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Biomedical subjects

B Bernstein

Publications and source records attributed to B Bernstein.

At least 37 records · Page 2Linked to original sources
PubMed1994

Disseminated cryptococcal disease complicating steroid therapy for Pneumocystis carinii pneumonia in a patient with AIDS.

Recent studies have suggested that steroid therapy may reduce the morbidity and mortality of HIV-associated Pneumocystis carinii pneumonia (PCP) in a select population of patients. However, the risks of steroid therapy for this group have not been well defined. We describe the case of a patient admitted with severe PCP whose treatment included high-dose steroids. During his hospitalization, overwhelming cryptococcal disease developed, contributing to his death. We postulate that the rapidity of progression was due, in part, to the steroid therapy. We have also reviewed the literature. We recommend screening for cryptococcal infection before beginning steroid therapy.

AIDS-Related Opportunistic Infections↗
PubMed1994

Do parental concerns predict a diagnosis of attention-deficit hyperactivity disorder?

Parents' concerns for their children's behavior were investigated to predict a diagnosis of attention-deficit hyperactivity disorder (ADHD) in this retrospective comparative study of 245 children, aged 4 through 15 years (mean = 8.1 years), consecutively referred for comprehensive pediatric evaluation of school problems between 1981 and 1992. Concerns identified by parents were categorized (inattention, impulsivity, overactivity) and compared to children's final diagnoses of ADHD to measure their sensitivity, specificity, and predictive value. For 92% of subjects, significant school-related problems were diagnosed and 38% received a diagnosis of ADHD. Parental concern for one or more major symptoms of ADHD identified almost all of the children with a diagnosis of ADHD (sensitivity = .87), but also identified many children without such a diagnosis (specificity = .41). Concerns with impulsivity and overactivity were specific (.82, .87) but not sensitive (.38, .29). Concerns with attention had modest sensitivity (.57) and specificity (.57). Positive predictive value was modest for all categories of concerns (.45 to .57). Findings support the importance of eliciting parents' concerns for their children's school performance and of performing comprehensive assessment to identify the underlying causes of problems with attention.

Adolescent↗
PubMed1994

Self-reported depressive symptoms in inner-city adolescents seeking routine health care.

This study examines the self-reported depressive symptoms of inner-city adolescents coming to a health center for routine care. Data were obtained from a confidential screening questionnaire. Of the 966 adolescents responding to questions about depression, 371 (38%) indicated never being down or depressed. Five hundred and seventy three indicated the frequency of their being down or depressed as follows: 446 (78%) infrequent (once a month or less) and 127 (22%) frequent (weekly or more often). Relationships between frequently feeling down or depressed and eight somatic and twelve psychosocial concerns were explored. A relative risk for frequently feeling down or depressed greater than threefold was found for six of these concerns, all psychosocial in nature. These data suggest that one-fifth of the teens coming for routine health care also reported frequent feelings of being down or depressed when specifically asked about such feelings. Identification of such teens may be facilitated by inquiries into specific somatic and psychosocial concerns. Follow-up care is also reviewed. Since adolescents do not routinely seek help for mental health concerns, health providers seeing adolescents for general health care should actively solicit information relating to such concerns.

Adolescent↗
PubMed1993

Cerebral perfusion abnormalities in children with central nervous system manifestations of lupus detected by single photon emission computed tomography.

OBJECTIVE: Central nervous system (CNS) abnormalities have been reported in 30-60% of children with systemic lupus erythematosus (SLE) during the course of the disease. Unlike most other manifestations of childhood lupus, few laboratory studies and imaging modalities aid in the documentation of CNS lupus. Single photon emission computed tomography (SPECT) provides a means of assessing cerebral blood flow and may reveal subtle areas of decreased perfusion or loss of functioning brain parenchyma. METHODS: We evaluated 5 children with clinical signs of CNS lupus using SPECT, lumbar puncture, electroencephalogram (EEG), computerized tomogram (CT) and magnetic resonance imaging (MRI), as well as autoantibody and complement serologic testing. All patients fulfilled classification criteria for SLE and within one year of onset presented with the following CNS manifestations: grand mal seizures with encephalopathy or psychosis (2) and transverse myelitis (1), focal seizure and depression (1), and severe headache and ophthalmitis (1). RESULTS: Four patients had anticardiolipin (aCL) antibodies. One girl with positive aCL had a concurrent ischemic event involving both parietal lobes and another had a CNS bleed. Both of these children had abnormal EEG, CT and MRI scans. All children had normal cerebral spinal fluid analyses. No correlation was found between serologic variables and CNS disease. All 5 children had abnormal SPECT perfusion studies. CT and MRI failed to demonstrate abnormalities in 3 children. Although CT and MRI documented parietal lobe infarcts in one child and focal hemorrhage in another, poor perfusion found with SPECT extended beyond these abnormalities and into areas which appeared intact using the conventional imaging techniques. All children improved clinically and 4/5 had additional SPECT studies. In all 4, the perfusion abnormalities improved but did not resolve. One of these patients had a recurrence of hallucinations and worsening of SPECT findings which improved again after the patient stabilized. CONCLUSIONS: We conclude that the cerebral perfusion SPECT scan is a sensitive tool and may prove useful in the documentation of CNS lupus in children.

Adolescent↗
PubMed1993

Prolonged course of illness in a child with malignant lymphoma mimicking sarcoidosis.

We describe a case of malignant lymphoma mimicking the rheumatic presentation of sarcoidosis in an adolescent with a 3-year history of febrile illness. Final diagnosis was established by tissue biopsy after multiple studies failed to provide histological evidence of granulomas consistent with sarcoidosis. We discuss the limited diagnostic specificity of serum angiotensin converting enzyme in sarcoidosis and emphasize the need for aggressive diagnostic evaluation of a patient whose clinical presentation is not fully explained by a known rheumatologic illness.

Adolescent↗
PubMed1992

Clinical implications of a folk illness: empacho in mainland Puerto Ricans.

The study of folk illnesses provides insight into client health beliefs and behaviors. This paper describes the expression of empacho in children living in a mainland Puerto Rican community. Etiology, symptom presentation, and treatment options in various health care sectors, as well as an investigation of overlapping folk/biomedical symptom domains are described. Implications regarding health and health care in the multicultural setting are discussed.

Connecticut↗
PubMed1992

Lupus nephritis: prognostic factors in children.

As newer treatment modalities become available for patients with severe lupus nephritis, it becomes increasingly important to identify patients at risk for renal failure. In this study, the records of 90 children presenting with systemic lupus erythematosus over a 13-year period were reviewed. Nineteen were lost to follow-up prior to completion of the study. Of the 71 remaining children, 16 (22%) progressed to chronic renal failure. Persistent hypertension lasting greater than 4 months, anemia, abnormalities of the urinalysis, and elevated serum creatinine level were significantly associated with progression to renal failure. Sex, race, age, abnormalities of creatinine clearance, and 24-hour urine protein collection were not associated with progression to renal failure. Renal biopsies were obtained in 45 children. Biopsies were initially classified according to World Health Organization criteria. Diffuse proliferative glomerulonephritis was significantly associated with progression to renal failure. The 45 biopsies available were reviewed by one of the authors and categorized by activity and chronicity indices. Both the active lesions of fibrinoid necrosis, synechiae, tubular casts, and vasculitic lesions and the chronic lesion of glomerular sclerosis correlated with progression to renal failure. Of the 16 children who progressed to renal failure, 2 had cadaver kidney transplants and are well 5 years posttransplant; 4 had fulminant lupus and died within 1 month of commencing dialysis; 10 began chronic dialysis. Five of the 10 children on chronic dialysis died from sepsis. These data suggest that children with systemic lupus erythematosus who undergo dialysis do poorly.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1991

EMG biofeedback treatment of pediatric hyperfunctional dysphonia.

A 9-year-old boy with a long history of impaired communication resulting from hyperfunctional dysphonia and vocal nodules had proven to be unresponsive to traditional voice therapy. In this study, he engaged in biweekly visual EMG biofeedback training to reduce laryngeal muscle tension. In a multiple baseline design across two responses with changing criteria, results demonstrated sequential stepwise reductions in muscle tension with each new criterion. Concomitant improvements were found in laryngeal aerodynamic functioning and in voice quality. The treatment also resulted in the elimination of the vocal nodules without surgical intervention. These effects were maintained at 6 month follow-up.

Biofeedback, Psychology↗
PubMed1990

High prevalence of IgA rheumatoid factor in severe polyarticular-onset juvenile rheumatoid arthritis, but not in systemic-onset or pauciarticular-onset disease.

The presence of IgA rheumatoid factor (IgA-RF) has been correlated with severe joint disease in adult rheumatoid arthritis (RA), but IgA-RF has not been reported in juvenile rheumatoid arthritis (JRA). In the present study, IgA-RF was assayed by an enzyme-linked immunosorbent assay and was found in the sera of 14 of 24 children (58%) with active polyarticular JRA. The presence of IgA-RF correlated with the degree of functional disability. In contrast, IgA-RF was not found in the sera of systemic-onset disease patients, regardless of the degree of dysfunction. IgA-RF was detected in only 1 patient with pauciarticular disease, despite the fact that several patients in this group had severe disease. The presence of IgA-RF in polyarticular JRA did not correlate with serum IgA levels, but did correlate with the presence and the level of serum IgM-RF. Thus, the presence of IgA-RF appears to be specific for polyarticular JRA, and shows a correlation with severe disease in this group.

Adolescent↗
PubMed1990

Ibuprofen suspension in the treatment of juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group.

Ninety-two children with juvenile rheumatoid arthritis were randomly assigned to treatment in a multicenter, double-blind, 12-week trial designed to compare the efficacy and safety of a liquid formulation of ibuprofen at a dosage of 30 to 40 mg/kg/day versus those of aspirin at a dosage of 60 to 80 mg/kg/day. No significant intergroup differences in response rates or in the amount of improvement in articular indexes of disease activity were observed. More children treated with aspirin discontinued treatment early because of adverse reactions. After this trial, 84 additional patients with juvenile rheumatoid arthritis entered a 24-week, multidose (30, 40, and 50 mg/kg/day), open trial of ibuprofen suspension. Favorable response rates for the three groups were similar, and continued improvement was observed throughout the 24-week period. A dose-response relationship was observed with respect to adverse reactions of the upper gastrointestinal tract. We conclude that ibuprofen suspension is an effective nonsteroidal antiinflammatory drug and that its tolerability in children is acceptable.

Adolescent↗
PubMed1990

Prevalence and concentration of IgM rheumatoid factor in polyarticular onset disease as compared to systemic or pauciarticular onset disease in active juvenile rheumatoid arthritis as measured by ELISA.

The prevalence and concentration of IgM rheumatoid factor (RF) in children with juvenile rheumatoid arthritis (JRA) and its major disease onset groups remains uncertain. In our study enzyme linked immunoabsorbent assay (ELISA) of 68 children with active JRA showed IgM RF in the area of 67% (16/24) of those with polyarticular onset disease, 26% (7/27) of those with systemic onset disease, and 6% (1/17) of those with pauciarticular onset disease. The median IgM RF concentration was 50-fold higher in polyarticular disease compared to systemic disease. The prevalence of IgM RF in polyarticular disease was greater in those with severe disease (functional classes and 3 and 4), with 90% (9/10) seropositive. By agglutination assay, the prevalence of IgM RF in JRA was significantly less than by ELISA, with 33% of the polyarticular group positive for IgM RF, and none of the systemic group positive, Relatively low concentration IgM RF similar to that seen in systemic JRA was also found in high prevalence in the area of children with non-JRA, systemic rheumatic disease (n = 8). In summary, our study shows by ELISA that high concentrations of IgM RF are found essentially only in the sera of children with polyarticular onset JRA and especially in those with severe disease.

Adolescent↗
PubMed1990

Seat belt use and stress in adolescents.

This study explored the association of adolescent seat belt use with psychosocial risk factors in an urban minority population after the enactment of a mandatory seat belt law. Data on seat belt use, family support, feelings of being down, suicidal ideation, substance abuse, sexual activity, school troubles, and problems with the law were obtained from 541 self-report intake forms administered to an adolescent medicine clinic population from 1986 to 1987. Respondents were almost exclusively black and Hispanic; 315 (59%) were females and 222 (41%) males, with a mean age of 15.4. Seat belt use was reported by 249 (46%) and no or intermittent use by 292 (54%). Chi-square and Wilcoxon rank sums tests were used to examine associations between seat belt use and risk factors. Results showed that the group comprised of those reporting no and intermittent seat belt use was significantly more likely to feel down, have decreased home support, have problems with school and the law, have been on probation, and feel that life in general was not going very well. No association was found between seat belt use and cigarette, drug, or alcohol use or sexual activity without contraceptives. Taking into account the lack of observed behavioral information to validate such self-report questionnaires, these data nevertheless point to the nonuse or intermittent use of seat belts as a possible manifestation of a lack of self-care due to feeling down and/or preoccupation with family, school, or societal problems.

Adolescent↗
PubMed1986

Brown recluse spider bites.

The brown recluse spider (Loxosceles reclusa), found in many areas of the United States, is capable of producing significant medical problems and potentially life-threatening systemic manifestations. This paper reviews the clinical presentation, diagnostic workup, pathophysiology, and management of the brown spider bite. Emphasis is placed on the potential for error in establishing this diagnosis. The need for a simplified management program is discussed along with current concepts on how to achieve this management program. Attention is also directed to the more serious complications.

Adult↗
PubMed1983

Consumption coagulopathy associated with systemic juvenile rheumatoid arthritis.

A coagulopathy resembling disseminated intravascular coagulation may occur in systemic juvenile rheumatoid arthritis. We have seen this in seven patients with three different circumstances of disease activity or drug treatment. In one patient, a coagulopathy was not associated with drug therapy, and required corticosteroid therapy for control. A second group of patients was receiving orally nonsteroidal anti-inflammatory drugs during an acute flare-up of disease associated with low serum albumin concentrations. Coagulopathy in these patients may be a result of reduced vascular endothelial cell cyclooxygenase activity secondary to increased levels of unbound nonsteroidal anti-inflammatory drug. In these children, corticosteroid therapy was required for control. A third form of coagulopathy was seen in patients receiving a second injection of aurothiomalate. This form appears to be idiosyncratic, self-limiting, and relatively benign.

Administration, Oral↗
PubMed1983

Cefotaxime: pharmacokinetics and in vitro antibacterial activity of serum and urine in normal human volunteers.

The pharmacokinetic and antibacterial properties of cefotaxime were determined in normal adult volunteers. Single doses of 250, 500, 1,000 and 2,000 mg were evaluated following 5- and 20-min intravenous (i.v.) infusions and intramuscular (i.m.) administration. Cefotaxime was well tolerated and mean peak serum levels exceeded the minimum inhibition concentration (MIC) values for a wide spectrum of potential bacterial pathogens. Approximately 48% of the i.v. doses was excreted renally; average volume of distribution was 30% of body weight and the t 1/2 was about 1 h. Cefotaxime was rapidly absorbed following i.m. injection with maximum serum concentrations occurring at approximately 0.6 h. Serum and urine antibacterial activity reflected the concentration of cefotaxime and MIC of the bacterial pathogens tested.

Bacteria↗
PubMed1983

It's time to fund physician shortage programs by abandoning unrestricted state subsidies to medical schools.

Last fiscal year, New York State spent more than $135 million to subsidize medical education. More than 95 percent of these funds were used to defray the general operating costs of the state's nine private and four public medical schools. Only $7 million was spent directly to support physician shortage and minority recruitment programs. This article argues that unrestricted subsidies are inequitable, wasteful, unnecessary, and inflationary; therefore they should be abandoned, in favor of programs that contribute directly to the supply of primary care physicians in medically underserved areas.

Education, Medical↗