Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children.

BACKGROUND: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. OBJECTIVES: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. METHODS: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum. RESULTS: Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). CONCLUSION: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

Potential links between COVID-19 and periodontitis: a bioinformatic analysis based on GEO datasets.

BACKGROUND: 2019 Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The COVID-19 pandemic has already had a serious influence on human existence, causing a huge public health concern for countries all around the world. Because SARS-CoV-2 infection can be spread by contact with the oral cavity, the link between oral illness and COVID-19 is gaining traction. Through bioinformatics approaches, we explored the possible molecular mechanisms linking the COVID-19 and periodontitis to provide the basis and direction for future research. METHODS: Transcriptomic data from blood samples of patients with COVID-19 and periodontitis was downloaded from the Gene Expression Omnibus database. The shared differentially expressed genes were identified. The analysis of Gene Ontology, Kyoto Encyclopedia of Genesand Genomes pathway, and protein-protein interaction network was conducted for the shared differentially expressed genes. Top 5 hub genes were selected through Maximal Clique Centrality algorithm. Then mRNA-miRNA network of the hub genes was established based on miRDB database, miRTarbase database and Targetscan database. The Least absolute shrinkage and selection operator regression analysis was used to discover possible biomarkers, which were then investigated in relation to immune-related genes. RESULTS: Fifty-six shared genes were identified through differential expression analysis in COVID-19 and periodontitis. The function of these genes was enriched in regulation of hormone secretion, regulation of secretion by cell. Myozenin 2 was identified through Least absolute shrinkage and selection operator regression Analysis, which was down-regulated in both COVID-19 and periodontitis. There was a positive correlation between Myozenin 2 and the biomarker of activated B cell, memory B cell, effector memory CD4 T cell, Type 17 helper cell, T follicular helper cell and Type 2 helper cell. CONCLUSION: By bioinformatics analysis, Myozenin 2 is predicted to correlate to the pathogenesis and immune infiltrating of COVID-19 and periodontitis. However, more clinical and experimental researches are needed to validate the function of Myozenin 2.

COVID-19-Related Misinformation among Parents of Patients with Pediatric Cancer.

We conducted a survey among 735 parents to determine differences in endorsement of misinformation related to the coronavirus disease pandemic between parents of children in cancer treatment and those with children who had no cancer history. Parents of children with cancer were more likely to believe misinformation than parents of children without cancer.

Hematologic changes predict clinical outcome in recovered patients with COVID-19.

2019 coronavirus disease (COVID-19) presents as a newly recognized pneumonia that has brought about a global pandemic and is increasingly considered as a systemic illness. We investigated the clinical and laboratory features of recovered COVID-19 patients without pre-existing hematologic diseases at Wuhan No. 1 Hospital. Fifty-nine male and 68 female Chinese patients were included with the median age at 64 years in the present study. Eosinopenia (37.80%), monocytosis (51.97%), lymphocytopenia (25.20%), and anemia (51.97%) were the most common hematologic findings in our cohort, particularly in severe or critically ill COVID-19. The levels of changes in leukocytes, neutrophils, lymphocytes, monocytes, eosinophils, basophils, platelets, hemoglobin levels, mean corpuscular volume (MCV), and mean cell hemoglobin concentration (MCHC) are overall associated with lung involvement, oxygen demand, and disease activity. However, changes of eosinophils (end hospitalization-baseline) (coefficients = 10.32; 95% CI = 1.03-19.60, P = 0.03) and basophils (Max - Min) (coefficients = 71.43; 95% CI = 8.55-134.31, P = 0.03) were independent predictors of delayed recovery in the hospital by the multivariate analysis in this recovered population. A variety of hematologic changes are associated with the severity and clinical outcome of recovered COVID-19 patients, which warrants further exploration of their underlying mechanisms.

Buying Time with COVID-19 Outbreak Response, Israel.

Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February-April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.

Maternal health care management during the outbreak of coronavirus disease 2019.

Coronavirus disease 2019 (COVID-19) is a novel type of highly contagious pneumonia caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the strong efforts taken to control the epidemic, hundreds of thousands of people were infected worldwide by 11 March, and the situation was characterized as a pandemic by the World Health Organization. Pregnant women are more susceptible to viral infection due to immune and anatomic alteration, though hospital visits may increase the chance of infection, the lack of medical care during pregnancy may do more harm. Hence, a well-managed system that allows pregnant women to access maternal health care with minimum exposure risk is desired during the outbreak. Here, we present the managing processes of three pregnant women who had fever during hospitalization in the gynecology or obstetrics department, and then, we further summarize and demonstrate our maternal health care management strategies including antenatal care planning, patient triage based on the risk level, admission control, and measures counteracting emergencies and newly discovered high-risk cases at in-patient department. In the meantime, we will explain the alterations we have done throughout different stages of the epidemic and also review relative articles in both Chinese and English to compare our strategies with those of other areas. Although tens of COVID-19 cases were confirmed in our hospital, no nosocomial infection has occurred and none of the pregnant women registered in our hospital was reported to be infected.

Importance of respiratory airway management as well as psychological and rehabilitative treatments to COVID-19 patients.

The clinical therapy for severe 2019 coronavirus disease (i.e., COVID-19) sufferers is relatively challenging. Herein, the processes involving salvage of a critical COVID-19 patient were retrospectively analyzed. The condition of an obese female critical COVID-19 sufferer progressively worsened in the initial period after admission. According to her symptoms and examination reports, endotracheal intubation and mechanical ventilation were timely conducted and meanwhile high-dose sedatives and analgesics were administrated. In the later therapeutic phase, however, sedative and analgesic dosages were gradually reduced, and psychological and rehabilitative therapies were conducted, concomitantly with enhancement of airway care to facilitate sputum expectoration. Eventually, the endotracheal tube was feasibly removed after intubation for 18 days and subsequently replaced with noninvasive ventilation and a high-flow nasal cannula oxygen therapy. Intensive airway care alongside psychological and rehabilitative therapies can shorten the mechanical ventilation time and improve the prognosis of COVID-19 sufferers.

[Consideration of surgeons participating in 2019 coronavirus disease emergency medical rescue].

As a newly epidemic, 2019 coronavirus disease (COVID-19) with a concentrated outbreak poses a great challenge to medical treatment. The severe and critical patients are complex complicatied with the psychological problems, and the medical staff are overworked and under tremendous psychological pressure. The surgeon participated in emergency medical rescue could provide professional treatment for the patients combined with surgical diseases, as well as specialized training for the non-surgeon crew, to reduce surgical-related mortality. With the advantages of good team consciousness, strong aseptic concept and good psychological quality, the surgeons can quickly adapt to and carry out rescue work under the premise of good self-protection. Surgeons need to develop critical care management concepts and focus on the critical care support equipment. Some suggestions are put forward for the standardized training of resident surgeons to cultivate compound talents. It is hoped that this article can lead to the thinking of how to participate in the emergency medical rescue of infectious diseases among surgeons and provide some enlightenment for future surgical education.

[The treatment proposal for the patients with breast diseases in the central epidemic area of 2019 coronavirus disease].

Currently, the epidemic of 2019 coronavirus disease (COVID-19) is still ongoing. Its characteristics include high contagiousness, herd susceptibility and clinical phenotype diversity, which have a severe influence on people's daily life and rountine therapy for other diseases. Breast dieases are clinical common diseases. In the central epidemic area of COVID-19, the clinical specialists of breast diseases should consider all of the following factors comprehensively: the prevention of COVID-19, the diagnosis and treatment of breast diseases and the accessibility of medical resources. Besides, we should select the appropriate therapy and optimize treatment process so as to prevent the propagation and cross infection of COVID-19 as well as manage the breast diseases without delay. Therefore, we carried out some management proposals of the patients with breast diseases in the central epidemic area during the epidemic of COVID-19 on the basis of conventional treatment guidelines and clinical experiences. The suggestions and corrections from colleagues will be welcomed.

[Recommendations for general surgery clinical practice in 2019 coronavirus disease situation].

The 2019 coronavirus disease(COVID-19) is a highly infectious disease, has a long incubation period and a variety of clinical manifestations, which has a significant impact on public health and life. Afterwards, scientific and standardized work processing during the epidemic is of great significance for prevention and control. In order to implement the central government's decision-making deployment and defeat the COVID-19 as soon as possible, we had focused on the key points in the clinical work of general surgery according to latest relevant guidelines, literature and experience in epidemic prevention. Finally, we drafted the prevention and control strategies and recommendations to make a reference for medical staff of general surgery to fight against COVID-19.

[Countermeasures and treatment for aortic acute syndrome with 2019 coronavirus disease].

The 2019 coronavirus disease(COVID-19) has cost a great loss to the health and economic property of Chines people. Under such a special circumstance, how to deal with such patients with acute aortic syndrome has become a serious challenge. Rapid diagnosis of concomitant COVID-19, safe and effective transportation, implementation of the interventional procedure, protection of vascular surgical team and postoperative management and follow-up of such patients have become urgent problems for us. Combined with the latest novel government documents, the literature and the experiences from Wuhan, we answered the above questions briefly and plainly. We also hope to inspire the national vascular surgeons to manage critical emergencies in vascular surgery and even routine vascular diseases with COVID-19, as a final point to limit the severe epidemic situation, and minimize the damage of COVID-19.

[Treatment of pancreatic diseases and prevention of infection during outbreak of 2019 coronavirus disease].

Objective: To explore the proper protective measures for pancreatic diseases treatment during the outbreak of 2019 coronavirus disease(COVID-19). Methods: Clinical data of four cases of patients that suffered COVID-19 from February 2(nd) to February 9(th), 2020 at Department of Pancreatic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology were reviewed induding 4 males and 1 female, aging of 50, 51, 46, 87 years old, respectively. After the first patients cuffed nosocomial infection of COVID-19, the general protective measures were updated.Only one patient was admitted to each room alone, with no more than one caregiver. The body temperature of care givers was measured twice a day.Primary protections were applied to all staff.The floor was sterilized using disinfectant with an effective chlorine concentration of 1 000 mg/L. The protective measures for interventional procedures were as follow. Primary protection was applied to the operators of central venipuncture catheter, percutaneous abdominal/pleural drainage, percutaneous retroperitoneal drainage, percutaneous transhepatic cholangial drainage and other surgical procedures with local anesthesia and epidural anesthesia. Secondary protection was applied to the operators of endoscopic retrograde cholangiopancreatography and surgical procedures with general anesthesia. Results: There were four patients who were diagnosed as COVID-19, of which one died of COVID-19, two were cured, and one was still in hospital for COVID-19. After the update of protective measures, no more nosocomial infection of COVID-19 occurred. Two central venipuncture catheter, three percutaneous abdominal or pleural drainage, one percutaneous retroperitoneal drainage, one percuteneous transhepatic cholecyst drainage and one open surgery with general anesthesia were performed with no infection of operators. Conclusions: The caregivers of patients are potential infection source of COVID-19. Enhanced protective measures including the management measures of caregivers can decrease the risk of nosocomial infection of COVID-19.

[Treatment strategies of Budd-Chiari syndrome during the epidemic period of 2019 coronavirus disease].

Prevention and control about the situation of 2019 coronavirus disease (COVID-19) are grim at present. In addition to supporting the frontline actively, medical workers in general surgery spare no efforts in making good diagnosis and treatment of specialized diseases by optimizing treatment process, providing medical advice online, mastering indications of delayed operation and emergency operation reasonably, etc. Budd-Chiari syndrome is a complex disorder, and severity of the disease varies, serious cases can be life threatening. While fighting the epidemic, medical workers should also ensure the medical needs of patients. However, instead of continuing the traditional treatment, a new management system should be developed. Based on the characteristics of Budd-Chiari syndrome patients in China and our experience, patients are divided into ordinary cases and critical cases, and treatment strategies suitable for the epidemic period of COVID-19 are put forward for reference and discussion by physicians.

[Suggestions for thoracic surgery clinical practice in non-epidemic area of 2019 coronavirus disease].

In this paper, the mechanism of destroying human alveolar epithelial cells and pulmonary tissue by 2019 novel coronavirus (2019-nCoV) was discussed firstly. There may be multiple mechanisms including killing directly the target cells and hyperinflammatory responses. Secondly, the clinical features, CT imaging, short-term and long-term pulmonary function damage of the 2019 coronavirus disease (COVID-19) was analyzed. Finally, some suggestions for thoracic surgery clinical practice in non-epidemic area during and after the epidemic of COVID-19 were provided, to help all the thoracic surgery patients receive active and effective treatment.

A Case of Neuroretinitis Following COVID-19 Vaccination.

PURPOSE: To present a case of neuroretinitis following an mRNA COVID-19 vaccination. CASE REPORT: A 78-year-old healthy woman was presented with blurry vision in her left eye 1 day after receiving the third dose of the Pfizer-BioNTech COVID-19 vaccine. The ocular examination revealed an optic disc swelling and retinal thickening of the macula with subretinal fluid in the left eye. The fluorescein angiography revealed hyperfluorescence of the left optic disc. The neuroretinitis resolved gradually after taking azithromycin and prednisolone orally. CONCLUSIONS: This is the first report of unilateral neuroretinitis following COVID-19 vaccination, implying a potential association between the mRNA vaccine and neuroretinitis.

Epidemiological characteristics, clinical course, and laboratory investigation of pediatric COVID-19 patients in a tertiary care center in Saudi Arabia.

Background: Since the initial emergence of the novel SARS-CoV-2 coronavirus responsible for the 2019 coronavirus disease (COVID-19) pandemic, many studies have been exploring the nature and characteristics of this virus and its associated clinical manifestations. The present study aimed to describe the clinical presentation and outcomes of COVID-19 infections in pediatric patients. Methods: A retrospective review of findings associated with 143 pediatric patients (age <14 years) with a confirmed COVID-19 diagnosis who had undergone inpatient or outpatient treatment at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia, between March 2020 and October 2020, was conducted. The analyzed data included patient demographic information, pre-existing medical conditions, symptoms, interventions, and outcomes. Results: The median age of this patient population was 7 years. Of these 143 patients, 67 (46.8%) had known pre-existing medical conditions including bronchial asthma (12.8%), chronic lung disease (CLD) (3%), congenital heart disease (CHD) (17%), primary immunodeficiencies (1.5%), malignancies (9.8%), and 7.5% were post-transplant patients. Thirty-seven patients (26%) were overweight or obese. Sixty-three of these patients (51%) were symptomatic, with the most common symptom being fever (55%). Ultimately, 45 patients (31%) required admission to the hospital, with a median duration of hospitalization of 9.6 days for admitted patients. There were no documented cases of infection-related mortality among this pediatric cohort, although 11 patients experienced post-infectious complications that primarily manifested as a loss of taste and smell. Conclusion: These findings suggest that pediatric COVID-19 patients tend to experience mild forms of the disease, without any significant differences in disease severity as a function of patient gender or immune status.

Environmental sampling of the severe acute respiratory syndrome coronavirus 2 Delta variant in the inpatient wards of a hospital in Nanjing.

BACKGROUND: Little is known about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant of concern (VOC)-contaminated environmental surfaces and air in hospital wards admitting COVID-19 cases. Our study was designed to identify high-risk areas of Delta VOC contamination in the hospital and provide suggestions to in-hospital infection control. We analyzed the SARS-CoV-2 Delta VOC contamination in the air and environmental surface samples collected from a hospital in Nanjing, China. METHODS: We collected data on clinical features, laboratory tests, swab tests, and hospital wards, identified the factors associated with environmental contamination, and analyzed patients' hygiene behaviors during hospitalization. RESULTS: A total of 283 environmental surface and air samples were collected from a hospital admitting 36 COVID-19 patients. Twelve swab samples from ten patients were positive. Toilet seats had the highest contamination rate (11.8%), followed by bedside tables (8.2%), garbage bins (5.9%), and bedrails (1.6%). The median time of symptom onset to surface sampling was shorter in the positive environment group than in the negative environment group (11 vs. 18 days; P=0.001). The results indicated that environmental surface contamination was associated with positive anal swabs [odds ratio (OR) 27.183; 95% CI: 2.359-226.063; P=0.003] and the time from symptom onset to surface sampling (OR 0.801; 95% CI: 0.501-0.990; P=0.046). The survey revealed that 33.3% of the patients never cleaned or disinfected their bedside tables or toilets, and 8.3% of them only cleaned their bedside tables or toilets. More than half of the patients often (25%) or always (30.6%) put the used masks on their bedside tables. Only 16.7% of the patients threw the masks into the specific garbage bin for used masks. CONCLUSIONS: The SARS-CoV-2 Delta VOC was detected on environmental surfaces, especially toilet seats and bedside tables, within a median time of 11 days after symptom onset. Our study provided potential predictors for environmental surface contamination, including positive anal swabs and the time from symptom onset to sampling. Disinfecting high-risk environmental surfaces should be emphasized in hospital wards, especially for patients in the early stage of COVID-19.

Prevalence of Voice Disorders in Healthcare Workers in the Universal Masking COVID-19 Era.

OBJECTIVES/HYPOTHESIS: To determine the prevalence and associated risk factors of voice disorders in healthcare workers of high-risk hospital care units during the 2019 coronavirus disease (COVID-19) pandemic. STUDY DESIGN: Cross-sectional study. METHODS: Questionnaire survey to healthcare personnel of COVID-19 high-risk hospital units was conducted, regarding demographic data, clinical activity, the pattern of usage of personal protective equipment, medical and vocal history, vocal symptoms, and Spanish validated Voice Handicap Index (VHI)-10 questionnaire. RESULTS: A total of 221 healthcare workers answered the survey. Nearly 33% of them reported having trouble with their voice during the last month, and 26.24% had an abnormal score in the Spanish validated VHI-10 questionnaire. The mean VHI-10 score was 7.92 (95% confidence interval 6.98-8.85). The number of working hours, the number of hours of mask daily use, simultaneous surgical and self-filtering mask use, and working in intermediate or intensive care units were independent variables significantly associated with a higher VHI-10 score. CONCLUSIONS: Healthcare workers of high-risk hospital care units during the universal masking COVID-19 pandemic are at risk of voice disorders. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E1227-E1233, 2021.

Supplementary research on K150del variant of activated protein C.

Activated protein C (APC) is an anticoagulant with potent cytoprotective and anti-inflammatory effects. K150del, a natural variant of APC, is associated with reduced anticoagulant activity. We performed a comprehensive study to analyze the functional alterations of the K150del mutant. Transcriptome analysis of HEK 293T cells treated with wild and mutant APC revealed differentially expressed genes enriched in inflammatory, apoptotic, and virus defense-related signaling pathways. Both wild and mutant APC displayed concentration-dependent cytoprotective effects. Low concentrations of K150del mutant resulted in decreased anti-inflammatory and anti-apoptotic activities, whereas its higher concentrations restored these effects. Expression of virus defense-related genes improved in mouse lung tissues after repeated administration of the APC variant. These results suggest that the APC K150del mutant could help clinicians to accurately predict disease risks and serve as a potential auxiliary therapeutic in viral infections, including 2019 coronavirus disease (COVID-19).