A Review of Coronavirus Disease (COVID-19) in Children

Abstract: Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) with a high morbidity and mortality rate has spread globally and affected all age groups. Children can carry and transmit the novel coronavirus, but usually do not develop severe disease. The number of children who contracted coronavirus disease 2019 has increased significantly; however, compared to adults, there have been fewer reported cases of COVID-19 in the pediatric population. This review is mainly about the epidemiological features, clinical findings, laboratory tests, imaging, and treatment recommendations in children with COVID-19 disease

Intra-Dialysis Hypotension in Patients Undergoing Hemodialysis

Introduction: Intra-dialysis hypotension occurs in 20- 55% of hemodialysis sessions. We aimed to define the prevalence and impact of pre-dialysis blood pressure, inter-dialysis weight gain, vasodilator agents, and characteristics of dialysis, serum calcium, and adjusted calcium, sodium, and albumin levels on intra-dialysis hypotension.Materials and Methods: In an observational prospective study, 44 hemodialysis cases aged 4.8-25 years were evaluated in 552 dialysis sessions. A decrease in the mean arterial blood pressure ≥ 10 mm Hg was defined as intra-dialysis hypotension. The characteristics of the patients were compared between cases and those without intra-dialysis hypotension.Results: Intra-dialysis hypotension was noted in 61.4% of the cases and 24.6% of the dialysis sessions. The duration of hemodialysis, weight gain between dialysis sessions, using vasodilator medications, serum sodium and adjusted calcium levels were compared between IDH + and IDH – cases. No significant differences were found in these variables between the 2 groups (P> 0.05 for all). Intra-dialysis hypotension was significantly more prevalent in cases with normal versus high systolic and diastolic blood pressure (P=0.014 and P=0.005 respectively). Intra-dialysis hypotension was significantly more frequent in girls, anuric patients, and patients with a history of transplantation (p=0.022, 0.011 and 0.008 respectively). A Significantly lower serum albumin concentration was found in cases with intra –dialysis hypotension (P=0.021).Conclusions: Intra-dialysis hypotension is a common complication of hemodialysis and is more prevalent in girls, normotensive patients, subjects with lower serum albumin concentrations, cases with a history of transplantation, and anuric patients. Keywords: Hemodialysis; Blood Pressure; Hypotension; Serum Albumin; Serum Calcium

Streptococcus Pneumonia-Associated Hemolytic Uremic Syndrome: A Case Report

Hemolytic uremic syndrome (HUS), a disease that destroys red blood cells, is the most common cause of sudden, short term acute kidney failure in children. By far, the commonest subgroup (>90% of childhood HUS) is induced by shiga toxin producing bacteria, usually enterohemorrhagic Escherichia coli (EHEC). These patients typically have a prodrome of diarrhea. Another important subgroup that is readily identified on clinical grounds follows invasive Streptococcus pneumonia infection. These infants tend to be younger than those with D + HUS, and the syndrome is very rare after the age of 4 years. They present with pneumonia, empyema, meningitis, and less often, isolated septicemia. Another group of patients may have mutations in complement regulators, and less often, inherited deficiency of von Willebrand protease or an inborn error of cobalamin metabolism. We report a 6-month-old child who developed hemolytic uremic syndrome following S. pneumonia meningitis.Keywords: Hemolytic-Uremic Syndrome; Meningitis; Streptococcus pneumonia; Chil

Comparative Study of Prophylactic Antibiotic Twice a Week Versus Every Night in Recurrent Urinary Tract Infections in Children

Background and Aim: Urinary tract infection is one of the most common childhood diseases. The results of studies investigating discontinuation or continuation of antibiotics in children with recurrent urinary tract infections and urinary reflux are controversial. Therefore, this study was conducted to compare prophylactic antibiotic treatment twice a week versus every night in the recurrence of urinary tract infections in children. Methods: This clinical trial was conducted using non-random simple sampling. Group A was given a single daily dose of cephalexin 10 mg/kg and group B was given cotrimoxazole at a dose of 5 mg/kg. Both groups were followed for ten months. Recurrences of urinary tract infections were compared between the two groups. Results: The mean age of the participants was 3.53±2.04 years. Most of the subjects were female (n=37, 61.7%). Urinary reflux was unilateral in 65% of the cases (n=39) and bilateral in the rest. There was no significant difference in age distribution, sex, and type of reflux between groups A and B. The frequency of recurrent urinary tract infection was 8.3% in group A and 6.7% in group B indicating no significant difference (p = 0.500). Conclusion: The results of this study showed that the frequency of recurrence of urinary tract infections in children who received prophylactic antibiotic treatment twice a week was not significantly different compared to the group of children who received continuous antibiotic prophylaxis

A Review on New Coronavirus Mechanism of Action

The new coronavirus outbreak caused by the severe acute respiratory syndrome coronavirus2 (SARS-CoV2) has resulted in more than 126750 deaths worldwide so far and billions of expenses for the governments. SARS-CoV2, similar to SARS, was transmitted from bats and spread via human to human closed contacts. The virus uses its spike protein to bind to angiotensin-converting enzyme 2 receptors on target cells to replicate. Consequently, it spreads from infected cells to contaminate other cells. The body’s first response toward the virus is to activate the innate immune system, leading to the synthesis of inflammatory mediators. In the next step, the adaptive immune system appears where B lymphocytes produce antibodies specific for the virus, and CD8+ cells kill the infected cells directly. In this article, we try to explain the virus mechanism of action and immune response in detail. Although many questions remain unanswered, we expect this review could help in vaccine and treatment progression, Keywords: COVID-19; SARS-CoV2; Mechanism; Review

The Effect of Rosa damascena on Children’s Enuresis: A Randomized Pilot Study

Background and Aim: Enuresis is one of the common problems among children. The present pilot study was conducted to investigate the effect of Rosa damascene on nocturnal enuresis in children. Materials and Methods: A randomized pilot study was performed from April 2017 to March 2018. The study participants were 40 children aged between 5-12 years with nocturnal enuresis. They were randomly divided to intervention and control groups using block randomization. The intervention group received R. damascena petals under the brand name Gole-Ghand (Barij- essence, Iran) as 5 cc orally, every 8 hours for one month. The control group received desmopressin as nasal spray (Sina Darou, Iran) 1-2 puffs for one month (maximum 20 mg daily). The primary outcome was complete or partial improvement in enuresis. The secondary outcome was frequency of side effects in patients. Results: Twenty-two out of 39 patients 22 (56.4%) were male and 17 patients (43.6%) were female with the average age of 7.3±1.86 years. There was no noticeable distinction between the groups in age, sex, urbanity, history of treatment, and primary or secondary enuresis (p>0.05). Complete improvement was observed in 14 patients (70%) in the control group. Partial improvement was observed in four patients (20%) in the control group and in six patients (31.5%) in the intervention group (p:0.001). No side effect was reported during the study in the intervention group. Conclusion: Based on the results of this pilot study, the use of R. damascena may lead to partial improvement against enuresis in some children. Further studies are required to evaluate this hypothesis

Rapid Intravenous Rehydration to Correct Dehydration and Resolve Vomiting in Children with Acute Gastroenteritis

SUMMARYObjectivesThe objective of this study is to evaluate the effect of rapid intravenous rehydration to resolve vomiting in children with acute gastroenteritis.MethodsThis randomized control trial was conducted in the pediatric emergency department in a tertiary care center in Tabriz, North-West of Iran. The study participants' were 150 children with acute gastroenteritis and vomiting who were moderately dehydrated, had not responded to oral rehydration therapy and without any electrolyte abnormalities. 20–30 cc/kg of a crystalloid solution was given intravenously over 2 hours and the control group was admitted in the emergency department (ED) for a standard 24 hour hydration. Effectiveness of rapid intravenous rehydration in the resolution of vomiting in children with acute gastroenteritis was evaluated.ResultsIn 63 children of the intervention group (out of 75) vomiting was resolved after rapid IV rehydration and they were discharged. Among them, 12 that did not tolerate oral fluids were admitted. In the control group, 62 patients' vomiting was resolved in the first 4 hours after admission, and there was no significant difference between the two groups regarding resolution of vomiting.ConclusionsRapid intravenous rehydration in children with moderate dehydration and vomiting due to gastroenteritis is effective in reducing admission rates in the ED

Safety and Efficacy of Rituximab in Children with Steroid-Dependent or Resistant Nephrotic Syndrome

Backgroundand Aim:Rituximab is a novel therapy that can help patients with steroid-dependent or resistant nephrotic syndrome.The aim of this study was to evaluate the efficacy of rituximab in children with corticosteroid-dependent and resistant nephrotic syndrome and to determine the factors associated with its efficacy. Methods:In this study, 40 children with corticosteroid-dependent or resistant nephrotic syndrome who were treated with rituximab in Dr. Sheikh Hospital,Mashhad,between 2014 and 2018 were enrolled. Patients with a history of hematuria, severe urinary tract infection, or secondary nephrotic syndrome were excluded. Results:The mean age of patients was 11.9 ± 5.04 years, and 55% were female. The most common underlying pathology of nephrotic syndrome was focal segmental glomerulonephritis (FSGS) (42.5%) followed by membranoproliferative glomerulonephritis (MPGN) and minimal change disease (MCD). Most of the participants (62.5%) were steroid-dependent and the rest (27.5%) were steroid resistant. Only 10% of the patients showed complications following rituximab administration and 57.5% went into complete remission. A negative family history and steroid-dependent nephrotic syndrome were significantly associated with a better treatment response. Moreover, patients with steroid-resistant nephrotic syndrome were more likely to have a positive family history, while factors associated with steroid response included underlying pathology, gender, and family history. Conclusion: Rituximab can cause remission in more than half of the patients with steroid-resistant or dependent nephrotic syndrome. Moreover, the only factors that reduce response to rituximab are a history of corticosteroid resistance and a positive family history of nephrotic syndrome

The Effects of Enzyme Replacement Therapy in Patients with Mucopolysaccharidosis Type 1: A Case Series Study

Background: Mucopolysaccharidosis type I (MPS1) is caused by mutations in the gene which encodes the enzyme alpha-L-iduronidase. Deficiency of this enzyme causes a range of clinical symptoms in patients. The main treatment for MPS1 is hematopoietic stem cell transplantation. But its morbidity and mortality rates are significant and require matched marrow donors. Another method of treating MPS1 is enzyme replacement therapy (ERT). This study was performed to determine the effects of ERT in patients with MPS1.Methods: Seven patients with MPS1, admitted in Imam Reza Hospital of Mashhad, Iran, during 2014, were included in the study. They were treated with a single dose (0.58 mg/kg) of enzyme laronidase and followed in 0, 3, 6, 9 and 12 months. The urinary glycosaminoglycan’s (GAG), shoulder and elbow joint range of motion, volume of liver and spleen, and six-minute walking test were evaluated. Data was analyzed by SPSS software (version 16.0).Results: The mean age of the patients was 22.43±5.85 months at the baseline. During follow-up, the level of urinary GAG showed a significant reduction (p=0.004), the volumes of liver (p<0.001) and spleen (p=0.004) were significantly reduced, and the result of 6-minute walking test was significantly increased (p<0.001). The side effects included generalized skin erythema as an allergic reaction in one patient and two episodes of fever during drug administration in one patient.Conclusion: According to the results, the treatment with L-iduronidase in patients with MPS1 was effective and mostly safe

Mimicry and well known genetic friends: molecular diagnosis in an Iranian cohort of suspected Bartter syndrome and proposition of an algorithm for clinical differential diagnosis.

BACKGROUND: Bartter Syndrome is a rare, genetically heterogeneous, mainly autosomal recessively inherited condition characterized by hypochloremic hypokalemic metabolic alkalosis. Mutations in several genes encoding for ion channels localizing to the renal tubules including SLC12A1, KCNJ1, BSND, CLCNKA, CLCNKB, MAGED2 and CASR have been identified as underlying molecular cause. No genetically defined cases have been described in the Iranian population to date. Like for other rare genetic disorders, implementation of Next Generation Sequencing (NGS) technologies has greatly facilitated genetic diagnostics and counseling over the last years. In this study, we describe the clinical, biochemical and genetic characteristics of patients from 15 Iranian families with a clinical diagnosis of Bartter Syndrome. RESULTS: Age range of patients included in this study was 3 months to 6 years and all patients showed hypokalemic metabolic alkalosis. 3 patients additionally displayed hypercalciuria, with evidence of nephrocalcinosis in one case. Screening by Whole Exome Sequencing (WES) and long range PCR revealed that 12/17 patients (70%) had a deletion of the entire CLCNKB gene that was previously identified as the most common cause of Bartter Syndrome in other populations. 4/17 individuals (approximately 25% of cases) were found to suffer in fact from pseudo-Bartter syndrome resulting from congenital chloride diarrhea due to a novel homozygous mutation in the SLC26A3 gene, Pendred syndrome due to a known homozygous mutation in SLC26A4, Cystic Fibrosis (CF) due to a novel mutation in CFTR and apparent mineralocorticoid excess syndrome due to a novel homozygous loss of function mutation in HSD11B2 gene. 1 case (5%) remained unsolved. CONCLUSIONS: Our findings demonstrate deletion of CLCNKB is the most common cause of Bartter syndrome in Iranian patients and we show that age of onset of clinical symptoms as well as clinical features amongst those patients are variable. Further, using WES we were able to prove that nearly 1/4 patients in fact suffered from Pseudo-Bartter Syndrome, reversing the initial clinical diagnosis with important impact on the subsequent treatment and clinical follow up pathway. Finally, we propose an algorithm for clinical differential diagnosis of Bartter Syndrome