Hematological laboratory parameters: may act as a surrogate of chest radiographs in Pediatric COVID-19 Pneumonia. (preprint)

Background: COVID-19 infection continues to be a serious health concern in pediatric patients, associated with substantial morbidity and mortality. An important clinical question is whether laboratory hematologic parameters may act as a surrogate for imaging findings in pediatric COVID-19 pneumonia, in order to reduce exposure to ionizing radiation. The aim is to investigate the relationship between radiographic findings and hematological laboratory parameters in pediatric patients with COVID-19 infection by directly comparing the findings from both studies. Methods: This was an institutional review board-approved retrospective study of 187 consecutive pediatric patients with microbiologically confirmed COVID-19 pneumonia and available initial chest radiographs at the time of diagnosis, obtained between March 2020 and December 2020. Two groups of patients were created: 1) 1st group (without radiographic evidence of COVID-19 pneumonia) and 2) second group (with radiographic evidence of COVID-19 pneumonia). Two experienced radiologists independently reviewed the initial chest radiographs for abnormalities. Patients’ medical records were reviewed for clinical presentation, hematological laboratory parameters, and patient outcomes. The relationship between initial chest radiographic findings and hematological laboratory parameters was evaluated between the two groups. Interobserver agreement was estimated with the Cohen k coefficient.  Results: The study population consisted of 187 chest radiographs from 187 individual pediatric patients (95 males and 92 females; mean age ± SD, 10.1 ± 6.0 years; range, 9 months – 18 years). Group 1 consisted of 103 chest radiographs (55.0%) from 103 individual pediatric patients (54 males and 49 females; mean age ± SD, 12.5 ± 5.2 years; range, 9 months – 18 years). Group 2 consisted of 84 chest radiographs (45.0%) from 84 individual pediatric patients (41 males and 43 females; mean age ± SD, 7.0 ± 5.6 years; range, 11 months – 18 years). In group 2, observed chest radiographic abnormalities included ground-glass opacity (GGO) in 75 patients (89.2%), GGO and consolidation in 6 (7.2%), peribronchial thickening in 1 patient (1.1%), consolidation in 1 patient (1.1%), and peribronchial thickening, GGO and consolidation in one patient (1.1%). In addition, group 2 patients (with radiographic abnormalities of COVID-19 pneumonia) had significantly elevated LDH (p = 0.001) compared to group 1 patients (without radiographic findings of COVID-19 pneumonia). All pediatric patients in both groups completely recovered from COVID-19 infection. Interobserver agreement for chest radiographic findings was nearly perfect between the two reviewers in both groups (k = 0.96, p = 0.001).Conclusion: The presence of radiographic abnormalities on initial chest radiographs correlates well with hematologic laboratory abnormalities, specifically elevated LDH, in pediatric patients with COVID-19 pneumonia. Therefore, it is reasonable to conclude that hematologic laboratory parameters may act as a surrogate for chest radiography in pediatric COVID-19 pneumonia and that chest radiography may not be clinically indicated in pediatric patients with COVID-19 infection with normal LDH level, resulting in decreased exposure to ionizing radiation in this vulnerable population.

The possible beneficial role of the regular use of potent mouthwash solutions in the treatment of COVID-19 (preprint)

As recently more in vitro studies demonstrated bactericidal and virucidal role for some of the over-the-counter mouthwash solutions. Meanwhile, Game theory and Evolutionary Biology suggests that inhibiting cooperation -reciprocal altruism- between two organisms can negatively affect their survival. Based on a set of relevant publications, it is proposed here that 2019-nCoV may be relying on a complicit; be it a certain organism (e.g. bacterial species), or a state of dysbiosis in general. On this premise, the regular use of potent disinfectant, (Hydrogen peroxide 2% and chlorhexidine gluconate mixed solution) for oral rinsing and gargling three times daily, through the repeated reduction in microbial load, was tested to determine whether it is able to induce a strain sufficient to inhibit reciprocal altruism, and hence halt the progression of the disease. through an RCT, (n = 93, intervention group: 47, control group: 46) the outcome tested in terms of in relation to the PCR/CT test of nasopharyngeal-oropharyngeal swabs from the baseline (at diagnosis), changes in the clinical category (improvement Vs. deterioration), and the final disposition (discharge Vs. Death) in different disease categories. Our findings showed, upon the regular use of mouthwash, more symptoms improvement after 2 days of treatment, higher rate of conversion to COVID19-negative PCR by 5 days of treatment, and less intubation and mortality, with all P-value < 0.05. There was also a trend of improvement in other outcome variables, though with no significant statistical difference; namely shorter hospital stay, less progression in Oxygen requirements, less rate of plasma transfusion, and extent of improvement in terms of disposition in relation to the clinical category on admission. were that can be justified by the complicit hypothesis, predict a rather preventive than therapeutic advantage, suggestive for a possible role for the regular use of potent mouthwash as an additional control measure in the community level.