Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)

BACKGROUND

The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial.

METHODS

The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life.

RESULTS

Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries.

LIMITATIONS

Cross-sectional and anonymous design.

CONCLUSIONS

Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.

The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic

BACKGROUND

. High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed.

METHODS

. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others.

RESULTS

. Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive.

LIMITATIONS

. Cross-sectional survey, preponderance of non-representative participants.

CONCLUSIONS

. Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics.

Cardiac masses and contrast echocardiography

Funding Acknowledgements

Type of funding sources: None.

Introduction

echocardiography may be the first imaging modality detecting a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast echocardiography may aid in the differential diagnosis. Methods: we describe five cardiac masses in which echo-contrast helped to assess the presence or not of vascularization. Panel A shows a left atrial mass attached to the fossa ovalis with a large stalk prolapsing to the mitral inflow. Contrast echocardiography showed late but homogeneous opacification of the mass. Gross pathology confirmed an atrial mixoma. Panel B shows two masses in a patient with non-small cell lung cancer one embedded in the inferior left ventricular wall and the other floating in the left atrium. Administration of echo-contrast showed late and inhomogeneous enhancement of the myocardial mass and absent opacification of the atrial mass suggesting a metastatic infiltration of the myocardium together with an avascular neoplastic thrombus in the left atrium. Panel C shows a multi-lobulated and mobile mass in the right atrium straddling the tricuspid valve. Contrast echocardiography highlighted an inhomogeneous diffusion of the contrast within the mass with a rapid opacification only of its atrial portion. Gross pathology confirmed a recurrent thymoma. Panel D shows an intraventricular mass arising from the interventricular septum with multiple hypoechoic areas in a patient with metastatic carcinoid. Contrast administration showed a very late and mild degree of inhomogeneous enhancement. Conclusion:  the echo-contrast allows a good differentiation between vascularized and non-vascularized cardiac masses, providing an important indication to differentiate thrombus from tumor. In those hypervascularized masses the homogeneous or inhomogeneous distribution of the contrast could be an interesting clue that orientates between primary or secondary cardiac tumors. Abstract Figure.

P1345 Tumors metastatic to the heart :Echo, CT, CMR Imaging

Background

The frequency of secondary metastatic tumors has increased over years attributable to increased life expectancy in oncologic patients. Imaging with different methods: echo, CMR, CT and PET can provide noninvasive characterization of cardiac masses. We present 3 cases of cardiac metastasis, different for localization in the heart, pathways of dissemination and relation with neighboring structures.

Case 1: a 62-years-old male was admitted to Cardiology department for chest pain and epistaxis. Patient’s medical history was negative for cardiovascular disease. The routine TTE detected a rounded,immobile,intra-myocardial mass (Panel A, fig.1) a the level of the interventricular septum protruding in the LV cavity. The mass was characterized by several anecogenic cavities and echo-contrast showed slight late hyperenhancement of the mass confirming vascularity (fig. 2).CMR gadolinium imaging confirmed late enhancement at the level of the edges of the cavities and in the external border (fig.4). In the suspicion of neuroendocrine tumor, a Gallium-68 dotatate PET/CT was performed with detection of pathological uptake at the abdominal and cardiac level (fig.3).

Case 2: a 64-years-old woman presented with shortness of breath, fatigue and weight loss in the past three months. History of smoke was present and diagnosis of non-small cell lung cancer was made. PET-CT demonstrated pathological uptake at pulmonary, limph-nodes, adrenal, hepatic, bone, muscular and pericardial level (Panel B, fig.1).CMR clearly revealed a massive lesion (7x3x3.5 cm) at the level of the LV antero-lateral wall (fig.2) and TTE SAX view (fig.3) confirmed the presence of a large infiltrative immobile mass in the antero-lateral wall. In the same region the pericardium was irregular and thickened suggestive of pericardial tumor involvement. Some degree of pericardial effusion was also present. The ECG was consistent with ST-T elevation in D1 and aVL in absence of ischemic symptoms (fig.4).Case 3: a 78-years-old man known for non-small cell lung cancer underwent transthoracic echo for monitoring cardiotoxicity.Two–chamber TTE showed a intra-myocardial mass in the inferior wall of LV and another rounded mass at the left atrial level (Panel C, fig.1). Chest CT showed the pulmonary mass with irregular borders, intravascular invasion of left lower pulmonary vein (LLPV) and extension into the left atrium (fig.2).2D/3D TEE well demonstrated the atrial invasion by the mass composed by one more echogenic part inside the llpv and outside in the left atrium a rounded head with several region of cystic colliquation (fig.3). Attached to the rounded head irregular protuberances was noted (thrombus?, fig.4). Conclusion: metastasis to the heart and pericardium are much more common than primary cardiac tumors and occur late in the course of malignant disease. Echo is the initial diagnostic test to evaluate for the presence of cardiac metastases.

Abstract P1345 Figure. Different cases of cardiac metastasis

[Donors' personal profile in Tuscany's network of milk banks]

AIM

An investigation on human milk donors among the milk banks of Tuscany's network was carried out. Milk banks select, collect, check, process, store and deliver human milk, whose donors should have certain physical and psychological well-being features. The aim of the study was to describe a personal and social profile of milk donors.

METHODS

The study included a sample of 100 milk donors and a sample of 100 non-milk donor mothers; a questionnaire that collected data about mothers' general information, clinical history, pregnancy and delivery, weight variations, state of health, lifestyle, breastfeeding and knowledge about milk banks was administered to all of them. Then information about food history of mothers has also been collected.

RESULTS

First the samples of donors were analysed for all variables considered. Subsequently the samples of donors were compared with the samples of non-donors: statistical analysis was carried out with χ2 test and documented significant differences between donors and non-donors for the majority of variables considered in the questionnaire and for food history.

CONCLUSION

Milk donors have a good state of health, and the integration in milk donation initiative headed towards a healthier lifestyle. It is necessary to promote an advertising campaign to integrate social and sanitary politics, fitting to local socio-economical contest. Furthermore, the improvement of milk banks of public hospitals is necessary, as hospitals are places of major stream both of potential donors and newborns.

Dual source CT: state of the art in the depiction of coronary arteries anatomy, anatomical variants and myocardial segments

Cardiovascular disease is the leading cause of death in adults in western countries. Coronary angiography remains the gold standard for the diagnosis of coronary artery disease, a procedure that carries risks. Nowadays, a significant number of the coronary angiographies performed every year are only diagnostic. Multidetector computed tomography (MDCT) allows non-invasive evaluation of coronary arteries. It is a continuously developing technique, and actually the top technology is represented by Dual Source CT. This scanner of new conception permits an improvement in image quality, and visualization of distal vessels and small collateral branches. The aim of our work is to illustrate the actual state of the art in non-invasive coronary arteries evaluation represented by Dual Source CT, presenting images of coronary arteries normal anatomy, anatomical variants and myocardial segment.

Abatement of thermal noise due to internal damping in 2D oscillators with rapidly rotating test masses

Mechanical oscillators can be sensitive to very small forces. Low frequency effects are up-converted to higher frequency by rotating the oscillator. We show that for 2-dimensional oscillators rotating at frequency much higher than the signal the thermal noise force due to internal losses and competing with it is abated as the square root of the rotation frequency. We also show that rotation at frequency much higher than the natural one is possible if the oscillator has 2 degrees of freedom, and describe how this property applies also to torsion balances. In addition, in the 2D oscillator the signal is up-converted above resonance without being attenuated as in the 1D case, thus relaxing requirements on the read out. This work indicates that proof masses weakly coupled in 2D and rapidly rotating can play a major role in very small force physics experiments.

Examination of periodontal pathogens in stenotic valve specimens and in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis

Periodontitis may be a risk factor for atherosclerosis and coronary heart disease. The influence of periodontal pathogens in cardiovascular diseases needs further investigation. Therefore, the aims of this clinical study are: to test the presence of periodontal bacteria DNA in aortic valves and to assess the concomitant presence of the same periodontal bacteria DNA in whole blood samples in patients affected by aortic valve stenosis and chronic periodontitis. Nineteen consecutive patients (12 males and 7 females, age: 49-85 years) were enrolled in this study after having been subjected to a complete periodontal evaluation to confirm the diagnosis of chronic periodontitis. All patients were scheduled for aortic valve replacement surgery. After clinical and microbial periodontal examination, the aortic valve tissue specimens were obtained by excision during valve replacement surgery and the patients were subjected to the whole blood sampling before the surgery. The polymerase chain reaction technology was used to detect the putative periodontal pathogens Tannerella forshytia, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens and Treponema denticola. Neither the 19 aortic valve specimens nor the blood samples were positive for the genoma of the selected periodontal pathogens. The selected periodontal pathogens did not colonize the aortic valve of patients affected by stenosis and bacterial genoma was not present in whole blood samples. A high blood pressure at the aortic valve may prevent the adhesion and proliferation of bacterial colonies.

[Algorithm for assessment of exposure to asbestos]

There is no universally approved method in the scientific literature to identify subjects exposed to asbestos and divide them in classes according to intensity of exposure. The aim of our work is to study and develope an algorithm based on the findings of occupational anamnestical information provided by a large group of workers. The algorithm allows to discriminate, in a probabilistic way, the risk of exposure by the attribution of a code for each worker (ELSA Code--work estimated exposure to asbestos). The ELSA code has been obtained through a synthesis of information that the international scientific literature identifies as the most predictive for the onset of asbestos-related abnormalities. Four dimensions are analyzed and described: 1) present and/or past occupation; 2) type of materials and equipment used in performing working activity; 3) environment where these activities are carried out; 4) period of time when activities are performed. Although it is possible to have informations in a subjective manner, the decisional procedure is objective and is based on the systematic evaluation of asbestos exposure. From the combination of the four identified dimensions it is possible to have 108 ELSA codes divided in three typological profiles of estimated risk of exposure. The application of the algorithm offers some advantages compared to other methods used for identifying individuals exposed to asbestos: 1) it can be computed both in case of present and past exposure to asbestos; 2) the classification of workers exposed to asbestos using ELSA code is more detailed than the one we have obtained with Job Exposure Matrix (JEM) because the ELSA Code takes in account other indicators of risk besides those considered in the JEM. This algorithm was developed for a project sponsored by the Italian Armed Forces and is also adaptable to other work conditions for in which it could be necessary to assess risk for asbestos exposure.

Global cardiac evaluation without heart rate control: preliminary experience with dual source CT (DSCT)

AIM

The aim of this work was to assess the role of dual source computed tomography (DSCT) in global cardiac evaluation without heart rate control, assessing the effect of average heart rate on coronary image quality, optimal reconstruction interval, ventricular function, and evaluation of left chamber valves.

METHODS

Fifteen consecutive patients under-went coronary CT angiography. For coronary evaluation, data sets were reconstructed in 5% steps from 30% to 80% of the RR interval. For the assessment of cardiac function, image were reconstructed with a slice thickness of 2.0 mm and 2.0 mm increment, at 10% steps from 0% to 90% of the RR interval. Two blinded independent readers assessed the image quality of the coronary arteries and left chamber valves.

RESULTS

The mean heart rate during the scan was 73+/-11.8 bpm (range 56-97). At the best reconstruction interval excellent diagnostic image quality (score 4) was achieved in 95.5% (43/45) of coronary arteries. Excellent inter-observer agreement was observed for image quality rating (k=0.82). No significant correlation was found between the average heart rate and the mean quality scores (rho=0.29). Comparison of image quality of the coronary arteries in systolic and diastolic reconstructions in each patient showed no statistically significant differences.

CONCLUSION

DSCT is an excellent technique for global cardiac imaging, as it allows to obtain coronary arteries of excellent quality and evaluate ventricular function and valvular area independent of the heart rate.

Immune reconstitution in human immunodeficiency virus type 1-infected children with different virological responses to anti-retroviral therapy

Immune repopulation, despite virological failure, often occurs in children under highly active anti-retroviral therapy (HAART). The aim of this study was to analyse the characteristics of immune repopulation and activation in children with and without virological response to HAART. Fourteen human immunodeficiency virus type 1 (HIV-1)-infected children with suppression of HIV-1 plasma viraemia (virological responders, VR) and 16 virological non-responders (VNR) to therapy were studied at baseline and after approximately 2 years of HAART. During therapy, CD4+ T cells increased in both groups, but were higher in the VR than in the VNR group. All CD4+ T cell subsets (naive, central memory, effector/memory and CD38+) increased significantly in VR children, while there was a significant increase only in naive cells in VNR children. Naive CD8+ T cells and T cell receptor rearrangement excision circles (TREC), an indicator of thymic output, increased in both VR and VNR children. Activated CD8+ CD38+ T cells decreased in VR but remained high in VNR children. Levels of circulating lipopolysaccharide (LPS), an indicator of microbial translocation, further increased in VNR children. In conclusion, HAART induced an increase in naive cells in all children, regardless of their virological response. However, the persistence of viraemia resulted in an impaired expansion of memory CD4+ T cells susceptible to HIV-1 infection, and together with the microbial translocation sustained the persistence of a high level of immune activation.

Impaired coronary and myocardial flow in severe aortic stenosis is associated with increased apoptosis: a transthoracic Doppler and myocardial contrast echocardiography study

OBJECTIVE

To test the hypothesis that impaired coronary and myocardial blood flow are linked with increased myocyte apoptosis, thus establishing a link between pressure overload and left ventricular (LV) remodelling.

METHODS AND RESULTS

Peak diastolic coronary blood flow velocity (CBFV) was evaluated at transthoracic Doppler echocardiography, and signal intensity (SI) and the rate of SI rise (beta) were measured at myocardial contrast echocardiography in 11 patients with severe aortic stenosis and LV hypertrophy. In the same patients, biopsies were obtained from the anterolateral LV free wall during surgery and analysed for cardiomyocyte apoptosis. LV mass corrected CBFV (CBFVI) was significantly lower in patients than in controls (median 0.100 cm.g/s (interquartile range 0.07-0.115) v 0.130 cm.g/s (0.130-0.160), p = 0.002). Similarly, SI*beta was significantly lower in patients than in controls (11 1/s (8-66) v 83 1/s (73-95), p = 0.001). Apoptotic rate was increased in aortic stenosis more than 100-fold versus controls (1.2% (0.8-1.4) v 0.01% (0.01-0.01), p < 0.001) and inversely correlated with lower CBFVI and SI*beta (r = -0.77, p = 0.001 for both).

CONCLUSIONS

Patients with severe aortic stenosis and LV hypertrophy have impaired myocardial perfusion, which is associated with enhanced cardiomyocyte apoptosis. Impaired myocardial perfusion and the ensuing oxygen demand-supply imbalance may, at least partially, be responsible for increased apoptosis and possible transition to heart failure, thus establishing a link between pressure overload, LV remodelling, and heart failure.

[Comparison of mechanical and manual anastomoses in emergency gastric resection]

Hundred and twenty-one patients underwent emergency subtotal gastrectomy for complications related to peptic ulcer (86) and malignant diseases (35). According to the type of anastomosis performed (manual or mechanical) patients were divided into two groups: 81 with hand-sutured anastomoses (double layer) and 40 with stapled anastomoses. The latter were more commonly used in the Roux-en-Y reconstruction and Billroth 1 gastrectomy. Median operating time (192' versus 190'), hospital stay (15.2 versus 13.5 days), postoperative complications (38% versus 32.5%) and anastomotic or duodenal stump leakage (7.4% versus 5%) showed no significant difference between groups. Therefore, in emergency subtotal gastrectomy mechanical anastomoses allow to obtain results comparable to the more used manual ones.

Primary cardiomyopathy in identical twins

Seventeen year old identical twin brothers with no family history of cardiopathy began experiencing palpitations almost simultaneously. In both, examination revealed marked cardiomegaly and hypokinesia of the ventricular walls, and clinical and radiologic signs of progressive cardiac failure developed a few days later. Both boys died suddenly, 49 days and 5 months, respectively, after the initial examination. Electrocardiographic and vectorcardiographic studies revealed a severe intraventricular conduction disturbance that coincided with histologic changes in the myocardial tissue, including profuse interstitial fibrosis, hypertrophy and degeneration of the myocardial fibers, aberrant arrangement of the muscular fibers and considerable alteration of the structure of cardiac tissue. In the absence of hereditary and chromosomal factors, and excluding possible viral intervention during fetal life, it is believed that a teratogenic factor can produce the structural alterations of the tissue and derangement of the fibers observed in these hearts. The irregular contractions of the heart at the level of the net-like meshwork, disarrangement of myocardial fibers, and adaptative mechanisms of the heart inherent in the destruction of the contractile tissue contributed to the functional cardiac disorders that resulted in congestive heart failure and sudden death in these twins.

Physiopathology of Chagas' heart disease: correlations between clinical and experimental findings

In penetrating the heart and developing in it, Trypanosoma cruzi produces an immunoallergic reaction that leads to changes in the histological structure of the myocardium; these changes alter the fundamental properties of the heart, causing fundamental dynamic disorders and morphological changes in the organ.In Chagas' cardiomyopathy, the velocity of impulse propagation diminishes in the auricular and ventricular musculature, altering the activation mechanism, this being shown by changes in the P-wave and in ventricular focal blocks.The functional refractory period (FRP) is shortened in the auricular and ventricular tissue and constitutes, together with changes in conductivity, the physiopathological basis that explains the circus movement-the fundamental factor of the arrhythmias of this stage of the disease. Localization of the inflammation in the A-V conduction system increases the duration of the FRP, producing all types of A-V block.The oedema and the cellular interstitial infiltration seen during this acute phase reduce the distensibility of the fibres; this, in turn, limits their contractility, producing a decrease in systolic volume and an increase in the final diastolic pressure in the chambers of the heart-fundamental factors in reducing kinesia and in increasing the heart's volume.In the chronic phase, destruction of the contractile tissue and fibroblastic proliferation bring into play compensatory mechanisms that maintain the strength of cardiac contractions; the elongation of the fibres and the nature of the dynamic pressure-volume curves explain the dilatation of the chambers of the heart and the dynamic changes seen in this phase of the disease.

Effect of Peruvosid (CD412) on excitability and functional refractory period of atrial and ventricular tissues in cardiomyopathy caused by Trypanosoma cruzi

Attempts were made to produce myocarditis by Trypanosoma cruzi inoculation in healthy dog puppies 6 to 8 weeks old. Significant electrocardiographic abnormalities were produced, coinciding with interstitial inflammatory processes in the cardiac tissue and with degenerative changes in the myocardial fibres. In puppies showing these changes, profound changes in the excitability and the functional refractory period of the atrial and ventricular muscular tissue were observed. The administration of Peruvosid in doses of 0.0240 to 0.0647 mg./kg. tended to diminish the excitability, previously increased by the inflammatory process, at the same time increasing the functional refractory period duration which had previously been shortened. The fact that Peruvosid corrects these fundamental factors in the genesis of cardiac arrhythmias suggests that the drug may be useful in the treatment of cardiac insufficiency produced by Chagas' myocardiopathy, in which arrhythmias are one of the basic characteristics.

Disturbances in the A-V conduction system in Chagas' myocarditis in the dog

Atrioventricular (A-V) conduction and the functional refractory period (FRP) of the A-V system were studied in 13 dogs chronically infected by T. cruzi that had ECG disturbances indicative of myocarditis. Histopathologic findings at the A-V node and the bundle of His were correlated with the FRP and with conduction times of the A-V propagation system. Retarded conduction was related to inflammatory and fibrotic processes localized at the bundle of His. At relatively slow rates of stimulation, conduction time was prolonged, but the ventricle was capable of following high atrial rates. With augmented FRP, mononuclear cell infiltrates were observed in the A-V node or in the septal muscle around the node. This suggests that the node was included in the inflammatory process. No correlation was found between inflammatory infiltrates of the bundle of His and changes in the FRP. At relatively slow rates of stimulation, normal A-V conduction time corresponded to prolonged FRP. A-V conduction became slow as the atrial rate increased. A point was reached when the ventricle could not follow the moderately increased atrial rates.

Excitability of cardiac tissues was so markedly altered in 5 dogs with severe inflammatory infiltrates that a similar study of the A-V system could not be made.