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Biomedical subjects

B Z Garty

Publications and source records attributed to B Z Garty.

At least 19 recordsLinked to original sources
PubMed2000

Prevalence of asthma in 13-14 yr-old schoolchildren across Israel.

There is evidence that the incidence and severity of asthma are increasing worldwide, but there are limited data on asthma in Israel. The aim of this study was to investigate the prevalence and severity of asthma and asthma symptoms in 13-14 yr-old schoolchildren in Israel. The self-completed questionnaire used was a modified version of that developed by the International Study of Asthma and Allergies in Childhood (ISAAC), and was administered to a national sample of 12,918 children. The prevalence of asthma ever, wheezing ever and wheezing in the last 12 months were 13.7, 23.8 and 17.9% respectively. Significantly higher rates of a history of asthma and asthma symptoms were observed in Jews compared with Arabs. Although asthma ever was more prevalent in males than in females, asthma symptoms were significantly more common in females. The type of area of residence had no effect on the prevalence of wheezing. The ethnic differences in the prevalence of asthma persisted after controlling for sex, district of residence and level of urbanization. The prevalence of both asthma and asthma symptoms in Israel are slightly above the mean reported from 10 other countries in Europe and the Far-East.

Adolescent↗
PubMed2000

Toxic epidermal necrolysis associated with acetaminophen ingestion.

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with acetaminophen ingestion. SUMMARY: A seven-year-old girl developed TEN after acetaminophen ingestion. The diagnosis was based on clinical evaluation and skin biopsy. A later acetaminophen challenge, undertaken by an allergist who questioned the diagnosis, resulted in a similar skin reaction. DISCUSSION: TEN is a severe disease with a high mortality rate. TEN may be either idiopathic or associated with several clinical conditions, such as viral infections, autoimmune disorders, malignancy, and drug hypersensitivity. Because of the rarity of its association with acetaminophen, the diagnosis in our patient was questioned by an allergist who performed an oral acetaminophen rechallenge test despite the potential risk. This caused a severe skin reaction that required rehospitalization. CONCLUSIONS: TEN can be caused by over-the-counter medications such as acetaminophen. Rechallenge with the causative drug carries a risk of severe complications and should be avoided.

Acetaminophen↗
PubMed2000

Soluble CD14 in children with status asthmaticus.

BACKGROUND: Inflammation is a major component in the pathogenesis of asthma. CD14 is an endotoxin (lipopolysaccharide) receptor, and is expressed mainly on monocytes and macrophages. Binding of LPS to CD14 activates the monocyte or macrophage and causes the release of different cytokines. The soluble form of CD14 is present in serum, and its concentration increases in several clinical conditions, including infections, autoimmune disorders, allergic disorders, and lung diseases. The possible role of CD14/sCD14 in asthma has been investigated in a few adult patients only. OBJECTIVES: To measure serum concentrations of sCD14 in children with status asthmaticus. METHODS: We compared serum concentration of sCD14 in 10 children with status asthmaticus measured within 24 hours of admission and after recovery from the acute episode. RESULTS: Levels of sCD14 were significantly higher during acute asthma attacks than at recovery. CONCLUSIONS: The elevated serum levels of sCD14 during status asthmaticus may be the result of the activation of monocytes, macrophages or other cells. The influence of medications on serum sCD14 cannot be ruled out. The possible use of sCD14 as a marker of lung inflammation in asthma warrants further investigation.

Adolescent↗
PubMed2000

Erythema nodosum in Israeli children.

BACKGROUND: Erythema nodosum, although uncommon in children, is the most frequent form of panniculitis in pediatrics. EN has been associated with various infections and chronic inflammations, and its course varies with age, gender, and racial and geographic factors. There is no information on EN in Israeli children. OBJECTIVES: To examine the clinical course of EN and the conditions with which it is associated in Israeli children. METHODS: We conducted a retrospective study of 24 children with a diagnosis of EN who presented at our Center over a 10 year period (1989-98). RESULTS: EN was more frequent in females than males (ratio 2:1) due to a cluster of adolescent girls. The mean duration of the skin manifestation was 18 days. The course was benign in all patients. Streptococcal infection was the most common cause (25%), followed by Epstein-Barr virus infection (18%) and inflammatory bowel disease (13%). In one-third of cases, no specific cause could be identified. Tuberculosis, an important cause of EN in the past, was not found in our patients. CONCLUSIONS: Most cases of EN in Israeli children are related to streptococcal and EBV infections or to chronic inflammatory conditions. Despite the increase in tuberculosis morbidity in Israel during recent years, we found no association of EN and tuberculosis in our study.

Adolescent↗
PubMed1999

Cirrhosis in a child with hypothalamic syndrome and central precocious puberty treated with cyproterone acetate.

UNLABELLED: Before the advent of gonadotropin-releasing-hormone analogues, cyproterone acetate (CPA) had been widely prescribed for the treatment of precocious puberty. Although it is usually well tolerated, liver toxicity has been recognized as a complication of its long-term use. We report the occurrence of cirrhosis in a 10-year-old boy with hypothalamic syndrome and precocious puberty who was treated with CPA for over 50 months. Despite discontinuation of the medication, the liver disease progressed. The patient died of sepsis and multiorgan failure at the age of 14 years. This is the first paediatric report of substantial liver damage and liver toxicity progressing to cirrhosis associated with CPA treatment. CONCLUSION: Prolonged cyproterone acetate treatment may induce cirrhosis. Monitoring of liver function both during treatment and for several months after discontinuation of therapy is recommended.

Adolescent↗
PubMed1999

Low serum C3, leukopenia, and thrombocytopenia: unusual features of henoch-schonlein purpura.

Henoch-Schonlein purpura (HSP) affects predominantly the skin, joints, gastrointestinal tract and kidney. Although the pathogenesis is probably of immune origin and complement activation is thought to play a role, laboratory findings including the serum level of the complement components are usually normal. We present a patient with a severe form of HSP nephritis who had unusual laboratory findings of a low level of C3, mild leukopenia and thrombocytopenia. These findings may further support the importance of complement activation in the pathogenesis of HSP.

Biopsy, Needle↗
PubMed1999

Genetic linkage of hyper-IgE syndrome to chromosome 4.

The hyper-IgE syndrome (HIES) is a rare primary immunodeficiency characterized by recurrent skin abscesses, pneumonia, and highly elevated levels of serum IgE. HIES is now recognized as a multisystem disorder, with nonimmunologic abnormalities of the dentition, bones, and connective tissue. HIES can be transmitted as an autosomal dominant trait with variable expressivity. Nineteen kindreds with multiple cases of HIES were scored for clinical and laboratory findings and were genotyped with polymorphic markers in a candidate region on human chromosome 4. Linkage analysis showed a maximum two-point LOD score of 3.61 at recombination fraction of 0 with marker D4S428. Multipoint analysis and simulation testing confirmed that the proximal 4q region contains a disease locus for HIES.

Chromosome Deletion↗
PubMed1999

Management of children with aseptic meningitis in the emergency department.

OBJECTIVE: To review the emergency department management of children with aseptic meningitis and compare the clinical features, laboratory findings, and short-term follow-up of those who were hospitalized or discharged to determine guidelines for discharge. DESIGN: Retrospective chart review study. SETTING: Emergency department of an inner-city teaching, level III, children's hospital during an outbreak of aseptic meningitis from, March through December 1993. METHODS: The medical records of children < or = 18 years of age diagnosed in the emergency department with aseptic meningitis after lumbar puncture were retrospectively reviewed and analyzed. Thirty-four parameters were recorded for each child including demographic (2), epidemiologic (5), clinical (2), laboratory (10), and short-term follow-up data (5). RESULTS: Of the 158 eligible patients, 99 (62.7%) were hospitalized, and 59 (37.3%) were discharged. Compared to the hospitalized group, children who were discharged were significantly older (5.7 years vs. 4.7 years, P < 0.05) and experienced a more benign course, with lower rates of headache (54.7 vs. 85.7%, P < 0.05), vomiting (38.2 vs. 69.7%, P < 0.05), and irritability (1.8 vs. 8.1%, P < 0.05). They also had significantly (P < 0.05) lower mean peripheral and cerebrospinal fluid leukocyte counts (13,233 vs. 11,498/mm3 and 293.91 vs. 105.29/mm3, respectively). Interestingly, 30 (50.8%) of children in the discharged group had over 50% polymorphonuclears in their cerebrospinal fluid (CSF) cell count. The hospitalization rate during the day was significantly (P < 0.05) lower than that for the evening and night shifts (51.5 vs. 66.7%, respectively). In the discharged group, symptoms of headache, fever, and vomiting resolved after an average of 3.05 days, 2.25 days, and 1.3 days, respectively. The average hospitalization time was 3.5 days. There were no significant complications in either group. More important, in neither group were there any misdiagnoses of bacterial meningitis as aseptic meningitis. During the study period, the ambulatory management of the 59 patients cost $51,625 less than the hospitalization of an equal number of children. CONCLUSION: It is feasible, clinically safe and less costly to treat a subgroup of children with aseptic meningitis in an ambulatory setting. Although absolute criteria for ambulatory follow-up could not be defined, age >1 year, a nontoxic clinical appearance, normal white blood cell count, mild cerebrospinal fluid pleocytosis (even with a high percentage of polymorphonuclear cells), negative CSF Gram stain, and a reliable family setting could serve as guidelines for decision-making regarding emergency department discharge. Further prospective research is needed to better specify these criteria.

Acute Disease↗
PubMed1999

Identification of a subset of common variable immunodeficiency patients with impaired B-cell protein tyrosine phosphorylation.

The mechanisms responsible for common variable immunodeficiency syndrome (CVID) are as yet unknown. In the present study, we show that the B-cell dysfunction in a subset of CVID patients is caused by defective protein tyrosine phosphorylation (PTP). We demonstrated that the PTP level and immunoglobulin (Ig) secretion malfunctions can be successfully repaired when normal plasma membrane components are implanted into these patients' B cells. Stimulation of CVID patients' peripheral blood mononucleated cells with anti-Ig antibody revealed that 7 of 11 patients had lower PTP levels than those found in the normal donor cells. Plasma membrane implantation to the cells of these patients resulted in elevated PTP levels which reached normal levels upon stimulation with anti-human Ig antibody. The results revealed two distinct groups of CVID patients. The first group included patients whose B cells expressed low PTP levels after Ig stimulation. In these patients the plasma membrane implantation restored the normal PTP level as well as the ability to secrete IgM and/or IgG after B-cell stimulation. In the second group, patients whose B cells expressed a normal PTP level after Ig stimulation, with no restoration of their ability to secrete Ig upon plasma membrane implantation and lipopolysaccharide stimulation. We conclude that the first group has an early signal transduction defect located in the B-cell plasma membrane, while in the second group the defect is located elsewhere.

Adult↗
PubMed1998

Prolonged croup due to herpes simplex virus infection.

UNLABELLED: Herpes simplex virus (HSV) is an uncommon cause of acute laryngitis in immunocompetent patients since it mostly occurs in immunocompromised subjects. We present two previously healthy children with prolonged gingivostomatitis and stridor (lasting 3 and 4 weeks) in whom HSV-1 was isolated from subglottal ulcers. CONCLUSION: HSV should be considered a possible pathogen in cases of prolonged or atypical croup not only in immunocompromised or elderly patients but also in otherwise healthy children.

Croup↗
PubMed1998

Emergency room visits of asthmatic children, relation to air pollution, weather, and airborne allergens.

BACKGROUND: The worldwide increase in the incidence, prevalence, and severity of asthma may suggest that environmental factors play a role in these epidemiologic changes. OBJECTIVE: To examine the correlations between air pollutants, weather conditions, airborne allergens, and the incidence of emergency room (ER) visits of children with acute asthma attacks. DESIGN: One-year prospective study. Data of daily concentration of air pollutants, weather conditions, and selective airborne allergens were collected and compared with the number of ER visits of asthmatic children. SUBJECTS: 1076 asthmatic children (aged 1 to 18 years) who presented at the Pediatric ER between January 1 and December 31, 1993. RESULTS: Correlations between fluctuations in ER visits of asthmatic children and various environmental parameters were more relevant for weekly than for daily values. Emergency room visits correlated positively with concentrations of NOx, SO2 and with high barometric pressure; and negatively with O3 concentration and minimal and maximal temperature. There were no significant correlations with concentrations of particulates, humidity, or airborne pollen and spores. An exceptionally high incidence of ER visits of asthmatic children was observed during September. This peak coincided with the beginning of the school year and the Jewish holidays. The correlations between ER visits and the environmental factors increased significantly when the September peak was excluded, revealing that 61% of the variance in ER visits was explained by NOx, SO2, and 03 concentrations, 46% by weather parameters, 66% by NOx, SO2 and barometric pressure, and 69% by the combination of air pollutants and weather parameters. CONCLUSION: The major factors found to be associated with ER visits of asthmatic children were high NOx, high SO2, and high barometric pressure. Negative correlation was found between ER visits of asthmatic children and ozone concentrations. The particularly high number of ER visits at the beginning of the school year and the Jewish holidays was probably associated with an increase in the number of viral infections and/or emotional stress.

Adolescent↗
PubMed1997

MRI meningeal enhancement with intracranial hypotension caused by lumbar puncture.

A 12-year-old girl with recent history of pseudotumor cerebri developed severe postural headache due to intracranial hypotension after lumbar puncture. Meningeal enhancement and thickening were demonstrated on magnetic resonance imaging. Repeated imaging 3 months later disclosed no abnormalities. This is the first report of a child with evident meningeal enhancement on magnetic resonance imaging related to lumbar puncture.

Child↗
PubMed1997

Cerebrospinal fluid leukocyte aggregation in meningitis.

OBJECTIVE: To evaluate whether the difference in aggregation of cerebrospinal fluid cells from patients with bacterial, viral, aseptic and partially treated meningitis can be used for diagnostic purposes. METHODS: Cerebrospinal fluid samples of 100 patients with meningitis (15 bacterial, 13 partially treated, 10 viral and 62 aseptic) were compared on the basis of the predefined leukocyte aggregation score (LAS). RESULTS: Mean LAS was 56% in the bacterial meningitis group (range, 15 to 90%), 5.8% in the partially treated meningitis group (range, 0 to 27%), 2% in the proven viral meningitis group (range, 0 to 5%) and 2% in the aseptic meningitis group (range, 0 to 15%). All patients with bacterial meningitis had a LAS of > 15%, whereas all those with viral or aseptic meningitis had a score of < 15%. Although most patients with partially treated meningitis had a low LAS, several had higher scores, which may indicate bacterial infection. There was no statistical correlation between number of cells, type of cells (mononuclear or polymorphonuclear) or cerebrospinal fluid protein and glucose concentration and degree of leukocyte aggregation for the different groups. CONCLUSION: Measurement of the LAS may contribute to the immediate differential diagnosis of bacterial or viral meningitis, especially in patients with very high pleocytosis, as sometimes seen in enteroviral meningitis. It may also serve as a guide for the likelihood of bacterial infection in cases of partially treated meningitis. Additional studies are needed to confirm these observations.

Adolescent↗