Integrating US National Guard with Public Health Partners at COVID-19 Testing Sites in West Virginia Counties with High Rural and Minority Populations: Lessons Learned.

This article analyzes the decisionmaking, communication, and outcomes of collaboration between the West Virginia National Guard (WVNG) and state and county organizations in hosting state-prioritized COVID-19 testing site events from May 22 to December 30, 2020. The United States Census Bureau designated 34 of the 55 counties in West Virginia as rural. For this study, we classified 23 counties as rural-identified counties, 14 counties as minority-identified counties and 14 counties as both rural and minority-identified counties. This resulted in a total 51 of the 55 counties receiving a rural, minority, or both rural and minority-identified county designation. Through collaboration between the WVNG and public health partners, 98,846 COVID-19 tests were conducted between May 22 and December 30, 2020, making up 7% of the total of 1,414,373 COVID-19 tests conducted in the entire state of West Virginia during that time frame. A total of 349 (68.2%) of the 512 WVNG-supported testing sites occurred in either rural or minority-identified counties: 185 (36.1%) in rural counties, 134 (26.2%) in minority-identified counties, and 30 (5.9%) in counties designated as both rural and minority-identified. The novel use of the WVNG to support county health departments in rural and minority-identified counties allowed more COVID-19 testing site events to occur. This demonstrates the use of the National Guard as a force multiplier, helping to reach the state's most vulnerable and underserved populations.

Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea.

CITATION: Children can exhibit a plethora of strange movements during sleep. Asymptomatic rhythmic movements of the head, neck, and trunk can be normal. When these interfere with sleep or cause self-injury, it is pathologic and termed rhythmic movement disorder. CITATION: Bishara J, Mitacek R. Images: Rhythmic movement disorder in a normal developing child with obstructive sleep apnea. J Clin Sleep Med. 2021;17(10):2137-2139.

The Tale of Stridor and Wheezing in an Infant.

Recurrent respiratory papillomatosis is a respiratory disease caused by human papillomavirus and can infect any part of the aerodigestive tract, but the larynx is most involved (Derkay et al. 2010). This report is a discussion about a 7-month-old male that presented to our institution for respiratory distress. He was admitted to the Pediatric Intensive Care Unit (PICU) for stabilization, observation, and further treatment and management due to an acute RSV infection. Initial efforts failed to improve his respiratory failure. A bronchoscopy was performed and showed various flesh-colored lesions throughout the larynx, vocal cords, and tracheal tree just above the carina. Pediatric otolaryngology performed an emergent debulking surgery to alleviate his respiratory failure. He has had multiple exacerbations of his condition since then and has required frequent debulking procedures with a few trials of intralesional bevacizumab therapies.

The genetics of congenital central hypoventilation syndrome: clinical implications.

Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder of the autonomic nervous system (ANS) and respiratory control. This disorder, formerly referred to as Ondine's curse, is due to a mutation in the PHOX2B gene that affects the development of the neural crest cells. CCHS has an autosomal dominant pattern of inheritance. Majority of the patients have a polyalanine repeat mutation (PARM) of the PHOX2B, while a small group has non-PARM (NPARM). Knowledge of the patient's PHOX2B gene mutation helps predict a patient's clinical presentation and outcome and aids in anticipatory management of the respiratory and ANS dysfunction.

Persistent Tachypnea and Alveolar Hemorrhage in an Infant: An Unexpected Etiology.

Persistent tachypnea and failure to thrive during infancy have a broad differential diagnosis which includes pulmonary and cardiovascular disorders. Diffuse alveolar hemorrhage (DAH) is a rare entity in children. DAH requires an extensive work-up as certain conditions may need chronic therapy. Cardiovascular disorders are included in the etiology of DAH. We present a case of an 8-month-old female with a moderate, restrictive patent ductus arteriosus (PDA) admitted to the hospital with respiratory distress and failure to thrive. An extensive work-up into tachypnea including multiple echocardiograms did not find an etiology. Open lung biopsy was performed and consistent with pulmonary hypertension. After closure of the PDA, patient's tachypnea improved, and she was discharged home with periodic follow-up showing a growing, thriving child. When an infant presents with tachypnea, a respiratory viral illness is often a common cause. The diagnosis of persistent tachypnea requires further investigation. Echocardiography, although readily available, may not always be sensitive in detecting clinically significant pulmonary hypertension. A clinician must have a heightened index of suspicion to proceed in evaluating for causes of tachypnea with a nonrespiratory etiology.