Search PubMed⌕ Search

Biomedical subjects

E Shahar

Publications and source records attributed to E Shahar.

At least 127 records · Page 7Linked to original sources
PubMed1990

Asthenic symptoms in a rural family practice. Epidemiologic characteristics and a proposed classification.

Asthenic symptoms (eg, fatigue, lassitude, weakness) are of major concern in family practice setting, yet relatively little research has addressed this issue. A retrospective chart review over a 10-year period was conducted to better characterize these symptoms in a rural family practice providing health care to 508 adult patients. Asthenic complaints were recorded at least once in the medical charts of 164 patients (32%) with a preponderance of female patients. Peak prevalence occurred in the third decade of age and during the summer months. Associated symptoms, mainly pain and dizziness, were reported in 75% of the cases. A cause or diagnosis was not identified by the practicing physician in nearly 50% of the encounters; nevertheless, most episodes resolved spontaneously. Patients could be subclassified into three categories according to the recurrence pattern of their asthenic symptoms during the study period. The largest category (64%) included patients who had a single or two episodes and was thus termed "episodic asthenia." Forty-five patients (27%) with recurrent episodes (mean 4.4, range 3 to 10) were classified as having "recurrent episodic asthenia." A third small group (14 patients, 9%) with persistent complaints over the years but no evidence of the chronic fatigue syndrome were classified as having "chronic persistent asthenia." The proposed classification may help future research of asthenic symptoms in the family practice setting.

Adult↗
PubMed1989

Effectiveness of vitamin E and colchicine in amelioration of paraquat lung injuries using an experimental model.

The major cause of death in paraquat poisoning is a rapidly progressive respiratory failure due to an oxidative insult to the alveolar epithelium with subsequent fulminant obliterating fibrosis. The present study evaluates the effectiveness of vitamin E in combination with colchicine in ameliorating paraquat lung injuries in rats. Vitamin E is a biologic antioxidant interfering with lipid peroxidation, and colchicine reduces collagen synthesis which is significantly augmented in pulmonary fibrosis. Eight normal rats were given a single i.p. dose of paraquat at 15 mg/kg. The treated group included eight animals that received, in addition to i.p. paraquat (15 mg/kg), daily doses of vitamin E (100 mg/kg i.p.) and colchicine (0.1 mg/kg i.p.). All the rats in the paraquat group died within 42 to 96 h, six of them within 60 h, following severe respiratory failure. The treated rats developed a somewhat milder form of respiratory insufficiency, six of them dying within 48 to 72 h. Less severe intra-alveolar hemorrhages were observed in this group. Two rats survived, and these had only mild emphysema on autopsy at 21 days. Our preliminary results suggest that the combination of vitamin E with colchicine may be effective in ameliorating lung injuries caused by paraquat, and warrant further studies.

Animals↗
PubMed1988

Variables affecting outcome from severe brain injury in children.

This study evaluates the outcome of 56 severely brain injured children (mean age 6.2 +/- 2.1 years) and relates the Initial Glasgow Coma Scale (IGCS), initial intracranial pressure (ICP int), maximal intracranial pressure (ICP max) and minimal cerebral perfusion pressure (CPP min) to quality of survival. Forty-one children sustained head trauma, five severe central nervous system infections and 10 were of miscellaneous etiology. Therapy consisted of mechanical hyperventilation, moderate fluid restriction, dexamethasone and diagnosis specific measures when indicated. Outcome was categorized according to the Glasgow outcome scale at discharge from the hospital. An IGCS of 3 was associated with 100% mortality, 7 and above resulted in 72% good recovery, 28% poor outcome and no mortality. ICP int of less than 20 torr was noted in (67%) of the patients, and did not correlate with ICP max or outcome. Conversely, ICP int in excess of 40 torr correlated well with ICP max and outcome. ICP max of less than 20 torr resulted in 57% good recovery, 36% poor outcome and 7% mortality. ICP max greater than 40 torr resulted in 7% poor outcome and 93% mortality (p less than 0.001). In head trauma, 32 patients (78%) were alive with mean ICP max 16.9 +/- 3.1 and CPP min 65.5 +/- 8.5 torr compared to 9 patients (22%) who died with mean ICP max 53.7 +/- 10.8 and CPP min 6 +/- 3.9 torr, (p less than 0.01). In children with infectious etiology 60% survived with mean ICP max 16 +/- 3 and CPP min 96 +/- 16 torr.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗
PubMed1988

Familial carnitine deficiency: further evidence for autosomal recessive transmission with variable expression.

Carnitine deficiency occurring in families has been rarely reported and the genetic transmission has not yet been clearly elucidated. Five members of one family showing marked heterogeneity of carnitine deficiency states are presented. In three patients, there was no correlation between measurable carnitine levels in serum and muscle and the clinical findings. The parents, who are remote relatives from an isolated village in Kurdistan (Iraq), had low muscle carnitine levels; however, they were asymptomatic. One son, with systemic carnitine deficiency causing muscle weakness and recurrent episodes of severe hepatic encephalopathy, died at 3 years of age. His brother had mild proximal muscle weakness associated with low muscle carnitine levels. He was successfully treated with L-carnitine and prednisone. A daughter is asymptomatic, but with low serum and muscle levels of carnitine. The marked heterogeneity of carnitine deficiency states within one family, where both parents had low muscle carnitine levels, suggests an autosomal recessive inheritance with variable expression.

Carnitine↗
PubMed1988

Heterogeneity of nemaline myopathy. A follow-up study of 13 cases.

The marked heterogeneity of nemaline myopathy is again shown in the present series of 13 patients. Most children have a long-standing, mild, and slowly progressing proximal myopathy. Two brothers with extreme weakness died during the neonatal period of respiratory failure representing the X-linked variant. One adult with proximal weakness was also diagnosed as having nemaline myopathy. An unusual course was observed in 2 infants who initially had moderate weakness but subsequently developed severe generalized weakness including respiratory muscles. This led to irreversible respiratory failure requiring continuous ventilatory support for as long as 9 and 15 years, respectively. Although uncommon, the possibility of an imminent respiratory failure in initially weak infants should also be taken into account within the clinical spectrum of nemaline myopathy.

Adult↗
PubMed1985

Diagnosis of bacterial meningitis in previously treated children.

We reviewed the charts of 115 children with the clinical diagnosis of bacterial meningitis admitted to our hospital over a period of eight years. Of these, 47 patients had received antimicrobial agents before hospitalization and eight (17%) of them had negative cerebrospinal fluid (CSF) cultures. These eight children, however, had CSF features suggestive of bacterial meningitis. We conclude that prior antimicrobial therapy does not alter the chemical properties of CSF, the response to pharmacologic agents, or the ultimate outcome, even though previously treated children may have lower rates of positive CSF and blood cultures.

Adolescent↗
PubMed1985

Breast feeding as prophylaxis for atopic eczema: a controlled study of 368 cases.

The present study was undertaken in an attempt to draw data whether breast-feeding is beneficial in prevention of atopic eczema. Three-hundred and sixty-eight babies given different feeding modalities were examined for the presence of atopic eczema at the age of three and six months. Seven percent of breast-fed infants developed eczema compared to 10% of formulae-fed and 6% of mixed breast and formulae-fed infants. No difference in the severity of atopic eczema was recorded in the three study groups. Our experience demonstrates the absence of a protective effect of breast-feeding against the development and severity of atopic eczema.

Breast Feeding↗
PubMed1984

Permanent cardiac pacing in congenital heart disease: a follow-up study of 20 patients.

Sinus nodal dysfunction (SND) and complete heart block (CHB) in congenital heart disease (CHD) are commonly associated with congestive heart failure, syncopal attacks, and sudden death. Permanent cardiac pacing (PCP) is required to avoid these manifestations which are frequently associated with a high rate of complications, particularly in the younger age group. Twenty patients with CHD aged 4 months to 46 years underwent pacemaker implantation. Twelve (60%) were less than 20 years of age. CHB was present in 15 patients: in 10 it developed 1 week to 11 years following surgery, in two it was congenital, and in three patients it developed spontaneously with previous conduction disturbances. SND was present in 5 patients: it was congenital in two patients and developed post-operatively in three. Seventeen patients are alive and no syncopal attacks or bradyarrhythmias were recorded 2.5 to 12.5 years following the initiation of PCP. Improvement in the cardiac output was noted in most patients with heart failure. The three patients who died had adequately functioning pacemakers. Only nine re-implantations were needed, seven of them in adult patients after closure of an atrial septal defect. Our experience indicates a favourable outcome for patients with CHD needing PCP.

Adolescent↗
PubMed1984

Kinetics of intravenous phenytoin in children.

Single-dose intravenous phenytoin (9.4-21.3 mg/kg) effectively eradicated seizures within 3 minutes in 12 out of 13 patients in status epilepticus. Eleven additional patients were treated prophylactically. No adverse effects were observed and neurological status was unaltered in all 24 cases. Phenytoin volume of distribution was found to decline significantly with age from 1.6 L/kg at 1 year to 0.6 at 10 years (P less than 0.01). Estimates of Vmax, the maximal rate of phenytoin metabolism, were obtainable in 8/24 patients and were in the expected range (10.6 +/- 4.2 mg/kg/day) for their age (6.6 +/- 2.8 years). Therapeutic serum concentrations (initial post distribution values 17.9 +/- 9.0 micrograms/ml) were maintained for more than 10 hours in 15/24 patients. Single-dose intravenous phenytoin is both effective and safe in the treatment and prevention of epileptic seizures in pediatric patients.

Adolescent↗
PubMed1983

Pre-excitation syndrome in infants and children. Effect of digoxin, verapamil, and amiodarone.

Clinical and electrocardiographic findings for 30 patients with the pre-excitation syndrome are described together with details of treatment. Nineteen (63%) were younger than 2 years, 14 of whom were under 2 months. Sixteen infants and 7 children (77%) presented with paroxysmal supraventricular tachycardia, 14 (61%) of whom had the electrocardiographic pattern of type A Wolff-Parkinson-White (WPW) syndrome. During paroxysmal bouts the QRS complex was normal in 21 patients and wide in two. Six (20%) patients had congenital heart disease often associated with WPW syndrome type B. Seventeen patients were treated with either digoxin or verapamil intravenously to stop tachyarrhythmias. Verapamil was more effective due to the immediate response and lack of adverse effects. The tachyarrhythmias resolved in all the patients and in some of them the WPW pattern resolved later indicating maturation of the conduction tissue with loss of the accessory pathways. Verapamil provides a rapid and safe form of treatment for conversion of tachyarrhythmias since it has no effect on the accessory pathways. Oral amiodarone prevents recurrent tachyarrhythmias resistant to other treatment.

Adolescent↗
PubMed1983

Amiodarone in control of sustained tachyarrhythmias in children with Wolff-Parkinson-White syndrome.

Oral amiodarone was administered to ten children aged 3 months to 15 years who had recurrent SVT associated with the Wolff-Parkinson-White syndrome. In nine patients, amiodarone was used following failure of oral digoxin, quinidine, propranolol, and verapamil. Each patient received an oral loading dose of 10 to 15 mg/kg followed by 5 mg/kg daily. All children became asymptomatic of tachyarrhythmias within five days of therapy and remained asymptomatic for 5 to 36 months. In one patient, amiodarone therapy was discontinued because of generalized urticaria after a positive initial response. After high-dose oral verapamil failed to eliminate recurrent bouts of SVT, the patient was again given amiodarone and he had a complete recovery. All ten children had normal results on thyroid function tests, and no other adverse effects were detected. Amiodarone has been shown to be highly effective and well tolerated in this series of children. Therefore, we recommend its use for the control and prevention of sustained arrhythmias in pediatric patients with Wolff-Parkinson-White syndrome when the traditional antiarrhythmic drugs fail.

Administration, Oral↗
PubMed1983

Elevated risk of osteoarticular complications in children with acute Brucella melitensis infection.

Infection with brucella microorganisms is considered uncommon in the paediatric age group. We report nine paediatric patients between the ages of 8 to 17 years with acute Brucella melitensis infection, who presented with spiking fever, night sweats, anorexia and malaise for 5 to 60 days prior to diagnosis. Four patients developed various osteoarticular complications: migratory arthralgia, hydroarthrosis of the knees, arthritis and osteomyelitis. Therapy with tetracyclines alone or in combination with streptomycin resulted in complete recovery in eight children. This combination failed in one patient who developed severe osteoarticular disease successfully responding to rifampicin. Since infection of bone and joints leads to irreversible damage, early recognition and immediate management are crucial for recovery. Rifampicin might be of benefit in children with severe osteoarticular complications when the traditional anti-brucella regimen fails.

Adolescent↗
PubMed1982

Bacterial meningitis. A follow-up study of 115 children.

The clinical and laboratory date on 115 pediatric patients with bacterial meningitis are presented. Sixty-one were less than 12 mo of age including 13 less than 1 mo of age. Thirty-nine children were treated prior to admission with antimicrobial agents which obscured accurate bacteriologic diagnosis in eight of them. Gram-negative enteric bacteria, mainly Escherichia coli, were recorded in 9 of 13 neonates. Hemophilus influenzae type B accounted for 56 (52%) of all isolated recorded in those greater than 2 mo of age, of which 35% were resistant to chloramphenicol. Seventy-eight patients (73%) recovered completely following 10 to 14 days of antimicrobial therapy. Fifteen patients died, most of whom were less than 1 yr of age, including five neonates. Major neurologic sequelae included subdural effusions, cerebral abscesses and recurrent convulsions. This study, which documents the infrequency of Streptococcus group B and H. influenzae as etiological agents of neonatal meningitis, indicates that treatment of this disease with ampicillin and an aminoglycoside is efficacious. Chloramphenicol may be the drug of choice in the postnatal period, since H. influenzae is partly resistant to ampicillin.

Aminoglycosides↗