Search

Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents. PSP symptoms can mimic cardiac event. We aimed to examine electrocardiography (ECG) changes that accompanied PSP in relation to side and size of pneumothorax. A retrospectively reviewed 57 adolescents presented with PSP and underwent a cardiac evaluation. Overall, 49 patients (86%) were male, median age of 16 years. Of these, 1 patient had a known mitral valve prolapse. In 56 patients the initial episode of PSP was unilateral (16 left sided and 40 right sided), and 1 was bilateral. The main initial symptom was chest pain or dyspnea and chest pain 66.6% and 33.3% respectively. Small pneumothorax was right and left sided in 1and 8 patients respectively, medium right (n = 8) medium left (n = 22), large right (n = 7) and large left (n = 10). One additional patient had medium bilateral pneumothorax. ECG findings were abnormal in 12 patients (21%) and included ST elevation in 5 patients, inverted T wave in 2 patients, incomplete right bundle branch block in 2 patients, poor R wave progression, left axis deviation and low QRS voltage in 1 patient each. Only 2 patients had abnormal echocardiography findings, MPV (n = 1) and minimal mitral and tricuspid regurgitation (n = 1). Serum troponin-T levels were normal in all patients. ECG changes were found in 21% among pediatric patients with PSP. No correlation was observed between ECG changes and side/size of pneumothorax. It is important to rule out pneumothorax among children presented with chest pain, dyspnea and ECG changes.

BackgroundMost studies have revealed that the incidence of morbidity and mortality of preterm male infants is greater than that of preterm female infants. Recently, conflicting outcomes have been reported regarding mixed-gender twins. The aim of this study was to estimate the association between gender and outcome in newborn twins of different gender.MethodsWe conducted a retrospective review of mixed-gender twins weighing < 1500 g that were born at Shamir Medical Center (Assaf Harofeh) between the years 1995 and 2016 (158 newborns). The incidence of morbidity and mortality until discharge from the hospital were evaluated while looking at gender differences.ResultsNo significant differences were found in neonatal mortality or morbidity between females and males from different-gender twins. Even after considering confounding variables (gestational age, birth weight & birth order) in linear and logistic regression models, no significant differences were found between the genders.ConclusionsOur study suggests that there are no significant differences in neonatal mortality or morbidity among different-gender twins. Our results support the need for further studies.

Aim: To explore if there is an interaction effect between gender (men and women) and profession (nurses and physicians) in posttraumatic growth (PTG). Background: PTG is defined as a positive psychological change experienced as a result of struggling with highly challenging life circumstances. It may take the form of improved self-image, a deeper understanding of self, increased spirituality, and/or enhanced interpersonal relationships. Gender and profession were found separately to be associated with PTG, but to date were not examined under interaction effect. Methods: We employed a cross-sectional study conducted in the tertiary medical center in Israel using a convenience sample. One hundred and twenty-eight nurses and seventy-eight physicians gave their consent and agreed to fill out self-report questionnaires regarding personal and professional data and PTG Inventory. Findings: The correlation matrix revealed that being a woman was associated with higher PTG total scale (r = 0.242; P ≤ 0.001) and its subscales except for spiritual change that showed no evidence of statistical effect. Similar pattern was found for being a nurse with PTG total scale (r = 0.223; P ≤0.001) and its subscales except for relating to others that showed no evidence of statistical effect. However, the interaction effect revealed that among men, there was no difference in the level of PTG and its subscales based on profession (Physicians men = 62.54 (20.82) versus Nurses men = 60.26 (22.39); F = 9.618; P = 0.002). Among women, nurses had a significantly higher scores in PTG (Physicians women = 61.81 (18.51) versus Nurses women = 73.87 (12.36); F = 9.618; P = 0.002) and its subscales in comparison to physicians except for subscale relating to other. Conclusions: Our findings suggest implications for research and practice namely exploring PTG among nurses and physicians would benefit from applying interaction effect of gender and profession. For practice, advocating PTG within the health care organization is needed to be tailored with gender and professional sensitivity.

Hypercalcemia is caused by many different conditions and may lead to severe complications. Loss-of-function mutations of CYP24A1, encoding vitamin D-24-hydroxylase, have recently been identified in idiopathic infantile hypercalcemia and in adult kidney stone disease. The aim of this study was to investigate the genetics and clinical features of both infantile and maternal hypercalcemia.We studied members of four unrelated Israeli families with hypercalcemia, namely, one woman during pregnancy and after delivery and three infants. Clinical and biochemical data were obtained from probands' medical charts. Genomic DNA was isolated from peripheral blood and CYP24A1 was sequenced.Typical symptoms of hypercalcemia associated with the intake of recommended doses of vitamin D developed in the infants and pregnant woman. Four different loss-of-function CYP24A1 mutations were identified, two of which are reported here for the first time (p.Trp134Gly and p.Glu315*). The infants from families 1 and 2, respectively, were found to be compound heterozygotes, and the infant from family 3 and the pregnant woman were found to be homozygous.This is the first report of maternal hypercalcemia caused by a CYP24A1 mutation, showing that not only infants are at risk for this complication. Our findings emphasize the importance of recognition, genetic diagnosis and proper treatment of this recently identified hypercalcemic disorder in this era of widespread vitamin D supplements.

Background Redox-active iron, a catalyst in the production of hydroxyl radicals via the Fenton reaction, is one of the key participants in ROS-induced tissue injury and general inflammation. According to our recent findings, an excess of tissue iron is involved in several airway-related pathologies such as nasal polyposis and asthma. Objective To examine the anti-inflammatory properties of a newly developed specific iron–chelating complex, Zn/Ga−DFO, in a mouse model of asthma. Materials and methods Asthma was induced in BALBc mice by ovalbumin, using aluminum hydroxide as an adjuvant. Mice were divided into four groups: (i) control, (ii) asthmatic and sham-treated, (iii) asthmatic treated with Zn/Ga−DFO [intra-peritoneally (i/p) and intra-nasally (i/n)], and (iv) asthmatic treated with Zn/Ga−DFO, i/n only. Lung histology and cytology were examined. Biochemical analysis of pulmonary levels of ferritin and iron-saturated ferritin was conducted. Results The amount of neutrophils and eosinophils in bronchoalveolar lavage fluid, goblet cell hyperplasia, mucus secretion, and peri-bronchial edema, showed markedly better values in both asthmatic-treated groups compared to the asthmatic non-treated group. The non-treated asthmatic group showed elevated ferritin levels, while in the two treated groups it returned to baseline levels. Interestingly, i/n-treatment demonstrated a more profound effect alone than in a combination with i/p injections. Conclusion In this mouse model of allergic asthma, Zn/Ga−DFO attenuated allergic airway inflammation. The beneficial effects of treatment were in accord with iron overload abatement in asthmatic lungs by Zn/Ga−DFO. The findings in both cellular and tissue levels supported the existence of a significant anti-inflammatory effect of Zn/Ga−DFO., Graphical abstract, Highlights Asthma pathophysiology was shown to be associated with iron overload. A therapeutic effect of the novel iron–chelating complexes was demonstrated. Histological and cytological markers of inflammation were studied. The complexes could be administered intranasally or by intraperitonneal injections.

The association between psychological distress and decision regret during armed conflict among hospital personnel is of interest. The objective of this study was to learn of the association between psychological distress and decision regret during armed conflict. Data was collected from 178 hospital personnel in Barzilai Medical Center in Ashkelon, Israel during Operation Protective Edge. The survey was based on intranet data collection about: demographics, self-rated health, life satisfaction, psychological distress and decision regret. Among hospital personnel, having higher psychological distress and being young were associated with higher decision regret. This study adds to the existing knowledge by providing novel data about the association between psychological distress and decision regret among hospital personnel during armed conflict. This data opens a new venue of future research to other potentially detrimental factor on medical decision making and medical error done during crisis.

Aim: To analyze trends in childhood body mass index (BMI) in Israel between 1990 and 2000, and to determine the proportion of obese children using US and population-specific reference values. Methods: Cross-sectional data from 13 284 second- and fifth-grade schoolchildren were collected, including age, sex, height, weight, country of birth, and time since immigration. Age- and sex-specific BMI means and centiles were calculated, and the prevalence of obesity was determined using Israeli and US reference values. Results: BMI values at the 95th centile increased monotonously over time in all age and sex categories. Between 1990 and 2000, 95th centile values increased by 12.7% and 11.8% among second-grade boys and girls, respectively. Among fifth-grade children, 95th centile values increased by 10.2% and 8.4%, respectively. Among second graders in 2000, 11.4% of both boys and girls exceeded the BMI value recorded at the 95th centile in 1990. Among fifth-graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference value (p for all comparisons

This study investigated the effect of fine particulate matter (PM2.5) in ambient air on hospital admissions and emergency room (ER) visits among young children (0-3 yr) residing in 4 communities in southern Israel, within an area 5-25 km from the 2 power plants, which operate within 25 km of each other. Daily records of hospitalizations and ER visits for respiratory diseases at the 3 hospitals serving the region were examined for 9 mo, October 1, 2000-June 30, 2001. Mean PM2.5 concentrations for the four communities ranged from 11.6 to 28.1 microg/m3. Time series analysis revealed a statistically significant association (p0.05) between the numbers of hospitalizations and ER visits for respiratory symptoms and concentrations of PM2.5. This effect was evaluated for 0-3 lag days, directly, and for interactions with temperatures and seasonal parameters. The respiratory health of young children may be affected by 24 hr concentrations of PM2.560 microg/m3, the threshold proposed by both Israel and the United States.

Study objectives Accurate prediction of the effect of atmospheric changes, including pollutants, on emergency department (ED) visits for respiratory symptoms would be useful, but has proven difficult. The main difficulty is the limitation of the classical linear models and logistic regression with multiple variables to handle the multifactorial effect. Design and setting To predict ED visits, we have created a computer-based model called an artificial neural network (ANN) using a back-propagation training algorithm and genetic algorithm optimization. This ANN was fed meteorologic and air pollution input variables and trained to predict the number of patients admitted to the ED with respiratory symptoms of asthma, COPD, and acute and chronic bronchitis on the corresponding day. One thousand twenty data sets were extracted from an ED admittance database at the Barzilai Medical Center (Ashkelon, Israel), and randomized to a network training set (n = 816) and a test set (n = 204). Results The neural network performed best when the predictor variables used were temperature, relative humidity, barometric pressure, SO 2 , and oxidation products of nitric oxide, and the data presented as peak value 24 h prior to ED admission and the average during the 7 days before the ED visit. The neural network was able to predict the test set with an average error of 12%. Conclusion Based on meteorologic and pollution data, the use of an ANN can assist in the prediction of ED visits related to respiratory conditions.

Objective: We conducted a retrospective study to determine the relationship between gastroesophageal reflux (GER) and large airways malacia in infancy. Methods: One hundred sixteen children referred for chronic respiratory problems who were between the ages of 3 and 28 months were investigated. All of them underwent flexible bronchoscopy and chest radiography. Eighteen children had laryngomalacia, 13 had tracheomalacia, and 23 had combined laryngotracheomalacia. During bronchoscopy, BAL was performed. An analysis of macrophages in the BAL fluid for lipid content was performed. Fifty-four children with laryngomalacia and tracheomalacia constituted the study group, and 62 children were in the control group. Reflux studies were obtained for 40 children from the study group and 41 from the control group. Results: In the study group, 28 children (70%) had GER documented by reflux studies compared with 16 children (39%) in the control group (p < 0.01). In the control group, GER was found mainly among those with recurrent bilateral pneumonia. The lipid-laden macrophage score was correlated with the documented GER. Conclusion: GER is prevalent among infants with large airways malacia, and treatment of this group with antireflux therapy should be considered. (CHEST 2001; 119:409 ‐ 413)

Background: Chronic sinusitis (CS) is a common disease in children, especially those with allergies, that is caused by impaired drainage from the sinuses. Hypertonic NaCl solution has been shown to increase mucociliary clearance and ciliary beat frequency. Objective: We performed a randomized double blind study to compare the effect of nasal wash with hypertonic saline (HS) (3.5%) versus normal saline (NS) (0.9%) on CS. Methods: Thirty patients with CS aged 3 to 16 years were studied. They were randomly divided into two treatment groups matched by age and severity of the disease. Each individual was treated with either HS or NS for 4 weeks. All patients were evaluated by two clinical scores (cough and nasal secretions/postnasal drip [PND]) and by a radiology score at the beginning of the study and after 4 weeks. Results: The HS group improved significantly in all scores (average ± SD): cough score, from 3.6 ± 0.51 to 1.6 ± 0.74; nasal secretion/PND score, from 2.86 ± 0.35 to 1.6 ± 0.74; and radiology score, from 8.06 ± 1.28 to 2.66 ± 1.04. The NS treatment group showed significant improvement only in the PND score (from 2.66 ± 0.49 to 1.53 ± 0.83) but no significant change in both the cough score (from 3.53 ± 0.52 to 3.33 ± 0.49) and the radiology score (from 8.13 ± 1.25 to 7.86 ± 0.91). Clinical observation 1 month after the end of the study showed no change compared with the end of the study in both groups. Conclusion: HS nasal wash is an efficient treatment of CS.(J Allergy Clin Immunol 1998;101:602-5)

Childhood tuberculosis (TB) poses a high risk for morbidity and death. This study describes the characteristics of childhood TB in Israel and examines treatment outcomes. Data sources were the National TB Registry and the National Civil Census. Between 1999 and 2010, 416 children (aged

Identification of children at risk for adolescent overweight can assist in targeting interventions. Uncertainty remains regarding the validity of current body mass index (BMI) reference values in predicting future risk on a population basis. This study aimed to assess the validity of current childhood adiposity classifications in predicting adolescent overweight and obesity among Israeli youth.Historical cohort study.School-based childhood health studies and adolescent physical examinations.A total of 3 163 subjects surveyed first at age 8-15 and again at age 17-19.Age, sex, height, weight and BMI.Sensitivity, specificity, positive and negative predictive values, and relative risk of childhood adiposity classification.Childhood overweight and obesity showed low sensitivity and high specificity for predicting adolescent overweight and obesity. Positive predictive values were low and varied by age and sex, but negative predictive values were consistently high in both sexes and all ages (range 0.85-0.99). After adjusting for age and sex, both childhood overweight and obesity substantially increased the risk of adolescent overweight (relative risk [RR] 7.03 and 7.20, respectively) and adolescent obesity (RR 24.34 and 28.41, respectively).Childhood overweight and obesity are strong risk factors for adolescent overweight and obesity among Israeli youth. Normal weight children were at very low risk for adolescent overweight. These findings suggest that population-based health promotion aimed at maintaining normal weight among children should be given preference over risk-guided approaches targeting weight reduction among obese children.

Background Patients with allergic rhinitis (AR) and perennial allergen sensitization are at increased risk for asthma. Objectives To determine the allergic profile of patients with clinical AR in regions of the coastal Mediterranean compared with the inland southern desert area of Israel and the impact of specific allergen sensitization on the prevalence of asthma in these patients. Methods Retrospective evaluation of medical records from patients referred for evaluation during 2002 and 2003 to the allergy clinics of 3 medical centers located in different geoclimatic areas. Results A total of 479 patients with AR were included (64% from the humid Mediterranean coast and 36% from the arid desert area), with a mean age of 32.8 years (range, 6-84 years). Sixty percent of the patients were male, and 33% had an additional diagnosis of asthma. Mite sensitization was 84%; cockroach, 34%; trees, 43%; weeds, 40%; grasses, 53%; and fungi, 30%. There were no significant differences in the prevalence of sensitization to any of the evaluated allergens except for weeds, which was higher in the arid region. A diagnosis of asthma was significantly associated with mite sensitization in the Mediterranean area (odds ratio, 2.24; 95% confidence interval, 1.14-4.4; P = .02) and mold sensitization in the arid climate zone (odds ratio, 2.18; 95% confidence interval, 1.05-4.6; P = .04). Conclusion Although sensitization to mites is high in the coastal areas and in the Negev desert-like environment, the presence of asthma in patients with AR is associated with mite sensitization in the humid environment but with fungal sensitization in the more arid environment.

Objective To identify the characteristics of CF patients with hemoptysis in Israel and to compare clinical features and risk factors to a control group of CF patients without hemoptysis. Design Retrospective chart review. Patients All CF patients in Israel who experienced hemoptysis between 2001 and 2005 and a control group of sex- and age-matched patients with no history of hemoptysis. Results 40/440 CF patients (9.1%) experienced hemoptysis during the study period, 50% were male. Ten patients (25%) were under 13 years old at the first hemoptysis episode. Pulmonary exacerbation was the precipitating factor in 90%. Twenty three patients showed moderate or major hemoptysis. 35/40 patients responded well to conservative therapy. Bronchial artery embolization (BAE) was performed in 5 patients with no recurrence of bleed within 24 h. However all of these patients experienced recurrent hemoptysis. One patient died during the follow-up period because of end stage lung disease. Pulmonary function tests, body-mass index, coagulation tests, pancreatic status, presence of bronchiectasis, sputum cultures and genetic mutations were similar in the two groups. A high incidence (57.5%) of associated diseases including cystic fibrosis related diabetes, cirrhosis and portal hypertension, and distal intestinal obstruction syndrome was found among hemoptysis patients, compared to only 5.2% in the control group ( p Conclusions Hemoptysis, even major, did not seem to be a risk factor for mortality in our patients. A higher incidence of hemoptysis was found in our pediatric patients compared to other series. BAE shows a high immediate rate of success in controlling hemoptysis, but does not prevent future disease.

Effective surveillance of trends in paediatric overweight and obesity requires the establishment of valid cutoff values to identify children at risk. In Israel, standard values for childhood BMI-for-age are currently based on growth charts published by the US Centers for Disease Control and Prevention. However, the appropriateness of using US reference values in populations outside the US is questionable, due to inherent differences in ethnicity, culture and socioeconomic status. We recorded data from 9,988 children aged 6–12 selected by random cluster sampling within the framework of school-based health surveys conducted in Israel during the years 1997 and 2000. We constructed population-specific centile BMI-for-age curves valid for Israeli children, and compared these curves to current standard US and international reference values. Curves were constructed using LMS statistical curve smoothing methods. The data set of Israeli schoolchildren produced reference centiles substantially different than those based on US children. Israeli reference values were closer to centile curves published by the International Obesity Task Force. In conclusion, local and national health planners should recognize the intrinsic limitations associated with the use of “standard” reference values in defining paediatric overweight and obesity in dissimilar populations. The results of this large population-based study highlight the need for population-specific BMI-for-age reference values, in order to accurately describe the prevalence of paediatric overweight and obesity.

During the last decade, Israel, a country with low tuberculosis rates, absorbed some 900,000 new immigrants from TB-endemic countries.To analyze the specific impact of our screening procedures on active TB among children in Israel.We conducted a retrospective analysis of epidemiologic and clinical data of all children (aged 0-17) with TB notified to the Ministry of Health between 1990 and 1999.There were 479 children with TB (male/female ratio 1.36). Most cases (81.8%) were foreign born, predominantly (88.2%) immigrants from Ethiopia and, therefore, huge differences existed in TB incidence rates according to countries of origin. Some 80% were diagnosed within 3 years of arrival, mainly due to active case-finding. Pulmonary TB, with infiltrates on chest X-ray, was found in 49.5%. Extra-pulmonary TB sites were: intra-thoracic lymphadenitis (31.1%), extra-thoracic lymphadenitis (12.5%), bones (3.6%), pleura (1.3%), meninges (1%), and others (1%). Seventy percent had a tuberculin skin test reactionor =10 mm in size. Two (non-immigrant) children died of TB meningitis.Most of the pediatric TB cases occurred in recent immigrants and were diagnosed within 3 years of immigration. These data support our policy of active case-finding among new immigrants from Ethiopia and extensive contact evaluation for all TB cases.

To evaluate the effect of inhaled dexamethasone on hospitalization for respiratory syncytial virus (RSV) bronchiolitis.A double-blind, placebo-controlled study compared nebulization of dexamethasone versus nebulization of 0.9% saline. Both groups were treated with epinephrine nebulizations. Follow-up continued for 3 mo.Sixty-one infants with bronchiolitis aged 3 to 12 mo were included. They were randomly allocated to nebulizations with 0.25 mg dexamethasone every 6 h (group 1) or an equivalent amount of normal saline (group 2).No statistically significant differences with respect to clinical score, oxygen saturation, or IV fluid requirement between the groups were noted. Using Kaplan-Meyer's method, the cumulative proportion of in-hospital stay was significantly lower in group 1 compared with group 2, mainly in days 5 and 6 post-hospitalization (p0.038). A subgroup of prematurely born children in group 1 had a shorter hospitalization period (6.5+/-1.7 d) compared with group 2 children (9.1+/-1.9) (p0.018). Follow-up revealed similar wheeze and hospitalization rates in the two groups.Inhaled dexamethasone may reduce the length of hospitalization among infants with acute viral bronchiolitis, especially among those born prematurely.

Summary Background Asthma treatment per Global Initiative for Asthma (GINA) guidelines targets airway remodeling and achievement of normal lung function. Objective To study inhaled steroid therapy on airway remodeling and achievement of normal lung function. Subjects and set up Asthmatic patients were followed over 5 years .The children were divided into two groups. Group I (148 children-treated group) consisted of all the children using inhaled steroids on a regular basis and group II (50 children-untreated group) included patients with mild intermittent asthma who did not use inhaled steroids and were treated with bronchodilators as needed. Detailed medication and compliance history were recorded and the children underwent regular pre- and post-bronchodilator spirometry and physician examination. Results The incidence of airways remodeling as defined by the low FEV 1 /FVC post-bronchodilator was markedly increased over the 5-year period in the untreated group compared to the treated group. In the treated group the FEV 1 /FVC ratio post-bronchodilator decreased from 35% to 20.9% ( P 0.0 0 9 % ) compared with the untreated group where the number of children with low FEV 1 /FVC post-bronchodilator increased from 10% to 28% by the end of the study period. Conclusion Patients with mild asthma who do not receive regular inhaled steroids are at increased risk for airway remodeling. Therefore, we recommend that children with mild intermittent asthma undergo regular pulmonary function testing and that if any deterioration is detected in the FEV 1 /FVC ratio post-bronchodilators; preventative inhaled corticosteroid therapy be initiated.

Vasopressin is an alternative drug to adrenaline in intractable ventricular fibrillation. However, vasopressin can cause significant bradycardia, resulting in reduced cardiac output. We investigated whether pre-treatment with atropine abrogates vasopressin-induced bradycardia in a beating-heart canine model.Five adult mongrel dogs received endotracheal vasopressin (1.0 U/kg) with or without endotracheal atropine (0.02 mg/kg) or a placebo (10 ml saline) after being anesthetized and ventilated. Hemodynamic variables and arterial blood gases were determined. Each dog (studied 3 times, one week apart) served as its own control.Endotracheal vasopressin produced early and significant (p0.05) bradycardia (from 55+/-7 mmHg to 35+/-5 beats/min) compared with controls, starting one minute post-injection and lasting one hour. In contrast, in atropine-pretreated animals the heart rate increased significantly (p0.05) for as long as one hour post-atropine and vasopressin administration. In addition, animals treated with vasopressin with or without atropine exhibited a significant rise in diastolic blood pressure (from 83+/-5 to 160+/-15 and from 83+/-3 to 108+/-10 mmHg, respectively). Systolic and mean blood pressures also increased significantly compared with controls. Blood gases remained unchanged in all groups.Endotracheal administration of vasopressin can cause protracted bradycardia. Pretreatment with atropine can abrogate this effect. We suggest that atropine administration be considered when vasopressin is administered during cardio-pulmonary resuscitation. Further studies are warranted to evaluate the effect of vasopressin and atropine in a closed-chest model of cardio-pulmonary resuscitation.

To determine whether obesity among children is associated with an increased incidence of asthma.Five thousand nine hundred eighty-four children participated in a lung health study in the Ashkelon region, Israel. A lung health questionnaire was completed and they underwent spirometry. Body mass index (BMI) was then calculated for each child.Three hundred two children (5.05%) were above the 95th percentile for BMI and considered obese. Obese children tended to wheeze more than the non-obese children 14.5% vs. 10.5%, respectively (p0.038). Asthma (physician diagnosis) was diagnosed more often among obese children than non-obese 7.2% vs. 3.9%, respectively (p0.008). Inhaler use was more prevalent among obese children than non-obese 15.9% vs. 8.8%, respectively (p0.001). Bronchial hyperreactivity was significantly greater among the non-obese asthmatic children compared with their obese counterparts, 352 (51.4%) vs. 10 (27.8%), respectively (p0.001). Chest symptoms and asthma were more frequent in obese than non-obese boys.Asthma, wheezing, and inhaler use were more common in obese children than in non-obese children. Symptoms were more prevalent among obese boys. Increasing BMI among children is a risk factor for asthma, which may in reality be obesity-related chest symptoms that mimic asthma.

Pulmonary tuberculosis (PTB) infection in children is difficult to diagnose.To evaluate the effectiveness of fiberoptic bronchoscopy in the diagnosis of PTB.Four hundred twenty-two children underwent bronchoscopic evaluation. The study population was composed of 80 children (study group) who were suspected of having PTB and 342 children with chronic cough or recurrent/persistent pneumonia (control group). Videotape reviews of each bronchoscopy were correlated with the results of smears and cultures.The majority of children in the study group (54 of 80 children) were new immigrants from Ethiopia, while most of the control group (323 of 342 children) were born in Israel. Among patients in the control group, physical anomalies such as laryngotracheomalacia were more common among children in the control group (105 of 342 children) compared with those in the study group (5 of 80 children; p0.03). In the study group, external compression of the right main bronchus, usually at the entrance, was more common (32 of 80 children) compared with the control group (6 of 342 children; p0.001). Cultures from BAL fluid revealed Mycobacterium tuberculosis in 3 of the 80 children from the study group compared with 2 children from the control group (p0.08). The children with positive cultures from the control group had external compression of the right main bronchus that had been documented by bronchoscopy.Bronchoscopy in children with suspected PTB has a low yield and does not significantly aid bacteriologic confirmation. External compression at the entrance to the right main bronchus is suggestive of PTB infection.

Injury to the oropharynx can be potentially life threatening. Innocent-looking injuries of the oropharynx may result in intravascular thrombosis of the internal carotid artery. The symptoms often appear some time after the initial injury. We present a case in which an apparently minor injury of the oropharynx developed into a life-threatening thrombus stretching from the internal carotid to the brain. Our patient underwent endarterectomy and thrombectomy. The case is presented with a review of the literature.

Evidence of increased asthma and allergic response among urban versus rural residents has been reported.To evaluate the prevalence of allergic response among asthmatic children from urban and rural areas living within close proximity.In all, 448 asthmatic children from urban (363) and rural (85) areas were studied. The study group consisted of 234 9-year-olds and 214 12-year-olds. A health questionnaire was completed on each child who subsequently underwent allergic skin prick tests (SPTs).There was significantly more positive SPT response to house-dust mite, mold, cat, and cypress among asthmatic children from urban areas compared with children living in rural areas: 58.3% versus 37.6%, 46.1% versus 31.8%, 17.45 versus 5.9%, and 26.2% versus 15.3%, respectively. Positive SPT for indoor allergens were significantly greater among asthmatic urban residents than asthmatic rural residents: 63.3% versus 45.5%, respectively (P0.02). Positive SPT response to all the allergens checked was higher among the 12-year-old age group when compared with the 9-year-olds, 34.6% versus 22.7%, respectively (P = 0.05).Allergic response measured by SPT is significantly more common among asthmatic children from urban areas as opposed to rural, even though both areas are within small distance of one another. Further, asthmatic children living in urban areas demonstrated more allergic response to both indoor and outdoor allergens. The allergic response tends to increase with increased age in both urban and rural asthmatic children.

Several reports have suggested that early chest tube drainage (CTD) may not be necessary in the treatment of severe pleural empyema (PE) in pediatric patients if appropriate antibiotic therapy and supportive care are provided.A prospective open study to compare the short-term course of two treatment protocols of severe PE in pediatric patients.One group of 32 patients was treated with early insertion of a chest tube for CTD, and a second group of 35 patients was treated by a repeated ultrasound-guided needle thoracocentesis (RUSGT). The severity of the empyema was assessed by chest radiograph, the amount of fluid drained, the number of days the patient had experienced a fever, and the duration of antibiotic treatment.No significant differences were found between the two groups (RUSGT vs CTD) in all of the following measurements: mean (plus minus SD) duration of a temperatureor = 39 degreesC, 6.2 +/- 2.4 vs 6.5 +/- 1.8 days, respectively; mean duration of a temperatureor = 38 degreesC, 9 +/- 3.9 vs 8.2 +/- 4.5 days, respectively; fluid drained, 35.1 + 23.8 vs 30 +/- 28.2 mL/kg, respectively; duration of antibiotic treatment, 30 +/- 13.2 vs 30.2 +/- 7.3 days, respectively; and length of hospitalization and home IV treatment, 22 +/- 7.6 vs 24.2 +/- 7.5 days, respectively. A failure to respond to treatment occurred in three patients in the RUSGT-treated group and in five patients in the CTD-treated group. The failure to respond occurred in the RUSGT-treated group only in those patients with very large empyemas that caused mediastinal deviation.The treatment of PE by RUSGT is as efficacious as CTD, unless PE causes mediastinal deviation.

Differences in lung functions of school-age children who lived near two electrical power plants in the Ashkelon district of Israel were studied. Lung-function tests were performed, and the American Thoracic Society questionnaire was administered in three study periods during the following years: (1) 1990, (2) 1994, and (3) 1997. Measurements of air pollutants (i.e., sulfur dioxide, nitric oxides, ozone) were also taken during the aforementioned study periods. Statistical analysis included an estimation of a series of fixed-effects regression models. A total of 2,455, 1,613, and 4,346 observations were included in the analyses for study years 1990, 1994, and 1997, respectively. The authors controlled for age, sex, height, weight, parents' education and smoking status, and being born out of Israel, and, consequently, substantial differences in lung function across the different communities and study periods were demonstrated in the study area. No robust association with air pollution was demonstrated. The cause of these differences in the respiratory health of children remains unknown.

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israel's southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985-94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV-positive.

Fifty children (27 females, 23 males) ages 6-15 years who were referred for evaluation of suspected asthma had baseline FEV1 and FEF25-75 of greater than or equal to 80% and FEF50 greater than or equal to 70% of predicted values. All had these tests repeated on the same day, after inhaling salbutamol. On a subsequent day PC-20 (methacholine) was determined as an index of bronchial hyperreactivity (BH). Fourteen age-matched healthy children (6 females, 8 males) were studied in a similar manner. There was no significant relationship between the PC20 and the change in FEF25-75 or FEF50 following salbutamol. There was a negative correlation between the initial FEV1 (% predicted) and the percent change in FEV1 following salbutamol (P less than 0.01). An increase in FEV1 of greater than 6% occurred in 7/12 (58.3%) patients with PC20 less than or equal to 0.25 mg/mL (Group I); in 7/24 (29.2%) patients with PC20 = 0.26-2.0 mg/mL (Group II); in only 1/14 (7.1%) patients with PC20 greater than 2.1 mg/mL (Group III) and in none of those asymptomatic (control) children with PC20 greater than 8.0 mg/mL (Group IV). All subjects who had a change in FEV1 greater than 6% after salbutamol had a PC20 less than 8 mg/mL and this test detected the majority of patients with severe BH. However, although the sensitivity of the test was 100%, the predictive value was only 36%. We conclude that in the presence of a normal baseline FEV1 a change of greater than 6% following salbutamol inhalation is indicative of bronchial hyperreactivity.

(1986). Variable Vocal Cord Dysfunction Presenting as Wheezing and Exercise-Induced Asthma. Journal of Asthma: Vol. 23, No. 5, pp. 241-244.

The diagnosis of typhoid fever (TF) is usually established by culturing 5. typhi from the blood or by serology. In this report we describe three patients in whom the diagnosis of TF was made by the isolation of 5. typhi from gastric contents, despite negative blood urine and stool cultures. Culture of gastric contents has not previously been recognized as a diagnostic tool in this disease.