Incidence of hyperkalemia in hospitalized patients.
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Adult↗
Biomedical subjects
J Shemer
Publications and source records attributed to J Shemer.
Quinine alone versus quinine plus a pyrimethamine-sulfadoxine combination in the treatment of Plasmodium faliciparum cerebral malaria.
Fifty-two patients with severe chloroquine resistant Plasmodium falciparum malaria were treated in a randomized double blind study with either quinine and a single dose of pyrimethamine-sulfadoxine (Fansidar) or quinine alone. Although no statistically significant differences were observed, the 25 patients who received both drugs responded faster and had a more favorable outcome (no deaths) when compared to the 27 who received quinine alone (2 deaths).
Clinical Trials as Topic↗
Amyloid in urinary sediments as a diagnostic technique.
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Amyloid↗
A potential risk of cancer in a central laboratory.
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Adult↗
Food-borne and air-borne streptococcal pharyngitis--a clinical comparison.
Different vehicles of transmission of the same pathogen may induce different clinical manifestations of the disease. The hypothesis was tested that the clinical manifestation of food-borne streptococcal pharyngitis is different from air-borne streptococcal pharyngitis. The symptoms and signs of 77 patients with endemic air-borne streptococcal pharyngitis compared to 103 patients with epidemic food-borne streptococcal pharyngitis (T type 8/25/imp19, M protein negative) and 11 patients with secondary air-borne epidemic streptococcal pharyngitis (T type 8/25/imp19, M protein negative) were prospectively evaluated. The patients with food-borne streptococcal pharyngitis had a significantly higher frequency of sore throat, fever, pharyngeal erythema, tonsillar enlargement and submandibular lymphadenopathy and a lower frequency of coryza and cough compared to the patients with endemic air-borne streptococcal pharyngitis. Although both food-borne and air-borne streptococcal infection caused upper respiratory tract infection, the clinical manifestation of food-borne streptococcal pharyngitis was more severe and more confined to the pharynx compared to the endemic air-borne disease. Involvement of the nasal mucosa and bronchial tree was more common in air-borne streptococcal pharyngitis than in the food-borne disease.
Air Microbiology↗
Prevalence of anti-hepatitis A antibodies, hepatitis B viral markers, and anti-hepatitis C antibodies among immigrants from the former USSR who arrived in Israel during 1990-1991.
The goal of this study was to assess the susceptibility of the sub-population of over 500,000 immigrants from the former USSR who came to Israel during 1989-94 to HAV infection, and to provide military physicians with estimates of the prevalence of HBV and HCV carriage in this sub-population. 987 males aged 17-49 and 195 females aged 17-19, reporting to military recruitment offices between December 1991 and March 1992 were tested. Anti-HAV, anti-HBV antibodies and hepatitis B surface antigen (HBsAg) were detected by using standard enzyme immunoassay (EIA) tests, and anti-HCV antibodies by a second-generation EIA and confirmed by a third-generation INNO-LIA test. It was found that in the 17-19-year age-group the prevalence of anti-HAV antibodies was 37%, anti-HBV was 12.8%, HBsAg was 3.0% and anti-HCV 1.3%. All markers were higher among males. The prevalence of anti-HAV and anti-HBs antibodies increased with age among males. That of HBsAg and anti-HCV antibodies increased with age overall. In the multiple logistic regression analysis, HAV and HBV seropositivity were significantly associated with the mother's education and republic of origin. It was concluded that the prevalence of anti-HAV antibodies is similar to that among the local population, which should not be considered at a higher risk of infection during military service. On the other hand, the higher prevalence of HBsAg and anti-HCV antibodies in this sub-population should heighten the awareness of the possibility of chronic liver pathology.
Adolescent↗
Immune status against diphtheria among immigrants from the former USSR who arrived in Israel during 1990-1991.
Large outbreaks of diphtheria occurred recently in the former USSR. Between 1989 and 1994, a total of about 600,000 Soviet immigrants arrived in Israel. The immune status against diphtheria in a sample of 992 men aged 17-49 and 195 women aged 17-19, who arrived in Israel during 1990-91, was studied in order to evaluate the need for vaccination. Participants completed a self-administered questionnaire and diphtheria antitoxin antibody levels were measured by means of ELISA. At age 17-19, the prevalence of antitoxin antibody levels below the protective level of 0.01 IU/ml was 4.8% in the men and 2.1% in the women. Among the men, the percentage lacking protection declined from 4.8% at age 17-19 years to 1.6% at age 20-24, and increased to 18.2% at age 35-49. In the oldest group, the prevalence of those lacking protection was considerably higher than for the general Israeli population. In the multivariate analysis, age, mother's education and republic of origin were significantly associated with the absence of protection. Immigrants from the former USSR appear to be more susceptible to diphtheria, thus increasing the possibility of clinical disease, and it is recommended that they receive booster doses of diphtheria toxoid.
Adolescent↗
Association in the seroprevalence of hepatitis A and herpes simplex-1 viruses in young adults in Israel.
BACKGROUND: The rise in the standard of living of the Israeli population during recent decades has been accompanied by a significant decline in the prevalence of various viral diseases including hepatitis A (HAV). This trend is not reflected in the seroprevalence of herpes simplex (HSV) infection, which has remained stable during these years. MATERIALS AND METHODS: The Public Health Branch of the Israel Defense Force (IDF) Medical Corps continuously draws a systematic, representative sample of male and female recruits on their 1st day of service, based on digit combinations of the military identification number. These recruits are asked to give a blood sample and to undergo a short interview. A quantitative determination of anti-HSV-1 and anti-HAV antibodies was performed. RESULTS: In the present study that included 124 male and 98 female 18-year-old army recruits, 51.1% of the anti-HSV-positive subjects was also positive for anti-HAV, compared to 27% among anti-HSV-negative persons. Rate ratio (RR) for anti-HAV seropositivity between anti-HSV-1-positive and negative recruits was 1.86 (95% CI 1.3-2.7). CONCLUSION: The present study suggests a strong association between the seroprevalence of both viruses.
Adolescent↗
Insulin-like growth factors.
The insulin-like growth factors (IGF-I and IGF-II) play important roles in the regulation of growth and metabolism. While the liver is the main source of circulating IGFs, their production by numerous extrahepatic tissues suggests the existence of autocrine and paracrine modes of action in addition to typical endocrine mechanisms. The actions of the IGFs are mediated through their activation of specific cell surface receptors, primarily the IGF-I receptor, although some effects may be mediated through the IGF-II receptor and the insulin receptor. The stability of the IGFs and their interaction with their receptors are mediated by specific IGF binding proteins (IGF-BPs) which are found in the circulation and in extracellular fluids. Thus, the overall biological actions of the IGFs can be regulated by control of ligand biosynthesis, modulation of receptor levels and postreceptor signalling pathways, and changes in the levels and activity of IGF-BPs.
Animals↗
The efficacy of integrating "smart simulated casualties" in hospital disaster drills.
INTRODUCTION: Full-scale disaster drills are complex, expensive, and may involve hundreds or thousands of people. However, even when carefully planned, they often fail to manifest the details of medical care given to the casualties during the drill. OBJECTIVE: To assess the feasibility of integrating physicians among the simulated casualties of a hospital disaster drill. METHODS: A total of 178 physicians graduating an Advanced Trauma Life Support (ATLS) course participated in eight hospital disaster drills during 1994 as "Smart Victims." The participants were given cards with descriptions of their injury and detailed instructions on how to manipulate their medical condition according to the medical care provided in the hospital. They also were given coded questionnaires to fill out during the process of the drill. Conclusions were drawn from analysis of the questionnaires and from a roundtable discussion following each drill. RESULTS: The "smart casualties" made comments on the following topics: 1) triage (over-triage in 9%, and under-triage in 4%); 2) treatment sites; 3) medical equipment usage (i.e., shortage of ventilators and splinting devices); 4) medical knowledge and care rendered by the hospital staff; 5) evacuation and escorting of the wounded; 6) management of patients with post-traumatic stress disorder; and 7) medical documentation. Their comments contributed valuable information on the quality of medical care and organization, and identified obstacles that otherwise would have been overlooked. The "smart casualties" were very cooperative and indicated that their participation in the drill contributed to their understanding of disaster situations in hospitals. CONCLUSION: Integrating physicians among the simulated casualties in a hospital disaster drill may contribute to achieving the objectives of hospital disaster drills and add to disaster management education of the simulated casualty physicians.
Adult↗
Herpes simplex-associated erythema multiforme (HAEM): a clinical therapeutic dilemma.
Erythema multiforme of the mouth is an acute vesiculo-ulcerative lesion, which presents a diagnostic and therapeutic challenge to the clinician. Herpes simplex is described as the most frequent cause of this disease. Controversy exists in the literature as to the definition of oral erythema multiforme and the role of systemic corticosteroids in its treatment. Recent treatment protocols advocate the use of systemic acyclovir, especially in cases triggered by the herpes simplex virus. Two cases of successful treatment of oral erythema multiforme with systemic corticosteroids after acyclovir treatment had failed are presented.
Acute Disease↗
Israeli medical lessons from the Gulf war: an overview.
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Chemical Warfare↗
Medical aspects of the Iraqi missile attacks on Israel.
During the period 18 January-28 February 1991, a total of 39 Iraqi modified Scud missiles landed in Israel, most of them in the densely populated Tel Aviv area. There were 23 missile attack alerts. These attacks caused 1,059 cases of injury; there were two deaths and 232 patients were admitted to emergency rooms for injuries directly related to the explosions, only one of which was severe. A survey among 91 of the injured showed that 46.6% of the wounds were caused by glass splinters, 31.1% were blunt contusions, and 22.2% were acute psychological reactions. No case of blast injury was reported. Inappropriate injection of atropine was reported in 230 cases. Acute anxiety was the reason for admission of 544 patients to emergency rooms. Another 40 patients sustained various traumas while rushing to the sealed room. The relatively low number of injured people is striking in view of the density of population in the areas hit. Various explanations are discussed.
Anxiety Disorders↗
Eighty years of the threat and use of chemical warfare: the medical-organizational challenge.
The threat of using chemical warfare (CW) by countries ruled by dictators and totalitarian governments still exists despite the Geneva Convention of 1925 that prohibited the use of CW. This situation forces nations and their armed forces to be in a state of preparedness in the event of a CW attack. A CW attack on an unprotected civilian population in a dense urban area can cause numerous casualities and become a mass disaster. However, this danger may be significantly reduced by: a) providing collective and individual protective measures, b) training the population in the use of protective measures, and c) early warning to provide sufficient lead time to use the various components of protection. Coping with a nonconventional warfare threat requires an innovative approach in the organization of the health care delivery system so as to maximize the number of survivors. The fact that the population is protected may deter the enemy from using CW since the potential destructive impact of CW is neutralized or at least reduced.
Antidotes↗
Civilian-military health services contingency program for a mass casualty situation and wartime in Israel.
The Israeli civilian-military health services contingency program for mass and wartime casualties has more than four decades of experience. The contingency program includes key civilian and military organizations that are involved in the planning, policy making and delivery of health care and support services to the wounded. During the Persian Gulf war the unified civilian and military command--the supreme hospitalization authority--implemented a national hospital and emergency medical services preparedness system designed to treat the victims of chemical warfare attacks.
Civil Defense↗
Physiological assessment of the passive children's hood.
The physiological effect of the "passive children's hood" (PCH) was studied in 24 children: 8 toddlers (3-4.5 years old), 8 pre-school pupils (4.5-6 years) and 8 first- and second-grade pupils (6-8 years). This device consists of a children's gas mask and a transparent PVC (polyvinyl chloride plastic) covering (hood). Inspiratory CO2 and O2 (FiCO2 and FiO2, respectively), temperature and humidity were monitored at 10-min intervals while the children were occupied with sedentary activities (playing and watching TV) in a sealed room. Ambient temperature and relative humidity were approximately 27 degrees C and 75% respectively. In the PCH space the temperature was 2 degrees C higher and humidity was near saturation at the end of exposure. FiCO2 in 12 children exceeded 2%, which is the upper acceptable limit according to industrial standards. In four of them FiCO2 was greater than 4% and FiO2 less than 16%. Twenty-two children tolerated the PCH for 92 +/- 35 min (range 24-133 min) with no physiological complications. A significant correlation was found between childrens' age and tolerance time (r = 0.47, P less than 0.025). We conclude that children whose masks are not well adjusted may be exposed to rebreathing CO2-enriched air.
Age Factors↗
An argument for equipping civilian hospitals with a multiple respirator system for a chemical warfare mass casualty situation.
During the Persian Gulf war, the entire Israeli population was under the threat of chemical missiles. One of the main effects of chemical agents (e.g., organophosphorus) is respiratory distress, which requires treatment with mechanical ventilation and oxygen enrichment. In the event of a chemical missile attack, the civilian hospitals may enter a state of insufficiency for treating such victims due to the limited amount of equipment, staff and oxygen/air sources. A possible technological solution is a multiple respirator system (MRS) with a multiple oxygen enrichment system designed for use in the battlefield. The advantages of these technologies in the civilian hospital setting during a chemical mass casualty situation are: (a) rapid deployment, (b) high transportability, (c) capability of operation in any location, (d) modularity, and (e) less medical staff for operation. Two types of MRS are described and issues concerning their selection are discussed. The authorities responsible for national health policy may wish to adopt and incorporate these technologies into their hospital and emergency services preparedness system.
Centralized Hospital Services↗
Acute pyridostigmine overdose: a report of nine cases.
Pyridostigmine is known as a pre-treatment drug against intoxication with organophosphorus nerve agents. During the Persian Gulf war, we encountered a cluster of nine cases of pyridostigmine self-poisoning, of which three presented with mixed drug poisoning. The clinical and laboratory features of pyridostigmine toxicity are presented. Doses ranged between 390 and 900 mg. Pyridostigmine ingestion resulted in mild to moderate cholinergic symptoms such as abdominal cramps, diarrhea, emesis, nausea, hypersalivation, urinary incontinence, fasciculations, muscle weakness and blurred vision. No central nervous system manifestations were evident. The symptoms developed within several minutes and lasted up to 24 h. All patients underwent gastric emptying followed by administration of activated charcoal. Atropine (1-8 mg) was required in only three patients. Measurement of serum cholinesterase inhibition was found to be a reliable and sensitive diagnostic tool in pyridostigmine poisoning. No clear correlation was found between the extent of cholinesterase inhibition and the incidence or severity of the cholinergic signs. The clinical recovery was faster than the spontaneous recovery of the enzyme. Pyridostigmine intoxication is self-limited and well tolerated by young healthy adults.
Adolescent↗