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A Porath

Publications and source records attributed to A Porath.

At least 19 recordsLinked to original sources
PubMed1995

[Seasonal variation in hospital admissions for cardiorespiratory diseases in the Negev].

Characteristics of patients admitted to the general medical wards of this hospital during the 21 months between January 1990 and September 1991 were analyzed. Cardiovascular and respiratory disease-related (CR) admissions accounted for 46.8% of the 18,774 admissions. Using a linear model, we examined the relationship between season and clinical characteristics of the patients admitted with CR diagnoses. They were admitted more often during the winter (December-February) than the summer (June-August). The ratio of CR admissions to other causes of admission was 0.75 in the summer, 0.93 in the spring, 1.01 in the winter, and 0.82 in the autumn (p < 0.0001). Seasonality affected more patients with coronary heart disease, noncoronary cardiac disease, and chronic pulmonary disease than those with pneumonia or other pulmonary diseases, or cerebrovascular events. Those admitted during the winter were older, had more than 1 CR condition, and their hospital stays were longer. This pattern of hospitalization partly explains the increase in admissions to medical wards in the winter with increase in work load.

Cardiovascular Diseases↗
PubMed1995

Microparticle agglutination versus antibody-capture enzyme immunoassay for diagnosis of community-acquired Mycoplasma pneumoniae pneumonia.

Community-acquired Mycoplasma pneumoniae pneumonia is a common disease which is usually diagnosed by serological methods. The objective of the present study was to understand the diagnostic significance and test characteristics of two different serological tests used to identify current Mycoplasma pneumoniae infection. Three hundred sixty-six patients who suffered from community-acquired pneumonia served as the study population. Six hundred ninety-four (328 paired and 38 unpaired) sera were examined for the presence of antibodies to Mycoplasma pneumoniae with commercial kits based on two serological methods, microparticle agglutination and antibody-capture EIA. Agreement between the two kits was 85.2% when individual sera were compared (kappa = 0.62) and 88.5% when patients were compared (Kappa = 0.69). The positive predictive value and the specificity for the identification of current Mycoplasma pneumoniae infection using a single acute-phase serum were 49.3% and 86.9%, respectively, for the microparticle agglutination method, compared to 91.3% and 97.7% for the antibody-capture EIA method (p < 0.001). The negative predictive value and the sensitivity were 86.3% and 48.1% for the microparticle agglutination, not significantly different from the corresponding values of 86.5% and 61.2% for the antibody-capture EIA. It is concluded that the overall agreement between the two methods tested is good, but not perfect. The methods complement each other in the identification of Mycoplasma pneumoniae as the causative agent in patients with community-acquired pneumonia.

Adolescent↗
PubMed1995

Ureaplasma urealyticum cervical colonization as a marker for pregnancy complications.

OBJECTIVES: To determine the clinical significance of cervical colonization with (Ureaplasma urealyticum (Uu) and its possible relationship to pregnancy outcome. METHODS: Cervical cultures for Uu and serum antibodies to Uu were determined in four groups of pregnant women: (1) 117 women who underwent mid-trimester amniocentesis; (2) 47 women with preterm labor and intact membranes; (3) 34 women with preterm premature rupture of membranes; and (4) a control group of 315 healthy women with normal pregnancies. Statistical methods used were the chi-square and Fisher's exact tests. RESULTS: A significant increase in the cervical colonization rate with Uu was detected in all study groups (62%, 77% and 74%, respectively) when compared with the control group (42%). Women at mid-trimester of pregnancy with a positive cervical culture and high levels of antibodies, had a higher rate of pregnancy complications than those with a negative culture and absence of antibodies (62 vs. 28%, respectively; P = 0.0006). CONCLUSION: Cervical colonization with Uu when associated with elevated titers of antibodies to Uu, may serve as a marker for the identification of a subpopulation of women who are at high risk for the development of pregnancy complications.

Adult↗
PubMed1995

Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women.

BACKGROUND: Changes in asthma activity, in part related to the female hormonal profile, have been observed during pre-menstrual periods and during pregnancy. Estrogen replacement therapy (ERT) is an accepted routine treatment for post-menopausal women. The effect of ERT on disease activity in post-menopausal asthmatic women has not been investigated in the past and is the subject of the present study. METHODS: Fifteen post-menopausal women with mild to moderate asthma completed two 30-day periods in which they measured peak expiratory flow (PEF) at home and filled in a daily diary of asthma-related symptoms. The first monitoring period was pre-ERT and the second was during ERT. In addition spirometry was performed on each woman three times, twice pre-ERT and once during ERT. RESULTS: The average daily PEF decreased from 241 (57.9, S.D.) l/min pre-ERT to 226.7 (62.7) l/min during ERT (P < 0.004). Significant differences between the two study periods were also found in morning and evening PEF values. Diurnal variation, measured as the difference between morning and evening PEF values, decreased significantly from 22.3 (26.7) l/min pre-ERT to 17.5 (26.8) l/min during ERT (P < 0.007). The average daily consumption of bronchodilator inhalers increased significantly from 3.7 puffs/day pre-ERT to 4.3 puffs/day during ERT (P < 0.006). Although the differences in spirometry between the two periods did not reach statistical significance, a trend towards a worsening of the obstructive disorder during ERT was observed. However, the general feeling of well-being of the asthmatics did not change during the two periods. CONCLUSIONS: During ERT a sub-clinical worsening of disease activity was found in postmenopausal women with mild to moderate asthma. We also detected a decrease in diurnal variation. Our findings should be substantiated by additional studies.

Asthma↗
PubMed1995

Q-fever pneumonia in the Negev region of Israel: a review of 20 patients hospitalised over a period of one year.

BACKGROUND: Three-hundred and forty-six patients with community acquired pneumonia were included in a prospective study of patients hospitalised over a 12-month period in the Soroka Medical Center in Beer-Sheva, Israel. Q-fever pneumonia (QFP) was diagnosed in 20 patients (5.8%). A detailed epidemiological and clinical description of this disease, is presented. METHODS: QFP was diagnosed by conventional criteria using a commercial immunofluorescent assay. RESULTS: The age of patients was 41 +/- 14 years (mean +/- S.D., range 20-69). Twelve of the patients were males. No concomitant or chronic disease was present in 16 patients. Chest radiograms revealed alveolar or air space pneumonia in 10 patients, bronchopneumonia in nine and interstitial pneumonia in one patient. The mean febrile period was 10.5 +/- 5.3 days. There was serological evidence of co-infection with Mycoplasma pneumonia in six patients, and with Legionella pneumophila in one patient. Patients treated with beta-lactam antibiotics recovered as quickly as those treated with tetracyclines or erythromycin. CONCLUSIONS: The Negev region of Israel is an endemic area for Q-fever. The diagnosis of QFP can be made only on the basis of a specific serological test. Clinical, radiologic or laboratory findings are not diagnostically definitive. The importance of specific therapy is unclear.

Adult↗
PubMed1995

Factors associated with inappropriate hospitalization in medical wards: a cross-sectional study in two university hospitals.

A comparative study of the appropriateness of hospitalization was conducted in the medical departments of two university hospitals in Israel. A cross-section of 297 patients on one hospitalization day was analyzed using the Appropriateness Evaluation Protocol (AEP). Data were independently collected by two reviewers (R1 and R2). The study revealed a significant difference in the percent of inappropriate hospitalization between the two hospitals, i.e. 13.3% (R1) or 19.3% (R2) for hospital B, and 24.5% (R1) or 32% (R2) for hospital A. The reviewers were in agreement regarding evaluation (92.6%, Kappa 0.78) of 275 index days. A multivariate analysis of the index days with agreed appropriateness correlated with occupancy and length of stay. Routine monitoring of appropriateness of hospital stay should, therefore, be targeted to medical departments with relatively low occupancy rates and/or prolonged average stay.

Aged↗
PubMed1995

Dibromochloropropane (DBCP): a 17-year reassessment of testicular function and reproductive performance.

The current study summarizes a 17-year reevaluation of testicular function and reproductive performance of 15 production workers with dibromochloropropane (DBCP)-induced testicular dysfunction. Sperm count recovery was evident within 36 to 45 months in three of the nine azoospermic and in three of the six oligozoospermic men with no improvement thereafter. A significant increase in plasma follicle-stimulating hormone (FSH) and luteinizing hormone (LH) and a nonsignificant decrease in testosterone level were detected in the severely affected individuals. There was no increase in the rate of spontaneous abortions and congenital malformations among pregnancies conceived during or after exposure. A low prevalence of male infants conceived during paternal exposure was found as compared with the preexposure period (16.6% versus 52.9%; P<.025). Restoration of fertility was followed by a gradual increase of this value to 41.4%.

Adult↗
PubMed1995

Influence of estrogen replacement therapy on airway reactivity.

The effect of estrogen on smooth muscle in various organs is unpredictable. Little is known about the effect of estrogen on respiratory tract smooth muscle, particularly in humans. In the present study we used the histamine challenge test (HCT) to assess the effect of estrogen replacement therapy (ERT) on airway reactivity in postmenopausal women who did not suffer from respiratory disease. Thirty-six women who were undergoing treatment at the postmenopausal clinic completed the study. All participants were nonsmokers whose pulmonary function tests were normal. HCT was performed twice before the inception of ERT, and a third time 4-6 weeks after ERT was begun. None of the 36 women demonstrated a 20% decrease in FEV1 values (PC20) after inhaling histamine at a concentration of 8 mg/ml, either before or during ERT. The maximal decrease in FEV1 values in response to the maximum concentration of histamine was significantly lower during ERT compared to the pretreatment period. The average maximal decrease in FEV1 during ERT was 2.63 +/- 2.72% (mean +/- DS) compared to 5.21 +/- 4.47% and 6.57 +/- 5.28% on the 2 tests prior to therapy (p < 0.0002). We conclude that ERT has an inhibitory effect on the bronchial reactivity of respiratory smooth muscle. There is no cause for concern about increased airway reactivity as an adverse effect of this therapy.

Estrogen Replacement Therapy↗
PubMed1995

Antibodies to Ureaplasma urealyticum in women with intraamniotic infection and adverse pregnancy outcome.

OBJECTIVE: To determine the association between antibody response to Ureaplasma urealyticum and pregnancy outcome in women with ureaplasmal invasion of the amniotic cavity. METHODS: A cross section study was performed in our high risk pregnancy unit. Three groups of pregnant women were identified: 1) 271 women at the midtrimester of pregnancy (16-20 weeks), who underwent transabdominal amniocentesis for genetic indications 2) 161 consecutive women admitted with preterm labor and intact membranes. 3) 118 consecutive patients with preterm premature rupture of membranes. Amniotic fluids were cultured for Ureaplasma urealyticum, Mycoplasma hominis and also for other aerobic and anaerobic bacteria. Serum antibodies to Uu were measured by a specific enzyme-linked-immunosorbent-assay. RESULTS: The prevalence of positive AF cultures with Uu in the 3 study groups was 2.9%, 4.3% and 17.8%, and the prevalence of antibodies to Uu in the AF-colonized patients was 50%, 86% and 57%, respectively. Adverse pregnancy outcome (preterm birth, low birth weight or fetal death) among all AF colonized women, was significantly higher in patients with antibodies to Uu than in those without antibodies; preterm delivery 90% vs. 43%, and low birth weight infants or fetal death 85% vs. 28%, p = 0.006 and 0.001 respectively. CONCLUSION: Women with intraamniotic infection with Uu and elevated levels of antibodies to Uu, had a higher rate of preterm delivery, and low birthweight infants/fetal death than those without antibody to Uu.

Adult↗
PubMed1995

The intermediate care unit as a cost-effective option for the treatment of medical patients in critical condition.

Since the limited accessibility of general intensive care units creates a situation in which medical patients in critical condition continue to be cared for in the regular wards, we conducted a retrospective cohort study to assess the treatment outcomes in such patients referred to the medical intermediate care unit (MICU). At the Soroka Medical Center, a facility with 810 beds, of which 170 beds are in medical wards, including an 8-bed intensive cardiac care unit and a 5-bed general intensive care unit, 119 patients were referred to the MICU, directly from the emergency room or from medical wards, during the first half of 1994. Eighty percent of the patients were admitted to the MICU directly from the emergency room. The mean disease severity, as measured by the APACHE II score, was 12.9, and the mean intensity of care for these patients, as measured by the TISS scale, was 12.6. Twenty-one of the 119 patients died during hospitalization (17.6%). This mortality rate conformed to the mortality risk of 15.5%, which was calculated using prognostic formulae. The ratio of nursing staff to patient in the MICU was approximately 1:3, compared to 2:3 in the general intensive care unit and 1:12 in the wards. The mean cost of one day of hospitalization in the MICU was one-third that in the general intensive care unit and double the cost in a ward. Medical patients in critical condition can be treated in an MICU, with a savings in expenses and without impairing the patient's chances for survival.

APACHE↗
PubMed1994

[Malignant lymphomas of the head and neck].

Review of 122 head and neck lymphomas diagnosed between 1976 and 1992 revealed 40 extranodal lymphomas. In 30 of them follow-up was available. We review the demographic, clinical, histological and immunohistochemical features of the 30 extranodal lymphomas according to site of origin. Comparison is made between these extranodal lymphomas and nodal non-Hodgkin's lymphomas and cases of Hodgkin's disease first diagnosed in the head and neck area.

Adolescent↗
PubMed1994

The risk of developing an acute coronary event as a measure of the quality of triage of patients presenting to the emergency room with chest pain.

The risk of developing an acute coronary event (ACE) in patients presenting to the emergency room with chest pain or shortness of breath was assessed in a prospective blinded fashion. The Time Insensitive Predictive Instrument (TIPI), which is appropriate for both prospective and retrospective assessment, was used to determine the risk. The average predictive probability for developing ACE among the 168 patients examined was 36.5%. The triage process created groups of patients with significantly different relative risks for ACE. The average predictive probability among the patients discharged from the emergency room was 23%, among those hospitalized in internal medicine 44%, and among those hospitalized in the coronary care unit (CCU) 62.4%. Among patients presenting with ACE the predictive probability determined using TIPI was 57.6% compared to 26.3% in patients without ACE. This difference was unaffected by the triage process or the decision where to hospitalize. TIPI permits assessment of the emergency room physician's decisions and also mirrors the limitations of the system as a whole in treating patients referred to the emergency room for a suspected acute coronary event.

Adult↗
PubMed1994

Evaluation of the APACHE II scoring system in an Israeli intensive care unit.

The objective of our study was to evaluate the applicability of the Acute Physiology and Chronic Health Evaluation (Apache II) scoring system in an Israeli general intensive care unit (GICU), and to monitor the outcome of care using the Apache II severity score. We compared over a 3-year period the distribution of Apache II score, and of hospital mortality in our GICU (790 consecutive admissions) to that of the original American study, using a prediction formula based on 5,815 admissions in the United States. Our admissions were classified as post-elective surgery, post-emergency surgery or nonsurgical. Patients' ages were 53 +/- 21 years. The mean APache II score was 13.3 +/- 7.8, and was significantly lower in the 612 survivors (11.1 +/- 6.7) than in the 178 nonsurvivors (19.2 +/- 8.4). The in-hospital mortality rate was higher, 22.5%, compared to the predicted 18.3% (odds ratio 1.14, 95% CI 1.01, 1.27). The majority of excess mortality occurred in the nonsurgical group (odds ratio 1.27, 95% CI 1.09, 1.48). We found the Apache II score useful for determining the severity of illness in our GICU. The Apache equation accurately predicts the mortality of elective and emergency surgery admissions, but underestimates the mortality of nonsurgical admissions.

Adolescent↗
PubMed1993

Pathogenetic aspects of persimmon bezoars. A case-control retrospective study.

To prove that ingestion of unpeeled persimmon is necessary for the development of a persimmon phytobezoar, we interviewed 15 patients, in most of whom this condition developed after peptic ulcer surgery. We compared the study group with a control group of 15 patients who had undergone peptic ulcer surgery but did not have a bezoar. In contrast with the control group, most patients with bezoars had ingested unpeeled fruits (p < 0.01). While ingestion of persimmon carried a 9.8-fold risk of bezoar development, ingestion of the unpeeled fruit increased the risk of this complication 56 times over that of age- and sex-matched controls. We recommend that patients who have undergone ulcer surgery be warned particularly against eating unpeeled persimmons.

Bezoars↗
PubMed1992

Risk indicators after envenomation in humans by Echis coloratus (mid-east saw scaled viper).

To determine the frequency, severity and predictors of bleeding and azotemia after envenomation in humans by Echis coloratus, a retrospective survey of 68 cases in Israel between 1970 and 1989 was carried out. We used univariate and multivariate analyses of clinical variables on admission for the outcome variables of bleeding, hemoglobin and platelet levels, and blood urea. Within hours or days after envenomation, a major bleeding episode occurred in 18% of the victims, a drop in hemoglobin to 10 g/dliter or less in 14%, and an increase in blood urea to 9 mmole/liter or more in 15%. These complications correlated with time interval between envenomation and hospital admission, and the following admission variables: degree of bleeding, hemoglobin level, platelet and white blood cell counts, blood urea and proteinuria. Complications were unlikely in patients who were presented with all of the following: a hemoglobin level of 13 g/dliter or more, a platelet count of 100,000/mm3 or more, a blood urea level of 7 mmole/liter or less, no proteinuria and no bleeding. Treatment on admission with a specific monovalent antiserum was associated with a shorter duration of hemostatic failure and a reduced incidence of anemia and thrombopenia. Infusion of fresh frozen plasma on admission did not appear to be effective in preventing complications.

Adult↗