Major discrepancy between clinical diagnosis of death and anatomopathological findings in adolescents with chronic diseases during 18-years

Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents’ autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). Results: Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). Conclusion: This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies

Poor Sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine

OBJECTIVE: To assess the possible factors that influence sleep quality in adolescents with and without chronic immunosuppressive conditions quarantined during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This cross-sectional study included 305 adolescents with chronic immunocompromised conditions and 82 healthy adolescents. Online surveys were completed, which included questions on socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and the following validated questionnaires: the Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0), and Pediatric Outcome Data Collection Instrument (PODCI). RESULTS: The median current age [14 (10-18) vs. 15 (10-18) years, p=0.847] and frequency of female sex (62% vs. 58%, p=0.571) were similar in adolescents with chronic conditions compared with healthy adolescents. The frequency of poor sleep quality was similar in both groups (38% vs. 48%, p=0.118). Logistic regression analysis, including both healthy adolescents and adolescents with chronic conditions (n=387), demonstrated that self-reported increase in screen time (odds ratio [OR] 3.0; 95% confidence interval [CI] 1.3-6.8; p=0.008) and intrafamilial violence report (OR 2.1; 95% CI 1.2-3.5; p=0.008) were independently associated with poor sleep quality in these adolescents. However, the PODCI global function score was associated with a lower OR for poor sleep quality (OR 0.97; 95% CI 0.94-0.99; p=0.001). Further logistic regression, including only adolescents with chronic conditions (n=305), demonstrated that self-reported increase in screen time (OR 3.1; 95% CI 1.4-6.8; p=0.006) and intrafamilial violence report (OR 2.0; 95% CI 1.2-3.4; p=0.011) remained independently associated with poor quality of sleep, whereas a lower PODCI global function score was associated with a lower OR for sleep quality (OR 0.96; 95% CI 0.94-0.98; p<0.001). CONCLUSION: Self-reported increases in screen time and intrafamilial violence report impacted sleep quality in both healthy adolescents and those with chronic conditions. Decreased health-related quality of life was observed in adolescents with poor sleep quality

Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital

OBJECTIVES: To prospectively evaluate demographic, anthropometric and health-related quality of life (HRQoL) in pediatric patients with laboratory-confirmed coronavirus disease 2019 (COVID-19) METHODS: This was a longitudinal observational study of surviving pediatric post-COVID-19 patients (n=53) and pediatric subjects without laboratory-confirmed COVID-19 included as controls (n=52) was performed. RESULTS: The median duration between COVID-19 diagnosis (n=53) and follow-up was 4.4 months (0.8-10.7). Twenty-three of 53 (43%) patients reported at least one persistent symptom at the longitudinal follow-up visit and 12/53 (23%) had long COVID-19, with at least one symptom lasting for >12 weeks. The most frequently reported symptoms at the longitudinal follow-up visit were headache (19%), severe recurrent headache (9%), tiredness (9%), dyspnea (8%), and concentration difficulty (4%). At the longitudinal follow-up visit, the frequencies of anemia (11% versus 0%, p=0.030), lymphopenia (42% versus 18%, p=0.020), C-reactive protein level of >30 mg/L (35% versus 0%, p=0.0001), and D-dimer level of >1000 ng/mL (43% versus 6%, p=0.0004) significantly reduced compared with baseline values. Chest X-ray abnormalities (11% versus 2%, p=0.178) and cardiac alterations on echocardiogram (33% versus 22%, p=0.462) were similar at both visits. Comparison of characteristic data between patients with COVID-19 at the longitudinal follow-up visit and controls showed similar age (p=0.962), proportion of male sex (p=0.907), ethnicity (p=0.566), family minimum monthly wage (p=0.664), body mass index (p=0.601), and pediatric pre-existing chronic conditions (p=1.000). The Pediatric Quality of Live Inventory 4.0 scores, median physical score (69 [0-100] versus 81 [34-100], p=0.012), and school score (60 [15-100] versus 70 [15-95], p=0.028) were significantly lower in pediatric patients with COVID-19 at the longitudinal follow-up visit than in controls. CONCLUSIONS: Pediatric patients with COVID-19 showed a longitudinal impact on HRQoL parameters, particularly in physical/school domains, reinforcing the need for a prospective multidisciplinary approach for these patients. These data highlight the importance of closer monitoring of children and adolescents by the clinical team after COVID-19

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

Objective: To assess factors associated with emotional changes and Hyperactivity/Inattention (HI) motivated by COVID-19 quarantine in adolescents with immunocompromising diseases. Methods: A cross-sectional study included 343 adolescents with immunocompromising diseases and 108 healthy adolescents. Online questionnaires were answered including socio-demographic data and self-rated healthcare routine during COVID-19 quarantine and validated surveys: Strengths and Difficulties Questionnaire (SDQ), Pittsburgh Sleep Quality Index (PSQI), Pediatric Quality of Life Inventory 4.0 (PedsQL4.0). Results: The frequencies of abnormal emotional SDQ scores from adolescents with chronic diseases were similar to those of healthy subjects (110/343 [32%] vs. 38/108 [35%], p = 0.548), as well as abnormal hyperactivity/inattention SDQ scores (79/343 [23%] vs. 29/108 [27%], p = 0.417). Logistic regression analysis of independent variables associated with abnormal emotional scores from adolescents with chronic diseases showed: female sex (Odds Ratio [OR = 3.76]; 95% Confidence Interval (95% CI) 2.00‒7.05; p < 0.001), poor sleep quality (OR = 2.05; 95% CI 1.08‒3.88; p = 0.028) and intrafamilial violence during pandemic (OR = 2.17; 95% CI 1.12‒4.19; p = 0.021) as independently associated with abnormal emotional scores, whereas total PedsQL score was inversely associated with abnormal emotional scores (OR = 0.95; 95% CI 0.93‒0.96; p < 0.0001). Logistic regression analysis associated with abnormal HI scores from patients evidenced that total PedsQL score (OR = 0.97; 95% CI 0.95‒0.99; p = 0.010], changes in medical appointments during the pandemic (OR = 0.39; 95% CI 0.19-0.79; p = 0.021), and reliable COVID-19 information (OR = 0.35; 95% CI 0.16‒0.77; p = 0.026) remained inversely associated with abnormal HI scores. Conclusion: The present study showed emotional and HI disturbances in adolescents with chronic immunosuppressive diseases during the COVID-19 pandemic. It reinforces the need to promptly implement a longitudinal program to protect the mental health of adolescents with and without chronic illnesses during future pandemics

Health-related quality of life and functionality in primary caregiver of surviving pediatric COVID-19

ObjectivesTo prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19.MethodsA longitudinal observational study was carried out on primary caregivers of surviving pediatric post-COVID-19 patients (n = 51) and subjects without COVID-19 (n = 60). EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and 12-question WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) were answered for both groups. The univariate regression analysis was carried out using SPSS (v 20) and significance was established at 5%.ResultsThe median duration between COVID-19 diagnosis in children and adolescents and longitudinal follow-up visits was 4.4 months (0.8–10.7). The median age of children and adolescents caregivers with laboratory-confirmed COVID-19 was similar to primary caregivers of subjects without laboratory-confirmed COVID-19 [43.2 (31.6–60.9) vs. 41.5 (21.6–54.8) years, p = 0.08], as well as similar female sex (p = 1.00), level of schooling (p = 0.11), social assistance program (p = 0.28), family income/month U$ (p = 0.25) and the number of household’s members in the residence (p = 0.68). The frequency of slight to extreme problems (level ≥ 2) of the pain/discomfort domain according to EQ-5D-5L score was significantly higher in the former group [74% vs. 52.5%, p = 0.03, OR = 2.57 (1.14–5.96)]. The frequency of disability according to WHODAS 2.0 total score was similar to those without disability and unknown (p = 0.79); however, with a very high disability in both groups (72.5% and 78.3%). Further analysis of primary caregivers of children and adolescents with post-COVID-19 condition (PCC) [n = 12/51 (23%)] compared to those without PCC [n = 39/51(77%)] revealed no differences between demographic data, EQ-5D-5L and WHODAS 2.0 scores in both groups (p > 0.05).ConclusionWe longitudinally demonstrated that pain/discomfort were predominantly reported in approximately 75% of primary caregiver of COVID-19 patients, with high disability in approximately three-quarters of both caregiver groups. These data emphasized the prospective and systematic caregiver burden evaluation relevance of pediatric COVID-19

Impact of social distancing on the physical and psychological health of adolescents with preexisting immunosuppressive/immunomediated chronic conditions during the confrontation of COVID-19

INTRODUÇÃO: Durante o ano de 2020, o mundo vivenciou uma crise sanitária global devido a COVID-19. Nesse período medidas sanitárias, incluindo a quarentena para conter a propagação viral foram instituídas. Dentre essas medidas estavam o uso de máscara, distanciamento e isolamento social. A conexão social é primordial para o desenvolvimento adequado das funções psicossocial durante a adolescência. Dessa forma, a quarentena teve um efeito potencialmente negativo na saúde física e mental. Não há estudos sistematizados avaliando o impacto do isolamento social/quarentena na saúde física e psíquica de adolescentes com condições crônicas. OBJETIVOS: Comparar e correlacionar indicadores de saúde física e mental em adolescentes com condições crônicas e adolescentes saudáveis durante a quarentena da COVID-19. MÉTODOS: Estudo transversal analítico, que incluiu 355 adolescentes com condições crônicas e 111 adolescentes saudáveis entre 10 a 18 anos. Foram aplicados dois questionários online no período julho a setembro de 2020. O primeiro destes foi criado pela equipe médica do Instituto da Criança e do Adolescente da Faculdade de Medicina da Universidade de São Paulo para investigar características sociodemográficas, rotina de saúde e o impacto da quarentena na saúde física e mental. O segundo foi a versão autorrelatada e validada para língua e cultura brasileira do Questionário de Capacidades e Dificuldades (SDQ) para avaliar a saúde mental dos adolescentes. RESULTADOS: A mediana de idade em anos [14 (10-18) vs. 15 (10-18), p = 0,733] e frequências do sexo feminino (61% vs. 60%, p = 0,970) foram semelhantes entre adolescentes com condições crônicas e adolescentes saudáveis durante a quarentena da pandemia de COVID-19. As frequências de escore total de dificuldades anormais do SDQ foram semelhantes em pacientes e controles (30% vs. 31%, p = 0,775). A análise de regressão logística mostrou que sexo feminino (OR = 1,965; IC 95% = 1,091-3,541) e medo da atividade/complicação da doença de base (OR = 1,009; IC 95% = 1,001-1,018) foram associados à disfunção psicossocial em adolescentes com condições crônicas, enquanto tarefa de casa escolar (OR = 0,449; IC 95% = 0,206-0,981) e atividade física (OR = 0,990; IC 95% = 0,981-0,999) foram fatores de proteção. A análise mais aprofundada de pacientes com condições crônicas e diagnóstico prévio de transtornos mentais (9%) mostrou maior mediana do escore total de dificuldades total, emocional, conduta, problemas interpares e hiperatividade (p < 0,050) em comparação com pacientes sem diagnóstico. CONCLUSÕES: Esse estudo demonstrou que a atual pandemia e as restrições subsequentes impactaram negativamente tanto a saúde mental de adolescentes com condições crônicas como os saudáveis. Dessa forma, é importante o sistema de saúde garantir a continuidade dos adolescentes com condições crônicas de forma regular e iniciar programas voltados para a saúde mental de adolescentes saudáveis durante a pandemiaINTRODUCTION: During the year 2020, the world experienced a global health crisis due to COVID-19. During this period, sanitary measures, including quarantine to contain the viral spread, were instituted. Among these measures were the use of mask, distancing and social isolation. Social connection is essential for the proper development of psychosocial functions during adolescence. In this way, quarantine had a potentially negative effect on physical and mental health. There are no systematic studies evaluating the impact of social isolation/quarantine on the physical and mental health of adolescents with chronic conditions. OBJECTIVES: To compare and correlate physical and mental health indicators in adolescents with chronic conditions and healthy adolescents during the COVID-19 quarantine. METHODS: Analytical crosssectional study, which included 355 adolescents with chronic conditions and 111 healthy adolescents, aged between 10 to 18 years. Two online questionnaires were applied from July to September 2020. The first of these was created by the medical staff of the Instituto da Criança e do Adolescente da Faculdade de Medicina da Universidade de São Paulo to investigate sociodemographic characteristics, health routine and the impact of the quarantine on physical and mental health. The second was the self-reported and validated version for the Brazilian language and culture of the Strengths and Difficulties Questionnaire (SDQ) to assess the mental health of adolescents. RESULTS: The median of age in years [14 (10-18) vs. 15 (10-18), p = 0.733] and female frequency (61% vs. 60%, p = 0.970) were similar between adolescents with chronic conditions and healthy adolescents during the quarantine of the COVID-19 pandemic. The abnormal total difficulties score of SDQ frequency was similar in both groups (30% vs. 31%, p = 0.775). Logistic regression analysis showed that female sex (OR = 1,965; 95% CI = 1,091-3,541), fear of underlying disease activity/complication (OR = 1,009; 95% CI = 1,001-1,018) were associated with psychosocial dysfunction in adolescents with chronic conditions, while school homework (OR = 0.449; 95% CI = 0.206-0.981) and physical activity (OR = 0.990; 95% CI = 0.981-0.999) were protective factors. Further analysis of patients with chronic conditions and a previous diagnosis of mental disorders (9%) showed a higher median total score for difficulties, emotional conduct, peer problems and hyperactivity (p < 0.050) compared with patients without a diagnosis. CONCLUSIONS: This study showed that the current pandemic and subsequent restrictions negatively impacted both the mental health of adolescents with chronic conditions and healthy adolescents. Thus, it is important for the health system to ensure the continuity of adolescents with chronic conditions on a regular basis and to initiate programs aimed at the mental health of healthy adolescents during the pandemi