Multisystem Inflammatory Syndrome in Children (MIS-C), a rare condition, has been reported approximately 2-4 weeks after the onset of COVID-19 in children and adolescents, causing inflammation in multiple systems, including cardiovascular and respiratory, digestive, and central nervous systems. This condition is also known as hyperinflammatory shock, Kawasaki-like disease, and Pediatric Inflammatory Multisystem Syndrome (PIMS). The signs and symptoms include but are not limited to fever, rash, peripheral edema, gastrointestinal symptoms, conjunctivitis, and shock. Thirty-eight studies met our criteria, with a total of 5822 patients. The most affected population was between 5-18 years of age. We noted that MIS-C presented with a wide range of signs and symptoms that overlap with Kawasaki Disease, including high fever, sore throat, malaise, tachypnea, tachycardia, conjunctival injection, mucosal edema, cardiac involvement, and gastrointestinal symptoms. It causes an increase SUMMARY in IL-17A, IL-6, and arterial damage, a distinct difference from Kawasaki disease. The laboratory findings in MIS-C showed an increase in inflammatory markers like CRP, ESR, ferritin, leukocytes, and TNF-α. WHO stated that 23% of affected children with MIS-C had underlying conditions like chronic lung diseases, cardiovascular disease, and immunosuppression. In most affected children, aspirin and IVIG were successful, which resulted in a decrease in the inflammatory markers. We find that MIS-C is a rare, but potentially fatal pediatric complication, after COVID-19 infection. The aim of this article is to study the emerging relationship between COVID-19 and MIS-C in children and adolescents affected by this condition, to discuss the immunological mechanisms, and explore potential therapies.
Introduction: Headache disorders have been linked with enhanced atherosclerosis, cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, and cervical artery dissection. We aimed to evaluate the risk of cardiovascular and cerebrovascular disorders amongst patients with status migrainosus and migraine with aura. Methods: We planned a cross-sectional observational study from nationwide inpatient data from 2016-2018. Patients with status migrainosus with intractable migraine, migraine with aura, migraine without aura (simple migraine) were identified and compared with population without no migraine (control) using ICD-10-CM codes. Chi-square test) and mix-effect multivariate survey logistic regression analysis adjusted for vascular events were performed to identify prevalence and risk of association between cerebrovascular and cardiovascular disorders and migraine. Results: We identified 1184130 migraineurs out of which 60140 had status migrainosus with intractable migraine, 45285 had migraine with aura, and 16860 had migraine without aura. Prevalence of identified acute ischemic stroke (AIS) (5.5% vs no-migraine: 1.71%), transient ischemic attack (TIA) (3.99% vs 0.38%), subarachnoid hemorrhage (SAH) (0.13% vs 0.08%), angina (0.07% vs 0.06%) was higher in patients with migraine with aura compared to non-migraineurs. (p<0.0001) In regression analysis, migraine with aura was associated with higher odds of AIS (aOR: 3.7, 95%CI 3.4-4.1) and TIA (11.8, 10.5-13.2). In risk adjusted effect modification analysis, patients with AIS (1.5, 1.2-1.9) and TIA (3.0, 2.1-4.3) had higher odds of severe and extreme disability (APR DRG Severity) in patients with migraine with aura compared to patients with intractable migraine. Conclusion: We found that the patients with migraine with aura had higher risk of stroke than patients with intractable or simple migraine. More prospective studies should be planned to evaluate the effect of long-term management of migraine with aura to mitigate the burden of cerebrovascular events and associated disability. Further studies should be directed towards identifying the relationship between migraine and cardiovascular disorders.
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