COVID-19 in Neonates, A Case Series Study From Tertiary Neonatal Centers in Iran

Introduction: The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates. Case Presentation: In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The patients aged 22 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest x-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC < 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease. Conclusions: This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

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Proxies for COVID-19 Diagnosis for Adults in Resource Limited Settings: A Case Series Study in Zambia.

10.21203/rs.3.rs-150178/v1 ◽

2021 ◽

Author(s):

Katongo H Mutengo ◽

John S Kachimba ◽

Francis Mupeta

Keyword(s):

Healthcare Costs ◽

Clinical Manifestations ◽

Case Series ◽

Respiratory Disorder ◽

The Novel ◽

Resource Limited Settings ◽

Resource Limited ◽

Case Series Study ◽

Novel Coronavirus ◽

Series Study

Abstract The novel coronavirus disease of 2019 (COVID-19); caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented a unique range of clinical manifestations. Thought to be primarily a respiratory disorder during its early outbreak in China in early December of 2019, it has now emerged from various scientific studies that the clinical manifestation of COVID-19 is indeed protean. This paper is aimed at exploring various proxies that can be used to increase the index of suspicion for COVID-19 in resource-limited settings like Zambia by reviewing four cases that presented to our health facilities. We hope this will help reduce healthcare costs through instituting early and more targeted treatment approaches.

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Role of antioxidant therapy in patients with moderate and severe COVID-19

Infekcionnye bolezni ◽

10.20953/1729-9225-2021-1-159-164 ◽

2021 ◽

Vol 19 (1) ◽

pp. 159-164

Author(s):

E.K. Shavarova ◽

◽

E.R. Cazakhmedov ◽

M.V. Alekseeva ◽

L.G. Ezhova ◽

...

Keyword(s):

Oxidative Stress ◽

Intervention Group ◽

Clinical Manifestations ◽

Organ Damage ◽

Control Group ◽

Reactive Protein ◽

Virus Rna ◽

Active Intervention Group ◽

Group 2 ◽

Novel Coronavirus

The coronavirus disease COVID-19 is characterized by high mortality and the lack of effective etiotropic therapy. Activation of oxidative stress may be one of the links in the pathogenesis of organ damage of this infection. Objective. To assess the ability of Mexidol® to influence the rate of clinical improvement in pneumonia caused by the SARSCoV-2 virus in hospitalized patients with the novel coronavirus disease COVID-19 and concomitant discirculatory encephalopathy. 62 patients over the age of 18 years with confirmed new coronavirus disease COVID-19 according to computed tomography (CT) of the lungs (stages CT1, CT2, CT3) and PCR of a swab from the nasopharynx and oropharynx for SARS-CoV-2 virus RNA were included. After randomization patients of group 1 received an infusion of Mexidol® at a dose of 1000 mg/day, patients of group 2 – an infusion of isotonic sodium chloride solution for 7 days. Compared with the control group, the patients receiving Mexidol® therapy showed a significantly more pronounced decrease in body temperature, a tendency towards a decrease in the severity of shortness of breath. In the Mexidol® group, the concentration of superoxidedismutase did not change, while in the control group there was a tendency to its decrease, C-reactive protein decreased 2.2 times more than in the control group (p = 0.09). There was a tendency for a more rapid decrease in ferritin in the active intervention group. Mexidol® therapy can have a positive effect on the clinical manifestations and severity of laboratory-inflammatory syndrome in patients with the new coronavirus disease COVID-19. Key words: coronavirus disease COVID-19, oxidative stress, Mexidol

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Analysis on Diagnosis of Family Clustering Infection of SARS-CoV-2

10.21203/rs.3.rs-18076/v1 ◽

2020 ◽

Author(s):

Rong Qiu ◽

Ming-wei Liu ◽

Chuan Zhao ◽

Wei-min Li

Keyword(s):

Nucleic Acid ◽

Respiratory Symptoms ◽

Clinical Manifestations ◽

Patient Treatment ◽

Human Interferon ◽

Epidemic Disease ◽

Intravenous Drip ◽

Child Patient ◽

Novel Coronavirus

Abstract Objective: Novel coronavirus (nCoV, SARS-CoV-2) infection becomes a world-wide epidemic which has complicated and diversified symptoms, but no special treatment. In this study, diagnosis and treatment of family clustering nCoV infection were analyzed.Methods: The Sichuan Suining Central Hospital received 11 patients with confirmed nCoV virus infection from 4 families during January 23rd, 2020 to February 20th, 2020. Their clinical symptoms, treatment conditions and changes of disease state were reviewed in the present study.Results: In all 4 families, there were 1-2 members in each family who had contact with epidemic disease. Clinical manifestations were: 3 cases had debilitation only, 1 case had cough only, 1 case had diarrhea (a child patient of four years old), 5 cases had fever and cough, and 1 case had blood-stained sputum. According to image changes, no image change was observed in 1 child patient. Multiple focal ground-glass opacities were detected from 2 patients and multiple patchy shadows were observed from 8 patients, especially in lung periphery. Complications with basic diseases: there were hypertension in 3 cases, diabetes in 2 cases, and hypertension and diabetes in 1 case. Moreover, there’s one patient who had rheumatic heart disease and received mitral and aortic valve replacement 2 years ago. There’s another one who had depression and suicidal tendency. All 11 cases divided into mild type (1 child patient), moderate type (8 patients), severe type (1 patient) and critical type (1 patient). Treatment: the mild child patient (4 years old) was administrated with 2.75ml lopinavir / ritonavir oral liquid (twice per day) and intravenous drip of 0.17g ribavirin injection (1ml: 0.1g*10pcs/box) every 12h for one week. Meanwhile, the child was asked to take azithromycin orally. 7 moderate patients were treated with intravenous drip of 0.5g ribavirin injection (1ml: 0.1g*10pcs/box) every 12h (twice per day) and two pieces of lopinavir/ritonavior (twice per day) for 7-10 days. In the same time, patients were given with reasonable amount of antibiotics by oral or intravenous drip. 1 severe patient and 1 critical patent were treated with 5,000,000 U recombinant human interferon α2b injection (3,000,000 U/pc) and aerosol inhalation of 2ml sterile water for injection (5ml*50 pcs/ box), twice per day. Besides, they took 2 pieces of lopinavir/ritonavior, twice per day. The whole treatment program lasted for 6-12 days, accompanied with appropriate amount of intravenous drip of antibiotics. The critical patient was also provided with mechanical ventilation. During the treatment, severe and critical patients were treated by resochin for 4-5 days for evident respiratory symptoms. One moderate patient was treated with 2 pieces of lopinavir/ritonavior, twice per day. In the same time, it was administrated by intravenous drip of antibiotics. However, resochin treatment was applied for positive novel coronavirus nucleic acid of respiratory sputum specimen after 11 days of treatment. Discharge: After treatment, patients with body temperatures of all patients recovered to normal level, and respiratory symptoms and digestive tract symptoms relieved significantly, significant coefficient of exudative lesion at lung according to chest CT and negative novel coronavirus nucleic acid of continuous two respiratory sputum specimens (sampling interval was at least 1 day) were allowed to be discharged. Adverse reactions: 4 patients had loose stools and abdominal discomfort, and another 2 cases had diarrhea.Conclusions: SARS-CoV-2 infection have complicated and diversified symptoms, which shall be identified according to epidemic history and novel coronavirus nucleic acid test. In particular, the whole family in which there’s a patient with confirmed SARS-CoV-2 shall be isolated for screening in addition to the patient. The lopinavir/ritonavior administration combined with ribavirin or recombinant Human Interferon (RHI) α2b is effective, accompanied with mild adverse reaction. If lopinavir/ritonavior administration and / or combined with ribavirin and RHI α2b is invalid, adding resochin might be effective.

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Clinical and Laboratory Profiles of 75 Hospitalized Patients with Novel Coronavirus Disease 2019 in Hefei, China

10.1101/2020.03.01.20029785 ◽

2020 ◽

Cited By ~ 12

Author(s):

Zonghao Zhao ◽

Jiajia Xie ◽

Ming Yin ◽

Yun Yang ◽

Hongliang He ◽

...

Keyword(s):

T Cell ◽

Treatment Effectiveness ◽

Antiviral Treatment ◽

Laboratory Data ◽

Clinical Manifestations ◽

Nasopharyngeal Swab ◽

The Novel ◽

Reactive Protein ◽

Cell Counts ◽

Novel Coronavirus

AbstractThe outbreak of the novel coronavirus disease 2019 (COVID-19) infection began in December 2019 in Wuhan, and rapidly spread to many provinces in China. The number of cases has increased markedly in Anhui, but information on the clinical characteristics of patients is limited. We reported 75 patients with COVID-19 in the First Affiliated Hospital of USTC from Jan 21 to Feb 16, 2020, Hefei, Anhui Province, China. COVID-19 infection was confirmed by real-time RT-PCR of respiratory nasopharyngeal swab samples. Epidemiological, clinical and laboratory data were collected and analyzed. Of the 75 patients with COVID-19, 61 (81.33%) had a direct or indirect exposure history to Wuhan. Common symptoms at onset included fever (66 [88.0%] of 75 patients) and dry cough (62 [82.67%]). Of the patients without fever, cough could be the only or primary symptom. The most prominent laboratory abnormalities were lymphopenia, decreased percentage of lymphocytes (LYM%), decreased CD4+ and CD8+ T cell counts, elevated C-reactive protein (CRP) and lactate dehydrogenase (LDH). Patients with elevated interleukin 6 (IL-6) showed significant decreases in the LYM%, CD4+ and CD8+ T cell counts. Besides, the percentage of neutrophils, CRP, LDH and Procalcitonin levels increased significantly. We concluded that COVID-19 could cause different degrees of hematological abnormalities and damage of internal organs. Hematological profiles including LYM, LDH, CRP and IL-6 could be indicators of diseases severity and evaluation of treatment effectiveness. Antiviral treatment requires a comprehensive and supportive approach. Further targeted therapy should be determined based on individual clinical manifestations and laboratory indicators.

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Utilization of a Dextrose-Only Purge Solution for an LVAD in Patients With Suspected HIT: A Case Series

Journal of Pharmacy Practice ◽

10.1177/0897190020934304 ◽

2020 ◽

pp. 089719002093430

Author(s):

Riley D. Bowers ◽

Jennifer Nowak ◽

Dustin Bryan ◽

Nicolas Biondi ◽

Brock Dorsett

Keyword(s):

Cardiogenic Shock ◽

Heart Surgery ◽

Case Reports ◽

Open Heart Surgery ◽

Case Series ◽

Bleeding Risk ◽

Ventricular Assist Devices ◽

Ventricular Assist ◽

Effective Option ◽

Manufacturer Recommendation

The Impella devices are percutaneous intravascular ventricular assist devices indicated for use in patients with cardiogenic shock that occurs following acute myocardial infarction (MI) or open heart surgery. These devices must be used with a purge solution that contains heparin per manufacturer recommendation, which will prevent blood from reaching the motor causing pump thrombosis and mechanical failure. We describe the utilization of a dextrose-only purge solution plus systemic argatroban in 2 patients with suspected heparin-induced thrombocytopenia (HIT). Each case describes a patient with suspected HIT following Impella placement for cardiogenic shock post-MI that had an increased bleeding risk. In each case, pharmacy monitored and adjusted the patients’ argatroban, resulting in therapeutic anticoagulation without major bleeding or thrombotic events. These case reports demonstrate that use of a dextrose-only purge solution in the Impella device may be a safe and effective option when combined with systemic argatroban in patients with suspected or confirmed HIT who exhibit increased bleeding risk. Further research is needed to determine the optimal concentrations and duration of anticoagulation-free purge solution in these patients.

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Neonatal seizures: clinical manifestations and etiology

Paediatrica Indonesiana ◽

10.14238/pi46.6.2006.266-70 ◽

2016 ◽

Vol 46 (6) ◽

pp. 266

Author(s):

Daisy Widiastuti ◽

Irawan Mangunatmadja ◽

Taralan Tambunan ◽

Rulina Suradi

Keyword(s):

Metabolic Disorders ◽

Clinical Manifestations ◽

Case Series ◽

Term Infant ◽

Common Type ◽

Neonatal Seizures ◽

Metabolic Disturbances ◽

Case Series Study ◽

Common Etiology ◽

Series Study

Background Neonatal seizures or fits are signs of central ner-vous system (CNS) diseases, metabolic disorders, or other dis-eases disrupting the CNS. Neonatal seizures are poorly classi-fied, under-recognized and often difficult to treat. It is important torecognize the type of neonatal seizures that might be the only signof a CNS disorder.Objective To recognize the type and etiology of neonatal sei-zures in several hospitals in Jakarta.Methods This was an observational case series study on full-termand preterm infants who had seizures during hospitalization in CiptoMangunkusumo, Harapan Kita, and Fatmawati Hospitals betweenJanuary-June 2005. Neonatal seizures were defined as seizuresoccurring in the first 28 days of life of a term infant or 44 completedweeks of the infant’s conception age of preterm infant.Results There were 40 neonates who born within the study periodand had seizures. Girls were outnumbered boys. Most neonateswere full-term with birth weight of more than 2500 grams. Analy-ses were done on 38 neonates with epileptic and non-epilepticseizures, while the other two who had mixed clinical manifestationwere not included. Most seizures occurred in the first 3 days of life(23/38). The most common type was focal clonic (12/14) followedby general tonic (11/24) and motor automatism or subtle (10/24).The most common etiology was hypoxic ischemic encephalopa-thy (HIE) (19/38) followed by metabolic disturbances, mainly hy-pocalcaemia (11/38).Conclusion Common types of seizures in neonates were focalclonic, general tonic, and motor automatism (subtle). The mostcommon etiology was HIE followed by metabolic disturbances,mainly hypocalcaemia

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Dying from haemorrhagic cardiac tamponade – a case series

Medico-Legal Journal ◽

10.1177/0025817219867268 ◽

2019 ◽

Vol 87 (4) ◽

pp. 210-214

Author(s):

Nagendra Singh Sonwani ◽

Navneet Ateriya ◽

Arvind Kumar

Keyword(s):

Myocardial Infarction ◽

Cardiac Tamponade ◽

Heart Surgery ◽

Open Heart Surgery ◽

Case Series ◽

Dissecting Aneurysm ◽

Pericardial Fluid ◽

Naturally Occurring ◽

Great Vessels ◽

Myocardial Abscess

Cardiac tamponade is a condition produced by the rapid accumulation of pericardial fluid, which restricts the filling of the heart. Often the forensic pathologist comes across different naturally occurring sudden deaths. Cardiovascular causes are the most common. Death due to cardiac tamponade can cause sudden cardiac death. Acute cardiac tamponade is almost invariably fatal, unless the pressure is relieved by removing the pericardial fluid, either by needle pericardiocentesis or surgical procedures. Cardiac tamponade is more commonly associated with cases of trauma, operative procedures, secondary to myocardial infarction or intra pericardial rupture of great vessels. Previous literature showed an association of cardiac tamponade with many other pathological conditions such as malignancy, central venous catheterisation, open heart surgery, dissecting aneurysm of the aorta, myocardial abscess, infective endocarditis, etc. We report a series of three cases where cardiac tamponade was given as the cause of death on autopsy secondary to post-myocardial infarction wall rupture.

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Absent right superior caval vein in situs solitus

Cardiology in the Young ◽

10.1017/s1047951115000268 ◽

2015 ◽

Vol 26 (2) ◽

pp. 334-339 ◽

Cited By ~ 1

Author(s):

Rebekka Lytzen ◽

Karin Sundberg ◽

Niels Vejlstrup

Keyword(s):

Incidental Finding ◽

Clinical Manifestations ◽

Case Series ◽

Retrospective Case ◽

Caval Vein ◽

Cardinal Vein ◽

Benign Condition ◽

Superior Caval Vein ◽

Case Series Study ◽

The Right

AbstractIntroductionIn up to 0.07% of the general population, the right anterior cardinal vein obliterates and the left remains open, creating an absent right superior caval vein and a persistent left superior caval vein. Absent right superior caval vein is associated with additional congenital heart disease in about half the patients. We wished to study the consequences of absent right superior caval vein as an incidental finding on prenatal ultrasonic malformation screening.Material and methodsThis is a retrospective case series study of all foetuses diagnosed with absent right superior caval vein at the national referral hospital, Rigshospitalet, Denmark, from 2009 to 2012.ResultsIn total, five cases of absent right superior caval vein were reviewed. No significant associated cardiac, extra-cardiac, or genetic anomalies were found. Postnatal echocardiographies confirmed the diagnosis and there were no postnatal complications. All children were found to have healthy hearts at follow-up.ConclusionsIn all cases, the findings proved to be a benign condition with no clinical manifestations or complications. Although isolated absent right superior caval vein does not seem to affect the outcome, associated anomalies may be serious. Absent right superior caval vein should, therefore, prompt a search for additional malformations. Furthermore, the diagnosis of an isolated absent right superior caval vein is important, because knowledge of the anomaly can prevent future problems when invasive procedures are necessary.

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Evaluation of Musculoskeletal Hydatid Cyst Cases in Terms of Clinical Manifestations, Method of Dealing, Treatment, and Recurrence

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4274 ◽

2020 ◽

Vol 8 (E) ◽

pp. 99-104

Author(s):

Setareh Soltany ◽

Hamid Reza Hemmati ◽

Jafar Alavy Toussy ◽

Hamid Nazifi ◽

Abbas Alibakhshi ◽

...

Keyword(s):

Differential Diagnosis ◽

Hydatid Cyst ◽

Diagnostic Method ◽

Clinical Manifestations ◽

Case Series ◽

Treatment Method ◽

Common Symptom ◽

Case Series Study ◽

Paravertebral Muscles ◽

Endemic Areas

Hydatid disease is one of the most common parasitic diseases caused by Echinococcus granulosus worm. In this disease, involvement of all organs is likely. However, primary hydatid cysts of muscle tissue are so rare that occasionally in differential diagnosis, cystic masses are not placed in endemic areas. Timely and accurate diagnosis is crucial to prevent unnecessary biopsy. In this case-series study conducted in hospitals of Semnan and Tehran, Iran, from 2009 to 2014, 15 patients with musculoskeletal problems due to hydatid cyst were evaluated. In each case, information about the patient’s clinical manifestations, including initial complaint, cyst location, treatment method, location of involvement organ, duration, dose of drug used and diagnostic method was evaluated. According to results of the present study, the prevalence of musculoskeletal system involvement was 7.21%. The most common site of involvement was spine and paravertebral muscles (7 cases) and the most common symptom was compressive symptoms on the spinal canal. Magnetic resonance imaging was the most commonly used diagnostic method and only in 1 case a wrong pre-operative diagnosis was made. Eleven patients reported a history of recurrence at the site of previous surgery (3 cases of hip involvement and 6 cases of spine involvement). There were 5 cases of recurrence following recent treatment, 2 of which were hip involvement and 2 cases of spine involvement. Furthermore, most patients (12 cases) underwent cyst resection surgery. The results of this study showed that although hydatid cystic skeletal muscle is rare, due to the possibility of repeated recurrence, especially in cases of spine and bone involvement, endemic areas should be considered in the differential diagnosis of each cystic mass of muscle and bone.

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