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Viral genome sequencing has guided our understanding of the spread and extent of genetic diversity of SARS-CoV-2 during the COVID-19 pandemic. SARS-CoV-2 viral genomes are usually sequenced from nasopharyngeal swabs of individual patients to track viral spread., Viral genome sequencing has guided our understanding of the spread and extent of genetic diversity of SARS-CoV-2 during the COVID-19 pandemic. SARS-CoV-2 viral genomes are usually sequenced from nasopharyngeal swabs of individual patients to track viral spread. Recently, RT-qPCR of municipal wastewater has been used to quantify the abundance of SARS-CoV-2 in several regions globally. However, metatranscriptomic sequencing of wastewater can be used to profile the viral genetic diversity across infected communities. Here, we sequenced RNA directly from sewage collected by municipal utility districts in the San Francisco Bay Area to generate complete and nearly complete SARS-CoV-2 genomes. The major consensus SARS-CoV-2 genotypes detected in the sewage were identical to clinical genomes from the region. Using a pipeline for single nucleotide variant calling in a metagenomic context, we characterized minor SARS-CoV-2 alleles in the wastewater and detected viral genotypes which were also found within clinical genomes throughout California. Observed wastewater variants were more similar to local California patient-derived genotypes than they were to those from other regions within the United States or globally. Additional variants detected in wastewater have only been identified in genomes from patients sampled outside California, indicating that wastewater sequencing can provide evidence for recent introductions of viral lineages before they are detected by local clinical sequencing. These results demonstrate that epidemiological surveillance through wastewater sequencing can aid in tracking exact viral strains in an epidemic context.

Early repolarization (ER), considered a common and benign electrocardiographic pattern on the surface 12-lead electrocardiogram (ECG), was recently found to be prevalent among patients with idiopathic ventricular fibrillation. It is also highly predominant in physically active young males. Reports on sudden cardiac death (SCD) of children and adolescents treated with psychotropic agents have raised concerns regarding the need for cardiovascular monitoring and risk stratification schedules. The rate of ER pattern has not been estimated in children with attention deficit/hyperactivity disorder (ADHD). Thus, in the present retrospective chart review study, we estimated the rate of ER pattern, as well as RR, QT, and QTc intervals, from ECG tracings of physically healthy children with ADHD versus physically and mentally healthy controls.The ECG tracings of 50 children (aged 8.7 +/- 1.4 years; 12 girls, 44 boys) diagnosed as suffering from ADHD were compared to 55 physically and mentally healthy controls (aged 8.25 +/- 2.1 years; 20 girls, 35 boys). ER was defined as an elevation of the QRS-ST junction (J point) of at least 0.1 mV from baseline with slurring or notching of the QRS complex, and assessed separately by two senior cardiologists who were blind to all other data relating to the study participants.The rate of ER pattern was significantly higher in ADHD children compared to normal controls (32% vs. 13%, respectively, P = 0.012; relative risk [RR] = 1.68, 95% confidence interval [CI] 1.16-2.44), irrespective of stimulant treatment or gender. All other standard ECG measures (heart rate, QT and QTc intervals) were within normal range.The rate of ER in children with ADHD is significantly higher than in normal controls. Its clinical significance awaits further research.

QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and risk for lethal cardiac arrhythmias. Research suggests a link between psychotropic treatment, ECG abnormalities (QT prolongation), and increased sudden cardiac mortality rates. Reports of sudden death in children treated with psychotropic drugs have raised concerns about cardiovascular monitoring and risk stratification. QTd analysis has not been investigated in very young children treated with antipsychotic drugs. In the present retrospective chart review study, we calculated QT interval, QTd, and their rate-corrected values in very young children treated with antipsychotics.The charts of 12 children (ages 5.8 +/- 0.98 yr; 4 girls, 8 boys) were examined before initiation of antipsychotic treatment [risperidone (n = 7), clotinapine (n = 1), and propericiazine (n = 4)] and during the maintenance period after achieving a positive clinical response. Three children were concomitantly maintained on methylphenidate. QT interval, QTd, and their rate-corrected values were calculated.QT interval, QTd, and their rate-corrected values were all within normal values both before and after successful drug treatment.This preliminary, naturalistic, small-scale study suggests that antipsychotic treatment, with or without methylphenidate, in very young children is not commonly associated with significant alterations of QT interval and dispersion, suggesting the relative safety of these agents in this unique age group.

In this study we aimed to examine the outcome of children's severe psychiatric disorders from preschool into later childhood and adolescence.Forty preschool children (28 boys and 12 girls) treated in a tertiary referral mental health center, evaluated at admission and 5.5 ± 1.2 years thereafter.Seven (58.3%) children diagnosed with internalizing disorders at baseline were free of any psychiatric diagnosis at follow-up (p=0.02). Conversely, only one child (8.3%) diagnosed with comorbid disruptive-internalizing disorders at baseline was free of any psychiatric disorder at follow-up (p=1.0). Seven (43.7%) children diagnosed with disruptive disorders at baseline were free of psychiatric diagnoses at follow-up (p=0.02).The small sample size and naturalistic nature of the study.The trajectories of severe psychiatric disorders at preschool years are similar to those reported in community samples and differ according to the baseline diagnosis. Children with internalizing disorders show a much better recovery rate than those with comorbid disruptive and internalizing disorders.

The first 5 years of life, the period called "early childhood", are characterized by a dynamic process of development and maturation of the central nervous system (CNS). This process is manifested by continuous changes in cognitive, motor, speech/language, psychological and sensory modulation skills and consequently, in the behavior of the developing child. It is a period of neuron-plasticity, in which the CNS structure and functioning are very sensitive to environmental influences. These influences could be positive or negative. On the one hand, early protective factors, like secure attachment, increase the resilience of the very young child against stressors and against the development of psychopathology; but on the other hand, there is a high vulnerability to early insults of any kind. It has been demonstrated that a high percentage of psychopathology in adult life has his roots in early childhood, and that early diagnosis, which leads to early therapeutic interventions, decreases morbidity and the later life consequences of the disorders. These findings have promoted the field of early childhood psychiatry during the last decade, to become one of the most promising challenges in the field of mental health. In our review, we present an update on the state of nosology, assessment and diagnosis in early childhood and provide clinical guidelines for the daily work of professionals involved in the mental health care of very young children.

Biological and environmental factors have been related to the persistence of psychopathology in preschool children. The objective of the study was to identify the factors predicting the clinical outcome in preschool inpatients with emotional and behavioral disorders.Twenty-eight children aged 3 to 6.5 years attending a therapeutic nursery were evaluated. Clinical data were collected from the children's charts, including: biological parameters, developmental milestones, intelligence level, socioeconomic status, and stressful life events. Severity of symptoms at follow-up was assessed using the Clinical Global Impression Scale.Low socioeconomic status, excess stressful life events, and female gender were associated with poor clinical outcome. Biological factors such as pregnancy and birth complications and genetic factors were not significant predictors.The study was limited by its retrospective design and small sample size.More effort in social interventions and supportive family therapy may improve the outcome of young children with emotional and behavioral problems.