PURPOSE: The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 43 million people resulting in over 1 million deaths. Approximately 2% of cases in the United States are children, and in most cases the child is either asymptomatic or has mild symptoms. However, some pediatric cases can present with Multisystem Inflammatory Syndrome (MIS-C). Understanding the epidemiology, clinical presentation, and management of MIS-C related to SARS-CoV-2 will help to streamline early diagnosis and treatment, particularly in pediatric patients with complex medical conditions. METHODS: This scoping review adopted methods from the Joanna Briggs Institute (JBI) manual for evidence synthesis and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies of patients meeting the Centers for Disease Control and Prevention (CDC) criteria for MIS-C from December 31st, 2019 to Oct 5th, 2020 were identified using PubMed and Scopus. Articles were screened for eligibility, and data collection was conducted on those fulfilling inclusion criteria. RESULTS: Of 417 studies identified, 57 met inclusion criteria, accounting for 875 patients from 15 countries. Globally, 57% of children affected with MIS-C were males. The median age was 9 years old, ranging from 6 months to 21 years. Forty-five percent of the patients had underlying comorbidities including obesity and lung disease. Fever, conjunctivitis and GI symptoms were common. Most MIS-C patients had high biomarkers including troponin I, N-terminal prohormone of B-type natriuretic peptide (NT-proBNP), D-dimer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), interleukin 6 (IL-6), procalcitonin, and ferritin. The treatment for most patients included IVIG and inotropic support. CONCLUSION: MIS-C can be a unique and potentially life-threatening manifestation of SARS-CoV-2 in children and often requires medical intervention.

No abstract

Objective: We assessed the feasibility of closing small intestine perforations with a mesh patch instead of sutures only. Methods: Nine porcine ex vivo small intestine specimens were incised 0.5 cm to simulate bowel perforations. Control group perforations were sutured closed without mesh. The two experimental groups were closed by mesh sewn to the outside (first group) or inside (second group) of the bowel wall. Each specimen was submerged in normal saline and insufflated until air bubbles leaked from the perforation. That insufflation pressure was recorded as the burst pressure. Results: The control group burst at 78.0±17.9 mmHg. The “patch outside” group burst at 54.7±9.1 mmHg. The “patch inside” group burst at 32.0 ±4.6 mmHg. Only the “patch inside” group had statistically significant inferiority, but both groups trended towards inferiority. Discussion: Preliminary research indicates that patch repair of intestinal perforations is likely inferior to sutures alone, although repair with the patch outside the bowel wall cannot be completely excluded because of the high variability of the data. Further research may try alternate patch types or different variations to find a non-inferior closure method. A sample size of n=9 each would give 80% power to detect a minimal detectable difference of 20 mmHg.