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Day-Lewis M, Chiel L, Gaffin J, Lee PY, Chandler MT, Son MB, Casey AM, Halyabar O. Pediatric EVALI in the Age of COVID-19/MIS-C: Diagnostic Considerations. Hosp Pediatr 2022; 12:e249-e254. [PMID: 35698884 DOI: 10.1542/hpeds.2021-006426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Multisystem inflammatory syndrome in children (MIS-C) and e-cigarette or vaping product use-associated lung injury (EVALI) have significant overlap in clinical features, which can contribute to delay in identification and treatment. The objectives of this report were to identify and describe features that are common in both diagnoses and those that may help distinguish EVALI from MIS-C, and to highlight the diagnostic challenges observed at our tertiary medical center. METHODS We identified adolescents diagnosed with MIS-C who had respiratory or gastrointestinal symptoms and patients diagnosed with EVALI during the same time period. We compared demographics, history, clinical manifestations, laboratory findings, and features of the hospital course to determine areas of overlap between MIS-C and EVALI, as well as distinct features of each diagnosis. Mann-Whitney U test was used to compare continuous variables and Fisher's exact test was used to compare categorical variables. RESULTS We found that cardiovascular and mucocutaneous findings and thrombocytopenia were more common in MIS-C. EVALI patients had a higher degree of inflammation and history of antecedent weight loss. Providers at our institution were more likely to consider MIS-C than EVALI on the differential diagnosis, including in patients with vaping history and no evidence of previous severe acute respiratory syndrome coronavirus 2 infection. CONCLUSIONS This study emphasizes the need for a thorough collection of substance use history for all patients and consideration of EVALI in adolescents who present with respiratory compromise or gastrointestinal symptoms and systemic inflammation, particularly in the absence of severe acute respiratory syndrome coronavirus 2 exposure or cardiac findings characteristic of MIS-C.
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Affiliation(s)
| | - Laura Chiel
- Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jonathan Gaffin
- Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Alicia M Casey
- Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Mandal G, Lale A, Greco R. E-vape and E-Cigarettes-Associated Lung Injury (EVALI) in the COVID-19 Pandemic: A Diagnostic Dilemma and Therapeutic Challenge. Cureus 2022; 14:e26200. [PMID: 35754440 PMCID: PMC9216167 DOI: 10.7759/cureus.26200] [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] [Accepted: 06/22/2022] [Indexed: 12/15/2022] Open
Abstract
E-vape and e-cigarettes-associated lung injury (EVALI) is a diagnostic dilemma and even more obscure during the coronavirus disease 2019 (COVID-19) pandemic. A rise was seen in EVALI cases at the beginning of the COVID-19 pandemic. Still, the non-specific presentation, or the overlapping symptoms of COVID-19 and EVALI, can negate the possible diagnosis of EVALI because of a clinician's predisposition toward infectious etiologies, and it becomes even more challenging during a viral pandemic. The patient's social history remains the key distinctive point in diagnosing EVALI. Systemic steroids are generally used along with supportive care to treat patients with EVALI. This case report demonstrates the dilemma in diagnosing EVALI in a 19-year-old female during the COVID-19 pandemic.
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Virgili F, Nenna R, Ben David S, Mancino E, Di Mattia G, Matera L, Petrarca L, Midulla F. E-cigarettes and youth: an unresolved Public Health concern. Ital J Pediatr 2022; 48:97. [PMID: 35701844 PMCID: PMC9194784 DOI: 10.1186/s13052-022-01286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/25/2022] [Indexed: 11/11/2022] Open
Abstract
The use of electronic cigarettes (e-cigarette) and vaping devices started as a potential aid for cessation and reducing the harmful consequences of cigarette smoking, mainly in the adult population. Today e-cigarette use is highly increasing in vulnerable populations, especially young and pregnant women, due to the misconception of its harmless use. Despite the growing acknowledgment in e-cigarette as a potential harmful device, and due to mixed information found concerning its beneficial aid for smokers, along with an insufficient clinical study done in human models, it is important to further evaluate the possible benefits and risks of non-combusting, vaping nicotine or non-nicotine delivery devices. In this review we tried to summarize the latest updated information found in the literature, concentrating mainly in the variety of adverse effects of e-cigarette use and its contribution for recent and future health concerns.
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Affiliation(s)
- Fabrizio Virgili
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Raffaella Nenna
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Shira Ben David
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Enrica Mancino
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Greta Di Mattia
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luigi Matera
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Laura Petrarca
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Fabio Midulla
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
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E Culbreth R, J Brandenberger K, Battey-Muse CM, Gardenhire DS. 2021 Year in Review: E-Cigarettes, Hookah Use, and Vaping Lung Injuries During the COVID-19 Pandemic. Respir Care 2022; 67:709-714. [PMID: 35606003 PMCID: PMC9994204 DOI: 10.4187/respcare.09919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electronic cigarettes (e-cigarettes) and hookah smoking have gained tremendous popularity over the past decade. With the constantly evolving e-cigarette market and potential impact of the COVID-19 pandemic on users of these tobacco products, research is needed to assess the prevalence and safety of these devices as well as potential public health implications and cessation tools. For this year in review, PubMed was searched from January 2021-December 14, 2021, for articles related to e-cigarettes, vaping-related lung injury, and hookah smoking. Relevant articles addressing the objectives were included in this review. This review focused primarily on articles based on United States populations. Gray literature and nonpublished articles were not included in this review. The 2020 pandemic resulted in a decline in e-cigarette usage among youth (potentially due to the COVID-19 pandemic); however, recent research in 2021 suggests that e-cigarette usage is increasing again among youth. Conflicting evidence exists for e-cigarettes and the risk of COVID-19 infection, but biological plausibility suggests that e-cigarette users are more susceptible to COVID-19 infection and more severe COVID-19 infection compared to non-e-cigarette users. Hookah smoking has remained stable across the past several years and remains a primarily social activity among youth. New e-cigarette devices are constantly emerging, resulting in an increased demand to understand the safety of these devices. Additionally, hookah smoking continues to be a concerning public health issue with the increase in hookah bars and venues coupled with lack of policy regulations for hookah smoking.
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Affiliation(s)
- Rachel E Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia.
| | - Kyle J Brandenberger
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Corinne M Battey-Muse
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Douglas S Gardenhire
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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5
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Marrocco A, Singh D, Christiani DC, Demokritou P. E-cigarette vaping associated acute lung injury (EVALI): state of science and future research needs. Crit Rev Toxicol 2022; 52:188-220. [PMID: 35822508 PMCID: PMC9716650 DOI: 10.1080/10408444.2022.2082918] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/03/2022]
Abstract
"E-Cigarette (e-cig) Vaping-Associated Acute Lung Injury" (EVALI) has been linked to vitamin-E-acetate (VEA) and Δ-9-tetrahydrocannabinol (THC), due to their presence in patients' e-cigs and biological samples. Lacking standardized methodologies for patients' data collection and comprehensive physicochemical/toxicological studies using real-world-vapor exposures, very little data are available, thus the underlying pathophysiological mechanism of EVALI is still unknown. This review aims to provide a comprehensive and critical appraisal of existing literature on clinical/epidemiological features and physicochemical-toxicological characterization of vaping emissions associated with EVALI. The literature review of 161 medical case reports revealed that the predominant demographic pattern was healthy white male, adolescent, or young adult, vaping illicit/informal THC-containing e-cigs. The main histopathologic pattern consisted of diffuse alveolar damage with bilateral ground-glass-opacities at chest radiograph/CT, and increased number of macrophages or neutrophils and foamy-macrophages in the bronchoalveolar lavage. The chemical analysis of THC/VEA e-cig vapors showed a chemical difference between THC/VEA and the single THC or VEA. The chemical characterization of vapors from counterfeit THC-based e-cigs or in-house-prepared e-liquids using either cannabidiol (CBD), VEA, or medium-chain triglycerides (MCT), identified many toxicants, such as carbonyls, volatile organic compounds, terpenes, silicon compounds, hydrocarbons, heavy metals, pesticides and various industrial/manufacturing/automotive-related chemicals. There is very scarce published toxicological data on emissions from THC/VEA e-liquids. However, CBD, MCT, and VEA emissions exert varying degrees of cytotoxicity, inflammation, and lung damage, depending on puffing topography and cell line. Major knowledge gaps were identified, including the need for more systematic-standardized epidemiological surveys, comprehensive physicochemical characterization of real-world e-cig emissions, and mechanistic studies linking emission properties to specific toxicological outcomes.
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Affiliation(s)
- Antonella Marrocco
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - David C. Christiani
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, T.H. Chan School of Public Health, Harvard University, 665 Huntington Ave., Boston, MA 02115, USA
- Environmental Occupational Health Sciences Institute, School of Public Health, Rutgers University, 170 Piscataway, NJ 08854, USA
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6
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Besaratinia A. COVID-19: a pandemic converged with global tobacco epidemic and widespread vaping-state of the evidence. Carcinogenesis 2021; 42:1009-1022. [PMID: 34223886 PMCID: PMC8344766 DOI: 10.1093/carcin/bgab061] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
This review highlights the convergence of three global health challenges at a crossroad where the pandemic of coronavirus disease 2019 (COVID-19) meets the tobacco epidemic and vaping. It begins with an overview of the current knowledge on the biology, pathophysiology and epidemiology of COVID-19. It then presents the state of smoking and vaping during the pandemic by summarizing the published data on prevalence, use patterns, product availability/accessibility, sales records and motivation to quit before and after the start of the pandemic. It highlights the state of evidence on the association of tobacco product use with COVID-19 infection and transmission rates, symptom severity and clinical outcomes. Also discussed are proposed biological mechanisms and behavioral factors that may modulate COVID-19 risk in tobacco product users. Furthermore, competing hypotheses on the protective effect of nicotine against COVID-19 as well as the claimed ‘smokers’ paradox’ are discussed. Considerations and challenges of COVID-19 vaccination in tobacco product users are underscored. Collectively, the present data show an ‘incomplete’ but rapidly shaping picture on the association of tobacco product use and COVID-19 infection, disease course and clinical outcomes. Evidence is also growing on the mechanisms by which tobacco product use may contribute to COVID-19 pathophysiology. Although we await definitive conclusions on the relative risk of COVID-19 infection in tobacco product users, compelling data confirm that many comorbidities associated with/caused by smoking predispose to COVID-19 infection, severe disease and poor prognosis. Additionally, it is becoming increasing clear that should smokers get the disease, they are more likely to have serious health consequences.
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Affiliation(s)
- Ahmad Besaratinia
- Department of Preventive Medicine, USC Keck School of Medicine, University of Southern California, M/C 9603, Los Angeles, CA, USA
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Moran A, Hampton S, Dowson S, Dagdelen J, Trewartha A, Ceder G, Persson K, Saxon E, Barker A, Charles L, Webb-Robertson BJ. Online Interactive Platform for COVID-19 Literature Visual Analytics: Platform Development Study. J Med Internet Res 2021; 23:e26995. [PMID: 34138726 PMCID: PMC8288648 DOI: 10.2196/26995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/29/2021] [Accepted: 06/12/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Papers on COVID-19 are being published at a high rate and concern many different topics. Innovative tools are needed to aid researchers to find patterns in this vast amount of literature to identify subsets of interest in an automated fashion. OBJECTIVE We present a new online software resource with a friendly user interface that allows users to query and interact with visual representations of relationships between publications. METHODS We publicly released an application called PLATIPUS (Publication Literature Analysis and Text Interaction Platform for User Studies) that allows researchers to interact with literature supplied by COVIDScholar via a visual analytics platform. This tool contains standard filtering capabilities based on authors, journals, high-level categories, and various research-specific details via natural language processing and dozens of customizable visualizations that dynamically update from a researcher's query. RESULTS PLATIPUS is available online and currently links to over 100,000 publications and is still growing. This application has the potential to transform how COVID-19 researchers use public literature to enable their research. CONCLUSIONS The PLATIPUS application provides the end user with a variety of ways to search, filter, and visualize over 100,00 COVID-19 publications.
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Affiliation(s)
- Addy Moran
- Pacific Northwest National Laboratory, Richland, WA, United States
| | - Shawn Hampton
- Pacific Northwest National Laboratory, Richland, WA, United States
| | - Scott Dowson
- Pacific Northwest National Laboratory, Richland, WA, United States
| | - John Dagdelen
- Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Department of Materials Science and Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Amalie Trewartha
- Lawrence Berkeley National Laboratory, Berkeley, CA, United States
| | - Gerbrand Ceder
- Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Department of Materials Science and Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Kristin Persson
- Lawrence Berkeley National Laboratory, Berkeley, CA, United States
- Department of Materials Science and Engineering, University of California, Berkeley, Berkeley, CA, United States
| | - Elise Saxon
- Pacific Northwest National Laboratory, Richland, WA, United States
| | - Andrew Barker
- Pacific Northwest National Laboratory, Richland, WA, United States
| | - Lauren Charles
- Pacific Northwest National Laboratory, Richland, WA, United States
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Groom AL, Vu THT, Landry RL, Kesh A, Hart JL, Walker KL, Wood LA, Robertson RM, Payne TJ. The Influence of Friends on Teen Vaping: A Mixed-Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136784. [PMID: 34202600 PMCID: PMC8296881 DOI: 10.3390/ijerph18136784] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/17/2021] [Accepted: 06/19/2021] [Indexed: 11/26/2022]
Abstract
Vaping is popular among adolescents. Previous research has explored sources of information and influence on youth vaping, including marketing, ads, family, peers, social media, and the internet. This research endeavors to expand understanding of peer influence. Our hypothesis is that friends’ influence on teen vapers’ first electronic nicotine delivery systems (ENDS) use varies by demographic variables and awareness of ENDS advertising. In August–October 2017, youth (n = 3174) aged 13–18 completed an online survey to quantify ENDS behaviors and attitudes and were invited to participate in follow-up online research in November-December 2017 to probe qualitative context around perceptions and motivations (n = 76). This analysis focused on the ENDS users, defined as having ever tried any ENDS product, from the survey (n = 1549) and the follow-up research (n = 39). Among survey respondents, friends were the most common source of vapers’ first ENDS product (60%). Most survey respondents tried their first ENDS product while “hanging out with friends” (54%). Among follow-up research participants, the theme of socializing was also prominent. ENDS advertising and marketing through social media had a strong association with friend networks; in fact, the odds of friends as source of the first vaping experience were 2 times higher for those who had seen ENDS ads on social media compared with other types of media. The influence of friends is particularly evident among non-Hispanic Whites, Hispanics/Latinos, those living in urban areas, those living in high-income households, those with higher self-esteem, and those who experiment with vaping. These findings support the premise that peer influence is a primary social influencer and reinforcer for vaping. Being included in a popular activity appears to be a strong driving force.
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Affiliation(s)
- Allison L. Groom
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX 75231, USA; (R.L.L.); (A.K.); (R.M.R.)
- Correspondence: ; Tel.: +1-214-641-9299
| | - Thanh-Huyen T. Vu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Robyn L. Landry
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX 75231, USA; (R.L.L.); (A.K.); (R.M.R.)
| | - Anshula Kesh
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX 75231, USA; (R.L.L.); (A.K.); (R.M.R.)
| | - Joy L. Hart
- Department of Communication, University of Louisville, Louisville, KY 40292, USA; (J.L.H.); (K.L.W.); (L.A.W.)
| | - Kandi L. Walker
- Department of Communication, University of Louisville, Louisville, KY 40292, USA; (J.L.H.); (K.L.W.); (L.A.W.)
| | - Lindsey A. Wood
- Department of Communication, University of Louisville, Louisville, KY 40292, USA; (J.L.H.); (K.L.W.); (L.A.W.)
| | - Rose Marie Robertson
- American Heart Association Tobacco Regulation and Addiction Center, Dallas, TX 75231, USA; (R.L.L.); (A.K.); (R.M.R.)
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Thomas J. Payne
- Department of Otolaryngology, Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Department of Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Schiliro M, Vogel ER, Paolini L, Pabelick CM. Cigarette Smoke Exposure, Pediatric Lung Disease, and COVID-19. Front Physiol 2021; 12:652198. [PMID: 33986692 PMCID: PMC8110920 DOI: 10.3389/fphys.2021.652198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/06/2021] [Indexed: 12/29/2022] Open
Abstract
The detrimental effects of tobacco exposure on children's health are well known. Nonetheless, the prevalence of secondhand or direct cigarette smoke exposure (CSE) in the pediatric population has not significantly decreased over time. On the contrary, the rapid incline in use of e-cigarettes among adolescents has evoked public health concerns since increasing cases of vaping-induced acute lung injury have highlighted the potential harm of these new "smoking" devices. Two pediatric populations are especially vulnerable to the detrimental effects of cigarette smoke. The first group is former premature infants whose risk is elevated both due to their prematurity as well as other risk factors such as oxygen and mechanical ventilation to which they are disproportionately exposed. The second group is children and adolescents with chronic respiratory diseases, in particular asthma and other wheezing disorders. Coronavirus disease 2019 (COVID-19) is a spectrum of diseases caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has spread worldwide over the last year. Here, respiratory symptoms ranging from mild to acute respiratory distress syndrome (ARDS) are at the forefront of COVID-19 cases among adults, and cigarette smoking is associated with worse outcomes in this population, and cigarette smoking is associated with worse outcomes in this population. Interestingly, SARS-CoV-2 infection affects children differently in regard to infection susceptibility, disease manifestations, and complications. Although children carry and transmit the virus, the likelihood of symptomatic infection is low, and the rates of hospitalization and death are even lower when compared to the adult population. However, multisystem inflammatory syndrome is recognized as a serious consequence of SARS-CoV-2 infection in the pediatric population. In addition, recent data demonstrate specific clinical patterns in children infected with SARS-CoV-2 who develop multisystem inflammatory syndrome vs. severe COVID-19. In this review, we highlight the pulmonary effects of CSE in vulnerable pediatric populations in the context of the ongoing SARS-CoV-2 pandemic.
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Affiliation(s)
- Marta Schiliro
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Elizabeth R. Vogel
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Lucia Paolini
- Department of Pediatric, San Gerardo Hospital, University of Milano-Bicocca, Fondazione MBBM, Monza, Italy
| | - Christina M. Pabelick
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, United States
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