Archives of Pediatric Infectious Diseases
Volume:10 Issue: 1, Jan 2022

There have been two coronavirus-related pandemics during the past 18 years, including severe acute respiratory syndrome (SARS)-CoV andMiddle East respiratory syndrome (MERS)-CoV in 2002 and 2012, respectively. In 2019, Seven years after the emergence of MERS, a new coronavirus (i.e., SARS-CoV-2) was detected in several patients. SARS-CoV-2 spread widely, and its high prevalence enabled the virus to start a new pandemic in 2020. It is believed that the higher infectivity of the virus in comparison to that of SARS-CoV is related to its molecular interaction affinity of transmembrane spike glycoprotein and human angiotensin-converting enzyme 2 (ACE-2) cell receptors. Moreover, the primary reason for the high case fatality rate (CFR) is the cytokine storm and acute respiratory distress syndrome (ARDS) because of the immune system response to the invaders. Hence, a solid understanding of the components involved in the mechanism of viral entry and immune system response is crucial for finding approaches to disrupt the virus-cell interplay and neutralizing its impacts on the host immune system. In this review, we investigated the molecular aspect and potential therapeutic targets associated with cell receptors and downstream signaling cascades.

A systematic search was implemented on several online databases, including Google Scholar, PubMed, and Scopus during 2019-2021 using the following keywords: "SARS-CoV-2", "COVID-19", "ACE-2", "Therapeutic Targets", "Acute Respiratory Distress Syndrome", and "Cytokine Storm".

Various internal or external agents are responsible for the virus infectivity and stimulating acute immune system response. Since currently there is no cure for the treatment of COVID-19, several repurposed drugs can be employed to disrupt the process of viral entry and mitigate the symptoms raised by the cytokine storm. Inhibition of several agents, including signal transduction mediators and TMPRSS2 may be momentous.

Despite the increase in the CFR, no drugs were developed with significant efficacy. Understanding the virus entry mechanism and the immune system’s role could help us surmount the problems in developing a promising drug or employing the repurposed ones.

Obtaining informed consent for diagnostic and therapeutic procedures is of greatmoral and legal importance, which is more important in the field of pediatrics due to its specific issues.

Obtaining informed consent in the pediatric field is specific because of many factors, including the age of the patients and the necessity of obtaining consent from parents or legal guardians. This study aimed to evaluate the process of obtaining informed consent from the viewpoint of substitute decision-makers (parents or guardians) and physicians. Attention to the differences between the views of these two groups by establishing appropriate and correct communication skills between them can lead to greater satisfaction and increased effectiveness of treatments.

In this descriptive study, the data were collected through questionnaires completed by 188 parents and 23 physicians. Finally, the statistical analysis was conducted using the one-sample t test method in SPSS 16.

In 96.3% of the cases, parents believed that where the patient, their relatives, and the medical team disagreed about the kind of treatment, the final decision was made by the medical team. One-third of them did not receive enough information or received no information at all. Informing parents about other possible treatments, complications of the procedures, considering the patients and their relatives’ opinions for the final decision, informing the child about his/her disease and treatment plans, and informing the parents about the possible outcomes were not in the favorable range. Physicians believed that decision about the treatment was made based on the opinion of the parents and the clinical committee, and only in 3.4% of the cases, their opinion was the basis for decision-making.

The results showed that there was a gap between the parents and physicians’ opinions about informed consent, as the physicians believed that they act as the patients’ parents wish and the parents believed that their opinion played no important role in the final decision regarding the health of their children. Thus, it seems necessary to institutionalize the culture of participatory decision-making by physicians and parents in decisions related to the diagnosis and treatment of children, and more emphasis should be placed on establishing the right relationship between treatment staff and patients and their relatives.

Streptococcus pneumoniae is recognized as one of the main pathogens inducing several invasive and non-invasive infections in children.

The present study aimed to evaluate the serotype distribution of S. pneumoniae in six–month–old carriers.

This study encompassed 600 six-month-old healthy infants whose pharyngeal swap samples were collected and then cultured to isolate S. pneumoniae. Twenty- five different serotypes were defined on positive culture samples by multiplex PCR.

In this study, 13 cases (2.2%) were positive S. pneumonia. The most common isolated serotypes of S. pneumoniae were serotypes 23F (n = 6, 1%) and 3 (n = 3, 0.5%), respectively. Notably, the most frequent serotype in formula-fed infants (n = 300) was Serotype 23F (n = 5, 1.7%); however, Serotype 3 (n = 3, 1%) was the most frequent one in breastfed participants (n = 300). According to the findings, the overall coverage of PCV10, PCV13, and PPSV23 on the S. pneumoniae serotypes at the age of six months was 50%, 73%, and 85%, respectively.

At this age, the type of feeding could not significantly affect the frequency rate of S. pneumoniae colonization, while the serotype distributions in the two breastfed and formula-fed groups were different.

Pediculosis is a common ectoparasitic infestation that involves especially the skin of children worldwide. Studying the children’s perception of the disease’s risk factors, the effectiveness of personal preventive measures, and its implications for their health could be a major leap forward in health promotion activities.

This study aimed to develop and evaluate the psychometric properties of the Children’s Perception Scale of Head Lice Infestation (CPS-HLI) and its initial feasibility assessment for use on Iranian and possibly other elementary school children.

The scale’s items were retained based on an extensive literature search and classified into the underlying constructs of the extended health belief model (EHBM). An expert panel endorsed the qualitative content and face validity of the preliminary draft, and 47 items remained for quantitative validity testing on a sample of 362 elementary school students in the city of Paveh, West of Iran. Explanatory and confirmatory factor analyses (EFA and CFA) were employed to test the content and structural validity of the constructed instrument. Cronbach’s alpha and intra-class correlation coefficients were calculated to assess the internal consistency and reliability of the scale.

The values of Lawshe’s content validity index (0.90) and content validity ratio (0.77), the subscales’ Cronbach’s alpha (0.59), and intra-class correlation (0.72) coefficients confirmed plausible internal consistency of the scale. The values of root mean square error of approximation (RMSEA) (< 0.08 with χ 2 < 0.05), Tucker-Lewis index (TLI), and comparative fit index (CFI) > 0.9 approved the applied statistical model’s goodness of fit. The ranges of Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy for the underlying subscales (0.49 - 0.74) and the statistically significant result of Bartlett’s test of sphericity (P < 0.001) confirmed the patterned relationship among the constructed scale’s items. The principal component analysis that was performed using STATA favored the 11-factor solution.

The study findings support the construct validity of CPS-HLI for use in studies on children’s perception of head lice infestation risk factors, the effectiveness of personal preventive measures, and the disease implications for their health and wellbeing. Further cross-cultural and cross-national validation studies are recommended for using the instrument in a wider range of populations and settings.

Surgical procedures may be complicated by post-surgical infections. This study investigates the role of administering perioperative narrow-spectrum antibiotic prophylaxis in preventing post-surgical infections as compared to routine broadspectrum antibiotic usage in the surgical ward.

Narrow-spectrum perioperative antibiotic prophylaxis, in accordance with CDC guidelines, was implemented in our hospital in October 2019. In this quasi-experimental study, all the children (one month to fifteen years old) who underwent surgery from April to September 2019 and had received broad-spectrum antibiotics for various durations, as well as those operated after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis plan (October 2019 to March 2020) were enrolled. Surgical wound type (clean, clean/contaminated, contaminated, and dirty), type and site of the infection, and the patient’s age and sex were recorded. Cases with postoperative infections were followed up in the two groups during hospitalization and for 30 days (or 90 days if a prosthetic material was implanted) after discharge. The rate of post-surgical infections was compared between the two groups by the Mann-Whitney and chi-squared tests.

In total, 4308 cases were enrolled in the first six months and 3650 in the second six months of the study. The rate of postsurgical infections in the first group was 31/4380 (23.7%) as compared to 22/3650 (20%) in the second group (P-value = 0.3365)

There was no increase in the frequency of post-surgical infections after the implementation of the perioperative narrow-spectrum antibiotic prophylaxis protocol. Reducing the use of antibiotics before surgery shrinks costs and antibiotic resistance without any effect on the post-surgical infection rate.

Health care workers (HCWs) are the frontline of coping COVID-19 pandemic, which indicates the importance of improving their mental wellness to better cope with the situation.

The current study aimed to firstly assess the severity of anxiety and depression and perceived vulnerability to diseases, and secondly to investigate their association with the fear of COVID-19 among Nigerian HCWs.

For this cross-sectional study, a purposefully selected sample of 413 HCWs from two tertiary healthcare institutions in Benin City, Edo State, South-South Nigeria, responded to the Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, and Perceived Vulnerability to Disease Scale. Data was collected between October 2020 and February 2021. Descriptive statistics were used to summarize socio-demographic variables, while inferential statistics (t-test for independent samples, one-way ANOVA, and linear regression) were used to test hypotheses.

A high prevalence of anxiety, depression, and perceived vulnerability to diseases (PVD) was observed. Perceived infectability (β = 0.244, P = 0.000), germ aversion (β = 0.166, P = 0.000), and composite PVD (β = 0.96, P = 0.000) were identified as independent and significant predictors of fear of COVID-19, accounting for 7.5; 3.3, and 9.9% variance in the severities of Fear of COVID-19, respectively. Anxiety and depression showed a significant joint prediction of Fear of COVID-19 severity, accounting for a 4.0% variance in the severity. Fear of COVID-19 was not found to be influenced by sex or job type differences among the HCWs.

This study demonstrated a high incidence of anxiety, depression, and perceived vulnerability to COVID-19 among Nigerian HCWs. These reported symptoms of psychopathology are also strong independent and joint predictors of fear of COVID19.

The coronavirus disease 2019 (COVID-19) pandemic has imposed a significant burden worldwide, manifesting as a severe disease and causing mortality even in children. Severe COVID-19 disease is characterized by cytokine storm with progression to secondary hemophagocytic lymphohistiocytosis (sHLH). We describe an 18-month-old boy in Iran, previously healthy, diagnosed with COVID19-induced sHLH. Three weeks after close contact with COVID-19 confirmed cases, he was admitted with high fever, lethargy, mild respiratory distress, skin rash, and conjunctivitis with swollen eyelids and lips. Laboratory data revealed elevated levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and liver enzymes, and mild thrombocytopenia. His clinical condition rapidly deteriorated, with septic shock, hepatosplenomegaly, and respiratory failure. Laboratory tests showed cytopenia, coagulopathy, hyperferritinemia, and hypertriglyceridemia, which met the criteria for sHLH diagnosis. Chest computed tomography (CT) revealed bilateral infiltrations that suggested acute respiratory distress syndrome (ARDS) of COVID-19 that was confirmed by a positive realtime polymerase chain reaction (RT-PCR) test. Therefore, the child was treated with intravenous immunoglobulin (IVIG), glucocorticoid, hydroxychloroquine, lopinavir/ritonavir, and interferonβ-1a. This therapeutic strategy enabled complete recovery from fever, regaining consciousness, weaning from respiratory support, and resolving shock. Serial chest radiographs showed diminishing infiltrations. Sequential physical examinations revealed an overall significant reduction in spleen and liver span. Laboratory data showed rapid improvement from cytopenia and coagulopathy, normalization of liver enzyme levels, and reduction in hyperinflammation markers. Although ARDS is the most common cause of death from COVID-19, other complications such as sHLH may be lethal; thus, early diagnosis and appropriate treatment are necessary for saving patients’ lives.