Whole genome analysis reveals unique traits of SARS-CoV-2 in pediatric patients.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) continues to challenge the global healthcare with emerging variants and higher infectivity as well as morbidities. This study investigated potential age-related variations through genomic characterization of the virus under common clinical settings. A cohort comprising 71 SARS-CoV-2 strains from both infected infants and accompanying adults, diagnosed via RT-PCR at a tertiary pediatric hospital and research center, underwent Illumina paired-end sequencing. The subsequent analysis involved standard genomic screening, phylogeny construction, and mutational analyses. The analyzed SARSCoV- 2 strains were compared with globally circulating variants. The overall distribution revealed 67.61 % Delta, 25.7 % Omicron, and 1 % either Kappa or Alpha variants. In 2021, Delta predominated at âˆ¼ 94 %, with Alpha/Kappa accounting for around 5 %. However, in 2022, over 94 % of the samples were Omicron variants, signifying a substantial shift from Delta dominance. Delta variants constituted 69.5 % of infections in adults and 78.5 % in infants, while Omicron variants were responsible for 31 % of cases in infants and 18 % in adults. The Spike region harbored the majority of mutations, with T19R being the most prevalent mutation in the Delta lineage. Notably, the frequencies of this mutation varied between infants and adults. In Omicron samples, G142D emerged as the most prevalent mutation. Our dataset predominantly featured clade 21A and lineage B.1.617.2. This study underscores the differential clinical presentations and genomic characteristics of SARS-CoV-2 in pediatric patients and accompanying adults. Understanding the dynamic evolution of the SARS- CoV-2 in both pediatric and adults can help in strengthening prophylactic measures.

Differentiating Multisystem Inflammatory Syndrome in Children (MIS-C) and Its Mimics - A Single-Center Experience From a Tropical Setting.

OBJECTIVE: Identifying clinical and laboratory indicators that differentiate multisystem inflam-matory syndrome in children (MIS-C) apart from other febrile diseases in a tropical hospital setting. METHODS: Review of hospital records done in a tertiary care exclusive children's hospital for children admitted from April, 2020 till June, 2021. Laboratory values, severe acute respiratory syndrome coronavirus (SARS-CoV-2) serological status, and clinical signs and symptoms of patients with MIS-C, and those with similar presentations were analyzed. RESULTS: 114 children fulfilled the inclusion criteria (age group of 1 mo-18 y) for whom a diagnosis of MIS-C was considered in the emergency room based on the clinical features. Among them, 64 children had the final diagnosis of MIS-C, and the remaining 50 children had confirmatory evidence of infections mimicking MIS-C such as enteric fever, scrub typhus, dengue and appendicitis. CONCLUSION: Older age group, presence of muco-cutaneous symptoms, very high C-reactive protein, neutrophilic leukocytosis, abdominal pain and absence of hepatosplenomegaly favor a diagnosis of MIS-C.

Abdominal Manifestations of Multisystem Inflammatory Syndrome in Children: A Single-Center Experience.

OBJECTIVES: We reviewed the cases of probable multisystem inflammatory syndrome in children (MIS-C) to identify those cases that mimicked surgical emergencies. METHODS: Records of children managed for MIS-C during a 15-month period between March, 2020 and April, 2021 were retrieved. Data on clinical presentation, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RT-PCR report, SARS-CoV-2 antibody status, blood investigations, radiological investigations and management were collected. RESULTS: A total of 28 out of 83 children with probable MIS-C had acute abdominal symptoms and signs. Fifteen children had mild features like diffuse abdominal pain or non-bilious vomiting, and the remaining 13 (46.2%) had severe abdominal signs or bilious vomiting. Four children worsened with conservative treatment for MIS-C and were detected with perforated appendicitis. Two more children developed recurrent appendicitis on follow up. One child with appendicitis who underwent laparoscopic appendectomy, later manifested with MIS-C. CONCLUSION: Surgical abdominal emergencies may be confused with or occur concurrently in children with MIS-C that should be identified with a high index of suspicion.

Androgen receptor polymorphism, mental rotation, and spatial visualization in men.

Circulating levels of testosterone (T) have been hypothesized to influence spatial cognition in adult men, but empirical support for this idea is mixed. Many of testosterone's effects are mediated by the classic nuclear androgen receptor (AR), which contains a polymorphic glutamine repeat (CAG repeat sequence) that varies significantly across individual men and confers differences in receptor function and therefore individual responsivity to T. We genotyped the AR CAG repeat length in 146 healthy adult men who also performed cognitive tests of mental rotation and spatial visualization. Circulating T concentrations were measured in saliva. CAG repeat length was found to be a significant predictor of spatial scores on tests of visualization but not mental rotation. A weaker AR was associated with lower visualization scores. In contrast, T itself, but not CAG repeat length predicted scores on two mental rotation tests. These results support the view that T action in the brain modestly influences spatial cognition in healthy men, but suggest that T's effects on mental rotation might not be AR-dependent and instead occur through an alternative mechanism.

Inflammatory demyelinating disorders of childhood: experience with six children.

Demyelinating disorders of the central nervous system (CNS) in children pose diagnostic and prognostic difficulties in clinical practice. In this report, we describe our experience with inflammatory demyelinating disorders of CNS in six children, classified as per the proposed criteria by the Pediatric Multiple Sclersois Study Group. We emphasize the importance of appropriate diagnosis and follow-up to distinguish transient inflammatory demyelinating diseases from chronic inflammatory demyelinating diseases.

Gorhams disease: vanishing bone syndrome.

Gorhams disease, also known as massive osteolysis or vanishing bone disease is an extremely rare bone disease. It is characterized by angiomatosis with adjacent bone resorption. We report an 8-years old boy with the disease who was managed successfully with alpha 2b interferon therapy.

Empyema Due to Thoracic Migrating Appendicolith.

BACKGROUND: Retained appendicolith following appendicectomy, and can cause recurrent abscess in the abdomen and retroperitoneum. CASE CHARACTERISTICS: 11-yr-old boy who presented with subpulmonic abscess and pneumonia following appendicectomy for perforated appendicitis. OBSERVATION: Thoracotomy revealed a thick walled subpulmonic abscess surrounding an appendicolith along with a rent in the posterolateral aspect of the diaphragm. MESSAGE: In children presenting with pus collections and a history of recent appendicectomy, the possibility of a migrating appendicolith should be considered.

Demographic profile of healthy children with nasopharyngeal colonisation of Streptococcus pneumoniae: A research paper.

BACKGROUND: Pneumonia is a preventable cause of mortality in children. Streptococcus pneumoniae colonising the nasopharynx of healthy children can cause invasive diseases and the serotype distribution of colonisation isolates should be an indicator of invasive disease, antibiotic resistance profiles, and potential vaccine coverage. Identifying factors influencing nasopharyngeal colonisation, the serotypes and antimicrobial resistance pattern can improve rational preventive strategies. OBJECTIVES: Identify risk factors associated with nasopharyngeal colonisation of S.pneumoniae in healthy children between 6 months to 5 years of age. Determine the serotype and antibiotic sensitivity of S. pneumoniae isolated from nasopharynx of healthy children. METHODS: This prospective observational included 500 healthy children, 6months to 5 years of age. Demographic features of the study population, the serotypes and antimicrobial sensitivity pattern of S.Pneumoniae isolated from cultures of nasopharyngeal swabs were subjected to statistical analysis. RESULTS: S. pneumoniae was isolated in 9% of 450 children. Increased nasopharyngeal carriage rate was associated with overcrowding 48.8% and poor ventilation 35.5%. 6B (n=16) was the most common serotype isolated. 69% were serogroups known to cause invasive disease All S. pneumoniae isolates were susceptible to vancomycin and linezolid. Antimicrobial susceptibility of PCV 7 serotypes were greater than non PCV 7 serotypes for almost all antimicrobials tested. Penicillin resistance was 11 % and MDR 51.

Infections in burn patients--experience in a tertiary care hospital.

A retrospective study was conducted at the Kanchi Kamakoti Childs Trust Hospital to analyze the bacterial isolates from the wounds of patients admitted to the Burns Unit and to determine the sensitivity patterns of the commonly cultured organisms over a 6-year period, December 1998 to December 2004. A total of 535 samples were analysed. Single isolates were more common. Pseudomonas was the most commonly cultured organism followed by Staphylococcus aureus. Escherechia coli and Klebsiella were seen in equal numbers. ESBL rates were 37%. Antibiotic sensitivity patterns and periodic ESBL surveillance helped in selection of appropriate antibiotics.

Profile of pediatric burns Indian experience in a tertiary care burn unit.

Pediatric burns admitted to the tertiary care burn facility of Kanchi Kamakoti CHILDS Trust Hospital in Chennai (India) were retrospectively analysed between 1992 and 2003. Five hundred and thirty-five burn cases were admitted during these years. These children belonged to the age group of 0-18 years (as WHO has increased the pediatric age group range to 0 to 18 years). The etiology of these burns was looked into and the outcome of these patients in respect to etiology and complications were studied. After analysis, they were classified according to age, sex, TBSA and the occurrence of infection during the course of treatment. The complications that really affected the outcome were looked into and infection ranked first in fatal cases. Inhalation burns were not very common in our group and were associated only with large flame burns, which occur when a child is burnt while the mother commits suicide, or in cases of abuse of female children in a closed room with lots of inflammable upholstery. Scalds were the most common type of burn among children under 4 years of age. Flame burns predominated the older age group. Although there were 13 deaths among the entire group, the majority occurred within the 2-4 years age group. There was no significant gender difference with respect to mortality. Large burn size and infection were the strongest predictors of mortality.

Evaluation of the use of DMSA in culture positive UTI and culture negative acute pyelonephritis.

This prospective study was done to assess the frequency of acute pyelonephritis (APN) in febrile children with positive urine culture as documented by Tc99m DMSA scintigraphy (DMSA) and the frequency of vesicoureteric reflux (VUR) in these children. Secondly, to determine the frequency of APN, in febrile children with supportive evidence for UTI but with negative urine culture, as documented by DMSA and frequency of VUR in them. Thirdly to stress the utility of DMSA to diagnose APN in urine culture negative febrile children and to suggest DMSA as a clinical tool in evaluation of fever of unknown origin (FUO). This study included 42 children with positive urine culture and 26 children with negative urine culture who had supportive evidence of UTI as determined by the predetermined criteria and diagnosed to have APN by DMSA. All of them had ultrasonogram (USG), DMSA and voiding cystourethrogram (VCU). They were followed up for a minimum period of 6 months. Out of the 42 children with positive urine culture 92.9% had features of APN in the DMSA of whom 82.1% had vesicoureteric relux (VUR). The DMSA was abnormal in 26 children with negative urine culture, of whom 65.4% had VUR. Ultrasound suggestive of parenchymal change was observed in 47.6% in the culture positive group and 65.4% in the culture negative group. In conclusion, it is suggested, that DMSA is a useful investigation for the diagnosis of APN in febrile UTI. DMSA is indicated in febrile children with negative urine culture but with supportive evidence of UTI and in FUO. An abnormal DMSA is a strong indication for work up for VUR.