MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN COURSE AMID COVID-19 PANDEMIC IN THE REBUBLIC OF BELARUS (preprint)

Resume. In first two years of COVID-19 pandemic, children usually had a mild or asymptomatic form of the disease. However, in rare cases, after suffering COVID-19, children had clinical manifestations similar to incomplete Kawasaki Disease (CD) or toxic shock syndrome. This condition is known as multisystem inflammatory syndrome in children (MIS-C). The purpose of this research was to study clinical and laboratory features and outcomes of multisystem inflammatory syndrome in children who were hospitalized during COVID-19 pandemic. Materials and methods. In 19 months (May 2020 - December 2021) 63 patients with a diagnosis of Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 were observed in the departments of Anesthesiology and Intensive Care of the Healthcare Institution "City Children's Infectious Clinical Hospital" in Minsk, Republic of Belarus. MIS-C was diagnosed on criteria of CDC/WHO, 2020. All calculations were carried out in the statistical package R, version 4.1. The results of the analysis were considered statistically significant with p<0,05. The results of the study. All of 63 children with MIS-C didnt have an acute coronavirus infection. Therefore, it was impossible to determine which strain of SARS-CoV-2 patient exactly had. However, we formed 3 groups of patients based on circulation of the dominant strain of SARS-CoV-2 in Belarus at different times. The 1st group included 40 patients (63,5%) received treatment from 05.25.2020 to 02.21.2021 ("wuhan strains"); the 2nd group - 9 children (14,3%) from 02.23.2021 to 06.13.2021 ("alpha"); the 3rd group - 14 children (22,2%) from 07.01.2021 to 11.19.2021 ("delta"). 47 (74,6%) patients had complete and incomplete Kawasaki Disease phenotype of MIS-C. Nonspecific phenotype was observed in 16 (25,4%) children. It manifested as signs of shock. The mean age didnt differ in study groups. All children had hyperthermic syndrome. Fever reached febrile numbers 3-4 times a day. Average fever duration was 3,2 [1-15] days. The course of MIS-C in children also didnt depend on the circulating strain of the virus. For instance, gastrointestinal dysfunction was observed in all three groups with equal frequency (73%, 78% and 57%, respectively). The only a statistically significant increase was in the number of children with cheilitis. In the 2nd group 8 children (89%) and the 3rd group 13 children (93%) had cheilitis, respectively, p=0,002. Neurological disorders such as headache, hyperesthesia, hallucinations, photophobia were more often observed in the 1st group of children - 19 (48%) cases and less frequently in the 2nd and 3rd group (in 11% and 14% of cases), p=0,022. Pathological blood flow regurgitation was the most common disorder (68-71%). Several biochemical markers of inflammation levels, such as C-reactive protein (CRP) and procalcitonin (PCT), were high. CRP levels were 162 mg/l [130; 245]; 130 mg/l [90; 160]; 130 mg/l [106; 149] in 3 study groups, respectively. In children of the 1st group CRP level was significantly higher, p=0.052. PCT level was higher in patients of the 3rd group (4.2 ng/ml [2,4; 8,8]; 3.9 ng/ml [3,2; 11,9]; 8.7 ng/ml [3,4; 14,1], p=0.625). Conclusion. As a result of the research there wasnt found notable connection between clinical or laboratory features of MIS-C and the dominant circulating strain of SARS-CoV-2 in given time periods. During the circulation of "alpha" and "delta" strains, the only significant differences were decrease of the number of patients with neurological disorders and increase in the frequency of cheilitis, p=0,002. The remaining indicators of organ dysfunction were similar in three groups of children. There was 1 (1,6%) fatal outcome in our study.

Allergic contact cheilitis caused by propolis: case report.

Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.

Comparative evaluation of oral lesions: Tale - the Covid 19 Tells (preprint)

Abstract: Introduction & Objectives: The COVID-19 pandemic has been raging across the globe since early January 2020. India has reported over 27 million cases and more than 3, 00,000 deaths. This study was planned to analyze the differences in demographic, clinical features, and oral manifestations of COVID 19 patients hospitalized during the COVID-19 pandemic. Methods: This observational pilot study had a total of 36 participants, 12 each of mild, moderate, and severe RT-PCR positive COVID cases hospitalized during the COVID 19 pandemic. All demographic, clinical features, treatment details, and oral manifestations were noted from the first day of admission to the hospital till treatment completion with a follow-up of a minimum of 7 days. Results: Mean age of the patients was 39.44 years with M: F ratio of 5:4. Most common clinical presentation was fever, shortness of breath, and treatment involved was symptomatic with supplemental oxygen & mechanical ventilation. The most common oral site involved was the tongue & oral lesions observed were herpes labialis, mucositis, burning sensation, dryness of oral cavity, angular cheilitis, aphthous ulcers, geographic tongue, fissuring of the tongue, candidiasis, coated tongue, sublingual varicosity, & scalloped tongue. Interpretation and Conclusion: All demographic, clinical, and oral manifestations were significantly different in mild, moderate, and severe cases of covid hospitalized patients. Though clinical symptoms were improved, oral lesions were worsened. Oral Lesions seen in covid patients were associated with multiple drug therapy for illness along with poor oral hygiene, but further etiology for lesions needs to be evaluated. Sublingual varicosity was observed in our hospitalized covid patients, but a large sample observation is required for confirmation of findings and maybe an early oral feature for covid detection. Prevention is always better than cure, so all patients positive for Covid should have a full mouth examination. Oral health should be a priority during the overall management of COVID patients and dentists should be a part of the Covid management team. Key Words: Oral Lesions, COVID 19, Sublingual varicosity, Candidiasis, Tongue.

COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis.

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: ("novel coronavirus" Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.