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.

the manuscript. None of these individuals received compensation for their contributions. 1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA.

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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.

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Results of this prospective cohort study suggest that digitally measured capillary-refill time more accurately predicts significant dehydration (> or = 5%) in young children with gastroenteritis than overall clinical assessment.

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