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Michael Huerta

Publications and source records attributed to Michael Huerta.

36 records · Page 2Linked to original sources
PubMed2005

[Antiviral prophylaxis following possible sexual exposure to HIV].

In Israel, as in certain European countries, national health guidelines exist for preventive treatment after possible post-coital exposure to the HIV virus. Scientifically, this treatment is still regarded as experimental, though over the past years there is a mounting level of evidence of its efficacy. The administration of prophylaxis for HIV after unprotected coitus may be justified by the similar risk of HIV transmission for certain sexual and occupational exposures. Other considerations include: biological plausibility, the effectiveness of post-exposure prophylaxis in animal studies and occupational exposures in humans, efficacy in the prevention of vertical HIV transmission, and cost effectiveness studies. The preventive post-exposure treatment bears many side effects and possible complications, and therefore, each case should be cautiously analyzed before starting such treatment. This article reviews the scientific evidence on this topic, the considerations taken by the physician in initiating post coital HIV exposure treatment, and the guidelines available in Israel and throughout the world.

Acquired Immunodeficiency Syndrome↗
PubMed2005

[Education level and origin as predictors of hospitalization among Jewish adults in Israel: a population-based study].

BACKGROUND: Age, sex, origin and level of education are recognized as predictors of healthcare utilization. However, the joint effects of these variables on the risk of hospitalization have yet to be described for specific diagnostic categories, such as diseases of the circulatory, respiratory, genitourinary, digestive and nervous systems, infectious and parasitic diseases, malignant neoplasms, injury and poisoning. OBJECTIVES: To evaluate the association between origin, education, sex, age and the risk of hospitalization due to major diagnostic categories. METHODS: Cross-sectional study linking population-based databases, including Israeli census and hospitalization records. RESULTS: The study encompassed 35,413 hospitalized subjects and 386,317 non-hospitalized subjects. Origin other than Israel was a risk factor for hospitalization, with an odds ratio of 1.31 (95% CI 1.25-1.36) for Asia, 1.43 (1.37-1.50) for Africa, and 1.24 (1.20-1.29) for Europe-America (P for all origins <0.0001). Compared to subjects with post-high school educations, those with high school educations were 1.18 times more likely to be hospitalized (1.14-1.21), while those with elementary school educations experienced a risk of 1.32 (1.28-1.37) (P < 0.0001). Origin was a marked risk factor for hospitalization due to malignancy, with an odds ratio of 2.19 (1.71-2.79) for European-American origin relative to Israeli origin (P < 0.0001). The inverse association between education level and risk of hospitalization was constant across all diagnostic categories other than malignancy. CONCLUSIONS: Lower education was found to be a significant risk factor for hospitalization in most diagnostic categories. Origin was associated with increased risk for hospitalization due to malignant neoplasms and diseases of the respiratory, nervous, genitourinary and circulatory systems.

Americas↗
PubMed2004

Successful steroid withdrawal in lung transplant recipients: result of a pilot study.

OBJECTIVE: Corticosteroids play a key role in immunosuppression after transplantation. However, because chronic steroid treatment may cause significant morbidity and mortality, steroid-free immunosuppression remains a desirable goal. To the best of our knowledge, there are no reports on successful steroid withdrawal (SW) in lung transplant recipients. METHODS: The study group included 35 patients who underwent heart-lung, double-lung or single-lung transplantation. Criteria for initiation of SW were stable pulmonary function tests and absence of clinical or bronchoscopic evidence of acute or chronic rejection in the last 6 months. Pulmonary function, blood pressure and metabolic parameters were compared between the patients who underwent SW and those who did not. RESULTS: Eight patients (23%) underwent SW. Median follow-up was 19 months (range 11-23 months). Compared to the non-withdrawal group, the withdrawal group was older (60+/-6 vs. 52+/-13 years, P=0.01, r=0.49), had higher rates of emphysema (88% vs. 18%, P=0.01) and use of a cyclosporine-based regimen (62% vs. 26%, P=0.0001), and had longer time from transplantation to the withdrawal attempt (70+/-13 vs. 29+/-26 months, P=0.0002). The SW group showed no adverse effects in graft function and no deterioration on pulmonary function tests. SW had a beneficial metabolic effect, with a decrease in mean cholesterol level from 229+/-45 to 194+/-25 mg/dl (P=0.02) and no significant change in weight, systolic blood pressure or glucose level. In the non-withdrawal group, mean cholesterol levels increased from 175+/-34 to 209+/-57 mg/dl (P=0.0005), weight increased from 72+/-15 to 80+/-14 kg (P=0.0001), and systolic blood pressure increased from 125+/-15 to 139+/-16 mmHg (P=0.001); glucose levels did not change. There was a significant correlation between total cholesterol level and weight in both groups (P=0.0006, r=-0.56 and P=0.01, r=-0.46, respectively). CONCLUSIONS: Late SW is safe in stable patients after lung transplantation. There was no evidence of rejection or a deterioration in pulmonary function. Lipid profile improvement and blood pressure stabilization accompanied the termination of steroid therapy.

Aged↗
PubMed2004

Associations between androgen receptor CAG repeat length and sperm morphology.

BACKGROUND: The number of (trinucleotide) CAG repeats within the androgen receptor (AR) gene is inversely correlated with transcriptional activity of testosterone-target genes. Although abnormally long CAG repeats are strongly associated with male infertility, it is unclear whether CAG repeat length polymorphism can affect androgen receptor activity and sperm parameters. To explore the previously suggested association between CAG repeats and male fertility, we conducted this prospective cohort study. METHODS: We enrolled 172 men attending the IVF unit in Shaare-Zedek Medical Center. Sperm concentration, motility and morphology and the number of CAG repeats in the AR gene were measured. RESULTS: Mean CAG repeat length was greater in teratozoospermia (<14% normal forms, strict criteria) than in the normal morphology group [mean +/- 95% confidence interval (CI) 22.19 +/- 0.38 versus 21.25 +/- 0.28, P = 0.02]. Logistic regression models showed that longer CAG repeats were associated with abnormal sperm morphology [odds ratio for percentage of normal forms per unit increase in CAG repeat length 1.14 (95% CI 1.01-1.28), P = 0.04]. No association was found between CAG repeat length and sperm concentration or motility. CONCLUSIONS: We found a positive correlation between CAG repeat length and teratozoospermia. This finding validates the concept that AR function is inversely regulated by length of its CAG repeat tract.

Adult↗
PubMed2004

Susceptibility of the influence of weight on blood pressure in men versus women: lessons from a large-scale study of young adults.

BACKGROUND: Weight and blood pressure (BP) are closely related. The aim of this study was to quantify this relationship and compare it to other factors in a population of relatively young adults, with particular focus on the possible role of gender. METHODS: We conducted a cross-sectional analysis of the Young Adult Periodic Examinations in Israel (YAPEIS) database of healthy people aged 25 to 45 years undergoing routine periodic examinations. Between 1991 and 1999, 38,558 subjects (88.1% men, mean age 36 +/- 8 years) were examined. The correlation between BP and weight was evaluated with adjustments for age, sex, physical activity, cigarette smoking, and fasting blood glucose levels. RESULTS: Blood pressure correlated positively with body mass index (BMI), spanning the spectrum of BMI values. Weight accounted for 8% to 10% of BP variance. The odds ratio for hypertension increased by 16% for each additional unit of BMI, compared to 6% for each year increase in age. The relative propensity of men toward hypertension, typical of this age group, was less pronounced at higher BMI values (male:female ratio = 2.2 at BMI <25 kg/m(2), and 1.28 at BMI > or =35 kg/m(2)). CONCLUSIONS: The association between BP and body weight is at least as strong as that between BP and age and is especially prominent in women.

Adult↗
PubMed2004

Declining seroprevalence of rubella antibodies among young Israeli adults: a 12-year comparison.

BACKGROUND: In March 2000, the Israel Defense Force (IDF) experienced an outbreak of rubella. No population-based rubella seroepidemiologic data were available for the 13-year period preceding the epidemic. METHODS: We conducted a population-based seroprevalence study of rubella antibodies among 289 IDF recruits drafted in 1999. RESULTS: We found that 69.2% of males and 90.8% of females in service were seropositive at recruitment in 1999, immediately before the outbreak. These rates were significantly lower than those last measured in 1987 (88% among males and 98.1% among females). CONCLUSIONS: Our findings indicate that this rubella outbreak among young adults was facilitated by a decrease in immunity to levels below those required for herd immunity, at which epidemic virus transmission was no longer blocked. This is most likely due to widespread pediatric vaccination coverage with incomplete catch-up immunization among adolescents and young adults. These findings serve as a reminder that changes to childhood vaccination programs may affect the epidemiology of disease among older segments of the population several years after the change is implemented.

Adult↗
PubMed2004

Transfusion-related leukocytosis in critically ill patients.

OBJECTIVE: We observed that many critically ill patients developed leukocytosis following blood transfusions. To validate this observation and to explore a possible mechanism, a prospective study was designed. DESIGN: Prospective, non-interventional study. SETTING: Surgical/medical intensive care unit in a university-affiliated community hospital. PATIENTS: Consecutive patients who required packed red blood cells transfusion. INTERVENTIONS: White blood cell count (mean +/- SD) x 10(9)/L before and 2, 4, 6, 12, and 24 hrs following transfusion of non-filtered packed red cells was measured in 96 patients. MEASUREMENTS AND MAIN RESULTS: Twenty patients were septic at the time of transfusion, whereas 76 were not. The incidence of post-transfusion leukocytosis in septic vs. nonseptic patients was 15% vs. 76%, respectively (p <.001). The white blood cell count in nonseptic patients increased from 14.3 +/- 4.8 before transfusion to 19.5 +/- 7.0 2 hrs following transfusion (p <.001) and returned to baseline in 24 hrs. In the septic group, no significant post-transfusion leukocytosis occurred. In 11 nonseptic patients requiring more than one unit of packed red cells, a significant increase in mean white blood cell count occurred 2 hrs after transfusion with non-filtered packed red cells, whereas transfusion with pre-storage-filtered packed red cells did not result in such an increase. Interleukin-8 concentrations (pg/mL) in stored non-filtered packed red cells were significantly higher after 4 wks of storage (745.5 +/- 710, p =.02) than at weeks 1 (61.2 +/- 21.6) and 2 (59.3 +/- 29). In the last 16 nonseptic patients, the units of non-filtered packed red cells were assayed for interleukin-8 immediately before transfusion. Interleukin-8 concentrations were higher in units that caused leukocytosis in the recipients compared with those that did not (408.4 +/- 202 vs. 65.1 +/- 49, p =.02). CONCLUSIONS: Transfusion of non-filtered packed red cells, but not of pre-storage-filtered packed red cells, may frequently cause an acute and transient leukocytosis in critically ill nonseptic patients. Interleukin-8 accumulating in stored non-filtered packed red cells may play a role in this phenomenon. Recognition of post packed red cell transfusion leukocytosis may avoid unnecessary investigations and therapies in false suspicion of sepsis.

Critical Illness↗
PubMed2004

Cycle ergometry estimation of physical fitness among Israeli soldiers.

We evaluated the level of fitness among a large population-based sample of Israeli men and women ages 18-25 years, within the framework of an ongoing survey of personnel discharged from military service in the Israel Defense Force. Aerobic capacity was predicted with the Astrand-Rhyming 6-minute cycle ergometer test and maximal oxygen uptake (VO2 max) was estimated using the Astrand-Rhyming nomogram based on cardiac response to 6 minutes of constant submaximal cycle work. Mean +/- SD VO2 max values were 41.05 +/- 10.52 mL/kg/min for men (range, 15-81 mL/kg/min) and 33.84 +/- 7.60 mL/kg/min for women (range, 16-65 mL/kg/min). Smoking was found to be associated with lower VO2 max among both men and women, whereas type of military service unit was unexpectedly not associated with physical fitness level.

Adult↗
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↗
PubMed2004

[Vaccination policy in the IDF--past, present and future].

The Army Health Branch of the Medical Corps in the Israel Defense Forces (IDF) maintains responsibility for the IDF's troop vaccination policy. This policy has undergone many changes and adaptations over time, due to shifting trends in civilian and military morbidity; technological advances and the introduction of new vaccines; changes to the cost-effectiveness ratio of specific vaccines; and other causes. The evolution of the IDF vaccination policy has not been reviewed to date, and can well serve as an example of the various considerations influencing public health policy in general, and specifically vaccination policy. Furthermore, questions are often raised by health care professionals as to discharged soldiers' military vaccination history, especially in the context of travel clinics. The authors present an historical review and current update of the IDF vaccination policy.

Health Policy↗
PubMed2003

SWOT analysis: strengths, weaknesses, opportunities and threats of the Israeli Smallpox Revaccination Program.

During September 2002, Israel began its current revaccination program against smallpox, targeting previously vaccinated "first responders" among medical and emergency workers. In order to identify the potential strengths and weaknesses of this program and the conditions under which critical decisions were reached, we conducted a SWOT analysis of the current Israeli revaccination program, designed to identify its intrinsic strengths and weaknesses, as well as opportunities for its success and threats against it. SWOT analysis--a practical tool for the study of public health policy decisions and the social and political contexts in which they are reached--revealed clear and substantial strengths and weaknesses of the current smallpox revaccination program, intrinsic to the vaccine itself. A number of threats were identified that may jeopardize the success of the current program, chief among them the appearance of severe complications of vaccination. Our finding of a lack of a generation of knowledge on smallpox vaccination highlights the need for improved physician education and dissipation of misconceptions that are prevalent in the public today.

Contraindications↗
PubMed2003

Clinical and epidemiologic investigation of two Legionella-Rickettsia co-infections.

BACKGROUND: We treated two patients diagnosed with legionellosis and simultaneous Rickettsia conorii co-infection. OBJECTIVES: To report the clinical and laboratory characteristics of this unusual combination, and to describe the execution and results of our environmental and epidemiologic investigations. METHODS: Serial serologic testing was conducted 1, 4 and 7 weeks after initial presentation. Water samples from the patients' residence were cultured for Legionella. Follow-up cultures were taken from identical points at 2 weeks and at 3 months after the initial survey. RESULTS: Both patients initially expressed a non-specific rise in anti-Legionella immunoglobulin M titers to multiple serotypes. By week 4 a definite pattern of specifically elevated IgG titers became apparent, with patient 1 demonstrating a rise in specific anti-L. pneumophila 12 IgG titer and patient 2 an identical response to L. jordanis. At 4 weeks both patients were positive for both IgM and IgG anti-R. conorii antibodies at a titer > or = 1:100. Heavy growth of Legionella was found in water sampled from the shower heads in the rooms of both patients. Indirect immunofluorescence of water cultures was positive for L. pneumophila 12 and for L. jordanis. CONCLUSIONS: Although most cases of community-acquired Legionella pneumonia in our region appear simultaneously with at least one other causative agent, co-infection with R. conorii is unusual and has not been reported to date. This report illustrates the importance of cooperation between clinicians and public health practitioners.

Adult↗
PubMed2003

[Israeli guidelines for investigation and management of SARS cases and their contacts].

As the first emerging epidemic of the 21st century, SARS has raised much interest and fear among statesmen, economists, and the general public, as well as within the medical community. This new disease is characterized by several daunting challenges, including person-to-person transmission, an environmentally resistant agent, a non-specific clinical presentation, and a high fatality rate among high risk individuals. In Israel, as elsewhere, public health authorities were forced to quickly design appropriate measures to confront this new threat. The Israeli guidelines for surveillance, epidemiologic investigation and intervention in the event of a SARS outbreak were drafted in the absence of complete data on some of the most basic epidemiologic characteristics of the disease. Discrepancies between published guidelines from several countries made the decision-making process even more complicated. We describe the epidemiologic guidelines for SARS drafted by the Israeli working group, as well as the considerations on which they are based. The recent experience with this new outbreak has already provided several valuable lessons on policy making which may help future planning for emerging and re-emerging infectious diseases.

Disease Outbreaks↗
PubMed2002

Adult infection with hepatitis A despite declining endemicity; in favor of adult vaccination.

Seropositivity against hepatitis A was examined among 4806 standing army personnel (4497 males and 309 females) during 1998-1999. Each bi-annual birth cohort examined showed a decline in seropositivity compared to the previous one. When compared with a study performed in 1989, however, for each of the 1961-1962, 1963-1964, 1965-1966, 1967-1968 and 1969-1970 birth cohorts examined, the 1998-1999 study showed 5-15% higher seropositivity. This trend remained after controlling for differences between the two studies in ethnic origin, sibship size and level of education. The overall seroconversion rate is estimated as 1.15% per year and the clinical to subclinical ratio as 1:14. Thus, hepatitis A infection continues to occur in the young adult age group and vaccination of this group should be considered.

Adult↗
PubMed2002

Significance of a plasma D-dimer test in patients with primary pulmonary hypertension.

BACKGROUND: D-dimer, a degradation product of fibrin, has been increasingly used as a marker or prognostic factor in various thrombotic diseases. OBJECTIVE: To assess the significance of a d-dimer test in patients with primary pulmonary hypertension (PPH). PATIENTS AND METHODS: Fourteen patients with PPH (12 women and 2 men) aged 25 to 68 years (mean +/- SD age, 50 +/- 14 years) entered the study. Plasma d-dimer was determined by Miniquant assay (Biopool International; Venture, CA) 3 +/- 5 months after the disease onset, and patients were followed up for 1 year. We compared the d-dimer levels to the demographic, clinical, and hemodynamic data of the patients. RESULTS: D-dimer levels were positively correlated with New York Heart Association classification (r = 0.59, p = 0.01) and pulmonary artery pressure (r = 0.43, p = 0.03) and were negatively correlated with oxygen saturation (r = - 0.45, p = 0.03) and 6-min walk distance (r = - 0.49, p = 0.04). One-year survival was also negatively correlated with d-dimer (point-biserial r = - 0.71, p = 0.004), with a higher d-dimer value associated with poorer survival. No significant correlations were found between d-dimer values and sex, age, diffusing capacity of the lung for carbon monoxide, or cardiac index. CONCLUSION: D-dimer levels may have a role in the evaluation of patients with PPH. This simple, noninvasive test may be helpful for identifying patients who are at a higher risk for severe disease.

Adult↗
PubMed2002

The epidemiologic pyramid of bioterrorism.

Recent events have drawn world attention to "mythological diseases"--such as anthrax, plague and smallpox--which have been out of the spotlight for some decades. Much of our current knowledge of epidemic intervention and disease prevention was acquired over history through our experience with these diseases, such that the sudden panic over the reemergence of these historically well-known entities is perplexing. Over time, changes in the balance of the epidemiologic triangle have driven each of these disease systems towards a new equilibrium with which we are not familiar. While the pathogens may be similar, these are not the diseases of the past. These new disease systems are insufficiently described by the classic epidemiologic triangle, which lacks a dimension necessary for providing a valid model of the real-world effects of bioterror-related disease. Interactions within the classic epidemiologic triangle are now refracted through the prism of the global environment, where they are mediated, altered, and often amplified. Bioterror-associated diseases must be analyzed through the epidemiologic pyramid. The added dimension represents the global environment, which plays an integral part in the effects of the overall disease system. The classic triangle still exists, and continues to function at the base of the new model to describe actual agent transmission, but the overall disease picture should be viewed from the height of the fourth apex of the pyramid. The epidemiologic pyramid also serves as a practical model for guiding effective interventional measures.

Anthrax↗
PubMedDate not supplied

Validity of self-assessment of skin reaction after smallpox vaccination.

OBJECTIVE: Smallpox vaccinees should be evaluated for the presence of a major skin reaction ("take") one week after vaccination, but this could prove to be logistically infeasible in the context of an emergency mass-vaccination campaign. We validated a tool for self-evaluation of the vaccination site for presence of take. METHODS: We conducted a prospective, double-blinded, paired-measurement validation study of 174 non-naive adult vaccinees and their physician evaluators. Subjects provided paired, blinded, independent assessments of take 7-9 days after vaccination. RESULTS: Overall, vaccinees and evaluators agreed on 157 of 174 (90.2%) take assessments. Sensitivity of the tool was 99.1%, and specificity was 75%. The positive predictive value of self-assessment was 87.2% and the negative predictive value was 98%. Specificity of the tool and measures of agreement were significantly modified by age, education, and occupation. When adjusted for the expected take rate among a population including naive vaccinees, positive predictive value and overall agreement increased significantly. CONCLUSIONS: Self-assessment may be a feasible option for evaluation of take in the event of mass smallpox vaccination. The predictive values and overall agreement of the tool are satisfactory, and can be expected to increase when used in a largely naive population.

Adult↗