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Biomedical subjects

E Israel

Publications and source records attributed to E Israel.

At least 91 records · Page 5Linked to original sources
PubMed1992

Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities.

PURPOSE: The purpose of this investigation was to observe and assess the actual disinfection or sterilization of endoscopes in health care facilities. MATERIALS AND METHODS: A total of 22 hospitals and four ambulatory care centers in three states were studied. Facility protocols were reviewed, interviews conducted with relevant personnel, actual disinfection or sterilization procedures observed, and biologic tests performed to determine and assess disinfection/sterilization procedures. RESULTS: Fundamental errors observed during the course of the investigation included respective failures to time the period of disinfection, to clean all channels, to flush all channels with disinfectant, to fully immerse the endoscope in the disinfectant solution, and to use a disinfectant. At 78% of the facilities, failure to sterilize all biopsy forceps was observed. A total of 23.9% of the bacterial cultures from the internal channels of 71 gastrointestinal endoscopes grew 100,000 colonies or more of bacteria. These cultures were obtained after the completion of all disinfection/sterilization procedures and the device was deemed ready for use in the next patient. CONCLUSIONS: These data indicate that actual disinfection/sterilization procedures for endoscopes are not always optimal, and high-level disinfection of gastrointestinal endoscopes is not always achieved.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Investigation of an outbreak of bloody diarrhea: association with endoscopic cleaning solution and demonstration of lesions in an animal model.

UNLABELLED: OUTBREAK INVESTIGATION: An outbreak of diarrhea, bloody diarrhea, and abdominal cramps occurred among persons undergoing flexible sigmoidoscopy at a branch clinic of a local health center. Illness was associated with use of sigmoidoscopes cleaned by one clinic assistant and appeared to be caused by 2% glutaraldehyde disinfectant solution left in the instruments after cleaning. ANIMAL STUDIES: In subsequent animal studies, colonic instillation of 2% glutaraldehyde solutions caused bloody diarrhea and a distinctive pattern of mucosal damage; similar changes were seen in a review of pathologic samples from other human cases of glutaraldehyde disinfectant-associated diarrhea. CONCLUSION: Our data indicate that improper endoscopic reprocessing can result in serious illness and underscore the importance of adequate training and quality control in this area.

Animals↗
PubMed1992

Nursing home outbreak of influenza A (H3N2): evaluation of vaccine efficacy and influenza case definitions.

OBJECTIVES: Describe an outbreak of influenza A (H3N2); provide an analysis of vaccine efficacy; measure the sensitivity, specificity, and positive predictive value of 3 clinical case definitions of influenza. SETTING: A nursing home in Washington County, Maryland. The outbreak involved 52 residents (attack rate = 47.7%) and at least 10 of 140 employees (minimum attack rate = 7.1%). RESULTS: Twenty-five residents exhibited a 4-fold or greater increase in titer to influenza A/Sichuan/2/87. Vaccine efficacy was measured at -7.1%, suggesting that the influenza vaccine in 1988/1989 did not offer optimal protection against influenza A infection for the institutionalized elderly. CONCLUSIONS: The outbreak was a clear indicator of the need for rapid diagnosis. With the use of rapid diagnostic tests, influenza A could have been detected in time to use amantadine.

Aged↗
PubMed1992

Changing clonal patterns of Salmonella enteritidis in Maryland: evaluation of strains isolated between 1985 and 1990.

We examined isolates from 203 sporadic and outbreak-associated Salmonella enteritidis cases occurring in Maryland between 1985 and 1990. Plasmid profiles were determined for all isolates; 52 isolates were phage typed. Ten plasmid profiles were identified. A single profile (consisting of a single ca. 55-kb plasmid) emerged as the predominant profile in Maryland during the study period. This profile (which was closely associated with phage type 8) accounted for 86% of a group of isolates from sporadic cases in 1988 and 1989, compared with 43% of the 1985 isolates. Strains with this profile were identified in four of nine outbreaks, including one of three outbreaks in which eggs were implicated as a vehicle. While plasmid profiles and phage typing appear to provide complementary means of identifying specific strains of S. enteritidis, the emergence of what appears to be a single predominant clone has reduced the discriminant ability of both typing systems. The factors be a single predominant clone has reduced the discriminant ability of both typing systems. The factors contributing to the emergence of this one clone are still not well understood.

Bacteriophage Typing↗
PubMed1992

Recovery of leukotriene E4 from the urine of patients with airway obstruction.

The urinary excretion of leukotriene E4 (LTE4) was measured in subjects presenting for emergency treatment of airway obstruction. A total of 72 subjects presenting with airway obstruction performed peak flow determinations before and after three treatments with nebulized albuterol given at 20-min intervals. Of these subjects, 22 more than doubled their peak flow rates, while 19 failed to increase their peak flow rates more than 25% during the treatment period. These groups were designated "responders" and "nonresponders," respectively. Urinary LTE4 excretion was determined in 16 of the 22 responders and 12 of the 19 nonresponders as well as 13 normal subjects by precolumn extraction, analytic reversed-phase high-performance liquid chromatography, and enzyme immunoassay. In the normal subjects the urinary LTE4 excretion was significantly (p less than 0.0001) less than the urinary LTE4 measured in the responder subjects, but not less than the urinary LTE4 excretion in the nonresponder group (p = 0.071). The enhanced recovery of LTE4 from the urine of subjects with acutely reversible airway narrowing is consistent with a bronchoconstrictor role for the cysteinyl leukotrienes in spontaneous acute asthma.

Acute Disease↗
PubMed1992

Acetazolamide and furosemide attenuate asthma induced by hyperventilation of cold, dry air.

We investigated the assumption that the efficacy of inhaled diuretics in asthma is dependent upon inhibition of the Na+/K+/2Cl- cotransporter. We compared the protective effect of acetazolamide, a diuretic without significant effect on the loop cotransporter, with the protection provided by inhaled furosemide in a cold, dry air hyperventilation model of asthma. Seven asthmatic subjects underwent a baseline bronchial challenge and then received a nebulized dose of 80 mg of furosemide or 500 mg of acetazolamide or saline placebo in a randomized, double-blind, placebo-controlled crossover design. Repeat challenges were performed immediately and at 2 and 4 h postnebulization. Acetazolamide caused a 47.2% increase in the amount of cold, dry air required to reduce the FEV1, by 20% (expressed in terms of respiratory heat loss as PD20RHL), from 0.79 multiplied or divided by (x/divided by) 1.13 kcal/min (geometric mean x/divided by geometric SEM) at baseline to 1.17 x/divided by 1.09 kcal/min postnebulization (p < 0.025). Furosemide increased the geometric mean PD20RHL by 53.9%, from 0.86 x/divided by 1.12 kcal/min to 1.33 x/divided by 1.12 kcal/min (p < 0.001). There was no significant change after placebo inhalation (0.81 x/divided by 1.15 kcal/min versus 0.87 x/divided by 1.10 kcal/min, NS). Airway responsiveness had returned to baseline by 2 h postnebulization on all 3 days. Furosemide also caused bronchodilatation, producing a 14.1% rise in the mean FEV1 (p < 0.005 versus prenebulization), whereas neither acetazolamide nor placebo altered airway tone significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetazolamide↗
PubMed1992

[The medical management of tubal pregnancy. Preliminary experience].

We present 3 cases of tubal pregnancy treated with methotrexate. According to the success that we have been obtaining, and the reports of the literature, we propose a local protocol of management of the unruptured tubal pregnancy using a single injection of intratubal methotrexate.

Adult↗
PubMed1992

Functional screening of lower-limb amputees: a role in predicting rehabilitation outcome?

The Functional Independence Measure (FIM), a single-score instrument used to measure independent functioning in six areas of basic self-care skills, was used to evaluate 68 patients following lower-limb amputation. Patients in a rehabilitation hospital were assessed with the FIM upon admission and discharge. Admission scores averaged 52.7, ranging from 25.2 to 70.0. Patients scoring in the lowest and highest quartiles were compared: no remarkable gender, ethnic, or age differences were evident. Persons with the lowest scores (ie, lowest functioning) had a higher prevalence of hypertension, coronary artery disease, and noninsulin-dependent diabetes mellitus. The success of rehabilitation in patients in the lower two quartiles upon admission was variable and not predicted well by the FIM. In contrast, predictability of rehabilitation success was high in patients functioning higher at admission, the majority achieving near-perfect scores by discharge. Length of hospitalization appeared to be largely unrelated to the net difference in FIM scores over the course of hospitalization.

Activities of Daily Living↗
PubMed1992

Lyme disease in Maryland: 1987-1990.

We describe the epidemiology of Lyme disease in Maryland for 1987 to 1990 when the number of cases reported grew from 23 to 448 and the number of cases meeting the CDC case definition grew from 23 to 238, as well as discuss the implications of increased reporting and diagnosis of Lyme disease.

Adolescent↗
PubMed1991

Glove use by health care workers: results of a tristate investigation.

The Center for Devices and Radiological Health, in collaboration with the state health departments of Iowa, Maryland, and Massachusetts, conducted a multi-state, multi-institutional investigation of glove use by health care workers (HCWs). Twenty-two hospitals and four ambulatory care centers were included in the investigation. All 26 health care facilities were found to have adopted universal precautions policies for glove use by HCWs, per Centers for Disease Control guidelines. Four hundred five observations were made of HCWs performing procedures that may involve contact with patient body fluids, particularly blood. The prevalence of glove use during selected procedures was as follows: arterial blood gas procedures, 92.3%; intravenous line initiation/maintenance, 77.6%; and phlebotomy, 70.6%. Glove use during phlebotomy (p less than 0.001) and intravenous line procedures (p less than 0.05) was significantly lower in the state with a prevalence of the acquired immunodeficiency syndrome (AIDS) below the national average than in the states with a higher AIDS prevalence. The investigation suggests that health care facilities have responded to the Centers for Disease Control and Occupational Safety and Health Administration campaign to adopt universal precaution policies for glove use by HCWs. Actual glove use by HCWs appears to be substantial but not universal. Glove use by HCWs is significantly related to statewide AIDS prevalence.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The epidemiology of rodent and lagomorph rabies in Maryland, 1981 to 1986.

Records from the Maryland Public Health Department were screened for confirmed rodent and lagomorph rabies between 1981 and 1986. Questionnaires were designed for collection of information about events that led to the exposure of human and/or domestic animals to rabid rodent or lagomorphs. These species comprised 1.2% of all the reported rabies in the state. Woodchucks (Marmota monax) constituted 80.0% of all the reported rodent/lagomorph rabies cases in Maryland. The majority showed aggressive behavior (55.0%). Woodchucks exposed 15 persons (75.0% of all the exposures by rodents/lagomorphs). Domestic animal and human rabies exposure due to rodents and lagomorphs represents a small but significant number of the total exposure to rabid animals.

Aggression↗
PubMed1991

Preventive therapy for tuberculosis in Maryland.

Maryland data substantiate the safety of isoniazid therapy in preventing tuberculosis. To eradicate tuberculosis in the U.S., private physicians must play an active role by offering preventive therapy to patients at high risk of developing the disease.

Adolescent↗
PubMed1990

The effects of a 5-lipoxygenase inhibitor on asthma induced by cold, dry air.

BACKGROUND: The enzyme 5-lipoxygenase catalyzes the metabolism of arachidonic acid to form products that have been implicated in the airway obstruction of asthma. We hypothesized that if products of the 5-lipoxygenase pathway are important in mediating this obstruction, then prevention of their formation should decrease the severity of an induced asthmatic response. METHODS: In a randomized, double-blind, placebo-controlled, crossover study, we examined the effect of A-64077, a 5-lipoxygenase inhibitor, on the bronchoconstriction induced by hyperventilation of cold, dry air in 13 patients with asthma. The completeness of 5-lipoxygenase inhibition was confirmed by examining the profile of eicosanoids produced in whole blood ex vivo after activation with the calcium ionophore A-23187. RESULTS: A-64077 decreased the mean (+/- SEM) ionophore-induced synthesis of leukotriene B4, a 5-lipoxygenase product, by 74 percent (from 265.3 +/- 30.3 to 69.5 +/- 21.5 ng per milliliter, P less than 0.001), but it did not affect the ionophore-induced synthesis of thromboxane B2, a cyclooxygenase metabolite of arachidonic acid (80.0 +/- 17.1 ng per milliliter before A-64077 vs. 75.8 +/- 14.3 ng per milliliter after A-64077). In concert with the selective inhibition of 5-lipoxygenase by A-64077, the amount of cold, dry air (expressed as respiratory heat exchange) required to reduce the forced expiratory volume in one second by 10 percent was increased by 47 percent after A-64077 (3.0 kJ per minute for placebo vs. 4.4 kJ per minute for A-64077, P less than 0.002). Similar results were obtained when minute ventilation was used as an indicator of outcome (27.5 liters per minute for placebo vs. 39.8 liters per minute for A-64077, P less than 0.005). CONCLUSIONS: Selective inhibition of 5-lipoxygenase by A-64077 is associated with a significant amelioration of the asthmatic response to cold, dry air, suggesting that 5-lipoxygenase products are involved in this response. This approach may be useful in the treatment of asthma.

Asthma↗