SARS-CoV-2 in pediatric age group: Multiple clinical presentations and broad spectrum of severity

INTRODUCTION: Since the new coronavirus began to spread throughout the world children and adolescents were affected on a smaller scale than adults, being mostly asymptomatic carriers or having mild to moderate symptoms, with lower risk of developing serious complications. When infected, patients in the pediatric age group presented a range of varied symptoms associated with the virus, different from adults where the main clinical symptom was respiratory. METHODS: Eight patients were admitted to our pediatric intensive care unit with a diagnosis of SARS-CoV-2, confirmed by PCR or serology;of these 3 were asymptomatic or presented mild flu symptoms, 2 had clinical presentation typical of severe acute respiratory distress syndrome, 1 presented abdominal pain associated with multisystemic inflammatory syndrome, 1 had clinical presentation of acute respiratory distress syndrome and later admitted again to our service fulfilling criteria for multisystemic inflammatory syndrome and 1 presented ischemic stroke after SARSCoV- 2. Four patients with severe symptoms required ventilatory support through mechanical ventilation due to respiratory failure, in most cases, difficult to manage and with shock requiring vasoactive drugs. Unlike adults, none of the 8 patients required renal replacement therapy. No outcome evolved to death. RESULTS: The diagnosis and management of SARS-CoV-2 in pediatrics is a challenge, due to this varied clinic and little experience of professionals due to a small number of cases, making this study important for better knowledge about the disease, thus improving care.

Ischemic stroke on multisystem inflammatory syndrome associated with SARS-CoV-2

INTRODUCTION: The World Health Association declared at match 2020 that the disease caused by nCoV-2019, the SARS-Cov-2, became a pandemic infection. The majority of patients infected by this new virus presented fever, cough and dyspnea, but also were reported cases of pneumonia leading to acute distress respiratory syndrome, acute kidney injury and encephalitis. Also, some patients presented a transient ischemic attack or a brain stroke as a complication of the infection. We will report a case of a pediatric patient that evolved with ischemic stroke after infection by nCoV-2019. METHODS: An 8 years old female patient, with previous asymptomatic infection by nCoV-2019 and no past medical history, started headache, abdominal pain and persistent fever for seven days evolving to left hemiparesis. At clinical assessment presented with ocular opening only when called (Glasgow coma scale of 14), tachypnea, dyspnea, hypotension, grade 3 muscular strength on left leg and grade 0 on left arm. Due to hypotension, at emergency sector, were initiated treatment with fluid resuscitation, but patient evolved to refractory shock needing vasoactive drugs and transference to intensive care unit. Performed cranial CT scan that showed recent extensive ischemic injury on territory supplied by left middle cerebral artery and occlusion of right internal carotid artery bifurcation. On laboratory tests patient presented increased C-reactive protein (35,8 mg/dL), ferritin (807 mg/ dL), D-dimer (13,69 μg/mL), ESR (50 mm/h) and troponin (0,097 ng/mL) with negative RT-PCR for SARS-CoV-2 and serology for SARS-CoV-2 with negative IgM, negative IgA and positive IgG. Towards this clinical case, patient fulfilled criteria for Pediatric Multisystem Inflammatory Syndrome temporally associated with SARS-CoV-2 (PIMS-TS), so were initiated treatment with human immunoglobulin 2g/Kg at the 3rd day after the admission of the patient on the intensive care unit. Patient evolved hemodynamically stable, being possible to suspend vasoactive drugs at the 4th day after admission. RESULTS: Although PIMS-TS is still considered a rare outcome, recognize its clinical and laboratorial manifestations and its possible complications, like the ischemic stroke, is essential to make an adequate and a timely management during patient hospitalization.

Women in a pandemic context: A theoretical-political essay about house and warfare

In this essay, we aim to think about the pandemic from the women's situation, by analyzing how the health crisis theoretically and politically operates the concepts of house and warfare. The house tenses borders between public and private spheres, especially when considering the issue of violence against women and the domestic work. As the strategy that has been used to combat coronavirus, warfare triggers concepts of masculinity. That withdraws women from political decision-making spaces, even though they are at the forefront fighting the pandemics as health workers and among other essential services. However, the warfare discourse also enables to expose attacks against women during a period if crisis. These devices are being used to direct social commotion and create a hierarchy over which lives matter. Thus, we highlight the importance of reading gender relations as a transversal issue in the construction of public policies during and after the pandemic. © 2020.