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Biomedical subjects

L Leibovici

Publications and source records attributed to L Leibovici.

At least 91 records · Page 5Linked to original sources
PubMed1991

Risk factors for development of diabetic nephropathy and retinopathy in Jewish IDDM patients.

Risk factors associated with diabetic microvascular complications, with special reference to ethnic origin, were looked for in 231 young Jewish insulin-dependent diabetes mellitus (IDDM) patients with duration of diabetes greater than or equal to 10 yr. Median age at diagnosis of diabetes was 9.2 yr (range 0.04-26.2 yr), and median duration of the disease was 15.3 yr (range 10.0-37.2 yr). Sixty-three percent of the patients were Ashkenazi Jews, and 37% were non-Ashkenazi Jews. HbA1 was evaluated every 3 mo in the last 10 yr of follow-up, and albumin excretion rate was tested in three 24-h urine collections. Direct and indirect ophthalmoscopy was performed every year since diagnosis of diabetes, and if retinal pathology was suspected, color photographs were taken. Microalbuminuria was detected in 31% and macroalbuminuria in 7% of the patients. Nonproliferative and proliferative retinopathy was found in 44 and 12% of the patients, respectively. On logistic regression analysis, two variables were significantly and independently associated with diabetic nephropathy--non-Ashkenazi origin and mean HbA1 values over the first 5 of 10 yr of follow-up. Variables significantly and independently related to diabetic retinopathy were non-Ashkenazi origin, mean HbA1 values over the last 10 yr of follow-up, and duration of diabetes. Because non-Ashkenazi Jews in Israel are of lower socioeconomic status than Ashkenazi Jews, we stratified our patients according to their socioeconomic parameters, median HbA1 values, and duration of diabetes. Non-Ashkenazi patients were at a higher risk to develop complications in all strata.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Bacteremia in adult diabetic patients.

OBJECTIVE: To compare the microbiology, sources, complications, and outcome of bacteremia in diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: A prospective study was conducted of all episodes of bacteremia in hospitalized diabetic and nondiabetic patients. The study consisted of patients greater than or equal to 18 yr of age with bacteremia detected within a 19-mo interval. RESULTS: We compared 124 episodes of bacteremia in 119 diabetic patients to 508 episodes in 480 nondiabetic patients. Diabetic patients were older than nondiabetic patients (median age 74 vs. 68 yr, P = 0.0001). In patients with an indwelling urinary catheter and bacteremic urinary tract infection, the percentage of Klebsiella in diabetic patients was 60% (6 of 10) and in nondiabetic patients was 17% (4 of 23, P = 0.04). In patients without an obvious source of bacteremia, the percentage of staphylococcal isolates in diabetic patients was 29% (10 of 35) and in nondiabetic patients was 14% (24 of 176, P = 0.04). Staphylococci were a common cause of bacteremic infections of the extremities in diabetic patients (12 of 19, 63%) and nondiabetic patients (20 of 50, 40%). Septic shock was the only complication that was more common in diabetic patients. The mortality in diabetic and nondiabetic patients was 28 and 29%, respectively. CONCLUSIONS: Our results represent elderly patients with non-insulin-dependent diabetes mellitus. In this group, empirical treatment for suspected bacteremic urinary tract infection in patients with a urinary catheter should include coverage for Klebsiella. Empiric treatment for suspected bacteremia of unknown origin or caused by infection of the extremities should include an antistaphylococcal drug. The prognosis of bacteremia in diabetic and nondiabetic patients was similar.

Adult↗
PubMed1991

Single-dose antibiotic treatment for symptomatic urinary tract infections in women: a meta-analysis of randomized trials.

The efficacy of single-dose antibiotics for treatment of symptomatic urinary tract infections in women was compared to the efficacy of conventional therapy in 25 controlled studies. The combined results of these studies indicate that single-dose antibiotics are less effective than conventional therapy at 3-14 days post-treatment (odds ratio of 0.5, 95 per cent confidence interval (C.I.) 0.4-0.7), and at 4-6 weeks (odds ratio of 0.4, 95 per cent C.I. 0.3-0.6). Single-dose therapy did not perform better in patients with bacterial isolates sensitive to the drug used. The cure rate achieved by single-dose amoxicillin was significantly lower than that afforded by conventional therapy. The equal efficacy of single-dose and conventional trimethoprim/sulphamethoxazole treatment at 3-14 days post-treatment could not be ruled out with a 95 per cent certainty. However, conventional treatment achieved cure rates significantly higher than single-dose therapy at 4-6 weeks (odds ratio 0.48, 95 per cent C.I. 0.3-0.8). Side-effects were lower among patients given a single dose (odds ratio 0.5, 95 per cent C.I. 0.4-0.6). Although single-dose trimethoprim/sulphamethoxazole is less effective than a course of treatment, it causes fewer side-effects: the decision of whether to use a single-dose has to be decided by cost-benefit analysis in any specific health-care system.

Amoxicillin↗
PubMed1991

Bacteremia in febrile patients. A clinical model for diagnosis.

Among 244 patients aged 18 to 98 years who were consecutively hospitalized in a department of internal medicine because of a febrile disease, 52 (21%) were bacteremic. On a logistic regression analysis, five variables known within 24 hours of admission were found to be associated both significantly and independently with bacteremia: low serum albumin level, low premorbid performance status, chills, renal failure, and an assumptive diagnosis of urinary tract infection on admission. The logistic model was used to divide patients into three groups. In group 1, the percentage of bacteremic patients was 5%, in group 2, 40%, and in group 3, 83%. The percentage of deaths in the three groups was 0%, 23%, and 50%, respectively. The model was validated in a second group of 257 patients. The percentage of bacteremia was 1% in group 1, 23% in group 2, and 65% in group 3. The death rate in three groups was 3%, 4%, and 35%, respectively. The accuracy of the attending physician in diagnosing bacteremia within 24 hours of hospitalization was compared with that of the model. Use of the model could have improved the diagnostic accuracy in 5% of the patients in group 1 and in 18% of patients in group 3.

Aged↗
PubMed1991

Alopecia in systemic lupus erythematosus. Relation to disease manifestations.

Alopecia was observed in 40/74 (54%) patients with systemic lupus erythematosus (SLE). Patients with alopecia had a significantly higher rating for cutaneous manifestations, Raynaud's phenomenon and muscle tenderness, and most of these signs correlated with the magnitude of alopecia. There was no difference between patients with or without alopecia for arthritis, nephritis or central nervous system manifestations. Alopecia correlated with disease activity index but did not correlate with various specific measurements of disease exacerbation.

Adult↗
PubMed1990

Accelerated heme synthesis and degradation in transformed fibroblasts.

Various parameters of the heme biosynthetic pathway were studied in two cell lines, one nontransformed and the other malignantly transformed (MLV/MS), both replicating at the same rate. Using the above system enabled us to distinguish between phenomena characteristic of the malignant transformation per se and those due to accelerated growth rate. Heme synthesis and degradation as well as the activities of ALAS, ALAD, PBGD, and FC were found to be increased in the transformed cells. However, the concentration of intracellular heme was markedly reduced from 30.4 +/- 4.4 pmole/mg protein in nontransformed cells to 10.5 +/- 2.6 pmole/mg protein in transformed cells. These observations show that malignant transformation leads to changes in heme metabolism unrelated to growth rate in this cell line.

Animals↗
PubMed1990

Effects of fish-oil ingestion on cardiovascular risk factors in hyperlipidemic subjects in Israel: a randomized, double-blind crossover study.

Effects of a daily fish-oil supplement on serum lipids, apolipoproteins, and some platelet functions and hemorheologic variables were examined in 27 hyperlipidemic subjects in a randomized, controlled, double-blind, crossover fashion with an identically encapsulated vegetable oil serving as the control treatment. Despite the habitual high linoleic acid intake of the study population, significant incorporation of n-3 (omega-3) fatty acids into the serum, platelet, and erythrocyte lipids was observed after the fish-oil supplement. Ingestion of fish oil resulted in a 40% decrease in the triglyceride concentration, a 12% increase in HDL cholesterol, and a significant decrease in plasma viscosity, whereas the vegetable-oil placebo had no significant effect. We conclude that a moderate intake of fish oil (15 g/d) is a feasible treatment for hypertriglyceridemia even in patients with a background of high linoleic acid intake and that it may have a beneficial effect on several cardiovascular risk factors.

Apolipoproteins↗
PubMed1990

Nasal carriage of Staphylococcus aureus: correlation with hormonal status in women.

In view of recent observations on hormone-microorganism interactions, a study of Staphylococcus aureus nasal carriage in relation to sex-hormone status was undertaken. Prospectively in 479 women attending a colpocytologic clinic, hormonal status was assessed by determining the karyopyknotic index (KI) on smears stained by the Papanicolaou method. Rates of S. aureus nasal carriage were 29.3% in premenopausal women and 21.9% in postmenopausal women (P not significant). Carriage rates were significantly higher (P = .026, chi 2 7.32) for women with high KIs (40.7%) than for those with intermediate and low KIs (27.03% and 25.1%, respectively). S. aureus nasal carriage also correlated independently and significantly with previous antibiotic use and the presence of insulin-treated diabetes mellitus. This preliminary observation confirms an association between levels of sex hormones as reflected by the KI and S. aureus nasal carriage rates.

Adolescent↗
PubMed1990

Prospective evaluation of liver function tests in patients treated with aminoglycosides.

We investigated the relationship between therapy with aminoglycoside antibiotics and alterations in serum liver enzymes and bilirubin. One hundred fourteen patients treated with aminoglycosides and 96 treated with other antibiotics were assessed prospectively during eight days. No elevation in serum alanine aminotransferase, lactic dehydrogenase, or bilirubin was detected in the aminoglycoside and control groups. Alkaline phosphatase increased significantly in the aminoglycoside group (average elevation of 28 +/- 16 units/L on day 6), but no patient had an elevation greater than twice the upper limit of the normal range. We conclude that the abnormality in liver enzymes during aminoglycoside therapy is a mild elevation in alkaline phosphatase, probably with no clinical significance.

Aged↗
PubMed1990

Occult bacterial infection in adults with unexplained fever. Validation of a diagnostic index.

We tested the performance of a previously developed index to diagnose occult bacterial infection and bacteremia in febrile patients. A total of 113 patients consecutively hospitalized because of an acute febrile disease, without a recognizable source of fever, were divided into four groups, with increasing probability of bacterial infection and bacteremia. None of the patients in the first group had bacterial infection or bacteremia. The incidence of bacterial infection and bacteremia was 27% and 11% in the second group, 32% and 17% in the third group, and 53% and 35% in the fourth group. No patient in the first group died, as opposed to 29% of patients in the fourth group. The use of the index at admission would have probably changed the treatment of 11% of patients. Thus, the index could be used to identify patients to be discharged from the emergency department (first group) or hospitalized and treated empirically (fourth group).

Adolescent↗
PubMed1989

Daily change of an antiseptic dressing does not prevent infusion phlebitis: a controlled trial.

We carried out a controlled, randomized study in which we compared the incidence of infusion phlebitis in 83 patients whose povidone-iodine dressing over the infusion site was changed daily with a control group of 84 patients whose original dressing was left unchanged. Over 3 days the cumulative incidence of phlebitis in the study group was 60% and in the control group 59%. We conclude that the daily change of an antiseptic dressing does not reduce the risk of infusion phlebitis.

Adolescent↗
PubMed1989

A clinical model for diagnosis of urinary tract infection in young women.

To develop a clinical model for diagnosis of bacterial urinary tract infection, we conducted a prospective study on 266 dysuric young women, 147 of whom had urinary tract infections. Five variables were found to be significant and independent correlates to bacterial urinary tract infection on logistic regression analysis: sexual activity, absence of vaginal discharge, short duration of complaints, leukocyturia, and hematuria. An algorithm combining the logistic model and a Gram-stained urine specimen, which was used in only a third of our patients, afforded a sensitivity of 86% and a specificity of 84%. The algorithm was validated in a second set of 166 dysuric women, 77 of whom had urinary tract infections. The algorithm led to a diagnosis of bacterial urinary tract infection with a sensitivity of 91% and specificity of 79%; the only laboratory test needed except for urinalysis was a Gram's stain of urine, obtained for 30% of the patients.

Adolescent↗
PubMed1989

Colchicine treatment of abdominal pains in porphyric patients.

Four hepatic porphyria patients were treated with colchicine for abdominal pains. Colchicine administration during prodromal abdominal symptoms prevented the development of these abdominal crises. When colchicine was given after initiation of the crisis the duration and magnitude of the abdominal pains decreased.

Abdomen↗
PubMed1988

Activity of porphobilinogen deaminase in peripheral blood mononuclear cells of patients with metastatic cancer.

Porphobilinogen deaminase (PBGD), one of the enzymes in the pathway of heme synthesis, was found to be elevated in peripheral mononuclear cells of 60% of patients with epithelial tumors and metastatic spread, but only in 14% of patients with tumor and no evidence of metastases. The combination of both high lactic dehydrogenase and high PBGD afforded a sensitivity of 40%, but a specificity of 96% in diagnosing metastatic spread.

Adult↗