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Biomedical subjects

S Sofer

Publications and source records attributed to S Sofer.

At least 19 recordsLinked to original sources
PubMed2000

Severe infantile hypothermia: short- and long-term outcome.

OBJECTIVE: To determine short- and long-term outcomes of infants with severe hypothermia (< or = 28 degrees C) treated in a pediatric intensive care unit (PICU). DESIGN: (1) Retrospective evaluation of medical records of all patients admitted for severe infantile hypothermia from 1984 to 1993. (2) Medical and developmental evaluations of survivors of severe infantile hypothermia 3-12 years after hospital discharge. SETTING: Six-bed PICU of a university teaching hospital. PATIENTS: Eighteen infants who arrived at the emergency room with a rectal temperature between 20 and 28 degrees C. MEASUREMENTS AND RESULTS: The ages of patients ranged between 5 and 30 days. Fifteen were Bedouins and three were Jews. Clinical features included sepsis in 9 (septic shock in 5 of 9) patients, respiratory failure in 11 and overt bleeding in 5. Rewarming was applied using rapid external warming under a radiant heater. Five infants died shortly after arrival and one patient at age 6 years; all of them had sepsis on arrival. Of the 12 survivors examined at ages 3-12 years, ten had normal psychomotor achievements, while the remaining two had mild (1 patient) and severe (1 patient) psychomotor retardation. Both of the latter two had sepsis on first admission for hypothermia. All nine hypothermic infants, who had no sepsis, had normal medical examinations and normal developmental achievements for their ages. CONCLUSION: Severe infantile hypothermia is a serious condition. When treating patients in a modern PICU, morbidity and mortality are mainly related to the presence or absence of an associated septicemia. Infants without septicemia may have normal growth and development.

Child Development↗
PubMed2000

Disseminated intravascular coagulation after cerastes vipera envenomation in a 3-year-old child: a case report.

This study presents a case of severe disseminated intravascular coagulation (DIC) in a 3-year-old child following envenomation by the snake, Cerastes vipera. A literature search revealed very few similar cases. We describe a child who was bitten in his left foot by a snake identified as a C. vipera. Initial symptoms were relatively benign. Local signs included a hemorrhagic vesicle at the site of the bite with marked swelling of the entire leg. Twenty-four hours later, the child developed severe bleeding due to DIC, which lasted 5 days and required repeated administration of blood and blood products and total exchange transfusion. The patient was discharged from the hospital after 7 days in good condition. To the best of our knowledge, severe DIC following envenomation by a C. vipera has not been previously described in the literature. Treatment was essentially supportive. The case report indicates that a specific antivenin against this snake's venom should be made available in our area.

Animals↗
PubMed2000

Repeat computed tomographic scan within 24-48 hours of admission in children with moderate and severe head trauma.

OBJECTIVE: To asses the yield and contribution of a routine predetermined repeat head computed tomographic (CT) scan within 24-36 hrs in pediatric patients with moderate to severe head trauma. DESIGN: Records review. SETTING: Five pediatric intensive care units. PATIENTS: We reviewed the charts of 173 consecutive pediatric patients with moderate to severe head trauma (Glasgow Coma Scale score of < or = 11) that survived the first 24 hrs after being admitted to five Israeli trauma centers. Clinical data collected included status at admission, at the time between the first and second CT scans, and after the second scan. Head details of the first, second, and, if performed, third CT scan were collected. Treatment strategy during each period was recorded, including any change in treatment after each CT scan. MEASUREMENTS AND MAIN RESULTS: A total of 47 (27%) of the second CT scans showed new lesions including six intracranial hemorrhages, 17 cases of worsening brain edema, and 18 newly diagnosed brain contusions. However, none of these findings necessitated surgical intervention or any change in therapy. Of the 67 patients who underwent a third CT scan, two cases required surgical intervention because of new findings in the third CT. CONCLUSIONS: A second routine prescheduled head CT scan within 24-36 hrs after admission in pediatric patients with moderate to severe head trauma is unlikely to yield any change in therapy. Clinically and intracranial pressure-oriented CT scan may better select and diagnose patients who require changes in therapy, including surgery. Studies aimed to determine the ideal timing for the second are warranted.

Adolescent↗
PubMed2000

Signs and symptoms of carbamazepine overdose in young children.

OBJECTIVE: To examine common signs and symptoms of mild to moderate carbamazepine (CBZ) overdose in young children. METHODS: The medical records of previously healthy children admitted to the pediatric departments for acute accidental CBZ poisoning during the years 1993-1998 were evaluated retrospectively. Information was retrieved on serum CBZ levels, signs and symptoms on admission and during hospitalization, ECG findings, and chemical laboratory test. RESULTS: There were 14 exposed children all under the age of 5 years. These children accidentally took CBZ prescribed for a family member. The diagnosis of CBZ poisoning in seven children was unknown on admission because of inadequate history and was revealed only on toxicology screen. Nystagmus and drowsiness occurred in 8 of the 14 children, nystagmus and ataxia in 4 children, and drowsiness and tachycardia in another 2 children. The peak CBZ serum levels in these children ranged from 18 microg/ml to 32 microg/ml, mean + SD; 25 microg/ml + 4.64 microg/ml (therapeutic range: 5-10 microg/ml). CONCLUSION: Based on a certain group of young pediatric patients with mild to moderate CBZ poisoning, it is concluded that, nystagmus is the most common sign of this overdose. Other common signs are drowsiness and ataxia. The presence of nystagmus and CNS depression of unknown etiology, in a young child should suggest the possibility of CBZ toxicity.

Anticonvulsants↗
PubMed1999

Airway obstruction by Ascaris, roundworm in a burned child.

Ascaris lumbricoides, roundworm, is a Nematode parasite infecting about 1 billion people worldwide. We report the case of a ten-year-old Bedouin girl hospitalized with burns to 45% of her body surface area, including the face. The patient was intubated upon admission and mechanically ventilated. Four days later she was extubated but required reintubation 15 min later for severe hypoxemia. Laryngoscopy disclosed an unidentified tube which obstructed the opening of the larynx. The 'tube' was removed by Magill forceps. The object was identified as a 35 cm long Ascaris roundworm. Once the worm was removed the patients' respiratory condition dramatically improved. We review the main features of Ascaris infection and some similar cases of airway obstruction caused by this worm.

Airway Obstruction↗
PubMed1999

Effects of adrenergic-receptor blockade and ligation of spleen vessels on the hemodynamics of dogs injected with scorpion venom.

OBJECTIVE: In dogs, scorpion venom evokes a rapid increase in cardiac output (CO) that decreases below baseline level in 1 hr. The changes in CO have recently been shown to be related to the effect of the venom on venous return. In the present study, we tested the hypothesis that changes in determinants of venous return are secondary to sympathoadrenal stimulation evoked by the venom, which causes splenic contracture in the first stage of envenomation leading to increased mean circulatory pressure (MCP) and CO. Persistence of adrenergic response is the main factor leading to the second stage of envenomation, characterized by an increase in resistance to venous return (Rv) and a decrease in CO. DESIGN: Repeated measures, prospective study in dogs. SETTING: University-affiliated research laboratory. SUBJECTS: Mixed-breed dogs injected with scorpion venom. INTERVENTIONS: The effects of alpha- and beta-adrenergic-receptor blockade (blockade group, n = 9 dogs) and effects of ligation of spleen vessels (spleen ligation group, n = 11 dogs) following intravenous injection of scorpion venom from Leiurus quinquestriatus (0.05 mg/kg) were tested on the determinants of venous return and compared with the effects of scorpion venom alone (control group, n = 6 dogs). MEASUREMENTS AND MAIN RESULTS: Scorpion venom in the control group caused a marked increase in CO from 2.9+/-0.2 SD L/min to 6.5+/-2.2 L/min (p<.001) and MCP from 8.7+/-2.7 torr (1.2+/-0.35 kPa) to 21.6+/-1.4 torr (2.9+/-0.19 kPa) (p<.001) within 5 mins after venom injection. Cardiac output and MCP markedly decreased at 60 mins to 1.8+/-0.3 L/min (p<.001) and 7.3+/-3.8 torr (1.0+/-0.5 kPa) (p<.05), respectively. Rv did not change at 5 mins but increased from 196+/-50 dyne x sec/cm5 to 335+/-102 dyne x sec/cm5 (p<.01) at 60 mins. Adrenergic-receptor blockade attenuated the increase of CO and MCP at 5 mins, from 2.1+/-0.5 L/min to 2.7+/-1 L/min (p<.001) and from 5.6+/-2.0 torr (0.8+/-0.27 kPa) to 7.5+/-2.3 torr (1.0+/-0.31 kPa) (p<.05), respectively. By 60 mins, both CO and MCP returned to baseline, while Rv was not affected and was maintained at 204+/-158 dyne x sec/cm5. Ligation of spleen vessels prevented a CO increase at 5 mins and it was maintained at baseline value (2.5+/-0.6 L/min). However, MCP increased from 7.9+/-0.5 torr to 12+/-1.3 torr (p<.05). At 60 mins, CO decreased to 1.6+/-0.7 L/min (p<.01) while MCP returned to baseline. The changes in MCP were accompanied by significant increases of Rv from 152+/-24 dyne x sec/cm5 to 383+/-93 dyne x sec/cm5 (p<.001) at 5 mins, and 510+/-175 dyne x sec/cm5 (p<.01) at 60 mins. CONCLUSIONS: The changes in CO and MCP following scorpion venom injection in dogs are in part related to sympathetic stimulation. Adrenergic-receptor blockade attenuated the initial inotropic effect of the venom and completely prevented a late decrease in CO and MCP. The increase in Rv is the most important factor for late decrease in CO, and results from persistent adrenergic-receptor stimulation. In addition, an Rv increase apparently expresses vasoconstriction and redistribution of blood flow. The initial increase in CO and MCP is explained mainly by adrenergic-receptor effects on the spleen leading to augmented circulatory blood volume.

Analysis of Variance↗
PubMed1999

Carbamate and organophosphate poisoning in young children.

OBJECTIVE: Retrospective evaluation of the clinical course of carbamate and organophosphate poisoning in young children. DESIGN: The records of 36 children intoxicated with carbamate and 16 children intoxicated with organophosphate (age range: 2 to 8 years, median: 2.8 years) were examined retrospectively. The carbamate agents were identified as methomyl or aldicarb, and the organophosphate as parathion, fenthion, malathion, and diazinon. The causes of poisoning were accidental ingestion in 46 children and inhalation in six children. CLINICAL SETTING: Pediatric Intensive Care Unit of a teaching hospital. INTERVENTIONS: Gastric lavage was performed, and activated charcoal was administered to all children who had ingested poisonous pesticides. Atropine sulphate was administered intravenously in repeated doses to all children with bradycardia, diarrhea, salivation, and miosis. Obidoxime chloride was administered to patients with organophosphate poisoning and to those in whom the ingested material was unidentified on admission. RESULTS: Predominant symptoms were related to central nervous system depression and severe hypotonia. Other clinical signs such as miosis, diarrhea, salivation, bradycardia, and fasciculation were less frequent, while tearing and diaphoresis were not observed. Pulmonary edema developed in six patients with organophosphte poisoning. Three children required mechanical ventilation for several hours. One child (organophosphate poisoning) died shortly after arrival at the emergency department. All other children recovered completely. CONCLUSION: Based on a relatively large group of young pediatric patients with carbamate and organophosphate poisoning, it is concluded that the clinical presentation differed from those described in adults. Absence of classic muscarinic effects does not exclude the possibility of cholinesterase inhibitor agents poisoning in young children with central nervous system depression.

Adult↗
PubMed1998

CT findings in neonatal hypothermia.

BACKGROUND: Newborn infants are particularly prone to hypothermia, a condition with a high mortality. OBJECTIVE: To study the CT brain patterns in infants with hypothermia and neurological symptoms. MATERIALS AND METHODS: We reviewed the brain CT of nine infants with neonatal hypothermia, multiple organ failure, seizures and coma. RESULTS: Two infants had normal CT scans, acutely and at follow-up, and were clinically normal at follow-up. In seven infants, CT showed diffuse cerebral oedema, with reversal of the normal density relationship between grey and white matter and a relative increased density of the thalami, brainstem and cerebellum - the 'reversal sign'. In six surviving infants with severe developmental delay, follow-up CT revealed cerebral atrophy with multicystic encephalomalacia. CONCLUSIONS: The 'reversal sign' has been described in the abused child, birth asphyxia and anoxia due to drowning. Neonatal hypothermia is offered as a further cause.

Brain↗
PubMed1998

Hypocomplementemic autosomal recessive hemolytic uremic syndrome with decreased factor H.

We describe the clinical course, complement components, and pathological findings of 10 infants with autosomal recessive hemolytic uremic syndrome (HUS). All patients were members of one extended highly inbred Bedouin kindred. The median age of presentation was 2 weeks (range 1-20 weeks). Eight patients died, 2 patients are alive, on dialysis. Renal biopsies revealed thrombotic microangiopathy with a predominant early arteriolar involvement and subsequent development of ischemic glomerular changes. Immunofluorescence was positive for C3 in glomeruli. All patients had low complement components levels during and between relapses, and in some this was evident soon after birth and prior to the onset of symptoms. This deficiency could not be normalized by repeated plasma transfusions. Biosynthetic labelling of patients' fibroblasts demonstrated normal rates of C3 protein synthesis. Serum factor H levels were greatly decreased or absent in 4 patients tested and moderately decreased in 15 of 23 healthy unaffected siblings and patients. This defect may cause complement activation and consumption, possibly at the endothelial cell level.

Arabs↗
PubMed1998

Predicting ability to drive after stroke.

OBJECTIVE: To determine the ability of perceptual testing to predict on-road driving outcome in subjects with stroke. STUDY DESIGN: Historical cohort study of 84 individuals with stroke who completed both the perceptual testing and the on-road driving evaluation conducted in a driving evaluation service. MEASURES: Perceptual tests, such as the Motor Free Visual Perception Test (MVPT) and Trail Making B test, and an on-road driving evaluation. Based on driving behaviors, a pass or fail outcome was determined by the examiners. RESULTS: Subjects who passed the on-road evaluation had better average scores on the majority of perceptual tests compared with those who failed. The MVPT was the most predictive of on-road performance (positive predictive value=86.1%; negative predictive value=58.3%). The combination of tests resulting in the most predictive and parsimonious model was the MVPT plus Trail Making B, such that those who scored poorly on both were 22 times more likely to fail the on-road evaluation. CONCLUSION: A screening process is useful in identifying persons who are not ready to undergo an on-road driving evaluation.

Adult↗
PubMed1998

Effects of antivenom serotherapy on hemodynamic pathophysiology in dogs injected with L. quinquestriatus scorpion venom.

In dogs, scorpion venom causes an immediate increase in cardiac output that declines below baseline values within one hour. We tested the hypotheses that antivenom given before venom injection may prevent changes in cardiac output, while antivenom given after the inotropic stage of envenomation cannot reverse cardiac output decline. Twenty-five anesthetized, mechanically ventilated dogs were given 0.1 mg/kg i.v. venom of the scorpion Leiurus quinquestriatus. The dogs were randomized into 4 groups: 5 dogs were given venom alone (control group) and 6 dogs were given 6 ml of antivenom one minute before venom injection while 8 and 6 dogs were given 6 ml of antivenom 20 and 60 min after venom injection, respectively. Parameters reflecting respiratory and circulatory functions were measured for 180 min after venom injection. Scorpion venom caused a gradual decrease in heart rate, an initial elevation of systemic and pulmonary blood pressure and cardiac output followed by a decline in these parameters. PO2, pH and HCO3- gradually decreased, while PCO2 gradually increased from baseline. Antivenom given before venom injection prevented all the effects induced by the venom. Antivenom given at 20 and 60 min after venom injection had no effect on cardiac output and HCO3- decline, but caused an increase in heart rate, PO2 and pH and a decrease in PCO2. We assume that antivenom clears free toxins from the circulation, and since cardiac output and HCO3- did not improve after this clearance, we conclude that following intravenous venom injection, heart and circulation are rapidly affected by the toxins or by other substances released by the venom which do not respond to antivenom. Improvements in respiration and heart rate with antivenom given after venom injection may be secondary to reversion of cholinergic effects of the venom. Improvement in respiration may be also explained by reversion of the toxic effects on Ca2+ activated K+ channels of bronchial smooth muscle. All these effects may be secondary to clearance of toxins by the antivenom.

Animals↗
PubMed1997

Effects of scorpion venom on central and peripheral circulatory response in an open-chest dog model.

Scorpion venom can induce in dogs severe haemodynamic changes leading to rapid rise in systemic blood pressure and cardiac output, followed by reduction of cardiac output and blood pressure within 1 h. The decrease in cardiac output is not related to myocardial dysfunction (Tarasiuk et al. 1994). We hypothesized that scorpion venom affects cardiac output by reducing venous return to the heart. Venous return was studied by steady-state measurements of cardiac output, the pressure gradient and resistance to venous return, in 16 dogs following injection of 0.05 mg kg-1 venom obtained from the scorpion species Leiurus quinquestriatus. In eight of the 16 dogs, atropine (0.1 mg kg-1) was given 15 min prior to venom injection (n = 4) or 85 min (n = 4) after venom administration. In five additional dogs, the stability of the preparation over time was evaluated following the same protocol without the injection of the venom. At 15 min, the venom induced an increase in blood pressure (80%) and cardiac output (250%) (P < 0.001) with little effect on heart rate. At 90 min, cardiac output and heart rate declined considerably below baseline (P < 0.001). Atropine prevented the decrease in heart rate, but did not affect the reduction of cardiac output. Five minutes after venom injection, mean circulatory pressure increased by 300% (P < 0.001), which was accompanied by a rightward shift of the venous return curve with no effect on resistance to venous return. At 120 min, mean circulatory pressure recovered and resistance to venous return remained at 40% (P < 0.01) above baseline. This study indicates that, in dogs, scorpion venom affects cardiac output by modifying the determinants of venous return. The initial increase in cardiac output is related to increased mean circulatory pressure since resistance to venous return did not change. The later fall in cardiac output is related to the reduction of mean circulatory pressure and increased resistance to venous return.

Animals↗
PubMed1997

Scorpion venom leads to gastrointestinal ischemia despite increased oxygen delivery in pigs.

OBJECTIVES: Scorpion envenomation may be accompanied by metabolic acidosis even in the absence of hypoxia and cardiovascular derangement. We tested the hypothesis that venom causes ischemia of the gastrointestinal tract rather than failure of delivery of oxygen to the periphery. DESIGN: Repeated measures, prospective study in experimental animals. SETTING: University-affiliated hospital research laboratory. INTERVENTIONS: In ten spontaneously breathing, intubated, sedated pigs, purified dried venom (Leiurus quinquestriatus), 0.05 mg/kg, was administered intravenously. Measurements were obtained before (baseline), and 5, 15, 30, 60, 120, 180, and 240 mins after injection. MEASUREMENTS AND MAIN RESULTS: Variables measured included: mean arterial pressure (MAP), heart rate (HR), mean pulmonary arterial pressure, pulmonary artery occlusion pressure, cardiac output, stroke volume, right ventricular ejection fraction (rapid thermistor), left ventricular dimensions (echocardiography), arterial gas tensions, lactate and catecholamine concentrations, gastric interstitial mucosal pH (tonometry), as well as systemic and pulmonary vascular resistances. Within 5 mins after venom injection, there was a hyperdynamic state accompanied by significantly increased MAP (97 +/- 18 to 136 +/- 47 mm Hg, p < .0003), HR (70 +/- 12 to 121 +/- 24 beats/min, p < .00006), and cardiac output (1.88 +/- 0.35 to 2.95 +/- 0.53 L/min, p < .0003), with no change in stroke volume, or pulmonary artery occlusion pressure. Right ventricular ejection fraction increased from 38.1 +/- 4.3 to 48.6 +/- 9.0% (p < .0009) by 15 mins. No change in left ventricular function was observed. There were significant decreases in systemic vascular resistance and pulmonary vascular resistance following envenomation. Arterial and gastric mucosal pH significantly decreased from 7.40 +/- 0.04 to 7.25 +/- 0.07 (p < .0001) for arterial pH, and 7.33 +/- 0.08 to 7.17 +/- 0.13 (p < .00001) for gastric mucosal pH by 30 mins after envenomation. The decrease in arterial pH was not sufficient to account for the change in gastric mucosal pH, indicating gastric mucosal ischemia. Arterial lactate increased from 2.6 +/- 1.4 to 7.4 +/- 1.9 (p < .05 x 10(-8)). There were significant increases in serum epinephrine and norepinephrine values by 5 mins. All hemodynamic variables and catecholamine concentrations returned to baseline by 4 hrs. However, there was persistent arterial and gastric mucosal acidosis and increased lactate concentrations even at 4 hrs. Oxygen delivery remained normal or supernormal for 4 hrs following envenomation. However, despite this finding, systemic and gastric mucosal pH changes indicate impaired gastrointestinal oxygen delivery. CONCLUSIONS: Despite increased peripheral oxygen delivery, scorpion envenomation was associated with evidence of ischemia of the gastrointestinal tract. This association could be due to shunting of blood from metabolically active areas, possibly associated with massive catecholamine release, or a direct toxic effect of the venom on regional oxygen transport at the cellular level.

Acidosis↗
PubMed1997

Carbamate poisoning in early childhood and in adults.

OBJECTIVE: Retrospective evaluation of the clinical course of carbamate poisoning in young children and adults. DESIGN: Thirty-six children aged 1 to 8 years (median 2.5 years) and 24 adults aged 17 to 41 years (median 22 years) ingested rat poison resulting in carbamate poisoning. The ingested poisons in all cases were positively identified as methomyl or aldicarb by gas chromatography-mass spectrometry. RESULTS: Symptoms of intoxication in children were compared to those in adults with similar depression of the serum cholinesterase. The predominant symptoms in young children were central nervous system depression and hypotonia. The most common muscarinic effect was diarrhea. In adults, the main signs were miosis and fasciculations. Fasciculations in children were less frequent. Central nervous system depression, hypotonia, and diarrhea were uncommon in adults. CONCLUSION: Based on a relatively large number of carbamate poisonings in young children, we conclude that the clinical presentation differs from adult poisoning manifestations. The absence of classic muscarinic effects does not exclude the possibility of carbamate poisoning in young children with central nervous system depression.

Adolescent↗
PubMed1996

Interleukin-6 release following scorpion sting in children.

Interleukin-6 levels were measured in the serum of ten children following severe scorpion envenomation. Measurements were taken on arrival, at the emergency room, and 12 and 24 hr after arrival. Interleukin-6 was markedly elevated in the serum of eight out of ten children on arrival. Interleukin-6 levels gradually decreased toward normal values on 12 and 24 hr measurements, but remained above control levels on all measurements. These results imply that signs and symptoms following scorpion envenomation may in part be explained by release of cytokines. Human and experimental animal studies are required in order to verify the assumption that interleukin-6 and other cytokines are involved in the pathogenesis of scorpion envenomation.

Animals↗
PubMed1996

Effect of Leiurus quinquestriatus hebreus venom on calcium and deoxyglucose uptake in cultured cardiac cells.

The effects of scorpion venom Leiurus quinquestriatus hebreus were studied on cardiac cells grown in culture. The venom (30 micrograms/ml) increased significantly (P < 0.05) Ca2+ uptake into intact cardiocytes and to sarcoplasmic reticulum of skinned cells. [3H]Deoxyglucose uptake was also increased significantly (P < 0.05) in venom treated cardiocytes. It was found that fractions I and III of the venom, separated by gel filtration and ion exchange chromatography, are responsible for the increased Ca2+ uptake by the sarcoplasmic reticulum, whereas fraction IIb, III and IV are responsible for the accelerated rate of uptake of 45Ca and [3H]deoxyglucose by intact cells. Ca channel blockers prevented these effects and similar results were obtained by propranolol. Thus, it is concluded that the venom exerts its effect through activation of beta-adrenoceptors which causes the opening of L-type Ca channels.

Adrenergic beta-Antagonists↗
PubMed1996

Possible aetiology of haemorrhagic shock and encephalopathy syndrome in the Negev area of Israel.

A retrospective study was performed for all patients diagnosed with haemorrhagic shock and encephalopathy syndrome (HSES) over an 11 year period (1984-94). Soroka University Medical Centre is the only medical facility in the southern Negev region of Israel serving a population of about 400,000 residents, consisting primarily of two ethnic populations, Jews and Bedouins. Twenty patients, 17 Bedouin and three Jews, were diagnosed with HSES. The annual incidence of HSES for infants under the age of 1 year was 5:10,000 for Bedouins and 0.6:10,000 for Jews. Patients ranged in age from 6 to 32 weeks and arrived at the hospital late at night or early morning (2:00 am to 11:00 am), during the winter or early spring (November to April). All were healthy before admission, with short prodromal symptoms of upper respiratory tract or gastrointestinal infection noted in 10 cases. Most infants had markedly high body temperature on arrival. A history of overwrapping and/or excessive heating was obtained in four of 20 infants. Bacteriological and virological cultures were negative in all infants. One infant died and neurological sequelae were observed in all survivors. The high prevalence of hyperpyrexia during sleep in the presence of negative microbiological results with no evidence of excessive heating, and the high incidence of HSES among a closed and culturally isolated society known to have a high incidence of congenital malformations, may support previous assumptions that HSES results from hyperpyrexia, originating in most cases from a 'physiological' heat induced trigger, which starts and peaks during the night in previously healthy infants who are genetically susceptible.

Arabs↗