Clinical Features and Outcomes Following SARS-CoV-2 Infection in Pediatric Liver Transplant Patients.

OBJECTIVES: Several studies suggest that chronic immunosuppression in pediatric liver transplant patients may affect the severity and mortality rates of SARS-CoV-2 infection. MATERIALS AND METHODS: We assessed a total of 118 pediatric liver transplant recipients for SARS-CoV-2 infection, aged 1 to 18 years, followed between March 2019 and January 2022. We compared the clinical characteristics and outcomes of SARS-CoV-2 infection in pediatric liver transplant patients to 187 non-liver transplant pediatric patients with SARSCoV-2 infection who had been diagnosed at our institution between March 15, 2020, and December 31, 2020. Demographic data, clinical features, and laboratory findings from the patients were retrospectively collected from hospital reports and telephone inquiries. RESULTS: A total of 20 liver transplant patients with SARS-CoV-2 infection were identified. Median age of liver transplant recipients with SARS-CoV-2 infection was higher than non-liver transplant pediatric patients with SARS-CoV-2 (14.8 [range, 7-16] vs 6.8 [range, 2-14] years; P = .016). There were no significant differences in mild and moderate disease courses of SARS-CoV-2 infection between liver transplant recipients and non-liver transplant pediatric patients (18 [90.0%] vs 133 [71.1%] patients [P = .188] and 2 [10%] vs 49 [26.2%] patients [P = .118], respectively). Fever was less frequently observed in liver transplant patients with SARS-CoV-2 infection compared with non-liver transplant patients (55.0% vs 80.2%; P = .015). We found no intergroup differences in sex (P = .342), hospitalization rate (P = .161), and overall clinical presentation. CONCLUSIONS: Despite the immunosuppression regimens, liver transplant patients in our series survived SARS-CoV-2 infection without serious sequelae and without graft rejection. Overall, liver transplant and non-liver transplant pediatric patients with SARSCoV-2 infection experienced a mild disease course.

Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center study.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) outbreak continues to evolve, it is crucially important for pediatricians to be aware of the differences in demographic and clinical features between COVID-19 and influenza A and B infections. PURPOSE: This study analyzed and compared the clinical features and laboratory findings of COVID-19 and influenza A and B infections in children. METHODS: This retrospective study evaluated the medical data of 206 pediatric COVID-19 and 411 pediatric seasonal influenza A or B patients. RESULTS: COVID-19 patients were older than seasonal influenza patients (median [interquartile range], 7.75 [2-14] years vs. 4 [2-6] years). The frequency of fever and cough in COVID-19 patients was lower than that of seasonal influenza patients (80.6% vs. 94.4%, P<0.001 and 22.8 % vs. 71.5%, P<0.001, respectively). Ageusia (4.9%) and anosmia (3.4%) were present in only COVID-19 patients. Leukopenia, lymphopenia, and thrombocytopenia were encountered more frequently in influenza patients than in COVID-19 patients (22.1% vs. 8.5%, P=0.029; 17.6% vs. 5.6%, P=0.013; and 13.2% vs. 5.6%, P= 0.048, respectively). Both groups showed significantly elevated monocyte levels in the complete blood count (70.4% vs. 69.9%, P=0.511). Major chest x-ray findings in COVID-19 patients included mild diffuse ground-glass opacity and right lower lobe infiltrates. There were no statistically significant intergroup differences in hospitalization or mortality rates; however, the intensive care unit admission rate was higher among COVID-19 patients (2.4% vs. 0.5%, P=0.045). CONCLUSION: In this study, pediatric COVID-19 patients showed a wide range of clinical presentations ranging from asymptomatic/mild to severe illness. We found no intergroup differences in hospitalization rates, oxygen requirements, or hospital length of stay; however, the intensive care unit admission rate was higher among COVID-19 patients.

Redesigning Human Physiology Labs as Integrated Instructional Units with Comparative Parallel Mechanistic Analyses for Post-COVID Online College Teaching

One of the biggest challenges in remote online college teaching of human physiology is the lab component. To overcome this challenge, we redesigned our pre-COVID face-to-face physiology labs with the objective of preserving most of their learning outcomes. Towards this end, we applied the concept of treating labs as integrated instructional units (America's Lab Report, https://www.nap.edu/read/11311/chapter/5). Our approach was to replace student hands-on lab protocol focus with an integrative lab approach that allows the students to not only record data from real-time, video-recorded experiments, but also to map them out on the corresponding anatomical architecture and mechanisms under investigation. The video recordings were performed by the instructor synchronously during the class session then posted for the students online as part of an expanded lab package that includes instrumentation and protocol details, experimental parameters and variables, relevant anatomical and physiological mechanistic footnotes, as well as expected lab report format and rubric. Using this approach, physiology labs originally designed separately to investigate principles and mechanisms of diffusion, neuronal reflexes, EMG, ECG, and hemodynamics were replaced with integrated labs designed to allow side-by-side comparisons and provide stimulating visual demonstrations of empirical work and relevant mechanistic and anatomical architecture. Two such lab examples are: (1) comparing speedsof: (a) food dye diffusion in solution based on real-time measurements in a glass plate aligned with measuring scales, (b) action potential conduction based on mapped-out neuronal pathway lengths and online measurement of relevant reaction time (https://faculty.washington.edu/chudler/java/redgreen.html), and (c) blood flow between the cardiac left ventricle and the site of pulse measurement in the finger based on vasculature anatomy and the time delay between the ECG's QRS electrical wave peak and onset of finger mechanical pulse wave, and (2) comparing time, amplitude, distribution, and discreteness of grip strength-forearm EMG recording with that of the QRS and P-wave of the ECG with emphasis on skeletal versus cardiac muscle electrophysiological mechanisms of action potential initiation and propagation as well as corresponding muscle mass as well as physiological mechanisms. Having successfully applied this new lab design in Fall 2020, more data is expected in Spring 2021 to be presented at the APS annual meeting in late April 2021.