ABSTRACT
Leukopenia, thrombocytopenia, elevated D-dimer, and prolonged prothrombin time are considered poor prognostic factors in adults with acute Coronavirus Disease 2019. The prognostic significance of these abnormalities among pediatric patients remains underreported in the literature. This retrospective cohort study evaluates the prognostic implications of hematologic and hemostatic derangements in patients younger than 22-years-of-age who were admitted to a tertiary-care referral institution for management of acute Coronavirus Disease 2019 infection. Leukopenia and thrombocytopenia were identified as independent prognostic factors of disease severity. Although the majority of children, with available results, had elevated D-dimer or prolonged prothrombin time upon initial presentation, these markers were not found to be associated with the development of severe clinical complications.
Subject(s)
COVID-19/blood , Hemostasis , Adolescent , Adult , COVID-19/complications , COVID-19/diagnosis , Child , Child, Preschool , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Infant , Leukopenia/blood , Leukopenia/complications , Leukopenia/diagnosis , Male , Prognosis , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index , Thrombocytopenia/blood , Thrombocytopenia/complications , Thrombocytopenia/diagnosis , Young AdultABSTRACT
Mesenchymal stem cells (MSC) have been shown to be immunomodulatory, tissue regenerative, and graft promoting; however, several questions remain with regard to ideal MSC source and timing of administration. In this study, we utilized a rigorous preclinical model of allogeneic islet cell transplantation, incorporating reduced immune suppression and near to complete mismatch of major histocompatibility antigens between the diabetic cynomolgus monkey recipient and the islet donor, to evaluate both the graft promoting impact of MSC source, that is, derived from the islet recipient, the islet donor or an unrelated third party as well as the impact of timing. Co-transplant of MSC and islets on post-operative day 0, followed by additional IV MSC infusions in the first posttransplant month, resulted in prolongation of rejection free and overall islet survival and superior metabolic control for animals treated with recipient as compared to donor or third-party MSC. Immunological analyses demonstrated that infusion of MSC from either source did not prevent alloantibody formation to the islet or MSC donor; however, treatment with recipient MSC resulted in significant downregulation of memory T cells, decreased anti-donor T cell proliferation, and a trend toward increased Tregulatory:Tconventional ratios.
Subject(s)
Islets of Langerhans Transplantation , Mesenchymal Stem Cells , Allografts , Animals , Macaca fascicularis , Transplantation, HomologousABSTRACT
Nuclear protein in testis carcinoma is a rare and highly aggressive carcinoma associated with a 70% mortality rate 1 year from diagnosis and a median survival of only 6.5 months. No established treatment protocol exists, although some success has been achieved using a multimodal approach including early surgical resection and adjuvant chemotherapy and radiation. Prior studies have not demonstrated successful treatment in the absence of upfront surgical resection. We describe the first reported case of a patient with unresectable nuclear protein in testis carcinoma treated successfully with definitive chemotherapy using the Scandinavian Sarcoma Group IX Protocol and concurrent radiation therapy, but without surgical resection.
Subject(s)
Carcinoma/drug therapy , Carcinoma/radiotherapy , Neoplasm Proteins/genetics , Nuclear Proteins/genetics , Adolescent , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma/genetics , Female , Humans , Treatment OutcomeABSTRACT
This case aims to remind all providers to scrutinise for atypical presentations of multisystem inflammatory syndrome in children (MIS-C) which may mimic a more routine diagnosis. In the absence of mucocutaneous symptoms, the diagnosis of MIS-C can be missed. Given the potential for rapid deterioration of patients with MIS-C, early treatment and inpatient interventions are necessary.
Subject(s)
Abdominal Pain/immunology , COVID-19/diagnosis , Fever/immunology , SARS-CoV-2/isolation & purification , Systemic Inflammatory Response Syndrome/diagnosis , Tachycardia/immunology , Abdominal Pain/blood , Abdominal Pain/therapy , Abdominal Pain/virology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , C-Reactive Protein/analysis , COVID-19/blood , COVID-19/immunology , COVID-19/therapy , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , Child , Diagnosis, Differential , Fever/blood , Fever/therapy , Fever/virology , Humans , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Intubation, Intratracheal , Male , Mucocutaneous Lymph Node Syndrome/diagnosis , Myocarditis/diagnosis , Nasopharynx/virology , Natriuretic Peptide, Brain/blood , SARS-CoV-2/immunology , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/therapy , Tachycardia/blood , Tachycardia/therapy , Tachycardia/virology , Treatment Outcome , COVID-19 Drug TreatmentABSTRACT
Engineered camelid antibody multimers can potently block SARS-CoV-2 viral entry.
Subject(s)
Antibodies, Viral , Coronavirus Infections , Pandemics , Pneumonia, Viral , Severe acute respiratory syndrome-related coronavirus , Betacoronavirus , COVID-19 , Humans , SARS-CoV-2ABSTRACT
Appendiceal mucinous neoplasms are rarely diagnosed in pediatric patients. We present a 16-year-old adolescent boy with severe Crohn's disease who was not on maintenance medication for his underlying diagnosis. He was referred for nutritional optimization and small bowel obstruction. An emergent laparoscopic ileocecectomy with primary ileocolonic anastomosis was carried out secondary to acute peritonitis. Small bowel pathologic findings were consistent with Crohn's disease with low-grade appendiceal mucinous neoplasm (LAMN) of the appendix.
