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Ikejezie J, Miglietta A, Hammermeister Nezu I, Adele S, Higdon MM, Feikin D, Lata H, Mesfin S, Idoko F, Shimizu K, Acma A, Moro S, Attar Cohen H, Sinnathamby MA, Otieno JR, Temre Y, Ajong BN, Mirembe BB, Guinko TN, Sodagar V, Schultz C, Muianga J, De Barros S, Escobar Corado Waeber AR, Jin Y, Rico Chinchilla A, Izawa Y, Khare S, Poole M, Alexander N, Ciobanu S, Dorji T, Hassan M, Kato M, Matsui T, Ogundiran O, Pebody RG, Phengxay M, Riviere-Cinnamond A, Greene-Cramer BJ, Peron E, Archer BN, Subissi L, Kassamali ZA, Awofisayo-Okuyelu A, le Polain de Waroux O, Hamblion E, Pavlin BI, Morgan O, Fall IS, Van Kerkhove MD, Mahamud A. Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update. BMJ Glob Health 2024; 9:e014466. [PMID: 38580376 PMCID: PMC11002403 DOI: 10.1136/bmjgh-2023-014466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024] Open
Abstract
On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.
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Affiliation(s)
| | | | | | - Sandra Adele
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Feikin
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Friday Idoko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kazuki Shimizu
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ayse Acma
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Moro
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Homa Attar Cohen
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Yosef Temre
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Tondri Noe Guinko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Vaishali Sodagar
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Craig Schultz
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Joao Muianga
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stéphane De Barros
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yeowon Jin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yurie Izawa
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Shagun Khare
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Marcia Poole
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Nyka Alexander
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Silviu Ciobanu
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tshewang Dorji
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Mahmoud Hassan
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Richard G Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manilay Phengxay
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Emilie Peron
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Esther Hamblion
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Boris Igor Pavlin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Abdi Mahamud
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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2
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Attar Cohen H, Mesfin S, Ikejezie J, Kassamali Z, Campbell F, Adele S, Guinko N, Idoko F, Mirembe BB, Mitri ME, Nezu I, Shimizu K, Ngongheh AB, Sklenovska N, Gumede N, Mosha FS, Mohamed B, Corpuz A, Pebody R, Marklewitz M, Gresh L, Mendez Rico JA, Hundal K, Kato M, Babu A, Archer BN, le Polain de Waroux O, Van Kerkhove MD, Mahamud A, Subissi L, Pavlin BI. Surveillance for variants of SARS-CoV-2 to inform risk assessments. Bull World Health Organ 2023; 101:707-716. [PMID: 37961054 PMCID: PMC10630725 DOI: 10.2471/blt.23.290093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 11/15/2023] Open
Abstract
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, numerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants have emerged, some leading to large increases in infections, hospitalizations and deaths globally. The virus's impact on public health depends on many factors, including the emergence of new viral variants and their global spread. Consequently, the early detection and surveillance of variants and characterization of their clinical effects are vital for assessing their health risk. The unprecedented capacity for viral genomic sequencing and data sharing built globally during the pandemic has enabled new variants to be rapidly detected and assessed. This article describes the main variants circulating globally between January 2020 and June 2023, the genetic features driving variant evolution, and the epidemiological impact of these variants across countries and regions. Second, we report how integrating genetic variant surveillance with epidemiological data and event-based surveillance, through a network of World Health Organization partners, supported risk assessment and helped provide guidance on pandemic responses. In addition, given the evolutionary characteristics of circulating variants and the immune status of populations, we propose future directions for the sustainable genomic surveillance of SARS-CoV-2 variants, both nationally and internationally: (i) optimizing variant surveillance by including environmental monitoring; (ii) coordinating laboratory assessment of variant evolution and phenotype; (iii) linking data on circulating variants with clinical data; and (iv) expanding genomic surveillance to additional pathogens. Experience during the COVID-19 pandemic has shown that genomic surveillance of pathogens can provide essential, timely and evidence-based information for public health decision-making.
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Affiliation(s)
- Homa Attar Cohen
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Samuel Mesfin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Juniorcaius Ikejezie
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Zyleen Kassamali
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Finlay Campbell
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Sandra Adele
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Noe Guinko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Friday Idoko
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Bernadette Basuta Mirembe
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Maria Elizabeth Mitri
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ingrid Nezu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Kazuki Shimizu
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Ajong Brian Ngongheh
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Nikola Sklenovska
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | | | - Basant Mohamed
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Aura Corpuz
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | | | | | - Lionel Gresh
- Pan American Health Organization, WashingtonD.C., United States of America
| | | | - Kareena Hundal
- WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Masaya Kato
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Amarnath Babu
- WHO Regional Office for South-East Asia, New Delhi, India
| | - Brett N Archer
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | | | - Maria D Van Kerkhove
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Abdirahman Mahamud
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Lorenzo Subissi
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
| | - Boris I Pavlin
- World Health Organization (WHO) Health Emergencies Programme, WHO, Avenue Appia 20, 1211Geneva, Switzerland
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Grant R, Sacks JA, Abraham P, Chunsuttiwat S, Cohen C, Figueroa JP, Fleming T, Fine P, Goldblatt D, Hasegawa H, MacIntrye CR, Memish ZA, Miller E, Nishioka S, Sall AA, Sow S, Tomori O, Wang Y, Van Kerkhove MD, Wambo MA, Cohen HA, Mesfin S, Otieno JR, Subissi L, Briand S, Wentworth DE, Subbarao K. When to update COVID-19 vaccine composition. Nat Med 2023; 29:776-780. [PMID: 36807683 DOI: 10.1038/s41591-023-02220-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- Rebecca Grant
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Jilian A Sacks
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Priya Abraham
- Indian Council of Medical Research - National Institute of Virology, Pune, India
| | | | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Thomas Fleming
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Paul Fine
- London School of Hygiene and Tropical Medicine, London, UK
| | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Hideki Hasegawa
- Center for Influenza and Respiratory Virus Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - C Raina MacIntrye
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ziad A Memish
- Research and Innovation Centre, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Samba Sow
- Centre for Vaccine Development, Ministry of Health, Bamako, Mali
| | - Oyewale Tomori
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Youchun Wang
- Institute for Biological Product Control, National Institutes for Food and Drug Control, Beijing, China
| | - Maria D Van Kerkhove
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Marie-Ange Wambo
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Homa Attar Cohen
- Department of Acute Response Coordination, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Department of Acute Response Coordination, World Health Organization, Geneva, Switzerland
| | - James R Otieno
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Lorenzo Subissi
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland
| | - Sylvie Briand
- Department of Epidemic and Pandemic Preparedness and Prevention, World Health Organization, Geneva, Switzerland.
| | - David E Wentworth
- Influenza Division, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kanta Subbarao
- WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Victoria, Australia
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Wong MK, Brooks DJ, Ikejezie J, Gacic-Dobo M, Dumolard L, Nedelec Y, Steulet C, Kassamali Z, Acma A, Ajong BN, Adele S, Allan M, Cohen HA, Awofisayo-Okuyelu A, Campbell F, Cristea V, De Barros S, Edward NV, Waeber AREC, Guinko TN, Laurenson-Schafer H, Mahran M, Carrera RM, Mesfin S, Meyer E, Miglietta A, Mirembe BB, Mitri M, Nezu IH, Ngai S, Ejoh OO, Parikh SR, Peron E, Sklenovská N, Stoitsova S, Shimizu K, Togami E, Jin YW, Pavlin BI, Novak RT, Le Polain O, Fuller JA, Mahamud AR, Lindstrand A, Hersh BS, O’Brien K, Van Kerkhove MD. COVID-19 Mortality and Progress Toward Vaccinating Older Adults - World Health Organization, Worldwide, 2020-2022. MMWR Morb Mortal Wkly Rep 2023; 72:113-118. [PMID: 36730046 PMCID: PMC9927068 DOI: 10.15585/mmwr.mm7205a1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
After the emergence of SARS-CoV-2 in late 2019, transmission expanded globally, and on January 30, 2020, COVID-19 was declared a public health emergency of international concern.* Analysis of the early Wuhan, China outbreak (1), subsequently confirmed by multiple other studies (2,3), found that 80% of deaths occurred among persons aged ≥60 years. In anticipation of the time needed for the global vaccine supply to meet all needs, the World Health Organization (WHO) published the Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework and a roadmap for prioritizing use of COVID-19 vaccines in late 2020 (4,5), followed by a strategy brief to outline urgent actions in October 2021.† WHO described the general principles, objectives, and priorities needed to support country planning of vaccine rollout to minimize severe disease and death. A July 2022 update to the strategy brief§ prioritized vaccination of populations at increased risk, including older adults,¶ with the goal of 100% coverage with a complete COVID-19 vaccination series** for at-risk populations. Using available public data on COVID-19 mortality (reported deaths and model estimates) for 2020 and 2021 and the most recent reported COVID-19 vaccination coverage data from WHO, investigators performed descriptive analyses to examine age-specific mortality and global vaccination rollout among older adults (as defined by each country), stratified by country World Bank income status. Data quality and COVID-19 death reporting frequency varied by data source; however, persons aged ≥60 years accounted for >80% of the overall COVID-19 mortality across all income groups, with upper- and lower-middle-income countries accounting for 80% of the overall estimated excess mortality. Effective COVID-19 vaccines were authorized for use in December 2020, with global supply scaled up sufficiently to meet country needs by late 2021 (6). COVID-19 vaccines are safe and highly effective in reducing severe COVID-19, hospitalizations, and mortality (7,8); nevertheless, country-reported median completed primary series coverage among adults aged ≥60 years only reached 76% by the end of 2022, substantially below the WHO goal, especially in middle- and low-income countries. Increased efforts are needed to increase primary series and booster dose coverage among all older adults as recommended by WHO and national health authorities.
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Abstract
BACKGROUND Home nebulizers are in widespread use in cystic fibrosis (CF) and other chronic pulmonary diseases. Bacterial contamination may be a source of respiratory tract colonization. OBJECTIVES To investigate microbial contamination of home nebulizers in CF patients, compare with sputum cultures and relate to cleaning practices. METHODS A total of 29 home nebulizers of CF patients were cultured. Families were interviewed regarding cleaning routines and patients had sputum cultures for bacteria and fungi. RESULTS In total, 19/29 (65%) nebulizers were contaminated: 18 reservoir cups, 14 mouthpieces and five filters. Pseudomonas spp. were isolated from 10 nebulizers (35%) and all 10 had Pseudomonas aeruginosa airway infection although without genetic typing we could not be sure this was the same bacteria as that from their nebulizer unit. An additional 7/29 had Pseudomonas aeruginosa airway infection without a contaminated nebulizer (P=0.001). No nebulizers were contaminated with Aspergillus. Only 4/19 contaminated nebulizers (22%) had been cleaned after every use, compared with seven of the 10 (70%) uncontaminated nebulizers (P=0.017). Only 7/19 patients with contaminated nebulizers (37%) and 5/10 with clean nebulizers (50%) recalled receiving cleaning instructions (not significant). CONCLUSIONS Home nebulizers are frequently contaminated, particularly when cleaning instructions are inadequate, and may be a source of airway infection or reinfection especially following contamination from a patient chronically colonized with P. aeruginosa. Simple oral and written cleaning instructions should be offered.
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Affiliation(s)
- H Blau
- Kathy and Lee Graub Cystic Fibrosis Center, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
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Abstract
BACKGROUND The hands of health care workers are a major source of nosocomial infection. Studies conducted mainly in intensive-care units and emergency departments have shown low compliance with hand hygiene recommendation. OBJECTIVE To study hand hygiene practices in outpatient dermatology clinics in Israel. METHODS The fingers of 13 dermatologist physicians were sampled for bacterial cultures and their hand hygiene practices were monitored by two observers. In addition, 51 dermatologists attending a professional conference completed a questionnaire on hand hygiene practice. RESULTS All the physicians' hands were found to be contaminated. Staphylococcus aureus was isolated in 9 cases (69.2%), a methicillin-resistant S. aureus in 1 (7.7%). Monitoring revealed 555 opportunities for handwashing; the average compliance was 31.4%. In the questionnaire, the main reasons given for poor hand hygiene were excessive work schedule (58%), lack of awareness (35.3%), reaction to disinfectants (17.7%) and lack of readily available facilities (15.7%). CONCLUSION The hands of dermatologists are frequently colonized with microbial pathogens, but compliance with hand hygiene practice recommendations is low, despite a fairly high awareness of the importance. An active educational infection control program should be introduced in dermatology clinics.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Center, Department of Family Medicine, Petach Tiqwa, Israel.
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Thiele H, Lauer B, Hambrecht R, Boudriot E, Cohen HA, Schuler G. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. Circulation 2001; 104:2917-22. [PMID: 11739306 DOI: 10.1161/hc4901.100361] [Citation(s) in RCA: 203] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recovery of myocardial function after revascularization of acutely occluded coronary arteries may require several days. During this critical time, patients in cardiogenic shock may have low output. A newly developed percutaneous left ventricular assist device (VAD) may offer effective treatment for these patients by providing active circulatory support. METHODS AND RESULTS Between May 2000 and May 2001, VADs were implanted in 18 consecutive patients who had cardiogenic shock after myocardial infarction. The device was connected to the patient's circulation by insertion of a 21F venous cannula into the left atrium by transseptal puncture; blood was returned to the iliac artery through an arterial cannula. Mean duration of cardiac assistance was 4+/-3 days. Mean flow of the VAD was 3.2+/-0.6 L/min. Before support, cardiac index was 1.7+/-0.3 L/min per m(2) and improved to 2.4+/-0.6 L/min per m(2) (P<0.001). Mean blood pressure increased from 63+/-8 mm Hg to 80+/-9 mm Hg (P<0.001). Pulmonary capillary wedge pressure, central venous pressure, and pulmonary artery pressure were reduced from 21+/-4, 13+/-4, and 31+/-8 mm Hg to 14+/-4, 9+/-3, and 23+/-6 mm Hg (all P<0.001), respectively. Overall 30-day mortality rate was 44%. CONCLUSIONS A newly developed VAD can be rapidly deployed in the catheterization laboratory setting. This device provides up to 4.0 L/min of assisted cardiac output, which may aid to revert cardiogenic shock. The left ventricle is unloaded by diverting blood from the left atrium to the systemic circulation, making recovery more likely after an ischemic event. The influence of this device on long-term prognosis warrants further investigation.
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Affiliation(s)
- H Thiele
- University of Leipzig, Heart Center, Department of Internal Medicine/Cardiology, Leipzig, Germany
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Sarrell EM, Mandelberg A, Cohen HA. Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med 2001; 155:796-9. [PMID: 11434846 DOI: 10.1001/archpedi.155.7.796] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the efficacy and tolerance of Otikon Otic Solution (Healthy-On Ltd, Petach-Tikva, Israel), a naturopathic herbal extract (containing Allium sativum, Verbascum thapsus, Calendula flores, and Hypericum perforatum in olive oil), compared with Anaesthetic (Vitamed Pharmaceutical Ltd, Benyamina, Israel) ear drops (containing ametocaine and phenazone in glycerin) in the management of ear pain associated with acute otitis media (AOM). DESIGN Children between the ages of 6 and 18 years who experienced ear pain (otalgia) and who were diagnosed with eardrum problems associated with AOM were randomly assigned to be treated with Otikon or Anaesthetic ear drops, which were instilled into the external canal(s) of the affected ear(s). Ear pain was assessed using 2 visual analog scales: a linear scale and a color scale. Pain assessment took place throughout the course of 3 days. The mean score of pain reduction was used to measure outcome. SETTING Primary pediatric community ambulatory centers. PARTICIPANTS One hundred three children aged 6 to 18 years who were diagnosed with otalgia associated with AOM. RESULTS Each of the 2 treatment groups were comparable on the basis of age, sex, laterality of AOM, and the effectiveness of ameliorating symptoms of otalgia. The 2 groups were also comparable to each other in the initial ear pain score and in the scores at each application of Otikon or Anaesthetic drops. There was a statistically significant improvement in ear pain score throughout the course of the study period (P =.007). CONCLUSIONS Otikon, an ear drop formulation of naturopathic origin, is as effective as Anaesthetic ear drops and was proven appropriate for the management of AOM-associated ear pain.
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Affiliation(s)
- E M Sarrell
- Pediatric and Adolescent Ambulatory Community Clinic of General Health Services, Hairis 7 Moshav Gan-Haim, 44910 Israel.
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9
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Abstract
The reported data on the association of kidney and urinary tract malformations with supernumerary nipples are contradictory. We examined 200 children, ages 1 month-16 years, who were being followed because of recurrent urinary tract infection for supernumerary nipples. The patients were divided into two groups: those who were found to have urinary tract malformations on radiographic studies (n=92) and those who were not (n=108). All children were examined for any abnormal pigmentation along the milk line, and the entire body was examined for ectopic supernumerary nipples. Two of the children with proved urinary tract pathology and two of the children with no urinary tract pathology had supernumerary nipples. The odds ratio for having supernumerary nipples among the first group was 1.18 (95% CI: 0.084-16.53, p=0.627). Our results indicate no association between kidney and urinary tract malformations and supernumerary nipples. We believe the message to the practicing physician is that there is no need for radiographic or ultrasonographic investigation of the urinary tract in asymptomatic children found to have supernumerary nipples on routine physical examination.
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Affiliation(s)
- I Grotto
- Department of General Pediatrics and Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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10
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Al Suwaidi J, Yeh W, Cohen HA, Detre KM, Williams DO, Holmes DR. Immediate and one-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). Am J Cardiol 2001; 87:1139-44. [PMID: 11356386 DOI: 10.1016/s0002-9149(01)01482-5] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Balloon angioplasty of bifurcation lesions has been associated with lower success and higher complication rates than most other lesion types. The development of alternative strategies such as debulking and stenting, either alone or in combination, are currently used relatively often. The relative role of these newer approaches in improving acute or long-term outcome, however, remains uncertain. Of the total of 2,436 patients treated between July 1997 to February 1998 in the National Heart, Lung, and Blood Institute Dynamic Registry, there were 321 patients (group 1) with bifurcation lesions and 2,115 patients without any bifurcation lesions attempted (group 2). Treatment strategies in terms of major devices used were significantly different between the 2 groups (group 1 vs 2): balloon angioplasty alone (23.1% vs 26.5%), balloon angioplasty and rotational atherectomy (6.9% vs 4.4%), balloon angioplasty and stent (55.8% vs 59.9%), and balloon angioplasty, rotational atherectomy, and stent (10.3% vs 7%) with p <0.01. There were no significant differences between the groups in terms of age, gender, and frequency of prior myocardial infarction (MI) or coronary artery bypass graft surgery (CABG). Complete angiographic success was achieved in only 86% of bifurcation lesions versus 93.5% of nonbifurcation lesions (p <0.001). In-hospital complication rates were increased in patients with bifurcation lesions compared with the nonbifurcation group: MI, 3.7% versus 2.6%; CABG, 2.2% versus 1.1%; side branch occlusion, 7.3% versus 2.3% (p <0.001); and the composite of death, MI, and any CABG, 7.2% versus 5.0%. At 1-year follow-up, major adverse cardiac events were 25% higher in group 1 than in group 2 (32.1% vs 25.7%, p <0.05). We conclude that despite the widespread use of newer percutaneous devices, treatment of bifurcation lesions remains difficult and is associated with decreased success and increased complication rates compared with nonbifurcation lesions.
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Affiliation(s)
- J Al Suwaidi
- Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA
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11
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Al Suwaidi J, Yeh W, Williams DO, Laskey WK, Cohen HA, Detre KM, Kelsey SF, Holmes DR. Comparison of immediate and one-year outcome after coronary angioplasty of narrowing < 3 mm with those > or =3 mm ( the National Heart, Lung, and Blood Institute Dynamic Registry). Am J Cardiol 2001; 87:680-6. [PMID: 11249883 DOI: 10.1016/s0002-9149(00)01483-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Balloon angioplasty of small coronary artery lesions has been associated with lower success and higher complication rates than large coronary artery lesions. This study evaluates the in-hospital and 1-year outcome of the treatment of small coronary artery lesions in the modern era of interventional cardiology and compares it with the outcome of treating large coronary artery lesions. Of 1,658 patients with a single lesion treated from July 1997 to February 1998 in the National Heart, Lung, and Blood Institute (NHLBI) Dynamic Registry, there were 587 patients with small coronary artery lesions (<3 mm) and 1,071 patients with large coronary artery lesions (> or =3 mm). Success, in-hospital, and 1-year outcomes between both groups were compared. Patients with lesions in small coronary arteries were more often women, insulin-treated diabetics, and had undergone more prior coronary bypass graft surgery. Conventional angioplasty alone was performed more often and angioplasty with stents was performed less often in the small coronary artery than in the large coronary artery group. Angiographic success was slightly lower in the small coronary artery group (94.2% vs 96.9%, p <0.05). Periprocedural and in-hospital complication rates were similar in both groups. Likewise, at 1-year follow-up, major adverse cardiac events including death, myocardial infarction, and coronary artery bypass graft surgery were relatively low and comparable between the 2 groups, although patients with small coronary arteries were more likely to undergo repeat revascularization (17.4% vs 13.6%, p <0.05). Treatment of lesions in small coronary arteries in the modern era is associated with high success and low complication rates, comparable to the treatment of large coronary artery lesions, although the incidence of repeat revascularization was significantly greater at follow-up even if stents were used.
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Affiliation(s)
- J Al Suwaidi
- Mayo Clinic and Foundation, Rochester, Minnesota, USA
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12
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Affiliation(s)
- O Soran
- Cardiovascular Institute of the UPMC Health System, Pittsburgh, PA 15213, USA
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13
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Abstract
Respiratory difficulties are not uncommon during epileptic activity in all age groups. Laryngospasm, as an isolated manifestation of epileptic disorder, is a rare phenomenon described previously in only two patients. We report our experience with five children in whom nocturnal laryngospasm was the only clinical manifestation of their epileptic disorder. All children underwent extensive workup and the diagnosis was made by sleep-deprived electroencephalography (two cases) and sleep study (three cases). All patients were treated with carbamezapine with prompt resolution of their laryngospasm.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Center, Petach Tikva, Israel
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14
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Zenati M, Cohen HA. Emerging new concepts of myocardial laser revascularization. J Thorac Cardiovasc Surg 1999; 118:977-8. [PMID: 10534811 DOI: 10.1016/s0022-5223(99)70082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M Zenati
- Director, Minimally Invasive Cardiac Surgery Program
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15
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Katz WE, Zenati M, Mandarino WA, Cohen HA, Gorcsan J. Assessment of left internal mammary artery graft patency and flow reserve after minimally invasive direct coronary artery bypass. Am J Cardiol 1999; 84:795-801. [PMID: 10513776 DOI: 10.1016/s0002-9149(99)00439-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite its merits, minimally invasive direct coronary artery bypass surgery (MIDCAB) has been criticized for variable left internal mammary artery (LIMA) graft patency rates, prompting the frequent use of postoperative LIMA angiography. Noninvasive transthoracic Doppler interrogation of LIMA grafts has recently been shown to have utility for assessing patency and flow reserve after conventional bypass surgery, but data after MIDCAB has been limited. The objective of this study was to assess LIMA graft anatomy and physiology in 54 patients after MIDCAB using angiography and noninvasive LIMA Doppler imaging. The right internal mammary artery (RIMA) was studied as a control. LIMA flow reserve in response to adenosine was evaluated in a subgroup of 18 randomly chosen patients with patent grafts. LIMA angiographic patency was 93%. Forty-four patients (81%) had obtainable LIMA Doppler data. Patent grafts had a diastolic dominant flow pattern with a peak diastolic/systolic velocity ratio of 1.3 +/- 0.6 and a percent diastolic time-velocity integral (TVI) of 70 +/- 11%. These data were significantly different than the RIMA control values of 0.2 +/- 0.1 and 30 +/- 10%, respectively (p <0.05). Occluded grafts had absent flow or a systolic dominant pattern. Adenosine-induced increases in LIMA peak diastolic velocity from 48 +/- 20 to 105 +/-28 cm/s (p <0.05 vs baseline) and diastolic TVI from 21 +/- 10 to 37 +/- 19 cm (p <0.05 vs baseline), yielding adenosine/baseline ratios of 2.4 +/- 0.9 and 2.0 +/- 0.7, respectively, which was consistent with normal flow reserve. The diastolic flow velocity reserve response was inversely related to baseline diastolic flow (r = -0.69). In conclusion, MIDCAB can be associated with a high rate of LIMA potency and favorable physiologic Doppler flow patterns. Correlation of these findings to long-term patient outcome after MIDCAB is warranted.
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Affiliation(s)
- W E Katz
- Division of Cardiology, University of Pittsburgh, Pennsylvania, USA.
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16
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Cannan CR, Yeh W, Kelsey SF, Cohen HA, Detre K, Williams DO. Incidence and predictors of target vessel revascularization following percutaneous transluminal coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Am J Cardiol 1999; 84:170-5. [PMID: 10426335 DOI: 10.1016/s0002-9149(99)00229-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We sought to determine the rate of target vessel revascularization (TVR) after percutaneous transluminal coronary angioplasty (PTCA) and to determine factors that predispose to its occurrence. The 10-year outcome of 2,262 patients in the National Heart, Lung, and Blood institute PTCA Registry was analyzed to determine the incidence and characterize predictors of TVR. TVR was performed in 30.4% of patients. Male gender (relative risk [RR] 1.26; p <0.05), diabetes (RR 1.57; p <0.001), multiple discrete lesions (RR 1.38, p <0.01), diffuse lesions (RR 1.27; p <0.05), and calcium at the lesion site (RR 1.25; p <0.05) were predictors for TVR. TVR was performed early (< or = 1 year) in 18.3% and late (> 1 year) in 12.2%. Age > or = 65 years (RR 1.24; p <0.05), congestive heart failure (RR 1.70; p <0.05), acute coronary insufficiency (RR 1.28; p <0.05), and left anterior descending lesion location (RR 1.34, p <0.01) were significant predictors of early versus late TVR by multivariate analysis. Coronary artery bypass grafting (CABG) rather than PTCA was the TVR procedure in 21% of patients undergoing early TVR and 58% of those undergoing late TVR. Significant independent predictors of CABG as the TVR procedure were multivessel disease (RR 1.97; p <0.001), presence of collateral vessels (RR 1.81; p <0.05), diffuse (RR 1.89; p <0.01), or occluded (RR 1.82; p <0.05) target lesions, and a greater residual stenosis after the initial PTCA (RR 1.19; p <0.001). Age > or = 65 years (RR 0.65; p <0.05) conferred a lower risk for CABG.
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Affiliation(s)
- C R Cannan
- Division of Cardiology, Rhode Island Hospital, Brown University, Providence 02906, USA
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17
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Abstract
This study describes a non-pharmacological treatment modality for children with trichotillomania. Three children with trichotillomania were treated using a hypnotherapy technique. All patients were observed in the outpatient clinic for 8 consecutive weeks and subsequently followed for 12-18 months. All children were cooperative in performing the hypnotherapy technique (relaxation/mental imagery). Two patients reported complete resolution of their complaints after 7-8 weeks and 1 patient after 16 weeks. The latter, reporting recurrence of the complaint after 4 weeks due to stressful school problems, was resolved after successful retreatment over 3 weeks. During a mean follow-up period of 16 months, there were no recurrences. In conclusion, hypnotherapy may be considered as a primary treatment modality for trichotillomania in children without associated emotional disorders.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Center, Petach Tikva, Israel
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18
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Abstract
OBJECTIVE Integrated coronary revascularization combines minimally invasive coronary artery bypass grafting (MICABG) with left internal thoracic artery-left anterior descending artery grafting and percutaneous coronary intervention. We hypothesized that integrated coronary revascularization could result in successful revascularization in suitable patients with multivessel coronary artery disease. METHODS Between September 1996 and January 1998, 31 consecutive patients underwent integrated coronary revascularization. Twenty-two were male; mean age was 69 years (46-86 years) and 42% were older than 75 years. Eight patients (26%) had a Parsonnet score greater than 20%. Left ventricular ejection fraction was 46.3% +/- 12%; 6 patients (19%) had a left ventricular ejection fraction less than 35%. RESULTS The anastomosis time for MICABG with the internal thoracic artery was 14.6 +/- 5.2 minutes and the operating time was 105 +/- 20 minutes; 28 patients (90%) were extubated in the operating room. The internal thoracic artery anastomosis was patent in all 31 patients (100%). Percutaneous coronary intervention was performed before MICABG in 2 patients (7%), on the same day of MICABG in 16 patients (52%), on postoperative day 1 in 3 patients (9%), and on postoperative days 2 to 4 in 10 patients (32%). Postprocedure length of stay in the hospital was 2.7 +/- 1.0 days and 13 patients (42%) were discharged home on postoperative day 1 or 2. Three patients (9.6%) required repeat target vessel revascularization in the distribution of the previous percutaneous coronary intervention. All patients are alive without angina at a follow-up of 10.8 +/- 3.8 months. CONCLUSION Our early results demonstrate that integrated coronary revascularization can be performed safely and effectively. Long-term results will be available from a prospective randomized trial now underway to compare integrated coronary revascularization with coronary artery bypass grafting for multivessel coronary artery disease.
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Affiliation(s)
- M Zenati
- Divisions of Cardiothoracic Surgery and Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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19
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Cohen HA, Zenati M. Integrated coronary revascularization. J Invasive Cardiol 1999; 11:184-90; discussion 190-1. [PMID: 10745509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- H A Cohen
- University of Pittsburgh Medical Center, Pennsylvania, USA
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20
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Reis SE, Holubkov R, Zell KA, Smith AJ, Cohen HA, Feldman MD, Blumenthal RS. Estrogen acutely abolishes abnormal cold-induced coronary constriction in men. Chest 1998; 114:1556-61. [PMID: 9872188 DOI: 10.1378/chest.114.6.1556] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND STUDY OBJECTIVE Ambient cold exposure may induce myocardial ischemia by precipitating coronary artery constriction and a decrease in coronary blood flow. Estrogen has vasoactive properties that may prevent abnormal coronary constriction in a sex-independent manner. The purpose of this study is to determine whether estrogen acutely abolishes abnormal coronary responses to cold exposure in men. DESIGN Randomized, double-blinded placebo-controlled clinical trial. SETTING Cardiac catheterization laboratory. PATIENTS Men referred for routine diagnostic coronary angiography who exhibit abnormal coronary artery constriction in response to a 90-s cold pressor test (CPT). INTERVENTION Intravenous conjugated estrogens (1.25 mg) vs. placebo. MEASUREMENTS AND RESULTS Rate-pressure product, coronary cross-sectional area (CSA), and coronary blood flow responses to the CPT were measured before and 15 min after intervention. In 12 men with CPT-induced coronary constriction who were assigned to estrogen, CPT induced a mean 21.8% decrease in coronary CSA (p < 0.01) and a nonsignificant change in coronary flow. After estrogen, the repeated CPT induced a 16.3% increase in CSA (p < 0.01) and a 54.9% increase in flow (p < 0.01). CSA and coronary flow responses to CPT were significantly different before and after estrogen (p < 0.01). In contrast, placebo was not associated with changes in CSA or coronary flow responses to CPT in eight men. CONCLUSIONS In men, conjugated estrogens acutely abolish abnormal coronary constriction and improve coronary blood flow responses to an exogenous cold stimulus. These results suggest that estrogen favorably alters coronary vasoreactivity in men.
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Affiliation(s)
- S E Reis
- Division of Cardiology, University of Pittsburgh, PA, USA.
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21
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Zenati M, Cohen HA, Holubkov R, Smith AJ, Boujoukos AJ, Caldwell J, Firestone L, Griffith BP. Preoperative risk models for minimally invasive coronary bypass: a preliminary study. J Thorac Cardiovasc Surg 1998; 116:584-9. [PMID: 9766586 DOI: 10.1016/s0022-5223(98)70164-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Available risk assessment models are designed for standard coronary artery bypass grafting. We hypothesized that minimally invasive coronary bypass could improve on predicted outcome in extremely high-risk patients (Parsonnet score > 20%) by the current risk models. METHODS From September 1996 to September 1997, 27 consecutive extremely high-risk patients underwent minimally invasive coronary bypass. Seventeen patients were male; age was 73 +/- 12 years, and 63% of patients were older than 75 years. Left ventricular ejection fraction was 33.7% +/- 15% and 63% had an ejection fraction of less than 35%. The predicted 30-day mortality according to the System 97 model was 25.6% +/- 11.3%. The Parsonnet risk score was 36.2% +/- 11%; the predicted length of stay in the hospital was 15.3 +/- 3 days. The predicted risk of stroke according to the Multicenter Perioperative Stroke Risk Index was 22.3% +/- 11.7%. RESULTS Minimally invasive coronary bypass was isolated in 20 patients and integrated with angioplasty and stenting in 7 patients. The observed 30-day mortality was 0% (P < .01 vs predicted): at an average follow-up of 10.8 +/- 4.1 months, 26 patients (96.3%) are alive without angina; one patient with acquired immunodeficiency syndrome died on postoperative day 40 of acute pancreatitis. No patient had a stroke or neurologic deficit (P < .01 vs predicted). Patency of internal thoracic artery anastomosis was confirmed by angiography in all 27 patients. No patient required reoperation. Eighteen patients (67%) were extubated in the operating room. The observed length of hospital stay after minimally invasive coronary bypass was 3.8 +/- 2.6 days (P < .01 vs predicted). CONCLUSION On the basis of our results on a relatively small series of patients, we suggest that risk models geared for standard coronary bypass grafting may not be appropriate for minimally invasive coronary bypass.
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Affiliation(s)
- M Zenati
- Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center, PA 15213-2582, USA
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22
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Cohen HA, Zenati M, Smith AJ, Lee JS, Chough S, Jafar Z, Counihan P, Izzo M, Burchenal JE, Feldman AM, Griffith B. Feasibility of combined percutaneous transluminal angioplasty and minimally invasive direct coronary artery bypass in patients with multivessel coronary artery disease. Circulation 1998; 98:1048-50. [PMID: 9736589 DOI: 10.1161/01.cir.98.11.1048] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Angioplasty has become an accepted treatment of patients with coronary artery disease and is now commonly used to treat patients with multivessel disease. The major disadvantage of angioplasty has been restenosis requiring repeat interventions with resultant loss of initial cost savings. Compared with the right and the circumflex coronary arteries, the left anterior descending artery (LAD) has been more adversely affected by restenosis. Recently, minimally invasive direct coronary artery bypass (MIDCAB) to the LAD through a small left anterior thoracotomy using the left internal mammary artery has been performed in some centers with excellent early results and with reduced costs compared with standard bypass surgery. METHODS AND RESULTS We retrospectively reviewed the first 31 consecutive patients treated in our institution with integrated coronary revascularization (ICR): MIDCAB to the LAD combined with PTCA of the other diseased vessels in patients with multivessel disease. Postoperative angiography in 84% of patients revealed a patent anastomosis and normal flow in the graft and bypassed vessel. Thirty-eight (97%) of 39 vessels were successfully treated percutaneously. At a mean follow-up of 7 months, all patients are currently asymptomatic. There have been 2 adverse clinical events, both related to angioplasty and not to MIDCAB. The average length of stay at the hospital after MIDCAB was 2.79+/-1.05 days. CONCLUSIONS These preliminary results with ICR are encouraging and suggest that a randomized, prospective clinical trial comparing ICR with standard coronary artery bypass surgery for the revascularization of symptomatic patients with multivessel disease involving the LAD is warranted.
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Affiliation(s)
- H A Cohen
- From the Divisions of Cardiology and Cardiovascular Surgery, The University of Pittsburgh Medical Center, Presbyterian University Hospital, Pittsburgh, PA 15213, USA.
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23
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Abstract
OBJECTIVES to determine whether non disposable aurioscope earpieces used in community paediatric clinics harbored pathogenic micro-organisms, and to explore primary pediatrician perception of the possibility of cross infection from contaminated aurioscope earpieces and of how their aurioscope earpieced are cleaned. DESIGN randomized survey. SETTING four community pediatric clinics. MATERIALS 42 pediatricians' aurioscope earpieces were cultured on blood agar and mannitol-salt-agar plates by two methods: (1) The earpieces were rolled for 5 s onto blood agar plates (TSA + 5% sheep blood, and a mannitol-salt-agar-plate). (2) The entire surface of the earpiece was swabbed with a sterile cotton tipped applicator moistened in sterile saline solution and was inoculated immediately onto a blood agar plate, and a mannitol-salt-agar-plate. The plates were incubated at 37 degrees C for 48 h and examined for colony growth at 24 and 48 h of incubation. Culture results were recorded as mean numbers of colony-forming units (CFUs). RESULTS 36 from 42 (86%) of the aurioscope earpieces were colonized by micro-organisms. Heavily contaminated earpieces were found in six (14%). Staphylococci were isolated from 27 (64%) of the earpieces: 19 (45%) being Staphylococci aureus coagulase positive, 4 (9%) were methicillin resistant S. aureus (MRSA). CONCLUSIONS Non disposable earpieces can harbor potentially pathogenic bacteria including MRSA. The increased trend for children with immunodeficiency to be managed in an ambulatory setting, often by physicians who also work in hospital, might be a risk of spreading potentially serious infections to such patients. Non disposable earpieces should be regularly disinfected to minimize the spread of infection.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Centre, Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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24
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Cohen HA, Ashkenasi A, Ring H, Weiss R, Wolach B, Paret G, Barzilai A. Poliomyelitis-like syndrome following asthmatic attack (Hopkins' syndrome)--recovery associated with i.v. gamma globulin treatment. Infection 1998; 26:247-9. [PMID: 9717685 DOI: 10.1007/bf02962374] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A report on a 15-year-old male with a diagnosis of poliomyelitis-like syndrome (Hopkins' syndrome) following an asthmatic attack is presented. The prognosis of Hopkins' syndrome is usually poor and the patients remain with permanent paralysis of the affected limb. The outcome correlates with severity of the initial injury to the anterior horn cell as reflected by abnormal electrophysiologic studies. This is the first case report of treatment with i.v. gamma globulin in Hopkins' syndrome which resulted in a nearly complete recovery.
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Affiliation(s)
- H A Cohen
- Family Medicine Dept., Lowenstein Rehabilitation Hospital, Israel
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25
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Abstract
Honey has been described in ancient and modern medicine as being effective in the healing of various infected wounds. In this report we present our experience in nine infants with large, open, infected wounds that failed to heal with conventional treatment. Conventional treatment was defined as having failed if after > or = 14 d of intravenous antibiotic and cleaning the wound with chlorhexidine 0.05% W/V in aqueous solution and fusidic acid ointment the wound was still open, oozing pus, and swab cultures were positive. All infants showed marked clinical improvement after 5 d of treatment with topical application of 5-10 ml of fresh unprocessed honey twice daily. The wounds were closed, clean and sterile in all infants after 21 d of honey application. There were no adverse reactions to the treatment. We conclude that honey is useful in the treatment of post-surgical wounds that are infected and do not respond to conventional systemic and local antibiotic treatment.
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Affiliation(s)
- A Vardi
- Paediatric Intensive Care Unit, Chaim Sheba Medical Centre, Tel Hashomer, Israel
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26
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Abstract
Handwashing is acknowledged as a critical factor in the prevention of nosocomial infection. Nonetheless, health care personnel often wash their hands inadequately. The purpose of this study was to examine the flora of hands and the frequency of handwashing of physicians working in primary care pediatric community clinics. The fingers of the dominant hand of 55 physicians working in 12 clinics were sampled for bacterial cultures. Only 354/720 (49%) of the expected handwashings by 17 board-certified pediatricians were recorded as having been performed. None of them washed their hands after each contact with an examined child. All physicians' hands were found to be contaminated with microorganisms. Staphylococcus species were isolated from 47 (85.4%) of the physicians' hands. Methicillin-resistant Staphylococcus aureus was found on the hands of 9.1% of the physicians. Such contaminated hands may serve as a potential vector of community-acquired infection with highly resistant organisms. Compliance with handwashing recommendations among these physicians was low. An active educational infection control program must be introduced in ambulatory pediatric community clinics.
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Affiliation(s)
- H A Cohen
- Dept. of Family Medicine, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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27
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Abstract
OBJECTIVES We aimed to determine whether stethoscopes and otoscopes used in community paediatric clinics harboured pathogenic micro-organisms, and, if so, which measures could prevent this. METHODS Fifty-five stethoscopes belonging to paediatric physicians working in 12 community clinics were sampled for bacterial cultures by two methods: (i) direct impression of the diaphragm and bell section of each stethoscope for 5 seconds onto blood agar plates and a mannitol-salt-agar plate; (ii) swabbing the entire surface of the diaphragm of the stethoscope with a sterile cotton-tipped applicator. Forty-two otoscopes from the same physicians were sampled by rubbing the handles of the otoscopes with cotton-tipped swabs. The plates were incubated at 37 degrees C for 48 hours and examined for colony growth at 24 and 48 hours of incubation. Culture results were recorded as mean numbers of colony-forming units (CFUs). Eight additional stethoscope diaphragms were chosen at random at the participating clinics and cultured as described above. They were then wiped with alcohol swabs (isopropyl alcohol 70%), allowed to air dry for approximately 10 minutes and cultured a second time. RESULTS All the stethoscopes and 90% of the otoscope handles were colonized by microorganisms. Staphylococci were isolated from 85.4% of the stethoscopes and 83.3% of the otoscopes, with 54.5% and 45.2% respectively being S. Aureus. Methicillin-resistant S. aureus were found in four each of the stethoscopes (7.3%) and otoscopes (9.5%). Cleaning with alcohol reduced the colony count by an average of 96.3%. CONCLUSIONS Fomites can harbour potentially pathogenic bacteria, and with the increasing trend for children with more complex medical problems to be managed in an ambulatory setting, often by physicians who also work in hospitals, there is a real risk of spreading potentially serious infections to such patients. Simple cleansing with alcohol effectively eliminates the bacterial contamination of the fomites, and should be encouraged.
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Affiliation(s)
- H A Cohen
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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28
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Abstract
Herpetic gingivostomatitis is common in young children, but primary oral infection has also been described in adults. Herpetic whitlow as an occupational hazard of medical personnel has been well documented. Four cases of primary herpetic gingivostomatitis are reported in two pediatricians and two pediatric nurses who contracted the infection in their fourth decade of life. All suffered from sore throat and fever as presenting symptoms. Correct diagnosis was delayed for 4-5 days. In conclusion, pediatric personnel with pharyngitis and a negative history of herpetic gingivostomatitis or herpes labialis should bear the possibility of oral HSV infection in mind. Early diagnosis is essential to prevent the spread of the infection to their patients.
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Affiliation(s)
- J Amir
- Dept. of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
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29
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Cohen HA, Matalon A, Mezger A, Ben Amitai D, Barzilai A. Striae in adolescents mistaken for physical abuse. J Fam Pract 1997; 45:84-85. [PMID: 9228918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Physiological striae are common in adolescence, occurring in the lumbar and gluteal regions, the upper thighs, breast, lower abdomen, and back. The lesions may be mistaken for nonaccidental injury, that is, physical abuse. We present four cases of adolescents with lesions thought to be due to physical abuse. Three of these cases were revealed during a school screening program for scoliosis; of the 2600 adolescents screened, aged 12 to 16 years, 168 were found to have striae. One case was found by a family physician when a young boy presented with low back pain. Since striae may be mistakenly ascribed to physical abuse, it is important for family physicians, nurses, and pediatricians to be familiar with this benign condition.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Center, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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30
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Abstract
OBJECTIVE To determine if vitamin C (ascorbic acid) has a protective effect on the hyperreactive airways of patients with exercise-induced asthma (EIA). DESIGN All the patients underwent pulmonary function tests at rest, before and 1 hour after receiving 2 g of oral ascorbic acid. They were then randomly assigned in a double-blind manner to receive 2 g of ascorbic acid or a placebo 1 hour before a 7-minute exercise session on a treadmill. Pulmonary function tests were performed after an 8-minute rest. This procedure was repeated 1 week later, with each patient receiving the alternative medication. SETTING A university hospital. PARTICIPANTS Twenty patients with asthma (13 males and 7 females), with ages ranging from 7 to 28 years (mean, 13.8 years). All patients who had a decline of at least 15% in their forced expiratory volume in 1 second after a standard exercise test on a motorized treadmill received a diagnosis of EIA. MAIN-OUTCOME MEASURES: All patients were advised to stop using their regular asthma medication or bronchodilator 12 hours before the test. Pulmonary function tests were performed in the same ambient conditions on all patients. RESULTS All patients received a diagnosis of EIA. Ascorbic acid administration did not change the results of pulmonary functions at rest after 1 hour. In 9 patients, a protective effect on exercise-induced hyperreactive airways was documented. Four of 5 patients who received ascorbic acid and documented a protective effect on EIA continued to receive ascorbic acid, 0.5 g/d, for 2 more weeks with the same protective effect. CONCLUSIONS The efficacy of vitamin C in preventing EIA cannot be predicted. However, vitamin C may have a protective effect on airway hyperreactivity in some patients with EIA.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Clinic, Rabin Medical Center, Petach Tiqva, Israel
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Cohen HA, Woloch B, Linder N, Vardi A, Barzilai A. Urine samples from disposable diapers: an accurate method for urine cultures. J Fam Pract 1997; 44:290-292. [PMID: 9071249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization. METHODS Urine was obtained from 38 infants aged under 2 years who presented with fever with no obvious cause. All infants had urine collected either by catheterization or suprapubic aspiration and by extraction from a disposable diaper. The urine samples were cultured using standard bacteriologic techniques. RESULTS Five infants had a urinary tract infection, as shown by a pure growth of more than 10(5) colonies/mL of a single species of bacterium. In all the cases the same result was obtained from both the diaper urine sample and the sample obtained by suprapubic aspiration or catheter. In 31 infants the urine samples collected by both techniques (diaper and catheter or suprapubic aspiration) were negative, and in only 2 infants did the diaper specimen yield a positive result, while the urine obtained by suprapubic aspiration or catheter was sterile. CONCLUSIONS Urine obtained from a disposable diaper can provide a valid sample for diagnosing urinary tract infection. The technique is simple, and can be carried out readily in ambulatory settings with minimal equipment and expense.
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Affiliation(s)
- H A Cohen
- Pediatric Ambulatory Center, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Abstract
OBJECTIVE To report four cases of fixed drug eruption induced by hydroxyzine hydrochloride (Otarex, Teva, Israel). CASE SUMMARY Four children with restlessness who were treated with hydroxyzine hydrochloride developed fixed drug eruption of the penis. Drug discontinuation was followed by complete resolution of the skin eruption. Rechallenge resulted in the same drug rash. Macrophage migration inhibiting factor (MIF) assay with hydroxyzine hydrochloride was positive. DISCUSSION The pathogenesis of fixed drug eruption and the role of macrophage MIF assay in diagnosis is discussed. CONCLUSIONS A fixed drug eruption induced by hydroxyzine hydrochloride is possible, but is a rare phenomenon.
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Affiliation(s)
- H A Cohen
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Cohen HA, Cohen Z, Frydman M. Fixed drug eruption of the scrotum due to hydroxyzine hydrochloride (Atarax). Cutis 1996; 57:431-2. [PMID: 8804847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fixed drug eruption describes a sharply localized dermatitis that characteristically recurs at the same site each time the offending drug is administered. Several drugs have been reported to cause this eruption, such as phenolphthalein, barbiturates, penicillin, and others. In this report, two children with fixed drug eruption of the scrotum due to hydroxyzine hydrochloride (Atarax) are described. To the best of our knowledge, no such cases have been reported previously in children.
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Affiliation(s)
- H A Cohen
- Department of Pediatrics, Hasharon Hospital, Petach Tikvah, Israel
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Cohen HA, Cohen Z, Ashkenasi A, Straussberg R, Frydman M, Kauschansky A, Varsano I. Melkersson-Rosenthal syndrome. Cutis 1994; 54:327-8. [PMID: 7835060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Four patients with recurrent upper lip and facial swelling and lingua plicata together with peripheral facial nerve palsy involvement were diagnosed as having Melkersson-Rosenthal syndrome. Because of the rarity of this syndrome in children, we present the results of follow-up evaluations of our patients and review the literature.
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Affiliation(s)
- H A Cohen
- Department of Pediatrics, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Cohen HA, Nussinovitch M, Straussberg R. Embedded earrings. Cutis 1994; 53:82. [PMID: 7851126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Techniques used to pierce ears include needles, safety pins, sharpened studs, self-piercing kits, and spring-loaded guns. The spring-loaded gun requires minimal personnel training and because it is easy to use, it has a widespread popularity. We report twenty-six cases of embedded earrings following ear piercing with the spring-loaded gun.
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Affiliation(s)
- H A Cohen
- Pediatric Community Clinic, Petach Tikvah, Israel
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Cohen HA, Kauschansky A, Ashkenasi A, Bahir A, Frydman M, Horev Z. Swimming and grommets. J Fam Pract 1994; 38:30-32. [PMID: 8289048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Traditionally, children with tympanostomy ventilating tubes, or grommets, were advised that water should not enter their ears in order to prevent ear infections. This group of children has been considered somewhat handicapped regarding swimming. We conducted a prospective study to determine if there is a relation between suppurative otitis media and surface swimming in children with grommets. METHODS Forty-two children with tympanostomy ventilating tubes were included in this study. Of the 42 children, 22 were swimmers and 20 were nonswimmers, who served as the control group. The age range was 3 to 12 years, and there was no difference in the age distribution between the groups. Surface swimming was allowed without earplugs or a bathing cap, although it was mandatory to use polymyxin B-neomycin-hydrocortisone eardrops at bedtime on the day of swimming. No diving was allowed. RESULTS Three of 22 swimmers and 2 of 20 nonswimmers developed otorrhea. In 4 of the 5 children, the otorrhea was followed by an upper respiratory tract infection. In all cases, a bacterial culture revealed Pseudomonas. The ear drainage was easily controlled with local otic treatment in all the patients. CONCLUSIONS Taking into consideration the possible risks of infection and bearing in mind the value and joy of swimming to children and parents, families should be reassured that surface swimming does not increase the risk of infection in children with tympanostomy tubes.
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Affiliation(s)
- H A Cohen
- Ambulatory Pediatric Center, Petach Tiqwa, Israel
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Ashkenasi A, Amir J, Cohen HA, Frydman M, Varsano I, Lahat E. Status epilepticus encephalopathy with cat-scratch disease. Clin Pediatr (Phila) 1993; 32:701-2. [PMID: 8299308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
Benign paroxysmal torticollis in infancy is characterized by periods of torticollic posturing of the head. The onset of the episodes usually occurs during the first month of life and may recur at varying intervals until the age of 1-5 years. This appears to be a self-limited disorder. The follow-up of 7 patients with benign paroxysmal torticollis is presented.
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Affiliation(s)
- H A Cohen
- Department of Pediatrics, Hasharon Hospital, Petach Tikvah, Israel
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Abstract
A sister and a brother, offspring of unaffected consanguineous Arab parents, were found to have leukonychia totalis and flat, wide nails. To our knowledge this is the first report of apparent autosomal recessive transmission of this trait. A parental somatic mutation with gonadal mosaicism may explain the unusual segregation of the trait in this family.
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Affiliation(s)
- M Frydman
- Department of Pediatrics, Hasharon Hospital, Petah Tiqwa, Israel
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Affiliation(s)
- R Straussberg
- Department of Pediatrics, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Abstract
Benign acquired isolated abducens nerve palsy in infants and children is a rare condition and recurrence is even less common. The diagnosis is essentially one of exclusion. Six children (1 male, 5 females) are reported with benign isolated abducens nerve palsy, ranging in age from 8 months to 12 years (median: 5.5 years). The left side was affected in all patients. Recovery occurred within 18-55 days, but 3 patients developed recurrence with complete resolution of symptoms within 10-21 days.
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Affiliation(s)
- H A Cohen
- Department of Pediatrics, Golda Medical Center, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Cohen HA, Nussinovitch M, Kauschansky A, Straussberg R, Ashkenasi A, Frydman M, Varsano I. Extraordinary daytime urinary frequency in children. J Fam Pract 1993; 37:28-29. [PMID: 8345336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Sudden onset of daytime urinary frequency of a small amount of urine in a previously toilet-trained child can be a disturbing problem. Psychosocial problems, problems at school, or problems within the family have to be taken into consideration. METHODS Fifteen children with sudden onset of isolated daytime urinary frequency were evaluated and followed for a period of 12 to 18 months. A thorough medical and family history was obtained for each child, with special attention given to any psychosocial problems the child had experienced. All the children underwent a physical examination, complete urinalysis, and ultrasonography of the kidneys and bladder. RESULTS In all of the patients, the urinalysis and ultrasonographic findings were within normal limits. A trigger factor was identified as the cause of urinary frequency in each case. CONCLUSIONS Because urinary frequency is usually a benign self-limited condition, an extensive urological evaluation is not indicated. In most cases, providing reassurance to the parents and the child is the only intervention necessary.
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Affiliation(s)
- H A Cohen
- Community Children's Clinic, Petah Tiqwah, Israel
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Affiliation(s)
- R Straussberg
- Department of Pediatrics, Hasharon Hospital, Petach Tikvah, Israel
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Abstract
Headache, nuchal rigidity, positive Kernig's sign, and even convulsions may be observed during severe bacterial infections such as pneumonia, pyelonephritis, typhoid fever, and bacillary dysentery. In such cases, meningitis can be excluded only by documentation of normal cerebrospinal fluid (CSF). The authors describe four children with lobar pneumonia in whom the clinical signs of meningeal irritation were associated with a mild increase in the white blood cell count in the CSF (pleocytosis) although there was no other evidence of meningeal infection.
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Affiliation(s)
- H A Cohen
- Department of Pediatrics, Hasharon Hospital, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel
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Frydman M, Cohen HA, Ashkenazi A, Varsano I. Familial segregation of cervical ribs, Sprengel anomaly, preaxial polydactyly, anal atresia, and urethral obstruction: a new syndrome? Am J Med Genet 1993; 45:717-20. [PMID: 8456850 DOI: 10.1002/ajmg.1320450611] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a consanguineous Jewish family originating from Bombay, India, the propositus presented with anal atresia, micropenis, urethral obstruction with secondary prune belly, omphalocele, patent urachus, and cryptorchidism. The kidneys were dysplastic and he had the Potter phenotype with limb deformities. Additional findings included IUGR with microcephaly, congenital heart defects, spinal anomalies, and hypoplastic lungs. The mother and all three sisters had cervical ribs, and she and one sister had 11 pairs of thoracic ribs. The other two sisters had chronic immune thrombopenia. One of those had bilateral Sprengel deformity with homovertebral bones, club feet, and microcephaly and the other sister also had unilateral preaxial hexadactyly. Although familial segregation of cervical ribs and Sprengel deformity has been reported, the association of the findings in this family is unique and may represent a new syndrome. X-linked dominant transmission may explain the severe manifestations in the affected male, but other modes of inheritance may also apply.
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Affiliation(s)
- M Frydman
- Department of Pediatrics, Hasharon Hospital, Petah Tiqva, Israel
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Abstract
Among the foreign bodies most often found in children's nostrils are hair, beads, toy parts, paper wads, and food. Sometimes extraction of nasal foreign bodies can be difficult, especially if they are spherical. The classical presentation is a unilateral, persistent, foul-smelling, purulent, or bloody nasal discharge. Ulceration, dislodgement of the foreign body into the nasopharynx, and aspiration of the foreign body can complicate the problem.
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Kauschansky A, Cohen HA, Varsano I, Laron Z, Frydman M. Familial isolated growth-hormone deficiency with advanced sexual maturation. Am J Dis Child 1993; 147:170-3. [PMID: 8427240 DOI: 10.1001/archpedi.1993.02160260060023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Two brothers, aged 15 1/2 and 13 1/2 years, with dwarfism, microcephaly, and advanced sexual and skeletal maturation are described. One patient was mentally retarded. The parents were first cousins. Endocrine studies of these patients documented low growth-hormone levels after clonidine and insulin stimulation and blunted growth-hormone response to growth hormone releasing hormone. Gonadotropin releasing hormone stimulation produced no changes in levels of luteinizing and follicle-stimulating hormones. Basal levels of 17-alpha-hydroxyprogesterone were elevated in the two patients and increased further in response to stimulation with corticotropin. Levels of testosterone, dehydroepiandrosterone sulfate, and androstenedione were variably increased in both patients and showed a proportional increase on stimulation with human chorionic gonadotropin. To our knowledge, this is the first report of a familial association between growth-hormone deficiency and advanced bone and sexual maturation. A pituitary and an independent adrenal defect could account for the observations in these patients, but in view of the familial recurrence, a common underlying defect is possible.
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Affiliation(s)
- A Kauschansky
- Endocrinology Clinic, Hasharon Hospital, Golda Medical Center, Petah Tiqwa, Israel
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Cohen HA, Abarbanel J, Ashkenasi A, Frydman M, Straussberg R, Varsano I. Urodynamic manifestations associated with Ramsay-Hunt syndrome. Case report. Scand J Urol Nephrol 1993; 27:129-31. [PMID: 8493462 DOI: 10.3109/00365599309180430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- H A Cohen
- Department of Pediatrics, Golda Medical Center, Hasharon Hospital, Petach Tikvah, Israel
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