Community-Acquired Pneumonia Requiring Hospitalization among French Guianese Children

Community-acquired pneumonia remains a leading cause of hospitalizations among children worldwide. The diagnosis is based on the history, the physical examination results in children with fever plus respiratory signs and symptoms, and chest radiography. The microbiological etiology is confirmed by viral testing and hemocultures. The most likely etiology depends on the age of the child. The features of childhood pneumonia vary between countries and territories. The purpose of this study was to describe the epidemiological characteristics and current microbial ecology of community-acquired pneumonia in children in French Guiana. We performed a retrospective, descriptive, and monocentric study between January 1, 2015, and December 31, 2017, in the pediatric ward of the Cayenne Hospital in French Guiana. The studied population was aged from 0 to 15 years and 3 months and hospitalized for acute community-acquired pneumonia. A total of 415 patients (mean age 3.62 years) were included. A pathogen was identifiable in 22.4% of cases, including bacteria in 61.3%, viruses in 43%, and coinfections in 14%. The main pathogens were respiratory syncytial virus (31.2%), Streptococcus pneumoniae (20.4%), Haemophilus influenzae (11.8%), and Mycoplasma pneumoniae (10.8%). The burden of hospitalization for children with community-acquired pneumonia was highest among less than 2 years, in whom respiratory viruses were the most commonly detected causes of pneumonia. The share of vaccine-preventable diseases (S. pneumoniae, H. influenzae, and influenza) remains high. With the vaccination requirement imposed since 1 January 2018 against pneumococcus, Haemophilus influenzae, and whooping cough and the possibility of practicing multiplex PCR in our hospital, it will be interesting to study the impact of this law enforcement on new child generations and compare these new data to our study.

Effectiveness of Chest Physiotherapy on Cardio-Respiratory Signs & Symptoms in COVID-19 Positive Patients

Introduction: Covid-19 is considered as world pandemic disease in which patient suffers from several respiratory impairments along with weakness which affects overall body functions, thus aim of this review is to highlight role of chest physiotherapy in improving respiratory signs/symptoms of Covid-19 positive patients. Method: The interventional study, convenient sampling with sample size of 41 subjects. Subjects of 35-80 years both male and female diagnosed with covid-19 positive were included in study. The exclusion criteria were any recent fracture, any medically diagnosed mental illness, neurological disorders and post covid-19 patients. The subjects are assessed of respiratory signs and symptoms like vital-signs, cough, dyspnea by American thoracic society grading of breathlessness, 1 minute sit to stand test, external oxygen supplement on the 1st day and again on 14th day physiotherapy administration for data analysis. The symptomatic chest physiotherapy was administered to each patient from day of reference until the discharge, 2 times in a day and 7 days/week. Results: There was decrease in mean ATS dyspnea scoring, respiratory rate, cough and oxygen supplement and increase in mean 1 minute sit to stand repetition, oxygen saturation (spo2) from 1st day to 14th day of physiotherapy treatment which is statistically significant comparing within groups. There was no significant difference noted in pre and post heart rate values comparing within groups. Conclusion: The study concluded that chest physiotherapy proved to be effective in improving the respiratory signs and symptoms and overall health of covid-19 positive patients. Key words: Covid-19 positive, chest physiotherapy, cough, dyspnea, oxygen supplement.

Pulmonary Manifestations and Management of COVID-19 Pediatric Patients Admitted in a Tertiary Government Hospital

Background. Coronavirus Disease 2019 (COVID-19) presents with respiratory signs and symptoms in children. Presently, there are no local studies on the pulmonary manifestations and management of COVID-19 among children. Objective. Our study aimed to identify and describe the presenting respiratory signs and symptoms, oxygenation status, radiologic findings, blood gas analysis, and pulmonary interventions among children admitted for COVID-19. We also analyzed the clinical and radiologic variables associated with mortality. Methodology. This is a retrospective study using data obtained from a review of medical records from April 1, 2020, to June 30, 2020, at a tertiary government institution in the Philippines. All pediatric patients (0-18 years) hospitalized for probable or confirmed COVID-19 during the said time period were included in this study. Univariate and multivariate logistic regression was applied to determine factors affecting mortality. Results. A total of 25 pediatric patients with a mean age of 7 years old (age range: 11 days to 18 years) were admitted for COVID-19. Cough (44%) and dyspnea (24%) were the most common presenting respiratory symptoms, while tachypnea (68%), crackles (36%), and peripheral oxygen desaturation (36%) were the most common respiratory signs. Indeterminate findings for COVID-19 such as multifocal or diffuse ground-glass opacities and/or consolidations were the most common radiographic abnormalities. Invasive ventilatory support was administered to 6 cases of severe COVID-19 and 4 critical cases. There were no variables that correlated significantly with mortality. Conclusion. Respiratory signs and symptoms were prominent in our cohort of children admitted due to COVID-19. Mechanical ventilation was required in more severe cases. Larger prospective studies may help identify variables that significantly correlate with poor outcomes among children with COVID-19.

Guillain-Barré syndrome: a rare association of COVID-19 pneumonia at presentation

COVID-19 is a global pandemic which has varied array of symptoms. A neurotropic presentation has also been described of which the most common is stroke. In this brief communication we report a case of COVID-19 who presented to our hospital with features suggestive of Guillain-Barré syndrome. A 76 year old male presented with chief complains of weakness in both lower limbs. On detailed examination the patient had LMN type quadriparesis without sensory involvement. Diagnosis of GBS was confirmed by CSF and NCV studies and other cases of quadriparesis were ruled out by appropriate investigations and treatment of the same was started. Respiratory examination revealed bilateral basal crepitations and CXR revealed B/L lower zone haziness so a secondary diagnosis of B/L Atypical Pneumonitis suspected COVID-19 was kept. A COVID-19 RTPCR turned out to be negative initially. However, looking at respiratory signs and symptoms along with increase in inflammatory markers a repeat COVID RTPCR was planned which turned out to be positive. Patient was further managed on the line of COVID-19 pneumonitis. He responded well to the treatment and is now asymptomatic on follow up. Nervous system involvement in COVID-19 may have been grossly underestimated. Over the course of this pandemic, an increasing number of COVID-19 patients are being reported with neurological complications. Physicians should be aware of atypical presentation where patient complained of weakness first and had respiratory symptoms later as in our case where early detection of atypical presentations help in better management.

Follow-up care for premature children: the repercussions of the COVID-19 pandemic

Objective: to analyze elements of the follow-up care provided to premature children amidst the COVID-19 pandemic. Method: qualitative study from the perspective of philosophical hermeneutics, interpreting experiences with childcare provided at home. Twelve mothers and 14 children aged two years old were interviewed online via a text messaging application. Data were analyzed by interpreting meanings. Results: weaknesses stood out in the follow-up care provided to children such as gaps of communication, lack of guidance and delayed immunizations, while care intended to meet health demands was interrupted. Vulnerability aspects affecting child development included: social isolation measures that impeded the children from socializing with their peers, increased screen time, the manifestation of demanding behaviors and irritation and the mothers experiencing an overload of responsibilities. The elements that strengthened maternal care included the mothers being attentive to contagion, enjoying greater experience and satisfaction with the maternal role, spending more time with their children, and recognizing respiratory signs and symptoms, especially fever. Conclusion: follow-up care provided to children in stressful situations implies implementing practices that support the wellbeing of children and families, decreasing the likelihood of children being exposed to development deficits, and detecting signs and symptoms timely. The use of nursing call centers can break the invisibility of longitudinal needs and promote health education actions at home.

Factors associated with death among postpartum women with COVID-19: a Brazilian population-based study

Objective: to identify the factors associated with death due to COVID-19 among Brazilian postpartum women in the first five months of the pandemic and five subsequent months, and describe the sociodemographic and clinical characteristics of postpartum women who developed the disease. Method: cross-sectional population-based study using a secondary database available in the Sistema de Informação de Vigilância Epidemiológica da Gripe -SIVEP-Gripe (Influenza Epidemiological Surveillance Information System), Brazilian Ministry of Health. A total of 869 postpartum women were included, and the analysis considered the first five months of the pandemic and subsequent five months. Association between the variables of interest and outcome (death due to COVID-19/cure) was investigated using logistic regression. Results: most participants were aged between 20 and 34, of mixed race or Caucasian, and lived in the urban/peri-urban area. The proportion of deaths was 20.2% in the first period and 11.2% in the second. The likelihood of death increased in both periods due to the presence of respiratory signs and symptoms: dyspnea, respiratory distress, and oxygen saturation below 95%, in addition to the need for ventilatory support and intensive care. Conclusion: the proportion of deaths among postpartum women was high and decreased in the second period under study. Respiratory signs and symptoms, mechanical ventilation, and intensive care were associated with death in both periods.

Upper and Lower Respiratory Signs and Symptoms in Workers Occupationally Exposed to Flour Dust

A group of 142 bakers was studied in order to investigate the relationship between higher/lower respiratory signs/symptoms and inflammation biomarkers and occupational exposure to flour dust. A complete upper and lower respiratory tract evaluation was performed. Seven percent of bakers complained of lower respiratory symptoms, while 22% of them complained of upper respiratory symptoms. Fifty five percent of the bakers were allergic, and 37.1% showed sensitization to occupational allergens. Abnormal spirometries were found in 15% of bakers, while fractional exhaled nitric oxide (FeNO) was above the normal reference in 24.5% of them. Moreover, 23.8% of bakers were found to be hyposmic. Population mean peak nasal inspiratory flow (PNIF) was in the normal range even if almost all the workers suffered from neutrophilic rhinitis at nasal cytology with the number of nasal neutrophils increasing with the increase of the duration of exposure to flour dust (p = 0.03). PNIF and FEV1 (forced expiratory volume in the 1st second) showed a positive correlation (p = 0.03; r = 0.19). The Tiffeneau index decreased with the increase of dust (p = 0.017). A similar result was obtained once we divided our population into smokers and non-smokers (p = 0.021). Long-term exposure to bakery dusts can lead to a status of minimal nasal inflammation and allergy.

Potential involvement of monoamine oxidase activity in SARS-COV2 infection and delirium onset

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a range of extra-respiratory signs and symptoms. One such manifestation is delirium, an acute confusional state occurring in 60-70% of severe SARS-CoV-2 cases. Delirium is also a common clinical syndrome following planned orthopedic surgery. This investigation initially explored the underlying role of metabolism in delirium-susceptibility in this setting. Metabolomics profiles of cerebrospinal fluid (CSF) and blood taken prior to surgery found significant concentration differences of several amino acids, acylcarnitines and polyamines were observed in delirium-prone patients. Phenethylamine (PEA) concentrations in delirium-prone patients was significantly lower in CSF than in blood, whilst in age- and gender-matched controls the opposite was observed (adjusted p values: 1.8×10−6 (control) and 1.788×10−10 (delirium)). PEA is metabolised by monoamine oxidase B (MAOB), a putative enzyme target for the treatment of Alzheimer’s disease, Parkinson’s disease and depression. Our computational structural comparisons of MAOB and angiotensin converting enzyme (ACE) 2 found high similarity, specifically within the SARS-CoV-2 spike protein. MAOB structural alignment to ACE2 was 51% overall, but this was over 95% in the ACE2-spike protein binding region. Thus, it is possible that the spike protein interacts with MAOB on a molecular level. A previously published metabolomic dataset of control subjects and patients with either mild or severe COVID-19 was then analysed. Major concentration differences in some metabolites attributed to altered MAO activity were detected. Therefore, our hypothesis is that the SARS-CoV-2 influences MAOB activity, which is one potential cause for the many observed neurological and platelet based complications of SARS-CoV-2 infection. Further research is required to establish what effect MAOB inhibitors might have on these pathways. There is no evidence at present to support the withholding of MAOB inhibitors.Significance StatementSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a range of extra-respiratory signs and symptoms including delirium, anosmia, intravascular coagulation. Analysis of metabolomics differences in delirium-prone patients and in severe cases of SARS-CoV2 infection indicate possibly significant role for monoamine oxidase B (MAOB). Changes in activity of MAOB have been shown in other conditions to cause range of symptoms observed in SARS-CoV2 infection. Computational structural analysis presented here demonstrations significant similarity between MAOB and ACE2 protein binding region leading to a hypothesis that SARS-CoV-2 spike protein affects MAOB activity during the infection. This proposition is possibly of significance for both diagnosis of high-risk subjects prior to infection as well as novel avenues for the development of treatment and prevention.

Hemophagocytic syndrome in patients infected with the human immunodeficiency virus: A study of 15 consecutive patients

Objectives. Hemophagocytic syndrome (HPS) is characterized by various clinical and biological data derived from cytokine hyperproduction and cell proliferation. The objectives of this study were to evaluate the epidemiological, etiological, clinical and evolutionary characteristics of patients diagnosed with hemophagocytic syndrome and HIV infection, as well as their comparison with data from the literature. Methods. A retrospective descriptive observational study was performed, including all adult patients with a diagnosis of HPS and HIV infection treated in the Infectious Diseases and Tropical Medicine Unit of the Hospital Universitario Insular, Las Palmas, Gran Canaria from June 1, 1998 to December 31, 2018. Results. An analysis of this series of case reports of 15 patients showed a higher percentage of males than females, with a mean age of 42 years. With respect to the diagnostic criteria for HPS, presence of fever, cytopenias and hyperferritinemia were a constant in all patients. Clinical neurological manifestations were frequent and clinical respiratory signs and symptoms absent. HPS was confirmed in some patients who were not severely immune-depressed and had undetectable viral loads. Furthermore, 40% of cases were not receiving ART. The most frequent triggering causes of HPS were viral, especially HHV-8. In addition, two new HPS triggers were identified: Blastocystis dermatitidis and Mycobacterium chelonae. Conclusion. Administration of treatment in HPS is arbitrary. This, together with the high mortality rate and the fact that it is underdiagnosed, indicates the importance of conducting future studies.