Background Despite the streaks of severity, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection is, in general, less frequent and severe in children than in adults. We searched for causal evidence of this mystery. Data sources An extensive search strategy was designed to identify papers on coronavirus disease 2019 (COVID-19). We searched Ovid MEDLINE, PubMed, EMBASE databases, and Cochrane library and carried out a review on the causes of this dilemma. Results Our searches produced 81 relevant articles. The review showed that children accounted for a lower percentage of reported cases, and they also experienced less severe illness courses. Some potential explanations, including the tendency to engage the upper airway, the different expression in both receptors of angiotensin-converting enzyme and renin-angiotensin system, a less vigorous immune response, the lower levels of interleukin (IL)-6, IL-10, myeloperoxidase, and P-selectin and a higher intracellular adhesion molecule-1, a potential protective role of lymphocytes, and also lung infiltrations might have protective roles in the immune system-respiratory tract interactions. Finally, what have shed light on this under representation comes from two studies that revealed high-titer immunoglobulin-G antibodies against respiratory syncytial virus and mycoplasma pneumonia, may carry out cross-protection against SARS-CoV-2 infection, just like what suggested about the vaccines. Conclusions These results require an in-depth look. Properties of the immune system including a less vigorous adaptive system beside a preliminary potent innate response and a trained immunity alongside a healthier respiratory system, and their interactions, might protect children against SARS-CoV-2 infection. However, further studies are needed to explore other possible causes of this enigma.
Background Although, preliminary reports of Severe Acute Respiratory Syndrome (SARS)-CoV-2 infection suggest that the infection causes a less severe illness in children, there is now growing evidence of other rare or even serious complications of disease. Case presentation During the recent COVID-19 pandemic in Kerman, Iran, two children (an 8 year-old boy and a 6 year-old girl) were referred to outpatient Clinic of Pediatric Rheumatology with complaints of limping. Both children had experienced fever and mild respiratory tract infection. At the beginning of the second week of infection, they developed joint effusion. They both tested positive for coronavirus infection and were therefore diagnosed with post Coronavirus reactive arthritis. Both children were treated successfully with rest and Non-Steroidal Anti-Inflammatory Drugs (NSAID). They did not have any medical problems in the two months fallow up. Conclusions These two cases suggest that COVID-19 may be rheumatogenic. Highlighting the need for awareness of physicians, especially pediatricians, regarding the pathogenesis margins of this virus, as late presentations are of great importance.
Background: Identification of the etiology of acute limping in children is challenging. Both benign and life- threatening disorders can present with limp. However, among atraumatic conditions, benign conditions including toxic synovitis and post infectious arthritis are the most common causes of this dilemma. Case Presentation: During the recent COVID-19 pandemic in Kerman, South East of Iran; two pediatric patients referred to the Rheumatology clinic with new onset gait disturbance. One 8 years old boy and the other 6 years old girl who presented with hip joint pain and limping. Both of them had joint effusion jackknife of mild respiratory symptoms and fever. Altogether, precise history taking and accurate physical examination, alongside radiological investigations and positive laboratory results for coronavirus infection emphasized the diagnosis of post Coronavirus arthritis. They treated with rest and Non-Steroidal Anti-Inflammatory Drugs (NSAID) successfully, and fallowed at least for one month later.Conclusions: Here, we described the first report of post n-CoV-2 arthritis in the world in two Iranian pediatric patients, who presented with limp. Contrary to preliminary phantasms, this may indicate that the Corona virus has some rheumatogenic specifications.
Background: The effective responses of both innate and adaptive immunity are crucial in combating Novel-Coronavirus-2 infection. An excessive response may lead to cytokine storm, which is a challenging problem in therapeutic strategies. Methods: A systematic review was carried out by searching OVID MEDLINE, PUBMED, Google Scholar, and Cochrane library databases from inception until August 2, 2020, for anti-inflammatory and immunomodulatory drugs against coronavirus disease 2019 (COVID-19). Results: The results of the effectiveness of Hydroxychloroquine are just like a sinusoidal diagram and in a state of ambiguity. Thalidomide was effective in some cases but has not yet been proven. Low-dose Corticosteroids may be effective in the early stages of the illness as a bridge. There is no evidence of benefits or adverse outcomes for the use of non-steroidal anti-inflammatory drugs and Cyclosporine-A. In some critically ill patients, Interleukin-6 (IL-6) and IL-1 blockers and to some extent Tumor-Necrosis-Factor-α and Janus-Kinase inhibitors are useful. Finally, high-dose intravenous immunoglobulin reversed the deterioration of patients in most trials. Conclusion: One strategy behind the treatments for COVID-19 is based on breaking the cytokine storm. Although avoiding the suppression of anti-viral immunity is crucial by choosing the weaker and more selective anti-inflammatories, some strategies are kept for hyper-inflammatory situations. Scheduling of treatment is also important. Although low-dose steroids may be effective in the early stages of the illness, "Tocilizumab" is more effective in severe situations, when the IL-6 level is high and other drugs are ineffective. Therefore, consideration should be given to each patient separately.
In Covid-19 pandemic, specific comorbidities are associated with the increased risk of worse outcomes and increased severity of lung injury and mortality. the aim of this study was to investigate the effects of antihypertensive medications on the severity and outcomes of hypertensive patients with COVID-19. This retrospective observational study conducted on patients with COVID-19 who referred to Afzalipour Hospital, Kerman, Iran during the six months from 19 February 2020 to 20 July 2020. The data were collected through medical chart reviews. We assessed 265 patients with Covid-19 and they stratified based on hypertension and type of antihypertension medications. The data were described and Student’s t -test, Mann–Whitney U and Fisher exact test were run to compare the patients ‘demographical and clinical information. The qualitative variables were compared using the by SPSS software version 23. The results of the present study showed that hypertension was a prevalent comorbidity among patients with COVID-19 and hypertensive patients compared to other patients without any comorbidity who were older ( P -value: 0.03). The oxygen saturation was higher for the patients in the control group than hypertensive patients ( P -value: 0.01). The severity of COVID-19 and its outcome were not different between the patients who took or did not take antihypertensive medications and also the type of antihypertensive medications. Hypertensive patients did not show any significant difference in survival, hospital stay, ICU admission, disease severity, and invasive medical ventilation in other normotensive patients with COVID-19.
Aim: SARS-COV-2 infections are causing substantial morbidity and mortality, especially due to "exuberant cytokine storm". In this study we review effectiveness of anti-inflammatory and immunomodulatory drugs in this situation. Methods: Ovid MEDLINE, PUBMED, Google Scholar and Cochrane library searched for anti-inflammatory and immunomodulatory drugs against COVID-19 including: Anti malaria agents, non-steroidal anti-inflammatory drugs, steroids, cyclosporine, thalidomide, IVIG, interlukin-6 blockade, IL-1 blockade, tumor necrosis factor-α blockade, and Janus kinase inhibitors. Results: We included 95 studies. Unlike preliminary positive results, the effect of Chloroquine is questionable. Thalidomide has been shown to be effective in some studies but not be proved yet. Low dose Corticosteroids may be effective in the early phases of SARS-CoV-2 as a bridge. There is neither evidence of benefits or adverse outcomes for the use of NSAIDs, nor is there evidence indicating that target therapies (IL-1, TNFα and JAK inhibitors) and also cyclosporine are effective. In some cases and clinical trials, interlukin-6 blockade is useful in critically ill patients. Finally, the high dose IVIG reversed the deterioration of patients in most clinical trials. Conclusion: Unlike preliminary positive results, Hydroxychloroquine seems ineffective. Thalidomide is effective in some cases. Although, low dose CS may be effective in the early phases of illness, administration of NSAIDs and steroids is controversial. The effectiveness of more target therapies including IL-1, TNF-α, and JAK inhibitors, also cyclosporine is less clear. Tocilizumab can be used in severe situations, where other drugs are ineffective. IVIG can be used at least as a bridge therapy in deteriorating patients.
Background There is growing evidence of nervous system involvement and related complaints in children with coronavirus disease 2019 (COVID-19). However, it seems that attempts to track of the virus in the nervous system have so far been unsuccessful. Case presentation Here we describe two pediatric cases of severe COVID-19 who had positive cerebrospinal fluid (CSF) and nasopharyngeal polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2). A 36-month-old girl who presented with fever, diarrhea, mild left ventricular dysfunction and bizarre movements, and a five-month-old boy who presented with fever, watery diarrhea, severe dehydration, mottling, and two episodes of seizure. Their CSF analyses and cultures were normal. They admitted in intensive care unit (ICU) for near four days and discharged after ten days without any complaint. Conclusion This is one of the first reports of the presence of coronavirus in the central nervous system in COVID-19 pediatric patients, emphasizing the neurotropism and neuroinvasion characteristics of the virus.
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