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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.

The COVID-19 pandemic is affecting healthcare services worldwide. We investigated the impact of a strict lockdown policy on the characteristics of neonatal and pediatric attendances to our pediatric emergency department (PED). The clinical features of PED visits in March–April 2020 (COVID-19) and March–April 2019 (non-COVID-19) were analyzed. During the COVID-19 lockdown period, visits reduced by 67%, from 3159 to 1039. Neonatal access decreased from 78 to 59, mainly due to fewer pathological conditions, with a complete disappearance of respiratory infections. On the other hand, minor neonatal clinical conditions rose from 44 (56.4%) to 48 (81.4%), mostly due to feeding-related issues. Communicable diseases, particularly respiratory infections and gastroenteritis, dropped from 1552 (49.1%) to 288 (27.7%). Accident-related visits also decreased during COVID-19, from 535 (16.9%) to 309 (29.7%), becoming the most common cause of PED access. Hospital admissions reduced from 266 to 109, while PICU (pediatric intensive care unit) admissions decreased from 27 to 11, with a comparable rate of 10.1% in both periods. The lockdown due to COVID-19 had a substantial impact on our PED visits, which markedly decreased, mainly due to fewer respiratory infections. Unexpectedly, neonatal visits for minor conditions did not decline, but rather slightly increased. Among the children admitted to the PICU, none had respiratory disease.

IntroductionThe ongoing COVID-19 pandemic is heavily affecting healthcare services worldwide. We investigated the impact of a lockdown policy on the characteristics of patients attending a Paediatric Emergency Department (PED), in one of the first areas of COVID-19 outbreak in Europe.MethodsWe retrieved data of all PED visits in March-April 2020 (COVID-19) and March-April 2019 (non-COVID-19), comparing volume and characteristics of PED accesses in the two periods.ResultsIn COVID-19 period, total visits reduced by 67% if compared to 2019. White codes decreased from 45.8–35%. Green codes raised from 45.9–52.2%, while yellow and red codes were comparable. As a percentage, accidents increased during COVID-19, being the first cause of PED access (29.7%) (p < 0.0001), while infections and fever category dropped from 49.1–27.7%. (p < 0.001). Within the neonatal population, minor conditions raised from 56.4% to 81.3. (p < 0.001). Hospitalisation rate slightly increased, while Paediatric Intensive Care Unit (PICU) admission rate was comparable in the two periods.ConclusionsThe lockdown due to COVID-19 had a substantial impact on volume and features of patients accessing our PED in Verona. PED visits abruptly decreased, mainly for a reduction of white codes. As a percentage, despite the stay-at-home order, accidents such as injuries, burns and wounds significantly increased, suggesting that home safety measures should be reinforced by parents during any lockdown. Finally, the increased accesses for minor neonatal conditions should prompt primary care services to be more efficient and easily available, in case of lockdown, to reduce unnecessary PED visits and risk of contagion for these infants and their families.

Brain abscess is a very rare and aggressive infection of the brain tissue; if this condition is not promptly recognized and adequately treated, it has a high mortality and a high frequency of long-term neurological outcomes. The paper describes two case reports with the aim of providing the tools to suspect and recognize this condition.