Significance of antibodies to cytoplasmic components of neutrophils.
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Biomedical subjects
Publications and source records attributed to M Isacsohn.
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A study in 1984 of the colonization rates of Group B beta hemolytic streptococci (GBS) in 257 Jewish and 189 Arab parturient women revealed rates of 5.4 and 1.6% respectively. In 1987, a study of 116 Jewish women noted a rte of 3.5%. GBS colonization rates in the newborns of the three groups were 1.8, 1.3 and 1.1% respectively. No statistically significant differences were noted between any of the maternal or neonatal groups. A review of the period 1982-87 revealed a GBS neonatal sepsis attack rate of 0.2/1,000 live births. These data confirm the persistent low incidence of GBS colonization and disease in the Jerusalem area.
Antral biopsy samples were taken from 147 patients undergoing gastroscopy. Campylobacter pylori was cultivated from 100 of these patients. C. pylori was isolated from 76% of the specimens showing any degree of histologic gastritis, but from only 11% of specimens with completely normal histology. A questionnaire was completed on all patients and included demographic, epidemiologic and clinical information. Sephardic origin, smoking, and a bad taste in the mouth were more prevalent in the campylobacter-positive group. Previous use of antibiotics was negatively associated with the presence of C. pylori. Histologically confirmed gastritis was highly associated with the presence of C. pylori, especially in the moderate or severe grades in which 84% of biopsy specimens were positive. C. pylori was also cultivated from 50% of patients with mild gastritis, in 88% of patients with duodenal ulcer and in 71% of patients with gastric ulcer. The presence of C. pylori in 11% of normal specimens and the absence of C. pylori in 24% of specimens with gastritis further raises the question of the exact role played by C. pylori in the etiology of gastritis.
Twenty-one children and adolescent patients, 2-19 years of age, on renal replacement therapy were immunised at monthly intervals with three doses of 20 micrograms hepatitis B vaccine (Heptavax B, Merck Sharp & Dohme). In the absence of seroconversion, vaccination was continued with monthly doses of 40 micrograms hepatitis B vaccine until antibody to hepatitis B surface antigen became positive. The rate of seroconversion increased from 33.3% (7 of 21) to 76.1% (16 of 21) and 85.6% (18 of 21) with three, four and five vaccine injections respectively. Three patients had no immune response despite six to seven vaccine dosages; they had previously received immunosuppressive therapy. Antibody titres measured 1 year after seroconversion were found to be within the protective range (85-2500 mIU/ml). These results show that the impaired immune response to hepatitis B vaccination in young dialysis patients can be overcome by increasing the number of injections and the dose of the vaccine. Protective antibody titres are maintained for at least 1 year after vaccination. Immunosuppressive therapy may interfere with the vaccine response.
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A baby girl, with a birth weight of 2540 g, developed myocarditis with gross, permanent myocardial calcification. The clinical course was progressively downhill, and she died at 14 months of age. Neutralisation antibody to Coxsackie virus group B1 rose from 1:80 after delivery to 1:1280 at age 5 months. The protracted course of this infant's disease represents a new clinical form of fatal neonatal Coxsackie virus group B infection.
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Escherichia coli strains grown on lincomycin-supplemented Mundell agar and on blood agar were compared for their ability to produce heat-labile enterotoxin, as detected by a commercial coagglutination kit. The special agar allowed more strains to be detected, and the results were much more clear-cut.
We evaluated 104 cases of pneumococcal bacteremia retrospectively: 55 adults and 49 children. The overall mortality rate was 33% in adults, and 6% in children. Mortality was associated with old age, severe underlying disease, vague clinical presentation, multilobar pneumonia, leukopenia and metabolic acidosis. Both vigorous treatment with mechanical ventilation devices, vasopressors and steroids, and sophisticated monitoring in the Intensive Care Unit did not improve survival. In six cases (5.8%) the pneumococcus was resistant to penicillin G. In reviewing the literature of the last 30 years, no change in mortality rate was noted. Vaccination of population at risk is highly recommended.
Within a 2 month period 131 Ethiopian immigrants were admitted for treatment at a general hospital in Jerusalem. There were 52 patients with malaria, 13 with typhoid fever, 24 with pneumonia, seven with tuberculosis, nine with shigella and 11 with campylobacter. Over three-quarters of these patients were anaemic. In the majority of cases anaemia was normocytic and was most probably secondary to malaria and other intercurrent infections. The prevalence of diffuse non-toxic goitre was 7% in children and 19% in adults with a male to female ratio of 4:13. A positive rapid plasma reagin (RPR) test was found in 4% of sera tested and a positive HBsAg in 13%. IgG antibodies to HBc antigen were found in 75% of subjects. All patients with infectious diseases responded to therapy and, despite their poor condition at arrival, there were no fatalities and no late sequelae. The high HBsAg carrier state calls attention to the risk of vertical transmission by infected mothers and underlines the need for active immunization of infants at risk. The high prevalence of untreated tuberculosis and malaria poses a potential public health hazard, but with the current systematic screening of this population leading to identification and effective treatment of affected subjects, chances for the practical eradication of malaria and tuberculosis are excellent. Finally, the large scale transfer of a population from rural Africa to a modern and largely urban society presents a unique opportunity for a prospective study of the impact of environment on the emergence of diseases which plague modern society such as diabetes, atherosclerotic cardiovascular disease, hypertension and cancer.
Botulism intoxication is described in a 45-year-old woman who was hospitalized with symptoms suggesting an intestinal obstruction. At intervention a 20-cm length of necrotic small intestine was excised and prophylactic antibiotics were given. Five days after surgery--during which time the patient was fed only parenterally--dryness of the mouth, difficulty in swallowing, general weakness, and difficulty with speech and in keeping her eyes open were noted. The patient was alert and well oriented. The clinical symptoms and the electrophysiological studies suggested the diagnosis of botulism. A serum sample caused death in mice upon inoculation and two samples of feces were positive for the presence of Clostridium botulinum organisms. Supportive treatment with botulinum antitoxin was given and the patient was discharged in good condition.
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We studied the epidemiology of cytomegalovirus (CMV) infection in women and neonates in the Jerusalem area. During the 6-month period from January to June 1982, we recorded the presence of antibody to CMV in pregnant and parturient Jewish and Arab women from West and East Jerusalem, respectively, in 18- to 22-year-old female students at a religious college, in female university students, in 18- to 22-year-old student nurses, and in the nursing staff of the Neonatal Intensive Care Unit in our hospital. In the 18- to 22-year-old age-group, the religious college students not working in a medical setting had the lowest rate of seropositivity. No difference in the rate of CMV infection was found between Jewish and Arab parturient women. In five cases of congenital CMV infection, representing different clinical aspects of the disease, a comparative study of diagnostic procedures for congenital CMV infection was performed.
The therapeutic effect of human fibroblast interferon (HFIF) was studied in 33 patients. Seven had ophthalmic lesions (three due to adenovirus Type 8, four to herpes simplex virus, and one to herpes zoster) and were treated with HFIF. In the four patients with herpes simplex keratitis, HFIF was given in addition to standard therapy or together with other antiviral agents. Ten other patients, 8 with herpes simplex or herpes zoster skin or mucous membrane lesions, were treated with HFIF. HFIF was incorporated into an ointment as well as into a solution for subconjunctival infections. Although the number of cases was small, our results showed that HFIF was effective in shortening the course of the disease.
A retrospective study on the incidence of congenital rubella (CR) in the past 10 years in the Jerusalem area was conducted. After the 1972 epidemic, which resulted in 48 cases of congenital rubella, few sporadic cases of CR appeared each year, and in the 1978-79 period the number of CR cases was relatively small. Immunity to rubella in different categories of population (children 3 months to 18 years, college students, nurses in pediatric, newborn and intensive care units, student nurses, and women of childbearing age) was determined by hemolysis in gel (HIG) and hemagglutination inhibition (HI) methods. Susceptibility was defined as an absence of antibody at a dilution of 1:16 in HI, and hemolysis of less than 7 mm in the HIG test. Compared with previous studies on the incidence of antibodies to rubella in women of childbearing age, a mild decrease in the percentage of sero-negative women was found.
Forty-eight children born with clinical and serologic manifestations of congenital rubella were followed for a three-year period. Expanded rubella syndrome, multiple anomalies and single defects were found, mostly in the child's first year of life. Some new organic problems were found at a later age in children who had initially been healthy but who had been followed up because of their high antibody levels to rubella. Of the 48 children, 15 (31%) were born to mothers who had had clinically and serologically diagnosed rubella during pregnancy. In 33 children (69%) the mother had had asymptomatic rubella. These findings emphasize the need to identify and immunize seronegative women before pregnancy.