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Biomedical subjects

M Shapiro

Publications and source records attributed to M Shapiro.

At least 361 records · Page 20Linked to original sources
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Endoscopy in the age of HIV: a study of current practices and attitudes.

Gastroenterologists are frequently asked to perform a variety of endoscopic procedures in patients with AIDS. A study published 6 years ago concluded that costly and inefficient practices resulted from anxiety about transmitting human immunodeficiency virus (HIV) to endoscopic personnel. We re-examined, by means of a questionnaire mailed to 200 program directors in gastroenterology, the perceived risk of acquiring HIV infection via endoscopy. Although the perception of risk had not changed, the level of concern was relatively low and endoscopic personnel were less reluctant than previously to be involved with such patients. Notwithstanding, protective garments were used two to seven times more often when the patient was known to be HIV-positive.

Attitude of Health Personnel↗
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Meningococcal meningitis among Rwandan refugees: diagnosis, management, and outcome in a field hospital.

OBJECTIVE: To study the diagnostic process, clinical course, and outcome of Rwandan refugees with meningococcal meningitis, treated in an Israeli field hospital in Goma, Zaire, in the summer of 1994. METHODS: Patient hospital charts and laboratory records were reviewed with critical evaluation of clinical presentation and diagnostic tests. Patients were treated as part of a disaster relief effort in a refugee camp experiencing several coexisting lethal epidemics. RESULTS: A total of 65 patients were identified as having group A meningococcal meningitis. Latex agglutination test for Neisseria meningitidis soluble antigen in the cerebrospinal fluid was found to be a superior diagnostic tool, as compared to Gram stain, and at least as effective as culture. The mortality rate was 14%; mortality was markedly affected by co-morbidity (e.g., dysentery, pneumonia, and malnutrition). CONCLUSIONS: The outcome of patients with meningococcal meningitis, treated in referral centers within a disaster area may be favorable, despite overwhelming coexisting epidemics, and may be comparable to that achieved in advanced medical facilities. Encephalopathy may be a diagnostic pitfall in the perspective of coexisting epidemics, requiring a high index of suspicion and routine lumbar puncture. The latex agglutination test is highly useful in achieving prompt diagnosis of meningococcal meningitis, in particular when sample handling for culture and microscopy is suboptimal.

Adolescent↗
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Perioperative prophylactic use of antibiotics in surgery: principles and practice.

Prophylactic use of antimicrobics represents about 30% of total hospital use of these agents. Previous studies in animal models have suggested that timing of such prophylaxis is crucial, to the extent of the existence of a "critical period" for effective administration. This phenomenon has further been shown to exist in man, in numerous double-blind, controlled clinical trials in various types of surgical wounds. On these bases, we introduced new prophylactic protocols in a university hospital, specifically directed at reducing infection in high-risk procedures. Surveillance was conducted by infection control nurses, and one antibiotic-day was the comparative unit. Infection rates were markedly diminished under these new protocols. Total usage of antimicrobial drugs also decreased by 38% over previous rates. The rationale for limiting prophylaxis to a circumscribed period was clearly demonstrated, although the exact mechanisms responsible for this effect are, as yet, unclear.

Anti-Bacterial Agents↗
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Risk factors for post-operative wound infection in cardiac surgery patients.

In a prospective study of 372 patients undergoing cardiac surgery, we evaluated the relative contribution of host factors and patient care variables to the risk of post-operative wound infection. Host factors studied were age, sex, country of origin, the diagnosis for which the operation was performed and, for coronary artery by-pass operations, the functional cardiac status according to modified New York Heart Association criteria. The performance of more than one operation during a single admission carried the highest risk for infection, followed by a coronary artery by-pass operation lasting for more than six hours or performed on patients 65 years or older. In patients undergoing coronary artery by-pass surgery, host factors (age and cardiac function) were associated with infections in the chest wound, while the length of the operation was found to affect the occurrence of infections at the "donor" site.

Adolescent↗
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Anti-Rh39--a "new" specificity Rh system antibody.

Two examples of an autoantibody that defines a hitherto unrecognized Rh system antigen are described. Both were produced by C-negative individuals and ostensibly resembled anti-C in specificity. However, adsorption studies showed that the antigen that the autoantibodies define is present on all red blood cells with a "normal" Rh phenotype and on D--/D-- and Dc--/Dc--samples. The antigen detected is not present on Rhnull red blood cells. Serologic studies have shown that the new antibody, that has been named anti-Rh39, has a different specificity from those that define the antigens C, Ce(rhi), G, Hro, Hr, CG, LW, Rh:29, Rh:34 and U. A possible relationship between auto-anti-Rh39 and allo-anti-C, in terms of the immune response, is discussed.

Adsorption↗
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Prophylaxis in otolaryngologic surgery and neurosurgery: a critical review.

In an assessment of prospective, controlled studies of antimicrobial prophylaxis against infections following otolaryngologic surgery and neurosurgery, the English-language literature on this topic was reviewed. Rates of infection following clean otolaryngologic operations are the same for patients receiving prophylaxis and those receiving placebo. For patients with head and neck cancer, rates of postoperative infection without antibiotic prophylaxis in clean surgery are less than 1%, and prophylaxis is not indicated; in contrast, in clean-contaminated procedures (infection rate, 18%-87%), prophylaxis is highly protective, although several studies have shown no advantage to its prolongation beyond 24 hours. For the latter operations, drugs with adequate activity against oral anaerobes are essential, whereas the need for coverage against Enterobacteriaceae is doubtful. In clean and clean-contaminated neurosurgical procedures, the rate of protective efficacy of prophylaxis ranges between 63% and 76%. For shunt operations the available evidence favors prophylaxis, but the wide range of infections reported mandates a large-scale multicenter trial to decide the issue.

Anti-Infective Agents↗
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Antibiotic use on the surgical services of two Jerusalem hospitals, as determined by surveillance and influenced by an intervention program.

The use of antimicrobial drugs on the surgical services of two hospitals in Jerusalem, Israel, was surveyed prospectively. At one hospital (C), the use of these drugs was controlled: at the other (N), the use was not controlled. At both hospitals the cephalosporins accounted for approximately 21% of the antimicrobial drug-group courses (AMDGCs), however, they accounted for only 11% of the antimicrobial days (AMDs) at C but 22% at N. Prophylaxis after surgical procedures accounted for the initiation of 36% and 33% of the AMDGCs at C and N, respectively. The geometric mean of the duration of prophylactic courses of drug therapy was 3.2 days at C and 3.9 days at N (P less than 0.01). Excessively prolonged prophylaxis accounted for approximately 61% (388 AMDs) of prophylactic use at N and 55% (646 AMDs) at C. At C the proportion of patients receiving prophylaxis in high-risk surgical operations increased from 39% to 97% after the introduction of protocols for prophylaxis, but the average quantity of antimicrobial drugs administered per patient decreased by 38%.

Adolescent↗
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Analysis of a serological determinant of H-Y antigen: evidence for carbohydrate specificity using an H-Y specific monoclonal antibody.

Using a monoclonal antibody to H-Y antigen we characterized the molecular determinant responsible for H-Y reactivity. H-Y-positive cells were treated with enzymes which alter carbohydrate structure and then were tested for their ability to absorb monoclonal anti-H-Y antibody. Indications are that the serological determinant recognized by this antibody is a glycoconjugate containing terminal non-reducing and internal galactosyl residues.

Animals↗
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Retinoblastoma.

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Adolescent↗
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Elevated carcinoembryonic antigen (CEA) levels in a patient with no malignancy.

Carcinoembryonic antigen rarely exceeds serum levels of 10-12 ng/mL in benign diseases and has never been found above 24 ng/ml. We report a case in which carcinoembryonic antigen serum levels reached the value of 44.9 ng/ml without any overt reason (after 22 months of follow-up). A decline of the carcinoembryonic antigen to normal ranges was noticed after a radiolabeled anti-carcinoembryonic antigen monoclonal antibody scan was performed. The reason for this phenomenon is unclear.

Aged↗
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[Antiarrhythmic effects of verapamil].

The effect of verapamil were studied on 50 episodes of supraventricular and ventricular tachycardia in 44 patients. An i.v. dose of 0.10 to 0.15 mg/kg. was used. In 5 cases His bundle electrograms were obtained while maximal dp/dt was determined in 7 others. Sinus rhythm was obtained in 21 (81%) of 26 cases of PSVT. In all cases of rapid atrial fibrillation (n-11), an important decrease in the ventricular response was elicited. Of 7 cases of atrial flutter, verapamil induced sinus rhythm in 3 and a significant decrease in the ventricular rate in 3 others. In 2 out of 6 cases ventricular tachycardia reverted to sinus rhythm. The latency time between the injection and the manifestation of the effect ranged from 2 to 4 minutes. A slight and short-lasting depression of dp/dt was observed in all cases studied. Verapamil produced an increase in the A-H interval in 4 of the 5 cases studied with His bundle recordings. Verapamil was found to be a useful drug to suppress PSVT, to decrease the ventricular response in flutter or atrial fibrillation and to convert some ventricular tachycardias to sinus rhythm. Verapamil should be used with caution in previously digitalized patients and is contraindicated when there is S-A node dysfunction as in the tachycardia-bradycardia syndrome.

Adult↗
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Antimicrobial resistance patterns among urine isolates from patients in a geriatric hospital and from older patients in a general hospital in Jerusalem.

INTRODUCTION AND RATIONALE: Urinary tract infection is the most common cause of nosocomial infections in patients hospitalized in chronic care facilities. The changing spectrum of microorganisms involved in urinary tract infections and the emerging resistance require continuous monitoring to provide crucial information to guide empirical therapy and encourage prudent use of antibiotics. The aim of this survey was to assess the antimicrobial resistance profile of urine isolates from patients hospitalized in a geriatric hospital and from elderly patients hospitalized in an acute care hospital in order to guide empirical therapy of urinary tract infections. METHODS: The survey was performed in two hospitals in Jerusalem: a university-affiliated geriatric hospital- Herzog -and an acute secondary- and tertiary-care university hospital- Hadassah. We performed a retrospective analysis of antimicrobial resistance of all positive urine cultures obtained from patients in the geriatric division of Herzog Hospital and from patients aged 65 years and older hospitalized in the Internal Medicine departments in Hadassah Hospital during a 1-year period. RESULTS: The most common bacteria isolated from urine specimens in Herzog Hospital were, in order of frequency, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. We demonstrated a high rate of antimicrobial resistance of those bacteria in both hospitals. The pattern we observed necessitates recommending ceftazidime as the most appropriate empirical therapy for urinary tract infection in Herzog Hospital. In Hadassah Hospital we recommend cefuroxime for those patients in good general condition and ceftazidime for those who present with clinical sepsis. Antimicrobial resistance patterns should be assessed periodically and recommendations modified accordingly. Infection control guidelines should be implemented in order to try to decrease the rate of antimicrobial resistance. Further research is requested to assess the efficacy of such interventions in long-term care facilities.

Journal Article↗