The challenges in diagnosis of multisystem inflammatory syndrome in children (MISC), comparison of MISC and drug eruption: A case report (preprint)

Unusual manifestations are possible for multi-system inflammatory syndrome brought on by SARS-Cov2 infection. Early diagnosis and effective treatment have a direct impact on the outcome. Every young patient who presents to the clinic with a fever, skin rash, stomach discomfort, or cardiovascular complications has to be evaluated for this potentially fatal disease. It is also of utmost importance to differentiate MIS-C from drug hypersensitivity (DHS). MIS-c highly resembles DHS but leads to more complications and a higher mortality rate. We report a 9-year-old female who initially presented with generalized abdominal pain, nausea, vomiting, and cough. She gradually developed an acute abdomen and was admitted for surgical management of a suspected perforated appendix. Her condition deteriorated despite surgery and medical treatment. Differentiating drug allergy from this new emerging syndrome can be difficult. Herein we discuss about it.

Synbiotic for prevention of SARS-Cov2 infection in high risk hospital staffs: A randomized controlled trial (preprint)

Introduction: COVID-19 pandemic caused by the novel coronavirus SARS-CoV-2 increasingly involves people worldwide. Probiotics can improve immune system functions via different mechanisms. We proposed that Synbiotic Lactocare® may also reduce SARS-Cov2 infection in high risk medical staff working in COVID-19 hospital wards. Method: In a randomized, controlled trial, 60 hospital staff without any history of clinical or laboratory evidence of SARS-Cov2 infection were received either once daily oral synbiotic capsule (Lactocare®) that contains 1 billion CFU/Cap of L. (Lactobacillus) casei, L. rhamnosus, Streptococcus thermophilus, Bifidobacterium breve, L. acidophilus, Bifidobacterium infantis, L. bulgaricus, and Fructooligosacharide (Zist Takhmir, Tehran, Iran) or placebo with the same appearance for 30 days. They were followed for two months. Result: During the two month period of this study, SARS-COV-2 RT-PCR test results were positive in three participants (9.67%) in placebo group compared to zero positive test in synbiotic group. The differences were not statistically significant (p= 0.238). During the study, two persons (7 %) of placebo group had respiratory complaint such as cough, rhinorrhea and/or dyspnea, compared with one in synbiotic group (p= 0.492). Conclusion: This study showed that overall frequency of SARS-COC2 infection in participants receiving synbiotic and those receiving placebo did not differ significantly. However, 3 hospital staff in placebo group compared to no one in synbiotic group had SARS-COV2 infection. Further studies with greater power and alternative probiotic strains and mixture are warranted to determine whether Synbiotic can prevent COVID-19 in at-risk hospital staff. Keywords: COVID-19, Synbiotic, prevention, Lactocare, SARS-Cov2

COVID-19 in a Child with Primary Specific Antibody Deficiency (preprint)

Background. In the recent coronavirus disease 2019 (COVID-19) pandemic, millions of people have been affected so far. Clinical manifestations and natural history of infections have a very wide range, which is important to know it in various underlying diseases. Although children are less affected than adults, its presentation especially in those with underlying diseases should not be neglected.Case presentation. Herein we report the first case of specific antibody deficiency, who was affected with COVID-19. The patient suffered from rhinorrhea and modestly increased in productive cough, but real-time reverse transcription polymerase chain reaction was positive for COVID-19.Conclusions. Although presentation of COVID-19 in patients with immunodeficiency could be mild, it should not be missed, while early diagnosis and appropriate treatment can survive affected patients.