[Sudden death from asthma in childhood, is it preventable?].

Sudden death from asthma is rare but occurs in the young age group. We recently faced this rare situation when 3 asthmatic children were dead on arrival at the local emergency room. All 3 had been treated with beta-2 agonist inhalation on a regular basis, without anti-inflammatory treatment, 2 of the children died while inhaling the beta-2 agonist. It is important that there be clear guidelines and full education about the management of asthma, during and between exacerbations, to prevent such deaths.

Variation in acceptance of common oral antibiotic suspensions.

Palatability of oral antibiotic suspensions is important and may be a substantial factor in determining compliance in young pediatric patients. Because no comparative systematic data are available, we undertook the present study to assess the acceptance of and compliance with oral antibiotic suspensions commonly used in Israel. During a 4-month period lists of children receiving oral antibiotic suspensions were obtained from 3 major pediatric clinics, and parents were contacted by telephone 10 to 14 days after initiation of therapy, at which time information on age, sex, main disease, prescribed drugs and duration of treatment was obtained. Information regarding acceptance, side effects and compliance was obtained from 11 questions with graded scores. In the study 546 children received one of the following drugs: amoxicillin (n = 222); cefaclor (n - 142); cefuroxime axetil (n = 107); trimethoprim/sulfamethoxazole (n = 75). No major differences in background data were noted; more than 50% of each group had acute otitis media. Seventy-three percent of the cefaclor group reported acceptance of the drug with "pleasure" or "without problems" vs. 60, 55 and 20% for amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, whereas "resentment" or "refusal" was reported in 11, 16, 26 and 56%, respectively (P < 0.0001). Mothers reported to be generally "satisfied" or "extremely satisfied" with the drug in 89, 81, 74 and 67% with cefaclor, amoxicillin, trimethoprim/sulfamethoxazole and cefuroxime axetil, respectively, and 85, 77, 73 and 67% of the children, respectively, received the drug for the entire prescribed course (P < 0.001). Our data demonstrate that marked variations exist in acceptance and compliance of oral antibiotic suspensions with children.(ABSTRACT TRUNCATED AT 250 WORDS)

[Quality control in primary care: an instrument for constructing a database].

An instrument for constructing a database and defining standards for quality control in primary care medicine is presented. A questionnaire adapted from a U.S. Department of Health and Human Services form will be used randomly at least twice a year for screening all patient-staff contacts in most Kupat Holim clinics in the Negev Region (small rural clinics excepted). Analysis of the responses will enable definition of standards for measuring the quality of primary care. The tool is simple, inexpensive, not too time-consuming, and can provide the required data. A pilot study to test the tool was carried out in 3 primary care clinics serving an insured population of 17,763. The study surveyed 474 patient visits to the clinics, of which 57% were consultations with a physician. The younger patients usually saw the physician, while the older tended to visit the nurse. The most common reason for clinic visits was an acute condition, and only 4% of visits were for administrative reasons. 28% of the patients were not prescribed any medication and 27% were prescribed only 1 drug. The majority of problems were dealt with at the clinic level and only a few were referred to specialists or to external diagnostic services.

Superior mesenteric artery syndrome presenting as an anorexia nervosa-like illness.

Anorexia nervosa is often overdiagnosed in adolescent females with anorexia and extreme weight loss. In some cases, an anorexia nervosa-like illness is due to a treatable organic disorder. We describe a 16-year-old female with anorexia, vomiting, extreme weight loss, and amenorrhea who was referred as an anorexia nervosa case and was subsequently found to have superior mesenteric artery syndrome that was causing a duodenal obstruction. Conservative treatment with oral hypercaloric liquid feeding resulted in optimal weight gain and complete recovery. This syndrome should be considered in adolescents with an anorexia nervosa-like illness associated with vomiting and postprandial epigastric discomfort.