Bilateral peritonsillar abscesses: relief of upper airway obstruction by quinsy tonsillectomy.
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Airway Obstruction↗
Biomedical subjects
Matitiahu Berkovitch
Publications and source records attributed to Matitiahu Berkovitch.
Ketoconazole-induced neurologic sequelae.
A 77-y-old patient developed weakness of extremities, legs paralysis, dysarthria and tremor 1 h after ingestion of 200 mg ketoconazole for the first time in his life. All complaints faded away within 24 h. Few days later, the patient used another 200 mg ketoconazole tablet, and within an hour experienced a similar clinical picture, which resolved again spontaneously within hours. Laboratory evaluations, including head CT scan, were normal. This case illustrates the need for close vigilance in adverse drug reactions, particularly in the elderly.
Administration, Oral↗
Colonization rate of bacteria in the throat of healthy infants.
OBJECTIVE: the human throat is a major ecological site for various bacteria that can reach neighbouring sterile sites and cause mild infections or invasive diseases. The aim of this study was to investigate the carriage rate of several potential pathogens in the throat of healthy children under the age of 2 years. METHODS: cultures were taken from the tonsils of 1000 healthy infants aged 1-24 months attending well-baby clinics, who had not received antibiotic therapy during the preceding 14 days. RESULTS: one hundred and ninety-eight (19.8%) cultures were positive. Thirteen (1.3%) cultures were positive for beta-haemolytic Streptococcus group A, 23 (2.3%) for Streptococcus pneumoniae. In 28 (2.8%) and 24 (2.4%) cultures, respectively, Haemophilus influenzae Type b and non-typeable Haemophilus influenzae were recovered. The commonest bacterium found was Staphylococcus aureus (99 positive cultures). Eleven children carried two species of bacteria and from one 6-month-old child three species were isolated concurrently. CONCLUSIONS: it is concluded that children younger than 2 years of age can be carriers of several types of pathogenic bacteria. In contrast to many other studies, in this study beta-haemolytic Streptococcus group A was isolated from the tonsils of children younger than 1 year of age.
Carrier State↗
Erythrocyte Na+,K+-ATPase and nasal potential in pseudohypoaldosteronism.
OBJECTIVES: Pseudohypoaldosteronism type 1 (PHA1) is a rare inherited disorder characterized by salt-wasting due to target organ unresponsiveness to mineralocorticoids. PHA1 comprises two clinically and genetically distinct entities; isolated renal and systemic forms. DESIGN: The aim of this study was to investigate red blood cell (RBC) Na+,K+-ATPase activity and nasal potential difference (PD) in two pairs of unrelated dyzygous twins; one with the systemic form of the disease (PHA1-S) and the second with the isolated renal form (PHA1-R). Total and ouabain-sensitive ATPase activities were measured spectrophotometrically by a method that couples ATP hydrolysis with NADH oxidation. Maximal PD and response to amiloride perfusion were evaluated by a standard technique. RESULTS: In the twins with PHA1-S, persistently low activity of RBC Na+,K+-ATPase was found during a 6-year follow-up. Normalization of plasma renin activity (PRA) and plasma aldosterone was observed at the end of the first year of life. Maximal nasal PD was low and there was no significant response to amiloride. In the twins with PHA1-R, RBC Na+,K+-ATPase activity was very low at the time of diagnosis and normalized at the age of 6-8 months. PRA reverted gradually to normal values, whereas aldosterone levels remained high during the 6 years of follow-up. Maximal nasal PD and response to amiloride were normal. CONCLUSIONS: The observed differences in RBC Na+,K+-ATPase activity and nasal PD response to amiloride between the two pairs of twins support the contention of different basic pathogenic mechanisms in the two forms of PHA1.
Aldosterone↗
Comparison of fast versus slow rewarming following acute moderate hypothermia in rats.
BACKGROUND: The aim of this study was to compare the biochemical and physiological responses of fast vs. slow rewarming from moderate hypothermia in anaesthetized rats. METHODS: Anaesthetized rats were surface cooled to 28 degrees C, for 20 min, then rewarmed either quickly over 30 min or slowly over 120 min with monitoring of vital signs, systemic vascular resistance (SVR), cardiac output, biochemical changes and activity for 31 days. RESULTS: At hypothermia, cardiac output decreased to 77 +/- 38 ml x min(-1) and lactate increased to 4.62 +/- 4.73 mmol x l(-)1. Fast rewarming caused an abrupt increase in cardiac output (270 +/- 24 ml x min(-1)) and a sharp drop in SVR (325.6 +/- 23.3 dyne x s(-1) x cm(-5)), compared with a smoother course with cardiac output (142 +/- 18 ml x min(-1), P < 0.01) and SVR (662.8 +/- 41.0 dyne x s(-1) x cm(-5), P < 0.01), measured during slow rewarming. Lactate failed to return to normal values (upon returning to normothermia) (2.5 +/- 0.75 mmol x l(-1)) only in the fast rewarming group. In both groups, activity in the open field was not different from control rats. CONCLUSIONS: In rats, moderate hypothermia for 20 min does not appear to cause lasting biochemical or behavioural consequences, whether rewarming lasted over 30 or 120 min. However, there was a greater early change in cardiac output and heart rate, due to systemic vasodilatation in the fast rewarming animals. These acute changes may have consequences in patients with compromised cardiovascular reserves.
Anesthesia, General↗
Unlicensed and off-label medication use in a neonatal intensive care unit: a prospective study.
The aim of this study is to determine the extent of use of medications that have not been specifically licensed for use in children (unlicensed), or medications whose use is not in accordance with the conditions of their license (off-label), in neonates in a neonatal intensive care unit (NICU). Medications given to 105 neonates were prospectively reviewed every 2 weeks during a 4-month period. The assessment as to whether every medication prescribed was unlicensed or off-label for use in children was based on a number of reference sources. Five hundred and twenty-five series of medications were used, of which 310 (59%) were off-label and 87 (16%) were unlicensed. Ninety-eight neonates (93%) received at least one off-label medication. The major reason for prescribing off-label medications was a deviation from the recommended dosage or age of the patient. The reason for giving unlicensed medications was changes in the formulation of the medication. The use of off-label and unlicensed medications is common in neonates. In view of the gravity and problematic nature of the issue, international consensus is evolving to conduct clinical trials in neonates and infants, with regard to medications already on the market, and new medications.
Drug Approval↗
Metoclopramide for nausea and vomiting of pregnancy: a prospective multicenter international study.
Nausea and vomiting are very common during pregnancy, mainly throughout the first trimester. Metoclopramide is a dopamine receptor blocking drug that is commonly used to treat nausea and vomiting. The aim of this prospective study was to investigate the effect on the fetus of intrauterine exposure to metoclopramide. One hundred and seventy-five women who received metoclopramide and consulted 6 teratogen information centers in Israel, Italy, Brazil, and Canada were studied. Women exposed to metoclopramide were paired for age, smoking and alcohol consumption habits with women exposed to nonteratogens. Women in the metoclopramide group had a significantly higher rate of premature births (8.1%) as compared with the control group (2.4%) ( p = 0.02, relative risk = 3.37, 95% confidence interval 1.12-10.12). Rates of major malformations in the metoclopramide group (4.4%) did not differ from controls (4.8%) ( p = 0.84, relative risk = 0.91, 95% confidence interval 0.34-2.45). According to our findings, metoclopramide use during the first trimester of pregnancy does not appear to be associated with an increased risk of malformations, spontaneous abortions, or decreased birth weight, however, larger studies are needed to confirm these observations.
Adolescent↗
Therapeutic drug monitoring of theophylline in frail elderly patients: oral compared with nasogastric tube administration.
SUMMARY: Treating debilitated elderly patients through nasogastric tube (NGT) can change the pharmacokinetic characteristics of drugs, mainly those that are slow released (SR). The purpose of this study was to compare pharmacokinetic parameters between patients who receive SR theophylline orally and those who receive it through NGT. PATIENTS AND METHODS: The authors studied elderly patients in the geriatric ward receiving SR theophylline for chronic obstructive lung disease. In 17 patients fed by NGT (group I), theophylline was removed from the capsule and mixed with 10 mL of water. Group II included 15 patients who swallowed the drug orally. Theophylline blood levels were measured, as were peak concentration (C(max) ), time to peak (T(max) ), and area under the serum concentration-time curves (AUC). RESULTS: The mean daily dose was not statistically different between the two groups: 320 +/- 130 (200-500) mg/d in group I and 360 +/- 85 (200-500) mg/d in group II, given twice daily. All pharmacokinetic measurements were lower in group I as compared with group II: trough theophylline blood levels were 3.78 +/- 3.2 (0.5-10.77) microg/mL versus 8.63 +/- 4.6 (0-15.61) microg/mL ( P= 0.002); C(max) was 6.53 +/- 4.1 (1.3-13.33) microg/mL versus 10.51 +/- 3.30 (4.3-16.28) microg/mL (P = 0.0058), and AUC was 50.04 +/- 38.59 (11-112) microg/h/mL versus 80.37 +/- 28.8 (23-148) microg/h/ml (P = 0.024). CONCLUSIONS Patients receiving the drug through NGT had variability and unexpectedly low blood levels. Therefore, the pharmacokinetic parameters of SR preparations should be evaluated before their administration through NGT.
Administration, Oral↗
A prospective study of multiple supratherapeutic acetaminophen doses in febrile children.
Repeated doses of acetaminophen given for therapeutic reasons have been reported to cause hepatotoxicity in adults and children. We studied the effect of repeated acetaminophen (APAP) overdoses administered for therapeutic purposes in a prospective cohort of children. Forty-four children, aged 2 mo to 10 y were referred with a fever of >38.5 C for more than 48 h, and received >60 mg APAP/kg/d. In each patient AST, ALT and APAP blood levels were measured. The mean total daily dose of APAP was 92+/-26 (63-171) mg/kg. There was a weak, but significant, negative correlation between age and daily dose of APAP where younger children received higher doses of APAP. In 4 children (9.1%) an elevation of AST and ALT was found. Three of the 4 patients with elevated liver enzymes had received >90 mg APAP/kg/day; APAP blood levels ranged from 0 to 23 mg/mL. No correlation was found between the time since last APAP dose and the serum drug level. Ill children receiving repeated supratherapeutic doses of acetaminophen may show abnormalities in liver function. However, severe liver injury was rare.
Acetaminophen↗