July 7, 2021 | Volume 12 | Issue 27
Comparison of symptoms and RNA levels in children and adults with SARS-CoV-2 infection in the community setting
From a cross-sectional study of 555 children and adults with confirmed SARS-CoV-2 infection symptomatic individuals had higher SARS-CoV-2 RNA levels compared to asymptomatic individuals (with no differences in RNA levels found between asymptomatic children and adults or between symptomatic children and symptomatic adults).

Underlying medical conditions associated with severe COVID-19 illness among children
Children make up a small, but increasing (now 14%; >4 million in the USA) proportion of COVID-19 hospitalizations. Severe disease is relatively uncommon.

A cross-sectional study of 43,465 children (aged 18 years or younger) with COVID-19 (march 2020 – January 2021) seen either in an Emergency Department setting or as an inpatient, examined the underlying risks (medical conditions/complexity) of severe COVID-19 illness.

In children, the most common underlying conditions associated with COVID-19 include asthma (10.2%), neurodevelopmental disorders (3.9%), anxiety and fear related disorders (3.2%), depressive disorders (2.8%) and obesity (2.5%).

The strongest risk factors for hospitalization are type 1 diabetes and obesity; for severe COVID-19 illness it’s type 1 diabetes and cardiac and circulatory congenital anomalies. (In infants <2 years of age a history of premature birth is associated with severe COVID-19 illness.)

Incidence of Multisystem of Inflammatory Syndrome in children (MIS-C) among US persons infected with SARS-CoV-2
MIS-C is a fairly rare, serious inflammatory condition in children that occurs during SARS-CoV-2 infection in which multi-organ (heart, lungs, blood vessels, kidney, digestive system, brain, skin and-or eyes) involvement occurs (similar to toxic shock syndrome or Kawasaki Disease where there is generalized inflammation of blood vessels).

The overall incidence of MIS-C (April—June 2020) is 5.1 persons/1 million person-months and 316 persons/1 million SARS-CoV-2 infection. Compared to white children (Risk Ratio – RR =1) MIS-C risk ratio in Black children is 5.62, for Hispanic/Latino 4.26, and Asian or Pacific Island persons 2.88. Compared to children <5 years of age MIS-C occurs more often in 6-10 year olds and less often in children 11-15 years of age. The cause of MIS-C and the reason/s for the variances by race/ethnicity and age is not understood at present.


See related video HERE & HERE.
Association of Cannabis use during adolescence with neurodevelopment
“Cannabis is a commonly used psychoactive drug, particularly among adolescents and young adults.” 78% of first-time cannabis users are between the ages of 12 and 20 years. During late adolescence significant structural changes occur in the brain most notably in the areas of the cerebral cortex that are late in development and myelinization. Few longitudinal neuroimaging studies have examined the potential association between cannabis use and adolescent brain development.

A retrospective cohort study of 799 adolescents (14-19 years of age) had behavioral and neuroimaging (magnetic resonance imaging – MRI’s- measuring cerebral cortex thickness) studies performed at base-line and at 5 years follow up.

Cannabis use in adolescence is associated with altered neurodevelopment (thinning of the cerebral cortex particularly the right prefrontal cortices rich in cannabinoid receptors) which is dose dependent and is associated with attentional impulsiveness at follow up.


See related video HERE, HERE & below:
How Marijuana Affects the Adolescent Brain
Cannabis and Schizophrenia
The incidence of vertebral exostosis in Multiple Hereditary Exostosis (MHE) and recommendations for spinal screening
Hereditary multiple exostosis (diaphyseal aclasis) is a benign, autosomal dominant (though mutations occur) hereditary disorder characterized by multiple osteochondromas (1-5% chance of malignant transformation), metaphyseal in origin found in children (usually <10 years of age) on the surfaces of bone, often at the site of tendon insertion. They may be sessile with a broad base or pedunculated, attached with a stalk. Vertebral involvement may encroach on the vertebral canal with significant neurologic deleterious consequences.

A retrospective chart review of 39 children (mean age 12.3 years) with MHE who underwent routine spinal screening with non-contrast entire spine magnetic resonance imaging (MRI) examined the incidence of vertebral and encroaching intracranial exostosis and assessed whether pelvic/rib exostoses are “harbingers” of vertebral involvement.

28% and 7.7% of children respectively with NEH have encroaching vertebral or intracanal exostoses respectively (20% have non-encroaching vertebral exostosis). MRI of the entire spine and/or neurologic symptoms can be used to determine which patients need close supervision.
Importance of low HbA1c during childhood on glycemic control in adulthood and the risk of late complications
Glycohemoglobin (also known as glycosylated hemoglobin or hemoglobin A1c – HbA1c) is a hemoglobin-glucose combination solely generated within the red blood cell by a non-enzymatic reaction between hemoglobin and glucose-6 phosphate. Levels directly relate to the concentration of blood glucose during the previous 2-3 months (normal level <5.7%; Prediabetic 5.7%-6.4%; diabetic >6.5%).

Data from 5,116 children with type 1 diabetes from a Swedish pediatric diabetes cohort was utilized to divide patients into 6 groups based on mean HbA1c levels and retinopathy, micro/macro albuminuria, age at onset and duration.

Children with the lowest mean HbA1c during childhood have the lowest mean levels as young adults. Retinopathy is the most common complication seen as a young adult and the prevalence increases within each higher mean HbA1c level group.


See related video below:
Screening, diagnosis & monitoring of diabetes mellitus newer markers
Long term complications of diabetes
2-year-old cognitive outcomes in children of pregnant women with epilepsy
 The neurodevelopment risks of fetal exposure to many anti-seizure medications (ASM’s) are uncertain.

A prospective, observational, multicenter investigation of pregnant women (456) on antiepileptic therapy, followed offspring from birth to 6 years of age, compared cognitive abilities (5 domains: language, motor, cognitive, social-emotional and general adaptive) to blood levels of two ASMs (lamotrigine/Lamictal and/or levetiracetam/Keppra).

While there are no differences in language domain scores between 2-year-old children of pregnant women with epilepsy vs. healthy women, ASMs given during the third trimester of pregnancy appear to be associated with lower scores in other domains (it will be remembered that Valproic given during pregnancy for epilepsy appears to increase rates of Autism/Autism Spectrum Disorder, Attention Deficit/Hyperactivity Disorder and intellectual and neurodevelopmental disorders in offspring. Ed).

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Meet Dr. Ronald Kanter- The Heart Institute at Nicklaus Children's
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Dear Reader

I am sure many of you, like I, are feeling great relief at the improving outcomes following the various public health measures and SARS-CoV-2 immunization programs being undertaken in the USA to date. It seems that while there are many unanswered questions remaining, and firm answers not yet available on many interesting aspects, at present there is significant optimism that the mRNA vaccines will provide not only substantial (but not total) protection against the worst results of COVID-19 but will also minimize spread while appearing to be effective against the variants circulating.

Nevertheless I would urge all to remember that there are places and situations that place us at increased risk for infection, like hospitals, nursing homes, prisons and homeless shelters or while traveling. Some immunocompromised people will remain vulnerable to COVID-19. Continue to take care, wear a mask when appropriate, in addition wash hands or use a sanitizer when in risky situations, continue to cough or sneeze into ones elbow and be aware and cautious in balancing risks and benefits.
 
Best of luck.

Jack Wolfsdorf, MD, Editor
Staff NCH
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