Wide spectrum of clinical picture of COVID-19 in children - from mild to severe disease

Abstract Context Due to the wide spectrum of clinical illness in coronavirus disease 2019 (COVID-19) patients, it is important to stratify patients into severe and nonsevere categories. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been evaluated rapidly by a few studies worldwide for its association with severe disease, but practically none have been conducted in the Indian population. This study was undertaken to examine the role of NLR and PLR in predicting severe disease in Indian patients. Objectives The objective was to study the association of NLR and PLR observed at the time of admission with maximum disease severity during hospitalization and to study their role in predicting disease severity. Material and Methods A total of 229 COVID-19 patients were admitted at the center during the study period. After applying inclusion and exclusion criteria, 191 patients were included in the study. The demographic, clinical, and laboratory (complete blood count, NLR, and PLR) data of all patients were obtained at the time of admission. Maximum disease severity of all patients was assessed during hospitalization. Statistical Analysis Chi-square and Mann–Whitney U tests were used to assess statistical significance. Receiver operating characteristic curve (ROC) was plotted for NLR and PLR to estimate the cutoff values and sensitivity and specificity using Youden’s index for predicting severe disease. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals. Results Mean NLR and PLR were significantly higher in severe patients (NLR = 7.41; PLR = 204) compared with nonsevere patients (NLR = 3.30; PLR = 121). ROC analysis showed that NLR, in comparison to PLR, had a higher area under the curve (AUC) of 0.779, with a larger OR of 1.237 and cutoff of 4.1, and showed 69% sensitivity and 78% specificity in predicting severe disease. Cut off for PLR was 115.3, which showed 79% sensitivity and 62% specificity in predicting severe disease. Conclusion NLR and PLR, both showing acceptable AUCs, can be used as screening tools to predict disease severity. However, NLR was a better predictor of disease severity.

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The Basics of Microbiology

10.33442/vt202101 ◽

2021 ◽

Author(s):

Werner Solbach

Keyword(s):

Infectious Diseases ◽

Defense Mechanisms ◽

Wide Spectrum ◽

Severe Disease ◽

Laboratory Diagnosis ◽

Asymptomatic Infection ◽

The Body ◽

Sufficient Evidence ◽

Effective Measure ◽

Hygiene Measures

Microorganisms constitute 70 percent of the biomass on Planet Earth. Comparatively few species are adapted to colonize human surfaces and form a complex Meta-Organism with manyfold mutual benefits. Occasionally, microorganisms may overcome the barriers of the skin and mucosal surfaces and may multiply locally or in multiple sites inside the body. This process is called infection. Infections can be caused by bacteria, viruses, parasites, helminths, and fungi. Immediately after infection, numerous defense mechanisms of the immune system are activated to combat replication of the microbes. There is a balance between microorganism and human defense mechanisms, which may lead to either asymptomatic infection or result in a wide spectrum of symptoms from mild to severe disease and even death. The most important factors in the diagnosis of infectious diseases are a careful history, physical examination and the appropriate collection of body fluids and tissues. Laboratory diagnosis requires between 2 and 72 hours. Wherever possible, antibiotics should only be used when sufficient evidence of efficacy is available. Then, however, they should be used as early as possible and in high doses. In addition to everyday hygiene measures, vaccination is the most effective measure to prevent infectious diseases.

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A Combined Evidence Approach to Prioritize Nipah Virus Inhibitors

10.1101/2020.03.12.977918 ◽

2020 ◽

Author(s):

Nishi Kumari ◽

Ayush Upadhyay ◽

Kishan Kalia ◽

Rakesh Kumar ◽

Kanika Tuteja ◽

...

Keyword(s):

Small Molecules ◽

Wide Spectrum ◽

Severe Disease ◽

Nipah Virus ◽

Case Fatality ◽

Structural Features ◽

Health Concern ◽

Public Health Concern ◽

Global Pandemic ◽

Nanomolar Range

AbstractBackgroundNipah Virus (NiV) came into limelight recently due to an outbreak in Kerala, India. NiV causes severe disease and death in people with over 75% case fatality rate. It is a public health concern and has the potential to become a global pandemic. Lack of treatment has forced the containment methods to be restricted to isolation and surveillance. WHO’s ‘R&D Blueprint list of priority diseases’ (2018) indicates that there is an urgent need for accelerated research & development for addressing NiV.Materials & MethodsIn the quest for druglike NiV inhibitors (NVIs) a thorough literature search followed by systematic data curation was conducted. Rigorous data analysis was done with curated NVIs for prioritizing druglike compounds. For the same, more than 1800 descriptors of NVIs were computed and comparative analysis was performed with the FDA approved small molecules and antivirals. These compounds were further evaluated through PAINS filter to study their toxicity profile. Simultaneously, compounds were also prioritized based on the robustness of the assays through which they were identified.ResultsOur efforts lead to the creation of a well-curated structured knowledgebase of 182 NVIs with 98 small molecule inhibitors. The reported IC50/EC50 values for some of these inhibitors are in the nanomolar range – as low as 0.47 nM. In order to prioritize these inhibitors, we performed several tests and applied filters to identify drug-like non-toxic compounds. Of 98, a few compounds passed DruLito & PAINS filters exhibiting drug-like properties and were also prioritized in an independent screen based only the assay robustness. The NVIs have diverse structural features and offer a wide spectrum of ways in which they can be developed further as druglike molecules.ConclusionWe report a knowledgebase for furthering the development of NVIs. The platform has a diverse set of 98 NVIs of which a few have been prioritized based on a combined evidence strategy. The platform has the provision to submit new inhibitors as and when reported by the community for further enhancement of NiV inhibitor landscape.

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CoViD-19: An early intervention therapeutic strategy to prevent developing a severe disease as an alternative approach to control the pandemic

10.14293/s2199-1006.1.sor-.ppurwmt.v1 ◽

2020 ◽

Author(s):

HAMID MERCHANT

Keyword(s):

Early Intervention ◽

Respiratory Tract ◽

Therapeutic Strategy ◽

Wide Spectrum ◽

Severe Disease ◽

Antimicrobial Properties ◽

The Body ◽

Upper Respiratory Tract ◽

Holistic Treatment ◽

Upper Respiratory

While we wait for a confirmed drug or a vaccine for CoViD-19, it may be possible to intervene early to prevent the virus causing a severe disease to offer an alternative therapeutic strategy to control the pandemic. The global burden of CoViD-19 on the healthcare system can be significantly reduced by targeting CoViD-19 patients with or without symptoms who are self-isolating at home or in quarantine. If any therapeutic support can be offered to this group of patients that could attenuate the virus within the upper respiratory tract during the early stages of CoViD-19, it can give the body the time to produce enough antibodies to recover naturally from the disease before progressing into severe disease. An early intervention can, therefore, prevent the virus to get down the lower respiratory tract, reduce the number of cases with severe disease involving pneumonia and the need for hospitalisation. This article presents a simple yet holistic treatment strategy that involves inhaling steam supplemented with essential oils possessing wide spectrum antimicrobial properties in conjunction with oropharyngeal sanitisation to all those who are CoViD-19 positive or are under self-isolation due to symptoms. The approach is very simple, cheap, and effective in relieving the symptoms of the disease and is likely to reduce the viral load in the upper respiratory tract that may help recover from the infection. Since there is no vaccine or treatment yet approved to prevent or treat the CoViD-19, the importance of early intervention is invaluable in reducing the global disease burden. In the authors opinion, this strategy may be very effective to nip the infection in the bud before it gets difficult to treat and therefore, have a potential to significantly reduce the CoViD-19 associated hospitalisation.

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81. Children and COVID-19 in Colorado: The Children’s Hospital Colorado Experience

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.391 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S172-S173

Author(s):

Kelly E Graff ◽

Lori Silveira ◽

Jane Jarjour ◽

Shane Curran-Hays ◽

Lauren Carpenter ◽

...

Keyword(s):

Hospital Admission ◽

Wide Spectrum ◽

Severe Disease ◽

Tertiary Care ◽

Pediatric Intensive Care ◽

Respiratory Support ◽

Logistic Regression Models ◽

Children's Hospital ◽

Children’S Hospital ◽

The Impact

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes coronavirus disease of 2019 (COVID-19) and has been reported in > 98,000 children in the U.S (5% of reported cases) as of early June 2020. Most published literature focuses on adults with COVID-19, but little is understood on the impact of SARS-CoV-2 in children. We created a database for children with COVID-19 at Children’s Hospital Colorado (CHCO), a large tertiary care pediatric hospital, to better understand the epidemiology and clinical outcomes of this disease in children. Methods We retrospectively reviewed the medical records of all pediatric and youth patients with positive SARS-CoV-2 PCR test results from March-May 2020. Univariate logistic regression models were used to identify predictors of hospital admission, need for critical care, and need for respiratory support among symptomatic patients, with p-values < 0.05 considered statistically significant. Results We identified 246 patients with SARS-CoV-2 (age range: 17 days-25 years). We noted a Hispanic predominance with 68% of all patients with SARS-CoV-2 identifying as Hispanic or Latino, compared to 29% among all CHCO visits in 2019 (Figure 1). The most common symptoms at presentation were fever, cough, or shortness of breath in 94% of symptomatic patients. Sixty-eight patients (28%) were admitted, of which 7 (10%) required admission to the pediatric intensive care unit (PICU) for symptomatic COVID-19 disease (Figure 2). Age 0–3 months, certain symptoms at presentation, and several types of underlying medical conditions were predictors for both hospital admission and need for respiratory support (Figure 3). Initial and peak C-reactive protein (CRP) values were predictors for PICU admission with median peaks of 24.8mg/dL vs. 2.0mg/dL among PICU vs. non-PICU patients (OR 1.27, p=0.004). Figure 3: Predictors for Admission and Respiratory Support Requirement in CHCO Patients with SARS-CoV-2 Conclusion There is a wide spectrum of illness in children with SARS-CoV-2, ranging from asymptomatic to critical illness. Hispanic ethnicity was disproportionately represented in our cohort, which requires further evaluation. We found that young age, comorbid conditions, and CRP appear to be risk factors for severe disease in children. Disclosures Kelly E. Graff, MD, BioFire Diagnostics, LLC (Grant/Research Support)

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Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer

Cancers ◽

10.3390/cancers12082325 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2325

Author(s):

Carlo Cattrini ◽

Melissa Bersanelli ◽

Maria Maddalena Latocca ◽

Benedetta Conte ◽

Giacomo Vallome ◽

...

Keyword(s):

Hormone Therapy ◽

Sex Hormones ◽

Wide Spectrum ◽

Severe Disease ◽

Host Cells ◽

Testosterone Levels ◽

Increased Risk ◽

Hormonal Therapies ◽

Novel Coronavirus ◽

Transmembrane Serine Protease

The novel coronavirus disease 2019 (COVID-19) shows a wide spectrum of clinical presentations, severity, and fatality rates. The reason older patients and males show increased risk of severe disease and death remains uncertain. Sex hormones, such as estradiol, progesterone, and testosterone, might be implicated in the age-dependent and sex-specific severity of COVID-19. High testosterone levels could upregulate transmembrane serine protease 2 (TMPRSS2), facilitating the entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into host cells via angiotensin-converting enzyme 2 (ACE2). Data from patients with prostate cancer treated with androgen-deprivation therapy seem to confirm this hypothesis. Clinical studies on TMPRSS2 inhibitors, such as camostat, nafamostat, and bromhexine, are ongoing. Antiandrogens, such as bicalutamide and enzalutamide, are also under investigation. Conversely, other studies suggest that the immune modulating properties of androgens could protect from the unfavorable cytokine storm, and that low testosterone levels might be associated with a worse prognosis in patients with COVID-19. Some evidence also supports the notion that estrogens and progesterone might exert a protective effect on females, through direct antiviral activity or immune-mediated mechanisms, thus explaining the higher COVID-19 severity in post-menopausal women. In this perspective, we discuss the available evidence on sex hormones and hormone therapy in patients infected with SARS-CoV-2, and we highlight the possible implications for cancer patients, who can receive hormonal therapies during their treatment plans.

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TO STUDY THE COMPLICATIONS IN DENGUE LIKE ILLNESSES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i7.1284 ◽

2020 ◽

Vol 4 (7) ◽

Author(s):

Girdhari lal Sharma ◽

Rakesh Bilwal

Keyword(s):

Physical Examination ◽

Clinical Course ◽

Wide Spectrum ◽

Severe Disease ◽

Tertiary Care ◽

History Taking ◽

Common Complication ◽

Exclusion Criteria ◽

Clinical Presentations ◽

Comprehensive History

Background: Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting nonsevere clinical course, small proportion progress to severe disease Methods: The hospital based study was conducted on patients presenting to tertiary care teaching hospital, who fulfilled inclusion and exclusion criteria were enrolled for the study. A comprehensive history taking, physical examination, and lab investigations were carried out and data were collected in pre-designed proforma. Results: According to complications, in dengue positive cases, bleeding was the most common complication seen in 48.00% cases while shock, myocarditis, and convulsion were present in 31.00%, 2.00% and 1.00% of cases respectively. Among the dengue negative cases, 60.00% had no complication while shock and bleeding were present in 28% and 12.00% cases respectively. Conclusion: It concluded that shock was most common complication. Keywords: Hematocrit, Dengue, Dengue Like Illness

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Predictor of Severity of Lung Injury and Oxygen Saturation in COVID- 19 Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i51a33474 ◽

2021 ◽

pp. 107-114

Author(s):

Fahimeh Shahjooie ◽

Sadrollah Mahmudi ◽

Somayeh Mohammadi ◽

Hassan Goodarzi ◽

Mehrdad Farajy ◽

...

Keyword(s):

Lung Injury ◽

Oxygen Saturation ◽

Significant Relationship ◽

Wide Spectrum ◽

Severe Disease ◽

Cross Sectional Study ◽

Shortness Of Breath ◽

Blood Oxygen Saturation ◽

Cross Sectional ◽

Early Management

Introduction: Wide spectrum of clinical features of COVID-19 was seen from mild to severe. This is very important to determine the severity of disease, early management of severe disorder may increase the chance of survival. Methods: This cross sectional study perform on 150 patients with mean age of 53 years that refer to from 21 February to 19 April 2020. Result: The most comorbidity disease HTN, DM and IHD with prevalence of 26.2%, 20%, 11.3% which had higher severity of lung disease. There was a significant relationship between age, lymphopenia, CRP, IHD, DM, shortness of breath and body pain with the severity of lung injury, shortness of breath had higher severity of lung injury but myalgia had a lower severity rather than the others. level of the LDH was associated with chest CT scan score and so severe disease Further results showed that the mean±SD of LDH in 3 CT group were 576.30±214.82, 641.89± 277.07, 919.92± 382.14 in CT score less than 20, 20-50 and more than 50 respectively (P=0.002). According this study there was significant relationship between age, BMI, CRP, shortness of breath and fever with blood oxygen saturation. Further results showed that the correlation between LDH and oxygen saturation was r=-0.31 (p=0.002)

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Severe COVID-19 is characterised by inflammation and immature myeloid cells early in disease progression

10.1101/2021.09.01.21262953 ◽

2021 ◽

Author(s):

Liam Townsend ◽

Adam H Dyer ◽

Aifric Naughton ◽

Sultan Imangaliyev ◽

Jean Dunne ◽

...

Keyword(s):

Wide Spectrum ◽

Severe Disease ◽

Therapeutic Interventions ◽

C Reactive Protein ◽

Inflammatory Cytokine Production ◽

Reactive Protein ◽

Hla Dr ◽

Cd10 Expression ◽

Immature Myeloid Cells ◽

Immune Changes

SARS-CoV-2 infection causes a wide spectrum of disease severity. Immune changes associated with severe disease include pro-inflammatory cytokine production and expansion of immature myeloid populations. The relative importance of the immunological changes in driving progression to severe disease remain poorly understood. We aimed to identify and rank clinical and immunological features associated with progression to severe COVID-19. We sought to use tests available in an on-site diagnostic hospital laboratory to identify an immunological signature for severe disease development which could be detected prior to peak severity thereby allowing initiation of therapeutic interventions. We used univariate and multivariate analysis, including unbiased machine learning, to investigate the relationships between clinical and demographic characteristics, inflammatory markers, and leukocyte immunophenotypes with progression to severe disease in 108 patients and to rank these in importance. A combination of four features (elevated levels of interleukin-6 and C-reactive protein, coupled with reduced monocyte HLA-DR expression and reduced neutrophil CD10 expression), were strongly predictive of severe disease with an average prediction score of 0.925.

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Clinical and Laboratory Characteristics of COVID-19 Infection in Patients Presenting to A Tertiary Care Hospital

BioMedica ◽

10.51441/biomedica/5-497 ◽

2021 ◽

Vol 37 (3) ◽

pp. 1-17

Author(s):

Huma Batool ◽

Asifa Karamat ◽

Khalid Waheed ◽

Sohail Anwar ◽

Syed Arslan Haider ◽

...

Keyword(s):

Medical Records ◽

Clinical Symptoms ◽

Wide Spectrum ◽

Severe Disease ◽

Tertiary Care ◽

Care Hospital ◽

Laboratory Findings ◽

Male Predominance ◽

Reactive Protein ◽

Clinical Records

Background and Objective: COVID-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) having a wide variety of clinical features ranging from asymptomatic carriers to respiratory failure requiring mechanical ventilation. The objective of the study was to analyze the spectrum of different symptoms, laboratory findings and complications in patients who were admitted in either COVID ward or intensive care unit (ICU) of a local hospital. Methods: A retrospective cohort study of the medical records of 100 COVID-19 disease patients with PCR detected SARS-CoV-2 infection were collected. Participant information was retrospectively obtained from the hospital medical records which included clinical records and laboratory findings. All statistical analyses were done using Statistical Package for the Social Sciences (SPSS) version 21. Results: The mean age of the patients was 50.8 ±5.86 with male predominance (79%). Most frequent co-morbidities were diabetes mellitus (42%) and hypertension (36%). Most frequent symptoms were fever (95.9%) and fatigue (95.9%) followed by dry cough (86.5%), myalgia (85.1) and shortness of breath (70%). Amongst the patients admitted, leukocyte count was 10.95 x 103, C-reactive protein (CRP) was 12.8mg/dl, ferritin was 730.8ng/ml and Lactate Dehydrogenase (LDH) was found to be 1254.7 U/l. Hepatic and renal functions were borderline deranged. Conclusion: COVID-19 disease has a wide spectrum of clinical symptoms. Patients with raised inflammatory markers have severe disease and are more likely in need of an ICU care. By carefully observing these markers may help in better management of COVID-19 disease.

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