Scientific Letter
Analysis of pancreatic function in pediatric patients with COVID-19
Análisis de la función pancreática en pacientes pediátricos con COVID-19
Miguel Ángel Molina Gutiérreza,
, María José Alcázar Villarb, José Antonio Ruíz Domínguezc, Belén Sagastizábal Cardelúsd, Beatríz García Cuarteroe, on behalf of the Research Group on Urgent Paediatric Endocrinological Diseases 1
Corresponding author
a Servicio de Urgencias Pediátricas, Hospital Universitario La Paz, Madrid, Spain
b Servicio de Pediatría, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
c Servicio de Urgencias Pediátricas, Hospital Universitario La Paz, Madrid, Spain
d Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, Spain
e Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Belén Sagastizábal Cardelús, Beatríz García Cuartero" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Miguel Ángel" "apellidos" => "Molina Gutiérrez" "email" => array:1 [ 0 => "malacatin@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María José" "apellidos" => "Alcázar Villar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José Antonio" "apellidos" => "Ruíz Domínguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Belén" "apellidos" => "Sagastizábal Cardelús" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span 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"identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario de Getafe, Getafe, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Unidad de Endocrinología y Diabetes Pediátrica, Servicio de Pediatría, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la función pancreática en pacientes pediátricos con COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3916 "Ancho" => 1675 "Tamanyo" => 621953 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analysis of pancreatic function.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">There has been a striking increase in the number of newly diagnosed cases of type 1 diabetes in children in the context of the coronavirus disease 2019 (COVID-19) pandemic.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">With the aim of assessing short-term pancreatic function in children with mild infection by SARS-CoV-2, we conducted a multicentre prospective study in 4 Spanish hospitals between September 2020 and June 2021. The study included 89 patients with a diagnosis of SARS-CoV-2 infection by RT-PCR or antigen testing of nasopharyngeal samples. Thirty days after the diagnosis, having obtained informed consent, we collected a fasting venous blood sample for the following tests: lipid profile, complete blood count and chemistry panel, basal insulin and C-peptide levels (chemiluminescence immunoassay) and concentration of glycated haemoglobin (HbA<span class="elsevierStyleInf">1c</span>) (ion-exchange reverse-phase high performance liquid chromatography; normal range, 4%–5.7%).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The mean duration of symptoms at the time of diagnosis was 1.8 days (standard deviation [SD], 1.8). The most frequent manifestations were respiratory symptoms (51.7%) and fever (48.3%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Only one patient was hospitalised due to suspicion of paediatric inflammatory multisystem syndrome.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The mean concentration of HbA<span class="elsevierStyleInf">1c</span> was 5.2% (significantly lower in female patients: 5.1% versus 5.3%; <span class="elsevierStyleItalic">P</span> = 0.006) with a statistically significant correlation between age and the HbA<span class="elsevierStyleInf">1c</span> concentration (Pearson <span class="elsevierStyleItalic">r</span>, 0.452; <span class="elsevierStyleItalic">P</span> < 0.001). None of the patients had HbA<span class="elsevierStyleInf">1c</span> levels of 6.5% or greater (range, 4.3%–5.9%); however, 5 patients (5.5%) had values of 5.7% or greater (80% with a body mass index [IMC] above the 90<span class="elsevierStyleSup">th</span> percentile).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The mean level of C-peptide was 1.3 ng/mL (SD, 0.7), with no differences based on sex (<span class="elsevierStyleItalic">P</span> = 0.289). Thirty-seven percent of patients had levels of less than 1 ng/dL; in this subset, the mean HbA<span class="elsevierStyleInf">1c</span> concentration was 5%. We found a statistically significant correlation between age and C-peptide levels (Pearson <span class="elsevierStyleItalic">r</span>, 0.456; <span class="elsevierStyleItalic">P</span> < 0.001).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The mean blood insulin level was 8.5 μU/mL (SD, 6), without differences based on sex (<span class="elsevierStyleItalic">P</span> = 0.289). We found a weak correlation between blood insulin levels and age (Pearson <span class="elsevierStyleItalic">r</span>, 0.392; <span class="elsevierStyleItalic">P</span> < 0.001) and a moderate correlation between insulin levels and BMI (Pearson <span class="elsevierStyleItalic">r</span>, 0.477; <span class="elsevierStyleItalic">P</span> < 0.001).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mean fasting blood glucose level was 88.2 mg/dL (SD, 10.2). None of the patients met the criteria for diabetes. In 6 patients (6.6%), we found abnormal fasting glucose levels (values ranging from 100 to 125 mg/dL); 3 of these patients (50%) had a BMI above the 97<span class="elsevierStyleSup">th</span> percentile, although none had dyslipidaemia and all had HbA<span class="elsevierStyleInf">1c</span> concentrations below 5.7% (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Based on our current knowledge on the pathophysiology of COVID-19, some authors have attributed a direct role in the development of type 1 diabetes to SARS-CoV-2.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The virus uses the angiotensin converting enzyme 2 receptor to enter and infect host cells, and this receptor is expressed both in the lung and in the endocrine pancreas. There is ample documentation of the pancreatic damage caused by SARS-CoV-2 in adults, but when it comes to the paediatric population, this issue remains to be elucidated.</p><p id="par0045" class="elsevierStylePara elsevierViewall">A recently published study by the Centers for Disease Control and Prevention of the United States analysed the risk of newly diagnosed diabetes (type 1, 2 or other) more than 30 days after the diagnosis of acute SARS-CoV-2 infection in patients aged less than 18 years,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and found a significantly greater incidence of diabetes in patients with COVID-19. However, as the authors themselves noted, a percentage of these new cases of diabetes probably occurred in patients with prediabetes, a condition that is present in 1 out of 5 adolescents in the United States.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Our findings suggest that the hypothetical pancreatic damage induced by SARS-CoV-2 would be transient and mild. None of the patients had HbA<span class="elsevierStyleInf">1c</span> or fasting glucose levels meeting the criteria for diagnosis of diabetes, and while 5 patients had HbA<span class="elsevierStyleInf">1c</span> concentrations of 5.7% or greater and 6 patients fasting glucose levels in the abnormal range, this was more likely related to their BMI rather than the infection by SARS-CoV-2.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the study was conducted in several centres, the sample was small and could not be considered representative of the general population of paediatric patients affected by COVID-19. Since similar studies have not been published before, we were unable to compare our findings with those of other researchers. We also do not know whether the cases in our sample were caused by the same variant of the virus or different variants. This could be relevant, since, as has occurred with other RNA retroviruses, as the pandemic has evolved, so has the genome of the virus and, consequently, its intrinsic characteristics related to its transmissibility or virulence.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, in this case series we did not find evidence of SARS-CoV-2 infection in children causing significant changes in pancreatic function or glucose metabolism, at least in the short term. Our results should be confirmed in larger population-based studies.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><a class="elsevierStyleCrossRef" href="#sec0005">Appendix A</a> lists the members of the Research Group on Urgent Paediatric Endocrinological Diseases.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Coordinator:</span> Miguel Ángel Molina Gutiérrez (Paediatric Emergency Department, Hospital Universitario La Paz).</p> <p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Secretary:</span> Belén Sagastizábal Cardelús (Department of Paediatrics, Hospital Universitario de Getafe).</p> <p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Members:</span> Ana Castel-Ruíz Molinelli (Department of Paediatrics, Hospital Universitario de Getafe), Blanca Guijo Alonso (Department of Paediatrics, Hospital Universitario Ramón y Cajal), Sinziana Stanescu (Metabolic Disease Unit, Department of Paediatrics, Hospital Universitario Ramón y Cajal), Isabel González Casado (Department of Paediatric Endocrinology, Hospital Universitario La Paz), José Antonio Ruíz Domínguez (Paediatric Emergency Department, Hospital Universitario La Paz), María José Alcázar Villar (Department of Paediatrics, Hospital Universitario de Fuenlabrada).</p>" "etiqueta" => "Appendix A" "titulo" => "Research Group on Urgent Paediatric Endocrinological Diseases" "identificador" => "sec0005" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3916 "Ancho" => 1675 "Tamanyo" => 621953 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analysis of pancreatic function.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">PIMS, paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex distribution</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (51.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (48.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age distribution (years)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (7.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1-3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (10.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>3-6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (13.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6-12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (37.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>>12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (31.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Ethnicity</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>European/Caucasian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78 (87.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Latin American \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Arab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Family history of diabetes</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Type 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 (41.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Characteristics of SARS-CoV-2 infection</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fever \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (48.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Respiratory symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46 (51.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gastrointestinal symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 (22.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Changes in taste/smell \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PIMS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. 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Perrine" ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.15585/mmwr.mm7109e1" "Revista" => array:4 [ "tituloSerie" => "MMWR Morb Mortal Wkly Rep" "fecha" => "2022" "volumen" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35238860" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.15585/mmwr.mm7109e1" "WWW" => array:1 [ "link" => "http://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm?s_cid=mm7102e2_w" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of prediabetes among adolescents and young adults in the United States, 2005-2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L.J. Andes" 1 => "Y.J. Cheng" 2 => "D.B. Rolka" 3 => "E.W. Gregg" 4 => "G. 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Manoli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Gene" "fecha" => "2022" "volumen" => "814" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack635124" "titulo" => "Acknowledgments" "texto" => "<p id="par0065" class="elsevierStylePara elsevierViewall">We thank Dr Manuel Molina Bayón and Dr María del Pilar Gutiérrez Díez.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009700000004/v2_202211110733/S2341287922001697/v2_202211110733/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009700000004/v2_202211110733/S2341287922001697/v2_202211110733/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287922001697?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 9 | 19 |
| 2024 October | 66 | 35 | 101 |
| 2024 September | 69 | 37 | 106 |
| 2024 August | 80 | 44 | 124 |
| 2024 July | 54 | 23 | 77 |
| 2024 June | 49 | 25 | 74 |
| 2024 May | 150 | 42 | 192 |
| 2024 April | 70 | 38 | 108 |
| 2024 March | 53 | 21 | 74 |
| 2024 February | 41 | 27 | 68 |
| 2024 January | 56 | 37 | 93 |
| 2023 December | 42 | 30 | 72 |
| 2023 November | 47 | 48 | 95 |
| 2023 October | 34 | 30 | 64 |
| 2023 September | 35 | 44 | 79 |
| 2023 August | 25 | 16 | 41 |
| 2023 July | 38 | 29 | 67 |
| 2023 June | 26 | 31 | 57 |
| 2023 May | 33 | 29 | 62 |
| 2023 April | 29 | 21 | 50 |
| 2023 March | 45 | 33 | 78 |
| 2023 February | 33 | 14 | 47 |
| 2023 January | 26 | 32 | 58 |
| 2022 December | 44 | 28 | 72 |
| 2022 November | 83 | 39 | 122 |
| 2022 October | 84 | 55 | 139 |
| 2022 September | 39 | 33 | 72 |
| 2022 August | 65 | 74 | 139 |
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