Imperial College London

DR. DANIEL MUNBLIT

Faculty of MedicineDepartment of Infectious Disease

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Paediatric Research UnitQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

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159 results found

Barker S, Daniels L, Chang Y-S, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Warner JO, Munblit Det al., 2021, Allergy education and training for physicians., World Allergy Organ J, Vol: 14, Pages: 1-12, ISSN: 1939-4551

The increasing prevalence of allergic diseases has placed a significant burden on global healthcare and society as whole. This has necessitated a rapid development of "allergy" as a specialist area. However, as allergy is so common and, for most, relatively easy to diagnose and control, all clinicians need to have basic knowledge and competence  to manage  mild disease and recognize when referral is required. The allergology specialty has not yet been recognized in many countries and even where allergy is fully recognized as a specialty, the approach to training in allergy differs significantly. In the light of recent developments in allergy diagnosis and management, there is an urgent need to harmonize core competences for physicians, as well as the standardization of core principles for medical education and post-graduate training in allergy. All physicians and allied health professionals must appreciate the multidisciplinary team (MDT) approach to allergy, which is key to achieving the highest standards in holistic care. Due to worldwide variation in resources and personnel, some MDT roles will need to be absorbed by the treating physician or other healthcare professionals. We draw particular attention to the role of psychological input for all allergy patients, dietetic input in the case of food allergy and patient education to support all patients in the supported self-management of their condition on a daily basis. A strong appreciation of these multidisciplinary aspects will help physicians provide quality patient-centered care. We consider that harmonization of allergy components within undergraduate curricula is crucial to ensure all physicians develop the appropriate allergy-related knowledge and skills, particularly in light of inconsistencies seen in the primary care management of allergy. This review from the World Allergy Organization (WAO) Education and Training Committee also outlines allergy-related competences required

Journal article

Mori F, Giovannini M, Barni S, Jimenez-Saiz R, Munblit D, Biagioni B, Liccioli G, Sarti L, Liotti L, Ricci S, Novembre E, Sahiner U, Baldo E, Caimmi Det al., 2021, Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate, FRONTIERS IN IMMUNOLOGY, Vol: 12, ISSN: 1664-3224

Journal article

Daniels L, Barker S, Chang Y-S, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal-Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Munblit D, Warner JOet al., 2021, Harmonizing allergy care–integrated care pathways and multidisciplinary approaches, World Allergy Organization Journal, Vol: 14, ISSN: 1939-4551

There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care.We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidel

Journal article

Michelen M, Manoharan L, Elkheir N, Cheng V, Dagens A, Hastie C, O'Hara M, Suett J, Dahmash D, Bugaeva P, Rigby I, Munblit D, Harriss E, Burls A, Foote C, Scott J, Carson G, Olliaro P, Sigfrid L, Stavropoulou Cet al., 2021, Characterising long COVID: a living systematic review, BMJ GLOBAL HEALTH, Vol: 6, ISSN: 2059-7908

Journal article

Sigfrid L, Drake TM, Pauley E, Jesudason EC, Olliaro P, Lim WS, Gillesen A, Berry C, Lowe DJ, McPeake J, Lone N, Munblit D, Cevik M, Casey A, Bannister P, Russell CD, Goodwin L, Ho A, Turtle L, O'Hara ME, Hastie C, Donohue C, Spencer RG, Donegan C, Gummery A, Harrison J, Hardwick HE, Hastie CE, Carson G, Merson L, Baillie JK, Openshaw P, Harrison EM, Docherty AB, Semple MG, Scott JT, ISARIC4C investigatorset al., 2021, Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol., The Lancet Regional Health - Europe, Vol: 8, Pages: 1-13, ISSN: 2666-7762

Background: This study sought to establish the long-term effects of Covid-19 following hospitalisation. Methods: 327 hospitalised participants, with SARS-CoV-2 infection were recruited into a prospective multicentre cohort study at least 3 months post-discharge. The primary outcome was self-reported recovery at least ninety days after initial Covid-19 symptom onset. Secondary outcomes included new symptoms, disability (Washington group short scale), breathlessness (MRC Dyspnoea scale) and quality of life (EQ5D-5L). Findings: 55% of participants reported not feeling fully recovered. 93% reported persistent symptoms, with fatigue the most common (83%), followed by breathlessness (54%). 47% reported an increase in MRC dyspnoea scale of at least one grade. New or worse disability was reported by 24% of participants. The EQ5D-5L summary index was significantly worse following acute illness (median difference 0.1 points on a scale of 0 to 1, IQR: -0.2 to 0.0). Females under the age of 50 years were five times less likely to report feeling recovered (adjusted OR 5.09, 95% CI 1.64 to 15.74), were more likely to have greater disability (adjusted OR 4.22, 95% CI 1.12 to 15.94), twice as likely to report worse fatigue (adjusted OR 2.06, 95% CI 0.81 to 3.31) and seven times more likely to become more breathless (adjusted OR 7.15, 95% CI 2.24 to 22.83) than men of the same age. Interpretation: Survivors of Covid-19 experienced long-term symptoms, new disability, increased breathlessness, and reduced quality of life. These findings were present in young, previously healthy working age adults, and were most common in younger females. Funding: National Institute for Health Research, UK Medical Research Council, Wellcome Trust, Department for International Development and the Bill and Melinda Gates Foundation.

Journal article

Buonsenso D, Di Giuda D, Sigfrid L, Pizzuto DA, Di Sante G, De Rose C, Lazzareschi I, Sali M, Baldi F, Chieffo DPR, Munblit D, Valentini Pet al., 2021, Evidence of lung perfusion defects and ongoing inflammation in an adolescent with post-acute sequelae of SARS-CoV-2 infection, LANCET CHILD & ADOLESCENT HEALTH, Vol: 5, Pages: 677-680, ISSN: 2352-4642

Journal article

Munblit D, Bobkova P, Spiridonova E, Shikhaleva A, Gamirova A, Blyuss O, Nekliudov N, Bugaeva P, Andreeva M, DunnGalvin A, Comberiati P, Apfelbacher C, Genuneit J, Avdeev S, Kapustina V, Guekht A, Fomin V, Svistunov AA, Timashev P, Subbot VS, Royuk VV, Drake TM, Hanson SW, Merson L, Carson G, Horby P, Sigfrid L, Scott JT, Semple MG, Warner JO, Vos T, Olliaro P, Glybochko P, Butnaru Det al., 2021, Incidence and risk factors for persistent symptoms in adults previously hospitalized for COVID-19, Clinical and Experimental Allergy, Vol: 51, Pages: 1107-1120, ISSN: 0954-7894

BackgroundThe long-term sequalae of COVID-19 remain poorly characterized. We assessed persistent symptoms in previously hospitalized patients with COVID-19 and assessed potential risk factors.MethodsData were collected from patients discharged from 4 hospitals in Moscow, Russia between 8 April and 10 July 2020. Participants were interviewed via telephone using an ISARIC Long-term Follow-up Study questionnaire.Results2,649 of 4755 (56%) discharged patients were successfully evaluated, at median 218 (IQR 200, 236) days post-discharge. COVID-19 diagnosis was clinical in 1291 and molecular in 1358. Most cases were mild, but 902 (34%) required supplemental oxygen and 68 (2.6%) needed ventilatory support. Median age was 56 years (IQR 46, 66) and 1,353 (51.1%) were women. Persistent symptoms were reported by 1247 (47.1%) participants, with fatigue (21.2%), shortness of breath (14.5%) and forgetfulness (9.1%) the most common symptoms and chronic fatigue (25%) and respiratory (17.2%) the most common symptom categories. Female sex was associated with any persistent symptom category OR 1.83 (95% CI 1.55 to 2.17) with association being strongest for dermatological (3.26, 2.36 to 4.57) symptoms. Asthma and chronic pulmonary disease were not associated with persistent symptoms overall, but asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18), and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32).ConclusionsAlmost half of adults admitted to hospital due to COVID-19 reported persistent symptoms 6 to 8 months after discharge. Fatigue and respiratory symptoms were most common, and female sex was associated with persistent symptoms.

Journal article

Parotta M, Myatra SN, Munblit D, Elhazmi A, Ranzani OT, Herridge MSet al., 2021, Recovery after prolonged ICU treatment in patients with COVID-19, LANCET RESPIRATORY MEDICINE, Vol: 9, Pages: 812-814, ISSN: 2213-2600

Journal article

Genuneit J, Jayasinghe S, RIGGIONI C, Peters R, Chu D, Munblit D, Boyle R, Toit GD, Skypala I, Santos Aet al., 2021, Protocol for a systematic review of the diagnostic test accuracy of tests for IgE-mediated food allergy

<jats:p id="p1">Background: The European Academy of Allergy and Clinical Immunology(EAACI) is in the process of updating the guidelines on the diagnosisand management of food allergy. The existing guidelines are based on asystematic review of the literature until 30th September 2012.Therefore, a new systematic review must be undertaken to inform the newguidelines. This systematic review aims to assess the accuracy of indextests to support the diagnosis of IgE-mediated food allergy. Methods:The databases Cochrane CENTRAL (Trials), MEDLINE (OVID) and Embase(OVID) will be searched for diagnostic test accuracy studies from 1stOctober 2012 to 30th June 2021. Inclusion and exclusion criteria will beused to select appropriate studies. Data from these studies will beextracted and tabulated, and then reviewed for risk of bias andapplicability using the QUADAS-2 tool. All evaluation will be done induplicate. Studies with a high risk of bias and low applicability willbe excluded. Meta-analysis will be performed if there are three or morestudies of the same index test and food. Results: A protocol for thesystematic review and meta-analyses is presented and was registeredusing Prospero prior to commencing the literature search. Discussion:Oral food challenges are the reference standard for diagnosis butinvolve considerable risks and resources. This protocol for systematicreview aims to assess the accuracy of various tests to diagnose foodallergy, which can be useful in both clinical and research settings.</jats:p>

Journal article

McArdle AJ, Vito O, Patel H, Seaby EG, Shah P, Wilson C, Broderick C, Nijman R, Tremoulet AH, Munblit D, Ulloa-Gutierrez R, Carter MJ, De T, Hoggart C, Whittaker E, Herberg JA, Kaforou M, Cunnington AJ, Levin Met al., 2021, Treatment of multisystem inflammatory syndrome in children, New England Journal of Medicine, Vol: 385, Pages: 11-22, ISSN: 0028-4793

BACKGROUNDEvidence is urgently needed to support treatment decisions for children with multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2.METHODSWe performed an international observational cohort study of clinical and outcome data regarding suspected MIS-C that had been uploaded by physicians onto a Web-based database. We used inverse-probability weighting and generalized linear models to evaluate intravenous immune globulin (IVIG) as a reference, as compared with IVIG plus glucocorticoids and glucocorticoids alone. There were two primary outcomes: the first was a composite of inotropic support or mechanical ventilation by day 2 or later or death; the second was a reduction in disease severity on an ordinal scale by day 2. Secondary outcomes included treatment escalation and the time until a reduction in organ failure and inflammation.RESULTSData were available regarding the course of treatment for 614 children from 32 countries from June 2020 through February 2021; 490 met the World Health Organization criteria for MIS-C. Of the 614 children with suspected MIS-C, 246 received primary treatment with IVIG alone, 208 with IVIG plus glucocorticoids, and 99 with glucocorticoids alone; 22 children received other treatment combinations, including biologic agents, and 39 received no immunomodulatory therapy. Receipt of inotropic or ventilatory support or death occurred in 56 patients who received IVIG plus glucocorticoids (adjusted odds ratio for the comparison with IVIG alone, 0.77; 95% confidence interval [CI], 0.33 to 1.82) and in 17 patients who received glucocorticoids alone (adjusted odds ratio, 0.54; 95% CI, 0.22 to 1.33). The adjusted odds ratios for a reduction in disease severity were similar in the two groups, as compared with IVIG alone (0.90 for IVIG plus glucocorticoids and 0.93 for glucocorticoids alone). The time until a reduction in disease severity was similar in the three groups.CONCLUSIONSWe found n

Journal article

Munblit D, Nekliudov NA, Bugaeva P, Blyuss O, Kislova M, Listovskaya E, Gamirova A, Shikhaleva A, Belyaev V, Timashev P, Warner JO, Comberiati P, Apfelbacher C, Bezrukov E, Politov ME, Yavorovskiy A, Bulanova E, Tsareva N, Avdeev S, Kapustina VA, Pigolkin YI, Dankwa EA, Kartsonaki C, Pritchard MG, Victor F, Svistunov AA, Butnaru D, Glybochko Pet al., 2021, StopCOVID cohort: An observational study of 3,480 patients admitted to the Sechenov University hospital network in Moscow city for suspected COVID-19 infection, Clinical Infectious Diseases, Vol: 73, Pages: 1-11, ISSN: 1058-4838

BACKGROUND: The epidemiology, clinical course, and outcomes of COVID-19 patients in the Russian population are unknown. Information on the differences between laboratory-confirmed and clinically-diagnosed COVID-19 in real-life settings is lacking. METHODS: We extracted data from the medical records of adult patients who were consecutively admitted for suspected COVID-19 infection in Moscow, between April 8 and May 28, 2020. RESULTS: Of the 4261 patients hospitalised for suspected COVID-19, outcomes were available for 3480 patients (median age 56 years (interquartile range 45-66). The commonest comorbidities were hypertension, obesity, chronic cardiac disease and diabetes. Half of the patients (n=1728) had a positive RT-PCR while 1748 were negative on RT-PCR but had clinical symptoms and characteristic CT signs suggestive of COVID-19 infection.No significant differences in frequency of symptoms, laboratory test results and risk factors for in-hospital mortality were found between those exclusively clinically diagnosed or with positive SARS-CoV-2 RT-PCR.In a multivariable logistic regression model the following were associated with in-hospital mortality; older age (per 1 year increase) odds ratio [OR] 1.05 (95% confidence interval (CI) 1.03 - 1.06); male sex (OR 1.71, 1.24 - 2.37); chronic kidney disease (OR 2.99, 1.89 - 4.64); diabetes (OR 2.1, 1.46 - 2.99); chronic cardiac disease (OR 1.78, 1.24 - 2.57) and dementia (OR 2.73, 1.34 - 5.47). CONCLUSIONS: Age, male sex, and chronic comorbidities were risk factors for in-hospital mortality. The combination of clinical features were sufficient to diagnoseCOVID-19 infection indicating that laboratory testing is not critical in real-life clinical practice.

Journal article

Buonsenso D, Munblit D, De Rose C, Sinatti D, Ricchiuto A, Carfi A, Valentini Pet al., 2021, Preliminary evidence on long COVID in children, ACTA PAEDIATRICA, Vol: 110, Pages: 2208-2211, ISSN: 0803-5253

Journal article

ISARIC Clinical Characterisation Group, 2021, COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study, Infection: journal of infectious disease, Vol: 49, Pages: 899-905, ISSN: 0300-8126

BACKGROUND: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. METHODS: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. RESULTS: 'Typical' symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. INTERPRETATION: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men.

Journal article

Munblit D, Nekliudov NA, Bugaeva P, Blyuss O, Timashev P, Warner JO, Comberiati P, Apfelbacher C, Politov ME, Yavorovskiy A, Avdeev S, Kapustina VA, Fomin V, Svistunov AA, Butnaru D, Glybochko Pet al., 2021, Reply to Russo et al., Clinical Infectious Diseases, Vol: 72, Pages: e1159-e1160, ISSN: 1058-4838

Journal article

Greenhawt M, Kimball S, DunnGalvin A, Abrams EM, Shaker MS, Mosnaim G, Comberiati P, Nekliudov NA, Blyuss O, Teufel M, Munblit Det al., 2021, Media Influence on Anxiety, Health Utility, and Health Beliefs Early in the SARS-CoV-2 Pandemic-a Survey Study, JOURNAL OF GENERAL INTERNAL MEDICINE, Vol: 36, Pages: 1327-1337, ISSN: 0884-8734

Journal article

Osmanov IM, Spiridonova E, Bobkova P, Gamirova A, Shikhaleva A, Andreeva M, Blyuss O, El-Taravi Y, DunnGalvin A, Comberiati P, Peroni DG, Apfelbacher C, Genuneit J, Mazankova L, Miroshina A, Chistyakova E, Samitova E, Borzakova S, Bondarenko E, Korsunskiy AA, Konova I, Hanson SW, Carson G, Sigfrid L, Scott JT, Greenhawt M, Whittaker EA, Garralda E, Swann O, Buonsenso D, Nicholls DE, Simpson F, Jones C, Semple MG, Warner JO, Vos T, Olliaro P, Munblit Det al., 2021, Risk factors for long covid in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study

<jats:p>Background The long-term sequelae of coronavirus disease 2019 (Covid-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with Covid-19 and associated risk factors.Methods This is a prospective cohort study of children (18 years old and younger) admitted with confirmed Covid-19 to Z.A. Bashlyaeva Children's Municipal Clinical Hospital in Moscow, Russia. Children admitted to the hospital during the first wave of the pandemic, between April 2, 2020 and August 26, 2020, were included. Telephone interview using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) Covid-19 Health and Wellbeing paediatric follow up survey. Persistent symptoms (&gt;5 months) were further categorised by system(s) involved. Findings Overall, 518 of 853 (61%) of eligible children were available for the follow-up assessment and included in the study. Median age was 10.4 years (IQR, 3-15.2) and 270 (52.1%) were girls; median follow-up since hospital discharge was 256 (223-271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%,) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: age "6-11 years" (odds ratio 2.74 (95% confidence interval 1.37 to 5.75) and "12-18 years" (2.68, 1.41 to 5.4), and a history of allergic diseases (1.67, 1.04 to 2.67).Interpretation A quarter of children experienced persistent symptoms months after hospitalization with acute covid-19 infection, with almost one in ten experiencing multi-system involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up. Our findings highlight the need for replication and further investigation of potential mechanisms as well as c

Journal article

Mustafa SS, Shaker MS, Munblit D, Greenhawt Met al., 2021, Paediatric allergy practice in the era of coronavirus disease 2019, CURRENT OPINION IN ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 21, Pages: 159-165, ISSN: 1528-4050

Journal article

Hilvo M, 2021, Maternal Elimination Diet and Symptoms of Cow's Milk Allergy in Breastfed Infants, JAMA PEDIATRICS, Vol: 175, Pages: 425-426, ISSN: 2168-6203

Journal article

Azad MB, Nickel NC, Bode L, Brockway M, Brown A, Chambers C, Goldhammer C, Hinde K, McGuire M, Munblit D, Patel AL, Perez-Escamilla R, Rasmussen KM, Shenker N, Young BE, Zuccolo Let al., 2021, Breastfeeding and the origins of health: Interdisciplinary perspectives and priorities, MATERNAL AND CHILD NUTRITION, Vol: 17, ISSN: 1740-8695

Journal article

Carson G, 2021, Research priorities for Long Covid: refined through an international multi-stakeholder forum, BMC MEDICINE, Vol: 19, ISSN: 1741-7015

Journal article

Yeruva L, Munblit D, Collado MC, 2021, Editorial: Impact of Early Life Nutrition on Immune System Development and Related Health Outcomes in Later Life, FRONTIERS IN IMMUNOLOGY, Vol: 12, ISSN: 1664-3224

Journal article

Sigfrid L, Drake TM, Pauley E, Jesudason EC, Olliaro P, Lim WS, Gillesen A, Berry C, Lowe DJ, McPeake J, Lone N, Cevik M, Munblit DJ, Casey A, Bannister P, Russell CD, Goodwin L, Ho A, Turtle L, OHara ME, Hastie C, Donohue C, Spencer R, Harrison J, Donegan C, Gummery A, Hardwick H, Hastie CE, Merson L, Carson G, Kenneth Baillie J, Openshaw PJM, Harrison EM, Docherty AB, Semple MG, Scott JTet al., 2021, Long Covid in adults discharged from UK hospitals after Covid-19: A prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol

<jats:title>Abstract</jats:title><jats:sec><jats:title>Evidence before this study</jats:title><jats:p>It is emerging that long-term symptoms are often present in people who have had acute COVID-19 disease. These symptoms affect a range of organ systems including respiratory, cardiovascular and neurological systems. It is not clear how many patients who required hospitalisation develop these symptoms and the impact they have on quality of life. We searched PubMed on 24<jats:sup>th</jats:sup> March 2021 using the terms ‘COVID-19’, ‘long-Covid’, ‘long-term’ and ‘outcomes’. This was supplemented by hand searching relevant references and news reports. We identified several small studies focussing on specific symptoms or diseases, studies of patients in community settings and studies of patients who were hospitalised for acute COVID-19 in Italy, Russia and China. There were no peer-reviewed published data at the time of searching which captured outcomes of patients within the United Kingdom.</jats:p></jats:sec><jats:sec><jats:title>Added Value of this study</jats:title><jats:p>We found that over half of patients reported not feeling fully recovered several months after onset of Covid-19 symptoms. The most common symptoms reported were fatigue, followed by breathlessness. Patients reported significant increases in new or worse disability, increases in MRC dyspnoea scale and worse quality of life as measured by EQ5D-5L summary index at the time of follow-up compared to before onset of acute COVID-19 symptoms. Our study found that women, in particular women under the age of 50 were significantly more likely to not feel fully recovered, were more breathless, more fatigued and had higher rates of new or worsened disability, even after taking severity of acute disease into account when compared to men of the same age.</jats:p></jats:sec>

Journal article

Buonsenso D, Espuny Pujol F, Munblit D, Mcfarland S, Simpson Fet al., 2021, Clinical Characteristics, Activity Levels and Mental Health Problems in Children with Long COVID: A Survey of 510 Children

<jats:p>Background The World Health Organization has recently recognized Long COVID, calling the international medical community to strengthen research and comprehensive care of patients with this condition. However, if Long COVID pertains to children as well is not yet clear. Methods An anonymous, online survey was developed by an organization of parents of children suffering from persisting symptoms since initial infection. Parents were asked to report signs and symptoms, physical activity and mental health issues. Only children with symptoms persisting for more than four weeks were included. Results 510 children were included (56.3% females) infected between January 2020 and January 2021. At their initial COVID-19 infection, 22 (4.3%) children were hospitalized. Overall, children had persisting COVID-19 for a mean of 8.2 months (SD 3.9). Most frequent symptoms were: Tiredness and weakness (444 patients, 87.1% of sample), Fatigue (410, 80.4%), Headache (401, 78.6%), Abdominal pain (387, 75.9%), Muscle and joint pain (309, 60.6%), Post-exertional malaise (274, 53.7%), rash (267, 52.4%). 484 (94.9%) children had had at least four symptoms. 129 (25.3%) children have suffered constant COVID-19 infection symptoms, 252 (49.4%) have had periods of apparent recovery and then symptoms returning, and 97 (19.0%) had a prolonged period of wellness followed by symptoms. Only 51 (10.0%) children have returned to previous levels of physical activity. Parents reported a significant prevalence of Neuropsychiatric symptoms. Conclusions Our study provides further evidence on Long COVID in children. Symptoms like fatigue, headache, muscle and joint pain, rashes and heart palpitations, and mental health issues like lack of concentration and short memory problems, were particularly frequent and confirm previous observations, suggesting that they may characterize this condition. A better comprehension of Long COVID is urgently needed..</jats:p>

Journal article

Mori F, Giovannini M, Barni S, Jiménez-Saiz R, Munblit D, Biagioni B, Liccioli G, Sarti L, Liotti L, Ricci S, Novembre E, Sahiner U, Baldo E, Caimmi Det al., 2021, Oral Immunotherapy for Food-Allergic Children: A Pro-Con Debate

<jats:p>The prevalence of food allergy has increased in recent years, especially in children. Food allergen avoidance and symptomatic drugs in case of an allergic reaction remain the standard of care in food allergy. Nevertheless, increasing attention has been given to the possibility to treat food allergy, through immunotherapy, particularly oral immunotherapy (OIT). Several OIT protocols and clinical trials have been published. Most of them focus on children allergic to milk, egg, or peanuts, although recent studies developed protocols for other foods, such as wheat and different nuts. OIT efficacy in randomized controlled trials is usually evaluated as the possibility for patients to achieve desensitization, while the issue of a possible long-term sustained unresponsiveness has not been completely addressed. Here, we evaluated current OIT knowledge, focusing on the results of clinical trials and current guidelines. Specifically, we wanted to highlight what is known in terms of OIT efficacy and effectiveness, safety, and impact on quality of life. For each aspect, we reported the pros and the cons, inferable from published literature. In conclusion, even though many protocols, reviews and meta-analysis have been published on this topic, OIT remains a controversial therapy and no definitive generalized conclusion may be drawn so far. It should be an option provided by specialized teams, when both patients and their families are prone to adhere to the proposed protocol. Efficacy, long-term effectiveness, possible role of adjuvant therapies, risk of severe reactions including anaphylaxis or eosinophilic esophagitis, and impact on the quality of life of both children and caregivers are all aspects that should be discussed before starting OIT. Future studies are needed to provide firm clinical and scientific evidence, which should also consider patient reported outcomes.</jats:p>

Journal article

Munblit D, Bobkova P, Spiridonova E, Shikhaleva A, Gamirova A, Blyuss O, Nekliudov N, Bugaeva P, Andreeva M, DunnGalvin A, Comberiati P, Apfelbacher C, Genuneit J, Avdeev S, Kapustina V, Guekht A, Fomin V, Svistunov AA, Timashev P, Drake TM, Hanson SW, Merson L, Horby P, Sigfrid L, Scott JT, Semple MG, Warner JO, Vos T, Olliaro P, Glybochko P, Butnaru Det al., 2021, Risk factors for long-term consequences of COVID-19 in hospitalised adults in Moscow using the ISARIC Global follow-up protocol: StopCOVID cohort study

<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The long-term sequalae of COVID-19 remain poorly characterised. In this study, we aimed to assess long-standing symptoms (LS) (symptoms lasting from the time of discharge) in previously hospitalised patients with COVID-19 and assess associated risk factors.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This is a longitudinal cohort study of adults (≥18 years of age) with clinically diagnosed or laboratory-confirmed COVID-19 admitted to Sechenov University Hospital Network in Moscow, Russia. Data were collected from patients discharged between April 8 and July 10, 2020. Participants were interviewed via telephone using Tier 1 ISARIC Long-term Follow-up Study CRF and the WHO CRF for Post COVID conditions. Reported symptoms were further categorised based on the system(s) involved. Additional information on dyspnoea, quality of life and fatigue was collected using validated instruments. Multivariable logistic regressions were performed to investigate risk factors for development of LS categories.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>Overall, 2,649 of 4,755 patients discharged from the hospitals were available for the follow-up and included in the study. The median age of the patients was 56 years (IQR, 46–66) and 1,353 (51.1%) were women. The median follow-up time since hospital discharge was 217.5 (200.4-235.5) days. At the time of the follow-up interview 1247 (47.1%) participants reported LS. Fatigue (21.2%, 551/2599), shortness of breath (14.5%, 378/2614) and forgetfulness (9.1%, 237/2597) were the most common LS reported. Chronic fatigue (25%, 658/2593) and respiratory (17.2% 451/2616) were the most common LS categories. with reporting of multi-system involvement (MSI) less common (11.3%; 299). Female sex was as

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Carr LE, Virmani MD, Rosa F, Munblit D, Matazel KS, Elolimy AA, Yeruva Let al., 2021, Role of Human Milk Bioactives on Infants' Gut and Immune Health, FRONTIERS IN IMMUNOLOGY, Vol: 12, ISSN: 1664-3224

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Wang A, Koleva P, du Toit E, Geddes DT, Munblit D, Prescott SL, Eggesbo M, Johnson CC, Wegienka G, Shimojo N, Campbell D, Kozyrskyj AL, Slupsky CMet al., 2021, The Milk Metabolome of Non-secretor and Lewis Negative Mothers, FRONTIERS IN NUTRITION, Vol: 7, ISSN: 2296-861X

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O'Reilly D, Dorodnykh D, Avdeenko NV, Nekliudov NA, Garssen J, Elolimy AA, Petrou L, Simpson MR, Yeruva L, Munblit Det al., 2021, Reply to J Zempleni., Adv Nutr, Vol: 12

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Bulanov N, Suvorov AY, Blyuss OB, Munblit DB, Butnaru DV, Nadinskaia MY, Zaikin AAet al., 2021, Basic principles of descriptive statistics in medical research, Sechenov Medical Journal, Vol: 12, Pages: 4-16, ISSN: 2218-7332

Descriptive statistics provides tools to explore, summarize and illustrate the research data. In this tutorial we discuss two main types of data – qualitative and quantitative variables, and the most common approaches to characterize data distribution numerically and graphically. This article presents two important sets of parameters – measures of the central tendency (mean, median and mode) and variation (standard deviation, quantiles) and suggests the most suitable conditions for their application. We explain the difference between the general population and random samples, that are usually analyzed in studies. The parameters which characterize the sample (for example, measures of the central tendency) are point estimates, that can differ from the respective parameters of the general population. We introduce the concept of confidence interval – the range of values, which likely includes the true value of the parameter for the general population. All concepts and definitions are illustrated with examples, which simulate the research data.

Journal article

Bulanov N, Blyuss OB, Munblit DB, Nekliudov NA, Butnaru DV, Kodzoeva KB, Nadinskaia MY, Zaikin AAet al., 2021, Studies and research design in medicine, Sechenov Medical Journal, Vol: 12, Pages: 4-17, ISSN: 2218-7332

Adequate design is an essential condition for conducting a successful study. This review describes the most common types of research design in medicine. We discuss the differences between different types of observational and interventional studies, their advantages and limitations providing examples for each study design. The concept of bias and its potential sources in different studies are covered. We suggest the most suitable approaches to study design for different research objectives and outline approaches to data presentation. During the last decades, several guidelines for conducting and reporting different types of research were proposed and they are also covered in this manuscript.

Journal article

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