Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. Methods: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. Results: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported (n = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%). The majority of the cases belonged to White (Caucasian) (n = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, n = 445, 34 studies, I2 85%, p < 0.01), 0.98% (95% CI 0.13 to 1.83, n = 17, six studies, I2 49%, p < 0.08), and 5.41% (95% CI 4.48 to 6.34, n = 441, 32 studies, I2 87%, p < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06–8.17, I2 = 0% versus 5.31%, 95% CI 4.31–6.30, I2 = 88%) and fungal (1.72%, 95% CI 0.45–2.99, I2 = 0% versus 0.62%, 95% CI 0.00–1.55, I2 = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70–4.34, I2 = 0% versus 4.91%, 95% CI 3.97–5.84, I2 = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV (n = 342, 31.4%) and Mycoplasma pneumonia (n = 120, 23.1%). Conclusion: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and Mycoplasma pneumonia were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.

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Network function virtualization (NFV) is an emerging technology that is becoming increasingly important due to its many advantages. NFV transforms legacy hardware-based network infrastructure into software-based virtualized networks. This transformation increases the flexibility and scalability of networks, at the same time reducing the time for the creation of new networks. However, the attack surface of the network increases, which requires the definition of a clear map of where attacks may happen. ETSI standards precisely define many security aspects of this architecture, but these publications are very long and provide many details which are not of interest to software architects. We start by conducting threat analysis of some of the NFV use cases. The use cases serve as scenarios where the threats to the architecture can be enumerated. Representing threats as misuse cases that describe the modus operandi of attackers, we can find countermeasures to them in the form of security patterns, and we can build a security reference architecture (SRA). Until now, only imprecise models of NFV architectures existed; by making them more detailed and precise it is possible to handle not only security but also safety and reliability, although we do not explore those aspects. Because security is a global property that requires a holistic approach, we strongly believe that architectural models are fundamental to produce secure networks and allow us to build networks which are secure by design. The resulting SRA defines a roadmap to implement secure concrete architectures.

Background and aim Hydroxyurea (HU) plays an essential role in the complex pathophysiology alteration of sickle‐cell disease (SCD), which translates clinically into the enhanced quality of life and increased survival. This research examines adult patients with SCD's attitudes and awareness toward HU, as well as underutilization consequences. Method A cross‐sectional research was performed in Saudi Arabia, and adult patients with SCD were interviewed. The survey includes patient demographics, attitudes, and knowledge of HU and clinical data. The chi‐square was applied through SPSS version 23 for assessing any association with outcome variables and demographic characteristics. Results HU is known to 72 (67.3%) of the 107 patients. The hydroxyurea treatment was initiated in 46 patients (63%). Of these, 23 (50%) discontinue HU, with the key factors being pregnancy preparation and side effects development. For those who were unaware of HU, 13 (37.1%) were admitted to the intensive care unit because of acute chest syndrome, 29 (82.8%) required a frequent blood transfusion and 12 (34.2%) with frequent hospitalizations. However, there was no significant relationship between awareness and education level (P value is .078 > .05). In addition, there was no significant relationship between the level of awareness and age and gender of participants (P value is .68 and .44, respectively). Conclusion HU is a long‐established and effective disease‐modifying agent for SCD patients, but it is underutilized. The causality of underuse is bidirectional between patients and healthcare providers. It is essential to educate healthcare providers and patients with SCD about hydroxyurea role in modifying disease severity, resolving adverse events, and achieving full benefits.