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Biomedical subjects

A Leibovitz

Publications and source records attributed to A Leibovitz.

At least 19 recordsLinked to original sources
PubMed2006

Gastric microbiota in elderly patients fed via nasogastric tubes for prolonged periods.

Aspiration of oropharyngeal contents is a constant threat for elderly patients fed via a nasogastric tube (NGT). Colonization of the oropharynx of these patients by pathological flora and the development of biofilms on the feeding tube has been documented recently. In addition, the presence of the NGT may interfere with the gastro-oesophageal sphincter, leading to gastro-oesophageal reflux. Thus, the passage of pathogenic bacteria in both directions is facilitated. The purpose of this study was to explore the microbiota of the gastric juice and the oropharynx in NGT-fed elderly patients. Samples of gastric juice were drawn after an overnight fast, and microbial cultures and direct pH measurement were performed. Concomitant cultures were obtained from the oropharynx. Overall, 107 gastric and oropharyngeal cultures were obtained from 52 subjects. Pathogenic flora (Gram-negative bacteria or Staphylococcus aureus) were isolated from 74% of stomach samples and from 69% of oropharynx samples. Proteus spp. (26%) and Escherichia coli (22%) were the most common isolates in the gastric juice, and Proteus spp. (24%) and Pseudomonas spp. (21%) were the most common isolates in the oropharynx. Similarity in the composition of the oropharynx and gastric flora was observed in most cases. The gastric pH was relatively high (4.57 +/- 0.65 at 3 h after feeding and 4.2 +/- 0.9 at 12 h after feeding) and was highly correlated with the isolation of pathogenic bacteria (r = 0.58, P < 0.01). These results support the view that in addition to the oropharynx, the stomach of NGT-fed elderly patients constitutes a reservoir of pathogens that could be associated with the risk of aspiration pneumonia. The cause of the high gastric pH and its relation to pathogenic bacteria warrants further study.

Aged↗
PubMed2006

Candida colonization of the vagina in elderly residents of a long-term-care hospital.

The present study was conducted in order to determine the prevalence of vaginal colonization by Candida spp in elderly residents of a long-term-care hospital and to examine the determinants of vaginal candidiasis. Vaginal swabs for Gram stain and culture were obtained from 106 bedridden residents of a long-term-care hospital (study group; mean age, 83+/-7 years) and a control group of 50 similarly aged women admitted to an acute-care hospital for non-genital problems (mean age, 81+/-8 years). The characteristics of patients who tested positive for Candida spp were compared with those who tested negative. Candida spp were isolated from 34 (32%) patients in the study group and from four (8%) control patients (p=0.001). In the study group, Candida glabrata was by far the most common species isolated (51.2%). The warm and moist environment in the perineal area created by diaper use in incontinent individuals, together with decubitus ulcers and immobilization, which are common in elderly patients receiving long-term care, might be responsible for the high occurrence of vaginal colonization with Candida in these women.

Aged↗
PubMed2005

Plasma levels of amino acids in elderly long term care residents with oropharyngeal dysphagia: comparison of hand-oral with tube-enteral-fed patients.

BACKGROUND: Dysphagia and eating difficulties are highly prevalent in long term care patients. Evaluation of their nutritional status is complicated by comorbidity, frailty and individual patterns of feeding. In previous studies we found vitamin deficiencies (folic acid B6 and B12) in orally fed elderly in early stages of oropharyngeal dysphagia despite satisfactory nutritional parameters (BMI, albumin and hemoglobin). The aim of this study is to evaluate the plasma amino acids levels in these hand-oral fed elderly patients with dysphagia. METHODS: Plasma amino acids were measured in 15 orally fed elderly patients in early functional outcome swallowing scale (FOSS), stage 2, and compared with those of 15 matched nasogastric-tube-fed counterparts. RESULTS: The plasma levels of all measured amino acids, ratio of essential to nonessential, levels of conditionally essential and the immune-enhancing amino acids were similar in both groups and within the normal range of our laboratory. The traditional nutritional parameters were also similar in both groups and within the normal range. CONCLUSIONS: Plasma levels of amino acids in elderly patients in early stage of FOSS are satisfactory, supporting the view that their protein intake is adequate. Further studies should concentrate on patients in advanced stages of FOSS.

Administration, Oral↗
PubMed2004

CD4 lymphocyte count and CD4/CD8 ratio in elderly long-term care patients with oropharyngeal dysphagia: comparison between oral and tube enteral feeding.

Many institutionalized elderly patients are at risk of undernutrition as a result of oropharyngeal dysphagia (OD) that possibly affects their immunological status. Tube enteral fed (TEF) patients on controlled intake of nutrients enables us to evaluate the effect of inadequate nutrition on the immune system in the orally fed elderly with OD. The aim of our study was to compare CD4 lymphocyte count and CD4/CD8 ratio between these two differently fed groups. Twenty-eight orally fed patients with OD in the Functional Outcome Swallowing Scale (FOSS) stage 2 (group A) and 17 TEF subjects (group B) were studied. CD4 and CD8 counts were determined by flow cytometry. Nutritional markers (albumin, hemoglobin, and basal metabolic index) were recorded for each group. The Charlson index was used for comparison of comorbidity between the two patient groups. The average count of CD4 lymphocytes was significantly lower in group A than in group B (754 +/- 365 vs. 1032 +/- 404 cells/ml, p < 0.01). Six patients in group A (21%) had a CD4 count of less than 400 cells/ml (lower threshold) while all the patients in group B had a CD4 count of over 500 cells/ml (p < 0.001). The CD4/CD8 average ratio was also significantly lower in group A (p < 0.008). Nutritional markers were within normal limits with no difference between the groups. These results confirm our presumption that a low CD4 lymphocyte count and a low CD4/CD8 ratio could prevail among elderly frail patients with dysphagia. This supports the view that under an apparently satisfactory nutritional profile these patients may be in a state of undernutrition that negatively influences their immunodefense.

Age Factors↗
PubMed2001

Postmortem examinations in patients of a geriatric hospital.

The rate of postmortem examinations (PME) especially in elderly patients is continuously declining, mostly due to the low interest of the medical staff and the reluctance of relatives. We surveyed PME performed over a 20-year period in patients of a geriatric hospital in Israel. The 93 autopsies represent a rate of 2.8% in the first five years which went down to 0.25% in the later years. In 58% of the cases, clinical cause of death was confirmed by the PME. Pulmonary embolism had the lowest confirmation rate, and was more frequently found in females (28%) than in males (10%) (p<0.03). Undiagnosed conditions in the elderly present a clinical challenge that increases with the patient's age. However, despite progress in diagnostic technology, confirmation rates of death causes have not changed much. Therefore, as the age of death rises, it is important to preserve and foster PMEs, the most reliable source of medical evidence.

Aged↗
PubMed2001

Clinical, radiologic, demographic, and occupational aspects of hand osteoarthritis in the elderly.

OBJECTIVE: Osteoarthritis (OA) of the hand is common in elderly patients. The aim of this study was to characterize OA frequency, severity, and distribution and to trace interrelationships between these findings and the demographic, occupational, and medical data from elderly Jewish nonrheumatologic patients. METHODS: Study participants were 253 consecutive patients admitted to a geriatric center for a variety of nonrheumatic medical conditions. Excluded patients were those with rheumatoid arthritis; neurologic, orthopedic, or other conditions that would interfere with symmetric hand function; and mental or medical states that would interfere with history taking and radiographic studies. Patient occupations were graded as workload degree (on a scale of 1 to 3) and as the total occupational score (workload degree multiplied by the duration of each job). Clinical findings of Heberden nodes, Bouchard nodes, and malignment, graded on a scale of 0 to 3, were summed as the clinical OA score. Hand radiographs were independently read (modified Altman method), grading 5 parameters in each joint on a scale of 0 to 3, summed as a radiologic OA score. Statistical analyses included the Student t test, chi(2) test, ANOVA, Pearson correlation, and partial correlation coefficients. RESULTS: Among 253 elderly patients (171 women, 82 men; mean age, 79 years) OA was frequent (occurring in about 80% of patients), involving most severely the second and third distal interphalangeal, right first interphalangeal, and both first carpometacarpal joints. The prevalence of OA was similar in women and men, with higher scores in women, and reached significance only in the distal interphalangeal joints. Metacarpophalangeal joints were more involved in men. Age had a clear influence on OA scores. Ethnicity affected OA severity, with Ashkenazi Jews having significantly higher scores than Sepharadi Jews. Dominant hands had significantly higher global OA scores as well as isolated joint scores (except for the first carpometacarpal joint). Occupational load, housekeeping tasks, and the number of children did not influence the total or specific joint OA scores. Associated conditions such as obesity, diabetes, hypothyroidism, and chondro calcinosis were not associated with more pronounced OA. CONCLUSIONS: Hand OA was prevalent in our elderly cohort, and its severity was influenced by inherent traits such as age, female gender, ethnicity, and handedness. In contrast, acquired factors such as workload, number of children, and associated diseases did not appear to influence OA expression.

Age Factors↗
PubMed2001

Age-associated neovasculopathy with recurrent bleeding.

We hypothesize the existence of an age-associated neovasculopathy with recurrent bleeding. It could be the result of age-related defects in the regulation of the angiogenetic process creating pathologic small vessels with a bleeding tendency. Conditions like subdural hematoma, ocular angiopathies, intestinal angiodysplasia, coronary atherosclerotic plaques and others, may be the clinical expression of such a neovasculopathy.

Aging↗
PubMed2000

The impact of a rotation in geriatrics during the internship on young doctors.

We initiated a study aimed to evaluate the impact of a rotation in geriatrics during the internship (Preregistration Year-PY). A total of 46 young doctors who completed a month's rotation in geriatrics during the 5 year period 1993-1997 were located and sent a mail questionnaire. It included queries on how they appreciate the contribution of the rotation on their training. A total of 36 doctors (78%) responded, 94% mentioned they learned new skills and ranked them as highly important, and 91% affirmed that the experience in the geriatric ward contributed to a more positive attitude toward elderly patients. A total of 86% stated they would recommend young graduates to elect a geriatric rotation, 56% believe it should be included as an obligatory rotation during the PY. Based on this survey we concluded that a month's rotation in geriatrics is an important contribution to young graduates' medical education before entering practice. In view of the increasing number of elderly patients in most medical fields such experience should be fostered.

Journal Article↗
PubMed2000

Vulvovaginal examinations in elderly nursing home women residents.

The purpose of this study was to survey nursing home women residents for pathologies in the vulvovaginal area. A total of 96 nursing and skilled nursing elderly woman, from four long-term care (LTC) wards entered the study. The average age was 82 (range 66-98). A total of 88% were wheel chair bound, 86% were urinary incontinent and 80% were communication handicapped. A total of 29% of the examined women had vulvovaginal pathologies. Atrophic vaginitis was detected in 14 cases. Candida vaginitis was found in four cases. Six women had uterine prolapse, three had lichen sclerosus and two had cervical polyps. Such a high rate of findings is probably influenced by age related changes, immobilization and incontinence. This study, a first of its kind emphasizes the importance of routine vulvovaginal examination in elderly LTC women.

Journal Article↗
PubMed2000

["Medicine on the Intenet"-- model course for physicians in the use of the Internet].

The Internet is efficient in coping with the ever-increasing volume of medical knowledge. This and other functions have lead to its integration into daily medical practice. It is therefore imperative to disseminate its use among physicians, as some, unfamiliar with the personal computer (PC), may be reluctant to learn to use it. We therefore developed a course for training physicians in the basics of Internet use, consisting of 6 sessions of 2 hours each. It includes training in PC operation as well as in the main Internet functions. The topics are medicine-oriented, including Medline search, general info search, exploring medical sites and reading medical journals on-line. 41 physicians (8 groups of 4-6 each) with various specialties attended, of whom 38 completed a feedback questionnaire 4 weeks later. 79% reported using the Internet either at home or at their working place. The function used mostly was Medline Search (68%). Although 83% had not been familiar with the PC before, 96% stated that the course was clear and understandable and 99% expressed satisfaction with the quality of the teaching. Based on these results we recommend this course as a model for teaching physicians the use of the Internet.

Curriculum↗
PubMed1998

Elevated serum digoxin level associated with coadministered fluoxetine.

After her daughter died, depression developed in a 93-year-old woman with congestive heart failure receiving digoxin therapy. After treatment with fluoxetine hydrochloride she became anorexic and her serum digoxin level increased. A possible interaction, which has not been reported in the literature, may have occurred between fluoxetine and digoxin.

Aged↗
PubMed1998

The impact of hemiparalysis on the expression of osteoarthritis.

OBJECTIVE: Primary generalized osteoarthritis (OA), the most prevalent joint disease, is usually symmetric. Sporadic case reports mention decreased OA manifestations in limbs in which there are neurologic deficits, but no systematic research has been published. The aim of the present study was to examine these observations in a planned and controlled survey in a group of patients with OA. METHODS: Seventy-five geriatric patients with a history of stroke and hemiparalysis were studied clinically and radiographically (hand radiographs; graded according to a modified Altman method) for the presence and the degree of OA in the hands. Detailed clinical and radiologic scores were calculated for each hand. Demographic, occupational, and neurologic data were collected. Patients with other joint or neurologic conditions were excluded. A group of 55 elderly patients without stroke were similarly studied (controls). Scores in the paralyzed hand were compared with those in the nonparalyzed hand in the stroke patients and subgroups (by Student's paired t-test and Wilcoxon test). Scores in the dominant hands were compared with those in the nondominant hands in stroke patients and control subjects (by Student's paired t-test and Mann-Whitney test). Correlation between the degree of neurologic damage and OA asymmetry (Pearson's correlation coefficient) was also sought. RESULTS: Paralyzed hands showed significantly fewer OA changes than nonparalyzed hands, both clinically and radiologically. This trend, accentuated in patients with more severe paralysis, disappeared in those with mild residual paresis. Asymmetry of OA was more pronounced in patients with flaccid, compared with spastic, paralysis. The degree of paralysis and loss of muscle strength correlated with the degree of OA asymmetry. Women had significantly higher OA scores than men. In the control group, dominant hands had higher OA scores, but this finding was concealed among hemiparalyzed patients. Lifetime gross occupational load and present grip strength did not correlate with the degree of OA. CONCLUSION: In elderly patients, hemiparalysis reduces ipsilateral hand expression of OA, while OA is accentuated (or increased) in the dominant hand of patients without paralysis. This first systematic study confirms the findings of previous case reports and lends support to the role of biomechanical factors in the development of OA.

Aged↗
PubMed1998

Psychiatric and polysomnographic evaluation of sleep disturbances.

BACKGROUND: We evaluated psychiatrically 100 subjects, who were referred to a sleep laboratory in a general hospital because of sleep complaints. METHODS: All subjects were interviewed using a Structured Clinical Interview for DSM-III-R and underwent one night of standard polysomnography (PSG) examination. RESULTS: Forty three percent of the population had at least one Axis I DSM-III-R disorder. High rate of depressive mood disorder (24%) was observed in our sample, in contrast to low prevalence of alcohol and drug abuse (4%). Our results of a Israeli population are different from the United States studies in respect to alcohol and drug abuse. Furthermore, 11% of patients with PSG diagnosis exhibited comorbid psychiatric disorder. CONCLUSION: it appears that individuals with sleep complaints have high rate of psychiatric morbidity, especially mood disorders. LIMITATION: The rapid eye movement (REM) latency, a biological marker for depression, was not investigated. CLINICAL RELEVANCE: it seems that both PSG and psychiatric evaluation of sleep disturbance are of importance for appropriate therapeutic strategy for individuals with sleep complaints, especially in those with features of suspected depressive mood disorders.

Adult↗