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Schnur A, Rav Acha M, Loutati R, Perel N, Taha L, Zacks N, Maller T, Karmi M, Bayya F, Levi N, Sabouret P, Fink N, Marmor D, Shuvy M, Glikson M, Asher E. Incidence of Ventricular Fibrillation and Sustained Ventricular Tachycardia Complicating Non-ST Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:2286. [PMID: 38673559 PMCID: PMC11050986 DOI: 10.3390/jcm13082286] [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: 03/04/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Primary ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) are potentially lethal complications in patients suffering from acute myocardial infarction (MI). In contrast with the profound data regarding the incidence and prognostic value of ventricular arrhythmias in ST elevation myocardial infarction (STEMI) patients, data regarding contemporary non-ST elevation myocardial infarction (NSTEMI) patients with ventricular arrhythmias is scarce. The aim of the current study was to investigate the incidence of VF/VT complicating NSTEMI among patients admitted to an intensive coronary care unit (ICCU). Methods: Prospective, single-center study of patients diagnosed with NSTEMI admitted to ICCU between June 2019 and December 2022. Data including demographics, presenting symptoms, comorbid conditions, and physical examination, as well as laboratory and imaging data, were analyzed. Patients were continuously monitored for arrhythmias during their admission. The study endpoint was the development of VF/sustained VT during admission. Results: A total of 732 patients were admitted to ICCU with a diagnosis of NSTEMI. Of them, six (0.8%) patients developed VF/VT during their admission. Nevertheless, three were excluded after they were misdiagnosed with NSTEMI instead of posterior ST elevation myocardial infarction (STEMI). Hence, only three (0.4%) NSTEMI patients had VF/VT during admission. None of the patients died during 1-year follow-up. Conclusions: VF/VT in NSTEMI patients treated according to contemporary guidelines including early invasive strategy is rare, suggesting these patients may not need routine monitoring and ICCU setup.
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Affiliation(s)
- Asher Schnur
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Moshe Rav Acha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Ranel Loutati
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nimrod Perel
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Louay Taha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Netanel Zacks
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Tomer Maller
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mohammad Karmi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Feras Bayya
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nir Levi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Pierre Sabouret
- ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75005 Paris, France;
- Department of Cardiology, National College of French Cardiologists, 13 Rue Niepce, 75014 Paris, France
| | - Noam Fink
- Assuta Medical Centers, Tel Aviv 6329302, Israel;
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - David Marmor
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mony Shuvy
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Michael Glikson
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Elad Asher
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
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Loutati R, Perel N, Marmor D, Maller T, Taha L, Amsalem I, Hitter R, Mohammed M, Levi N, Shrem M, Amro M, Shuvy M, Glikson M, Asher E. Artificial intelligence based prediction model of in-hospital mortality among females with acute coronary syndrome: for the Jerusalem Platelets Thrombosis and Intervention in Cardiology (JUPITER-12) Study Group. Front Cardiovasc Med 2024; 11:1333252. [PMID: 38500758 PMCID: PMC10944920 DOI: 10.3389/fcvm.2024.1333252] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Despite ongoing efforts to minimize sex bias in diagnosis and treatment of acute coronary syndrome (ACS), data still shows outcomes differences between sexes including higher risk of all-cause mortality rate among females. Hence, the aim of the current study was to examine sex differences in ACS in-hospital mortality, and to implement artificial intelligence (AI) models for prediction of in-hospital mortality among females with ACS. Methods All ACS patients admitted to a tertiary care center intensive cardiac care unit (ICCU) between July 2019 and July 2023 were prospectively enrolled. The primary outcome was in-hospital mortality. Three prediction algorithms, including gradient boosting classifier (GBC) random forest classifier (RFC), and logistic regression (LR) were used to develop and validate prediction models for in-hospital mortality among females with ACS, using only available features at presentation. Results A total of 2,346 ACS patients with a median age of 64 (IQR: 56-74) were included. Of them, 453 (19.3%) were female. Female patients had higher prevalence of NSTEMI (49.2% vs. 39.8%, p < 0.001), less urgent PCI (<2 h) rates (40.2% vs. 50.6%, p < 0.001), and more complications during admission (17.7% vs. 12.3%, p = 0.01). In-hospital mortality occurred in 58 (2.5%) patients [21/453 (5%) females vs. 37/1,893 (2%) males, HR = 2.28, 95% CI: 1.33-3.91, p = 0.003]. GBC algorithm outscored the RFC and LR models, with area under receiver operating characteristic curve (AUROC) of 0.91 with proposed working point of 83.3% sensitivity and 82.4% specificity, and area under precision recall curve (AUPRC) of 0.92. Analysis of feature importance indicated that older age, STEMI, and inflammatory markers were the most important contributing variables. Conclusions Mortality and complications rates among females with ACS are significantly higher than in males. Machine learning algorithms for prediction of ACS outcomes among females can be used to help mitigate sex bias.
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Affiliation(s)
- Ranel Loutati
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Levi N, Wolff R, Jubeh R, Shuvy M, Steinmetz Y, Perel N, Maller T, Amsalem I, Hitter R, Asher E, Turyan A, Karmi M, Orlev A, Dratva D, Khoury Z, Hasin T, Wolak A, Glikson M, Dvir D. Culprit Lesion Coronary Intervention Before Complete Angiography in ST-Elevation Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e243729. [PMID: 38551563 PMCID: PMC10980970 DOI: 10.1001/jamanetworkopen.2024.3729] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/24/2024] [Indexed: 04/01/2024] Open
Abstract
Importance Rapid reperfusion during primary percutaneous coronary intervention (PCI) is associated with improved outcomes among patients with ST-elevation myocardial infarction (STEMI). Although attempts at reducing the time from STEMI diagnosis to arrival at the catheterization laboratory have been widely investigated, intraprocedural strategies aimed at reducing the time to reperfusion are lacking. Objective To evaluate the effect of culprit lesion PCI before complete diagnostic coronary angiography (CAG) vs complete CAG followed by culprit lesion PCI on reperfusion times among patients with STEMI. Design, Setting, and Participants This open-label, prospective, randomized clinical trial was conducted between April 1, 2021, and August 31, 2022, among patients admitted to a tertiary center in Jerusalem, Israel, with a diagnosis of STEMI undergoing primary PCI. All patients were followed up for 1 year. Analysis was on an intention-to-treat basis. Intervention Patients were randomized in a 1:1 ratio to undergo either culprit lesion PCI before complete CAG or complete CAG followed by culprit lesion PCI. Main Outcomes and Measures A needle-to-balloon time of 10 minutes or less. Results A total of 216 patients were randomized, with 184 patients (mean [SD] age, 62.9 [12.2] years; 155 men [84.2%]) included in the final intention-to-treat analysis; 90 patients (48.9%) were randomized to undergo culprit lesion PCI before CAG, and 94 (51.1%) were randomized to undergo to CAG followed by PCI. Patients who underwent culprit lesion PCI before complete CAG had a shorter mean (SD) needle-to-balloon time (11.4 [5.9] vs 17.3 [13.3] minutes; P < .001). The primary outcome of a needle-to-balloon time of 10 minutes or less was achieved for 51.1% of patients (46 of 90) who underwent culprit lesion PCI before CAG and for 19.1% of patients (18 of 94) who underwent complete CAG followed by culprit lesion PCI (odds ratio, 4.4 [95% CI, 2.2-9.1]; P < .001). Rates of adverse events were similar between groups. In a subgroup analysis, the effect of culprit lesion PCI before complete CAG on the primary outcome was consistent. There were no differences in rates of in-hospital, 30-day, and 1-year all-cause mortality. Conclusions and Relevance In this randomized clinical trial of patients with STEMI, culprit lesion PCI before complete CAG resulted in shorter reperfusion times. Larger trials are needed to validate these results and to evaluate the effect on clinical outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT05415085.
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Wolff
- Heart Institute, Ha’Emek Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rami Jubeh
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mony Shuvy
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tomer Maller
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Turyan
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammad Karmi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dmitry Dratva
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Zahi Khoury
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Loutati R, Bruoha S, Taha L, Karmi M, Perel N, Maller T, Amsalem I, Hitter R, Levi N, Zacks N, Shrem M, Amro M, Shuvy M, Glikson M, Asher E. The Effect of War on STEMI Incidence: Insights from Intensive Cardiovascular Care Unit Admissions. J Clin Med 2024; 13:1356. [PMID: 38592151 PMCID: PMC10931653 DOI: 10.3390/jcm13051356] [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: 02/07/2024] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The impact of armed conflicts on public health is undeniable, with psychological stress emerging as a significant risk factor for cardiovascular disease (CVD). Nevertheless, contemporary data regarding the influence of war on CVD, and especially on acute coronary syndrome (ACS), are scarce. Hence, the aim of the current study was to assess the repercussions of war on the admission and prognosis of patients admitted to a tertiary care center intensive cardiovascular care unit (ICCU). (2) Methods: All patients admitted to the ICCU during the first three months of the Israel-Hamas war (2023) were included and compared with all patients admitted during the same period in 2022. The primary outcome was in-hospital mortality. (3) Results: A total of 556 patients (184 females [33.1%]) with a median age of 70 (IQR 59-80) were included. Of them, 295 (53%) were admitted to the ICCU during the first three months of the war. Fewer Arab patients and more patients with ST-segment elevation myocardial infraction (STEMI) were admitted during the war period (21.8% vs. 13.2%, p < 0.001, and 31.9% vs. 24.1%, p = 0.04, respectively), whereas non-STEMI (NSTEMI) patients were admitted more frequently in the pre-war year (19.3% vs. 25.7%, p = 0.09). In-hospital mortality was similar in both groups (4.4% vs. 3.4%, p = 0.71; HR 1.42; 95% CI 0.6-3.32, p = 0.4). (4) Conclusions: During the first three months of the war, fewer Arab patients and more STEMI patients were admitted to the ICCU. Nevertheless, in-hospital mortality was similar in both groups.
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Affiliation(s)
- Ranel Loutati
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Sharon Bruoha
- Department of Cardiology, Barzilai Medical Center, and The Ben-Gurion University of the Negev, Ashkelon 7830604, Israel;
| | - Louay Taha
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mohammad Karmi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nimrod Perel
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Tomer Maller
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Rafael Hitter
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Nir Levi
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Netanel Zacks
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Maayan Shrem
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Motaz Amro
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Mony Shuvy
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Michael Glikson
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
| | - Elad Asher
- Jesselson Integrated Heart Center, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112002, Israel; (R.L.); (L.T.); (M.K.); (N.P.); (T.M.); (I.A.); (R.H.); (N.L.); (N.Z.); (M.A.); (M.S.); (M.G.)
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Perel N, Tovia-Brodie O, Schnur A, Acha MR, Levi N, Cohen Y, Dvir D, Glikson M, Michowitz Y. Post-transcatheter aortic valve implantation isolated PR prolongation: incidence and clinical significance. Europace 2023; 26:euae011. [PMID: 38225168 PMCID: PMC10808043 DOI: 10.1093/europace/euae011] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/08/2024] [Indexed: 01/17/2024] Open
Abstract
AIMS Conduction abnormalities post-transcatheter aortic valve implantation (TAVI) are common. Post-TAVI PR prolongation was mainly studied as an adjunct to new-onset bundle branch block. The net effect of isolated PR prolongation (IPRP) without post-TAVI QRS changes is not well known. The aim of this study was to define the incidence and clinical significance of post-TAVI IPRP. METHODS AND RESULTS A total of 1108 consecutive TAVI patients were reviewed. Patients with IPRP were compared with patients without post-TAVI electrocardiogram (ECG) changes. Clinical outcomes included permanent pacemaker implantation (PPI) and overall mortality. A total of 146 patients with IPRP were compared with 290 patients without post-TAVI ECG changes. At 1 year follow-up, 4 (2.7%) and 7 (2.4%) patients underwent PPI (P = 0.838) and 10 (6.8%) and 25 (8.6%) died (P = 0.521), from the study and control groups, respectively. No patient with IPRP and narrow QRS underwent PPI during 1 year post-TAVI, and all death events were non-cardiac except one unknown cause. Permanent pacemaker implantation rates among patients with IPRP and wide QRS were higher (n = 4, 12.1%), compared with patients with wide QRS without post-TAVI ECG change (n = 3, 4%) however not reaching statistical significance (P = 0.126). Multivariate Cox proportional hazards model demonstrated that in patients with narrow QRS, neither PR prolongation nor baseline or maximal PR intervals was associated with the combined endpoint of PPI and mortality. However, in patients with wide QRS, baseline PR intervals and QRS width, but not PR prolongation were associated with the combined outcome. CONCLUSION Post-TAVI IPRP in patients with narrow QRS is not associated with adverse outcome. This finding may translate clinically into a more permissive approach to these patients.
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Affiliation(s)
- Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Asher Schnur
- Department of Internal Medicine C, Shaare Zedek Medical Center,12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yogev Cohen
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Danny Dvir
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
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6
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Dadon Z, Steinmetz Y, Levi N, Orlev A, Belman D, Butnaru A, Carasso S, Glikson M, Alpert EA, Gottlieb S. Artificial Intelligence-Powered Left Ventricular Ejection Fraction Analysis Using the LVivoEF Tool for COVID-19 Patients. J Clin Med 2023; 12:7571. [PMID: 38137638 PMCID: PMC10743829 DOI: 10.3390/jcm12247571] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We sought to prospectively investigate the accuracy of an artificial intelligence (AI)-based tool for left ventricular ejection fraction (LVEF) assessment using a hand-held ultrasound device (HUD) in COVID-19 patients and to examine whether reduced LVEF predicts the composite endpoint of in-hospital death, advanced ventilatory support, shock, myocardial injury, and acute decompensated heart failure. COVID-19 patients were evaluated with a real-time LVEF assessment using an HUD equipped with an AI-based tool vs. assessment by a blinded fellowship-trained echocardiographer. Among 42 patients, those with LVEF < 50% were older with more comorbidities and unfavorable exam characteristics. An excellent correlation was demonstrated between the AI and the echocardiographer LVEF assessment (0.774, p < 0.001). Substantial agreement was demonstrated between the two assessments (kappa = 0.797, p < 0.001). The sensitivity, specificity, PPV, and NPV of the HUD for this threshold were 72.7% 100%, 100%, and 91.2%, respectively. AI-based LVEF < 50% was associated with worse composite endpoints; unadjusted OR = 11.11 (95% CI 2.25-54.94), p = 0.003; adjusted OR = 6.40 (95% CI 1.07-38.09, p = 0.041). An AI-based algorithm incorporated into an HUD can be utilized reliably as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients and may identify patients at risk for unfavorable outcomes. Future larger cohorts should verify the association with outcomes.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Daniel Belman
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shemy Carasso
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 1311502, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Evan Avraham Alpert
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem 9103102, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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7
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Meerkin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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8
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Levi N, Hasin T. Myocardial injury related to SARS-CoV-2 mRNA vaccination: The plot thickens. Eur J Heart Fail 2023; 25:1882-1883. [PMID: 37642187 DOI: 10.1002/ejhf.3013] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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9
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Levi N, Bnaya A, Wolak A, Shavit L, Jaffal S, Amsalem I, Hitter R, Wolak T. Administration of Intravenous Furosemide in Patients with Acute Infection: Patient Characteristics and Impact on In-Hospital Outcome. J Clin Med 2023; 12:jcm12103496. [PMID: 37240603 DOI: 10.3390/jcm12103496] [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: 03/26/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Intravenous (IV) fluid is frequently used to treat patients who have been admitted with an acute infection; among these patients, some will experience pulmonary congestion and will need diuretic treatment. Consecutive admissions to the Internal Medicine Department of patients with an acute infection were included. Patients were divided based on IV furosemide treatment within 48 h after admission. A total of 3556 admissions were included: In 1096 (30.8%), furosemide was administered after ≥48 h, and in 2639 (74.2%), IV fluid was administered within <48 h. Mean age was 77.2 ± 15.8 years, and 1802 (50.7%) admissions were females. In a multivariable analysis, older age (OR 1.01 [95% CI, 1.00-1.01]), male gender (OR 0.74 [95% CI, 0.63-0.86]), any cardiovascular disease (OR 1.51 [95% CI, 1.23-1.85]), congestive heart failure (CHF) (OR 2.81 [95% CI, 2.33-3.39), hypertension (OR 1.42 [95% CI, 1.22-1.67]), respiratory infection (OR 1.38 [95% CI, 1.17-1.63]), and any IV fluid administration (OR 3.37 [95% CI, 2.80-4.06]) were independently associated with furosemide treatment >48 h after hospital admission. In-hospital mortality was higher in patients with furosemide treatment (15.9% vs. 6.8%, p < 0.001). Treatment with furosemide in patients admitted with an infection was found to be associated with prolonged hospital stay and increased in-hospital mortality.
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Affiliation(s)
- Nir Levi
- Internal Medicine Department D, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Alon Bnaya
- Nephrology Unit, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Linda Shavit
- Nephrology Unit, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Sabre Jaffal
- Internal Medicine Department D, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Itshak Amsalem
- Internal Medicine Department D, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Rafael Hitter
- Internal Medicine Department D, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Talya Wolak
- Internal Medicine Department D, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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Perel N, Taha L, Farkash R, Steinmetz Y, Shaheen F, Levi N, Dadon Z, Karameh H, Karmi M, Maller T, Hamyil K, Turyan A, Manatzra M, Bayya F, Glikson M, Asher E. Level of Hypoalbuminemia as a Prognostic Factor in Patients admitted to a Tertiary Care Intensive Coronary Care Unit. Cardiol Cardiovasc Med 2023; 6:536-541. [PMID: 36817321 PMCID: PMC9937588 DOI: 10.26502/fccm.92920296] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction Hypoalbuminemia is common in acute and chronic diseases. It has been proposed as a potential biomarker of frailty, which itself is associated with worse outcomes. However, data regarding the level of hypoalbuminemia and its prognosis in contemporary intensive coronary care unit (ICCU) patients is scarce. Materials and Methods All patients who had albumin level on admission to an ICCU at a tertiary care center between January 1, 2020, and December 31, 2020, were included in the study. Patients were divided into 3 groups according to their albumin level on admission: low (< 3 g/dL), intermediate (3 g/dL≤ and ≤ 4 g/dL) and high albumin level (> 4 g/dL). Survival and in-hospital interventions and complications were compared. Results Overall 1,036 consecutive patients were included, mean age was 67±16 years and 70% were males. Of them 88 (8.5%) had low, 739 (71.5%) intermediate and 209 (20%) had high albumin levels. In a multivariate cox proportional hazards analysis, low albumin level was independently associated with higher 1-year mortality rate as compared with high albumin level (HR=9.5; 95% CI: 3.2-25.5, p<0.001). Intermediate albumin level had also a trend toward higher 1-year mortality rate as compared with high albumin level (HR=2.1; 95% CI: 0.9-5.6, p=0.09). Conclusion Hypoalbuminemia in ICCU patients is a poor prognostic factor associated with in-hospital complications and an independent risk factor for 1-year mortality rate, while intermediate albumin level shows a trend towards higher 1-year mortality rate as well.
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Affiliation(s)
- Nimrod Perel
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Rivka Farkash
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yoed Steinmetz
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Fauzi Shaheen
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Nir Levi
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ziv Dadon
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Hani Karameh
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Mohamed Karmi
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tomer Maller
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Kamal Hamyil
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Anna Turyan
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Mohamed Manatzra
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Feras Bayya
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Levi N, Moravsky G, Weitsman T, Amsalem I, Bar‐Sheshet Itach S, Algur N, Lapidus I, Mitz O, Glikson M, Wiener‐Well Y, Hasin T. A prospective study on myocardial injury after BNT162b2 mRNA COVID-19 fourth dose vaccination in healthy persons. Eur J Heart Fail 2023; 25:313-318. [PMID: 36097844 PMCID: PMC9538001 DOI: 10.1002/ejhf.2687] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 11/18/2022] Open
Abstract
AIMS To prospectively evaluate the incidence of myocardial injury after the administration of the fourth dose BNT162b2 mRNA vaccine (Pfizer-BioNTech) against COVID-19. METHODS AND RESULTS Health care workers who received the BNT162b2 vaccine during the fourth dose campaign had blood samples collected for high-sensitivity cardiac troponin (hs-cTn) during vaccine administration and 2-4 days afterward. Vaccine-related myocardial injury was defined as hs-cTn elevation above the 99th percentile upper reference limit and >50% increase from baseline measurement. Participants with evidence of myocardial injury underwent assessment for possible myocarditis. Of 324 participants, 192 (59.2%) were female and the mean age was 51.8 ± 15.0 years. Twenty-one (6.5%) participants had prior COVID-19 infection, the mean number of prior vaccine doses was 2.9 ± 0.4, and the median time from the last dose was 147 (142-157) days. Reported vaccine-related adverse reactions included local pain at injection site in 57 (17.59%), fatigue in 39 (12.04%), myalgia in 32 (9.88%), sore throat in 21 (6.48%), headache in 18 (5.5%), fever ≥38°C in 16 (4.94%), chest pain in 12 (3.7%), palpitations in 7 (2.16%), and shortness of breath in one (0.3%) participant. Vaccine-related myocardial injury was demonstrated in two (0.62%) participants, one had mild symptoms and one was asymptomatic; both had a normal electrocardiogram and echocardiography. CONCLUSION In a prospective investigation, an increase in serum troponin levels was documented among 0.62% of healthy health care workers receiving the fourth dose BNT162b2 vaccine. The two cases had mild or no symptoms and no clinical sequela. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05308680.
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
| | - Gil Moravsky
- Cardiology departmentShamir Medical CenterTzrifinIsrael
| | - Tatyana Weitsman
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
| | | | - Nurit Algur
- Clinical Biochemistry LaboratoryShaare Zedek Medical CenterJerusalemIsrael
| | - Ira Lapidus
- Cardiology departmentShamir Medical CenterTzrifinIsrael
| | - Ofir Mitz
- Cardiology departmentShamir Medical CenterTzrifinIsrael
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
| | - Yonit Wiener‐Well
- Infectious Disease Unit, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of MedicineThe Hebrew UniversityJerusalemIsrael
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12
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Amsalem I, Asher E, Blaufeld I, Hitter R, Levi N, Taha L, Shaheen FF, Karameh H, Maller T, Perel N, Steinmetz Y, Karmi M, Hamayel K, Manassra M, Wolak T, Glikson M, Wolak A. Mean Platelet Volume as a Predictor of Coronary Artery Disease Severity and its Association With Coronary Artery Calcification. Clin Appl Thromb Hemost 2023; 29:10760296231159113. [PMID: 36999275 PMCID: PMC10068979 DOI: 10.1177/10760296231159113] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Coronary calcium score (CCS) is a highly sensitive marker for estimating coronary artery calcification (CAC) and detecting coronary artery disease (CAD). Mean platelet volume (MPV (is a platelet indicator that represent platelet stimulation and production. The aim of the current study was to examine the association between MPV values and CAC. We examined 290 patients who underwent coronary computerized tomography (CT) exam between the years 2017 and 2020 in a tertiary care medical center. Only patients evaluated for chest pain were included. The Multi-Ethnic Study of Atherosclerosis (MESA) CAC calculator was used to categorize patients CCS by age, gender, and ethnicity to CAC severity percentiles (<50, 50-74, 75-89, ≥90). Thereafter, the association between CAC percentile and MPV on admission was evaluated. Out of 290 patients, 251 (87%) met the inclusion and exclusion criteria. There was a strong association between higher MPV and higher CAC percentile (P = .009). The 90th CAC percentile was associated with the highest prevalence of diabetes mellitus (DM), hypertension, dyslipidemia, and statin therapy (P = .002, .003, .001, and .001, respectively). In a multivariate analysis (including age, gender, DM, hypertension, statin therapy, and low-density lipoprotein level) MPV was found to be an independent predictor of CAC percentile (OR 1.55-2.65, P < .001). Higher MPV was found to be an independent predictor for CAC severity. These findings could further help clinicians detect patients at risk for CAD using a simple and routine blood test.
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Affiliation(s)
- Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Inbar Blaufeld
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rafael Hitter
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Fauzi Fadi Shaheen
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tomer Maller
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammad Karmi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kamal Hamayel
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammed Manassra
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Talya Wolak
- Internal Medicine Department D, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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13
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Hitter R, Orlev A, Amsalem I, Levi N, Wolak T, Farkash R, Bogot N, Glikson M, Wolak A. The Added Value of a High CT Coronary Artery Calcium Score in the Management of Patients Presenting with Acute Chest Pain vs. Stable Chest Pain. J Cardiovasc Dev Dis 2022; 9:jcdd9110390. [PMID: 36421925 PMCID: PMC9694127 DOI: 10.3390/jcdd9110390] [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: 10/05/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Contrast computerized tomography (CT) scan is occasionally aborted due to a high coronary artery calcium score (CACS). For the same CACS in our clinical practice, we observed a higher occurrence of severe coronary artery disease (CAD) in patients with acute chest pain (ACP) compared to patients with stable chest pain (SCP). Since it is known that ACP differs in many ways from SCP, the aim of this study was to compare the predictive value of a high CACS for the diagnosis of severe CAD between ACP and SCP patients. Methods: This single center observational retrospective study included consecutive patients who underwent cardiac CT for chest pain and were found to have a CACS of >200 Agatston units. Patients were divided into two groups, ACP and SCP. Severe CAD was defined as ≥70% stenosis on coronary CT angiography or invasive coronary angiography. Baseline characteristics and final diagnosis of severe CAD were compared. Results: The cohort included 220 patients, 106 with ACP and 114 with SCP. ACP patients had higher severe CAD rates (60.4% vs. 36.8%; p < 0.001). On multivariate analysis including cardiac risk factors, CACS > 400 au (OR = 2.34 95% CI [1.32−4.15]; p = 0.004) and ACP (OR = 2.54 95% CI [1.45−4.45]; p = 0.001) were independent predictors of severe CAD. The addition of the clinical setting of ACP added significant incremental predictive value for severe stenosis. Conclusion: A high CACS is more associated with severe CAD in patients presenting with ACP than SCP. The findings suggest that the CACS could impact the management of patients during the scan.
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Affiliation(s)
- Rafael Hitter
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Talya Wolak
- Department of Internal Medicine, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Rivka Farkash
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Naama Bogot
- Department of Radiology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Arik Wolak
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Correspondence: ; Tel.: +972-2-6555955; Fax: +972-2-6555437
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14
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Karameh H, Taha L, Karmi M, Hamayel K, Perel N, Steinmetz Y, Levi N, Shaheen F, Manassra M, Maller T, Glikson M, Asher E. Outcomes of patients treated with blood transfusion in a contemporary tertiary intensive cardiac care unit. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1485] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Different trials showed that patients treated with blood transfusion (BT) have unfavorable prognosis regarding outcomes and mortality. Nevertheless, outcomes in patients treated with BT hospitalized in a contemporary tertiary intensive cardiac care unit (ICCU) is limited.
Objective
To determine mortality rate in patients treated with BT in a contemporary tertiary ICCU.
Methods
A prospective single center study to evaluate short- and long-term mortality rate of patients treated with BT between January 2020 and December 2021 in a tertiary ICCU.
Outcomes
During the study period 2132 consecutive patients were admitted with a mean age of 66.9±16 and 650 (30.5%) of them were women. Of the total population, 108 (5%) patients were treated with BT (BT-group) during their hospitalization. Patients were followed-up for 2 years with a median [IQR] follow up time of 82.5 [12.25–240.50] days in BT-group vs. 138.5 [34–325, 75] days in the non-BT (NBT) group. Mean age was 73.81±14 years in BT-group vs. 66.59±16 years in NBT-group, p<0.0001. There was a higher rate of female gender in the BT-group 48.1% vs. 29.5% in the NBT, p<0.0001. Crude mortality rate was 29.6% in BT-group and 9.2% in NBT-group, p<0.0001. Median [IQR] length of stay was 5 [2–6] days in BT-group vs. 3 [2–4] days in the NBT-group. Multivariate Cox analysis for (Female gender, prior trans-catheter aortic valve replacement, prior cardiac intervention, sepsis, history of congestive heart failure, pulmonary hypertension, pacemaker implantation and anemia) showed that BT was independently associated with more than two folds the mortality rate [HR=2.19 95% CI (1.47–3.62)] as compared with the NBT-group, p<0.0001. Receiver operating characteristic curve (ROC) was plotted for multivariable analysis and showed area under curve (AUC) of 0.8, 95% CI [0.760–0.852].
Conclusion
Even in contemporary tertiary ICCU, with advanced technology, equipment and delivery of care, BT remains a strong predictor for short- and long-term mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Karameh
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - L Taha
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - M Karmi
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - K Hamayel
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - N Perel
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - Y Steinmetz
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - N Levi
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - F Shaheen
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - M Manassra
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - T Maller
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - M Glikson
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
| | - E Asher
- Shaare Zedek Medical Center, The Jesselson Integrated Heart Center , Jerusalem , Israel
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15
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Dadon Z, Levi N, Orlev A, Belman D, Butnaru A, Glikson M, Gottlieb S, Alpert EA. Use of artificial intelligence for point-of-care echocardiographic assessment of left ventricular ejection fraction among COVID-19 patients. Eur Heart J 2022. [PMCID: PMC9619537 DOI: 10.1093/eurheartj/ehac544.004] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The association between COVID-19 infection and the cardiovascular system has been well described. Isolation precautions limit the use of formal echocardiography in this setting. Artificial intelligence (AI) utilization using a hand-held device in these patients can be a reliable tool for left ventricular ejection fraction (LVEF) assessment. Aims To prospectively investigate the accuracy of AI-base tool for LVEF assessment using a hand-held echocardiogram in patients with COVID-19. Methods From April-28 through July-26, 2020, consecutive patients with COVID-19 underwent a real-time LVEF assessment within 48-h of admission using a hand-held echocardiogram evaluation (Vscan Extend) equipped with LVivoEF, an AI-based tool that automatically evaluates LVEF. The examinations were further analyzed off-line by a blinded fellowship-trained echocardiographer for LVEF as a gold standard. Results Among 42 patients, 21 (50%) were male (aged 53.3±17.8 years, mean BMI 27.6±5.1 kg/m2). Seven (16.7%) patients couldn't turn on their left side and three (7.1%) couldn't maintain effective communication. The mean length of each echocardiogram study was 6.8±2.2 minutes, battery usage was 13.4±4.9%, and mean operator-to-patient proximity was 64.5±9.3 cm. A fair to good correlation was demonstrated between the AI and the echocardiographer LVEF assessment (Pearson's correlation of 0.691, p<0.001). An almost perfect agreement was demonstrated between the AI and the echocardiographer for LVEF using a threshold of 45% (kappa=0.806, p<0.001). The sensitivity of focused echocardiogram for 45% LVEF threshold is 85.7%, specificity is 97.1% with a PPV of 85.7% and NPV of 97.1%. Conclusions An AI-based algorithm incorporated into an existing hand-held echocardiogram device can be reliably utilized as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients. Funding Acknowledgement Type of funding sources: None.
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Affiliation(s)
- Z Dadon
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - N Levi
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - A Orlev
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - D Belman
- Shaare Zedek Medical Center, Intensive Care Unit , Jerusalem , Israel
| | - A Butnaru
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - M Glikson
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - S Gottlieb
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center , Jerusalem , Israel
| | - E A Alpert
- Shaare Zedek Medical Center, Emergency Department , Jerusalem , Israel
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16
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Mevorach D, Anis E, Cedar N, Hasin T, Bromberg M, Goldberg L, Levi N, Perzon O, Magadle N, Barhoum B, Parnassa E, Dichtiar R, Hershkovitz Y, Green MS, Ash N, Keinan-Boker L, Alroy-Preis S. Myocarditis After BNT162b2 COVID-19 Third Booster Vaccine in Israel. Circulation 2022; 146:802-804. [PMID: 36067275 PMCID: PMC9439627 DOI: 10.1161/circulationaha.122.060961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Dror Mevorach
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.).,Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.)
| | - Emilia Anis
- Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.).,Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.)
| | - Noa Cedar
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.)
| | - Tal Hasin
- Faculty of Medicine, Hebrew University, Jerusalem, Israel (D.M., E.A., T.H.).,Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel (T.H., N.L.)
| | - Michal Bromberg
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.).,Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel (M.B.)
| | - Lital Goldberg
- Division of Epidemiology, Israeli Ministry of Health, Jerusalem (E.A., N.C., L.G.).,Braun School of Public Health, Jerusalem, Israel (E.A., N.C., L.G.).,Clalit Health Services, Tel Aviv, Israel (L.G.)
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel (T.H., N.L.)
| | - Ofer Perzon
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Nur Magadle
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Barhoum Barhoum
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Elchanan Parnassa
- Pnimit B & Division of Rheumatology-Immunology-Allergology and the Wohl Institute for Translational Medicine, Department of Medicine, Hadassah Medical Center, Jerusalem, Israel (D.M., O.P., N.M., B.B., E.P.)
| | - Rita Dichtiar
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.)
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.)
| | - Manfred S. Green
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (M.S.G., L.K.-B.)
| | - Nachman Ash
- Department of Health Management, Ariel University, Jerusalem, Israel (N.A.).,Israeli Ministry of Health, Jerusalem (N.A., S.A.-P.)
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (M.B., R.D., Y.H., L.K.-B.).,School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel (M.S.G., L.K.-B.)
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17
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Levi N, Jacobzon E, Tobar A, Weitsman T, Maleszewski JJ, Hasin T. Embolized Hydrophilic Coating Polymers Found in Left Ventricular Assist Device Apical Core Specimen. JACC Case Rep 2022; 4:819-821. [PMID: 35818595 PMCID: PMC9270635 DOI: 10.1016/j.jaccas.2022.03.035] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Left ventricular assist devices are increasingly used in patients with advanced heart failure. Gross and histologic evaluation of myocardial apical core specimens, extracted during device placement, can provide important insights. Herein, we describe a case of hydrophilic polymer embolization with associated foreign-body giant cell reaction discovered during apical core evaluation. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ehud Jacobzon
- Department of Cardiothoracic Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Tobar
- Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - Tatyana Weitsman
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph J. Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tal Hasin
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Address for correspondence: Dr Tal Hasin, Jesselson Integrated Heart Center, Shaare Zedek Medical Center, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
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18
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Levi N, Dadon Z, Steinmetz Y, Perel N, Orlev A, Asher E, Jubeh R, Farkash R, Gottlieb S, Almagor Y, Dvir D, Glikson M, Wolff R. Prevalence, Predictors, and Outcomes of Patients With ST-Elevation Myocardial Infarction and Angiographically Significant Coronary Artery Disease of Non-Infarct-Related Artery. Am J Cardiol 2022; 173:73-79. [PMID: 35369934 DOI: 10.1016/j.amjcard.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022]
Abstract
Patients with ST-elevation myocardial infarction (STEMI) can present with angiographically significant coronary artery disease (CAD) of non-infarct-related artery (IRA) or with IRA-only CAD. This study aimed to evaluate the prevalence, predictors, and outcome of patients with STEMI and angiographically significant CAD of non-IRA. All consecutive patients with STEMI who underwent primary percutaneous coronary intervention between 2000 and 2020 were included. Angiographically significant CAD was defined as >50% stenosis of the left main coronary artery and/or >90% stenosis for all other coronary arteries. A total of 2,663 patients had IRA-only CAD (80.2%) and 657 had angiographically significant non-IRA CAD (19.8%). Independent predictors for non-IRA CAD were male gender (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.05 to 1.70, p = 0.021), age >50 years (OR 1.45, 95% CI 1.11 to 1.91, p = 0.007), and diabetes mellitus (OR 1.56, 95% CI 1.29 to 1.9, p <0.001), whereas smoking (OR 0.83, 95% CI 0.68 to 0.99, p = 0.004) and family history of CAD (OR 0.78, 95% CI 0.62 to 0.98, p = 0.032) were found to be negatively associated with non-IRA CAD. In-hospital 30-day and 1- and 5-year all-cause mortality were higher in patients with non-IRA CAD compared with IRA-only CAD (5.8% vs 2.5%, 8.5% vs 3.3%, 18.4% vs 7.6% and 36.3% vs 20.3%, respectively; p for all <0.001). In conclusion, 20% of patients with STEMI had angiographically significant non-IRA CAD. Older age, male gender, and diabetes mellitus were independent predictors for non-IRA CAD, whereas smoking and family history of CAD predicted IRA-only CAD. The presence of non-IRA CAD was associated with higher short- and long-term all-cause mortality rates.
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19
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Dadon Z, Levi N, Alpert EA, Orlev A, Belman D, Glikson M, Butnaru A, Gottlieb S. The quality, safety, feasibility, and interpretive accuracy of echocardiographic and lung ultrasound assessment of COVID-19 patients using a hand-held ultrasound. Echocardiography 2022; 39:886-894. [PMID: 35668047 PMCID: PMC9348495 DOI: 10.1111/echo.15372] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/01/2022] [Accepted: 05/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background The association between COVID‐19 infection and the cardiovascular system necessitates the use of an echocardiogram in this setting. Information on the utilization, safety, and quality of point‐of‐care cardiac and lung ultrasound using a hand‐held device in these patients is scarce. Aims To investigate the safety, technical aspects, quality indices, and interpretive accuracy of a hand‐held echocardiogram in patients with COVID‐19. Methods From April‐28 through July‐27, 2020, consecutive patients with COVID‐19 underwent hand‐held echocardiogram and lung ultrasound evaluation (Vscan Extend™; GE Healthcare) within 48‐h of admission. The operators recorded a series of technical parameters and graded individual experiences. The examinations were further analyzed by a blinded fellowship‐trained echocardiographer for general quality, proper acquisition, and right ventricular (RV) demonstration. Results Among 103 patients, 66 (64.1%) were male. Twenty‐nine (28.2%) patients could not turn on their left side and 23 (22.3%) could not maintain effective communication. The mean length of each echocardiogram study was 8.5 ± 2.9 min, battery usage was 14 ± 5%, and mean operator‐to‐patient proximity was 59 ± 11 cm. Ninety‐five (92.2%) examinations were graded as fair/good quality. A fair agreement was demonstrated between the operator and the echocardiographer for general ultrasound quality (Kappa = 0.329, p < 0.001). A fair‐good correlation (r = 0.679, p < 0.001) and substantial agreement (Kappa = 0.612, p < 0.001) were demonstrated between the operator and echocardiographer for left ventricular ejection fraction (LVEF), whereas a fair agreement was demonstrated for RV systolic function (Kappa = 0.308, p = 0.002). LVEF agreement was also assessed using the Bland‐Altman analysis revealing a mean bias of −0.96 (95% limits of agreement 9.43 to −11.35; p = 0.075). Conclusions Among patients with COVID‐19, echocardiography with a hand‐held ultrasound is a safe and reasonable alternative for a complete formal study (<10% poor‐quality indices). Echocardiogram assessment by the operators during the exam acquisition is reliable for LVEF, while RV systolic function should be subsequently offline reassessed.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Evan Avraham Alpert
- Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daniel Belman
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Lupu L, Taha L, Farkash R, Bayya F, Karmi M, Steinmetz Y, Shaheen FF, Perel N, Hamayel K, Levi N, Maller T, Karameh H, Lichewitz G, Gavish D, Algur N, Glikson M, Asher E. Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit : The Jerusalem platelets thrombosis and intervention in cardiology (JUPITER-6) study group. Cardiovasc Diabetol 2022; 21:86. [PMID: 35637510 PMCID: PMC9153197 DOI: 10.1186/s12933-022-01529-1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/20/2022] [Indexed: 01/08/2023] Open
Abstract
Background Hemoglobin A1C (HbA1c) is a form of glycated hemoglobin used to estimate glycemic control in diabetic patients. Data regarding the prognostic significance of HbA1c levels in contemporary intensive cardiac care unit (ICCU) patients is limited. Methods All patients admitted to the ICCU at a tertiary care medical center between January 1, 2020, and June 30, 2021, with documented admission HbA1c levels were included in the study. Patients were divided into 3 groups according to their HbA1c levels: < 5.7 g% [no diabetes mellitus (DM)], 5.7–6.4 g% (pre-DM), ≥ 6.5 g% (DM). Results A total of 1412 patients were included. Of them, 974 (69%) were male with a mean age of 67(± 15.7) years old. HbA1c level < 5.7 g% was found in 550 (39%) patients, 5.7–6.4 g% in 458 (32.4%) patients and ≥ 6.5 g% in 404 (28.6%) patients. Among patients who did not know they had DM, 81 (9.3%) patients had high HbA1c levels (≥ 6.5 g%) on admission. The crude mortality rate at follow-up (up to 1.5 years) was almost twice as high among patients with pre-DM and DM than in patients with no DM (10.6% vs. 5.4%, respectively, p = 0.01). Interestingly, although not statistically significant, the trend was that pre-DM patients had the strongest association with mortality rate [HR 1.83, (95% CI 0.936–3.588); p = 0.077]. Conclusions Although an HbA1c level of ≥ 5.7 g% (pre-DM & DM) is associated with a worse prognosis in patients admitted to ICCU, pre-DM patients, paradoxically, have the highest risk for short and long-term mortality rates.
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Affiliation(s)
- Lior Lupu
- Department of Cardiology, Tel Aviv Medical Center (Affiliated to The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Weizmann 6, 6423919, Tel Aviv, Israel.
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Rivka Farkash
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Feras Bayya
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Mohammad Karmi
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Yoed Steinmetz
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Fauzi Fadi Shaheen
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Nimrod Perel
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Kamal Hamayel
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Nir Levi
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Tommer Maller
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Hani Karameh
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Gavriel Lichewitz
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Dov Gavish
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Nurit Algur
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, Shaare Zedek Medical Center (Affiliated to The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel), Jerusalem, Israel
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Levi N, Shavit L, Farkas A, Atrash J, Helvitz Y, Esayag Y, Wolak T. Late Post Native Kidney Biopsy Complication: Renal Pseudoaneurysm Rupture. Isr Med Assoc J 2022; 24:265-267. [PMID: 35415988] [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: 06/14/2023]
Affiliation(s)
- Nir Levi
- Department of Internal Medicine D, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Linda Shavit
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Adam Farkas
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Joad Atrash
- Department of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yigal Helvitz
- Department of Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yaacov Esayag
- Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Talya Wolak
- Department of Internal Medicine D, Shaare Zedek Medical Center, Jerusalem, Israel
- Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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22
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Rav Acha M, Taha L, Turyan A, Farkash R, Bayya F, Karmi M, Steinmetz Y, Shaheen FF, Perel N, Hamayel K, Levi N, Karameh H, Tvito A, Glikson M, Asher E. D-Dimer as a Prognostic Factor in a Tertiary Center Intensive Coronary Care Unit. Clin Appl Thromb Hemost 2022; 28:10760296221110879. [PMID: 35866208 PMCID: PMC9310202 DOI: 10.1177/10760296221110879] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION D-dimer is a small protein fragment produced during fibrinolysis. High D-dimer levels were shown to have prognostic impact in critically ill patients. Nevertheless, data regarding D-dimer's prognostic impact among tertiary care intensive coronary care unit (ICCU) patients is scarce. MATERIAL AND METHOD All patients admitted to the ICCU between 1-12/2020 were prospectively included. Based on admission D-dimer level, patients were categorized into low and high D-dimer groups (< 500 ng/ml and ≥ 500 ng/ml) and also to age-adjusted D-dimer cutoff (500 ng/ml for ages ≤ 50 years old and age*10 for ages>50 years old). RESULTS AND DISCUSSION A total of 959 consecutive patients were included, including 296 (27.4%) and 663 (61.3%) patients with low and high D-Dimer levels, respectively. Patients with high D-dimer level were older compared with patients with low D-dimer level (age 70.4 ± 15 and 59 ± 13 years, p = 0.004) and had more comorbidities. The most common primary diagnosis on admission among the low D-dimer group was acute coronary syndrome (ACS) (74.3%), while in the high D-dimer group it was a combination of ACS (33.6%), cardiac structural interventions (26.7%) and various arrhythmias (21.1%). High D-dimer levels were associated with increased mortality rate, even after adjustment for age, gender, comorbidities and left ventricular ejection fraction (LVEF). High D-dimer levels were independently associated with increased overall 1-year mortality rate (HR = 5.8; 95% CI; 1.7-19.1; p = 0.004). CONCLUSION Elevated D-dimer levels on admission in ICCU patients is an independently poor prognostic factor for in-hospital morbidity and 1-year overall mortality rate following hospitalization.
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Affiliation(s)
- Moshe Rav Acha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Louay Taha
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Turyan
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rivka Farkash
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Feras Bayya
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mohammad Karmi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yoed Steinmetz
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Fauzi Fadi Shaheen
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nimrod Perel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kamal Hamayel
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Levi
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hani Karameh
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Tvito
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Glikson
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Asher
- Department of Cardiology, Jesselson Integrated Heart Center, 26743Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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23
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Dadon Z, Levi N, Orlev A, Belman D, Alpert EA, Glikson M, Gottlieb S, Butnaru A. The Utility of Hand-held Cardiac and Lung Ultrasound in Predicting Outcomes of Hospitalized Patients with COVID-19. Can J Cardiol 2021; 38:338-346. [PMID: 34871728 PMCID: PMC8641404 DOI: 10.1016/j.cjca.2021.11.016] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/14/2021] [Accepted: 11/28/2021] [Indexed: 02/01/2023] Open
Abstract
Background Strict isolation precautions limit formal echocardiography use in the setting of COVID-19 infection. Information on the importance of handheld focused ultrasound for cardiac evaluation in these patients is scarce. This study investigated the utility of a handheld echocardiography device in hospitalised patients with COVID-19 in diagnosing cardiac pathologies and predicting the composite end point of in-hospital death, mechanical ventilation, shock, and acute decompensated heart failure. Methods From April 28 through July 27, 2020, consecutive patients diagnosed with COVID-19 underwent evaluation with the use of handheld ultrasound (Vscan Extend with Dual Probe; GE Healthcare) within 48 hours of admission. The patients were divided into 2 groups: “normal” and “abnormal” echocardiogram, as defined by biventricular systolic dysfunction/enlargement or moderate/severe valvular regurgitation/stenosis. Results Among 102 patients, 26 (25.5%) had abnormal echocardiograms. They were older with more comorbidities and more severe presenting symptoms compared with the group with normal echocardiograms. The prevalences of the composite outcome among low- and high-risk patients (oxygen saturation < 94%) were 3.1% and 27.1%, respectively. Multivariate logistic regression analysis revealed that an abnormal echocardiogram at presentation was independently associated with the composite end point (odds ratio 6.19, 95% confidence interval 1.50-25.57; P = 0.012). Conclusions An abnormal echocardiogram in COVID-19 infection settings is associated with a higher burden of medical comorbidities and independently predicts major adverse end points. Handheld focused echocardiography can be used as an important “rule-out” tool among high-risk patients with COVID-19 and should be integrated into their routine admission evaluation. However, its routine use among low-risk patients is not recommended.
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Affiliation(s)
- Ziv Dadon
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amir Orlev
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Daniel Belman
- Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Evan Avraham Alpert
- Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - Shmuel Gottlieb
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Adi Butnaru
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel
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Mevorach D, Anis E, Cedar N, Bromberg M, Haas EJ, Nadir E, Olsha-Castell S, Arad D, Hasin T, Levi N, Asleh R, Amir O, Meir K, Cohen D, Dichtiar R, Novick D, Hershkovitz Y, Dagan R, Leitersdorf I, Ben-Ami R, Miskin I, Saliba W, Muhsen K, Levi Y, Green MS, Keinan-Boker L, Alroy-Preis S. Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel. N Engl J Med 2021; 385:2140-2149. [PMID: 34614328 PMCID: PMC8531987 DOI: 10.1056/nejmoa2109730] [Citation(s) in RCA: 372] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Approximately 5.1 million Israelis had been fully immunized against coronavirus disease 2019 (Covid-19) after receiving two doses of the BNT162b2 messenger RNA vaccine (Pfizer-BioNTech) by May 31, 2021. After early reports of myocarditis during adverse events monitoring, the Israeli Ministry of Health initiated active surveillance. METHODS We retrospectively reviewed data obtained from December 20, 2020, to May 31, 2021, regarding all cases of myocarditis and categorized the information using the Brighton Collaboration definition. We analyzed the occurrence of myocarditis by computing the risk difference for the comparison of the incidence after the first and second vaccine doses (21 days apart); by calculating the standardized incidence ratio of the observed-to-expected incidence within 21 days after the first dose and 30 days after the second dose, independent of certainty of diagnosis; and by calculating the rate ratio 30 days after the second dose as compared with unvaccinated persons. RESULTS Among 304 persons with symptoms of myocarditis, 21 had received an alternative diagnosis. Of the remaining 283 cases, 142 occurred after receipt of the BNT162b2 vaccine; of these cases, 136 diagnoses were definitive or probable. The clinical presentation was judged to be mild in 129 recipients (95%); one fulminant case was fatal. The overall risk difference between the first and second doses was 1.76 per 100,000 persons (95% confidence interval [CI], 1.33 to 2.19), with the largest difference among male recipients between the ages of 16 and 19 years (difference, 13.73 per 100,000 persons; 95% CI, 8.11 to 19.46). As compared with the expected incidence based on historical data, the standardized incidence ratio was 5.34 (95% CI, 4.48 to 6.40) and was highest after the second dose in male recipients between the ages of 16 and 19 years (13.60; 95% CI, 9.30 to 19.20). The rate ratio 30 days after the second vaccine dose in fully vaccinated recipients, as compared with unvaccinated persons, was 2.35 (95% CI, 1.10 to 5.02); the rate ratio was again highest in male recipients between the ages of 16 and 19 years (8.96; 95% CI, 4.50 to 17.83), with a ratio of 1 in 6637. CONCLUSIONS The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients. The clinical presentation of myocarditis after vaccination was usually mild.
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Affiliation(s)
- Dror Mevorach
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Emilia Anis
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Noa Cedar
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Michal Bromberg
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Eric J Haas
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Eyal Nadir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Sharon Olsha-Castell
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Dana Arad
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Tal Hasin
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Nir Levi
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Rabea Asleh
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Offer Amir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Karen Meir
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Dotan Cohen
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Rita Dichtiar
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Deborah Novick
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Yael Hershkovitz
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ron Dagan
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Iris Leitersdorf
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ronen Ben-Ami
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Ian Miskin
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Walid Saliba
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Khitam Muhsen
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Yehezkel Levi
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Manfred S Green
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Lital Keinan-Boker
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
| | - Sharon Alroy-Preis
- From the Department of Internal Medicine B, Division of Immunology-Rheumatology, and Wohl Institute for Translational Medicine (D.M.) and the Departments of Cardiology (R.A., O.A.), Pathology (K. Meir), and Radiology (D.C.), Hadassah Medical Center, Braun School of Public Health (E.A.), Jesselson Integrated Heart Center, Shaare Zedek Medical Center (T.H., N.L.), and the Department of Family Medicine (I.M.), Faculty of Medicine, Hebrew University of Jerusalem, the Divisions of Epidemiology (E.A., N.C., E.J.H., E.N.), Patient Safety (S.O.-C., D.A.), and Medicine (I.L.), Israeli Ministry of Health (M.B., R. Dichtiar, D.N., Y.H., Y.L., L.K.-B., S.A.-P.), and Clalit Health Services (E.N., I.M.), Jerusalem, Israel Center for Disease Control, and Azrieli Faculty of Medicine, Bar-Ilan University (O.A.), Ramat Gan, the Department of Epidemiology and Preventive Medicine, School of Public Health (M.B., K. Muhsen), and Tel Aviv Sourasky Medical Center (R.B.-A.), Tel Aviv University, Tel Aviv, Ben Gurion University of the Negev, Beer Sheva (E.J.H., R. Dagan), and the Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Technion-Israel Institute of Technology (W.S.), and the School of Public Health, University of Haifa (M.S.G., L.K.-B.), Haifa - all in Israel
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25
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Levi N, Bongiorni MG, Rav Acha M, Tovia-Brodie O, Kennergren C, Auricchio A, Maggioni AP, Rinaldi CA, Nof E, Ilan M, Blomstrom-Lundqvist C, Deharo JC, Leclercq C, Glikson M, Michowitz Y. Lead fixation mechanism impacts outcome of transvenous lead extraction: Data from the European Lead Extraction ConTRolled Registry. Europace 2021; 24:817-827. [PMID: 34652415 DOI: 10.1093/europace/euab240] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/26/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS The aims of this study is to characterize the transvenous lead extraction (TLE) population with active (A) compared with passive fixation (PFix) leads and to compare the safety, efficacy, and ease of extracting active fixation (AFix) compared with PFix right atrial (RA) and right ventricular (RV) leads. METHODS AND RESULTS The European Lead Extraction ConTRolled Registry (ELECTRa) was analysed. Patients were divided into three groups; those with only AFix, only PFix, and combined Fix leads. Three outcomes were defined. Difficult extraction, complete radiological, and clinical success. Multivariate model was used to analyse the independent effect of Fix mechanism on these outcomes. The study included 2815 patients, 1456 (51.7%) with only AFix leads, 982 (34.9%) with only PFix leads, and 377 (13.4%) with combined Fix leads. Patients with AFix leads were younger with shorter lead dwelling time. Infection was the leading cause for TLE among the combined Fix group with lowest rates among AFix group. No difference in complications rates was noted between patients with only AFix vs. PFix leads. Overall, there were 1689 RA (1046 AFix and 643 PFix) and 2617 RV leads (1441 AFix and 1176 PFix). Multivariate model demonstrated that PFix is independently associated with more difficult extraction for both RA and RV leads, lower radiological success in the RA but has no effect on clinical success. CONCLUSION Mechanism of Fix impact the ease of TLE of RA and RV leads and rates of complete radiological success in the RA but not clinical success. These findings should be considered during implantation and TLE procedures.
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Affiliation(s)
- Nir Levi
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Moshe Rav Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Oholi Tovia-Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Charles Kennergren
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Eyal Nof
- Leviev Heart Institute, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Michael Ilan
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | | | - Jean-Claude Deharo
- Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, Marseille, France.,Aix Marseille University, C2VN Marseille, France
| | | | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine Hebrew University, 12 Shmuel Beit Street, Jerusalem 9103102, Israel
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26
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Dadon Z, Levi N, Orlev A, Belman D, Alpert EA, Steinmetz Y, Wolak A, Glikson M, Gottlieb S, Butnaru A. Association between cardiac pathology and outcomes of patients with COVID-19 using a hand-held ultrasound. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0101] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The association between COVID-19 infection and the cardiovascular system has been well described. Strict precautions limit the use of formal echocardiography in this setting. Information on the importance of the utilization of a hand-held point-of-care cardiac ultrasound (POCCUS) for cardiac evaluation in these patients is scarce.
Objective
To investigate the utilization of hand-held echocardiography in COVID-19 hospitalized patients and the association between cardiac pathologies and outcomes.
Methods
Consecutive patients diagnosed with COVID-19 underwent POCCUS evaluation using a hand-held ultrasound within 24 hours of admission at our institute, throughout March-May 2020. According to the POCCUS results, the patients were divided into two groups: 'Normal' and 'Abnormal' (including left or right ventricular dysfunction or enlargement, or moderate/severe valvular regurgitation/stenosis).
Results
Among 102 patients, 26 (25.5%) had an abnormal POCCUS study. They were older, with more co-morbidities, cardiovascular disease history, chronic medical therapy, and more severe presenting symptoms, as compared to the group with a normal echocardiography exam. Individual and composite endpoints (advanced ventilatory support, acute decompensated heart failure, shock, or death) are presented in Table 1. Multivariate logistic regression analysis adjusting for pertinent variables revealed that abnormal echocardiography at presentation was independently associated with the composite endpoint OR=4.63 (95% CI 1.51–14.15, p=0.007).
Conclusions
Abnormal echocardiography results in COVID-19 infection settings are associated with a higher burden of medical comorbidities and independently predict major adverse endpoints. Hand-held POCCUS at presentation can be utilized as an important tool for risk stratification for hospitalized COVID-19 patients.
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): SZMC Scientific
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Affiliation(s)
- Z Dadon
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - N Levi
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - A Orlev
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - D Belman
- Shaare Zedek Medical Center, Intensive Care Unit, Jerusalem, Israel
| | - E A Alpert
- Shaare Zedek Medical Center, Emergency Department, Jerusalem, Israel
| | - Y Steinmetz
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - A Wolak
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - M Glikson
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - S Gottlieb
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
| | - A Butnaru
- Shaare Zedek Medical Center, Jesselson Integrated Heart Center, Jerusalem, Israel
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27
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Steinmetz Y, Wolff R, Farkash R, Dadon Z, Levi N, Anguizola F, Taha L, Shaheen F, Glikson M, Asher E. The prevalence and characteristics of patients with ST-elevation myocardial infarction during the first two months of the COVID-19 pandemics. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1272] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
ST-Segment elevation MI (STEMI) is one of the leading cause of mortality in the western world. The coronavirus disease-2019 (COVID-19) pandemic might have implications of the treatment of STEMI patients. Our aim was to evaluate the treatment of STEMI patients during 2 months of the COVID-19 pandemic as compared with the year before.
Methods
Data of 90 STEMI patients treated at the Shaare Zedek Medical Center intensive coronary care unit (ICCU) Between March-April 2019 and March-April 2020 were collected. Patients were divided into 2 groups: The pre COVID-19 group and the COVID-19 era group. Data regarding complications upon arrival and during hospitalization, door to balloon time and echocardiographic exams.
Results
Fifty one (56%) patients were admitted with STEMI in the pre COVID-19 group and only 39 (44%) in the COVID-19 era group. Of them 13.7% vs. 20.5% were female, p=0.392 with a mean age of 62.1 (±13.5) vs. 63.4 (±11) years old, p=0.635 in the pre vs. post COVID-19 era group, respectively. Interestingly, more Jewish vs. non-Jewish were admitted with STEMI in the COVID-19 era group. There were no differences regarding baseline characteristics, catheterization access, culprit vessel and percutaneous coronary intervention rate. Door to balloon time was also similar in both pre and post COVID-19 era groups 35.4 (±32) vs. 30.5 (±29.1) minutes (p=0.896). Moreover, there was no difference regarding infarct size. Complications including acute renal failure, cardiogenic shock, and the use of intra-aortic balloon pump were similar in both groups. 30-day mortality rate was low and similar in both pre and post COVID-19 era groups (5.9% vs. 2.6%, respectively, p=0.426).
Conclusions
During the beginning of COVID-19 era there was a reduction in STEMI admission rate, while no significant difference was found regarding baseline characteristics, door to balloon time, infarct size and mortality rate
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- Y Steinmetz
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - R Wolff
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - R Farkash
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Z Dadon
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - N Levi
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - F Anguizola
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - L Taha
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - F Shaheen
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - M Glikson
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - E Asher
- Shaare Zedek Medical Center, Jerusalem, Israel
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Levi N, Baker H, Ben-Chetrit E, Levine P, Margalit N, Winestone J. Decompressive craniectomy for treatment of elevated intracranial pressure in community-acquired bacterial meningitis: Case study, literature review, and proposed guidelines. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101107] [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: 10/22/2022] Open
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29
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Levi N, Meerkin D. Transcatheter Repair of the Mitral Valve: Relevant Pathophysiology, Investigation, and Management. Can J Cardiol 2021; 37:1027-1040. [PMID: 33753201 DOI: 10.1016/j.cjca.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022] Open
Abstract
Mitral regurgitation (MR) is a common condition causing significant morbidity and mortality in the Western world. Although surgical therapy has developed over 5 decades to provide solutions, only a minority of patients undergo surgery. The last decade has seen the emergence and application of multiple transcatheter techniques in attempts to address this undertreated population with the large clinical experience of MitraClip providing the most insight. Clear understanding of the pathophysiology of different MR types as well as the role of particularly secondary MR on patient's clinical syndrome allow for better prediction as to which patient subgroups will benefit from different repair techniques or intervention at all. Most of the techniques are based on surgical technique and are applied as single-device/technique solutions, whether leaflet, chordal, or annular solutions, but with broadening experience, combination therapies are likely to find a place in creating a more complete and surgical-like solution.
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Affiliation(s)
- Nir Levi
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - David Meerkin
- Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel.
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Litaor M, Meir-Dinar N, Castro B, Azaizeh H, Rytwo G, Levi N, Levi M, MarChaim U. Treatment of winery wastewater with aerated cells mobile system. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.enmm.2015.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Friedman Y, Yudkin E, Nowik I, Felner I, Wille HC, Röhlsberger R, Haber J, Wortmann G, Arogeti S, Friedman M, Brand Z, Levi N, Shafir I, Efrati O, Frumson T, Finkelstein A, Chumakov AI, Kantor I, Rüffer R. Synchrotron radiation Mössbauer spectra of a rotating absorber with implications for testing velocity and acceleration time dilation. J Synchrotron Radiat 2015; 22:723-728. [PMID: 25931089 DOI: 10.1107/s1600577515001411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/22/2015] [Indexed: 06/04/2023]
Abstract
Many Mössbauer spectroscopy (MS) experiments have used a rotating absorber in order to measure the second-order transverse Doppler (TD) shift, and to test the validity of the Einstein time dilation theory. From these experiments, one may also test the clock hypothesis (CH) and the time dilation caused by acceleration. In such experiments the absorption curves must be obtained, since it cannot be assumed that there is no broadening of the curve during the rotation. For technical reasons, it is very complicated to keep the balance of a fast rotating disk if there are moving parts on it. Thus, the Mössbauer source on a transducer should be outside the disk. Friedman and Nowik have already predicted that the X-ray beam finite size dramatically affects the MS absorption line and causes its broadening. We provide here explicit formulas to evaluate this broadening for a synchrotron Mössbauer source (SMS) beam. The broadening is linearly proportional to the rotation frequency and to the SMS beam width at the rotation axis. In addition, it is shown that the TD shift and the MS line broadening are affected by an additional factor assigned as the alignment shift which is proportional to the frequency of rotation and to the distance between the X-ray beam center and the rotation axis. This new shift helps to align the disk's axis of rotation to the X-ray beam's center. To minimize the broadening, one must focus the X-ray on the axis of the rotating disk and/or to add a slit positioned at the center, to block the rays distant from the rotation axis of the disk. Our experiment, using the (57)Fe SMS, currently available at the Nuclear Resonance beamline (ID18) at the ESRF, with a rotating stainless steel foil, confirmed our predictions. With a slit installed at the rotation axis (reducing the effective beam width from 15.6 µm to 5.4 µm), one can measure a statistically meaningful absorption spectrum up to 300 Hz, while, without a slit, such spectra could be obtained up to 100 Hz only. Thus, both the broadening and the alignment shift are very significant and must be taken into consideration in any rotating absorber experiment. Here a method is offered to measure accurately the TD shift and to test the CH.
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Affiliation(s)
- Y Friedman
- Jerusalem College of Technology, POB 16031, Jerusalem 91160, Israel
| | - E Yudkin
- Jerusalem College of Technology, POB 16031, Jerusalem 91160, Israel
| | - I Nowik
- Racah Institute of Physics, Hebrew University, Jerusalem 91904, Israel
| | - I Felner
- Racah Institute of Physics, Hebrew University, Jerusalem 91904, Israel
| | - H-C Wille
- Deutsches Elektronen-Synchrotron, Notkestrasse 85, D-22607 Hamburg, Germany
| | - R Röhlsberger
- Deutsches Elektronen-Synchrotron, Notkestrasse 85, D-22607 Hamburg, Germany
| | - J Haber
- Deutsches Elektronen-Synchrotron, Notkestrasse 85, D-22607 Hamburg, Germany
| | - G Wortmann
- Department Physik, Universität Paderborn, Warburger Strasse 100, D-33098 Paderborn, Germany
| | - S Arogeti
- Ben-Gurion University of the Negev, Ber Sheva, Israel
| | - M Friedman
- Ben-Gurion University of the Negev, Ber Sheva, Israel
| | - Z Brand
- Nuclear Research Center Negev, Ber Sheva, Israel
| | - N Levi
- Nuclear Research Center Negev, Ber Sheva, Israel
| | - I Shafir
- Nuclear Research Center Negev, Ber Sheva, Israel
| | - O Efrati
- Colibri Spindles Ltd, Industrial Park Lavon, Bdg 1, MP Bikat Bet Hakerem 2011800, Israel
| | - T Frumson
- Colibri Spindles Ltd, Industrial Park Lavon, Bdg 1, MP Bikat Bet Hakerem 2011800, Israel
| | - A Finkelstein
- Colibri Spindles Ltd, Industrial Park Lavon, Bdg 1, MP Bikat Bet Hakerem 2011800, Israel
| | - A I Chumakov
- European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble, France
| | - I Kantor
- European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble, France
| | - R Rüffer
- European Synchrotron Radiation Facility, BP 220, F-38043 Grenoble, France
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Morgan A, Levi N, Bernie C. Increasing self-efficacy – the effectiveness of a pain management programme for children and parents. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194440 DOI: 10.1186/1546-0096-9-s1-o43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau J, Flahault A, Kelly J, Kaufman D, Maison P. Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.132] [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: 10/20/2022] Open
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Vasilakos C, Levi N, Maggos T, Hatzianestis J, Michopoulos J, Helmis C. Gas-particle concentration and characterization of sources of PAHs in the atmosphere of a suburban area in Athens, Greece. J Hazard Mater 2007; 140:45-51. [PMID: 16876935 DOI: 10.1016/j.jhazmat.2006.06.047] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/14/2006] [Accepted: 06/15/2006] [Indexed: 05/11/2023]
Abstract
Atmospheric polycyclic aromatic hydrocarbons (PAH) were determined in two places in a suburban area of Athens greater area (AGA) during June and November 2003. Fourteen PAHs were quantified in the collected samples. The total concentration in the gas phase ranged between 6.89 and 124ngm(-3), while in the particulate phase between 0.44 and 13.2ngm(-3). Maximum concentrations of the total PAHs (gas and particulate phase) were observed during the cold period with an average of 40.7ngm(-3). PAHs were correlated with NO, NO(2) and O(3), wind speed, wind direction and temperature. Positive correlation was observed between PAHs and NO, NO(2), while negative correlation was detected between PAHs and O(3). The most abundant members were phenanthrene, anthracene, fluorene, fluoranthene and pyrene. Potential sources of PAHs in aerosols were investigated using molecular diagnostic ratios, which reflect sources such as diesel and gasoline engines, although other sources such as coal combustion and liquefied petroleum gas also contributed.
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Affiliation(s)
- Ch Vasilakos
- Environmental Research Laboratory/INT-RP, National Center for Scientific Research DEMOKRITOS, 153 10 Aghia Paraskevi Attikis, P.O.B. 60228, Athens, Greece.
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Gribomont AC, Levi N. [Prognosis of surgery in epimacular membranes after retinal break or rhegmatogenous retinal detachment]. J Fr Ophtalmol 2003; 26:364-8. [PMID: 12843893] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
INTRODUCTION The prognosis of the formation of epiretinal membranes after retinal break or rhegmatogenous retinal detachment, treated or not treated, does not seem as favorable as that of the idiopathic membranes, but has not yet been extensively studied. Our goal was to analyze the functional result and the retinal complications of the treatment of these membranes. METHODS The retrospective study deals with a consecutive series of 28 patients operated on for epimacular membranes, with a minimum follow-up of 3 months. The outcome measures were the postoperative visual acuity at 3-6 months compared with the preoperative visual acuity, taking into account the condition of the crystalline lens as well as the incidence of membrane recurrence and new or recurrent retinal detachment. RESULTS A 2-line or more visual improvement was achieved in 57% of the cases (16/28), i.e., 36% of eyes with progressive cataract (4/11), 50% of primary pseudophakic eyes (3/6), and 80% of eyes with unchanged lens (8/10). There was no recurrent epimacular membrane formation, with a mean follow-up of 8.7 months. A new or recurrent retinal detachment was observed in 25% of the cases (7/28). DISCUSSION AND CONCLUSION These results, compared with those achieved in the treatment of idiopathic membranes, as the literature reports, confirm the fair surgical prognosis of epimacular membrane formation after retinal break or rhegmatogenous retinal detachment.
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Affiliation(s)
- A-C Gribomont
- Service d'Ophtalmologie, Cliniques Universitaires St-Luc, Université Catholique de Louvain, 10, avenue Hippocrate, B1200 Bruxelles, Belgique
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Ben-Ari Z, Tur-Kaspa R, Schafer Z, Baruch Y, Sulkes J, Atzmon O, Greenberg A, Levi N, Fainaru M. Basal and post-methionine serum homocysteine and lipoprotein abnormalities in patients with chronic liver disease. J Investig Med 2001; 49:325-9. [PMID: 11478408 DOI: 10.2310/6650.2001.33897] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/18/2022]
Abstract
BACKGROUND Lipoprotein abnormalities are commonly found in chronic liver diseases (CLDs), particularly hypercholesterolemia in primary biliary cirrhosis (PBC). However, affected patients may not be at increased risk of coronary heart disease. Cirrhotic patients display impaired methionine clearance, and an increased level of homocysteine, a methionine metabolite, is an independent risk factor for coronary heart disease. Thus, we hypothesized that the low risk of coronary heart disease in patients with CLD may be related to low serum levels of homocysteine. The aim of this study was to test this hypothesis after methionine load and to describe the serum lipoprotein profile in patients with PBC and in patients with hepatocellular liver disease. METHODS Fifteen female patients (mean age, 58.2 +/- 11.7 years) with PBC, 15 female patients (mean age, 54.5 +/- 9.6 years) with other causes of CLD, and 15 healthy sex- and age-matched controls were given L-methionine (50 mg/kg of ideal body weight). Basal fasting serum homocysteine level and 2, 4, and 6 hours of post-methionine load were determined using high-performance liquid chromatography with a fluorometric detector. Levels of fasting serum cholesterol, triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipoprotein (a) (Lp(a)), and apoprotein B were also determined. RESULTS Results showed that mean basal and post-methionine load (6 hours) serum homocysteine levels were statistically significantly higher in the patients with PBC and with CLD than in the control group (P=0.04) and that levels of serum cholesterol, LDL, HDL, and apoprotein B were significantly higher in the PBC patients than in the other two groups (P < or = 0.05). There was no correlation between any of these parameters and the severity of liver disease. Serum HDL was significantly lower in the CLD group (P < or = 0.05) and correlated with severity of liver disease. There was no significant difference in serum cholesterol, LDL, or apoprotein B between the CLD group and the controls. Serum triglyceride and Lp(a) levels were similar for all three groups. CONCLUSIONS In contrast to previous reports, the site of the methionine metabolic impairment was found to be below the homocysteine synthesis level. For most patients with CLD, factors other than serum homocysteine or Lp(a) are responsible for the reduction in the risk of coronary heart disease. Further studies with larger samples are needed.
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Affiliation(s)
- Z Ben-Ari
- Department of Medicine, Rabin Medical Center, Petah Tiqva, Israel
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Gebuhr P, Stentzer K, Thomsen F, Levi N. Failure of total hip arthroplasty with Boneloc bone cement. Acta Orthop Belg 2000; 66:472-6. [PMID: 11196371] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Early failure of Boneloc cemented total hip arthroplasty is well documented. However, information regarding the long term prognosis is scanty. The aim of this study was therefore to assess the long term failure rate of total hip replacement with Boneloc bone cement. Between January 1991 and March 1992, Boneloc bone cement (Polymers Recontructive A/S, Farum, Denmark) was used in 42 consecutive total hip replacements in 42 patients. The average age of the patients was 75 years. There were 25 women and 17 men. The diagnosis at operation was osteoarthritis in all cases. A cemented Muller Taperloc femoral stem was used with a cemented Muller acetabular cup (Biomet, Warsaw, USA). The follow-up time was 9 years. All patients underwent radiographic control the first postoperative year and annually after 1995. To date 21 patients have been revised for aseptic loosening at a mean of 5 years (range: one year to 8 years). Three other patients have definite radiographic evidence of loosening. The overall failure rate is therefore 24/42 = 57%. Our results confirm the previously reported poor results of Boneloc bone cement for hip arthroplasty and support the recommendation of indefinite follow-up for surviving prostheses. New prosthesis designs and new cements should have documentation, including laboratory tests and randomized clinical studies with radiostereometric evaluation. However, the ethical responsibility rests heavily on the shoulders of the clinician to make a correct analysis of the need for a new product before he begins to use it.
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Affiliation(s)
- P Gebuhr
- Department of Orthopaedic Surgery, Amager Hospital, University Hospital of Copenhagen, Italiensvej 1, Copenhagen 2300 S, Denmark
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Levi N, Olsen PS. Primary closure of deep sternal wound infection following open heart surgery: a safe operation? J Cardiovasc Surg (Torino) 2000; 41:241-5. [PMID: 10901528] [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: 02/17/2023]
Abstract
BACKGROUND Deep median sternotomy wound infection is a significant source of morbidity and mortality after cardiac operations. Management of an infected median sternotomy incision is a subject of controversy. The aim of this study was to assess our experience with primary closure without any irrigation system for infected deep median sternotomy wound. METHODS Between January 1994 and December 1997, 4,227 consecutive open heart procedures via a median sternotomy under cardiopulmonary bypass were performed in our department. A total of 27 (0.64%) consecutive patients with deep sternotomy wound infection were identified. The mean age of the patients was 45 years. Six were female and 21 were male. RESULTS The incidence of deep sternal wound infection was therefore 0.64%. The mean duration between the primary operation and the onset of deep sternal wound infection was 2.5 weeks. Staphylococcus aureus and Staphylococcus epidermidis were the most common pathogen causing postoperative mediastinal infection. Out of the 27 cases, 17 were successfully treated, 8 (30%) died and 2 had a persistent fistula. The mean follow-up time was 18 months (range 4 to 52 months). The mortality in the pediatric group was 4/8 (50%) and 4/19 (21%) in the adult group. The mortality for mediastinitis presenting before one week or after 4 weeks after operation was 63%. In contrast, the mortality for mediastinitis presenting after one week but before 4 weeks after operation was 17%. CONCLUSIONS Mediastinitis after cardiac surgical procedures remains a devastating complication. Primary closure without irrigation-suction system should only be considered in selected patients.
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Affiliation(s)
- N Levi
- Department of Cardiothoracic Surgery, Rigshospitalet, The National University Hospital, Copenhagen, Denmark
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Abstract
The purpose of this study was to develop a method to store viruses on filter paper without the need for special conditions for future use of the genetic material. Two non-enveloped viruses were used as models. Infectious bursal disease virus (IBDV), a double-stranded RNA virus that infects chickens, belongs to the Birnaviridae family. Hemorrhagic enteritis virus (HEV), with double-stranded DNA, belongs to the Adenoviridae family. Three different solutions were found suitable for loading the virus. The viruses were stored at room temperature or at 37 degrees C for periods of 5-30 days. Direct reverse transcription-polymerase chain reaction (RT-PCR) (without previous extraction of the RNA) was carried out on filter paper loaded with IBDV, and fragments of the expected size were detected. HEV DNA was extracted from filter paper loaded with purified virus or crude tissue. PCR fragments were found to be of similar intensity to those of control virus that was kept in a tube at -20 degrees C. This method permits the storage and transport of viruses from the field or from clinics to a regional laboratory or any laboratory elsewhere, without the need for prior treatment or special environmental conditions.
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Affiliation(s)
- J Pitcovski
- MIGAL, South Industrial Zone, Kiryat Shmona, Israel
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Levi N. Dynamic hip screw versus 3 parallel screws in the treatment of garden 1 + 2 and garden 3 + 4 cervical hip fractures. Panminerva Med 1999; 41:233-7. [PMID: 10568121] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE The main objective of this study was to evaluate the failure rate following operations of undisplaced and displaced cervical hip fractures with a dynamic hip screw compared with 3 parallel screws. DESIGN The study was retrospective. The minimum follow-up time was 1 year. The data tta collested between January 1990 and December 1993. SETTING University Hospitals. PATIENTS A total of 456 patients (352 women and 104 men) with cervical hip fractures were included. The mean age was 80 years (range 51-100 years). INTERVENTION This was internal fixation of the fractured hip with a dynamic hip screw or 3 parallel screws. MAIN OUTCOME MEASURES Failure was defined as nonunion, fixation failure or avascular necrosis and reoperation was found indicated. The 3 months mortality rate, the wound infection rate, the delay between admission and time of surgery and the blood transfusion requirement were also recorded. RESULTS A total of 456 cervical hip fractures were operated with a dynamic hip screw or 3 parallel screws. The failure rate for fractures treated with a dynamic hip screw was 14/98 = 14% for Garden 1 + 2 fractures and 43/108 = 40% for Garden 3 + 4 fractures. The failure rate for fractures treated with 3 parallel screws was similar: 23/154 = 15% for Garden 1 + 2 fractures and 38/196 = 40% for Garden 3 + 4 fractures. The average follow-up time was 2.5 years. CONCLUSION Operation of cervical hip fracture with a dynamic hip screw or 3 parallel screw seem to give similar results.
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Affiliation(s)
- N Levi
- Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Denmark
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Levi N, Schroeder TV. True and anastomotic femoral artery aneurysms: is the risk of rupture and thrombosis related to the size of the aneurysms? Eur J Vasc Endovasc Surg 1999; 18:111-3. [PMID: 10426967 DOI: 10.1053/ejvs.1999.0842] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [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: 11/11/2022]
Abstract
OBJECTIVE the management of asymptomatic femoral aneurysms remains controversial. The purpose of this study was to investigate the relation between the diameter of true and anastomotic aneurysms and the risk of rupture. DESIGN retrospective study. MATERIAL AND METHODS we reviewed the case records of 17 patients who underwent 17 arterial reconstructive procedures for true femoral aneurysms. In addition, the case records of 76 patients who underwent 90 arterial reconstructive procedures for femoral anastomotic aneurysms were identified and reviewed. RESULTS the rupture rate for aneurysms less than 5 cm in diameter was 1.6% (one out of 64) compared with 16% (seven out of 43) for those larger than 5 cm. The thrombosis rate for aneurysms less than 5 cm in diameter was 17% compared with 5% for those larger than 5 cm. CONCLUSIONS this study seems to show that the risk of rupture of femoral artery aneurysms is related to the diameter of the aneurysms. However, the rise in the risk of rupture with increasing size seems less dramatic than for abdominal aortic aneurysm (AAA).
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, Rigshospitalet, The National University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark
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Levi N, Peterson J, Larsen CF, Hede A. Pneumococcal arthritis in the wrist and ankle. A case report and short review of the literature. Panminerva Med 1999; 41:171-4. [PMID: 10479919] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
In this paper we report a 48-year-old man with septic arthritis of the wrist and ankle due to Streptococcus pneumoniae. No known predisposing factor was found. Only about 300 cases of pneumococcal arthritis have been reported in the literature since 1888 and less than 10% of these affect the wrist. The management of bacterial arthritis is reviewed.
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Affiliation(s)
- N Levi
- Department of Orthopaedic Surgery, Rigshospital University of Copenhagen, Denmark
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Levi N, Sonksen JR, Schroeder TV, Kristensen JK. False iliac artery aneurysm following renal transplantation. Osaka City Med J 1999; 45:1-7. [PMID: 10723196] [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: 02/15/2023]
Abstract
We report a very rare case of a false iliac artery aneurysm following renal transplantation. The patient was a 51-year-old women who presented with a painful 10 x 10 cm pulsating mass in her left iliac fossa. The patient had received a second cadaveric renal transplantation 5 years previously. The graft never functioned and transplant nephrectomy was performed 2 weeks later. A CT-scanning showed a 10 x 10 cm large aneurysm arising from the left external iliac artery. At operation a large false aneurysm was identified arising from the original transplant anastomotic site. Due to the extent of the aneurysms, a Gortex graft was inserted between the external iliac artery and the common femoral artery. The patient made an uneventful post-operative recovery.
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, National University Hospital, Copenhagen, Denmark
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Levi N, Gjerris F, Dons K. Thoracic disc herniation. Unilateral transpedicular approach in 35 consecutive patients. J Neurosurg Sci 1999; 43:37-42; discussion 42-3. [PMID: 10494664] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Thoracic disc herniation is uncommon and surgery for thoracic disc herniation represents less than 1-2% of operations for disc disease. However, there is no consensus on the best approach and reports are based on small series. METHODS A consecutive series of 35 thoracic disc herniations (25 in women and 10 in men) were treated between 1991 and 1996 using the transpedicular approach and followed in a prospective study. All patients had a preoperative MRI examination. The mean age was 51 years. The T6-7 and T7-8 level were the most frequent localization. The interval between onset of symptoms and operation ranged from 6 weeks to 4 years with a mean of 18 months. Presenting symptoms on admission was radiculopathy in 12 patients and myelopathy in 23 patients. Severe urinary symptoms were found in 2 patients, moderate symptoms in 9 patients, mild symptoms in 3 patients and 21 patient had no urinary symptoms. RESULTS One patient was paraplegic immediately after surgery and she made no further improvement. A good result was found in 15 patients, a fair result was found in a further 11 patients but in 8 patients the outcome was unchanged with no effect of a reoperation in two cases. No clinical or radiographic features of instability were found. The postoperative course was uneventful, except in one patient with a wound abscess leading to discitis. CONCLUSIONS The transpedicular approach can be an effective and safe method of surgical decompression in carefully selected patients.
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Affiliation(s)
- N Levi
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Denmark
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, National University Hospital, Copenhagen, Denmark
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Levi N, Schroeder TV. Undiagnosed phaeochromocytoma following infrainguinal bypass surgery. Panminerva Med 1998; 40:332-3. [PMID: 9973831] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We present a rare case of undiagnosed phaeochromocytoma following infrainguinal bypass surgery. The patient, a 59-year-old lady, had a one year history of hypertension following a first femoro-tibial bypass and presented as a cardiorespiratory emergency in the admission room following her contralateral femoro-tibial bypass. The patient recovered after some days in intensive care despite a delayed diagnosis.
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark
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Peled N, Greenberg A, Pillar G, Zinder O, Levi N, Lavie P. Contributions of hypoxia and respiratory disturbance index to sympathetic activation and blood pressure in obstructive sleep apnea syndrome. Am J Hypertens 1998; 11:1284-9. [PMID: 9832170 DOI: 10.1016/s0895-7061(98)00159-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.0] [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: 11/27/2022] Open
Abstract
Hypertension is a common finding among obstructive sleep apnea (OSA) patients, and is thought to be caused by sympathetic hyperactivity. The present study compares the contributions of the respiratory disturbance index (RDI) as a reflection of sleep fragmentation, and the magnitude of oxygen desaturation, to sympathetic activation as indexed by urinary norepinephrine concentrations, as well as to morning and evening blood pressure in sleep apnea syndrome patients. Data (polysomnography, blood pressure [BP], and urine catecholamines) of 38 consecutive OSA patients (age, 46+/-14.5 years) were analyzed. Stepwise logistic regression analysis revealed that minimal oxygen saturation level (SaO2min) was a significant predictor of both morning and evening norepinephrine levels, and that 37% of morning systolic BP variance could be accounted for by a combination of age and norepinephrine, while 20% of the diastolic BP variance was accounted for by SaO2min alone. In contrast, RDI entered the prediction equation only when minimal oxygen saturation was rejected first. Our results indicate that the degree of nocturnal hypoxia is more closely associated with the level of sympathetic activation and with daytime level of blood pressure than with sleep fragmentation.
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Affiliation(s)
- N Peled
- Sleep Laboratory, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Abstract
OBJECTIVE To assess our experience with isolated iliac artery aneurysms and to assess the blood transfusion requirement in patients undergoing surgery for iliac artery aneurysms. MATERIAL AND METHODS The case records of 12 patients who underwent 12 arterial reconstructive procedures for isolated iliac aneurysms from January 1989 to December 1995 were identified from our prospective vascular database and reviewed. Only patients with aneurysms limited to the common, external, or internal iliac arteries were included. RESULTS Eleven patients had symptoms and rupture occurred in five patients. Aneurysmorrhaphy with graft interposition was the most common procedure. There was no perioperative mortality. The median transfusion requirement was 11 units per operation (range 1-30 units). The median intraoperative blood loss was 4700 ml (range < 500-13,000 ml). CONCLUSIONS Isolated iliac aneurysm is a dangerous condition. A low perioperative mortality is possible only if large volumes of blood are available.
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Affiliation(s)
- N Levi
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
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Levi N, Dons K. Two-level thoracic disc herniation. Mt Sinai J Med 1998; 65:404-5. [PMID: 9844371] [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: 02/09/2023]
Abstract
We report a rare case of two-level thoracic disc herniation that occurred in a 48-year-old woman. She was referred with a 10-month history of pain on the right side of the thorax. On examination, she had hypoesthesia and hypalgesia in the right T6-T8 dermatomes. An MRI scan revealed a large herniated disc at the T7/8 level and a smaller herniated disc at the T6/7 level. At surgery, the unilateral transpedicular approach was used, and a large prolapse was removed at the T7/8 level. The T6/7 level was decompressed. The patient made an uneventful recovery. Six months after surgery her pain had disappeared, but she still had hypoesthesia in the right T6-T8 dermatomes.
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Affiliation(s)
- N Levi
- Department of Neurosurgery, Rigshospitalet, University of Copenhagen, Denmark
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