Clinical Course and Characteristics of COVID-19 in Patients With Inborn Errors of Immunity: A Retrospective Multicenter Experience From Iran (preprint)

Purpose: This study aimed to assess the effect of COVID-19 on patients with IEIs, the potentially at-risk population, regarding the clinical course, complications, severity, and outcomes. Methods This two-phase study was conducted on patients from three referral immunodeficiency centers in Iran. At phase one, 98 IEI patients with COVID-19 infection were evaluated by telephone follow-up (TFU). At phase two, the demographic, clinical, and laboratory records of clinically confirmed 33 IEI patients with COVID-19 infection were collected and analyzed. Results At phase one, 16.3% represented COVID-19 infection without any report of pediatric intensive care unit (PICU) admission or death. During the second phase, combined immunodeficiency (CID) (42.4%) and predominantly antibody deficiencies (PADs) (33.3%) were the predominant immune defects. Atopy (27.3%) and lung disorders (27.3%) were the frequent pre-existing comorbidities. Organomegaly (p=0.030) and renal disorders ( p=0.033 ) were significantly associated with the development of respiratory insufficiency. Cyanosis, tachypnea, intercostal retraction, and seizure were the chief complaints of patients who were more likely to progress respiratory insufficiency (p<0.05) , being admitted to the PICU (p<0.05) , and/or deceased (p<0.05) . Laboratory evaluation revealed a marked positive correlation between D-Dimer ( p=0.045 ), prothrombin time ( p=0.045 ), C-reactive protein ( p=0.041 ), proteinuria ( p=0.013 ), ferritin ( p=0.020 ), metabolic acidosis ( p=0.003 ), and troponin ( p=0.049 ) level with mortality. We detected a significant association between the chest X-ray pattern of COVID-19 infection with PICU admission (p=0.023) and death (p=0.046) . Conclusion In the current study, patients with CID and PAD were introduced as patients at high risk of COVID-19 infection, who may need extra protective and therapeutic measurements.

Acute Kidney Injury in Pediatric Patients with COVID-19; Clinical Features and Outcome (preprint)

Background: Renal disorders are reported as both underlying conditions and complications in critical pediatric COVID-19 infection. Herein, we investigated the pattern of renal involvement, particularly acute kidney injury (AKI), among pediatric patients with COVID-19. Methods: We prospectively enrolled hospitalized pediatric patients with the clinical diagnosis of COVID-19 infection. Demographic, clinical, and laboratory findings were gathered and analyzed, using a mixed method of qualitative and quantitative approaches and descriptive statistics. Results: 187 patients including 120 (64.2%) male and 67 (35.8%) female with COVID-19 infection at a median (interquartile range) of 60 (24-114) months were enrolled in this study.Most patients (n=108, 58.1%) were suffered from one or two underlying comorbidities, mainly malnutrition (77.4%), neurologic/learning disorders (21.4%) and malignancy (10.2%). Kidney was the third organ involved in 30 patients (16%) during hospital admission, after lung (53.5%) and gastrointestinal tract (39%). According to the KDIGO definition and classification, AKI was detected in 38.5% of patients (stage 1: 55.6%, stage 2: 36.1%, stage 3: 8.3%) at presentation or during follow up. Nine patients (4.8%) required hemodialysis and 16 (8.6%) patients were eventually died. There was no significant association between AKI and pediatric intensive care unit (PICU) admission ( p=0.079 ), multisystem inflammatory syndrome in children (MIS-C) ( p=0.051 ), comorbidities ( p=0.067 ), and mortality rate ( p=0.789 ). Conclusions: Kidneys are one of the major organs affected by COVID-19 infection. Although kidney abnormalities resolve in the majority of pediatric COVID-19 infection, particular attention should be given to kidney involvement in COVID-19 patients, particularly children with history of malnutrition and renal disorders.

Knowledge, attitude and practice of Sari Birth Cohort members during early weeks of COVID-19 outbreak in Iran (preprint)

Background It has been determined that the coronavirus disease 2019 (COVID-19) pandemic needs social distancing and proper measures to prevent its spreading. This study aimed to determine COVID-19 knowledge, attitude, and practice among Sari Birth Cohort (SBC) members.Methods In this cross-sectional study linked to the SBC in north of Iran, mothers living in Sari and its suburbs from March 28 to April 8, 2020 were evaluated. The measurement tool was an online researcher-made, self-reported knowledge, attitude, and practice questionnaire related to COVID-19.Results In total, 1449 mothers with a mean age of 31.51 ± 5.73 years participated. Of them, 82.4% had good knowledge (98.6% in healthcare workers and 79.2% in housewives, p = 0.000). Most of them were worried about spread of the disease in the country (97.4%) and agreed that COVID-19 will finally be successfully controlled around the world (72.2%). Sleep disturbance was reported in 42.7% of mothers. Eighty-eight percent of cases wore masks and gloves when leaving the house, 99.4% washed their hands frequently while 12.9% went to any crowded places. People with better knowledge followed safer practices (p = 0.000) and were more worried about the spread of the disease in the country and infection (among themselves and their first-degree relatives) (p = 0.000).Conclusions Most of the SBC members had a good level of knowledge about COVID-19 but were worried about a long-term pandemic period. They also had good practices regarding the prevention of the disease.