LitCovid-sentences  

PMC:7455510 / 1357-15301 JSONTXT 13 Projects

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Id Subject Object Predicate Lexical cue
T15 0-12 Sentence denotes Introduction
T16 13-140 Sentence denotes SARS-CoV-2 infection in children younger than 10 years of age has been described in around 1% of identified cases in China [1].
T17 141-254 Sentence denotes Although data on children is still limited, most series agree that cases are mostly mild, even in infants [2, 3].
T18 255-410 Sentence denotes Very little information is available about pediatric patients with underlying diseases, and data in children with immunosuppression is almost non-existent.
T19 411-531 Sentence denotes COVID-19 serious disease has been described in a child with post-chemotherapy agranulocytosis due to acute leukemia [4].
T20 532-794 Sentence denotes Preliminary data from Bergamo [5] indicates that in Italy, practically no cases of infection have been detected in immunosuppressed patients (3 mild cases), which has led them to consider that this group of patients is not a high-risk group for COVID-19 disease.
T21 795-887 Sentence denotes Spain is currently one of the most affected countries with more than 100,000 reported cases.
T22 888-1013 Sentence denotes The first case in Spain was declared on January 31st, 2020, and the first case in Madrid was declared on February 27th, 2020.
T23 1014-1160 Sentence denotes La Paz University Hospital in Madrid, Spain, is a national reference tertiary center for transplanted, oncological, and immunosuppressed children.
T24 1161-1370 Sentence denotes Over 1,300 pediatric solid organ (SOT) and 630 hematopoietic stem cell transplants (HSCT) have been performed in our hospital, and more than 3,200 cancer patients have been treated over more than five decades.
T25 1371-1463 Sentence denotes Per year, we diagnose 100–120 new pediatric cancer patients, and perform 35 HSCT and 65 SOT.
T26 1464-1622 Sentence denotes Our aim was to describe the children with primary or secondary immunosuppression, and SARS-CoV-2 infection attended in our hospital during the month of March.
T27 1624-1644 Sentence denotes Patients and methods
T28 1645-1876 Sentence denotes A retrospective study (1st to 31st of March, 2020) of children less than 15 years old with primary or secondary immunosuppression infected with SARS-CoV-2 and treated at the University Hospital La Paz, Madrid, Spain, was performed.
T29 1877-1971 Sentence denotes For inclusion in the study, the SARS-CoV-2 polymerase chain reaction (PCR) had to be positive.
T30 1972-2112 Sentence denotes PCR was performed via nasal swabs, and if the test was initially negative but clinical suspicion was high, it was repeated in the next 24 h.
T31 2113-2154 Sentence denotes Inpatients and outpatients were included.
T32 2155-2339 Sentence denotes Symptoms, blood analysis results and radiological data, previous underlying disease, immunosuppressive treatment, treatment received for COVID-19 disease, and evolution were collected.
T33 2341-2348 Sentence denotes Results
T34 2349-2470 Sentence denotes During the month of March, a total of 315 children were tested in our hospital for SARS-CoV-2 and 51 were positive (16%).
T35 2471-2526 Sentence denotes Twenty-eight of the positive cases (55%) were admitted.
T36 2527-2628 Sentence denotes A total of 8 positive cases (15%) were immunosuppressed patients, and 3 were followed as outpatients.
T37 2629-2928 Sentence denotes The underlying pathology was hemato-oncological in most cases (three patients had undergone a hematopoietic stem cell transplant), two patients had undergone a liver or a kidney transplant, and the last case was a girl on chronic hemodialysis with a vasculitis receiving immunosuppressive treatment.
T38 2929-2995 Sentence denotes The median age was 12.6 years (interquartile range: IQR 9.5–12.6).
T39 2996-3101 Sentence denotes All the patients had been on immunosuppressive treatment with a median duration of 24 months (IQR 12–93).
T40 3102-3239 Sentence denotes All had respiratory symptoms, 5 of them had fever, and the majority had slight radiological alterations (only two had focal infiltrates).
T41 3240-3305 Sentence denotes In only one case the chest X-ray worsened during hospitalization.
T42 3306-3366 Sentence denotes One patient needed oxygen therapy and one case had diarrhea.
T43 3367-3403 Sentence denotes None of them had anosmia or ageusia.
T44 3404-3667 Sentence denotes One patient developed a hemophagocytic lymphohistiocytosis-like syndrome (sHLH), with persistent fever, cytopenias, low fibrinogen and elevated triglycerides, and elevated ferritin, and required specific treatment with dexamethasone, as per the HLH-2004 protocol.
T45 3668-4056 Sentence denotes Antiviral treatment was initiated according to our National guidelines, developed by the National Infectious Disease Society (SEIP), in coordination with the National Pediatric Intensive Care Society (SECIP) and the National Pediatric Association (AEP) available at https://www.aeped.es/noticias/documento-manejo-clinico-paciente-pediatrico-y-pacientes-riesgo-con-infeccion-por-sars-cov2.
T46 4057-4323 Sentence denotes Hydroxychloroquine was initiated upon diagnosis (positive PCR for SARS-CoV-2) when there were signs/ symptoms of moderate-severe disease (respiratory signs, pneumonia on chest X ray, blood parameters of severity such as lymphopenia or elevated CRP, D-dimer or Il-6).
T47 4324-4400 Sentence denotes Remdesivir was requested, under compassionate use, in the most severe cases.
T48 4401-4533 Sentence denotes Following theses guidelines, in 5/8 cases, some antiviral treatment was prescribed, with hydroxychloroquine being the most frequent.
T49 4534-4846 Sentence denotes Two patients received remdesivir (the two oncological patients who required admission: patient 1 who had oxygen requirement and patient 4 who had persistent symptoms with severe lymphopenia and elevated inflammatory parameters) and only one patient received tocilizumab due to persistent fever and elevated IL-6.
T50 4847-4918 Sentence denotes There were no significant toxicities following the treatments received.
T51 4919-5066 Sentence denotes Immunosuppressive therapy was decreased or withdrawn in 6 patients (the other two had been off immunosuppression for 1 and 2 months, respectively).
T52 5067-5118 Sentence denotes All but one case developed progressive lymphopenia.
T53 5119-5151 Sentence denotes D-dimer was moderately elevated.
T54 5152-5300 Sentence denotes With a median follow up of 106 days (IQR 103–113) from COVID-19 diagnosis, no child required admission to the pediatric intensive care unit or died.
T55 5301-5425 Sentence denotes At present, all the patients are being followed up as outpatients and have had no further complications related to COVID-19.
T56 5426-5542 Sentence denotes The clinical characteristics of the patients, as well as details on the treatment received, are outlined in Table 1.
T57 5543-5627 Sentence denotes Table 1 Clinical characteristics of immunocompromised children with COVID-19 disease
T58 5628-5650 Sentence denotes Case # 1 2 3 4 5 6 7 8
T59 5651-5692 Sentence denotes Age (years) 15 13 12.6 9 6.7 11 12.6 14.8
T60 5693-5715 Sentence denotes Gender F M M M M M F M
T61 5716-5736 Sentence denotes Primary disease HSCT
T62 5737-5764 Sentence denotes PID (CTLA4 deficiency) HSCT
T63 5765-5794 Sentence denotes Myelodysplastic syndrome HSCT
T64 5795-5843 Sentence denotes B-ALL T-ALL Melanoma Liver Tx C-ANCA vasculitis.
T65 5844-5866 Sentence denotes Hemodialysis Kidney Tx
T66 5867-5939 Sentence denotes Immunosuppressive treatment/targeted therapy None (stopped for 1 month).
T67 5940-5950 Sentence denotes CD4 cells:
T68 5951-5999 Sentence denotes 216/ μL Ruxolitinib None (stopped for 2 months).
T69 6000-6010 Sentence denotes CD4 cells:
T70 6011-6157 Sentence denotes 30/ μL Oral mercaptopurine and methotrexate Trametinib Prednisone, tacrolimus Prednisone, azathioprine Prednisone, tacrolimus, mycophenolate (MMF)
T71 6158-6192 Sentence denotes Fever Yes No Yes Yes No Yes Yes No
T72 6193-6227 Sentence denotes Cough No No No Yes Yes Yes Yes Yes
T73 6228-6265 Sentence denotes Sore throat No Yes No No No No Yes No
T74 6266-6298 Sentence denotes Dyspnea Yes No No No No No No No
T75 6299-6314 Sentence denotes Lymphocytes/mm3
T76 6315-6365 Sentence denotes (minimum value) 730 1210 520 340 2730 970 380 1620
T77 6366-6379 Sentence denotes D-dimer ng/mL
T78 6380-6423 Sentence denotes (maximum value) 301 - 418 1143 370 - 1168 -
T79 6424-6474 Sentence denotes IL-6 pg/mL (maximum value) 9.60 2.30 - 192 - - - -
T80 6475-6534 Sentence denotes C- Reactive Protein (mg/L) 26.2 1.9 18.9 24.6 0.6 0.9 9 106
T81 6535-6605 Sentence denotes Ferritin (mg/dl) Not done Not done 622 1534 Not done Not done 1270 553
T82 6606-6624 Sentence denotes Chest X-ray Normal
T83 6625-6634 Sentence denotes (Previous
T84 6635-6829 Sentence denotes lobectomy) Interstitial infiltrate Interstitial infiltrate Interstitial infiltrate Focal infiltrate Mild parahilar infiltrates Normal initially but focal infiltrate on evolution Focal infiltrate
T85 6830-6883 Sentence denotes Required hospitalization Yes No No Yes No Yes Yes Yes
T86 6884-6898 Sentence denotes Treatment HCQ*
T87 6899-6944 Sentence denotes Remdesivir** IS withdrawal HCQ* IS withdrawal
T88 6945-6949 Sentence denotes HCQ*
T89 6950-6962 Sentence denotes Remdesivir**
T90 6963-6974 Sentence denotes Tocilizumab
T91 6975-7098 Sentence denotes Dexamethasone*** Trametinib withdrawal Reduction in IS (50% tacrolimus reduction) Reduction in IS (azathioprine withdrawal)
T92 7099-7106 Sentence denotes LPV/Rtv
T93 7107-7189 Sentence denotes HCQ* Reduction in IS (MMF withdrawal, tacrolimus decrease and prednisone increase)
T94 7190-7194 Sentence denotes HCQ*
T95 7195-7236 Sentence denotes Duration of stay (days) 11 - - 28 - 3 4 2
T96 7237-7346 Sentence denotes Complications O2 requirement on nasal cannula (maximun 2 lpm) None None HLH-like syndrome None None None None
T97 7347-7443 Sentence denotes F female, M male, HSCT: hematopoietic stem cell transplant, PID primary immunodeficiency, B-ALL:
T98 7444-7664 Sentence denotes B cell acute lymphoblastic leukemia, T-ALL T cell acute lymphoblastic leukemia, Tx transplant, HCQ hydroxychloroquine, IS immunosuppressors, LPV/Rtv lopinavir/ritonavir, O2 oxygen; HLH hemophagocytic lymphohistiocytosis.
T99 7665-7682 Sentence denotes MMF mycophenolate
T100 7683-7844 Sentence denotes *HCQ was initiated in patients 1, 3, 4, and 8 once confirmation of positive SARS-CoV-2 with a nasal swab was obtained (< 24 h from consultation at our hospital).
T101 7845-7942 Sentence denotes Patients 1, 3, and 8 attended the Emergency Department in the first 24 h after onset of symptoms.
T102 7943-8109 Sentence denotes Patient 4 had fever of 4 days when the nasal swab was obtained, and patient 7 received 5 days of LPV/Rtv initially and due to persistent symptoms was switched to HCQ.
T103 8110-8314 Sentence denotes According to our guidelines, the oral dose was as follows: HCQ 6.5 mg/kg/day (dosing q12 h) in 6 year-olds, and HCQ 10 mg/kg/day (dosing q12 h) in children > 6 years (maximum daily dose 400 mg) for 5 days
T104 8315-8599 Sentence denotes **Remdesivir was given for a total of 7 days on patient 1 and 10 days on patient 4, at an intravenous dose of 5 mg/kg on day 1, followed by a maintenance dose of 2.5 mg/kg from days 2 to 9 (patients <40 kg) or 200 mg/iv on day 1 followed by 100 mg/iv on days 2-9 (for patients >40 kg)
T105 8600-8687 Sentence denotes ***Dexamethasone was given as per the HLH 2004 trial, although with a shorter duration:
T106 8688-8860 Sentence denotes 10 mg/m2/day for 7 days, followed by 5 mg/m2/day for another 7 days, followed by 2.5 mg/m2 for 7 days and 1.25 mg/m2 for 2 days and then a tapering dose with hydrocortisone
T107 8862-8872 Sentence denotes Discussion
T108 8873-9046 Sentence denotes In this small series, 8 immunocompromised patients with COVID-19 disease are reported, accounting for 15% of the positive cases detected in children in a reference hospital.
T109 9047-9264 Sentence denotes The severity of the symptoms was mild-moderate in the majority with a predominance of febrile syndrome, with mild radiological involvement and in some cases with mild respiratory distress that required oxygen therapy.
T110 9265-9419 Sentence denotes Most patients received antiviral treatment, and immunosuppressive treatment was decreased or even discontinued for a short period of time in most of them.
T111 9420-9589 Sentence denotes It has been described by most of the authors that children have a milder disease than adults [2, 3] and immunocompromised patients do not seem to evolve differently [5].
T112 9590-9635 Sentence denotes Data in children is practically non-existent.
T113 9636-9838 Sentence denotes Recently, a study carried out by the European Society for Gastroenterology (ESPGHAN), described children with inflammatory bowel disease who presented COVID-19 disease with a mild outpatient course [6].
T114 9839-9970 Sentence denotes In addition, they warned of the risk of developing acute exacerbations of the disease if immunosuppressant treatments were delayed.
T115 9971-10017 Sentence denotes Data from cancer pediatric patients is scarce.
T116 10018-10181 Sentence denotes A recent report from a childhood cancer center in Lombardy, Italy, reported five positive cases in childhood cancer patients and all of them had a mild course [7].
T117 10182-10418 Sentence denotes In fact, the International Society of Pediatric Oncology (SIOP) highlighted that there is no reason to discontinue daily activities in pediatric hematology/oncology units; however, general principles for prevention were recommended [8].
T118 10419-10562 Sentence denotes SARS-CoV-2 infection is proposed to evolve in three phases, causing mortality in the third phase, after 2 or more weeks from symptom onset [9].
T119 10563-10693 Sentence denotes During the early phase, SARS-CoV-2 multiplies and establishes residence in the host, primarily focusing on the respiratory system.
T120 10694-10890 Sentence denotes SARS-CoV-2 binds to its target using the angiotensin-converting enzyme 2 (ACE2), receptor on human cells [10] mainly in human lung, small intestine epithelium, as well as the vascular endothelium.
T121 10891-10942 Sentence denotes This phase presents with mild respiratory symptoms.
T122 10943-11053 Sentence denotes During the second phase, lung involvement is established, with viral pneumonia and the development of hypoxia.
T123 11054-11151 Sentence denotes Lymphopenia appears or increases and a moderate increase in inflammatory markers can be observed.
T124 11152-11232 Sentence denotes A minority of patients will reach the third phase of systemic hyperinflammation.
T125 11233-11548 Sentence denotes There is a decrease in helper, suppressor, and regulatory T cell counts, with increase of inflammatory cytokines and biomarkers such as interleukins IL-2, IL-6, IL-7, granulocyte-colony-stimulating factor, macrophage inflammatory protein 1-α, tumor necrosis factor-α, C-reactive protein, ferritin, and D-dimer [11].
T126 11549-11663 Sentence denotes A hemophagocytic lymphohistiocytosis-like syndrome (sHLH) may occur in patients in this advanced stage of disease.
T127 11664-11850 Sentence denotes The possibility that immunosuppressed patients may not be able to progress to advanced stages of the disease could explain why most behave with mild symptoms, as previously reported [5].
T128 11851-11984 Sentence denotes Although our patients presented lymphopenia, most of them did not have significantly increased D-dimer or Il-6 when it was performed.
T129 11985-12171 Sentence denotes Despite two patients having elevated D-dimer, anticoagulation treatment was not given, as it is not recommended by our Spanish Infectious Disease Society based on the available evidence.
T130 12172-12291 Sentence denotes One of our patients developed sHLH that was treated with dexamethasone as per the HLH-2004 trial and entered remission.
T131 12292-12368 Sentence denotes The patient finished the course of steroids, and had no signs of recurrence.
T132 12369-12519 Sentence denotes Therefore, although most children have a mild-moderate course, it is important to be aware of possible complications that require prompt intervention.
T133 12520-12645 Sentence denotes A problem that must be assessed is the balance between risk and benefit of the suspension of the immunosuppressive treatment.
T134 12646-12764 Sentence denotes We believe that risk has to be individually assessed, as well as the necessity to start specific antiviral treatments.
T135 12765-13050 Sentence denotes Based on our experience, monitoring of children with immunosuppression and COVID-19 disease can be performed as outpatients, if close monitoring is possible with radiological and blood test controls if necessary, and carefully selecting the patients depending on their individual risk.
T136 13051-13168 Sentence denotes Hospitalization should be assessed when high fever, radiological involvement, and/or respiratory distress is present.
T137 13169-13307 Sentence denotes Also, it should be considered if there are signs of disease severity (lymphopenia, elevated D-dimer, C-reactive protein or Interleukin-6).
T138 13308-13362 Sentence denotes Depending on the evolution, an sHLH must be ruled out.
T139 13363-13485 Sentence denotes A judicious and conservative treatment seems safe and recommended since to date no antiviral treatment has shown efficacy.
T140 13486-13748 Sentence denotes It is particularly relevant to be very careful when recommending any specific antiviral treatment in this group of patients given the numerous drug interactions that may appear with their immunosuppressive treatment, such as calcineurin inhibitors, among others.
T141 13749-13829 Sentence denotes The available tables of pharmacological interactions should always be consulted.
T142 13830-13944 Sentence denotes Other groups should communicate their experience with these patients to offer appropriate treatment and follow-up.