1
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Saar S, Scheuerman O, Zuabi T, Amarilyo G, Abu M, Goldberg L, Goldberg B, Shirman N, Vardi Y, Pasternak Y, Levinsky Y. Clinical implications of extremely elevated C-reactive protein among febrile immunocompetent children. Acta Paediatr 2024; 113:531-536. [PMID: 38102896 DOI: 10.1111/apa.17060] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
AIM To identify the various diagnoses associated with extremely elevated C-reactive protein (CRP) (>30 mg/dL) among immunocompetent children and to evaluate its clinical implications during emergency department (ED) workup and hospital management. METHODS Children (3 months-18 years) with fever in ED were included, retrospectively. The cohort was divided into two groups-'extremely elevated CRP' (>30 mg/dL) and 'highly elevated CRP' (15-30 mg/dL). RESULTS Included were 1173 patients with CRP 15-30 mg/dL and 221 with CRP > 30 mg/dL. Bacterial infection was more prevalent among the extremely elevated CRP group (94.1% vs. 78.5%, respectively, p = 0.002). Specifically, bacterial pneumonia (52%), cellulitis (7.2%) and sepsis (4.1%) were more prevalent among this group. More of these patients were reported as 'Ill appearing' [78 (35.3%) vs. 166 (17.4%), p < 0.001]. They were more often treated with fluids [33 (14.9%) vs. 50 (5.3%), p < 0.001] and a higher portion of them required admission to an intensive care unit [11 (5.0%) vs. 16 (1.7%), p = 0.007]. CONCLUSION Febrile children with extremely elevated CRP showed greater illness severity (haemodynamic instability, PICU admissions), thus careful clinical attention is desirable in these cases. More than half of them had bacterial pneumonia, which reinforces the importance of relevant investigation when diagnosis is unclear.
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Affiliation(s)
- Shirley Saar
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tarek Zuabi
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Amarilyo
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Mor Abu
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nina Shirman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Vardi
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Pasternak
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Kipper Institute of Clinical Immunology and Allergy, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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2
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Gilony D, Scheuerman O, Kornreich L, Hod R, Raveh E. Unilateral Choanal Atresia Presenting With Congenital Respiratory Distress and Recurrent Cyanotic Episodes. Ear Nose Throat J 2023; 102:NP429-NP431. [PMID: 34047200 DOI: 10.1177/01455613211020978] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Congenital unilateral choanal atresia (CA) is not considered an emergent condition and should not cause respiratory distress in the newborn. Therefore, surgical repair of unilateral CA is usually delayed. This description of a newborn with congenital unilateral CA that caused significant respiratory distress, recurrent cyanotic episodes, and severe feeding difficulties highlights an exception to that rule.
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Affiliation(s)
- Dror Gilony
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Liora Kornreich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Imaging Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Roy Hod
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Raveh
- Pediatric Otorhinolaryngology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Marcus-Mandelblit N, Ashkenazi-Hoffnung L, Scheuerman O. Reply to "SARS-CoV-2 reinfection or persistence among immunodeficient patients". J Allergy Clin Immunol Pract 2023; 11:972-973. [PMID: 36894285 PMCID: PMC9989502 DOI: 10.1016/j.jaip.2022.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 03/09/2023]
Affiliation(s)
- Nufar Marcus-Mandelblit
- Schneider Children's Medical Center of Israel, Kipper Institute of Immunology, Petah Tikva, Israel.
| | - Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Oded Scheuerman
- Pediatrics B, Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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4
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Sachs N, Goldberg L, Levinsky Y, Dizitzer Y, Vardi Y, Krause I, Scheuerman O, Livni G, Bilavsky E, Bilavsky-Yarden H. The Effect of the COVID-19 Pandemic on Pediatric Respiratory Hospitalizations. Isr Med Assoc J 2023; 25:171-176. [PMID: 36946659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND During coronavirus disease 2019 (COVID-19) pandemic, less isolation of common winter viruses was reported in the southern hemisphere. OBJECTIVES To evaluate annual trends in respiratory disease-related admissions in a large Israeli hospital during and before the pandemic. METHODS A retrospective analysis of medical records from November 2020 to January 2021 (winter season) was conducted and compared to the same period in two previous years. Data included number of admissions, epidemiological and clinical presentation, and isolation of respiratory pathogens. RESULTS There were 1488 respiratory hospitalizations (58% males): 632 in 2018-2019, 701 in 2019-2020, and 155 in 2020-2021. Daily admissions decreased significantly from a median value of 6 (interquartile range [IQR] 4-9) and 7 per day (IQR 6-10) for 2018-2019 and 2019-2020, respectively, to only 1 per day (IQR 1-3) in 2020-2021 (P-value < 0.001). The incidence of all respiratory viruses decreased significantly during the COVID-19 pandemic, with no hospitalizations due to influenza and only one with respiratory syncytial virus. There was also a significant decline in respiratory viral and bacterial co-infections during the pandemic (P-value < 0.001). CONCLUSIONS There was a significant decline in pediatric respiratory admission rates during the COVID-19 pandemic. Possible etiologies include epidemiological factors such as mask wearing and social distancing, in addition to biological factors such as viral interference. A herd protection effect of adults and older children wearing masks may also have had an impact.
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Affiliation(s)
- Nimrod Sachs
- Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Dizitzer
- Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Vardi
- Department of Pediatrics B, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irit Krause
- Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Department of Pediatrics C, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Havatzelet Bilavsky-Yarden
- Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Goldberg B, Danino D, Levinsky Y, Levy I, Straussberg R, Dabaja-Younis H, Guri A, Almagor Y, Tasher D, Elad D, Baider Z, Blum S, Scheuerman O. Infant Botulism, Israel, 2007-2021. Emerg Infect Dis 2023; 29:235-241. [PMID: 36692296 PMCID: PMC9881770 DOI: 10.3201/eid2902.220991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infant botulism (IB) is an intestinal toxemia that manifests as descending paralysis, constipation, and, in some cases, respiratory failure. Laboratory-confirmed IB cases are rare, and recent data in Israel are lacking. We conducted a national multicenter retrospective study of laboratory-confirmed IB cases reported in Israel during 2007-2021. A total of 8 cases were reported during the study period. During 2019-2021, incidence may have increased because of a cluster of 5 cases. Infant median age for diagnosis was 6.5 months, older than previously reported (3 months). Most cases occurred during March-July. Honey consumption was reported in 1 case, and possible environmental risk factors (living nearby rural or construction areas, dust exposure, and having a father who works as a farmer) were reported in 6 cases. Although IB is rare, its incidence in Israel may have increased over recent years, and its epidemiology and risk factors differ from cases reported previously in Israel.
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6
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Mor M, Paz M, Amir L, Levy I, Scheuerman O, Livni G, Guetta-Oz C, Yochpaz S, Berant R, Schwartz R, Niv O, Singer D, Ashkenazi S, Waisman Y. Bacterial vs viral etiology of fever: A prospective study of a host score for supporting etiologic accuracy of emergency department physicians. PLoS One 2023; 18:e0281018. [PMID: 36716321 PMCID: PMC9886241 DOI: 10.1371/journal.pone.0281018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A host-protein score (BV score) that combines the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10) and C-reactive protein (CRP) was developed for distinguishing bacterial from viral infection. This study assessed the potential of the BV score to impact decision making and antibiotic stewardship at the emergency department (ED), by comparing BV score's performance to physician's etiological suspicion at patient presentation. METHODS Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. 465 patients were recruited, 298 met eligibility criteria and 287 were enrolled. ED physician's etiological suspicion was recorded in a questionnaire. BV score was measured retrospectively with results interpreted as viral, bacterial or equivocal and compared to reference standard etiology, which was adjudicated by three independent experts based on all available data. Experts were blinded to BV scores. RESULTS Median age was 1.3 years (interquartile range 1.7), 39.7% females. 196 cases were reference standard viral and 18 cases were reference standard bacterial. BV score attained sensitivity of 88.9% (95% confidence interval: 74.4-100), specificity 92.1% (88.1-96.0), positive predictive value 53.3% (35.5-71.2) and negative predictive value 98.8% (97.1-100). Positive likelihood ratio was 11.18 (6.59-18.97) and negative likelihood ratio was 0.12 (0.03-0.45). The rate of BV equivocal scores was 9.4%. Comparing physician's suspicion to BV score and to the reference standard, and assuming full adoption, BV score could potentially correct the physician's diagnosis and reduce error ~2-fold, from 15.9% to 8.2%. CONCLUSIONS BV score has potential to aid the diagnostic process. Future studies are warranted to assess the impact of real-time BV results on ED practice.
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Affiliation(s)
- Meirav Mor
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Meital Paz
- Carmel Medical Center, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lisa Amir
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Levy
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Sivan Yochpaz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Berant
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Rama Schwartz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Omer Niv
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Dana Singer
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Yehezkel Waisman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
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7
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Mor M, Paz M, Amir L, Levy I, Scheuerman O, Livni G, Guetta-Oz C, Yochpaz S, Berant R, Schwartz R, Niv O, Singer D, Ashkenazi S, Waisman Y. 528. Bacterial vs viral etiology of fever: a prospective study to estimate a host score’s potential to support ED physicians' etiologic accuracy. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
A host-protein score (BV) combining the circulating levels of TRAIL, IP-10 and CRP was developed for distinguishing bacterial from viral infection. BV’s potential to impact decision making at the emergency department (ED) was assessed by comparing BV to physician’s etiological suspicion.
Methods
Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. The main eligibility criteria were symptoms for less than 7 days and immunocompetence. ED physician’s initial etiological suspicion (bacterial/viral/I don’t know) and degree of confidence (low/medium/high) were recorded in a questionnaire. BV was interpreted based on pre-defined score thresholds (viral/bacterial/equivocal); the results were not available to the physician. The etiologic reference standard was based on the diagnoses (bacterial/viral/indeterminate) of 3 independent pediatricians who were provided with all available patient data but blinded to BV. BV’s potential to impact the physician’s etiologic accuracy was estimated according to alignment between BV and etiological suspicion as filled in the questionnaire (assuming full adoption of BV by the physician).
Results
Among 348 patients recruited, 290 met eligibility criteria and had requisite serum sample (Figure 1A). Median age was 1.3 years (interquartile range 1.7), 37.5% were female. 211 patients had questionnaires filled. BV matched physician’s label and reference standard in 72% of the cases (151/211; Figure 1B); of these, 52% (78/151) were labeled by the physician with low/medium confidence, i.e., BV could reinforce the physician’s suspicion. In 12% of the cases (26/211) BV aligned with the reference standard but not with the physician’s suspicion, and therefore could correct the physician's etiologic diagnosis. BV did not align with the reference standard in 7% of the cases (14/211) and was equivocal in 9% of the cases (20/211). Overall, BV could potentially correct physician diagnosis and reduce error >2-fold, from 16.1% to 8.1%. Figure 1.Assessing the potential impact of BV on ED physician’s etiologic accuracy.
(A) Reference standard outcomes and BV scores. (B) BV versus adjudication-based reference standard and ED physician etiologic suspicion. Cases with missing questionnaire were omitted; n=211.
Conclusion
BV has potential to aid the diagnostic process. Future studies are warranted to assess the real-world impact of BV on ED practice.
Disclosures
Meital Paz, MD, MeMed: employee Oded Scheuerman, MD, MeMed: Grant/Research Support Ron Berant, MD, GE: Advisor/Consultant.
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Affiliation(s)
- Meirav Mor
- Schneider Children's Medical Center of Israel; Tel Aviv University , Petach Tikva , Israel
| | | | - Lisa Amir
- Schneider Children Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Itzhak Levy
- Schneider Children's Medical Center in Israel; Tel Aviv University , Petach Tikva, Tel Aviv , Israel
| | - Oded Scheuerman
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Gilat Livni
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Claire Guetta-Oz
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Sivan Yochpaz
- Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center , Tel Aviv, Tel Aviv , Israel
| | - Ron Berant
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Rama Schwartz
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Omer Niv
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Dana Singer
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University , Ariel, Israel, Petach Tikva, Tel Aviv , Israel
| | - Yehezkel Waisman
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
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8
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Zuabi T, Scheuerman O, Dizitzer Y, Amarilyo G, Abu M, Goldberg L, Goldberg B, Shirman N, Vardi Y, Levinsky Y. Elevated C-Reactive Protein With Normal Leukocytes Count Among Children With Fever. Pediatrics 2022; 150:190103. [PMID: 36416012 DOI: 10.1542/peds.2022-057843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/24/2022] Open
Abstract
Approximately 40% of patients with highly elevated C-reactive protein had a normal white blood cell count. The majority of them had a bacterial infection.
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Affiliation(s)
- Tarek Zuabi
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Dizitzer
- Department of Pediatrics C.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Amarilyo
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mor Abu
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lotem Goldberg
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bar Goldberg
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nina Shirman
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Vardi
- Department of Pediatrics B.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Levinsky
- Department of Pediatrics B.,Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Goldberg L, Laron Z, Kornreich L, Scheuerman O, Goldberg-Stern H, Kraus D. Focal Epilepsy in Individuals with Laron Syndrome. Horm Res Paediatr 2022; 95:286-290. [PMID: 35358968 PMCID: PMC9501736 DOI: 10.1159/000524350] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The aim of the study was to describe focal epilepsy in patients with Laron syndrome (LS). METHODS Data were retrieved from medical records of a single-center cohort of 75 patients with LS. RESULTS We describe for the first time 4 patients with concomitant focal epilepsy and LS. Two of them experienced episodes of status epilepticus. Electroencephalogram examination in all 4 patients showed interictal epileptiform discharges in the temporal regions. Three achieved long-term seizure freedom on antiseizure medications. CONCLUSION Patients with LS may be at risk of developing focal epilepsy, which seems to be unrelated to hypoglycemic episodes in childhood.
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Affiliation(s)
- Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel, .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
| | - Zvi Laron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Endocrinology and Diabetes Research Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Liora Kornreich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Institute of Pediatric Imaging, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadassa Goldberg-Stern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Dror Kraus
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel,*Dror Kraus,
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10
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Marcus N, Ashkenazi-Hoffnung L, Ovadia A, Dalal I, Yoffe S, Kropach N, Zuckerman N, Scheuerman O. SARS-CoV-2 symptomatic reinfection among patients with primary antibody deficiency. The Journal of Allergy and Clinical Immunology: In Practice 2022; 10:1907-1909. [PMID: 35598866 PMCID: PMC9117157 DOI: 10.1016/j.jaip.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nufar Marcus
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY; Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Day Hospitalization, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Adi Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY; Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel; Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY; Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel; Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Siril Yoffe
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY
| | - Nesia Kropach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Department of Genetics, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Neta Zuckerman
- Central Virology Laboratory, Israel Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel
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11
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Aviran N, Amarilyo G, Lakovsky Y, Tal R, Garkaby J, Haviv R, Uziel Y, Spielman S, Natour HM, Herman Y, Scheuerman O, Butbul Aviel Y, Levinsky Y, Harel L. Magnetic resonance findings may aid in diagnosis of protracted febrile myalgia syndrome: a retrospective, multicenter study. Orphanet J Rare Dis 2022; 17:15. [PMID: 35012585 PMCID: PMC8751329 DOI: 10.1186/s13023-021-02155-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/15/2021] [Accepted: 12/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Protracted febrile myalgia syndrome (PFMS) is a rare complication of Familial Mediterranean fever (FMF). The diagnosis is based on clinical symptoms and is often challenging, especially when PFMS is the initial manifestation of FMF. The aim of this report was to describe the magnetic resonance imaging (MRI) findings in pediatric patients with PFMS. Results There were three girls and two boys ranging in age from 6 months to 16 years, all of Mediterranean ancestry. Three had high-grade fever, and all had elevated inflammatory markers. MRI of the extremities yielded findings suggestive of myositis, which together with the clinical picture, normal CPK levels, and supporting family history of FMF, suggested the diagnosis of PFMS. Out of most common MEFV mutations tested, one patient was homozygous for M694V mutation, three were heterozygous for M694V mutation, and one was compound heterozygous for the M694V and V726A mutations. Conclusions MRI may serve as an auxiliary diagnostic tool in PFMS.
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Affiliation(s)
- Neta Aviran
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Rheumatology Unit, Schneider Children's Medical Center of Israel, 4942035, Petach Tikva, Israel.
| | - Gil Amarilyo
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Lakovsky
- Department of Radiology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Rotem Tal
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Day Care Center, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Jenny Garkaby
- Department of Pediatrics B, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Rubi Haviv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Shiri Spielman
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Tel Aviv, Israel
| | - Hamada Mohammad Natour
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yonatan Herman
- Pediatric Day Care Center, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yonatan Butbul Aviel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Rheumatology Unit, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yoel Levinsky
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liora Harel
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Goldberg L, Ziv A, Vardi Y, Hadas S, Zuabi T, Yeshareem L, Gur T, Steinling S, Scheuerman O, Levinsky Y. The effect of COVID-19 pandemic on hospitalizations and disease characteristics of adolescents with anorexia nervosa. Eur J Pediatr 2022; 181:1767-1771. [PMID: 34981183 PMCID: PMC8722655 DOI: 10.1007/s00431-021-04350-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023]
Abstract
UNLABELLED Social distancing and quarantines have major negative psychological implications. Our aim was to study the rate of pediatric hospitalizations due to anorexia nervosa (AN) during the first year of coronavirus disease 2019 (COVID-19) pandemic as compared to previous years, with regard to clinical and laboratory parameters. This is a retrospective study in a tertiary pediatric hospital in Israel. Data regarding inpatient hospitalizations due to AN were retrieved, then epidemiological, clinical, and laboratory parameters compared. During the entire study period, 275 hospitalizations were due to AN: 94 patients were admitted during the 12 months of the pandemic as compared to a yearly mean of 45.25 during 2015-2019, resulting in a 2.4-fold increase (p < 0.001). The mean admission age and female predominance were similar in the two study groups. The weight of the patients at admission was higher during the COVID-19 period (44.5 kg vs. 41.2 kg, p = 0.004), and fewer patients had clinical signs typical of AN upon physical examination (p = 0.022). There was a 35% reduction in median hospitalization duration (9 days [IQR 8.21] in 2020-2021 and 14 [IQR 6, 16.75] days in 2015-2019, p = 0.01). No other differences were found. CONCLUSIONS During the first year of the COVID-19 pandemic, there was a significant increase in the number of adolescents hospitalized with AN. Nevertheless, disease characteristics were not more severe as compared to the preceding 5 years. WHAT IS KNOWN • Social distancing and quarantines were announced during the COVID-19 pandemic in numerous countries. These measures have potential negative psychological effects on adolescents. WHAT IS NEW • During the COVID-19 pandemic period, there was an increase in the number of hospitalizations of adolescents with AN, although disease characteristics were not more severe as compared to the preceding 5 years.
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Affiliation(s)
- Lotem Goldberg
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Day Hospitalization Department, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Yoav Vardi
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Hadas
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tarek Zuabi
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Yeshareem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics A, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
| | - Tomer Gur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
| | - Shelly Steinling
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tiqva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Levinsky Y, Vardi Y, Gafner M, Cohen N, Mimouni M, Scheuerman O, Furst DE, Amarilyo G. Trend in women representation among authors of high rank rheumatology journals articles, 2002-2019. Rheumatology (Oxford) 2021; 60:5127-5133. [PMID: 33560297 DOI: 10.1093/rheumatology/keab134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/18/2020] [Accepted: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The representation of women among authors of peer reviewed scientific papers is gradually increasing. The aims of this study were to examine the trend of the proportion of women among authors in the field of rheumatology during the last two decades. METHODS Articles published in journals ranked in the top quartile of the field of rheumatology in the years 2002-2019 were analysed. The authorship positions of all authors, country of the article's source and manuscript type were retrieved by specifically designed software. RESULTS Overall, 153 856 author names were included in the final analysis. Of them, 55 608 (36.1%) were women. There was a significant rise in the percentage of women authors over time (r = 0.979, P <0.001) from 30.9% in 2002 to 41.2% in 2018, with a slight decline to 39.8% in 2019. There were significantly fewer women in the senior author positions compared with the first author positions (24.3% in senior position vs 40.9% as first author, P <0.001). CONCLUSION The proportion of women among authors of rheumatology articles has increased over the years, both in general and as a first or senior author; however, their proportion is still <50% and there is still a gap between the proportion of women among first authors and the proportion of women among senior authors.
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Affiliation(s)
- Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva.,Sackler Faculty of Medicine, Tel Aviv University
| | - Yoav Vardi
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva.,Sackler Faculty of Medicine, Tel Aviv University
| | - Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva.,Sackler Faculty of Medicine, Tel Aviv University
| | - Neta Cohen
- Emergency Medicine Department, Dana Duek Children Hospital, Tel-Aviv
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Healthcare Campus affiliated with the Technion-Israel Institute of Technology, Haifa, Israrel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva.,Sackler Faculty of Medicine, Tel Aviv University
| | - Daniel E Furst
- University of California, Los Angeles, Los Angeles, CA.,University of Washington, Seattle, WA, USA.,University of Florence, Florence, Italy
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel Aviv University.,Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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14
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Lowenthal A, Weisblum-Neuman H, Birk E, Ashkenazi-Hoffnung L, Levy I, Ben-Zvi H, Amir G, Frenkel G, Bruckheimer E, Yarden-Bilavsky H, Marom D, Shostak E, Nahum E, Dagan T, Chodick G, Scheuerman O. Clinical Features and Comparison of Kingella and Non-Kingella Endocarditis in Children, Israel. Emerg Infect Dis 2021; 27:703-709. [PMID: 33622463 PMCID: PMC7920667 DOI: 10.3201/eid2703.203022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Kingella spp. have emerged as an important cause of invasive pediatric diseases. Data on Kingella infective endocarditis (KIE) in children are scarce. We compared the clinical features of pediatric KIE cases with those of Streptococcus species IE (StIE) and Staphylococcus aureus IE (SaIE). A total of 60 patients were included in the study. Throughout the study period, a rise in incidence of KIE was noted. KIE patients were significantly younger than those with StIE and SaIE, were predominately boys, and had higher temperature at admission, history of oral aphthae before IE diagnosis, and higher lymphocyte count (p<0.05). Pediatric KIE exhibits unique features compared with StIE and SaIE. Therefore, in young healthy children <36 months of age, especially boys, with or without a congenital heart defect, with a recent history of oral aphthae, and experiencing signs and symptoms compatible with endocarditis, Kingella should be suspected as the causative pathogen.
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15
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Gavish R, Levinsky Y, Dizitzer Y, Bilavsky E, Livni G, Pirogovsky A, Scheuerman O, Krause I. The COVID-19 pandemic dramatically reduced admissions of children with and without chronic conditions to general paediatric wards. Acta Paediatr 2021; 110:2212-2217. [PMID: 33539565 PMCID: PMC8013809 DOI: 10.1111/apa.15792] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/21/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/24/2022]
Abstract
Aim We examined the impact of the COVID‐19 pandemic on how many children were admitted to Israel's largest tertiary paediatric hospital and why they were admitted. Methods Israel declared COVID‐19 a national emergency on 19 March 2020. This study examined daily hospital admissions to our three general paediatric wards during the COVID‐19 lockdown period from 20 March to 18 April 2020. These 258 admissions were compared with the 4217 admissions from the period immediately before this, 1 February to 19 March 2020, plus 1 February to 18 April in 2018 and 2019. We also compared why patients were admitted during the study period, and any pre‐existing conditions, with 638 children hospitalised during the same period in 2019. Results The mean number of daily hospitalisations during the COVID‐19 lockdown period was 8.6, which was 59% lower than the 20.9 recorded during the other three periods before COVID‐19. There was a significant decrease in the number of patients admitted with infectious (74%) and non‐infectious (44%) aetiologies from 2019 to 2020, and these occurred among patients with (58%), and without (55%), pre‐existing medical conditions. Conclusion The Israeli COVID‐19 lockdown had a dramatic effect on admissions to the paediatric wards of a tertiary hospital.
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Affiliation(s)
- Rachel Gavish
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tiqva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yoel Levinsky
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petah Tiqva Israel
| | - Yotam Dizitzer
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tiqva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Efraim Bilavsky
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tiqva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gilat Livni
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatrics A Schneider Children's Medical Center of Israel Petah Tiqva Israel
| | - Avinoam Pirogovsky
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Medical Management Schneider Children's Medical Center of Israel Petah Tiqva Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petah Tiqva Israel
| | - Irit Krause
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petah Tiqva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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16
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Goldbart AD, Arazi A, Golan-Tripto I, Levinsky Y, Scheuerman O, Tarasiuk A. Altered slow-wave sleep activity in children with rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation syndrome. J Clin Sleep Med 2021; 16:1731-1735. [PMID: 32638701 DOI: 10.5664/jcsm.8678] [Citation(s) in RCA: 4] [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] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Rapid-onset obesity with hypothalamic dysregulation, hypoventilation, and autonomic dysregulation (ROHHAD) is a rare condition. Little is known about sleep/wake and slow-wave activity in this condition, although the central hypothalamic dysfunction associated with autonomic dysregulation would make the occurrence of SWA deregulation most likely. METHODS Two children with clinical presentation of ROHHAD syndrome were evaluated, diagnosed, and treated. Their polysomnographic studies were compared with 4 matched children with obstructive sleep apnea and 6 controls. RESULTS Children that were clinically diagnosed with ROHHAD exhibited significantly weaker slow-wave activity power and shallower slow-wave activity slopes during the first 2 sleep cycles compared with children with obstructive sleep apnea or controls. CONCLUSIONS This study shows that children with ROHHAD have suppressed slow-wave activity, possibly because of hypothalamic dysregulation that may contribute to their rapid-onset obesity and excessive daytime sleepiness.
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Affiliation(s)
- Aviv D Goldbart
- Department of Pediatrics B, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ayelet Arazi
- Department of Brain and Cognitive Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Department of Pediatrics B, Soroka University Medical Center, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Tarasiuk
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Sleep-Wake Disorders Unit, Soroka Medical Center, Beer-Sheva, Israel
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17
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Ben-Shimol S, Livni G, Megged O, Greenberg D, Danino D, Youngster I, Shachor-Meyouhas Y, Dabaja-Younis H, Scheuerman O, Mor M, Somekh E, Yakub Hanna H, Givon-Lavi N, Guri A, Leibovitz E, Alkan Y, Grupel D, Rubinstein U, Steinberg Ben Zeev Z, Bamberger E, Asher Kuperman A, Grisaru-Soen G, Tasher D, Gottesman G, Glikman D, Stein M. COVID-19 in a Subset of Hospitalized Children in Israel. J Pediatric Infect Dis Soc 2021; 10:757-765. [PMID: 34129032 PMCID: PMC8344587 DOI: 10.1093/jpids/piab035] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 01/31/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most pediatric coronavirus disease 2019 (COVID-19) is mild. We assessed nationally severe COVID-19, including pediatric inflammatory multisystem syndrome (PIMS), in hospitalized children. METHODS An ongoing, prospective, national surveillance was conducted from March 2020 through March 2021, at 20 hospitals treating children <18 years across Israel (~75% of Israeli hospitals). RESULTS Overall, 1007 cases (439 outpatients and 568 hospitalized) identified represent 0.35% of pediatric COVID-19 nationwide (n = 291 628). Of hospitalized cases, 464 (82%), 48 (8%), and 56 (10%) had mild, moderate/severe, and PIMS disease, respectively. The mean ± SD age was 5.6 ± 6.4 years. In mild, moderate/severe, and PIMS disease, 55%, 23%, and 4% of patients were <1 year old, respectively. Obesity was reported in 1%, 4%, and 13% of patients, respectively (P < .001). The most common symptom was fever in 67%, 60%, and 100%, respectively, whereas respiratory symptoms were documented in 33%, 41%, and 38% of patients, respectively. Lymphopenia was recorded in 25%, 60%, and 86% of cases, respectively. PIMS diagnosis was mainly serology-based (in 59%). Gastrointestinal symptoms, cardiovascular involvement, rash, and conjunctivitis were noted in 82%, 61%, 57%, and 34% of PIMS episodes, respectively. Elevated C-reactive protein (100%), ferritin, troponin, D-dimer, low albumin, and thrombocytopenia were common in PIMS. Echocardiography revealed pathological findings in 33% of patients. PIMS mainstay treatment included corticosteroids (77%) and intravenous immunoglobulin (53%). No mortality was recorded. CONCLUSIONS At a national level, pediatric COVID-19 is mild, even in hospitalized cases, with only a third presenting with respiratory involvement. PIMS is rare, but necessitates a high index of suspicion, and with suitable treatment prognosis is favorable.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel,Corresponding Author: Shalom Ben-Shimol, MD, Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel. E-mail:
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dana Danino
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilan Youngster
- Pediatric Infectious Diseases Unit, Shamir Medical Center, Zerifin, Israel,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Shachor-Meyouhas
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Halima Dabaja-Younis
- Pediatric Infectious Disease Unit, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Meirav Mor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Infection Control Unit and Emergency Department, Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Eli Somekh
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Husam Yakub Hanna
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel,Department of Pediatrics, Mayanei Hayeshua Medical Center, Bnei Brak, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alex Guri
- Department of Pediatrics, Kaplan Medical Center, Rehovot, Israel,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Eugene Leibovitz
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Alkan
- Clalit Health Services, Sharon Shomron District, Israel
| | - Daniel Grupel
- Infectious Diseases Unit, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Uri Rubinstein
- Department of Pediatrics, Laniado Medical Center, Netanya, Israel
| | | | - Ellen Bamberger
- Department of Pediatrics, Bnai Zion Medical Center, Haifa, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Galia Grisaru-Soen
- Pediatric Infectious Disease Unit, Dana Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Diana Tasher
- Department of Pediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Giora Gottesman
- Pediatric Infectious Disease Unit, Meir Medical Center, Kfar Saba, Israel
| | - Daniel Glikman
- Infectious Diseases Unit, The Baruch Padeh Medical Center, Poriya, Israel,Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Michal Stein
- Infectious Disease and Infection Control Unit, Hillel Yaffe Medical Center, Hadera, Israel,Rappaport Faculty of Medicine, Technion Institute, Haifa, Israel
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18
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Levinsky Y, Broide M, Kagan S, Goldberg O, Scheuerman O, Tal R, Tirosh I, Butbul Y, Harel L, Amarilyo G. POS1295 PERFORMANCE OF 2019 EULAR/ACR CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A PEDIATRIC POPULATION – A MULTICENTER STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The “European League Against Rheumatism” and “American College of Rheumatology” 2019 (EULAR/ACR-19) criteria for the diagnosis of Systemic Lupus Erythematosus (SLE) were recently published, with the stated goal of maintaining the level of sensitivity and raising the level of specificity for classification of SLE in adults.Objectives:We aimed to examine the function of the new EULAR/ACR-19 criteria in a population of children and compare them to the SLICC-12 and ACR-97 criteria.Methods:In this multicenter study the charts of jSLE patients from three tertiary medical centers were reviewed and compared to patients with non-jSLE diagnosis. Pediatric rheumatologists, blinded to the original diagnosis, reviewed and diagnosed all cases. Pediatric patients’ clinical and laboratory data were retrospectively extracted and then examined with regard to how they met the new and old criteria.Results:Included were 225 patients (112 jSLE, 113 non-SLE). When applied to juvenile SLE classification, the sensitivity of the new EULAR/ACR-19 criteria was 0.96 (0.9-.0.99) and the specificity was 0.89 (0.82-0.94). These were comparable to the Systemic Lupus International Collaborating Clinics (SLICC) criteria. The sensitivity of the EULAR/ACR-19 criteria improves over time and was 0.83 twelve months following disease onset, reaching 0.96 after longer than 24 months.Conclusion:Among a cohort of jSLE patients, sensitivity of the new EULAR/ACR-19 criteria was found to be high and specificity may have improved slightly compared to the SLICC-12 criteria. We support the use of the new classification criteria for pediatric patients in future jSLE studies, but it should be noted that its specificity is lower than for adults.ACR-97SLICC-12EULAR/ACR-19Sensitivity (95% CI)0.79 (0.70-0.86)0.96 (0.9-0.99)0.96 (0.9-.0.99)Specificity (95% CI)0.94 (0.88-0.97)0.85 (0.77-0.91)0.89 (0.82-0.94)Accuracy (95% CI)0.86 (0.81-0.9)0.9 (0.86-0.94)0.92 (0.88-.0.96)Positive Likelihood Ratio (95% CI)12.7(6.1-26.2)6.35(4.1-9.9)9.0 (5.3-15.4)Negative Likelihood Ratio (95% CI)0.23(0.16-0.33)0.05(0.02-0.12)0.05(0.02-0.12)Diagnostic odds ratio (95% CI)55.5(22.80-135.0)120.85(43.0-340.0)180.1(61.3-529.4)References:[1]Smith EMD, Lythgoe H, Midgley A, Beresford MW, Hedrich CM. Juvenile-onset systemic lupus erythematosus: Update on clinical presentation, pathophysiology and treatment options. Clin Immunol 2019 published on December 2019. doi: 10.1016/j.clim.2019.108274[2]Massias JS, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, et al. Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups. Lupus 2020;29(5):474–81.[3]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997 Sep;40(9):1725[4]Petri M, Orbai AM, Alarcõn GS, Gordon C, Merrill JT, Fortin PR, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012 Aug;64(8):2677-86[5]Hartman EAR, van Royen-Kerkhof A, Jacobs JWG, Welsing PMJ, Fritsch-Stork RDE. Performance of the 2012 Systemic Lupus International Collaborating Clinics classification criteria versus the 1997 American College of Rheumatology classification criteria in adult and juvenile systemic lupus erythematosus. A systematic review and meta-an. Autoimmun Rev. 2018;17(3):316–22.[6]Aringer M, Costenbader K, Daikh D, Brinks R, Mosca M, Ramsey-Goldman R, et al. 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol 2019;71(9):1400–12.Disclosure of Interests:None declared
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Ashkenazi-Hoffnung L, Shecter N, De-Vries I, Levy I, Scheuerman O, Yarden-Bilavsky H, Bernfeld Y, Mor M. Factors predicting efficacy of ethanol lock therapy as catheter salvage strategy for pediatric catheter-related infections. Pediatr Blood Cancer 2021; 68:e28856. [PMID: 33352003 DOI: 10.1002/pbc.28856] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/09/2022]
Abstract
AIM Catheter-related infections are difficult to cure, and failure rates are high. We aimed to evaluate the efficacy and safety of ethanol lock therapy (ELT) as catheter salvage strategy in children with central-line-associated bloodstream infection (CLABSI), and to identify factors associated with treatment failure. METHODS Data were collected of all the children who received ELT for treatment of CLABSI during 2013-2018 due to failure of standard therapy or multiple catheter-related infections. Univariate and multivariate analyses of risk-factors for ELT failure were performed. Catheter salvage rates were compared to those achieved using systemic antimicrobials alone in an historical control group. RESULTS A total of 123 ELT episodes among 95 patients were analyzed. The majority of patients had underlying hemato-oncological disorders. Approximately half the episodes occurred in patients with implantable ports. Early and late treatment failure rates of ELT were 16% (20/123) and 7% (9/123), respectively. Overall, successful catheter salvage was achieved in 78% (96/123) of episodes, compared to 54% using systemic antimicrobials alone (P < .001), including mycobacterium, candida, and most staphylococcus aureus infections. Adverse events were reported in 9% (11/123) of episodes and were mostly mechanical. Multivariate analysis identified four risk factors for ELT failure: Gram-positive bacteria, elevated C-reactive protein, signs of tunnel infection, and low absolute neutrophil counts. CONCLUSIONS Our findings support the use of ELT for catheter salvage in children with CLABSI who failed standard therapy or had multiple catheter-related infections. The identified variables associated with ELT failure may help identify patients who can most benefit from ELT.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Shecter
- Department of Pediatrics A&B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Irit De-Vries
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Itzhak Levy
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A&B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Havatzelet Yarden-Bilavsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A&B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Yael Bernfeld
- Department of Pharmacy, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Mor
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Levine H, Prais D, Aharoni S, Nevo Y, Katz J, Rahmani E, Goldberg L, Scheuerman O. COVID-19 in advanced Duchenne/Becker muscular dystrophy patients. Neuromuscul Disord 2021; 31:607-611. [PMID: 34053847 PMCID: PMC8021445 DOI: 10.1016/j.nmd.2021.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 12/24/2022]
Abstract
Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy. As a result of progressive muscle weakness, pulmonary function decreases during the second decade of life and lung disease contributes significantly to morbidity and mortality in these patients. Corticosteroids are the current standard of care for patients with DMD, despite known adverse effects such as obesity and immunosuppression. Over the past year (2020), the novel coronavirus (COVID-19/SARS-CoV2) outbreak has caused a global pandemic. Restrictive lung disease due to low lung volumes, chronic immunosuppressive treatment with corticosteroids, and obesity are potential risk factors that may contribute to a more severe course of the disease. Out of 116 Duchenne/Becker muscular dystrophy patients treated in our tertiary neuromuscular center, six patients with DMD and one with advanced Becker muscular dystrophy were found to be positive for COVID-19 infection. Two of the DMD patients were admitted for hospitalization, of whom one was dependent on daily nocturnal non-invasive ventilation. All patients recovered without complications despite obesity, steroid treatment and severe restrictive lung disease.
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Affiliation(s)
- Hagit Levine
- Pulmonary Institute, Schneider Children's Medical Center, Petah-Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Dario Prais
- Pulmonary Institute, Schneider Children's Medical Center, Petah-Tikva 49100, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Sharon Aharoni
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Neurology Institute, Schneider Children's Medical Center, Petah-Tikva, Israel
| | - Yoram Nevo
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Neurology Institute, Schneider Children's Medical Center, Petah-Tikva, Israel
| | - Julia Katz
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Eyal Rahmani
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center, Petah-Tikva, Israel
| | - Lotem Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center, Petah-Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center, Petah-Tikva, Israel; Pediatric Infectious Disease Unit, Schneider Children's Medical Center
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21
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Levinsky Y, Broide M, Kagan S, Goldberg O, Scheuerman O, Tal R, Tirosh I, Butbul Y, Furst DE, Harel L, Amarilyo G. Performance of 2019 EULAR/ACR classification criteria for systemic lupus erythematosus in a paediatric population—a multicentre study. Rheumatology (Oxford) 2021; 60:5142-5148. [DOI: 10.1093/rheumatology/keab140] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/18/2021] [Indexed: 02/03/2023] Open
Abstract
AbstractObjectivesThe European League Against Rheumatism and American College of Rheumatology 2019 (EULAR/ACR-19) criteria for the diagnosis of SLE were recently published, with the stated goal of maintaining the level of sensitivity and raising the level of specificity for classification of SLE in adults. The aim of this study is to examine their application to juvenile SLE (jSLE) patients.MethodsIn this multicentre study the charts of jSLE patients from three tertiary medical centres were reviewed and compared with patients with non-jSLE diagnosis. Paediatric rheumatologists, blinded to the original diagnosis, reviewed and diagnosed all cases. Paediatric patients' clinical and laboratory data were retrospectively extracted and then examined with regard to how they met the new and old criteria.ResultsIncluded were 225 patients (112 jSLE, 113 non-SLE). When applied to juvenile SLE classification, the sensitivity of the new EULAR/ACR-19 criteria was 0.96 (95% CI: 0.9, 0.99) and the specificity was 0.89 (95% CI: 0.82, 0.94). These were comparable to the SLICC criteria. The sensitivity of the EULAR/ACR-19 criteria improves over time and was 0.83 12 months following disease onset, reaching 0.96 after longer than 24 months.ConclusionAmong a cohort of jSLE patients, sensitivity of the new EULAR/ACR-19 criteria was found to be high and specificity may have improved slightly compared with the SLICC-12 criteria. We support the use of the new classification criteria for paediatric patients in future jSLE studies, but it should be noted that its specificity is lower than for adults.
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Affiliation(s)
- Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Mor Broide
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Department of Pediatrics A, Schneider Children's Medical Center
| | - Shelly Kagan
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Ori Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Pulmonary Unit
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Rotem Tal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Irit Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer
| | - Yoni Butbul
- Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa, Israel
| | - Daniel E Furst
- Department of Medicine, Rheumatology Division, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Department of Experimental and Clinical Medicine, University of Florence, and Division of Rheumatology AOUC, Florence, Italy and
- Department of Rheumatology, University of Washington, Seattle, WA, United States
| | - Liora Harel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
| | - Gil Amarilyo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
- Pediatric Rheumatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva
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22
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Goldberg L, Levinsky Y, Marcus N, Hoffer V, Gafner M, Hadas S, Kraus S, Mor M, Scheuerman O. SARS-CoV-2 Infection Among Health Care Workers Despite the Use of Surgical Masks and Physical Distancing-the Role of Airborne Transmission. Open Forum Infect Dis 2021; 8:ofab036. [PMID: 33732749 PMCID: PMC7928680 DOI: 10.1093/ofid/ofab036] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 12/17/2020] [Accepted: 01/25/2021] [Indexed: 12/23/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted mainly via respiratory droplets. A key question in the coronavirus disease 2019 pandemic is whether SARS-CoV-2 could be transmitted via the airborne route as well. We report for the first time SARS-CoV-2 nosocomial infections despite using surgical masks and physical distancing. This report may provide possible evidence for airborne transmission of SARS-CoV-2.
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Affiliation(s)
- Lotem Goldberg
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nufar Marcus
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Hoffer
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Gafner
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Hadas
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sraya Kraus
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Meirav Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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23
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Marcus N, Frizinsky S, Hagin D, Ovadia A, Hanna S, Farkash M, Maoz-Segal R, Agmon-Levin N, Broides A, Nahum A, Rosenberg E, Kuperman AA, Dinur-Schejter Y, Berkun Y, Toker O, Goldberg S, Confino-Cohen R, Scheuerman O, Badarneh B, Epstein-Rigbi N, Etzioni A, Dalal I, Somech R. Minor Clinical Impact of COVID-19 Pandemic on Patients With Primary Immunodeficiency in Israel. Front Immunol 2021; 11:614086. [PMID: 33519822 PMCID: PMC7840610 DOI: 10.3389/fimmu.2020.614086] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
In the last few months the world has witnessed a global pandemic due to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19). Obviously, this pandemic affected individuals differently, with a significant impact on populations considered to be at high-risk. One such population, was assumed to be patients with primary genetic defect involving components or pathways of the immune system. While human immunity against COVID-19 is not fully understood, it is, so far, well documented, that both adaptive and innate cells have a critical role in protection against SARS-CoV-2. Here, we aimed to summarize the clinical and laboratory data on primary immunodeficiency (PID) patients in Israel, who were tested positive for SARS-CoV-2, in order to estimate the impact of COVID-19 on such patients. Data was collected from mid-February to end-September. During this time Israel experienced two “waves” of COVID-19 diseases; the first, from mid-February to mid-May and the second from mid-June and still ongoing at the end of data collection. A total of 20 PID patients, aged 4 months to 60 years, were tested positive for SARS-CoV-2, all but one, were detected during the second wave. Fourteen of the patients were on routine monthly IVIG replacement therapy at the time of virus detection. None of the patients displayed severe illness and none required hospitalization; moreover, 7/20 patients were completely asymptomatic. Possible explanations for the minimal clinical impact of COVID-19 pandemic observed in our PID patients include high level of awareness, extra-precautions, and even self-isolation. It is also possible that only specific immune pathways (e.g. type I interferon signaling), may increase the risk for a more severe course of disease and these are not affected in many of the PID patients. In some cases, lack of an immune response actually may be a protective measure against the development of COVID-19 sequelae.
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Affiliation(s)
- Nufar Marcus
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Shirly Frizinsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, "Edmond and Lily Safra" Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Department of Medicine, Allergy and Clinical Immunology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Ovadia
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel.,Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Suhair Hanna
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Michael Farkash
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Ramit Maoz-Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Nancy Agmon-Levin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.,Sackler School of Medicine, Tel Aviv University, Ramat-Aviv, Israel
| | - Arnon Broides
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amit Nahum
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Elli Rosenberg
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Immunology Clinic, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Asher Kuperman
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.,Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Center, Nahariya, Israel
| | - Yael Dinur-Schejter
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Bone Marrow Transplantation Department, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yackov Berkun
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Department of Pediatrics, Mount Scopus Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ori Toker
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,The Allergy and Immunology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shmuel Goldberg
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Pediatric Pulmonary Unit, Pediatric Division, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ronit Confino-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Meir Medical Center, Kfar-Saba, Israel
| | - Oded Scheuerman
- Pediatrics B, Schneider Children Medical Center Israel, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Basel Badarneh
- Allergy and Immunology Unit, Schneider Children's Medical Center of Israel, Felsenstein Medical Research Center, Kipper Institute of Immunology, Petach Tikva, Israel.,Pediatric Department, Allergy and Immunology Clinic, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel
| | - Na'ama Epstein-Rigbi
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir (Former Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Amos Etzioni
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Ruth Children Hospital, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Allergy Unit, E. Wolfson Medical Center, Holon, Israel.,Pediatric Department, E. Wolfson Medical Center, Holon, Israel
| | - Raz Somech
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States.,Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, "Edmond and Lily Safra" Children's Hospital, Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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24
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Goldberg O, Sokolover N, Bromiker R, Amitai N, Chodick G, Scheuerman O, Ben-Zvi H, Klinger G. Antibiotic Discontinuation 24 h After Neonatal Late-Onset Sepsis Work-Up-A Validated Decision Tree Model. Front Pediatr 2021; 9:693882. [PMID: 34490157 PMCID: PMC8417412 DOI: 10.3389/fped.2021.693882] [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: 04/12/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Neonatal late-onset sepsis work-up is a frequent occurrence in every neonatal department. Blood cultures are the diagnostic gold standard, however, a negative culture prior to 48-72 h is often considered insufficient to exclude sepsis. We aimed to develop a decision tree which would enable exclusion of late-onset sepsis within 24 h using clinical and laboratory variables. Study Design: Infants evaluated for late-onset sepsis during the years 2016-2019, without major malformations, in a tertiary neonatal center were eligible for inclusion. Blood cultures and clinical and laboratory data were extracted at 0 and 24 h after sepsis work-up. Infants with bacteriologically confirmed late-onset sepsis were compared to matched control infants. Univariate logistic regression identified potential risk factors. A decision tree based on Chi-square automatic interaction detection methodology was developed and validated. Results: The study cohort was divided to a development cohort (105 patients) and a validation cohort (60 patients). At 24 h after initial evaluation, the best variables to identify sepsis were C-reactive protein > 0.75 mg/dl, neutrophil-to-lymphocyte ratio > 1.5 and sick-appearance at 24 h. Use of these 3 variables together with blood culture status at 24 h, enabled identification of all infants that eventually developed sepsis through the decision tree model. Our decision tree has an area under the receiver operating characteristic curve of 0.94 (95% CI: 0.90-0.98). Conclusions: In non-sick appearing infants with a negative blood culture at 24 h and normal laboratory values, sepsis is highly unlikely and discontinuing antibiotics after 24 h is a viable option.
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Affiliation(s)
- Ori Goldberg
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Nir Sokolover
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruben Bromiker
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nofar Amitai
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Gabriel Chodick
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Haim Ben-Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petah Tikva, Israel
| | - Gil Klinger
- Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Ashkenazi-Hoffnung L, Livni G, Scheuerman O, Berger I, Eden E, Oved K, Shani L, Kronenfeld G, Simon E, Boico O, Navon R, Gottlieb TM, Barash E, Paz M, Yuhas Y, Berent E, Ashkenazi S. Differential Serum and Urine CRP, IP-10, and TRAIL Levels in Pediatric Urinary Tract Infection. Front Pediatr 2021; 9:771118. [PMID: 34966702 PMCID: PMC8710750 DOI: 10.3389/fped.2021.771118] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: It is estimated that clinical evaluation and urinalysis are unable to diagnose >10% of urinary tract infections (UTI) in young children. TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10), and C-reactive protein (CRP) exhibit differential expression in the blood in response to bacterial vs. viral infection. We assessed if the urinary and serum levels of these host biomarkers discriminate UTI, nephronia, and response to antibiotic treatment. Methods: Hospitalized febrile children aged <18 years with suspected UTI based on abnormal urinalysis were recruited prospectively between 2016 and 2018; also, non-febrile controls were recruited. Following urine culture results and hospitalization course, participants were divided into three groups based on AAP criteria and expert adjudication: UTI, viral infection, and indeterminate. Results: Seventy-three children were enrolled, 61 with suspected UTI and 12 non-febrile controls. Of the 61 with suspected UTI, 40 were adjudicated as UTI, 10 viral infection, and 11 as indeterminate. Urinary CRP and IP-10 levels were significantly higher in the UTI group (p ≤ 0.05). Urinary CRP differentiated UTI from non-bacterial etiology in children under and over 3 months of age, with AUCs 0.98 (95% CI: 0.93-1.00) and 0.82 (0.68-0.95), respectively. Similarly, urinary IP-10 discriminated with AUCs of 0.80 (0.59-1.00) and 0.90 (0.80-1.00), respectively. Serum CRP and IP-10 levels were significantly higher in UTI cases with nephronia (p ≤ 0.03). UTI-induced changes in the levels of urinary and serum biomarkers resolved during recovery. Conclusions: CRP, IP-10, and TRAIL represent biomarkers with potential to aid the clinician in diagnosis and management of UTI.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Schneider Children's Medical Center, Petah Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Oded Scheuerman
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Itay Berger
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | | | | | | | | | | | | | | | | | | | | | - Yael Yuhas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eva Berent
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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26
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Rosenberg Danziger C, Krause I, Scheuerman O, Luder A, Yulevich A, Dalal I, Grisaru-Soen G, Bilavsky E. Pediatrician, watch out for corona-phobia. Eur J Pediatr 2021; 180:201-206. [PMID: 32661937 PMCID: PMC7357258 DOI: 10.1007/s00431-020-03736-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 01/17/2023]
Abstract
The current outbreak of COVID-19 raging globally is taking a heavy toll on the adult population, with a rapidly growing number of newly infected and critically ill patients. However, to date, mortality rate among children is low as they mostly suffer from a mild disease. Yet, other more routinely encountered childhood diseases do not stand still and continue to be the main share of pediatricians' everyday challenges. Here we describe a case series of routinely seen pediatric diseases with delayed diagnosis due to different aspects of what we call "Corona-phobia". These cases were easily collected within a 1-week period which implies that this is a more widespread phenomenon.In conclusion, this raises the possibility that measures taken to mitigate this pandemic may be more damaging to children overall than the virus itself. We believe that pediatricians as well as policy makers should take this important aspect into consideration. What is Known: • COVID-19 manifests as a mild disease in most children; however, children are an important reservoir and may become spreaders of the disease. • Social distancing and isolation are important tools in mitigating COVID-19 transmission. What is New: • This case series describes 7 cases with delayed diagnosis of every-day pediatric diseases that were not caused by COVID-19 but were highly influenced by different aspects of "Corona-phobia". • Our objective is to highlight the possibility that measures taken to mitigate this pandemic may lead to a substantial delay in the diagnosis of other non-COVID-19 related diseases.
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Affiliation(s)
- Chen Rosenberg Danziger
- Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Irit Krause
- Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | - Anthony Luder
- Department of Pediatrics, Ziv Medical Center, Safed, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Alon Yulevich
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Department of Pediatric Surgery, Ziv Medical Center, Safed, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Paediatrics, Edith Wolfson Medical Center, Holon, Israel
| | - Galia Grisaru-Soen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Dana- Dwek Children’s Hospital, Tel Aviv, Israel
| | - Efraim Bilavsky
- Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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27
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Levinsky Y, Tamari I, Zuabi T, Mor M, Asher G, Pirogovsky A, Marcus N, Goldberg L, Scheuerman O. Hospitalisation of children with SARS-CoV-2 on the general paediatric ward: coping with a persistent pandemic. Arch Dis Child 2020; 106:archdischild-2020-321058. [PMID: 33262174 DOI: 10.1136/archdischild-2020-321058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Yoel Levinsky
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Tamari
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tarek Zuabi
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meirav Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Paediatric Emergency Medicine and Infection Control, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Galit Asher
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | | - Nufar Marcus
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lotem Goldberg
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Rubin LG, Shin J, Kaur I, Scheuerman O, Levy I, Long SS. Frequency of Multifocal Disease and Pyogenic Arthritis of the Hip in Infants with Osteoarticular Infection in Three Neonatal Intensive Care Units. J Pediatr 2020; 227:157-162. [PMID: 32707046 DOI: 10.1016/j.jpeds.2020.07.055] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/29/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To describe the clinical features of osteoarticular infection in infants cared for in neonatal intensive care units (NICUs) and to assess the presence of multifocal infection. STUDY DESIGN Retrospective medical record review with structured data abstraction of infants with osteomyelitis or pyogenic arthritis or both in NICUs at 3 children's hospitals over a 29-year period. RESULTS Of the 45 cases identified, 87% occurred in prematurely born infants, with a median gestational age of 27.4 weeks (IQR, 26, 31 weeks). Median postnatal age at diagnosis of infection was 33 days (IQR, 20, 50 days). Osteomyelitis was present without joint involvement in 53% and with joint involvement in 44% of cases. Methicillin-susceptible Staphylococcus aureus (71%) was the predominant pathogen, despite prevalent methicillin-resistant S aureus in community-associated infections. More than 1 bone was infected in 34% of cases. The femur (in 50% of patients) was the most frequently involved bone and the hip (in 20% of patients) was the most frequently involved joint. Bacteremia persisted for 4 or more days in 54% of patients with a positive blood culture despite active antimicrobial therapy. CONCLUSIONS Among infants with osteoarticular infection in NICUs, multifocal disease is common and frequently is unsuspected. Search for additional sites of infection including the hip is warranted following the diagnosis of osteoarticular infection at a single site. Involvement of contiguous joints should be suspected in cases of osteomyelitis; conversely the presence of pyogenic arthritis usually indicates extant osteomyelitis in a contiguous bone.
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Affiliation(s)
- Lorry G Rubin
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
| | - Jiwoong Shin
- Department of Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY
| | - Ishminder Kaur
- St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA
| | - Oded Scheuerman
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Levy
- Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarah S Long
- St. Christopher's Hospital for Children and Drexel University College of Medicine, Philadelphia, PA
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29
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Stafler P, Zaks-Hoffer G, Scheuerman O, Ben-Zvi H, Mussaffi H, Mei-Zahav M, Steuer G, Levine H, Bar-On O, Mantin H, Prais D, Blau H. Diagnostic value of sputum cultures in children under 2 years of age with chronic suppurative lung diseases. Pediatr Pulmonol 2020; 55:3421-3428. [PMID: 33006230 DOI: 10.1002/ppul.25103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/28/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Acquiring sputum cultures from infants is considered challenging. We describe their yield in infants with cystic fibrosis (CF) and other chronic suppurative lung diseases (CSLDs). METHODS Retrospective medical record review over a 4-year period, for infants aged 0-2 years with ≥2 airway bacterial cultures acquired by deep suction or induced sputum ≥4 weeks apart. Data included demographics, culture results, and clinical status. RESULTS A total of 98 infants (16 CF) were evaluated and 534 sputum cultures acquired, 201 in CF and 333 in CSLD. There were 12 (2-23), median (range) cultures/CF infant, and 3 (2-21)/CSLD infant. Age at first culture was 3.8 (1-19.5) months for CF and 10.4 (0.5-22) months for CSLD; p = .016. In total, 360 cultures (67%) were positive for any bacteria, with 170/234 (73%) positive during exacerbations, compared with 190/300 (63%) during routine visits; p = .05. More infants with CF than CSLD had cultures positive for Staphylococcus aureus (SA; 75% vs. 34%; p = .004) throughout the period. Pseudomonas aeruginosa (PA) was common in both CF and CSLD (56% and 44%, respectively; p = .42) and increased over time for CF but was high throughout for CSLD. The number of hospital days before PA acquisition was 6 (10.2) for CF and 28.8 (38.7) for CSLD (p = .003). No CF but 6/82 (7%) CSLD infants had chronic PA (p = .56). CONCLUSIONS Sputum cultures showed that infection, in particular PA, is common in CF and CSLD whereas SA is more common in CF. Prospective studies are warranted to elucidate the role of active surveillance in guiding antibiotic therapy.
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Affiliation(s)
- Patrick Stafler
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gal Zaks-Hoffer
- Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Genetics Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | - Huda Mussaffi
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Guy Steuer
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Hagit Levine
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ophir Bar-On
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hadas Mantin
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dario Prais
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hannah Blau
- Graub CF Center Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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30
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Ulanovski D, Shavit SS, Scheuerman O, Sokolov M, Hilly O, Raveh E. Medical and surgical characteristics of fusobacterium necrophorum mastoiditis in children. Int J Pediatr Otorhinolaryngol 2020; 138:110324. [PMID: 32911237 DOI: 10.1016/j.ijporl.2020.110324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/29/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics of Fusobacterium necrophorum mastoiditis (FnM) to characteristics of acute mastoiditis (AM) caused by other bacteria in tertiary children hospital Methods : Children with FnM (N=43) and non FnM (N=88). Assess medical, microbiologic and imaging characteristics, surgical findings and postoperative recovery. RESULTS Children with FnM had a positive history of otitis media, ear discharge and sub-periosteal abscess (p=0.0004, 0.09, 0.0003, respectively) at presentation. Their temperature, WBC and CRP were significantly higher (39.8 vs. 37.9, 19.4K vs. 16.1K, 21 vs. 8.7, p=0.0001). Positive culture was found in 46% of patients; 64% were diagnosed by PCR. CT scan was indicated in 95% and surgical intervention in 93% of children with FnM, compared to 15% and 9.7% of children in the non-FnM group (p=0.0001). Complex post-operative course was frequent for the FnM group: 88% of children had persistent fever, 46% had additional imaging and 14% additional surgical intervention. Children with FnM were treated with IV antibiotics for an average of 22 compared to seven days for non-FnM children (p=0.0001). CONCLUSIONS Fusobacterium should be suspect in a child presenting with AM, a septic appearance, high fever and increased inflammation markers. A regimen of two antibiotics should be empirically started, then proceed to imaging and early surgical intervention. A relatively slow post-operative recovery process should be expected; however, prognosis is good.
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Affiliation(s)
- David Ulanovski
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern Shavit
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Meirav Sokolov
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Raveh
- Pediatric Ear-Nose-Throat Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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31
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Goldberg O, Amitai N, Chodick G, Bromiker R, Scheuerman O, Ben-Zvi H, Klinger G. Can we improve early identification of neonatal late-onset sepsis? A validated prediction model. J Perinatol 2020; 40:1315-1322. [PMID: 32203177 DOI: 10.1038/s41372-020-0649-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk. STUDY DESIGN A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016-2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis. RESULTS The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with: sick appearance (OR: 5.7, 95% CI: 1.1-29.1), C-reactive protein > 0.75 (OR: 5.4, 95% CI: 1.1-26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR: 6.7, 95% CI: 1.2-38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI: 0.86-0.97). CONCLUSIONS Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.
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Affiliation(s)
- Ori Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Nofar Amitai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatrics Department A, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabi Institute of Health Services Research, Maccabi Health Care Services, Tel Aviv, Israel
| | - Reuben Bromiker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatrics Department B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Haim Ben-Zvi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Microbiology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | - Gil Klinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Neonatal Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
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32
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Sokolov M, Tzelnick S, Stern S, Hilly O, Scheuerman O, Raveh E, Ulanovski D. Acute mastoiditis in infants younger than 6 months: is an alternative treatment protocol needed? Eur Arch Otorhinolaryngol 2020; 278:339-344. [PMID: 32500325 DOI: 10.1007/s00405-020-06088-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Several studies have reported that younger children suffer from increased incidence and more severe episodes of acute mastoiditis (AM) than older children, whereas other researchers have found the opposite. The aim of our study was to describe the occurrence, clinical, and microbiological aspects of AM in children 6 months or younger, and compare them with the results in an older reference age band. METHODS The medical files of children hospitalized with a diagnosis of AM during 2001-2016 were retrospectively reviewed. Diagnosis of AM was based on the presence of clinical signs of acute otitis media (AOM) accompanied by two or more of the following: auricle protrusion, retro-auricular erythema, swelling, and local tenderness. Children were divided into two age bands, 6 months or younger, and older than 6 months. RESULTS Fifty patients in the young age band and 335 in the older reference age band were included. Bilateral AOM was identified in 14 (28%) children under 6 months, and 50 (14.9%) in the reference age band (p < 0.001). Fever, mean WBC, and CRP values were similar in both age bands; 4 (8%) children under 6 months had pre-auricular/zygomatic area swelling, as compared to 1(0.02%) in the reference age band (p < 0.001). Complication rates (subperiosteal abscess, sinus vein thrombosis, and epidural abscess) were similar in both age bands. All children were treated with myringotomy and IV antibiotics. Cortical mastoidectomy with the insertion of ventilation tube was performed in 10 (20%) children in the younger age band and 58(17.3%) in the reference age band. Streptococcus pneumoniae was the most common (38%) isolated bacteria in the younger age band, and Group A streptococcous (GAS) (20.6%) in the reference age band. CONCLUSIONS AM in children 6 months or younger has similar presentation and characteristics as in older children. Pre-auricular swelling and bilateral AOM are more typical in the younger age band; Streptococcus pneumoniae is the most common pathogen in the younger children. We suggest that the treatment approach should be the same for both groups.
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Affiliation(s)
- Meirav Sokolov
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Sharon Tzelnick
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Hilly
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Raveh
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Ulanovski
- Department of Otorhinolaryngology and Head and Neck Surgery, Schneider Children's Medical Center of Israel and Rabin Medical Center, Beilinson Campus, 49202, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mintz A, Mor M, Klinger G, Scheuerman O, Pirogovsky A, Sokolover N, Bromiker R. Changing epidemiology and resistance patterns of pathogens causing neonatal bacteremia. Eur J Clin Microbiol Infect Dis 2020; 39:1879-1884. [PMID: 32415489 DOI: 10.1007/s10096-020-03921-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/01/2020] [Indexed: 01/21/2023]
Abstract
To conduct a survey of the local prevalent bacteria and antibiotic resistance in a referral tertiary neonatal intensive care unit (NICU), in order to assess the efficacy of local antibiotic policies. We reviewed all positive blood and cerebrospinal fluid cultures obtained between January 2007 and December 2017 in the NICU of Schneider Children's Medical Center of Israel. Early and late-onset bacteremia were defined as episodes occurring within or after the first 3 calendar days of life respectively. Empiric treatment included ampicillin and gentamicin or piperacillin-tazobactam and amikacin for early or late-onset bacteremia respectively. The prevalence and antibiotic resistance of the bacteria were described and compared over time. Eight hundred and twenty nine of 15,947 (5.2%) newborns had at least one episode of bacteremia; 81 had multiple episodes. The most common bacteria were Escherichia coli (32.35%) and group B Streptococcus (19.11%) or coagulase negative Staphylococcus (CoNS) (60.5%) and Klebsiella sp. (12.4%) in early or late-onset bacteremia respectively. Overall, all Gram-positive bacteria were susceptible to vancomycin and most non-CoNS to ampicillin. Nosocomial vs. vertical bacteremia had increased resistance to ampicillin and cephalosporins. Resistance of nosocomial bacteria to piperacillin-tazobactam was 22.4%, to amikacin 3.3%, and to meropenem 1.8%. Changes over time: Gram-negative bacteria had a significant increase in resistance to cotrimoxazole and piperacillin. The resistance to gentamicin doubled. Our empiric antibiotic regimen covers the most frequent isolates. Amikacin may replace gentamicin for selected sick patients in early-onset bacteremia. Piperacillin-tazobactam should be combined with amikacin until susceptibility is available.
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Affiliation(s)
- Ayelet Mintz
- Department of Neonatology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Meirav Mor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Emergency Pediatrics, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Gil Klinger
- Department of Neonatology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Avinoam Pirogovsky
- Hospital Administration, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Medical Corps, Israel Defense Forces (IDF), Tel Aviv, Israel
| | - Nir Sokolover
- Department of Neonatology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruben Bromiker
- Department of Neonatology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Raibin K, Levy I, Atiya Nasagi Y, Ashkenazi‐Hoffnung L, Sherman G, Avneri L, Landau D, Scheuerman O. Atypical presentation of human ehrlichiosis and anaplasmosis in children in Israel. Acta Paediatr 2019; 108:1727-1728. [PMID: 31140643 DOI: 10.1111/apa.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Karine Raibin
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Itzhak Levy
- Pediatric Infectious Diseases Unit Schneider Children's Medical Center of Israel Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | | | - Liat Ashkenazi‐Hoffnung
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petach Tikva Israel
- Pediatric Infectious Diseases Unit Schneider Children's Medical Center of Israel Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gilad Sherman
- Pediatric Infectious Diseases Unit Schneider Children's Medical Center of Israel Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Liad Avneri
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Pediatrics C Schneider Children's Medical Center of Israel Petach Tikva Israel
| | - Daniel Landau
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Oded Scheuerman
- Department of Pediatrics B Schneider Children's Medical Center of Israel Petach Tikva Israel
- Pediatric Infectious Diseases Unit Schneider Children's Medical Center of Israel Petach Tikva Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Ben-Zvi H, Drozdinsky G, Kushnir S, Avni T, Scheuerman O, Bishara J, Yahav D. Corrigendum to "Influence of GeneXpert MRSA/SA test implementation on clinical outcomes of Staphylococcus aureus bacteremia - A before-after retrospective study" [Diagn Microbiol Infect Dis 2019;93(2):120-124]. Diagn Microbiol Infect Dis 2019; 94:107. [PMID: 30857918 DOI: 10.1016/j.diagmicrobio.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haim Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Genady Drozdinsky
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel
| | - Shiri Kushnir
- Research and Development Unit, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel
| | - Tomer Avni
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel
| | - Jihad Bishara
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach-Tikva, Israel
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Shin J, Scheuerman O, Levy I, Rubin L. 2316. The Frequency of Multifocal Disease and Pyogenic Hip Arthritis in Neonates With Osteomyelitis. Open Forum Infect Dis 2018. [PMCID: PMC6254530 DOI: 10.1093/ofid/ofy210.1969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Jiwoong Shin
- Pediatrics, Northwell Health - Cohen Children’s, Queens, New York
| | - Oded Scheuerman
- Pediatrics B, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Itzhak Levy
- Schneider Children’s Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Lorry Rubin
- Cohen Children’s Medicine Center of New York, Northwell Health, New Hyde Park, New York
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Brameli A, Ashkenazi-Hoffnung L, Giloni D, Friling R, Chodick G, Landau D, Scheuerman O. Systemic corticosteroids may be beneficial for managing severe or refractory orbital cellulitis in children. Acta Paediatr 2018; 107:2028-2029. [PMID: 29920768 DOI: 10.1111/apa.14467] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Anna Brameli
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva
| | - Liat Ashkenazi-Hoffnung
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva
- Pediatric Infectious Diseases Unit; Schneider Children's Medical Center of Israel; Petach Tikva
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dror Giloni
- Pediatric Otorhinolaryngology Unit; Schneider Children's Medical Center of Israel; Petach Tikva
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ronit Friling
- Pediatric Ophthalmology Unit; Schneider Children's Medical Center of Israel; Petach Tikva
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Daniel Landau
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Oded Scheuerman
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva
- Pediatric Infectious Diseases Unit; Schneider Children's Medical Center of Israel; Petach Tikva
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Orenstein N, Goldberg-Stern H, Straussberg R, Bazak L, Weisz Hubshman M, Kropach N, Gilad O, Scheuerman O, Dory Y, Kraus D, Tzur S, Magal N, Kilim Y, Shkalim Zemer V, Basel-Salmon L. A de novo GABRA2 missense mutation in severe early-onset epileptic encephalopathy with a choreiform movement disorder. Eur J Paediatr Neurol 2018; 22:516-524. [PMID: 29422393 DOI: 10.1016/j.ejpn.2017.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 05/28/2017] [Revised: 12/16/2017] [Accepted: 12/22/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Early-onset epileptic encephalopathy (EOEE) is a severe convulsive disorder with a poor developmental prognosis. Although it has been associated with mutations in a number of genes, the fact that there is a large proportion of patients who remain undiagnosed suggests that there are many more still-unknown genetic causes of EOEE. Achieving a genetic diagnosis is important for understanding the biological basis of the disease, with its implications for treatment and family planning. METHODS Whole-exome sequencing was performed in a family of Ashkenazi Jewish origin in which a male infant was diagnosed with EOEE. There was no family history of a similar neurologic disease. The patient had extreme hypotonia, neonatal hypothermia, choreiform movements, and vision impairment in addition to the convulsive disorder. RESULTS A de novo heterozygous missense mutation, c.1003A > C, p.Asn335His, was identified in a conserved domain of GABRA2. GABRA2 encodes the α2 subunit of the GABAA receptor. CONCLUSIONS In the context of previous reports of an association of de novo mutations in genes encoding different subunits of the GABAA receptor (GABRB1, GABRA1, GABRG2, GABRB3) with autosomal dominant epileptic disorders, we conclude that a de novo mutation in GABRA2 is likely to cause autosomal dominant EOEE accompanied by a movement disorder and vision impairment.
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Affiliation(s)
- Naama Orenstein
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Hadassa Goldberg-Stern
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Pediatric Epilepsy Unit, Neurological Institute, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Rachel Straussberg
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Neurogenetic Service, Neurological Institute, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Lily Bazak
- Raphael Recanati Genetics Institute, Rabin Medical Center- Beilinson Hospital, Petach Tikva 4941492, Israel; Mina and Everard Goodman Faculty of Life Science, Bar Ilan University, Ramat Gan 5290002, Israel; Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
| | - Monika Weisz Hubshman
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Raphael Recanati Genetics Institute, Rabin Medical Center- Beilinson Hospital, Petach Tikva 4941492, Israel; Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
| | - Nesia Kropach
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Oded Gilad
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel.
| | - Oded Scheuerman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Yahav Dory
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Dror Kraus
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Pediatric Epilepsy Unit, Neurological Institute, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Shay Tzur
- Mina and Everard Goodman Faculty of Life Science, Bar Ilan University, Ramat Gan 5290002, Israel; Laboratory of Molecular Medicine, Rambam Health Care Campus, Haifa 3109601, Israel; Genomic Research Department, Emedgene Technologies, Tel Aviv, Israel.
| | - Nurit Magal
- Raphael Recanati Genetics Institute, Rabin Medical Center- Beilinson Hospital, Petach Tikva 4941492, Israel; Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
| | - Yael Kilim
- Raphael Recanati Genetics Institute, Rabin Medical Center- Beilinson Hospital, Petach Tikva 4941492, Israel; Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
| | - Vered Shkalim Zemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel.
| | - Lina Basel-Salmon
- Pediatric Genetics Clinic, Schneider Children's Medical Center of Israel, Petach Tikva 4920235, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel; Raphael Recanati Genetics Institute, Rabin Medical Center- Beilinson Hospital, Petach Tikva 4941492, Israel; Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikva 4941492, Israel.
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Ashkenazi-Hoffnung L, Oved K, Navon R, Friedman T, Boico O, Paz M, Kronenfeld G, Etshtein L, Cohen A, Gottlieb TM, Eden E, Chistyakov I, Srugo I, Klein A, Ashkenazi S, Scheuerman O. A host-protein signature is superior to other biomarkers for differentiating between bacterial and viral disease in patients with respiratory infection and fever without source: a prospective observational study. Eur J Clin Microbiol Infect Dis 2018; 37:1361-1371. [PMID: 29700762 PMCID: PMC6015097 DOI: 10.1007/s10096-018-3261-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 02/14/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
Bacterial and viral infections often present with similar symptoms. Etiologic misdiagnosis can alter the trajectory of patient care, including antibiotic overuse. A host-protein signature comprising tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein (CRP) was validated recently for differentiating bacterial from viral disease. However, a focused head-to-head comparison of its diagnostic performance against other biomarker candidates for this indication was lacking in patients with respiratory infection and fever without source. We compared the signature to other biomarkers and prediction rules using specimens collected prospectively at two secondary medical centers from children and adults. Inclusion criteria included fever > 37.5 °C, symptom duration ≤ 12 days, and presentation with respiratory infection or fever without source. Comparator method was based on expert panel adjudication. Signature and biomarker cutoffs and prediction rules were predefined. Of 493 potentially eligible patients, 314 were assigned unanimous expert panel diagnosis and also had sufficient specimen volume. The resulting cohort comprised 175 (56%) viral and 139 (44%) bacterial infections. Signature sensitivity 93.5% (95% CI 89.1–97.9%), specificity 94.3% (95% CI 90.7–98.0%), or both were significantly higher (all p values < 0.01) than for CRP, procalcitonin, interleukin-6, human neutrophil lipocalin, white blood cell count, absolute neutrophil count, and prediction rules. Signature identified as viral 50/57 viral patients prescribed antibiotics, suggesting potential to reduce antibiotic overuse by 88%. The host-protein signature demonstrated superior diagnostic performance in differentiating viral from bacterial respiratory infections and fever without source. Future utility studies are warranted to validate potential to reduce antibiotic overuse.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Department of Pediatrics B, Schneider Children's Medical Center, Petach Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | - Irina Chistyakov
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Isaac Srugo
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Pediatrics, Bnai-Zion Medical Center, Haifa, Israel
| | - Adi Klein
- Department of Pediatrics, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shai Ashkenazi
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Pediatrics A, Schneider Children's Medical Center, 14 Kaplan Street, 49202, Petach Tikva, Israel.
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center, Petach Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kropach N, Shkalim-Zemer V, Orenstein N, Scheuerman O, Straussberg R. Novel RRM2B Mutation and Severe Mitochondrial DNA Depletion: Report of 2 Cases and Review of the Literature. Neuropediatrics 2017; 48:456-462. [PMID: 28482374 DOI: 10.1055/s-0037-1601867] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose To describe the clinical presentation and implications of mitochondrial DNA depletion disorder of two siblings with early fatal encephalomyopathy and a novel mutation in the RRM2B gene. The relevant literature is reviewed. Methods We describe two brothers aged 2.5 months and 1 month, respectively, who were hospitalized in a tertiary pediatric medical center for evaluation of focal seizures, hypotonia, poor feeding, failure to thrive, lactic acidosis, and developmental delay. The older brother also had seizures, and the younger had severe bilateral neurosensory deafness. Results Genetic sequencing of the RRM2B gene revealed the same novel mutation in both the siblings. Both children died due to respiratory failure at ages 3 and 2.5 months, respectively. Conclusion The combination of neonatal hypotonia, developmental delay, and lactic acidosis should raise a clinician's suspicion of a mitochondrial depletion disorder and prompt further genetic studies.
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Affiliation(s)
- Nesia Kropach
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vered Shkalim-Zemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Hematology-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Naama Orenstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Genetics, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Oded Scheuerman
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rachel Straussberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Scheuerman O, Zilber E, Davidovits M, Chodick G, Levy I. Nephrologists need to play a key role in improving annual influenza vaccination rates in children with kidney disease. Acta Paediatr 2017; 106:812-818. [PMID: 28130859 DOI: 10.1111/apa.13763] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/19/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
AIM This study investigated the under-researched area of annual influenza vaccination rates in children with chronic kidney disease and identified reasons for nonimmunisation. METHODS A prospective cross-sectional study was conducted in the nephrology clinic and dialysis unit of a tertiary paediatric medical centre from August to October 2011 and September to October 2012. Parents were asked to complete a questionnaire on their child's immunisation against influenza. RESULTS Of the 217 children studied, 45.6% were vaccinated against influenza. The major reason for nonimmunisation was because the parents had not received the necessary information from the primary physician or treating nephrologist. The nonvaccinated children were significantly more likely to be less than two years old and female and to have parents who did not believe in the benefits of vaccination (p < 0.05). Of the parents who did not vaccinate their child, 38% claimed they would have done so if the vaccine had been offered in the nephrology clinic. CONCLUSION Children with kidney disease had a higher annual influenza vaccination rate than the general population, but it was still suboptimal. Nephrologists should be alerted to the need to provide parents with information on influenza vaccinations and they should be available in nephrology clinics.
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Affiliation(s)
- Oded Scheuerman
- Pediatric Infectious Disease Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eyal Zilber
- Pediatric Infectious Disease Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Miriam Davidovits
- Institute of Nephrology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Itzhak Levy
- Pediatric Infectious Disease Unit; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Ashkenazi-Hoffnung L, Ari A, Bilavsky E, Scheuerman O, Amir J, Prais D. Pseudomonas aeruginosa identified as a key pathogen in hospitalised children with aspiration pneumonia and a high aspiration risk. Acta Paediatr 2016; 105:e588-e592. [PMID: 27387674 DOI: 10.1111/apa.13523] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/21/2023]
Abstract
AIM Data on the causative pathogens and optimal empirical therapy of aspiration pneumonia in children are limited. This study sought to describe the bacteriology of aspiration pneumonia in hospitalised children with a high aspiration risk. METHODS Respiratory tract specimens were prospectively collected using the induced sputum technique from children with a high aspiration risk who were hospitalised for aspiration pneumonia in a tertiary paediatric medical centre from 2009 to 2014. Clinical, microbiological and treatment data were recorded and analysed for each admission. RESULTS The cohort comprised 50 children with 235 hospital admissions. Of the 183 respiratory tract cultures performed, 110 were positive for bacteria, with 169 isolates, mostly Gram-negative. The most common Gram-negative pathogen was Pseudomonas aeruginosa. If patients had Pseudomonas aeruginosa isolation, the risk of them having the pathogen again was 81%. The multivariate analysis showed that the use of antibiotic prophylaxis and number of hospitalisations were significantly associated with Pseudomonas aeruginosa isolation. CONCLUSION Gram-negative bacilli, especially Pseudomonas aeruginosa, were the major causative agents of paediatric aspiration pneumonia in our study. Empiric antipseudomonas treatment should be considered, particularly in patients who are receiving antibiotic prophylaxis, have experienced recurrent hospitalisations or with previous respiratory cultures that showed Pseudomonas aeruginosa isolation.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anne Ari
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - Efraim Bilavsky
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Oded Scheuerman
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Jacob Amir
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dario Prais
- Department of Pediarics B&C; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Scheuerman O, Barkai G, Mandelboim M, Mishali H, Chodick G, Levy I. Human metapneumovirus (hMPV) infection in immunocompromised children. J Clin Virol 2016; 83:12-6. [PMID: 27522636 DOI: 10.1016/j.jcv.2016.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/21/2015] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Human metapneumovirus (hMPV) is a major cause of upper and lower respiratory tract infection (URTI, LRTI) in children. The prognosis of hMPV is unclear in immunocompromised patients. OBJECTIVES To describe the characteristics of hMPV infection in immunocompromised pediatric patients and to review the literature. STUDY DESIGN This retrospective study included 39 immunocompromised children (age 0-18 years) with proven hMPV infection attending two tertiary pediatric medical centers in 2004-2014. Demographic, clinical, laboratory, and radiological data were collected from the medical files. RESULTS Median age was 6 years. Seven patients had primary immune deficiency and 32, secondary immune deficiency, including 9 patients who underwent hematopoietic stem cell transplantation (HSCT). Most cases (92%) occurred in January-May. Twenty patients (51%) had lower respiratory tract infection and 17 (44%), upper respiratory tract infection; 2 patients (5%) had fever only. Presenting symptoms were fever (70%), cough (54%), and rhinorrhea (35%). Severe lymphopenia (<1000lymphocytes/mL) was noted in 64% of patients and elevated liver enzyme levels in 49%. Seventeen patients had pneumonia: bilateral and alveolar in 13 patients, each. HSCT was not associated with more severe disease. Respiratory failure occurred in 6 patients, of whom 4 died (10% of cohort). All children who died had severe lymphopenia. On multivariate analysis, bacterial or fungal co-infection was the only major risk factor for death. Review of the literature showed variable clinical presentations and severity in pediatric patients with hMPV infection. CONCLUSIONS Infection with hMPV may be associated with relatively high morbidity and mortality in immunocompromised children. Death was associated with bacterial and fungal co-infection.
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Affiliation(s)
- Oded Scheuerman
- Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel.
| | - Galia Barkai
- Pediatric Infectious Disease Unit, The Edmond and Lily Safra Children's Hospital, Tel Hashomer, Ramat Gan 52621, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
| | - Michal Mandelboim
- Department of Virology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel
| | - Hagit Mishali
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel
| | - Gabriel Chodick
- Department of Epidemiology & Preventive Medicine, Tel Aviv, Ramat Aviv 6997801, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
| | - Itzhak Levy
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petach Tikva 49202, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv 6997801, Israel
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Scheuerman O, Bar-Sever Z, Hoffer V, Gilad O, Marcus N, Garty B. Functional hyposplenism is an important and underdiagnosed immunodeficiency condition in children. Acta Paediatr 2014; 103:e399-403. [PMID: 24850471 DOI: 10.1111/apa.12697] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 01/22/2014] [Revised: 03/23/2014] [Accepted: 05/16/2014] [Indexed: 01/04/2023]
Abstract
AIM Few studies have focused on paediatric hyposplenism/asplenism, in which splenic phagocytic activity is diminished or absent in an anatomically present spleen. This study aimed to evaluate clinical findings, laboratory tests and prognosis of children with functional hyposplenism/asplenism. METHODS The study group comprised 74 children who had liver/spleen technetium-99m sulphur colloid scintigraphy from 2002 to 2008. Information collected included demographic features, background diseases, blood smear findings, indications for scintigraphy and outcome. Children with functional hyposplenism were followed until 2012. RESULTS We found that 34 patients had functional hyposplenism/asplenism. The main indications for scintigraphy in the hyposplenic patients were persistent thrombocytosis and recurrent infections. Associated conditions included immunodeficiencies, autoimmune diseases, malignancies and genetic disorders. Main infections were sinopulmonary infections, bacteraemia and sepsis. The major pathogens were Streptococcus pneumoniae and Haemophilus influenza group A. There was no correlation between the presence of Howell-Jolly bodies in blood smear with clinical disease severity or scintigraphic findings. Repeated scintigraphy showed spontaneous normalisation in 40% of patients. CONCLUSION Functional hyposplenism is an important and underdiagnosed immunodeficiency condition in children, associated with various clinical conditions including prolonged unexplained thrombocytosis, immune deficiency and autoimmunity. Technetium-99m sulphur colloid scintigraphy is the method of choice for evaluating splenic function.
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Affiliation(s)
- O. Scheuerman
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Z. Bar-Sever
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Institute of Nuclear Medicine; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - V. Hoffer
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - O. Gilad
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - N. Marcus
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Kipper Institute of Allergy and Immunology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
| | - B.Z. Garty
- Department of Pediatrics B; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Kipper Institute of Allergy and Immunology; Schneider Children's Medical Center of Israel; Petach Tikva Israel
- Felsenstein Medical Research Center; Petach Tikva Israel
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Scheuerman O, Grinbaum I, Garty BZ. [Münchausen syndrome by proxy]. Harefuah 2013; 152:639-689. [PMID: 24416819] [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: 06/03/2023]
Abstract
Münchausen syndrome by proxy (also known as factitious disorder by proxy) is a psychiatric disorder which consists of fabricating or inducing illness in a child, usually by his mother. The motivation for the perpetrator's behavior is receivng satisfaction from the investigations and treatments that the child receives and from the medical environment, as part of a unique mental disturbance. External incentives for the behavior (such as economic gain) are absent. During the last few years about 20 cases of Münchausen syndrome by proxy were diagnosed in our ward. We describe a few less typical cases of patients with Münchausen syndrome by proxy. In all cases the offender, the mother, had only secondary education and no medical background. The socioeconomic background was variable. Recognition of the syndrome and a high index of clinical suspicion are needed in order to diagnose the disorder. Suspicious signs and symptoms include prolonged and illogical course of disease, odd complications, exacerbation that appear just before discharge from the hospital and symptoms that occur only in the presence of a specific care giver. Münchausen syndrome by proxy is not very rare. It appears in all ethnic groups, socioeconomic status and educational backgrounds.
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Affiliation(s)
- Oded Scheuerman
- Pediatrics B, Schneider Children Medical Center, Petah Tikva, Israel.
| | - Iris Grinbaum
- Pediatrics B, Schneider Children Medical Center, Petah Tikva, Israel
| | - Ben Zion Garty
- Pediatrics B, Schneider Children Medical Center, Petah Tikva, Israel
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Yarden-Bilavsky H, Raveh E, Livni G, Scheuerman O, Amir J, Bilavsky E. Fusobacterium necrophorum mastoiditis in children - emerging pathogen in an old disease. Int J Pediatr Otorhinolaryngol 2013; 77:92-6. [PMID: 23102657 DOI: 10.1016/j.ijporl.2012.10.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/03/2012] [Accepted: 10/06/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anaerobic bacteria are uncommon etiologic agents of acute mastoiditis in children. However, recent studies suggest an increase in the incidence of Fusobacterium necrophorum mastoid infections in the last two decades. METHODS A surveillance study performed over 3.5 years in a tertiary pediatric medical center identified 7 children with acute F. necrophorum mastoiditis. Clinical, laboratory, and treatment data were collected by file review. RESULTS Five of the 7 children presented in the last year of the study. All 7 children were less than 26 months old on admission, and none had a history of otogenic infections. All cases were characterized by significantly elevated levels of inflammatory markers. All were diagnosed as complicated mastoiditis with abscess formation. Four children had an epidural abscess, three children had evidence of osteomyelitis beyond the mastoid bone, and four children had imaging evidence of sinus vein thrombosis. All seven children required cortical mastoidectomy with ventilatory tubes insertion and two children required more than one surgical intervention. During follow-up, two children had recurrent episodes of mastoiditis due to other pathogens. CONCLUSION Our data support the literature suggesting that the occurrence of F. necrophorum mastoiditis among children is rising. Acute coalescent mastoiditis due to F. necrophorum is associated with a complicated course and warrants particular attention by pediatricians, infectious disease experts, and ear, nose and throat specialists.
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Abstract
Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.
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Affiliation(s)
- V Hoffer
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
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Abstract
AIMS The aim of the study was to characterize the clinical course of post-varicella idiopathic thrombocytopenic purpura (ITP) and to asses the risk of acquiring ITP after varicella infection. METHODS A retrospective study of all children diagnosed with ITP in a tertiary medical centre during 1998-2008. Findings were compared with the Intercontinental Childhood ITP Study Group database. The risk of acquiring ITP after a varicella infection was assessed. RESULTS Ten children were diagnosed with post-varicella ITP. The incidence of post-varicella ITP was 1.9% amongst children diagnosed with ITP and 1.1% amongst children hospitalized for varicella. ITP was diagnosed, on average, 8.5 days after the onset of the varicella rash. The female-to-male ratio was 1:1.5. The average minimal platelet count was 9.5 × 10⁹ platelets/L. Post-varicella ITP had an acute course in 80% of cases and a chronic course in the remaining 20%. Bleeding episodes occurred in three patients. During the follow-up period, 11 patients with previously diagnosed ITP developed varicella. The infection had no apparent affect on the platelet count of the children with acute ITP, but caused a relapse in 71% of the patients with chronic ITP. CONCLUSIONS Post-varicella ITP has similar clinical features and course to non-varicella associated ITP. The calculated risk of ITP as a complication of varicella infections is approximately 1:25,000.
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Affiliation(s)
- Achiya Amir
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tiqwa, Israel
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Kraus D, Yacobovich J, Hoffer V, Scheuerman O, Tamary H, Garty BZ. Infantile pyknocytosis: a rare form of neonatal anemia. Isr Med Assoc J 2010; 12:188-189. [PMID: 20684190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Dror Kraus
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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Gazit Y, Mory A, Etzioni A, Frydman M, Scheuerman O, Gershoni-Baruch R, Garty BZ. Leukocyte adhesion deficiency type II: long-term follow-up and review of the literature. J Clin Immunol 2010; 30:308-13. [PMID: 20099014 DOI: 10.1007/s10875-009-9354-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 11/20/2009] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Leukocyte adhesion deficiency (LAD) is a group of rare inherited disorders characterized by immune deficiency and peripheral neutrophilia. There are only seven reported cases of LAD type II worldwide, and no long-term follow-up data. CASE REPORT We reviewed the medical file of a 20-year-old man with LAD II. Clinical characteristics included short stature, severe mental retardation, and autistic features. He had had no severe infections since infancy, and his current immunological status was stable. The last laboratory work-up revealed mild leukocytosis and neutrophilia. Genetic analysis of the Golgi GDP-fucose transporter (GFTP) sequence yielded a point mutation resulting in Y337C amino acid transition in the tenth transmembrane domain. CONCLUSION In conclusion, in LAD II, the main clinical countenance shifts from frequent infections due to immunodeficiency in the early years to the metabolic consequences of the defect in fucose metabolism, i.e., retarded growth and mental retardation, in the later years. A novel mutation in the GFTP loci associated with LAD II is described.
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Affiliation(s)
- Yael Gazit
- Kipper Institute of Allergy and Immunology, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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