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Aim is to discuss diagnostic and therapeutic difficulties in COVID-19 related postoperative outcomes. A 5-year-old boy operated for jejunal atresia in neonatal period admitted with recurrent bilious vomiting. The upper GI series revealed dilated jejunum and absence of mechanical obstruction. The dilated jejunal segment was excised and anastomosis was performed. Later, he developed peritonitis without signs of anastomotic leaks. The second surgical exploration revealed diffuse peritonitis causing thickened and fibrous bowel loops causing hardly lysable adhesions. Then, his grandmother was learned to be COVID-PCR positive. Therefore, patients with atypical postoperative course should be investigated for possible COVID-19 during pandemics. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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Objective Oxidative stress and antioxidants play an important role in infections' response. We aimed to investigate the potential association between oxidative stress and the pathogenesis of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Methods We analyzed oxidant and antioxidant parameters from serum samples of children with novel corona virus disease 2019 (COVID-19) besides demographic and clinical data of children. Serum levels of the 8-hydroxy deoxyguanosine (8-OHdG), protein carbonyl (CO), malondialdehyde (MDA), total glutathione (GSH), superoxide dismutase (SOD), catalase (CT), and glutathione peroxidase (GPx) enzyme activities were evaluated and compared between groups. Discussion A total of 96 children were evaluated, including 32 patients with confirmed COVID-19 (group 1), 35 patients with symptomatic infections without COVID-19 (group 2), and 29 healthy patients as a control group (group 3). Group 1 included 7 (21.8%) asymptomatic, 22 (68.7%) mild, and 3 (9.5%) moderate patients according to the severity of the disease. In all groups, there were no significant differences in oxidative stress and antioxidant parameter levels (p > 0.05). Furthermore, no statistical difference was found when the parameters of patients with COVID-19 and healthy children were evaluated according to disease course. Conclusion Serum levels of oxidant and antioxidant parameters were similar in children infected with SARS-CoV-2 and other infectious agents. However, further studies, including children with severe to critical disease, are necessary to characterize the oxidative stress, antioxidants, cytokine responses in COVID-19, and elucidate the pathogenesis.
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Introduction: Coronavirus disease (COVID-19) has brought many changes in our daily lives such as wearing masks, social distancing, and curfews. These implemented measures and restrictions have probably prevented some other infections. The impact of the COVID-19 pandemic, and implemented measures/ restrictions on the frequency of the pediatric rheumatic diseases remain unknown. Objectives: We aim to investigate the effect of COVID-19 on the frequency of the pediatric rheumatic diseases in our practice. Methods: We retrospectively reviewed the medical records of patients admitted to the pediatric rheumatology unit between February 2016 and March 2021. Patients were divided into five groups according to the year of diagnosis (February 2016 to February 2017;March 2017 to February 2018;March 2018 to February 2019;March 2019 to February 2020;and March 2020 to March 2021). The distribution of the patients who were newly diagnosed with a rheumatic disease in the pre-COVID- 19 period (February 2016-March 2020) and during the COVID-19 pandemic (March 2020-March 2021) was compared. Results: A total of 32,333 patients visited the pediatric rheumatology department between 2016 and 2021. The mean annual number of patients decreased by 42% during the COVID-19 pandemic (7060 patients/ year vs. 4090 patients/ year). 25,156 out of 32,333 admissions (77.8%) were recurrent visits. Among the 7177 patients who remained after the exclusion of repeated visits, 2728 patients got 2813 new diagnoses of rheumatic diseases. In the pre-pandemic period, the most frequently diagnosed rheumatic disease was familial Mediterranean fever (FMF) (n=695, 28.3%), whereas multisystem inflammatory syndrome in children (MIS-C) (n=68, 18.6%) was the most common diagnosis in the pandemic period. There were significant differences in the numbers of newly diagnosed cases with FMF, Behçet's disease, and IgA vasculitis (IgAV), chronic non-bacterial osteomyelitis (CNO), cutaneous vasculitis, primary central nervous system (CNS) vasculitis, and idiopathic orbital myositis. When we compared the frequencies during the 2019-2020 period with those in the pandemic period (2020-2021), there were significant decreases in the numbers of newly diagnosed patients with FMF (p=0.043), IgAV (p=0.001), primary CNS vasculitis (p=0.035), and idiopathic uveitis (p=0.015);while the number of newly diagnosed cases with CNO increased (p<0.001). Also, the numbers of newly diagnosed patients with juvenile idiopathic arthritis, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome, acute rheumatic fever, and Kawasaki disease decreased remarkably in the pandemic period although these differences were not statistically significant. Conclusion: This study highlighted the decreased prevalence of some rheumatic diseases in the COVID-19 period. The potential decrease in infectious diseases due to pandemic restrictions could be affecting the diagnostic rates in pediatric rheumatology since infection is a trigger for some rheumatic diseases such as IgAV. Another reason could be the decrease in clinical visits of patients during the pandemic.
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Objective The frequency of coinfections in pediatric Coronavirus disease 2019 (COVID-19) cases and their impact on the clinical course are not fully understood. We aimed to investigate the viral and bacterial respiratory pathogens in children admitted to the pediatric emergency department (PED), their clinical course, and the presence of coinfections during the early months of the COVID-19 pandemic. Methods Clinical, laboratory and radiological findings, viral and bacterial pathogens detected by multiplex polymerase chain reaction (PCR) tests in nasopharyngeal swabs, clinical course, and treatments of all children who were tested for severe acute respiratory coronavirus 2 (SARS-CoV-2) at the PED between March 16 and May 15, 2020, were recorded. SARS-CoV-2 PCR-positive and negative groups were compared. Results Out of 570 patients tested for SARS-CoV-2 during the study period, 43 were found positive (7.5%). Non-SARS-CoV-2 viral pathogens were more common in the SARS-CoV-2 PCR-negative group than the SARS-CoV-2 PCR-positive group (13.2%, n=68 versus 4.7%, n=2), but this result was not statistically significant. Leukocyte, neutrophil, lymphocyte, and platelet counts were lower in SARS-CoV-2 PCR-positive group. Bacterial panel positivity was significantly higher in the SARS-CoV-2 PCR-positive group compared with the SARS-CoV-2 PCR-negative group (52%, n=12 versus 28%, n=91;p<0.05). The presence of coinfection did not alter the course of therapy in SARS-CoV-2 PCR-positive cases. Conclusion While viral coinfections were rare, bacterial panel positivity was common in children with COVID-19, but this had not influenced management decisions. The limitations of the tests should be kept in mind while interpreting the results.
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Background: The severity of COVID-19 symptoms can range from mild to severe. Severe COVID-19 cases with excessive hyperinflammation have many overlap features with multisystem inflammatory syndrome in children (MIS-C). Objectives: We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with MIS-C and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country. Methods: Children (aged <18 years) who diagnosed with MIS-C and severe/ critical pediatric cases with COVID-19, were admitted to hospital between 26 March and 3 November 2020 were enrolled in the study. Results: A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only 3 deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral. Conclusion: Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count seem good diagnostic parameters for MIS-C cases.
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AIMS & OBJECTIVES: We will present the management of three patients with tracheostomies with COVID-19 infection. METHODS: We will present the management of three patients with tracheostomies with COVID-19 infection. RESULTS: The first patient, 13 years old girl, had a diagnosis of osteopetrosis and recurrent osteomyelitis, presented with four days of fever. She had in-house contact and computed tomography was consistent with COVID 19 pneumonia, and PCR was positive. Antibiotic treatment, favipravir, hydroxychloroquine and enoxaparin treatments were began. On the 15th day;ventilator support was given her, after radiological progression and clinical worsening. PCRs were negative on day 13 and 17. Patient was discharged with oxygen support on day 24. The second patient;2-years-old with tracheostomy with BPD admitted for a tracheostomy closure plan. Routine COVID PCR test was positive before the procedure. The patient without complaint had sore throat in her parents, but their COVID 19 PCR test was negative. On the 4th day, she was discharged without any problem. On the 12th day, the COVID PCR test was negative. The third patient, with tracheostomy and gastrostomy, who applied with fever and respiratory distress. In addition to wide antibiotic therapy, favipravir and bemiparin treatments were also began. In the follow-up, mechanical ventilation support was provided. COVID PCR positive taken on the 10th day of treatment;resulted negative on day 17. The patient was discharged on the 20th day. CONCLUSIONS: There is no information about covid 19 pneumonia in pediatric patients with tracheostomy. Followup of these patients will provide insight into the follow-up of patients with future tracheostomy.