Severity of Illness Caused by Severe Acute Respiratory Syndrome Coronavirus 2 Variants of Concern in Children: A Single-Center Retrospective Cohort Study

Background: Recent surges in coronavirus 2019 disease (COVID-19) is attributed to the emergence of more transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs). However, the relative severity of SARS-CoV-2 VOCs in children is unknown. Methods: This retrospective single-center cohort study was performed at the Ann & Robert H. Lurie Childrens Hospital of Chicago, academic free-standing childrens hospital. We included all children 0-18 years-old diagnosed with COVID-19 between October 15th, 2020 and August 31st, 2021 and whose SARS-CoV-2 isolate was sequenced using the Illumina platform. For each patient sample, we identified the SARS-CoV-2 lineage, which was assigned to one of the following groups: Non-VOC, alpha VOC, beta VOC, gamma VOC, or delta VOC. We measured frequency of 5 markers of COVID-19 severity: hospitalization; COVID-19 pharmacologic treatment; respiratory support; intensive care unit admission; and severe disease as classified by the COVID-19 World Health Organization (WHO) Clinical Progression Scale (severe disease; score of 6 or higher). A series of logistic regression models were fitted to estimate odds of each severity marker with each VOC (in comparison to non-VOCs), adjusting for COVID-19 community incidence and demographic and clinical co-variates. Results: During the study period, 2,025 patients tested positive for SARS-CoV-2; 1,422 (70.2%) had sufficient viral load to permit sequencing. Among the 499 (35.1%) patients whose isolate was sequenced, median (inter-quartile range) age was 7 (1,12) years; 256 (51.3%) isolates were a VOC: 96 (37.5%) alpha, 38 (14.8%) gamma, and 119 (46.5%) delta. After adjusting for age, Black race, Hispanic ethnicity, high-risk medical conditions, and COVID-19 community incidence, neither alpha nor delta was associated with severe COVID-19. Gamma was independently associated with hospitalization (OR 5.9, 95% CI 1.6-21.5, p=0.007), respiratory support (OR 8.3, 95% CI 1.5-56.3, p=0.02), and severe disease as classified by the WHO Clinical Progression Scale (OR 7.7, 95% CI 1.0-78.1, p=0.05). Conclusions: Compared to non-VOC COVID-19 infections, the gamma VOC, but not the alpha or delta VOCs, was associated with increased severity. These data suggest that recent increased in pediatric COVID-19 hospitalizations are related to increased delta COVID-19 incidence rather than increased delta virulence in children.

MRI-geleide Laser Interstitiële ThermoTherapie bij het hypothalamus hamartoom

Behandeling van epilepsie bij een patiënt met een hypothalamus hamartoom met traditionele chirurgische technieken is complex en geassocieerd met hoge morbiditeit en mortaliteit. De minimaal invasieve behandeling met MRI-geleide laser interstitiële thermotherapie lijkt daarentegen een veelbelovende techniek met hoge succes- en lage complicatiepercentages. In deze bijdrage worden de resultaten beschreven voor acht kinderen, die werden verwezen naar het Texas Childrens Hospital in Houston.

COVID-19 screening at Emergency and Trauma Department, Sabah Women and Childrens Hospital, Malaysia

Many cases of COVID-19 infections involved healthcare workers around the world. In Malaysia, healthcare workers accounted for 2% of the total infected cases. Among the healthcare workers, nurses were most infected. At the Sabah Women and Childrens Hospital, the number of swabs taken for HCWs between May and November 2020 aggregated to 7,476 swabs, from which 167 positive cases were detected.

COVID-19 Healthcare Worker Screening at Emergency Department, Hospital Wanita & Kanak- Kanak Sabah, Malaysia from May-December 2020

Since the beginning of the pandemic we have recorded a total of 3,355 healthcare workers (HCW) screened at Emergency & Trauma Department (ETD) of Sabah Women and Childrens Hospital (HWKSS). This amounted to 8,823 swabs taken for HCWs from a total of 21,367 swabs taken in ETD during the same period. The average swab per HCW was 2.62 swab/person. From the 8,823 swabs taken, 46 HCWs were detected positive for Covid-19.

COVID-19 Healthcare Worker Screening at Emergency Department, Hospital Wanita & Kanak- Kanak Sabah, Malaysia from May-December 2020

Since the beginning of the pandemic we have recorded a total of 3,355 healthcare workers (HCW) screened at Emergency & Trauma Department (ETD) of Sabah Women and Childrens Hospital (HWKSS). This amounted to 8,823 swabs taken for HCWs from a total of 21,367 swabs taken in ETD during the same period. The average swab per HCW was 2.62 swab/person. Data for patient screening are not included in this paper. From the 8,823 swabs taken, 46 HCWs were detected positive for Covid-19.

EVALUATION OF PRESCRIBING INDICATORS AND PRESCRIPTION WRITING AT THE OUTPATIENT DEPARTMENT OF A PEDIATRIC TEACHING HOSPITAL IN LIBYA

Background:Irrational drug prescribing and inappropriate prescription writing have a serious medical and economicimpacton patients and society. Information on pediatric prescribing and quality of prescription writing in Libya are lacking. The aim of this study was to evaluate the extent of rational prescribing using the WHO indicatorsand to assessthe completeness of prescriptions recorded informationat the outpatient department of Benghazi Childrens Hospital. Results:A total of 603 prescriptions were sampled and analyzed. Concerning the prescribing indicators, the average number of medicines per encounter was 1.52, 5.47% of drugs were prescribed by generic name, 20.56% of encounters had at least one antibiotic prescribed, 25.87% of encounters were prescribed one injection or more and 61.27% of the prescribed drugs were from the Essential Drugs List. As regards the completeness of the recorded data on prescriptions, the patients name, gender, age and diagnosis were recorded in 99.34%, 10.78%, 85.74% and 29.85% of prescriptions, respectively. None of the prescriptions included the patients contact details and only 0.66% mentioned the patients weight. Prescribers information such as the name, signature and contact details were present in more than half of prescriptions while only 3.98% were stamped.Medication details like the dosage form, dose and frequency were written for more than 82% of the prescribed drugs whereas the strength and treatment duration were the least recorded drug information, 46.28% and 56.67%, respectively. Conclusion:Some forms of irrational drug prescribing as well as suboptimal recording of prescriptions information were observed at the outpatient department of Benghazi Childrens Hospital.

Utilisation of laboratory test results for patient management by clinicians at two large referral hospitals in Zambia

Background Medical laboratory diagnosis is a critical component of patient management in the healthcare setup. Despite the availability of laboratory tests, clinicians may not utilise them to make clinical decisions. We investigated utilsation of laboratory tests for patient management among clinicians at Ndola Teaching Hospital (NTH) and Arthur Davison Childrens Hospital (ADCH), two large referral hospitals in the Copperbelt Province, Ndola, Zambia. Method We conducted a descriptive cross-sectional study among clinicians. The study deployed self-administered questionnaires to evaluate clinician utilisation, querying and confidence in laboratory results. Additional data on demographics and possible laboratory improvements were also obtained. Data were entered in Microsoft excel and exported to SPSS version 16 for statistical analysis. Results Of the 80 clinicians interviewed, 96.2% (77) reported using laboratory tests and their results in patient management. 77.5% (62) of the clinicians indicated they always used laboratory results to influence their patient management decisions. Of the selected laboratory tests, clinicians were more confident in using haemoglobin test results (91.2%). There was no statistically significant association between the clinicians gender or qualification and use of test results in patient management. Conclusion Our findings show that despite the majority querying laboratory results, most of the clinicians use laboratory results for patient management. There is need for interactions between the laboratory and clinical area to assure clinician confidence in laboratory results. Key words: utilisation, clinicians, laboratory tests, Ndola Teaching Hospital, Arthur Davison Childrens Hospital