Clinical features and laboratory findings of multisystem inflammatory syndrome in children (MIS-C)

Introduction: Children mostly have mild or asymptomatic forms of SARS-CoV-2 infection, but during pandemic a higher incidence of Kawasaki disease, Kawasaki-like syndrome and the emergence of a new clinical entity, multisystem inflammatory post-covid syndrome (MIS-C) has also been observed. Objectives: The aim of this study is to determine clinical features and laboratory findings in patients with MIS-C. Methods: Retrospective analysis of clinical features and laboratory findings of MIS-C patients treated at our tertiary referal center (Clinic of Pediatric, University Clinical Centre Nis, Serbia). Results: From 18th of March 2020 till 30st of April 2021 there were 10 patients diagnosed as MIS-C according to CDC criteria. Eight patients were male and two were female. Patients age was 2 to 13 years (average 7.9 years, median 7 years). All patients had SARS -CoV-2 N-protein IgG antibodies but without history of disease symptoms and had positive contact four weeks prior to the onset of MIS-C symptoms. First symptom of MIS-C was fever (over 38C) which lasted in average for 4.4 days (3-7 days). Muco-cutaneous and gastrointestinal manifestations were most common. All patients had bulbar conjuctivitis, rash was present in 8 patients (80%), hand/foot oedema in 6 cases (60%), anterior cervical lymphadenopathy and cheliitis in 4 cases (40%) and periobital oedema in one case (details presented in Table 1. Clinical features of MIS-C patients). Nine patients (90%) presented with gastrointestinal symptoms while nervous system was affected in 5 patients. Three patients developed heart insuffitiency and one patient developed early signs of right coronary arthery aneurism. All patients had elevated inflammatory markers. Complete blood count showed elevated levels of white blood cells in 9 patients. Hypoalbuminemia and hypoproteinemia, low levels of serum potassium and sodium were present during ten days after the onset of symptoms. Troponines were elevated in 4 cases, proBNP in 5 cases. Abdominal ultrasound was performed and 6 patients presented with hepatoplenomegaly, 3 with enlarged spleen, one with enlagred liver and 4 had ascites. All patients were treated with combination of two antibiotics till cultures were proven negative, corticosteroid therapy and antiaggregation therapy. Three patients received a IVIG in a single dose (2gr/kg). All patients had good response to corticosteroid therapy (2mg/kg). Corticosteroid therapy was continued for four weeks (tapering). Conclusion: MIS-C can be a life-threatening condition in children. Early diagnosis and timely adequate treatment are of paramount importance. In children less than 5 years of age, the distinction between Kawasaki (Kawasaki shock) syndrome and MIS-C might be difficult, influencing the decision to use IVIG or steroids alone.

Kawasaki-like syndrome associated with COVID-19: clinical characteristics of mild to moderate forms of a disease

Introduction: In setting of global pandemic of coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), cases resembling Kawasaki disease (KD) were repeatedly reported. Soon afterwards it began to be considered as separate entity named multisystem inflammatory syndrome in children (MIS-C). In addition to this newly recognized syndrome which has overlapping features with KD and is still occasionally described as its from, during COVID-19, a high incidence of Kawasaki-like syndrome (KLS) with mild to moderate symptoms was also noted. Recently, it was proposed that even such cases should, in clinical context, be treated as MIS-C if appropriate criteria are met. On the other hand, clear distinction of the two entities can help researchers to answer the question of its etiology and pathogenesis and could direct the clinicians what to expect during the course of the disease. Objectives: The aim was to describe main epidemiologic and clinical characteristics of KLS during the first year of COVID-19 pandemic. Methods: This retrospective study included analysis of medical documentation of patients treated for KLS at Clinic of Pediatrics, University Clinical Center Niš, between March 2020 and 2021. Inclusion criteria was fulfillment of KD or KLS criteria, based on CDC1 or WHO2 recommendation. Severe form of the disease with signs of a shock was exclusion criteria. The results were elaborated with the statistical method of descriptive and quantitative analysis. Results: A total of 21 subjects fulfilled the criteria for KLS during the study period. The cumulative incidence was 8.48 per 105 minors. Male to female ratio was 2:1 and mean age at diagnosis was 6.5 years (min. 8 months;max. 17 years). In fourteen cases current or recent COVID-19 infection or confirmed COVID-19 exposure was observed. When only these patients are analyzed average age was 8.2 years. Antibodies against SARS-CoV-2 were confirmed in seven patients, three had positive PCR test for COVID-19 and one had close contact with someone who has COVID-19 but COVID-19 was not proved. Interestingly, three patients that were antigen positive had respiratory organ involvement. In the reaming seven cases all the other possible causes of symptoms were ruled out and possible contact with SARS-CoV-2 was assumed. In addition to prolonged fever, that was present in all patients, polymorphous rash (95%) was the most common clinical feature flowed by bilateral nonpurulent conjunctivitis (47%). Gastrointestinal tract involvement was the most common internal organ manifestation. Treatment included corticosteroids (15 patients), intravenous immunoglobulin (1 patient) and two patients received nonsteroidal anti-inflammatory drug in anti-inflammatory dose, while the rest were only treated symptomatically. Favorable outcome was achieved in all patients with no morphological changes observed on echocardiography during the hospitalization and 2 weeks after discharge. Conclusion: Our findings suggest connection between infection and occurrence of the disease in susceptible children. Yet, a large portion of the population had contact with SARS-CoV-2, thus the exact role of infectious agent and pathophysiological mechanisms have to be determined. Gender distribution with male dominance among our patients is expected. Still, average age at diagnosis was bit higher than what is usually observed in classic KD and is more in line with characteristics of MIS-C. Further research are to be done in order to define what determine progression of the disease and are there any signs that may point in which way it will develop. Only in that way the clinicians would made right choices regarding the patients treatment.

Comorbidities and Syndemics in the COVID-19 Age: Challenges and Opportunities for Bringing Separated Branches of Medicine Closer to Each Other

The Corona Virus Disease 2019 (COVID-19) as a unique disaster has stressed the extreme importance of the three issues for medicine, society and humanity in general: comorbidity, pandemic and syndemic. There are many reasons why the study of comorbidities and syndemics of COVID-19 is of great importance for researchers, clinicians and health policy makers who are responsible for health care organization and funding in a bid to develop more effective and efficient prevention and treatment. Thinking about COVID-19 through a syndemics concept and taking biological, psychological, social and spiritual dimensions into account, physicians could be more effective in clinical practice and community-based interventions. The outcome of SARS-CoV-2 infection is determined by the virus-host interaction, with pathogenicity of SARS-CoV-2 being related to the presence of comorbid diseases. The risk for severe COVID-19 clinical manifestations and death increases with age of patients and comorbidity. General mechanisms of multi-system dysfunction and multi-organ damage reported in COVID-19 are probably related to ubiquitous expression of ACE2 in many tissues and its important role in the renin-angiotensin-aldosterone system (RAAS) functioning. Physicians all over the world should be aware of COVID-19 related comorbidities, multisystem disorders and syndemics, as well as treatment and preventive strategies. COVID-19 age is a right time to reconsider the state of science and practice in comorbidity medicine field from the both epistemological and treatment perspective. Comorbidities and multimorbidities are indifferent to medical specializations, so the integrative and complementary medicine is an imperative in the both education and practice. Shifting the paradigm from vertical and mono-morbid interventions to comorbidity, multimorbidity and multi-system disease approaches enhances effectiveness and efficiency of human resources utilization. The aim of this review is to summarize the theoretical concepts and clinical experience and research regarding comorbidity in general, and specifically related to the COVID-19 pandemic, syndemics and infodemic.

Sanitary and hygienic aspects of the covid-19 self-isolation

Introduction: Self-isolation during the COVID-19 pandemic is a temporary measure to limit the spread of infection. All citizens arriving from abroad to Russia must comply with the rules of self-isolation. Since April 2, 2020, almost all citizens of the Russian Federation have followed the rules of self-isolation. Also, this month in the Russian capital, Moscow, about 6 million citizens have isolated themselves. In general, in the territory of Russia, the number of citizens on self-isolation reached 100 million. Billions of citizens around the world are staying at home due to the self-isolation regime, so a sanitary assessment must be considered. Self-isolation, characterized by physical inactivity, hypoxia, diet disturbances, lifestyle changes during work / rest, mental stress;this provides an opportunity to identify the presence of public health risk factors and contributes to an increase in the incidence of No Communicable Diseases (NCDs). Purpose of the Study: Carrying out a sanitary-hygienic assessment of COVID-19 self-isolation, determining priority risk factors causing non-infectious diseases, and proposing preventive measures. Objectives: To Identify public health risk factors during self-isolation. To conduct a comprehensive hygienic assessment of self-isolation according to the priority criteria. To develop a pointing system (hygiene index for self-isolation). To propose measures to minimize health risks during self-isolation. Materials and Methods: We used analytical, and systematization approaches. Information from the legal documents of the hygienic-sanitary laws of the Government of the Russian Federation (nutrition hygiene, hygiene of workforce, children, and teenagers). World Health Organization COVID-19 documents. Research Results: We assessed the sanitary-hygienic aspects of self-isolation to identify the leading risk factors on public health, and as a result, we proposed hygienic criteria for self-isolation. We developed a hygienic self-isolation index point score (HSIPS) that considers the Russian law-based requirements for diet, work, rest, and physical activities. Thus, the usage of those hygienic standards is beneficial to prevent public health risks in ordinary and extremely challenging conditions of self-isolation. We proposed measures to minimize risks during self-isolation, and we based them on adequate sanitary-hygienic standards. The main sanitary-hygienic risk factors of self-isolation are: sedentary lifestyle, hypoxia, nutritional deficiencies (malnutrition), and work/rest imbalance. Conclusion: We proposed a sanitary-hygienic definition of self-isolation. We identified leading risk factors for public health of the self-isolated population. We proposed sanitary-hygienic criteria for assessing self-isolation based on the regulations and standards of the Government of the Russian Federation. We developed a hygienic self-isolation index point score (HSIPS), which determines that the optimal mode is directly proportional to the coefficients of a person’s physical activity (D), indoor area (air cubic capacity) per isolated (S), time spent in fresh air (T) and inversely proportional to the calorie intake. We proposed measures to prevent noncommunicable diseases (NCD) for citizens on self-isolation. © 2020 Mitrokhin et al.

Coronavirus disease-2019 or the end of a happy globalization

Recent catastrophic consequences of coronavirus pandemic stimulate some deeper analysis of present level of globalization, particularly connected with public health problems. One definition of globalization may be that it is the integration of capital, technology, and information across national borders in a way that is creating a single global market and, to some degree, a global village. Besides economic, it includes many different processes such as development of communications systems, the increase in human mobility, the integration of trade and investment across boundaries, the spread of democracy and human rights, the increasing role of nongovernmental organizations in international politics, the growing concern about global epidemics, and ecological matters such as climate change that are happening at the same time and in many cases reinforcing one another. Up till now, in June 2020, there have been over 20,000 published scientific papers on Coronavirus Disease-2019 (COVID-19), which is an unprecedented level of interest in any topic in the entire history of science. Besides the described effect of remdesivir on reducing the length of the illness and the announced research on the effect of dexamethasone on reducing the mortality rate, science has not offered any other news on medication effectiveness so far. After the vaccine’s effectiveness in developing antibodies and protecting from COVID-19 is proven, then its safety will need to be proven. Vaccines have to be harmless and their only effect on the organism should be the developing of permanent immunity to the novel coronavirus. However, never have we in history, as humanity, had planned to simultaneously vaccinate 4 or 5 billion people. Most of us welcomed positive globalization process, but with the recent pandemic of corona disease, we are introducing negative part of globalization with many unpredictable developments. Indeed, globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care.