Search PubMed⌕ Search

Biomedical subjects

S Sofer

Publications and source records attributed to S Sofer.

At least 73 records · Page 4Linked to original sources
PubMed1990

Vasodilators and hypertensive encephalopathy following scorpion envenomation in children.

Twenty-three children were admitted to a pediatric intensive care unit for scorpion envenomation with severe hypertension. The hypertension responded to analgesics and sedatives in 15 (65 percent) of the 23. The remaining eight children required specific antihypertensive therapy, and their condition promptly responded to intravenous hydralazine and sublingual nifedipine; rebound hypertension was observed in one. Hypertension is a frequent complication of a scorpion's sting in children, and specific antihypertensive therapy is indicated in severe cases. Hydralazine and nifedipine are effective and safe in such instances.

Acute Disease↗
PubMed1989

Carbamate and organophosphate poisoning in early childhood.

Twenty-five infants and young children intoxicated by carbamate and organophosphorus compounds are described. Presenting signs and symptoms in children differed from those described in adults and were mainly related to severe CNS depression, coma and stupor, dyspnea, and flaccidity. Other clinical signs such as miosis, excessive salivation and tearing, sweaty, cold skin, and gastrointestinal symptoms were less frequent, while fasciculations and bradycardia were quite uncommon on arrival. Only two patients presented with all typical signs of organophosphate poisoning as described in adults. Signs of carbamate poisoning were indistinguishable from those of organophosphate poisoning and included signs of myoneural and CNS cholinergic receptor involvement, in addition to parasympathetic muscarinic dysfunction. Atropine sulfate was found to have a clear beneficial CNS effect in addition to its known peripheral antimuscarinic effect. Our data suggest that the clinical presentation of carbamate and organophosphate poisoning in early childhood and its response to therapy are quite different from those of adults and older children.

Atropine↗
PubMed1988

Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment.

Ventricular function was evaluated using radionuclide ventriculography in 27 children with oropharyngeal obstruction and clinical features of obstructive sleep apnea. Their mean age was 3.5 years (9 months to 7.5 years). Conventional clinical assessment did not detect cardiac involvement in 25 of 27 children; however, reduced right ventricular ejection fraction (less than 35%) was found in 10 (37%) patients (mean: 19.5 +/- 2.3% SE, range: 8-28%). In 18 patients wall motion abnormality was detected. In 11 children in whom radionuclide ventriculography was performed before and after adenotonsillectomy, right ventricular ejection fraction rose from 24.4 +/- 3.6% to 46.7 +/- 3.4% (P less than 0.005), and in all cases wall motion showed a definite improvement. In five children, left ventricular ejection fraction rose greater than 10% after removal of oropharyngeal obstruction. It is concluded that right ventricular function may be compromised in children with obstructive sleep apnea secondary to adenotonsillar hypertrophy, even before clinical signs of cardiac involvement are present.

Adenoids↗
PubMed1988

Respiratory failure in children following envenomation by the scorpion Leiurus quinquestriatus: hemodynamic and neurological aspects.

Nine children, hospitalized for severe respiratory failure following scorpion envenomation, were a part of a group of 61 youngsters and infants admitted to the Pediatric Intensive Care Unit of the Soroka Medical Center, Beer-Sheva during the years 1983-87 because of scorpion venom intoxication. Four out of the nine had cardiogenic shock, three had severe systemic hypertension and one had severe airway obstruction. All nine patients had central nervous system manifestations, including lethargy, confusion and agitation (three cases), and markedly reduced level of consciousness (six cases). Hemodynamic studies performed in two patients showed 'high pressure' (cardiogenic) pulmonary edema. Seven patients recovered completely, one died and another one was left severely handicapped. Hydralazine i.v. showed a remarkable effect on the systemic blood pressure and central nervous system disturbances in addition to mechanical ventilation. Based on our own experience and previous clinical and experimental studies, the possible pathogenetic mechanisms underlying the respiratory and central nervous system dysfunction following scorpion sting are discussed.

Adolescent↗
PubMed1988

Obstructive sleep apnea in young infants.

Obstructive sleep apnea (OSA) was diagnosed in 14 infants less than 18 months of age. Snoring, apnea, failure to thrive, developmental delay and recurrent respiratory infections were the main presenting symptoms. The diagnosis was made by polysomnographic studies or overnight monitoring. Adenotonsillectomy resulted in the relief of symptoms and signs in 13 children. In one infant prolonged nasopharyngeal intubation was needed. An increased awareness of OSA in young infants may prevent the delay in diagnosis, will allow early treatment and thus prevent the development of sequela or complications associated with this syndrome.

Adenoidectomy↗
PubMed1988

Ambulatory care of febrile infants younger than 2 months of age classified as being at low risk for having serious bacterial infections.

We prospectively examined whether febrile infants younger than 2 months of age who were defined as being at low risk for having bacterial infection could be observed as outpatients without the usual complete evaluation for sepsis and without antibiotic treatment. A total of 237 previously healthy febrile infants were seen at the Pediatric Emergency Room over 17 1/2 months. One hundred forty-eight infants (63%) fulfilled the criteria for being at low risk: no physical findings consisting of soft tissue or skeletal infections, no purulent otitis media, normal urinalysis, less than 25 white blood cells per high-power field on microsopic stool examination, peripheral leukocyte count 5000 to 15,000/mm3 with less than 1500 band cells/mm3. One infant appeared too ill to be included, and had sepsis and meningitis. None of the 148 infants at low risk had bacterial infections, versus 21 of 88 (24%) of those at high risk (P less than 0.0001); eight of 88 (9%) had bacteremia. Of the 148 infants classified as being at low risk for having bacterial infection, 62 (42%) were discharged to home, and 72 (49%) were initially observed for less than or equal to 24 hours and then discharged. Seventeen infants (11%) were hospitalized: in six, low risk became high risk; six had indications other than fever; and five because the study physicians could not be found. The 137 nontreated infants were closely observed as outpatients. The duration of fever was less than 48 hours in 42%, and less than 96 hours in 91%. All infants were observed for at least 10 days after the last examination. The fever resolved spontaneously in all infants but two, with otitis media, who were treated as outpatients. Our data suggest that management of fever in selected young infants as outpatients is feasible if meticulous follow-up is provided.

Ambulatory Care↗
PubMed1988

Differences in the epidemiology of childhood community-acquired bacterial meningitis between two ethnic populations cohabiting in one geographic area.

A comparison of the epidemiology of community-acquired bacterial meningitis between Jewish and Bedouin populations cohabiting one geographical area is reported here. During the years 1981 to 1985, 100 children younger than 13 years old with community-acquired bacterial meningitis were hospitalized. Seventy-one patients were younger than 12 months. The principal bacteria isolated were Haemophilus influenzae 42%; Streptococcus pneumoniae 29% and Neisseria meningitidis 20%. The case fatality rate was 12%. The chance of acquiring meningitis during the first 5 years of life was twice as common among Bedouins than among Jews (328/100,000 vs. 173/100,000, respectively; P less than 0.0001). The most common cause of meningitis during the first year of life was S. pneumoniae among Bedouins and H. influenzae among Jews. Meningitis caused by H. influenzae and S. pneumoniae was usually associated with respiratory morbidity during fall and winter among Jews, but with diarrheal morbidity during summer and fall among Bedouins. Since the most prevalent type of morbidity among Jews results from respiratory infections and among Bedouins from diarrhea, our findings suggest that community-acquired bacterial meningitis is associated with the type of morbidity most prevalent in the community at any given season rather than with a specific type of infection.

Child↗
PubMed1988

Cor pulmonale due to adenoidal or tonsillar hypertrophy or both in children. Noninvasive diagnosis and follow-up.

Four children, aged 1 to 3 1/2, were first seen with cor pulmonale, pulmonary edema and severe respiratory distress due to chronic upper airway obstruction secondary to adenoidal or tonsillar hypertrophy or both. Arterial blood gas values, electrocardiograms and chest x-ray films were compatible with cor pulmonale. Echocardiography (four cases) and radionuclide angiography (two cases) showed severe right ventricular and right atrial dilation with reduced right ventricular ejection fraction. Following surgery, all four children improved; their echocardiographic and radionuclide findings returned to normal. Cardiac catheterization, traditionally performed in such cases, was unnecessary. The diagnosis and follow-up of this syndrome are adequately performed noninvasively.

Adenoids↗
PubMed1987

Maple syrup urine disease in a Bedouin tribe: pre- and postnatal diagnosis.

Maple syrup urine disease (MSUD) was diagnosed in four Bedouin infants as a result of the lack of branched-chain keto amino acids (BCKA) decarboxylase activity in leukocytes and skin fibroblasts. Second trimester amniocenteses were performed in five at risk pregnancies for measurement of BCKA decarboxylase. The activity measured in amniocytes was undetectable in two of them. Pregnancy was terminated only in one case and the second continued to term. The diagnosis of MSUD was confirmed in tissues of one aborted fetus, and in leukocytes of the liveborn infant. The other three pregnancies, in which normal enzymatic activity was found in the amniotic cells, were carried to term, and BCKA decarboxylase activity was evident in the leukocytes.

3-Methyl-2-Oxobutanoate Dehydrogenase (Lipoamide)↗
PubMed1986

Urinary metabolites of caffeine in the premature infant.

Caffeine metabolites in urine from premature infants were analysed by TLC and HPLC. Caffeine, dimethyluric acids, mono- and dimethylxanthines and, for the first time, a uracil derivative (6-amino-5-[N-methylformylamino]-1,3-dimethyluracil) were identified.

Biotransformation↗
PubMed1986

Improved outcome of hypothermic infants.

Fifty-six hypothermic infants (23 to 34 degrees C), aged four to 113 days, admitted during the winter months over a three-year period are reported. Low weight and malnutrition were frequent findings on admission. One or more severe associated disturbances, including metabolic abnormalities, bleeding tendency, infection, and respiratory failure were observed in most cases. All 56 patients were closely monitored for vital signs and metabolic status. Thirty-eight received conventional slow warming, but 18 of the worst cases received rapid warming. These 18 were among the 24 cases treated in a pediatric intensive care unit. Fourteen of the 56 infants required assisted mechanical ventilation. Fifty-three of 56 infants survived. Of the three who died, none was rapidly warmed, and two of them had severe underlying central nervous system infection. Hypothermia of infancy and the associated disturbances are treatable today, on condition that modern medical facilities are available. It appears that the warming method has been overly stressed.

Body Temperature↗
PubMed1986

Viral myocarditis simulating dilated cardiomyopathy in early childhood: evaluation by serial echocardiography.

Left ventricular dimensions and function were assessed by serial M mode and cross sectional echocardiography in ten infants and young children with heart muscle disease characterised by left ventricular dilatation and impaired systolic function presenting in congestive heart failure, severe respiratory distress, or both. The patients were followed for 8-60 months after their initial admission. The aetiology was probably viral in all cases. One patient died three weeks after diagnosis. Left ventricular size and function returned to normal in only one child; however, various degrees of improvement were found in seven others who were symptom free at follow up. This study demonstrates that serial echocardiography adequately defines this disease in infants and young children and that invasive evaluation is seldom required. Furthermore, it emphasises the fact that even in symptom free children an echocardiographic picture that is indistinguishable from dilated cardiomyopathy may persist; such patients required continued follow up.

Cardiomyopathy, Dilated↗