Latency of Symptom Progression in Mild Daboia palaestinae Envenomation.

INTRODUCTION: Daboia palestinae is the most common venomous snake in Israel. In most cases, snakebite does not develop into a systemic disease. Since the introduction of specific antivenom therapy, the mortality rate has declined sharply. Nevertheless, there is still no uniform therapeutic protocol in Israel for patients who have been envenomated, and there is no current data regarding latency of symptom development. We aimed to evaluate the latency of symptom development after D palaestinae snakebite in patients presenting to the emergency department (ED) with local reaction. METHODS: This was a retrospective single-center study of all patients who presented following a snakebite from 2015 to 2020. Patients with confirmed or suspected D palaestinae bite were included. Demographical and clinical data were extracted from each electronical medical record and subjected to descriptive and comparative analysis. RESULTS: Sixty-two patients met the inclusion criteria. Their median (IQR) age was 30 (17-48) y, and 75% were male. Forty-one percent presented with local reactions to the snakebite, 29% presented with advanced local reaction, and 29% presented with systemic symptoms. Antivenom was given to 22% of patients with advanced local reaction and 89% of patients with systemic reaction. The median (IQR) time from bite to antivenom and from ED arrival to antivenom were 2 (1.5-2.5) h and 1 (0.75-1.5) h, respectively. Antivenom was administered at the latest 3.5 h after presentation to the ED for progression of local symptoms. CONCLUSIONS: Our study may support a 4- to 6-h observation period in the ED for patients with mild clinical presentation after D palaestinae bite. Further larger prospective studies are needed.

Changes in acute mastoiditis in a single pediatric tertiary medical center: our experience during 2008-2009 compared with data for 1983-2007.

OBJECTIVE: The objective of this study was to assess clinical reports and bacteriological changes over a 25-y period in children with acute mastoiditis. METHODS: The medical files of all children with a discharge diagnosis of mastoiditis, hospitalized in a tertiary pediatric medical center over a 2-y period (2008-2009), were reviewed and compared to previously published data from the same center for the y 1983-1985, 1993-1995, and 2003-2007. RESULTS: One hundred and thirty-four children (143 episodes) with acute mastoiditis were identified during 2008-2009; 81% had fever, 95% auricular displacement, and 80% post-auricular swelling. Forty-nine children were diagnosed with acute otitis media and had been treated with antibiotics prior to hospitalization. However, 22% showed no clinical symptoms preceding ear protrusion. Cultures grew Streptococcus pneumoniae in 32%, Streptococcus pyogenes in 20%, Pseudomonas aeruginosa in 13%, and Haemophilus influenzae in 10% of cases. From 1990 to 2005, the incidence of S. pyogenes isolation increased from approximately 5% to 20%. During this period, the number of cases increased from 8-20 to 67 per y. CONCLUSIONS: S. pyogenes has emerged as a significant pathogen. We found that acute mastoiditis may appear without preceding symptoms in approximately 22% of cases.