SARS-CoV-2 Infection in Venezuelan Pediatric Patients-A Single Center Prospective Observational Study.

Several studies suggest that children infected with SARS-CoV-2 have fewer clinical manifestations than adults; when they develop symptoms, they rarely progress to severe disease. Different immunological theories have been proposed to explain this phenomenon. In September 2020, 16% of the active COVID-19 cases in Venezuela were children under 19 years. We conducted a cross-sectional study of pediatric patients' immune response and clinical conditions with SARS-CoV-2 infection. The patients were admitted to the COVID-19 area of the emergency department of Dr José Manuel de los Ríos Children's Hospital (2021-2022). The lymphocyte subpopulations were analyzed by flow cytometry, and IFNγ, IL-6, and IL-10 serum concentrations were quantified using commercial ELISA assays. The analysis was conducted on 72 patients aged one month to 18 years. The majority, 52.8%, had mild disease, and 30.6% of the patients were diagnosed with MIS-C. The main symptoms reported were fever, cough, and diarrhea. A correlation was found between IL-10 and IL-6 concentrations and age group, lymphocyte subpopulations and nutritional status and steroid use, and IL-6 concentrations and clinical severity. The results suggest a different immune response depending on age and nutritional status that should be considered for treating pediatric COVID-19 patients.

Analysis of Microvasculature in Children Recovered from COVID-19 Using Swept-Source OCT/OCTA Technology.

PURPOSE: To analyze structural and vascular changes of the retina and choroid in pediatric patients with coronavirus disease 2019 (COVID-19) using optical coherence tomography (OCT)/OCT angiography (OCTA). METHODS: This comparative cross-sectional study consists of the COVID-19 group including pediatric COVID-19 patients and the control group including healthy children. Vessel density (VD), central macular thickness,, and choroidal thickness (ChT) measurements were performed using swept-source OCT/OCTA 12 weeks after the recovery from COVID-19. RESULTS: The mean VD measurements in the central fovea and nasal quadrants of all three retinal layers and choriocapillaris showed insignificantly lower values in the COVID-19 group when compared to the control group (0:002 < p < 0:05 for all). Similar to VD measurements, insignificant lower ChT measurements were obtained in the central fovea and nasal points in the COVID-19 group. CONCLUSION: OCTA can be used as a non-invasive and valid biomarker in the assessment of early microvascular dysfunction associated with COVID-19.

Smell and Taste in Children with Covid-19.

Objectives: To assess the frequency of loss of smell and taste in children during Covid-19 infection and their prevalence along with other symptoms, as well as the recovery of chemosensory function once healed. Methods: To evaluate symptoms during infection, we adapted the Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire and the modified Monel-Jefferson questionnaire. For smell analysis we used Odor Identification (OI) and two variants of the Odor Discrimination (OD) test, and we compared the results with those of a control group. Results: We enrolled nine patients in our experimental group and nine in our control group. Fever was the most frequent symptom (55% of cases), followed by anosmia and ageusia (44% of cases), muscle pain and asthenia (22% of cases) and diarrhea, abdominal pain, cough, and headache (11% of cases). In 11% of cases, olfactory symptoms were the only manifestation of the disease. There was no statistically significant difference in OI test and OD tests between the two groups (Children healed from Covid-19 and Control Group). Conclusion: Loss of smell and taste are the second most common symptoms of pediatric Covid-19, and they should always be tested because they can be the only manifestations of infection. Olfactory function in Covid-19 children decreases with increasing age and improves with the passage of time after illness.

Comparison of first admission hemogram parameters and chest computed tomography findings of pediatric COVID-19 patients Blood parameters of pediatric COVID-19 patients

Aim: We use computed tomography, which is one of the frequently used imaging tests, both as a disease diagnosis method and to follow the clinical course in COVID-19 patients. This also means radiation exposure. Radiation exposure, especially in pediatric patients, can cause life-threatening diseases. Is there a blood parameter that will reduce this undesirable event and allow estimation of computed tomography findings? Are hemogram analysis, one of the most commonly used blood tests, and tomography findings of the disease related? We designed this study based on the questions. Material(s) and Method(s): Among the patients under the age of 18 who applied to the emergency department, those with a positive reverse transcription-polymerase chain reaction (RT-PCR) and chest CT and hemogram were included in the study. Chest CT findings were classified according to the CO-RADS classification. We compared the CO-RADS classification with hemogram parameters and the ratios of these parameters. Result(s): Platelet-to-lymphocyte ratio (PLR) rates were found to be significantly lower as imaging findings became more severe (<0.05). The ratio of MedianPlatelet Volume and Platelet (MPV/Plt) was found to be significantly higher as the imaging findings worsened (p<0.05). When the relationship between laboratory parameters according to imaging groups in our study was evaluated, there was a moderate negative correlation between lymphocyte and platelet levels and imaging findings (p<0.05). A moderate positive correlation with the monocyte level was found (p<0.05). Discussion(s): For the CO-RADS classification, it can be said that the patient was established to classify possible COVID-19 patients only according to chest CT. There is no study in the literature on the classification of pediatric patients with RT-PCR positive definite COVID-19 according to chest CT scans and the comparison of laboratory findings of patients with this classification. The combination of laboratory parameters and CO-RADS classification will guide clinicians in pediatric COVID-19 patient management.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Temperature screening and detection of Covid-19 in school-aged children: A retrospective cohort study assessing the efficacy of temperature screening in schools

In July 2020, Corinth School District was the first in Mississippi to return to the classroom setting. Coronavirus disease 2019 (Covid-19) protocols were developed to maintain the safety of students. These included mandatory masking, seating charts, desk spacing, sanitizing protocols, lunch within classrooms, alteration of extracurriculars, cancellation of assemblies, and quarantine policies. Temperature screenings were also performed. Students registering as febrile would undergo Covid-19 testing. To evaluate the efficacy of temperature scanning as a surveillance method for Covid-19 in the school setting, deidentified data was obtained from the Corinth School District. Overall incidence and grade level incidence of Covid-19 were calculated in children attending school from July 27, 2020 to September 25, 2020. Data were examined for a correlation between documented fevers and Covid-19 positivity. Reports provided by the school district were investigated for positive test groupings signifying a school-related outbreak. Of 28 children with fevers at school, zero tested positive for Covid-19. Twenty-six children tested positive for Covid-19;none were febrile at school. The incidence of Covid-19 in our population during the study period was 1.03%. Incidence in elementary students was 0.34%, 0.93% in middle school, and 2.51% in high school students. There were no school outbreaks during the study period. Both relative risk and odds ratio were calculated as equal to zero (0.00). Temperature scanning is not a sensitive screening method for Covid-19 in school children.Copyright © 2023 Policy Studies Organization.

Incidence of asymptomatic SARS-CoV-2 infection in children undergoing elective otolaryngologic surgery throughout the COVID-19 pandemic.

Objective: Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are less clinically affected than adults, with most cases presenting as asymptomatic or mildly symptomatic. However, true rates of asymptomatic SARS-CoV-2 infection in children remain unclear. We sought to examine rates of SARS-CoV-2 in asymptomatic children and the role of children in transmission. Methods: We performed a retrospective review of patients between 6 months and 17 years of age who underwent elective or semi-elective otolaryngologic surgery with physicians affiliated with Weill Cornell Medicine between May 15, 2020 and March 31, 2022. Patients were included if they received molecular assay testing for SARS-CoV-2 without SARS-CoV-2 symptoms within 5 days of scheduled surgery. SARS-CoV-2 infection status, exposure, clinical symptoms, demographic data, and insurance status were recorded. Results: 1047 patients met inclusion criteria. Thirteen positive cases (1.24%) were identified in the study population. Six cases occurred between December 2021 and February 2022 following the classification of the omicron variant as a variant of concern in November 2021. Five of the 13 cases occurred in children under 2 years of age. Seven patients were male, and five were female. Residences spanned all five boroughs of New York City and the surrounding metropolitan area. Conclusion: Throughout the pandemic, children have had a low rate of asymptomatic disease and likely pose a low risk of transmission of SARS-CoV-2 to the general population. Our results suggest that testing of asymptomatic children is a low-yield practice that is unlikely to influence rates of SARS-CoV-2 in the general population. Level of Evidence: 3.

Vaccines for Children Provider Practices in the COVID-19 Vaccination Program: Barriers to Participation, Intentions to Offer COVID-19 Vaccination to Children Aged <5 Years, and Vaccination Promotion, United States, March 2022.

The aim of the study was to assess barriers to Vaccines for Children (VFC) provider practices participating in the COVID-19 Vaccination Program and intentions to offer COVID-19 vaccination to children aged <5 years. We invited a random sample of 15 000 VFC provider practices in the United States to complete an online survey during February 28 to March 11, 2022. Of 2809 practices that completed the survey, 2246 (80.0%) were enrolled in the COVID-19 Vaccination Program. Concerns around staff resources, vaccine and supply storage space, and vaccine wastage from multidose vials were the most frequently reported program-enrollment barriers. Among enrolled practices that have decided whether to offer COVID-19 vaccination to the children aged <5 years, 1641 (88.8% of 1848) reported likely offering it to current patients, and 1165 reported likely offering it to children who are not current patients. Addressing participation barriers and encouraging active promotion may increase COVID-19 vaccination coverage of children.

Jin-Zhen oral liquid for pediatric coronavirus disease (COVID-19): A randomly controlled, open-label, and non-inferiority trial at multiple clinical centers.

Background: As the coronavirus disease 2019 (COVID-19) pandemic progressed, especially with the emergence of the Omicron variant, the proportion of infected children and adolescents increased significantly. Some treatment such as Chinese herbal medicine has been administered for COVID-19 as a therapeutic option. Jin-Zhen Oral Liquid is widely used for pediatric acute bronchitis, while the efficacy and safety in the treatment of pediatric COVID-19 are unclear. Methods: We conducted a randomized controlled, open-label, multicenter, non-inferiority clinical study involving hospitalized children with mild to moderate COVID-19. Children eligible for enrollment were randomly assigned in a 1:1 ratio to Jin-Zhen Oral Liquid (the treatment group) and Jinhua Qinggan Granules (the positive control group) and received the respective agent for 14 days, followed by a 14-day follow-up after discontinuation of the treatment. The primary efficacy endpoint was the time to first negative viral testing. The secondary endpoints were the time and rate of major symptoms disappearance, duration of hospitalization, and the proportion of symptoms changed from asymptomatic or mild to moderate or severe/critical illness. In addition, the safety end points of any adverse events were observed. Results: A total of 240 child patients were assigned randomly into the Jin-Zhen Oral Liquid (117 patients) and Jinhua Qinggan Granules (123 patients) groups. There was no significant difference of the baselines in terms of the clinical characteristics and initial symptoms between the two groups. After 14-day administration, the time to first negative viral testing in the Jin-Zhen group (median 6.0 days, 95% CI 5.0-6.0) was significantly shorter compared with the positive control Jinhua Qinggan Granules group (median 7.0 days, 95% CI 7.0-8.0). The time and rate of major clinical symptoms disappearance were comparable to the positive control. The symptom disappearance time of pharyngalgia and hospitalization duration were significantly shortened in the Jin-zhen Oral Liquid group. No participants in either group experienced post-treatment exacerbation to severe or critical illness. No adverse events were observed in the Jin-Zhen Oral Liquid treatment group (0.0%) while 1 patient with adverse events occurred in the positive control Jinhua Qinggan granules group (0.8%). No serious adverse events were observed during the study period in both groups. Conclusion: Jin-Zhen Oral Liquid is safe and effective in the treatment of mild to medium COVID-19 in children. It is non-inferior to Jinhua Qinggan granules in shortening the time to first negative viral testing, the time and rate of major clinical symptoms disappearance, and the hospitalization duration. The results suggest that Jin-Zhen Oral Liquid can be a recommended drug for treatment of pediatric COVID-19 patients.

Community-Onset Bacterial Coinfection in Children Critically Ill With Severe Acute Respiratory Syndrome Coronavirus 2 Infection.

Background: Community-onset bacterial coinfection in adults hospitalized with coronavirus disease 2019 (COVID-19) is reportedly uncommon, though empiric antibiotic use has been high. However, data regarding empiric antibiotic use and bacterial coinfection in children with critical illness from COVID-19 are scarce. Methods: We evaluated children and adolescents aged <19 years admitted to a pediatric intensive care or high-acuity unit for COVID-19 between March and December 2020. Based on qualifying microbiology results from the first 3 days of admission, we adjudicated whether patients had community-onset bacterial coinfection. We compared demographic and clinical characteristics of those who did and did not (1) receive antibiotics and (2) have bacterial coinfection early in admission. Using Poisson regression models, we assessed factors associated with these outcomes. Results: Of the 532 patients, 63.3% received empiric antibiotics, but only 7.1% had bacterial coinfection, and only 3.0% had respiratory bacterial coinfection. In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34 [95% confidence interval {CI}, 1.01-1.79]), those requiring any respiratory support except mechanical ventilation (aRR, 1.41 [95% CI, 1.05-1.90]), or those requiring invasive mechanical ventilation (aRR, 1.83 [95% CI, 1.36-2.47]) (compared with no respiratory support). The presence of a pulmonary comorbidity other than asthma (aRR, 2.31 [95% CI, 1.15-4.62]) was associated with bacterial coinfection. Conclusions: Community-onset bacterial coinfection in children with critical COVID-19 is infrequent, but empiric antibiotics are commonly prescribed. These findings inform antimicrobial use and support rapid de-escalation when evaluation shows coinfection is unlikely.

Clinical and epidemiological features of pediatric population hospitalized with COVID-19: a multicenter longitudinal study (March 2020-December 2021) from Pakistan.

Background: We aimed to explore the epidemiological, clinical, and phenotypic parameters of pediatric patients hospitalized with COVID-19 in Pakistan. Methods: This longitudinal cohort study was conducted in five tertiary care hospitals in Pakistan from March 2020 to December 2021. Data on various epidemiological and clinical variables were collected using Case Report Forms (CRFs) adapted from the WHO COVID-19 clinical data platform at baseline and at monthly follow-ups for 3 months. Findings: A total of 1090 children were included. The median age was 5 years (Interquartile range 1-10), and the majority presented due to new signs/symptoms associated with COVID-19 (57.8%; n = 631), the most common being general and respiratory symptoms. Comorbidities were present in 417 (38.3%) children. Acute COVID-19 alone was found in 932 (85.5%) children, 81 (7.4%) had multisystem inflammatory syndrome (MIS-C), 77 (7.0%) had overlapping features of acute COVID-19 and MIS-C, and severe disease was found in 775/1086 (71.4%). Steroids were given to 351 (32.2%) patients while 77 (7.1%) children received intravenous immunoglobulins. Intensive care unit (ICU) care was required in 334 (31.6%) patients, and 203 (18.3%) deaths were reported during the study period. The largest spike in cases and mortality was from July to September 2021 when the Delta variant first emerged. During the first and second follow-ups, 37 and 10 children expired respectively, and medical care after discharge was required in 204 (25.4%), 94 (16.6%), and 70 (13.7%) children respectively during each monthly follow-up. Interpretation: Our study highlights that acute COVID-19 was the major phenotype associated with high severity and mortality in children in Pakistan in contrast to what has been observed globally. Funding: The study was supported by the World Health Organization (WHO), which was involved in the study design but played no role in its analysis, writeup, or publication.

Demographic Characteristics, Clinical Features, Laboratory, and Radiological Findings in Children Admitted to COVID19 Center in Amara City, Misan Province, Iraq

Background: Most pediatric patients with covid 19 had mild to moderate infection and some had severe challenging infection. Generally, they had variable signs and symptoms, laboratory, and radiological findings correlated with the patient age, the involved system, disease severity and probably any underlying disease. Aim: To identify the most common clinical features, the frequency of positive radiological findings, and laboratory results of the infected children hospitalized in Misan COVID-19 Center. Materials and method: A retrospective descriptive with some analytic study applied on 100 pediatric patients in the age range of (0-16) years, diagnosed with COVID-19 or were highly suspected cases, depending on clinical findings, laboratory tests, COVID-19 RT-PCR and/or chest (X-ray + CT), whom were admitted to the Pediatric Covid -19 Center in Amara City, Iraq during the time period of (February-June, 2021). Their medical records were reviewed for demographic information, (gender, age, and residence), medical history, clinical examination, laboratory and imaging studies, (X-ray + CT), O saturation, the duration of illness before admission of any underlying chronic diseases as well as the most common presenting signs and symptoms. Results: Children infected slightly more in the age range of (5-10 years), boys slightly more infected than girls as (54%) and (46%), respectively. The urban residents suffered more than the rural ones, 4% of all cases had low O2 saturation. Fever and malaise were the most common presenting symptoms as (93%) and (68%), respectively. The illness duration before hospitalization commonly was (<5days), (RT-PCR) was negative in 45% of patients, 54% had anemia with or without leukopenia and lymphopenia, CTs were positive in (62%) and CXR was positive in (53%), while the underlying chronic diseases were found in (23%) of the cases. Conclusion: Children of ages between (5-<10 years) were slightly more infected than others, fever, malaise, and cough were the most common manifestations, the urban predominance is high, and half of patients had anemia about one third and had lymphopenia. Likewise, one forth had thrombocytopenia, negative Covid-19 (RT-PCR), and/or CXR. The CT results did not exclude infection. Thus, we need further local studies to support our results. © 2023 by SPC (Sami Publishing Company)

Clinical characteristics of pediatric cases infected with the SARS-CoV-2 Omicron variant in a tertiary children's medical center in Shanghai, China.

BACKGROUND: The number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has increased. Here, we describe the clinical characteristics of children in a tertiary children's medical center in Shanghai. METHODS: A total of 676 pediatric coronavirus disease 2019 (COVID-19) cases caused by the Omicron variant who were admitted to the Shanghai Children's Medical Center from March 28 to April 30, 2022 were enrolled in this single-center, prospective, observational real-world study. Patient demographics and clinical characteristics, especially COVID-19 vaccine status, were assessed. RESULTS: Children of all ages appeared susceptible to the SARS-CoV-2 Omicron variant, with no significant difference between sexes. A high SARS-CoV-2 viral load upon admission was associated with leukocytopenia, neutropenia, and thrombocytopenia (P = 0.003, P = 0.021, and P = 0.017, respectively) but not with physical symptoms or radiographic chest abnormalities. Univariable linear regression models indicated that comorbidities (P = 0.001) were associated with a longer time until viral clearance, and increasing age (P < 0.001) and two doses of COVID-19 vaccine (P = 0.001) were associated with a shorter time to viral clearance. Multivariable analysis revealed an independent effect of comorbidities (P < 0.001) and age (P = 0.003). The interaction effect between age and comorbidity showed that the negative association between age and time to virus clearance remained significant only in patients without underlying diseases (P < 0.001). CONCLUSION: This study describes the clinical characteristics of children infected with the Omicron variant of SARS-CoV-2 and calls for additional studies to evaluate the effectiveness and safety of vaccination against COVID-19 in children.

Inflammatory and coagulation marker profiles in severe pediatric COVID-19 patients: a systematic review

Background Children are susceptible to SARS-CoV-2 infection and often present mild manifestations. However, severe and critical cases have also been reported. The inflammation and coagulation marker profile pattern in these patients along with the white blood cell differential count in critical PICU cases with non-COVID-19 etiology is not entirely clear.Objective To evaluate the inflammation and coagulation profiles in children presenting with severe/critical SARS-CoV-2 infection. Methods A systematic search and review of scientific literature was conducted following the PRISMA guidelines using ProQuest, SCOPUS, EBSCOHost, ScienceDirect, Cochrane, EMBASE, and Pubmed databases. All relevant original studies until March 11, 2021, were included. The risk of bias was appraised using the Modified Newcastle Ottawa Scale and JBI Critical Appraisal Checklist tools. Results We identified 14 studies across 6 countries, including a total sample of 159 severe and critically ill pediatric COVID-19 patients. Most of the subjects showed normal leukocytes, but in-creased CRP, procalcitonin, ferritin, and IL-6. Studies on coagula-tion profiles showed normal platelets, PT, aPTT, and inconsistent D-dimer results. Conclusion Inflammation and coagulation parameters in severe/ critically ill children with COVID-19 are atypical. Several inflammatory markers were elevated, including CRP, ferritin, procalcitonin, and IL-6. However, the elevated marker values are still lower compared to non-COVID infection patients. Further investigation of the parameters need to be done in serial examina-tion multicenter studies, which include control subjects. [Paediatr Indones. 2022;62:411-21;DOI: https://doi.org/10.14238/ pi62.6.2022.411-21 ].

Clinicolaboratory Profile and Treatment Outcome Within Ninety Days After Discharge During Second Wave of Pediatric COVID-19.

BACKGROUND: The second wave of COVID-19 pandemic hit all age groups with different presentations and outcomes. This study aimed to explore the clinical characteristics, investigational findings, hospital outcomes along with a ninety days telephonic follow-up of COVID-19 infection in children. METHODS: A longitudinal descriptive study among COVID-19 RT-PCR positive hospital-admitted children was conducted during the second wave of the pandemic from 15 Mar 2021 to 15 Oct 2021 at Kanti Children's Hospital. Demographics, clinical characteristics, oxygen saturation, comorbidities, need of oxygen, need of ventilator, laboratory investigations, admission to intensive care unit, duration of hospital stay and patient's outcome (improved and discharged or death) were recorded. A follow up at ninety days from discharge was also done via telephonic call to inquire for any illness and hospital admission. RESULTS: Among the 156 admitted children, males and females were 54.5% and 45.5% with a median age of 15 months and Inter quartile range (IQR) of 63. Thirty-six (23.1%) were underweight and 31 (19.9%) had comorbidities. The most common presenting symptoms were fever 115 (73.7%), cough 50 (32.1%) and vomiting 38 (24.4%). The median (IQR) length of hospital stay was 15 (range of 11-20) days. Oxygen use was seen among 35 (22.4%) cases and 36 (23.1%) cases were admitted to the ICU. Ventilator was required for 7 (4.5%) cases. The number of deaths was 9 (5.8%) during hospital stay. After discharge from the hospital during the ninety days follow-up, 117 children had no health problems while 42 reported having some health problems and 5 died after discharge. CONCLUSIONS: In the second wave of the pandemic, only symptomatic children were admitted. Respiratory and gastrointestinal symptoms were common among the admitted cases. The majority of admitted cases had a good outcome and had no other health problems attributable to COVID-19 till ninety days of follow-up.

Neurological Manifestations in Pediatric COVID-19 Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Study.

There are limited data about neurological manifestations in pediatric COVID-19 patients from all over the world, including Saudi Arabia. This study was performed to identify characteristics of pediatric COVID-19 cases with neurologic involvement hospitalized at King Abdulaziz University Hospital (KAUH), Saudi Arabia. This retrospective cross-sectional study included hospitalized patients aged 0-19 years with confirmed SARS-CoV-2 from April 2020 to February 2022. The required data were retrieved from patients' medical records. Ninety-four cases were included. The median ages of the studied group, those with neurological manifestations, and those without neurologic manifestations, were 6.5, 11.0, and 5.0 years, respectively. Neurological manifestations occurred in 29 COVID-19 patients (30.9%) with headache and decreased consciousness being the most common recorded manifestations in 8.5% and 6.4% of patients, respectively. Specific neurological manifestations were rare, as only two infants developed encephalopathy with fatal outcome. Most patients with and without neurological manifestations survived. Neuroimaging abnormalities were detected in 8 cases with neurological manifestations. Neurological manifestations were common in 31% of hospitalized pediatric COVID-19 cases. However, most of the neurological manifestations were mild and nonspecific, with headache being the most common one. Specific neurological manifestations were rare; however, pediatric COVID-19 patients, particularly young infants, were at risk of developing severe encephalopathy with fatal outcome.

Serum Vitamin D Levels in Relation to Development of Multisystem Inflammatory Syndrome in Pediatric COVID-19

Objective The aim of the study is to evaluate vitamin D (vit D) levels in children with and without development of multisystem inflammatory syndrome in children (MIS-C) after coronavirus disease 2019 (COVID-19) and also between those with severe and moderate MIS-C. Methods This comprises retrospective data of 68 patients including 34 patients with MIS-C and admitted into the pediatric intensive care unit (MIS-C group) and 34 patients without MIS-C (non-MIS-C group) were analyzed for their presenting characteristics, serum vit D levels, ventilatory needs, and prognostic scores. Results Vit D levels were significantly lower in patients with versus without MIS-C [9 (2-18) vs. 19 (10-43) ng/mL, p <0.001], and also in patients with severe versus moderate MIS-C [7.5 (2-17) vs. 9 (5-18) ng/mL, p = 0.024]. Vit D deficiency (levels <12 ng/mL) was more common in the MIS-C versus non-MIS-C group (79.4 vs. 11.8%, p <0.001) and in severe versus moderate MIS-C (92.9 vs. 70.0%, p <0.001). The severe versus moderate MIS-C was associated with significantly higher levels of procalcitonin [7.6 (0.9-82) vs. 1.7 (0.2-42) ng/mL, p = 0.030] and troponin [211 (4.8-4,545) vs. 14.2 (2.4-3,065) ng/L, p = 0.008] and higher likelihood of reduced ejection fraction (75.0 vs. 15.4%, p = 0.004). Conclusion Our findings indicate the higher prevalence of vit D deficiency in pediatric COVID-19 patients with versus without MIS-C, as well as in those with severe versus moderate MIS-C. Higher troponin and procalcitonin levels and dyspnea at presentation seem also to be risk factors for severe MIS-C, more pronounced cardiac dysfunction, and poorer prognosis.

Healthcare Chatbot System: A Survey

A chatbot is a software that produces a computer model of conversation through auditory or textual method between the user and the computer. Such bots use AI and NLP to understand user's questions and automate responses to them, simulating human conversation. In this modern technology almost, every person utilize smartphones in their day to day lives. Simply because, it has made life of a person simple by the touch of the screen, from extracting information from the internet, to provide personal assistance to entertainment everything happens just by the click of a button. Today Chatbots are used in various domains like education, customer service, medical, website help etc for seeking information, FAQ answering and guidance. Due to the advancements in AI and techniques used in data mining, healthcare chatbots are often used for medical screening. The aim of this paper is to do detailed study of various research papers related to chatbots and analyze the different tools, algorithms, software and platforms that are utilized. © 2022 IEEE.

Neurological and Neuroradiological Patterns with COVID-19 Infection in Children: A Single Institutional Study.

Background Varied neurological manifestations in pediatric patients with coronavirus disease 2019 (COVID-19) have been increasingly reported from all across the world in the scientific literature. Objective We aimed to evaluate pediatric cases with neurological symptoms and neuroimaging findings with COVID-19 infection in our hospital. Materials and Methods Children from 0 to 12 years with laboratory evidence of COVID-19 infection and acute neurological manifestations within 3 months, who have undergone magnetic resonance imaging (MRI) were included in the study. We categorized them based on neurological findings into four groups: acute encephalitis syndrome (AES), acute flaccid paralysis (AFP), cerebrovascular event/stroke, and miscellaneous consisting of acute seizures without encephalopathy. Results A total of 19 children with neurological manifestations related to COVID-19 infection were included in the study. AES was the most common neurological syndrome seen in 47.36%, followed by AFP in 26.31% and cardiovascular event/stroke in 21.05%. Seizure was the most common neurological symptoms in 62.15%, followed by encephalopathy in 42.10% and AFP in 26.31%. On neuroimaging, pattern observed were immune-mediated cauda equina nerve roots enhancement in 26.31% or acute disseminated encephalitis in 5.26%, small acute infarcts, hippocampal, and bilateral thalamic signal changes seen in 21.05% each, microhemorrhages and leukoencephalopathy in 15.78%, and coinfection in 5.26%. Conclusion In our study, seizures and encephalopathy were the most common neurological symptoms with COVID-19 infection. Postinfectious immune-mediated cauda equina nerve root enhancement or acute demyelinating encephalomyelitis-like brain imaging, followed by small acute infarcts and hippocampal/thalamic signal changes were most common imaging patterns. We found overlapping neurological and MRI patterns in many children, suggesting that various pathophysiological mechanisms act individually or synergistically.

Antibody response against SARS-CoV-2 variants of concern in children infected with pre-Omicron variants: An observational cohort study.

BACKGROUND: Despite that pediatric COVID-19 is usually asymptomatic or mild, SARS-CoV-2 infection typically results in the development of an antibody response. Contradictory observations have been reported when the antibody response of children and adults were compared in terms of strength, specificity and perdurability. METHODS: This observational study includes three cohorts infected with SARS-CoV-2 between March 2020-July 2021: unvaccinated infected children (n=115), unvaccinated infected adults (n=62), and vaccinated infected children (n=76). Plasma anti-spike IgG antibodies and neutralising activity against Wuhan, Delta and Omicron variants after 7-17 months post-infection were analysed. FINDINGS: More than 95% of unvaccinated infected children and adults remained seropositive when evaluated at 382-491 and 386-420 days after infection, respectively. Anti-spike IgG titers and plasma neutralising activity against Wuhan, Delta and Omicron variants were higher in children compared to adults. No differences were found when unvaccinated infected children were stratified by age, gender or presence/absence of symptoms in the acute phase of SARS-CoV-2 infection, but a slight decrease in the antibody response was observed in those with comorbidities. Vaccination of previously infected children with two doses of the inactivated BBIBP-CorV or the mRNA vaccines, BNT162b2 and/or mRNA-1273, further increased anti-spike IgG titers and neutralising activity against Wuhan, Delta and Omicron variants. INTERPRETATION: Unvaccinated infected children mount a more potent and sustained antibody response compared with adults, which is significantly increased after vaccination. Further studies including not only the analysis of the immune response but also the effectiveness to prevent reinfections by the different Omicron lineages are required to optimise vaccination strategy in children. FUNDING: National Agency for Scientific and Technological Promotion from Argentina (PICTO-COVID-SECUELAS-00007 and PMO-BID-PICT2018-2548).