Varying presentations of multisystem inflammatory syndrome temporarily associated with COVID-19

Background. A novel coronavirus identified in 2019 leads to a pandemic of severe acute respiratory distress syndrome with important morbidity and mortality. Initially, children seemed minimally affected, but there were reports of cases similar to (atypical) Kawasaki disease or toxic shock syndrome, and evidence emerges about a complication named paediatric inflammatory multisystem syndrome temporarily associated with SARS-CoV-2 (PIMS-TS) or multisystem inflammatory syndrome in children (MIS-C). Case Presentations. Two cases were compared and discussed demonstrating varying presentations, management, and evolution of MIS-C. These cases are presented to increase awareness and familiarity among paediatricians and emergency physicians with the different clinical manifestations of this syndrome. Discussion. MIS-C may occur with possible diverse clinical presentations. Early recognition and treatment are paramount for a beneficial outcome

Evaluation of late cardiac effects after multisystem inflammatory syndrome in children

IntroductionMultisystem inflammatory syndrome in children (MIS-C) is associated with important cardiovascular morbidity during the acute phase. Follow-up shows a swift recovery of cardiac abnormalities in most patients. However, a small portion of patients has persistent cardiac sequelae at mid-term. The goal of our study was to assess late cardiac outcomes of MIS-C.MethodsA prospective observational multicenter study was performed in children admitted with MIS-C and cardiac involvement between April 2020 and March 2022. A follow-up by NT-proBNP measurement, echocardiography, 24-h Holter monitoring, and cardiac MRI (CMR) was performed at least 6 months after MIS-C diagnosis.ResultsWe included 36 children with a median age of 10 (8.0–11.0) years, and among them, 21 (58%) were girls. At diagnosis, all patients had an elevated NT-proBNP, and 39% had a decreased left ventricular ejection fraction (LVEF) (<55%). ECG abnormalities were present in 13 (36%) patients, but none presented with arrhythmia. Almost two-thirds of patients (58%) had echocardiographic abnormalities such as coronary artery dilation (20%), pericardial effusion (17%), and mitral valve insufficiency (14%). A decreased echocardiographic systolic left ventricular (LV) function was detected in 14 (39%) patients. A follow-up visit was done at a mean time of 12.1 (±5.8) months (range 6–28 months). The ECG normalized in all except one, and no arrhythmias were detected on 24-h Holter monitoring. None had persistent coronary artery dilation or pericardial effusion. The NT-proBNP level and echocardiographic systolic LV function normalized in all patients, except for one, who had a severely reduced EF. The LV global longitudinal strain (GLS), as a marker of subclinical myocardial dysfunction, decreased (z < −2) in 35%. CMR identified one patient with severely reduced EF and extensive myocardial fibrosis requiring heart transplantation. None of the other patients had signs of myocardial scarring on CMR.ConclusionLate cardiac outcomes after MIS-C, if treated according to the current guidelines, are excellent. CMR does not show any myocardial scarring in children with normal systolic LV function. However, a subgroup had a decreased GLS at follow-up, possibly as a reflection of persistent subclinical myocardial dysfunction

Pandemic A/H1N1v influenza 2009 in hospitalized children: a multicenter Belgian survey

<p>Abstract</p> <p>Background</p> <p>During the 2009 influenza A/H1N1v pandemic, children were identified as a specific "at risk" group. We conducted a multicentric study to describe pattern of influenza A/H1N1v infection among hospitalized children in Brussels, Belgium.</p> <p>Methods</p> <p>From July 1, 2009, to January 31, 2010, we collected epidemiological and clinical data of all proven (positive H1N1v PCR) and probable (positive influenza A antigen or culture) pediatric cases of influenza A/H1N1v infections, hospitalized in four tertiary centers.</p> <p>Results</p> <p>During the epidemic period, an excess of 18% of pediatric outpatients and emergency department visits was registered. 215 children were hospitalized with proven/probable influenza A/H1N1v infection. Median age was 31 months. 47% had ≥ 1 comorbid conditions. Febrile respiratory illness was the most common presentation. 36% presented with initial gastrointestinal symptoms and 10% with neurological manifestations. 34% had pneumonia. Only 24% of the patients received oseltamivir but 57% received antibiotics. 10% of children were admitted to PICU, seven of whom with ARDS. Case fatality-rate was 5/215 (2%), concerning only children suffering from chronic neurological disorders. Children over 2 years of age showed a higher propensity to be admitted to PICU (16% vs 1%, p = 0.002) and a higher mortality rate (4% vs 0%, p = 0.06). Infants less than 3 months old showed a milder course of infection, with few respiratory and neurological complications.</p> <p>Conclusion</p> <p>Although influenza A/H1N1v infections were generally self-limited, pediatric burden of disease was significant. Compared to other countries experiencing different health care systems, our Belgian cohort was younger and received less frequently antiviral therapy; disease course and mortality were however similar.</p

Clinical predictors of the severity of bronchiolitis

Introduction Bronchiolitis is the most common serious, acute viral infection in infants. Besides the diagnostic and treatment challenges, the appropriate time and the need of hospitalization remain unanswered. We wonder whether clinical predictors such as age less than 6 months, respiratory frequency more than 45 breaths per minute and oxygen saturation less than 95% could be of any help in assessing the severity of the disease and the need for admission. Materials and methods A prospective study was held in the emergency department from November 2000 to January 2002, in which each patient with positive nasopharyngeal respiratory syncytial virus was included. Other inclusion criteria were full-term birth, clinical signs of respiratory diseases, age between 2 weeks up to 24 months and no underlying illnesses such as bronchopulmonary dysplasia and chronic heart or lung diseases. The sensitivity, specificity and relative risk (RR) were calculated by statistical analyses. Results During the study period, 378 patients were included, 117 of whom were hospitalized (31%). Age less than 6 months (sensitivity 62%, specificity 72% and RR 2.68), respiratory frequency more than 45 breaths per minute (sensitivity 68%, specificity 82% and RR 4.57) and oxygen saturation less than 95% (sensitivity 68%, specificity 87% and RR 4.67) predicted the severity of the pulmonary disease and the need for admission. The cumulative analysis of the three parameters showed a specificity of 91% and a sensitivity of 86%, with a relative risk of 4.54 among those admitted into the hospital. Respiratory frequency more than 45 breaths per minute (sensitivity 76%, specificity 82% and RR 2.85) and oxygen saturation less than 95% (sensitivity 84%, specificity 86% and RR 2.65) were more significant than age less than 6 months (sensitivity 60%, specificity 70% and RR 3.70) in predicting the admission into the paediatric intensive care unit. Conclusion Oxygen saturation less than 95%, respiratory frequency more than 45 breaths per minute and age less than 6 months in respiratory-distressed infants are important parameters to predict the need for admission and emphasize the severity of bronchiolitis. (C) 2006 Lippincott Williams & Wilkins

Congenital cervical kyphosis in a child associated with tetraparesis : case report

Congenital cervical kyphosis is a rare clinical condition. We describe an infant presenting with tetraparesis, rapidly progressing to phrenic paralysis and fatal respiratory insufficiency. Therapeutic options remain challenging. Surgical arthrodesis is technically difficult, and one report of a therapeutic thermoplastic body splint is described. Final outcome, however, is dismal. No long-term survivors have been described. Copyright (C) 2009 S. Karger AG, Base

Data from: Children in the Syrian civil war: the familial, educational, and public health impact of ongoing violence

The Syrian civil war since 2011 has led to one of the most complex humanitarian emergencies in history. The objective of this study was to document the impact of the conflict on the familial, educational, and public health state of Syrian children. A cross-sectional observational study was conducted in May 2015. Health care workers visited families with a prospectively designed data sheet in 4 Northern Syrian governorates. The 1001 children included in this study originated from Aleppo (41%), Idleb (36%), Hamah (15%), and Lattakia (8%). The children’s median age was 6 years (range, 0-15 years; interquartile range, 3-11 years), and 61% were boys. Almost 20% of the children were internally displaced, and 5% had deceased or missing parents. Children lacked access to safe drinking water (15%), appropriate sanitation (23%), healthy nutrition (16%), and pediatric health care providers (64%). Vaccination was inadequate in 72%. More than half of school-aged children had no access to education. Children in Idleb and Lattakia were at greater risk of having unmet public health needs. Younger children were at greater risk of having an incomplete vaccination state. After 4 years of civil war in Syria, children have lost parents, live in substandard life quality circumstances, and are at risk for outbreaks because of worsening vaccination states and insufficient availability of health care providers

Data from: A refugee camp in the center of Europe: clinical characteristics of asylum seekers arriving in brussels

Background In the summer of 2015, the exodus of Syrian war refugees and saturation of refugee camps in neighboring countries led to the influx of asylum-seekers in European countries, including Belgium. This study aims to describe the demographic and clinical characteristics of asylum-seekers that arrived in a huddled refugee camp, in the center of a well-developed country with all medical facilities. Methods Using a descriptive cross-sectional study design, physicians of Médecins du Monde prospectively registered age, gender, origin, medical complaints and diagnoses of all patients presenting to an erected Field Hospital in Brussels in September 2015. Diagnoses were post-hoc categorized according to the International Classification of Diseases. Results Of 4037 patients examined in the Field Hospital, 3907 were included and analyzed for this study. Over 11% of patients suffered from injuries, but these were outnumbered by the proportion of patients with respiratory (36%), dental (9%), skin (9%) and digestive (8%) diagnoses. More than 49% had features of infections at the time of the consultation. Conclusion Asylum seekers arriving in a refugee camp in Brussels after a long and hazardous journey, suffer mostly from respiratory, dental, skin and digestive diseases. Still one of seven suffers from injury. These findings – consistent with other reports – should be anticipated when composing Emergency Medical Teams and Interagency Emergency Health or similar Kits to be used in a Field Hospital, even in a Western European country