Tan Specialist Child and Family Cinic

03/02/2022

Unvaccinated children were better protected when both parents were vaccinated, but even just one immunized parent helped, data from Israel show.

20/04/2020

Fewer patients with diabetes (than those without) experienced fever (59.5% vs 83.2%; P = .002),
chills (56.8% vs 71.5%; P = .08),
chest tightness (13.5% vs 29.2%; P = .05),
and shortness of breath (13.5% vs 27%; P = .08).
"This phenomenon, which resembles the silent symptoms people with diabetes experience also in other conditions such as myocardial infarction, may cause a life-threatening delay in providing the needed care, finally resulting in poorer prognosis,"
Medscape Medical News
COVID-19 and Diabetes: Known Mechanisms and a 'New Beast'?
Miriam E. Tucker. April 14, 2020

20/04/2020

COVID-19 and Diabetes: Known Mechanisms and a 'New Beast'? Miriam E. Tucker
April 14, 2020 News > Medscape Medical News

'those with diabetes still had a significantly greater risk of severe pneumonia, release of tissue injury-related enzymes, excessive uncontrolled inflammatory responses, and hypercoagulable state associated with dysregulated glucose metabolism, compared to those with no diabetes"
Fewer patients with diabetes (than those without) experienced fever (59.5% vs 83.2%; P = .002),
chills (56.8% vs 71.5%; P = .08),
chest tightness (13.5% vs 29.2%; P = .05),
and shortness of breath (13.5% vs 27%; P = .08).
"This phenomenon, which resembles the silent symptoms people with diabetes experience also in other conditions such as myocardial infarction, may cause a life-threatening delay in providing the needed care, finally resulting in poorer prognosis," they caution.

22/03/2020

In view of the lockdown, the clinic will be closed until Sunday 29th March.
We will be open on Monday 830 -230 pm . 30th March
The night sessions will depend on whether the authorities impose night curfew.
Any inconvenience is regretted.

22/03/2020

How should you be washing your hands?
this video shows all the steps how Medical personnel wash their hands.

20/03/2020

March 18, 2020
DOI: 10.1056/NEJMc2005073
SARS-CoV-2 Infection in Children
TO THE EDITOR:
As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited.1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age.2 In order to determine the spectrum of disease in children, we evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan. Both symptomatic and asymptomatic children with known contact with persons having confirmed or suspected SARS-CoV-2 infection were evaluated. Nasopharyngeal or throat swabs were obtained for detection of SARS-CoV-2 RNA by established methods.4 The clinical outcomes were monitored up to March 8, 2020.
Table 1.

Epidemiologic Characteristics, Clinical Features, and Radiologic Findings of 171 Children with SARS-CoV-2 Infection.
Of the 1391 children assessed and tested from January 28 through February 26, 2020, a total of 171 (12.3%) were confirmed to have SARS-CoV-2 infection. Demographic data and clinical features are summarized in Table 1. (Details of the laboratory and radiologic findings are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median age of the infected children was 6.7 years. Fever was present in 41.5% of the children at any time during the illness. Other common signs and symptoms included cough and pharyngeal erythema. A total of 27 patients (15.8%) did not have any symptoms of infection or radiologic features of pneumonia. A total of 12 patients had radiologic features of pneumonia but did not have any symptoms of infection. During the course of hospitalization, 3 patients required intensive care support and invasive mechanical ventilation; all had coexisting conditions (hydronephrosis, leukemia [for which the patient was receiving maintenance chemotherapy], and intussusception). Lymphopenia (lymphocyte count,

20/03/2020

SARS-CoV-2 Infection in Children

TO THE EDITOR:
New England Journal of Medicine March 18, 2020
DOI: 10.1056/NEJMc2005073

As of March 10, 2020, the 2019 novel coronavirus (SARS-CoV-2) has been responsible for more than 110,000 infections and 4000 deaths worldwide, but data regarding the epidemiologic characteristics and clinical features of infected children are limited.1-3 A recent review of 72,314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age.2 In order to determine the spectrum of disease in children, we evaluated children infected with SARS-CoV-2 and treated at the Wuhan Children’s Hospital, the only center assigned by the central government for treating infected children under 16 years of age in Wuhan. Both symptomatic and asymptomatic children with known contact with persons having confirmed or suspected SARS-CoV-2 infection were evaluated. Nasopharyngeal or throat swabs were obtained for detection of SARS-CoV-2 RNA by established methods.4 The clinical outcomes were monitored up to March 8, 2020.
Table 1.

Epidemiologic Characteristics, Clinical Features, and Radiologic Findings of 171 Children with SARS-CoV-2 Infection.
Of the 1391 children assessed and tested from January 28 through February 26, 2020, a total of 171 (12.3%) were confirmed to have SARS-CoV-2 infection. Demographic data and clinical features are summarized in Table 1. (Details of the laboratory and radiologic findings are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.) The median age of the infected children was 6.7 years. Fever was present in 41.5% of the children at any time during the illness. Other common signs and symptoms included cough and pharyngeal erythema. A total of 27 patients (15.8%) did not have any symptoms of infection or radiologic features of pneumonia. A total of 12 patients had radiologic features of pneumonia but did not have any symptoms of infection. During the course of hospitalization, 3 patients required intensive care support and invasive mechanical ventilation; all had coexisting conditions (hydronephrosis, leukemia [for which the patient was receiving maintenance chemotherapy], and intussusception). Lymphopenia (lymphocyte count,

20/03/2020

"At this time in the evolution of the SARS-CoV-2 pandemic, pregnant women with COVID-19 do not appear to be at risk for transmitting the virus to their fetus during the 3rd trimester. However, there remains little or no information available on the effects of COVID-19 infection occurring early in pregnancy."
News > Reuters Health Information
Infants Born to Mothers With COVID-19 Appear Healthy

By Will Boggs MD
March 17, 2020

20/03/2020

The Conference on Retroviruses and Opportunistic Infections went virtual last week to prevent the spread of coronavirus, but one of the organizers was diagnosed with it after the move.

19/03/2020

"The possibility of enteric involvement has important infection control implications. "
"Coronaviruses are susceptible to antiseptics containing ethanol and disinfectants containing chlorine or bleach,
" Dr. Yeo said. "This should be borne in mind when using hand-rub for cleaning of hands or using disinfectants for cleaning of the environment. Frequent hand washing and cleaning of the environment should be emphasized."

see article in next post for details

19/03/2020

Diarrhea Likely Underestimated in COVID-19

By Will Boggs MD
March 03, 2020


NEW YORK (Reuters Health) - Diarrhea is likely underestimated as a feature of disease caused by the 2019 novel coronavirus (COVID-19), researchers from China report.
Most patients with COVID-19 present with fever and cough, but the incidence of other clinical features varies across reports.
Dr. Wei Qi from The Second Hospital of Hebei Medical University, Shijiazhuang, China and colleagues, using data from three reported studies, found that the incidence of leukopenia, fever, and diarrhea differed significantly among the studies, with diarrhea showing the most significant difference.
Because the spike protein of the new coronavirus shares the same cell entry receptor ACE2 as the SARS coronavirus (known to exhibit fecal-oral transmission), they examined the expression profiles of ACE2 in various human tissues.
ACE2 was highly expressed in proximal and distal enterocytes in the small intestine, as were two entry receptors for other coronaviruses, according to the online report in Gut.
Based on these findings, the researchers propose that the incidence of diarrhea may be underestimated in previous investigations and that ACE2-expressing small intestinal epithelial cells might be more vulnerable to attack by the 2019 coronavirus.
They note that the 2019 coronavirus, which shares epidemiological features of SARS, might also use fecal-oral transmission. "Thus," the authors conclude, "future efforts at prevention and control must take into consideration the potential for fecal-mediated spread of this virus."
A recent online commentary in Lancet Gastroenterology and Hepatology also postulated enteric involvement of coronaviruses. Dr. Danson Yeo from Tan Tock Seng Hospital, Singapore, one of the co-authors of that commentary, told Reuters Health by email, "Early reports of COVID-19 suggest approximately 10% present with gastrointestinal symptoms. Until more data emerge, physicians should have a high degree of suspicion in anyone with fever, gastrointestinal symptoms, and significant contact/travel history."

The possibility of enteric involvement has important infection control implications. "Coronaviruses are susceptible to antiseptics containing ethanol and disinfectants containing chlorine or bleach," Dr. Yeo said. "This should be borne in mind when using hand-rub for cleaning of hands or using disinfectants for cleaning of the environment. Frequent hand washing and cleaning of the environment should be emphasized."
"We should approach this pandemic based on knowledge from studies that have been performed on previous coronaviruses, instead of waiting for new data to emerge before we react," he said.
Dr. Qi and co-author Dr. Qi Zhang from The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
SOURCE: https://bit.ly/2TiTp6R Gut, online February 26, 2020 and https://bit.ly/2Tt41yR Lancet Gastroenterology and Hepatology, online February 19, 2020.

A series of pneumonia cases caused by 2019 novel coronavirus (2019-nCoV, also named COVID-19) are being reported globally. Based on recent publications,1–3 the most common symptoms in patients infected by 2019-nCoV were fever and cough. However, the incidence of other clinical features differs in ...

19/03/2020

Viral shedding persisted for a median duration of 20 days in survivors, ranging from 8 to 37.
The virus (SARS-CoV-2) was detectable in nonsurvivors until death.
Antiviral treatment did not curtail viral shedding.

Patients who did not survive hospitalization for COVID-19 in Wuhan were more likely to be older and have comorbidities and elevated D-dimer, new data showed.