The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience.

OBJECTIVES: To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. METHODS: A retrospective chart review of children 0-14 years old admitted to PICU with a viral infection. RESULTS: Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). CONCLUSION: Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.

A 16-Year-Old Saudi Boy with a Symptomatic Large Splenic Epidermoid Cyst.

BACKGROUND Splenic epidermoid cysts rarely occur and the majority of cases are discovered incidentally. However, large cysts can present with symptoms due to mass effect. Splenectomy is the treatment indicated for most splenic cysts and definitive diagnosis can only be made after histopathological examination. CASE REPORT A 16-year-old boy was referred to the general surgery clinic from a local hospital with a history of abdominal asymmetry, distention, decreased oral intake, and early satiety. Abdominal computed tomography (CT) was performed and revealed a large splenic mass measuring 18.4×14×17.4 cm with multiple mural calcifications at the rim. The mass was displacing the stomach, jejunal loops, pancreas, left kidney, and transverse colon. Preoperative biopsy was not possible because a parasitic cyst was suspected; therefore, splenectomy was performed through midline laparotomy. The patient recovered well, with no complications except for transient reactive thrombocytosis. Histopathology was reported as benign epithelial cysts, with the most likely diagnosis being a splenic epidermoid cyst. Subsequently, the patient was followed up at the surgery clinic. During the last outpatient visit, the patient exhibited good recovery with no problems. CONCLUSIONS Large splenic epidermoid cysts are rare, particularly in the pediatric population. Nonspecific clinical and radiological findings are hurdles to an accurate diagnosis. Preoperative diagnosis is crucial to determine the type of intervention. However, a final diagnosis can only be made after histopathological examination.