The prevalence of multisystem inflammatory syndrome in children (MIS-C) has increased since the coronavirus disease 2019 (COVID-19) pandemic started. This study was aimed to describe clinical manifestation and outcomes of MIS-C associated with COVID-19. This systematic review and meta-analysis were conducted on all available literature until July 3rd, 2020. The screening was done by using the following keywords: (“novel coronavirus” Or COVID-19 or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus) and ("MIS-C" or "multisystem inflammatory" or Kawasaki). Data on gender, ethnicity, clinical presentations, need for mechanical ventilation or admission to intensive care unit (ICU), imaging, cardiac complications, and COVID-19 laboratory results were extracted to measure the pooled estimates. Out of 314 found articles, 16 articles with a total of 600 patients were included in the study, the most common presentation was fever (97%), followed by gastrointestinal symptoms (80%), and skin rashes (60%) as well as shock (55%), conjunctivitis (54%), and respiratory symptoms (39%). Less common presentations were neurologic problems (33%), and skin desquamation (30%), MIS-C was slightly more prevalent in males (53.7%) compared to females (46.3%). The findings of this meta-analysis on current evidence found that the common clinical presentations of COVID-19 associated MIS-C include a combination of fever and mucocutaneous involvements, similar to atypical Kawasaki disease, and multiple organ dysfunction. Due to the relatively higher morbidity and mortality rate, it is very important to diagnose this condition promptly.

Non detection of CGA at second trimester ultrasonography is a predictor of preterm delivery.

The present study was performed to evaluate the clinical symptoms and cardiovascular complications in patients with typical and atypical Kawasaki disease (KD). This retrospective study was conducted on the medical records of 176 patients with KD for three years. The study population was divided into two groups of typical and atypical based on the KD clinical criteria. The two groups were compared in terms of demographic data, clinical symptoms, cardiac lesions, and laboratory markers. Based on the diagnostic criteria, 105 (60%) and 71 (40%) patients were diagnosed with typical and atypical KD, respectively. The mean age of the typical patients (38.16 months) was higher than that of the atypical group (24.03 months) at the time of diagnosis (p < 0.05). The results revealed no significant difference between the two groups regarding the seasonal distribution of KD onset (p = 0.422). However, the most common season for the diagnosis of the disease was spring, followed by winter. There was no significant difference between the two groups in terms of fever duration (p = 0.39). Furthermore, vomiting was more common in the atypical patients than in the typical group (p = 0.017). In terms of the cardiac lesions, ectasia (p = 0.005) and lack of tapering of the distal coronary vessels (p = 0.015) were more frequently detected in the atypical group than in the typical group. Considering the laboratory findings, thrombocytosis (p = 0.010) and anemia (p = 0.048) were more common in the atypical group, compared to those in the typical group. On the other hand, the typical group had a higher serum alanine aminotransferase level (adjusted for age) (p = 0.012) and Hyponatremia (serum sodium concentration ≤130 mmol/L) (p = 0.034). Based on the findings of the current study, the fever duration from onset to diagnosis was slightly more in atypical KD patients than in the typical group, but not statistically significant, possibly due to more timely diagnosis of atypical KD. There was no difference in coronary aneurysm between the two groups at the time of diagnosis. The atypical group had a higher frequency of coronary ectasia and lack of tapering, indicating cardiac involvement. Consequently, these conditions should be given more attention in the atypical patients. Furthermore, the higher frequency of anemia and thrombocytosis in the atypical patients can be useful for diagnosis of this kind of KD.

Context: Multisystem inflammatory syndrome in children (MIS-C) is an emerging condition after the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, termed COVID-19. This study aimed to describe the cardiac manifestations of children diagnosed with MIS-C. Evidence Acquisition: This narrative review was conducted by searching the PubMed, Scopus, and Google Scholar databases to review MIS-C cardiac manifestations up to September 30, 2020. The demographic features, past medical history, clinical signs and symptoms, cardiac involvement, and the type of COVID-19 diagnosis confirmation were extracted. Results: In many children, MIS-C seems to be a post-infectious complication of the COVID-19 infection. This syndrome affects multiple organs and has various clinical manifestations mimicking Kawasaki disease. Patients frequently present with persistent fever, kidney injury, gastrointestinal (GI) problems, neurologic symptoms, mucosal changes, conjunctivitis, and cardiac involvement. Children with MIS are more likely to present with hypotension, shock, and cardiac dysfunction, rather than coronary artery abnormalities and arrhythmia. Children with MIS need close observation; some need to be hospitalized, and a few may need a Pediatric Intensive Care Unit (PICU) admission. Treatment currently includes anticoagulants, IV immunoglobulin, and anti-inflammatory drugs. Conclusions: As a novel syndrome associated with SARS-CoV-2 infection, MIS-C is potentially lethal. Cardiac manifestations, including coronary and myocardial involvement, are common and should be carefully identified. With prompt diagnosis and proper treatment, most children will survive, but the outcomes of the disease are unknown, so long-term follow-ups are required.

This study evaluated the clinical features, course, and outcomes of Iranian children with juvenile dermatomyositis (JDM), juvenile polymyositis (JPM), and other uncommon connective tissue disorders. A chart review of 85 Iranian children with JDM and JPM was performed during a 10-year period from 2003 to 2013. The patients' clinical signs and symptoms, laboratory data, and other factors affecting clinical outcomes were recorded using questionnaires. Statistical analysis was performed using SPSS software version 20. In all, 40 boys and 45 girls were included in the study (F/M, 1.1:1). Disease frequency was significantly higher in boys aged <5 years (F/M, 0.4:1) and girls aged >5 years (F/M, 1.6:1). The combined mean age at diagnosis was 7.5 years. Muscle weakness, particularly in the proximal muscles of lower extremities (96 %); fatigue (83 %); and heliotrope rash (71 %) were the most frequently recorded symptoms. Elevated lactate dehydrogenase level was the most common enzyme disturbance (98 %). Monocyclic course was seen in 60 % of patients. The mean treatment duration was 3 years. The incidence rate of complications such as calcinosis, lipodystrophy, and growth disturbances was 20, 9, and 30 %, respectively. The occurrence of these complications in patients with monocyclic disease was significantly lower. Vital organ involvement led to the death of four patients. The incidence of calcinosis was significantly lower in patients having a shorter interval between disease onset and treatment. Two important complications, failure to thrive and lipodystrophy, were significantly higher in patients having antinuclear antibodies. The incidence of the above three complications was higher in patients with polycyclic or continuous chronic disease. Respiratory failure was the most common cause of patient mortality.

: The coronavirus disease 2019 (COVID-19) pandemic, with a high morbidity and mortality rate, has affected all age groups. COVID-19 infection in children usually has minimal symptoms, but the number of children with the inflammatory syndrome with clinical features similar to the Kawasaki disease has increased during the COVID-19 pandemic. Information about this emerging COVID-19 manifestation also called the multisystem inflammatory syndrome in children (MIS-C), is still incomplete. Patients typically present with persistent fever, followed by shock or multi-organ involvement. Laboratory findings and clinical presentation of this multi-organ involvement is part of the diagnostic criteria. Early treatment and multidisciplinary referral to pediatric specialists are essential. The prognosis of MIS-C is not yet fully understood. Although most children survive, several deaths have also been reported. Based on relevant evidence, this study aimed to review the pathophysiology, clinical manifestations, laboratory and imaging findings, diagnosis, treatment recommendations, and prognosis of MIS-C associated with COVID-19.

Sydenham chorea is known for its rapid, irregular, and aimless involuntary movements and is considered a benign and self-limiting condition among the major manifestations of rheumatic fever. The current study reviewed the demographic, clinical, and paraclinical findings of pediatric patients with Sydenham chorea. Methods: This cross-sectional study was conducted among 22 patients with Sydenham chorea who were admitted to the pediatric wards of Mashhad Imam Reza and Ghaem Hospitals between 2006 and 2016. Data from these patients' medical records were extracted, organized using checklist forms, and analyzed. Results: Eight patients were male and 14 were female. The average age was 10.09±3.53 years. In 31.8% of patients, chorea was the only sign of rheumatic fever. Chorea was unilateral in 21.1% of patients. The most common clinical findings were, in descending order, jerky movements, facial grimacing, gait disorders, mental disorders, speech disorders, muscle weakness, and milkmaid's grip. Cardiac auscultation was normal in 76.2% of patients, while a holosystolic murmur was heard in 23.8%. In laboratory exams, 50% of patients were erythrocyte sedimentation rate (ES-R)-positive, 31.2% were C-reactive protein (CRP)-positive, and 53.3% were anti-streptolysin O (ASO)-positive. Echocardiography showed the prevalence of mitral regurgitation (63.6%), aortic regurgitation (45.5%), tricuspid regurgitation (22.7%), pulmonary regurgitation (4.5%), and pericardial effusion (4.5%). Conclusion: This study showed that Sydenham chorea can be the only sign of rheumatic fever. This disease typically occurs in children between the ages of 7 and 12. ESR, CRP, and ASO can be the most effective laboratory tests for diagnosis.

Objective To study the cardiac outcomes of patients with multisystem inflammatory syndrome in children (MIS-C) after 6-month of diagnosis. Methods This review of hospital records was conducted on MIS-C patients (aged <21 years) who completed a six-month follow-up. The baseline demographic, clinical, laboratory, and treatment characteristics during the acute phase, and echocardiographic findings during follow-up were collected. Results 116 patients (61.2% male, median age 7 years) with MIS-C were included in the study. At the time of admission, cardiac abnormalities were present in 70.7% of MIS-C patients, and the most common cardiac abnormalities were valve failure (50.9%), followed by ventricular dysfunction (39.7%), and pericardial effusion (23.3%). Six month after diagnosis, cardiac abnormalities were found in 10.3% of patients, and patients had lower rates of ventricular dysfunction ( P <0.001), valve failure ( P <0.001), pericardial effusion ( P <0.001), and coronary involvement ( P <0.001) as compared to the baseline. Intravenous immunoglobulin (IVIG) and steroid treatment significantly reduced the odds of occurrence of ventricular dysfunction ( P =0.002), valve failure ( P =0.004), and low ejection fraction ( P =0.002) in comparison to IVIG treatment alone. Conclusion While most MIS-C patients had abnormal echocardiographic findings at admission, only 10.3% of patients had cardiac abnormalities during follow up.