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Barasche-Berdah D, Ein-Mor E, Calderon-Margalit R, Rose AJ, Krieger M, Brammli-Greenberg S, Ben-Yehuda A, Manor O, Cohen AD, Bar-Ratson E, Bareket R, Matz E, Paltiel O. Nationwide Evaluation of Quality of Care Indicators for Individuals with Severe Mental Illness and Diabetes Mellitus, Following Israel's Mental Health Reform. Community Ment Health J 2024; 60:354-365. [PMID: 37697183 DOI: 10.1007/s10597-023-01178-y] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/31/2023] [Indexed: 09/13/2023]
Abstract
Diabetes Mellitus (DM) is more common among individuals with severe mental illness (SMI). We aimed to assess quality-of-care-indicators in individuals with SMI following the 2015 Israel's Mental-Health-reform. We analyzed yearly changes in 2015-2019 of quality-of-care-measures and intermediate-DM-outcomes, with adjustment for gender, age-group, and socioeconomic status (SES) and compared individuals with SMI to the general adult population. Adults with SMI had higher prevalences of DM (odds ratio (OR) = 1.64; 95% confidence intervals (CI): 1.61-1.67) and obesity (OR = 2.11; 95% CI: 2.08-2.13), compared to the general population. DM prevalence, DM control, and obesity rates increased over the years in this population. In 2019, HbA1c testing was marginally lower (OR = 0.88; 95% CI: 0.83-0.94) and uncontrolled DM (HbA1c > 9%) slightly more common among patients with SMI (OR = 1.22; 95% CI: 1.14-1.30), control worsened by decreasing SES. After adjustment, uncontrolled DM (adj. OR = 1.02; 95% CI: 0.96-1.09) was not associated with SMI. Cardio-metabolic morbidity among patients with SMI may be related to high prevalences of obesity and DM rather than poor DM control. Effective screening for metabolic diseases in this population and social reforms are required.
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Affiliation(s)
- Deborah Barasche-Berdah
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel.
| | - Eliana Ein-Mor
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Adam J Rose
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Michal Krieger
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Shuli Brammli-Greenberg
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arye Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Arnon D Cohen
- Clalit Health Services, 101 Arlozorov St., POB 16250, 62098, Tel Aviv, Israel
| | | | - Ronen Bareket
- Meuhedet Health Fund, 124 Ibn Gvirol St, 62038, Tel Aviv, Israel
- Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Department of Medical Education, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Matz
- Leumit Health Fund, 23 Sprinzak St, 64738, Tel Aviv, Israel
| | - Ora Paltiel
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 92210, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Sagy YW, Krieger M, Horwitz E, Paltiel O, Ravel-Vilk S, Ben-Yehuda A, Manor O, Calderon-Margalit R. Diabetes care in individuals with severe mental Illnesses in Israel. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiovascular disease and risk factors are more common in people with severe mental illness (SMI; schizophrenia, schizoaffective disorders, and bi-polar disorders). For instance, diabetes mellitus (DM) prevalence was reported to be 2-3 times higher, with higher incidence and severity of complications. In 2015, following a reform in mental health services in Israel, services were transferred to the responsibility of the health plans, allowing a comprehensive healthcare. We aimed to compare quality of care indicators and intermediate DM outcomes in individuals with SMI compared to the general population.
Methods
The Israel national program for quality indicators in community healthcare obtains data from electronic medical records from the four health plans, covering the entire civilian population. In 2017, n = 74,226 individuals aged ≥18 years had a registered diagnosis of SMI (prevalence 1.37%). DM prevalence, hemoglobin A1c (HbA1c) testing yearly, and DM control in individuals with SMI were compared with the general population.
Results
DM prevalence in adults with SMI in 2017 was 14.3%, compared with 9.7% among all Israeli adults (RR of 1.5). rates of HbA1c testing and control (HbA1c<7-8%, depending on age and duration of disease) were similar among DM patients with SMI and the general population (testing: 90.1% and 90.9%; Control: 70.8% and 69.7%, SMI and general population, respectively); Similarly, uncontrolled DM (HbA1c>9%) was observed in 10.8% of individuals with SMI and in 10.0% of the general population.
Conclusions
Along with the expected excess of DM prevalence in individuals with SMI, quality of care DM indicators rates were alike among those with SMI as in the general population, suggesting non-inferior quality of care. This is consistent with results reported by the British national diabetes audit for England and Wales. However, our results are limited by a possible under-registration or diagnosis of SMI in the Israeli population.
Key messages
Higher diabetes mellitus prevalence is observed in individuals with severe mental illness. Hemoglobin A1c testing and diabetes mellitus control rates are alike in individuals with severe mental illness compared with the general population, suggesting non-inferior quality of care.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare-Zedek, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Wolff Sagy Y, Krieger M, Horwitz E, Ben-Yehuda A, Paltiel O, Ravel-Vilk S, Manor O, Calderon-Margalit R. Diabetes in Israel- do all patients receive equal care? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Diabetes Mellitus (DM) is associated with micro- and macro-vascular complications, leading to high burden of morbidity and mortality. Populations of low socioeconomic position (SEP) in various countries were found to have increased prevalence of the disease, worse glycemic control, and increased complications. We aimed to examine whether there are social disparities in diabetes care in Israel, as reflected in a national program for quality indicators.
Methods
The Israel National Program for Quality Indicators in Community Healthcare obtains data from electronic medical records from all health plans, covering the entire Israeli population. In 2017, 497,397 individuals aged >18 years were identified with DM. DM prevalence, quality of care indicators, including process and intermediate outcomes were explored by SEP categories (1-10), determined according to residential addresses.
Results
DM prevalence in Israeli adults in 2017 was 9.7%, showing a strong SEP gradient, with higher prevalence in individuals of lower SEP. No SEP disparities were observed in process indicators with overall rates of documentation of hemoglobin A1c (HbA1c) of 90.9%, ophthalmologic examinations of 72.5%, and kidney function examinations of 92.5%. However, strong SEP disparities were observed in the prevalence of uncontrolled diabetes (HbA1c≥9%), with an overall rate of 10.0%, and a 5.4-times higher rate in diabetics of the lowest SES level (23.5%) compared with the highest SEP level (4.3%). A somewhat weaker gradient was seen for the well-control of DM (HbA1c<7-8%, according to duration of disease and age), with an overall rate of 69.7%, and a 1.7 ratio, comparing diabetics of the highest vs the lowest SEP level.
Conclusions
These findings suggest that access to care does not explain SEP disparities in diabetes control in Israel. There is a need to explore the underlying social, cultural, and possibly the benefits-policy determinants of poor control among individuals of low SEP.
Key messages
Wide socioeconomic disparities are present among Israeli adults in diabetes mellitus prevalence and control rates, but not in care processes indicators. These findings call for a deeper understanding of the determinants and perhaps a revision of current social benefits policy, which may encourage lack of glycemic control.
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Affiliation(s)
- Y Wolff Sagy
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - M Krieger
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pharmacy Division, Hadassah Medical Center, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Internal Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - S Ravel-Vilk
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
- Pediatric Hemato-Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
| | - R Calderon-Margalit
- Braun School of Public Health & Community Medicine, Hebrew University, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthc, Israel National Institute for Health Policy Research, Tel Hashomer, Israel
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Weisband YL, Calderon-Margalit R, Wolff-Sagy Y, Krieger M, Abu-Ahmed W, Ben-Yehuda A, Horwitz E, Manor O. Socioeconomic disparities in diabetes prevalence and quality of care among Israeli children. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Despite Israel’s universal health coverage, disparities in health services provision may still exist. We aimed to assess socioeconomic disparities in diabetes prevalence and quality of care among Israeli children, and to assess trends in these over time.
Methods
Repeated cross-sectional analyses in the setting of the National Program for Quality Indicators in Community Healthcare that receives data based on electronic medical records from Israel’s four health maintenance organizations. The study population included all Israeli children aged 2-19 years in 2011-2017 (for 2017: N = 2,364,374, including 2,914 with diabetes). Socio-economic position (SEP) was measured using Central Bureau of Statistics data further updated by a private company (Points Business Mapping Ltd), and grouped into 4 categories, ranging from 1 (lowest) to 4 (highest). Using logistic regression, we assessed the association of SEP with diabetes prevalence, diabetes clinic visits, hemoglobin A1C (HbA1C) testing, and poor glycemic control (HbA1C> 9%), and assessed whether these changed over time. Models were adjusted for age, and sex.
Results
Diabetes prevalence increased with age and SEP. SEP was positively associated with visiting a specialized diabetes clinic (OR SEP 4 vs. 1 2.53, 95% CI 1.72 - 3.70). Odds of HbA1C testing and odds of poor glycemic control were negatively associated with SEP (OR SEP 4 vs. 1: 0.54, 95% CI 0.40 - 0.72 and OR SEP 4 vs. 1: 0.25, 95% CI 0.18 - 0.34 respectively). Disparities were especially apparent among children aged 2-9 (4.6% poor glycemic control in SEP 4 vs. 40.8% in SEP 1). Poor glycemic control decreased over time, from 44.0% in 2011 to 34.8% in 2017.
Conclusions
While poor glycemic control rates among children have improved, significant socioeconomic gaps remain. It is eminent to study the causes of these disparities and develop policies to improve care provided to children in the lower SEP levels, to promote health equity.
Key messages
Major socioeconomic inequalities in the control of diabetes among children in Israel remain despite universal health care coverage. The rate of uncontrolled diabetes among Israeli children has improved over time.
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Affiliation(s)
- Y Loewenberg Weisband
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - R Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - Y Wolff-Sagy
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - M Krieger
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - W Abu-Ahmed
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - A Ben-Yehuda
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - E Horwitz
- Pharmacy Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
| | - O Manor
- Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Program Directorate, National Program for Quality Indicators in Community Healthcare in Israel, Jerusalem, Israel
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Sagy YW, Kaufman-Shriqui V, Manor O, Ben-Yehuda A. Israel’s elderly population quality of care: overview of community health indicators. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Wolff Sagy
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
| | - V Kaufman-Shriqui
- National Program For Quality Indicators In Community Healthcare, Ariel, Israel
| | - O Manor
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program For Quality Indicators In Community Healthcare, Jerusalem, Israel
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Lubezky N, Papoulas M, Lessing Y, Gitstein G, Brazowski E, Nachmany I, Lahat G, Goykhman Y, Ben-Yehuda A, Nakache R, Klausner JM. Solid pseudopapillary neoplasm of the pancreas: Management and long-term outcome. Eur J Surg Oncol 2017; 43:1056-1060. [PMID: 28238521 DOI: 10.1016/j.ejso.2017.02.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Solid pseudopapillary neoplasm (SPN) of pancreas is a rare pancreatic neoplasm with a low metastatic potential. Our aim was to study the clinical-pathological characteristics, and long-term outcome of this tumor. MATERIALS Rretrospective single center study of patients operated for SPN of pancreas. Clinical and pathological data were collected. RESULTS From 1995 to 2016, 1320 patients underwent pancreatic resection. SPN was confirmed in 32 cases (2.46%), including 29 (90.6%) female and three (9.4%) male, with a mean age of 28.4 ± 12.2 years. SPN was the most common pathology among female patients under age of 40 (72.4%). Abdominal pain was the most frequent presenting symptom (48%), whereas none of the patients presented with jaundice. Mean tumor diameter was 5.9 cm (range, 0.9-14 cm). All patients underwent margin-negative surgical resection. Two patients demonstrated gross malignant features, including liver metastases at presentation (n = 1), and adjacent organ and vascular invasion (n = 1). Microscopic malignant features were present in thirteen patients (40.6%). Recurrence occurred in the retroperitoneal lymph nodes (n = 1, 7 years post resection) and in the liver (n = 2, 1 and 5 years post resection). Mean follow-up was 49.2 months (range, 1-228 months). Five and 10-year disease-free survival was 96.5% and 89.6% respectively. CONCLUSIONS SPNs are low-grade tumors with a good prognosis. Margin-negative surgical resection is curative in most patients. However, almost 15% of patients demonstrate malignant features including invasion of adjacent organs or metastatic disease. Patients with malignant disease are still expected to have long survival, and aggressive surgical approach is advocated.
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Affiliation(s)
- N Lubezky
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel.
| | - M Papoulas
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - Y Lessing
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - G Gitstein
- Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - E Brazowski
- Institute of Pathology, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - I Nachmany
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - G Lahat
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - Y Goykhman
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - A Ben-Yehuda
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - R Nakache
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
| | - J M Klausner
- The Department of Surgery, Tel-Aviv Medical Center, The Sackler Faculty of Medicine at the Tel-Aviv University, Israel
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Kaufman-Shriqui V, Calderon-Margalit R, Abu-Ahmed W, Krieger M, Horwitz E, Shmueli A, Ben-Yehuda A, Paltiel O, Manor O. Primary prevention of cardiometabolic disease – is everybody receiving quality care? Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Kaufman-Shriqui
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - R Calderon-Margalit
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - W Abu-Ahmed
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - M Krieger
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - E Horwitz
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - A Shmueli
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - A Ben-Yehuda
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - O Paltiel
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
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Kaufman-Shriqui V, Krieger M, Abu-Ahmed W, Ben-Yehuda A, Manor O. Quality of care among diabetic patients with renal disease in Israel. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Kaufman-Shriqui
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - M Krieger
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - W Abu-Ahmed
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
| | - A Ben-Yehuda
- The Hebrew University- Hadassah, Jerusalem, Israel
- Hadassah Medical Center, Jerusalem, Israel
| | - O Manor
- The Hebrew University- Hadassah, Jerusalem, Israel
- National Program for Quality Indicators in Community Healthcare, Jerusalem, Israel
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Kaufman-Shriqui V, Podell R, calderon-Margalit R, Ben-Yehuda A. ISQUA16-2502ISRAEL'S ELDERLY POPULATION: DO THEY RECEIVE HIGH QUALITY CARE? Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.70] [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: 11/14/2022] Open
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Abstract
SLE nephritis is usually a slow process that may lead to renal failure many years after its first presentation. Success of different therapeutic modalities in preventing renal failure is therefore evaluated and compared only after many years of treatment. Lately, this conservative philosophy has been challenged with the acknowledgment of collapsing glomerulopathy (CG), a recent recognized clinical-pathological entity, characterized by rapidly progressive renal failure. Despite this ominous description we present an unusual case of a patient who presented with systemic lupus erythematosus (SLE) and clinical and pathological findings of CG, who completely remitted several weeks after commencing immunosuppressive therapy with intravenous cyclophosphamide and prednisolone.
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Affiliation(s)
- O Arbel
- Department of Medicine, Hadassah University Hospital, Jerusalem, Israel
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Nachmany I, Pencovich N, Zohar N, Ben-Yehuda A, Binyamin C, Goykhman Y, Lubezky N, Nakache R, Klausner JM. Laparoscopic versus open liver resection for metastatic colorectal cancer. Eur J Surg Oncol 2015; 41:1615-20. [PMID: 26454765 DOI: 10.1016/j.ejso.2015.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Application of minimally invasive surgery for oncologic liver resection is still limited to expert centers. We describe our experience in laparoscopic liver resection (LLR) for colorectal liver metastases (CLM). PATIENTS AND METHODS Between February 2010 and February 2015, 174 patients underwent resection of CLM. LLR was chosen according to surgeon's preferences. Data was retrieved from the institutes' electronic charts and retrospectively analyzed. RESULTS LLR was performed in 42 patients (24.5%) and OLR in 132. Increased number of metastases were found in OLR (2.82 ± 2.81 versus 1.78 ± 1.16, P = 0.02), with no difference in maximal lesion size (33.1 ± 22 versus 34.9 ± 27.5 cm, P = 0.7). Altogether 55 patients underwent major hepatectomy, and 50 of the OLR group (37.8%, 37 right hepatectomy and 7 left hepatectomy) (P = 0.02). In 5 patients (11.6%) a conversion to open surgery was indicated. Operative time was longer in LLR. Estimated blood loss was decreased in laparoscopic minor resections. One OLR patient died during the postoperative period (0.7%). Eight patients in the OLR group had major complications, versus 1 in the LLR group (P = 0.0016). Reoperation within 30 days was performed in 4 OLR patients and none in the LLR group. Patients in the LLR group had shorter length of stay (LOS) (6.78 ± 2.75 versus 8.39 ± 5.64 days, P = 0.038). R0 resection was 88% in both groups. CONCLUSIONS In selected patients with CLM, LLR is feasible, safe and may achieve shorter LOS without inferior oncologic outcome.
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Affiliation(s)
- I Nachmany
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - N Pencovich
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Zohar
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - A Ben-Yehuda
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - C Binyamin
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Goykhman
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - N Lubezky
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - R Nakache
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J M Klausner
- Department of General Surgery B, Division of General Surgery, Tel-Aviv Sourasky Medical Center, The Nikolas & Elizabeth Shlezak Fund for Experimental Surgery, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Elias S, Kuint R, Levy I, Ben-Yehuda A, Berkman N, Muszkat M. Massive subcutaneous emphysema in a long-term ventilated patient. QJM 2015; 108:67-8. [PMID: 24890557 DOI: 10.1093/qjmed/hcu121] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Elias
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - R Kuint
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - I Levy
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - A Ben-Yehuda
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - N Berkman
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - M Muszkat
- Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
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13
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Affiliation(s)
- S Elias
- Department of Medicine, Hebrew University-Hadassah Medical Center, POB 12000, Jerusalem 91120, Israel.
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14
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Cohen MJ, Nahmias A, Moses AE, Ben-Yehuda A, Shibolet O. Cellulitis in a post-kidney transplant patient--more than meets the eye. QJM 2011; 104:805-6. [PMID: 20685843 DOI: 10.1093/qjmed/hcq137] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Cohen
- Division of Internal Medicine, Hadassah Hospital Ein-Kerem Campus, POB 12000, Jerusalem 91120, Israel
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15
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Abdul-Hai A, Weiss L, Ben-Yehuda A, Ergas D, Shapira MY, Slavin S. Interleukin-7 induced facilitation of immunological reconstitution of sublethally irradiated mice following treatment with alloreactive spleen cells in a murine model of B-cell leukemia/lymphoma (BCL1). Bone Marrow Transplant 2007; 40:881-9. [PMID: 17704792 DOI: 10.1038/sj.bmt.1705819] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Interleukin-7 (IL-7) plays a key role in maturation and function of both T and B cells. We investigate the potential use of recombinant human IL-7 for facilitation of graft-versus-leukemia (GVL) effects mediated by T cells following transplantation in a murine model. Administration of IL-7 in vivo to allogeneic-transplanted mice improved disease-free survival: 67% of mice treated with IL-7 remained alive and disease free for more than 60 days, in comparison to 17% of the controls (P<0.05). Similar results were obtained when C57BL/6 spleen cells sensitized against irradiated B-cell leukemia (BCL(1)) cells in the presence of IL-7 were transplanted to F(1) mice, followed by IL-7 treatment in vivo. Of the BALB/c mice that received spleen cells from F(1) mice treated with IL-7 following transplantation of C57BL/6 spleen cells sensitized with irradiated BCL(1) in the presence of IL-7, only 29% developed leukemia, as compared to 79% in the control group (P<0.05). Mice treated with IL-7 showed increased splenic and thymic cellularity and improved T cell-dependent proliferative responses compared to the controls (P<0.05). IL-7 may provide a novel tool to enhance immune reconstitution following transplantation of mismatched stem cells and for enhancement of GVL effects mediated by alloreactive lymphocytes.
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Affiliation(s)
- A Abdul-Hai
- Department of Bone Marrow Transplantation and Cancer Immunotherapy, Cell Therapy and Transplantation Research Center, Hadassah University Hospital, Jerusalem, Israel
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16
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Berkun Y, Levartovsky D, Rubinow A, Orbach H, Aamar S, Grenader T, Abou Atta I, Mevorach D, Friedman G, Ben-Yehuda A. Methotrexate related adverse effects in patients with rheumatoid arthritis are associated with the A1298C polymorphism of the MTHFR gene. Ann Rheum Dis 2004; 63:1227-31. [PMID: 15361376 PMCID: PMC1754756 DOI: 10.1136/ard.2003.016337] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [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: 11/04/2022]
Abstract
BACKGROUND There is an association between C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene and methotrexate related toxicity. OBJECTIVE To examine the relations between the recently described A1298C polymorphism of the MTHFR gene, plasma homocysteine, methotrexate toxicity, and disease activity in patients with rheumatoid arthritis. DESIGN A cross sectional study on 93 methotrexate treated patients with rheumatoid arthritis, comprising a clinical interview and physical examination to determine disease activity and methotrexate related adverse reactions. Genotype analysis of the MTHFR gene was carried out and fasting plasma homocysteine and serum folate concentrations were measured. The data were analysed using univariate analysis. Allele and genotype distributions were compared with those of a healthy control group. RESULTS The frequency of the 1298CC genotype (24.7%) in the rheumatoid study group was greater than expected in the general population (12.8%, p<0.001). This genotype was associated with a significantly low rate of methotrexate related side effects. The odds ratio for side effects in patients with wild type 1298AA genotype v 1298CC genotype was 5.24 (95% confidence interval, 1.38 to 20). No correlation of disease activity variables or plasma homocysteine with MTHFR A1298C and C677T polymorphisms was observed. CONCLUSIONS 1298CC polymorphism was more common in methotrexate treated rheumatoid patients than expected in the population, and was associated with a reduction in methotrexate related adverse effects. The A1298C polymorphism of the MTHFR gene may indicate a need to adjust the dose of methotrexate given to patients with rheumatoid arthritis.
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Affiliation(s)
- Y Berkun
- Department of Paediatrics, Bikur Cholim General Hospital, POB 492, Jerusalem 91004, Israel.
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17
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Klein BY, Rojansky N, Ben-Yehuda A, Abou-Atta I, Abedat S, Friedman G. Cell death in cultured human Saos2 osteoblasts exposed to low-density lipoprotein. J Cell Biochem 2003; 90:42-58. [PMID: 12938155 DOI: 10.1002/jcb.10603] [Citation(s) in RCA: 23] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Osteoporosis (OP) and atherosclerotic-cardiovascular diseases (and possibly dementia) constitute emerging age-related co-morbidity states that might share risk factors. Blood-born lipids, like LDL involved in atherosclerosis and apolipoprotein-E4 (ApoE4) involved in dementia, may also be implicated in development of OP. We examined osteoblast cell lines as a culture model for OP by exposure to lipoproteins. ApoE expression in Saos2 and U2OS osteoblasts was confirmed by PCR. ApoE4 did decrease cell counts relatively to ApoE3, especially in Saos2 cells in which it was less selective for cells with higher alkaline phosphatase (ALP, an osteoblast marker) activity than ApoE3. This associates with ApoE4, being a risk factor for both dementia and OP. Saos2, but not U2OS, showed a decrease in cell counts after 48 h exposure to native LDL (NLDL). Both cell lines had decreased cell counts already after 24 h when exposed to oxidized-LDL (OxLDL) for which Saos2 also showed a higher sensitivity than U2OS. Exposure of Saos2 to both, OxLDL at low concentration (5 microg/ml) and NLDL revealed a shrunken size cell fraction of 17-23% on the fluorescence-activated cell sorter (FACS) analysis. Such shrunken cell fraction was not seen when Saos2 cells were exposed to 50 microg/ml of OxLDL or to OxLDL combined with 10 nM dexamethasone (DEX, a stimulator of osteoprogenitor differentiation). DEX treatment has lysed the cells earlier than 24 h post exposure and has selected more resistant cells that did not show apoptotic shrinkage in the FACS analysis done after 24 h. We interpret this as a failure to detect the apoptotic cell fraction due to their lysis prior to the FACS analysis. Western blots performed at different time points (10 min, 30 min, 4 h, 24 h, and 48 h) under OxLDL + DEX revealed a fall in the positive regulator of pp60Src-kinase phosphotyrosine (pY)418 relative to the DEX controls during the first 4 h. This is consistent with DEX osteogenic induction, known to be negatively regulated by c-Src, although the pY418/pY529 ratios (negative/positive kinase regulation) fell only at the 10 min time point. Contrarily the pY418/pY529 ratio increased, relative to untreated controls, under 5 microg/ml and 50 microg/ml of NLDL at the 4 h time point and under 50 microg/ml NLDL only at the 10 min time point, being consistent with the ability of a higher dose of LDL to antagonize osteoblast differentiation. This could be even more acceptable if the NLDL would have become minimally oxidized during its long purification procedure. Under NLDL, the Bcl-2/Bax ratio was pro-apoptotic at 10 min, 30 min, and 4 h only under 50 microg/ml, whereas under OxLDL + DEX it was pro-apoptotic only after 4 h suggesting that additional pathways contribute to cell death. These results indicate that lipid effects on human osteoblast lines in culture may be used as a model to identify molecular targets shared between OP and atherosclerosis for intervention in this co-morbidity.
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Affiliation(s)
- Benjamin Y Klein
- Laboratory of Experimental Surgery, Hadassah University Hospital, Jerusalem 91120, Israel.
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18
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Haviv YS, Shpichinetsky V, Goldschmidt N, Atta IA, Ben-Yehuda A, Friedman G. The common mutations C677T and A1298C in the human methylenetetrahydrofolate reductase gene are associated with hyperhomocysteinemia and cardiovascular disease in hemodialysis patients. Nephron Clin Pract 2002; 92:120-6. [PMID: 12187094 DOI: 10.1159/000064485] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plasma total homocysteine (tHcy) level might be an important risk factor for the development of cardiovascular disease (CVD) in dialysis patients. While both renal failure and mutations of the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene may result in hyperhomocysteinemia and CVD, the distinct roles of the thermolabile MTHFR mutation at nucleotide C677T and the more recently described mutation at nucleotide A1298C have not been evaluated concurrently in patients on hemodialysis. METHODS A cross-sectional study was performed in 120 maintenance HD patients to determine the prevalence of MTHFR C677T and A1298C mutations and their relative association to hyperhomocysteinemia and CVD. RESULTS Both mutations, the C677T and the A1298C, were highly prevalent in HD patients with allele frequencies of 0.41 and 0.27, respectively. The prevalence of CVD in HD patients was 55% and its significant risk factors included, in descending order, hyperhomocysteinemia, MTHFR C677T mutation, low serum folate levels, diabetes mellitus, hypertension, and double heterozygote state for both MTHFR mutations (677CT/1298AC). MTHFR A1298C mutation alone and gender were not associated with either hyperhomocysteinemia or increased CVD risk, but the HD patients with homozygotes 1298CC and wild alleles 677CC (677CC/1298CC) have significant increase of tHcy (37.7 +/- 12) and high prevalence of CVD. CONCLUSIONS Hyperhomocysteinemia, serum folate levels and both C677T and A1298C MTHFR mutations are associated with CVD in HD patients.
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Affiliation(s)
- Y S Haviv
- Department of Nephrology and Hypertension, Hebrew University Hadassah Medical Center, Jerusalem, Israel
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19
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Abstract
OBJECTIVE To report a case of complete atrioventricular (AV) block and QTc prolongation following coadministration of high-dose verapamil and erythromycin. CASE SUMMARY A 79-year-old white woman was admitted to the hospital due to extreme fatigue and dizziness. On admission, heart rate was 40 beats/min and blood pressure was 80/40 mm Hg. An electrocardiogram showed complete atrioventricular (AV) block, escape rhythm of 50 beats/min, and QTc prolongation 583 msec. This event was attributed to concomitant treatment with verapamil 480 mg/d and erythromycin 2,000 mg/d, which was prescribed one week before admission. DISCUSSION This is the first case published describing complete AV block and prolongation of QTc following coadministration of erythromycin and verapamil. CYP3A4 is the main isoenzyme responsible for metabolism of erythromycin and verapamil. Both drugs are potent inhibitors of CYP3A4 and of P-glycoprotein; this may be the basis for the pharmacokinetic interaction between erythromycin and verapamil. In addition to being a woman, our patient had other risk factors for QT prolongation: slow baseline heart rate (probably induced by verapamil), left-ventricular hypertrophy, and possibly ischemic heart disease. CONCLUSIONS This life-threatening arrhythmia was probably the result of a pharmacokinetic and/or pharmacodynamic interaction of high-dose verapamil and erythromycin.
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Affiliation(s)
- N Goldschmidt
- Department of Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel
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20
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Geva E, Yaron Y, Shomrat R, Ben-Yehuda A, Zabari S, Peretz H, Naiman T, Yeger H, Orr-Urtreger A. The risk of fragile X premutation expansion is lower in carriers detected by general prenatal screening than in carriers from known fragile X families. Genet Test 2001; 4:289-92. [PMID: 11142761 DOI: 10.1089/10906570050501524] [Citation(s) in RCA: 26] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The Fragile X syndrome is the most common cause of inherited mental retardation. For a female premutation carrier, the risk of having a child with a full mutation is positively correlated with the size of the premutation. The current study was performed to evaluate the risk of premutation expansion in the offspring of average-risk carriers detected by general prenatal screening. Over a 4-year period, 9,660 women underwent DNA screening for FMR1 mutation/premutation at the Tel Aviv Sourasky Medical Center. A premutation was defined as a CGG repeat number >50 in the 5' untranslated region (UTR) of exon 1 in the FMR1 gene. The study included only individuals with no family history of X-linked mental retardation or known FMR1 mutations. A premutation was found in 85 women (1 in 114), 68 of whom consented to have prenatal diagnoses in 74 pregnancies. The abnormal allele was transmitted to the offspring in 44 pregnancies. Of these, no change in allele size was noted in 35 pregnancies (79.6%), and expansion within premutation range was evident in 4 pregnancies (9%). In 5 pregnancies (11.4%), expansion to the full mutation was noted. This occurred only in carriers having more than 90 repeats. We conclude that the likelihood of Fragile X premutation expansion to full mutation is significantly lower in individuals ascertained by general prenatal carrier testing than in those from known Fragile X families.
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Affiliation(s)
- E Geva
- Department of Obstetrics and Gynecology, Tel Aviv Sourasky Medical Center, Israel
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21
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Friedman G, Ben-Yehuda A, Dabach Y, Hollander G, Babaey S, Ben-Naim M, Stein O, Stein Y. Macrophage cholesterol metabolism, apolipoprotein E, and scavenger receptor AI/II mRNA in atherosclerosis-susceptible and -resistant mice. Arterioscler Thromb Vasc Biol 2000; 20:2459-64. [PMID: 11073853 DOI: 10.1161/01.atv.20.11.2459] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Female mice known to be susceptible (C57BL) and resistant (C3H and BALB/c) to diet-induced atherosclerosis were studied. Feeding of a cholate-containing atherogenic diet for 1 month resulted in an increase in plasma total cholesterol, little or no change in total phospholipids and high density lipoprotein (HDL) cholesterol, and a fall in HDL phospholipid, which was most pronounced in the C57BL strain. In elicited macrophages, cholesterol esterification was lower with acetylated low density lipoprotein (acLDL) and higher with beta-very low density lipoprotein (beta-VLDL) in C57BL than in C3H or BALB/C strains. In resident macrophages, acLDL enhanced cholesterol esterification more than did rabbit beta-VLDL. With acLDL, more apolipoprotein E (apoE) was recovered in all macrophage cultures. In macrophages from chow-fed mice, most apoE was in the medium, whereas in mice fed an atherogenic diet, half of the apoE was in the cells. ApoE protein was highest in macrophages from BALB/c mice fed an atherogenic diet; an increase in apoE mRNA occurred in BALB/c and C3H macrophages. Scavenger receptor AI/II mRNA was significantly higher in macrophages from atherosclerosis-resistant mice. Thus, higher HDL phospholipid and plasma apoE levels (reported by others), together with high macrophage scavenger receptor AI/II mRNA, could inhibit accretion of cholesterol in the vessel wall in the 2 resistant strains.
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MESH Headings
- Animals
- Apolipoproteins E/biosynthesis
- Apolipoproteins E/genetics
- Arteriosclerosis/etiology
- Arteriosclerosis/metabolism
- Arteriosclerosis/pathology
- Cells, Cultured
- Cholesterol/blood
- Cholesterol/metabolism
- Cholesterol Esters/metabolism
- Diet, Atherogenic
- Disease Susceptibility
- Female
- Lipids/blood
- Macrophages, Peritoneal/metabolism
- Macrophages, Peritoneal/pathology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C3H
- Mice, Inbred C57BL
- RNA, Messenger/biosynthesis
- RNA, Messenger/metabolism
- Rabbits
- Receptors, Immunologic/metabolism
- Receptors, Scavenger
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Affiliation(s)
- G Friedman
- Division of Medicine, Geriatric Unit, Lipid Research Laboratory, Hadassah University Hospital, Jerusalem, Israel
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22
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Shpichinetsky V, Raz I, Friedlander Y, Goldschmidt N, Wexler ID, Ben-Yehuda A, Friedman G. The association between two common mutations C677T and A1298C in human methylenetetrahydrofolate reductase gene and the risk for diabetic nephropathy in type II diabetic patients. J Nutr 2000; 130:2493-7. [PMID: 11015479 DOI: 10.1093/jn/130.10.2493] [Citation(s) in RCA: 41] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mutations of the methylenetetrahydrofolate reductase (MTHFR) gene have been shown to be associated with a predisposition to developing diabetic nephropathy (DN) in specific populations. The frequency of two MTHFR mutations, a recently described mutation in the human MTHFR gene A1298C and C677T, whose association with DN is already known, was determined in an Israeli Jewish population with type 2 diabetes mellitus (DM). Both A1298C and C677T are highly prevalent in the diabetic population with allele frequencies of 0.35 and 0.36, respectively. The genotype frequency and allele frequency for these two polymorphisms in patients who are normoalbuminuric (n = 55) were compared with those of patients who had either micro- or macroalbuminuria (n = 43). For both polymorphisms, there were no significant differences in either the genotype distribution or allele frequency in patients with or without DN. However, in patients with serum folate <15.4 nmol/L, there was a greater incidence of DN in those patients who were homozygous or heterozygous for the C677T mutation. For the A1298C mutation, there is evidence suggesting that the homozygous state may be protective in patients with low-normal serum folate. Folate supplementation in diabetic patients with the C677T mutation and low-normal serum folate may prevent the onset or retard the progression of DN.
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Affiliation(s)
- V Shpichinetsky
- Diabetes Unit, Geriatric Unit and. Department of Social Medicine, School of Public Health and Community Medicine, Hebrew University Hadassah Medical Center, Jerusalem, Israel
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23
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Abstract
We report on a 74-year-old carcinoid patient who, following acute myocardial infarction (MI) and percutaneous transluminal coronary angioplasty, suffered recurrent episodes of chest pain and ST-segment elevation on ECG. This was accompanied by elevation of urinary 5-hydroxy-indole acetic acid. A review of the patient's file revealed that during the 3 weeks prior to the MI, she had been treated inadvertently with a fivefold lower dosage of octreotide. Following the correction of octreotide dosage, episodes of chest pain resolved immediately. We therefore suggest that this patient suffered from recurrent coronary vasospasm due to uncontrolled carcinoid tumour.
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Affiliation(s)
- M Muszkat
- Division of Internal Medicine, Department of Cardiology, Hadassah University Hospital, Jerusalem, Israel
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24
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Abstract
OBJECTIVES Hyperhomocysteinemia as well as insulin resistance are considered to be risk factors for the development of coronary artery disease. This study was aimed at determining whether any relationship between plasma insulin and glucose levels and total plasma homocysteine (tHcy) concentrations exists in a population based survey performed 10 years apart. DESIGN AND SETTING A cross-sectional study was undertaken during the years 1986-87 to examine risk factors for diabetes and for coronary artery disease (CAD) in the Jewish population of Jerusalem. Ten years later two groups of individuals were invited for re-examination. SUBJECTS Two groups of individuals were examined: the first one consisted of nondiabetic subjects (n = 86), who had hyperinsulinemia 10 years previously (at the first visit), the second group consisted of normoinsulinemic nondiabetic individuals (n = 265) who had initially normal glucose and insulin levels. MAIN OUTCOME MEASURES Metabolic, biochemical and anthropomorphic features were determined. Fasting and post load glucose, as well as insulin concentrations on fasting and 2 h post glucose load were measured at the first and second visits. Plasma tHcy and folic acid were determined only at the second visit. RESULTS The results demonstrated a significant negative correlation between plasma tHcy levels and insulin levels at the second visit. No difference was found in folic acid levels between these two groups. CONCLUSIONS In general, hyperinsulinemia and hyperhomocysteinemia are both related to an increased incidence of CAD. In our population most of the subjects examined had tHcy levels within the normal range and only a few demonstrated very high levels. However, negative association between insulin levels and tHcy concentrations was found. Possible explanations for this finding are discussed.
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Affiliation(s)
- H Bar-On
- Diabetes Unit and Geriatric Unit, Department of Medicine, School of Public Health and Community Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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25
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Gare M, Haviv YS, Ben-Yehuda A, Rubinger D, Bdolah-Abram T, Fuchs S, Gat O, Popovtzer MM, Gotsman MS, Mosseri M. The renal effect of low-dose dopamine in high-risk patients undergoing coronary angiography. J Am Coll Cardiol 1999; 34:1682-8. [PMID: 10577557 DOI: 10.1016/s0735-1097(99)00422-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.3] [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: 11/21/2022]
Abstract
OBJECTIVES The purpose of the study was to examine the potential renal protective effect of low-dose dopamine in high-risk patients undergoing coronary angiography. BACKGROUND Contrast nephropathy is prevalent in patients with chronic renal failure (CRF) and/or diabetes mellitus (DM). Decreased renal blood flow due to vasoconstriction was suggested as a contributory mechanism. Low-dose dopamine has a dilatory effect on the renal vasculature. METHODS Sixty-six patients with mild or moderate CRF and/or DM undergoing coronary angiography were prospectively double-blindedly randomized, to either 120 ml/day of 0.9% saline plus dopamine 2 microg/kg/min (Dopamine group) or saline alone (Control group) for 48 h. RESULTS Thirty-three Dopamine-treated (30 diabetics and 6 with CRF) and 33 Control (28 diabetics and 5 with CRF) patients were compared. Plasma creatinine (Cr) level increased in the Control group from 100.6+/-5.2 before to 112.3+/-8.0 micromol/liter within five days after angiography (p = 0.003), and in the Dopamine group from 100.3+/-5.4 before to 117.5+/-8.8 micromol/liter after angiography (p = 0.0001), respectively. There was no significant difference in the change of Cr level (deltaCr) between the two groups. However, in a subgroup of patients with peripheral vascular disease (PVD), deltaCr was -2.4+/-2.3 in the Control group and 30.0+/-12.0 micromol/liter in the Dopamine group (p = 0.01). No significant difference occurred in deltaCr between Control and Dopamine in subgroups of patients with preangiographic CRF or DM. CONCLUSIONS Contrast material caused a small but significant increase in Cr blood level in high-risk patients. There is no advantage of dopamine over adequate hydration in patients with mild to moderate renal failure or DM undergoing coronary angiography. Dopamine should be avoided in patients with PVD exposed to contrast medium.
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Affiliation(s)
- M Gare
- Cardiology Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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26
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Friedman G, Goldschmidt N, Friedlander Y, Ben-Yehuda A, Selhub J, Babaey S, Mendel M, Kidron M, Bar-On H. A common mutation A1298C in human methylenetetrahydrofolate reductase gene: association with plasma total homocysteine and folate concentrations. J Nutr 1999; 129:1656-61. [PMID: 10460200 DOI: 10.1093/jn/129.9.1656] [Citation(s) in RCA: 186] [Impact Index Per Article: 7.4] [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: 11/14/2022] Open
Abstract
Methylenetetrahydrofolate reductase (MTHFR) is one of the main regulatory enzymes of homocysteine metabolism. Previous studies revealed that a common mutation in MTHFR gene C677T is related to hyperhomocysteinemia and occlusive vascular pathology. In the current study, we determined the prevalence of a newly described mutation in the human MTHFR gene A1298C, and the already known C677T mutation, and related them to plasma total homocysteine and folate concentrations. We studied 377 Jewish subjects, including 190 men and 186 women aged 56.8 +/- 13 y (range 32-95 y). The frequency of the homozygotes for the A1298C and the C677T MTHFR mutations was common in the Jewish Israeli population (0.34 and 0.37, respectively). Subjects homozygous (TT) for the C677T mutation had significantly greater plasma total homocysteine concentrations (P < 0.01) than subjects without the mutation (CC). Homozygotes (CC) for the A1298C mutation did not have elevated plasma total homocysteine concentrations. Our study indicated that subjects with the 677CC/1298CC genotype had significantly lower concentrations (P < 0. 05) than those with a 677CC/1298AA genotype. Neither mutation (the A1298C and the C677T) was associated with established cardiovascular risk factors such as hypertension, elevated total cholesterol or body mass index.
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Affiliation(s)
- G Friedman
- Geriatric Unit, Lipid Research Laboratory, School of Public Health and Community Medicine and Diabetes Unit, Hebrew University Hadassah Medical Center, Jerusalem, Israel
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Friedmann D, Yachimovich N, Mostoslavsky G, Pewzner-Jung Y, Ben-Yehuda A, Rajewsky K, Eilat D. Production of high affinity autoantibodies in autoimmune New Zealand Black/New Zealand white F1 mice targeted with an anti-DNA heavy chain. J Immunol 1999; 162:4406-16. [PMID: 10201976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Lupus-prone, anti-DNA, heavy (H) chain "knock-in" mice were obtained by backcrossing C57BL/6 mice, targeted with a rearranged H chain from a VH11(S107)-encoded anti-DNA hybridoma (D42), onto the autoimmune genetic background of New Zealand Black/New Zealand White (NZB/NZW) F1 mice. The targeted female mice developed typical lupus serologic manifestations, with the appearance of transgenic IgM anti-DNA autoantibodies at a young age (2-3 mo) and high affinity, somatically mutated IgM and IgG anti-DNA Abs at a later age (6-7 mo). However, they did not develop clinical, lupus-associated glomerulonephritis and survived to at least 18 mo of age. L chain analysis of transgenic anti-DNA Abs derived from diseased NZB/NZW mouse hybridomas showed a very restricted repertoire of Vkappa utilization, different from that of nonautoimmune (C57BL/6 x BALB/c)F1 transgenic anti-DNA Abs. Strikingly, a single L chain was repetitively selected by most anti-DNA, transgenic NZB/NZW B cells to pair with the targeted H chain. This L chain had the same Vkappa-Jkappa rearrangement as that expressed by the original anti-DNA D42 hybridoma. These findings indicate that the kinetics of the autoimmune serologic manifestations are similar in wild-type and transgenic lupus-prone NZB/NZW F1 mice and suggest that the breakdown of immunologic tolerance in these mice is associated with the preferential expansion and activation of B cell clones expressing high affinity anti-DNA H/L receptor combinations.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Antinuclear/biosynthesis
- Antibodies, Antinuclear/blood
- Antibodies, Antinuclear/chemistry
- Antibodies, Antinuclear/genetics
- Antibodies, Monoclonal/chemistry
- Antibodies, Monoclonal/genetics
- Antibody Affinity/genetics
- Base Sequence
- Crosses, Genetic
- DNA/immunology
- Female
- Gene Targeting
- Immunoglobulin Heavy Chains/administration & dosage
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/administration & dosage
- Immunoglobulin Variable Region/genetics
- Lupus Vulgaris/genetics
- Lupus Vulgaris/immunology
- Mice
- Mice, Inbred BALB C
- Mice, Inbred C57BL
- Mice, Inbred NZB
- Mice, Transgenic
- Molecular Sequence Data
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Affiliation(s)
- D Friedmann
- Division of Medicine, Hadassah University Hospital, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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28
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Ben-Yehuda A, Wirtheim E, Abdul-Hai A, Or R, Slavin S, Babaey S, Friedman G. Activation of the recombination activating gene 1 (RAG-1) transcript in bone marrow of senescent C57BL/6 mice by recombinant interleukin-7. J Gerontol A Biol Sci Med Sci 1999; 54:B143-8. [PMID: 10219001 DOI: 10.1093/gerona/54.4.b143] [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: 11/13/2022] Open
Abstract
The level of the recombination activating gene 1 (RAG-1) mRNA in bone marrow cells decreases to a minimal level by the age of 10 months. Recominbant interleukin-7 (rIL-7) is a potent proliferative stimulus for B cell progenitors and upregulates RAG-1 expression in lymphocyte precursors. To investigate the stimulatory effect of rIL-7 on the expression of RAG-1 in old mice, we compared the level of RAG-1 message in short-term bone marrow cultures of cells from mice aged 1 month and 18 months. We found similar levels of RAG-1 mRNA in bone marrow cells of young mice before and after 24 hours of incubation. No RAG-1 mRNA was detected in bone marrow cell cultures prepared from old mice after 24 hours of incubation. However, when rIL-7 was added to the culture medium, RAG-1 mRNA was detected after 24 hours of incubation and its level was similar to that measured in cells from young mice. The expression of RAG-1 was dose-dependent, with 20 ng of rIL-7 per 10(6) old nucleated cells yielding the maximal response. Our results indicate that despite the low or no RAG-1 expression in bone marrow cultures of old mice, the potential to activate RAG-1 in B-cell precursors is still present, and immunoglobulin heavy chain (V(H)D(H)J(H)) rearrangement may be enhanced by rIL7.
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Affiliation(s)
- A Ben-Yehuda
- Division of Medicine, Geriatric Unit, Hadassah University Hospital, Jerusalem, Israel
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29
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Abstract
Cutaneous T-cell lymphomas (CTCL) are diseases characterized by cutaneous infiltrates of malignant clonally expanded T cells. CTCL cells exhibit a cytokine profile consistent with T helper-2 type (TH2) cells. Eosinophilic pneumonias are individual syndromes characterized by eosinophilic pulmonary infiltrates and commonly peripheral blood eosinophilia. CTCL and chronic eosinophilic pneumonia are rare clinical entities. We report a patient with the association of CTCL and chronic eosinophilic pneumonia. To understand the mechanism leading to the eosinophilia, we examined the patient's cytokine profile. This was consistent with a high TH2 activity. Her interleukin (IL) 5, 6, and 10 levels were extremely high, while her IL-2 and interferon-gamma (IFN-gamma) levels (TH1 profile) were low. We believe that eosinophilic pneumonia in this patient is probably secondary to high TH2 cytokine levels induced by tumor cells. We suggest that eosinophilic pneumonia should be considered as a possible diagnosis in patients with CTCL who have respiratory complaints.
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Affiliation(s)
- B Hirshberg
- Division of Medicine, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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30
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Or R, Abdul-Hai A, Ben-Yehuda A. Reviewing the potential utility of interleukin-7 as a promoter of thymopoiesis and immune recovery. Cytokines Cell Mol Ther 1998; 4:287-94. [PMID: 10068062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The identification of interleukin-7 (IL-7) as a critical cytokine in early B- and T-cell development, combined with the discovery that it acts on mature T cells, opens new avenues for investigating the thymopoietic machinery and manipulation of the immune system. Initially, IL-7 was thought to be a growth factor in the context of the B-cell lineage in that it stimulates proliferation of early B-cell progenitors. However, it appears that this cytokine has a much broader field of activity within the network of signal transduction. Indeed, evidence exists to support the pivotal involvement of IL-7 in the gene rearrangement of the T-cell receptor repertoire that ultimately leads to thymocyte commitment. The finding that IL-7 is an inducer of both cytotoxic T-cell- and lymphocyte-activated killer cells is one of the significant recent developments in the field of tumor immunology. Lately, it has been demonstrated that administration of IL-7 to mice after myeloablative treatment accelerates immune recovery via a unique pathway. This review of the literature dealing with IL-7 in the realm of immune function shows, inter alia, the value of the cytokine in immunosuppressed animals. The collection of findings noted in this paper may be considered the forerunner for clinical application of IL-7 in a variety of conditions of hematolymphopoietic failure.
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Affiliation(s)
- R Or
- Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel.
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31
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Ben-Yehuda A, Szabo P, LeMaoult J, Manavalan JS, Weksler ME. Increased VH 11 and VH Q52 gene use by splenic B cells in old mice associated with oligoclonal expansions of CD5 + B cells. Mech Ageing Dev 1998; 103:111-21. [PMID: 9701765 DOI: 10.1016/s0047-6374(98)00004-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A significant increase in the utilization of the VH gene families VH11 and Q52 was observed in LPS-stimulated splenic B lymphocytes from aged mice compared to young mice. VH gene usage was assayed by in situ DNA/RNA hybridization using VH family-specific and kappa chain probes. The observed age-dependent differences appear to reflect the preferential use of VH11 and Q52 VH gene use by the CD5 + B lymphocyte subset whose numbers in the spleen increase with age. The increased use of VH11 by splenic cells from old mice is associated with clonal expansions of splenic CD5 + B lymphocytes.
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Affiliation(s)
- A Ben-Yehuda
- Department of Medicine, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel
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32
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Ben-Yehuda A, Danenberg HD, Zakay-Rones Z, Gross DJ, Friedman G. The influence of sequential annual vaccination and of DHEA administration on the efficacy of the immune response to influenza vaccine in the elderly. Mech Ageing Dev 1998; 102:299-306. [PMID: 9720660 DOI: 10.1016/s0047-6374(98)00017-7] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study examined the effect of repeated vaccination and of dehydroepiandrosterone (DHEA) treatment on the immune response to influenza vaccine in elderly subjects. Seventy-one elderly volunteers, aged 61-89 years, enrolled in a prospective randomized, double-blind study to receive either DHEA (50 mg qd p.o. for 4 consecutive days starting 2 days before immunization) or placebo. Antibody response against the three strains of vaccine was measured before and 28 days after vaccination, and compared between previously vaccinated and non-vaccinated subjects. DHEA treatment did not enhance established immunity. A significant decrease in attainment of protective antibody titer (titer of 1:40 or greater) against A/Texas in subjects with non-protective baseline antibody titer was recorded following DHEA treatment compared to placebo (52 vs. 84%, P < 0.05). Post-immunization titers against influenza A strains were significantly higher in those subjects who were never immunized before. Additionally, post-vaccination protective titers against the A/Johannesburg strain were more prevalent in those subjects who were never vaccinated before. The results were not the same for anti-B/Harbin antibodies-repeated vaccination caused a non-significant increase in HI titer in previously vaccinated subjects.
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Affiliation(s)
- A Ben-Yehuda
- Department of Medicine, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel.
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33
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Abstract
We present a case of a young man with meningococcal meningitis and various asymptomatic temporary ECG abnormalities, including sinus bradycardia, atrioventricular dissociation and non specific ST-T changes.
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Affiliation(s)
- M Y Shapira
- Division of Medicine, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
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34
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Safadi R, Berkman N, Haviv YS, Ben-Yehuda A, Amir G, Naparstek Y. Primary non-Hodgkin's lymphoma of the lung presenting as bronchiolitis obliterans organizing pneumonia. Leuk Lymphoma 1997; 28:209-13. [PMID: 9498722 DOI: 10.3109/10428199709058349] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 44-year-old man presented with fever, dyspnea, and bilateral cavitary lung lesions. Following percutaneous transthoracic CT guided needle biopsy of the lung, a diagnosis of bronchiolitis obliterans organizing pneumonia (BOOP) was made and the patient was treated with corticosteroids. Despite a good initial response he developed new lung lesions within six months, associated with a lack of response to corticosteroids. Due to further deterioration and the development of Guillian-Barre' syndrome an open lung biopsy was performed and revealed T-cell rich, B-cell non Hodgkin's lymphoma with BOOP. We suggest that BOOP may be the presenting manifestation of primary lung lymphoma. We recommend that when BOOP has an atypical course or does not respond to corticosteroids open lung biopsy should be performed in order to exclude pulmonary lymphoma.
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Affiliation(s)
- R Safadi
- Department of Medicine, Hadassah University Hospital, Hebrew University Medical School, Jerusalem, Israel
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35
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Abstract
OBJECTIVE To determine clinical characteristics of elderly patients presenting with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), their outcome, and the extent of evaluation that is warranted. DESIGN A retrospective study. SETTING An 800-bed primary and tertiary care center in Jerusalem, Israel. PATIENTS Fifty elderly patients, hospitalized with serum sodium levels below 130 mmol/L consistent with a diagnosis of SIADH. MEASUREMENTS Data collection of the medical history, functional status, physical examination, laboratory evaluation, length of hospital stay, treatment, and outcome. RESULTS The neurological clinical presentation on admission ranged widely: 48% were fully alert, 42% were stuporotic, and 10% had seizures. Sensorial impairment was significantly associated only with sodium values of less than 110 mmol/L. The majority of patients underwent a comprehensive work-up including chest x-ray, computerized tomography (CT) scans, and thyroid and adrenal function tests. The cause of SIADH in most of the patients remained obscure (60% of cases were idiopathic). The 2 main causes identified were pneumonia in 9 cases (18%) and medication in 6 cases (12%). Most of the patients survived the event; only two patients died, both because of sepsis and not due to hyponatremia. The average hospital stay was 12.8 +/- 9 days. CONCLUSIONS Elderly patients with SIADH usually have an idiopathic form of this condition and a benign course. Extensive routine diagnostic procedures are not warranted. Simple measures like medical history taking with special emphasis on medications, physical examination, and chest x-rays can lead to a treatable diagnosis in most patients who do not have the idiopathic form of SIADH.
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Affiliation(s)
- B Hirshberg
- Division of Medicine, Hadassah University Hospital, Hebrew University-Hadassah Medical School, Jerusalem, Israel
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36
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Danenberg HD, Ben-Yehuda A, Zakay-Rones Z, Gross DJ, Friedman G. Dehydroepiandrosterone treatment is not beneficial to the immune response to influenza in elderly subjects. J Clin Endocrinol Metab 1997; 82:2911-4. [PMID: 9284718 DOI: 10.1210/jcem.82.9.4256] [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: 02/05/2023]
Abstract
BACKGROUND Dehydroepiandrosterone (DHEA) is a native steroid with an immunomodulating activity that was suggested to counter-regulate some phenomena of immunosenescence. Recently, it was shown to reverse the age-associated decline of immune response against influenza vaccine in aged mice. The present study was designed to evaluate the effect of DHEA on the immunization of elderly volunteers against influenza. METHODS Seventy-one elderly volunteers age 61-89 yr were enrolled in a prospective randomized, double-blind study to receive either DHEA (50 mg qd p.o. for four consecutive days starting two days before immunization) or placebo. Antibody response to the vaccine was measured before and 28 days after vaccination. RESULTS DHEA treatment significantly increased serum DHEA-sulfate (DHEA-S). No enhancement in established immunity was observed. A significant decrease in attainment of protective antibody titer (1:40 or higher) against the A/Texas strain in subjects with nonprotective baseline antibody titer was recorded following DHEA treatment compared with placebo (52% vs. 84%, P < 0.05). Baseline DHEA-S serum levels were inversely related to attainment of immunization in DHEA-treated subjects. Influenza-like morbidity during the winter was low in the study group with no difference between the DHEA and placebo groups. CONCLUSIONS Although highly effective in aged rodents, a short course of DHEA treatment did not improve the age-related declined response to immunization against influenza in human subjects. Higher baseline DHEA-S levels are not predictive of better immunization against influenza in the elderly.
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Affiliation(s)
- H D Danenberg
- Department of Medicine, Hadassah University Hospital, Ein-Karem, Israel
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37
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Haviv YS, Ben-Yehuda A, Polliack A, Safadi R. Lymphoma and systemic sclerosis--an uncommon association or possible coincidence of two disorders with a fatal outcome. Eur J Haematol Suppl 1997; 59:194-6. [PMID: 9310129 DOI: 10.1111/j.1600-0609.1997.tb00975.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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38
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Abstract
Legionella feeleii pneumonia has been described in seven cases, three of them being immunocompromised. We describe a case of L. feeleii pneumonia and pericarditis in a healthy man. Epidemiological survey was not conclusive. To the best of our knowledge, there have been no previous descriptions of pericarditis caused by this organism.
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Affiliation(s)
- S Sviri
- Division of Medicine, Hadassah Medical Center, Hebrew University Hospital, Jerusalem, Israel
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39
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Friedman G, Gabizon R, Ben-Yehuda A. Apolipoprotein Eϵ4 allele, a risk factor for late onset nonfamilial Alzheimer's disease among Israeli Jews. Arch Gerontol Geriatr 1997; 24:175-81. [PMID: 15374124 DOI: 10.1016/s0167-4943(96)00750-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/1996] [Revised: 07/08/1996] [Accepted: 07/12/1996] [Indexed: 11/24/2022]
Abstract
Apolipoprotein (apoE) genotypes were determined in 90 Israeli Jews with late onset sporadic Alzheimer's Disease (AD) and in 90 age- and sex-matched non-demented controls. The percentage of subjects carrying at least one apoEepsilon4 allele was 6% among the controls, and 42% among the patients (P<0.001), indicating a strong association between late onset sporadic AD and the apoEepsilon4 allele. However, no association was found between the apoEepsilon4 allele in demented and non-demented Jewish Israeli patients with Down's syndrome or Creutzfeldt-Jakob disease (CJD). The data presented in this paper confirmed several recent reports, suggesting that the apoEepsilon4 allele is a risk factor for the development of AD but not for the development of CJD or Down's syndrome among Israeli Jews.
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Affiliation(s)
- G Friedman
- Division of Medicine, Geriatric Unit, Hadassah University Hospital, POB 12000, Jerusalem 91120, Israel
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40
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Abdul-Hai A, Ben-Yehuda A, Weiss L, Friedman G, Zakay-Rones Z, Slavin S, Or R. Interleukin-7-enhanced cytotoxic T lymphocyte activity after viral infection in marrow transplanted mice. Bone Marrow Transplant 1997; 19:539-43. [PMID: 9085732 DOI: 10.1038/sj.bmt.1700706] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lethally irradiated BALB/c mice were reconstituted by syngeneic bone marrow transplantation (BMT), and injected with recombinant interleukin 7 (rIL-7), recombinant interleukin 2 (rIL-2), or saline 10 days post-transplantation. Intranasal infection with A/PR8/34 influenza virus 2 weeks after BMT was associated with the highest survival rate in the rIL-7 treated group. The protective mechanism elicited by rIL-7, as manifested by very low virus titers in the lung, involves T and B cell functions. High hemagglutinin inhibition antibody levels were observed on days 7 and 12 post-challenge in the rIL-7 mice. Moreover, the anti-influenza cytotoxic T lymphocyte activity was induced primarily by rIL-7, leaving the effect of rIL-2 on the same level as that of the control. Thus, rIL-7 promotes both T cell-mediated function and B cell production during the immunodeficient state after BMT. This cytokine may prove a potential immunotherapeutic modality in BMT recipients.
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Affiliation(s)
- A Abdul-Hai
- Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel
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41
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Friedman G, Ben-Yehuda A, Dabach Y, Ben-Naim M, Hollander G, Retter O, Friedlander Y, Stein O, Stein Y. Scavenger receptor activity and expression of apolipoprotein E mRNA in monocyte-derived macrophages of young and old healthy men. Atherosclerosis 1997; 128:67-73. [PMID: 9051199 DOI: 10.1016/s0021-9150(96)05987-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to compare some aspects of lipid metabolism in monocyte-derived macrophages isolated from young males, aged 18-24 years, and old males, aged 74-90 years, who were found healthy in accordance with the Senieur protocol. The parameters tested were metabolism of 125I-acetylated low-density lipoproteins (LDL) and oxidized LDL, incorporation of [3H]cholesterol into cholesteryl ester and expression of apolipoprotein E (apo E) mRNA. Cell association and degradation of 125I-acetylated LDL by macrophages of old and young subjects, respectively, was 15,978 +/- 2492 and 9300 +/- 1416 ng/mg cell protein per 24 h. Incorporation of [3H]cholesterol into cellular [3H]cholesteryl ester in the presence of acetylated LDL in cells isolated from old subjects was twice that in cells from young subjects. The macrophages from both age groups metabolized less 125I-oxidized LDL than 125I-acetylated LDL. Cell association and degradation of 125I-oxidized LDL in cells from old and young subjects, respectively, was 6779 +/- 1398 and 3219 +/- 643 ng/mg cell protein per 24 h. Expression of apo E mRNA was determined by reverse transcriptase polymerase chain reaction. In the basal state, it was 5.8 +/- 0.4 and 2.4 +/- 0.2 photo-stimulated luminescence (PSL) units in cells from the old and young subjects, respectively, and increased after exposure to acetylated LDL. In conclusion, these findings suggest that a combination of higher scavenger receptor activity and increased expression of apo E mRNA in macrophages could contribute to (a) enhanced metabolism of modified LDL and (b) more efficient removal of cholesterol from arteries, thus leading to healthy old age.
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Affiliation(s)
- G Friedman
- Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
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42
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Yossepowitch O, Sviri S, Ben-Yehuda A, Eid A, Safadi R. Salmonella infection and pneumonia in a patient with kyphoscoliosis. Eur J Med Res 1996; 1:589-90. [PMID: 9438168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pulmonary involvement is an uncommon extraintestinal manifestation of salmonellosis. We describe a 30 year old man with mental retardation, presenting with salmonella gastroenteritis and bacteremia. An early pneumonia evolving in the clinical setting of severe kyphoscoliosis, suggests that hematogenous spread to the lungs may occur as a result of abnormalities of the chest wall.
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Affiliation(s)
- O Yossepowitch
- Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
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43
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Abdul-Hai A, Or R, Slavin S, Friedman G, Weiss L, Matsa D, Ben-Yehuda A. Stimulation of immune reconstitution by interleukin-7 after syngeneic bone marrow transplantation in mice. Exp Hematol 1996; 24:1416-22. [PMID: 8913288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Successful outcome of autologous bone marrow transplantation (BMT) is severely handicapped by susceptibility to infection and by a high rate of relapse. While quantitative aspects of the immune system generally return to normal within the first 3-4 months after BMT, the recovery of qualitative immune functions is prolonged. Since interleukin-7 (IL-7) has growth-promoting and differentiating effects on pre-B cells and immature thymocytes, its role in the recovery of immune functions was investigated in BALB/c mice after syngeneic BMT (sBMT). After sBMT, mice treated with human recombinant IL-7 (rIL-7) showed an 11.9-fold increase in thymic cellularity associated with an enhanced response to a mitogenic stimulus compared with the controls. rIL-7 significantly increased RAG-1 expression and promoted V beta 8(D)J gene rearrangement of the T cell receptor in the thymus. Further, the cytokine boosted survival after challenge with influenza virus following sBMT. The finding that rIL-7 induces differentiation and proliferation of immature thymocytes and counteracts post-BMT immune deficiency makes it a promising medium for clinical application in BMT patients.
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Affiliation(s)
- A Abdul-Hai
- Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel
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44
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Abstract
Immunization with pathogenic lymphoid cells has been shown to induce resistance to disease in experimental animal models of cell mediated autoimmunity. In the present work we tested the effectiveness of this approach in a spontaneous murine autoimmune disease, the MRL/lpr/lpr (MRL/1) murine lupus model. We now report that the anti-DNA antibodies and glomerulonephritis of MRL/1 mice could be prevented by the adoptive transfer of spleen cells from MRL/+ mice that had been vaccinated with MRL/1 lymph node T lymphocytes, but not by direct vaccination of MRL/1 mice with their cells. These results indicate that the lupus of MRL/1 mice is susceptible to regulation by adoptive vaccination and that these autoimmune mice lack the ability to raise a suppressive response against their own pathogenic cells.
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Affiliation(s)
- A Ben-Yehuda
- Department of Medicine, Hadassah University Hospital, Jerusalem, Israel
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45
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Danenberg HD, Ben-Yehuda A. [Physiologic importance of dehydroepiandrosterone]. Harefuah 1996; 130:353-6. [PMID: 8707186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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46
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Safadi R, Yossepowitch O, Ben-Yehuda A. [Lactic acidosis associated with biguanides]. Harefuah 1996; 130:280-283. [PMID: 8675126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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47
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Abstract
A 69-year-old diabetic woman with diffuse atherosclerosis presented with acute renal failure due to contrast nephropathy and severe metformin-induced lactic acidosis. There was a discrepancy between the patient's elevated serum creatinine level, indicative of severe renal insufficiency, and her very low blood urea nitrogen content. It is postulated that the patient's extremely severe acidosis interfered with her hepatic urea generation, contributing to this unusual biochemical abnormality.
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Affiliation(s)
- R Safadi
- Division of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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48
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Abstract
The effect of DHEA administration on the age-associated decline in immunity against influenza vaccine was studied. Increased humoral response was observed in 16- and 24-month-old mice immunized by live A/PR/8/34 (H1N1) influenza virus following DHEA treatment (a single injection adjacent to immunization). Furthermore, DHEA-treated mice demonstrated increased resistance to postvaccination intranasal challenge with live influenza virus. Thus, DHEA treatment overcomes the age-related defect in the immunity of old mice against influenza.
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Affiliation(s)
- H D Danenberg
- Division of Medicine, Hadassah University Hospital, Jerusalem, Israel
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49
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Orbach H, Ben-Yehuda A, Ben-Yehuda D, Manor D, Rubinow A, Naparstek Y. Successful treatment of pure red cell aplasia in systemic lupus erythematosus with erythropoietin. J Rheumatol 1995; 22:2166-9. [PMID: 8596164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We describe a 32-year-old woman who developed severe anemia due to pure red cell aplasia in the course of systemic lupus erythematosus (SLE). After failure of therapy with high doses of glucocorticoids and immunoglobulins, and despite high levels of endogenous erythropoietin, she was treated with human recombinant erythropoietin with dramatic and sustained improvement. Based on this case and on the literature review of erythropoietin therapy in pure red cell aplasia, we suggest that erythropoietin should be used in SLE associated pure red cell aplasia before cytotoxic therapy.
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Affiliation(s)
- H Orbach
- Department of Medicine, Hadassah University Hospital, Jerusalem, Israel
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