Analysis of risk factors for seizures and short-term reoccurrence of seizures in febrile children with SARS-CoV-2 infection: an observational study (preprint)

Background:With the epidemic of the Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) variant Omicron, its accompanying neurological manifestations have gradually attracted attention.The main objective of this study was to compare seizures in febrile children with and without coronavirus disease 2019(COVID-19) and to conduct a short-term follow-up in the COVID-19 positive group to investigate the risk factors for short-term recurrence of seizures in children with febrile seizures(FS). Methods: Retrospective analysis of patients admitted to the Children's Hospital of Chongqing Medical University for fever and seizures between October 1 and December 30, 2022.Based on the results of SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR), the patients were divided into a COVID-19 positive group and a COVID-19 negative group.Moreover,we followed up patients in the COVID-19-positive group for 3 months using outpatient or telephone follow-up, and the main content of follow-up included whether the patients had seizures after discharge and whether there were neurological abnormalities. Results:Compared with the COVID-19-negative group, the COVID-19-positive group had a higher proportion of seizure duration ≥ 15 minutes(18.7%VS5.1%;P=0.001), seizure ≥ 2 time(54.4%VS41.0%;P=0.024), status epilepticus(15.4%VS5.1%;P=0.005), and Electroencephalogram (EEG) abnormalities(29.4%VS13.6%;P=0.016).Seizures ≥2 time[P=0.015,OR(95% CI)=4.632(1.347-15.928)], peak temperature ≤39°C[P=0.001,OR(95% CI)=6.296(2.059-19.254)], and history of convulsions[P=0.005,OR(95% CI)=5.628(1.707-18.550)] were risk factors for recurrence of seizures within a short period of time in children with covid-19 infected febrile convulsions.In the COVID-19 positive group, three patients died and four patients had residual cognitive or motor dysfunction. Conclusions:The seizures were more severe in the COVID-19 positive group compared to the COVID-19 negative group.In addition, patients with COVID-19 who present with seizures and persistent impaired consciousness need to be alerted to serious neurological disorders such as acute necrotizing encephalopathy.

Clinical Analysis of Febrile Seizures in Children with COVID-19 in the Omicron Era: a Single-Center Retrospective Observational Study (preprint)

Objectives：This study sought to investigate the characteristics of febrile seizures in children infected with the Omicron variant in Chongqing province, west of China, and underscore the importance of monitoring for potential neurological complications associated with this variant. Methods: This retrospective study enrolled a total of 84 pediatric patients with COVID-19 and FS who were admitted to Chongqing University Three Gorges Hospital between December 11th and December 26th, 2022. Demographic, clinical, laboratory, radiological and EEG data were retrospectively summarized. Results: The study enrolled 84 children, with a median age of 21.5 (15-35.5) months and a range of 6-162 months. Among these, 11.9% were of atypical age (age > 5 years). The patient population comprised of 54 (64.29%) boys and 30 (35.71%) girls. 32.14% presented with complex FS. Generalized tonic-clonic seizures occurred in 51.19%, followed by generalized tonic seizures (43.43%). 86.9% occurred within 24h after fever onset and 80.95% continued for ≤ 5min. Conclusions: Febrile seizures in children with Omicron VOC are common COVID-19 illness with a higher prevalence compared with other VOCs. They present with similar clinical manifestations and resolve spontaneously with a benign clinical outcome in line with other seasonal viruses.

Challenge of treating cancer amid the COVID-19 pandemic: case of skeletal muscle metastasis from primary carcinoma of the lung mistaken as sarcoma (preprint)

Background. The authors report on an extremely rare case of skeletal muscle metastasis from primary lung cancer that involved the radial nerve and humerus, which was “overtreated” with wide tumor resection and frozen autograft reconstruction upon misdiagnosis of sarcoma by intraoperative frozen section, amid pressure of expediting hospital care during the COVID-19 pandemic.     Case presentation. A 61-year-old male living outside Metro Manila presented with painful mass in his left distal arm during the enhanced community quarantine, and requested admission upon testing negative for COVID-19. Imaging studies suggested a diagnosis of soft tissue sarcoma involving the radial nerve and humerus, and intending to prevent nosocomial SARS-CoV-2 infection of patient, treatment was expedited by foregoing biopsy and opting for intraoperative frozen section prior to resection. Frozen section findings suggested malignancy intraoperatively, and we proceeded with wide tumor resection and frozen autograft reconstruction of the humerus using plates and screws. However, permanent sections revealed metastatic carcinoma from primary non-small cell lung cancer, with PET scan confirming lung mass in the right apical lobe.        Conclusion. The report concludes that establishment of a definite tumor diagnosis by final histopathological analysis is indispensable, even when planning for emergent surgery in the time of COVID-19 pandemic.