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Biomedical subjects

Y L Danon

Publications and source records attributed to Y L Danon.

At least 19 recordsLinked to original sources

Cerebrospinal fluid leukocyte aggregation in meningitis.

OBJECTIVE: To evaluate whether the difference in aggregation of cerebrospinal fluid cells from patients with bacterial, viral, aseptic and partially treated meningitis can be used for diagnostic purposes. METHODS: Cerebrospinal fluid samples of 100 patients with meningitis (15 bacterial, 13 partially treated, 10 viral and 62 aseptic) were compared on the basis of the predefined leukocyte aggregation score (LAS). RESULTS: Mean LAS was 56% in the bacterial meningitis group (range, 15 to 90%), 5.8% in the partially treated meningitis group (range, 0 to 27%), 2% in the proven viral meningitis group (range, 0 to 5%) and 2% in the aseptic meningitis group (range, 0 to 15%). All patients with bacterial meningitis had a LAS of > 15%, whereas all those with viral or aseptic meningitis had a score of < 15%. Although most patients with partially treated meningitis had a low LAS, several had higher scores, which may indicate bacterial infection. There was no statistical correlation between number of cells, type of cells (mononuclear or polymorphonuclear) or cerebrospinal fluid protein and glucose concentration and degree of leukocyte aggregation for the different groups. CONCLUSION: Measurement of the LAS may contribute to the immediate differential diagnosis of bacterial or viral meningitis, especially in patients with very high pleocytosis, as sometimes seen in enteroviral meningitis. It may also serve as a guide for the likelihood of bacterial infection in cases of partially treated meningitis. Additional studies are needed to confirm these observations.

Adolescent

Reactogenicity and immunogenicity of a new recombinant hepatitis B vaccine containing Pre S antigens: a preliminary report.

A new vaccine against hepatitis B virus (HBV) infection, produced in mammalian Chinese hamster ovary (CHO) cells, contains the small(s), middle (Pre S2) and large (Pre S1) surface proteins of HBV. Three injections of a 5-micrograms or 10-micrograms dose were administered intramuscularly (i.m.) at 0, 1 and 6 months to a group of 105 young adults, who were monitored for a period of 6 months after the third injection. Seroconversion rates were 100% after the second injection of the 5-micrograms or 10-micrograms dose. Geometric mean titres of HBsAb at 1 month after the third injection were 12,156 mIU ml-1 and 13,482 mIU ml-1 in those receiving the 5-micrograms and 10-micrograms dose respectively. The vaccine was well tolerated with no significant adverse events. These preliminary results suggest that the Pre S-s recombinant vaccine, produced in mammalian cells, is highly immunogenic, leading to 100% seroconversion in the population tested after injection of only two doses of 5 micrograms.

Adolescent

Myopia in neurofibromatosis type 1.

We studied the prevalence of myopia in 17-year-old Israeli military recruits with neurofibromatosis type 1 (NF1). Twenty-four percent of the youngsters with neurofibromatosis had myopia, compared to 19% of the controls; this difference was statistically significant (P < 0.03). The recruits with NF1 had a slightly lower IQ, fewer years of education, and lower height and weight than the controls. Thus, these factors, which have been reported to be associated with myopia, did not significantly influence the high prevalence of myopia in the neurofibromatosis subjects. A high prevalence of myopia seems to be an additional feature of NF1.

Adolescent

Immune deficiency in glycogen storage disease type 1B.

Patients with glycogen storage disease type 1B present the clinical features of glycogen storage disease type 1A. In addition, they are susceptible to recurrent bacterial infection and have recurrent oral ulcers and occasionally Crohn's-like disease. There features are due to immune dysfunction caused by a combination of neutropenia and impaired phagocytic functions.

Bacterial Infections

[Application of patient card technology to health care].

The potential benefits of patient card technology in improving management and delivery of health services have been explored. Patient cards can be used for numerous applications and functions: as a means of identification, as a key for an insurance payment system, and as a communication medium. Advanced card technologies allow for the storage of data on the card, creating the possibility of a comprehensive and portable patient record. There are many types of patient cards: paper or plastic cards, microfilm cards, bar-code cards, magnetic-strip cards and integrated circuit smart-cards. Choosing the right card depends on the amount of information to be stored, the degree of security required and the cost of the cards and their supporting infrastructure. Problems with patient cards are related to storage capacity, backup and data consistency, access authorization and ownership and compatibility. We think it is worth evaluating the place of patient card technology in the delivery of health services in Israel.

Delivery of Health Care

The cognitive outcome of full-term small for gestational age infants at late adolescence.

OBJECTIVE: To assess the cognitive and academic performance of adolescents who were born small for gestational age (SGA) at term. METHODS: A 17-year historical prospective study was done by matching neonatal data of 1758 infants to the results of the medical and intelligence assessment performed at age 17 years at the army draft board medical examination in Israel. The results of children born SGA (weight at term birth below the third percentile) were compared to those of children who were born appropriate for gestational age (AGA). RESULTS: After adjustment by a multiple linear regression analysis, the mean (+/- standard error of the mean) intelligence test scores were 103.1 +/- 2.9 versus 105.8 +/- 1.5 (P = 0.3) for the males and 100.3 +/- 2.5 versus 104.7 +/- 1.6 (P < .03) for the females. Males born SGA at term were found to have lower educational achievements (having less than 12 years of schooling or attending a vocational school) compared with the AGA group. The odds ratio for this finding after adjustment by a logistic regression analysis was 2.40 (95% confidence interval 1.07-5.39; P < .03). Intranatal events were not found to have an effect on the measured neurodevelopmental outcome. CONCLUSION: Infants born SGA at term have an increased risk for lower cognitive performance and schooling achievements than those born AGA; this result seems to be unrelated to their intranatal course.

Adolescent

Effect of valvular heart diseases, migraine headaches, and perianal diseases on the risk of involvement in motor vehicle crashes.

Impaired health can interfere with driving performance. We have launched this investigation to identify in professional military drivers health parameters that might be associated with involvement in motor vehicle crashes (MVCs). All Israel Defense Forces professional male drivers (N = 5,605) conscripted into compulsory military service between April 1, 1988 and April 1, 1990 were divided into two groups according to whether (N = 1,300) or not (N = 4,305) the driver was involved in MVCs during the same time frame. Using the multivariate Cox model, a significant association was shown between involvement in MVCs and the following health parameters: mild-to-moderate valvular heart disease (p = 0.0002, chi 2 = 13.89), migraine headaches (p = 0.009, chi 2 = 6.91), and perianal diseases (p = 0.006, chi 2 = 7.44). We hypothesize that interference with the driver's performance level may be a result of the discomfort associated with those clinical conditions. It is possible that interference with the personal performance level decreased the ability of the driver to cope with the specific driving task demands and resulted in the involvement of the driver in MVCs. We suggest that because of the high social and economic costs associated with road accidents, it is important to investigate further the association of involvement in MVCs and health problems. If our findings are confirmed in the future studies, intervention programs to reduce MVC rates would be suggested and conducted among professional drivers.

Accidents, Traffic

Urinary tract infections with low and high colony counts in young women. Spontaneous remission and single-dose vs multiple-day treatment.

BACKGROUND: The aim of this study was to test whether the spontaneous cure rate is higher in dysuric women with low urinary colony counts (10(2) to 10(4) colony-forming units [cfu] per milliliter) than in women with high colony counts (> or = 10(5) cfu/mL) and whether the response of patients with low colony counts to single-dose treatment is better than those with high colony counts. METHODS: Dysuric women underwent a clinical interview, examination, urine culture, and microscopic examination of urine, and were asked to postpone treatment for 2 days. At that time, the urine tests were repeated. Women with bacterial urinary tract infection were randomized to a group given a single dose of 1200 mg of norfloxacin and to a group treated with 400 mg of norfloxacin twice daily for 7 days. Cure rates were tested at 1 and 5 weeks after treatment. RESULTS: Of 146 women with urinary tract complaints, 113 (25 patients with sterile urine cultures, 21 with low colony counts, and 67 with high colony counts) agreed to postpone antibiotic treatment. Two days after the initial urine culture, only one patient with a low initial colony count had a sterile urine culture (5%, 95% confidence interval, 0% to 14%); and 10 patients (48%, 95% confidence interval, 27% to 69%) had a colony count of 10(5) cfu/mL or more. The rate of spontaneous cure in women with high initial colony count was 7%, 95% confidence interval, 1% to 13%. One week after treatment, the cure rates were 48 (84%) of 57 patients given single-dose treatment vs 49 (98%) of 50 patients treated for 7 days. Five weeks after treatment the rates were 63% and 83%, respectively. The efficacy of single-dose treatment in patients with low urinary counts were similar to those with high counts, and less than that achieved by 7 days of treatment. CONCLUSIONS: The spontaneous cure rate for a 2-day period is minimal in patients with both a low and a high colony count, but half of the patients with low urinary counts will have high colony counts after this interval. The response to single-dose treatment is similar in patients with low and high colony counts, and lower than with multiday treatment.

Adolescent

Placental transfer of immunoglobulin G subclasses.

The concentrations in cord blood of total immunoglobulin G (IgG) and the four subclasses of IgG were measured in 34 fetuses at a mean gestational age of 25 weeks (range, 18 to 35 weeks). The blood samples were obtained by percutaneous umbilical blood sampling, and results were compared with the respective IgG subclass concentrations of the mothers. The efficiency of transplacental transfer of the different IgG subclasses was determined. Transfer of IgG1 and IgG4 was found to be significantly more efficient than that of IgG3 and IgG2. IgG2 was the subclass least efficiently transferred from mother to fetus. These differences may partly explain the susceptibility of newborns to various pathogens, such as streptococcus group B.

Female

Neurofibromatosis type 1 in Israel: survey of young adults.

Neurofibromatosis type 1 (NF1) (von Recklinghausen's disease) is one of the most common human autosomal dominant disorders. In a survey of 374440 17 year old Jewish recruits for military service, 390 cases of NF1 were discovered, with a prevalence of 1.04/1000 (0.94/1000 for males and 1.19/1000 for females), or two to five times the reported prevalence of this disease. NF1 was more common in youngsters whose parents were of North African and Asian origin (1.81/1000 and 0.95/1000, respectively) and less common in those of European and North American origin (0.64/1000). All these differences were statistically significant and may be partially explained by the more advanced parental age of the NF group (as suggested by the larger number of children in the North African and Asian families) or by founder effect or both. The height and weight of the NF1 subjects was significantly lower than those of the controls. The intelligence score of persons with NF1 was similar to that of the control group when corrected for gender and ethnic origin. No significant increase in epilepsy or mental illnesses was found. This study provides evidence of the high overall prevalence of NF1 among Jews in Israel, with significantly increased prevalence in certain ethnic groups.

Analysis of Variance

Erythema multiforme and hypersensitivity myocarditis caused by ampicillin.

OBJECTIVE: To report a case of erythema multiforme and hypersensitivity myocarditis caused by ampicillin. CASE SUMMARY: A 13-year-old boy was treated with ampicillin and gentamicin because of suspected septicemia. Medications were discontinued when erythema multiforme and congestive heart failure caused by myocarditis occurred. The patient was treated with methylprednisolone and gradually improved. Macrophage-migration inhibition (MIF) test with ampicillin was positive. DISCUSSION: After most infections causing erythema multiforme and myocarditis were ruled out, a drug-induced allergic reaction was suspected. Positive MIF test for ampicillin showed sensitization of the patient's lymphocytes to ampicillin. CONCLUSIONS: Hypersensitivity myocarditis is a rare and dangerous manifestation of allergy to penicillins.

Adolescent

Food allergy in infants and children: clinical evaluation and management.

A total of 122 infants and children up to age 17 (69 males and 53 females) who were referred for food allergy to the Pediatric Allergy and Clinical Immunology Unit were evaluated by complete history, emphasizing the implicated foods, clinical presentation and involvement of various organ systems, physical examination, and prick skin tests to food allergens. Fourteen infants with a history of egg white allergy and positive skin tests to egg white also underwent skin tests (prick and intradermal in 1:100 dilution) to measles-mumps-rubella (MMR) vaccine; 35 children under 3 years old had 41 oral challenges with the suspected foods; and 9 children over 3 years old had 12 oral challenges with the suspected foods. We found that cow milk/humanized milk formula, egg white, soybean, and peanut are the main allergenic foods in the pediatric population. Thirteen children had 13 positive oral challenges: 12 to cow milk/humanized milk formula and one to egg white. Symptoms reproduced by oral challenges included urticarial and erythematous rash, conjunctival itching, angioedema, abdominal pain, vomiting, diarrhea, and rhinorrhea. No anaphylactic shock was reported. Negative skin test has an excellent predictive accuracy for negative oral challenge with the suspected food in children > 3 years old. The negative predictive accuracy of cow milk skin test in children < 3 years was 73%. Positive skin test is not a good predictor of a clinical reaction to food. Oral food challenge performed cautiously in a medical setting is the "gold standard" for diagnosis. MMR vaccine can be safely administered to infants with egg white allergy after skin tests with the vaccine are performed.

Administration, Oral