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Purpose of Study Treatment outcomes of children diagnosed with MIS-C are unclear and warrant investigation. The purpose of this study is to investigate the characteristics of pediatric patients diagnosed with MIS-C and their treatment outcomes with an emphasis on fatalities associated with MISC. Methods Used A literature review using Google Scholar and Pubmed using keywords such as 'Multisystem Inflammatory Syndrome in Children', 'Pediatric Inflammatory Multisystem Syndrome', and 'Coronavirus Disease 2019' was conducted. We included studies of hospitalized MIS-C patients with a sample size of more than 15. Summary of Results Of ten studies published before August 2020, five reported hospitalized MIS-C cases in the United States and five in Europe. A total of 514 hospitalized patients were reported with a sample size of 15 to 186 in various studies. Of 514 patients, 431 (84%) tested positive for SARS-CoV-2 via RT-PCR or serology. In different studies, 50% to 100% of MIS-C patients required PICU admission, 10% to 54% were intubated, and up to 80% required vasopressors. In studies that reported echocardiogram results, coronary artery dilations or aneurysm were noted in up to 93%, and depressed cardiac function was reported in 51- 100% of MIS-C patients. Treatment of MIS-C patients included intravenous immunoglobulins (IVIG) 388/514 (75%) plus steroids 288/514 (56%), along with anticoagulants and Anakinra 26/514 (5%). In total, 23 patients were put on ECMO, and of those, 16 (70%) survived. The larger studies reported fatality rate of 2% to 3% in hospitalized MIS-C patients. A total of 10 deaths were reported. Of the fatality causes that were described, 3 were associated with cerebral infarction after ECMO, 2 had not received IVIG, systemic glucocorticoids, or immunomodulators, and another 2 had co-morbidities. Conclusions Our review suggests that children with MIS-C who are hospitalized typically have a severe disease course. The outcome in vast majority of patients is favorable but death can occur, most likely as a result of cardiac dysfunction or cerebral infarction. Larger studies are needed to identify clinical features as well as laboratory and diagnostic parameters that predict disease severity and outcome.
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BACKGROUND AND AIM: The clinical spectrum and management of Multi-system Inflammatory Syndrome in Children (MIS-C) is evolving with each wave of COVID-19. This study aims to compare the clinical spectrum and immunomodulatory management of children with MIS-C between first and second wave in a tertiary care hospital in south India. METHOD(S): This prospective observational comparative study included children satisfying CDC MIS-C criteria admitted during 1st and 2nd wave of COVID 19 (total period from September 2019 to January 2022). We compared the clinical presentation, severity of illness, inflammatory biomarker profile, immunomodulatory therapy, need for inotropic support, duration of stay and outcome. RESULT(S): Study population included 27 during 1st wave and 75 during 2nd wave. Median age (IQR) of patients was 4.4years (3.15, 7.95) and 5.6 years (3.25, 8.8) during 1st and 2nd wave respectively. Males preponderance was seen in both waves (69% VS 65%). Clinical presentation was similar in both waves. 37% patients presented with shock during 1st wave while 36% in 2nd wave. Gastrointestinal symptoms were predominant (78% VS 82%) followed by cardiac manifestations (44% VS 45%), while a higher incidence of coronary artery dilatation was seen in 2nd wave (35% VS 26%). Comparison of immunomodulatory therapy is depicted in table 1. IVIG and pulse Methylprednisolone requirement was more during 2nd wave. 3 patients during 2nd wave needed additional immunomodulatory therapy with Anakinra (table 1). No patient required 2nd dose of IVIG. There was no mortality. CONCLUSION(S): Clinical presentation was similar in both waves. Requirement of immunomodulatory therapy was more during 2nd wave.
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BACKGROUND AND AIM: The clinical spectrum and management of Multi-system Inflammatory Syndrome in Children (MIS-C) is evolving with each wave of COVID-19 and emerging literature. This study aims to describe the clinico-pathological spectrum and immunomodulatory management of MIS-C in a tertiary care hospital in south India. METHOD(S): This prospective observational study included children satisfying CDC MIS-C criteria admitted from September 2019 to January 2022. We studied the characteristics of patients receiving immunomodulatory therapy with respect to need for inotropic support, duration of stay, mortality, escalation of immunomodulation, time to defervescence and persistence of coronary abnormalities at 2 weeks. RESULT(S): 102 children were included with median (IQR) age of 5.5 (3.2-8.5) years with male: female ratio of 1.84. Gastrointestinal symptoms were seen in 85 (84%), cardiac manifestations in 48 (47%) and coronary artery dilatation was seen in 33 (32%). Methylprednisolone and intravenous immunoglobulin were used as first line therapy in 31 (30.4%), and 25 (24.5%) patients, respectively. 46 (45.1%) children received both IVIG and IV Methylprednisolone. 30 (29%) presented with shock and 28 (27%) required inotropic support. Defervescence at 48hrs was observed in 30 (96%) in steroids alone group, 18 (72%) in IVIG group and 26 (57%) in IVIG+steroid group. 4 needed additional immunomodulatory therapy with Anakinra (table 1). None of them required 2nd dose of IVIG. There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 9 children. CONCLUSION(S): Immunomodulator therapy was based on severity at presentation and all combinations of therapy were effective.
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With the COVID-19 pandemic establishing its reign world-wide in the last two years with over 260 million cases and more than 5 million deaths, there has been an incessant need to quell the increasing fear and anxiety which has taken root in the minds of people. One way to do this has been to create an awareness about the global pandemic and arm people with a way to track various indispensable resources during these tough times. This paper discusses, in detail, the implementation of this idea - a real-time, COVID-19 resource tracker website which scrapes data from the most favored social media, Twitter and collates them to display the relevant information about the resources related to COVID-19;and provides vital particulars and facts about donation sites (in real-time) and general guidance in symptoms, treatments and precautions - integrated into an all-in-one website equipped with auto-completion feature and a handy navigation to increase its user friendly nature. © 2022 IEEE
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We present the case of a 41-year-old male, suspected to have pulmonary thromboembolism with a history of coronavirus disease 2019 (COVID-19) infection 1 month ago. He presented with dyspnea and dry cough for 2 weeks. D-dimer was >776.70 mcg/L. Lung perfusion scan with Tc-99m macroaggregated albumin revealed multiple bilateral segmental perfusion defects with no mass lesion/consolidation on high-resolution computed tomography (CT) of lungs suggestive of pulmonary embolism (PE) present according to perfusion only modified PIOPED II criteria. CT pulmonary angiogram showed a large filling defect in the right pulmonary artery. The case emphasizes the prolonged sequelae following COVID-19 after recovery from the acute phase of the illness. Lung perfusion scintigraphy can play an important role in the screening of such patients who may be at risk for developing PE as post-COVID-19 sequelae.
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Background: Passive immunization has a long history for infection prevention following exposure. We report results of a descriptive interim analysis from a study of an antibody “cocktail” of casirivimab with imdevimab (cas/imdev;formerly REGN-COV2) designed to bind non-competing epitopes of the viral spike protein, as a potential passive vaccine for the prevention of COVID-19 in people at risk of infection from household contact. Methods: In this ongoing Phase 3 study, asymptomatic participants exposed to a COVID-19-infected household member were randomized 1:1 to placebo or 1200 mg cas/imdev (600 mg of each antibody administered subcutaneously) within 96 hours of their household member testing positive. The analysis included participants who tested negative for SARS-CoV-2 by nasal, saliva, or nasopharyngeal swab and who were seronegative to SARS-CoV-2 antibodies at baseline. The proportion of participants who developed an RT-PCR-confirmed SARS-CoV-2 infection (asymptomatic or symptomatic) during the 1-month efficacy assessment period was summarized. Results: Initial results from the first evaluable 223 placebo and 186 cas/imdev participants who completed ≥29 days of the study are reported. Reduction in PCR-positive symptomatic disease was 100% (0/186 cas/imdev vs 8/223 placebo;OR 0.00 [CI 0.00, 0.69]). Reduction in any PCR-positive infection (symptomatic or asymptomatic) was 48% (10/186 vs 23/223;OR 0.49 [CI 0.20, 1.12]). Placebo-group participants had on average 100-fold higher peak viral load. In the cas/imdev group, viral RNA was not detected for longer than 1 week but was detected for 3-4 weeks in approximately 40% of placebo participants (Fig. 1). The proportions of infected participants with high viral loads (>10 4 copies/mL) were 13/21 placebo vs 0/9 cas/imdev. Total weeks of viral RNA detection and high viral load were 44 and 22 weeks in the placebo group vs 9 and 0 in the cas/imdev group. Total symptomatic weeks were 21 for placebo vs 0 for cas/imdev. A similar proportion of participants experienced at least 1 serious adverse event: placebo, 3/222 and cas/imdev, 1/186;none were deemed related to study treatment. Injection site reactions were similar: placebo, 1.4%;cas/ imdev, 2.6%. Conclusion: In this descriptive interim analysis of participants at risk of SARSCoV- 2 infection from household transmission, a subcutaneous dose of the cas/ imdev antibody cocktail prevented symptomatic infection, reduced overall infection, and decreased viral load and duration of viral RNA detection.
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As we all know the current rapid of the covid-19 in the most of the world has become a pandemic situation. Many research studies have been by various countries to develop a vaccines against the coronavirusSARS-CoV-2. Currently about six vaccine candidates have passed early testing and have entered the clinical trials across the globe, along with more than80 other candidates reported to be in preclinical stages. This state that many different approaches are being moved forward at the same time. However, the destination is not yet completed and so no vaccines are currently licensed for any of the other corona viruses affecting humans. If we go in the past few decades, various vaccines were given to geriatrics as well as paediatrics. So if we look the same in other countries the use of the vaccines is very less or instead some countries have no authentic grant to sell or use the vaccines. Here in this present study we are trying to propose that by the early use of the vaccines also reduced the number of reported COVID-19 cases in a country. So is the combination of these vaccines a reason for the reduced morbidity and mortality and can it be a boon to fight against the disaster of COVID-19 in future.