Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of SARS-CoV-2 infection.¹ A previous study that described MIS-C cases in the first 3 waves of the COVID-19 pandemic found that the proportion of individuals with severe illness declined after the first wave.² In Israel, the Omicron (B.1.1.529) variant started to spread in November 2021.³ We describe outcomes of MIS-C in a multicenter cohort and assessed incidence nationally during the Alpha, Delta, and Omicron variant waves.

A major challenge with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is the effective protection of health care workers.¹ Recommendations for the use of personal protective equipment to protect against SARS-CoV-2 exposure by health care workers were recently published by the World Health Organization and the US Centers for Disease Control and Prevention. For aerosol-generating procedures, N95 respirators, eye protection, isolation gowns, and gloves were recommended. Coveralls, boots with a cover, and hair coverings were not part of the recommended protective clothing.^2,3

Narghile (water pipe, hookah, shisha, goza, hubble bubble, argeela) is a traditional method of tobacco use. In recent years, its use has increased worldwide, especially among young people. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide (CO). We present an acutely confused adolescent patient who had CO poisoning after narghile tobacco smoking. She presented with syncope and a carboxyhemoglobin level of 24% and was treated with hyperbaric oxygen. Five additional cases of CO poisoning after narghile smoking were identified during a literature search, with carboxyhemoglobin levels of 20 to 30%. Each patient was treated with oxygen supplementation and did well clinically. In light of the increasing popularity of narghile smoking, young patients presenting with unexplained confusion or nonspecific neurologic symptoms should be asked specifically about this exposure, followed by carboxyhemoglobin measurement.

Research from JAMA Pediatrics — Enhancing Patient Safety During Pediatric Sedation — The Impact of Simulation-Based Training of Nonanesthesiologists

Multisystem inflammatory syndrome in children (MIS-C) is a novel, life-threatening hyperinflammatory condition that develops in children a few weeks after infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This disease has created a diagnostic challenge due to overlap with Kawasaki disease (KD) and KD shock syndrome. The majority of patients with MIS-C present with the involvement of at least four organ systems, and all have evidence of a marked inflammatory state. Most patients show an increase in the level of at least four inflammatory markers (C-reactive protein, neutrophil count, ferritin, procalcitonin, fibrinogen, interleukin-6, and triglycerides). Therapy is primarily with immunomodulators, suggesting that the disease is driven by post-infectious immune dysregulation. Most patients, even those with severe cardiovascular involvement, recover without sequelae. Since coronary aneurysms have been reported, echocardiographic follow-up is needed.Further study is needed to create uniform diagnostic criteria, therapy, and follow-up protocols.