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Our objective was to investigate the impact of increased asthma awareness among primary care physicians on the asthma control and satisfaction of their patients. Physicians attended an asthma education session with emphasis on patient-physician partnership followed by 4 month monitored follow-up of patients aged 5–44 years with mild to moderate asthma. Findings were compared with a group of patients whose physician attended the session but did not participate in the follow-up and two other control groups. The study included pediatricians and general practitioners of Maccabi Healthcare Services and their patients. Asthma symptoms were rated by patients and physicians. Data on drug prescription and use were derived from the Maccabi central database. Patient response and satisfaction and physician satisfaction were evaluated by telephone interviews. Mean asthma symptom score improved from 2.0 to 1.1 in the study group of patients (p < 0.001). The use of reliever drugs decreased concomitantly with a rise in controller drugs in all patients. An improvement in asthma status was reported by 64% of the study patients and 39% of non participating patients (p = 0.007). Fifty-eight percent of the patients rated their competence to deal with asthma as high before the intervention compared to 62% of the participating and 55% of the non-participating patients after the intervention (p = 0.002). Most physicians claimed that simply increasing their awareness on asthma led to beneficial results in their patients. Physician education followed by monitored follow-up enhanced asthma control and patient satisfaction. Nevertheless, physician education alone appears to have a significant isolated impact on asthma control. [ABSTRACT FROM AUTHOR]

Aim: To study the lactic dehydrogenase isoenzyme values in children with simple and complex febrile convulsions.Methods: Cerebrospinal fluid samples were collected from 115 children, 57 with simple febrile convulsions, 27 with complex febrile convulsions and 31 with no neurological or intracranial pathology (controls). Lactic dehydrogenase activity and isoenzyme levels were measured on a Hitachi analyser.Results: Mean total lactic dehydrogenase activity was similar in the three groups. In the control group, lactic dehydrogenase-1 was the main fraction, followed by lactic dehydrogenase-2 and lactic dehydrogenase-3; only small percentages of lactic dehydrogenase-4 and lactic dehydrogenase-5 were detected. In the febrile convulsion group, the lactic dehydrogenase-1 fraction percentage was lower and lactic dehydrogenase-2, lactic dehydrogenase-3 percentages were higher than those in the control group; and the differences were statistically significant between the control and study groups (p < 0.01). Values of lactic dehydrogenase-4 and lactic dehydrogenase-5 were similar in all three groups.Conclusion: This is the first report on the lactic dehydrogenase isoenzyme pattern in the cerebrospinal fluid of patients with simple and complex febrile convulsions. The important finding that focal and general febrile convulsions are not associated with cell damage and changes in aerobic and anaerobic metabolism as lactic dehydrogenase remained unchanged. Analysis of cerebrospinal fluid lactic dehydrogenase isoenzyme levels can assist clinicians in differentiating febrile convulsions from clinical situations that might mimic them. [ABSTRACT FROM AUTHOR]

Background: Clinical, dysentery is a severe presentation of an enteric infection. The aim of the study was to evaluate the impact of a serious bacterial, etiology in clinical dysentery in hospitalized children and determine if children at high risk can be identified on the basis of clinical, or laboratory parameters. Patients and Methods: A prospective study design was used. The study population included 60 children admitted to our department with clinical dysentery over a 16-month period. Fresh stool specimens were collected on days 1, 2 and 3. The clinical. and laboratory data of the children were analyzed. Results: Clinical dysentery accounted for 1.7% of all pediatric hospitalizations during this period. Stool cultures were positive for Shigella spp. in 18 children (30%), and Salmonella spp. in 15 children (25%), Campylobacter jejuni was identified in one patient (2%). There were no significant differences in clinical characteristics or laboratory parameters between children with positive and negative stool cultures. Conclusion: 40% of the children hospitalized for clinical dysentery were eligible for antibiotic treatment. Early administration of empiric antibiotic treatment is justified in children hospitalized for clinical dysentery in Israel Clinical or laboratory parameters were unable to differentiate those with clinical dysentery at risk of serious bacterial pathogens in stool. [ABSTRACT FROM AUTHOR]

Although acute asthma is a very common cause of emergency department visits in children, there is as yet insufficient evidence for the establishment of a standardized treatment protocol. The aim of this review is to describe updated information on the management of asthma exacerbations in the pediatric emergency department. Oxygen is the first-line treatment of acute asthma exacerbations in the emergency department to control hypoxemia. It is accompanied by the administration of β-adrenoceptor agonists followed by corticosteroids. β-Adrenoceptor agonists have traditionally been administered by nebulization, although spacers have recently been introduced and proven, in many cases, to be as effective as nebulization. Oral prednisolone, with its reliability, simplicity, convenience and low cost, should remain the treatment of choice for the most severe asthma exacerbations, when the lung airways are extremely contracted and filled with secretions. Recently, several studies have shown that high-dose inhaled corticosteroids are at least as effective as oral corticosteroids in controlling moderate to severe asthma attacks in children and therefore should be considered an alternative treatment to oral corticosteroids in moderate to severe asthma attacks. Studies of other drugs have shown that ipratropium bromide may be given only in addition to β-adrenoceptor agonists; theophylline has no additional benefit, and magnesium sulfate has no clear advantage. Comprehensive asthma management should also include asthma education, measures to prevent asthma triggers, and training in the use of inhalers and spacers. Proper management will avoid most asthma attacks and reduce admission and readmission to emergency departments. [ABSTRACT FROM AUTHOR]

Asthmatic attacks continue to be a major cause of referral to the emergency room (ER), despite currently available effective treatments. We have prospectively evaluated 100 consecutive children who were referred to the ER with acute asthma and were followed by their primary physicians. Only 46% were able to recognize acute attacks, and 26% had the knowledge and skills for self-management. The prophylactic therapy recommended was usually appropriate, but the compliance was poor and mean serum theophylline levels (STL) was 6.8 µg/ml with subtherapeutic values (<10 µg/ml) in 44 (88%). We studied an additional group of 50 consecutive children who were on a routine follow-up in the hospital asthma clinic. All were examined periodically and were instructed on the disease. The compliance of these children was much better and STL were within the therapeutic range in 73%, significantly higher than in the ER patients (p <0.001). Their need for ER treatment or hospitalization was much lower than the former group. Poor compliance is a major factor causing referral of asthmatic children to ER, and careful education can improve patient compliance with reduced referral and subsequent hospitalization. [ABSTRACT FROM AUTHOR]

One hundred and seven chronically wheezing infants, aged 6 months to 3 years, completed a double-blind placebo controlled multicenter study. After a two-week baseline period the patients were randomized into two groups receiving twice daily either ketotifen or placebo for a period of 12 weeks. The ketotifen dosage was 0.5 mg for children younger than one year and 1 mg for the older. During the 12-week treatment period the patients from the two groups demonstrated gradual improvement of the disease severity parameters, as compared with the baseline period. The amelioration was more marked in the ketotifen treated patients and during the 0-4, and 4-8 weeks of treatment a significant decrease was achieved in the percentage of days with a cough (p<0.04) and in the number of wheezing episodes (p = 0.02). Moreover, a 50% reduction of the days and nights with cough and in the number of wheezing episodes occurred earlier in the ketotifen than in the placebo treated patients, i.e. after 1.2 vs 4.6; 4.4 vs 8.6 and 5.2 vs 7.2 weeks, respectively. It should be stressed that the ameloration of the asthmatic morbidity in the ketotifen group was achieved with a significantly reduced need for the concomitant use of bronchodilators. The principal side effects observed were weight gain and transient sedation. It is concluded that ketotifen may be effective in the amelioration of asthma associated symptomatology and acceleration in the natural tendency for improvement in chronic wheezing infants. [ABSTRACT FROM AUTHOR]

Unlabelled: Two hundred and fifteen children aged 4 months 6 years with acute otitis media (AOM) were randomized to be treated either by a single i.m. injection of ceftriaxone, 50 mg/kg, with a second dose in the event of unsatisfactory response after 48 h or a history of recurrent AOM (109 patients) or amoxicillin clavulanate 12.5 mg tid (106 patients). The failure rate was similar in children treated by ceftriaxone and amoxicillin clavulanate, 4.6% and 4.7%, respectively (standard error for intergroup difference -2.87%, 95% confidence interval -5.62% to 5.87%). No significant differences between the groups were found in the dynamics of the resolution of the acute symptomatology, otoscopy findings, relapse rate at 30 days or tympanographic evidence of middle ear effusion at the scheduled visits on days 30, 60 and 90. Recurrence of AOM between days 31 and 90 was observed significantly in more children treated with amoxicillin clavulanate than with ceftriaxone--25 out of 84 (29.4%) versus 11 out of 81 (13.6%) (P = 0.012).Conclusion: Ceftriaxone injection(s) is as efficient at least as 10-day oral amoxicillin clavulanate for treatment of acute otitis media in children. Although not recommended as routine, ceftriaxone can be considered in the management of acute otitis media under special circumstances, particularly in cases when the ability to tolerate or absorb oral drugs is compromised, in children refusing or unable to take oral therapy or when the compliance is questionable. [ABSTRACT FROM AUTHOR]

Two hundred and fifteen children aged 4 months–6 years with acute otitis media (AOM) were randomized to be treated either by a single i.m. injection of ceftriaxone, 50 mg/kg, with a second dose in the event of unsatisfactory response after 48 h or a history of recurrent AOM (109 patients) or amoxicillin clavulanate 12.5 mg tid (106 patients). The failure rate was similar in children treated by ceftriaxone and amoxicillin clavulanate, 4.6% and 4.7%, respectively (standard error for intergroup difference -2.87%, 95% confidence interval -5.62% to 5.87%). No significant differences between the groups were found in the dynamics of the resolution of the acute symptomatology, otoscopy findings, relapse rate at 30 days or tympanographic evidence of middle ear effusion at the scheduled visits on days 30, 60 and 90. Recurrence of AOM between days 31 and 90 was observed significantly in more children treated with amoxicillin clavulanate than with ceftriaxone – 25 out of 84 (29.4%) versus 11 out of 81 (13.6%) (P=0.012).Conclusion Ceftriaxone injection(s) is as efficient at least as 10-day oral amoxicillin clavulanate for treatment of acute otitis media in children. Although not recommended as routine, ceftriaxone can be considered in the management of acute otitis media under special circumstances, particularly in cases when the ability to tolerate or absorb oral drugs is compromised, in children refusing or unable to take oral therapy or when the compliance is questionable. [ABSTRACT FROM AUTHOR]

Unlabelled: Various neurological disorders are associated with specific changes in the level of total lactic dehydrogenase and concentrations of its isoenzymes in the cerebrospinal fluid. We describe the lactic dehydrogenase isoenzyme values in children with hydrocephalus. Cerebrospinal fluid samples collected from 10 patients (2 to 16 mo) with hydrocephalus were analysed for total lactic dehydrogenase activity and lactic dehydrogenase isoenzymes. Findings were compared with those in samples from 15 paediatric patients, with normal results. Mean total lactic dehydrogenase activity in the cerebrospinal fluid was significantly higher in the patients with hydrocephalus (101 +/- 23.11 U/L) than in the controls (33.53 +/- 5.75 U/L) (p <0.001). In the control samples, lactic dehydrogenase-1 was the main fraction, followed by lactic dehydrogenase-2 and 3; only small concentrations of lactic dehydrogenase-4 and lactic dehydrogenase-5 were detected. By contrast, patients with hydrocephalus had lower concentrations of the lactic dehydrogenase-1 fraction and higher lactic dehydrogenase-2 and lactic dehydrogenase-3 concentrations, the differences between these results and those in the control group being statistically significant (p < 0.001). The values for lactic dehydrogenase-4 and lactic dehydrogenase-5 were similar in both groups.Conclusion: Findings should be considered together with computed tomography/magnetic resonance imaging and ultrasound scans. The cerebrospinal fluid lactic dehydrogenase profile may prove to be an important predictor of cerebral injury, obstructive hydrocephalus and long-term neurodevelopmental problems. [ABSTRACT FROM AUTHOR]

Six asthmatic children participated in an acute crossover randomized study. They received a single dose of aminophylline syrup 6 mg/kg after having received ketotifen syrup 1 mg b.i.d. or place-bo for 8 days. Ketotifen did not significantly affect the heart rate, pulse pressure or such pharmacokinetic parameters of theophylline as peak serum level, time to peak, half life and AUC. Thus, ketotifen had no significant effect on the disposition of theophylline. [ABSTRACT FROM AUTHOR]

Congenital syphilis is re-emerging in modern society. The pediatric radiologist may contribute to its early diagnosis. A case of unusual bone involvement with fracture of the olecranon and facial bone lesions is described; the condition had to be differentiated from the 'battered child syndrome'. The problem of congenital syphilis as an infectious disease versus bone dystrophy is also discussed. [ABSTRACT FROM AUTHOR]

Unlabelled: During the years 1987-1988, an outbreak of mumps was reported among the paediatric population in Israel. Mumps immunization in Israel was not universal at that time and most of the population had not been immunized. During that period, 66 children with evidence of recent mumps parotitis with several complications, i.e. meningo-encephalitis, cerebellar ataxia, arthritis, orchitis, transverse myelitis, deafness and presternal oedema were treated in our department. All patients had recovered completely except one who had permanent hearing loss.Conclusion: This paper provides a reminder that mumps, while basically benign, has complications serious enough to lead to hospitalization without immunization. [ABSTRACT FROM AUTHOR]

Background: Increased levels of lactic dehydrogenase (LDH) in the cerebrospinal fluid (CSF) have been reported in association with several intracranial pathologies. No studies have been performed on patients with Guillain-Barré syndrome (GBS).Aims: To study LDH isoenzymes in CSF of children with GBS.Methods: CSF samples collected from nine patients with GBS were analysed for total LDH isoenzymes activity, and compared to samples from 15 patients with normal results.Results: Mean total LDH activity was 33.33 (6.63) U/l. All patients had significantly increased LDH-3 isoenzyme compared to controls. LDH-3 was the predominant fraction, accounting for more than 50% of total LDH activity and present in more than twice the percentage of LDH-1 or LDH-2. By contrast, in the control group, there were high percentages of mainly LDH-1 and LDH-2.Conclusions: GBS is apparently associated with a distinct LDH isoenzyme pattern in the CSF. More studies are needed to confirm the rise in LDH-3, as serial CSF analyses are unavailable, and to determine the optimum time of analysis when this finding first becomes detectable. [ABSTRACT FROM AUTHOR]

Presents a report of the World Health Organization on the prevention of allergy and asthma. Genetic and environmental influences; Early immunological influences; Predictive and early diagnosis; Preventive measures.