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Kaufman-Shriqui V, Shani M, Boaz M, Lahad A, Vinker S, Birk R. Opportunities and challenges in delivering remote primary care during the Coronavirus outbreak. BMC Prim Care 2022; 23:135. [PMID: 35641930 PMCID: PMC9151999 DOI: 10.1186/s12875-022-01750-7] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/25/2022] [Indexed: 11/18/2022]
Abstract
Background Social distancing and lockdowns were implemented during the first period of the COVID-19 pandemic. Primary care physicians needed to adapt quickly to deliver remote care/telemedicine. Methods A cross-sectional, 47-item online Google Survey was distributed through the Israel Association of Family Physicians (IAFP) mailing list between March 31-May 5, 2020. The questionnaire included demographics, physician characteristics, and information on usage and perceived telemedicine quality. Sampling weights by sex and age groups were applied. Results One hundred fifty-nine primary care physicians (10.6% of registered IAFP members; 63.5% women; mean age 53.4 ± 10.4 years and median professional experience 21.3 years) replied to the survey. The majority (59.7%) of the participants performed a mixture of in-person along with phone counseling. About 40% had no former telemedicine experience. The majority indicated that telephone and video formats were inferior to in-person consultation (68%, 57.1% online and phone, respectively). The overall counseling quality grade (on a 1–10 scale,)median (IQR)) was 6.2 (3) for telephone and 7(2) for video. While 66.9% reported experiencing no challenges, 10% had technical problems, 10% interpersonal problems, 5.6% scheduling difficulties, and 7.5% other difficulties. Majority of 56.6% physicians indicated they prescribed more antibiotics,16.4% sent more blood tests, 24.5% referred more to experts, and 49.7% referred more to imaging in comparison to usual counseling. Higher phone quality score was significantly associated with physicians who indicated not prescribing more antibiotics during the pandemic (OR = 0.30, 95%CI 0.134–0.688, p = 0.004). Higher online quality score was associated with physicians who indicated not sending more blood tests during the pandemic (OR = 0.06 95%CI 0.008–0.378, P = 0.003). Conclusions Our findings suggest telehealth holds considerable promise for counseling in the primary care setting. However, interpersonal challenges raised by physicians should be understood in-depth to develop tailored training and further examine it in randomized trials while integrating patient-reported outcomes. Finally, further research on utility, cost, and cost-efficiency during remote counseling with follow-ups, medical prescribing, and additional referrals is needed.
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Leibovitz E, Wainstein J, Boaz M. Association of albumin and cholesterol levels with incidence of hypoglycaemia in people admitted to general internal medicine units. Diabet Med 2018; 35:1735-1741. [PMID: 30091149 DOI: 10.1111/dme.13792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 12/20/2022]
Abstract
AIM To study the association between serum albumin and cholesterol levels at hospital admission and incident hypoglycaemia among people admitted to internal medicine units. METHODS In this cross-sectional analysis, we examined the electronic medical records of people hospitalized in internal medicine departments. Data extracted included all glucose measurements as well as serum albumin and cholesterol, which were measured upon admission. A hypoglycaemia event was recorded for a given person if at least one glucose measurement of ≤ 3.9 mmol/l was recorded during the hospital stay. Regression analysis was used to determine which clinical measures predict hypoglycaemia. RESULTS During the acquisition period, 45 224 people (mean age 68.9 ± 17.8 years, 49.4% male, 21.1% diabetes mellitus) were discharged from internal medicine units. Hypoglycaemia was documented in 7.5% of these individuals (15.4% of people with diabetes vs. 5.5% of those without; P < 0.001). Logistic regression showed that both serum albumin [odds ratio (OR) 0.908, 95% confidence interval (CI) 0.896-0.919; P < 0.001) and cholesterol (OR 0.938, 95% CI 0.896-0.981; P = 0.005] were significantly associated with incident hypoglycaemia. Results remained significant even after controlling for age, sex, average glucose during hospitalization, length of hospital stay, acute infection upon admission, diabetes status, haemoglobin, white blood cell count and C-reactive levels. A combination of hypoalbuminaemia (< 35 g/l) and hypocholesterolaemia (< 3.37 mmol/l) upon admission greatly increased the risk of incident hypoglycaemia (OR 2.544, 95% CI 2.096-3.088; P < 0.001). CONCLUSION Hypoalbuminaemia and hypocholesterolaemia predict incident hypoglycaemia in the hospital setting among people with and without diabetes mellitus.
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Affiliation(s)
- E Leibovitz
- Department of Internal Medicine, 'A' Yoseftal Hospital, Eilat
| | - J Wainstein
- Diabetes Unit, E. Wolfson Medical Center, Holon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - M Boaz
- Department of Nutrition Sciences, Ariel University, Ariel, Israel
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Ditch M, Adler H, Giryes S, Felner Burg N, Boaz M, Leibovitz E. Nutritional screen and admission serum albumin are predictors of hypoglycemia incidence during hospitalization of non-critically ill patients regardless of diabetes mellitus status: Results from the menu study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1141] [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: 10/28/2022]
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Leibovitz E, Moore F, Dobinsky R, Boaz M. SUN-LB330: Nutritional Care Plan to Prevent Hypoglycemia During Admission – Results from the Menu Project. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30633-7] [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: 10/18/2022]
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Hod K, Sperber AD, Ron Y, Boaz M, Dickman R, Berliner S, Halpern Z, Maharshak N, Dekel R. A double-blind, placebo-controlled study to assess the effect of a probiotic mixture on symptoms and inflammatory markers in women with diarrhea-predominant IBS. Neurogastroenterol Motil 2017; 29. [PMID: 28271623 DOI: 10.1111/nmo.13037] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 12/22/2016] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Micro-inflammation is considered an element in the pathogenesis of irritable bowel syndrome (IBS). High-sensitivity C reactive protein (hs-CRP) was previously shown to be higher in IBS compared to healthy controls, albeit within the normal range. Since probiotics may suppress micro-inflammation in the gut, we tested if they reduce symptoms and inflammatory markers (hs-CRP and fecal calprotectin (FC) in diarrhea-predominant IBS (IBS-D). The aim of this study was to assess the clinical and laboratory effects of BIO-25, a multispecies probiotic, in women with IBS-D. METHODS A double-blind, placebo-controlled study. Following a 2-week run-in, eligible women were assigned at random to a probiotic capsule or an indistinguishable placebo, twice daily for 8 weeks. IBS symptoms and stool consistency were rated daily by Visual Analogue Scales (VAS) and the Bristol Stool Scale (BSS). High-sensitivity C reactive protein was tested at baseline, 4 and 8 weeks. FC was tested at baseline and 8 weeks. KEY RESULTS One hundred and seventy-two IBS-D patients were recruited and 107 eligible patients were allocated to the intervention (n=54) or placebo (n=53) group. All symptoms improved in both groups with no significant difference between them in symptom improvement, hs-CRP or FC levels. CONCLUSIONS & INFERENCES An 8-week treatment with BIO-25 improved symptoms in women with IBS-D, but was not superior to placebo. This rigorously designed and executed study supports the findings of other studies that did not demonstrate superiority of probiotics over placebo in IBS. High quality clinical studies are necessary to examine the efficacy of other specific probiotics in IBS-D patients since data are still conflicting.
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Affiliation(s)
- K Hod
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Research Division, Epidemiology Service, Assuta Medical Centers, Tel Aviv, Israel
| | - A D Sperber
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Y Ron
- Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - M Boaz
- Department of Nutrition Sciences, School of Health Sciences, Ariel University, Ariel, Israel
| | - R Dickman
- Department of Gastroenterology and Liver Diseases, Rabin Medical Center, Belinson Hospital, Petach Tikva, Israel
| | - S Berliner
- Department of Medicine E, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Z Halpern
- Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - N Maharshak
- Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - R Dekel
- Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv, Israel
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Elhanan E, Boaz M, Schwartz I, Schwartz D, Chernin G, Soetendorp H, Gal Oz A, Agbaria A, Weinstein T. A randomized, controlled clinical trial to evaluate the immunogenicity of a PreS/S hepatitis B vaccine Sci-B-Vac™, as compared to Engerix B ®, among vaccine naïve and vaccine non-responder dialysis patients. Clin Exp Nephrol 2017; 22:151-158. [PMID: 28456864 DOI: 10.1007/s10157-017-1416-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 05/02/2016] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Dialysis patients have a suboptimal response to hepatitis B (HBV) vaccination. This study aimed to compare the immunogenicity of two vaccines: the third-generation Sci-B-Vac™ vs. the second-generation Engerix B®. The cohort included two groups of dialysis patients: naïve and previously vaccinated non-responders. Primary endpoints were antibody titers ≥10 IU/L at 3 and 7 month post-vaccination. Secondary objectives were seroprotection rates in vaccine-naïve patients and in previously vaccinated non-responders. METHODS Eighty-six patients were assigned to vaccine (Sci-B-Vac™ or Engerix B®) using computer-generated randomization, stratified by age, gender, diabetes, and previous HBV vaccination. Sci-B-Vac™ was administered in three doses, 10 μg, at 0, 1, and 6 months in naïve patients; or 20 μg in previously vaccinated non-responders. Engerix B® included four doses, 40 μg at 0, 1, 2, and 6 months. RESULTS Each group had 43 patients. Seroconversion was 69.8% with Engerix B® vs. 73.2% with Sci-B-Vac™. Antibody titers at 7 months were higher with Sci-B-Vac™ (266.4 ± 383.9, median 53.4) than with Engerix® (193.2 ± 328.9, median 19). However, these differences were not significant, perhaps due to a suboptimal sample size. CONCLUSIONS This study suggests comparable immunogenicity for both vaccines. Thus, we cannot reject the null hypothesis that there is no difference in seroconversion by vaccine type. It is noteworthy that naïve patients were vaccinated with a standard dose of Sci-B-Vac™, while Engerix B® was administered at a double dose. Similarly, although mean antibody titer levels in the Sci-B-Vac™ group were higher than in the Engerix® group, this difference did not reach significance. Consequently, a future clinical trial should recruit a larger cohort of patients, using a standard double-dose protocol in both groups.
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Affiliation(s)
- E Elhanan
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - M Boaz
- Epidemiology and Research Unit, E. Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - I Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - D Schwartz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - G Chernin
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - H Soetendorp
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Gal Oz
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - A Agbaria
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel
| | - T Weinstein
- Nephrology Department, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman st., 64239, Tel Aviv, Israel.
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Bar-Dayan Y, Beer I, Boaz M, Landau Z, Jakubowicz D, Wainstein J. Hyperglycaemia in patients with no history of diabetes presenting to Internal Medicine Departments. Int J Clin Pract 2015; 69:1289-95. [PMID: 26178790 DOI: 10.1111/ijcp.12690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/30/2015] [Indexed: 01/08/2023] Open
Abstract
AIMS Stress hyperglycaemia during hospitalisation may be the first sign of diabetes mellitus (DM). Most hospitals routinely measure blood glucose, which may enable early diagnosis. This study measured the prevalence of hyperglycaemia in hospitalised adults with no history of diabetes, and whether the discharge summary recommended work-up. METHODS Files with at least one random blood glucose (RBG) sample were included and reviewed for specific discharge recommendations concerning elevated blood glucose. Hyperglycaemia was defined as serum glucose > 200 mg/dl. Length of stay, in-hospital mortality and 3-year mortality were examined. RESULTS Among 5274 discharged patients, 1479 had DM. They were older and had a higher incidence of cerebrovascular risk factors. Among 3714 patients without known DM, 211 (5.7%) had at least one RBG > 200 mg/dl. Of these patients, 31 died and 24 left against medical advice. Of the remaining 156, 25(16%) files included instructions to the family physician. These patients were younger, more overweight and less frequently diagnosed with dementia or other mental illness. Patients with RBG > 200 mg/dl had prolonged hospital stay (6.5 ± 5.3 vs. 4.0 ± 4.8; p < 0.001). In-hospital mortality and 3-year mortality were increased by 5.1 and 1.89, respectively (p < 0.001 for both parameters) compared to those without RBG ≤ 200 mg/dl. RBG > 200 mg/dl emerged as a significant, independent predictor of prolonged hospital stay and death. CONCLUSIONS Random blood glucose > 200 mg/dl is common in medical departments and is associated with increased in-hospital and 3-year out-hospital mortality.
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Affiliation(s)
- Y Bar-Dayan
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv, Israel
| | - I Beer
- Department of Medicine, Wolfson Medical Center, Holon, Israel
| | - M Boaz
- Epidemiology and Research Unit, Wolfson Medical Center, Holon, Israel
- Ariel University, Ariel, Israel
| | - Z Landau
- Sackler Faculty of Medicine, Tel Aviv, Israel
- Pediatric Diabetes Unit, Wolfson Medical Center, Holon, Israel
| | - D Jakubowicz
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv, Israel
| | - J Wainstein
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
- Sackler Faculty of Medicine, Tel Aviv, Israel
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Raz O, Rogowski O, Rosenzweig T, Shapira I, Berliner S, Boaz M, Rosenzweig T, Rogowski O. Anti inflammatory effect of high complex carbohydrate diet in obese volunteers: Gender related effects. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.942] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Rachmiel M, Landau Z, Boaz M, Mazor Aronovitch K, Loewenthal N, Ben-Ami M, Levy-Shraga Y, Modan-Moses D, Haim A, Abiri S, Pinhas-Hamiel O. The use of continuous glucose monitoring systems in a pediatric population with type 1 diabetes mellitus in real-life settings: the AWeSoMe Study Group experience. Acta Diabetol 2015; 52:323-9. [PMID: 25223531 DOI: 10.1007/s00592-014-0643-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 07/04/2014] [Accepted: 08/21/2014] [Indexed: 02/06/2023]
Abstract
AIMS The aim of the study was (a) to compare annual glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) who used a healthcare-funded continuous glucose monitoring system (RT-CGMS) to that of those who performed self-monitoring blood glucose (SMBG) only, in a real-life setting, and (b) to define parameters associated with compliance and glycemic control. METHODS A total of 149 youth with T1DM (52.3 % females), mean age 11.8 ± 3.6 years, and 83 in the CGMS group were followed prospectively for 12 months. Glycemic control parameters and compliance to RT-CGMS were assessed periodically. RESULTS Glycemic parameters did not differ significantly between the groups during follow-up periods. The time spent with RT-CGMS decreased and only 38 % used it for more than 75 % of the time during the 12 months (consistent users). Mean HbA1c decreased by 0.27 % in consistent users and increased by 0.21 % among intermittent users (used RT-CGMS less than 75 % of time), p = 0.013. Consistent users were younger 10. 6 ± 4.2 vs. 12.5 ± 3.6, p = 0.07, and had higher frequency of SMBG at baseline, 10.6 ± 4.9 vs. 6.3 ± 2.8, p = 0.011. CONCLUSIONS The adoption of RT-CGMS was low, even in a healthcare system that funds its use. Caregivers should consider patient characteristics when recommending RT-CGMS use.
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Affiliation(s)
- M Rachmiel
- Pediatric and Adolescent Diabetes Mellitus Service, Assaf Harofeh Medical Center, 70300, Zerifin, Israel,
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Leibovitz E, Wainstein J, Boaz M. PP158-SUN: Outstanding abstract: Admission Albumin Levels are Associated with Increased Risk for Hypoglycaemia during Hospitalization as well as Poor 1-Year Survival, Among Patients with Diabetes Mellitus. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50200-2] [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: 11/25/2022]
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Navarro D, Singer P, Krause I, Boaz M. PP222-SUN: Inter- and Intra-Rater Reliability of Dietary Intake Using Digitally Captured Images of Plate Waste. Clin Nutr 2014. [DOI: 10.1016/s0261-5614(14)50264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Poorly controlled hyperglycaemia is associated with increased morbidity and mortality in hospitalised patients. Based on the view that hospitalisation provides a window of opportunity to improve patient quality of care and health status, a comprehensive program for treating hospitalised diabetic patients was initiated. This study assessed the effectiveness of the Inpatient Hyperglycaemia Improvement Quality Program (IHIQP) over a 4-year period. METHODS Pre-test post-test design. In the pre-intervention period (August-December 2007), an institution-wide blood glucose monitoring system was introduced in August 2007. The remaining program components were introduced in January 2008, including implementing a hospital care protocol based on the 2007 American Diabetes Association Standards, a multidisciplinary team that participates in patient care and arranges continuing care after discharge and comprehensive patient education prior to discharge. Program results from January 2008 through October 2011 were evaluated. RESULTS During follow-up, more than 600,000 blood glucose tests were performed. Blood glucose values declined from 196.4 ± 98.4 mg/dl pre-IHIQP (August-December 2007) to 174.5 ± 82.0 mg/dl post-IHIQP (January-October 2011) (p < 0.0001). Prevalence of glucose values lower than 60 mg/dl declined from 2% to 1.3% (p < 0.004). Prevalence of glucose values ≥ 300 mg/dl declined from 13.6% to 8.4% (p < 0.0001). Concomitantly, the proportion of in-target values of 80-180 mg/dl increased from 47.7% to 58.1% (p < 0.0001). CONCLUSION This in-patient hyperglycaemia quality improvement program led to improvements in-patient glycaemic control, which continued over time. The effect of this improvement on in-patient mortality and morbidity needs additional follow-up.
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Affiliation(s)
- Y Bar-Dayan
- Diabetes Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Bar-Dayan Y, Bogaiov A, Boaz M, Landau Z, Wainstein J. Opinion and knowledge among hospital medical staff regarding diagnosis of diabetes and proper usage of a specific test tube for glucose analysis. Int J Clin Pract 2014; 68:278-82. [PMID: 24373068 DOI: 10.1111/ijcp.12314] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 08/29/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Accuracy of blood sugar values, as examined by glucose analysis, has significant importance on the diagnosis of diabetes and follow up of diabetes treatment. Usage of a designated test tube significantly improves the accuracy of measurement. Knowledge of the medical staff is a major determinant in the current usage of such a technology. The aim of the study was to assess the level of knowledge exhibited by medical staff in the diabetes field and specifically for the usage of a designated tube to test blood glucose level. METHODS A prospective study. The staff of the internal and surgical departments and outpatient clinics at the Wolfson Medical Center completed a questionnaire that assessed the level of knowledge about the designated glucose test tube, other randomly used test tubes, the parameters that influence the blood glucose values in a non-designated tube and the diagnosis of diabetes. RESULTS A number of 160 questionnaires (50% from internal departments, 36% from surgical departments and 14% from outpatient clinics) were analysed. The majority of the staff members (65%) knew that diabetes is diagnosed by glucose levels in blood. Of the 35% that did not know, 91% were nurses. The majority (75%) knew that diabetes is diagnosed during fasting conditions; however, most of the staff indicated that 12 h is needed. Only 25% knew of the designated test tube, and most of the staff indicated that a regular chemistry tube was the tube of choice for them. The staff exhibited poor level of knowledge regarding the parameters that influence the quality of the test. CONCLUSIONS Staff members are not aware of the various aspects of diabetes diagnosis and the designated test tube for glucose measurements, and most of them use a tube that gives inaccurate measurements, therefore there is an urgent need to improve diabetes knowledge among staff members.
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Affiliation(s)
- Y Bar-Dayan
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
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Landau Z, Rachmiel M, Pinhas-Hamiel O, Boaz M, Bar-Dayan Y, Wainstein J, Tauman R. Parental sleep quality and continuous glucose monitoring system use in children with type 1 diabetes. Acta Diabetol 2014; 51:499-503. [PMID: 24370924 DOI: 10.1007/s00592-013-0545-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 12/07/2013] [Indexed: 02/05/2023]
Abstract
To compare sleep quality and sleep-wake patterns in parents of children with type 1 diabetes before routine use of the continuous glucose monitoring system (CGMS) and while using it. Thirteen parents completed the Pittsburg Sleep Quality Index (PSQI), a 7-day sleep diary, and wore an actigraph (a wristwatch-size motion detector) during the night for 1 week before pediatric use of CGMS and 4-8 weeks after initiating routine use of the CGMS. Mean age of parents (ten mothers, three fathers) was 39 (range 32-47) years; mean age of children was 9.3 years (range 5.5-16.5 years); mean disease duration was 3.4 (range 0.6-11.2) years. PSQI total score demonstrated similar quality of sleep with and without use of the CGMS (4.6 and 4.9, respectively, p = 0.45). Six of the 13 parents reported severe sleep problems (PSQI ≥ 5) with and without the CGMS. The sleep diary indicated a greater number of awakening episodes during CGMS use than without the CGMS (1.6 and 1, respectively, p = 0.03), and actigraphy documented an increase in the number of wake bouts (22.9 and 19.7, p = 0.03) as well as in total wake time (48.3 and 42.2 min, p = 0.03) during CGMS use as compared with the period prior to CGMS use. Although self-perception of sleep quality remained unchanged, CGMS use appeared to affect actual parental sleep continuity somewhat negatively. This should be made clear to parents who may hold expectations of improvement in sleep quality following initiation of CGMS use.
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Affiliation(s)
- Z Landau
- Pediatric Endocrine and Diabetes Service, E. Wolfson Medical Center, Holon, 58100, Israel,
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Abstract
Sexual re-victimisation refers to a pattern in which the sexual assault victim has an increased risk of subsequent victimisation relative to an individual who was never victimised. The purpose of our study was to identify risks factors for a second rape, the severest form of sexual re-victimisation. All rape victims treated at the First Regional Israeli Center for Sexual Assault Victims between October 2000 and July 2010 were included in this retrospective analysis. We compared characteristics of 53 rape victims who were victimised twice to those of 1,939 rape victims who were victimised once. We identified several risk factors for a second rape, which can be used in prevention programmes. These are: psychiatric background, history of social services involvement, adulthood, non-virginity and minority ethnicity.
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Affiliation(s)
- S Lurie
- Department of Obstetrics and Gynecology
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Leibovitz E, Giryes S, Makhline R, Zikri Ditch M, Berlovitz Y, Boaz M. Malnutrition risk in newly hospitalized overweight and obese individuals: Mr NOI. Eur J Clin Nutr 2013; 67:620-4. [PMID: 23549203 DOI: 10.1038/ejcn.2013.45] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition risk and its consequences have not been reported in obese and overweight newly hospitalized patients. To estimate malnutrition risk among newly hospitalized overweight or obese patients, and to assess the effect of body mass index (BMI) on duration of hospitalization and risk of in-hospital death among hospitalized adults at increased risk of malnutrition. SUBJECTS/METHODS In this survey, all adults newly admitted to internal medicine and surgical departments at a large tertiary medical center, during the 5-week data acquisition period in 2010, were screened for malnutrition risk using the Nutrition Risk Screen (NRS 2002). Malnutrition risk was compared across body weight categories. In addition, overweight/obese subjects were compared by malnutrition risk category. RESULTS Of the 431 individuals analyzed, 138 were overweight and 105 were obese. Among overweight or obese patients, 23.2% and 24.8%, respectively, were at increased risk for malnutrition. Elevated risk for malnutrition prolonged hospitalization for both overweight and obese patients (from 5.6 ± 7.9 to 10.0 ± 10.3 days (P=0.04) and from 4.8 ± 4.6 to 15.1 ± 25.7 days (P=0.001), respectively). Prolonged hospital stay remained associated with malnutrition risk after controlling for age and BMI. Malnutrition risk significantly increased odds of in-hospital death: odds ratio (OR) 6.4, 95% confidence interval (CI) 1.2-33.2, P=0.03, even after controlling for age and BMI. CONCLUSIONS Increased malnutrition risk is a frequent finding in newly hospitalized overweight/obese adults, prolongs length of hospital stay and increases risk of in-hospital mortality.
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Affiliation(s)
- E Leibovitz
- Internal Medicine Department 'A', E Wolfson Medical Center, Holon, Israel
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17
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Breslavsky A, Frand J, Matas Z, Boaz M, Barnea Z, Shargorodsky M. Effect of high doses of vitamin D on arterial properties, adiponectin, leptin and glucose homeostasis in type 2 diabetic patients. Clin Nutr 2013; 32:970-5. [PMID: 23561637 DOI: 10.1016/j.clnu.2013.01.020] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [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: 06/26/2012] [Revised: 01/16/2013] [Accepted: 01/26/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Vitamin D supplementation has the potential to alleviate the cardiovascular damage in diabetic patients. The present study was designed to evaluate long term impact of high doses of vitamin D on arterial properties, glucose homeostasis, adiponectin and leptin in patients with type 2 diabetes mellitus. METHODS AND RESULTS In randomized, placebo-controlled study 47 diabetic patients were assigned into two groups: Group 1 received oral daily supplementation with vitamin D at a dose of 1000 U/day for 12 months. Group 2 received matching placebo capsules. Blood sampling for metabolic parameters, including fasting glucose, lipid profile, HbA1C, insulin, hs-CRP, 25 OH Vit D, adiponectin and leptin was performed at baseline and at the end of the study. Insulin resistance was assessed by homeostasis model assessment (HOMA-IR). Central aortic augmentation index (AI) was evaluated using SphygmoCor. RESULTS The two groups were similar at baseline in terms of hemodynamic parameters. After 12 months, AI decreased significantly during the treatment period in patients received vitamin D (p < 0.0001) and did not change in placebo group. Glucose homeostasis parameters, leptin as well as leptin adiponectin ratio did not change in both groups. 25 OH Vit D level significantly increased (p = 0.022) and circulating adiponectin marginally increased (p = 0.065) during 12 month treatment period in active treatment and did not change in placebo group. CONCLUSIONS High doses of vitamin D supplementation in diabetic patients was associated with significant decrease in AI during one year treatment. This beneficial vascular effect was not associated with improvement in glucose homeostasis parameters.
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Affiliation(s)
- A Breslavsky
- Department of Medicine, Wolfson Medical Center, Israel
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18
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Frand J, Borislavsky A, Boaz M, Matas Z, Shargorodsky M. Does adiponectin level explain the atherogenic properties of Hp 2-2 phenotype in type 2 diabetic patients? Atherosclerosis 2013. [DOI: 10.1016/j.atherosclerosis.2012.10.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Briskman I, Bar G, Boaz M, Shargorodsky M. Impact of co-morbid mental illness on the diagnosis and management of patients hospitalized for medical conditions in a general hospital. Int J Psychiatry Med 2012; 43:339-48. [PMID: 23094466 DOI: 10.2190/pm.43.4.d] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
AIMS Comorbidities including hyperglycemia, diabetes, and hypertension are frequently observed in psychiatric patients. Nevertheless, this population has higher rates of morbidity and mortality from medical illnesses compared to non-psychiatric patients. The present study evaluated the diagnosis and management of general medical hospitalized patients with and without mental illness. METHODS The study group consisted of 200 hospitalized subjects including 100 subjects who met the DSM-IV criteria for schizophrenia or bipolar disorder and 100 age-matched controls. All patients were evaluated for a comorbid condition, concomitant medication, biochemical parameters. Comorbid conditions were defined using the National Cholesterol Education Program risk factors categories: diabetes (fasting plasma glucose level > or = 126 mg/dl and/or pharmacological treatment); hypertension (systolic blood pressure > or =140 mm Hg and/or diastolic BP > or = 90 mm Hg and/or pharmacological treatment); dyslipidemia (hypertriglyceridemia (> or = 150 mg/dl); and/or pharmacological treatment and/or low HDL cholesterol level (< 40 mg/dl in men and < 50 mg/dl in women). RESULTS The two groups were similar in terms of age, sex, mean blood pressure, glucose, and lipids. Patients with a history of psychiatric illness were less frequently diagnosed with medical conditions such as hypertension, dyslipidemia, and diabetes compared to the non-psychiatric population, though according NCEP criteria, these conditions did not significantly differ between the two groups. Significantly fewer psychiatric than non-psychiatric patients received aspirin, statins, anti-hypertensive and anti-diabetic medications. Although more obesity was diagnosed in psychiatric patients, significantly fewer diet consults were performed during hospitalization. While significantly more smokers and more pulmonary hospitalizations were observed in the psychiatric group, fewer subjects in this group received instruction for smoking cessation compared to the non-psychiatric population. CONCLUSIONS Comorbid medical conditions such as diabetes, hypertension, dyslipidemia, and obesity are under-diagnosed and under-treated in hospitalized psychiatric patients compared with the non-psychiatric population. Patients with mental illness have significantly less preventive intervention during hospitalization.
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Affiliation(s)
- I Briskman
- Wolfson Medical Center and Tel Aviv University, Israel
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20
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Shor R, Tirosh A, Shemesh L, Krakover R, Bar Chaim A, Mor A, Boaz M, Golik A. 25 hydroxyvitamin D levels in patients undergoing coronary artery catheterization. Eur J Intern Med 2012; 23:470-3. [PMID: 22726379 DOI: 10.1016/j.ejim.2012.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 01/12/2012] [Accepted: 01/23/2012] [Indexed: 12/20/2022]
Abstract
INTRODUCTION A growing body of evidence suggests that vitamin D deficiency is associated with increased cardiovascular morbidity and mortality. The present study assessed the association between low serum 25-hydroxyvitamin D (25(OH)D) and coronary artery disease status defined by coronary catheterization findings. METHODS An observational study of 101 consecutive patients admitted to Assaf Harofeh Medical Center during 2009, and scheduled to undergo coronary catheterization was undertaken. Blood was collected for parathyroid hormone, 25(OH)D and high sensitivity C reactive protein (hsCRP). 25(OH)D deficiency was defined as <20 ng/ml. Patients were divided into two groups: patients with normal or non-significant coronary artery disease and patients with a significant coronary artery disease as found during cardiac catheterization. Logistic regression model was used to compare pathological coronary catheterization findings, including 25(OH)D levels dichotomized to low (serum 25(OH)D levels<20 ng/ml) vs. high (serum 25(OH)D levels ≥ 20 ng/ml) and other confounders. RESULTS Patients with pathological coronary catheterization had 25(OH)D deficiency (75% vs 55.1%, p=0.036). Pathological coronary catheterization was more prevalent among patients with 25(OH)D deficiency (Odds ratio (OR) 2.44, 95% confidence interval (CI) 1.05-5.68, p=0.038). This difference was more pronounced after controlling for sex, age, BMI, ethnicity and present smoking (OR 2.92, 95% CI 1.01-8.46, p=0.016). CONCLUSIONS 25(OH)D deficiency is significantly associated with pathological cardiac catheterization findings. This association is strengthened further by controlling for other cardiovascular disease risk factors.
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Affiliation(s)
- R Shor
- Internal Medicine A Department, Assaf-Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
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Wainstein J, Landau Z, Matas Z, Chaimy T, Boaz M. Jewish New Year associated with decreased point of care glucose in hospitalised patient population. Int J Clin Pract 2011; 65:1055-8. [PMID: 21923846 DOI: 10.1111/j.1742-1241.2011.02707.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In individuals with diabetes, glycaemic control has been shown to be disrupted during the winter holiday period. OBJECTIVES The aim of this study was to examine whether blood glucose levels are influenced by the Jewish New Year period in hospitalised individuals with diabetes. METHODS At E. Wolfson Medical Center, Holon, Israel, blood glucose values from individuals hospitalised in internal medicine units were collected and analysed during the period surrounding Rosh Hashanah, the Jewish New Year, 2010. Values obtained from 4 to 7 September 2010 were categorised as preholiday values; values from 8 to 11 September 2010 were classed as holiday values; and values from 12 to 15 September 2010 were labelled postholiday values. All values were collected at point of care (POC) using an automated, institutional glucometer located in each department, the data from which is downloaded to a central database. RESULTS A total of 3403 POC glucose values were recorded during the observation period. POC glucose values were significantly lower during the Rosh Hashanah holiday than the pre holiday or postholiday periods: 176.8 ± 81.3 mg/dl vs. 181.4 ± 78.8 mg/dl or 184.9 ± 83.02 mg/dl, p = 0.03. During the Rosh Hashanah holiday, mean patient age was significantly older than the preholiday or postholiday period: 77.4 ± 10.9 years vs. 74.9 ± 12.0 years or 75.3 ± 11.8 years, p < 0.0001; however, age predicted less than 1% of the variability in POC glucose: r = 0.02, p = 0.23. Significantly more women were hospitalised during the preholiday than during the holiday or postholiday periods. In a linear regression model, holiday period remained a significant independent predictor of POC glucose even after controlling for age and gender. CONCLUSIONS Point of care glucose was significantly lower during the Rosh Hashanah period relative to preholiday and postholiday values. This may reflect a shift in the composition of the hospitalised patient population during the holidays towards older individuals with more restricted dietary intake.
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Affiliation(s)
- J Wainstein
- Diabetes Unit, E. Wolfson Medical Center, Holon, Israel
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22
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Boaz M, Katzir Z, Schwartz D, Gafter U, Biro A, Shtendik L, Kon V, Chernin G, Weinstein T. Effect of Sevelamer Hydrochloride Exposure on Carotid Intima Media Thickness in Hemodialysis Patients. ACTA ACUST UNITED AC 2011; 117:c83-8. [DOI: 10.1159/000319654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/08/2010] [Indexed: 11/19/2022]
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Wolfson N, Garish D, Goldberg Y, Boaz M, Matas Z, Shargorodsky M. Effect of Weight Loss Maintenance on Arterial Compliance and Metabolic and Inflammatory Parameters: A Three-Year Follow-Up Study. Ann Nutr Metab 2010; 57:204-10. [DOI: 10.1159/000313453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 04/13/2010] [Indexed: 11/19/2022]
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24
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Lukich E, Matas Z, Boaz M, Shargorodsky M. Increasing derangement of glucose homeostasis is associated with increased arterial stiffness in patients with diabetes, impaired fasting glucose and normal controls. Diabetes Metab Res Rev 2010; 26:365-70. [PMID: 20568265 DOI: 10.1002/dmrr.1086] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM Glucose intolerance produces structural and functional changes in the arterial wall. The present study investigated association between glucose tolerance status and arterial stiffness in subjects with normal and impaired glucose regulation (IGR). METHODS The study group consisted of 284 subjects, including 111 subjects with normal fasting glucose (NFG), 61 subjects classed as impaired fasting glucose (IFG) according of the new fasting blood glucose (FBG) cut-off point of 100 mg/dL and 112 patients with diabetes mellitus (DM). All patients were evaluated for glucose, HbA1C, insulin, lipids, C-reactive protein (CRP) and homeostasis model assessment-insulin resistance. Pulse wave velocity (PWV) and augmentation index (AI) were performed as a noninvasive recording of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). RESULTS Pulse wave velocity, augmentation index and central arterial pressure increased consistently with deterioration of glucose tolerance. PWV was significantly higher in subjects with diabetes than in the normal and IFG groups (p < 0.0001 and p = 0.007, respectively). IFG subjects had marginally higher PWV than normal subjects (p = 0.050). Compared to normal subjects, IFG and diabetes groups were associated with increased AI (p = 0.003 and p < 0.0001, respectively). Arterial stiffness parameters remained significantly higher in both IFG and diabetes groups compared to normal after adjustment for cardiovascular risk factors and concomitant medications. Positive correlations between FBG, HbA1C and arterial stiffness parameters were detected. CONCLUSIONS Arterial stiffness parameters varied significantly across subgroups of patients with different degrees of impaired glucose regulation, such that increasingly deranged glucose homeostasis was associated with increased arterial stiffness. Early adverse vascular changes were detected in subjects with IFG.
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Affiliation(s)
- E Lukich
- Department of Medicine, Wolfson Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cernes R, Peer M, Boaz M, Harpaz D, Matas Z, Shargorodsky M. Relation of Arterial Properties to Left Ventricular Hypertrophy in Hypertensive Adults: Focus on Gender-Related Differences. Angiology 2010; 61:510-5. [DOI: 10.1177/0003319709355800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Although gender-related differences in ventricular remodeling and arterial stiffness have been described, the impact of gender on the association between vascular compliance and left ventricular hypertrophy (LVH) has not been investigated. The current study was designed to determine the gender-related differences in the association between echographically determined LVH measures and arterial stiffness in hypertensive men and women. Methods: In the current study, 104 hypertensive participants (61 men and 43 women) were enrolled. Large artery elasticity index (LAEI) and small artery elasticity index (SAEI) were determined using pulse wave contour analysis (HDI CR 2000, Eagan, Minnesota). Left ventricular hypertrophy parameters including intraventricular septum thickness (IVST), posterior wall thickness (PWT), and left ventricular mass index (LVMI) were assessed echographically. Results: Hypertensive male versus female were similar in terms of age, body mass index (BMI), blood pressure, concomitant medications, and cardiovascular risk factors. Left ventricular mass index was significantly, inversely associated with IVST (r = —.32, P = .01), PWT (r = —.32, P = .01), and LVMI (r = —.28, P = .03) in men and significantly, inversely associated with IVST (r = —39, P = .01), PWT (r = —.42, P = .005), LVMI (r = —.54, P < .0001) in women. Small artery elasticity index was significantly, inversely associated with LVMI (r = —0.36, P = .02) in women only. In regression analysis, LAEI explained more variability than SAEI and was an independent predictor of LVH parameters in hypertensive men and women. Conclusions: Compliance of large arteries is potentially an independent predictor of LVH in hypertensive men and women. Therefore, arterial compliance is being considered an important tool in predicting LVH in hypertensive participants.
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Affiliation(s)
- R. Cernes
- Department of Nephrology, E. Wolfson Medical Center, Israel, Sackler School of Medicine, Tel Aviv University, Israel
| | - M. Peer
- Internal Medicine, E. Wolfson Medical Center, Israel
| | - M. Boaz
- Epidemiology and Statistics, E. Wolfson Medical Center, Israel, The Brunner Institute for Cardiovascular Research, E. Wolfson Medical Center, Israel
| | - D. Harpaz
- Sackler School of Medicine, Tel Aviv University, Israel, Cardiology, E. Wolfson Medical Center, Israel
| | - Z. Matas
- Biochemistry, E. Wolfson Medical Center, Israel, The Brunner Institute for Cardiovascular Research, E. Wolfson Medical Center, Israel
| | - M. Shargorodsky
- Sackler School of Medicine, Tel Aviv University, Israel, Endocrinology, E. Wolfson Medical Center, Israel, The Brunner Institute for Cardiovascular Research, E. Wolfson Medical Center, Israel,
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Lorberboym M, Mena I, Wainstein J, Boaz M, Lampl Y. The effect of sildenafil citrate (Viagra) on cerebral blood flow in patients with cerebrovascular risk factors. Acta Neurol Scand 2010; 121:370-6. [PMID: 20028342 DOI: 10.1111/j.1600-0404.2009.01307.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Sildenafil citrate is widely used for erectile dysfunction. The present study examined the short-term effects of sildenafil administration in individuals with cerebrovascular risk factors, including patients with a history of stroke. MATERIALS AND METHODS Twenty-five consecutive male patients with erectile dysfunction and vascular risk factors were included in the study. A perfusion brain SPECT study was performed at baseline and 1 h after the oral administration of sildenafil. RESULTS Associations between any of the risk factors and the perfusion scores were not detected, with the exception of stroke. Stroke patients showed significantly more areas with diminished perfusion after sildenafil administration compared to baseline. CONCLUSIONS In patients with diabetes or hypertension, a dose of 50 mg sildenafil does not appear to produce detrimental effects on cerebral blood flow. However, patients with a history of stroke may be at increased risk of hemodynamic impairment after the use of sildenafil.
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Berkun Y, Zandman-Goddard G, Barzilai O, Boaz M, Sherer Y, Larida B, Blank M, Anaya JM, Shoenfeld Y. Infectious antibodies in systemic lupus erythematosus patients. Lupus 2010; 18:1129-35. [PMID: 19880558 DOI: 10.1177/0961203309345729] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infections can act as environmental triggers that induce or promote systemic lupus erythematosus (SLE) in genetically predisposed individuals. New technologies, developed recently, enable simultaneous assessment of multiple antibodies. Antibodies to specific infectious agents may shed light into the mechanisms of induction of SLE. The aim of this study was to investigate the prevalence of seropositivity and the titers of antibodies to bacterial, viral, and parasitic agents in SLE patients compared with non-autoimmune controls. Sera from 260 individuals (120 SLE patients and 140 controls) were tested by the BioPlex 2200 Multiplexed Immunoassay method (BioRad) for the prevalence and titers of antibodies to eight infectious agents (Epstein-Barr virus: early antigen IgG, nuclear antigen IgG, viral capsid antigen IgG and IgM, heterophile IgM; cytomegalovirus IgG and IgM; Toxoplasma gondii IgG and IgM; rubella IgG and IgM; Treponema pallidum TPr15G, TPr17G, TPr47G; herpes simplex virus type 1 and 2 IgG; hepatitis C virus and hepatitis B core antibodies. Cytomegalovirus IgM and Epstein-Barr virus early antigen IgG (but not other Epstein-Barr virus antigens) were significantly more prevalent in SLE patients than in controls. Conversely, positive titers of hepatitis B core and rubella IgG antibodies were less prevalent in the SLE patients than in controls. Other differences in titer positivity prevalence were not detected between patients and controls. The titers of the cytomegalovirus IgM, Toxoplasma IgG, Epstein-Barr virus early antigen, and viral capsid antigen IgG antibodies were significantly higher in SLE compared with controls. Our data suggest the importance of previous exposure to infectious agents in the induction and the prevention of SLE.
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Affiliation(s)
- Y Berkun
- Safra Children Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
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29
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Boaz M, Lisy L, Zandman-Goddard G, Wainstein J. The effect of anti-inflammatory (aspirin and/or statin) therapy on body weight in Type 2 diabetic individuals: EAT, a retrospective study. Diabet Med 2009; 26:708-13. [PMID: 19573120 DOI: 10.1111/j.1464-5491.2009.02747.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Obesity is associated with inflammation. Anti-inflammatory interventions such as aspirin and statins (anti-IFRx) might be a novel approach to the treatment of obesity and Type 2 diabetes mellitus (T2DM). The present study was designed to determine whether exposure to anti-IFRx is associated with weight loss in T2DM patients. METHODS Exposure to anti-IFRx was compared between T2DM patients with a history of weight loss (n = 100) and those with no weight loss or with weight gain (n = 102) during a 1-year follow-up period. Logistic regression was used to develop odds ratios for weight loss status. RESULTS Subjects who lost weight were more frequently exposed to anti-IFRx (85.0 vs. 71.5%, P = 0.018) than subjects who maintained or gained weight during follow-up. The 158 subjects exposed to anti-IFRx were older (64.2 +/- 9.4 vs. 60.6 +/- 11.2 years, P = 0.04), had longer duration T2DM (14.5 +/- 9.5 vs. 9.0 +/- 9.4 years, P = 0.001), had greater prevalence of dyslipidaemia (72 vs. 19%, P < 0.0001) hypertension (57.3 vs. 38.1%, P = 0.03) and cardiovascular disease (37.7 vs. 9.5%, P < 0.0001) than subjects not exposed to anti-IFRx. In a logistic regression model for weight change status, anti-IFRx exposure was significantly associated with weight status (odds ratio = 2.3, 95% confidence interval 1.1-4.8, P = 0.02, an association that persisted), even after controlling for age, sex, baseline body mass index, years since diagnosis, OHA therapy and co-morbidities. CONCLUSIONS Exposure to anti-IFRx more than doubled the odds of weight loss in T2DM patients. Results of this study justify a randomized clinical trial to determine definitively the role of anti-IFRx in weight loss in subjects with T2DM.
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Affiliation(s)
- M Boaz
- Epidemiology and Research Unit, Wolfson Medical Center, Holon, Israel.
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Shargorodsky M, Boaz M, Luckish A, Matas Z, Gavish D, Mashavi M. Osteoprotegerin as an independent marker of subclinical atherosclerosis in osteoporotic postmenopausal women. Atherosclerosis 2009; 204:608-11. [DOI: 10.1016/j.atherosclerosis.2008.10.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 10/16/2008] [Accepted: 10/16/2008] [Indexed: 11/25/2022]
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Weiss A, Boaz M, Beloosesky Y, Kornowski R, Grossman E. Body mass index and risk of all-cause and cardiovascular mortality in hospitalized elderly patients with diabetes mellitus. Diabet Med 2009; 26:253-9. [PMID: 19317820 DOI: 10.1111/j.1464-5491.2009.02672.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIMS Obesity is linked to increased morbidity and mortality risk in both the general population and in patients with diabetes mellitus; however, recent reports suggest that, in hospitalized elderly individuals, the association between body mass index (BMI) and mortality may be inverse. The present study sought to investigate the association between BMI and survival in hospitalized elderly individuals with diabetes mellitus. METHODS The medical records of 470 patients (226 males, mean age of 81.5 +/- 7.0 years) admitted to an acute geriatric ward between 1999 and 2000 were reviewed. Of the 140 patients with diabetes mellitus, 122 had more than 6 months of follow-up and were included in this analysis. Patients were followed up until 31 August 2004. Mortality data were extracted from death certificates. RESULTS During a mean follow-up of 3.7 +/- 1.6 years, 69 (56.6%) subjects died, 31 (25.4%) from cardiovascular causes. Those who died from any cause had lower baseline BMI than those who survived (24.0 +/- 4.0 vs. 27.1 +/- 4.3 kg/m(2); P < 0.0001). Similarly, those who died of cardiovascular causes had lower baseline BMI than those who did not (23.7 +/- 3.6 vs. 25.9 +/- 4.5, P = 0.01). BMI was inversely associated with all-cause [relative risk (RR) 0.89, 95% confidence interval (CI) 0.83-0.96, P = 0.002] and cardiovascular death (RR 0.83, 95% CI 0.74-0.93, P = 0.002) even after controlling for age, sex, smoking, dyslipidaemia and reason for hospital admission. CONCLUSIONS In very elderly subjects with diabetes mellitus, increased BMI was associated with reduced mortality risk.
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Affiliation(s)
- A Weiss
- Geriatric Ward, Rabin Medical Center, Petah Tikvah, Israel.
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Shargorodsky M, Boaz M, Pasternak S, Hanah R, Matas Z, Fux A, Beigel Y, Mashavi M. Serum homocysteine, folate, vitamin B12 levels and arterial stiffness in diabetic patients: which of them is really important in atherogenesis? Diabetes Metab Res Rev 2009; 25:70-5. [PMID: 19065546 DOI: 10.1002/dmrr.902] [Citation(s) in RCA: 28] [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] [Indexed: 11/09/2022]
Abstract
AIM Hyperhomocystinaemia is associated with macro- and microangiopathic diabetic complications. However, the role of homocysteine (Hcy), serum folate, and vitamin B12 level in the development of premature vascular damage in type 2 diabetic patients is not clear. The present study was designed to assess the relationship between total Hcy, folate, and vitamin B12 levels and arterial stiffness, an early marker of generalized atherosclerosis. METHODS As many as 86 subjects with type 2 diabetes mellitus were studied. All participants were evaluated for glucose, HbA(1C), lipid profile, hs-CRP, endothelin, Hcy, vitamin B12, and folate. Pulse wave velocity (PWV) and augmentation index (AI) were performed as a non-invasive recording and computer analysis of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). RESULTS Hcy was significantly positively associated with age, serum creatinine, and vitamin B12 levels. No association between Hcy and folate was observed. The Hcy concentration was significantly positively associated with PWV (r = 0.540, p < 0.0001) and AI (r = 0.390, p < 0.0001). In a general linear model of PWV, Hcy emerged as an independent predictor of PWV even after controlling for age, creatinine, vitamin B12, and folate levels. In a multiple linear regression analysis, the association between Hcy and arterial stiffness was independent of traditional cardiovascular risk factors. Vitamin B12 levels were significantly inversely associated with tHcy (r = - 0.263, p = 0.015) and marginally associated with PWV(r = - 0.212, p = 0.052). Significant associations between folate levels and PWV were not detected. CONCLUSIONS The results lend support to the hypothesis that elevated Hcy may have a key role in the development of atherogenesis in diabetic patients. Additionally, vitamin B12 is significantly associated with tHcy concentrations and is identified as a marginally independent correlate of PWV in diabetic patients in the absence of folate deficiency.
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Affiliation(s)
- M Shargorodsky
- Department of Endocrinology, Wolfson Medical Center, Tel Aviv, Israel.
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Mashavi M, Hanah R, Boaz M, Gavish D, Matas Z, Fux A, Shargorodsky M. Effect of homocysteine-lowering therapy on arterial elasticity and metabolic parameters in metformin-treated diabetic patients. Atherosclerosis 2008; 199:362-7. [DOI: 10.1016/j.atherosclerosis.2007.11.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/25/2007] [Accepted: 11/28/2007] [Indexed: 10/22/2022]
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Luckish A, Cernes R, Boaz M, Gavish D, Matas Z, Fux A, Shargorodsky M. Effect of long-term treatment with risedronate on arterial compliance in osteoporotic patients with cardiovascular risk factors. Bone 2008; 43:279-283. [PMID: 18515205 DOI: 10.1016/j.bone.2008.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [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: 07/04/2007] [Revised: 03/23/2008] [Accepted: 03/28/2008] [Indexed: 12/23/2022]
Abstract
Accumulating evidence suggests that osteoporosis and coronary artery disease have epidemiologic similarities. Moreover, the anti-atherogenic effects of bisphosphonates have been observed in vitro and in animal models. The present study investigated the effect of risedronate on indices of arterial compliance, serum osteoprotegerin (OPG) level, inflammatory and metabolic parameters in osteoporotic women with cardiovascular risk factors. In an open label, prospective study 68 postmenopausal osteoporotic women were evaluated for the study. Patients received risedronate orally in a dose of 35 mg per week, daily supplements of calcium and cholecalciferol during 6month treatment period. Patients were evaluated for lipid profile, HbA1C, insulin, C-peptide, fibrinogen, hs-CRP and plasma osreoprotegerin. Arterial elasticity was evaluated using pulse wave contour analysis (HDI CR 2000, Eagan, Minnesota). Large artery elasticity index (LAEI) increased from 9.86+/-3.66 to 11.54+/-">+/-3.16 ml/mm HgX10 (p<0.0001) during treatment period. Small artery elasticity index (SAEI) increased from 2.64+/-1.10 to 3.28+/-1.16 ml/mm HgX100 (p<0.0001). Systemic vascular resistance (SVR) decreased from 1876.12+/-457.72 to 1646.12+/-260.17 dyn/s/cm(- 5) (p<0.013). Metabolic parameters did not change during the treatment period. Plasma osteoprotegerin was significantly, positively correlated to SVR at baseline (r=0.36, p=0.045). At the final visit, OPG was marginally inversely associated with LAE (r=- 0.312, p=0.09), and significantly, positively associated with total vascular impedance (r=0.43, p=0.015). In conclusion, prolonged treatment with risedronate improved arterial elasticity of small and large arteries, and decreased SVR. These beneficial vascular effects were not related to changes in cardiovascular risk factors and may be attributed to direct effects of risedronate on the vascular wall.
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Affiliation(s)
- A Luckish
- Department of Internal Medicine, Holon, 58100, Israel
| | - R Cernes
- Department of Nephrology, Holon, 58100, Israel
| | - M Boaz
- Department of Epidemiology and Statistics, Holon, 58100, Israel
| | - D Gavish
- Department of Internal Medicine, Holon, 58100, Israel; The Brunner Institute for Cardiovascular Research, Holon, 58100, Israel; E. Wolfson Medical Center; and Sackler School of Medicine, Tel Aviv University, Israel
| | - Z Matas
- Department of Biochemistry, Holon, 58100, Israel
| | - A Fux
- Department of Biochemistry, Holon, 58100, Israel
| | - M Shargorodsky
- Endocrinology Unit, Holon, 58100, Israel; The Brunner Institute for Cardiovascular Research, Holon, 58100, Israel; E. Wolfson Medical Center; and Sackler School of Medicine, Tel Aviv University, Israel.
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Serour F, Weissenberg M, Boaz M, Ezri T, Gorenstein A. Intravenous fluids warming by mattress is simple and efficient during pediatric surgery. Acta Anaesthesiol Scand 2008. [DOI: 10.1111/j.1399-6576.1970.tb00935.x-i1] [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: 11/27/2022]
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Abstract
Infections can act as environmental triggers inducing or promoting systemic lupus erythematosus (SLE) in genetically predisposed individuals. The aim of the present study was to compare the titres of antibodies (Abs) to infectious agents with neuropsychiatric (NPSLE) clinical manifestations. The sera of 260 individuals (120 patients with SLE and 140 geographic controls) were evaluated for the titres of Epstein bar virus (EBV), cytomegalovirus (CMV), toxoplasma, rubella and syphilis Abs using the BioPlex 2200 Multiplexed Immunoassay method (BioRad) and by the ELISA method for Helicobacter pylori and Hepatitis B core Ag. All BioPlex 2200 kits used were in developmental stages. Data analysis was performed using SPSS 9.0 statistical analysis software (SPSS Inc., Chicago, IL, USA, 1999). Correlation analysis indicated that rubella IgM Ab titres were marginally, positively associated with psychosis ( P = 0.09). No other associations were detected between the 17 infectious Abs and five NP manifestations. When the positivity cut-off for anti-rubella IgM Abs was set at three standard deviations above normal, three positive subjects were identified: one patient with psychosis and one with depression, for a total NPSLE prevalence of 33.3%. On the contrary, the prevalence of NPSLE in the remaining subjects was 6.5%. Marginally significant correlations between elevated titres of rubella IgM Ab with psychosis and depression were found. Although this nearly 5-fold increase is not statistically significant, it appears that in a larger sample size, significance would be reached. This is the first study reported that examined the correlation of NPSLE manifestations with anti-infectious Abs.
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Affiliation(s)
- G Zandman-Goddard
- Department of Medicine C, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Y Berkun
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Pediatric Department, Safra Childrens Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - O Barzilai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Medicine B, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - M Boaz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Epidemiology Unit, Wolfson Medical Center, Holon, Israel
| | - M Ram
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Medicine B, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - JM Anaya
- Cellular Biology and Immunogenetics Unit, CIB-Universitario del Rosaria, Medellin, Columbia
| | - Y Shoenfeld
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Department of Medicine B, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Incumbent of Laura Schwartz-Kipp Chair in Autoimmunity, Tel-Aviv University, Tel Aviv, Israel
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Shapiro Y, Boaz M, Matas Z, Fux A, Shargorodsky M. The association between the renin-angiotensin-aldosterone system and arterial stiffness in young healthy subjects. Clin Endocrinol (Oxf) 2008; 68:510-2. [PMID: 18194491 DOI: 10.1111/j.1365-2265.2008.03176.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aldosterone might affect arterial stiffening, in both the short- and long-term. We investigated a possible association between excess aldosterone, reflected by an increased aldosterone : renin ratio (ARR) and pulse wave velocity (PWV) in young healthy adults. In a single-centre study, 60 subjects were evaluated for lipid profile, glucose, hs-CRP, renin and aldosterone. PWV was performed as a simple non-invasive recording and computer analysis of the two artery sites pressure waveform using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia). The ARR was significantly, positively associated with PWV: r = 0.298, P = 0.02. ARR was not associated with anthropometric variables, blood pressure (BP), metabolic and inflammatory parameters. In conclusion, the ARR was significantly associated with PWV and may exhibit direct effects of aldosterone on the vascular wall, which are not related to changes in conventional cardiovascular risk factors.
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Affiliation(s)
- Y Shapiro
- Department of Medicine, Wolfson Medical Center and Sackler School of Medicine, Tel Aviv, Israel
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Shargorodsky M, Hass E, Boaz M, Gavish D, Zimlichman R. High dose treatment with angiotensin II receptor blocker in patients with hypertension: Differential effect of tissue protection versus blood pressure lowering. Atherosclerosis 2008; 197:303-10. [PMID: 17588581 DOI: 10.1016/j.atherosclerosis.2006.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 09/15/2006] [Revised: 11/03/2006] [Accepted: 12/01/2006] [Indexed: 01/13/2023]
Abstract
Aggressive inhibition of renin-angiotensin-aldosterone system may provide the best cardiovascular protection. We examined the effect of different doses of angiotensin II receptor blocker, Candesartan, on arterial elasticity, inflammatory and metabolic parameters in hypertensive patients with multiple cardiovascular risk factors. 69 hypertensive patients were randomized into three groups: group 1 included patients treated with high doses of Candesartan (32 mg), group 2 included patients treated with conventional doses of Candesartan (16 mg), group 3 included patients that received antihypertensive treatment other that angiotensin II type-1 receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs). Patients were evaluated for lipid profile, HbA1C, insulin, C-peptide, hs-CRP, aldosterone, renin and Homeostasis model assessment-insulin resistance (HOMA-IR). Arterial elasticity was evaluated using pulse wave contour analysis method (HDI CR 2000, Eagan, Minnesota). In patients treated with high doses of Candesartan: large artery elasticity index (LAEI) increased from 8.6+/-2.8 to 16.6+/-5.1 ml/mm Hg x 100 after 6 months of treatment (p<0.0001). Small artery elasticity index (SAEI) increased from 2.7+/-1.3 to 5.9+/-2.8 ml/mm Hg x 100 (p<0.0001). Systemic vascular resistance (SVR) decreased from 1881.5+/-527.5 to 1520.9+/-271.8 (p<0.0006). In patients treated with conventional doses of Candesartan: LAEI index increased from 11.0+/-3.5 to 14.4+/-3.2 ml/mm Hg x 100 (p<0.0001). SAEI increased during the study from 3.7+/-1.4 to 5.4+/-2.1 ml/mm Hg x 100 (p<0.0001). SVR decreased from 1699.8+/-327.6 to 1400.7+/-241 (p<0.0001). In the control group: neither LAE nor SAE improved during the treatment period. Although similar reduction in blood pressure was observed in all three groups, both LAE and SAE improved only in patients treated by ARBs. Treatment with high doses of Candesartan improves arterial stiffness to a greater extent than conventional doses of Candesartan, despite comparable changes in blood pressure.
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Affiliation(s)
- M Shargorodsky
- Department of Endocrinology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Shargorodsky M, Michaelova K, Boaz M, Gavish D, Zimlichman R. Effect of long-term treatment with rosiglitazone on arterial elasticity and metabolic parameters in patients with Type 2 diabetes mellitus: a 2-year follow-up study. Diabet Med 2007; 24:1254-60. [PMID: 17725634 DOI: 10.1111/j.1464-5491.2007.02231.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS Thiazolidinediones may influence the atherogenic process by improving cardiovascular risk factors. The present study was designed to determine the long-term effect of rosiglitazone on arterial compliance and metabolic parameters in patients with Type 2 diabetes. METHODS In an open-label, prospective study, 65 diabetic patients received rosiglitazone orally (4-8 mg/day) for 6 months. After 6 months, the patients continued an open follow-up study and were divided into two groups: group 1 included patients continuing rosiglitazone for 2 years, group 2 included patients discontinuing rosiglitazone and receiving other oral glucose-lowering agents. Lipid profile, glycated haemoglobin (HbA1c), insulin, C-peptide, fibrinogen, high-sensitivity-CRP and homeostasis model assessment-insulin resistance were measured. Arterial elasticity was assessed using pulse wave contour analysis. RESULTS In patients treated with rosiglitazone for 2 years: the large artery elasticity index (LAEI) increased from 10.0 +/- 4.6 to 13.9 +/- 4.7 ml/mmHg x 100 after 2 years (P = 0.003). The small artery elasticity (SAEI) index increased significantly from 3.2 +/- 1.2 to 5.1 +/- 1.9 (P < 0.0001). In patients who discontinued rosiglitazone: LAEI did not change after 6 months, but decreased from 12.1 +/- 5.4 to 8.9 +/- 3.9 ml/mmHg x 10 (P < 0.0001) at the end of 2 years. SAEI increased during the first 6 months of treatment, from 3.9 +/- 1.8 to 5.1 +/- 1.5 ml/mmHg x 100 (P < 0.0001) and decreased after discontinuation of rosiglitazone (P = 0.042). CONCLUSIONS Prolonged treatment with rosiglitazone improved arterial elasticity. However, significant deterioration in LAEI and SAEI was observed in patients who discontinued rosiglitazone. The beneficial vascular effect of rosiglitazone on arterial elasticity was independent of glycaemic control.
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Affiliation(s)
- M Shargorodsky
- Department of Endocrinology, Brunner Institute for Cardiovascular Research, Wolfson Medical Center Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lampl Y, Boaz M, Gilad R, Lorberboym M, Dabby R, Rapoport A, Anca-Hershkowitz M, Sadeh M. Minocycline treatment in acute stroke: an open-label, evaluator-blinded study. Neurology 2007; 69:1404-10. [PMID: 17909152 DOI: 10.1212/01.wnl.0000277487.04281.db] [Citation(s) in RCA: 339] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Ischemic animal model studies have shown a neuroprotective effect of minocycline. OBJECTIVE To analyze the effect of minocycline treatment in human acute ischemic stroke. METHODS We performed an open-label, evaluator-blinded study. Minocycline at a dosage of 200 mg was administered orally for 5 days. The therapeutic window of time was 6 to 24 hours after onset of stroke. Data from NIH Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI) were evaluated. The primary objective was to compare changes from baseline to day 90 in NIHSS in the minocycline group vs placebo. RESULTS One hundred fifty-two patients were included in the study. Seventy-four patients received minocycline treatment, and 77 received placebo. NIHSS and mRS were significantly lower and BI scores were significantly higher in minocycline-treated patients. This pattern was already apparent on day 7 and day 30 of follow-up. Deaths, myocardial infarctions, recurrent strokes, and hemorrhagic transformations during follow-up did not differ by treatment group. CONCLUSIONS Patients with acute stroke had significantly better outcome with minocycline treatment compared with placebo. The findings suggest a potential benefit of minocycline in acute ischemic stroke.
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Affiliation(s)
- Y Lampl
- Department of Neurology, Edith Wolfson Medical Center, Holon 58100, Israel.
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Abstract
The normal electromyographic values and the significance of spontaneous activity, when examining the cervical paraspinal muscles, has been studied rarely, and there are very few studies concerning this issue. To obtain muscle unit potential (MUP) reference values for cervical paraspinal muscles, we examined 100 volunteers. Spontaneous activity and the analysis of 20 MUPs in every individual were checked by the automated MUP analysis program. In those individuals ages 20 to 40 years, no spontaneous activity was observed, and in the ones ages 40 to 60 years and 60 years or older, fibrillations and/or positive sharp waves were seen in 8% and 92%, respectively. MUP values were found to be close to those of upper limb muscles. Age has no significant effect on MUP values, except for mean amplitude that was increased in individuals ages 60 to 80 years.Our findings suggest that fibrillations and positive sharp waves do not have much electrodiagnostic value in the study of cervical paraspinal muscles of middle-aged and elderly subjects, when it is an isolated finding, and there is a need for an extended electromyographic examination, including other muscles, to exclude radiculopathy. Automated MUP analysis is easily performed, and our results may serve as reference values.
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Affiliation(s)
- R Gilad
- Department of Neurology, Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Mullerad M, Kravtzov A, Meyer G, Kastin A, Gross M, Biton K, Elias I, Boaz M, Ofer N. MP-15.03. Urology 2006. [DOI: 10.1016/j.urology.2006.08.470] [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: 10/24/2022]
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Shargorodsky M, Fleed A, Boaz M, Gavish D, Zimlichman R. The effect of a rapid weight loss induced by laparoscopic adjustable gastric banding on arterial stiffness, metabolic and inflammatory parameters in patients with morbid obesity. Int J Obes (Lond) 2006; 30:1632-8. [PMID: 16552402 DOI: 10.1038/sj.ijo.0803320] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the effect of drastic weight loss on arterial compliance, inflammatory and metabolic parameters in patients with morbid obesity with and without cardiovascular risk factors who underwent laparoscopic adjustable gastric banding (LAGB). DESIGN Open prospective study, morbidly obese subjects divided into low- and high-risk group were evaluated before and 4 months after LAGB. SUBJECTS Forty-one Caucasian subjects aged between 16 and 55 years, with morbid (grade 3) obesity (20 low- risk and 21 high-risk subjects) who underwent LAGB and completed a 16-week follow-up. MEASUREMENTS Patients were evaluated at baseline and 4 months after LAGB for body mass index (BMI), arterial blood pressure (BP), metabolic factors including lipid profile, HbA1C, insulin, C-peptide, fibrinogen, hs-C reactive protein (CRP) and Homeostasis model assessment-insulin resistance (HOMA-IR). Arterial elasticity of large and small arteries was evaluated using pulse-wave contour analysis method (HDI CR 2000, Eagan, Minnesota) at baseline and after 4 months. RESULTS Body mass index reduction induced by LABG, from 43.55+/-5.11 to 35.10+/-4.87 in low-risk patients and from 42.90+/-3.22 to 35.00+/-3.24 in high-risk patients, significantly improved small artery elasticity (SAE) from 6.30+/-2.74 to 7.25+/-1.85, in morbidly obese patients with multiple cardiovascular risk factors (high-risk group). Improvement in SAE was accompanied by improvement of arterial BP, glucose and lipid metabolism, and reduction of CRP values. CONCLUSION Although dramatic weight reduction induced by surgical intervention was associated with similar changes in body weight and significant improvement of metabolic and inflammatory parameters in two groups of obese patients, SAE improved only in high-risk patients.
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Affiliation(s)
- M Shargorodsky
- Department of Endocrinology, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ravhon A, Miles L, Weissman A, Biran G, Boaz M, Levran D. Early Consecutive Beta HCG, Progesterone and Estradiol Measurements May Predict Pregnancy Outcome Following Fresh Embryo Transfer. Fertil Steril 2005. [DOI: 10.1016/j.fertnstert.2005.07.731] [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: 10/25/2022]
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Wainstein J, Metzger M, Boaz M, Minuchin O, Cohen Y, Yaffe A, Yerushalmy Y, Raz I, Harman-Boehm I. Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patients. Diabet Med 2005; 22:1037-46. [PMID: 16026370 DOI: 10.1111/j.1464-5491.2005.01597.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To compare the efficacy of insulin pump treatment with multiple daily injections in the treatment of poorly controlled obese Type 2 diabetic patients already receiving two or more daily injections of insulin plus metformin. METHODS Forty obese Type 2 diabetic subjects (using insulin) were randomized to treatment with continuous subcutaneous infusion pump (CSII) (Minimed) or multiple daily insulin injections (MDI). At the end of the first 18-week treatment period, patients underwent a 12-week washout period during which they were treated with MDI plus metformin. They were then crossed-over to the other treatment for an 18-week follow-up period. Patients performed 4-point daily self blood-glucose monitoring (SBGM) on a regular basis and 7-point monitoring prior to visits 2, 8, 10 and 16. A subset of patients underwent continuous glucose monitoring using the Minimed(R) continuous glucose monitoring system (CGMS) at visits 2, 8, 10 and 16. A standard meal test was performed in which serum glucose was tested at fasting and once each hour for 6 h following a test meal. Glucose levels were plotted against time and the area under the curve (AUC) was calculated. HbA(1c), weight, daily insulin dose and hypoglycaemic episodes were recorded. RESULTS In obese Type 2 diabetic patients already treated with insulin, treatment with CSII significantly reduced HbA(1c) levels compared with treatment with MDI. An additional CSII treatment benefit was demonstrated by reduced meal-test glucose AUC. Initial reduction of daily insulin requirement observed in CSII-treated subjects during the first treatment period was attributable to a period effect and did not persist over time. CONCLUSIONS In the intent-to-treat analysis, CSII appeared to be superior to MDI in reducing HbA(1c) and glucose AUC values without significant change in weight or insulin dose in obese, uncontrolled, insulin-treated Type 2 diabetic subjects.
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Affiliation(s)
- J Wainstein
- Diabetes Unit, Wolfson Medical Center, Holon, Israel
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Boaz M, Weinstein T, Matas Z, Smetana S. Peripheral vascular disease and serum phosphorus in hemodialysis: a nested case-control study. Clin Nephrol 2005; 63:98-105. [PMID: 15730051 DOI: 10.5414/cnp63098] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Serum phosphorus (P) and the product of serum calcium x serum P (Ca x P), are frequently elevated in end-stage renal disease patients on maintenance hemodialysis (HD). Elevated P and Ca x P have been associated with vascular calcification in dialysis patients. OBJECTIVE [corrected] To examine the role of P and Ca x P as risk factors for incident peripheral vascular disease (PVD) in HD patients with pre-existing CVD. METHODS This nested case-control study is drawn from the 11 incident PVD events reported in the cohort of the Secondary prevention with antioxidants of cardiovascular disease in end-stage renal disease (SPACE): a randomized placebo-controlled trial. PVD was defined clinically and confirmed ultrasonographically. Each individual with a PVD event was matched for SPACE treatment group (vitamin E or placebo), age (in 4-year categories) and gender with two individuals who had no CVD end point during the follow-up period. RESULTS Serum P and Ca x P levels were significantly higher in PVD patients than in controls. In univariate logistic regression analysis, only serum P predicted PVD in this population (OR 2.02, 95% CI 1.07 - 3.81, p = 0.03). In multivariate analysis, adjustment was made for variables dissimilar by PVD status including underlying renal disease, diabetes, smoking, history of angina pectoris, prescription for vitamin D3, erythropoietin, calcium channel blockers and aspirin. In this model, serum P remained the only significant predictor of incident PVD (OR 2.4, 95% CI 1.01 - 5.74, p = 0.04). CONCLUSIONS Findings of the present study are consistent with a role for serum P and Ca x P in the pathogenesis of PVD in HD patients.
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Affiliation(s)
- M Boaz
- Epidemiology Unit and Brunner Institute of Medical Research, Holon, Israel.
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Abstract
BACKGROUND AND AIMS The association of hepatic haemangiomas with female sex hormones is not entirely clear. We prospectively evaluated the impact of female sex hormones on the natural history of liver haemangiomas. METHODS We followed 94 women with 181 haemangiomas diagnosed by ultrasound for a period of1-17 years (mean 7.3 (5.5) years). The location, number, size, and ultrasonographic pattern of the lesions were evaluated. Patients were also evaluated by questionnaire for gynaecological and reproductive history. We compared the change in number and size of haemangiomas in patients who received or did not receive exogenous hormonal treatment. RESULTS Age at first period was inversely associated with the size of haemangiomas (r = 0.181, p = 0.015) while age at menopause was positively correlated with the number of haemangiomas detected at first ultrasound (r = 0.542, p<0.0001). During follow up, no change in the ultrasonographic pattern or number of haemangiomas was observed. An increase in the size of the lesions was demonstrated in 5/22 (22.7%) hormone therapy exposed patients compared with 7/72 (9.7%) controls. Three variables (ultrasonographic pattern, number of haemangiomas, and hormone therapy) predicted whether or not a given haemangioma would increase in size. A hypoechoic pattern increased the risk of progression while a hyperechoic pattern decreases that risk (p = 0.003). The number of haemangiomas was inversely associated with the likelihood of progression (p = 0.006) and hormone therapy increased the risk of haemangioma enlargement (p = 0.05). CONCLUSIONS Hepatic haemangiomas seem to be influenced by both endogenous and exogenous female sex hormones although significant enlargement occurs only in a minority of patients. Consequently, routine liver ultrasound follow up in women with hepatic haemangiomas receiving hormone therapy appears appropriate.
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Affiliation(s)
- V Glinkova
- Department of Gastroenterology, The E Wolfson Medical Center, Holon 58100, Israel.
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48
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Levine A, Shevah O, Shabat-Sehayek V, Aeed H, Boaz M, Moss SF, Niv Y, Avni Y, Shirin H. Masking of 13C urea breath test by proton pump inhibitors is dependent on type of medication: comparison between omeprazole, pantoprazole, lansoprazole and esomeprazole. Aliment Pharmacol Ther 2004; 20:117-22. [PMID: 15225178 DOI: 10.1111/j.1365-2036.2004.02021.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The need to withhold acid suppression therapy while awaiting urea breath test results is a common clinical problem in symptomatic patients. It is unclear at present if the dose or type of proton pump inhibitor or the type of test meal govern the apparent masking effect of proton pump inhibitors on the urea breath test. AIM To prospectively evaluate Helicobacter pylori detection rates during treatment with four different proton pump inhibitors, utilizing a high-dose citric acid-based 13C urea breath test. METHODS Patients positive for Helicobacter pylori by urea breath test were randomized to receive either omeprazole 20 mg/day, pantoprazole 40 mg/day, lansoprazole 30 mg/day or esomeprazole 40 mg/day for 14 days. A repeat breath test was performed on day 14 of treatment. RESULTS One hundred and seventy-nine patients, mean age 45.8 +/- 16.8, completed the study. Treatment with omeprazole or pantoprazole prior to urea breath test (UBT) was associated with low false negative results, while lansoprazole and esomeprazole caused clinically unacceptable high false negative rates (pantoprazole 2.2% vs. lansoprazole 16.6%, P = 0.02, vs. esomeprazole 13.6%, P = 0.05; omeprazole 4.1% vs. lansoprazole 16.6%, P = 0.05). CONCLUSIONS Proton pump inhibitor-induced false negative results on high-dose citric acid based urea breath test vary with the type of proton pump inhibitor used. Selection of the appropriate test meal and proton pump inhibitor may allow symptomatic individuals to continue their proton pump inhibitors prior to performing a urea breath test.
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Affiliation(s)
- A Levine
- Pediatric Gastroenterology Unit, The E. Wolfson Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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49
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Abstract
Few cases of pamidronate (bisphosphonate class of drugs) nephrotoxicity in humans have been previously reported in the literature. In 7 patients, the pamidronate-related nephrotoxicity was attributed to focal collapsing glomerulosclerosis [Markowitz et al. 2001], and in 1 patient was related to tubulo-interstitial inflammatory nephritis [Van Doom et al. 2001]. We report herein on a 65-year-old Caucasian female patient who presented with acute chronic renal failure due to pamidronate-induced toxic proximal tubular necrosis without immunologic or inflammatory tubulo-interstitial involvement. The acute pattern of renal failure resolved following cessation of pamidronate administration in this patient for osteoporosis; the patient also had a monoclonal gammopathy of unspecific origin (MGUS).
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Affiliation(s)
- S Smetana
- Nephrology Institute, Edith Wolfson Medical Center, Holon, Israel.
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50
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Katzir Z, Rotmensch S, Boaz M, Biro A, Michlin A, Smetana S. Pregnancy in membranous glomerulonephritis--course, treatment and outcome. Clin Nephrol 2004; 61:59-62. [PMID: 14964459 DOI: 10.5414/cnp61059] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The effect and outcome of pregnancy in women with preexisting glomerulonephritis is a controversial issue. CASE We report the clinical course and treatment of a 23-year-old pregnant woman with biopsy-proven membranous glomerulonephritis. When she conceived, the patient had been in stable remission for 1 year. In the 14th week of pregnancy, the patient developed uncontrolled hypertension and nephrotic syndrome. Daily 1 g methylprednisolone intravenous pulses were administered for 3 days, followed by a 4-week course of oral prednisone, 50 mg/day. Clinical improvement and normalization of arterial blood pressure were achieved. Oral prednisone 60 mg was administered on alternate days for another 4 weeks following 3 days of pulse therapy. At the end of treatment (26th gestational week), we observed a decrease of proteinuria (from 10.6-4.8 g/24 h) and rise in serum albumin (from 2.1-2.9 g/100 ml). At this time, blood pressure was 130/85. In the 34th week, a normal healthy male newborn was delivered by cesarean section. One year later she felt well, her blood pressure was 140/90, serum albumin was 3.4 g/100 ml, urine protein was 1.65 g/24 h and renal function was normal. The patient's child was healthy and well developed. CONCLUSION Judicious use of a specific therapy to the underlying renal disease during pregnancy, together with a continuous supervision, can improve outcomes of these particular high-risk conditions.
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Affiliation(s)
- Z Katzir
- Nephrology and Hypertension Institute, E. Wolfson Medical Center, Holon, Israel.
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