Al-Kindy College Medical Journal

Background: Coronavirus disease 2019 (COVID-19) is
one of the updated challenges facing the whole world.
Objective: To identify the characteristics risk factors that
present in humans to be more liable to get an infection
than others.
Methods: A cross-sectional study was conducted for
positively confirmed 35 patients with polymerase chain
reaction in Wasit province at AL-Zahraa Teaching
Hospital from the period of March 13th till April 20th. All
of them full a questionnaire regarded by risk factors and
other comorbidities. Data were analyzed by SPSS version
23 using frequency tables and percentage. For numerical
data, the median, and interquartile range (IQR) were used.
Differences between categorical groups were performed by
fissure exact test.
Results: The median age of the patients was 43 years old
and interquartile range (25-56 years). Majority of the
patients were female (60%) and (51%) of them were from
the same region (AL-ezza). The dominant blood group
among patients was (O) (40%). About 11.4% of patients
had a travel history especially to Islamic Republic of Iran,
while (77.1%) had contact with positive cases. The highest
percentage of comorbidities among patients was
hypertension (40%), and the most presenting symptoms
were cough and fever. About 51% of patients were with
mild symptoms. Diabetes, coronary heart diseases, and
chronic renal diseases were significantly related to disease
severity (P-value=0.02, 0.001, 0.01 respectively).
Conclusion: Being a female, overweight or obese, and
with blood group (O) are the major risk factors among
patients. Comorbidities can play an important role in the
severity of disease especially hypertension, diabetes,
coronary heart diseases, and chronic renal diseases.

The outbreak of a current public health coronavirus 2019 disease is a causative agent of a serious acute respiratory syndrome and even death. COVID-19 has exposed to multi-suggested pharmaceutical agents to control this global disease. Baricitinib, a well-known antirheumatic agent, was one of them. This article reviews the likely pros and cons of baricitinib in attenuation of COVID-19 based on the mechanism of drug action as well as its pharmacokinetics. The inhibitory effect of baricitinib on receptor mediated endocytosis promoter, AKK1, and on JAK-STAT signaling pathway is benefacial in inhibition of both viral assembling and inflammation. Also, its pharmacokinetic has encouraged the physicians toward the drug selection for COVID-19 treatment. On the other hand, most of baricitinib side effects are dose-dependent. In conclusion, targeting of AAK1 and JAK1/2 using baricitinib has predicted to be potential and effective with minimal side effects in management COVID-19 infected patients for a short therapeutic dosing period. Laboratory monitoring should be considered for some parameters. However, experimental trials are mandatory for a long-term treatment with a lower dose of baricitinib to evaluate its effectiveness and safety in patients with moderate COVID-19 infection.

The rapid spread of novel coronavirus disease
(COVID19) throughout the world without available
specific treatment or vaccine necessitates alternative
options to contain the disease. Historically, children
and pregnant women were considered high-risk
population of infectious diseases but rarely have been
spotlighted nowadays in the regular COVID-19
updates, may be due to low global rates of incidence,
morbidity, and mortality. However, complications did
occur in these subjects affected by COVID-19. We
aimed to explore the latest updates of
immunotherapeutic perspectives of COVID-19
patients in general population and some added details
regarding pediatric and obstetrical practice.
Immune system boosting strategy is one of the
recently emerging issues allowing the body defense
mechanism to produce virus-neutralizing antibodies to
counteract the viral impacts on multiple organ
damage. Measles vaccination (which is universally
used for children in many countries, but
contraindicated during pregnancy) could urge the
body to produce these antibodies which may apply
their effects through cross-reactivity of measles
vaccine and COVID-19 antigenic proteins. In
addition, intravenous immunoglobulin and
convalescent plasma could have such neutralizing
antibody effect leading to clinical improvement and
viral elimination. Pediatric and obstetrical experience
has appeared in previous publications.
Human monoclonal antibodies are the future
promising approach to treat and prevent COVID-19
with the use of tocilizumab in recent studies. Pediatric
data are still in progress while no pregnancy ongoing
trials are planned up to date.
The better understanding of the host antiviral response
may pave the way to develop immunotherapeutic
plans against COVID-19 in the near upcoming days.

There is limited data and evidence about the effects of COVID-19 on Maternal health, especially when new information is emerging daily, through pregnancy, child birth and post natal period, women are vulnerable to have the infection, this article, aimed to show the suitable measures that should be applied for women at reproductive age who are suspected /confirmed with COVID -19 infection,

During pregnancy it is advisable to continue the antenatal care schedule, although reducing face to face visit is recommended (unless the pregnant condition required that ),and prioritize ANC at health facilities for high-risk pregnancy and during second half of pregnancy with adequate infection prevention control measures.

Regarding child birth, positive COVID-19 result without other indications is not an indication to expedite birth, decision for mode of birth not influenced by positive COVID-19 result, it is recommended to support normal labour and if elective caesarean has been planned, epidural anesthesia is highly recommended than general anesthesia. For women with suspected or confirmed COVID-19, Betamimetics: should be avoided as they may exacerbate maternal hypotension, tachycardia and pulmonary edema.

Maternal mental wellbeing should be screened in postnatal period because infected women with COVID -19 are more prone to develop an anxiety than general population because of the demands of the disease like isolation, bereavement, financial difficulties, insecurity and inability to access support systems which are considered as added risk factors to develop mental illnesses

The world is currently challenging the serious effects of the pandemic of the Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Data on pediatric COVID are rare and scattered in the literature. In this article, we presented the updated knowledge on the pediatric COVID-19 from different aspects. We hope it will increase the awareness of the pediatricians and health care professionals on this pandemic

Sufficient high-quality data are unavailable to describe the management approach and guideline of COVID-19 disease in pediatric and adolescent population which may be due to mild presentation in most of cases and less severe complications than older ages.

World Health Organization was concerned with the establishment of an approved guideline to manage the increasing number of COVID-19 patients worldwide aiming to prevent or lessen COVID-19 global burden.

The clinical features have a wide spectrum starting from uncomplicated mild illness, mild-moderate pneumonia, severe pneumonia, acute respiratory distress syndrome, sepsis, septic shock, and multisystem inflammatory syndrome in children.

Many important definitions were developed to identify the COVID-19 case status including confirmed, suspected, and probable case.

Many laboratory tests may be beneficially done but reverse transcriptase – polymerase chain reaction (RT-PCR) for SARS-CoV-2 RNA is diagnostic.

Patient isolation and adequate intake of fluid and calories, antipyretics (preferably paracetamol), antibiotics (in secondary bacterial infections), and bed rest are the mainstay of approved supportive treatment. While oxygen supplementation may be added in moderate to severe cases; anticoagulation prophylaxis (enoxaparin) is strongly advised in children with certain situations where hypercoagulability state is identified, and therapy should be evaluated based on risk factors.

New approaches, drugs, and therapies are currently under research to manage COVID-19 pediatric and adolescent patients including antivirals (lopinavir/ritonavir, and favipiravir), remdesivir, tocilizumab, dexamethasone, convalescent plasma, and specific treatment of multisystem inflammatory syndrome in children (immunoglobulin, steroids, tocilizumab, anakinra, and aspirin).

The practical approach was summarized in a flow chart scheme to assist health care professionals to manage COVID-19 in children and adolescents within a rapid look though details are given in the text.