RESUMEN
INTRODUCTION: The aim of this study was to investigate the association between helminth infections and celiac disease (CeD), examining various demographic and clinical factors in CeD cases compared to controls. METHODS: We conducted a retrospective case-control study utilizing Leumit Health Care Services' electronic health records. The study encompassed individuals with CeD and a matched control group. We analyzed demographic and clinical characteristics, examining their association with helminth infections. RESULTS: We observed CeD cases and controls had similar mean ages (17.8 years vs. 18.0 years, p = 0.565) and gender distributions (64.0% females in both groups, p = 0.999). There were no significant differences in socioeconomic status and ethnic distribution between the two groups. Most of the helminthiases in the CeD group were due to intestinal helminthiases, and most of the intestinal helminthiases were nematode (roundworm) infections. Enterobiasis (the pinworm Enterobius vermicularis) is involved in most cases (odds ratio 1.32, 95% confidence interval 1.20-1.45, p < 0.001). While the prevalence of ascariasis and anisakiasis was also higher in the CeD group, these differences were not statistically significant (p = 0.115 and p = 0.174, respectively). No significant differences were found in the prevalence of other specific helminth infections, such as echinococcosis, cestode infections, and strongyloidiasis. CONCLUSIONS: This study reveals an unexpected association between CeD and helminth infections, challenging prevailing hypotheses, particularly within the context of the hygiene hypothesis. These findings warrant further investigation to elucidate the mechanisms underlying this intriguing relationship.
RESUMEN
With the transition to distance-learning at the beginning of the COVID-19 outbreak, several countries required parents and their children to remain at home, under lockdown. Many parents found themselves taking on additional responsibilities regarding their children's education. However, children do not always interpret their parents' intentions as they intended. This study investigated this complex relationship, showing that parents' emphases regarding science learning changed during the first COVID-19 lockdown and in parallel, the relations between these emphases and their adolescent children's goal orientation and self-efficacy toward science learning also changed. In 2019, one year before the COVID-19 lockdown, the children's mastery and performance orientations toward science, and their self-efficacy in science were significantly correlated with their parent's attitudes toward science. In 2020, shortly after the end of the first COVID-19 lockdown, these relations remained significant, but in addition the parents' emphasis on performance became a significant predictor of the children's mastery and performance orientations, and of their self-efficacy in science. A small increase in the children's performance orientation and self-efficacy in science was seen, and only a small decline in their mastery orientation toward science. These findings contrast with what the literature indicates is typical at this age, when there are no lockdown conditions.
RESUMEN
OBJECTIVE: To assess the correlation of co-morbid ADHD and diabetes-related complications in patients with type-1-diabetes-mellitus (T1DM). METHODS: A retrospective cross-sectional study was conducted during 2018 using the Leumit-Health-Services(LHS) database. Diabetes-related complications were assessed in patients with T1DM and ADHD (T1DM-ADHD+) and compared with patients with T1DM alone (T1DM-ADHD-). RESULTS: Out of 789 adult-patients with T1DM, 75 (9.5%) were T1DM-ADHD+, matched to 225 T1DM-ADHD-. HbA1C levels were higher in T1DM-ADHD+ patients (8.1% ± 1.6 vs. 7.4% ± 1.2, p < .01), as well as diabetes-related complications: neuropathy (22.7% vs. 5.8%, p < .01), ulcers (8% vs. 0.9%, p < .05), limb amputation (5.3% vs. 0.9%, p < .05), albuminuria (15.5% vs. 2.8%, p < .01), chronic renal failure (10.6% vs. 2.5%, p = .01), and emergency room admissions rate (26.7% vs. 15.1%, p < .05). In sub-analysis, lower average HbA1C levels and diabetic ulcer rates were found among ADHD patients treated with stimulants, all p < .05. CONCLUSION: Co-morbidity of ADHD and T1DM is associated with poor glycemic control and higher complication rates.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Complicaciones de la Diabetes , Diabetes Mellitus Tipo 1 , Adulto , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estudios Transversales , Complicaciones de la Diabetes/complicaciones , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/terapia , Control Glucémico , Humanos , Estudios RetrospectivosRESUMEN
BACKGROUND: The coronavirus disease-2019 (COVID-19) social-distancing strategy, including 7 weeks of strict lockdown, enabled an extraordinary test of stay-at-home regulations, which forced a sedentary lifestyle on all children and adolescents. OBJECTIVES: To assess the lockdown effect on pediatric weight. METHODS: A retrospective-prospective cohort study at our hospital's pediatric outpatient clinics following the COVID-19 lockdown. Patients aged 0-18 years visiting the clinic were weighed and previous weight and other clinical data were collected from the medical charts. Weight-percentile-for-age standardization was calculated according to the U.S. Centers for Disease Control and Prevention and the World Health Organization growth tables. Pre- and post-lockdown weight-percentiles-for-age were compared using paired t-test. Multivariate analysis was conducted using linear regression model. RESULTS: The study was comprised of 229 patients; 117/229 (51.1%) were boys, 60/229 (26.2%) aged under 6 years. Total mean weight-percentile was significantly higher following the lockdown (40.44 vs. 38.82, respectively, P = 0.029). Boys had a significant post-lockdown weight-percentile rise (37.66 vs. 34.42, P = 0.014), whereas girls had higher baseline pre-quarantine weight-percentile of 43.42, which did not change. Patients younger than 6 years had a significant increase in weight-percentiles (39.18 vs. 33.58, P = 0.021). In multivariate analysis these correlations were preserved.
Asunto(s)
COVID-19 , Cuarentena , Aumento de Peso , Adolescente , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
Gram-negative rod (GNR) infections adversely affect the outcome of patients with malignancies and following hematopoietic stem cell transplantation (HSCT). This retrospective observational study aimed to describe the epidemiology, outcome, and resistance patterns of GNR bacteremia in children with hematologic malignancies (HM) and after HSCT during the period spanning from 2010 to 2014 in a tertiary children's hospital. A total of 270 children were included in the analysis; 65 (24%) developed 85 episodes of GNR bacteremia; the rate was 36/122 (29.5%) in post-HSCT and 29/178 (16.3%) in HM patients (P<0.05). Overall, 10% of the GNRs were carbapenem resistant. In multivariate analysis, prolonged neutropenia (≥7 d; odds ratio: 19.5, 95% confidence interval: 2.6-148.4) and total hospitalization for a duration of >30 days in the last 3 months (odds ratio: 17.5, 95% confidence interval: 1.4-224.4) were associated with carbapenem-resistant GNR bacteremia. Thirty-day mortality following GNR bacteremia was 0% in HM and 7/52 episodes (13.5%) in HSCT patients (P<0.05). Carbapenem-resistant versus carbapenem-sensitive bacteremia was associated with longer duration of bacteremia (mean: 3.8 vs. 1.7 d), higher risk for intensive care unit hospitalization (44.4% vs. 10.1%), and higher mortality rate (33% vs. 5.8%) (P<0.05). To summarize, GNR bacteremia was frequent, especially in post-HSCT children. Carbapenem resistance adversely affects patients' outcome, increasing morbidity and mortality. Empirical antibiotic therapy must be adjusted to the local resistance patterns.
Asunto(s)
Bacteriemia , Farmacorresistencia Bacteriana , Neoplasias Hematológicas , Trasplante de Células Madre Hematopoyéticas , Infecciones por Pneumocystis , Pneumocystis carinii , Adolescente , Aloinjertos , Bacteriemia/sangre , Bacteriemia/etiología , Bacteriemia/prevención & control , Niño , Preescolar , Combinación de Medicamentos , Femenino , Gentamicinas/administración & dosificación , Neoplasias Hematológicas/sangre , Neoplasias Hematológicas/patología , Neoplasias Hematológicas/terapia , Humanos , Lactante , Recién Nacido , Masculino , Neutropenia/sangre , Neutropenia/terapia , Piperacilina/administración & dosificación , Infecciones por Pneumocystis/sangre , Infecciones por Pneumocystis/prevención & control , Estudios Retrospectivos , Sulfadoxina/administración & dosificación , Trimetoprim/administración & dosificaciónRESUMEN
OBJECTIVE: To assess the interactions between attention-deficit hyperactivity disorder (ADHD) and type 1 diabetes mellitus (T1DM), including diabetes outcomes and patients' general health status. METHODS: Primary care and hospital records of patients aged 5 to 18 years with T1DM were analyzed using the Leumit Health Services database. The diabetic control and general health of patients with T1DM and ADHD diagnoses were compared with those of patients with T1DM alone in a cross-sectional study. The ADHD group included patients with ADHD diagnosis who purchased at least 3 prescriptions of psychostimulant agents and nootropics. Parameters including demographic, clinical, and laboratory data were collected and assessed. RESULTS: The study included 230 patients with T1DM; of them, 24 had ADHD (10.4%). Twenty of 24 patients with ADHD (83.3%) had hemoglobin A1C of 9% and higher versus 87 of 206 patients with diabetes alone (43.3%) (p < 0.05). The ADHD group had significantly higher annual emergency department admissions [15/24 (62.5%) vs 77/201 (37.4%); p < 0.05], higher annual hospitalization rates [18/24 (75%) vs 78/206 (37.9%); p < 0.05], and longer hospitalization stays (mean, 2.21 vs 0.65 days; p < 0.05). The total medical annual costs per patient were twice as high in the ADHD group (p < 0.05). In multivariate analysis, these unfavorable outcomes of the ADHD group were preserved. CONCLUSION: In this study, having ADHD and T1DM comorbidity was associated with a higher complications rate and poorer diabetes control in comparison to having T1DM alone. Although further research is needed, our data suggest that this group requires special care and attention of the medical staff.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Diabetes Mellitus Tipo 1/terapia , Servicio de Urgencia en Hospital , Hospitalización , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/sangre , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Preescolar , Comorbilidad , Estudios Transversales , Bases de Datos Factuales , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hemoglobina Glucada , Hospitalización/estadística & datos numéricos , Humanos , Israel/epidemiología , Masculino , Nootrópicos/uso terapéuticoRESUMEN
To assess the association of ankylosing spondylitis (AS) and ischemic heart disease (IHD) compared to traditional cardiovascular (CV) risk factors. Primary care and hospital records of patients with AS were analyzed, using the largest health maintenance organization in Israel, the "Clalit" Health Services data. These patients were compared with age- and gender-matched controls regarding the proportion of IHD in a cross-sectional study. Parameters including socioeconomic status, body mass index (BMI), smoking habits, and coexistent medical conditions hypertension, hyperlipidemia, and diabetes mellitus (DM) - as well as the use of NSAIDs and anti-TNFs were also assessed. The study included 4076 AS patients compared to 20,290 age- and gender-matched controls without AS. The proportion of IHD was higher among AS patients as compared to controls (14.1 vs. 6.36%, respectively, p < 0.01) and patients treated with anti-TNFs had a lower risk for IHD compared to non-anti-TNF users. The proportion of hypertension, hyperlipidemia, DM, and smoking was also higher among AS patients. However, in multivariate analyses following adjustment to these risk factors, AS was not found to be associated with IHD nor anti-TNF therapy to be a protective factor. Patients with AS have more traditional CV risk factors, thus are in a higher risk for IHD. AS itself was not shown to be independently associated with IHD. These findings emphasize the multifactorial process leading to increased proportion of IHD among AS patients and the need for a stringent control of traditional risk factors in these patients.
Asunto(s)
Inflamación/complicaciones , Isquemia Miocárdica/complicaciones , Espondilitis Anquilosante/complicaciones , Adulto , Anciano , Estudios Transversales , Femenino , Humanos , Inflamación/patología , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/patología , Factores de Riesgo , Espondilitis Anquilosante/patologíaRESUMEN
INTRODUCTION: A 63-year-old, right-handed woman with a history of hypertension presented to the ED with left arm paresis of 2 days duration. Three weeks before admission, she had flu-like symptoms with intermittent left arm weakness that had recovered briefly but recurred 2 days prior to her presentation. On neurological examination, GCS was 15 and cranial nerves' function was normal. Left upper limb strength was 4/5. There was left arm drift and pronation but the patient denied noticing any difference between the positions of her arms. Hyper-reflexion was presented in the left arm. The rest of her motor, cerebellar, sensation and gait functions were normal. She was asked to draw a clock and set it to 15:30 (figure 1).emermed;35/1/38/F1F1F1Figure 1Clock drawing test results. QUESTION: What is the most probable aetiology?Right cerebral bleeding involving the occipital lobeRight middle cerebral artery occlusionRight parietal lesion, likely neoplasmLeft cortical stroke.