scholarly journals 526. Clinical Presenting Characteristics of Pediatric COVID-19 Infection in a Tertiary Care Children’s Hospital in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S330-S330
Author(s):  
Jocelyn Y Ang ◽  
Nirupama Kannikeswaran ◽  
Basim Asmar
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Pediatric Emergency ◽  
Study Cohort ◽  
Mild Disease ◽  
Presenting Symptoms ◽  
Patient Disposition

Abstract Background There is limited data regarding the presenting clinical characteristics of COVID-19 in children. Our objective is to describe the clinical presentations and outcomes of COVID-19 infection early in the pandemic at our institution. Methods We performed a retrospective chart review of children up to 18 years who underwent testing for SARS CoV-2 from March 1st to May 10th 2020 at our pediatric emergency department. We abstracted patient’s demographics, clinical presentation, diagnostic studies and patient disposition. We classified the severity of clinical illness based on published criteria. We excluded patients diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19. Results SARS CoV-2 testing was performed on 481 patients of whom 43 (8.9%) tested positive. Of these, 4 were diagnosed with MIS-C. Data of 39 patients were analyzed. Patients’ demographics, co-morbidities, presenting signs and symptoms and disposition are shown in Table 1. Age range was 47 days – 18 years. Infants representing one third (14/39; 35.9%) of our study cohort. There was equal sex distribution. Asthma or obesity was present in 17 (44%). The most common presenting symptoms included fever, cough, shortness of breath and diarrhea. Chest radiograph showed pneumonia in 12 (30.8%) patients. Two thirds (27/39; 69.2%) were asymptomatic or had mild disease; six patients (15.4%) had severe or critical illness (Figure 1). Nineteen (48%) patients were admitted to the general pediatric service. Eleven (28%) were admitted to the Intensive Care Units (ICU). The characteristics, presenting symptoms and interventions performed in the PICU cohort are shown in Table 2. Half of these patients required mechanical ventilation. There was one death in a 3 month old infant unrelated to SARS CoV-2. Majority of the infants required hospitalization (12/14; 85.7%), including 4 to the PICU (one each for non accidental trauma, ingestion, seizure and pneumonia). Table 1. Patient demographics, signs and symptoms of COVID-19 infection in Children Table 2: PICU patients: Characteristics, Interventions and pharmacotherapy Figure 1: Severity of Ill ness in the study cohort Conclusion Majority (17; 43%) of our children with COVID-19 had a mild disease. Eleven (28%) including 4 infants required critical care; 5 required mechanical ventilation. There was no COVID-19 related mortality. Larger studies are needed to further define the spectrum of COVID- 19 and risk factors associated with severe disease in children. Disclosures All Authors: No reported disclosures

scholarly journals Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome

Viruses ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 693 ◽  
Author(s):  
René López ◽  
Cecilia Vial ◽  
Jerónimo Graf ◽  
Mario Calvo ◽  
Marcela Ferrés ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Platelet Count ◽  
Severe Disease ◽  
Tertiary Care ◽  
Curve Analysis ◽  
Roc Curve Analysis ◽  
Mild Disease ◽  
Laboratory Variables ◽  
Advanced Support ◽  
Tertiary Care Centers

Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35–40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34–58) vs. 83 (64–177) K/mm3, p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78–1.0) p < 0.001, with a platelet count greater than 115K /mm3 ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.

A Case Series of SARS-CoV-2 RT-PCR-Positive Hospitalized Infants 60 Days of Age or Younger From 2 New York City Pediatric Emergency Departments

2021 ◽  
Vol 60 (4-5) ◽  
pp. 247-251
Author(s):  
Ameer Hassoun ◽  
Nessy Dahan ◽  
Christopher Kelly
Keyword(s):  
New York ◽  
Case Reports ◽  
Severe Disease ◽  
Case Series ◽  
Pediatric Emergency ◽  
Rt Pcr ◽  
Vulnerable Group ◽  
Mild Disease ◽  
Young Infants ◽  
Novel Coronavirus

The emergence of novel coronavirus disease-2019 poses an unprecedented challenge to pediatricians. While the majority of children experience mild disease, initial case reports on young infants are conflicting. We present a case series of 8 hospitalized infants 60 days of age or younger with coronavirus disease-2019. A quarter of these patients had coinfections (viral or bacterial). None of these infants had severe disease. Continued vigilance in testing this vulnerable group of infants is warranted.

scholarly journals A national study of choanal atresia in tertiary care centers in Canada – part I: clinical presentation

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Josee Paradis ◽  
Agnieszka Dzioba ◽  
Hamdy El-Hakim ◽  
Paul Hong ◽  
Frederick K. Kozak ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Choanal Atresia ◽  
Case Series ◽  
Retrospective Chart Review ◽  
National Study ◽  
Feeding Difficulties ◽  
Presenting Symptoms ◽  
Tertiary Care Centers

Abstract Background To evaluate the clinical presentation of choanal atresia (CA) in tertiary centers across Canada. Methods Multi-centre case series involving six tertiary care pediatric hospitals across Canada. Retrospective chart review of patients born between 1980 and 2010 diagnosed with CA at a participating center. Results The health charts of 215 patients (59.6% female) with CA were reviewed and included in this study. The mean age of patients at time of CA presentation was 0.4 months (range 0.1 to 7.2 months) for bilateral CA and 37.8 months (range 0.1 to 164.1 months) for unilateral cases. The most common presenting symptoms for bilateral CA in decreasing order were respiratory distress (96.4%), feeding difficulties (68.2%), and rhinorrhea (65.5%), and for unilateral cases in decreasing order were rhinorrhea (92.0%), feeding difficulties (24.7%), and respiratory distress (18.0%). For the majority of patients (73.2%), the obstruction comprised mixed bony and membranous tissue, with only 10.5% presenting with a purely membranous obstruction. Familial history of CA was confirmed in only 3.3% of cases. One half of patients with CA presented with one or more associated anomalies and 30.6% had a syndrome. Conclusions The present investigation is the first national multi-institutional study evaluating the clinical presentation of CA over three decades. The present cohort of CA patients presented with a breadth of co-morbidities with highly variable presentations, with bilateral cases being more severely affected than unilateral cases. Further investigation into hereditary linkages to CA development is warranted. Graphical abstract

scholarly journals Role of BAP 65 (Blood Urea Nitrogen, Altered Mental Status, Pulse, Age 65 Years) Scoring System in Risk Stratification of Patients with Acute Exacerbation of Chronic Obstructive Lung Disease in Tertiary Care Hospital

2019 ◽  
Vol 2 (2) ◽  
pp. 5-10
Author(s):  
Ashish Thapa
Keyword(s):  
Mechanical Ventilation ◽  
Acute Exacerbation ◽  
Severe Disease ◽  
Tertiary Care ◽  
Chronic Obstructive Lung Disease ◽  
Institutional Review Boards ◽  
Mortality Data ◽  
Chronic Obstructive ◽  
P Value ◽  
Care Hospital

Introduction: Exacerbations are important events in the management of COPD because they negatively impact health status, rates of hospitalization and readmission, and disease progression. COPD AE is one of the commonest case presenting to the TUTH Emergency, average being 5 patients a day. The aim of the study was to co-relate the BAP 65 score, mortality and mechanical ventilation in patients with acute exacerbation of COPD. Methods: It was an observational study, 648 patients from emergency of TUTH were screened for the study from Magh 2073 to Asar 2074 after getting approval from the institutional review boards, among them 114 were included after applying inclusion and exclusion criteria and BAP 65 score was calculated. The patients were followed till discharge, mechanical ventilation or mortality. Data entry was done in MS EXCEL and statistical analysis was done using SPSS version 24. Results: Total of 114 patients enrolled for the study from the emergency of TUTH. There were total 16 mortality and 12 patients were mechanically ventilated. Most of the mortality and mechanical ventilation were from severe group ie BAP class IV and V. We used Pearson Chi-squared test to compare between BAP 65 class and Mortality, and found that mortality rate increased with increasing BAP 65 class with a p value of < 0.0001. The need of Mechanical Ventilation increased as well, as the BAP 65 Class increased, less than 1% of the patients with BAP class I needed MV, the cause being Type II Respiratory Failure, while around 50% of the patients with BAP class V needed MV. Conclusions: BAP 65 score is an effective and simple tool to classify the patients presenting with AECOPD, it correlated well with both the need of mechanical ventilation and mortality. Higher the score higher the chances of severe disease.

scholarly journals Predictors of Mortality in Pulmonary Haemorrhage during SLE: A Single Centre Study Over Eleven Years

2019 ◽  
Vol 7 (1) ◽  
pp. 92-96
Author(s):  
Ibrahim Masoodi ◽  
Irshad A. Sirwal ◽  
Shaikh Khurshid Anwar ◽  
Ahmed Alzaidi ◽  
Khalid A. Balbaid
Keyword(s):  
Mechanical Ventilation ◽  
Lupus Erythematosus ◽  
Tertiary Care ◽  
Pulmonary Involvement ◽  
Pulmonary Haemorrhage ◽  
Study Cohort ◽  
Care Hospital ◽  
Neuropsychiatric Complications ◽  
Single Centre Study ◽  
Case Files

BACKGROUND: Pulmonary haemorrhage (PH) is a serious complication during Systemic Lupus Erythematosus (SLE). AIM: The aim was to present data on 12 patients of SLE with classic symptoms and signs of PH admitted throughout eleven years. METHODS: This retrospective study was carried out at King Abdul Aziz Specialist hospital in Taif-a tertiary care hospital in the western region of Saudi Arabia. The data was analysed from the case files of SLE patients who had episodes of PH throughout 11 years (January 2007 to December 2017). RESULTS: Twelve patients (10 females and 2 males) were found to have diffuse pulmonary haemorrhage during their SLE in the study period. Of 12 patients with confirmed pulmonary haemorrhage (hemoptysis, hypoxemia, new infiltrates on chest radiography, fall in haemoglobin and hemorrhagic returns of bronchoalveolar lavage with hemosiderin-laden macrophages) 4 patients had PH as the first presentation of SLE and 8 patients developed this complication during the disease. All patients presented with shortness of breath and hemoptysis. The most common extra-pulmonary involvement in the study cohort was renal (83%), which ranged from clinical nephritis, nephrotic syndrome to acute renal failure. All patients were managed in intensive care of the hospital, and of 12 patients, 9 (75%) required mechanical ventilation. All patients were uniformly treated with pulse Methylprednisolone; 9 received Cyclophosphamide, 6 received IVIG, and 4 received Plasmapheresis. Only 3 patients (25%) survived despite maximum possible support during their mean hospital stay of 18 ± 5 days. CONCLUSION: The requirement of mechanical ventilation and the association of renal and neuropsychiatric complications predicted mortality in patients with pulmonary haemorrhage.

scholarly journals Study of symptomatology and presentations of COVID-19 in pregnancy at a tertiary care hospital

2020 ◽  
Vol 9 (11) ◽  
pp. 4410
Author(s):  
Ankita M. Metkari ◽  
Tushar T. Palve
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Common Symptom ◽  
Care Hospital ◽  
Mild Disease ◽  
Moderate Disease ◽  
Different Populations ◽  
Clinical Records ◽  
In Pregnancy

Background: Objectives of this study were to study the incidence of SARS-CoV-19 positivity and the incidence of different signs and symptoms associated with COVID-19 in pregnancy and comparison of the same with studies done in different populations previously.Methods: In this retrospective study, antepartum and postpartum parameters were integrated into the clinical records and total 205 ANC and PNC SARS-CoV-19 positive patients were evaluated for the signs and symptoms of COVID -19 over 2 months.Results: In our study, of all patients tested SARS-CoV-19 positive only 14.65% were symptomatic and rest were incidentally tested positive on admission. Of the symptomatic patients 50% had breathlessness followed by fever (13.33%). 92% patients had mild disease; approximately 8% had moderate disease and 6 out of 205 patient needed ICU care.Conclusions: The present study shows that 85.35% SARS-CoV-19 positive ANC and PNC patients were asymptomatic while only 14.65% symptomatic with breathlessness being the most common symptom at our institute.

scholarly journals Experience of managing first fifty COVID-19 positive peripartum women in a tertiary care centre in North India

2021 ◽  
Vol 10 (3) ◽  
pp. 1036
Author(s):  
Vijay Zutshi ◽  
Neha Mohit Bhagwati ◽  
Alka .
Keyword(s):  
Pregnant Women ◽  
Severe Disease ◽  
Tertiary Care ◽  
Birth Asphyxia ◽  
Fetal Distress ◽  
North India ◽  
Tertiary Care Centre ◽  
Mild Disease ◽  
Qrt Pcr ◽  
The Mean

Background: SARS-CoV-2 has caused significant morbidity and mortality worldwide. Analysis of the clinical profile of COVID-19 positive pregnant women is important to understand the pathophysiology, transmission and outcome of the disease in Indian population.Methods: It is a retrospective observational study of first fifty pregnant patients tested positive for COVID-19 by qRT PCR admitted for delivery in our hospital.Results: In this audit, first fifty COVID-19 pregnant women were studied and the mean age of the patients in this study was 26 years. 98% of these women were admitted for obstetric indications. Seventy two percent of these women were admitted with spontaneous onset of labour. Based on disease severity, 49 (98%) were either asymptomatic or exhibited mild disease and only 1 (2%) had severe disease who succumbed to her illness. Forty six percent patients delivered vaginally and 54% required cesarean delivery. The most common indication for LSCS was fetal distress (43%). Eighteen percent had preterm delivery. Among the newborn babies, one died due to severe birth asphyxia. Sixteen percent babies required NICU stay. Five babies tested positive for COVID-19 of which one baby was positive on day one of life.Conclusions: As per our results, majority of the COVID-19 positive pregnant women had mild disease. There has been increase in cesarean section rate as compared to the previous hospital figures. Only one baby tested positive within 24 hours of delivery so the possibility vertical transmission can not be commented upon as of today.

scholarly journals Hepatocellular carcinoma in eastern India, a detail analytical report from a tertiary care hospital

2015 ◽  
Vol 1 (1) ◽  
pp. 69 ◽  
Author(s):  
Sudeb Mukherjee ◽  
Kingshuk Dhar ◽  
Suhana Datta ◽  
Apurba Kumar Mukherjee
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Etiologic Agent ◽  
Care Hospital ◽  
Eastern India ◽  
Mild Disease ◽  
B Virus

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Hepatocellular carcinoma is the one of the commonest tumour worldwide.  A detailed clinical profile including its etiology and vast presentation is not available in Eastern India.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>Retrospective chart review of 90 patients with HCCwas done. Total 90 patients (male 81, female9)  fulfillingdiagnostic criteria for HCC adopted by Barcelona-2000 EASL conferencewere analyzed for clinical, etiological, biochemical and radiological profile.</p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>Underlying cirrhosis was seen in 60% cases with Hepatitis B virus being the most common (33.3%) etiologic agent followed by Alcoholism (26.6%) in cirrhotic range. In 76.7% of HCC patients have AFP level more than 500 unit and practically diagnostic of HCC. Almost all patients presented with advanced disease (96.7%). Only 3.3% of HCC patients presented with mild disease.</p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong>The characteristics of HCC in eastern India are somewhat different from the rest of worlds. Alcohol and HBV infection are the two most important etiology prevailing here. </p><p class="keywords"><strong><span lang="EN-US">Keywords: </span></strong>HCC (Hepatocellular carcinoma), AFP (Alpha fetoprotein), HBV (Hepatitis B virus), HCV (Hepatitis C virus)</p>

scholarly journals Hospitalized COVID-19 Patients treated with Convalescent Plasma in a Mid-size City in the Midwest

2020 ◽  
Author(s):  
William Hartman ◽  
Aaron S Hess ◽  
Joseph P Connor
Keyword(s):  
Mechanical Ventilation ◽  
Care Center ◽  
Severe Disease ◽  
Tertiary Care ◽  
The United States ◽  
Severe Illness ◽  
Care Needs ◽  
Course Of Disease ◽  
Effective Option ◽  
Life Threatening

AbstractBackgroundSARS-CoV-2 and its associated disease, COVID-19, has infected over seven million people world-wide, including two million people in the United States. While many people recover from the virus uneventfully, a subset of patients will require hospital admission, some with intensive care needs including intubation, and mechanical ventilation. To date there is no cure and no vaccine is available. Passive immunotherapy by the transfusion of convalescent plasma donated by COVID-19 recovered patients might be an effective option to combat the virus, especially if used early in the course of disease. Here we report our experience of using convalescent plasma at a tertiary care center in a mid-size, midwestern city that did not experience an overwhelming patient surge.MethodsHospitalized COVID-19 patients categorized as having Severe or Life-Threatening disease according to the Mayo Clinic Emergency Access Protocol were screened, consented, and treated with convalescent plasma collected from local donors recovered from COVID-19 infection. Clinical data and outcomes were collected retrospectively.Results31 patients were treated, 16 severe patients and 15 life-threatened patients. Overall mortality was 27% (4/31) but only patients with life-threatening disease died. 94% of transfused patients with severe disease avoided escalation to ICU care and mechanical ventilation. 67% of patients with life-threatening disease were able to be extubated. Most transfused patients had a rapid decrease in their respiratory support requirements on or about day 7 following convalescent plasma transfusion.ConclusionOur results demonstrate that convalescent plasma is associated with reducing ventilatory requirements in patients with both severe and life-threatening disease, but appears to be most beneficial when administered early in the course of disease when patients meet the criteria for severe illness.

scholarly journals 0961 Comparison of Clinical Characteristics of Children With Narcolepsy With and Without Sleep Related Movement Disorders

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A365-A365
Author(s):  
E A McIntyre ◽  
S K Oles ◽  
A Bandyopadhyay ◽  
A Daftary
Keyword(s):  
Movement Disorders ◽  
Clinical Characteristics ◽  
Sleep Problems ◽  
Retrospective Chart Review ◽  
Female Gender ◽  
P Value ◽  
Study Cohort ◽  
Chi Square ◽  
Presenting Symptoms ◽  
Icd 10

Abstract Introduction Narcolepsy is known to be associated with sleep related movement disorders (SRMD) including periodic limb movement and restless leg syndrome. However, there is paucity of data comparing the clinical characteristics of children with narcolepsy with and without SRMD. Methods Retrospective chart review of all children presenting to the sleep clinic for sleep problems between March 2016 to June 2017 was performed. Demographics, sleep intake patient questionnaires and ICD-10 codes for comorbidities and sleep diagnoses were collected. Children with diagnosis of narcolepsy (ICD-10 G47.4) were included in this study. Cohort was divided into 2 groups- with and without co-existing diagnoses of sleep related movement disorders (ICD-10 G47.6). Demographics, presenting symptoms, Epworth sleepiness scores and prevalence of sleep comorbidities were compared using T-test (continuous) and Chi square (categorical). Unadjusted odds ratio was calculated for demographics and presence of SRMD. P value of &lt;0.05 was considered significant. Results 28 (F=14,50%) children with narcolepsy were included. 25% children were diagnosed with SRMD. Mean (SD) age of children with SRMD presenting to the sleep clinic was 11.14 (5.08) years while mean age (SD) of children without SRMD was 9.52 (3.87) years. Age and race of children with and without SRMD were not statistically different. There was an increased prevalence of females in the group with narcolepsy and SRMD compared to the group without SRMD (86%vs38%, p=0.029). Epworth sleepiness score was not statistically different between the 2 groups. Female gender increased the odds of SRMD in children with narcolepsy (OR:9.75, 0.98- 96.56). Conclusion Children with narcolepsy can present with comorbid sleep related movement disorder. Females were more likely to present with associated SRMD compared to males. Support None

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