Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793840

ABSTRACT

Introduction: Timeliness of diagnosis and treatment of MIS-C has increased amid the COVID-19 pandemic. Methods: A child was admitted to our clinic (male, 14 years old). He was in contact with a COVID-19 patient 17 days before. Upon admission, the patient complained of a rise in body temperature to 40° C, abdominal pain, vomiting, and diarrhea. Hemorrhagic rash on the skin of the upper and lower extremities, hyperemia of the mucous membrane of the lips and tongue, arterial hypotension were found. Hospitalized at ICU. In laboratory tests: WBC 3.42 × 109/ l, RBC 4 × 1012/ l, HB 111 g/l, HTC 31, PLT 31 × 109/ l, CRP 283 mg/l, PCT 6.66, D-dimer 9.2, LDG 194 U/l, ferritin 989 mcg/l, ALT 54 U/l, GGT 79 IU/l, albumin 32 g/l;proteinuria 0.75 g\l, hematuria. Diagnosis: MIS-C associated with COVID-19. Results: Prescribed: Meropenem 20 mg/kg/d, methylprednisolone 2 mg/kg/d. After 8 h-septic shock. 0.3 μg/kg/min norepinephrine was started. ECG-a violation of repolarization with ST elevation up to 0.3 mm. Echocardiography-a decrease in the left ventricular ejection fraction to 47%, pericardial effusion. Ultrasound examination of the abdominal cavity: hepatosplenomegaly. Dobutamine 3 μg/kg/min was added to the therapy. An increase in PCT up to 19.8 was found. IV IgG 2 g/kg was added to the therapy. On the 3rd day of therapy, regression of all symptoms was obtained. On the 8th day, the child was transferred from the ICU to the pediatric department. On the 12th day he was discharged home. Conclusions: Thus, the timely diagnosis of MIS-C associated with COVID-19 and the appointment of intensive therapy with the inclusion of methylprednisolone and IV IgG allows achieving a positive result in the shortest possible time. Consent to Publish: Written informed consent was obtained from the next of kin.

2.
Journal of Cystic Fibrosis ; 20:S109, 2021.
Article in English | EMBASE | ID: covidwho-1735130

ABSTRACT

Objective: To explore the impact of COVID-19 on paediatric cystic fibrosis (CF) patient care.Method: A retrospective review of data on 20 CF patients between 1March - 30 November 2020 compared to data from 1 March - 30 November2019. This included: courses of oral antibiotics;days requiring intravenousantibiotics (IVAB);routine IVAB;home IVAB;face-to-face/phone appointments;acute hospital presentations;and microbiology samples.Results: In 2020 the number of courses of oral antibiotics for exacerbationsor bacteria growth decreased from 29 to 14;total IVAB days decreased from177 days to 107. 2 courses of routine IVAB were cancelled and 1 coursewaspostponed, home IVAB decreased from 125 days to 85 due to reducedaseptic IV services. Face-to-face appointments decreased from 76 appointmentsto 15. In 2019 no phone appointments were completed;in 2020there were 51. 10 patients presented to Paediatric Observation andAssessment Unit in 2019;this halved to 5 in 2020. Microbiology samplesnearly halved from 276 to 141 samples.Conclusion: Oral antibiotic courses, IVAB therapy and acute hospitaladmissionswere reduced in 2020. This could be due to a number of reasonssuch as shielding, closure of the paediatric unit to house adult patients,reduced aseptic IV services, family reluctance to access care at a differenthospital or being hesitant to present to hospital due to increased infectionrisk. Microbiology samples are less practical to collect due to reduced faceto-face contacts. Some families may be apprehensive to drop samples at thehospital due to potential exposure to COVID-19. In 2020, most appointmentswerevia phone;this is a change from 2019. Due to the increased riskof cross-infection for CF patients, limiting hospital attendance is a majorstep in the right direction to improve care. Although changes can bebeneficial, it is important to recognise the limitations of reduced face-tofacepatient contact and consider family preferences of care delivery

3.
Safety and Health at Work ; 13:S196-S197, 2022.
Article in English | EMBASE | ID: covidwho-1677123

ABSTRACT

Introduction : The COVID-19 pandemic has focused attention on the challenges and risks faced by frontline healthcare workers (HCW). This study aimed to describe the quality of management of HCW affected by the COVID-19. Methods : This is a cross-sectional study enrolling all HCW of Farhat Hached Academic hospital who had been affected by COVID-19 during the period from september to December 2020. Results : During the study period, 27 HCW were affected with a mean age of 42.3 ±10 years and a ratio-sex of 0.25. The most represented category was nurses (33.3%) followed by technicians (26.1%). Gynecology department had the highest number of affected HCW (14.4%) followed by pediatric department and administration in 7.2% and 5.7% respectively. The mean of seniority was 14.5± 11 years. The majority of participants (97.4%) reported a medical care. Twelve HCW (4.5%) were hospitalized with an average length of hospital stay of 7.55 ± 6.12 days. The average length of sick leave was 18.68 ± 10.99 days. During the lockdown, 38.6% of HCW took care of their children without any external help. All of the HCW were supported by phone calls from colleagues in 88.4% of cases, the hierarchy in 67.4% of cases, occupational medicine in 60.3% of cases. Conclusion : The impact of COVID 19 is greater in HCW than in the general population. The affected staff should have a multidimensional management to avoid post covid sequelae in both physical and mental levels.

4.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617072

ABSTRACT

Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.

5.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617063

ABSTRACT

Background: Whilst the Irish Health Service Executive (HSE) currently recommends COVID-19 screening for all adult hospital admissions, current guidelines state that the screening of asymptomatic paediatric admissions is not necessarily required. However, clinically determining who requires testing can be difficult and subject to inter-carer variability. We sought to audit our acute admissions and swab results to determine rates of testing, characteristics of those being tested, and rates of positivity in a busy Irish tertiary paediatric unit. Methods: We reviewed the charts of 122 patients admitted acutely to our unit over the course of July 2021 to determine whether or not they had undergone COVID-19 screening using a nasopharyngeal PCR test and the clinical indication for testing. The clinical presentation of these admissions was analysed to try to determine positive predictive factors for COVID-19 screening and better streamline surveillance criteria. Results: A total of 122 admissions were analysed, with 74 (60.7%) having had a COVID-19 PCR test performed at the point of admission. Of these, 1 patient was found to be COVID-19 positive, giving an overall positivity rate of 0.8% amongst admissions analysed and 1.4% for admissions screened. The patient who returned a positive result was febrile at presentation but did not have any respiratory symptoms. Respiratory symptoms were documented for 45 of the 122 admissions (36.9%), and 42 of these underwent COVID-19 screening (93.3%). All swabs were negative. A total of 59 out of 122 were febrile at presentation, 55 (93.2%) of whom underwent screening. As above, 1 case tested positive. Of the afebrile patients, 19 out of 64 underwent COVID-19 screening. COVID-19 screening was performed in 12 patients who did not have a fever or respiratory symptoms at the time of presentation. In terms of non-respiratory presentations, screening was performed in 12 out of 14 (85.7%) presenting with gastritis/gastroenteritis, and 9 out of 12 (75%) presenting with a history and examination consistent with a UTI/pyelonephritis. Of 18 patients who were admitted with primarily psychiatric presentations, none had either a fever or respiratory symptoms at presentation, and none underwent COVID-19 screening. Conclusion: Our results reflect the existing data that COVID-19 appears to be less pathogenic in paediatric populations than in adult ones. Our low positivity rate compared to a high swab rate has repercussions in terms of bed allocation and isolation status. There is variation in terms of clinical criteria being viewed as sufficient to justify screening. Further study is required to determine consensus guidelines for COVID-19 surveillance in acute paediatric hospital admissions.

6.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e69-e71, 2021.
Article in English | EMBASE | ID: covidwho-1584141

ABSTRACT

Background Fever is a common presentation among children coming to the Emergency Department (ED) and a urinary tract infection (UTI) often needs to be excluded. Sterile techniques, like catheterization, are invasive, can be traumatizing to children, and are time consuming to complete. A two-step approach has been shown to reduce the catheterization rate in febrile, young children without unintended consequences. Objectives Our aim was to implement a two-step approach for UTI screening in febrile children 6-24 months in order to decrease unnecessary urine catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs). Design/Methods After engaging key stakeholders and a nursing champion, we created a process map to understand the current urine collection process in our ED, and areas for targeted improvement. Using the model for improvement, we adopted a 2-step pathway for a suspected UTI in children 6-24 months as our change idea. The pathway involved identifying children who met inclusion criteria for UTI screening, followed by urine bag application and urinalysis (UA) if clinically indicated. Only if the UA was positive, a second urine sample was collected via catheterization, for repeat UA and culture. Through multiple PDSA cycles, our pathway was implemented in the ED along with concurrent staff education. The outcome measure was the rate of ED urine catheterizations. Process measures included the total number of urine cultures sent to microbiology and percent positivity. The balancing measures included ED LOS and RVs. Results Since project initiation in July 2019, the ED catheterization rate decreased from 73% to 53% (Figure 1) and the number of urine cultures sent to Microbiology decreased by 23%. The number of urine cultures sent to Microbiology decreased by 23% with a mild improvement in the positivity rate by 2% (Figure 2). There was no significant change in RVs. There was a slight 10-min increase in ED LOS, most likely confounded by the COVID pandemic. Conclusion Using improvement methodology, we successfully decreased the number of unnecessary catheterizations in children and the number of urine cultures sent to microbiology. Further refinements to our intervention are ongoing and include optimizing urine screening equipment in patient rooms, poster reminders, re-education for providers, and introducing a parent resource explaining the 2-step pathway. This improvement work is also being spread to the paediatric wards and can easily be adopted by other paediatric centres. It has also been adapted by the Choosing Wisely hospital campaign.

7.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e88, 2021.
Article in English | EMBASE | ID: covidwho-1584135

ABSTRACT

BACKGROUND: Asthma in children and adolescents is a major cause of urgent visits and hospitalizations. In preschoolers, viral infections remain the main cause of these exacerbations, although environmental factors may also play a role. In older children and adolescents, many other risk factors are present including respiratory allergies, exercise, strong emotions, active and passive smoking and poor adherence to recommended treatments. In the context of the COVID-19 pandemic, clinicians have been concerned about the possibility of a significant increase in urgent consultations for asthma in children. However, due to the confinement imposed on a large part of the population from March 2020, we have suspected a reduction in the number of viral infections leading to urgent visits and hospitalizations in pediatric patients. OBJECTIVES: Our hypothesis was that the number of children hospitalized with asthma exacerbations during the pandemic lockdown declined significantly. Our objective was to determine if the number and severity of hospitalizations at the CME of the CHU de Québec for asthma exacerbations in children aged 1 to 17 had significantly decreased during the confinement period from April 1 to July 1, 2020 and to what extent, according to various clinical features. DESIGN/METHODS: Retrospective study reviewing episodes of care in medical records in children aged 1 to 17 and hospitalized on all wards at the CME-CHU de Québec. All patients with primary diagnosis of asthmatic exacerbation according to the summary sheets between April 1 to July 1, 2020 for the study group and from April 1 to July 1, 2019 for the control group were included. We aimed to determine the number of hospitalizations for this diagnosis for each period and determine the length of stay on the various pediatric wards for each episode of care according to the established criteria. We have determined the presence of risk factors (asthma diagnosis, underlying condition, regular asthma medication, allergies, and other factors relevant to asthma).We have further determined the presence of gravity markers during the course of hospitalization (need for: IV corticosteroids, Mg sulfate, IV bronchodilators, non-invasive ventilation, intubation, ICU stay and radiological pneumonia) for each episode of care. The data was denominated and collated in an encoded file, and shareable only between the investigators. RESULTS: After exclusions, a total of 97 charts were analyzed. Between April 1 and July 1 2019, a total of 89 patients were admitted with a diagnosis of asthma exacerbation while only eight patients were admitted during the same period in 2020. The median age of patients admitted in 2020 was higher than in 2019 (53 vs 25 months). In 2019, 40 children (48%) had a previous diagnosis of asthma, of whom 28 used regular controller medications compared to 2 children (25%) in 2020, both taking regular controller medications. More patients had an associated diagnosis of upper respiratory tract infection in 2019 than in 2020 (92% vs 63%). Nine patients required intensive care in 2019 compared to none in 2020. CONCLUSION: Compared to 2019, hospital admissions for asthma exacerbations in our tertiary care centre in Quebec City were significantly lower during the early phase of the 2020 pandemic. More research is required to determine the exact causes of this significant reduction.

8.
Przeglad Pediatryczny ; 49(2):24-28, 2020.
Article in Polish | EMBASE | ID: covidwho-1567728

ABSTRACT

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.

9.
Przeglad Pediatryczny ; 49(2):6-18, 2020.
Article in Polish | EMBASE | ID: covidwho-1567523

ABSTRACT

The guidelines outline the key principles for the medical management of children admitted to pediatric emergency department, emergency room and hospital without or with COVID-19 (caused by the SARS-CoV-2 virus). The guidance is based on a review of liter-ature published to date. The guidelines will evolve as we learn more about this infection. Most children will have mild symptoms – much milder than those seen in adults and will not have respiratory problems. Current evidence suggests that paediatric departments will not be at the frontline with the coronavirus, but they have a key role to play, which should be remembered and planned well.

SELECTION OF CITATIONS
SEARCH DETAIL