W ith the rapidly evolving severe acute respiratory syndrome coronavirus-2 (SARS-Cov-2) pandemic, the knowledge about the disease manifestations and severity has also evolved quickly. Due to its resemblance to SARS, influenza, and other respiratory viruses, children were initially thought to be more susceptible than adults. However, less than 5% of total coronavirus disease (COVID-19) cases belong to the pediatric age group, and the severity has been milder as compared to adults [3,4]. Information regarding clinical manifestations and outcomes of COVID-19 in adults is available due to a huge number of reported cases, but the scenario for the pediatric population is different as our knowledge about clinical and laboratory characteristics as well as prognosis of COVID-19 is very limited. Due to this difference in the manifestations of COVID-19 among pediatric patients from adults, there is a need to clarify the disease manifestations and course among children. We performed this systematic review to synthesize the information on clinical manifestations, laboratory findings, and outcome of COVID-19 among the pediatric population.

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Background The majority of the children with SARS-CoV-2 infection present with respiratory symptoms, hence various chest imaging modalities have been used in the management. Knowledge about the radiological findings of coronavirus disease (COVID-19) in children is limited. Hence, we systematically synthesized the available data that will help in better management of COVID-19 in children. Methods Four different electronic databases (MEDLINE, EMBASE, Web of Science and CENTRAL) were searched for articles reporting radiological findings in children with COVID-19. Studies reporting thoracic radiological findings of COVID-19 in patients aged <19 years were included. A random-effect meta-analysis (wherever feasible) was performed to provide pooled estimates of various findings. Results A total of 1984 records were screened of which forty-six studies (923 patients) fulfilled the eligibility criteria and were included in this systematic review. A chest computed tomography (CT) scan was the most frequently used imaging modality. While one-third of the patients had normal scans, a significant proportion (19%) of clinically asymptomatic children had radiological abnormalities too. Unilateral lung involvement (55%) was frequent when compared with bilateral and ground-glass opacities were the most frequent (40%) definitive radiological findings. Other common radiological findings were non-specific patchy shadows (44%), consolidation (23%), halo sign (26%), pulmonary nodules and prominent bronchovascular marking. Interstitial infiltration being the most frequent lung ultrasound finding. Conclusion CT scan is the most frequently used imaging modality for COVID-19 in children and can detect pneumonia before the appearance of clinical symptoms. Undefined patchy shadows, grand-glass opacities and consolidation are commonly observed imaging findings in COVID-19 pneumonia.

Introduction Hydroxychloroquine (HCQ) has been evaluated for treatment and prophylaxis against SARS-CoV-2 infection in various studies with conflicting results. We performed a systematic review to synthesize the currently available evidence over the efficacy and safety of HCQ/CQ therapy alone against SARS-CoV-2 infection. Methods We searched Embase, PubMed, Web of Science, and Cochrane central for randomized controlled trials (RCTs) and prospective cohort studies published until October 15, 2020 and assessing the efficacy of HCQ alone against SARS-CoV-2 infection. We included studies evaluating HCQ/CQ alone as intervention and placebo/standard care as a control group. Retrospective studies and studies using other drugs (namely azithromycin, corticosteroids, immunomodulators, etc.) we excluded. Thirteen RCTs and three prospective cohort studies were included in this review. We pooled data using a random-effect model. Results Pooled data from nine RCTs (9171 participants) showed that HCQs increase mortality as compared to placebo/standard of care (RR 1.10; 95% CI:1.00-1.21). Hydroxychloroquine did not reduce the need for hospitalization in out-patients (RR 0.57; 95% CI 0.31-1.02). HCQ group has a significantly higher rate of any adverse event (RR 2.68; 95% CI 1.55-4.64), as compared to the control group. Also, using HCQ for prophylaxis against SARS-CoV-2 infection did not reduce the risk of acquiring SARS-CoV-2 infection (RR 1.04; 95% CI 0.58-1.88). Conclusions HCQ therapy for COVID-19 is associated with an increase in mortality and other adverse events. The negative effects are more pronounced in hospitalized patients. Therefore, with the available evidence, HCQ should not be used in prophylaxis or treatment of patients with COVID-19.

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We describe a case of bilateral persistent fetal vasculature (PFV) in a 3-month-old boy who presented with bilateral white pupillary reflex and a possible diagnosis of retinoblastoma. On ultrasonography, there was an echogenic band in the posterior segment of both eyes which connected the posterior surface of the lens capsule to the optic disc. Colour Doppler revealed the presence of vascularity in the band along its entire length. No calcification or mass lesion was seen. These findings are diagnostic of PFV. Most cases of PFV are unilateral and sporadic in nature and closely mimic retinoblastoma. Although rare, PFV should be considered in the differential diagnosis when examining a case of bilateral leukocoria. Paediatricians should be aware of this rare but serious entity.

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The trial by Schanler et al 1 failed to show a difference between the acidified and non-acidified liquid human milk fortifier among objectively measured outcomes. However, the authors emphasized differences between subjective, relatively less significant outcomes of a nonblinded, industryfunded trial.In the protocol, 2 only 4 outcomes were planned to be assessed at day 29 or discharge, however, many intermediate outcomes (post hoc) were presented as primary analyses, to show differences. Despite the fact that the originally planned outcomes were similar among the groups, much emphasis is given to post hoc intermediate outcomes, for which study is neither designed, nor they are much relevant in isolation and are subjected to bias as well as type I error.This is an open-label, industry-funded trial and is prone to biases. The secondary outcomes including feeding intolerance, abdominal distension, vomiting, and gastric residuals are subjective and are likely to be biased; hence, clear stringent objective definitions should have been stated a priori and more important clinical outcomes like necrotizing enterocolitis should have been compared. Also, the report of zero episodes of vomiting in the nonacidified group is unusual.On careful analysis, all biochemical parameters were within the normal range in both groups. Comparison of continuous variables using statistical tests, although within a normal range is not justified. A difference of 1-2 meq/L in sodium levels may be statistically significant, nevertheless is clinically irrelevant; provided both are within normal range.The supporting data for significantly more cases of metabolic acidosis in acidified-liquid human milk fortifier was not shown. Bicarbonate in both groups was within normal range. Again, post hoc analysis showing merely weak correlation between intermediate weight gain and base excess was overemphasized.The best strategy for such a study is a blinded trial using similar looking unlabeled formulations.