Perception and Awareness About COVID-19 Pandemic Among Children Visiting a Tertiary Care Centre.

Children between 8-12 years of age attending the institution between May and September, 2022 were enrolled, and their knowledge and perception of COVID-19 evaluated by asking them to draw a diagram of SARS-CoV-2, and by getting their responses on a multiple-choice written questionnaire. Majority had correct knowledge regarding the mode of spread of virus (n=91), safe practices (n=91) and prevention by vaccine (n=69).

Seroprevalence of SARS-CoV-2 in children and factors affecting the sero-positivity

912 Table 1Association of demographic and clinical features with serology status of SARS-CoV-2Results88 pediatric patients up to the age of 18 years attending the pediatric department at AIIMS Patna were enrolled for the study. Only two patients had history of positive RT-PCR test for COVID-19 infection in the past. 63.6% (56 out of 88) had seropositive status against SARS-Cov-2. Various demographic and clinical variables described in table 1 were analysed and none of the demographic features had statistically significant association with serology status of SARS-CoV-2. Out of 88 children, 57 (64.8%) were males and 31(35.2%) were females. 58% of the children were from urban areas and 42% were from rural areas. The majority of the patients i.e 58 (65.9%) belonged to lower socioeconomic class and 30 (34.0%) belonged to upper class according to modified Kuppuswamy scale 2021. The corticosteroid therapy was received by 13 patients for various clinical indications among which 5 (38%) had seropositive status and 8(61.5%) had seronegative status against SARS-CoV-2 and the association was statistically significant with p-value of 0.041and Odd’s ratio ( 95% CI) of 0.29 (0.087-0.994) suggesting that patients who received corticosteroid therapy had 29% lesser chances of getting seropositive status compared to those who did not receive the therapy.ConclusionAmong the participants, 63.6% were seropositive against SARS-CoV-2 while only 2.2% had history of COVID 19 RTPCR positivity in past. The patients who received corticosteroids had lesser chances of getting positive antibody status against SARS-CoV-2 infection compared to those who did not receive the same.

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India.

OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3-5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ2 or Fischer's exact tests, Student's t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85-302.1, p<0.01), CKD (5.67, 1.08-29.64, p=0.04), high urea (11.05, 3.9-31.02, p<0.01), high prothrombin time (3.91, 1.59-9.65, p<0.01) and elevated ferritin (1.02, 1.00-1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3-5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3-5 of admission or days 6-13 of illness onset acts as 'turning point' for timely referral or treatment intensification for optimum use of resources.

Hyperpigmented patch: an uncommon but early marker of Wilson's disease.

Wilson's disease in childhood could present with features ranging from asymptomatic liver disease to acute liver failure and cirrhosis. Neurological manifestations and psychiatric illness occur more commonly in adults and older children. Skin manifestation with Wilson's disease is not frequently reported in literature but could be an early diagnostic clincher. We present a child with hepatic Wilson's disease and skin hyperpigmentation. We aim to highlight the possible importance of skin lesions as an early marker of Wilson's disease.

Vertical transmission and clinical outcome of the neonates born to SARS-CoV-2-positive mothers: a tertiary care hospital-based observational study.

Background: Neonatal transmission of SARS-CoV-2 from positive mothers to their babies has been a real concern, opening the arena of research in this area. Objective: To detect the possibility of vertical transmission of SARS-CoV-2 from COVID-19-positive mothers to their neonates and the clinicopathological outcome in them. Design: A single-centre, prospective, observational study involving 47 COVID-19-positive mothers and their neonates. Setting: A tertiary care hospital in Eastern India. Participants: Neonates born to SARS-CoV-2-infected mothers. Main outcome measures: We investigated the SARS-CoV-2 positivity rate by real-time reverse transcriptase-PCR (RT-PCR) done twice (on admission and after 24 hours of admission) in neonates born to SARS-CoV-2-positive mothers, who tested RT-PCR positive for this virus in their nasopharyngeal swab. Clinical outcome was also assessed in these neonates during their hospital stay. Results: Out of 47 neonates born to SARS-CoV-2-positive mothers, four were SARS-CoV-2 positive by RT-PCR. All the neonates in our study were discharged home in stable condition after management of acute complications. None of them required readmission. Conclusion: Vertical transmission occurs in neonates born to COVID-19-positive mothers; however, the risk is small. Majority of the neonates remain asymptomatic with good clinical outcome.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study.

Background: Breast feeding by SARS-CoV-2-infected mothers has been a concern because of the possibility of excretion of virus in breast milk. Objective: To detect SARS-CoV-2 in expressed breast milk (EBM) of mothers infected with SARS-CoV-2 and clinical outcome of neonates delivered and breast fed by them. Design: A single-centre, prospective observational study involving 50 SARS-CoV-2-infected mothers and their 51 neonates. Setting: A tertiary care hospital in Eastern India. Participants: SARS-CoV-2-infected mothers and neonates delivered by them. Main outcome measures: We investigated the presence of SARS-CoV-2 in the breast milk of mothers, who tested positive for this virus in their nasopharyngeal swab (NPS). Clinical outcome was assessed in neonates breast fed by these mothers after 1 month of the postnatal period. Results: 50 SARS-CoV-2-positive expectant mothers were enrolled for the study. One out of 51 neonates, who delivered through lower segment caesarean section at term gestation and tested SARS-CoV-2 negative, died due to severe birth asphyxia. One sample of EBM was collected from each of the 49 mothers within 4 days of delivery. All EBM samples tested negative for SARS-CoV-2 through real-time reverse transcriptase-PCR (RT-PCR). All the newborns were screened twice for presence of SARS-CoV-2 RNA in their NPS, by RT-PCR. 2 of 51 neonates had COVID-19 infection after 24 hours of life. Caregivers of 37 of 50 alive neonates responded to follow-up via telephone. Except for minor feed intolerance in one (1 of 37) neonate, all neonates were reported well after 1 month of their age. Conclusion: All the samples of breast milk were negative for SARS-CoV-2. Most of the neonates remained asymptomatic on breast feeding, whose mothers had SARS-CoV-2 infection before delivery.

Persistent positivity of SARS-CoV-2 nucleic acid in asymptomatic healthcare worker: infective virion or inactive nucleic acid?

Asymptomatic individuals positive for SARS-CoV-2 RNA constitute a significant proportion of the infected population and play a role in the transmission of the virus. We describe a healthcare worker who presented with fever and malaise and was diagnosed with mild COVID-19. The symptoms resolved within 4 days but there was persistent positivity of viral RNA in the upper respiratory tract for more than 58 days, which is the longest reported duration of persistence of SARS-CoV-2 in a healthcare worker. In this case report, we discuss clinical and administrative issues such as the role of asymptomatic cases in the transmission of the virus to patients and coworkers as an occupational hazard, interpretation of persistent positivity of nucleic acid test, duration of isolation and return-to-work guidelines pertinent to researchers and global health policymakers.

COVID-19 with dengue shock syndrome in a child: coinfection or cross-reactivity?

COVID-19, caused by SARS-CoV-2, has spread globally. Coinfection with other endemic viruses is likely to complicate the clinical presentation and outcome. Information on clinical manifestations and management strategies on COVID-19 coinfection with endemic diseases in children is yet to evolve. The risk of dengue infection exists in 129 countries and it is endemic in more than 100 countries. The SARS-CoV-2 pandemic might overlap with the dengue epidemics in tropical countries. We report the first paediatric case to the best of our knowledge of COVID-19 encephalitis with dengue shock syndrome. This clinical syndrome could be attributed to serological cross-reactivity, incidental coinfection or perhaps a warning for dengue-endemic regions to face the unique challenge of differentiating and managing two disease entities together. Enhanced understanding of potential COVID-19 and dengue coinfection warrants immediate attention of researchers and international health policy makers.

IAP ALS Update on Resuscitation Guidelines During COVID-19 Pandemic.

Corona virus disease 2019 (COVID-19) pandemic has posed significant risk for health care workers. Various steps of cardiopulmonary resuscitation involve aerosol-generating procedures and have significant risk of spread of corona virus. Indian Academy of Pediatrics Advanced Life Support Basic Life Support (IAP ALS BLS) group had constituted a guideline update team to suggest modifications in existing resuscitation guidelines in view of COVID-19 pandemic. The GRADE approach was used to develop recommendations on shortlisted clinical practice questions on resuscitation during COVID pandemic as modifications.