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E Shabtai

Publications and source records attributed to E Shabtai.

27 records · Page 2Linked to original sources
PubMed1990

Multivariate and Boolean factor analysis of immune complex/complement deposits and their effects on renal blood flow during allograft rejection.

The role of humoral immune factors in graft destruction is not fully understood. With immunofluorescence techniques the possibility of a specific pattern and/or clustering of immune complex or complement deposits was analyzed in 140 percutaneous kidney needle biopsies performed in 73 patients with renal allograft dysfunction. The results were correlated with concomitant alterations in renal blood flow as measured by cortical and global perfusion indexes and graft survival. The deposition of IgG, IgM, C3 and C4 correlated significantly with acute rejection confirmed by biopsy (p less than 0.05, less than 0.001, less than 0.02 and less than 0.001, respectively). Subsequent graft survival was compromised when IgA, IgG, IgM, C3, C4 and properdin were present together in biopsy specimens (p less than 0.05). There was a significant clustering of IgA with C3, of IgG with C3 and C4, and of IgM with C1, C3 and C4 (p less than 0.001). There also was a significant association among alterations in renal blood flow, deposition of IgA (p less than 0.05) and C4 (p less than 0.02), and graft outcome. Higher perfusion indexes, indicative of decreased blood flow, showed significant associations (p less than 0.007 and less than 0.04 for the cortical and global perfusion indexes, respectively) with a greater risk of graft loss. Although it primarily is a cellular event, the data suggest that acute rejection is associated with a deposition of various humoral factors that may mediate alterations in renal blood flow. The latter may affect graft function and structural integrity, and, thus, may show a direct correlation with the outcome of a graft.

Antigen-Antibody Complex↗
PubMedDate not supplied

Activation of flexor and extensor trunk muscles in hemiparesis.

OBJECTIVE: The purpose of this work was to study the bilateral activity of trunk flexor and extensor muscles in post-stroke hemiparetic patients. DESIGN: Criterion variables were degree of temporal synchronization and level of electromyographic activity in pertinent muscle pairs during two symmetrical tasks: (1) from reclined sitting, bringing the trunk forward; (2) during upright sitting, shrugging shoulders, and extending back. The recti abdomini and external oblique muscles were tested as prime movers of the first task, and the lumbar erector spinae and latissimus dorsi muscles were tested in the second task. Electromyographic recordings from these muscles during three repetitions of each exercise were used for analysis. RESULTS: Cross-correlation analysis pointed to higher temporal synchronization between the abdominal muscles than between the back extensor muscles and in axial compared with para-axial muscles. Differences between patients and controls were found only for the erector spinae muscle pair, which indicates less synchronous activity between the two sides in the patients. The average electromyographic activity level was comparable for corresponding abdominal muscles, both in the patients and in the control subjects. Regarding the back extensor, side differences were detected for the latissimus dorsi muscles in both groups, with the paretic and right side less active in the patients and controls, respectively. CONCLUSIONS: Altogether, the findings do not support the claim of unilateral deficits in the function of trunk muscles in post-stroke hemiparetic patients. They emphasize the need for further characterization of the impairment of trunk extensor and flexor muscles in post-stroke patients.

Abdominal Muscles↗
PubMedDate not supplied

Comparing medical centers treating hip fractures in the elderly: the importance of multi-outcome measurements.

The objective of this study was to assess the merit of multi-outcome measurements on the evaluation of quality of care, comparing different health care providers. We performed a cross-sectional study in 3 medical centers. Three hundred three patients undergoing surgical repair of traumatic femoral neck fracture were included. Trained nurses gathered data by patient and proxy interview and by chart abstraction. Multivariate analysis was performed to obtain an explanatory model for each outcome. Then, the additional contribution of each of the centers to the explanatory power of the model was examined. The outcomes were mortality, functional capacity, post-operative complications, and length of stay. Explanatory variables included were sociodemographic details, comorbidity indices, preoperative functional capacity, depression, and cognition. The results demonstrated that center A was a "good" outlier for mortality rate but, in contrast, was a "bad" outlier for complication rate and length of stay. Center B was a "bad" outlier for functional capacity but a "good" outlier for length of stay. We conclude that outcome studies for quality assurance programs should include all relevant outcomes, as the assumption that one major outcome may be representative for quality of care assessment may be misleading.

Activities of Daily Living↗
PubMedDate not supplied

Factors associated with nonprescription of evolving modes of therapy--a model for drug use evaluation in hospitalized medical patients.

OBJECTIVE: To measure the rate of inappropriate underuse of drug therapy among hospitalized patients and to identify factors associated with nonprescription of two effective modes of therapy. DESIGN: A survey was conducted by retrospective chart extraction to measure the rates of nonprescription of two therapeutic modalities--aspirin and angiotensin converting enzyme inhibitors. Stepwise logistic regression was used to determine which factors were significantly associated with nonprescription of either drug. SETTING: Two internal medicine departments in a major community and referral hospital in Israel. PATIENTS: Those who were hospitalized through 1990 with a diagnosis on their discharge sheet of angina pectoris or congestive heart failure. A random sample selection was made to define the study population. RESULTS: The rates of nonprescription among patients in whom there are no drug contraindications were 54% (95% CI 47-62) for aspirin and 34% (95% CI 27-41) for angiotensin converting enzyme inhibitors. Three variables correlated independently with nonprescription of both drugs: hospitalization in ward B, nonuse of the drug prior to hospitalization, and secondary priority of the diagnosis angina pectoris or congestive heart failure on discharge sheet. CONCLUSIONS: Nonprescription of essential drugs is a common phenomenon that varies significantly among physicians. Inconsistency in application of knowledge to clinical practice, as well as a diversity of approaches toward interpretations of clinical study results, significantly influences the prescription rates of evolving modes of therapy.

Angina Pectoris↗
PubMedDate not supplied

Variation in mortality among seven hemodialysis centers as a quality indicator.

OBJECTIVES: To identify patient attributes that were associated with increased mortality; variables that were associated with process of care that were correlated with mortality; and outlier centers after adjustment for patient attributes. DESIGN: Standard interviews were conducted by trained nurses with all patients. Detailed information regarding primary renal diagnosis, comorbidity, and results of laboratory tests were obtained from the medical charts. The vital status of the patients was obtained from the records of each of the centers. We used the Cox hazard method to identify variables that correlated with a 1-year mortality. Centers with observed mortality exceeding the 95% confidence interval (CI95) of the expected probability of death were marked as outliers. SETTING: Seven dialysis centers located in large teaching hospitals in Israel. PATIENTS: The current study included patients > 16 years of age who had undergone hemodialysis > 4 weeks prior to the day of data collection. RESULTS: The study included 564 patients. Significant differences were found in patient demographics and process variables among the centers. The following variables correlated with mortality; diabetes (odds ratio [OR], 2.03; CI95, 1.28-3.21); ischemic heart disease (OR, 2.2; CI95, 1.39-3.49); each year of age (OR, 1.04; CI95, 1.02-1.06); each 1 g% of albumin (OR, 0.51; CI95, 0.30-0.86). The average observed mortality in all centers was 17.4%. After adjustment for casemix, one center showed excess mortality (24% observed compared to 15% expected after adjustment for patient attributes; CI95, 6.2-23.7). CONCLUSIONS: The ability to compare mortality rates among dialysis centers to detect possible quality outliers depends on thorough consideration of patient attributes and random variation.

Adolescent↗