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Biomedical subjects

S Scharf

Publications and source records attributed to S Scharf.

At least 37 records · Page 2Linked to original sources

[Has the health profile and pregnant Ethiopian immigrants changed in the Ashkelon region in the past years?].

There are about 6500 births yearly in the Ashkelon District. 6% of the mothers are Ethiopians, most of whom immigrated to Israel since the early 90's. Our data are from 3 sources: birth certificates, infant death certificates, and the national population register. Birth rates in single mothers and rates of low-birth-weight births have declined over the years. Infant mortality and still-birth rates have also shown remarkable and consistent declines between 1990-1995. We conclude that improvement in life conditions of Ethiopian immigrants and better use of health services have had a great impact on birth outcomes and pregnancy patterns. The gap between Ethiopian immigrants and other Jewish communities in Israel is closing fast.

Birth Certificates↗

Epidemiology of childhood tuberculosis in the Ashkelon region in Israel, 1958-1994.

The incidence rates of tuberculosis (TB) in Israel decreased steadily up to 1984, but rose again between 1985 and 1991, mainly due to immigration waves from Ethiopia. The epidemiology of TB in children was surveyed in the Ashkelon region. The regional TB register of Barzilai Medical Centre, kept since 1958, was used as the source for our data. Two hundred and fifty TB cases in children were reported between 1958 and 1994, constituting 9.7% of the total 2565 cases reported in the whole population of Israel's southern Mediterranean coast. While in the late 1950s and early 1960s the majority of reported cases occurred in children of North African origin, reflecting the large wave of immigration from North Africa at that time, in 1985-94 at the time of the Ethiopian immigration wave, Ethiopian children constituted the majority of the patients. They were diagnosed up to 9 years after arrival. None of the reported cases was HIV-positive.

Adolescent↗

Effects of age on neutrophil function and its relevance to bacterial infections in the elderly.

OBJECTIVE: To determine the effect of age on neutrophil function in patients with and without acute bacterial infections. METHOD: Four groups of patients were recruited: Group 1: 15 elderly patients with infection (mean age 80.4 +/- 1.9 years), Group 2: 15 elderly control patients without infection (mean age 81.1 +/- 2.2 years), Group 3: 8 young patients with infections (mean age 26.7 +/- 2.9 years) and Group 4: 23 young controls (mean age 27.6 +/- 0.9 years). The main outcome measures included neutrophil counts and respiratory burst activation as measured by luminol enhanced chemiluminescence. RESULTS: Mean neutrophil counts were significantly higher in young patients with infections (5.04 +/- 0.96 x 10(9)/L) compared with young controls (2.63 +/- 0.33 x 10(9)/L) (p = 0.008) and in elderly with infections (6.51 +/- 0.97 x 10(9)/L) compared with elderly controls (4.1 +/- 0.88 x 10(9)/L) (p = 0.046). There was no significant difference between neutrophil counts of old and young patients (p = 0.40) or controls (p = 0.16). Mean peak luminol chemiluminescence was significantly increased in young patients (3329 +/- 284 mV) compared with young controls (1398 +/- 108 mV) and in elderly patients (2994 +/- 219 mV) compared with elderly controls (1674 +/- 197 mV) (p < 0.001). There was no significant difference between chemiluminescence activities of young and elderly controls (p = 0.41) or young and elderly patients (p = 0.14). CONCLUSION: Age is not associated with a change in neutrophil number or activity in the absence of bacterial infection. Infection in both young and elderly produces a significant increase in neutrophil number and chemiluminescence activity.

Adult↗

An outbreak of cutaneous aspergillosis in a tertiary-care hospital.

A cluster of four cases of surgical and burn wound aspergillosis occurred in a 900-bed, adult, tertiary-care hospital. The source was traced to the outside packages of dressing supplies, which had become contaminated during construction in the central Inventory Control area. This resulted in patients with large exposed surface areas being inoculated directly with Aspergillus spores.

Adult↗

Age as a basis for healthcare rationing. Arguments against agism.

Age alone is a poor marker of disability. Decision making in medicine should be based on potential benefit to the individual. Most healthcare expenditure on the elderly is for routine care, which few could argue should be denied because of age. Healthcare reforms that encourage functional independence and community based care of the elderly are more likely to lead to cost savings than simple rationing according to age. Treatment options previously thought futile in the elderly, particularly surgical interventions and drug therapy for cardiovascular disease, have been shown to be effective in terms of improved health and cost benefit. Thus, discrimination on the basis of age (agism) is not only ethically unacceptable in a society embracing principles of justice and equity, but also unsupportable on scientific and/or economic analysis.

Aged↗

Erythropoietin response in subjects with obstructive sleep apnea.

We measured nocturnal plasma erythropoietin concentration (EPO) in eight subjects with obstructive sleep apnea syndrome (OSAS) and eight healthy overweight subjects while they were undergoing nocturnal polysomnography. We also measured EPO (radioimmunoassay) after 120 min of exposure to 10.5% O2. The subjects with OSAS had a respiratory disturbance index (RDI) of 50.8 +/- 41.9 and a maximal O2 desaturation of 65 +/- 13.3%, and they spent 104.5 +/- 89.3 min out of a total sleep time of 356 +/- 54 min below 90% oxygen saturation (T90). Nocturnal EPO concentrations were normal and did not differ between the two groups. We found no correlation between the T90, T80, or RDI and either the mean or maximal EPO concentrations. After the exposure to 10.5% oxygen, during which oxygen saturations were between 80 and 85%, the healthy subjects and those with OSAS developed increases in EPO of 34 and 49%, respectively, 240 min after the initiation of exposure (p < 0.05). We conclude that the nocturnal hypoxemia occurring in these subjects with OSAS may not have been sufficiently severe to stimulate an increased EPO production. The lack of EPO response was not due to down-regulation of EPO production.

Adaptation, Physiological↗

[All-terrain vehicle accidents].

All-terrain vehicles (ATV) are designed for off-the-road occupational or recreational use. As their popularity has been increasing steadily, information has been accumulating on the morbidity and mortality associated with their use. The attributes of the ATV that make it attractive for recreation and sport are the reasons for much of its danger. Thus, horsepower, speed and ability to travel on rough and uncertain terrain are causal factors for accidents. The poor judgment and risk-taking of many of the young and immature drivers contribute to the great danger. 61 admissions due to ATV accidents from October 1992 to April 1995 are reviewed. The data suggest that ATV riders are at high risk for serious skeletal injuries and death. ATVs clearly present health hazards for riders of all ages, unless they are driven with great care. Guidelines for reducing the number and severity of injuries, such as age limits, safety programs and protective equipment are suggested.

Accident Prevention↗

Relevance of pharmacokinetics and pharmacodynamics.

Appropriate and rational use of drugs in the elderly is a matter of growing medical and social concern. The elderly as a group are particularly prone to adverse drug reactions. Such reactions have often been due to inappropriate drug prescribing, based on incomplete recognition and knowledge of changes in drug handling with age and pathological states associated with ageing. Recognition of such changes with modification of prescribing practice may lead to benefits by minimising the incidence of adverse drug reactions. This article discusses the current knowledge of age-related changes in drug absorption, distribution, clearance and sensitivity and some implications of these changes for clinical therapeutics in the elderly.

Aged↗

Analysis of HLA class II polymorphism using polymerase chain reaction.

A simple, rapid, and precise method of typing HLA class II polymorphism would be valuable in the areas of disease susceptibility, tissue transplantation, individual identification, and anthropological genetics. Herein, we describe a method of analyzing class II sequence polymorphism based on polymerase chain reaction (PCR) amplification and hybridization with oligonucleotide probes. Many more DNA-defined alleles at the class II loci have been identified than can be distinguished by conventional serologic typing. Consequently, matching transplant donors and recipients by PCR/oligonucleotide typing should reduce graft rejection and graft-vs-host disease. Also, the ability to identify alleles conferring genetic predisposition to specific diseases (eg, insulin-dependent diabetes mellitus) is significantly enhanced by distinguishing the many alleles or "subtypes" within a serologic type (eg, DR4). One valuable property of sequence-based HLA typing strategies, like oligonucleotide probe hybridization, is that they reveal how and where two alleles differ, not simply that they can be operationally distinguished. The nature and location of HLA polymorphisms appears to be critical in disease association studies and are important in tissue typing for transplantation. New alleles at the DRB1, DPB1, and DQB1 loci are likely to be identified as this technology is applied to more and more samples, particularly in nonwhite ethnic groups. A new allele is uncovered as an unusual pattern of probe binding and then confirmed by sequencing. This pattern is observed because class II polymorphism is localized to specific regions and virtually all "new" alleles represent "shuffled" combinations of polymorphic sequences found in previously known alleles. Since these polymorphisms are in the region of probe binding, these new alleles can be detected without increasing the probe panel. Obviously, any new allele with a new polymorphic sequence in a region for which typing probes are not available would not be revealed by oligonucleotide typing. With the PCR primers and probes described here, 7 DQ alpha 1 alleles, 15 DQ beta 1 alleles, 18 DPB1 alleles, and 32 DRB1 alleles are distinguished. Additional primers and/or probes can, of course, increase the allelic discrimination of PCR/oligonucleotide probe typing. These horseradish peroxidase-labeled oligonucleotide probes are stable (> 2 years when stored at 4 degrees C) and the typing system is simple and robust. Although this dot blot/oligonucleotide hybridization procedure is a powerful and precise method of HLA class II typing, the complexity of the procedure increases as the number of probes required for analysis increases.(ABSTRACT TRUNCATED AT 400 WORDS)

Alleles↗

Erythropoietin response to acute normobaric hypoxia in humans.

Hypoxia causes an increased production of erythropoietin (EPO), but the time course of the EPO response in humans has not been well characterized. This study examines the relationship between the duration of normobaric hypoxic exposure and plasma EPO levels in healthy human subjects. Six volunteers breathed a gas mixture of 10.5% O2-89.5% N2 continuously for 5, 60, and 120 or intermittently for 240 min. O2 saturations were maintained between 75 and 85% during the exposure. Arterial pH was 7.467 +/- 0.019, PO2 37.05 +/- 2.43 Torr, and PCO2 36.69 +/- 2.05 Torr. O2 half-saturation pressures of hemoglobin were normal for all subjects. Plasma EPO was measured every 30 min for 360 min by radioimmunoassay. No increase in EPO was seen after the 5- and 60-min exposures. However, a 50% increase was seen 240 min after the initiation of the 120-min hypoxic exposure (P less than 0.01). Intermittent exposure resulted in an increase of EPO by 52% 360 min after the onset of exposure (P less than 0.05). Therefore, exposing humans continuously to an inspiratory O2 fraction of 0.105 for 120 min or intermittently for 240 min provides a sufficient stimulus to increase production of EPO.

Adult↗

Leukocyte alkaline phosphatase and carcinoembryonic antigen in metastatic colorectal cancer patients.

Peripheral blood leukocyte alkaline phosphatase scores and plasma carcinoembryonic antigen levels in 26 patients with metastatic colorectal cancer were compared to those in 30 healthy controls. Patients had metastases to the liver and abdomen. The mean leukocyte alkaline phosphatase score in the metastatic colorectal cancer patients was significantly higher than in the control group (246 +/- 65 vs, 52 +/- 26, p less than 0.001); and the mean carcinoembryonic antigen level in the patients was also significantly higher than in the controls (110 +/- 100 vs, 4.9 +/- 3 ng/ml, p less than 0.001). One hundred percent of the metastatic cancer patients had elevated LAP scores and 73% of these patients had elevated CEA levels. There was a difference between the mean CEA levels in the patients with liver metastases and those with abdominal metastases (162 +/- 135 vs, 39 +/- 53 ng/ml, p less than 0.04). The results suggest that although both markers were elevated in metastatic colorectal cancer, the LAP score seems to be more useful in detecting metastatic disease, since we found 11% false negatives with the CEA level and 0% false negatives with the LAP score.

Abdominal Neoplasms↗

Specific HLA-DQA and HLA-DRB1 alleles confer susceptibility to Sjögren's syndrome and autoantibody production.

Primary Sjögren's syndrome (1. SS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the salivary glands and autoantibody production. In order to identify genetic factors that play a role in pathogenesis and predict extent of disease, we used Southern blot and polymerase chain reaction (PCR) methods to detect polymorphisms of the HLA-DRB1 (DR), HLA-DRB3 (DRw52), and HLA-DQA1 genes among 75 Caucasoid 1. SS patients and 150 Caucasoid controls living in the same geographic region of Southern California. We found significantly increased frequency of HLA-DR3 (P less than .001), HLA-DW52a (P less than .001), and HLA-DQA4 (P less than .05), in comparison to normal controls. Also, an increased frequency of heterozygosity for HLA-DQA1/DQA4 (P less than .05) was present among 1. SS patients. Autoantibodies to SS-A and to SS-B were significantly associated with DR3 (P less than .001), HLA-DQA4, (P less than .05), and DQA4/DQA1 heterozygotes (P less than .01). Among the 1. SS patients, clinical and laboratory features such as hypergammaglobulinemia, symmetric peripheral neuropathy, and hypothyroidism were significantly associated with HLA-DR3 (P less than .01) but not with HLA-DR2 (P greater than .10). In comparison, 1. SS patients with leukocytoclastic vasculitis were more frequently HLA-DR2 (P less than .05). These results using PCR methods confirm and extend prior studies that have used serologic methods.

Adolescent↗

A study of the use of gloves in a large teaching hospital.

A study was conducted in the wards and laboratory of a 900-bed teaching hospital to determine the appropriateness of glove use. In the wards the rate of appropriate use was 59%, and in the laboratory it was 90%. In general, in the patient areas gloves were used for specific tasks (70%) whereas in the laboratory use for a specific task was only 32%. Financial savings could be realized by educational programs in infection control directed toward a more rational use of gloves.

Attitude of Health Personnel↗

Leukocyte alkaline phosphatase and carcinoembryonic antigen in colorectal cancer patients (usefulness in the assessment of the stage).

Leukocyte alkaline phosphatase (LAP) scores in peripheral blood, and plasma carcinoembryonic antigen (CEA) levels were determined in 122 colorectal cancer patients, and compared to 30 healthy persons, who served as controls. Both markers are gradually elevated according to the severity of tumor penetration. LAP scores in Dukes'C and D (157 +/- 79) were significantly higher than in Dukes'A, B1 and B2 (81 +/- 43), p less than 0.001. CEA levels were also higher in Dukes'C and D (50 +/- 95) than in patients with Dukes'A, B1 and B2 (25 +/- 54), p less than 0.07, but less significantly. The LAP score has at least the same reliability as the CEA values as a marker of stage in colorectal cancer patients.

Alkaline Phosphatase↗