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Biomedical subjects

Benjamin Volovitz

Publications and source records attributed to Benjamin Volovitz.

14 recordsLinked to original sources
PubMed2006

Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: a review of the evidence.

The use of systemic corticosteroids, together with bronchodilators and oxygen therapy, has become established for the management of acute asthma. These agents are undoubtedly effective, but are also associated with problems such as metabolic adverse effects. Inhaled corticosteroids (ICS) offer potential benefit in the acute setting because they are delivered directly to the airways. They are also likely to reduce systemic exposure, which would lead in turn to reductions in rates of unwanted systemic effects. In order to evaluate the role of budesonide in the management of acute asthma exacerbations we conducted a review of the literature and critically evaluated the rationale for the use of ICS in general in this setting. Trials in adults and children requiring treatment for acute exacerbation of asthma have shown clinical and/or spirometric benefit for budesonide when delivered via nebulizer, dry powder inhaler, or aerosol in the emergency department, hospital and follow-up settings. The efficacy seems to benefit from high doses given repeatedly during the initial phase of an acute exacerbation. These acute effects are likely to be linked to the drug's distinctive pharmacokinetic and pharmacodynamic profile. The current evidence base revealed encouraging results regarding the efficacy of the ICS budesonide in patients with wheeze and acute worsening of asthma. Future studies should focus on the efficacy of these agents in more severe asthma worsenings.

Acute Disease↗
PubMed2004

Cotton-tip applicators as a leading cause of otitis externa.

OBJECTIVE: Otitis externa (OE), also known as "swimmer's ear", is an inflammation or infection of the external auditory canal. Many risk factors have been identified, mainly excessive moisture in the canal from swimming. STUDY DESIGN/METHODS: To study the leading risk factors of otitis externa. Eighty-seven children aged 3.5-12 years (mean 68+/-6.5 months) who were diagnosed with otitis externa from December 1999 to March 2001 were studied for age, sex, cerumen cleaning habits, signs and symptoms. Findings were compared to an age-matched control group of 90 children without otitis externa. RESULTS: Sixty-one children (70.1%) in the study group had their ears cleaned with a cotton-tip applicator (Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the control group, only 31 (34%) used applicators routinely during the 10 days prior to diagnosis (P<0.001). Other risk factors for otitis externa were swimming in a pool (34%), wax removal (5.8%) and ventilation tubes (1.1%). CONCLUSIONS: Use of a cotton-tip applicator to clean the ear seems to be the leading cause of otitis externa in children and should be avoided.

Case-Control Studies↗
PubMed2003

Effect of high starting dose of budesonide inhalation suspension on serum cortisol concentration in young children with recurrent wheezing episodes.

INTRODUCTION: There are no available data on the safety of recommended schedules for the initiation of treatment with budesonide inhalation suspension in children with recurrent wheezing episodes. We compared the safety of high and low starting dose of budesonide by measuring their effect on plasma cortisol concentration. METHODS: A randomized double-blind, placebo-controlled design was used. Twenty-nine children ages 6 months to 3 years were divided into three groups: (1) high starting dose: 1 mg budesonide inhalation suspension twice daily followed by a stepwise decrease of 25% every second day for 8 days (n = 11); (2) low starting dose: 0.25 mg twice daily for 8 days (n = 11); (3) placebo (n = 7). The 8 AM (fasting) and 1-hour post-ACTH stimulation plasma cortisol concentrations were measured before and 10 days after initiation of budesonide treatment. RESULTS: Before treatment and after 8-10 days of treatment, there was no significant difference in mean serum cortisol concentration in the high starting dose, low-dose and placebo groups, either at 8 AM or at 1 hour after ACTH stimulation. CONCLUSION: The administration of nebulized suspension of budesonide at a high starting dose (2 mg/day for 2 days) followed by a rapid stepwise decrease over 8 days was safe, causing similar changes in serum cortisol levels to low-dose budesonide suspension or placebo.

Administration, Inhalation↗
PubMed2003

Lactic dehydrogenase isoenzyme in cerebrospinal fluid of children with infantile spasms.

Increased levels of lactic dehydrogenase (LDH) in cerebrospinal fluid (CSF) have been reported in association with several intracranial pathologies. We studied LDH isoenzymes in the CSF of children with infantile spasms. CSF samples collected from 12 patients (aged 4-9 months) with infantile spasms were analyzed for total LDH isoenzymes activity, and were compared to samples from 15 normal children. Mean total LDH activity in the CSF was 34.62 +/- 6.52 U/l. Patients with infantile spasms had a lower LDH-1 percentage and higher LDH-3 percentage; the differences from the control group were statistically significant (p < 0.01). LDH-4 and LDH-5 had similar values in both groups. Infantile spasm is apparently associated with a distinct LDH isoenzyme pattern in the CSF. More studies are needed to confirm the rise in LDH-2, LDH-3 and to determine the optimum time of analysis.

Humans↗
PubMed2003

Post-infectious acute cerebellar ataxia in children.

Acute cerebellar ataxia is a relatively common neurologic disorder among children. Our aim was to characterize the clinical picture, etiology, and prognosis of acute cerebellar ataxia. The medical records of all children with a diagnosis of acute cerebellar ataxia hospitalized in our center and Hasharon Medical Center from 1990 to 2001 were reviewed. The diagnosis of acute cerebellar ataxia was based on the following criteria: acute onset of ataxia with or without nystagmus; absence of known genetic predisposing factors, such as familial degenerative disorders; and absence of drug intoxication, bacterial meningitis, and metabolic disorders. Thirty-nine children were identified; 54% were male; mean age at presentation was 4.8 +/- 3.8 years. All patients were observed for at least 1 year. A prodromal febrile illness was noted in 74.4%: varicella, 31%; mumps, 20%; nonspecific viral infection, 15.4%; mycoplasma, 5%; Epstein Barr virus, 3%. Latency from the prodromal illness to the onset of ataxia was 8.8 +/- 7.4 days. The most common associated neurologic findings were nystagmus and dysmetria. Full gait recovery took less than 2 weeks on average, and the longest duration of neurologic signs was 24 days (mumps-related). Acute cerebellar ataxia in childhood is a self-limited disease. The recovery was faster than that reported in previous publications and was complete in all children without any neurologic sequelae. Imaging studies are needed only in atypical presentation or if there is no spontaneous improvement after 1 to 2 weeks.

Acute Disease↗
PubMed2003

[Treatment of acute asthma attack in the emergency department].

Although acute asthma is a very common cause of emergency department visits of children and adults, there is not as yet a standardized accepted treatment protocol. The aim of the present review is to describe updated information on the various medications used for the treatment of acute asthma attack in the emergency department on the basis of published controlled studies. Oxygen is the first treatment the patient needs in order to overcome hypoxemia. Beta-2 agonists should always be given with oxygen in order to prevent the decrease in oxygen saturation due to the increase of blood flow in relatively poor ventilated areas of the lung. With the exception of hypoxemic patients who also need oxygen, the administration of beta-2 agonists using metered-dose inhalers with a holding chamber was found to be as effective as administration with nebulizers, and in some studies, even more effective and safer. Oral prednisolone is the treatment of choice for the most severe asthma exacerbations, given together with oxygen and beta-2 agonists. With the exception of the most severe asthma attacks, high-dose inhaled corticosteroids are at least as effective as oral corticosteroids in controlling moderate-to-severe asthma attacks especially in children. This form of drug delivery is accompanied with less cortisol suppression. Other drugs such as: ipratropium bromide, theophyline or magnesium sulfate do not provide significant additional clinical benefit for the treatment of acute asthma attacks and should not be use routinely.

Acute Disease↗
PubMed2002

Neurologic abnormalities in children presenting with diskitis.

BACKGROUND: Neurologic impairment is not considered a clinical manifestation of diskitis in children and has seldom been associated with it in the medical literature. OBJECTIVE: To describe neurologic findings and their implications in children with diskitis. STUDY DESIGN: Retrospective medical records review of children discharged with a diagnosis of diskitis between January 1992 and December 2000. The study included children in whom the diagnosis was based on the presence of clinical findings, laboratory evidence of an inflammatory process, and findings on imaging studies compatible with diskitis. RESULTS: Neurologic findings of decreased muscle strength or hyporeflexia in the lower extremities were found in 7 (41%) of 17 children who met the diagnostic criteria for diskitis. Five of the 7 underwent magnetic resonance imaging, 2 of whom demonstrated intraspinal inflammatory involvement. CONCLUSIONS: Neurologic impairment does not exclude the diagnosis of diskitis and may be a common manifestation of the disease in children. Nevertheless, when neurologic findings are present, advanced imaging studies are needed to exclude intraspinal involvement.

Child↗
PubMed2002

Reference values for lactic dehydrogenase activity and isoenzyme distribution in cerebrospinal fluid in neonates with fever but no evidence of cerebral disease.

Levels of lactic dehydrogenase (LDH) in the cerebrospinal fluid (CSF) have been used to evaluate a variety of neurologic disorders. However, few studies have been performed on neonates. CSF samples were collected from 39 neonates, 19 aged 1-4 weeks and 20 aged 5-8 weeks with neonatal fever. Findings were compared to those in 15 infants mean age 10 +/- 6.4 months with suspected nervous system disease and normal CSF findings. Mean total LDH activity in the CSF was significantly higher in the first month of life than in the second month of life and compared with the control group (p <0.001). The LDH isoenzyme pattern was also different, with lower values of LDH-1 than LDH-2 and -3 in the study groups. Differences were significant among all three groups for LDH-1 (p <0.001) and between the whole study group and the controls for LDH-2 and -3 (p <0.001). We propose reference values for total LDH activity and LDH isoenzyme distribution in the CSF of normal neonates.

Fever↗
PubMed2002

Management of children with severe asthma exacerbation in the emergency department.

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 beta(2)-adrenoceptor agonists followed by corticosteroids. beta(2)-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 beta(2)-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.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Fixed drug eruption in the genital area in 15 boys.

Fixed drug eruption (FDE) is manifested as localized, circumscribed, round or oval plaques that characteristically recur in the same site with each use of the offending drug. The drugs most commonly implicated are phenolphthalein, barbiturates, antibiotics, salicylates, contraceptives, and anticonvulsants. FDE can appear on different parts of the body. The sites of predilection are the lips, genitalia, and sacral area. There are no reports of large series of pediatric patients with FDE involving the genitalia. We describe 15 boys with genital FDE associated with several drugs. Their average age at diagnosis was 3.2+/-2.2 years (range 6 months-8 years). The clinical presentation usually consisted of swelling and erythema of the penis and/or scrotum associated with pruritus, restlessness, urinary retention, and painful micturation. The diagnosis was supported by clinical history. The causative drugs were identified and confirmed by a provocation test, resolution after the drug was stopped, and a positive migration inhibiting factor (MIF) test. Genital FDE in children is uncommon, but the drugs associated with this entity are in such widespread use in pediatric practice that its recognition may be important, especially considering its easy treatability.

Child↗
PubMedDate not supplied

Hypertension as a late sequela of Henoch-Schönlein purpura.

The development of hypertension was examined several years after an episode of Henoch-Schönlein purpura (HSP) in children with or without urinary abnormalities or hypertension at diagnosis. Medical records of 155 children (mean age 6.8+/-2.3) with HSP from 1969 to 1997 were reviewed for a specific description of renal involvement, blood pressure, and urinary abnormalities. The study group consisted of 86 boys (55.47%) and 69 girls (44.53%); 30% had renal involvement, 5 among them presented with nephritic-nephrotic syndrome. Hypertension was found in 7 patients with HSP on long-term follow-up including the 5 who had nephritic-nephrotic syndrome at presentation, 1 who had macroscopic hematuria but normal blood pressure, and 1 with normal urine and normal blood pressure. These data emphasize the need for regular monitoring of children with HSP with or without renal findings.

Blood Pressure↗