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1.
Pediatricheskaya Farmakologiya ; 19(2):105-114, 2022.
Article in Russian | EMBASE | ID: covidwho-2067386

ABSTRACT

This article describes various COVID-19 dermatological manifestations that can develop in children. Their incidence and clinical features are described. Сhilblain-like lesions were considered as the most typical in children population after coronavirus infection. Description of skin manifestations in multisystem inflammatory syndrome in children is also presented, issues of laboratory diagnosis are covered as well.

2.
Pediatricheskaya Farmakologiya ; 19(1):78-81, 2022.
Article in Russian | EMBASE | ID: covidwho-2067385

ABSTRACT

Background. The morbidity of new coronavirus infection remains high (in children as well). Children with bronchial asthma are not at risk this disease development and severe course of COVID-19 according to the previous studies results. Objective. The aim of the study is to compare the morbidity rate of COVID-19 among children with and without bronchial asthma between May 2020 and October 2021 with the results from the beginning of pandemics. Methods. Online questionnaires in Google form have been developed and sent to parents of 83 patients aged from 7 to 17 years who have been interviewed at the beginning of the pandemics. The main group includes 49 patients diagnosed with bronchial asthma, and the control group includes 25 children without bronchial asthma. Results. 45% (22) of patients had COVID-19 in the main group and 32% (8) — in the control group (p = 0.636). 80% of patients had mild course of disease and 20% — moderate in the main group, and 62% and 37% in the control group respectively. Febrile fever was observed in 40% of respondents in the main group and in 33% — in the control group;anosmia — in 35% in the main and in 14% — in the control group;pulse oximetry was used by 44% of patients in the main group (SpO2 94–98%) and 42% in the control group (SpO2 98–99%);66% of patients had baseline therapy and 6% had rescue medications in the main group. No one from both groups has been hospitalized. Conclusion. Pediatric patients both with and without bronchial asthma have COVID-19 more often compared to the pandemics beginning. The disease in most cases had mild course and did not require hospitalization, aggravations of bronchial asthma were rare and saturation values did not decrease below 94%.

3.
Acta Haematologica Polonica ; 53(4):273-276, 2022.
Article in English | EMBASE | ID: covidwho-2067065

ABSTRACT

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.

4.
World Journal of Traditional Chinese Medicine ; 8(4):491-496, 2022.
Article in English | EMBASE | ID: covidwho-2066907

ABSTRACT

Photobiomodulation (PBM) therapy is a therapeutic method that can produce a range of physiological effects in cells and tissues using certain wavelengths. The reparative benefits of PBM therapy include wound healing, bone regeneration, pain reduction, and the mitigation of inflammation. Advances in the development of laser instruments, including the use of high-intensity lasers in physiotherapy, have recently led to controllable photothermal and photomechanical treatments that enable therapeutic effects to be obtained without damaging tissue. The combination of PBM therapy with acupuncture may provide new perspectives for investigating the underlying therapeutic mechanisms of acupuncture and promote its widespread application.

5.
CMAJ. Canadian Medical Association Journal ; 64(5 Supplement 1):S59-S60, 2021.
Article in English | EMBASE | ID: covidwho-2065172

ABSTRACT

Background: Injured adolescents may go to pediatric (PTC) or adult (ATC) trauma centres. Although there appears to be little difference in mortality when adolescents are managed in PTCs versus ATCs, evidence suggests differences in clinical processes (e.g., computed tomographic scanning, operative intervention). Moreover, there is little information on nonclinical outcome variation. We aimed to examine differences in nonclinical outcomes of injured adolescents admitted to the lead PTC or ATC within a regional Canadian trauma system. Method(s): After injury-related hospital admission at the PTC or ATC, adolescents (15-17 yr, inclusive) and parents completed the following: the Quality of Trauma Acute Care Patient-Reported (or Parent- Reported) Experience Measure (QTAC-PREM), examining clinical care, information delivery, education and social supports, and opioid exposure;the Pediatric Quality of Life Inventory;and the Brief Symptom Inventory, a psychological distress measure. Data were collected on clinical outcomes and processes. Descriptive bivariate analyses compared outcomes by trauma centre type. Result(s): Twenty-six ATC and 32 PTC patients have been enrolled to date. Survey response rates were 69% (patients) and 75% (parents) at the PTC and 58% (patients) and 54% (parents) at the ATC. There was a similar age and sex distribution between the 2 centres. Injury severity was higher at the ATC, reflected by greater mean lengths of stay (PTC 2.3 d [standard deviation (SD) 2.1 d], ATC 13.3 d [SD 23.7 d]), and lower mean Glasgow Coma Scale scores (PTC 15.0, ATC 13.8) at the ATC. There were also 3 critical care admissions at the ATC and none at the PTC among recruited patients. No differences were observed in patient- or parent-reported clinical care and follow-up experiences. There was also no difference in patient- or parent-reported social and educational support, although subscales were limited by visitor restrictions because of the COVID-19 pandemic, and the majority of injuries occurring during summer months when students were out of school. Parents at the ATC reported fewer opportunities to stay with or near their child compared with those at the PTC (100% v. 69.2%). Parents reported better information provision at the PTC (mean 17.3 [SD 1.3] v. 13.9 [SD 5.2], out of 18 as measured by the QTAC-PREM). Patients and parents were more likely to report receiving opioid prescriptions on discharge at the ATC (55.6% v. 14.3%). There was no difference in quality of life or psychological distress between the PTC and ATC. Conclusion(s): Injured adolescents and their parents indicated similar clinical and follow-up experiences, although parents felt better informed at the PTC and reported better opportunities to stay near their child. Parents and patients reported higher opioid exposures at the ATC. Sharing of communication, accommodation and opioid prescribing practices may allow for improved experiences and reduced opioid exposures in injured adolescents presenting to ATCs. Multivariable analyses are necessary in the future to adjust for injury severity differences..

6.
Archives of Disease in Childhood ; 107(Supplement 2):A395-A396, 2022.
Article in English | EMBASE | ID: covidwho-2064051

ABSTRACT

Aims Due to public health measures, such as social distancing, reductions of patient admissions and resulting lack of teaching opportunities, medical students' time spent on, and intensity of, paediatric placements was severely impacted. A mentorship program at Sheffield Children's Hospital (SCH) was developed in response to restrictions to paediatric medical student placements during the first and second wave of the COVID-19 pandemic. Even in the absence of a pandemic, medical students report high levels of apprehension and anxiety around paediatric patient interactions, therefore, the need to supplement student learning, and to offer teaching opportunities, was paramount. The mentorship program was developed, following a needs assessment of medical students on placement, and delivered by volunteer junior doctors. In its pilot version, 28 took part and returned feedback. The feedback was implemented into a revised mentorship program, and delivered to a further two cohorts. Aims 1. Evaluate the acceptability of the revised mentorship program for medical students on paediatric placement. 2. Evaluate the efficacy of the revised mentorship program for medical students on paediatric placement. 3. Assess feasibility to deliver the mentorship program long-term, without the acute Covid-19 context. Methods Between September and November 2021, 24 medical students were on placement at SCH. All students received an email with an allocated mentor, which they were told to contact. The mentorship program follows a clear pro-forma, with the student and mentor meeting a number of times to complete the tasks in the pro-forma [ range of meetings 1-4, depending on availability]. The scheme was also meant to run in January 2022, with 15 students on placement at SCH, however, there were only four volunteer junior doctors, which meant the scheme was unable to run. At the end of the mentorship program, participants (mentors, mentees) completed an online questionnaire to collect feedback, assess acceptability, ascertain efficacy and feasibility of the mentorship program. Results Out of the 24 students, only nine (38%) returned questionnaires at the end of their placement, and only five mentors completed feedback questionnaires. The program was found to have good acceptability, with 78% of students strongly agreeing that it has been beneficial to have a junior doctor as a mentor. The feedback regarding efficacy was mixed, with some students indicating their felt confident in some areas but not others (especially neonatal medicine). Feasibility of delivering this scheme project is dependent on voluntary participation of mentors. Conclusion Due to medical students' apprehension regarding paediatric student placements, and lack of exposure due to Covid-19, this ongoing mentorship seeks to support medical students during this time. Results indicate good acceptability and moderate efficacy. However, the feasibility of the program is dependent on voluntary participation from paediatric trainees. Ongoing high levels of burnout, staffing pressures and lack of organizational structures encouraging mentor-mentee exchanges especially impacted mentor retention and recruitment. Results are limited due to small numbers of returned feedback, despite implementing easier processes of giving feedback for students.

7.
Archives of Disease in Childhood ; 107(Supplement 2):A369-A370, 2022.
Article in English | EMBASE | ID: covidwho-2064047

ABSTRACT

Aims Raised Intracranial Pressure (ICP) is frequently encountered condition amongst children due to neurological and non-neurological etiologies. It contributes towards 20% of the admissions in our PICU at tertiary care institute of North India. Timely diagnosis of raised intracranial pressure is critical for appropriate management. Ultrasonographic measurement of optic nerve sheath diameter (ONSD) is non-invasive point of care tool to recognize raised intracranial pressure however there are very limited studies in pediatric population on this. Aim of this study was to measure the ONSD of children admitted in pediatric intensive care unit (PICU) to identify the difference in ONSD among the pediatric patients with normal and raised ICP and to achieve the cut-off value for diagnosing raised ICP. Methods A Hospital based observational comparative study conducted at PICU of a tertiary care institute of national importance in North India. ONSD measurement of all the patients aged 2-14 years admitted in pediatrics department for >48 hours was done in two phases due to COVID-19 related restrictions in routine admissions for some months. First phase was from 1st January 2020 to 31st March 2021 and second phase started from 15th January 2022. Complete enumeration technique was used for the study. Children receiving treatment for raised ICP based on clinical features (Muir's criteria) and neuroimaging were included in raised ICP group and they were compared with the patients without any signs of raised ICP. Optic nerve sheath diameter was measured in both the groups on Day 1 (i.e. within 24 hours of admission) and Day 2 of admission. Third and last ONSD measurement was done on any day between day 4 and day 7 of admission. On each day, 3 readings were taken from each eye and average of 3 readings was used for final statistical analysis for that particular day. Treating team was unaware of the USG findings throughout the stay of the patient in the department. Results Total 101 patients recruited, among them 16 patients had raised ICP and 85 patients had normal ICP. The mean optic nerve sheath diameter on day 1 was found to be higher in the patients with raised ICP (Mean ONSD = 4.955 +/- 0.80) as compared to those with normal ICP (Mean ONSD = 4.05 +/- 0.43). Their mean difference was 0.90 mm (95% CI 0.07-1.48 p value <0.01). Mean ONSD on day 2 also was higher in raised ICP patients (Mean ONSD = 4.82 +/- 0.73) in comparison to normal ICP patients (Mean ONSD = 4.06 +/- 0.47) which was statistically significant (p value = 0.001). The cut-off ONSD value for detecting the raised ICP was estimated to be 4.35 mm on ROC curve with area under the curve 0.862 (95% CI, 0.721-0.943), sensitivity of 75% and specificity of 76.5%. Conclusion Raised ICP is one of the important neurological entities in children contributing towards significant morbidity. Measurement of ONSD by trans-orbital ultrasound was able to detect raised ICP with excellent discriminatory performance.

8.
Archives of Disease in Childhood ; 107(Supplement 2):A272-A273, 2022.
Article in English | EMBASE | ID: covidwho-2064034

ABSTRACT

Aims Our aim is to assess whether Covid-19 had an overall impact on diabetic control within the paediatric type 1 diabetic population who attend Causeway Hospital. We retrospectively compared baseline HbA1cs of patients between the years 2019 - 2021 to assess for change in the mean HbA1c throughout all paediatric T1DM patients as well as to compare patients with and without an insulin pump. We planned to retrospectively assess the percentage of newly diagnosed diabetic patients who were in DKA on initial presentation. Finally, we wanted to assess HbA1c control of patients with a libre 2 sensor to assess whether patients who scanned more frequently have better overall HbA1c and/or time in target glucose range. Methods NIECR, TWINKLE and LIBREVIEW systems were used to collect data from all Causeway diabetic patients from 2019-2021 to compare HbA1c, number of libre scans and data including whether patients presented in DKA. For data collected on patients with a libre sensor - this was analysed using an unpaired t-test and a p-value subsequently calculated to assess statistical significance. Results In total data was collected from 92 patients throughout the years 2019 - 2021. The median HbA1c of all T1DM patients increased from 65.2 in 2019 to 65.7 in 2020 then improved in 2021 to 64.07mmol/mol. In 2020, there were fewer overall patients with a new diagnosis of T1DM (n=8) compared with 2019 (n=11) and 2021 (n=11). In 2020 37.5% of newly diagnosed patients were in DKA on initial presentation compared with 18% in 2019 and 27% in 2021. Total number of T1DM patients with an HbA1c <48 was 5.6% in 2019, 3.8% in 2020 and 11.8% in 2021. Mean HbA1c from all T1DM patients increased from 65.24mmol/mol in 2019 to 65.72mmol/mol in 2020 and improved to 64.08mmol/mol in 2021. Mean HbA1c in T1DM patients with an insulin pump also increased from 57.76mmol/ mol in 2019 to 59.63mmol/mol in 2020 and improved to 57.56mmol/mol in 2021. In patients with a libre 2 sensor, percentage time within target glucose range (3.9-10mmol/L) increased from 31.25% in those who scanned <4 times/day(n=12) to 59.44% in those who scanned >12 times/day(n=18) resulting in a pvalue of 0.0001. In patients with a libre 2 sensor, mean HbA1c values in those who scanned <4 times per day was 76.5 compared to 55mmol/mol for patients who scanned >12/day resulting in a p-value of 0.0003. Conclusion Throughout all T1DM paediatric patients, we noted an increased HbA1c in 2020 and an improvement in 2021. There was also an increase in incidence of DKA at presentation in newly diagnosed patients who presented in 2020 compared to 2019/2021. Our patients with an insulin pump had better overall HbA1c control than those who self-inject. Patients with a libre 2 sensor who scan more frequently are more likely to have an increased amount of time within the target glucose range of 3.9-10mmol/L and are more likely to have a lower HbA1c.

9.
Archives of Disease in Childhood ; 107(Supplement 2):A267, 2022.
Article in English | EMBASE | ID: covidwho-2064032

ABSTRACT

Aims To review the glycaemic control of type 1 diabetic patients attending the paediatric and transition adolescent diabetes clinic within NHS Lanarkshire during the coronavirus pandemic. Methods A quantitative analysis of 348 patients attending the paediatric and transition adolescent diabetes clinics within NHS Lanarkshire was carried out. Data collected included age, sex, date of diagnosis and insulin delivery device. Comparing these measures to the Scottish Index of Multiple Deprivation (SIMD) of the patient. Patient data was anonymised within a single data collection sheet. Results 94% of patients across both clinics (n=298) attended a consultation during lockdown, before returning to school in August. Within the paediatric diabetes clinic, results from 199 patients were analysed. 30.65% (n=61) patients experienced a rise in their HbA1c over lockdown whilst 65.32% (n=130) of patients reduced their HbA1c. In this cohort, the mean HbA1c before lockdown compared to after lockdown was 3.77mmol/mol (95% CI 1.93, 5.61;P=0.000). 90 sets of patient data were analysed from the transition adolescent diabetes clinic. 27.78% (n=25) of patients had a rise in their HbA1c and whilst patients from this clinic gained tighter glycaemic control over lockdown. The mean HbA1c pre-lockdown compared to post-lockdown in this clinic reduced by 4.67mmol/mol (CI: +1.35, +7.99, P= 0.006). Patients residing in SIMD quintiles 3-5 had the greatest improvement in HbA1c over lockdown. Conclusion Glycaemic control of patients within the NHS Lanarkshire paediatric diabetes clinics improved over lockdown. There was a mean reduction in HbA1c over the lockdown period. Repeating this audit in a year would be beneficial to see how returning to school and further local lockdowns affected the glycaemic control of paediatric patients.

10.
American Journal of Transplantation ; 22(Supplement 3):873-874, 2022.
Article in English | EMBASE | ID: covidwho-2063475

ABSTRACT

Purpose: The global COVID-19 pandemic has significantly altered delivery of healthcare. Hospital resource utilization has been impacted on multiple levels including solid organ transplantation and overall access to transplant care. In the United States, significant regional variation and decreased living donor transplantation occurred during the initial 6 months of the pandemic. We examined the multi-year impact of COVID-19 on pediatric organ donation and transplantation. Method(s): Pediatric (<18 years of age) organ donation and transplant data was obtained from the Organ Procurement and Transplantation Network (OPTN). Data included pediatric donors after brain death (pDBD), donors after circulatory death (pDCD), living donors (LD), and recipient details including total number of transplants, waitlist deaths, and removals were reviewed between January 2019 to December 2021. Result(s): Total pediatric transplants performed in 2019, 2020, and 2021 were 1923, 1766, and 1890 (p=0.004) respectively. Organ specific data is outlined in Table 1. In 2019, 2020, and 2021, living donor transplantation accounted for 320, 288, and 311 (p=0.838) cases, while 1579, 1456, and 1552 (p=<0.0001) deceased donor allografts were utilized. There were 171, 176, and 209 pDCD and 746, 684, and 713 pediatric pDBD donors. Living donors across all recipient ages were 7391, 5725, and 6539. 2392, 2337, and 2430 pediatric patients were added to all organ waitlists during the study period. 2347, 2198, and 2288 children were removed from the waitlist with 93, 82, and 76 of those cases due to patient death. There was no statistically significant difference in the proportion of pediatric patients added to the waitlist vs those removed during 2019-2021 (p=0.505) Conclusion(s): Transplant volume transiently decreased in the first six months of the COVID-19 pandemic. However, transplantation rates in children, specifically abdominal organ transplantation, increased to nearly pre-pandemic levels in 2021. Lung transplants were significantly decreased during the study period. Pediatric donation remained relatively steady from 2019-2021. Living donor transplantation in children was significantly impacted in 2020. Waitlist additions/removals remained consistent throughout the study period. (Table Presented).

11.
American Journal of Transplantation ; 22(Supplement 3):731, 2022.
Article in English | EMBASE | ID: covidwho-2063453

ABSTRACT

Purpose: We report the first two pediatric liver transplants utilizing allografts from COVID+ donors, infected at time of organ procurement, demonstrating a pivotal step toward donor pool maximization amid a viral pandemic with poorly understood transmissibility in the pediatric patient. Method(s): This is a prospective and retrospective review of two pediatric liver transplants and their donors who tested positive for SARS-CoV-2 at time of procurement. Data was obtained through the electronic medical record system and UNet DonorNet platform. Result(s): The first donor is a 3-year-old male succumbing to head trauma. 1 of 5 nasopharyngeal swab RT-PCR tests demonstrated COVID-19 positivity while 1 of 3 bronchoalveolar lavage RT-PCR tests indicated SARS-CoV-2 infection. Preceding procurement in the second donor, a 16-month-old male with unknown etiology of cardiorespiratory arrest, 2 nasopharyngeal swab RT-PCR tests and 1 bronchoalveolar lavage RT-PCR test failed to detect SARS-CoV-2 infection. Diagnosis was not made until the Medical Examiner's office repeated a nasopharyngeal swab RT-PCR and archive plasma RT-PCR which were both positive for SARS-CoV-2. The two 2-yearold pediatric liver recipients underwent transplantation in November 2021. Continued follow-up demonstrates successful transplant void of viral transmission or hepatic artery thrombosis as liver chemistries have anticipatorily normalized with excellent graft function. One recipient experienced early portal vein thrombosis treated by interventional radiology with discharge on postoperative day 20. Conclusion(s): This report is the first to describe successful pediatric liver transplants from COVID+ donors. This data reinforces case reports in the adult transplant population of successful use of COVID + donor organs and further supports the judicious use of COVID+ donors for extrapulmonary pediatric organ transplant. The concern for donor-derived transmission must now be weighed against the realized benefit of successful, life-saving transplantation for end stage liver disease in the pediatric patient. (Figure Presented).

12.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P104-P105, 2022.
Article in English | EMBASE | ID: covidwho-2064498

ABSTRACT

Introduction: The COVID-19 pandemic has resulted in delayed provision of essential and nonessential medical care. The objective of this study was to identify trends and possible delays in the timing of pediatric cochlear implant (CI) preand postoperative care during COVID-19 compared with pre- COVID at a single center. Method(s): Patients under the age of 18 years old who underwent initial CI at a single tertiary care center between January 1, 2016, and February 29, 2020, were included in the pre- COVID-19 group, and patients implanted between March 1, 2020, and December 31, 2021, were included in the COVID- 19 group. Data from revision or sequential second-side CI surgeries were excluded. Time intervals between care milestones including confirmation of severe to profound hearing loss, CI surgery, and CI activation were compared for the pre- COVID-19 and COVID-19 groups, as were the number and type (virtual vs in person) of postoperative visits. Result(s): A total of 98 patients met inclusion criteria, of which 70 were implanted pre-COVID and 28 during COVID. At the time of first CI, patients in the COVID group were significantly older (mu=5.7 years, 95% CI, 4.0-7.5) compared with patients in the pre-COVID group (mu=3.7 years, 95% CI, 2.9-4.6;P=.02). The interval between severe to profound hearing loss confirmation and first CI surgery was significantly longer for the COVID group (mu=99.7 weeks, 95% CI, 48.8-150) compared with the pre-COVID group (mu=54.2 weeks, 95% CI, 39.6-68.8;P=.02). All patients underwent activation within 7 weeks after implantation, although the time between first CI surgery and activation was significantly shorter for the COVID group (mu=3.8 weeks, 95% CI, 3.6-4.0) compared with the pre-COVID group (mu=4.3 weeks, 95% CI, 4.1-4.5;P=.01). Conclusion(s): Pediatric patients undergoing cochlear implantation during the COVID-19 pandemic experienced significant delays in care. Future work will aim to reveal impact of delayed care on outcomes in this population.

13.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P252-P253, 2022.
Article in English | EMBASE | ID: covidwho-2064418

ABSTRACT

Introduction: Viral upper respiratory tract infections (URTI) such as respiratory syncytial virus, rhinoenterovirus coronavirus, and others are common in children, and they can have serious effects on the pediatric airway. The literature is limited on how often ear, nose, and throat (ENT) clinician involvement is required in patients admitted with a URTI. This project aims to characterize and identify factors associated with ENT involvement in care of pediatric patients with positive respiratory virus panels (RVP) and if any require airway interventions. Method(s): A retrospective study was conducted collecting information on patient demographics, comorbidities, course of treatment, incidence of ENT consultation, and incidence of airway interventions (flexible laryngoscopy, intubation, tracheostomy, direct laryngoscopy, etc) for all pediatric patients with a positive RVP who were treated either inpatient or in the emergency department from January 2018 to January 2020 at a tertiary care academic facility. Result(s): A total of 1019 of 1317 consecutive charts with a positive RVP over a 2-year period were reviewed. Preliminary result analysis was completed for the 1019 completed charts. Twenty-eight patients (2.7%) required an ENT consultation. Congenital birth defects were significantly associated with ENT consultation (odds ratio [OR]=3.75;P=.001). Length of stay was significantly associated with higher rate of ENT consultation per day of stay (OR=1.07 per day of stay;P<.001). All other factors studied were not significantly associated with higher rate of ENT consult. Conclusion(s): The incidence of ENT consultation in inpatients with URTIs is relatively uncommon. The preliminary data of this study suggest congenital birth defects and longer length of stay could be used as potential markers to help identify patients who may be at increased risk for worse airway outcomes and need for further airway intervention.

14.
American Journal of Transplantation ; 22(Supplement 3):597, 2022.
Article in English | EMBASE | ID: covidwho-2063345

ABSTRACT

Purpose: Lung transplantation (LTx) has been shown to be a viable treatment for irreversible lung disease caused by COVID-19. Given the limited data on the subject, our purpose was to examine the process and outcomes of LTx for COVID Acute Respiratory Distress Syndrome (ARDS) in a retrospective single center cohort study which includes one pediatric patient. Method(s): This case series is a retrospective review of our patients diagnosed with COVID ARDS who underwent LTx for that diagnosis. All LTx in this cohort occurred between September 9, 2020 and August 26, 2021. We report on candidate selection, pre-LTx patient care, intra-operative procedure, and post-transplant recovery. Result(s): A total of ten patients that underwent LTx for COVID ARDS were identified. The average age of the cohort was 44.9 years (range of 16-60 years) and the mean Lung Allocation Score (LAS) 85.4 +/- 9.65. LTx occurred on average 96.5 +/- 32.9 days following onset of COVID symptoms. Seven patients (70%) in the cohort were bridged to LTx on extracorporeal membrane oxygenation (ECMO) for an average of 72.1 +/- 25.9 days. Six patients (60%) required mechanical ventilation prior to LTx. Intra-operatively, seven patients received life support via ECMO, 2 via off-pump, and 1 via cardio-pulmonary bypass (CPB). Seven patients required intraoperative packed red blood cells (mean 5.4 +/- 2.5). Following transplant, 60% of patients received ECMO for a mean duration of 2.0 +/- 0.9 days;90% of the cohort received ventilatory support. At 72 hours following surgery, cohort graft viability surpassed in center averages for non COVID LTx recipients;50% of patients had no primary graft dysfunction (PGD) (grade 0) and 50% had PDG grade 1. Discharges occurred 29.0 +/- 11.7 days following LTx and no episodes of acute rejection were noted in this time frame. As of publication there is 100% patient and allograft survival. Conclusion(s): While substantial center resources and expertise are required, LTx for COVID ARDS can be safely performed with a high rate of success. Careful candidate selection, donor selection, and institutional support were all critical elements that contributed to the 100% success rate observed in this cohort, which includes the youngest reported patient to undergo LTx for COVID ARDS.

15.
Cardiology in the Young ; 32(Supplement 2):S93, 2022.
Article in English | EMBASE | ID: covidwho-2062119

ABSTRACT

Background and Aim: Clinical manifestations of children's corona-virus disease-2019 (COVID-19) are generally considered less severe compared with adult patients. The objective of this study was to evaluate cardiac involvement in healthy children with asymptomatic or mildly symptomatic severe acute respiratory syn-drome coronavirus-2 (SARS-CoV-2) infection. Method(s): We analysed a cohort of 210 paediatric patients, mean age 7 +/- 4 years, who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study 138 +/- 65 days after diagnosis. Seventy-two age, sex, and body sur-face area comparable healthy subjects were used as control group. Result(s): Left ventricular ejection fraction was within normal limits but significantly lower in the cases group compared to controls (62 +/- 4% vs. 65 +/- 5%;P = 0.012). Left ventricular (LV) global longi-tudinal strain (-20,91 +/- 2,83 % vs.-22,73 +/- 2,51 %;P lt;0.001) was significantly reduced in cases compared with CTRLs. Regional LV strain analysis showed a significant reduction of the LV mid-wall segments strain among cases compared to controls. Furthermore, in the cases group, there were 25% of subjects with a regional peak systolic strain below-16% (-2.5 Z score in our healthy cohort) in at least two segments. These subjects did not show any difference regarding symptoms or serological findings. Conclusion(s): SARS-CoV-2 infection may affect left ventricular deformation in 26% of children despite an asymptomatic or only mildly symptomatic acute illness. A follow-up is needed to verify the reversibility of these alterations and their impact on long-term outcomes.

16.
Cardiology in the Young ; 32(Supplement 2):S242, 2022.
Article in English | EMBASE | ID: covidwho-2062090

ABSTRACT

Background and Aim: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, cardiopulmonary repercussions in paediat-ric patients with congenital heart disease (CHD) are unknown. The aim of this study is to compare changes in cardiopulmonary exercise test (CPET) in this patients before and after COVID-19. Method(s): Prospective observational study was lead comparing CPET results after COVID-19 in paediatric patients with stable CHD who had a previous routine CPET. All underwent for stand-ardised CPET, using Godfrey ramp protocol as recommended by the European Society of Cardiology (ESC). Measured variables, expressed by predicted values, were: forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of minute venti-lation to carbon dioxide production (VE/VO2 slope), peak oxy-gen consumption (peak VO2), oxygen uptake efficiency slope (OUES), oxygen pulse (O2 pulse) and peak heart rate (pHR). Wilcoxon test was used to compare continuous variables for related samples. Result(s): Ten patients (6 boys, 60%;mean age 11,4 +/- 2,4 years) with hemodynamically stable CHD (3 Tetralogy of Fallot, 30%;2 trans-position of the great arteries, 20%;2 dilated cardiomyopathy, 20%;2 Kawasaki disease, 20%;1 cardiac tumor, 10%) were selected to repeat a post-COVID CPET. All of them had mild COVID and could follow ambulatory treatment. Comparing before/post COVID tests, there were no significantly changes in predicted res-piratory parameters: FVC (90,6 +/- 7,4 vs 98,1 +/- 23,9%;p = 0,799), FEV1 (89,5 +/- 13,8 vs 94,5 +/- 8,8%;p = 0,475), VE/CO2 slope (31,6 +/- 3,7 vs 30,6 +/- 3,9degree, p = 0,203). In the same way, no significantly changes were seen in cardiovascular predicted parameters: oxygen pulse (97,3 +/- 19,2 vs 98,5 +/- 17,4%, p = 0,798), peak VO2 (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123) and OUES (1,79 +/- 0,4 vs 2,01 +/- 0,6;p = 0,066). Respect peak VO2, there was a non-significant slightly decrease in post-COVID test (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123). Conclusion(s): In our series, post-COVID CPET results showed that paediatric patients with hemodynamically stable CHD had no impairment in their functional capacity in relation to Sars-CoV-2 disease. Contrary to adults with previous cardiovascular disease, children should have mild infections without sequelae in cardio-pulmonary function.

17.
Chest ; 162(4):A2032, 2022.
Article in English | EMBASE | ID: covidwho-2060888

ABSTRACT

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Two years into the COVID-19 pandemic, knowledge about how infection affects children is still lacking. Unlike adults, prior to the recent surge widespread symptomatic childhood illness has not been seen, likely due to school shutdowns, strict social distancing, and less severe illness course. During the omicron surge in NYC, an increase in pediatric cases was noted likely due to reinstatement of in-person learning and relaxing of social distancing. Though vaccines were available, only 9% of children aged 5-11 years and 35% of adolescents aged 12-17 years were vaccinated. During omicron surge, a large proportion of adult patients positive for COVID-19 were asymptomatic. We aimed to explore incidence of ED visits, hospital admissions, vaccine status and presenting complaints in pediatric population who tested positive for COVID-19 during the omicron surge in NYC. METHODS: A retrospective chart review was conducted of patients <18 years who tested positive for COVID-19 at two multiethnic community hospitals during the Omicron wave (Nov 1, 2021-Feb 28, 2022). Demographics, vaccine status, reason for visit, diagnosis and disposition were extracted from EHR. Data were analyzed according to age group: 0 to <5 years (G1), 5 to <12 years (G2) and 12 to <18 years (G3). RESULTS: During this time, close to 2800 patients tested positive for COVID-19 at presentation to the ED or during hospitalization. Of these, 343 were <18 years of age (~10%). Overall, 53% of these pediatric patients were male. Ethnic make-up mirrored that of our community (approx. 60% Hispanic, 20% Asian, 10% Black). Admission status included 27 (7.8%) admitted to our hospitals, 18 (5.2%) transferred to other hospitals from our ED, and 298 (87%) treated and released from the ED. By age group, 183 (59%) were in G1, 76 (24%) in G2 and 51 (17%) in G3. Patients in G1 were <5 years and therefore ineligible for vaccine. Only 5% of G2 and 33% of G3 were fully vaccinated. In all groups, majority of patients presented for symptoms of viral infection (G1>80%, G2>90%, G3>90%). Symptoms of upper respiratory infection were most frequent in all groups (>80%). Convulsions (4.3%, 1.3%), croup (8.2%, 2.6%) and otitis media (3.3%, 1.3%) were noted in G1 and G2, respectively. In G3, acute appendicitis, diabetic ketoacidosis, and otitis media were present on admission in 2% each. Majority of patients requiring admission were from G1 (74%). CONCLUSIONS: Though adults during the recent surge often presented with asymptomatic COVID-19, pediatric patients in our sample typically presented for viral illness. It is difficult to interpret vaccine data except to say that there was a small group of pediatric patients who were symptomatic despite vaccination. CLINICAL IMPLICATIONS: We present early descriptive data from the Omicron surge in NYC in a pediatric sample. DISCLOSURES: No relevant relationships by Won Baik-Han No relevant relationships by Tamana Bismillah No relevant relationships by Kelly Cervellione no disclosure on file for Gagan Gulati;No relevant relationships by LOCHANA KC No relevant relationships by Lily Lew

18.
Chest ; 162(4):A2030-A2031, 2022.
Article in English | EMBASE | ID: covidwho-2060887

ABSTRACT

SESSION TITLE: Drug-Induced and Associated Critical Care Cases Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The use of remdesivir in critical care setting has been utilized treatment of covid, but not without risk. Many cases have reported severe cardiac effects with bradycardia being the most common. CASE PRESENTATION: The patient was a 15-year-old female with a history of asthma, hyperinsulinemia who required hospitalization for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. She received ceftriaxone, azithromycin, and a 10-day course of remdesivir (RDV). On her third day of admission, the patient developed significant sinus bradycardic with heart rate nadir of 30-40 bpm but denied any symptoms. She completed her remdesivir course on day five of hospitalization and was discharged on day nine with a heart rate of 47 bpm. She later presented to ED the night of discharge following acute onset of lightheadedness and blurry vision at home secondary to orthostatic hypotension and bradycardia. Her pulse was 48 bpm, temperature 36.1 C, respirations 24/min, blood pressure 119/50 mmHg and SpO2 99% on room air. Her physical exam was unremarkable. EKG showed sinus bradycardia with a PR interval of 124 ms and QTc of 406 ms. Echocardiogram showed normal cardiac anatomy and function. Patient was diagnosed with persistent RDV-associated bradycardia and discharged home with a Holter monitor and cardiology follow-up. Bradycardia resolved by her follow-up visit two weeks later. DISCUSSION: According to the WHO pharmacovigilance database, bradycardia is a relatively new adverse effect and 3.6% of the 2,603 adverse effects reported since the onset of the pandemic, with 2 million RDV doses administered during this time [1]. The mechanism of RDV-associated bradycardia is proposed to be an effect of adenosine triphosphate, an active metabolite, which reduces SA node automaticity via stimulation of vagal nerve, as well as RDV cross-reactivity with mRNA polymerase, leading to cardiotoxicity that usually resolves within 24 hours of medication discontinuation. In our patient's case bradycardia did not resolve until eight days after discontinuation of medication [2]. Review of previously case reports does not identify any association with patient age but could be related to timing of when medication reaches therapeutic window, as many patients had onset of bradycardia on day 3 of treatment [3]. We report a pediatric case of severe acute COVID-19 who developed sinus bradycardia on day 3 of RDV treatment as previously described, but the bradycardia persisted long after the discontinuation of RDV. CONCLUSIONS: With over 50 thousand pediatric COVID-19 hospitalizations to date, this case serves as a timely reminder that medication side effects should be monitored closely, and that more research needs to be done into the effects of RDV on cardiac function in pediatric patients. Reference #1: Jung SY, Kim MS, Li H, Lee KH, Koyanagi A, Solmi M, Kronbichler A, Dragioti E, Tizaoui K, Cargnin S, Terrazzino S, Hong SH, Abou Ghayda R, Kim NK, Chung SK, Jacob L, Salem JE, Yon DK, Lee SW, Kostev K, Kim AY, Jung JW, Choi JY, Shin JS, Park SJ, Choi SW, Ban K, Moon SH, Go YY, Shin JI, Smith L. Cardiovascular events and safety outcomes associated with remdesivir using a World Health Organization international pharmacovigilance database. Clin Transl Sci. 2022 Feb;15(2):501-513. doi: 10.1111/cts.13168. Epub 2021 Oct 31. PMID: 34719115;PMCID: PMC8841455. Reference #2: Touafchia A, Bagheri H, Carrié D, Durrieu G, Sommet A, Chouchana L, Montastruc F. Serious bradycardia and remdesivir for coronavirus 2019 (COVID-19): a new safety concerns. Clin Microbiol Infect. 2021 Feb 27;27(5):791.e5–8. doi: 10.1016/j.cmi.2021.02.013. Epub ahead of print. PMID: 33647441;PMCID: PMC7910147. Reference #3: Rau, Cornelius MPhil;Apostolidou, Sofia MD;Singer, Dominique MD, PhD;Avataneo, Valeria PhD;Kobbe, Robin MD Remdesivir, Sinus Bradycardia and Therapeutic Drug Monitoring in Children With Severe CO

19.
Chest ; 162(4):A939-A940, 2022.
Article in English | EMBASE | ID: covidwho-2060734

ABSTRACT

SESSION TITLE: Not the Normal Host: Infections Still Matter SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Utilization of ECMO support for refractory cardiogenic, and respiratory failure has increased exponentially over the last 20 years. The advent of miniaturized and portable machines has led to a shift of cannulation strategies in the operating room/cath lab to the bedside. Transitioning to bedside cannulation has been previously reported as safe, with minimal risk for mortality or catheter site infections. However, bedside cannulations in the critically ill crashing patient raises concern for sterility. The aim of this study was to assess the risk of ECMO cannula site infections in bedside vs operating room/catheterization suite. METHODS: It is a retrospective single institution case series review of 52 adult and pediatric patients who were required either Veno-Venous (VV) or Veno-Arterial (VA) ECMO. Data gathering was used to quantify the rate of catheter site infections after initiation of extracorporeal support. Catheter site infections were defined as localized erythema, fluctuance, or purulence from the cannula site within 7 days of of ECMO cannula placement. RESULTS: A total of 42 (81%) pts had bedside cannulation, and the other 10 (19%), were done in IR suite/cath lab. The total number of catheter site infections was 1 (2.4%) in the bedside cannulation group. There were no infections in the non-bedside cannulation groups. 13 (30%) of the bedside cannulations, and 3 (30%) of the non-bedside cannulation group were on antibiotics during or prior to cannula insertion. CONCLUSIONS: Current literature suggests that the prevalence of infections on ECMO is 10-12%,. Traditionally, this has predisposed most cannulations to be performed in the surgical setting rather than at bedside. During the recent COVID pandemic, the frequency of bedside cannulation for ECMO had increased and was not associated with significant morbidity, and mortality. The risk of infection from the catheter site had also been determined to be minimal to none. From the data gathered above, it can be safely assumed that the risk of catheter site infection with bedside cannulation is minimal. However, the major contributing factor to decreased infection risk appears to be meticulous cannula site nursing care. The current ECMO nursing protocol utilized at our hospital required twice daily dressing changes with stringent chlorhexidine cleanses prior to redressing. The only case of catheter site infection we experienced was when this protocol was deviated. CLINICAL IMPLICATIONS: Utilizations of bedside ECMO cannulation techniques carries minimal risk for catheter site infections. It is important to state that nursing driven protocols for cannula site dressing changes, has one of the biggest implications on the risk of catheter site infections. Therefore, with the employment of appropriate nursing protocols, the concern for catheter site infections should not preclude the decision to proceed with bedside cannulation. DISCLOSURES: No relevant relationships by Ajit Alexander No relevant relationships by Melodie Blackmon Scientific Medical Advisor relationship with ALung Technologies, Inc. Please note: $5001 - $20000 by Steven Conrad, value=Consulting fee No relevant relationships by ANIBAL DOMINGUEZ no disclosure on file for Jonathan Eaton;No relevant relationships by Laurie Grier No relevant relationships by Rajkamal Hansra No relevant relationships by Prathik Krishnan No relevant relationships by Nathaniel LSUHSC-Shreveport No relevant relationships by Alex Manuel No relevant relationships by Jonathan Packer No relevant relationships by arunima sharma no disclosure on file for Chris Trosclair;No relevant relationships by Gregory Vo No relevant relationships by Robert Walter

20.
American Journal of Translational Research ; 14(9):6375-6381, 2022.
Article in English | EMBASE | ID: covidwho-2058689

ABSTRACT

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.

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