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Doron Zamir

Publications and source records attributed to Doron Zamir.

16 recordsLinked to original sources
PubMed2006

Readmissions to hospital within 30 days of discharge from the internal medicine wards in southern Israel.

INTRODUCTION: Hospital readmission within a short time of discharge is a common phenomenon in internal medicine. Although there are a few reports of intensive care and surgical readmission rates there is almost no information available on the readmission rates of internal medicine patients. AIMS: To explore the medical patient readmission rate within 30 days of discharge from a medical center in southern Israel, and determine how it may be related to age, gender, diagnoses and other factors. METHODS: Chart review of all 2469 patients admitted to the departments of internal medicine of Barzilai Health Center between May 1st and July 15th 2002. A randomized control group of 87 patients was gathered from patients admitted to hospital during the study period but who were not readmitted within 30 days of discharge. RESULTS: 124 patients (5%) were readmitted. They were significantly older than controls (mean age 68.7+/-14.8 vs. 59.3+/-16.3 years), (p<0.0003), 21% being over 80 years of age (compared with 9% of controls, p<0.05) and had a lower average Functional Independence Measure (FIM). The index hospitalization of readmitted patients was significantly longer than the hospitalization of control patients (6.1+/-5.5 vs. 4.1+/-3.8 days), (p<0.04). Most patients (85%) were readmitted for the same medical reason that prompted the original hospitalization. The 15% readmitted for other reasons were older (74.9+/-12.4 vs. 67.6+/-15.0 years) (p<0.001) and had a lower Functional Independence Measure (mean FIM 4.6+/-2.2 vs. 5.7+/-1.9), (p<0.05). New immigrants (mean age 71.1+/- 12.9 years) had significantly lower readmission rate compared to the general population (3.2% vs. 4.98%), (p<0.05). Veteran Israelis, on the other hand, had a higher readmission rate than the general population (6.8% vs. 4.98%) (p<0.001). CONCLUSION: Only 5% of patients required readmission. The original hospitalization period of readmitted patients was significantly longer than controls and most readmissions were for the original medical problem for which they were readmitted originally or because of a low functional status. Hospitalized new immigrants although being older in age are less likely to require readmission, while veteran Israelis are more likely to be readmitted.

Journal Article↗
PubMed2006

Single-dose quinolone treatment in acute gastroenteritis.

BACKGROUND: Acute diarrhea is a common disease worldwide and in Israel, a Mediterranean country. Acute bacterial gastroenteritis (ABGE) is the leading cause of severe diarrhea in Israel in summer and early autumn. Although there are some reports showing some benefit from empiric antibiotic therapy in acute gastroenteritis, most are old reports using nondefinitive diagnostic criteria and using 5-day antibiotic regimens. AIMS: 1. To examine the efficiency of antibiotic therapy in relatively severe ABGE in general. 2. To check the efficiency of the different types of quinolones in the treatment of ABGE. 3. To compare various therapy regimens. METHODS: All patients admitted to the Barzilai Medical Center emergency room during the period June to October in 2002-2004 who were defined by protocol as having relatively severe gastroenteritis and required hospitalization in the Department of Internal Medicine were included in the study. All were randomized either to a supportive treatment only group (STG) or to the antibiotic treatment group (ATG) of ofloxacin or levofloxacin with a single dose or BID for 5 days in addition to STGs. All patients were interviewed a week later about their medical history and duration of symptomatology. RESULTS: One hundred thirty-nine patients were found eligible for the study in the above-mentioned period. Abdominal pain resolved 1.3 days earlier in the ATG in comparison to the STG whereas vomiting and diarrhea disappeared 1.0 and 0.8 days earlier, respectively, in the ATG versus the STG. In terms of fever abatement there was no difference between the regimens and no significant difference in symptomatology disappearance between various types of quinolones used or between the single antibiotic dose regimen and the 5-day antibiotic regimen groups. CONCLUSIONS: 1. Antibiotic therapy was found to shorten duration of symptoms in patients with relatively severe gastroenteritis. 2. Single-dose therapy is as effective and certainly significantly more cost effective in comparison to the 5-day antibiotic treatment regimen.

Acute Disease↗
PubMed2005

Gastroesophageal reflux.

Gastroesophageal reflux disease (GERD) is the most common disease of the gastrointestinal system. Heartburn, regurgitation, and dysphagia are the most common symptoms of GERD. However, chest pain, chronic cough, laryngitis, hoarseness, and other otolaryngologic manifestation can be the primary manifestations of the disease. Endoscopy, barium studies, and especially pH monitoring and therapeutic trials may help in establishing the diagnosis of GERD. The introduction of H2 antagonists and especially of proton pump inhibitors (PPI) has brought symptomatic relief in most patients. However, surgical procedures, especially laparoscopic fundoplication, are still required in some patients. Barrett's esophagitis is the most common complication of GERD and is associated with a high prevalence of esophageal adenocarcinoma. Whether or not treatment with either PPIs or H2 antagonists can prevent this complication is still under investigation.

Journal Article↗
PubMed2004

Thrombotic thrombocytopenic purpura due to alcohol binge drinking.

Binge alcohol drinking is a pattern of alcohol abuse that is common among young males worldwide. It has been found to be associated with an increased likelihood of injury as a cause of death. Chronic alcohol abuse is known to cause some common hematological manifestations such as macrocytosis, thrombocytopenia, sideroblastic anemia, global marrow suppression, and folic acid deficiency anemia. We present a rare case involving an unusual and severe hematological manifestation of binge alcohol drinking: thrombotic thrombocytopenic purpura (TTP). The patient we present had severe and prolonged TTP necessitating prolonged treatment with plasmapheresis and plasma exchange. We discuss the relevant medical literature and the possible physiopathology of this complication.

Journal Article↗
PubMed2003

Severe enoxaparin-induced thrombocytopenia complicated by pulmonary emboli.

Low molecular weight heparins (LMWH) have been widely used in the last decade, especially for prophylaxis of deep venous thrombophlebitis. Enoxaparin-induced thrombocytopenia is rarely encountered, in contrast to its high prevalence among patients treated with unfractionated heparin. We report a case of a patient who was admitted because of a pulmonary embolus due to proximal deep vein thrombophlebitis 2 weeks after surgery, despite prophylaxis with low-dose enoxaparin after prostatectomy. The patient's original normal platelet count (255,000/microl) dropped to 30,000/microl while on enoxaparin therapy. Testing for antibodies against heparin was positive. Warfarin was initiated and an inferior vena caval filter was inserted. Within a few days, platelet count increased to 100,000/microl, pulmonary status improved, and the patient was released in good clinical condition. Heparin-induced thrombocytopenia (HIT) is discussed, as are alternative treatments for unfractionated heparins and LMWH.

Journal Article↗
PubMed2003

Recurrent pneumonia post-thymectomy as a manifestation of Good syndrome.

A 78-year-old woman presented with right lobar pneumonia. Six months before, the patient had undergone surgery due to a large mass that was found to be spindle cell thymoma. During the past 6 months, the patient had been admitted to the hospital several times with recurrent pneumonia in both lungs; this was treated successfully with antibiotics. Laboratory examinations revealed lymphopenia, eosinopenia, hypogammaglobulinemia, and a low count of CD4 T cells and an inverted CD4:CD8 T cell ratio, both on peripheral blood and bone marrow. History and laboratory findings were compatible with the diagnosis of the rare Good syndrome. This syndrome is discussed here.

Journal Article↗
PubMed2003

[Human transmissible spongiform encephalopathies].

A new variant of Creutzfeldt-Jakob disease was discovered in 1996. This new variant was found to be related to encephalopathy. There are 5 known human transmissible spongiform encephalopathies, all created by prions. The prion, a pure protein, smaller than a virus is derived from a normal glycoprotein of human cells wall. The function of this protein is unknown but supposed to be connected with copper incorporation into superoxide dismutase. Creutzfeldt-Jakob disease is an early dementive disease with loss of neurons, accumulation of amyloid and spongiform degeneration of the brain. We discuss the epidemiology, diagnosis and therapy of Creutzfeldt-Jakob and its variant. The increased life expectancy will certainly cause these diseases to be more common, thereby having a definite affect on the economy in both developing and developed countries. Future therapy will concentrate on either preventing the creation of pathologic prions or extracting intracellular prions.

Creutzfeldt-Jakob Syndrome↗
PubMed2003

[Nosocomial infections in internal medicine departments].

BACKGROUND: Nosocomial infections are a major cause of morbidity and mortality among hospitalized patients. The use of new generation antibiotics of wide spectrum caused a higher rate of virulent infections. AIMS: a) To study the prevalence, pattern and etiology of nosocomial infections in patients hospitalized in departments of internal medicine. b) to determine the characteristics of high-risk patients, deserving special precautions. METHODS: All medical files of patients who were admitted to internal medicine departments during the years 1994-8 were reviewed. All patients with nosocomial infections were included according to specific criteria. RESULTS: Of 2789 medical files, 72 (2.6%) patients, randomly elected had 76 episodes of nosocomial infection. Urinary tract infection (40.8%), pneumonia (32.9%) and sepsis (9.2%) were the most frequent infections. Mortality was significantly higher in patients with nosocomial infections--48.6% compared to 5% in a control group (p < 0.001). E. Coli, Pseudomonas auroginosa, and Staphylococcus Aureus were the most frequent infecting bacteria. Empiric antibiotic therapy was used in 84.7% of the patients. Any bacterial isolation was found in 61.9% of the patients samples (including blood cultures, urine cultures etc). Old age, female gender, prolonged hospitalization, mechanical ventilation and indwelling urinary catheter were found as risk factors for nosocomial infections. CONCLUSIONS: 1. Nosocomial infections in internal medicine departments in Brazilai hospital were found to be less common than previously reported. 2. Five risk factors for nosocomial infections were correlated with a higher prevalence of the disease. 3. Mortality due to nosocomial infections is very common, probably due to inappropriate empiric treatment and high rate of bacterial resistance. 4. Simple preventive measures as well as immediate treatment of nosocomial infection with proper antibiotics are expected to decrease mortality.

Aged↗
PubMed2002

[Splenic abscess as an unusual manifestation of colonic carcinoma].

A patient was admitted to the Internal Medicine Department after suffering from fever for 4 days. A splenic abscess was found in an ultrasound examination and was confirmed by an abdominal computerized tomography and galium scan. Antibiotic treatment was successful, however barium enema was performed due to the lack of a predisposing factor for this unusual abscess. A polypoid mass was found in the splenic flexure of the colon. Colonoscopy and histologic examination confirmed the mass to be colonic adenocarcinoma. Either an endoscopic examination or barium enema are recommended to exclude colonic lesions in cases of splenic abscess without an obvious cause.

Adenocarcinoma↗
PubMed2002

Early detection of hepatic encephalopathy by recording visual evoked potential (VEP).

The visual evoked potential (VEP) record in response to a pattern stimulus is a non invasive and reliable method of detecting central and peripheral nerve system abnormalities. VEP recording have been used in animals with fulminant hepatic failure, and also in-patients with hepatic encephalopathy and acute severe hepatitis. Our aims were: a. to evaluate the potency of PVEP in assessing hepatic encephalopathy. b. to find the rate of pathologic PVEP in patients with advanced liver cirrhosis. VEP was recorded in 14 chronic liver cirrhotic patients (6 alcoholic, 6 HCV-related, 2 cryptogenic) and 14 controls. Patients with any neurologic abnormalities were excluded from the study. All patients were subjected to the Mental State Score (MSS) test, and venous blood ammonia was measured on the same day of VEP recording. In 10/14 (71%) patients some VEP recording abnormality was detected. In the cirrhotic patients, P100 latency was significantly longer (P < 0.05) than in controls. Low amplitude was observed in 8 patients compared to controls. Marked increase of N75 (3 patients) and marked increase of N145 (2 patients) were observed. Mean blood ammonia and MSS score were normal in all patients. No correlation was found between both MSS score and blood ammonia levels and the P100 delay. Five out of 10 patients with pathologic VEP developed hepatic encephalpathy during a follow-up of one year, compared to one out of 4 patients with no pathology on VEP recording. VEP recording may be a valuable tool in assessing patients with early hepatic encephalopathy and in predicting encephalopathy.

Adult↗
PubMedDate not supplied

Phytobezoars and trichobezoars: a 10-year experience.

INTRODUCTION: Bezoars are retained concretions of animal or vegetable material in the gastrointestinal tract. Most bezoars reside in the stomach, but they may be encountered elsewhere. Previous gastric surgery, which has resulted in impaired gastric emptying and/or decreased acid production, is usually the cause of bezoars. Phytobezoars are more common, while trichobezoars are rare. Endoscopy and gastrografin swallow may aid in diagnosis. The treatment of bezoars can be either conservative or surgical. METHODS: After searching the computerized medical database, all files of hospitalized patients in the years 1992 to 2002 with the diagnoses "bezoars," "phytobezoars," and "tricobezoars" were evaluated. RESULTS: Eighteen patients had bezoars: 16 had phytobezoars and 2 patients were diagnosed as having trichobezoars. Eleven of the patients had previous gastric operation. All patients but one were treated surgically. Two unusual cases of trichobezoar are presented here. DISCUSSION: Thorough understanding of bezoars can allow the clinician to be especially alert when dealing with those patients most likely to develop them, and thus diagnose the condition at an early stage.

Adolescent↗