Evidence-Based Prediction of COVID-19 Severity in Hospitalized Children.

Objective: In this study, by using clinical and paraclinical characteristics, we have aimed to predict the severity of the disease in hospitalized COVID-19 children. Method: This cross-sectional study was conducted on medical records about epidemiologic data, underlying diseases, symptoms, and laboratory tests from March to October, 2020, on 238 hospitalized confirmed COVID-19 paediatric cases in several children's hospitals of Tehran, Ahwaz, Isfahan, and Bandar Abbas. Results: From 238 patients, 140 (59%) were male and most of them were in the age group of 1 to 5 years (34.6%). Among all hospitalized patients, 38% had an underlying disease and in total, 5% of cases were expired. Conclusion: Determining patient severity is essential for appropriate clinical decision making; our results showed that in hospitalized pediatric patients, by using several variables such as SGOT, CRP, ALC, LDH, WBC, O2sat, and ferritin, we can use clinical and paraclinical characteristics for predicting the severity of COVID-19.

Anemia in chronic obstructive pulmonary disease: A systematic review.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a type of obstructive lung disease that is characterized by poor airflow and airway inflammation. It is estimated that the global prevalence of COPD is about 13.1%. Anemia is associated with increased morbidity and hospitalization duration. In this systematic review, we investigate the association between all types of anemia and COPD progression. METHODS: We systematically searched electronic databases, including Scopus, Medline/PubMed, EMBASE, Web of Sciences (WOS), and Cochrane Library, using the following mesh-standardized keywords: (((anemia∗ OR anaemia∗) OR "chronic anemia disease" [Mesh] OR "CAD" OR "iron deficiency anemia" OR" IDA" OR) AND ("COPD" [Mesh] OR "chronic obstructive pulmonary disease")) until February 2022. RESULTS: Overall of 11,158 studies were included. Ultimately, 59 studies were included in the analysis. The most apparent findings from the analysis were that exacerbation of COPD, increased hospitalization, and increased long-term mortality were associated with anemia. Further analysis showed that iron deficiency (ID) is a common finding in COPD and is accompanied by an increase in the systolic pulmonary artery pressure. CONCLUSION: Despite the comfortable control of anemia, the absence of treatment can be life-threatening in patients with COPD. Our systematic results showed significant homogeneity between studies on the increased mortality rate in anemic COPD, increased hospitalization, and decreased quality of life.

Hematologic Evaluation of Children with COVID-19 Infection: Mortality Biomarkers.

BACKGROUND: In this study, we investigated the predictive value of routine coagulation parameters including D-dimer, Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) and Complete Blood Count (CBC) test parameters in children with COVID-19 infection. METHODS: Retrospective and observational study carried out in Abuzar Hospital, Ahvaz Jundishapur University of Medical Sciences (Ahvaz, Iran) included COVID-19 patients. RESULTS: Deceased patients (n = 5) compared to alive patients (n = 76) showed higher RDW (p = 0.005), PT (p = 0.005), INR (p = 0.004), PTT (p = 0.009), platelet count (p < 0.001), PLR (p < 0.001), and hospitalization time (p < 0.001). The area under the curve (AUC) of RDW was 0.85 (95% CI 0.75 - 0.96) which indicates its high power for mortality prediction in hospitalized children with COVID-19. We did not find significant differences in parameters in comparison between different severities. CONCLUSIONS: To our knowledge, our study is one of the few studies to evaluate routine coagulation tests and the CBC test parameters predictive value in children with COVID-19. RDW has the most power to predict the mortality of children with COVID-19, followed by PT, INR, aPTT, platelet count, PLR, and hospitalization time have a high power to predict the risk of death in patients.

Association of vitamin D status with COVID-19 disease severity in pediatric patients: A retrospective observational study.

Background and Aims: Vitamin D deficiency is associated with increased vulnerability to respiratory infections. This study aimed to determine the potential relationships between coronavirus disease 2019 (COVID-19) severity, serum vitamin D concentrations, and some inflammatory markers among pediatric COVID-19 patients in Iran. Methods: A retrospective study was conducted among hospitalized pediatric COVID-19 cases in Abuzar Hospital (Ahvaz, Iran) for 6 months. The COVID-19 diagnosis was based on the real-time reverse transcription-polymerase chain reaction technique. Demographic and clinical data of patients were recorded. Patients with serum vitamin D levels lower than 20 ng/ml were assigned as Group 1 and those with serum vitamin D concentrations equal to or more than 20 ng/ml were considered as Group 2. Results: A total of 144 patients were enrolled. Their mean age was 80 ± 49 months (range: 1-16 years). Patients in Group 1 had significantly lower levels of serum vitamin D, calcium, and lymphocytes, as well as higher fibrinogen, d-dimer, and C-reactive protein (CRP) levels compared with those in Group 2 (p < 0.001). In addition, they had a significantly higher dry cough, fever, chest radiographic findings, respiratory rate, and longer hospital length of stay than patients in Group 2. Serum concentrations of vitamin D were positively correlated with levels of serum calcium, lymphocytes, and neutrophils but negatively correlated with CRP, fibrinogen, and d-dimer values. Furthermore, patients with moderate or severe courses of COVID-19 had significantly higher inflammatory markers (CRP, d-dimer, and fibrinogen), as well as lower levels of serum calcium, vitamin D, lymphocytes, and neutrophils than those with mild COVID-19 (p < 0.001). In the multivariate analysis, fibrinogen level on admission was detected as the independent predictor of severe COVD-19 (odds ratio = 1.06, 95% confidence interval: 1.03-1.09; p < 0.001). Conclusion: This study indicated associations between the severity of COVID-19, serum vitamin D concentrations, and some inflammatory markers in pediatric COVID-19 patients.

A multicenter retrospective study of clinical features, laboratory characteristics, and outcomes of 166 hospitalized children with coronavirus disease 2019 (COVID-19): A preliminary report from Iranian Network for Research in Viral Diseases (INRVD).

BACKGROUND: The objectives of this study were to analyze the clinical features and laboratory profiles and risk factors associated with critical illness of children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: One hundred and sixty-six coronavirus disease 2019 (COVID-19) Iranian pediatric patients were recruited through a collaborative research network between March and May 2020. Demographics, clinical, laboratory, and radiological results were obtained from patient files. RESULTS: Of 166 patients, 102 (61%) and 64 (39%) were males and females, respectively. Ninety-six (57.8%) and 70 (42.2%), had moderate and severe conditions, respectively. Thirty (18%) of patients died. The common symptoms were fever (73%), cough (54%), and shortness of breath, headache decrease in neutrophil and platelet counts; increase values in lactate dehydrogenase, decrease in the blood pH and HCO3 were significantly associated with the disease severity. 54% and 56% of patients showed abnormal radiographic appearance in Chest X-ray and in chest computed tomography scan, respectively. Sixty-one (36.7%) of patients were referred to intensive care unit (ICU). The coexistence of comorbidity was the main factor associated with ICU admission, shock, arrhythmia, acute kidney injury, acute respiratory distress syndrome, acute cardiac injury, and death. CONCLUSIONS: We describe a higher than previously recognized rate of COVID-19 mortality in Iranian pediatric patients. Epidemiological factors, such as the relatively high case fatality rate in the country and the presence of underlying diseases were the main factors for the high death rate.

Clinical and Epidemiological Determinants of Lower Respiratory Tract Infections in Hospitalized Pediatric Patients.

BACKGROUND: Lower respiratory tract infection (LRTI) is the main cause of pediatric mortality and morbidity in low- and middle-income countries. PURPOSE: This study was carried out to determine the clinical and epidemiological characteristics of children with LRTI. METHOD: A retrospective study was conducted on all pediatric patients who were hospitalized due to LRTI in Abuzar Hospital (Ahvaz, Iran) during one year. Incomplete medical records and children who were treated on an outpatient basis, as well as infants younger than 1 month of age, were excluded. The patients were evaluated in terms of epidemiological, clinical, and paraclinical characteristics. RESULTS: A total of 303 hospitalized children and infants were identified. Their mean age was 29.09 ± 38.96 months (range 1 month-15 years), and 59.4% of them were males. The highest frequency of patients was at the age below one year (50.8%, n = 154). Pneumonia and bronchitis were the most common LRTIs. Respiratory (54.6%) and neurological (21.6%) diseases were the most prevalent underlying medical conditions. Admission was more common in winter (n = 120, 39.6%) and spring (n = 79, 26.1%). The mean length of stay (LOS) in the hospital was 8.2 ± 5.5 days, and the overall mortality rate was 11.6%. In addition, 65 patients were severely underweight and 271 patients were malnourished. Moreover, there was a significant association between mortality and disease diagnosis (p < 0.05). Furthermore, there was a significant association between having an underlying disease and consanguineous parents (p < 0.01), as well as the frequency of hospitalization (p < 0.001). CONCLUSION: Additional studies are required to determine factors contributing to disease severity among children with LRTI to develop appropriate preventive and therapeutic strategies.

Effect of Ventolin on QTc in children with respiratory distress.

INTRODUCTION: ß2-agonists are first election drugs for the treatment of respiratory disease that may alter cardiac autonomic modulation. The aim of this study was to evaluate the effects of nebulized Ventolin on electrocardiogram, particularly QTc interval to assess the potential arrhythmogenic risks. METHODS: A total of 192 patients between 2 months and 15 years which received nebulized Ventolin were enrolled in this study. Patients were divided into two groups. Electrocardiograms of patients before and after nebulized Ventolin were taken. Differences between two groups were assessed using a paired student's t test. RESULTS: There was statistically significant differences in QTc before and after Ventolin in each groups (P<0.005).Ventolin effect on QTc interval in both groups did not differ. In first group, there was statistically significant differences between heart rate before and after Ventolin taken (P=0.009) but in second group there was not statistically significant differences between heart rate (P=0.345). CONCLUSION: Although Ventolin can cause changes in QTc, Ventolin with 0.15 mg/kg/dose in comparison with 0.1 mg/kg/dose does not cause significant changes in QTc.