Adverse reactions to coronavirus disease 2019 vaccines in children and adolescents

The incidence of coronavirus diseases 2019 (COVID-19), including severe cases, has been increasing in both children and adolescents with the spread of the delta variant. COVID-19 vaccines have been identified to be effective in the prevention of COVID-19transmission in children and adolescents and keeping schools open. However, adverse reactions associated with COVID-19 vaccination in children and adolescents contribute to parents’ hesitation to proceed with vaccination, especially due to serious, albeit rare, reactions. The results from COVID-19 vaccine clinical trials on the safety and efficacy of COVID-19 vaccines in children and adolescents are promising in terms of their effects on COVID-19 infection prevention. In the present study, we summarize the adverse reactions of COVID-19 vaccines in children and adolescents, based on the clinical trials, mainly including Pfizer-BioNTech and Moderna COVID-19 vaccines. In the Pfizer-BioNTech COVID-19 clinical trials, the most common local adverse reaction was pain at the injection site in 74.1%–86%, depending on age, and the most common systemic adverse reaction was fatigue, followed by headache, myalgia, diarrhea, and fever with differences in the distribution according to age. There was no severe adverse reaction related to any COVID-19 vaccine in children and adolescents during the study period. In the mass vaccination program of COVID-19 in children and adolescent, myocarditis has rarely been diagnosed after COVID-19 vaccination, which most commonly occurred in boys after the second dose. Currently, Pfizer-BioNTech COVID-19 vaccines can be safely recommended in children and adolescents for the prevention of COVID-19 infection and the reduction in COVID-19 severity.

Changes in the Clinical Characteristics of Kawasaki Disease After Coronavirus Disease (COVID-19) Pandemic: A Database Analysis

Background@#The impact of the coronavirus disease 2019 (COVID-19) pandemic on Kawasaki disease (KD) has not yet been established. We investigated changes in the observed number and severity of KD cases and accompanying coronary artery complications during the COVID-19 pandemic in Korea. @*Methods@#This retrospective observational study included patients aged < 18 years with acute-phase KD diagnosed between March 2018 and February 2021. Data were extracted from the Clinical Data Warehouse that houses data from five affiliated university hospitals in Korea. We analyzed changes in the number of patient admissions and clinical characteristics, including cardiac complications, before and after the onset of the COVID-19 pandemic. @*Results@#A total of 475 admissions were included in the analysis. After March 2020, we observed a significant decrease of 33% in the number of hospitalizations for KD compared with the average number of hospitalizations during the previous 2 years. The number of admissions per month significantly decreased by 7.9 persons/month (95% confidence interval, −13.8 to −2.0; P < 0.05) compared with that before COVID-19. By contrast, the proportion of patients aged < 1 year with KD increased. The proportion of patients with refractory KD and the rate of cardiac complications did not change significantly. @*Conclusion@#Since the onset of the COVID-19 pandemic, the total number of hospital admissions for KD has decreased in Korea. Although the proportion of admissions of infants aged < 1 year increased, no changes were observed in clinical courses and complications.

Prediction of COVID-19-related Mortality and 30-Day and 60-Day Survival Probabilities Using a Nomogram

Background@#Prediction of mortality in patients with coronavirus disease 2019 (COVID-19) is a key to improving the clinical outcomes, considering that the COVID-19 pandemic has led to the collapse of healthcare systems in many regions worldwide. This study aimed to identify the factors associated with COVID-19 mortality and to develop a nomogram for predicting mortality using clinical parameters and underlying diseases. @*Methods@#This study was performed in 5,626 patients with confirmed COVID-19 between February 1 and April 30, 2020 in South Korea. A Cox proportional hazards model and logistic regression model were used to construct a nomogram for predicting 30-day and 60-day survival probabilities and overall mortality, respectively in the train set. Calibration and discrimination were performed to validate the nomograms in the test set. @*Results@#Age ≥ 70 years, male, presence of fever and dyspnea at the time of COVID-19 diagnosis, and diabetes mellitus, cancer, or dementia as underling diseases were significantly related to 30-day and 60-day survival and mortality in COVID-19 patients. The nomogram showed good calibration for survival probabilities and mortality. In the train set, the areas under the curve (AUCs) for 30-day and 60-day survival was 0.914 and 0.954, respectively; the AUC for mortality of 0.959. In the test set, AUCs for 30-day and 60-day survival was 0.876 and 0.660, respectively, and that for mortality was 0.926. The online calculators can be found at https://koreastat.shinyapps.io/RiskofCOVID19/. @*Conclusion@#The prediction model could accurately predict COVID-19-related mortality; thus, it would be helpful for identifying the risk of mortality and establishing medical policies during the pandemic to improve the clinical outcomes.

Prediction of COVID-19-related Mortality and 30-Day and 60-Day Survival Probabilities Using a Nomogram

Background@#Prediction of mortality in patients with coronavirus disease 2019 (COVID-19) is a key to improving the clinical outcomes, considering that the COVID-19 pandemic has led to the collapse of healthcare systems in many regions worldwide. This study aimed to identify the factors associated with COVID-19 mortality and to develop a nomogram for predicting mortality using clinical parameters and underlying diseases. @*Methods@#This study was performed in 5,626 patients with confirmed COVID-19 between February 1 and April 30, 2020 in South Korea. A Cox proportional hazards model and logistic regression model were used to construct a nomogram for predicting 30-day and 60-day survival probabilities and overall mortality, respectively in the train set. Calibration and discrimination were performed to validate the nomograms in the test set. @*Results@#Age ≥ 70 years, male, presence of fever and dyspnea at the time of COVID-19 diagnosis, and diabetes mellitus, cancer, or dementia as underling diseases were significantly related to 30-day and 60-day survival and mortality in COVID-19 patients. The nomogram showed good calibration for survival probabilities and mortality. In the train set, the areas under the curve (AUCs) for 30-day and 60-day survival was 0.914 and 0.954, respectively; the AUC for mortality of 0.959. In the test set, AUCs for 30-day and 60-day survival was 0.876 and 0.660, respectively, and that for mortality was 0.926. The online calculators can be found at https://koreastat.shinyapps.io/RiskofCOVID19/. @*Conclusion@#The prediction model could accurately predict COVID-19-related mortality; thus, it would be helpful for identifying the risk of mortality and establishing medical policies during the pandemic to improve the clinical outcomes.

The diagnostic usefulness and correlation of nasal eosinophil count and percentage in children with rhinitis

PURPOSE: Allergic rhinitis is the most common atopic disease and the most common chronic disease of children. Eosinophil count and percentage in nasal smear are useful for differential diagnosis of allergic rhinitis. The aim of this study is to investigate the correlation between nasal eosinophil count and percentage.METHODS: Between January 2017 and August 2018, 221 children patients with a clinical history of rhinitis were tested at the outpatient respiratory and allergy unit of the Department of Pediatrics, School of Medicine, The Catholic University of Korea. Nasal secretion was collected by swabbing a children's nasal inferior turbinate 3–4 times with a cotton swab and then placed on to a glass slide. Later, the smear was stained by Giemsa stain.RESULTS: This is the first study to assess the comparison of nasal eosinophil count and percent. There is a positive correlation between nasal eosinophil count and percent Y=1.02 X+2.82 (Y=Eosinophil count, X=Eosinophil percentage). To determine the usefulness of nasal eosinophil count and percentage in the diagnosis of allergic rhinitis, we analyzed receiver operating characteristic curves. The cutoff value of the nasal eosinophil count was 6.5/high-power field, and that of the nasal eosinophil ratio was 3% for the diagnosis of allergic rhinitis.CONCLUSION: In patients with suspected rhinitis, one of the values of nasal eosinophil count or percentage can be used in clinical practice.

Anaphylaxis to honey

Honey is a food ingested worldwide. Allergic reaction to honey is rare and only a few cases have been reported in the literature. A 20-month-old boy developed angioedema 30 minutes after eating rice cake containing honey. After 2 weeks, we performed food challenge tests with honey which resulted in anaphylaxis. This is the first case report on anaphylaxis to honey in Korea.

Tracheostomy in children: A 9-year experience in a tertiary hospital in Korea

PURPOSE: Tracheostomy has been increasingly performed in children, along with the improvements in neonatal and pediatric intensive care. The objective of this study was to describe the indications, comorbidities, complications, and outcomes of tracheostomy in children in a tertiary hospital. METHODS: This was a retrospective study of children who required tracheostomy in a tertiary hospital in Korea between April 2009 and March 2018. The medical records of the patients were retrospectively reviewed and analyzed. RESULTS: A total of 41 children underwent tracheostomy. The median age of the patients was 11.9 months (interquartile range [IQR], 5.4–179.2 months), and 20 (48.8%) were boys. Tracheostomy was performed commonly in respiratory disease (12 [29.2%]) and neurologic disease (17 [41.5%]). The indications of tracheostomy differed according to patient age. There were trends toward longer length of intubation (median, 78.0 days; IQR, 36.0–185.0 days), longer hospitalization (213.3±154.5 days), higher decannulation rate (32.0%) and lower complications (12.0%) in patients who received tracheostomy as an infant/toddler. CONCLUSION: Regarding pediatric tracheostomy in this study, there were bimodal age distribution and consequential clinical differences depending on patient age.

Chest radiographs and computed tomography scans in children with airway foreign body

PURPOSE: This study aimed to evaluate the diagnostic value of radiologic findings in children with suspected foreign body aspiration. METHODS: A retrospective medical chart review was done on 32 children with suspected foreign bodies in terms of age, sex, symptoms, signs, bronchographic findings, and type and location of foreign bodies. The diagnostic value of radiography was analyzed: 29 with chest anteroposterior (AP) or posteroanterior (PA) view, 23 with chest lateral decubitus view, 27 with chest computed tomography (CT), 29 with chest AP, PA or chest lateral decubitus view, and 25 with bronchoscopy. RESULTS: As a measure for detecting foreign body aspiration, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of radiologic findings were: chest AP or PA view, 50%, 100%, 100%, 29.4%, and 58.6%, respectively; chest lateral decubitus view, 57.9%, 50.0%, 84.6%, 20.0%, and 56.5%, respectively; chest AP, PA or chest lateral decubitus view, 69.6%, 66.7%, 88.8%, 36.4%, and 69.0%, respectively; and chest CT, 100.0%, 85.7%, 95.2%, 100.0%, and 96.2%, respectively. CONCLUSION: There is clinical benefit to take chest radiographs to diagnose foreign body aspiration. However, based on the results of this study, it may be not necessary to take chest lateral decubitus to diagnose foreign body aspiration. If chest radiographs show unilateral hyperinflation, foreign body aspiration can be diagnosed. In cases of normal chest radiography and history of a witnessed choking episode combined with positive signs, the diagnosis of airway foreign body aspiration should be made by using chest CT.

Efficacy of neutrophil-lymphocyte ratio and clinical predicting indexes on differentiating subarachnoid hemorrhage from acute headache patients at emergency department

OBJECTIVE: This study evaluated the clinical usefulness of the neutrophil-lymphocyte ratio (NLR), Ottawa subarachnoid hemorrhage (SAH) rule and EMERALD (Emergency Medicine, Registry Analysis, Learning and Diagnosis) SAH rule for predicting SAH in patients with acute headache. METHODS: This clinical retrospective study was conducted at an urban emergency department between January 2008 and December 2017. Alert, neurologically intact adult patients with acute headache were included. All data were drawn from electrical medical charts. The Ottawa SAH rule (positive if any of age ≥40, neck pain, loss of consciousness, onset during exertion, thunderclap headache, and neck stiffness), EMERALD SAH rule (positive if any of systolic blood pressure >150 mmHg, diastolic blood pressure >90 mmHg, serum glucose >115 mg/dL, or serum potassium 2.1) was added to the last step to have achieve 99.0% sensitivity and 56.7% specificity. CONCLUSION: The stepwise application of the Ottawa, EMERALD SAH rule, and NLR increased the specificity compared to each application. On the other hand, further studies will be needed to increase the sensitivity.

Ellagic acid plays a protective role against UV-B-induced oxidative stress by up-regulating antioxidant components in human dermal fibroblasts

Ellagic acid (EA), an antioxidant polyphenolic constituent of plant origin, has been reported to possess diverse pharmacological properties, including anti-inflammatory, anti-tumor and immunomodulatory activities. This work aimed to clarify the skin anti-photoaging properties of EA in human dermal fibroblasts. The skin anti-photoaging activity was evaluated by analyzing the reactive oxygen species (ROS), matrix metalloproteinase-2 (MMP-2), total glutathione (GSH) and superoxide dismutase (SOD) activity levels as well as cell viability in dermal fibroblasts under UV-B irradiation. When fibroblasts were exposed to EA prior to UV-B irradiation, EA suppressed UV-B-induced ROS and proMMP-2 elevation. However, EA restored total GSH and SOD activity levels diminished in fibroblasts under UV-B irradiation. EA had an up-regulating activity on the UV-B-reduced Nrf2 levels in fibroblasts. EA, at the concentrations used, was unable to interfere with cell viabilities in both non-irradiated and irradiated fibroblasts. In human dermal fibroblasts, EA plays a defensive role against UV-B-induced oxidative stress possibly through an Nrf2-dependent pathway, indicating that this compound has potential skin antiphotoaging properties.

Relative risk of virulence factors in Candida-infected mouse

Candida albicans is one of the most frequently isolated fungal pathogens in human. Recently, the prevalence of candida infection has markedly increased, partially due to the increase of immunocompromised hosts. Proposed virulence factors of the pathogenic Candida are the ability to form hyphae to adhere to epithelial cell surfaces, and to secrete acid proteinases and phospholipases. We measured the relative cell surface hydrophobicity (CSH) and the ability of proteinase production (PROT), phospholipase production (PLase), adherence to host epithelium (ADH), and hyphal transition (Germ). The relative risk of virulence factors was analyzed by lethality test in murine model of hematogeneously disseminated candidal infection. According to Cox's proportional hazard analysis, the statistically significant virulence factors were PROT, ADH, and CSH. PROT was the highest risk factor of them. To evaluate the applicability for the diagnosis and treatment of Candidiasis, we examined the protective effect of the active and passive immunizations with the materials purified from virulence factors and antibodies to them in Candia-infected mice model. The mean survival times of active and passive immunized groups were slightly longer than those of non-immunized groups.

The Effect of Rabbit Serum on the Expression of Cell Surface Hydrophobicity in Candida albicans / 대한의진균학회지

No abstract available.