Biomedical subjects
Publications and source records attributed to I Elian.
Administration of ceftriaxone for 5 days has been shown to be highly efficient in the treatment of severe shigellosis in children. Our study, involving 40 children, demonstrated that a 2-day course of ceftriaxone was as beneficial as a 5-day course and constituted effective therapy for children with severe shigellosis.
In a prospective randomized open study, ceftriaxone, 50 mg/kg per day, was compared with ampicillin, 100 mg/kg per day, both given for a period of 5 days, for the treatment of 40 children whose mean (+/- SD) age was 4.5 +/- 3.2 years and who had severe dysentery caused by Shigella organisms. Twenty patients were treated with ceftriaxone and 20 with ampicillin. Both drugs were initially given intravenously for a period of 1 to 2 days and were continued intramuscularly, in the case of ceftriaxone, or orally, in the patients receiving ampicillin. All Shigella organisms isolated were susceptible to ceftriaxone; 28% were resistant to ampicillin. The diarrhea persisted for a mean (+/- SD) period of 2.5 +/- 1.0 days in the ceftriaxone-treated patients versus 6.8 +/- 6.3 days in the ampicillin-treated patients (p less than 0.005). At the end of the 5 days of therapy, stool cultures for Shigella organisms were negative in 12 (60%) of the 20 patients from the ampicillin group and in all the children (100%) from the ceftriaxone group (p less than 0.001). Bacteriologic relapses were observed in eight (40%) of the patients treated with ampicillin but in none of the children treated with ceftriaxone (p less than 0.001). In instances of clinical or bacteriologic failure in the ampicillin group, retreatment was instituted in most of the cases with ceftriaxone; persistent clearing of the Shigella organisms from the stool was finally achieved after a mean (+/- SD) period of 11.75 +/- 9.4 days after therapy was started, as compared with 1.85 +/- 0.6 days in the ceftriaxone-treated patients (p less than 0.001). We conclude that in children with severe shigellosis, treatment with ceftriaxone for 5 days is effective and better than use of ampicillin for clinical cure and eradication of the Shigella organisms from the stool.
Staphylococcus epidermidis (SE) is the leading pathogen of prosthetic valve endocarditis. At the same time it is a very rare cause of native valve endocarditis and it follows a clinical course and outcome similar to Streptococcal viridans endocarditis. We report here the case of a 41-year-old man with a community acquired SE endocarditis of a native aortic valve. Despite early surgical intervention, the case followed an acute and fatal course.
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Vaginal and cervical cultures were obtained in 20 women undergoing intra-amniotic saline infusion and 20 women having extraamniotic saline infusion for second-trimester abortion. Following expulsion intrauterine cultures were taken and the patients were followed for signs of clinical infection. Sixty percent of the patients had pathogenic bacteria cultured intrauterine cultures after abortion and 7.5% had clinical infection. There was a positive correlation between infection-abortion time and pathogenic intrauterine cultures. No significant differences in the incidence of positive intrauterine cultures or clinical infection between the two groups were found. Of those patients with positive preabortion cultures 70% had identical pathogens cultured from the uterus after expulsion suggesting that most postabortal pathogens arise from endogenous vaginal and cervical sites rather than from exogenous sources.
The upper vaginal and cervical bacterial flora, especially the anaerobic one which has a particular role in postoperative morbidity, was studied in 78 menopausal women between 48 and 78 yr of age. The aim of the present study was to compare the results obtained with those reported for bacterial flora in women of other age groups. The patients were divided into the following 3 groups. (I) Twenty-eight healthy women with a natural menopause; (II) 30 women, 2-6 mth after surgical menopause due to panhysterectomy; and (III) 20 menopausal women 3 mth after vaginal hysterectomy. 30.7% of the cultures were found to be sterile. The anaerobic bacteria, developed only in the presence of aerobic germs, represented 11.5% of the total number of cultures and was found to be formed by Streptococcus bacteroides sp. and Bacteroides fragilis. The vaginal flora of menopausal women is not different from that found in children, young women, in pregnancy or postpartum. The anaerobic germs isolated in our study are normal inhabitants of the vagina and cervix which may occasionally become pathogens.
The transfer of cefazolin, an antibiotic compound of the cefalosporin group, through the placental barrier was investigated in the first trimester of pregnancy. All cases were chosen from among women admitted for therapeutic abortion. The test group comprised 70 women, while there were 30 in the control group. The bacteriostatic activity was examined in the amniotic fluid, obtained by the vaginal route as well as the maternal blood, following the i.m. injection of 500 mg cefazolin. Our results indicate that the antibiotic cefazolin crosses the placental barrier, even during the first trimester of pregnancy. However, the concentrations obtained were considerably lower than those observed in the 2nd and 3rd trimesters.
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A study was made of the cervical and upper vaginal flora in menopausal women, in an attempt to determine whether such women are predisposed to infections when undergoing gynecologic operations. The series comprised 72 women (age range, 44-80 years) classified as follows: a) 35 with a natural menopause, b) 18 with a surgical menopause induced by abdominal panhysterectomy, and c) 19 postmenopausal women after vaginal hysterectomy performed for genital prolapse. The vaginal flora of these menopausal women consisted predominantly of Gram-positive bacteria which, together with the Gram-negative bacteria, conformed to the normal pattern of microorganisms in the vagina. Such bacteria also are found in women of child-bearing age, but occasionally they can be pathogenic. Despite the inherent biohormonal changes of the memopause, expressed especially by the low estrogen level, 26.4 percent of the cultures in our study were sterile, even after major vaginal operations. Thus, the pattern of the vaginal flora, even though occasionally pathogen, should not be a contraindication to gynecologic surgical procedures in postmenopausal women. Even when vaginal cultures show the presence of these bacteria, it does not seem necessary to use prophylactic antibiotic and hormonal therapy routinely. Rather, it should be given selectively, depending upon the local state of the tissues and upon the postoperative course.
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A family with allergic manifestations, haemostatic disturbances, total absence of haemolytic activity of the complement system and low IgG levels is described. It is suggested that this functional abnormality of the complement system and the decreased level of immunoglobulin G may be due to immune complex reactions.
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A 51-year-old woman presented with intermittent diarrhea and marked loss of weight. Stool examination and duodenal intubation both yielded coccidian oocytes of Isospora belli. The patient responded to treatment with Septrin (trimethoprim and sulfamethoxazole), 2 g daily for three weeks. This is the first reported case of severe human coccidiosis in Israel.
The phagocytotic activity of monocytes from diabetic patients and healthy controls was studied. It was found that the number of phagocytizing cells from diabetic patients was significantly reduced in comparison with that from control individuals. However, the number of bacteria phagocytized per cell was similar in both groups. Plasma from healthy controls added to diabetic monocytes did not cause any significant change in their phagocytotic capacity. Addition of insulin to the plasma of diabetic patients failed to alter the number of phagocytizing diabetic monocytes. Similarly, addition of glucose to control plasma did not affect the number of control monocytes capable of phagocytosis. Protein synthesis was increased during phagocytosis in both control and diabetic cells. The importance of monocytes in the defense mechanism of the organism is discussed.