Pulmonary hypertension in patients with end stage renal disease undergoing hemodialysis.

BACKGROUND: Pulmonary hypertension (PH) is a serious cardiovascular complication in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD) via arterio-venous fistulas (AVF). AIM: The aim of this study was to assess pulmonary vascular resistance (PVR), AVF flow volume (AVF-FV) and cardiac output (CO) and to highlight the impact of their augmentation, as well as of the duration of HD, on the occurrence of PH in patients with ESRD. METHODS: Our study group consisted of 51 dialyzed patients, with ESRD, without history of PH. We determined by ultrasonography the systolic pulmonary arterial pressure (PAPs), the left ventricular ejection fraction (EF), the cardiac output (CO), PVR and AVF-FV. RESULTS: We documented PH in 27 (52.94%) patients. All had elevated PVR, higher AVF-FV and CO comparing to patients without PH. They were undergoing HD for a longer period and had lower EF than those without PH. For all patients, we documented strong correlations between PAPs and PVR (r = 0.933, P < 0.001) and the duration of HD (r = 0.702, P < 0.001), but moderate ones with AVF-FV (r = 0.583, P < 0.001) and CO (r = 0.519, P < 0.001). CONCLUSION: In patients with ESRD undergoing HD, PH was a common finding being associated with increased PVR, a longer duration of HD and chronic glomerulonephritis as etiology for ESRD. The majority of patients with PH had altered left ventricular systolic function, predisposing them to an increased risk to develop heart failure.

Mitochondrial DNA damage is involved in apoptosis caused by pro-inflammatory cytokines in human OA chondrocytes.

OBJECTIVE: Pro-inflammatory cytokines play a pivotal role in cartilage destruction during the progression of osteoarthritis (OA). Additionally, these cytokines are capable to generate reactive oxygen and nitrogen species within chondrocytes. Mitochondrion is a prime target of oxidative damage and an important player in aging and degenerative processes. The purpose of the present study was to investigate whether these cytokines will alter the mitochondrial DNA (mtDNA) integrity and mitochondrial function in both normal and osteoarthritic human chondrocytes. DESIGN: Primary normal and osteoarthritic human chondrocyte cultures were exposed to various concentrations of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) for different time. Following exposure, chondrocytes were evaluated for mitochondrial DNA damage, ATP production, changes in mitochondrial transcription, and apoptosis. Adenoviral vectors were used to deliver DNA repair enzyme hOGG1 to mitochondria. RESULTS: Pro-inflammatory cytokines IL-1beta and TNF-alpha disturb mitochondrial function in human chondrocytes by inducing mitochondrial DNA damage, decreasing energy production and mitochondrial transcription, which correlated with the induction of apoptosis. Increased NO production was the key factor responsible for accumulation of mtDNA damage after cytokine exposure. Mitochondrial superoxide production was also enhanced following pro-inflammatory cytokine exposure. OA chondrocyte mitochondria were more susceptible to damage induced by pro-inflammatory cytokines then mitochondria from normal chondrocytes. Protection of human chondrocytes from mtDNA damage by the mitochondria-targeted DNA repair enzyme hOGG1 rescued mtDNA integrity, preserved ATP levels, reestablished mitochondrial transcription, and significantly diminished apoptosis following IL-1beta and TNF-alpha exposure. CONCLUSION: Mitochondrion is an important target in pro-inflammatory cytokine toxicity, maintaining of mitochondrial DNA integrity is necessary to prevent chondrocytes from apoptosis induced by IL-1beta and TNF-alpha.

Immunologic response to a single dose of tetanus toxoid in older people.

OBJECTIVES: Several studies have demonstrated that a large percentage of older people are inadequately immunized against tetanus. The aim of this study was to assess the immunity against tetanus in a group of individuals aged 69 and older and to examine the immune response to a single dose of tetanus toxoid. DESIGN: A convenience sample of 115 residents of a large retirement home, aged 69 and older, was studied. After a blood sample for anti-tetanus antibody titer, a single dose of tetanus toxoid vaccine was administered. Repeat titers were obtained 6 weeks after the vaccination and analyzed by ELISA assay. Antibody levels equal to or greater than 0.1 IU/mL were considered protective. RESULTS: Sixty-seven of 115 (58.3%) individuals had adequate antibody titers. Those individuals who reported having been vaccinated with tetanus toxoid in the past were more likely to be immunized adequately compared with those who reported having never been vaccinated (66.7% vs 39.3%, P = .02). After vaccination, 34 of 46 (73.9%) individuals with inadequate antibody titers became seropositive. Those who remained seronegative had mean prevaccination antibody titers significantly lower than those who seroconverted. Sixteen of 17 (94.1%) persons who reported having been vaccinated in the past and were found to be seronegative developed adequate antibody titers following vaccination, compared with only nine of 16 (56.2%) who reported never having been vaccinated (P = .04). There was no association between seroconversion rate and age, sex, underlying diseases, and army service. CONCLUSIONS: Most individuals will develop an adequate anti-tetanus antibody titer following administration of a single dose of tetanus vaccine. A history of past immunization is a good predictor of becoming adequately immunized. It is important that physicians follow the current recommendations for adult immunization and initiate campaigns to ensure that the older population is protected against tetanus.

Antimicrobial resistance trends in Shigella serogroups isolated in Israel, 1990-1995.

From a total of 31319 Shigella strains isolated in Israel between 1990 and 1996, 17574 were sent to the National Shigella Reference Center for typing. Of these, 15287 were identified as Shigella sonnei, 1833 as Shigella flexneri, 327 as Shigella boydii and 127 as Shigella dysenteriae. In all, 4395 strains were tested for sensitivity to ampicillin, trimethoprim-sulfamethoxazole, tetracycline, chloramphenicol, nalidixic acid and ofloxacin. All strains tested were sensitive to ofloxacin, and only three strains were resistant to nalidixic acid. Only 113 of 3240 (3.5%) Shigella sonnei strains, 172 of 970 (17.7%) Shigella flexneri strains and 45 of 185 (24.3%) Shigella boydii strains tested were sensitive to four other antibiotic agents. The rates of resistance of Shigella sonnei, Shigella flexneri and Shigella boydii to trimethoprimsulfamethoxazole were 94.4%, 51.3% and 61.6%, respectively. Rates of resistance to ampicillin among these species were 73.4%, 63.5% and 21.4%, respectively. The proportion of strains exhibiting multiple drug resistance was higher for Shigella sonnei than for the other serotypes studied. These results emphasize the need to reassess the use of antibiotic agents in the treatment of shigellosis.

A double-selective tissue culture system for isolation of wild-type poliovirus from sewage applied in a long-term environmental surveillance.

We describe a simple, cost-efficient, double-selective method for isolation of wild-type poliovirus from sewage samples containing vaccine polioviruses and other enteroviruses, with a detection limit of 18 to 50 PFU per 1 to 2 liters of sewage. By this method we were able to process 1,700 sewage samples collected between 1991 and 1996, from which 10,472 plaques were isolated, 41 of them being identified as wild-type polioviruses.

A 10 year survey on Mycobacterium tuberculosis isolates in Israel and their drug resistance.

An increased incidence of tuberculosis has been observed in Israel in 1985, 1986 and since 1990--years of large waves of immigrations. A very similar trend of disease was observed in the Mycobacterium Reference Laboratory of Israel, and consequently a survey was undertaken among the 1,181 bacteriologically confirmed tuberculosis cases newly registered there in 1983-92. The overall percent distribution of drug-resistant Mycobacterium tuberculosis during this period was 12.6% (7.3% resistant to one drug and 5.3% (multiple drug resistance). The highest percent distribution of drug-resistant bacilli was found among immigrants from the former Soviet Union (37.3%) and Ethiopia (16.2%). The highest incidence of disease was found in males and in patients aged > 30. Pulmonary disease was the most common form for all patients: among the extrapulmonary cases, the most frequently involved site was the genitourinary system in Israelis and the lymph nodes in Ethiopians. Most isolates fit into one variant by biochemical analysis, indicating the need for a more sensitive method to type M. tuberculosis for epidemiological purposes. The data included in this survey provide information useful for a national tuberculosis program.

Quantitative determination of Candida albicans in sea water.

Candida albicans counts were assessed in Mediterranean sea water using MCA media. From 116 seawater samples C. albicans was detected in 22 samples of 100 ml sea water. In sixteen samples only one colony, and in six samples two colonies, of C. albicans were found and the fungus does not appear to be an important contaminant of sea water.

Improved m-Enterococcus agar for counting faecal streptococci in sea water.

An improved medium for counting faecal streptococci in sea water is described. The medium was based on m-Enterococcus agar with the addition of 20 mg/l colistin sulphate and 10 mg/l oxolinic acid. There was no inhibition of faecal streptococci counts from sea water by the addition of these antibiotics. No significant differences were observed between the mean colony counts on media before and after identification of the colonies. The qualities of this improved medium make it the logical choice for counting faecal streptococci in sea water.

Seroprevalence of antibodies against Toxoplasma gondii among two rural populations in northern Israel.

The prevalence of antibodies against Toxoplasma gondii was measured in two rural populations in northern Israel--Jewish kibbutz members and Arab villagers. The respective prevalences in these two populations were 22.2% and 55.8% (P < 0.001). No correlation was found between the presence of antibodies and sex, occupation, contact with cats, a history of fever and/or lymphadenopathy, eye disease, abortions or delivery of children with congenital malformations. In contrast to Jewish children who were not found to have antibodies in the first decade of life, 20.5% of Arab children tested positive. A gradual increase in the prevalence of antibodies with age was seen in both groups, with the Jews reaching a prevalence of 42.6% at age 60+ and the Arabs reaching 74% at age 40. The difference between the two groups probably stems from different eating habits, namely ingestion of raw meat and unpasteurized milk and milk products.

Seroprevalence of antibodies against Toxoplasma gondii among recently immigrating Ethiopian Jews.

Sera from 144 Ethiopian immigrants who arrived in Operation Solomon, 1991, living in three absorption centers in the Jezreel Valley were tested for antibodies against Toxoplasma gondii. Antibodies were found in 34% of the test group, with a rise in prevalence with age from 0% in the first decade to 46% in the > 40 age-groups. The prevalence in the Ethiopians was higher than in Jewish kibbutz members (22.8%) and lower than in Arab villagers (55.8%). During the reproductive years (age 20-39) the rate of seroconversion is 1% per year, and screening of pregnant Ethiopian women for antibodies to T. gondii should be considered.

Prevalence of antibodies to Toxoplasma gondii in the Tel-Mond area.

Sera from 1,315 inhabitants of the Tel-Mond area were tested by the indirect immunofluorescent and Sabin Feldman tests for Toxoplasma antibodies. The overall prevalence of antibodies was 29.3%. Antibodies rose with age from 9.9% in the 1-4 year age-group up to 40.9% in the 45 age-group. There was no significant difference in prevalence of antibodies between the sexes. The prevalence of antibodies to Toxoplasma was lower in those born in Israel (21.2%) than in immigrants from Europe, America, Australia (49.4%), and Africa, Asia (40.8%) in the age groups of 20-45+. An extremely high prevalence of antibodies (41.5%) was found in Moshav Porat, a low socioeconomic settlement.

Mycobacterium xenopi, a potential human pathogen.

Mycobacterium xenopi is infrequently recognized as a cause of pulmonary disease. During a 12-year survey (1978-89),. 108 strains of this Mycobacterium were isolated from 90 persons and 6 hot water samples. From 87 patients 89 occasional strains of M. xenopi were isolated, and 3 patients were diagnosed as having pulmonary mycobacteriosis caused by it. The treatment and the response in these three cases were variable, depending on clinical conditions and sensitivity to drugs. Most of the strains isolated came from patients hospitalized at the Barzilai Hospital, Ashkelon, therefore a local environmental contamination was suspected. The suspicion was confirmed by the isolation of this thermophile organism from the hot water samples of the above hospital.

Uniformity of serotype and electropherotype in local human rotavirus isolates during each of three successive cold seasons.

Each of three consecutive cold seasons (November-March) in the town of Tiberias, Israel, was dominated by one particular rotavirus serotype causing acute diarrhoea in the community: the 1987/88 season by serotype-2; 1988/89 by serotype-1 and 1989/90 by serotype-4. Each season was also characterized by a particular pattern of rotaviral RNA when visualized using electrophoresis in gels. RNA profiles of identical rota serotypes and serotypic prevalence for any given cold season were unique for the town of Tiberias and different from other localities throughout Israel. The meaning of these findings in terms of herd immunity is discussed.

Effect of seawater storage on coliforms, faecal coliforms and Escherichia coli.

The effect of refrigeration of seawater samples for 24 h prior to assaying coliforms, faecal coliforms and Escherichia coli was assessed. When the initial coliform counts were low, the amount of bacteria in refrigerated samples decreased. When the number of initial total coliforms was high, there was an increase following cold storage. E. coli counts also decreased. Faecal coliforms, when in the initial 200-500 count range, showed a decrease during cold storage but with good correlation (r = 0.9). In all other groups, no correlation between counts of before versus after storage was found. Assessment of seawater pollution following 24 h cold storage should not be made.

Quantitative determination of Escherichia coli from coliforms and faecal coliforms in sea water.

Escherichia coli concentration in sea water was determined by the MUG test after primary growth on membrane filters used to determine total coliforms or faecal coliforms. A good correlation (r = 0.86) was found between E. coli obtained from coliforms versus those from faecal coliforms. Verification procedures showed that all the MUG-positive colonies obtained on both media were E. coli. Evaluation of this data and the literature indicated that this technique for estimation of E. coli in sea water is a useful addition to laboratory procedures without generally increasing the time and the expense of the analysis of recreational water.

The significance of testing for Pseudomonas aeruginosa in recreational seawater beaches.

The occurrence of Pseudomonas aeruginosa and faecal coliforms in Mediterranean sea water from beaches was investigated. Water samples (1,598 in toto) were tested and P. aeruginosa was found in 222 samples (14%). In 31% of samples where P. aeruginosa was detected, faecal coliforms of less than ten bacteria per 100 ml were found. In a group of 98 samples which had > 500 faecal coliforms per 100 ml, 41% had no detectable P. aeruginosa. The inclusion of P. aeruginosa as an additional parameter for approving beaches for recreational activity is recommended.

Rectal lymphogranuloma venereum in a bisexual patient.

Rectal Lymphogranuloma venereum (LGV) due to Chlamydia trachomatis (Ct) serotype L2 is reported. LGV was isolated from the lymph node biopsy of a bisexual male and was cultured on McCoy cycloheximide treated-cells. Serological tests such as the Micro-immunofluorescent test and the indirect immunoperoxidase assay for Chlamydia trachomatis done on the patient's serum were positive with a titer of 1/200 and 1/256 respectively. Smears taken from the rectal discharge were stained by the direct immunoperoxidase assay and showed inclusion bodies with positive staining. The search for the origin source of infection as well as the diagnostic and follow-up strategy in the male and female partners is also discussed.

Membrane filtration differentiation of E. coli from coliforms in the examination of water.

A membrane filter-Endo agar method for enumerating Escherichia coli as distinct from other coliforms in drinking water was developed. Membranes containing coliform colonies are transferred to nutrient agar containing 4-methyl umbelliferyl-beta-D-glucuronide (MUG) and incubated at 35 degrees C for 4 h. The MUG is hydrolyzed by the glucuronidase of E. coli and the fluorogenic product is visualized. The method recovered 98% of E. coli without false positives and is proposed as an additional test in routine water examination for the detection of pollution.

Milkborne gastroenteritis due to Staphylococcus aureus enterotoxin B from a goat with mastitis.

Three children developed Staphylococcus aureus food poisoning due to enterotoxin type B following ingestion of milk from a goat with overt mastitis.

Quantitative determination of Escherichia coli from faecal coliforms in seawater.

A simple rapid method was developed for counting Escherichia coli in sea water using a membrane filter procedure. Following filtration the membrane filter was incubated on mFC agar medium for 24 +/- 2 h at 44.5 +/- 0.2 degrees C for determination of faecal coliforms. An in situ test for the determination of E. coli was carried out by transferring the membrane filter to nutrient agar containing 4,methyl-umbiliferyl-B-D, glucoronide, followed by incubation for 3 h at 35 degrees C. The E. coli colonies were detected by fluorescence under long wavelength UV light. Extensive biochemical confirmation tests on the isolates showed that all the fluorescence colonies which were either lactose positive or negative were E. coli.