Epidemiological, clinical and biomarker profile of pediatric patients infected with COVID-19.

BACKGROUND: Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population. METHODS: For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis. RESULTS: Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818-24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356-0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48-64%) and cough (35-55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4-61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2-50% and 0.3-67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality. CONCLUSION: Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population.

Managing with maps? The development and institutionalization of a map-based health management information system in Madhya Pradesh, India.

AIMS: This paper presents the development of a map-based health management information system (mHMIS) in the central Indian province of Madhya Pradesh. Sample outputs and statistics from the system for one district are presented. The implementation dynamics and the preliminary performance of the system are discussed. METHODS: The development of the mHMIS was a collaborative effort between the provincial Department of Health, the medical university and the Danidasupported Madhya Pradesh Basic Health Services project. One of India's most socioeconomically backward provinces, Madhya Pradesh is spread over an area of 304,000 km(2), and has a population of 60.4 million distributed in its 55,392 villages and 394 towns. A primary survey of all healthcare providers (public and private) in the province was done to map these. Secondary data sources for sociodemographic information (census of India), vital statistics and health program indicators (health worker records) were used in developing the system. The process of mapping from obtaining hand-drawn maps of the villages from the commissioner, land records, to final digitizing is also described. CONCLUSIONS: Sample outputs and statistics for one district (Chindwara) from the system are presented. There were 20.35 trained doctors in rural areas and 72.78 in urban areas per 100,000 population. Preliminary experience after a year, advantages, constraints (both systemic limitations and weakness in the mHMIS) to optimal usage, and future prospects for use in this setting are discussed.

Correlations between periovulatory serum and follicular fluid CA-125 and granulosa cell hormones after controlled ovarian hyperstimulation.

OBJECTIVE: To determine the presence and concentration of CA-125 in periovulatory follicular fluid (FF) and serum after controlled ovarian hyperstimulation and to determine if the CA-125 in these two compartments could be related to granulosa cell markers such as inhibin or estradiol. STUDY DESIGN: Fifteen women undergoing controlled ovarian hyperstimulation for in-vitro fertilization-embryo transfer were studied. A transvaginal, ultrasound-guided follicular aspiration was performed. CA-125, inhibin, estradiol and FSH were measured in FF and serum. Pearson and Spearman's Rank Correlation tests were performed. RESULTS: CA-125 was measurable in 59% of follicles. Values ranged from undetectable to 3630 U/ml. Serum CA-125 ranged from undetectable to 126 U/ml. CA-125 and inhibin correlated negatively in FF and positively in serum. CONCLUSION: CA-125 was present in significant but variable concentrations in 59% of periovulatory follicles. A negative correlation was noted between CA-125 and inhibin or estradiol in the FF and a positive correlation with serum inhibin. No correlations were noted to oocyte retrieval or fertilization.

The use of an indwelling Doppler probe to study acute changes in umbilical artery waveforms in the fetal sheep.

A chronic sheep model for Doppler umbilical vascular analysis was developed, in which indwelling Doppler probes were used. These were designed with a fixed angle of insonation and implanted directly on the umbilical cord to register umbilical artery velocity waveforms. The fetuses in eight pregnant ewes underwent maternal aortic and umbilical cord constrictions producing serial blood flow reductions. Occlusion of the umbilical cord and maternal aorta caused distinctly different waveforms. Cord occlusion produced an immediate response with an elevated systolic/diastolic ratio and disappearance of diastolic velocity. Maternal aortic occlusion produced a delayed response with drops in both systolic and diastolic velocity; diastolic velocity never reached zero. Although systolic/diastolic ratios are believed to reflect placental resistance, the maintenance of the systolic/diastolic ratio with diminution of systolic velocity suggests declining fetal cardiac output as an additional factor. It is possible to differentiate uteroplacental from umbilicoplacental insufficiency by Doppler methods. With technologic improvements Doppler ultrasonography may allow better analysis of acute stressful conditions during human labor.

Endometrioma of the kidney: case report.

A case of endometrioma of the right kidney with extensive involvement is presented. The patient complained of vague pain in the right lumbar region with no specific symptom relating to the kidney. An excretory urogram revealed a hydronephrotic kidney and diagnosis was a renal hydatid cyst. The 7 cases reported previously in the medical literature are reviewed briefly.