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1.
Gastroenterology ; 162(7):S-846, 2022.
Article in English | EMBASE | ID: covidwho-1967375

ABSTRACT

The incidence of Eosinophilic Oesophagitis (EoE) is increasing worldwide in the paediatric population. Management of these children is complex, and includes elimination diet (2/4/ 6 food), steroids etc. It is recommendedto perform endoscopies between each reintroduction to assessdisease activity. In our centre dietary exclusion is the standard practice. Since 2019 we follow a step-up approach with regards to elimination diet starting with 2 food exclusion diet (FED) and building up as required. Food is reintroduced gradually with significant dietetic support and proactive monitoring including endoscopy. Objectives: We looked at the outcomes of children with EoE referred to Maidstone and Tunbridge Wells NHS Trust from Kent and East Sussex. Methods: Retrospective review of case notes of paediatric patients diagnosed with EoE between January 2015 and December 2020. Data collected included symptoms, endoscopy findings and histology at diagnosis and compared the same after dietary intervention. Results 21 patients were diagnosed with EoE between January 2015 and December 2020 between 5-16 yrs Median age at diagnosis 11years. Frequently seen in boys (65%). Dysphagiawas the predominant symptom (76%) followed by vomiting (60%), abdominal pain (50%), and choking (20%). Features of EoE were seen during endoscopy in 71% and oesophagus looked endoscopically normal in 29% of patients. Diagnosis was made on eosinophil count as per ESPGHAN guidance. The frequency and timing of repeat endoscopies following dietary intervention varied due to a multitude of factors including COVID-19 restrictions (between 4-9 months median 4 months). Histological remission (Eosinophils <15 pHPF) was achieved in 15/21 (70%) of patients. 7/10 children on 2FED, 3/3 patients on 4FED and 5/5 children on 6FEDachieved histological resolution. The 6FED group took significantly longer to identify the causative food, establish long term dietary management and required more endoscopies. Food was reintroduced gradually on an individual basis with the aim of introducing back all food groups. 13/15 continue to be on milk free diet, 5/15 remain on milk and wheat free diet, 1/15 on soya and egg free diet and the other patient remains on 4FED (parental choice). 2 patients have started steroids due to on-going symptoms findings on surveillance endoscopy and histological following reintroduction. Summary and Conclusion Dysphagia was the predominant symptom in our cohort of patients. Furrowing and oedema was the major finding duringendoscopy. With dietary exclusion endoscopic resolution was seen in 62% and histological resolution seen in 70% of patients at first surveillance endoscopy. Re-introduction continues to remains a major challenge and we have not been able to introduce all the food groups in any of our patients due to either symptoms or recurrence on endoscopy/histology.

2.
Enfermedades Infecciosas y Microbiologia ; 41(3):97-101, 2021.
Article in Spanish | EMBASE | ID: covidwho-1965436

ABSTRACT

sars-cov-2 infections appear to affect children less frequently and severely than adults. Children are frequently asymptomatic or have less severe symptoms and, therefore, less tested. objective. To determine prevalence and epidemiological characterization of sars-cov-2 in children from Chaco, Argentina. material and method. Descriptive, observational study. Once authorized by the Ethics Committee, the Chaco Epidemiology Computerized Database was reviewed, laboratory confirmed pediatric patients with sars-cov-2 infection of both sexes were included, aged between 30 days of life and under 13 years and 11 months of age, from March to September 2020. results. 320 pediatric patients (170 men and 150 women) were admitted. The ages between one and 13 years;average of seven years. The provenance mostly from Resistencia. Regarding morbidities, 86.8% did not present any type and 13.1% did. The most frequent comorbidity was asthma. Regarding the signs and symptoms of presentation: 285 (89%) presented signs-symptoms and 35 (10.9%) asymptomatic. The most frequent signs and symptoms were: fever 106 (37.1%);cough 61 (21.4%);odynophagia 47 (16.4%). conclusions. In the studied population, a higher prevalence of symptomatic was found;being fever and cough, the most prevalent symptoms, however they cannot be considered characteristic of sars-cov-2 in children, requiring further studies.

3.
Journal of Clinical and Diagnostic Research ; 16(7):EC13-EC16, 2022.
Article in English | EMBASE | ID: covidwho-1957576

ABSTRACT

Introduction: There is inadequate information on infections with the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) in children. Their clinical, as well as pathological correlation, is poorly understood. In India, children and adolescents account for 12% of all Coronavirus Disease 2019 (COVID-19) cases reported. Children accounted for roughly 11% of those impacted globally last year. However, this year, we are seeing around 20-40% of youngsters in positive instances over the world. Even babies and infants are testing positive for COVID-19, although their illness is under control and seldom becomes fatal. Children aged 5 to 12 years, on the other hand, are at a higher risk. Aim: To study the clinical, pathological and genomic characteristics among children with SARS-CoV-2 infection. Materials and Methods: This cross-sectional study was conducted among 48 paediatric positive patients for SARSCoV-2 at Government Institute of Medical Sciences, Noida, Uttar Pradesh, and CSIR-Institute of Genomics and Integrative Biology, New Delhi, India, from 2021 and May 2021. The laboratory testing was done by the real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) method. The patients were classified as mild, moderate, severe, or asymptomatic. Their clinical and pathological findings were recorded in the case sheet. Genomic analyses were done for identifying the genetic variant in the nine selected samples. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 26.0. Chi-square test was used for categorical variables and the t-test was used for continuous variables. results: The study group has median age of 12 years. Male:Female ratio was 2:3. Most children had acquired infection from the community and 30% had the moderate illness and were admitted. Serum Glutamic-Oxalacetic Transaminase (SGOT) and Glutamic-Pyruvic Transaminase (SGPT) were raised in six patients. Alkaline Phosphatase (ALP) was raised in 21 patients and bilirubin was raised in two patients. The average duration of hospitalization was 6 days (range 2-13 days). No mortality among the 48 paediatric patients studied was identified in the hospital. Delta variant (B.1.617.2) was identified in seven patients with D614, P681R, L452R mutations and B.1.617.2 was identified in two patients. Delta variant was present in the paediatric patients but it did not prolong the hospital stay or cause mortality. conclusion: The findings of the study suggest that children may be a potential source of infection in the SARS CoV2 pandemic while having an asymptomatic to mild illness.

4.
Revista Paulista de Pediatria ; 40, 2022.
Article in English | EMBASE | ID: covidwho-1957119

ABSTRACT

Objective: The aim of this study was to evaluate the coronavirus disease 2019 (COVID-19) cutaneous manifestations described in pediatric patients and discuss their relevance for early diagnosis. Data source: The study consisted of a systematic review of original articles indexed in PubMed and Embase databases, as well as gray literature articles found through Google Scholar. A search strategy, based on PICO (Patient, Intervention, Comparison, Outcome) Tool, with the terms "child," "infant," "childhood," "adolescents," "teenagers," "COVID-19," "SARS-CoV-2," and "skin manifestations," was performed to optimize the findings. The study did not restrict any article regarding language. Data synthesis: Out of the 310 articles that initially met the inclusion criteria, 35 were selected for review, totalizing 369 patients. The most common COVID-19 cutaneous manifestations in children and adolescents were Chilblain-like lesions, presented in 67.5% of the cases, followed by erythema multiforme-like (31.7%) and varicella-like lesions (0.8%). The Chilblain-like lesions appeared 7.6 days (95%CI 7.4-7.8) after the viral infection and lasted for 17.5 days (95%CI 16.5-18.5), erythema multiformelike lesions appeared in 9.5 days (95%CI 9-10) and lasted for 10.3 days (95%CI 9.1-11.5), and varicella-like lesions appeared in 12.3 days (95%CI 4-20.6) and lasted for 7 days. Conclusions: Knowledge of the different skin manifestations in children and adolescents with COVID-19 is essential for an early diagnosis and, consequently, the possibility of promptly care adoption as well as to interrupt the new coronavirus transmission chains in the current pandemic context.

5.
British Journal of Dermatology ; 186(6):e255, 2022.
Article in English | EMBASE | ID: covidwho-1956699

ABSTRACT

A 13-year-old boy presented with oral pain and mucositis on a background of preceding sore throat, fever and malaise. His lips were swollen and ulcerated with tonsillar exudate visible. Reverse transcriptase polymerase chain reaction testing for SARS-CoV-2 was positive, and inflammatory markers were raised (C-reactive protein 77 mg L-1, erythrocyte sedimentation rate 31 mm h-1);additional virology (herpes simplex virus, cytomegalovirus, Epstein-Barr virus and HIV) was negative. Intravenous fluids, ceftriaxone, acyclovir and analgesia including morphine were commenced. He was unable to tolerate soluble oral steroid rinses. Over 24 h, his oral mucositis progressed with the additional development of conjunctival injection and nontargetoid, erythematous papules. A diagnosis of erythema multiforme (EM) major in conjunction with COVID-19 infection was made. His condition deteriorated with oral intubation required to maintain airway patency and deep sedation for pain control. During a 13-day paediatric intensive care admission he developed an extensive rash including ulceration of the external genitalia. There was marked ulceration of the trachea but fortunately tracheostomy was avoided. The patient has subsequently recovered well. A variety of cutaneous features, including EM, have been described in conjunction with COVID-19 infection. The incidence of distinct rashes varies between adults and children with EM uncommon in both groups but seemingly more frequent in paediatric patients (Bennardo L, Nistoc®o SP, Dastoli S et al. Erythema multiforme and COVID-19: what do we know? Medicina (Kaunas) 2021;57: 828). The relationship of EM to outcome from COVID-19 infection itself is yet to be fully established. As with other infections, EM in children with COVID-19 exhibits a range of clinical presentations. This case highlights the severe end of the disease spectrum and underlines the role of the multidisciplinary team in management.

6.
Neuro-Oncology ; 24:i166, 2022.
Article in English | EMBASE | ID: covidwho-1956581

ABSTRACT

INTRODUCTION: Unplanned reoperations and mortality within 30 days are important indicators when evaluating the quality of care provided by surgical systems. We reviewed these outcomes among children with primary central nervous system (CNS) tumors treated during the COVID- 19 pandemic. METHODS: This is a retrospective study of all pediatric patients who underwent neurosurgery for primary CNS tumors at the Philippine General Hospital, the national university hospital, from January 1, 2020 until December 31, 2021. Their clinical presentation, perioperative course, and outcomes were analyzed. During this time, our hospital concurrently served as a COVID-19 referral center, thus, the workforce was restructured, and resources were reallocated to care for COVID-19 patients. RESULTS: A total of 92 pediatric patients with CNS tumors underwent 140 neurosurgical operations during the study period. Two-thirds of the patients were males, and mean age was 9.3 ± 5.0 years (range: 3 months to 18 years). Average preoperative length of stay was 3.9 ± 2.6 days. Tumor resection was performed in 73 patients (79%). Most common histologic diagnoses were medulloblastoma (20%) and low-grade glioma including pilocytic astrocytoma (20%). Overall, the 30-day mortality and unplanned reoperation rates were 12% and 22%, respectively. Eight patients died from brain herniation and/or tumor progression. Reasons for unplanned reoperations were postoperative hydrocephalus (20%), infection (9%), hematoma (7%), and tumor residual (3%). DISCUSSION: Worldwide, the COVID-19 pandemic has altered hospital protocols and shifted resources considerably. The observed high rates of death and reoperation are likely due to delays in seeking care leading to worse neurologic status at presentation, delays in performing essential surgery within the hospital, and shortage of health workers providing specialist care. It is important to periodically assess perioperative outcomes to improve the quality of surgical care given to children with CNS tumors, who remain a vulnerable population during the COVID-19 pandemic.

7.
Neuro-Oncology ; 24:i166, 2022.
Article in English | EMBASE | ID: covidwho-1956580

ABSTRACT

INTRODUCTION: Central nervous system (CNS) tumors account for 20 - 30% of all childhood cancers. The Philippines is a lower-middle income country, wherein brain centers are located mostly in urban areas. We aimed to identify challenges that pediatric patients with CNS tumors encountered during the COVID-19 pandemic, which aggravated delays in their diagnosis and treatment. METHODS: This is a retrospective review of all pediatric patients who underwent neurosurgery for CNS tumors at the Jose R. Reyes Memorial Medical Center, a tertiary referral center, from January 2020 until December 2021. We summarized patients' demographic data, clinical course, and perioperative outcomes. RESULTS: A total of 38 pediatric patients underwent neuro-oncologic surgery in our center during the study period. There were 18 males and 20 females, with a mean age of 7.5 ± 4.9 years. Tumor was biopsied and/or resected in 35 cases (92%). The most common histologic diagnoses were medulloblastoma (n=8, 21%) and high-grade glioma/glioblastoma (n=5, 13%). Median preoperative length of stay and total length of stay were 10 (IQR: 17) and 28 (IQR 33.75), respectively. There was a high perioperative mortality rate in 2020 (71%), but this decreased to 20% in 2021. Six patients (16%) developed COVID-19 infection during the perioperative period. There were nine patients (24%) who had documented tumor progression because of delays in adjuvant therapy. DISCUSSION: Aside from geographic barriers and catastrophic health expenditure, the major challenges that disrupted the care of pediatric patients with CNS tumors in our center during the COVID-19 pandemic were delays in neuroimaging for diagnosis, unavailability of operating room slots, deficiency in critical care beds, and workforce shortage due to COVID-19 infection among health workers. Health care systems must adapt to the changes brought about by the pandemic, so that children with CNS tumors are not neglected.

8.
Neuro-Oncology ; 24:i165, 2022.
Article in English | EMBASE | ID: covidwho-1956579

ABSTRACT

INTRODUCTION: A multidisciplinary team (MDT) approach is essential for quality cancer care. Since 2019, we have conducted regular MDT meetings to discuss pediatric patients with central nervous system (CNS) tumors at the Philippine General Hospital. Because of COVID-19, an abrupt transition from in-person to virtual meetings became necessary. METHODS: We reviewed the proceedings of MDT meetings for pediatric CNS tumors from March 2020-December 2021. We identified the strategies and adaptations of our pediatric neuro-oncology group, and outlined recommendations for other institutions in low- and middle-income countries. RESULTS: Our pediatric neuro-oncology group conducted 18 virtual MDT meetings during the study period. Meetings were scheduled every last Tuesday of the month, with pediatric oncologists, neurologists, neurosurgeons, radiation oncologists, radiologists, and neuropathologists regularly attending. We invited other specialists as needed. In total, we had 135 case discussions for 79 unique patients, or about 8 patients per meeting. These included both inpatients (74%) and outpatients (26%). Ten patients received prior treatment elsewhere. At the time of the meeting, 86% were postoperative, 8% were preoperative, and 6% did not require surgery. Most (60%) had malignant CNS tumors and 15% had disseminated/leptomeningeal disease. Histopathologic diagnosis was obtained for 62 patients (79%). Concerns addressed were: formulating a treatment plan (88%), surveillance strategy (10%), and diagnostic workup (5%). DISCUSSION: Several factors contributed to the ease of online transition: (1) motivated care providers including a patient navigator, (2) fixed schedule, (3) institutional Zoom account for securing data privacy, and (4) availability of picture archiving and communication system (PACS) for neuroimaging. Challenges included: (1) delays due to internet connectivity, (2) Zoom fatigue and online distractions, and (3) risk for miscommunication or misunderstanding. Commitment of the entire neuro-oncology team is essential to ensure the delivery of best possible care for pediatric patients with CNS tumors.

9.
Neuro-Oncology ; 24:i149, 2022.
Article in English | EMBASE | ID: covidwho-1956577

ABSTRACT

Primary central nervous system (CNS) tumors are a leading cause of death and disability amongst pediatric cancer patients. The early identification of symptom onset is critical in preventing diagnostic delays. In 2018, Akron Children's Hospital published data on our response time to brain tumor diagnosis and launched educational programs in an effort to decrease diagnostic delays. The goal was to reduce the total diagnostic interval (TDI) in our patient population and reduce tumor- and treatment-related morbidities for these patients. Our post intervention group (2018-2021) was drastically affected by the numerous hospital changes secondary to the COVID-19 pandemic. We sought to examine the impact of COVID-19 related changes on TDI and attempted to identify groups at potential increased risk for diagnostic delays due to the unique pandemic constraints. A retrospective chart review was performed on patients at Akron Children's Hospital to evaluate both for pre- (diagnosed Jan 1, 2018-February 29, 2020) and post- COVID-19 (diagnosed Mar 1, 2020-June 8, 2021) groups. Both subsets were evaluated statistically and were similar in all respects including demographics, symptomatology, tumor location, tumor type, and survival. The pre-COVID-19 group demonstrated a median TDI of 43.5 days, while the post-COVID-19 group demonstrated a 30-day median. The TDI for low-grade lesions increased from 32 to 59 days and for high-grade lesions decreased from 60 to 27.5 days in the post-pandemic cohort. Overall, this demonstrates a maintained average time to diagnosis for patients despite the pandemic restrictions in place. In addition, the differences in low vs. high-grade lesions suggest that tumors with a more subtle onset of symptoms were disproportionately affected, and highlight a population for intervention during the continued pandemic.

10.
Neuro-Oncology ; 24:i145, 2022.
Article in English | EMBASE | ID: covidwho-1956576

ABSTRACT

INTRODUCTION: Surgery in patients diagnosed with COVID-19 is associated with increased risk of morbidity and mortality, especially within 6 weeks of SARSCoV- 2 infection. Furthermore, most studies have focused on adults, and little is known about perioperative outcomes in children with COVID-19. METHODS: We reviewed the operative census of the Division of Neurosurgery of Philippine General Hospital from March 2020 until December 2021. We identified all pediatric patients with brain tumors and confirmed COVID-19 infection within two weeks of their neuro-oncologic surgery. Their clinical course and outcomes are described herein. RESULTS: Four patients were included in this case series: three had tumors in the cerebellum, one in the pineal region. All of them were boys, with ages ranging from 4 months to 13 years. All tumors were malignant, and two were confirmed to be medulloblastoma after tumor resection. COVID-19 infection was diagnosed by the presence of SARS-CoV-2 RNA through a nasopharyngeal swab. Three patients acquired the virus post-operatively, likely from nosocomial transmission. In the remaining patient, it was community-acquired. All the patients had chest radiographs consistent with pneumonia but none had marked elevation of serum inflammatory markers. No patient received remdesivir or tocilizumab. At the time of their presentation, either the COVID-19 vaccine was not yet available in the country, or the patient was not yet eligible for vaccination. One patient died because of brain herniation from tumor progression, two were discharged and eventually underwent adjuvant therapy, and one remained in-hospital as of this writing. DISCUSSION: COVID-19 infection resulted in delays in the management of patients with pediatric CNS tumors. Given the high risk of these patients for potential complications, consensus guidelines must be established to achieve good outcomes and prolong survival.

11.
Neuro-Oncology ; 24:i74-i75, 2022.
Article in English | EMBASE | ID: covidwho-1956572

ABSTRACT

INTRODUCTION: High-grade gliomas account for <5% of all pediatric brain tumors with a 20% 5-year overall survival even with maximal safe resection followed by concurrent radiotherapy and chemotherapy. Patients in low-and middle-income countries already face delays and barriers to the treatment they require. The current COVID pandemic has added unique challenges to the delivery of complex, multidisciplinary health services to these patients. METHODOLOGY AND RESULTS: We retrospectively reviewed the records of four patients, ages 2-18 years old, with histologically confirmed high-grade glioma managed in a tertiary government institution from 2020-2021. Three of the patients had a supratentorial tumor and one patient had multiple tumors located in both supra-and infratentorial compartments. Neurosurgical procedures performed were: gross total excision (1), subtotal excision (2), and biopsy (1). The tissue diagnoses obtained were glioblastoma (3) and high-grade astrocytoma (1). Two patients survived and are currently undergoing adjuvant radiotherapy and chemotherapy. The remaining two patients expired: one from hospital-acquired pneumonia and the other from COVID-19 infection. DISCUSSION: Decreased mobility due to lockdowns, the burden of requiring negative COVID-19 results before admission for surgery, reduced hospital capacity to comply with physical distancing measures, the postponement of elective surgery to minimize COVID-19 transmission, physician and nursing shortages due to infection or mandatory isolation of staff, cancellation of face-to-face outpatient clinics, and hesitation among patients and their families to go to the hospital for fear of exposure were found to be common causes of delays in treatment. Also, the redirection of health resources and other government and hospital policies to handle the COVID-19 pandemic resulted in an overall delay in the delivery of health services. In particular, the management of pediatric patients with cancers, especially high-grade gliomas, was significantly disrupted.

12.
Journal of Pediatric Infectious Diseases ; 2022.
Article in English | EMBASE | ID: covidwho-1956443

ABSTRACT

Objective: Multisystem inflammatory syndrome in children (MIS-C) is a hyperinflammatory syndrome associated with multiorgan damage that occurs following coronavirus disease 2019 (COVID-19). Research on clinical and laboratory findings, and imaging studies, aiming to predict the progression to severe disease state is limited. This study recruited patients with MIS-C who presented with mild or severe symptoms from a single center in Turkey and evaluated factors related to their symptoms. Methods: This retrospective study included 25 pediatric patients with mild and severe presentations of MIS-C. We explored the differences in demographic and clinical data on clinical severity to understand their possible diagnostic and prognostic values. Results: Patients with MIS-C had cardiovascular symptoms (68%), gastrointestinal symptoms (64%), dermatologic/mucocutaneous findings (64%), lung involvement (36%), and neurological symptoms (16.0%). About 45.1% of patients with MIS-C had manifestations that overlapped with Kawasaki disease. Eleven patients (44%) were admitted to the intensive care unit, and one (4%) patient died. Grouping based on clinical severity did not differ statistically in terms of gender, age, height, weight, body mass index, and duration of hospital stay. Procalcitonin and ferritin levels correlated with disease severity. The receiver operating characteristic curve for D-dimer gave the highest value of area under the curve, among other biomarkers. The cutoff value for D-dimer was determined as more than 6780. Conclusions: Although COVID-19 is usually mild in children, some can be severely affected, and clinical severity in MIS-C can differ from mild to severe multisystem involvement. This study shows that procalcitonin, ferritin, and D-dimer levels may give us information about disease severity.

13.
Journal of Pediatric Infectious Diseases ; 2022.
Article in English | EMBASE | ID: covidwho-1956442

ABSTRACT

Objective Vitamin D has many immune benefits and because its deficiency impacts most age groups, it became a nutrient of interest in the coronavirus disease 2019 (COVID-19) era. The objective of this study was to highlight the contribution of vitamin D status to the disease severity of hospitalized pediatric patients suffering from COVID-19 infection. Methods This was a cross-sectional study that was conducted on 42 children with documented positive polymerase chain reaction for COVID-19 infection. Detailed history taking and thorough clinical examination were done for each recruited patient. Besides the laboratory and radiological assessment done for COVID-19 patients, 25 hydroxy vitamin D levels [25(OH) D] in the serum were estimated using enzyme linked immunosorbent assay. Results Using the cutoff level of 10 ng/mL, only 40% of the patients were below this level and 60% had their vitamin D level more than or equal to 10 ng/mL. Significantly more patients of the first group needed oxygen support (denoting more severe COVID-19 infection and lung involvement). The older the patients, the more evident was vitamin D deficiency among them, and 25(OH) D values were not correlated to weight for length nor weight categories in the studied series of patients suffering from COVID-19. Conclusion Vitamin D deficiency affects the severity of pediatric COVID-19 infection in hospitalized patients. It is prudent to advise vitamin D level assessment in such cases and promptly manage the patients accordingly. We recommend further studies to assess the effect of vitamin D supplementation on the clinical outcome of COVID-19 in the pediatric population and other vulnerable groups.

14.
Respir Med Case Rep ; 37: 101655, 2022.
Article in English | MEDLINE | ID: covidwho-1946477

ABSTRACT

Mucormycosis is a rare, potentially life-threatening disease that is growing during the Covid-19 pandemic. This study reports a case of an 11-year-old patient with fatal Covid-19-related pulmonary mucormicosis and diabetes mellitus with ketoacidosis. The diagnosis was set post mortem. It was based on histochemical detection of the causative agent. Massive hemoptysis due to erosion of a large pulmonary vessel caused mechanical asphyxia and lethal outcome. Pulmonary mucormycosis may be highly suspected in patients with long-term Covid-19, poorly controlled diabetes mellitus with ketoacidosis, and corticosteroid therapy. Early diagnosis and treatment with Amphotericin B are potentially curative options for this invasive fungal infection and can led to better outcome.

15.
Supportive Care in Cancer ; 30:S136-S137, 2022.
Article in English | EMBASE | ID: covidwho-1935785

ABSTRACT

Introduction Child Life Specialists (CLS) cannot support pediatric cancer patients (PCPs) in hospitals during COVID-19 to minimize infection risk. We have recently developed an out-of-hospital radiotherapy (RT) preparatory workshop for PCPs and their carers, providing multidisciplinary support before the actual radiation treatment. Methods 6 PCPs were referred by the Hong Kong Children's Cancer Foundation (Table 1). RT undergraduates and practising radiotherapists hosted individualized, 2-hour simulation workshop for PCPs with a theme featuring PCP's favorite game or cartoon character. The Virtual Environment for Radiotherapy Training system realistically mimics the RT environment. The workshop included treatment preparation and delivery simulation to improve PCP's compliance with daily RT. Carer's queries were addressed by our professional workers. Evaluative questionnaires were given to participating families and CLS, with 6 questions to assess if the workshop addressed the needs of relevant stakeholders. Results The carers opined that the workshops eased their concerns and helped PCPs comply with daily RT (Figure 1). The CLS found the workshop was as effective as hospital visits, and should be continued after COVID19 (Table 2). The workshop allowed more time and multidisciplinary resources than hospital visits. Conclusions The proposed workshop provides better support for PCPs and their carers compared to conventional in-hospital counseling and should be recommended as a standard service provision beyond COVID-19.

16.
Iranian Journal of Pharmaceutical Research ; 21(1), 2022.
Article in English | EMBASE | ID: covidwho-1939347

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) affects the pediatric population. Objectives: Due to limited data, this study aimed to evaluate the safety and efficacy of favipiravir in the hospitalized pediatric population diagnosed with COVID-19. Methods: The present retrospective cohort study was conducted on pediatric patients aged 1-18 years with a diagnosis of COVID-19 admitted to Mofid Children’s Hospital, Tehran, Iran. Favipiravir was administrated at a dose of 60 mg/kg/day (max: 3200 mg/day) on the first day and then 23 mg/kg/day (max: 1200 mg/day) for 7 to 14 days. The patients were evaluated regarding the need for invasive mechanical ventilation, intensive care unit admission, duration of hospital stay, and mortality. Safety was measured by the occurrence of related adverse drug reactions (ADRs). Results: A total of 95 patients were included in the study. Favipiravir was administered to 25 patients. The need for invasive mechanical ventilation was reported in 4 (16.00%) and 11 (15.71%) patients in the favipiravir and control groups, respectively (P = 1.000). The median duration of hospital stays was significantly higher in patients who received favipiravir than in the controls (P = 0.002). No difference was observed in the mortality rate (P = 0.695). The ADRs, including decreased appetite, hypotension, and chest pain, were more prevalent in patients who received favipiravir than in the controls (P < 0.05). Conclusions: The administration of favipiravir in the pediatric population is associated with higher ADR occurrence with no pos-itive effect on the need for invasive mechanical ventilation, hospital stay, and mortality. Further randomized controlled trials are necessary for better judgment.

17.
Journal of Comprehensive Pediatrics ; 13(2), 2022.
Article in English | EMBASE | ID: covidwho-1939346

ABSTRACT

Background: Depending on the level of care and the availability of pediatric intensive care unit (PICU) facilities, the mortality rate of acutely ill children varies in PICUs. Referral of patients from other medical centers, admission during working or off-work hours, and nosocomial infections are the most important risk factors for the high mortality rates in PICUs. Objectives: The present study aimed to investigate the characteristics and factors related to the risk of mortality in pediatric patients admitted to the PICU of a pediatric hospital in Qazvin, Iran. Methods: This cross-sectional study was performed on children admitted to the PICU of a pediatric hospital in Qazvin, Iran, between June 2017 and June 2020. During this period, a total of 1504 children, aged one month to 13 years, were admitted to the PICU, and 106 cases expired. The patients’ clinical data (ie, demographic characteristics, underlying disease, cause of death, and length of hospital stay) was extracted from their medical records. A prolonged length of stay was defined as more than 28 days of PICU admission. Results: A total of 106 children, with a mean age of 3.89 ± 3.23 years, expired during the study, with 41 (38.7%) cases being male. Among the investigated cases, 61 (57%) were < 2 years, 18 (17%) were 2 - 5 years old, and 27 (26%) were ≥ 6 years. In these patients, sepsis (13/82, 15.85%) and pneumonia (10/82, 12.19%) were the main causes of death. Other mortalities (14/106) were due to infectious diseases (gastroenteritis, influenza, and coronavirus disease) and non-infectious diseases (aspiration, anaphylaxis, and electrocution). The majority of children with a prolonged length of stay were < 2 years (17/23, 74%). The length of PICU stay was shorter in children with a lower weight percentile (P = 0.016). Conclusions: Following infectious diseases, congenital abnormalities and genetic disorders were the most common causes of pediatric mortality. Chronically ill children were more likely to be underweight and develop nutritional disorders, leading to the deterioration of their condition.

18.
Open Access Macedonian Journal of Medical Sciences ; 10:1473-1478, 2022.
Article in English | EMBASE | ID: covidwho-1939108

ABSTRACT

BACKGROUND: Kidney manifestations are life-threatening conditions, such as end-stage kidney disease, notably when caused by viral infections. The severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), is an emerging global health problem, potentially affecting all organs, including the kidney. Most reports on kidney manifestations were focused on the adult and elderly population but limited on children. AIM: This study aims to analyze the association between kidney function and the severity of the disease of pediatric patients suffering from COVID-19. METHODS: From March 2020 to March 2021, an observational analytic study was conducted in Hasan Sadikin General Hospital, Bandung, Indonesia. The demographic data, clinical signs, laboratory results, and notable kidney function were analyzed, and based on its clinical appearance the disease was classified as severe and non-severe. Subsequently, the Mann–Whitney test for nonparametric was used to analyze the collected data. RESULTS: In this study, 40 COVID-19 children were selected as the subjects, and the median estimated glomerular filtration rate (eGFR) value in the severe group was discovered to be lower (88.2 mL/min/1.73 m2) compared to the non-severe (124.4 mL/min/1.73 m2), it was statistically significant (p = 0.041). There was no difference in hemoglobin and leukocyte values between the two groups (p > 0.05). Furthermore, the CRP and NLR results showed no difference between the groups (p > 0.05). CONCLUSION: A severe SARS-CoV-2 infection correlates with kidney function, which was manifested by a lower median eGFR value in the severe compared to the non-severe group.

19.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1938375

ABSTRACT

Background: Chest radiographs are frequently used to evaluate pediatric patients with COVID-19 infection during the current pandemic. Despite the minimal radiation dose associated with chest radiography, children are far more sensitive to ionizing radiation's carcinogenic effects than adults. This study aimed to examine whether serum biochemical markers could be potentially used as a surrogate for imaging findings to reduce radiation exposure. Methods: The retrospective posthoc analysis of 187 pediatric patients who underwent initial chest radiographs and serum biochemical parameters on the first day of emergency department admission. The cohort was separated into two groups according to whether or not the initial chest radiograph revealed evidence of pneumonia. Spearman's rank correlation was used to connect serum biochemical markers with observations on chest radiographs. The Student's t-test was employed for normally distributed data, and for non-normally distributed data, the Mann–Whitney U test was used. A simple binary logistic regression was used to determine the importance of LDH in predicting chest radiographs. The discriminating ability of LDH in predicting chest radiographs was determined using receiver operating characteristics (ROC) analysis. The cut-off value was determined using Youden's test. Interobserver agreement was quantified using the Cohen k coefficient. Results: 187 chest radiographs from 187 individual pediatric patients (95 boys and 92 girls;mean age ± SD, 10.1 ± 6.0 years;range, nine months–18 years) were evaluated. The first group has 103 patients who did not have pneumonia on chest radiographs, while the second group contains 84 patients who had evidence of pneumonia on chest radiographs. GGO, GGO with consolidation, consolidation, and peri-bronchial thickening were deemed radiographic evidence of pneumonia in group 2 patients. Individuals in group 2 with radiological indications of pneumonia had significantly higher LDH levels (p = 0.001) than patients in group 1. The Spearman's rank correlation coefficient between LDH and chest radiography score is 0.425, showing a significant link. With a p-value of < 0.001, the simple binary logistic regression analysis result validated the relevance of LDH in predicting chest radiography. An abnormal chest radiograph was related to LDH > 200.50 U/L (AUC = 0.75), according to the ROC method. Interobserver agreement between the two reviewers was almost perfect for chest radiography results in both groups (k = 0.96, p = 0.001). Conclusion: This study results show that, compared to other biochemical indicators, LDH has an 80.6% sensitivity and a 62% specificity for predicting abnormal chest radiographs in a pediatric patient with confirmed COVID-19 infection. It also emphasizes that biochemical measures, rather than chest radiological imaging, can detect the pathogenic response to COVID-19 infection in the chest earlier. As a result, we hypothesized LDH levels might be potentially used instead of chest radiography in children with COVID-19, reducing radiation exposure.

20.
Sleep ; 45(SUPPL 1):A231-A232, 2022.
Article in English | EMBASE | ID: covidwho-1927417

ABSTRACT

Introduction: CPAP Adherence in children with OSA is often sub-optimal and there is concern for worsening during the COVID-19 pandemic. Although telehealth has been used in sleep clinics during the pandemic, there is little known about telemedicine's effectiveness in specialized care. The purpose of this study is to compare CPAP adherence and related outcome metrics in pediatric OSA patients seen before and during the COVID-19 pandemic and between those seen in person and by telemedicine. Methods: This retrospective cohort consisted of patients who were diagnosed with OSA, prescribed CPAP, and were seen in a CPAP clinic between 1/1/2018 and 9/31/2021. CPAP adherence data and outcome metrics including the Epworth Sleepiness Scale (ESS), Michigan Sleep-disordered Breathing (PSQ) and Pediatric Quality of Life questionnaires (Ped-QOL) were collected. Only patients with one pre-pandemic and at least one post-pandemic visit were included. All variables were reported as mean± SD. Statistical comparison was performed using the mixed-effects model. Results: 147 patients met criteria with 353 total visits. 147 were before the pandemic (pre) and 206 were during the pandemic (post). Demographic data indicated 57% male, 82% white, and 63% 12 years and older. Post-pandemic visits consisted of 78% telemedicine. Comparison between pre and post pandemic data demonstrated no statistically significant differences in % CPAP usage>4hrs (71±31% [pre] vs 73±33% [post], p=0.95), ESS (6.4±5.5 [pre] vs 5.9±5.8 [post], p=0.27), or PSQ (0.38±0.22 [pre] vs 0.36±0.22 [post] p=0.90). However, there was a significant difference in Psychosocial Health domain of Ped-QOL (68.6±19.4 [pre] vs 74.5±17.9 [post], p=0.012). Comparison between telemedicine and in-person visits during the pandemic showed no differences in %CPAP usage>4hrs (73±31% [Tele] vs 73±37%, p=0.73), ESS, PSQ, or Ped-QOL. Conclusion: In our cohort, children with OSA had no significant changes in CPAP adherence, sleepiness, or OSA symptoms during the COVID-19 pandemic. CPAP telehealth visits provided the same effectiveness as in-person visits, as evidenced by similar adherences and outcome metrics. Interestingly, patients reported higher psychosocial health during the pandemic despite no difference in CPAP adherence. Factors not related to OSA management may contribute to the improvement of quality of life in this population.

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