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Ben-Sheetrit J, Hermon Y, Birkenfeld S, Gutman Y, Csoka AB, Toren P. Estimating the risk of irreversible post-SSRI sexual dysfunction (PSSD) due to serotonergic antidepressants. Ann Gen Psychiatry 2023; 22:15. [PMID: 37085865 PMCID: PMC10122283 DOI: 10.1186/s12991-023-00447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 08/30/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Sexual dysfunction is a common side effect of Serotonergic antidepressants (SA) treatment, and persists in some patients despite drug discontinuation, a condition termed post-SSRI sexual dysfunction (PSSD). The risk for PSSD is unknown but is thought to be rare and difficult to assess. This study aims to estimate the risk of erectile dysfunction (ED) and PSSD in males treated with SAs. METHODS A 19-year retrospective cohort analysis was conducted using a computerized database of the largest HMO in Israel. ED was defined by phosphodiesterase-5 inhibitors prescriptions. 12,302 males aged 21-49 met the following criteria: non-smokers, no medical or psychiatric comorbidities or medications associated with ED, no alcohol or substance use. Logistic regression was used for estimation of ED risk in SA-treated subjects compared to non-SA-treated controls, assessed with and without the effects of age, body mass index (BMI), socioeconomic status (SES), depression and anxiety, yielding crude and adjusted odds ratios (cOR and aOR, respectively). RESULTS SAs were associated with an increased risk for ED (cOR = 3.6, p < 0.000001, 95% CI 2.8-4.8), which remained significant after adjusting for age, SES, BMI, depression and anxiety (aOR = 3.2, p < 0.000001, 95% CI 2.3-4.4). The risk for PSSD was 1 in 216 patients (0.46%) treated with SAs. The prevalence of PSSD was 4.3 per 100,000. CONCLUSIONS This work offers a first assessment of the small but significant risk of irreversible ED associated with the most commonly prescribed class of antidepressants which should enhance the process of receiving adequate informed consent for therapy.
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Affiliation(s)
- Joseph Ben-Sheetrit
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel
- Geha Mental Health Center, Petah Tikva, Israel
| | - Yehonathan Hermon
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel.
| | - Shlomo Birkenfeld
- Clalit Health Services, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Antonei B Csoka
- Department of Anatomy, School of Medicine, Howard University, Washington DC, US
| | - Paz Toren
- Tel-Aviv Brüll Community Mental Health Center, Clalit Health Services, 9 Hatzvi St., 6719709, Tel-Aviv, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Itzhaki Ben Zadok O, Murninkas D, Iakobishvili Z, Jino H, Yohananov E, Birkenfeld S, Hasdai D. Characteristics Associated with Upper-Range Doses of Beta-Blockers and Angiotensin-Renin Inhibitors in Reduced Ejection Fraction. Isr Med Assoc J 2020; 22:441-445. [PMID: 33236570] [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 Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta blockers (BBs). OBJECTIVES To determine factors associated with attaining upper-range doses in patients with HFrEF. METHODS We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines. RESULTS The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titration program, 41% and 35% of patients achieved upper-range doses of ACE-Is/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-I/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P = 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI ≥ 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P = 0.031). CONCLUSIONS Achieving upper-range doses of ACE-Is/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Murninkas
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv-Jaffa District, Clalit Health Services, Tel Aviv, Israel
| | - Zaza Iakobishvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv-Jaffa District, Clalit Health Services, Tel Aviv, Israel
| | - Henri Jino
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv-Jaffa District, Clalit Health Services, Tel Aviv, Israel
| | - Esther Yohananov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv-Jaffa District, Clalit Health Services, Tel Aviv, Israel
| | - Shlomo Birkenfeld
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Tel Aviv-Jaffa District, Clalit Health Services, Tel Aviv, Israel
| | - David Hasdai
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Murninkas D, Itzhaki Ben Zadok O, Iakobishvili Z, Jino H, Yohananov E, Birkenfeld S, Hasdai D. Comparison of 18-Month Outcomes of Ambulatory Patients With Reduced (≤40%) Left Ventricular Ejection Fraction Treated in a Community-Based, Dedicated Heart Failure Clinic Versus Treated Elsewhere. Am J Cardiol 2019; 123:1101-1108. [PMID: 30658921 DOI: 10.1016/j.amjcard.2018.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/14/2018] [Accepted: 12/19/2018] [Indexed: 11/30/2022]
Abstract
We sought to examine the management and outcomes of ambulatory patients with heart failure and reduced ejection fraction in a community-based, dedicated clinic. Patients with left ventricular ejection fraction (LVEF) ≤40% were actively solicited to attend a community-based, dedicated clinic. Eligible patients who chose to decline constituted our control group. Of 552 patients with LVEF ≤40% (median age 73 years and median LVEF 35%), 304 (55%) agreed to attend the clinic. Patients with worse New York Heart Association class were more likely to attend the clinic (odds ratio 2.07 [1.45, 2.95], p <0.001), whereas women were more likely to decline (odds ratio 0.63 [0.42, 0.93], p <0.022). During 18 months of follow-up, patients in the dedicated clinic significantly improved their functional capacity (56% New York Heart Association 3 to 4 at baseline vs 27% at follow-up, p <0.001) and LVEF (35% [interquartile range 25, 35] at baseline vs 35% (interquartile range 30, 40) at follow-up, p <0.001). In comparison with patients managed routinely, patients treated in a dedicated clinic achieved better guideline-recommended pharmacological treatment (65% vs 85% receiving β blockers, p <0.001, 65% vs 82% receiving renin-angiotensin inhibitors, p = 0.0006, 31% vs 45% receiving mineralocorticoid receptor antagonists, p <0.001). During follow-up, electrical device implantation was similar (6% vs 7% of dedicated-HF-clinic patients, p = 0.700). Furthermore, overall survival was better in patients treated in the clinic (log rank p = 0.0006), even after censoring the first 4 months to account for potential bias (log rank p = 0.0232). In conclusion, management in a community-based, dedicated clinic compared with routine management was associated with augmented guideline-recommended treatment and improved survival.
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Affiliation(s)
- Daniel Murninkas
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel.
| | - Zaza Iakobishvili
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henri Jino
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ester Yohananov
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Birkenfeld
- Clalit Health Services, Tel-Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Hasdai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
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Zvidi I, Boltin D, Niv Y, Dickman R, Fraser G, Birkenfeld S. The Incidence and Prevalence of Inflammatory Bowel Disease in the Jewish and Arab Populations of Israel. Isr Med Assoc J 2019; 21:194-197. [PMID: 30905106] [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: 06/09/2023]
Abstract
BACKGROUND Temporal trends in the incidence of inflammatory bowel disease (IBD) in the Arab and Jewish populations in Israel have been poorly described. OBJECTIVES To compare the annual incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in the Arab and Jewish populations in Israel between the years 2003 and 2008. METHODS We applied a common case identification algorithm to the Clalit Health Services database to both determine trends in age-adjusted incidence and prevalence rates for IBD in both populations during this period and estimate the burden of IBD in Israel. RESULTS The incidence of CD in the Arab population increased from 3.1/100,000 in 2003 to 10.6/100,000 person-years in 2008, compared with a decrease in the Jewish population from 14.3/100,000 to 11.7/100,000 person-years for the same period. The incidence of UC in the Arab population increased from 4.1/100,000 in 2003 to 5.0/100,000 person-years in 2008, a low but stable rate, compared with a decrease from 16.4/100,000 to 9.5/100,000 person-years for the same time period in the Jewish population. The prevalence of both diseases increased due to the accumulation of incident cases but remained much lower among Arabs. CONCLUSIONS Understanding the factors underlying the differences in incidence and prevalence of IBD in the Jewish and Arab populations may shed light on the genetic and environmental factors associated with these diseases.
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Affiliation(s)
| | - Doron Boltin
- Department of Gastroenterology, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ram Dickman
- Department of Gastroenterology, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gerald Fraser
- Department of Gastroenterology, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Boltin D, Dotan I, Birkenfeld S. Improvement in the implementation of Helicobacter pylori management guidelines among primary care physicians following a targeted educational intervention. Ann Gastroenterol 2019; 32:52-59. [PMID: 30598592 PMCID: PMC6302200 DOI: 10.20524/aog.2018.0329] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/15/2018] [Indexed: 12/16/2022] Open
Abstract
Background Consensus guidelines recommend that in regions with a high rate of clarithromycin resistance, Helicobacter pylori (H. pylori) infection be treated with 4 drugs. Compliance with this recommendation among primary care physicians (PCPs) is low. We aimed to examine whether PCP compliance with H. pylori treatment recommendations increased following a targeted educational intervention. Methods A questionnaire assessing H. pylori treatment was sent to >2000 PCPs in June 2015 and June 2018. In the interim, 3 interventions were performed: distribution of printed materials, educational outreach visits, and education over a social media platform. Results A total of 635 PCPs returned questionnaires, including 314 in 2015 and 321 in 2018 (148 [46.3%] male, age 44.7±10.9 years). The number of PCPs who recommended a 4-drug treatment protocol increased from 12 (3.8%) in 2015 to 119 (37.1%) in 2018 (P<0.001). The number of PCPs who recommended bismuth- or levofloxacin-based therapy for second-line treatment increased from 95 (30.3%) in 2015 to 247 (77.1%) in 2018 (P<0.001). Independent predictors for a 4-drug treatment protocol included central clinic location (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.38-5.60; P<0.003), exposure to printed educational materials (OR 1.64, 95%CI 0.99-2.72; P=0.04) and exposure to the social media platform (OR 6.60, 95%CI 3.08-14.13; P<0.001. There were no independent predictors of compliance with second-line treatment. Conclusions PCP compliance with H. pylori guidelines remains suboptimal. Educational initiatives may be effective in increasing PCPs’ knowledge and compliance with guidelines. Direct web-based interaction between PCPs and gastroenterologists may be particularly effective.
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Affiliation(s)
- Doron Boltin
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Doron Boltin, Iris Dotan).,Bat Yamon Medical Center, Clalit Health Services, Bat Yam, Israel (Doron Boltin)
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Doron Boltin, Iris Dotan)
| | - Shlomo Birkenfeld
- Tel Aviv and Central Administration, Clalit Health Services, Tel Aviv (Shlomo Birkenfeld), Israel
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Cohen-Mansfield J, Hazan H, Lerman Y, Shalom V, Birkenfeld S, Cohen R. Efficacy of the I-SOCIAL intervention for loneliness in old age: Lessons from a randomized controlled trial. J Psychiatr Res 2018; 99:69-75. [PMID: 29407289 DOI: 10.1016/j.jpsychires.2018.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 09/27/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
Loneliness is common among older persons and is associated with adverse health and wellbeing outcomes. We investigated a theory-based intervention that addresses barriers to social contacts and aims at increasing social self-efficacy. Individuals that met pre-assessment criteria of cognitive function, physical health, and loneliness levels were randomly assigned either to the I-SOCIAL intervention that combined both individual and group sessions to address individuals' unique social challenges, or to the control group. Assessment was administered at baseline, after the completion of the intervention, and after a 3-month follow-up period. The intervention group showed significant decline in loneliness level compared to the control group, both after the intervention and after the follow-up period. This innovative combination of analysis of personal barriers, support provided by the counselors, group activities, and individualized suggestions for social activities in the participant's neighborhood, may account for the success of the intervention in decreasing participants' loneliness levels.
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Affiliation(s)
- Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Herczeg Institute on Aging, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel.
| | - Haim Hazan
- Herczeg Institute on Aging, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Department of Sociology and Anthropology, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel.
| | - Yaffa Lerman
- Geriatric Division, Tel-Aviv Medical Center, 6 Weizmann St., Tel-Aviv, 6423906, Israel; Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel.
| | - Vera Shalom
- National Insurance Institute of Israel, 15 Hashmonaim St. Ramat-Gan, 5200202, Israel.
| | - Shlomo Birkenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Clalit Health Services, 7 Zadal St. Rishon Le-Zion, 7526658, Israel.
| | - Rinat Cohen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel-Aviv University, P.O.B. 39040, 30 Haim Levanon St., Ramat Aviv, Tel-Aviv, 6997801, Israel.
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Boltin D, Gingold-Belfer R, Kimchi NA, Ben-Bassat O, Langiewicz J, Niv Y, Birkenfeld S. Uptake of influenza vaccine in ulcerative colitis. Vaccine 2014; 32:5484-9. [PMID: 25132337 DOI: 10.1016/j.vaccine.2014.07.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/25/2014] [Accepted: 07/22/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND The incidence of vaccine-preventable-disease is increasing. Current practice guidelines recommend annual influenza vaccination for all inflammatory bowel disease (IBD) patients. STUDY Using the Business Objects database of Clalit Health Services in the Tel Aviv district we identified all patients over 18 years-old with a diagnosis of ulcerative colitis (UC) on 31.12.05. This cohort was followed until 31.12.12. Subjects over age 50 without IBD who are also targeted for influenza vaccination served as controls. The uptake of annual influenza vaccination was recorded. RESULTS 470 UC patients were included (241 (51.3%) males, age 50.4 ± 18.4 years, disease duration 158.9 ± 86.5 months), and 2960 controls. During the years 2006, 2007, 2008, 2009, 2010, 2011 and 2012 the uptake of influenza vaccination was 101 (21.5%), 122 (26.0%), 147 (31.3%), 181 (38.5%), 177 (37.7%), 170 (36.2%) and 178 (37.9%) amongst UC patients, and 993 (33.5%), 1360 (45.9%), 1524 (51.5%), 1611 (54.4%), 1446 (48.9%), 1576 (53.2%) and 1557 (52.6%) amongst controls (p<0.0001 for every year). Independent predictors of vaccination included age (OR, 1.05; 95% CI, 1.03-1.06; p<0.001) and cardiovascular risk (OR, 1.81; 95% CI, 1.31-2.49; p<0.01). CONCLUSIONS Although uptake influenza vaccination is consistently lower in UC compared to controls, an upward trend was observed over the study period. Public health initiatives should target this high-risk population to promote immunization.
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Affiliation(s)
- Doron Boltin
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Gastroenterology, Batyamon Health Center and Clalit Health Services, Israel.
| | - Rachel Gingold-Belfer
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Alain Kimchi
- Department of Gastroenterology, Batyamon Health Center and Clalit Health Services, Israel
| | - Ofer Ben-Bassat
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Judith Langiewicz
- Clalit Health Services, Tel Aviv District Head Office, Tel Aviv, Israel
| | - Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Birkenfeld
- Clalit Health Services, Tel Aviv District Head Office, Tel Aviv, Israel
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Zvidi I, Fraser GM, Niv Y, Birkenfeld S. The prevalence of inflammatory bowel disease in an Israeli Arab population. J Crohns Colitis 2013; 7:e159-63. [PMID: 22921466 DOI: 10.1016/j.crohns.2012.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 07/24/2012] [Accepted: 07/25/2012] [Indexed: 02/08/2023]
Abstract
AIMS To determine the prevalence of inflammatory bowel disease among the 1.5 million Arab residents in Israel who represent 20% of the total population. METHODS Family physicians in all Arab towns and villages were contacted to obtain information on patients with inflammatory bowel disease. Relevant clinical data were retrieved and updated to December 31, 2009. RESULTS Information was obtained from 23/71 municipalities approached (representing 200,000 out of 1.5 million Arabs). There were 64 confirmed cases of Crohn's disease indicating a prevalence rate of 32/100,000. The rate of smoking within this cohort was lower than in the general population (1.5% vs. 40%; P<0.001). There were 44 confirmed cases of ulcerative colitis with a prevalence rate of 22/100,000. The percentage of active smokers in this cohort was 18%. Clinical remission or mild activity was observed in 75% of patients in both cohorts at the time of the survey. Fourteen patients (21%) had undergone surgery for Crohn's disease, whereas none had undergone surgery for ulcerative colitis. Twenty-eight (42%) patients with Crohn's disease and 20 (45%) with ulcerative colitis were on maintenance therapy with 5-aminosalicylic acid. Only 18% with Crohn's disease and 6.8% with ulcerative colitis had received anti-tumor necrosis factor. The most prevalent extra-intestinal manifestations were perianal disease (18%) in Crohn's disease, and arthralgia or arthritis (6.8%) in ulcerative colitis. CONCLUSIONS We found a low prevalence rate of inflammatory bowel disease in the Israeli Arab population.
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Affiliation(s)
- Ibrahim Zvidi
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Clalit Health Services, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Birkenfeld S, Belfer RG, Chared M, Vilkin A, Barchana M, Lifshitz I, Fruchter D, Aronski D, Balicer R, Niv Y, Levi Z. Factors affecting compliance in faecal occult blood testing: a cluster randomized study of the faecal immunochemical test versus the guaiac faecal occult test. J Med Screen 2012; 18:135-41. [PMID: 22045822 DOI: 10.1258/jms.2011.010147] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the uptake of faecal immunochemical occult blood test (FIT) with guaiac faecal occult blood test (gFOBT) in a screening programme, with specific attention to the demographic and socioeconomic factors that might affect test uptake. SETTING The Clalit Health Service screening programme, Israel. METHODS Average-risk individuals aged 50-75 years were randomized into a FIT arm or gFOBT arm using a programme based on the socioeconomic status (SES) of their primary care clinics. G-FOBT was performed with Hemoccult SENSA™ (3 evacuations) and FIT with the OC- MICRO(TM) (3 evacuations, refrigerating mandated). The GLIMMIX model was used. RESULTS There were 5,464 and 10,668 eligible participants in the FIT and gFOBT arms respectively. Compliance in taking the kits was better (but not statistically significantly better) with gFOBT (37.8% vs. 29.3%; odds ratio [OR] 1.43 [95% CI 0.73-2.80]; P = 0.227). Kit return was higher in the FIT arm (65.0% vs. 78.9%; OR 0.45 [95% CI 0.24-0.83], P = 0.021). Overall test uptake was affected by age, gender, being immigrant and SES (determined by whether or not the participant paid national insurance tax, and the SES of the primary care clinic). The overall uptake of gFOBT and FIT was comparable (OR 0.996 [95% CI 0.46-2.17], P = 0.99). CONCLUSIONS Overall compliance for test uptake was comparable between the two methods despite the more demanding procedure in the FIT arm. Sociodemographic parameters were the major determinants of compliance. An educational programme, with emphasis on the sociodemographic characteristics of the target population, should be instigated.
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Niv Y, Gershtansky Y, Kenett RS, Tal Y, Birkenfeld S. Complications in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS): analysis of 7-year physician-reported adverse events. Drug Healthc Patient Saf 2011; 3:21-5. [PMID: 21753900 PMCID: PMC3132860 DOI: 10.2147/dhps.s21369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 06/20/2011] [Indexed: 11/23/2022]
Abstract
Introduction: The number of malpractice claims against physicians and health institutes is increasing continuously in Israel as in the rest of the Western world, and has become a serious financial burden. Aim: In this study we analyzed the reports of gastroenterologists on endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) adverse events to the risk management authority between January 1, 2000 and December 31, 2006. Methods: All the reported adverse events associated with ERCP and EUS of health institutes and covered by Madanes Insurance Agency were summarized and analyzed. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an Excel worksheet, discussed, and evaluated. Results: Forty-two cases of ERCP and EUS adverse events were reported. There were nine cases of men (21.4%) and the average age was 69.3 ± 14.3 years. During this period, 10,647 procedures were performed by the institutes concerned and the number of adverse events was 20.2 to 67.8 per year for 10,000 procedures. Perforation occurred in one out of 367 procedures, bleeding in one out of 5323 procedures, teeth trauma in one out of 5323 procedures, and respiratory complications in one out of 10,647 procedures. Conclusion: This is the first study in Israel about physicians’ reports of ERCP and EUS adverse events. Physicians reported only about severe adverse events with high rate of mortality and morbidity.
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Affiliation(s)
- Yaron Niv
- Department of Gastroenterology, Rabin Medical Center, Petach Tikva, Israel
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Birkenfeld S, Dreiher J, Weitzman D, Cohen AD. A study on the association with hepatitis B and hepatitis C in 1557 patients with lichen planus. J Eur Acad Dermatol Venereol 2011; 25:436-40. [PMID: 20666875 DOI: 10.1111/j.1468-3083.2010.03809.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous reports have demonstrated contradicting results on the association between lichen planus and hepatitis. OBJECTIVES The aim of this study was to investigate the association between lichen planus and viral hepatitis. METHODS Patients with lichen planus were compared with controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate regression models. The study was performed utilizing the medical database of Clalit Health Services. RESULTS The study included 1557 lichen planus patients over the age of 20 years and 3115 age- and gender-matched controls. The prevalence of hepatitis C in patients with lichen planus was higher than that in the control group (1.9%, 0.4% respectively, P<0.001). In a multivariate analysis, lichen planus was associated with hepatitis C (OR 4.19, 95% CI 2.21; 7.93). The prevalence of hepatitis B in patients with lichen planus was similar to that in the control group (0.9%, 0.5% respectively, P=0.12). A multivariate analysis revealed that lichen planus was not associated with hepatitis B (OR 1.69, 95% CI 0.82; 3.47). CONCLUSION Lichen planus is associated with hepatitis C but not with hepatitis B. Physicians who care for patients with lichen planus should consider screening patients with lichen planus for hepatitis C.
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Affiliation(s)
- S Birkenfeld
- Clalit Health Services Siaal Research Center for Family Medicine and Primary Care Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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12
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Levi Z, Birkenfeld S, Vilkin A, Bar-Chana M, Lifshitz I, Chared M, Maoz E, Niv Y. A higher detection rate for colorectal cancer and advanced adenomatous polyp for screening with immunochemical fecal occult blood test than guaiac fecal occult blood test, despite lower compliance rate. A prospective, controlled, feasibility study. Int J Cancer 2011; 128:2415-24. [PMID: 20658527 DOI: 10.1002/ijc.25574] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Immunochemical fecal occult blood test (FIT) is a new colorectal cancer (CRC) screening method already recommended by the American screening guidelines. We aimed to test the feasibility of FIT as compared to guaiac fecal occult blood test (G-FOBT) in a large urban population of Tel Aviv. Average-risk persons, aged 50-75 years, were offered FIT or G-FOBT after randomization according to the socioeconomic status of their clinics. Participants with positive tests underwent colonoscopy. Participants were followed through the Cancer Registry 2 years after the study. Hemoccult SENSA™ and OC-MICRO™ (three samples, 70 ng/ml threshold) were used. FIT was offered to 4,657 persons (Group A) and G-FOBT to 7,880 persons (Group B). Participation rate was 25.9% and 28.8% in Group A and B, respectively (p < 0.001). Positivity rate in Group A and B was 12.7% and 3.9%, respectively (p < 0.001). Cancer found in six (0.49%) and eight (0.35%) patients of Group A and B, respectively (NS). Cancer registry follow-up found missed cancer in five (0.22%) cases of Group B and none in Group A (NS). The sensitivity, specificity, negative and positive predictive value for cancer in Group A and B were 100%, 85.9%, 100%, 3.9% and 61.5%, 96.4%, 99.8%, 9.1%, respectively. There was increased detection of advanced adenomatous polyp (AAP) by FIT, irrespective of age, gender, and socioeconomic status (Per Protocol: odds ratio 2.69, 95% confidence interval 1.6-4.5; Intention to Screen: odds ratio 3.16, 95% confidence interval 1.8-5.4). FIT is feasible in urban, average-risk population, which significantly improved performance for detection of AAP and CRC, despite reduced participation.
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Affiliation(s)
- Zohar Levi
- Gastroenterology Department, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
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Rozen P, Comaneshter D, Levi Z, Hazazi R, Vilkin A, Maoz E, Birkenfeld S, Niv Y. Cumulative evaluation of a quantitative immunochemical fecal occult blood test to determine its optimal clinical use. Cancer 2010; 116:2115-25. [PMID: 20186820 DOI: 10.1002/cncr.25012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Quantified, human hemoglobin (Hb)-specific, immunochemical fecal occult blood test (IFOBT) measurements are now used for colorectal cancer (CRC) screening. The objective was to evaluate sensitivity and specificity for CRC and advanced adenomatous polyps (APs) by the fecal Hb threshold used to determine a positive test and the number of IFOBTs prepared per test, so as to determine the least number of colonoscopies required to detect a neoplasm. METHODS Cumulative data were analyzed from a prospective cross-sectional double-blind study of 1682 consecutive, ambulatory, nonbleeding colonoscopy patients who volunteered for IFOBTs, most of above average risk, from 3 ambulatory-endoscopy centers. Fecal Hb was measured in 3 samples and analyzed by an automated instrument, and the highest result >or=50 ng Hb/mL of buffer was related to findings. RESULTS Colonoscopy identified CRC in 20 patients and advanced APs in 129. Sensitivity for either was best when any of 3 tests had >or=50 ng Hb/mL of buffer; sensitivity was 61.1% (95% confidence interval [CI], 53.2-68.9), and specificity was 87.8% (95% CI, 86.2-89.4). Positive tests identified 100% of CRCs and 55% of advanced APs every 3.1 colonoscopies. Sensitivity of a single test at the commonly used 100-ng Hb/mL threshold was lower at 31.5% (95% CI, 24.1-39.0) (P<.001), but specificity was higher at 96.4% (95% CI, 95.5-97.3) (P<.001). Positive tests identified 65% of CRCs and 26.4% of advanced APs every 2.2 colonoscopies. CONCLUSIONS The fecal Hb cutoff chosen by the screener and the number of samples collected per patient determine sensitivity and specificity for CRC/advanced AP; these factors determine the number of colonoscopies needed for positive tests and neoplasia yield. This information provides guidelines for IFOBT screening. Limitations are 1-time screening and most examinees not being at average risk for CRC.
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Affiliation(s)
- Paul Rozen
- Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
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Cohen AD, Weitzman D, Birkenfeld S, Dreiher J. Psoriasis associated with hepatitis C but not with hepatitis B. Dermatology 2010; 220:218-22. [PMID: 20185894 DOI: 10.1159/000286131] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 11/19/2009] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the association between psoriasis and viral hepatitis. METHODS Psoriasis patients were compared to controls regarding the prevalence of viral hepatitis in a case-control study using logistic multivariate models. The study was performed utilizing the medical database of Clalit Health Services. RESULTS The study included 12,502 psoriasis patients >20 years old and 24,287 age- and sex-matched controls. The prevalence of hepatitis C in patients with psoriasis was increased compared to the prevalence in controls (1.03 vs. 0.56%; p < 0.001). In a multivariate analysis, psoriasis was associated with hepatitis C. An interaction with smoking was noted (smokers: odds ratio, OR = 1.93, 95% confidence interval, CI = 1.30-2.67; nonsmokers: OR = 2.22, 95% CI = 1.63-3.04). The prevalence of hepatitis B in patients with psoriasis was higher than in the controls (0.74 vs. 0.56%; p = 0.043). However, in a multivariate analysis psoriasis was not associated with hepatitis B (OR = 1.22, 95% CI = 0.93-1.60, p = 0.15). CONCLUSION Our observation supports previous reports of an association between psoriasis and hepatitis C but not with hepatitis B. Physicians who care for patients with psoriasis should be aware of this possible association and consider screening patients with psoriasis for hepatitis C.
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Affiliation(s)
- Arnon D Cohen
- Clalit Health Services, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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15
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Hazazi R, Rozen P, Leshno M, Levi Z, Samuel Z, Waked A, Vilkin A, Maoz E, Birkenfeld S, Niv Y. Can patients at high risk for significant colorectal neoplasms and having normal quantitative faecal occult blood test postpone elective colonoscopy? Aliment Pharmacol Ther 2010; 31:523-33. [PMID: 19925498 DOI: 10.1111/j.1365-2036.2009.04202.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Common reasons for elective screening and surveillance colonoscopy, at predetermined intervals, are family or personal history of colorectal cancer (CRC) or advanced adenoma (AAP). Quantified, human haemoglobin (Hb)-specific, immunochemical faecal occult blood tests (I-FOBT) detect bleeding. AIM To determine I-FOBT sensitivity for CRC or AAP before elective colonoscopy in patients at high-risk of cancer or advanced adenoma. METHODS Prospective double-blind study of 1000 ambulatory asymptomatic high-risk patients (555 family history of CRC, 445 surveillance for past neoplasm), who prepared three I-FOBTs before elective colonoscopy. I-FOBTs quantified as ngHb/mL of buffer by OC-MICRO instrument and results >or=50 ngHb/mL considered positive. RESULTS At colonoscopy, eight patients had CRC, 64 others had AAP. Sensitivity for CRC and/or AAP was the highest, 65.3% (95% CI 54.3, 76.3), when any of the three I-FOBTs was >or=50 ngHb (15.4%), with specificity of 87.5% (95% CI 86.4, 90.5) identifying all CRCs and 62% of AAPs. CONCLUSIONS All cancers or an AAP were detected every third I-FOBT-positive colonoscopy (47/154), so colonoscopy was potentially not needed at this time in 84.6% (846 patients). I-FOBT screening might provide effective supervision of high-risk patients, delaying unnecessary elective colonoscopies. This favourable evaluation needs confirmation and cost-benefit study by risk-group.
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Affiliation(s)
- R Hazazi
- Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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18
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Rozen P, Levi Z, Hazazi R, Waked A, Vilkin A, Maoz E, Birkenfeld S, Leshno M, Niv Y. Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performed. Aliment Pharmacol Ther 2009; 29:906-17. [PMID: 19183147 DOI: 10.1111/j.1365-2036.2009.03946.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening. AIMS To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected. METHODS Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings. RESULTS In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P < 0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples. CONCLUSIONS Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests.
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Affiliation(s)
- P Rozen
- Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva.
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Rozen P, Levi Z, Hazazi R, Waked A, Vilkin A, Maoz E, Birkenfeld S, Niv Y. Quantitative colonoscopic evaluation of relative efficiencies of an immunochemical faecal occult blood test and a sensitive guaiac test for detecting significant colorectal neoplasms. Aliment Pharmacol Ther 2009; 29:450-7. [PMID: 19035980 DOI: 10.1111/j.1365-2036.2008.03898.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The guaiac faecal occult blood test (G-FOBT), HemoccultSENSA, is sensitive for significant neoplasms [colorectal cancer (CRC), advanced adenomatous polyps (AAP)], but faulted by non-specificity for human haemoglobin (Hb). Quantified, Hb- specific, immunochemical faecal occult blood tests (I-FOBT) are now used. AIMS To (i) compare I-FOBT and G-FOBT efficacy in identifying significant neoplasms and colonoscopy needs for positive tests and (ii) examine number of I-FOBTs needed and test threshold to use for equivalent or better sensitivity than G-FOBT and fewest colonoscopies for positive tests. METHODS Three daily G-FOBTs and I-FOBTs were collected and analysed in 330 patients scheduled for colonoscopy. RESULTS Colonoscopy found significant neoplasms in 32 patients, 6 CRC, 26 AAP. G-FOBT, sensitivity and specificity were 53.1% (17 neoplasms) and 59.4%, resulting in 8.1 colonoscopies/neoplasm. One I-FOBT having >or=50 ngHb/mL of buffer provided equivalent sensitivity but 94.0% specificity, resulting in 2.1 colonoscopies/neoplasm. By analysing the higher of two I-FOBTs at 50 ngHb/mL threshold, sensitivity increased to 68.8% (22 neoplasms, P = 0.063), specificity fell to 91.9% (P < 0.001), but still required 2.1 colonoscopies/neoplasm. CONCLUSIONS In this population, quantified I-FOBT had significantly better specificity than G-FOBT for significant neoplasms, reducing the number of colonoscopies needed/neoplasm detected. Results depend on the number of I-FOBTs performed and the chosen development threshold.
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Affiliation(s)
- P Rozen
- Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.
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20
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Liberman E, Naumov I, Kazanov D, Dvory-Sobol H, Sagiv E, Birkenfeld S, Deutsch V, Trakhtenbrot L, Moshkowitz M, Arber N. Malignant transformation of normal enterocytes following downregulation of Bak expression. Digestion 2008; 77:48-56. [PMID: 18349538 DOI: 10.1159/000121411] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 02/06/2008] [Indexed: 02/04/2023]
Abstract
Bak is a pro-apoptotic gene, which plays an important role in the multi-step process of gastrointestinal tumorigenesis. We hypothesized that downregulation of Bak expression in normal enterocytes will result in a transformed phenotype. The nontumorigenic intestinal epithelial cell line (IEC18) was transfected with the vector pMV12-AS-bak (encoding anti-sense bak). Three clones, with Bak protein levels similar to those seen in colon cancer cell lines and significantly lower than those found in the parental cells, were further evaluated. The three clones proliferated faster, demonstrated anchorage-independent growth in soft agar and a higher saturation density and plating efficiency. Furthermore, when injected into nude mice, these cells generated tumors after approximately 2-3 weeks. The cells were more resistant to the induction of apoptosis by sulindac sulfide and sulindac sulfone but more sensitive to COX 2 inhibitors (celecoxib and nimesulide). The levels of p16, cyclin D1 and COX 2 were higher in the three transformed clones. In summary,downregulation of Bak expression in normal enterocytes contributes to abnormal growth and tumorigenesis. COX 2 inhibitors may serve as important agents in the prevention and treatment of CRC as they only inhibit the growth of malignant cells.
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Affiliation(s)
- Eliezer Liberman
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
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21
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Nirel N, Matzliach R, Birkenfeld S, Benbassat J. [Medical specialties in crisis: causes of the crisis and possible solutions]. Harefuah 2008; 147:482-576. [PMID: 18693621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Several clinical specialties in Israel appear to be experiencing an ongoing crisis. In this paper the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, during preliminary interviews and in the testimonies presented to a Public Committee appointed by the Prime Minister (the Amorai Committee) that addressed this problem in 2002. OBJECTIVES To identify the causes of the crisis and possible solutions. METHODS Qualitative analysis of interviews and written testimonies of hospital directors, departmental heads of general surgery and internal medicine, key personnel in the Israeli health care system and heads of scientific associations abroad. RESULTS The causes of the crisis in general surgery and internal medicine appear to be at three different levels: those related to the health system and its environment; causes related to the organizational structure of the hospitals; and causes inherent to the characteristics of the relevant medical specialty. The solutions proposed by the respondents in Israel, Europe and the United States should be considered at each of these levels: at the system-wide level (such as increase in tenured positions, and improvements in the residency programs); at the hospital level (such as the addition of auxiliary paramedical employees with a view to reduce the administrative burden of the physicians); and at the level of the specific medical specialty (such as the development of new subspecialties, e.g., acute care surgeons). CONCLUSIONS It is possible to identify the perceived causes of the crisis and possible ways of coping with their consequences. The findings of this pilot study justify a broader survey of additional medical specialties and a larger number of physicians.
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Nirel N, Birkenfeld S, Benbassat J. [Criteria for a medical specialty in crisis: a case study of general surgery and internal medicine]. Harefuah 2008; 147:553-572. [PMID: 18693635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Several clinical specialties in Israel appear to be experiencing an ongoing crisis. Recently, a Public Committee addressed this problem and recommended its further study. In this paper, the authors report a pilot case study of general surgery and internal medicine, which have been identified as "clinical specialties in crisis" in the medical literature, in the testimonies presented to the Public Committee, and during our preliminary interviews. OBJECTIVES to identify (a) the criteria for a "medical specialty in crisis" and (b) measures for the assessment of the extent of the crisis. METHODS (a) Qualitative analysis of interviews and written testimonies of hospital directors, departmental heads of general surgery and internal medicine, and key personnel in the health care system; (b) Analysis of data derived from national administrative data databases and (c) Secondary analysis of data from a nationwide survey of board certified Israeli specialists. RESULTS We identified five criteria of "medical specialties in crisis": shortage of "good" applicants for residency training; difficulties in filling vacant positions; excessive workload due to the limited number of staff physician and residents; a perceived low remuneration and limited opportunities for additional income; poor quality of professional working life. Some of these criteria can be used as a proxy for measuring the extent of the crisis. CONCLUSIONS It is possible to identify criteria defining clinical specialties in crisis, as well as its extent, as a first step toward identification of possible ways of coping with it. The findings of this pilot study justify a broader survey of additional medical specialties and a larger number of physicians.
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Zbidi I, Hazazi R, Niv Y, Birkenfeld S. Colonosopy screening and surveillance of colorectal cancer and polyps: physicians' knowledge. Isr Med Assoc J 2007; 9:862-865. [PMID: 18210926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Colonoscopy is the gold standard procedure for screening for colorectal cancer and surveillance after polypectomy or colorectal cancer surgery, for diagnosis in symptomatic patients and patients with fecal occult blood, and for screening in the high risk population. The adherence of referring physicians to the accepted recommendations can prevent long waiting lists for colonoscopy and save lives, costs and resources. OBJECTIVES To evaluate the knowledge of primary care physicians and gastroenterologists in Israel about current guidelines for colonoscopy screening and surveillance. METHODS A 10-item questionnaire on proper follow-up colonoscopy for surveillance after polypectomy and screening for colorectal cancer in various clinical and epidemiological situations was administered to 100 expert gastroenterologists and 100 primary care physicians at a professional meeting. Answers were evaluated for each group of physicians and compared using the chi-square test. RESULTS The compliance rate was 45% for the gastroenterologists and 80% for the primary care physicians. The rate of correct answers to the specific items ranged from 18.7% to 93.75% for the gastroenterologists and from 6.2% to 58.5% for the primary care physicians (P< 0.001 for almost every item). CONCLUSIONS The knowledge of physicians regarding the screening and surveillance of colorectal cancer needs to be improved.
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Affiliation(s)
- Ibrahim Zbidi
- Gastroenterology Unit, Bat-Yamon Clinic, Clalit Health Services, Bat Yam, Israel
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Horowitz N, Moshkowitz M, Leshno M, Ribak J, Birkenfeld S, Kenet G, Halpern Z. Clinical trial: evaluation of a clinical decision-support model for upper abdominal complaints in primary-care practice. Aliment Pharmacol Ther 2007; 26:1277-83. [PMID: 17944742 DOI: 10.1111/j.1365-2036.2007.03497.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) and dyspepsia affect 25-40% of the general population. In the absence of alarm symptoms, the current recommended policy in young dyspeptic patients is a 'test and treat' strategy for Helicobacter pylori; in GERD patients, a therapeutic trial with proton pump inhibitors is the treatment of choice. AIM To create a short and simple clinical algorithm, for the diagnosis and treatment of patients with upper gastrointestinal complaints. METHODS The clinical usefulness and cost-effectiveness of the new algorithm were evaluated in a controlled clinical trial, held in primary-care clinics in Israel. Clinical and economical treatment outcomes were evaluated after 1, 3 and 6 months comparing doctors who used the algorithm (cases) vs. those who did not (controls). RESULTS 78 cases and 54 controls completed the 6 months of follow up. The improvement in symptom severity and quality of life was greater in the cases than in the controls (P < 0.05). General practitioner clinics visits (P = 0.04), gastroenterology clinics visits (P = 0.02) and medication costs (P = 0.004) were all significantly reduced among cases. Controls underwent also more imaging tests (computerized tomography, ultrasound and X-ray) and endoscopies. The average cost for 6 months' treatment and follow-up was $US 199 for cases compared with an average of $US 336 in the control group. CONCLUSION The use of a clinical decision-support tool can facilitate and promote the implementation of management guidelines by general practitioners. The short algorithm presented in the study was found to be useful and easy to apply in clinical practice. Its effectiveness can be further increased by implementing it in computerized medical systems.
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Affiliation(s)
- N Horowitz
- Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
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Shoenfeld Y, Eidelman L, Afek A, Birkenfeld S, Blachar Y, Shemer J. [The need for a fifth faculty of medicine and where to locate it]. Harefuah 2007; 146:818-820. [PMID: 18087821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Nirel N, Birkenfeld S, Israeli A. [Has the time come to transfer residency training from hospitals to the community? Lessons from other countries and implications for Israel]. Harefuah 2007; 146:447-52, 501, 500. [PMID: 17760399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Most medical practice has moved from the hospital to the community. Nevertheless, in the western world, including Israel, residency training in various specialties has remained mostly in the hospital. Residents have no opportunity to encounter the morbidity and the patient mix that they are likely to encounter in their future work life in the community, after their residency. Neither do they have any opportunity for practical training in medical procedures that are now practiced mainly in the ambulatory setting. Therefore, efforts are being made to promote community work in residency training in order to adapt it to medicine of the future. In this literature review the authors summarized the accumulated experience of transferring residency to ambulatory settings in other countries. The literature review deals with the organizational aspects of accreditation of residency training and with ways of coping with budgetary difficulties as well as infrastructure and faculty recruitment issues. It also reviews the accumulated experience with the content of community residency: the acquisition of knowledge and medical skills, and the maintenance of academic standards. This was done in order to benefit from the lessons learned from others' experience and to raise public discussion issues related to the implementation of this process in Israel.
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Kimchi NA, Broide E, Scapa E, Birkenfeld S. Antiplatelet therapy and the risk of bleeding induced by gastrointestinal endoscopic procedures. A systematic review of the literature and recommendations. Digestion 2007; 75:36-45. [PMID: 17429206 DOI: 10.1159/000101565] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Antiplatelet drugs may increase the risk of bleeding induced by gastrointestinal endoscopic procedures. The antiplatelet effect of cyclooxygenase-1 inhibitors lasts less than 4 h. Skin and colonic bleeding times are prolonged for 3 and 5 days after aspirin and ticlopidine withdrawal respectively. Major bleeding from endoscopic biopsies is extremely rare. In the four recent largest series, the general incidence of polypectomy-induced major bleeding was 0.11-0.42%. In more than half of the cases the bleeding was delayed, usually up to 2 weeks after the endoscopy. Although three retrospective studies suggested that aspirin does not increase the risk of polypectomy-induced bleeding, the power of these studies is limited. Similarly, it is difficult to draw conclusions from the two studies that assessed the risk of aspirin use during sphincterotomy. Aspirin withdrawal may be harmful in susceptible patients, mainly if it is for more than 7 days. There is no indication to stop aspirin before esophagogastroduodenoscopy, which may reveal aspirin-induced lesions. We recommend discontinuation of aspirin 4-7 days (according to the cardiovascular risk) before other endoscopic procedures. When aspirin is indicated for primary prevention, it can be resumed 14 and 10 days after polypectomy and sphincterotomy respectively. In cases of secondary prevention, it should be resumed after 1 week.
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Affiliation(s)
- N A Kimchi
- Institute of Gastroenterology, Liver Diseases and Nutrition, Assaf Harofeh Medical Center, Zerifin, Israel.
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Abstract
BACKGROUND Guaiac-based fecal occult blood tests (FOBTs) for colorectal cancer screening are not specific for human hemoglobin and have low sensitivity. Automated-development, immunochemical FOBT is quality-controlled, is specific for human hemoglobin, and does not require diet restriction. OBJECTIVES To measure the sensitivity and specificity of quantitative immunochemical fecal hemoglobin measurements for detection of cancer and advanced adenoma in patients undergoing colonoscopy, to determine fecal hemoglobin thresholds that give the highest posttest probability for neoplasia, and to determine the number of immunochemical FOBTs needed. DESIGN Prospective, cross-sectional study. SETTING Ambulatory endoscopy services of the main health medical organization in Tel Aviv, Israel. PARTICIPANTS 1000 consecutive ambulatory patients--some asymptomatic but at increased risk for colorectal neoplasia and some symptomatic--who were undergoing elective colonoscopy and volunteered to prepare immunochemical FOBTs. INTERVENTION The hemoglobin content of 3 bowel movements was measured, and the highest value was compared with colonoscopy findings. MEASUREMENTS Sensitivity, specificity, predictive values, likelihood ratios, and 95% CIs of fecal hemoglobin measurements for clinically significant neoplasia, their relationship to the amount of fecal hemoglobin measured, and the number of immunochemical FOBTs performed. RESULTS Colonoscopy identified clinically significant neoplasia in 91 patients (cancer in 17 patients and advanced adenomas in 74 patients). Using 3 immunochemical FOBTs and a hemoglobin threshold of 75 ng/mL of buffer, sensitivity and specificity were 94.1% (95% CI, 82.9% to 100.0%) and 87.5% (CI, 85.4% to 89.6%), respectively, for cancer and 67% (CI, 57.4% to 76.7%) and 91.4% (CI, 89.6% to 93.2%), respectively, for any clinically significant neoplasia. LIMITATIONS The fecal sampling method is standardized, but the sample size depends on fecal consistency. Some patients were tested while discontinuing aspirin and anticoagulant therapies. Study patients were at increased risk, and results might not apply to average-risk populations. CONCLUSIONS Quantitative immunochemical FOBT has good sensitivity and specificity for detection of clinically significant neoplasia. Test performance in screening average-risk populations is not known.
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Affiliation(s)
- Zohar Levi
- Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Levi Z, Rozen P, Hazazi R, Vilkin A, Waked A, Maoz E, Birkenfeld S, Niv Y. Can quantification of faecal occult blood predetermine the need for colonoscopy in patients at risk for non-syndromic familial colorectal cancer? Aliment Pharmacol Ther 2006; 24:1475-81. [PMID: 17032281 DOI: 10.1111/j.1365-2036.2006.03152.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients at risk for non-syndromic (Lynch or polyposis) familial colorectal neoplasia undergo colonoscopic surveillance at intervals determined by clinically ascertained protocols. The quantitative immunochemical faecal occult blood test for human haemoglobin is specific and sensitive for significant colorectal neoplasia (cancer or advanced adenomatous polyp). AIM To determine immunochemical faecal occult blood test efficacy for identifying significant neoplasia in at-risk patients undergoing elective colonoscopy. METHODS We retrospectively identified consecutive at-risk patients who provided three immunochemical faecal occult blood tests before colonoscopy. Quantitative haemoglobin analysis was performed by the OC-MICRO automated instrument using the 100 ng Hb/mL threshold to determine positivity. RESULTS In 252 at-risk patients undergoing colonoscopy; five had cancer, 14 an advanced adenoma and 46 a non-advanced adenoma. The immunochemical faecal occult blood test was positive in 31 patients (12.3%). Sensitivity, specificity, positive and negative predictive values for cancer were: 100%, 90%, 16% and 100%, and for all significant neoplasia: 74%, 93%, 45% and 98%. With 88% fewer colonoscopies, all colorectal cancers and 74% of all significant neoplasia would have been identified by this one-time immunochemical faecal occult blood test screening. CONCLUSIONS A sensitive, non-invasive, interval screening test might be useful to predetermine the need for colonoscopy in this at-risk population and minimize unnecessary examinations. This favourable retrospective evaluation will be extended to a prospective study.
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Affiliation(s)
- Z Levi
- Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Dvory-Sobol H, Cohen-Noyman E, Kazanov D, Figer A, Birkenfeld S, Madar-Shapiro L, Benamouzig R, Arber N. Celecoxib leads to G2/M arrest by induction of p21 and down-regulation of cyclin B1 expression in a p53-independent manner. Eur J Cancer 2006; 42:422-6. [PMID: 16426843 DOI: 10.1016/j.ejca.2005.11.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 10/31/2005] [Accepted: 11/04/2005] [Indexed: 12/30/2022]
Abstract
A unique in vitro system has been developed in our lab that consists of normal enterocytes derived from the rat ileum (IEC-18 cells) and their transformed derivatives with c-K-ras (R1 cells), anti-sense bak (B3 cells) and cyclin D1 (D1 cells). R1 and B3 cells express high level of COX-2 protein and PGE2. IEC 18 and D1 cells express negligible amount of COX-2, and produce very low level of PGE2. A relatively low dose of celecoxib (5-10 microM) induced G2/M arrest, followed by induction of apoptosis in the transformed but not in the normal cells. Down-regulation of cyclin B1 and up-regulation of p21 expressions independent of p53 might have cause this cell cycle block. Growth inhibition was related to COX-2 function with 90-95% reduction in PGE2 production. These findings may be of clinical importance, since low concentration of celecoxib can be achieved in human serum following standard anti-inflammatory (100-200 mg bid) regime.
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Affiliation(s)
- Hadas Dvory-Sobol
- Integrated Comprehensive Cancer Prevention Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 64239, Israel
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Abstract
OBJECTIVE Colorectal cancer (CRC) is the most common of the gastrointestinal cancers in Israel. The low rate of patient compliance to a recent CRC screening program of Clalit Health Services, a major health management organization in Israel, prompted the present survey of primary care physicians' knowledge and practices regarding CRC screening. METHODS A 23-item questionnaire, formulated according to the policy of the Israel Ministry of Health and the recommendations of the American Gastroenterological Association, was distributed to 150 primary physicians of Clalit Health Services. The relative ratio of correct to incorrect answers was calculated for every question and by professional group. RESULTS The response rate was 89%. Total score (out of a maximum 23) was 20.68 for family physicians (experts in family medicine), 17.79 for experts in other fields, and 17.82 for general practitioners (average, 0.90, 0.77, and 0.77, respectively). The score for the family physicians was significantly higher than for the other two groups (P=0.0070). Clustering items by specific issues yielded significantly better scores for the family physicians in four areas: screening (P=0.0164), appropriate test for high-risk population in Israel (P=0.0012), definition of average-risk population (P=0.0012), and CRC symptoms (P=0.0108). A low level of knowledge on the definition of the high-risk population was noted in all three groups. CONCLUSIONS Experts in family medicine in Israel have significantly greater knowledge of most issues of CRC than primary care experts in other fields and general practitioners, although all three groups lack knowledge on the definition of the high-risk population. Continuing physician education should focus on these areas.
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Affiliation(s)
- Shlomo Birkenfeld
- Batiamon Gastroenterology Unit, Rabin Medical Center, Petah Tiqva, Clalit Health Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dvory-Sobol H, Kazanov D, Liberman E, Birkenfeld S, Bulvik B, Luk P, Leshno M, Arber N. MF tricyclic and sulindac retard tumor formation in an animal model. Int J Cancer 2005; 118:11-6. [PMID: 16003752 DOI: 10.1002/ijc.21218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
New selective cyclooxygenase-2 inhibitors offer the benefit of cancer protection with less gastrointestinal toxicity associated with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). We hypothesize that MF tricyclic and sulindac can retard all stages of tumor formation in nude mice. In a blinded placebo controlled study, 3 types of experiments were performed: 1) 2.5 x 10(6) cells were injected into 2 flanks of nude mice subcutaneously, as a model for in situ cancer (n = 192); 2) 1 x 10(6) cells were injected into the cecum of mice as a model for in situ colorectal cancer (n = 78) and 3) 0.5 x 10(6) cells were implanted into the splenic subcapsule to establish a colorectal cancer liver metastasis model (n = 78). The animals were fed with standard chow containing either placebo, MF tricyclic (67 mg/kg of chow) or sulindac (150 mg/kg of chow). Mice that were given MF tricyclic or sulindac, at clinical anti-inflammatory plasma concentrations, were significantly more tumor free and had significantly smaller primary tumors and fewer metastases, as compared to mice that consumed placebo. The mortality and the latency period were significantly better in the treatment groups. These findings suggest that selective COX-2 inhibitors may serve as an adjunct to standard therapy in colorectal cancer.
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Affiliation(s)
- Hadas Dvory-Sobol
- Department of Cancer Prevention, Tel Aviv Medical Center, Tel Aviv, Israel
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Shirin H, Levine A, Shevah O, Shabat-Sehayek V, Aeed H, Wardi J, Birkenfeld S, Eliakim R, Avni Y. Eradication of Helicobacter pylori can be accurately confirmed 14 days after termination of triple therapy using a high-dose citric acid-based 13C urea breath test. Digestion 2005; 71:208-12. [PMID: 16024926 DOI: 10.1159/000087045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Accepted: 12/07/2004] [Indexed: 02/04/2023]
Abstract
BACKGROUND Confirmation of Helicobacter pylori eradication by urea breath test (UBT) is currently performed 4-6 weeks after completion of therapy because of unacceptable false-negative results in UBTs performed earlier. Use of a high-dose citric acid test meal appears to enable accurate detection of H. pylori even during short term therapy with proton pump inhibitors. AIM To evaluate if use of a high dose citric acid (4.0 g) test meal can decrease the interval required for confirmation of eradication after triple therapy. METHODS 233 patients positive for H. pylori were randomized to undergo UBT at 7 days or 14 days after triple therapy, and again at 6 weeks. The latter test was considered the gold standard test. RESULTS The UBT performed 6 weeks after the end of treatment found that 79.9% were cured. The same test 7 days after therapy found false-negative detection of H. pylori in 7.3% patients compared to 3.2% patients examined after 14 days. The sensitivity, specificity, positive and negative predictive values and accuracy for evaluation on day 14 were 80, 100, 100, 96.3 and 96.7%, respectively. CONCLUSIONS High-dose citric acid-based UBT is a valid test for the assessment of H. pylori status 14 days after triple therapy. This may obviate the delay in instituting second-line eradication therapy, or further evaluation of the symptomatic patient unresponsive to therapy despite eradication.
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Affiliation(s)
- Haim Shirin
- Department of Gastroenterology, The E. Wolfson Medical Center, Holon, Tel-Aviv University, Tel Aviv, Israel.
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Vilkin A, Rozen P, Levi Z, Waked A, Maoz E, Birkenfeld S, Niv Y. Performance characteristics and evaluation of an automated-developed and quantitative, immunochemical, fecal occult blood screening test. Am J Gastroenterol 2005; 100:2519-25. [PMID: 16279909 DOI: 10.1111/j.1572-0241.2005.00231.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Guaiac fecal occult blood colorectal cancer (CRC) screening tests (FOBT) are faulted for low sensitivity and nonspecificity for human hemoglobin (Hb). Automated-developed, immunochemical, human Hb FOBT (I-FOBT) is specific, eliminates diet restrictions, and Hb quantification allows selection of a threshold for colonoscopy. Aims were to determine 1) test reproducibility; 2) test stability; 3) intrapatient daily I-FOBT variation; 4) test sensitivity and specificity for neoplasia in 500 symptomatic/high-risk patients undergoing colonoscopy; and 5) to correlate fecal Hb measurements with findings. METHODS The desktop instrument OC-Sensor (Eiken, Japan) automatically develops and quantitates 50 tests/h for Hb. Patients prepared three tests, which were quantified and then 1) repeatedly re-examined; 2) stored at 4 degrees C or 20 degrees C or 28 degrees C and repeatedly examined; and 3) fecal Hb levels were correlated with colonoscopic findings. RESULTS Five I-FOBTs re-examined five times in 1 day had no significant measurement changes. Thirty tests stored for 21 or more days had a decay/day of 0.3%+/- 0.4 at 4 degrees C (NS), 2.2%+/- 1.7 at 20 degrees C (NS), and 3.7%+/- 1.8 at 28 degrees C (p < 0.05). There were intrapatient variations between the three daily I-FOBTs (NS). At the recommended 100 ng Hb/mL threshold, all six cases of CRCs and 20 out of 28 cases of advanced adenomas were detected; evaluated together their sensitivity and specificity were 76.5% and 95.3%. CONCLUSIONS Desktop, automated-developed, quantitative I-FOBT is now available. Refrigerated OC-Sensor samples are stable for 21 days, easy to prepare and develop and, at the 100 ng Hb/mL threshold, have high sensitivity, specificity, and negative predictive values for significant neoplasia. Suitability for population CRC screening awaits further evaluation.
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Affiliation(s)
- Alex Vilkin
- Gastroenterology Department, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
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Avni Y, Shirin H, Aeed H, Shahmurov M, Birkenfeld S, Bruck R. Thioacetamide-induced hepatic damage in a rat nutritional model of steatohepatitis. Hepatol Res 2004; 30:141-147. [PMID: 15588779 DOI: 10.1016/j.hepres.2004.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Revised: 07/29/2004] [Accepted: 08/09/2004] [Indexed: 02/08/2023]
Abstract
BACKGROUND:: Nonalcoholic steatohepatitis is most often attributed to the effects of obesity, hyperlipidemia, diabetes mellitus and drugs. It is still unknown whether livers with steatohepatitis are more vulnerable to toxic damage. AIM:: To determine the effect of the hepatotoxicant thioacetamide in a rat nutritional model of hepatic steatohepatitis. METHODS:: Steatohepatitis was induced in rats by placing them on a methionine-choline deficient diet for 1 month. Thioacetamide was administered by three consecutive intraperitoneal injections (300mg/kg) at 24h intervals. RESULTS:: Following treatment with thioacetamide, the elevated serum levels of liver enzymes and blood ammonia, liver necroinflammation and the survival rate after 48h were not different between rats with normal or fatty liver. However, those parameters were significantly worse when steatohepatitis regressed after return to normal diet for 1 month (P < 0.01). Western blot analysis of hepatic extracts revealed no difference in cytochrome P4502E1 levels between livers with steatohepatitis and steatohepatitis after regression, suggesting that the enhanced hepatotoxicity after regression of steatohepatitis could not be attributed to increased cytochrome P4502E1. CONCLUSIONS:: In a nutritional model of steatohepatitis, rats with fatty liver were not more vulnerable than normal rats to liver damage induced by thioacetamide. However, liver damage was significantly more severe in rats with steatohepatitis after 1 month regression.
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Affiliation(s)
- Yona Avni
- Department of Gastroenterology, The E. Wolfson Medical Center, Holon 58100, Israel
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Barak V, Kalickman I, Halperin T, Birkenfeld S, Ginsburg I. PADMA-28, a Tibetan herbal preparation is an inhibitor of inflammatory cytokine production. Eur Cytokine Netw 2004; 15:203-9. [PMID: 15542444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
BACKGROUND Previous studies have shown that PADMA-28, a multicomponent, traditional Tibetan herbal plant preparation possesses a variety of beneficial effects on several experimental models of inflammatory and immune processes, including autoimmune diabetes and autoimmune encephalomyelitis. In humans, PADMA-28 attenuated the symptoms associated with intermittent claudications in atherosclerotic patients. OBJECTIVE To assess the effect of PADMA 28 on the immune system, e.g. cytokine (interleukins) production. DESIGN Cytokine production by human blood monocytes (derived from 12 healthy donors) stimulated in vitro, either by endotoxin (LPS) from Salmonella typhi or by lipoteichoic acid (LTA) from group A Streptococci was modulated by PADMA-28. RESULTS The present study showed that an aqueous extract of PADMA-28 strongly decreased the production of the inflammatory cytokines IL-1beta, IL-6, IL-8 and TNF-alpha, and more moderately, also decreased the anti-inflammatory cytokine IL-10 induced by LPS. However, the LTA - induced IL-10 production was [not significantly] increased by the low dose PADMA-28, while not effected at all by the higher dose of PADMA-28. CONCLUSIONS The data from these finding suggest a possible clinical efficacy of PADMA-28 either in autoimmune and in inflammatory conditions or in post-inflammatory sequelae, as previously shown in in vivo and human studies, probably by decreasing inflammatory cytokines.
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Affiliation(s)
- Vivian Barak
- Immunology Laboratory for Tumor Diagnosis, Israeli Cytokine Standardization Laboratory, Faculty of Dental Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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Shirin H, Birkenfeld S, Shevah O, Levine A, Epstein J, Boaz M, Niv Y, Avni Y. Application of Maastricht 2-2000 guidelines for the management of Helicobacter pylori among specialists and primary care physicians in israel: are we missing the malignant potential of Helicobacter pylori? J Clin Gastroenterol 2004; 38:322-5. [PMID: 15087690 DOI: 10.1097/00004836-200404000-00005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND The Maastricht 2-2000 guidelines on the current management of Helicobacter pylori infection were recently adopted by the Israeli Gastroenterological Association. GOAL To determine the impact of these clinical guidelines on the current knowledge, attitudes, and management of H. pylori among primary care physicians, hospital internists, and gastroenterologists in Israel. STUDY Self-administered, voluntary, anonymous questionnaires were given personally to 229 physicians, 73 primary care physicians, 71 internists, and 85 gastroenterologists. The questions evaluated 4 main issues in the management of H. pylori: (1). the optimal diagnostic test, (2). indications for eradication, (3). combination and duration of triple therapy, and (4). the need for confirmation following eradication. RESULTS There were significant variations in the adherence of those recommendations among gastroenterologists, internists, and primary care physicians. Specifically, 94.1% of gastroenterologists and 88.9% of internists consider the urea breath test the test of choice for H. pylori diagnosis compared with 60.0% of the primary care physicians. Significant differences in the eradication indications for mucosa-associated lymphoid tissue (MALT) lymphoma, first-degree relatives of gastric cancer patients, atrophic gastritis, functional dyspepsia, and concomitant use of nonsteroidal antiinflammatory drugs were demonstrated among gastroenterologists and the other groups. CONCLUSIONS Primary care physicians may not be aware of important indications for diagnosis and eradication of H. pylori related to the risk of gastric malignancy or concomitant use of nonsteroidal antiinflammatory drugs. Public health agencies may need to increase penetration of the Maastricht 2000 recommendations to primary care physicians.
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Affiliation(s)
- Haim Shirin
- Department of Gastroenterology, the E Wolfson Medical Center, Holon, Israel.
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Birkenfeld S, Keter D, Dikman R, Shevah O, Shirin H, Niv Y. Prevalence of Helicobacter pylori infection in health-care personnel of primary care and gastroenterology clinics. J Clin Gastroenterol 2004; 38:19-23. [PMID: 14679322 DOI: 10.1097/00004836-200401000-00006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND & AIMS Helicobacter pylori (Hp) infection clusters within families, is usually acquired early in life, and is strongly associated with lower socioeconomic status during childhood. Transmission in adulthood is relatively rare, and reports on the prevalence of Hp infection among health personnel, especially endoscopists, are controversial. The present prospective study evaluated the prevalence of Hp infection in health-care workers in primary-care clinics and in gastroenterology units. METHODS Health care personnel from gastrointestinal units (n = 191) and primary care-clinics (n = 98) of the Clalit Health Services (CHS) in Israel underwent the carbon 13 breath test (13C-UBT) and completed a 21-item demographic and socioeconomic questionnaire. The control group consisted of 4633 symptomatic patients with no evidence of previous Hp infection. RESULTS The 13C-UBT was positive in 108 gastrointestinal unit personnel (73%) and 70 primary-care workers (71%); both rates were statistically higher significantly than the 53% positivity in the controls. Comparison of the 13C-UBT Hp-positive and Hp-negative health-care personnel yielded a significantly higher index of crowded living conditions in the Hp-positive group. In the gastrointestinal unit workers, Hp positivity was also associated with several years in practice, and in the primary-care workers, with Sephardic (Asian and African origin) versus Ashkenazi (Europe and American) origin. Profession (physician, nurse, technician, secretary, or maintenance worker), history of duodenal ulcer, smoking, marital status, and blood group did not have predictive value for Hp colonization. CONCLUSIONS The prevalence of Hp infection in Israel is higher in health-care staff of primary-care clinics and gastrointestinal units than in the general population. This may be related to socioeconomic facts and professional hazard. Further studies are needed to clarify this issue.
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Avni Y, Shirin H, Aeed H, Matas Z, Shahmurov M, Birkenfeld S, Bruck R. Thioacetamide-induced hepatic damage in a rat nutritional model of steatohepatitis. J Med 2003; 34:121-37. [PMID: 17682318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Nonalcoholic steatohepatitis is most often attributed to the effects of obesity, hyperlipidemia, diabetes mellitus and drugs. It is still unknown whether livers with steatohepatitis are more vulnerable to toxic damage. AIM To determine the effect of the hepatotoxicant thioacetamide in a rat nutritional model of hepatic steatohepatitis. METHODS Fatty liver was induced in rats by placing them on a methionine-choline deficient diet for one month. Thioacetamide was administered by 3 consecutive intraperitoneal injections (300 mg/kg) at 24 h intervals. RESULTS Following treatment with thioacetamide, the elevated serum levels of liver enzymes and blood ammonia, liver necrotic inflammation and the survival rate after 48 h were not different between rats with normal or fatty liver. However, those parameters were significantly worse when fatty liver regressed after return to normal diet for one month (p < 0.01). Western blot analysis of hepatic extracts revealed no difference in cytochrome P4502E1 levels between fatty livers and fatty livers after regression, suggesting that the enhanced hepatotoxicity after regression of fatty liver could not be attributed to increased cytochrome P4502E1. CONCLUSIONS In a nutritional model of steatohepatitis, rats with fatty liver were not more vulnerable than normal rats to liver damage induced by thioacetamide. However, liver damage was significantly more severe in rats with fatty livers after one month regression of steatosis.
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Affiliation(s)
- Yona Avni
- Department of Gastroenterology, The E. Wolfson Medical Center, Holon, Israel
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Barak V, Birkenfeld S, Halperin T, Kalickman I. The effect of herbal remedies on the production of human inflammatory and anti-inflammatory cytokines. Isr Med Assoc J 2002; 4:919-22. [PMID: 12455180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
BACKGROUND Some herbal remedies are sold as food additives and are believed to have immune-enhancing properties. OBJECTIVES To study the effect of five herbal remedies--Sambucol Black Elderberry Extract, Sambucol Active Defense Formula and Sambucol for Kids (with known antiviral properties), Protec and Chizukit N (containing propolis and Echinacea, claimed to be immune enhancers)--on the production of cytokines, one of the main components of the immune system. METHODS The production of four inflammatory cytokines (interleukin-1 beta, tumor necrosis factor alpha, and IL-6 and IL-8) and one anti-inflammatory cytokine (IL-10) was tested using blood-derived monocytes from 12 healthy donors. RESULTS The Sambucol preparations increased the production of five cytokines (1.3-6.2 fold) compared to the control. Protec induced only a moderate production of IL-8 (1.6 fold) and IL-10 (2.3 fold) while Chizukit N caused only a moderate increase in IL-10 production (1.4 fold). Both Protec and Chizukit N caused moderate decreases in IL-1 beta, TNF alpha and IL-6 production. Lipopolysaccharide, a known activator of monocytes, induced the highest levels of cytokine production (3.6-10.7 fold). CONCLUSIONS The three Sambucol formulations activate the healthy immune system by increasing inflammatory and anti-inflammatory cytokines production, while the effect of Protec and Chizukit N is much less. Sambucol could therefore have immunostimulatory properties when administered to patients suffering from influenza (as shown before), or immunodepressed cancer or AIDS patients who are receiving chemotherapy or other treatments.
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Affiliation(s)
- Vivian Barak
- Immunology Laboratory for Tumor Diagnosis, Department of Oncology, Hadassah University Hospital, Jerusalem, Israel.
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Kashtan H, Umansky M, Birkenfeld S, Scherübl H, Haddad R, Greenberg R, Konikoff F. Photodynamic Therapy of Barrett's Esophagus with Dysplasia Using Systemic Aminolevulinic Acid and a Non-laser Light Source. A Phase I/II Study. ACTA ACUST UNITED AC 2002. [DOI: 10.1080/1475956021000017020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
INTRODUCTION Anismus is a common cause of constipation and outlet obstruction. Standard therapy with laxatives or biofeedback has conflicting results. Surgical treatment gives poor results and has practically been abandoned. PURPOSE This study was designed to evaluate the efficacy of botulinum toxin type-A (Botox) injection to the puborectalis muscle in patients with anismus. METHODS Twenty-five patients (15 females; mean age, 23.2) with history of constipation and symptoms of outlet obstruction underwent anorectal perfusion manometry and video-proctography. All patients were found to have a nonrelaxing puborectalis muscle on both modalities. All have been unable to expel a rectal balloon. Each patient who participated in the study was randomly assigned to undergo local injection of Botox--10 units to each side of the puborectalis or 20 units to the posterior aspect of this muscle. Eight patients underwent further injections1-5 every 3 months in accordance with previous results. Follow-up was conducted 1, 4, 12, and 24 weeks after injection. Straining, anorectal pain, and overall satisfaction were assessed on a visual analog scale. Weekly evacuation, fecal incontinence, and complications were recorded. At the weekly meeting, each patient underwent anorectal manometry with a balloon expulsion test. RESULTS Manometric relaxation was achieved after the first injection in 18 patients (75 percent). Once relaxation was achieved, it lasted throughout the follow-up. Nine patients (37.5 percent) expelled the rectal balloon after the first injection. Seven of 16 patients who failed the first injection had an additional one. In 2 patients it was successful (28.6 percent). Symptom improvement of 29.2 percent in straining index was recorded during follow-up. In 3 patients (12.5 percent) pain developed after injection. No other complications were observed. Overall satisfaction with Botox injection results was observed in 58.3 percent. CONCLUSIONS Botox injection to the puborectalis muscle has been found to have a limited therapeutic effect on patients suffering from anismus. Our results justify the need for further double-blind placebo-controlled trials to determine the exact role of botulinum toxin type-A in anismus.
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Affiliation(s)
- Y Ron
- Department of Gastroenterology, The E. Wolfson Medical Center, Holon 58100, Israel
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Shirin H, Kenet G, Shevah O, Wardi J, Wardi Y, Birkenfeld S, Shahmurov M, Bruck R, Niv Y, Moss SF, Avni Y. Evaluation of a novel continuous real time (13)C urea breath analyser for Helicobacter pylori. Aliment Pharmacol Ther 2001; 15:389-94. [PMID: 11207514 DOI: 10.1046/j.1365-2036.2001.00926.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the sensitivity and specificity of a new (13)C urea breath test, Oridion BreathID, for the diagnosis of Helicobacter pylori. METHODS A total of 97 consecutive symptomatic patients referred for upper endoscopy were included in the 'pre-therapy' part of the study. After endoscopy the patients were analysed for H. pylori by Oridion BreathID. BreathID continuously sampled the subject's breath for 20 min, and displayed the results on the BreathID screen in real time. Results of the BreathID were compared with the 'gold standard' (rapid urease test and histology). We also prospectively tested the validity of BreathID in comparison to isotope ratio mass spectrometry, in 40 patients referred to monitor the efficacy of H. pylori eradication treatment. RESULTS Complete agreement was observed between the 'gold standard' and the Breath ID test in 96.9% (94 out of 97) of the patients. The sensitivity and specificity of BreathID were 97.8% and 96.1%, respectively. The correlation between BreathID and isotope ratio mass spectrometry breath test was 100%. CONCLUSIONS The Oridion BreathID has comparable sensitivity and specificity to the claims of the currently available urea breath tests. Furthermore, BreathID has the potential advantages of ease of use with minimal medical staff requirement, and real time rapid results (20 min maximum) which may make the BreathID preferable to other urea breath test assays.
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Affiliation(s)
- H Shirin
- Department of Gastroenterology, The E. Wolfson Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
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Abstract
Primary neoplasms of the small bowel are unusual and constitute 1-5% of all gastrointestinal tract neoplasms. Preoperative diagnostic difficulties, frequent dissemination at the time of the diagnosis, and poor prognosis are characteristic of this pathology. During a period of 26 years we treated 61 patients with tumors of the small bowel, 44 malignant and 18 benign (1 patient had both). The most common symptoms were abdominal pain (62%), weight loss (41%), and gastro-intestinal bleeding (31%). More than half of the patients were treated as emergencies and among the remaining, the most useful diagnostic test was the small intestinal barium study. Seventeen patients were operated on for intestinal obstruction, 6 of them due to intussusception of the tumor, while 8 other patients presented with perforation and 7 with massive gastrointestinal bleeding. Leiomyoma was the most frequent benign lesion. Among malignancies lymphoma was encountered in 38.6%, followed by adenocarcinoma (29.6%) and leiomyosarcoma (22.8%). Lymphoma was predominant among Sephardic Jews. Curative procedures were attempted in all but one of the benign cases and in 21 of the malignant cases. At the time of surgery metastases were present in 23 patients. The postoperative mortality was high (20% and 14% in the benign and malignant groups, respectively) most probably due to the high incidence of emergency surgery in a high risk population. The prognosis of the malignant tumors was poor with a 5-year survival of 18%. Their disappointing course seems to be related to late diagnosis because of nonspecific symptoms and difficulty in bringing the tumor to the fore. Hopefully, a greater awareness will lead to an earlier diagnosis and improve the prognosis.
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Affiliation(s)
- F Serour
- Department of Surgery A, Edith Wolfson Medical Center, Holon, Israel
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45
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Amir-Zaltsman Y, Ausher Y, Gayer B, Lichter S, Serour F, Birkenfeld S, Kohen F. Pharmacological effects of the continuous administration of an LHRH agonist in the ageing male rat: comparison with orchidectomy. J Endocrinol 1990; 124:261-8. [PMID: 2179456 DOI: 10.1677/joe.0.1240261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The age-related changes in tissue response to chronic treatment for 1 month with a potent LHRH agonist were investigated in the ageing male rat, and the observed pharmacological effects were compared with orchidectomy. In both young (4 months) and old (22 months) rats, treatment resulted in a significant decrease in the weights of prostates and testes, a decrease in plasma LH and testosterone levels, a loss of LH receptors in the testes and in a complete depletion of prostatic nuclear androgen receptors, reaching levels observed after castration. In young rats, treatment with an LHRH agonist or orchidectomy induced a three- or sixfold increase in prostatic creatine kinase (CK) activity which may have been induced by the local stimulatory effect of oestradiol arising from the conversion of precursor steroids secreted by the adrenal. On the other hand, in old rats, 7 days after orchidectomy or after treatment with an LHRH agonist a twofold increase or no change was induced in prostatic CK activity respectively. SDS gel electrophoresis patterns of cytosolic prostatic proteins of young rats treated with an LHRH agonist or young rats orchidectomized 7 days previously revealed the presence of several intensified proteins, two of them having apparent molecular weight of 67 kDa and 43 kDa, whereas in the old rats treated with LHRH agonist or old rats castrated 7 days previously, these two proteins were not intensified. The results of this study confirmed that continuous treatment with an LHRH agonist to young and old rats induces medical castration since the pharmacological effects observed were the same as those induced with surgical castration.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- Y Amir-Zaltsman
- Department of Hormone Research, Weizmann Institute of Science, Rehovot, Israel
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Birkenfeld S, Federico C, Dermansky-Avni Y, Bruck R, Melzer E, Bar-Meir S. Double-blind controlled trial of flumazenil in patients who underwent upper gastrointestinal endoscopy. Gastrointest Endosc 1989; 35:519-22. [PMID: 2689262 DOI: 10.1016/s0016-5107(89)72902-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The antisedative effect of flumazenil, a benzodiazepine antagonist, was studied in a double-blind placebo controlled trial in 61 patients who underwent upper gastrointestinal endoscopy and sedation with benzodiazepines. The efficacy of flumazenil in reversing the effect of both benzodiazepines, diazepam and midazolam, was significantly higher than placebo (p less than 0.0001). The effect of flumazenil was prompt and was clearly noticed at the first assessment, 5 min after its administration. In none of the patients was a relapse of the sedative effect of the benzodiazepines noticed. The administration of flumazenil was free of major side effects. Flumazenil administration permits an earlier discharge of patients following endoscopy. Its availability in the endoscopy suite may improve the outcome of serious but rare side effects related to benzodiazepines.
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Affiliation(s)
- S Birkenfeld
- Department of Gastroenterology, E. Wolfson Medical Center, Holon, Israel
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Birkenfeld S, Noiman G, Krispin M, Schwartz S, Zakut H. The incidence and significance of serum hCG and CEA in patients with gastrointestinal malignant tumors. Eur J Surg Oncol 1989; 15:103-8. [PMID: 2703054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Beta-human chorionic gonadotropin (hCG) is normally produced and secreted by trophoblastic cells in pregnancy, by tumors arising from those cells and by a wide variety of tumors of nonendocrine origin. Gonadotropin is produced and secreted by various tissues (stomach, pancreas, ovary, etc.) and the incidence of ectopic secretion varies between 0 and 43%. Our report is an attempt to evaluate the incidence of high plasma beta hCG levels in 101 patients with gastrointestinal malignant tumors. The results revealed negative beta hCG in the control samples, while in the studied patients 41 were positive for beta hCG (44.4%). Three samples from oesophagus squamous cell carcinoma were positive. Twenty-five out of 69 with colorectal carcinoma had raised serum beta hCG (36.8%). Gastric carcinoma showed positive beta hCG in 52% of the patients. Among all the patients high beta hCG levels were far more common in those with positive lymphnodes (P less than 0.05). The beta hCG levels decreased with colorectal carcinoma tumor size and with smaller tumors there was the probability of increasing positive serum measurements (P less than 0.05). The patients with adenocarcinoma of the stomach showed good statistical correlation between stages of the disease at the operation time to beta hCG levels. In our opinion this serological assay will become one of the markers to be added to our armamentarium in the evaluation of patients with gastrointestinal malignant tumors.
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Affiliation(s)
- S Birkenfeld
- Department of Surgery, Sackler Faculty of Medicine, Tel Aviv University, Holon, Israel
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48
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Abstract
Histologically proved Paget's disease of the breast with negative hormonal receptor assay in a 73-year-old man induced a review of the 27 valuable cases of the literature. Our patient is disease-free, eight years after treatment by modified radical mastectomy and adjuvant irradiation. Peak incidence of the disease is between 50 and 70 years of age. The most frequent presenting signs reported are ulcerations and eczematous lesions of the nipple (71.4%) with discharge and bleeding in 39.3% of the cases. Other findings are a palpable mass (42.8%) and involved axillary lymph nodes (53.5%). The treatment of choice is shown to be radical or modified radical mastectomy with adjuvant radiotherapy. To date, no proof exists of the value of hormone receptors assays and routine adjuvant hormone therapy is not practiced.
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Affiliation(s)
- F Serour
- Department of Pathology, Edith Wolfson Medical Center, Holon, Israel
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Birkenfeld S, Serour F, Levi S, Abulafia A, Balassiano M, Krispin M. Choledochoduodenostomy for benign and malignant biliary tract diseases. Surgery 1988; 103:408-10. [PMID: 3353854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Although nonsurgical alternative treatments for primary or retained common bile duct stones--such as dissolution of gallstones with deoxycholic acids and, especially endoscopic papillotomy--have become available, choledochoduodenostomy (CDS) has been used with increasing frequency over the past decade, with extension of the indications for its use. We report our experience with side-to-side CDS in 116 patients with benign (65 patients) and malignant (46 patients) biliary diseases. Even though the mean age of our patients with benign disease--patients who underwent urgent operations because of obstructive jaundice (74%), liver damage (approximately 60%), and other biliary complications--was 66.8 years, the perioperative mortality was 3.07% and the long-term follow-up results were excellent with no biliary complications. In regard to the controversy about the use of CDS in malignant biliary obstructions, our experience shows that none of the 42 patients had any complication due to malignant invasion of the stoma, and only one patient had ascending cholangitis; the perioperative mortality in this group was 8.6%. In our opinion, CDS is a relatively safe, definitive procedure for treatment of benign and malignant biliary diseases, with good long-term results in high-risk, aged patients.
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Affiliation(s)
- S Birkenfeld
- Department of Surgery, Edith Wolfson Hospital, Holon, Israel
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50
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Abstract
Cholinesterases were characterized in the serum of 77 treated and 11 untreated patients having primary carcinomas of various tissue origins and 21 healthy volunteers which served as controls. In most of the samples, pseudocholinesterase (BuChE) accounted for almost all cholinesterase (ChE) activity and was inhibited by the organophosphorous poison tetraisopropyl pyrophosphoramide (iso-OMPA). In samples from the tumor-bearing patients, ChE degraded 733 +/- 59 nmole acetylcholine/h/mg protein, lower than the 960 +/- 175 nmole/hour/mg levels measured in controls. Tumor serum ChE exhibited elevated sensitivity to 1,5-bis-(4-allyldimethyl ammonium phenyl)-pentan-3-one dibromide (BW), the selective bisquaternary inhibitor of "true" acetylcholinesterase (AChE), with no correlation to age, sex, staging of tumor, presence of metastases or the specific treatment protocol, and with a different distribution pattern from the decrease in ChE specific activity or the sensitivity to iso-OMPA. In sucrose gradients, ChE sedimented as 12S in controls whereas in tumor serum samples from treated patients an additional component of 6 to 7 S, inhibited by both iso-OMPA and BW, also was detected. However, the ChE activity in serum of patients with diagnosed carcinomas before surgery and medical treatment appeared to be nondistinguishable from controls. These findings suggest that the modified properties of serum cholinesterases in carcinoma patients are not the result of the tumor itself, but that the common therapy protocols used in the treatment of primary carcinomas may cause the appearance of soluble ChE activity with properties of both AChE and BuChE, which accumulates in the serum.
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Affiliation(s)
- H Zakut
- Department of Biological Chemistry, Hebrew University, Jerusalem, Israel
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