CLINICAL AND LABORATORY CHARACTERISTICS OF SARS-COV-2 INFECTION IN CHILDREN AND ADOLESCENTS

ABSTRACT Objective: To present the current evidence on clinical and laboratory characteristics of infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during childhood and adolescence. Data source: This is a narrative review conducted in the databases: Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Latin American and Caribbean Health Sciences Literature in the Virtual Health Library (LILACS/VHL), Scopus, Web of Science, Cochrane Library, portal of the Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES), Scientific Electronic Library Online (SciELO), ScienceDirect, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used were SARS-CoV-2, COVID-19, novel coronavirus, child, newborn, and adolescent. Data synthesis: Unlike adults, most children infected by SARS-CoV-2 have mild or asymptomatic clinical presentations. Symptomatic children mainly have low fever and cough, with some associated gastrointestinal symptoms. Severe cases are rare and occur especially in infants under one year of age. Detection of viral particles in feces seems to be more persistent in children and can be used as a tool for diagnosis and control of the quarantine period. Different from adults, children can present distinct inflammatory responses, as has happened in new cases of Kawasaki-like syndrome associated with SARS-CoV-2 infection. Conclusions: Most children have asymptomatic or mild presentations, with a prevalence of fever, cough, and gastrointestinal symptoms. New cases with different systemic inflammatory reactions in children have been reported, with clinical manifestations distinct from those typically found in adults.

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Effectiveness and safety of antiviral or antibody treatments for coronavirus

10.1101/2020.03.19.20039008 ◽

2020 ◽

Cited By ~ 4

Author(s):

Patricia Rios ◽

Amruta Radhakrishnan ◽

Jesmin Antony ◽

Sonia Thomas ◽

Matthew Muller ◽

...

Keyword(s):

Case Reports ◽

Gastrointestinal Symptoms ◽

Conclusive Evidence ◽

Current Evidence ◽

Cochrane Library ◽

Antiviral Therapies ◽

Unpublished Studies ◽

Novel Coronavirus ◽

Altered Liver ◽

Reporting Rates

ABSTRACTBackgroundTo identify safe and effective medical countermeasures (e.g., antivirals/antibodies) to address the current outbreak of a novel coronavirus (COVID-19)MethodsComprehensive literature searches were developed by an experienced librarian for MEDLINE, EMBASE, the Cochrane Library, and biorxiv.org/medrxiv.org; additional searches for ongoing trials and unpublished studies were conducted in clinicaltrials.gov and the Global Infectious Diseases and Epidemiology Network (GIDEON). Title/abstract and full-text screening, data abstraction, and risk of bias appraisal were carried out by single reviewers.Results54 studies were included in the review: three controlled trials, 10 cohort studies, seven retrospective medical record/database studies, and 34 case reports or series. These studies included patients with severe acute respiratory syndrome (SARs, n=33), middle east respiratory syndrome (MERS, n=16), COVID-19 (n=3), and unspecified coronavirus (n=2). The most common treatment was ribavirin (n=41), followed by oseltamivir (n=10) and the combination of lopinavir/ritonavir (n=7). Additional therapies included broad spectrum antibiotics (n=30), steroids (n=39) or various interferons (n=12). No eligible studies examining monoclonal antibodies for COVID-19 were identified. One trial found that ribavirin prophylactic treatment statistically significantly reduced risk of MERS infection in people who had been exposed to the virus. Of the 21 studies reporting rates of ICU admission in hospitalized SARS or MERS patients, none reported statistically significant results in favour of or against antiviral therapies. Of the 40 studies reporting mortality rates in hospitalized SARS or MERS patients, one cohort study (MERS) and one retrospective study (SARS) found a statistically significant increase in the mortality rate for patients treated with ribavirin. Eighteen studies reported potential drug-related adverse effects including gastrointestinal symptoms, anemia, and altered liver function in patients receiving ribavirin.ConclusionThe current evidence for the effectiveness and safety of antiviral therapies for coronavirus is inconclusive and suffers from a lack of well-designed prospective trials or observational studies, preventing any treatment recommendations from being made. However, it is clear that the existing body of evidence is weighted heavily towards ribavirin (41/54 studies), which has not shown conclusive evidence of effectiveness and may cause harmful adverse events so future investigations may consider focusing on other candidates for antiviral therapy.

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Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

Journal of Child Science ◽

10.1055/s-0040-1717077 ◽

2020 ◽

Vol 10 (01) ◽

pp. e137-e140

Author(s):

Mosaad Abdel-Aziz ◽

Nada M. Abdel-Aziz ◽

Dina M. Abdel-Aziz ◽

Noha Azab

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Clinical Course ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Angiotensin Converting Enzyme 2 ◽

Compulsory Vaccination ◽

Specific Factors ◽

Novel Coronavirus ◽

Radiographic Data

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

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Challenges and Opportunities from Targeting Inflammatory Responses to SARS-CoV-2 Infection: A Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm9124021 ◽

2020 ◽

Vol 9 (12) ◽

pp. 4021

Author(s):

Vincenzo Lariccia ◽

Simona Magi ◽

Tiziano Serfilippi ◽

Marwa Toujani ◽

Santo Gratteri ◽

...

Keyword(s):

Inflammatory Responses ◽

Early Stage ◽

Clinical Care ◽

Current Evidence ◽

Global Pandemic ◽

Challenges And Opportunities ◽

Inflammatory Processes ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Novel Coronavirus

The novel coronavirus disease 2019 (COVID-19) is a global pandemic that continues to sweep across the world, posing an urgent need for effective therapies and prevention of the spread of the severe acute respiratory syndrome related to coronavirus-2 (SARS-CoV-2). A major hypothesis that is currently guiding research and clinical care posits that an excessive and uncontrolled surge of pro-inflammatory cytokines (the so-called “cytokine storm”) drives morbidity and mortality in the most severe cases. In the overall efforts made to develop effective and safe therapies (including vaccines) for COVID-19, clinicians are thus repurposing ready-to-use drugs with direct or indirect anti-inflammatory and immunomodulatory activities. Speculatively, there are many opportunities and challenges in targeting immune/inflammatory processes in the evolving settings of COVID-19 disease because of the need to safely balance the fight against virus and aggressive inflammation versus the suppression of host immune defenses and the risk of additional harms in already compromised patients. To this end, many studies are globally underway to weigh the pros and cons of tailoring drugs used for inflammatory-driven conditions to COVID-19 patient care, and the next step will be to summarize the growing clinical trial experience into clean clinical practice. Based on the current evidence, anti-inflammatory drugs should be considered as complementary approaches to anti-viral drugs that need to be timely introduced in the management of COVID-19 according to disease severity. While drugs that target SARS-CoV-2 entry or replication are expected to confer the greatest benefits at the early stage of the infection, anti-inflammatory drugs would be more effective in limiting the inflammatory processes that drive the worsening of the disease.

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COVID-19 Associated Multisystem Inflammatory Syndrome: A Systematic Review and Meta-analysis

Iranian Journal of Allergy Asthma and Immunology ◽

10.18502/ijaai.v19i6.4927 ◽

2020 ◽

Author(s):

Ashkan Baradaran ◽

Abdolreza Malek ◽

Nasrin Moazzen ◽

Zahra Abbasi Shaye

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Gastrointestinal Symptoms ◽

Multiple Organ ◽

Current Evidence ◽

Cardiac Complications ◽

Clinical Presentations ◽

Atypical Kawasaki Disease ◽

Novel Coronavirus ◽

Inflammatory Syndrome

The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

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Practices in Handling Clinical Samples in a COVID-19 Laboratory - An Experience from Chennai, India

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/711 ◽

2021 ◽

Vol 10 (39) ◽

pp. 3508-3510

Author(s):

Saramma Mini Jacob ◽

Kanagasabai Sivasangeetha ◽

Durairaj Anitha ◽

Singaram Kaplana

Keyword(s):

Wide Spectrum ◽

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

World Health ◽

Clinical Samples ◽

The Novel ◽

Global Pandemic ◽

Novel Coronavirus ◽

Health Organization ◽

Respiratory Droplets

In early January 2020, China had started raising concerns of a new contagious disease caused by new strains of coronavirus, Severe Acute Respiratory SyndromeCoronavirus-2 (SARS-CoV-2). The World Health Organization (WHO) on March 11, 2020, had declared the novel coronavirus (COVID-19) outbreak a global pandemic. COVID-19 was transmitted from person to person through respiratory droplets generated when an infected person coughs, sneezes, breathing or through contact with a surface that has been contaminated 1 and through aerosols-airborne microdroplets.2 The clinical manifestations of COVID-19 represents a wide spectrum of disease ranging from mild to severe respiratory syndrome influenza-like illness with mainly lower respiratory tract symptoms, complicated by pneumonia and Acute Respiratory Distress Syndrome (ARDS), high fever, and headache. In many cases, loss of taste and smell and severe gastrointestinal symptoms were reported, as are cardiac problems, with the latter being perhaps secondary to a cytokine storm such as is seen in the more severely affected patients. 3 WHO COVID-19 dashboard on June 25th 2021 showed 179, 686, 071 confirmed cases worldwide.

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Clinical Benefits of Acupuncture for the Reduction of Hormone Therapy–Related Side Effects in Breast Cancer Patients: A Systematic Review

Integrative Cancer Therapies ◽

10.1177/1534735418786801 ◽

2018 ◽

Vol 17 (3) ◽

pp. 602-618 ◽

Cited By ~ 7

Author(s):

Yuanqing Pan ◽

Kehu Yang ◽

Xiue Shi ◽

Haiqian Liang ◽

Xiping Shen ◽

...

Keyword(s):

Breast Cancer ◽

Side Effects ◽

Hormone Therapy ◽

Cancer Patients ◽

Gastrointestinal Symptoms ◽

Well Being ◽

Current Evidence ◽

Cochrane Library ◽

Breast Cancer Patients

Importance. Acupuncture can help reduce unpleasant side effects associated with endocrine therapy for breast cancer. Nevertheless, comprehensive evaluation of current evidence from randomized controlled trials(RCTs) is lacking. Objective. To estimate the efficacy of acupuncture for the reduction of hormone therapy-related side effects in breast cancer patients. Evidence review. RCTs of acupuncture in breast cancer patients that examined reductions in hormone therapy–related side effects were retrieved from PubMed, EMBASE, Web of Science, Ovid MEDLINE, and Cochrane Library databases through April 2016. The quality of the included studies was evaluated according to the 5.2 Cochrane Handbook standards, and CONSORT and STRICTA (Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture) statements. Intervention. Interventions included conventional acupuncture treatment compared with no treatment, placebo, or conventional pharmaceutical medication. Major outcome measures were the alleviation of frequency and symptoms and the presence of hormone therapy–related side effects. Findings/Results. A total of 17 RCTs, including a total of 810 breast cancer patients were examined. The methodological quality of the trials was relatively rigorous in terms of randomization, blinding, and sources of bias. Compared with control therapies, the pooled results suggested that acupuncture had moderate effects in improving stiffness. No significant differences were observed in hot flashes, fatigue, pain, gastrointestinal symptoms, Kupperman index, general well-being, physical well-being, tumor necrosis factor (TNF), and interleukin (IL). Conclusions. Acupuncture therapy appears to be potentially useful in relieving functional stiffness. However, further large-sample trials with evidence-based design are still needed to confirm these findings.

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Targeting Microbiome: An Alternative Strategy for Fighting SARS-CoV-2 Infection

Chemotherapy ◽

10.1159/000515344 ◽

2021 ◽

Vol 66 (1-2) ◽

pp. 24-32

Author(s):

Ornella Spagnolello ◽

Claudia Pinacchio ◽

Letizia Santinelli ◽

Paolo Vassalini ◽

Giuseppe Pietro Innocenti ◽

...

Keyword(s):

Clinical Manifestations ◽

Gastrointestinal Symptoms ◽

Intestinal Microbiome ◽

Current Evidence ◽

Evidence Based ◽

Intestinal Epithelial ◽

Limited Evidence ◽

Medical Treatments ◽

Intestinal Dysbiosis ◽

Evidence Based Therapy

Respiratory and gastrointestinal symptoms are the predominant clinical manifestations of the coronavirus disease 2019 (COVID-19). Infecting intestinal epithelial cells, the severe acute respiratory syndrome coronavirus-2 may impact on host’s microbiota and gut inflammation. It is well established that an imbalanced intestinal microbiome can affect pulmonary function, modulating the host immune response (“gut-lung axis”). While effective vaccines and targeted drugs are being tested, alternative pathophysiology-based options to prevent and treat COVID-19 infection must be considered on top of the limited evidence-based therapy currently available. Addressing intestinal dysbiosis with a probiotic supplement may, therefore, be a sensible option to be evaluated, in addition to current best available medical treatments. Herein, we summed up pathophysiologic assumptions and current evidence regarding bacteriotherapy administration in preventing and treating COVID-19 pneumonia.

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Current Evidence of the Pharmacological Treatments for Novel Coronavirus Disease 2019 (COVID-19) A Scoping Review

10.1101/2020.05.12.20093997 ◽

2020 ◽

Author(s):

Noyuri Yamaji ◽

Sachiko Ohde ◽

Kimi Estela Kobayashi-Cuya ◽

Shota Saito ◽

Osamu Takahashi

Keyword(s):

Scoping Review ◽

Experimental Studies ◽

Case Series ◽

Severe Infection ◽

Current Evidence ◽

Cochrane Library ◽

The Novel ◽

Pharmacological Treatments ◽

Ongoing Research ◽

Novel Coronavirus

Background: As of May 2 2020, 3,267,184 confirmed cases of COVID-19 and 229,971 COVID-19-caused deaths have been reported worldwide. Currently, there is limited clarity on the pharmacological treatments available for the novel coronavirus. We systematically identified the current evidence and ongoing research on the pharmacological treatments for COVID-19. Methods: We conducted a scoping review using PRISMA-ScR. Observational studies, including cohort studies and case series, as well as experimental studies, including randomized controlled trials (RCTs) and non-RCTs were searched electronically on April 7, 2020 and by hand on May 1, 2020. PubMed, EMBASE, and Cochrane library databases were searched along with seven trial registries. The inclusion criteria were patients with confirmed COVID-19 who received pharmacological therapies, including hydroxychloroquine and chloroquine, lopinavir/ritonavir, remdesivir, tocilizumab, and favipiravir. Results: We identified 222 studies on pharmacological treatment of the novel coronavirus. We included 11 of these studies in this review, including the ones on hydroxychloroquine and chloroquine (one cohort), lopinavir/ritonavir (one RCT, three cohorts, and two case series), remdesivir (one RCT and one case series), tocilizumab (one case series), and favipiravir (one RCT). In the three RCTs carried out in China, both lopinavir/ritonavir and remdesivir did not show any significant earlier clinical improvement in case of severe infection [Hazard ratio (HR): 1.31, p=0.09 and HR: 1.24, p=0.24, respectively], The clinical recovery rate on day seven was not significantly different between the favipiravir and arbidol groups (p=0.14) for moderate patients, although the duration of pyrexia and cough in the favipiravir group was significantly shorter as compared to the arbidol group (p<0.01). There are 135 ongoing RCTs, including 72 for hydroxychloroquine and chloroquine, 29 for lopinavir/ritonavir, 14 for remdesivir, 16 for tocilizumab, and 4 for favipiravir. Conclusion: The clinical effectiveness and safety of these drugs for the treatment of COVID-19 remains unclear owing to the lack of large, high-quality RCTs. However, in the event of emerging infectious diseases, we need to repeatedly and systematically update the best available evidence to avoid misleading information.

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Promoting Factfulness in the Covid-19 pandemic-related policymaking: a map to understanding school closures

10.22541/au.162252898.83343648/v1 ◽

2021 ◽

Author(s):

Raffaella Nenna ◽

Hana Zeric ◽

Laura Petrarca ◽

Enrica Mancino ◽

Fabio Midulla

Keyword(s):

School Closure ◽

Current Evidence ◽

Cochrane Library ◽

School Closures ◽

High Background ◽

Community Transmission ◽

One Year ◽

Closure Policy ◽

The Cost

Introduction: In the era of data-driven decision-making, an unacceptable haziness and inconsistency surrounds the yearlong scientific and public debate on the school closure policy in the COVID-19 pandemic mitigation efforts. Aim: The present literature review stems out of the need for a clear scaffold collecting in one place all current evidence, as well as helping organizing incoming future evidence, concerning both the role of schools in driving the Sars-CoV-2 community spread and the cost-effectiveness of school closure in containing such spread. Methods: References for this review were initially identified through searches of PubMed, Scopus and Cochrane Library for articles published from March, 2020, to March, 2021 by use of the terms “Schools” “COVID-19” “pandemic” “clusters” “outbreak” “seroprevalence”. Further search was undertaken through Google Scholar and ResearchGate, and finally through Google. Results: School closure at times of high background prevalence of COVID-19 should not be considered a measure implemented to protect the health of children. Children had lower secondary attack rates than adults and that they infrequently represented the index case. One year of pandemic has been sufficient for the emergence of one indication of concern: a potentially increased burden of paediatric mental health disorders. Conclusions: A fact-based understanding of what is currently known on such a consequential policy is required to provide a basis of evidence for an advocacy of either school closure or school opening at times of high intensity community transmission of Sars-CoV-2.

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Evaluation of the condition of the eye surface in patients with burdened general somatic history. Early diagnosis, treatment and prevention methods

Fyodorov journal of ophthalmic surgery ◽

10.25276/0235-4160-2020-4-56-62 ◽

2020 ◽

pp. 56-62

Author(s):

I.E. Shvailikova ◽

◽

E.I. Belikova ◽

Keyword(s):

Dry Eye ◽

Postoperative Period ◽

Inflammatory Responses ◽

Clinical Manifestations ◽

Additional Treatment ◽

Dry Eye Syndrome ◽

Comprehensive Treatment ◽

Inflammatory Reactions ◽

Surgical Interventions ◽

Somatic Status

Introduction. Modern computerisation, frequent use of contact correction, surgical interventions on the visual organ and long-term drug installations often lead to the formation and further progression of dry eye syndrome (DES) with subsequent increased sensitivity and inflammatory symptoms on the conjunctiva and cornea. Purpose. Evaluation of the condition of the eye surface in patients with a burdened general somatic history. Development of measures for prevention, diagnosis and comprehensive treatment of this condition. Material and methods. A retrospective analysis of disease histories and medical records of 108 patients (108 eyes) with phacoemulsification of uncomplicated cataract with IOL implantation was carried out. Patients were divided into three main groups based on the presence of burdening factors of somatic status and the course of the postoperative period: I group included patients with unburdened somatic status and no complications during the course of the postoperative period; II group included patients with burdened general somatic history with complications during the course of the postoperative period; 3rd group included patients with burdened general somatic history with complications during the course of the postoperative period. 3rd group of patients used a special scheme to prevent and treat inflammatory reactions from the eye surface. Results. 1st group patients were less likely to complain and had no clinical manifestations of conjunctival and corneal inflammatory responses. Accordingly, this group of patients did not require additional treatment, which is indicative of the low incidence of complications in this category of patients. II group patients who had been identified as predisposing factors for conjunctival and corneal inflammatory reactions and did not receive additional treatment were more likely to experience complaints and the frequency of clinical manifestations was 20% higher than III group patients. Patients in III group required additional treatment in the postoperative period. Conclusion. Prolonged prescription of high doses of drugs of different groups with different preservative and auxiliary substances content in patients after surgical intervention in some cases leads to damage to the conjunctival and corneal epithelium, which in turn causes an aggravation of symptoms of SSG with the development of inflammatory reaction of the conjunctiva and cornea. The application of preventive measures before and after the surgery leads to a significant reduction in the objective manifestations of the eye surface complications and, as a result, a reduction in the number of complaints from patients about discomfort in the postoperative period. Key words: ocular surface, dry eye syndrome, cataract, allergies, tear film stability.

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