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Biomedical subjects

D Lieberman

Publications and source records attributed to D Lieberman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Atypical pathogen pneumonia.

The term atypical pathogens has been applied in recent years to Chlamydia pneumoniae, Mycoplasma pneumoniae, and the various species of Legionella. The incidence of pneumonia caused by these pathogens has increased with the development of specific diagnostic techniques. Atypical pathogen community-acquired pneumonia demonstrates a broad spectrum of severity from a mild disease not requiring hospitalization to adult respiratory distress syndrome necessitating mechanical ventilation. The clinical, radiological, and laboratory manifestations of the disease are similar to those of community-acquired pneumonia caused by other pathogens, and reliable etiological differentiation cannot be based on these factors alone. The possibility of shortening treatment time, at least in some patients, by antibiotic therapy with the new macrolides has been added to standard therapeutic regimens with erythromycin, tetracyclines, or quinolones.

Chlamydia Infections↗
PubMed1997

Pneumonia with serological evidence of acute infection with the Chlamydia-like microorganism "Z".

"Z" is a recently discovered microorganism that may belong to a new genus in the family Chlamydiaceae. Using an ELISA test we developed, we measured levels of serum antibody against "Z" for 308 paired sera obtained from adult patients hospitalized with community-acquired pneumonia (CAP). In 114 patients (37%), serological evidence of past infection with "Z" was found. In eight patients (2.6%) there was serological evidence of acute infection with this pathogen. In four of these eight patients, no other pathogen for CAP was identified despite an intensive serological investigation encompassing 13 etiological agents. The four patients were about 30 yr old, and three of them had no history of chronic illness. Their illness was characterized by high fever, a nonproductive cough, gastrointestinal symptoms, a shift to the left in the white blood cell count, and a prompt, dramatic response to erythromycin therapy. We conclude that the microorganism "Z", or a close variant, is infectious for humans, in some cases causing CAP. In these cases the disease is mild and responds quickly to treatment with erythromycin.

Acute Disease↗
PubMed1997

Management of symptoms of gastroesophageal reflux disease: does endoscopy influence medical management?

OBJECTIVES: The purpose of this study was to examine the theories that underlie the clinical decision to perform endoscopy in patients with symptoms of gastroesophageal reflux disease (GERD). Physicians reported that they use endoscopic findings to modify medical treatment of GERD. This study was undertaken to test this hypothesis in clinical practice. METHODS: A consortium of community specialists in gastrointestinal disease was formed. Physicians completed a database on patients undergoing elective endoscopy for symptoms of GERD, which includes symptom severity, endoscopic findings, and medical treatment before and after endoscopy. An increase in medical treatment was defined as an increase in acid suppression therapy, and/or the addition of a promotility drug, and/or referral for surgery. RESULTS: Data were collected prospectively over 6 months on 664 patients with symptoms of GERD, and complete data were available on 598 patients. Barrett's esophagus or active esophagitis (erythema, erosions, or ulceration) was present in 374 patients. Of these patients, 74% had an increase in therapy after endoscopy; for only 5% did therapy decrease. In contrast, among 224 patients with a normal-appearing esophagus, 35% had an increase in treatment and 65% had either a decrease in treatment or no change. In most cases, the increase in treatment was due to persistence of symptoms or because of endoscopic findings in the stomach or duodenum. The differences in treatment changes between the two groups was highly significant (p < 0.0001). CONCLUSION: The results support the theory that physicians often use endoscopic results to tailor medical therapy in patients with symptoms of GERD.

Antacids↗
PubMed1996

Placement of left double-lumen endobronchial tubes with or without a stylet.

PURPOSE: This study was designed to determine if leaving a stylet in the left Bronch-Cath endobronchial tube (DLT) for the entire intubating procedure improves the accuracy of placement on the initial attempt, without introducing complications. METHODS: Sixty ASA 1-3 patients were randomized to one of two groups. In Group 1 (n = 30), the stylet was retained for the entire intubation procedure and in Group 2 (n = 30), the stylet was removed once the bronchial cuff had passed the vocal cords. In both groups, the DLT was turned 110 degrees counterclockwise and advanced until resistance was encountered. Placement was assessed by auscultation and fibreoptic bronchoscopy (FOB). After surgery, the DLT was replaced by a single-lumen endotracheal tube. The thoracic surgeon (blinded to the method of intubation, and using a FOB) assessed the appearance of the tracheobronchial mucosa. RESULTS: The two groups were similar with respect to sex, height, weight, DLT size, surgeon and expertise of the laryngoscopist. When the stylet was retained, the DLT was correctly placed 60% of the time compared with 17%, if the stylet was removed, (P = 0.001). Seven out of 30 DLTs in Group 2 were initially placed into the right mainstem bronchus, (P = 0.005). The average time to confirmation of correct tube placement by FOB was increased in Group 2, (P = 0.01). Although the observed incidence of left bronchial, mucosal petechiae and erythema was greater in Group 2, this was not statistically significant, (P = 0.063). CONCLUSION: Retaining the stylet for the entire intubation procedure allows for a more rapid, accurate placement of the DLT without increasing the incidence of tracheobronchial mucosa injury.

Bronchi↗
PubMed1996

Appropriateness of hospitalization of patients with community-acquired pneumonia.

STUDY OBJECTIVE: To investigate the association between the appropriateness of hospitalization and the course of hospitalization in patients with community-acquired pneumonia (CAP). METHODS: We carried out a prospective study of 346 adult patients hospitalized with community-acquired pneumonia (CAP). Appropriateness of hospitalization was assessed with a modified appropriateness evaluation protocol (AEP) based on vital signs and laboratory tests. Hospitalizations that ended in death, lasted more than 4 days, or involved resuscitation, incubation, monitoring, or supplemental oxygen therapy were considered complicated. RESULTS: According the AEP protocol, hospitalization was not appropriate for 210 of the 346 patients (61%). However, AEP proved to be an insensitive tool for the identification of patients with complicated hospital courses. Half of the 346 patients had complicated courses, including 82 of the 210 patients with inappropriate hospitalization (39%), according to the AEP. Four independent factors, age greater than 50 years, female sex, no antibiotic treatment before hospitalization, and more than 4 days of illness before admission predicted a complicated course in patients with inappropriate hospitalization as determined with the AEP criteria. CONCLUSION: It is important to avoid the unnecessary hospitalization of patients with CAP. However, this should not be achieved at the expense of unjustified discharge from the emergency department. In the decision to hospitalize, additional prognostic factors, such as those presented here, should be taken into consideration to improve the admission process. This is particularly relevant for cases in which the AEP is invalid and indications for hospitalization are not clear cut. In these patients, a simpler and more precise scoring system should be developed.

APACHE↗
PubMed1996

Multiple pathogens in adult patients admitted with community-acquired pneumonia: a one year prospective study of 346 consecutive patients.

BACKGROUND: The purpose of this study was to assess the causes of community-acquired pneumonia in adult patients admitted to hospital. METHODS: A prospective study was performed on 346 consecutive adult patients (54% men) of mean (SD) 49.3 (19.5) years (range 17-94) admitted to a university affiliated regional hospital in southern Israel with community-acquired pneumonia over a period of one year. Convalescent serum samples were obtained from 308 patients (89%). The aetiological diagnosis for community-acquired pneumonia was based on positive blood cultures and/or significant changes in antibody titres to Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, respiratory viruses, Coxiella burnetii, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella sp. RESULTS: The aetiology of community-acquired pneumonia was identified in 279 patients (80.6%). The distribution of causal agents was as follows: S pneumoniae, 148 patients (42.8%); M pneumoniae, 101 (29.2%); C pneumoniae, 62 (17.9%); Legionella sp, 56 (16.2%); respiratory viruses, 35 (10.1%); C burnetii, 20 (5.8%); H influenzae 19 (5.5%); and other causes, 21 patients (6.0%). In patients above the age of 55 years C pneumoniae was the second most frequent aetiological agent (25.5%). In 133 patients (38.4%) more than one causal agent was found. CONCLUSIONS: The causal agents for community-acquired pneumonia in Israel are different from those described in other parts of the world. In many of the patients more than one causal agent was found. In all these patients treatment should include a macrolide antibiotic, at least in the first stage of their illness.

Adolescent↗
PubMed1996

Mycoplasma pneumoniae community-acquired pneumonia: a review of 101 hospitalized adult patients.

The features of community-acquired Mycoplasma pneumoniae pneumonia (MP-CAP) were assessed in a prospective study of 101 adults who were hospitalized over the course of 1 year, and were compared with 245 patients who were hospitalized during the same period of time with community-acquired pneumonia (CAP) not caused by M. pneumoniae (non-MP-CAP). MP was the second most common etiology (29.2%) in all CAP patients, and the most common etiological agent (43.2%) in the 17- to 44-year age group. In 65 patients (64.3%) at least one other pathogen was identified for CAP in addition to MP. Although the disease was most prevalent among younger patients, it also involved older and even elderly patients. Compared to non-MP-CAP patients, the severity of disease was significantly lower on average in the MP-CAP group and the length of hospitalization was significantly shorter. Radiologic findings were the same in the two groups. Twenty-two MP-CAP patients recovered without receiving the treatment which is recognized as effective in this disease. We concluded that (1) in most patients with MP-CAP a second CAP pathogen can be identified serologically, (2) MP-CAP cannot be differentiated from non-MP-CAP on the basis of clinical, radiologic, or routine laboratory tests, and (3) in some MP-CAP patients the disease is self-limited, and in these patients the usefulness of standard antibiotic therapy is doubtful.

Adolescent↗
PubMed1996

Seasonal variation in community-acquired pneumonia.

Seasonal variation in the incidence of disease in general, and of infectious diseases in particular, is vitally important information for epidemiologists and for clinicians who deal with these diseases. In relation to community-acquired pneumonia (CAP), the seasonal distribution of the disease and, in particular, of each of the specific aetiological agents is important. All 346 adult patients who were admitted to a regional hospital in southern Israel for CAP over a period of 1 year were included in a prospective study. As part of the study, a comprehensive diagnostic work-up was performed to identify the specific causative agents for CAP. The study findings were analysed and are presented in terms of the seasonal distribution of the disease. Thirty four percent of CAP cases occurred in the spring and only 18% in the autumn (p = 0.036). Respiratory viruses CAP were predominant in the winter and spring (p = 0.009), whilst Mycoplasma pneumoniae CAP reached its peak incidence of 41% in the spring compared with 15% during the winter months (p = 0.054). No significant seasonal predominance was observed for the other specific aetiological agents of CAP. In 58% of the CAP patients who were hospitalized in the autumn we identified a pneumococcal aetiology, whilst this agent was found in only 32% of the cases in the winter. In contrast with popular public opinion, winter with its low temperatures is not the main reason for the development of community-acquired pneumonia. Most of the specific aetiologies for community-acquired pneumonia, with the exception of respiratory viruses and Mycoplasma pneumoniae, have no seasonal predilection.

Community-Acquired Infections↗
PubMed1996

Legionella species community-acquired pneumonia. A review of 56 hospitalized adult patients.

BACKGROUND: In a prospective study, Legionella species (Lsp) was identified as the causative agent in 56 (16.2%) of 346 adult patients hospitalized over the course of 1 year with community-acquired pneumonia (CAP), in the Soroka Medical Center, Beer-Sheva, Israel. OBJECTIVE: To characterize patients with Lsp CAP in our study. METHODS: The diagnosis of infection with Lsp was based on serologic testing of antibodies using the indirect immunofluorescent method. RESULTS: In 35 (62.5%) of the patients, at least one other etiologic agent for CAP was identified in addition to Lsp. The patient population was relatively young, with relatively low rates of chronic comorbidity, and a broad spectrum of disease severity compared with previously published studies. No single epidemiologic, clinical, laboratory, or radiographic characteristic differentiated between Lsp CAP and other CAP patients in our study. Three patients (5.4%) who were not treated with erythromycin died. However, in contrast, nine patients who were treated with beta-lactam antibiotics recovered completely. CONCLUSIONS: Lsp is a common cause of CAP in our region, usually as a coinfection with another causative agent. Lsp CAP, which cannot be characterized on the basis of clinical, routine laboratory, or radiographic data, requires specific microbiologic or serologic diagnosis. Treatment with erythromycin appears to be important to reduce mortality from this disease, but in a significant number of patients, the disease may be self-limited.

Adolescent↗
PubMed1996

Factors related to successful rehabilitation after hip fracture: a case-control study.

A case-control study was performed to evaluate factors associated with successful rehabilitation in elderly patients who sustained hip fractures. All 170 patients with fractured hips hospitalized in the geriatrics ward of the Soroka Medical Center in Beer-Sheva, Israel between 1987 and 1991 were studied. Success of rehabilitation was determined by staff evaluation of the patient's ability to walk and perform activities of daily living. The independent variables, including sociodemographic and medical variables, and mental and functional assessments, were assessed by chart reviews, staff evaluation and mental tests. One-hundred and twenty-nine patients (75.9%) were successfully rehabilitated. A normal mental state (p < 0.0001), female gender (p < 0.02) and absence of diabetes mellitus (p < 0.008) were associated significantly with successful rehabilitation.

Activities of Daily Living↗
PubMed1995

Microparticle agglutination versus antibody-capture enzyme immunoassay for diagnosis of community-acquired Mycoplasma pneumoniae pneumonia.

Community-acquired Mycoplasma pneumoniae pneumonia is a common disease which is usually diagnosed by serological methods. The objective of the present study was to understand the diagnostic significance and test characteristics of two different serological tests used to identify current Mycoplasma pneumoniae infection. Three hundred sixty-six patients who suffered from community-acquired pneumonia served as the study population. Six hundred ninety-four (328 paired and 38 unpaired) sera were examined for the presence of antibodies to Mycoplasma pneumoniae with commercial kits based on two serological methods, microparticle agglutination and antibody-capture EIA. Agreement between the two kits was 85.2% when individual sera were compared (kappa = 0.62) and 88.5% when patients were compared (Kappa = 0.69). The positive predictive value and the specificity for the identification of current Mycoplasma pneumoniae infection using a single acute-phase serum were 49.3% and 86.9%, respectively, for the microparticle agglutination method, compared to 91.3% and 97.7% for the antibody-capture EIA method (p < 0.001). The negative predictive value and the sensitivity were 86.3% and 48.1% for the microparticle agglutination, not significantly different from the corresponding values of 86.5% and 61.2% for the antibody-capture EIA. It is concluded that the overall agreement between the two methods tested is good, but not perfect. The methods complement each other in the identification of Mycoplasma pneumoniae as the causative agent in patients with community-acquired pneumonia.

Adolescent↗
PubMed1995

Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women.

BACKGROUND: Changes in asthma activity, in part related to the female hormonal profile, have been observed during pre-menstrual periods and during pregnancy. Estrogen replacement therapy (ERT) is an accepted routine treatment for post-menopausal women. The effect of ERT on disease activity in post-menopausal asthmatic women has not been investigated in the past and is the subject of the present study. METHODS: Fifteen post-menopausal women with mild to moderate asthma completed two 30-day periods in which they measured peak expiratory flow (PEF) at home and filled in a daily diary of asthma-related symptoms. The first monitoring period was pre-ERT and the second was during ERT. In addition spirometry was performed on each woman three times, twice pre-ERT and once during ERT. RESULTS: The average daily PEF decreased from 241 (57.9, S.D.) l/min pre-ERT to 226.7 (62.7) l/min during ERT (P < 0.004). Significant differences between the two study periods were also found in morning and evening PEF values. Diurnal variation, measured as the difference between morning and evening PEF values, decreased significantly from 22.3 (26.7) l/min pre-ERT to 17.5 (26.8) l/min during ERT (P < 0.007). The average daily consumption of bronchodilator inhalers increased significantly from 3.7 puffs/day pre-ERT to 4.3 puffs/day during ERT (P < 0.006). Although the differences in spirometry between the two periods did not reach statistical significance, a trend towards a worsening of the obstructive disorder during ERT was observed. However, the general feeling of well-being of the asthmatics did not change during the two periods. CONCLUSIONS: During ERT a sub-clinical worsening of disease activity was found in postmenopausal women with mild to moderate asthma. We also detected a decrease in diurnal variation. Our findings should be substantiated by additional studies.

Asthma↗
PubMed1995

Q-fever pneumonia in the Negev region of Israel: a review of 20 patients hospitalised over a period of one year.

BACKGROUND: Three-hundred and forty-six patients with community acquired pneumonia were included in a prospective study of patients hospitalised over a 12-month period in the Soroka Medical Center in Beer-Sheva, Israel. Q-fever pneumonia (QFP) was diagnosed in 20 patients (5.8%). A detailed epidemiological and clinical description of this disease, is presented. METHODS: QFP was diagnosed by conventional criteria using a commercial immunofluorescent assay. RESULTS: The age of patients was 41 +/- 14 years (mean +/- S.D., range 20-69). Twelve of the patients were males. No concomitant or chronic disease was present in 16 patients. Chest radiograms revealed alveolar or air space pneumonia in 10 patients, bronchopneumonia in nine and interstitial pneumonia in one patient. The mean febrile period was 10.5 +/- 5.3 days. There was serological evidence of co-infection with Mycoplasma pneumonia in six patients, and with Legionella pneumophila in one patient. Patients treated with beta-lactam antibiotics recovered as quickly as those treated with tetracyclines or erythromycin. CONCLUSIONS: The Negev region of Israel is an endemic area for Q-fever. The diagnosis of QFP can be made only on the basis of a specific serological test. Clinical, radiologic or laboratory findings are not diagnostically definitive. The importance of specific therapy is unclear.

Adult↗
PubMed1995

Chlamydia pneumoniae-induced ciliostasis in ciliated bronchial epithelial cells.

The ciliary activity of ciliated bronchial epithelial cells was studied after infection with Chlamydia pneumoniae (strain TW-183) and Chlamydia trachomatis (biovar L2 [434/Bu]). C. pneumoniae, known to cause respiratory infections, had a marked ciliastatic effect, completely aborting ciliary motion within 48 h. This effect was not inhibited by inactivation of C. pneumoniae elementary bodies (EBs) by UV irradiation. In contrast, inactivation of EBs by heat (56 degrees C, 30 min) or by rabbit-specific immune sera to TW-183 antigen blocked the ciliastatic effect induced by C. pneumoniae infection. The effect of C. pneumoniae was specific. C. trachomatis, which causes sexually transmitted disease, did not block ciliary motion by 48 h after infection. A decrease in ciliary activity of ciliated bronchial cells produced by C. pneumoniae can contribute to both initiation and pathogenesis of respiratory infections induced by this pathogen.

Antibodies, Bacterial↗