Upper Respiratory Symptoms Research Articles

Disease Spectrum in COVID-19 Cohort with Travel History from Iran

Background: Coronavirus disease 2019 (Covid-19), declared as a pandemic in March 2020, is an acute respiratory tract illness caused by coronavirus 2 (SARS-CoV2) with clinical manifestations ranging from mild upper respiratory tract symptoms to severe pneumonia. Objectives: To determine the disease spectrum of Covid-19 in a cohort with a travel history from Iran. Materials & Methods: This cross-sectional study with a retrospective collection of data was conducted at Agha Khan University, Karachi from 15th March to 19th April 2020. One hundred and fifty-five laboratory-confirmed cases of Covid-19 were recruited from a government quarantine facility. Data were obtained from the Punjab Emergency Services (Rescue 1122) database where a record of SARS-CoV-2 positive cases and quarantined persons is maintained. Study subjects with a travel history to Iran were contacted by telephone to obtain information about demographics, symptoms, and co-morbid conditions. SPSS version 24 was used to analyze the data. Frequencies and percentages were calculated. Results: Among the returning travelers, 213 had laboratory-confirmed Covid-19, out of which 155 were included in this study. 56.1% were males with a mean age of 40 years. Among the study participants, 91.6% remained asymptomatic throughout the stay, while 8.4 % became symptomatic. 77.5% of the participants had received BCG vaccination in childhood. Among symptomatic cases 15.4% had asthma and 7.7% had hypertension. The most common clinical manifestation was cough which was present in 38.5% of the study participants. None died among the study participants. Conclusion: A mild presentation of COVID-19 was seen in our study participants with 91.6% among them being asymptomatic, while 8.4% were symptomatic. There was a high positivity rate in males as compared to females.

Viral Myocarditis: Classification, Diagnosis, and Clinical Implications.

Myocarditis is an inflammatory disease of the myocardium with focal or diffuse involvement. Viral infections are the most common cause of myocarditis, especially in Western countries. A recent viral illness with gastroenteric or upper respiratory symptoms often precedes myocarditis. The absence of specific pathognomonic features in conjunction with the wide spectrum of clinical manifestations that range from subclinical cases to sudden cardiac death (SCD) makes myocarditis diagnosis particularly challenging. Moreover, myocarditis might represent a cause of initially unexplained dilated cardiomyopathy (DCM) and heart failure (HF), especially among children and young adults. Cardiac magnetic resonance imaging (CMR) is crucial for myocarditis diagnosis, because of its ability to detect interstitial edema during acute inflammation. Assessment of subepicardial or mid-myocardial fibrosis by late gadolinium enhancement (LGE) is typical for myocarditis. Cardiac arrhythmias are frequent events that may arise especially in more severe myocarditis cases. The most common form of arrhythmia is atrial fibrillation, followed by ventricular tachycardia. Documented arrhythmias have been reported more commonly with HIV myocarditis than other more common infections such as Adenovirus, Parvovirus B19, human Herpes virus 6, and Enterovirus. The mechanisms of arrhythmogenesis in myocardial inflammation are not fully understood; in the acute phase, the spectrum of arrhythmogenesis ranges from a direct effect on cardiomyocytes that leads to electrical instability and ion channel impairment to ischemia from coronary macro- or microvascular disease. In chronic myocarditis, instead, myocardial replacement with fibrosis promotes scar-mediated re-entrant ventricular arrhythmias. Observational data suggested the important role of CMR, with LGE being the strongest independent predictor of SCD, cardiac, and all-cause mortality. In acute myocarditis, the most common localization of subepicardial LGE dwells in the lateral wall. Patients with myocarditis that develop HF and arrhythmias usually show a larger LGE distribution involving several myocardial segments. Moreover, a mid-layer LGE in the interventricular septum is more frequent in acute myocarditis than in acute coronary syndromes cases. The risk of SCD in patients with wide areas of LGE is significant, and a shared decision-making approach is warranted. Nevertheless, there is no formal consensus about the extension of LGE to justify implantable cardioverter defibrillator (ICD) implantation in primary prevention.

Women with polycystic ovary syndrome are burdened with multimorbidity and medication use independent of body mass index at late fertile age: A population-based cohort study.

This population-based follow-up study investigated the comorbidities, medication use, and healthcare services among women with polycystic ovary syndrome (PCOS) at age 46 years. The study population derived from the Northern Finland Birth Cohort 1966 and consisted of women reporting oligo/amenorrhea and hirsutism at age 31 years and/or a PCOS diagnosis by age 46 years (n=246) and controls without PCOS symptoms or diagnosis (n=1573), referred to as non-PCOS women. The main outcome measures were self-reported data on symptoms, diagnosed diseases, and medication and healthcare service use at the age of 46 years. Overall morbidity risk was increased by 35% (risk ratio [RR] 1.35, 95% confidence interval [CI] 1.16-1.57) and medication use by 27% [RR 1.27, 95% CI 1.08-1.50) compared with non-PCOS women, and the risk remained after adjusting for body mass index. Diagnoses with increased prevalence in women with PCOS were migraine, hypertension, tendinitis, osteoarthritis, fractures, and endometriosis. PCOS was also associated with autoimmune diseases and recurrent upper respiratory tract infections and symptoms. Interestingly, healthcare service use did not differ between the study groups after adjusting for body mass index. Women with PCOS are burdened with multimorbidity and higher medication use, independent of body mass index.

Toddler With Fever and Limp.

Toddler With Fever and Limp.

Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post-operative outcomes.

AimTo investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post‐operative complications.MethodsWe included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008–2017. Health information was obtained from administrative hospitalisation data. Rates of post‐operative complications and reoperation were evaluated using generalised estimating equations and Kaplan–Meier methods, respectively.ResultsOut of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008–2017 (ADT: 68–79 per 10 000 children; AD: 25–34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post‐operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0–1 years, lowest for those 2–5 years and increased with age thereafter. Three‐year reoperation rates for children aged 0–1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12–13 years.ConclusionsADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post‐operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.

Spontaneous enteroatmospheric fistula in a patient with COVID-19 disease

Coronavirus 2019 (COVID-19) disease patients present with upper respiratory symptoms; however, these patients may show gastrointestinal symptoms on arrival at the hospital. This finding requires an abdominal physical examination and imaging for 33% of patients. Enteroatmospheric fistulas (EAF) may form a connection between the external environment and the gastrointestinal tract and usually presents various difficulties in controlling the disease without surgical intervention. Its management requires a high level of clinical expertise to control and treat the fistula. In this case report, spontaneous EAF and its management are presented in a 65-year-old morbidly obese female patient who spontaneously had EAF during her hospitalization for COVID-19.

Pushy Patients Or Pushy Providers? Effect Of Patient Knowledge On Antibiotic Prescribing In Tanzania.

Antimicrobial resistance is one of the most serious threats to global health, but little progress has been made in reversing its spread. Inappropriate use of antibiotics in humans is a major driver of antimicrobial resistance, and rates are high and growing in lower- and middle-income countries. Antibiotics are thought to be subject to supplier-induced demand, whereby providers prescribe them to patients who do not know they are unnecessary. We conducted a randomized field experiment in 227 private health facilities in Tanzania, with standardized patients presenting uncomplicated upper respiratory tract infection symptoms. Standardized patients were randomly assigned to express knowledge (informed) or not (uninformed) that antibiotics were not required to treat them. There was a very high rate of inappropriate antibiotic prescription, with 86.0percent of informed standardized patients and 94.8percent of uninformed standardized patients prescribed an antibiotic, for an adjusted difference of 7.8percentage points between the groups. This small effect suggests that broader health systems factors are at play and that interventions should be aimed at systems, health facilities, and providers.

Divergent age-related humoral correlates of protection against respiratory syncytial virus infection in older and young adults: a pilot, controlled, human infection challenge model

Respiratory viral infections are typically more severe in older adults. Older adults are more vulnerable to infection and do not respond effectively to vaccines due to a combination of immunosenescence, so-called inflamm-ageing, and accumulation of comorbidities. Although age-related changes in immune responses have been described, the causes of this enhanced respiratory disease in older adults remain poorly understood. We therefore performed volunteer challenge with respiratory syncytial virus (RSV) in groups of younger and older adult volunteers. The aim of this study was to establish the safety and tolerability of this model and define age-related clinical, virological, and immunological outcomes. In this human infection challenge pilot study, adults aged 18-55 years and 60-75 years were assessed for enrolment using protocol-defined inclusion and exclusion criteria. Symptoms were documented by self-completed diaries and viral load determined by quantitative PCR of nasal lavage. Peripheral blood B cell frequencies were measured by enzyme-linked immunospot and antibodies against pre-fusion and post-fusion, NP, and G proteins in the blood and upper respiratory tract were measured. The study was registered with ClinicalTrials.gov, NCT03728413. 381 adults aged 60-75 years (older cohort) and 19 adults aged 18-55 years (young cohort) were assessed for enrolment using protocol-defined inclusion and exclusion criteria between Nov 12, 2018, and Feb 26, 2020. 12 healthy volunteers aged 60-75 years and 21 aged 18-55 years were inoculated intranasally with RSV Memphis-37. Nine (67%) of the 12 older volunteers became infected, developing mild-to-moderate upper respiratory tract symptoms that resolved without serious adverse events or sequelae. Viral load peaked on day 6 post-inoculation and symptoms peaked between days 6 and 8. Increases in circulating IgG-positive and IgA-positive antigen-specific plasmablasts, serum neutralising antibodies, and pre-F specific IgG were similar younger and older adults. However, in contrast to young participants, secretory IgA titres in older volunteers failed to increase during infection and, unlike serum IgG, did not correlate with protection. Better understanding of age-related differences in clinical outcomes and immune correlates of protection can overcome reduction in vaccine efficacy with advancing age. We identify correlates of protection in older adults, revealing previously unrecognised factors which might have implications for targeted vaccine discovery and drug development in this vulnerable group. Medical Research Council and GlaxoSmithKline EMINENT Consortium.

Immunofluorescence-Mediated Detection of Respiratory Virus Infections in Human Airway Epithelial Cultures.

A diverse collection of viral pathogens target airway epithelial cells for infection, with effects ranging from mild upper respiratory tract symptoms to death of the infected individual. Among these pathogens are recently discovered and/or emergent viruses that sometimes fail to infect commonly used, immortalized cell lines and for which infection phenotypes in the respiratory tract remain unknown. Human airway epithelial cultures have been developed over the past several decades and have proven to be a useful model system in culturing hard‐to‐grow viruses and assaying various features of infection in a physiologically relevant setting. This article includes methods for the generation of well‐differentiated human airway epithelial cell cultures at air‐liquid interface that recapitulate the mucosal epithelium of the trachea/bronchus in vivo. We further detail inoculation of these cultures with respiratory viruses—specifically rhinovirus, influenza virus, and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)—and provide a protocol for the detection of double‐stranded RNA or viral antigen–positive cells by immunofluorescence microscopy. These techniques, together with a post‐imaging analysis, can be applied to characterize the efficiency of infection and kinetics of spread within the airway epithelium. Furthermore, these methods can be utilized in conjunction with antibodies against cellular targets to determine cell tropism and colocalization with specific host factors during infection. © 2022 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Generation of human airway epithelial cultures at air‐liquid interface (HAE‐ALI) Basic Protocol 2: Viral inoculation of HAE‐ALI Basic Protocol 3: Immunofluorescence (IF)‐based detection of infected cells in HAE‐ALI

Relation Between Sex Hormones and Covid-19

Coronavirus is one of the major viruses that mainly attack human respiratory system . there are similarities in symptoms between COVID – 19 and earlier Coronavirus infections such as fever , dry cough , however , COVID – 19 showed unique clinical feature , that involve the targeting of the lower airways as evident by upper respiratory tract symptoms such as rhinorrhea , sneezing and sore throat . The severity of COVID- 19 as indicated by hospitalization , admission to intensive care unit , has been greater in men than women . Many hypotheses have been found to explain this difference in susceptibility and severity of the disease . The difference in immune response between sex is consider the main factor in outcomes of viral infection . Estrogen has immunoenhancing effect on the immune system , while testosterone has immunosuppressive role , also progesterone inhibits inflammatory innate immune response . In this review , its concluded that sex hormones have relation with COVID-19 severity .It was concluded that estrogen and progesterone reduce disease severity in contrast , testosterone increase the severity and susceptibility for COVID-19 . Keywords: sex hormones ; immunity ; Covid – 19

Social support, exhaled nitric oxide, and upper respiratory symptoms in health and asthma

Accumulating research identifies a role of psychological process, particularly negative affect, in the expression of airway nitric oxide (NO), yet directional associations tend to vary across methodologies and samples. Recent findings indicate higher social support to be associated with higher airway NO; however, consequences for respiratory infection remain unexplored. NO has a key role in the first line of epithelial defense against pathogens, thus, social support could unfold airway protective effects through enhanced production of NO. We therefore examined the associations among social support, negative affect, airway NO, and cold symptoms in a sample of undergraduate students. In this cross-sectional study, 637 participants completed questionnaires of social support, negative affect, medical history, and current cold symptoms followed by measurements of fractional exhaled NO (FENO) to study airway NO during a semester period of relative low stress. Findings showed that greater social support was associated with higher FENO and fewer cold symptoms, controlling for key covariates. Further analysis suggested an additional indirect effect of social support on FENO through cold symptoms such that higher social support was related to lower cold symptoms, which were related to lower FENO. These results, coupled with longitudinal findings in the previous research, suggest that social support can affect FENO and cold symptoms through a complex pattern of direct and indirect effects. Overall, findings support the role of psychological processes – particularly social support - as relevant to FENO and cold symptoms in young adults.

Māori Experiences and Beliefs about Antibiotics and Antimicrobial Resistance for Acute Upper Respiratory Tract Symptoms: A Qualitative Study.

Antimicrobial resistance (AMR) is a threat to public health. Addressing unnecessary antibiotic use provides an opportunity to reduce antibiotic consumption and to slow AMR. Understanding people’s beliefs is important for informing antimicrobial stewardship (AMS) initiatives. Within New Zealand, health inequities exist between Māori and non-Māori; however, no research has examined Māori beliefs about antibiotics and AMR. The aim of this study was to explore the experiences related to antibiotic use of Māori in New Zealand. In-depth, semi-structured interviews were conducted with 30 Māori adults recruited from primary care to explore the experiences, perceptions and beliefs that Māori have about antibiotics, and about AMR. Overall, 30 Māori adults (23% male; age range from 20 to 77 years) participated. Three themes emerged: systemic-, social-, and individual-related factors. From these themes, seven subthemes explained the factors that influenced antibiotic use and their perceptions of AMR in Māori: general practitioner (GP) times and ratios, effect of colonisation, lack of knowledge and information, access and poverty barriers, relationship with health professionals, illness perceptions, treatment beliefs and Whaakaro (thoughts), and beliefs pertaining to natural (rongoā) and Western medicine. Participants identified potential solutions to improve antibiotic use such as cultural support and involving Te Ao Māori; recognising these can inform future AMS initiatives.

Relation between Sex Hormones and COVID 19

Coronavirus is one of the major viruses that mainly attack human respiratory system . there are similarities in symptoms between COVID – 19 and earlier Coronavirus infections such as fever , dry cough , however , COVID – 19 showed unique clinical feature , that involve the targeting of the lower airways as evident by upper respiratory tract symptoms such as rhinorrhea , sneezing and sore throat . The severity of COVID- 19 as indicated by hospitalization , admission to intensive care unit , has been greater in men than women . Many hypotheses have been found to explain this difference in susceptibility and severity of the disease . The difference in immune response between sex is consider the main factor in outcomes of viral infection . Estrogen has immunoenhancing effect on the immune system , while testosterone has immunosuppressive role , also progesterone inhibits inflammatory innate immune response . In this review , its concluded that sex hormones have relation with COVID-19 severity .It was concluded that estrogen and progesterone reduce disease severity in contrast , testosterone increase the severity and susceptibility for COVID-19 . Keywords: sex hormones ; immunity ; Covid – 19

Use of a multiplex polymerase chain reaction assay for the early detection of an outbreak of human parainfluenza virus type 3 infection in a nursery school during the COVID-19 pandemic

SummaryIntroductionAlthough outbreaks of parainfluenza virus type 3 (PIV-3) have been reported in children, to our knowledge none have been reported in a nursery school. As the symptoms of PIV-3 infection are similar to those of COVID-19 infection, accurate diagnosis of PIV-3 and other respiratory viruses is important during the COVID-19 pandemic.AimsWe experienced an outbreak of upper respiratory symptoms at a nursery school in Miyagi Prefecture, Japan, from 29/5/2021 to 13/6/2021 and aimed to determine the causative organism(s).MethodsA multiplex polymerase chain reaction (PCR) assay which enabled rapid detection of a variety of causative microorganisms of respiratory tract infections was used to analyse 13 nasopharyngeal swabs collected during the outbreak. Infection Prevention and control measures were implemented to prevent further spread of infection.ResultsAll 13 samples were positive for PIV-3 infection. 2 of the 13 samples were also positive for rhinovirus/enterovirus and 1 sample was also positive rhinovirus/enterovirus and coronavirus NL 63. No samples were positive for SARS-CoV-2.DiscussionChildren in school settings are especially vulnerable to respiratory viral infections, including COVID-19. Children under two years are unable to wear masks reliably, and the COVID-19 vaccine was approved only for older children. Multiplex PCR assays can be used for the rapid diagnosis of respiratory infections.ConclusionWe identified an outbreak of PIV-3 in a nursery school during the COVID-19 pandemic. The investigation of the outbreak highlighted that it was important not to overlook other respiratory infections including PIV-3 during the COVID-19 pandemic. The multiplex PCR assay provided rapid and accurate diagnosis of the causative organisms in the outbreak and helped to direct appropriate interventions to control the outbreak.

SARS-CoV-2 symptomatic reinfection among patients with primary antibody deficiency

SARS-CoV-2 symptomatic reinfection among patients with primary antibody deficiency

A case of rhabdomyolysis with rigors

Introduction: Rhabdomyolysis is a potential life-threatening condition caused by extensive skeletal muscle breakdown with leakage of toxic muscle contents into the circulation. The most dreaded complication is acute renal failure caused by toxic effects of myoglobin in the kidneys. The causes of rhabdomyolysis are classified into traumatic, non-traumatic exertional, and non-traumatic rhabdomyolysis. The pathophysiologic hallmark of rhabdomyolysis regardless of etiology is increased free ionized calcium due to cellular energy depletion (ATP) or direct plasma membrane rupture and consequent intensified muscle contractility, mitochondrial dysfunction, and production of oxygen radicals. Case Report: We report a case of a middle-aged black woman with rhabdomyolysis that was caused by intense shivering chills, and rigor from pneumonitis. She had no personal or family history of muscle disorder and was admitted to the hospital after a weeklong history of upper and lower respiratory symptoms that led to the worse shivering and shaking chills she ever had. She was noted to have elevated creatine phosphokinase (CPK) of 200,000 uL (26–192 uL) and creatinine level of 5.52 (0.81–1.2 mg/dL). She was started on intravenous fluid with half-isotonic saline (0.45%) or 77 mmol/L sodium, 75 mmol/L sodium bicarbonate, and hemodialysis with progressive improvement in kidney function that took up to seven weeks to full recovery. Conclusion: Shivering and shaking chills from respiratory infection can cause rhabdomyolysis with severe muscle damage and renal failure in a patient with no known underlying muscular-skeletal disorder condition but has good recovery with fluid management and hemodialysis. Renal function has returned back to normal.

Analysis of clinical characteristics and prognosis of 4 264 patients with asymptomatic and mild novel coronavirus infections in Shanghai

To analyze the clinical characteristics and prognosis of patients infected with novel coronavirus Omicron variant in Shanghai, as to provide a reference for epidemic prevention, clinical diagnosis, and treatment. Altogether 4 264 novel coronavirus Omicron variant-infected patients with positive results of nucleic acid admitted to Shanghai New International Expo Center N3 Mobile Cabin Hospital from April 2 to May 7, 2022, were included. The demographic and baseline clinical characteristics, treatment strategy, prognosis, and different factors affecting the length of hospital stay were analyzed. A total of 4 264 novel coronavirus variant Omicron-infected cases were collected, including 3 111 cases (73.0%) asymptomatic infections and 1 153 cases (27.0%) mild infections. The overall median age was 45 (33, 55) years old with a range from 2 years old to 81 years old. The male to female ratio was 1.37:1. Altogether 3 305 cases (77.5%) had been vaccinated, of which 3 166 cases completed more than 2 doses. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical manifestations of these infected patients. During the course of the disease, patients with asymptomatic infection were mainly treated with traditional Chinese medicine (TCM, 55.1%) and clinical observation (36.8%), and those with mild infection were mainly treated with TCM (42.2%) or integrated Chinese and Western medicine (30.4%). All patients were cured and discharged. The overall median length of hospital stay and the negative conversion time of nucleic acid were 9 (6, 10) days and 8 (5, 9) days, respectively. Compared with the asymptomatic infected patients, the hospitalization duration and the nucleic acid negative conversion time of the mildly infected patients were slightly longer [days: 10 (8, 11) vs. 9 (5, 10); 8 (6, 10) vs. 7 (4, 9), both P < 0.001]. Multiple linear regression analysis showed that the increasing age and mild infection were associated with longer hospitalization duration, and the treatment of TCM or integrated Chinese and Western medicine was associated with shortened length of hospital stay (all P < 0.05). The current novel coronavirus Omicron variant epidemic in Shanghai mainly caused asymptomatic and mild infections. The young and middle-aged population had a relatively high infection rate. The upper respiratory tract symptoms such as cough and expectoration were the most common clinical symptoms. Elderly and confirmed patients had prolonged hospitalization duration, while for patients receiving TCM treatment, the hospitalization duration was shortened.

Beware of the jolly toddler who has not read the right textbooks.

It was one of those busy days in the children's emergency department (ED) in December 2021. Omicron was the dominant virus. Along came an 18-month-old girl, whose mother gave a history that she was unsettled for 5 days with upper respiratory symptoms, constipation, and abdominal pain. She was being treated for constipation. She would not allow the junior doctor to examine her, but made friends with the consultant after extensive bribery involving bubbles, stickers, colouring and choice of movie. Clinical observations and examination were normal when done whilst watching the aforesaid movie. Her abdomen was soft and non-tender. A period of observation was decided on, given the history. At the same time, there was a 15-year-old boy in ED with fever and abdominal pain. Appendicitis was suspected; the surgical team got ready to take him to theatre. The ED team expressed concerns as he looked relatively well but with a raised serum C Reactive Protein (CRP) of 202 mg/L. Abdominal ultrasound was reported as showing ileitis. Negotiations between both teams were started, facilitated by the ED consultant. The toddler, in the Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2, decided that more food supplies were in order after consuming personal supplies of Hula Hoops, and approached the consultant. She departed into the waiting room after procuring biscuits and orange juice. Attention returned to the 15-year-old; it was decided that he should be admitted and observed. Once this was settled, further history taken from the mother revealed that over the past 3 days her daughter woke up at night screaming with pain, so much so that neighbours would call and ask if all was well. A peculiar history of neighbours checking in the great city of London was notable. It was decided to perform an abdominal ultrasound, based on the history. Extensive negotiations with the radiology team commenced and 2 h later it was agreed the ultrasound would be done at a sister hospital. The toddler had in the meantime spent 3 h in ED eating and drinking and enjoying the facilities. Hula Hoops were removed from the toddler's fingers by the consultant, on account of the fact that she was requesting an ultrasound for intussusception and did not want to look foolish (the consultant not the toddler). The toddler amicably ate the removed Hula Hoops and set off after waving a cheerful goodbye. ED became busy and numerous children were seen. Two hours later the radiologist called – abdominal ultrasound showed a doughnut-shaped mass, an ileocolic intussusception. At the receiving hospital, a fresh bag of Hula Hoops was removed from the toddler who showed great anger at this turn of events, especially as this was followed by cannulation. Bloods showed a non-specific CRP of 11 mg/L. The toddler was transferred to a tertiary centre where an air enema resulted in resolution of the intussusception. As it turned out she was also COVID positive on nasopharyngeal swabs. She was discharged home and is subsequently living happily ever after. As for the 15-year-old, he too was COVID positive, diagnosed as having Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS).1 He continued to spike fevers, was started on IV methylprednisolone and had a good outcome. PIMS-TS is notably a great masquerader,1 mimicking appendicitis on this occasion. The toddler was unique: 5 days of varied symptoms, normal examination and an excellent appetite. The clue was in the history. In the COVID-19 pandemic, when our concentration is on the obviously sick children, along comes one who teaches us an unforgettable lesson. What we see in ED is a snapshot, the movie is evolving at home, hence history is the key. Paediatrics is a speciality like no other, extraordinary learning interspersed with magic.

Organ-specific symptom patterns during oral food challenge in children with peanut and tree nut allergy.

Peanut and tree nut allergies are common in childhood and often severe in nature. The clinical picture shows a wide variety of symptoms. To analyze the distribution of clinical symptoms and severity during oral food challenges (OFC) in children. Analysis of 1.013 prospectively recorded, positive OFCs with peanut (n=607), hazelnut (n=266), walnut (n=97), and cashew (n=43). Symptoms were categorized as immediate-type skin, gastrointestinal, upper and lower respiratory, cardiovascular symptoms, and eczema exacerbation. Symptom severity and treatment were recorded. Skin symptoms presented in 78%, followed by gastrointestinal (47%), upper (42%), and lower respiratory symptoms (32%). Cardiovascular symptoms presented in 6%. In three-quarter of the reactions, more than one organ was involved. Importantly, severe reactions occurred at every dose level. Peanut- and cashew-allergic patients had a higher relative risk of gastrointestinal symptoms compared with hazelnut- and walnut-allergic patients. Patients without vomiting had a 1.7 times higher risk developing immediate-type skin and/or lower respiratory symptoms. Three-quarter of the patients ever had eczema but worsening presented in only 10.5% of the OFCs. In patients with multiple food allergies, organs involved, eliciting dose and severity differed between allergens. Although comparisons between allergen groups with different clinical history, severity, comorbidities and laboratory data are difficult and might contain bias, our data confirm the high allergenic potential of peanut and tree nuts. The rare occurrence of eczema worsening emphasizes that avoidance diets of peanuts and tree nuts to cure eczema seem to be unnecessary and may hamper tolerance maintenance.

Clinical, Radiographic And Bronchoscopic Findings of Tracheal Collapse in A Calf

A six-day-old calf was presented to the XXX University Veterinary Teaching Hospital with a history of wheezing (noisy respiration), dyspnea that worsens with exercise and drinking. The calf shown upper respiratory tract symptoms including extended head and neck, dilated nostrils, severe inspiratory stridor with characteristic “honking” sound, and exophthalmos. Upon these findings, we suspected upper airway obstruction and decided to perform cervical-thoracal radiography and bronchoscopy to obtain detailed visualization of the upper respiratory tract. On the thorax radiograph, significant tracheal narrowing was visible at the thoracic inlet, and it was beginning at the caudal cervical region (C5) and extending to the cranial thorax (T1). Also, severe dorsoventrally narrowing was displayed approximately 15 cm after entering the trachea using bronchoscopy. The tracheal collapse was diagnosed in this case based on clinical, radiographical, and bronchoscopy findings. It is important to remember that tracheal collapse should be considered in the differential diagnosis in calves that show upper respiratory tract symptoms such as extended head and neck, dilated nostrils, severe inspiratory stridor with characteristic “honking” sound.