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Chest CT features of children infected by B.1.617.2 (Delta) variant of COVID-19
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Qi-Rui Cheng, Ming-Xing Fan, Jing Hao, Xiao-Chen Hu, Xu-Hua Ge, Zhi-Liang Hu, Zhuo Li |
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Background: This study aimed to explore the imaging characteristics, diversity and changing trend in CT scans of pediatric patients infected with Delta-variant strain by studying imaging features of children infected with Delta and comparing the results to those of children with original COVID-19.
Methods: A retrospective, comparative analysis of initial chest CT manifestations between 63 pediatric patients infected with Delta variant in 2021 and 23 pediatric patients with COVID-19 in 2020 was conducted. Corresponding imaging features were analyzed. In addition, the changing trend in imaging features of COVID-19 Delta-variant cases were explored by evaluating the initial and follow-up CT scans.
Results: Among 63 children with Delta-variant COVID-19 in 2021, 34 (53.9%) showed positive chest CT presentation; and their CT score (1.10 ㊣ 1.41) was significantly lower than that in 2020 (2.56 ㊣ 3.5) (P = 0.0073). Lesion distribution: lung lesions of Delta cases appear mainly in the lower lungs on both sides. Most children had single lobe involvement (18 cases, 52.9%), 14 (41.2%) in the right lung alone, and 14 (41.2%) in both lungs. A majority of Delta cases displayed initially ground glass (23 cases, 67.6%) and nodular shadows (13 cases, 38.2%) in the first CT scan, with few extrapulmonary manifestations. The 34 children with abnormal chest CT for the first time have a total of 92 chest CT examinations. These children showed a statistically significant difference between the 0每3 day group and the 4每7 day group (P = 0.0392) and a significant difference between the 4每7 day group and the more than 8 days group (P = 0.0003). Conclusions: The early manifestations of COVID-19 in children with abnormal imaging are mostly small subpleural nodular ground glass opacity. The changes on the Delta-variant COVID-19 chest CT were milder than the original strain. The lesions reached a peak on CT in 4每7 days and quickly improved and absorbed after a week. Dynamic CT re-examination can achieve a good prognosis. |
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[Abstract] [Full Text] [PDF]
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Evaluation of the Quick Wee method of inducing faster clean catch urine collection in pre-continent infants: a randomized controlled trial
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Aoife Branagan, Niofa Canty, Evanne O*Halloran, Marian Madden, Michael Brendan O*Neill |
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Background: The acquisition of non-contaminated urine samples in pre-continent infants remains a challenge. The Quick Wee method uses bladder stimulation to induce voiding. A previous randomized trial showed a higher rate of voiding within 5 minutes using this method. We evaluated this method in an Irish hospital providing secondary care.
Methods: A non-blinded, randomized, controlled trial was carried out. Eligible infants were between 1 and 12 months of age, who required urine sampling as part of clinical care. Participants were randomly allocated to receive the intervention (Quick Wee Method〞supra-pubic stimulation with cold saline) or the control (usual care〞clean catch with no bladder stimulation) for 5 min. Primary outcome was voiding of urine within 5 min.
Results: A total of 140 infants were included in this study (73 in intervention group; 67 in control group). Baseline characteristics were similar. 25% in the intervention group passed urine in the 5-min trial period compared with 18% in the control group [P = 0.4, absolute difference 7% (95% confidence interval: − 7% to + 20%)]. Conclusion: The Quick Wee method is a simple and inexpensive intervention that did not show a statistically significant increase in urine samples obtained in pre-continent infants. |
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[Abstract] [Full Text] [PDF]
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Physicians* perspectives on adverse drug reactions in pediatric routine care: a survey
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Martina P. Neininger, Sarah Jeschke, Lisa M. Kiesel, Thilo Bertsche, Astrid Bertsche |
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Background: Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians* perceptions on ADRs in pediatric routine care.
Methods: In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions.
Results: Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol. Conclusion: Physicians* perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures. |
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[Abstract] [Full Text] [PDF]
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Two approaches for newborns with critical congenital heart disease: a comparative study
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Guan-Xi Wang, Kai Ma, Kun-Jing Pang, Xu Wang, Lei Qi, Yang Yang, Feng-Qun Mao, Shou-Jun Li |
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Background: Prenatal diagnosis and planned peripartum care is an unexplored concept in China. This study aimed to evaluate the effects of the ※prenatal diagnosis and postnatal treatment integrated model§ for newborns with critical congenital heart disease.
Methods: The medical records of neonates (≒ 28 days) admitted to Fuwai Hospital were reviewed retrospectively from January 2019 to December 2020. The patients were divided into ※prenatal diagnosis and postnatal treatment integrated group§ (n = 47) and ※non-integrated group§ (n = 69).
Results: The age of admission to the hospital and the age at surgery were earlier in the integrated group than in the nonintegrated group (5.2 ㊣ 7.2 days vs. 11.8 ㊣ 8.0 days, P < 0.001; 11.9 ㊣ 7.0 days vs. 16.5 ㊣ 7.7 days, P = 0.001, respectively). The weight at surgery also was lower in the integrated group than in the non-integrated group (3.3 ㊣ 0.4 kg vs. 3.6 ㊣ 0.6 kg, P = 0.010). Longer postoperative recovery time was needed in the integrated group, with a median mechanical ventilation time of 97 h (interquartile range 51每259 h) vs. 69 h (29每168 h) (P = 0.030) and with intensive care unit time of 13.0 days (8.0每21.0 days) vs. 9.0 days (4.5每16.0 days) (P = 0.048). No significant difference was observed in the all-cause mortality (2.1 vs. 8.7%, P = 0.238), but it was significantly lower in the integrated group for transposition of the great arteries (0 vs. 18.8%, log rank P = 0.032). Conclusions: The prenatal diagnosis and postnatal treatment integrated model could significantly shorten the diagnosis and hospitalization interval of newborns, and surgical intervention could be performed with a lower risk of death, especially for transposition of the great arteries. |
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[Abstract] [Full Text] [PDF]
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Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019
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Wen-Wen Zhang, Yong-Hui Yu, Xiao-Yu Dong, Simmy Reddy |
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Background: There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations.
Methods: We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019.
Results: Of the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001). Conclusions: The mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities. |
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[Abstract] [Full Text] [PDF]
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