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M Baskin

Publications and source records attributed to M Baskin.

13 recordsLinked to original sources

Putative contributors to the secular increase in obesity: exploring the roads less traveled.

OBJECTIVE: To investigate plausible contributors to the obesity epidemic beyond the two most commonly suggested factors, reduced physical activity and food marketing practices. DESIGN: A narrative review of data and published materials that provide evidence of the role of additional putative factors in contributing to the increasing prevalence of obesity. DATA: Information was drawn from ecological and epidemiological studies of humans, animal studies and studies addressing physiological mechanisms, when available. RESULTS: For at least 10 putative additional explanations for the increased prevalence of obesity over the recent decades, we found supportive (although not conclusive) evidence that in many cases is as compelling as the evidence for more commonly discussed putative explanations. CONCLUSION: Undue attention has been devoted to reduced physical activity and food marketing practices as postulated causes for increases in the prevalence of obesity, leading to neglect of other plausible mechanisms and well-intentioned, but potentially ill-founded proposals for reducing obesity rates.

Age Factors↗

Oral versus initial intravenous therapy for urinary tract infections in young febrile children.

BACKGROUND: The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy. METHODS: In a multicenter, randomized clinical trial, we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short-term clinical outcomes (sterilization of the urine and defervescence) and long-term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by 99mTc-dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days. RESULTS: Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Bacteremia was present in 3.4% of children treated orally and 5.3% of children treated intravenously. Of the short-term outcomes, 1) repeat urine cultures were sterile within 24 hours in all children, and 2) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously, respectively. Of the long-term outcomes, 1) symptomatic reinfections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously, 2) renal scarring at 6 months was noted in 9.8% children treated orally versus 7.2% of children treated intravenously, and 3) mean extent of scarring was approximately 8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 vs $1473) compared with those treated orally. CONCLUSIONS: Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.

Acute Disease↗

Intravenous versus oral corticosteroids in the management of acute asthma in children.

STUDY OBJECTIVE: To determine whether oral corticosteroids are significantly better at preventing the need for hospital admission than i.v. corticosteroids in children with moderate to severe asthma exacerbation. METHODS: We carried out a randomized, double-blind, controlled trial of patients in the emergency department of a tertiary urban children's hospital. Patients who presented to the ED with moderate to severe asthma (defined as forced expiratory volume in 1 second [FEV1] < 60% predicted for height in patients aged 7 to 18 years and as Pulmonary Index Score [PIS] between 6 and 11 for patients aged 18 months through 6 years). Patients were randomized to receive 2 mg/kg oral methylprednisolone or 2 mg/kg i.v. methylprednisolone 30 minutes after the initial treatment with nebulized albuterol. Each patient was otherwise treated with an identical regimen of frequent nebulized albuterol and i.v. theophylline for a total of 4 hours. RESULTS: Forty-nine patients were enrolled. Four hours after treatment, both groups had similar respiratory rates, oxygen saturation, PISs, and FEV1 values. Eleven of 23 patients in the oral group (48%) and 13 of 26 patients in the i.v group (50%) were admitted to the hospital (P = .88). The 90% confidence interval for the 2% cifference in admission rate to the hospital (favoring oral methylprednisolone) ranged from 21% (favoring i.v. methylpredinisolone) to 25% (favoring oral methylprednisolone). Patients discharged home demonstrated greater improvement from baseline with regard to PIS and FEV1 than patients who were admitted. Two patients in each group failed to complete the standard treatment or returned to the hospital within 48 hours of ED discharge. CONCLUSION: These data suggest that for children with moderate to severe asthma exacerbation, hospital admission rates are similar in children given oral methylprednisolone and those given i.v. methylprednisolone.

Administration, Oral↗

Effect of polymyxin B on experimental shock from meningococcal and Escherichia coli endotoxins.

Meningococcemia is the most frequent cause of septic shock in healthy children. To determine whether polymyxin B (PMB) might improve mortality from meningococcal shock, its protective activity was evaluated in rabbits challenged with an LD90 of meningococcal lipooligosaccharide (LOS) and compared with an LD80 of Escherichia coli O111:B4 lipopolysaccharide (LPS). PMB (5 mg/kg) administered intravenously 30 min before meningococcal LOS challenge had no significant effect on heart rate, mean arterial pressure, serum bicarbonate, serum tumor necrosis factor (TNF) levels, or survival relative to controls. However, PMB premixed with LOS in vitro increased serum bicarbonate levels (P less than .05) and improved 24-h survival (P less than .05). In contrast, PMB given before E. coli LPS challenge increased serum bicarbonate levels, decreased TNF levels, and improved 24-h survival (all, P less than .05). In vitro studies confirmed that PMB at 10 micrograms/ml neutralized E. coli LPS but not meningococcal LOS activity. Thus, pretreatment with PMB apparently protects rabbits against shock induced by E. coli LPS but not by meningococcal LOS.

Animals↗

Comparison of external jugular and peripheral venous administration of sodium bicarbonate in puppies.

We compared the administration of sodium bicarbonate via a catheter inserted in the external jugular and extending to the junction with the subclavian vein (group 1) and a peripheral hindpaw vein (group 2) in puppies. During spontaneous cardiac activity, the increases in pH (0.12 +/- 0.04 in group 1 vs. 0.08 +/- 0.04 in group 2) and PCO2 (11 +/- 2.8 torr in group 1 vs. 6 +/- 3.2 torr in group 2) in blood from the right atrium 10 sec after the injection of bicarbonate differed significantly. However, the increases in pH (0.31 +/- 0.07 in group 1 vs. 0.30 +/- 0.15 in group 2) and PCO2 (86 +/- 33 torr in group 1 vs. 72 +/- 35 torr in group 2) in blood from the right atrium during closed chest CPR were similar in the two groups. We found that the sodium bicarbonate reached the central circulation more rapidly when administered in the external jugular vein as compared to a peripheral site, but this difference was small and did not reach the level of significance during CPR. Our findings do not provide evidence of any advantage to obtaining central venous access (a potentially complicated procedure) in children with cardiac arrest in regard to the delivery of medications to the heart.

Animals↗

Spinal fluid pleocytosis in acute posterior multifocal placoid pigment epitheliopathy.

Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is a disorder of the fundus frequently characterized by sudden onset of bilateral, marked visual loss associated with yellowish-white, ill-defined placoid lesions of the retina. Most cases show a rapid resolution with restoration of vision to normal or near-normal levels. We evaluated an 11-year-old boy with presumed APMPPE who showed a mononuclear cell pleocytosis on spinal fluid examination.

Cerebrospinal Fluid↗

Lysophosphatidyl choline and cataracts in uveitis.

In aqueous humor from rabbits with uveitis or after anterior chamber paracentesis, the levels of lysophosphatidyl choline (LPC) were 10.2mug/ml and 14.7mug/ml, respectively. These LPC levels induce early cataractous changes in the rabbit lens in culture. Analysis of the fatty acid composition of LPC showed that saturated fatty acids were more predominant in secondary aqueous humor than in primary aqueous humor. In vitro, natural LPC induced more pronounced gains in sodium ions and water by the lens than similar concentrations of synthetic L-alpha-lysopalmitoyl phosphatidyl choline. In contrast to prostaglandin E, the levels of LPC in aqueous humor of rabbits with uveitis are cataractogenic. Thus, LPC or its precursors, rather than prostaglandins, are involved in the production of cataracts in uveitis.

Animals↗

Effects of lysophosphatidyl choline and phospholipase A on the lens.

Lenses incubated for 24 or 63 hours in media containing either lysophosphatidyl choline or phospholipase A gained Na+ ions and water. Electrolyte imbalances and damage to lens fiber membranes occurred at lysophosphatidyl choline and phospholipase A concentrations of 7.5 mug per milliliter and 0.25 mug per milliliter, respectively. Intravitreal injection of 250 mug of lysophosphatidyl choline or 0.4 mug of phospholipase A induced posterior subcapsular cataracts which progressed to maturity only in the latter instance. This is the first demonstration of the cataractogenic effects of a naturally occurring aqueous humor phospholipid or its generating enzyme.

Animals↗

Diet in uremia.

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Beverages↗