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Biomedical subjects

R Raz

Publications and source records attributed to R Raz.

At least 37 records · Page 2Linked to original sources
PubMed2002

Randomized controlled trial of sequential intravenous (i.v.) and oral moxifloxacin compared with sequential i.v. and oral co-amoxiclav with or without clarithromycin in patients with community-acquired pneumonia requiring initial parenteral treatment.

The objective of the present trial was to compare the efficacy, safety, and tolerability of moxifloxacin (400 mg) given intravenously (i.v.) once daily followed by oral moxifloxacin (400 mg) for 7 to 14 days with the efficacy, safety, and tolerability of co-amoxiclav (1.2 g) administered by i.v. infusion three times a day followed by oral co-amoxiclav (625 mg) three times a day, with or without clarithromycin (500 mg) twice daily (i.v. or orally), for 7 to 14 days in adult patients with community-acquired pneumonia requiring initial parenteral therapy. A total of 628 patients were enrolled and assessed by evaluation of their clinical and bacteriological responses 5 to 7 days and 21 to 28 days after administration of the last dose of study medication. Although the trial was designed, on the basis of predefined outcomes, to demonstrate the equivalence of the two regimens, the results showed statistically significant higher clinical success rates (for moxifloxacin, 93.4%, and for comparator regimen, 85.4%; difference [Delta], 8.05%; 95% confidence interval [CI], 2.91 to 13.19%; P = 0.004) and bacteriological success rates (for moxifloxacin, 93.7%, and for comparator regimen, 81.7%; Delta, 12.06%; 95% CI, 1.21 to 22.91%) for patients treated with moxifloxacin. This superiority was seen irrespective of the severity of the pneumonia and whether or not the combination therapy included a macrolide. The time to resolution of fever was also statistically significantly faster for patients who received moxifloxacin (median time, 2 versus 3 days), and the duration of hospital admission was approximately 1 day less for patients who received moxifloxacin. The treatment was converted to oral therapy immediately after the initial mandatory 3-day period of i.v. administration for a larger proportion of patients in the moxifloxacin group than patients in the comparator group (151 [50.2%] versus 57 [17.8%] patients). There were fewer deaths (9 [3.0%] versus 17 [5.3%]) and fewer serious adverse events (38 [12.6%] versus 53 [16.5%]) in the moxifloxacin group than in the comparator group. The rates of drug-related adverse events were comparable in both groups (38.9% in each treatment group). The overall incidence of laboratory abnormalities was similar in both groups. Thus, it is concluded that monotherapy with moxifloxacin is superior to that with a standard combination regimen of a beta-lactam and a beta-lactamase inhibitor, co-amoxiclav, with or without a macrolide, clarithromycin, in the treatment of patients with community-acquired pneumonia admitted to a hospital.

Administration, Oral↗
PubMed2001

Bacteroides fragilis vertebral osteomyelitis secondary to anal dilatation.

STUDY DESIGN: A case report of anaerobic vertebral osteomyelitis after anal dilatation. OBJECTIVES: To present a patient with monomicrobial anaerobic vertebral osteomyelitis secondary to a previously undescribed source of infection. SUMMARY OF BACKGROUND DATA: A 17-year-old boy presented with low back pain 3 months after anal dilatation. METHODS: Physical examination, technetium-99m bone scan, plain radiograph, CT, and MRI studies of the lumbar spine were used to clinically diagnose lumbar osteomyelitis. Culture material from the involved disc was positive for Bacteroides fragilis. RESULTS: The patient recovered after 8 weeks of treatment with oral metronidazole. CONCLUSIONS: Bacteroides fragilis hematogenous osteomyelitis is a rare entity. This is the first reported case of such disease after anal dilatation.

Adolescent↗
PubMed2001

Gram-Negative anaerobic endocarditis: two case reports and review of the literature.

The rarity of anaerobic gram-negative endocarditis limits the ability of physicians to define its prognosis. Two cases of endocarditis due to Bacteroidesfragilis are described, and a review of the English literature for all cases of anaerobic gram-negative endocarditis reported since 1940 is presented. The disease predominantly affects males. Clinical features are similar to those of endocarditis due to nonanaerobic organisms, but underlying heart disease is less common and the rate of thromboembolic complications is high. All deaths reported were due to Bacteroides spp.; no deaths due to Fusobacterium spp. have been reported. Treatment with metronidazole has dramatically improved the prognosis of patients with endocarditis due to anaerobic gram-negative bacilli.

Aged↗
PubMed2001

Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors.

We conducted a case-control study to explore the role of health behavior and sexual and medical history on urinary tract infection (UTI) risk among otherwise healthy women aged 40-65. Cases and controls were recruited from nine practices and clinics in Michigan and a single clinic in Israel. In both countries, several factors were reported significantly more frequently among UTI cases than controls: a previous UTI within 12 months, incontinence symptoms, a recent episode of 30-plus minutes of cold hands, feet, back or buttocks, and recent antibiotic use. Cases were less likely than controls to report recent estrogen use, but the results were only statistically significant in Michigan. Sexual activity during the previous 2 weeks and having ceased menses were modestly, but not statistically significantly, protective at both study sites. Risk factors for UTI among women 40-65 differ from those for younger women and these differences cannot be attributed solely to changes in menopausal status.

Adult↗
PubMed2001

Postmenopausal women with recurrent UTI.

Urinary tract infection is a frequent disease in elderly women. The lack of estrogen, which characterizes the postmenopause, plays an important role in the pathogenesis of this infective disease. Exogenous estrogen replacement, however, is very effective in the prevention of bacteriuria in these women. The safety of oral and vaginal estriol and their efficacy in comparison to antimicrobial prophylaxis should be confirmed in the future.

Adult↗
PubMed2001

Antimicrobial susceptibility of community-acquired uropathogens in northern Israel.

In order to study the trends in resistance to first line antimicrobial agents, the susceptibility patterns of 8338 community urinary isolates collected during 1995 were compared with 6692 isolates from 1999. Our data shows that community-acquired Gram-negative uropathogens remained highly susceptible to ciprofloxacin, cefuroxime and amoxycillin/clavulanate with sensitivities of 94, 89 and 83% respectively. Nitrofurantoin was shown to be suitable (99% susceptibility rate) only for Escherichia coli urinary tract infections. Ampicillin, first generation cephalosporins and sulphamethoxazole/trimethoprim could no longer be considered first line drugs for empirical treatment of clinically evident urinary tract infection because of very high resistant rates. Ampicillin remained a good choice for urinary infections caused by enterococci, 98% of the strains being susceptible. It was found that 1.25% of the Gram-negative uropathogens isolated during 1999 were extended spectrum beta-lactamase producers which suggests that this plasmid-encoded trait is finding its way into the community.

Anti-Bacterial Agents↗
PubMed2001

Cooperation between STAT3 and c-jun suppresses Fas transcription.

Decreased Fas expression during tumor progression often results in a loss of Fas-ligand (FasL)-mediated apoptosis. Human and mouse melanoma exhibit an inverse correlation between the degree of Fas cell surface expression, tumorigenicity, and metastatic capacity. The expression of dominant negative Stat3 or c-Jun in melanoma cells efficiently increased Fas expression and sensitized cells to FasL-induced apoptosis. Stat3+/- as well as c-Jun-/- cells exhibited increased Fas cell surface expression and higher sensitivity to FasL-mediated apoptosis. Suppression of Fas expression by Stat3 and c-Jun is uncoupled from Stat3-mediated transcriptional activation. Our findings indicate that Stat3 oncogenic activities could also be mediated through its cooperation with c-Jun, resulting in downregulation of Fas surface expression, which is implicated in the tumor's ability to resist therapy and metastasize.

Animals↗
PubMed2001

High-level handwashing compliance in a community teaching hospital: a challenge that can be met!

Handwashing is the most important and least expensive measure for preventing the transmission of hospital-acquired infection. Compliance, however, rarely exceeds 40%, even in intensive care units. The present study evaluated the effectiveness of the authors' infection control programme in relation to handwashing compliance of healthcare workers. Ten nursing students observed 300 uninformed staff members and recorded their handwashing practices throughout the working day. The observations were categorized by profession, gender, age, hospital unit and type of delivered care. In 1035 opportunities that required handwashing, the overall compliance was 76%. Healthcare workers washed hands before (68%) and after patient care (80%). Females complied more than males (69 vs. 80%, P<0.0001) and nurses more than physicians (81 vs. 69%, P<0.001). In intensive care units, overall compliance exceeded 97%, while in other wards and in the emergency departments, it approximated 61%. More handwashing was observed during the evening shift compared with the morning shift (P=0.02). Despite the high compliance, only 30% washed their hands for the required 10-20s. In conclusion, compliance with handwashing in the authors' institution is the highest reported to date, and reflects the intensive and incessant educational infection control programme.

Adult↗
PubMed2001

Home intravenous antibiotic therapy programme, 1999.

OBJECTIVES: To evaluate the cost-effectiveness and safety of the Home Intravenous Antibiotic Therapy (HIAT) program in the district of Haifa and Western Galilee in Northern Israel. METHODS: We checked all the medical records of all the patients who had been treated at home with intravenous antibiotics during 1999. We reviewed the mean clinical diagnosis, aetiological agent, type of antibiotic given, complications and cost evaluation. RESULTS: During 1999, 250 patients received 284 courses of HIAT. The total duration of treatments was 3404 days; 61% of the patients were referred from clinical departments from one of the medical centres in our area. Soft-tissue infections and osteomyelitis were the most common clinical diagnoses at 40%. Pseudomonas aeruginosa was the most frequent pathogen presented and Ceftazidine the most common antimicrobial agent prescribed. The HIAT program saved $815 000 during 1999. Only minor complications were present. CONCLUSIONS: HIAT is effective, safe, comfortable for the patients, and has an important economical impact.

Adolescent↗
PubMed2001

Risk of infection and death among post-splenectomy patients.

OBJECTIVES: The true incidence of post-splenectomy sepsis remains undetermined. METHODS: An English literature review on post-splenectomy sepsis was undertaken by means of databases of MEDLINE for the period 1966-96. The data registered included age at splenectomy, indication for splenectomy, incidence of infection and death, interval between splenectomy and infection, and microbial aetiology. RESULTS: The reports include 19 680 patients having undergone splenectomy with a median follow up of 6.9 years. The incidence of infection after splenectomy was 3.2% and the mortality rate was 1.4%. Only 6942 reports were sufficiently detailed to allow useful analysis. The incidence of infection among children and adults was similar, 3.3% and 3.2%, respectively. However, the death rates among children were higher than adults (1.7% vs. 1.3%). The incidence of infection was highest among patients with thalassemia major (8.2%), and sickle-cell anaemia (7.3%). The highest mortality rates were observed among patients with thalassaemia major (5.1%), and sickle-cell anaemia (4.8%). CONCLUSION: The incidence of sepsis among post-splenectomy patients is low, however, it carries a high mortality rate especially among children with hematological disorders.

Adolescent↗
PubMed2001

STAT1 mediates the increased apoptosis and reduced chondrocyte proliferation in mice overexpressing FGF2.

Unregulated FGF receptor signaling results in bone malformations that affect both endochondral and intramembranous ossification, and is the basis for several genetic forms of human dwarfism. FGF signaling inhibits chondrocyte proliferation and we have previously shown that the transcription factor STAT1 mediates the growth inhibitory effect of FGF in vitro. We provide genetic evidence that STAT1 is a modulator of the negative regulation of bone growth by FGF in vivo. We crossed Stat1(-/-) mice with a transgenic mouse line overexpressing human FGF2 (TgFGF). TgFGF mice exhibit phenotypes characterized by chondrodysplasia and macrocephaly, which affect endochondral and intramembranous ossification. We found that the chondrodysplasic phenotype of these mice results both from reduced proliferation and increased apoptosis of growth plate chondrocytes. Loss of STAT1 function in TgFGF mice led to a significant correction of the chondrodysplasic phenotype, but did not affect the skull malformations. The reduced proliferation of TgFGF growth plate chondrocytes, as well as their excessive apoptosis, were restored to near-normal levels in the absence of STAT1 function. Unregulated FGF signaling in TgFGF mice also induced apoptosis in calvarial osteoblasts that was not, however, corrected by the absence of STAT1. Detailed analysis of Stat1(-/-) growth plates uncovered a transient phenotype, characterized by an expansion of the proliferative zone and by acceleration of longitudinal bone growth, that attenuated as the animals grew older. These results document an essential role for STAT1 in FGF-mediated regulation of cell growth that is specific to the epiphyseal growth plate.

Animals↗
PubMed2001

Safety and immunogenicity of a new mammalian cell-derived recombinant hepatitis B vaccine containing Pre-S1 and Pre-S2 antigens in adults.

BACKGROUND: Previous data showed that new recombinant hepatitis B virus vaccine, which contains the S-protein component of the HBV surface together with the Pre-S1 and Pre-S2, is considerably more immunogenic than a second-generation recombinant HBV vaccine. OBJECTIVES: To compare the immunogenicity and safety of a novel recombinant HBV vaccine S1, Pre-S1 and Pre-S2 protein components of the hepatitis B surface antigen--BioHep, 10 micrograms dose, to a licensed vaccine containing only the S-protein component--Engerix-B, 20 micrograms dose. METHODS: A prospective randomized study included 524 adults--260 in the Bio-Hep group and 264 in the Engerix-B group. Both vaccines were administered in a three-dose regimen given at 0, 1 and 6 months, and adverse events were recorded on a diary card 5 days after each vaccination. Immunogenicity was tested by measuring anti-hepatitis B surface antibody. RESULTS: One month after the third injection, 98% of the BioHep subjects were found to be seroprotected vs. 85.1% of the Engerix-B group. In addition, the geometric mean titers were 2,203 mIU/ml and 326 mIU/ml in the Bio-Hep-B and Engerix-B groups respectively. An immunogenic advantage of Bio-Hep-B was suggested by the rapid onset of antibody response--66.5% were seroconverted one month after the first injection as compared to 19.3% in the Engerix-B group. No unexpected adverse events were observed, and the recorded events were mild in both groups. CONCLUSIONS: BioHep, a novel recombinant HBV vaccine containing S, Pre-S1 and Pre-S2 protein components, at a lower dose, is safe and more immunogenic than the conventional HBV vaccine that contains only S protein.

Adolescent↗
PubMed2001

[Autochthonous subcutaneous dirofilariasis in Israel].

BACKGROUND: Canine dirofilariasis has been recognized for over 300 years, but human dirofilariasis has received relatively little attention. Sporadic cases of human dirofilariasis have been reported in Israel. Dogs, cats and foxes are the reservoir, mosquitoes of the genera Culex and Aedes are the vectors and humans are the accidental hosts. CASE REPORT: We present a case of human dirofilariasis (Dirofilaria repens) in a young Israeli patient. The thickness of the multilayered cuticle of the worm, the size of the body and the form and numbers of the longitudinal ridges on its surface are used in the histological diagnosis of the parasite. CONCLUSIONS: Since our patient had never been abroad, this case must be considered an autochthonous infection. Furthermore, since the reservoir and the vectors are abundant in Israel, the potential for human infection exists, but probably this pathology is underdiagnosed in primary care practice.

Adolescent↗
PubMed2000

[Familial parinaud oculo-glandular syndrome in cat-scratch disease].

Cat-scratch disease is manifested by subacute, regional lymphadenitis and occurs mainly in children. The causative agent is a pleomorphic, gram-negative bacillus, Bartonella henselae carried by asymptomatic cats. Parinaud oculoglandular syndrome is the most common ocular manifestation of this disease. It is characterized by unilateral conjunctivitis with polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. The diagnosis is supported by a history of exposure to cats and is confirmed by positive serologic tests or positive PCR assay. The occurrence of more than 1 case of Parinaud syndrome in a family is rare. We describe 2 sisters with Parinaud oculoglandular syndrome, proven by serologic tests. They reported that they used to cuddle with their cats, among them a kitten. Because of the refractory conjunctivitis and signs of imminent periorbital cellulitis, they were treated with oral tetracycline with apparently good responses. We recommend asking about contacts with cats in any atypical conjunctivitis accompanied by regional lymphadenopathy, especially in young patients. Systemic antibiotics should be given when there is any suspicion of significant ocular involvement, if the patient is immunosuppressed, or if there are systemic manifestations of cat-scratch disease.

Adolescent↗
PubMed2000

Ciprofloxacin 250 mg twice daily versus ofloxacin 200 mg twice daily in the treatment of complicated urinary tract infections in women.

In a multicenter, prospective, double-blind, double-dummy randomized study conducted in Israel and Germany, the efficacy and safety of ciprofloxacin 250 mg b.i.d. versus ofloxacin 200 mg b.i.d. was compared in the treatment of women with complicated lower urinary tract infection. A total of 465 women were enrolled in the study, 427 of whom were included in the intent-to-treat analysis. Two hundred fourteen received ciprofloxacin 250 mg b.i.d. and 213 received ofloxacin 200 mg b.i.d. Both regimens were administered for 7 days. The primary efficacy parameter was the microbiologic result obtained 5-9 days after cessation of therapy; secondary efficacy parameters were urine cultures obtained 28-42 days after the end of therapy and clinical outcome 5-9 days and 28-42 days post-therapy. There were no relevant differences in the primary efficacy parameter or in any secondary efficacy parameter between the average response rate of patients who received ciprofloxacin and that of patients who received ofloxacin: 90.1% of the ciprofloxacin group and 87.2% of the ofloxacin group had sterile urine 5-9 days after the end of therapy; 77.1% and 76.1% had sterile cultures, respectively. Clinical cure was achieved in 97.2% of both groups 5-9 days after cessation of therapy and a month later in 87.7% and 87.3%, respectively. Adverse events were mild and similar in both groups. In conclusion, for the primary efficacy parameter as well as for all secondary efficacy parameters, ciprofloxacin 250 mg b.i.d. is at least as effective as ofloxacin 200 mg b.i.d. in women with complicated lower urinary tract infection.

Aged↗