Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 1174

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : SC15 - SC18 Full Version

Clinical Profile and Short-term Outcome of Paediatric COVID-19 in the First, Second and Third Wave of the Pandemic in India-An Observational Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60141.18038
Sai Swaroop Archaka, Alexander Mannu, Vinoth Gnana Chellaiyan

1. Resident, Department of Paediatrics, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India. 2. Professor, Department of Paediatrics, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India. 3. Associate Professor, Department of Community Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Alexander Mannu,
Professor, Department of Paediatrics, Chettinad Hospital and Research Institute, Chettinad Academy and Research Education, OMR Kelambakkam, Chennai-603103, Tamil Nadu, India.
E-mail: paedsalex@gmail.com

Abstract

Introduction: There has been adequate evidence that children are less likely to contract the Coronavirus Disease-2019 (COVID-19) infection and less likely to experience a deadly course of the disease in the paediatric group. The majority of the time, they exhibit moderate respiratory symptoms, like fever, dry cough and exhaustion. They were all free of COVID-19 pneumonia.

Aim: To compare the clinical features and short-term outcomes of COVID-19 in children during March 2020 to March 2022.

Materials and Methods: The present analytical observational study was conducted in the Department of Paediatrics, Chettinad Hospital, Chennai, Tamil Nadu, India, from March 2020 to March 2022. The study population included Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive COVID-19 children between age groups of one month and 18 years age. A sample size of 103, 90 and 98 were included from first, second and third wave, respectively. Kruskal-Wallis test and Analysis of Variance (ANOVA) test were used were used for statistical analysis.

Results: In the study population, the mean age in the wave 1, wave 2 and wave 3 was 9.1±5.25 years, 9.3±4.99 years and 9.2±5.12 years, respectively. Males were more affected in all the phases than females. The most common symptoms in all the three waves were cough, myalgia and fever. Fever was the predominant symptom reported in all three waves (74.8% in wave 1, 80.6% in wave 2 and 75% in wave 3). Between the COVID-19 waves, baseline investigations such as Alanine Transaminase (ALT) and Aspartate Transaminase (AST) (p-value=0.001, 0.02) showed significant differences. C-reactive Protein (CRP) was non reactive in (81.55%) in wave 1, (85.07%) in wave 2 and (65.3%) in wave 3. (p-value=0.029).

Conclusion: The present study results conclude that the presenting features of COVID-19 in children were mild, and the outcome was good. The first, second and third waves had considerable differences in clinical findings and short-term outcomes among COVID-19-affected children.

Keywords

Capillary refilling time, Coronavirus disease-2019, Fever, Myalgia

The risk of COVID-19 infection is universal. Based on previous literature, there does not appear to be an age limit for COVID-19 susceptibility. According to recent research, children represent a tiny percentage of COVID-19 occurrences as compared to adults (1),(2). Although, COVID-19, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Disease (MERS) are all caused by a coronavirus and can cause severe respiratory distress, but COVID-19 has its unique epidemiological and clinical characteristics. COVID-19 has a prolonged incubation time, high infectivity, unusual clinical signs, and a significant fatality rate in elderly adults (3),(4).

According to some reports, children are at higher risk to contract SARS-CoV-2, although they had minimal symptoms and a milder sickness, as well as a lesser case-fatality rate compared to adults (5),(6),(7). Because many of the early investigations in China were conducted in adult facilities, the number of children reported was limited (8). The number of paediatric children infected with COVID-19 is expected to grow rapidly, if it has not already, due to the fast global spread of SARS-CoV-2 infection (9). The report by Max Planck Institute for Demographic Research (MPIDR) coverage database suggested that among 3.7 million deaths, over 13,400 (0.4%) were recognised in paediatrics and adolescents under 20 years of age. Specifically, the epidemiological and clinical manifestations of COVID-19 in the 0-14 years paediatric population until now are not completely described (10). The devastating second wave of COVID-19 in India peaked during the May 2021 primary, fueled by B1 617 lineage variations, particularly the delta variant (5). It is probable that the clinical aspects of each wave will alter based on the variants that dominate the waves (11),(12). The current research was conducted to compare the clinical manifestations and short-term aftermaths of COVID-19 in children during the first wave, second wave and third wave.

Material and Methods

The present analytical observational study was conducted in the Department of Paediatrics, Chettinad Hospital, Chennai, Tamil Nadu, India, from March 2020 to March 2022. The Institutional Ethics Committee had approved the study (IEC number: IHEC-II/0437/22).

The study population included RT-PCR positive COVID-19 children between age groups from one month to 18 years age. The children with incomplete record of data were excluded. First COVID-19 wave was from March 2020 to October 2020, second wave was from April 2021 to September 2021 and third wave was from December 2021 to March 2022 [13,14]. The sample included in the first wave was 103 subjects and 90 subjects in the second wave and 98 subjects in the third wave. The data was collected regarding demographical, clinical symptoms and signs, including daily vital parameters, laboratory measurements, imaging findings, management, and outcome.

All children were monitored for their vitals from admission till discharge and parameters includes, temperature, heart rate, respiratory rate and Capillary Refilling Time (CRT). A complete haemogram, CRP, liver function tests (AST, ALT), D-dimer, serum electrolytes, and urea creatinine at admission is done for all cases and second-line additional tests like Prothrombin Time (PT), Activated Partial Thromboplastin (aPTT), ferritin, Fibrinogen Degradation Products (FDPs) were ordered based on the severity progression of the disease. Ultrasonogram (USG), Computed Tomography (CT) scan and Chest X-ray (CXR) were requested only for children admitted to Intensive Care Unit (ICU) care.

Nasal and throat samples were collected and transported in viral transport media. During the procedure, appropriate Personal Protective Equipment (PPE) for specimen collection was used. Visitors were strictly restricted from entering the sample collection areas. RT-PCR was considered as positive with a Cycle threshold (Ct) value of 36 and below for the E gene and confirmed after Rdrp gene detection with recommended SD Biosensor kit for Rotor Gene Q(Qiagen) machine in all the three waves.

In the present study COVID-19 patients meeting any of the following criteria were diagnosed as severe: 1) respiratory distress, higher respiratory rate (age specific criteria as per IMNCI); 2) oxygen saturation ≤93% at rest; and 3) Partial pressure of Oxygen (PaO2)/Fraction of Inspired Oxygen (FiO2) ≤300 mmHg. COVID-19 patients with any of the following criteria were diagnosed as critical: 1) respiratory failure and mechanical ventilation needed; 2) shock; or 3) organ failure and ICU admission needed for monitoring and treatment (15).

Management of the COVID-19 patients was based on the existing guidelines issued by Indian Council of Medical Research (ICMR). On the third defervescence day or after clinical improvement is attained, the study participants were discharged from the hospital. The parents of the children were instructed to report through telecommunication, if there were general red flag signs. Follow-up of the participants and enquiry about the wellbeing was done through a telephonic conversation after 14 days of discharge.

Statistical Analysis

All quantitative variables were inspected for normal distribution. The quantitative variables like age (in years), serum electrolytes like (Na, K, Cl, and HCO3), etc., were compared between the 3-study groups and reported as mean±Standard Deviation (SD) using the Analysis of Variance (ANOVA) test. For non normally distributed quantitative parameters, Interquartile Range (IQR) and Median were compared using the Kruskal-Wallis test. While the categorical variables like gender, symptoms, treatment, etc., were reported as percentages and counted between the three study groups. The test statistic used was Chi-square or Fisher’s-exact test. The p-value <0.05 defined as statistically significant. Statistical Package for the Social Sciences (SPSS) software version 22.0 was utilised for statistical analysis.

Results

A total of 291 subjects were involved in the final analysis. Mean age was slightly less in COVID-19 first wave (p-value=0.621), males were more affected in all the waves compared to females (p-value=0.71). All vitals were reported to be normal in the majority of study participants and no statistically significant difference was found between the three phases. Vomiting, diarrhoea and pain abdomen were reported by a very few participants in all the three waves (Table/Fig 1).

Fever was the predominant symptom reported in all three waves (74.8% in wave 1, 80.6% in wave 2 and 75% in wave 3). On comparison of COVID-19 waves 1, 2, and 3 no significant difference was found in majority of laboratory parameters including D-dimers (p-value=0.338). CRP was non reactive in 84 (81.55%) in phase 1, 76 (84.44%) in phase 2 and 64 (65.3%) in phase 3. The difference in CRP was found to be statistically significant (p-value <0.05). AST testand ALT levels were found to be higher in wave 3 compared to wave 1 and wave 2 (p-value <0.05). D-dimer levels were comparable in all three waves (Table/Fig 2).

After the follow-up period, majority (95%) had no complaints in wave 1 (95%), wave 2 (97%) and wave 3 (93%). (p-value=0.725) (Table/Fig 2). Most common presenting was fever followed by cough in 42.7%, 58.2% and 62.76% in wave 1, 2 and 3, respectively (Table/Fig 3),(Table/Fig 4).

There was no statistically significant difference in mean duration of any complaints between the waves (p-value >0.05) (Table/Fig 3),(Table/Fig 4).

Discussion

The present study was an attempt to compare the clinical features and outcomes of three waves of COVID-19 infection among children. The most common symptoms in all the three waves were cough, myalgia and fever. Fever was the predominant symptom among it, which was found in 74.8% of wave 1, 80.6% of wave 2 and 75% of wave three patients. This is comparable to a meta-analysis of 7780 youngsters by Hoang A et al., (16). In a research by Li B et al., the most common clinical symptoms were fever (47%) and cough (42%) (17). According to Tung Ho CL et al., the majority (59.3%) experienced an usual temperature, with a decreased occurrence of cough, runny nose or throat congestion, and loose stools in the study (18). In the present study, a very uncommon symptom observed was vomiting. A meta-analysis found that (48%) of cases had fever, and (6% of cases) had diarrhoea and nausea/vomiting (19). In a retrospective analysis of 26 children, 11 experienced fever and two experienced vomiting (20).

Less severe or mild illness affected over 90% of the children in the present study. This is comparable to the United States (US) database, where 11.7% of the youngsters needed admission (21). None of the children in the present study required ICU admissions. However this is in contrast to other studies which reported considerable proportion of ICU admissions for further management. In the Madrid research, 10% of youngsters required ICU admission (22). There was a larger proportion of infants requiring ICU hospitalisation (20.7% vs 14%), which was similar to a Chinese study where a higher proportion of infants had severe and critical disease (23).

No complications were reported by the study populations during the follow-up period in all three waves. In previous studies Multisystem Inflammatory Syndrome (MIS-C) has been reported [12,24,25]. In another study, more children were diagnosed with MISC in the first wave than in the second wave (2.2% vs 0.25%) (12).

Limitation(s)

The study comes from a single multispecialty tertiary care facility, which makes it susceptible to referral bias. There probably would have been a more severe end of the COVID-19 disease spectrum and more comorbidities. Smaller sample size, non inclusion of asymptomatic patients were other pitfalls.

Conclusion

The severity of clinical presentation of COVID-19 in children was mild, and the outcome was generally good. Fever cough and myalgia were chief complaints of the study participants. There were no complications reported during the follow-up period, including mortality and ICU admissions. Hence, the study found that the three COVID-19 waves did have a considerable difference in clinical findings and short-term outcomes among COVID-19 affected children.

Acknowledgement

The authors acknowledge the support rendered by Dr. L. Umadevi, Professor.

References

1.
Castagnoli R, Votto M, Licari A, Brambilla I, Bruno R, Perlini S, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children and adolescents: A systematic review. JAMA Pediatr. 2020;174(9):882-89. [crossref][PubMed]
2.
Ludvigsson JF. A systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta Paediatr. 2020;109(6):1088-95. [crossref][PubMed]
3.
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet (London, England). 2020;395(10224):565-74. [crossref]
4.
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study. BMJ. 2020;368:m1091. [crossref][PubMed]
5.
Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: A retrospective cohort study. Lancet Infect Dis. 2020;20(8):911-19. [crossref][PubMed]
6.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA-J Am Med Assoc. 2020;323(13):1239-42. [crossref][PubMed]
7.
Child mortality and COVID-19-UNICEF DATA. [Cited 2022 Apr 8]. Available from: https://data.unicef.org/topic/child-survival/covid-19/.
8.
Guo CX, He L, Yin JY, Meng XG, Tan W, Yang GP, et al. Epidemiological and clinical features of pediatric COVID-19. BMC Med. 2020;18(1):250. [crossref][PubMed]
9.
Krajcar N, Stemberger Maric´ L, Šurina A, Kurec? ic´ Filipovic´ S, Trkulja V, Roglic´ S, et al. Epidemiological and clinical features of Croatian children and adolescents with a PCR-confirmed coronavirus disease 2019: Differences between the first and second epidemic wave. Croat Med J. 2020;61(6):491-500. [crossref][PubMed]
10.
WHO. Coronavirus.[Internet] World Health Organisation. Published 2022. [Cited 2022 Jan 7]. Available from: https://www.who.int/health-topics/coronavirus#tab=tab.
11.
Kumar A, Asghar A, Dwivedi P, Kumar G, Narayan RK, Jha RK, et al. Second wave of COVID-19 in India could be predicted with genomic surveillance of SARSCoV-2 variants coupled with epidemiological data: A tool for future. medRxiv. 2021. [crossref]
12.
Murugan TP, Ghosh U, Rajan RJ, Punnen A, Chandran J, Das Adhikari D, et al. Spectrum of COVID-19 disease in children: A retrospective analysis comparing wave 1 and wave 2 from a tertiary hospital in South India. Indian J Pediatr. 2022;89(12):1222-28. [crossref][PubMed]
13.
Bogam P, Joshi A, Nagarkar S, Jain D, Gupte N, Shashidhara L, et al. Burden of COVID-19 and case fatality rate in Pune India: An analysis of first and second wave of the pandemic. IJID Reg. 2021;2:74-81. [crossref][PubMed]
14.
Thacker T. Omicron wave likely to subside by March: Experts [Internet]. The Economic Times. 2022 [cited 13 July 2022]. Available from: https://economictimes.indiatimes.com/news/india/omicron-wave-likely-to-subside-by-march-experts/articleshow/88887741.cms.
15.
Li Y, Shi J, Xia J, Duan J, Chen L, Yu X, et al. Asymptomatic and symptomatic patients with non severe Coronavirus Disease (COVID-19) have similar clinical features and virological courses: A retrospective single center study. Front Microbiol. 2020;11:1570. [crossref][PubMed]
16.
Hoang A, Chorath K, Moreira A. COVID-19 in 7780 pediatric patients: A systematic review. E Clinical Medicine. 2020;24:100433. [crossref][PubMed]
17.
Li B, Zhang S, Zhang R, Chen X, Wang Y, Zhu C. Epidemiological and clinical characteristics of COVID-19 in children: A systematic review and meta-analysis. Front Pediatr. 2020;8:591132. [crossref][PubMed]
18.
Tung Ho CL, Oligbu P, Ojubolamo O, Pervaiz M, Oligbu G. Clinical characteristics of children with COVID-19. AIMS Public Heal. 2020;7(2):258-73. [crossref][PubMed]
19.
Wang Z, Zhou Q, Wang C, Shi Q, Lu S, Ma Y, et al. Clinical characteristics of children with COVID-19: A rapid review and meta-analysis. Ann Transl Med. 2020;8(10):620. [crossref][PubMed]
20.
Tang A, Xu W, Shen M, Chen P, Li G, Liu Y, et al. A retrospective study of the clinical characteristics of COVID-19 infection in 26 children. medRxiv. 2020. [crossref]
21.
Preston LE, Chevinsky JR, Kompaniyets L, Lavery AM, Kimball A, Boehmer TK, et al. Characteristics and disease severity of US children and adolescents diagnosed with COVID-19. JAMA Netw Open. 2021;4:e215298. [crossref][PubMed]
22.
Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020:e201346. [crossref][PubMed]
23.
Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145:e20200702.[crossref][PubMed]
24.
Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347-58. [crossref][PubMed]
25.
Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 202l;383:334-46.

DOI and Others

DOI: 10.7860/JCDR/2023/60141.18038

Date of Submission: Sep 09, 2022
Date of Peer Review: Dec 28, 2022
Date of Acceptance: Jan 14, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 23, 2022
• Manual Googling: Jan 06, 2023
• iThenticate Software: Jan 11, 2023 (9%)

ETYMOLOGY: Author Origin

Emendations: 6

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com