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Padawer D, Qadan A, Karameh M, Darawshy F, Laor A, Banker S, Fridlender ZG. Breath of Health: spectroscopy-based breath test for the detection of SARS-CoV-2. Infect Dis (Lond) 2024; 56:376-383. [PMID: 38424673 DOI: 10.1080/23744235.2024.2313020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/27/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Nucleic acid amplification tests (NAAT) are considered the gold standard for COVID-19 diagnosis. These tests require professional manpower and equipment, long processing and swab sampling which is unpleasant to the patients. Several volatile organic compounds (VOCs) have been identified in the breath of COVID-19 patients. Detection of these VOCs using a breath test could help rapidly identify COVID-19 patients. OBJECTIVE Assess the accuracy of 'Breath of Health' (BOH) COVID-19 Fourier-transform infra-red (FTIR) Spectroscopy-based breath test. METHODS Breath samples from patients with or without symptoms suggestive for COVID-19 who had NAAT results were collected using Tedlar bags and were blindly analysed using BOH FTIR spectroscopy. BOH Measures several VOCs simultaneously and differentiating positive and negative results. BOH results were compared to NAAT results as gold standard. RESULTS Breath samples from 531 patients were analysed. The sensitivity of BOH breath test was found to be 79.5% and specificity was 87.2%. Positive predictive value (PPV) was 74.7% and negative predictive value (NPV) 90.0%. Calculated accuracy rate was 84.8% and area under the curve 0.834. Subgroup analysis revealed that the NPV of patients without respiratory symptoms was superior over the NPV of symptomatic patients (94.7% vs 80.7%, P-value < 0.0001) and PPV of patients with respiratory symptoms outranks the PPV of individuals without symptoms (85.3% vs 69.2%, P-value 0.0196). CONCLUSION We found BOH COVID-19 breath test to be a patient-friendly, rapid, non-invasive diagnostic test with high accuracy rate and NPV that could efficiently rule out COVID-19 especially among individuals with low pre-test probability.
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Affiliation(s)
- Dan Padawer
- Institute of Pulmonary Medicine, Hadassah Medical Center, Jerusalem, Israel
- Department of Internal Medicine D, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abed Qadan
- Department of Internal Medicine D, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mutaz Karameh
- Department of Internal Medicine D, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Fares Darawshy
- Institute of Pulmonary Medicine, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arie Laor
- Breath of Health Ltd, Rehovot, Israel
| | | | - Zvi G Fridlender
- Institute of Pulmonary Medicine, Hadassah Medical Center, Jerusalem, Israel
- Department of Internal Medicine D, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Stivi T, Padawer D, Dirini N, Nachshon A, Batzofin BM, Ledot S. Using Artificial Intelligence to Predict Mechanical Ventilation Weaning Success in Patients with Respiratory Failure, Including Those with Acute Respiratory Distress Syndrome. J Clin Med 2024; 13:1505. [PMID: 38592696 PMCID: PMC10934889 DOI: 10.3390/jcm13051505] [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: 02/01/2024] [Revised: 02/29/2024] [Accepted: 03/03/2024] [Indexed: 04/10/2024] Open
Abstract
The management of mechanical ventilation (MV) remains a challenge in intensive care units (ICUs). The digitalization of healthcare and the implementation of artificial intelligence (AI) and machine learning (ML) has significantly influenced medical decision-making capabilities, potentially enhancing patient outcomes. Acute respiratory distress syndrome, an overwhelming inflammatory lung disease, is common in ICUs. Most patients require MV. Prolonged MV is associated with an increased length of stay, morbidity, and mortality. Shortening the MV duration has both clinical and economic benefits and emphasizes the need for better MV weaning management. AI and ML models can assist the physician in weaning patients from MV by providing predictive tools based on big data. Many ML models have been developed in recent years, dealing with this unmet need. Such models provide an important prediction regarding the success of the individual patient's MV weaning. Some AI models have shown a notable impact on clinical outcomes. However, there are challenges in integrating AI models into clinical practice due to the unfamiliar nature of AI for many physicians and the complexity of some AI models. Our review explores the evolution of weaning methods up to and including AI and ML as weaning aids.
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Affiliation(s)
- Tamar Stivi
- Department of Anesthesia, Critical Care and Pain Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel; (N.D.); (A.N.); (B.M.B.); (S.L.)
| | - Dan Padawer
- Department of Pulmonary Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel;
- Faculty of Medicine, Hebrew University of Jerusalem, Campus Ein Kerem, Jerusalem 9112102, Israel
| | - Noor Dirini
- Department of Anesthesia, Critical Care and Pain Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel; (N.D.); (A.N.); (B.M.B.); (S.L.)
| | - Akiva Nachshon
- Department of Anesthesia, Critical Care and Pain Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel; (N.D.); (A.N.); (B.M.B.); (S.L.)
| | - Baruch M. Batzofin
- Department of Anesthesia, Critical Care and Pain Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel; (N.D.); (A.N.); (B.M.B.); (S.L.)
| | - Stephane Ledot
- Department of Anesthesia, Critical Care and Pain Medicine, Hadassah Medical Center, Ein Kerem, POB 12000, Jerusalem 9112001, Israel; (N.D.); (A.N.); (B.M.B.); (S.L.)
- Faculty of Medicine, Hebrew University of Jerusalem, Campus Ein Kerem, Jerusalem 9112102, Israel
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Darawshy F, Abu Rmeileh A, Kuint R, Padawer D, Karim K, Fridlender Z, Laxer U, Goychman Cohen P, Berkman N. Residual symptoms, lung function, and imaging findings in patients recovering from SARS-CoV-2 infection. Intern Emerg Med 2022; 17:1491-1501. [PMID: 35235130 PMCID: PMC8889872 DOI: 10.1007/s11739-022-02950-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/12/2022] [Indexed: 01/08/2023]
Abstract
Symptoms following acute COVID-19 infection are common, but their relationship to initial COVID-19 severity is unclear. We hypothesize that residual symptoms are related to disease severity, and severe acute COVID-19 infection is more likely to cause residual pulmonary damage. This study aims to evaluate symptoms, lung function, and abnormal imaging within 3 months following COVID-19 infection, and to determine whether they are related to initial disease severity. A cross-sectional study was carried out at a designated post-COVID clinic in Hadassah Medical Center, Jerusalem, Israel. Patients with PCR-confirmed SARS-CoV-2 infection were evaluated within 12 weeks following infection and included both admitted and non-admitted subjects. All study participants underwent assessment of symptoms, quality of life (SGRQ), pulmonary function tests, and imaging. A total of 208 patients (age 49.3 ± 16 years) were included in the study. Initial disease severity was mild in 86, moderate in 49, and severe in 73 patients. At the time of follow-up, there were no differences in frequency of residual symptoms or in SGRQ score between groups. Patients with severe COVID-19 were more likely to have residual dyspnea (p = 0.04), lower oxygen saturation (p < 0.01), lower FVC and TLC (p < 0.001, p = 0.03 respectively), abnormal CXR (p < 0.01), and abnormal CT scan (p < 0.01) compared to other groups.Frequency of symptoms and impairment of quality of life at 12 week follow-up are common and are not related to severity of initial COVID-19 disease. In contrast, reduced lung function and abnormal pulmonary imaging are more common in patients with more severe acute COVID-19 infection.
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Affiliation(s)
- Fares Darawshy
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel.
| | - Ayman Abu Rmeileh
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Rottem Kuint
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Dan Padawer
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Khalil Karim
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Zvi Fridlender
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Uri Laxer
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Polina Goychman Cohen
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
| | - Neville Berkman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Institute of Pulmonary Medicine, Medical Ward, Hadassah Medical Center, 12000, 91120, Jerusalem, Israel
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Stolovich-Rain M, Kumari S, Friedman A, Kirillov S, Socol Y, Billan M, Pal RR, Das K, Golding P, Oiknine-Djian E, Sirhan S, Sagie MB, Cohen-Kfir E, Gold N, Fahoum J, Kumar M, Elgrably-Weiss M, Zhou B, Ravins M, Gatt YE, Bhattacharya S, Zelig O, Wiener R, Wolf DG, Elinav H, Strahilevitz J, Padawer D, Baraz L, Rouvinski A. Intramuscular mRNA BNT162b2 vaccine against SARS-CoV-2 induces neutralizing salivary IgA. Front Immunol 2022; 13:933347. [PMID: 36798518 PMCID: PMC9927016 DOI: 10.3389/fimmu.2022.933347] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 12/21/2022] [Indexed: 02/03/2023] Open
Abstract
Intramuscularly administered vaccines stimulate robust serum neutralizing antibodies, yet they are often less competent in eliciting sustainable "sterilizing immunity" at the mucosal level. Our study uncovers a strong temporary neutralizing mucosal component of immunity, emanating from intramuscular administration of an mRNA vaccine. We show that saliva of BNT162b2 vaccinees contains temporary IgA targeting the receptor-binding domain (RBD) of severe acute respiratory syndrome coronavirus-2 spike protein and demonstrate that these IgAs mediate neutralization. RBD-targeting IgAs were found to associate with the secretory component, indicating their bona fide transcytotic origin and their polymeric multivalent nature. The mechanistic understanding of the high neutralizing activity provided by mucosal IgA, acting at the first line of defense, will advance vaccination design and surveillance principles and may point to novel treatment approaches and new routes of vaccine administration and boosting.
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Affiliation(s)
- Miri Stolovich-Rain
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sujata Kumari
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ahuva Friedman
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saveliy Kirillov
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,National Center for Biotechnology, Astana, Kazakhstan.,Department of General Biology and Genomics, L.N. Gumilyov Eurasian National University, Astana, Kazakhstan
| | - Yakov Socol
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maria Billan
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ritesh Ranjan Pal
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kathakali Das
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peretz Golding
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Salim Sirhan
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Bejerano Sagie
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einav Cohen-Kfir
- Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naama Gold
- Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jamal Fahoum
- Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Manoj Kumar
- Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Elgrably-Weiss
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bing Zhou
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Ravins
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair E Gatt
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Saurabh Bhattacharya
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orly Zelig
- Blood Bank, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Reuven Wiener
- Department of Biochemistry, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Lautenberg Centre for Immunology and Cancer Research, The Institute for Medical Research Israel-Canada (IMRIC), Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hila Elinav
- Department of Clinical Microbiology and Infectious Diseases, Hadassah AIDS Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dan Padawer
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,Institute of Pulmonary Medicine, Hadassah Medical Center, Affiliated to the Faculty of Medicine, Hebrew University Jerusalem, Jerusalem, Israel.,Department of Internal Medicine D, Hadassah Medical Center, affiliated to the Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Leah Baraz
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,Hadassah Academic College Jerusalem, Jerusalem, Israel
| | - Alexander Rouvinski
- Department of Microbiology and Molecular Genetics, Institute for Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Kuvin Center for the Study of Infectious and Tropical Diseases, The Hebrew University-Hadassah Medical School, The Hebrew University of Jerusalem, Jerusalem, Israel
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Marom G, Khoury T, Gazla SA, Merhav H, Padawer D, Benson AA, Zamir G, Luques L, Safadi R, Khalaileh A. Operative treatment of hepatic hydatid cysts: A single center experience. Asian J Surg 2018; 42:702-707. [PMID: 30446425 DOI: 10.1016/j.asjsur.2018.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 08/02/2018] [Revised: 09/19/2018] [Accepted: 09/27/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Hydatid cyst is a zoonotic disease caused by Echinococcus genera. Surgery is needed in most cases. We aimed to describe our center's experience in the surgical management of hepatic hydated cysts (HHC). METHODS Data was retrospectively collected for patients who underwent operative management for HHC between the years 1994-2014. RESULTS Sixty-nine underwent surgical treatment for HHC. Group A included 34 treated with an unroofing procedure, group B included 24 patients who underwent hepatectomy and group C included 11 patients who underwent peri-cystectomy. The median ± (range) age for groups A, B and C were 39.5 (6.5-69), 40 (17-74) and 32 (20-62), respectively (P > 0.1). Post-operative complications occurred in 16, 11 and 5 patients in group A, B and C, respectively, as assessed by clavien-dindo classification (CDC). The average CDC was significantly higher in the hepatectomy group as compared to the unroofing group (2.3 vs.1.5, P = 0.04). Recurrence was significantly higher after the unroofing procedure as compared to the hepatectomy group (P = 0.05). CONCLUSION Surgery remains the mainstay of treatment for HHC, once surgery is pursued, the results are satisfactory.
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Affiliation(s)
- Gad Marom
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Tawfik Khoury
- Department of Gastroenterology and Liver Diseases, Hadassah Medical Center, Jerusalem, Israel.
| | - Samir Abu Gazla
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Hadar Merhav
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Dan Padawer
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Ariel A Benson
- Department of Gastroenterology and Liver Diseases, Hadassah Medical Center, Jerusalem, Israel.
| | - Gidon Zamir
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Lisandro Luques
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
| | - Rifaat Safadi
- Department of Gastroenterology and Liver Diseases, Hadassah Medical Center, Jerusalem, Israel
| | - Abed Khalaileh
- Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel.
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