The Characteristics and Follow-Up of SARS-CoV-2 Infection in Pediatric Oncology Patients

Introduction Clinical data about the first and second most prominent waves of SARS-CoV-2 among pediatric cancer patients were inconsistent. This study aims to retrospectively report the clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric oncology patients. Methods This is an observational, retrospective study conducted in a tertiary care oncology center from March 2020 to May 2022. We reviewed the prevalence, severity of symptoms, and duration of positivity in relation to blood count laboratory data and mortality with a follow-up of 30 days post-infection for SARS-CoV-2. Results A total of 396 PCR tests were performed on 342 pediatric cancer patients. The overall rate of SARS-CoV-2 positivity was 43.1% (2.7% in the first wave and 95.4% in the second wave). Among 342 screened pediatric cancer patients, 72 patients had confirmed SARS-CoV-2 positivity in 92 different episodes. Nearly 59% had a mild or moderate infection, with fever and cough as the predominant presentations. The mean duration of positivity was 18.4±7.76 days. Comparing the laboratory values before and after acquiring the COVID-19 infection, only monocytes, hemoglobin, hematocrit, and platelets were statistically significantly affected, with P-values of 0.002, 0.03, 0.02, and 0.01, respectively. More than 18% of patients had grade 3 to 4 neutropenia (absolute neutrophil count=0.39±0.35) before COVID-19 infection and remained neutropenic throughout the disease, regardless of symptom severity. The mean recovery time was 13.67±8 days, which resulted in a delay in cancer treatment delivery of up to four weeks in 42.2% of patients. Conclusion Our data demonstrated that pediatric cancer patients with SARS-CoV-2 infection have a mild to moderate course of COVID-19 disease, with the majority being symptomatic, yet a great portion of our study population experienced treatment interruptions reaching up to four weeks caused by COVID-19.

Effect of n-3 supplementation on hyperactivity, oxidative stress and inflammatory mediators in children with attention-deficit-hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with difficulties in learning, behaviour and psychosocial adjustment that persist into adulthood. Decreased omega-3 fatty acids and increased inflammation or oxidative stress may contribute to neuro-developmental and psychiatric disorders such as ADHD. The aim of this study was to determine the effect of n-3 supplementation on hyperactivity, oxidative stress and inflammatory mediators in children with ADHD.

METHODS

In this double blind study, 103 children (6-12 years) with ADHD receiving maintenance therapy were assigned randomly into two groups. The n-3 group received n-3 fatty acids (635 mg eicosapentaenoic acid (EPA), 195 mg docosahexaenoic acid (DHA)), and the placebo group received olive oil capsules which were visually similar to the n-3 capsules. The duration of supplementation was 8 weeks. Plasma C-reactive protein (CRP), interleukin-6 (IL-6) and the activity of glutathione reductase (GR), catalase (CAT) and superoxide dismutase (SOD) were determined before and after the intervention. Likewise the Conners' Abbreviated Questionnaires (ASQ-P) was applied.

RESULTS

After 8-week intervention, a significant reduction was observed in the levels of CRP ( P < 0.05, 95% CI = 0.72-2.02) and IL-6 (P < 0.001, 95% CI = 1.93-24.33) in the n-3 group. There was also a significant increase in activity of SOD and GR (P < 0.001). A significant improvement was seen in the ASQ-P scores in the n-3 group (P < 005).

CONCLUSION

Eight weeks of EPA and DHA supplementation decreased plasma inflammatory mediators and oxidative stress in the children with ADHD. These results suggest that n-3 fatty acid supplementation may offer a safe and efficacious treatment for children with ADHD.

Rhinosinusitis, symptomatology & absence of polyposis in children with primary ciliary dyskinesia

INTRODUCTION

Primary Ciliary Dyskinesia (PCD) describes a group of inherited disorders which result in functional ciliary defects leading to mucous stasis. Clinical manifestations include otitis media with effusion and chronic rhinosinusitis. Nasal polyposis has previously been thought to be linked to PCD, and current theories of 'polypogenesis' suggest that early and severe polyp formation could be expected among sufferers of this condition.

METHODS

Cross-sectional observational review of all children attending the multi-disciplinary clinic at a national tertiary-referral centre for PCD across a 3-month period. Careful examination was undertaken, and the SNOT-20 questionnaire administered.

RESULTS

Thirty patients were included. No nasal polyps were found, despite children clearly suffering rhinosinusitis and being debilitated by their symptoms. The rhinologically orientated questions of the SNOT-20 produced the most positive responses; however some other questions were found not to be useful in a paediatric population.

CONCLUSIONS

Nasal polyps do not occur in children with PCD, despite the presence of rhinosinusitis. Given that many current theories of polyp pathogenesis hinge on prolongation of proinflammatory stimuli, further investigations are needed into why this should not occur in the situation of chronic mucous stasis which is the hallmark of PCD.

High resolution spiral CT scan in the diagnosis of pseudoaneurysm of ascending aorta

Pseudoaneurysms of the ascending aorta are rare (<1%), and extremely rare from aortic vent site, but can be a lifethreatening complication. The basic methods of diagnosis are computed tomography scan and aortography. We report high resolution spiral CT may provide the best less invasive means in the diagnosis of the pseudoaneurysm of the ascending aorta originated from the aortic vent site.

Hearing outcomes in children with primary ciliary dyskinesia--a longitudinal study

Primary ciliary dyskinesia (PCD) is a congenital abnormality of ciliary structure or function. The otological manifestations of the disease include otitis media with effusion (OME). To date, the severity of hearing loss and natural progression of OME in this select group of patients has not been documented. In this retrospective observational study, we looked at the tympanograms and audiograms of all children with PCD attending the Royal Brompton Hospital multidisciplinary clinic. Our results show an improvement in both hearing thresholds and tympanograms with age (p<0.001). Most cases resolve by the age of 12. This supports the current practice of conservative management in these patients. The problems of persistent otorrhoea and residual tympanic membrane perforation are thereby avoided with the reassurance that hearing loss will spontaneously resolve with time.

Biogenesis of multilamellar bodies via autophagy

Transfection of Mv1Lu mink lung type II alveolar cells with beta1-6-N-acetylglucosaminyl transferase V is associated with the expression of large lysosomal vacuoles, which are immunofluorescently labeled for the lysosomal glycoprotein lysosomal-associated membrane protein-2 and the beta1-6-branched N-glycan-specific lectin phaseolis vulgaris leucoagglutinin. By electron microscopy, the vacuoles present the morphology of multilamellar bodies (MLBs). Treatment of the cells with the lysosomal protease inhibitor leupeptin results in the progressive transformation of the MLBs into electron-dense autophagic vacuoles and eventual disappearance of MLBs after 4 d of treatment. Heterologous structures containing both membrane lamellae and peripheral electron-dense regions appear 15 h after leupeptin addition and are indicative of ongoing lysosome-MLB fusion. Leupeptin washout is associated with the formation after 24 and 48 h of single or multiple foci of lamellae within the autophagic vacuoles, which give rise to MLBs after 72 h. Treatment with 3-methyladenine, an inhibitor of autophagic sequestration, results in the significantly reduced expression of multilamellar bodies and the accumulation of inclusion bodies resembling nascent or immature autophagic vacuoles. Scrape-loaded cytoplasmic FITC-dextran is incorporated into lysosomal-associated membrane protein-2-positive MLBs, and this process is inhibited by 3-methyladenine, demonstrating that active autophagy is involved in MLB formation. Our results indicate that selective resistance to lysosomal degradation within the autophagic vacuole results in the formation of a microenvironment propicious for the formation of membrane lamella.

Primary ciliary dyskinesia: diagnosis and standards of care

Primary ciliary dyskinesia (PCD) is characterized by disease of the upper and lower respiratory tract, in association with visceral mirror image arrangement in 50% of cases, due to abnormal structure and/or function of cilia. The purpose of this paper is to review the clinical features, diagnosis and management of PCD. Presentations include neonatal respiratory distress, recurrent lower respiratory tract infection, chronic rhinosinusitis and male infertility. PCD enters the differential diagnosis of bronchiectasis, atypical asthma, and unusually severe upper airway disease. Diagnosis is by a cascade of investigations, starting with the saccharin test in patients older than 10 yrs; ciliary beat frequency and pattern on light microscopy; and electron microscopy to assess ciliary morphology and orientation. It is important not to confuse primary and secondary ciliary abnormalities. Nasal nitric oxide is low in PCD, and this measurement shows promise as a screening test for PCD. Diagnosis is important, in order to prevent the development of bronchiectasis and to avoid any unnecessary otorhinolaryngological procedures. Regular follow-up is essential, and management should be multidisciplinary, with input from centres with a special interest in PCD, having access to paediatric and adult chest physicians, otolaryngologists and audiological physicians, physiotherapists, counselling services and fertility clinics. The prognosis is good, but morbidity can be considerable if PCD is incorrectly managed.

Primary ciliary dyskinesia: diagnosis and standards of care

Primary ciliary dyskinesia (PCD) is characterized by disease of the upper and lower respiratory tract, in association with visceral mirror image arrangement in 50% of cases, due to abnormal structure and/or function of cilia. The purpose of this paper is to review the clinical features, diagnosis and management of PCD. Presentations include neonatal respiratory distress, recurrent lower respiratory tract infection, chronic rhinosinusitis and male infertility. PCD enters the differential diagnosis of bronchiectasis, atypical asthma, and unusually severe upper airway disease. Diagnosis is by a cascade of investigations, starting with the saccharin test in patients older than 10 yrs; ciliary beat frequency and pattern on light microscopy; and electron microscopy to assess ciliary morphology and orientation. It is important not to confuse primary and secondary ciliary abnormalities. Nasal nitric oxide is low in PCD, and this measurement shows promise as a screening test for PCD. Diagnosis is important, in order to prevent the development of bronchiectasis and to avoid any unnecessary otorhinolaryngological procedures. Regular follow-up is essential, and management should be multidisciplinary, with input from centres with a special interest in PCD, having access to paediatric and adult chest physicians, otolaryngologists and audiological physicians, physiotherapists, counselling services and fertility clinics. The prognosis is good, but morbidity can be considerable if PCD is incorrectly managed.

Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis

CONCLUSIONS

Urinary TAP obtained within the first 48 h of the onset of symptoms can distinguish patients with severe acute pancreatitis.

BACKGROUND

Urinary trypsinogen activation peptide (TAP) has recently been described as an early marker of severity in acute pancreatitis.

METHODS

In a multicenter study, urine samples were collected for TAP concentration at 6-12, 24, and 48 h after admission from 139 patients with acute pancreatitis (99 with mild disease, 40 with severe disease) and from 50 control patients. Severity of acute pancreatitis was defined by the presence of organ failure and/ or pancreatic necrosis on dynamic contrast-enhanced computed tomography.

RESULTS

Median urinary TAP in the 139 patients with acute pancreatitis compared to the 50 control patients was significantly higher at admission, 4.6 vs 0.8 ng/mL (p < 0.001), and 6-12 h, 1.9 vs 0.55 ng/mL (p = 0.04). Among patients who presented within 48 h of the onset of symptoms, the median urinary TAP for severe pancreatitis (9 patients) compared to mild pancreatitis (40 patients) was significantly higher at admission, 29.6 vs. 3.6 ng/mL (p = 0.001). Also, when obtained within 48 h of the onset of symptoms, all patients with severe pancreatitis had an admission urinary TAP level > 10 ng/mL. The sensitivity and specificity of an admission urinary TAP > or = 10 for severe pancreatitis was 100 and 85%, respectively. Given a cutoff of 10 ng/mL for an admission urinary TAP obtained within 48 h of the onset of symptoms, the negative predictive value was 100% for mild pancreatitis.

Pseudocyst drainage predisposes to infection when pancreatic necrosis is unrecognized

OBJECTIVE

The objective of this report was to determine the clinical outcome of intervention among patients with a pancreatic pseudocyst associated with sterile pancreatic necrosis.

METHODS

We reviewed records of all patients with sterile pancreatic necrosis who required intervention during the past 10 yr.

RESULTS

A total of 17 patients required intervention. Twelve with sterile necrosis unassociated with a pancreatic pseudocyst underwent surgical debridement. An additional five patients with sterile necrosis associated with a pancreatic pseudocyst underwent drainage of the pseudocyst (two by pigtail catheter drainage, one by endoscopic cyst gastrostomy, and two by surgical cyst gastrostomy). After drainage, four of these five patients developed pancreatic infection that required surgical debridement. Pancreatic infection occurred because the drainage procedures in these four patients failed to remove the underlying necrotic material.

CONCLUSIONS

When a pancreatic pseudocyst occurs in association with pancreatic necrosis, radiological and endoscopic decompression should not be attempted.