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Abstract Post‐acute sequelae of Coronavirus (PASC), or Long COVID, has emerged as a critical health concern. The clinical manifestations of PASC have been described, but studies have not quantified the cardiopulmonary effects. The goal of this study was to quantify PASC cardiopulmonary changes among endurance athletes. Endurance athletes were recruited via social media; 45 met inclusion criteria, 32 had PASC and 13 were asymptomatic at 3 months (control). Comprehensive interviews were conducted to assess: cardiopulmonary symptoms at 3 months; quantitative and qualitative changes in cardiovascular endurance; exercise hours per week at baseline and 3 months; and Modified Oslo, Dyspnea, and EQ‐5D‐5L scales. All collected data was based on self‐reported symptoms. Wilcoxon rank sum compared PASC with control to distinguish the effects of PASC vs effects of COVID infection/lockdown. PASC subjects were more likely to be female (Table). The most common 3‐month symptoms in PASC were fatigue and shortness of breath. Based on self‐reported data, subjects endorsed a median decrease of 27% in cardiopulmonary endurance levels compared with 0% in controls (p = 0.0019). PASC subjects exercised less hours and had worse self‐reported health as compared with controls. PASC subjects also had significantly worse Modified Oslo, Dyspnea, and EQ‐5D‐5L scores. Of the 32 PASC patients, 10 (31%) reported a complete inability to engage in any cardiovascular endurance exercise at 3 months. PASC leads to a significant, quantifiable decrease in cardiopulmonary health and endurance.

BackgroundNeonates with apnea of prematurity (AOP) clinically deteriorate because continuous positive airway pressure (CPAP) provides inadequate support during apnea. Neurally adjusted ventilatory assist (NAVA) provides proportional ventilator support from the electrical activity of the diaphragm. When the NAVA level is 0 cmH2O/mcV (NAVA-PAP), patients receive CPAP when breathing and backup ventilation when apneic. This study evaluates NAVA-PAP and time spent in backup ventilation.MethodsThis was a prospective, two-center, observational study of preterm neonates on NAVA-PAP for AOP. Ventilator data were downloaded after 24 h. The number of clinically significant events (CSEs) was collected. A paired t-test was used to perform statistical analysis.ResultsThe study was conducted on 28 patients with a gestational age of 25 ± 1.8 weeks and a study age of 28 ± 23 days. The number of CSEs was 4 ± 4.39/24 h. The patients were on NAVA-PAP for approximately 90%/min, switched to backup mode 2.5 ± 1.1 times/min, and spent 10.6 ± 7.2% in backup.ConclusionPreterm neonates on NAVA-PAP had few CSEs with minimal time in backup ventilation.

Abstract Background A de novo, pathogenic, missense variant in UBTF, c.628G>A p.Glu210Lys, has been described as the cause of an emerging neurodegenerative disorder, Childhood‐Onset Neurodegeneration with Brain Atrophy (CONDBA). The p.Glu210Lys alteration yields a positively charged stretch of three lysine residues. Functional studies confirmed this change results in a stronger interaction with negatively charged DNA and gain‐of‐function activity when compared to the wild‐type sequence. The CONDBA phenotype reported in association with p.Glu210Lys consists of normal early‐neurodevelopment followed by progressive motor, cognitive, and behavioral regression in early‐to‐middle childhood. Methods and Results The current proband presented at 9 months of age with baseline developmental delay and more extensive neuroradiological findings, including pontine hypoplasia, thalamic volume loss and signal abnormality, and hypomyelination. Like the recurrent CONDBA p.Glu210Lys variant, this novel variant, c.608A>G p.(Gln203Arg) lies within the highly conserved second HMG‐box homology domain and involves the replacement of the wild‐type residue with a positively charged residue, arginine. Computational structural modeling demonstrates that this amino acid substitution potentiates the interaction between UBTF and DNA, likely resulting in a gain‐of‐function effect for the UBTF protein, UBF. Conclusion Here we present a new divergent phenotype associated with a novel, likely pathogenic, missense variant at a different position in the UBTF gene, c.608A>G p.(Gln203Arg).

Streptococcus pneumonia is a gram-positive bacteria most commonly associated with respiratory tract infections such as acute otitis media, sinusitis, and pneumonia. While a common cause of upper respiratory infections, the current Infectious Diseases Society of America (IDSA) guidelines on Urinary Tract Infections (UTIs) do not cite S. pneumoniae as a cause for UTIs in children. In addition, previous research associating S. pneumonia with UTIs has been scarce. We report the case of a three-year-old girl presenting to the emergency room with abdominal pain, vomiting, and fever. Her clinical picture was consistent with right sided pyelonephritis. A urine analysis (UA) was conducted which showed trace leukocyte esterase, 150mg/dL ketones, 21-50 WBCs, and negative nitrites. A blood culture returned positive for Streptococcus pneumoniae along with right kidney hydronephrosis on ultrasound. This patient presented with a full clinical picture of pyelonephritis, fever, leukocytosis, elevated CRP and Procalcitonin levels, and later found to be S. pneumoniae positive. Although the urine culture did not grow any definitive single bacteria as a causative agent, due to the presentation of pyelonephritis along with CVA tenderness, dysuria, and a positive blood culture, we conclude the patient was exhibiting urosepsis due to S. pneumoniae. Upon discovering previous case reports noting S. pneumoniae as a possible agent for UTIs, we believed this bacterium to be contributing to the patient’s symptoms. While S. pneumoniae has only been a rarely reported cause of UTIs, we believe there is sufficient evidence that demonstrates S. pneumoniae to at least be considered a possible contributing cause of UTIs, especially if the patient has a coinciding septic picture. Contributors: Daniel Lubarsky (a) (1) Daniel Garcia (b) and Deepa Mukundan (c) (a) M.D. Candidate, Class of 2021, The University of Toledo Heath Science Campus, Toledo, OH, USA, (b) Department of Pediatrics, University of Toledo Health Science Campus, Toledo, OH, USA , and (c) Department of Pediatric Infectious Disease, The University of Toledo Heath Science Campus, Toledo, OH, USA

Streptococcus intermedius lung abscess and empyema is a chronic infectious process associated with a high morbidity and mortality. It is typically seen in adults, and is considered a rare disease process in the pediatric population. Our case describes a 17 year old male presenting with 3 months of cough associated with later development of chest and back pain. He was later found to have a severe empyema secondary to Streptococcus intermedius. This case underlines a rare diagnosis in the pediatric population, as well as a association with smoking and vaping.