scholarly journals Multisystem inflammatory syndrome in children related to COVID-19: A systematic review

2020 ◽  
Author(s):  
Levi Hoste ◽  
Ruben Van Paemel ◽  
Filomeen Haerynck
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Case Reports ◽  
Case Definition ◽  
World Health ◽  
Research Database ◽  
Term Outcome ◽  
Male Predominance ◽  
Extracorporal Membrane Oxygenation ◽  
Inflammatory Syndrome

Importance. In April 2020, multiple reports of an association between a hyperinflammatory, Kawasaki-like condition and SARS-CoV-2 were published and termed as pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome (MIS). A thorough characterization of this syndrome (demographics, presentation, diagnosis, and outcome) is currently lacking. Objective. We aimed to perform a systematic review of published cases of this novel multisystem inflammatory syndrome in children associated with COVID-19. Evidence review. A literature search of Pubmed, Embase, BioRxiv, MedRxiv and COVID-19 specific research repositories (Cochrane COVID‐19 Study Register and the World Health Organization (WHO) COVID‐19 Global Research Database) was conducted from December 30th, 2019 to June 30th, 2020. Publications describing inflammatory syndromes associated with COVID-19 were included. Of 333 unique publications, 229 records were excluded based on title and abstract. After screening the full text, 40 observational studies and case reports were included, comprising 687 cases (published between May 9th, 2020 and June 30th, 2020). Findings. In contrast to classic Kawasaki disease, epidemiological enrichment for adolescents (median age 9 [6.0-12.3]) and ethnic minorities (35.8% black and 24.5% Hispanic/Latino) was observed. There was a male predominance (59.1%). Apart from obesity (24.4%), pre-existing conditions were infrequent. The majority suffered from gastrointestinal (87.2%) and cardiocirculatory (79.2%) manifestations. Respiratory symptoms (51.2%) were less frequent. Over half of patients (56.3%) presented with hemodynamic shock, and critical care interventions were often necessary (inotropics (56.5%), mechanical ventilation (22.9%), non-invasive ventilation (30.6%), extracorporal membrane oxygenation (ECMO;4.5%)). Anti-SARS-CoV-2 IgG and RT-PCR were positive in respectively 69.4% and 36.7%. Eleven deaths were reported (1.6%). The RCPCH case definition proved to be most comprehensive comprising all single cases. In contrast, WHO and CDC MIS definitions are more stringent, with the CDC case definition often missing severe cases requiring intensive care (n = 33 out of 95 cases). Conclusions and Relevance. This novel pediatric multisystem hyperinflammatory condition, associated with COVID-19, is characterized by a severe and heterogeneous disease spectrum. Despite frequent intensive care interventions, mortality rate was low and short-term outcome favorable. Long-term follow-up of possible chronic complications and additional clinical research, to elucidate the underlying immunological pathogenesis and possible genetic predisposition is crucial.

scholarly journals Clinicolaboratory Profile, Treatment, Intensive Care Needs, and Outcome of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Vijai Williams ◽  
Nabaneeta Dash ◽  
Renu Suthar ◽  
Vichithra Mohandoss ◽  
Nishant Jaiswal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Clinical Features ◽  
Myocardial Dysfunction ◽  
Random Effect Model ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
World Health ◽  
Research Database ◽  
Care Needs

AbstractThis study was aimed to summarize the current data on clinicolaboratory features, treatment, intensive care needs, and outcome of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2; PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C). Articles published in PubMed, Web of Science, Scopus, Google Scholar, and novel coronavirus disease 2019 (COVID-19) research database of World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) database, and Cochrane COVID-19 study register between December 1, 2019 and July 10, 2020. Observational studies involving patients <21 years with PIMS-TS or MIS-C were reported the clinicolaboratory features, treatment, intensive care needs, and outcome. The search identified 422 citations and finally 18 studies with 833 participants that were included in this study, and pooled estimate was calculated for parameters of interest utilizing random effect model. The median age was 9 (range: 8–11) years. Fever, gastrointestinal symptoms, rash, conjunctival injection, and respiratory symptoms were common clinical features. Majority (84%) had positive SARS-CoV-2 antibody test and only one-third had positive reverse transcript polymerase chain reaction (RT-PCR). The most common laboratory abnormalities noted were elevated C-reactive protein (CRP), D-dimer, procalcitonin, brain natriuretic peptide (BNP), fibrinogen, ferritin, troponin, interleukin 6 (IL-6), lymphopenia, hypoalbuminemia, and thrombocytopenia. Cardiovascular complications included shock (65%), myocardial dysfunction (61%), myocarditis (65%), and coronary artery abnormalities (39%). Three-fourths of children required admission to pediatric intensive care unit (PICU) where they received vasoactive medications (61%) and mechanical ventilation (25%). Treatment strategies used included intravenous immunoglobulin (IVIg; 82%), steroids (54%), antiplatelet drugs (64%), and anticoagulation (51%). Mortality for patients with PIMS-TS or MIS-C was low (n = 13). In this systematic review, we highlight key clinical features, laboratory findings, therapeutic strategies, intensive care needs, and observed outcomes for patients with PIMS-TS or MIS-C. Commonly observed clinical manifestations include fever, gastrointestinal symptoms, mucocutaneous findings, cardiac dysfunction, shock, and evidence of hyperinflammation. The majority of children required PICU admission, received immunomodulatory treatment, and had good outcome with low mortality.

scholarly journals Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on Children—A Systematic Review

2021 ◽  
Vol 18 (5) ◽  
pp. 2361
Author(s):  
Katharina Boldt ◽  
Michaela Coenen ◽  
Ani Movsisyan ◽  
Stephan Voss ◽  
Eva Rehfuess ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Health Management ◽  
Psychosocial Interventions ◽  
Well Being ◽  
World Health ◽  
Research Database ◽  
Psychosocial Effects ◽  
Global Database ◽  
Study Protocols

The aim of this study was to identify interventions targeting children and their caregivers to reduce psychosocial problems in the course of the COVID-19 pandemic and comparable outbreaks. The review was performed using systematic literature searches in MEDLINE, Embase, PsycINFO and COVID-19-specific databases, including the CDC COVID-19 Research Database, the World Health Organisation (WHO) Global Database on COVID-19 Research and the Cochrane COVID-19 Study Register, ClinicalTrials.gov, the EU Clinical Trials Register and the German Clinical Trials Register (DRKS) up to 25th September 2020. The search yielded 6657 unique citations. After title/abstract and full text screening, 11 study protocols reporting on trials planned in China, the US, Canada, the UK, and Hungary during the COVID-19 pandemic were included. Four interventions targeted children ≥10 years directly, seven system-based interventions targeted the parents and caregivers of younger children and adolescents. Outcome measures encompassed mainly anxiety and depressive symptoms, different dimensions of stress or psychosocial well-being, and quality of supportive relationships. In conclusion, this systematic review revealed a paucity of studies on psychosocial interventions for children during the COVID-19 pandemic. Further research should be encouraged in light of the expected demand for child mental health management.

scholarly journals Multisystem inflammatory syndrome in an adolescent girl presenting as atypical Kawasaki-like illness associated with coronavirus disease-19

2021 ◽  
Vol 8 (8) ◽  
pp. 302-304
Author(s):  
Meghmala Sadhukhan ◽  
Ranjit K. Joshi ◽  
Prabin P. Pahi
Keyword(s):  
Intensive Care ◽  
Coronary Artery ◽  
Adolescent Girl ◽  
Similar Case ◽  
World Health ◽  
Intensive Care Admission ◽  
Multisystem Involvement ◽  
The World ◽  
Health Organization ◽  
Inflammatory Syndrome

During the current pandemic of Coronavirus disease (COVID)-19, multiple cases of a new condition in children have been reported with multisystem involvement associated with severe acute respiratory syndrome coronavirus-2, requiring intensive care admission. The World Health Organization has defined it as multisystem inflammatory syndrome in children and adolescents. Here, we report a similar case of a 15-year-old adolescent who presented with clinical features of Kawasaki-like illness along with multisystem involvement. The echocardiogram suggested the presence of coronary artery dilatation and the patient responded well to Intravenous immunoglobulin. Hence, pediatricians need to be aware of this condition in children with multisystemic involvement and these patients need to be treated as early as possible since they may deteriorate quickly.

scholarly journals ASSOCIATION BETWEEN ETHNICITY AND SEVERE COVID-19 DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

2020 ◽  
Author(s):  
Antony Raharja ◽  
Alice Tamara ◽  
Li Teng Kok
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Ethnic Minorities ◽  
Independent Risk Factor ◽  
Case Reports ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Research Database ◽  
All Cause Mortality

Background: Multiple reports suggested disproportionate impact of Covid-19 on ethnic minorities. Whether ethnicity is an independent risk factor for severe Covid-19 illness is unclear. Purpose: Review the association between ethnicity and poor Covid-19 outcomes including all-cause mortality, hospitalisation, critical care admission, respiratory and kidney failure. Data Sources: MEDLINE, EMBASE, Cochrane COVID-19 Study Register, WHO COVID-19 Global Research Database up to 15/06/2020, and preprint servers. No language restriction. Study Selection: All studies providing ethnicity-aggregated data on the pre-specified outcomes, except case reports or interventional trials Data Extraction: Pairs of investigators independently extracted data, assessed risk of bias using Newcastle-Ottawa scale (NOS), and rated certainty of evidence following GRADE framework. Data Synthesis: Seventy-two articles (59 cohort studies with 17,950,989 participants; 13 ecological studies; 54 US-based and 15 UK-based; 41 peer-reviewed) were included for systematic review and 45 for meta-analyses. Risk of bias was low, with median NOS of 7 (interquartile range 6-8). In the unadjusted analyses, compared to white ethnicity, all-cause mortality risk was similar in Black (RR:0.96 [95%CI: 0.83-1.08]), Asian (RR:0.99 [0.85-1.16]) but reduced in Hispanic ethnicity (RR:0.69 [0.57-0.84]). Age and sex-adjusted-risks were significantly elevated for Black (HR:1.38 [1.09-1.75]) and Asian (HR:1.42 [1.15-1.75]), but not for Hispanic (RR:1.14 [0.93-1.40]). Further adjusting for comorbidities attenuated these association to non-significance; Black (HR:0.95 [0.72-1.25]); Asian (HR:1.17 [0.84-1.63]); Hispanic (HR:0.94 [0.63-1.44]). Similar results were observed for other outcomes. In subgroup analysis, there is a trend towards greater disparity in outcomes for UK ethnic minorities, especially hospitalisation risks. Limitations: Paucity of evidence on native ethnic groups, and studies outside US and UK. Conclusions: Currently available evidence cannot confirm ethnicity as an independent risk factor for severe Covid-19 illness, but indicates that disparity may be partially attributed to greater burden of comorbidities. Registration: PROSPERO, CRD42020188421 Funding source: none

scholarly journals Clinico-laboratory profile, intensive care needs, treatment details, and outcome of Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): A systematic review and Meta-analysis

2020 ◽  
Author(s):  
Vijai Williams ◽  
Nabaneeta Dash ◽  
Renu Suthar ◽  
Vichithra Mohandoss ◽  
Nishant Jaiswal ◽  
...  
Keyword(s):  
Intensive Care ◽  
Myocardial Dysfunction ◽  
Random Effect ◽  
Random Effect Model ◽  
Gastrointestinal Symptoms ◽  
Current Data ◽  
Research Database ◽  
Care Needs ◽  
Term Outcome ◽  
Laboratory Features

AbstractObjectivesTo synthesize the current data on clinico-laboratory features, intensive care needs, treatment, and outcome of Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C).Data SourcesArticles published in PubMed, Web of Science, Scopus, Google Scholar, and WHO COVID-19 research database, CDC database, and Cochrane COVID-19 study register between 1st December 2019 to 10th July 2020.Study SelectionObservational studies involving patients ≤21 years with PIMS-TS or MIS-C, that reported the clinico-laboratory features, intensive care needs, treatment, and outcome.Data ExtractionThe search identified 422 citations and finally 18 studies with 833 participants were included and pooled estimate was calculated for parameters of interest utilising random effect model.Data SynthesisThe median age was 9 (8-11) years. Fever, gastrointestinal symptoms, rash, conjunctival injection, and respiratory symptoms were common clinical features. Majority had positive SARS-CoV-2 antibody test and only 1/3rd had RT-PCR positive. The commonest laboratory abnormalities were elevated CRP, D-dimer, procalcitonin, BNP, fibrinogen, ferritin, troponin, and IL-6; and lymphopenia, hypoalbuminemia, and thrombocytopenia. The cardiovascular complications included shock (65%), myocardial dysfunction (61%), myocarditis (65%), and coronary artery abnormalities (39%). Three-fourth children required admission in PICU for mechanical ventilation (25%) and vasoactive drugs (61%). The common treatment provided was IVIG (82%), steroids (54%), antiplatelet drugs (64%), and anticoagulation (51%). The mortality was low (n=13).ConclusionFever, gastrointestinal and mucocutaneous symptoms, cardiac dysfunction, shock, and hyperinflammation are common manifestations of PIMS-TS or MIS-C. The short-term outcome is good with supportive intensive care and immunomodulatory treatment.

scholarly journals Snakebite associated thrombotic microangiopathy: a systematic review of clinical features, outcomes, and evidence for interventions including plasmapheresis

2020 ◽  
Vol 14 (12) ◽  
pp. e0008936
Author(s):  
Tina Noutsos ◽  
Bart J. Currie ◽  
Rachel A. Lek ◽  
Geoffrey K. Isbister
Keyword(s):  
Systematic Review ◽  
Thrombotic Microangiopathy ◽  
Case Reports ◽  
Grey Literature ◽  
Kidney Injury ◽  
Major Complication ◽  
Organ Damage ◽  
Blood Film ◽  
Case Definition

Snakebite is a neglected tropical disease with significant morbidity and mortality. Thrombotic microangiopathy (TMA) is an important but poorly understood complication of snakebite associated with acute kidney injury (AKI). Numerous treatments have been attempted based on limited evidence. We conducted a systematic review of TMA following snakebite using a pre-determined case definition of blood film red cell schistocytes or histologically diagnosed TMA. The search strategy included major electronic databases and grey literature. We present a descriptive synthesis for the outcomes of AKI, dialysis free survival (DFS), other end-organ damage, overall survival, and interventions with antivenom and therapeutic plasmapheresis (TPE). This study was prospectively registered with PROSPERO (CRD42019121436). Seventy-two studies reporting 351 cases were included, predominantly small observational studies. Heterogeneity for study selection, design, reporting and outcomes were observed. The commonest envenoming species were hump-nosed vipers (Hypnale spp.), Russell’s viper (Daboia russelii) and Australian brown snakes (Pseudechis spp.). The prevalence of TMA was at least 5.4% in proven and probable Hypnale bites, and 10–15% of Australian elapid envenomings, AKI occurred in 94% (293/312) of TMA cases, excluding case reports. The majority of cases with AKI required dialysis. Included prospective and retrospective cohort studies reporting interventions and renal outcomes showed no evidence for benefit from antivenom or TPE with respect to DFS in dialysis dependant AKI. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment for quality of accumulated evidence for interventions was low. The major complication of TMA following snakebite is AKI. AKI improves in most cases. We found no evidence to support benefit from antivenom in snakebite associated TMA, but antivenom remains the standard of care for snake envenoming. There was no evidence for benefit of TPE in snakebite associated TMA, so TPE cannot be recommended. The quality of accumulated evidence was low, highlighting a need for high quality larger studies.

scholarly journals COVID-19 infection complicated by Guillain-Barre Syndrome: a systematic review of clinical features, pathogenic mechanism, and respiratory failure

2021 ◽  
Vol 9 (1) ◽  
pp. 34-34
Author(s):  
Mahya Khaki ◽  
Parastoo Dehghan ◽  
Naghmeh Malekzadeh ◽  
Mohsen Khamoushi ◽  
Fahimehalsadat Shojaei ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Clinical Features ◽  
Case Reports ◽  
Case Series ◽  
Diagnostic Workup ◽  
Guillain Barre Syndrome ◽  
World Health ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Background: The World Health Organization (WHO) declared a pandemic in March 2020 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the neurotropism feature of the coronavirus and growing number of COVID-19 associated neurological disorders, including Guillain Barre syndrome (GBS), we conducted a systematic review to thoroughly describe the clinical features, diagnostic workup, and clinical outcome of COVID-19 associated GBS in 78 cases. Methods: We identified case reports and case series of COVID-19 associated GBS by conducting a search in the PubMed/MEDLINE and EMBASE databases. We assessed the quality of studies using an appraisal checklist presented by Cochrane Murad et al. Extracted data included demographic characteristics, clinical presentation, diagnostic workup, and outcome. Results: The systematic search yielded a total of 60 articles reporting 78 patients with a diagnosis of COVID-19 associated GBS. The patients were mainly male (65.3%) with an average age of 57 years. The ascending symmetrical paresis was the most common presentation (79.4%), with demyelinating pattern in 54 patients (79.4%). The CSF analysis showed albuminocytologic dissociation in 48 patients (75%). The mortality of COVID-19 associated GBS was estimated as 6.4% attributable to progressive respiratory failure. Conclusion: Given the associated morbidities such as respiratory failure in patients with COVID-19 associated GBS, its timely detection is crucial to prevent poor clinical outcomes. On the other hand, clinicians must be vigilant to identify the clinical findings of SARS-CoV-2 infection in newly diagnosed GBS patients, as this might be a neurological complication of the subclinical viral infection.

scholarly journals Assessment of the possibility of vertical transmission of COVID-19: A systematic review and meta-analysis protocol

2020 ◽  
Author(s):  
Sareh Dashti ◽  
Tahereh Fathi Najafi ◽  
Hamid Reza Tohidinik ◽  
Narjes Bahri
Keyword(s):  
Systematic Review ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Observational Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
World Health ◽  
Free Text ◽  
Care Providers

Abstract BackgroundThe novel coronavirus 2019 (COVID-19) outbreak has put a great burden on global health and healthcare systems. One of the vulnerable groups to COVID-19 infection and complications is the pregnant women. There is controversy regarding the possibility of vertical transmission of COVID-19 from mother to infant. The aim of this systematic review and meta-analysis was to assess the possibility of vertical transmission of COVID-19 based on currently published literature including observational studies. All published articles including case reports, case series,MethodsThis study will be conducted on all published observational studies, including cross-sectional studies, cohort, case-control, case reports, and case series, in peer reviewed journals in any language until the end of March 2020. Editorials, commentaries and letter to editors will be excluded from the review. Search will be conducted in international bibliographic databases including PubMed, Embase, and Web of Science based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Primary search will be performed in PubMed and Embase using the Coronavirus 2019 and vertical transmission keywords based on medical subject heading (MeSH) terms along with free text searching in combination with Boolean operations. The search strategy will be improved and finalized based on the results of the primary search. The World Health Organization (WHO) and google scholar websites will be searched as grey literature. Articles will be reviewed by two authors independently for the relevance of titles and abstracts. Data extraction of the included articles will be performed by two researchers using the Zotero and review manager (revMan) software. Heterogeneity of the articles will be assessed using DerSimonian & Laird Q test and I 2 statistic. The pooled estimated prevalence of vertical transmission of COVID-19 will be performed using the Metaprop command. Publication bias will be assessed using the Begg's rank correlation and the Egger weighted regression methods.DiscussionThe findings of this systematic review and meta-analysis will help practitioners and health care providers in decision making for the care and management of COVID-19 infected pregnant women. Systematic review registration In process

scholarly journals Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) case reporting in the World Health Organization European Region in 2006

2008 ◽  
Vol 13 (39) ◽  
Author(s):  
I Devaux ◽  
J Alix ◽  
G Likatavicius ◽  
M Herida ◽  
S Nielsen ◽  
...  
Keyword(s):  
Data Collection ◽  
Case Reports ◽  
Case Definition ◽  
Hiv And Aids ◽  
World Health ◽  
European Region ◽  
Reporting Systems ◽  
The World ◽  
Health Organization ◽  
Hiv Aids

This article presents information on HIV and AIDS case reporting systems as part of a survey on HIV/AIDS surveillance practices in the World Health Organization (WHO) European Region. A standardised questionnaire was sent to the 53 national correspondents of the European Centre for the Epidemiological Monitoring of AIDS (EuroHIV). The HIV and AIDS case reporting section of the questionnaire comprised four parts: data collection system, HIV/AIDS case definition for surveillance, variables collected, and evaluation of surveillance systems). Individual-based data collection systems for HIV case reports have been implemented in 43 of 44 countries in the WHO European Region and for AIDS case reports in all the countries. For HIV case reports, a coded identifier is used in 28 countries, and full names are used in 11 countries. The European AIDS case definition has been adopted in 35 countries (80%). Information on molecular epidemiology is available in 30 countries, and HIV drug resistance is monitored in 11 countries. HIV/AIDS case reporting systems have been evaluated for under-reporting in 17 countries and for completeness in 11 countries. This article outlines the future needs for HIV/AIDS surveillance and presents recommendations on how to improve data comparability across European countries in the WHO region

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