Objectives: To determine the demographic and clinical characteristics, underlying comorbidities, and outcomes of children with coronavirus disease 2019 (COVID-19) infection. Methods: In this retrospective study, we reported 62 pediatric patients (age <14 years) with confirmed COVID-19 between March 2 and July 1, 2020, at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Results: Comorbid conditions, including cardiac, neurological, respiratory, and malignant disorders, were reported in 9 patients (14.5%). The most prominent presenting complaints were fever (80.6%) and cough (48.4%). Most of our patients (80.6%) had mild disease, 11.3% had moderate disease, and 8.1% exhibited severe and critical illness. Twenty-one patients (33.9%) were hospitalized, with 4 patients (6.5%) admitted to the pediatric intensive care unit, and 3 (4.8%) patients died. Conclusion: All pediatric age groups are susceptible to COVID-19, with no gender difference. COVID-19 infection may result in critical illness and even mortality in subsets of pediatric patients.

Clostridium difficile is the leading cause of healthcare‐associated infections worldwide. The diagnosis of C. difficile infection (CDI) in pediatric oncology patients is complex as diarrhea is common, and there is a high rate of colonization in infants and young children. This study was conducted to assess the accuracy of the surveillance definitions of healthcare‐associated CDI (HA‐CDI) and to determine the prevalence of toxigenic C. difficile colonization among pediatric oncology and stem cell transplant patients. Methods A prospective cohort study was conducted over a three‐year period in an inpatient pediatric oncology and stem cell transplant setting. Baseline stool samples were collected within three days of admission and were genotypically compared with clinically indicated samples submitted after three days of admission. Results A total of 175 patients were recruited with a total of 536 admissions. The adjusted prevalence of baseline toxigenic C. difficile colonization among admissions was 32.8%. Seventy‐eight percent of positive admissions did not have history of CDI. Colonization with a toxigenic strain on admission was predictive of CDI (OR = 28.6; 95% CI, 6.58–124.39; P < 0.001). Nearly all clinical isolates (8/9) shared identical pulsed‐field gel electrophoresis patterns with baseline isolates or were closely related (1/9). Only one of the 11 cases that were considered HA‐CDI was potentially nosocomially acquired. Conclusion The prevalence of colonization with toxigenic C. difficile in our cohort is high. Unfortunately, the current CDI surveillance definitions overestimate the incidence of HA‐CDI in pediatric oncology and stem cell transplantation settings.

Clostridium difficile is the most common cause of antibiotic-associated diarrhea, and it occasionally causes extraintestinal infections. We present a case of C. difficile-associated diarrhea that led to vertebral osteomyelitis associated with hardware. The osteomyelitis became symptomatic 2 years after the initial diarrheal event. C. difficile recovered from internal hardware sites cannot simply be regarded as a contaminant but should be treated.

Human respiratory syncytial virus (HRSV) is a main cause of hospital admission for lower respiratory tract infection. In previous studies from Saudi Arabia, higher prevalence of the NA1 genotype in group A was observed from Riyadh and Taif. This study recruited respiratory cases from Jeddah during January to December, 2017. RSV represented 13.4% in the recruited cases with 64% of them belonging to group A and 36% to group B. All group A cases in this study were ON1 type characterized by duplication of 72 nucleotides, 24 amino acids in the C-terminal in the second hypervariable region of the G gene. In addition, for group B all of the cases were clustered under BA9, which had uniquely characterized as duplication of 60 nucleotides in the G protein. Our sequences showed similarity with earlier sequences from Saudi Arabia, Kuwait, Thailand, South Africa, Spain, the USA and Cyprus. Some amino acid substitutions in the investigated sequences would cause a change in potential O-glycosylation and N-glycosylation profiles from prototype ON1. The predominance of the ON1 and BA9 genotype of RSV-A in Jeddah compared to previous Saudi studies showing predominance of the NA1 genotype for group A. This difference in genotype prevalence could be due to fast spread of the ON1 genotype worldwide or due to the flux of travelers through Jeddah during hajj/umrah compared to Riyadh and Taif. This shift in genotype distribution requires continuous surveillance for genetic characterization of circulating respiratory infections including RSV. These findings may contribute to the understanding of RSV evolution and to the potential development of a vaccine against RSV.

Background Studies about the incidence and severity of coronavirus disease 2019 (COVID-19) in children are still significantly lower than those in adults. Moreover, data on the effect of COVID-19 in children with congenital heart disease (CHD) are limited. To the best of our knowledge, this study first reported mortality in a child with CHD who acquired COVID-19. Case summary A 16-month-old boy presented to the emergency department due to shortness of breath, fever, cough, and poor oral intake. He tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He required mechanical ventilation for rapidly progressing respiratory failure. The patient had a large mid-muscular ventricular septal defect (VSD) that was closed percutaneously at the age of 13 months. Moreover, we followed his hospital sequelae from admission to death. Discussion This child had multiple risk factors, including malnutrition and persistent pulmonary hypertension (PH) after late closure of the VSD. The pre-existing PH could have been aggravated by the lung condition associated with COVID-19 and the respiratory failure triggered by SARS-CoV-2 infection. The patient presented with ventricular systolic dysfunction, elevated troponin serum levels and newly developed trifascicular block, which were indicative of myocardial injury. The elevated inflammatory markers and multi-organ dysfunction seem to corroborate multisystem inflammatory syndrome in children, which was described recently among paediatric patients with COVID-19.

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PMF is a mixture of compounds extracted from lyophilized camel urine. It has many therapeutic effects including anticancer/antiviral activities. It has also a good safety profile. The aim of this study is to assess PMF safety in mice lung tissue after repeated inhalation. Adult male mice (N=15) were used. Clean surgical pads were used as cage bedding to avoid inhalation of wooden bedding. PMF aqueous solution, low and high doses were provided by whole-body inhalation exposure system, once daily for 3 successive days. At the end of the experiment, blood samples were collected, animals were sacrificed, and both lungs were taken for immunological and histology investigations. PMF inhalation in low and high doses showed normal levels of pro-inflammatory cytokines (TNF alpha and IL6) as well as normal antioxidants (GSH, SOD and catalase) in lung tissues. Whereas PMF inhalation in high doses led to an increasing level of MDA. The histological assessment also showed low or mild changes in both alveoli and bronchioles which are more obvious in the case of a high PMF dose. In conclusion, PMF inhalation either in high or low doses does not likely to induce an immunological inflammatory response in lung tissue. However, high doses may cause some histological changes. meta-analysis', Tropical medicine and infectious disease, 5: 180. Ali, A, F Khorshid, H Abu-Araki, and AM Osman. 2011. 'Tumor lung cancer model for assessing anti-neoplastic effect of PMF in rodents: histopathological study', Trends in Applied Sciences Research, 6: 1214.