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Biomedical subjects

L Levi

Publications and source records attributed to L Levi.

At least 19 recordsLinked to original sources
PubMed2005

Increased risk of bloodstream and urinary infections in intensive care unit (ICU) patients compared with patients fitting ICU admission criteria treated in regular wards.

Critically ill patients, eligible for admission into intensive care units (ICUs), are often hospitalized in other wards due to a lack of ICU beds. Differences in morbidity between patients managed in ICUs and elsewhere are unknown, specifically the morbidity related to hospital-acquired infection. Patients fitting ICU admission criteria were identified by screening five entire hospitals on four separate days. Hospital infections within a 30-day follow-up period were compared in ICU patients and in patients on other wards using Kaplan-Meier curves. Residual differences in the patients' case mix between ICUs and other wards were adjusted for utilizing multivariate Cox models. Of 13415 patients screened, 668 were critically ill. The overall infection rates (per 100 patient-days) were 1.2 for bloodstream infection (BSI) and 1.9 for urinary tract infection (UTI). The adjusted hazard ratios in ICU patients compared with patients on regular wards were 3.1 (P<0.001) for BSI and 2.5 (P<0.001) for UTI. This increased risk persisted even after adjusting for the disparity in the number of cultures sent from ICUs compared with ordinary wards. No interdepartmental differences were found in the rates of pneumonia, surgical wound infections and other infections. Minimizing the differences between characteristics of patients hospitalized in ICUs and in other wards, and controlling for the higher frequency of cultures sent from ICUs did not eliminate the increased risk of BSI and UTI associated with admission into ICUs.

Aged↗
PubMed2000

[Prioritizing suspected diagnosis of both brain and abdominal injuries--is it a problem?].

Current guidelines for management of suspected head and abdominal injuries are based on retrospective studies like that of Wisner & al, Following a recent review in this journal by Y. Kluger & al, which was based on non-Israeli data, we decided to define the current status at our trauma center. We compare our data of 18 months of hospital admissions for acute trauma in which head CTs were done with those of 5 articles advocating specific protocols for decisions in pre-laparotomy diagnosis. In the 861 cumulated cases, compared with the 800 of Wisner & al, craniotomy was required in 15% vs 7% (p < 0.05); laparotomy was much less frequent, 2.7% vs 12.9% (p < 0.05). The chance of finding a case requiring both craniotomy and laparotomy was 1 in 300. As the clinical condition of multiple trauma involving the head and abdomen is becoming less frequent and includes diverse situations, a comprehensive algorithm might be inaccurate. Good clinical judgment of the clinician and teamwork are therefore preferable.

Abdominal Injuries↗
PubMed2000

Systemic toxicity of topical and periocular corticosteroid therapy in an 11-year-old male with posterior uveitis.

PURPOSE: To report a case of systemic corticosteroid toxicity resulting from topical and periocular therapy. METHODS: Treatment and follow-up of an 11-year-old male with uveitis are illustrated. Initial presentation of the patient was bilateral iridocyclitis, for which he was treated with prednisolone acetate 1% every 2 hours for 6 months. Subsequently, posterior uveitis developed, necessitating posterior subtenon injections. RESULTS: After initial topical corticosteroid therapy, the patient developed a cushingoid habitus accompanied by increased lanugo hair, acanthosis nigricans, posterior subcapsular lens opacities, and increased intraocular pressure. Cushingoid stigmata worsened after administration of posterior subtenon injection of corticosteroids. The patient's truncal obesity worsened, and his linear growth stopped. CONCLUSIONS: Systemic toxic effects may develop as a result of topical and local use of ophthalmic corticosteroid preparations in susceptible patients.

Acanthosis Nigricans↗
PubMed2000

Optic disk edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection.

PURPOSE: To describe optic disk edema associated with peripapillary serous retinal detachment as an early sign of systemic Bartonella henselae infection. METHODS: Multicentered, retrospective case series. RESULTS: Five women and two men presented with optic disk edema producing peripapillary serous retinal detachment. Each patient had a markedly elevated serum anti-B. henselae antibody titer. Patient age ranged from 11 to 44 years, with a mean and median of 26.6 and 28 years, respectively. The time from the onset of systemic symptoms to the onset of visual symptoms varied from 3 days to 1 month. The peripapillary serous retinal detachment resolved within 1 to 3 weeks in each case, producing a macular star in four of seven patients. Initial vision was 20/200 or worse in five of seven patients and improved in four of these five patients to 20/30 or better. CONCLUSIONS: Systemic B. henselae infection should be considered in patients who develop optic disk edema associated with a peripapillary serous retinal detachment, even in the absence of classic neuroretinitis with a macular star.

Adolescent↗
PubMed1998

[Use of Intranet in the hospital setting].

In the Intranet system, the organization uses technologies developed and applied in the Internet network world-wide. Hospitals can use Internet technologies to make hospital information systems more efficient by improving use of existing systems and by adding additional possibilities. Furthermore, the hospital can improve its relations with its customers and also bring the organization additional customers. Intranet implementation can be divided into the areas of: communication, managing and distributing information, and application linkage. Implementation must be modular, gradual and planned according to economic, technological and organizational aspects of the hospitals. By the Intranet, organizations can achieve benefits that include: improving communication array, availability of data and information, using existing information systems and their applications, enhancing customer satisfaction and saving costs of manual application systems.

Hospital Information Systems↗
PubMed1998

Unusual ocular motility disturbances with increased intracranial pressure.

We evaluated nine patients with external ophthalmoparesis and increased intracranial pressure. The eye movements normalized when the intracranial pressure was controlled. Investigations for an underlying cause of elevated cerebrospinal fluid pressure are warranted when ocular motility disorders are present.

Adolescent↗
PubMed1997

Cloning and characterization of BS-cadherin, a novel cadherin from the colonial urochordate Botryllus schlosseri.

The genomic DNA for a novel member of the cadherin family (BS-cadherin) was cloned and characterized from the colonial marine invertebrate, Botryllus schlosseri. Using a differential display of mRNA by means of PCR, a small cDNA fragment of 380 nucleotides was found to be specifically expressed in a colony undergoing allogeneic rejection processes, as compared with naive parts of the same genotype. This cDNA fragment was used as a probe to screen a genomic library of Botryllus schlosseri. A genomic fragment containing an ORF of 2718 nucleotides, with no introns, was isolated. The encoded protein exhibits a typical structure of cadherins; an extracellular domain with conserved repeated sequences (cadherin signatures), a single transmembrane domain and a conserved cytoplasmic tail region. The BS-cadherin amino-acid sequence shows 32-35% identity to mature classical cadherins type I, e.g., N-, P- and E-cadherin as well as mature classical cadherins type II, e.g., human cadherin-6, -8 and OB-cadherin. This cadherin represents a new cadherin gene family, evolutionarily distant to all other known classical cadherins.

Amino Acid Sequence↗
PubMed1997

Severe vision loss and neovascular glaucoma complicating superior ophthalmic vein approach to carotid-cavernous sinus fistula.

PURPOSE: To report a patient with unilateral vision loss and neovascular glaucoma after attempted superior ophthalmic vein embolization in the treatment of a carotid-cavernous sinus fistula. METHODS: A 69-year-old man with a history of a left dural carotid-cavernous sinus fistula underwent attempted treatment with superior ophthalmic vein embolization. The procedure was unsuccessful, and the left superior ophthalmic vein was ligated. RESULTS: Uncontrolled left proptosis and intraocular pressure necessitated urgent orbital decompression with severe vision loss and neovascular glaucoma. CONCLUSION: Superior ophthalmic vein embolization in the management of carotid-cavernous fistula may be associated with vision-threatening complications.

Aged↗
PubMed1997

Videotaping in the admitting area: a most useful tool for quality improvement of the trauma care.

The treatment of trauma patients in the admitting area is performed under stress and requires team work. The goals of this research were to develop and analyse the implementation process of videotaping trauma care. The Rambam Medical Center is a 900-bed referral teaching hospital. It serves a population of more than 1.5 million in northern Israel. The trauma unit has focused on various activities to increase the quality of trauma care over the past few years. We installed a video camera and taped the treatment as part of a programme for the quality improvement of trauma care. Reviewing the tapes was carried out by the trauma team under guidance in order to identify deviation from treatment protocols, errors in techniques, improper usage of time, equipment failure and problems in team work. After 3 years' experience, we found that videotaping is an accurate and inexpensive way of achieving quality control in the admitting area. It now serves as a regular method in Israeli trauma centres and we encourage others to try this method.

Adult↗
PubMed1997

A biopsychosocial approach to etiology and pathogenesis.

The interactive etiological and pathogenic processes between physical and psychosocial environ-mental stimuli, the individual's appraisal of these influences, and his or her reactions to them in terms of emotion, cognition, behaviour, and physiology; the modification of these reactions through coping, social support, and other interacting variables; and the resulting changes in health and well-being--are extremely complex and poorly understood. Against this background, this paper argues for a biopsychosocial approach, based on an ecological model influenced by, and influencing, James P. Henry's related approaches. This approach is exemplified in six studies carried out by our group and briefly reviewed in this paper.

Animals↗
PubMed1997

Psychosocial environmental factors and psychosocially mediated effects of physical environmental factors.

The great difficulty with psychosocial environmental factors and psychosocially mediated effects of physical environmental factors is their great complexity. They finally produce stimuli that act on an organism. The organism is characterized by psychobiological programming determined by genetic factors and by earlier environmental influences. The interaction between these factors causes the organism to react. In some cases the reaction manifests itself as a disease, in some as a psychosomatic symptom. The task is to identify critically important system components that are necessary or sufficient or contributory in causing disease or accelerating its course or triggering its symptoms. It is not just causation in the strict sense of the word; a broader concept is needed to identify these components so that something can be done about them.

Adaptation, Psychological↗
PubMed1996

Optic neuropathy preceding acute retinal necrosis in acquired immunodeficiency syndrome.

OBJECTIVE: To describe the clinical course of varicella-zoster optic neuropathy preceding acute retinal necrosis in patients with acquired immunodeficiency syndrome. DESIGN: Case series. SETTING: Two tertiary care centers in San Diego, Calif, and London, England. PATIENTS: Three human immunodeficiency virus-positive men with previous cutaneous zoster infection, optic neuropathy, and necrotizing retinitis. RESULTS: All patients had an episode of zoster dermatitis treated with acyclovir. Visual loss consistent with an optic neuropathy ensued, followed by typical herpetic retinitis. The cause of visual loss was not suspected to be varicella-zoster until after the retinitis occurred. Despite aggressive medical treatment, 4 of 6 eyes progressed to retinal detachment. CONCLUSIONS: Varicella-zoster may cause an optic neuropathy in patients with acquired immunodeficiency syndrome, especially in those with previous shingles. A high index of suspicion is necessary to establish the diagnosis and begin early antizoster treatment.

AIDS-Related Opportunistic Infections↗
PubMed1996

Health and unemployment.

This paper reviews the relationship between health and inadequate employment, especially unemployment. Poor physical or mental health can lead, via poor work performance, to job loss; however, studies that control for such selection effects are still scarce except for a few health outcomes. For example, aggregate-level studies typically find a positive association between unemployment and suicide rates over time. At the individual level of analysis, panel surveys of laid-off workers tend to find increased psychiatric problems such as depression and substance abuse. Few studies have evaluated interventions to prevent or reduce the adverse health effects of job loss. There have been even fewer studies of the health effects of other types of inadequate employment such as the increasingly prevalent forms of underemployment.

Adaptation, Psychological↗
PubMed1995

Effects of stimulus velocity and acceleration on smooth pursuit in motor neuron disease.

Sinusoidal smooth pursuit eye movements were evaluated in 11 normals, five moderately and four severely affected motor neuron disease (MND) patients, using two target amplitudes and a range of frequencies. This enabled us to examine separately the effects of peak target velocity and acceleration on pursuit gain. Moderately affected patients showed an acceleration, but not a velocity saturation; severely impaired patients' performance declined with increased velocity. Smooth pursuit eye movements are thus impaired in MND, but the nature of this pursuit deficit is complex and changes with the progression of the disease.

Aged↗