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Hidayat AA, Gunawan VA, Iragama FR, Alfiansyah R, Hertanto DM, Tjempakasari A, Thaha M. Risk Factors and Clinical Characteristics of Acute Kidney Injury in Patients with COVID-19: A Systematic Review and Meta-Analysis. PATHOPHYSIOLOGY 2023; 30:233-247. [PMID: 37218918 DOI: 10.3390/pathophysiology30020020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/24/2023] Open
Abstract
Acute kidney injury (AKI) is associated with a worse prognosis in coronavirus disease 2019 (COVID-19) patients. Identification of AKI, particularly in COVID-19 patients, is important for improving patients' management. The study aims to assess risk factors and comorbidities of AKI in COVID-19 patients. We systematically searched PubMed and DOAJ databases for relevant studies involving confirmed COVID-19 patients with data on risk factors and comorbidities of AKI. The risk factors and comorbidities were compared between AKI and non-AKI patients. A total of 30 studies involving 22385 confirmed COVID-19 patients were included. Male (OR: 1.74 (1.47, 2.05)), diabetes (OR: 1.65 (1.54, 1.76)), hypertension (OR: 1.82 (1.12, 2.95)), ischemic cardiac disease (OR: 1.70 (1.48, 1.95)), heart failure (OR: 2.29 (2.01, 2.59)), chronic kidney disease (CKD) (OR: 3.24 (2.20, 4.79)), chronic obstructive pulmonary disease (COPD) (OR: 1.86 (1.35, 2.57)), peripheral vascular disease (OR: 2.34 (1.20, 4.56)), and history of nonsteroidal anti-inflammatory drugs (NSAID) (OR: 1.59 (1.29, 1.98)) were independent risk factors associated with COVID-19 patients with AKI. Patients with AKI presented with proteinuria (OR: 3.31 (2.59, 4.23)), hematuria (OR: 3.25 (2.59, 4.08)), and invasive mechanical ventilation (OR: 13.88 (8.23, 23.40)). For COVID-19 patients, male gender, diabetes, hypertension, ischemic cardiac disease, heart failure, CKD, COPD, peripheral vascular disease, and history of use of NSAIDs are associated with a higher risk of AKI.
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Affiliation(s)
- Amal Arifi Hidayat
- Internal Medicine Resident, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Vania Azalia Gunawan
- Internal Medicine Resident, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Firda Rachmawati Iragama
- Internal Medicine Resident, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Rizky Alfiansyah
- Internal Medicine Resident, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Decsa Medika Hertanto
- Division of Nephrology-Hypertension, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Artaria Tjempakasari
- Division of Nephrology-Hypertension, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | - Mochammad Thaha
- Division of Nephrology-Hypertension, Department of Internal Medicine, Dr. Soetomo Hospital, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
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K U S, Hunakunti BB, Le Gratiet A, Gogoi A, Mazumder N. Stokes-Mueller polarization-based analysis of model SARS-CoV-2 virions. Lasers Med Sci 2023; 38:35. [PMID: 36622455 PMCID: PMC9827445 DOI: 10.1007/s10103-022-03680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/12/2022] [Indexed: 01/10/2023]
Abstract
Understanding the virology of the coronavirus at the structural level has gained utmost importance to overcome the constant and long-term health complications induced by them. In this work, the light scattering properties of SARS-CoV-2 of size 140 nm were simulated by using discrete dipole approximation (DDA) for two incident wavelengths 200 nm and 350 nm, respectively. Three different 3-dimensional (3D) models of SARS-CoV-2 corresponding to 15, 20, and 40 numbers of spike proteins on the viral capsid surface were constructed as target geometries for the DDA calculations. These models were assessed by employing Stokes-Mueller polarimetry to obtain individual polarization properties such as degree of polarization (DOP), degree of linear polarization (DOLP), and degree of circular polarization (DOCP). Irrespective of its spike numbers, all the coronavirus models were found to display higher DOP and DOCP values and negligibly small DOLP values for circularly polarized incident light, indicating the presence of chiral structures. On the other hand, the lack of understanding about the dependence of the Mueller matrix on its microstructural properties was overcome by transforming 16 Mueller elements into sub-matrices with specific structural and physical properties using Lu-Chipman-based Mueller matrix polar decomposition method. The obtained properties such as retardance, diattenuation, and depolarization were used for investigating the composition and microstructural information. The approach presented in this work has the potential to understand the virology of the coronavirus at the structural level and, therefore, will be beneficial in developing effective detection strategies by exploiting their characteristic electromagnetic scattering signatures.
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Affiliation(s)
- Spandana K U
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Bhagesh Basavraj Hunakunti
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104
| | - Aymeric Le Gratiet
- Université de Rennes, CNRS, Institut FOTON - UMR 6082, F-22305, Lannion, France.
| | - Ankur Gogoi
- Department of Physics, Jagannath Barooah College, Jorhat, 785001, Assam, India.
| | - Nirmal Mazumder
- Department of Biophysics, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India, 576104.
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Sarfraz M, Sarfraz A, Sarfraz Z, Nadeem Z, Khalid J, Butt SZ, Thevuthasan S, Felix M, Cherrez-Ojeda I. Contributing factors to pediatric COVID-19 and MIS-C during the initial waves: A systematic review of 92 case reports. Ann Med Surg (Lond) 2022; 81:104227. [PMID: 35937636 PMCID: PMC9339082 DOI: 10.1016/j.amsu.2022.104227] [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: 05/13/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background As the coronavirus disease 2019 (COVID-19) pandemic continues to sweep the world with unprecedented speed and devastation, data has shown that cases in the pediatric population have been significantly lower than in the adult population. We conducted a systematic review of case reports to identify the contributing factors of confirmed pediatric COVID-19 patients. Methods Using the PubMed platform, and Cochrane Central, we searched for primary studies alone. All database searches were performed between December 2019 and December 2020. We incorporated keywords including “pediatrics,” “Case reports,” “Cases,” “Covid-19″ into all searches. Results A total of 92 records were included in this novel review. Of all patients, 58% were male and the mean age of the patients was 6.2 years (SD: 5.9). Contributing factors to MIS-C infections were G6PD deficiency (17.6%), Group A streptococcus co-infection (17.6%), infancy (11.8%), whereas those in COVID-19 pediatric patients included congenital (18.5%), and genetic defects (13.8%), in addition to vertical transmission or during infancy (16.9%). Data of baseline demographic characteristics and clinical sequelae of included COVID-19 pediatric and MIS-C patients is presented. Conclusion With schools reopening and closing, the pediatric age group is susceptible to high rates of COVID-19 community transmission. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts. COVID-19 continues to devastate communities worldwide. The pediatric population has faced the ups and downs of the many variants of disease. This systematic review includes a total of 92 studies and identifies key contributing factors from developmental, maternal and pediatric. We provide insights into potential contributing factors to pediatric COVID-19 and MIS-C patients. These insights are critical to guide future guidelines on the management and potential vaccination efforts.
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Clyne B, Jordan K, Ahern S, Walsh KA, Byrne P, Carty PG, Drummond L, O'Brien KK, Smith SM, Harrington P, Ryan M, O'Neill M. Transmission of SARS-CoV-2 by children: a rapid review, 30 December 2019 to 10 August 2020. Euro Surveill 2022; 27. [PMID: 35115076 PMCID: PMC8815097 DOI: 10.2807/1560-7917.es.2022.27.5.2001651] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2023] Open
Abstract
BackgroundThe role of children in the transmission of SARS-CoV-2 during the early pandemic was unclear.AimWe aimed to review studies on the transmission of SARS-CoV-2 by children during the early pandemic.MethodsWe searched MEDLINE, Embase, the Cochrane Library, Europe PubMed Central and the preprint servers medRxiv and bioRxiv from 30 December 2019 to 10 August 2020. We assessed the quality of included studies using a series of questions adapted from related tools. We provide a narrative synthesis of the results.ResultsWe identified 28 studies from 17 countries. Ten of 19 studies on household and close contact transmission reported low rates of child-to-adult or child-to-child transmission. Six studies investigated transmission of SARS-CoV-2 in educational settings, with three studies reporting 183 cases from 14,003 close contacts who may have contracted COVID-19 from children index cases at their schools. Three mathematical modelling studies estimated that children were less likely to infect others than adults. All studies were of low to moderate quality.ConclusionsDuring the early pandemic, it appeared that children were not substantially contributing to household transmission of SARS-CoV-2. School-based studies indicated that transmission rates in this setting were low. Large-scale studies of transmission chains using data collected from contact tracing and serological studies detecting past evidence of infection would be needed to verify our findings.
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Affiliation(s)
- Barbara Clyne
- Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Jordan
- Health Information and Quality Authority, Dublin, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Dublin, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Dublin, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Dublin, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Máirín Ryan
- Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, St James's Hospital, Dublin, Ireland
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Hare D, Gonzalez G, Dean J, McDonnell K, Carr MJ, De Gascun CF. Genomic epidemiological analysis of SARS-CoV-2 household transmission. Access Microbiol 2021; 3:000252. [PMID: 34595399 PMCID: PMC8479960 DOI: 10.1099/acmi.0.000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/08/2021] [Indexed: 11/18/2022] Open
Abstract
Family clusters have contributed significantly to the onward spread of SARS-CoV-2. However, the dynamics of viral transmission in this setting remain incompletely understood. We describe the clinical and viral-phylogenetic characteristics of a family cluster of SARS-CoV-2 infections with a high attack rate, and explore how whole-genome sequencing (WGS) can inform outbreak investigations in this context. In this cluster, the first symptomatic case was a 22-month-old infant who developed rhinorrhoea and sneezing 2 days prior to attending a family gathering. Subsequently, seven family members in attendance at this event were diagnosed with SARS-CoV-2 infections, including the infant described. WGS revealed indistinguishable SARS-CoV-2 genomes recovered from the adults at the gathering, which were closely related genetically to B.1 lineage viruses circulating in the local community. However, a divergent viral sub-lineage was recovered from the infant and another child, each harbouring a distinguishing spike substitution (N30S). This suggested that the infant was unlikely to be the primary case, despite displaying symptoms first, and additional analysis of her nasopharyngeal swab revealed a picornavirus co-infection to account for her early symptoms. Our findings demonstrate how WGS can elucidate the transmission dynamics of SARS-CoV-2 infections within household clusters and provide useful information to support outbreak investigations. Additionally, our description of SARS-CoV-2 viral lineages and notable variants circulating in Ireland to date provides an important genomic-epidemiological baseline in the context of vaccine introduction.
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Affiliation(s)
- Daniel Hare
- National Virus Reference Laboratory (NVRL), School of Medicine, University College Dublin 4, Belfield, D04 V1W8, Dublin, Ireland
| | - Gabriel Gonzalez
- National Virus Reference Laboratory (NVRL), School of Medicine, University College Dublin 4, Belfield, D04 V1W8, Dublin, Ireland.,International Collaboration Unit, Research Center for Zoonosis Control, Hokkaido University, N20 W10 Kita-ku, Sapporo, 001-0020, Japan
| | - Jonathan Dean
- National Virus Reference Laboratory (NVRL), School of Medicine, University College Dublin 4, Belfield, D04 V1W8, Dublin, Ireland
| | - Kathleen McDonnell
- Public Health Department, Health Service Executive South East, Kilkenny, Ireland
| | - Michael J Carr
- National Virus Reference Laboratory (NVRL), School of Medicine, University College Dublin 4, Belfield, D04 V1W8, Dublin, Ireland.,International Collaboration Unit, Research Center for Zoonosis Control, Hokkaido University, N20 W10 Kita-ku, Sapporo, 001-0020, Japan
| | - Cillian F De Gascun
- National Virus Reference Laboratory (NVRL), School of Medicine, University College Dublin 4, Belfield, D04 V1W8, Dublin, Ireland
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A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168269. [PMID: 34444014 PMCID: PMC8394392 DOI: 10.3390/ijerph18168269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/18/2022]
Abstract
Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.
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Abstract
BACKGROUND The majority of the children with SARS-CoV-2 infection present with respiratory symptoms, hence various chest imaging modalities have been used in the management. Knowledge about the radiological findings of coronavirus disease (COVID-19) in children is limited. Hence, we systematically synthesized the available data that will help in better management of COVID-19 in children. METHODS Four different electronic databases (MEDLINE, EMBASE, Web of Science and CENTRAL) were searched for articles reporting radiological findings in children with COVID-19. Studies reporting thoracic radiological findings of COVID-19 in patients aged <19 years were included. A random-effect meta-analysis (wherever feasible) was performed to provide pooled estimates of various findings. RESULTS A total of 1984 records were screened of which forty-six studies (923 patients) fulfilled the eligibility criteria and were included in this systematic review. A chest computed tomography (CT) scan was the most frequently used imaging modality. While one-third of the patients had normal scans, a significant proportion (19%) of clinically asymptomatic children had radiological abnormalities too. Unilateral lung involvement (55%) was frequent when compared with bilateral and ground-glass opacities were the most frequent (40%) definitive radiological findings. Other common radiological findings were non-specific patchy shadows (44%), consolidation (23%), halo sign (26%), pulmonary nodules and prominent bronchovascular marking. Interstitial infiltration being the most frequent lung ultrasound finding. CONCLUSION CT scan is the most frequently used imaging modality for COVID-19 in children and can detect pneumonia before the appearance of clinical symptoms. Undefined patchy shadows, grand-glass opacities and consolidation are commonly observed imaging findings in COVID-19 pneumonia.
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Affiliation(s)
- Jogender Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Jitendra Meena
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Arushi Yadav
- Department of Radiodiagnosis and Imaging, Government Medical College and Hospital, Chandigarh 160032, India
| | - Jaivinder Yadav
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Park M, Pawliuk C, Nguyen T, Griffitt A, Dix-Cooper L, Fourik N, Dawes M. Determining the communicable period of SARS-CoV-2: A rapid review of the literature, March to September 2020. Euro Surveill 2021; 26:2001506. [PMID: 33834961 PMCID: PMC8034061 DOI: 10.2807/1560-7917.es.2021.26.14.2001506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/31/2020] [Indexed: 12/15/2022] Open
Abstract
IntroductionStandard testing for infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is based on RT-PCR tests, but detection of viral genetic material alone does not indicate ongoing infectious potential. The ability to isolate whole virus represents a better proxy for infectivity.AimThe objective of this study was to gain an understanding of the current literature and compare the reported periods of positive SARS-CoV-2 detection from studies that conducted RT-PCR testing in addition to experiments isolating whole virus.MethodsUsing a rapid review approach, studies reporting empirical data on the duration of positive RT-PCR results and/or successful viral isolation following SARS-CoV-2 infection in humans were identified through searches of peer-reviewed and pre-print health sciences literature. Articles were screened for relevance, then data were extracted, analysed, and synthesised.ResultsOf the 160 studies included for qualitative analysis, 84% (n = 135) investigated duration of positive RT-PCR tests only, 5% (n = 8) investigated duration of successful viral isolations, while 11% (n = 17) included measurements on both. There was significant heterogeneity in reported data. There was a prolonged time to viral clearance when deduced from RT-PCR tests compared with viral isolations (median: 26 vs 9 days).DiscussionFindings from this review support a minimum 10-day period of isolation but certain cases where virus was isolated after 10 days were identified. Given the extended time to viral clearance from RT-PCR tests, future research should ensure standard reporting of RT-PCR protocols and results to help inform testing policies aimed at clearance from isolation.
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Affiliation(s)
- Mina Park
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Pawliuk
- School of Information, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tribesty Nguyen
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Griffitt
- School of Information, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Nadia Fourik
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Martin Dawes
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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Williams N, Radia T, Harman K, Agrawal P, Cook J, Gupta A. COVID-19 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents: a systematic review of critically unwell children and the association with underlying comorbidities. Eur J Pediatr 2021; 180:689-697. [PMID: 32914200 PMCID: PMC7483054 DOI: 10.1007/s00431-020-03801-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022]
Abstract
Data show that children are less severely affected with SARS-Covid-19 than adults; however, there have been a small proportion of children who have been critically unwell. In this systematic review, we aimed to identify and describe which underlying comorbidities may be associated with severe SARS-CoV-2 disease and death. The study protocol was in keeping with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A total of 1726 articles were identified of which 28 studies fulfilled the inclusion criteria. The 28 studies included 5686 participants with confirmed SARS-CoV-2 infection ranging from mild to severe disease. We focused on the 108 patients who suffered from severe/critical illness requiring ventilation, which included 17 deaths. Of the 108 children who were ventilated, the medical history was available for 48 patients. Thirty-six of the 48 patients (75%) had documented comorbidities of which 11/48 (23%) had pre-existing cardiac disease. Of the 17 patients who died, the past medical history was reported in 12 cases. Of those, 8/12 (75%) had comorbidities.Conclusion: Whilst only a small number of children suffer from COVID-19 disease compared to adults, children with comorbidities, particularly pre-existing cardiac conditions, represent a large proportion of those that became critically unwell. What is Known: • Children are less severely affected by SARS-CoV-2 than adults. • There are reports of children becoming critically unwell with SARS-CoV-2 and requiring intensive care. What is New: • The majority of children who required ventilation for SARS-CoV-2 infection had underlying comorbidities. • The commonest category of comorbidity in these patients was underlying cardiac disease.
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Affiliation(s)
- Nia Williams
- Department of Paediatric Medicine, King’s College Hospital, London, UK
| | - Trisha Radia
- Department of Paediatric Medicine, King’s College Hospital, London, UK
| | - Katharine Harman
- Department of Paediatric Respiratory Medicine, King’s College Hospital, London, SE5 9RS UK
| | - Pankaj Agrawal
- Department of Paediatric Medicine, King’s College Hospital, London, UK
| | - James Cook
- Department of Paediatric Respiratory Medicine, King’s College Hospital, London, SE5 9RS UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King’s College Hospital, London, SE5 9RS UK
- Institute for Women’s and Children’s Health, King’s College London, London, UK
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Sarin E, Kumar A, Alwadhi V, Saboth P, Kumar H. Experiences with use of a pulse oximeter multimodal device in outpatient management of children with Acute Respiratory Infection during Covid pandemic. J Family Med Prim Care 2021; 10:631-635. [PMID: 34041052 PMCID: PMC8138404 DOI: 10.4103/jfmpc.jfmpc_1410_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background: While Covid-19 infection rate in children is low, respiratory symptoms are a common mode of presentation which calls for better management of such symptoms. However, ARI case managemnet in primary health settings settings has challenges as health workers lack skills to count respiratory rate and check chest indrawing. To address this multimodal pulse oximeters have been introduced in health and wellness centres of seven states to ease the work of front line health workers. A study was undertaken to understand the usability of the multimodal pulse oximeter during Covid times. Methods: A qualitative study was conducted with the aid of indepth interviews among a convenience sample of eleven health care workers from ten health and wellness centres. Interviews were conducted and recorded over phone, after obtaining consent. Transcribed interviews were coded and analysed on a qualitative analysis software. Content analysis was conducted. Results: Total children screened during covid lockdown period (April 1-May 31) is 571, those diagnosed with pneumonia and severe pneumonia is 68 and 2. Health care workers were satisfied with pulse oximeter as it helped in timely diagnosis and treatment, and offered protection from possible infection as it mitigated the need for physical contact. Conclusion: The multimodal pulse oximeter is well accepted among providers as it is easy to use aiding in timely management of ARI in children. It has an added protection as it's use reduces the need for physical contact. It can be adopted in other HWC and primary health facilities.
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Affiliation(s)
- Enisha Sarin
- Health, Nutrition and WASH, IPE Global, B-84, Defence Colony, New Delhi, India
| | - Arvind Kumar
- Health, Nutrition and WASH, IPE Global, B-84, Defence Colony, New Delhi, India
| | - Vaishali Alwadhi
- Community Health, St Stephens Hospital, St. Stephen's Hospital Marg, Tis Hazari, New Delhi, India
| | - Prasant Saboth
- Health, Nutrition and WASH, IPE Global, B-84, Defence Colony, New Delhi, India
| | - Harish Kumar
- Health, Nutrition and WASH, IPE Global, B-84, Defence Colony, New Delhi, India
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Alabbas A, Kirpalani A, Morgan C, Mammen C, Licht C, Phan V, Wade A, Harvey E, Zappitelli M, Clark EG, Hiremath S, Soroka SD, Wald R, Weir MA, Chanchlani R, Lemaire M. Canadian Association of Paediatric Nephrologists COVID-19 Rapid Response: Guidelines for Management of Acute Kidney Injury in Children. Can J Kidney Health Dis 2021; 8:2054358121990135. [PMID: 33614056 PMCID: PMC7868478 DOI: 10.1177/2054358121990135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This article provides guidance on managing acute kidney injury (AKI) and kidney replacement therapy (KRT) in pediatrics during the COVID-19 pandemic in the Canadian context. It is adapted from recently published rapid guidelines on the management of AKI and KRT in adults, from the Canadian Society of Nephrology (CSN). The goal is to provide the best possible care for pediatric patients with kidney disease during the pandemic and ensure the health care team's safety. INFORMATION SOURCES The Canadian Association of Paediatric Nephrologists (CAPN) COVID-19 Rapid Response team derived these rapid guidelines from the CSN consensus recommendations for adult patients with AKI. We have also consulted specific documents from other national and international agencies focused on pediatric kidney health. We identified additional information by reviewing the published academic literature relevant to pediatric AKI and KRT, including recent journal articles and preprints related to COVID-19 in children. Finally, our group also sought expert opinions from pediatric nephrologists across Canada. METHODS The leadership of the CAPN, which is affiliated with the CSN, solicited a team of clinicians and researchers with expertise in pediatric AKI and acute KRT. The goal was to adapt the guidelines recently adopted for Canadian adult patients for pediatric-specific settings. These included specific COVID-19-related themes relevant to AKI and KRT in a Canadian setting, as determined by a group of kidney disease experts and leaders. An expert group of clinicians in pediatric AKI and acute KRT reviewed the revised pediatric guidelines. KEY FINDINGS (1) Current Canadian data do not suggest an imminent threat of an increase in acute KRT needs in children because of COVID-19; however, close coordination between nephrology programs and critical care programs is crucial as the pandemic continues to evolve. (2) Pediatric centers should prepare to reallocate resources to adult centers as needed based on broader health care needs during the COVID-19 pandemic. (3) Specific suggestions pertinent to the optimal management of AKI and KRT in COVID-19 patients are provided. These suggestions include but are not limited to aspects of fluid management, KRT vascular access, and KRT modality choice. (4) Considerations to ensure adequate provision of KRT if resources become scarce during the COVID-19 pandemic. LIMITATIONS We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. The local context, including how the provision of care for AKI and acute KRT is organized, may impede the implementation of many suggestions. As knowledge is advancing rapidly in the area of COVID-19, suggestions may become outdated quickly. Finally, most of the literature for AKI and KRT in COVID-19 comes from adult data, and there are few pediatric-specific studies. IMPLICATIONS Given that most acute KRT related to COVID-19 is likely to be required in the pediatric intensive care unit initial setting, close collaboration and planning between critical care and pediatric nephrology programs are needed. Our group will update these suggestions with a supplement if necessary as newer evidence becomes available that may change or add to the recommendations provided.
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Affiliation(s)
- Abdullah Alabbas
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Amrit Kirpalani
- Department of Paediatrics, Division of Nephrology, Western University, London, ON, Canada
| | - Catherine Morgan
- Department of Paediatrics, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Cherry Mammen
- Department of Paediatrics, Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - Christoph Licht
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Veronique Phan
- Department of Paediatrics, Division of Nephrology, Université de Montréal, Québec, Canada
| | - Andrew Wade
- Department of Paediatrics, Division of Nephrology, University of Calgary, AB, Canada
| | - Elizabeth Harvey
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Michael Zappitelli
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Steven D. Soroka
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael’s Hospital and Department of Medicine, University of Toronto, ON, Canada
| | - Matthew A. Weir
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - Mathieu Lemaire
- Department of Paediatrics, Division of Nephrology, University of Toronto, ON, Canada
- Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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12
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Thakur N, Rai N. An unusual case of multisystem inflammatory syndrome in children in newborn due to covid-19 – presenting with stage 11 b necrotizing enterocolitis. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_78_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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13
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Centeno‐Tablante E, Medina‐Rivera M, Finkelstein JL, Rayco‐Solon P, Garcia‐Casal MN, Rogers L, Ghezzi‐Kopel K, Ridwan P, Peña‐Rosas JP, Mehta S. Transmission of SARS-CoV-2 through breast milk and breastfeeding: a living systematic review. Ann N Y Acad Sci 2021; 1484:32-54. [PMID: 32860259 PMCID: PMC7970667 DOI: 10.1111/nyas.14477] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) is caused by infection with a novel coronavirus strain, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At present, there is limited information on potential transmission of the infection from mother to child, particularly through breast milk and breastfeeding. Here, we provide a living systematic review to capture information that might necessitate changes in the guidance on breast milk and breastfeeding given the uncertainty in this area. Our search retrieved 19,414 total records; 605 were considered for full-text eligibility and no ongoing trials were identified. Our review includes 340 records, 37 with breast milk samples and 303 without. The 37 articles with analyzed breast milk samples reported on 77 mothers who were breastfeeding their children; among them, 19 of 77 children were confirmed COVID-19 cases based on RT-PCR assays, including 14 neonates and five older infants. Nine of the 68 analyzed breast milk samples from mothers with COVID-19 were positive for SARS-CoV-2 RNA; of the exposed infants, four were positive and two were negative for COVID-19. Currently, there is no evidence of SARS-CoV-2 transmission through breast milk. Studies are needed with longer follow-up periods that collect data on infant feeding practices and on viral presence in breast milk.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn,
Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | - Lisa Rogers
- Department of Nutrition and Food
SafetyWorld Health OrganizationGenevaSwitzerland
| | | | - Pratiwi Ridwan
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
| | | | - Saurabh Mehta
- Division of Nutritional
SciencesCornell UniversityIthacaNew York
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14
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Raina R, Chakraborty R, Mawby I, Agarwal N, Sethi S, Forbes M. Critical analysis of acute kidney injury in pediatric COVID-19 patients in the intensive care unit. Pediatr Nephrol 2021; 36:2627-2638. [PMID: 33928439 PMCID: PMC8083920 DOI: 10.1007/s00467-021-05084-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/25/2021] [Accepted: 04/07/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES COVID-19 is responsible for the 2019 novel coronavirus disease pandemic. Despite the vast research about the adult population, there has been little data collected on acute kidney injury (AKI) epidemiology, associated risk factors, treatments, and mortality in pediatric COVID-19 patients admitted to the ICU. AKI is a severe complication of COVID-19 among children and adolescents. METHODS A comprehensive literature search was conducted in PubMed/MEDLINE and Cochrane Center Trials to find all published literature related to AKI in COVID-19 patients, including incidence and outcomes. RESULTS Twenty-four studies reporting the outcomes of interest were included. Across all studies, the overall sample size of COVID positive children was 1,247 and the median age of this population was 9.1 years old. Among COVID positive pediatric patients, there was an AKI incidence of 30.51%, with only 0.56% of these patients receiving KRT. The mortality was 2.55% among all COVID positive pediatric patients. The incidence of multisystem inflammatory syndrome in children (MIS-C) among COVID positive patients was 74.29%. CONCLUSION AKI has shown to be a negative prognostic factor in adult patients with COVID-19 and now also in the pediatric cohort with high incidence and mortality rates. Additionally, our findings show a strong comparison in epidemiology between adult and pediatric COVID-19 patients; however, they need to be confirmed with additional data and studies.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA. .,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA. .,School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - Ronith Chakraborty
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA ,Department of Nephrology, Akron Children’s Hospital, Akron, OH USA
| | - Isabelle Mawby
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA
| | - Nirav Agarwal
- Department of Nephrology, Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH USA
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana India
| | - Michael Forbes
- Director of Clinical Research and Outcomes Analysis, Department of Pediatrics, Akron Children’s Hospital, Akron, OH USA
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15
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Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol 2020; 55:3252-3267. [PMID: 32965785 PMCID: PMC7646267 DOI: 10.1002/ppul.25087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.
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Affiliation(s)
| | - Aggelos Tsalkidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andrew Bush
- Departments of Pediatrics and Pediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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16
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Fang F, Chen Y, Zhao D, Liu T, Huang Y, Qiu L, Hao Y, Hu X, Yin W, Liu Z, Jin R, Ning Q, Cheung PT, Liu C, Shu S, Wang T, Luo X. Recommendations for the Diagnosis, Prevention, and Control of Coronavirus Disease-19 in Children-The Chinese Perspectives. Front Pediatr 2020; 8:553394. [PMID: 33224906 PMCID: PMC7674551 DOI: 10.3389/fped.2020.553394] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Ever since SARS-CoV-2 began infecting people by the end of 2019, of whom some developed severe pneumonia (about 5%), which could be fatal (case fatality ~3.5%), the extent and speed of the COVID-19 outbreak has been phenomenal. Within 2.5 months (by March 18, 2020) over 191,127 COVID-19 patients have been identified in 161 countries. By then, over 700 pediatric patients were confirmed to have COVID-19 in China, with only about 58 diagnosed elsewhere. By now, there are thousands of children and adolescents infected. Chinese pediatricians would like to share their experience on how these patients were managed in China and the key recommendations that had guided them in meeting the evolving challenges. A group of experts were summoned by the Chinese Pediatric Society and Editorial Board of Chinese Journal of Pediatrics to extract informative data from a survey on confirmed COVID-19 pediatric patients in China. Consensus on diagnosis, management, and prevention of pediatric COVID-19 were drawn up based on the analysis of such data plus insights gained from the past SARS and MERS coronavirus outbreaks. Relevant cumulating experiences from physicians managing adult patients, expedited reports on clinical and scientific COVID-19 and SARS-CoV-2 data, and the National Health Committee guidelines on COVID-19 management were integrated into this proposal.
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Affiliation(s)
- Feng Fang
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Chen
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dongchi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tonglin Liu
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yongjian Huang
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liru Qiu
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Hao
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Hu
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Yin
- Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science, Wuhan, China
| | - Zhisheng Liu
- Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science, Wuhan, China
| | - Runming Jin
- Department of Pediatrics, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Ning
- Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pik-to Cheung
- Virtus Medical Group, Pediatric Endocrinology, Genetics, and Metabolism, Hong Kong, China
| | - Chunfeng Liu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Sainan Shu
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tianyou Wang
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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17
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Dong QQ, Qiu LR, Cheng LM, Shu SN, Chen Y, Zhao Y, Hao Y, Shi H, Luo XP. Kindergartens Reopening in the Period of Regular Epidemic Prevention and Control, Benefitial or Harmful? Curr Med Sci 2020; 40:817-821. [PMID: 33123896 PMCID: PMC7595053 DOI: 10.1007/s11596-020-2257-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/12/2020] [Indexed: 12/24/2022]
Abstract
In the period of regular epidemic prevention and control of Coronavirus disease 2019 (COVID-19) in our country, work resumption has been fully advanced. But there are still new sporadic local cases and imported cases across the country. In this situation, whether kindergartens reopening will increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread still remains uncertain. We reviewed two pediatric patients with moderate COVID-19, collected the epidemiologic information and monitored the cycle threshold value of rectal specimen and the viral loads, and discussed the transmission of SARS-CoV-2 in pediatric patients and the virulence of feces in children with moderate COVID-19, in order to analyze the risk of kindergartens reopening.
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Affiliation(s)
- Qiao-qiao Dong
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Li-ru Qiu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Li-ming Cheng
- Department of Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Sai-nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Yu Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Yue Zhao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Yan Hao
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Huan Shi
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
| | - Xiao-ping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030 China
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18
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Okonkwo INC, Howie A, Parry C, Shelton CL, Cobley S, Craig R, Permall N, El-Sheikha SH, Herbert N, Arnold P. The safety of paediatric surgery between COVID-19 surges: an observational study. Anaesthesia 2020; 75:1605-1613. [PMID: 32955100 PMCID: PMC7537528 DOI: 10.1111/anae.15264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 12/20/2022]
Abstract
Despite the ongoing coronavirus disease 2019 (COVID‐19) pandemic, elective paediatric surgery must continue safely through the first, second and subsequent waves of disease. This study presents outcome data from a children's hospital in north‐west England, the region with the highest prevalence of COVID‐19 in England. Children and young people undergoing elective surgery isolated within their household for 14 days, then presented for real‐time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus disease‐2 (SARS‐CoV‐2) within 72 h of their procedure (or rapid testing within 24 h in high‐risk cases), and completed a screening questionnaire on admission. Planned surgery resumed on 26 May 2020; in the four subsequent weeks, there were 197 patients for emergency and 501 for elective procedures. A total of 488 out of 501 (97.4%) elective admissions proceeded, representing a 2.6% COVID‐19‐related cancellation rate. There was no difference in the incidence of SARS‐CoV‐2 among children and young people who had or had not isolated for 14 days (p > 0.99). One out of 685 (0.1%) children who had surgery re‐presented to the hospital with symptoms potentially consistent with SARS‐CoV‐2 within 14 days of surgery. Outcomes were similar to those in the same time period in 2019 for length of stay (p = 1.0); unplanned critical care admissions (p = 0.59); and 14‐day hospital re‐admission (p = 0.17). However, the current cohort were younger (p = 0.037); of increased complexity (p < 0.001) and underwent more complex surgery (p < 0.001). The combined use of household self‐isolation, testing and screening questionnaires has allowed the re‐initiation of elective paediatric surgery at high volume while maintaining pre‐COVID‐19 outcomes in children and young people undergoing surgery. This may provide a model for addressing the ongoing challenges posed by COVID‐19, as well as future pandemics.
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Affiliation(s)
- I N C Okonkwo
- Jackson Rees Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Howie
- Jackson Rees Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Parry
- Microbiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - C L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - S Cobley
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - R Craig
- Jackson Rees Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - N Permall
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S H El-Sheikha
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - N Herbert
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - P Arnold
- Jackson Rees Department of Anaesthesia, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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19
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Loron G, Tromeur T, Venot P, Beck J, Andreoletti L, Mauran P, Bednarek N. COVID-19 Associated With Life-Threatening Apnea in an Infant Born Preterm: A Case Report. Front Pediatr 2020; 8:568. [PMID: 33042914 PMCID: PMC7522361 DOI: 10.3389/fped.2020.00568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
A pandemic linked to the new coronavirus strain (SARS-CoV-2) has been raging for several months. Pediatric populations are less impacted than adults, and critical respiratory diseases seem rare (1, 2). We report the case of an infant, who presented with life-threatening apneas at home requiring basic life support. SARS-CoV-2 was subsequently identified in the patient's nasopharyngeal aspirate. He did not present with bronchiolitis or hypoxic failure as described in severe forms of COVID-19. The outcome was favorable in a few hours. The occurrence of apneas is not uncommon during viral respiratory infections in early infancy; however, there are very few descriptions related to a documented SARS-CoV-2 respiratory tract infection. In light of this clinical case, it seems necessary to quickly bring up a potential COVID-19 contamination in infants admitted for life-threatening apnea, in order to properly report and isolate these patients to avoid further nosocomial dissemination of SARS-CoV-2.
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Affiliation(s)
- Gauthier Loron
- Department of Pediatrics, CHU Reims, Reims, France
- CReSTIC / EA 3804, Reims Champagne-Ardenne University, Reims, France
- Medical University Reims Champagne-Ardenne University, Reims, France
| | - Thibault Tromeur
- Department of Pediatrics, CHU Reims, Reims, France
- Medical University Reims Champagne-Ardenne University, Reims, France
| | | | | | - Laurent Andreoletti
- Cardiovir, EA 4684, Reims Champagne-Ardenne University, Reims, France
- Department of Virology, CHU Reims, Reims, France
| | - Pierre Mauran
- Department of Pediatrics, CHU Reims, Reims, France
- Pediatric Cardiology Unit, CHU Reims, Reims, France
| | - Nathalie Bednarek
- Department of Pediatrics, CHU Reims, Reims, France
- CReSTIC / EA 3804, Reims Champagne-Ardenne University, Reims, France
- Medical University Reims Champagne-Ardenne University, Reims, France
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20
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de Farias ECF, Justino MCA, de Mello MLFMF. MULTISYSTEM INFLAMMATORY SYNDROME IN A CHILD ASSOCIATED WITH CORONAVIRUS DISEASE 19 IN THE BRAZILIAN AMAZON: FATAL OUTCOME IN AN INFANT. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2020; 38:e2020165. [PMID: 32876282 PMCID: PMC7450692 DOI: 10.1590/1984-0462/2020/38/2020165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Recently, there have been reports of children with severe inflammatory syndrome and multiorgan dysfunction associated with elevated inflammatory markers. These cases are reported as presenting the Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. In this study, we describe with parental permission a case of MIS-C in an infant with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. CASE DESCRIPTION A seven-month-old infant, with SARS-CoV-2 infection and a history of extreme preterm birth and very low weight at birth, with an initial course of mild respiratory symptoms and abrupt progression to vasoplegic shock, myocarditis and hyperinflammation syndrome, shown by high levels of troponin I, ferritin, CRP, D-dimer and hypoalbuminemia. Despite the intensive care provided, the child developed multiple organ dysfunction and died. COMMENTS Patients with a history of extreme prematurity may present with MIS-C in the presence of COVID-19 and are a group of special concern.
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21
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Multiple drugs. REACTIONS WEEKLY 2020. [PMCID: PMC7378986 DOI: 10.1007/s40278-020-81225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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