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Biomedical subjects

N Peled

Publications and source records attributed to N Peled.

At least 55 records · Page 3Linked to original sources
PubMed1997

Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991-1995.

In order to monitor changes in the frequency and antimicrobial resistance of urinary pathogens over several years, urinary cultures received from outpatient clinics and from a hospital during a period of one month each in 1991 and 1995 were analyzed at a clinical microbiology laboratory. In 1991 and 1995, 1366 and 1534 significant monomicrobic cultures respectively were reviewed. The frequency of Escherichia coli dropped significantly in the outpatient clinics from 70.5% to 61.2% (p < 0.0001). The frequency of Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa and other gram-negative bacteria also decreased, but the frequency of Klebsiella spp. and Enterobacter spp. increased from 2.6% to 5.8% (p < 0.0001). In the hospital, the frequency of Enterobacter spp. (p < 0.04), Escherichia coli and Morganella morganii declined from 1991 to 1995, whereas the frequency of Pseudomonas aeruginosa (p = 0.001), Acinetobacter spp. (p < 0.05), Klebsiella spp., Proteus mirabilis and other gram-negative rods increased considerably. The frequency of gram-positive aerobic bacteria rose markedly in outpatient specimens from 6.1% to 13.5% (p < 0.0001), while a decline from 14.4% to 9.3% was noted in hospital specimens (p < 0.02). A significant rise in the resistance of Escherichia coli to gentamicin and ciprofloxacin (p < 0.0001) was detected in outpatient isolates. In the hospital, gram-negative urinary pathogens demonstrated increased resistance to ampicillin (p = 0.042), cefuroxime (p = 0.005), gentamicin (p = 0.002) and ciprofloxacin (p < 0.0001) during the study period. The changing etiology of urinary tract infections and the increasing resistance of organisms indicate that periodic monitoring and possibly also modification of empirical therapy are required.

Ambulatory Care Facilities↗
PubMed1997

Rapid increase in the prevalence of antimicrobial drug resistance among enterococcal blood isolates in southern Israel.

A prospective surveillance was conducted to monitor the prevalence and dynamics of antimicrobial resistance among enterococci isolated from blood cultures in southern Israel. A total of 242 organisms isolated between 1993 and 1996 were studied. The prevalence of Enterococcus faecalis significantly decreased during the study period, whereas that of Enterococcus faecium doubled. Antimicrobial drug resistance increased steadily among Enterococcus faecium isolates: resistance to ampicillin increased from 19% in 1993-1994 to 53% in 1995, and to 67% in 1996 (p = 0.005); during the same period, resistance to vancomycin increased from 0% to 20%, and to 50% (p = 0.002), and combined resistance to ampicillin and vancomycin and high-level resistance to gentamicin from 0% to 20% and to 38% (p < 0.02).

Ampicillin Resistance↗
PubMed1997

Rapid detection of Brucella melitensis from blood cultures by a commercial system.

To assess the capability of the Peds Plus medium of the Bactec 9240 blood culture system to recover Brucella melitensis within the routine seven-day protocol used by most clinical microbiology laboratories, inoculated blood culture bottles were monitored by the Bactec 9240 instrument for four weeks, and blind subcultures were performed once a week. A total of 2579 blood cultures were drawn, 42 (1.6%) of which were positive for Brucella melitensis. Forty-one of the 42 (97.6%) positive cultures were detected by the Bactec 9240 instrument within two to six days; a single positive culture was missed by the instrument and detected by blind subculture performed on day 7.

Adolescent↗
PubMed1997

Comparison of BACTEC 9240 Peds Plus medium and isolator 1.5 microbial tube for detection of Brucella melitensis from blood cultures.

The sensitivity and time to detection of Brucella melitensis by the BACTEC 9240 and the Isolator blood culture systems were compared in a prospective volume-controlled study. Blood sample aliquots, obtained from children with suspected brucellosis, were inoculated into a BACTEC 9240 Peds Plus bottle and into an Isolator 1.5 Microbial Tube. Overall, 122 pairs of blood samples for culture were obtained, and 28 (23%) were positive by at least one method. The BACTEC 9240 system detected all 28 positive cultures (sensitivity, 100%), and the Isolator system detected 22 positive cultures (sensitivity, 79%) (P = 0.023). Among those 22 cultures positive by both methods, 21 (95%) and 15 (68%) were found to be positive within 3 days by the BACTEC and the Isolator systems, respectively; 8 (36%) were found to be positive at least 1 day earlier by the BACTEC instrument, and the remaining 14 were found to be positive by the two systems on the same day (P = 0.045). The BACTEC 9240 blood culture system is more sensitive than the Isolator system for the detection of B. melitensis and is superior in terms of time to detection of the organism.

Bacteremia↗
PubMed1997

Impaired respiratory response to resistive loading during sleep in healthy offspring of patients with obstructive sleep apnea.

To evaluate the possibility that healthy offspring of patients with obstructive sleep apnea syndrome (OSAS) may have covert signs of sleep disordered breathing, we compared the respiratory response to inspiratory resistive loads (IRL) in 10 adult offspring of fathers previously diagnosed with OSAS with that of 14 offspring of healthy parents. None of the offspring in either group had any sign of OSAS, and groups were age, weight, and body mass index matched. Both ventilatory response to progressively increasing levels of IRL and the IRL required to produce severe hypopnea (tidal volume [V(T)] < 20% of unloaded magnitude) were determined, during NREM sleep. Offspring of patients with OSAS (OSAS offspring) responded to all levels of IRL with greater decreases in V(T). Their V(T) decreased in the second breath on IRL of 23 cm H2O/l/s by 39 +/- 10%, as compared with a decrease of 19 +/- 4% (mean +/- SD) in the control group (p < 0.05). Severe hypopnea occurred in the OSAS offspring in response to smaller IRL compared to controls (79 +/- 20 and 153 +/- 14 cm H2O/l/s, respectively, p < 0.005). Total upper airway occlusion in response to IRL occurred in three of the OSAS offspring, but in none of the controls. We conclude that apparently healthy offspring of patients with OSAS may inherit subtle defects that reduce their ability to compensate for increased loads and maintain upper airway patency during sleep. We speculate that offspring of OSAS patients with decreased tolerance to IRL may be prone to developing OSAS later on in life.

Adolescent↗
PubMed1997

[Narcolepsy].

Explore the source record for details and available documents.

Antidepressive Agents↗
PubMed1996

A fibroepithelial urethral polyp protruding into the base of the bladder: sonographic diagnosis.

A case of congenital urethral polyp in a 10-month-old boy is presented. These rare congenital tumors can lead to urinary retention, hematuria, urinary tract infections, hydronephrosis and hydroureter. Traditionally the diagnosis was based either on voiding cystourethrography or cystoscopy. The sonographic features of these polyps have only been reported in a few cases in the past. This modality is not infrequently the imaging procedure of choice in the work-up of children with signs and symptoms related to the urinary system. In the case presented herein the polyp was demonstrated initially by sonography as a soft tissue mass arising at the base of the urinary bladder. The differential diagnosis of these lesions is presented.

Diagnosis, Differential↗
PubMed1995

Radiologic features of gastric outlet obstruction in infants after long-term prostaglandin administration.

Long-term prostaglandin (PG) therapy has recently been associated with gastric mucosal hyperplasia. We reviewed the clinical and radiologic (especially sonographic) records of eight patients with complex congenital heart disease who were on PG therapy. Feeding problems, vomiting, and abdominal distension were present in six patients. Barium meal revealed antral narrowing in three patients, suggestive of hypertrophic pyloric stenosis in two. Sonography showed a variable degree of increased gastric mucosal lobulation often accompanied by a marked polypoid or lobular appearance. Cortical hyperostosis related to PG therapy was seen in three patients. PG-associated gastric mucosal hyperplasia can cause feeding problems and pronounced gastric lobulation.

Alprostadil↗
PubMed1995

HLA class II analysis in Jewish Israeli narcoleptic patients.

HLA class II was investigated in eight Jewish narcoleptic patients, representing the total of such patients known in Israel at present, and in three patients suffering from sleep disturbances other than narcolepsy. All (11 out of 11) patients carried the serologic specificities DR2, DQ6 (DQ1). At the DNA level, all narcoleptics were found to be DRB1*1501, DQA1*0102, DQB1*0602 which indicates that the susceptibility gene may be located within the HLA class II region, DR, and/or DQ. As for the nonnarcoleptic patients with idiopathic hypersomnia, they carried different alleles of DR2 and DQ6, namely DRB1*1502, DQA1*0103, DQB1*0601. This study confirms that the incidence of narcolepsy in Israel is extremely low and that HLA class II genes or a gene(s) tightly linked to them are involved in the disease.

Alleles↗
PubMed1994

Predictive value of specific risk factors, symptoms and signs, in diagnosing obstructive sleep apnoea and its severity.

A positive diagnosis of obstructive sleep apnoea (OSA) is based on a combination of characteristic symptoms and polysomnographic findings. The present study evaluated the specificity and sensitivity of several risk factors, signs and symptoms in predicting an Apnoea Index in 86 patients referred to the sleep laboratory with suspected OSA. All 86 subjects completed a detailed questionnaire, were interviewed, underwent a brief physical examination, and then a whole-night polysomnographic study. Stepwise multiple regression analysis revealed that self reporting on apnoeas, neck circumference index (NCI), age, and a tendency to fall asleep unintentionally, were all significant positive predictors of apnoea index (AI), explaining 41.8% of the variability. The sensitivity of the model for predicting OSA (taking OSA as AI > 10) was 92.2%, specificity was 18.2% and the positive predictive value was 76.6%. Raising the cut-off AI values resulted in decreased sensitivity and increased specificity. Applying the predicting equation of AI to another group of 50 patients referred to the sleep laboratory with suspected OSA revealed similar results. However, running the equation on 105 offspring of OSA patients who did not complain of OSA-associated symptoms resulted in 32% sensitivity and 94% specificity in predicting OSA. It is concluded that questionnaires, interviews and physical examination, can only vaguely predict AI, and cannot replace polysomnographic recordings. However, the low rates of false negative in predicting AI > 10, and the low rates of false positive in predicting AI > 50, can be used for specific purposes.

Journal Article↗
PubMed1993

Prostaglandin-induced antral hyperplasia in neonates: clinical experience and dose-response characteristics.

Antral hyperplasia (AH) induced by prostaglandins (PG) has been described by us recently in 5 infants with cyanotic heart disease receiving the drug. The purpose of the present study was to analyze 14 infants diagnosed as having AH either sonographically or pathologically in an attempt to characterize the dose-response characteristics of this adverse drug reaction, its clinical course and its optimal management. Infants with AH exhibiting large gastric aspirates have received a significantly lower cumulative dose (1,633 +/- 1,266 micrograms/kg) than those presented also with a palpable mass (3,458 +/- 1,703 micrograms/kg), (p < 0.01). While in general there is a dose-related clinical toxicity, variability in the location of the hyperplasia can explain cases of no apparent obstruction despite large cumulative doses of PG. In asymptomatic cases the antral hyperplasia, although visualized, it did not result in gastric outlet obstruction. In all cases followed by us to date, discontinuation of the PG has resulted in resolution of the clinical and sonographic findings. Nasojejunal tube was successfully attempted in several cases, preventing surgery in these very-high-risk infants.

Dose-Response Relationship, Drug↗
PubMed1993

Aggressive fibromatosis simulating congenital lung malformation.

Aggressive fibromatosis is a locally invasive, non-metastasizing tumour of fibrous origin and variable radiologic appearance. The authors describe a child with intrathoracic aggressive fibromatosis that mimicked congenital malformation of the lung.

Cystic Adenomatoid Malformation of Lung, Congenita↗
PubMed1992

Gastric-outlet obstruction induced by prostaglandin therapy in neonates.

BACKGROUND: An infusion of prostaglandin E1 is widely used to maintain patency of the ductus arteriosus in neonates with congenital heart disease. After gastric-outlet obstruction was recognized in several infants who received prostaglandin E1, we studied the association between the drug and this complication. METHODS: We evaluated all neonates who received prostaglandin E1 in our hospital between October 1, 1989, and September 30, 1991, for clinical, radiologic, or pathological evidence of acute gastric-outlet obstruction. RESULTS: Of the 74 neonates evaluated, 65 had no signs of gastric obstruction and were considered normal; 5 had clinical and radiologic or pathological evidence of gastric obstruction consistent with the presence of antral mucosal hyperplasia. The remaining four neonates had clinical signs of gastric obstruction, but no radiologic or pathological examinations were performed. The 5 neonates with antral hyperplasia had received prostaglandin E1 for longer periods (mean [+/- SD] duration, 569 +/- 341 hours) than the 65 normal neonates (54 +/- 58 hours, P less than 0.001) or the 4 neonates with clinical signs of gastric obstruction (119 +/- 60 hours, P less than 0.05). The cumulative dose of prostaglandin E1 was higher in the neonates with antral hyperplasia (2982 +/- 1392 micrograms per kilogram of body weight) than in the normal neonates (279 +/- 270 micrograms per kilogram, P less than 0.001) or the neonates with signs of gastric obstruction (528 +/- 306 micrograms per kilogram, P less than 0.01). In two neonates with antral hyperplasia, the cessation of therapy lessened the gastric-outlet obstruction. CONCLUSIONS: The administration of prostaglandin E1 to neonates can cause gastric-outlet obstruction due to antral hyperplasia. Neonates who receive prostaglandin E1 at recommended doses for more than 120 hours should be closely monitored for evidence of antral hyperplasia.

Alprostadil↗