scholarly journals Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C)

2021 ◽  
pp. 153537022110285
Author(s):  
Frans A Kuypers ◽  
Christina A Rostad ◽  
Evan J Anderson ◽  
Ann Chahroudi ◽  
Preeti Jaggi ◽  
...  
Keyword(s):  
Severe Disease ◽  
Pediatric Intensive Care ◽  
Cellular Damage ◽  
Inflammasome Activation ◽  
Igg Antibodies ◽  
Secretory Phospholipase ◽  
History Of ◽  
Adults And Children ◽  
Therapeutic Compounds ◽  
Inflammatory Syndrome

Secretory phospholipase 2 (sPLA2) acts as a mediator between proximal and distal events of the inflammatory cascade. Its role in SARS-CoV-2 infection is unknown, but could contribute to COVID-19 inflammasome activation and cellular damage. We present the first report of plasma sPLA2 levels in adults and children with COVID-19 compared with controls. Currently asymptomatic adults with a history of recent COVID-19 infection (≥4 weeks before) identified by SARS-CoV-2 IgG antibodies had sPLA2 levels similar to those who were seronegative (9 ± 6 vs.17 ± 28 ng/mL, P = 0.26). In contrast, children hospitalized with severe COVID-19 had significantly elevated sPLA2 compared with those with mild or asymptomatic SARS-CoV-2 infection (269 ± 137 vs. 2 ± 3 ng/mL, P = 0.01). Among children hospitalized with multisystem inflammatory syndrome in children (MIS-C), all had severe disease requiring pediatric intensive care unit (PICU) admission. sPLA2 levels were significantly higher in those with acute illness <10 days versus convalescent disease ≥10 days (540 ± 510 vs. 2 ± 1, P = 0.04). Thus, sPLA2 levels correlated with COVID-19 severity and acute MIS-C in children, implicating a role in inflammasome activation and disease pathogenesis. sPLA2 may be a useful biomarker to stratify risk and guide patient management for children with acute COVID-19 and MIS-C. Therapeutic compounds targeting sPLA2 and inflammasome activation warrant consideration.

scholarly journals Clinical features and outcome of Covid-19 in individuals without Comorbidities. Do children have the advantage?

2021 ◽  
Vol 8 (2) ◽  
pp. 88-93
Author(s):  
Dr. Abhishek Kumar ◽  
◽  
Dr. Nilu Kumari ◽  
Dr. Ranjeet Kumar Singh ◽  
Dr. Alok Kumar ◽  
...  
Keyword(s):  
Severe Disease ◽  
Age Groups ◽  
Asymptomatic Infection ◽  
Healthy Individuals ◽  
Adult Group ◽  
Middle Aged ◽  
History Of ◽  
Adults And Children ◽  
The Mean ◽  
Respiratory Complaints

Objective: Information regarding clinical characteristics and the natural course of COVID-19amongst individuals without comorbidities is scarce. We therefore conducted a retrospectiveobservational study to decipher the disease profile in two different age groups, middle-aged (40-59years) and children (up to 12 years). Method: Study was conducted by reviewing the medicalrecords of all patients in the desired age groups and excluding all those with preexisting illness(called comorbidities). Result: A total of 154 and 27 patients were enrolled and studied in themiddle-aged adults and children group respectively. Males dominated in both groups with a sex ratioof 2.9 in adults and 1.7 in children. Most of the children (92.5%) had a history of exposure from aninfected family member, while in the adult group history of contact was present in 71.4% ofpatients.62.9% of children had an asymptomatic infection which was significantly higher than 22.8%in adults. Cough and fever were the most common symptoms in both age groups, but adults weremore likely to have respiratory complaints when compared with children.11 (7.1%) patients in theadult group had severe disease while in the children group none had severe disease. Similarly in theadult group 11 patients required ICU admission, but none in the children group. The mean durationof RTPCR positivity was similar in both groups. There was 1 (0.6%) expiry in the adult groupwhereas none in children. Conclusion: Healthy individuals in both middle-aged and children grouptend to have milder disease and both harbour the virus for the almost same duration but adults aremore symptomatic in comparison to children and hence children are more likely to be potentialasymptomatic carrier and transmitter of infection.

scholarly journals First reported case of Multisystem Inflammatory Syndrome in children in West Texas

2021 ◽  
Vol 9 (37) ◽  
pp. 66-69
Author(s):  
Ryan Dean ◽  
Monisha Narayanan ◽  
Evan Nix ◽  
Kinsley Stepka ◽  
Raphael Mattamal
Keyword(s):  
Inflammatory Markers ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Cervical Lymphadenopathy ◽  
Pediatric Intensive Care ◽  
Maculopapular Rash ◽  
High Dose ◽  
West Texas ◽  
History Of ◽  
Inflammatory Syndrome

Research focusing on COVID-19-associated complications has become a growing area of importance. One such complication is multisystem inflammatory syndrome, a rare immune-mediated condition that most commonly presents with Kawasaki-like symptoms in the pediatric population. Potential complications include myocarditis, renal impairment, and cytokine storm. Here we describe the first reported case of multisystem inflammatory syndrome in the West Texas region, presenting in a Hispanic 5-year-old female with a recent history of COVID-19. The patient arrived to the hospital with a 4 day history of high fever, a 2 day history of diffuse maculopapular rash, and complaints of fatigue, generalized body aches, decreased appetite, headache, and abdominal pain. Further physical exam revealed hepatosplenomegaly and cervical lymphadenopathy, while labs revealed elevated inflammatory markers, lymphopenia, left shift with bandemia and immature cells, thrombocytopenia, hypoalbuminemia, and transaminitis. The patient was admitted to the pediatric intensive care unit with a suspected Kawasaki-like illness and started on high dose aspirin and IV immunoglobulin. She was placed on methylprednisolone, albumin, and acetaminophen on hospital day 3. By hospital day 4, the patient defervesced, inflammatory markers decreased, and clinical symptoms improved. The patient was discharged on hospital day 10 with absent fever and improvement of clinical symptoms for 6 consecutive days. No complications were detected upon follow-up 2 weeks later. A low threshold of suspicion for this illness is required in any child with a history of SARS-CoV-2 infection, as the presentation is vague and early identification is necessary to prevent further complications.

scholarly journals Unusual Presentation of Kawasaki Disease with Multisystem Inflammation and Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2: A Case Report

2020 ◽  
Author(s):  
Haena Kim ◽  
Jung Yeon Shim ◽  
Jae-Hoon Ko ◽  
Aram Yang ◽  
Jae Won Shim ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Severe Acute Respiratory Syndrome ◽  
Signs And Symptoms ◽  
Enzyme Linked Immunosorbent Assay ◽  
Igg Antibodies ◽  
Case Presentation ◽  
History Of ◽  
Polymerase Chain ◽  
High Index Of Suspicion ◽  
Inflammatory Syndrome

Abstract Background: Since mid-April 2020, cases of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease (COVID-19) that mimic Kawasaki disease (KD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever and abdominal pain. He had no contact history to any patient with COVID-19. Blood acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis, but he suddenly developed hypotension. Inotropics and intravenous immunoglobulin were administered to manage septic shock. On hospitalization day 6, he developed signs and symptoms of KD (conjunctival injection, strawberry tongue, cracked lip, and coronary artery dilatation) in addition to pleural/pericardial effusion and mesenteric lymphadenitis. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), were negative. Fluorescent immunoassay and enzyme-linked immunosorbent assay revealed abundant IgG antibodies against SARS-CoV-2 in his serum, but no IgM antibodies. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children with a previously asymptomatic COVID-19 infection. A high index of suspicion is required for this novel syndrome in unusual cases of KD or KD shock syndrome with multisystem inflammation, even when there is no clear history of contact or symptoms of COVID-19.

scholarly journals COVID-19 and Multisystem Inflammatory Syndrome in Latin American children: a multinational study

2020 ◽  
Author(s):  
Omar Yassef Antunez-Montes ◽  
Maria Isabel Escamilla ◽  
Augusto Flavio Figueroa-Uribe ◽  
Erick Arteaga-Menchaca ◽  
Manuel Lavariega-Sarachaga ◽  
...  
Keyword(s):  
Latin American ◽  
Medical Condition ◽  
Severe Disease ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Severe Form ◽  
Current Evidence ◽  
Lower Socioeconomic ◽  
American Children ◽  
Inflammatory Syndrome

Background To date, there are no comprehensive data on pediatric COVID19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS C) in Latin American children, in order to appropriately plan and allocate resources to face the pandemic on a local and International lever Methods Ambispective multicentre cohort study from five Latin American countries. Children aged 18 years or younger with microbiologically confirmed SARS CoV 2 infection were included. Findings 409 children were included, with a median age of 53.0 years (IQR 0.6 9.0). Of these, 95 191 (23.2%) were diagnosed with MIS C. 191 (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a Pediatric Intensive Care Unite (PICU). 92 (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure (CPAP) and 29 (7%) on mechanical ventilation. 35 (8.5%) patients required inotropic support. The following factors were associated with PICU admission: pre-existing medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P< 0.0001), gastrointestinal symptoms (P = 0.006), radiological changes suggestive of pneumonia and acute respiratory distress syndrome (P< 0.0001), low socioeconomic conditions (P 0.009). Conclusions This study shows a generally more severe form of COVID 19 and a high number of MIS C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hyspanic children or in people of lower socioeconomic level. The findings highlight an urgent need of more data of COVID 19 in South America.

Corticosteroids in Inflammatory Bowel Disease patients: a practical guide for physicians.

2020 ◽  
Vol 15 ◽  
Author(s):  
Maria Carla Di Paolo ◽  
Cristiano Pagnini ◽  
Maria Giovanna Graziani
Keyword(s):  
Severe Disease ◽  
Unknown Etiology ◽  
History Of Disease ◽  
Bowel Diseases ◽  
Literature Evidence ◽  
History Of ◽  
Inflammatory Bowel ◽  
Favorable Safety ◽  
Pass Metabolism

: Inflammatory bowel diseases (IBDs) are chronic conditions characterized by unknown etiology and pathogenesis with deregulation of mucosal immunity. Among possible treatments, corticosteroids, already available from the 50’, are still the mainstay of treatment for moderate-severe disease. Nonetheless, the use of steroids is still largely empirical and solid evidence about therapeutic schemes are lacking. Moreover, due to the important side-effects and for the unsatisfactory impact on long-term natural history of disease, the steroid sparing has become an important therapeutic goal in IBD management. Besides conventional steroids, the so called “low bioavailability” steroids, which are steroids with high affinity for peripheral receptors and elevated hepatic first-pass metabolism, have demonstrated efficacy and more favorable safety profile. In the present review of the literature evidence of efficacy and safety of conventional and low bioavailability steroids in IBD patients are evaluated, and practical suggestions for a correct use in clinical practice are presented according to the current clinical guidelines.

scholarly journals Flavonoids: Nutraceuticals for Rheumatic Diseases via Targeting of Inflammasome Activation

2021 ◽  
Vol 22 (2) ◽  
pp. 488
Author(s):  
Young-Su Yi
Keyword(s):  
Rheumatic Diseases ◽  
Fruits And Vegetables ◽  
Inflammatory Responses ◽  
Protein Complexes ◽  
Cellular Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Inflammasome Activation ◽  
Central Feature ◽  
Inflammatory Protein ◽  
Anti Inflammatory

Inflammation, an innate immune response that prevents cellular damage caused by pathogens, consists of two successive mechanisms, namely priming and triggering. While priming is an inflammation-preparation step, triggering is an inflammation-activation step, and the central feature of triggering is the activation of inflammasomes and intracellular inflammatory protein complexes. Flavonoids are natural phenolic compounds predominantly present in plants, fruits, and vegetables and are known to possess strong anti-inflammatory activities. The anti-inflammatory activity of flavonoids has long been demonstrated, with the main focus on the priming mechanisms, while increasing numbers of recent studies have redirected the research focus on the triggering step, and studies have reported that flavonoids inhibit inflammatory responses and diseases by targeting inflammasome activation. Rheumatic diseases are systemic inflammatory and autoimmune diseases that primarily affect joints and connective tissues, and they are associated with numerous deleterious effects. Here, we discuss the emerging literature on the ameliorative role of flavonoids targeting inflammasome activation in inflammatory rheumatic diseases.

The contamination of trauma. Traumatized minds, broken families and dysfunctional work groups: Organizational and interpersonal dynamics in complex child welfare court proceedings

2021 ◽  
pp. 053331642110150
Author(s):  
Stuart Stevenson
Keyword(s):  
Decision Making ◽  
Work Groups ◽  
Work Group ◽  
Best Interests ◽  
Organizational Dynamics ◽  
Children And Families ◽  
Vulnerable Children ◽  
History Of ◽  
Adults And Children ◽  
Court Proceedings

Professional work groups engaging with traumatized and dysfunctional families are presented with a disproportionate challenge to an already inevitably painful process that can be an obstacle to balanced decision-making in the children’s best interests. Trauma, abuse and neglect can influence the professional culture that condenses around these families. This occurs more often with the most challenging families with a possible history of professional failure resulting in professional conflict, impulsive and poor decision-making due to the occasions that these destructive dynamics have become unmanageable. Serious case reviews into the deaths of children regularly outline professional failures relating to a breakdown in communication within the professional system and essential and potential lifesaving information having been lost or failing to have been acted upon. The ability to understand complex group and organizational dynamics and the ability to manage relationships with traumatized adults and children, as well as within traumatized work groups is, therefore, an essential skill set for professionals working with the most vulnerable children and families. This article explores trauma and its impact on a work group and why this process was disturbed by uncontained anxiety resulting in professional conflict.

scholarly journals COVID-19 in a Cohort of Patients with Congenital Myasthenic Syndrome

2021 ◽  
pp. 1-3
Author(s):  
Setareh Alabaf ◽  
Karen O'Connell ◽  
Sithara Ramdas ◽  
David Beeson ◽  
Jacqueline Palace
Keyword(s):  
High Risk ◽  
Neuromuscular Transmission ◽  
Genetic Disorders ◽  
Severe Disease ◽  
Congenital Myasthenic Syndrome ◽  
Referral Centre ◽  
History Of ◽  
Myasthenic Syndrome ◽  
The Uk ◽  
Rare Group

Congenital Myasthenic Syndrome (CMS) are a rare group of genetic disorders of neuromuscular transmission. Some subtypes of CMS can be associated with respiratory and bulbar weakness and these patients may therefore be at high risk of developing a severe disease from COVID-19. We screened 73 patients with genetically confirmed CMS who were attending the UK national referral centre for evidence of previous Severe Acute Respiratory Syndrome Corona Virus 2 infection and their clinical outcome. Of 73 patients, seven had history of confirmed COVID-19. None of the infected patients developed a severe disease, and there were no signals that CMS alone carries a high risk of severe disease from COVID-19.

scholarly journals 1641. A Comparative Analysis Of Lymph Node Tuberculosis Between Children And Adults

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S810-S810
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Amal Chakroun ◽  
Khaoula Rekik ◽  
Fatma Smaoui ◽  
...  
Keyword(s):  
Lymph Node ◽  
Family History ◽  
Extrapulmonary Tuberculosis ◽  
Diagnostic Delay ◽  
Disease Evolution ◽  
Evolutionary Features ◽  
Significant Difference ◽  
History Of ◽  
Adults And Children ◽  
Lymph Node Tuberculosis

Abstract Background Lymph node tuberculosis (LNTB) represents the most common site of extrapulmonary tuberculosis. Among children, due to non-specific clinical features, the diagnosis is often delayed. We aimed to compare the clinical, therapeutic and evolutionary features of LNTB between adults and children. Methods We conducted a retrospective study including patients hospitalized for LNTB in the infectious diseases and pediatric department between 1993 and 2018. Children aged ≤18 years were included. Results Overall, we encountered 231 cases of LNTB. There were 40 children (17.3%) with a mean age of 11±4 years and 191 adults (82.7%) with a mean age of 42±16 years. As to gender, females were more affected (adults: 67% vs children: 70%), with no significant difference (p &gt;0.05). A family history of tuberculosis was significantly more frequent among children (20% vs 6.3%; p=0.01). Raw milk consumption (38.2% vs 30%; p &gt;0.05) and close contact with animals (29.8% vs 35%; p &gt;0.05) were noted among both adults and children. Fever (53.4% vs 32.5%; p=0.01), night sweats (35.8% vs 10%; p=0.001), loss of appetite (38.2% vs 17.5%; p=0.01) and weight loss (35.1% vs 15%; p=0.01) were significantly more frequent among adults. Tuberculin skin test was positive in 75.8% of the cases among adults and in 86.2% of the cases among children (p &gt;0.05). Multifocal tuberculosis was significantly more frequent among adults (23.8% vs 5.7%; p=0.01). Antitubercular therapy was prescribed for a mean duration of 10±4 months among adults and for 9±3 months among children, with no significant difference (p &gt;0.05). Side effects of antitubercular drugs were more frequent among adults (33% vs 10.3%), with a significant difference (p=0.004). Comparison of the disease evolution showed no significant difference between adults and children, regarding recovery (94.8% vs 90%), relapse (5.2% vs 5%) and death (0.5% vs 2.5%). Conclusion The clinical presentation of LNTB among children was less common and misleading. A family history of tuberculosis and a high index of suspicion might shorten the diagnostic delay. Disclosures All Authors: No reported disclosures

scholarly journals COVID-19 in Children: Expressions of Type I/II/III Interferons, TRIM28, SETDB1, and Endogenous Retroviruses in Mild and Severe Cases

2021 ◽  
Vol 22 (14) ◽  
pp. 7481
Author(s):  
Pier-Angelo Tovo ◽  
Silvia Garazzino ◽  
Valentina Daprà ◽  
Giulia Pruccoli ◽  
Cristina Calvi ◽  
...  
Keyword(s):  
Viral Infections ◽  
Severe Disease ◽  
Endogenous Retroviruses ◽  
Type I ◽  
Human Endogenous Retroviruses ◽  
Moderate Disease ◽  
Amplification Assay ◽  
Positive Correlations ◽  
Inducible Genes ◽  
Inflammatory Syndrome

Children with the new coronavirus disease 2019 (COVID-19) have milder symptoms and a better prognosis than adult patients. Several investigations assessed type I, II, and III interferon (IFN) signatures in SARS-CoV-2 infected adults, however no data are available for pediatric patients. RIM28 and SETDB1 regulate the transcription of multiple genes involved in the immune response as well as of human endogenous retroviruses (HERVs). Exogenous viral infections can trigger the activation of HERVs, which in turn can induce inflammatory and immune reactions. Despite the potential cross-talks between SARS-CoV-2 infection and TRIM28, SETDB1, and HERVs, information on their expressions in COVID-19 patients is lacking. We assessed, through a PCR real time Taqman amplification assay, the transcription levels of six IFN-I stimulated genes, IFN-II and three of its sensitive genes, three IFN-lIIs, as well as of TRIM28, SETDB1, pol genes of HERV-H, -K, and -W families, and of env genes of Syncytin (SYN)1, SYN2, and multiple sclerosis-associated retrovirus (MRSV) in peripheral blood from COVID-19 children nd in control uninfected subjects. Higher expression levels of IFN-I and IFN-II inducible genes were observed in 36 COVID-19-infected children with mild or moderate disease as compared to uninfected controls, whereas their concentrations decreased in 17 children with severe disease and in 11 with multisystem inflammatory syndrome (MIS-C). Similar findings were found for the expression of TRIM-28, SETDB1, and every HERV gene. Positive correlations emerged between the transcriptional levels of type I and II IFNs, TRIM28, SETDB1, and HERVs in COVID-19 patients. IFN-III expressions were comparable in each group of subjects. This preserved induction of IFN-λs could contribute to the better control of the infection in children as compared to adults, in whom IFN-III deficiency has been reported. The upregulation of IFN-I, IFN-II, TRIM28, SETDB1, and HERVs in children with mild symptoms, their declines in severe cases or with MIS-C, and the positive correlations of their transcription in SARS-CoV-2-infected children suggest that they may play important roles in conditioning the evolution of the infection.

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