Multisystem Inflammatory Syndrome in Children (MIS-C) is a new phenomenon reported worldwide with temporal association with Covid-19. The objective of this paper is to evaluate reported cases in children and adolescents. From 1726 papers, 35 documented papers related to MIS-C cases identified 783 individual cases of MIS-C between March-June 2020; with 55% being male ( n = 435) and a median age of 8.6 years (IQR, 7–10 years; range 3 months–20 years). Patients with MIS-C were noted to have a high frequency of gastrointestinal symptoms (71%) including abdominal pain (34%) and diarrhea (27%). Cough and respiratory distress were reported in 4.5% and 9.6% cases respectively. Blood parameters showed neutrophilia in 345/418 (83%) of cases and a high CRP in 587/626 (94%). 362/619 (59%) cases were SARS-CoV-2 infection positive (serology or PCR) however only 41% demonstrated pulmonary changes on chest imaging. Severity of illness was high with 68% cases requiring intensive care admission; 63% requiring inotropic support; 244/783 (28%) cases needing some form of respiratory support (138 mechanically ventilated), and 31 required extra-corporeal membrane oxygenation. Treatment strategies included intravenous immunoglobulin (63%) and intravenous steroids (44%). 29 cases received Infliximab, 47 received IL1 (interleukin) receptor antagonist, and 47 received IL6-receptor antagonist. 12/783 (1.5%) children died. In summary, a higher incidence of gastrointestinal symptoms were noted in MIS-C. In contrast to acute Covid-19 infection in children, MIS-C appears to be a condition of higher severity with 68% of cases having required critical care support.

Data show that children are less severely affected with SARS-Covid-19 than adults; however, there have been a small proportion of children who have been critically unwell. In this systematic review, we aimed to identify and describe which underlying comorbidities may be associated with severe SARS-CoV-2 disease and death. The study protocol was in keeping with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 1726 articles were identified of which 28 studies fulfilled the inclusion criteria. The 28 studies included 5686 participants with confirmed SARS-CoV-2 infection ranging from mild to severe disease. We focused on the 108 patients who suffered from severe/critical illness requiring ventilation, which included 17 deaths. Of the 108 children who were ventilated, the medical history was available for 48 patients. Thirty-six of the 48 patients (75%) had documented comorbidities of which 11/48 (23%) had pre-existing cardiac disease. Of the 17 patients who died, the past medical history was reported in 12 cases. Of those, 8/12 (75%) had comorbidities. Conclusion: Whilst only a small number of children suffer from COVID-19 disease compared to adults, children with comorbidities, particularly pre-existing cardiac conditions, represent a large proportion of those that became critically unwell. What is Known:• Children are less severely affected by SARS-CoV-2 than adults.• There are reports of children becoming critically unwell with SARS-CoV-2 and requiring intensive care. What is New:• The majority of children who required ventilation for SARS-CoV-2 infection had underlying comorbidities.• The commonest category of comorbidity in these patients was underlying cardiac disease.

Background The Coronavirus Disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), evolved rapidly in the United States. This report describes the demographic, clinical, and epidemiologic characteristics of 544 U.S. persons under investigation (PUI) for COVID-19 with complete SARS-CoV-2 testing in the beginning stages of the pandemic from January 17 through February 29, 2020. Methods In this surveillance cohort, the U.S. Centers for Disease Control and Prevention (CDC) provided consultation to public health and healthcare professionals to identify PUI for SARS-CoV-2 testing by quantitative real-time reverse-transcription PCR. Demographic, clinical, and epidemiologic characteristics of PUI were reported by public health and healthcare professionals during consultation with on-call CDC clinicians and subsequent submission of a CDC PUI Report Form. Characteristics of laboratory-negative and laboratory-positive persons were summarized as proportions for the period of January 17−February 29, and characteristics of all PUI were compared before and after February 12 using prevalence ratios. Results A total of 36 PUI tested positive for SARS-CoV-2 and were classified as confirmed cases. Confirmed cases and PUI testing negative for SARS-CoV-2 had similar demographic, clinical, and epidemiologic characteristics. Consistent with changes in PUI evaluation criteria, 88% (13/15) of confirmed cases detected before February 12, 2020, reported travel from China. After February 12, 57% (12/21) of confirmed cases reported no known travel- or contact-related exposures. Conclusions These findings can inform preparedness for future pandemics, including capacity for rapid expansion of novel diagnostic tests to accommodate broad surveillance strategies to assess community transmission, including potential contributions from asymptomatic and presymptomatic infections.

The mechanisms by which glucocorticoids regulate food intake and resulting body mass in humans are not well-understood. One potential mechanism could involve modulation of reward processing, but human stress models examining effects of glucocorticoids on behavior contain important confounds. Here, we studied individuals with Cushing's syndrome, a rare endocrine disorder characterized by chronic excess endogenous glucocorticoids. Twenty-three patients with Cushing's syndrome (13 with active disease; 10 with disease in remission) and 15 controls with a comparably high body mass index (BMI) completed two simulated food-choice tasks (one with “explicit” task contingencies and one with “probabilistic” task contingencies), during which they indicated their objective preference for viewing high calorie food images vs. standardized pleasant, unpleasant, and neutral images. All participants also completed measures of food craving, and approximately half of the participants provided 24-h urine samples for assessment of cortisol and cortisone concentrations. Results showed that on the explicit task (but not the probabilistic task), participants with active Cushing's syndrome made fewer food-related choices than participants with Cushing's syndrome in remission, who in turn made fewer food-related choices than overweight controls. Corroborating this group effect, higher urine cortisone was negatively correlated with food-related choice in the subsample of all participants for whom these data were available. On the probabilistic task, despite a lack of group differences, higher food-related choice correlated with higher state and trait food craving in active Cushing's patients. Taken together, relative to overweight controls, Cushing's patients, particularly those with active disease, displayed a reduced vigor of responding for food rewards that was presumably attributable to glucocorticoid abnormalities. Beyond Cushing's, these results may have relevance for elucidating glucocorticoid contributions to food-seeking behavior, enhancing mechanistic understanding of weight fluctuations associated with oral glucocorticoid therapy and/or chronic stress, and informing the neurobiology of neuropsychiatric conditions marked by abnormal cortisol dynamics (e.g., major depression, Alzheimer's disease).

Objectives Infants receiving care from neonatal intensive care unit (NICU) can develop chronic problems and be transferred to a paediatric intensive care unit (PICU) for on-going care. There is concern that such infants may take up a large amount of PICU resource, but this is not evidence based. We determined the impact of such transfers. Methods We reviewed 10 years of NICU admissions to two tertiary PICUs, which had approximately 12,000 admissions during that period. Results Sixty-seven infants, gestational age at birth 34.7 (IQR 27.1–38.8) weeks and postnatal age on transfer 81 (IQR 9–144) days were admitted from NICUs. The median (IQR) length of stay was 12 (4–41) days. The 19 infants born <28 weeks of gestation had a greater median length of stay (32, range IQR 10–93 days) than more mature born infants (7.5, IQR 4–26 days) (p=0.003). The median cost of PICU stay for NICU transfers was £23,800 (range 1,205–1,034,000) per baby. The total cost of care for infants transferred from NICUs was £6,457,955. Conclusions Infants transferred from NICUs were a small proportion of PICU admissions but, particularly those born <28 weeks of gestation, had prolonged stays which needs to be considered when determining bed capacity.

Decreases in circadian rhythms of cardiovascular parameters, such as day to night changes in mean arterial pressure (MAP), heart rate (HR), pulse pressure (PP), systolic (SP) and diastolic pressure (DP) are an index of cardiovascular disease. Peroxisome proliferator activated receptor - alpha (PPAR-α) has been shown to decrease inflammatory markers and hypertension a slow pressor dose of Angiotensin II (Ang II); however, the role of PPAR-α on cardiovascular parameters during the initial stages of Ang II infusion is unknown. We hypothesize that the absence of PPAR-α will cause a reduction in the day to night changes in MAP, HR, PP, SP and DP during the initial stages of a slow pressor dose of Ang II. Male (10 - 12 weeks old) PPAR-αknockout (KO) and wild-type (WT) mice were infused with Ang II (400 ng/kg/min) for three days. Radiotelemetry was used to measure the cardiovascular parameters. The baseline MAP values were: 100 + 10 mmHg (WT) and 108 + 9 mmHg for KO. The baseline HR values were: 530 + 10 bpm (WT) and 526 + 6 bpm (KO). The baseline PPs were 17 + 0.2 mmHg (WT) and 18 + 0.3 mmHg (KO). The baseline SBPs were 108 + 9 mmHg (WT) and 116 + 10 mmHg (KO). The baseline DBPs were 91 + 9 mmHg (WT) and 98 + 10 mmHg (KO). During the first three days of Ang II infusion, the change in day to night MAP was 20 ± 2 mmHg and 10 ± 2 mmHg in Ang II treated WT and KO mice, respectively. Changes in day to night HR were 25 ± 4 bpm and 46 ± 7 bpm for WT and KO mice, respectively. The day to night changes in PP were 8 ± 1 mmHg for WT and 2 ± 2 mmHg for KO mice. The day to night changes in SBPs were 20 ± 2 mmHg and 12 ± 3 mmHg for WT and KO mice, respectively. Changes in day to night DBPs were 18 ± 2 mmHg for WT and 9 ± 2 mmHg for KO mice. TBARS and Interleukin-17 were increased in heart homogenates of KO + Ang II (15 ± 2 μM) and (1.5 ± 0.3 ng/mL) vs WT + Ang II (11 ± 3 μM) and (1.0 ± 0.2 ng/mL). Nitrite/Nitrate was decreased in KO + Ang II (1.0 ± 0.1 nM) vs WT + Ang II (1.5 ± 0.5 nM). In summary, the absence of PPAR-α decreases the day to night changes in MAP, SBP, DBP and PP during the initial three days of a slow pressor dose of Ang II. In the absence of PPAR-α, increases in oxidative stress and inflammation are mechanisms that may contribute to the changes in the cardiovascular parameters and suggest the occurrence of cardiovascular diseases during a slow pressor dose of Ang II-infusion.

Objective: An estimated 1 in 5 American Indian and Alaska Native (AI/AN) adults living with HIV are unaware of their status. We investigated HIV testing among AI/AN people receiving a Centers for Disease Control and Prevention (CDC)–funded test from 2014 through 2020. Methods: We analyzed data on CDC-funded HIV tests reported by health departments and community-based organizations in the United States. We described the number of CDC-funded HIV tests, the percentage of people with newly and previously diagnosed HIV, and linkage to HIV medical care within 90 days of diagnosis. Results: CDC-funded health departments and community-based organizations provided 99 227 HIV tests to AI/AN people during 2014-2020. Seven hundred thirty-five (0.7%) AI/AN people were diagnosed with HIV; 361 (0.4%) were newly diagnosed, 319 (0.3%) had a previous HIV diagnosis, and 55 (0.1%) had a previously unknown HIV status. Positivity for new diagnoses was highest among the following population groups tested in non–health care settings: men who had sex with men (MSM; n = 72, 1.2%), MSM who inject drugs (n = 12, 1.8%), and transgender people (n = 12, 1.5%). The percentage of linkage to HIV medical care was 80.6% for newly diagnosed people and 78.2% for previously diagnosed people. Conclusions: MSM AI/AN, including those who inject drugs, and transgender AI/AN may benefit from prioritized HIV testing. All AI/AN people with HIV, whether newly or previously diagnosed, should rapidly link to HIV medical care and receive support throughout the continuum of care. Our findings can inform which AI/AN population subgroups may benefit from enhanced HIV testing efforts and interventions.