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Shioji N, Sumie M, Englesakis M, Gilfoyle E, Maynes JT, Aoyama K. Multisystem inflammatory syndrome in children: an Umbrella review. J Anesth 2024; 38:309-320. [PMID: 38530453 DOI: 10.1007/s00540-024-03323-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/08/2024] [Indexed: 03/28/2024]
Abstract
We conducted an Umbrella review of eligible studies to evaluate what patient features have been investigated in the multisystem inflammatory syndrome in children (MIS-C) population, in order to guide future investigations. We comprehensively searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from December 1, 2019 to the May 6, 2022. The time period was limited to cover the coronavirus disease-2019 (COVID-19) pandemic period. The protocol was registered in the PROSPERO registry (CRD42022340228). Eligible studies included (1) a study population of pediatric patients ≤21 years of age diagnosed with MIS-C; (2) an original Systematic review or Mata-analysis; (3) published 2020 afterward; and (4) was published in English. A total of 41 studies met inclusion criteria and underwent qualitative analysis. 28 studies reported outcome data of MIS-C. 22 studies selected clinical features of MIS-C, and 6 studies chose demographic data as a main topic. The mortality rate for children with MIS-C was 1.9% (interquartile range (IQR) 0.48), the ICU admission rate was 72.6% (IQR 8.3), and the extracorporeal membrane oxygenation rate was 4.7% (IQR 2.0). A meta-analysis of eligible studies found that cerebral natriuretic peptide in children with MIS-C was higher than that in children with COVID-19, and that the use of intravenous immunoglobulin (IVIG) in combination with glucocorticoids to treat MIS-C compared to IVIG alone was associated with lower treatment failure. In the future, for patients with MIS-C, studies focused on safety of surgery requiring general anesthesia, risk factors, treatment, and long-term outcomes are warranted.
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Affiliation(s)
- Naohiro Shioji
- Department of Anesthesiology and Intensive Care Medicine, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Sumie
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Department of Anesthesiology, St. Mary's Hospital, Fukuoka, Japan
- Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Canada
| | - Elaine Gilfoyle
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Jason T Maynes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
- Program in Molecular Medicine, SickKids Research Institute, Toronto, ON, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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2
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Oragui CC, Dilibe A. Fatal Arrhythmic Complications of Multisystemic Inflammatory Syndrome (MIS-C) in a Pediatric Patient. Cureus 2024; 16:e60927. [PMID: 38784686 PMCID: PMC11115374 DOI: 10.7759/cureus.60927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/25/2024] Open
Abstract
In 2019, the emergence of the coronavirus disease 2019 (COVID-19) virus triggered a global pandemic, reminiscent of the magnitude witnessed during the flu pandemic of 1918. Initially, children often presented with either asymptomatic or mild upper respiratory tract infection symptoms. However, in the post-acute phase, a distinct syndrome affecting multiple organ systems emerged, sharing similarities with Kawasaki's disease. This syndrome was later classified as multisystem inflammatory syndrome in children (MIS-C) by the Pediatric Intensive Care Society in April 2020. Notably, cardiac manifestations and complications associated with COVID-19 constitute a significant source of morbidity and mortality, characterized by left ventricular dysfunction, cardiac conduction abnormalities, and arrhythmias. Although cases of arrhythmias with MIS-C are rare in the literature, we present a unique case involving a 14-year-old without known cardiac risk factors who presented with conduction abnormalities and fatal arrhythmias secondary to MIS-C.
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Affiliation(s)
- Chika C Oragui
- Pediatrics, Pediatric Intensive Care Unit (PICU), Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, USA
| | - Arthur Dilibe
- Internal Medicine, ECU Health, East Carolina University, Greenville, USA
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3
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Duan C, Liu L, Wang T, Wang G, Jiang Z, Li H, Zhang G, Ye L, Li C, Cao Y. Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review. BMC Med 2024; 22:116. [PMID: 38481207 PMCID: PMC10938697 DOI: 10.1186/s12916-024-03334-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Experiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one's lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus. METHODS In this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg's FSN was calculated for both binary and continuous measures. RESULTS We identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression. CONCLUSIONS The findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.
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Affiliation(s)
- Chengchen Duan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Guanru Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
| | - Honglin Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gaowei Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Li Ye
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, 3rd Section of Ren Min Nan Rd., Chengdu, 610041, China.
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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Sabri MR, Ahmadi A, Saviz M, Ghaderian M, Dehghan B, Mahdavi C, Ramezani Nezhad D, Rahimi H, Mostafavi N, Pourmoghaddas Z. Cardiac Function in Pediatric Patients with MIS-C Using Speckle Tracking and Conventional Echocardiography: A Longitudinal, Single-Center Study. Pediatr Cardiol 2024:10.1007/s00246-024-03432-w. [PMID: 38431886 DOI: 10.1007/s00246-024-03432-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
Cardiovascular involvement in Multisystem Inflammatory Syndrome in Children (MIS-C), a potential consequence of coronavirus disease-2019 (COVID-19), is common. Conventional transthoracic echocardiography (TTE) provides primary data on the function of the left and right ventricles, while Speckle Tracking Echocardiography (STE) is more sensitive. This study aims to assess longitudinal cardiac function using STE in these patients. This longitudinal study was conducted from late 2021 to early 2022 at Imam Hossein Children's Hospital, Isfahan. Cardiac function was assessed by STE at the time of diagnosis and again two months later. Demographics, clinical characteristics, ECG interpretations, imaging studies, and serum cardiac marker levels were collected. Thirty-five pediatric patients with a mean age of 5.1 years (range: 4 months to 17 years) were included and prospectively followed. Twenty-nine of them, comprising 14 males (48.3%) and 15 females (51.7%), underwent STE and were compared with 29 healthy age- and sex-matched children. Factors related to adverse events included reduced myocardial function, enlarged left atrium or ventricle, and mitral regurgitation (MR). Patients with comorbidities affecting strain measurements were excluded from the strain analyses. A significant difference was observed between the groups in regional strains in the basal and apical septal and middle lateral regions. Global strain rate (GLS) and strain rates were not significantly different but were still lower than the control group. Twenty percent of patients had abnormal GLS but normal left ventricular ejection fraction (LVEF). All patients exhibited reduced segmental myocardial strain in at least one segment. Four out of 26 recovered patients without comorbidities had abnormal GLS at follow-up, despite normal LVEF. STE proves more useful than conventional echocardiography in patients with MIS-C, revealing subclinical cardiac injury in the acute and post-acute phases.
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Affiliation(s)
- Mohammad Reza Sabri
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Ahmadi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdieh Saviz
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mehdi Ghaderian
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahar Dehghan
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Chehreh Mahdavi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Ramezani Nezhad
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Rahimi
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naseroldin Mostafavi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Pourmoghaddas
- Pediatric Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Alamiri B, Alkhamis MA, Naguy A, Alenezi HF, Al Shekaili M. Anxiety disorders among children and adolescents during COVID-19 lockdowns and school closures: a cross-sectional study in Kuwait. Front Psychiatry 2024; 15:1322745. [PMID: 38410676 PMCID: PMC10895000 DOI: 10.3389/fpsyt.2024.1322745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Investigating the epidemiology of mental health disorders resulting from COVID-19 intervention measures, primary school closures, and social isolation in children and adolescents needs to be prioritized over adults at the post-pandemic stage. Most preliminary psychosocial studies conducted during the pandemic have demonstrated that younger age groups are the most vulnerable to such implications. Thus, this study aims to estimate the probable prevalence of specific anxiety disorders in children and quantify their relationships with relevant demographic risk factors. Methods We used a cross-sectional study comprising 430 children aged between 8- and 18 years old living in Kuwait during the period of school closures as well as full and partial lockdowns. The survey included questions about participants' characteristics, children's anxiety using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED) scale, and children's emotions and behaviours using the Strengths and Difficulties Questionnaire (SDQ). Univariate and multivariate logistic regression analyses were used to summarize the demographic and characteristics of the participants and their association with general, social, and generalized anxieties, as well as behavioural and emotional difficulties. Results We inferred that 24.83% of our participants had at least one anxiety disorder, while 20.19% were classified as abnormal on the SDQ scale. Our multivariate analysis revealed that lockdown duration and sex of the child were consistently significant predictors (p-values < 0.05) of the broad spectrum of selected mental disorders. Additionally, we inferred notable increases in the likelihood of mental disorders associated with the increased duration of lockdowns. Conclusions Our findings revealed preliminary insights into the vulnerability of young populations to the indirect negative impacts of strict public health measures during pandemic emergencies. Thus, authorities should consider such implications when planning and implementing similar interventions in future pandemics.
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Affiliation(s)
- Bibi Alamiri
- Almanara, Kuwait Center for Mental Health, Ministry of Health, Kuwait City, Kuwait
| | - Moh A. Alkhamis
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Naguy
- Almanara, Kuwait Center for Mental Health, Ministry of Health, Kuwait City, Kuwait
| | - Hend F. Alenezi
- General Adult Psychiatry Department, Kuwait Center for Mental Health, Kuwait City, Kuwait
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Herber JM, Bhumbra SS, Johansen MW, Slaven JE, Serrano RM. Cardiac injury in children with COVID-19. Cardiol Young 2024; 34:62-66. [PMID: 37190870 DOI: 10.1017/s1047951123000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND There is little known about the spectrum of cardiac injury in acute COVID-19 infection in children. METHODS A single-centre, retrospective chart analysis was performed. The protocol was deemed IRB exempt. All patients under the age of 21 years admitted from 20 March, 2020 to 22 June, 2021 for acute symptomatic COVID-19 infection or clinical suspicion of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were included. Past medical history, lab findings, echocardiogram and electrocardiogram/telemetry findings, and clinical outcomes were reviewed. RESULTS Sixty-six patients with MIS-C and 178 with acute COVID-19 were reviewed. Patients with MIS-C had more cardiac testing than those with acute COVID-19. Inflammatory markers were more likely elevated, and function was more likely abnormal on echocardiogram in those with MIS-C with testing performed. Among patients with MIS-C, 17% had evidence of coronary dilation versus 0% in the acute COVID-19 group. One (0.6%) patient with acute COVID-19 had clinically significant electrocardiogram or telemetry findings, and this was in the setting of prior arrhythmias and CHD. Four (6%) patients with MIS-C had clinically significant findings on electrocardiogram or telemetry. Among patients with acute COVID-19, extracorporeal membrane oxygenation support was required in 0.6% of patients with acute COVID-19, and there was a 2.8% mortality. There were no deaths in the setting of MIS-C. CONCLUSIONS Patients with acute COVID-19 and clinical suspicion of cardiac injury had a lower incidence of abnormal laboratory findings, ventricular dysfunction, or significant arrhythmia than those with MIS-C.
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Affiliation(s)
- Joshua M Herber
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
| | - Samina S Bhumbra
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Riley Hospital for Children, Indianapolis, IN, USA
| | - Michael W Johansen
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ryan M Serrano
- Pediatric Cardiology Department, Riley Hospital for Children, Indianapolis, IN, USA
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Şahan YÖ, Sakcak B, Göncü Ayhan Ş, Tanaçan A, Kibar Gül AE, Şahin D, İlker Çetin İ. The influence of maternal COVID-19 on cardiac functions: From fetal life to infancy. Echocardiography 2024; 41:e15736. [PMID: 38284669 DOI: 10.1111/echo.15736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/29/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE To evaluate both short and mid-term effects of maternal COVID-19 on cardiac functions of fetuses and children. METHODS The present case-control study was conducted on 36 pregnant women who had COVID-19 infection in the second trimester of pregnancy and 30 pregnant women as healthy controls. Fetal, neonatal, and infant cardiac functions were compared between the groups. Assessment of fetal cardiac functions were performed in the last trimester of the pregnancy at least 6 weeks after the recovery of infection. The first postnatal echo was performed within the first 2 weeks and the follow-up (second) echo was performed in the 6-8 weeks of life. RESULTS The demographic data were similar between groups. Interventricular septum and left ventricular posterior wall end-diastolic dimensions were significantly higher in the study group in both fetal, neonatal, and infant periods. Impaired diastolic functions of right and left ventricles were detected and myocardial performance indexes with tissue doppler imaging of both lateral walls and septum were significantly higher than controls at all periods. CONCLUSION Maternal COVID-19 seems to have a global impact on the cardiac functions of babies in the short and mid-term periods after maternal recovery.
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Affiliation(s)
- Yasemin Özdemir Şahan
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Bedri Sakcak
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Şule Göncü Ayhan
- Department of Obstetrics and Gynecology, Division of Perinatology, Memorial Bahcelievler Hospital, İstanbul, Turkey
| | - Atakan Tanaçan
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar Gül
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Department of Obstetrics and Gynecology, Division of Perinatology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Walton M, Raghuveer G, Harahsheh A, Portman MA, Lee S, Khoury M, Dahdah N, Fabi M, Dionne A, Harris TH, Choueiter N, Garrido-Garcia LM, Jain S, Dallaire F, Misra N, Hicar MD, Giglia TM, Truong DT, Tierney ESS, Thacker D, Nowlen TT, Szmuszkovicz JR, Norozi K, Orr WB, Farid P, Manlhiot C, McCrindle BW. Cardiac Biomarkers Aid in Differentiation of Kawasaki Disease from Multisystem Inflammatory Syndrome in Children Associated with COVID-19. Pediatr Cardiol 2023:10.1007/s00246-023-03338-z. [PMID: 38157048 DOI: 10.1007/s00246-023-03338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 01/03/2024]
Abstract
Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show clinical overlap and both lack definitive diagnostic testing, making differentiation challenging. We sought to determine how cardiac biomarkers might differentiate KD from MIS-C. The International Kawasaki Disease Registry enrolled contemporaneous KD and MIS-C pediatric patients from 42 sites from January 2020 through June 2022. The study population included 118 KD patients who met American Heart Association KD criteria and compared them to 946 MIS-C patients who met 2020 Centers for Disease Control and Prevention case definition. All included patients had at least one measurement of amino-terminal prohormone brain natriuretic peptide (NTproBNP) or cardiac troponin I (TnI), and echocardiography. Regression analyses were used to determine associations between cardiac biomarker levels, diagnosis, and cardiac involvement. Higher NTproBNP (≥ 1500 ng/L) and TnI (≥ 20 ng/L) at presentation were associated with MIS-C versus KD with specificity of 77 and 89%, respectively. Higher biomarker levels were associated with shock and intensive care unit admission; higher NTproBNP was associated with longer hospital length of stay. Lower left ventricular ejection fraction, more pronounced for MIS-C, was also associated with higher biomarker levels. Coronary artery involvement was not associated with either biomarker. Higher NTproBNP and TnI levels are suggestive of MIS-C versus KD and may be clinically useful in their differentiation. Consideration might be given to their inclusion in the routine evaluation of both conditions.
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Affiliation(s)
- Mollie Walton
- Children's Mercy Hospital, Kansas City, MO, USA.
- Division of Pediatric Cardiology, Ward Family Heart Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 61408, USA.
| | | | - Ashraf Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, QC, Canada
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Audrey Dionne
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Nadine Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Supriya Jain
- New York Medical College, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY, USA
| | - Frédéric Dallaire
- Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Nilanjana Misra
- Cohen Children's Medical Center, Northwell Health, Queens, NY, USA
| | - Mark D Hicar
- Jacobs School of Medicine and BioMedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Dongngan T Truong
- University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Elif Seda Selamet Tierney
- Division of Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, CA, USA
| | | | | | | | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, ON, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Pedrom Farid
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W McCrindle
- Department of Pediatrics, The Hospital for Sick Children, Labatt Family Heart Centre, University of Toronto, Toronto, ON, Canada
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Oragui C, Gonzalez L, Agha R. Pediatric Cavernous Sinus Thrombosis and COVID-19 Infection: Case Report. Clin Pediatr (Phila) 2023; 62:1461-1464. [PMID: 36919824 PMCID: PMC10018112 DOI: 10.1177/00099228231161024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Affiliation(s)
- Chika Oragui
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Lisandra Gonzalez
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
| | - Rabia Agha
- Department of Pediatrics, Maimonides Children’s Hospital, Brooklyn, NY, USA
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10
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Godoy-Leite M, Santos FGCD, Penido EAR, Ribeiro KA, Dos Santos LM, Rodrigues-Machado MDG, Rezende BA. Impact of social isolation during COVID-19 on anthropometric data, quality of life, baseline physical activity and aortic pulse wave parameters in children and adolescents in two independent samples. Ital J Pediatr 2023; 49:154. [PMID: 37981678 PMCID: PMC10659065 DOI: 10.1186/s13052-023-01558-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/05/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND The social restrictions resulting from the COVID-19 pandemic had a great impact on the routine of children and adolescents, with important consequences such as sleep, eating, and psychological/psychiatric disorders. Even though there are no studies on the subject, it is possible that these changes in habit and routine have also affected arterial stiffness (AS) in this population, which is an important predictor of cardiovascular risk. This study aimed to assess possible changes in AS, anthropometry, and quality of life (QoL) resulting from the COVID-19 pandemic in children and adolescents. METHODS A controlled observational cross-sectional study was performed with 193 children and adolescents aged 9 to 19 years, allocated into two groups: before the pandemic (BPG) and one year after the pandemic (APG), matched by age and sex. Cardiovascular parameters were measured non-invasively by brachial artery oscillometry with a portable device. The main AS indices evaluated were the augmentation index (AIx) and pulse wave velocity (PWV) derived from the aortic pulse wave. QoL was assessed using the Paediatric Quality of Life Inventory version 4.0 (PedsQL 4.0). RESULTS Regarding QoL, the APG showed a worsening in emotional (p = 0.002) and school-related (p = 0.010) aspects. There was no statistically significant difference for most anthropometric parameters, except for the hip circumference, which was higher in the APG group (p < 0.001). The main predictor of AS in the paediatric population, AIx@75, was shown to be increased in the APG group (p < 0.001). Other cardiovascular parameters were also different, such as peripheral (p = 0.002) and central (p = 0.003) diastolic blood pressure, stroke volume (p = 0.010), and total vascular resistance (p = 0.002), which were shown to be decreased in the APG group, while the heart rate was increased (p < 0.001). CONCLUSIONS Our results show that routine changes resulting from the period of social isolation increased cardiovascular risk in children and adolescents, evident by the increase in AIx@75, which is considered to be an important marker of cardiovascular risk in the paediatric population.
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Affiliation(s)
- Mariana Godoy-Leite
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | | | - Kennad Alves Ribeiro
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | - Luzia Maria Dos Santos
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil
| | | | - Bruno Almeida Rezende
- School of Medical Sciences of Minas Gerais, 275, Alameda Ezequiel Dias, Belo Horizonte, 30130-110, Brazil.
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11
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Murished GM, Dandachi I, Aljabr W. Side effects of COVID-19 vaccines in the middle eastern population. Front Immunol 2023; 14:1270187. [PMID: 38022593 PMCID: PMC10654979 DOI: 10.3389/fimmu.2023.1270187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The COVID-19 pandemic has caused severe worldwide health concerns since its first description as the SARS-COV-2 virus in December 2019. The wide dissemination of this virus, together with the lack of treatment, prompted vaccine development within a short period of time to elicit a protective immunity against COVID-19. Due to their rapid development, potential subsequent side effects of COVID-19 vaccines were overlooked, which might lead to many health concerns. This is especially true for patients at a greater risk of harm from COVID-19, such as pregnant women, children, and patients with pre-existing chronic diseases. In this review, we provide a summary of common to rare side effects of administrated COVID-19 vaccines in a Middle Eastern population. We have found that the distinction between side effects from COVID-19 vaccines in terms of frequency and severity is attributed to the differences in study populations, gender, and age. Pain at the injection site, fever, headache, fatigue, and muscle pain were the most common reported side effects. Vaccinated subjects with previous COVID-19 infection exhibited an equivalent neutralizing response after just one dose compared to two doses of vaccine. Consequently, individuals who experienced more side effects had significantly higher antibody levels. This indicates that having better immunity correlates with higher antibody levels, leading to a higher frequency of vaccine side effects. Individuals with underlying comorbidities, particularly having known allergies and with illnesses such as diabetes and cancer, might be more prone to post-vaccination side effects. Studies of a high-risk population in Middle Eastern countries are limited. Future studies should be considered to determine long-term side effects, side effects after booster doses, and side effect differences in cases of heterologous and homologous vaccination for better understanding and proper handling of high-risk populations and patients who experience these side effects.
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Affiliation(s)
| | | | - Waleed Aljabr
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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12
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Paglialonga L, Aurelio C, Principi N, Esposito S. Return to Play after SARS-CoV-2 Infection: Focus on the Pediatric Population with Potential Heart Involvement. J Clin Med 2023; 12:6823. [PMID: 37959288 PMCID: PMC10647408 DOI: 10.3390/jcm12216823] [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: 10/04/2023] [Revised: 10/22/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
The COVID-19 pandemic has entailed consequences on any type of physical activities, mainly due to the social restriction measures applied to reduce the spreading of SARS-CoV-2. When public health policies progressively reduced limitations and resuming a normal life was possible, the return to previous physical activity and sports was not only requested by people who had deeply suffered from limitations, but was also recommended by experts as a means of reducing the physical and psychological consequences induced by the pandemic. The aim of this narrative review is to summarize the available evidence on the return to play in children after SARS-CoV-2 infection, suggesting an algorithm for clinical practice and highlighting priorities for future studies. Criteria to identify subjects requiring laboratory and radiological tests before returning to physical activity are severity of COVID-19 and existence of underlying disease. Children of any age with asymptomatic infection or mild disease severity, i.e., the great majority of children with previous COVID-19, do not need a cardiologic test before resumption of previous physical activity. Only a visit or a telephonic contact with the primary care pediatricians should be established. On the contrary, children with moderate COVID-19 should not exercise until they are cleared by a physician and evaluated for resting electrocardiogram, exercise testing, and echocardiogram. Finally, in those with severe COVID-19, return to play should be delayed for several months, should be gradual and should be performed only after a cardiologist's clearance. Further studies are needed to assess the risks of returning to sports activity in pediatric age, including careful age-adjusted risk stratification, in order to improve the cost-benefit ratio of specific screenings.
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Affiliation(s)
- Letizia Paglialonga
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
| | - Camilla Aurelio
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (L.P.); (C.A.)
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13
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Oragui CC. Cardiovascular Manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With COVID-19. Cureus 2023; 15:e41950. [PMID: 37588330 PMCID: PMC10426319 DOI: 10.7759/cureus.41950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/18/2023] Open
Abstract
Since 2019, the global pandemic caused by the SARS-CoV-2 virus, also known as COVID-19, has dramatically affected every aspect of health and society. With wide-ranging socio-economic ramifications and the morbidity/mortality associated with the disease, a lot of research has been done on this disease. With recent surges and new variants of the COVID-19 virus, we must have regularly updated information on this disease to effectively manage this disease and to maximize outcomes for patients. Worldwide data, so far, has suggested that children have milder or asymptomatic acute infectious phase, most often presenting with mild upper respiratory infection (URI) symptoms compared to the adult population. However, in the post-acute phase, it was observed that children presented with a syndrome that strongly resembled Kawasaki's disease (KD), and like in KD, they could potentially develop severe life-threatening complications. The significant difference between KD and this syndrome is the association with COVID-19 infection. This syndrome was observed to affect almost all organ systems including cardiovascular, gastrointestinal, and integumentary and was later named multisystem inflammatory syndrome in children (MIS-C) by the Pediatric Intensive Care Society in April 2020. The cardiovascular manifestations of this clinical entity have been associated with significant morbidity and mortality. This review is an attempt to give consolidated information from the studies done so far about the cardiac changes that occur from SARS-CoV-2 infection/MIS-C.
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14
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Santos FGCD, Godoy-Leite M, Penido EAR, Ribeiro KA, da Gloria Rodrigues-Machado M, Rezende BA. Eating behaviour, quality of life and cardiovascular risk in obese and overweight children and adolescents: a cross-sectional study. BMC Pediatr 2023; 23:299. [PMID: 37328794 PMCID: PMC10276388 DOI: 10.1186/s12887-023-04107-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Childhood obesity is a major cardiovascular risk factor because it predisposes individuals to comorbidities that are implicated in an increased risk of cardiovascular events. Its origin may be related to poor eating habits, such as the intake of foods of low nutritional value or inadequate eating behaviours related to emotional factors. This work aims to evaluate the relationship between the total body mass of children and adolescents and its association with eating habits, quality of life (QoL), and possible changes in early markers of cardiovascular risk. METHODS This was a cross-sectional observational study that evaluated anthropometric and cardiovascular parameters, QoL, and eating behaviour in 181 children and adolescents aged between 5 and 13 years. Participants were stratified according to BMI/age into three groups (Adequate Weight, Overweight, and Obesity). Anthropometry included weight, height, waist and hip circumferences, waist-hip ratio, and waist-height ratio. QoL was assessed using the Peds-QL 4.0 questionnaire, and eating behaviour was assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Cardiovascular parameters were assessed using the Mobil-O-Graph® device, which measures the pulse wave velocity (PWV) and augmentation index (AIx@75) to estimate arterial stiffness (AS), which is considered an early marker of cardiovascular disease. RESULTS In addition to the increase in anthropometric measurements (p < 0.001), the Obesity group exhibited behaviour related to food intake (p < 0.05). When analysing QoL, a worsening in the social domain was also observed in the Obesity group (p < 0.05). However, PWV and AIx@75 did not differ between groups. CONCLUSIONS Eating behaviour is related to the development of childhood obesity. However, early markers of cardiovascular risk related to AS did not change as a function of total body mass in the children evaluated.
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Affiliation(s)
| | - Mariana Godoy-Leite
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil
| | | | - Kennad Alves Ribeiro
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil
| | | | - Bruno Almeida Rezende
- Programa de Pós-Graduação em Ciências da Saúde - Faculdade Ciências Médicas- MG, Belo Horizonte, MG, Brasil.
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15
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Katoto PDMC, Byamungu LN, Brand AS, Tamuzi JL, Kakubu MAM, Wiysonge CS, Gray G. Systematic review and meta-analysis of myocarditis and pericarditis in adolescents following COVID-19 BNT162b2 vaccination. NPJ Vaccines 2023; 8:89. [PMID: 37296167 DOI: 10.1038/s41541-023-00681-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Myocarditis and pericarditis are frequent complications of COVID-19, but have also been reported following vaccination against COVID-19 in adolescents. To build vaccine confidence and inform policy, we characterized the incidence of myocarditis/pericarditis in adolescents following BNT162b2 vaccination and explored the association with dose and sex. We searched national and international databases for studies reporting the incidence of myocarditis/pericarditis following BNT162b2 vaccination as the primary endpoint. The intra-study risk of bias was appraised, and random-effects meta-analyses were performed to estimate the pooled incidence by dose stratified by sex. The pooled incidence of myocarditis/pericarditis was 4.5 (95%CI: 3.14-6.11) per 100,000 vaccinations across all doses. Compared to dose 1, the risk was significantly higher after dose 2 (RR: 8.62, 95%CI: 5.71-13.03). However, adolescents experienced a low risk after a booster dose than after dose 2 (RR: 0.06; 95%CI: 0.04-0.09). Males were approximately seven times (RR: 6.66, 95%CI: 4.77-4.29) more likely than females to present myocarditis/pericarditis. In conclusion, we found a low frequency of myocarditis/pericarditis after BNT162b2, which occurred predominantly after the second dose in male adolescents. The prognosis appears to be favorable, with full recovery in both males and females. National programs are recommended to adopt the causality framework to reduce overreporting, which undercuts the value of the COVID-19 vaccine on adolescent life, as well as to extend the inter-dose interval policy, which has been linked to a lower frequency of myocarditis/pericarditis.
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Affiliation(s)
- Patrick D M C Katoto
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Centre for Tropical Diseases and Global Health, Department of Medicine, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
| | - Liliane N Byamungu
- Department of Pediatric, Faculty of Medicine and Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Amanda S Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jacques L Tamuzi
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Charles S Wiysonge
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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16
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Luca AC, Curpăn AȘ, Manea RS, Butnariu LI, Țarcă E, Starcea IM, Roșu ST, Mîndru DE, Macsim E, Adumitrăchioaiei H, Pădureț IA. Total Anomalous Pulmonary Venous Return in the Time of SARS-CoV-2-Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020387. [PMID: 36832516 PMCID: PMC9955405 DOI: 10.3390/children10020387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
The management of children with complex and life-threatening heart malformations became a clinical conundrum during the SARS-CoV-2 pandemic. The pathophysiological features of the new coronavirus infection have raised major dilemmas regarding the postoperative evolution of an infected patient, and the epidemiological limitations have tightened the criteria for selecting cases. We present the case of a newborn diagnosed with total anomalous pulmonary venous return (TAPVR) who underwent surgical repair of the defect with favorable outcome, despite a prior diagnosis of SARS-CoV-2 infection. We discuss the medical and surgical management of TAPVR, highlighting possible management difficulties brought by the SARS-CoV-2 pandemic.
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Affiliation(s)
- Alina-Costina Luca
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Alexandrina-Ștefania Curpăn
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University, 700505 Iasi, Romania
- Correspondence:
| | - Raluca-Stefania Manea
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
- Department of Medical Genetics, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, University Street, No 16, 700115 Iasi, Romania
| | - Elena Țarcă
- Department of Surgery II—Pediatric Surgery, ”Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iuliana Magdalena Starcea
- Nephrology Clinic, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Solange Tamara Roșu
- Emergency Room, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Dana Elena Mîndru
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Macsim
- Radiology Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Heidrun Adumitrăchioaiei
- Department of Pediatrics, Faculty of Medicine, Grigore T. Popa’ University of Medicine and Pharmacy, 700115 Iasi, Romania
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
| | - Ioana Alexandra Pădureț
- Pediatrics Department, “St. Mary” Children’s Hospital, Vasile Lupu Street, No 62-64, 700309 Iasi, Romania
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17
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Ghazaryan N, Hovakimyan T. Successful management of near-incessant bidirectional ventricular tachycardia in one-year-old child with COVID-19 infection: a case report. Eur Heart J Case Rep 2023; 7:ytad064. [PMID: 36819878 PMCID: PMC9933944 DOI: 10.1093/ehjcr/ytad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/13/2022] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Background The COVID-19 is an infectious disease, caused by SARS-CoV-2 virus. Cardiovascular complications of COVID-19 are reported more often, from inflammatory cardiac diseases to acute coronary syndromes, thromboembolic events and arrhythmias. Sometimes, these arrhythmias may be life threatening and require urgent intervention. Case summary This is a case of one-year-old boy, who was referred to our hospital because of premature ventricular complexes on ECG. The child had genetic chimerism with a karyotype of 46XY(12)/46XX(3) and small patent ductus arteriosus. We observed non-sustained episodes of bidirectional ventricular tachycardia (VT) on 24 h Holter monitor, which increased over time and caused multiple planned and urgent shocks, despite antiarrhythmic drugs and deep sedation and intubation. Patient was tested positive for COVID-19 using PCR. After thorough echocardiographic testing and a negative genetic analysis for arrhythmogenic disorders he was diagnosed with COVID-19 associated ventricular tachycardia, taking into account that he also developed multisystem inflammatory syndrome. Further, a significant decrease of ventricular activity was observed, which allowed us to implant a cardioverter-defibrillator (ICD). Soon after the implantation the storm of ventricular tachycardia restarted with multiple shocks of the device. This time left partial thoracic sympathectomy was performed and the patient didn't have ICD shocks any more. Discussion COVID-19 infection can be associated with significant arrhythmias, including fatal ventricular arrhythmias also in children. Left partial thoracic sympathectomy can be a helpful option in patients with sustained ventricular tachycardia and multiple ICD shocks, in whom antiarrhythmic treatment or VT ablation is useless or not available.
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18
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Bréhin C. [Diagnosis of a pediatric inflammatory multisystemic syndrome associated with COVID-19]. JOURNAL DE PEDIATRIE ET DE PUERICULTURE 2023; 36:1-7. [PMID: 36407823 PMCID: PMC9663735 DOI: 10.1016/j.jpp.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Following the spread of the 2019 coronavirus (COVID-19) pandemic, a new disease entity has emerged, defined as Pediatric Inflammatory Multisystemic Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). The purpose of this article is to detail the approach to establishing the diagnosis of pediatric multisystemic inflammatory syndrome (PIMS). PIMS is a rare and serious condition. This condition needs to be detected early to initiate emergency hospital management. PIMS should be considered in a child presenting with the following warning signs: high fever with marked deterioration in general condition and digestive signs. This syndrome should be considered in children with features of Kawasaki disease (typical or atypical) or toxic shock syndrome or in cases of acute heart failure/acute myocarditis. As this area is rapidly evolving, changes in the coming months are possible; as the pandemic progresses.
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Affiliation(s)
- C Bréhin
- Urgences pédiatriques - pédiatrie générale- infectiologie, hôpital des enfants CHU de Toulouse, 330, avenue de Grande Bretagne, 31300 Toulouse, France
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19
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Barie PS, Brindle ME, Khadaroo RG, Klassen TL, Huston JM. Omicron, Long-COVID, and the Safety of Elective Surgery for Adults and Children: Joint Guidance from the Therapeutics and Guidelines Committee of the Surgical Infection Society and the Surgery Strategic Clinical Network, Alberta Health Services. Surg Infect (Larchmt) 2023; 24:6-18. [PMID: 36580648 DOI: 10.1089/sur.2022.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Active and recent coronavirus disease 2019 (COVID-19) infections are associated with morbidity and mortality after surgery in adults. Current recommendations suggest delaying elective surgery in survivors for four to 12 weeks, depending on initial illness severity. Recently, the predominant causes of COVID-19 are the highly transmissible/less virulent Omicron variant/subvariants. Moreover, increased survivability of primary infections has engendered the long-COVID syndrome, with protean manifestations that may persist for months. Considering the more than 600,000,000 COVID-19 survivors, surgeons will likely be consulted by recovered patients seeking elective operations. Knowledge gaps of the aftermath of Omicron infections raise questions whether extant guidance for timing of surgery still applies to adults or should apply to the pediatric population. Methods: Scoping review of relevant English-language literature. Results: Most supporting data derive from early in the pandemic when the Alpha variant of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) predominated. The Omicron variant/subvariants generally cause milder infections with less organ dysfunction; many infections are asymptomatic, especially in children. Data are scant with respect to adult surgical outcomes after Omicron infection, and especially so for pediatric surgical outcomes at any stage of the pandemic. Conclusions: Numerous knowledge gaps persist with respect to the disease, the recovered pre-operative patient, the nature of the proposed procedure, and supporting data. For example, should the waiting period for all but urgent elective surgery be extended beyond 12 weeks, e.g., after serious/critical illness, or for patients with long-COVID and organ dysfunction? Conversely, can the waiting periods for asymptomatic patients or vaccinated patients be shortened? How shall children be risk-stratified, considering the distinctiveness of pediatric COVID-19 and the paucity of data? Forthcoming guidelines will hopefully answer these questions but may require ongoing modifications based on additional new data and the epidemiology of emerging strains.
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Affiliation(s)
- Philip S Barie
- Department of Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Mary E Brindle
- Departments of Surgery and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada
| | - Rachel G Khadaroo
- Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada.,Departments of Surgery and Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tara L Klassen
- Surgery Strategic Clinical Network, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada.,Department of Surgery, Calgary Zone, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jared M Huston
- Departments of Surgery and Science Education, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Bioelectronic Medicine, The Feinstein Institute for Medical Research, Manhasset, New York, USA
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20
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COVID-19 Heart Lesions in Children: Clinical, Diagnostic and Immunological Changes. Int J Mol Sci 2023; 24:ijms24021147. [PMID: 36674665 PMCID: PMC9866514 DOI: 10.3390/ijms24021147] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
In the beginning of COVID-19, the proportion of confirmed cases in the pediatric population was relatively small and there was an opinion that children often had a mild or asymptomatic course of infection. Our understanding of the immune response, diagnosis and treatment of COVID-19 is highly oriented towards the adult population. At the same time, despite the fact that COVID-19 in children usually occurs in a mild form, there is an incomplete understanding of the course as an acute infection and its subsequent manifestations such as Long-COVID-19 or Post-COVID-19, PASC in the pediatric population, correlations with comorbidities and immunological changes. In mild COVID-19 in childhood, some authors explain the absence of population decreasing T and B lymphocytes. Regardless of the patient's condition, they can have the second phase, related to the exacerbation of inflammation in the heart tissue even if the viral infection was completely eliminated-post infectious myocarditis. Mechanism of myocardial dysfunction development in MIS-C are not fully understood. It is known that various immunocompetent cells, including both resident inflammatory cells of peripheral tissues (for example macrophages, dendritic cells, resident memory T-lymphocytes and so on) and also circulating in the peripheral blood immune cells play an important role in the immunopathogenesis of myocarditis. It is expected that hyperproduction of interferons and the enhanced cytokine response of T cells 1 and 2 types contribute to dysfunction of the myocardium. However, the role of Th1 in the pathogenesis of myocarditis remains highly controversial. At the same time, the clinical manifestations and mechanisms of damage, including the heart, both against the background and after COVID-19, in children differ from adults. Further studies are needed to evaluate whether transient or persistent cardiac complications are associated with long-term adverse cardiac events.
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21
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Cardiac Involvement in Children Affected by COVID-19: Clinical Features and Diagnosis. Diagnostics (Basel) 2022; 13:diagnostics13010120. [PMID: 36611412 PMCID: PMC9818331 DOI: 10.3390/diagnostics13010120] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/24/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
COVID-19 (Coronavirus disease 2019) in children is usually mild. However, multiple organ disorders associated with SARS-CoV-2 (severe acute respiratory syndrome-related coronavirus 2) have been detected with poor respiratory symptoms. Cardiac changes are noted in 17% to 75% of cases, which are associated with diagnostic difficulties in high-risk groups for the development of complications that are associated with myocardial damage by the SARS-CoV-2 virus. The objective of this review is to identify the most significant symptoms of cardiac involvement affected by COVID-19, which require in-depth examination. The authors analyzed publications from December 2019 to the October 2022, which were published in accessible local and international databases. According to the analysis data, the main sign of myocardial involvement was increasing as cardiomarkers in the patient's blood, in particular troponin I or troponin T. Many authors noted that the increased level of CRP (C-reactive protein) and NT-proBNP, which are accompanied by changes in the ECG (electrocardiogram) and EchoCG (echocardiography), as a rule, were nonspecific. However, the identified cardiac functional dysfunctions affected by SARS-CoV-2, required an cardiac MRI. The lack of timely diagnosis of myocardial involvements, especially in children at high risk for the development of complications associated with SARS-CoV-2 myocardial injury, can lead to death. The direct damage of the structural elements of myocardial blood vessels in patients with severe hypoxic changes resulted from respiratory failure caused by SARS-CoV-2 lung damage, with the development of severe acute diffuse alveolar damage and cell-mediated immune response and myocardial involvement affected by SARS-CoV-2 damage. In this article, the authors introduce a clinical case of a child who dead from inflammatory myocardities with COVID-19 in a background of congenital heart disease and T-cell immunodeficiency.
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Semiz S. COVID19 biomarkers: What did we learn from systematic reviews? Front Cell Infect Microbiol 2022; 12:1038908. [PMID: 36583110 PMCID: PMC9792992 DOI: 10.3389/fcimb.2022.1038908] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID19) pandemic continues to represent a substantial public health concern. It can rapidly progress to severe disease, with poor prognosis and a high mortality risk. An early diagnosis and specific prognostic tools can help healthcare providers to start interventions promptly, understand the likely prognosis and to identify and treat timely individuals likely to develop severe disease with enhanced mortality risk. Here we focused on an impressive set of systematic reviews and meta-analyses that were performed since the start of the COVID19 pandemic and summarized their results related to the levels of hematologic, inflammatory, immunologic biomarkers as well as markers of cardiac, respiratory, hepatic, gastrointestinal and renal systems and their association with the disease progression, severity and mortality. The evidence outlines the significance of specific biomarkers, including inflammatory and immunological parameters (C-reactive protein, procalcitonin, interleukin-6), hematological (lymphocytes count, neutrophil-to-lymphocyte ratio, D-dimer, ferritin, red blood cell distribution width), cardiac (troponin, CK-MB, myoglobin), liver (AST, ALT, total bilirubin, albumin) and lung injury (Krebs von den Lungen-6) that can be used as prognostic biomarkers to aid the identification of high-risk patients and the prediction of serious outcomes, including mortality, in COVID19. Thus, these parameters should be used as essential tools for an early risk stratification and adequate intervention in improving disease outcomes in COVID19 patients.
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Lee H, Byun JC, Kim WJ, Chang MC, Kim S. Multiple cranial nerve palsies with small angle exotropia following COVID-19 mRNA vaccination in an adolescent: A case report. World J Clin Cases 2022; 10:12289-12294. [PMID: 36483824 PMCID: PMC9724525 DOI: 10.12998/wjcc.v10.i33.12289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/08/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several vaccines against the severe acute respiratory syndrome coronavirus 2 have been approved and widely distributed, raising public concerns regarding the side effects of immunization, as the incidence of ease. Although many adverse events following the coronavirus disease 2019 (COVID-19) vaccine have been reported, neurological complications are relatively uncommon. Herein, we report a rare case of multiple cranial palsies following COVID-19 vaccination in an adolescent patient.
CASE SUMMARY A previously healthy, 14-year-old Asian girl with facial palsy presented to the emergency department with inability to close the right eye or wrinkle right side of the forehead, and pain in the right cheek. She had received second dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech) 18 days before onset of symptoms. She was diagnosed with Bell’s palsy and prescribed a steroid (1 mg/kg/day methylprednisolone) based on symptoms and magnetic resonance imaging findings. However, the next day, all sense of taste was lost with inability to swallow solid food; the gag reflex was absent. Horizontal diplopia was also present. Due to worsening of her condition, she was given high-dose steroids (1 g/day methylprednisolone) for 3 days and then discharged with oral steroids. Improvement in the symptoms was noted 4 days post steroid treatment completion. At the most recent follow-up, her general condition was good with no symptoms except diplopia; ocular motility disturbances were noted. Hence, prism glasses were prescribed for diplopia relief.
CONCLUSION Small-angle exotropia was observed in the facial, trigeminal, and glossopharyngeal nerve palsies, in our patient. The etiology of this adverse effect following vaccination was thought to be immunological.
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Affiliation(s)
- Heejin Lee
- Department of Pediatrics, Yeungnam University Medical Center, Daegu 42415, South Korea
| | - Jun Chul Byun
- Department of Pediatrics, Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
| | - Saeyoon Kim
- Department of Pediatrics, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 42415, South Korea
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Kocivnik N, Velnar T. A Review Pertaining to SARS-CoV-2 and Autoimmune Diseases: What Is the Connection? LIFE (BASEL, SWITZERLAND) 2022; 12:life12111918. [PMID: 36431053 PMCID: PMC9698792 DOI: 10.3390/life12111918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious viral disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is known that infection with SARS-CoV-2 can lead to various autoimmune and autoinflammatory diseases. There are few reports in the literature on the association between SARS-CoV-2 and autoimmune diseases, and the number of reports has been increasing since 2020. Autoimmune diseases and SARS-CoV-2 infections are intertwined in several ways. Both conditions lead to immune-mediated tissue damage, the immune response is accompanied by the increased secretion of inflammatory cytokines and both conditions can be treated using immunomodulatory drugs. Patients with certain autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes, cardiac sarcoidosis, idiopathic pulmonary fibrosis, autoimmune hepatitis, multiple sclerosis and others, are more susceptible to SARS-CoV-2 infection, either because of the active autoimmune disease or because of the medications used to treat it. Conversely, SARS-CoV-2 infection can also cause certain autoimmune diseases. In this paper, we describe the development of autoimmune diseases after COVID-19 and the recovery from COVID-19 in people with autoimmune diseases.
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Affiliation(s)
- Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Circulating Serum Cystatin C as an Independent Risk Biomarker for Vascular Endothelial Dysfunction in Patients with COVID-19-Associated Multisystem Inflammatory Syndrome in Children (MIS-C): A Prospective Observational Study. Biomedicines 2022; 10:biomedicines10112956. [PMID: 36428524 PMCID: PMC9687890 DOI: 10.3390/biomedicines10112956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multisystem inflammatory syndrome in children (MIS-C) is a new clinical entity that has emerged in the context of the COVID-19 pandemic. Despite the less severe course of the disease, varying degrees of cardiovascular events may occur in MIS-C; however, data on vascular changes occurring in MIS-C are still lacking. Endothelial dysfunction (ED) is thought to be one of the key risk factors contributing to MIS-C. BACKGROUND We conducted a prospective observational study. We investigated possible manifestations of cardiac and endothelial involvement in MIS-C after the treatment of the acute stage and potential predictive biomarkers in patients with MIS-C. METHODS Twenty-seven consecutive pediatric subjects (≥9 years), at least three months post-treated MIS-C of varying severity, in a stable condition, and twenty-three age- and sex-matched healthy individuals (HI), were enrolled. A combined non-invasive diagnostic approach was used to assess endothelial function as well as markers of organ damage using cardiac examination and measurement of the reactive hyperemia index (RHI), by recording the post- to pre-occlusion pulsatile volume changes and biomarkers related to ED and cardiac disease. RESULTS MIS-C patients exhibited a significantly lower RHI (indicative of more severe ED) than those in HI (1.32 vs. 1.80; p = 0.001). The cutoff of RHI ≤ 1.4 was independently associated with a higher cardiovascular risk. Age and biomarkers significantly correlated with RHI, while serum cystatin C (Cys C) levels were independently associated with a diminished RHI, suggesting Cys C as a surrogate marker of ED in MIS-C. CONCLUSIONS Patients after MIS-C display evidence of ED, as shown by a diminished RHI and altered endothelial biomarkers. Cys C was identified as an independent indicator for the development of cardiovascular disease. The combination of these factors has the potential to better predict the cardiovascular consequences of MIS-C. Our study suggests that ED may be implicated in the pathophysiology of this disease.
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Thiele K, Balfanz P, Müller T, Hartmann B, Spiesshoefer J, Grebe J, Müller-Wieland D, Marx N, Dreher M, Daher A. Cardiopulmonary work up of patients with and without fatigue 6 months after COVID-19. Sci Rep 2022; 12:18038. [PMID: 36302947 PMCID: PMC9607837 DOI: 10.1038/s41598-022-22876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 10/20/2022] [Indexed: 01/24/2023] Open
Abstract
The pathogenesis of long-Covid symptoms remains incompletely understood. Therefore, we aimed to determine cardiopulmonary limitations 6 months after surviving COVID-19 using pulmonary function tests, echocardiographic studies to the point of analysis of global-longitudinal-strain (GLS), which describes the cycling myocardium deformation and provides better data on left ventricular (LV) dysfunction than LV ejection fraction (LVEF), and validated questionnaires. Overall, 60 consecutive hospitalized patients were included (61 ± 2 years, 40% treated in the ICU). At follow-up (194 ± 3 days after discharge), fatigue was the most prevalent symptom (28%). Patients with fatigue were more symptomatic overall and characterized by worse quality of life (QoL) scores compared to patients without fatigue (all p < 0.05), mainly due to limited mobility and high symptom burden. While PFT variables and LVEF were normal in the vast majority of patients (LVEF = 52% (45-52%)), GLS was significantly reduced (- 15% (- 18 to - 14%)). However, GLS values were not different between patients with and without fatigue. In conclusion, fatigue was the most prevalent long-Covid symptom in our cohort, which was associated with worse QoL mainly due to limited mobility and the high burden of concomitant symptoms. Patients showed a subtle myocardial dysfunction 6 months after surviving COVID-19, but this did not relate to the presence of fatigue.
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Affiliation(s)
- Kirsten Thiele
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Paul Balfanz
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Tobias Müller
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Bojan Hartmann
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Jens Spiesshoefer
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Julian Grebe
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Dirk Müller-Wieland
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Nikolaus Marx
- grid.412301.50000 0000 8653 1507Department of Cardiology, Angiology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Michael Dreher
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
| | - Ayham Daher
- grid.412301.50000 0000 8653 1507Department of Pneumology and Intensive Care Medicine, University Hospital RWTH, 52074 Aachen, Germany
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Estrada-Luna D, Carreón-Torres E, González-Reyes S, Martínez-Salazar MF, Ortiz-Rodríguez MA, Ramírez-Moreno E, Arias-Rico J, Jiménez-Osorio AS. Nutraceuticals for Complementary Treatment of Multisystem Inflammatory Syndrome in Children: A Perspective from Their Use in COVID-19. Life (Basel) 2022; 12:life12101652. [PMID: 36295088 PMCID: PMC9605437 DOI: 10.3390/life12101652] [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: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Multisystem inflammatory syndrome in children (MIS-C) has been widely reported in some children diagnosed with SARS-CoV-2. Clinical signs of MIS-C are manifested at 2 to 4 weeks after SARS-CoV-2 infection, where elevated biomarkers of inflammation and cardiac dysfunction are the hallmark of this syndrome when infection or exposure to SARS-CoV-2 has been confirmed. However, after two years of acknowledgment, MIS-C treatment is still under research to reach safety and effectiveness in the acute phase in children. Therefore, in this review, we discuss the potential use of natural compounds with antioxidant and anti-inflammatory effects to reduce collateral damage caused by hyperinflammation in MIS-C pathology for new research in treatment and interventions.
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Affiliation(s)
- Diego Estrada-Luna
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Elizabeth Carreón-Torres
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, Tlalpan, Mexico City 14080, Mexico
| | - Susana González-Reyes
- Facultad de Medicina y Psicología, Universidad Autónoma de Baja California, Tijuana 22390, Mexico
| | - María Fernanda Martínez-Salazar
- Facultad de Ciencias del Deporte, Universidad Autónoma del Estado de Morelos, Av. Universidad No. 1001 Col. Chamilpa, Cuernavaca 62209, Mexico
| | - María Araceli Ortiz-Rodríguez
- Facultad de Nutrición, Universidad Autónoma del Estado de Morelos, Iztaccíhuatl 100 Col. Los Volcanes, Cuernavaca 62350, Mexico
| | - Esther Ramírez-Moreno
- Área Académica de Nutrición, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - José Arias-Rico
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
| | - Angélica Saraí Jiménez-Osorio
- Área Académica de Enfermería, Instituto de Ciencias de la Salud, Universidad Autónoma del Estado Hidalgo, Circuito Ex Hacienda La Concepción S/N, Carretera Pachuca-Actopan, San Agustín Tlaxiaca 42160, Mexico
- Correspondence: ; Tel.: +52-771-717-2000 (ext. 4323)
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Rodriguez-Gonzalez M, Castellano-Martinez A. Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19 (MIS-C). World J Clin Cases 2022; 10:10435-10450. [PMID: 36312492 PMCID: PMC9602208 DOI: 10.12998/wjcc.v10.i29.10435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular dysfunction.
AIM To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide (NT-proBNP) value (Z-log-NT-proBNP) is associated with severe MIS-C and myocardial dysfunction.
METHODS A retrospective study was conducted which included children with MIS-C managed at our institution between April 1, 2020, and February 28, 2022. We divided the population into groups depending on severity based on pediatric intensive care unit (PICU) admission. We compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the one-month follow-up.
RESULTS We included 17 participants [median age 3 (2-9) years] and seven (41%) required PICU admission. All (100%) of these cases presented very high (Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5 (50%) patients with non-severe MIS-C (P = 0.025). NT-proBNP was significantly correlated with high-sensitive Troponin I levels (P = 0.045), Ross modified score (P = 0.003) and left ventricle ejection fraction (P = 0.021).
CONCLUSION Raised NT-proBNP, specifically very high values (Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.
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Abdel-Ghaffar TY, Zakaria HM, Elsayed EM, Magdy S, El Naghi S, Naeem SAM, Hasan MY, khallaf RQ. COVID-19-induced multisystem inflammatory syndrome in a child with Wilson disease: a case report. EGYPTIAN LIVER JOURNAL 2022; 12:51. [PMID: 36101833 PMCID: PMC9458478 DOI: 10.1186/s43066-022-00214-y] [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: 06/01/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infection with coronavirus disease 2019 (COVID-19) can progress to the multisystem inflammatory syndrome in children (MIS-C). Patients with liver cirrhosis are at increased risk of complications. Case presentation We report on a 13-year-old Wilson’s disease patient who was referred for liver transplantation because of rapid deterioration in his hepatic condition. After admission, he developed fever, respiratory distress, coronary arteries dilatation on echocardiography, laboratory evidence of inflammation, and positive severe acute respiratory syndrome coronavirus (SARS-CoV-2) PCR. SARS-CoV-2-induced MIS-C was diagnosed. Inspite of aggressive management of MIS-C, progressive deterioration of the respiratory, liver, kidney, and cardiac functions occurred and he passed away. Conclusion MIS-C is a serious possible complication leading to multiorgan failure and higher death rate especially in cirrhotic children. So, early diagnosis and management with higher level of care by a multidisciplinary team are warranted.
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Vidusa L, Kalejs O, Maca-Kaleja A, Strumfa I. Role of Endomyocardial Biopsy in Diagnostics of Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12092104. [PMID: 36140505 PMCID: PMC9497694 DOI: 10.3390/diagnostics12092104] [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: 07/03/2022] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/19/2022] Open
Abstract
Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.
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Affiliation(s)
- Liga Vidusa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
| | - Oskars Kalejs
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Aija Maca-Kaleja
- Department of Internal Medicine, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Centre of Cardiology, Pauls Stradins Clinical University Hospital, 13 Pilsonu Street, LV-1002 Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Correspondence:
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Fadel FI, Sabry S, Mawla MAA, Galal REE, Salah DM, Helmy R, Ramadan Y, Elzayat W, Abdelfattah M, Abd Alazem EA. Covid-19 in Egyptian hemodialysis and kidney transplant children: retrospective analysis of single center experience. Ital J Pediatr 2022; 48:149. [PMID: 35986373 PMCID: PMC9389481 DOI: 10.1186/s13052-022-01345-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic kidney disease stage 5 (CKD 5) populations have peculiar risk for severe Covid-19 infection. Moreover; pediatric data are sparse and lacking. The aim of this study is to report our experience in CKD 5 children treated by hemodialysis (CKD 5D) and CKD 5 children after kidney transplantation (KTR) during one year of Covid-19 pandemic. Methods Retrospective analysis of 57 CKD 5 children with Covid-19 like symptoms during 1 year pandemic was performed. A cohort of 19 confirmed patients (13 CKD 5D and 6 KTR) was analyzed in details as regard clinical, laboratory, radiological criteria, management and their short term outcome. Results Conclusion Pediatric patients on regular HD (CKD 5D) are at higher risk and worse outcome of Covid-19 infection than KT recipients (KTR). Pre-existing HTN and shorter duration after KT are potential risk factors. Reversible AGD after KT and CVC related infections in HD patients are additional presenting features of Covid-19 infection.
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胡 亚, 姚 开. Clinical characteristics and epidemiological significance of coronavirus disease 2019 in children and adolescents. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:846-852. [PMID: 36036120 PMCID: PMC9425860 DOI: 10.7499/j.issn.1008-8830.2205026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/09/2022] [Indexed: 11/05/2022]
Abstract
The epidemic of coronavirus disease 2019 (COVID-19) started in late December 2019, and spread rapidly throughout the world. In March 2020, the World Health Organization (WHO) declared global epidemic of COVID-19. According to the American Academy of Pediatrics, nearly 13 million children have been diagnosed with COVID-19 since the outbreak. In general, children and teens have milder symptoms and fewer deaths from COVID-19 than adults. Understanding the symptoms, infectivity, and transmission patterns of COVID-19 in children and adolescents is of great significance for timely identifying suspected patients and developing effective control measures. Considering that some children will not be vaccinated for quite some time in the future, it is more important to improve the understanding of the clinical and epidemiological significance of COVID-19 in children and adolescents. This article summarizes the current understanding of the clinical manifestations and epidemiological significance of COVID-19 in children and adolescents to provide a reference for clinical diagnosis and treatment and the formulation of epidemic prevention and control strategies in children's gathering institutions such as kindergartens and schools.
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McDaniel CG, Commander SJ, DeLaura I, Cantrell S, Leraas HJ, Moore CB, Reed CR, Pahl KS, Tracy ET. Coagulation Abnormalities and Clinical Complications in Children With SARS-CoV-2: A Systematic Review of 48,322 Patients. J Pediatr Hematol Oncol 2022; 44:323-335. [PMID: 34862349 DOI: 10.1097/mph.0000000000002321] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/07/2021] [Indexed: 02/03/2023]
Abstract
Given the limited information on the coagulation abnormalities of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in pediatric patients, we designed a systematic review to evaluate this topic. A comprehensive literature search was conducted for "SARS-CoV-2," "coagulopathy," and "pediatrics." Two authors independently screened the articles that the search returned for bleeding, thrombosis, anticoagulant and/or antiplatelet usage, and abnormal laboratory markers in pediatric patients with SARS-CoV-2, and the authors then extracted the relevant data. One hundred twenty-six publications were included. Thirty-four (27%) studies reported thrombotic complications in 504 patients. Thirty-one (25%) studies reported bleeding complications in 410 patients. Ninety-eight (78%) studies reported abnormal laboratory values in 6580 patients. Finally, 56 (44%) studies reported anticoagulant and/or antiplatelet usage in 3124 patients. The variety of laboratory abnormalities and coagulation complications associated with SARS-CoV-2 presented in this review highlights the complexity and variability of the disease presentation in infants and children.
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Affiliation(s)
| | | | | | - Sarah Cantrell
- Duke University School of Medicine
- Duke University Medical Center Library and Archives, Durham, NC
| | | | | | | | - Kristy S Pahl
- Division of Pediatric Hematology-Oncology
- Department of Pediatrics
| | - Elisabeth T Tracy
- Department of Surgery
- Division of Pediatric Surgery, Duke University Medical Center
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Al-Beltagi M, Saeed NK, Bediwy AS. COVID-19 disease and autoimmune disorders: A mutual pathway. World J Methodol 2022; 12:200-223. [PMID: 36159097 PMCID: PMC9350728 DOI: 10.5662/wjm.v12.i4.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/17/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a real challenge for humanity with high morbidity and mortality. Despite being primarily a respiratory illness, COVID-19 can affect nearly every human body tissue, causing many diseases. After viral infection, the immune system can recognize the viral antigens presented by the immune cells. This immune response is usually controlled and terminated once the infection is aborted. Nevertheless, in some patients, the immune reaction becomes out of control with the development of autoimmune diseases. Several human tissue antigens showed a strong response with antibodies directed against many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) proteins, such as SARS-CoV-2 S, N, and autoimmune target proteins. The immunogenic effects of SARS-CoV-2 are due to the sizeable viral RNA molecules with interrupted transcription increasing the pool of epitopes with increased chances of molecular mimicry and interaction with the host immune system, the overlap between some viral and human peptides, the viral induced-tissue damage, and the robust and complex binding between sACE-2 and SARS-CoV-2 S protein. Consequently, COVID-19 and its vaccine may trigger the development of many autoimmune diseases in a predisposed patient. This review discusses the mutual relation between COVID-19 and autoimmune diseases, their interactive effects on each other, the role of the COVID-19 vaccine in triggering autoimmune diseases, the factors affecting the severity of COVID-19 in patients suffering from autoimmune diseases, and the different ways to minimize the risk of COVID-19 in patients with autoimmune diseases.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
| | - Nermin Kamal Saeed
- Medical Microbiology Section, Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama 12, Manama, Bahrain
- Microbiology Section, Department of Pathology, Irish Royal College of Surgeon, Bahrain, Busaiteen 15503, Muharraq, Bahrain
| | - Adel Salah Bediwy
- Department of Chest Disease, Faculty of Medicine, Tanta University, Tanta 31527, Algharbia, Egypt
- Department of Chest Disease, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al-Habib Medical Group, Manama 26671, Manama, Bahrain
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Multisystem inflammatory syndrome (MIS-C): a systematic review and meta-analysis of clinical characteristics, treatment, and outcomes. J Pediatr (Rio J) 2022; 98:338-349. [PMID: 34863701 PMCID: PMC9432310 DOI: 10.1016/j.jped.2021.08.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/27/2021] [Accepted: 10/28/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The clinical cases of patients with multisystem inflammatory syndrome (MIS-C) were analyzed via a systematic review and meta-analysis of the clinical findings, treatments, and possible outcomes of articles retrieved via database searches. SOURCES The authors searched the PubMed, Scielo, Web of Science, Science Direct, EMBASA, EBSCO, and Scopus databases for articles containing the keywords "multisystem inflammatory syndrome in children" or "MIS-C" or "PIMS-TS" or "SIMP" and "COVID-19" or "SARS-CoV-2" published between December 1st, 2019 and July 10th, 2021. Patient characteristics, tissue and organ comorbidities, the incidence of symptoms after COVID-19 infection, treatment, and patient evolution in the articles found were evaluated. The data were abstracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Newcastle-Ottawa Scale (NOS). FINDINGS In total, 98 articles (2275 patients) were selected for demographics, clinical treatment, and outcomes of patients diagnosed with MIS-C. The average age of children with MIS-C, 56.8% of whom were male, was of nine years. Fever (100%), gastrointestinal (GI) (82%), and abdominal pain (68%) were the decisive symptoms for the diagnosis of MIS-C. Shock and/or hypotension were common in patients with MIS-C. Cardiac symptoms (66%) predominated over respiratory (39%) and neurological (28%) symptoms. MIS-C treatment followed the common guidelines for treating children with septic shock and Kawasaki disease (KD) and proved to be effective. CONCLUSIONS This meta-analysis highlights the main clinical symptoms used for the diagnosis of MIS-C, the differences between MIS-C and KD, and the severity of the inflammatory process and urgency for hospital care.
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Getting Ready for Fall Sports. Sports Health 2022; 14:458-459. [PMID: 35722836 DOI: 10.1177/19417381221101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jone PN, John A, Oster ME, Allen K, Tremoulet AH, Saarel EV, Lambert LM, Miyamoto SD, de Ferranti SD. SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e1037-e1052. [PMID: 35400169 DOI: 10.1161/cir.0000000000001064] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.
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Luz Romero RM, Illán Ramos M, Berzosa Sánchez A, Joyanes Abancens B, Baos Muñoz E, Ramos Amador JT. Clinical characteristics of children hospitalized for COVID-19. MEDICINA CLINICA (ENGLISH ED.) 2022; 158:336-339. [PMID: 35224201 PMCID: PMC8858688 DOI: 10.1016/j.medcle.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
Introduction Most SARS-CoV2 infections in the pediatric population are asymptomatic or with mild symptoms, with a minimal proportion of severe cases described as SARS-CoV2-associated multi-system inflammatory syndrome (MIS-C).The objective was to describe the clinical and epidemiological characteristics of pediatric patients admitted with confirmed diagnosis of SARS-CoV2 infection from the beginning of the pandemic until May 2021. Methods Retrospective observational study of pediatric patients hospitalized with confirmed COVID-19, in a tertiary hospital. Epidemiological and clinical data, additional tests, treatments administered and evolution were collected. Results 30 patients were included, classified into 3 groups according to diagnosis: respiratory infection, MIS-C and compatible symptoms. The patients with pneumonia were associated with age older, comorbidities and lymphopenia. MIS-C were more serious patients, with marked laboratory involvement and greater admission to PICU. Most of these were secondary cases of contact in the family environment. Discussion The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory with good evolution. MIS-C is another form of expression of SARS-COV2 infection of greater severity, but usually with good prognosis after early diagnosis and frequent PICU admission.
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Affiliation(s)
| | | | | | | | - Elvira Baos Muñoz
- Servicio de Microbiología Clínica, Hospital Clínico San Carlos, Madrid, Spain
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Luz Romero RM, Illán Ramos M, Berzosa Sánchez A, Joyanes Abancens B, Baos Muñoz E, Ramos Amador JT. Clinical characteristics of children hospitalized for COVID-19. Med Clin (Barc) 2022; 158:336-339. [PMID: 35039168 PMCID: PMC8712264 DOI: 10.1016/j.medcli.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Most SARS-CoV-2 infections in the pediatric population are asymptomatic or with mild symptoms, with a minimal proportion of severe cases described as SARS-CoV-2-associated multi-system inflammatory syndrome (MIS-C). The objective was to describe the clinical and epidemiological characteristics of pediatric patients admitted with confirmed diagnosis of SARS-CoV-2 infection from the beginning of the pandemic until May 2021. METHODS Retrospective observational study of pediatric patients hospitalized with confirmed COVID-19, in a tertiary hospital. Epidemiological and clinical data, additional tests, treatments administered and evolution were collected. RESULTS 30 patients were included, classified into 3 groups according to diagnosis: respiratory infection, MIS-C and compatible symptoms. The patients with pneumonia were associated with age older, comorbidities and lymphopenia. MIS-C were more serious patients, with marked laboratory involvement and greater admission to PICU. Most of these were secondary cases of contact in the family environment. DISCUSSION The most frequent clinical manifestations of COVID-19 in children are mild-moderate respiratory with good evolution. MIS-C is another form of expression of SARS-CoV-2 infection of greater severity, but usually with good prognosis after early diagnosis and frequent PICU admission.
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Affiliation(s)
| | | | | | | | - Elvira Baos Muñoz
- Servicio de Microbiología Clínica, Hospital Clínico San Carlos, Madrid, España
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Cinteză E, Voicu C, Filip C, Ioniță M, Popescu M, Bălgrădean M, Nicolescu A, Mahmoud H. Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis. Diagnostics (Basel) 2022; 12:diagnostics12040884. [PMID: 35453932 PMCID: PMC9025069 DOI: 10.3390/diagnostics12040884] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/19/2022] Open
Abstract
Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis.
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Affiliation(s)
- Eliza Cinteză
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristiana Voicu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Correspondence: (E.C.); (C.V.)
| | - Cristina Filip
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihnea Ioniță
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Monica Popescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Mihaela Bălgrădean
- “Carol Davila” Pediatrics Department, University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Alin Nicolescu
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
| | - Hiyam Mahmoud
- “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania; (C.F.); (M.I.); (M.P.); (A.N.); (H.M.)
- Royal Brompton Hospital, London SW3 6NP, UK
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Octavius GS, Tan R, Pratama TA, Budiputri CL, Meliani F, Heriyanto RS, Muljadi R, Juliansen A. Cardiac manifestations and diagnostic imaging in pediatric inflammatory multisystem syndrome temporally associated with COVID-19: a systematic review. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.225754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Several studies have reported pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) cases with their cardiac manifestations, but only few studies synthesize the cardiovascular characteristics in children with PIMS-TS. However, detecting cardiac abnormalities is crucial in improving patients' outcomes and reducing mortality. This review aimed to summarize the overall symptoms, laboratory, and workup findings in PIMS-TS patients, focusing on cardiovascular manifestations.
METHODS We searched 4 medical databases (PubMed, Science Direct, Medline, and Scielo) and 4 preprint databases (Medrxiv, Research Square, SSRN, and Biorxiv). The literature search was done on November 8, 2021. All case reports, case series, cross-sectional studies, cohort studies, and possible clinical trials published from December 2020 onward that studied PIMS-TS on cardiac manifestation (aged 0–18 years) were included. Studies on multisystem inflammatory syndrome in children, animal studies, and studies without full-text availability were excluded. This review was registered in PROSPERO (CRD42021194468).
RESULTS 59 studies were included with a total of 698 patients. The most common cardiovascular findings were the presence of cardiogenic shock (37%) and hypotension (8.5%). Almost all laboratory values were deranged. Cardiac computed tomography scan mostly showed normal results (56%), followed by cardiomegaly with pericardial effusion (14%). Electrocardiography showed normal findings (46%), ST-segment abnormalities (32%), and abnormal T wave (12%). Echocardiography findings showed left ventricle dysfunction (40.6%), which can be considered most significant, followed by pericardial effusion together with pericarditis (11.4%) and tricuspid regurgitation (6.9%).
CONCLUSIONS This review found various cardiac abnormalities that may develop during PIMS-TS. Due to these findings, we should be more vigilant and not underestimate the consequences in pediatric COVID-19 patients.
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Romani L, Calò Carducci FI, Chiurchiù S, Cursi L, De Luca M, Di Giuseppe M, Krzysztofiak A, Lancella L, Palma P, Vallesi L, Corsetti T, Campana A, Nicastri E, Rossi P, Bernardi S. Safety of Monoclonal Antibodies in Children Affected by SARS-CoV-2 Infection. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030369. [PMID: 35327741 PMCID: PMC8947030 DOI: 10.3390/children9030369] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/15/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
Monoclonal antibody therapies for COVID-19 have been frequently used in adults, whereas there are little data regarding the safety or efficacy of monoclonal antibody treatments in pediatric patients affected by COVID-19. We report our experience in the administration of mAb as a treatment for SARS-CoV-2 infection in children aged from 24 days to 18 years old.
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Affiliation(s)
- Lorenza Romani
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
- Correspondence:
| | - Francesca Ippolita Calò Carducci
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Sara Chiurchiù
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Cursi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Maia De Luca
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Martina Di Giuseppe
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Andrzej Krzysztofiak
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Laura Lancella
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
| | - Paolo Palma
- Research Unit of Congenital and Perinatal Infections, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Leonardo Vallesi
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Tiziana Corsetti
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.V.); (T.C.)
| | - Andrea Campana
- Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Emanuele Nicastri
- National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, 00149 Rome, Italy;
| | - Paolo Rossi
- Chair of Pediatrics, Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Academic Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Stefania Bernardi
- Immunology and Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (F.I.C.C.); (S.C.); (L.C.); (M.D.L.); (M.D.G.); (A.K.); (L.L.); (S.B.)
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Santos JDL, Bhisitkul D, Carman M, Wilson K, Hasara S, Homa K, Reyes P, Bugajski A, Barbera A. The use of monoclonal antibody therapy in pediatric patients with COVID-19: a retrospective case series. Int J Emerg Med 2022; 15:9. [PMID: 35240983 PMCID: PMC8892120 DOI: 10.1186/s12245-022-00414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Monoclonal antibody (MCA) therapies have been utilized under emergency use authorization (EUA) for high-risk pediatric patients with mild to moderate coronavirus disease 2019 (COVID-19) in the outpatient setting since late 2019. The purpose of this study was to describe the use of MCA therapy in pediatric patients in the pediatric emergency department (ED) at a large community hospital. Methods This was a retrospective case series of high-risk pediatric patients 12 to 17 years of age who received MCA therapy in the pediatric ED between December 8, 2020 and June 3, 2021. The primary outcome was to describe the patient characteristics, clinical presentation, and safety profile of the pediatric population that received MCA therapy. The secondary outcome was to describe the incidence of hospitalizations or ED visits up to 28 days following therapy. Results A total of 44 patients were included in the analysis. The median number of days of symptoms was 4 with 41% of patients having symptoms between 0 and 3 days at time of MCA administration. Only one patient experienced a mild adverse event that did not require epinephrine administration. Two patients returned to the ED for reevaluation during the study follow-up period. No patients required admission within 28 days post-therapy. Conclusions The administration of MCA therapy in high-risk pediatric patients in the pediatric ED was well-tolerated with subjective improvement noted in COVID-19 symptoms post-therapy. Further studies are necessary to determine the role MCA therapy may play in reducing morbidity from COVID-19 infection in high-risk pediatric patients.
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Affiliation(s)
- Jesse De Los Santos
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Donna Bhisitkul
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Matthew Carman
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA.
| | - Kayla Wilson
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Shannon Hasara
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA.
| | - Karen Homa
- Department of Research and Sponsored Studies, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Pedro Reyes
- Department of Research and Sponsored Studies, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Andrew Bugajski
- Department of Research and Sponsored Studies, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
| | - Andrew Barbera
- Department of Emergency Medicine, Lakeland Regional Health, 1324 Lakeland Hills Blvd, Lakeland, FL, 33805, USA
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CMR Imaging 6 Months After Myocarditis Associated with the BNT162b2 mRNA COVID-19 Vaccine. Pediatr Cardiol 2022; 43:1522-1529. [PMID: 35320390 PMCID: PMC8941830 DOI: 10.1007/s00246-022-02878-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/15/2022] [Indexed: 12/19/2022]
Abstract
Temporal association between BNT162b2 mRNA COVID-19 vaccine and myocarditis (PCVM) has been reported. We herein present early and 6-month clinical follow-up and cardiac magnetic resonance imaging (CMR) of patients with PVCM. A retrospective collection of data from 15 patients with PCVM and abnormal CMR was performed. Clinical manifestation, laboratory data, hospitalizations, treatment protocols, and imaging studies were collected early (up to 2 months) and later. In nine patients, an additional CMR evaluation was performed 6 months after diagnosis. PCVM was diagnosed in 15 patients, mean age 17 ± 1 (median 17.2, range 14.9-19 years) years, predominantly in males. Mean time from vaccination to onset of symptoms was 4.4 ± 6.7 (median 3, range 0-28) days. All patients had CMR post diagnosis at 4 ± 3 (median 3, range 1-9) weeks, 4/5 patients had hyper enhancement on the T2 sequences representing edemaQuery, and 12 pathological Late glandolinium enhancement. A repeat scan performed after 5-6 months was positive for scar formation in 7/9 patients. PCVM is a rare complication, affecting predominantly males and appearing usually within the first week after administration of the second dose of the vaccine. It usually is a mild disease, with clinical resolution with anti-inflammatory treatment. Late CMR follow up demonstrated resolution of the edema in all patients, while some had evidence of residual myocardial scarring.
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45
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Howard‐Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Britton PN. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health 2022; 58:46-53. [PMID: 34694037 PMCID: PMC8662268 DOI: 10.1111/jpc.15811] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 12/26/2022]
Abstract
The global disruption of the COVID-19 pandemic has impacted the life of every child either directly or indirectly. This review explores the pathophysiology, immune response, clinical presentation and treatment of COVID-19 in children, summarising the most up-to-date data including recent developments regarding variants of concern. The acute infection with SARS-CoV-2 is generally mild in children, whilst the post-infectious manifestations, including paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and 'long COVID' in children, are more complex. Given that most research on COVID-19 has focused on adult cohorts and that clinical manifestations, treatment availability and impacts differ markedly in children, research that specifically examines COVID-19 in children needs to be prioritised.
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Affiliation(s)
- Annaleise R Howard‐Jones
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,NSW Health Pathology‐NepeanNepean HospitalSydneyNew South WalesAustralia
| | - David P Burgner
- Infectious Diseases UnitDepartment of General Medicine, Royal Children's HospitalMelbourneVictoriaAustralia,Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
| | - Nigel W Crawford
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Emma Goeman
- Department of Infectious Diseases and MicrobiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| | - Paul E Gray
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Peter Hsu
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of ImmunologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Stephanie Kuek
- Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia
| | - Brendan J McMullan
- Department of Immunology and Infectious DiseasesSydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Shidan Tosif
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Danielle Wurzel
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of Respiratory and Sleep MedicineThe Royal Children's HospitalMelbourneVictoriaAustralia,School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Asha C Bowen
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Margie Danchin
- Infection and Immunity ThemeMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia,Department of General MedicineRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Archana Koirala
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Infectious DiseasesNepean HospitalPenrithNew South WalesAustralia
| | - Ketaki Sharma
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Daniel K Yeoh
- Department of Infectious DiseasesPerth Children's HospitalPerthWestern AustraliaAustralia,Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
| | - Philip N Britton
- Discipline of Child and Adolescent HealthUniversity of Sydney, The Children's Hospital at WestmeadSydneyNew South WalesAustralia,Department of Infectious Diseases and MicrobiologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
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46
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Kurosaki S, Otani A, Senoo S, Hataya H, Horikoshi Y. A child with the Omicron variant coronavirus disease 2019 pneumonia complicated with arrhythmia. Pediatr Int 2022; 64:e15299. [PMID: 36112041 PMCID: PMC9539145 DOI: 10.1111/ped.15299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Shumpei Kurosaki
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Anna Otani
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Shohei Senoo
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuho Horikoshi
- Division of Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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47
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Acute appendicitis and SARS-CoV-2 in children: imaging findings at a tertiary children's hospital during the COVID-19 pandemic. Pediatr Radiol 2022; 52:460-467. [PMID: 34741178 PMCID: PMC8570768 DOI: 10.1007/s00247-021-05219-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 09/09/2021] [Accepted: 10/05/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Evidence suggests severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may be associated with appendicitis or clinical symptoms that mimic appendicitis, but it is not clear if the findings or utility of imaging in pediatric patients with suspected appendicitis have changed since the onset of the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE To evaluate for potential differences in SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients imaged for suspected appendicitis to determine the reliability of the existing medical imaging approach for appendicitis in a population that contains both SARS-CoV-2 positive and SARS-CoV-2 negative pediatric patients. MATERIALS AND METHODS Patients imaged for suspected appendicitis Apr. 1, 2020, to Dec. 31, 2020, were identified via an electronic medical records search. Differences in ultrasound (US) diagnostic performance, use of computed tomography (CT) following US, rates of appendicitis, imaging findings of appendicitis and perforation were compared between SARS-CoV-2 positive and SARS-CoV-2 negative tested patients, using pathology and surgery as reference standards for appendicitis and perforation, respectively. Fisher exact test and Student's t-test were used for statistical analysis. RESULTS One thousand, six hundred and ninety-three patients < 18 years old met inclusion criteria, with 46% (772/1,693) female, 11 imaged with only CT and 1,682 with US. Comparing SARS-CoV-2 positive and SARS-CoV-2 negative patients, no statistically significant differences in sensitivity or specificity of US (P = 1 and P = 1, respectively), or in the US (P-values ranging from 0.1 to 1.0) or CT imaging findings (P-values ranging from 0.2 to 1.0) in appendicitis were found. Perforation rates were similar between SARS-CoV-2 positive (20/57, 35.1% perforated) and SARS-CoV-2 negative (359/785, 45.7% perforated) patients with appendicitis (P = 0.13). Use of CT following first-line US was similar, with 7/125 (5.6%) of SARS-CoV-2 positive imaged with CT after US and 127/1,557 (8.2%) of SARS-CoV-2 negative imaged with CT after US (P = 0.39). CONCLUSION In pediatric patients with suspected appendicitis, no significant difference was found in the diagnostic performance of US, CT usage or perforation rates between SARS-CoV-2 positive and SARS-CoV-2 negative patients.
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48
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Sayad E, Hammoud M, Khreis D, El Shami M, Matar M, Farah R. COVID-19 associated respiratory failure complicating a pericardial effusion in a patient with sideroblastic anemia. Respir Med Case Rep 2021; 34:101543. [PMID: 34777989 PMCID: PMC8571102 DOI: 10.1016/j.rmcr.2021.101543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background COVID-19 disease has been associated with several cardiovascular complications that rarely occur in the acute phase of the disease. Case report A 13-year-old pediatric patient with congenital sideroblastic anemia associated with YARS2 mutation presenting with COVID-19 infection and worsening pericardial effusion followed by a respiratory failure refractory to supplemental oxygen therapy leading to cardiac arrest. Discussion This case highlights the rapid deterioration that can occur in children with serious hematologic disorders in the context of COVID-19 especially when complicated with pericardial effusion. Conclusion The importance of pericardiocentesis early in order to allow better ventilation in any significant pericardial effusion case associated with COVID-19 infection and the need for prompt care escalation to centers where ECMO is available.
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Affiliation(s)
- Edouard Sayad
- Gilbert and Rose-Marie Chagoury School of Medicine and LAU Medical Center-Rizk Hospital, Department of Pediatrics, Lebanese American University, Beirut, Lebanon
| | - Mohamad Hammoud
- Gilbert and Rose-Marie Chagoury School of Medicine and LAU Medical Center-Rizk Hospital, Department of Pediatrics, Lebanese American University, Beirut, Lebanon
| | - Dima Khreis
- American University of Beirut Medical Center, Department of Pediatrics, Beirut, Lebanon
| | - Maher El Shami
- Gilbert and Rose-Marie Chagoury School of Medicine and LAU Medical Center-Rizk Hospital, Department of Pediatrics, Lebanese American University, Beirut, Lebanon
| | - Maroun Matar
- Gilbert and Rose-Marie Chagoury School of Medicine and LAU Medical Center-Rizk Hospital, Department of Pediatrics, Lebanese American University, Beirut, Lebanon
| | - Roula Farah
- Gilbert and Rose-Marie Chagoury School of Medicine and LAU Medical Center-Rizk Hospital, Department of Pediatrics, Lebanese American University, Beirut, Lebanon
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49
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Shah K, Upadhyaya M, Kandre Y, Pandya A, Saraf V, Saxena D, Mavalankar D. Epidemiological, clinical and biomarker profile of pediatric patients infected with COVID-19. QJM 2021; 114:476-495. [PMID: 34293142 PMCID: PMC8420635 DOI: 10.1093/qjmed/hcab206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/25/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population. METHODS For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis. RESULTS Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality. CONCLUSION Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.
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Affiliation(s)
- Komal Shah
- Assistant Professor, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
- Dr. Komal Shah (*Corresponding Author) Assistant Professor, Indian Institute of Public Health – Gandhinagar, Opp. Air Force Head Quarters, Nr. Lekawada Bus Stop, Gandhinagar-Chiloda Road, Gandhinagar – 382042, Mob: 9924264500,
| | - Mudita Upadhyaya
- Independent Researcher, 9138 Harbor Hills Drive, Houston Texas, 77054, USA
| | - Yogini Kandre
- Programe Associate, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
| | - Apurvakumar Pandya
- Economic Evaluation Specialist, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Vishakh Saraf
- MPH Student, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Deepak Saxena
- Professor, Indian Institute of Public Health Gandhinagar-382042, Gujarat, India
| | - Dileep Mavalankar
- Director, Indian Institute of Public Health Gandhinagar - 382042, Gujarat, India
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50
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Snapiri O, Rosenberg Danziger C, Shirman N, Weissbach A, Lowenthal A, Ayalon I, Adam D, Yarden-Bilavsky H, Bilavsky E. Transient Cardiac Injury in Adolescents Receiving the BNT162b2 mRNA COVID-19 Vaccine. Pediatr Infect Dis J 2021; 40:e360-e363. [PMID: 34077949 PMCID: PMC8443419 DOI: 10.1097/inf.0000000000003235] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccines are paramount in the effort to end the coronavirus disease 2019 global epidemic. BNT162b2 is approved for the vaccination of adolescents over 16 years of age. Systemic adverse events were scarce though the pretested cohort of this age group was relatively small. The aim of the current study is to raise awareness for potential adverse reactions. METHODS This is a case series of patients diagnosed with perimyocarditis following vaccination. Patients were compiled from 3 pediatric medical centers in Israel through a network of pediatricians and data regarding those cases was collected. In addition, incidence of perimyocarditis during the vaccination period was compared with previous years. RESULTS All patients were males 16-18 years old, of Jewish descent, who presented with chest pain that began 1-3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose. All cases were mild and none required cardiovascular or respiratory support. The incidence of perimyocarditis during the vaccination period was elevated in comparison to previous years. CONCLUSIONS This case series describes a time association between coronavirus disease 2019 vaccine and perimyocarditis in adolescents. All cases were mild, although only long-term follow-up can reveal the true impact of this cardiac injury. While it seems that the incidence of perimyocarditis during the vaccination campaign period is increased, a more comprehensive data collection on a wider scale should be done. We hope this report will serve as a reminder to report events and allow for analysis of potential adverse reactions.
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Affiliation(s)
| | | | | | - Avichai Weissbach
- Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lowenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Cardiology Department, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Itay Ayalon
- Pediatric Intensive Care Unit, Dana-Dwek Children’s Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Dganit Adam
- Pediatric Intensive Care Unit, Meir Medical Center, Kfar Saba, Israel
| | - Havatzelet Yarden-Bilavsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics A, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Efraim Bilavsky
- From the Department of Pediatrics C
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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