Adult Coronavirus Disease 2019 Research Articles

VitaminD supplementation for the prevention and treatment of COVID-19: a position statement from the Spanish Society of Geriatrics and Gerontology

The coronavirus disease 2019 (COVID-19) produces severe respiratory symptoms such as bilateral pneumonia associated to a high morbidity and mortality, especially in patients of advanced age. Vitamin D deficiency has been reported in several chronic conditions associated with increased inflammation and dysregulation of the immune system. Vitamin D in modulates immune function too. Vitamin D receptor (VDR) is expressed by most immune cells, including B and T lymphocytes, monocytes, macrophages, and dendritic cells and the signalling of vitamin D and VDR together has an anti-inflammatory effect. Some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19 because vitamin D plays an important role as a modulator of immunocompetence. Over the last few months, some studies have hypothesized the possible beneficial effect of vitamin D supplementation in patients with COVID-19 in order to improve the immune balance and prevent the hyperinflammatory cytokine storm. Some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. Vitamin D should be administered daily until adequate levels are achieved due to vitamin D behaves as a negative acute phase reactant (APR). Despite the lack of evidence on specific doses of vitamin D to treat COVID-19 in older adults, authors consider it is necessary to standardize the use in clinical practice. These recommendations advice supplement vitamin D in a protocoled fashion based on expert opinions, level of evidence 5.

Health-Related Quality of Life of Adult COVID-19 Patients Following One-Month Illness Experience Since Diagnosis: Findings of a Cross-Sectional Study in Bangladesh

Background: The pandemic coronavirus disease 2019 (COVID-19) verdures an incredible impact on the quality of life of the patients. The disease not only denigrates the physical health of the patients but also affect their mental health. Relevant information is very scarce to contribute to improving the health of the COVID-19 victims. This current study aimed to know the impact of the COVID-19 on the health-related quality of life (HRQOL) of patients. Methods: This cross-sectional study was conducted at the National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh during the period from June to November 2020. Total 1204 adult COVID-19 patients aged >18 years diagnosed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay at the central laboratory of NIPSOM, Dhaka were enrolled in the study. The patients who completed the one-month duration of illness were interviewed to assess their health-related quality of life using the CDC HRQOL-14 questionnaire. Data were collected by telephone-interview and reviewing medical records using a semi-structured questionnaire and checklist respectively. Informed consent was obtained from each of the patients and relevant ethical issues were maintained strictly during data collection.Findings: The majority of the COVID-19 patients were males (72.3%), urban residents (50.2%), and service holders (49.6%). The mean±SD duration of physical illness and mental illness was 9.83(±7.09) and 7.97(±8.12) days respectively. After 30 days following CIVID-19 illness, the general health condition was excellent/very good/good in 70.1% of patients while it was fair/poor in 29.8% of patients. Older age, sex, and marital status were significantly associated with at least one dimension of HRQOL. Patients having symptoms of COVID-19 and comorbidity had significantly poorer HRQOL.Interpretation: COVID-19 pretenses a significant impact on multiple dimensions of health-related quality of life of the patients. Both the physical and mental health of COVID-19 patients is impaired during the clinical course of the disease. Our findings suggest that more effective preventive, promotive, and curative initiatives should be taken to prevent morbidity and mortality by restoring the health-related quality of life of COVID-19 patients. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. All the authors had self-financial contribution to conduct the research.Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: Ethical clearance was obtained from the Institutional Review Board (IRB) of NIPSOM, Dhaka, Bangladesh (Ref. No. NIPSOM/IRB/2020/5).

Autoantibodies in severe COVID-19-related acute respiratory distress syndrome: Just innocent bystanders?

Autoantibodies in severe COVID-19-related acute respiratory distress syndrome: Just innocent bystanders?

Altered Blood Cell Traits Underlie a Major Genetic Locus of Severe COVID-19.

BackgroundThe genetic locus 3p21.31 has been associated with severe coronavirus disease 2019 (COVID-19), but the underlying pathophysiological mechanism is unknown.MethodsTo identify intermediate traits associated with the 3p21.31 locus, we first performed a phenome-wide association study (PheWAS) with 923 phenotypes in 310,999 European individuals from the UK Biobank. For genes potentially regulated by the COVID-19 risk variant, we examined associations between their expression and the polygenic score (PGS) of 1,263 complex traits in a meta-analysis of 31,684 blood samples. For the prioritized blood cell traits, we tested their associations with age and sex in the same UK Biobank sample.ResultsOur PheWAS highlighted multiple blood cell traits to be associated with the COVID-19 risk variant, including monocyte count and percentage (p = 1.07×10 -8, 4.09×10 -13), eosinophil count and percentage (p = 5.73×10 -3, 2.20×10 -3), and neutrophil percentage (p = 3.23×10 -3). The PGS analysis revealed positive associations between the expression of candidate genes and genetically predicted counts of specific blood cells: CCR3 with eosinophil and basophil (p = 5.73×10 -21, 5.08×10 -19); CCR2 with monocytes (p = 2.40×10 -10); and CCR1 with monocytes and neutrophil (p = 1.78×10 -6, 7.17×10 -5). Additionally, we found that almost all examined white blood cell traits are significantly different across age and sex groups.ConclusionsOur findings suggest that altered blood cell traits, especially those of monocyte, eosinophil, and neutrophil, may represent the mechanistic links between the genetic locus 3p21.31 and severe COVID-19. They may also underlie the increased risk of severe COVID-19 in older adults and men.

COVID-19 with and without anosmia or dysgeusia: A case-control study.

Various new clinical signs and symptoms, such as dysfunction of smell (anosmia) and taste (dysgeusia) have emerged ever since the coronavirus disease 2019 (COVID-19) pandemic begun. The objective of this study was to identify the clinical presentation and factors associated with 'new loss/change of smell (anosmia) or taste (dysgeusia)' at admission in patients positive by real time polymerase chain reaction for SARS-CoV-2 infection. All adult COVID-19 patients with new onset anosmia or dysgeusia at admission were included in study group. Equal number of age and gender matched COVID-19 patients without anosmia or dysgeusia at admission were included in the control group. A total of 261 COVID-19 patients were admitted during the study period of which 55 (21%) had anosmia and or dysgeusia. The mean (SD) age was 36 (13) years and majority were males (58%, n = 32). Comorbidity was present in 38% of cases (n = 21). Anosmia and dysgeusia were noted in more than 1/5th of the cases. Anosmia (96%, n = 53) was more common than dysgeusia (75%, n = 41). Presence of both ansomia and dysgeusia was noted in 71% of patients (n = 39). On comparing the cases with the controls, on univariate analysis, fever (higher in cases), rhinitis (lower in cases), thrombocytopenia, elevated creatinine and bilirubin (all higher in cases) were significantly associated with anosmia or dysgeusia. On multivariate analysis, only rhinitis (odds ratio [OR]:0.28; 95% confidence interval [CI]: 0.09-0.83; p = .02) thrombocytopenia (OR: 0.99; 95% CI: 0.99-0.99; p = .01) and elevated creatinine (OR: 7.6; 95% CI: 1.5-37.6; p = .01) remained significant. In this retrospective study of COVID-19 patients, we found anosmia and dysgeusia in more than 1/5th of the cases. Absence of rhinitis, low platelet counts and elevated creatinine were associated with anosmia or dysgeusia in these patients.

Association analysis framework of genetic and exposure risks for COVID-19 in middle-aged and elderly adults

Coronavirus disease 2019 (COVID-19) is a current pandemic, and studies reported that older people have higher rates of infection and more severe cases. Recently, studies have revealed the involvement of both genetic and exposure factors in the susceptibility of COVID-19. However, the correlation between them is still unclear. Thus, we aimed to investigate the correlation between genetic and exposure factors associated with COVID-19. We retrieved the information of 7362 participants with COVID-19 testing results from the UK Biobank. We identified genetic factors for COVID-19 by genome-wide association studies (GWAS) summary analysis. In this study, 21 single-nucleotide polymorphisms (SNPs) and 15 exposure factors [smoking, alcohol intake, daytime dozing, body mass index (BMI), triglyceride, High Density Lipoprotein (HDL), diabetes, chronic kidney disease, chronic liver disease, dementia, atmosphere NO2 concentration, socioeconomic status, education qualification, ethnicity, and income] were found to be potential risk factors of COVID-19. Then, a gene-exposure (G × E) association network was built based on the correlation among and between these genetic factors and exposure factors. rs140092351, a SNP on microRNA miR1202, not only had the most significant association with COVID-19, but also interacted with multiple exposure factors. Dementia, alcohol consumption, daytime dozing, BMI, HDL, and atmosphere NO2 concentration were among most significant G × E interactions with COVID-19 infection (P = 0.001).

Baseline characteristics of COVID-19 Italian patients admitted to Desio Hospital, Lombardy: a retrospective study

The correlation of clinical, radiological and laboratory findings of patients at admission in the Emergency Department (ED) with clinical severity and risk of mortality was investigated. Adult coronavirus disease 2019 (COVID-19) patients hospitalized in March 2020 in Desio Hospital, Lombardy, were retrospectively included in the study, and categorized in terms of disease severity and adverse outcome. Out of the 175 patients enrolled, 79% presented one or more comorbidities, with cardiovascular disease being the most frequent (62%). More than half of the patients showed lymphocytopenia and 20% thrombocytopenia. The patients in the severe group presented higher absolute neutrophil count (ANC), C-reactive protein (CRP), AST, LDH, procalcitonin (PCT) and BUN values compared to the non-severe group (p < .05). Increased odds of mortality associated with older age (OR = 22.43; 95% CI 5.22–96.27), partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FIO2) ratio < 200 (OR = 4.97; 95% CI 1.55–15.84), clinical severity (OR = 21.32; 95% CI 2.27–200.13), creatinine > 106.08 µmol/L (OR = 2.87; 95% CI 1.04–7.92) and creatine kinase > 2.90 µkat/L (OR = 3.80; 95% CI 1.31–10.9) were observed on admission (p < .05). The above findings may contribute to identify early risk factors of poor prognosis, and to select the most appropriate management for patients.

COVID-19 in children: Pathogenesis and current status.

Background: Since its initial description in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has rapidly progressed into a worldwide pandemic, which has affected millions of lives. Unlike the disease in adults, the vast majority of children with COVID-19 have mild symptoms and are largely spared from severe respiratory disease. However, there are children who have significant respiratory disease, and some may develop a hyperinflammatory response similar to that seen in adults with COVID-19 and in children with Kawasaki disease (KD), which has been termed multisystem inflammatory syndrome in children (MIS-C). Objective: The purpose of this report was to examine the current evidence that supports the etiopathogenesis of COVID-19 in children and the relationship of COVID-19 with KD and MIS-C as a basis for a better understanding of the clinical course, diagnosis, and management of these clinically perplexing conditions. Results: The pathogenesis of COVID-19 is carried out in two distinct but overlapping phases of COVID-19: the first triggered by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) itself and the second by the host immune response. Children with KD have fewer of the previously described COVID-19-associated KD features with less prominent acute respiratory distress syndrome and shock than children with MIS-C. Conclusion: COVID-19 in adults usually includes severe respiratory symptoms and pathology, with a high mortality. It has become apparent that children are infected as easily as adults but are more often asymptomatic and have milder disease because of their immature immune systems. Although children are largely spared from severe respiratory disease, they can present with a SARS-CoV-2-associated MIS-C similar to KD.

Multisystem Inflammatory Syndrome Temporally Related to COVID-19 in Adults

As novel viral pandemic is unfolding and new information about SARS-CoV-2 related illnesses is being released, a new multisystem inflammatory syndrome emerged particularly among children and adolescents temporally related to coronavirus disease 2019 (COVID-19). After several similar cases were reported in the United Kingdom and the United States of America, the World Health Organization recognized this new syndrome on May 15, 2020 and released its case definition. Cases have now emerged in adult patients as well. Physicians need to stay vigilant about this syndrome in adults to promptly diagnose and intervene. This article highlights all cases reported in the literature so far, particularly their common presenting signs, symptoms, and the way these cases are being managed.

Acute Kidney Injury and Renal Replacement Therapy in COVID-19 Versus Other Respiratory Viruses: A Systematic Review and Meta-Analysis.

Background:Acute kidney injury (AKI) is a potentially fatal complication of Coronavirus Disease-2019 (COVID-19). Binding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19, to its viral receptor, angiotensin converting enzyme 2 (ACE2), results in viral entry and may cause AKI.Objectives:We performed a systematic review and meta-analysis of the frequencies of AKI and renal replacement therapy (RRT) in critically ill COVID-19 patients and compared those frequencies with patients who were infected by respiratory viruses that bind or downregulate ACE2 (ACE2-associated viruses) and viruses that do not bind nor downregulate ACE2 (non-ACE2-associated viruses).Design:Systematic review and meta-analysis.Setting:Observational studies on COVID-19 and other respiratory viral infections reporting AKI and RRT were included. The exclusion criteria were non-English articles, non-peer-reviewed articles, review articles, studies that included patients under the age of 18, studies including fewer than 10 patients, and studies not reporting AKI and RRT rates.Patients:Adult COVID-19, Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and influenza patients.Measurements:We extracted the following data from the included studies: author, year, study location, age, sex, race, diabetes mellitus, hypertension, chronic kidney disease, shock, vasopressor use, mortality, intensive care unit (ICU) admission, ICU mortality, AKI, and RRT.Methods:We systematically searched PubMed and EMBASE for articles reporting AKI or RRT. AKI was defined by authors of included studies. Critical illness was defined by ICU admission. We performed a random effects meta-analysis to calculate pooled estimates for the AKI and RRT rate within each virus group using a random intercept logistic regression model.Results:Of 23 655 hospitalized, critically ill COVID-19 patients, AKI frequencies were not significantly different between COVID-19 patients (51%, 95% confidence interval [CI]: 44%-57%) and critically ill patients infected with ACE2-associated (56%, 95% CI: 37%-74%, P = .610) or non-ACE2-associated viruses (63%, 95% CI: 43%-79%, P = .255). Pooled RRT rates were also not significantly different between critically ill, hospitalized patients with COVID-19 (20%, 95% CI: 16%-24%) and ACE2-associated viruses (18%, 95% CI: 8%-33%, P = .747). RRT rates for both COVID-19 and ACE2-associated viruses were significantly different (P < .001 for both) from non-ACE2-associated viruses (49%, 95% CI: 44%-54%). After adjusting for shock or vasopressor use, AKI and RRT rates were not significantly different between groups.Limitations:Limitations of this study include the heterogeneity of definitions of AKI that were used across different virus studies. We could not match severity of infection or do propensity matching across studies. Most of the included studies were conducted in retrospective fashion. Last, we did not include non-English publications.Conclusions:Our findings suggest that viral ACE2 association does not significantly alter the rates of AKI and RRT among critically ill patients admitted to the ICU. However, the rate of RRT is lower in patients with COVID-19 or ACE2-associated viruses when compared with patients infected with non-ACE2-binding viruses, which might partly be due to the lower frequencies of shock and use of vasopressors in these two virus groups. Prospective studies are necessary to demonstrate whether modulation of the ACE2 axis with Renin-Angiotensin System inhibitors impacts the rates of AKI and whether they are beneficial or harmful in COVID-19 patients.

Efficacy and Safety of IL-6 Inhibitors in Patients with COVID-19 Pneumonia: A Systematic Review and Meta-Analysis of Multicentre, Randomised Trials

Introduction: The novel coronavirus disease 2019 (COVID-19) is frequently characterized by dysregulated host immune response with hyperinflammation and self-induced host inflammatory damage that results in severe respiratory failure and frequently death. Interleukin-6 (IL-6) appeared among the key cytokines involved in COVID-19 associated cytokine storm. Therefore, several trials investigated whether IL-6 inhibition with tocilizumab or sarilumab could improve symptoms and outcome of COVID-19 patients. We performed a meta-analysis of randomized trials to test this hypothesis.Methods: PubMed, Scopus, Cochrane central register and medRxiv were searched by two independent investigators up to February 23rd, 2021. Inclusion criteria were: administration of tocilizumab or sarilumab, COVID-19 pneumonia, randomized controlled trials. Studies in setting other than adult human COVID-19 were excluded. The primary outcome was mortality at the longest follow-up available. Secondary outcomes included need for intubation and incidence of adverse events. Two independent investigators examined and extracted data from eligible trials.Results: A total of 371 studies were assessed, with a total of 10 studies (6,465 patients) finally included in the meta-analysis. All the trials were multicentre and the majority were open-label vs standard treatment. IL-6 inhibitors use was associated with reduced all-cause mortality at the longest follow-up available (823/3,310 [24·9%] in the IL-6 inhibitors group versus 902/3,038 [29·7%] in the control group, RR = 0·89; 95% CI 0·82 to 0·96; p for effect = 0·003, I2 = 6%, with eight studies included). Use of IL-6 inhibitors was associated with a significant reduction in need for intubation, while we found no difference in rate of adverse events and secondary infections.Conclusion: Administration of IL-6 inhibitors may reduce all-cause longest follow-up mortality and need for intubation in COVID-19 patients, without increasing risk of adverse events. However, these findings need to be confirmed in high-quality randomized controlled trials.Funding Statement: None.Declaration of Interests: None.

Predictors of Clinical Outcomes in Adult COVID-19 Patients Admitted to a Tertiary Care Hospital in India: an analytical cross-sectional study.

Background:The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in exponential rise in the number of patients getting hospitalised with corona virus disease 2019 (COVID-19). There is a paucity of data from South East Asian Region related to the predictors of clinical outcomes in these patients. This formed the basis of conducting our study.Methods:This was an analytical cross-sectional study. Demographic, clinical, radiological and laboratory data of 125 patients was collected on admission. The study outcome was death or discharge after recovery. For univariate analysis, unpaired t-test, Chi-square and Fisher’s Exact test were used. Receiver operating characteristic (ROC) curves were plotted for Sequential Organ Failure Assessment (SOFA) score and few laboratory parameters. Logistic regression was applied for multivariate analysis.Results:Elderly age, ischemic heart disease and smoking were significantly associated with mortality. Elevated levels of D-dimer and lactate dehydrogenase (LDH) and reduced lymphocyte counts were the predictors of mortality. The ROCs for SOFA score curve showed a cut-off value ≥ 3.5 (sensitivity- 91.7% and specificity- 87.5%), for IL-6 the cut-off value was ≥ 37.9 (sensitivity- 96% and specificity- 78%) and for lymphocyte counts, a cut off was calculated to be less than and equal to 1.46 x 109 per litre (sensitivity- 75.2% and specificity- 83.3%).Conclusion:Old age, smoking history, ischemic heart disease and laboratory parameters including elevated D-dimer, raised LDH and low lymphocyte counts at baseline are associated with COVID-19 mortality. A higher SOFA score at admission is a poor prognosticator in COVID-19 patients. (www.actabiomedica.it)

When Pediatric Hospitalists Took Care of Adults During the COVID-19 Pandemic.

In April 2020, the coronavirus disease 2019 (COVID-19) pandemic raged through our hospital system in Connecticut.1 Medical teams for adult patients mobilized their staff and units for the incessant surge. Patient volume and acuity on the adult units began to rise amid the uncertainty of personal protective equipment (PPE) supplies, fear of a formidable impact, and potential depletion of the clinical workforce. In preparation, the pediatrics department chair of our children’s hospital within a larger academic medical center asked for volunteers to help the adult teams. The pediatric wards were strangely quiet as patients and families stayed away from the hospital and elective surgeries were canceled. In comparison, admissions to adult units in our hospital continued to rise exponentially (3 cases of COVID-19 on March 15 and 354 on April 9), further displaying the disproportionate impact of the pandemic on adults. Because pediatric hospitalizations to COVID-19 remained low and the demand for beds for hospitalized adults continued to rise, we initially gave two of our pediatric units to internal medicine clinician teams for adult admissions. Along with more hospitalized patients, the need for more clinicians to care for patients became more apparent. We heard that our pediatric critical care and pediatric emergency department faculty were helping to staff with adult medical ICUs. We knew that would be us soon and began work to brush up on our internal medicine skills.2 Instead of waiting to be asked, we decided proactively to offer our services to the internal medicine department as a team of pediatric nurses, pediatric housestaff, and pediatric hospitalists under the guidance of medicine-pediatrics hospitalists and medicine-pediatrics housestaff. Shortly, we were deployed to open a new adult COVID-19 …

Guillain-Barré Syndrome in a Pediatric Patient with COVID-19: A Case Report and Review of Literature

The novel coronavirus disease 2019 (COVID-19) has created a global health impact to millions of people. There have been studies of COVID-19 patients manifesting with neurologic symptoms. Although the number of adult COVID-19 infections diagnosed with Guillain-Barre Syndrome (GBS) is increasing, the occurrence of cases in pediatric population remains limited or perhaps underreported. We report a rare case of an asymptomatic COVID-19 infection manifesting as acute progressive ascending polyneuropathy and hyporeflexia in a 16-year-old teen. The diagnosis of COVID-19 infection was confirmed by reverse transcription polymerase chain reaction for SARS-CoV-2 of oropharyngeal and nasopharyngeal swab specimens. Magnetic resonance imaging of the spine revealed abnormal enhancement of the cauda equina, including the dorsal and ventral roots. Electromyography and nerve conduction studies were compatible with an acute inflammatory demyelinating polyneuropathy subtype of GBS. Although lumbar puncture was not done, the clinical findings and electrodiagnostic tests were both consistent with GBS. The patient had improvement of both motor and sensory functions after completing the treatment of intravenous immunoglobulins. Neurologic manifestations of systemic illness especially in children during this time of pandemic warrants scrutiny, as these may mask a potentially dangerous and infectious ongoing COVID infection.

Ruxolitinib and the Mitigation of Severe COVID-19: A Systematic Review and Meta-analysis.

BackgroundThe cause of end-organ damage and acute respiratory distress syndrome (ARDS) in coronavirus disease 2019 (COVID-19) patients is postulated to be connected to the uncontrolled increase of pro-inflammatory cytokines. The upregulation of many cytokines is dependent on signaling through the Janus kinase 1 (JAK-1) and JAK-2 pathways. Ruxolitinib, a JAK-1 and JAK-2 inhibitor, is documented to have potent anti-inflammatory activity by targeting several cytokines and growth factors with proposed efficacy in the cytokine storm observed in severe COVID-19 patients; therefore, this study examines the efficacy and tolerability of ruxolitinib for adult COVID-19 patients.Materials and MethodsThis review was conducted using preferred reporting items for aystematic reviews and meta-analyses (PRISMA) methodology. Six reviewers analyzed 1,120 results. Seven studies were selected and validated. A quantitative meta-analysis was further performed to evaluate clinical improvement at day 28, mortality at day 28, and oxygen requirements comparing treatment and standard of care groups.Results168 individuals were involved in the studies selected: 122 in cohort studies, 4 in case reports, and 41 in randomized controlled studies. The ruxolitinib group had a higher likelihood of clinical improvement by the 28th day of treatment when assessed with the standard of care (SOC) group (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 0.53 - 4.16; P = 0.45; I2 = 0%). The SOC group was at a higher risk of experiencing serious adverse events (OR: 0.17; 95% CI: 0.03 - 1.13; P = 0.07). Notably the SOC group had a higher likelihood of death (OR: 0.51; 95% CI: 0.11-2.29; P = 0.07; I2 = 0%).ConclusionPrior studies on ruxolitinib have demonstrated it is able to decrease inflammatory markers. In recent studies on COVID-19, treatment with ruxolitinib decreased the time on mechanical ventilation, hospitalization time, and the need for vasopressor support. Additionally, ruxolitinib showed decreased mortality and demonstrated improvement in lung congestion as evidenced by computerized tomography imaging. These findings warrant further clinical investigation into Ruxolitinib as a potential treatment approach for severe COVID-19.

Imaging characteristics of coronavirus disease 2019 (COVID-19) in pediatric cases: a systematic review and meta-analysis.

BackgroundThe confirmed coronavirus disease 2019 (COVID-19) cases, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have exceeded 21 million (with more than 775,000 fatalities), and the number of children with COVID-19 is also increasing. This study aimed to summarize the chest imaging characteristics of pediatric COVID-19 cases and provide a reference for the diagnosis and control of pediatric COVID-19.MethodsThe study protocol was registered in PROSPERO, number CRD42020177391. Studies related to pediatric COVID-19 imaging manifestations were accessed from PubMed, Web of Science, and the Cochrane library databases, without language limitations. The publication date was limited to April 1, 2020, and it was updated on May 1 and May 27, 2020. Data normalization was determined with the Freeman-Tukey double arcsine transformation. Summarized incidences with 95% confidence intervals of various imaging manifestations were assessed by random-effects models. Heterogeneity was assessed with meta-regression and subgroup analyses, robustness with sensitivity analyses; and publication biases with Egger’s test.ResultsTwenty-three with 517 cases were included in this study. The summarized incidence of chest computed tomography abnormalities in pediatric COVID-19 cases was 70%, which was lower than what has been seen in adults. The incidence of halo signs in pediatric COVID-19 cases was 26%, which is rarely seen in adult COVID-19 cases. The incidences of ground-glass opacities (GGOs), GGOs and consolidations, consolidations, reverse halo signs, crazy paving signs, pleural effusion, bronchopneumonia-like signs, air bronchograms, and increased lung markings were 40%, 25%, 10%, 2%, 4%, 1%, 15%, 12%, and 31%, respectively. Pericardial effusions were found in the computed tomography images of adult COVID-19 cases but were scarcely seen in the computed tomography images of pediatric COVID-19 cases. The incidences of bilateral lesions, unilateral lesions, and peripheral lesions were 35%, 22%, and 26%, respectively.ConclusionsChest computed tomography imaging of pediatric COVID-19 cases resulted in various abnormalities that were milder than those of adults. This study will hopefully provide a reference to help identify pediatric COVID-19 cases.

Asthma does not increase COVID-19 mortality and poor outcomes: A systematic review and meta-analysis.

The Center for Disease Control and Prevention (CDC) has mentioned Coronavirus Disease 2019 (COVID-19) patients with moderate or severe asthma as a high risk group for severe illness. While WHO mentioned only chronic respiratory diseases, not specifically asthma as a risk factor for severe illness. There has been asthma prevalence discrepancy in studies of COVID-19 across the world. This meta-analysis aims to investigate the association between asthma and composite poor outcome in patients with coronavirus disease (COVID-19). We conducted a systematic literature search from PubMed and Embase database. We included all original research articles with adult COVID-19 patients > 18 years old and had information related to asthma as a risk factor. Studies with outcomes consisting of mortality, severe COVID-19, use of mechanical ventilation, ICU admission, and hospital admission were included in this study. The outcomes of interest were divided into severe COVID-19, mortality and other poor outcomes. Eleven studies were included in meta-analysis with a total of 6,046 patients. Asthma was not associated with composite poor outcomes with OR = 0.92 (95%CI 0.71-1.19, p = 0.61, and I2 = 8.49%). Furthermore, subgroup analysis showed that asthma was not associated with severe COVID (p = 0.76), mortality (p = 0.45), and other poor outcomes (p = 0.28). Our study showed that asthma was not associated with severe COVID-19, mortality, and other poor outcomes in patients with COVID-19.

Clinical Features of Adult COVID-19 Patients without Risk Factors before and after the Nationwide SARS-CoV-2 B.1.617.2 (Delta)-variant Outbreak in Korea: Experience from Gyeongsangnam-do.

BackgroundData on severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) delta variant virulence are insufficient. We retrospectively compared the clinical features of adult coronavirus disease 2019 (COVID-19) patients without risk factors for severe COVID-19 who entered residential treatment centers (RTCs) before and after the delta variant outbreak.MethodsWe collected medical information from two RTCs in South Korea. On the basis of nationwide delta variant surveillance, we divided the patients into two groups: 1) the delta-minor group (diagnosed from December 2020–June 2021, detection rate < 10%) and 2) the delta-dominant group (diagnosed during August 2021, detection rate > 90%). After propensity-score matching, the incidences of pneumonia, hospital transfer and need for supplemental oxygen were compared between the groups. In addition, risk factors for hospital transfer were analysed.ResultsA total of 1,915 patients were included. The incidence of pneumonia (14.6% vs. 9.2%, P = 0.009), all-cause hospital transfer (10.4% vs. 6.3%, P = 0.020) and COVID-19-related hospital transfer (7.5% vs. 4.8%, P = 0.081) were higher in the delta-dominant group than those in the delta-minor group. In the multivariate analysis, the delta-dominant group was an independent risk factor for all-cause (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.16–3.13; P = 0.011) and COVID-19-related hospital transfer (aOR, 1.86; 95% CI, 1.04–3.32; P = 0.036).ConclusionHospitalization rates were increased in the adult COVID-19 patients during the delta variant nationwide outbreak. Our results showed that the delta variant may be more virulent than previous lineages.

Blood Gas Analysis among COVID-19 Patients: A Single Centre Retrospective Observational Study

Introduction: The dominant respiratory feature of Coronavirus Disease 2019 (COVID-19) is arterial hypoxaemia, greatly exceeding abnormalities in pulmonary mechanics. Arterial Blood Gas (ABG) analysis helps to find out respiratory, metabolic acidosis and alkalosis. Aim: To evaluate the blood gas levels among critically ill COVID- 19 positive patients admitted in Intensive Care Unit (ICU). Materials and Methods: A retrospective, observational study was conducted in East Midnapore district of West Bengal, India from July 2020 to February 2021. Data of ABG analysis {pH, PaO2 (partial pressure of oxygen in arterial blood), PaCO2 (partial pressure of carbon dioxide in arterial blood) and bicarbonate (HCO3)} in 314 adult COVID-19 positive cases, were obtained from ICU records. All critically ill COVID-19 patients those who were admitted in ICU with more than 15 years of age were included in this study. Data were analysed and Pearson correlation test was applied for statistical significance. Results: Among the study subjects, 234 (74.5%) were males. Most affected age group was 51-60 years among males and above 60 years among females. Most common ABG finding was high pH indicating alkalosis, found among 183 (58.3%) patients. Acidosis was rare and seen in only 19 (6.0%) patients. A total of 174 (55.4%) patients developed respiratory alkalosis with low PaCO2. Hypoxaemia was found in 144 (45.9%) patients. High HCO3, indicating metabolic alkalosis, was seen in 144 (45.9%) patients. Statistically significant correlation was found between PaCO2 and pH (pearson correlation coefficient (r)=-0.153, p=0.007) and PaCO2 and HCO3 standard (r=0.185, p=0.001). Conclusion: ABG should be done in all COVID-19 patients during admission. A regular interval monitoring of ABG can help in early identification of respiratory damage, silent hypoxia and cytokine storm and with early detection many lives can be saved with early initiation of management.

COVID-19 and Pulmonary Hypertension in Children: What Do We Know So Far?

The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control’s guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.