Neuropsychiatric Manifestations of COVID-19 in Hospitalized Pediatrics: A Multicenter Cross-sectional Study

Background: The large proportion of coronavirus disease 2019 (COVID-19) patients has been associated with a large number of neu-ropsychiatric manifestations. Despite the high prevalence of COVID-19, few studies have examined such manifestations, especially in children and adolescents. Objective(s): This study investigated neuropsychiatric manifestations in hospitalized children and adolescents admitted for COVID-19 infection in Iran. Method(s): This prospective observational study included admitted children and adolescents (4-18 years old) diagnosed with COVID-19 infection, pediatric neurologists, child and adolescent psychiatrists, and infectious disease specialists, and assessed 375 infected patients during August and December 2021. Result(s): Of the 375 patients, 176 (47%) were female, with a mean age of 9.0 +/- 3.39 years. Psychiatric and neurological manifestations were reported in 58 (15.5%) and 58 (15.5%) patients, respectively. The most prevalent psychiatric disorders were separation anxiety disorder (SAD) (5.1%), major depressive disorder (MDD) (3.5%), generalized anxiety disorder (GAD) (2.7%), insomnia (2.4%), and op-positional defiant disorder (ODD) (2.4%). Regarding neurological complications, seizures were the most prevalent (13.1%), followed by encephalitis (1.9%), transverse myelitis (0.3%), acute ischemic stroke (0.3%), and Guillain-Barre syndrome (0.3%). There was no significant relationship between the duration of COVID-19 infection (P = 0.54) and ICU admission (P = 0.44) with the emergence of psychiatric symptoms. Conclusion(s): The most prevalent neurologic and psychiatric complications among children and adolescents with COVID-19 infection were seizures and the symptoms of anxiety/mood disorders, respectively.Copyright © 2023, Author(s).

Intestinal Carriage of Carbapenemase-Producing Enterobacteriaceae Members in Immunocompromised Children During COVID-19 Pandemic

Background: Hospital-acquired infection with carbapenem-resistant Enterobacteriaceae (CRE) is a global concern. The administration of antibiotics among the infected and non-infected immunocompromised children with SARS-CoV-2 is associated with an increased risk of intestinal CRE colonization and bacteremia during hospitalization. Objective(s): The present study aimed to detect the correlation between the intestinal colonization of carbapenemase encoding Enterobacteriaceae with SARS-CoV-2 infection and antibiotic prescription among immunocompromised children admitted to the oncology and Bone Marrow Transplantation (BMT) wards. Method(s): Stool samples were collected from the immunocompromised children, and the members of Enterobacteriaceae were isolated using standard microbiological laboratory methods. Carbapenem resistance isolates were initially characterized by the disc diffusion method according to CLSI 2021 and further confirmed by the PCR assay. SARS-CoV-2 infection was also recorded according to documented real-time PCR results. Result(s): In this study, 102 Enterobacteriaceae isolates were collected from the stool samples. The isolates were from Escherichia spp. (59/102, 57.8%), Klebsiella spp. (34/102, 33.3%), Enterobacter spp. (5/102, 4.9%), Citrobacter spp. (2/102, 1.9%), and Serratia spp. (2/102, 1.9%). The carbapenem resistance phenotype was detected among 42.37%, 73.52%, 40%, 50%, and 100% of Escherichia spp., Klebsiella spp., Enterobacter spp., Citrobacter spp., and Serratia spp., respectively. Moreover, blaOXA-48 (49.1%) and blaNDM-1 (29.4%), as well as blaVIM (19.6%) and blaKPC (17.6%) were common in the CRE isolates. SARS-CoV-2 infection was detected in 50% of the participants;however, it was confirmed in 65.45% (36/55) of the intestinal CRE carriers. The administration of antibiotics, mainly broad-spectrum antibiotics, had a significant correlation with the CRE colonization in both the infected and non-infected children with SARS-CoV-2 infection. Conclusion(s): Regardless of the COVID-19 status, prolonged hospitalization and antibiotic prescription are major risk factors associated with the CRE intestinal colonization in immunocompromised children. Copyright © 2023, Author(s).

Corrigendum to: Development of a Novel Scoring System for Comprehensive COVID-19 Patient Evaluation: Evidence-Based Systematic Review (Archives of Pediatric Infectious Diseases)

Due to our mistake in entering the affiliation and name of Mojgan Sarmadi in our article (Article ID: 110201, DOI: 10.5812/pedinfect.110201), we would like to apologize for any inconvenience made to our author and her affiliated organization, which is "National Institute of Dental and Craniofacial Research, Oral Immunity and Infection Unit, Oral and Pharyngeal Cancer Branch, National Institute of Health, Bethesda, MD 20892, US". We declare the correct affiliation of Mojgan Sarmadi is a private practice. © 2022, Author(s).

Spontaneous Pneumothorax in a Child with COVID-19

Introduction: SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality. Case Presentation: This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever. Conclusions: The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations. © 2021, Author(s).

Isolated Chronic Aseptic Meningitis Due to SARS-COV-2 Unresponsive to Ordinary Treatments

Serious, and sometimes, deadly complications of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are devastating. Whereas most manifestations of COVID-19 are respiratory (fever, dry cough, fatigue, pneumonia), it is getting to be progressively recognized that numerous organ functions can be affected by this disease, and the nervous system is one of them as neurological complications can affect up to 36% of adult patients. However, the prevalence and pathophysiology of these complications have yet to be fully elucidated in children. Here, we discuss an infant with neurological symptoms manifested as chronic isolated aseptic meningitis associated with COVID-19, which was unresponsive to ordinary treatments and dramatically responsive to dexamethasone. Immune-mediated reactions may have had a major pathophysiologic role in this case. © 2021, Author(s).

Life-threatening SARS-CoV-2 Infection in Children: A Single-center Case Series

Introduction: Coronavirus disease 2019 (COVID-19) is known as the most recent pandemic condition declared by the World Health Organization (WHO). It is widely believed that this infection is less frequent and severe in children, but few mortality reports are available in this age group population. Case Presentation: We described nine pediatric patients with probable or confirmed COVID-19 who died due to disease complications. Their age ranged between seven months and 14 years. All had underlying diseases, and three of them had been hospitalized before the COVID-19 diagnosis due to their previous medical conditions. Cough and respiratory symptoms were the most common symptoms observed in these patients. Bilateral ground-glass opacities were common radiologic findings. Conclusions: Although COVID-19 is less common in the pediatric group, all ages are vulnerable to this infection, and mortality may occur, especially in patients with underlying diseases. We emphasize that children with underlying diseases and COVID-19 should be hospitalized and monitored tightly during treatment. © 2021, Author(s).

An Algorithmic Approach to Children's Gastroenteritis in SARS-CoV-2 Epidemic: Iranian Expert's Consensus Statement

Diarrhea and vomiting with or without fever are common symptoms in children, while one of the most common clinical findings of Coronavirus disease 2019 (COVID-19) is gastrointestinal symptoms. Therefore, there is a need to develop an algorithm for dealing with a patient with gastroenteritis in the SARS-CoV-2 epidemic.

Development of a Novel Scoring System for Comprehensive COVID-19 Patient Evaluation: An Evidence-Based Systematic Review

Context: In the era of the SARS-CoV-2 virus pandemic, new scoring systems need to be developed to estimate the risk of COVID-19 complications aiding in the accurate prognosis. Improved scoring systems by combining multiple variables allow clinicians to optimize the allocation of limited medical resources for the best clinical outcomes. Methods: Published articles were selected that assessed the relationship between clinical, para-clinical, demographics, comorbidities, and outcomes of COVID-19 patients in a systematic review to develop a novel scoring system. Results: In this study, by summarizing the results of 97 studies and the experiences of experts, prognostic factors were determined and divided into four groups: Age, clinical symptoms, co-morbidities, and tests. Twenty-three published articles met the selection criteria and were included in this study. Accordingly, by the opinion of experts, prognostic factors were categorized into four main groups: Age, clinical symptoms, co-morbidities, and specific test results. Conclusions: This novel scoring model helps physicians to early identify critical COVID-19 patients and optimize patient management based on recent comprehensive data of the most significant predictive factors.

Renal Involvement in COVID-19 Among Iranian Children

Background: Information about renal involvement in pediatric patients with COVID-19 is limited, and there is not enough data about renal and urinary tract involvement in children infected with this novel virus. Objectives: This study aimed to determine the spectrum of kidney diseases in pediatric patients with COVID-19, admitted to a tertiary children's hospital. Methods: This cross-sectional study was conducted on 71 pediatric patients with COVID-19 infection. Diagnosis of COVID-19 was established basedonthe guidelinesby the Iranian Ministry of Health. The patients' demographiccharacteristics, clinicalsymptoms, laboratory results, and renal ultrasonography findings were extracted from the hospital medical records. Results: On admission, 10% of patients had oliguria, 7.7% had edema, and 3% had hypertension. The first urinalysis indicated proteinuria, leukocyturia, and hematuria in 46%, 24%, and 23% of the patients, respectively. Overall, 40.7% of the patients showed some degree of renal involvement. During hospitalization, acute kidney injury (AKI) occurred in 34.5% of the patients. Based on the pediatric risk, injury, failure, loss of kidney function, and end-stage kidney disease (pRIFLE) classification, stage I (risk group) was found in 20% of patients, stage II (injury group) in 25% of patients, and stage III (failure group) in 55% of patients with AKI. The total mortality rate was estimated at 12.67%, and the incidence of in-hospital death was 30% in pediatric patients with severe COVID-19 infection associated with AKI. Conclusions: The prevalence of AKI was high in patients with COVID-19 infection hospitalized in our tertiary hospital. We also found that a decrease in renal function was associated with a higher risk of mortality. Overall, early detection of AKI and effective treatment may help reduce mortality in patients with COVID-19.

Three Probable Pediatrics COVID-19 Cases with Kawasaki-Like Disease: A Case Series with Fallow-Up

The first case of Kawasaki-like disease in children infected with COVID-19 was reported in a preprint case report. In the present case series, three pediatric probable cases with COVID-19, who presented signs and symptoms of Kawasaki-like syndrome, and their three-month follow-up are provided.

Prevalence of SARS-CoV-2 Specific Antibodies in the Staff of a Children's Hospital, in Tehran, Iran

Background: In December 2019, a new coronavirus appeared in China, as a cause of acute respiratory disease. Healthcare Workers (HCWs) in children's hospitals are one of the groups who are at a high rate of exposure to COVID-19 patients. The detection of antibodies is useful and helps diagnose late or recent SARS-CoV-2 infection. Most children may present with asymptomatic or mild SARS-CoV-2 infection and can be silent sources of infection in the community and hospitals. Objectives: This study was conducted to determine the antibodies (IgM and IgG) against SARS-CoV-2 in Mofid children's hospital staff. Methods: This cross-sectional study evaluated 475 staff from Mofid children's hospital from April 20 to May 5, 2020, in Tehran. We collected blood samples for the antibody assay with a rapid test kit. A questionnaire was used to collect demographic and clinical data. Results: Of 475 staff who participated in this study, 25 (5.3%) were diagnosed with COVID-19 by Polymerase Chain Reaction (PCR) and/or CT scan. Besides,140 (29.4%) of them were positive for IgM and/or IgG SARS-CoV-2 antibodies. Conclusions: The seropositivity of antibodies against SARS-CoV-2 among children's hospital staff was higher than expected. Approximately 5% of the participants were diagnosed as definitive positive COVID-19 cases by PCR and/or CT scan, but 29.4% of them were seropositive. The difference is a warning, as it shows seropositive people could be silent sources of transmission during asymptomatic infection.

Reductions in commuting mobility correlate with geographic differences in SARS-CoV-2 prevalence in New York City.

SARS-CoV-2-related mortality and hospitalizations differ substantially between New York City neighborhoods. Mitigation efforts require knowing the extent to which these disparities reflect differences in prevalence and understanding the associated drivers. Here, we report the prevalence of SARS-CoV-2 in New York City boroughs inferred using tests administered to 1,746 pregnant women hospitalized for delivery between March 22nd and May 3rd, 2020. We also assess the relationship between prevalence and commuting-style movements into and out of each borough. Prevalence ranged from 11.3% (95% credible interval [8.9%, 13.9%]) in Manhattan to 26.0% (15.3%, 38.9%) in South Queens, with an estimated city-wide prevalence of 15.6% (13.9%, 17.4%). Prevalence was lowest in boroughs with the greatest reductions in morning movements out of and evening movements into the borough (Pearson R = -0.88 [-0.52, -0.99]). Widespread testing is needed to further specify disparities in prevalence and assess the risk of future outbreaks.

COVID-19 in obstetrics 2020: the experience at a New York City medical center.

The global spread of the SARS-CoV-2 virus during the early months of 2020 was rapid and exposed vulnerabilities in health systems throughout the world. Obstetric SARS-CoV-2 disease was discovered to be largely asymptomatic carriage but included a small rate of severe disease with rapid decompensation in otherwise healthy women. Higher rates of hospitalization, Intensive Care Unit (ICU) admission and intubation, along with higher infection rates in minority and disadvantaged populations have been documented across regions. The operational gymnastics that occurred daily during the Covid-19 emergency needed to be translated to the obstetrics realm, both inpatient and ambulatory. Resources for adaptation to the public health crisis included workforce flexibility, frequent communication of operational and protocol changes for evaluation and management, and application of innovative ideas to meet the demand.

Current concepts on immunopathology of COVID-19 and emerging therapies

Context: This scoping review tries to synthesize early findings on the immunopathogenicity of SARS-CoV-2 to assess the emerging therapies and vaccines by evaluating their impact based on the mechanism of pathogenicity. Methods: The three databases of PubMed, Scopus, and Google Scholar were searched from January 1, 2020, to March 15, 2020. To extract the results from the studies, the content, thematic analysis method was used. In this method, the topics studied were coded in the articles, and then major topics related to the articles were determined. After identifying major issues, the contents of the articles were reviewed. Results: A total of 2,250 articles were retrieved after deleting duplications, and after reviewing the thematic relevance, 45 of them were selected for the final analysis. Topics studied in the articles were classified into four main areas, including “virus entry inhibi-tion and immune response”, “vaccine and treatment targets”, “genome structure similarity to other coronaviruses,” and “pathogen-sis”. Conclusions: Results of this review showed that we have a long way to develop an effective and safe vaccine due to the structural and behavioral complexities of this virus. In the meantime, the scientific community should use results of megatrials, but until their accomplishing them, we have to use results of systematic reviews of randomized controlled trials.

COVID-19 and chickenpox as a viral co-infection in a 12-year-old patient, a case report

Introduction: Since the end of December 2019, most countries have been affected by the coronavirus disease 2019 (COVID-19) epidemic. The prevalence of COVID-19 in children has been reported much lower than adults. Most patients have mild symptoms, whereas some cases are asymptomatic. Information on the pediatric clinical manifestations is limited;therefore, reporting specific cases can improve the diagnosis process. Case Presentation: In this article, we reported a 12-year-old boy with chickenpox and COVID-19 at the same time. The patient initially had symptoms of chickenpox and then developed pneumonia. The PCR-test for COVID-19 was positive. The IgM test was positive, and IgG was negative. Chickenpox infection was confirmed by the serological test (positive IgM). The radiographic results showed reverse halo sign and vascular enlargement. Conclusion(s): These imaging findings are uncommon signs of COVID-19 in pediatrics. The patient was treated with hydroxychloro-quine and azithromycin and discharged a few days later with good condition. Copyright © 2020, Author(s).

Utility of available methods for diagnosing SARS-CoV-2 in clinical samples

The laboratory diagnosis of SARS-CoV-2 should be done to confirm coronavirus disease 2019 (COVID-19) in suspected patients. Although several diagnostic methods have been developed in this regard, their accuracy for clinical application is not very clear yet. To compare the diagnostic value of laboratory tests for the detection of COVID-19 infection, this study provides an upcoming review of the newly developed detection methods. Sensitivity, specificity, detection limit, and turn-around-time of these methods are compared and challenges for their application in clinical settings are reviewed. PubMed and Google Scholar web sites were used for the systematic search until April 9, 2020 to identify the published studies based on the following keywords: "Detection", "Coro-navirus 2019", "SARS-CoV-2", and "Sensitivity". Out of 526 results, a total of 54 articles, including 46 studies on detection methods, were considered eligible for the review. The results showed that most of the proposed tests focused on molecular methods, while immunological and point-of-care tests were investigated in 13 studies. There were also a few commercial automated methods for the qualitative detection of SARS-CoV-2 in clinical samples, most of which are not examined in the current review, as no data about their sensitivity and specificity were presented. Although the assessment of publication biases showed that 64% sensitivity and nearly 100% specificity for RT-PCR are close to reality, most of the related reports for serological methods are not valid and further studies are needed to confirm their utility in clinical settings. Moreover, the RT-PCR test alone cannot act as a gold standard because of bias in measurements. Therefore, antibody tests and other proposed methods could be used as supplementary diagnostic tests to improve RT-PCR accuracy. Although clinical findings are invaluable, in many cases, they can provide more valuable supportive data than serological tests. Copyright © 2020, Author(s).

An algorithmic approach to diagnosis and treatment of coronavirus disease 2019 (COVID-19) in children: Iranian expert’s consensus statement

After the outbreak of 2019 novel corona virus infection in China, we have the outbreak of disease in Iran and until March 05, 2020 have been reported a total number of confirmed cases more than 3500 and approximately 3.3% deaths. The corona virus disease 2019 (COVID-19) infection as a newly emerging disease in East Asia has caused a great challenge in managing the patients and controlling the disease especially in children. This algorithm is based on the standard diagnosis and treatment strategies for pediatric viral infections and available strategies to prevention of COVID-19 infection. It is hoped that with international co-operation, this global dilemma will end with the least burden of disease. Due to the lack of scientific evidences in children, this algorithm is essential for decision making.