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Braester A, Akria L, Zarfati M, Barhoum M. [PATIENT BLOOD MANAGEMENT - IT IS IMPOSSIBLE TO IGNORE THIS POLICY]. Harefuah 2024; 163:244-248. [PMID: 38616635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Anemia is common and is an independent risk factor for morbidity and mortality, especially in pre- (30-40% of patients undergoing major surgery) or post-operative anemia (up to 80-90%). Using World Health Organization (WHO) criteria, in 2010 one quarter of the global population was anemic (1.9 billion people) and iron deficiency anemia (IDA( was and still remains the most common type of anemia worldwide, accounting for more than half of the total anemia burden. In a systematic analysis for the Global Burden of Disease Study 2016, IDA was the fourth leading cause of years lived with disability, particularly in women, thus highlighting prevention and treatment of IDA as a major public health goal. Red blood cells (RBC) transfusion is a common therapeutic intervention with considerable variation in clinical practice. More than 85 million units packed RBC (PRBC) are transfused annually worldwide. The principal indication for blood transfusion (BT) is anemia, yet a significant percentage of RBC transfusions are inappropriately overused. For many physicians and clinicians, across many different specialties, BT is still considered to be the first-line treatment when facing anemia. The Joint Commission along with the American Medical Association has included BT in a list of the five most overused therapeutic procedures in the United States. Restrictive blood transfusion (RBT) is an evidence-based policy, at least as effective, if not superior to the liberal policy of BT. Patient blood management (PBM) is a patient-centered systematic, evidence-based approach, supported by RBT. In this article we analyze the factors which influence the implementation of PBM.
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Affiliation(s)
- Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
| | - Luiza Akria
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Galilee Medical Center, Nahariya
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2
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Braester A, Suriu C, Akria L, Zarfati M, Dally N, Barhoum M. Can an Anemic Patient Be a Partner to Treatment Decision-Making? Isr Med Assoc J 2023; 25:766-768. [PMID: 37980625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Celia Suriu
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Luiza Akria
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Moran Zarfati
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Najib Dally
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel, Department of Hematology, Ziv Medical Center, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Kridin K, Abou Amara Y, Barhoum M, Cohen AD. Vitiligo and systemic lupus erythematosus: A population-based study investigating the epidemiological association. J Eur Acad Dermatol Venereol 2023; 37:2262-2263. [PMID: 37326169 DOI: 10.1111/jdv.19263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Galilee Medical Center, Nahariya, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Mizrachi M, Levy E, Dror AA, Sela E, Kutikov S, Barhoum M, Ronen O, Gruber M. Humanitarian Outpatient Pediatric Endeavor (HOPE): A Novel Specialist Ambulatory Health-Care Concept in Conflict Areas. Disaster Med Public Health Prep 2023; 17:e498. [PMID: 37781787 DOI: 10.1017/dmp.2023.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
With the collapse of the medical system in Syria, Israel began providing Syrians with humanitarian aid, first to the war-injured and then general medical treatment. We developed a novel specialist ambulatory care concept to provide medical care for Syrian children. Children with their caregivers were transported by bus across the border from Syria to our medical center in Israel for day-stay outpatient-clinic advanced evaluation and treatment due to coordination between Syrian, Red Cross, and Israeli authorities, including Israeli Defense Forces. This retrospective field report includes 371 Syrian children treated as outpatients at Galilee Medical Center between January 2016 and September 2018. In our experience, this novel pediatric ambulatory care concept has been feasible, efficient, and successful in providing specialist care for children in a crisis region devoid of access to health care. We believe it can also serve adult patients and be implemented in other crises and disasters scenarios.
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Affiliation(s)
- Matti Mizrachi
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Einat Levy
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amiel A Dror
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Administration, Galilee Medical Center, Nahariya, Israel
| | - Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maayan Gruber
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Morozov NG, Dror AA, Daoud A, Eisenbach N, Kaykov E, Barhoum M, Sheleg T, Sela E, Edelstein M. Reasons underlying the intention to vaccinate children aged 5-11 against COVID-19: A cross-sectional study of parents in Israel, November 2021. Hum Vaccin Immunother 2022; 18:2112879. [PMID: 36037533 DOI: 10.1080/21645515.2022.2112879] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Vaccination is a key tool to mitigate impacts of the COVID-19 pandemic. In Israel, COVID-19 vaccines became available to adults in December 2020 and to 5-11-year-old children in November 2021. Ahead of the vaccine roll-out in children, we aimed to determine whether surveyed parents intended to vaccinate their children and describe reasons for their intentions. We collected information on parental socio-demographic characteristics, COVID-19 vaccine history, intention to vaccinate their children against COVID-19, and reasons for parental decisions using an anonymous online survey. We identified associations between parental characteristics and plans to vaccinate children using a logistic regression model and described reasons for intentions to vaccinate or not. Parental non-vaccination and having experienced major vaccination side effects were strongly associated with non-intention to vaccinate their children (OR 0.09 and 0.18 respectively, p < .001). Parents who were younger, lived in the socio-economically deprived periphery, and belonged to the Arab population had lower intentions to vaccinate their children. Reasons for non-intention to vaccinate included concerns about vaccine safety and efficacy (53%, 95%CI 50-56) and the belief that COVID-19 is a mild disease (73%, 95%CI 73-79), while a frequent motive for vaccination was the return to normal social and educational life (89%, 95%CI 87-91). Understanding rationales for COVID-19 vaccine rejection or acceptance, as well as parental demographic data, can pave the way for intentional educational campaigns to encourage not only vaccination against COVID-19, but also regular childhood vaccine programming.
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Affiliation(s)
| | - Amiel A Dror
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amani Daoud
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Edward Kaykov
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Masad Barhoum
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Tsvi Sheleg
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Eyal Sela
- Galilee Medical Center, Nahariyah, Israel.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Michelis R, Milhem L, Galouk E, Stemer G, Aviv A, Tadmor T, Shehadeh M, Shvidel L, Barhoum M, Braester A. Increased serum level of alpha-2 macroglobulin and its production by B-lymphocytes in chronic lymphocytic leukemia. Front Immunol 2022; 13:953644. [PMID: 36119042 PMCID: PMC9478581 DOI: 10.3389/fimmu.2022.953644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL), the most common adult’s leukemia in the western world, is caused in 95% of the cases by uncontrolled proliferation of monoclonal B-lymphocytes. The complement system in CLL is chronically activated at a low level via the classical pathway (CP). This chronic activation is induced by IgG-hexamers, which are formed after binding to alpha-2-macroglobulin (A2M). The study investigated for the first time the serum levels of A2M in CLL patients, their association with the disease severity, and A2M production by the malignant B-lymphocytes. Blood samples were collected from 65 CLL patients and 30 normal controls (NC) subjects, and used for quantifications of the A2M levels, the complement activation marker (sC5b-9), the complement components C2, C3 and C4, and clinical biochemistry and hematology parameters. The production of A2M was studied in B-lymphocytes isolated from blood samples as well as in CLL and non-CLL cell lines.The serum A2M levels were significantly higher in CLL patients vs NCs, showing values of 3.62 ± 0.22 and 1.97 ± 0.10 mg/ml, respectively. Within the CLL group, A2M levels correlated significantly with the disease stage, with sC5b-9, and with clinical indicators of the disease severity. Increased A2M production was showed in three out of four CLL B-lymphocytic lines that were studied, as compared to non-CLL lines, to a non-lymphocytic line, and to blood-derived primary B-lymphocytes. A2M production was further increased both in primary cells and in the CLL cell-line after incubation with CLL sera, compared to NC sera. This study shows for the first time that serum A2M levels in CLL are significantly increased, likely due to A2M production by the malignant B-lymphocytes, and are correlated with the disease severity and with chronic complement activation. The moderate change in A2M production after incubation with NC sera in-vitro supports the hypothesis that inhibition of excess A2M production can be achieved, and that this may potentially down-regulate the IgG-hexamerization and the resulting chronic CP activation. This may also help restore complement system activity, and eventually improve complement activity and immunotherapy outcomes in CLL.
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Affiliation(s)
- Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- *Correspondence: Regina Michelis,
| | - Lama Milhem
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Evleen Galouk
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Galia Stemer
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
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7
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Dror AA, Morozov N, Daoud A, Namir Y, Yakir O, Shachar Y, Lifshitz M, Segal E, Fisher L, Mizrachi M, Eisenbach N, Rayan D, Gruber M, Bashkin A, Kaykov E, Barhoum M, Edelstein M, Sela E. Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness. PLoS One 2022; 17:e0263069. [PMID: 35113901 PMCID: PMC8812897 DOI: 10.1371/journal.pone.0263069] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/12/2022] [Indexed: 12/16/2022] Open
Abstract
Objective Studies have demonstrated a potential correlation between low vitamin D status and both an increased risk of infection with SARS-CoV-2 and poorer clinical outcomes. This retrospective study examines if, and to what degree, a relationship exists between pre-infection serum 25-hydroxyvitamin D (25(OH)D) level and disease severity and mortality due to SARS-CoV-2. Participants The records of individuals admitted between April 7th, 2020 and February 4th, 2021 to the Galilee Medical Center (GMC) in Nahariya, Israel, with positive polymerase chain reaction (PCR) tests for SARS-CoV-2 (COVID-19) were searched for historical 25(OH)D levels measured 14 to 730 days prior to the positive PCR test. Design Patients admitted to GMC with COVID-19 were categorized according to disease severity and level of 25(OH)D. An association between pre-infection 25(OH)D levels, divided between four categories (deficient, insufficient, adequate, and high-normal), and COVID-19 severity was ascertained utilizing a multivariable regression analysis. To isolate the possible influence of the sinusoidal pattern of seasonal 25(OH)D changes throughout the year, a cosinor model was used. Results Of 1176 patients admitted, 253 had records of a 25(OH)D level prior to COVID-19 infection. A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL [34.3%] p < 0.001). Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D ≥40 ng/mL (odds ratio [OR], 14; 95% confidence interval [CI], 4 to 51; p < 0.001). Conclusions Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.
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Affiliation(s)
- Amiel A. Dror
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- * E-mail:
| | - Nicole Morozov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amani Daoud
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Yoav Namir
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orly Yakir
- Statistical Analysis Division, Galilee Medical Center, Nahariya, Israel
| | - Yair Shachar
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
| | - Mark Lifshitz
- Computer Data Division, Galilee Medical Center, Nahariya, Israel
| | - Ella Segal
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Lior Fisher
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Matti Mizrachi
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Doaa Rayan
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Maayan Gruber
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Amir Bashkin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Endocrinology Unit, Galilee Medical Center, Nahariya, Israel
| | - Edward Kaykov
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Geriatric Medicine Department, Galilee Medical Center, Nahariya, Israel
| | | | | | - Eyal Sela
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Braester A, Barhoum M. Choosing Wisely Project and Patient Shared Decision-making: Between Hammer and Alvin. Isr Med Assoc J 2021; 23:754. [PMID: 34811998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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Braester A, Stemer G, Khouri S, Raviv B, Barhoum M. Is There a Predictive Value of High Mean Platelet Volume in Early Diagnosis of Venous Thromboembolism? Isr Med Assoc J 2021; 23:635-638. [PMID: 34672445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a serious disease, which demands a fast accurate diagnosis to begin suitable treatment. It presents a major problem in the emergency department (ED), and its confirmation requires adequate evaluation. OBJECTIVES To evaluate a potential role of mean platelet volume (MPV) in differentiating VTE from other potential diagnosis in patients with suspected VTE. METHODS We conducted a retrospective case-controlled study of 440 consecutive patients who presented to the ED of our hospital with clinical VTE, but only 316 with proven VTE. A control group was composed of patients (124) who presented with clinical VTE but without proven VTE. We checked the MPV value in all 440 patients and the correlation with VTE occurrence in the study group vs. control group. RESULTS Statistical analysis of the acquired results indicated that MPV value could not aid in determining the difference of real VTE vs. patients with VTE-like clinical picture presenting to the ED. We found an inverse correlation between MPV value and proven VTE, in contrast to most researchers who have studied the same issue. CONCLUSIONS Although MPV can be a useful diagnostic marker in many diseases, we found no definite association between low MPV and VTE.
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Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | | | - Sahar Khouri
- Department of Hematology Galilee Medical Center, Nahariya, Israel
| | - Bennidor Raviv
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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10
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Braester A, Shaoul E, Mizrachi O, Akria L, Shelev L, Barhoum M. Patient Involvement in the Transfusion Decision-Making Can Change Patient Blood Management Practice for Better or Worse. Acta Haematol 2021; 145:5-8. [PMID: 34525473 DOI: 10.1159/000518947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Red blood cell transfusion (RBCT) is a therapeutic procedure with important and undesirable secondary effects. Inappropriate overuse of RBCT is significant, and a significant percentage of physicians prescribe RBCT unnecessarily. Patient involvement in treatment decision-making is poor worldwide. Shared (with the patient) transfusion decision-making (TrDM) can temper a "quick finger on the trigger" of blood transfusion (BT). The objective of this study was to determine patients' preferences surrounding their involvement in the TrDM process as well as physicians' willingness to involve the patient in TrDM. The study also determined the role of patient age, gender, ethnicity, and schooling years in the TrDM process. METHODS This cross-sectional study was conducted in a variety of departments, with 123 patients over 18 years old, who received a BT for the first time. The patients completed an anonymous questionnaire which included demographic characteristics (age, gender, ethnicity, and schooling years) and 2 questions linked to potential willingness to participate in the decision to transfuse. RESULTS The questionnaire response rate was 100%. The data showed that 60% of patients (especially younger patients), independent of ethnicity, preferred a passive role in TrDM and 40% preferred to share the decision. CONCLUSIONS The majority of patients, especially younger patients, prefer a passive role in TrDM, possibly due to insufficient information about the need for BT and its significance. We feel that active involvement on the part of the patient can provoke a more judicious thought process about the real need of BT on the part of the physician and have a positive influence on patient blood management.
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Affiliation(s)
- Andrei Braester
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ety Shaoul
- Galilee Medical Center, Nahariya, Israel
| | - Oded Mizrachi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Luiza Akria
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Masad Barhoum
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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11
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Dror AA, Daoud A, Morozov NG, Layous E, Eisenbach N, Mizrachi M, Rayan D, Bader A, Francis S, Kaykov E, Barhoum M, Sela E. Vaccine hesitancy due to vaccine country of origin, vaccine technology, and certification. Eur J Epidemiol 2021; 36:709-714. [PMID: 34037927 PMCID: PMC8149582 DOI: 10.1007/s10654-021-00758-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
Vaccine hesitancy is a global health threat which may hinder the widespread acceptance of several COVID-19 vaccines. Following the collection of 2470 responses from an anonymous questionnaire distributed between October and November 2020 across Israel, we analyzed the responses of physicians, life science graduates (biology, virology, chemistry, etc.), and the general public to whether they would obtain a COVID-19 vaccine with particular vaccine characteristics such as vaccine country of origin, technology, side effect profile, efficacy, and other attributes. Physicians and life science graduates were least likely to accept a vaccine based on mRNA technology (30%) while the general population seemed to adopt any vaccine technology if the declared efficacy is above 90% and the country of manufacturing is the USA/UK rather than China or Russia. However, current inoculation rates in Israel far outpace our predicted rate. Our results highlight the importance of tailored vaccine educational campaigns based on population demographic details and specific vaccine concerns.
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Affiliation(s)
- Amiel A Dror
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel.
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
| | - Amani Daoud
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nicole G Morozov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Layous
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Netanel Eisenbach
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Matti Mizrachi
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Doaa Rayan
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ahmad Bader
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Shawky Francis
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Edward Kaykov
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Geriatric Medicine Department, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Galilee Medical Center, Nahariya, Israel
| | - Eyal Sela
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Nahariya, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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12
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Braester A, Barhoum M. Implementation of patient blood management strategies in an Israeli hospital: caught between hope and despair. Isr Med Assoc J 2021; 23:198. [PMID: 33734637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Andrei Braester
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Masad Barhoum
- Department of Hematology Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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13
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Naseraldeen N, Michelis R, Barhoum M, Chezar J, Tadmor T, Aviv A, Shvidel L, Litmanovich A, Shehadeh M, Stemer G, Shaoul E, Braester A. The Role of Alpha 2 Macroglobulin in IgG-Aggregation and Chronic Activation of the Complement System in Patients With Chronic Lymphocytic Leukemia. Front Immunol 2021; 11:603569. [PMID: 33643290 PMCID: PMC7905172 DOI: 10.3389/fimmu.2020.603569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in the western world. One of the treatments offered for CLL is immunotherapy. These treatments activate various cellular and biochemical mechanisms, using the complement system. Recently it was shown that the complement system in CLL patients is persistently activated at a low level through the classical pathway (CP). The mechanism of chronic CP activation involves the formation of IgG-hexamers (IgG-aggregates). According to recent studies, formation of ordered IgG-hexamers occurs on cell surfaces via specific interactions between Fc regions of the IgG monomers, which occur after antigen binding. The present study investigated the formation of IgG-hexamers in CLL patients and normal (non-malignant) controls (NC), their ability to activate complement, their incidence as cell-free and cell-bound forms and the identity of the antigen causing their formation. Sera from 30 patients and 12 NC were used for separation of IgG- aggregates. The obtained IgG- aggregates were measured and used for assessment of CP activation. For evaluation of the presence of IgG- aggregates on blood cells, whole blood samples were stained and assessed by flow cytometry. Serum levels of IgG- aggregates were higher in CLL and they activated the complement system to a higher extent than in NC. Alpha 2 macroglobulin (A2M) was identified as the antigen causing the hexamerization/aggregation of IgG, and was found to be part of the hexamer structure by mass spectrometry, Western blot and flow cytometry analysis. The presence of A2M-IgG-hexamers on B-cells suggests that it may be formed on B cells surface and then be detached to become cell-free. Alternatively, it may form in the plasma and then attach to the cell surface. The exact time course of A2M-IgG-hexamers formation in CLL should be further studied. The results in this study may be useful for improvement of current immunotherapy regimens.
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Affiliation(s)
- Naseba Naseraldeen
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Judith Chezar
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Tamar Tadmor
- Hematology Unit, Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Adi Litmanovich
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Galia Stemer
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Ety Shaoul
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.,Institute of Hematology, Galilee Medical Center, Nahariya, Israel
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14
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Braester A, Akria L, Yakir O, Shelev L, Barhoum M. Blood Myths and Ethnic-Cultural Background as Impediments in Patient Blood Management Education. J Relig Health 2020; 59:2918-2927. [PMID: 32285248 DOI: 10.1007/s10943-020-01015-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A significant percentage of red blood cell transfusions (RBCTs) are the result of overuse. The implementation of patient blood management (PBM) is challenging. We examined whether blood-linked myths and ethnic-cultural background factors are impediments to PBM education and implementation. Data about the influence of blood myths and diverse ethnic-cultural communities were collected from physicians in our medical center via an anonymous questionnaire which contained questions about myths as well as knowledge of blood transfusion. No statistical differences were found between ethnic and cultural groups regarding blood myths and cultural background influence, although the Jewish participants were less influenced by myths than their Arab colleagues. The influence of blood myths concerning the decision to transfuse exists in both studied ethnic groups. With regard to the association between knowledge and myths influence, we found that the greater the knowledge of the participant, the lower was the myths influence. In a significant proportion of our physician cohort, blood myths and cultural-ethnic status influenced their approach toward RBCT and can be considered an impediment in PBM education. A high knowledge level is associated with less myths influence. The myths and cultural-ethnic background may play a role in PBM education.
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Affiliation(s)
- Andrei Braester
- Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel.
- Hematology Institute, Galilee Medical Center, POB 21, 22100, Nahariya, Israel.
| | - Luiza Akria
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Orly Yakir
- Galilee Medical Center, Nahariya, Israel
| | | | - Masad Barhoum
- Galilee Medical Center, Nahariya, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
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15
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Braester A, Bornstein J, Zverev A, Kukuyev Y, Stemer G, Barhoum M. Reassessment of Venous Thromboembolism Risk and Prophylaxis in Postdelivery Period of Healthy Women. Am J Med Sci 2020; 360:604-606. [DOI: 10.1016/j.amjms.2020.04.025] [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] [Received: 12/22/2019] [Revised: 04/10/2020] [Accepted: 04/21/2020] [Indexed: 11/16/2022]
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16
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Michelis R, Tadmor T, Aviv A, Stemer G, Majdob R, Shvidel L, Shehadeh M, Barhoum M, Braester A. Cell-free IgG-aggregates in plasma of patients with chronic lymphocytic leukemia cause chronic activation of the classical complement pathway. PLoS One 2020; 15:e0230033. [PMID: 32150580 PMCID: PMC7062264 DOI: 10.1371/journal.pone.0230033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/19/2020] [Indexed: 11/18/2022] Open
Abstract
Therapy regimens for Chronic lymphocytic leukemia (CLL) commonly include chemotherapy and immunotherapy, which act through complement-mediated-cytotoxicity (CDC) and other mechanisms. CDC depends on several factors, including the availability and activity of the complement classical pathway (CP). Recently, a significant decrease in CP activity was shown to be associated with an immunoglobulin-C5a complex (Ig-C5a) and other markers of chronic CP activation in 40% of the patients. The study focused on the involvement of IgG-hexamers, an established CP activator, in the mechanism of chronic CP activation in CLL. Sera from 51 naïve CLL patients and 20 normal controls were collected. CP and alternative pathway (AP) activities were followed by the complement activity marker sC5b-9. Serum high molecular weight (HMW) proteins were collected by gel-filtration chromatography and their complement activation capacity was assessed. The levels of IgM, another established CP activator, were measured. Data were associated with the presence of Ig-C5a. Baseline levels of activation markers negatively correlated with CP and the AP activities, supporting chronic complement activation. In patients with Ig-C5a, HMW proteins that are not IgM, activated the complement. HMW proteins were identified as IgG-aggregates by affinity binding assays and Western blot analysis. The data indicate chronic CP activation, mediated by cell-free IgG-hexamers as a cause of decreased CP activity in part of the CLL population. This mechanism may affect immunotherapy outcomes due to compromised CP activity and CDC.
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Affiliation(s)
- Regina Michelis
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Tamar Tadmor
- Hematology Division, Bnai Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ariel Aviv
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Galia Stemer
- Department of Hematology, Emek Medical Center, Afula, Israel
| | - Rawan Majdob
- The Institute for Medical Research, Galilee Medical Center, Nahariya, Israel
| | - Lev Shvidel
- Hematology Institute, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Mona Shehadeh
- Biochemistry Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Andrei Braester
- Institute of Hematology, Galilee Medical Center, Nahariya, Israel.,Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
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17
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Meerson A, Najjar A, Saad E, Sbeit W, Barhoum M, Assy N. Sex Differences in Plasma MicroRNA Biomarkers of Early and Complicated Diabetes Mellitus in Israeli Arab and Jewish Patients. Noncoding RNA 2019; 5:E32. [PMID: 30959814 PMCID: PMC6631160 DOI: 10.3390/ncrna5020032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 12/15/2022] Open
Abstract
MicroRNAs play functional roles in the etiology of type 2 diabetes mellitus (T2DM) and complications, and extracellular microRNAs have attracted interest as potential biomarkers of these conditions. We aimed to identify a set of plasma microRNAs, which could serve as biomarkers of T2DM and complications in a mixed Israeli Arab/Jewish patient sample. Subjects included 30 healthy volunteers, 29 early-stage T2DM patients, and 29 late-stage T2DM patients with renal and/or vascular complications. RNA was isolated from plasma, and the levels of 12 candidate microRNAs were measured by quantitative reverse transcription and polymerase chain reaction (qRT-PCR). MicroRNA levels were compared between the groups and correlated to clinical measurements, followed by stepwise regression analysis and discriminant analysis. Plasma miR-486-3p and miR-423 were respectively up- and down-regulated in T2DM patients compared to healthy controls. MiR-28-3p and miR-423 were up-regulated in patients with complicated T2DM compared to early T2DM, while miR-486-3p was down-regulated. Combined, four microRNAs (miR-146a-5p, miR-16-2-3p, miR-126-5p, and miR-30d) could distinguish early from complicated T2DM with 77% accuracy and 79% sensitivity. In male patients only, the same microRNAs, with the addition of miR-423, could distinguish early from complicated T2DM with 83.3% accuracy. Furthermore, plasma microRNA levels showed significant correlations with clinical measurements, and these differed between men and women. Additionally, miR-183-5p levels differed significantly between the ethnic groups. Our study identified a panel of specific plasma microRNAs which can serve as biomarkers of T2DM and its complications and emphasizes the importance of sex differences in their clinical application.
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Affiliation(s)
- Ari Meerson
- MIGAL Galilee Research Institute, Kiryat Shmona 1101602, Israel.
- Tel Hai Academic College, Upper Galilee 1220800, Israel.
| | - Azwar Najjar
- Department of Internal Medicine A, Galilee Medical Center, Nahariya, Israel.
| | - Elias Saad
- Department of Internal Medicine A, Galilee Medical Center, Nahariya, Israel.
| | - Wisam Sbeit
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel.
| | | | - Nimer Assy
- Department of Internal Medicine A, Galilee Medical Center, Nahariya, Israel.
- The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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18
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Kakiashvili E, Mansour M, Weiss M, Barhoum M, Khatib K, Bickel A. The Significance of Routine Computer Tomography in Evaluation of Asymptomatic Postoperative War Trauma Patients Transferred from Syria for Further Treatment. Isr Med Assoc J 2018; 20:211-212. [PMID: 29629726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Eli Kakiashvili
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Muhammad Mansour
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Michael Weiss
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Kamal Khatib
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
| | - Amitai Bickel
- Department of Surgery A, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
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Rahav Koren R, Suriu C, Yakir O, Akria L, Barhoum M, Braester A. Physicians' lack of knowledge - a possible reason for red blood cell transfusion overuse? Isr J Health Policy Res 2017; 6:49. [PMID: 29228989 PMCID: PMC5725969 DOI: 10.1186/s13584-017-0173-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 08/30/2017] [Indexed: 12/13/2022] Open
Abstract
Background A significant percentage of red blood cell transfusions are inappropriately overused. This study investigated physicians from the western Galilee in terms of their knowledge of transfusion medicine as a potential reason for red blood cell overuse, and assessed the influence of personal background characteristics on their knowledge. Methods Data were collected via anonymous questionnaires. The questionnaires included a personal background section and a professional section. Study participants were grouped according to field of specialty, seniority, and location of medical school graduation, in order to correlate participant characteristics with knowledge. Results Scores were calculated on a 0–100 scale. The overall knowledge of the study population was low (mean score 47.8 ± 18.6). Knowledge regarding basic physiology of red blood cell transfusion was also low. Internal medicine physicians and senior physicians had significantly greater overall knowledge scores and were more familiar with a restrictive blood management policy than were surgeons and residents, respectively. Comparing knowledge scores, no difference was found regarding indications for transfusion. Conclusion General and fundamental knowledge in transfusion medicine is lacking among physicians in the non-operating room setting, which may play a role in red blood cell transfusion overuse. Field of specialty and professional status influenced knowledge of transfusion medicine. Educational programs and increased physicians’ awareness might help decrease unnecessary transfusions. Trial registration Not applicable. Electronic supplementary material The online version of this article (10.1186/s13584-017-0173-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roni Rahav Koren
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel. .,Meir Medical Center, Kfar Saba, Israel.
| | - Celia Suriu
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Orly Yakir
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Luiza Akria
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, 8 Henrietta Szold St., 1589, Tzfat, Israel.,Galilee Medical Center, Nahariya, Israel
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20
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Flugelman AA, Barhoum M. Humanitarian Aid Bridging Across a Hostile Border. Pediatrics 2017; 140:peds.2016-3667. [PMID: 28974536 DOI: 10.1542/peds.2016-3667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Anath A Flugelman
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israeli Institute of Technology, Haifa, Israel; and
| | - Masad Barhoum
- Galilee Medical Center, Nahariya, Israel and Faculty of Medicine, Bar-Ilan University, Safed, Israel
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21
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Akria L, Chezar J, Zisman-Rozen S, Scheinman EJ, Zonis Z, Hoffmann Y, Falik-Zaccai T, Kalfon L, Weiss M, Braester A, Suriu C, Barhoum M, Kuperman A, Shaoul E. A Puzzling "Switch" in Blood Type Following Blood Transfusion. Ann Lab Med 2017; 37:293-295. [PMID: 28224781 PMCID: PMC5339107 DOI: 10.3343/alm.2017.37.3.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/04/2016] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Luiza Akria
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.
| | - Judith Chezar
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Simona Zisman-Rozen
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Eyal J Scheinman
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Zeev Zonis
- Pediatric Intensive Care Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Yoav Hoffmann
- Pediatric Intensive Care Unit, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
| | - Tzipora Falik-Zaccai
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Cytogenetic Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Limor Kalfon
- Cytogenetic Laboratory, Galilee Medical Center, Nahariya, Israel
| | - Michael Weiss
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Surgery, Galilee Medical Center, Nahariya, Israel
| | - Andrei Braester
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Celia Suriu
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Masad Barhoum
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - Amir Kuperman
- Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel.,Department of Pediatrics, Galilee Medical Center, Nahariya, Israel
| | - Ety Shaoul
- Blood Bank and Molecular Hematology Laboratory, Galilee Medical Center, Nahariya, Israel.,Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
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22
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Haverkort JJM, de Jong MB, Foco M, Gui D, Barhoum M, Hyams G, Bahouth H, Halberthal M, Leenen LPH. Dedicated mass-casualty incident hospitals: An overview. Injury 2017; 48:322-326. [PMID: 28024651 DOI: 10.1016/j.injury.2016.11.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 11/21/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hospitals worldwide are preparing for mass casualty incidents (MCIs). The Major Incident Hospital in the Netherlands was constructed 25 years ago as a dedicated hospital for situations wherein a sudden increase in medical surge capacity is mandated to handle an MCI. Over the years, more initiatives of dedicated MCIs have arisen. Herein, we compared the MCI facilities from three countries considering the reasons for construction and the functionality. METHODS Three dedicated mass casualty hospitals and one hospital with a largely fortified structure were compared. The centres were located in the Netherlands, Italy, and Israel. Between August 2015 and January 2016, structured interviews were conducted with representatives of the hospitals' medical operations. The interviews focussed on general information regarding the need for MCI preparedness and scenarios that require preparation, reasons for construction, hospital missions, and the experiences gained including training. RESULTS All dedicated MCI hospitals had a common policy wherein they sought to create normal work circumstances for the medical staff by using similar equipment and resources as in normal hospitals. The MCI hospitals' designs differed substantially, as determined by the threats faced by the country. In Europe, these hospitals are designed as a solution to surge capacity and function as buffer hospitals offering readily available, short term, additional medical capacity to the local health care system. Israel faces constant threat from long-term conflicts; during the 2006 war, several hospitals suffered direct missile impacts. Therefore, Israeli MCI hospitals are designed to be fortified structures offering shelter against both conventional and non-conventional warfare and intended as a long-term solution during siege situations. CONCLUSION Several dedicated MCI hospitals are presently being constructed. During construction, the local circumstances should be taken into account to determine the functionality for both short-term solutions for surge capacity and as fortified structures to withstand under-siege situations.
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Affiliation(s)
- J J Mark Haverkort
- Major Incident Hospital, University Medical Center Utrecht, UMC Utrecht, Utrecht, CX, 3584, The Netherlands.
| | - Mirjam B de Jong
- Major Incident Hospital, University Medical Center Utrecht, UMC Utrecht, Utrecht, CX, 3584, The Netherlands
| | - Maurizio Foco
- Policlinico A. Gemelli Hospital, Catholic University of Rome, Rome, 00168, Italy
| | - Daniele Gui
- Policlinico A. Gemelli Hospital, Catholic University of Rome, Rome, 00168, Italy
| | | | - Gila Hyams
- Rambam Health Care Campus Hospital, Haifa, 3109601, Israel
| | - Hany Bahouth
- Rambam Health Care Campus Hospital, Haifa, 3109601, Israel
| | | | - Luke P H Leenen
- Major Incident Hospital, University Medical Center Utrecht, UMC Utrecht, Utrecht, CX, 3584, The Netherlands
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23
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Suriu C, Akria L, Azoulay D, Shaoul E, Barhoum M, Braester A. Absolute lymphocyte count as a prognostic marker in newly diagnosed multiple myeloma patients. Int J Lab Hematol 2016; 38:e56-9. [PMID: 27018225 DOI: 10.1111/ijlh.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Suriu
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - L Akria
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - D Azoulay
- Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - E Shaoul
- Department of Hematology, Galilee Medical Center, Nahariya, Israel
| | - M Barhoum
- Galilee Medical Center, Bar Ilan University, Faculty of Medicine, Nahariya, Israel
| | - A Braester
- Department of Hematology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel.
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24
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Barhoum M, Tobias S, Elron M, Sharon A, Heija T, Soustiel JF. Syria civil war: Outcomes of humanitarian neurosurgical care provided to Syrian wounded refugees in Israel. Brain Inj 2015. [PMID: 26204320 DOI: 10.3109/02699052.2015.1043346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND As an expected consequence of the civil war in Syria, emergent neurosurgical care for battlefield trauma has been provided for severely head-injured Syrians transferred to Northern Israel. METHODS Sixty-six patients suffering from brain injury were brought to the border and then referred to the institution after initial resuscitation. Both the time and type of injury were recorded based on paramedic testimony, forensic material or on details provided by patients. A retrospective analysis of all medical charts and imaging material was performed. RESULTS Most injuries were combat-related, either caused by blast (13.6%), shrapnel (24.2%), assault (28.8%) or gunshot wound (15.2%). Only a minority of patients (18.2%) suffered from injuries that were not directly caused by weapon. A total of 55 surgical procedures were performed in 46 out of 66 patients, including craniotomies in 40 patients, burr hole alone for placement of intraparenchymal intracranial pressure (ICP) sensor in nine instances and ventricle peritoneal shunt in two patients. Decompressive craniectomy was used only for the treatment of gunshot wound and was performed in eight out of 10 patients. The most common complication consisted in cerebrospinal fluid fistulas (16.7%). Post-operative infections occurred in seven patients (10.6%). Short-term outcomes were favourable in 60.7%, with a mortality rate of 4.5%. DISCUSSION The present findings suggest that aggressive surgery and neuro-intensive care measures may lead to good functional results, even in the presence of seemingly devastating injuries in some selected patients.
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Affiliation(s)
- Masad Barhoum
- a Faculty of Medicine , Bar Ilan University , Safed , Israel .,b General Direction , and
| | - Samuel Tobias
- c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel
| | - Moshe Elron
- c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel
| | - Aviram Sharon
- c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel
| | - Tariq Heija
- c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel
| | - Jean F Soustiel
- a Faculty of Medicine , Bar Ilan University , Safed , Israel .,c Department of Neurosurgery and Galilee Medical Center , Naharia , Israel
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Volach-Mena V, Embon O, Onn E, Barhoum M, Luder A. Lancet's unethical behavior. Isr Med Assoc J 2014; 16:529-530. [PMID: 25269354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Zarka S, Barhoum M, Bader T, Zoaretz I, Glassberg E, Embon O, Kreiss Y. Israel's medical support to victims of the civil war in Syria. Isr Med Assoc J 2014; 16:71-72. [PMID: 24645222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Barhoum M, Hutchins L, Fonseca VA. Intractable hypercalcemia due to a metastatic carcinoid secreting parathyroid hormone-related peptide and interleukin-6: response to octreotide. Am J Med Sci 1999; 318:203-5. [PMID: 10487414 DOI: 10.1097/00000441-199909000-00019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a patient with a malignant carcinoid tumor who presented with severe, intractable hypercalcemia that would not respond to conventional therapy with fluids and pamidronate. His plasma concentrations of parathyroid-hormone-related peptide (PTHrP) and interleukin-6 (IL-6) were elevated. The patient was treated with subcutaneous injections of octreotide with a good response, resulting in normocalcemia. Plasma PTHrP and IL-6 fell with the octreotide but remained elevated above the upper limit of normal. We conclude that although rare, hypercalcemia may be associated with carcinoid tumors and may be mediated through the secretion of cytokines and or PTHrP. Treatment with octreotide may be effective in treating hypercalcemia in such patients.
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Affiliation(s)
- M Barhoum
- Department of Medicine, University of Arkansas for Medical Sciences and John L. McClellan Memorial Veterans' Hospital, Little Rock, USA
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Kalach N, Nocton F, Barhoum M, Debard A, de Mongolfier I, Bonnard P, Dupic L, Kazerouni F, Osman Z, Benhamou PH. [Schistosoma haematobium in an infant: a duodenal infection]. Arch Pediatr 1998; 5:463-4. [PMID: 9759176 DOI: 10.1016/s0929-693x(98)80045-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Barhoum M, Kalach N, Osman Z, Cahuzac C, Nocton F, Risbourg B, Lucet V, de Broca A. P84 Étude prospective dés malaises du nourrisson accueillies aux urgences d'un hôpital général. Arch Pediatr 1995. [DOI: 10.1016/0929-693x(95)90096-9] [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: 11/15/2022]
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