1
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Sorotzky M, Raphael A, Breuer A, Odeh M, Gillis R, Gillis M, Shibli R, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Mendelovich J, Weiser G, Berliner E, Barak-Corren Y, Heiman E. Jerusalem's CoVID-19 Experience-The Effect of Ethnicity on Disease Prevalence and Adherence to Testing. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01965-7. [PMID: 38457104 DOI: 10.1007/s40615-024-01965-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The management of the SARS-CoV-2 pandemic depends amongst other factors on disease prevalence in the general population. The gap between the true rate of infection and the detected rate of infection may vary, especially between sub-groups of the population. Identifying subpopulations with high rates of undetected infection can guide authorities to direct resource distribution in order to improve health equity. METHODS A cross-sectional epidemiological survey was conducted between April and July 2021 in the Pediatric Emergency Department of the Shaare Zedek Medical Center, Jerusalem, Israel. We compared three categories: unconfirmed disease (UD), positive serology test result with no history of positive PCR; confirmed disease (CD), history of a positive PCR test result, regardless of serology test result; and no disease (ND), negative serology and no history of PCR. These categories were applied to local prevailing subpopulations: ultra-orthodox Jews (UO), National Religious Jews (NRJ), secular Jews (SJ), and Muslim Arabs (MA). RESULTS Comparing the different subpopulations groups, MAs and UOs had the greatest rate of confirmed or unconfirmed disease. MA had the highest rate of UD and UO had the highest rate of CD. UD significantly correlated with ethnicity, with a low prevalence in NRJ and SJ. UD was also associated with larger family size and housing density defined as family size per number of rooms. CONCLUSION This study highlights the effect of ethnicity on disease burden. These findings should serve to heighten awareness to disease burden in weaker populations and direct a suitable prevention program to each subpopulation's needs. Early awareness and possible intervention may lower morbidity and mortality.
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Affiliation(s)
- Michael Sorotzky
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel.
| | - Allon Raphael
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Ma'aran Odeh
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roni Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Michal Gillis
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Roaia Shibli
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Judith Fiszlinski
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joseph Mendelovich
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Giora Weiser
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elihay Berliner
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yuval Barak-Corren
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Predictive Medicine Group, Boston Children's Hospital, Boston, USA
| | - Eyal Heiman
- Department of Pediatrics, Shaare Zedek Medical Center, 12 Shmuel Bait St, PO Box 3235, 9103102, Jerusalem, Israel
- Pediatric Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
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Raphael A, Schlesinger Y, Nir A. Sinus arrest during respiratory syncytial virus bronchiolitis: A report of two cases and literature review. Pediatr Pulmonol 2023; 58:3330-3332. [PMID: 37417816 DOI: 10.1002/ppul.26589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/04/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Allon Raphael
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Yechiel Schlesinger
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
- Pediatric Infectious Diseases Unit, Wilf Children Hospital, Shaare Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
| | - Amiram Nir
- Department of Pediatrics, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
- Pediatric Cardiology and Adult Congenital Heart Disease Unit, Wilf Children Hospital, Sha'are Zedek Medical Center, Affiliated to the Hadassah-Hebrew University Medical School, Jerusalem, Israel
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Raphael A, Shamriz O, Tvito A, Magen S, Goldberg S, Megged O, Lev A, Simon AJ, Tal Y, Somech R, Eisenberg R, Toker O. SARS-CoV-2 spike antibody concentration in gamma globulin products from high-prevalence COVID-19 countries are transmitted to X-linked agammaglobulinemia patients. Front Immunol 2023; 14:1156823. [PMID: 37063907 PMCID: PMC10090293 DOI: 10.3389/fimmu.2023.1156823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
PurposePatients with X-linked agammaglobulinemia (XLA) are characterized by humoral impairment and are routinely treated with intravenous immunoglobulin (IVIG). In this study, we aimed to investigate the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in IVIG preparations harvested globally and evaluate the transfer of SARS-CoV-2 antibodies to the XLA patient.MethodsA single-center, prospective cohort study was conducted in the period of November 2020 to November 2022. Clinical and laboratory data, specifically, SARS-CoV-2 spike IgG levels from the serum of 115 IVIG preparations given to 5 XLA patient were collected. Concurrently, SARS-CoV-2 spike IgG levels from the serum of the 5 XLA was collected monthly.ResultsFive XLA patients were evaluated within the study period. All were treated monthly with commercial IVIG preparations. A total of 115 IVIG treatments were given over the study period. The origin country and the date of IVIG harvesting was obtained for 111 (96%) of the treatments. Fifty-four IVIG preparations (49%) were harvested during the COVID-19 pandemic of which 76% were positive (>50AU/mL) for SARS-CoV-2 spike antibodies which were subsequently transmitted to the XLA patients in an approximate 10-fold reduction. SARS-CoV2 spike IgG was first detected in IVIG batches that completed their harvest date by September 2021. Positive products were harvested from origin countries with a documented prevalence over 2,000 per 100,000 population.ConclusionAs the prevalence of COVID-19 infections rises, detection of SARS-CoV-2 spike IgG in commercial IVIG products increases and is then transmitted to the patient. Future studies are needed to investigate the neutralizing capabilities of SARS-CoV-2 IgG and whether titer levels in IVIG remain consistent as the incidence of infection and vaccination rates in the population changes.
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Affiliation(s)
- Allon Raphael
- Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Oded Shamriz
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Lautenberg Center for Immunology and Cancer Research, Institute of Medical Research Israel-Canada, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariella Tvito
- Department of Hematology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shmuel Goldberg
- Department of Pediatrics, Pediatric Pulmonology Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orli Megged
- Department of Pediatrics, Infectious Diseases Unit, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Atar Lev
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Amos J. Simon
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Raz Somech
- Pediatric Department A and the Immunology Service, Jeffrey Modell Foundation Center, Edmond and Lily Safra Children’s Hospital, Tel-Hashomer Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Jeffrey Modell Foundation Israeli Network for Primary Immunodeficiency, New York, NY, United States
| | - Rachel Eisenberg
- Department of Pediatrics, Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ori Toker
- Department of Pediatrics, Allergy and Clinical Immunology Unit, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- *Correspondence: Ori Toker,
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Breuer A, Raphael A, Stern H, Odeh M, Fiszlinski J, Algur N, Magen S, Megged O, Schlesinger Y, Barak‐Corren Y, Heiman E. SARS-CoV-2 antibodies started to decline just four months after COVID-19 infection in a paediatric population. Acta Paediatr 2021; 110:3054-3062. [PMID: 34265136 PMCID: PMC8444680 DOI: 10.1111/apa.16031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
Aim We evaluated the prevalence of paediatric severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections using antibody testing and characterised antibody titres by time from exposure. Methods This was a single‐centre, prospective, cross‐sectional cohort study. Patients under 18 years old were eligible to participate if they attended the paediatric emergency department at the tertiary Shaare Zedek Medical Center, Jerusalem, Israel, from 18 October 2020 to 12 January 2021 and required blood tests or intravenous access. SARS‐CoV‐2 seropositivity and antibody levels were tested by a dual‐assay model. Results The study comprised 1138 patients (56% male) with a mean age of 4.4 years (interquartile range 1.3–11.3). Anti‐SARS‐CoV‐2 antibodies were found in 10% of the patients. Seropositivity increased with age and 41% of seropositive patients had no known exposure. Children under 6 years of age had higher initial antibody levels than older children, followed by a steeper decline. The seropositivity rate did not vary during the study, despite schools re‐opening. The findings suggest that children's immunity may start falling 4 months after the initial infection. Conclusion Immunity started falling after just 4 months, and re‐opening schools did not affect infection rates. These findings could aid decisions about vaccinating paediatric populations and school closures.
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Affiliation(s)
- Adin Breuer
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Allon Raphael
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Hagay Stern
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Ma'aran Odeh
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Judith Fiszlinski
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
| | - Nurit Algur
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Sophie Magen
- Clinical Endocrinology Laboratory Shaare Zedek Medical Center Jerusalem Israel
| | - Orli Megged
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yechiel Schlesinger
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Infectious Diseases Unit Shaare Zedek Medical Center Jerusalem Israel
- Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
| | - Yuval Barak‐Corren
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Predictive Medicine Group Boston Children's Hospital Boston Massachusetts USA
| | - Eyal Heiman
- Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel
- Pediatric Emergency Department Shaare Zedek Medical Center Jerusalem Israel
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Raphael A, Friger M, Biderman A. Seasonal variations in HbA1c among type 2 diabetes patients on a semi-arid climate between the years 2005-2015. Prim Care Diabetes 2021; 15:502-506. [PMID: 33309124 DOI: 10.1016/j.pcd.2020.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/08/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
AIMS To investigate the seasonal variations of HbA1c values in a semi-arid climate among type 2 diabetic patients throughout 11 years of care. METHODS A retrospective cohort study of 2860 patients with 61,187 HbA1c measures. We calculated the averages of HbA1c values of all patients and sub-groups defined by age, gender, BMI, ethnicity, insulin use, smoking status and region of residence, matched to the mean temperature and diurnal range over the 30 and 60 days prior to the HbA1c test date. RESULTS We found a sinusoidal seasonal pattern with statistically significant HbA1c levels gaps between the spring peak and the autumn trough (F = 18.4, P < 0.001). The lowest values were in October-November and the highest in March or August with a difference of 0.17-0.31% (2-4 mmol/mol). We found different relations between the mean temperature and HbA1c depending on season, gender, age, ethnicity and smoking habits. CONCLUSION The study identified specific subgroups in which the seasonal influence is particularly marked. A possible explanation is that during hot periods people tend to change their diet and decrease their physical activity, effecting indirectly diabetic imbalance. Recognition of the seasonal variations of HbA1c levels in this geographical region could help physicians with diabetes care and HbA1c control.
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Affiliation(s)
- Allon Raphael
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
| | - Aya Biderman
- Department of Family Medicine and Siaal Center for Community Research, Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clalit Health Services, Southern District, Beer-Sheva, Israel.
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Abstract
OBJECTIVE The objective of this study was to evaluate the combined use of cryopreserved human umbilical cord (cUC) allograft and negative pressure wound therapy (NPWT) in treating complex diabetic foot ulcers (DFUs) with bone exposure and osteomyelitis. These types of wound are known to carry a high morbidity and mortality. METHODS A single-center, retrospective chart review was performed to assess the efficacy of the combined use of cUC with NPWT, by the same surgeon, to help promote the closure of complex DFUs presenting with biopsy-proven osteomyelitis. Change in wound size and volume, time to wound closure, and number of cUC applications were assessed. RESULTS We identified of 14 wounds in 13 patients, with an average initial wound area of (mean±standard devaition) 33.2±21.7cm2 and wound volume of 52±26.2cm3. All achieved complete re-epithelialisation with an average time to closure of 24.0±10.9 weeks, using between 2-5 cUC applications. No adverse events were noted and none of the wounds required limb amputation during the a follow-up of 24 months for each patient. CONCLUSION The results suggest that combined use of cUC and NPWT may be effective in improving the healing of complex DFUs that present with osteomyelitis. Prospective, randomised controlled trials are warranted to confirm this efficacy as well as its potential applications in other chronic wounds.
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Affiliation(s)
- A Raphael
- Partner Podiatrist, Village Podiatry Centers, Smyrna, GA, US
| | - J Gonzales
- Podiatry Resident, PGY-3, Dekalb Medical Podiatric Residency, Decatur, GA, US
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Abstract
OBJECTIVE Histopathological studies have shown a prolonged inflammatory phase in wounds of patients with diabetes, delaying formation of mature granulation tissue and reducing wound tensile strength, making these wounds difficult for physicians to heal. Cryopreserved human umbilical cord (cUC) tissues possess unique anti-inflammatory and anti-scarring properties and have been found to help improve closure of these chronic wounds. METHOD A retrospective chart review was performed to assess the efficacy of cUC as an advanced treatment modality to help promote the closure of chronic DFUs. Overall healing rate, duration to wound closure, and number of cUC applications used to achieve closure were used to assess cUC treatment efficacy. RESULTS A total of 32 wounds in 29 patients treated at a single health-care centre were included in the study population The average initial wound area for all wounds was 10.6 ± 2.15cm2. Of the 32 wounds 28 achieved complete epithelialisation for an overall healing rate of 87.5%. Average time to wound closure was 13.8 ± 1.95 weeks with a median of 9 weeks and an average of 1.68 ± 0.18 cUC applications. CONCLUSION The results suggest cUC allograft may be effective in improving the healing of DFUs ulcers as well as potentially reducing the medical costs associated with chronic DFUs due to the low number of applications needed to achieve complete wound closure. Prospective, randomised controlled trials are suggested to better understand the efficacy of cUC in chronic wound healing. DECLARATION OF INTEREST Dr Raphael is a paid speaker for Amniox Medical, Inc.
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Affiliation(s)
- A Raphael
- Village Podiatry Centers, Smyrna, GA, US
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Rav Acha M, Raphael A, Keanney J, Elitzur Y, Shauer A, Taha L, Sechter Y, Ilan M, Luria D, Singh S, Weisz G, Mella T, Medina A. 175The management of cardiac implantable electronic device (CIED) lead perforation: A multicenter study. Europace 2017. [DOI: 10.1093/ehjci/eux136.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Raphael A. A single-centre, retrospective study of cryopreserved umbilical cord/amniotic membrane tissue for the treatment of diabetic foot ulcers. J Wound Care 2016. [DOI: 10.12968/jowc.2016.25.7.s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Raphael A, Hawkes CH, Bernat JL. To tell or not to tell? Revealing the diagnosis in multiple sclerosis. Mult Scler Relat Disord 2013; 2:247-51. [PMID: 25877731 DOI: 10.1016/j.msard.2012.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/20/2012] [Accepted: 12/26/2012] [Indexed: 10/27/2022]
Abstract
We review briefly (1) the history of patient-physician relationship and its evolution from a physician-centered to patient-centered model; (2) the impact of the McDonald Criteria for Multiple Sclerosis (MS); (3) why it is important to tell patients of their diagnosis; (4) how physicians should disclose the diagnosis to patients; (5) dealing with suspected MS; and (6) prognosis and treatment. For the majority of clinically definite MS patients we advocate disclosure, identify steps for physicians to communicate the diagnosis and propose a framework to follow when revealing a diagnosis of MS.
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Affiliation(s)
- A Raphael
- Institute for Science, Ethics and Innovation, Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
| | - C H Hawkes
- Neuroscience Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
| | - J L Bernat
- Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire 03756, USA
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Macko T, Denayer JF, Pasch H, Pan L, Li J, Raphael A. Adsorption of Polypropylene and Polyethylene on Liquid Chromatographic Column Packings. Chromatographia 2004. [DOI: 10.1365/s10337-004-0228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Weinberger A, Halabe A, Raphael A, Samuel R, Pinkhas J. Spherulite crystals in synovial tissue of a patient with recurrent monoarthritis. Clin Exp Rheumatol 1984; 2:63-5. [PMID: 6532612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Frozen, unstained sections of synovial tissue of a 38-year-old man with recurrent monoarthritis and hyperuricemia were studied. Negatively birefringent crystals in a spherulite form were detected by using a compensated polarized light microscope. It is postulated that in some cases of gout the first stage of crystallization is in the spherulite form.
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Azoulay E, Jouanneau F, Bertrand JC, Raphael A, Janssens J, Lebeault JM. Fermentation Methods for Protein Enrichment of Cassava and Corn with
Candida tropicalis. Appl Environ Microbiol 1980; 39:41-7. [PMID: 16345495 PMCID: PMC291281 DOI: 10.1128/aem.39.1.41-47.1980] [Citation(s) in RCA: 34] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida tropicalis
grows on soluble starch, corn, and cassava powders without requiring that these substrates be previously hydrolyzed.
C. tropicalis
possesses the enzyme needed to hydrolyze starch, namely, an α-amylase. That property has been used to develop a fermentation process whereby
C. tropicalis
can be grown directly on corn or cassava powders so that the resultant mixture of biomass and residual corn or cassava contains about 20% protein, which represents a balanced diet for either animal fodder or human food. The fact that no extra enzymes are required to hydrolyze starch results in a particularly efficient way of improving the nutritional value of amylaceous products, through a single-step fermentation process.
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Affiliation(s)
- E Azoulay
- Laboratoire de Structure et Fonction des Biomembranes, U.E.R. de Luminy, 13288 Marseille Cedex 2, France
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Mendes E, Raphael A, Mota NG, Mendes NF. Cell-mediated immunity in leprosy and transfer of delayed hypersensitivity reactions. J Allergy Clin Immunol 1974; 53:223-9. [PMID: 4835734 DOI: 10.1016/0091-6749(74)90084-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Raphael A. Health and social welfare of Kentucky black people, 1865-1870. Societas 1972; 2:143-57. [PMID: 11633203] [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: 02/21/2023]
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Lopes CF, Raphael A, Neto VA, Sampaio SA. Treatment of South American blastomycosis with a new long-acting sulfonamide. Dermatol Int 1967; 6:231-5. [PMID: 4877617 DOI: 10.1111/j.1365-4362.1967.tb05275.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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acaz CDS, Ferri RG, Raphael A, Netto CF, Minami PS, Castro RM, Dillon NL. [Keloidal blastomycosis associated with South American blastomycosis. Report of a case]. Hospital (Rio J) 1967; 71:1-11. [PMID: 4971067] [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: 01/13/2023]
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Pereira WC, Tenuto RA, Raphael A, Sallum J. [Brain localization of South American blastomycosis. Considerations apropos of 9 cases]. Arq Neuropsiquiatr 1965; 23:113-26. [PMID: 5851892 DOI: 10.1590/s0004-282x1965000200006] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Lesões encefálicas produzidas pelo Paracoccidioides brasiliensis têm sido registradas na literatura com relativa freqüência. Os autores chamam a atenção para a dificuldade diagnóstica dêstes processos que, na quase totali- dade, constituem-se de achados cirúrgicos ou de necropsia. A síndrome de hipertensão intracraniana é a manifestação mais comum, levando quase sempre ao diagnóstico de tumor intracraniano. Os exames complementares, inclusive o líquido cefalorraqueano, são pobres em dados específicos; o encontro do parasita, assim como a positividade das reações de fixação de complemento e de precipitação nesse humor, são raramente verificadas. A natureza da afecção só tem sido suspeitada quando existem lesões paracocci-dióicas conhecidas em outros órgãos. Nove casos de blastomicose sul-americana com localização encefálica são estudados. Sete foram submetidos a intervenções cirúrgicas, dêstes, 3 tiveram boa evolução, sendo os únicos que sobreviveram de tôda a série. Nos três casos foi empregada, em épocas diversas depois da intervenção cirúrgica, anfotericina B pelas vias intravenosa ou intratecal. Os autores consideram a excição cirúrgica dos granulomas encefálicos imprescindível, mormente quando existem sinais de compressão bem localizadas. Após o ato cirúrgico a administração de anfotericina B, pelas vias intravenosa ou intratecal, deve ser prescrita a fim de evitar possíveis recidivas da moléstia.
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Pereira WC, Raphael A, Sallum J. [Neurological lesions in South American blastomycosis. Anatomopathological study of 14 cases]. Arq Neuropsiquiatr 1965; 23:95-112. [PMID: 5851897 DOI: 10.1590/s0004-282x1965000200005] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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