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Biomedical subjects

M Weinberg

Publications and source records attributed to M Weinberg.

At least 19 recordsLinked to original sources
PubMed2003

Anti-cytomegalovirus (CMV) IgG antibody titer in patients with risk factors to atherosclerosis.

Studies have demonstrated cytomegalovirus (CMV) DNA particles in restenotic lesions in atherosclerotic coronary arteries. We have shown that high (>1:800) anti-CMV IgG antibody titers in the serum are associated with active coronary disease and with post coronary angioplasty restenosis. In this study we assessed the anti-CMV antibody titer in patients with risk factors for atherosclerosis (but without documented clinical manifestations). One hundred and eighly-seven patients (men and women aged 40-80 years) that were admitted to the Department of Internal Medicine were recruited to this prospective study. All had at least one risk factor for atherosclerosis, and none had documented coronary artery disease. Fasting blood samples were drawn on admission. Risk factors included hypertension, diabetes mellitus, active smoking, hyperlipidemia, and a positive family history. Ninety-three age- and sex-matched individuals without atherosclerosis risk factors served as the control group. One Hundred and twentysix patients had high anti-CMV antibody titers (>/=1:800) compared with none in the control group. Although 80 patients (90%) in the control group were seropositive, none had anti-CMV IgG antibody titers higher than 1:400. The statistical difference between the patients and the control group was highly significant ( p<0.0001). An immunological response against CMV (expressed as an anti-CMV IgG antibody titer) could be a marker of a long-standing immunological reaction causing an inflammatory response that eventually would cause advanced clinical atherosclerosis. We suggest that anti-CMV antibody titer should be used as an early predictor of atherosclerosis. Our findings support the infectious theory and an association between CMV infection and atherosclerosis at an early stage, maybe even years before clinical events occur.

Adult↗
PubMed2001

Enzyme immunoassay for the diagnosis of cat-scratch disease defined by polymerase chain reaction.

Whole-cell immunofluorescent antibody (IFA) tests for detection of anti-Bartonella henselae immunoglobulin (Ig) G are commonly used to diagnose cat-scratch disease (CSD). The need to cultivate B. henselae in Vero cells for antigen preparation and the absence of routinely applied IFA assays for IgM constitute the major disadvantages of this form of test. We describe the results of an enzyme immunoassay (EIA) for IgM and IgG that used N-lauroyl-sarcosine-insoluble outer membrane antigens from agar-grown B. henselae performed in 84 patients with definite CSD (regional lymphadenitis, cat contact, and > or =1 confirmatory test: polymerase chain reaction, skin test, or B. henselae culture). Although this method has been used as a diagnostic tool in several case reports, it has not previously been evaluated in a large study of definitively proven CSD cases. Results of this study indicate that the EIA described herein can play an important role in the serodiagnosis of CSD, although improvement of the sensitivity, particularly that of the IgM, would be desirable.

Adolescent↗
PubMed2001

Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods.

BACKGROUND: Improving obstetric care in resource-limited countries is a major international health priority. OBJECTIVE: To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods. METHODS: Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate. RESULTS: Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04). CONCLUSION: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.

Ampicillin↗
PubMed2001

The postnatal management of congenital cystic adenomatoid malformation.

BACKGROUND: Routine prenatal ultrasound has increased the frequency of prenatal diagnosis of congenital cystic lung malformation, such as cystic adenomatoid malformation, pulmonary sequestration, congenital lobar emphysema, and bronchogenic cyst. OBJECTIVES: To evaluate the methods of postnatal diagnosis, the optimal age for operation since surgery is always required, and the optimal extent of lung resection. METHODS: The clinical courses of 11 patients with congenital lung cysts who underwent surgical lung resection (8 lobectomies and 3 segmentectomies) were reviewed. RESULTS: The diagnosis was confirmed by computed tomography scan in all. In nine patients the diagnosis was made prenatally. Chest X-ray was normal postnatally in all patients except for two who had recurrent pneumonia. Postoperative follow-up showed excellent recovery in all operated children. One patient who underwent surgery for CCAM following episodes of severe pneumonia died from another cause 5 months later. Postoperative chest CT scan showed no residual disease in eight patients. In two who had undergone limited resection, tomography showed a small segment of residual disease in one and a suspected residual lesion in the other. CONCLUSION: With prenatal ultrasound the true frequency of congenital cystic lung anomaly appears to be higher than previously reported. Postnatal CT is mandatory to confirm or to rule out the diagnosis. The mere presence of cystic lung malformation is an indication for surgery. Complete removal of the affected lung lobe is recommended. Segmental resection may be inadequate. Early operation is tolerated well by infants and small children and we recommend that surgery be performed in children between 6 and 12 months of age.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed2000

In situ demonstration of inhibitory effects of hammerhead ribozymes that are targeted to the hepatitis Bx sequence in cultured cells.

Chronic hepatitis B virus (HBV) infection is endemic to several populous areas of the world and is frequently complicated by hepatocellular carcinoma. Ribozymes can be designed to cleave target RNA sequences specifically and show promise for the treatment of HBV infection. Demonstration of intracellular inhibition of HBV gene expression, essential to developing therapeutic ribozymes, has been the aim of this investigation. We generated two vectors encoding hammerhead ribozymes that target the HBx region of HBV. Plasmids containing intact HBV sequences or a modification in which the preS2/S region was replaced by DNA encoding enhanced green fluorescent protein (EGFP) were used to test ribozyme action in transfected cells. Both ribozymes inhibited surface antigen secretion and EGFP expression similarly. The measurement of EGFP expression is convenient to assess ribozyme action in situ and effective targeting of HBV sequences that are common to all HBV transcripts is potentially useful to develop strategies to counter HBV infection.

Base Sequence↗
PubMed2000

The cost of hepatitis A infections in American adolescents and adults in 1997.

The incidence of hepatitis A has declined in the United States for several decades, leading to an increased number of susceptible adolescents and adults. Because clinical severity increases with age, hepatitis A infections in older individuals cause greater morbidity, mortality, and treatment costs. Because the economic burden of hepatitis A has not been well described, we estimated its costs, from the societal perspective, for patients infected at distinct ages. A case-series study described treatment patterns, work loss, and symptom duration. Disease outcomes were estimated by an expert panel. Economic losses were calculated by applying normative data reflecting treatment charges, employee compensation, and the value of housekeeping services. In the case-series study, mean treatment charges were $740 for nonhospitalized patients versus $6,914 for hospitalized patients (P <.001). Symptom duration (67.8 vs. 34.4 days, P <.001) and work loss (33.2 vs. 15.5 days, P <.01) were also greater for those hospitalized. Nationally, we estimate 63,363 symptomatic hepatitis A infections occurred among adolescents and adults during 1997, resulting in 8,403 hospital admissions and 255 deaths. Nearly 2.5 million days of symptomatic illness and 829,000 work-loss days resulted, and 7,466 years of life were lost. Under base-case assumptions, annual hepatitis A costs were estimated at $488.8 million. In sensitivity analyses, this estimate varied from $332.4 to $579.9 million. These costs may be reduced by regionally targeted vaccination of children, as recommended by the Advisory Committee on Immunization Practices, although the cost effectiveness of this policy has not yet been established.

Adolescent↗
PubMed2000

Hammerhead ribozyme-mediated inhibition of hepatitis B virus X gene expression in cultured cells.

BACKGROUND/AIMS: Chronic infection with hepatitis B virus (HBV) is endemic to sub-Saharan Africa and parts of Asia. Common complications of HBV persistence include cirrhosis and hepatocellular carcinoma (HCC). Present treatment of chronic HBV infection is usually ineffective and novel therapeutic approaches are an important objective. The HBV X protein (HBx) is a transcriptional activator that is required for the establishment of HBV infection and is implicated in hepatocarcinogenesis. The aim of this study was to assess the ability of two endogenously expressed hammerhead ribozymes to inhibit expression of HBV genes in transfected cultured cells. METHODS: Eukaryotic expression plasmids producing two ribozymes targeted to the HBx open reading frame, as well as their catalytically inactive homologues, were generated. Established cell lines and a primary culture of malignant hepatocytes were transfected to assess ribozyme effects on HBx expression and HBV replication. RESULTS: The ribozyme-expressing vectors inhibit expression of functional HBx protein and decrease HBV mRNA encoding surface and HBx sequences in transfected cells. Moreover, decreased HBsAg and HBeAg secretion from cells transfected with the ribozymes and an HBV replication competent plasmid provide evidence for an antireplicative effect of the ribozymes. However, the data do not exclude a dominant antisense effect that inhibits HBV gene expression. CONCLUSIONS: Inactivation of HBx, a sequence that is conserved in mammalian hepadnaviruses and found in all HBV transcripts, has potential for the treatment of chronic HBV infection.

Base Sequence↗
PubMed2000

Knowledge, attitudes, and practices of parents of asthmatic children in Cape Town.

To obtain information useful to asthma care in a relatively poor, high asthma prevalence population, a focus group study was undertaken with 72 parents of children with asthma or recurrent wheezing. There was a reasonable level of understanding of the causes of asthma, although variable acceptance of the diagnosis. Willingness to undertake home management of acute episodes and environmental control measures was high. Reported treatment was characterized by reliance on syrups, use of home remedies, resistance to inhaled therapy, and relatively low compliance with prescribed treatment. There was agreement on the poor level of service offered by doctors and public sector clinics. Asthma education in this population needs to build on what parents know and accept, but stress the relative safety of inhaled therapy, the need for maintenance therapy, and the value of pre-exercise prophylaxis, house dust mite control, and smoking cessation. There is an urgent need to improve the quality of asthma care provided by public sector clinics.

Adult↗
PubMed2000

The status of serum iron and transferrin saturation in acute non-hepatotrophic viral infections.

Elevation of serum iron is frequently observed in patients' with chronic Hepatitis C virus infection and was found to be a negative predictive factor for treatment response. We prospectively evaluated the iron status of 112 patients with acute viral infection not due to hepatitis viruses. The virus infections included Epstein-Barr virus (57%), cytomegalovirus (22.3%) and others (20.7%). Increased serum iron was documented in two patients only. Out of nine patients who were evaluated twice, seven had increased serum iron but the level remained well within the normal range. Transferrin saturation was normal in all patients. Disturbed liver function tests were documented in 30-40% of patients. We conclude that serum iron is not significantly increased during acute non (A-E) hepatitis viral infections with or without liver involvement.

Adolescent↗
PubMed1999

[Laser treatment of airway obstruction in infants and children].

Airway obstruction during infancy and childhood requiring surgical ablation is rare, and surgical intervention poses a significant challenge. During recent decades, appropriate endoscopic instrumentation, together with advanced laser beam technology have provided new operative modalities for such patients. From 1993 to 1995 we treated 40 infants and children, 26 males and 14 females, 13 days to 11 years old (mean 3.3 years) with Nd-YAG or CO2 laser. Obstructing lesions included granulation tissue or polyps (16 cases), septa or webs (27), or benign tumors (4). 7 had more than a single lesion. All were treated endoscopically under general anesthesia without any operative or postoperative deaths. Surgical intervention removed the obstruction and related symptoms in 34. In 6, laser treatment failed, necessitating additional surgical procedures. 3 had circumferential subglottic web. Operative complications included bleeding during removal of a hemangioma in 1 and recrudescence in another. Postoperative complications were transient respiratory failure and pneumonia in 6, all of which resolved with appropriate treatment. This series proves that laser technology is feasible in the treatment of airway obstruction during infancy and childhood, and is safe and effective.

Airway Obstruction↗
PubMed1999

A cohort study of breast cancer risk in breast reduction patients.

Surgical reduction of the female breast (reduction mammaplasty) is very common in plastic surgery. The purpose of this study was to determine whether women who have undergone breast reduction surgery are at the same, greater, or lesser risk of developing breast cancer than women who have not undergone breast reduction surgery. This study incorporates a population-based, non-concurrent cohort linkage methodology. The Canadian Institute for Health Information hospital records were used to identify all Ontario women who had undergone breast reduction surgery in Ontario between 1979 and 1992. Three computerized probabilistic record linkages were performed. The first linkage was between a file of the 28,042 Ontario women who had undergone bilateral breast reduction surgery between April 1, 1979, and December 31, 1992, and a file of incident cancer cases among Ontario women for the calendar period 1979 to 1993. Follow-up of the cohort was undertaken starting from the date of breast reduction surgery, and vital status was ascertained as of December 31, 1993, by record linkage with the Ontario Mortality Database maintained at the Ontario Cancer Registry. The incidence of cancer in the Ontario breast reduction cohort was compared with the cancer incidence of the general Ontario population after appropriate adjustments for age and calendar time period. The expected number of cancers was calculated using the "PERSON YEARS" computer program. Within the cohort, followed for an average of 6.5 years after bilateral breast reduction surgery, 101 breast cancers were observed and 165.8 were expected, for a standardized incidence ratio of 0.61 (0.50 to 0.74, 95 percent confidence interval). This effect was independent of patient age at breast reduction. This study demonstrates that there is no increased risk of breast cancer after bilateral breast reduction surgery and, in fact, a significant decreased risk existed in women followed for an average of 6.5 years.

Adolescent↗
PubMed1999

[One-stage surgery for Hirschsprung's disease in children].

Traditionally Hirschsprung's disease has been treated by 2- or 3-stage procedures. During the past 6 years a 1-stage Duhamel procedure without stoma has become our treatment of choice for Hirschsprung's disease in neonates and young infants. Over a 6-year period, 15 infants and children with colonic Hirschsprung's disease were treated with the 1-stage Duhamel retro-rectal pull-through procedure without a stoma, with the Lester-Martin modification. All patients had the usual short segment aganglionosis, but 1 had a long segment which included the splenic flexure. Early complications included wound infection in 1 and minor rectal bleeding in 3. Late complications included constipation in 1 and enterocolitis in 4. Long-term functional results were very good in all those operated except for 1 with rectal achalasia. We conclude that Hirschsprung's disease can be successfully treated with a 1-stage pull-through operation, the child usually benefitting from the shorter hospital stay and the avoidance of a colostomy.

Child, Preschool↗
PubMed1998

High anti-cytomegalovirus (CMV) IgG antibody titer is associated with coronary artery disease and may predict post-coronary balloon angioplasty restenosis.

Recent studies have demonstrated that cytomegalovirus (CMV) DNA was found in atherosclerotic coronary arteries in restenotic lesions, and prior infection with CMV could be a strong independent risk factor for restenosis after coronary atherectomy. We studied the correlation between anti-CMV antibody titer and coronary artery disease. Sixty-five patients (50 men and 15 women) with coronary artery disease were enrolled prospectively. All had symptomatic coronary artery disease with an angiographic documentation of a de novo single coronary lesion. All underwent balloon coronary angioplasty and were followed for 12 months with a thallium perfusion scan 3 months after angioplasty. Patients who had recurrent chest pain and/or a positive thallium scan had another coronary angiography. Blood samples were taken before angiography and 1 and 3 months later. Patients with high anti-CMV titer > or = 1:800 had a higher prevalence of coronary artery disease (p <0.001) than seropositive patients with a lower antibody titer (< or = 1:400); patients with high antibody titer (> or = 1:800) had a higher restenosis rate than seropositive patients with a low antibody titer (< or = 1:400) (p <0.05). High antibody titers against CMV (IgG) may be a strong marker for coronary artery disease, and might predict post-coronary angioplasty restenosis. These findings support the infectious theory of atherosclerosis (especially with prior CMV infection), and also suggest that a chronic immunologic response has a role in atherosclerosis and restenosis.

Adult↗
PubMed1998

Effect of RenaGel, a non-absorbed, calcium- and aluminium-free phosphate binder, on serum phosphorus, calcium, and intact parathyroid hormone in end-stage renal disease patients.

BACKGROUND: Control of dietary phosphate absorption in end-stage renal disease patients is essential to prevent the deleterious sequelae of phosphorus retention. Efficacy of currently available calcium- and aluminium-containing phosphate binders is constrained by the side-effects associated with the absorption of calcium and aluminium. The current study examined the efficacy of RenaGel, a calcium- and aluminium-free, polymeric phosphate binder, in end-stage renal disease patients. METHODS: Administration of calcium- or aluminium-containing phosphate binders ceased during a 2-week washout period. RenaGel, at starting doses of one, two, or three 500-mg capsules three times per day with meals, was administered for 8 weeks. RenaGel dose was titrated up 1 capsule per meal at the end of each 2-week period if necessary to achieve phosphorus control. A second 2-week washout period followed the end of RenaGel treatment. RESULTS: Mean serum phosphorus rose from a pre-washout level of 6.9 mg/dl (2.23 mmol/l) to 8.1 mg/dl (2.62 mmol/l) at the end of the initial 2-week washout. With RenaGel treatment, serum phosphorus declined and returned to pre-washout levels after 4 weeks. Serum phosphorus reached a nadir of 6.5 mg/dl (2.10 mmol/l) after 7 weeks of RenaGel treatment. Serum phosphorus rose to 8.2 mg/dl (2.65 mmol/l) 2 weeks after cessation of RenaGel treatment. As anticipated, calcium declined during the initial washout period when calcium-based phosphate binders were stopped for the majority of patients. The rise in serum phosphorus and decline in serum calcium during washout resulted in an increase in median intact parathyroid hormone (iPTH) levels from 292 pg/ml to 395 pg/ml. iPTH fell to 283 pg/ml after 6 weeks of RenaGel treatment despite a persistently lower serum calcium. RenaGel treatment also reduced serum total and LDL cholesterol by 25 mg/dl (0.65 mmol/l) and 23 mg/dl (0.59 mmol/l) respectively. CONCLUSIONS: RenaGel appears to be an effective phosphate binder free of calcium and aluminium. Phosphorus control with two to four RenaGel capsules per meal appears to result in comparable phosphorus lowering seen with calcium- or aluminium-based phosphate binders. RenaGel may offer an alternative for the control of phosphorus retention in end-stage renal disease patients.

Adult↗
PubMed1997

Combined orthodontic-orthognathic surgical treatment of a Class II, Division I malocclusion.

This case report shows the need to extract four first premolars in addition to orthognathic surgery, even though the initial treatment plan involved a nonextraction strategy. The extractions were necessary to reduce maxillary dental protrusion and proclination and also to recover from the mandibular incisor proclination that occurred as a consequence of leveling the mandibular arch.

Cephalometry↗
PubMed1996

Acute appendicitis following abdominal trauma.

Acute appendicitis (AA) is generally considered to be a consequence of lumenal obstruction and inflammation of the appendix. At the beginning of the 20th century, trauma was considered to be one of the possible causes of AA but this relationship has not been examined much since then. Our experience with three cases of AA following blunt abdominal trauma led to an extensive review of the world literature on the subject. We believe that abdominal trauma might be causative of AA. The potential for this hazardous and easily missed diagnostic entity should be appreciated in cases of blunt abdominal trauma both for sound clinical decision making and for its potential medical and legal implications.

Abdominal Injuries↗
PubMed1996

Resolution of mandibular arch crowding in growing patients with Class I malocclusions treated nonextraction.

The purpose of this study was to determine the manner in which mandibular arch crowding was resolved in Class I growing patients who were treated nonextraction. A retrospective study was completed with 30 patients from a postgraduate orthodontic clinic, treated with a variety of treatment modalities. Eight study models and six cephalometric parameters were examined before treatment and at the end of active treatment (posttreatment). The results showed that statistically significant increases in arch width occurred at the canine (0.9 mm), first premolar (1.6 mm), second premolar (1.8 mm), and first molar (1.2 mm). The incisors were advanced an average of 2.1 mm and proclined 6.1 degrees. The molars showed no anteroposterior movement. Arch perimeter increased 2.3 mm and arch depth increased 1.6 mm. Multiple linear regression analysis revealed that 52% of the variance in crowding resolution was accounted for by an increase in arch perimeter. It was concluded that the resolution of crowding, in this group of patients with Class I malocclusions, was achieved by generalized expansion of the buccal segments, along with advancement of the lower incisors. In some cases, these changes may be consistent with treatment objectives; in others, they may be undesirable. It is therefore important for practitioners to carefully evaluate treatment outcome irrespective of the treatment modality, to determine whether treatment objectives are being met.

Adolescent↗