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OBJECTIVE: It is accepted that the only way to end severe acute respiratory syndrome coronavirus 2 epidemic is through community vaccination. The frequency and clinical features of infection after vaccination are not known clearly. The aim of this study is to determine the frequency and clinical features of coronavirus disease 2019 seen after either the first or second dose of CoronaVac vaccination in healthcare workers and their relatives. MATERIAL AND METHODS: This is a cross-sectional retrospective survey study. The study was carried out in 2013 volunteers, including 1903 (94.5%) healthcare workers and 110 (5.5%) relatives of healthcare workers. The frequency and clinical features of coronavirus disease 2019 before and after the first or second dose of CoronaVac vaccination were retrospectively evaluated using an online questionnaire conducted in July 2021. RESULT(S): A total of 2013 people, 1312 women and 701 men, participated in the study. Of these individuals, 245 (12.1%) were polymerase chain reaction positive for coronavirus disease 2019 before vaccination. Of this group, 185 (75.5% of polymerase chain reaction positives and 9.1% of the whole population) received home-based therapy, while 38 (15.5%) received hospital admission. Asymptomatic polymerase chain reaction positivity before vaccination was seen in 22 (9%) individuals. There were 177 (8.8%) participants who developed polymerase chain reaction positivity at any time after vaccination. In 129 (72.8%) of these participants, polymerase chain reaction positivity occurred 21 days after the second dose of vaccine. While the number of patients hospitalized before vaccination was 38 (15.5% of the polymerase chain reaction positivity group and 1.89% of the general population), the number of patients hospitalized after the vaccination was 17 (10.1% of the polymerase chain reaction positivity group and 0.80% of the general population). The decrease in hospitalization proportion was statistically significant (P = .002). CONCLUSION(S): The frequency of coronavirus disease 2019, severe illness, and hospitalization rates were found to be lower in post-vaccination period. The vaccine is effective in preventing coronavirus disease 2019 and severe disease.Copyright © Author(s).
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Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia. Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d);Group 2 (those receiving methylprednisolone 1 mg/kg/d);Group 3 (those receiving methylprednisolone 2 mg/kg/d);and Group 4 (those receiving pulse methylprednisolone 10-30 mg/kg/d). Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p < 0.001, p < 0.001). No significant difference was found among the groups in terms of mortality (p = 0.15). The most common comorbidity was obesity (33%). A significant association was found between the presence of comorbidity and mortality (p < 0.001). All patients who died had an underlying disease. Cerebral palsy was the most common underlying disease among the patients who died. Worsening of lymphopenia was significant in patients with severe COVID-19 pneumonia at the time of transfer to the PICU (p = 0.011). Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients. © 2022. Thieme. All rights reserved.
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Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia. Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d);Group 2 (those receiving methylprednisolone 1 mg/kg/d);Group 3 (those receiving methylprednisolone 2 mg/kg/d);and Group 4 (those receiving pulse methylprednisolone 10-30 mg/kg/d). Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p < 0.001, p < 0.001). No significant difference was found among the groups in terms of mortality (p = 0.15). The most common comorbidity was obesity (33%). A significant association was found between the presence of comorbidity and mortality (p < 0.001). All patients who died had an underlying disease. Cerebral palsy was the most common underlying disease among the patients who died. Worsening of lymphopenia was significant in patients with severe COVID-19 pneumonia at the time of transfer to the PICU (p = 0.011). Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients. Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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Objective: To identify effects of various nationwide vaccination protocols on the evolution of new SARS-CoV-2 infections among adult population and to evaluate the safety of mRNA (BioNTech/ Pfizer) vaccine.
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The novel coronavirus disease (COVID-19) has emerged as a global pandemic. This was a prospective, case-control study conducted in Izmir, Turkey. The aim of this study was to assess the relationship between COVID-19 and new-onset T1DM. We included pediatric patients (aged 6 mo-18 yr) with new-onset type-1 diabetes mellitus (T1DM) diagnosed during the COVID-19 pandemic, between April 2020 and January 2021. Polymerase chain reaction was used to diagnose COVID-19 after hospital admission. An enzyme-linked immunoassay for IgM and IgG against SARS-CoV-2 was performed after the diagnosis was confirmed. In the control group, the blood antibody test was conducted as close as possible to the time of the T1DM patient referral. A total of 118 participants were included in the study, comprising 57 (48%) patients with new-onset T1DM and 61(52%) healthy controls. Of the 57 patients, 36 (63.2%) presented with DKA, 17 (29.7%) with diabetic ketosis, and four (7%) incidentally. The SARS-CoV-2 antibody test was positive in five (8.7%) patients with T1DM and six (10%) controls. The rate of positivity did not differ between the two groups (p = 0.901). It was not possible to demonstrate a clear association between SARS-CoV-2 infection and new-onset T1DM. Whether SARS-CoV-2 increases susceptibility to diabetes by triggering islet cell autoimmunity and affects the timing of overt diabetes in patients with existing autoimmunity should be studied in large cohorts.
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Introduction: What a biological disease-modifying antirheumatic drugs (bDMARDs)? and/or underlying rheumatological diseases, which we frequently use in our pediatric rheumatology practice, affect the clinical course of COVID-19 has not been fully demonstrated. Objectives: Here, we aimed to reveal the course of COVID-19 infection in patients with rheumatic disease and receiving bDMARD treatment. Methods: This was a retrospective, multicenter study in patients with a biological treatment had been initiated. This real-life study is based on secondary data collection from medical records of patients evaluated at the 14 Pediatric Rheumatology Clinics in Turkey from April 2020 to April 2021. The diagnosis of COVID-19 was confirmed in 101 patients by nasal PCR and in 10 patients by antibody test. Results: The study population of 112 patients consisted of 70 females (63.6%). The mean age of patients was 12.87 ± 4.69 years. The primary diagnosis of patients was as follows;59 juvenile idiopathic arthritis, 33 systemic autoinflammatory diseases, 10 vasculitis, 8 connective tissue diseases. The mean duration of primary disease was 4.62±3.65 years. Nineteen patients had also additional comorbid diseases (hypertension, Chron's disease, hereditary spherocytosis, and chronic renal failure, astma, cardiomyopathy, adrenal insufficiency in individual patients). Prior to COVID-19 infection, 35 patients (31.8%) were using canakinumab, 10 were infliximab (9.1%), 25 were adalimumab (21.8%), 18 were etanercept (16.4%), 9 were tocilizumab (8.2%), 4 were anakinra (3.6%), 6 were rituximab (5.5%), 1 was abatacept (0.9%), and 3 was tofacitinib (2.7%). The median exposure time of a biologic drug was 13.5 months. Additionally, 66 patients were using DMARD, and 27 patients were also receiving corticosteroid. 70 (63.6%) patients had at least one COVID-19-related symptom (fever, cough, diarrhea, myalgia, anosmia and/or rash), while 40 (36.4%) patients were asymptomatic. Respiratory findings were seen in 26% of all patients, 7 patients also had pathology in computed tomography. Hospitalization was required in 25 patients (22.7%) at median of 6 days (IQR: 4-10). Five patients developed MIS-C and 2 of these patients were followed up in the pediatric intensive care unit. Laboratory tests revealed that fourteen patients had elevated acute phase reactants, ten had elevated D-dimer levels, 5 had lymphopenia (< 1000/mm3), and five had hyperferritinemia. Conclusion: In patients with underlying comorbidities, COVID-19 can have a severe course regardless of the use of bDMARD. In the light of these findings, it would not be correct to say that the currently used bDMARDs worsen the course of COVID-19 infection or to say whether they affect the severity of the disease, but still, the disease findings-modifying effects of these drugs, especially high fever and myalgia, have been observed.
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Introduction: Coronavirus disease (COVID-19) has brought many changes in our daily lives such as wearing masks, social distancing, and curfews. These implemented measures and restrictions have probably prevented some other infections. The impact of the COVID-19 pandemic, and implemented measures/ restrictions on the frequency of the pediatric rheumatic diseases remain unknown. Objectives: We aim to investigate the effect of COVID-19 on the frequency of the pediatric rheumatic diseases in our practice. Methods: We retrospectively reviewed the medical records of patients admitted to the pediatric rheumatology unit between February 2016 and March 2021. Patients were divided into five groups according to the year of diagnosis (February 2016 to February 2017;March 2017 to February 2018;March 2018 to February 2019;March 2019 to February 2020;and March 2020 to March 2021). The distribution of the patients who were newly diagnosed with a rheumatic disease in the pre-COVID- 19 period (February 2016-March 2020) and during the COVID-19 pandemic (March 2020-March 2021) was compared. Results: A total of 32,333 patients visited the pediatric rheumatology department between 2016 and 2021. The mean annual number of patients decreased by 42% during the COVID-19 pandemic (7060 patients/ year vs. 4090 patients/ year). 25,156 out of 32,333 admissions (77.8%) were recurrent visits. Among the 7177 patients who remained after the exclusion of repeated visits, 2728 patients got 2813 new diagnoses of rheumatic diseases. In the pre-pandemic period, the most frequently diagnosed rheumatic disease was familial Mediterranean fever (FMF) (n=695, 28.3%), whereas multisystem inflammatory syndrome in children (MIS-C) (n=68, 18.6%) was the most common diagnosis in the pandemic period. There were significant differences in the numbers of newly diagnosed cases with FMF, Behçet's disease, and IgA vasculitis (IgAV), chronic non-bacterial osteomyelitis (CNO), cutaneous vasculitis, primary central nervous system (CNS) vasculitis, and idiopathic orbital myositis. When we compared the frequencies during the 2019-2020 period with those in the pandemic period (2020-2021), there were significant decreases in the numbers of newly diagnosed patients with FMF (p=0.043), IgAV (p=0.001), primary CNS vasculitis (p=0.035), and idiopathic uveitis (p=0.015);while the number of newly diagnosed cases with CNO increased (p<0.001). Also, the numbers of newly diagnosed patients with juvenile idiopathic arthritis, PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis) syndrome, acute rheumatic fever, and Kawasaki disease decreased remarkably in the pandemic period although these differences were not statistically significant. Conclusion: This study highlighted the decreased prevalence of some rheumatic diseases in the COVID-19 period. The potential decrease in infectious diseases due to pandemic restrictions could be affecting the diagnostic rates in pediatric rheumatology since infection is a trigger for some rheumatic diseases such as IgAV. Another reason could be the decrease in clinical visits of patients during the pandemic.
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Background: The severity of COVID-19 symptoms can range from mild to severe. Severe COVID-19 cases with excessive hyperinflammation have many overlap features with multisystem inflammatory syndrome in children (MIS-C). Objectives: We aimed to describe the typical clinical and laboratory features and treatment of children diagnosed with MIS-C and to understand the differences as compared to severe/critical pediatric cases with COVID-19 in an eastern Mediterranean country. Methods: Children (aged <18 years) who diagnosed with MIS-C and severe/ critical pediatric cases with COVID-19, were admitted to hospital between 26 March and 3 November 2020 were enrolled in the study. Results: A total of 52 patients, 22 patients diagnosed with COVID-19 with severe/critical disease course and 30 patients diagnosed with MIS-C. Although severe COVID-19 cases and cases with MIS-C share many clinical and laboratory features, MIS-C cases had longer fever duration and higher rate of the existence of rash, conjunctival injection, peripheral edema, abdominal pain, altered mental status, and myalgia than in severe cases (p<0.001 for each). Of all, 53.3% of MIS-C cases had the evidence of myocardial involvement as compared to severe cases (27.2%). Additionally, C-reactive protein (CRP) and white blood cell (WBC) are the independent predictors for the diagnosis of MIS-C, particularly in the existence of conjunctival injection and rash. Corticosteroids, intravenous immunoglobulin (IVIG), and biologic immunomodulatory treatments were mainly used in MIS-C cases rather than cases with severe disease course. There were only 3 deaths among 52 patients, one of whom had Burkitt lymphoma and the two cases with severe COVID-19 of late referral. Conclusion: Differences between clinical presentations, acute phase responses, organ involvements, and management strategies indicate that MIS-C might be a distinct immunopathogenic disease as compared to pediatric COVID-19. Conjunctival injection and higher CRP and low WBC count seem good diagnostic parameters for MIS-C cases.
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BACKGROUND: In March, we first hypothesized that;even though there was a higher number of COVID-19 patients in countries with a high population such as China, mortality rates in those countries were lower compared to other countries which do not have routine BCG vaccination. Therefore, we aimed to evaluate the accuracy of the hypothesis we made, by investigating the relationship of COVID-19 patients with BCG vaccine. METHODS: We retrospectively analyzed tuberculosis sequelae lesions and the presence of BCG vaccination in the radiological images and clinical reports of first fifty confirmed COVID-19 in-patients to evaluate our hypothesis in the shortest time. RESULTS: There was no pneumonia in 16 (32%) of patients. The mild, moderate and severe pneumonia ratios were 12 (24%), 10 (20%) and 12 (24%), respectively. Seven (1.4%) of the patients had respiratory failure and were followed up in the intensive care unit (ICU). Only one patient died during the follow-up time. CONCLUSIONS: We think that a considerably lower mortality rate, less severe course and more favorable prognosis of COVID-19 can be associated with the BCG vaccine. Current knowledge supports the utilization of a single-dose BCG vaccine to fight with this novel virus with its immunomodulatory properties, at least until the specific immunizations will be developed.