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Sarıoğlu E, Sarıaltın SY, Çoban T. Neurological complications and effects of COVID-19: Symptoms and conceivable mechanisms. BRAIN HEMORRHAGES 2023; 4:154-173. [PMID: 36789140 PMCID: PMC9911160 DOI: 10.1016/j.hest.2023.02.001] [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: 01/12/2023] [Revised: 02/04/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
A novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in Wuhan, China. The new coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (WHO) in March 2020. SARS-CoV-2 can invade the nervous system aside from infecting the respiratory system as its primary target. The most common nervous system symptoms of COVID-19 are stated as headache, myalgia, fatigue, nausea, vomiting, sudden and unexplained anosmia, and ageusia. More severe conditions such as encephalomyelitis, acute myelitis, thromboembolic events, ischemic stroke, intracerebral hemorrhage, Guillain-Barré-syndrome, Bell's palsy, rhabdomyolysis, and even coma have also been reported. Cohort studies revealed that neurological findings are associated with higher morbidity and mortality. The neurological symptoms and manifestations caused by SARS-CoV-2 and COVID-19 are examined and summarized in this article.
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Affiliation(s)
- Elif Sarıoğlu
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Sezen Yılmaz Sarıaltın
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
| | - Tülay Çoban
- Ankara University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, 06560 Ankara, Turkey
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2
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A systematic review and meta-analysis of otorhinolaryngological manifestations of coronavirus disease 2019 in paediatric patients. The Journal of Laryngology & Otology 2022; 136:588-603. [PMID: 35172911 DOI: 10.1017/s0022215122000536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND This meta-analysis provides a quantitative measure of the otorhinolaryngological manifestations of coronavirus disease 2019 in children. METHODS A structured literature review was carried out using PubMed, Embase and Cochrane Central, employing pertinent search terms. The statistical analysis was performed using Stata version 14.2 software, and the analysed data were expressed as the pooled prevalence of the symptoms with 95 per cent confidence intervals. RESULTS The commonest symptoms noted were cough (38 per cent (95 per cent confidence interval = 33-42; I2 = 97.5 per cent)), sore throat (12 per cent (95 per cent confidence interval =10-14; I2 = 93.7 per cent)), and nasal discharge (15 per cent (95 per cent confidence interval = 12-19; I2 = 96.9 per cent)). Anosmia and taste disturbances showed a pooled prevalence of 8 per cent each. Hearing loss, vertigo and hoarseness were rarely reported. CONCLUSION Cough, sore throat and nasal discharge were the commonest otorhinolaryngological symptoms in paediatric patients with coronavirus disease 2019. Compared with adults, anosmia and taste disturbances were infrequently reported in children.
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Sharma AG, Kumar V, Sodani R, Sapre A, Singh P, Saha A, Sharma S, Ray S, Pemde H. Predictors of mortality in children admitted with SARS-CoV-2 infection to a tertiary care hospital in North India. J Paediatr Child Health 2022; 58:432-439. [PMID: 34546612 PMCID: PMC8661990 DOI: 10.1111/jpc.15737] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 08/04/2021] [Accepted: 08/23/2021] [Indexed: 12/15/2022]
Abstract
AIM To compare the demographic, clinical, laboratory and radiological parameters of patients with different clinical outcomes (death or discharge) and analyse them to find out the potential predictors for mortality in children hospitalised with SARS-CoV-2 infection. METHODS Retrospective chart review of all patients less than 18 years of age with laboratory-confirmed SARS-CoV-2 infection and requiring hospital admission between 16 April 2020 and 31 October 2020. RESULTS Of 255 children with SARS-CoV-2 infection, 100 patients (median age 62.5 months, 59% males, 70% with moderate to severe disease) were hospitalised, of whom 27 died (median age 72 months, 59% males and 30% severely underweight). The subgroup with comorbidities (n = 14) was older (median age 126 months) and had longer duration of stay (median 10 days). Fever and respiratory symptoms were comparable while gastrointestinal symptoms were more common among non-survivors. Hypoxia at admission (odds ratio (OR) 5.48, P = 0.001), multiorgan dysfunction (OR 75.42, P = 0.001), presence of acute kidney injury (OR 11.66, P = 0.001), thrombocytopenia (OR 4.40, P = 0.003) and raised serum C-reactive protein (CRP) (OR 4.69, P = 0.02) were independently associated with mortality. The median time from hospitalisation to death was 3 days. The deceased group had significantly higher median levels of inflammatory parameters and a higher incidence of complications (myocarditis, encephalitis, acute respiratory distress syndrome and shock). CONCLUSIONS Hypoxia at admission, involvement of three or more organ systems, presence of acute kidney injury, thrombocytopenia and raised serum C-reactive protein were found to be independently associated with increased odds of in-hospital mortality in children admitted with SARS-CoV-2 infection.
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Affiliation(s)
- Ankita G Sharma
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Virendra Kumar
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Ravitanaya Sodani
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Anuja Sapre
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Preeti Singh
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Abhijeet Saha
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Suvasini Sharma
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Sandip Ray
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
| | - Harish Pemde
- Department of PediatricsLady Hardinge Medical college and Kalawati Saran Children HospitalDelhiIndia
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Singla M, Chhabra S, Sethi S, Kaur S, Jindal J, Midha V, Mahajan R, Bansal N, Mohan B. Clinical profile of coronavirus disease 2019 comparing the first and second waves: A single-center study from North India. Int J Appl Basic Med Res 2022; 12:95-102. [PMID: 35754672 PMCID: PMC9215178 DOI: 10.4103/ijabmr.ijabmr_691_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/02/2022] [Accepted: 03/19/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Objectives: Severe acute respiratory syndrome coronavirus 2, caused by the novel coronavirus disease 2019 (COVID-19), led to a devastating pandemic that hit majority of the countries globally in a wave-like pattern. The characteristics of the disease varied in different geographical areas and different populations. This study highlights the epidemiological and clinical characteristics of COVID-19 during two major waves in North India. Materials and Methods: Clinical characteristics and outcomes of all COVID-19-reverse transcription-polymerase chain reaction-positive patients, admitted from March 2020 to June 2021, to a tertiary care center in North India, were studied retrospectively. Results: During this period, total of 5652 patients were diagnosed having COVID. Patients who were incidentally diagnosed as COVID-positive (n=667) with other unrelated comorbid conditions and patients admitted under level 1 facility (n=1655; 1219 from first and 436 from second wave) were excluded from final analysis. Males were most commonly affected in both waves, with male to female ratio 4:1 in first and 3:1 in second wave. First wave had significantly more people with co-morbidities like diabetes mellitus and hypertension (P=0.001), whereas younger age group (age <40 years) were significantly more affected in second wave (P= 0.000). Fever was the most common presenting complaint in both waves, followed by cough and breathlessness. Patients during first wave had more severe disease at presentation and high mortality compared to the second wave. Conclusion: Majority of the patients with COVID-19 infection presenting to our hospital were young during the second wave. Fever was noted as presenting manifestation. Mortality was low during the second wave as compared to the first wave, likely to be due to proper protocol-based treatment resulting in better outcomes.
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Sarkar M, Khemka A, Raychaudhuri D, Pampi D, Ghosh S, Chowdhoury S, Mahapatra M, Bhakta S. Clinico-laboratory profile, outcome, and risk factors for pediatric intensive care admission among hospitalized COVID-19–infected children from Eastern India. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shree N, Kommalur A, M. L, Kariyappa M, Devadas S, Kumble D, Sajjan SV, Rangegowda RK, Patel AS. Acute Ischemic Stroke in a Young Child and Its Association with SARS-CoV-2 Infection. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractThe coronavirus disease 2019 (COVID-19) in children has been shown to have lower morbidity and mortality in children as compared with adults. The neurological complications related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly reported in children, yet the cerebrovascular complications are rare. We report a case of a toddler who presented with right-sided hemiparesis and motor aphasia, with an antecedent history suggestive of COVID-19 infection. The child tested negative on the nasopharyngeal swab for real-time reverse transcription-polymerase chain reaction (RT-PCR), but the serology for anti-SARS-CoV-2 IgG assay was positive. The neuroimaging showed an acute infarct in the left middle cerebral artery territory. A detailed evaluation for causes of childhood stroke was unrevealing, except for the presence of severe iron deficiency anemia (IDA). The child was diagnosed as acute ischemic stroke (AIS) most probably secondary to mild COVID-19 infection. The objective of this case report is to explain the possibility of AIS after a mild COVID-19 infection, complicated by the underlying severe IDA. Therefore, an association between COVID-19 and stroke in children needs to be emphasized and RT-PCR for SARS-CoV-2 as well as serological assay must be included in the workup of stroke in the young.
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Affiliation(s)
- Nivya Shree
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Anitha Kommalur
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Lakshmi M.
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Mallesh Kariyappa
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sahana Devadas
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Dhanalakshmi Kumble
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Sushma Veeranna Sajjan
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ravichandra Kothur Rangegowda
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ashray Sudarshan Patel
- Department of Paediatrics, Vani Vilas Hospital, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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D V, Sharma A, Kumar A, Flora SJS. Neurological Manifestations in COVID-19 Patients: A Meta-Analysis. ACS Chem Neurosci 2021; 12:2776-2797. [PMID: 34260855 PMCID: PMC8291134 DOI: 10.1021/acschemneuro.1c00353] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 01/08/2023] Open
Abstract
Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2-17.2), fatigue 33.6% (29.5-37.8), olfactory dysfunction 26.4% (21.8-31.3), gustatory dysfunction 27.2% (22.3-32.3), vomiting 6.7% (5.5-8.0), nausea 9.8% (8.1-11.7), dizziness 6.7% (4.7-9.1), myalgia 21.4% (18.8-24.1), seizure 4.05% (2.5-5.8), cerebrovascular diseases 9.9% (6.8-13.4), sleep disorders 14.9% (1.9-36.8), altered mental status 17.1% (12.3-22.5), neuralgia 2.4% (0.8-4.7), arthralgia 19.9% (15.3-25.0), encephalopathy 23.5% (14.3-34.1), encephalitis 0.6% (0.2-1.3), malaise 38.3% (24.7-52.9), confusion 14.2% (6.9-23.5), movement disorders 5.2% (1.7-10.4), and Guillain-Barre syndrome 6.9% (2.3-13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.
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Affiliation(s)
- Vitalakumar D
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
| | - Ankita Sharma
- Department of Biotechnology, National
Institute of Pharmaceutical Education and Research (NIPER)-Raeberali,
Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical Research, Delhi
Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi
Pharmaceutical Sciences & Research University (DPSRU), New Delhi
110017, India
| | - S. J. S. Flora
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
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Jat KR, Sankar J, Das RR, Ratageri VH, Choudhary B, Bhat JI, Mishra B, Bhatnagar S, Behera B, Charoo BA, Goyal JP, Gupta AK, Gulla KM, Gera R, Illalu S, Kabra SK, Khera D, Kumar B, Lodha R, Mohan A, Mohanty PK, Satapathy AK, Singh K, Singh A, Sharma SV, Tiwari P, Trikha A, Wari PK. Clinical Profile and Risk Factors for Severe Disease in 402 Children Hospitalized with SARS-CoV-2 from India: Collaborative Indian Pediatric COVID Study Group. J Trop Pediatr 2021; 67:6307282. [PMID: 34152424 PMCID: PMC8344837 DOI: 10.1093/tropej/fmab048] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION There is a lack of large multicentric studies in children with COVID-19 from developing countries. We aimed to describe the clinical profile and risk factors for severe disease in children hospitalized with COVID-19 from India. METHODS In this multicentric retrospective study, we retrieved data related to demographic details, clinical features, including the severity of disease, laboratory investigations and outcome. RESULTS We included 402 children with a median (IQR) age of 7 (2-11) years. Fever was the most common symptom, present in 38.2% of children. About 44% had underlying comorbidity. The majority were asymptomatic (144, 35.8%) or mildly symptomatic (219, 54.5%). There were 39 (9.7%) moderate-severe cases and 13 (3.2%) deaths. The laboratory abnormalities included lymphopenia 25.4%, thrombocytopenia 22.1%, transaminitis 26.4%, low total serum protein 34.7%, low serum albumin 37.9% and low alkaline phosphatase 40%. Out of those who were tested, raised inflammatory markers were ferritin 58.9% (56/95), c-reactive protein 33.3% (41/123), procalcitonin 53.5% (46/86) and interleukin-6 (IL-6) 76%. The presence of fever, rash, vomiting, underlying comorbidity, increased total leucocyte count, thrombocytopenia, high urea, low total serum protein and raised c-reactive protein was factors associated with moderate to severe disease. CONCLUSION Fever was the commonest symptom. We identified additional laboratory abnormalities, namely lymphopenia, low total serum protein and albumin and low alkaline phosphatase. The majority of the children were asymptomatic or mildly symptomatic. We found high urea and low total serum protein as risk factors for moderate to severe disease for the first time.
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Affiliation(s)
- Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India,Correspondence: Jhuma Sankar, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India. Tel: 91-11-26546784. E-mail
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Vinod H Ratageri
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka 580021, India
| | - Bharat Choudhary
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Javeed Iqbal Bhat
- Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar 190011, India
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | | | - Sushma Bhatnagar
- Department of Onco-anaesthesia and Palliative Medicine, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Bashir Ahmad Charoo
- Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar 190011, India
| | - Jagdish P Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aditya Kumar Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Rani Gera
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi, India
| | - Shivanand Illalu
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka 580021, India
| | - S K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Daisy Khera
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Balbir Kumar
- Department of Onco-anaesthesia and Palliative Medicine, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pankaj Kumar Mohanty
- Department of Neonatology, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Amit Kumar Satapathy
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar 751019, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Amitabh Singh
- Department of Pediatrics, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sumant Vinayak Sharma
- Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Prakash K Wari
- Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubli, Karnataka 580021, India
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Bolia R, Dhanesh Goel A, Badkur M, Jain V. Gastrointestinal Manifestations of Pediatric Coronavirus Disease and Their Relationship with a Severe Clinical Course: A Systematic Review and Meta-analysis. J Trop Pediatr 2021; 67:6288463. [PMID: 34050766 PMCID: PMC8244720 DOI: 10.1093/tropej/fmab051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on the gastrointestinal (GI) manifestations of Pediatric Corona Virus Disease (COVID-19) are conflicting and the relationship between GI involvement and the severity of COVID-19 disease has not been evaluated. The objectives of this systematic review were to determine the GI manifestations of pediatric COVID-19 and to evaluate their role as risk factors for a severe clinical course. METHODS : A systematic literature search was carried out in PubMed and Scopus for studies published before 31 December 2020 with information about the GI manifestations of pediatric COVID-19. Patients with a severe and nonsevere clinical course were compared using the inverse variance heterogeneity model and odds ratio (OR) as the effect size. A sensitivity analysis was performed if the heterogeneity was high among studies. RESULTS A total of 811 studies were identified through a systematic search of which 55 studies (4369 patients) were included in this systematic review. The commonest GI symptoms were diarrhea-19.08% [95% confidence interval (CI) 10.6-28.2], nausea/vomiting 19.7% (95% CI 7.8-33.2) and abdominal pain 20.3% (95% CI 3.7-40.4). The presence of diarrhea was significantly associated with a severe clinical course with a pooled OR of 3.97 (95% CI 1.80-8.73; p < 0.01). Abdominal pain and nausea/vomiting were not associated with disease severity. CONCLUSIONS Diarrhea, nausea/vomiting or abdominal pain are present in nearly one-fifth of all children with COVID-19. The presence of diarrhea portends a severe clinical course.
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Affiliation(s)
- Rishi Bolia
- Division of Paediatric Gastroenterology, Department of
Paediatrics, All India Institute of Medical
Sciences—, Rishikesh, Uttarakhand, 249201, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine,
All India Institute of Medical Sciences, Jodhpur,
Rajasthan, 342005, India,Corresponding Author: Dr. Akhil Dhanesh
Goel, Address: C214, Academic Block, Department of Community Medicine and Family
Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
342005, Mobile No:
+91-9643158274
| | - Mayank Badkur
- Department of General Surgery, All India Institute
of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Vidhi Jain
- Department of Microbiology, All India Institute of
Medical Sciences, Jodhpur, Rajasthan, 342005, India
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10
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Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child 2021; 106:440-448. [PMID: 33593743 PMCID: PMC8070630 DOI: 10.1136/archdischild-2020-321385] [Citation(s) in RCA: 120] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity. DESIGN Systematic review and meta-analysis. SETTING Between 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0-19 years old) COVID-19 were considered for inclusion. MAIN OUTCOMES AND MEASURES The pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity. RESULTS 129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample. CONCLUSION Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.
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Affiliation(s)
- Omar Irfan
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fiona Muttalib
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kun Tang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Li Jiang
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zohra S Lassi
- Robinson Research Institute, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Zulfiqar Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute for Global Health & Development, Aga Khan University, Karachi, Pakistan
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Rao S, Gavali V, Prabhu SS, Mathur R, Dabre LR, Prabhu SB, Bodhanwala M. Outcome of Children Admitted With SARS-CoV-2 Infection: Experiences From a Pediatric Public Hospital. Indian Pediatr 2021; 58:358-362. [PMID: 33452767 PMCID: PMC8079837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 07/01/2023]
Abstract
OBJECTIVE To study clinical characteristics and outcome of children with admitted to a paediatric hospital in Mumbai, India. METHODS Review of medical records of 969 children admitted between 19 March and 7 August, 2020, to assess the clinico-demographic characteristics, disease severity and factors predicting outcome in COVID-19 children. Variables were compared between children who were previously healthy (Group I) and those with co-morbidity (Group II). RESULTS 123 (71 boys) children with median (IQR) age of 3 (0.7- 6) years were admitted, of which 47 (38%) had co-morbidities. 39 (32 %) children required intensive care and 14 (11.4%) died. Male sex, respiratory manifestation, oxygen saturation <94%; at admission, mechanical ventilation, inotrope, hospital stay of <10 days were independent predictors of mortality. Oxygen saturation <94% at admission (OR 35.9, 95% CI 1.5-856) and hospital stay <10 days (OR 9.1, 95% CI 1.04-99.1) were significant. CONCLUSION COVID-19 in children with co-morbidities causes severe disease. Association of mortality with oxygen saturation by pulse oximeter <94% on admission, and hospital stay <10 days, needs further evaluation.
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Affiliation(s)
- Sudha Rao
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India. Correspondence to: Dr. Sudha Rao, Professor and, Head Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Acharya Dhonde Marg, Parel, Mumbai, India.
| | - Vrushabh Gavali
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Shakuntala S Prabhu
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Radhika Mathur
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Larissa Robert Dabre
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Sanjay B Prabhu
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
| | - Minnie Bodhanwala
- Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India
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Gupta ML, Gothwal S, Gupta RK, Sharma RB, Meena JS, Sulaniya PK, Dev D, Gupta DK. Duration of Viral Clearance in Children With SARS-CoV-2 Infection in Rajasthan, India. Indian Pediatr 2021; 58:123-125. [PMID: 33257599 PMCID: PMC7926061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/21/2020] [Accepted: 11/29/2020] [Indexed: 04/01/2024]
Abstract
OBJECTIVE To study the clinical and laboratory profile and to assess period for viral clearance in COVID 19 children. METHODS We reviewed hospital records of children (<18 years) admitted from 1 April to 31 May, 2020 at a tertiary-care public hospital and identified those positive for severe acute respiratory syndrome corona virus (SARS-CoV-2) by RT-PCR of respiratory secretions. RESULTS 81.2% of the 85 children studied were asymptomatic and 3 (8.5%) died. Severe lymphopenia (43.8%), raised C-reactive protein (93.8%), raised erythrocyte sedimentation rate (75%) and high (>500ng/mL) levels of D-dimer (37.5%) were common. Median (IQR) duration of viral shedding was 7 (5-10) days, with range of 2 to 45 days; 96.3% had viral clearance within 14 days. CONCLUSIONS Majority of children aged <18 years with SARS-CoV-2 infection had viral clearance within 14 days.
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Affiliation(s)
- Manohar Lal Gupta
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Sunil Gothwal
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Raj Kumar Gupta
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India. Correspondence to: Prof RK Gupta, Department of Pediatric Medicine, SMS Medical College, Jaipur, India.
| | - Ram Babu Sharma
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Jeetam Singh Meena
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Pawan Kumar Sulaniya
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Deveshwar Dev
- Department of Pediatrics, SPMCH Institute, SMS Medical College, Jaipur, Rajasthan, India
| | - Deepak Kumar Gupta
- Centre for Data Analysis, Research and Training (CDART) Jaipur, Rajasthan, India
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Rao S, Gavali V, Prabhu SS, Mathur R, Dabre LR, Prabhu SB, Bodhanwala M. Outcome of Children Admitted With SARS-CoV-2 Infection: Experiences From a Pediatric Public Hospital. Indian Pediatr 2021. [PMID: 33452767 PMCID: PMC8079837 DOI: 10.1007/s13312-021-2196-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective To study clinical characteristics and outcome of children with admitted to a paediatric hospital in Mumbai, India. Method Review of medical records of 969 children admitted between 19 March and 7 August, 2020, to assess the clinico-demographic characteristics, disease severity and factors predicting outcome in COVID-19 children. Variables were compared between children who were previously healthy (Group I) and those with co-morbidity (Group II). Results 123 (71 boys) children with median (IQR) age of 3 (0.7–6) years were admitted, of which 47 (38%) had co-morbidities. 39 (32 %) children required intensive care and 14 (11.4%) died. Male sex, respiratory manifestation, oxygen saturation <94% at admission, mechanical ventilation, inotrope, hospital stay of <10 days were independent predictors of mortality. Oxygen saturation <94% at admission (OR 35.9, 95% CI 1.5–856) and hospital stay <10 days (OR 9.1, 95% CI 1.04–99.1) were significant. Conclusion COVID-19 in children with co-morbidities causes severe disease. Association of mortality with oxygen saturation by pulse oximeter <94% on admission, and hospital stay <10 days, needs further evaluation.
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Gupta P, Bhinder O, Gupta V, Ahuja A, Pandey A, Mandal Ravi RN. Symptomatology and outcome of acute COVID-19 illness in children at Faridabad, India. ACTA MEDICA INTERNATIONAL 2021. [DOI: 10.4103/amit.amit_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ramteke S, Tikkas R, Goel M, Mandraha S, Shrivastava J. Paediatric COVID-19: Milder Presentation-A Silver Lining in Dark Cloud. J Trop Pediatr 2020; 67:6024860. [PMID: 33280024 PMCID: PMC7798610 DOI: 10.1093/tropej/fmaa106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the clinico-epidemiological profile of paediatric patients with Corona virus disease 2019 (COVID-19) infection during the pandemic. METHODS Clinico-epidemiological and laboratory profile of children between 1 month and 14 years were studied between 15 May and 31 July 2020, who had positive nasopharyngeal and oropharyngeal swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS A total of 30 children with median age of 10.5 years (8 months to 14 years) were included in the present study. Sixty percent were boys. Twenty-seven (90%) belonged to an urban area and all 30 children were from a containment area. All were belonging to Kuppuswamy upper lower and lower socioeconomic class. Twenty-one (70%) were asymptomatic. All children had a positive household contact. Symptomatic children had only mild symptoms of fever, dry cough and rhinitis. All were fully vaccinated as per age. Nine (30%) had anaemia. The mean leucocyte count was 7470 ± 2427 (4300-14 100). Leucocytosis was seen in 3 (9%) children. C-reactive protein was found to be raised in only 4 (13%) children. We did not find alteration in sense of smell and taste. No mortality was reported. CONCLUSION COVID-19 in paediatric patients is usually mild. Severe acute respiratory infection is not a major manifestation of COVID 19 infection in children. All children infected by the novel Corona virus-2 in this study, have a documented household contact.
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Affiliation(s)
- Sharmila Ramteke
- Department of Pediatrics, GMC, Bhopal, Madhya Pradesh 462001, India
| | - Rajesh Tikkas
- Department of Pediatrics, GMC, Bhopal, Madhya Pradesh 462001, India
| | - Manjusha Goel
- Department of Pediatrics, GMC, Bhopal, Madhya Pradesh 462001, India
| | - Shipra Mandraha
- Department of Pediatrics, GMC, Bhopal, Madhya Pradesh 462001, India,Correspondence: Shipra Mandraha, Department of Pediatrics, GMC, Bhopal, Madhya Pradesh, India. E-mail <>
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Gupta ML, Gothwal S, Gupta RK, Sharma RB, Meena JS, Sulaniya PK, Dev D, Gupta DK. Duration of Viral Clearance in Children With SARS-CoV-2 Infection in Rajasthan, India. Indian Pediatr 2020. [PMID: 33257599 PMCID: PMC7926061 DOI: 10.1007/s13312-021-2125-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective Methods Results Conclusions
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