Publications (25)71.33 Total impact
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Article: Severe abdominal pain as a presenting symptom of probable catastrophic antiphospholipid syndrome.
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ABSTRACT: Catastrophic antiphospholipid syndrome (APS) in pediatric medicine is rare. We report 3 adolescents who presented with acute onset of severe abdominal pain as the first manifestation of probable catastrophic APS. The 3 patients, 2 male patients and 1 female patient were 14 to 18 years old. One had been diagnosed with systemic lupus erythematosus in the past, but the other 2 had no previous relevant medical history. All presented with excruciating abdominal pain without additional symptoms. Physical examination was noncontributory. Laboratory results were remarkable for high inflammatory markers. Abdominal ultrasonography was normal, and abdominal computed tomography scan showed nonspecific findings of liver infiltration. Only computed tomography angiography revealed evidence of extensive multiorgan thrombosis. All patients had elevated titers of antiphospholipid antibodies. The patients were treated with full heparinization, high-dose steroids, and intravenous immunoglobulin with a resolution of symptoms. One patient was resistant to the treatment and was treated with rituximab. In conclusion, severe acute abdominal pain can be the first manifestation of a thromboembolic event owing to catastrophic APS even in previously healthy adolescents. Diagnosis requires a high index of suspicion with prompt evaluation and treatment to prevent severe morbidity and mortality.PEDIATRICS 06/2012; 130(1):e230-5. · 4.47 Impact Factor -
Article: Dexamethasone therapy for septic arthritis in children: results of a randomized double-blind placebo-controlled study.
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ABSTRACT: We evaluated the effect of adding dexamethasone to antibiotic therapy in the clinical course of septic arthritis in children. A randomized double-blind placebo-controlled trial was performed. The study group included 49 children with septicarthritis. In addition to antibiotic therapy given, patients were randomly assigned to receive intravenous dexamethasone 0.15 mg/kg every 6 hours for 4 days or placebo. The groups were compared for clinical and laboratory parameters, length of hospital stay, and late sequelae. Mean age was 33±42 months (range: 6 to 161 mo). There was no significant difference between the dexamethasone and placebo groups in age, duration of symptoms, joint affected, or levels of acute phase reactants. Bacteria were isolated from joint fluid in 17 patients (35%) and from blood in 4 patients. Compared with the placebo group, patients treated with dexamethasone had a significantly shorter duration of fever (P=0.021; mean first day without fever 1.68 vs 2.83) and local inflammatory signs (P=0.021; mean first day without pain 7.18 vs 10.76), lower levels of acute phase reactants (P=0.003; mean last day of erythrocyte sedimentation rate>25 mm/h 3.76 vs 8.40), shorter duration of parenteral antibiotic treatment (P=0.007; mean of 9.91 d vs 12.60 d), and shorter hospital stay. No side effects of treatment were recorded in either group. A 4-day course of dexamethasone given at the start of antibiotic treatment in children with septic arthritis, is safe, and leads to a significantly more rapid clinical improvement, shortening duration of hospitalization compared with those treated with antibiotics alone. I.Journal of pediatric orthopedics 03/2011; 31(2):211-5. · 1.23 Impact Factor -
Article: Growing pains: myth or reality.
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ABSTRACT: Growing pains are common among children aged 2-12 years and are characterized by recurrent, self-limited, bilateral lower extremity pain, mostly in the afternoon and evening, and even at night, in an otherwise healthy child. The etiology is unknown and prognosis is excellent. It is important to distinguish between this benign condition and other serious rheumatic or malignant diseases.Pediatric endocrinology reviews: PER 12/2010; 8(2):76-8. -
Article: Differentiation of post-streptococcal reactive arthritis from acute rheumatic fever.
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ABSTRACT: To perform a retrospective study comparing clinical and laboratory aspects of patients with acute rheumatic fever (ARF) and patients with post-streptococcal reactive arthritis (PSRA), to discern whether these are 2 separate entities or varying clinical manifestations of the same disease. We located the records of 68 patients with ARF and 159 patients with PSRA, whose diseases were diagnosed with standardized criteria and treated by 8 pediatric rheumatologists in 7 medical centers, using the Israeli internet-based pediatric rheumatology registry. The medical records of these patients were reviewed for demographic, clinical, and laboratory variables, and the data were compared and analyzed with univariate, multivariate, and discriminatory analysis. Four variables were found to differ significantly between ARF and PSRA and serve also as predictors: sedimentation rate, C-reactive protein, duration of joint symptoms after starting anti-inflammatory treatment, and relapse of joint symptoms after cessation of treatment. A discriminative equation was derived that enabled us to correctly classify >80% of the patients. On the basis of simple clinical and laboratory variables, we were able to differentiate ARF from PSRA and correctly classify >80% of the patients. It appears that ARF and PSRA are distinct entities.The Journal of pediatrics 11/2008; 153(5):696-9. · 4.02 Impact Factor -
Article: Effect of benzathine penicillin treatment on antibiotic susceptibility of viridans streptococci in oral flora of patients receiving secondary prophylaxis after rheumatic fever.
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ABSTRACT: To assess the level of antibiotic resistance of viridans streptococci in the oral flora of children with a history of rheumatic fever, receiving long-term monthly intramuscular benzathine penicillin G prophylaxis. Oral swabs from patients receiving monthly penicillin G prophylaxis for rheumatic fever were cultured and tested for viridans streptococci. The E-test was used to test susceptibility to penicillin G, clindamycin, clarithromycin and rifampin. Findings were compared with samples from healthy children who had not been exposed to antibiotic treatment for at least 2 months. Twenty-six patients and 20 control children were included in the study. Duration of intramuscular antibiotic treatment ranged from 5 months to 13.5 years. Sixty isolates of viridans streptococci species were obtained, with a similar distribution in the two groups. Intermediate resistance to penicillin (MIC 0.25-2 mg/L) was documented in 10 of the 32 isolates (31.2%) in the study group, and high resistance in none, compared to seven of 28 isolates (25%) with intermediate or high resistance in the control group (p=NS). All isolates in the study group and all but one in the control group were susceptible to clindamycin, and all isolates from both groups were susceptible to rifampin. One isolate (3.1%) in the study group and two (7.1%) in the control group were resistant to clarithromycin. Monthly Intramuscular penicillin prophylaxis has no effect on the antibiotic susceptibility of viridans streptococci in oral flora in children with a history of rheumatic fever, receiving secondary prophylaxis after rheumatic fever, regardless of the duration of treatment.The Journal of infection 05/2008; 56(4):244-8. · 4.13 Impact Factor -
Article: Association of hypoalbuminemia with the presence and size of pleural effusion in children with pneumonia.
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ABSTRACT: Hypoalbuminemia is a common finding in children with massive parapneumonic pleural effusion; however, its incidence and pathogenesis are unclear. The objective of this study was to assess the presence and severity of hypoalbuminemia in children with parapneumonic pleural effusion and to propose a possible pathophysiologic mechanism. The clinical charts of patients who were hospitalized in a tertiary pediatric center with bacterial pneumonia complicated by pleural effusion were reviewed. The volume of pleural fluid was assessed semiquantitatively and categorized as small, moderate, or large. The lowest serum albumin level was recorded, and caloric intake and protein loss were evaluated. Findings were compared with age- and gender-matched children who had bacterial pneumonia without pleural effusion and with children who had acute illnesses other than pneumonia. Of the 50 patients in the study group, 15 (30%) had small effusions, 16 (32%) had moderate effusions, and 19 (38%) had large effusions. Moderate-to-severe hypoalbuminemia was found in 52% of the study group, 6% of the patients with pneumonia without pleural effusion, and none of the patients with other illnesses. Mean serum albumin level was lower in patients with large pleural effusions than in patients with small effusions (2.66 +/- 0.37 vs 3.66 +/- 0.47 g/dL). There was no evidence of albumin loss or significant malnutrition. Estimation of the amount of albumin in the drained pleural fluid suggested an albumin shift from blood to pleural fluid. Significant hypoalbuminemia is common in children with parapneumonic pleural effusion. Large effusions are associated with low serum albumin levels, which might be explained in part by a shift from blood to pleural fluid.PEDIATRICS 04/2008; 121(3):e533-8. · 4.47 Impact Factor -
Article: [Acne--merely a cosmetic problem? Acne associated musculoskeletal syndromes].
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ABSTRACT: Acne can be associated with severe musculoskeletal and constitutional symptoms. This is a case history of a 15 year-old boy with severe acne, treated with isotretinoin, who was admitted because of high fever and weight loss of 3 weeks duration. His complaints were of severe chest and back pain, and inability to walk. His laboratory results revealed elevated erythrocyte sedimentation rate and C-reactive protein. On a pelvic radiograph bilateral sacroiliitis was noticed. Radionuclide bone scan revealed increased uptake in the right sacroiliac joint, in small vertebral bodies and sternum. A diagnosis of acne-associated musculoskeletal syndrome was made and the patient was treated with high dose steroids. His symptoms resolved and his acne improved. This case report sheds light on the relationship between acne and associated musculoskeletal syndromes. Physicians should be aware of this association in order to provide prompt and efficient treatment.Harefuah 02/2008; 147(1):12-5, 96. -
Article: Nitrous Oxide sedation for intra-articular injection in juvenile idiopathic arthritis.
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ABSTRACT: Intra-articular corticosteroid injection in juvenile idiopathic arthritis (JIA) is often associated with anxiety and pain. Recent reports advocate the use of nitrous oxide (NO), a volatile gas with analgesic, anxiolytic and sedative properties. To prospectively evaluate the effectiveness and safety of NO analgesia for intra-articular corticosteroid injection in JIA, and to assess patients and staff satisfaction with the treatment. NO was administered to JIA patients scheduled for joint injection. The patient, parent, physician and nurse completed visual-analog scores (VAS) (0-10) for pain, and a 5-point satisfaction scale. Change in heart rate (HR) during the procedure was recorded in order to examine physiologic response to pain and stress. Patient's behavior and adverse reactions were recorded. 54 procedures (72 joints) were performed, 41 females, 13 males; 39 Jewish, 13 Arab; mean age was 12.2 +/- 4.7 year. The median VAS pain score for patients, parents, physicians and nurses was 3. The HR increased >/= 15% in 10 patients. They had higher VAS scores as evaluated by the staff. The median satisfaction level of the parents and staff was 3.0 and 5.0 respectively. Adverse reactions were mild. NO provides effective and safe sedation for JIA children undergoing intra-articular injections.Pediatric Rheumatology 01/2008; 6:1. · 1.44 Impact Factor -
Article: Neurological manifestations of folate transport defect: case report and review of the literature.
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ABSTRACT: Folate is essential for normal brain development. This report describes a 15-month-old boy who presented with generalized and focal seizures and a decline in mental status. Laboratory tests revealed low folate levels in blood (1.13 nmol/L) and cerebrospinal fluid, accompanied by pancytopenia. Bone marrow aspiration confirmed the presence of megaloblastic anemia. Treatment with high-dose intravenous folinic acid led to normalization of cerebrospinal folate levels. These findings apparently indicate a defect in folic acid transport to the central nervous system. A clinical picture of developmental arrest, seizures, somnolence, and megaloblastic anemia should alert physicians to the possibility of folate deficiency.Journal of Child Neurology 07/2007; 22(6):783-6. · 1.75 Impact Factor -
Article: Presence of D8/17 B-cell marker in patients with poststreptococcal reactive arthritis.
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ABSTRACT: An elevated expression of the alloantigen D8/17 on B lymphocytes has been previously proposed as a susceptibility marker in rheumatic fever. The aim of the study was to investigate the presence of the D8/17 marker on B lymphocytes in poststreptococcal reactive arthritis (PSRA). The study sample included 19 patients (15 boys, 4 girls; mean age 11.7 +/- 5.4 years) who were diagnosed with PSRA (mean age at diagnosis, 9.4 +/- 5.6 years) and 18 healthy controls (10 boys and 8 girls) matched for ethnic background. B-cell D8/17 expression was tested by flow cytometry assay using monoclonal antibodies. Laboratory results showed a higher expression of D8/17 in the patient group (23.1 +/- 10.4%, range 11.6-51.9%) than in the control group (17.1 +/- 8.2%, range 7.1-35.7) in controls; this difference was statistically significant after log transformation of the data (P = 0.035). The high rate of expression of the D8/17 marker in patients with PSRA suggests that RF and PSRA share the same genetic susceptibility.Rheumatology International 07/2007; 27(8):695-8. · 1.88 Impact Factor -
Article: Neuropsychiatric manifestations in pediatric systemic lupus erythematosus and association with antiphospholipid antibodies.
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ABSTRACT: To determine the prevalence of neuropsychiatric (NP) manifestations in children with systemic lupus erythematosus (SLE) using the 1999 American College of Rheumatology case definitions for NP syndromes in SLE, and their association with antiphospholipid antibodies (aPL). We performed a retrospective cohort study of 106 pediatric and adolescent SLE patients at 2 academic medical centers. Clinical and laboratory data were obtained by medical record review. All aPL testing was performed in standard clinical laboratories. Twenty-five patients (23.6%) had NP manifestations, including seizures (9.4%), headaches (4.7%), mood disorders (4.7%), cognitive dysfunction (4.7%), cerebrovascular accident (CVA), psychosis and pseudotumor (2.8% each), aseptic meningitis (0.9%), acute confusional state (0.9%), anxiety (0.9%), and cranial neuropathy (0.9%). NP events were not necessarily accompanied by an SLE flare. aPL were positive in 70% of all SLE patients, including anticardiolipin antibodies (aCL) in 64%, aCL IgG in 56%, aCL IgM in 35%, rapid plasma reagin or Venereal Disease Research Laboratory test in 13%, and lupus anticoagulant (LAC) in 18%. The only significant association between NP manifestations and aPL was for CVA and IgM aCL (p=0.03). LAC was slightly more common among patients with NP events, and the finding of LAC on more than one occasion was significantly associated with developing a NP event (p = 0.01). NP manifestations occur in about one-fourth of children with SLE, are an early event in the course of the disease, and are not necessarily accompanied by an SLE flare. Seizures are the most frequent symptom. Although aPL are common, their association with NP events, unlike in adults, is weak, except for CVA, suggesting a different pathogenic mechanism for NP manifestations in pediatric SLE.The Journal of Rheumatology 10/2006; 33(9):1873-7. · 3.69 Impact Factor -
Article: Treatment of anticonvulsant hypersensitivity syndrome with intravenous immunoglobulins and corticosteroids.
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ABSTRACT: Anticonvulsant hypersensitivity syndrome is a specific severe idiosyncratic reaction to the aromatic antiepileptic drugs. The most frequent presenting symptoms are fever and rash, lymphadenopathy owing to lymphoid hyperplasia, hepatitis, and interstitial nephritis. Severe skin reactions (Stevens-Johnson syndrome or toxic epidermal necrolysis) have also been reported. Early detection is crucial owing to the high mortality rate. Although withdrawal of the offending drug is critical, the optimal treatment approach remains controversial. Previous studies report a severe course and prolonged hospital stay for cutaneous drug-related reactions, including referral to a burn center, skin débridement, and allograft skin coverage. The aim of the present report is to describe four adolescents with antiepileptic drug hypersensitivity syndrome who were treated with intravenous immunoglobulin and systemic corticosteroids. All recovered completely following an uncomplicated and relatively short course and hospitalization. Findings indicate that this regimen might be a promising treatment option in this patient population. Larger, controlled trials are needed to reach a definitive conclusion.Journal of Child Neurology 06/2006; 21(5):380-4. · 1.75 Impact Factor -
Article: Increased prevalence of antithyroid antibodies and subclinical hypothyroidism in children with juvenile idiopathic arthritis.
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ABSTRACT: To estimate the occurrence of antithyroid antibodies (ATA) and hypothyroidism in children with juvenile idiopathic arthritis (JIA) compared to matched healthy controls. The occurrence of ATA, including antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies, was evaluated by quantitative immunometric ELISA in children with JIA and in a healthy matched control group. Thyroid function was assessed in both groups. The study group included 66 patients with JIA (50 girls, 16 boys) of mean age 11.7 +/- 4.4 years (range 2-23). The control group included 89 children (71 girls, 18 boys) of mean age 10.8 +/- 4.2 years (range 2-18). Mean age at onset of joint disease was 7.3 +/- 3.6 years (range 1-15). Anti-TG antibodies were found in 7 of 62 patients (11.3%) in the JIA group and 2 of 89 controls (2.2%) (p = 0.03); anti-TPO antibodies were found in 5 of 65 patients (7.9%) and one of 89 controls (1.1%) (p = 0.08). All patients with ATA had oligoarticular type JIA (p = 0.01). Mean thyroid stimulating hormone (TSH) levels were higher in the study group than in controls (2.6 +/- 2.3 vs 1.9 +/- 1.0 mIU/l; p = 0.01); levels were above normal range (0.4-4 mIU/l) in 8 study patients (12%) and 3 controls (3.4%) (p = 0.055). Overall, ATA were found in 9 of the 150 study participants, 4 (44%) of whom had TSH levels above 4 mIU/l (p = 0.001). Children with JIA have a higher than normal incidence of ATA and subclinical hypothyroidism and should be routinely screened for these variables.The Journal of Rheumatology 02/2006; 33(1):164-6. · 3.69 Impact Factor -
Article: Efficacy of postexposure immunization with live attenuated varicella vaccine in the household setting--a pilot study.
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ABSTRACT: The aim of the present study was to examine the efficacy of postexposure vaccination with Varilrix in the household setting. A randomized, double-blind, placebo-controlled design was used. Twenty-two children received the varicella vaccine and 20, a placebo. The relative risk of developing varicella with a placebo compared with the vaccine was 1.1 (95% confidence interval 0.55-2.21). The risk of developing moderate to severe disease was eight times greater in the placebo group (RR=8), indicating an 80% protective effect against moderate/severe disease. The varicella vaccine Varilrix may not be effective in preventing varicella when administered after household exposure, although it is highly effective in ameliorating the disease in those who acquire it under these circumstances.Vaccine 01/2005; 23(3):325-8. · 3.77 Impact Factor -
Article: Presence of viremia in patients with primary herpetic gingivostomatitis.
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ABSTRACT: Presence of viremia during primary herpes simplex virus (HSV) infections has been previously investigated, but the findings for immunocompetent individuals have only rarely been reported. With use of polymerase chain reaction (PCR), we evaluated blood samples obtained from children with primary herpes simplex virus (HSV) gingivostomatitis for viremia. There were 16 girls and 16 boys, aged 9-44 months (median age, 19 months). Serological test results for HSV type 1 were positive for 3 subjects (10.3%), borderline for 7 (24.1%), and negative for 19 (65.5%). Results of PCR of peripheral blood samples were positive for 11 subjects (34.4%). Time from disease onset to specimen collection was 24-216 h (median, 72 h) and was longer for subjects with positive results of serological tests (P =.014) and shorter for subjects with positive PCR results (P=.42). No cases with positive results of both PCR and serological tests were found. PCR detected viremia in 34% of patients with primary herpetic gingivostomatitis. Presence of viremia may play a potential role in viral dissemination, providing a better understanding of the pathogenesis of HSV infections, especially of the central nervous system.Clinical Infectious Diseases 10/2004; 39(5):636-40. · 9.15 Impact Factor -
Article: THE ISRAELI INTERNET-BASED REGISTRY: NOVEL CONCEPT OF MULTICENTER DATA COLLECTION IN PEDIATRIC RHEUMATOLOGY
Pediatric Rheumatology Online Journal. 01/2004; -
Article: Naproxen as an alternative to aspirin for the treatment of arthritis of rheumatic fever: a randomized trial.
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ABSTRACT: We performed a prospective, randomized, open-label equivalence study comparing the use of naproxen to aspirin in 33 patients with rheumatic fever. The mean time until resolution of arthritis was 2.9+/-2.9 days in both groups. Liver enzyme elevations were more frequent in the aspirin group (P=.002). We conclude that naproxen is as effective, is easier to use, and is safer than aspirin in the treatment of the arthritis of rheumatic fever.Journal of Pediatrics 10/2003; 143(3):399-401. · 4.11 Impact Factor -
Article: Absolute neutrophil count in aseptic and bacterial meningitis related to time of lumbar puncture.
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ABSTRACT: Previous studies have demonstrated that during the first 24 hours of illness caused by aseptic meningitis, polymorphonuclear cells predominate in cerebrospinal fluid and decline afterward. To test the hypothesis that the absolute neutrophil count and percentage of polymorphonuclear cells in cerebrospinal fluid of bacterial meningitis patients are elevated and sustained after 24 hours compared with that of patients with aseptic meningitis. Seventy-two patients with aseptic meningitis and 13 with bacterial meningitis participated. All patients with aseptic meningitis and four patients with bacterial meningitis were followed-up prospectively. The patients were enrolled in four groups according to the interval between onset of symptoms and performance of the lumbar puncture (<12 hours, 12-24 hours, 24-36 hours, and >36 hours). In aseptic meningitis the mean absolute neutrophil count was 182, 164, 79, and 68 cells/mm(3), respectively (P = 0.025). In bacterial meningitis the absolute neutrophil count was 28, 1,466, 5,853, and 235 cells/mm(3), respectively. The mean percentage of polymorphonuclear cells in aseptic meningitis was 49%, 46%, 40%, and 26%, respectively (P = 0.038); in bacterial meningitis, 70%, 83%, 81%, and 58%, respectively. The findings suggest that the absolute neutrophil count and the polymorphonuclear cell percentage in cerebrospinal fluid have different kinetics in aseptic vs. bacterial meningitis.Pediatric Neurology 05/2003; 28(5):365-9. · 1.52 Impact Factor -
Article: Citrobacter koseri (diversus) meningitis in an otherwise healthy adolescent.
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ABSTRACT: Citrobacter infection is commonly reported in neonates and immunocompromised patients. Citrobacter koseri (diversus) is an important cause of neonatal meningitis and brain abscess formation. It adults, however, Citrobacter infection with central nervous system involvement is rare, and is usually associated with an underlying disorder. This report describes a 12-y-old previously healthy girl with Citrobacter koseri meningitis. Intravenous treatment with ceftriaxone for 10 d led to complete recovery. Head computed tomography and brainstem-evoked response audiometry were normal. On follow-up, the patient was completely healthy. Previously reported cases of C. koseri meningitis in the adult population were associated with underlying predisposing factors. In this case a normal, healthy adolescent was treated with intravenous ceftriaxone without any of the known neurological complications observed in the neonatal cases.Scandinavian Journal of Infectious Diseases 02/2003; 35(3):202-4. · 1.72 Impact Factor -
Article: Papular purpuric rash due to parvovirus B19 with distribution on the distal extremities and the face.
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ABSTRACT: We describe 3 patients who presented with a distinctive clinical picture of the purpuric rash called "gloves-and-socks syndrome" which was characterized by an acral distribution of the rash that involved not only the distal part of the extremities but also the chin and perioral area. Serologic analysis for parvovirus B19 yielded positive results. Parvovirus B19 should be included in the evaluation of febrile purpura.Clinical Infectious Diseases 01/2003; 35(12):1558-61. · 9.15 Impact Factor
Top co-authors
Top Journals
Institutions
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2002–2012
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Schneiders Children's Medical Center Of Israel
Petah Tikva, Central District, Israel
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2011
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Meir Medical Center
Kfar Saba, Central District, Israel
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2002–2007
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Tel Aviv University
Tel Aviv, Tel Aviv, Israel
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