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Biomedical subjects

S Sofer

Publications and source records attributed to S Sofer.

At least 37 records · Page 2Linked to original sources
PubMed1997

Carbamate poisoning in early childhood and in adults.

OBJECTIVE: Retrospective evaluation of the clinical course of carbamate poisoning in young children and adults. DESIGN: Thirty-six children aged 1 to 8 years (median 2.5 years) and 24 adults aged 17 to 41 years (median 22 years) ingested rat poison resulting in carbamate poisoning. The ingested poisons in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. RESULTS: Symptoms of intoxication in children were compared to those in adults with similar depression of the serum cholinesterase. The predominant symptoms in young children were central nervous system depression and hypotonia. The most common muscarinic effect was diarrhea. In adults, the main signs were miosis and fasciculations. Fasciculations in children were less frequent. Central nervous system depression, hypotonia, and diarrhea were uncommon in adults. CONCLUSION: Based on a relatively large number of carbamate poisonings in young children, we conclude that the clinical presentation differs from adult poisoning manifestations. The absence of classic muscarinic effects does not exclude the possibility of carbamate poisoning in young children with central nervous system depression.

Adolescent↗
PubMed1996

Interleukin-6 release following scorpion sting in children.

Interleukin-6 levels were measured in the serum of ten children following severe scorpion envenomation. Measurements were taken on arrival, at the emergency room, and 12 and 24 hr after arrival. Interleukin-6 was markedly elevated in the serum of eight out of ten children on arrival. Interleukin-6 levels gradually decreased toward normal values on 12 and 24 hr measurements, but remained above control levels on all measurements. These results imply that signs and symptoms following scorpion envenomation may in part be explained by release of cytokines. Human and experimental animal studies are required in order to verify the assumption that interleukin-6 and other cytokines are involved in the pathogenesis of scorpion envenomation.

Animals↗
PubMed1996

Effect of Leiurus quinquestriatus hebreus venom on calcium and deoxyglucose uptake in cultured cardiac cells.

The effects of scorpion venom Leiurus quinquestriatus hebreus were studied on cardiac cells grown in culture. The venom (30 micrograms/ml) increased significantly (P < 0.05) Ca2+ uptake into intact cardiocytes and to sarcoplasmic reticulum of skinned cells. [3H]Deoxyglucose uptake was also increased significantly (P < 0.05) in venom treated cardiocytes. It was found that fractions I and III of the venom, separated by gel filtration and ion exchange chromatography, are responsible for the increased Ca2+ uptake by the sarcoplasmic reticulum, whereas fraction IIb, III and IV are responsible for the accelerated rate of uptake of 45Ca and [3H]deoxyglucose by intact cells. Ca channel blockers prevented these effects and similar results were obtained by propranolol. Thus, it is concluded that the venom exerts its effect through activation of beta-adrenoceptors which causes the opening of L-type Ca channels.

Adrenergic beta-Antagonists↗
PubMed1996

Possible aetiology of haemorrhagic shock and encephalopathy syndrome in the Negev area of Israel.

A retrospective study was performed for all patients diagnosed with haemorrhagic shock and encephalopathy syndrome (HSES) over an 11 year period (1984-94). Soroka University Medical Centre is the only medical facility in the southern Negev region of Israel serving a population of about 400,000 residents, consisting primarily of two ethnic populations, Jews and Bedouins. Twenty patients, 17 Bedouin and three Jews, were diagnosed with HSES. The annual incidence of HSES for infants under the age of 1 year was 5:10,000 for Bedouins and 0.6:10,000 for Jews. Patients ranged in age from 6 to 32 weeks and arrived at the hospital late at night or early morning (2:00 am to 11:00 am), during the winter or early spring (November to April). All were healthy before admission, with short prodromal symptoms of upper respiratory tract or gastrointestinal infection noted in 10 cases. Most infants had markedly high body temperature on arrival. A history of overwrapping and/or excessive heating was obtained in four of 20 infants. Bacteriological and virological cultures were negative in all infants. One infant died and neurological sequelae were observed in all survivors. The high prevalence of hyperpyrexia during sleep in the presence of negative microbiological results with no evidence of excessive heating, and the high incidence of HSES among a closed and culturally isolated society known to have a high incidence of congenital malformations, may support previous assumptions that HSES results from hyperpyrexia, originating in most cases from a 'physiological' heat induced trigger, which starts and peaks during the night in previously healthy infants who are genetically susceptible.

Arabs↗
PubMed1995

Severe complications of measles requiring intensive care in infants and young children.

OBJECTIVE: To evaluate the characteristics of severe complications of measles in patients admitted to a pediatric intensive care unit. DESIGN: Clinical description of a case series. SETTING: The Pediatric Intensive Care Unit of Soroka Medical Center, Beer-Sheva, Israel, during a measles epidemic. PATIENTS: Fifteen pediatric patients with measles requiring intensive care. RESULTS: Fifteen of 237 hospitalized children with measles required intensive care in the Pediatric Intensive Care Unit. Eleven patients were malnourished; none had been vaccinated for measles. All 15 patients required mechanical ventilation for pneumonia that had caused severe respiratory distress. Twelve of 15 patients were severely hypoxemic before intubation. Seven had a clinical syndrome consistent with adult respiratory distress syndrome. Other complications on admission to the intensive care unit included spontaneous pneumothorax in three patients, empyema in two, encephalopathy in seven, shock in three, sepsis in five, hypocalcemia in 11, thrombocytopenia in eight, and coagulopathy in seven. Complications during treatment included pneumothorax in four patients, fibrosing alveolitis in one, brain infarct in one, thrombus formation in three, and nosocomial sepsis in one. Four patients had long-term sequelae (chronic lung disease, subacute sclerosing panencephalitis, hemiplegia, and partial amputation of a limb), and seven patients recovered uneventfully. Four patients died; all had adult respiratory distress syndrome, three had pneumothorax, and one had nosocomial sepsis. CONCLUSIONS: Patients with measles who require intensive care have a high risk for death or long-term complications, even when treated in a modern pediatric intensive care unit. Adult respiratory distress syndrome and air leaks were the most severe complications in these patients. To reduce the severity of these complications, mechanical ventilation should be based on using the lowest possible inspiratory pressure and fraction of inspired oxygen, while accepting an arterial oxygen pressure less than 60 mm Hg. Secondary bacteremia was an early and prominent complication, and antibiotic treatment should be instituted early in patients with measles requiring intensive care.

Bacteremia↗
PubMed1995

Successful radiofrequency ablation in a 3-month-old baby with permanent junctional reciprocating tachycardia: a new era in the treatment of incessant life-threatening arrhythmias in infants.

We report our experience in treating a 3-month-old baby with accessory atrioventricular pathway by radiofrequency (RF) ablation. The baby was discovered to have incessant supraventricular tachycardia at 4 weeks of age. At that time, two-dimensional echocardiography showed dilated cardiomyopathy. Multiple direct current shocks and multipharmaceutical treatment failed to restore sinus rhythm. Electrophysiology study showed the presence of posteroseptal accessory pathway. Immediately after delivery of two RF pulses, successful ablation of the accessory pathway and complete atrioventricular (AV) block with good junctional escape rhythm were observed. Normal rhythm and AV conduction subsequently returned and all medical treatment was discontinued. To our best knowledge, this is the first case of successful treatment with RF ablation in early infancy.

Catheter Ablation↗
PubMed1995

Snake bite by Cerastes vipera in children: report of two cases.

Two children, ages 2 and 4 years, envenomed by the snake Cerastes vipera are presented. Both children suffered from local pain and swelling of the hand that spread up to the shoulder in the 2-year-old and up to the elbow in the 4-year-old. A hemorrhagic blister was noted on the bitten finger in the younger patient. Urinary retention, tachycardia, and a slight prolongation of prothrombin time was noted in the 2-year-old, whereas hypertension and fever were observed in the 4-year-old. In both cases, the swelling receded gradually and the patients were discharged from the hospital after several days without any complications and in a good condition.

Animals↗
PubMed1994

Abnormal coronary perfusion in experimental scorpion envenomation.

Perfusion defects and left ventricular dilation after experimental scorpion envenomation were evaluated in five dogs. Left Left ventricular dilation was observed in three dogs and right ventricular dilation in one other, in scans immediately after envenomation. Perfusion defects were inferred from scans in four dogs. The data are strongly suggestive of coronary hypoperfusion, and the mechanics of abnormal coronary flow after scorpion envenomation are discussed.

Animals↗
PubMed1994

The role of the intensivist in the treatment of the cardiovascular manifestations of scorpion envenomation.

The following report summarizes the role of the intensivist in the treatment of the cardiovascular manifestations of scorpion envenomation within the intensive care unit. It emphasizes the need for a clear understanding the mechanisms involved behind the manifestations of myocardial damage and the rational approach of aggressive treatment of the overstimulated autonomic nervous system. The report emphasizes the complexity of the clinical picture and the intensivist approach based on clinical and experimental evidence, with excellent results.

Animals↗
PubMed1994

Hemodynamic effects following injection of venom from the scorpion Leiurus quinquestriatus.

PURPOSE: The present study tested the hypothesis that scorpion sting induces left ventricular (LV) hypokinesia and myocardial ischemia shortly after injection due to reduction of coronary blood flow (CBF) and increased oxygen demand. METHODS: In 5 mechanically ventilated, open-chest dogs, we measured LV function following i.v. injection of venom (0.05 mg/kg) obtained from the scorpion Leiurus quinquestriatus. Hemodynamic responses to the venom were followed up for 90 minutes. RESULTS: The venom induced significant combined respiratory and metabolic acidosis (arterial pH progressed from 7.35 +/- 0.03 at baseline to 7.10 +/- 0.06 at 90 minutes). There were large increases in blood pressure, LV end systolic pressure, stroke work, and velocity of contraction. Twenty minutes following venom injection, cardiac output (CO) increased by 37% but then declined to 36% below baseline by 90 minutes (P < .05). CBF increased significantly in proportion to increased perfusion pressure; hence, there was no change in coronary vascular resistance. There was no evidence of myocardial ischemia or LV dysfunction because there was no change in myocardial pH, percentage fiber shortening, or LV end-diastolic pressure. Despite the fact that some variables returned to baseline at 90 minutes, they did not reach steady state; thus, the preparation would have continued to deteriorate. CONCLUSIONS: Myocardial ischemia does not occur in this dog model immediately following administration of scorpion venom. There are significant peripheral circulatory effects of the venom, which account for many of the hemodynamic changes.

Animals↗
PubMed1994

Scorpion envenomation and antivenom therapy.

The clinical course and outcome of scorpion envenomation in 52 children treated in a pediatric intensive care unit without specific antivenom were retrospectively evaluated and compared with those of scorpion envenomation in the 52 preceding cases treated with specific scorpion antivenom. The demographic, clinical, and laboratory features on hospital arrival were similar in the two groups. The lengths of stay in the pediatric intensive care unit and in the pediatric wards were comparable. Hypotension with pulmonary edema developed in four of the children who did not receive antivenom and in one child who did receive antivenom as a complication of the envenomation; all completely recovered. Cardiogenic shock occurred in one child who did not receive antivenom, but who recovered completely, and in three children who received antivenom, of whom two died and one survived with a major deficit. Our study did not demonstrate any beneficial effect of therapy with antivenom for scorpion envenomation in children. However, our "control" group (i.e., the treated group) was a historical one; thus a prospective, randomized study appears to be warranted. Such a study may define specific subgroups that may benefit from treatment with antivenom.

Adolescent↗
PubMed1994

Assessing ability to drive following an acute neurological event: are we on the right road?

Every day in Canada occupational therapists are asked to assess clients with neurological impairments and to provide recommendations to provincial licensing bureaus regarding the individual's fitness to drive. These decisions have great impact on the client and on society. In this paper we briefly review the findings that have been published regarding the assessment of individuals with neurological conditions who wish to resume driving. In addition, a description of the tools commonly used to assess individuals is provided, along with where available, the measurement properties of each. Finally, the Driving Evaluation Service of a physical rehabilitation centre is described.

Automobile Driving↗
PubMed1994

Carbamate poisoning and oxime treatment in children: a clinical and laboratory study.

OBJECTIVE: (1) Retrospective evaluation of the clinical course of carbamate poisoning and the effect of oxime therapy in children. (2) In vitro study of the effect of oximes on the reactivation of carbamylated cholinesterase. DESIGN: (1) Clinical survey: The records of 26 children intoxicated with carbamates were examined retrospectively. The poisoning agents in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. (2) Laboratory study: The direct effect of obidoxime and of pralidoxime on acetylcholinesterase activity in vitro was investigated in normal human packed red blood cells pretreated with an organophosphate (paraoxon) or a carbamate (aldicarb or methomyl). CLINICAL SETTING: Pediatric intensive care unit of a teaching hospital. PATIENTS: Twenty-six infants and young children (aged 1 to 8 years) admitted to the pediatric intensive care unit with severe carbamate intoxication. INTERVENTIONS: All cases had been treated with repeated doses of atropine sulfate (0.05 mg/kg) administered every 5 to 10 minutes until muscarinic symptoms disappeared. Obidoxime chloride (Toxogonin, 6 mg/kg) was administered on admission, and again after 4 to 5 hours. RESULTS: Predominant symptoms were related to central nervous system and nicotinic effects. All the patients showed marked improvement within several hours and recovered completely within 24 hours. None of the children deteriorated and none showed exacerbation of cholinergic symptoms after obidoxime treatment. In vitro, oximes reactivated acetylcholinesterase inhibited with paraoxon, whereas no significant effect of oximes on carbamylated enzyme activity was observed. CONCLUSIONS: Based on the recovery of all cases, as compared with other reports of carbamate poisoning treated with atropine alone, it is concluded that, in the case of aldicarb or methomyl poisoning, oxime therapy apparently does not contribute to the recovery of poisoned patients. In cases of poisoning by an unknown pesticide or of mixed poisoning, oxime therapy can prove beneficial because no negative effects of the therapy can be discerned.

Aldicarb↗
PubMed1993

Biodegradation of phenol: a comparative study with and without applying magnetic fields.

The objective of this work was to study the effect of magnetic fields on the rate of phenol biodegradation using immobilized activated sludge. A recirculation flow bioreactor employing immobilized bacterial beads was used with phenol as the substrate to study the biodegradation process. This study was conducted by applying separately the north pole and the south pole magnetic fields to the bioreactor. Rate of dissolved oxygen consumption, phenol concentration and extracellular protein concentration were the parameters monitored during the process. It was observed that by applying a magnetic south pole to the process, biodegradation in the form of biological oxidation was enhanced. A 30% increase in biodegradation rate was obtained by applying a magnetic south pole of strength of 0.45 Tesla to the bioreactor with immobilized microbial beads as compared to the control. Magnetic north pole irradiation inhibited this type of biooxidation. This process has potential for biological treatment of organic wastes.

Bacteria↗