A Prospective Study of Clinical, Epidemiological and Serologic Status Features in a Paediatric Pcr Sars-Cov-2 Positive Population

Abstract Background:Although most cases of SARS-CoV-2 infection in pediatric population are asymptomatic or mild, severe cases may occur in a small percentage. Unlike other respiratory infections, children usually develop it from infected adults. Percentage of seroconversión and outcome of antibodies after infection anti-SAR-CoV-2 in children are still poorly understood and may be different from adults. The first aim was to describe clinical and epidemiological characteristics of pediatric patients diagnosed of SARS-CoV-2 infection in the second epidemic wave in two tertiary hospitals in Madrid, Spain and to determine the proportion of seronegative by comparing 3 serological techniques. As secondary aim it was proposed to determine the proportion of seronegative by comparing 3 serological techniques, seroconversion associated variables and the way of infection among the family members. Methods:Multicenter prospective observational study in two university hospitals of the Community of Madrid, between September and November 2020, of COVID-19 infection confirmed by PCR in the Emergency Department. A retrospective data collection was performed at 4-8 weeks after diagnosis on an outpatient basis, using a clinical-epidemiological questionnaire. At this time blood samples were collected to analyse the humoral response by 3 different serological assays.The quantitative variables are expressed as medians (interquartile range (IQR) 25-75).Univariate analysis of possible factors associated with seropositivity absence was performed.Results: One hundred and eleven patients (58 girls) were included with a median days of 37 (IQR: 34-44) between diagnosis and serologic test performed.Median age was 88 (IQR: 24-149) months. Parents were from abroad in 62 cases (50% from South and Central America).Ninety eight children were symptomatic, 17 children were diagnosed by epidemiological screening, 4 of whom subsequently developed symptoms.Eight of them needing admission with a median length of stay 2 days (IQR: 2-4), none of them in PICU.Underlying conditions were found in 33 patients, mainly recurrent bronchitis.Most frequent symptoms (70%) were low-grade fever (37-38ºC) or fever (≥ 38ºC), rhinorrhea 44%, cough 31.5%, headache 29.7%, weakness 27%, diarrhea 19.8%, abdominal pain and vomiting 26%, anosmia 16.2% (median 10 days; IQR: 6-30). Infection was interpreted as a secondary case in 56 patients, being a relative the index case in 96.4%. Seronegativity was observed in 19 patients in any of the 3 serological techniques (17.1%; 95% CI: 10.6-25.4), this proportion was higher among children aged 2-to 10-year-old age (16 of 45; 35%, p <0.05).In univariate analysis a lower proportion of seroconversion was found in those children in whom COVID-19 confirmation is not documented among household contacts (15/29; 51.7%; p <0.05). Conclusions: Our results confirm the mild clinical picture in children during the second epidemic wave, and that in most cases, children are not the index case in the family. Likewise, in children the proportion in whom seroconversion is not detected is high, and seems higher than that reported in adults. In our series, an association of seronegativity was seen in the 2 to 10 year-old age group and when there was no documentation of COVID-19 in any household contact.

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Methicillin-Resistant Staphylococcus aureus Prevalence Among Healthcare Workers in Contact Tracings in a Dutch Hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.910 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s316-s317

Author(s):

Veronica Weterings ◽

Heidi Kievits ◽

Miranda van Rijen ◽

Jan Kluytmans

Keyword(s):

Staphylococcus Aureus ◽

The Netherlands ◽

Healthcare Workers ◽

Index Case ◽

Contact Tracing ◽

Secondary Case ◽

National Guidelines ◽

Carriage Rate ◽

Methicillin Resistant ◽

Mlva Type

Background: In The Netherlands, the national guidelines on Methicillin-Resistant Staphylococcus aureus (MRSA) prevention and control advocate screening of healthcare workers (HCWs) after unprotected exposure to MRSA carriers. Although this strategy is largely successful, contact tracing of staff is a time-consuming and costly component. We evaluated our contact tracing policy for HCWs over the years 2010–2018. Methods: A retrospective, observational study was performed in a Dutch teaching hospital. All HCWs who had unprotected contact with an MRSA carrier were included in contact tracing. When there had been a long period of unprotected admission prior to an MRSA finding, or when the index case was an HCW, the entire (nursing) team was tested. All samples of HCWs who were tested for MRSA carriage as part of contact tracing from 2010 until 2018 were included. A pooled nose, throat, and perineum swab was collected using the eSwab medium (Copan) and inoculated on chromID MRSA agar plates (bioMérieux) after enrichment in a broth. Molecular typing was performed using multiple-locus variable number of tandem repeat analysis (MLVA). Results: In total, we included 8,849 samples (range, 677–1,448 samples per year) from 287 contact tracings (range, 26–55 contact tracings per year). Overall, 32 HCWs were colonized with MRSA (0.36%; 95% CI, 0.26%–0.51%). None of them developed a clinical infection. Moreover, 8 HCWs (0.10%; 95% CI, 0.05%–0.19%) were colonized with the same MLVA type as the index case and were detected in 6 of 287 contact tracings (2%). In 4 of 8 of these cases, a positive HCW was the index for undertaking contact tracing. In 3 of 8 cases, it was clear that the HCW who was identified in the contact tracing was the source of the outbreak and was the cause of invasive MRSA infections in patients. Notably, a different MLVA type as the index case was found in 24 HCWs (0.27%; 95% CI, 0.18%–0.40%) of whom 7 of 24 HCWs (29.2%) were intermittent carriers. Conclusions: This study revealed a sustained low MRSA prevalence among samples in contact tracing of HCWs over 9 years. Furthermore, it shows that when MRSA contact tracing is performed according to the national guideline, only 1 of 1,000 samples results in a secondary case. This is similar to the population carriage rate of MRSA in The Netherlands. More frequently, an unrelated strain is found. These findings raise questions regarding the efficacy of the current strategy to perform contact tracing after unprotected exposure.Funding: NoneDisclosures: None

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Pathobiology ofHelicobacter pyloriInfection in Children

Canadian Journal of Gastroenterology ◽

10.1155/1999/591767 ◽

1999 ◽

Vol 13 (7) ◽

pp. 599-603 ◽

Cited By ~ 25

Author(s):

Robert H Riddell

Keyword(s):

Intestinal Metaplasia ◽

Pediatric Population ◽

Paediatric Population ◽

Lymphoid Hyperplasia ◽

Host Responses ◽

Low Grade ◽

Cell Axis ◽

Age Related ◽

H Pylori ◽

Time Required

In the paediatric population, the associations ofHelicobacter pyloriwith gastritis, gastric ulcer, duodenitis and duodenal ulcer, and with duodenal gastric surface metaplasia and disorders of the D cell-G cell axis resulting in hypergastrinemia, are well established and in many ways resemble their counterparts in adults. Eradication ofH pyloriinvariably results in the reversal of these diseases with time. There are also suggestions that gastric surface metaplasia is more extensive in children withH pylori, and may be the site of duodenalH pyloriinfection and associated duodenal erosions or ulcers. There is no consensus as to whetherH pyloriin children is more or less severe than in adults. In one paediatric cohort,H pyloriwas associated with increased intensity of inflammation, while other studies suggest that acute inflammation may be less intense in children overall but that chronic inflammation may be increased in intensity, including lymphoid hyperplasia, which in turn may correlate with endoscopic nodularity. Lymphoid hyperplasia and nodular gastritis appear to be more frequent in children than in adults and usually regress followingH pylorieradication. However, in children, other diseases or morphological abnormalities, including some loss of glands (atrophy), occasionally intestinal metaplasia, lymphoproliferative diseases including low grade mucosal-associated lymphoid tissue lymphoma, lymphocytic gastritis and hypertrophic gastritis/Menetrier’s disease, are much less frequently associated withH pylorithan in adults. Other associations are rarely seen in children, primarily because the time required for these to develop takes the individual to adulthood; for example, while intestinal metaplasia occurs in the pediatric population, the complications of adenoma/dysplasia and carcinoma are rare. In adults, inflammatory and hyperplastic polyps, atrophic gastritis and pernicious anemia, and in some patients granulomas (granulomatous gastritis), may also be associated withH pyloriinfection. Greater awareness of the spectrum of diseases associated withH pylorimay well lead to their increased recognition in the paediatric population. Some diseases, particularly Crohn’s disease, but also human immunodeficiency virus infection, have a negative association withH pylorithat appears not to be simply a result of the excess antibiotic therapy that these patients receive. These variations in association and reactions toH pylori, some of which are age-related, may allow the different host responses toH pylorithat occur in humans to be examined.

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LGG-28. NOVEL BRAF INTRAGENIC DELETION IN A GLIOMA: A CASE REPORT OF A PEDIATRIC PATIENT

Neuro-Oncology ◽

10.1093/neuonc/noaa222.410 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii371-iii372

Author(s):

Valerie Cruz Flores ◽

Maxine Sutcliffe ◽

Thomas Geller ◽

Ignacio Gonzalez Gomez ◽

Stephanie Smith ◽

...

Keyword(s):

Pediatric Patient ◽

Pilocytic Astrocytoma ◽

Pediatric Population ◽

Binding Pocket ◽

Genetic Alterations ◽

Low Grade ◽

Braf Gene ◽

Intragenic Deletion ◽

Whole Genome Microarray ◽

Intragenic Deletions

Abstract BACKGROUND Numerous variant BRAF genetic alterations have been associated with malignancies. BRAF activating fusions/mutations are frequently present in low grade gliomas. BRAF intragenic deletions have been reported in melanoma, but have not previously been reported in gliomas. OBJECTIVE To report a BRAF intragenic deletion in a pediatric patient with recurrent low-grade glioma. RESULTS A 3-year-old female underwent a complete resection of a posterior fossa pilocytic astrocytoma. She had recurrences at age 4, and then at age 9; pathology was consistent with pilocytic astrocytoma. Microarray analysis on sample from the first recurrence showed one region of loss encompassing 86 Kbp within the BRAF gene. The deletion breakpoints are within intron 1 and 9, resulting in loss of exons 2 through 9, inclusive. This has been previously described melanoma, but appears to be a novel finding in glioma. It is hypothesized that, since the loss retains the kinase and ATP binding pocket domains but deletes the N-terminal conserved region 1 and 2 (CR1, CR2) of the BRAF gene, it is likely functionally similar to the loss and activation resulting from the more usually described KIAA1549 and BRAF gene fusion. CONCLUSION This is the first BRAF intragenic deletion involving exons 2–9 reported in a glioma. Although 86kbp is small using whole genome microarray technology, it is large using sequencing strategies, and a targeted sequencing approach to investigate the BRAF gene would not readily identify this deletion. It is speculated that the deletion may be under ascertained in the pediatric population.

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THE FAMILY HISTORY OF SPINA BIFIDA CYSTICA

PEDIATRICS ◽

10.1542/peds.35.4.589 ◽

1965 ◽

Vol 35 (4) ◽

pp. 589-595

Author(s):

John Lorber

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Spina Bifida ◽

Index Case ◽

Progressive Increase ◽

Point Of View ◽

The Family ◽

History Of ◽

The Central Nervous System ◽

Spina Bifida Cystica

1. The family histories of 722 infants who were born with spina bifida cystica were studied. 2. The index cases were referred for surgical treatment and were not selected in any way from the genetic point of view. 3. Intensive inquiries were made to obtain a complete family pedigree, including a prospective follow-up of siblings born after the index case. 4. Of 1,256 siblings 85 or 6.8% had gross malformation of the central nervous system: spina bifida cystica in 54, anencephaly in 22, and uncomplicated hydrocephalus in 9. 5. Of 306 children born after the index case 25 (8%) or 1 in 12 were affected. 6. There was a progressive increase in multiple cases in the family with increasing family size. In sibships of five or more, multiple cases occurred in 24.1%. 7. In 118 families cases of gross malformation of the central nervous system were known to have occurred among members of the family other than siblings. Cases occurred in three generations. 8. It is possible that spina bifida cystica might be a recessively inherited condition.

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Gender and Social Security: Some Lessons from Europe

European Journal of Social Security ◽

10.1023/a:1021328903833 ◽

2002 ◽

Vol 4 (3) ◽

pp. 227-239 ◽

Cited By ~ 3

Author(s):

Ann-Charlotte Ståhlberg

Keyword(s):

Social Security ◽

Labour Market ◽

Old Age ◽

Gender Inequality ◽

Sickness Benefit ◽

Men And Women ◽

Dual Earner ◽

The Family ◽

Gender Neutral ◽

The Individual

Different social security schemes affect men and women differently. This article compares the family or single earner model with the individual or dual earner model and examines their impact on gender inequality. However, even where social security schemes are designed to be gender neutral, when applied in a context that is systematically structured by gender, it points out that they will have a different impact on men and women. The article examines the ways in which supposedly gender-neutral rules, in sickness benefit, survivors' pensions and old age pensions have affected men and women in Sweden and concludes that, if countries wish to achieve equal economic outcomes for men and women, they will need to introduce measures to equalise men's and women's commitments to the home and the labour market, and to enable women to attain higher-paid jobs on the same basis as men.

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Cat-Scratch Disease

Otolaryngology ◽

10.1177/019459988609400616 ◽

1986 ◽

Vol 94 (6) ◽

pp. 622-627 ◽

Cited By ~ 4

Author(s):

James R. Spires ◽

Richard J.H. Smith

Keyword(s):

Symptomatic Relief ◽

Lymph Node Involvement ◽

Low Grade ◽

Outpatient Basis ◽

Cat Scratch Disease ◽

Cutaneous Infections ◽

Recommended Treatment ◽

Disease Spectrum ◽

Granulomatous Lymphadenitis ◽

Initial Description

Cat-scratch disease has been reported with increasing frequency since its initial description in 1931. It is now recognized as being so prevalent that it probably represents the most common cause of unilateral lymphadenopathy in children, once nonspecific viral diseases and cutaneous infections have been excluded. The cardinal feature of the disease is a subacute regional granulomatous lymphadenitis. Because of its relatively mild natural course, most cases are treated on an outpatient basis. Forty-four children, representing the more seriously ill portion of the disease spectrum, were treated at Texas Children's Hospital from 1972 to 1984 and constitute the data base for this article. Most patients were symptomatic for nearly 1 month prior to admission, typically complaining of low-grade fever and regional lymphadenopathy. The two most common sites of lymph node involvement were the axilla (54%) and the neck (46%). Although there is, at this time, no specifically recommended treatment, 80% of patients received antibiotics and 70% underwent a surgical procedure—usually total nodal excision. Nodal excision was followed by rapid resolution of symptoms. Because cat-scratch disease is benign, surgery should be reserved for severe cases with signs of significant suppuration. Generally, symptomatic relief can be afforded by warm soaks and analgesics and recovery over the course of several weeks is uneventful.

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On Assurances against the Risk of ‘Invalidity’ or Permanent Inability to Work

Journal of the Institute of Actuaries and Assurance Magazine ◽

10.1017/s204616740004979x ◽

1869 ◽

Vol 15 (2) ◽

pp. 143-145

Author(s):

Wilhelm Lazarus

Keyword(s):

Old Age ◽

Premature Death ◽

The Real ◽

Life Assurance ◽

The Family ◽

Inability To Work ◽

Deferred Annuity

Life Assurance provides for the family of the deceased in case of premature death; deferred Annuities provide for old age; but both institutions leave uncovered the risk of premature inability to work. Invalidity Assurance, including the benefits of a deferred Annuity, would be the real complement to Life Assurance. This truth is so deeply felt in Germany, that a good many institutions, employing a large number of officers, workmen, and labourers; many mills, and particularly the Railway Companies, long since directed their attention to the providing for their officers in case of their being invalided. How were they to calculate the annual contribution, how to make the valuation of their liabilities?

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CK20 and CK5/6 Immunohistochemical Staining of Urothelial Neoplasms: A Perspective

Advances in Urology ◽

10.1155/2020/4920236 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Mohammed Akhtar ◽

Sameera Rashid ◽

Mohamed Ben Gashir ◽

Noheir Mostafa Taha ◽

Issam Al Bozom

Keyword(s):

Mechanical Stability ◽

Basal Layer ◽

Low Grade ◽

High Grade ◽

Basal Cells ◽

The Family ◽

Prognostic Implications ◽

Umbrella Cells ◽

Proper Interpretation ◽

Aggressive Clinical Behavior

Cytokeratins belong to the family of intermediate filaments. They are expressed in a highly specific manner in epithelial cells where they play a crucial role in the integrity and mechanical stability of the cells. Several types of cytokeratins have been described in normal as well as neoplastic urothelium. In the case of urothelial neoplasms expression of CK20 and CK5/6 has been shown in several studies to have diagnostic and prognostic implications. Thus, low-grade urothelial carcinoma manifests CK expression limited to the umbrella cells, while high-grade tumors usually have an expression in the entire thickness of the urothelium except for the basal layer. CK5/6 expression on the other hand is expressed in the basal cells in all low-grade and some high-grade urothelial carcinomas. Diffuse CK20 staining accompanied by loss of CK5/6-positive basal layer is usually associated with aggressive clinical behavior. Double staining of the slides for these cytokeratins may facilitate proper interpretation and correlation.

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The toll of COVID-19 on African children: A descriptive analysis on the COVID-19-related morbidity and mortality among the pediatric population in Sub-Saharan Africa

10.1101/2021.07.02.21259857 ◽

2021 ◽

Author(s):

Sabina Rodriguez Velasquez ◽

Lea Jacques ◽

Jyoti Dalal ◽

Paolo Sestito ◽

Zahra Habibi ◽

...

Keyword(s):

Cumulative Incidence ◽

Pediatric Population ◽

Adult Population ◽

Age Groups ◽

Sub Saharan Africa ◽

Morbidity And Mortality ◽

African Countries ◽

Regional Office ◽

Sub Saharan ◽

Epidemiological Characteristics

Introduction: Since the beginning of the COVID-19 pandemic, very little data on the epidemiological characteristics among the pediatric population in Africa has been published. This paper examines the age and sex distribution of the morbidity and mortality rate in children with COVID-19 and compares it to the adult population within 15 Sub-Saharan African countries. Methods: A merge line listing dataset using a reverse engineering model shared by countries within the Regional Office for Africa was analyzed. Patients diagnosed within 1 March 2020 and 1 September 2020 with confirmed positive RT-PCR test for SARS-CoV-2 were analyzed. Children data were stratified into three age groups: 0-4 years, 5-11 years, and 12-17 years, while adults were combined. The cumulative incidence of cases including its medians and 95% confidence intervals were calculated. Results: 9% of the total confirmed cases and 2.4% of the reported deaths were pediatric cases. The 12-17 age group in all 15 countries showed the highest cumulative incidence proportion in children. COVID-19 cases in males and females under the age of 18 were evenly distributed. Among adults, a higher case incidence per 100,000 people was observed compared to children. Conclusion: The cases and deaths within the children population was smaller than the adult population. These differences can reflect biases in COVID-19 testing protocols and reporting implemented by countries, highlighting the need for more extensive investigation and focus on the effects of COVID-19 in children.

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Public Views on Priority Groups for COVID-19 Vaccination: A Survey from Iran

Shiraz E-Medical Journal ◽

10.5812/semj.113359 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Najmeh Moradi ◽

Seyyed Taghi Heydari ◽

Leila Zarei ◽

Jalal Arabloo ◽

Aziz Rezapour ◽

...

Keyword(s):

Online Survey ◽

Univariate Analysis ◽

Random Order ◽

The Elderly ◽

Iranian Population ◽

Vulnerable Groups ◽

Vaccination Programs ◽

The Family ◽

Key Factor ◽

Allocation Strategies

Background: In the initial coronavirus disease 2019 (COVID-19) vaccination program, prioritizing vulnerable groups is inevitable due to limited supply. Currently, most of the allocation strategies are focused on individuals’ characteristics. Objectives: The present study aimed to assess the opinions of Iranian population in specifying high-priority individuals and groups for COVID-19 vaccination. Methods: An online survey was conducted using some popular social media in Iran. The data was collected from Iranian population (878 individuals) aged 18 years and older during the COVID-19 pandemic (2 - 20 May 2020) to investigate their opinions towards vaccine allocation strategies at the family and society levels. In vaccine prioritizing within family three option and in vaccine prioritizing within society, seven population groups were introduced by the respondents in a random order, respectively. To analyze the data, mean rank and univariate analysis was used. Results: Healthcare workers, high-risk patients, and the elderly were the first priority groups for a vaccination with a mean rank of 2.8, 2.8, and 3.8, respectively. The least priority group was policymakers and executive managers (mean rank = 5.75). At the family level, 64% of the respondents introduced one of the family members as the first priority for vaccination, followed by their children (29%) and themselves (7%). No significant relationship was observed between respondents’ characteristics and their prioritization in vaccine prioritizing within society. Conclusions: Although involving public preference in decision-making is a key factor for the success of policies, careful design and implementation of vaccination programs through considering risk-benefit assessment is strongly recommended.

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