Biomedical subjects

J B Orenstein

Publications and source records attributed to J B Orenstein.

6 recordsLinked to original sources

PubMed1996

Invasive pneumococcal infection in a community hospital, 1993 to 1995. Characteristics of resistant strains.

OBJECTIVES: To review all cases of invasive Streptococcus pneumoniae infection at a single institution and to identify factors that may allow distinguishing between penicillin-resistant pneumococcal (PRP) and penicillin-sensitive pneumococcal strains at presentation for emergency care. PATIENTS AND METHODS: Consecutive patient series of all children with positive blood and cerebrospinal fluid cultures for S pneumoniae from January 1993 to April 1995 at a general community hospital. RESULTS: Fifty-three patients with invasive S pneumoniae infections were identified; 21% of the infections were resistant to penicillin, 9% were resistant to multiple antibiotics, and 4% were highly resistant to penicillin (minimum inhibitory concentration, > 2 mg/L). At admission, a diagnosis of meningitis or sepsis was made in 14 patients; of these, 8 cerebrospinal fluid cultures yielded S pneumoniae, and 5 were PRP (P < .001). Significant differences between sensitive and resistant strains were not found for sex, age, race, ill household contacts, or physician type. Five of 11 children with PRP strains were either receiving antibiotics concurrently or in the prior 30 days compared with 5 of 42 children with penicillin-sensitive pneumococcal strains (P = .002). Children with PRP strains had a lower mean white blood cell count (14.9 x 10(9)/L vs 22.8 x 10(9)/L, P = .008) than children with penicillin-sensitive pneumococcal strains, owing to a lower mean absolute neutrophil count (7250 vs 12700, P = .006). Children with lower white blood cell and absolute neutrophil counts did not, however, differ in other objective measures. Regression analysis showed that the combination of current or prior antibiotic use and an absolute neutrophil count predicted 63% of the resistant strains and 92% of the sensitive strains (P = .001). CONCLUSIONS: A high proportion of S pneumoniae infections were caused by strains that were resistant to penicillin. We discuss factors that are associated with resistance in this population. The PRP strains were associated with recent antibiotic therapy and a low absolute neutrophil count. Further surveillance is warranted by these findings.

Adolescent↗

PubMed1996

Injuries and small-wheel skates.

STUDY OBJECTIVE: To determine the types of injuries sustained during the use of in-line skates and to compare them with injuries sustained during the use of roller skates and skateboards, which have similar riding mechanics; and to assess the protection afforded by wrist, elbow, and knee guards. METHODS: The study population was a consecutive series of injured patients who presented to the emergency department of a Level 1 trauma center between May 1992 and October 1993. RESULTS: Of the 137 patients with skating injuries evaluated in the ED during the study period, 63 (46%) were in-line skaters, 36 (26%) were roller skaters, and 38 (28%) were skateboarders. Minor injuries (sprains, bruises, lacerations) were more common than fractures, and there was no statistical difference in the types of injury between skate groups (P=NS). The most common serious injury was fracture of the distal arm, which occurred in each of the three skater groups (43%, n=59). Of these patients 37% (n=21) required open or closed orthopedic reduction. More fractures of the distal forearm or elbow occurred among skaters who had not been wearing wrist guards (P=.013; risk ratio, 2.07; 95% confidence interval, 1.37 to 3.13). Only 25% of skaters used any protective equipment. In-line skaters owned and used protective equipment more often than did roller-skaters or skateboarders. Most injuries occurred while the patient was travelling in the street or on the sidewalk. Injuries occurred more commonly because the skater was going too fast (35%), because the skater struck an object in the pavement (20%), or because the skater was unable to brake (19%) than because of equipment failure (2%) or interference from motor vehicles (3%). CONCLUSION: Injuries sustained by in-line skaters were similar to those sustained by roller skaters and skateboarders. The risk of wrist or elbow fracture is greater when wrist guards are not worn.

Adolescent↗

PubMed1994

Age and outcome in pediatric cervical spine injury: 11-year experience.

Age-related outcome in children with cervical spine injury has not been previously reported. We performed a retrospective chart review of all children with cervical spine injury who presented to a children's hospital during an 11-year period; 73 patients were identified. Their mean age was 8.6 years, with bimodal peaks at 2 to 4 and 12 to 15 years. Sixty-seven percent of the injuries were traffic-related, resulting from motor vehicle crashes affecting passengers, pedestrians, or bicyclists. Distraction and subluxation injuries were the most common injuries in children aged eight years or younger, whereas fractures were more common in older children. Younger children sustained more severe injuries than older children, as measured by the Revised Trauma Score, Injury Severity Score, and Trauma Score-Injury Severity Score estimated probability of survival, and were more likely to sustain injuries to higher levels of the cervical spine. Deaths occurred exclusively in children eight years old or younger, but the rate of occurrence of neurologic disability was similar in both groups: 26% in those eight years old and under, and 25% in those more than eight years old. The mortality in younger patients was not caused exclusively by the higher level of cervical injury, but it occurred more often in the presence of head injury and multiple trauma.

Accidents, Traffic↗

PubMed1992

Emergency care of children in shelters.

Children living in homeless shelters often lack the health care resources usually available to other children. They are often more acutely and chronically ill than domiciled children and frequently use the emergency department (ED) as their point of entry into the health care system. To identify differences in health status, we surveyed sheltered children and domiciled controls during a nine-month period in our ED. One hundred sixty-two families completed a self-administered questionnaire during the study period: 54 homeless and 108 age-matched controls. Mean patient age was 3.4 years, mean maternal age was 27 years in both groups, and average time spent in shelters was 7.8 months. Shelter families had more children, more single mothers, and higher rates of unemployment and uninsurance than did control families. Shelter children showed greater frequencies of immunization delay, lack of TB testing, and lack of a regular health care site and higher rates of medical admissions from the ED. These data show that children in shelters have limited personal, financial, and medical resources and suggest that there are significant disparities in health status. These patients need to be identified when they present to the ED in order to meet subtle, as well as obvious, health needs.

Adolescent↗

PubMed1992

Delayed diagnosis of pediatric cervical spine injury.

We report on nine patients in whom there were delays in establishing a diagnosis of cervical spine injury and discuss the causes that contributed to the delays, their clinical significance, and whether or not asymptomatic injury occurs.

Adolescent↗

PubMed1991

Pneumococcal bacterial tracheitis.

Bacterial tracheitis is an uncommon cause of acute respiratory distress in children. The authors present a case of bacterial tracheitis in a 6-year-old girl caused by an unusual pathogen, Streptococcus pneumoniae. Her clinical presentation and radiographic findings are typical for an older child. Management of this case involved endotracheal intubation, although a review of the literature suggests that airway management can vary with age and size of the tracheal lumen. The microbiology of bacterial tracheitis shows a predominance of Staphylococcus and Streptococcus reported previously, with only three prior reported cases of Pneumococcus.

Adolescent↗