NBS) referrals require varying levels of acuity, whether telemedicine could be used as a safe and effective medium to return these results were unknown. We sent an online survey to metabolism providers internationally to investigate triage differences of abnormal NBS results during the COVID-19 pandemic. The survey compared personal practice for the periods of March-June 2019 and March-June 2020. Responses were received from 44 providers practicing in 8 countries. Nearly all (93%) practiced in areas of widespread SARS-COV-2 community transmission during spring 2020. There was a significant expansion of telemedicine use for NBS referrals at the onset of the COVID-19 pandemic (OR: 12, 95% CI: 3.66-39.3, p < 0.0001). Telehealth primarily replaced in-person ambulatory metabolism visits. The increased frequency of virtual care was similar across NBS analytes. Providers found telehealth for NBS referral equally efficacious to in-person care. Institutional patient surveys showed no difference in satisfaction with provider communication, provider empathy, or appointment logistics. Our survey was limited by unprecedented disruption in healthcare delivery, necessitating further validation of telegenetics for NBS in the post-pandemic era. Nevertheless, our findings demonstrate that telemedicine is potentially a viable and practical tool for triaging abnormal NBS results.
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21
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Yekedüz MK, Köse E, Eminoğlu FT. A case with Gaucher disease unable to reach enzyme replacement therapy because of COVID-19 quarantine: The first case from Turkey. Turk Arch Pediatr 2021; 56:270-271. [PMID: 34104921 DOI: 10.5152/turkarchpediatr.2021.21023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/28/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Merve Koç Yekedüz
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
| | - Engin Köse
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
| | - Fatma Tuba Eminoğlu
- Department of Pediatric Metabolism, Ankara University School of Medicine, Ankara, Turkey
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22
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Singh RH, Pringle T, Kenneson A. The Use of Telemedicine and Other Strategies by Registered Dietitians for the Medical Nutrition Therapy of Patients With Inherited Metabolic Disorders During the COVID-19 Pandemic. Front Nutr 2021; 8:637868. [PMID: 33987197 PMCID: PMC8110701 DOI: 10.3389/fnut.2021.637868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/29/2021] [Indexed: 01/18/2023] Open
Abstract
The clinical management of patients with inherited metabolic disorders (IMDs) includes medical nutrition therapy (MNT) by a registered dietitian (RD). We utilized an online quantitative and qualitative survey to characterize the practices of RDs treating patients with IMDs during the COVID-19 pandemic and to identify challenges and unmet needs. We received responses from 117 RDs. Results indicate that RDs are using alternate methods to engage this vulnerable population and provide MNT during the pandemic, including offering telemedicine appointments. Barriers to implementation of telemedicine include the limitations of virtual visits (inability to conduct physical exams and collect blood samples), time, patient knowledge of technology, audio problems, and patient access to internet, computers, or smartphones. RDs have addressed these barriers by extending prescriptions without a medical exam, relying on local facilities for blood draws, increasing the number of patients that use at-home filter papers for blood monitoring, and expanding the use of phone calls and emails. RDs identified patient education materials to facilitate telemedicine visits as a primary unmet need. Despite the reported barriers and limitations of telemedicine for MNT of IMDs, there was widespread satisfaction with the approach among RDs, with 96.9% reporting that they were somewhat or very satisfied with telemedicine. Although this survey focused on barriers, benefits of telemedicine for both RDs and patients were also reported. Identification of barriers and unmet needs can help clinics plan strategies to maximize telemedicine delivery models, to improve efficiency and patient outcomes, and to support sustained use of telemedicine post-pandemic.
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Affiliation(s)
- Rani H Singh
- Department of Human Genetics, Emory University, Atlanta, GA, United States.,Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Theresa Pringle
- Department of Human Genetics, Emory University, Atlanta, GA, United States
| | - Aileen Kenneson
- Department of Human Genetics, Emory University, Atlanta, GA, United States
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23
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Husser D, Pellissier V, Hohenstein S, Ueberham L, König S, Hindricks G, Meier-Hellmann A, Kuhlen R, Bollmann A. Hospital care of patients with inherited cardiomyopathies in Germany during the Covid-19 pandemic insights from the German-wide Helios hospital network. Am J Med Genet A 2021; 185:2278-2282. [PMID: 33876564 PMCID: PMC8250485 DOI: 10.1002/ajmg.a.62209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/09/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Daniela Husser
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Vincent Pellissier
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Sven Hohenstein
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Sebastian König
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
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24
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Pal S, Bhatia S, Bijarnia-Mahay S, Verma IC, Puri RD. Challenges in Chronic Genetic Disorders: Lessons From the COVID-19 Pandemic. Indian Pediatr 2021; 58:391-392. [PMID: 33883315 PMCID: PMC8079848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
To examine the impact of the COVID-19 pandemic, we interviewed 26 patients with lysosomal storage disorders receiving enzyme replacement therapy. 20 (77 %) had significant interruption in their treatment, with an average of 8 (range 2-28) missed doses. Alternate methods of delivering uninterrupted care including home therapy were used. Vulnerable patients with chronic genetic disorders require organization for their multidisciplinary needs of care.
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Affiliation(s)
- Swasti Pal
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sameer Bhatia
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sunita Bijarnia-Mahay
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ishwar C Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.
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25
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Ginns EI, Ryan E, Sidransky E. Gaucher disease in the COVID-19 pandemic environment: The good, the bad and the unknown. Mol Genet Metab 2021; 132:213-214. [PMID: 33676819 PMCID: PMC7903902 DOI: 10.1016/j.ymgme.2021.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/17/2021] [Accepted: 02/20/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Edward I Ginns
- Lysosomal Disorders Treatment and Research Program, Departments of Neurology and Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655, USA; Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-3708, USA
| | - Emory Ryan
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-3708, USA
| | - Ellen Sidransky
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-3708, USA.
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26
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Zubarioglu T, Hopurcuoglu D, Uygur E, Ahmadzada S, Oge-Enver E, Isat E, Cansever MS, Kiykim E, Aktuglu-Zeybek C. The Impact of Telemedicine for Monitoring and Treatment of Phenylketonuria Patients on Metabolic Outcome During Coronavirus Disease-19 Outbreak. Telemed J E Health 2021; 28:258-265. [PMID: 33719565 DOI: 10.1089/tmj.2020.0569] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The prognosis of phenylketonuria (PKU) in terms of neurocognitive outcome is directly related to lifelong phenylalanine (Phe) levels and adherence to treatment. Monitoring and treatment of PKU patients can be complicated in challenging circumstances as pandemics. This study aims to evaluate the impact of telemedicine for monitoring and treatment of PKU patients on metabolic outcome during coronavirus disease-19 (COVID-19) outbreak. Materials and Methods: Patients who were diagnosed as PKU and treated with low Phe diet, tetrahydrobiopterin (BH4), or BH4 adjunct with low Phe diet were enrolled. Study period was divided into two periods: prepandemic period wherein patients were followed up in outpatients' clinic and during pandemic wherein telemedicine was used. Demographic findings, laboratory results, and therapy responses were reviewed retrospectively and compared between the two periods. All procedures were in accordance with the ethical standards of the local ethical committee of Cerrahpasa Medical Faculty (17/11/2020-151640) and with the Helsinki Declaration of 1975, as revised in 2013. Results: Ninety-three (n = 93) patients were enrolled to this study. The ratio of the samples with Phe levels in the recommended ranges was found to be statistically higher during the pandemic wherein an online monitoring system was used in all treatment modalities (p < 0.05). The decrease in Phe washout frequency was statistically significant during the pandemic in the low Phe diet group (p < 0.05). Considering the relationship between Phe tolerance before and during the pandemic, a significant increase in Phe tolerance was noted during the pandemic in the low Phe diet group (p < 0.05). Conclusions: Telemedicine can be an appropriate and effective monitoring option for PKU patients during the COVID-19 pandemic.
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Affiliation(s)
- Tanyel Zubarioglu
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Duhan Hopurcuoglu
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Uygur
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Saffa Ahmadzada
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ece Oge-Enver
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esra Isat
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Serif Cansever
- Division of Medical Laboratory Techniques, Department of Medical Documentation and Techniques, The Vocational School of Health Services, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ertugrul Kiykim
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cigdem Aktuglu-Zeybek
- Cerrahpasa Medical Faculty, Division of Nutrition and Metabolism, Department of Pediatrics Istanbul University-Cerrahpasa, Istanbul, Turkey
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27
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Cohen AJ, Shur N, Starin D, MacLeod E, Roshan Lal T, Leon E, Regier DS. Pediatric medical genetics house call: Telemedicine for the next generation of patients and providers. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2021; 187:55-63. [DOI: 10.1002/ajmg.c.31882] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Andrea J. Cohen
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Natasha Shur
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Danielle Starin
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Erin MacLeod
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Tamanna Roshan Lal
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Eyby Leon
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
| | - Debra S. Regier
- Genetics and Metabolism Children's National Hospital Washington District of Columbia USA
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