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Sarkadi A, Thell M, Jirblom K. Perceptions of the COVID-19 pandemic as demonstrated in drawings of Swedish children aged 4-6 years. Acta Paediatr 2023; 112:1275-1283. [PMID: 36773326 DOI: 10.1111/apa.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
AIM To explore the perceptions of the COVID-19 pandemic, as expressed in the drawings of Swedish children aged 4-6 years. METHODS We analysed 91 drawings with associated descriptions submitted to the Swedish Archive of Children's Art from April 2020 to February 2021. RESULTS The visual and text analysis resulted in three themes. First, illustrating the virus and embodying the danger showed that young children understood the invisible enemy, combining realistic elements of the virus particle with fantasies of the 'virus monster' that needs to be fought off. Second, life has changed for the worse describes the profound effect the pandemic had on young children's lives also in Sweden, with comparatively mild restrictions and no school closures. Third, the virus spreads across the world, affects people and infects their bodies conveys young children's understanding of the pandemic as an existential challenge affecting the whole world. Children displayed surprisingly high levels of health literacy related to COVID-19, including contagion routes and the importance of hand hygiene. CONCLUSION The drawings of Swedish children aged 4-6 years demonstrated the profound, practical and emotional effects of the pandemic on their lives. Drawings also illuminated young children's level of health literacy regarding COVID-19.
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Affiliation(s)
- Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Thell
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Klara Jirblom
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Guner Ozenen G, Akaslan Kara A, Boncuoglu E, Kiymet E, Cem E, Sahinkaya S, Yilmaz Celebi M, Gulderen M, Kacar P, Uras M, Hilkay Karapinar T, Oymak Y, Bayram N, Devrim I. Evaluation of antithrombotic prophylaxis and thrombotic events in children with COVID-19 or MIS-C: A tertiary pediatric center experience. Arch Pediatr 2023; 30:172-178. [PMID: 36907731 PMCID: PMC9902296 DOI: 10.1016/j.arcped.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/26/2022] [Accepted: 01/15/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVES COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis. METHODS A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C. RESULTS The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease. CONCLUSION In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors; perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.
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Affiliation(s)
- G Guner Ozenen
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey.
| | - A Akaslan Kara
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - E Boncuoglu
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - E Kiymet
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - E Cem
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - S Sahinkaya
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - M Yilmaz Celebi
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - M Gulderen
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - P Kacar
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - M Uras
- Department of Pediatrics, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - T Hilkay Karapinar
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - Y Oymak
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - N Bayram
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
| | - I Devrim
- Department of Pediatric Infectious Diseases, University of Health Sciences, Dr. Behçet Uz Children's Hospital, İzmir, Turkey
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153
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Efendi F, Haryanto J, Has EMM, Makhfudli M, Indarwati R, Kuswanto H, Wahyuhadi J, Farabi MJA, Ho KHM, Susanti IA. Predictors of Mortality Among Children with Confirmed and Suspected Cases of COVID-19 in East Java, Indonesia. J Multidiscip Healthc 2023; 16:355-362. [PMID: 36785579 PMCID: PMC9921435 DOI: 10.2147/jmdh.s391917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Coronavirus disease 2019 (COVID-19) increases rapidly and causes mortality in all groups, including children. However, the predictive risk factors of mortality among children remain inconclusive. This study aimed to analyse the predictors related to mortality among children with COVID-19. Methods Secondary data analysis was conducted using provincial COVID-19 data from April 2020 to May 2021. We selected 6441 children under age 18 to be included in this study. Chi-square and binary logistic regression were used to evaluate the predictors of mortality in children with COVID-19. Results This study showed that the prevalence of children who died COVID-19 was 2.7%. Age, case definition, treatment status, severity of illness, and travel history had a significant relationship with survival status in children with COVID-19. As the increasing age, the risk of death with COVID-19 will decrease [AOR=0.94; CI 95%=0.91-0.97]. Otherwise, suspected status [AOR=2.12; 95% CI=1.48-3.04], hospitalization with ventilators [AOR=22.25; 95% CI=5.73-86.42], severe illness [AOR=46.76; 95% CI=21.69-100.80], and travel history [AOR=1.78; 95% CI=1.22-2.60] were significantly related with an increased risk of death in children with COVID-19. Discussion Severe illness in children was the strongest predictor of mortality. Disease prevention and health promotion programs are the key to preventing hospitalizations in children and decreasing the mortality rate.
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Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia,Correspondence: Ferry Efendi, Email
| | - Joni Haryanto
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | | | | | - Retno Indarwati
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Heri Kuswanto
- Department of Statistics, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia,Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Makhyan Jibril Al Farabi
- Dr. Soetomo General Hospital, Surabaya, Indonesia,Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ken Hok Man Ho
- Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, Hong Kong
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154
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Soares MCB, de Freitas BAC, Toledo LV, Mendes IR, Quintão APDC, de Souza SM. Hospitalizations and deaths of children and adolescents with Severe Acute Respiratory Infection due to COVID-19 during the epidemiological year of 2020. Rev Inst Med Trop Sao Paulo 2023; 65:e11. [PMID: 36722673 PMCID: PMC9886224 DOI: 10.1590/s1678-9946202365011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/13/2022] [Indexed: 02/02/2023] Open
Abstract
This study aimed to analyze the profile of hospitalizations and factors associated with the deaths of children and adolescents with severe acute respiratory infection (SARI) caused by SARS-CoV-2 nationwide. The study comprised 6,843 children and adolescents hospitalized in 2020 who tested positive for COVID-19, based on data from the Influenza Epidemiological Surveillance Information System. Sociodemographic and clinical profiles, hospitalization frequency, lethality and recovery rates were analyzed. The outcome was recovery or death. The 6,843 children and adolescents comprised 1.9% of SARI hospitalized cases (n = 563,051). Of these, 57.7% developed critical SARI and 90% survived. Comorbidities were present in 40.8%, especially asthma, immunodepression, and neurological and cardiovascular diseases. The main symptoms were fever, cough, dyspnea, respiratory distress, and low oxygen saturation. Among those with critical SARI, 91.4% died. There was a higher frequency of children, especially those under five years of age and of mixed ethnicity. The highest hospitalization frequency occurred in the Southeastern and Northeastern regions, the highest recovery rates in the Southeastern and Southern regions, and the highest lethality rates in the Northern and Northeastern regions. Deaths were associated with ages ranging from 12 to 19 and being under one year of age, living in the Northern and Northeastern regions, progression to critical SARI, and having immunosuppression and cardiovascular disease. In contrast, asthma was associated with lower death rates. The frequency of complications and mortality rates caused by SARS-Cov-2 in the pediatric population are relevant, as well as the severity of the epidemic in the social inequality context and the health services' frailty.
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Affiliation(s)
- Maria Cristina Bento Soares
- Universidade Federal de Viçosa, Programa de Pós-Graduação em Ciências da Saúde, Viçosa, Minas Gerais, Brazil
| | | | - Luana Vieira Toledo
- Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, Minas Gerais, Brazil
| | - Igor Rodrigues Mendes
- Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, Minas Gerais, Brazil
| | | | - Silvania Medina de Souza
- Universidade Federal de Viçosa, Programa de Pós-Graduação em Ciências da Saúde, Viçosa, Minas Gerais, Brazil
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155
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Gobena D, Kebede Gudina E, Yilma D, Girma T, Gebre G, Gelanew T, Abdissa A, Mulleta D, Sarbessa T, Asefa H, Woldie M, Shumi G, Kenate B, Kroidl A, Wieser A, Eshetu B, Degfie TT, Mekonnen Z. Escalating spread of SARS-CoV-2 infection after school reopening among students in hotspot districts of Oromia Region in Ethiopia: Longitudinal study. PLoS One 2023; 18:e0280801. [PMID: 36735689 PMCID: PMC9897530 DOI: 10.1371/journal.pone.0280801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 01/09/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND COVID-19 pandemic caused by extended variants of SARS-CoV-2 has infected more than 350 million people, resulting in over 5.5 million deaths globally. However, the actual burden of the pandemic in Africa, particularly among children, remains largely unknown. We aimed to assess the seroepidemiological changes of SARS-CoV-2 infection after school reopening among school children in Oromia, Ethiopia. METHODS A prospective cohort study involving students aged 10 years and older were used. A serological survey was performed twice, at school reopening in December 2020 and four months later in April 2021. Participants were selected from 60 schools located in 15 COVID-19 hotspot districts in Oromia Region. Serology tests were performed by Elecsys anti-SARS-CoV-2 nucleocapsid assay. Data were collected using CSentry CSProData Entry 7.2.1 and exported to STATA version 14.2 for data cleaning and analysis. RESULTS A total of 1884 students were recruited at baseline, and 1271 completed the follow-up. SARS-CoV-2 seroprevalence almost doubled in four months from 25.7% at baseline to 46.3% in the second round, with a corresponding seroincidence of 1910 per 100,000 person-week. Seroincidence was found to be higher among secondary school students (grade 9-12) compared to primary school students (grade 4-8) (RR = 1.6, 95% CI 1.21-2.22) and among those with large family size (> = 5) than those with a family size of <3 (RR = 2.1, 95% CI 1.09-4.17). The increase in SARS-CoV-2 seroprevalence among the students corresponded with Ethiopia's second wave of the COVID-19 outbreak. CONCLUSION SARS-CoV-2 seroprevalence among students in hotspot districts of the Oromia Region was high even at baseline and almost doubled within four months of school recommencement. The high seroincidence coincided with the second wave of the COVID-19 outbreak in Ethiopia, indicating a possible contribution to school opening for the new outbreak wave.
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Affiliation(s)
- Dabesa Gobena
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
- * E-mail:
| | | | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - Tsinuel Girma
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Getu Gebre
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | | | | | - Daba Mulleta
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Tarekegn Sarbessa
- Public Health Emergency Management and Health Research Directorate, Oromia Health Bureau, Addis Ababa, Ethiopia
| | - Henok Asefa
- Department of Epidemiology, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Gemechu Shumi
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Birhanu Kenate
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Arne Kroidl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Andreas Wieser
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
- German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Beza Eshetu
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - Tizta Tilahun Degfie
- Fenot Project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Zeleke Mekonnen
- School of Medical Laboratory Science, Institute of Health, Jimma University, Jimma, Ethiopia
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156
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C R V, Sharma R, Jayashree M, Nallasamy K, Bansal A, Angurana SK, L Mathew J, Sankhyan N, Dutta S, Verma S, Kumar R, Devnanai M, Vaidya PC, Samujh R, Singh MP, Goyal K, Lakshmi PVM, Saxena AK. Epidemiology, Clinical Profile, Intensive Care Needs and Outcome in Children with SARS-CoV-2 Infection Admitted to a Tertiary Hospital During the First and Second Waves of the COVID-19 Pandemic in India. Indian J Pediatr 2023; 90:131-138. [PMID: 35921029 PMCID: PMC9362352 DOI: 10.1007/s12098-022-04283-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To compare the epidemiological, clinical profile, intensive care needs and outcome of children hospitalized with SARS-CoV-2 infection during the first and second waves of the pandemic. METHODS This was a retrospective study of all children between 1 mo and 14 y, admitted to a dedicated COVID-19 hospital (DCH) during the first (1st June to 31st December 2020) and second waves (1st March to 30th June 2021). RESULTS Of 217 children, 104 (48%) and 113 (52%) were admitted during the first and second waves respectively. One hundred fifty-two (70%) had incidentally detected SARS-CoV-2 infection, while 65 (30%) had symptomatic COVID-19. Comorbidities were noted in 137 (63%) children. Fifty-nine (27%) and 66 (30%) children required high-dependency unit (HDU) and ICU care respectively. Severity of infection and ICU needs were similar during both waves. High-flow oxygen (n = 5, 2%), noninvasive ventilation [CPAP (n = 34, 16%) and BiPAP (n = 8, 5%)] and invasive ventilation (n = 45, 21%) were respiratory support therapies needed. NIV use was more during the second wave (26% vs. 13%; p = 0.02). The median (IQR) length (days) of DCH stay among survivors was longer during the first wave [8 (6-10) vs. 5.5 (3-8); p = 0.0001]. CONCLUSIONS Disease severity, associated comorbidities, PICU and organ support need and mortality were similar in the first and second waves of the pandemic. Children admitted during the second wave were younger, had higher proportion of NIV use and shorter length of COVID-19 hospital stay.
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Affiliation(s)
- Vishwa C R
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Raman Sharma
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Joseph L Mathew
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Division of Neonatology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sanjay Verma
- Division of Pediatric Infectious Disease, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rakesh Kumar
- Division of Pediatric Endocrinology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mahesh Devnanai
- Division of Hospital Administration, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj C Vaidya
- Division of Pediatric Pulmonology, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mini P Singh
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kapil Goyal
- Department of Virology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Akshay K Saxena
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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157
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Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol 2023; 64:90-107. [PMID: 35044620 PMCID: PMC8767775 DOI: 10.1007/s12016-022-08921-5] [Citation(s) in RCA: 210] [Impact Index Per Article: 210.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
The outbreak of the coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become an evolving global health crisis. Currently, a number of risk factors have been identified to have a potential impact on increasing the morbidity of COVID-19 in adults, including old age, male sex, pre-existing comorbidities, and racial/ethnic disparities. In addition to these factors, changes in laboratory indices and pro-inflammatory cytokines, as well as possible complications, could indicate the progression of COVID-19 into a severe and critical stage. Children predominantly suffer from mild illnesses due to COVID-19. Similar to adults, the main risk factors in pediatric patients include age and pre-existing comorbidities. In contrast, supplementation with a healthy diet and sufficient nutrition, COVID-19 vaccination, and atopic conditions may act as protective factors against the infection of SARS-CoV-2. COVID-19 vaccination not only protects vulnerable individuals from SARS-CoV-2 infection, more importantly, it may also reduce the development of severe disease and death due to COVID-19. Currently used therapies for COVID-19 are off-label and empiric, and their impacts on the severity and mortality of COVID-19 are still unclear. The interaction between asthma and COVID-19 may be bidirectional and needs to be clarified in more studies. In this review, we highlight the clinical evidence supporting the rationale for the risk and protective factors for the morbidity, severity, and mortality of COVID-19.
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Affiliation(s)
- Jin-Jin Zhang
- Department of Allergology, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, 430071, Hubei, China
| | - Xiang Dong
- Department of Allergology, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, 430071, Hubei, China
| | - Guang-Hui Liu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, 430071, Hubei, China
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Donghu Road 169, Wuhan, 430071, Hubei, China.
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, 430071, Hubei, China.
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158
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Chiew CJ, Premikha M, Chong CY, Wei WE, Ong B, Lye DC, Heng D, Lee VJ, Tan KB. Effectiveness of primary series and booster vaccination against SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years in Singapore: a national cohort study. THE LANCET. INFECTIOUS DISEASES 2023; 23:177-182. [PMID: 36182678 PMCID: PMC9519171 DOI: 10.1016/s1473-3099(22)00573-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Singapore offered the BNT162b2 vaccine (tozinameran; Pfizer-BioNTech) to adolescents aged 12-17 years in May 18, 2021, and extended booster vaccines to this group in Jan 21, 2022. Literature on the effectiveness of primary series and booster vaccination among adolescents is scarce outside of Europe and North America. We aimed to determine primary series and booster vaccine effectiveness against SARS-CoV-2 infection and hospitalisation among adolescents in Singapore. METHODS For this national cohort study, we assessed the incidence of confirmed SARS-CoV-2 infection and hospitalisation among adolescents aged 12-17 years vaccinated with BNT162b2 in Singapore from Sept 1 to Dec 15, 2021, during the delta (B.1.617.2) variant wave, and from Jan 21 to April 28, 2022, during the omicron (B.1.1.529) variant wave. Data were collected from official databases maintained by the Ministry of Health of Singapore. Individuals were classified as partly vaccinated (those who had received one dose and those who had received the second dose no more than 7 days previously), fully vaccinated (8 days after receiving a second dose), or boosted (8 days after receiving a third dose) and compared with unvaccinated individuals. FINDINGS 249 763 individuals aged 12-17 years were included in the study, contributing over 56·2 million person-days of observation. Compared with unvaccinated individuals, two vaccine doses achieved vaccine effectiveness of 66% (95% CI 63-69) against infection with the delta variant and 25% (21-29) against infection with the omicron variant, and 83% (74-89) against delta variant-associated hospitalisation and 75% (56-86) against omicron variant-associated hospitalisation. Booster vaccination with a third dose achieved vaccine effectiveness of 56% (53-58) against infection with the omicron variant and 94% (86-97) against omicron-associated hospitalisation, compared with unvaccinated adolescents. Vaccine effectiveness against infection for both variants after two doses waned over time, whereas vaccine effectiveness against hospitalisation for both variants remained stable; both were increased after three doses. INTERPRETATION Among adolescents aged 12-17 years, vaccine effectiveness against confirmed SARS-CoV-2 infection after two doses of BNT162b2 decreased over time and increased after a third dose. Boosted adolescents were also the most protected from hospitalisation compared with fully vaccinated, partly vaccinated, and unvaccinated adolescents. Therefore, the booster dose of BNT162b2 can help to reduce the burden on the health-care system and individual morbidity during an omicron wave. FUNDING None.
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Affiliation(s)
| | - M Premikha
- Crisis Strategy and Operations Group, Ministry of Health, Singapore
| | - Chia Yin Chong
- Department of Infectious Diseases, KK Women's and Children's Hospital, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,Duke-NUS Medical School, Singapore
| | | | - Benjamin Ong
- DMS Office, Ministry of Health, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David Chien Lye
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore,National Centre for Infectious Diseases, Singapore,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Derrick Heng
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Vernon J Lee
- Public Health Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kelvin Bryan Tan
- Crisis Strategy and Operations Group, Ministry of Health, Singapore,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Al-Khlaifat AM, Al Quraan AM, Nimri AF, Khaled NEB, Ramadina N, Ayyash FF, Daoud SO, Hamlan SY, Hababeh BM. Factors Influencing the Length of Hospital Stay Among Pediatric COVID-19 Patients at Queen Rania Al Abdullah Hospital for Children: A Cross-Sectional Study. Cureus 2023; 15:e35000. [PMID: 36949998 PMCID: PMC10027108 DOI: 10.7759/cureus.35000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Background COVID-19 caused by SARS-CoV-2 is a worldwide epidemic. Children are less commonly infected and have less severe symptoms than adults. However, they are at risk for COVID-19-associated severe sickness and hospitalization. The duration of stay is a major driver of effective health treatment during hospitalization; thus, it is only logical to attempt to comprehend the factors influencing the length of stay (LOS) for these patients, particularly in light of the ongoing pandemic caused by the new SARS-CoV-2 virus. As predictors of hospital LOS, several variables, including age, gender, disease severity, hospital mortality, insurance type, and hospital location, have been discovered. In our study, we focused on the severity of the patient's condition, the presence of comorbidities, and the necessary therapeutic regimen to predict the duration of stay. This study aimed to answer the following questions: If a patient has comorbidity and has COVID-19 requiring hospital treatment, will the patient's comorbidity elongate the duration of stay at the hospital for further management in the pediatric age group? What are the risk factors that play a significant role in the hospital stay duration in pediatrics? Methodology We gathered data from 100 hospitalized children aged up to 14 years who tested positive for COVID-19, which was not specific to variants of SARS-CoV-2, over 24 months (February 2020-February 2022) at Queen Rania Al Abdullah Hospital for Children, one of the Health Care Accreditation Council accredited facilities. Clinical symptoms, signs, oxygen demand, imaging study results, laboratory data, and usage of corticosteroid and antiviral medication were all taken from patients' medical records. There were no limitations in taking the sample of patients. All patients in the duration mentioned were included. Results Clinical data of 100 COVID-19-positive pediatric patients were analyzed; 52% of the patients had associated chronic illnesses, while 48% were medically free. The longest duration of LOS was 28 days, the shortest was one day, the median was eight days, and five days was the most frequent among patients owing to 21% of patients, using mean descriptive statistics. We compared LOS to having or not having comorbidities. The mean LOS of patients with the comorbid disease was 6.15 days, with a maximum of 28 days, while for patients without chronic illnesses, the mean was 4.81 days with a maximum of 14 days. The significance was 0.07. Our results also showed a significant correlation between using steroids and LOS, as it had an advantageous effect by decreasing it with a significance value of 0.04. Having abnormal findings on chest computed tomography (CT) scan was also associated with increased LOS with a significant value of 0.00. Conclusions According to our research, there was no direct association between comorbidity and hospital LOS, which is counterintuitive, as it was influenced by multiplayers of variables such as using steroids, which decreased the LOS, and abnormal findings on chest CT, which resulted in lengthening of the hospital stay. Our findings cannot be proven without further research and a larger patient sample.
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Affiliation(s)
- Alia M Al-Khlaifat
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Amman, JOR
| | - Asmaa M Al Quraan
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Aseel F Nimri
- Pediatric Infectious Diseases, Jordanian Royal Medical Services, Amman, JOR
| | | | | | - Fadi F Ayyash
- Pediatric Endocrinology, Jordanian Royal Medical Services, Amman, JOR
| | - Shadi O Daoud
- Rheumatology, Jordanian Royal Medical Services, Amman, JOR
| | - Sarah Y Hamlan
- Pediatrics, Jordanian Royal Medical Services, Amman, JOR
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160
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Zuccotti G, Calcaterra V, Mannarino S, D’Auria E, Bova SM, Fiori L, Verduci E, Milanese A, Marano G, Garbin M, Zirpoli S, Fabiano V, Carlucci P, Olivotto S, Gianolio L, De Santis R, Pelizzo G, Zoia E, Dilillo D, Biganzoli EM. Six-month multidisciplinary follow-up in multisystem inflammatory syndrome in children: An Italian single-center experience. Front Pediatr 2023; 10:1080654. [PMID: 36776681 PMCID: PMC9909209 DOI: 10.3389/fped.2022.1080654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background A severe multisystem inflammatory syndrome in children (MIS-C) related to SARS-CoV-2 has been described after infection. A limited number of reports have analyzed the long-term complications related to pro-inflammatory status in MIS-C. We evaluated multiorgan impairment at the 6-month follow-up in MIS-C. Methods We enrolled 33 pediatric patients consecutively hospitalized for MIS-C and monitored for almost 6 months. The inter-relationship of patient's features and disease severity at admission with long term complications was studied by multivariate analysis. Results Endo-metabolic derangement, cardiac injury, respiratory, renal and gastrointestinal manifestations and neurological involvement are part of the initial presentation. The most abnormalities appear to resolve within the first few weeks, without significant long term dysfunction at the 6-months follow-up, except for endocrine (non-thyroidal illness syndrome in 12.1%, insulin resistance in 21.2%) and neurological system (27.3% cognitive or psychological, behavioral, adaptive difficulties). Endocrine and heart involvement at admission represent a significant factor on the long term sequelae; however no association between severity score and long-term outcome was noted. Conclusions The severity of initial clinical presentation may be associated to organ domain, however it is not related to long term sequelae. The prevalent organ restoration supports a predominant indirect immune-mediated injury triggered by a systemic inflammatory response; however a direct damage due to the viral entry could be not excluded. Eventhought our preliminary results seem to suggest that MIS-C is not a long-term risk condition for children health, a longer follow-up is mandatory to confirm this hypothesis.
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Affiliation(s)
- Gianvincenzo Zuccotti
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | - Valeria Calcaterra
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children’s Hospital, Milan, Italy
| | - Enza D’Auria
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | | | - Laura Fiori
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | - Elvira Verduci
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
- Department of Health Sciences, University of Milano, Milano, Italy
| | - Alberto Milanese
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, University of Milan, Milan, Italy
| | - Giuseppe Marano
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, University of Milan, Milan, Italy
| | - Massimo Garbin
- Pediatric Cardiology Unit, Buzzi Children’s Hospital, Milan, Italy
| | | | - Valentina Fabiano
- Department of Biomedical and Clinical Science, University of Milan, Milan, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | | | - Sara Olivotto
- Pediatric Neurology Unit, Buzzi Children’s Hospital, Milan, Italy
| | - Laura Gianolio
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | | | - Gloria Pelizzo
- Pediatric Surgery Department, Buzzi Children’s Hospital, Milan, Italy
| | - Elena Zoia
- Intensive Care Unit, Buzzi Children’s Hospital, Milan, Italy
| | - Dario Dilillo
- Pediatric Department, Buzzi Children’s Hospital, Milan, Italy
| | - Elia Mario Biganzoli
- Medical Statistics Unit, Department of Biomedical and Clinical Sciences, “Luigi Sacco” University Hospital, University of Milan, Milan, Italy
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161
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García-García A, Fortuny C, Fumadó V, Jordan I, Ruiz-López L, González-Navarro EA, Egri N, Esteve-Solé A, Luo Y, Vlagea A, Cabedo MM, Launes C, Soler A, Codina A, Juan M, Pascal M, Deyà-Martínez A, Alsina L. Acute and long-term immune responses to SARS-CoV-2 infection in unvaccinated children and young adults with inborn errors of immunity. Front Immunol 2023; 14:1084630. [PMID: 36742319 PMCID: PMC9896004 DOI: 10.3389/fimmu.2023.1084630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023] Open
Abstract
Purpose To describe SARS-CoV-2 infection outcome in unvaccinated children and young adults with inborn errors of immunity (IEI) and to compare their specific acute and long-term immune responses with a sex-, age-, and severity-matched healthy population (HC). Methods Unvaccinated IEI patients up to 22 years old infected with SARS-CoV-2 were recruited along with a cohort of HC. SARS-CoV-2 serology and ELISpot were performed in the acute phase of infection (up to 6 weeks) and at 3, 6, 9, and 12 months. Results Twenty-five IEI patients (median age 14.3 years, min.-max. range 4.5-22.8; 15/25 males; syndromic combined immunodeficiencies: 48.0%, antibody deficiencies: 16.0%) and 17 HC (median age 15.3 years, min.-max. range 5.4-20.0; 6/17 males, 35.3%) were included. Pneumonia occurred in 4/25 IEI patients. In the acute phase SARS-CoV-2 specific immunoglobulins were positive in all HC but in only half of IEI in whom it could be measured (n=17/25): IgG+ 58.8% (10/17) (p=0.009); IgM+ 41.2% (7/17)(p<0.001); IgA+ 52.9% (9/17)(p=0.003). Quantitative response (index) was also lower compared with HC: IgG IEI (3.1 ± 4.4) vs. HC (3.5 ± 1.5)(p=0.06); IgM IEI (1.9 ± 2.4) vs. HC (3.9 ± 2.4)(p=0.007); IgA IEI (3.3 ± 4.7) vs. HC (4.6 ± 2.5)(p=0.04). ELISpots positivity was qualitatively lower in IEI vs. HC (S-ELISpot IEI: 3/11, 27.3% vs. HC: 10/11, 90.9%; p=0.008; N-ELISpot IEI: 3/9, 33.3% vs. HC: 11/11, 100%; p=0.002) and also quantitatively lower (S-ELISpot IEI: mean index 3.2 ± 5.0 vs. HC 21.2 ± 17.0; p=0.001; N-ELISpot IEI: mean index 9.3 ± 16.6 vs. HC: 39.1 ± 23.7; p=0.004). As for long term response, SARS-CoV-2-IgM+ at 6 months was qualitatively lower in IEI(3/8, 37.5% vs. 9/10 HC: 90.0%; p=0.043), and quantitatively lower in all serologies IgG, M, and A (IEI n=9, 1.1 ± 0.9 vs. HC n=10, 2.1 ± 0.9, p=0.03; IEI n=9, 1.3 ± 1.5 vs. HC n=10, 2.9 ± 2.8, p=0.02; and IEI n=9, 0.6 ± 0.5 vs. HC n=10, 1.7 ± 0.8, p=0.002 -respectively) but there were no differences at remaining time points. Conclusions Our IEI pediatric cohort had a higher COVID-19 pneumonia rate than the general age-range population, with lower humoral and cellular responses in the acute phase (even lower compared to the reported IEI serological response after SARS-CoV-2 vaccination), and weaker humoral responses at 6 months after infection compared with HC.
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Affiliation(s)
- Ana García-García
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Victoria Fumadó
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- CIBER of Epidemiology and Public Health, Madrid, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Iolanda Jordan
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
- Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laura Ruiz-López
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Natalia Egri
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ana Esteve-Solé
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Yiyi Luo
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandru Vlagea
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Manel Monsonís Cabedo
- Department of Microbiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Cristian Launes
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Aleix Soler
- Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Codina
- Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Pathology Department and Biobank Department, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain
| | - Manel Juan
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- Spanish Network for Allergy - RETIC de Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Angela Deyà-Martínez
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - Laia Alsina
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Department of Surgery and Surgical Specializations, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
- Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Joung J, Yang H, Choi YJ, Lee J, Ko Y. The Impact of Omicron Wave on Pediatric Febrile Seizure. J Korean Med Sci 2023; 38:e18. [PMID: 36647218 PMCID: PMC9842486 DOI: 10.3346/jkms.2023.38.e18] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/17/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) omicron (B.1.1.529) variant reduced the risk of severe disease compared with the original strain and other variants, but it appeared to be highly infectious, which resulted in an exponential increase in confirmed cases in South Korea. As the number of confirmed cases increased, so did the number of pediatric patients' hospitalization. This study aims to evaluate the frequency and clinical features of febrile seizure associated with the COVID-19 omicron variant in children. METHODS We retrospectively reviewed the medical records of children aged under 18 years with febrile seizure who were tested for COVID-19 from February 2020 to April 2022 at Ajou University Hospital, South Korea. Based on the dominant variants, we divided the period into the pre-omicron (from February 2020 to December 2021) and omicron periods (from January 2022 to April 2022) and compared the clinical characteristics between the two. Also, we compared the clinical characteristics of febrile seizure between COVID-19 positive and negative group during the omicron period. RESULTS Among the 308 children, 211 patients (9.2 patients/months) and 97 patients (24.3 patients/months) were grouped into pre-omicron and omicron periods, respectively. Compared with the pre-omicron period, patients in the omicron period showed significantly higher mean age (pre-omicron vs. omicron, 22.0 vs. 28.0 months; P = 0.004) and COVID-19 positive results (pre-omicron vs. omicron, 0.5% vs. 62.9%; P < 0.001). As the COVID-19 confirmed cases in the omicron period increased, the number of COVID-19 associated febrile seizure also increased. In the omicron period, 61 children were confirmed to be positive for COVID-19, and COVID-19 positive group showed statistically significant higher mean age (positive vs. negative, 33.0 vs. 23.0 months; P = 0.003) and peak body temperature than the negative group (positive vs. negative, 39.1°C vs. 38.6°C; P = 0.030). Despite the lack of significance, COVID-19 positive group showed longer seizure time, multiple seizure episodes, and higher prevalence of complex febrile seizure. CONCLUSION The frequency of COVID-19 associated febrile seizure increased in the omicron periods. In addition, in this period, children with febrile seizure diagnosed with COVID-19 had a higher mean age and higher peak body temperature.
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Affiliation(s)
- Jaehyung Joung
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Heewon Yang
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yoo Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Korea.
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Khatrawi EM, Sayed AA. The Reasons behind COVID-19 Vaccination Hesitancy among the Parents of Children Aged between 5 to 11 Years Old in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1345. [PMID: 36674101 PMCID: PMC9859117 DOI: 10.3390/ijerph20021345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 06/01/2023]
Abstract
Simultaneously with the development of the COVID-19 vaccination plan for minors, it is critical to understand the reasons related to parental COVID-19 vaccination hesitancy. This study aims to determine the reasons associated with vaccination hesitancy among parents, and the prevalence and the characteristics of the parents who are hesitant to allow their children aged between 5 to 11 years old to be administered the COVID-19 vaccines. A web-based questionnaire was used to perform this study between May 2022 to September 2022 in Saudi Arabia (SA). Several factors, personal and social, affected the participants' willingness to vaccinate their children with the COVID-19 vaccines. The age of the parents was found to have a significant impact on their decision to vaccinate their children. Those between the age of 40-49 years of age were the most willing to vaccinate (almost 41%) compared to those 50 years or older who were most resistant to vaccination. Female participants were more resistant to vaccinating their children compared to their male counterparts. Saudis were more resistant to vaccinating their children compared to the non-Saudi participants. Those private sector-employed parents were the most willing to vaccinate (16.6%), followed by those working in the governmental sector (13.8%). About 40.7% of non-healthcare workers were resistant to vaccinating their minor compared to healthcare workers (8.7%). In conclusion, the study presents several factors that affect the parental willingness to vaccinate their children in SA. These factors should be properly addressed when developing public health strategies to promote the COVID-19 vaccination of children in SA.
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Affiliation(s)
- Elham Mohammed Khatrawi
- Department of Medical Microbiology and Immunology, Taibah University, College of Medicine, Madinah 42353, Saudi Arabia
| | - Anwar A. Sayed
- Department of Medical Microbiology and Immunology, Taibah University, College of Medicine, Madinah 42353, Saudi Arabia
- Department of Surgery and Cancer, Imperial College London, London SW7 2AZ, UK
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Sulaimanov SA. Allergic diseases in children in the age of the COVID-19 pandemic. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-25-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
COVID-19 coronavirus infection caused by the SARS-CoV-2 virus has become a real disaster for all of humanity. Today, issues related to diagnostics, clinical presentations, treatment of the complications, preventive measures, including vaccination for a new coronavirus infection, are relevant. It is also important to identify risk factors for a severe course of the disease, features of the development of infection against the background of comorbid conditions and different immunological reactivity of the human body. The comorbidity of allergic and infectious diseases is based on the common humoral and cellular mechanisms of the immune response. The trigger for the development of allergic diseases is often the viruses of measles and chickenpox, influenza, parainfluenza, rhinoviruses, enteroviruses, respiratory syncytial viruses, coronaviruses, and others. Most allergic patients are predisposed to acute respiratory viral infections. COVID-19 occurs in 0.39–12.3% of children. Children tend to have milder disease than adults and have low mortality rates. At the same time, one should not forget about the adequate support for patients with chronic diseases, especially children with allergic diseases. Viruses and preventive hygiene measures associated with a pandemic are triggers of an exacerbation of bronchial asthma and atopic dermatitis. Early diagnosis, adequate treatment of allergic diseases in children, and provision of doctors with information are also problematic. It is important to understand which patients with bronchial asthma are at particular risk and how inhaled glucocorticosteroids may influence the course and outcome of COVID-19. International associations and societies have developed guidelines for the management of children with allergies during the COVID-19 pandemic. Inhaled glucocorticosteroids for bronchial asthma reduce the expression of genes of the main target receptors for the SARS-CoV-2 virus. Anti-inflammatory therapy for asthma, primarily inhaled glucocorticosteroids, should be continued until asthma control is achieved, which will help reduce the risk of an unfavorable course of COVID-19.
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165
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COVID-19 Heart Lesions in Children: Clinical, Diagnostic and Immunological Changes. Int J Mol Sci 2023; 24:ijms24021147. [PMID: 36674665 PMCID: PMC9866514 DOI: 10.3390/ijms24021147] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
In the beginning of COVID-19, the proportion of confirmed cases in the pediatric population was relatively small and there was an opinion that children often had a mild or asymptomatic course of infection. Our understanding of the immune response, diagnosis and treatment of COVID-19 is highly oriented towards the adult population. At the same time, despite the fact that COVID-19 in children usually occurs in a mild form, there is an incomplete understanding of the course as an acute infection and its subsequent manifestations such as Long-COVID-19 or Post-COVID-19, PASC in the pediatric population, correlations with comorbidities and immunological changes. In mild COVID-19 in childhood, some authors explain the absence of population decreasing T and B lymphocytes. Regardless of the patient's condition, they can have the second phase, related to the exacerbation of inflammation in the heart tissue even if the viral infection was completely eliminated-post infectious myocarditis. Mechanism of myocardial dysfunction development in MIS-C are not fully understood. It is known that various immunocompetent cells, including both resident inflammatory cells of peripheral tissues (for example macrophages, dendritic cells, resident memory T-lymphocytes and so on) and also circulating in the peripheral blood immune cells play an important role in the immunopathogenesis of myocarditis. It is expected that hyperproduction of interferons and the enhanced cytokine response of T cells 1 and 2 types contribute to dysfunction of the myocardium. However, the role of Th1 in the pathogenesis of myocarditis remains highly controversial. At the same time, the clinical manifestations and mechanisms of damage, including the heart, both against the background and after COVID-19, in children differ from adults. Further studies are needed to evaluate whether transient or persistent cardiac complications are associated with long-term adverse cardiac events.
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Abeynayake J, Harshani HC, Wijewickrama R, Wimalarathne G, Jayamaha CS. Sociodemographic and clinical characteristics of SARS-CoV-2 infected population during the second and third epidemiological waves in Sri Lanka. ASIAN PAC J TROP MED 2023. [DOI: 10.4103/1995-7645.368015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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ICU Admission, Invasive Mechanical Ventilation, and Mortality among Children and Adolescents Hospitalized for COVID-19 in a Private Healthcare System. Int J Pediatr 2023; 2023:1698407. [PMID: 36873820 PMCID: PMC9981283 DOI: 10.1155/2023/1698407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/12/2023] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Aim The COVID-19 pandemic devastated healthcare around the world. Data about the COVID-19 outcomes among young people are still scarce. We aim to identify factors associated with the composite outcome among children and adolescents hospitalized due to COVID-19. Methods We performed a search in the database of a large Brazilian private healthcare system. Insured people aged 21 years or younger who were hospitalized due to COVID-19 from Feb/28th/2020 to Nov/1st/2021 were included. The primary endpoint was the composite outcome consisting of ICU admission, need for invasive mechanical ventilation, or death. Results We evaluated 199 patients who had an index hospitalization due to COVID-19. The median monthly rate of index hospitalization was 2.7 (interquartile range [IQR], 1.6-3.9) per 100,000 clients aged 21 years or less. The median age of the patients was 4.5 years (IQR, 1.4-14.1). At the index hospitalization, the composite outcome rate was 26.6%. The composite outcome was associated with all the previous coexisting morbidities evaluated. The median follow-up was 249.0 days (IQR, 152.0-438.5). There were 27 readmissions (16 patients) within 30 days after the discharge. Conclusions In conclusion, hospitalized children and adolescents had a composite outcome rate of 26.6% at the index hospitalization. Having previous chronic morbidity was associated with the composite.
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Horlenko OM, Hechko KA, Prylypko LB, Blaga O, Horlenko FV, Kutsyn ОO, Halay BM. IMMUNE-INFLAMMATORY-ENDOCRINE REGULATION DISORDERS IN CHILDREN WITH CORONAVIRUS INFECTION. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2420-2428. [PMID: 38112359 DOI: 10.36740/wlek202311113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim: To study the of homeostasis links desorder and indicators imbalance in children with Coronavirus infection. PATIENTS AND METHODS Materials and methods: A clinical and laboratory study was conducted in children (50 persons) with Coronavirus infection. The children were used outpatient treatment. RESULTS Results: It was found that Direct bilirubin was increased in 3 times (10.55±7.67 vs. 3.63±0.49 μmol/l, p<0.01), Alanine aminotransferase - in 1.7 times (37,02±20.53 vs. 21.90±1.82 IU/l, p<0.01). An levels increassng of Ig G - in 12.3 times, Ig E - in 4.6 times, Ig M - in 3.4 times was observed. The CRP level was increased in 3.1 times (8.76 ± 2.16 vs. 2.54 ± 0.53 mg/l, p< 0.01), C-peptide (4.65±1.67 vs. 1.23±0.08 ng/ml, p<0.01) - in 3.8 times. Negative correlations of T3 with Procalcitonin (r=-0.30) and Creatinine (r=-34) were revealed. T4 values are correlated with Total cholesterol (r=-0.65) and Creatinine (r=0.29). Leptin was presented positive correlations with Alanine aminotransferase (r=0.48) and with C-peptide (r=0.39). CONCLUSION Conclusions: There was an increase in the Ig G levels in 12.3 times, Ig E - in 4.6 times, and the Ig M level - in 3.4 times. The Thyroid stimulating hormone level was significantly lower (in 4.7 times). An increase in the C-reactive protein levels (in 3.1 times) and C-peptide (in 3.8 times) was observed. It should be noted that the strongest negative correlation between T4 and Total cholesterol (r=-0.65) and the highest positive correlation between Leptin and Alanine aminotransferase (r=0.48) and C-peptide (r=0. 39).
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Affiliation(s)
| | | | | | - Olga Blaga
- UZHHOROD NATIONAL UNIVERSITY, UZHHOROD, UKRAINE
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169
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Chiodini B, Bellotti AS, Morello W, Bulgaro C, Farella I, Giordano M, Montini G, Ismaili K, Wissing KM. Relapse rate in children with nephrotic syndrome during the SARS-CoV-2 pandemic. Pediatr Nephrol 2023; 38:1139-1146. [PMID: 35976441 PMCID: PMC9383657 DOI: 10.1007/s00467-022-05702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/02/2022] [Accepted: 07/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Viral upper respiratory tract infections trigger nephrotic syndrome relapses. Few data exist on the impact of the SARS-CoV-2 pandemic on the risk of relapse in children with idiopathic nephrotic syndrome (INS). METHODS In a Belgian and Italian cohort of children with INS, we performed a retrospective analysis on the number and duration of relapses observed in 3 different periods in 2020: first COVID period, February 15-May 31; second COVID period, June 1-September 14; third COVID period, September 15-December 31. Relapse rates were compared to those of the previous 5 years (PRECOVID period). For the years 2019 and 2020, all causes and INS relapse-related hospitalizations were recorded. Hospitalizations and deaths due to SARS-CoV-2 infection were also recorded. In the Belgian cohort, SARS-CoV-2 serologies were performed. RESULTS A total of 218 patients were enrolled, and 29 (13.3%) were diagnosed with new-onset INS during the COVID period. Relapse rates per 1000 person-days were as follows: 3.2 in the PRECOVID period, 2.7 in the first COVID period, 3.3 in the second COVID period, and 3.0 in the third COVID period. The incidence rate ratio for the total COVID period was 0.9 (95%CI 0.76 to 1.06; P = 0.21) as compared to the PRECOVID period. During 2020, both the proportion of patients hospitalized for recurrence (14.2% vs. 7.6% in 2019; P = 0.03) and the rate of hospitalization for recurrence (IRR 1.97 (95%CI 1.35 to 2.88); P = 0.013) were higher compared to 2019. In December 2020, anti-SARS-CoV-2 antibodies were detected in 31% of the Belgian cohort. Patients with positive and negative SARS-CoV-2 serology did not differ significantly in relapse rate (2.4 versus 4.2 per 1000 person-days). The number of new INS cases remained similar between 2020, 2019, and 2018. CONCLUSION The first year of the SARS-CoV-2 pandemic did not significantly affect the relapse rate in children with INS. No serious infections were reported in this population of immunosuppressed patients. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Benedetta Chiodini
- Department of Pediatric Nephrology, Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium.
| | - Anita Sofia Bellotti
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Di Milano, via Commenda 9, 20122, Milan, Italy
| | - William Morello
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Di Milano, via Commenda 9, 20122, Milan, Italy
| | - Chiara Bulgaro
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Di Milano, via Commenda 9, 20122, Milan, Italy
| | - Ilaria Farella
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", 70123, Bari, Italy
| | - Mario Giordano
- Pediatric Nephrology and Dialysis Unit, Pediatric Hospital "Giovanni XXIII", 70123, Bari, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Di Milano, via Commenda 9, 20122, Milan, Italy
| | - Khalid Ismaili
- Department of Pediatric Nephrology, Hôpital Universitaire Des Enfants Reine Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Karl Martin Wissing
- Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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170
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Parents' perception of COVID-19 risk of infection and intention to vaccinate their children. VACUNAS 2023; 24:37-44. [PMID: 36062027 PMCID: PMC9424507 DOI: 10.1016/j.vacun.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/22/2022] [Indexed: 02/08/2023]
Abstract
Background Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs. Objective Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children. Method Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire. Results Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766). Conclusion Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.
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Bourque SL, Weikel BW, Palmer C, Cataldi JR, Blackwell S, Hwang SS. Prevalence and Predictors of Pediatric COVID-19 Vaccine Acceptance. Am J Perinatol 2023; 40:106-114. [PMID: 35554887 DOI: 10.1055/a-1850-3199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE As pediatric COVID-19 vaccine eligibility expands, understanding predictors of vaccine intent is critical to effectively address parental concerns. Objectives included: (1) Evaluate maternal COVID-19 vaccine intent for child(ren) and associated predictors of stated intent; (2) Describe attitudes related to hypothetical vaccination policies; (3) Summarize themes associated with intention to vaccinate child(ren) for COVID-19. STUDY DESIGN Mothers enrolled in Heath eMoms, a longitudinal survey project, were recruited for this electronic COVID-19 survey. Chi-square analysis was used to compare proportions of respondent characteristics based on vaccination intent. Population survey logistic regression was used for multivariable modeling to assess the independent association between vaccine intent and demographics. RESULTS The response rate was 65.3% (n = 1884); 44.2% would choose vaccination, 20.3% would not choose vaccination, and 35.5% are unsure whether to have their child(ren) vaccinated for COVID-19. Black mothers (AOR 0.26, 95% CI 0.13, 0.54), respondents with less than high school education (AOR 0.26, 95% 0.12, 0.56) and those in rural areas (AOR 0.28, 95% CI 0.16, 0.48) were less likely to choose vaccination. Commonly cited reasons for vaccine hesitancy include the belief that the vaccine was not tested enough, is not safe, and there are concerns regarding its side effects. CONCLUSION Over 50% of respondents do not intend or are unsure about their intent to vaccinate their child(ren) for COVID-19 with variability noted by demographics. Opportunities exist for perinatal and pediatric providers to educate pregnant people, parents, and caregivers with a focus on addressing concerns regarding vaccine safety and efficacy. KEY POINTS · COVID-19 vaccination rates remain suboptimal, especially in the pediatric population, with variation across states.. · We found that the prevalence of vaccine acceptance for young children is low.. · We highlight opportunities for providers to educate parents, focusing on addressing vaccine safety and efficacy..
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Affiliation(s)
- Stephanie L Bourque
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Blair W Weikel
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Claire Palmer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Jessica R Cataldi
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, United States.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, United States
| | - Sarah Blackwell
- Colorado Department of Public Health and Environment, Aurora, Colorado, United States
| | - Sunah S Hwang
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, Colorado, United States
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172
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Rzhevska OO, Shevchenko NS, Horbas VA, Kondratiuk NY. CLINICAL AND EPIDEMIOLOGICAL FEATURES OF COVID-19 IN CHILDREN FOR THE PERIOD 2020-2022. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:2302-2307. [PMID: 37948730 DOI: 10.36740/wlek202310126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The aim: To investigate the epidemiological and clinical characteristics of COVID-19 in children for the period 2020-2022. PATIENTS AND METHODS Materials and methods: A retrospective analysis of 1144 case histories of children who were hospitalized at the St. Zinaida Children's Clinical Hospital (Sumy, Ukraine) for coronavirus disease for 2020-2022 was carried out. The observed patients were divided into 3 groups corresponding to the 3 waves of the pandemic: group 1 - 120 children, group 2 - 311 children, and group 3 - 713. The diagnosis of COVID-19 was established based on clinical, medical histories, laboratory and instrumental data. The etiology of coronavirus disease was determined based on the detection of antigens of the SARS-CoV-2 virus using PCR reverse transcription of a nasopharyngeal swab. RESULTS Results: An analysis of the clinical and epidemiological indicators of children who were treated for COVID-19 during 2020-2022 was conducted, depending on the outbreak of the pandemic. The frequency of lesions in children of different age groups was determined, and the main clinical symptoms and the frequency of complications in the form of pneumonia during different waves of COVID-19 were determined. CONCLUSION Conclusions: The incidence of coronavirus infection was mainly observed in children of the younger group (0-5 years). A more severe course of the disease and a higher frequency of complications in the form of pneumonia in children were determined during the 3rd wave of the COVID-19 pandemic.
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Affiliation(s)
- Olga O Rzhevska
- V.N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE; PRIVATE INSTITUTION OF HIGHER EDUCATION «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE
| | - Natalia S Shevchenko
- V.N. KARAZIN KHARKIV NATIONAL UNIVERSITY, KHARKIV, UKRAINE; STATE INSTITUTION «INSTITUTE FOR CHILDREN AND ADOLESCENT`S HEALTH CARE OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE», KHARKIV, UKRAINE
| | - Viktoriia A Horbas
- ACADEMIC AND RESEARCH MEDICAL INSTITUTE «SUMY STATE UNIVERSITY», SUMY, UKRAINE
| | - Natalia Yu Kondratiuk
- PRIVATE INSTITUTION OF HIGHER EDUCATION «KYIV MEDICAL UNIVERSITY», KYIV, UKRAINE; STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE» STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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173
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Aldè M, Di Berardino F, Ambrosetti U, Barozzi S, Piatti G, Zanetti D, Pignataro L, Cantarella G. Audiological and vestibular symptoms following SARS-CoV-2 infection and COVID-19 vaccination in children aged 5-11 years. Am J Otolaryngol 2023; 44:103669. [PMID: 36283164 PMCID: PMC9583622 DOI: 10.1016/j.amjoto.2022.103669] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/15/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE The present study assessed the prevalence of audio-vestibular symptoms following SARS-COV-2 infection or COVID-19 vaccination among children, comparing the two groups. A further aim was to evaluate whether children with pre-existing unilateral hearing loss were more prone to adverse events. MATERIALS AND METHODS This retrospective study included children aged 5-11 years with normal hearing or a proven history of unilateral hearing loss who contracted SARS-CoV-2 or received two doses of COVID-19 vaccine. Tinnitus, hyperacusis, aural fullness, otalgia, otorrhea, new-onset hearing loss, vertigo and dizziness were investigated as possible complications of SARS-CoV-2 infection or the COVID-19 vaccine. RESULTS This study included 272 children (143 boys, 129 girls), with a mean age of 7.8 ± 2.3 years. Among these, 120 were affected by pre-existing unilateral hearing loss. The most common audio-vestibular symptoms reported by children following SARS-CoV-2 infection and COVID-19 vaccination were aural fullness (33/132, 25 %) and dizziness (5/140, 3.6 %), respectively. All symptoms following COVID-19 vaccination resolved within 24 h. Compared to children who received the COVID-19 vaccine, those infected with SARS-CoV-2 had a higher prevalence of tinnitus (p = 0.009), hyperacusis (p = 0.003), aural fullness (p < 0.001), otalgia (p < 0.001), otorrhea (p < 0.001), and vertigo (p = 0.006). Two girls also experienced new-onset unilateral sensorineural hearing loss following SARS-CoV-2 infection. Children with a known history of unilateral hearing loss did not have a higher prevalence of audio-vestibular symptoms than children with normal hearing. CONCLUSIONS Our results suggest that the COVID-19 vaccine is safe and can be recommended for children with unilateral hearing loss without fear of possible audio-vestibular sequelae.
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Affiliation(s)
- Mirko Aldè
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Federica Di Berardino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Umberto Ambrosetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Stefania Barozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Gioia Piatti
- Department of Pathophysiology and Transplantation, University of Milan and Unit of Bronchopneumology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Diego Zanetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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174
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Niemann A, Boudriot A, Brett B, Fritzsch C, Götz D, Haase R, Höhne S, Jorch G, Köhn A, Lux A, Zenker M, Rissmann A. Impact of the COVID-19 Pandemic Regulations on the Health Status and Medical Care of Children with Trisomy 21. KLINISCHE PADIATRIE 2023; 235:31-37. [PMID: 36108644 DOI: 10.1055/a-1757-9948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND While children are considered at low risk for COVID-19, little is known about the impact of SARS-CoV-2 on paediatric risk patients like children with Trisomy 21 (T21). As these children often need regular therapy and various medical appointments, this study aimed to investigate the possible impact of the COVID-19 pandemic on children with T21. PATIENTS AND METHODS Parents of children with T21 in the age of 0-12 years in Saxony-Anhalt were interviewed via phone in June 2021 regarding the health status and medical care of their children during the past 15 months of pandemic. RESULTS 37 children with mean age of 6.1 years (min 0; max 12) were included in the study. The majority did not have any additional congenital anomalies. Surveyed parents hardly reported adverse changes of health status during the pandemic, but rather improvements, such as decreased number of respiratory infections and more time spend with their children. Outpatient appointments and therapy were cancelled or postponed at the onset of the pandemic, but parents reported low impact on their child's health and development. The main concern seemed to be lack of childcare during school and day-care closures and uncertainty concerning possible health impacts of an infection on their children. CONCLUSION There was low impact of the COVID-19 pandemic on health and medical care of children with T21 in our study population. Further research is needed to help weigh the child's individual risk of infection against the need for medical treatment and therapy when dealing with paediatric risk patients.
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Affiliation(s)
- Annika Niemann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anett Boudriot
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Birgit Brett
- Social Paediatric Centre, Children's Centre Magdeburg gGmbH, Magdeburg, Germany
| | - Christiane Fritzsch
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Dorit Götz
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Roland Haase
- Klinik für Kinder- und Jugendmedizin, Martin-Luther-Universität Halle Wittenberg, Halle/Saale, Germany.,Department of Neonatology and Paediatric Intensive Care, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Sibylle Höhne
- Social Paediatric Centre, St. Elisabeth and St. Barbara Hospital Halle (Saale), Halle (Saale), Germany
| | - Gerhard Jorch
- Universitätsklinikum Magdeburg, Universitätskinderklinik, Magdeburg, Germany
| | - Andrea Köhn
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Lux
- Institute of Biometry and Medical Informatics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Martin Zenker
- Institut für Humangenetik, Otto von Guericke Universitat Magdeburg, Magdeburg, Germany.,Department of Paediatrics, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
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Ong RYL, Seah VXF, Chong CY, Thoon KC, Tan NWH, Li J, Nadua KD, Soh SY, Seng MSF, Pham TNA, Yung CF, Kam KQ. A cohort study of COVID-19 infection in pediatric oncology patients plus the utility and safety of remdesivir treatment. Acta Oncol 2023; 62:53-57. [PMID: 36661030 DOI: 10.1080/0284186x.2023.2169079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rina Yue Ling Ong
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Valerie Xue Fen Seah
- Department of Pharmacy, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Koh Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jiahui Li
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Karen Donceras Nadua
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Shui Yen Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Michaela Su-Fern Seng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Haematology/Oncology Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thi Ngoc Anh Pham
- Nursing Clinical Services, Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Kai-Qian Kam
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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176
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Ortiz-Prado E, Izquierdo-Condoy JS, Fernandez-Naranjo R, Vasconez J, Dávila Rosero MG, Revelo-Bastidas D, Herrería-Quiñonez D, Rubio-Neira M. The deadly impact of COVID-19 among children from Latin America: The case of Ecuador. Front Pediatr 2023; 11:1060311. [PMID: 37152328 PMCID: PMC10160383 DOI: 10.3389/fped.2023.1060311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background The SARS-CoV-2 pandemic remains a critical global health concern, with older adults being the most vulnerable group. Nonetheless, it is crucial to recognize that COVID-19 has caused numerous deaths in children worldwide. Emerging evidence indicates that infants and breastfeeding children, particularly those aged below one year, face a greater risk of hospitalization and mortality than older children with COVID-19. Objective This study aimed to describe the epidemiology of COVID-19 among children during the early phase of the pandemic in Ecuador. Methods We conducted a country-wide population-based analysis of the epidemiology of COVID-19, using incidence and mortality data reported from Ecuador between February 15, 2020 and May 14 2021. Measurements of frequency, central tendency, dispersion, and absolute differences were calculated for all categorical and continuous variables. Results At least 34,001 cases (23,587 confirmed cases, 5,315 probable and 5,099 suspected) and 258 COVID-19 related deaths have been reported among children in Ecuador during the first 16 months of the pandemic. The overall incidence rate was 612 cases per 100,000 children, the mortality rate was 3 per 100,000, while the case fatality rate was 0.76%. The highest risk group for infection was children and adolescents between 15 and 19 years of age; however, the highest mortality rate occurred in children under one year of age. The largest provinces, such as Pichincha, Guavas and Manabí, were the ones that reported the highest number of cases, 27%, 12.1% and 10.8%, respectively. Conclusions This study is the first to report on COVID-19 epidemics among children in Ecuador. Our findings reveal that younger children have a lower risk of SARS-CoV-2 infection, but a higher risk of mortality compared to older children and adolescents. Additionally, we observed significant disparities in infection rates and outcomes among children living in rural areas, those with comorbidities, and those from indigenous ethnic groups.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
- Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica,San José, Costa Rica
- Correspondence: Esteban Ortiz-Prado
| | - Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Jorge Vasconez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - María Gabriela Dávila Rosero
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Doménica Revelo-Bastidas
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Diva Herrería-Quiñonez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Mario Rubio-Neira
- Department of Cardiology, Baca Ortiz Pediatric Hospital, Quito, Ecuador
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Özen T, Kahraman FC, Öcal S, Ovalı HF. Skin, mucosa and nail findings in hospitalized pediatric patients with Coronavirus disease-2019 (COVID-19). An Bras Dermatol 2023; 98:208-215. [PMID: 36435635 PMCID: PMC9682411 DOI: 10.1016/j.abd.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cutaneous manifestations of Coronavirus Disease-2019 (COVID-19) disease have not yet been fully described in hospitalized pediatric patients. OBJECTIVES This prospective study aims to demonstrate the skin, mucosal, and nail findings of hospitalized children with COVID-19. METHODS The authors included hospitalized pediatric patients. Two dermatologists examined skin, hair, nails, and mucosa. Patients with drug eruptions were excluded with an anamnesis, clinical and laboratory test results. RESULTS Out of 46 enlisted patients, 19 (41,3%) patients displayed skin, mucosal or nail findings. Skin findings were seen on 14 (30.4%) patients. Ten (22%) patients presented skin findings matching described patterns. Half of the patients with patterned rashes had confluent erythematous/maculopapular/morbilliform rashes. Eleven out of 46 (23.9%) patients developed periorbital erythema and edema. Ten (22%) patients had at least one oral mucosal finding. One telogen effluvium, one blue nail, and one flag sign on nails were noticed. Nine (19.5%) patients out of 46 had developed MIS-C. MIS-C patients had mucocutaneous manifestations except one (88.8%). STUDY LIMITATIONS The authors have detected a higher rate of mucocutaneous manifestations compared to out-patients with mild COVID-19 because the study is based on hospitalized patients only. CONCLUSIONS Pediatric COVID-19 patients are more susceptible to developing mucocutaneous manifestations compared to adults. The authors propose COVID-19 should be acknowledged as one of the viral exanthem rashes of childhood. The authors noticed that the most common findings were periorbital erythema and edema. The confluent erythematous/maculopapular/morbilliform rashes appear to be the most common patterns associated with severe COVID-19.
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Affiliation(s)
- Tunç Özen
- Department of Dermatology, İstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey.
| | - Filiz Cebeci Kahraman
- Department of Dermatology, İstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Sevliya Öcal
- Department of Pediatric Infectious Diseases, İstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
| | - Hüsnü Fahri Ovalı
- Department of Pediatric Diseases, İstanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, İstanbul, Turkey
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178
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Gonçalves GS, Correa-Silva S, Zheng Y, Avelar I, Montenegro MM, Ferreira AEF, Bain V, Fink TT, Suguita P, Astley C, Lindoso L, Martins F, Matsuo OM, Ferreira JCOA, Firigato I, de Toledo Gonçalves F, Fernanda B Pereira M, Artur A da Silva C, Carneiro-Sampaio M, Marques HHS, Palmeira P. Circulating sTREM-1 as a predictive biomarker of pediatric multisystemic inflammatory syndrome (MIS-C). Cytokine 2023; 161:156084. [PMID: 36403563 PMCID: PMC9671781 DOI: 10.1016/j.cyto.2022.156084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
The exacerbation of the inflammatory response caused by SARS-CoV-2 in adults promotes the production of soluble mediators that could act as diagnostic and prognostic biomarkers for COVID-19. Among the potential biomarkers, the soluble triggering receptor expressed on myeloid cell-1 (sTREM-1) has been described as a predictor of inflammation severity. The aim was to evaluate sTREM-1 and cytokine serum concentrations in pediatric patients during the acute and convalescent phases of COVID-19. This was a prospective study that included 53 children/adolescents with acute COVID-19 (Acute-CoV group); 54 who recovered from COVID-19 (Post-CoV group) and 54 controls (Control group). Preexisting chronic conditions were present in the three groups, which were defined as follows: immunological diseases, neurological disorders, and renal and hepatic failures. The three groups were matched by age, sex, and similar preexisting chronic conditions. No differences in sTREM-1 levels were detected among the groups or when the groups were separately analyzed by preexisting chronic conditions. However, sTREM-1 analysis in the seven multisystemic inflammatory syndrome children (MIS-C) within the Acute-Cov group showed that sTREM-1 concentrations were higher in MIS-C vs non-MIS-C acute patients. Then, the receiver operating curve analysis (ROC) performed with MIS-C acute patients revealed a significant AUC of 0.870, and the sTREM-1 cutoff value of > 5781 pg/mL yielded a sensitivity of 71.4 % and a specificity of 91.3 % for disease severity, and patients with sTREM-1 levels above this cutoff presented an elevated risk for MIS-C development in 22.85-fold (OR = 22.85 [95 % CI 1.64-317.5], p = 0.02). The cytokine analyses in the acute phase revealed that IL-6, IL-8, and IL-10 concentrations were elevated regardless of whether the patient developed MIS-C, and those levels decreased in the convalescent phase, even when compared with controls. Spearman correlation analysis generated positive indexes between sTREM-1 and IL-12 and TNF-α concentrations, only within the Acute-CoV group. Our findings revealed that sTREM-1 in pediatric patients has good predictive accuracy as an early screening tool for surveillance of MIS-C cases, even in patients with chronic underlying conditions.
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Affiliation(s)
- Guilherme S Gonçalves
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Simone Correa-Silva
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Universidade Paulista, UNIP, Sao Paulo, SP, Brazil.
| | - Yingying Zheng
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Isabela Avelar
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marília M Montenegro
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Arthur E F Ferreira
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vera Bain
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thais T Fink
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Priscila Suguita
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camilla Astley
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Livia Lindoso
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda Martins
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Olivia M Matsuo
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Juliana C O A Ferreira
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Isabela Firigato
- Laboratorio de Imunohematologia e Hematologia Forense (LIM-40), Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fernanda de Toledo Gonçalves
- Laboratorio de Imunohematologia e Hematologia Forense (LIM-40), Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Fernanda B Pereira
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Clovis Artur A da Silva
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Heloisa H S Marques
- Departamento de Pediatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Patricia Palmeira
- Laboratorio de Pediatria Clinica (LIM-36), Departamento de Pediatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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179
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Iznak AF, Iznak EV, Damyanovich EV, Oleichik IV. [EEG correlates of suicidal intentions in depressive patients who survived and have not been ill with COVID-19]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:92-95. [PMID: 38127707 DOI: 10.17116/jnevro202312311292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To search for EEG correlates of suicidal intentions in young depressive patients who survived and have not been ill with COVID-19. MATERIAL AND METHODS We studied 46 female patients, aged 16-25 years, with depressive disorders who had previously had a mild or asymptomatic coronavirus infection («COVID» group) and 40 female patients with depressive disorders matched in age, syndromic structure of disorders and the initial severity of depression to patients of the «COVID» group but who are known not to have COVID-19 («non-COVID» group). The severity of suicidal intentions was assessed by the number of points of item 3 of HDRS-17. In all patients, pre-treatment multichannel background EEG was recorded with spectral power analysis in narrow frequency sub-bands. RESULTS In patients of the «COVID» group, the mean number of points of item 3 of HDRS-17 was slightly higher (at the trend level) than in the «non-COVID» group (2.1±1.5 and 1.8±1.6 points, respectively), and positively correlated (p<0.05) with the spectral power values of theta2 (6-8 Hz) and delta (2-4 Hz) EEG sub-bands. In the «non-COVID» group, the severity of suicidal intentions positively correlated (p<0.05) with the values of the spectral power of alpha2 (9-11 Hz) EEG sub-band. CONCLUSION Suicidal intentions increased in depressive patients survived from COVID-19, and their severity is associated with EEG signs of a reduced functional state of the cerebral cortex.
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Affiliation(s)
- A F Iznak
- Mental Health Research Cenetr, Moscow, Russia
| | - E V Iznak
- Mental Health Research Cenetr, Moscow, Russia
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180
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Parents' perception of COVID-19 risk of infection and intention to vaccinate their children. VACUNAS (ENGLISH EDITION) 2023; 24. [PMCID: PMC9969534 DOI: 10.1016/j.vacune.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background Parent's perception of the COVID-19 vaccines is very important to protect themselves and their children and achieve maximum effect of vaccination programs. Objective Evaluate the perception and attitude of parents towards COVID-19 risk of infection and intentions to vaccinate their children. Method Cross-sectional study including 1032 participants who have children aged from 5 to 18 years using a structured questionnaire. Results Overall, 65.0% of participants or their family members suffered from comorbidities that poses them at risk for COVID-19 infection such as hypertension (25.1%) and diabetes mellitus (16.1%). The prevalence of tobacco smoking in the studied families was 36.9%. Among participants, 40.6% had a family member with history of confirmed COVID-19 infection. Nearly one-half of studied parents (48.2%) reported COVID-19 as a serious infection and the majority were worried about getting a family member infected (86.8%). Among participants 62.0% of male parents and 57.8% of female parents agreed that vaccine information is reliable. Participants reporting safety of COVID-19 vaccination represented 45.3%. If vaccine is available, 40.1% of parents intended to vaccinate their children. The main factors associated with the willingness to vaccinate children were vaccine is not suitable for children under 18 years (OR = 11.508), concern about vaccination safety (OR = 8.678), doubts about reliability of vaccine information (OR = 7.811) and ability of vaccine to prevent infection (OR = 5.766). Conclusion Our study provides a brief insight about how parents think about COVID-19 vaccines and acceptance to vaccinate their children.
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181
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Ichhpujani P, Singh RB, Dhillon HK, Kumar S. Ocular manifestations of COVID-19 in pediatric patients. Ther Adv Ophthalmol 2023; 15:25158414221149916. [PMID: 36938488 PMCID: PMC10015281 DOI: 10.1177/25158414221149916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 12/16/2022] [Indexed: 03/15/2023] Open
Abstract
The coronavirus disease-19 (COVID-19) infection may remain asymptomatic or may have several different presentations. Although this disease primarily affects the respiratory system, systemic manifestations affecting the gastrointestinal, cardiovascular, neurological, otorhinolaryngologic, and ophthalmic systems have been reported. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. In the current narrative review, we report the ophthalmic manifestations of COVID-19 in the pediatric age cohort. We performed a comprehensive literature search for the publications on ophthalmic manifestations of COVID-19 in children between 1 March 2020 and 1 January 2022 and compiled the ophthalmic manifestations of this entity among the pediatric population. Conjunctivitis is the most common ophthalmic manifestation in children and can develop at any stage of the disease. Ophthalmic manifestations are seen more commonly in children with severe systemic disease. Long-term and indirect consequence of the COVID-19 disease is the rise of myopia among children. Ophthalmic signs may be the first and only sign of COVID-19 infection in children. Pediatricians, as well as ophthalmologists, must keep observing all children with COVID-19 closely for ophthalmic signs.
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Affiliation(s)
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
- Discipline of Ophthalmology and Visual Sciences, Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Hennaav Kaur Dhillon
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Suresh Kumar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
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Moya-Vergara R, Portilla-Saavedra D, Castillo-Morales K, Espinoza-Tapia R, Sandoval Pastén S. Prevalence and Risk Factors Associated with Mental Health in Adolescents from Northern Chile in the Context of the COVID-19 Pandemic. J Clin Med 2022; 12:269. [PMID: 36615070 PMCID: PMC9821586 DOI: 10.3390/jcm12010269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
The COVID-19 pandemic has affected the world population; however, there is limited knowledge about its impact on adolescents. The aim of this study was to estimate the prevalence and risk factors associated with mental health in the context of the COVID-19 pandemic in young people in northern Chile. The sample consisted of 1315 young people between the ages of 14 and 18. Univariate analysis and multiple logistic regression were performed to identify the risk factors associated to the considered symptomatology. Depressive symptomatology was reported at 36.3%, anxiety at 6%, and social phobia at 27.8%. Adolescent females reported a higher probability of presenting depressive (OR, 3.409), anxious (OR, 3.949), and social phobia (OR, 3.027) symptomatology. Young women between the ages of 17 and 18 were more likely to present anxiety (OR, 2.172); moreover, being a migrant was related to lower odds of presenting anxiety (OR, 0.259) and depression (OR, 0.662). Having a family member diagnosed with COVID-19 was associated with depressive symptomatology (OR, 1.369). The COVID-19 pandemic can have serious repercussions on the mental health of adolescents. It is important to generate interventions to meet the needs of youth during the post-confinement period.
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Affiliation(s)
- Rodrigo Moya-Vergara
- Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta 1240000, Chile
| | - Diego Portilla-Saavedra
- Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta 1240000, Chile
- Escuela de Psicología, Facultad de Ciencias Sociales, Universidad Santo Tomás, Antofagasta 1240000, Chile
| | - Katherin Castillo-Morales
- Escuela de Psicología, Facultad de Ciencias Sociales, Universidad Santo Tomás, Antofagasta 1240000, Chile
| | - Ricardo Espinoza-Tapia
- Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta 1240000, Chile
| | - Sandra Sandoval Pastén
- Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta 1240000, Chile
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Maruyama K, Yasuda K, Ito R, Imanaka‐Yoshida K. Histopathological findings of pericarditis in a patient with multisystem inflammatory syndrome in children associated with COVID-19: A case report. Pathol Int 2022; 73:91-96. [PMID: 36575945 PMCID: PMC9880697 DOI: 10.1111/pin.13304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C), which is associated with the novel coronavirus disease 2019 (COVID-19), has been described as an inflammatory complication of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It carries a risk of serious and lethal complications, including cardiogenic shock. Here, we report the pathological findings of the pericardium in a 10-year-old child with MIS-C, who developed pericarditis-induced cardiac tamponade. In the patient's pericardium, the numbers of infiltrating CD68+ macrophages; CD3+ , CD4+ , and CD8+ T cells; and myeloperoxidase+ granulocytes were increased, although the number of CD20+ B cells was not. These findings provide a clue to understanding the pathophysiology of MIS-C.
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Affiliation(s)
- Kazuaki Maruyama
- Department of Pathology and Matrix Biology, Graduate School of MedicineMie UniversityMieJapan
| | - Kazushi Yasuda
- Department of Pediatric CardiologyAichi Children's Health and Medical CentreObuJapan
| | - Ryoichi Ito
- Department of Pediatric CardiologyAichi Children's Health and Medical CentreObuJapan
| | - Kyoko Imanaka‐Yoshida
- Department of Pathology and Matrix Biology, Graduate School of MedicineMie UniversityMieJapan
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Borgi A, Louati A, Miraoui A, Lahmar L, Ayari A, Hajji A, Bouziri A, Menif K, Smaoui H, Jaballah NB. Critically ill infants with SARS-COV-2 delta variant infection. Pediatr Neonatol 2022; 64:335-340. [PMID: 36631339 PMCID: PMC9767656 DOI: 10.1016/j.pedneo.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/29/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND SARS-CoV-2 is described to cause mild to moderate symptoms in children. To date, clinical data and symptoms of the Delta variant in pediatric patients are lacking. AIM To describe clinical characteristics and outcomes of infants admitted in the pediatric intensive care unit (PICU) during the period of Delta variant predominance. METHODS We performed a retrospective study, between June 23, 2021 and August 16, 2021. We included children aged under 15 years, admitted to PICU with severe and critical form of SARS-CoV-2 infection as confirmed by RT-PCR. We reviewed medical records for all patients. RESULTS During the study period, 20 infants were included. The median age was 47 days (IQR: 26.5-77). The sex ratio was 0.8 (9 males). No underlying medical conditions were noted. Parents were not vaccinated. Respiratory involvement was the main feature to be observed in our cohort. Eleven patients had pediatric acute respiratory distress (PARDS) with a median oxygen saturation index (OSI) of 9 (IQR: 7-11). PARDS was mild in 4 cases, moderate in 5 cases and severe in 2 cases. Hemodynamic instability was observed in 4 cases. The main radiological finding was ground glass opacities in 11 cases. Seventeen patients were mechanically ventilated and 3 of them were escalated to high-frequency oscillatory ventilation. The median duration of mechanical ventilation was 6 days (IQR 2.5-12.5). The remaining patients were managed with high flow nasal cannula. Four patients died. CONCLUSION We report herein a case series of very young infants, with no comorbidities, and with a life-threatening illness due to SARS-CoV-2 Delta variant.
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Affiliation(s)
- Aida Borgi
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
| | - Assaad Louati
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia.
| | - Amal Miraoui
- PICU of Children's Hospital Béchir Hamza of Tunis, Tunisia
| | - Lilia Lahmar
- Department of Radiology of Children's Hospital Béchir Hamza of Tunis, Tunisia
| | - Ahmed Ayari
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
| | - Ahmed Hajji
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
| | - Asma Bouziri
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
| | - Khaled Menif
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
| | - Hanen Smaoui
- Microbiology Department of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis- Tunis EL-Manar University, Tunisia
| | - Nejla Ben Jaballah
- PICU of Children's Hospital Béchir Hamza of Tunis - Faculty of Medicine of Tunis-Tunis EL-Manar University, Tunisia
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Cardiac Evaluation in Children with Multisystem Inflammatory Syndrome Associated with SARS-CoV-2. SISLI ETFAL HASTANESI TIP BULTENI 2022; 56:461-465. [PMID: 36660390 PMCID: PMC9833351 DOI: 10.14744/semb.2022.23921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 01/22/2023]
Abstract
Objectives The heart is one of the organs frequently affected by the multisystem inflammatory syndrome in children (MIS-C), associated with severe acute respiratory syndrome coronavirus 2 infection. Cardiac involvement in patients with MIS-C was evaluated with physical examination findings, biochemical test, and cardiological imaging tests. We reported the degree of cardiac involvement in patients with MIS-C. Methods In this retrospective study, the complaints, physical examination, and cardiac findings of patients with MIS-C were evaluated. Results Sixteen patients (four males and 12 females) with MIS-C were included in the study. The median age was 6 (5-17) years. In patients, palpitations (6%), chest pain (12%), ECG changes (50%), valve insufficiency (50%), low ejection fraction (6%), coronary dilatation (6%), troponin (38%), and d-dimer (88%) elevation were detected. One patient died. Valve insufficiency persisted in 5 (31%) patients. Conclusion Severe cardiac involvement can be seen in MIS-C patients. Due to its serious effects on mortality and morbidity, cardiac involvement should be evaluated with cardiac imaging tools such as echocardiography and ECG in all MIS-C patients.
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186
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The COVID-19 pandemic as a traumatic event and the associated psychological impact on families - A systematic review. J Affect Disord 2022; 319:27-39. [PMID: 36089074 PMCID: PMC9458546 DOI: 10.1016/j.jad.2022.08.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/01/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic and its accompanying containment measures can be conceptualized as traumatic events. This review systematically investigates trauma-related symptoms in the course of the COVID-19 pandemic and the association of the pandemic and its containment measures with trauma-related disorders or symptoms. METHODS The EBSCO (MEDLINE, PsycINFO, PsycARTICLES, PSYNDEX), Cochrane Library, and Web of Science databases were searched in June 2021. The Quality Assessment Tool for Quantitative Studies (EPHPP-QAT; Thomas et al., 2004) was applied. Studies conceptualizing the COVID-19 pandemic as a traumatic event and assessing typically developing children and adolescents (under 18 years), and/or caregivers (at least 18 years) were included. RESULTS AND LIMITATIONS 22 primary studies including 27,322 participants were evaluated. Only three primary studies executed a statistical comparison with pre-pandemic or retrospective data, showing a negative impact of the COVID-19 pandemic and its associated measures on children's and caregiver's internalizing symptoms and hyperactivity. In the majority of the remaining studies, prevalence rates of various trauma sequelae in children, adolescents, and caregivers were reported to be descriptively higher in the context of the COVID-19 pandemic when compared to other pre-pandemic studies. However, due to numerous methodological differences between these studies the statement that the pandemic is associated with higher prevalence rates of trauma-associated symptoms cannot be validly answered at this point. CONCLUSION Due to some methodological shortcomings of the primary studies, our results might be cautiously interpreted as a first indicator of an association between the COVID-19 pandemic and trauma sequelae.
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Meliante PG, Marcellino A, Altomari R, Testa A, Gallo A, Ralli M, de Vincentiis M, Lubrano R. Smell and Taste in Children with Covid-19. ALLERGY & RHINOLOGY (PROVIDENCE, R.I.) 2022; 13:21526575221144950. [PMID: 36571076 PMCID: PMC9768832 DOI: 10.1177/21526575221144950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives To assess the frequency of loss of smell and taste in children during Covid-19 infection and their prevalence along with other symptoms, as well as the recovery of chemosensory function once healed. Methods To evaluate symptoms during infection, we adapted the Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire and the modified Monel-Jefferson questionnaire. For smell analysis we used Odor Identification (OI) and two variants of the Odor Discrimination (OD) test, and we compared the results with those of a control group. Results We enrolled nine patients in our experimental group and nine in our control group. Fever was the most frequent symptom (55% of cases), followed by anosmia and ageusia (44% of cases), muscle pain and asthenia (22% of cases) and diarrhea, abdominal pain, cough, and headache (11% of cases). In 11% of cases, olfactory symptoms were the only manifestation of the disease. There was no statistically significant difference in OI test and OD tests between the two groups (Children healed from Covid-19 and Control Group). Conclusion Loss of smell and taste are the second most common symptoms of pediatric Covid-19, and they should always be tested because they can be the only manifestations of infection. Olfactory function in Covid-19 children decreases with increasing age and improves with the passage of time after illness.
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Affiliation(s)
- Piero Giuseppe Meliante
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy,Piero Giuseppe Meliante, “Sapienza,” University of Rome, Department of Sense Organs, Otorhinolaryngology, Viale del Policlinico, 155, 00161,
Rome RM.
,
| | - Alessia Marcellino
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Roger Altomari
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Alessia Testa
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
| | - Andrea Gallo
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Riccardo Lubrano
- Department of Pediatrics, Sapienza University of Rome, Pediatric and Neonatology Unit, Ospedale Goretti Polo Pontino, Rome, Italy
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El-Sayed ZA, El-Owaidy RH, Harb WN, Shousha GA. COVID-19 in a group of children with asthma: presentation, severity, and outcome. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2022; 11:92-102. [PMID: 36660141 PMCID: PMC9845840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are insufficient data concerning COVID-19 severity among asthmatic children. AIM to evaluate the impact of asthma on COVID-19 severity and outcome. PATIENTS AND METHODS We carried out an observational study that comprised 2 matched groups of children with confirmed/probable COVID-19: 30 with and 32 without asthma aged 6-18 years, who were enrolled consecutively from Children's Hospital, Ain Shams University, Egypt. COVID-19 clinical presentations, laboratory and radiological abnormalities, severity and outcome were compared between the 2 groups. Asthma severity and control were assessed based on GINA 2020. RESULTS The asthmatic COVID-19 children were 9 boys and 21 girls, with median age 9 years, IQR: 8-12 years. The non-asthmatic COVID-19 group included 18 males and 14 females with median age 9.5 years, IQR: 7-12.5 years. Clinical manifestations of COVID-19 were comparable among the 2 groups, except for wheezes which were more frequently encountered as a COVID-19 manifestation among the asthmatics (p=0.001). Multisystem inflammatory syndrome (MIS-c) was diagnosed in one asthmatic and 3 non-asthmatic patients. The asthmatic group had higher frequency of serum ferritin, LDH and D-dimer elevations compared to the non-asthmatic peers (p values 0.014, 0.001, and 0.015 respectively). Based on CO-RAD classification, 70% of the asthmatic patients had CO-RAD score of 5 versus 6.3 % among the non-asthmatic group with significant differences between the 2 groups in their CO-RAD scores (P=0.002). COVID-19 severity was comparable among the studied groups (P=0.775), as well as COVID-19 outcome and duration of hospital stay (p values 0.999, and 0.655, respectively). CONCLUSION From our limited sample sized study, childhood asthma did not pose a significant impact on COVID-19 severity and outcome. Further longitudinal studies are warranted to validate our conclusion and investigate the relation of COVID-19 severity and outcome to allergen immunotherapy and the use of biologicals for asthma treatment.
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Affiliation(s)
- Zeineb A El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
| | - Rasha H El-Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
| | - Waleed N Harb
- Fever Hospital of Al-Mahalla Al-KubraAl-Gharbya Governate, Egypt
| | - Ghada A Shousha
- Pediatric Allergy, Immunology and Rheumatology Unit, Children’s Hospital, Ain Shams UniversityCairo, Egypt
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189
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Clinical assessment of children with long COVID syndrome. Pediatr Res 2022; 93:1616-1625. [PMID: 36474113 PMCID: PMC10172119 DOI: 10.1038/s41390-022-02378-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/16/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is a need for further understanding pediatric long COVID syndrome (LCS) to be able to create specific case definitions and guidelines for providing good clinical care. METHODS Medical records of all LCS patients who presented at our designated LC clinic were collected. We carried out descriptive analyses summarizing the history, clinical presentation, and findings of children, while doing a diagnosis of exclusion with multi-disciplinary medical examinations (physical, laboratory, and radiological examinations, specialist consultations, etc.) without a control group. RESULTS Most children reported at least minor impairment to their quality of life, of which 17 (23%) had moderate or severe difficulties. Findings that could be directly connected to the linked complaint category were observed in an average of 18%, respiratory symptoms with objective alterations being the most frequent (37%). Despite our detecting mostly non-specific conditions, in a smaller number we identified well-described causes such as autoimmune thyroiditis (7%). CONCLUSIONS The majority of children stated an impairment in their quality of life, while symptom-related conditions were detected only in a minority. Controlled studies are needed to separate the effect of the pandemic era from the infection itself. Evidence-based pediatric guidelines could aid to rationalize the list of recommended examinations. IMPACT Long COVID syndrome is a complex entity with a great impact on children's everyday lives. Still, there is no clear guidance for pediatric clinical management. Systematic, detailed studies with medical assessment findings could aid the process of creating evidence-based guidelines. We present validated systematic information collected during in-person medical assessments with detailed medical findings and quality of life changes. While making a diagnosis of exclusion, we could confirm symptom-related conditions only in a minority of children; however, the majority reported at least minor impairment to their quality of life.
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De Haro JC, Rosel EM, Salcedo-Bellido I, Leno-Durán E, Requena P, Barrios-Rodríguez R. Psychological Impact of COVID-19 in the Setting of Dentistry: A Review Article. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16216. [PMID: 36498295 PMCID: PMC9739953 DOI: 10.3390/ijerph192316216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
The worldwide pandemic has exposed healthcare professionals to a high risk of infection, exacerbating the situation of uncertainty caused by COVID-19. The objective of this review was to evaluate the psychological impact of the COVID-19 pandemic on dental professionals and their patients. A literature review was conducted using Medline-Pubmed, Web of Science, and Scopus databases, excluding systematic reviews, narratives, meta-analyses, case reports, book chapters, short communications, and congress papers. A modified version of the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the selected studies. The search retrieved 3879 articles, and 123 of these were selected for the review (7 longitudinal and 116 cross-sectional studies). Elevated anxiety levels were observed in dental professionals, especially in younger and female professionals. Except for orthodontic treatments, patients reported a high level of fear that reduced their demand for dentist treatment to emergency cases alone. The results suggest that the COVID-19 pandemic has had psychological and emotional consequences for dental professionals and their patients. Further research is necessary to evaluate the persistence of this problem over time.
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Affiliation(s)
| | - Eva María Rosel
- Departamento de Estomatología, Facultad de Odontología, Universidad de Granada, 18011 Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, 18011 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria (ibs. GRANADA), 18014 Granada, Spain
| | - Ester Leno-Durán
- Departamento de Obstetricia y Ginecología, Universidad de Granada, 18011 Granada, Spain
| | - Pilar Requena
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, 18011 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria (ibs. GRANADA), 18014 Granada, Spain
| | - Rocío Barrios-Rodríguez
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, 18011 Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Instituto de Investigación Biosanitaria (ibs. GRANADA), 18014 Granada, Spain
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Ait-Belkacem I, Cartagena García C, Millet-Wallisky E, Izquierdo N, Loosveld M, Arnoux I, Morange PE, Galland F, Lambert N, Malergue F, Busnel JM. SARS-CoV-2 spike protein induces a differential monocyte activation that may contribute to age bias in COVID-19 severity. Sci Rep 2022; 12:20824. [PMID: 36460710 PMCID: PMC9716544 DOI: 10.1038/s41598-022-25259-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
A strong bias related to age is observed in COVID-19 patients with pediatric subjects developing a milder disease than adults. We hypothesized that a specific SARS-CoV-2 effect conjugated with preexisting differences in the immune systems may explain this. Using flow cytometry, we investigated basal immune differences in a cohort consisting of 16 non-infected young and 16 aged individuals and further leveraged an in vitro whole blood model of SARS-CoV-2 infection so that functional differences could be mined as well. In short, blood diluted in culture media was incubated 5 or 24 h with the trimeric spike protein or controls. Following unsupervised analysis, we first confirmed that the immune lymphoid and myeloid systems in adults are less efficient and prone to develop higher inflammation than those in children. We notably identified in adults a higher CD43 lymphocyte expression, known for its potentially inhibitory role. The spike protein induced different responses between adults and children, notably a higher increase of inflammatory markers together with lower monocyte and B cell activation in adults. Interestingly, CD169, a CD43 ligand overexpressed in COVID-19 patients, was confirmed to be strongly modulated by the spike protein. In conclusion, the spike protein exacerbated the preexisting lower immune responsiveness and higher inflammatory potential in adults. Altogether, some of the markers identified may explain the marked age bias and be predictive of severity.
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Affiliation(s)
- Ines Ait-Belkacem
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
- Aix Marseille Université CNRS INSERM CIML Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Celia Cartagena García
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
- INSERM UMRs 1097, Aix Marseille University, Marseille, France
| | - Ewa Millet-Wallisky
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Nicolas Izquierdo
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France
| | - Marie Loosveld
- Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | - Isabelle Arnoux
- Hematology Laboratory, Timone University Hospital, APHM, Marseille, France
| | | | - Franck Galland
- Aix Marseille Université CNRS INSERM CIML Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | | | - Fabrice Malergue
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.
| | - Jean-Marc Busnel
- Department of Research and Development, Beckman Coulter Life Sciences-Immunotech, Marseille, France.
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Santos NMVD, Brito DHSD, Santos TGFTD, Silva MCPMD, Lavôr JRD, Heimer MV, Rosenblatt A. Oral manifestations in hospitalized children with COVID-19. Braz Oral Res 2022; 36:e139. [PMID: 36477216 DOI: 10.1590/1807-3107bor-2022.vol36.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/19/2022] [Indexed: 12/03/2022] Open
Abstract
As the pandemic progressed, the incidence of viruses among children also increased. This study investigates the presence of oral lesions in hospitalized children by analyzing data collected from medical records of infants seen at the pediatric Infectious disease unit at the General Hospital of the University of Pernambuco, Recife, Brazil, from March to August 2020. This study includes children aged 0 to 12 years diagnosed with severe symptoms of COVID-19. The data describe the frequencies and percentages of categorical variables, expressed as mean, median, and standard deviation. The chi-square test evaluated the association of oral manifestations according to the presence of comorbidities. Of 89 children, 20.2% had oral manifestations, and mucositis was the most prevalent lesion (12.4%). Of the 18 children with oral manifestations, 12 did not present comorbidities, but 7.9% had multisystem inflammatory syndrome and 5.6% had Kawasaki disease. Results show that children with oral lesions had longer hospital stays. These findings indicate the need for further studies to clarify the relationship between the oral manifestations of COVID-19 in pediatric patients for screening of the virus by dentists.
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Affiliation(s)
| | | | | | | | - Juliane Rolim de Lavôr
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
| | - Monica Vilela Heimer
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
| | - Aronita Rosenblatt
- Universidade de Pernambuco - UPE, School of Dentistry, Department of Pediatric Dentistry, Recife, PE, Brazil
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193
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Xu C, Ma M, Yi Y, Yi C, Dai H. Clinical features and high-resolution chest computerized tomography findings of children infected by the B.1.617.2 variant of coronavirus disease 2019. Ann Med 2022; 54:2391-2401. [PMID: 36039499 PMCID: PMC9448437 DOI: 10.1080/07853890.2022.2114608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To analyse the clinical symptoms, laboratory examinations and chest CT findings of children infected by the B.1.617.2 variant of COVID-19 and to compare the differences between clinical subtypes. METHODS Fifty-three children (28 males, 25 females; age ranging from 4 months to 17 years) were included with B.1.617.2 variant infection in Nanjing, China, from July 21 to August 12 2021. Clinical data from patients were collected and analysed in groups of mild and common types. Imaging data were divided into three stages for evaluation: early, intermediate and late stages. RESULTS In our study, fever (53%), cough (34%) and pharyngeal discomfort (28%) were the main symptoms. There were no differences in clinical symptoms between the mild and common type. The most common laboratory test items outside the normal range were decreased mean corpuscular volume (68%), lymphocyte percentage (64% elevated and 2% decreased) and decreased serum alkaline phosphatase concentration (66%). The differences in haemoglobin and monocyte percentages between the mild and common types were statistically significant (p = .037 and .033, respectively). No influencing factor was statistically significant in the regression analysis of both symptoms and clinical subtypes. The main CT findings were ground-glass opacity and consolidation located in the periphery and bilateral multilobed involvement. The mean CT score was 1.6. CT score correlated with packet cell volume, haemoglobin, mean erythrocyte volume, mean platelet volume and platelet distribution width. CONCLUSION The pathogenetic condition of children with B.1.617.2 variant infection is mild. Although there were intergroup differences in some blood cell analyses, T-lymphocyte counts, and comprehensive biochemical indicators, no factors had a significant effect on clinical typing and the presence or absence of symptoms. CT findings and CT scores reflect disease stage and pathological changes and correlate moderately with laboratory tests, making them of good value for disease diagnosis and monitoring.Key MessagesPaediatric patients infected with B.1.617.2 variant have a milder clinical and imaging presentation than adults and are similar to the prototype infection.CT findings and scores which reflect disease stages and pathological changes.There is a correlation between chest CT and laboratory tests, which can be useful for the diagnosis and follow-up of the disease.
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Affiliation(s)
- Chuanjun Xu
- Department of Radiology, The Second Hospital of Nanjing Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Mengya Ma
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Institute of Medical Imaging, Soochow University, Suzhou, P.R. China
| | - Yongxiang Yi
- Nanjing Infectious Disease Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Changhua Yi
- Nanjing Infectious Diseases Clinical Medical Center, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing, P.R. China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, P.R. China.,Institute of Medical Imaging, Soochow University, Suzhou, P.R. China
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Mohammadi M, Bid-Hendi S, Baghershiroodi M, Chehrazi M, Yahyapour Y, Gouranourimi A, Sadeghi F. Detection of human adenovirus among Iranian pediatric hospitalized patients suspected of COVID-19: epidemiology and comparison of clinical features. LE INFEZIONI IN MEDICINA 2022; 30:563-569. [PMID: 36482963 PMCID: PMC9715001 DOI: 10.53854/liim-3004-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/26/2022] [Indexed: 06/17/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children typically results in similar symptoms with other viral respiratory agents including human adenoviruses (HAdVs). Mixed HAdV and SARS-CoV-2 infection (co-infection) in children might result in enhanced or reduced disease severity compared with single infections. The present study aims to investigate the rate of SARS-CoV2 and HAdV infection and also their coinfection and compare the two infections regarding their laboratory and clinical characteristics at hospital admission. A total of 360 combined oropharyngeal and nasopharyngeal swab samples from hospitalized children were examined by real-time PCR for the existence of the SARS-CoV-2 and HAdVs. The symptoms, the clinical characteristics and laboratory findings were retrieved and compared in SARS-CoV-2 and HAdVs positive cases. Of the total 360 suspected COVID-19 hospitalized children, 45 (12.5%) and 19 (5.3%) specimens were PCR-positive for SARS-CoV-2 and HAdV respectively. SARS-CoV-2 and HAdV co-infection was detected in 4 cases (1.1%). Regarding symptoms at hospital admission, fever in SARS-CoV-2 positive group was significantly higher than that in HAdV positive group [34 (85%) vs. 7 (46.7%), p = 0.012]. However, percentages of cases with sore throat, headache, fatigue, lymphadenopathy and conjunctivitis in HAdV positive group were significantly higher than those in SARS-CoV-2 positive group. SARS-CoV-2 and HAdV co-infected children showed mild respiratory symptoms. The present study revealed that SARS-CoV-2 positive children often appear to have a milder clinical course than children with respiratory HAdV infection and children co-infected with SARSCoV-2 and HAdV had less-severe disease on presentation.
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Affiliation(s)
- Mohsen Mohammadi
- Non-Communicable Pediatric Research Center, Babol University of Medical Sciences, Babol,
Iran
| | - Shadi Bid-Hendi
- Student Research Committee, Babol University of Medical Sciences, Babol,
Iran
| | - Mahnaz Baghershiroodi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol,
Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol,
Iran
| | - Yousef Yahyapour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol,
Iran
| | - Azin Gouranourimi
- Student Research Committee, Babol University of Medical Sciences, Babol,
Iran
| | - Farzin Sadeghi
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol,
Iran
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Long F, Zhu S, Wang Z, Zhang S, He J, Ge X, Ning J. Update on the treatment of multisystem inflammatory syndrome in children associated with COVID-19. Future Virol 2022:10.2217/fvl-2022-0048. [PMID: 36699562 PMCID: PMC9853872 DOI: 10.2217/fvl-2022-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023]
Abstract
In late 2019, SARS-CoV-2 was detected in China and spread worldwide. In rare cases, children who were infected with COVID-19 may develop multisystem inflammatory syndrome (MIS-C), which could have higher mortality than COVID-19 itself. Therefore, diagnosis and management are critical for treatment. Specifically, most of the initial treatment options of MIS-C choose intravenous immunoglobulin (IVIG) and steroids as the first-line treatment for patients. Moreover, antagonists of some cytokines are used as potential future therapeutics. Of note, therapeutic plasmapheresis can be used as a treatment for refractory severe MIS-C. We believe that each patient, especially those with comorbid conditions, should have individualized treatment based on both multidisciplinary consensus approach and expert opinion.
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Affiliation(s)
- Fangyuan Long
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Shiheng Zhu
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Zeguang Wang
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Shungeng Zhang
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Jinlong He
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Xinbin Ge
- 1Department of Physiology, Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Jun Ning
- 2Department of Paediatrics, Affiliated Hospital of Jining Medical University, Jining, Shandong, 272029, China,Author for correspondence:
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Liu E, Smyth RL, Li Q, Qaseem A, Florez ID, Mathew JL, Amer YS, Estill J, Lu Q, Fu Z, Lu X, Chan ESY, Schwarze J, Wong GWK, Fukuoka T, Ahn HS, Lee MS, Nurdiati D, Cao B, Tu W, Qian Y, Zhao S, Dong X, Luo X, Chen Z, Li G, Zhang X, Zhao X, Xu H, Xu F, Shi Y, Zhao R, Zhao Y, Lei J, Zheng X, Wang M, Yang S, Feng X, Wu L, He Z, Liu S, Wang Q, Song Y, Luo Z, Zhou Q, Guyatt G, Chen Y, Li Q. Guidelines for the prevention and management of children and adolescents with COVID-19. Eur J Pediatr 2022; 181:4019-4037. [PMID: 36109390 PMCID: PMC9483317 DOI: 10.1007/s00431-022-04615-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/26/2022] [Accepted: 09/04/2022] [Indexed: 12/15/2022]
Abstract
Children are the future of the world, but their health and future are facing great uncertainty because of the coronavirus disease 2019 (COVID-19) pandemic. In order to improve the management of children with COVID-19, an international, multidisciplinary panel of experts developed a rapid advice guideline at the beginning of the outbreak of COVID-19 in 2020. After publishing the first version of the rapid advice guideline, the panel has updated the guideline by including additional stakeholders in the panel and a comprehensive search of the latest evidence. All recommendations were supported by systematic reviews and graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Expert judgment was used to develop good practice statements supplementary to the graded evidence-based recommendations. The updated guideline comprises nine recommendations and one good practice statement. It focuses on the key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin (IVIG) for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health. CONCLUSION This updated evidence-based guideline intends to provide clinicians, pediatricians, patients and other stakeholders with evidence-based recommendations for the prevention and management of COVID-19 in children and adolescents. Larger studies with longer follow-up to determine the effectiveness and safety of systemic glucocorticoids, IVIG, noninvasive ventilation, and the vaccines for COVID-19 in children and adolescents are encouraged. WHAT IS KNOWN • Several clinical practice guidelines for children with COVID-19 have been developed, but only few of them have been recently updated. • We developed an evidence-based guideline at the beginning of the COVID-19 outbreak and have now updated it based on the results of a comprehensive search of the latest evidence. WHAT IS NEW • The updated guideline provides key recommendations pertinent to the following issues: identification of prognostic factors for death or pediatric intensive care unit admission; the use of remdesivir, systemic glucocorticoids and antipyretics, intravenous immunoglobulin for multisystem inflammatory syndrome in children, and high-flow oxygen by nasal cannula or non-invasive ventilation for acute hypoxemic respiratory failure; breastfeeding; vaccination; and the management of pediatric mental health.
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Affiliation(s)
- Enmei Liu
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Rosalind Louise Smyth
- UCL Great Ormond St Institute of Child Health, London, UK
- Great Ormond Street Hospital, London, UK
| | - Qinyuan Li
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Amir Qaseem
- Clinical Policy and Center for Evidence Reviews, American College of Physicians, Philadelphia, USA
| | - Ivan D. Florez
- School of Rehabilitation Science, McMaster University, Hamilton, ON Canada
- Department of Pediatrics, University of Antioquia, Medellin, Antioquia Colombia
- Pediatric Intensive Care Unit, Clinica Las Americas, Medellin, Colombia
| | - Joseph L. Mathew
- Advanced Pediatrics Centre, PGIMER Chandigarh, Chandigarh, India
| | - Yasser Sami Amer
- Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines & Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Pediatrics Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Quan Lu
- Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Zhou Fu
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaoxia Lu
- Department of Respiratory Medicine, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Edwin Shih-Yen Chan
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-National University of Singapore Medical School, Singapore, Singapore
- Singapore Clinical Research Institute, Singapore, Singapore
| | - Jürgen Schwarze
- Children’s Research Network and Department of Child Life and Health, Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Gary Wing-Kin Wong
- Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshio Fukuoka
- Emergency and Critical Care Center, the Department of General Medicine, Department of Research and Medical Education at Kurashiki Central Hospital, Kurashiki, Japan
- Advisory Committee in Cochrane Japan, Tokyo, Japan
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, Korea University, Seoul, South Korea
- Korea Cochrane Centre, Seoul, South Korea
- Institute for Evidence-Based Medicine, Korea University College of Medicine, Seoul, South Korea
- Korea University School of Medicine, Seoul, South Korea
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- Korean Convergence Medicine, University of Science and Technology, Daejeon, South Korea
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Detty Nurdiati
- Cochrane Indonesia, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China
| | - Wenwei Tu
- Department of Pediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Yuan Qian
- Capital Institute of Pediatrics, Beijing, China
| | | | - Xiaoyan Dong
- Shanghai Children’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guobao Li
- National Clinical Research Center for Infectious Disease, Shenzhen, China
- Shenzhen Third People’s Hospital, Shenzhen, China
| | - Xiaobo Zhang
- Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Xiaodong Zhao
- Department of Pediatric Research Institute, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hongmei Xu
- Department of Infection Diseases Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Feng Xu
- Department of Critical Care Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Shi
- Department of Neonatology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ruiqiu Zhao
- Department of Infection Diseases Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yao Zhao
- National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Junqiang Lei
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Xianlan Zheng
- Department of Nursing, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Mengshu Wang
- Department of Radiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Shu Yang
- Chengdu University of TCM, Chengdu, China
| | - Xixi Feng
- Chengdu Medical College, Chengdu, China
| | - Liqun Wu
- Shenzhen Health Development Research Center, Shenzhen, China
| | - Zhihui He
- Chongqing Ninth People’s Hospital, Chongqing, China
| | - Shihui Liu
- Beijing Jishuitan Hospital, Beijing, China
| | - Qi Wang
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
- McMaster Health Forum, McMaster University, Hamilton, Canada
| | - Yang Song
- Iberoamerican Cochrane Centre-Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Zhengxiu Luo
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Canada
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Lanzhou University GRADE Centre, Lanzhou, China
| | - Qiu Li
- Department of Nephrology Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Can Fetal Heart Lie? Intrapartum CTG Changes in COVID-19 Mothers. J Obstet Gynaecol India 2022; 72:479-484. [PMID: 35634476 PMCID: PMC9128777 DOI: 10.1007/s13224-022-01663-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 05/01/2022] [Indexed: 02/08/2023] Open
Abstract
Background COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome. Methods A case-control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication. Results COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities. Conclusions The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS. Supplementary Information The online version contains supplementary material available at 10.1007/s13224-022-01663-6.
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198
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Willis DE, Long CR, Rowland B, Tidwell C, Andersen JA, McElfish PA. COVID-19 and food insecurity in a vulnerable rural state. DIALOGUES IN HEALTH 2022; 1:100013. [PMID: 36636611 PMCID: PMC9098512 DOI: 10.1016/j.dialog.2022.100013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/16/2023]
Abstract
Objective This study explored variations in food insecurity across sociodemographic groups and changes specific to the COVID-19 pandemic, including income loss, stimulus check receipt, and changes in household size. Design A cross-sectional online survey was conducted using a 2-item food insecurity screener. COVID-19 related factors and sociodemographic data were collected. Setting Data were collected in Arkansas, United States, during July and August 2020. Participants A sample of 1205 adults was recruited using ARresearch, a volunteer research registry. Participants were over the age of 18 and living, working, or receiving health care in Arkansas. Results The prevalence of food insecurity was 24.9% during the COVID-19 pandemic. Food insecurity was elevated even after the majority of respondents received a stimulus check. Chi-square and t-tests revealed that food insecurity was more prevalent among those who are younger, Black, Hispanic/Latinx, lower-income, less educated, and living in households with children. Multivariate logistic regression revealed that odds of food insecurity were greater for individuals who reported income loss due to the pandemic (OR = 3.29; p < .001), Black respondents (OR = 2.06, p = .014), Hispanic respondents (OR = 3.34, p = .001), those earning less than $25,000 annually (OR = 4.92; p < .001) or between $25,000 to $49,999 (OR = 2.04; p = .023), respondents with a high school degree or less (OR = 4.21; p < .001) or some college (OR = 2.55; p < .001), and those living in households with children (OR = 1.62; p = .021). Odds of food insecurity were lower for those who had received a stimulus check (OR = 0.60; p = .026). Conclusion Food insecurity prevalence was high in Arkansas in July and August 2020. The risk of food insecurity was uneven across sociodemographic groups. Several factors related to the COVID-19 pandemic were indicators for increased risk of food insecurity. Interventions to address food insecurity that recognize social factors unique to the pandemic are needed to reduce levels of food insecurity.
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Affiliation(s)
- Don E. Willis
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Christopher R. Long
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Brett Rowland
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Caitlin Tidwell
- University of Arkansas for Medical Sciences Northwest, Office of Community Health and Research, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Jennifer A. Andersen
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA
| | - Pearl A. McElfish
- University of Arkansas for Medical Sciences Northwest, College of Medicine, 1125 N. College Avenue, Fayetteville, AR 72703, USA,Corresponding author
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199
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Iervasi E, Zarcone D, Saverino D. COVID-19: why did Italy decide to keep schools closed? Minerva Pediatr (Torino) 2022; 74:806-808. [PMID: 33820404 DOI: 10.23736/s2724-5276.21.05897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Erika Iervasi
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Daniele Zarcone
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Daniele Saverino
- Department of Experimental Medicine, University of Genoa, Genoa, Italy - .,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Fedorczak A, Zielińska N, Nosek-Wasilewska P, Mikołajczyk K, Lisiak J, Zeman K, Tkaczyk M. Comparison of COVID-19 and RSV Infection Courses in Infants and Children under 36 Months Hospitalized in Paediatric Department in Fall and Winter Season 2021/2022. J Clin Med 2022; 11:jcm11237088. [PMID: 36498663 PMCID: PMC9741168 DOI: 10.3390/jcm11237088] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The study aimed to determine the differences between COVID-19 and Respiratory syncytial virus (RSV) infections in young children hospitalized in the pediatric department. METHODS This retrospective study included 52 children with COVID-19 and 43 children with RSV infection younger than 36 months hospitalized in a pediatric department between September 2021 and March 2022. Clinical and laboratory findings, methods of treatment and hospitalization length were compared. RESULTS In the RSV group, significantly higher rates of cough (93.2% vs. 38.5%), rhinitis (83.7% vs. 50%), dyspnea (83.7% vs. 21.1%), crackles (69.8% vs. 5.8%) and wheezes (72.1% vs. 9.6%) were observed. The COVID-19 group had significantly higher rates of fever (80.8% vs. 37.2%) and seizures (13.5% vs. 0%). Patients with RSV infection had significantly higher rates of bronchodilator therapy (88.37% vs. 5.77%) and oxygen therapy (48.8% vs. 7.7%) and required a longer hospital stay (8 vs. 3 days). In admission, the majority of the patients from both groups were not treated with antibiotics, but because of clinical deterioration and suspected bacterial co-infections, antibiotics were administered significantly more frequently in the RSV group (30.2% vs. 9.6%). CONCLUSIONS RSV infection in infants and small children had a more severe course than COVID-19 infection. RSV infection was associated with a longer hospitalization period and required more elaborate treatment.
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Affiliation(s)
- Anna Fedorczak
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
- Correspondence: ; Tel.: +48-422-711-381
| | - Natalia Zielińska
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Paulina Nosek-Wasilewska
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Katarzyna Mikołajczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Joanna Lisiak
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Krzysztof Zeman
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Marcin Tkaczyk
- Department of Pediatrics, Nephrology and Immunology, Medical University of Lodz, 90-419 Lodz, Poland
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Lodz, Poland
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