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Shopen L, Zmora O, Barash G, Bahat H. [13-YEAR-OLD GIRL WITH PHEOCHROMOCYTOMA PRESENTING WITH SECONDARY NOCTURNAL ENURESIS]. Harefuah 2021; 160:818-821. [PMID: 34957719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pheochromocytoma is a rare, catecholamine secreting tumor arising from chromaffin cells of the adrenal medulla and it is responsible for 0.5-2% of pediatric hypertension cases. We hereby present a case of a 13-year-old girl with obesity, excessive hypertension, prediabetes and secondary nocturnal enuresis, who was eventually diagnosed with pheochromocytoma. Most symptoms significantly improved after treating the tumor. We suggest that this diagnosis should be considered in pediatric patients presenting with similar symptoms.
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Affiliation(s)
- Libby Shopen
- Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, affiliated with Sackler Faculty of Medicine, Tel- Aviv University
| | - Osnat Zmora
- Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, affiliated with Sackler Faculty of Medicine, Tel- Aviv University
| | - Galia Barash
- Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, affiliated with Sackler Faculty of Medicine, Tel- Aviv University
| | - Hilla Bahat
- Department of Pediatrics, Shamir (Assaf Harofeh) Medical Center, affiliated with Sackler Faculty of Medicine, Tel- Aviv University
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2
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Bahat H, Hasidov-Gafni A, Youngster I, Goldman M, Levtzion-Korach O. The prevalence and underreporting of needlestick injuries among hospital workers: a cross-sectional study. Int J Qual Health Care 2021; 33:6101296. [PMID: 33449085 DOI: 10.1093/intqhc/mzab009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Needlestick and sharps injuries (NSIs) are known occupational risks among health-care workers. Reporting these injuries is important for early prevention and management of blood-borne infections. We investigated the prevalence and characteristics of NSIs and underreporting among hospital workers (HWs) from different sectors. METHODS A single-center cross-sectional study, involving an anonymous survey delivered to 2205 HWs. The survey included demographic information about the worker and information about training, injuries and reporting. RESULTS Of the 844 HWs respondents (40%), NSIs occurred in 443 of them (53%); the majority were from needles (68%) and at bedside (51%). Significantly higher prevalences of injuries (P < 0.001) were noted among physicians (75%) and workers in their 40s (61%) and in the emergency and surgical departments (66% and 55%, respectively). NSIs were reported among 28% of workers who did not directly use needles. Underreporting was found in 46%, with a significant decrease in the report rate as the number of injuries increased (P < 0.001). Underreporting was significantly more common (P < 0.001) among physicians (59%), especially seniors (72%), workers without training about NSIs (59%), older age groups (56% in workers above 51 years, P = 0.003) and males (54%, P = 0.01). The highest underreporting rate was in injuries occurring in the operating room and the lowest in witnessed injuries occurring while passing a needle (82% vs. 31%, P < 0.001). CONCLUSIONS NSIs and underreporting are common among HWs from all sectors, including those who do not use needles. Improving preventive measures and reporting should be encouraged. We recommend reducing bedside procedures as possible and assigning two workers to procedures at risk for injuries, to increase the report rate.
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Affiliation(s)
- Hilla Bahat
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Adi Hasidov-Gafni
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel
| | - Ilan Youngster
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Michael Goldman
- Department of Pediatrics, Shamir Medical Center, Zerifin 70300, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Osnat Levtzion-Korach
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.,Medical Management, Shamir Medical Center, Zerifin 70300, Israel
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3
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Bahat H, Apelman Cipele R, Maymon T, Youngster I, Goldman M. Catheter-Obtained Urine Culture Contamination Among Young Infants: A Prospective Cohort Study. Front Pediatr 2021; 9:762577. [PMID: 34790635 PMCID: PMC8591076 DOI: 10.3389/fped.2021.762577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: A correct diagnosis of urinary tract infection in young infants requires an uncontaminated urine culture, commonly obtained by urethral catheterization. In the current study, we examined the rates and factors associated with contaminations of catheter-obtained urine cultures in very young infants. Methods: This prospective cohort study included 143 catheter-obtained urine cultures of infants ≤2 months of age admitted to the pediatric ward of a tertiary hospital in Israel from April 2019 to September 2020. Patient's and operator's study variables were documented at the time of catheter insertion. Positive urine cultures were reviewed by a pediatric nephrologist and a pediatric infectious disease specialist and designated as infection or contamination. The study variables were compared between those with or without contamination. Results: The contamination rate in our cohort was 29%. Females were more than twice as likely to have a contaminated urine culture (37 vs. 18%, respectively, P = 0.014). Circumcision status, official training about sterile catheterization, a sense of difficult catheterization, and the shift in which the culture was obtained did not influence the contamination rate. Conclusions: Catheter-obtained urine cultures have a high contamination rate among very young infants, especially among girls.
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Affiliation(s)
- Hilla Bahat
- Department of Pediatrics, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tali Maymon
- Department of Pediatrics, Shamir Medical Center, Zerifin, Israel
| | - Ilan Youngster
- Department of Pediatrics, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Goldman
- Department of Pediatrics, Shamir Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kronenfeld N, Gamsu S, Keidar R, Livneh A, Berkovitch M, Goldman M, Bahat H, Shchory-Potlog M, Ziv-Baran T, Abu-Kishk I. The Role of an Interventional Program for Improving Pharmacovigilance at a Pediatric Facility. Front Pharmacol 2019; 10:1004. [PMID: 31551794 PMCID: PMC6746909 DOI: 10.3389/fphar.2019.01004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/07/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The reporting rate of adverse drug reactions (ADRs) by healthcare professionals is low. ADR interventional programs may improve the reporting rate by the medical team. Our literature search revealed that only a few interventional studies among the pediatric population have been published. Objective: We aimed to create an interventional program in order to improve the reporting rate of ADRs during the interventional period compared to the control period, detect which drugs frequently lead to ADRs and determine the most serious ADRs. Design: A 3-month prospective intervention study compared with one year prior to the intervention (control period). ADR data was also collected for the year following the study period. Healthcare professionals were encouraged to report ADRs and an ADR reporting system was created for them. Setting: Pediatric Division at Shamir Medical Center (Assaf Harofeh), a tertiary care medical center. Results: The study population included 3,753 admitted patients with 1,323 prescriptions during the study period. During the period before the intervention was started, the ADR reporting rate was null. During the study period, 46 reports were collected: 46% from the general pediatric department, 26% from the pediatric neurology department, and 22% and 6% from the pediatric and neonatal intensive care units, respectively. Antiepileptic medications, IVIG, steroids and antibiotics were frequently reported to induce ADRs. Serious ADRs were also reported in 5 cases. One year of follow up after the intervention revealed a significant decline in the reporting rate. Conclusion: It is important to periodically encourage healthcare professionals to report any ADRs in order to increase knowledge about medication safety and prevent fatal harm.
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Affiliation(s)
- Nirit Kronenfeld
- Pharmacy Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shirly Gamsu
- Pediatric Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rimona Keidar
- Neonatal Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ayelet Livneh
- Neonatal Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Goldman
- Pediatric Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hilla Bahat
- Pediatric Department, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Shchory-Potlog
- Shamir (Assaf Harofeh) Academic School of Nursing, Zerifin, Israel, affiliated to the Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibrahim Abu-Kishk
- Pediatric Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Neheman A, Shumaker A, Levin D, Abu-Kishk I, Bahat H, Asiya D, Zisman A, Haifler M. Robot-assisted Laparoscopic Pyeloplasty for "Huge" Hydronephrosis Causing Vena Cava Thrombus. Urology 2019; 133:240. [PMID: 31465792 DOI: 10.1016/j.urology.2019.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 07/31/2019] [Accepted: 08/20/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To present a rare case of "huge" hydronephrosis causing distortion of large vessels and formation of a thrombus in the inferior vena cava. Multidisciplinary treatment was applied with particular focus on pyeloplasty utilizing a robot-assisted laparoscopic approach. METHODS A 20-month-old male presented to the emergency room severely ill with abdominal pain, nausea, vomiting, and fever and was subsequently transferred to the intensive care unit, in septic shock. An abdominal ultrasound revealed a large multilobular cystic structure in the right hemiabdomen, which was initially interpreted as an infected mesenteric cyst. CT scan revealed a huge hydronephrotic kidney crossing the midline, causing a mass effect that compressed and distorted the vena cava laterally, in addition to a thrombus between the hepatic vein and right renal vein. Intravenous Ceftriaxone and Amikacin, as well as anticoagulation therapy with low molecular weight heparin (Enoxaparin) were initiated. A nephrostomy tube was inserted that drained 900 mL of purulent urine. A full hematology investigation including protein C, S, and antithrombin III was carried out, excluding factor V Leiden and prothrombin mutation. All values were in the normal range. Dimercaptosuccinic Acid (DMSA) scan showed 30% function on the affected kidney and Voiding Cystourethrogram (VCUG) excluded any bladder pathology or reflux. Subcutaneous Enoxaparin was continued for 3 months, maintaining antifactor Xa in the therapeutic range (0.7-1 IU/mL). Ultrasound Doppler of the vena cava showed full resolution of the thrombus. Robot-assisted laparoscopic pyeloplasty was performed and significant reduction of the renal pelvis was carried out, taking care to preserve the calyces. Postoperative ultrasound 4 months after surgery showed a complete resolution of the hydronephrosis. CONCLUSION Giant hydronephrosis is a rare finding. Distortion of adjacent veins and formation of thrombosis should be kept in mind, as they are life threatening. A multidisciplinary collaboration is mandatory to ensure optimal treatment.
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Affiliation(s)
- Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Andrew Shumaker
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel.
| | - Dror Levin
- Pediatric Hemato-oncology Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ibrahim Abu-Kishk
- Pediatric Intensive Care Unit, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Hilla Bahat
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Disin Asiya
- Department of Radiology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Miki Haifler
- Department of Urology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
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Bahat H, Ben-Ari M, Ziv-Baran T, Neheman A, Youngster I, Goldman M. Predictors of grade 3-5 vesicoureteral reflux in infants ≤ 2 months of age with pyelonephritis. Pediatr Nephrol 2019; 34:907-915. [PMID: 30588547 DOI: 10.1007/s00467-018-4167-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to assess predictors for grade 3-5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI). METHODS Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3-5 VUR and different patient characteristics. RESULTS Twenty infants (10%) were diagnosed with grade 3-5 VUR; all had fever. Infants with grade 3-5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3-5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3-5 VUR. BNP was the best single marker for grade 3-5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75-0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79-0.93, P = 0.007). CONCLUSIONS Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3-5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.
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Affiliation(s)
- Hilla Bahat
- Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mai Ben-Ari
- Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel
| | - Tomer Ziv-Baran
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Urology, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ilan Youngster
- Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Goldman
- Department of Pediatrics, Assaf Harofeh Medical Center, 70300, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Arane K, Mendelsohn K, Mimouni M, Mimouni F, Koren Y, Brik Simon D, Bahat H, Hanna Helou M, Mendelson A, Hezkelo N, Glatstein M, Berkun Y, Eisenstein E, Butbul YA, Brik R, Hashkes PJ, Uziel Y, Harel L, Amarilyo G. Japanese scoring systems to predict resistance to intravenous immunoglobulin in Kawasaki disease were unreliable for Caucasian Israeli children. Acta Paediatr 2018; 107:2179-2184. [PMID: 29797463 DOI: 10.1111/apa.14418] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/13/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022]
Abstract
AIM This study assessed the validity of using established Japanese risk scoring methods to predict intravenous immunoglobulin (IVIG) resistance to Kawasaki disease in Israeli children. METHODS We reviewed the medical records of 282 patients (70% male) with Kawasaki disease from six Israeli medical centres between 2004 and 2013. Their mean age was 2.5 years. The risk scores were calculated using the Kobayashi, Sano and Egami scoring methods and analysed to determine whether a higher risk score predicted IVIG resistance in this population. Factors that predicted a lack of response to the initial IVIG dose were identified. RESULTS We found that 18% did not respond to the first IVIG dose. The three scoring methods were unable to reliably predict IVIG resistance, with sensitivities of 23%-32% and specificities of 67%-87%. Calculating a predictive score that was specific for this population was also unsuccessful. The factors that predicted a lacked of response to the first IVIG dose included low albumin, elevated total bilirubin and ethnicity. CONCLUSION The established risk scoring methods created for Japanese populations with Kawasaki disease were not suitable for predicting IVIG resistance in Caucasian Israeli children, and we were unable to create a specific scoring method that was able to do this.
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Affiliation(s)
- Karen Arane
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Kerry Mendelsohn
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | | | | | - Yael Koren
- Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Dafna Brik Simon
- Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Hilla Bahat
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Assaf Harofeh Medical Center; Zerifin Israel
| | | | | | - Nofar Hezkelo
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Miguel Glatstein
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Yackov Berkun
- Hadassah Hebrew University Medical Center; Jerusalem Israel
| | - Eli Eisenstein
- Hadassah Hebrew University Medical Center; Jerusalem Israel
| | | | - Riva Brik
- Rambam Health Care Campus; Haifa Israel
| | | | - Yosef Uziel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Meir Medical Center; Kfar Saba Israel
| | - Liora Harel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Gil Amarilyo
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Schneider Children's Medical Center of Israel; Petach Tikva Israel
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Mekory TM, Bahat H, Bar-Oz B, Tal O, Berkovitch M, Kozer E. The proportion of errors in medical prescriptions and their executions among hospitalized children before and during accreditation. Int J Qual Health Care 2018; 29:366-370. [PMID: 28340029 DOI: 10.1093/intqhc/mzx031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/24/2017] [Indexed: 01/19/2023] Open
Abstract
Objective To evaluate the rate of medication related errors in the pediatric ward and pediatric emergency department (PED), before and after implementing intervention strategies according to the Joint Commission International (JCI) accreditation program. Design A retrospective cross-sectional study that included chart review. Setting A university affiliated pediatric ward and PED. Participants Children 0-18 years old admitted on February 2013 (before the JCI program) and February 2014 (during implementation of the JCI program). Intervention(s) A training program designed to meet the JCI official standards on medication prescribing. Main outcome measure(s) The number of prescribing and medication administration errors in the 2 years. Results We collected 937 valid prescription orders and 924 administration orders (1861 medical orders) from February 2013, and 961 valid prescription orders and 958 administration orders (1919 medical orders) from February 2014. There was a significant reduction in prescribing errors from 6.5 to 4.2% between years 2013 and 2014 (P = 0.03). There was no significant difference in administration error rates between the two periods (104 (11.3%) in the first period and 114 (11.9%) in the second; P = 0.61). Conclusions The errors rate we found was within the range described in the literature. Quality assurance interventions can significantly reduce medication prescribing errors.
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Affiliation(s)
- Tal Margalit Mekory
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.,Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Hilla Bahat
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Benjamin Bar-Oz
- Department of Neonatology, Hadassah Medical Center, The Hebrew University, Jerusalem
| | - Orna Tal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Assaf Harofeh Medical Center, Hospital Management Zerifin, Zerifin, IL, Israel
| | - Matitiahu Berkovitch
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kozer
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
OBJECTIVE History and physical examination do not reliably exclude serious bacterial infections (SBIs) in infants. We examined potential markers of SBI in young febrile infants. DESIGN We reviewed white cell count (WBC), absolute neutrophil count (ANC), neutrophil to lymphocyte count ratio (NLR) and C reactive protein (CRP) in infants aged 1 week to 90 days, admitted for fever to one medical centre during 2012-2014. RESULTS SBI was detected in 111 (10.6%) of 1039 infants. Median values of all investigated diagnostic markers were significantly higher in infants with than without SBI: WBC (14.4 vs 11.4 K/µL, P<0.001), ANC (5.8 vs 3.7 K/µL, P<0.001), CRP (19 vs 5 mg/L, P <0.001) and NLR (1.2 vs 0.7, P<0.001). Areas under the receiver operating characteristic curve (AUC) for discriminating SBI were: 0.65 (95% CI 0.59 to 0.71), 0.69 (95% CI 0.63 to 0.74), 0.71 (95% CI 0.65 to 0.76) and 0.66 (95% CI 0.60 to 0.71) for WBC, ANC, CRP and NLR, respectively. Logistic regression showed the best discriminative ability for the combination of CRP and ANC, with AUC: 0.73 (95% CI 0.67 to 0.78). For invasive bacterial infection, AUCs were 0.70 (95% CI 0.56 to 0.85), 0.80 (95% CI 0.67 to 0.92), 0.78 (95% CI 0.68 to 0.89) and 0.78 (95% CI 0.66 to 0.90), respectively. CRP combined with NLR or ANC were the best discriminators of infection, AUCs: 0.82 (95% CI 0.70 to 0.95) and 0.82 (95% CI 0.68 to 0.95), respectively. CONCLUSIONS Among young febrile infants, CRP was the best single discriminatory marker of SBI, and ANC was the best for invasive bacterial infection. ANC and NLR can contribute to evaluating this population.
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Affiliation(s)
- Uri Hamiel
- Department of Pediatrics, Assaf Harofeh Medical Centre, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hilla Bahat
- Department of Pediatrics, Assaf Harofeh Medical Centre, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Kozer
- Department of Pediatrics, Assaf Harofeh Medical Centre, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Hamiel
- Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Goldman
- Department of Pediatrics, Assaf Harofeh Medical Centre, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Demir K, Yildiz M, Bahat H, Goldman M, Hassan N, Tzur S, Ofir A, Magen D. Clinical Heterogeneity and Phenotypic Expansion of NaPi-IIa-Associated Disease. J Clin Endocrinol Metab 2017; 102:4604-4614. [PMID: 29029121 DOI: 10.1210/jc.2017-01592] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/22/2017] [Indexed: 12/21/2022]
Abstract
CONTEXT NaPi-IIa, encoded by SLC34A1, is a key phosphate transporter in the mammalian proximal tubule and plays a cardinal role in renal phosphate handling. NaPi-IIa impairment has been linked to various overlapping clinical syndromes, including hypophosphatemic nephrolithiasis with osteoporosis, renal Fanconi syndrome with chronic kidney disease, and, most recently, idiopathic infantile hypercalcemia and nephrocalcinosis. OBJECTIVES We studied the molecular basis of idiopathic infantile hypercalcemia with partial proximal tubulopathy in two apparently unrelated patients of Israeli and Turkish descent. DESIGN Genetic analysis in two affected children and their close relatives was performed using whole-exome sequencing, followed by in vitro localization and trafficking analysis of mutant NaPi-IIa. RESULTS Mutation and haplotype analyses in both patients revealed a previously described homozygous loss-of-function inserted duplication (p.I154_V160dup) in NaPi-IIa, which is inherited identical-by-descent from a common ancestor. The shared mutation was originally reported by our team in two adult siblings with renal Fanconi syndrome, hypophosphatemic bone disease, and progressive renal failure who are family members of one of the infants reported herein. In vitro localization assays and biochemical analysis of p.I154_V160dup and of additional NaPi-IIa mutants harboring a trafficking defect indicate aberrant retention at the endoplasmic reticulum in an immature and underglycosylated state, leading to premature proteasomal degradation. CONCLUSIONS Our findings expand the phenotypic spectrum of NaPi-IIa disruption, reinforce its link with proximal tubular impairment, enable longitudinal study of the natural history of the disease, and shed light on cellular pathways associated with loss of function and impaired trafficking of NaPi-IIa mutants.
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Affiliation(s)
- Korcan Demir
- Division of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, Turkey
| | - Melek Yildiz
- Division of Pediatric Endocrinology, Dr. Behçet Uz Children's Hospital, Turkey
| | - Hilla Bahat
- Department of Pediatrics, Assaf Harofeh Medical Center, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michael Goldman
- Department of Pediatrics, Assaf Harofeh Medical Center, Israel, and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Nisreen Hassan
- Laboratory of Molecular Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Israel
| | - Shay Tzur
- Laboratory of Molecular Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Israel
- Genomic Research Department, Emedgene Technologies, Israel
| | - Ayala Ofir
- Laboratory of Molecular Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Israel
| | - Daniella Magen
- Laboratory of Molecular Medicine, Rappaport Faculty of Medicine and Research Institute, Technion-Israel Institute of Technology, Israel
- Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Israel
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11
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Amarilyo G, Koren Y, Brik Simon D, Bar-Meir M, Bahat H, Helou MH, Mendelson A, Hezkelo N, Chodick G, Berkun Y, Eisenstein E, Butbul Aviel Y, Barkai G, Bolkier Y, Padeh S, Brik R, Hashkes PJ, Harel L, Uziel Y. High-dose aspirin for Kawasaki disease: outdated myth or effective aid? Clin Exp Rheumatol 2017; 35 Suppl 103:209-212. [PMID: 28079513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To compare the efficacy and safety of intravenous immunoglobulin (IVIG) plus high-dose aspirin (HDA) vs. IVIG plus low-dose aspirin (LDA) for the treatment of Kawasaki disease, with an emphasis on coronary artery outcomes. METHODS This study was a retrospective, medical record review of paediatric patients with Kawasaki disease comparing 6 centres that routinely used HAD for initial treatment and 2 that used LDA in 2004-2013. Treatment response and adverse events were compared. The primary outcome measure was the occurrence of coronary aneurysm at the subacute or convalescent stage. RESULTS The cohort included 358 patients, of whom 315 were initially treated with adjunctive HDA and 43 with LDA. There were no demographic differences between the groups. Coronary aneurysms occurred in 10% (20/196) of the HDA group and 4% (1/24) of the LDA group (p=0.34). Equivalence tests indicate it is unlikely that the risk of coronary aneurysm in LDA exceeds HDA by more than 3.5%. There were no significant between-group differences in the need for glucocorticoid pulse therapy or disease recurrence. Coronary ectasia rate and hospitalisation time were significantly greater in the HDA group. Adverse events were similar in the two groups. CONCLUSIONS We found no significant clinical benefit in using IVIG+HDA in Kawasaki disease compared to IVIG+LDA. The use of adjunctive HDA in this setting should be reconsidered.
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Affiliation(s)
- Gil Amarilyo
- Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yael Koren
- Department of Paediatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Brik Simon
- Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Maskit Bar-Meir
- Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hilla Bahat
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Assaf Harofeh Medical Center, Zerifin, Israel
| | | | - Amir Mendelson
- Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel
| | - Nofar Hezkelo
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yackov Berkun
- Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eli Eisenstein
- Department of Paediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | - Galia Barkai
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel
| | - Yoav Bolkier
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel
| | - Shai Padeh
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Sheba Medical Center, Tel Hashomer, Israel
| | - Riva Brik
- Department of Paediatrics, Rambam Medical Center, Haifa, Israel
| | - Phillip J Hashkes
- Department of Paediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Liora Harel
- Department of Paediatrics, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and Department of Paediatrics, Meir Medical Center, Kfar Saba, Israel.
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12
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Oren-Amit A, Berkovitch M, Bahat H, Goldman M, Kozer E, Ziv-Baran T, Abu-Kishk I. Complementary and alternative medicine among hospitalized pediatric patients. Complement Ther Med 2017; 31:49-52. [PMID: 28434470 DOI: 10.1016/j.ctim.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and describe the characteristics of complementary and alternative medicine (CAM) use among hospitalized children, and to discover the awareness of medical staff regarding CAM use. DESIGN/SETTING Parents of children aged 0-18 years admitted to the Pediatric Division at Assaf Harofeh Medical Center in Israel between January and July of 2015 (n=146) were provided a questionnaire regarding socio-economic status and evaluating the CAM use. The medical charts of the participants were reviewed in order to establish whether or not CAM use was documented. RESULTS Of those who completed the questionnaire, 78 (54.3%) were using CAM. The major indications for CAM use were colic and teething. CAM use was advised by the family in 44.9%, physician 34.6%, pharmacist 34.6%, friends 30.8%, previous experience 23.1, advertisements 18%, nurses 6.4%, and homeopaths 2.6%. The family physician was aware of CAM use was in 42%. During the admission, only 5 patients were asked about CAM use (3.4%) by the medical staff. Reviewing the medical charts revealed there was no documentation of CAM use in any of the participants. Socio-demographic analysis of our population revealed no differences between users and non users of CAM, but significant differences in belief in CAM (p=0.018) were found. CAM use was age related; the older the child the less the use (p=0.010). CONCLUSION CAM use is common among hospitalized pediatric patients and is often overlooked by the medical staff. CAM use should be included in the medical history.
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Affiliation(s)
- Adi Oren-Amit
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Matitiahu Berkovitch
- Pharmacology Unit, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hilla Bahat
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Goldman
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eran Kozer
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Ziv-Baran
- School of Public Health, Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ibrahim Abu-Kishk
- Pediatric Division, Assaf Harofeh Medical Center, Zerifin, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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13
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Melcer Y, Kaplan G, Ben-Ami I, Bahat H, Neheman A, Galoyan N, Maymon R. Termination of pregnancy due to renal tract abnormalities: survey of 97 fetuses from a single medical center. Prenat Diagn 2017; 37:215-221. [DOI: 10.1002/pd.4988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/02/2016] [Accepted: 12/09/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Yaakov Melcer
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Gaby Kaplan
- Anesthesia, Pain and Intensive Care Division, Tel Aviv Sourasky Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Ido Ben-Ami
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Hilla Bahat
- Pediatric Nephrology Service, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Amos Neheman
- Pediatric Urology Service, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Narine Galoyan
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center; Affiliated with the Sackler School of Medicine, Tel-Aviv University; Tel-Aviv Israel
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14
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Moore SS, Bahat H, Rachmiel M, Ziv-Baran T, Youngster I, Goldman M. Guidelines for urinary tract infections and antenatal hydronephrosis should be gender specific. Acta Paediatr 2015; 104:e512-7. [PMID: 26173376 DOI: 10.1111/apa.13129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 04/19/2015] [Accepted: 07/09/2015] [Indexed: 01/10/2023]
Abstract
AIM Febrile urinary tract infections (UTIs) may be associated with long-term renal damage. Our goal was to identify risk factors for future UTIs in children who had voiding cystourethrography (VCUG) as a part of an antenatal hydronephrosis (ANH) assessment or after a febrile UTI. METHODS We conducted a cohort study based on the medical records of children aged 0-24 months who underwent a VCUG between January 2004 and December 2011 and had at least six months of follow-up. The incidence of future UTIs was assessed. RESULTS We included 285 children: 176 had a primary UTI and 109 had ANH. We recorded 28 UTIs during the follow-up period, and the risk was 12.5% after a primary UTI and 5.5% after an ANH (p = 0.049). Multivariate analysis showed no risk difference was found between the groups. Females had a greater risk of febrile UTIs (hazard ratio 3.3, 95% confidence interval 1.03-9.2, p = 0.04), but the UTI risk did not differ between children with or without VURs. CONCLUSION Female infants were at greater risk of febrile UTIs, regardless of the presence of VUR, VUR degree, ANH or a previous UTI. Clinical guidelines for UTI and ANH assessment should preferably be gender specific.
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Affiliation(s)
- Shiran S. Moore
- Department of Paediatrics; Meir Medical Centre; Kfar Saba Israel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Hilla Bahat
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Mariana Rachmiel
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine; School of Public Health; Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ilan Youngster
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
| | - Michael Goldman
- Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Paediatrics; Assaf Harofeh Medical Centre; Zerifin Israel
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Affiliation(s)
- Michal Feldon
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
| | - Hilla Bahat
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
| | - Shirly Gamsu
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
| | - Noa Rosenfeld
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
| | - Zvi Bistritzer
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
| | - Michael Goldman
- Department of Pediatrics, Asaf Harofe Medical Center, Zriffin, Israel
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Dinour D, Gray NK, Campbell S, Shu X, Sawyer L, Richardson W, Rechavi G, Amariglio N, Ganon L, Sela BA, Bahat H, Goldman M, Weissgarten J, Millar MR, Wright AF, Holtzman EJ. Homozygous SLC2A9 mutations cause severe renal hypouricemia. J Am Soc Nephrol 2009; 21:64-72. [PMID: 19926891 DOI: 10.1681/asn.2009040406] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hereditary hypouricemia may result from mutations in the renal tubular uric acid transporter URAT1. Whether mutation of other uric acid transporters produces a similar phenotype is unknown. We studied two families who had severe hereditary hypouricemia and did not have a URAT1 defect. We performed a genome-wide homozygosity screen and linkage analysis and identified the candidate gene SLC2A9, which encodes the glucose transporter 9 (GLUT9). Both families had homozygous SLC2A9 mutations: A missense mutation (L75R) in six affected members of one family and a 36-kb deletion, resulting in a truncated protein, in the other. In vitro, the L75R mutation dramatically impaired transport of uric acid. The mean concentration of serum uric acid of seven homozygous individuals was 0.17 +/- 0.2 mg/dl, and all had a fractional excretion of uric acid >150%. Three individuals had nephrolithiasis, and three had a history of exercise-induced acute renal failure. In conclusion, homozygous loss-of-function mutations of GLUT9 cause a total defect of uric acid absorption, leading to severe renal hypouricemia complicated by nephrolithiasis and exercise-induced acute renal failure. In addition to clarifying renal handling of uric acid, our findings may provide a better understanding of the pathophysiology of acute renal failure, nephrolithiasis, hyperuricemia, and gout.
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Affiliation(s)
- Dganit Dinour
- Nephrology and Hypertension Institute, Sheba Medical Center, Tel-Hashomer, 52621, Israel.
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Abstract
OBJECTIVE To determine the aetiologies and clinical characteristics of infants with fever and a bulging fontanelle. DESIGN The medical records of all febrile infants with a bulging fontanelle who underwent a lumbar puncture from January 2000 to February 2008 in Assaf Harofeh Medical Center, a university affiliated hospital in central Israel, were identified. RESULTS 153 patients met the inclusion criteria. The male to female ratio was 100:53; age range was 3-11 months with a mean age of 5.6 (SD 1.8) months and a median age of 5 months. Cerebrospinal fluid pleocytosis was found in 42 cases (27.3%), including one case of bacterial meningitis (0.6%). Other leading diagnoses were aseptic meningitis (26.7%), upper respiratory tract infection (18.3%), viral disease not otherwise specified (15.6%), roseola infantum (8.5%) and acute otitis media (6.5%). Appearance on admission was described as good to excellent in 113 (73.8%) infants, none of whom had bacterial meningitis. 32 had aseptic meningitis and 17 had other bacterial disease (pneumonia, acute otitis media, pyelonephritis, bacteraemia, shigella or salmonella gastroenteritis). All the latter had, upon admission, symptoms, signs, laboratory tests or imaging studies suggesting a bacterial aetiology. CONCLUSIONS In this large cohort, all infants who appeared well on admission and had normal clinical, laboratory and imaging studies had benign (non-bacterial) disease. In an infant who appears well and has no evidence of bacterial disease, it is reasonable to observe the infant and withhold lumbar puncture. Prospective studies should be carried out to confirm this approach.
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Affiliation(s)
- S Shacham
- Department of Pediatrics, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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Affiliation(s)
- M Haktan
- Department of Pediatrics, Cerrahpasa, Turkey
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