Evaluation of antithrombotic prophylaxis and thrombotic events in children with COVID-19 or MIS-C: A tertiary pediatric center experience.

OBJECTIVES: COVID-19 and multisystem inflammatory syndrome in children (MIS-C) are associated with a risk of hypercoagulability and thrombotic events. We aimed (a) to evaluate the demographic, clinical, and laboratory findings as well as the incidence of thrombotic events of COVID-19 and MIS-C in children and (b) to determine the role of antithrombotic prophylaxis. METHODS: A single-center retrospective study evaluated hospitalized children with COVID-19 or MIS-C. RESULTS: The study group consisted of 690 patients, 596 (86.4%) diagnosed with COVID-19 and 94 (13.6%) diagnosed with MIS-C. Antithrombotic prophylaxis was used for 154 (22.3%) patients: 63 patients (10.6%) in the COVID-19 group and 91 (96.8%) patients in the MIS-C group. Use of antithrombotic prophylaxis was statistically higher in the MIS-C group (p<0.001). Patients who received antithrombotic prophylaxis were of older median age, were more commonly male, and had more frequent underlying diseases than those without prophylaxis (p<0.001, p<0.012, p<0.019, respectively). The most common underlying condition was obesity in patients who received antithrombotic prophylaxis. Thrombosis was observed in one (0.2%) patient in the COVID-19 group with a thrombus in the cephalic vein, two (2.1%) patients in the MIS-C group, with a dural thrombus in one patient and a cardiac thrombus in the other patient. The patients with thrombotic events were previously healthy and had mild disease. CONCLUSION: In our study, thrombotic events were rare compared with previous reports. We used antithrombotic prophylaxis for most children with underlying risk factors; perhaps for this reason, we did not observe thrombotic events in children with underlying risk factors. We suggest that patients diagnosed with COVID-19 or MIS-C be closely monitored for thrombotic events.

Successful treatment of hepatic and mesh Aspergillosis in a neonate with giant omphalocele.

Aspergillosis is a rare and life-threatening fungal infection in immunocompetent children, particularly in infants. We present a case of invasive Aspergillosis (IA) that developed hepatic and mesh infection due to Aspergillus flavus following the rupture of a giant omphalocele. A male baby was born at 37 weeks of gestation with a giant omphalocele. No other congenital abnormalities were found. In the pediatric surgery operation room, the amniotic membrane seemed to be ruptured in some parts, which had been repaired within a few hours of birth. No further intervention to reduce the volume of visceral organs could be performed due to the tiny abdominal cavity. Postoperatively piperacillin-tazobactam and fluconazole were empirically initiated. Abdominal defects had been covered with polypropylene polylactic acid synthetic Mesh on postnatal day 11 to protect the organs and prevent abdominal infections. Fungal hepatic lesions were observed during surgery, and black necrotic lesions were also observed on the mesh on day 12. On the 16th postnatal day, Aspergillus flavus grew in the wound, graft, hepatic biopsy cultures. Serum galactomannan (GM) assay test was positive (GM:2.9), and voriconazole was initiated. All necrotic lesions resolved with liposomal amphotericin B (L-AmB) and voriconazole treatment, and antifungal therapy was discontinued after 134 days. Eye examination for the retinopathy didn't show any abnormalities. The patient was discharged with full recovery on day 155. In conclusion, IA is a rare and life-threatening infection in the neonatal period. To the best of our knowledge, this is the first case of hepatic and mesh infection caused by Aspergillus flavus that was successfully treated with voriconazole and l-AmB.

Evaluating the Efficacy of Chemical Disinfectants on Contaminated Dental Materials Contaminated by An Airborne Disease Tuberculosis Similar to COVID-19.

BACKGROUND: Tuberculosis (TB) is a communicable disease as well as an airborne disease. Mycobacterium tuberculosis (MTB) could survive on dental materials shipped to dental laboratories. AIMS: The aim of this study was to determine the number of bacilli held on the prosthetic material and the effect of chemical disinfection agents on various prosthetic materials that were shipped to dental laboratory of TB patient. MATERIALS AND METHODS: The study consisted of three study groups, and a control group. 10 mm x 2 mm disc-shaped (n = 18 for each group, n = 72 in total) nickel-chromium alloy (Ni-Cr), polymethylmethacrylate (PMMA), and dental ceramic (DC) samples were prepared. After exposure to MTB 24 hours in a 37°C incubator, six samples for each group (PMMA), Ni-Cr alloy and a control group DC samples) were exposed to three disinfectants; 10 minutes into 2% glutaraldehyde, 10 minutes into 5% sodium hypochlorite, and 1 minute into alcohol-based disinfectant after vortexed in distilled water. Colony forming units (CFU/ml) were calculated per milliliters. Two-way ANOVA statistical analysis method was used, and a P value less than 0.05 was considered as significant. RESULTS: The bacteria count for six Ni-Cr alloy disc-shaped specimens were recorded as 40, 10, 8, 6, 5, and 4 CFU/ml, respectively. Intensity of the colonies were found to be lower in other groups. 5 CFU/ml were detected on a single PMMA sample in the control group, and 40 CFU/ml were detected on one of the dental ceramic sample. No MTB uptake was observed on any sample in the 2% glutaraldehyde and 5% NaOCl disinfectant study groups. In alcohol-based disinfectant group, 1 CFU/ml was observed on Ni-Cr alloy sample. The effect of prosthetic materials used in this experimental study were not statistically significant on the CFU (p = 0.293). However, the disinfectants use was statistically significant on the number of colonies (p = 0.004). CONCLUSION: NaOCl and glutaraldehyde appeared to be more effective than alcohol-based disinfectant in removing MTB from Ni-Cr alloy, PMMA and dental ceramic surfaces.