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p kzn
Hematological manifestations of SARS‐CoV‐2 in children
Abstract
Infection from severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID‐19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS‐CoV‐2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID‐19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS‐CoV‐2.
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P KZN
Neuropathic pain is associated with poor health‐related quality of life in adolescents with sickle cell disease: A preliminary report
Funding information
NIH/NHLBI 1K23HL114636‐01A (AMB), U54 HL090503, Project 3 (JAP), R01 HL103427‐01A1 (JAP), ASH HONORS Award (MER)
Previously published as “Neuropathic Pain is Associated with Poor Health‐Related Quality of Life in Adolescents with Sickle Cell Disease” at the American Society of Hematology Annual Meeting & Exposition. Published November 13, 2019. https://ashpublications.org/blood/
Abstract
Background
Neuropathic pain is associated with poor health‐related quality of life (HRQL) in pain conditions other than sickle cell disease (SCD); this relationship in SCD is unknown. We investigated this relationship and hypothesized neuropathic pain is associated with poor HRQL in adolescents with SCD.
Methods
We conducted a cross‐sectional study of patients with SCD ages 13‐18 years during baseline health. Primary outcome was HRQL, assessed by the PedsQL SCD Module (child self‐report, parent proxy report). PedsQL is scored from 0 to 100, with higher scores indicating better HRQL. Neuropathic pain was assessed using the painDETECT questionnaire (scored 0‐38); higher scores indicated greater likelihood of neuropathic pain. All completed both PedsQL SCD Module and painDETECT questionnaire. Descriptive statistics were used and associations between painDETECT and PedsQL Total Score, Pain Impact, Pain and Hurt, and Pain Management and Control Scores were determined via Pearson correlation. Significance was P < .05.
Results
Twelve patients were enrolled. Median (interquartile range [IQR]) age was 15 (14‐16.5) years, 75% were female, and 83% were on hydroxyurea. Higher painDETECT scores were significantly associated with lower PedsQL SCD Module child self‐report Pain and Hurt Scores (r = −0.68, P = .01). Higher painDETECT scores were also significantly associated with lower PedsQL parent proxy‐report Total Scores (r = −0.64, P = .03) and Pain and Hurt Scores (r = −0.67, P = .02).
Conclusions
These data suggest that adolescents with SCD and neuropathic pain have poor HRQL even in their baseline state of health. Prospective, larger studies are needed to confirm this preliminary finding and explore a multimodal approach for pain assessment in SCD.
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P KZN
Epidemiology of paediatric Middle East respiratory syndrome coronavirus and implications for the control of coronavirus virus disease 2019
Conflict of interest: None declared.
Abstract
Aim
To compare the clinical features of Middle East respiratory syndrome coronavirus (MERS‐CoV) infection between paediatric and adult cases.
Methods
Using multiple public data sources, we created an enhanced open‐source surveillance dataset of all MERS‐CoV cases between 20 September 2012 and 31 December 2018 in Saudi Arabia including available risk factor data.
Results
Of the 1791 cases of MERS‐CoV identified, 30 cases (1.7%) were aged under 18 years and 1725 cases (96.3%) were aged 18 years and over. Three paediatric cases were fatal, aged 0, 2 and 15 years. The odds of asymptomatic MERS‐CoV infection among cases under 18 years (n = 10/23; 44%) was significantly higher (odds ratio (OR) = 4.98; 95% confidence interval (CI): 2.15–11.51; P = 0.001) compared to adults (n = 199/1487; 13%). The odds of hospitalisation were significantly lower (OR = 0.17; 95% CI: 0.08–0.39; P < 0.001) among cases under 18 years (n = 12/24; 50%) compared to adults (n = 1231/1443; 85%). Children were more likely to have a known source of exposure compared to adults (OR = 2.68; 95% CI: 1.29–5.56; P = 0.008).
Conclusions
Clinically severe illness is less common in children, although death can occur, and the proportion of paediatric cases (1.7%) is similar to that reported for COVID‐19. Age‐specific differences in the clinical presentation of MERS‐CoV cases could have implications for transmission for other betacoronaviruses including severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Children may be at risk within the household with an infected adult. More studies are required on the role of children in transmission of betacoronaviruses.
What is already known on this topic
- Asymptomatic infection with coronaviruses including MERS‐CoV and SARS‐CoV‐2/COVID‐19 has been frequently reported, especially in children and young adults, but age‐specific differences are poorly described.
- Paediatric cases of MERS‐CoV have been described in a small case series.
What this paper adds
- Children infected with MERS‐CoV were more likely to present with asymptomatic infection compared to adults and less likely to be hospitalised, but may still have fatal outcomes.
- Children are more likely to have a known source of exposure than adults, indicating they may acquire infection from an adult household contact.
- These results could have implications for the control of MERS‐CoV and other betacoronaviruses such as SARS‐CoV2/COVID‐19.
Early lactate measurements for predicting in‐hospital mortality in paediatric sepsis
Conflict of Interest: None
Author contributions: PD and PJ conceptualized the study. All authors participated in the study design. PJ, PD and SG were involved in patient management. MK, VT and BB provided laboratory support. PJ, PD SG and VT collected data. RM performed the statistical analysis. PD and PJ drafted the initial manuscript. MK, SG, BB, VT and RM provided critical input. All authors approved final version.
Abstract
Aim
We compared the performance of plasma lactate with high‐sensitivity C‐reactive protein (hs‐CRP), and paediatric sepsis‐related organ failure assessment (pSOFA) score for predicting mortality in septic children.
Methods
Serial plasma lactate and hs‐CRP levels and pSOFA score was assessed during early hospital stay in septic children.
Results
Out of 149 participants, 45 died. Plasma lactate at 0 h and 6 h was significantly higher, and lactate clearance was significantly lower in non‐survivors. The optimal cut‐off of plasma lactate at 6h for identifying mortality was 2.5 mmol/L (sensitivity 85% and specificity 74%). pSOFA score had the best predictive ability for mortality (AUC 0.89) followed by hs‐CRP at 0 h (AUC 0.86), hs‐CRP at 48 h (AUC 0.83), plasma lactate levels at 6 h (AUC 0.83), and plasma lactate at 0 h (AUC 0.67).
Conclusion
pSOFA score, hs‐CRP and hyperlactemia at 6 h can identify septic children at risk of dying.
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TANTRA ENDED BDHISM IN JINDE
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B MIND BSAD
Dealing with fears
8.5 mins read.
There’s a lot of anxiety, fear, and sadness going around this year. It is arguably leading to people feeling fragile and on a shorter fuse, more upset and angry than usual with each other and with everything that seems to be going on in our world. If we check where a lot of this is coming from, it comes because deep down most people are scared not just of losing the way of life they’ve known but of dying.
For this reason, to get rid of the underlying fear, it is really important that we don’t shy away from contemplating what is inevitable for all of us. That we come to terms with it, come to accept it, and even come to welcome it! After all, there is no getting around it. As Buddha says in Sutra Addressed to a King:
Many people hold off thinking about things like serious illness, ageing, and death for as long as possible because they don’t know how to deal with them — they just seem catastrophic, terrifying. Like when the Doctor tells you or a loved one some test results, “I’m afraid it is not good news,” and our heart sinks — we just want to run away, even though there is nowhere to run to. However, we can face whatever happens not alone and scared but within the context of refuge – feeling safe, protected, okay. Also, if we can accept death, we find we can far more easily accept all the other things that go wrong with our lives.
We are all mortals made of flesh and bone, and the purpose of contemplating the mortal facts of sickness, ageing, death, and rebirth every day is not to paralyze us but to give rise to deep refuge in what will actually help us – and not just when these things happen, but now, straightaway. This includes, as we’ll see more in the next article, tuning into the blessings or protection of countless enlightened beings that are always on tap, and making an effort to apply the Dharma teachings that enable us to stay peaceful regardless of what is going on. With these we can stay happy in the present, and we are also ready for the illness and death when they come. We become fearless.
There is nothing to fear but fear itself, as the saying goes. And it turns out that our fear and anxiety, along with all our other unpeaceful thoughts, are delusions arising from grasping at something that is not there, such as a real body, or a real self, or a self that is more important than everyone else. Our fears are directly proportional to how tightly we are grasping. Luckily we can all learn to let go of these thoughts, to stop grasping. And it is helpful to remember that our mind is naturally peaceful, we are just shaking it up with our own inappropriate thoughts.
Getting started
We can start to relax straightaway through a few minutes breathing exercize or clarity of mind or turning the mind to wood. As Geshe Kelsang says:
A lot of our ill health is enormously exacerbated – sometimes even brought on — by anxiety and tension in the mind. Therefore it would be great to start practicing these simple strategies now on a daily basis because they will be very healing. Then, through using wisdom and compassion to get rid of our grasping once and for all, we will become free from all sickness permanently.
Inner and outer problems
With our world in turmoil and anxiety, we have to learn how to keep our mind peaceful and calm. If we are peaceful, we are happy. We are also strong, which means we can help others stay strong too.
If we understand the difference between inner and outer problems we can understand why being able to keep a peaceful mind is the actual solution when things are going wrong. A quick reminder: if our car breaks down, that is an outer problem belonging to the car. It can be fixed (or not) depending on outer means, such as taking it to the garage, and it can be fixed by other people.
If we get upset that the car has broken down, that is an inner problem, an unpleasant feeling in our own mind. This is what makes us unhappy and is therefore our actual problem. It can ONLY be fixed by internal means, and by ourself.
It is never too late to start controlling our own mind – on one level it is not hard, it just takes a decision to get started, to make it a priority.
Dharma solves inner problems, that is its actual function. And on one level the solution to these problems is so very simple. If we let go of self-cherishing (believing we are more important than others) and self-grasping (believing everything is real, existing from its own side), the whole house of cards will come tumbling down. If we do not, then even if we manage to get over one fear or upset, this is a temporary relief – another is already on its way. It’s endless, life after life.
Being trapped in so-called samsara, the cycle of impure life, is not being trapped in an external prison – it simply means that we still have self-cherishing and self-grasping. If we learn how we are creating this prison, we can dismantle it. It is useful to let our daily problems remind us not that we are doomed, but instead:
Rinse and repeat. This way, it’s like our run of the mill outer and inner problems are giving us practice in getting rid of all of our problems once and for all!
Can we be ill and happy at the same time?!
But surely being ill is an inner problem? you may be thinking. No. It is our body’s problem, not our mind’s problem. We can include bodily ailments within outer problems. We believe our feelings of pain are coming from our body, but our body is inanimate and doesn’t feel anything. The pain is our bodily awareness, which pervades our body, but which is part of our mind. And the painful bodily feelings arise only because we have self-grasping ignorance, believing our body is inherently existent. If we get a direct realization of emptiness, we never feel any physical (or mental) pain again. Meantime, we can also have unpleasant bodily feelings while at the same time having peaceful mental feelings, such as compassion or renunciation.
Soooo… if we make a point of stopping self-cherishing and self-grasping with respect to our body, we will be able to stay increasingly pain-free and happy even when we’re getting older, sicker, and deader. And how important is that!!
I’ve had some practice with this of late — for example my lungs got a bit infected by all the wildfire smoke and I had to have laser surgery for a torn retina – and this fear (aargh, I have lung cancer and I’m going blind!) and loathing (why did this happen to me!? I was so happy before! I don’t like it!) has given me ample incentive to contemplate that my body is not my mind, and nor is it me. It is just a possession I use, like my car or my carrot peeler. It is inanimate. Plus it is not inherently existent. (Despite numerous contemplations on the subject over the years, I think I was still kinda hoping I might get away with not having to go through all that aging and sickness stuff, just drop dead one day and go to the Pure Land. Been having to rethink my strategy 😂).
At times when things go wrong with my body, I naturally turn to think of practitioners who are really good at transforming sickness and creeping fears; and there is actually no shortage of inspiration. Lhatse Geshe visited us at Madhyamaka Centre many years ago, possibly the happiest most fun-loving person in the world. He came for a week and stayed 3 months, and we never knew till after he’d left that he’d had migraines almost every day. (He and I stayed in touch for years, and a long time later he also had an awesome death — I’ll tell you that story another day.)
One senior Kadampa nun I know has experienced painful and debilitating arthritis for years, but she is always genuinely smiling and kind. The other day someone asked her how she was and she replied:
I find this really helpful to contemplate.
Another 40-something Kadampa has recently come through cancer but she told me that she’d happily do it all again if it meant COVID would go away for everyone else. Shows how much authentic compassion she developed in the course of her illness and treatment.
A good friend with a degenerative illness replied to me the other day:
Another friend told me that if he hadn’t suffered from so much ill health, he would never have turned so much to Dharma or led such a good and basically happy life, so he doesn’t regret any of it (even the operations where there was no anaesthesia ….) What about Harriet Tubman, still running the equivalent of five marathons to save people from slavery despite the horrendous headaches that would have floored less inspired people?
And something for the Tantric practitioners amongst you … You know those car stickers you see on old bangers, “My other car is a Mercedes?” I remember conversations with my ancient friend Eileen, who suffered sickness and old age for years, when she would say,
Which brings me to my Mom, too. She’s had a lot of serious health challenges in her life, but manages most all of the time to stay peaceful and keep enjoying life. If she isn’t happy she isn’t one to complain, she generally just waits patiently for it to pass. This is because she can be rather wise. The other day she was saying that our body is a thing, it is not us. It is a tool or an instrument that we use. Our mind is more important. She told me she makes an effort to think about things that are “important”, not to worry about small things. The main thing is to keep our mind peaceful and happy, not to worry about all the external things that we can do nothing about, which is pointless because we can do nothing about them. That includes all the things that can go wrong with our problematical body and, as she said, hers has been that.
There is literally no point following the inappropriate attention of anxiety or fear when it comes to our body. We don’t freak out (much) when the car is dented, we just take it to the garage. In a similar way, we can learn to patiently accept whatever is coming up with the body while taking it to the doctor.
Kadampa Geshes would pray to have a mind like a blacksmith’s anvil, undaunted however hard it is hit. Sounds good to me! Shortly after Venerable Geshe Kelsang came over to the West to help us, in the early 1980s, he developed tuberculosis and almost passed away. After he had recovered, I remember his doctor telling us that he saw absolutely no difference in Geshe-la’s way of being when he was well and when he was gravely ill. He said you couldn’t tell he was ill.
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P KZN
SARS-CoV-2 Transfusion Transmission
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TAKE-HOME MESSAGE
This study evaluated SARS-CoV-2 infectivity via blood transfusion using French National Blood Service data. Out of 268 donations investigated, 3 (1.1%) tested positive for SARS-CoV-2 RNA, with all testing negative for anti–SARS-CoV-2 antibodies. The virus could not be isolated from the 3 donations.
- In this limited study, SARS-CoV-2 viral RNA levels were low when detected among asymptomatic donors, and the corresponding plasma was not infectious in culture.
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