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Bombaci B, Passanisi S, Sorrenti L, Salzano G, Lombardo F. Examining the associations between COVID-19 infection and pediatric type 1 diabetes. Expert Rev Clin Immunol 2023; 19:489-497. [PMID: 36888906 DOI: 10.1080/1744666x.2023.2189587] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION The COVID-19 pandemic represents an unprecedented challenge for public health worldwide, not only for the very high number of cases and deaths but also due to a wide variety of indirect consequences. Among these, the possible relationship between SARS-CoV-2 infection and type 1 diabetes (T1D) in pediatric age has aroused notable interest in the scientific community. AREAS COVERED This perspective article aims to focus on the epidemiological trend of T1D during the pandemic, the diabetogenic role of SARS-CoV-2, and the influence of preexisting T1D on COVID-19 outcomes. EXPERT OPINION The incidence of T1D has considerably changed during the COVID-19 pandemic, but any direct role of SARS-CoV-2 is uncertain. It is more likely that SARS-CoV-2 infection acts as an accelerator of pancreatic β-cell immunological destruction, which is activated by known viral triggers whose spread has been abnormal during these pandemic years. Another interesting aspect to consider is the role of immunization as a potential protective factor both for T1D development and the risk of severe outcomes in already diagnosed patients. Future studies are still required to address unmet needs, including the early use of antiviral drugs to reduce the risk of metabolic decompensation in children with T1D.
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Affiliation(s)
- Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Lacrima Sorrenti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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Mastromauro C, Blasetti A, Primavera M, Ceglie L, Mohn A, Chiarelli F, Giannini C. Peculiar characteristics of new-onset Type 1 Diabetes during COVID-19 pandemic. Ital J Pediatr 2022; 48:26. [PMID: 35139895 PMCID: PMC8827260 DOI: 10.1186/s13052-022-01223-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/22/2022] [Indexed: 01/30/2023] Open
Abstract
Background The COVID-19 pandemic period is having a strong impact on the management of diabetes as well as other chronic diseases as shown by the most severe clinical presentation at onset. The aim of this study was to evaluate the severity of diabetic ketoacidosis (DKA) in youth with newly diagnosed type 1 diabetes in “Santissima Annunziata Hospital” (Chieti, Italy) during COVID-19 pandemic in comparison to the five previous years. Methods A retrospective population-based incidence study was performed. Data were obtained from hospital records of 172 patients with new onset type 1 diabetes divided into two groups according to the diagnosis: Group I, between January 2015 and February 2020; Group II, between March 2020 and April 2021. Data regarding anthropometric, socio-economic and laboratory test were analyzed. DKA (pH < 7.30) and different severity of the disease (severe pH < 7.10; moderate pH < 7.20, mild pH < 7.30) were evaluated. A Spearman correlation between pH values and the main variables of interest was performed. Results DKA frequency was increased by 19 percentage in Group II compared to Group I (55% vs 36%; P = 0.03) with a significant increased risk of severe DKA cases compared to the previous five years (severe DKA 22.5% vs. 8.4%, P = 0.01). pH values were significantly related with HbA1c, blood glucose and c-peptide values in all groups. In addition, in Group II but not in Group I, pH values correlated with Triglycerides and TG/HDL cholesterol ratio. Conclusions During COVID-19 pandemic the risk of more severe clinical presentation of type 1 diabetes at onset is increased. The correlation with lipid profile might suppose an additional effect of lifestyle changes beside the delay in the diagnosis. Modifications of health care system need to be implemented during this peculiar situation in order to avoid such a relevant complication at onset.
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Affiliation(s)
- Concetta Mastromauro
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Annalisa Blasetti
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Marina Primavera
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Lucio Ceglie
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Angelika Mohn
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti, Chieti, Italy.,Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Cosimo Giannini
- Department of Pediatrics, University of Chieti, Chieti, Italy. .,Department of Pediatrics, University of Chieti, Chieti, Italy.
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Lombardo F, Salzano G, Bombaci B, Basile P, Lucania G, Alibrandi A, Passanisi S. Has COVID-19 lockdown improved glycaemic control in pediatric patients with type 1 diabetes? An analysis of continuous glucose monitoring metrics. Diabetes Res Clin Pract 2021; 178:108988. [PMID: 34331977 PMCID: PMC8416096 DOI: 10.1016/j.diabres.2021.108988] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022]
Abstract
AIMS Our observational study aimed to evaluate the impact of the lockdown period due to 2019 Coronavirus disease pandemic on glycaemic control in a cohort of paediatric patients with type 1 diabetes (T1D). METHODS Eighty-five patients with T1D aged 5-18 years using continuous glucose monitoring (CGM) systems were enrolled. Demographic and clinical data, including glucose metrics generated by CGM-specific web-based cloud platforms, were collected in three different periods (pre-lockdown phase, lockdown phase, and post-lockdown phase) of 90 days each and were statistically analysed. RESULTS During the lockdown period, a clear improvement in almost all CGM metrics (time in range, time above range, coefficient of variation, and glucose management indicator) was observed in our study population, regardless of age and insulin type treatment. In the months following lockdown, maintaining satisfactory diabetes outcomes was confirmed only in younger patients (aged 5-9 years) and in those individuals on hybrid closed loop therapy. CONCLUSIONS The increasing use of innovative technological devices together with data sharing systems and interaction with multidisciplinary diabetes team through telemedicine allowed paediatric patients with T1D to improve glucose metrics during the lockdown period. However, our findings showed that the achievement of better glycaemic control was transient for most patients.
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Affiliation(s)
- Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy.
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Pietro Basile
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giovanni Lucania
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economics, Unit of Statistical and Mathematical Sciences, University of Messina, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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4
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Calcaterra V, Iafusco D, Carnevale Pellino V, Mameli C, Tornese G, Chianese A, Cascella C, Macedoni M, Redaelli F, Zuccotti G, Vandoni M. "CoVidentary": An online exercise training program to reduce sedentary behaviours in children with type 1 diabetes during the COVID-19 pandemic. J Clin Transl Endocrinol 2021; 25:100261. [PMID: 34307052 PMCID: PMC8283025 DOI: 10.1016/j.jcte.2021.100261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/11/2021] [Accepted: 07/01/2021] [Indexed: 01/16/2023]
Abstract
Covid-19 restrictions disrupted physical activities in children with type 1 diabetes. Diabetes management worsened in glycemia values and insulin delivery. Active breaks rather than structured training may interrupt sedentary in children with type 1 diabetes.
Aim We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists. Methods Parents of children with T1D (<18 years) filled out an online survey. Anthropometric characteristics, PA, play, sport and sedentary time and the medical related outcomes were recorded. An adapted online program “Covidentary” was proposed through full-training (FT) and active breaks (AB) modality. Results 280 youth (11.8 ± 3.3 years) were included in the analysis. We reported a decline in sport (-2.1 ± 2.1 h/week) and outdoor-plays (-73.9 ± 93.6 min/day). Moreover, we found an increase in sedentary time (+144.7 ± 147.8 min/day), in mean glycaemic values (+25.4 ± 33.4 mg/dL) and insulin delivery (71.8% of patients). 37% of invited patients attended the training program, 46% took part in AB and 54% in FT. The AB was carried out for 90% of the total duration, while the FT for 31%. Both types of training were perceived as moderate intensity effort. Conclusion A decline of participation in sport activities and a subsequent increase of sedentary time influence the management of T1D of children, increasing the risk of acute/long-term complications. Online exercise program may contrast the pandemic's sedentary lifestyle.
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Affiliation(s)
- Valeria Calcaterra
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy.,Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Dario Iafusco
- Regional Center of Pediatric Diabetology "G. Stoppoloni" Department of Pediatrics, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vittoria Carnevale Pellino
- Laboratory of Adapted Motor Activity (LAMA) - Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy.,Department of Industrial Engineering, University of Tor Vergata, Rome, Italy
| | - Chiara Mameli
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy
| | - Gianluca Tornese
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Antonietta Chianese
- Regional Center of Pediatric Diabetology "G. Stoppoloni" Department of Pediatrics, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Crescenzo Cascella
- Regional Center of Pediatric Diabetology "G. Stoppoloni" Department of Pediatrics, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Francesca Redaelli
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, "Vittore Buzzi" Children's Hospital, Milano, Italy.,Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Milano, Italy
| | - Matteo Vandoni
- Laboratory of Adapted Motor Activity (LAMA) - Department of Public Health, Experimental Medicine and Forensic Science, University of Pavia, Pavia, Italy
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Manfredi M, Ragni P, Gargano G. Creation of a specific and separated pediatric intra-hospital pathway in primary level hospitals during the era of COVID-19. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211010897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Every new pandemic forces us to start new specific behaviors both in the civil life and within the hospitals trying to contain the spreading of the infection and preserve the more fragile people. In this regard, at the debut of Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2) pandemic, our Local Health Agency had drastically modified every clinical and organizational pathways in order to limit the diffusion of the infection as well as to maintain a good quality of care and preserve healthcare workers. We report how we have modified the usual pediatric intra-hospital pathways in our primary level hospital to avoid mixing children with suspected and non-suspected symptoms of SARS-CoV-2 infection. Before every hospitalization, regardless of symptoms, each child and him/her parent/caregiver are undergone to rapid antigenic and molecular swab to rule out a SARS-CoV-2 infection; hence, positive patients are transferred to Pediatric Unit of third level hospital equipped by a Pediatric COVID Intensive Unit. We think the healthcare behaviors described in this manuscript can help to reduce the intra-hospital spreading of SARS-CoV-2, although children seem to have a minimal role in the dissemination, but we cannot let down your guard. Simultaneously we observed that the overall children requiring inpatient pediatric evaluation and hospitalization have dramatically decreased from the beginning of pandemic.
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Affiliation(s)
- Marco Manfredi
- Maternal and Child Department, Azienda USL-IRCCS di Reggio Emilia, Pediatric Unit, Sant’Anna Hospital, Castelnovo ne’ Monti, Reggio Emilia, Italy
| | - Pietro Ragni
- Infective Risk Control Strategic Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giancarlo Gargano
- Maternal and Child Department, Azienda USL-IRCCS di Reggio Emilia, ASMN Hospital, Reggio Emilia, Italy
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6
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Dipasquale V, Passanisi S, Cucinotta U, Cascio A, Romano C. Implications of SARS-COV-2 infection in the diagnosis and management of the pediatric gastrointestinal disease. Ital J Pediatr 2021; 47:71. [PMID: 33761992 PMCID: PMC7988257 DOI: 10.1186/s13052-021-01020-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal diseases such as celiac disease, functional gastrointestinal disorders (FGIDs), inflammatory bowel disease (IBDs) and acute or chronic diarrhea are quite frequent in the pediatric population. The approach, the diagnosis and management can be changed in the 2019 coronavirus disease (COVID-19) pandemic era. This review has focused on: i) the current understanding of digestive involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected children and adolescents and the clinical implications of COVID-19 for pediatric gastroenterologists, ii) the impact of COVID-19 on the clinical approach to patients with pre-existing or onset diseases, including diagnosis and treatment, and iii) the role and limited access to the instrumental diagnosis such as digestive endoscopy. To date, it is unclear if immunosuppression in patients with IBD and chronic liver disease represents a risk factor for adverse outcomes. Scheduled outpatient follow-up visits may be postponed, especially in patients in remission. Conversely, telemedicine services are strongly recommended. The introduction of new therapeutic regimens should be made on an individual basis, discussing the benefits and risks with each patient. Furthermore, psychological care in all children with chronic disease and their parents should be ensured. All non-urgent and elective endoscopic procedures may be postponed as they must be considered at high risk of viral transmission. Finally, until SARS-CoV-2 vaccination is not available, strict adherence to standard social distancing protocols and the use of personal protective equipment should continue to be recommended.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Stefano Passanisi
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via Consolare Valeria, 98124, Messina, Italy.
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7
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Iafusco M, Ciampa C, De Maddi F, Palamone G, Quarantiello F, De Luca G, Iannello C, Pisano S, Nocerino A, Russo R, Orlando F, Iafusco D. PediaVirus chatline: all together against COVID-19. Arch Dis Child 2021; 106:e12. [PMID: 32690580 DOI: 10.1136/archdischild-2020-319551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Michele Iafusco
- Pediatrics Department,"Pediatria 2", National Specialty Hospital Santobono Pausilipon, Naples, Italy
| | - Clotilde Ciampa
- Neurology Department, San Giovanni Bosco Hospital, Naples, Italy
| | - Francesco De Maddi
- Pediatrics Department, National Specialty Hospital Santobono Pausilipon, Naples, Italy
| | - Gianluigi Palamone
- Pediatrics Department, Martiri del Villa Malta Hospital of Sarno, Salerno, Italy
| | | | - Giuseppe De Luca
- Pediatrics Department, San Giovanni di Dio Frattamaggiore Hospital, Naples, Italy
| | | | - Simone Pisano
- Neuropsychiatry Department, National Specialty Hospital Santobono Pausilipon, Naples, Italy
| | | | - Rocco Russo
- Mother and child Department, ASL, Benevento, Italy
| | - Francesca Orlando
- Pediatrics Department,"Pediatria 2", National Specialty Hospital Santobono Pausilipon, Naples, Italy
| | - Dario Iafusco
- Department of Women and Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
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8
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Salzano G, Passanisi S, Pira F, Sorrenti L, La Monica G, Pajno GB, Pecoraro M, Lombardo F. Quarantine due to the COVID-19 pandemic from the perspective of adolescents: the crucial role of technology. Ital J Pediatr 2021; 47:40. [PMID: 33618753 PMCID: PMC7897888 DOI: 10.1186/s13052-021-00997-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The year 2020 will be remembered as the "year of the COVID-19 pandemic". The world population had to familiarize themselves with words as swabs, personal protective equipment, pandemic. To curb the wave of the pandemic, almost all the countries imposed self-isolation and social distancing. We conducted a web-based survey to investigate the behavioural responses during the quarantine due to the COVID-19 pandemic. METHODS Participants were 1860 youth aged 12-18 years attending lower secondary schools and upper secondary schools. Data were collected on demographic characteristics, lifestyle changes during the quarantine period, and the psychological impact of the lock-down on adolescents' life. RESULTS Most adolescents experienced feelings of fear, discouragement, and anxiety which strongly affected the approach to their daily lifestyles. Most of the surveyed subjects reported having used this period to acquire new skills and to practice physical activities at home. The use of technology was predominant both for recreational activities and educational purposes. CONCLUSIONS Despite the strong psychological impact of the quarantine, adolescents showed good levels of resilience. Technology played a crucial role during the quarantine for young subjects who have increased the daily use of technological devices to stay connected with the rest of the world.
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Affiliation(s)
- Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy.
| | - Francesco Pira
- Department of Ancient and Modern Civilizations, University of Messina, Messina, Italy
| | - Lacrima Sorrenti
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Giuseppa La Monica
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Maria Pecoraro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy
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9
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Mazzolani BC, Smaira FI, Astley C, Iraha AY, Pinto AJ, Marques IG, Cordeiro Amarante M, Rezende NS, Sieczkowska SM, Franco TC, Miranda LCDA, Lindoso L, Helito AC, Oba J, Queiroz LB, Pereira RMR, Roschel H, Silva CA, Gualano B. Changes in Eating Habits and Sedentary Behavior During the COVID-19 Pandemic in Adolescents With Chronic Conditions. Front Pediatr 2021; 9:714120. [PMID: 34966698 PMCID: PMC8711628 DOI: 10.3389/fped.2021.714120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Among healthy adolescents, school closures and home confinement were shown to increase unhealthier eating habits and sedentary behavior. It remains unknown to which extent the pandemic has impacted the lifestyle of adolescents with chronic conditions. Thus, the aim of this study is to report on the impact of the COVID-19 outbreak on eating habits and sedentary behavior among adolescents with multiple chronic conditions (n = 347) from a tertiary, referral hospital vs. healthy peers. Methods: This observational study was conducted in São Paulo (Brazil) between July and October 2020, period in which a set of social distancing measures to contain the pandemic. Results: The main findings of this study were that adolescents with chronic conditions and health peers showed important changes in eating habits (e.g., more often cooking and eating in front of television than before quarantine). Also, 86.8% of adolescents with chronic conditions and 91.6% of healthy adolescents reported increasing screen time during pandemic. No major differences were observed between patients and controls. Conclusions: Adolescents with chronic conditions and healthy peers exposed to pandemic showed substantial changes in lifestyle, stressing the need for specific care to mitigate poor eating habits and excessive sedentary behavior for patients and healthy adolescents.
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Affiliation(s)
- Bruna Caruso Mazzolani
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Fabiana Infante Smaira
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Camilla Astley
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Amanda Yuri Iraha
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Ana Jessica Pinto
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Isabela Gouveia Marques
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Milla Cordeiro Amarante
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Nathalia Saffioti Rezende
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Sofia Mendes Sieczkowska
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Tathiane Christine Franco
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Luana Cristina do Amaral Miranda
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Lívia Lindoso
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Carame Helito
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Jane Oba
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Ligia Bruni Queiroz
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria R Pereira
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Hamilton Roschel
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Clovis Artur Silva
- Instituto da Criança e do Adolescente, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil.,Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina (HCFMUSP), Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Gualano
- Applied Physiology and Nutrition Research Group, Rheumatology Division, School of Physical Education and Sport, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Laboratory of Assessment and Conditioning in Rheumatology, Disciplina de Reumatologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, São Paulo, Brazil.,Food Research Center, University of São Paulo, São Paulo, Brazil
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Williams PCM, Howard-Jones AR, Hsu P, Palasanthiran P, Gray PE, McMullan BJ, Britton PN, Bartlett AW. SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings. Pathology 2020; 52:801-8. [PMID: 32888706 DOI: 10.1016/j.pathol.2020.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
As the SARS-CoV-2 pandemic unfolds across the globe, consistent themes are emerging with regard to aspects of SARS-CoV-2 infection and its associated disease entities in children. Overall, children appear to be less frequently infected by, and affected by, SARS-CoV-2 virus and the clinical disease COVID-19. Large epidemiological studies have revealed children represent less than 2% of the total confirmed COVID-19 cases, of whom the majority experience minimal or mild disease that do not require hospitalisation. Children do not appear to be major drivers of SARS-CoV-2 transmission, with minimal secondary virus transmission demonstrated within families, schools and community settings. There are several postulated theories regarding the relatively low SARS-CoV-2 morbidity and mortality seen in children, which largely relate to differences in immune responses compared to adults, as well as differences in angiotensin converting enzyme 2 distribution that potentially limits viral entry and subsequent inflammation, hypoxia and tissue injury. The recent emergence of a multisystem inflammatory syndrome bearing temporal and serological plausibility for an immune-mediated SARS-CoV-2-related disease entity is currently under investigation. This article summarises the current available data regarding SARS-CoV-2 and the paediatric population, including the spectrum of disease in children, the role of children in virus transmission, and host-virus factors that underpin the unique aspects of SARS-CoV-2 pathogenicity in children.
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11
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Abstract
COVID-19 disease affects all ages, but severe cases of the disease and mortality are very rarely seen among children. In most cases, they acquire the virus from their parents or from an another infected person. The exact reasons why the disease has a milder course in children is unknown but high numbers of Angiotensin Converting Enzyme-2 (ACE2) receptors, underdeveloped immune responses, cross-reaction with other viruses, protective effect of fetal hemoglobin and fewer outdoor activities as well as journeys, and nonexposure to air pollution, and smoking. Although many cases are asymptomatic, they can still shed the virus. Materno-fetal vertical transmission has not been shown so far. In symptomatic cases, clinical findings include fever and respiratory symptoms, followed by diarrhea and vomiting. There are signs indicating a possible association between Kawasaki disease and COVID-19. Clinical findings and diagnostic procedures in newborns, and older children are similar. Supportive therapy is essential and antiviral agents are not required in most cases. During cytokine storm, anti-inflammatory treatments may be tried. There is no evidence for transmission through breastmilk; therefore infected mothers should breastfeed their infants by taking all precautions. Routine immunizations of children should not be deferred during COVID-19 outbreak period. Psychological support for children who need to stay at home and for healthcare personnel should be provided.
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Affiliation(s)
- Fahri Ovali
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Istanbul, Turkey
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12
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Abstract
Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV-2) affects people at all ages and it may be encountered in pregnant women and newborns also. The information about its clinical features, laboratory findings and prognosis in children and newborns is scarce. All the reported cases in pregnant women were in the 2nd or 3rd trimester and only 1% of them developed severe disease. Miscarriages are rare. Materno-fetal transmission of the disease is controversial. Definitive diagnosis can be made by a history of contact with a proven case, fever, pneumonia and gastrointestinal disorder and a Polymerase chain reaction (PCR) test of nasopharyngeal swabs. Lymphopenia as well as liver and renal dysfunctions may be seen. Suspected or proven cases of newborns with symptoms should be quarantined in the neonatal intensive care unit for at least 14 days with standart and droplet isolation precautions. Asymptomatic infants may be quaratined at home. Transport of the neonates should be performed in a dedicated transport incubator and ambulance with isolation precautions. There is no specific treatment for the disease, but hemodynamic stabilization of the infant, respiratory management and other daily care are essential. Drugs against cytokine storm syndrome such as corticosteroids or tocilizumab are under investigation. Routine antibiotics are not recommended. No deaths have been reported so far in the neonatal population. Families and healthcare staff should receive pyschological support. Since the infection is quite new and knowledge is constantly accumulating, following developments and continuous updates are crucial.
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Affiliation(s)
- Fahri Ovalı
- Division of Neonatology, Department of Pediatrics, Istanbul Medeniyet University, Istanbul, Turkey
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13
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Passanisi S, Pecoraro M, Pira F, Alibrandi A, Donia V, Lonia P, Pajno GB, Salzano G, Lombardo F. Quarantine Due to the COVID-19 Pandemic From the Perspective of Pediatric Patients With Type 1 Diabetes: A Web-Based Survey. Front Pediatr 2020; 8:491. [PMID: 32850562 PMCID: PMC7411347 DOI: 10.3389/fped.2020.00491] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background: A crucial aspect of the 2019 coronavirus disease (COVID-19) pandemic was the psychological impact on the population. Most countries issued restrictive laws to reduce community-based viral spread. Children and adolescents were forced to experience physical and social distancing. Subjects with chronic diseases, such as type 1 diabetes, were more vulnerable and at higher risk of developing psychological disorders. Methods: We conducted a web-based survey to investigate the behavioral responses during quarantine due to the COVID-19 outbreak in a cohort of pediatric patients with type 1 diabetes. Data were collected on demographic and clinical characteristics, lifestyle changes, and the impact of COVID-19 on the management of diabetes. Results: Two hundred four pediatric patients (aged 5-18 years) with type 1 diabetes completed the questionnaire. Interestingly, patients ≤12 years were significantly more influenced by the quarantine period in their approach to the disease than older patients. Conclusion: Although quarantine was a stressful psychological condition, our results showed that most children and adolescents with type 1 diabetes developed high levels of resilience and excellent coping skills by using technology in a proper way.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Maria Pecoraro
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Francesco Pira
- Department of Ancient and Modern Civilizations, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, Messina, Italy
| | - Vittoria Donia
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Paola Lonia
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giovanni Battista Pajno
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
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