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Israel A, Merzon E, Krone B, Faraone SV, Green I, Golan Cohen A, Vinker S, Cohen S, Ashkenazi S, Magen E, Weizman A, Manor I. The Association Between Repeated Measured Febrile Episodes During Early Childhood and Attention Deficit Hyperactivity Disorder: A Large-Scale Population-Based Study. J Atten Disord 2024; 28:677-685. [PMID: 38281128 DOI: 10.1177/10870547231215289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
OBJECTIVE We examined the association between the number, magnitude, and frequency of febrile episodes during the 0 to 4 years of life and subsequent diagnosis of ADHD. METHODS This population-based case-control study in an Israeli HMO, Leumit Health Services (LHS), uses a database for all LHS members aged 5 to 18 years between 1/1/2002 and 1/30/2022. The number and magnitude of measured fever episodes during the 0 to 4 years were recorded in individuals with ADHD (N = 18,558) and individually matched non-ADHD controls in a 1:2 ratio (N = 37,116). RESULTS A significant, independent association was found between the number and magnitude of febrile episodes during the 0 to 4 years and the probability of a later diagnosis of ADHD. Children who never had a measured temperature >37.5°C had a significantly lower rate of ADHD (OR = 0.834, 95% CI [0.802, 0.866], p < .0001). CONCLUSIONS Febrile episodes during 0 to 4 years are associated with a significantly increased rate of a later diagnosis of ADHD in a doseresponse relationship.
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Affiliation(s)
- Ariel Israel
- Department of Epidemiology and Disease Prevention, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eugene Merzon
- Department of Epidemiology and Disease Prevention, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Ilan Green
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shlomo Vinker
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eli Magen
- Ben-Gurion University of the Negev Marcus Family Campus, Beer-Sheva, Israel
| | | | - Iris Manor
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Merzon E, Israel A, Krone B, Medvejer S, Cohen S, Green I, Golan-Cohen A, Vinker S, Faraone SV, Newcorn JH, Ashkenazi S, Weizman A, Manor I. Increased Rate of Familial Mediterranean Fever in Children With ADHD: A Population-Based Case-Control Study. J Atten Disord 2024; 28:669-676. [PMID: 38069539 DOI: 10.1177/10870547231215045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE There is growing evidence of involvement of inflammatory mechanisms in ADHD. Previous studies found significantly higher rates of ADHD among children with FMF. The present study examined the rate of exposure to FMF in children with a later (within a 5-year period) diagnosis of ADHD compared to non-ADHD children. METHODS A population-based case-control study of all children (<18 years) registered in Leumit Health Services during 01.01.2006 to 06.30.2021. All cases met ICD-9/10 criteria for ADHD. They were matched by age, sex, and socioeconomic status on a 1:2 rate to randomly selected non-ADHD controls. RESULTS Fifty-six (0.30%) children with ADHD (N = 18,756) were previously diagnosed with FMF compared to 65 of 37,512 controls (0.17%). A significant, independent association existed between a preceding FMF diagnosis and a later ADHD diagnosis [OR = 1.72 (95% CI 1.18-2.51); p = .003]. CONCLUSIONS The mechanisms underlying the association w between FMF and later ADHD diagnosis merit further elucidation.
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Affiliation(s)
- Eugene Merzon
- Lehumit Health Services, Tel-Aviv, Israel
- Ariel University, Israel
| | | | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Shira Cohen
- Geha Mental Health Center, Petah Tikva, Israel
| | - Ilan Green
- Lehumit Health Services, Tel-Aviv, Israel
- Tel Aviv University, Israel
| | | | - Shlomo Vinker
- Lehumit Health Services, Tel-Aviv, Israel
- Tel Aviv University, Israel
| | | | | | | | - Abraham Weizman
- Tel Aviv University, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Iris Manor
- Tel Aviv University, Israel
- Geha Mental Health Center, Petah Tikva, Israel
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Tarabeih N, Kalinkovich A, Ashkenazi S, Cherny SS, Shalata A, Livshits G. Relationships between Circulating Biomarkers and Body Composition Parameters in Patients with Metabolic Syndrome: A Community-Based Study. Int J Mol Sci 2024; 25:881. [PMID: 38255954 PMCID: PMC10815336 DOI: 10.3390/ijms25020881] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Metabolic syndrome (MetS) is a complex disease involving multiple physiological, biochemical, and metabolic abnormalities. The search for reliable biomarkers may help to better elucidate its pathogenesis and develop new preventive and therapeutic strategies. In the present population-based study, we looked for biomarkers of MetS among obesity- and inflammation-related circulating factors and body composition parameters in 1079 individuals (with age range between 18 and 80) belonging to an ethnically homogeneous population. Plasma levels of soluble markers were measured by using ELISA. Body composition parameters were assessed using bioimpedance analysis (BIA). Statistical analysis, including mixed-effects regression, with MetS as a dependent variable, revealed that the most significant independent variables were mainly adipose tissue-related phenotypes, including fat mass/weight (FM/WT) [OR (95% CI)], 2.77 (2.01-3.81); leptin/adiponectin ratio (L/A ratio), 1.50 (1.23-1.83); growth and differentiation factor 15 (GDF-15) levels, 1.32 (1.08-1.62); inflammatory markers, specifically monocyte to high-density lipoprotein cholesterol ratio (MHR), 2.53 (2.00-3.15), and a few others. Additive Bayesian network modeling suggests that age, sex, MHR, and FM/WT are directly associated with MetS and probably affect its manifestation. Additionally, MetS may be causing the GDF-15 and L/A ratio. Our novel findings suggest the existence of complex, age-related, and possibly hierarchical relationships between MetS and factors associated with obesity.
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Affiliation(s)
- Nader Tarabeih
- Department of Morphological Sciences, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (N.T.); (S.A.)
| | - Alexander Kalinkovich
- Department of Anatomy and Anthropology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (A.K.); (S.S.C.)
| | - Shai Ashkenazi
- Department of Morphological Sciences, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (N.T.); (S.A.)
| | - Stacey S. Cherny
- Department of Anatomy and Anthropology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (A.K.); (S.S.C.)
| | - Adel Shalata
- The Simon Winter Institute for Human Genetics, Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel;
| | - Gregory Livshits
- Department of Morphological Sciences, Adelson School of Medicine, Ariel University, Ariel 40700, Israel; (N.T.); (S.A.)
- Department of Anatomy and Anthropology, Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel; (A.K.); (S.S.C.)
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Green I, Merzon E, Vinker S, Golan-Cohen A, Israel A, Scheinowitz M, Ishai R, Magen E, Ashkenazi S. Author's reply to comment on: A higher frequency of physical activity is associated with reduced rates of SARS-CoV-2 infection. Eur J Gen Pract 2023; 29:2188015. [PMID: 36942729 PMCID: PMC10256241 DOI: 10.1080/13814788.2023.2188015] [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] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Affiliation(s)
- Ilan Green
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugene Merzon
- Leumit Health Services, Tel Aviv, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mickey Scheinowitz
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv, Israel
- Sylvan Adams Sports Institute, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Reuven Ishai
- Department of Ear, Nose and Throat, and Head and Surgery, Rambam Medical Center, Haifa, Israel
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Eli Magen
- Leumit Health Services, Tel Aviv, Israel
- Clinical Immunology and Allergy Division, Medicine C Department, Barzilai University Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Shai Ashkenazi
- The Adelson School of Medicine, Ariel University, Ariel, Israel
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Salai M, Sandhaus Y, Golik A, Rahimi-Levene N, Castel H, Grossman Z, Tzabari A, Lunenfeld E, Ashkenazi S, Kushnir T. Desecration by Hamas of the Holy Ten Commandments Embedded in Medical Education during the Iron Swords War in Gaza. Isr Med Assoc J 2023; 25:791-792. [PMID: 38142314] [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: 12/25/2023]
Affiliation(s)
- Moshe Salai
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Yoram Sandhaus
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ahuva Golik
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | | | - Hana Castel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | | | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Talma Kushnir
- Adelson School of Medicine, Ariel University, Ariel, Israel
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Merzon E, Magen E, Ashkenazi S, Weizman A, Manor I, Krone B, Green I, Golan-Cohen A, Vinker S, Faraone SV, Israel A. The Association between Glucose 6-Phosphate Dehydrogenase Deficiency and Attention Deficit/Hyperactivity Disorder. Nutrients 2023; 15:4948. [PMID: 38068806 PMCID: PMC10708268 DOI: 10.3390/nu15234948] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/09/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Glucose-6-phosphate dehydrogenase (G6PD) deficiency, impacting 4.9% of the population and more prevalent in Mediterranean communities, is a common enzymopathy with potential relevance to Attention Deficit/Hyperactivity Disorder (ADHD). This study investigated this association. METHODS The clinical characteristics of 7473 G6PD-deficient patients and 29,892 matched case-controls (selected at a 1:4 ratio) from a cohort of 1,031,354 within the Leumit Health Services database were analyzed using Fisher's exact test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS In total, 68.7% were male. The mean duration of follow-up was 14.3 ± 6.2 years at a mean age of 29.2 ± 22.3 years. G6PD deficiency was associated with an increased risk of being diagnosed with ADHD (Odds Ratio (OR) = 1.16 [95% CI, 1.08-1.25], p < 0.001), seeking care from adult neurologists (OR = 1.30 [95% CI, 1.22-1.38], p < 0.001), and consulting adult psychiatrists (OR = 1.12 [95% CI, 1.01-1.24], p = 0.048). The use of stimulant medications among G6PD-deficient individuals was 17% higher for the methylphenidate class of drugs (OR = 1.17 [95% CI, 1.08, 1.27], p < 0.001), and there was a 16% elevated risk for amphetamine use (OR = 1.16 [95% CI, 1.03, 1.37], p = 0.047). CONCLUSIONS G6PD deficiency signals an increased risk of ADHD diagnosis, more severe presentations of ADHD and a greater need for psychiatric medications to treat ADHD.
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Affiliation(s)
- Eugene Merzon
- Adelson School of Medicine, Ariel University, Ariel 40776, Israel;
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
| | - Eli Magen
- Department of Medicine A, Assuta Ashdod University Hospital, Faculty of Health Sciences, Ben Gurion University, Beer Sheba 84990, Israel;
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 40776, Israel;
| | - Abraham Weizman
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Laboratory of Molecular and Biological Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Iris Manor
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ilan Green
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Stephen V. Faraone
- Department of Psychiatry, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA;
| | - Ariel Israel
- Leumit Health Services, Tel Aviv 64738, Israel; (I.G.); (A.G.-C.); (S.V.); (A.I.)
- Department of Epidemiology and Disease Prevention, Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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Kushnir T, Sandhaus Y, Castel H, Golik A, Salai M, Tzabari A, Yahav Y, Grossman Z, Mazuz H, Ashkenazi S. Physician-Patient Communication Course: When the Inauguration of a New Israeli Medical School Coincided with COVID-19 Pandemic. Adv Med Educ Pract 2023; 14:1013-1024. [PMID: 37745031 PMCID: PMC10517698 DOI: 10.2147/amep.s410953] [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] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/13/2023] [Indexed: 09/26/2023]
Abstract
Purpose The curriculum of the Adelson School of Medicine at Ariel University, the newly established sixth medical school in Israel, includes a simulation center-based extended course on physician-patient communication, aiming to help students master the core competency of interpersonal and communication skills. For more than a year following the emergence of the COVID-19 pandemic, the school suspended most face-to-face (F2F) encounters, transforming most teaching activities to remote platforms. The paper outlines the ways we adapted teaching of this course to these circumstances, the reactions of students and mentors to the changes and results of 1st year students' survey. Methods During the lockdown in the first year 48 of 70 first-year students participated in a voluntary anonymous online evaluation of the course assessing motivation to become a physician; perceptions, feelings and attitudes towards the communication course, and advantages and disadvantages of online and F2F medical interviews. Results 46.1% of the responding students reported that the pandemic strengthened their desire to become physicians. 56.3% claimed that they were able to a relatively large extent to empathize with COVID-19 patients who were exposed to the virus; 79.1% viewed their mentors as positive role models of communication skills. The students were able to receive and offer social support to their peers. They evaluated very highly the short instructional videos produced by the faculty. Conclusion During the lockdown, the respondents generally indicated positive attitudes towards the communication course, the mentors and the inclusion of physician-patient communication as a topic in medical education. The students and mentors reported many disadvantages and few advantages of remote learning. Yet inevitably remote learning including online-based simulations is a step towards preparations for future practice within virtual medical care and telemedicine. The limitations of this study include the cross-sectional design, small sample size and self-reporting.
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Affiliation(s)
- Talma Kushnir
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Psychology, Ariel University, Ariel, Israel
| | - Yoram Sandhaus
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Hana Castel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Ahuva Golik
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Moshe Salai
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | | | - Yakov Yahav
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Hana Mazuz
- Simulation Center, Ariel University, Ariel, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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Frish N, Israel A, Ashkenazi S, Vinker S, Green I, Golan-Cohen A, Merzon E. The Association of Weight Reduction and Other Variables after Bariatric Surgery with the Likelihood of SARS-CoV-2 Infection. J Clin Med 2023; 12:4054. [PMID: 37373747 DOI: 10.3390/jcm12124054] [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: 03/27/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND AND AIMS Although obesity has been confirmed as a risk factor for SARS-CoV-2 infection and its severity, the role of post-bariatric surgery (BS) variables and the infection is unclear. We, therefore, aimed to study comprehensively the relationship between the extent of weight reduction after surgery and other demographic, clinical, and laboratory variables with the rates of SARS-CoV-2 infection. METHODS A population-based cross-sectional study was performed, utilizing advanced tracking methodologies on the computerized database of a nation-wide health maintenance organization (HMO). The study population included all HMO members aged ≥18 years that had been tested at least once for SARS-CoV-2 during the study period and underwent BS at least one year before their testing. RESULTS Of the total 3038 individuals who underwent BS, 2697 (88.78%) were positive for SARS-CoV-2 infection and 341 (11.22%) were negative. Multivariate regression analysis demonstrated that the body mass index and the amount of weight reduction after the BS were not related to the likelihood of SARS-CoV-2 infection. Post-operative low socioeconomic status (SES) and vitamin D3 deficiency were associated with significant and independent increased rates of SARS-CoV-2 infection (odds ratio [OR] 1.56, 95% confidence interval [CI], 1.19-2.03, p < 0.001; and OR 1.55, 95% CI, 1.18-2.02, p < 0.001; respectively). Post-operative physical activity > 3 times/week was associated with a significant and independent reduced rate of SARS-CoV-2 infection (OR 0.51, 95% CI, 0.35-0.73, p < 0.001). CONCLUSION Post-BS vitamin D3 deficiency, SES, and physical activity, but not the amount of weight reduction, were significantly associated with the rates of SARS-CoV-2 infection. Healthcare workers should be aware of these associations after BS and intervene accordingly.
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Affiliation(s)
- Noam Frish
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Ariel Israel
- Leumit Health Services, Tel Aviv 64738, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv 64738, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilan Green
- Leumit Health Services, Tel Aviv 64738, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv 64738, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Eugene Merzon
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel
- Leumit Health Services, Tel Aviv 64738, Israel
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Reingold SM, Grossman Z, Hadjipanayis A, Del Torso S, Valiulis A, Dembinski L, Ashkenazi S. Pediatric antibiotic stewardship programs in Europe: a pilot survey among delegates of The European Academy of Pediatrics. Front Pediatr 2023; 11:1157542. [PMID: 37342529 PMCID: PMC10277725 DOI: 10.3389/fped.2023.1157542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/05/2023] [Indexed: 06/23/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the leading causes of morbidity and mortality worldwide. Efforts to promote the judicious use of antibiotics and contain AMR are a priority of several medical organizations, including the WHO. One effective way to achieve this goal is the deployment of antibiotic stewardship programs (ASPs). This study aimed to survey the current situation of pediatric ASPs in European countries and establish a baseline for future attempts to harmonize pediatric ASPs and antibiotic use in Europe. Methods A web-based survey was conducted among national delegates of the European Academy of Paediatrics (EAP). The survey assessed the presence of pediatric ASPs in the representatives' countries in the inpatient and outpatient settings, the staff included in the programs, and their detailed activities regarding antibiotic use. Results Of the 41 EAP delegates surveyed, 27 (66%) responded. Inpatient pediatric ASPs were reported in 74% (20/27) countries, and outpatient programs in 48% (13/27), with considerable variability in their composition and activities. Guidelines for managing pediatric infectious diseases were available in nearly all countries (96%), with those for neonatal infections (96%), pneumonia (93%), urinary tract (89%), peri-operative (82%), and soft tissue (70%) infections being the most common. Pediatric ASPs were reported at the national (63%), institutional (41%), and regional/local (<15%) levels. Pediatricians with infectious disease training (62%) and microbiologists (58%) were the most common members of the program personnel, followed by physician leaders (46%), infectious disease/infection control physicians (39%), pharmacists (31%), and medical director representatives (15%). Activities of the pediatric ASPs included educational programs (85%), monitoring and reporting of antibiotic use (70%) and resistance (67%), periodic audits with feedback (44%), prior approval (44%), and post-prescription review of selected antibiotic agents (33%). Conclusion Although pediatric ASPs exist in most European countries, their composition and activities vary considerably across countries. Initiatives to harmonize comprehensive pediatric ASPs across Europe are needed.
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Affiliation(s)
- Stephen M. Reingold
- Department of Pediatrics, Meuhedet Health Maintenance Organization, Tel Aviv, Israel
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Pediatrics, Maccabi Health Services, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- Medical School, European University Cyprus, Nicosia, Cyprus
- Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Stefano Del Torso
- Department of Pediatrics, ChildCare WorldWide—CCWWItalia OdV, Padova, Italy
| | - Arunas Valiulis
- Clinic of Children’s Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
- Human Ecology Research Group, Department of Public Health, Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Lukasz Dembinski
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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Hiayev S, Shacham-Shmueli E, Berkovitch M, Weiss I, Ashkenazi S, Vexberg MH, Hershkowitz R, Gorelik E, Mayan H, Steinmetz Y, Yanai NB, Schlissel O, Azem M, Gutgold N, Shulman K, Divinsky M, Yarom N, Vishkautzan A, Ganzel C, Gatt ME, Arcavi L, Marom E, Uziely B, Zevin S, Meirow H, Luxenburg O, Ainbinder D. Process of drug registration in Israel: the correlation between the number of discussions within the Ministry of Health and postapproval variations by EMA and/or FDA. BMJ Open 2023; 13:e067313. [PMID: 37142315 PMCID: PMC10163499 DOI: 10.1136/bmjopen-2022-067313] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVES US FDA and EMA allow facilitated regulatory pathways to expedite access to new treatments. Limited supportive data may result in major postapproval variations. In Israel, partly relying on Food and Drug Administration (FDA) and European Medicines Agency (EMA), clinical data are reviewed independently by the Advisory Committee of Drug Registration (ACDR). In this study, the correlation between the number of discussions at the ACDR and major postapproval variations is examined. DESIGN This is an observational retrospective comparative cohort study. SETTING Applications with FDA and/or EMA approval at time of assessment in Israel were included. The timeframe was chosen to allow a minimum of 3 years of postmarketing approval experience for potential major label variations. Data regarding the number of discussions at ACDR were extracted from protocols. Data on postapproval major variations were extracted from the FDA and EMA websites. RESULTS Between 2014 and 2016, 226 (176 drugs) applications, met the study criteria. 198 (87.6%) and 28 (12.4%) were approved following single and multiple discussions, respectively. A major postapproval variation was recorded in 129 (65.2%) compared with 23 (82.1%) applications approved following single and multiple discussions, respectively (p=0.002). Increased risk for major variation was found for medicines approved following multiple discussions (HR=1.98, 95% CI: 1.26 to 3.09) with a median time of 1.2 years, applications approved based on phase II trials (HR=2.58, 95% CI: 1.72 to 3.87), surrogate endpoints (HR=1.99, 95% CI: 1.44 to 2.74) and oncologic indications (HR=2.48, 95% CI: 1.78 to 3.45). CONCLUSIONS Multiple ACDR discussions associated with limited supportive data are predictive for major postapproval variations. Moreover, our findings demonstrate that approval by the FDA and/or EMA does not pave the way to automatic approval in Israel. In a substantial per cent of the cases, submission of the same clinical data resulted in different safety and efficacy considerations, requiring additional supporting data in some cases or even rejection of the application in others.
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Affiliation(s)
- Stephany Hiayev
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Einat Shacham-Shmueli
- Oncology Department, Sheba Medical Center, Tel Hashomer, Israel
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
| | - Matitiahu Berkovitch
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center, Tzrifin, Israel
| | - Ilana Weiss
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Shai Ashkenazi
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | | | - Rami Hershkowitz
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
- Department of Internal Medicine T, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Gorelik
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Haim Mayan
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
- Department of Internal Medicine E, Sheba Medical Center, Tel Hashomer, Israel
| | - Yehudit Steinmetz
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Noa Berar Yanai
- Nephrology Department, Hillel Yaffe Medical Center, Hadera, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Orly Schlissel
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Muhammad Azem
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Neriya Gutgold
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Katerina Shulman
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
- Oncology Institute, Carmel Medical Center, Haifa, Israel
| | - Milly Divinsky
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Nirit Yarom
- Faculty of Medicine, Tel Aviv University Sackler, Tel Aviv, Israel
- Oncology Department, Shamir Medical Center, Tzrifin, Israel
| | - Alla Vishkautzan
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Chezi Ganzel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Hematology Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Moshe E Gatt
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Lidia Arcavi
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Pharmacology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Eli Marom
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Biatrice Uziely
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Hadassah University Medical Center Sharett Institute of Oncology, Jerusalem, Israel
| | - Shoshana Zevin
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Hadar Meirow
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Director, State of Israel Ministry of Health, Jerusalem, Israel
| | - Denize Ainbinder
- The Pharmaceutical Division, State of Israel Ministry of Health, Jerusalem, Israel
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11
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Cohen D, Ashkenazi S, Schneerson R, Farzam N, Bialik A, Meron-Sudai S, Asato V, Goren S, Baran TZ, Muhsen K, Gilbert PB, MacLennan CA. Threshold protective levels of serum IgG to Shigella lipopolysaccharide: re-analysis of Shigella vaccine trials data. Clin Microbiol Infect 2023; 29:366-371. [PMID: 36243351 PMCID: PMC9993342 DOI: 10.1016/j.cmi.2022.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 07/23/2022] [Revised: 10/03/2022] [Accepted: 10/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Establishing a correlate of protection is essential for the development and licensure of Shigella vaccines. We examined potential threshold levels of serum IgG to Shigella lipopolysaccharide (LPS) that could predict protection against shigellosis. METHODS We performed new analyses of serologic and vaccine efficacy (VE) data from two randomized vaccine-controlled trials of the Shigella sonnei-Pseudomonas aeruginosa recombinant exoprotein A (rEPA) conjugate conducted in young adults and children aged 1-4 years in Israel. Adults received either S. sonnei-rEPA (n = 183) or control vaccines (n = 277). Children received the S. sonnei-rEPA conjugate (n = 1384) or S. flexneri 2a-rEPA conjugate (n = 1315). VE against culture-proven shigellosis was determined. Sera were tested for IgG anti-S. sonnei LPS antibodies. We assessed the association of various levels of IgG anti-S. sonnei LPS antibodies with S. sonnei shigellosis risk using logistic regression models and the reverse cumulative distribution of IgG levels. RESULTS Among adults, four vaccinees and 23 controls developed S. sonnei shigellosis; the VE was 74% (95% CI, 28-100%). A threshold of ≥1:1600 IgG anti-S. sonnei LPS titre was associated with a reduced risk of S. sonnei shigellosis and a predicted VE of 73.6% (95% CI, 65-80%). The IgG anti-S. sonnei LPS correlated with serum bactericidal titres. In children, a population-based level of 4.5 ELISA Units (EU) corresponding to 1:1072 titre, predicted VE of 63%, versus 71% observed VE in children aged 3-4 years. The predicted VE in children aged 2-4 years was 49%, consistent with the 52% observed VE. CONCLUSION Serum IgG anti-S. sonnei LPS threshold levels can predict the degree of VE and can be used for the evaluation of new vaccine candidates.
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Affiliation(s)
- Dani Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel; Schneider Children's Medical Center, Petach Tikva, Israel
| | - Rachel Schneerson
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Nahid Farzam
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Tel Aviv, Israel
| | - Anya Bialik
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiri Meron-Sudai
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valeria Asato
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophy Goren
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Ziv Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Peter B Gilbert
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Calman A MacLennan
- Bill and Melinda Gates Foundation, London, United Kingdom; Nuffield Department of Medicine, Jenner Institute, University of Oxford, Oxford, United Kingdom
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12
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Ashkenazi S. Autoimmunity, COVID-19, Post-COVID19 Syndrome and COVID-19 Vaccination. Isr Med Assoc J 2023; 25:161-162. [PMID: 36841990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Affiliation(s)
- Shai Ashkenazi
- Dean, Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
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13
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Mor M, Paz M, Amir L, Levy I, Scheuerman O, Livni G, Guetta-Oz C, Yochpaz S, Berant R, Schwartz R, Niv O, Singer D, Ashkenazi S, Waisman Y. Bacterial vs viral etiology of fever: A prospective study of a host score for supporting etiologic accuracy of emergency department physicians. PLoS One 2023; 18:e0281018. [PMID: 36716321 PMCID: PMC9886241 DOI: 10.1371/journal.pone.0281018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A host-protein score (BV score) that combines the circulating levels of TNF-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein 10 (IP-10) and C-reactive protein (CRP) was developed for distinguishing bacterial from viral infection. This study assessed the potential of the BV score to impact decision making and antibiotic stewardship at the emergency department (ED), by comparing BV score's performance to physician's etiological suspicion at patient presentation. METHODS Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. 465 patients were recruited, 298 met eligibility criteria and 287 were enrolled. ED physician's etiological suspicion was recorded in a questionnaire. BV score was measured retrospectively with results interpreted as viral, bacterial or equivocal and compared to reference standard etiology, which was adjudicated by three independent experts based on all available data. Experts were blinded to BV scores. RESULTS Median age was 1.3 years (interquartile range 1.7), 39.7% females. 196 cases were reference standard viral and 18 cases were reference standard bacterial. BV score attained sensitivity of 88.9% (95% confidence interval: 74.4-100), specificity 92.1% (88.1-96.0), positive predictive value 53.3% (35.5-71.2) and negative predictive value 98.8% (97.1-100). Positive likelihood ratio was 11.18 (6.59-18.97) and negative likelihood ratio was 0.12 (0.03-0.45). The rate of BV equivocal scores was 9.4%. Comparing physician's suspicion to BV score and to the reference standard, and assuming full adoption, BV score could potentially correct the physician's diagnosis and reduce error ~2-fold, from 15.9% to 8.2%. CONCLUSIONS BV score has potential to aid the diagnostic process. Future studies are warranted to assess the impact of real-time BV results on ED practice.
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Affiliation(s)
- Meirav Mor
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Meital Paz
- Carmel Medical Center, Haifa, Israel
- Technion Israel Institute of Technology, Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Lisa Amir
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Itzhak Levy
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Oded Scheuerman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | | | - Sivan Yochpaz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
- Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Berant
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Rama Schwartz
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Omer Niv
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Dana Singer
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Yehezkel Waisman
- Schneider Children’s Medical Center, Petach Tikva, Israel
- Tel Aviv University, Tel Aviv, Israel
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14
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Mor M, Paz M, Amir L, Levy I, Scheuerman O, Livni G, Guetta-Oz C, Yochpaz S, Berant R, Schwartz R, Niv O, Singer D, Ashkenazi S, Waisman Y. 528. Bacterial vs viral etiology of fever: a prospective study to estimate a host score’s potential to support ED physicians' etiologic accuracy. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.583] [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] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
A host-protein score (BV) combining the circulating levels of TRAIL, IP-10 and CRP was developed for distinguishing bacterial from viral infection. BV’s potential to impact decision making at the emergency department (ED) was assessed by comparing BV to physician’s etiological suspicion.
Methods
Rosetta study participants, aged 3 months to 18 years with febrile respiratory tract infection or fever without source, were prospectively recruited in a tertiary care pediatric ED. The main eligibility criteria were symptoms for less than 7 days and immunocompetence. ED physician’s initial etiological suspicion (bacterial/viral/I don’t know) and degree of confidence (low/medium/high) were recorded in a questionnaire. BV was interpreted based on pre-defined score thresholds (viral/bacterial/equivocal); the results were not available to the physician. The etiologic reference standard was based on the diagnoses (bacterial/viral/indeterminate) of 3 independent pediatricians who were provided with all available patient data but blinded to BV. BV’s potential to impact the physician’s etiologic accuracy was estimated according to alignment between BV and etiological suspicion as filled in the questionnaire (assuming full adoption of BV by the physician).
Results
Among 348 patients recruited, 290 met eligibility criteria and had requisite serum sample (Figure 1A). Median age was 1.3 years (interquartile range 1.7), 37.5% were female. 211 patients had questionnaires filled. BV matched physician’s label and reference standard in 72% of the cases (151/211; Figure 1B); of these, 52% (78/151) were labeled by the physician with low/medium confidence, i.e., BV could reinforce the physician’s suspicion. In 12% of the cases (26/211) BV aligned with the reference standard but not with the physician’s suspicion, and therefore could correct the physician's etiologic diagnosis. BV did not align with the reference standard in 7% of the cases (14/211) and was equivocal in 9% of the cases (20/211). Overall, BV could potentially correct physician diagnosis and reduce error >2-fold, from 16.1% to 8.1%. Figure 1.Assessing the potential impact of BV on ED physician’s etiologic accuracy.
(A) Reference standard outcomes and BV scores. (B) BV versus adjudication-based reference standard and ED physician etiologic suspicion. Cases with missing questionnaire were omitted; n=211.
Conclusion
BV has potential to aid the diagnostic process. Future studies are warranted to assess the real-world impact of BV on ED practice.
Disclosures
Meital Paz, MD, MeMed: employee Oded Scheuerman, MD, MeMed: Grant/Research Support Ron Berant, MD, GE: Advisor/Consultant.
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Affiliation(s)
- Meirav Mor
- Schneider Children's Medical Center of Israel; Tel Aviv University , Petach Tikva , Israel
| | | | - Lisa Amir
- Schneider Children Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Itzhak Levy
- Schneider Children's Medical Center in Israel; Tel Aviv University , Petach Tikva, Tel Aviv , Israel
| | - Oded Scheuerman
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Gilat Livni
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Claire Guetta-Oz
- Schneider Children's Hospital of Israel , Petach Tikva, Tel Aviv , Israel
| | - Sivan Yochpaz
- Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center , Tel Aviv, Tel Aviv , Israel
| | - Ron Berant
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Rama Schwartz
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Omer Niv
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Dana Singer
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University , Ariel, Israel, Petach Tikva, Tel Aviv , Israel
| | - Yehezkel Waisman
- Schneider Children's Medical Center of Israel , Petach Tikva, Tel Aviv , Israel
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15
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Yuhas Y, Ashkenazi S, Berent E, Weizman A. Clozapine Suppresses the Gene Expression and the Production of Cytokines and Up-Regulates Cyclooxygenase 2 mRNA in Human Astroglial Cells. Brain Sci 2022; 12:brainsci12121703. [PMID: 36552163 PMCID: PMC9775287 DOI: 10.3390/brainsci12121703] [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: 09/28/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Schizophrenia (SCZ) is a chronic neurodevelopmental psychotic disorder. The immune system and neuroinflammation seem to play a central role in the pathophysiology of SCZ. Clozapine is an effective atypical antipsychotic used for treatment-resistant SCZ. Life-threatening side effects, such as myocarditis, limit its use. We investigated the immunomodulatory effects of clozapine in an astroglial model of neuroinflammation. We thus assessed the effect of clozapine on the production of inflammatory mediators in human-derived astroglial (A172) cells, stimulated with a cytokine mix (TNFα, IL-1β, IFNγ). RT-PCR and ELISA analyses demonstrated that clozapine suppressed gene expression and production of TNFα, IL-1β and IL-8 and increased COX2 mRNA 24 h after stimulation. Clozapine inhibited Akt phosphorylation induced by the cytokine mix at 10 min and 40 min, as assessed by Western blot analysis with anti-pT308Akt antibody. Pretreatment with the Akt inhibitor MK-2206 increased COX2 gene expression in cytokine-stimulated cells, suggesting that Akt inhibition may be involved in COX2 gene expression upregulation. Clozapine may possess dual beneficial effects: inhibiting astroglial production of proinflammatory cytokines, thus attenuating neuroinflammation, and upregulating COX2 expression that may be relevant to improvement of neural functioning while accounting for some of its detrimental effects. Patients with TRS and neuroinflammatory markers may benefit particularly from clozapine treatment.
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Affiliation(s)
- Yael Yuhas
- Laboratory of Pediatric Infectious Diseases, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
- Correspondence:
| | - Shai Ashkenazi
- Laboratory of Pediatric Infectious Diseases, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Eva Berent
- Laboratory of Pediatric Infectious Diseases, Felsenstein Medical Research Center, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva 4941492, Israel
| | - Abraham Weizman
- Laboratory of Molecular and Biological Psychiatry, Felsenstein Medical Research Center, Petach Tikva 4941492, Israel
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Research Unit, Geha Mental Health Center, Petach Tikva 4941492, Israel
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16
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Lazebnik T, Bunimovich-Mendrazitsky S, Ashkenazi S, Levner E, Benis A. Early Detection and Control of the Next Epidemic Wave Using Health Communications: Development of an Artificial Intelligence-Based Tool and Its Validation on COVID-19 Data from the US. Int J Environ Res Public Health 2022; 19:16023. [PMID: 36498096 PMCID: PMC9740968 DOI: 10.3390/ijerph192316023] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Social media networks highly influence on a broad range of global social life, especially in the context of a pandemic. We developed a mathematical model with a computational tool, called EMIT (Epidemic and Media Impact Tool), to detect and control pandemic waves, using mainly topics of relevance on social media networks and pandemic spread. Using EMIT, we analyzed health-related communications on social media networks for early prediction, detection, and control of an outbreak. EMIT is an artificial intelligence-based tool supporting health communication and policy makers decisions. Thus, EMIT, based on historical data, social media trends and disease spread, offers an predictive estimation of the influence of public health interventions such as social media-based communication campaigns. We have validated the EMIT mathematical model on real world data combining COVID-19 pandemic data in the US and social media data from Twitter. EMIT demonstrated a high level of performance in predicting the next epidemiological wave (AUC = 0.909, F1 = 0.899).
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Affiliation(s)
- Teddy Lazebnik
- Department of Cancer Biology, Cancer Institute, University College London, London WC1E 6DD, UK
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
| | - Eugene Levner
- Department of Applied Mathematics, Faculty of Sciences, Holon Institute of Technology, Holon 5810201, Israel
| | - Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel
- Department of Digital Medical Technologies, Holon Institute of Technology, Holon 5810201, Israel
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17
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Brill G, Manor I, Bril Paroz R, Ashkenazi S, Cohen S, Golan-Cohen A, Green I, Israel A, Vinker S, Weizman A, Merzon E. The Association between Somatotropin Therapy and the Risk of SARS-CoV-2 Infection in Children with Short Stature: A Population-Based Cross-Sectional Study. Children (Basel) 2022; 9:children9121844. [PMID: 36553288 PMCID: PMC9777504 DOI: 10.3390/children9121844] [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] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
COVID-19 is a worldwide pandemic caused by SARS-CoV-2, to which adults are usually more susceptible than children. Growth hormone (GH) levels differ between children and adults and decrease with age. There is bidirectional crosstalk between the GH/insulin-like growth factor-1 (IGF-1) pathway and the immune system that plays a significant role in SARS-CoV-2 infection. We evaluated the association between somatotropin treatment (GH replacement therapy) and the risk for SARS-CoV-2 positivity (a marker for COVID-19 infection) in children with growth hormone issues (GHI): growth hormone deficiency (GHD) and idiopathic short stature (ISS). A population-based cross-sectional study in Leumit Health Services (LHS) was performed using the electronic health record (EHR) database. The rates of SARS-CoV-2 positivity were evaluated among children with GHI, treated or untreated with somatotropin. Higher rates of SARS-CoV-2 positivity were found in GHI children, influenced by the same confounders reported in the pediatric population. A lower prevalence of SARS-CoV-2 PCR positivity was found among the somatotropin-treated children. A multivariate analysis documented that somatotropin treatment was associated with a reduced risk of SARS-CoV-2 positivity (Odds Ratio (OR) = 0.47, Confidence Interval (CI) 0.24-0.94, p = 0.032). Thus, somatotropin might be a protective factor against SARS-CoV-2 infections, possibly related to its immunomodulatory activity.
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Affiliation(s)
- Gherta Brill
- Pediatric Endocrinology Unit, Leumit Health Services, Tel-Aviv 6473817, Israel
| | - Iris Manor
- ADHD Unit, Geha Mental Health Center, Clalit Health Services, Petah Tikva 49100, Israel
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roberta Bril Paroz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
| | - Shira Cohen
- ADHD Unit, Geha Mental Health Center, Clalit Health Services, Petah Tikva 49100, Israel
| | - Avivit Golan-Cohen
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Leumit Health Services, Medical Division, Tel Aviv 6473817, Israel
| | - Ilan Green
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Leumit Health Services, Medical Division, Tel Aviv 6473817, Israel
| | - Ariel Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Leumit Health Services, Medical Division, Tel Aviv 6473817, Israel
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Leumit Health Services, Medical Division, Tel Aviv 6473817, Israel
| | - Abraham Weizman
- ADHD Unit, Geha Mental Health Center, Clalit Health Services, Petah Tikva 49100, Israel
- Department of Psychiatry, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
| | - Eugene Merzon
- Adelson School of Medicine, Ariel University, Ariel 4077625, Israel
- Leumit Health Services, Medical Division, Tel Aviv 6473817, Israel
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18
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Green I, Merzon E, Vinker S, Golan-Cohen A, Israel A, Scheinowitz M, Ishai R, Ashkenazi S, Magen E. A higher frequency of physical activity is associated with reduced rates of SARS-CoV-2 infection. Eur J Gen Pract 2022:1-7. [PMID: 36342205 DOI: 10.1080/13814788.2022.2138855] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with health benefits. Previous studies have shown that regular PA decreases the incidence of viral respiratory tract infections, but data on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are unavailable. OBJECTIVES The objective of this study is to examine the association between PA frequency and SARS-CoV-2 infection. METHODS A population-based cross-sectional study was conducted on data from 1 February 2020 to 31 December 2020, using the registry of Leumit Health Services (LHS), a national health maintenance organisation in Israel. All LHS patients aged 18 to 80 years who underwent at least one RT-PCR test for SARS-CoV-2 during the study period were included. We examined the association between PA frequency (hours per week) and being tested positive for SARS-CoV-2. RESULTS Of 113,075 subjects tested for SARS-CoV-2 by RT-PCR (mean age 41.6 years, 54.4% female), 17,465 (15%) were positive. In the SARS-CoV-2-negative group, significantly more subjects were engaged with PA than in the SARS-CoV-2-positive group [crude odds ratio (OR) for any PA 0.75 (95% confidence interval (CI) 0.72-0.77)]. After adjusting for possible confounders, PA frequency had a significant negative association with the likelihood of being SARS-CoV-2 positive (adjusted OR 0.67, 95% CI 0.64-0.68). Moreover, as the frequency of PA increased, the ORs of being SARS-CoV-2-positive decreased (occasional PA: OR 0.71, 95% CI 0.67-0.74; PA 1-3 times/week: OR 0.62, 95% CI 0.58-0.65 and PA > 3 times/week: OR 0.54, 95% CI 0.49 - 0.59). CONCLUSION Our large population-based study in patients undergoing SARS-CoV-2 RT-PCR testing showed that a higher frequency of PA is associated with a lower rate of positive test results.
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Affiliation(s)
- Ilan Green
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eugene Merzon
- Leumit Health Services, Tel Aviv, Israel
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Shlomo Vinker
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel Aviv, Israel
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Mickey Scheinowitz
- Department of Biomedical Engineering, Faculty of Engineering, Tel-Aviv University, Tel-Aviv, Israel
- Sylvan Adams Sports Institute, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer, Israel
| | - Reuven Ishai
- Department of Ear, Nose and Throat, and Head & Surgery, Rambam Medical Center, Haifa, Israel
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Shai Ashkenazi
- The Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eli Magen
- Leumit Health Services, Tel Aviv, Israel
- Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben-Gurion University of the Negev, Ashkelon, Israel
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19
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Golan N, Ashkenazi S, Davidovich R, Levinsky A, Bar Chaim A, Abu Hamad R, Raveh O, Yitzhaki S, Livni G. Quantitative Analysis of Vertical Transmission of Maternal SARS-CoV-2 Antibodies to Neonates and Young Infants Following Immunization During Pregnancy. J Pediatric Infect Dis Soc 2022; 11:506-509. [PMID: 35929547 PMCID: PMC9384628 DOI: 10.1093/jpids/piac065] [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: 12/13/2021] [Accepted: 06/28/2022] [Indexed: 11/12/2022]
Abstract
Serum antibody levels to SARS-CoV-2 in infants born to mothers who had received 2 doses of the BNT2b2 vaccine during pregnancy correlated positively with increasing gestational age at vaccination (P < .01) and negatively with increasing time from vaccination (P < .01), with a significant drop in infants aged >60 days (P = .045).
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Affiliation(s)
- Naama Golan
- Corresponding Author: Naama Golan, MD, Department of Pediatrics A, Schneider Children’s Medical Center, 14 Kaplan Street, Petah Tikva 49202, Israel. E-mail:
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Rotem Davidovich
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Alina Levinsky
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Adina Bar Chaim
- Laboratory of Clinical Chemistry, Shamir Medical Center, Beer Yaakov, Israel
| | - Ramzia Abu Hamad
- Laboratory of Clinical Chemistry, Shamir Medical Center, Beer Yaakov, Israel
| | - Omer Raveh
- Department of Emergency Pediatrics, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Shai Yitzhaki
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Gilat Livni
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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20
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Shkalim Zemer V, Grossman Z, Cohen HA, Hoshen M, Gerstein M, Yosef N, Cohen M, Ashkenazi S. Acceptance Rates of COVID-19 Vaccine Highlight the Need for Targeted Public Health Interventions. Vaccines (Basel) 2022; 10:vaccines10081167. [PMID: 35893816 PMCID: PMC9331185 DOI: 10.3390/vaccines10081167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/16/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to examine rates of COVID-19 vaccination to elucidate the need for targeted public health interventions. We retrospectively reviewed the electronic medical files of all adults registered in a central district in Israel from 1 January 2021 to 31 March 2022. The population was characterized by vaccination status against COVID-19 and the number of doses received. Univariate and multivariable analyses were used to identify predictors of low vaccination rates that required targeted interventions. Of the 246,543 subjects included in the study, 207,911 (84.3%) were vaccinated. The minority groups of ultra-Orthodox Jews and Arabs had lower vaccination rates than the non-ultra-Orthodox Jews (68.7%, 80.5% and 87.7%, respectively, p < 0.001). Adults of low socioeconomic status (SES) had lower vaccination rates compared to those of high SES (74.4% vs. 90.8%, p < 0.001). Adults aged 20−59 years had a lower vaccination rate than those ≥60 years (80.0% vs. 92.1%, p < 0.0001). Multivariate analysis identified five independent variables that were significantly (p < 0.001) associated with low vaccination rates: minority groups of the ultra-Orthodox sector and Arab population, and underlying conditions of asthma, smoking and diabetes mellitus (odds ratios: 0.484, 0.453, 0.843, 0.901 and 0.929, respectively). Specific targeted public health interventions towards these subpopulations with significantly lower rates of vaccination are suggested.
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Affiliation(s)
- Vered Shkalim Zemer
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva 4972339, Israel; (M.H.); (N.Y.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Correspondence: ; Tel.: +972-9101200
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel; (Z.G.); (M.G.); (S.A.)
- Maccabi Healthcare Services, Tel Aviv 6910107, Israel
| | - Herman Avner Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
- Pediatric Ambulatory Community Clinic, Petach Tikva 49504, Israel
| | - Moshe Hoshen
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva 4972339, Israel; (M.H.); (N.Y.)
- Bioinformatics Department, Jerusalem College of Technology, Jerusalem 9372115, Israel
| | - Maya Gerstein
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel; (Z.G.); (M.G.); (S.A.)
- Pediatric Ambulatory Community Clinic, Petach Tikva 49504, Israel
| | - Noga Yosef
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva 4972339, Israel; (M.H.); (N.Y.)
| | - Moriya Cohen
- Microbiolog Unit, Ariel University, Ariel 4070000, Israel;
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel; (Z.G.); (M.G.); (S.A.)
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21
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Ben Ami N, Ashkenazi S. Sustainability in Medicine: Primum non Nocere. Isr Med Assoc J 2022; 24:347-349. [PMID: 35734829] [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: 06/15/2023]
Affiliation(s)
- Noa Ben Ami
- Department of Physiotherapy, Faculty of Health Sciences, School of Medicine, Ariel University, Ariel, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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22
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Ashkenazi S. Antibiotic Overuse and Its Effects on our Planet. Isr Med Assoc J 2022; 24:353-356. [PMID: 35734831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The development of antibiotic agents has revolutionized the treatment of infectious diseases and clinical practice. However, antibiotic overuse, together with biologic evolution, has resulted in escalating antibiotic resistance of bacteria; with the One Health concept, it affects our planet including animals, aquatic wildlife, rivers, groundwater, lakes, sea water, aqua farming, and soil. This situation threatens our ability to treat infections effectively in the near future and raises the alarming question of whether we are getting close to the post-antibiotic era. Several measures are suggested to prevent the apocalyptic consequence of antibiotic overuse, few of which are novel with thinking outside the box.
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Affiliation(s)
- Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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23
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Merzon E, Weiss M, Krone B, Cohen S, Ilani G, Vinker S, Cohen-Golan A, Green I, Israel A, Schneider T, Ashkenazi S, Weizman A, Manor I. Clinical and Socio-Demographic Variables Associated with the Diagnosis of Long COVID Syndrome in Youth: A Population-Based Study. IJERPH 2022; 19:ijerph19105993. [PMID: 35627530 PMCID: PMC9141083 DOI: 10.3390/ijerph19105993] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 02/01/2023]
Abstract
This study examines the demographic, clinical and socioeconomic factors associated with diagnosis of long COVID syndrome (LCS). Data of 20,601 COVID-19-positive children aged 5 to 18 years were collected between 2020 and 2021 in an Israeli database. Logistic regression analysis was used to evaluate the adjusted odds ratio for the characteristics of the COVID-19 infection and pre-COVID-19 morbidities. Children with LCS were significantly more likely to have been severely symptomatic, required hospitalization, and experienced recurrent acute infection within 180 days. In addition, children with LCS were significantly more likely to have had ADHD, chronic urticaria, and allergic rhinitis. Diagnosis of LCS is significantly associated with pre-COVID-19 ADHD diagnosis, suggesting clinicians treating ADHD children who become infected with COVID-19 remain vigilant for the possibility of LCS. Although the risk of severe COVID-19 infection and LCS in children is low, further research on possible morbidity related to LCS in children is needed.
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Affiliation(s)
- Eugene Merzon
- Leumit Health Services, Tel-Aviv 6473817, Israel; (E.M.); (S.V.); (A.C.-G.); (I.G.); (A.I.)
- Adelson School of Medicine, Ariel University, Ariel 4076414, Israel;
| | | | - Beth Krone
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Shira Cohen
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Correspondence: ; Tel.: +972-3-9728600
| | - Gili Ilani
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Shlomo Vinker
- Leumit Health Services, Tel-Aviv 6473817, Israel; (E.M.); (S.V.); (A.C.-G.); (I.G.); (A.I.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Avivit Cohen-Golan
- Leumit Health Services, Tel-Aviv 6473817, Israel; (E.M.); (S.V.); (A.C.-G.); (I.G.); (A.I.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilan Green
- Leumit Health Services, Tel-Aviv 6473817, Israel; (E.M.); (S.V.); (A.C.-G.); (I.G.); (A.I.)
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ariel Israel
- Leumit Health Services, Tel-Aviv 6473817, Israel; (E.M.); (S.V.); (A.C.-G.); (I.G.); (A.I.)
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4076414, Israel;
| | - Abraham Weizman
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Iris Manor
- ADHD Unit, Geha Mental Health Center, Petah Tikva 49100, Israel; (A.W.); (I.M.)
- Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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24
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Merzon E, Weiss MD, Cortese S, Rotem A, Schneider T, Craig SG, Vinker S, Golan Cohen A, Green I, Ashkenazi S, Weizman A, Manor I. The Association between ADHD and the Severity of COVID-19 Infection. J Atten Disord 2022; 26:491-501. [PMID: 33797281 DOI: 10.1177/10870547211003659] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with ADHD are at increased risk of acquiring COVID-19. The present study assessed the possibility that ADHD also increases the risk of severe COVID-19 infection. METHOD We assessed 1,870 COVID-19 positive patients, aged 5 to 60 years, registered in the database of Leumit Health Services (LHS, Israel), February to -June 2020, of whom 231 with ADHD. Logistic regression analysis models evaluated the association between ADHD and the dependent variables of being symptomatic/referral to hospitalization, controlling for demographic and medical variables. RESULTS Age, male sex, and BMI were confirmed to be significant risk factors for increased COVID-19 severity. ADHD was found to be associated with increased severity of COVID-19 symptoms (OR = 1.81, 95% CI [1.29, 2.52], p < .05) and referral to hospitalization (OR =1.93, 95% CI [1.06, 3.51], p = .03). CONCLUSION ADHD is associated with poorer outcomes in COVID-19 infection.
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Affiliation(s)
- Eugene Merzon
- Leumit HMO, Tel-Aviv, Israel.,Tel Aviv University, Israel
| | | | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.,Solent NHS Trust, Southampton, UK.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ann Rotem
- ADHD Unit, Geha Mental Health Center, Petah Tikva, Israel
| | | | | | - Shlomo Vinker
- Leumit HMO, Tel-Aviv, Israel.,Tel Aviv University, Israel
| | | | - Ilan Green
- Leumit HMO, Tel-Aviv, Israel.,Tel Aviv University, Israel
| | | | - Abraham Weizman
- Tel Aviv University, Israel.,ADHD Unit, Geha Mental Health Center, Petah Tikva, Israel
| | - Iris Manor
- Tel Aviv University, Israel.,ADHD Unit, Geha Mental Health Center, Petah Tikva, Israel
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25
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Bowirrat A, Ashkenazi S, Bowirrat A, Pinhasov A. Does the Application of Deep Brain Stimulation to Modulate Memory and Neural Circuity in AD Hold Substantial Promise? Neurosci Bull 2022; 38:553-557. [PMID: 35050484 PMCID: PMC9106774 DOI: 10.1007/s12264-021-00815-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/29/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Abdalla Bowirrat
- Adelson School of Medicine and Department of Molecular Biology, Ariel University, 40700, Ariel, Israel.
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, 40700, Ariel, Israel
| | - Aia Bowirrat
- Department of Orthopedic Surgery, Hasharon Hospital, Rabin Medical Center, Tel Aviv University, 4941492, Petah-Tikva, Israel
| | - Albert Pinhasov
- Adelson School of Medicine and Department of Molecular Biology, Ariel University, 40700, Ariel, Israel
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26
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Stein M, Ashkenazi-Hoffnung L, Greenberg D, Dalal I, Livni G, Chapnick G, Stein-Zamir C, Ashkenazi S, Hecht-Sagie L, Grossman Z. The Burden of COVID-19 in Children and Its Prevention by Vaccination: A Joint Statement of the Israeli Pediatric Association and the Israeli Society for Pediatric Infectious Diseases. Vaccines (Basel) 2022; 10:81. [PMID: 35062742 PMCID: PMC8781684 DOI: 10.3390/vaccines10010081] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/29/2021] [Indexed: 01/27/2023] Open
Abstract
As of October 2021, SARS-CoV-2 infections were reported among 512,613 children and adolescents in Israel (~33% of all COVID-19 cases). The 5-11-year age group accounted for about 43% (223,850) of affected children and adolescents. In light of the availability of the Pfizer-BioNTech BNT162b2 vaccine against COVID-19 for children aged 5-11 years, we aimed to write a position paper for pediatricians, policymakers and families regarding the clinical aspects of COVID-19 and the vaccination of children against COVID-19. The first objective of this review was to describe the diverse facets of the burden of COVID-19 in children, including the direct effects of hospitalization during the acute phase of the disease, multisystem inflammatory syndrome in children, long COVID and the indirect effects of social isolation and interruption in education. In addition, we aimed to provide an update regarding the efficacy and safety of childhood mRNA COVID-19 vaccination and to instill confidence in pediatricians regarding the benefits of vaccinating children against COVID-19. We reviewed up-to-date Israeli and international epidemiological data and literature regarding COVID-19 morbidity and its sequelae in children, vaccine efficacy in reducing COVID-19-related morbidity and SARS-CoV-2 transmission and vaccine safety data. We conducted a risk-benefit analysis regarding the vaccination of children and adolescents. We concluded that vaccines are safe and effective and are recommended for all children aged 5 to 11 years to protect them from COVID-19 and its complications and to reduce community transmissions. Based on these data, after weighing the benefits of vaccination versus the harm, the Israeli Ministry of Health decided to recommend vaccination for children aged 5-11 years.
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Affiliation(s)
- Michal Stein
- Infectious Diseases and Infection Control Unit, Hillel Yaffe Medical Center, Hadera 3810101, Israel
- Rappaport Faculty of Medicine, Technion—Israel Institute of Technology, Haifa 3109601, Israel
| | - Liat Ashkenazi-Hoffnung
- Department of Day Care Hospitalization, Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka Medical Center, Be’er Sheva 8458900, Israel;
- The Faculty of Health Sciences, Joyce & Irving Goldman Medical School at Ben Gurion University of the Negev, Be’er Sheva 8410501, Israel
| | - Ilan Dalal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Pediatric Department, E. Wolfson Medical Center, Holon 5822012, Israel
| | - Gilat Livni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo 6997801, Israel; (I.D.); (G.L.)
- Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva 4920245, Israel
| | - Gil Chapnick
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Chen Stein-Zamir
- Jerusalem District Health Office, Jerusalem 9137001, Israel;
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shai Ashkenazi
- Schneider Children’s Medical Center, Petah Tikva 4920235, Israel;
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
| | - Lior Hecht-Sagie
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
| | - Zachi Grossman
- Maccabi Healthcare Services, Tel Aviv-Yafo 6812509, Israel; (G.C.); (L.H.-S.); (Z.G.)
- Adelson School of Medicine, Ariel University, Ari’el 4070000, Israel
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27
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Hoshen M, Shkalim Zemer V, Ashkenazi S, Grossman Z, Gerstein M, Yosef N, Cohen M, Cohen HA. How to increase COVID-19 vaccine uptake among children? determinants associated with vaccine compliance. Front Pediatr 2022; 10:1038308. [PMID: 36714648 PMCID: PMC9880470 DOI: 10.3389/fped.2022.1038308] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Three aims: to elucidate determinants associated with COVID-19 vaccine uptake in children and the association with parental vaccination; to compare rates of PCR-positive SARS-CoV-2 results between vaccinated and unvaccinated children; to estimate the rate of parental COVID-19 vaccination and its association with the vaccination rate of their children. METHODS We performed a retrospective chart review of all children aged 5-11 years registered at a central district in Israel from November 21st, 2021 to April 30th, 2022, and characterized COVID-19 vaccinated vs. unvaccinated individuals. Data retrieved from the electronic medical files included: demographics [age, gender, sector, socioeconomic status (SES)]; COVID-19 vaccination (first and second doses) and influenza vaccination status; co-morbidities; and parental vaccinations for COVID-19. We divided the population into three distinct demographic groups: non-ultra-orthodox Jews (43,889 children), ultra-orthodox Jews (13,858 children), and Arabs (4,029 children). RESULTS Of the 61,776 children included in the study, 20,355 (32.9%) received at least one dose of the COVID-19 vaccine. Vaccination rates were similar amongst males and females and were higher in children aged 9-11 years compared to children aged 5-6 years. Multivariate analysis identified five independent determinants that were significantly (p < 0.001) associated with low vaccination rates: Arab and ultra-orthodox sectors (odds ratios: 0.235 and 0.617, respectively); children aged 5-8 years; children of low SES; and children who had not received previous seasonal influenza vaccination. Relatively high vaccination rates were noted amongst children with the following medical co-morbidities: treatment with biological agents (42.9%); solid tumor transplantation (42.9%); type 1 diabetes mellitus (38.5%), asthma (38.2%), and attention deficit and hyperactivity disorder (ADHD) (37.6%). Regarding the uptake of two vaccine doses among children with co-morbidities, it was highest in those with type 1 diabetes mellitus, heart failure, treatment with biological agents, asthma and obesity. CONCLUSION This study highlights several pediatric sub-populations with low and high vaccine uptake. It is essential to focus on determinants associated with low vaccination rates.
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Affiliation(s)
- Moshe Hoshen
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva, Israel.,Bioinformatics Department, Jerusalem College of Technology, Jerusalem, Israel
| | - Vered Shkalim Zemer
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Healthcare Services, Tel Aviv, Israel
| | - Maya Gerstein
- Adelson School of Medicine, Ariel University, Ariel, Israel.,Pediatric Ambulatory Community Clinic, Petach Tikva, Israel
| | - Noga Yosef
- Dan-Petach Tikva District, Clalit Health Services, Petach Tikva, Israel
| | - Moriya Cohen
- Microbiology Unit, Ariel University, Ariel, Israel
| | - Herman Avner Cohen
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Pediatric Ambulatory Community Clinic, Petach Tikva, Israel
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28
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Punnoose J, Nachman H, Ashkenazi S. Oxygen Imaging for Non-Invasive Metastasis Detection. Sensors (Basel) 2021; 22:s22010237. [PMID: 35009780 PMCID: PMC8749708 DOI: 10.3390/s22010237] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 05/16/2023]
Abstract
Sentinel lymph node (SLN) biopsy is an integral part of treatment planning for a variety of cancers as it evaluates whether a tumor has metastasized, an event that significantly reduces survival probability. However, this invasive procedure is associated with patient morbidity, and misses small metastatic deposits, resulting in the removal of additional nodes for tumors with high metastatic probability despite a negative SLN biopsy. To prevent this over-treatment and its associated morbidities for patients that were truly negative, we propose a tissue oxygen imaging method called Photoacoustic Lifetime Imaging (PALI) as an alternative or supplementary tool for SLN biopsy. As the hyper-metabolic state of cancer cells significantly depresses tissue oxygenation compared to normal tissue even for small metastatic deposits, we hypothesize that PALI can sensitively and specifically detect metastases. Before this hypothesis is tested, however, PALI's maximum imaging depth must be evaluated to determine the cancer types for which it is best suited. To evaluate imaging depth, we developed and simulated a phantom composed of tubing in a tissue-mimicking, optically scattering liquid. Our simulation and experimental results both show that PALI's maximum imaging depth is 16 mm. As most lymph nodes are deeper than 16 mm, ways to improve imaging depth, such as directly delivering light to the node using penetrating optical fibers, must be explored.
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Affiliation(s)
- Joshua Punnoose
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Henry Nachman
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Shai Ashkenazi
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA;
- Correspondence:
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Lucero Y, Matson DO, Ashkenazi S, George S, O’Ryan M. Norovirus: Facts and Reflections from Past, Present, and Future. Viruses 2021; 13:v13122399. [PMID: 34960668 PMCID: PMC8707792 DOI: 10.3390/v13122399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/21/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023] Open
Abstract
Human Norovirus is currently the main viral cause of acute gastroenteritis (AGEs) in most countries worldwide. Nearly 50 years after the discovery of the "Norwalk virus" by Kapikian and colleagues, the scientific and medical community continue to generate new knowledge on the full biological and disease spectrum of Norovirus infection. Nevertheless, several areas remain incompletely understood due to the serious constraints to effectively replicate and propagate the virus. Here, we present a narrated historic perspective and summarize our current knowledge, including insights and reflections on current points of interest for a broad medical community, including clinical and molecular epidemiology, viral-host-microbiota interactions, antivirals, and vaccine prototypes. We also include a reflection on the present and future impacts of the COVID-19 pandemic on Norovirus infection and disease.
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Affiliation(s)
- Yalda Lucero
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (Y.L.); (S.G.)
- Hospital Dr. Roberto del Río Hospital, Department of Pediatrics and Pediatric Surgery (Northern Campus), Faculty of Medicine, Universidad de Chile, Santiago 8380418, Chile
- Clínica Alemana de Santiago, Faculty of Medicine, Universidad del Desarrollo-Clínica Alemana, Santiago 7650568, Chile
| | - David O. Matson
- Eastern Shore Health Department, Virginia Department of Public Health, Accomack County, VA 23301, USA;
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
- Department of Pediatrics A, Schneider Children’s Medical Center, Petach Tikva 49202, Israel
| | - Sergio George
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (Y.L.); (S.G.)
| | - Miguel O’Ryan
- Microbiology and Mycology Program, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (Y.L.); (S.G.)
- Correspondence:
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Benis A, Banker M, Pinkasovich D, Kirin M, Yoshai BE, Benchoam-Ravid R, Ashkenazi S, Seidmann A. Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study. J Clin Med 2021; 10:jcm10235519. [PMID: 34884221 PMCID: PMC8658517 DOI: 10.3390/jcm10235519] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic challenges healthcare services. Concomitantly, this pandemic had a stimulating effect on technological expansions related to telehealth and telemedicine. We sought to elucidate the principal patients' reasons for using telemedicine during the COVID-19 pandemic and the propensity to use it thereafter. Our primary objective was to identify the reasons of the survey participants' disparate attitudes toward the use of telemedicine. We performed an online, multilingual 30-question survey for 14 days during March-April 2021, focusing on the perception and usage of telemedicine and their intent to use it after the pandemic. We analyzed the data to identify the attributes influencing the intent to use telemedicine and built decision trees to highlight the most important related variables. We examined 473 answers: 272 from Israel, 87 from Uruguay, and 114 worldwide. Most participants were women (64.6%), married (63.8%) with 1-2 children (52.9%), and living in urban areas (84.6%). Only a third of the participants intended to continue using telemedicine after the COVID-19 pandemic. Our main findings are that an expected substitution effect, technical proficiency, reduced queueing times, and peer experience are the four major factors in the overall adoption of telemedicine. Specifically, (1) for most participants, the major factor influencing their telemedicine usage is the implicit expectation that such a visit will be a full substitute for an in-person appointment; (2) another factor affecting telemedicine usage by patients is their overall technical proficiency and comfort level in the use of common web-based tools, such as social media, while seeking relevant medical information; (3) time saving as telemedicine can allow for asynchronous communications, thereby reducing physical travel and queuing times at the clinic; and finally (4) some participants have also indicated that telemedicine seems more attractive to them after watching family and friends (peer experience) use it successfully.
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Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
- Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon 5810201, Israel
- Correspondence:
| | - Maxim Banker
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - David Pinkasovich
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Mark Kirin
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | - Bat-el Yoshai
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel; (M.B.); (D.P.); (M.K.); (B.-e.Y.)
| | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel 4070000, Israel;
| | - Abraham Seidmann
- Department of Information Systems, Questrom Business School, Boston University, Boston, MA 02215, USA;
- Health Analytics and Digital Health, Digital Business Institute, Boston University, Boston, MA 02215, USA
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Merzon E, Gutbir Y, Vinker S, Golan Cohen A, Horwitz D, Ashkenazi S, Sadaka Y. Early Childhood Shigellosis and Attention Deficit Hyperactivity Disorder: A Population-Based Cohort Study with a Prolonged Follow-up. J Atten Disord 2021; 25:1791-1800. [PMID: 32698643 PMCID: PMC8427818 DOI: 10.1177/1087054720940392] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Although the short-term neurological complications of Shigella spp. are well described, potential neuropsychiatric outcomes have not been studied yet. We investigated the association between early childhood shigellosis and subsequent ADHD. METHODS This is a retrospective population-based cohort. Using a large Health Maintenance Organization database, the prevalence of ADHD was investigated among children aged 5-18 years who underwent stool culture prior to the age of 3 years. RESULTS Of 52,761 children with a stool culture examined, 5,269 (9.98%) had Shigella-positive results. The rate of ADHD was 10.6% and 8.6% among children with Shigella-positive and Shigella-negative stool cultures, respectively (p < .001). Adjusted odds ratio for ADHD after controlling for gender and socioeconomic status was 1.21 (CI 1.13-1.29, p < .001). The younger the child was during Shigella gastroenteritis, the higher was the association with ADHD (p < .001). CONCLUSION Early childhood shigellosis is associated with an increased rate of long-term ADHD.
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Affiliation(s)
- Eugene Merzon
- Leumit HMO, Tel-Aviv, Israel,Tel Aviv University, Tel Aviv, Israel
| | - Yuval Gutbir
- Ben-Gurion University of the Negev, Beer-Sheva, Israel,Hadassah Ein Karem Hospital, Jerusalem, Israel
| | - Shlomo Vinker
- Leumit HMO, Tel-Aviv, Israel,Tel Aviv University, Tel Aviv, Israel
| | | | - Dana Horwitz
- Ben-Gurion University of the Negev, Beer-Sheva, Israel,Mental Health Institute, Beer Sheva, Israel
| | | | - Yair Sadaka
- Ben-Gurion University of the Negev, Beer-Sheva, Israel,Mental Health Institute, Beer Sheva, Israel,Yair Sadaka, Neuro-Developmental Center, The Beer Sheva Mental Health Center, Hazadik Meyerushalim 2, Beer Sheva, Israel.
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Benis A, Chatsubi A, Levner E, Ashkenazi S. Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence-Based Infodemiology Study. ACTA ACUST UNITED AC 2021; 1:e31983. [PMID: 34693212 PMCID: PMC8521455 DOI: 10.2196/31983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022]
Abstract
Background Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines. Objective Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence–based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications. Methods The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy. Results We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: “flu,” “influenza,” “vaccination,” “vaccine,” and “vaxx.” We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that “flu” and “covid” occurrences were inversely correlated as “flu” disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: “health and medicine (biological and clinical aspects),” “protection and responsibility,” and “politics.” By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events. Conclusions This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations’ engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process.
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Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management Holon Institute of Technology Holon Israel.,Faculty of Digital Technologies in Medicine Holon Institute of Technology Holon Israel
| | - Anat Chatsubi
- Faculty of Industrial Engineering and Technology Management Holon Institute of Technology Holon Israel
| | - Eugene Levner
- Faculty of Sciences Holon Institute of Technology Holon Israel
| | - Shai Ashkenazi
- Adelson School of Medicine Ariel University Ariel Israel
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Sadaka Y, Freedman J, Ashkenazi S, Vinker S, Golan-Cohen A, Green I, Israel A, Eran A, Merzon E. The Effect of Antibiotic Treatment of Early Childhood Shigellosis on Long-Term Prevalence of Attention Deficit/Hyperactivity Disorder. Children (Basel) 2021; 8:children8100880. [PMID: 34682145 PMCID: PMC8535120 DOI: 10.3390/children8100880] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
It has recently been shown that children with early shigellosis are at increased risk of attention deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the association between antibiotic treatment of shigellosis with long-term ADHD rates. A retrospective cohort study was conducted that included all the Leumit Health Services (LHS) enrollees aged 5-18 years between 2000-2018 with a documented Shigella-positive gastroenteritis before the age of 3 years. Of the 5176 children who were positive for Shigella gastroenteritis before the age of 3 years, 972 (18.8%) were treated with antibiotics early (<5 days), 250 (4.8%) were treated late (≥5 days), and 3954 children (76.4%) were not prescribed antibiotics. Late antibiotic treatment was associated with significantly increased rates of ADHD (adjusted OR = 1.61; 95% CI, 1.1-2.3). Early treatment with antibiotics was not associated with increased ADHD rates (adjusted OR = 1.02; 95% CI, 0.8-1.3). In conclusion, late antibiotic treatment of early childhood shigellosis was associated with increased rates of ADHD.
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Affiliation(s)
- Yair Sadaka
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8443944, Israel; (Y.S.); (J.F.)
- Neuro-Developmental Research Center, Mental Health Institute, Beer Sheva 8461144, Israel
| | - Judah Freedman
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8443944, Israel; (Y.S.); (J.F.)
- Neuro-Developmental Research Center, Mental Health Institute, Beer Sheva 8461144, Israel
| | - Shai Ashkenazi
- The Adelson School of Medicine, Ariel University, Ariel 40700, Israel;
| | - Shlomo Vinker
- Leumit Health Services, Tel-Aviv 6473817, Israel; (S.V.); (A.G.-C.); (A.I.)
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Avivit Golan-Cohen
- Leumit Health Services, Tel-Aviv 6473817, Israel; (S.V.); (A.G.-C.); (A.I.)
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ilan Green
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Ariel Israel
- Leumit Health Services, Tel-Aviv 6473817, Israel; (S.V.); (A.G.-C.); (A.I.)
| | - Alal Eran
- Department of Life Sciences, Ben Gurion University, Beer Sheva 8443944, Israel;
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Eugene Merzon
- Leumit Health Services, Tel-Aviv 6473817, Israel; (S.V.); (A.G.-C.); (A.I.)
- Correspondence: ; Tel.: +972-50-7643281
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Kertcher C, Zion H, Ashkenazi S, Shoenfeld Y. [A STRATEGY FOR PEACE BUILDING THROUGH MEDICINE: THE ISRAELI-PALESTINIAN CASE]. Harefuah 2021; 160:482-485. [PMID: 34396719] [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: 06/13/2023]
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35
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Cohen D, Atsmon J, Artaud C, Meron-Sudai S, Gougeon ML, Bialik A, Goren S, Asato V, Ariel-Cohen O, Reizis A, Dorman A, Hoitink CWG, Westdijk J, Ashkenazi S, Sansonetti P, Mulard LA, Phalipon A. Safety and immunogenicity of a synthetic carbohydrate conjugate vaccine against Shigella flexneri 2a in healthy adult volunteers: a phase 1, dose-escalating, single-blind, randomised, placebo-controlled study. The Lancet Infectious Diseases 2021; 21:546-558. [DOI: 10.1016/s1473-3099(20)30488-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/11/2020] [Accepted: 05/20/2020] [Indexed: 12/17/2022]
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Benis A, Seidmann A, Ashkenazi S. Reasons for Taking the COVID-19 Vaccine by US Social Media Users. Vaccines (Basel) 2021; 9:vaccines9040315. [PMID: 33805283 PMCID: PMC8067223 DOI: 10.3390/vaccines9040315] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Political and public health leaders promoting COVID-19 vaccination should identify the most relevant criteria driving the vaccination decision. Social media is increasingly used as a source of vaccination data and as a powerful communication tool to increase vaccination. In December 2020, we performed a cross-sectional social media-based survey addressing personal sentiments toward COVID-19 vaccination in the USA. Our primary research objective is to identify socio-demographic characteristics and the reasons for the 1644 survey participants’ attitudes regarding vaccination. We present clear evidence that, contrary to the prevailing public perceptions, young audiences using social media have mostly a positive attitude towards COVID-19 vaccination (81.5%). These younger individuals want to protect their families and their relatives (96.7%); they see vaccination as an act of civic responsibility (91.9%) and express strong confidence in their healthcare providers (87.7%). Another critical factor is the younger population’s fear of personal COVID-19 infection (88.2%); moreover, the greater the number of children the participants have, the greater is their intent to get the COVID-19 vaccine. These results enable a practical public-messaging pathway to reinforce vaccination campaigns addressing the younger population.
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Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon 5810201, Israel
- Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon 5810201, Israel
- Correspondence:
| | - Abraham Seidmann
- Department of Information Systems, Questrom Business School, Boston University, Boston, MA 02215, USA;
- Health Analytics and Digital Health, Digital Business Institute, Boston University, Boston, MA 02215, USA
| | - Shai Ashkenazi
- School of Medicine, Ariel University, Ariel 40700, Israel;
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Benis A, Khodos A, Ran S, Levner E, Ashkenazi S. Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study. J Med Internet Res 2021; 23:e25977. [PMID: 33651709 PMCID: PMC7968480 DOI: 10.2196/25977] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 11/23/2020] [Revised: 12/28/2020] [Accepted: 03/01/2021] [Indexed: 12/25/2022] Open
Abstract
Background Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. Objective The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. Methods A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. Results A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. Conclusions Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well.
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Affiliation(s)
- Arriel Benis
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon, Israel.,Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon, Israel
| | - Anna Khodos
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon, Israel
| | - Sivan Ran
- Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Holon, Israel
| | - Eugene Levner
- Faculty of Sciences, Holon Institute of Technology, Holon, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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Bensoussan E, Ouldali N, Ashkenazi S, Angoulvant F, Cohen R, Levy C. Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Pediatric Infectious Disease Research. J Pediatr 2021; 230:279-281.e2. [PMID: 33271191 PMCID: PMC7834229 DOI: 10.1016/j.jpeds.2020.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 11/24/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Eden Bensoussan
- Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Naim Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France,Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - François Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France,Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, IMRB-GRC GEMINI, Créteil, France,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.
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Ashkenazi-Hoffnung L, Livni G, Scheuerman O, Berger I, Eden E, Oved K, Shani L, Kronenfeld G, Simon E, Boico O, Navon R, Gottlieb TM, Barash E, Paz M, Yuhas Y, Berent E, Ashkenazi S. Differential Serum and Urine CRP, IP-10, and TRAIL Levels in Pediatric Urinary Tract Infection. Front Pediatr 2021; 9:771118. [PMID: 34966702 PMCID: PMC8710750 DOI: 10.3389/fped.2021.771118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: It is estimated that clinical evaluation and urinalysis are unable to diagnose >10% of urinary tract infections (UTI) in young children. TNF-related apoptosis induced ligand (TRAIL), interferon gamma induced protein-10 (IP-10), and C-reactive protein (CRP) exhibit differential expression in the blood in response to bacterial vs. viral infection. We assessed if the urinary and serum levels of these host biomarkers discriminate UTI, nephronia, and response to antibiotic treatment. Methods: Hospitalized febrile children aged <18 years with suspected UTI based on abnormal urinalysis were recruited prospectively between 2016 and 2018; also, non-febrile controls were recruited. Following urine culture results and hospitalization course, participants were divided into three groups based on AAP criteria and expert adjudication: UTI, viral infection, and indeterminate. Results: Seventy-three children were enrolled, 61 with suspected UTI and 12 non-febrile controls. Of the 61 with suspected UTI, 40 were adjudicated as UTI, 10 viral infection, and 11 as indeterminate. Urinary CRP and IP-10 levels were significantly higher in the UTI group (p ≤ 0.05). Urinary CRP differentiated UTI from non-bacterial etiology in children under and over 3 months of age, with AUCs 0.98 (95% CI: 0.93-1.00) and 0.82 (0.68-0.95), respectively. Similarly, urinary IP-10 discriminated with AUCs of 0.80 (0.59-1.00) and 0.90 (0.80-1.00), respectively. Serum CRP and IP-10 levels were significantly higher in UTI cases with nephronia (p ≤ 0.03). UTI-induced changes in the levels of urinary and serum biomarkers resolved during recovery. Conclusions: CRP, IP-10, and TRAIL represent biomarkers with potential to aid the clinician in diagnosis and management of UTI.
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Affiliation(s)
- Liat Ashkenazi-Hoffnung
- Department of Day Hospitalization, Schneider Children's Medical Center, Petah Tikva, Israel.,Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilat Livni
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Oded Scheuerman
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Itay Berger
- Pediatric Infectious Disease Unit, Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pediatrics A and B, Schneider Children's Medical Center, Petah Tikva, Israel
| | | | | | | | | | | | | | | | | | | | | | - Yael Yuhas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eva Berent
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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40
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Green I, Ashkenazi S, Merzon E, Vinker S, Golan-Cohen A. The association of previous influenza vaccination and coronavirus disease-2019. Hum Vaccin Immunother 2020; 17:2169-2175. [PMID: 33377817 DOI: 10.1080/21645515.2020.1852010] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Studies have shown similarities in the structure of influenza and coronaviruses, in their binding receptors and in patterns of immune responses; and that influenza vaccine can induce cross-immunity. We examined the association of previous influenza vaccination and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, resulting in coronavirus disease-2019 (COVID-19), among 715,164 members of a health maintenance organization. In a multivariate regression model, the odds ratios for SARS-CoV-2 infection among individuals vaccinated for influenza in 2018-2019, 2019-2020, and in both seasons, compared to non-vaccinated individuals, were 0.82 (95% CI 0.68-0.99, p = .048), 0.79 (95% CI 0.67-0.98, p = .005), and 0.76 (95% CI 0.61-0.97, p = .004), respectively. Based on our findings, administration of influenza vaccine before the influenza season is highly recommended to reduce the burden of influenza, which is critical in scenarios of outbreaks of both influenza and SARS-CoV-2 infections, and also regarding its association with reduced rate of COVID-19.
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Affiliation(s)
- Ilan Green
- Leumit Health Services, Medical Division, Tel-Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Eugene Merzon
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Vinker
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Golan-Cohen
- Leumit Health Services, Medical Division, Tel-Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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41
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Grossman Z, Chodick G, Reingold SM, Chapnick G, Ashkenazi S. The future of telemedicine visits after COVID-19: perceptions of primary care pediatricians. Isr J Health Policy Res 2020; 9:53. [PMID: 33081834 PMCID: PMC7573530 DOI: 10.1186/s13584-020-00414-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022] Open
Abstract
Background Facing the global health crisis of COVID-19, health systems are increasingly supporting the use of telemedicine in ambulatory care settings. It is not clear whether the increased use of telemedicine will persist after the pandemic has resolved. The aims of this study were to assess the use of telemedicine by Israeli pediatricians before and during the first lockdown phase of the pandemic, and to elucidate how they foresee telemedicine as a medium of medical practice in the post-pandemic era. Methods A web-based survey was distributed among Israeli pediatricians in May 2020, soon after the end of first lockdown was announced. The survey assessed the frequency of telemedicine use as well as its influence on clinical decision making before and during the first COVID-19 lockdown, using two hypothetical clinical scenarios. The same scenarios were also used to assess how the pediatricians foresaw telemedicine in the post-pandemic period. In addition, administrative data from Maccabi on telemedicine use before, during and after the first lockdown were retrieved and analyzed. Results One hundred and sixty-nine pediatricians responded to the survey (response rate = 40%). The percentage of respondents who reported daily use of text messages, pictures and videoconferencing increased from 24, 15 and 1% before COVID-19 to 40, 40 and 12% during the lockdown, respectively (p < 0.05). After the pandemic, projected use of text messages and pictures/videoclips was expected to decrease to 27 and 26% of respondents, respectively (p < 0.05), but pictures/videoclips were expected to increase from 15% of respondents before to 26% of respondents after (p < 0.05). The reported high likelihood of treating suspected pneumonia or prescribing antibiotics for suspected otitis media via telemedicine was expected to decrease from 20% of respondents during the COVID-19 lockdown to 6%% of respondents after (p < 0.05), and from 14% of respondents during the lockdown to 3% of respondents after, respectively. (p < 0.05). Maccabi administrative data indicated that during the lockdown, there was an increase in phone visits and a decrease in in-person visits compared to the pre-lockdown levels of use. One month after the end of the first lock-down there was a partial return to baseline levels of in-person visits and a sustained increase in phone visits. Phone visits accounted for 0% of pediatrician visits before the first lockdown, 17% of them during the lockdown, and 19% of them 1 month after the lockdown relaxation. Conclusions The study indicates that use of telemedicine technologies by primary care pediatricians increased substantially during the first COVID-19 lockdown. The study also found that pediatricians expected that use levels will recede after the pandemic. As the pandemic continues and evolves, it will be important to continue to monitor the level of telemedicine use as well as expectations regarding post-pandemic use levels.
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Affiliation(s)
- Zachi Grossman
- Adelson School of Medicine, Ariel University, Ariel, Israel. .,Pediatric Clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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42
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Sandhaus Y, Kushnir T, Ashkenazi S. Electronic Distance Learning of Pre-clinical Studies During the COVID-19 Pandemic: A Preliminary Study of Medical Student Responses and Potential Future Impact. Isr Med Assoc J 2020; 22:489-493. [PMID: 33236581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Social distancing, implemented to decrease the spread of coronavirus disease-2019 (COVID-19), forced major changes in medical practices, including an abrupt transition from face-to-face to remote patient care. Pre-clinical medical studies were concomitantly switched to electronic distance learning. OBJECTIVES To explore potential implications of COVID-19 on future pre-clinical medical studies. METHODS We examined responses of pre-clinical medical students to the remote electronic learning in terms of quality of and satisfaction with teaching and technical support, attendance to classes, and the desire to continue electronic learning in the post-epidemic era. A survey of responses from first-year students at the Adelson School of Medicine was conducted. To optimize the reliability of the survey, a single research assistant conducted telephone interviews with each student, using a structured questionnaire concerning aspects of participation and satisfaction with teaching and with technical components of the remote electronic learning. RESULTS With 100% response rate, the students reported high satisfaction with the electronic learning regarding its quality, online interactions, instructions given, technical assistance, and availability of recording for future studies. Most of the students (68.6%) noted a preference to continue < 90% of the learning online in the post-outbreak era. A high level of overall satisfaction and a low rate of technical problems during electronic learning were significantly correlated with the desire to continue online learning (P < 0.01). CONCLUSIONS The high satisfaction and the positive experience with the electronic distance learning imposed by the COVID-19 epidemic implied a successful transition and might induce future changes in pre-clinical medical studies.
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Affiliation(s)
| | - Talma Kushnir
- Medical Education, Adelson School of Medicine
- Department of Psychology, Ariel University, Israel
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43
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Natan M, Jacobi G, Banin E, Ashkenazi S. Prevention and Treatment of Pseudomonas Aeruginosa-Based Biofilm with Ethanol. Isr Med Assoc J 2020; 22:299-302. [PMID: 32378822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although indwelling catheters are increasingly used in modern medicine, they can be a source of microbial contamination and hard-to-treat biofilms, which jeopardize patient lives. At times 70% ethanol is used as a catheter-lock solution due to its bactericidal properties. However, high concentrations of ethanol can result in adverse effects and in malfunction of the catheters. OBJECTIVES To determine whether low concentrations of ethanol can prevent and treat biofilms of Pseudomonas aeruginosa. METHODS Ethanol was tested at a concentration range of 0.625-80% against laboratory and clinical isolates of P. aeruginosa for various time periods (2-48 hours). The following parameters were evaluated following ethanol exposure: prevention of biofilm formation, reduction of biofilm metabolic activity, and inhibition of biofilm regrowth. RESULTS Exposing P. aeruginosa to twofold ethanol gradients demonstrated a significant biofilm inhibition at concentrations as low as 2.5%. Treating pre-formed biofilms of P. aeruginosa with 20% ethanol for 4 hours caused a sharp decay in the metabolic activity of both the laboratory and clinical P. aeruginosa isolates. In addition, treating mature biofilms with 20% ethanol prevented the regrowth of bacteria encased within it. CONCLUSIONS Low ethanol concentrations (2.5%) can prevent in vitro biofilm formation of P. aeruginosa. Treatment of previously formed biofilms can be achieved using 20% ethanol, thereby keeping the catheters intact and avoiding complications that can result from high ethanol concentrations.
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Affiliation(s)
- Michal Natan
- Institute for Advanced Materials and Nanotechnology, Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Gila Jacobi
- Institute for Advanced Materials and Nanotechnology, Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ehud Banin
- Institute for Advanced Materials and Nanotechnology, Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Department of Pediatrics A, Schneider Children's Medical Center, Petah Tikva, Israel
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44
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Grossman Z, Porter B, Meyerovitch J, Rubin L, Kuint J, Wechsler E, Dushnitzky D, Ashkenazi S. International workshop on the future of community child healthcare. Isr J Health Policy Res 2019; 8:85. [PMID: 31806046 PMCID: PMC6896762 DOI: 10.1186/s13584-019-0355-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022] Open
Abstract
Increasing numbers of children with developmental, emotional, and psychosocial issues require adaptation of the services provided by pediatricians in the community. An international workshop that took place in Israel on June 3–4, 2019, addressed this need. Local policy makers and international experts discussed the following topics: (1) the future of training in community pediatrics; (2) enhancing the prestige of the community pediatrician; (3) development of management and research skills; (4) academic advancement within community pediatrics; (5) the future content of community pediatric practice; (6) visit length and community pediatricians’ reimbursement; (7) developing the collaborative model of care in community pediatrics and (8) integrating child healthcare. The meeting provided a venue to understand the challenges and to formulate recommendations to policymakers. A key target highlighted was the increased exposure of all pediatric residents to community pediatrics. This gained the support of the Chief Executive Officers of all four Health Funds in Israel. This document provides a synopsis of the topics addressed and suggested recommendations.
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Affiliation(s)
- Zachi Grossman
- Pediatric clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.
| | - Boaz Porter
- Pediatric clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Joseph Meyerovitch
- Clalit Health Services and Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Rubin
- Ministry of Health, Jerusalem, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Jacob Kuint
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.,K.S.M Research and innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Doron Dushnitzky
- Leumit Health Services, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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45
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Ashkenazi S, Schwartz E. Traveler's diarrhea in children: New insights and existing gaps. Travel Med Infect Dis 2019; 34:101503. [PMID: 31654742 DOI: 10.1016/j.tmaid.2019.101503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/16/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 01/17/2023]
Abstract
The number of children accompanying their parents in international travel is increasing steadily, and with the rising global migration, children more frequently accompany their parents or caregivers for visiting friends or relatives (VFR). As compared to travel for tourism, VFR children are at higher risk of acquiring local diseases, as they more often stay in rural areas in resource-poor locations, have longer periods of visit, are less likely to attend pre-travel consultations, and less frequently adhere to recommended precautions. Travelers's diarrhea (TD) is the most common travel-associated illnesses in children. This review updates the existing knowledge on TD in children, regarding its distinctive epidemiology, risk factors, preventive measures, clinical manifestations, complications, causative microorganisms and management. Despite the limited focused research on pediatric TD, which challenges the formulation of children-oriented evidence-based guidelines, practical recommendations are suggested.
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Affiliation(s)
- Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel; Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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46
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Ashkenazi S. Traveler's Diarrhea: The Other Side of the Coin. Isr Med Assoc J 2019; 21:552-554. [PMID: 31474019] [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: 06/10/2023]
Affiliation(s)
- Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Israel
- Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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47
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Cohen D, Meron-Sudai S, Bialik A, Asato V, Goren S, Ariel-Cohen O, Reizis A, Hochberg A, Ashkenazi S. Serum IgG antibodies to Shigella lipopolysaccharide antigens - a correlate of protection against shigellosis. Hum Vaccin Immunother 2019; 15:1401-1408. [PMID: 31070988 DOI: 10.1080/21645515.2019.1606971] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Shigella is a leading cause of diarrhea among children globally and of diarrheal deaths among children under 5 years of age in low- and middle-income countries. To date, no licensed Shigella vaccine exists. We review evidence that serum IgG antibodies to Shigella LPS represent a good correlate of protection against shigellosis; this could support the process of development and evaluation of Shigella vaccine candidates. Case-control and cohort studies conducted among Israeli soldiers serving under field conditions showed significant serotype-specific inverse associations between pre-exposure serum IgG antibodies to Shigella LPS and shigellosis incidence. The same serum IgG fraction showed a dose-response relationship with the protective efficacy attained by vaccine candidates tested in phase III trials of young adults and children aged 1-4 years and in Controlled Human Infection Model studies and exhibited mechanistic protective capabilities. Identifying a threshold level of these antibodies associated with protection can promote the development of an efficacious vaccine for infants and young children.
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Affiliation(s)
- Dani Cohen
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Shiri Meron-Sudai
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Anya Bialik
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Valeria Asato
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Sophy Goren
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Ortal Ariel-Cohen
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Arava Reizis
- a School of Public Health, Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv Israel
| | - Amit Hochberg
- b Newborn and Neonatal Care Department , Hillel Yaffe Medical Center , Hadera , Israel
| | - Shai Ashkenazi
- c Adelson School of Medicine , Ariel University, and Schneider Children's Medical Center , Israel
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48
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Marderfeld L, Rub G, Hodik G, Poraz I, Hartman C, Ashkenazi S, Shamir R. Validation and impact of paediatric malnutrition screening tool in hospitalised children on awareness of medical staff and health-related outcomes. Nutr Diet 2019; 76:574-579. [PMID: 31012267 DOI: 10.1111/1747-0080.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/17/2019] [Accepted: 02/20/2019] [Indexed: 11/28/2022]
Abstract
AIMS This study aimed to evaluate the use of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP) among children admitted in a paediatric hospital, and assess its impact on the nutritional status awareness among the medical staff and on health outcomes at discharge. METHODS STAMP performed by nurses on admission was compared with full nutritional assessment performed by a dietitian. Area under the receiving operating characteristic (AUROC) curve was used to evaluate validity of the tool. To assess how the tool affected awareness among the staff, information on nutritional status was compared prior to and following the intervention period. Therewith, health outcomes at discharge were compared for the children who had been screened by STAMP and the children who had not. RESULTS The analysis was performed for a total of 60 children (38 boys, 63%). The mean age was 7.8 ± 4.7 years. Malnutrition was found in 16% of patients, segregating equally between acute and chronic malnutrition. Sensitivity, specificity, positive predictive value and negative predictive value were 95.7% (95% confidence interval, CI = 85.75-98.83%), 76.9% (95% CI = 49.74-91.82%), 93.7 and 83.3, respectively. AUROC was 0.863 (95% CI = 0.72-1). There was no difference either in malnutrition awareness among the medical staff before and after the intervention period or in health outcomes at discharge. CONCLUSIONS STAMP is a valid tool for malnutrition screening in hospitalised children; however, its use does not influence admitted patients' nutritional status awareness among the medical staff nor their outcomes at discharge.
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Affiliation(s)
- Luba Marderfeld
- Nutrition and Dietetics Department, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Gal Rub
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Gavriel Hodik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Epidemiology & Database Research Department, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Irit Poraz
- Nutrition and Dietetics Department, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,National Management Office, Clalit Health Services, Tel Aviv, Israel
| | - Corina Hartman
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Internal Department A, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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49
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van Houten CB, Naaktgeboren CA, Ashkenazi-Hoffnung L, Ashkenazi S, Avis W, Chistyakov I, Corigliano T, Galetto A, Gangoiti I, Gervaix A, Glikman D, Ivaskeviciene I, Kuperman AA, Lacroix L, Loeffen Y, Luterbacher F, Meijssen CB, Mintegi S, Nasrallah B, Papan C, van Rossum AMC, Rudolph H, Stein M, Tal R, Tenenbaum T, Usonis V, de Waal W, Weichert S, Wildenbeest JG, de Winter-de Groot KM, Wolfs TFW, Mastboim N, Gottlieb TM, Cohen A, Oved K, Eden E, Feigin PD, Shani L, Bont LJ. Expert panel diagnosis demonstrated high reproducibility as reference standard in infectious diseases. J Clin Epidemiol 2019; 112:20-27. [PMID: 30930247 DOI: 10.1016/j.jclinepi.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/24/2019] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE If a gold standard is lacking in a diagnostic test accuracy study, expert diagnosis is frequently used as reference standard. However, interobserver and intraobserver agreements are imperfect. The aim of this study was to quantify the reproducibility of a panel diagnosis for pediatric infectious diseases. STUDY DESIGN AND SETTING Pediatricians from six countries adjudicated a diagnosis (i.e., bacterial infection, viral infection, or indeterminate) for febrile children. Diagnosis was reached when the majority of panel members came to the same diagnosis, leaving others inconclusive. We evaluated intraobserver and intrapanel agreement with 6 weeks and 3 years' time intervals. We calculated the proportion of inconclusive diagnosis for a three-, five-, and seven-expert panel. RESULTS For both time intervals (i.e., 6 weeks and 3 years), intrapanel agreement was higher (kappa 0.88, 95%CI: 0.81-0.94 and 0.80, 95%CI: NA) compared to intraobserver agreement (kappa 0.77, 95%CI: 0.71-0.83 and 0.65, 95%CI: 0.52-0.78). After expanding the three-expert panel to five or seven experts, the proportion of inconclusive diagnoses (11%) remained the same. CONCLUSION A panel consisting of three experts provides more reproducible diagnoses than an individual expert in children with lower respiratory tract infection or fever without source. Increasing the size of a panel beyond three experts has no major advantage for diagnosis reproducibility.
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Affiliation(s)
- Chantal B van Houten
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Division Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands
| | - Liat Ashkenazi-Hoffnung
- Schneider Children's Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Wim Avis
- Department of Pediatrics, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Irena Chistyakov
- Department of Pediatrics, Bnai Zion Medical Centre, Haifa, Israel
| | - Teresa Corigliano
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Annick Galetto
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Iker Gangoiti
- Department of Pediatric Emergency Medicine, Cruces University Hospital, Bilbao, Spain
| | - Alain Gervaix
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Daniel Glikman
- Infectious Diseases Unit, Padeh Poria Medical Center and the Azrieli faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Inga Ivaskeviciene
- Clinic of Children Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Vilnius, Lithuania
| | - Amir A Kuperman
- Blood Coagulation Service and Pediatric Hematology Clinic, Galilee Medical Centre, Nahariya, and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Laurence Lacroix
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Yvette Loeffen
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Fanny Luterbacher
- Department of Pediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Clemens B Meijssen
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Santiago Mintegi
- Department of Pediatric Emergency Medicine, Cruces University Hospital, Bilbao, Spain
| | | | - Cihan Papan
- Pediatric Infectious Diseases, University Children's Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Henriette Rudolph
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Michal Stein
- Department of Pediatrics, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Roie Tal
- Department of Pediatrics, Galilee Medical Centre, Nahariya and Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tobias Tenenbaum
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Vytautas Usonis
- Clinic of Children Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Vilnius, Lithuania
| | - Wouter de Waal
- Department of Pediatrics, Diakonessenhuis, Utrecht, The Netherlands
| | - Stefan Weichert
- Department of Pediatrics, Meander Medical Centre, Amersfoort, The Netherlands
| | - Joanne G Wildenbeest
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M de Winter-de Groot
- Department of Pediatric Respiratory Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tom F W Wolfs
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | | | - Paul D Feigin
- Faculty of Industrial Engineering and Management, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Louis J Bont
- Division of Pediatric Immunology and Infectious Diseases, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
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Sorek N, Ashkenazi S, Livni G, Ben-Zvi H. Neisseria meningitidis and cytomegalovirus simultaneous detection in the filmarray meningitis/encephalitis panel and its clinical relevance. IDCases 2019; 17:e00516. [PMID: 31193598 PMCID: PMC6536664 DOI: 10.1016/j.idcr.2019.e00516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/05/2019] [Accepted: 03/05/2019] [Indexed: 11/07/2022] Open
Abstract
A BioFire FilmArray Meningitis/Encephalitis test was performed on a 7-month old child suspected for bacterial meningitis. Two pathogens were detected, Neisseria meningitidis and cytomegalovirus (CMV). We verified the filmarray meningitis/encephalitis test by pan-bacterial assay to test for Neisseria meningitidis and CMV viral load test for the CMV detection. Pan-bacterial confirmed presence of N. meningitidis, but CMV was not detected by the CMV viral load test. Together with the manifestations of high fever, vomiting, diffuse petechial rash, bulging fontanel, and leukocytosis, it is a clear case of meningococcal meningitis, while CMV detection had no clinical relevance.
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Affiliation(s)
- Nadav Sorek
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Israel
| | | | | | - Haim Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Israel
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