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Background: The most common oral antibiotics used in the treatment of urinary tract infection (UTI) are sulphonamides and cephalosporins, but emerging resistance is not unusual. Aims: To assess the change [...]

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]

A retrospective study was performed comparing bilirubin levels in 40 preterm newborns with uncomplicated courses fed a combination of premature breast milk and formula to those of 60 comparable preterm newborns fed formula only. A significantly higher bilirubin level was noted in the group fed the combined diet on the 6th day of life and on the day of discharge. Seventy-six and seven tenths percent of the preterm infants fed breast milk and formula met the criteria for phototherapy, whereas only 45 percent were treated in the group fed formula alone. Our findings indicate that premature breast milk might cause early and late increase in bilirubin levels in healthy preterm newborns [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: Bulimia nervosa (BN) patients are characterized by binge eating followed by compensatory behaviors. Ingestion of emetic substances, characteristic to some BN patients, has been reported to be associated with supraventricular arrhythmias., Aims: To evaluate atrial electrocardiographic markers for supraventricular arrhythmias in patients with BN., Method: The cohort included 31 patients with BN and sex- and age-matched controls. Twelve-lead electrocardiography was conducted on all participants under strict standards. P wave length and P wave dispersion in each patient were computed from a randomly selected beat and an averaged beat constructed from 7-12 beats, included in a 10-s ECG., Results: No statistically significant differences were found between the groups for minimal, maximal, and average P wave duration and P wave dispersion, calculated either from a random beat or averaged beats., Conclusion: BN patients who are medically monitored and treated, have normal P wave parameters and P wave dispersion, and therefore do not appear to have an increased risk for developing supraventricular arrhythmias. Future research should focus on evaluating the effect of acute ingestion of emetic drugs on resting ECG of BN patients, as well as using signal averaging techniques and prolonged ECG-Holter monitoring.

Objective: Eating disorders, in particular anorexia nervosa (AN), are associated with cardiovascular complications and risk of arrhythmias. In a recent published study, it was found that patients with eating disorders, especially those affected by bulimia nervosa (BN) and a history of AN have abnormal late ventricular potentials (LPs). LPs are electrocardiographic markers used in detecting abnormal depolarization and increased risk of arrhythmias. Given the paucity of knowledge regarding the affects of eating disorders on cardiac depolarization, our aim was to further explore LPs in patients with eating disorders., Method: The study group included 30 hospitalized patients with eating disorders (14 with AN, 10 with BN with no history of AN, and 6 with BN and history of AN). Signal averaged electrocardiography was conducted on all patients using the Frank corrected orthogonal lead system., Results: No patient with either eating disorder tested positive for LPs., Discussion: Hospitalized patients with eating disorders, medically monitored and treated for several weeks, had normal serum electrolytes, started to normalize their weight, and did not appear to be prone to arrhythmias associated with abnormal depolarization. The prognostic significance of LPs in risk stratification of patients with eating disorders should be further evaluated by large cohort studies and longer follow-up studies., (Copyright © 2011 Wiley Periodicals, Inc.)

Anorexia nervosa (AN) is an increasingly common medical condition. Some studies have demonstrated an increased prevalence of atrial premature contractions and anatomical changes in AN patients. Our aim was to investigate P wave parameters and P wave dispersion, an electrocardiographic marker for supraventricular arrhythmias, and its effect on AN. The study group included 48 patients with AN, most hospitalized for a few weeks, and a matched control group. All participants underwent 12-lead electrocardiography (ECG) under strict standards. P wave length and P wave dispersion in each patient were computed from a randomly selected beat and an averaged beat, constructed from 7 to 12 beats, included in a 10-s ECG. There were no statistically significant differences found between the groups for minimal, maximal, average P wave duration and P wave dispersion, calculated either from a random beat or averaged beats. In conclusion, medically treated AN patients who have gained weight have normal P wave parameters, and therefore do not appear to have an increased electrocardiographic risk for atrial fibrillation compared with healthy controls. Further studies are required to evaluate the influence of different disease stages, electrolyte imbalance and other medical complications on P wave parameters and risk for supraventricular arrhythmias in AN patients., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The association between familial Mediterranean fever (FMF) and subclinical cardiac disease remains controversial. The aim of the current study was to evaluate whether FMF patients, who do not respond to colchicine treatment, and thereby endure persistent inflammation, have increased QT dispersion (QTd) values. Twenty-two FMF patients and 22 age- and sex-matched control subjects were included in the study. Repolarization and QT dispersion parameters were computed from 12-lead ECG recording using designated computer software, and results of five beats were subsequently averaged. Both FMF patients and controls had similar comorbidities, similar values of average QT, average corrected QT interval length, average QTd interval, average QT corrected dispersion, QT dispersion ratio, JT dispersion (JTd), and JT corrected dispersion. In conclusion, FMF patients who were unresponsive to colchicine treatment and did not develop amyloidosis had normal QTd and JTd parameters, indicating a non-increased risk for repolarization-associated ventricular arrhythmias.

Cardiac amyloid deposition in FMF may cause increased QT dispersion (QTd), a marker for cardiac arrhythmias. The aim of this study was to further evaluate repolarization dispersion in familial Mediterranean fever (FMF) with amyloidosis. Findings on 12-lead electrocardiography were compared between 18 patients with FMF-amyloidosis and 18 age- and sex-matched control subjects. Repolarization and dispersion parameters were computed with designated computer software, and results of the 5 beats were subsequently averaged. There were no statistically significant differences between the groups as to average corrected QT interval length, average QTd interval, average QT corrected dispersion, or QT dispersion ratio. JT dispersion and JT corrected dispersion were also similar in both groups. In conclusion, patients with FMF-amyloidosis seem to have QT and JT dispersion parameters similar to those of healthy subjects. Future research and longer follow-ups should be conducted in order to evaluate the prognostic importance of repolarization dispersion parameters in amyloidosis of FMF.

The association between familial Mediterranean fever (FMF), early atherosclerosis, and electrocardiographic markers for arrhythmias remains controversial. There are conflicting results as to the occurrence of high QT dispersion in FMF. The aim of the present study was to further investigate repolarization dynamics and other repolarization-associated pro-arrhythmogenic markers in FMF patients. To explore repolarization in FMF, patients who responded well to colchicine and patients who had not responded to colchicine, yet were amyloidosis-free, were included. We aimed to evaluate whether increased inflammatory burden, a characteristic of non-responsive patients, was specifically associated with abnormal repolarization. Included in the study were 53 FMF patients (27 colchicine non-responders) and 53 age- and sex-matched control subjects. Electrocardiograms were performed under strict standards. QT variability parameters were computed with custom-made computer software. No significant difference in any of the QT dynamic parameters was found in either FMF group compared with the healthy controls. Mean values of QT variability index, regardless of colchicine response, were similar to previously published results for healthy persons. In conclusion, patients with FMF who are continuously treated with colchicine and have not developed amyloidosis, regardless of their clinical response, have normal QT variability parameters, indicating normal repolarization dynamics and suggesting no increased risk of repolarization-associated cardiac arrhythmias.

Objective: Anorexia nervosa (AN) may be complicated by cardiac arrhythmias and sudden death. A single study reported an increased QT variability index (QTVI), a marker for cardiac arrhythmogenicity, in AN patients. The aim of the current study was to further evaluate repolarization dynamics in a large cohort of patients with AN without electrolyte abnormalities and to evaluate previously unreported repolarization dynamics parameters., Methods: Forty-three AN patients and 45 age- and sex-matched controls were included in the study. Twenty-nine AN patients were hospitalized for a mean time of 1.5±1.1 months. The rest were ambulatory AN patients. Electrocardiograms were conducted under strict standards. QT variability index, normalized QT variability (QTVN) and power spectral analysis of QT dynamics were conducted with designated computer software., Results: None of the patients had an electrolyte imbalance. Although mean QT was higher in AN patients compared with controls, QTc results were similar following corrections for RR interval. There was no significant difference in QTVI, QTVN and power spectral analysis parameters among groups. The results of QTVI and QTVN were comparable to those previously published for healthy individuals. During 3 years of follow-up, no patient developed arrhythmias or suddenly died., Conclusions: Medically treated AN patients who gained weight and had normal serum electrolytes appeared to have normal QTc and QT variability indexes, reflecting a nonincreased risk for cardiac arrhythmias. We suggest that weight normalization, medical treatment and lack of electrolyte abnormalities are responsible in part for these results. Further evaluation of the prognostic significance of QTVI and QTVN in AN is warranted., (Copyright © 2012 Elsevier Inc. All rights reserved.)