Objective
To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and/or intravenous immunoglobulin (IVIG).
Method
This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks.
Results
Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5–9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (
P
=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group.
Conclusion
In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.
Objectives
To compare the clinical profile and short-term outcome of children admitted with acute SARS-CoV-2 infection during the first and second waves of the Coronavirus Disease (COVID-19).
Methods
This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confirmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay.
Results
One thousand and twenty-four children were recruited, 592 of the first wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR = 3.38) and neurological manifestations (OR = 4.61). There was a higher requirement of intensive care (OR = 4.2) and invasive mechanical ventilation (OR = 4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the difference was not statistically significant. Children with neurological comorbidities (OR = 8.73), malnutrition (OR = 3.01), and preterm babies (OR = 6.8) were associated with severe COVID.
Conclusion
The clinical profile of the second wave of COVID-19 in children was different from the first wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a significant increase in the incidence of severe infections requiring ICU care was observed.
Objectives: To study the clinical profile and electrocardiographic (ECG) changes in rodenticide poisoning in children. Methods: Patients admitted with a history of ingestion of rat poison between October 2014 and October 2016 were included in the study. Clinical history was taken in detail, and stomach wash samples were sent for toxicological analysis. Continuous ECG monitoring was done in all cases. Investigations to assess organ functions and coagulation profile were done at admission and repeated as indicated. Results: There were 17 cases of rodenticide poisoning. Zinc phosphide was the rodenticide identified in 50% of cases, bromodiolone in 30%, and yellow phosphorous in 20% cases. Only 23% presented within 1 h of ingestion and only 12% received stomach wash from referring hospital. Out of the 17 cases, 12 cases (70%) were symptomatic, of which 42% hadminor symptoms such as vomiting and abdominal pain and 58% had major symptoms including dysrhythmias, shock, coagulation abnormality, hepatic failure, and seizures. ECG changes were observed in 7 cases (42%), and coagulopathy was seen in 2 (12%) cases of which one had hepatic failure. The mean time of onset of ECG changes was 19.7 h (range 9-36 h). The overall mortality rate was 17.6%. Cardiac arrhythmia was the most common cause of death (66%). Conclusion: Zinc phosphide has been detected as the most common chemical being used as domestic rodenticide. Transient rate abnormalities, metabolic acidosis, fever, and leukocytosis are early markers of toxicity and they should be looked for in all cases. General public, medical, and aramedicalpersonnel should be made aware of the toxic nature of rodenticides.
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