Multisystem inflammatory syndrome in children (MIS-C) is a newly recognized disease process that can complicate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We present what we believe to be the earliest case of MIS-C, occurring in February 2020. Our patient’s SARS-CoV-2 infection was caused by an emerging lineage with the D614G variant in the spike protein. This lineage would subsequently become the predominant cause of SARS-CoV-2 outbreaks in Europe and the United States where MIS-C was first described.
BackgroundConflict in paediatric healthcare is becoming increasingly prevalent, in particular relation to paediatric end of life. This is damaging to patients, families, professionals and healthcare resources. Current research has begun to explore perspectives of healthcare professionals (HCPs), but the parental views on conflict are lacking.ObjectivesThis scoping review explores parental views on conflict during a child’s end of life. In addition, parental views are mapped onto HCPs’ views.MethodsA search was completed of the databases CINAHL, PubMed, Web of Science, Embase and Medline between 1997 and 2019, focused on parents of children with involvement with palliative or end-of-life care referring to conflict or disagreements.ResultsThe review found 10 papers that included parental views on conflict. Data on conflict were categorised into the following seven themes: communication breakdown, trust, suffering, different understanding of ‘best interest’, disagreements over treatment, spirituality and types of decision-making. In particular, parental expertise, perspectives on suffering and ways of making decisions were significant themes. A subset of themes mirror those of HCPs. However, parents identified views of conflict unique to their perspective.ConclusionsParents identified important themes, in particular their perspective of what constitutes suffering and ‘best interest’. In addition, parents highlight the importance of being recognised as an expert.
An handsheet study was performed to compare the application of unmodified pearl corn starch and cationic tapioca starch on 100% recycled paperboard. To analyze the benefits tensile index, Canadian Standard Freeness, and starch retention was measured. The results found that cationic tapioca starch had the highest tensile index at 61.36 N*m/g for a dosage rate of 16 lbs./ton at a comparable dosage for unmodified pearl corn starch at 48 lbs./ton the tensile index was 56.11 N*m/g. Tests of the Canadian Standard Freeness showed that the unmodified pearl corn starch had the lowest freeness at 34.3 ml. The cationic tapioca starch had a freeness of 53.5 ml. For starch retention, more starch was retained in the sheet with cationic tapioca starch, with only 0.0065 grams ending up in the filtrate, compared to 0.015 grams of filtrate for the sheet containing unmodified pearl corn starch.
Background
Isolation of Candida from the respiratory tract of patients with cystic fibrosis (CF) is common, but its clinical significance remains unclear. We evaluated whether pediatric Candida colonization is associated with specific risk factors, co-pathogens, and degree of respiratory disease.
Methods
Using the Military Healthcare System database, we identified 273 pediatric patients with CF who were followed for 938 person-years between 2012 and 2017. To determine whether prevalence was associated with different categorical variables, Fisher’s exact tests were performed on 1000 random samples with the constraint that exactly one interval was selected from each individual to generate each sample. When appropriate, follow-up binomial tests were performed to identify species differences. Individuals with a specific Candida species isolated in ≥50% of their respiratory cultures were considered colonized. Those with C. albicans were analyzed separately from all other Candida species. FEV1 values < 80% predicted were used as a surrogate for degree of respiratory disease.
Results
Candida colonization was not associated with degree of respiratory disease, exocrine pancreatic insufficiency, co-existing diabetes, or the presence of a homozygous F508del CFTR mutation. C. albicans colonization differed by age, and was least prevalent amongst 0-2 year olds (p=0.031) (Fig 1). Compared to those either not colonized with Candida, or colonized with a species other than C. albicans, patients colonized with C. albicans had lower rates of co-infection with Aspergillus (p = 0.041) (Fig 2). Significant differences in Candida colonization between groups was also notable for those colonized with Stenotrophomonas (p=0.014) and Nontuberculous Mycobacterium (p < 0.01), but not for Staphylococcus aureus or Pseudomonas (all p > 0.1).
Figure 1. C. albicans prevalence differed by age group (p<0.01). Specifically, prevalence was lower in the 0-2 year old age group (p=0.031).
Figure 2. Individuals were grouped into those without a Candida infection (None), those with non-C. albicans colonization (Other), and those with C. albicans colonization. No differences were found with respect to co-infection with MRSA, MSSA, or Pseudomonas. Significant differences were found with respect to Stenotrophomonas (p=0.014), Aspergillus (p < 0.01), and NTM (p < 0.01). The prevalence of Aspergillus in those individuals with C. albicans was lower compared to those with a different Candida infection or no Candida infection (p=0.041). The prevalence of co-infection with Stenotrophomonas was somewhat elevated among those with a non-C. albicans infection (p=0.052).
Conclusion
C. albicans likely plays a role in influencing the airway microbiome of patients with CF. The significance of colonization with other Candida species warrants further exploration. Our data suggests that further studies are needed to evaluate whether Candida may be seen as protective against certain pathogens and therefore this may influence recommendations to treat patients who have CF with antifungals.
Disclosures
All Authors: No reported disclosures
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