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Summary of the COVID science: Possible link to hepatitis in children

The following is a summary of some recent studies on COVID-19. This includes research results that warrant further studies to confirm the results and that have yet to be certified through peer review.

SARS-CoV-2 could be the cause of mysterious hepatitis in children

A chain of events potentially triggered by undetected infection with the SARS-CoV-2 coronavirus could be causing the mysterious cases of severe hepatitis being reported in hundreds of young children around the world, researchers suspect.

Children with COVID-19 have a significantly increased risk of liver dysfunction afterwards, according to a report published on medRxiv on Saturday ahead of the peer review. But most children with acute hepatitis – which is generally rare in this age group – do not report previous SARS-CoV-2 infection. Instead, the majority were found to be infected with an adenovirus called 41F, which is not known to attack the liver.

It’s possible the affected children, many of whom are too young to be vaccinated, may have had mild or asymptomatic COVID infections that went unnoticed, a separate research team in The Lancet Gastroenterology & Hepatology suggests. If that were true, the theory goes, lingering particles of coronavirus in the gastrointestinal tract in these children could prime the immune system to overreact to adenovirus-41F with high levels of inflammatory proteins that ultimately damage the liver.

“We propose that children with acute hepatitis be screened for stool persistence of SARS-CoV-2” and other signs of liver damage because the coronavirus spike protein is a “superantigen” that oversensitizes the immune system. Said.

Prone position not helpful for awake patient

For hospitalized COVID-19 patients who are breathing on their own but are on supplemental oxygen, lying face down may not help prevent them eventually needing mechanical ventilation, a new study finds.

In the study, 400 patients were randomly assigned to normal care or standard care plus intermittent prone positioning, a position known to improve disease progression in sedated patients on ventilators. In the next 30 days, 34.1% in the prone group and 40.5% in the usual care group required intubation and ventilation, a difference that was not statistically significant. There may have been a reduction in the risk of prone intubation in some patients, researchers said Monday in JAMA, but they couldn’t statistically confirm this from their data. The average time spent in prone position per day was about five hours, less than the goal of eight to 10 hours per day.

“Long hours in an awake prone position are challenging and are strongly influenced by patient comfort and preferences,” the researchers said. “The most common reason for interrupting the prone position was patient desire, which could possibly be related to the overall subjective improvement or discomfort from the prone position.”

Reporting by Nancy Lapid and Megan Brooks; Edited by Bill Berkrot

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