A retrospective review of severe acute respiratory syndrome-coronavirus-2 infection in children with acute leukemia-from a tertiary hospital in Northern India Running Title: SARS-CoV2 infection in children with acute leukemia from Northern India To the Editor, Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is thought to cause milder infections in children; however various risk groups for severe coronavirus disease (COVID-19) have been identified. Few reports have highlighted poorer outcomes in children with Cancer. 1]Hematological malignancies have been found to have increased mortality by 37%. 2] The highest risk of COVID-19 infection has been noted with acute lymphoblastic leukemia (ALL), at a higher risk of viral and fungal infections. However, reported data is scarce in the literature. 3] Identifying the differences with which SARS CoV2 behaves in an immunocompromised patient would assist in prognostication and resource allocation for this vulnerable section. The present retrospective study assessed the demographic and clinical characteristics and outcomes of children admitted with acute leukemia at our tertiary care referral center in Northern India with COVID 19 infection. Chart review of children aged 12 years or younger, with an underlying diagnosis of acute leukemia, admitted for acute COVID-19 care between October 1, 2020, and March 31, 2021was done. All children were positive for SARS-CoV-2 by real-time reverse transcription-polymerase chain reaction (RT-PCR) from the combined nasopharyngeal and oropharyngeal swab. The severity of COVID-19 was categorized as mild, moderate, severe, and critical based on the latest operational guidelines . 4] Children who quickly progressed to acute respiratory distress syndrome or respiratory failure and had life-threatening organ dysfunction including shock, encephalopathy, myocardial injury or heart failure, coagulation dysfunction, and acute kidney injury were classified as having a critical illness. Baseline laboratory parameters were recorded. Information regarding demographic and clinical details, including age, sex, leukemia treatment, clinical features, and laboratory investigations, were A c c e p t e d A r t i c l e Key message Question: What are the demographic, clinical characteristics, and outcome of SARS-CoV2 in children undergoing chemotherapy with acute leukemia? Finding: Mild clinical illness was predominant, fever being the most common. Raised inflammatory markers were noted irrespective of severity. Severe and critical illnesses were infrequently observed. All patients recovered well except 2, who died. Meaning: Children with acute leukemia on chemotherapy infected with SARS-CoV2 do not have adverse outcomes. Footnotes Conflicts of interestNo potential conflict of interest relevant to this article was reported. Ethics statementThe institutional ethics committee approved the study. Ethics clearance was obtained (IEC /VMMC/SSJH/Project/ 2021-05/CC-143).

IntroductionSevere acute respiratory syndrome Coronavirus 2 (SARS-CoV 2) is a novel coronavirus that caused an outbreak since 31 December 2019. Although the most commonly noted symptoms were fever and respiratory illness, a wide variety of other symptoms have also been seen. There has been increasing number of cases of neurological manifestations of Covid –19. Further, there has been growing association between Covid-19 and Guillain Barre Syndrome (GBS).Case presentationIn this report, we present two cases of acute lymphoblastic leukemia affected by Covid-19 who after recovery from Covid-19 developed symptoms of GBS. They presented with complaints of bilaterally symmetrical ascending motor paralysis and were diagnosed with Guillain Barre Syndrome by electrophysiological tests and were started on intravenous immunoglobins for five days @ 0.4mg/kg/day after which the condition of both children gradually improved.ConclusionThis case report adds to the emerging evidence that suggests the association of GBS post Covid infections. COVID-19 can result in several autoimmune neurological phenomena including GBS. In the setting of the pandemic, COVID-19 as an underlying trigger should be considered in all immunologic phenomena. This applies to all patients, including children.

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The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has created havoc in adults and children. Immunocompromised children are considered a high-risk group for the extreme manifestation of coronavirus disease 2019 (COVID-19) infection. There are conflicting reports on the outcome of SARS-CoV-2 disease in immunocompromised children. We aimed to find the difference in clinical outcomes of COVID-19 infection between immunocompetent and immunocompromised children. This includes a retrospective chart review of children admitted with COVID-19 infection in a tertiary care pediatric hospital in Northern India from March 1, 2021, to May 31, 2021. There were 35 COVID-19-positive children aged 1 to 12 years admitted during the study period. The study participants were divided into two groups: immunocompetent and immunocompromised patients. The clinical features, laboratory parameters, treatment needs, and outcomes in both groups were compared. Among 35 patients enrolled, 17 were immunocompromised and 18 were immunocompetent. The median duration of hospital stay, clinical features, laboratory parameters, severity of illness, treatment needs, and outcomes were comparable between the two groups. Immunocompromised children are not at a higher risk of severe COVID-19 manifestation compared to immunocompetent children.

Delta beta thalassemia is an unusual variant of thalassemia with elevated level of fetal hemoglobin (HbF). Unlike beta thalassemia, delta beta thalassemia heterozygotes have milder phenotype and homozygotes present as thalassemia intermedia phenotype.  We report a 11-month-old male child who presented with severe anemia, and hepatosplenomegaly, thalassemia major phenotype. On evaluation was diagnosed as compound heterozygous for δβ0/β thalassemia with IVS 1-5 (G>C) mutation. This case highlights the importance of genotyping of patients with δβ thalassemia and co-inheritance of δβ thalassemia deletion with point mutation for β-thalassemia results in severe clinical phenotype as thalassemia major.