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Biomedical subjects

R Raz

Publications and source records attributed to R Raz.

At least 55 records · Page 3Linked to original sources
PubMed2000

Recurrent urinary tract infections in postmenopausal women.

To evaluate factors associated with recurrent urinary tract infection (UTI) in postmenopausal women, we conducted a case-control study comparing 149 postmenopausal women referred to an infectious diseases outpatient clinic who had a history of recurrent UTI (case patients) with 53 age-matched women without a history of UTI (control patients). Each woman completed a questionnaire providing demographic data, history and clinical characteristics of prior infections, and information regarding risk factors for UTI. In addition, each patient underwent a gynecologic evaluation, renal ultrasound and urine flow studies, and blood group and secretor status testing. Three urologic factors-namely, incontinence (41% of case patients vs. 9.0% of control patients; P<.001), presence of a cystocele (19% vs. 0%; P<.001), and postvoiding residual urine (28% vs. 2.0%; P=.00008)-were all strongly associated with recurrent UTI. Multivariate analysis showed that urinary incontinence (odds ratio [OR], 5.79; 95% confidence interval [CI], 2.05-16.42; P=.0009), a history of UTI before menopause (OR, 4.85; 95% CI, 1.7-13.84; P=. 003), and nonsecretor status (OR, 2.9; 95% CI, 1.28-6.25; P=.005) were most strongly associated with recurrent UTI in postmenopausal women. Prospective studies are needed to confirm these observations and to develop approaches for prevention.

Aged↗
PubMed2000

Demographic characteristics of patients with community-acquired bacteriuria and susceptibility of urinary pathogens to antimicrobials in northern Israel.

BACKGROUND: Urinary tract infection is one of the most common bacterial infections. Since antibiotics are given empirically, it is necessary to assess the distribution and susceptibility of the microorganisms in each case. OBJECTIVES: To evaluate the demographic characteristics of ambulatory patients with UTI, the distribution and susceptibility of uropathogens, and the risk factors associated with trimethoprim-sulfamethoxazole resistant bacteria in women. METHODS: During 12 days in August 1997 all the urine cultures sent to the Tel-Hanan Laboratory (Haifa) were evaluated. Demographic characteristics of the patients, their underlying diseases and the previous use of antibiotics were obtained. RESULTS: During the 12 day survey 6,495 cultures were sent for evaluation. Of the 1,075 (17%) that were positive 950 were included in the study; 83.7% were from females, of whom 57% were > or = 50 years old. Escherichia coli was the most common pathogen, with 74.7% in the female and 55% in the male population; 86.2% of the E. coli were resistant to amoxicillin, 38.8% to cephalexin and 46.8% to TMP-SMX. Cefuroxime (4.2%), ofloxacin (4.8%), ciprofloxacin (4.8%) and nitrofurantoin (0.4%) showed the lowest rates of resistance. By a multivariant analysis, post-menopause and recurrent UTI were found to be independent factors related to TMP-SMX resistance in women. CONCLUSION: In northern Israel, ampicillin, cephalexin and TMP-SMX cannot be used empirically in the treatment of community-acquired UTI. Post-menopause and recurrent UTI are independent factors associated with TMP-SMX resistant pathogens in women.

Adolescent↗
PubMed2000

Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection.

PURPOSE: We determined whether routine replacement of a chronic indwelling catheter before instituting antimicrobial therapy leads to an improved bacteriological or clinical outcome when treating symptomatic urinary tract infection in elderly nursing home residents. MATERIALS AND METHODS: We performed a prospective randomized open clinical trial at 2 long-term care facilities. Patients were randomized to indwelling catheter replacement before initiating antimicrobial therapy or no replacement. Urine and blood cultures were done before antimicrobial therapy began. Clinical and microbiological outcomes were assessed after 3 days of therapy, and 7 and 28 days after therapy was complete. RESULTS: Enrolled in our study were 21 male and 33 female nursing home residents with a mean age of 72.6 years, a chronic indwelling catheter and a clinical diagnosis of urinary tract infection. A total of 27 cases were randomized to either catheter replacement and no replacement before antimicrobial therapy. Polymicrobial bacteriuria significantly decreased 3 days after therapy was initiated, and 7 and 28 days after it was discontinued in 24 versus 8 (p = 0.002), 18 versus 9 (p = 0.01) and 13 versus 5 (p = 0.02) patients with and without catheter replacement, respectively. Catheter replacement was also associated with a shorter time to afebrile status, improved clinical status 72 hours after the initiation of therapy in 25 versus 11 patients (p <0.001) and a lower rate of symptomatic clinical relapse 28 days after therapy in 3 versus 11 (p = 0.015). CONCLUSIONS: Clinical and bacteriological outcomes are improved when long-term indwelling catheters are replaced before initiating antimicrobial therapy for symptomatic urinary tract infection.

Aged↗
PubMed1999

Clinical, epidemiological, and microbiological features of Vibrio vulnificus biogroup 3 causing outbreaks of wound infection and bacteraemia in Israel. Israel Vibrio Study Group.

BACKGROUND: Vibrio vulnificus is a gram-negative bacterium that causes septicaemia and wound infection. Cases occur sporadically, and no previous outbreaks due to a common source or a clonal strain have been reported. In the summer and autumn of 1996 and 1997, an outbreak of invasive V. vulnificus infection occurred in Israel in people who had recently handled fresh, whole fish purchased from artificial fish-ponds. METHODS: We reviewed clinical and epidemiological information, and undertook an environmental investigation to assess disease characteristics, modes of transmission, phenotypic characteristics of the bacterium, and fish-marketing policy. The clonal nature of 19 isolates was studied by biotyping, pulsed-field gel electrophoresis, and restriction-fragment length polymorphism (RFLP) analysis of a PCR fragment. FINDINGS: During 1996-97, 62 cases of wound infection and bacteraemia occurred. 57 patients developed cellulitis, four had necrotising fasciitis, and one developed osteomyelitis. In all cases, the fish were cultivated in inland fish-ponds. In the summer of 1996, fish-pond managers initiated a new marketing policy, in which fish were sold alive instead of being packed in ice. Phenotypically, the isolates had five atypical biochemical test results. The isolates were non-typeable by pulsed-field gel electrophoresis, and all had the same PCR-RFLP pattern which had not been seen previously. INTERPRETATION: The cause of the outbreak was a new strain of V. vulnificus, classified as biogroup 3. A new fish-marketing policy that began in 1996 may have exposed susceptible people to the organism.

Adolescent↗
PubMed1999

Essential role of STAT3 for embryonic stem cell pluripotency.

Propagation of mouse embryonic stem (ES) cells in vitro requires exogenous leukemia inhibitory factor (LIF) or related cytokines. Potential downstream effectors of the LIF signal in ES cells include kinases of the Src, Jak, and mitogen-activated protein families and the signal transducer and transcriptional activator STAT3. Activation of nuclear STAT3 and the ability of ES cells to grow as undifferentiated clones were monitored during LIF withdrawal. A correlation was found between levels of STAT3 activity and maintenance of an undifferentiated phenotype at clonal density. In contrast, variation in STAT3 activity did not affect cell proliferation. The requirement for STAT3 was analyzed by targeted mutagenesis in ES cell lines exhibiting different degrees of LIF dependency. An insertional mutation was devised that abrogated Stat3 gene expression but could be reversed by Cre recombination-mediated excision. ES cells heterozygous for the Stat3 mutation could be isolated only from E14 cells, the line least dependent on LIF for self-renewal. Targeted clones isolated from other ES cell lines were invariably trisomic for chromosome 11, which carries the Stat3 locus, and retained normal levels of activated STAT3. Cre-regulated reduction of Stat3 gene copy number in targeted, euploid E14 clones resulted in dose-dependent losses of STAT3 activity and the efficiency of self-renewal without commensurate changes in cell cycle progression. These results demonstrate an essential role for a critical amount of STAT3 in the maintenance of an undifferentiated ES cell phenotype.

Animals↗
PubMed1999

The proximal tyrosines of the cytoplasmic domain of the beta chain of the type I interferon receptor are essential for signal transducer and activator of transcription (Stat) 2 activation. Evidence that two Stat2 sites are required to reach a threshold of interferon alpha-induced Stat2 tyrosine phosphorylation that allows normal formation of interferon-stimulated gene factor 3.

The precise role of the different subunits (alpha/IFNAR1 and betaL/IFNAR2) of the type I interferon receptor (IFN-R) in the activation of signal transducer and activator of transcription (Stat) 1, Stat2, and Stat3 has not yet been established. In this report we demonstrate that there are functionally redundant phosphotyrosine-dependent and -independent binding sites for Stat2 in the alpha and beta subunits of the type I IFN-R. Expression of a type I IFN-R containing only the constitutive Stat2 site or the proximal tyrosines of betaL, but not the docking site on the alpha chain (Tyr466 and Tyr481), supported low levels of Stat2 activation. However, the presence of only one intact Stat2 site did not lead to induction of interferon-stimulated gene factor 3 (ISGF3) or an antiviral state. Normal levels of Stat2 tyrosine phosphorylation, induction of ISGF3, and an antiviral effect always required the proximal tyrosines of betaL and at least one of the other Stat2 sites (Tyralpha466, 481 or betaL404-462). These data suggest that a threshold of Stat2 tyrosine phosphorylation is required for complete activation of ISGF3. Interestingly, a receptor in which all tyrosines were mutated to phenylalanine shows normal Stat3 phosphorylation and low levels of activation of Stat1.

Animals↗
PubMed1999

Campylobacter bacteremia and pneumonia in two splenectomized patients.

Two patients with beta thalassemia who had undergone splenectomy for hypersplenism were admitted to the hospital with high fever and lobar pneumonia. Neither patient had gastrointestinal symptoms. Campylobacter bacteremia was diagnosed in both patients. Campylobacter jejuni was identified in the first patient and Campylobacter fetus in the second. Both patients were treated with broad-spectrum antibiotics and recovered fully.

Adult↗
PubMed1999

Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections.

Recurrent urinary tract infections (UTIs) account for substantial morbidity, losses in work time, and medical costs. Recent studies suggest that the major factors predisposing to recurrent UTIs differ by age and functional status. In premenopausal women, sexual intercourse, spermicide exposure, maternal history of UTI, and a history of UTI in childhood have been associated with recurrent infections. In postmenopausal women, lack of estrogen appears to be an important factor predisposing to recurrent UTI, as does nonsecretor status, a history of UTI in the premenopausal period, incontinence, presence of a cystocele, and postvoid residual urine. In older women who are institutionalized, catheterization, incontinence, antimicrobial exposure, and functional status are most strongly related to risk of recurrent UTI. Further research is needed to better identify measures for prevention of recurrent UTI, which likely differ by age group.

Adolescent↗
PubMed1999

[Cryptococcal meningitis following cryptococcal pneumonia in an immunocompetent].

Cryptococcal meningitis (CM) is common in the immunocompromised (especially due to AIDS), but also occurs in immunocompetent subjects. CM can complicate cryptococcal pneumonia (CP) not only in the immunocompromised but also in the immunocompetent. We describe a healthy 26-year-old man who developed a prolonged lung infection. Diagnosis of cryptococcal pneumonia was established from bronchoscopic washings. He recovered spontaneously, so no antifungal treatment was given. 4 months later he was admitted with cryptococcal meningitis and was treated successfully with amphotericin B. An extensive immunologic study revealed no abnormalities. Since CM can complicate cryptococcal pneumonia, it is recommended that patients with CP be followed, even if recovery is apparently complete.

Adult↗
PubMed1998

Familial pattern of infection with hepatitis B virus among immigrating Ethiopian Jews in Israel.

Seventy-eight families (506 members) of recently immigrating Ethiopian Jews to Israel, were tested for the presence of HBV serological markers to evaluate the intrafamilial horizontal transmission of the virus. Eighty-four members (16.6%) were carriers and 20.2% were HBeAg positive, the overall infection rate was 67.8%. In 40 families (51.3%) at least one family member was HBsAG positive, and in 19 families (24.4%) two or more family members were HBsAg positive. Thirty-six carriers (42.8%) were children under the age of 10, by one year of age 30% have contracted the virus, and by the age of 5 and 10 years 43.5% and 57.1% have had serological markers for past HBV infection, respectively. Our data correlate with other studies regarding the importance of horizontal spread of HBV among Sub-Saharan Africans.

Adolescent↗
PubMed1997

[Infection by Vibrio vulnificus after a prick from from the spine of a Tilapia].

Vibrio vulnificus is a Gram-negative bacterium living in warm salty water that produces a spectrum of human disease which may progress to devastating, sometimes fatal infections in susceptible individuals. Such infections have rarely been reported in Israel. However, over the past few months we have been seeing a sharp increase in V. vulnificus infections with a common history of injury to extremities by the sharp spines of Tilapia zillii, ("amnon" or St. Peter's fish). Clinical suspicion and prompt intervention prevent the untoward consequences of misdiagnosis or delay.

Adult↗
PubMed1997

[Isolated susceptibility of Streptococcus pyogenes to 3 macrolides].

Erythromycin is considered the drug of choice in the treatment of streptococcal pharyngitis in patients allergic to penicillin. However, in recent years several publications, especially in Finland and Italy, showed high resistance rates of S. pyogenes isolates to erythromycin and other new macrolides. To evaluate the situation in Israel, we checked the MIC of isolates from patients with tonsillitis during 1996. E-test results showed an MIC-50 of 0.23, 0.13 and 0.47 mcg/ml for erythromycin, clarithromycin and roxithromycin, respectively and a MIC-90 of 0.37, 0.23 and 0.78 mcg/ml. Only 2 isolates (2.1%) were partially or completely resistant to all 3 antibiotics. We conclude that empiric therapy with macrolides in Israel is still a viable option and can be recommended in S. pyogenes tonsillitis for patients allergic to penicillin.

Anti-Bacterial Agents↗
PubMed1997

Empiric antibiotic treatment and the misuse of culture results and antibiotic sensitivities in patients with community-acquired bacteraemia due to urinary tract infection.

Recent data suggests that culture isolations and susceptibility profiles are overlooked, misinterpreted and are not a major determinant in the process of selecting anti-bacterial therapy. Compliance with empiric antibiotic protocols, relationship between blood culture results, change and selection of secondary antibiotic regimens and effect on outcome and length of hospitalization were assessed prospectively in 134 episodes of community-acquired bacteraemia due to urinary tract infection in adults. Empiric antibiotic protocols were correct in 112 episodes (83.6%), excessive in 12 episodes (8.95%) and inappropriate in 10 (7.5%) episodes, with no significant difference in outcome or length of hospitalization. Excluding early deaths, the adequacy of the initial antibiotic therapy was clearly associated with mortality (four deaths out of eight episodes treated incorrectly vs. 21/117 treated appropriately [P = 0.029]), but not with length of hospitalization. Antibiotic change was theoretically required in 92/119 (77.3%) episodes (27 [29.3] incorrect regimen, 65 [70.65%] excessive regimen), but actual change was made in only 43 episodes, of which three protocols were changed from a correct to an incorrect regimen, and one patient continued to receive an incorrect regimen. Eighteen out of 34 changes in excessive protocols were still excessive. Adequacy of secondary antibiotic treatment was clearly associated with outcome (5/10 vs. 4/109 [P<0.001]). Excessive protocols were not associated with better outcome or shorter hospital stay. Change of antibiotic regimen was associated with the presence of background diseases (5.6-fold increase) and inversely with hospitalization on the urology ward (0.254), but no independent factors associated with correct or incorrect secondary regimens could be identified. Although the compliance rate with empiric protocols was satisfactory, in many bacteraemic episodes blood culture results and antibiotic sensitivity profiles are overlooked, leading to higher mortality and excessive, unjustified use of expensive and broad-spectrum antibiotics. We could not identify factors associated with this disregard of susceptibility profiles.

Adult↗