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Sorotzky M, Raphael A, Breuer A, Odeh M, Gillis R, Gillis M, Shibli R, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Mendelovich J, Weiser G, Berliner E, Barak-Corren Y, Heiman E. Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01965-7. [PMID: 38457104 DOI: 10.1007/s40615-024-01965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity. METHODS A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA). RESULTS Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms. CONCLUSION This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.
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Affiliation(s)
- Michael Sorotzky
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel.
| | - Allon Raphael
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Ma'aran Odeh
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roni Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Michal Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roaia Shibli
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Judith Fiszlinski
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Mendelovich
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elihay Berliner
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yuval Barak-Corren
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Predictive Medicine Group, Boston Children's Hospital, Boston, USA
| | - Eyal Heiman
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
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Raphael A, Schlesinger Y, Nir A. Sinus arrest during respiratory syncytial virus bronchiolitis: A report of two cases and literature review. Pediatr Pulmonol 2023; 58:3330-3332. [PMID: 37417816 DOI: 10.1002/ppul.26589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/04/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Allon Raphael
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Wilf Children Hospital, Shaare Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Amiram Nir
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
- Pediatric Cardiology and Adult Congenital Heart Disease Unit, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Ben Shoham A, Schlesinger Y, Miskin I, Kalderon Z, Michaelson-Cohen R, Wiener-Well Y. Correction: Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. Isr J Health Policy Res 2023; 12:23. [PMID: 37231490 DOI: 10.1186/s13584-023-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Assaf Ben Shoham
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel.
| | - Yechiel Schlesinger
- Wilf Children's Hospital, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ian Miskin
- Clalit Health Services, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ziva Kalderon
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel
| | - Rachel Michaelson-Cohen
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonit Wiener-Well
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben Shoham A, Schlesinger Y, Miskin I, Kalderon Z, Michelson-Cohen R, Wiener-Well Y. Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. Isr J Health Policy Res 2023; 12:16. [PMID: 37098565 PMCID: PMC10131385 DOI: 10.1186/s13584-023-00566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/20/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Maternal CMV infection during pregnancy, either primary or non-primary, may be associated with fetal infection and long-term sequelae. While guidelines recommend against it, screening for CMV in pregnant women is a prevalent clinical practice in Israel. Our aim is to provide updated, local, clinically relevant, epidemiological information about CMV seroprevalence among women at childbearing age, the incidence of maternal CMV infection during pregnancy and the prevalence of congenital CMV (cCMV), as well as to provide information about the yield of CMV serology testing. METHODS We performed a descriptive, retrospective study of women at childbearing age who were members of Clalit Health Services in the district of Jerusalem and had at least one gestation during the study period (2013-2019). We utilized serial serology tests to determine CMV serostatus at baseline and at pre/periconception and identified temporal changes in CMV serostatus. We then conducted a sub-sample analysis integrating inpatient data on newborns of women who gave birth in a single large medical center. cCMV was defined as either positive urine CMV-PCR test in a sample collected during the first 3 weeks of life, neonatal diagnosis of cCMV in the medical records, or prescription of valganciclovir during the neonatal period. RESULTS The study population Included 45,634 women with 84,110 associated gestational events. Initial CMV serostatus was positive in 89% women, with variation across different ethno-socioeconomic subgroups. Based on consecutive serology tests, the detected incidence rate of CMV infection was 2/1000 women follow-up years, among initially seropositive women, and 80/1000 women follow-up years, among initially seronegative women. CMV infection in pregnancy was identified among 0.2% of women who were seropositive at pre/periconception and among 10% of women who were seronegative. In a subsample, which included 31,191 associated gestational events, we identified 54 newborns with cCMV (1.9/1000 live births). The prevalence of cCMV among newborns of women who were seropositive at pre/periconception was lower than among newborns of women who were seronegative (2.1 vs. 7.1/1000). Frequent serology tests among women who were seronegative at pre/periconception detected most primary CMV infections in pregnancy that resulted in cCMV (21/24). However, among women who were seropositive, serology tests prior to birth detected none of the non-primary infections that resulted in cCMV (0/30). CONCLUSIONS In this retrospective community-based study among women of childbearing age characterized by multiparity and high seroprevalence of CMV, we find that consecutive CMV serology testing enabled to detect most primary CMV infections in pregnancy that led to cCMV in newborns but failed to detect non-primary CMV infections in pregnancy. Conducting CMV serology tests among seropositive women, despite guidelines' recommendations, has no clinical value, while it is costly and introduces further uncertainties and distress. We thus recommend against routine CMV serology testing among women who were seropositive in a prior serology test. We recommend CMV serology testing prior to pregnancy only among women known to be seronegative or women whose serology status is unknown.
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Affiliation(s)
- Assaf Ben Shoham
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel.
| | - Yechiel Schlesinger
- Wilf Children's Hospital, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ian Miskin
- Clalit Health Services, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ziva Kalderon
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel
| | - Rachel Michelson-Cohen
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonit Wiener-Well
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Eldar-Yedidia Y, Ben-Shalom E, Hillel M, Belostotsky R, Megged O, Freier-Dror Y, Frishberg Y, Schlesinger Y. Association of post-transplantation anellovirus viral load with kidney transplant rejection in children. Pediatr Nephrol 2022; 37:1905-1914. [PMID: 34999988 DOI: 10.1007/s00467-021-05336-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/14/2021] [Accepted: 10/14/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Post-transplantation immunosuppressive therapy reduces the risk of graft rejection but raises the risk of infection and malignancy. A biomarker of the level of immunosuppression can be helpful in monitoring immunosuppressive therapy. Inverse correlation between Torque teno virus (TTV) from the Anelloviridae (AV) family load and immune competence was described in previous studies. The aim of this study was to analyze the association between AV family viruses' kinetics and the risk for graft rejection in the first year after kidney transplantation in children. METHODS The titers of three genera (TTV, TTMDV, and TTMV) from the AV family were monitored by real-time PCR in consecutive samples from children before and after kidney transplantation. RESULTS Twenty-one children who underwent kidney transplantation were enrolled. Five out of 21 patients experienced acute graft rejection within a year from transplantation. We found that in patients who experienced graft rejection, the median titers of TTV and total AV titers at 5-6 months post-transplantation were lower than in those who did not. Using a threshold determined by ROC analysis, significant differences in TTV and total AV load were found between patients who had or did not have graft rejection (p = 0.002 and 0.004, respectively). No association was found between the dominance of any AV genus titer and the likelihood of rejection. CONCLUSION This pilot study suggests that children after kidney transplantation with low TTV and total AV titers 5-6 months post-transplantation are at increased risk for graft rejection within a year after transplantation. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Yifat Eldar-Yedidia
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel.
| | - Efrat Ben-Shalom
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Miriam Hillel
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel
| | - Ruth Belostotsky
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Yaacov Frishberg
- Pediatric Nephrology Institute, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School Jerusalem, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yechiel Schlesinger
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hadassah - Hebrew University Medical School, 12 Beit Shmuel Street, 91031, Jerusalem, Israel.,Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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Breuer A, Raphael A, Stern H, Odeh M, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Barak‐Corren Y, Heiman E. SARS-CoV-2 antibodies started to decline just four months after COVID-19 infection in a paediatric population. Acta Paediatr 2021; 110:3054-3062. [PMID: 34265136 PMCID: PMC8444680 DOI: 10.1111/apa.16031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
Aim We evaluated the prevalence of paediatric severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections using antibody testing and characterised antibody titres by time from exposure. Methods This was a single‐centre, prospective, cross‐sectional cohort study. Patients under 18 years old were eligible to participate if they attended the paediatric emergency department at the tertiary Shaare Zedek Medical Center, Jerusalem, Israel, from 18 October 2020 to 12 January 2021 and required blood tests or intravenous access. SARS‐CoV‐2 seropositivity and antibody levels were tested by a dual‐assay model. Results The study comprised 1138 patients (56% male) with a mean age of 4.4 years (interquartile range 1.3–11.3). Anti‐SARS‐CoV‐2 antibodies were found in 10% of the patients. Seropositivity increased with age and 41% of seropositive patients had no known exposure. Children under 6 years of age had higher initial antibody levels than older children, followed by a steeper decline. The seropositivity rate did not vary during the study, despite schools re‐opening. The findings suggest that children's immunity may start falling 4 months after the initial infection. Conclusion Immunity started falling after just 4 months, and re‐opening schools did not affect infection rates. These findings could aid decisions about vaccinating paediatric populations and school closures.
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Affiliation(s)
- Adin Breuer
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Allon Raphael
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Hagay Stern
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Ma'aran Odeh
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Judith Fiszlinski
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Orli Megged
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yechiel Schlesinger
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yuval Barak‐Corren
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Predictive Medicine Group Boston Children's Hospital Boston Massachusetts USA
| | - Eyal Heiman
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Emergency Department Shaare Zedek Medical Center Jerusalem Israel
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Yinnon AM, Gabay D, Raveh D, Schlesinger Y, Slotki I, Attias D, Rudensky B. Comparison of Peritoneal Fluid Culture Results from Adults and Children Undergoing Capd. Perit Dial Int 2020. [DOI: 10.1177/089686089901900109] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities. Objective To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities. Design Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD. Results We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2 ± 3.5, range 1 – 15) compared to 187 in adults (2.1 ± 1.9, range 1 – 10) ( p < 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) ( p < 0.001). The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8 ± 2.3, range 1 – 12; and 5.3 ± 5.2, range 1 – 27) than in adults (2.0 ± 1.3, range 1 – 6; and 2.7 ± 2.4, range 1 – 10) ( p < 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children ( p < 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults ( p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children ( p < 0.01), whereas S. aureus occurred more often in adults ( p < 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults ( p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults ( p < 0.05 – 0.001). Conclusions CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
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Affiliation(s)
- Amos M. Yinnon
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Dorit Gabay
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - David Raveh
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Yechiel Schlesinger
- Infectious Diseases Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Itzchak Slotki
- Nephrology Unit, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Denise Attias
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Bernard Rudensky
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center and Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Ginsberg GM, Somekh E, Schlesinger Y. Should we use Palivizumab immunoprophylaxis for infants against respiratory syncytial virus? - a cost-utility analysis. Isr J Health Policy Res 2018; 7:63. [PMID: 30554570 PMCID: PMC6296113 DOI: 10.1186/s13584-018-0258-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Passive immunization against RSV (Respiratory Syncytial Virus) is given in most western countries (including Israel) to infants of high risk groups such as premature babies, and infants with Congenital Heart Disease or Congenital Lung Disease. However, immunoprophylaxis costs are extremely high ($2800-$4200 per infant). Using cost-utility analysis criteria, we evaluate whether it is justified to expand, continue or restrict nationwide immunoprophylaxis using palivizumab of high risk infants against RSV. METHODS Epidemiological, demographic, health service utilisation and economic data were integrated from primary (National Hospitalization Data, etc.) and secondary data sources (ie: from published articles) into a spread-sheet to calculate the cost per averted disability-adjusted life year (DALY) of vaccinating various infant risk groups. Costs of intervention included antibody plus administration costs. Treatment savings and DALYs averted were estimated from applying vaccine efficacy data to relative risks of being hospitalised and treated for RSV, including possible long-term sequelae like asthma and wheezing. RESULTS For all the groups RSV immunoprophylaxis is clearly not cost effective as its cost per averted DALY exceeds the $105,986 guideline representing thrice the per capita Gross Domestic Product. Vaccine price would have to fall by 48.1% in order to justify vaccinating Congenital Heart Disease or Congenital Lung Disease risk groups respectively on pure cost-effectiveness grounds. For premature babies of < 29 weeks, 29-32 and 33-36 weeks gestation, decreases of 36.8%, 54.5% and 83.3% respectively in vaccine price are required. CONCLUSIONS Based solely on cost-utility analysis, at current price levels it is difficult to justify the current indications for passive vaccination with Palivizumab against RSV. However, if the manufacturers would reduce the price by 54.5% then it would be cost-effective to vaccinate the Congenital Heart Disease or Congenital Lung Disease risk groups as well as premature babies born before the 33rd week of gestation.
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Affiliation(s)
- Gary M. Ginsberg
- Department of Technology Assessment, Public Health Service, Ministry of Health, Jerusalem, Israel
| | - Eli Somekh
- Department of Pediatrics, Wolfson Hospital, Holon, and Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- European Paediatric Association/Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaarae Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Gilboa Y, Frenkel TI, Schlesinger Y, Rousseau S, Hamiel D, Achiron R, Perlman S. Visual biofeedback using transperineal ultrasound in second stage of labor. Ultrasound Obstet Gynecol 2018; 52:91-96. [PMID: 29155474 DOI: 10.1002/uog.18962] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 10/29/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess the obstetric and psychological effects of visual biofeedback by transperineal ultrasound (TPU) during the second stage of labor. METHODS This was a prospective, single-center observational study of low-risk nulliparous women with epidural analgesia undergoing vaginal delivery. Visual biofeedback using TPU was provided to 26 women during the second stage of labor. Pushing efficacy was assessed by the change in the angle of progression (AoP) at rest and during pushing efforts, before and after biofeedback. Obstetric outcomes included incidence of perineal tearing, mode of delivery and length of second stage of labor. Psychological outcomes were assessed by self-reported measures obtained during the postnatal hospital stay and included measures of perceived control and maternal satisfaction with childbirth, as well as level of maternal feelings of connectedness with the newborn. Obstetric and psychological results were compared with those of a control group of 69 women who received standard obstetric coaching from midwives. RESULTS Pushing efficacy increased significantly following visual biofeedback by TPU (P = 0.01), as indicated by a significantly lower delta AoP before (mean, 22.2° (95% CI, 13.9-31.7°)) compared with after (mean, 35.2° (95% CI, 25.9-45.3°)) biofeedback. A significant association was found between visual biofeedback and an intact perineum following delivery (P = 0.03). No significant differences were found between the two groups with regard to mode of delivery or length of the second stage. Feelings of maternal connectedness with the newborn were significantly stronger (P = 0.003) in women who received visual biofeedback than in those who did not. However, perceived control during childbirth and maternal satisfaction with childbirth did not differ significantly between the biofeedback and control groups. CONCLUSIONS This pilot study suggests that biofeedback using TPU may serve as a complementary tool to coached maternal pushing during the second stage of labor, with obstetric as well as psychological benefits. Further studies are required to confirm our findings and define the optimal duration of the intervention. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Y Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Ha-Shomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T I Frenkel
- Ziama Arkin Infancy Institute, Interdisciplinary Center (IDC), Herzliya, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - Y Schlesinger
- Ziama Arkin Infancy Institute, Interdisciplinary Center (IDC), Herzliya, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - S Rousseau
- Ziama Arkin Infancy Institute, Interdisciplinary Center (IDC), Herzliya, Israel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
| | - D Hamiel
- Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel
- Cohen Harris Resilience Center, Tel Aviv, Israel
- Tel Aviv Brill Community Mental Health Center, Clalit Health Services, Israel
| | - R Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Ha-Shomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Ha-Shomer, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Eldar-Yedidia Y, Hillel M, Cohen A, Bar-Meir M, Freier-Dror Y, Schlesinger Y. Association of toll-like receptors polymorphism and intrauterine transmission of cytomegalovirus. PLoS One 2017; 12:e0189921. [PMID: 29267374 PMCID: PMC5739442 DOI: 10.1371/journal.pone.0189921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 12/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Congenital Cytomegalovirus (CMV) is a very common intrauterine infection which can cause severe developmental disabilities. Transmission of the virus to the fetus occurs in only 40% of primarily infected women. The probability of intrauterine transmission is higher when infection occurs during the second trimester of pregnancy than in the first trimester. The Toll-like receptors (TLRs) protein family plays a key role in both innate immune response to CMV infections and in normal pregnancy. Specific single nucleotide polymorphisms (SNPs) in TLRs can affect CMV infections and maternal-fetal interface expression. Therefore, TLR SNPs could be involved in intrauterine transmission determination. STUDY AIM To establish a correlation between TLR2 (rs4696480, rs3804100, rs1898830), TLR3 (rs3775291) and TLR7(rs179008) SNPs with CMV intrauterine transmission during the first and second trimester. METHODS SNPs of 83 pregnant women with primary CMV were analyzed by Real-Time PCR and PCR-RFLP assay and compared to intrauterine transmission state. RESULTS Women bearing the GG genotype in the rs1898830 TLR2 SNP who were infected with CMV during the second trimester did not transmit the virus to the fetus. Likewise, in the co-dominant or recessive models of this SNP, a significant association was found between the genotypes and CMV intrauterine transmission. In all cohort women or in women infected during the first trimester, no such associations were found between the tested SNPs and intrauterine transmission of the virus. CONCLUSION Women bearing the GG genotype in the rs1898830 SNP, who are infected with CMV during the second trimester of pregnancy, have a low likelihood of transmitting the virus to the fetus.
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Affiliation(s)
- Yifat Eldar-Yedidia
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
| | - Miriam Hillel
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
| | - Amitay Cohen
- Hadassah- Hebrew University Medical School, Jerusalem, Israel
| | - Maskit Bar-Meir
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Yechiel Schlesinger
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- * E-mail:
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11
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Wolach B, Gavrieli R, de Boer M, van Leeuwen K, Berger-Achituv S, Stauber T, Ben Ari J, Rottem M, Schlesinger Y, Grisaru-Soen G, Abuzaitoun O, Marcus N, Zion Garty B, Broides A, Levy J, Stepansky P, Etzioni A, Somech R, Roos D. Chronic granulomatous disease: Clinical, functional, molecular, and genetic studies. The Israeli experience with 84 patients. Am J Hematol 2017; 92:28-36. [PMID: 27701760 DOI: 10.1002/ajh.24573] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 12/31/2022]
Abstract
Chronic granulomatous disease (CGD) is an innate immunodeficiency with a genetic defect of the nicotinamide adenosine dinucleotide phosphate, reduced, oxidase components. This leads to decreased reactive oxygen species (ROS) production, which renders patients susceptible to life-threatening infections. Over the course of 30 years, we diagnosed CGD in 84 patients from 61 families using functional, molecular, and genetic studies. The incidence of CGD in Israel is 1.05 per 100,000 live-births in the Jewish population and 1.49 in the Israeli Arab population. We diagnosed 52 patients (62%) with autosomal recessive inheritance (AR-CGD) and 32 (38%) with X-linked recessive inheritance (XLR-CGD). Consanguinity was detected in 64% of AR-CGD families (14% in Jews and 50% in Israeli Arabs). We found 36 different mutations (23 in XLR-CGD and 13 in AR-CGD patients), 15 of which were new. The clinical spectrum of CGD varied from mild to severe disease in both XLR and AR forms, although the AR subtype is generally milder. Further, residual ROS production correlated with milder clinical expression, better prognosis and improved overall survival. Patients with recurrent pyogenic infections developed fibrosis and hyperinflammatory states with granuloma formation. The management of CGD has progressed substantially in recent years, evolving from a fatal disease of early childhood to one of long-term survival. Our present cohort displays an encouraging 81% overall long term survival. Early hematopoietic stem cell transplantation is advisable before tissue damage is irreversible. Successful transplantation was performed in 18/21 patients. Therapeutic gene modification could become an alternative cure for CGD. Am. J. Hematol. 92:28-36, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Baruch Wolach
- Pediatric Hematology Clinic and the Laboratory for Leukocyte Function, Meir Medical Center, Kfar Saba Israel, and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Ronit Gavrieli
- Pediatric Hematology Clinic and the Laboratory for Leukocyte Function, Meir Medical Center, Kfar Saba Israel, and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Martin de Boer
- Sanquin Research, and Landsteiner Laboratory, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Karin van Leeuwen
- Sanquin Research, and Landsteiner Laboratory, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - Sivan Berger-Achituv
- Department of Pediatric Hemato-Oncology; Dana Children's Hospital, Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Tal Stauber
- Immunology Service, Department of Pediatrics, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Josef Ben Ari
- Meyer Children's Hospital and Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology; Haifa Israel
| | - Menachem Rottem
- Division of Allergy & Immunology, Ha'Emek Medical Center, Afula, Israel and Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology; Haifa Israel
| | | | - Galia Grisaru-Soen
- Pediatric Infectious Diseases Unit; Sourasky Medical Center; Tel Aviv Israel
| | | | - Nufar Marcus
- Allergy and Immunology Unit; Schneider Children's Medical Center; Tel Aviv Israel
| | - Ben Zion Garty
- Allergy and Immunology Unit; Schneider Children's Medical Center; Tel Aviv Israel
| | - Arnon Broides
- Immunology Clinic, Soroka Medical Center; Beer Sheva Israel
| | - Jakov Levy
- Immunology Clinic, Soroka Medical Center; Beer Sheva Israel
| | - Polina Stepansky
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation; Hadassah Medical Center; Jerusalem Israel
| | - Amos Etzioni
- Meyer Children's Hospital and Rappaport Faculty of Medicine, The Technion-Israel Institute of Technology; Haifa Israel
| | - Raz Somech
- Immunology Service, Department of Pediatrics, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel and Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dirk Roos
- Sanquin Research, and Landsteiner Laboratory, Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
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12
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Affiliation(s)
- Shimrit Tzvi-Behr
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Yechiel Schlesinger
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Maskit Bar-Meir MD
- Shaare Zedek Medical Center (affiliated with
Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
| | - Orli Megged
- Shaare Zedek Medical Center (affiliated with Hebrew University, Hadassah School of Medicine), Jerusalem, Israel
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13
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Ben-Shimol S, Greenberg D, Givon-Lavi N, Schlesinger Y, Miron D, Aviner S, Dagan R. Impact of PCV7/PCV13 introduction on invasive pneumococcal disease (IPD) in young children: Comparison between meningitis and non-meningitis IPD. Vaccine 2016; 34:4543-4550. [PMID: 27475471 DOI: 10.1016/j.vaccine.2016.07.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/18/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The worldwide introduction of pneumococcal conjugate vaccines (PCV) into National Immunization Programs resulted in rapid and substantial reduction of invasive pneumococcal disease (IPD) rates in children. However, the reduction of meningitis vs. non-meningitis IPD (nm-IPD) was not yet fully elucidated. We compared 7-valent and 13-valent PCV (PCV7 and PCV13) impact on pneumococcal-meningitis vs. nm-IPD in Israeli children <5years. METHODS We conducted an ongoing nationwide, prospective, population-based, active surveillance. PCV7 and PCV13 were implemented in Israel in July 2009 and November 2010, respectively. All pneumococcal isolates (blood and/or CSF) from IPD episodes in children <5years from July 2000 through June 2015 were included. Extrapolation for missing serotypes (34.7% of all isolates) was conducted. RESULTS 4163 IPD cases were identified; 3739nm-IPD (89.8%) and 424 meningitis (10.2%). During the pre-PCV period (2000-2008), children <12months constituted 52.1% and 33.7% of meningitis and nm-IPD, respectively (p<0.001). The respective proportions of non-PCV13 serotypes (non-VT) were 18.2% vs. 10.1%, (p<0.001). Comparing the last study year (2014-2015) to the mean of pre-PCV period, meningitis incidence in children <5years decreased non-significantly by 27%, while nm-IPD decreased significantly by 69%. Dynamic rates of meningitis and nm-IPD caused by PCV13 serotypes were similar, with 93% and 95% overall reductions, respectively. However, non-VT increased in meningitis relatively to nm-IPD, mainly in children <24months. Serotype 12F rose sharply and significantly since 2009-2010 through 2014-2015 (28.6% of all non-VT meningitis in children <24m). CONCLUSIONS The overall impact of PCV7/PCV13 in children <5years in Israel was less prominent in meningitis than in nm-IPD. This could be attributed to the younger age of children with meningitis and differences in causative serotypes between the two groups, as the decline of the incidence of meningitis and nm-IPD caused by vaccine-serotypes is similar. Continuous monitoring of meningitis and nm-IPD is warranted.
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Affiliation(s)
- S Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - D Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Y Schlesinger
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - D Miron
- Pediatric Infectious Diseases Service, Emek Medical Center, Afula, Israel
| | - S Aviner
- Department of Pediatrics, The Barzilai University Medical Center, Ashkelon, Israel
| | - R Dagan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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14
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Schlesinger Y. Editorial Commentary: Amniocentesis for Detection of Congenital Cytomegalovirus Infection: What Is the Point? Clin Infect Dis 2016; 63:39-40. [PMID: 27114377 DOI: 10.1093/cid/ciw238] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yechiel Schlesinger
- Wilf Children's Hospital, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
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15
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Eldar-Yedidia Y, Bar-Meir M, Hillel M, Abitbol G, Broide E, Falk R, Assous M, Schlesinger Y. Low Interferon Relative-Response to Cytomegalovirus Is Associated with Low Likelihood of Intrauterine Transmission of the Virus. PLoS One 2016; 11:e0147883. [PMID: 26881863 PMCID: PMC4755570 DOI: 10.1371/journal.pone.0147883] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/08/2016] [Indexed: 11/19/2022] Open
Abstract
Background Congenital Cytomegalovirus (CMV) is a very common intrauterine infection which can cause severe mental and hearing impairments. Notably, only 40% of primarily infected women transmit CMV to the fetus. CMV-specific T-cell response has a role in CMV disease but individual immune heterogeneity precludes reliable correlation between measurable T-cells response and intrauterine transmission. Study Aim To establish a correlation between maternal T-cells response and fetal CMV transmission using an individual normalized immune response. Methods We analyzed IFN-γ secretion upon whole blood stimulation from primary CMV-infected pregnant women, with either CMV-peptides or PHA-mitogen. Results We established a new normalization method of individual IFN-γ response to CMV by defining the ratio between specific-CMV response and non-specific mitogen response (defined as IFN-γ relative response, RR), aiming to overcome high person-to-person immune variability. We found a unique subpopulation of women with low IFN-γ RR strongly correlated with absence of transmission. IFN-γ RR lower than 1.8% (threshold determined by ROC analysis) reduces the pre-test probability of transmission from 40% to 8%, revealing an unexpected link between low IFN-γ RR and non-transmission. Conclusion In pregnant women with primary CMV infection, low IFN-γ RR is associated with low risk of transmission.
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Affiliation(s)
- Yifat Eldar-Yedidia
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
| | - Maskit Bar-Meir
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Miriam Hillel
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
| | - Guila Abitbol
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
| | - Eti Broide
- Microbiology @ Immunology laboratories, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Roni Falk
- Microbiology @ Immunology laboratories, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Marc Assous
- Microbiology @ Immunology laboratories, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yechiel Schlesinger
- Research Laboratory of Infectious Diseases, Shaare Zedek Medical Center, affiliated to the Hebrew University Medical School, Jerusalem, Israel
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
- * E-mail:
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16
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Lélu K, Evlachev A, Kratzer R, Godon O, Mancini-Bourgine M, Dion S, Schmitt D, Dubois C, Meritet J, Schlesinger Y, Marchand J, Geist M, Brandely R, Findeli A, Zhu R, Menguy T, Silvestre N, Michel M, Inchauspé G, Martin P. TG1050, a novel immunotherapeutic for the treatment of chronic hepatitis B, can control HBsAg and provoke HBsAg seroconversion in HBV-persistent mouse models. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Merin O, Fink D, Fink DL, Shahroor S, Schlesinger Y, Amir G, Birk E. Salvage ECMO deployment for fatal aluminum phosphide poisoning. Am J Emerg Med 2015; 33:1718.e1-3. [PMID: 25910669 DOI: 10.1016/j.ajem.2015.03.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ofer Merin
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Daniel Fink
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel 91031.
| | - Daniel L Fink
- Pediatric Cardiology Unit, Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Sarit Shahroor
- Pediatric Intensive Care Unit, Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Yechiel Schlesinger
- Division of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel 91031
| | - Gabriel Amir
- Department of Cardiothoracic Surgery, Schneider's Children Medical Center, Petach Tikva, Israel 4920235
| | - Einat Birk
- Cardiology Institute, Schneider's Children Medical Center, Petach Tikva, Israel 4920235
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18
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Yarden-Bilavsky H, Ashkenazi S, Amir J, Schlesinger Y, Bilavsky E. Fever survey highlights significant variations in how infants aged ≤60 days are evaluated and underline the need for guidelines. Acta Paediatr 2014; 103:379-85. [PMID: 24446962 DOI: 10.1111/apa.12560] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 12/30/2013] [Accepted: 01/15/2014] [Indexed: 11/30/2022]
Abstract
AIM To assess the common practices for evaluating and treating febrile infants aged ≤60 days in a nationwide survey. METHODS Questionnaires were administrated to inpatient paediatric departments in all 25 hospitals in Israel. RESULTS Of the 25 centres surveyed (100% response rate), only 36% had written protocols concerning the approach to young febrile infants. The existence of a written protocol was significantly associated with the level of medical centre (tertiary versus primary and secondary, p = 0.041) and with the number of local paediatric infectious disease specialists (p = 0.034). In 13 (52%) hospitals, a normal white blood cell count was defined as 5000-15 000 cells/mL and 20 (80%) centres use C-reactive protein. Hospitalisation was mandatory in most (96%) centres for all neonates aged ≤28 days. Low-risk infants aged 29-60 days were hospitalised in 68.4% of the primary and secondary hospitals, compared with 33.3% tertiary centres. Ampicillin and gentamicin was the routine empiric antibiotic treatment for febrile infant in 92% of centres. CONCLUSION Significant differences exist among centres in the evaluation of febrile infants aged ≤60 days exist. These differences reflect the lack of, and highlight the need for, national or international guidelines for the evaluation of fever in this age group.
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Affiliation(s)
- Havatzelet Yarden-Bilavsky
- Department of Pediatrics A; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Shai Ashkenazi
- Department of Pediatrics A; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Jacob Amir
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Yechiel Schlesinger
- Department of Pediatrics; Shaare Zedek Medical Center; Hadassah-Hebrew University Medical School; Jerusalem Israel
| | - Efraim Bilavsky
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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19
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Ben-Shimol S, Greenberg D, Givon-Lavi N, Schlesinger Y, Somekh E, Aviner S, Miron D, Dagan R. Early impact of sequential introduction of 7-valent and 13-valent pneumococcal conjugate vaccine on IPD in Israeli children <5 years: an active prospective nationwide surveillance. Vaccine 2014; 32:3452-9. [PMID: 24690148 DOI: 10.1016/j.vaccine.2014.03.065] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND The 7-valent pneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7. AIM To report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years. METHODS An ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included. RESULTS Overall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7+6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR]=0.05; 95% CI=0.03-0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR=0.30; 0.21-0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR=2.43; 1.73-3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2-4 years old, respectively). CONCLUSIONS After initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.
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Affiliation(s)
- Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel
| | | | | | | | - Dan Miron
- The Pediatric Infectious Disease Service, HaEmek Medical Center, Afula, Israel
| | - Ron Dagan
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Ben-Gurion University, Beer-Sheva, Israel.
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20
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Affiliation(s)
- Shimrit Tzvi-Behr
- Pediatrics Department, Shaare Zedek Medical Center, Jerusalem, Israel
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21
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Megged O, Assous MV, Miskin H, Peleg U, Schlesinger Y. Neurologic manifestations of Fusobacterium infections in children. Eur J Pediatr 2013; 172:77-83. [PMID: 23015047 DOI: 10.1007/s00431-012-1847-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/10/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Fusobacterium necrophorum causes various clinical syndromes, ranging from otitis media to life-threatening Lemierre's syndrome. The purpose of this study was to review our experience with pediatric Fusobacterium infections. The medical records of all children aged 0 to 18 years who were diagnosed between 1999 and 2011 with Fusobacterium infection were reviewed. Fusobacterium was isolated from clinical samples of 27 children: blood cultures (n = 16), abscesses (n = 8), joint fluids (n = 2), and cerebrospinal fluid (n = 1). The median age at admission was 3.5 years (range, 7 months to 17 years). Eight children (30 %) had seizures at presentation. Ten children (37 %) underwent lumbar puncture. Fifteen children (56 %) underwent brain imaging, and in seven of these children, a thrombus was identified either in a sinus vein or in an internal jugular vein. The most common source of infection was otogenic in 19 (70 %) of the children. Six of the children presented in 2011. All patients recovered. CONCLUSIONS Neurologic manifestations are common at presentation of children with Fusobacterium infections. In young children, the most common source of infection is otogenic. Thrombotic complications are common, and imaging should be considered in all children with Fusobacterium infections arising from the head or neck region. There was a recent increase in the isolation of this bacterium, either because of better culturing techniques and increased awareness to this entity or a true increase in infections due to this organism.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, P.O.B. 3235, Jerusalem, Israel.
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22
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Bromiker R, Ernest N, Meir MB, Kaplan M, Hammerman C, Schimmel MS, Schlesinger Y. Correlation of bacterial type and antibiotic sensitivity with maternal antibiotic exposure in early-onset neonatal sepsis. Neonatology 2013; 103:48-53. [PMID: 23095252 DOI: 10.1159/000342215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/19/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antibiotic administration during pregnancy as group B Streptococcus prophylaxis or as treatment of maternal conditions has become widespread. OBJECTIVE To assess whether bacterial type and antibiotic resistance in early-onset neonatal sepsis are associated with maternal antibiotic use. METHODS All positive blood and/or cerebrospinal fluid cultures (case-only study) and respective antibiotic sensitivities from newborns delivered in Shaare Zedek Medical Center, Jerusalem, Israel, between 01/01/1997 and 31/01/2007, taken during the first 72 h of life, were studied. Clinical and demographic data were obtained from the medical records of the infant/mother dyads. Three groups were defined by type of maternal antibiotic exposure: (1) no exposure, (2) intrapartum antibiotic prophylaxis (IAP), (3) antepartum antibiotic exposure during the month prior to delivery and extending into delivery or with subsequent IAP (AAE). Factors potentially associated with Gram-negative bacteremia and resistance to ampicillin were analyzed using multivariate logistic regression. RESULTS Ninety-seven different organisms grew from 94 infants (1.03 per 1,000 live births). By univariate analysis, AAE, gestational age ≤ 32 weeks, chorioamnionitis and rupture of membranes ≥ 18 h, were significantly associated with both Gram-negative sepsis and antibiotic resistance. By multivariate analysis, AAE was significantly associated with both outcomes, while gestational age ≤32 weeks was only associated with antibiotic resistance. CONCLUSIONS AAE for more than 24 h is associated with an increased proportion of Gram-negative organisms and ampicillin resistance in early-onset neonatal sepsis. Antepartum antibiotic therapy and its ramifications need to be continuously monitored and prospectively studied.
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Affiliation(s)
- Ruben Bromiker
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel. bromi @ szmc.org.il
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Megged O, Assous M, Weinberg G, Schlesinger Y. Inducible clindamycin resistance in β-hemolytic streptococci and Streptococcus pneumoniae. Isr Med Assoc J 2013; 15:27-30. [PMID: 23484235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Resistance to macrolides in beta-hemolytic streptococci and Streptococcus pneumoniae arises primarily due to Erm(B) or Mef(A). Erm(B) typically confers high level resistance to macrolides, lincosamides and streptogramin B (MLSB phenotype), whereas Mef(A) confers low level resistance to macrolides only (M phenotype). OBJECTIVES To investigate the incidence of macrolide resistance mechanisms in isolates of beta-hemolytic streptococci and pneumococci in Israel, with particular emphasis on inducible MLSB phenotype. METHODS We collected 316 clinical isolates of streptococci during May-August 2010. Erythromycin resistance mechanism was determined by the erythromycin-clindamycin double disk diffusion method. RESULTS Erythromycin and clindamycin resistance rates were 19.4% and 13.4% for S. pneumoniae, 4.7% and 1.6% for group A Streptococcus (GAS), 17% and 17% for group B Streptococcus (GBS), and 38.8% and 27.8% for group G Streptococcus (GGS) respectively. The most common resistance mechanism for all streptococci was constitutive MLSB (cMLSB). Inducible MLSs (iMLSB) mechanism was found in 3% of all strains and represented 25% of resistance mechanisms. CONCLUSIONS The prevalence of macrolide resistance and the distribution of resistance mechanisms differ among beta-hemolytic streptococci and S. pneumoniae, with GBS, GGS and S. pneumoniae showing the highest resistance rate. Macrolide or lincosamide cannot be empirically used for severe streptococcal infections before strains are proved to be susceptible. Continuous surveillance of erythromycin and clindamycin resistance patterns among streptococci is needed.
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Affiliation(s)
- Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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Megged O, Bar-Meir M, Schlesinger Y. Haemophilus influenzae activity in a single medical center in Israel in the post-vaccine era. Isr Med Assoc J 2012; 14:410-414. [PMID: 22953615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The incidence of invasive disease due to Haemophilus influenzae has decreased since the implementation of vaccination against serotype B. OBJECTIVES To describe the epidemiological, clinical and microbiological characteristics of patients with H. influenzae meningitis or bacteremia in the vaccine era in Israel. METHODS We reviewed the medical records of all patients admitted to Shaare Zedek Medical Center between 1997 and 2010 who had blood or cerebrospinal fluid culture positive for H. influenzae. RESULTS The study group comprised 104 patients - 57 children and 47 adults. Overall, 21 (20%) of the infections were due to serotype b. The children had shorter hospitalizations (6vs. 12 days, P = 0.005) and lower mortality rate (5% vs. 28%, P = 0.003) as compared to the adults. Bacteremic pneumonia was the most common diagnosis in adults (45% vs. 28% in children, P = 0.08) while meningitis was more common in children (17% vs. 3.5%, P = 0.09). There was a seasonal pattern, with infections being more common during the winter and spring. CONCLUSIONS Invasive H. influenzae disease is uncommon but still exists in both children and adults. The disease course tends to be more severe in adults. Even in the global vaccination era, serotype b constitutes a significant portion of invasive disease.
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Affiliation(s)
- Orli Megged
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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Abstract
OBJECTIVE To review the epidemiology and clinical course of invasive pneumococcal diseases of infants younger than 60 days. STUDY DESIGN All Streptococcus pneumoniae strains isolated from blood and cerebrospinal fluid cultures of infants below the age of 60 days during the years 1999-2009 were included in this study. Demographic, clinical, and laboratory data were collected from medical records. RESULTS In all, 24 cases of pneumococcal invasive infections were identified. The primary diagnoses were bacteremia without a focus (n = 13), meningitis (n = 6), bacteremia with otitis media (n = 3), and joint infection with bacteremia (n = 2). Only one of the serotypes found is included in the heptavalent pneumococcal conjugated vaccine (PCV7). CONCLUSIONS Streptococcus pneumoniae should be considered and treated empirically in infants with suspected invasive bacterial disease during the first 60 days of life. Routine vaccination with PCV7 in not expected to substantially reduce the incidence of invasive pneumococcal disease in Israeli infants of this age as a result of herd immunity.
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Affiliation(s)
- Limor Ashkenazi
- Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
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26
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Wiener-Well Y, Galuty M, Rudensky B, Schlesinger Y, Attias D, Yinnon AM. Nursing and physician attire as possible source of nosocomial infections. Am J Infect Control 2011; 39:555-9. [PMID: 21864762 DOI: 10.1016/j.ajic.2010.12.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 12/12/2010] [Accepted: 12/14/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Uniforms worn by medical and nursing staff are not usually considered important in the transmission of microorganisms. We investigated the rate of potentially pathogenic bacteria present on uniforms worn by hospital staff, as well as the bacterial load of these microorganisms. METHODS Cultures were obtained from uniforms of nurses and physicians by pressing standard blood agar plates at the abdominal zone, sleeve ends, and pockets. Each participant completed a questionnaire. RESULTS A total of 238 samples were collected from 135 personnel, including 75 nurses (55%) and 60 physicians (45%). Of these, 79 (58%) claimed to change their uniform every day, and 104 (77%) defined the level of hygiene of their attire as fair to excellent. Potentially pathogenic bacteria were isolated from at least one site of the uniforms of 85 participants (63%) and were isolated from 119 samples (50%); 21 (14%) of the samples from nurses' gowns and 6 (6%) of the samples from physicians' gowns (P = NS) included of antibiotic-resistant bacteria. CONCLUSION Up to 60% of hospital staff's uniforms are colonized with potentially pathogenic bacteria, including drug-resistant organisms. It remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.
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Toker O, Schwartz S, Segal G, Godovitch N, Schlesinger Y, Raveh D. A costly covenant: ritual circumcision and urinary tract infection. Isr Med Assoc J 2010; 12:262-265. [PMID: 20929075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Ritual circumcision in neonates may cause a urinary tract infection within 2 weeks of the procedure. OBJECTIVES To evaluate the prevalence of urinary tract infection among Jewish male circumcised neonates < or = 28 days old) evaluated for fever in the emergency room. METHODS All available medical records of neonates presenting to the pediatric emergency room for evaluation of fever over a 10 year period were reviewed. Data included gender, ethnic background, age (in days) on presentation to the emergency room, age (in days) when circumcision was performed (in males > or = 8 days of age), and results of urine, blood and cerebrospinal fluid cultures. Families of males older than 8 days of age who had a UTI were contacted by telephone to verify the circumcision status when the infant presented to the ER, to ascertain whether the circumcision had been performed ritually by a mohel* or by a physician, and, if not recorded in the chart, to verify the day of life on which circumcision was performed. RESULTS Among neonates older than 8 days of age, 60 (24.7%) of the 243 febrile Jewish males had a UTI, as compared to 12 (8.4%) of 143 females (P < 0.0001). In 39 of 54 male neonates (72%) for whom circumcision was performed ritually on the eighth day of life, UTI occurred within 9 days of the circumcision. For females, there was no such clustering of UTI cases in the second week of life, nor during any other time period. CONCLUSIONS Febrile male neonates who have undergone ritual circumcision have a high prevalence of UTI and must be evaluated and treated accordingly.
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Affiliation(s)
- Ori Toker
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Miron D, Horovitz Y, Luder A, Ohnona FS, Schlesinger Y. Age-related immunoglobulin G seroprevalence of human parvovirus B-19 in Israeli children. Isr Med Assoc J 2010; 12:277-279. [PMID: 20929079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Human parvovirus B19 is a global and common infectious pathogen in humans, particularly in children. OBJECTIVES To assess the immunoglobulin G3 seroprevalence of B19 in children in Israel. METHODS Overall, 128 previously healthy children (1.5-17 years old) hospitalized for various diseases other than acute human parvovirus B19 infection were assessed for IgG to the virus by enzyme-linked immunosorbent assay. RESULTS The IgG seroprevalence increased from 22% in children aged 1.5-9 years to 52% in older children (P = 0.001). CONCLUSIONS Our data suggest that most acute parvovirus B19 infections in Israel occur in the early school years, and that by 18 years of age 50% of Israeli children have been infected by the virus.
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Affiliation(s)
- Dan Miron
- Department of Pediatrics A, HaEmek Medical Center, Afula, Israel.
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Wiener-Well Y, Rudensky B, Yinnon A, Kopuit P, Schlesinger Y, Broide E, Lachish T, Raveh D. Carriage rate of carbapenem-resistant Klebsiella pneumoniae in hospitalised patients during a national outbreak. J Hosp Infect 2010; 74:344-9. [DOI: 10.1016/j.jhin.2009.07.022] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/21/2009] [Indexed: 12/01/2022]
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Megged O, Schlesinger Y, Attias D, Rudensky B. [Gastrointestinal carriage of Pseudomonas aeruginosa in children residing in chronic care institutes in Jerusalem: high prevalence and high rates of antibiotic resistance]. Harefuah 2009; 148:766-793. [PMID: 20027979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa carriage in the gastrointestinal tract is uncommon in healthy children. Children living in chronic care institutions are often carriers of P. aeruginosa in the respiratory tract, but data is lacking regarding gastrointestinal carriage in these children. AIMS To examine the carriage rate of P. aeruginosa in children living in chronic care institutions in Jerusalem and to assess resistance rates of the bacteria to different classes of antibiotics. METHODS Rectal swabs were taken from all children residing in two chronic care institutions in Jerusalem: "St. Vincent" and "Aleh". The swabs were examined for presence of Pseudomonas aeruginosa. The authors used disk diffusion technique and E Test to assess resistance for different antibiotics. RESULTS Gastrointestinal carriage of P. aeruginosa was detected in 37 out of 125 of the children (30%); 16% of the P. aeruginosa isolates were resistant to carbapenems; 16% were resistant to aminoglycosides, 14% to ureidopenicillins and 11% to quinolones. All isolates were sensitive to ceftazidime and colistin. In 84% of the isolates, the minimal inhibitory concentration (MIC) for meropenem was significantly lower than the MIC for imipenem. SUMMARY P. aeruginosa is a common colonizer of the gastrointestinal tract of children living in chronic care institutions. Empiric antibiotic treatment against P. aeruginosa should be considered when treating children with acute gastrointestinal pathologies. Antibiotic resistance, and particularly carbapenem resistance, is common in this population. There is a significant difference between the MICs for imipenem and meropenem. Future studies are needed to understand the clinical significance of this finding.
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Affiliation(s)
- Orli Megged
- Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem.
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Schlesinger Y, Ben-Shalom E, Raveh DP, Yinnon AM, Miskin H, Rudensky B. [Vibrio vulnificus infection outside of the fish ponds in northern Israel: acquisition in the "Einot Tzukim" springs near the Dead Sea]. Harefuah 2009; 148:772-792. [PMID: 20027981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Vibrio vulnificus is a Gram-negative bacterium that may cause severe skin and systemic infection after exposure of open wounds to contaminated water, especially in patients with underlying disease such as immune-deficiency, iron overload or end stage liver or renal disease. The V. vulnificus infection has been reported in Israel almost exclusively after exposure to Tilapia fish cultivated in fresh water fish ponds in northern Israel. The authors report the first case of V. vulnificus infection acquired in a nature reserve in southeastern Israel, with no connection to fish handling. A 14.5-years-old girl with transfusion-dependant thalassemia major presented with high fever and a rapidly progressive bullous cellulitis of the ankle. The infection occurred around a cut on the left lateral malleolus, after bathing in the fresh water ponds of Einot Tzukim (Ein Feshcha) in south-eastern Israel, and progressed despite the use of broad-spectrum antibiotics. Blood and wound cultures eventually yielded Vibrio vulnificus and appropriate treatment was commenced. The fever subsided after a few days but resolution of the local findings was very gradual and lasted for weeks. The presence of V. vulnificus in natural springs far from the northern artificial fish ponds broadens the danger of this infection. We find it prudent to advise people at risk for V. vulnificus infection, such as those suffering from immunedeficiency, iron overload and end stage liver or renal disease, to refrain from bathing in natural ponds whilst injured.
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Affiliation(s)
- Yechiel Schlesinger
- Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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33
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Maayan H, Cohen-Poradosu R, Halperin E, Rudensky B, Schlesinger Y, Yinnon AM, Raveh D. Infective endocarditis due to Moraxella lacunata: report of 4 patients and review of published cases of Moraxella endocarditis. ACTA ACUST UNITED AC 2009; 36:878-81. [PMID: 15764178 DOI: 10.1080/00365540410024925] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Moraxella is an aerobic, oxidase-positive, Gram-negative coccobacillus, which is rarely associated with serious and invasive infections. We describe 4 cases of Moraxella lacunata endocarditis and review 12 previously published cases of Moraxella endocarditis, including 1 further case with M. lacunata, 5 with M. catarrhalis, 2 with M. phenylperuvica and the remainder consisting of 1 case each of M. liquefaciens, M. osloensis, M. nonliquefaciens and 1 non-specified. Of these 16 patients, 5 had prosthetic valves, 5 suffered from an underlying heart abnormality, and the other 6 had normal hearts. Therapy consisted of a beta-lactam antimicrobial and, in several instances, an aminoglycoside as well. The mean duration of antibiotic treatment was 35+/-13 d. Four patients (25%) underwent surgery and 4 out of 16 (25%) died. Moraxella should be added to the growing list of organisms which may occasionally cause infective endocarditis, even in patients without preexisting valvular abnormality.
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Abstract
Q fever endocarditis is a chronic disease with protean manifestations. The clinical and serological manifestations of nine patients diagnosed as having Q fever endocarditis during a 19-year period are reviewed. Four patients (44%) required valve replacement due to congestive heart failure. Three of these four patients were diagnosed as having Q fever endocarditis only after elective valve surgery, by histopathological examination of the valve and subsequent serological tests. Prior to surgery they were afebrile and had no other symptom or sign indicative of endocarditis. The antibiotic treatment and the decreasing titres of Q fever antibodies of all nine patients during several years of follow-up are summarized. Careful assessment of heart valves for histopathological evidence of inflammation is suggested, even after elective replacement. If found, clinical and laboratory evaluation should include determination of anti-Coxiella burnetti antibodies.
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Affiliation(s)
- Y Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Centre, affiliated with the Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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35
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Baneth G, Harrus S, Ohnona FS, Schlesinger Y. Longitudinal quantification of Ehrlichia canis in experimental infection with comparison to natural infection. Vet Microbiol 2009; 136:321-5. [DOI: 10.1016/j.vetmic.2008.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/25/2008] [Accepted: 11/28/2008] [Indexed: 11/25/2022]
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Megged O, Schlesinger Y. Varicella zoster infection in adults: a preventable disease. Isr Med Assoc J 2009; 11:306-307. [PMID: 19637510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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37
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Schwartz S, Raveh D, Toker O, Segal G, Godovitch N, Schlesinger Y. A week-by-week analysis of the low-risk criteria for serious bacterial infection in febrile neonates. Arch Dis Child 2009; 94:287-92. [PMID: 18977786 DOI: 10.1136/adc.2008.138768] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the reliability of "low-risk" criteria (LRC) to exclude serious bacterial infection (SBI) in febrile neonates (< or =28 days), according to age in weeks. DESIGN Epidemiological and clinical data and final diagnosis of all febrile neonates presenting to the emergency room from June 1997 to May 2006 were reviewed. Neonates who fulfilled specific LRC for the presence of SBI were classified as LRC+. The prevalence of SBI and the percentage of LRC+ neonates who had SBI were calculated for each of the first 4 weeks of life. RESULTS A total of 449 neonates were evaluated. Eighty-seven (19.4%) neonates had an SBI. The prevalence of SBI among infants 3-7, 8-14, 15-21 and 22-28 days of age was 21.6%, 26.1%, 17.9% and 12.1%, respectively (p = 0.007 for linear trend after second week of life). Of the 226 LRC+ neonates, 14 (6.2%) had an SBI, including one case of bacteraemia and meningitis and 13 cases of urinary tract infection (UTI). The negative predictive value (NPV) of the LRC for SBI was 93.8% (95% CI 90.1% to 96.4%). The prevalence of SBI among LRC+ infants 3-7, 8-14, 15-21 and 22-28 days of age was similar, with rates of 15%, 6.3%, 3.0% and 6.7%, respectively. CONCLUSION LRC are not sufficiently reliable to exclude the presence of SBI, including bacteraemia and meningitis in febrile neonates of all ages. All febrile neonates should therefore be hospitalised, undergo a full "sepsis evaluation" and receive empirical intravenous antibiotic therapy.
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Affiliation(s)
- S Schwartz
- Department of Pediatrics, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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Wiener-Well Y, Raveh D, Schlesinger Y, Yinnon AM, Rudensky B. Cefuroxime for empiric treatment of community-acquired pneumococcal pneumonia: is there a generation gap? Chemotherapy 2009; 55:97-104. [PMID: 19145079 DOI: 10.1159/000192393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2008] [Accepted: 11/04/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND Streptococcus pneumoniae infection is an important cause of morbidity and mortality. The recommendations to use expanded-spectrum beta-lactam drugs for patients with community-acquired pneumonia derived from the growing prevalence of penicillin-resistant pneumococci. Controversy exists regarding the use of second generation cephalosporins for empirical treatment of community-acquired pneumonia. METHODS In a retrospective study, 31 adult patients with pneumococcal pneumonia and bacteremia caused by S. pneumoniae that was intermediately resistant to penicillin were compared with 31 control patients with similar infection caused by penicillin-susceptible pneumococci. All patients were treated empirically with cefuroxime, alone or in combination with other antibiotics. Morbidity and mortality were studied. RESULTS All unsusceptible pneumococci isolates were intermediately resistant to penicillin. No cases of fully resistant pneumococci were isolated from blood cultures in our hospital. Two factors were significantly associated with non-susceptibility to penicillin: hematologic malignancy and immunosuppression. No significant difference in morbidity or mortality was detected between the 2 groups, and penicillin minimum inhibitory concentration was not found to be a factor associated with mortality. CONCLUSIONS Patients with pneumococcal pneumonia caused by intermediately resistant pneumococci can be empirically treated with cefuroxime. In regions where fully resistant pneumococci are rare, the use of a second generation cephalosporin for empiric treatment of community-acquired pneumonia may be appropriate.
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Affiliation(s)
- Yonit Wiener-Well
- Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel
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Abstract
Menetrier's disease is an uncommon disease in childhood, characterized by gastric hypertrophy and hypoalbuminemia secondary to protein loss through the gastric mucosa. This paper describes a series report of protein-losing gastropathy associated with cytomegalovirus (CMV) infection in children and reviews the literature. We reviewed the medical records of eight children with diagnosis of Menetrier's disease or protein-losing gastropathy with evidence of acute CMV infection. During a five-year period there were eight children that were diagnosed with CMV-associated protein-losing gastropathy, all in one medium-sized pediatric ward in a general hospital. The mean age was 32 months and there was no gender predominance. The most common presenting symptoms were vomiting and edema. Average symptoms' duration prior to admission was 3.2 weeks and mean albumin at presentation was 1.8 g/dl (range, 1.5-2.5 g/dl; normal values, 3.5-5 g/dl). All eight children fully recovered. In conclusion, CMV infection should be suspected in every child who presents with protein-losing gastropathy. The availability of newer, rapid diagnostic techniques such as polymerase chain reaction (PCR) may facilitate diagnosis, as serology studies may be misleading. Usually, only supportive care is required, but treatment with ganciclovir may be considered for severe or prolonged cases.
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Affiliation(s)
- O Megged
- Department of Pediatrics and Infectious Diseases Unit, Shaare Zedek Medical Center, Hadassah-Hebrew University Medical School, Jerusalem, Israel.
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40
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Rudensky B, Sirota G, Erlichman M, Yinnon AM, Schlesinger Y. Neutrophil CD64 expression as a diagnostic marker of bacterial infection in febrile children presenting to a hospital emergency department. Pediatr Emerg Care 2008; 24:745-8. [PMID: 18955911 DOI: 10.1097/pec.0b013e31818c2679] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The expression of CD64 (Fcgamma receptor) is increased in neutrophils from an almost negligible value to a marked level in patients with bacterial infections. CD64 expression on neutrophils might therefore be useful to differentiate between bacterial and viral infections in young children. We evaluated the usefulness of CD64 as a marker for the diagnosis of bacterial infections in children up to the age of 3 years and its ability to differentiate between bacterial and viral infections. METHODS Blood samples were drawn from 70 children aged 3 years or younger who presented to the pediatric emergency department with fever as their main complaint. Thirty-eight children were diagnosed as having bacterial infection and 32 as having viral infection. The control group included 39 healthy children. CD64, C-reactive protein (CRP), and procalcitonin levels were determined for each child. The sensitivity and specificity of these parameters were calculated. RESULTS Neutrophil expression of CD64 was significantly higher in the bacterial infection group compared with the viral infection and the control groups (P < 0.0001). Raising the cutoff for diagnosis of bacterial disease lowered the sensitivity but improved the specificity. CD64 was found to have a very high sensitivity (94.7%), but its specificity was poor (46.5%). No significant differences were found between the diagnostic performance of CD64 and that of CRP: both have high sensitivity and low specificity (94.7% and 47.9%, respectively, for CRP). In contrast, procalcitonin had a betterspecificity (91%), but its sensitivity reached only 71.9%. CD64 expression was increased in patients with respiratory syncytial virus-related infections compared with that in patients with other viral infections and was similar to that found during bacterial illness. CONCLUSIONS Neutrophil CD64 expression is a sensitive marker for diagnosing bacterial infection in young children, but as it is also raised in viral infection, it lacks specificity.
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Affiliation(s)
- Bernard Rudensky
- Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel.
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Wolach B, Gavrieli R, de Boer M, Gottesman G, Ben-Ari J, Rottem M, Schlesinger Y, Grisaru-Soen G, Etzioni A, Roos D. Chronic granulomatous disease in Israel: Clinical, functional and molecular studies of 38 patients. Clin Immunol 2008; 129:103-14. [DOI: 10.1016/j.clim.2008.06.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 05/28/2008] [Accepted: 06/21/2008] [Indexed: 11/28/2022]
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Butenko AV, Sandomirsky V, Kahatabi R, Dashevsky Z, Kasiyan V, Schlesinger Y. Pyroelectric effect induced by the built-in field of the p-n junction in the quantum paraelectric PbTe: experimental study. Phys Rev Lett 2008; 100:057603. [PMID: 18352432 DOI: 10.1103/physrevlett.100.057603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Indexed: 05/26/2023]
Abstract
We report here the first observation of a pyroelectric effect in a nonpolar semiconductor. This effect originates in the temperature-dependent electric dipole of the PbTe p-n junction. The junction was illuminated by a chopped CO(2) laser beam, and periodic and single-pulse pyroelectric signals were observed and measured as a function of temperature, reverse bias voltage, and chopper frequency. The measured pyroelectric coefficient is approximately 10(-3) microC/cm(2) K in the region of 40-80 K. The theoretical model describes quantitatively all experimental features. The time evolution of the temperature inside the junction region was reconstructed.
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Affiliation(s)
- A V Butenko
- Department of Physics, Bar-Ilan University, Ramat-Gan 52900, Israel
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43
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Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum beta-lactamases (ESBL) by Enterobacteriaceae. Infection 2008; 34:66-74. [PMID: 16703295 DOI: 10.1007/s15010-006-4114-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Accepted: 11/21/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND We conducted a retrospective, cohort-controlled study to evaluate the effect of extended-spectrum beta-lactamase (ESBL) production by Enterobacteriaceae isolated from blood cultures, and of third or fourth generation cephalosporin treatment, on outcome. METHODS Four hundred and fifty patient-unique Enterobacteriaceae, isolated from blood cultures during 2000 (before routine ESBL testing was introduced), were tested for ESBL by double-disk method and by E-test, assessing cefotaxime, ceftazidime and cefpodoxime, with and without clavulanate. Cases consisted of ESBL-positive (+) samples, originally reported as ceftazidime-susceptible; controls were ESBL-negative (-). Patient records were extensively reviewed. RESULTS We identified 68 Enterobacteriaceae that were ESBL(+); they were compared with 186 ESBL(-) control organisms. Patients with sepsis due to an ESBL(+) organism more often had nosocomial infection, resided in nursing homes, were functionally dependent, had an indwelling catheter, had Klebsiella, and had a lower serum albumin level (all p < 0.001). Survival of patients with ESBL(+) and ESBL(-) sepsis was, respectively, 71% and 84% (p < 0.05). Multivariate analysis revealed that the only independent risk factor for death was a low serum albumin. Neither empiric nor definite treatment with cephalosporins was found to be an independent risk factor for death. Subset analysis was conducted on 15 patients with ESBL(+) sepsis and 21 controls with ESBL(-) sepsis, who had been treated with ceftazidime or cefepime only. In this subset, ESBL(+) patients more often resided in nursing homes (< 0.05), they had a significantly lower APACHE-II score (< 0.01) and the infection was more often nosocomial (< 0.005). Survival of ESBL(+) and ESBL(-) patients was 67% and 71%, respectively (NS). Time till defervescence did not differ between cases and controls. CONCLUSION Mortality of patients with ESBL(+) sepsis was higher than that of patients with ESBL(-) sepsis. The reason appears to be related to other factors rather than to empiric treatment with cephalosporins or the nature or resistance pattern of the organism. This, at least, appears to be the case for patients with urosepsis, who constituted the majority of patients in this study.
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Affiliation(s)
- R Henshke-Bar-Meir
- Infectious Diseases Unit, Shaare Zedek Medical Center 3235, Jerusalem 91031, Israel
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Grisaru-Soen G, Engelhard D, Pearl S, Schlesinger Y, Shtein M, Ashkenazi S. [Hospitalizations associated with rotavirus gastroenteritis in Israel--a retrospective study]. Harefuah 2008; 147:8-96. [PMID: 18300615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Rotavirus is a major cause of infantile gastroenteritis worldwide and remains a common cause of hospitalizations in developed countries. The study aimed to assess the hospitalizations due to rotavirus gastroenteritis in Israel and their characteristics. METHODS A retrospective review of the records of children < 18 years hospitalized in six medical centers in Israel between April 2004 and March 2006 with acute gastroenteritis (AGE) and stool positive for rotavirus. Children with nosocomial infections, immune deficiency or under immunosuppressive therapy were excluded. RESULTS During the study period, 1912 children were hospitalized with AGE due to rotavirus, of whom 1719 were included in this study. The peak rate of admission due to rotavirus was in November and December, when 34% of the admissions for AGE were caused by rotavirus, and the lowest rate was in August (7%, p < 0.0001). Annually, rotavirus caused 18.4% and 2.8% of the hospitalization for AGE and of all pediatric hospitalizations, respectively. The mean age on admission was 14 months (median 12 months) and the mean hospitalization--3.9 days. According to the annual pediatric statistics in Israel for 2004, the estimated annual rotavirus-associated hospitalization in Israel is 3816, with 14,692 hospitalization days. CONCLUSIONS Rotavirus gastroenteritis is an important cause for hospitalizations and complications in children < 5 years in Israel, stressing the need for safe and efficacious vaccines to reduce the burden of the infection.
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Affiliation(s)
- Galia Grisaru-Soen
- Department of Pediatrics at Dana Children's Hospital, Sourasky Medical Center, Tel Aviv, Israel.
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Turner D, Hammerman C, Rudensky B, Schlesinger Y, Wine E, Muise A, Schimmel MS. Low levels of procalcitonin during episodes of necrotizing enterocolitis. Dig Dis Sci 2007; 52:2972-6. [PMID: 17393328 DOI: 10.1007/s10620-007-9763-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 01/03/2007] [Indexed: 12/13/2022]
Abstract
The pathogenesis of necrotizing enterocolitis (NEC) remains poorly understood. We aimed to assess the extent of bacterial infection in the pathogenesis of NEC using serial procalcitonin measurements. Blood samples were drawn during the first 4 days following every clinical event requiring a workup for presumed NEC. Eight episodes were confirmed as NEC, 7 of which showed procalcitonin levels <1 ng/ml at presentation and <1.3 ng/ml thereafter, comparable to 24 healthy controls. The one infant with elevated procalcitonin had bacteremia in addition to NEC. Procalcitonin levels of 24 matched septic infants were higher than those of NEC infants, peaking at 4.1 ng/ml. We conclude that low procalcitonin values are the rule during episodes of NEC and provide further evidence that overactive local immune response, and not active infection, is primarily responsible for the mucosal damage in NEC.
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Affiliation(s)
- Dan Turner
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
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Wilschanski M, Schlesinger Y, Faber J, Rudensky B, Ohnona FS, Freier S, Rahman E, Refael S, Halle D. Combination of Helicobacter pylori strain and tumor necrosis factor-alpha polymorphism of the host increases the risk of peptic ulcer disease in children. J Pediatr Gastroenterol Nutr 2007; 45:199-203. [PMID: 17667716 DOI: 10.1097/mpg.0b013e3180616bbe] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Helicobacter pylori infection is probably acquired in childhood and causes a vigorous immune response. It is unclear why only a subgroup of infected children develops peptic ulcer disease. We have previously reported that iceA1 strains tend to be associated with duodenal disease in children. However, the pathogenesis probably does not depend solely on the H pylori strain but also on the variability of the host response. OBJECTIVES The aim of this study was to assess the significance of tumor necrosis factor-alpha (TNF-alpha) promoter polymorphism in relation to infection with H pylori strains in children. METHODS A total of 113 antral biopsies of H pylori-positive children (ages 2-18 years) were analyzed. Of these, 23 had duodenal disease, including erosive duodenitis and/or duodenal ulceration, and 90 had gastritis only. H pylori infection was diagnosed by bacterial culture and histology. Patient genomic DNA extracted from the antral biopsy was used to characterize the genetic polymorphism of TNF-alpha promoter at nucleotide positions -308 and -238 by polymerase chain reaction-based restriction fragment-length polymorphism. All H pylori strains were examined for cytotoxin-associated gene A and induced-by-contact-with-epithelium gene (iceA1). RESULTS A total of 31% of children with duodenal disease were infected with iceA1 positive strains and had the -238 G to A polymorphism in the TNF-alpha gene vs only 1.6% of children with gastritis alone (P < 0.0005). CONCLUSIONS The combination of bacterial iceA1 and TNF-alpha 238 G to A polymorphism may be a risk factor for peptic ulcer disease in children infected with H pylori. Larger studies are needed to confirm this association.
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Affiliation(s)
- Michael Wilschanski
- Pediatric Gastroenterology and Nutrition Unit, Division of Pediatrics, Hadassah University Hospital, Jerusalem, Israel.
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Bahagon Y, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Prevalence and predictive features of bacteremic urinary tract infection in emergency department patients. Eur J Clin Microbiol Infect Dis 2007; 26:349-52. [PMID: 17431694 DOI: 10.1007/s10096-007-0287-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine the prevalence and predictive features of bacteremia among patients evaluated in the emergency department for urinary tract infection. Of the 350 patients with symptomatic urinary tract infection included in this retrospective study, 53 (15%; 95%CI 11.6-19.4%) were bacteremic. Five variables were independently associated with bacteremia: residence at home rather than in an institution (OR 4; 95%CI 1.5-10.7), presence of an indwelling urinary catheter (OR 3.3; 95%CI 1.3-8.8), presence of band forms in the blood count (OR 3.3; 95%CI 1.5-7.2), shaking chills (OR 2.3; 95%CI 1.1-4.8), and neutrophilia (OR 1.1; 95%CI 1.04-1.15). These easily assessable parameters may assist in the diagnosis of bacteremic urinary tract infection and the selection of empiric antibiotic treatment, thus potentially improving a patient's prognosis.
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Affiliation(s)
- Y Bahagon
- Department of Family Medicine, Clalit Health Services, Hebrew University Hadassah Medical School, Jerusalem, 91120, Israel
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Schlesinger Y. Routine screening for CMV in pregnancy: opening the Pandora box? Isr Med Assoc J 2007; 9:395-7. [PMID: 17591384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Yechiel Schlesinger
- Pediatric Infectious Diseases Unit. Shaare Zedek Medical Center, Jerusalem, Israel.
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Affiliation(s)
- O Megged
- Department of Pediatrics and Infectious Diseases, Shaare Zedek Medical Center, Jerusalem, Israel.
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Abstract
AIM To assess the role of procalcitonin in detecting nosocomial sepsis in preterm infants, after the onset of clinical symptoms. SUBJECTS 100 preterm infants, 24-36 wk of gestation, were followed from the age of 3 d until discharge. Procalcitonin and C-reactive protein (CRP) levels were measured within 3 d of sepsis workup events. RESULTS 141 blood samples were drawn from 36 infants during 85 episodes of sepsis workup performed between 4 and 66 d of life. Of these episodes, 51 (60%) were not a result of documented sepsis and thereby served as the negative comparison group. Median procalcitonin levels were higher in the septic group compared with the non-septic group at the time of the sepsis workup (2.7 vs 0.5 ng/ml, p=0.003), at 1-24 h after the sepsis workup (4.6 vs 0.6 ng/ml, p=0.003), and at 25-48 h (6.9 vs 2.0 ng/ml, p=0.016). Using high cutoff levels, both procalcitonin (2.3 ng/ml) and CRP (30 mg/l) had high specificity and positive predictive value (97%, 91% and 96%, 87%, respectively) but low sensitivity (48% and 41%, respectively) to detect sepsis. Areas under the ROC curve for procalcitonin and CRP were 0.74 and 0.73, respectively. CONCLUSION Procalcitonin >2.3 ng/ml or CRP >30 mg/l indicates a high likelihood for neonatal sepsis, and antibiotic therapy should be continued even in the presence of sterile cultures.
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Affiliation(s)
- Dan Turner
- Departments of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
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