ABSTRACT
BACKGROUND AND AIM: Sars-CoV-2 infection can lead to severe pulmonary impairment at all ages, however, the best therapy in children is not established. Our objective is to discuss a severe pulmonary case in a pediatric oncology patient who presented good clinical evolution and the therapeutic measures chosen in its management. METHOD(S): Case report and literature review. RESULT(S): A 2-year-old girl undergoing chemotherapy for acute lymphocytic leukemia had received cytarabine and methotrexate one week before being admitted to the ward for febrile neutropenia, identified with Sars-Cov-2 infection by RT-PCR. Referred to pediatric intensive care on day 3 of symptoms when she was prostrate and antibiotics switched to a broader spectrum. On day 8 of symptoms she rapidly developed respiratory failure and required mechanical ventilation at high parameters, CT scan showed lesions in ground glass in 75% of the lung parenchyma. On day 9, she was still feverish and showed altered inflammatory tests, such as ferritin 4492 mcg/L D-dimer 5909 ng/dL CRP 28 mg/ dL. Cardiac, hepatic and renal functions remained stable. At that moment, the patient received gammaglobulin 2g/kg in a single dose and methylprednisolone 2mg/kg/day for 5 days. Substantial improvement was observed 48 hours after the introduction of anti-inflammatory therapy, allowing for weaning and extubation after 7 days of mechanical ventilation. 72 hours after extubation, she was discharged home, breathing normally on room air. CONCLUSION(S): Severe Sars-Cov-2 lung infection in a pediatric oncology patient with markedly high inflammatory tests was treated with anti-inflammatory therapies such as steroids and gammaglobulin, with rapid and favorable recovery (Figure Presented).
ABSTRACT
Background and aims: Cerebral venous sinus thrombosis (CVST) has been acknowledged as a rare adverse event related to thrombosisthrombocytopenia syndrome (TTS) following COVID-19 vaccination. Methods: A systematic review and meta-analysis of investigator-initiated registries including confirmed CVST cases was performed, with the aim to calculate the odds ratio of TTS-CVST versus non-TTS-CVST (1) after vector-based vaccines and (2) after non-vector-based vaccines;(3) the inhospital mortality ratio of TTS-CVST compared to non-TTS-CVST;and (4) the dependency or death at discharge among TTS-CVST compared to non-TTS-CVST cases. Results: Two eligible studies were included in the meta-analysis, comprising a total of 211 patients with CVST associated with COVID-19 vaccination. Vector-based COVID-19 vaccination was associated with a higher likelihood of TTS-associated CVST than with non-TTS-CVST (OR: 52.34, 95%CI: 9.58-285.98). TTS-CVST was also associated with higher likelihood of in-hospital mortality (OR: 13.29;95%CI: 3.96-44.60) and death or dependency at discharge compared to non-TTS-CVST (OR: 6.70;95%CI: 3.15-14.26). TTS-CVST was recorded with a shorter interval between vaccination and symptom onset [Mean Difference (MD):- 6.54 days;95%CI:-12.64 - -0.45], affecting younger patients (MD:-9.00 years;95%CI: -14.02 - -3.99) without risk factors for thromboses (OR:2.34;95%CI: 1.26-4.33), and was complicated more frequently with intracerebral hemorrhage (OR:3.60;95%CI: 1.31-9.87) and concomitant thromboses in other sites (OR:11.85;95%CI: 3.51-39.98) compared to non-TTS-CVST cases. Conclusions: TTS-CVT following COVID-19 has distinct clinical phenotype and prognosis compared to non-TTS-CVT. Further epidemiological data are required to evaluate the impact of different treatment strategies on outcome of TTS-CVT cases following COVID-19 vaccination.
ABSTRACT
Introduction: Cerebral Venous Sinus Thrombosis (CVST) as a part of the thrombosis and thrombocytopenia syndrome is a rare adverse drug reaction of SARS-CoV-2 vaccination. The estimated background rate of CVST in adults is around 1 case per million per month, and CVST with thrombocytopenia accounts for 8% of all CVST. We assessed the age-stratified risk of CVST with and without thrombocytopenia after SARS-CoV-2 vaccination. Methods: We estimated the absolute risk of any CVST, CVST with thrombocytopenia, and CVST without thrombocytopenia, within 28 days of first dose SARS-CoV-2 vaccination, using data from the European Medicines Agency's EudraVigilance database (until 13 June 2021). As a denominator, we used data on vaccine delivery from 31 European countries. For 22.8 million adults from 25 countries we estimated the absolute risk of CVST after the first dose of ChAdOx1 nCov-19 per age category. Results: The absolute risk of CVST within 28 days of first dose vaccination was 7.5 (95%CI 6.9- 8.3), 0.7 (95%CI 0.2-2.4), 0.6 (95%CI 0.5-0.7) and 0.6 (95%CI 0.3-1.1) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. The absolute risk of CVST with thrombocytopenia within 28 days of first dose vaccination was 4.4 (95%CI 3.9-4.9), 0.7 (95%CI 0.2-2.4), 0.0 (95%CI 0.0-0.1) and 0.0 (95%CI 0.0-0.2) per million of first doses of ChAdOx1 nCov-19, Ad26.COV2.S, BNT162b2 and mRNA-1273, respectively. In recipients of ChAdOx1 nCov-19, the risk of CVST, both with and without thrombocytopenia, was the highest in the 18-24 years age group (7.3 per million, 95%CI 2.8-18.8 and 3.7, 95%CI 1.0-13.3, respectively). The risk of CVST with thrombocytopenia was the lowest in ChAdOx1 nCov-19 recipients ≥70 years (0.2, 95%CI 0.0- 1.3). Age <60 compared to ≥60 was a predictor for CVST with thrombocytopenia (incidence rate ratio 5.79;95%CI 2.98-11.24, p<0.001). Discussion: The risk of CVST with thrombocytopenia within 28 days of first dose vaccination with ChAdOx1 nCov-19 was higher in younger age groups. The risk of CVST with thrombocytopenia was slightly increased in patients receiving Ad26.COV2.S, comparing with the estimated background risk. The risk of CVST with thrombocytopenia was not increased in recipients of mRNA vaccines for SARS-CoV-2.
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This article has as main goal to discuss the Covid-19 spread due to the mobility of the patients over the urban network in the city of Imperatriz, in Maranhao State. The analyzed time frame refers to the first 100 days of the pandemic, emphasizing the urban network of the Imperatriz city space. The examined data of the ICU, hospital beds and respirators in the State, also the data about the viral evolution in this period. The main data source are the Datasus and the Maranhao State health offil ce. The studied characteristics suggest that the medical-hospital equipment concentration in few cities of the State, especially in Imperatiz, is an expressive bottleneck when fighting the Sars-CoV-2 pandemic, due to the necessity of mobilization of people from the smaller centers with less health services to the ones with more hospital beds, resulting in more spread areas. Therefore, the spread of the disease happens in a graduated way in the urban network of the city, and this data is not always evident in the epidemiologic reports.