This cross-sectional study compares the trends in incidence and hospitalization for eating disorders among children and adolescents 5 years before and in the first months of the COVID-19 pandemic.

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Postural orthostatic tachycardia syndrome (POTS) is a clinical chronic condition characterized by chronic fatigue and orthostatic symptoms associated with postural tachycardia. Early diagnosis and intervention can prevent significant functional consequences, although it can be very difficult to recognize. Two cases of POTS were presented in this article to help clinicians identify POTS more easily. Firstly, we present a 16-year-old adolescent female who was hospitalized for daily headaches, chronic fatigue, bilateral lower limbs discoloration and edema on standing position associated with orthostatic symptoms. All investigations were negative except for tilt table test, which showed heart rate increase of 80 beats per min, hypotension and discoloration of lower limbs, confirming POTS diagnosis. Non-pharmacological treatment showed no improvement. Midodrine was started because of β-blockers intolerance with only moderate response. Secondly, we present a 17-year-old patient diagnosed with benign hypermobility syndrome who was referred for recurring episodes of palpitations associated with heat, nausea, headache and vertigo for the past year. She also reported dizziness and lower limbs discoloration on standing position. Previous investigations were negative. A clinical diagnosis of POTS was made based on history. Non-pharmacologic treatments with hydration, increase of salt intake and regular exercise were tested. However, no improvement was shown. Symptoms were controlled by a propranolol trial. These cases relate a clinical sign that can be easily identified by a clinician attempting to diagnose POTS. Acrocyanosis can be unquestioned or ignored. Clinicians should be attentive to this condition, and attempt to diagnose its underlying causes. This can result in lowering unnecessary testing and interventions. Patients with dependent acrocyanosis should be closely evaluated for the diagnosis of POTS.

Background Alcohol cessation in youth with daily drinking poses a risk of severe and life-threatening alcohol withdrawal. If unsupervised, alcohol withdrawal in heavy users can cause severe complications, such as seizures, delirium tremens, and death. We present the case of a teenager admitted at our pediatric center for the prevention of alcohol withdrawal using an innovative protocol, including a fixed-dosage benzodiazepine regimen. Case description A 16-year-old Caucasian male, known to have anxiety and an attention deficit disorder, was electively admitted for medical stabilization and surveillance of alcohol withdrawal. He had been previously diagnosed with alcohol use disorder and had a past history of withdrawal symptoms. He was prescribed a course of thiamine, folic acid, as well as a fixed-dosage benzodiazepine taper over 5 days. His withdrawal symptoms were evaluated using a standardized Clinical Institute Withdrawal Assessment for Alcohol scale. During his stay, he reported minimal symptoms, as well as a score on the Clinical Institute Withdrawal Assessment for Alcohol scale consistently lower than 5. His mood, motivation, eating habits and sleeping patterns significantly improved during his stay. He developed no medical complications and demonstrated pride in his successes. He was successfully transferred to a long-term rehabilitation center. Conclusions A withdrawal prevention protocol was developed on the basis of existing literature. It included a soothing environment, basic laboratory work evaluating the medical complications of alcohol use, as well as medication aiming to prevent and reduce potential withdrawal symptoms. The patient responded well to the fixed-dosage taper with minimal symptoms and discomfort. Although alcohol use in adolescents is frequent, alcohol withdrawal in this population is rarely seen in a pediatric hospital setting. Nonetheless, given the lack of existing guidelines regarding alcohol withdrawal in adolescents, standardized protocols could be greatly beneficial for the prevention of this condition in this population.

Purpose: Anorexia Nervosa (AN) is a serious and potentially lethal mental disorder characterised by a deliberate quest to reduce one's weight. It can have multiple physical and psychological consequences. The clinical presentation of AN can include gastrointestinal symptoms, however, the pathophysiology of these symptoms in the context of AN remains uncertain. It is hypothesised that patients with AN may have an increase in intestinal permeability, which could lead to an increase in faecal calprotectin (fCP), a marker of intestinal inflammation. No relation between AN and elevation of fCP has been previously described in literature. Methods: Eight patients hospitalised for AN have a dosage of fCP.Results: Calprotectine was found to be elevated in 50% of cases, with or without any underlying comorbid gastrointestinal disease. Only the duration of illness tended to be associated with the increase in fCP suggesting a greater alteration as a function related to the time of denutrition. Conclusion: Although these findings provide insights in the potential pathophysiology of gastrointestinal symptoms in AN, further studies that evaluate the factors associated with elevated fCP in patients with AN are needed.