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Ritto AP, de Araujo AL, de Carvalho CRR, De Souza HP, Favaretto PMES, Saboya VRB, Garcia ML, Kulikowski LD, Kallás EG, Pereira AJR, Cobello Junior V, Silva KR, Abdalla ERF, Segurado AAC, Sabino EC, Ribeiro Junior U, Francisco RPV, Miethke-Morais A, Levin ASS, Sawamura MVY, Ferreira JC, Silva CA, Mauad T, Gouveia NDC, Letaif LSH, Bego MA, Battistella LR, Duarte AJDS, Seelaender MCL, Marchini J, Forlenza OV, Rocha VG, Mendes-Correa MC, Costa SF, Cerri GG, Bonfá ESDDO, Chammas R, de Barros Filho TEP, Busatto Filho G. Data-driven, cross-disciplinary collaboration: lessons learned at the largest academic health center in Latin America during the COVID-19 pandemic. Front Public Health 2024; 12:1369129. [PMID: 38476486 PMCID: PMC10927964 DOI: 10.3389/fpubh.2024.1369129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction The COVID-19 pandemic has prompted global research efforts to reduce infection impact, highlighting the potential of cross-disciplinary collaboration to enhance research quality and efficiency. Methods At the FMUSP-HC academic health system, we implemented innovative flow management routines for collecting, organizing and analyzing demographic data, COVID-related data and biological materials from over 4,500 patients with confirmed SARS-CoV-2 infection hospitalized from 2020 to 2022. This strategy was mainly planned in three areas: organizing a database with data from the hospitalizations; setting-up a multidisciplinary taskforce to conduct follow-up assessments after discharge; and organizing a biobank. Additionally, a COVID-19 curated collection was created within the institutional digital library of academic papers to map the research output. Results Over the course of the experience, the possible benefits and challenges of this type of research support approach were identified and discussed, leading to a set of recommended strategies to enhance collaboration within the research institution. Demographic and clinical data from COVID-19 hospitalizations were compiled in a database including adults and a minority of children and adolescents with laboratory confirmed COVID-19, covering 2020-2022, with approximately 350 fields per patient. To date, this database has been used in 16 published studies. Additionally, we assessed 700 adults 6 to 11 months after hospitalization through comprehensive, multidisciplinary in-person evaluations; this database, comprising around 2000 fields per subject, was used in 15 publications. Furthermore, thousands of blood samples collected during the acute phase and follow-up assessments remain stored for future investigations. To date, more than 3,700 aliquots have been used in ongoing research investigating various aspects of COVID-19. Lastly, the mapping of the overall research output revealed that between 2020 and 2022 our academic system produced 1,394 scientific articles on COVID-19. Discussion Research is a crucial component of an effective epidemic response, and the preparation process should include a well-defined plan for organizing and sharing resources. The initiatives described in the present paper were successful in our aim to foster large-scale research in our institution. Although a single model may not be appropriate for all contexts, cross-disciplinary collaboration and open data sharing should make health research systems more efficient to generate the best evidence.
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Affiliation(s)
- Ana Paula Ritto
- Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Heraldo Possolo De Souza
- Departamento de Emergências Médicas, Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Manga e Silva Favaretto
- Diretoria Executiva dos Laboratórios de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vivian Renata Boldrim Saboya
- Diretoria Executiva dos Laboratórios de Investigação Médica, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Michelle Louvaes Garcia
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | | | - Esper Georges Kallás
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Vilson Cobello Junior
- Núcleo Especializado em Tecnologia da Informação, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Katia Regina Silva
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Eidi Raquel Franco Abdalla
- Divisão de Biblioteca e Documentação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Aluisio Augusto Cotrim Segurado
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ulysses Ribeiro Junior
- Departamento de Gastroenterologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rossana Pulcineli Vieira Francisco
- Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Miethke-Morais
- Diretoria Clínica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna Sara Shafferman Levin
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcio Valente Yamada Sawamura
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana Carvalho Ferreira
- Faculdade de Medicina, Instituto do Coração, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Clovis Artur Silva
- Instituto da Criança e do Adolescente, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nelson da Cruz Gouveia
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Leila Suemi Harima Letaif
- Diretoria Clínica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marco Antonio Bego
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Linamara Rizzo Battistella
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Divisão de Laboratório Central, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Julio Marchini
- Departamento de Emergências Médicas, Faculdade de Medicina, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Orestes Vicente Forlenza
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Geraldo Rocha
- Departamento de Clínica Médica, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cassia Mendes-Correa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Giovanni Guido Cerri
- Faculdade de Medicina, Instituto de Radiologia, Hospital das Clínicas HC-FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Roger Chammas
- Departamento de Radiologia e Oncologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Geraldo Busatto Filho
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas HC-FMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Martins F, Gonçalves FT, Imamura M, Barboza DS, Matheus D, Pereira MFB, Marques HHS, Correa-Silva S, Montenegro MM, Fink TT, Lindoso L, Bain V, Ferreira JCOA, Astley C, Matsuo OM, Suguita P, Trindade V, Paula CSY, Litvinov N, Palmeira P, Gualano B, Delgado AF, Carneiro-Sampaio M, Forsait S, Odone-Filho V, Antonangelo L, Battistella LR, Silva CA. Health-related quality of life and functionality in primary caregiver of surviving pediatric COVID-19. Front Public Health 2023; 11:1117854. [PMID: 37408752 PMCID: PMC10319046 DOI: 10.3389/fpubh.2023.1117854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Objectives To prospectively assess health-related quality of life (HRQoL), global functionality, and disability in primary caregivers of surviving children and adolescents after COVID-19. Methods A 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%. Results The 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). Conclusion We 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.
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Affiliation(s)
- Fernanda Martins
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brazil
| | - Fernanda T. Gonçalves
- Laboratorio de Imunohematologia e Hematologia Forense (LIM-40), Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marta Imamura
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Daniela S. Barboza
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brazil
| | - Denise Matheus
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brazil
| | - Maria Fernanda B. Pereira
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Heloisa H. S. Marques
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Simone Correa-Silva
- Laboratório de Pediatria Clínica (LIM-36), Departamento de Pediatria, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marilia M. Montenegro
- Laboratório de Pediatria Clínica (LIM-36), Departamento de Pediatria, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais T. Fink
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Livia Lindoso
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vera Bain
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana C. O. A. Ferreira
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camilla Astley
- Faculdade de Medicina, Divisão de Reumatologia, Hospital das Clínicas, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Olivia M. Matsuo
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Priscila Suguita
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vitor Trindade
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Camila S. Y. Paula
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Nadia Litvinov
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Patricia Palmeira
- Laboratório de Pediatria Clínica (LIM-36), Departamento de Pediatria, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Bruno Gualano
- Faculdade de Medicina, Divisão de Reumatologia, Hospital das Clínicas, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Artur F. Delgado
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvana Forsait
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Vicente Odone-Filho
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Leila Antonangelo
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Linamara R. Battistella
- Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, São Paulo, SP, Brazil
- Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clovis A. Silva
- Faculdade de Medicina, Instituto da Criança e do Adolescente, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
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Gonçalves GS, Correa-Silva S, Zheng Y, Avelar I, Montenegro MM, Ferreira AEF, Bain V, Fink TT, Suguita P, Astley C, Lindoso L, Martins F, Matsuo OM, Ferreira JCOA, Firigato I, de Toledo Gonçalves F, Fernanda B Pereira M, Artur A da Silva C, Carneiro-Sampaio M, Marques HHS, Palmeira P. Circulating sTREM-1 as a predictive biomarker of pediatric multisystemic inflammatory syndrome (MIS-C). Cytokine 2023; 161:156084. [PMID: 36403563 PMCID: PMC9671781 DOI: 10.1016/j.cyto.2022.156084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of > 5781 pg/mL yielded a sensitivity of 71.4 % and a specificity of 91.3 % for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR = 22.85 [95 % CI 1.64-317.5], p = 0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.
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Affiliation(s)
- Guilherme S Gonçalves
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Simone Correa-Silva
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Universidade Paulista, UNIP, Sao Paulo, SP, Brazil.
| | - Yingying Zheng
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Isabela Avelar
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marília M Montenegro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Arthur E F Ferreira
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vera Bain
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thais T Fink
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Suguita
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camilla Astley
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Livia Lindoso
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda Martins
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Olivia M Matsuo
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Juliana C O A Ferreira
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Isabela Firigato
- Laboratorio de Imunohematologia e Hematologia Forense (LIM-40), Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda de Toledo Gonçalves
- Laboratorio de Imunohematologia e Hematologia Forense (LIM-40), Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Fernanda B Pereira
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis Artur A da Silva
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Heloisa H S Marques
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Patricia Palmeira
- Laboratorio de Pediatria Clinica (LIM-36), Departamento de Pediatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Dondi A, Sperti G, Gori D, Guaraldi F, Montalti M, Parini L, Piraccini BM, Lanari M, Neri I. Epidemiology and clinical evolution of non-multisystem inflammatory syndrome (MIS-C) dermatological lesions in pediatric patients affected by SARS-CoV-2 infection: A systematic review of the literature. Eur J Pediatr 2022; 181:3577-3593. [PMID: 35948654 PMCID: PMC9365226 DOI: 10.1007/s00431-022-04585-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
COVID-19 can present with a range of skin manifestations, some of which specific of the pediatric age. The aim of this systematic literature review was to determine the type, prevalence, time of onset, and evolution of cutaneous manifestations associated with COVID-19 in newborns, children, and adolescents, after excluding multisystem inflammatory syndrome in children (MIS-C). PubMed, Tripdatabase, ClinicalTrials, and Cochrane Library databases were searched using an ad hoc string for case reports/series and observational studies, published between December 2019 and February 2022. Study quality was assessed using the STROBE and CARE tools. Seventy-three (49 case reports/series and 24 studies) out of 26,545 identified articles were included in the analysis. Dermatological lesions were highly heterogeneous for clinical presentation, time of onset, and association with other COVID-19 manifestations. Overall, they mainly affected the acral portions, and typically presented a favorable outcome. Pseudo-chilblains were the most common. CONCLUSIONS Mucocutaneous manifestations could be the only/predominant and early manifestation of COVID-19 that could precede other more severe manifestations by days or weeks. Therefore, physicians of all disciplines should be familiar with them. WHAT IS KNOWN • A variety of cutaneous manifestations have been reported in association with COVID-19. • Urticaria, maculopapular, or vesicular rashes can occur at any age, while chilblains and erythema multiforme are more common in children and young patients. WHAT IS NEW • Skin lesions related to SARS-CoV-2 infection often show a peculiar acral distribution. • Mucocutaneous lesions of various type may be the only/predominant manifestation of COVID-19; they could present in paucisymptomatic and severely ill patients and occur at different stages of the disease.
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Affiliation(s)
- Arianna Dondi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giacomo Sperti
- School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Federica Guaraldi
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, 40139, Bologna, Italy.
| | - Marco Montalti
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
| | - Lorenza Parini
- School of Pediatrics, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- School of Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
| | - Marcello Lanari
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Busatto GF, Silva CA, Pereira AJR, Bonfá E, de Barros-Filho TEP. Scientific legacy of COVID-19 at the FMUSP-HC academic health system: current status and implications for the future. Clinics (Sao Paulo) 2021; 76:e3630. [PMID: 34909915 PMCID: PMC8612300 DOI: 10.6061/clinics/2021/e3630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Geraldo Filho Busatto
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR
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