Surface Titrations of Perlite Suspensions

The surface charge behaviour of unexpanded and expanded perlite samples in KNO3 and NaCl solutions were investigated as a function of pH and ionic strength. The solutions of KNO3 and NaCl ranging from 10(-3) to 1.0 M were used. The potentiometric titration method was used to determine the surface charge of perlite samples. It was confirmed that the perlite samples had no the point of zero charge and was negatively charged in the pH range of 3-10. The double extrapolation method was used for determining the intrinsic equilibrium constants for simple ionization and complex ionization reactions. The values obtained are pKinta2 = 2.5 and p*KintK+ = 2.3 in KNO3 solutions and pKinta2 = 3.0 and p*KintNa+ = 2.4 in NaCl solutions for unexpanded perlite, and pKinta2 = 2.6 and p*KintK+ = 2.4 in KNO3 solutions and pKinta2 = 2.7 and pKintNa+ = 2.4 in NaCl solutions for expanded perlite. Copyright 1998 Academic Press.

Schistosomiasis presenting as acute appendicitis in a traveler

Schistosomiasis, a waterborne trematode infestation, is one of the most widespread parasitic diseases in the world. It occurs in well-defined endemic geographical areas. Schistosomiasis of the appendix was first described by Turner in 1909, and has been reported from endemic areas. However, appendicular schistosomiasis in travelers has not been reported in the English literature. We describe an Israeli traveler with acute appendicitis as the presenting symptom of schistosomiasis, 2 years after a visit to Africa.

Imported severe falciparum malaria in Israel

Malaria remains an overwhelming problem in tropical developing countries, with 300 to 500 million new cases and 1.5 to 3.5 million deaths per year. Malaria is a potentially life-threatening disease for travelers to the tropics. Imported malaria is an important clinical problem in nonendemic areas of the world because of increasing numbers of travelers, overseas workers, and immigrants from endemic areas. According to the World Health Organization's criteria, the recognition of one or more of the following clinical features should raise the suspicion of severe malaria: cerebral malaria (unrousable coma), severe anemia (hemoglobin <5 g/dL), renal failure (serum creatinine >3 mg/dL), pulmonary edema or adult respiratory distress syndrome, hypoglycemia (glucose <40 mg/dL), circulatory collapse or shock, disseminated intravascular coagulation, repeated generalized convulsions, acidosis (pH <7.25), macroscopic hemoglobinuria, hyperparasitemia (>5 percent of the erythrocytes infested by parasites), or jaundice (bilirubin >3 mg/dL). Although only a small proportion of patients with malaria develops severe manifestations, these patients require the most urgent and intensive care. Mortality among patients with cerebral malaria, even when treated in modern intensive care units, exceeds 30%, and when complicated by the adult respiratory distress syndrome, it may approach 80%. Among travelers, mortality remains a serious issue because of failure to obtain and use preventive measures, delay in seeking medical attention, and misdiagnosis.

Antibodies to mycoplasma fermentans in HIV-positive heterosexual patients: seroprevalence and association with AIDS

There are conflicting reports concerning the prevalence of Mycoplasma fermentans in HIV-positive patients and its association with AIDS. Serum antibodies to M. fermentans were measured by a modified immunoblotting technique in 48 HIV-positive heterosexual patients and in 30 HIV-negative heterosexual controls. Antibodies to M. fermentans were detected in 19 (40%) of HIV-positive patients and in three (10%) of the HIV-negative controls (P = 0.01). The prevalence of antibodies to Mycoplasma hominis and to Ureaplasma urealyticum was similar in both groups. In the HIV-positive group, 16/19 (84%) M. fermentans-positive patients developed AIDS, compared to eight of 29 (28%) M. fermentans-negative patients (P = 0.0004). The HIV-positive patients with antibodies to M. fermentans had a lower CD4+ cell count and a higher prevalence of antibodies to the other mycoplasma tested (P = 0.007 and P = 0.03, respectively), as compared to the patients without antibodies to M. fermentans. These findings may suggest that the presence of antibodies to M. fermentans indicate an opportunistic infection. Of the 19 M. fermentans-positive patients, 11 were positive on the first examination, and eight became positive during the follow-up period. Seven out of these eight patients developed antibodies to M. fermentans before the development of AIDS. Therefore, the possibility exists that M. fermentans might influence the development of AIDS.

Impaired neutrophil functions in patients with leukocytoclastic vasculitis

BACKGROUND

Leukocytoclastic vasculitis (LV) is characterized by segmental inflammation of small blood vessels, resulting in ischemic damage to the surrounding tissue. It is considered to be related to a type III hypersensitivity reaction, although the exact etiologic mechanism is not clear.

OBJECTIVE

The purpose of this study was to evaluate neutrophil functions in patients with LV in order to understand their role in the pathogenesis of the disease.

METHODS

Neutrophil functions were examined in 25 LV patients. The patients were divided into two groups: Group A consisted of 14 patients with drug-induced LV and Group B consisted of 11 patients where LV was induced by other factors.

RESULTS

Both groups of patients showed significantly reduced chemotaxis and phagocytosis. Superoxide generation was significantly lower (P < 0.001) only in neutrophils from patients in Group A: 5.8 +/- 0.5 nmoles O2/10(6) cells/min compared to 9.08 +/- 0.8 nmoles O2/10(6) cells/min in the controls. Preincubation on normal neutrophils with the patients' sera caused an increase in their superoxide generation in accordance with the high IL-8 levels in these sera.

CONCLUSIONS

Neutrophil functions were significantly impaired in patients with LV. It is likely that factors present in LV plasma may chronically activate neutrophils, so that they become refractory to further stimulation. Our study showed that neutrophil superoxide generation is low only in drug-induced LV; this test may assist in distinguishing such patients from those with LV induced by other causes.

Pleural empyema caused by Leuconostoc spp

A rare case of pleural empyema caused by Leuconostoc spp. is reported. The patient was treated successfully with clindamycin. To our knowledge this is the first reported case of pleural empyema caused by Leuconostoc spp. In a patient with characteristic predisposing factors, such as a serious underlying disease, previous vancomycin therapy and thoracic access device. Our case illustrates that Leuconostoc spp. can cause pleural infection as further evidence of its human pathogenicity.

'Travelers' thyrotoxicosis'. Transitory thyrotoxicosis induced by iodinated preparations for water purification

Two young adults presented with thyrotoxicosis after increased iodide ingestion in the course of backpacking trips to Central and South America, during which each of them used an iodinated preparation for water purification. In both cases, serologic tests were positive for antithyroid peroxidase antibodies, and one had a family history of immune thyroid disease. We suggest that in these two cases the condition was a variant of iodide-induced thyrotoxicosis, reflecting an inadequate response to iodide excess in association with a presumed preexisting asymptomatic immune thyroid disease. This observation adds a new consideration for travelers' consultation.

Musculoskeletal manifestations of brucellosis: a study of 90 cases in Israel

Rheumatological manifestations are frequently reported in patients with brucellosis. In a retrospective study of 90 patients diagnosed with brucellosis over a period of 18 years, 83 (92%) patients were Bedouins, 55 of whom (61%) reported ingestion of unpasteurized goat milk and goat milk products. The male/female ratio was 1:1, and the adult to child ratio was 3:2. The mean age of the patients was 25 years (range, 1-72 years). Rheumatological manifestations (myalgia, arthralgia, and arthritis) were reported in more than half of the patients. These manifestations started on days 3 and 4 of the disease and were mild to moderate in severity. Myalagia was evident in 49 (54%) patients and was more common in adults than in children (67% versus 37%; P < .01) and in men (67%) than in women (42%; P < .01). Arthralgia was the most common musculoskeletal manifestation, found in 55 (61%) patients, and occurred more often in children than in adults (74% versus 52%; P < .05). Arthritis was detected in 37 (41%) patients. The hip and knee joints were the most common sites of arthritis (31% each) followed by sacroiliac involvement (17%) and shoulder or spine involvement (5% each). Arthritis was also more common in children (63% versus 29%; P < .01). The prevalence of arthritis was similar in men and women. Cure was achieved in all patients after antibiotic therapy.

[A national qualifying internal medicine examination for Israeli medical students]

In 1991 the deans of the 4 medical schools in Israel decided to institute a national qualifying examination in internal medicine. This marked the beginning of the process of unifying the qualifying examinations in all major medical fields. We describe the development of the examination, experience with its administration to 720 students in 1992-1994, and the outcome of this initial effort. The examinations were prepared by a committee of senior faculty from the 4 schools, representing all the relevant clinical areas. Professional consultation was provided by the Unit for Medical Education of Tel Aviv University. Each examination consisted of 180 multiple choice items, reflecting an agreed representation of the various medical specialties, and was designed to test both comprehension and problem-solving ability. A syllabus was published by the committee and distributed to students and faculty in preparation for the examination. In composing the examination, the committee took into consideration differences in general policy and varying emphases in the curricula of the 4 schools. Analysis of the results of the 3 annual examinations showed both a high level of reliability and high quality of the majority of the individual test items. There was a trend with time to slightly lower average scores, and fewer passed the exam last year. There was improvement in the results after the first 2 years in the area of problem-solving related to interpretation of imaging, blood smears and clinical photographs, but this trend did not continue into 1994. The introduction of a high level examination based on a common syllabus provided important feedback, improving both student motivation and clinical teaching. For all schools, the outcome of the examination served as an important external indicator of teaching standards. Following this positive experience, uniform examinations in surgical subjects and pediatrics were introduced for the first time in 1993. The committee recommends that Israeli medical schools gradually introduce a comprehensive qualifying examination based on a mutually agreed list of objectives and syllabus.

Streptococcal group C bacteremia. Survey in Israel and analytic review

BACKGROUND

Data concerning group C streptococcal bacteremia come mainly from case reports; thus, population-based studies from different geographic areas are needed to validate these findings.

METHODS

Eight years of data on group C streptococcal infection in Israel and cases of bacteremia in five hospitals were reviewed. We compared data from our survey as well as from other population-based studies with multiple cases published as case reports.

RESULTS

The organisms were isolated in 78 cases (excluding pharyngitis); 16 had bacteremia. Ten cases of bacteremia were reviewed in five hospitals; none of the patients reported exposure to animals, and nine had severe underlying diseases. The clinical syndromes included four cases of primary bacteremia, four cutaneous infections, and one case each of meningitis and pneumonia. There were two deaths, one patient underwent amputation of a toe, one had a stroke, and one had a relapse. We compared 80 cases published as case reports with 59 cases reported in five population-based studies from different countries. We found higher rates of underlying diseases, alcohol abuse, liver diseases, and cutaneous infections, and lower rates of exposure to animals or raw products, endovascular infections, and central nervous system infections in population-based studies. Morbidity and mortality were 20% to 30% each in both types of studies.

CONCLUSIONS

Group C streptococcal bacteremia affects patients with underlying diseases; exposure to animals is variable and less frequent than previously reported. Morbidity and mortality are high and probably reflect the patients' underlying state as well as the severity of the infection.

Immigration of Ethiopians with typhoid fever to Israel: apparent lack of influence on the local population

The epidemiology of typhoid fever in Western countries may be affected by immigration from developing countries. We studied the immigration of Ethiopian Jews to Israel to find the effects of an influx of many individuals infected with typhoid into an area with a low incidence of the disease. Typhoid fever affected 204 Israelis and 121 (1.1%) of 10,654 Ethiopian immigrants during the period of 1984-1985. Of those Ethiopian cases, 107 occurred during a 3-month period. During the 5 months following that 3-month period, there was no increase in the number of cases of typhoid among Israelis. Although after that time there was a local waterborne outbreak of typhoid that affected 83 Israelis, no Ethiopians resided in the area where the outbreak occurred; therefore, we concluded that these 83 cases of typhoid fever were not related to the immigration of Ethiopians into Israel. In fact, if those 83 cases were excluded from the statistical analysis, there was no increase in the occurrence of typhoid during the 2-year period studied. Therefore, the immigration of many people with typhoid into an area of low incidence does not necessarily confer a risk of infection to the local population.

Superoxide production by neutrophils from trauma patients: regulation of NADPH oxidase activity

The production of free oxygen radicals by polymorphonuclear cells (PMNs) was studied in 25 patients after blunt trauma. Superoxide generation significantly increased immediately after trauma and returned to normal soon after the event. Patients were subsequently divided into two groups: those who developed sepsis and those who did not develop infectious complications. Superoxide production by intact PMNs following stimulation by three different stimulants was initially not different in trauma patients who developed sepsis. Follow-up showed an increase in superoxide production when infection complicated the course of trauma patients. Further studies were performed in a cell-free system containing cell membranes and cytosol from patients or healthy controls. No difference in the production of superoxide was found when membranes from trauma patients or controls were mixed with cytosols from controls. When cytosols from patients were mixed with membranes from controls, a significant increase in superoxide production was observed in the group that developed sepsis. Immunoblotting analysis of two protein components of the cytosolic portion of the NADPH oxidase, p47 and p67, were done. The increase in quantity of p47 correlated with the increase in superoxide production during sepsis, and thus may be the major contributor to the high activity.

An outbreak of foodborne streptococcal throat infection

Streptococcal pharyngitis is a common disease of epidemic nature, usually transmitted by saliva droplets. We present an epidemiologic analysis of an outbreak of streptococcal pharyngitis in a military unit involving 75 soldiers. The causing organism was Streptococcus pyogenes (group A beta hemolytic Streptococcus, T28 M56), which was isolated from 53 affected individuals. The source of the epidemic was probably an army cook. The infection was transferred by a cabbage salad to individuals who became symptomatic within 24-48 h. This epidemic is a reminder of an exceptional route of streptococcal dissemination and one of the largest outbreaks of foodborne streptococcal pharyngitis documented.

Cefuroxime prophylaxis in biliary surgery: single versus triple dose

The standard regimen for prophylaxis in bilary surgery consists of three doses of a first- or second-generation cephalosporin (one pre- and two postoperatively). The purpose of our study was to compare a single dose of cefuroxime (1.5 gi.v. on call to surgery) with the standard regimen (1.5 gi.v. on call to surgery followed by two additional doses of 750 mg i.v. each, 8 and 16 h after surgery). One hundred patients participated in the study, 44 in the single-dose group and 56 in the triple-dose group. These two groups did not differ with regard to sex, risk factors, duration of surgery, etc. The incidence of infection was 9% in the single-dose group and 7% in the triple-dose group. We conclude that one dose of cefuroxime is as effective as three for biliary surgery. This regimen would reduce the risk of side effects and/or suprainfections and the emergence of resistant strains of bacteria. It is also more convenient for the nursing staff and reduces the cost by one-half.

Health education for the Ethiopian community in the Negev

The importance of health education as part of health enhancement programs is well accepted. The encounter with the Ethiopian Jews introduced a new set of problems, requiring a novel approach to old concepts. A project that was carried out during the last decade is presented. Three target populations were identified: the Ethiopian population with 851 participants, medical and community teams with 843 participants, and 138 Ethiopian instructors. An effort was made to make the interaction between these groups more coherent. The project included 65 series of activities: lectures, workshops, staff meetings and conferences. The major topics included medical, emotional, anthropological and behavioral issues. The project was initiated for immigrants of Operation Moses (1984-85), and reinforced in Operation Solomon (1991). A follow-up is presently underway to aid in the absorption of this unique community.

Typhoid fever in Ethiopian immigrants to Israel and native-born Israelis: a comparative study

Typhoid fever remains a major cause of mortality in developing countries, with a case-fatality rate (CFR) of 12%-32%, whereas in developed countries this rate has successfully been reduced to < 2%. The cause of this high CFR in developing countries was investigated by studying two populations of patients who had typhoid fever during the years 1984-1985: Ethiopian Jews who were infected in Africa (a region with a high CFR) and treated in Israel (a region with a low CFR) and native-born Israelis. The causative organisms were of similar phage types. Among 121 Ethiopian Jews there were two fatalities (CFR, 1.65%), and among 204 native-born Israelis there were three fatalities (CFR, 1.47%). Findings of the clinical course and treatment were similar for 15 Ethiopian Jews and 14 native-born Israelis and consistent with those of reports from developed countries. We conclude that the high CFR for typhoid fever in Africa is due to delayed hospitalization and treatment rather than to differences in host factors or in the virulence of the pathogen and that mortality can be reduced by hastening hospitalization and treatment.

Arrangement of DYZ1 and DYZ2 repeats on the human Y-chromosome: a case with presence of DYZ1 and absence of DYZ2

The composition of Yq-heterochromatin is dominated by the two repetitive sequences DYZ1 (4000 copies) and DYZ2 (2000 copies). Probes derived from these sequences can be used for sex determination and the structural analysis of aberrant Y-chromosomes. Using such probes Schmid et al., have recently proposed a regular interspersion of the two sequences in a ratio of 2:1 over the entire Yq12 chromosome region. By Southern analysis we investigated the DNA of a normal male, cytogenetically negative for Yq-heterochromatin. Applying the same probes as used by Schmid et al., only a small amount of DYZ1 material could be detected. The case presented indicates the presence of DYZ1 only in the Yq11-Yq12 junction region and excludes DYZ2 from any function relevant for normal male development.

Paternal origin of the de novo deleted chromosome 4 in Wolf-Hirschhorn syndrome

The parental origin of the de novo deleted chromosome 4 was studied in five cases of Wolf-Hirschhorn syndrome using polymorphic probes mapping in the 4p16.3 region. In all the patients the deleted chromosome was found to be of paternal origin and these results, together with similar ones obtained by another group, make the preferential paternal origin of the de novo chromosome 4 deletion highly significant.

Salmonella neck abscess associated with jugular vein thrombosis

An unusual case of synergistic infection caused by Salmonella paratyphi and anaerobic streptococcus resulting in necrotizing cervical infection associated with deep neck abscess and internal jugular vein thrombosis, is presented. Salmonella acting as an oxygen consumer in the infected tissues, facilitates the growth of anaerobic cocci, hence the development of a devastating soft tissue infection. The precipitating cause was a tonsillar infection developing due to 'post-anginal sepsis'. The aetiopathogenesis of the cervical infection is discussed.

Association between haplotypes and specific mutations in Swiss cystic fibrosis families

Cystic fibrosis (CF) is the most common severe autosomal recessive genetic disorder in Caucasian populations, with an incidence of about 1 in 2000 live births, implying a carrier frequency of about 1 in 22. In 1989, the CF gene was isolated and characterized and the major mutation (delta F508), a 3-bp deletion that results in the loss of a phenylalanine residue at position 508, was detected. To determine the frequency of the delta F508 mutation and the predicted number of additional mutations in our population, we have undertaken a collaborative study of 215 CF patients and 175 CF parents in Switzerland. The delta F508 mutation in exon 10 has been found in 70% of the CF chromosomes, and the exon-11 mutation R553X seems to be the second most common CF mutation in our population, with a frequency of 5.3%, whereas the G551D mutation (also in exon 11) has not been detected at all. Haplotype determination of 430 CF and 175 normal chromosomes using XV-2c, KM19, MP6d-9, and J3.11 has been proven to be very helpful in providing additional carrier risk calculations: Haplotypes 1 (1221), 2 (1222), 6 (2111), and 7 (2221) increase the risk of being a carrier from 1 in 55 (haplotype 6) to 1 in 17 (haplotype 1), whereas haplotypes 3 (1122), 4 (1112), 8 (2222) and 10 (1111) lower the risk from 1 in 144 (haplotype 3) to 1 in 1678 (haplotype 10). Moreover, the mutation R553X shows strong correlation with haplotype 3, leading to the suggestion that haplotypes 1, 2, 5, and 6 may account for four additional mutations in Switzerland.(ABSTRACT TRUNCATED AT 250 WORDS)

Tuberculosis in Israel: a 10-year survey of an immigrant society

Over a 10-year period (1978-87), 279 tuberculosis (TB) patients were diagnosed at the Soroka Medical Center. Of these, 48% were Ethiopian Jews, 28% Bedouin Arabs, and 24% were Jews of other origins. The Bedouin and Ethiopian patients were younger and had fewer concomitant diseases. The Ethiopian patients were hospitalized longer than other patients. Ethiopian and Bedouin patients were less compliant with therapy. There were 187 cases of pulmonary TB (67%), and 92 cases of extrapulmonary TB (33%). The majority of the Bedouin and Ethiopian patients had pulmonary tuberculosis, while extrapulmonary TB was more frequent among the rest of the patients. It is concluded that TB in the Negev reflects the diversity of its population, with characteristics of both a developing and a developed country.