First generation cephalosporins as therapy for uncomplicated pyelonephritis in children. A retrospective analysis

There is no consensus opinion for the optimal management of pyelonephritis in children. We summarized our experience with first generation cephalosporins by a retrospective analysis of 129 pediatric patients with pyelonephritis who were treated either by first generation cephalosporins (97 patients, group 1) or broad-spectrum antibiotics (32 patients, group 2). Group 1 patients were less likely to have reported previous urinary infections or anatomical urinary tract abnormalities (16.2% vs. 53.1%, p= 0.002) and pathogens other than E. coli (7.3% vs. 25%, p=0.02). Resistance to first generation cephalosporins was identified in 22.6% of pathogens cultured, however, only 7.5% of them had poor clinical responses and required alternative treatment replacement. Our findings show that first generation cephalosporins could be used in our region to treat pyelonephritis in an otherwise healthy child, and that they can provide therapeutic success even in the face of apparent bacterial resistance.

Vitamin D deficiency and insufficiency in Orthodox and non-Orthodox Jewish mothers in Israel

BACKGROUND

The modest clothing that Orthodox Jewish women wear exposes very little of their skin to sunlight. Under these conditions they may develop vitamin D deficiency, even in sunny Israel.

OBJECTIVES

To determine and compare the vitamin D nutritional status in Jewish orthodox mothers to that of non-orthodox mothers who live in the same metropolitan area in Israel.

METHODS

25-Hydroxyvitamin D was measured by competitive protein-binding radioassay in the sera of 341 Jewish Israeli mothers (156 orthodox and 185 non-orthodox). The sera were obtained 48-72 hours after childbirth during the late summer of 1998 and the spring of 1999.

RESULTS

The mean (SD) serum concentration of 25-OHD was significantly (P < 0.002) lower (13.5 +/- 7.5 ng/ml) in the orthodox than in the non-orthodox mothers (18.6 +/- 9.6 ng/ml). Vitamin D deficiency (< 5 ng/ml) and insufficiency (< 10 ng/ml) were more common in the orthodox mothers (5.1% and 32.7% respectively) than in the non-orthodox mothers (2.7% and 13%, respectively). In subgroups of mothers supplemented with 400 units of vitamin D daily during pregnancy, vitamin D deficiency and insufficiency were less common (2.2% and 13%, respectively) in orthodox and non-orthodox mothers (0% and 8.1%, respectively). Vitamin D insufficiency was more common in the winter than in the summer only among non-orthodox mothers.

CONCLUSIONS

The high prevalence of vitamin D deficiency and insufficiency in Israeli mothers raises the question whether vitamin D supplements should be given to pregnant women in Israel, at least to orthodox mothers.

Procalcitonin correlates with C-reactive protein as an acute-phase reactant in pediatric patients

BACKGROUND

Previous reports on the behavior of procalcitonin blood levels in diverse clinical conditions suggest that it is part of the activation of cellular immunity and is another acute-phase reactant.

OBJECTIVE

To compare procalcitonin with C-reactive protein, a well-known acute-phase reactant, in a series of acutely febrile pediatric patients and to review recent literature on procalcitonin.

METHODS

Procalcitonin and CRP levels were evaluated in 38 blood samples of pediatric patients who were admitted to the Dana Children's Hospital for evaluation of unexplained fever or for sepsis work-up.

RESULTS

The parallelism between procalcitonin and CRP was found to be highly significant (P < 0.01).

CONCLUSION

The rise of procalcitonin blood levels in febrile pediatric patients suggests that it is part of the acute-phase reaction, parallel with the CRP reaction.

Complications of minocycline therapy for acne vulgaris: case reports and review of the literature

In order to raise the awareness of the potential side effects that can be induced by minocycline, we report three adolescent girls who experienced serious adverse reactions to this therapy, which was prescribed for acne vulgaris.

[Hemophilus influenzae meningitis despite vaccination]

An 18-month-old male previously vaccinated with 4 doses of HbOC developed meningitis caused by Hemophilus influenzae type B. Immunological status was normal and antibody titer to Hemophilus influenzae type b was in the normal range for immunized children. Meningitis due to this organism should be considered even in children who are fully vaccinated.

Prevention of febrile seizures by dietary supplementation with N-3 polyunsaturated fatty acids

N-3 polyunsaturated fatty acids reduce the synthesis of IL-1, the main molecule responsible for fever. We speculate that this action may be used as a prophylactic in preventing febrile seizures in susceptible children.

Cranial auscultation in two children with intracranial vascular malformation

Although most bruits heard over the skull in children are innocent, they might represent the sign of a treatable intracranial vascular pathology. Nevertheless, cranial auscultation is not routinely carried out during physical examination at a young age. Two children with vascular malformations are described in whom a cranial murmur was an early sign of intracranial vascular pathology. Routine cranial auscultation during physical examination of children is recommended.

Assessment of craniocerebral asymmetries in children by computed tomography

Computed tomographic (CT) scans of 32 children (mean age 2.8 +/- 2.5 years) with a wide range of craniocerebral asymmetry (CCA) were analyzed. Hemiparesis and epilepsy were the main clinical presentations. Two-thirds of the patients had brain infarcts. The degree of cerebral and ventricular asymmetry was evaluated by ratios obtained by linear measurements. The patients were divided into two groups according to the index of maximal asymmetry. The incidence of hemiparesis and the width of the cerebral ventricles did not differ in the two groups. This may be due to the fact that most of our patients suffered from perinatal insult to the brain, allowing time for remodeling and plastic changes to occur. The use of measurable structural parameters in craniocerebral asymmetry offers a basis for comparable radiological assessment.

Computed tomographic demonstration of brain changes in incontinentia pigmenti

Incontinentia pigmenti is a rare condition, which may involve the central nervous system. Computed tomographic (CT) examination can supply important information about the dynamics and pathologic nature of this poorly understood syndrome. Two patients suffering from incontinentia pigmenti were examined by CT because of central nervous system symptoms. Large low-density areas in the brain were demonstrated in the CT examination of the first patient a few days after birth, suggesting a local edema. Diffuse brain atrophy was found two years later. Brain atrophy was also found in the second patient in a CT examination done at the age of 11 years.