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Background and aims: Children with chronic diseases follow complex treatment plans at home thus risking unintended medication errors (ME). To evaluate ME at home in chronic children with complex treatment plans after discharge, we trained parents to use an app to report ME and their satisfaction with it.

Methods: This was a 1-year prospective cohort study with parents of children following a complex therapeutic plan discharged from four units of a major pediatric hospital in Rome, Italy. Parents were trained to use an app to prospectively analyze clinical outcome variables, ME type and incidence at home. Parental satisfaction with the app was evaluated using a 5-point Likert scale.

Results: We enrolled 310 children’s parents (children’s mean age=7.3; SD=5.6) of which 194 (63%) downloaded and used the app at least once in 6 months. A total of 30/194 parents (15.5%) reported 41 ME, 28 (68.3%) of which occurred during administration, 34 (83%) with enteral drugs, and 9 (36%) with antihypertensive treatments. ME incidence was 0.46/patient/year (CI 95%=0.31-0.66). A higher ME risk was associated with age <1 year (p=0.002) and Italian nationality (p=0.009). A lower ME risk was associated with rheumatic diseases (p<0.05). Parents reported high levels of satisfaction with the app (M=4.34, SD=0.68).

Conclusions: Nurses should encourage parents of children with complex therapeutic plans to pay attention to the management of drugs at home, especially with patients aged <1 year and with chronic diseases other than rheumatic. Apps could increase parents’ awareness about ME improving pediatric patient’s safety at home.

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Stress is a known concern among resident doctors that may affect patient care adversely. Trainees working in an intensive care setting face more stress because of direct involvement with acutely ill patients and prolonged working hours. Seasonal variation can also affect their performance and quality of personal or professional life.

The purpose of the study was to investigate seasonal stress variation among a group of medical residents working in intensive care units.

Monthly survey for stress assessment were collected over the period between July 2017- June 2018. Canadian Mental Health Association (CMHA) stress questionnaire was used for self-assessment of stress level, Stress index was calculated for each response, with a minimum score of 1 (lowest stress level) and a maximum score of 20 (dangerous stress level).

14 trainees participated in this study,and 152 responses were collected. The response rate was 87.9%. The results showed that the average score of residents’ stress index (SI) over the year was 15.3 (0.7) which was considered as high. The highest (17.2) and lowest (5.08) average stress scores noted in February and September, respectively. 62.8% of residents had a high level and 37.2% of them had a moderate level of stress. High SI was noted in the months before the scheduled examinations (Male trainee reported a lower stress index (10.4) than female (15.9).

Seasonal stress level variation should be taken into consideration planning workload and educational activities. Important to implement stress management techniques among residents, discuss the importance of the outdoor time at daylights.

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Endothelitis and microvascular dysfunction may be the presumed underlying mechanisms in occurence of shock in the SARS-CoV-2 related multisystem inflammatory in chidlren (MIS-C) suggesting therefore endothelial activation and disruption.

Herein, we described the endothelial activation during MIS-C with shock and we aimed to correlate the severity of acute cardiovascular manifestations to the degree of endothelial involvement.

We included 28 children with a median age [IQ] of 9 [7.5-11.2] years old. They were admitted for a motive of shock, 5 days [5-6] following the beginning of signs. Twenty six children received vasoactive and or inotropic support : dobutamine (n=18), epinephrine (n=15), milrinone (n=11), norepinephrine (n=7). The vasoactive inotropic score (VIS) was at 8 [5-28]. Intravenous immunoglobulin (n=28) and corticosteroids (n=11) were administered once the diagnosis confirmed. All children survived and their left ventricular function fully recovered at the PICU discharge. Biomarkers of systemic inflammation (C Reactive Protein (CRP), Procalcitonin, Interleukin 6 (IL6)), endothelial activation and coagulation (in particular sE-Selectin, angiopoietin 2, VWF:Ag, sTM, D-dimers, fibrinogen) were notably increased compared to reference values.

Angiopoietin 2 was correlated with left venricular ejection fraction (r=-0.46; p=0.01) and lactate level, (r=0.39; p=0.04). Angiopoietin 2, sE-Selectin and VWF:Ag were significantly correlated to the VIS (r=0.45, p=0.016; r=0.53, p=0.04; r=0.46 p=0.013 respectively) as well as CRP and IL6 (r= 0.42, p=0.011 and r=0.39, p=0.029 respectively).

Endothelial activation is markedly observed in MIS-C with shock, highlighting the relationship between the endothelium activation, systemic hyper inflammation and acute severe cardiovascular manifestations.

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Background and aims: This non-randomized pre and posttest control group study was conducted with children between 10-16 ages and who receive chemotherapy to evaluate the effect of training children by a tablet game (KeTO) and a booklet on symptom management and quality of life.

Methods: The study sample consisted of 50 children (game: 25; booklet: 25) who met the inclusion criteria and who were hospitalized between February 2017-July 2018 at Pediatric Hematology-Oncology Units of two hospitals in Istanbul, Turkey. Ethics committee approval, permissions from Institutions, and permissions form children and their parents were received. Data collection tools and equipment consisted of a patient presentation form, Memorial Symptom Assessment Scale, KINDL-Oncology Module, tablet game, training booklet, and tablet. Data were evaluated with SPSS 20.0.

Results: Before and after the administration of the Memorial Symptom Assessment Scale, total and subscale points means were not statistically significant between groups (p<0.05). When groups were evaluated within themselves after administration, the decrease of disturbance level of symptoms at the game group was higher than the booklet group (p:.004). After administration, KINDL-Oncology Module total point (p:.000), mental (p:.030), and treatment (p:.009) subscale point means were statistically significantly less at game group than booklet group.

Conclusions: Consequently, it was determined that both administrations were effective for symptom management, and they were not superior to each other. Still, the quality of life was higher in children in the game group than in the booklet group.

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Introduction: COVID 19 disease in children has been manifesting in a wide spectrum of presentations, some of them very severe. It became a priority to report serious and atypical presentations, contributing to knowledge, adequacy and improvement of care provision in these cases.

Description: A 13-year-old boy presenting with persistent fever, precordial pain, skin rash, and abdominal pain, rapidly progressing to vasoplegic shock requiring respiratory and cardiovascular support and evidence of severe multisystem hyperinflammatory response affecting the cardiac, renal, pulmonary and gastrointestinal systems. A SARS-CoV-2 infection had been diagnosed to his mother in the previous month. PCR for SARS-CoV-2 in naso/oropharyngeal swab, secretions and tracheal aspirates were negative, but IgG serology was positive. Elevated inflammatory markers with C-reactive protein 399mg/dL, procalcitonin 1.10 ng/dL, leucocytosis 19170 leuc/mm3 (17950 neutrophils/mm3), interleukin-6 456,70 pg/mL and serum protein amyloid A 1140mg/L were found together with increased cardiac lesion markers (troponin I 4632pg/mL) and severity markers (lymphopenia 610 lymph/mm3, ferritin 426 ng/mL and d-Dimers 2123 μg/L). Echocardiogram showed left ventricle fractional shortening of 25%, with Pro-BNP of 564 pg/mL. Treated with vasopressor support (dopamine and noradrenaline) along with intravenous immunoglobulin, methylprednisolone, hydroxychloroquine, antibiotics and prophylactic enoxaparin. He presented a favorable evolution with a small area of myocardial fibrosis on cardiac magnetic resonance imaging, one month after discharge.

Discussion: MIS-C associated with COVID-19 severity derives from an inappropriate immunomodulatory response supporting the need for the use of effective and safe anti-inflammatory strategies, and should be considered in the future approaches for standardization of treatment options.