SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG and DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022)

Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people. Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on. Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.Copyright © 2023. Thieme. 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%110/618vs 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.

Autoimmune pulmonary alveolar proteinosis in an adolescent girl with rapidly progressive dyspnea

Autoimmune pulmonary alveolar proteinosis (PAP) is a rare disease, especially in pediatrics, but important to consider, as it may avoid unnecessary and/or invasive investigations and delayed diagnosis. This case report highlights an adolescent girl with rapid onset dyspnea but an unremarkable physical exam and initial testing. However, due to a high index of suspicion, a chest computed tomography (CT) scan was done, revealing a "crazy paving" pattern, which then prompted expedited assessment. This finding, however, is not as specific as often discussed and has a broad differential diagnosis, which will be reviewed in detail as part of this case. Furthermore, this report demonstrates a diagnostic approach for PAP that avoids lung biopsy, previously considered to be required for diagnosis of PAP, but is increasingly becoming unnecessary with more advanced blood tests and understanding of their sensitivity and specificity. Additionally, management strategies for PAP will be briefly discussed.Copyright © 2022 Canadian Thoracic Society.

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.

Treating Lymphoma in the Pandemic Era: What We Learned from Our Experience at Fondazione Irccs Istituto Nazionale Dei Tumori

From March 2020 to May 2022, when SARS-CoV2 pandemic started spreading in Italy, 15 consecutive patients with non-Hodgkin Lymphoma (NHL) have been treated at the Pediatric Unit of Fondazione IRCCS Istituto Nazionale dei Tumori. Three of 15 patients developed COVID19 while on treatment [1 Burkitt lymphoma (BL), 1 anaplastic large cell lymphoma, 1 lymphoblastic T-cell lymphoma (T-LL)] and one patient at diagnosis [gray zone lymphoma (GZL), previously misdiagnosed as Hodgkin lymphoma]. Median age at diagnosis was 12 years;3 were male. Median positivity time of the nasal swab was 58 days (range 9-107 days). All patients remained asymptomatic or paucisymptomatic (flu-like symptoms) while positive. The first positive patient with T-LL, was in the induction phase of the Euro-LB-02 protocol guidelines: he succeeded in completing the whole treatment during the 107 days of swab positivity, experiencing mild toxicities (grade 2 transaminases and grade 3 lipase increase, both reversible) without significant delays. For this reason, we reduced the total dose of the first HD-MTX (protocol M) and administer the subsequent doses in 6 hours infusion instead of 24 with no further toxicities. After this first experience, all the subsequent patients have been treated accordingly, without major deviations from the established protocols. Minor precautions: the patient with refractory GZL received IEP course instead of IGEV as second-line treatment to avoid severe subsequent immunosuppression;the patient with BL omitted the fourth course of Rituximab during the period of swab positivity. Overall, we did not observe outstanding toxicities except for a toxic MTX level with subsequent reversible acute renal failure. Main teaching from these pilot experiences, which may translate into guidelines: 1) SARS-CoV2 infection is not an absolute contraindication to the oncological treatments. This is of main importance for the patients affected by lymphoma whose dose-intensity has a prognostic value. 2)We need to pay caution during HD-MTX treatment;indeed, we observed unexpected similar toxicities in other patients treated with HD-MTX for other solid malignancies. 3) The clearance of SARS-CoV2 might be exceptionally prolonged with persistent positivity of the nasal swabs for a longer time than the matched healthy population due to the immunosuppression characterizing lymphoma patients. For this reason and given the importance of maintaining the dose-intensity, specific treatments aiming at speeding up the clearing process are warmly suggested. (Figure Presented) Figure 1: (: 091) ITHACA study design and blood sampling time points. (OHT = Orthotopic Heart Transplant).Copyright © 2022 Elsevier Ltd. All rights reserved.

mRNA VACCINES INDUCES A HIGHER ANTIBODIES RESPONSE IN CHILDREN WITH PREVIOUS COVID-19

Background: mRNA vaccines elicit a durable humoral response to SARS-CoV-2 in adults, whereas evidence in children is lacking. This study aimed to evaluate the early and long-term immunological response after the BNT162b2 vaccine in children with or without a previous SARS-CoV-2 infection. Method(s): In a multicenter, prospective, observational study we profiled the immune response to the BNT162b2 vaccine in children aged 5-11 years attending the Pediatric Departments at the University of Padua and Bambino Gesu Children's Hospital in Rome (Italy). Forty-four healthy children (HC), 20 immune compromised (IC), and 18 children who previously developed MIS-C (MIS-C) were included in the study. Blood samples were collected pre-, 1, and 6 months after a 2-doses vaccination schedule. Neutralizing antibodies (NAbs) and anti-S-RBD IgG titers were analyzed through Plaque Reduction Neutralization Test (PRNT) and chemiluminescent immune-enzymatic assay (CLIA), respectively. B and T cell phenotypes were analyzed by flow cytometry. Geometric mean titers (GMTs) and 95% confidence intervals and median and interquartile range (IQR) of variables were evaluated according to pre-existing confirmed COVID-19. Result(s): Eighty-two children were studied;60 with a molecular-documented previous COVID-19 (Group A) and 22 without previous infection defined as the absence of antigen-specific antibodies before the vaccination (Group B). Overall, in Group A we observed higher NAbs GMTs, anti-S-RBD titers, and T- and B-reg cells than in Group A, at both 1 and 6 mo after vaccination (table);Nabs against the parental virus resulted to be greater in Group A than in Group B by a factor of 18 and 11, at 1 and 6 mo after vaccination, respectively. Both Groups recorded a decrease in antibody titers of approximately 50-70% between 1 and 6 months. A significant difference for Omicron NAbs (p=0.02) and anti-S-RBD (p=0.07) titers decay was observed between Group A and B;in contrast, Parental NAbs titers appeared to have similar trends in the 2 groups (p=0.47). Comparable antibody titers at 1 and 6 mo. (p=0.37) were detected across the three categories of HC, IC, and MIS-C (table). Conclusion(s): mRNA vaccination triggers a higher humoral response in children with a previous history of COVID-19, regardless of the immune deficiency or previous MIS-C, at least up to 6 mo, providing insight into boosting preexisting immunity with mRNA vaccines.

The Evolution of SARS-CoV-2 Infection in the Pediatric Ward at St. Andrew's County Emergency Clinical Hospital Constanta

In the period April 24, 2020 - December 31, 2021 at Saint Andrew's County Emergency Clinical Hospital's Molecular Biology Laboratory were performed 2856 RT-PCR tests on childrens. This method consists of two steps: extraction and amplification. RT-PCR is the golden standard to diagnose infection with Covid-19. The tests were performed on patients of both genders and under 18 years old. Statistics show that both male and female patients were affected by Sars-Cov-2 in relatively equal proportions: in the first year (male 46% and female 54%), followed by the next year (male 48% and female 52%). The results concluding, that during the study, in 2020, 6.98% of the total number of tests came out positive, 92.32% came out negative, 0.70% inconclusive. In 2021, 4.21% of the total number of tests came out positive, 95.56% came out negative, 0.23% inconclusive. This study highlights the situation of Covid-19 cases encountered at childrens from the Pediatric section diagnosed in Constanta, Romania.Copyright © 2022 Ramona-Anca Sterian et al., published by Sciendo.

Strategies to meet blood demand for transfusions during the COVID-19 pandemic: lessons learnt from a large central hospital in Malawi

Background: The coronavirus disease-19 (COVID-19) pandemic affected blood banks globally. We sought to examine how COVID-19 affected blood supply and transfusion in our institution. Method(s): The study was conducted at the Queen Elizabeth Central Hospital (QECH) and the Malawi Blood Transfusion Service (MBTS) in Malawi. Data from April to November 2020, collected during the pandemic, were compared with data from the same time period in 2019 pre-COVID-19. Additionally, in-depth interviews with key personnel were conducted at both institutions. Statistical analysis was performed using Stata 15 and qualitative data were analyzed using Nvivo software. Result(s): There was a significant reduction in blood supplied to the QECH from 7,303 [2019] to 6,028 units [2020] (P<0.04). The highest reduction in blood supply was to the Adult Emergency & Trauma department (29%) while the lowest was in Obstetrics & Gynecology, and Pediatric departments (17% reduction each). This is despite that the transfusion services continued to conduct blood drives during the pandemic, and the hospital laboratory prioritized blood issuing for emergency indications. Conclusion(s): Blood supply has significantly reduced during COVID-19 pandemic in our centers. Developing plans for overcoming similar shortages in future pandemics is critical.Copyright © Annals of Blood. All rights reserved.

Profile of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital

Introduction: There is sparse literature on child and adolescent consultation liaison psychiatry during the COVID pandemic in India. Aims and objectives: To study the patterns of Child and Adolescent Consultation Liaison Psychiatry Services at a Covid-19 Designated Tertiary Medical College and Hospital Material(s) and Method(s): This was a retrospective chart-based study. Institutional Ethics Committee clearance was obtained. It was conducted from April 2020-21. The inclusion criteria comprised records of children and adolescents who were referred for consultation liaison services while they were admitted in COVID-19 designated tertiary hospital. Incomplete records were excluded. Data was tabulated and analysed with descriptive analysis. Result(s): We found 50 referrals out of which 42 records were complete and 8 incomplete were excluded. There were 47.62% boys and 52.38% girls with the mean age (10.8 years) All the 42 patients had been tested for COVID-19 at the time of intake admission as per hospital protocol. We found that 11.9% were confirmed cases of COVID-19 disease and 88.1% had tested negative for COVID-19 disease .The referrals were received mostly from Paediatric Intensive Care Unit (57.14%) followed by Paediatric ward (26.19%) and Special Paediatrics COVID High Dependency Unit (16.67%). The most common psychiatric disorder in COVID negative patients was adjustment disorder with deliberate self-harm (35.14%) and in COVID positive patients was delirium (60%) .The most commonly used medication were Escitalopram, Risperidone and Clonazepam. Conclusion(s): We conclude that psychiatric disorders were prevalent in child and adolescent patients admitted during COVID 19 pandemic and had a distinct profile.

Variation in the pattern of childhood respiratory viral infections during the COVID-19 pandemic

Introduction: The COVID-19 pandemic forced taking measures to restrain viral transmission. Our aim was to describe the changes in the patterns of childhood respiratory viral infections in admitted patients during the COVID19 pandemic. Method(s): We performed an observational study. Trends in respiratory PCR results, from all children admitted to the pediatric departments between Jan. 2015 to Aug. 2021 were evaluated using time series models. Weekly patterns were compared between pre-COVID era and COVID-19 era. Result(s): A total of 7322 pediatric admissions with respiratory viral panel PCR results from 43,466 admissions were evaluated. When comparing Pre-COVID-19 to the COVID-19 era, there was a significant decrease in the number of admissions in which a respiratory viral panel was performed (18% vs. 12%, p<0.001) and a decrease in the number of panels positive for a respiratory viral pathogen (47% vs. 36%, p<0.001). We observed a change in the circulation pattern of respiratory viruses during the COVID-19 era, with marked differences between different respiratory viruses;Influenza viruses completely disappeared;The peak in RSV infection was delayed from the 1st week of 2021 to the 25th week;HMPV had an attenuated peak in 2020 and peaked normally in 2021;parainfluenza viruses did not peak during 2020 with an early peak in the 1st week of 2021;Adenovirus circulation pattern was only minimally affected. Conclusion(s): This study offers a detailed picture of the change in respiratory viruses in children during the COVID19 pandemic, compared to previous years. The changes in patterns are probably related to the application of measures taken to control the SARS-CoV-2 transmission.

Pediatric admissions due to respiratory diseases during the COVID-19 pandemic

Introduction: The COVID-19 pandemic has affected the incidence of respiratory viral infections. Our aim was to assess changes in pediatric admissions due to respiratory diseases and associated respiratory viral infections. Method(s): This was a case control study. All children hospitalized with a respiratory disease from Jan. 2015 to Aug. 2021 to the pediatric departments were included. Cases consisted of children admitted between Mar. 2020 to Aug. 2021 (COVID-19 era) and controls between Jan. 2015 to Mar. 2020 (pre COVID-19 era). Diagnosis, length of stay, demographic data, and viral panel results were compared. Result(s): A total of 8774 patients were included, 7157 controls and 1617 cases. There was a significant decrease in respiratory admission rates during the COVID-19 era (17.4% vs 20.9% of all admission, p<0.001). Cases had decreased rates of admissions due to bronchiolitis (4.72% vs 6.3%, p<0.001) and pneumonia (4.87% vs 6.26%, p<0.001) but not asthma (3.84% vs 3.9%), wheezing illness (2.62% vs 2.38%), complicated pneumonia (2.0% vs 2.0%) or stridor (1.79% vs 1.72%). There was a significant decrease in the detection of a respiratory viral pathogen in cases vs controls (44% vs 52%, p<0.001). This was related to a significant decrease in the detection of RSV (27% vs. 37%, p<0.001) and influenza (0.3% vs 5%, p<0.001), but not other respiratory viruses. Conclusion(s): During the COVID-19 pandemic, a decrease in pediatric admissions due to bronchiolitis and pneumonia was observed and associated with a decreased prevalence of RSV and influenza. This may allow us to estimate the significance of preventive measures and vaccination programs for RSV and influenza on respiratory pediatric diseases.

Bronchiolitis 2021-2022: the other viruses revenge

Background: bronchiolitis is a common lung infection in young children and infants. Bronchiolitis is almost always caused by a virus. Typically, the peak time for bronchiolitis is during the winter months. During covid pandemic, the incidence of bronchiolitis had drastically decreased but this winter, cases of this airway inflammation increased and were more severe. Objective(s): to study the prevalence of bronchiolitis during the winter season and describe its epidemiology, clinical features and outcome. Method(s): retrospective study in a general pediatric ward from november 2021 till january 2022. Result(s): we collected 207 cases admitted for bronchiolitis, in compraison with 162 cases in 2020. Le The hospitalization peak was in november 2021 (36.7%). The sex ratio was 1.43. The mean age was 88 days, the younger than 3 months represented 69.5% of cases. A viral contat was noted in 84.5% of cases. The bronchiolitis was mild in 20.2% of cases, moderate in 57.9% of cases and severe in 21.7% of cases. RSV was isolated in 25 case, Influenza A in 20 cases, viral co-infection was noted in 14 cases while bacterial co-infection was observed in 25 patients. Oxygenotherapy was indicated in 64.7% of patients with a mean duration of 5.6 days. Twenty-two patients were transferred in ICU with the use of non-invasive ventilation in 14 cases and mecahnical ventilation in 13 cases. The mean hospital stay was about 6.7 days. Conclusion(s): although the decrease of the incidence of bronchiolitis during covid 19 pandemic, an important incerease in incidence and intensity of this airway pathology was noted after the 4th wave, explained by the loss of the collective immunity in the younger infants less than 3 months.

Influence of the COVID-19 pandemic on the emergency care in a private hospital.

Introduction: in order to limit the contagion of COVID-19, home confinement and the application of sanitary measures were necessary, which had an effect in the emergency services. Objective(s): to analyze the impact of the COVID-19 pandemic in the frequency of patient care in a pediatric emergency department. Material(s) and Method(s): retrospective study in a private hospital in Mexico, in which two periods were analyzed: pre-pandemic (2019-2020) and during the first year of the COVID-19 pandemic (2020-2021). In these two periods, the frequency of emergency medical consultations provided to children and adolescents was compared. The information is broken down by month and by type of illness: infectious, noninfectious, and due to accidents. Result(s): in the pre-pandemic period, 5,905 consultations were provided, and 2,384 during the pandemic (59.6% reduction), without differences with respect to age group and sex. When analyzing according to the month, it was observed that, compared to December 2019, in December 2020 there was the greatest reduction (70% decrease). Consultations for infectious causes were reduced by 74.4%, non-infectious ones by 25.3%, and accidents by 51.4%. Consultations for real urgency decreased by 64.5%, while felt urgency decreased by 55.2%. Conclusion(s): COVID-19 pandemic decreased emergency care consultations for pediatric patients, particularly due to infectious diseases.Copyright © 2022 Sociedad Mexicana de Pediatria. All rights reserved.

Bronchiolitis vs. COVID-19: epidemiologic correlations from a single Pediatric Unit experience

Introduction: The spread of SARS-CoV-2 pandemia in Europe has been socially counteracted with the aid of nonpharmaceutical interventions (NPIs). This rapidly changed the epidemiology of viral respiratory diseases other than the COVID-19. Thus a sharp decrease in bronchiolitis patients has been recorded all over Europe since 2020. Aims and Objectives: Due to the looser NPIs and to the increased accesses to hospitals than the year before we chose to analyze the series of admissions to our Unit either for bronchiolitis or for COVID-19, from 2021 October, 1st to 2022 January, 31st. Method(s): Data were obtained from the hospital database. Overall 2582 patients accessed the Pediatric Emergency Room (PER). Of them 228 (8.8%) were admitted to the Pediatric Unit (PU). All admissions were tested for SARSCoV-2 by nasopharyngeal molecular swab. Result(s): Overall we recorded 71 bronchiolitis and 26 COVID-19. Data are reported in the table herein. View inline In January 2022 the COVID-19 impacted overall admissions more significantly than did the bronchiolitis in November plus December 2021 (chi2, p<0.01). Conclusion(s): By our limited experience we tried to describe the relationships that seemingly regulate the epidemiology of respiratory viruses. As a matter of fact, when one virus promptly emerged the other seemed to find no space in the ecosystem despite the rules for NPIs did not change meanwhile. Epidemiology of viruses looking for the same habitat maybe needs furher evaluations.

Coronavirus Disease 2019 in Pediatric Emergency Room: The Dilemma of Cycle Threshold Value

Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection. Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied. Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower. Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered. © 2022. Thieme. All rights reserved.

Efficacy of a Shorter Bowel Prep Regime Trialled during Constraints from Covid19

Background Bowel preparation remains a significant barrier for patients who need to undergo colonoscopy and is recognised by children as the most difficult aspect of the colonoscopy process. Inadequate bowel preparation can lead to increased procedural times, lower caecal intubation rates, and the need for repeat colonoscopy. Practice across paediatric units providing colonoscopy is not uniform with regard to the total number of days of prep prior a colonoscopy and the agent(s) used. Data comparing a two-day regime vs a shorter one-day regime in children is limited. Restrictions during COVID19 including shielding, need for PCR testing, reduction in theatre capacity led to a re-appraisal of the need for a 2-day bowel prep, which was standard practice until 2020. Aim To evaluate the efficacy and safety profile of a shorter 1- day bowel prep regime in children undergoing colonoscopy and compare this to a standard 2-day regime. Methods Data was collected prospectively on patients who were prescribed a one-day regime prior to colonoscopy. The data was then compared with similar data on patients who were prescribed a two-day regime from an audit carried out 1 year prior to the COVID19 pandemic. The one-day regime involved taking a high dose of senna followed by two doses of picolax (dose dependent on age). The two-day regime involved a smaller dose of senna followed by three doses of picolax. Comparison was carried out between the two regimes. Boston Bowel Preparation Scale (BBPS) was used to assess the efficacy of bowel preparation. The maximum score possible for the BBPS is 9, and a score of -2 in all 3 segments is considered optimal for colonoscopy.1 Results There were 24 patients in the one-day bowel prep group and 19 patients in the two-day group. The mean age of children in the two groups were identical (11.4). The majority of patients in both groups received their bowel preparation at home. The indications for colonoscopy were very similar in both cohorts with IBD and PR bleeding being the most common indications. The median BBPS score in the 2- day regime was 6 and was 7 in the 1-day regime. 67% of patients in the one-day group had a BBPS score -2 in all 3 segments compared with only 47% of patients in the two-day group. In each group one procedure could not be completed due to inadequate bowel preparation. Conclusions The one-day bowel preparation was not inferior to the two-day regime. The higher dose of senna used in the shorter 1-day regime was well tolerated. There appears to be little to gain from a longer bowel prep regime. There are several benefits of the one-day regime such as acceptability by patients, fewer days off school/work, reduced numbers of medication doses, and fewer inpatient hospital days necessary to admit for supervised bowel prep.

Heartbreak and Loneliness Due to Family Separations and Limited Visiting during COVID-19: A Qualitative Study.

The COVID-19 pandemic has greatly impacted the healthcare system. In the pediatric unit, stress, uncertainty, and many unexpected challenges for many parents were frequently reported. Research has shown that parents had less contact with their children during the pandemic due to hospital restrictions. However, it is unknown how parents perceived their experiences in a pediatric unit. This study aimed to describe the lived experiences of parents who had a child in the pediatric unit during the pandemic. A qualitative descriptive approach was used to investigate parents' experiences of having children admitted to the pediatric unit during the pandemic in Hong Kong. Eight Chinese parents participated in the interview. Three major themes emerged: (1) parents' pediatric ward experiences during COVID-19 were emotionally isolating and overwhelming, (2) the family and family-centered care were disrupted, and (3) interactions with pediatric providers intensified or alleviated emotional distress. Integrating the above themes of experiences of emotional distress was the main characteristic of the parents' experiences during the pandemic. Therefore, policymakers should understand the lived experiences of parents of children diagnosed with COVID-19 and should make prompt decisions to deal with both parental concerns and safety issues.

The national recommendation for the covid-19 prevention and control in pediatric units of hematology and oncology, hematopoietic cell transplantation units and respective outpatient clinics: Guidelines of polish society of pediatric oncology and hematology

In December 2019 novel coronavirus SARS-CoV-2 has been identified. It is responsible for a pandemic COVID-19 disease with a risk of fatal outcome ranging 2% to 6%. Pediatric patients with cancer during intensive oncological treatment are considered as a risk group of unfavorable outcomes because of profound immunosuppression. Based on literature and the national local experiences, the Polish Society of Pediatric Oncology and Hematology provided with the national recommendation for the COVID-19 prevention and control in pediatric hematology and oncology, hematopoietic cell transplantation units and well as respective outpatient clinics. Copyright © 2020, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.