(1) Background: We aimed to analyze the characteristics associated with the in-hospital mortality, describe the early CT changes expressed quantitatively after tocilizumab (TOC), and assess TOC timing according to the oxygen demands. (2) Methods: We retrospectively studied 101 adult patients with severe COVID-19, who received TOC and dexamethasone. The lung involvement was assessed quantitatively using native CT examination before and 7–10 days after TOC administration. (3) Results: The in-hospital mortality was 17.8%. Logistic regression analysis found that interstitial lesions above 50% were associated with death (p = 0.01). The other variables assessed were age (p = 0.1), the presence of comorbidities (p = 0.9), the oxygen flow rate at TOC administration (p = 0.2), FiO₂ (p = 0.4), lymphocyte count (p = 0.3), and D-dimers level (p = 0.2). Survivors had a statistically significant improvement at 7–10 days after TOC of interstitial (39.5 vs. 31.6%, p < 0.001), mixt (4.3 vs. 2.3%, p = 0.001) and consolidating (1.7 vs. 1.1%, p = 0.001) lesions. When TOC was administered at a FiO₂ ≤ 57.5% (oxygen flow rate ≤ 13 L/min), the associated mortality was significantly lower (4.3% vs. 29.1%, p < 0.05). (4) Conclusions: Quantitative imaging provides valuable information regarding the extent of lung damage which can be used to anticipate the in-hospital mortality. The timing of TOC administration is important and FiO₂ could be used as a clinical predictor.

Objective: To review the current literature regarding infection and inflammation of the thoracic aorta and to summarise its aetiologies, pathogenesis and clinical presentation. Additionally, the authors sought to compare diagnostic methods and to analyse the different management options. Method: A comprehensive electronic search using PubMed, MEDLINE, Scopus and Google Scholar was conducted to find relevant journal articles with key search terms including: ‘aortitis’, ‘thoracic aortic infection’ and ‘surgical management of infected thoracic aortic aneurysms’. Prominent publications from 1995 till present (2021) were analysed to achieve a deeper understanding of thoracic aorta infection and inflammation, and the information was then collated to form this review. Results: The literature review revealed that infectious causes are more prominent than non-infectious causes, with Gram positive bacteria such as Staphylococcus, Enterococcus and Streptococcus accounting for approximately 60% of the infections. The authors also noted that Staphylococcus Aureus was associated with poorer outcomes. Key diagnostic tools include MRI and multi-slice CT imaging, which are useful imaging modalities in defining the extent of the disease thus allowing for planning surgical intervention. Surgical intervention itself is extremely multifaceted and the rarity of the condition means no large-scale comparative research between all the management options exists. Until more large-scale comparative data becomes available to guide treatment, the optimal approach must be decided on a case-by-case basis, considering the benefits and drawback of each treatment option. Conclusion: A high index of suspicion and a comprehensive history is required to effectively diagnose and manage infection and inflammation of the thoracic aorta. Differentiating between infectious and inflammatory cases is crucial for management planning, as infectious causes typically require antibiotics and surgical intervention. Over the years, the post treatment results have shown significant improvement due to earlier diagnosis, advancement in surgical options and increasingly specific microbial therapy.

Constipation is common in children and adults with varied worldwide prevalence. The majority of children have functional constipation as defined by Rome clinical criteria and respond favourably to standard medical therapy; up to one-third can develop difficult-to-treat constipation requiring investigation and specialist treatment. Colon function tests aim to assess the neuromuscular integrity, the movement of faeces across the colon and evaluate/predict response to the therapy. The ‘ideal’ test should be practical, non-invasive, widely available and cost-effective. None of the available diagnostic tools is designed to provide a comprehensive assessment of colon function and clinicians often have to combine more than one test to answer different questions. In this review, we aim to assess the strengths and limitations of the commonly available diagnostic investigations (radiopaque marker studies, scintigraphy, wireless motility capsule and colonic manometry) used to assess colon transit in children and to provide guidance on the most appropriate test for particular clinical settings.

Background and objectives Gastrostomy tubes are commonly used to provide an alternative route for enteral nutrition. Most of the gastrostomies are inserted in children with cerebral palsy. Previous studies have shown an increase in insertion rate, however, epidemiological studies reveal a stasis in prevalence of cerebral palsy. We aimed to provide an up-to-date rate of gastrostomy insertion in children in England over a 20-year period and systematically review the prevalence of cerebral palsy to ascertain an epidemiological explanation for insertion trends. Methods Retrospective search of Hospital Episode Statistic, a database held diagnosis and procedural code from all England National Health Service hospitals from 2000 to 2021 using International Classification of Disease-10 and Office of Population Censuses and Survey’s Classification-4. England Office for National Statistics data were used for population census. MEDLINE and EMBASE were systematically searched for epidemiology of cerebral palsy. Results There were 23 079 gastrostomies inserted in children <15 years in England (2000–2021) leading to a frequency of 12.4 insertions per 100 000 children per year and 1383 gastrostomy insertions in 15–18 years age group (6 per 100 000). The overall gastrostomy insertion rate in children <15 years has increased from 3.7 procedures per 100 000 in 2000 to 18.3 per 100 000 in 2017. Prevalence of cerebral palsy remained stable (1.5–3.3 per 1000 birth) since 1985. Conclusions There was a significant increase in the rate of gastrostomy insertion in children in England during most of the last 20 years not explained by a stable prevalence of cerebral palsy.

Background. The number of gastrointestinal endoscopies in children is rapidly increasing without evidence of a parallel increase in disease burden. The positive yield of paediatric endoscopies outside certain conditions is small but the impact of normal “negative” results on clinical management is poorly studied. Routine mucosal biopsy in all paediatric endoscopies is common practice. We aimed to assess the impact of normal endoscopy on patient care, defined by symptom improvement and discharge from hospital follow-up, and calculate the correlation between endoscopic and histological findings. Methods. Retrospective analysis of the first diagnostic endoscopy in children (2015–2019) from Evelina London Children’ Hospital, in London, UK. Endoscopy and histology findings were recorded. Symptoms and follow-up were reviewed up to six months after the endoscopy. Results. 362 children were included; 46.7% were female. Mean age 10.5 (±4.1) years, 66.3% underwent OGDs, and 33.7% underwent combined OGD and colonoscopies. 72.9% of endoscopies and 57.2% of all biopsies were normal. There was a strong positive correlation between endoscopic findings and biopsy results (phi 0.68 $p<.001$ ). 31.2% of children reported symptom improvement and were discharged from further follow-up after undergoing endoscopy after 1.9 (±1.5) clinics, phi 0.2 $p<0.001$ between normal endoscopy and discharge. Conclusion. Negative endoscopy appears to influence clinical management and discharge from hospital follow-up in about a third of children undergoing endoscopy. The practice of routine biopsies in all paediatric endoscopies should be considered due to a strong positive correlation between normal endoscopies and normal biopsies.

Background Paediatric endoscopies are expensive and invasive procedures requiring general anaesthetic and should be performed to answer specific clinical questions. There is an increase in number of endoscopies performed in children but no epidemiological evidence of increasing paediatric GI disease burdens. Biopsies are also routinely performed during endoscopies adding to overall procedure cost. Aims This study aimed to assess the indications of paediatric endoscopy, the association between endoscopic and histological results and the correlation between endoscopy and clinical outcome defined as discharge from hospital follow up. Patients and Methods Retrospective review of clinical databases from June 2015 to July 2019. Only first diagnostic endoscopies were included, subsequent endoscopies and therapeutics endoscopies were excluded. Number of clinics prior and up to 6 months of endoscopies were reviewed and outcomes at 6 months were assessed. Correlation between endoscopy, histology results and outcome at 6 months were calculated using phi correlation Results 196 children were included, 47.6% were females. Mean (± SD) age 10.9 (± 3.8). Indications were: abdominal pain 33%, diarrhoea 14%, rectal bleeding 9%, suspected coeliac 7.5%, constipation 9%, reflux 12.3% and vomiting 15.1%. 71.3% were upper endoscopies only and 28.7% were upper and lower endoscopies. 64% of all endoscopies were normal and 43.4% of the total were histologically normal. Number of clinics prior to endoscopies were 1.39 (±1.0) and children were seen 2.3 (±1.6) times in the six months after endoscopy. 18.5% of children were discharge from follow up within 6 months of having an endoscopy. There was weak (phi 0.18) but statistically significant (p<0.05) correlation between endoscopy and discharge at 6 months. There was also weak (phi 0.2, p 0.006) correlation between histology results and discharge at 6 months. There was a strong (phi 0.46 p<0.005) positive correlation between endoscopic appearance and histological results. All children were day cases and there was no complication identified in the studied population. Conclusion Paediatric endoscopy appears to be a safe procedure with low risk of complication and most children were discharge on the same day. The majority of endoscopies in children were normal and about half were histologically normal with strong positive correlation between endoscopic and histological results, hence biopsies should not be performed if endoscopy is normal. Endoscopy did not appear to influence discharge from hospital follow up and the majority of children were still under follow up 6 months after having an endoscopy.