Pediatrician, watch out for corona-phobia.

The current outbreak of COVID-19 raging globally is taking a heavy toll on the adult population, with a rapidly growing number of newly infected and critically ill patients. However, to date, mortality rate among children is low as they mostly suffer from a mild disease. Yet, other more routinely encountered childhood diseases do not stand still and continue to be the main share of pediatricians' everyday challenges. Here we describe a case series of routinely seen pediatric diseases with delayed diagnosis due to different aspects of what we call "Corona-phobia". These cases were easily collected within a 1-week period which implies that this is a more widespread phenomenon.In conclusion, this raises the possibility that measures taken to mitigate this pandemic may be more damaging to children overall than the virus itself. We believe that pediatricians as well as policy makers should take this important aspect into consideration. What is Known: • COVID-19 manifests as a mild disease in most children; however, children are an important reservoir and may become spreaders of the disease. • Social distancing and isolation are important tools in mitigating COVID-19 transmission. What is New: • This case series describes 7 cases with delayed diagnosis of every-day pediatric diseases that were not caused by COVID-19 but were highly influenced by different aspects of "Corona-phobia". • Our objective is to highlight the possibility that measures taken to mitigate this pandemic may lead to a substantial delay in the diagnosis of other non-COVID-19 related diseases.

Delayed diagnosis of paediatric appendicitis during the COVID-19 pandemic.

AIM: To present seven paediatric patients with appendicitis, all with late diagnosis resulting from different aspects of the fear from the current global COVID-19 pandemic. METHODS: Cases were collected from three paediatric surgical wards. Comparison between complicated appendicitis rates in the COVID-19 era and similar period in previous year was performed. RESULTS: All seven children presented with complicated appendicitis. Main reasons for the delayed diagnosis during the COVID-19 era were parental concern, telemedicine use and insufficient evaluation. Higher complication rates were found during the COVID-19 era compared to similar period in previous year (22% vs 11%, P-value .06). CONCLUSION: The fear from COVID-19 pandemic may result in delayed diagnosis and higher complication rates in common paediatric medical conditions. We believe caregivers and healthcare providers should not withhold necessary medical care since delay in diagnosis and treatment in these routinely seen medical emergencies may become as big of a threat as COVID-19 itself.

Angiographic Embolization in Pediatric Abdominal Trauma.

BACKGROUND: Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group. METHODS: Three children with blunt abdominal trauma and one child with iatrogenic renal injury (age 4-13 years) were managed with TAE for lacerated liver (one patient), pelvic fractures (one patient) and renal injuries (two patients). The first two patients, victims of road accidents, had multisystem injuries and were treated by emergency embolization after fluid resuscitation in the Emergency Department (ED). The other two patients had renal injuries: a 4 year old boy with blunt abdominal trauma was diagnosed on initial computed tomography with an unexpected Wilms tumor and was treated with embolization 1 day after admission due to hemodynamic deterioration caused by active arterial tumor bleeding. The following day he underwent successful nephrectomy. The other patient was 13 year old boy with nephrotic syndrome who underwent renal biopsy and developed hemodynamic instability. After fluid resuscitation, he underwent an initial negative angiography, but second-look angiography the following day revealed active bleeding from an aberrant renal artery, which was then successfully embolized. RESULTS: In all four patients, TAE was diagnostic as well as therapeutic, and no child required surgical intervention for control of bleeding. CONCLUSIONS: We propose that emergency transcatheter angiography and arterial embolization be considered following resuscitation in the ED as initial treatment in children with ongoing bleeding after blunt abdominal trauma or iatrogenic renal injury. Implementation of this policy demands availability and cooperation of the interventional radiology services.

Pediatric Electrical Bicycle Road Accidents.

INTRODUCTION: The use of electric bicycles (EBs) among children younger than 18 years of age is rapidly increasing worldwide and becoming a substantial contributor to road accidents. We analyzed patterns and severity of pediatric bicycle-related injuries, comparing children riding EBs and classic bicycles (CBs). MATERIALS AND METHODS: This was a retrospective study (January 2016-December 2018) of patients arriving at our medical center due to a bicycle accident. Data were collected from medical records and included demographics, injury characteristics, treatment, and outcomes. RESULTS: Of 561 children, 197 (35%) were EB riders and 364 (65%) were CB riders. Injury severity score (ISS) of EB cyclists was significantly higher than CB cyclists (mean 4.08 ± 4.67 and 3.16 ± 2.84, respectively, p = 0.012). The rate of accidents involving motorized vehicles was higher in the EB versus CB group (25.9 vs. 11.3%, p < 0.001). Head injuries were the most common type of injury in both groups; incidence was higher in CB than in EB cyclists. However, loss of consciousness was more common in the EB group (18.3 and 12.1%, respectively, p = 0.057). Lower extremity injuries were more common in EBs versus CBs (55.8 and 37.6%, respectively, p < 0.001). Orthopaedic surgical interventions were significantly higher in the EB group (49.2 vs. 33.2%, p < 0.001), and length of stay in hospital and admission to pediatric intensive care unit were more common in EB compared with CB, although not significantly. CONCLUSION: Injury severity of EB patients was significantly higher than that of CB patients. Accidents involving motorized vehicles were more common in the EB group. Head injury associated with loss of consciousness was significantly higher in EB patients.

Congenital Hypotonia: Cracking a SAGA of consanguineous kindred harboring four genetic variants.

BACKGROUND: We aimed to determine the molecular and biochemical basis of an extended highly consanguineous family with multiple children presenting severe congenital hypotonia. METHODS: Clinical investigations, homozygosity mapping, linkage analyses and whole exome sequencing, were performed. mRNA and protein levels were determined. Population screening was followed. RESULTS: We have identified a novel nonsense variant in NGLY1 in two affected siblings, and compound heterozygosity for three novel RYR1 variants in two affected sisters from another nuclear family within the broad pedigree. Population screening revealed a high prevalence of carriers for both diseases. The genetic variants were proven to be pathogenic, as demonstrated by western blot analyses. CONCLUSIONS: Revealing the genetic diagnosis enabled us to provide credible genetic counselling and pre-natal diagnosis to the extended family and genetic screening for this high-risk population. Whole exome/genome sequencing should be the first tier tool for accurate determination of the genetic basis of congenital hypotonia. Two different genetic disorders within a large consanguineous pedigree should be always considered.

Syria civil war pediatric casualties treated at a single medical center.

PURPOSE: We describe the medical and surgical treatment outcomes of Syrian civil war pediatric casualties admitted to our tertiary medical center in northern Israel and compare them to reports of pediatric war victims in Iraq and Afghanistan. METHODS: 117 pediatric casualties up to age 18 (median age: 12 years, 91 males) were admitted from 2013 to 2016. We measured demographics, injury mechanism, wound type, injury severity, surgical interventions, morbidity, and mortality. RESULTS: Injury mechanisms were penetrating injuries (n = 87, 74%), blunt (n = 34, 29%) and blast (n = 13, 11%) injuries, caused by fragments (56, 48%), blasts (51, 44%), and gunshot wounds (24, 21%). Most common injuries were head trauma (n = 66, 56%) and lower extremities injury (n = 45, 38%). 51 children (44%) had Injury Severity Score > 25. Surgical procedures, most commonly orthopedic (n = 35) and neurosurgical (n = 27), were performed on 81 children (69%). Average number of procedures per patient was 2 ±â€¯2.5; average hospitalization time was 25.8 days. Mortality rate was 3.4% (four children). Injury characteristics were different from those reported for pediatric war casualties in Iraq and Afghanistan. CONCLUSIONS: Head trauma was associated with serious injury and mortality; most injuries were penetrating and complex. Collaboration of various hospital departments was often necessary for efficient and successful treatment. LEVEL OF EVIDENCE III: Retrospective comparison study.