Gastrointestinal features of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in selected referral hospitals in Iran

Background and purpose: Multisystem Inflammatory Syndrome in Children (MIS-C) occurs after having COVID-19. The severity and outcomes of COVID-19 with gastrointestinal symptoms are higher. The aim of this study was to investigate gastrointestinal manifestations in MIS-C patients in selected referral hospitals in Iran to obtain comprehensive information about the treatment and prevention of MIS-C. Materials and methods: In this cross-sectional study, all MIS-C patients <21 years in Dec 2019 to Oct 2021 were included. The patients were identified by the Centers for Disease Control and Prevention (CDC) checklist and data were analyzed applying t-test and Chi-square in STATA11. Results: There were 225 patients with a median age of 55 months (26-96 months), including 59.56% boys and all had fever on admission. At least one gastrointestinal symptom was seen in 200 patients and the most common symptoms were vomiting (60.9%) and abdominal pain (45.77%). Almost 60% of the patients had positive RT-PCR results. Among the patients with and without gastrointestinal symptoms 85.5% and 48% were admitted to intensive care unit (ICU), respectively. There were significant differences between the two groups in respiratory symptoms, ALT, AST, NT-pro BNP, ESR, and PLT (P < 0.05). All patients without gastrointestinal symptoms were discharged but nine patients in the group with gastrointestinal symptoms deceased. Conclusion: According to the current study, gastrointestinal symptoms are common in MIS-C patients and are associated with higher rates of death and intensive care unit admission. Therefore, in providing services to COVID-19 patients, all typical and atypical signs and symptoms should be considered to prevent unnecessary interventions.

Gastrointestinal Features of the Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19 Infection in Selected Referral Hospitals in Iran

Background and purpose: Multisystem Inflammatory Syndrome in Children (MIS-C) occurs after having COVID-19. The severity and outcomes of COVID-19 with gastrointestinal symptoms are higher. The aim of this study was to investigate gastrointestinal manifestations in MIS-C patients in selected referral hospitals in Iran to obtain comprehensive information about the treatment and prevention of MIS-C. Materials and methods: In this cross-sectional study, all MIS-C patients <21 years in Dec 2019 to Oct 2021 were included. The patients were identified by the Centers for Disease Control and Prevention (CDC) checklist and data were analyzed applying t-test and Chi-square in STATA11. Results: There were 225 patients with a median age of 55 months (26-96 months), including 59.56% boys and all had fever on admission. At least one gastrointestinal symptom was seen in 200 patients and the most common symptoms were vomiting (60.9%) and abdominal pain (45.77%). Almost 60% of the patients had positive RT-PCR results. Among the patients with and without gastrointestinal symptoms 85.5% and 48% were admitted to intensive care unit (ICU), respectively. There were significant differences between the two groups in respiratory symptoms, ALT, AST, NT-pro BNP, ESR, and PLT (P<0.05). All patients without gastrointestinal symptoms were discharged but nine patients in the group with gastrointestinal symptoms deceased. Conclusion: According to the current study, gastrointestinal symptoms are common in MIS-C patients and are associated with higher rates of death and intensive care unit admission. Therefore, in providing services to COVID-19 patients, all typical and atypical signs and symptoms should be considered to prevent unnecessary interventions. © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Clinical Characteristics of a Group of Patients Confirmed with COVID-19 at a Hospital in Tehran, Iran: A Retrospective Case Report

Introduction: The present study examines clinical features of patients infected with the 2019 sever acute respiratory syndrome coronavirus 2(SARS-Cov-2) leading to the coronavirus disease 2019 (covid-2019) in Rasool Akram hospital, Tehran, Iran. Material(s) and Method(s): This was a retrospective case report performed at Rasool Akram hospital, Tehran, Iran. A total of 77 patients referred to the hospital with SARS-Covid-2 infection. Data of the present study has been collected from March 5th to April 5th 2020. Result(s): Intensive care unit (ICU) has admitted 20 patients out of 77 patients. Among this sample, 23 patients were infected with acute respiratory syndrome and the other 18 remaining passed away. The calculated mean age of the patients admitted to the ICU was 60.8, 18 out of whom had deceased. In our results, male patients outnumber female patients where male patients account for 62.33% and female patients account for 37.66% of the whole study population. The most frequent and usual sings of this disease first reported as respirational distress or dyspnea (54.54%), coughs (54.54%) and myalgia (25.97). Only 3.89% of the patients had chest pain or chest discomfort. The most common comorbidities among those patients taken in the ICU and or deceased were diabetes, cardiovascular problems, hypertension and endocrine system problems. Out of 18 deaths, 11 (61.11%) cased had comorbidities. Among radiography and CT-scan results, 62.79% of the patients had involvement on chest radiography and 98.15% of the patients showed consolidation with ground glass opacities and 83.33% showed pleural effusion on their scan results. Conclusion(s): Having as much thorough information as possible about the characteristics of the patients infected with this virus helps us make better and sooner judgmental calls and more accurate diagnosis.Copyright © 2020 Ubiquity Press. All rights reserved.

Gastrointestinal Features of the Multisystem Inflammatory Syndrome in Children (MIS-C) Following COVID-19 Infection in Selected Referral Hospitals in Iran.

Background and purpose: Multisystem Inflammatory Syndrome in Children (MIS-C) occurs after having COVID-19. The severity and outcomes of COVID-19 with gastrointestinal symptoms are higher. The aim of this study was to investigate gastrointestinal manifestations in MIS-C patients in selected referral hospitals in Iran to obtain comprehensive information about the treatment and prevention of MIS-C. Material(s) and Method(s): In this cross-sectional study, all MIS-C patients <21 years in Dec 2019 to Oct 2021 were included. The patients were identified by the Centers for Disease Control and Prevention (CDC) checklist and data were analyzed applying t-test and Chi-square in STATA11. Result(s): There were 225 patients with a median age of 55 months (26-96 months), including 59.56% boys and all had fever on admission. At least one gastrointestinal symptom was seen in 200 patients and the most common symptoms were vomiting (60.9%) and abdominal pain (45.77%). Almost 60% of the patients had positive RT-PCR results. Among the patients with and without gastrointestinal symptoms 85.5% and 48% were admitted to intensive care unit (ICU), respectively. There were significant differences between the two groups in respiratory symptoms, ALT, AST, NT-pro BNP, ESR, and PLT (P<0.05). All patients without gastrointestinal symptoms were discharged but nine patients in the group with gastrointestinal symptoms deceased. Conclusion(s): According to the current study, gastrointestinal symptoms are common in MIS-C patients and are associated with higher rates of death and intensive care unit admission. Therefore, in providing services to COVID-19 patients, all typical and atypical signs and symptoms should be considered to prevent unnecessary interventions.Copyright © 2023, Mazandaran University of Medical Sciences. All rights reserved.

Factors Associated with Mortality in Patients Hospitalized with COVID-19 Using Generalized Linear Model (Ordinal Logistic Regression) in North of Iran

Background and purpose: Controlling the severity and death of the COVID-19 disease is still a major challenge. This research aimed at identifying the factors associated with mortality in hospitalized patients with COVID-19 applying generalized linear model. Materials and methods: In this cross-sectional study, demographic and clinical data of COVID-19 patients hospitalized with positive RT-PCR test results (n=6759) in Mazandaran hospitals (August 2019) were obtained from the national registration system for COVID-19. SPSS V27 and R V4.0 were used for data analyses and multivariate generalized linear model test with an ordinal logistic scale was applied. Results: Findings showed that full recovery and relative recovery occurred in 5888 (87.11%) and 400 (5.92%) patients, respectively. Mortality rate was 6.97%. The chance of death in patients with relative recovery (49.55%) compared with those with full recovery (21.61%) was almost 2.3 times higher. Predictors of mortality in these patients included age over 60 years (OR: 1.60), ICU admission (OR: 5.09), intubation (OR: 4.10), SpO2≤ 93% (OR: 2.41), cancer (OR: 1.74), diabetes (OR: 1.29), heart disease (OR: 1.41), and chronic kidney disease (OR: 2.17). Conclusion: Specific and timely medical care, considering the mentioned risk factors, should be introduced and provided to prevent mortality in patients hospitalized with COVID-19. © 2022, Mazandaran University of Medical Sciences. All rights reserved.

Admission Rate and Factors Associated with COVID-19 Disease in Children Attending the Emergency Department in Hospitals Affiliated to Mazandaran University of Medical Sciences, 2019-2020

Background and purpose: Coronavirus (COVID-19) in children includes 1 to 5% of all cases but child mortality due to the disease is rare. The aim of this study was to determine the admission rate and factors associated with Covid-19 disease in children to better understand and control the disease. Materials and methods: In a descriptive-analytical and cross-sectional study 594 samples were selected by systematic random sampling from 1847 children under 18 years of age attending the emergency departments affiliated with Mazandaran University of Medical Sciences. Information was collected from medical records and telephone interviews with parents using a researcher-made questionnaire. Data were analyzed in SPSS V21 applying descriptive statistics, Fisher Exact test, Spearman, Kruskal–Wallis test, and Mann Whitney U test. Results: The mean age of patients was 69.4±71.7 months and 53% were boys. Common symptoms included fever (67%) and cough (29%) and mortality rate was 0.3%. Underlying diseases were seen in 9.3% and seizure was more prevalent (27.3%). Contact with COVID-19 patients was reported by 18.69%. The most common diagnostic method was based on clinical symptoms (80%). Among the children studied, 92.6% were admitted to hospital, of whom 13.5% were admitted to ICU. The mean SpO2 was 96.6% and 13.1% of the patients required respiratory support. The average fear of parents about their child getting Covid-19 was reported to be 5.1. Conclusion: The disease is observed to be mild and moderate in children. Also, severity of the disease and the resulting mortality rate are higher in children with underlying diseases. The most important reason for the delay in referring to medical centers was fear of parents about their child developing COVID-19. © 2022, Mazandaran University of Medical Sciences. All rights reserved.

Clinical manifestations of multisystem inflammatory syndrome in children following covid-19: A narrative review

Coronavirus 2 acute and severe respiratory infection virus (SARS-CoV2) has been identified as a pathogen of COVID-19 disease. Initially it was thought that children were safe from the virus, but several reports showed Multisystem Inflammatory Syndrome in Children (MIS-C) as a dangerous complication of COVID-19. There are similarities and differences between MIS-C and Kawasaki disease, Kawasaki shock syndrome, and toxic shock. It is a multisystem disease that affects major systems, including cardiovascular, respiratory, blood and coagulation, kidney, and nervous systems. Diagnosis of MIS-C is based on evidence of recent SARS-CoV2 infection and multiple system involvement, and laboratory criteria for high inflammation in the absence of other causes. In many of these patients chest imaging may show no evidence of COVID-19 involvement, or abnormal findings such as pleural effusion, ground glass patchy opacities, or local density and atelectasis may be seen. Echocardiography shows involvement of pericardium, myocardium, endocardium, and coronary arteries, which may be accompanied by cardiac arrhythmias. On abdominal imaging, evidence of ascites may be reported in these patients. In whole blood tests, lymphopenia, anemia, and thrombocytopenia are common, and inflammatory markers are very high. In mild cases, patients can be closely monitored, but many of these children develop severe forms and require hospitalization or pediatric intensive care unit. This study narratively reviews the clinical manifestations of multisystemic inflammatory syndrome in children following COVID-19.

Diagnosis and treatment of multisystem inflammatory syndrome following covid-19 in children

Multisystem Inflammatory Syndrome in Children (MIS-C) is recognized as a life threatening complication of Coronavirus disease (COVID-19) in children which can affect major systems such as cardiovascular, respiratory, blood and coagulation, renal, and nervous system. Mild cases of MIS-C can be followed up closely, but, severe illnesses that require hospitalization or pediatric intensive care are also common. Treatment of these patients includes supportive measures to improve the function of vital organs such as the heart and arteries, respiration, and kidneys. Antiviral therapy is recommended in patients with clear involvement of the respiratory system. Treatment with empirical antibiotics and drugs effective in suppressing or modulating the immune system such as steroids in various doses, intravenous immunoglobulins, biologic drugs, anticoagulants, and antiplatelets are recommended. In case of shock or decreased cardiac function, vasopressor drugs are suggested along with supportive measures to maintain tissue perfusions such as albumin and compressed red blood cells. Timely diagnosis and appropriate treatments improve the patient's condition and evaluation of long-term complications of this disease should be done.

A comparative analysis of clinical characteristics and laboratory findings of covid-19 between intensive care unit and non-intensive care unit pediatric patients: A multicenter, retrospective, observational study from iranian network for research in viral diseases (inrvd)

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively;p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions. © 2021 Tehran University of Medical Sciences.

Invasive and non-invasive mechanical ventilation in pediatric patients with COVID-19: A systematic review

Background and purpose: In the last months of 2019, the new coronavirus infection (COVID-19) spread worldwide. This study investigated the need for mechanical ventilation in children who were admitted for COVID-19. Materials and methods: This article provides a systematic review of studies about children with COVID-19 requiring invasive or non-invasive mechanical ventilation. Electronic databases including SID, Iran Medex, Magiran, PubMed, and Google Scholar were searched using related keywords in Persian and English until July 20, 2020. Also, references in the selected articles were screened. Results: Twenty studies were selected in which 1709 hospitalized children were included. Mechanical ventilation methods were used in 15% of the patients, while in 260 non-invasive ventilation (n=130, 7.6%) and invasive ventilation (n=130, 7.6%) were used. In critically ill children or those who needed intensive care (n=302), non-invasive ventilation and invasive mechanical ventilation were performed in 72 (23.8%) and 71 (23.5%), respectively. Mortality occurred in 1.3% of all admitted patients and 4% of critically ill children. Conclusion: According to this review, 15% of hospitalized children with COVID-19 needed a form of mechanical ventilation. © 2020, Mazandaran University of Medical Sciences. All rights reserved.