Mutant adenosine deaminase 2 in a polyarteritis nodosa vasculopathy.

Background: Polyarteritis nodosa is a systemic necrotizing vasculitis with a pathogenesis that is poorly understood. We identified six families with multiple cases of systemic and cutaneous polyarteritis nodosa, consistent with autosomal recessive inheritance. In most cases, onset of the disease occurred during childhood.

Multiple hymenoptera stings in children: clinical and laboratory manifestations.

Multiple hymenoptera stings are a cause of rhabdomyolysis, elevated liver enzymes, clotting abnormalities, kidney injury, and even death. However, the progression of the clinical and laboratory findings has been described mainly in sporadic case reports. We report the clinical and laboratory manifestations of multiple hymenoptera stings in six children who were hospitalized and referred for a nephrology evaluation and follow-up over a 12-year period.

Unrealistic concerns about fever in children: the influence of cultural-ethnic and sociodemographic factors.

Background: Parental fear and misconceptions about fever are widespread in western society. Ethnicity and sociodemographic factors have been suggested as contributing factors.

Objectives: To test the hypothesis that undue parental concern about fever is less in traditional than in western cultural-ethnic groups.

Flow cytometry and morphology analysis of bone marrow in a child with brucellosis and hematologic manifestations.

Constitutional symptoms and pancytopenia are occasionally the initial presentation of pediatric brucellosis. Therefore, in endemic areas, in children with pancytopenia, both brucellosis and malignancy should be included in the deferential diagnosis. We report here a child with pancytopenia and hepatosplenomegaly as manifestations of brucellosis in whom bone marrow morphology and flow cytometry data revealed hemophagocytosis, left shift in myeloid cells and activation changes in antigenic properties of T and B lymphocytes and monocytes.

Referral criteria from community clinics to pediatric emergency departments.

Referral of patients to a pediatric emergency department (PED) should be medically justified and the need for referral well communicated. The objectives of this paper were (1) to create a list of criteria for referral from the community to the PED, (2) to describe how community physicians categorize their need for referral, and (3) to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003.

Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis.

Background: Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA) is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO), a volatile gas with analgesic, anxiolytic and sedative properties.

Objective: To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment.

Influenza vaccination of patients with systemic lupus erythematosus: safety and immunogenecity issues.

The influenza vaccine is highly efficacious in the general population; however there have been concerns about the safety, and immunogenecity of the vaccine in patients with SLE. Several studies have suggested that the immune response of patients with SLE to influenza vaccine is significantly lower than the general population, mainly in patients with age > or =50 years and those treated with prednisone. The vaccine is safe for patients with SLE and it does not affect the clinical manifestations of SLE including renal features, disease activity, or the requirement for steroids or cytotoxic drugs.

Increased proportion of CD3+CD4-CD8- double-negative T cells in peripheral blood of children with Behcet's disease.

Introduction: Behcet's disease (BD) is a multi-system inflammatory disorder of poorly understood pathogenesis, which is characterized by oral aphtosis, genital ulcers and uveitis.

Objective: To assess the role of CD3+CD4-CD8- double negative (DN) T cells in pathogenesis of Behcet's disease.

Patients: Ten BD patients (age 12.

Determinants of antipyretic misuse in children up to 5 years of age: a cross-sectional study.

Background: Fever in children is a common and usually benign symptom. It is known that antipyretic treatment is ineffective in the prevention of simple febrile seizures. Caregivers' administration of antipyretic medications to children has been reported, but data concerning the formulations used, actual doses administered, and effects of ethnicity and socioeconomic status on administration practices are incomplete.

Community-acquired bloodstream infections in children > one month old in southern Israel (1992-2001): epidemiological, clinical and microbiological aspects.

We studied the epidemiology, microbiology, clinical picture and outcome of community-acquired bloodstream infections (CABI) in children in southern Israel during 1992-2001. Information was collected prospectively by daily surveillance. CABI was diagnosed when a positive blood culture was reported in a patient discharged from the emergency room or during <48 h since admission if hospitalized.

Blood culture contamination in pediatric patients: young children and young doctors.

Objective: The objective of this study was to assess the role played by the patient's age and physician's experience in determining the contamination rate of pediatric blood cultures.

Methods: The proportion of true-positive (isolation of a pathogen) and false-positive (isolation of a contaminant) results among blood cultures obtained by in-training physicians and experienced pediatricians from young children (aged 1-35 months) and older children (>or=36 months of age) and the value of a positive blood culture to predict a true-positive result were retrospectively determined.

Results: The odds of a positive blood culture to predict isolation of a true-pathogen was 0.

Increased prevalence of antithyroid antibodies and subclinical hypothyroidism in children with juvenile idiopathic arthritis.

Objective: To estimate the occurrence of antithyroid antibodies (ATA) and hypothyroidism in children with juvenile idiopathic arthritis (JIA) compared to matched healthy controls.

Methods: The occurrence of ATA, including antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies, was evaluated by quantitative immunometric ELISA in children with JIA and in a healthy matched control group. Thyroid function was assessed in both groups.

Adherence to therapeutic guidelines for acute otitis media in children younger than 2 years.

Objectives: to analyze adherence to therapeutic guidelines for AOM.

Methods: Descriptive retrospective study of community primary care providers in southern Israel. Study population (n = 590) included all children aged 0-48 months diagnosed with AOM in PED during the year 2000 who had a referral letter from a community physician and an AOM diagnosis confirmed by tympanocentesis.

Accuracy of acute otitis media diagnosis in community and hospital settings.

Aim: To evaluate the accuracy rates of acute otitis media (AOM) diagnosis in the community by analyzing the initial AOM diagnosis (according to information from the referral letters to the Pediatric Emergency Department [PED]) among children with AOM diagnosis confirmed by tympanocentesis at PED.

Methods: A descriptive, retrospective study conducted during the year 2000, including 590 children aged 0-48 mo diagnosed with AOM at PED. AOM was confirmed by tympanocentesis.

Genetic factors in neuromuscular pain.

Recent evidence suggests that fibromyalgia, a chronic widespread pain condition and related syndromes (chronic fatigue syndrome, irritable bowel syndrome, etc.) may share heritable pathophysiologic features. We review the recent literature on genetic and familial factors found to participate in the pathogenesis of these syndromes, specifically fibromyalgia, including evidence suggesting that serotonin- and dopamine-related genes may play a role in the pathogenesis of these illnesses.

Adolescent injury risk behavior.

Health-risk behaviors that contribute to the leading causes of morbidity and mortality among adolescents and young adults are often established during adolescence and extended into adulthood. Unintentional motor vehicle injury is the leading cause of mortality in childhood and adolescence in developed countries. This review presents some of the risk factors found in research on unintentional injury and death in adolescence, including risk factors for siblings and adolescents with intellectual disability.

[Evaluation of hospital admissions: admission guidelines implementation in a pediatric emergency department].

Objectives: To develop and implement locally tailored pediatric admission guidelines for use in a pediatric emergency department and evaluate the appropriateness of admissions based on these guidelines.

Methodology: Our Study was based on the development of admission guidelines by senior physicians, using the Delphi Consensus Process, for use in the Pediatric Emergency Department (PED) at Soroka University Medical Center (Soroka). We evaluated the appropriateness of admissions to the pediatric departments of Soroka on 33 randomly selected days in 1999 and 2000 prior to guideline implementation and 30 randomly selected days in 2001, after guideline implementation.

Clinical holistic medicine: holistic adolescent medicine.

The holistic medical approach seems to be efficient and can also be used in adolescent medicine. Supporting the teenager to grow and develop is extremely important in order to prevent many of the problems they can carry into adulthood. The simple consciousness-based, holistic medicine--giving love, winning trust, giving holding, and getting permission to help the patient feel, understand, and let go of negative beliefs--is easy for the physician interested in this kind of practice and it requires little previous training for the physician to be able to care for his/her patient.

The Arab community in Israel coping with intellectual and developmental disability.

The Arab family in Israel is still embedded in the traditional society with extended family support systems, but we see a population in transition influenced by the surrounding society. This paper looks at the different religious attitudes toward the exceptional people in our society (i.e.

Bacteriologic and clinical efficacy of oral gatifloxacin for the treatment of recurrent/nonresponsive acute otitis media: an open label, noncomparative, double tympanocentesis study.

Background: Gatifloxacin is an 8-methoxyfluoroquinolone with good activity against respiratory pathogens.

Objectives: To document the bacteriologic and clinical efficacy of gatifloxacin in recurrent/nonresponsive acute otitis media (AOM).

Methods: One hundred sixty patients 6 to 48 months of age with recurrent/nonresponsive AOM received gatifloxacin suspension (10 mg/kg once daily for 10 days).

Pain sensitivity in prematurely born adolescents.

Background: Several studies reported that preterm infants were found to be hypersensitive to pain. However, longitudinal and quantitative assessments of subsequent pain thresholds in adolescence are scarce.

Objective: To assess the tenderness threshold in adolescents born prematurely compared with matched children born at full term.

Can acute otitis media caused by Haemophilus influenzae be distinguished from that caused by Streptococcus pneumoniae?

Background: Previous limited data suggest that acute otitis media (AOM) caused by Streptococcus pneumoniae can present as a more severe disease than that caused by Haemophilus influenzae or Moraxella catarrhalis, as expressed by both tympanic membrane and systemic findings.

Objectives: To evaluate the severity of disease and impact of various pathogens, age, disease history and previous antibiotic therapy in children with AOM by using a comprehensive clinical/otologic score.

Patients And Methods: The study group consisted of 372 children ages 3 to 36 months with AOM seen at the pediatric emergency room during 1996 through 2001.