Review
BibTex RIS Cite

Çocuklarda COVID-19

Year 2022, Volume: 2 Issue: 1, 1 - 8, 30.06.2022

Abstract

COVID-19 (Korona virüs hastalığı 2019) ilk kez 2019’da Çin’de görülen ve sonradan SARS-CoV-2 (şiddetli akut respiratuvar sendrom koronavirüs-2) olarak adlandırılan bir RNA virüsünün meydana getirdiği ve milyonlarca ölüme sebep olan, komplikasyonlar yaratan, pandemiye neden olan bir hastalıktır. Hastalık farklı yaş gruplarında farklı kliniklerle kendisini göstermektedir. Çocuklarda erişkinlere oranla asemptomatik vaka oranı çok daha yüksek olsa da risk grubundaki çocuklarda ciddi sorunlar yaratabilmektedir. Özellikle hastalık döneminde çocuklarda ateş, öksürük, kusma gibi semptomlara sebep olabilirken bu süreçten sonra da çok farklı klinik tablolar izlenebilmektedir. Günümüzde ne kadar vaka sayıları ve yoğun bakım yükü azalmış olsa da halen hastalığın önemi açıktır. Çalışmamızdaki amacımız COVID-19 hastalığının patogenezine genel bakış açısıyla yaklaşım yaratmak ve çocuklardaki olası klinikler için bir öngörü oluşturmaktır.

Supporting Institution

Çukurova Üniversitesi Tıp Fakültesi

Thanks

Katkılarından dolayı bizi geleceğe hazırlayan Derya ALABAZ hocamıza sonsuz teşekkürler

References

  • Vlachos J, Hertegård E, B Svaleryd H. The effects of school closures on SARS-CoV-2 among parents and teachers. Proc Natl Acad Sci U S A. 2021 Mar 2;118(9):e2020834118. doi:10.1073/pnas.2020834118. PMID: 33574041; PMCID: PMC7936333.
  • Covid-19 (SARS-CoV-2 Enfeksiyonu) Güncel Dönemde Covid-19’a Yönelik Okullarda Alınması Gereken Önlemler (Mart 2022), Türkiye Cumhuriyeti Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Ankara
  • Howard-Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Britton PN. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022 Jan;58(1):46-53. doi: 10.1111/jpc.15811. Epub 2021 Oct 25. PMID: 34694037; PMCID: PMC8662268.
  • Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
  • Rathore JS, Ghosh C. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a newly emerged pathogen: an overview. Pathog Dis. 2020 Aug 1;78(6):ftaa042. doi: 10.1093/femspd/ftaa042. PMID: 32840560; PMCID: PMC7499575.
  • Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020 Mar;104(3):246-251. doi: 10.1016/j.jhin.2020.01.022. Epub 2020 Feb 6. Erratum in: J Hosp Infect. 2020 Jun 17;: PMID: 32035997; PMCID: PMC7132493.
  • Cui J, Li F, Shi Z-L. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019; 17(3):181-192. doi: 10.1038/s41579-018-0118-9
  • Bosch BJ, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex. J Virol. 2003 Aug;77(16):8801-11. doi: 10.1128/jvi.77.16.8801-8811.2003. PMID: 12885899; PMCID: PMC167208.
  • Wu K, Werner AP, Moliva JI, et al. mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants.external icon bioRxiv. Posted January 25, 2021.
  • Xie X, Zou J, Fontes-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited seraexternal icon. bioRxiv. Posted January 7, 2021. Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodiesexternal icon. bioRxiv. [Preprint posted online January 4, 2021]
  • Bunyavanich S, Do A, Vicencio A. Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults. JAMA. 2020 Jun 16;323(23):2427-2429. doi: 10.1001/jama.2020.8707. PMID: 32432657; PMCID: PMC7240631.
  • Horby P, Huntley C, Davies N, et al. NERVTAG note on B.1.1.7 severitypdf iconexternal icon. SAGE meeting report. January 21, 2021.
  • Wu K, Werner AP, Moliva JI, et al. mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants.external icon bioRxiv. Posted January 25, 2021.
  • Xie X, Zou J, Fontes-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited seraexternal icon. bioRxiv. Posted January 7, 2021. Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodiesexternal icon. bioRxiv. [Preprint posted online January 4, 2021]
  • Allen H, Vusirikala A, Flannagan J, Twohig KA, Zaidi A, Chudasama D et al; COVID-19 Genomics UK (COG-UK Consortium). Household transmission of COVID-19 cases associated with SARS-CoV-2 delta variant (B.1.617.2): national case-control study. Lancet Reg Health Eur. 2022 Jan;12:100252. doi: 10.1016/j.lanepe.2021.100252. Epub 2021 Oct 28. PMID: 34729548; PMCID: PMC8552812.
  • Chen J, Wang R, Gilby NB, Wei GW. Omicron Variant (B.1.1.529): Infectivity, Vaccine Breakthrough, and Antibody Resistance. J Chem Inf Model. 2022 Jan 24;62(2):412-422. doi: 10.1021/acs.jcim.1c01451. Epub 2022 Jan 6. PMID: 34989238; PMCID: PMC8751645.
  • Domingo P, Mur I, Pomar V, Corominas H, Casademont J, de Benito N. The four horsemen of a viral Apocalypse: The pathogenesis of SARS-CoV-2 infection (COVID-19). EBioMedicine. 2020 Aug;58:102887. doi: 10.1016/j.ebiom.2020.102887. Epub 2020 Jul 29. PMID: 32736307; PMCID: PMC7387269.
  • Shang J, Wan Y, Luo C, Ye G, Geng Q, Auerbach A et al. Cell entry mechanisms of SARS-CoV-2. Proc Natl Acad Sci U S A. 2020 May 26;117(21):11727-11734. doi: 10.1073/pnas.2003138117. Epub 2020 May 6. PMID: 32376634; PMCID: PMC7260975.
  • Totura AL, Baric RS. SARS coronavirus pathogenesis: host innate immune responses and viral antagonism of interferon. Curr Opin Virol. 2012 Jun;2(3):264-75. doi: 10.1016/j.coviro.2012.04.004. Epub 2012 May 7. PMID: 22572391; PMCID: PMC7102726.
  • Grubaugh ND, Hanage WP, Rasmussen AL. Making Sense of Mutation: What D614G Means for the COVID-19 Pandemic Remains Unclear. Cell. 2020 Aug 20;182(4):794-795. doi: 10.1016/j.cell.2020.06.040. Epub 2020 Jul 3. PMID: 32697970; PMCID: PMC7332445.
  • Nikolopoulou GB, Maltezou HC. COVID-19 in Children: Where do we Stand? Arch Med Res. 2022 Jan;53(1):1-8. doi: 10.1016/j.arcmed.2021.07.002. Epub 2021 Jul 6. PMID: 34311990; PMCID: PMC8257427.
  • Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP et al ; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13. PMID: 32179124; PMCID: PMC7102608.
  • Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020 Jun;80(6):656-665. doi: 10.1016/j.jinf.2020.03.041. Epub 2020 Apr 10. PMID: 32283155; PMCID: PMC7151416.
  • Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One. 2020 Jun 23;15(6):e0234765. doi: 10.1371/journal.pone.0234765. PMID: 32574165; PMCID: PMC7310678.
  • Viner RM, Ward JL, Hudson LD, Ashe M, Patel SV, Hargreaves D et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020 Dec 17:archdischild-2020-320972. doi: 10.1136/archdischild-2020-320972. Epub ahead of print. PMID: 33334728; PMCID: PMC7747494.
  • Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr Pulmonol. 2020 Oct;55(10):2565-2575. doi: 10.1002/ppul.24991. Epub 2020 Aug 4. PMID: 32725955.
  • Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol. 2021 Feb;93(2):1057-1069. doi: 10.1002/jmv.26398. Epub 2020 Sep 28. PMID: 32761898; PMCID: PMC7436402.
  • Molteni E, Sudre CH, Canas LS, Bhopal SS, Hughes RC, Antonelli M et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health. 2021 Oct;5(10):708-718. doi: 10.1016/S2352-4642(21)00198-X. Epub 2021 Aug 3. Erratum in: Lancet Child Adolesc Health. 2021 Aug 31;: PMID: 34358472; PMCID: PMC8443448.
  • Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child. 2021 Feb 16;106(5):440–8. doi: 10.1136/archdischild-2020-321385. Epub ahead of print. PMID: 33593743; PMCID: PMC8070630.
  • Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep. 2021 May 13;11(1):10231. doi: 10.1038/s41598-021-89553-1. PMID: 33986390; PMCID: PMC8119690.
  • Yazdanpanah N, Rezaei N. Autoimmune complications of COVID-19. J Med Virol. 2022 Jan;94(1):54-62. doi: 10.1002/jmv.27292. Epub 2021 Aug 31. PMID: 34427929; PMCID: PMC8661629.
  • Henry BM, Benoit SW, de Oliveira MHS, Hsieh WC, Benoit J, Ballout RA et al. Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review. Clin Biochem. 2020 Jul;81:1-8. doi: 10.1016/j.clinbiochem.2020.05.012. Epub 2020 May 27. PMID: 32473151; PMCID: PMC7251358.
  • Mansourian M, Ghandi Y, Habibi D, Mehrabi S. COVID-19 infection in children: A systematic review and meta-analysis of clinical features and laboratory findings. Arch Pediatr. 2021 Apr;28(3):242-248. doi: 10.1016/j.arcped.2020.12.008. Epub 2021 Jan 9. PMID: 33483192; PMCID: PMC7794595.
  • Isoldi S, Mallardo S, Marcellino A, Bloise S, Dilillo A, Iorfida D, et al. The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID-19: A 6-months prospective study. J Med Virol. 2021 May;93(5):3122-3132. doi: 10.1002/jmv.26871. Epub 2021 Feb 16. PMID: 33570199; PMCID: PMC8014060.
  • Guner Ozenen G, Sahbudak Bal Z, Umit Z, Bilen NM, Yildirim Arslan S, Yurtseven A, et al. Demographic, clinical, and laboratory features of COVID-19 in children: The role of mean platelet volume in predicting hospitalization and severity. J Med Virol. 2021 May;93(5):3227-3237. doi: 10.1002/jmv.26902. Epub 2021 Mar 11. PMID: 33629365; PMCID: PMC8013348.
  • Karbuz A, Akkoc G, Bedir Demirdag T, Yilmaz Ciftdogan D, Ozer A, Cakir D, et al. Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey. Front Pediatr. 2021 May 7;9:631547. doi: 10.3389/fped.2021.631547. PMID: 34055680; PMCID: PMC8161543.
  • Qi K, Zeng W, Ye M, Zheng L, Song C, Hu S, et al. Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis. Medicine (Baltimore). 2021 Apr 16;100(15):e25230. doi: 10.1097/MD.0000000000025230. PMID: 33847620; PMCID: PMC8052054.
  • Giannattasio A, D'Anna C, Muzzica S, Mauro A, Rosa M, Angrisani F, et al. Is COVID-19 a hyperferritinemic syndrome in children? Clin Chem Lab Med. 2021 May 20;59(11):e409-e412. doi: 10.1515/cclm-2021-0373. PMID: 34013681.
  • Pekçevik Y, Belet Ü. SARS-CoV-2 Pandemisinde Radyoloji Kliniğinde Hasta Yönetimi, Akciğer Görüntülemenin Rolü ve COVID-19 Pnömonisi ile İlişkili Toraks BT Bulguları. Tepecik Eğit. ve Araşt. Hast. Dergisi 2020;30(Ek sayı):195-212
  • Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Rofo. 2022 Feb;194(2):141-151. English, German. doi: 10.1055/a-1522-3155. Epub 2021 Oct 14. PMID: 34649291.
  • de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB. Clinical manifestations of children with COVID-19: A systematic review. Pediatr Pulmonol. 2020 Aug;55(8):1892-1899. doi: 10.1002/ppul.24885. Epub 2020 Jun 15. PMID: 32492251; PMCID: PMC7300659.
  • Laçinel Gürlevik S, Günbey C, Ozsurekci Y, Oygar PD, Kesici S, Gocmen R et al. Neurologic manifestations in children with COVID-19 from a tertiary center in Turkey and literature review. Eur J Paediatr Neurol. 2022 Mar;37:139-154. doi: 10.1016/j.ejpn.2022.02.003. Epub 2022 Feb 18. PMID: 35287009; PMCID: PMC8853984.
  • Rostad BS, Shah JH, Rostad CA, Jaggi P, Richer EJ, Linam LE et al. Chest radiograph features of multisystem inflammatory syndrome in children (MIS-C) compared to pediatric COVID-19. Pediatr Radiol. 2021 Feb;51(2):231-238. doi: 10.1007/s00247-020-04921-9. Epub 2021 Jan 6. PMID: 33404786; PMCID: PMC7785920.
  • DeBiasi RL, Delaney M. Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface. JAMA Pediatr. 2021 Jan 1;175(1):16-18. doi: 10.1001/jamapediatrics.2020.3996. PMID: 32857158.
  • Bohn MK, Yousef P, Steele S, Sepiashvili L, Adeli K. MultiInflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective. J Appl Lab Med. 2022 Jan 5;7(1):311-321. doi: 10.1093/jalm/jfab114. PMID: 34463724; PMCID: PMC8499820.
  • Icenogle, T. (2020). COVID-19: Infection or autoimmunity. Frontiers in Immunology, 11,2055.
  • Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020 Jul 21;324(3):259-269. doi: 10.1001/jama.2020.10369. PMID: 32511692; PMCID: PMC7281356.
  • Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020 Jul 23;383(4):334-346. doi: 10.1056/NEJMoa2021680. Epub 2020 Jun 29. PMID: 32598831; PMCID: PMC7346765.
  • Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020 Jul 23;383(4):347-358. doi: 10.1056/NEJMoa2021756. Epub 2020 Jun 29. PMID: 32598830; PMCID: PMC7346766.
  • Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J et al; California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080. doi: 10.15585/mmwr.mm6932e2. Erratum in: MMWR Morb Mortal Wkly Rep. 2020 Sep 04;69(35):1229. PMID: 32790663; PMCID: PMC7440126.
  • Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H et al; Overcoming COVID-19 Investigators. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA. 2021 Mar 16;325(11):1074-1087. doi: 10.1001/jama.2021.2091. PMID: 33625505; PMCID: PMC7905703.
  • Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020 Sep;4(9):669-677. doi: 10.1016/S2352-4642(20)30215-7. Epub 2020 Jul 9. Erratum in: Lancet Child Adolesc Health. 2020 Jul 17;: PMID: 32653054; PMCID: PMC7347350.
  • Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2020 Nov;39(11):e340-e346. doi: 10.1097/INF.0000000000002888. PMID: 32925547.
  • Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 2021 Jun;38:51-57. doi: 10.1016/j.prrv.2020.08.001. Epub 2020 Aug 11. PMID: 32891582; PMCID: PMC7417920.
  • Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020 Sep;26:100527. doi: 10.1016/j.eclinm.2020.100527. Epub 2020 Sep 4. PMID: 32923992; PMCID: PMC7473262.
  • Halepas S, Lee KC, Myers A, Yoon RK, Chung W, Peters SM. Oral manifestations of COVID-2019-related multisystem inflammatory syndrome in children: a review of 47 pediatric patients. J Am Dent Assoc. 2021 Mar;152(3):202-208. doi: 10.1016/j.adaj.2020.11.014. Epub 2020 Dec 9. PMID: 33632409; PMCID: PMC7832615.
  • CDC Covid Data Tracker. Centers for Disease Control and Pre- vention, Centers for Disease Control and Prevention, covid.cdc. gov/covid-data-tracker/#mis-national-surveillance
  • Aldawas A, Ishfaq M. COVID-19: Multisystem Inflammatory Syndrome in Children (MIS-C). Cureus. 2022 Jan 9;14(1):e21064. doi: 10.7759/cureus.21064. PMID: 35165539; PMCID: PMC8826481.
  • Kavurt AV, Bağrul D, Gül AEK, Özdemiroğlu N, Ece İ, Çetin İİ et al. Echocardiographic Findings and Correlation with Laboratory Values in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol. 2022 Feb;43(2):413-425. doi: 10.1007/s00246-021-02738-3. Epub 2021 Sep 26. PMID: 34564734; PMCID: PMC8475320.
  • Waseem M, Shariff MA, Tay ET, Mortel D, Savadkar S, Lee H, et al. Multisystem Inflammatory Syndrome in Children. J Emerg Med. 2022 Jan;62(1):28-37. doi: 10.1016/j.jemermed.2021.07.070. Epub 2021 Sep 17. PMID: 34538678; PMCID: PMC8445772.
  • Thomson, H. (2021). Children with long covid. New Scientist, 3323, 10-11
  • Fainardi V, Meoli A, Chiopris G, Motta M, Skenderaj K, Grandinetti R, et al. Long COVID in Children and Adolescents. Life (Basel). 2022 Feb 14;12(2):285. doi: 10.3390/life12020285. PMID: 35207572; PMCID: PMC8876679.
  • Stephenson, T.; Pinto Pereira, S.; Shafran, R.; De Stavola, B.; Rojas, N.; McOwat, K.; Simmons, R.; Zavala, M.; O’Mahoney, L.; Chalder, T.; et al. Long COVID—The physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) study. In Nature Portfolio; Research Square: Durham, NC, USA, 2021.
  • Scapaticci S, Neri CR, Marseglia GL, Staiano A, Chiarelli F, Verduci E. The impact of the COVID-19 pandemic on lifestyle behaviors in children and adolescents: an international overview. Ital J Pediatr. 2022 Feb 4;48(1):22. doi: 10.1186/s13052-022-01211-y. PMID: 35120570; PMCID: PMC8815717.
  • Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996. PMID: 32471884; PMCID: PMC7256651.

COVID-19 in children

Year 2022, Volume: 2 Issue: 1, 1 - 8, 30.06.2022

Abstract

COVID-19 (Corona virus disease 2019) is caused by an RNA virus first seen in China in 2019 and later named SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), causing millions of deaths and causing complications. It is a disease that causes a pandemic. The disease manifests itself in different clinics in different age groups. Although the rate of asymptomatic cases is much higher in children than in adults, it can cause serious problems in children in the risk group. While it may cause symptoms such as fever, cough, and vomiting, especially in children during the disease period, very different clinical presentation can be observed after this process. Although the number of cases and the intensive care burden have decreased today, the importance of the disease is still clear. Our aim in our study is to create an approach with an overview of the pathogenesis of COVID-19 disease and to create a foresight for possible clinics in children.

References

  • Vlachos J, Hertegård E, B Svaleryd H. The effects of school closures on SARS-CoV-2 among parents and teachers. Proc Natl Acad Sci U S A. 2021 Mar 2;118(9):e2020834118. doi:10.1073/pnas.2020834118. PMID: 33574041; PMCID: PMC7936333.
  • Covid-19 (SARS-CoV-2 Enfeksiyonu) Güncel Dönemde Covid-19’a Yönelik Okullarda Alınması Gereken Önlemler (Mart 2022), Türkiye Cumhuriyeti Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü, Ankara
  • Howard-Jones AR, Burgner DP, Crawford NW, Goeman E, Gray PE, Hsu P, Kuek S, McMullan BJ, Tosif S, Wurzel D, Bowen AC, Danchin M, Koirala A, Sharma K, Yeoh DK, Britton PN. COVID-19 in children. II: Pathogenesis, disease spectrum and management. J Paediatr Child Health. 2022 Jan;58(1):46-53. doi: 10.1111/jpc.15811. Epub 2021 Oct 25. PMID: 34694037; PMCID: PMC8662268.
  • Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
  • Rathore JS, Ghosh C. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a newly emerged pathogen: an overview. Pathog Dis. 2020 Aug 1;78(6):ftaa042. doi: 10.1093/femspd/ftaa042. PMID: 32840560; PMCID: PMC7499575.
  • Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect. 2020 Mar;104(3):246-251. doi: 10.1016/j.jhin.2020.01.022. Epub 2020 Feb 6. Erratum in: J Hosp Infect. 2020 Jun 17;: PMID: 32035997; PMCID: PMC7132493.
  • Cui J, Li F, Shi Z-L. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol 2019; 17(3):181-192. doi: 10.1038/s41579-018-0118-9
  • Bosch BJ, van der Zee R, de Haan CA, Rottier PJ. The coronavirus spike protein is a class I virus fusion protein: structural and functional characterization of the fusion core complex. J Virol. 2003 Aug;77(16):8801-11. doi: 10.1128/jvi.77.16.8801-8811.2003. PMID: 12885899; PMCID: PMC167208.
  • Wu K, Werner AP, Moliva JI, et al. mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants.external icon bioRxiv. Posted January 25, 2021.
  • Xie X, Zou J, Fontes-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited seraexternal icon. bioRxiv. Posted January 7, 2021. Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodiesexternal icon. bioRxiv. [Preprint posted online January 4, 2021]
  • Bunyavanich S, Do A, Vicencio A. Nasal Gene Expression of Angiotensin-Converting Enzyme 2 in Children and Adults. JAMA. 2020 Jun 16;323(23):2427-2429. doi: 10.1001/jama.2020.8707. PMID: 32432657; PMCID: PMC7240631.
  • Horby P, Huntley C, Davies N, et al. NERVTAG note on B.1.1.7 severitypdf iconexternal icon. SAGE meeting report. January 21, 2021.
  • Wu K, Werner AP, Moliva JI, et al. mRNA-1273 vaccine induces neutralizing antibodies against spike mutants from global SARS-CoV-2 variants.external icon bioRxiv. Posted January 25, 2021.
  • Xie X, Zou J, Fontes-Garfias CR, et al. Neutralization of N501Y mutant SARS-CoV-2 by BNT162b2 vaccine-elicited seraexternal icon. bioRxiv. Posted January 7, 2021. Greaney AJ, Loes AN, Crawford KHD, et al. Comprehensive mapping of mutations to the SARS-CoV-2 receptor-binding domain that affect recognition by polyclonal human serum antibodiesexternal icon. bioRxiv. [Preprint posted online January 4, 2021]
  • Allen H, Vusirikala A, Flannagan J, Twohig KA, Zaidi A, Chudasama D et al; COVID-19 Genomics UK (COG-UK Consortium). Household transmission of COVID-19 cases associated with SARS-CoV-2 delta variant (B.1.617.2): national case-control study. Lancet Reg Health Eur. 2022 Jan;12:100252. doi: 10.1016/j.lanepe.2021.100252. Epub 2021 Oct 28. PMID: 34729548; PMCID: PMC8552812.
  • Chen J, Wang R, Gilby NB, Wei GW. Omicron Variant (B.1.1.529): Infectivity, Vaccine Breakthrough, and Antibody Resistance. J Chem Inf Model. 2022 Jan 24;62(2):412-422. doi: 10.1021/acs.jcim.1c01451. Epub 2022 Jan 6. PMID: 34989238; PMCID: PMC8751645.
  • Domingo P, Mur I, Pomar V, Corominas H, Casademont J, de Benito N. The four horsemen of a viral Apocalypse: The pathogenesis of SARS-CoV-2 infection (COVID-19). EBioMedicine. 2020 Aug;58:102887. doi: 10.1016/j.ebiom.2020.102887. Epub 2020 Jul 29. PMID: 32736307; PMCID: PMC7387269.
  • Shang J, Wan Y, Luo C, Ye G, Geng Q, Auerbach A et al. Cell entry mechanisms of SARS-CoV-2. Proc Natl Acad Sci U S A. 2020 May 26;117(21):11727-11734. doi: 10.1073/pnas.2003138117. Epub 2020 May 6. PMID: 32376634; PMCID: PMC7260975.
  • Totura AL, Baric RS. SARS coronavirus pathogenesis: host innate immune responses and viral antagonism of interferon. Curr Opin Virol. 2012 Jun;2(3):264-75. doi: 10.1016/j.coviro.2012.04.004. Epub 2012 May 7. PMID: 22572391; PMCID: PMC7102726.
  • Grubaugh ND, Hanage WP, Rasmussen AL. Making Sense of Mutation: What D614G Means for the COVID-19 Pandemic Remains Unclear. Cell. 2020 Aug 20;182(4):794-795. doi: 10.1016/j.cell.2020.06.040. Epub 2020 Jul 3. PMID: 32697970; PMCID: PMC7332445.
  • Nikolopoulou GB, Maltezou HC. COVID-19 in Children: Where do we Stand? Arch Med Res. 2022 Jan;53(1):1-8. doi: 10.1016/j.arcmed.2021.07.002. Epub 2021 Jul 6. PMID: 34311990; PMCID: PMC8257427.
  • Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP et al ; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Electronic address: https://www.lancovid.org. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020 Mar-Apr;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13. PMID: 32179124; PMCID: PMC7102608.
  • Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020 Jun;80(6):656-665. doi: 10.1016/j.jinf.2020.03.041. Epub 2020 Apr 10. PMID: 32283155; PMCID: PMC7151416.
  • Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL et al. The prevalence of symptoms in 24,410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. PLoS One. 2020 Jun 23;15(6):e0234765. doi: 10.1371/journal.pone.0234765. PMID: 32574165; PMCID: PMC7310678.
  • Viner RM, Ward JL, Hudson LD, Ashe M, Patel SV, Hargreaves D et al. Systematic review of reviews of symptoms and signs of COVID-19 in children and adolescents. Arch Dis Child. 2020 Dec 17:archdischild-2020-320972. doi: 10.1136/archdischild-2020-320972. Epub ahead of print. PMID: 33334728; PMCID: PMC7747494.
  • Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID-19 in children: A systematic review. Pediatr Pulmonol. 2020 Oct;55(10):2565-2575. doi: 10.1002/ppul.24991. Epub 2020 Aug 4. PMID: 32725955.
  • Cui X, Zhao Z, Zhang T, Guo W, Guo W, Zheng J et al. A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19). J Med Virol. 2021 Feb;93(2):1057-1069. doi: 10.1002/jmv.26398. Epub 2020 Sep 28. PMID: 32761898; PMCID: PMC7436402.
  • Molteni E, Sudre CH, Canas LS, Bhopal SS, Hughes RC, Antonelli M et al. Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2. Lancet Child Adolesc Health. 2021 Oct;5(10):708-718. doi: 10.1016/S2352-4642(21)00198-X. Epub 2021 Aug 3. Erratum in: Lancet Child Adolesc Health. 2021 Aug 31;: PMID: 34358472; PMCID: PMC8443448.
  • Irfan O, Muttalib F, Tang K, Jiang L, Lassi ZS, Bhutta Z. Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis. Arch Dis Child. 2021 Feb 16;106(5):440–8. doi: 10.1136/archdischild-2020-321385. Epub ahead of print. PMID: 33593743; PMCID: PMC8070630.
  • Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep. 2021 May 13;11(1):10231. doi: 10.1038/s41598-021-89553-1. PMID: 33986390; PMCID: PMC8119690.
  • Yazdanpanah N, Rezaei N. Autoimmune complications of COVID-19. J Med Virol. 2022 Jan;94(1):54-62. doi: 10.1002/jmv.27292. Epub 2021 Aug 31. PMID: 34427929; PMCID: PMC8661629.
  • Henry BM, Benoit SW, de Oliveira MHS, Hsieh WC, Benoit J, Ballout RA et al. Laboratory abnormalities in children with mild and severe coronavirus disease 2019 (COVID-19): A pooled analysis and review. Clin Biochem. 2020 Jul;81:1-8. doi: 10.1016/j.clinbiochem.2020.05.012. Epub 2020 May 27. PMID: 32473151; PMCID: PMC7251358.
  • Mansourian M, Ghandi Y, Habibi D, Mehrabi S. COVID-19 infection in children: A systematic review and meta-analysis of clinical features and laboratory findings. Arch Pediatr. 2021 Apr;28(3):242-248. doi: 10.1016/j.arcped.2020.12.008. Epub 2021 Jan 9. PMID: 33483192; PMCID: PMC7794595.
  • Isoldi S, Mallardo S, Marcellino A, Bloise S, Dilillo A, Iorfida D, et al. The comprehensive clinic, laboratory, and instrumental evaluation of children with COVID-19: A 6-months prospective study. J Med Virol. 2021 May;93(5):3122-3132. doi: 10.1002/jmv.26871. Epub 2021 Feb 16. PMID: 33570199; PMCID: PMC8014060.
  • Guner Ozenen G, Sahbudak Bal Z, Umit Z, Bilen NM, Yildirim Arslan S, Yurtseven A, et al. Demographic, clinical, and laboratory features of COVID-19 in children: The role of mean platelet volume in predicting hospitalization and severity. J Med Virol. 2021 May;93(5):3227-3237. doi: 10.1002/jmv.26902. Epub 2021 Mar 11. PMID: 33629365; PMCID: PMC8013348.
  • Karbuz A, Akkoc G, Bedir Demirdag T, Yilmaz Ciftdogan D, Ozer A, Cakir D, et al. Epidemiological, Clinical, and Laboratory Features of Children With COVID-19 in Turkey. Front Pediatr. 2021 May 7;9:631547. doi: 10.3389/fped.2021.631547. PMID: 34055680; PMCID: PMC8161543.
  • Qi K, Zeng W, Ye M, Zheng L, Song C, Hu S, et al. Clinical, laboratory, and imaging features of pediatric COVID-19: A systematic review and meta-analysis. Medicine (Baltimore). 2021 Apr 16;100(15):e25230. doi: 10.1097/MD.0000000000025230. PMID: 33847620; PMCID: PMC8052054.
  • Giannattasio A, D'Anna C, Muzzica S, Mauro A, Rosa M, Angrisani F, et al. Is COVID-19 a hyperferritinemic syndrome in children? Clin Chem Lab Med. 2021 May 20;59(11):e409-e412. doi: 10.1515/cclm-2021-0373. PMID: 34013681.
  • Pekçevik Y, Belet Ü. SARS-CoV-2 Pandemisinde Radyoloji Kliniğinde Hasta Yönetimi, Akciğer Görüntülemenin Rolü ve COVID-19 Pnömonisi ile İlişkili Toraks BT Bulguları. Tepecik Eğit. ve Araşt. Hast. Dergisi 2020;30(Ek sayı):195-212
  • Gross A, Albrecht T. One year of COVID-19 pandemic: what we Radiologists have learned about imaging. Rofo. 2022 Feb;194(2):141-151. English, German. doi: 10.1055/a-1522-3155. Epub 2021 Oct 14. PMID: 34649291.
  • de Souza TH, Nadal JA, Nogueira RJN, Pereira RM, Brandão MB. Clinical manifestations of children with COVID-19: A systematic review. Pediatr Pulmonol. 2020 Aug;55(8):1892-1899. doi: 10.1002/ppul.24885. Epub 2020 Jun 15. PMID: 32492251; PMCID: PMC7300659.
  • Laçinel Gürlevik S, Günbey C, Ozsurekci Y, Oygar PD, Kesici S, Gocmen R et al. Neurologic manifestations in children with COVID-19 from a tertiary center in Turkey and literature review. Eur J Paediatr Neurol. 2022 Mar;37:139-154. doi: 10.1016/j.ejpn.2022.02.003. Epub 2022 Feb 18. PMID: 35287009; PMCID: PMC8853984.
  • Rostad BS, Shah JH, Rostad CA, Jaggi P, Richer EJ, Linam LE et al. Chest radiograph features of multisystem inflammatory syndrome in children (MIS-C) compared to pediatric COVID-19. Pediatr Radiol. 2021 Feb;51(2):231-238. doi: 10.1007/s00247-020-04921-9. Epub 2021 Jan 6. PMID: 33404786; PMCID: PMC7785920.
  • DeBiasi RL, Delaney M. Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface. JAMA Pediatr. 2021 Jan 1;175(1):16-18. doi: 10.1001/jamapediatrics.2020.3996. PMID: 32857158.
  • Bohn MK, Yousef P, Steele S, Sepiashvili L, Adeli K. MultiInflammatory Syndrome in Children: A View into Immune Pathogenesis from a Laboratory Perspective. J Appl Lab Med. 2022 Jan 5;7(1):311-321. doi: 10.1093/jalm/jfab114. PMID: 34463724; PMCID: PMC8499820.
  • Icenogle, T. (2020). COVID-19: Infection or autoimmunity. Frontiers in Immunology, 11,2055.
  • Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P et al; PIMS-TS Study Group and EUCLIDS and PERFORM Consortia. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA. 2020 Jul 21;324(3):259-269. doi: 10.1001/jama.2020.10369. PMID: 32511692; PMCID: PMC7281356.
  • Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF et al; Overcoming COVID-19 Investigators; CDC COVID-19 Response Team. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. 2020 Jul 23;383(4):334-346. doi: 10.1056/NEJMoa2021680. Epub 2020 Jun 29. PMID: 32598831; PMCID: PMC7346765.
  • Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J et al; New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem Inflammatory Syndrome in Children in New York State. N Engl J Med. 2020 Jul 23;383(4):347-358. doi: 10.1056/NEJMoa2021756. Epub 2020 Jun 29. PMID: 32598830; PMCID: PMC7346766.
  • Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J et al; California MIS-C Response Team. COVID-19-Associated Multisystem Inflammatory Syndrome in Children - United States, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1074-1080. doi: 10.15585/mmwr.mm6932e2. Erratum in: MMWR Morb Mortal Wkly Rep. 2020 Sep 04;69(35):1229. PMID: 32790663; PMCID: PMC7440126.
  • Feldstein LR, Tenforde MW, Friedman KG, Newhams M, Rose EB, Dapul H et al; Overcoming COVID-19 Investigators. Characteristics and Outcomes of US Children and Adolescents With Multisystem Inflammatory Syndrome in Children (MIS-C) Compared With Severe Acute COVID-19. JAMA. 2021 Mar 16;325(11):1074-1087. doi: 10.1001/jama.2021.2091. PMID: 33625505; PMCID: PMC7905703.
  • Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020 Sep;4(9):669-677. doi: 10.1016/S2352-4642(20)30215-7. Epub 2020 Jul 9. Erratum in: Lancet Child Adolesc Health. 2020 Jul 17;: PMID: 32653054; PMCID: PMC7347350.
  • Kaushik A, Gupta S, Sood M, Sharma S, Verma S. A Systematic Review of Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 Infection. Pediatr Infect Dis J. 2020 Nov;39(11):e340-e346. doi: 10.1097/INF.0000000000002888. PMID: 32925547.
  • Radia T, Williams N, Agrawal P, Harman K, Weale J, Cook J, Gupta A. Multi-system inflammatory syndrome in children & adolescents (MIS-C): A systematic review of clinical features and presentation. Paediatr Respir Rev. 2021 Jun;38:51-57. doi: 10.1016/j.prrv.2020.08.001. Epub 2020 Aug 11. PMID: 32891582; PMCID: PMC7417920.
  • Ahmed M, Advani S, Moreira A, Zoretic S, Martinez J, Chorath K et al. Multisystem inflammatory syndrome in children: A systematic review. EClinicalMedicine. 2020 Sep;26:100527. doi: 10.1016/j.eclinm.2020.100527. Epub 2020 Sep 4. PMID: 32923992; PMCID: PMC7473262.
  • Halepas S, Lee KC, Myers A, Yoon RK, Chung W, Peters SM. Oral manifestations of COVID-2019-related multisystem inflammatory syndrome in children: a review of 47 pediatric patients. J Am Dent Assoc. 2021 Mar;152(3):202-208. doi: 10.1016/j.adaj.2020.11.014. Epub 2020 Dec 9. PMID: 33632409; PMCID: PMC7832615.
  • CDC Covid Data Tracker. Centers for Disease Control and Pre- vention, Centers for Disease Control and Prevention, covid.cdc. gov/covid-data-tracker/#mis-national-surveillance
  • Aldawas A, Ishfaq M. COVID-19: Multisystem Inflammatory Syndrome in Children (MIS-C). Cureus. 2022 Jan 9;14(1):e21064. doi: 10.7759/cureus.21064. PMID: 35165539; PMCID: PMC8826481.
  • Kavurt AV, Bağrul D, Gül AEK, Özdemiroğlu N, Ece İ, Çetin İİ et al. Echocardiographic Findings and Correlation with Laboratory Values in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19. Pediatr Cardiol. 2022 Feb;43(2):413-425. doi: 10.1007/s00246-021-02738-3. Epub 2021 Sep 26. PMID: 34564734; PMCID: PMC8475320.
  • Waseem M, Shariff MA, Tay ET, Mortel D, Savadkar S, Lee H, et al. Multisystem Inflammatory Syndrome in Children. J Emerg Med. 2022 Jan;62(1):28-37. doi: 10.1016/j.jemermed.2021.07.070. Epub 2021 Sep 17. PMID: 34538678; PMCID: PMC8445772.
  • Thomson, H. (2021). Children with long covid. New Scientist, 3323, 10-11
  • Fainardi V, Meoli A, Chiopris G, Motta M, Skenderaj K, Grandinetti R, et al. Long COVID in Children and Adolescents. Life (Basel). 2022 Feb 14;12(2):285. doi: 10.3390/life12020285. PMID: 35207572; PMCID: PMC8876679.
  • Stephenson, T.; Pinto Pereira, S.; Shafran, R.; De Stavola, B.; Rojas, N.; McOwat, K.; Simmons, R.; Zavala, M.; O’Mahoney, L.; Chalder, T.; et al. Long COVID—The physical and mental health of children and non-hospitalised young people 3 months after SARS-CoV-2 infection; a national matched cohort study (The CLoCk) study. In Nature Portfolio; Research Square: Durham, NC, USA, 2021.
  • Scapaticci S, Neri CR, Marseglia GL, Staiano A, Chiarelli F, Verduci E. The impact of the COVID-19 pandemic on lifestyle behaviors in children and adolescents: an international overview. Ital J Pediatr. 2022 Feb 4;48(1):22. doi: 10.1186/s13052-022-01211-y. PMID: 35120570; PMCID: PMC8815717.
  • Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG et al. Characterization and clinical course of 1000 patients with coronavirus disease 2019 in New York: retrospective case series. BMJ. 2020 May 29;369:m1996. doi: 10.1136/bmj.m1996. PMID: 32471884; PMCID: PMC7256651.
There are 65 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Review
Authors

Volkan Odabaşı

Görkem Öztosun

Ömer Faruk Özdemir

Türkan Bozdemir

Derya Alabaz

Publication Date June 30, 2022
Published in Issue Year 2022 Volume: 2 Issue: 1

Cite

AMA Odabaşı V, Öztosun G, Özdemir ÖF, Bozdemir T, Alabaz D. Çocuklarda COVID-19. Çukurova Tıp Öğrenci Derg. June 2022;2(1):1-8.