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Background: Of all teenage deaths caused by coronavirus disease 2019 (COVID-19), 47% occurred in children aged 0-9. Like many other infectious diseases, reducing mortality in children requires widespread vaccination. Despite the availability of the COVID-19 vaccine, a large percentage of children have not received the vaccine. Objective(s): This survey aimed to study parents' reluctance to receive the COVID-19 vaccine for their children in Shiraz, Iran. Method(s): An online questionnaire was sent to parents whose 5 to 11-year-old children had received no COVID-9 vaccine through the health educators of primary schools in Shiraz, Iran. The questionnaire contained demographic questions and 16 beliefs about COVID-19 vaccination that were answered as yes/no. Result(s): We assessed 1093 respondents, including 49.5% (n = 542) male and 50.5% female students' parents. The mean number of wrong beliefs was 7.21 +/- 2.80 in parents who had boys and 7.78 +/- 2.95 in girls' parents. Also, 78.6% of participants had at least five wrong beliefs or excuses for not vaccinating their children. Notably, 82.8% of mothers and 84.3% of fathers were vaccinated with 2-3 doses against COVID-19. The most common wrong beliefs were probable vaccines' side effects in the future, the undesirable effect of vaccination on children's growth, and the awful effect of the vaccine on fertility, with a prevalence of 82.7%, 81.2%, and 76.7%, respectively. Conclusion(s): This study identified that most participants believed that COVID-19 vaccines have side effects for their children and unfavorable effects on children's growth and infertility.Copyright © 2023, Author(s).
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Background: Coronavirus disease 2019 (COVID-19) has turned into a global public health crisis since the end of 2019. It may thus take years to develop new drugs, so evaluating the existing ones can play a key role in suppressing or even mitigating the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Objective(s): This study reflected on the effects of ivermectin (IVM) and metronidazole (MTR) vs. standard treatment protocols on symptoms, humoral immune responses, and outcomes of COVID-19 in hospitalized patients. Method(s): This triple-blinded randomized controlled trial (RCT) of IVM and MTR vs. standard treatment protocols was conducted from February 2021 to May 2021. A total number of 107 participants were accordingly selected from all patients infected with SARS-CoV-2 and positive results for SARS-CoV-2 based on the reverse transcription-polymerase chain reaction (RT-PCR) or the computerized tomography (CT) scan results at three teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. In this RCT, several indicators, including some vital signs, biomedical parameter, length of hospital stay (LOS), and death, were considered the outcomes. Result(s): A total number of 107 patients were recruited in this study. The results revealed that 10 patients (10.4%) expired during hospitalization. The mortality rate in IVM group (4.5%) was lower compared with MTZ (15.8%) and standard treatment (11.8%) (P = 169). After five days, the mean differences of lymphocyte and neutrophil counts differed significantly between groups (P = 0.020 and P = 0.029, respectively). But, other outcomes did not differ (P > 0.05). Conclusion(s): Based on this RCT, neither IVM nor MTZ could significantly affect COVID-19 patients' recovery patterns compared with the standard treatment protocols. Hence, more studies are needed to test diverse combinations of immunological response trigger-ing and anti-inflammatory drugs. Moreover, including and relying on IVM in clinical guidelines for COVID-19 should be cautioned and based on more evidence. Copyright © 2022 Author(s).
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Background: Background The SARS-CoV- 2 infection has been associated with a potentially severe inflammatory reaction, endothelial damage, and coagulation cascade activation that cause thrombosis. There is limited information on the thrombosis and anticoagulant therapy in children with COVID-19 and no design pediatric-specific recommendations for thromboprophylaxis in COVID-19 are available. Aim(s): This study aims to evaluate the outcome of thromboprophylaxis in children less than 18-year- old with COVID-19 infection. Method(s): A retrospective study was conducted on 184 pediatric patients with confirmed COVID-19 infection in southern Iran. A designed questionnaire was made to collect all demographic, clinical, and laboratory data. According to World Health Organization, the patients were classified as asymptomatic/mild, moderate, severe, and critically ill. Result(s): The mean age of the patients was 7.04 +/- 5.9 (1 week to < 18 years), 96 boys and 88 girls. Overall, 33 patients received anticoagulant therapy. The median of D-dimer was insignificantly higher in patients taking anticoagulant therapy compared to another group. (P = 0.133). All variables were comparable between the two groups. The mortality rate was non-significantly higher in patients who were not treated with anticoagulants (14%) compared to the thromboprophylaxis group (9%) (P = 0.567). In the critical group, two patients were complicated with disseminated intravascular coagulation (2.56%), one patient (1.28%) with deep vein thrombosis despite taking thromboprophylaxis, and one (1.28%) with pulmonary thromboembolism while the patient did not take anticoagulant during hospital admission Table 1). Conclusion(s): Our data showed a lower rate of thrombosis (1.4% in moderate to severe/critically ill patients) than adult patients with COVID-19 infection. Moreover, higher mortality rate was observed in patients without anticoagulant therapy, though statistically not significant. It may underline the role of anticoagulants in moderate to severe/critically ill children with COVID-19 infection. Expert opinion and personal experience are necessary, while we have a significant knowledge gap in understanding COVID-19- associated coagulopathy and thrombotic risk in children. (Table Presented).
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Background: SARS-CoV-2 has been characterized since December 2019 as the etiology of severe pneumonia throughout the world. However, the majority of children and adolescents with the respective infection have mild COVID-19. In April 2020, a warning was issued by the National Health Service (NHS), based on which a multisystem inflammatory syndrome in children (MIS-C) could be associated with COVID-19, presenting with cardiovascular shock, fever, and hyperinflammation. The syndrome presents with fever and organ involvement but with no pathognomonic findings or diagnostic tests, while some of the manifestations are almost the same as those of Kawasaki disease.Objectives: Knowledge of clinical course, demographic data, treatment, and prognosis can contribute to the more efficient man-agement of the patients and, consequently, a decrease in morbidity and mortality.Methods: Seventy-five patients < 18 years from September 22, 2020, to March 10, 2021, in Namazi hospital, Shiraz, Iran, with a diag-nosis as per MIS-C defined criteria, were recruited.Results: Median age of the patients was 6.2 years, and 58.6% were male. Of the patients, 46% had positive SARS-CoV-2 RT-PCR, an-tibody, or both. Thirty percent of the total patients reported contact with proven COVID-19 cases. The abdominal free fluid in 17 patients, hepatitis in one patient, and stasis in both kidneys of one patient were detected. Upon echocardiography on the first day, 77%, 48%, 21%, and one patient were with tricuspid regurgitation, mitral regurgitation, abnormal LV function, and myocarditis, re-spectively;however, after 5 -7 days, the repeated echocardiography revealed 44% of patients with tricuspid regurgitation, 30% with mitral regurgitation, and 6% with abnormal LV function. For the treatment, 18% of the patients received inotropes, 60% ASA, 32% IVIG, 84% glucocorticoids, and 25.3% received furosemide. All of the patients received antibiotics as well. Finally, 97% of the patients were discharged alive, while two cases died.Conclusions: The results of this study suggest the importance of cardiac consultation along with early hospital care during the course of MIS-C in order to prevent the associated short-term and long-term complications.
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Objectives The medical and health facilities are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study tested the preprocedural prophylactic mouthwash rinses to reduce the oral viral load. The findings from this study will help the practitioners to select the best mouthwash for the patients to mitigate the risk of transmission during aerosolizing. This study aimed to evaluate the effectiveness of four commonly used types of mouthwash in reducing intraoral viral load among hospitalized coronavirus disease 2019 patients. Materials and Methods This prospective cohort study was conducted with 116 patients referred to the Masih Daneshvari Hospital in Tehran, Hamadan University of Medical Sciences of Hamadan City, and Mashhad University of Medical Sciences. Patients were randomized into four groups with each group rinsed their mouth with 20 mL of 2% povidone-iodine, 1% hydrogen peroxide, normal saline as a control study group, or 0.12% chlorhexidine, respectively, for 20 seconds. The standard reverse transcription polymerase chain reaction method evaluated the virus load before and at 1 hour, 2 hours, and 4 hours after using the mentioned mouthwash. Results Our results revealed that chlorhexidine and H 2O 2showed the highest efficiency in reducing SARS-Co-2 load in the oral cavity and nasopharyngeal region of patients;they increased the Ct values by 9 to 10 (before: 25.84 vs. after 32. 4, p < 0.455) (17.333 vs. after 26.497, p <0.097). Conclusion Our findings suggest that chlorhexidine and H 2O 2could be used in dental clinics to reduce the risk of transmitting the SARS-CoV-2 virus from infected individuals to dentists before dental procedures. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction: The first cases of coronavirus disease 2019 (COVID-19) were identified in Wuhan, China, in December 2019, and then it immediately spread to other parts of the world. Conjunctivitis has been reported as one of the manifestations of the disease. In this study, we report a three-year-old child with a confirmed diagnosis of COVID-19 developing conjunctivitis in Iran. Case Presentation: The patient was a three-year-old male child who was referred to Namazee Hospital (Shiraz) due to fever, dry cough, tachypnea, and respiratory distress. He was admitted with the impression of a COVID-19 infection. On the sixth day of admission, the patient developed unilateral red-eye and foreign body sensation in the left eye. A conjunctival swab was done for collecting tears and conjunctival secretions from the lower eyelid fornix without topical anesthesia and was sent for assessing the presence of SARS-CoV-2 RNA, which was demonstrated to be positive after two days. Conclusions: Our findings suggest that the COVID-19 virus can be present in tears and conjunctiva. Additionally, it should be taken into account that ocular complications may not appear in the early stages of infection. © 2021, Author(s).
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Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively;p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. © 2021 Tehran University of Medical Sciences.
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Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the leading cause of death since December 2019. The most common clinical manifestations are cough, fever, and dyspnea;however, non-specific findings are also reported. This virus affects all age groups with a predilection to the adults, but children and neonates can also be affected. Case Presentation: An 11-days-old male neonate was brought to the hospital with chief complaints of vomiting and severe watery diarrhea. All laboratory data, including the stool OB/OP test, were normal except for leukocytosis. His parents were asymptomatic. In the following, qRT-PCR from neonate’s nasopharynx reported positive. Supportive and symptomatic treatments were done. The neonate discharged from the hospital without any significant sequelae. Conclusions: Extrapulmonary manifestation of COVID-19, especially gastrointestinal findings, should be considered in neonates to avoid possible complications and further spread of the disease.
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The COVID-19 pandemic has raised a huge sense of anxiety in people and health care staff. Yet, there are concerns regarding the exact routes of transmission and the best protective measures in health centers. It seems that a major route of transmission is via respiratory droplets, but it could be spread in an airborne mode in some airborne-producing procedures. This study provides a protocol as a quick, concise infection control module for those who work in operating rooms at the time of the outbreak of COVID-19 or similar infectious diseases.
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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.