Regarding echocardiogram findings at hospital admission (Table 3), 29% of both cohorts had left ventricular dysfunction. The median LVSF was the same in both groups, at 32%. Five patients (16%) in the anakinra group had coronary artery dilation, which was not different when compared to zero of those without anakinra.

We included children admitted from May 2020 to May 2021 diagnosed with MIS-C based on CDC criteria. The exposure of interest was anakinra use at any point during admission. The anakinra exposed group and the anakinra unexposed group were propensity score matched based on demographic and clinical severity indicators at initial presentation. Our primary outcome was length of hospital stay. Secondary outcomes were duration of vasoactive support, vasoactive inotropic score (VIS), level of respiratory support, time to fever resolution, reduction of CRP levels, and length of ICU stay. We used Wilcoxon rank sum, t-test, Chi square and Fisher’s exact tests. Results

Gender Difference in Severity and Mortality of COVID-19

Buerger's disease affects blood vessels in the legs and arms, leading to reduced blood flow to the hands and feet. It's closely linked to smoking. Reveals the powerful role inflammation plays in a wide variety of common health conditions from simple aches and pains to heart disease, obesity, diabetes, arthritis, asthma, and athletic injuries What you eat can play both a positive and negative role in managing chronic inflammation. Foods to eat Kone-Paut I, Tellier S, Belot A, et al. Phase II open label study of Anakinra in Intravenous Immunoglobulin-Resistant Kawasaki Disease. Arthritis Rheumatol Jan. 2021;73(1):151–61. https://doi.org/10.1002/art.41481. In severe cases of COVID-19, there is a significant decrease in oxygen saturation (less than 90%), which produces significant hypoxic changes ( 46, 47). This events also lead to the development of OS just as the reduction in oxygen saturation enhances the formation of ROS such as superoxide

Our institutional protocols for MIS-C changed over the study period. Over time, anakinra was used earlier in the disease course in severe patients and some moderate patients. The decision to initiate anakinra, along with its dosing and duration, was based on institutional guidelines and consultation with a pediatric rheumatology specialist. Anakinra was administered subcutaneously or intravenously, with dosing tailored to the severity of the disease, ranging between 2 and 10 mg/kg/day or 100-400 mg/day with a maximum of 400 mg/day. Anakinra was typically given between the first and second echo. Treatment was subsequently tapered off by the time of discharge.The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus first discovered in Wuhan on the 31 st of December 2019. Known as the third highly infective CoV, it has a high transmissibility capacity. It has a basic reproduction number (R0) of 2.2 and a 2% mortality rate ( 1). Due to the rapid spread of this virus across the globe, the World Health Organisation (WHO) declared Coronavirus disease 2019 (COVID-19) as a global pandemic on the 11 th of March 2020 ( 2). As of the 8 th of September 2021, there are currently 221,648,869 confirmed cases of COVID-19 and 4,582,338 deaths reported ( 3). In this retrospective cohort study of children hospitalized with moderate to severe MIS-C, hospital stay was longer in patients who received anakinra compared to patients who did not receive anakinra. Also, there was no difference in vasoactive support duration, VIS, fever duration, CRP reduction, or ICU length of stay in patients who received anakinra compared to patients who did not receive anakinra. This finding does not support improved outcomes with anakinra in the propensity score matched cohort. IVIG and steroids The hallmarks of neuropathic pain are chronic allodynia and hyperalgesia. Allodynia is defined as pain resulting from a stimulus that ordinarily does not elicit a painful response (e.g. light touch). Hyperalgesia is defined as an increased sensitivity to normally painful stimuli. Type I Interferon (IFN) are the common cytokines generated in response to viral infection ( 95, 96). In view of the mounting evidence on COVID-19-related cytokine storm, a similar phenomenon is postulated in COVID-19 infection. According to a study by Roy etal. the IFNs are observed to directly activate CNS microglia and promote the complement cascade ( 95, 96). The nucleic acid-containing amyloid fibrils enveloped by the microglia is found to upregulate gene expression involved in IFN interaction ( 95, 96). Moreover, the amyloid fibres may capture SARS-CoV-2 viral particles and contribute synergistically to the augmentation of IFN effect ( 95, 96). This resulted in synaptic loss, commonly seen in Alzheimer’s Disease ( 95, 96). Therapeutic Modulation of Primary Cytokines in COVD-19

Respiratory support was applied to 18 patients (58%) in the anakinra group and 24 patients (77%) in the no anakinra group. The median duration of respiratory support was 5 vs. 2 days in anakinra vs. no anakinra group with no difference.

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Case series of multisystem inflammatory syndrome in adults associated with SARS-CoV-1 infection — United Kingdom and United States, March-August 2020. MMWR Recommendations and Reports.2020; doi: 10.15585/mmwr.mm6940e1. Ferrara G, Giani T, Caparello MC, Farella C, Gamalero L, Cimaz R. Anakinra for Treatment-Resistant Kawasaki Disease: evidence from a literature review. Paediatr Drugs Dec. 2020;22(6):645–52. https://doi.org/10.1007/s40272-020-00421-3.