Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center studyRunning title: Clinical and laboratory findings of pediatric COVID-19 versus influenza patients

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Introduction: Several studies suggest that chronic immunosuppressive treatment in pediatric liver transplant recipients may predispose to increased risk of acquiring SARS-CoV-19 infection, however, the severity of the infection and mortality rates remains unclear due to the lack of sufficient clinical data. Herein, we assessed the severity and clinical features following SARS-CoV-19 infection in our pediatric liver transplant recipient's cohort. Methods: We assessed total of 118 pediatric liver transplant recipients between 1-18 years of age who had been followed between 01 March 2019 to December 2021. Demographic data, clinical and laboratory features were obtained from electronic medical record as well as the state health record system. The information regarding the severity of the symptoms, duration of hospitalization, and outcomes of the infection were obtained by telephone inquiries. Patients with COVID-19 infection prior liver transplantation, unknown hospitalization status or unconfirmed SARS-CoV infection were excluded. The demographic, clinical and laboratory features of the patients were analysed descriptively. Results: A total of 16 out of 118 (13.5%) pediatric liver transplant recipients were diagnosed with COVID-19 infection. Eleven (68.8%) patients were male with a median age of 14.8 (interquartile range, 8-16) years. The main presenting symptoms were as follows; fever in 8 (50%), cough in 6 (37.5%), sore throat in 4 (25%), runny nose in 5 (31.3%), myalgia in 3 (18.8%), and abdominal pain in 2 (12.5%) patients. None of the patients exhibited respiratory failure, arthralgia, smell and taste loss, or diarrhea. Out of 16 COVID-19 patients, 6 (37.5%) had complete blood count, biochemistry tests and coagulation profile. Four of them exhibited leukopenia and mildly elevated C-reactive protein. One patient required computed tomography of thorax due to respiratory distress which revealed the ground-glass opacity and minimal pleural effusion. Only 3 out of 16 patients required hospitalization with a mean 2.67-days length of stay. Two out of 16 patients received favipiravir and two patients required antibiotics treatment due to suspected pneumonia. No SARS-CoV-19 infection associated intensive care admission or death were observed in our study. Nine out of 16 patients with SARS-CoV-19 were unvaccinated due to following reasons: 8 patients were younger than 12 years as vaccination is not recommended in this age group by the current guidelines of the Turkish ministry of health, and 1 patient was recently tested positive for COVID-19 infection. Rest seven out of 16 patients had two doses of COVID-19 vaccination. Conclusion: In this study, pediatric LT patients with SARS-CoV-19 infection showed a wide range of clinical presentations while the outcomes of the infection were generally mild.

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One of the biggest challenges in remote online college teaching of human physiology is the lab component. To overcome this challenge, we redesigned our pre‐COVID face‐to‐face physiology labs with the objective of preserving most of their learning outcomes. Towards this end, we applied the concept of treating labs as integrated instructional units (America's Lab Report, https://www.nap.edu/read/11311/chapter/5). Our approach was to replace student hands‐on lab protocol focus with an integrative lab approach that allows the students to not only record data from real‐time, video‐recorded experiments, but also to map them out on the corresponding anatomical architecture and mechanisms under investigation. The video recordings were performed by the instructor synchronously during the class session then posted for the students online as part of an expanded lab package that includes instrumentation and protocol details, experimental parameters and variables, relevant anatomical and physiological mechanistic footnotes, as well as expected lab report format and rubric. Using this approach, physiology labs originally designed separately to investigate principles and mechanisms of diffusion, neuronal reflexes, EMG, ECG, and hemodynamics were replaced with integrated labs designed to allow side‐by‐side comparisons and provide stimulating visual demonstrations of empirical work and relevant mechanistic and anatomical architecture. Two such lab examples are: (1) comparing speedsof: (a) food dye diffusion in solution based on real‐time measurements in a glass plate aligned with measuring scales, (b) action potential conduction based on mapped‐out neuronal pathway lengths and online measurement of relevant reaction time (https://faculty.washington.edu/chudler/java/redgreen.html), and (c) blood flow between the cardiac left ventricle and the site of pulse measurement in the finger based on vasculature anatomy and the time delay between the ECG's QRS electrical wave peak and onset of finger mechanical pulse wave, and (2) comparing time, amplitude, distribution, and discreteness of grip strength‐forearm EMG recording with that of the QRS and P‐wave of the ECG with emphasis on skeletal versus cardiac muscle electrophysiological mechanisms of action potential initiation and propagation as well as corresponding muscle mass as well as physiological mechanisms. Having successfully applied this new lab design in Fall 2020, more data is expected in Spring 2021 to be presented at the APS annual meeting in late April 2021.

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BackgroundLiterature supports the protective role of mineralocorticoid antagonist (MRA) against the renal injury induced by aldosterone in kidney transplant recipients. However, there is limited data available regarding the safety and efficacy of MRAs in pediatric renal transplant patients. Therefore, we aimed to investigate the effect of long‐term eplerenone administration in children with chronic allograft nephropathy (CAN).MethodsTwenty‐six renal transplant children with biopsy‐proven CAN, an estimated glomerular filtration rate (eGFR ) > 40 mL/min per 1.73 m2 and with a significant proteinuria were included. Selected patients were randomly divided into two groups as follows; Group 1 (n = 10) patients received 25 mg/day eplerenone and Group 2 (n = 16) patients did not receive eplerenone for 36 months. Patients were examined in the renal transplant outpatient clinic biweekly for the first month and once a month thereafter. The primary outcome of the patients was compared.ResultsMean eGFR stayed stable in group 1 patients, but significantly decreased in group 2 at 36 months (57.53 ± 7.53 vs. 44.94 ± 8.04 mL/min per 1.73 m2, p = .001). Similarly, spot protein–creatinine ratio was significantly lower in group 1 compared to group 2 patients at 36 months (1.02 ± 7.53 vs. 3.61 ± 0.53, p < .001). Eplerenone associated hyperkalemia was not observed in group 1 patients (4.6 ± 0.2 vs. 4.56 ± 0.3, p = .713).ConclusionThe long‐term eplerenone administration blunted the chronic allograft nephropathy by maintaining a stable eGFR levels and decreasing urine protein–creatinine ratio. Eplerenone associated hyperkalemia was not observed in our study.