Biomedical subjects

Francis B Mimouni

Publications and source records attributed to Francis B Mimouni.

At least 19 recordsLinked to original sources

PubMed2004

Smoking habits in adolescents with mild to moderate asthma.

To study the impact of mild to moderate asthma on smoking habits in adolescents. Specifically, we tested the hypothesis that asthma does not prevent adolescents from smoking. A research questionnaire, filled by a systematic sample of military personnel upon enrollment to service in the Israeli Defense Force (IDF), was analyzed. Conscripts were asked to voluntarily fill (after obtaining a signed informed consent) a research questionnaire about their medical history, and several health related topics including smoking. This database was matched with the military medical profile of the soldier, which includes the patient asthma status. Overall, 38,047 young adults were included in this study. There was a significant increase in the rate of mild to moderate asthma, from the mid-1980's to date. During the 1980's and early 1990's, asthmatics smoked significantly less frequently (20-22%) than non-asthmatics (25-27%). In the mid- to late-1990's, the smoking rates increased relatively more in asthmatics, to the point that in the last 8 years of this study, they were found to be almost identical in both groups, at a rate of approximately 30%. The presence of asthma is not a powerful motivating agent to prevent from smoking. It is likely that smoking asthmatic teenagers are at risk for suboptimal lung growth, and as young adults, they will become at greater risk of lung function deterioration. We suggest that primary care physicians, caring for asthma in children, adolescents, and young adults, should explain the particular risks generated by tobacco smoking.

Adolescent↗

PubMed2004

Nucleated red blood cells in concordant, appropriate-for-gestational age twins.

OBJECTIVES: The purpose of this study was to test the hypothesis that neonatal nucleated red blood cell (RBC) counts are elevated in nondiscordant twins compared with singletons. STUDY DESIGN: We compared absolute nucleated RBC counts taken after birth in 2 groups of term, appropriate-for-gestational age infants; 74 concordant twins, and 29 singleton control infants. We excluded infants with factors associated with a potential increase in absolute nucleated RBC counts. RESULTS: Birth weight and gestational age were significantly lower in twins than in singletons (P < .01). Hematocrit, absolute nucleated RBC count, and corrected lymphocyte counts were significantly higher in twins (P < .01). In multiple regression, the significantly higher absolute nucleated RBC count in twins remained significantly higher even after taking into account gestational age and Apgar scores. CONCLUSION: Concordant, appropriate-for-gestational age twins have increased nucleated RBCs at birth compared with singleton control infants.

Apgar Score↗

PubMed2004

Nucleated red blood cells in preterm infants who have necrotizing enterocolitis.

Absolute nucleated red blood cell counts for 23 preterm newborn infants who subsequently had development of necrotizing enterocolitis were significantly higher than for 23 control infants. These infants may have been exposed to relative intrauterine hypoxemia, a possible risk factor for the development of necrotizing enterocolitis.

Case-Control Studies↗

PubMed2004

Decreased bone ultrasound velocity in large-for-gestational-age infants.

BACKGROUND: Bone speed of sound is a measure of bone breakability. There are few reports on bone mineral content in large for gestational age infants; most of them in infants of diabetic mothers. There are no data on bone speed of sound in large for gestational age infants of nondiabetic mothers. OBJECTIVE: To test the hypothesis that large for gestational age infants of nondiabetic mothers have lower bone speed of sound than appropriate for gestational age infants. DESIGN/METHODS: Bone speed of sound was measured within the first 96 hours of life at the right tibial midshaft in 25 singleton large for gestational age infants of non diabetic mothers and compared to appropriate for gestational age controls. RESULTS: Bone speed of sound measured in large for gestational age infants of nondiabetic mothers was lower than in controls. CONCLUSIONS: Large for gestational age infants of nondiabetic mothers have lower bone speed of sound than controls.

Birth Weight↗

PubMed2004

Gastric residual in growing preterm infants: effect of body position.

Studies of the effect of body position during and after bolus feeding upon gastric emptying or gastric residual have not had consistent results. We tested the hypotheses that right lateral decubitus leads to less gastric residual than left lateral decubitus and that the prone position leads to less gastric residual than the supine position. A prospective randomized clinical trial with triple crossover of healthy growing, appropriate for gestational age preterm infants. Each infant was successively studied while fed in the four different positions. Gastric residuals were measured at 1 and 3 hours after initiation of feeding and returned. Thirty-one patients were studied. At 1 hour, right lateral decubitus led to less significant residuals than the left lateral decubitus and the prone position led to less residual than the left lateral decubitus. The amount of gastric residuals 1 hour after a meal appears to be in the following decreasing order: left, supine, prone, right.

Cross-Over Studies↗

PubMed2004

Energy expenditure in infants weaned from a convective incubator.

Small preterm infants usually require a heated environment to survive. After weaning, some infants become hypothermic, and eventually require external thermal support for an additional period. We hypothesized that preterm infants respond to weaning from an incubator by increasing their resting metabolic rate. Thermally stable infants were studied when they had reached a weight of at least 1600 g. Resting energy expenditure was measured 2 hours before weaning and at 6, 23, 30, and 53 hours after weaning. Two-way analysis of variance for repeated measures was used for analysis. Sixteen infants with mean birthweight of 1270 +/- 375 g and gestational age 31 +/- 2.3 weeks were studied. After weaning, there was a significant increase in energy expenditure from 95.0 +/- 21.9 kcal/d in the incubator, to a 30-hours peak of 111.9 +/- 10.5 kcal/d after weaning. Weaning from a convective incubator results in an increase in metabolic rate in very low birth weight infants. We speculate that the infants' ability to increase metabolic rate might influence weaning success.

Analysis of Variance↗

PubMed2004

Indomethacin-induced early patent ductus arteriosus closure cannot be predicted by a decrease in pulse pressure.

Wide pulse pressure is considered to be a sign of patent ductus arteriosus (PDA). We tested the hypothesis that, following indomethacin therapy, PDA closure is associated with a significant decrease in pulse pressure. Thirty-two ventilated preterm infants were echocardiographically diagnosed within the first 24 hours of life with PDA. Systolic, diastolic, and mean arterial blood pressures were measured prior to indomethacin treatment and after echocardiographically confirmed PDA closure. Following PDA closure, systolic and diastolic blood pressures and mean arterial pressure increased significantly without a significant change of pulse pressure (17 +/- 7 to 20 +/- 12 torr). We conclude that in preterm infants with PDA, systolic, diastolic, and mean arterial blood pressures increase significantly within first few days of life. Pulse pressure does not appear to be affected by early PDA closure. We speculate that high pulmonary resistance in the first days of life prevents significant diastolic aortic runoff and leaves pulse pressure unaffected by PDA, as well as by its closure.

Blood Pressure↗

PubMed2004

Bone ultrasound velocity of appropriately grown for gestational age concordant twins.

In neonates, quantitative ultrasound has been shown to be predictive of bone breakability and an index of biophysical property of bone. There are no data on bone speed of sound (SOS) in appropriate for gestational age (AGA) twins. The purpose of this study was to test the hypothesis that AGA twins who had normal intrauterine growth have bone SOS similar to that of AGA singletons. We measured tibial midshaft bone SOS within the first 96 hours of life in 25 pairs of AGA twins, 27 to 40 weeks gestation, and compared them with our data of 73 singletons. There were no significant differences in bone SOS between twin and singleton infants in any of the parameters studied. We found no significant difference in bone SOS between twins of the same pair. AGA twins have bone SOS very similar to that of AGA singletons. We suggest that intrauterine weight sparing occurs also in terms of biophysical properties of bone.

Bone Development↗

PubMed2004

Neonatal nucleated red blood cells in discordant twins.

The objective of this study was to test the hypothesis that in discordant twins, the smaller infant has higher absolute nucleated red blood cell (RBC) count than the larger sibling. We compared absolute nucleated RBC counts, hematocrits, absolute leukocyte counts, absolute granulocyte counts, absolute lymphocyte counts, RBC counts and platelet counts obtained in the first 12 hours of life in 30 discordant twin sets. The smaller infant had a higher absolute nucleated red blood cell count and lower platelet counts than its larger sibling. Platelet counts correlated inversely with absolute nucleated RBC counts ( R(2) = 24.5%; p < 0.001) and absolute nucleated RBCs correlated directly with percent intertwin weight differences ( R(2) = 17.8%; p = 0.02). In discordant twins, the smaller infant has higher absolute nucleated RBC count and lower platelet counts than the larger sibling. We speculate that the hematologic alterations in the smaller fetus are linked to relative fetal hypoxia.

Birth Weight↗

PubMed2004

The effect of positioning on energy expenditure in preterm infants: a feasibility study.

The aim of this study was to determine the feasibility of a study of the effect of positioning on energy expenditure in preterm infants. We performed a prospective, randomized, clinical cross-over pilot study of eight healthy, appropriate weight for gestational age, gavage-fed, clinically stable preterm infants at the postmenstrual age of 30 weeks. Prior to the study and in accord with our feeding protocol, infants uniformly received either their own mother's milk or a preterm formula. Each infant was studied in four different positions after randomization to eight different sequences. Infants were studied asleep, 90 minutes after feeding, after 20 minutes of being nursed in a given position. They were cared for in a servo-controlled convective incubator during the metabolic measurements, which were performed by indirect calorimetry. Energy expenditure was not significantly affected by the body position in which the infant was studied. The difference between the highest and the lowest mean energy expenditure was 3.7% of the highest one. We conclude that attempts to minimize energy expenditure by modifying infant positioning are likely to be insignificant, from a practical standpoint, because of the nonsignificant or minimal differences in energy expenditure.

Calorimetry, Indirect↗

PubMed2004

Height-related changes in body mass index: a reappraisal.

OBJECTIVES: To study the relationship between body mass index (BMI) and height in 20-22 year-old patients. METHODS: A research questionnaire filled by a representative sample of military personnel upon discharge from service was analyzed. At the same time, weight and height were measured, and BMI was calculated (BMI = weight (Kg)/height(2)(m(2))). RESULTS: There were 35,951 participants in the study, including 16204 females and 19747 males. There was a positive correlation between BMI and height in men (regression slope = 0.00717, r = 0.015, p = 0.03), while the correlation was negative in women (regression slope = -0.02811, r = -0.05, p < 0.0001). In multiple regression analysis, when BMI was used as the dependent variable and height, gender, ethnic origin, smoking, oral contraceptive use, and level of recreational exercise as the independent variables, only height, gender, and ethnic origin remained significant in the final analysis (R-square 0.0205, p < 0.0001). CONCLUSION: In young adults, BMI is affected in a subtle, but opposite manner in males and females. In males, BMI increases with increasing height, while in females, BMI decreases with increasing height.

Adult↗

PubMed2004

Quality assessment program in primary care clinics: a tool for quality improvement.

BACKGROUND: Assessment of quality of health care is a major ongoing project of the Israeli Defense Forces (IDF) medical corps. OBJECTIVE: (i) To describe mechanisms of quality assessment (QA) in IDF primary care clinics; (ii) to compare quality of care in different types of primary care clinics; and (iii) to test the hypothesis that implementation of the QA program results in improved quality of care. RESEARCH DESIGN: A prospective, single-blinded, uncontrolled, non-randomized study. MEASURES: Teams of two physicians carry out the QA process once or twice a year according to clinic size. Five areas were evaluated: (i) physician-patient interaction; (ii) medical chart evaluation; (iii) high-risk patients management; (iv) medical care provided by specialists; and (v) medical staff guidance. Clinics were classified in two groups: single-physician clinics (battalion troop clinics) and multi-physician clinics (home-front base clinics). General Linear Models were used for analysis. A P-value <0.05 was considered significant. RESULTS: In 2000 and 2001, 99 primary clinics and 162 primary care physicians were assessed. Seventy-four (45%) physicians were evaluated twice. Single-physician clinics scored higher than multi-physician clinics on most QA parameters. Physicians had significantly better QA results at the second encounter, regardless of the type of clinic. CONCLUSIONS: A primary care medicine QA system is feasible in the IDF. It allows for standardized, reliable, and comprehensive assessment of primary care across the military clinics. We postulate that the increase in QA assessment scores from one examination to the next one indicates an improvement in quality due to the QA program.

Ambulatory Care Facilities↗

PubMed2004

Army personnel satisfaction in different settings of primary health care clinics.

PURPOSE: To analyze patient satisfaction in Israeli Defense Forces primary care clinics (PCCs), and to compare different satisfaction indices that best correlate with general satisfaction index. METHODS: Large-scale patient satisfaction survey throughout all PCCs, classified as active front clinics, training schools clinics, and home front clinics. RESULTS: Participants (5,103) filled out standardized questionnaires. Patients in active front clinics were more satisfied with their PCCs than in the other two settings. Patients showed the highest satisfaction level in the environment questions and the lowest satisfaction level in the accessibility questions. In training school clinics and home front clinics, accessibility questions were most important, whereas in active front clinics, health outcome questions prevailed. CONCLUSIONS: Overall patient satisfaction is the highest in active front clinics, lower in training school clinics, and lowest in home front clinics. Accessibility is the most important factor in patient satisfaction in training school and home front units, and is less important in active front units.

Ambulatory Care Facilities↗

PubMed2004

Increased serum potassium and intraventricular hemorrhage revisited.

BACKGROUND: Increased serum potassium and intraventricular hemorrhage occur frequently in preterm infants. OBJECTIVE: To retrospectively analyze data obtained on infants with severe IVH in relation to blood K+ concentrations. METHODS: We identified all patients with severe IVH bom between July 1997 and July 2000. Each patient was pair-matched with a control infant of the same gestational age (+/- 1 week) without IVH in terms of head ultrasound findings on day 5 and whole blood K+ on days 3-5. RESULTS: There were 24 infants in each group. The IVH group had significantly lower 1 minute Apgar scores and pH and higher blood K+ than the control group. Blood pH and K+ were inversely correlated. Stepwise regression analysis, taking into account blood pH and 1 minute Apgar score, showed a correlation only between blood K+ and IVH status. CONCLUSIONS: Severe IVH is significantly associated with higher blood K+ concentrations. A causal relationship cannot be ascertained at this point.

Cerebral Hemorrhage↗

PubMed2004

Effect of bicarbonate on neonatal serum ionized magnesium in vitro.

Sodium bicarbonate is used to treat metabolic acidosis, or to induce metabolic alkalosis in sick neonates. The aim of this study was to quantify the decrease in serum concentration of ionized magnesium ([Mg2+]) when sodium bicarbonate is added to neonatal serum in vitro. Sodium bicarbonate was added to 30 cord serum samples of term infants to reach incremental concentrations of 0 to 2.0 mEq/L and [Mg2+] was measured. Serum [Mg2+] decreased significantly with the addition of sodium bicarbonate. At incremental sodium bicarbonate concentrations of 1.0 to 2.0 mEq/L, which is within the range of the desired aim in the treatment of metabolic acidosis, the magnitude of the decrease in serum [Mg2+] was approximately 0.084 to 0.158 mmol/L (18% to 34%) from the average baseline value. The addition of sodium bicarbonate causes a significant decrease in [Mg2+]. From this in vitro study we speculate that fast infusion of sodium bicarbonate in human neonates may potentially cause a clinically significant decrease in serum [Mg2+].

Bicarbonates↗

PubMed2004

Oral contraceptive use and smoking habits in young Israeli women: a cross-sectional study.

BACKGROUND: Oral contraceptive users are at increased risk for both arterial and venous thrombosis, some of which can be fatal. Studies are consistent with the existence of a synergism between cigarette smoking and OC use in the pathogenesis of myocardial infarction in young women. OBJECTIVES: To study the relationship between OC use, cigarette smoking and other cardiovascular risk factors among young women. METHODS: A systematic sample of military personnel, upon discharge from service in the Israel Defense Forces, was asked to complete a research questionnaire. Body weight and height were measured and body mass index computed. RESULTS: Overall, 16,258 questionnaires were collected and analyzed during this 20 year study. There was a gradual, significant increase in OC use until the mid-1980s, from approximately 45% to 60% (P < 0.001), followed by steady rates of 58-64% since then. In contrast, the rates of smoking decreased significantly in the mid-1980s, from approximately 42% to a nadir of 22% in 1991. Since then, the rate of smoking has increased slowly but steadily to reach a level of 35% in 1999. The OC users were more often of western (Ashkenazi) origin and came from families with more education and fewer siblings. They were more often smokers than non-OC users, and started smoking at a younger age. They had significantly lower BMI than non-users. OC use was nearly identical in groups with or without multiple cardiovascular risk factors (smoking, obesity, family history). CONCLUSIONS: Smoking and OC use are strongly associated. Other cardiovascular risk factors (smoking, obesity, family history) do not prevent OC users from smoking or smokers to use OC. We suggest that primary care physicians discourage smoking among adolescent females who wish to start using OC. A thorough medical history should be obtained in order to recognize all risk factors for cardiovascular disease and to provide for appropriate contraception counseling.

Adult↗

PubMed2003

Evaluation of a new thermometer for rapid axillary temperature measurement in preterm infants.

Mercury-in-glass thermometers are considered the "gold-standard" for temperature measurements, but require at least 4 minutes for accuracy. Electronic thermometers sample temperature measurements over a shorter period. The objective of this study was to evaluate the accuracy and reproducibility of the Penguin (Medisim, Jerusalem, Israel) and the IVAC (San Diego, CA) Temp plus II thermometers in preterm infants. Axillary temperature was obtained in 50 thermally stable preterm infants each time with the mercury-in-glass, the IVAC, and the Penguin thermometers. Analysis of variance F-test, and linear regression analyses were used to test correlation of each electronic thermometer with the mercury-in-glass one, and the effect of body weight. Temperature measurement taken with the Penguin thermometer was significantly higher than that measured with the two other ones, p < 0.001. The differences in means and in variances were not significantly different between IVAC and mercury-in-glass, while the variance of the Penguin measurement was higher than that of the two other instruments (p < 0.001). The IVAC instrument correlated more tightly with the mercury-in-glass (r = 0.89, p < 0.001) than did the Penguin (r = 0.54, p < 0.001). There was an inverse correlation between the deviation of the Penguin measurement from the mercury-in-glass and the weight of the patient ( p < 0.08), while no significant correlation was found between the deviation of the IVAC measurement from the mercury in glass and the patient's weight (p = 0.56). Measurements of axillary temperature using the Penguin thermometer in incubated preterm infants are less accurate and less reproducible than those obtained using the IVAC or the glass thermometers.

Axilla↗

PubMed2003

Labor does not affect the neonatal absolute nucleated red blood cell count.

We investigated whether the presence or absence of physiologic labor may affect the neonatal nucleated red blood cell (RBC) count. We compared absolute nucleated RBC counts taken at approximately 6 hours of life in term infants born by elective cesarean delivery without trial of labor ( n = 32) and in vaginally delivered infants ( n = 28). Venous blood samples were analyzed and differential cell counts were performed manually; absolute nucleated RBC were counted and expressed as an absolute number. There were no significant differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. There was a significantly higher hematocrit and RBC count in the vaginally delivered group as compared with the cesarean group. The absolute nucleated RBC, corrected leukocyte and lymphocyte, and platelet counts were strikingly similar in both groups. We conclude that labor does not affect the neonatal nucleated RBC count. This finding supports the speculation that physiologic labor does not induce a fetal hypoxemia severe or prolonged enough to produce hematological evidence of increased erythropoiesis.

Adult↗