Background: Vaccines are paramount in the effort to end the coronavirus disease 2019 global epidemic. BNT162b2 is approved for the vaccination of adolescents over 16 years of age. Systemic adverse events were scarce though the pretested cohort of this age group was relatively small. The aim of the current study is to raise awareness for potential adverse reactions. Methods: This is a case series of patients diagnosed with perimyocarditis following vaccination. Patients were compiled from 3 pediatric medical centers in Israel through a network of pediatricians and data regarding those cases was collected. In addition, incidence of perimyocarditis during the vaccination period was compared with previous years. Results: All patients were males 16–18 years old, of Jewish descent, who presented with chest pain that began 1–3 days following vaccination (mean, 2.1 days). In 6 of the 7 patients, symptoms began following the 2nd dose and in 1 patient following the 1st dose. All cases were mild and none required cardiovascular or respiratory support. The incidence of perimyocarditis during the vaccination period was elevated in comparison to previous years. Conclusions: This case series describes a time association between coronavirus disease 2019 vaccine and perimyocarditis in adolescents. All cases were mild, although only long-term follow-up can reveal the true impact of this cardiac injury. While it seems that the incidence of perimyocarditis during the vaccination campaign period is increased, a more comprehensive data collection on a wider scale should be done. We hope this report will serve as a reminder to report events and allow for analysis of potential adverse reactions.

Results demonstrate the significant added value of chest radiography as an ancillary test for diagnosis of pneumonia in the emergency department setting.

OBJECTIVES:To explore the hypothesis that obesity is associated with increased mortality and worse outcomes in children who are critically ill.METHODS: Secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, a prospective, multinational observational study. Patients between 3 months and 25 years across Asia, Australia, Europe, and North America were recruited for 3 consecutive months. Patients were divided into 4 groups (underweight, normal weight, overweight, and obese) on the basis of their BMI percentile for age and sex.RESULTS: A total of 3719 patients were evaluated, of whom 542 (14%) had a primary diagnosis of sepsis. One thousand fifty-nine patients (29%) were underweight, 1649 (44%) were normal weight, 423 (11%) were overweight, and 588 (16%) were obese. The 28-day mortality rate was 3.6% for the overall cohort and 9.1% for the sepsis subcohort and differed significantly by weight status (5.8%, 3.1%, 2.2%, and 1.8% for subjects with underweight, normal weight, overweight, and obesity, respectively, in the overall cohort [P , .001] and 15.4%, 6.6%, 3.6%, and 4.7% in the sepsis subcohort, respectively [P = .003]). In a fully adjusted model, 28-day mortality risk was 1.8-fold higher in the underweight group versus the normal weight group in the overall cohort and 2.9-fold higher in the sepsis subcohort. Patients who were overweight and obese did not demonstrate increased risk in their respective cohorts. Patients who were underweight had a longer ICU length of stay, increased need for mechanical ventilation support, and a higher frequency of fluid overload.CONCLUSIONS: Patients who are underweight make up a significant proportion of all patients in the PICU, have a higher short-term mortality rate, and have a more complicated ICU course.WHAT'S KNOWN ON THIS SUBJECT: Patients who are underweight and critically ill are overrepresented in the PICU in comparison with the general population, but the exact prevalence is not clear. Weight status is suggested to be a direct modifier of short-term outcomes of children who are critically ill.WHAT THIS STUDY ADDS: In this study, we present the epidemiology of children who are critically ill on the basis of their weight status in a large multinational cohort and describe the effect of weight status on short-term outcomes.

Severe sepsis and septic shock are the biggest cause of mortality in critically ill patients. Obesity today is one of the world’s greatest health challenges. Little is known about the extent of involvement of the white adipose tissue (WAT) in sepsis and how it is being modified by obesity. We sought to explore the involvement of the WAT in sepsis. We hypothesize that sepsis induces browning of the WAT and that obesity alters the response of WAT to sepsis. Six-week old C57BL/6 mice were randomized to a high fat diet to induce obesity (obese group) or control diet (non-obese group). After 6-11 weeks of feeding, polymicrobial sepsis was induced by cecal ligation and puncture (CLP). Mice were sacrificed at 0, 18 and 72h after CLP and epididymal WAT (eWAT), inguinal WAT (iWAT) and brown adipose tissue (BAT) harvested. Both types of WAT were processed for light microscopy (LM) and transmission electron microscopy (TEM) to assess for morphological changes in both obese and non-obese mice. Tissues were processed for immunohistochemistry (IHC), image analyses and molecular analyses. BAT were used as a positive controls. Non-obese mice have an extensive breakdown of the unilocular lipid droplet and smaller adipocytes in WAT compared to obese mice after sepsis. Neutrophil infiltration increases in eWAT in non-obese mice after sepsis but not in obese mice. Non-obese septic mice have an increase in mitochondrial density compared to obese septic mice. Furthermore, non-obese septic mice have an increase in UCP1 expression. Whereas the WAT of non-obese mice have multiple changes characteristic of browning during sepsis, these changes are markedly blunted in obesity.