On the pathogenesis of destructive pneumonia during COVID-19: a clinical case.

Community-acquired pneumonia is a potentially serious infection in children with high morbidity rate, risk of severe course and unfavorable outcomes. Specialists have noted the increased incidence of the destructive forms in the recent years. Aim. To present a clinical case of destructive pneumonia in a 1 year 2 month old child, hospitalized in the State Budgetary Healthcare Institution "Children's City Clinical Hospital of St. Vladimir Moscow Healthcare Department", and analyze it in terms of current understanding on the disease pathogenesis. Conclusion. During COVID-19 (COronaVIrus Disease 2019) pandemic, pulmonologists and pediatric surgeons encountered an unconventional course of destructive pneumonia. A large number of studies of pathophysiological processes in acute viral interstitial pneumonias have recently allowed to expand our understanding of the role of coagulation system. At the same time, new questions arose concerning the clinical course and development of the pathological infectious process.Copyright © Zaytseva O.V. et al., 2023.

Pediatric Inflammatory Multisystem Syndrome Temporally Associated with Sars-Cov-2 Infection

Despite the low incidence, low mortality and relatively mild symptoms of COVID-19 in children, there has been a rise in pediatric patients who develop a condition resembling Kawasaki disease after COVID-19 or contact with individuals infected with SARS-CoV-2. This condition is known as the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS). This review introduces the reader to the hypotheses of PIMS-TS pathogenesis, provides information about its diagnosis and treatment, presents clinical and laboratory data and describes treatments strategies used in children and adolescents hospitalized to the intensive care unit of the Pediatric Research and Clinical Center for Infectious Diseases. Besides, the review outlines the main diagnostic and prognostic challenges of PIMS-TS.Copyright © Extreme Medicine.All right reserved.

Unexpected Severe Bocavirus Infections among Hospitalized Children during the COVID-19 Pandemic

Objective: Acute respiratory tract infections are one of the leading causes of morbidity and mortality in children. Although human bocavirus (HBoV) infections are not as common as other seasonal respiratory viruses, children who are infected with HBoV are more likely to suffer from a variety of respiratory conditions, including the common cold, acute otitis media, asthma exacerbations, bronchiolitis pneumonia, some of the affected children require pediatric intensive care unit stay. Here, we aimed to evaluate pediatric bocavirus (HBoV) cases presenting with severe respiratory tract symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Method(s): This retrospective study evaluated the medical records of children diagnosed with respiratory infections, followed up at the Faculty of Medicine, Eskisehir Osmangazi University between September 2021 and March 2022. In this study, patients with HBoV identified using nasopharyngeal polymerase chain reaction (PCR) were considered positive. Cases were analyzed retrospectively for their clinical characteristics. Result(s): This study included 54 children (29 girls and 25 boys) with HBoV in nasopharyngeal PCR samples. The cases ranged in age from 1 month to 72 months (median 25 months). At the time of presentation, cough, fever, and respiratory distress were the most prevalent symptoms. Hyperinflation (48%), pneumonic consolidation (42%), and pneumothorax-pneumomediastinum (7%) were observed on the chest X-ray;54% of the children required intensive care unit stay. The median length of hospitalization was 6 days. Bacterial coinfection was detected in 7 (17%) children, while HBoV and other viruses were present in 20 (37%) children;57% of children received supplemental oxygen by mask, 24% high-flow nasal oxygen, 7% continuous positive airway pressure, and 9% invasive mechanical ventilation support. Antibiotics were given to 34 (63%) cases, and systemic steroid treatment was given to 41 (76%) cases. Chest tubes were inserted in three out of the four cases with pneumothorax-pneumomediastinum. All patients were recovered and were discharged from the hospital. Conclusion(s): The COVID-19 pandemic changed the epidemiology of seasonal respiratory viruses and the clinical course of the diseases. Although it usually causes mild symptoms, severe respiratory symptoms can lead to life-threatening illnesses requiring intensive care admission.Copyright © 2023. The Author(s).

Analysis of disease spectrum of hospitalized children during outbreak of coronavirus disease 2019 in pediatric department of a tertiary general hospital in Shanghai.

Objective To analyze the changes of disease spectrum in pediatric inpatients before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The data of gender, age, habitual residence, diagnosis and other relevant information of 1 931 hospitalized children in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Feb. 2019 to Jan. 2020 (1 year before the COVID-19 epidemic) and 618 hospitalized children from Feb. 2020 to Jan. 2021 (1 year after the COVID-19 epidemic) were collected. The total number, habitual residence, gender and disease spectrum of hospitalized children 1 year before and 1 year after the COVID-19 epidemic were statistically analyzed. Results The number of hospitalized children decreased by 68.00% (1 313/1 931) 1 year after the COVID-19 epidemic. The number of hospitalized children from other provinces and cities was decreased (17.80%110/618vs 29.00%560/1 931) and there was significantly difference in the distribution of habitual residence of hospitalized children between 1 year before and 1 year after the COVID-19 epidemic (P<0.01). One year after the COVID-19 epidemic, the number of children with respiratory diseases decreased by 92.04% (971/1 055), and the proportion was also decreased (13.59%84/618vs 54.63%1 055/1 931);the number of children with endocrine system diseases increased by 20.71% (29/140), and the proportion was increased (27.35%169/618vs 7.25%140/1 931);the number of children with neonatal diseases decreased by 43.01% (166/386), but the proportion was increased (35.60%220/618 vs 19.99%386/1 931). Compared with 1 year before the COVID-19 epidemic, there were significant differences in the proportions of respiratory diseases, endocrine system diseases and neonatal diseases in hospitalized children 1 year after the COVID-19 epidemic (all P<0.01). The age distribution of hospitalized children 1 year before and 1 year after the epidemic of COVID-19 was different (P<0.01), and the number of hospitalized children was also different in different seasons (P<0.05). One year after the epidemic of COVID-19, the number of hospitalized children with respiratory diseases was decreased most significantly, and the number of children with pneumonia decreased by 93.71% (655/699), with a significant difference found in the proportions of pneumonia between 1 year before and 1 year after the COVID-19 epidemic (52.38%44/84vs 66.26% 699/1 055, P<0.05). Compared with 1 year before the COVID-19 epidemic, the proportion of endocrine system diseases such as short stature/growth retardation was decreased and the proportion of precocious puberty/early puberty development was increased 1 year after the COVID-19 epidemic (P<0.05). Conclusion The COVID-19 epidemic has led to a significant decrease in hospitalized children in department of pediatric, especially in the proportion of respiratory diseases, but it has led to an increase in hospitalized children with endocrine system diseases, suggesting that epidemic prevention and control measures can effectively reduce respiratory diseases requiring hospitalization, but may increase precocious puberty and early puberty development. These changes should be considered by department of pediatrics in general hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Analysis of disease spectrum of hospitalized children during outbreak of coronavirus disease 2019 in pediatric department of a tertiary general hospital in Shanghai

Objective To analyze the changes of disease spectrum in pediatric inpatients before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The data of gender, age, habitual residence, diagnosis and other relevant information of 1 931 hospitalized children in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Feb. 2019 to Jan. 2020 (1 year before the COVID-19 epidemic) and 618 hospitalized children from Feb. 2020 to Jan. 2021 (1 year after the COVID-19 epidemic) were collected. The total number, habitual residence, gender and disease spectrum of hospitalized children 1 year before and 1 year after the COVID-19 epidemic were statistically analyzed. Results The number of hospitalized children decreased by 68.00% (1 313/1 931) 1 year after the COVID-19 epidemic. The number of hospitalized children from other provinces and cities was decreased (17.80%[110/618]vs 29.00%[560/1 931]) and there was significantly difference in the distribution of habitual residence of hospitalized children between 1 year before and 1 year after the COVID-19 epidemic (P<0.01). One year after the COVID-19 epidemic, the number of children with respiratory diseases decreased by 92.04% (971/1 055), and the proportion was also decreased (13.59%[84/618]vs 54.63%[1 055/1 931]);the number of children with endocrine system diseases increased by 20.71% (29/140), and the proportion was increased (27.35%[169/618]vs 7.25%[140/1 931]);the number of children with neonatal diseases decreased by 43.01% (166/386), but the proportion was increased (35.60%[220/618] vs 19.99%[386/1 931]). Compared with 1 year before the COVID-19 epidemic, there were significant differences in the proportions of respiratory diseases, endocrine system diseases and neonatal diseases in hospitalized children 1 year after the COVID-19 epidemic (all P<0.01). The age distribution of hospitalized children 1 year before and 1 year after the epidemic of COVID-19 was different (P<0.01), and the number of hospitalized children was also different in different seasons (P<0.05). One year after the epidemic of COVID-19, the number of hospitalized children with respiratory diseases was decreased most significantly, and the number of children with pneumonia decreased by 93.71% (655/699), with a significant difference found in the proportions of pneumonia between 1 year before and 1 year after the COVID-19 epidemic (52.38%[44/84]vs 66.26% [699/1 055], P<0.05). Compared with 1 year before the COVID-19 epidemic, the proportion of endocrine system diseases such as short stature/growth retardation was decreased and the proportion of precocious puberty/early puberty development was increased 1 year after the COVID-19 epidemic (P<0.05). Conclusion The COVID-19 epidemic has led to a significant decrease in hospitalized children in department of pediatric, especially in the proportion of respiratory diseases, but it has led to an increase in hospitalized children with endocrine system diseases, suggesting that epidemic prevention and control measures can effectively reduce respiratory diseases requiring hospitalization, but may increase precocious puberty and early puberty development. These changes should be considered by department of pediatrics in general hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.

Etiological structure of acute respiratory viral infections in children hospitalized in 2015-2018

Acute respiratory viral infections (ARVI) play an important role in morbidity formation among children. At the same time, studies about the ARVI etiological structure are not enough. The article presents the results of structure analyses of ARVI in children with severe and moderate degrees of disease hospitalized in the children's clinical hospital of Novosibirsk for the period 2015-2018. This research aimed to analyze the morbidity of acute respiratory viral infections with the estimation of a causal virus in children admitted to the hospital for the period 2015-2018. Material and methods. In this study, 1137 children aged between 0 and 15 years were examined. In order to determine the etiological factor in children with damage of the upper or lower respiratory tract, by using the method of RT-PCR (AmpliSensARVI-screen-FL test systems (InterLabService, Russia), mucus from the nose and throat was examined for the presence of genetic material of viruses that cause ARVI (influenza A and B viruses, parainfluenza viruses of types 1-4, respiratory syncytial virus, metapneumovirus, four types of human coronavirus, rhinovirus, adenovirus, and bocavirus). Results. The research found that the most frequently detected pathogens are respiratory syncytial virus (23.52%), influenza A and B viruses (19.73%) and rhinovirus (19.21%). Observe the dynamics some fluctuations in the detection of mentioned viral agents and increasing of mixed infections were detected. In addition, the importance of respiratory and gastrointestinal tract combined lesions, particularly for infants and preschool - age children has been noted. Conclusion. The distribution of respiratory viruses in children with severe ARVI who required hospitalization was assessed. It was shown the significance of the respiratory syncytial infection virus, influenza virus and rhinovirus in the etiological structure of hospitalized children of different ages that damage not only the respiratory tract, but also to the gastrointestinal tract. This is an important factor in optimizing the diagnosis, treatment and prevention of viral infections in children.Copyright © Infectious Diseases: News, Opinions, Training 2021.

Clinical and immunological parallels in children patients with COVID-19

The problem of the incidence of new coronavirus infection in childhood is becoming increasingly important. At the same time, questions arise regarding the peculiarities of the pathogenesis of COVID-19 in children. The aim of the research was to study the clinical and immunological features of COVID-19 in children hospitalized with a severe course of the disease. Material and methods. We examined 53 children from 0 to 15 years old, hospitalized with suspected new coronavirus infection at Children's Clinical Hospital No. 3 in Novosibirsk from October to December 2020. Determination of specific IgM and IgG antibodies to SARS-CoV-2 antigens in serum blood was carried out using the ELISA method. SARS-CoV-2 virus RNA in nasopharyngeal and oropharyngeal swabs was determined using commercial kits for PCR diagnostics. A z-test was used to compare relative numbers. The significance level was taken equal to 5% (p=0.05). Results and discussion. All examined children hospitalized with suspected COVID-19, regardless of the duration of the disease, had specific IgG antibodies to SARS-CoV-2 antigens, which confirms earlier contact with the new coronavirus in relation to the time of the examination. In 63.6% of cases, specific IgM antibodies of the class to SARS-CoV-2 were detected in the blood serum, in 6% of cases the result was doubtful. IgM antibodies were not detected in blood serum in 30.3% of patients. The results obtained for the determination of IgG and IgM antibodies to SARS-CoV-2 antigens may reflect the atypical nature of seroconversion in COVID-19. An extremely diverse clinical symptomatology was revealed, including, in addition to catarrhal syndrome and intoxication syndrome, abdominal, meningeal, and articular syndromes. In 24.3% of children, polymorphic exanthema was detected, which may be a manifestation of the systemic nature of damage to the vascular wall. Conclusion. With serologically confirmed SARS-CoV-2 etiology of the infectious process in the examined children, an extremely diverse clinical symptomatology was revealed, which, most likely, may be associated with multiple organ damage.Copyright © Transplantologiya. The Russian Journal of Transplantation.All right reserved.

Clinical and laboratory characteristics of new coronaviral infection (COVID-19) in children

Another rise in the incidence of a new coronavirus infection (COVID-19), due to the penetration of the SARS-CoV-2 delta strain into Russia in the second half of April 2021, is characterized by rapid spread, severe course in adults and an increase in cases of the disease among children. The aim of the work is to assess the clinical and laboratory parameters of a new coronavirus infection (COVID-19) in children. Material and methods. The results of clinical and laboratory examination and complex therapy of 95 children with moderate and severe forms of COVID-19, hospitalized in the Republican Clinical Infectious Diseases Hospital in Ufa from May to September 2021, are presented. Results. The anamnesis of the disease and life, epidemiological, clinical and laboratory, instrumental data obtained during the examination of children with COVID-19 in the course of the disease were studied. Among the clinical manifestations in children, symptoms of acute respiratory infection (37.9+/-4.98%), pneumonia without respiratory failure (26.3+/-4.52%), pneumonia with acute respiratory failure (33.7+/-4.85%). In 2 patients of the first months of life (2.1+/-1.47%), against the background of a aggravated premorbid background, immunodeficiency, COVID-19 proceeded in an extremely severe form with a fatal outcome. Conclusion. The clinical manifestations of COVID-19 are similar in children and adults, but differ in the frequency of respiratory symptoms. A severe course with a fatal outcome was registered in children in the first months of life with a burdened premorbid background.Copyright © Infectious Diseases: News, Opinions, Training 2022.

Comorbidities That Increase Risk for Severe Acute Covid-19 in Pediatric Population

Background: Little is understood about which comorbidities are associated with severe outcomes in children hospitalized with acute COVID-19. Some confusion lies especially for cancer or diabetes. Method(s): Data from 2 multicenter prospective cohort studies of hospitalized children (aged 0-18 years) with confirmed SARS-CoV-2 in Spain and Colombia were combined for this analysis. Data were obtained from 116 hospitals. Outcome was classified as (in decreasing order of severity): death, mechanical ventilation (MV), pediatric intensive care unit (PICU) admission, high flow/CPAP, oxygen therapy with nasal prong (NP) and hospitalization without respiratory support. Risk factors for severity, adjusting for age and gender, were identified using multinominal logistic regression and a backwards selection process. Result(s): A total of 1,753 patients were included, 734 (41.8%) in Spain and 1,019 (58.1%) in Colombia. The most frequent comorbidities were asthma (9.0%), chronic neurological disorder (NRL) (7.4%), immunosuppressive medication (7.2%), malignant neoplasms (5.4%) and chronic lung disease (not asthma) (CLD) (4.5%). Comorbidities associated with the different endpoints are summarized in Figure 1. Asthma was associated with a significantly increased risk of death (OR: 4.17;95%CI 1.34-12.97), MV (OR: 7.94 (3.59-17.56)), PICU admission (OR: 3.37 (1.91- 5.96)), high flow/CPAP (OR: 6.65 (2.69-16.46)), and NP (OR: 3.85 (2.57-5.77)) compared to hospitalization without respiratory support. NRL was associated with increased risk of death (OR: 7.34 (3.01-17.90)), MV (OR: 3.07 (1.20-7.82)) and high flow/CPAP (OR: 4.36 (1.68-11.29)). CLD was associated with increased risk of death (OR: 6.22 [2.28-16.94]) and NP (OR: 3.1 (1.74-5.58)) and in addition, chronic cardiac disease was associated with increased risk of MV (OR: 5.21 (1.76-15.41)) and PICU (OR: 2.78 (1.27-6.08)). Risks of death (OR: 4.49 (2.03-9.05)), MV (OR: 2.97 (1.52-5.81)), PICU (OR: 4.27 (2.89-6.33)), and NP (OR: 4.67 (3.64-5.99)) were higher in the Colombia Cohort. Conclusion(s): Asthma, chronic neurological, cardiac and lung disease;and belonging to the Colombia cohort were consistently associated with multiple severe outcomes of COVID-19. Cancer and diabetes association with selected endpoints rather than with most endpoints may be more related to the baseline disease than with the actual COVID-19.

Respiratory Syncytial Virus (RSV) infections in children: recent concepts in immunopathogenesis and diagnostic dilemma

Respiratory viral infections are important cause of morbidity and mortality in early life. The relative influence of host and viral factors possibly contribute to the disease pathogenesis. Predisposing conditions like prematurity, Low birth weight and congenital heart diseases etc. have been incriminated in the disease progression. The development of cough, wheezing, and tachypnea, usually peaking on days 4 to 5, go parallel with host cytokine responses and viral load. Various host cytokines, chemokines and molecules involved in the immune response against RSV infection might be responsible for the outcome of the disease process. Nasopharyngeal aspirates (NPAs) from children (n = 349) between 2013-2017 were subjected for IL-17A, IFN-gamma, TNF-alpha, IL-10, IL-6 levels by CBA and MMP-9 and TIMP-1 levels by ELISA. The viral load in RSV positive samples and cytokine levels were correlated with the WHO criteria for acute lower respiratory tract illness (ALRTI). RSV viral load, Pro-inflammatory cytokine (TNF-alpha) levels in severe ALRTI patients were significantly higher than the ALRTI patients [p<0.001]. Whereas Th17 cytokine (IL-17) was found to be significantly higher (p<0.05) in ALRTI patients than severe patients. MMP-9 is secreted in higher levels in severe ALRTI patients (n = 77) in comparison to Acute LRTI patients (n = 35) with an increase of thirty seven fold (p<0.001). Thus, the study highlights the role of TNF -alpha, IL-17 and Th2 cytokine biasness in the pathogenesis of RSV disease with the possible contribution of higher MMP-9/TIMP-1 ratio as a bad prognostic marker towards disease severity. To study the gene expression of autophagy and mTOR signalling pathways in RSV infected children with ALRTI. Nasopharyngeal aspirate (NPA) samples (n = 145) from children suffering from ALRTI were subjected for detection of RSV (Oct 2019 to March 2020). Semi-quantitative gene expression analysis for 5 representative genes each of mTOR signalling and autophagy pathway were performed in respiratory tract epithelial cells using 25 RSV positive cases and 10 healthy controls subjects. Autophagy gene expression analysis revealed significant upregulation in NPC1 and ATG3 autophagy genes. mTOR, AKT1 and TSC1 genes of mTOR pathway were significantly down-regulated in RSV positive patients except RICTOR gene which was significantly upregulated. Thus, survival of RSV within autophagosome might have been facilitated by upregulation of autophagy and downregulation of mTOR signalling genes. To assess the impact of SARS-CoV2 pandemic on RSV, samples were collected from children with ALRTIs admitted to emergency, PICU and indoor admissions during pre-pandemic period (October 2019 to February 2020;n = 166) and during COVID-19 Pandemic (July 2021 to July 2022;n = 189, SARS-CoV2 negative). These NP swabs were analyzed for pdm InfA H1N1, InfA H3N2, Inf B, RSV, hMPV, hBoV, hRV, PIV-2 and PIV-3 by PCR. Higher proportion of children with ALRTIs have had virus/es isolated during pre-pandemic period than during pandemic period (p<0.001). During pre-pandemic period, significantly higher proportion of children had RSV positivity (p<0.001);and significantly lower positivity for hRV (p<0.05), hMPV (p<0.05), and hBoV (p <= 0.005). The occurrence of COVID-19 pandemic has significantly impacted the frequency and pattern of detection of RSV among hospitalized children with LRTIs. RSV Fusion protein plays a critical role in the entry of the virus into the host cell by initiating the fusion of host and viral membranes. It happens to be a target of neutralizing antibodies paving the way as a vaccine candidate. Hence effort was made to introduce point mutation in hRSV fusion protein which can confer stability in its prefusion form. In-silico a stable structure of RSV fusion protein was generated making it a potential vaccine candidate. The timely diagnosis of RSV infection in this population is important for initiating therapy and instituting appropriate infection prevention measures. Serological testing is not widely used for the diagnosis of RSV. C ll Cultures including shell vial culture were used for RSV diagnosis. However, culture approaches lack sensitivity, often quite significantly, compared to nucleic acid amplification assays for the diagnosis of RSV infections. Molecular multiplex assays now offer increased sensitivity for a more accurate diagnosis. However issues with the use of these types of commercial panel assays include the requirement for substantial training, quality systems, and infrastructure to maintain and run these assays and many a times identification of viruses where the true pathogenic potential of those multiple viruses are debatable. Studies are available with laboratory- developed nucleic acid amplification test systems for the detection of RSVA and RSVB in clinical specimens either by PCRbased technologies or RT-LAMP. Gene targets of laboratory-developed molecular assays point towards M gene and the N gene in RSVA and -B with the benefits of flexibility to modify assays when targets are under evolutionary pressure to change, as well as a perceived initial low cost to carry out testing.

Cystic fibrosis fitness during inpatient treatment

Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

NILMATREVIR-RITONAVIR TREATMENT IN CHILDREN WITH SARS-CoV-2 INFECTION

Background: Children seem to experience a less severe form of COVID-19 disease than adults, nevertheless, cases of severe infection have been described in a small proportion of patients, requiring hospitalization in 5-10% of cases. Among COVID-19 deaths 0,4% occurred in children and adolescents under 20 years of age. Most hospitalized children with acute COVID-19 had underlying conditions. Moreover, some children with previous COVID-19 infection, may later develop Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but serious condition associated with COVID-19. These data suggest that a specific therapy is necessary in high-risk pediatric population, in order to prevent severe COVID-19, especially in children with underlying conditions. Antiviral paediatric data are currently very few Methods: We conducted a retrospective study on patients < 18 years of age who received Paxlovid (nirmatrelvir-ritonavir) for the treatment of mild-tomoderate COVID-19 at Bambino Gesu Children's Hospital from April 2022 to September 2022. Patients at high risk of progression to severe COVID-19 who had no need of supplemental oxygen received Paxlovid according to AIFA's indications for adults with the Informed Consent of relatives Results: 40 patients aged 1-18 years with confirmed SARS-CoV-2 infection were treated with Paxlovid (Tab 1)The average symptom duration was 4.2 days. No patient developed severe COVID-19 r All patients were treated within 5 days of symptom onset, Four patients received a longer course treatment (10 days) due to the persistence of symptoms combined with the presence of severe comorbidities .The mean time of viral shedding was 12.7 days, with a patient being persistently positive for 56 days. After Paxlovid initiation, only 5 patients (12.5%) experienced adverse reactions: Conclusion(s): Treatment with Paxlovid has proven to be safe. Further pharmacokinetic studies are required species for children < 5 years old.

Lung damage in children with SARS-CoV- 2 infection: Radiological and clinical study

Background: SARS-Co- V 2 infection has a global impact, being declared by the WHO pandemic since march 2020. The pediatric population is also affected, according to the latest data in approximately 18% of cases. Children endure the disease in milder forms compared to adults. The clinical picture is dominated by catarrhal respiratory signs, febrile syndrome, cough. Radiological investigations are designed to assess the stage of the disease, the affected lung volume and the complications present. Aim.The evaluation of radiological and clinical changes in children with COVID-19 infection correlated with age. Method(s): The study includes 64 children hospitalized in the COVID-19 department of the IMSP Mother and Child Institute. The study sample was divided into 5 groups, with the age: 0-1 month, 1-12 months, 1-3 years, 3-7 years, > 7 years. The mean age was 2.04 +/- 0.38 years. All patients were evaluated according to clinical manifestations and chest radiography. Result(s): The largest share among hospitalized children up to one year -33%. Frequent hospitalization of these children is due to immune system and anatomical features of the respiratory tract. The severe debut of the disease presented the newborns (58.3%: 95% CI 27.67-84.83) and children up to one year (52.4%: 95% CI 29,78-74,29), caused by febrile syndrome in 48.4%: 95% CI 35,75-61.27, chi2 = 3,18, p > 0.5, catarrhal respiratory signs in 50%: 95% CI 37,23-62,77, chi2 = 3.49, p > 0.4, cough in 63.5%: 95% CI 52.19-78.19, chi2 = 5.5, p > 0.05. The most common radiological change in children with COVID-19 infection is the interstitial inflammation "ground-glass". It has a frequency of about 60% in all study groups, with maximum enrollment in children up to one year 66.7%: 95% CI, 34.9-90 and in children aged 1-3 years -57.1%: 95% CI, 38.6-90.9, chi2 = 0.9, p > 0.05. Pneumonic infiltrations is detected in 40%, with the maximum enrollment in children up to one year (42.9%: 95% CI, 21.8-66) and pre-school children (57.1%: 95% CI, 21.5 -69,2) chi2 = 0.44, p > 0.05. Conclusion(s): Children up to one year of age needed more frequent hospitalization due to the severe onset of the disease. The predominant clinical manifestations is fever, catarrhal respiratory signs and cough. The most common radiological change in children with COVID-19 infection is the interstitial inflammation "ground-glass".

Clinical-epidemiological study of COVID-19 infection in hospitalized children

Background: Emerging evidence suggests that children are at greater risk of COVID-19 infection than initially predicted. Although studies show a slight evolution in pediatric patients, there is an increased risk in newborns and infants, as immaturity of the respiratory tract and immune system contributes to the development of severe forms in this age group. There is also insufficient information on the role of children in the transmission of the virus, which is important in making public health decisions. Aim(s): To identify the clinical and epidemiological characteristics and transmission patterns of pediatric patients with the Covid-19. Method(s): The study includes 417 children hospitalized in the COVID-19 section of the IMSP Mother and Child Institute in 2021. The mean age was 3.96 +/- 3.97 years. Confirmation of the diagnosis was based on the detection of SARS-CoV- 2 virus by the application of molecular biology tests or rapid tests for the detection of SARS-CoV- 2 antigen. Result(s): More than half of the children were under the age of 5 (58.27%: 95% CI, 65.3-74.3), of which newborns accounted for 10.79%: 95% CI, 8.1-14.3, and infants up to one year -28.29%: 95% CI, 24.1-32.9. Boys prevailed slightly, accounting for 56.83%: 95% CI, 51.9-61.6, and 60.67%: 95% CI, 55.8-65.4 of children with COVID-19 infection were from urban areas. From the anamnestic data, the mean time from the onset of SARS-CoV- 2 infection to the time of diagnostic was 3.88 +/- 1.98 days. The conditions of transmission of the virus to children included in the study were: family contact in 46.04%: 95% CI, 41.2-51.0 cases, import cases 6.95%: 95% CI, 4.8-9.9, participation in public events in 5.7%: 95% CI, 3.8-8.6, contact in children's communities (schools/kindergartens) in 4.31%: 95% CI, 2.1-6.9. Also, there were 1.67%: 95% CI, 0.7-3.6 newborns of COVID-19 positive mothers with symptomatic forms. The number of hospitalizations was obviously increased in march-april and august-september, confirming the evolution in waves of the SARS-CoV- 2 pandemic. Conclusion(s): Frequent affecting to children up to one year of age is a cause for concern, as infants have a developing immune system and are at risk for bronchopulmonary damage. Family contact is the main source of infection for the pediatric population, so interventions targeting children could have a relatively small impact on reducing the transmission of SARS-CoV- 2 infection.

Clinical and paraclinical manifestation COVID-19 in different age children

Purpose - to establish the clinical and paraclinical manifestations of the course of COVID-19 in children, depending on age to predict the severity of the disease's manifestation. Materials and methods. The 60 children aged from 3 months to 17 years old with laboratory-confirmed SARS-CoV-2 were examined. All patients underwent general clinical, laboratory, and instrumental examinations and received therapy according to Ukrainian National protocol. SARS-CoV-2 infection was confirmed by real-time PCR. Results. Thus, in young children COVID-19 begins acutely (90.0%) with intoxication (75.0%), fever (65.0%), nasal congestion (25.0%), rhinorrhea (20.0%), dry cough (60.0%), increased ESR and C-reactive protein (55.0%). The course of COVID-19 in children 4-6 years is accompanied by acute onset (85.71%), fever (85.71%), pharyngitis (85.71%), lymphopenia (28.56%), and no CT signs of lesions (71.43%). In children 7-12 years old, COVID-19 causes intoxication (88.89%), fever (83.33%), pharyngitis (55.56%), dry cough (77.78%), lymphocytosis (16.67%) with accelerated ESR (38.89%) and pneumonia (38.89%). The course of COVID-19 in children was older than 13 years old characterized by fever (73.33%), pharyngitis (66.67%), dry cough (73.33%), olfactory loss (20.0%), leukopenia (20.0%), ESR acceleration (20.0%), and a decrease in prothrombin (13.33%) without pulmonary lesions (73.33%). Conclusions. These data suggest that the severity and duration of clinical and laboratory manifestations of COVID-19 depend on the child's age. The course of COVID-19 in children of all age groups is mostly of moderate severity with a favorable prognosis ((56.67%) hospitalized children did not have any complications). Only children from 7 to 12 years old need additional attention due to the severe manifestations of intoxication (88.89%) and the risk of complications with pneumonia (38.89%). The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.Copyright © 2022 Modern Pediatrics. Ukraine. All rights reserved.

Evolution of the frequency of COVID-19 infection cases among children in the pandemic period

Background: Aim: evaluation of the frequency with COVID-19 infection among children hospitalized during the pandemic in relation to the age of the patients. Method(s): Expected research appreciated the dynamics of the number of children with SARS-CoV- 2 infection hospitalized in the COVID-19 profile department of the Mother and Child Institute between January 2021 and February 2022. 967 children with COVID-19 infection were hospitalized with moderate and severe form, from the age of 2 days till 17 years 9 months. Age distribution of hospitalized children with clinical signs of COVID-19 infection: < 1 year -464 children (48,1%: 95%CI 44.9-51.3), 1-2 years -159 children (16.4%: 95%CI 14.1-18.9), 2-4 years -99 children (10.2%: 95%CI 8.4-12.3), 4-14 years -183 children (18.9%: 95%CI 16.5-21.5), 14-18 years-62 children (6.4%: 95%CI 5-8.2). Result(s): At the beginning of 2021, the hospitalization of children with COVID-19 infection was 21-28 children per month, with a double increase of hospitalization in March-April (60-43 children). Further, it was a period of significant decrease of hospitalized children (13-28 children/month), then, from the end of July there was a gradual increase in cases of COVID-19 from 39 to 105 (October) and 63 (November) hospitalized children. Insignificant decrease in hospitalization of children in December (39 children) was followed by the exponential increase in the hospitalization of children with COVID-19 to 133 cases in January 2022 and 251 children in February. The increase in hospitalization of children with COVID-19 in the fall coincided with the wave caused by the Delta variant of SARS-CoV- 2, and the highest number of hospitalizations in January-February 2022 was during the dominance of the Omicron variant. Conclusion(s): The frequency of hospitalization of children with COVID-19 infection was correlated with pandemic waves with an increase during the dominance of the Delta variant and the Omicron variant of the SARS-CoV- 2. In the age structure of hospitalized children with COVID-19 infection, predominated children of the first year of life.

Features of clinical and laboratory changes in adolescents in the dynamics of novel coronavirus infection.

The relevance of research on a novel coronavirus infection is associated with an increase in the incidence among children since 2021, which may be due to the accumulation of mutations in the virus genome and its evolution towards increased contagiousness, replicative ability, and evasion of immune protection. While there are many studies in adults, data analyzing the clinical course of the disease in pediatric patients infected with SARS-CoV-2 are limited, particularly regarding adolescents. Objective. To study the clinical and laboratory features of the course of a novel coronavirus infection in hospitalized adolescents in Novosibirsk during the first, second and third waves of the pandemic. Materials and methods. A retrospective analysis of case histories of 125 children treated at Novosibirsk Children's Clinical Hospital No 6 with a confirmed diagnosis of coronavirus infection during three pandemic waves was carried out (June- August 2020, October-December 2020, June-August 2021). Based on these time intervals, three groups of adolescents admitted to the hospital during the first, second, and third waves of coronavirus infection were formed. SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal scrapings was determined using the PCR-RT method. Biochemical and general clinical studies were performed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Statistical processing was carried out using the Satistika 7.0 software package (StatSoft, USA). Differences between the groups were assessed using the Z-test and the Mann-Whitney U test. Differences between the compared series were considered statistically significant with a probability level of 95%. Results. It was shown that during three pandemic waves (June 2020 - August 2021), more than half of the hospitalized children were adolescents. At the same time, regardless of the pandemic wave, intoxication, catarrhal and intestinal syndromes predominated in hospitalized adolescents. CNS injury symptoms were significantly less frequent in the first wave, as were skin rashes. Cough in the third wave was observed in 100% of hospitalized adolescents. The average values of the parameters of complete blood count, as well as CRP, D-dimer and ferritin had no statistically significant differences in different pandemic waves, but there was a significant variation in individual values within the groups in each wave.Copyright © 2022, Dynasty Publishing House. All rights reserved.

Features of clinical and laboratory changes in adolescents in the dynamics of novel coronavirus infection.

The relevance of research on a novel coronavirus infection is associated with an increase in the incidence among children since 2021, which may be due to the accumulation of mutations in the virus genome and its evolution towards increased contagiousness, replicative ability, and evasion of immune protection. While there are many studies in adults, data analyzing the clinical course of the disease in pediatric patients infected with SARS-CoV-2 are limited, particularly regarding adolescents. Objective. To study the clinical and laboratory features of the course of a novel coronavirus infection in hospitalized adolescents in Novosibirsk during the first, second and third waves of the pandemic. Materials and methods. A retrospective analysis of case histories of 125 children treated at Novosibirsk Children's Clinical Hospital No 6 with a confirmed diagnosis of coronavirus infection during three pandemic waves was carried out (June- August 2020, October-December 2020, June-August 2021). Based on these time intervals, three groups of adolescents admitted to the hospital during the first, second, and third waves of coronavirus infection were formed. SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal scrapings was determined using the PCR-RT method. Biochemical and general clinical studies were performed in accordance with the guidelines of the Ministry of Health of the Russian Federation. Statistical processing was carried out using the Satistika 7.0 software package (StatSoft, USA). Differences between the groups were assessed using the Z-test and the Mann-Whitney U test. Differences between the compared series were considered statistically significant with a probability level of 95%. Results. It was shown that during three pandemic waves (June 2020 - August 2021), more than half of the hospitalized children were adolescents. At the same time, regardless of the pandemic wave, intoxication, catarrhal and intestinal syndromes predominated in hospitalized adolescents. CNS injury symptoms were significantly less frequent in the first wave, as were skin rashes. Cough in the third wave was observed in 100% of hospitalized adolescents. The average values of the parameters of complete blood count, as well as CRP, D-dimer and ferritin had no statistically significant differences in different pandemic waves, but there was a significant variation in individual values within the groups in each wave.Copyright © 2022, Dynasty Publishing House. All rights reserved.

COVID-19 infection in children through lung radiographic imaging changes

Background: Radiological changes in children with lung damage caused by SARS-CoV-2 can be diagnosed by radiology exams with the identification of interstitial inflammation characterized of viral pneumonia. Aim(s): Evaluation of pulmonary radiological manifestations in children with COVID-19 infection. Method(s): Expected research evaluated pulmonary radiological changes among 315 children with SARS-CoV-2 infection, with moderate and severe form, from the age of 2 days till 18 years. Age distribution of hospitalized children with clinical signs of COVID-19 infection:<28 days-36 children(11,4%:95%CI8,2-15,6),28 days-1year-72 children(22,9%:95%CI18,4-28),1-3years-65 children(20,6%:95%CI16,4-25,6),4-7 years-66 children(21%:95%CI16,7-26),7-18years-76 children(24,1%:95%CI19,6-29,3). Result(s): Chest X-ray in children with SARS-CoV-2 infection found interstitial changes of the ground glass"type among 161 children(52.8%:95%CI 47-58.5) Condensation opacities in 51 children(16.7%:95%CI12.8-21.5)confirmed pneumonia of bacterial etiology associated with COVID-19 infection. Bronchitis was confirmed in 62 cases among hospitalized children(20.3%:95% CI16-25.4),and obstructive bronchitis characterized by imaging of hyperinflation- among 25 children(12.6%:95%CI8,3-18). Young children and infants had a thymus hyperplasia in 21.6%:95%CI17.2- 26.8 cases. At the acute stage of COVID-19 infection signs of fibrosis, atelectasis, traction bronchiectasis were detected in unique cases(0.3%:95%CI0-2.1). Conclusion(s): Lung damage caused by COVID-19 infection in children is generally characterized by changes with interstitial inflammation that are confirmed by Chest X-ray.