Podcasts about multisystem inflammatory syndrome

The Centers for Disease Control and Prevention (CDC) recently provided important updates on COVID-19, suggesting it resembles other common respiratory illnesses more and more. With this shift in perspective, the organization released a comprehensive guide on respiratory viruses, implying that COVID-19-specific health regulations may not be necessary anymore. In a detailed document, the CDC presented the reasoning behind integrating COVID-19 into the broad segment of respiratory viruses. This scope includes well-known viruses such as influenza, RSV, adenoviruses, and rhinoviruses among others. It's important to note that measles, a highly contagious virus, is explicitly not part of this grouping. The newly released guidance isn't applicable to medical care environments or outbreak situations. While the risks posed by COVID-19 have not vanished entirely, they no longer categorize it as a unique emergency. The health consequences of this disease now closely parallel those stemming from other respiratory infections, according to the CDC. A significant modification in the brand-new guidelines involves adjusting the required isolation period for individuals diagnosed with COVID-19. Prior advice urged patients to undergo a fixed five-day isolation stint. This viewpoint has been reviewed lately. The duration of seclusion is now primarily symptom-driven, resonating with established isolation principles applied to other respiratory viruses. The modified Respiratory Virus Guidance from CDC puts forth the recommendation to maintain segregation from others for at least 24 hours post the alleviation of fever and other symptoms. Individuals whose symptoms cannot be attributed to any other known cause should adopt this strategy. This advice covers the period of maximum infectious potential and matches the timeline when symptoms are usually most severe. Even under these revised isolation instructions, the CDC concedes 'residual risk' of the viral transmission. For this reason, the organization strongly suggests continuing masking, testing, distancing, and maintaining hygiene. Improving air quality and adhering to these interventions for at least five additional days after isolation is also recommended. The CDC contends that a truncated isolation period won't necessarily result in serious implications. This standpoint is supported by patterns noted in other countries and jurisdictions which didn't observe a sudden surge in emergency department visits or hospital admissions after scrapping fixed isolation durations. Fewer people, according to a recent survey by the CDC, indicated they would test for the virus if they experienced cold-like symptoms. A mere 10 percent of those surveyed stated they would visit a pharmacy or healthcare provider for testing. This poses a challenge and also highlights a potential area for increased education and outreach. The body also highlighted practical issues surrounding isolation guidelines, such as the absence of paid sick leave for workers in many sectors. Other secondary effects comprise social isolation and the financial strain that society bears as a whole. By reducing isolation periods, the CDC hopes to alleviate some of these pressures. The CDC proposed that COVID-19 presents a lessening threat in its latest announcement. Several indicators such as a decline in hospitalizations, death rate, and the frequency of long-COVID, and complications related to the virus among children like Multisystem Inflammatory Syndrome in Children (MIS-C) support this premise. Vaccines against COVID-19 have proven to be protective shields, contributing effectively to the prevention of severe illnesses. Not only that, they play a critical role in avoiding fatalities, and to a considerable extent, long-COVID. Hence, the call of the hour is to increase vaccination rates and expand their coverage. Visit realnewsnow.com for more articles and updates!  https://realnewsnow.com/cdc-shifts-stance-covid19-bears-resemblance-to-other-respiratory-viruses  See omnystudio.com/listener for privacy information.

This week, please join author Jan Vincent Beltran and Associate Editor Charles Lowenstein as they discuss the article "Single-Cell Meta-Analysis of Neutrophil Activation in Kawasaki Disease and Multisystem Inflammatory Syndrome in Children Reveals Potential Shared Immunological Drivers." For episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20231127.335747

In this episode of Kid's Corner, Dr. Liz Mumper discusses MIS-C (Multisystem Inflammatory Syndrome in Children) and the incidence of this diagnosis with COVID-19. Dr. Mumper also explains whether or not receiving COVID-19 vaccinations prevents MIS-C by breaking down this study: https://www.medrxiv.org/content/10.1101/2022.09.30.22280573v2.full-text MIS-C is also referred to as Pediatric Inflammatory Multisystem Syndrome temporally associated with SARS-COV2 (PIM-TS). Common symptoms of MIS-C in babies show as a rash and/or diarrhea. In older children, the symptoms are respiratory. MIS-C is similar to Kawasaki's disease, although the symptoms usually resolve in contrast to Kawasaki's disease. Treatment for MIS-C includes:• supportive care and observation• maintaining volume status as dehydration worsens symptoms• steroids• IVIG• Interleukin blockers• anti-coagulation• cardiology work-up with an EKG and cardiac echo Kid's Corner with Dr. Lizhttps://covid19criticalcare.com/courses/kids-corner-with-dr-liz/ FLCCC | Front Line COVID-19 Critical Care Alliancehttps://covid19criticalcare.com/ Donate to the Front Line Covid-19 Critical Care Alliance, Inc. to help educate medical professionals and the public in safe and effective ways to prevent and treat COVID-19. Click here to make a donation:https://frontlinecovid-19criticalcarealliance.salsalabs.org/donate/index.html Buy FLCCC gear:https://supportflccc.store/ Subscribe to our mailing list on our website:http://flccc.net/signup Disclaimer:
This video is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. The content provided in this video is for informational and educational purposes only. Please consult with a physician or healthcare professional regarding any medical or mental health related diagnosis or treatment. No information in this video should ever be considered as a substitute for advice from a healthcare professional.

This week we talk with Amberlee Rich from Idaho. Former art teacher turned homeschool mom and financial coach, Amberlee walks us through what made her decide to homeschool her children. Have you ever felt your child was not safe when you dropped them off at school?? Amberlee tells us about that experience.Soon after feeling unsafe in the school system, Amberlee's daughter was diagnosed with  MIS-C, a Multisystem Inflammatory Syndrome in Children (MIS-C). It is a rare condition associated with SARS-CoV-2 (the virus that causes COVID-19) that usually occurs 2-6 weeks after a child is infected with SARS-CoV-2. MIS-C causes different internal and external body parts to become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal tract. After Amberlee's daughter's diagnosis, she knew home was the best place for her kids. We talk about the importance of teaching financial literacy to our children starting at an early age and how you can incorporate it into your everyday homeschooling life (no extra curriculum needed!)Amberlee explains how she juggles teaching two kids at different levels, and how she picks the books they read. Are you wondering- how has homeschooling been going for ME?? Oh goodness- you don't want to miss this! I ask Amberlee how she handles the situation when her kids just want to be crazy and not pay attention to that pesky ol' school work, and her response is SO SIMPLE! We discuss, "Is homeschooling for everyone?" and when it might not be for you.  You can contact Amberlee by emailin Amberlee@richlivingcoaching.comSchedule a free Q&A Session with Amberlee to see how financial coaching can help you.Here are her social media links:TikTokFacebookInstagramWould you like to help keep this podcast going by sending me a small tip?paypal.me/TheHomeschoolHowToUnable to support the show monetarily but want to help me out in another way?No Problem! Share this link with friends and in your favorite homeschool group facebook page! http://thehomeschoolhowto.com/Do you want to help your children learn about true history, sound money, personal freedom, responsibility, entrepreneurship and individual rights? Then check out The Tuttle Twins books through my link:Cheryl's link to: The Tuttle Twinswith coupon code: Cheryl40for 40% off ages 5-11 book series and more!Treehouse Schoolhouse:Our resources are designed with family-style learning in mind, so they can be used across multiple ages. We design our curriculum to be easy to follow with minimal prep needed. Our products educate more than just a child's mind through music, poetry, art, nature, scripture, and rich literature.Cheryl's Treehouse Schoolhouse linkDiscount code for 10% off: TheHomeschoolHowToPodcastSupport the showInstagram: TheHomeschoolHowToPodcast Facebook: The Homeschool How To Podcast

It can be very stressful for a first-time parent with a child who presents with illness and injury, especially when your child presents with symptoms; so many things are running through your head to sort out the issue. My guest has specialized in pediatric cardiology for over 15 years and has written numerous articles and lectures on childhood illnesses related to the cardiovascular system.  Dr. Robert Rollins is here to discuss Multisystem Inflammatory Disease vs. Kawasaki disease on the Medical Truth Podcast. For Current and Previous Podcast Episodes, Show Notes, and Videos go to www.MedicalTruthPodcast.comYou can also find the Medical Truth Podcast on Facebook, Twitter, YouTube, Rumble, and Substack, as well as all the major podcast platforms such as Apple Podcast, Spotify, Google Podcast, Amazon Music, iHeart, and Podchaser

Welcome to "PICU Doc On Call," a podcast dedicated to current and aspiring intensivists. In this episode, Dr. Pradip Kamat and Dr. Rahul Damania discuss an interesting case of a 16-year-old male with high-grade fever and abdominal pain. The patient also presents with a rash and other concerning symptoms, leading to urgent medical attention. They provide a summary of the key elements from the case, including vital signs, physical examination findings, and laboratory and imaging results.Dr. Kamat then shares his thought process regarding the working diagnosis for this patient, considering several possibilities such as severe bacterial infection, atypical appendicitis or cholecystitis, toxic shock syndrome, and systemic inflammatory processes like Multisystem Inflammatory Syndrome in Children (MIS-C) and atypical Kawasaki disease.Moving on to the topic of vasopressors, Dr. Damania explains the importance of understanding how these medications work and their specific pharmacological properties. They discuss the classification of shock as cold or warm and the limitations of relying solely on clinical signs to categorize septic shock in children.They highlight the challenges in selecting the appropriate vasopressor, such as a lack of standardization in clinical examination and individual variability in response to medications. They emphasize the need for a comprehensive approach when evaluating and managing pediatric shock patients, considering multiple factors beyond traditional bedside signs.The hosts then engage in a rapid review of pressors, starting with a multiple-choice question regarding the choice of vasoactive infusion for a patient with toxic shock syndrome. They discuss the pros and cons of using norepinephrine (NE) in distributive shock and highlight its vasoconstrictive effects, inotropic activity, and potential side effects.They proceed to compare NE with epinephrine, explaining the differences in their actions on adrenergic receptors and their effects on various circulations. They mention that epinephrine acts on all adrenergic receptors and has hemodynamic and metabolic effects, redirecting cardiac output and increasing myocardial oxygen demand.Lastly, the hosts touch on phenylephrine, a vasopressor that acts on the alpha-1 receptor and elevates systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR). They stress the importance of securing central line access when administering vasopressors to avoid harm to peripheral and systemic tissues.In conclusion, this episode provides valuable insights into the diagnosis and management of a complex pediatric case involving high-grade fever, abdominal pain, and shock. The hosts also offer a rapid review of common vasopressors, highlighting their mechanisms of action, pros, and cons.

This podcast discuss an overview and approach to multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection in COVID-19, also known as [MIS-C]. The podcast was created by Mia Voyatzis, a second-year medical student at the University of Alberta, with the guidance of Dr. Lillian Lim, an Assistant Professor in Pediatric Rheumatology at the Stollery Children's Hospital of the University of Alberta.

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19), Multisystem Inflammatory Syndrome in Children (MIS-C), Adults (MIS-A), Neonates (MIS-N), and some Vaccinees (MIS-V). These are all considered clinically distinct diseases; however, the MIS-X diseases have overlapping symptoms and treatments with Kawasaki Disease (KD). MIS-C, MIS-A, MIS-N, and KD occur with increased frequencies several weeks following increased numbers of COVID-19 and for KD other pathogens. The incidence rate for MIS-C, MIS-A, MIS-N, and KD are typically a factor of roughly 5,000 lower than COVID-19 and for KD other pathogens. In this podcast, Dr. Darrell Ricke advances the hypothesis that MIS-C, MIS-A, MIS-N, MIS-V, and KD all represent a novel type of antibody-dependent enhanced (ADE) diseases associated with hyperactivation of granulocytes or mast cells. Symptoms for these diseases overlap those of histamine intolerance (HIT) coupled with pathogen associated symptoms. This ADE model proposes that antibody titer levels higher than primary immune response levels can hyperactivate granulocytes or mast cells to release inflammatory molecules including histamine; MIS-X and KD disease symptoms onset when histamine levels exceed the individual's tolerance level. The proposed ADE model purports that patient treatment with intravenous immunoglobulin (IVIG) is successful in treating the MIS-X disease because IVIG compete with pathogen antibodies for binding to Fc receptors on immune cells, thereby reducing the immune responses to the pathogen or vaccine protein. This model is further supported with the vaccine spike protein activating immune cells via envisioned Fc receptor binding. This ADE model proposes additional antihistamine and diamine oxidase (DAO) adjunctive treatments combined with current standard of care treatments for investigation.

AMA's Vice President of Science, Medicine and Public Health Andrea Garcia, JD, MPH, discusses recent release by CDC, FDA regarding possible link between Pfizer's bivalent booster and stroke risk for those 65 and older. Also covering the potential increased risk of measles, mumps and rubella (MMR) for kindergartners given a decrease in pediatric vaccinations this year, as well as new findings regarding multisystem inflammatory syndrome (MIS-C) in children. American Medical Association CXO Todd Unger hosts.

In this World Shared Practice Forum podcast, Dr. Robert Tasker continues highlighting research trends from his position as Editor-in-Chief of the Pediatric Critical Care Medicine Journal. Dr. Tasker presents notable articles from 2022, shares a look into upcoming topics and themes for 2023, and provides his perspective on how academic journals such as PCCM are evolving to meet the needs of modern readers and clinicians. Following this podcast, listeners will be able to: - List some of the prominently featured and shared articles from Pediatric Critical Care Medicine for the first half of 2022 - Identify topics and areas of active research interest within the field of pediatric critical care medicine - Discuss approaches to increasing engagement with an academic publication, including content curation, online presentation, and uses of alternative formats such as podcasting Articles referenced: •2:17 Nellis ME, Karam O, Valentine SL, et al. Executive Summary of Recommendations and Expert Consensus for Plasma and Platelet Transfusion Practice in Critically Ill Children: From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB). Pediatr Crit Care Med. 2022;23(1):34-51. •2:27 Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility. Pediatr Crit Care Med. 2022;23(2):e74-e110. •3:16 Dewan M. I Cannot Let It Go. Pediatr Crit Care Med. 2022;23(3):214-215. doi:10.1097/PCC.0000000000002862 •4:16 Mazer MB, Bulut Y, Brodsky NN, et al. Multisystem Inflammatory Syndrome in Children: Host Immunologic Responses. Pediatr Crit Care Med. 2022;23(4):315-320. •4:36 Kozyak BW, Fraga MV, Juliano CE, et al. Real-Time Ultrasound Guidance for Umbilical Venous Cannulation in Neonates With Congenital Heart Disease. Pediatr Crit Care Med. 2022;23(5):e257-e266. •5:34 François T, Sauthier M, Charlier J, et al. Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study. Pediatr Crit Care Med. 2022;23(6):435-443. Publish date: December 22, 2022. Citation: Tasker R, Daniel D, Burns JP. Research Trends in Pediatric Critical Care Medicine: Current and Emerging Areas of Interest. 12/2022. Online Podcast. OPENPediatrics. https://youtu.be/tcn-MQ_jHv4. Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this World Shared Practice Forum podcast, Dr. Robert Tasker discusses trends in research over the past year from his position as Editor-in-Chief of the Pediatric Critical Care Medicine Journal. Dr. Tasker shares his views on some of the most active areas of research in the field of pediatric critical care medicine in 2022 and provides an insider's look at many metrics relating to the PCCM Journal itself, including impact factors, subscribership numbers, and Altmetric scores. Upon listening to this presentation, learners should be able to: -Identify diverse areas of active research interest within the field of pediatric critical care medicine -Describe the reach and impact of the journal Pediatric Critical Care Medicine within the field of pediatrics, and within medicine more generally -Interpret Altmetric scores to better understand the global reach of a published work Publication date: November 18, 2022. Citation: Tasker R, Daniel D, Burns JP. Research Trends in Pediatric Critical Care Medicine: Editor's Perspective. 11/2022. Online Podcast. OPENPediatrics. https://youtu.be/EnOz15CTiEI. Articles referenced: Jonat B, Gorelik M, Boneparth A, et al. Multisystem Inflammatory Syndrome in Children Associated With Coronavirus Disease 2019 in a Children's Hospital in New York City: Patient Characteristics and an Institutional Protocol for Evaluation, Management, and Follow-Up. Pediatr Crit Care Med. 2021;22(3):e178-e191. (11:39) Capasso L, De Bernardo M, Vitiello L, Rosa N. Ultrasound Options for Measuring Optic Nerve Sheath Diameter in Children. Pediatr Crit Care Med. 2021;22(5):e329-e330. (12:40) Staveski SL, Pickler RH, Khoury PR, et al. Prevalence of ICU Delirium in Postoperative Pediatric Cardiac Surgery Patients. Pediatr Crit Care Med. 2021;22(1):68-78. (13:42) Ozment CP, Scott BL, Bembea MM, Spinella PC; Pediatric ECMO (PediECMO) subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network and the Extracorporeal Life Support Organization (ELSO). Anticoagulation and Transfusion Management During Neonatal and Pediatric Extracorporeal Membrane Oxygenation: A Survey of Medical Directors in the United States. Pediatr Crit Care Med. 2021;22(6):530-541 (14:05) Rimensberger PC, Kneyber MCJ, Deep A, et al. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med. 2021;22(1):56-67. (14:47) Additional references: Pediatric Critical Care Medicine journal: https://journals.lww.com/pccmjournal (06:42) Pediatric Critical Care section of Frontiers in Pediatrics journal: https://www.frontiersin.org/journals/pediatrics/sections/pediatric-critical-care (06:59) Journal of Pediatric Critical Care: https://www.jpcc.org.in (07:06) Critical Care Medicine journal: https://journals.lww.com/ccmjournal/pages/default.aspx (07:20) Pediatric Pulmonology journal: https://onlinelibrary.wiley.com/journal/10990496 (07:28) Atlmetric: https://www.altmetric.com/ (16:42) Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access and thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

In this week's episode, Dr. Shanmugam welcomes Dr. Mary Beth Son, the senior author and corresponding author of “Treatment of Multisystem Inflammatory Syndrome in Children: Understanding Differences in Results of Comparative Effectiveness Studies.” This study sought to determine whether the application of different MIS-C definitions and differing disease severity in patients participating in two separate comparative cohorts underlay discrepant results. Dr. Jon Hausmann, pediatric rheumatologist and host of “ACR on Air”, joins Dr. Shanmugam and Dr. Son to add to the significant expertise on this episode, with his own in both clinical pediatric and adult rheumatology. Here, Dr. Hausmann shares further insights on integrating the published literature with pediatric treatment of MIS-C. 

COVID-19 vaccinations to protect children from six months through the age of 5 are now available. Experts say it is best to get your child vaccinated as soon as it's available. In this episode, we're joined by MercyOne pediatrician Dr. Mustafa Eldadah who says, “Every day a child is unvaccinated there is risk of them getting a COVID-19 infection.  The vaccine is safe and getting it now can help put an end to the COVID-19 pandemic. Children can be fully protected by the time school starts.” Vaccination will: • Help prevent the risk of serious illness like Multisystem Inflammatory Syndrome in Children (MIS-C) • Keep your child from missing sporting events or extracurricular activities after exposure • Reduce the need to quarantine if your child is exposed to COVID-19 at school or elsewhere • Help prevent long-term effects of COVID-19 • Reduce the risk of passing COVID-19 infection to family members and others at high-risk for severe illness from COVID-19 Scheduling a vaccination appointment for your child may vary depending on where you live. When ready, contact your pediatric or family medicine physician.  Send us your feedback by emailing podcast@mercyhealth.com, or fill out the submission form at MercyOne.org/podcast Your Best Life – powered by MercyOne

The Journal of Rheumatology's Editor-in-Chief Earl Silverman discusses this month's selection of articles that are most relevant to the clinical rheumatologist. Included is an excerpt from this month's Editor's Picks spotlight interview with author Sofie Gernaat about her and her co-author's article "Gestational Diabetes Mellitus Risk in Pregnant Women With Systemic Lupus Erythematosus" - https://doi.org/10.3899/jrheum.210087 This month's selections also include: Movahedi, et al: Physician- and Patient-reported Effectiveness Are Similar for Tofacitinib and TNFi in Rheumatoid Arthritis: Data From a Rheumatoid Arthritis Registry - https://doi.org/10.3899/jrheum.211066 El Tal, et al: Consensus Approach to a Treat-to-target Strategy in Juvenile Idiopathic Arthritis Care: Report From the 2020 PR-COIN Consensus Conference - https://doi.org/10.3899/jrheum.210709 Thompson, et al: Modifiable Factors and Incident Gout Across Ethnicity Within a Large Multiethnic Cohort of Older Adults - https://doi.org/10.3899/jrheum.210394 Widdifield, et al: COVID-19 Vaccination Uptake Among Individuals With Immune-mediated Inflammatory Diseases in Ontario, Canada, Between December 2020 and October 2021: A Population-based Analysis - https://doi.org/10.3899/jrheum.211148 Van Praet, et al: Acute Perimyocarditis in a Case of Multisystem Inflammatory Syndrome in Adults - https://doi.org/10.3899/jrheum.210850 Chang, et al: Systemic Lupus Erythematosus Increases the Risk of Gestational Diabetes: Truth or Illusion? - https://doi.org/10.3899/jrheum.211374 McCormick and Choi: Racial Disparities in the Modern Gout Epidemic - https://doi.org/10.3899/jrheum.220173 To read these, and other full articles visit www.jrheum.org. Music by David Hilowitz

9 May 2022 Content: Symptoms of COVID-19 infection between the ages of 5 and 11 and subsequent symptoms may lead to Multisystem Inflammatory Syndrome. 內容: 5至11歲兒童感染新冠病毒的症狀 及 其後可能導致引起多系統痰症綜合症。 Parramatta Libraries Health Awareness Talks in Cantonese Language. In partnership with Australian Chinese Medical Association. Health talks to promote better understanding and awareness of common health issues and related services in the Chinese Australian community. Presented by Professor Stephen Li. Chemical Pathologist | Clinical Lipidologist | Chartered Manager Director Core Pathology & Clinical Chemistry, Pathology West, NSW Health Pathology Director Westmead Hospital Lipid Clinic Chair, Community Health, ACMA Honorary President and Foundation Fellow, ACMA

Welcome back to some Transport Tidbits. Join members of our transport team at Children's Hospital and Medical Center as they talk through various diagnoses in each episode. They will cover four things in each short episode: (1) an overview of the condition, (2) assessment of the condition and diagnostic tests, (3) priority interventions for this patient (including medications), and (4) the biggest risk for decompensation in this patient. They will also highlight pertinent questions for you, the inpatient bedside team, to ask when receiving handoff and admitting this patient from the transport team. In this second episode, Kristen Foster, a former transport nurse and now the trauma outreach coordinator at Children's Hospital and Medical Center, will give an overview of the diagnosis MIS-C or Multisystem Inflammatory Syndrome.

The COVID 19 pandemic has brought with it the presence of a severe illness in children called Multisystem Inflammatory Syndrome in Children (MIS-C).  Pediatric specialists and scientists around the world have been researching and working to find out what this syndrome is and how to diagnose and treat it.  Dr. Nisha Agasthya is a pediatric intensivist at Wesley Children's Hospital who has spent the past two years studying and treating this condition in pediatric patients.   She joins Wesley Kidscast to provide a refresher on just what MIS-C is including diagnostic criteria and updates on how to manage patient's with this condition.  Below is the link to the MIS-C webinar that was mentioned in this podcast episode.  Please note that this recording occurred in Sept 2021 so while a majority of recommendations remain the same, please refer to this podcast recording for current guidelines as well as the updated guidance from the American College of Rheumatology linked below.   https://hcaconnect.webex.com/recordingservice/sites/hcaconnect/recording/6d260895ee3610398ef30050568fc16a/playback   American College of Rheumatology Clinical Guidance https://www.rheumatology.org/Portals/0/Files/ACR-COVID-19-Clinical-Guidance-Summary-MIS-C-Hyperinflammation.pdf  

In this World Shared Practice Forum podcast, Dr. Robert Tasker discusses highlights from his first year as Editor-in-Chief of the Pediatric Critical Care Medicine Journal. Dr. Tasker shares his views on some of the most active areas of research and discussion in the field of pediatric critical care medicine in 2021, along with an in-depth look at reach and impact data for a number of the most widely read articles of the year published by PCCM. Learning Objectives -Identify areas of active investigation and discussion in the field of pediatric critical care medicine in 2021 -List prominent articles published in the Pediatric Critical Care Medicine journal published in 2021, as recommended by the Editor-in-Chief of Pediatric Critical Care Medicine -Identify some of the guiding principles of the Editor-in-Chief of Pediatric Critical Care Medicine applied in selecting articles for publication Initial publication date: February 18, 2022 Citation: Tasker R, Daniel D, Burns JP. Pediatric Critical Care Medicine - Year in Review: Thoughts From The Editor In Chief. 2/2022. Online Podcast. OPENPediatrics. https://youtu.be/F995J0JnlZ4. Articles referenced -Tasker R. C. (2021). 2021 in Review. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 22(12), 1009–1010. (4:07) -https://journals.lww.com/pccmjournal/pages/collectiondetails.aspx?TopicalCollectionId=25 (5:17) -Wong HR, Reeder RW, Banks R, et al. Biomarkers for Estimating Risk of Hospital Mortality and Long-Term Quality-of-Life Morbidity After Surviving Pediatric Septic Shock: A Secondary Analysis of the Life After Pediatric Sepsis Evaluation Investigation. Pediatr Crit Care Med. 2021;22(1):8-15. (11:35) -Rimensberger PC, Kneyber MCJ, Deep A, et al. Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections' Collaborative of the European Society of Pediatric and Neonatal Intensive Care. Pediatr Crit Care Med. 2021;22(1):56-67. (9:37) -Jonat B, Gorelik M, Boneparth A, et al. Multisystem Inflammatory Syndrome in Children Associated With Coronavirus Disease 2019 in a Children's Hospital in New York City: Patient Characteristics and an Institutional Protocol for Evaluation, Management, and Follow-Up. Pediatr Crit Care Med. 2021;22(3):e178-e191. (9:58) -Tripathi S, Gist KM, Bjornstad EC, et al. Coronavirus Disease 2019-Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry. Pediatr Crit Care Med. 2021;22(7):603-615. (10:08) -Woods KS, Horvat CM, Kantawala S, et al. Intracranial and Cerebral Perfusion Pressure Thresholds Associated With Inhospital Mortality Across Pediatric Neurocritical Care. Pediatr Crit Care Med. 2021;22(2):135-146. (11:58) -Mitting RB, Peshimam N, Lillie J, et al. Invasive Mechanical Ventilation for Acute Viral Bronchiolitis: Retrospective Multicenter Cohort Study. Pediatr Crit Care Med. 2021;22(3):231-240. (12:36) -Sleeper LA, Mulone M, Diallo F, et al. Stratification of Bleeding Risk Using Thromboelastography in Children on Extracorporeal Membrane Oxygenation Support. Pediatr Crit Care Med. 2021;22(3):241-250. (13:04) -Patel RV, Redivo J, Nelliot A, et al. Early Mobilization in a PICU: A Qualitative Sustainability Analysis of PICU Up!. Pediatr Crit Care Med. 2021;22(4):e233-e242. (13:32) -https://journals.lww.com/pccmjournal/pages/collectiondetails.aspx?TopicalCollectionId=27 (18:10) -Tasker RC. PCCM Narratives, Letters, and Correspondence. Pediatr Crit Care Med. 2021;22(4):426-427. (18:35) -Schober ME, Pavia AT, Bohnsack JF. Neurologic Manifestations of COVID-19 in Children: Emerging Pathophysiologic Insights. Pediatr Crit Care Med. 2021;22(7):655-661. (19:43)

In the pandemic that keeps on going, Omicron's infectiousness means most kids and families will be exposed. But that doesn't mean we can't be prepared. Here are things you can do to protect your kids and your community amid Omicron's surge. Vaccinate your kids if they're eligible Vaccination is the most effective intervention right now to reduce severity of COVID-19 infections and prevent complications, including Multisystem Inflammatory Syndrome in Children, says Jennifer Kwan, a family physician in Burlington, Ontario. MIS-C is a rare but serious inflammatory condition which can be life-threatening, and unvaccinated kids who get COVID-19 are at increased risk. COVID-19 infections in children may also trigger new onset diabetes or symptoms of long COVID.

Will children with COVID-19-related multisystem inflammatory syndrome suffer from long-term cardiac issues? Find out about this and more in today's PV Roundup podcast.

Hermes and Khaleesi chop it up again following another sit down. They discuss some current events, past events, and some personal thoughts/feelings/experiences on everything in between. Enjoy. .If you liked this, and want to hear more, give us a follow and let us know! Or maybe you just want to tell us how awful we are? Comments help the algorithm, and we love to see ‘em! And as always, don't kill the messenger. .Further Reading/Sources: .CUMULATIVE ANALYSIS OF POST-AUTHORIZATION ADVERSE EVENT REPORTS OF {[VACCINES]--PF-07302048 (BNT162B2)} RECEIVED THROUGH 28-FEB-2021https://phmpt.org/wp-content/uploads/2021/11/5.3.6-postmarketing-experience.pdf.Psychedelics Show Promise in Treating Mental Illness: Depression, Anxiety, Addiction, and PTSDhttps://scitechdaily.com/psychedelics-show-promise-in-treating-mental-illness-depression-anxiety-addiction-and-ptsd/.Autoantibody Release in Children after Corona Virus mRNA Vaccination: A Risk Factor of Multisystem Inflammatory Syndrome?https://www.mdpi.com/2076-393X/9/11/1353.~Beloved Sponsors~Rogue Ales & Spirits - https://www.rogue.com/ Exotic Fridge - https://www.instagram.com/exoticfridge .Join our DISCORD server!! https://discord.gg/z7Nbk2Fkv9 .Whiskey Fund (help support our podcast habit!):PayPal - hermesauslander@gmail.com  Patreon - https://www.patreon.com/hermesauslander YouTube - https://youtube.com/channel/UCY9JLTc925sjlmRUjxHPC3Q. If you're interested in some of the stuff we use or maybe just some of the specific items discussed during the episode: check out these links. Full disclosure, we do get a monetary kickback from some of them. We seriously just want to keep doing this forever, and links like this make it possible. Thanks for your support!.Affiliate Links https://linktr.ee/equiplinks .Connect with Hermes:https://www.instagram.com/hermes_auslander/ https://twitter.com/hermesauslander.Connect with Morpheus:https://www.instagram.com/gamespainter723/ .Connect with Khaleesi:https://www.instagram.com/khal.33si/https://twitter.com/khal_3ssi Support the show (https://www.patreon.com/hermesauslander?fan_landing=true)

As of the typing of these words, there are 22 days until the solstice when our portion of the world will slowly begin illuminating a little more each day. This is the 333rd day of this year. What significance might there be in the number 4,444? Stick around for enough editions of Charlottesville Community Engagement, and that figure may one day show up. I’m your host Sean Tubbs, tracking the trivial and monitoring the memorable. On today’s show:Charlottesville’s Planning Commission gets a look at the preliminary capital budget for fiscal year 23University Transit Service buses return to full capacity More news about the transition team of Governor-elect Glenn Youngkin Let’s begin today with two Patreon-fueled shout-outs. The first comes a long-time supporter who wants you to know:"Today is a great day to spread good cheer: reach out to an old friend, compliment a stranger, or pause for a moment of gratitude to savor a delight."The second comes from a more recent supporter who wants you to go out and read a local news story written by a local journalist. Whether it be the Daily Progress, Charlottesville Tomorrow, C-Ville Weekly, NBC29, CBS19, WINA, or some other place I’ve not mentioned - the community depends on a network of people writing about the community. Go learn about this place today!As the week begins, the Virginia Department of Health reports a seven-day average of 1,377 new cases and the seven-day percent positivity is at 6.1 percent. On Friday, the VDH reported the first fatality of a child from Multisystem Inflammatory Syndrome. In the Blue Ridge Health District, there are another 55 new cases today and a seven-day percent positivity of 5.8 percent. There have been two more fatalities reported since Wednesday. Last week, the Jefferson Madison Regional Library entered into a partnership with the Virginia Department of Health to distribute at-home COVID-19 testing kits. The pilot program offers rapid antigen tests that are guided by a virtual assistant. “The test kits must be used away from the library, via an internet-connected device with a camera (including smart phones) with digital test results available within 15 minutes,” reads a press release. “Library staff cannot assist with administering tests, and tests cannot be taken inside any JMRL location.”Today marks the first day in a year and a half that passengers on University Transit Service buses will board from the front door. UTS has ended rules that required riders to board from the middle door. Capacity restrictions have also been dropped, meaning buses will be able to fill to standing. However, masks and facial coverings are still mandatory. The University Transit Service will also restore service to stops at Garrett Hall and Monroe Hall whenever UTS is serving McCormick Road. Those stops had been dropped to help UTS manage the capacity restrictions. Visit the UTS website to learn more about specific details.To learn more about transit, consider attending the Regional Transit Partnership’s meeting on Thursday at 4 p.m. On the agenda is a look at the Regional Transit Vision plan that is in development by the Thomas Jefferson Planning District. (agenda)Jaunt buses returned to 100 percent capacity earlier this year. There are a few local names on what Governor-elect Glenn Youngkin is calling his transition landing teams. The “landing teams that will coordinate with the cabinet secretaries from the current administration and conduct due diligence across all agencies so that the Youngkin administration will hit the ground running and begin delivering on its promises on Day One,” reads a press release from Wednesday.Senator Emmet Hanger (R-24) will serve on the Agriculture and Forestry team and Delegate Rob Bell (R-58) is on the Education team. Bell will also serve on the Public Safety and Homeland Security team. Senator Bryce Reeves (R-17) will be on the Veterans and Defense Affairs team. For the full list, take a look at the full press release. In today’s second subscriber-supported public service announcement: The Charlottesville Jazz Society at cvillejazz.org is dedicated to the promotion, preservation, and perpetuation of all that  jazz, and there’s no time like now to find a time to get out and watch people love to play. The Charlottesville Jazz Society keeps a running list of what’s coming up at cvillejazz.org. Sign up for their newsletter today. The Charlottesville Planning Commission got a look last week at a preliminary budget for the capital improvement program for the fiscal years 2023 through 2027. Council will vote next spring to approve the first year of spending, but decisions for future years would be for future versions of Council. (November 23 presentation) (watch the meeting)But first, what is a capital improvement program? Krissy Hammill is a Senior Budget and Management Analyst for the City of Charlottesville. “It’s basically a five-year financing plan that contains infrastructure type projects that usually cost more than $50,000,” Hammill said. “They’re generally non-recurring and non-operational and they generally have a useful life of five years or more.” Major items are usually funded by debt the city takes on in the form of bond sales. Investors front the money in exchange for a steady and guaranteed return. Like Albemarle County, Charlottesville has a AAA bond rating that is both attractive to investors and has a low interest rate. The latter results in a lower debt-service payment for the city. “We are actually part of a very small group of localities that have that rating,” Hammill said. “It is the premiere marker of a locality’s financial stability in strength.” In recent years, Council has increased the amount of spending on affordable housing initiatives, directly funding redevelopment of public housing and Friendship Court. In the past budget cycle, Council expressed a willingness to fund the configuration of City Schools. “We had a placeholder for that project at $50 million and based on Council’s direction from a meeting in October, that has now been increased from $50 million to $75 million,” Hammill said. “The funding has been moved up from FY25 to FY24. We also know that in doing this there will need to be additional revenue enhancements to pay for the additional debt service that will be required.”Revenue enhancements can be translated as “tax increase” and Hammill has previously told Council and the public that the equivalent of a 15 cent increase on the property tax rate may be required to cover the cost. There’s the possibility of the next General Assembly allowing Charlottesville voters to decide on a sales-tax increase with proceeds going toward schools. Even with that possibility, the city may not be able to make any new investments for some time. “We know that our debt capacity will be exhausted for some period of time,” Hammill said. In the current fiscal year, debt service is just under five percent of the $192.2 million General Fund Budget. That amount does not include the amount of general fund cash used for capital projects. That number will increase. “The plan put before you has debt service basically doubling from just over ten million to just over $20 million within a very short period of time, about four years,” Hammill said. A draft of the next Capital Improvement Program won’t be officially presented to Council until late February or early March. Hammill documented several other revisions to the preliminary budget. At Council’s direction, $18.25 million in city funds for the West Main Streetscape were transferred to the school reconfiguration project as well as $5 million from a parking garage on 7th and Market Street. In December 2018, a previous City Council  signed an agreement with Albemarle County to provide parking as part of a multimillion project to locate a joint General District Court downtown. Subsequent Councils have opted to not build a new parking garage to honor the terms of that agreement. (read the agreement)“We don’t have any specifics right now,” said Chris Engel, the city’s economic development director. “We’re in the midst of conversation with the county about the fact that we’re not going to build a structure and what the agreement leaves them with regard to their options and trying to figure out what’s best for both parties.” Pre-construction of the courts facility is underway. Another adjustment in the city’s preliminary capital improvement program is additional funding for a comprehensive plan for the Parks and Recreation Department. “This would be to look at Parks and Rec programs,” Hammill said. “This is not the normal master plan for the parks per se master planning process, but more of a programmatic master plan.” There are also programs for drainage issues at Oakwood Cemetery and McIntire Park as well as funding to assist the removal of dead Ash trees in the city. Council has also approved a housing plan that asks for $10 million a year on affordable housing initiatives. Hammill said not all of the funding for that initiative would come from the capital improvement program budget. City Council will review the Charlottesville Affordable Housing Fund at its meeting on December 6. Another item not in the capital budget is private funding for a sidewalk on Stribling Avenue. Southern Development has offered to loan the city $2.9 million to cover the cost of the project as part of a rezoning in Fry’s Spring area. The Charlottesville Planning Commission will hold a public hearing on the preliminary CIP on December 14. Finally today, the second shout-out for today specifically asked you to check out a local news story. Here’s one to begin with. Last week, Carly Haynes of CBS19 reported on the intersection of Preston Avenue and Grady Avenue in Charlottesville. Charlottesville was awarded $7.743 million in a Smart Scale project to alter the intersection. Learn more in this report from November 23rd.Special announcement of a continuing promo with Ting! Are you interested in fast internet? Visit this site and enter your address to see if you can get service through Ting. If you decide to proceed to make the switch, you’ll get:Free installationSecond month of Ting service for freeA $75 gift card to the Downtown MallAdditionally, Ting will match your Substack subscription to support Town Crier Productions, the company that produces this newsletter and other community offerings. So, your $5 a month subscription yields $5 for TCP. Your $50 a year subscription yields $50 for TCP! The same goes for a $200 a year subscription! All goes to cover the costs of getting this newsletter out as often as possible. Learn more here!. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

During the fall and winter months, we're all thinking about colds and the flu and how to keep our kids healthy. We often read about foods and natural ways to boost immunity but the immune system is more complex than we realize.  In this episode, I sat down with Dr. Heather Moday, an immunologist, allergist, and functional medicine doctor, and author of a new book, The Immunotype Breakthrough. We talked about how the immune system works, why boosting the immune system may not always be the best idea, and the effects that COVID-19 may have on our kids' health. We also talked about the best nutrients, superfoods, and healthy habits that help support our kids' immune systems.  Welcome 3:17 Let's talk about your story! 5:25 Can you give us a primer on the immune system?  8:10 What happens to a child's immune system as they grow? 9:53 We hear a lot about “boosting” our immune systems, but I read that you say balance is more important—why? 13:12 What should parents know about COVID-19 at this stage of the game?  16:22 What do you think about the COVID-19 vaccine for kids? 17:29 Do experts expect to see—or are they already seeing—certain types of illnesses in kids this year? 19:08 Are there long-term effects to a kid's immune system because of COVID-19 masking, social distancing, etc.? 21:00 What are the best ways parents can keep their kids healthy this fall and winter?  22:21 What are foods kids should avoid? 23:38 There's controversy around the term “leaky gut syndrome,” so is it legitimate? 26:57 Which nutrients should kids focus on? 27:23 Are vitamin D, antioxidants, and omega-3 fatty acids important for the immune system? 29:12 What are the best superfoods for kids? 30:27 Should kids take probiotics? 31:56 Should kids with allergies, eczema, and food allergies take antioxidants and probiotics? 32:54 How can parents make sure their kids are getting enough sleep—and quality sleep—every night? 34:59 How can parents get activity and exercise in their kids' days? 36:34 Kids are under a ton of stress, which can affect your immune systems. What can parents do to help their kids?  LINKS MENTIONED IN THE SHOW Julie mentions the “Food Issues” episode with Dr. Tracy Shafizadeh from Evolve BioSystems and Evivo. Julie mentions that her young daughter had a severe case of COVID-19. Dr. Moday talks about Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki disease. Grab a copy of Dr. Moday's new book, The Immunotype Breakthrough. Learn more about Dr. Moday at ModayCenter.com and follow her on Instagram. FROM OUR PARTNERS Kids Cook Real Food eCourse The Kids Cook Real Food eCourse, created by a mom of 4 and a former elementary school teacher, is designed to build connection, confidence, and creativity in the kitchen. The course includes 30 basic cooking skills, 45 videos including several bonuses, printable supply and grocery shopping lists, and kid-friendly recipes. The course is designed for all kids ages 2 to teen and has three different skill levels. More than 18,000 families have taken the course and The Wall Street Journal named it the #1 cooking class for kids. Sign up now for the Kids Cook Real Food ecourse and get a free lesson for being a “Food Issues” listener.    Thrive Market  Thrive Market is an online membership-based market that has the highest quality, organic, non-GMO, healthy, and sustainable products. From groceries, clean beauty, safe supplements, and non-toxic home products to ethical meat, sustainable seafood, clean wine, and more, Thrive Market is where members save an average of $32 on every order! Through Thrive Gives, every paid membership sponsors a free one for a low-income family. Join Thrive Market today and get 25% off your first order and a free gift.  Vitamix  Unlike other blenders, the Vitamix blends everything up into a super-smooth consistency, much like a juicer would, except you get all the nutritious fiber that regular juicers leave behind.

Episode 75: Multisystem Inflammatory Syndrome in Children (MIS-C).  Dr Schlaerth explains the signs, symptoms, and basic management of MIS-C. Lam explain the role of anti-obesity medications in weight management. Introduction: The Role of Drugs in Weight Loss Management    By Lam Chau, MS3, Ross University School of Medicine     Today about 70% of adult Americans are overweight or obese. Obesity is associated with increased risk of heart disease, stroke, and diabetes, among many other diseases. Studies have shown losing 5-10% of your body weight can substantially reduce your risk of cardiovascular disease.  Traditional belief is that weight loss can only be attributed to diet and exercise. While there are certainly elements of truth to that statement, medication is a safe and proven method for weight management that is often overlooked. The fact of the matter is that weight loss is an ongoing field of study with constant new research and innovations.  In June of this year, a medication named Wegovy was approved for weight loss management by the FDA. This drug is indicated for chronic weight management in patients with a BMI of 27 or greater with an accompanying weight-related ailment or in a patient with a BMI of 30 or greater. Rachel Batterham, PhD, of the Centre for Obesity Research at University College London, shared: "The findings of this study represent a major breakthrough for improving the health of people with obesity. No other drug has come close to producing this level of weight loss — this really is a game changer.” Despite breakthroughs like these, the use of medication for weight loss is still relatively low. Dr. Erin Bohula, a cardiologist and assistant professor at Harvard Medical School, believes “there are probably a few reasons for this, including cost, if not covered by insurance, and a perception these agents are not safe in light of the history with weight loss agents.” A study from 2019 examined the medical records from eight geographically dispersed healthcare organizations. They found that out of 2.2 million patients who were eligible for weight loss medication, only 1.3% filled at least 1 prescription. Weight loss is a dynamic process with many different variables. While it may not necessarily be for everyone, medication can help tremendously and is an option you should consider if you are interested in weight loss[1,2]. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.  ___________________________Multisystem Inflammatory Syndrome in Children (MIS-C).   By Katherine Schlaerth, MD, and Hector Arreaza, MD. History and epidemiologyMost children who get COVID-19 have either no symptoms or very mild symptoms. However, about 18 months ago, a new pediatric complication of COVID-19, possibly postinfectious, was described.  The eight children who were initially described had a clinical presentation which was similar to either Kawasaki Disease or perhaps toxic shock syndrome, and since these children had signs of a hyperinflammatory state coupled with shock, the new syndrome was named Multisystem Inflammatory Syndrome in Children, or MIS-C for short. By midsummer of 2021, the United States had about two thousand cases and 30 deaths in children under 21.  Other name for this condition is Pediatric Hyperinflammatory Shock. DiagnosisWhat are the criteria for a diagnosis of Multisystem Inflammatory Syndrome? They include:Age below 21Fever above 100.4 degrees Fahrenheit or 38 degrees centigrade for 24 hours (a subjective fever for more than 24 hours counts too). Laboratory evidence of inflammation which should include at least two of the following tests: elevated CRP, elevated ESR, elevated fibrinogen level, procalcitonin, D-dimer, ferritin, lactic acid dehydrogenase (LDH), interleukin-6, and neutrophil counts, low lymphocyte count and low albumin.Severe disease necessitating hospitalization with multisystem organs affected. The systems affected include cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, and neurologic (at least three systems need to be involved). No creditable other diagnosis. Other symptoms include:GI complaints (diarrhea, vomiting, abdominal pain)Skin rashConjunctivitisHeadacheLethargyConfusionRespiratory distressSore throatMyalgiasSwollen hands/feetLymphadenopathyCardiac signs and symptoms include troponin/BNP elevation and arrhythmia. Findings on ECHO may include depressed LVEF, coronary artery abnormalities, including dilation or aneurysm, mitral regurgitation, and pericardial effusion. There also must be a positive test for SARS-CoV-2 and this test can be either a reverse transcriptase polymerase chain reaction (RT-PCR), serologic, or antigen testing. Exposure to someone who has had or is suspected of having had COVID-19 within the last 4 weeks also counts.  Patients with MIS-C may have predominately gastrointestinal symptoms, mucocutaneous findings, and may be hypotensive or “shocky” on presentation. Up to 80% require ICU admission. Thrombocytopenia and /or elevated transaminase levels can also be seen.  MIS-C vs Kawasaki DiseaseThe big issue in diagnosing MIS-C is the overlap with Kawasaki's disease and with toxic shock syndrome. Patients with Kawasaki Disease in their second week of illness often will have thrombosis, not thrombocytopenia. Whereas MIS-C usually affects school age children or adolescents, Kawasaki Disease is more commonly a problem in younger children, who have an average age of 2 years.  Kawasaki Disease is also more common in Asian children and MIS-C disproportionately seems to affect Black and Hispanic children.  Obesity seems to be another risk factor for MIS-C.  Kawasaki's Disease also has different cardiac manifestations from MIS-C. Coronary artery dilatation is common in Kawasaki's disease and left ventricular dysfunction in MIS-C, although sometimes coronary artery dilatation and rarely aneurisms can be noted on echocardiogram in putative MIS-C, which is why differentiation from Kawasaki's Disease is an issue.  PathophysiologyThe cause of MIS-C is probably postinfectious immune dysregulation. Only a minority of MIS-C patients are identified as having COVID-19 by RT-PCR, but most have positive tests for immunoglobulin G.  Statistically, there is a lag of 4-6 weeks between peak community cases of COVID-19 and the time at which children present with MIS-C.   Although research is being done on MIS-C, and theories abound about etiology, there is no clear-cut answer to why some children get MIS-C and the vast majority do not. In a review of the literature on MIS-C using literature from December 2019 through May 2020, gastrointestinal symptoms such as diarrhea, and abdominal pain were 4-5 times more common than cough and respiratory distress.  There was a slight preponderance of male patients and mean age was 8 ½ years. ICU admission was common and 2/3 required inotropic support, over ¼ needed respiratory help with extracorporeal membrane oxygenation warranted in 31 children. The death rate was 1.5 % of these very sick children treated in hospital.  In another smaller study, 80% had mild, but 44% had moderate to severe EKG abnormalities including coronary involvement. The good news was that coronary arteries were normal in all children after a month, and at 4-9 months, only 2-4% had mild heart abnormalities. Unfortunately, mechanisms of MIS-C as well as universal treatment is still being worked out. Published articles may be delayed due to time constraints in publishing. Other immunologic interventions do not have sufficient data. TreatmentWhat about the treatment of children diagnosed with MIS-C?Usually, a variety of specialists become involved initially. These can include pediatric rheumatology, infectious disease, cardiology, and hematology. If children with MIS-C meet criteria for complete or incomplete Kawasaki disease as well, regardless of COVID-19 testing results, IVIG and aspirin are reasonable.  Corticosteroid use must be individualized, and if used it may require a taper.  An echocardiogram can be done initially looking for coronary aneurisms and repeated in a week.  In severe cases, shock may be a presenting factor needing urgent attention. Generally, the treatments used are decided by the aforementioned consults and may consist of immunomodulating therapy, including possibly IVIG (2g/kg), and/or corticosteroids methylprednisolone (30mg/kg).  AntiviralsThe role of antiviral therapy is unclear and remdesivir should be reserved for children with acute COVID-19.  COVID-19 vaccination-associated myocarditisAnother entity which needs further evaluation is COVID-19 vaccination-associated myocarditis in adolescents. This problem is more common in young males and may occur after the administration of mRNA based COVID-19 vaccines. The presentation occurs within 2 weeks of COVID-19 vaccination, and clinical presentation can include chest pressure, abnormal biomarkers (elevated troponins), and cardiac imaging findings. It is unknown if subclinical cases occur.  COVID-19 infection in children, while usually benign, has the potential to become serious, and the association between some mRNA vaccines and the occurrence of myocarditis has yet to be thoroughly studied. We look forward to more and better data to guide the care of children and young adults in these spheres. The risk of having myocarditis is still higher with the actual COVID-19 than the COVID-19 vaccine. The incidence of myocarditis after BioNtech/Pfizer vaccine was 2.13 cases per 100,000 persons in a large study done in a large health care organization in Israel where more than 2 million people were vaccinated (that represents 0.00213%). Another US study showed that there were 77 cases per million doses of vaccines in young male, in contrast, there were 450 cases of myocarditis per million COVID-19 cases in the same age group.____________________________Conclusion: Now we conclude our episode number 74 “Multisystem Inflammatory Syndrome in Children.” Dr. Schlaerth explained that MIS-C is a work in progress in terms of pathophysiology, diagnosis, treatment, and prognosis. MIS-C and Kawasaki Disease are very similar, but, for example, GI symptoms, cardiac dysfunction, shock and multisystem dysfunction are more prominent in MIS-C than Kawasaki Disease. Whereas coronary artery aneurysms are more common in Kawasaki disease than MIS-C. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Katherine Schlaerth, and Lam Chau. Audio edition: Suraj Amrutia. See you next week! _____________________References:FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014, June 04, 2021, U.S. Food and Drug Administration (FDA), https://www.fda.gov/news-events/press-announcements/fda-approves-new-drug-treatment-chronic-weight-management-first-2014. Saxon DR, Iwamoto SJ, Mettenbrink CJ, et al. Antiobesity Medication Use in 2.2 Million Adults Across Eight Large Health Care Organizations: 2009-2015. Obesity (Silver Spring). 2019;27(12):1975-1981. doi:10.1002/oby.22581. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868321/.  Carroll, Linda, Weight-loss pills can help. So why don't more people use them? NBC News Health Care, September 2, 2018.  https://www.nbcnews.com/health/health-care/weight-loss-pills-can-help-so-why-don-t-more-n905211 World Health Organization, WHO recommends groundbreaking malaria vaccine for children at risk, October 6, 2021. https://www.who.int/news/item/06-10-2021-who-recommends-groundbreaking-malaria-vaccine-for-children-at-risk Lee, Min-Sheng et. al, Similarities and Differences Between COVID-19-Related Multisystem Inflammatory Syndrome in Children and Kawasaki Disease, Front. Pediatr., 18 June 2021, https://doi.org/10.3389/fped.2021.640118.  Gail F. Shust, Vijaya L. Soma, Philip Kahn and Adam J. Ratner, Pediatrics in Review July 2021, 42 (7) 399-401; DOI: https://doi.org/10.1542/pir.2020-004770. Jain SS, Steele JM, Fonseca B, et al. COVID-19 vaccination-associated myocarditis in adolescents. Pediatrics. 2021; doi:10.1542/peds.2021-053427.  https://pediatrics.aappublications.org/content/pediatrics/early/2021/08/12/peds.2021-053427.full.pdf.  Wilson, Clare, Myocarditis is more common after covid-19 infection than vaccination,  New Scientist, 4 August 2021, https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/#ixzz79JPn2E47. Son, Mary Beth F, MD, and Kevin Friedman, MD, COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis, Up to Date, September 2021, https://www.uptodate.com/contents/covid-19-multisystem-inflammatory-syndrome-in-children-mis-c-clinical-features-evaluation-and-diagnosis?search=kawasaki%20vs%20misc&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1  

NASN School Nurse Editor, Cynthia Galemore, interviews author Margaret Bultas and Kelli Fuller about the article, "Multisystem Inflammatory Syndrome in Children and COVID-19 Infections". To view the article, click here.

  Vidcast:  https://youtu.be/dk1FqpAEIQg   Let's take a look at the data submitted by Pfizer to the FDA in support of an Emergency Use Authorization for Pfizer vaccine use in children 5 to 12 years of age.  Pfizer studied 2250 children 1518 of whom were vaccinated and 750 of whom served as placebo controls.  An additional 2250 children were studied to add additional safety data.   The vaccinated children received 10 ug of mRNA, one-third the adult dose, twice 3 weeks apart.  Their levels of anti-CoVid antibodies were comparable to those elicited from vaccinating young adults 16 to 25 years of age.  A supplemental analysis of sera from 38 randomly selected vaccinated children showed equivalent potency against the Delta variant compared with the original CoVid strain.   The real-life vaccine effectiveness during the tine of Delta was 90.7%.  There were no cases of severe CoVid and no cases of Multisystem Inflammatory Syndrome, MIS-C.  This indicates a high level of protection for children  without an undue risk of side effects.   The safety data showed mild to moderate reactions during the first 2 days after vaccination.  The most common local reaction was injection site pain and the most common systemic reactions were fatigue, headache, muscle pain, and chills.  There were no cases of myocarditis.   https://www.fda.gov/media/153409/download   #CoVid #pfizer #children #vaccine   

Commentary by Dr. Julia Grapsa

In this episode Stuart Weinberg, MD, FAAP, FAMIA, past chair of the AAP's Council on Clinical Information Technology, describes ways pediatricians can use Web applications and services to improve functionality of the Electronic Health Record. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Kanwal Farooqi, MD, about longitudinal outcomes for Multisystem Inflammatory Syndrome in Children (MIS-C). For resources go to aap.org/podcast.

Join Zac Hodges as he discusses MIS-C with two local experts. Dr. Pushpa Shivaram is a pediatric cardiologist and Dr. Julisa Patel is a pediatric rheumatologist.  They discuss What this syndrome is How to make this tough diagnosis Proper management of patients This is a brand new disease that we all need a refresher on.

Pediatrician Dr. Tehseen Ladha discusses the latest pandemic plan announced by the Alberta government as well as the emerging cases of Multisystem Inflammatory Syndrome in Children (MIS-C) and Long COVID sufferers.  Cat researcher, Gabriella Smith explains her research on 'If I Fits I Sits' exploring one of the distinctive feline behaviours endearing them to humans. She's part of the Edmonton International Cat Festival. Event founder, Linda Hoang shares about what's in store at this year's virtual two-day festival. 13:06 - Dr. Tehseen Ladha 1:07:10 - Cat Fest panel

As of earlier this month, 127 kids aged 12 to 17 years old had died of COVID-19 in the United States . The number may pale in comparison to the more than half a million adults who’ve died so far, but because deaths among kids are so rare, the total is still high enough to rank COVID-19 among the leading causes of death among that age group. Death, however, isn’t the only negative COVID outcome in young people: More than 3,700 kids and teenagers have been diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C), a mysterious but serious inflammatory disease that can land children in the hospital weeks after they appear to have recovered from COVID infection. For these reasons and many others, the American Academy of Pediatrics has recommended that all children receive the COVID vaccine as soon as they’re eligible—including adolescents 12 years and older, who have now been eligible for a week. This week’s COVID update explores the implications of the COVID vaccine for kids,

This episode features pediatrician Jacques-Brett Burgess, MD, MPH, SFHM, FAAP and hosts Dr. Christine Nefcy and Laura Glenn speaking on Multisystem Inflammatory Syndrome (MIS-C). MIS-C is a rare but serious inflammatory condition seen in children that is a delayed immune response to COVID-19. Dr. Burgess shared local numbers, symptoms and signs of MIS-C, treatment recommendations (when to refer/transfer), and potential long-term ramifications. 

Editor-in-chief Shawn Kennedy and senior clinical editor Christine Moffa present the highlights of the May issue of AJN, including articles such as “Multisystem Inflammatory Syndrome in Children: A Review,” “Providing Care for Caregivers During COVID-19,” “A Look Back at the Year of the Nurse and the Midwife,” “Immunity from Civil Liability,” “Addressing Hospital-Acquired Hypoglycemia,” and more!

AJN editor-in-chief Shawn Kennedy speaks with Kerry Shields and Kristin Atlas about their article, which describes the epidemiology, pathophysiology, signs and symptoms, other potential diagnoses, and treatments relevant to MIS-C.

Editor-in-chief Shawn Kennedy and senior clinical editor Christine Moffa present the highlights of the May issue of AJN, including articles such as “Multisystem Inflammatory Syndrome in Children: A Review,” “Providing Care for Caregivers During COVID-19,” “A Look Back at the Year of the Nurse and the Midwife,” “Immunity from Civil Liability,” “Addressing Hospital-Acquired Hypoglycemia,” and more!

Multisystem Inflammatory Syndrome in Children is a rare but scary byproduct of COVID infections in kids that causes dangerous swelling of internal organs, especially the heart. The largest study to date of this syndrome has just been completed. Dr. Dean Blumberg is a pediatrician & infectious disease specialist at UC Davis Health. California Governor Gavin Newsom has announced that he plans to swing the doors wide open and drop almost all COVID restrictions and precautions by June 15th. Dr. Robert Wachter is chair of the Department of Medicine at University of California, San Francisco. The CDC is advising all of us to back away from the disinfecting wipes and sprays. Reaffirming that the novel coronavirus is transmitted almost exclusively through the air, the CDC says old fashioned soap and water should work just fine to keep surfaces clean. Dr. Joseph Allen directs the Healthy Buildings Program at Harvard's Chan School of Public Health. The thinking among mental health professionals was that a year of high anxieties from a global pandemic, combined with persistent social isolation, would result in a rise of suicides during 2020. But, according to new statistics compiled by the CDC, suicides decreased in 2020 for the first time in several years, down almost 5-percent. Dr. Larry Wright directs the Forefront Suicide Prevention Center at the University of Washington. The airline industry is bracing for a possible shortage of pilots. United Airlines is making a move to get ahead of the issue by committing to train 5,000 pilots at its own academy over the next 10-years. Joe Schwieterman is the Director of the Chaddick Institute at DePaul University in Chicago.  The pandemic is causing a ketchup shortage. With many people turning to takeout meals, tiny ketchup packets are in high demand. It appears suppliers can't seem to keep up with it. The Wall Street Journal says the price for packaged ketchup has gone up 13%. Another reason for the high demand : restaurants are trying to reduce ketchup sharing during the pandemic by stocking up on those packets.  Learn more about your ad choices. Visit podcastchoices.com/adchoices

Multisystem Inflammatory Syndrome in Children is a rare but scary byproduct of COVID infections in kids that causes dangerous swelling of internal organs, especially the heart. The largest study to date of this syndrome has just been completed. Dr. Dean Blumberg is a pediatrician & infectious disease specialist at UC Davis Health.California Governor Gavin Newsom has announced that he plans to swing the doors wide open and drop almost all COVID restrictions and precautions by June 15th. Dr. Robert Wachter is chair of the Department of Medicine at University of California, San Francisco.The CDC is advising all of us to back away from the disinfecting wipes and sprays. Reaffirming that the novel coronavirus is transmitted almost exclusively through the air, the CDC says old fashioned soap and water should work just fine to keep surfaces clean. Dr. Joseph Allen directs the Healthy Buildings Program at Harvard's Chan School of Public Health.The thinking among mental health professionals was that a year of high anxieties from a global pandemic, combined with persistent social isolation, would result in a rise of suicides during 2020. But, according to new statistics compiled by the CDC, suicides decreased in 2020 for the first time in several years, down almost 5-percent. Dr. Larry Wright directs the Forefront Suicide Prevention Center at the University of Washington.The airline industry is bracing for a possible shortage of pilots. United Airlines is making a move to get ahead of the issue by committing to train 5,000 pilots at its own academy over the next 10-years. Joe Schwieterman is the Director of the Chaddick Institute at DePaul University in Chicago. The pandemic is causing a ketchup shortage. With many people turning to takeout meals, tiny ketchup packets are in high demand. It appears suppliers can't seem to keep up with it. The Wall Street Journal says the price for packaged ketchup has gone up 13%. Another reason for the high demand : restaurants are trying to reduce ketchup sharing during the pandemic by stocking up on those packets.  To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

Today's Patreon-fueled shout-out is for the Plant Northern Piedmont Natives Campaign, an initiative that wants you to grow native plants in yards, farms, public spaces and gardens in the northern Piedmont. Native plants provide habitat, food sources for wildlife, ecosystem resiliency in the face of climate change, and clean water.  Start at the Plant Northern Piedmont Natives Facebook page and tell them Lonnie Murray sent you! On today’s show:CRHA gets an update on two upcoming construction projectsBatesville residents have the chance to ask questions about a 60-acre solar projectVirginia General Assembly is considering legislation to require schools return to in-person educationLet’s begin with a quick look at COVID numbers today.The local surge continues while the statewide recedes. The Virginia Department of Health reports 1,907 new cases today, which is just one number off the statewide 7-day average of 1,908. 102 of those new cases are in the Blue Ridge District with 80 from Albemarle and ten from Albemarle. The University of Virginia is now reporting 853 active cases on its COVID tracker. Source: Virginia Department of HealthWe need to talk a little about deaths. After over a week without any fatalities, thirteen new cases have been reported in Blue Ridge Health District for the past four days. That doesn’t mean the individuals died yesterday, as the Virginia Department of Health recommends looking at fatalities on the day they occured. Statewide the death count had been going up sharply as a backlog of death certificate data is entered. The total is 7,807 in Virginia as of today. One alarming metric change today is a sudden increase of cases of Multisystem Inflammatory Syndrome in Children from 18 on Monday to 25 yesterday to 27 today. Read coverage on that topic in the Henrico Citizen. Charlottesville is moving forward with a plan to return students to classrooms on March 8. Albemarle County goes from Stage 3 to Stage 4 on March 15.  A bill that would require school systems to make in-person instruction the default form of education has passed a Virginia House of Delegates panel. SB1303 was approved by the 17-3 by the House Education Committee on Monday. Here’s the sponsor, Senator Siobhan Dunnavunt (R-12).“It requires each School Board to offer in-person education for the minimal number of hours required annually to each person in K-12 schools [and] to follow the mitigation guidelines of the CDC to do that in a safe way,” Dunnavant said. Schools would be directed to work with local health departments to ensure anyone who contracts a case would be quarantined. Dunnavunt said opening schools will help some people get back to work. “We are seeing that working mothers have the highest unemployment rate and after all of our efforts in equality in employment, we have had a huge setback with untold jeopardy for moms going forward because the infrastructure of school is a necessary component of the stability of the family,” Dunnavunt said. The bill under consideration is a substituted amended to allow some students to continue to attend school virtually. “Folks are able to learn virtually if they have medical reasons they feel are important or if their community is just a bit more wary of going back,” said Delegate Schuyler VanValkenburg (D-72).The legislation would go into effect July 1. An emergency clause requiring schools to open immediately was removed before it passed the Senate. For a snapshot of what divisions are doing what at the moment, consult the Virginia Department of Education map. Source: Virginia Department of EducationWhile we’re on the topic of legislation, a bill to create a passenger rail authority for the New River Valley has passed the full General Assembly. This year’s recommended Smart Scale projects include $50 million to expand passenger rail to Christiansburg. More on that in Amy Freidenberger’s story in the Roanoke Times.Finally in brief COVID news, the Center at Belvedere has announced it will reopen its doors on March 15. The community space off of Rio Road closed their doors in late January amid a surge in cases. An email from Center executive director Peter Thompson said vigilance will still be required. “Not everyone has received a vaccination, and uncertainty surrounding coronavirus variants remains,” Thompson wrote. “To safeguard against complacency, we are adding a few new protocols to ensure the safest possible environment in which to enjoy our many programs.”* The Charlottesville Redevelopment and Housing Authority’s Board of Commissioners held their final meeting before groundbreaking will take place for the first new public housing units to be built in a generation. Jay Kessler has been working as the project manager on behalf of the CRHA in a position known as “owner’s representative.”  Riverbend Development is the private partner under an LLC called the Affordable Housing Group.  “And in this case, the owner is different than my normal clients because it really is AHG, it’s CRHA, and it’s PHAR,” Kessler said. “Owners have a significant role to play in the success of their design and construction projects. I bring a 35-year construction background.”  Kessler said he had no prior experience working on projects that trigger regulations from the U.S. Department of Housing and Urban Development. Kessler said actual work at South First Street began on February 8.“Right now they are working on getting erosion and sediment control set up, getting security fencing up, getting signs and banners up so people know what’s going on if they drive by on if they are not familiar with it,” Kessler said. The first building pad will be ready in April, followed by significant construction activities.  The work is expected to be complete in June 2022. Kessler said the Crescent Halls renovations are not as close to construction and negotiations are still underway for a contract price with GMH Construction. He said he hoped the project could close by the first week of March with construction beginning in mid-April and concluding toward the the end of 2022. “We had hoped to be there at the end of last week but didn’t quite get to where we have a final contract in place,” Kessler said. “Their plan is to start on the re-roofing of the building once the 8th floor is vacant so that we don’t have too much noise for residents living there.” Kessler said the construction schedule depended on enough residents volunteering to be temporarily relocated to other units within the building and that CRHA had enough verbal commitments to proceed.  “There will be challenges with it being occupied during the renovations but that’s had a lot of discussion, a lot of planning,” Kessler said. The cost of both projects have increased due to a scarcity of building materials, which has resulted in an increase in costs.“That’s definitely an issue on South First Street, but I know our contractor Breeden Construction factored in the cost risk into their contract so if the market changes, they are at that risk, not us, not the owner,” Kessler said. The occasion was noted by Joy Johnson of the Public Housing Association of Residents, who recently won the Dolbeare Lifetime Service Award from the National Low-Income Housing Coalition for her work in laying the groundwork for affordable housing reform in the city.“The work that PHAR and myself has done, and to see those 63 units getting ready to go up and to see Crescent Halls getting ready…. ...to be able to see that to me I am just very thankful,” Johnson said. The CRHA will have a work session on the agency’s capital budget on Thursday. It’s been postponed twice due to recent inclement weather. Crescent Halls was built in 1976. Learn more about it in on cvillepedia.Last night, a community meeting was held for a special use permit for a 60-acre utility-scale solar facility near Batesville. Sun Tribe Solar is applying for the 8-megawatt project on behalf of the Central Virginia Electric Cooperative, which purchased the property last year. Supervisors updated the zoning code to allow such facilities with a special use permit. Bobby Jocz is a permitting lead with Sun Tribe Solar. “Once the life of this facility is complete, the site will be restored to its original condition,” Jocz said. Neighbors had the opportunity to ask questions about the project. Paul Miller is a resident of Craigs Store Road, where the site would be located.“I’m in general in favor of solar development, but I’m not so sure about this particular location when I look at opportunities for development on top of buildings in urban areas,” Miller said. Miller asked if there could be opportunities for sheep to be able to graze on the property. Miller and others also expressed concern about outdoor lighting at the facility given concerns about preserving the dark sky. Mark Tueting also lives on Craigs Store Road and he is concerned on the visual impacts for the years before vegetated landscaping grows in. He also had a question about whether this would be a “substantial detriment” “I’m excited solar and they’ve been really good to work with and they’ve talked about letting my son keep running his sheep there, but I have to worry about property values, too,” Tueting said. “I think most of us who live in the area said we wanted to live in a rural area. We know we probably wouldn’t have bought here if there was a power plant next door.” Bill Fritz with Albemarle’s Community Development Department said there is a high bar to stop a project based on the claims for “substantial detriment.”“Substantial detriment that planners use is that the impact is such a severe impact that it denies the right to use another property,” Fritz said. “For example, if I have a use that generates a massive amount of odor, and I am next to a restaurant, I have effectively made it so that restaurant cannot operate. That would be a substantial detriment. The mere fact it can be seen would not be a substantial detriment.” However, Fritz said there are three other factors staff will review while it conducts its review.“It may not be a substantial detriment but it might be inconsistent with the character of the area,” Fritz said. The project will next go to the Planning Commission for a recommendation followed by the Board of Supervisors. Watch the whole video of the community meeting on YouTube.Location of the property on Craigs Store Road where the 60-acre facility would be located. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

TITLE: Multisystem Inflammatory Disease in Children (MIS-C) Last Updated: January 22, 2021 PARTICIPANTS: Hosts: Sonal Dugar, Zachary Hodges, Pushpa Shivaram, Julisa Patel Peer Reviewer #1: Smitha Mathew Peer Reviewer #2: Reda Bassali By the end of listening to this podcast, learners should be able to: Recognize the general clinical presentation of MIS-C. Create a differential diagnosis for children presenting with a non-specific hyperinflammatory syndrome. Recall the CDC case definition of MIS-C. Recall the general approach to the initial evaluation of a patient with possible MIS-C. Compare and contrast the general presentation of MIS-C and Kawasaki disease. Recall the initial treatment of MIS-C including supportive care, IVIG and corticosteroids. Recall that anakinra and other immunomodulating drugs may be indicated for refractory MIS-C. Recognize that aspirin and anticoagulation may be indicated in severe cases of MIS-C. Recall the follow-up required for children with moderate to severe COVID-19 and MIS-C prior to return to normal activities. Thank you for listening to this episode from the Department of Pediatrics at the Medical College of Georgia. If you have any comments, suggestions, or feedback- you can email us at mcgpediatricpodcast@augusta.edu Visit our website at https://www.augusta.edu/mcg/pediatrics/residency/podcast.php for more information and show-notes. Remember that all content during this episode is intended for informational and educational purposes only.  It should not be used as medical advice to diagnose or treat any particular patient. Clinical vignette cases presented are based on hypothetical patient scenarios. We look forward to speaking to you on our next episode of the MCG Pediatric Podcast.     References: Godfred-Cato S, Bryant B, Leung J, et al. COVID-19–Associated Multisystem Inflammatory Syndrome in Children — United States, March–July 2020. MMWR Morb Mortal Wkly Rep 2020;69:1074–1080. DOI: http://dx.doi.org/10.15585/mmwr.mm6932e2external icon Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395:1607–8. Dufort EM, Koumans EH, Chow EJ, et al.; New York State and CDC Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State. N Engl J Med 2020;383:347–58. Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020;383(4):334-346. doi:10.1056/NEJMoa2021680 Whittaker E, Bamford A, Kenny J, et al.; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2. JAMA 2020;324:259–69. Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, et al. American College of Rheumatology Clinical Guidance for Pediatric Patients with Multisystem Inflammatory Syndrome in Children (MIS‐C) Associated with SARS‐CoV‐2 and Hyperinflammation in COVID‐19. Version 1. Arthritis Rheumatol doi: https://onlinelibrary.wiley.com/doi/10.1002/art.41454. Abrams JY, Godfred-Cato SE, Oster ME, Chow EJ, Koumans EH, Bryant B, Leung JW, Belay ED, Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with SARS-CoV-2: A Systematic Review, The Journal of Pediatrics (2020), doi: https://doi.org/10.1016/jpeds.2020.08.003. 1161.CIRCULATIONAHA.120.049836. Review of Cardiac Involvement in MISC. Circulation Kaushik, Ashlesha MD*; Gupta, Sandeep MD†; Sood, Mangla MD‡; Sharma, Seema MD§; Verma, Shikha MD§ A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection, The Pediatric Infectious Disease Journal: November 2020 - Volume 39 - Issue 11 - p e340-e346 doi: 10.1097/INF.0000000000002888 CDC MIS-C Information Webpage. https://www.cdc.gov/mis-c/cases/index.html

Host: Dr. Sinai Zyblewski (MUSC). Editor/Producer: Dr. David Werho (UCSD) Dr. Eva Cheung from New York-Presbyterian Morgan Stanley Children's Hospital of Columbia University and Dr. Katherine Cashen from Children's Hospital of Michigan in Detroit discuss their experience on the front lines as MIS-C was first recognized and discuss our current knowledge of this disease.

On today’s show:A COVID update packed with important information News from Charlottesville’s public housing authority board including a new vacancyA group continues to seek ways to increase glass recycling from local wineries Today's Patreon-fueled shout-out is for the Plant Northern Piedmont Natives Campaign, an initiative that wants you to grow native plants in yards, farms, public spaces and gardens in the northern Piedmont. Native plants provide habitat, food sources for wildlife, ecosystem resiliency in the face of climate change, and clean water.  Start at the Plant Northern Piedmont Natives Facebook page and tell them Lonnie Murray sent you! *We begin today with COVID-19. The Virginia Department of Health reports another 4,707 new cases today, and another 93 fatalities. The seven-day average for positive PCR tests has dropped to 12.5 percent, down from 13.6 percent a week ago. There are another 71 cases in the Blue Ridge Health District and another death in Fluvanna County. That’s now 106 people in the district who have passed on from COVID-related complications. Note that there is a new case of the Multisystem Inflammatory Syndrome in Children. The continued surge as well as a shortage of vaccines has led the Center at Belvedere to close its doors through at least March 1, though programming will continue online. The nonprofit group that offers community space closed in the early days of the pandemic, but reopened. Peter Thompson is the executive director. “Conditions are quite different from what they were last June when we resumed on-site programs,” Thompson wrote in a message posted to the Center’s website. “Due to the increase in Covid-19 infection rates locally, the emergence of highly contagious new variants, and the complexities of vaccine distribution, we have determined that the best way for us to support community health is to temporarily move all of our programs online.”Yesterday the Virginia Department of Health reported the presence in Northern Virginia of a more infectious strain of COVID that was first discovered in the United Kingdom. In a press release, health officials said they will continue to monitor the situation. “While scientists are working to better understand its impact on vaccine efficacy, early data suggests currently authorized vaccines are effective against the new variant,” the release continues. Also yesterday, Albemarle’s communications director Emily Kilroy briefed the Places29-Hydraulic Community Advisory Committee on the vaccine roll-out. Albemarle County has increased the presence of COVID-related information on its website following concerns from some that not enough was being done to get shots in people’s arms. Kilroy urged patience while the vaccine supply is replenished. “We like try to to remind folks that we are still much in the middle of the pandemic and even once folks start getting vaccinated, and are getting vaccinated, that still does not change your day to day,” Kilroy said. “You’re still wearing a mask. You’re still keeping distance. You’re still safest at home.” As for vaccines, the seven-day average for vaccines administered per day is now at 24,790, up from 21,823 yesterday. In the past 24 hours, the VDH reports 39,109 doses administered. Keep in mind there has been a data backlog at times, but the number of vaccines administered per day has been increasing. The goal set by Governor Ralph Northam is 50,000 a day. In other COVID news, the Federal Transit Administration has awarded nearly a quarter of a million dollars to the Virginia Department of Rail and Public Transportation (DRPT) to help transit providers recover even before the pandemic is over. The DRPT will create a toolkit called “Adapting to a New Normal” that will offer advice on how to increase safety and reduce contacts. (release)Update from CRHA meetingThere’s a new vacancy on the Board of Commissioners for the Charlottesville Redevelopment and Housing Authority. Michael Osteen has resigned in the midst of his second term. CRHA Chair Betsy Roettger read from a resolution last night. “And whereas his tenure on the CRHA Board, Mr. Osteen has worked diligently to represent the needs of CRHA residents and brought his expertise in design, building, and property management,” Roettger said. “And whereas Mr. Osteen’s commitment to a resident-centric approach to the management of CRHA demonstrates the fundamental values of true-asset based community leadership…”Osteen also served on the Planning Commission from 2006 to 2014. City Council will need to appoint a vacancy. A frequent speaker at CRHA meetings noted that last night’s meeting is perhaps the last before groundbreaking takes place for the first new public housing units. Brandon Collins is on the staff at the Public Housing Association of Residents (PHAR) and wanted to note the occasion. He said many residents became frustrated in the early 2010’s after nothing happened following adoption of a master plan for public housing in the summer of 2010. “We all kind of got over that hump,” Collins said. “PHAR made an important realization which was that redevelopment was needed but it needed to be on residents term and PHAR needed to say yes to something, so we set out and we did the work for about a year putting together what we called the positive vision for redevelopment.” Collins said the vision calls for reparations for past wrongs by providing for resident self-determination. “And that’s something to work towards and it’s something that this housing authority has been bold in accepting the idea that the only way to make this work is through resident-led redevelopment,” Collins said. The CRHA Board got an update on redevelopment last night. Renovation of Crescent Halls and creation of new units at South First Street are the two plans that are moving forward. Kathleen Glenn-Matthews is director of operations at CRHA.“After a really long day, we finally have closed on South First Street and we’re really excited that we’re going to be able to have a community meeting this Sunday,” Glenn-Matthews said. There’s no date set yet for ground-breaking at the first phase South First Street, but she said it may happen toward the end of the month once there is equipment on site. A virtual ceremony will be held due to COVID.Glenn-Matthews said that redevelopment is moving forward despite a recent staff vacancy. Dave Norris has left his position as CRHA Redevelopment Director. There’s an application for the position on the CRHA website. In an email to me this morning, Norris confirmed his departure and said he continued working to help get the agency closer to ground-breaking. He also said he has been focusing time recently on the Sister City partnership between Charlottesville and Winneba, Ghana.   You can learn more about the status of redevelopment in an update Glenn-Matthews posted. The CRHA has not closed the financing deal for the Crescent Halls project. The waiting list for the CRHA’s Mainstream Voucher Program will open back up on January 29, according to a blog post on their website. Group seeks information from beverage producers on glass recyclingAn ad hoc group of environmental professionals working on a way to reduce the amount of glass that winds up in landfills resumed the conversation earlier this month. The work is an outcome of Albemarle County’s Solid Waste Advisory Committee and Better World Betty. They have been asking area wineries and breweries to tell them how much glass they discard in an online survey that is open through February 1. “There’s just a lot of glass to be had and we’re excited about the survey results that we’ve received,” said Teri Kent, the founder of Better World Betty. The group wants wineries, breweries, and other beverage producers to fill out a survey on glass recycling needs. (survey)The idea is to collect the information with an eye towards hiring a hauler who could collect glass from beverage providers and aggregate the material at a processing facility run by the Rivanna Solid Waste Authority. For this to work, the glass must be separated in the waste stream to avoid contamination. A co-founder of Valley Road Vineyards in Afton said he supported the idea.“I am instinctively drawn to anything that will do something than what we’re doing with glass now which is just putting it in the landfill,” said Stan Joynes. “But I do have this question at the outset which is what is the end of this material?”Philip McKalips is the solid waste manager at the RSWA. He said for many years, the agency collected glass and was able to find places for it to go but has recently formalized an arrangement.“More recently we wanted to have more of a structured program, something that we could rely on functionally, and we set up an arrangement with Strategic Materials where they actually a hire a trucking company, they come on a regular process, out to our closed landfill, where we stockpile our recycled glass that comes in from our collection centers,” McKalips said.  From there, the  glass goes to a facility in Wilson, North Carolina, where the materials are sorted. “And then they either use it internally or sell it to other users,” McKalips said. The goal of the current initiative is to collect enough glass so it can be used as material to make new containers. Localities in Northern Virginia have created a program where purple bins are used to collect glass, returning to a time when materials were separated by those who purchased the product. Scott DeFife is with the Glass Packaging Institute. “All of the glass that’s going into the bins in the Northern Virginia communities of Arlington, Alexandria and Fairfax is now making its way down to Wilson and getting turned around into glass container plants,” DeFife said. DeFife said much of what ends up in mixed recycling bins winds up in a landfill. “Getting enough clean, you know, a critical mass of good quality glass can get that glass back into the supply chain,” DeFife said. He added that there is a market for a glass manufacturer somewhere in Virginia which would reduce travel time.“But the economics of processing are very chicken and egg,” DeFife said. “Nobody is going to build a $10 million to $15 million glass processing plant if there’s no glass to go to it.” So work continues to organize the waste stream. The group wants as many beverage producers as possible to fill out the survey. Jesse Warren is with UVA Sustainability. “What we’re thinking is some kind of weekly hauling route where a provider will provide something like a 64x96 gallon cart that you all will then fill up with glass,” Warren said. *Special thanks to the Valley Road Research Center for their musical contributions, funded by an anonymous donor. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

In today's episode we discuss: —Understanding the Pathology: Researchers from the Department of Health & Exercise Science at Appalachian State University analyze the vascular impact of SARS-CoV-2 on 20 healthy young adults 3-4 weeks post-infection by doppler ultrasound of arterial blood flow in the upper and lower extremities (markers of vascular function) and pulse wave velocity (indicator of arterial stiffness). Results demonstrated that brachial artery flow-mediated dilation (FMD) was 6% lower after COVID-19 infection, which is clinically significant because each 1% decrease in FMD is associated with a 13% higher risk of cardiovascular events, suggesting that systemic vascular dysfunction and arterial stiffness may be a potential mechanism of COVID-19 vasculopathy. —Management: A single-center observational cohort study from Turin, Italy analyzed coagulopathy in 36 hospitalized pediatric patients (ages birth to 21 years) with COVID-19 (n=30) and Multisystem Inflammatory Syndrome in Children (MIS-C) (n=6) and found that D-dimer values were not useful in predicting disease severity. Significant differences between D-dimer and CRP values were observed between COVID-19 and MIS-C patients, however there was no difference in coagulopathy incidence in these groups (as measured by fibrinogen levels). They recommend against universal pharmacologic prophylaxis in pediatric COVID-19 patients except in cases of multiple concurrent pro-thrombotic risk factors such as obesity, active malignancy, and sickle cell disease. --- Support this podcast: https://anchor.fm/covid19lst/support

Ellen H. Lee, MD, joins JAMA Network Open Digital Media Editor, Seth Trueger, MD, MPH, to discuss a cohort study describing the distribution of race/ethnicity among cases of coronavirus disease 2019 (COVID-19)–associated multisystem inflammatory syndrome in children reported to the New York City Department of Health and Mental Hygiene. Read the article here: https://ja.ma/37vCJ1K. JNO Live is a weekly broadcast featuring conversations about the latest research being published in JAMA Network Open. Follow us on Facebook, Twitter and YouTube for details on the next broadcast.

FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P

FDA 批准2种治疗儿童遗传性癫痫综合征的药物NEJM 早产儿Apgar评分与新生儿死亡风险的关系Science Translational Medicine 基因治疗可逆转Danon病的代谢和多器官功能障碍司替戊醇（Stiripentol）Dravet综合征，以前称为婴儿严重肌阵挛性癫痫，是一种罕见的儿童遗传性癫痫综合征。其典型的特征是药物难治性癫痫发作，抗癫痫药物治疗是主要手段，但总体疗效有限，初始药物选择包括丙戊酸盐、苯二氮卓类药物氯巴占；一线药物治疗失败，也有选择生酮饮食疗法和神经调控技术治疗的。司替戊醇（Stiripentol，CYP450抑制剂，2018年FDA批准用于Dravet综合征的二线治疗，需与丙戊酸盐和氯巴占合用）。《STICLO-France和STICLO-Italy研究：司替戊醇治疗Dravet综合征》Drugs，2019年11月 (1)司替戊醇可以用于氯巴占和丙戊酸盐无法控制的Dravet综合征患者。佐证其疗效的最重要的两个随机对照研究分别为STICLO-France和STICLO-Italy，这两个小型的、随机对照试验，2个月的司替戊醇辅助疗法与明显优于安慰剂，两个研究数据放在一起分析，司替戊醇的缓解率是安慰剂组的10倍（70%比7%）。随后，这些短期结果被扩展为开放标签、观察性研究，当时3-21岁的参与者，长期使用该药物直至中青年，最长服药24年，疗效维持。乏力、食欲减退、体重减轻、共济失调和震颤是最常见的不良事件。结论：根据现有证据，司替戊醇作为Dravet综合征的辅助药物，疗效和安全性均较可靠。芬氟拉明（fenfluramine）2020年6月，芬氟拉明（fenfluramine），是一种安非他明的衍生物，被FDA批准用于治疗≥2岁的Dravet综合征患儿。《FAiRE DS研究：芬氟拉明剂量滴定治疗Dravet综合征的剂量滴定的3期研究》JAMA Neurology，2019年12月 (2)研究旨在评估芬氟拉明治疗司替戊醇治疗效果不佳的、Dravet综合征患者是否可以减少每月惊厥发作频率。这项双盲、安慰剂对照、平行组随机、剂量滴定的3期临床试验，纳入确诊为Dravet综合征的、2岁-18岁的、正在接受稳定剂量司替戊醇治疗的、115名儿童。他们被随机分配到芬氟拉明组和或安慰剂，经过3周的药物滴定后，进入12周的维持治疗。患儿平均年龄9.1岁，惊厥性癫痫发作平均每月25次。12周后，芬氟拉明组的患儿发作频率较安慰剂组下降54.0%；同时，芬氟拉明组54%的患者发作频率下降≥50%，而安慰剂组仅5% (P

Tonight and tomorrow, Decades Arcade will have a costume contest and scavenger hunt for Halloween this Friday and Saturday. Details are in this instagram post. Visit decadesarcade.com for more information on how you can book and their COVID-19 rules and precautions. You’ll also learn that for $200, you can rent the place for two hours for a private party. There are another 1,456 cases of COVID-19 in Virginia today, bringing the seven-day average for new daily cases to 1,194. The seven-day average for positive tests has increased to 5.4 percent, up from 5.3 percent yesterday. An additional case of Multisystem Inflammatory Syndrome in Children has been reported, bringing the number of cases to eleven. Another metric to watch is the total number of cases per 100,000 people within the last 14 days. That number is 182.2 today, trending upwards from 171.8 a week ago. In the Blue Ridge Health District, there are another 31 cases, bringing the seven-day average to 29. That’s 13 new cases from Albemarle, eight from Charlottesville, three from Fluvanna, one from Greene, and six from Louisa. In October to date, the district as a whole added 896 cases, or about a fifth of the total cases since March. Albemarle has added 285 cases and Charlottesville has added 341 cases. Their October are also around a fifth of the total to date. Fluvanna did not experience as steep an increase this month, with 52 new cases to add to its total of 433. Much of that number is related to an outbreak at the Fluvanna Correctional Center for Women. Louisa added 114 cases in October, or just over a quarter of their total of 410 to date. Greene added 71 caes for a total of 294. Nelson added 33 cases this month to date, bringing their total to 140. The seven-day average for positive PCR testing in the district is 2.6 percent. That figure is 2.9 percent when all tests are included. In all there have been 100,972 testing encounters in the district since the beginning of the pandemic. No serious changes on the University of Virginia COVID-tracker. There are 56 active cases listed as of yesterday afternoon, with 43 of them students. Five percent of quarantine rooms are in use, as are three percent of isolation rooms. *Earlier this week, officials with the Blue Ridge Health District briefed UVa, Charlottesville and Albemarle County officials on the health district’s pandemic response. Ryan McKay is the director of policy and planning at the district. “In September and October we saw some pretty big increases in the daily cases. We’ve dropped off a little bit in early October but now we’re picking up again,” McKay said. “I think this is sort of the nature of how COVID is going to work. We’ll see increases, we’ll work quickly to mitigate and hopefully contain spread and then at some point we see another increase.” Cases roses as UVA began classes on September 8. But McKay said they were largely contained to the UVA community. “I will say that even though we say larger numbers of cases coming from the University setting, we did not see transmission from students or faculty into the community,” McKay said. However, the University has been conducting a lot of tests, and they all count toward the percent positivity rating. On September 6, the positive percentage for PCR tests was 7.5 percent. That number was at 2.6 percent today.“It’s important to understand that positivity rate may be being skewed by all of those tests that are being done,” McKay said. “We really need to look at what we’re seeing in terms of the raw data, the number of cases we’re seeing, and where that transmission is occurring.” McKay pointed to a key demographic when it comes to the impact of COVID-19. “We also see a pretty significant change when it comes to age,” McKay said. “Even though the majority of our cases are among those who are 10-19 and 20-29, those who are dying of COVID are of older populations, 50 and above.” For the rest of this discussion, take a listen to the latest episode of the Charlottesville Quarantine Report. Download McKay’s presentation here. *The election is a few days away, and tensions are running high across the Commonwealth and the nation. The Center for Politics at the University Virginia will take one more look into Sabato’s Crystal Ball on Monday to give their final thoughts. On Thursday’s episode, Larry Sabato said the national polls are showing Joe Biden ahead, but that may not mean anything. “The polling average as of Thursday is between eight and nine percent lead for Joe Biden, and that’s national, and that’s a healthy lead assuming that the data machine isn’t broken,” Sabato said. “In the swing states, though, it is closer.”Sabato said Biden is leading in California, a state where the high number of votes there won’t gain any electoral votes in the electoral college.“All of those other votes are wasted and they tend to inflate his polling average, his national average in the polls. We certainly think you’d rather be Joe Biden than Donald Trump right now, but I think it’s important to point out that we can see a clear path for Donald Trump to get to 270. Not that it’s easy. A clear path isn’t easy.” You can watch this installment on the Center for Politics’ YouTube page. *In-person voting in Albemarle County was briefly disrupted this morning when emergency crews showed up to investigate a potential gas leak. According to a release, the building was evacuated for about half an hour, and in-person voting resumed soon after. Today and tomorrow are the last days to make a contribution through Patreon for this month. This weekend I’m going to revamp how I use Patreon to emphasize the “behind-the-scenes” content you can get there. You’ll also begin to see the Patreon-fueled shout-outs at the end of these newsletters rather than the top. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

Support for this program comes from the many people who have decided to fund it through a monthly contribution through my Patreon account. For $25 a month, you too can have me read a shout-out! Support also comes from those who have paid for a subscription through this newsletter service. Either way, thank you!  Over 3,540 Albemarle voters have already cast their ballot in early voting, according to county registrar Jake Washburne. Jim Heilman, a member of the county’s electoral board, gave an update to the Places29-Rio Community Advisory Committee last night as part of their monthly meeting. There are 39 days including today until November 3, the final deadline for voting in this year’s federal election. Early voting is underway across Virginia and local election officials are trying to get the word out about what has changed in this pandemic year. “We have basically a perfect storm of an election this year,” said Jim Heilman, a member of the Albemarle County Electoral Board. “All presidential elections are a storm for sure but this one has a lot of added things to it. We have a whole raft of new election laws.”These include expanded early voting and no-excuse absentee voting. Heilman said the electoral board is not seeing a spike in new voter registrations. “Voter registration is something that normally is spiking right now in a presidential year, but it’s not spiking here,” Heilman said. “It’s going up but it’s not spiking, and I think the main reason for that is because the normal ways of getting voter registration up by door-to-door registration drives and registration drives at concerts, Fridays after Five, none of those are happening.” Heilman and the rest of the electoral board and staff are recommending people vote in advance to avoid large crowds on election day. There is a pandemic after all. “However we do want to assure our voters that all 30 of our polling places will be open, and that we are making out best efforts to make that they are safe and clean on election day,” Heilman said.If you still need to register to vote, visit this site. *There are another 941 cases of COVID-19 reported today by the Virginia Department of Health, for a total of 144,433 since the pandemic began. At some point, Governor Ralph Northam and First Lady Pamela Northam will be among that number, as both tested positive for COVID-19 yesterday. That means they will be isolating for ten days. “As I’ve been reminding Virginians throughout this crisis, COVID-19 is very real and very contagious,” said Governor Northam in a release. “The safety and health of our staff and close contacts is of utmost importance to Pam and me, and we are working closely with the Department of Health to ensure that everyone is well taken care of.”Contact tracing is now underway. Another 23 deaths are reported today, but that figure represents a continuing update as death certificates come into the VDH. The seven day average for positive PCR test results has dropped to 5.1 percent. Statewide, there is an additional case of the Multisystem Inflammatory Syndrome in Children, for a total of nine to date. There are another 48 cases in the Thomas Jefferson Health District with 25 new cases in Charlottesville, and 18 from Albemarle. Looked at another way, there are 52 new cases per 100,000 people in Charlottesville, and 16.6 new cases per 100,000 in Albemarle. The seven-day rate for positive tests is now at 4.9 percent, up from 4.7 percent. The University of Virginia reported another 22 cases yesterday, all students. The official number of active cases is now at 238, and that means people tested at UVA who were positive in the past ten days. *Many who live in this region are unaware the confluence of the Rivanna and James Rivers in Fluvanna County is sacred ground for the Monacan Nation. Now the National Trust for Historic Protection has named the site known as Rassawek as one of its 11 most endangered places. “Researchers verified Rassawek’s location in the 1880s, the 1930s and the 1980s,” reads a Preservation Virginia blog post on the announcement. “It is the Monacan equivalent of Werowocomoco, the Powhatan capital now planned to be a national park.”The James River Water Authority has planned to locate a pump station on the site as part of an effort to bring public water to Zion Crossroads. In August, public pressure from the Monacan Nation and others led the Authority to hit pause on the planning process to explore previously discarded alternatives. The next meeting of the James River Water Authority is October 14. (read Allison Wrabel’s Daily Progress article from August)*Every part of the Earth contains plants that are home to that specific region. Some of these have fruits that make their way into the rest of the world, if they are a product that can be sold. But, what about the rest of the ecosystem from which that food comes from? Enrique Salmónis an ethnobotanist whose work is based on the belief that “all life-forms are interconnected and share the same breath.” That’s according to the materials for a presentation the Virginia Festival of the Book offered yesterday on Salmón’s book, Iwígara: American Indian Ethnobotanical Traditions and Science. He said he often gives his students this example. “I ask them, ‘well, how many of you like guacamole?’ And of course most of them will raise their hands although there are always a couple that don’t like the texture of avacado,” Salmón said. “I ask them where does guacamole come from, and most of them will know that it’s avocado. And then I ask them what does an avocado tree look like, and that’s when only one or two hands will go up and then I ask when do you pick avocados and most of the time, they don’t really know.”Salmón is head of the American Indian Studies Program at Cal State University-East Bay, in Hayward, California. The event can be watched on the Virginia Festival of the Book’s Facebook page.  *There are two meetings today both under the auspices of the Thomas Jefferson Planning District Commission (TJPDC). The TJPDC’s Regional Housing Partnership begins a fall speaker series. At 11 a.m., Dr. Lisa Sturtevant, chief economist with Virginia Realtors, will talk about the impact of COVID-19 on the Charlottesville Area housing market. (register)The Rivanna River Basin Commission will hold its annual conference at noon, this time virtually. There will be an update on the Chesapeake Bay Watershed Improvement Plan (WIP), a presentation on Best Management Practices for Stormwater Management, and updates on local efforts to improve water quality. You can listen to the 2018 conference here.  (more info and registration)If you made it to this point, I thank you. You are also likely someone who would be interested in filling out this survey I am doing as part of a course I am taking with the Community Investment Collaborative. As I launch this new venture, I am seeking ways to understand more about how what people think about news and information. This is my first ever attempt at market research, and if you have a moment, I’d love to get your thoughts. This is a public episode. Get access to private episodes at communityengagement.substack.com/subscribe

In May 2020, the CDC issued a national health advisory on a newly reported multisystem inflammatory syndrome in children. This syndrome presented with fever, shock, and signs of hyperinflammation, and temporally occurred 2-4 weeks following COVID-19 exposure. Panelists discuss this newly identified syndrome, its presentation, clinical course, potential pathophysiology, and potential treatment options. (Originally recorded July 2, 2020) Moderators: Christopher Carroll, MD, FCCP, and Nancy Stewart, DO Panelists: Adrienne Randolph, MD, MSc, and Manish Patel, MD For more tools to help in the fight against COVID-19, visit CHEST's COVID-19 Resource Center at chestnet.org/COVID19.

Dr. Eva Cheung from New York-Presbyterian Morgan Stanley Children’s Hospital of Columbia University and Dr. Katherine Cashen from Children’s Hospital of Michigan in Detroit discuss their experience on the front lines as MIS-C was first recognized and discuss our current knowledge of this disease. Host: Dr. Sinai Zyblewski Editor/Producer: Dr. David Werho.

The biggest debate right now concerns whether or not it is safe to open up schools in light of COVID-19.  In this episode, you'll learn: —How anxiety and stress are high right now, which weakens the immune system. —Why the death rate is NOT increasing even while the number of reported COVID-19 cases is increasing. —The results of Sweden's strategy, which declined to have the lockdowns of other nations in dealing with COVID-19. —How "everyone" will eventually get COVID-19 "unless you live in a bubble for the rest of your life." —The status of a COVID-19 vaccine.  And how one of the top researchers disagrees with Dr. Fauci on when a vaccine will be released. —Which treatment is being shown to "turn things around on a dime" for those with severe COVID-19 cases. —Why most of the children who get COVID-19 have no or few symptoms. —The health conditions in children which place them more at risk for COVID-19. —The Multisystem Inflammatory Syndrome that has occurred in children from COVID-19.  And how it is being confused for Kawasaki Disease or Toxic Shock Syndrome. —Why Dr. Prather says "it is one of the worst things you can do" to give antibiotics and prescription drugs for children with COVID-19.  And the two cases Dr. Prather has personally helped with after children infected with COVID-19 were given the wrong pharmaceutical. www.TheVoiceOfHealthRadio.com    

Dr. Terri Finkel discusses the Multisystem Inflammatory Syndrome (MIS-C) showing up in children, how it's related to COVID-19, symptoms to watch out for, and when to seek medical attention.

Introduction by Dato Dr Goh Pik Pin (00:00:03) Management of ILI and COVID-19 in Health Clinic by Dr. Narul Aida Salleh, Kuala Lumpur Health Clinic (Slide link: https://cutt.ly/kyCBkst) (00:01:17) The scars of COVID-19 by Dr. Syazatul Syakirin binti Sirol Aflah, Institute of Respiratory Medicine (Slide link: https://cutt.ly/NyCBn0B) (00:19:14) Kawasaki Disease & Multisystem Inflammatory Syndrome in Children by Dr. Hung Liang Choo, Hospital Tunku Azizah, Kuala Lumpur (Slide link: https://cutt.ly/CyNZaOI) (00:46:37) Continuing Care to Cancer Patients during COVID-19 Pandemic-Experience from Radiotherapy and Oncology Department, Hospital Umum Sarawak by Dr. Voon Pei Jye, Sarawak General Hospital (Slide link: https://cutt.ly/8yCBvQH) (01:15:27) Q&A session (01:41:11) YouTube Video https://youtu.be/AZFUqlGADVo

Your daily COVID-19 LST Report: — Climate: A research letter published in JAMA that analyzed pharmacy records during the pandemic, found a 1,977% increase in fills for Hydroxychloroquine/Chloroquine. The authors warn that this sharp increase in demand may lead to medication shortages for patients who require these for treatment for their chronic conditions, such a s Systemic Lupus Erythematosus and Rheumatoid Arthritis. — Epidemiology: In pediatrics, a case series conducted at the Children's Hospital of Philadelphia found evidence to support Multisystem Inflammatory Syndrome in Children (MIS-C) in six patients with COVID-19. They report two notable findings associated with the condition include the development of neurological symptoms and hyponatremia. They note MIS-C resembles Kawasaki disease in clinical features and response to therapeutics, emphasizing the need for further research to determine if MIS-C is distinct clinical syndrome or an atypical presentation of Kawasaki disease. — Understanding the Pathology: Molecular docking analysis found an increased affinity (–8.6 kcal/mol) between dithymoquinone (an active ingredient in black seed) and the SARS-CoV-2 S protein: human ACE2 receptor interface. This binding could disrupt host recognition and the S-protein pathway for disease progression, suggesting dithymoquinone as a potential natural antiviral worth further studying. — Management: Clinicians at New York Presbyterian Hospital describe their protocol to place non-intubated, awake, mobile, and hemodynamically stable COVID-19 patients in the prone position in order to prevent worsening respiratory failure. —R&D: A prospective cohort study of 1788 patients in an Australian screening clinic found that the presence of either anosmia or ageusia exhibited a positive predictive value (PPV) for COVID-19 positivity of only 9.3%, suggesting that while these are more common in COVID-19 positive patients than negative (39.3% vs 8.9%, p

Featured Interview: Coronavirus-linked multisystem inflammatory syndrome in children -코로나19 관련 소아·청소년 다기관염증증후군 Guest: Kathleen Sullivan, Division of Allergy Immunology, The Children's Hospital of Philadelphia

In this episode, Dr, Bob and Dr. Deborah Lehman discuss the latest in COVID-19 infection in children and recently recognized MIS-C complications of infections. Deborah Lehman, MD, is Professor of Pediatrics at the David Geffen School of Medicine at the University of California, Los Angeles. She received her undergraduate degree from Stanford University and MD from UCLA School of Medicine. She completed her pediatric residency at Children's Hospital of Los Angeles and pediatric infectious diseases training at UCSF. She serves as the Associate Vice Chair for education for the department of Pediatrics and in this role oversees the pediatric clerkship for third-year medical students, and pediatric electives for fourth year students. She serves as an Assistant Dean for Student Affairs at the David Geffen School of Medicine in their longitudinal advising program leading a society of 180 students. She is the recipient of several teaching awards and has created a popular pediatric infectious diseases curriculum for rotating medical students and residents. She recently completed a month long faculty development course at Stanford University, training her to be a facilitator for the 14 hour clinical teaching course. Her special interests include congenital infections and medical education. She is on the editorial board of NEJM Journal Watch Pediatrics and Adolescent Medicine and a senior deputy editor of NEJM Knowledge Plus, an online adaptive learning program. How to contact Dr. Bob: Dr. Bob on YouTube: https://www.youtube.com/channel/UChztMVtPCLJkiXvv7H5tpDQ Dr. Bob on Instagram: https://www.instagram.com/drroberthamilton/ Dr. Bob on Facebook: https://www.facebook.com/bob.hamilton.1656 Dr. Bob's Seven Secrets Of The Newborn website: https://7secretsofthenewborn.com/ Dr. Bob's website: https://roberthamiltonmd.com/ Pacific Ocean Pediatrics: http://www.pacificoceanpediatrics.com/

Important: An in-depth look at Multisystem Inflammatory Syndrome in Children. Everything we know at this time in plain English and in five minutes.