COVID-19-Associated Parotitis in a 10-Week-Old Male.

We describe a case of parotitis associated with coronavirus disease 2019 (COVID-19) in a young male infant. His presenting symptom at the time of diagnosis of COVID-19 was unilateral facial swelling. He then developed upper respiratory infection symptoms and proceeded to recover over a period of about a month. Testing for other causes of parotitis was unrevealing. Other cases of COVID-19-associated parotitis have been presented in the literature, but this case is by far the youngest child noted, and is a useful reminder to pediatricians and general practitioners to consider COVID-19 as a cause of parotitis. Additionally, it sheds light on possible transmission and pathophysiology of COVID-19 in the salivary glands, as several other authors have noted.

Recommendations of Nutritional Treatment for Patients with COVID-19 Infection (2023).

The standardized nutrition support therapy can improve the nutritional status, immunity, quality of life, and clinical outcomes of patients with novel coronavirus disease (COVID-19) infection. The latest Chinese government policy also clearly states that nutrition support therapy should be included in the whole process of treatment and recovery of patients with COVID-19. Therefore, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy has organized relevant experts to formulate the Recommendations of Nutritional Treatment for Patients with COVID-19 Infection (2023), following the latest clinical nutrition guidelines, research evidence and clinical practice of nutrition support of COVID-19. The recommendations suggest that individualized nutrition management be implemented by fol-lowing the standardized pathway of nutrition management, which includes nutrition-risk screening, malnu-trition diagnosis, nutrition treatment and nutrition monitoring, and by taking into account the clinical char-acteristics of patients with COVID-19.Copyright © 2023, Peking Union Medical College Hospital. All rights reserved.

COVID-19 in Pediatric Patients: An update on Features and Treatment Options

This review aimed to identify the features of coronavirus disease 2019 (COVID-19) in pediatric patients after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. According to the literature, the incidence of COVID-19 was reported to be 1-5% among children. However, the incidence of infection with the new variant of the virus is higher in children. The most common features were fever and respiratory manifestation. The milder severity and lower mortality of COVID-19 among children are related to their less contact, immature immune system, and different features of angiotensin-converting enzyme 2 (ACE2), an important receptor of the virus to invade the host cells. Several complications were observed in severe pediatric patients, such as coinfections, encephalitis, multisystem inflammatory syndrome, and multiorgan failure. The most frequent laboratory data were the procalcitonin elevation. The enhanced inflammatory factors and lymphocytopenia were less common among this population. In the CT findings, the ground-glass opacities, pulmonary consolidation, fine mesh shadow, and tiny nodules were most common. While some children were admitted to the ICU, mechanical ventilation was rarely reported. The vertical intrauterine transmission from mother to child has not been proven. The treatment mainly focuses on maintaining balance in the fluids and electrolytes, nutritional support, and oxygen therapy for this vulnerable population.Copyright © 2022, Shaheed Beheshti University of Medical Sciences and Health Services. All rights reserved.

Viral metagenomics unveils MW (Malawi) polyomavirus infection in Brazilian pediatric patients with acute respiratory disease.

Viral metagenomics has been extensively applied for the identification of emerging or poorly characterized viruses. In this study, we applied metagenomics for the identification of viral infections among pediatric patients with acute respiratory disease, but who tested negative for SARS-CoV-2. Twelve pools composed of eight nasopharyngeal specimens were submitted to viral metagenomics. Surprisingly, in two of the pools, we identified reads belonging to the poorly characterized Malawi polyomavirus (MWPyV). Then, the samples composing the positive pools were individually tested using quantitative polymerase chain reaction for identification of the MWPyV index cases. MWPyV-positive samples were also submitted to respiratory virus panel testing due to the metagenomic identification of different clinically important viruses. Of note, MWPyV-positive samples tested also positive for respiratory syncytial virus types A and B. In this study, we retrieved two complete MWPyV genome sequences from the index samples that were submitted to phylogenetic inference to investigate their viral origin. Our study represents the first molecular and genomic characterization of MWPyV obtained from pediatric patients in South America. The detection of MWPyV in acutely infected infants suggests that this virus might participate (coparticipate) in cases of respiratory symptoms. Nevertheless, future studies based on testing of a larger number of clinical samples and MWPyV complete genomes appear to be necessary to elucidate if this emerging polyomavirus might be clinically important.

Disaster Evacuation for Home-Based Patients with Special Healthcare Needs: A Cross-Sectional Study.

Recent super-typhoons and torrential rains triggered by global warming have had disproportionately large effects on medically vulnerable people in Japan. This study aimed to identify factors associated with intention to evacuate to the nearest public shelter among family caregivers of pediatric patients receiving home medical care. The study included family caregivers of these patients from the Department of Pediatrics, Fukuoka University Hospital, Japan, including family caregivers of young adults with special healthcare needs. An original questionnaire was prepared drawing on previous studies and used for an interview survey. Overall, 57 individuals provided valid data and were included in the analysis. Factors associated with evacuation intention were non-use of a home ventilator (odds ratio [OR] 3.99, 95% confidence interval [CI]: 1.13-14.03) and not having made arrangements to use a non-public shelter (OR 7.29 95% CI: 1.62-32.88). This means that those who use mechanical ventilation or have secured alternative places to go if they need to evacuate their homes may not use the nearest public shelter in a disaster. We recommend that policy makers consider the use of mechanical ventilation and the availability of non-public shelters as predictors of evacuation behavior when considering disaster preparedness for these patients.

Monoclonal antibodies for the treatment of COVID-19 infection in children.

INTRODUCTION: Monoclonal antibodies (mAbs) have been authorized for the treatment of COVID-19 in pediatric populations, however, there is a lack of evidence for their use in these populations. AREAS COVERED: We outline the evidence of mAbs for COVID-19, discuss their use in the treatment of COVID-19 infection for pediatric patients, and consider alternative treatment options and challenges to COVID-19 drug approvals. EXPERT OPINION: Limited evidence exists for the safety and efficacy of mAbs to treat COVID-19 in children as new variants emerge. In rare pediatric outpatient settings, such as profound immunodeficiency or severe pulmonary disease, the benefits of antiviral treatment for COVID-19 likely outweigh the relatively small risks. However, for the great majority of pediatric patients, mAb treatment is likely not indicated. Small molecule antiviral therapies are another potential treatment for COVID-19 in children in an outpatient setting, though neither mAb nor small molecule antiviral treatments have significant supporting evidence in children and developing a strong evidence base for these decisions will be challenging if not impractical. Ultimately, these decisions are likely to be made at the level of individual cases using expert opinion as the primary guiding principle.

The longitudinal evaluation of COVID-19 in pediatric patients and the impact of delta variant.

BACKGROUND: Pediatric patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) displayed milder symptoms than adults. However, they play an important role in case numbers and virus transmission. Therefore, we aimed to determine the epidemiological features of all pediatric patients infected with SARS-CoV-2 and put forth case numbers longitudinally throughout the delta variant dominant period. METHODS: A retrospective study was conducted at a university hospital and included patients between 0 and18 years old with a SARS-CoV-2 polymerase chain reaction (PCR) positive result, including inpatients and outpatients. Epidemiological and clinical features were recorded from electronic files, and telephone visits were performed between March 2020 and December 2021. RESULTS: During the study period, 3175 coronavirus disease 2019 (COVID-19) pediatric patients were admitted to our hospital with a mean age of 10.61 ± 4.6 years. Of the 1815 patients who could be interviewed, 85.7% reported at least one symptom. Before the delta variant period, 0-4 years aged children were more commonly infected, while school-aged children and adolescents were more common, and the rate of pediatric cases to all COVID-19 cases increased to 35.8% after the delta variant became dominant. Symptomatic cases were significantly higher before the delta variant (87.8% vs. 84.06%, p = 0.016). The hospitalization rate was higher before the delta variant (p < 0.001), whereas PICU admission showed no statistical difference. CONCLUSIONS: The frequency of school-aged children and adolescents raised with the impact of both school openings and the delta variant, and the rate of pediatric cases increased in total COVID-19 patient numbers.

Neurological manifestations in pediatric patients with COVID-19: A case series

In this case series of two male and one female patient with an age range of 2-12 years, only one patient had a history of neurological disorder and underwent ventriculoperitoneal shunt for a medulloblastoma, which describes coronavirus disease-associated neurological manifestations in pediatric patients, among which seizures and sensory disturbances are noticeable. In order to describe the various clinical and neurological manifestations that appeared earlier or developed over the course of illness, a series of cases of pediatric patients with coronavirus disease was documented. Copyright © 2022, Indian Association of Biomedical Scientists. All rights reserved.

No Child Should Be Left Behind by COVID-19: A Report about the COVID-19 Pandemic Experience in Children and Adolescents with Acute or Chronic Disease Treated at a Pediatric Referral Hospital in Italy.

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) was undoubtedly a stressful experience for everyone. General opinion believed that children with acute or chronic illness could experience additional burden, but this is not confirmed. The aim of this study is to understand how children and adolescents already suffering from acute or chronic illness (e.g., cancer, cystic fibrosis, neuropsychiatric disorders) feel about the COVID-19 pandemic, and if the experience is significantly different between these children and children without illness. METHODS: Children and adolescents affected by acute or chronic illness (named the "fragile group") treated at the Regina Margherita Children Hospital in Italy, were enrolled in the study by filling a questionnaire about their pandemic experiences. Also, a group of children and adolescents without acute or chronic illness (named the "low-risk group") recruited in the emergency department of the hospital, participated in the study in order to compare experiences. RESULTS: The study group was composed of 166 children and adolescents (Median age = 12 yrs; 78% fragile group, 22% low-risk group). Participants experienced a general state of fear of the virus and of a potential infection for both themselves and their families, while feelings and thoughts that interfere with daily functioning were less frequent. The fragile group seems to be more resilient towards the pandemic situation than low-risk group and some differences on the basis of the type of illness were found in the fragile group. CONCLUSIONS: Dedicated psychosocial intervention must be proposed in order to support fragile children and adolescents' well-being during the pandemic, also on the basis of their clinical and mental history.

Emergence of a unique SARS-CoV-2 Delta sub-cluster harboring a constellation of co-appearing non-Spike mutations.

Accumulation of diverse mutations across the structural and nonstructural genes is leading to rapid evolution of SARS-CoV-2, altering its pathogenicity. We performed whole genome sequencing of 239 SARS-CoV-2 RNA samples collected from both adult and pediatric patients across eastern India (West Bengal), during the second pandemic wave in India (April-May 2021). In addition to several common spike mutations within the Delta variant, a unique constellation of eight co-appearing non-Spike mutations was identified, which revealed a high degree of positive mutual correlation. Our results also demonstrated the dynamics of SARS-CoV-2 variants among unvaccinated pediatric patients. 41.4% of our studied Delta strains harbored this signature set of eight co-appearing non-Spike mutations and phylogenetically out-clustered other Delta sub-lineages like 21J, 21A, or 21I. This is the first report from eastern India that portrayed a landscape of co-appearing mutations in the non-Spike proteins, which might have led to the evolution of a distinct Delta subcluster. Accumulation of such mutations in SARS-CoV-2 may lead to the emergence of "vaccine-evading variants." Hence, monitoring of such non-Spike mutations will be significant in the formulation of any future vaccines against those SARS-CoV-2 variants that might evade the current vaccine-induced immunity, among both the pediatric and adult populations.

Recommendations on the follow-up of patients with Gaucher disease in Spain: Results from a Delphi survey.

Management of Gaucher disease (GD) is challenging due to its wide genotypic and phenotypic variability and changing clinical manifestations due to effective treatment. Sixteen face-to-face meetings with experts were held in order to discuss daily clinical practice and identify controversies regarding the management of GD. With this information, a questionnaire with 93 recommendations for different clinical scenarios was designed, and a Delphi survey among 86 physicians with experience in GD was conducted. Consensus was reached on 73 out of the 93 items. Recommendations on follow-up of adult and pediatric patients were in line with current guidelines, and underscored the importance of a patient-tailored approach. For the follow-up of stable patients receiving long-term treatment, consensus was reached on the importance of multidisciplinary care that involves pediatricians, internal medicine, and primary care, specialized radiologists, orthopedic surgeons, and hematologists when required. Degree of pain, use of painkillers and antidepressants, and quality of life should be evaluated at every follow-up visit or at least once per year. In general, a closer follow-up was recommended for untreated patients or patients who underwent a treatment change (every 3 months during the first year) and during pregnancy. For pregnant patients, hemostasis and risk of hemorrhage should be assessed, but no consensus was reached for initiation of treatment in asymptomatic pregnant patients. Lastly, recommendations on how to adapt GD management during a COVID-19 pandemic were collected. This expert consensus may help decision-making during the management of GD in specific clinical scenarios.

Clinical and immunological features of convalescent pediatric patients infected with the SARS-CoV-2 Omicron variant in Tianjin, China.

COVID-19 has spread surprisingly fast worldwide, and new variants continue to emerge. Recently, the World Health Organization acknowledged a new mutant strain "Omicron", with children were accounting for a growing share of COVID-19 cases compared with other mutant strains. However, the clinical and immunological characteristics of convalescent pediatric patients after Omicron infection were lacking. In this study, we comparatively analyzed the clinical data from pediatric patients with adult patients or healthy children and the effects of SARS-CoV-2 vaccine on the clinical and immune characteristics in convalescent pediatric patients. Our results indicated that convalescent pediatric patients had unique clinical and immune characteristics different from those of adult patients or healthy children, and SARS-CoV-2 vaccination significantly affected on the clinical and immune characteristics and the prevention of nucleic acid re-detectable positive (RP) in convalescent patients. Our study further deepens the understanding of the impact of Omicron on the long-term health of pediatric patients and provides a valuable reference for the prevention and treatment of children infected with Omicron.

Characteristics of COVID-19 in pediatric patients with hematological malignancies

Introduction: As more data is collected, hematologists will be able to gain more insight into the impact of coronavirus disease 2019 (COVID-19) on pediatric patients with hematological malignancies. Material(s) and Method(s): We analysed 21 cases of COVID-19 in pediatric patients with onco-hematological diseases treated in the Western Ukrainian Pediatric Medical Center from March 2020 through May 2021. The majority of patients (71.4%) were diagnosed with acute lymphoblastic leukemia. All patients from the analyzed cohort had an asymptomatic, mild or moderate course of coronavirus-19 infection. The most common symptoms of COVID-19 were fever, cough, gastrointestinal symptoms, and dermatitis. Severe severe acute respiratory syndrome coronavirus 2 increased the risk of liver toxicity and venous thrombosis. Result(s) and Conclusion(s): Our analysis showed that pediatric patients with hematological malignancies need the same treatment approach for COVID-19 as for other infective complications. Copyright © 2022.

Dynamic characteristics of COVID-19 infection in Chinese children

From the start of the coronavirus disease 2019 (COVID-19) pandemic in 2020, COVID-19 infection in the pediatric population has aroused great attention. This article presents dynamic epidemiological characteristics of COVID-19 infection in pediatric patients from January 2020 to March 2022 in China. These data contributed essential insights and shared experience on the management of COVID-19 in children. To date, the unvaccinated population and events with children need more attention. Copyright © 2022 E-Century Publishing Corporation. All rights reserved.

First outbreak of COVID-19 in Cuban pediatric patients

Introduction: Until June 11, 2020, 10.4% of the total positive cases of SARS-CoV-2 in Cuba corresponded to patients under 18 years of age. Clinical manifestations in children affected by SARS-CoV-2 are usually mild and few deaths occur compared to other age groups. Objective: Characterize from the clinical, epidemiological and immunological point of view the Cuban pediatric patients infected by SARS-CoV-2 until June 11, 2020. Methods: Observational, cross-sectional study in 137 pediatric patients infected with COVID-19, who were epidemiologically discharged. Results: 56.9 % of the patients presented asymptomatic form of the disease. Havana was the most affected province and the average age was 11.3 years. The most frequent symptoms were: fever, cough and diarrhea and occurred more frequently in patients with black skin (Odd Ratio = 3.40). Antibody concentrations for tetanus and Haemophilus influenzae type b provided protection in 92.7% to 100% of children, while for diphtheria 24.8% had no reliable protection. Of the symptomatic patients, 62.5% developed specific total antibodies against SARS-CoV-2. Conclusions: Patients in pediatric ages can contribute significantly to the transmission dynamics. Reliable protection for specific vaccines, the development of total antibodies to SAR-Cov-2, and general favorable prognosis without complications require continued research to identify biological and immunological differences between children and other age groups. © 2021, Editorial Ciencias Medicas. All rights reserved.

A Review of a Research in 2021 on Coronavirus Disease (COVID-19) in Pediatric Patients

Background Although there were other reviews in 2019 and 2020, this is the first review of research that summarizes clinical features of the children with COVID-19 mentioned in literature in 2021. This paper analyses the findings on COVID-19 infection in children in three countries. Objective The purpose of this paper is to review publications using chest CT scans and chest X-ray findings for children with COVID-19 in 2021. Materials and methods Studies on COVID-19 for articles presenting scan findings in children with COVID-19 have been included in this review. This review focused on articles including 0 < age and age < 18 years using descriptive statistics to identify patterns including duration and several symptoms of the disease, and their relationship with outcomes. Results 12 research articles (n = 6212 children) based on chest CT scans and chest X-ray have been examined. The main results of this review article are as follows: (i) Approximately 1728 (27.81%) of pediatric patients with COVID-19 had normal chest CT scans and chest X-ray images. (ii) The most frequently detected parenchymal lesion was ground glass opacity (GGO) and also bilateral lesions were the common signs of lung lesions. (iii) The lung CT scan findings in children with COVID‐19 were less severe than in adult patients. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Cell Therapy in the Times of SARS-CoV-2

An entire spectrum of disruptions, but also some lightning fast innovations, were brought on by the SARS-CoV-2 pandemic. This focused review looks at the pandemic from the vantage point of cellular therapy;specifically four aspects are considered: How do risks of cell therapy patients with SARS-CoV-2 infection and COVID differ from the general population? Do recipients of cellular therapies, here specifically recipients of autologous and allogeneic stem cell transplants and CAR-T-cells, meaningfully respond to SARS-CoV-2 vaccines? What effects does the pandemic have on donor availability and cell therapy supply chains and hence, on the accessibility of cellular therapies? What cell therapies, if any, are therapeutically beneficial in severe COVID? Briefly, the excessive risk of an unfavorable, frequently lethal course of cell therapy patients with SARS-CoV-2 infection was confirmed. The vaccine frequently, albeit not with the same regularity as in healthy vaccinees, induces presumably clinically meaningful humoral and/or cellular immunity. Creative solutions have quantitatively maintained access to cellular therapeutics. SARS-CoV-2-specific T-cell products for adoptive immune transfer were developed, although an opportunity for their clinical evaluation did not arise. Clinical trials with mesenchymal stromal cells for severe COVID are being pursued world-wide;the question of efficacy currently remains unanswered, but initial data fuel considerable optimism of the scene. Some of the insights and innovations from the SARS-CoV-2-pandemic can possibly be generalized and may thus prevail.

A Comparison of Emergency Department Revisit Rates of Pediatric Patients between Pre-COVID-19 and COVID-19 Periods.

Unscheduled revisits to emergency departments (EDs) are important because they indicate the quality of emergency care. However, the characteristics of pediatric patients visiting EDs changed during the coronavirus disease (COVID-19) pandemic, and these changes may have affected their revisit patterns. Therefore, we aimed to compare the ED revisit patterns of pediatric patients between the pre-COVID-19 and COVID-19 periods. This retrospective multicenter study included patients aged below 18 years who visited the ED in the pre-COVID-19 and COVID-19 periods. ED revisit rates were analyzed using five age groups and three visit-revisit intervals. In the pre-COVID-19 period, the revisit rates decreased with increasing age. In the COVID-19 period, the revisit rates were the lowest for the group aged 4-6 years, and the rates increased for those aged ≥7 years. In conclusion, there were changes in the patterns of revisit rates of pediatric patients according to age between the pre-COVID-19 and COVID-19 periods. Therefore, it is necessary to identify the reasons for revisits according to age and establish strategies to reduce the revisit rates of pediatric patients.

COVID-19, Symptoms with Pre-Existing and Not Pre-Existing Neurological Disorders in Pediatrics

Objective The symptoms of coronavirus disease 2019 (COVID-19) in children with pre-existing neurological disease are unknown. We aimed to find out the difference in the symptoms of children with pre-existing neurological disease and those without. Methods In this single-center, retrospective, cohort study, 96 pediatric patients who had COVID-19 between March 2020 and April 2021 were enrolled. Results There were 35 males and 61 females. The median age was 14 years (interquartile range [IQR] 10.25-16). Fever (38.5%), headache (35.4%), and cough (32.3%) were the most common symptoms. In 53.1%, neurological complaints (headache, taste-smell loss, vertigo, febrile seizure, coma, and ataxia), in 40.6%, respiratory symptoms (cough, dyspnea, rhinitis, and pharyngitis), and in 8.3%, gastrointestinal symptoms (gastroenteritis, vomiting, nausea, and abdominal pain) were seen. While 23 (62.2%) patients with fever did not have neurological complaints, 14 (37.8%) had neurological complaints (p = 0.017). Eight (21.6%) patients with fever were hospitalized (p = 0.067). Fever was seen significantly more frequently with preexisting neurological disease (p < 0.001). Younger children were more likely to have fever (p = 0.008). Headaches and taste-smell loss were seen more frequently in patients with no pre-existing neurological disease (p < 0.001, p= 0.034, respectively). The patients with headaches were older than the ones without headaches (p < 0.001). Patients with headaches and loss of taste and smell were older than those without (p = 0.003). Conclusion Neurological symptoms differed significantly between those who had pre-existing neurological disease and those who did not. Headaches and taste-smell loss were seen more frequently in patients with no pre-existing neurological disease. Fever was significantly higher in patients who had pre-existing neurological disease.

Rule-Based Expert System for Diagnosing Common Childhood Illnesses: Smartphone App to Assist in Curbing the Spread of COVID-19

Since the World Health Organization declared the COVID-19 outbreak a global pandemic, constraints on face-to-face clinical consultation have become more challenging to implement in healthcare institutions. In common childhood illnesses, inexperienced parents may have difficulties determining whether a child is in a severe condition that requires hospitalization, thus increasing the risk of catching the Coronavirus. During the current COVID-19 pandemic, information technologies play a significant role in maintaining social distancing, such as telemedicine applications. Developing expert systems using Artificial Intelligence techniques can substitute experts (doctors) for remote patient consultation and care in the medical field. This paper discusses the design and implementation of a Rule-Base Expert system based on a mobile application on the Android platform, a healthcare expert system for diagnosing common childhood illnesses. The proposed application acts as an intelligent medical assistant, providing remote medical consultations and detecting emergencies for pediatric patients undergoing treatment in areas where medical services are limited or curfew. The proposed application asks a series of questions regarding a group of frequent symptoms in children's diseases, the inference engine generates instant recommendations for performing specific basic medical treatment steps when necessary. The proposed approach is applicable, effective, and efficient when comparing the application's diagnostic results with a physician's diagnosis on pediatric patients. © 2021 ACM.