Multisystem inflammatory syndrome in children associated with COVID-19: nursing care

In 2019, a new viral disease, known as SARS-Cov-2 infection, was identified. Scientists believed that it was a disease with low morbidity for pediatric patients; however, a small percentage of children infected with the new coronavirus developed a multisystem inflammatory response, which aroused the interest of many researchers and health professionals. The objective of the study is to describe the main characteristics related to the Pediatric Multisystemic Inflammatory Syndrome Associated with Covid-19 (MIS-C), its complications and nursing care. The main clinical manifestations of MIS-C are hyperthermia, gastrointestinal symptoms, skin manifestations, generalized lymphadenopathy, cardiac and neurological disorders. The main nursing care was listed according to the signs and symptoms, such as monitoring of neurological and hydroelectrolytic changes. The nurse professional must add knowledge about MIS-C so that he is able to qualify his care and improve his skills to provide quality care to pediatric patients.

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COVID-19 associated multisystem inflammatory syndrome in children mimicking acute appendicitis - how to differentiate and conduct pediatric patients during the pandemic? - Proposal of a management flowchart

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-6991e-20213012 ◽

2021 ◽

Vol 48 ◽

Author(s):

LORAINE ENTRINGER FALQUETO ◽

CAROLINA MARTINS VISSOCI ◽

ISABELLA CRISTINA BONETTO FERREIRA ◽

AMANDA GINANI ANTUNES ◽

FERNANDO ANTÔNIO BERSANI AMADO ◽

...

Keyword(s):

Acute Appendicitis ◽

Acute Abdomen ◽

Initial Phase ◽

Pediatric Patients ◽

Pediatric Population ◽

Gastrointestinal Symptoms ◽

Signs And Symptoms ◽

Clinical History ◽

Pediatric Hospital ◽

Inflammatory Syndrome

ABSTRACT Introduction: the new coronavirus pandemic has been a reality throughout 2020, and it has brought great challenges. The virus predominantly manifests in the pediatric population with mild symptoms. However, an increase in the incidence of Multisystemic Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 has been described in the literature. MIS-C manifests mainly with fever and gastrointestinal symptoms and may mimic acute abdomen due to acute appendicitis. The objective of this study is to propose a care flowchart for suspected cases of acute appendicitis in the initial phase in pandemic times, considering the possibility of MIS-C. This situation was brought up by a patient treated in a pediatric hospital in Brazil. Discussion: It was possible to identify common signs and symptoms in the reported patient and those published cases that may serve as alerts for early identification of MIS-C cases. Based on the literature review and on the similarities between the syndrome and the inflammatory acute abdomen in children, we elaborated an initial approach for these cases to facilitate the identification, early diagnosis, and management. The flowchart considers details of the clinical history, physical examination, and complementary exams prior to the indication of appendectomy in patients with initial phase symptoms. Conclusion: MIS-C, although rare and of poorly known pathophysiology, is most often severe and has a high mortality risk. The use of the proposed flowchart can help in the diagnosis and early treatment of MIS-C.

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A study on the clinical features of dengue virus infected pediatric patients

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180437 ◽

2018 ◽

Vol 5 (2) ◽

pp. 368 ◽

Cited By ~ 4

Author(s):

Abhra Banerjee ◽

Kanai Lal Barik ◽

Arup Bandyopadhyay ◽

Uttam Kumar Paul

Keyword(s):

Dengue Fever ◽

Clinical Features ◽

Pediatric Patients ◽

Tertiary Care ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Viral Disease ◽

Teaching Hospitals ◽

Eastern India ◽

Gastrointestinal Infections

Background: Dengue fever is currently the most important arthropod borne viral disease. During recent outbreaks in India, the clinical manifestations which were shown by the patients were slightly different from those in previous years. The present study was done to analyze the clinical features of all pediatric cases admitted for dengue to three tertiary care teaching hospitals in eastern India, to facilitate early treatment and better outcome.Methods: A direct history and clinical examination-record based descriptive study was conducted on pediatric patients admitted with signs and symptoms suggestive of dengue fever to two hospitals in West Bengal and one in Bihar, during the period between January 2016 and December 2017. The data obtained were analyzed with correlative studies.Results: Total 200 patients of Dengue viral infected pediatric patients were included in the study. All these 200 children presented with fever. 126(63%) children had myalgia and arthralgia, 111 (55.5%) had headache, 58 (29%) presented with gastrointestinal infections, 51 (25.5%) had rash and 26 (13%) had hemorrhagic manifestations. Features of shock were present in 14 (7%) children, retro-orbital pain in 13 (6.5%) children and generalized swelling in 9 (4.5%) children.Conclusions: Increased awareness about the changing clinical features of dengue in pediatric cases in the present scenario as observed in recent epidemics, at least in eastern India is needed to further reduce mortality and complications of dengue cases.

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Key Elements of Professional Nursing Practice: A Scoping Review

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5885 ◽

2021 ◽

Vol 9 (T4) ◽

pp. 253-260

Author(s):

Novita Kurnia Sari ◽

Titi Savitri Prihatiningsih ◽

Lely Lusmilasari

Keyword(s):

Nursing Care ◽

Scoping Review ◽

Nursing Practice ◽

Quality Care ◽

Practice Model ◽

Basic Care ◽

Professional Nursing ◽

Professional Nursing Practice ◽

Provide Quality Care ◽

And Performance

BACKGROUND: Professional nursing practice can be used as a standard reference for implementing nursing care to help nurses provide quality care in accordance with their authorities. AIM: The review is purposed to synthesis the pieces of literature telling the development and / or application and / or assessment of a professional nursing practice to determine the crucial elements. METHODS: This study was guided by the following framework for a scoping review, using electronic databases including ScienceDirect, EBSCO, ProQuest, Pubmed, and Google Scholar within keywords of professional nursing practice, model, nurse and conceptual framework. RESULTS: Of a total of 2870 paper found, 28 papers were selected. This study seven key elements: health system competency, professional value, reward and performance evaluation, leadership, nursing care, professional development, and basic care competency. CONCLUSION: A professional nursing practice would provide the minimum standard of quality nursing practice.

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Caring for the victim of near drowning

Critical Care Nurse ◽

10.4037/ccn1993.13.4.25 ◽

1993 ◽

Vol 13 (4) ◽

pp. 25-32 ◽

Cited By ~ 1

Author(s):

DM Glankler

Keyword(s):

Critical Care ◽

Nursing Care ◽

Quality Care ◽

Complex Care ◽

Major Focus ◽

Care Nurse ◽

Critical Care Nurse ◽

Near Drowning ◽

Provide Quality Care

If no complications arise, the near-drowning victim is usually discharged within 48 hours. However, some patients require complex care because of multisystem failure. These patients challenge the critical care nurse, who must understand the interrelationships of the problems to provide quality care. The major focus of care is stabilization and normalization of the cardiovascular, respiratory and neurologic systems through accurate nursing assessments and implementation of appropriate nursing care.

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A Case of Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis and Pancreatitis

PRILOZI ◽

10.2478/prilozi-2021-0027 ◽

2021 ◽

Vol 42 (2) ◽

pp. 95-101

Author(s):

Lidija Kareva ◽

Katarina Stavrik ◽

Kristina Mironska ◽

Arjeta Hasani ◽

Sonja Bojadzieva ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Close Contact ◽

Multiorgan Failure ◽

Gastrointestinal Symptoms ◽

Gastrointestinal Diseases ◽

Serological Testing ◽

Inflammatory Syndrome ◽

Pcr Test

Abstract Multisystem Inflammatory Syndrome in Children (MIS-C) is characterized by an inflammation with fever, elevated inflammatory markers, conjunctivitis, rash, impaired coagulation, gastrointestinal symptoms and cardiac abnormalities that may progress to multiorgan failure. The presence of a positive COVID-19 antigen via a PCR test, serological testing for antibodies or close contact with a person diagnosed with COVID-19 helps differentiate MIS-C from other diseases. Gastrointestinal symptoms are recognized to be associated with COVID-19 infection or MIS-C in children, presenting as abdominal pain, gastrointestinal infection with watery stools, appendicitis, ileitis, pancreatitis and hepatitis, confusing the diagnosis with other gastrointestinal diseases. In this case report, we describe an 11 year old boy with MIS-C, who presents acute phlegmona of the appendix for which he undergoes appendectomy, accompanied with acute pancreatitis. These manifestations of MIS-C in our patient resolved without additional complications after a 2 month follow up. We call attention to MIS-C presenting in pediatric patients with fever and abdominal pain which might be caused by appendicitis and pancreatitis, and we recommend abdominal imaging and additional laboratory investigation to promote earlier diagnosis.

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Case Report: Pediatric Patient with COVID-19 and Multisystem Inflammatory Syndrome in Children

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.8.48376 ◽

2020 ◽

Vol 4 (4) ◽

pp. 513-516

Author(s):

MacKenzie Burger ◽

Marcus Moore ◽

John Wilburn

Keyword(s):

Case Report ◽

Risk Stratification ◽

Extracorporeal Membrane Oxygenation ◽

Cardiogenic Shock ◽

Pediatric Patient ◽

Pediatric Patients ◽

Signs And Symptoms ◽

Unique Case ◽

Venoarterial Extracorporeal Membrane Oxygenation ◽

Inflammatory Syndrome

Introduction: Coronavirus disease 2019 (COVID-19) rarely manifests with severe complications in pediatric patients. An association between COVID-19 and a Kawasaki-like inflammatory syndrome has recently presented in pediatric patients. Case Report: We report a unique case of multisystem inflammatory syndrome in children presenting with characteristic findings in a child who later developed cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. Conclusion: Recognition of these early signs and symptoms facilitates screening and risk stratification of pediatric COVID-19 cases associated with increased morbidity.

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Pyogenic Arthritis of the Sacroiliac Joint in Pediatric Patients

PEDIATRICS ◽

10.1542/peds.66.3.375 ◽

1980 ◽

Vol 66 (3) ◽

pp. 375-379

Author(s):

Urs B. Schaad ◽

George H. McCracken ◽

John D. Nelson

Keyword(s):

Pediatric Patients ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Etiologic Agent ◽

Cast Immobilization ◽

Radiographic Findings ◽

Pyogenic Sacroiliitis ◽

Bone Scans ◽

Adequate Management

Clinical manifestations, diagnostic studies, and management of pyogenic sacroiliitis were reviewed in 77 pediatric patients. This infection occurs primarily in late childhood, is more common in boys, and has a subacute onset in about two thirds of cases. Recognition of the characteristic signs and symptoms of sacroiliac involvement coupled with radioisotope bone scanning substantially reduces the delay in correct diagnosis that averaged 3.9 weeks in all patients (4.8 weeks in those without and 1.7 weeks in those with bone scans performed). Joint aspiration under biplane fluoroscopic control and culture of the aspirated material is indicated in establishing the specific etiologic agent which is Staphylococcus aureus in most cases. Adequate management of pyogenic sacroiliitis consists of appropriately monitored antibiotic treatment and, if present, evacuation of pus. The use of spica cast immobilization offers no apparent beneficial effect. Indications for surgery include drainage of pus and removal of sequestered bone. With adequate management the prognosis of suppurative sacroiliitis in pediatric patients is excellent, despite persistent abnormal radiographic findings in most patients.

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Clinical Characteristics of Pediatric Patients with Ocular Toxocariasis in China

Ophthalmologica ◽

10.1159/000443215 ◽

2016 ◽

Vol 235 (2) ◽

pp. 97-105 ◽

Cited By ~ 7

Author(s):

Yalu Liu ◽

Qi Zhang ◽

Jing Li ◽

Xunda Ji ◽

Yu Xu ◽

...

Keyword(s):

Rural Areas ◽

Clinical Characteristics ◽

Pediatric Patients ◽

Age Of Onset ◽

Age Groups ◽

Clinical Signs ◽

Clinical Manifestations ◽

Signs And Symptoms ◽

Enzyme Linked Immunosorbent Assay ◽

Ocular Toxocariasis

Objective: The aim of the study was to analyze the clinical characteristics of pediatric patients with ocular toxocariasis. Methods: Ocular toxocariasis was diagnosed and treated in 46 children from Shanghai and surrounding provinces. The diagnosis of ocular toxocariasis was confirmed immunologically by performing an enzyme-linked immunosorbent assay on serum and/or intraocular fluid. All pediatric patients and their guardians completed a questionnaire concerning their cases and living habits. Results: The mean age of onset was 6 ± 3 years. Most children (85%) resided in rural areas, and 91% of the children had contact with adult dogs or puppies. At the first visit, visual acuity (VA) was <20/200 in 36 cases, and we detected peripheral granuloma in 36 patients. In our study, the most common signs were vitritis, vitreous strands, and tractional retinal detachment. The Optomap 200Tx device detected granuloma with an 85% sensitivity, which is much higher than that of other techniques. We treated 40 cases (87%) with topical corticosteroids, while 28 patients (61%) were treated with systemic corticosteroids. Only 18 children (39%) required surgical intervention. All patients were examined and treated by the same ophthalmologists. Conclusions: Preschool children in China are more often affected by toxocariasis compared with other age groups. The most common signs included unilateral granuloma and ocular inflammation. In our study, clinical manifestations were severe and complicated. At the first visit, VA was <20/200 in most patients. Ocular toxocariasis was diagnosed on the basis of clinical signs and symptoms; the diagnosis was confirmed by immunological testing. Techniques using the Optomap 200Tx device can facilitate the early detection and lead to better visual prognosis.

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COVID-19: Specific and Non-Specific Clinical Manifestations and Symptoms: The Current State of Knowledge

Journal of Clinical Medicine ◽

10.3390/jcm9061753 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1753 ◽

Cited By ~ 14

Author(s):

Jacek Baj ◽

Hanna Karakuła-Juchnowicz ◽

Grzegorz Teresiński ◽

Grzegorz Buszewicz ◽

Marzanna Ciesielka ◽

...

Keyword(s):

Pediatric Patients ◽

Distress Syndrome ◽

Wide Spectrum ◽

Clinical Manifestations ◽

The Elderly ◽

Viral Disease ◽

Atypical Symptoms ◽

Current State ◽

Specific Symptoms ◽

Degrees Of Severity

Coronavirus disease 2019 (COVID-19), due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become an epidemiological threat and a worldwide concern. SARS-CoV-2 has spread to 210 countries worldwide and more than 6,500,000 confirmed cases and 384,643 deaths have been reported, while the number of both confirmed and fatal cases is continually increasing. COVID-19 is a viral disease that can affect every age group—from infants to the elderly—resulting in a wide spectrum of various clinical manifestations. COVID-19 might present different degrees of severity—from mild or even asymptomatic carriers, even to fatal cases. The most common complications include pneumonia and acute respiratory distress syndrome. Fever, dry cough, muscle weakness, and chest pain are the most prevalent and typical symptoms of COVID-19. However, patients might also present atypical symptoms that can occur alone, which might indicate the possible SARS-CoV-2 infection. The aim of this paper is to review and summarize all of the findings regarding clinical manifestations of COVID-19 patients, which include respiratory, neurological, olfactory and gustatory, gastrointestinal, ophthalmic, dermatological, cardiac, and rheumatologic manifestations, as well as specific symptoms in pediatric patients.

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New coronavirus infection in children in the Moscow region: clinical, epidemiological and treatment aspects

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2021-49-032 ◽

2020 ◽

Vol 49 ◽

Author(s):

E. R. Meskina ◽

M. K. Khadisova ◽

T. V. Stashko ◽

A. V. Bitsueva

Keyword(s):

Pediatric Patients ◽

Respiratory Infections ◽

Severe Disease ◽

Age Distribution ◽

Clinical Manifestations ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Generation Cephalosporin ◽

Moscow Region ◽

Epidemiological Characteristics

Aim: To assess clinical and epidemiological characteristics, as well as treatment results in COVID-19 pediatric patients hospitalized to the Department of infectious disease in the Moscow region.Materials and methods: We retrospectively analyzed medical records of 124 pediatric patients aged from 1 month to 17 years with confirmed (63.7%) and highly probable (proven epidemiological association with the infection source) COVID-19 infection. The children were hospitalized from March 25, 2020 to August 11, 2020. Among patients that were hospitalized during this time period, 43% had pneumonia and 30% had acute respiratory disorders. All cases of pneumonia were confirmed by computed tomography. The children were treated according to the standard Russian guidelines.Results: The children had been infected with SARS-CoV-2 mostly from family members (75%; 95% confidence interval (CI) 66.4–82.3). In the families of the children with pneumonia, the number of pneumonia cases in their relatives was higher than in the families of the children with acute respiratory infections (1.7±1.0 vs. 1.1±0.5 respectively; р<0.001). The mean age of the hospitalized children was 8 years (7.4–9.6), with an even age distribution. The main COVID-19 signs and symptoms were as follows: fever (75.8%; 95% CI 67.3–83.0), cough (66.1%; 95% CI 57.1–74.4]), fatigues (38.7%; 95% CI 30.1–47.9), and hyposmia (33.9%; 95% CI 25.6–42.9). The severe disease course was rare (2.4%; 95% CI 0.5–6.9). The rates of positive reverse transcriptase polymerase chain reaction tests for SARS-CoV-2 were rapidly decreased at repeated tests: at day 3, 63.7% of the tests were positive, at day 7, 21.8% and at day 14, 5.6% (р<0.001). The prevalence of pneumonia was 56.4% without any age differences, with mostly minimal areas of lung abnormalities (78.6%). The severity of pneumonia and duration of clinical manifestations in the patients treated with a III generation cephalosporin or its combination with a macrolide were similar. Cough duration in those, who were treated with ipratropium bromide /fenoterol inhalations including their combination with budesonide, was higher than in those who did not use inhalation treatment. Pyrexia of>5 days duration can be a predictor of pneumonia in a pediatric patient with COVID-19 (odds ratio 4.55 (2.1–9.9), sensitivity 61.4%, specificity 74.1%).Conclusion: The results obtained are important to develop further treatment strategies for children with COVID-19.

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