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Perets M, Yellinek S, Carmel O, Boaz E, Dagan A, Horesh N, Reissman P, Freund MR. The effect of mechanical bowel preparation on postoperative complications in laparoscopic right colectomy: a retrospective propensity score matching analysis. Int J Colorectal Dis 2023; 38:133. [PMID: 37193834 DOI: 10.1007/s00384-023-04409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To assess whether full bowel preparation affects 30-day surgical outcomes in laparoscopic right colectomy for colon cancer. METHODS A retrospective chart review of all elective laparoscopic right colectomies performed for colonic adenocarcinoma between Jan 2011 and Dec 2021. The cohort was divided into two groups-no bowel preparation (NP) group and patients who received full bowel preparation (FP), including oral and mechanical cathartic bowel preparation. All anastomoses were extracorporeal stapled side-to-side. The two groups were compared at baseline and then were matched using propensity score based on demographic and clinical parameters. The primary outcome was 30-day postoperative complication rate, mainly anastomotic leak (AL) and surgical site infection (SSI) rate. RESULTS The original cohort included 238 patients with a median age of 68 (SD 13) and equal M:F ratio. Following propensity score matching, 93 matched patients were included in each group. Analysis of the matched cohort showed a significantly higher overall complication rate in the FP group (28 vs 11.8%, p = 0.005) which was mostly due to minor type II complications. There were no differences in major complication rates, SSI, ileus, or AL rate. Although operative time was significantly longer in the FP group (119 vs 100 min, p ≤ 0.001), length of stay was significantly shorter in the FP group (5 vs 6 days, p = 0.001). CONCLUSIONS Aside from a shorter hospital stay, full mechanical bowel preparation for laparoscopic right colectomy does not seem to have any benefit and may be associated with a higher overall complication rate.
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Affiliation(s)
- Michal Perets
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Shlomo Yellinek
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofra Carmel
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Boaz
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nir Horesh
- Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael R Freund
- Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Itelman E, Perelman M, Bivar N, Kent D, Vaisman A, Segal G, Negru L, Dagan A. Hospitalized patients with positive antiphospholipid antibodies who have low complement levels are at increased risk for death-a retrospective cohort study. Lupus 2023; 32:668-674. [PMID: 36951167 PMCID: PMC10155279 DOI: 10.1177/09612033231164091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
PURPOSE To investigate whether low complement levels can predict worse outcomes in patients hospitalized with positive anti-phospholipid antibodies. METHODS This was a retrospective cohort study. We obtained demographics, laboratory, and prognostic data of all consecutive patients hospitalized between 2007 and 2021, for whatever reason, with at least one positively abnormal anti-phospholipid antibody, who were also tested for complement levels (C3 or C4). We then compared the rates of long-term mortality, 1-year mortality, deep vein thrombosis, and pulmonary emboli between groups of low complement and normal complement levels. Multivariate analysis was used to control for levels of clinical and laboratory confounders. RESULTS We identified 32,286 patients tested for anti-phospholipid antibodies. Of those patients, 6800 tested positive for at least one anti-phospholipid antibody and had a documented complement level. Significant higher mortality rates were found in the low complement group, with an odds ratio for mortality (OR 1.93 CI 1.63-2.27 p < .001). Deep vein thrombosis and pulmonary emboli rates were similar. Multivariate analysis confirmed that low complement was an independent predictor for mortality after controlling for age, sex, dyslipidemia, chronic heart failure (CHF), chronic kidney disease (CKD), and anemia. CONCLUSIONS Our study results indicate that low complement is associated with significantly higher mortality rates in admitted patients with elevated levels of anti-phospholipid antibodies. This finding correlates with recent literature suggesting a vital role for complement activation in anti-phospholipid syndrome.
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Affiliation(s)
- Edward Itelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Maxim Perelman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Natali Bivar
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Daniella Kent
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Adva Vaisman
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Gad Segal
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Liat Negru
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Amir Dagan
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Zloof Y, Agmon-Levin N, Toledano K, Oren S, Lidar M, Zisman D, Tavor Y, Amit-Vazina M, Sabbah F, Breuer GS, Dagan A, Beshara-Garzuzi R, Markovits D, Elias M, Feld J, Tayer-Shifman O, Gazitt T, Reitblatt T, Rubin L, Haddad A, Giryes S, Paran D, Peleg H, Molad Y, Elkayam O, Mevorach D, Balbir-Gurman A, Braun-Moscovici Y. A deep look into the storm: Israeli multi-center experience of coronavirus disease 2019 (COVID-19) in patients with autoimmune inflammatory rheumatic diseases before and after vaccinations. Front Immunol 2023; 14:1064839. [PMID: 36993961 PMCID: PMC10040776 DOI: 10.3389/fimmu.2023.1064839] [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: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectiveWe aimed to characterize the course of COVID-19 in autoimmune inflammatory rheumatic disease (AIIRD) patients in Israel, taking into consideration several remarkable aspects, including the outcomes of the different outbreaks, the effect of vaccination campaigns, and AIIRD activity post-recovery.MethodsWe established a national registry of AIIRD patients diagnosed with COVID-19, including demographic data, AIIRD diagnosis, duration and systemic involvement, comorbidities, date of COVID-19 diagnosis, clinical course, and dates of vaccinations. COVID-19 was diagnosed by a positive SARS-CoV-2 polymerase chain reaction.ResultsIsrael experienced 4 outbreaks of COVID-19 until 30.11.2021. The first three outbreaks (1.3.2020 – 30.4.2021) comprised 298 AIIRD patients. 64.9% had a mild disease and 24.2% had a severe course; 161 (53.3%) patients were hospitalized, 27 (8.9%) died. The 4th outbreak (delta variant), starting 6 months after the beginning of the vaccination campaign comprised 110 patients. Despite similar demographic and clinical characteristics, a smaller proportion of AIIRD patients had negative outcomes as compared to the first 3 outbreaks, with regards to severity (16 patients,14.5%), hospitalization (29 patients, 26.4%) and death (7 patients, 6.4%). COVID-19 did not seem to influence the AIIRD activity 1-3 months post-recovery.ConclusionsCOVID-19 is more severe and has an increased mortality in active AIIRD patients with systemic involvement, older age and comorbidities. Vaccination with 3 doses of the mRNA vaccine against SARS-CoV-2 protected from severe COVID-19, hospitalization and death during the 4th outbreak. The pattern of spread of COVID-19 in AIIRD patients was similar to the general population.
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Affiliation(s)
- Fadi Kharouf
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tali Eviatar
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maya Braun
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elisheva Pokroy-Shapira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Michal Brodavka
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Yair Zloof
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nancy Agmon-Levin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Clinical Immunology, Angioedema and Allergy Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Kochava Toledano
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Shirly Oren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Merav Lidar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Devy Zisman
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Yonit Tavor
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Mirit Amit-Vazina
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Service, Shamir Medical Center, Be’er Ya’akov, Israel
| | - Firas Sabbah
- Rheumatology Service, Baruch Padeh Medical Center, Tiberias, Israel
| | - Gabriel S. Breuer
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Rheumatology Unit, Shaare Tzedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Clinic, Assuta Ashdod Hospital, Ashdod, Israel
| | - Rima Beshara-Garzuzi
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Doron Markovits
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Muna Elias
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Joy Feld
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Oshrat Tayer-Shifman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Tal Gazitt
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | | | - Limor Rubin
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Allergy and Clinical Immunology Unit, Department of medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Amir Haddad
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- Rheumatology Unit, Carmel Medical Center, Haifa, Israel
| | - Sami Giryes
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Daphna Paran
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Peleg
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yair Molad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Rheumatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ori Elkayam
- Rheumatology Department, Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mevorach
- The Department of Medicine, Rheumatology Unit and Rare Disease Research Center, Hadassah Medical Center, Jerusalem, Israel
- The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Alexandra Balbir-Gurman
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
| | - Yolanda Braun-Moscovici
- Rheumatology Institute, Rambam Health Care Campus, Haifa, Israel
- Rappaport Faculty of Medicine, Israeli Institute of Technology-Technion, Haifa, Israel
- *Correspondence: Yolanda Braun-Moscovici,
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Klein L, Barkai T, Carmel-Neiderman N, Scheinowitz M, Dagan A, Shilo S, DeRowe A. Unilateral Increase of Gustatory Thresholds in Acute Otitis Media: A Pilot Study. J Int Adv Otol 2023; 19:112-115. [PMID: 36975083 PMCID: PMC10152077 DOI: 10.5152/iao.2023.22694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND To evaluate chorda tympani nerve function as measured by unilateral increases of gustatory thresholds in the presence of ipsilateral acute otitis media. METHODS Prospective clinical study comparing electrogustometric measurements was conducted to evaluate the taste thresholds of each side of the tongue in a patient during an acute episode of unilateral acute otitis media. Included were patients aged 12-40 who presented to the emergency department and outpatient ear, nose, and throat clinic of a university-affiliate tertiary medical center with unilateral acute otitis media between January 2019 and January 2020 and consented to the study. RESULTS Eleven patients were initially recruited into the study, and 10 patients aged (mean ± standard deviation) 26.1 ± 11.2 years comprised the final study group. Taste thresholds were significantly elevated on the side ipsilateral to the ear affected by acute otitis media (P < .05). CONCLUSION Chorda tympani nerve conductance is impaired during the acute stage of acute otitis media. This may have implications in the understanding of peripheral neural properties during acute middle ear inflammatory conditions and on the diagnosis of acute otitis media.
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Affiliation(s)
- Linor Klein
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tal Barkai
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Narin Carmel-Neiderman
- Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mickey Scheinowitz
- Sylvan Adams Sports Institute - Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Amir Dagan
- Sylvan Adams Sports Institute - Department of Biomedical Engineering, Tel-Aviv University, Tel Aviv, Israel
| | - Shahaf Shilo
- Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari DeRowe
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Otolaryngology Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dagan A, Rabin E. Not Every Pus Is Purulent. Isr Med Assoc J 2023; 25:163. [PMID: 36841991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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Dagan A, Sebag E. A Tale of Toes. Isr Med Assoc J 2023; 25:77. [PMID: 36718746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Amir Dagan
- Department of Internal Medicine I, Sheba Medical Center, Tel Hashomer, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elsa Sebag
- Maccabi Healthcare Services, Tel Aviv, Israel
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Paolisso P, Dagan A, Gallinoro E, De Colle C, Bertolone DT, Moya A, Penicka M, Degrieck I, Vanderheyden M, Bartunek J. Aortic thoracic neuromodulation in heart failure with preserved ejection fraction. ESC Heart Fail 2022; 10:699-704. [PMID: 36151858 PMCID: PMC9871658 DOI: 10.1002/ehf2.14136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/07/2022] [Accepted: 08/24/2022] [Indexed: 01/27/2023] Open
Abstract
The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device-based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance. In this first-in-man experience with chronic stimulation of aortic vagal afferents (Harmony™ System, Enopace, Israel), we demonstrate improved left atrial remodelling and function parallel with improved left ventricular performance. The observed favourable structural and functional cardiac changes remained stable throughout the 1 year follow-up and were associated with improved symptoms and physical fitness. The current experience warrants further validation of the endovascular stimulation of aortic thoracic afferents as a new interventional approach for device-based treatment in HFpEF.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | | | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Translational Medical SciencesUniversity of Campania' Luigi Vanvitelli'NaplesItaly
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium,Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Ana Moya
- Cardiovascular Center Aalst, OLV HospitalAalstBelgium
| | | | - Ivan Degrieck
- Cardiovascular and Thoracic Surgery, OLV‐ClinicAalstBelgium
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Dorot S, Tankel J, Doviner V, Shmeeda H, Amitay Y, Ohana P, Dagan A, Ben-Haim M, Reissman P, Gabizon A. Ex-vivo activation of a liposomal prodrug of mitomycin C by human tumors. Cancer Chemother Pharmacol 2022; 90:109-114. [PMID: 35802145 DOI: 10.1007/s00280-022-04451-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the ex- vivo ability of explanted human tumors and normal tissue to activate liposomal mitomycin C lipidic prodrug (MLP) by releasing the active free drug form, mitomycin C (MMC). METHODS We tested conversion of MLP to MMC in an ex vivo assay using explanted tissues obtained during routine surgery to remove primary tumors or metastases. Tumor and adjacent normal tissue were obtained from freshly explanted tumors and were immediately deep frozen at - 70 °C. On test day, the fragments were thawed, homogenized and incubated in the presence of a fixed amount of liposomal MLP at 37 °C for 1 h. We measured MLP and its rate of conversion to MMC by HPLC. Controls included plasma, malignant effusions, red blood cells, tumor cell lines, mouse liver, and buffer with dithiothreitol, a potent reducing agent. RESULTS Most patients tested (16/20) were diagnosed with colo-rectal carcinoma. The average fraction of MLP cleaved per 100-mg tumor tissue (21.1%, SEM = 1.8) was greater than per 100-mg normal tissue (16.6%, SEM = 1.3). When the tumor and normal tissue samples were paired by patient, the difference was statistically significant (p = 0.022, paired t test). Biological fluids did not activate liposomal MLP, while normal liver tissue strongly does. Interestingly, the omental fatty tissue also greatly activated MLP. CONCLUSIONS Tumor tissue homogenates activate MLP with greater efficiency than the surrounding normal tissues, but far less than liver and adipose tissue. These observations demonstrate the bioavailability of liposomal MLP in human tumors, and its pharmacologic potential in cancer therapy.
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Affiliation(s)
- Shira Dorot
- Department of Surgery, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - James Tankel
- Department of Surgery, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - Victoria Doviner
- Department of Pathology, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - Hilary Shmeeda
- Oncology Institute, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | | | | | - Amir Dagan
- Department of Surgery, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - Menachem Ben-Haim
- Department of Surgery, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - Petachia Reissman
- Department of Surgery, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel
| | - Alberto Gabizon
- Oncology Institute, Shaare Zedek Medical Center and Hebrew University-Faculty of Medicine, Jerusalem, Israel. .,Shaare Zedek Nano-oncology Research Center, POB 3235, 12 Shmuel Bayit St., 91031, Jerusalem, Israel.
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Agmon-Levin N, Toledano K, Oren S, Lidar M, Amit Vazina M, Sabbah F, Tavor Y, Breuer G, Zisman D, Markovits D, Dagan A, Bishara Garzuzi R, Shifman O, Giryes S, Elias M, Feld J, Reitblat T, Gazit T, Hadad A, Elkayam O, Paran D, Mevorach D, Balbir-Gurman A, Braun-Moscovici Y. POS1254 RISK FACTORS FOR SEVERE COVID-19 INFECTION AMONG PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIRD) AND THE IMPACT OF VACCINATIONS - AN ISRAELI, MULTI-CENTER EXPERIENCE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundAIRD patients (pts) may be more susceptible to severe COVID19.ObjectivesTo determine the risk factors for severe COVID19 and the effect of vaccinations among AIRD pts followed at dedicated rheumatology clinics.MethodsAt the onset of the pandemic, we established a national registry of AIRD pts, diagnosed with COVID19, based on voluntary reporting by the treating rheumatologist. 12 centers from Israel participated in the study. COVID19 was confirmed by a positive SARS CoV2 PCR. The indications for PCR testing were clinical symptoms or close contact with an infected person. Severe illness was defined by SpO2 <94% in room air, respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infiltrates >50% on imaging. The registry included demographic data, AIRD diagnosis and duration, visceral involvement, co-morbidities, immunomodulatory treatment, date of diagnosis and severity of COVID19 disease, management, complications, duration of hospitalization, the dates of the mRNA vaccinations, lab results and outcome. We analyzed data from 1.3.2020 to 30.11.2021ResultsDuring the study period we experienced 4 outbreaks of COVID19 infection. Initially social distancing, followed by a lockdown were imposed. The low number of cases led to relaxation of the measures. Two more severe outbreaks followed, which triggered 2 new lockdowns. The 3rd outbreak ended almost 2 months after vaccination started (BNT162b2 mRNA COVID19 vaccine). From March 1st 2020 to April 30, 2021, 298 AIRD pts (70.8% females, mean (SD) age 53.3(15.3)) with confirmed COVID19 infection were included. 43.3%(129) had visceral involvement due to the AIRD. 58.7%(175 pts) were on conventional synthetic disease modifying drugs (csDMARDs), 44.6% (133) on biologic/targeted DMARDs and 40% (120) on prednisone. Almost 2/3 of pts had at least one comorbidity.In a multivariate logistic regression analysis age, AIRD with pulmonary involvement, diabetes and treatment with prednisone, mycophenolate mofetil or JAK inhibitors were associated with hospitalization. Older age, renal and vascular involvement due to the AIRD, and congestive heart failure were associated with higher mortality.The 4th outbreak occurred 6 months after the introduction of vaccines, with spreading of the delta variant: 110 AIRD pts with COVID19 were recorded. Demographic data, clinical AIRD‘s characteristics, immunomodulatory treatment and comorbidities were similar to the previous outbreaks. However, during the 4th outbreak, the proportion of pts with severe COVID19, the hospitalization and mortality rate were significantly lower as compared to the first 3 outbreaks (15% vs 24%, 27% vs 53%, 6.7% vs 9.1%, respectively). Among COVID19 pts, 25% received a 3rd vaccine dose (booster), 56% contracted infection more than 5 months after the 2nd vaccine dose and 24% were unvaccinated. Most of the pts who received the booster contracted the disease within a week of vaccination. The odds ratio for hospitalization in vaccinated pts compared to unvaccinated was 0.11 (0.01 – 0.63 95% CI, p=0.041) in those vaccinated within the previous 1-5 months, and 0.38 (0.21-0.67 95% CI, p=0.001) in those vaccinated more than 6 months ago. 9 pts died, 5 were more than 6 months after the 2nd mRNA vaccine, 2 were unvaccinated and 1 patient received the booster on the same day of COVID19 diagnosis.ConclusionBefore the vaccination campaign, the hospitalization and mortality rate in our cohort were similar to the data reported by other registries. COVID19 tends to be more severe, with increased mortality in patients with active AIIRD and visceral involvement (pulmonary, cardiac, renal), advanced age and co-morbidities. The delta outbreak occured 6 months after the implementation of vaccinations and was associated with significantly lower hospitalization and mortality rates, despite the increased aggressiveness of the variant. Vaccination of AIIRD pts with 3 doses of mRNA vaccines protects from severe COVID19 disease, hospitalization, and death.AcknowledgementsFadi Kharouf and Tali Eviatar had equal contributionDisclosure of InterestsNone declared
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Itelman E, Perelman M, Kent D, Bibar N, Segal G, Negru L, Dagan A. POS0784 LOW COMPLEMENT LEVELS ARE ASSOCIATED WITH HIGHER MORTALITY IN HOSPITALIZED PATIENTS WITH POSITIVE ANTIPHOSPHOLIPID ANTIBODIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAntiphospholipid Syndrome is an autoimmune disease characterized by increased risk for vascular thrombosis (arterial and/or venous) thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies. The mechanisms by which aPLs induce thrombosis are unclear; several have been suggested, among them complement activation.(1-2) The complement system is a system of enzymes and regulatory proteins of the innate immune system that play a crucial role in the inflammatory response to various pathogenic stimuli. The complement and coagulation pathways are interconnected, and expanding evidence indicates that complement may be activated in patients with antiphospholipid syndrome (3-5).ObjectivesOur study was intended to better characterize the complicated relations between antiphospholipid antibodies and complement activation among hospitalized patients with antiphospholipid syndrome and its impact on short- and long-term prognosisMethodsA retrospective cohort studies. Clinical and prognostic data of hospitalized patients with antiphospholipid syndrome and a measurement of complement levels (C3 or C4) were obtained. Rates of long-term mortality, one-year mortality, deep vein thrombosis (DVT), and pulmonary emboli (PE) were compared between patients with low complement levels and patients with normal complement levels. Low complement was defined as C3 < 90 mg/dl or C4 < 10 mg/dl. A multivariate analysis was performed to control for Anticardiolipin levels, β₂ macroglobulin levels and RVVT ratio.ResultsComplete data was available for 6,599 patients, of which 712 (11%) had low complement levels. The median age of the cohort was 47.7, and most of the patients were females (56%). Patients with low complement levels had significantly higher mortality rates 30% vs. 18%, p < 0.001 for long-term mortality (Figure 1) and 15% vs. 5%, p < 0.001 for 1 year mortality when compared to patients with normal complement levels. DVT and PE rates were similar (4% vs 3.8%, P = 0.78 and 4% vs 2.4%, P = 0.13 respectively). Results of the multivariate analysis (Table 1) were consistent and showed that patients with low complement levels had 111% higher mortality rates (CI 1.52-2.90, P < 0.001).Table 1.Multivariate Analysis for long term mortalityMultivariate AnalysisOR (CI)pLow Complement2.11 [1.52, 2.90]<0.001Anticardiolipin IGG1.00 [1.00, 1.01]0.243Anticardiolipin IGM0.99 [0.98, 1.00]0.084β₂ IGM1.01 [1.00, 1.01]0.017β₂ IGG1.00 [0.99, 1.00]0.663RVVT Ratio0.99 [0.63, 1.52]0.954Figure 1.Cumulative 10-Year survivalConclusionIn hospitalized patients with high aPLs, low complement levels are associated with significantly higher mortality rates. This finding is in correlation with recent literature, suggesting an important role for complement activation in APS.References[1]Chaturvedi S, Brodsky RA, McCrae KR. Complement in the pathophysiology of the antiphospholipid syndrome. Front Immunol. 2019 Mar 14;10:449.[2]Bu C, Gao L, Xie W, Zhang J, He Y, Cai G, et al. beta2-glycoprotein i is a cofactor for tissue plasminogen activator-mediated plasminogen activation. Arthritis Rheum. 2009 Feb;60(2):559–568.[3]Tedesco F, Borghi MO, Gerosa M, Chighizola CB, Macor P, Lonati PA, et al. Pathogenic role of complement in antiphospholipid syndrome and therapeutic implications. Front Immunol. 2018 Jun 19;9:1388.[4]Oku K, Nakamura H, Kono M, Ohmura K, Kato M, Bohgaki T, et al. Complement and thrombosis in the antiphospholipid syndrome. Autoimmun Rev. 2016 Oct;15(10):1001–1004.[5]Salmon JE, Girardi G, Holers VM. Complement activation as a mediator of antiphospholipid antibody induced pregnancy loss and thrombosis. Ann Rheum Dis. 2002 Nov;61 Suppl 2:ii46–50.Disclosure of InterestsNone declared
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Boaz E, Freund MR, Harbi A, Dagan A, Gilshtein H, Reissman P, Yellinek S. Anorectal Malignancies Presenting as a Perianal Abscess or Fistula. Am Surg 2022:31348221101481. [PMID: 35621130 DOI: 10.1177/00031348221101481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute anorectal abscess and fistula are common conditions that usually presents as a painful lump close to the anal margin. Tumors in the distal rectum and in the perianal region may mimic the symptoms and signs of anorectal sepsis, thereby leading to a delay in diagnosis and management. The purpose of this study was to describe patients presenting with acute perianal abscess or fistula who were subsequently diagnosed with anorectal cancer. METHODS We performed a retrospective, review of all cases presenting with acute perianal abscess or fistula who were subsequently found to have anorectal carcinoma on biopsy in two tertiary centers. We analyzed the data focusing on the clinical features, laboratory values, clinical staging of the tumors, the subsequent management, the pathological staging, and the outcome of each patient. RESULTS Overall, 3219 patients presenting with anorectal abscess or fistula were reviewed. Cancer was diagnosed in 16 (.5%) patients, 12 with adenocarcinoma of the rectum and 4 with squamous cell carcinoma of the anus. In 5 patients (31.2%), cancer was diagnosed in the setting of chronic perianal fistula, 4 of them had Crohn's disease. In 10 patients (62.5%), cancer was not diagnosed during the initial evaluation of the acute symptoms. CONCLUSIONS A high index of suspicion is required to make the diagnosis of perianal tumors when assessing patients presenting with perianal sepsis, particularly those with Crohn's disease, a long history of persistent perianal disease, and an advanced age. In most cases, proper drainage followed by proximal diversion are the surgical treatment of choice in the acute setting.
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Affiliation(s)
- Elad Boaz
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Michael R Freund
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Asaf Harbi
- Colorectal Unit, Department of General Surgery, 574334Rambam Health Care Campus, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amir Dagan
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Hayim Gilshtein
- Colorectal Unit, Department of General Surgery, 574334Rambam Health Care Campus, The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Petachia Reissman
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Shlomo Yellinek
- Department of General Surgery, 26743Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
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Boaz E, Ben-Chetrit E, Bokhobza Y, Yellinek S, Ben-Haim M, Reissman P, Dagan A. Pyogenic Liver Abscess: Contemporary Trends in a Tertiary Institute. Int J Clin Pract 2022; 2022:4752880. [PMID: 36567774 PMCID: PMC9750783 DOI: 10.1155/2022/4752880] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) is an uncommon but potentially life-threatening condition. In recent years, advances in diagnostics and management have led to early diagnosis and treatment and decreased mortality. We present recent data from a large series of patients with PLA and examine the trends in the management of PLA over a period of 50 years. METHODS The medical records of all patients admitted to the Shaare Zedek Medical Center, Israel, between January 2011 and December 2021 with a primary or secondary diagnosis of PLA were reviewed retrospectively. RESULTS : Ninety-five patients with PLA were identified. Thirty-eight (40%) were female. The median patient age was 66 years (range 18-93). The diagnosis of PLA in all patients was confirmed with abdominal computed tomography (CT). In twenty patients (21.1%), PLA was not diagnosed by the initial abdominal US. Most abscesses were right-sided. Biliary tract origin was the most common underlying cause of PLA (n = 57, 60%), followed by cryptogenic etiology (n = 28, 30%). Escherichia coli, Klebsiella pneumoniae, and Streptococcus species were most commonly identified. The most common primary treatment modality was percutaneous drainage (PD), which was performed in 81 patients (85.3%). Fourteen patients (14.7%) were treated medically without intervention, and two patients (2.1%) were treated surgically following a failure of PD. Four patients died as a direct result of PLA. CONCLUSIONS Patients diagnosed with PLA are older, the male predominance is less pronounced, and the offending pathogens are likely to originate from the biliary tract. This study questions the utility of abdominal US as the initial diagnostic imaging in patients with suspected PLA (versus CT) and demonstrates improved outcomes for patients with PLA over the years.
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Affiliation(s)
- Elad Boaz
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Faculty of Medicine, Hebrew University of Jerusalem, Infectious Diseases Unit, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Yonathan Bokhobza
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Shlomo Yellinek
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Menahem Ben-Haim
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Petachia Reissman
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Faculty of Medicine, Hebrew University of Jerusalem, Surgical Department, Shaare-Zedek Medical Center, Jerusalem, Israel
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Ben Shimol A, Dahan S, Alon N, Soffer S, Hod K, Brosh-Nissimov T, Shoenfeld Y, Dagan A. Can laboratory evaluation differentiate between coronavirus disease-2019, influenza, and respiratory syncytial virus infections? A retrospective cohort study. Croat Med J 2021. [PMID: 34981695 PMCID: PMC8771226 DOI: 10.3325/cmj.2021.62.623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aim To identify clinical and laboratory parameters that can assist in the differential diagnosis of coronavirus disease 2019 (COVID-19), influenza, and respiratory syncytial virus (RSV) infections. Methods In this retrospective cohort study, we obtained basic demographics and laboratory data from all 685 hospitalized patients confirmed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza virus, or RSV from 2018 to 2020. A multiple logistic regression was employed to investigate the relationship between COVID-19 and laboratory parameters. Results SARS-CoV-2 patients were significantly younger than RSV (P = 0.001) and influenza virus (P = 0.022) patients. SARS-CoV-2 patients also displayed a significant male predominance over influenza virus patients (P = 0.047). They also had significantly lower white blood cell count (median 6.3 × 106 cells/μ) compared with influenza virus (P < 0.001) and RSV (P = 0.001) patients. Differences were also observed in other laboratory values but were insignificant in a multivariate analysis. Conclusions Male sex, younger age, and low white blood cell count can assist in the diagnosis of COVID-19 over other viral infections. However, the differences between the groups were not substantial enough and would probably not suffice to distinguish between the viral illnesses in the emergency department.
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Stanescu N, Wood K, Greenberg T, Maklakovski M, Rubinov A, Dagan A. Hemi-central Retinal Artery Occlusion Associated with Giant Cell Arteritis. Isr Med Assoc J 2021; 23:454-455. [PMID: 34251132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Keren Wood
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Tal Greenberg
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Marina Maklakovski
- Department of Pathology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Avi Rubinov
- Department of Ophthalmology, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amir Dagan
- Department of Rheumatology, Wolfson Medical Center, Holon, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
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Kharouf F, Eviatar T, Braun M, Pokroy-Shapira E, Brodavka M, Agmon-Levin N, Toledano K, Oren S, Lidar M, Tavor Y, Amit Vazina M, Sabbah F, Breuer G, Dagan A, Zisman D, Markovits D, Reitblat T, Giryes S, Mevorach D, Paran D, Elkayam O, Balbir-Gurman A, Braun-Moscovici Y. POS1217 THE PATTERN OF COVID 19 PANDEMIC AMONG PATIENTS WITH AUTOIMMUNE INFLAMMATORY RHEUMATIC DISEASES (AIIRD). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The epidemiology of COVID19 among patients with AIIRD may be influenced by a dysregulated immune system, immunosuppressive therapies and behavioral patterns. Data regarding the epidemiology of COVID19 among patients with AIIRD is scarce.Objectives:To assess the pattern of COVID19 pandemic among patients with AIIRD compared to the general population in IsraelMethods:At the beginning of the COVID-19 pandemic, we established a national registry of patients with AIIRD, diagnosed with COVID-19, based on voluntary reporting by the treating rheumatologist. All the members of the Israeli Society of Rheumatology were encouraged to participate and repeatedly reminded to report any new cases. Rheumatology centers from 11 hospitals from the Northern and Central part of Israel participated in this study. The registry included demographic data, AIIRD diagnosis and duration, systemic organ involvement, co-morbidities, treatment (conventional synthetic disease modifying drugs (csDMARDs), biologic/targeted (b/ts) DMARDs, corticosteroids use, dose and treatment duration, date of COVID19 diagnosis, severity of the viral disease and complications, duration of hospitalization, if required, treatment for COVID 19, laboratory results and outcome. The diagnosis of COVID 19 was made by a positive SARS CoV2 PCR. The indications for SARS CoV2 PCR testing in Israel comprise clinical symptoms or exposure to a confirmed close contact. Severe illness was defined by SpO2 <94% in room air, respiratory rate of >30 breaths/min, PaO2/FiO2 <300 mm Hg, or lung infiltrates >50% on chest imaging.The epidemiological data regarding the number of COVID19 confirmed patients, the number of severe cases and the rate of mortality among the general population per day and per week, were extracted from the data dashboard of the Israeli Ministry of Health. We analyzed data from 02.2020 to 15.01.2021.Results:During the study period we experienced 3 waves of COVID 19 pandemic. The governmental management of COVID19 spread, at the beginning of the pandemic, included inforcement of severe travel restrictions and social distancing, followed eventually by a preventive lockdown, in spite of the relatively low number of cases. Easing of the restrictions, lifting the travel ban, opening of the commerce and schools led to 2 much more severe waves, which triggered 2 new lockdowns. Up to January 2021, 549763 Israelis had confirmed COVID19, 30% of whom had severe disease, 0.84% died (30% of the patients with severe disease).We identified 190 AIIRD patients (mean(SD) age 52(18), 30% males) who had confirmed COVID19. The weekly incidence curve of patients with rheumatic diseases correlated with the curve of the general population (Figure 1).Sixty-one % of the patients with AIIRD received csDMARDs, 41% were on b/tsDMARDs, 39% on chronic corticosteroids, 12% on ≥10mg prednisone. Forty-seven% of patients required hospitalization, 20% had severe COVID19. Sixteen patients (42% of patients with severe COVID19) (mean(SD), median age 64.7(15.4),67)) died (systemic sclerosis-4 patients, rheumatoid arthritis – 6, systemic lupus erythematosus – 2, antiphospholipid syndrome-2, granulomatous polyangiitis -1, polymyalgia rheumatica-1). The AIIRD was active in 56% of them, 50% received csDMARDs, none of them were on b/tsDMARDs, 31% received chronic prednisone>10 mg. All patients who died had at least 2 comorbidities.Conclusion:The pattern of spread of COVID19 in AIIRD patients is similar to the general population despite repeated mass media alerts for enhanced social distancing for elderly and immune suppressed patients. The disease tends to be more severe with enhanced mortality, especially in those with active AIIRD disease and organ involvement (lungs, heart, renal), older age and co-morbidities. A reporting bias cannot be excluded.Figure 1.Acknowledgements:Both first authors contributed equally to the manuscript.Disclosure of Interests:None declared.
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Manor U, Doviner V, Kolodziejek J, Weidinger P, Dagan A, Ben-Haim M, Rokah M, Nowotny N, Boleslavsky D. Capillaria hepatica (syn. Calodium hepaticum) as a Cause of Asymptomatic Liver Mass. Am J Trop Med Hyg 2021; 105:204-206. [PMID: 33999846 DOI: 10.4269/ajtmh.21-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/10/2021] [Indexed: 11/07/2022] Open
Abstract
Capillaria hepatica (syn. Calodium hepaticum) is a parasitic nematode of rodents, rarely infecting humans. An asymptomatic Israeli adult male with extensive travel history was diagnosed with a liver mass on routine post-thymectomy follow-up. Imaging and computer tomography (CT) guided biopsy were inconclusive. Surgical excision revealed an eosinophilic granuloma with fragments of a nematode suspected to be C. hepatica. Molecular methods verified the diagnosis, and the patient was treated empirically. This is the first case of hepatic capillariasis described in Israel, and the first to be diagnosed using molecular methods.
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Affiliation(s)
- Uri Manor
- 1Sheba Medical Center, Ramat Gan, Israel.,2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Doviner
- 3Shaare Zedek Medical Center, Jerusalem, Israel.,4The Hebrew University School of Medicine, Jerusalem, Israel
| | | | - Pia Weidinger
- 5University of Veterinary Medicine Vienna, Vienna, Austria
| | - Amir Dagan
- 3Shaare Zedek Medical Center, Jerusalem, Israel.,4The Hebrew University School of Medicine, Jerusalem, Israel
| | - Menahem Ben-Haim
- 3Shaare Zedek Medical Center, Jerusalem, Israel.,4The Hebrew University School of Medicine, Jerusalem, Israel
| | - Merav Rokah
- 1Sheba Medical Center, Ramat Gan, Israel.,2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Norbert Nowotny
- 5University of Veterinary Medicine Vienna, Vienna, Austria.,6College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Daniel Boleslavsky
- 1Sheba Medical Center, Ramat Gan, Israel.,2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Affiliation(s)
- Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel, and Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Shani Dahan
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel, and Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Marina Maklakovski
- Pathology Department, Assuta Medical Center, Ashdod, Israel, and Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Amir Dagan
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel, and Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Dahan S, Segal G, Katz I, Hellou T, Tietel M, Bryk G, Amital H, Shoenfeld Y, Dagan A. Ferritin as a Marker of Severity in COVID-19 Patients: A Fatal Correlation. Isr Med Assoc J 2020; 22:494-500. [PMID: 33236582] [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 Ferritin, the cellular protein storage for iron, has emerged as a key molecule in the immune system, orchestrating the cellular defense against inflammation. At the end of 2019, the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) rapidly spread throughout China and other countries around the world, resulting in a viral pandemic. OBJECTIVES To evaluate the correlation between ferritin and disease severity in coronavirus disease-2019 (COVID-19). METHODS In this cross-sectional study, we obtained clinical and laboratory data regarding 39 hospitalized patients with confirmed COVID-19 from two hospitals in Israel. RESULTS A significant increase in ferritin levels was demonstrated in patients with moderate and severe disease, compared to patients with mild disease (P = 0.006 and 0.005, respectively). Severe patients had significantly higher levels of ferritin (2817.6 ng/ml) than non-severe patients (708.6 ng/ml) P = 0.02. CONCLUSIONS In this preliminary cross-sectional study, elevated ferritin levels were shown to correlate with disease severity in 39 patients from Israel with confirmed COVID-19 infection. Our results further strengthen the hypothesis that severe COVID-19 disease might be due to an underlying dysregulated hyperimmune response. In order to identify these patients early and prioritized resources, we believe that all patients with COVID-19 should be screened for hyperferritinemia.
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Affiliation(s)
- Shani Dahan
- Department of Internal Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated with Ben-Gurion University of the Negev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Department of Internal Medicine T, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Katz
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Hellou
- Department of Internal Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated with Ben-Gurion University of the Negev
| | - Michal Tietel
- Department of Internal Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated with Ben-Gurion University of the Negev
| | - Gabriel Bryk
- Department of Internal Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Howard Amital
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Dagan
- Department of Internal Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated with Ben-Gurion University of the Negev
- Department of Rheumatology, Assuta Ashdod Medical Center, Ashdod, Israel, affiliated with Ben-Gurion University of the Negev
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Abstract
Both total-body iron stores and inflammation influence the concentration of ferritin in the blood. Ferritin as an inflammatory marker might serve as a prognostic marker in the elderly. Therefore, we characterized the clinical circumstances and long-term outcomes of hyperferritinemia (> 1000 μg/L) in hospitalized elderly patients.A retrospective analysis of elderly (> 70 years) inpatients with ferritin levels of > 1000 μg/L in a tertiary medical center during a 3-year period. We obtained both laboratory and clinical data, assessing the potential association of high ferritin levels with long-term mortality.Overall, 242 patients (median age 79 years; median ferritin level 1436 μg/L) met the inclusion criteria and were followed for a median time of 18.6 months. Clinical outcomes were dismal for the whole cohort: the diagnosis of solid malignancy occurred in 23.5% of cases while 31% had a severe infection (ranging from sepsis to septic shock). The median survival time of the whole cohort was 4.7 months only. Within the cohort, risk stratification was feasible: higher ferritin levels differentiate between groups of patients who had a poor prognosis (with either septic shock or solid malignancy) and those who had a relatively favorable prognosis (patients diagnosed as suffering from sepsis without shock and patients with iatrogenic causes for hyperferritinemia).Hyperferritinemia in elderly inpatients is associated with high rates of mortality. Within this group of patients, differential ferritin levels enable further risk stratification. High ferritin levels in the elderly can differentiate the bad from the worst.
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Affiliation(s)
- Gal Goldhaber
- Department of Internal Medicine “T”, Chaim Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer
| | - Gad Segal
- Department of Internal Medicine “T”, Chaim Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hashomer
| | - Amir Dagan
- Rheumatology Unit, Assuta Ashdod Medical Center, Affiliated with Ben-Gurion University of the Negev, Ashdod
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Hoshomer, Israel
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Tankel J, Sahnan K, Neumann M, Carmel O, Dagan A, Reissman P, Ben Haim M. Enhanced Recovery Deviation and Failure After Pancreaticoduodenectomy: Causative Factors and Impact. J Surg Res 2019; 245:569-576. [PMID: 31494390 DOI: 10.1016/j.jss.2019.07.055] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/26/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) following pancreaticoduodenectomy (PD) is popular and safe. This study aimed to describe the incidence, causative factors, and clinical impact of deviation from and failure of an ERAS protocol. MATERIALS AND METHODS A prospective cohort analysis of elective PD patients managed according to an ERAS protocol between October 2015 and June 2018 was performed. Univariate and multivariate analyses identified variables associated with protocol deviation and failure. The relationship between protocol deviation and failure was also explored. RESULTS A total of 97 patients were identified comprising of 46 females and 51 males. The median age was 68 y (range 17-85). Twenty-one patients (21.6%) suffered serious complications, whereas two (2.1%) died perioperatively. The median length of stay (LoS) was 14 d (6-36). In total, 73 (75.3%) patients deviated, whereas 39 (40.2%) failed the protocol. On univariate analysis, protocol deviation was associated with male gender, surgery time ≥270 min, and prolonged LoS. On multivariate analysis only prolonged LoS remained significant. Only serious complications were associated with protocol failure on multivariate analysis. Protocol deviation was not associated with significant complications nor ERAS protocol failure. CONCLUSIONS ERAS protocol deviation does not alter the course of those destined to protocol failure. Greater understanding into the causative factors of either protocol deviation or failure may be the only way to personalize care and realize the maximal benefit of ERAS in this specific group of patients.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel; Department of Surgery and Cancer, Imperial College Healthcare Trust, London, St Mary's Hospital, London, UK.
| | - Kapil Sahnan
- Department of Surgery and Cancer, Imperial College Healthcare Trust, London, St Mary's Hospital, London, UK
| | - Michael Neumann
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Ofra Carmel
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel
| | - Menahem Ben Haim
- Department of General Surgery, Shaare Zedek Medical Centre, The Hebrew University School of Medicine, Jerusalem, Israel
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Goren I, Brom A, Yanai H, Dagan A, Segal G, Israel A. Risk of bacteremia in hospitalised patients with inflammatory bowel disease: a 9-year cohort study. United European Gastroenterol J 2019; 8:195-203. [PMID: 32213075 DOI: 10.1177/2050640619874524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with inflammatory bowel disease might be at increased risk of invasive bacterial infections. OBJECTIVES The objective of this study was to identify the rate of bacteremia in hospitalised patients with inflammatory bowel disease and risk factors. METHODS An observational cohort of hospitalised patients with inflammatory bowel disease, aged 16-80 years, from 2008 to 2017 in a large tertiary hospital. Patients with Charlson comorbidity index of 2 or greater were excluded. Patients with one or more positive blood culture were reviewed. Logistic regression was used to evaluate risk factors for bacteremia. RESULTS Of 5522 admitted patients, only 1.3% had bacteremia (73/5522) (39, Crohn's disease; 25, ulcerative colitis; nine, unclassified inflammatory bowel disease). The most common pathogen was Escherichia coli (19/73 patients). The mortality rate at 30 days of patients with bacteremia was 13.7% (10/73). Longer hospitalisations (mean length of stay (21.6 ± 31.0 vs. 6.4 ± 16.0 days; P < 0.0001) and older age (mean age 47.5 ± 18.0 vs. 40.2 ± 15.4 years, P < 0.0001)) were associated with an increased risk of bacteremia. In multivariate analysis, treatment with either anti-tumour necrosis factor α, purine analogues, steroids or amino salicylates was not associated with an increased risk of bacteremia. Risk was greatest among patients aged 65 years or older (relative risk 2.84, 95% confidence interval 1.6-4.8; P = 0.0001) relative to those under 65 years. CONCLUSION Age over 65 years, but not inflammatory bowel disease-related medications, is associated with an increased risk of bacteremia in hospitalised patients with inflammatory bowel disease.
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Affiliation(s)
- Idan Goren
- Division of Gastroenterology, Rabin Medical Center * , Petah Tikva, Israel
| | - Adi Brom
- Internal Medicine T, Chaim Sheba Medical Center * , Tel-Hashomer, Ramat-Gan, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center * , Petah Tikva, Israel
| | - Amir Dagan
- Rheumatology Unit, Assuta Medical Center, Ashdod, Israel
| | - Gad Segal
- Internal Medicine T, Chaim Sheba Medical Center * , Tel-Hashomer, Ramat-Gan, Israel
| | - Ariel Israel
- Clalit Jerusalem Research Center, Clalit Health Services, Jerusalem, Israel
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22
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Haviv-Yadid Y, Segal Y, Dagan A, Sharif K, Bragazzi NL, Watad A, Amital H, Shoenfeld Y, Shovman O. Mortality of patients with rheumatoid arthritis requiring intensive care: a single-center retrospective study. Clin Rheumatol 2019; 38:3015-3023. [PMID: 31254235 DOI: 10.1007/s10067-019-04651-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/10/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) are at a high risk for life-threatening conditions requiring admission to the intensive care unit (ICU), but the data regarding the outcomes of these patients is limited. The present study investigated the clinical characteristics and outcomes of RA patients admitted to an ICU. METHODS This retrospective cohort study included RA patients admitted to the general ICU of the Sheba Medical Center during 2002-2018. The main outcome was 30-day mortality. Using Student's t test, χ2, and multivariable analyses, we compared the demographic, clinical, and laboratory parameters of the survivors and the non-survivors. Figures with p value < 0.05 were considered statistically significant. RESULTS Forty-three RA patients were admitted to the ICU during the study period (mean age, 64.0 ± 13.1 years; 74.4% female). The leading causes of ICU admission were infection (72.1%), respiratory failure (72.1%), renal failure (60.5%), and septic shock (55.8%). The 30-day mortality rate was 34.9%, with infection (9/15, 60%) as the most frequent cause. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were 19.7 ± 12.5 and 7.0 ± 4.5, respectively. Multivariable analysis showed that heart failure (p = 0.023), liver failure (p = 0.012), SOFA score (p = 0.007), and vasopressor treatment in ICU (p = 0.039) were significantly associated with overall mortality. SOFA score was linked with overall mortality (area under the curve (AUC) = 0.781 ± 0.085, p = 0.003) and mortality from respiratory failure (AUC = 0.861 ± 0.075, p = 0.002), while APACHE II score was only correlated with mortality from infection (AUC = 0.735 ± 0.082, p = 0.032). CONCLUSIONS Our study demonstrated a relatively high mortality rate among RA patients who were admitted to the general ICU. RA patients with risk factors such as heart failure, liver failure, elevated SOFA score, and vasopressor treatment in ICU should be promptly identified and treated accordingly. Key Points • The 30-day mortality rate of patients with RA that were admitted to the general ICU of a tertiary hospital was 34.9%. • The most common causes of ICU admission among patients with RA were infections and respiratory failure. Infections were the most common cause of death among these patients. • Patients with RA that present to the ICU with heart failure, liver failure, elevated SOFA score, and/or require vasopressor treatment in ICU should be promptly identified and treated accordingly.
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Affiliation(s)
| | - Yulia Segal
- Department of Internal Medicine 'T', Sheba Medical Center, Ramat Gan, Israel
| | - Amir Dagan
- Department of Internal Medicine 'B', Assuta Ashdod Medical Center, Ashdod, Israel
- Rheumatology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Kassem Sharif
- Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel
| | - Howard Amital
- Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Past incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Tel Aviv University, Tel Aviv, Israel
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Ora Shovman
- Department of Internal Medicine 'B', Sheba Medical Center, Ramat Gan, Israel.
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Dagan A, Langevitz P, Shoenfeld Y, Shovman O. Anakinra in idiopathic recurrent pericarditis refractory to immunosuppressive therapy; a preliminary experience in seven patients. Autoimmun Rev 2019; 18:627-631. [DOI: 10.1016/j.autrev.2019.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/08/2019] [Indexed: 12/31/2022]
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24
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Boaz E, Tankel J, Dagan A, Weinberg L, Mogilevsky L, Hadas I, Reissman P, Ben Haim M. [SARCOPENIA IS AN INDEPENDENT RISK FACTOR FOR DELAYED GASTRIC EMPTYING AFTER PANCREATICODUODENECTOMY]. Harefuah 2019; 158:218-221. [PMID: 31032551] [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 Sarcopenia is defined as the degenerative loss of skeletal muscle and can be measured using the cross-sectional diameter of the psoas muscle on computed tomography. Sarcopenia has been associated with a variety of post-operative complications. We propose that sarcopenia acts as an independent factor predictive of delayed gastric emptying (DGE) after elective pancreaticoduodenectomy (PD). METHODS A retrospective analysis of a prospectively maintained database of all patients undergoing PD at our tertiary hepatobiliary center was performed for the period December 2014 - March 2017. For each patient, the preoperative cross-sectional diameter of the psoas muscle at the upper border of L4 was calculated. Measurements in the lowest third of gender specific groups were considered to be sarcopenic. The presence of DGE, post-operative pancreatic fistulas (POPF) and major postoperative complications graded as Clavien Dindo III or more were included in the analysis. RESULTS A total of 40 patients were included, 15 (37.5%) of whom were classified as sarcopenic. Comparison between the sarcopenic and non-sarcopenia groups revealed homogeneity in terms of gender, age, BMI and pre-operative albumin levels. DGE occurred in 11 patients (27.5%) of whom 7 were sarcopenic. Significantly more sarcopenic patients suffered from DGE (7/15 vs 4/25, p = 0.042). Major postoperative complications and POPF occurred in 15 patients each (37.5%). Nevertheless, sarcopenia was not significantly associated with POPF or other complications. The presence of sarcopenia was found to have a significant relationship with the incidence of DGE (OR 4.594, 95% CI 1.052-20.057). DISCUSSION Sarcopenia acted as an independent risk factor predicting DGE after PD but not for POPF or other major postoperative complications.
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Affiliation(s)
- Elad Boaz
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - James Tankel
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Lena Weinberg
- Department of Radiology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Liel Mogilevsky
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Irit Hadas
- Department of Radiology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Menahem Ben Haim
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
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25
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Halfteck G, Doviner V, Dagan A, Neumann M, Reissman P, Ben Haim M. [INTRACHOLECYSTIC PAPILLARY-TUBULAR NEOPLASM: A NEW PATHOLOGY OF THE GALLBLADDER?]. Harefuah 2019; 158:233-236. [PMID: 31032554] [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
The clinicopathologic characterization of tumoral intra-epithelial neoplasms of the gallbladder is fairly limited compared to that of similar tumors of the pancreatobiliary system. Until recently, pre-malignant lesions of the gallbladder were mostly reported as adenomas, which were microscopic and therefore regarded as benign and clinically inconsequential, whereas papillary lesions have been largely regarded as a papillary subtype of gallbladder invasive adenocarcinoma. In an attempt to create a unified terminology for these tumors, the term Intracholecystic papillary-tubular neoplasm (ICPN) was proposed to include all exophytic intra-epithelial tumors of the gallbladder measuring ≥1 cm under one category. A few studies which have retrospectively analyzed tumors fulfilling this category found them to be remarkable analogous to the more well-characterized intra-epithelial tumors of the pancreato-biliary system such as IPMN of the pancreas and IPNB of the bile ducts and as such they also represent an 'adenoma-carcinoma' sequence in the gallbladder. Since then a number of case series have been published which attempted to characterize the clinical and pathological features of these tumors and their relationship with invasive carcinoma. In this paper we report three cases of ICPN which represent different stages of the 'adenoma-carcinoma' sequence.
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Affiliation(s)
- Gili Halfteck
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Victoria Doviner
- Department of Pathology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michael Neumann
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Menahem Ben Haim
- Department of General Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
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26
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Ashkenazi M, Nathan N, Sarouk I, Aluma BEB, Dagan A, Bezalel Y, Keler S, Vilozni D, Efrati O. Nutritional Status in Childhood as a Prognostic Factor in Patients with Cystic Fibrosis. Lung 2019; 197:371-376. [DOI: 10.1007/s00408-019-00218-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/12/2019] [Indexed: 01/01/2023]
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27
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Fallek Boldes O, Dahan S, Segal Y, Ben-Ami Shor D, Huber RK, Barshack I, Horowitz Y, Segal G, Dagan A. Characteristics of Pericardial Biopsy: 100 Cases in a Single Center. Isr Med Assoc J 2019; 21:183-188. [PMID: 30905104] [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 Pericardial biopsies are rarely performed during the diagnosis and management of pericardial diseases. The circumstances and clinical profile of patients undergoing pericardial biopsies are largely uncharacterized. OBJECTIVES To examine the circumstances in which pericardial biopsies are obtained and to evaluate their diagnostic yield. METHODS We studied a total of 100 cases (71% males, mean age 60.8 years, range 8.1-84.5 years) of surgically resected pericardium specimens obtained from 2000 to 2015 at Sheba Medical Center, the largest medical center in Israel. Patients were classified into groups according to four major histological etiologies: idiopathic pericarditis, constrictive pericarditis, malignant pericarditis, and post-cardiac injury syndrome (PCIS). The clinical history and course, laboratory, echocardiography, and histological results were reviewed retrospectively. RESULTS Causes of pericarditis according to histological definitions included idiopathic pericarditis (29%), constrictive pericarditis (29%), PCIS (9%), and malignant pericarditis (26%). Overall sensitivity of the pericardial biopsy in patients with malignancy was 57.7%. During the study period, we found a trend toward an increased number of biopsies due to constrictive pericarditis and PCIS, along with a decrease in the number of biopsies performed in patients with malignant or idiopathic pericarditis. The diagnosis following biopsy did not change for any of the patients. CONCLUSIONS Our findings suggest a low diagnostic yield from pericardial biopsies, especially in malignant pericarditis. This conclusion, along with novel therapies, resulted in the infrequent use of pericardial biopsy in recent years.
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Affiliation(s)
| | - Shani Dahan
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yahel Segal
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Dana Ben-Ami Shor
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Robert K Huber
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Barshack
- Institute of Pathology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Horowitz
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gad Segal
- Department of Internal Medicine T, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Dagan
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
- Department of Rheumatology Unit, Assuta Ashdod Medical Center, Ashdod, Israel
- Soroka Medical Center and Ben-Gurion University of the Negev, Beer Sheva, Israel
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28
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Tankel J, Dagan A, Vainberg E, Boaz E, Mogilevsky L, Hadas I, Reissman P, Ben Haim M. Sarcopenia is associated with a greater incidence of delayed gastric emptying following pancreaticoduodenectomy. Clin Nutr ESPEN 2018; 27:105-109. [PMID: 30144881 DOI: 10.1016/j.clnesp.2018.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/26/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS Sarcopenia is the degenerative loss of skeletal muscle and has been associated with a variety of post-operative complications. We propose sarcopenia is associated with delayed gastric emptying (DGE) following elective pancreaticoduodenectomy (PD). METHODS A retrospective analysis of a computerised database maintained in real time of all patients undergoing PD within our hepatobiliary unit was performed. The cross-sectional area of the psoas muscle at the upper border of L3 was calculated and corrected for patient height. The lowest quartile of gender specific groups was considered to be sarcopenic. RESULTS 61 patients were included, 32 male and 29 female of whom 8 from each group were sarcopenic (26.2%). Although the sarcopenic and non-sarcopenia groups were found to be comparable, significantly more sarcopenic patients were older (75 vs 64 years, p = 0.003), had a lower body mass index (21.9 vs 25.0 kg/m2, p = 0.003) and suffered from DGE (7/16 vs 8/45, p = 0.045). On multivariate analysis, these variables maintained their significance with DGE having an OR of 6.042 (p = 0.036). CONCLUSION Sarcopenia is significantly associated with DGE, older age and lower BMI in this specific cohort of patients. Further research into the reversibility of this phenomenon is warranted.
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Affiliation(s)
- James Tankel
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel.
| | - Amir Dagan
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Elena Vainberg
- Department of Radiology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Elad Boaz
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Liel Mogilevsky
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Irit Hadas
- Department of Radiology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Petachia Reissman
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Menahem Ben Haim
- Department of General Surgery, Shaare Zedek Medical Centre, Jerusalem, Israel
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29
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Anani S, Goldhaber G, Wasserstrum Y, Dagan A, Segal G. The 'SILENT Alarm': When History Taking Reveals a Potentially Fatal Toxicity. Eur J Case Rep Intern Med 2018; 5:000843. [PMID: 30756037 PMCID: PMC6346880 DOI: 10.12890/2018_000843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/16/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The combination of acute/sub-acute neurological and metabolic derangements should always raise the suspicion of toxicity, either endogenous or exogenous. The adverse effects of psychiatric medications are especially difficult to determine since the psychiatric background of patients is often inaccessible. Clinical Presentation A 66-year-old man presented to the emergency department with dysarthria and uncontrolled tremor, rapidly deteriorating into a complex of severe neurological and metabolic derangements. Only after repeated attempts to take a thorough history was lithium toxicity identified. Conclusion Thorough, comprehensive history taking, including chronic medications and their substitutes, is essential and lifesaving when potentially lethal medications are involved. LEARNING POINTS
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Affiliation(s)
- Sapir Anani
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Gal Goldhaber
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Yishay Wasserstrum
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Amir Dagan
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Gad Segal
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel.,St. Georges School of Medicine, London, program by the University of Nicosia in the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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30
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Dagan A, Stein GY, Winter S, Avaky C, Hofstetter L, Gringauz I, Biber A, Segal G. Sodium phosphate enemas do not worsen renal function among hospitalized patients with mild to moderate renal failure: a matched, case-control study. QJM 2017; 110:803-806. [PMID: 29025112 DOI: 10.1093/qjmed/hcx165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sodium phosphate enemas (SPEs) are widely used among hospitalized patients despite their potential to worsen renal failure. AIM We decided to assess the extent to which this side effect is clinically relevant. DESIGN We conducted a matched case-control, retrospective study in a cohort of hospitalized patients. METHODS Patients treated and untreated with SPEs were matched for age, gender, baseline creatinine, usage of certain medications and several background diagnoses. Three groups of matched patients (whole study cohort, patients with baseline creatinine > 1.5 mg/dl and those with baseline creatinine > 2 mg/dl) were compared with regards to their creatinine and blood electrolyte concentrations during 3 consecutive hospitalization days after SPE application. RESULTS Four hundred and twelve patients were included in this study of which 206 were treated by single SPEs. Exact matching was done for the whole study cohort, for 108 patients with baseline creatinine > 1.5 mg/dl and for 58 patients with baseline creatinine > 2 mg/dl. During 3 consecutive days after SPEs, the maximal blood concentrations of creatinine, phosphor and potassium did not differ significantly between treated patients and matched controls, in all three patients' groups. CONCLUSION Application of SPEs neither seem to worsen mild to moderate renal failure, nor are associated with hyperphosphatemia or hyperkalemia in patients hospitalized in internal medicine departments.
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Affiliation(s)
- A Dagan
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
| | - G Y Stein
- Department of Internal Medicine B (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Rabin Medical Center, Beilinson Hospital, Petach Tikva
- MedAware Ltd., Raanana, Israel
| | | | - C Avaky
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
| | - L Hofstetter
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
| | - I Gringauz
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
| | - A Biber
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
| | - G Segal
- From the Department of Internal Medicine T (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel), Chaim Sheba Medical Center, Ramat Gan
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31
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Hassidim A, Bratman Morag S, Giladi M, Dagan Y, Tzadok R, Reissman P, Dagan A. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res 2017; 220:293-299. [DOI: 10.1016/j.jss.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
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32
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Gringauz I, Shemesh Y, Dagan A, Israelov I, Feldman D, Pelz-Sinvani N, Justo D, Segal G. Risk of falling among hospitalized patients with high modified Morse scores could be further Stratified. BMC Health Serv Res 2017; 17:721. [PMID: 29132427 PMCID: PMC5684764 DOI: 10.1186/s12913-017-2685-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background Falls during hospitalization harbor both clinical and financial outcomes. The modified Morse fall scale [MMFS] is widely used for an in-hospital risk-of-fall assessment. Nevertheless, the majority of patients at risk of falling, i.e. with high MMFS, do not fall. The aim of this study was to ascertain our study hypothesis that certain patients' characteristics (e.g. serum electrolytes, usage of a walking device etc.) could further stratify the risk of falls among hospitalized patients with MMFS. Methods This was a retrospective cohort analysis of adult patients hospitalized in Internal Medicine departments. Results The final cohort included 428 patients aged 76.8±14.0 years. All patients had high (9 or more) MMFS upon admission, and their mean MMFS was 16.2±6.1. A group of 139 (32.5%) patients who fell during their hospitalization was compared with a control group of 289 (67.5%) patients who did not fall. The fallers had higher MMFS, a higher prevalence of mild dependence, and a greater use of a cane or no walking device. Regression analysis showed the following patients' characteristics to be independently associated with an increased risk of falling: mild dependence (OR=3.99, 95% CI 1.97-8.08; p<0.0001), treatment by anti-epileptics (OR=3.9, 95% CI 1.36-11.18; p=0.011), treatment by hypoglycemic agents (OR=2.64, 95% CI 1.08-6.45; p= 0.033), and hypothyroidism (OR=3.66, 05%CI 1.62-8.30; p=0.002). In contrast to their role in the MMFS, the use of a walker or a wheelchair was found to decrease the risk of falling (OR=0.3, 95% CI 0.13-0.69; p=0.005 and OR=0.25, 95% CI 0.11-0.59; p= 0.002). Conclusions Further risk stratification of hospitalized patients, already known to have a high MMFS, which would take into account the characteristics pointed out in this study, should be attained.
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Affiliation(s)
- Irina Gringauz
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Shemesh
- Patient Safety Assurance Unit, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amir Dagan
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Irina Israelov
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dana Feldman
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Naama Pelz-Sinvani
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Justo
- Geriatric Medicine D Department, Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Segal
- Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Agmon-Levin N, Dagan A, Peri Y, Anaya JM, Selmi C, Tincani A, Bizzaro N, Stojanovich L, Damoiseaux J, Cohen Tervaert JW, Mosca M, Cervera R, Shoenfeld Y. The interaction between anti-Ro/SSA and anti-La/SSB autoantibodies and anti-infectious antibodies in a wide spectrum of auto-immune diseases: another angle of the autoimmune mosaic. Clin Exp Rheumatol 2017; 35:929-935. [PMID: 28770708] [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] [Received: 09/21/2016] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES The presence of anti-Ro/SSA and anti-La/SSB antibodies has been linked with autoimmunity in general and with several autoimmune diseases (AID) in particular. In the current study we evaluated these antibodies in a wide spectrum of AID as well as the links between them and anti-infectious antibodies. METHODS We examined 2082 sera from patients with 16 different AID compared to 524 sera from geographically-matched healthy controls, for the presence and titres of anti-Ro/SSA and anti-La/SSB. All samples were also tested for a variety of anti-infectious agents' antibodies using the BioPlex 2200-immunoassay (Bio-Rad, USA). RESULTS Anti-Ro/SSA was more prevalent, with significantly higher titre in 5 autoimmune diseases namely Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS) both primary and APS linked to SLE, systemic sclerosis (SSc) and primary biliary cirrhosis (PBC). Anti-La/SSB was more prevalent with higher titers in SS, SLE, APS linked to SLE and PBC. Prevalence, but not titers, of both antibodies were higher also in polymyositis (PM). Additionally, we found a correlation between anti-Ro/SSA antibodies and antibodies of the IgM and IgG subtypes directed at cytomegalovirus as well as IgG-antibodies directed at Epstein-Barr virus (EBV) and toxoplasma (p<0.001). Anti-La/SSB antibodies correlated with the presence of IgG antibodies against EBV early antigen (p<0.001). CONCLUSIONS In a large cohort of patients with autoimmune diseases we found an association between anti-Ro/SSA and anti-La/SSB antibodies and 6 autoimmune diseases, amongst which primary APS and PM. Additionally, we observed linkages between these autoantibodies and anti-infectious antibodies directed at Epstein-Barr virus, toxoplasma and cytomegalovirus. Our findings support the concept of interplay between infectious agents and autoimmunity, such as the plausibility of an infectious agent that trigger the immune system to produce specific antibodies which will later result in a unique group of AID.
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Affiliation(s)
- Nancy Agmon-Levin
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center; and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Amir Dagan
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center; and Internal Medicine T, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Yogev Peri
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel Aviv, Israel
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Carlo Selmi
- Department of Internal Medicine, IRCCS Istituto Clinico Humanitas, University of Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology, Spedali Civili and University of Brescia, Italy
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale Civile, Tolmezzo, Italy
| | | | - Jan Damoiseaux
- Laboratory of Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan Willem Cohen Tervaert
- Laboratory of Clinical Immunology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases; Hospital Clínic, Barcelona, Spain
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Chaim Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University; and Incumbent of the Laura Schwarz-KipChair for Research of Autoimmune Diseases, Tel-Aviv University, Israel.
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Dagan A, Avaky C, Ehrenfeld M, Segal G. Image Challenge: Mysterious Ulcers. Isr Med Assoc J 2017; 19:528. [PMID: 28825775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Amir Dagan
- Department of Medicine 'T', Sheba Medical Center, Tel Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Department of Rheumatic Disease Unit Sheba Medical Center, Tel Hashomer, Israel
| | - Chen Avaky
- Department of Medicine 'T', Sheba Medical Center, Tel Hashomer, Israel
| | - Michael Ehrenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Department of Rheumatic Disease Unit Sheba Medical Center, Tel Hashomer, Israel
| | - Gad Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Braun-Moscovici Y, Dagan A, Toledano K, Markovits D, Saffouri A, Beshara-Garzoz R, Naffaa ME, Rozin A, Nahir MA, Balbir-Gurman A. [THE INPUT OF MEASURING INFLIXIMAB LEVELS AND LEVELS OF ANTIBODIES TO INFLIXIMAB IN THE MANAGEMENT OF PATIENTS WITH RHEUMATIC DISEASES]. Harefuah 2017; 156:427-430. [PMID: 28786280] [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: 06/07/2023]
Abstract
BACKGROUND High levels of infliximab (IFX) directed antibodies (IFX-Ab) may result in significant reduction in IFX concentration and loss of drug efficacy. OBJECTIVES To assess the input of measuring serum IFX levels and levels of IFX-Ab in the management of rheumatic diseases. METHODS Serum levels of IFX and anti-IFX-Ab were measured by ELISA (IFX-Abs were also identified by anti-human lambda chain Ab) and correlated to patients (responders and nonresponders) disease activity scores. RESULTS A total of 144 tests for IFX were performed in 91 patients (mean age 50.2 years and disease duration 9.9 years). Among responders (57 patients) levels (mean, median) of IFX were significantly higher than in non-responders (34 patients) (4.2 mcg/ml (2.3) versus 1.1 mcg/ml (0.45)); levels of IFX-Ab in responders were significantly lower than in non-responders (4.59 mcg/ml (1.0) versus 13.1 (6.1)). High IFX-Ab levels predicted IFX discontinuation in 8.8% of responders and 55.9% among non-responders. In non-responders with low IFX levels and low IFX-Ab, the shortening of re-treatment intervals lead to significant improvement. In about 28% of patients, results of blood tests influenced treatment decisions. CONCLUSIONS Assessment of immunogenicity of anti-TNF monoclonal antibodies proved useful information for guiding the therapy in rheumatic diseases with suboptimal clinical response. Patients with low IFX levels and low levels of IFXAb may benefit from increasing the drug dose or decreasing of re-treatment intervals. In patients with negligible serum levels of IFX and high levels of IFX-Ab, the therapy should be switched to another biological agent, probably with a different mechanism of action.
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Affiliation(s)
- Yolanda Braun-Moscovici
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Amir Dagan
- B. Shine Rheumatology Unit, Rambam Health Care Campus
| | - Kochava Toledano
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | | | - Amer Saffouri
- B. Shine Rheumatology Unit, Rambam Health Care Campus
| | | | - Muhamad E Naffaa
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Alexander Rozin
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Menahem A Nahir
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Alexandra Balbir-Gurman
- B. Shine Rheumatology Unit, Rambam Health Care Campus &The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
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Dagan A, Mahroum N, Segal G, Tiosano S, Watad A, Comaneshter D, Cohen AD, Amital H. The Association Between Giant Cell Arteritis and Ischemic Heart Disease: A Population Based Cross-Sectional Study. Isr Med Assoc J 2017; 19:411-414. [PMID: 28786254] [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: 06/07/2023]
Abstract
BACKGROUND Patients with giant cell arteritis (GCA) suffer from inflammatory diseases often treated by large amounts of corticosteroids. Whether this inflammatory burden also carries an increased risk for cardiovascular morbidity, and especially ischemic heart disease, is not clearly established. OBJECTIVES To clarify the linkage between GCA and ischemic heart disease. METHODS In a cross-sectional study, we assessed the association between GCA and ischemic heart disease, adjusting for cardiovascular risk factors, among GCA patients and matched controls using the database of the largest healthcare provider in Israel. RESULTS The study group was comprised of 5659 GCA patients and 28,261 age and gender matched controls. The proportion of ischemic heart disease was higher in the GCA group (27.5% vs. 12.5% among controls, odds ratio 2.65). Diabetes mellitus, hypertension, hyperlipidemia and smoking were also found to have higher concurrency in GCA. After stratifying for those cardiovascular co-morbidities using logistic regression, GCA remained independently associated with ischemic heart disease with an odds ratio of 1.247 (1.146-1.357 P < 0.001). CONCLUSIONS GCA is associated with both cardiovascular risk factors and ischemic heart disease. Healthcare professionals should not overlook this aspect of the disease when managing GCA patients.
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Affiliation(s)
- Amir Dagan
- Department of Medicine 'T', Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naim Mahroum
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Department of Medicine 'T', Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Tiosano
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abdulla Watad
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Arnon D Cohen
- Chief Physicians Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Howard Amital
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Dagan A, Sella T, Urban D, Bar Y, Onn A, Segal G. Low alanine transaminase is not associated with increased rate of mortality in patients with advanced lung cancer. JCSM Clinical Reports 2017. [DOI: 10.17987/jcsm-cr.v2i1.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Low alanine transaminase (ALT) has been shown to serve as a marker for sarcopenia and frailty in both healthy populations and in patients with chronic illness. Its yield in cancer patients in general and in particular in lung-cancer patients was not assessed. Methods: Lung cancer patients presenting to an outpatient thoracic oncology clinic in a tertiary hospital were included. ALT plasma levels as well as other potential prognostic factors were collected retrospectively. Associations of those factors with survival were examined by univariate and multivariate analyses. Results: 203 patients were eligible for analysis, of which 149 (73.4%) were diagnosed to have advanced disease. During median follow-up period of 15.4 months, 79 (38.9%) died. The mean ALT level of activity was 17.53±7.8 IU/L. The following parameters were found to be associated with increased risk of mortality: histologic type, male gender, advanced disease and low performance status upon diagnosis. Low ALT levels were not found to be associated with increased risk of mortality. Conclusion: Low ALT activity levels, associated with sarcopenia, frailty and shortened survival in other patients' populations might not be predictive for shortened survival in lung cancer patients.
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Dagan A, Segal G, Tiosano S, Watad A, Neumann SG, Comaneshter D, Cohen AD, Amital H. Coexistent malignant conditions in rheumatoid arthritis - A population-based cross-sectional study. Int J Clin Pract 2017; 71. [PMID: 28150372 DOI: 10.1111/ijcp.12929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate if association exist between rheumatoid arthritis and malignant diseases. METHODS A cross-sectional study was conducted comparing rheumatoid arthritis patients with age and gender matched controls regarding the proportion of patients with comorbid malignant conditions. Chi-square tests and t-tests were used for univariate analysis. A logistic regression model was used for multivariate analysis. The study was performed utilising the medical database of Clalit Health Services. RESULTS The study group included 11 782 rheumatoid arthritis patients and 57 973 controls. The total proportion of malignancies was significantly higher in the study group than in the control group (21.4% vs 11.2%; P<.001). The disease for which there was the strongest association among patients with rheumatoid arthritis was non-Hodgkin's lymphoma (1.1% vs 0.6%; P<.01). After multivariate analysis, lung cancer was not found to be significantly associated with rheumatoid arthritis. CONCLUSION Rheumatoid arthritis is associated with several malignant disorders, in particular non-Hodgkin's lymphoma. Appropriate measures for non-Hodgkin's lymphoma screening in this patient population should be considered.
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Affiliation(s)
- Amir Dagan
- Department of Medicine 'T', Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Segal
- Department of Medicine 'T', Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Tiosano
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Abdulla Watad
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Shana G Neumann
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Arnon D Cohen
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Howard Amital
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
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Wasserstrum Y, Lotan D, Itelman E, Barbarova I, Kogan M, Klempfner R, Dagan A, Segal G. Corrected QT interval anomalies are associated with worse prognosis among patients suffering from sepsis. Intern Med J 2016; 46:1204-1211. [DOI: 10.1111/imj.13170] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 12/11/2022]
Affiliation(s)
- Y. Wasserstrum
- Sackler School of Medicine, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - D. Lotan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - E. Itelman
- Sackler School of Medicine, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - I. Barbarova
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - M. Kogan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - R. Klempfner
- Leviev Heart Institute, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - A. Dagan
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - G. Segal
- Internal Medicine ‘T’, Chaim Sheba Medical Center, Tel Ha'Shomer, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Dagan A, Vilozni D, Sokol G, Onn A, Efrati O. Effect of professional physiotherapy on patients with non CF bronchiectasis – a preliminary study. Pneumologie 2016. [DOI: 10.1055/s-0036-1592264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
PURPOSE The purpose of this review is to highlight the perils and pitfalls associated with high vascular ligation during right colectomies for adenocarcinoma and to identify the various mechanisms of injury to the superior mesenteric vein (SMV) and its tributaries. METHODS This is a retrospective chart review of 304 right colectomies (159 open and 145 laparoscopic) performed over a period of 10 years (1 June 2006-31 May 2016) for right-sided colonic adenocarcinoma in an academic medical center. RESULTS During a 10-year study period, we encountered five cases in which significant damage to the SMV and its tributaries occurred. This accounts for a total of 1.6 % of all right colectomies performed for colonic adenocarcinoma. CONCLUSIONS Iatrogenic superior mesenteric vein injury is a rare, severe, and underreported complication of both open and laparoscopic right colectomy for colonic adenocarcinoma. We identified several mechanisms of injury such as anatomic misperception, excessive traction and pulling on the venous system, extensive tumor involvement of the mesentery, and uncontrolled suturing attempts at hemostasis. We believe that increased awareness of this complication with profound understanding of vascular anatomy and the different mechanisms of injury will allow surgeons to avoid this often devastating complication.
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Affiliation(s)
- M R Freund
- Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Y Edden
- Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - P Reissman
- Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
| | - A Dagan
- Department of General Surgery, Shaare Zedek Medical Center, Affiliated with the Hebrew University School of Medicine, Jerusalem, Israel
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Dagan A, Gringouz I, Kliers I, Segal G. Disability Progression in Multiple Sclerosis Is Affected by the Emergence of Comorbid Arterial Hypertension. J Clin Neurol 2016; 12:345-50. [PMID: 27273922 PMCID: PMC4960220 DOI: 10.3988/jcn.2016.12.3.345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/02/2016] [Accepted: 01/05/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND PURPOSE We assessed the prevalence and potential association of hypertension with multiple sclerosis (MS)-related disability progression. METHODS This was a retrospective study of 2,813 patients who were followed for 20 years. We modeled the associations of several risk factors with the pattern of disability progression. The primary end point was the rate of disability progression. RESULTS In total, 2,396 patients were available for analysis, of which 1,074 (44.8%) scored 4 (EDSS4) on the Expanded Disability Status Scale (EDSS), 717 (29.9%) scored 6 (EDSS6), and 261 (10.9%) scored 8 (EDSS8). The mean times to reach scores of 4, 6, and 8 were 123.5, 163.1, and 218.9 months, respectively. Hypertension was present in 207 (8.6%) patients during follow-up. Hypertension was associated with a higher probability of reaching each EDSS score compared to non-hypertensive patients: 62% vs. 43% for EDSS4 (p<0.01), 51% vs. 28% for EDSS6 (p<0.01), and 17% vs. 10% for EDSS8 (p<0.01). Nevertheless, hypertensive MS patients experienced longer intervals to reach each EDSS score: longer by 51.6, 38.9, and 62.7 months to EDSS4, EDSS6, and EDSS8, respectively (p<0.01) when compared to non-hypertensive MS patients reaching the same EDSS scores. CONCLUSIONS Disability progression is more prevalent amongst hypertensive MS patients. However, they experience longer time intervals between the stages of disability progression.
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Affiliation(s)
- Amir Dagan
- Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Irina Gringouz
- Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Kliers
- Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Segal
- Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Tiosano S, Segal G, Dagan A, Comaneshter D, Cohen A, Amital H. FRI0108 Rheumatoid Arthritis Is Associated with Increased Rate of Malignancy: A Cross-Sectional Analysis of 69755 Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3038] [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: 11/03/2022]
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Goren I, Israel A, Carmel-Neiderman NN, Kliers I, Gringauz I, Dagan A, Lavi B, Segal O, Segal G. Vomiting and Hyponatremia Are Risk Factors for Worse Clinical Outcomes Among Patients Hospitalized Due to Nonsurgical Abdominal Pain: A Retrospective Cohort Study. Medicine (Baltimore) 2016; 95:e3274. [PMID: 27057886 PMCID: PMC4998802 DOI: 10.1097/md.0000000000003274] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
After initial evaluation in the Emergency Department (ED), many patients complaining of abdominal pain are classified as suffering from nonsurgical abdominal pain (NSAP). Clinical characteristics and risk factors for worse prognosis were not published elsewhere.Characterizing the clinical profile of patients hospitalized due to NSAP and identifying predictor variables for worse clinical outcomes.We made a retrospective cohort analysis of patients hospitalized due to NSAP compared to matched control patients (for age, gender, and Charlson comorbidity index) hospitalized due to other, nonsurgical reasons in a ratio of 1 to 10. We further performed in-group analysis of patients admitted due to NSAP in order to appreciate variables (clinical and laboratory parameters) potentially associated with worse clinical outcomes.Overall 23,584 patients were included, of which 2144 were admitted due to NSAP and 21,440 were matched controls. Patients admitted due to NSAP had overall better clinical outcomes: they had lower rates of in-hospital and 30-days mortality (2.8% vs 5.5% and 7.9% vs 10.4% respectively, P < 0.001 for both comparisons). They also had a significantly shorter length of hospital stay (3.9 vs 6.2 days, P < 0.001). Rates of re-hospitalization within 30-days were not significantly different between study groups. Among patients hospitalized due to NSAP, we found that vomiting or hyponatremia at presentation or during hospital stay were associated with worse clinical outcomes.Compared to patients hospitalized due to other, nonsurgical reasons, the overall prognosis of patients admitted due to NSAP is favorable. The combination of NSAP with vomiting and hyponatremia is associated with worse clinical outcomes.
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Affiliation(s)
- Idan Goren
- From the Internal Medicine "T," Chaim Sheba Medical Center (IG, IK, IG, AD, GS), Tel Hashomer, Ramat Gan*; Clalit Health Services (AI), Jerusalem; Sackler Faculty of Medicine (NC, OS), Tel-Aviv University, Tel Aviv; Technologies Management (BL), Chaim Sheba Medical Center, Tel Hashomer, Israel
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Segal O, Hassin-Baer S, Kliers I, Gringouz I, Dagan A, Cohen S, Segal G. Decreased Anti-Parkinson's Therapy during Hospitalization due to Infectious Diseases is Associated with Worse Prognosis. CNS Neurosci Ther 2016; 22:423-5. [PMID: 27012371 DOI: 10.1111/cns.12545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/01/2016] [Accepted: 03/06/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Omer Segal
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Arrow Research Program for Medical Students, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Hassin-Baer
- Movement Disorders Institute, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Iris Kliers
- Internal Medicine "T", Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Irina Gringouz
- Internal Medicine "T", Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Amir Dagan
- Internal Medicine "T", Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Shay Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Gad Segal
- Arrow Research Program for Medical Students, Chaim Sheba Medical Center, Ramat Gan, Israel.,Internal Medicine "T", Chaim Sheba Medical Center, Ramat Gan, Israel
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Bindoli S, Dagan A, Torres-Ruiz JJ, Perricone C, Bizjak M, Doria A, Shoenfeld Y. Sarcoidosis and Autoimmunity: From Genetic Background to Environmental Factors. Isr Med Assoc J 2016; 18:197-202. [PMID: 27228643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sarcoidosis is a chronic multisystem disease with variable course resulting from the interaction between environmental factors and the immune system of individuals genetically predisposed. The evidence linking sarcoidosis with environmental triggers such as metals is increasing. We describe the case of a 44 year old female with a history. of smoking since age 30 and previous mercury dental filling who presented at physical examination with numerous subcutaneous nodules. Laboratory data showed accelerated erythrocyte sedimentation rate and high titer of anti-U1 ribonucleoprotein antibodies (U1 RNP). Skin biopsy and chest X-ray suggested the diagnosis of sarcoidosis. In this report we illustrate the different causes involved in the onset of sarcoidosis.
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David PR, Dagan A, Colaris M, de Boer M, Cohen Tervaert JW, Shoenfeld Y. Churg-Strauss Syndrome: Singulair or Silicone (or both?). Isr Med Assoc J 2016; 18:168-170. [PMID: 27228637] [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: 06/05/2023]
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Frenkel-Rutenberg T, Dagan A, Lotan E, Lotan D, Segal G. Is There More to This Case than Mere Pulmonary Alveolar Proteinosis? A Clinical Case Presentation. Eur J Case Rep Intern Med 2015. [DOI: 10.12890/2015_000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Amir Dagan
- Internal Medicine T, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Eyal Lotan
- Internal Medicine T, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dor Lotan
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gad Segal
- Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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Dagan A, Dagan B, SegaL G. [SGLT2 inhibitors: a new therapeutic class for the treatment of type 2 diabetes mellitus]. Harefuah 2015; 154:200-210. [PMID: 25962253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
SGLT2 (Sodium Glucose co-Transporter 2 Inhibitors) inhibitors are a new group of oral medications for the treatment of type 2 diabetes mellitus patients. These medications interfere with the process of glucose reabsorption in the proximal convoluted tubules in the kidneys, therefore increasing both glucose and water diuresis. SGLT2 inhibitors were found to be effective in lowering HbA1c levels in double-blinded studies, both as monotherapy and in combination with other oral hypoglycemic medications of various other mechanisms of action. SGLT2 Inhibitors are not a risk factor for hypoglycemia and are suitable for combination with insulin therapy. Their unique mode of action, relying on glomerular filtration, make these medication unsuitable for usage as treatment for type 2 diabetes patients who are also suffering from moderate to severe renal failure. Their main adverse effects are increased risk for urinary and genital tract infections. The following review describes the relevant pathophysiology addressed by these novel medications, evidence for efficacy and the safety profile of SGLT2 Inhibitors.
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Balbir-Gurman A, Yigla M, Guralnik L, Hardak E, Solomonov A, Rozin AP, Toledano K, Dagan A, Bishara R, Markovits D, Nahir MA, Braun-Moscovici Y. Long-term follow-up of patients with scleroderma interstitial lung disease treated with intravenous cyclophosphamide pulse therapy: a single-center experience. Isr Med Assoc J 2015; 17:150-156. [PMID: 25946765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Scleroderma lung disease (ILD-SSc) is treated mainly with cyclophosphamide (CYC). The effectiveness of CYC was judged after 12-24 months in most reports. OBJECTIVES To analyze the effect of monthly intravenous CYC on pulmonary function tests including forced vital capacity (FVC) and diffusing lung capacity (DLCO), as well as Rodnan skin score (mRSS), during long-term follow-up. METHODS We retrospectively collected the data on 26 ILD-SSc patients who began CYC treatments before 2007. Changes in FVC, DLCO and mRSS before treatment, and at 1,4 and 7 years after completion of at least six monthly intravenous CYC treatments for ILD-SSc were analyzed. RESULTS Mean cumulative CYC dose was 8.91 ± 3.25 G. More than 30% reduction in FVC (0%, 8%, and 31% of patients), DLCO (15%, 23%, 31%), and mRSS (31%, 54%, 62%) at years 1, 4 and 7 was registered. During the years 0-4 and 4-7, annual changes in FVC, DLCO and mRSS were 3.2 vs. 0.42% (P < 0.040), 4.6 vs. 0.89% (P < 0.001), and 1.8 vs. 0.2 (P = 0.002). The greatest annual FVC and DLCO reduction over the first 4 years correlated with mortality (P = 0.022). There were no differences in the main variables regarding doses of CYC (< 6 G and > 6 G). CONCLUSIONS In patients with ILD-SSc, CYC stabilized the reduction of FVC during treatment, but this effect was not persistent. The vascular characteristic of ILD-SSc (DLCO) was not affected by CYC treatment. CYC rapidly improved the mRSS. This effect could be achieved with at least 6 G of CYC. Higher rates of annual reduction in FVC and DLCO in the first 4 years indicate the narrow window of opportunity and raise the question regarding ongoing immunosuppression following CYC infusions.
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