Foreign Body Ingestion: A Real Hazard during the Covid Pandemic

Children curiosity for exploring their surrounding environment make them prone to foreign body (FB) ingestion which may lead to injuries and surgical intervention. COVID pandemic and national lockdown has impacted children's normal environment in addition to the changes in the health care system provision. The aim was to determine if the pandemic had a direct impact on the number and management of FB ingestion cases. Method All patients who were referred to our institution with diagnosis of FB from March 2020 to December 2020 were included. They were compared with FB referral during the period March-Dec 2019 as a control. Data included patients' demographics time to presentation type of FB ingested and management approach. Results There was a total of 30 patients with diagnosis of gastrointestinal FB during the study period as compared to 12 patients during the control periods. Thus during the COVID pandemic there was 2.5 times rise in number of cases. The mean age at presentation was 6.4 years during the study period as compared to 4.6 years in the control group. Timing of presentation varied from 0 to 57 days during the COVID pandemic as compared to control group who presented within 24hr except one who presented after 48hr.The most common foreign bodies encountered during the pandemic were button batteries (12) magnets (7) coins (5), other sharp and metallic objects (6). Two third (67%) of patients in the study period required surgical intervention as compared to one third (33%) during the control period. Most common site of impaction was stomach (40%) followed by oesophagus (36.6%). Conclusion The total number of children diagnosed with FB ingestion had significantly increased during the COVID pandemic. Public campaigns should be focused on raising awareness about the danger and medical emergency as a result of FB ingestion.

Junior Doctor Burnout Following the First Wave of the Covid-19 Pandemic

Objective The aim of the present study was to assess the burden of burnout in junior medical staff working across all surgical specialities at Great Ormond Street Hospital following the first wave of the COVID-19 pandemic. Methods We conducted a cross-sectional study in surgical junior doctors at Great Ormond Street Hospital following relaxation of the COVID-19-related restrictions at the end of June 2020. Burnout was evaluated using the Maslach Burnout Inventory (MBI). This is a widely-used validated questionnaire, which evaluates burnout across three domains: emotional exhaustion depersonalisation and personal accomplishment. All responses were anonymised points (0-6) were awarded for each response and composite scores were generated using an online tool. The degree of burnout was classified as low medium or high for each of the three domains using standardised score ranges. Results A total of 25 surgical junior doctors were included in our study. The response rate was 48% and scores from 12 fully completed MBI-HSS were included in subsequent analysis. 10 of the responders (83%) reported high burnout levels in at least one domain and 6 (50%) across at least two domains. The main contributor to burnout was the lack of feeling of personal accomplishment that was found to be high in 67% medium in 25% and low in 8% of the responders. We also found significant levels of emotional exhaustion (high: 42%;medium 42%;low 17%) as well as depersonalisation (high: 42%;medium 42%;low 17%). Conclusions Our study confirms the significant burden of burnout among junior doctors working in surgical specialities at Great Ormond Street Hospital for Children during the first wave of the COVID-19 pandemic. This could have detrimental effects on both doctor health and patient outcomes. Future work needs to focus on strategies to improve junior doctor wellbeing and prevent burnout.

Paediatric regenerative medicine 2 Regenerative medicine: postnatal approaches

Paper 2 of the paediatric regenerative medicine Series focuses on recent advances in postnatal approaches. New gene, cell, and niche-based technologies and their combinations allow structural and functional reconstitution and simulation of complex postnatal cell, tissue, and organ hierarchies. Organoid and tissue engineering advances provide human disease models and novel treatments for both rare paediatric diseases and common diseases affecting all ages, such as COVID-19. Preclinical studies for gastrointestinal disorders are directed towards oesophageal replacement, short bowel syndrome, enteric neuropathy, biliary atresia, and chronic end-stage liver failure. For respiratory diseases, beside the first human tracheal replacement, more complex tissue engineering represents a promising solution to generate transplantable lungs. Genitourinary tissue replacement and expansion usually involve application of biocompatible scaffolds seeded with patient-derived cells. Gene and cell therapy approaches seem appropriate for rare paediatric diseases of the musculoskeletal system such as spinal muscular dystrophy, whereas congenital diseases of complex organs, such as the heart, continue to challenge new frontiers of regenerative medicine.

COVID-19 and vertical transmission: assessing the expression of ACE2/TMPRSS2 in the human fetus and placenta to assess the risk of SARS-CoV-2 infection.

BACKGROUND: Pregnant women have been identified as a potentially at-risk group concerning COVID-19 infection, but little is known regarding the susceptibility of the fetus to infection. Co-expression of ACE2 and TMPRSS2 has been identified as a prerequisite for infection, and expression across different tissues is known to vary between children and adults. However, the expression of these proteins in the fetus is unknown. METHODS: We performed a retrospective analysis of a single cell data repository. The data were then validated at both gene and protein level by performing RT-qPCR and two-colour immunohistochemistry on a library of second-trimester human fetal tissues. FINDINGS: TMPRSS2 is present at both gene and protein level in the predominantly epithelial fetal tissues analysed. ACE2 is present at significant levels only in the fetal intestine and kidney, and is not expressed in the fetal lung. The placenta also does not co-express the two proteins across the second trimester or at term. INTERPRETATION: This dataset indicates that the lungs are unlikely to be a viable route of SARS-CoV2 fetal infection. The fetal kidney, despite presenting both the proteins required for the infection, is anatomically protected from the exposure to the virus. However, the gastrointestinal tract is likely to be susceptible to infection due to its high co-expression of both proteins, as well as its exposure to potentially infected amniotic fluid. TWEETABLE ABSTRACT: This work provides detailed mechanistic insight into the relative protection & vulnerabilities of the fetus & placenta to SARS-CoV-2 infection by scRNAseq & protein expression analysis for ACE2 & TMPRSS2. The findings help to explain the low rate of vertical transmission.

The local and systemic response to SARS-CoV-2 infection in children and adults

T1 Figure 1ConclusionsOverall, this largest paediatric single cell COVID-19 study to date showed significant differences in response to SARS-CoV-2 between children and adults, reflecting the changes of the immune landscape over developmental time, which in children are dominated by naïve and innate responses.