ABSTRACT
Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study is to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis. Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included. Results Seven patients with a median age of 12.5 (interquartile range 10.5-13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also had an acute abdomen. One patient had malignant hyperthermia during induction of anesthesia, so surgery was postponed and medical management was commenced. The clinical picture regressed with immunomodulation. All patients were treated with intravenous immunoglobulin and steroids. Four patients with acute abdomens improved with immunomodulation, and surgery was not needed. Conclusion MIS-C may present with an acute abdomen. Immunomodulation should be considered instead of surgery if the clinical course is not complicated.
ABSTRACT
This study focuses on modeling the daily deaths per new case of COVID-19 by using the Fractional Calculus and the Least Squares Method. Based on our prior work, we proposed a new modeling approach, assessed the strength of outbreak response, and analyzed possible underlying factors of the outbreak for 8 countries including China, France, Germany, Italy, Russia, Spain, the UK, and the US. First, we modeled weekly deaths per new case of COVID-19 using our new modeling method Deep Assessment Methodology - Second Derivative (DAM-SD). Later, we defined a performance indicator to understand how well each country copes with the pandemic. Lastly, Pearson correlations between the performance indicator and several economic, social, and environmental indices, such as Human Development Index, Human Freedom, Democracy, Competitiveness, and Trust Index are computed, and p-values are reported. Results showed that DAM-SD successfully models the daily new cases of COVID-19 with 3.7390% Mean Average Precision Error and outperforms the DAM by 1.5678% MAPE. China is the best-modeled country with 4.0975e-08% MAPE whereas the model produced the highest error rate for France as 8.8317% MAPE. According to the analysis with the performance indicators, China is the most successful country against the pandemic while the United States and France fail to confine COVID-19 outbreak compared to the others. Indicators such as Human Development Index, Human Freedom, Human Democracy, GINI Index, Workers Rights, the Trust Index, and Air Pollution are found significant for COVID-19 response according to the p-values. In the correlation analysis, Average Class Size, Government’s Long Term Vision, Responsiveness to Change, Better Life Index, and Population Density were the least significant indicators. Long Term Care Beds, Social Capital, and Global Social Mobility indicators are found correlated with the COVID-19 response. Household Spending and Student Skills are found insignificant. Author