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Lerman TT, Greenberg N, Fishman B, Goldman A, Talmor-Barkan Y, Bauer M, Goldberg I, Goldberg E, Kornowski R, Krause I, Levi A, Cohen E. The real-world safety of sacubitril / valsartan among older adults (≥75): A pharmacovigilance study from the FDA data. Int J Cardiol 2024; 397:131613. [PMID: 38030039 DOI: 10.1016/j.ijcard.2023.131613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/12/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Heart failure is a major cause of morbidity and mortality among older adults. Sacubitril-Valsartan (Sac/Val) has been shown to improve patients' outcomes; however, its safety profile among older adults has not been adequately examined. We therefore aimed to examine its safety profile among this population. METHODS We conducted a retrospective pharmacovigilance study utilizing the FDA's database of safety reports (FAERS). We employed disproportionality analysis comparing Sac/Val to angiotensin receptor blockers (ARBs). We aim to evaluate the reporting of pre-defined adverse events associated with Sac/Val (hypotension, acute kidney injury (AKI), hyperkalemia and angioedema) in two age groups: adults (< 75 years) and older adults (≥ 75). For each subgroup, we calculated reporting odds ratio (ROR) and compared them by calculating P for interaction. RESULTS The FAERS database encompassed 18,432 unique reports of Sac/Val. Of them, 12,630 (68.5%) subjects were adults (< 75 years), and 5802 (31.5%) were older adults (≥ 75 years), with a median age (IQR) of 68 (59-77). When compared to ARBs, Sac/Val was associated with higher reporting of hypotension, lower reporting of acute kidney injury (AKI) and hyperkalemia, and similar reporting of angioedema. Notably, we did not observe a significant interaction between the age subgroups and the risk estimates (AKI: Pinteraction = 0.72, hyperkalemia: Pinteraction = 0.94, hypotension: Pinteraction = 0.31, and angioedema: Pinteraction = 0.61). CONCLUSIONS In this postmarking study, none of the prespecified adverse events was reported more frequently in older adults. These findings provide reassurance for safety use of Sac/Val in older adults.
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Affiliation(s)
- Tsahi T Lerman
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noam Greenberg
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Fishman
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Adam Goldman
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel; Department of Internal Medicine F, Sheba Medical Center, Ramat-Gan, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Bauer
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Idan Goldberg
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - Elad Goldberg
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Krause
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eytan Cohen
- Department of Internal Medicine F-Recanati, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel; The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tsur AM, Akavian I, Landau R, Derazne E, Tzur D, Vivante A, Grossman E, Rotem RS, Fishman B, Pinhas-Hamiel O, Afek A, Coresh J, Chodick G, Twig G. Adolescent Body Mass Index and Early Chronic Kidney Disease in Young Adulthood. JAMA Pediatr 2024; 178:142-150. [PMID: 38079159 PMCID: PMC10714283 DOI: 10.1001/jamapediatrics.2023.5420] [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] [Received: 07/23/2023] [Accepted: 10/03/2023] [Indexed: 02/06/2024]
Abstract
Importance Despite increasing obesity rates in adolescents, data regarding early kidney sequelae are lacking. Objective To assess the association between adolescent body mass index (BMI) and early chronic kidney disease (CKD) in young adulthood (<45 years of age). Design, Setting, and Participants This cohort study linked screening data of mandatory medical assessments of Israeli adolescents to data from a CKD registry of a national health care system. Adolescents who were aged 16 to 20 years; born since January 1, 1975; medically evaluated for mandatory military service through December 31, 2019; and insured by Maccabi Healthcare Services were assessed. Individuals with kidney pathology, albuminuria, hypertension, dysglycemia, or missing blood pressure or BMI data were excluded. Body mass index was calculated as weight in kilograms divided by height in meters squared and categorized by age- and sex-matched percentiles according to the US Centers for Disease Control and Prevention. Follow-up started at the time of medical evaluation or January 1, 2000 (whichever came last), and ended at early CKD onset, death, the last day insured, or August 23, 2020 (whichever came first). Data analysis was performed from December 19, 2021, to September 11, 2023. Main Outcomes and Measures Early CKD, defined as stage 1 to 2 CKD by moderately or severely increased albuminuria, with an estimated glomerular filtration rate of 60 mL/min/1.73 m2 or higher. Results Of 629 168 adolescents evaluated, 593 660 (mean [SD] age at study entry, 17.2 [0.5] years; 323 293 [54.5%] male, 270 367 [45.5%] female) were included in the analysis. During a mean (SD) follow-up of 13.4 (5.5) years for males and 13.4 (5.6) years for females, 1963 adolescents (0.3%) developed early CKD. Among males, the adjusted hazard ratios were 1.8 (95% CI, 1.5-2.2) for adolescents with high-normal BMI, 4.0 (95% CI, 3.3-5.0) for those with overweight, 6.7 (95% CI, 5.4-8.4) for those with mild obesity, and 9.4 (95% CI, 6.6-13.5) for those with severe obesity. Among females, the hazard ratios were 1.4 (95% CI, 1.2-1.6) for those with high-normal BMI, 2.3 (95% CI, 1.9-2.8) for those with overweight, 2.7 (95% CI, 2.1-3.6) for those with mild obesity, and 4.3 (95% CI, 2.8-6.5) for those with severe obesity. The results were similar when the cohort was limited to individuals who were seemingly healthy as adolescents, individuals surveyed up to 30 years of age, or those free of diabetes and hypertension at the end of the follow-up. Conclusions and Relevance In this cohort study, high BMI in late adolescence was associated with early CKD in young adulthood. The risk was also present in seemingly healthy individuals with high-normal BMI and before 30 years of age, and a greater risk was seen among those with severe obesity. These findings underscore the importance of mitigating adolescent obesity rates and managing risk factors for kidney disease in adolescents with high BMI.
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Affiliation(s)
- Avishai M. Tsur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbal Akavian
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Regev Landau
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Asaf Vivante
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Ehud Grossman
- Department of Medicine, Sheba Medical Center, Tel HaShomer, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran S. Rotem
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Boris Fishman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Cardiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Orit Pinhas-Hamiel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children’s Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Afek
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gabriel Chodick
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Gilad Twig
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel
- Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
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3
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Fishman B, Bardugo A, Zloof Y, Bendor CD, Libruder C, Zucker I, Lutski M, Ram A, Hershkovitz Y, Orr O, Omer M, Furer A, Goldman A, Yaniv G, Tanne D, Derazne E, Tzur D, Afek A, Grossman E, Twig G. Adolescent Hypertension Is Associated With Stroke in Young Adulthood: A Nationwide Cohort of 1.9 Million Adolescents. Stroke 2023; 54:1531-1537. [PMID: 37139816 DOI: 10.1161/strokeaha.122.042100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Adult hypertension is a well-established risk factor for stroke in young adults (aged <55 years), and the effects are even more deleterious than at an older age. However, data are limited regarding the association between adolescent hypertension and the risk of stroke in young adulthood. METHODS A nationwide, retrospective cohort study of adolescents (aged 16-19 years) who were medically evaluated before compulsory military service in Israel during 1985 to 2013. For each candidate for service, hypertension was designated after constructed screening, and the diagnosis was confirmed through a comprehensive workup process. The primary outcome was ischemic and hemorrhagic stroke incidence as registered at the national stroke registry. Cox proportional-hazards models were used. We conducted sensitivity analyses by excluding people with a diabetes diagnosis at adolescence or a new diabetes diagnosis during the follow-up period, analysis of adolescents with overweight, and adolescents with baseline unimpaired health status. RESULTS The final sample included 1 900 384 adolescents (58% men; median age, 17.3 years). In total, 1474 (0.08%) incidences of stroke (1236 [84%] ischemic) were recorded, at a median age of 43 (interquartile range, 38-47) years. Of these, 18 (0.35%) occurred among the 5221 people with a history of adolescent hypertension. The latter population had a hazard ratio of 2.4 (95% CI, 1.5-3.9) for incident stroke after adjustment for body mass index and baseline sociodemographic factors. Further adjustment for diabetes status yielded a hazard ratio of 2.1 (1.3-3.5). We found similar results when the outcome was ischemic stroke with a hazard ratio of 2.0 (1.2-3.5). Sensitivity analyses for overall stroke, and ischemic stroke only, yielded consistent findings. CONCLUSIONS Adolescent hypertension is associated with an increased risk of stroke, particularly ischemic stroke, in young adulthood.
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Affiliation(s)
- Boris Fishman
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Division of Cardiology, Sheba Medical Center, Ramat Gan, Israel. (B.F., A.F.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. (B.F., A.G., G.T.)
| | - Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Yair Zloof
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Carmit Libruder
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.)
| | - Inbar Zucker
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.)
| | - Miri Lutski
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.)
| | - Amit Ram
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.)
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel (C.L., I.Z., M.L., A.R., Y.H.)
| | - Omri Orr
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
- Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel (O.O.)
| | - Ma'ayan Omer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Ariel Furer
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Division of Cardiology, Sheba Medical Center, Ramat Gan, Israel. (B.F., A.F.)
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Adam Goldman
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Israel. (A.G., G.T.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. (B.F., A.G., G.T.)
- Department of Medicine F, Sheba Medical Center, Ramat Gan, Israel. (A.G.)
| | - Gal Yaniv
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel. (G.Y.)
| | - David Tanne
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Haifa, Israel (D. Tanne)
| | - Estela Derazne
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel (A.B., Y.Z., C.D.B., O.O., M.O., A.F., D. Tzur)
| | - Arnon Afek
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Central Management, Sheba Medical Center, Ramat Gan, Israel. (A.A.)
| | - Ehud Grossman
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Hypertension Unit and the Internal Division, Sheba Medical Center, Ramat Gan, Israel. (E.G.)
| | - Gilad Twig
- Faculty of Medicine, Tel Aviv University, Israel. (B.F., Y.Z., I.Z., M.L., A.F., A.G., G.Y., E.D., A.A., E.G., G.T.)
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Israel. (A.G., G.T.)
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel. (B.F., A.G., G.T.)
- Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel. (G.T.)
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Segev A, Fishman B, Wasserstrum Y, Beinart R, Arad M, Sabbag A. Failed Shocks in Patients with Hypertrophic Cardiomyopathy. Heart Rhythm 2023; 20:940-941. [PMID: 36934982 DOI: 10.1016/j.hrthm.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/21/2023]
Affiliation(s)
- Amitai Segev
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Fishman
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishay Wasserstrum
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Beinart
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel
| | - Michael Arad
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Sabbag
- Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Davidai Arrhythmia Center, Sheba Medical Center, Ramat Gan, Israel.
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5
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Goldman A, Fishman B, Twig G, Raschi E, Cukierman-Yaffe T, moshkovits Y, Pomerantz A, Ben-Zvi I, Dankner R, Maor E. The real-world safety profile of sodium-glucose co-transporter-2 inhibitors among older adults (≥ 75 years): a retrospective, pharmacovigilance study. Cardiovasc Diabetol 2023; 22:16. [PMID: 36694178 PMCID: PMC9875397 DOI: 10.1186/s12933-023-01743-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND As indications for sodium-glucose co-transporter-2 inhibitors (SGLT2i) are expanding, a growing number of older adults have become candidates for treatment. We studied the safety profile of SGLT2i among older adults. METHODS A retrospective, pharmacovigilance study of the FDA's global database of safety reports. To assess reporting of pre-specified adverse events following SGLT2i among adults (< 75 years) and older adults (≥ 75), we performed a disproportionality analysis using the sex-adjusted reporting odds ratio (adj.ROR). RESULTS We identified safety reports of 129,795 patients who received non-insulin anti-diabetic drugs (NIAD), including 24,253 who were treated with SGLT2i (median age 60 [IQR: 51-68] years, 2,339 [9.6%] aged ≥ 75 years). Compared to other NIAD, SGLT2i were significantly associated with amputations (adj.ROR = 355.1 [95%CI: 258.8 - 487.3] vs adj.ROR = 250.2 [79.3 - 789.5]), Fournier gangrene (adj.ROR = 45.0 [34.5 - 58.8] vs adj.ROR = 88.0 [27.0 - 286.6]), diabetic ketoacidosis (adj.ROR = 32.3 [30.0 - 34.8] vs adj.ROR = 23.3 [19.2 - 28.3]), genitourinary infections (adj.ROR = 10.3 [9.4 - 11.2] vs adj.ROR = 8.6 [7.2 - 10.3]), nocturia (adj.ROR = 5.5 [3.7 - 8.2] vs adj.ROR = 6.7 [2.8 - 15.7]), dehydration (adj.ROR = 2.5 [2.3 - 2.8] vs adj.ROR = 2.6 [2.1 - 3.3]), and fractures (adj.ROR = 1.7 [1.4 - 2.1] vs adj.ROR = 1.5 [1.02 - 2.1]) in both adults and older adults, respectively. None of these safety signals was significantly greater in older adults (Pinteraction threshold of 0.05). Acute kidney injury was associated with SGLT2i in adults (adj.ROR = 1.97 [1.85 - 2.09]) but not in older adults (adj.ROR = 0.71 [0.59 - 0.84]). Falls, hypotension, and syncope were not associated with SGLT2i among either adults or older adults. CONCLUSION In this global post-marketing study, none of the adverse events was reported more frequently among older adults. Our findings provide reassurance regarding SGLT2i treatment in older adults, although careful monitoring is warranted.
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Affiliation(s)
- Adam Goldman
- grid.12136.370000 0004 1937 0546Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.413795.d0000 0001 2107 2845Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel ,grid.413795.d0000 0001 2107 2845Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel ,The Talpiot Sheba Medical Leadership Program, Ramat-Gan, Israel
| | - Boris Fishman
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel. .,The Talpiot Sheba Medical Leadership Program, Ramat-Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. .,The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel.
| | - Gilad Twig
- grid.12136.370000 0004 1937 0546Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.413795.d0000 0001 2107 2845Division of Endocrinology & Metabolism, Sheba Medical Center, Ramat-Gan, Israel ,grid.413795.d0000 0001 2107 2845The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Emanuel Raschi
- grid.6292.f0000 0004 1757 1758Pharmacology Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Tali Cukierman-Yaffe
- grid.12136.370000 0004 1937 0546Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.413795.d0000 0001 2107 2845Division of Endocrinology & Metabolism, Sheba Medical Center, Ramat-Gan, Israel
| | - Yonatan moshkovits
- grid.413795.d0000 0001 2107 2845Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Alon Pomerantz
- grid.413795.d0000 0001 2107 2845Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Ilan Ben-Zvi
- grid.413795.d0000 0001 2107 2845Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rachel Dankner
- grid.12136.370000 0004 1937 0546Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.413795.d0000 0001 2107 2845The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Elad Maor
- Leviev Heart Center, Sheba Medical Center, Ramat-Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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6
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Sharon A, Fishman B, Massalha E, Itelman E, Mouallem M, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Management and outcome of patients with non-ST elevation myocardial infarction and intercurrent non-coronary precipitating events. Eur Heart J Acute Cardiovasc Care 2022; 11:922-930. [PMID: 36229932 DOI: 10.1093/ehjacc/zuac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
AIMS To evaluate the effect of an intercurrent non-coronary illness on the management and outcome of patients with non-ST-segment elevation myocardial infarction (NSTEMI). METHODS AND RESULTS Consecutive hospitalized patients with a primary diagnosis of NSTEMI between August 2008 and December 2019 at Sheba Medical Center. All patients' records were reviewed for the presence of a non-coronary precipitating event (NCPE): a major intercurrent acute non-coronary illness or condition, either cardiac or non-cardiac. The primary outcome was all-cause mortality. Cox regression with interaction analysis was applied. Final study population comprised 6491 patients, of whom 2621 (40%) had NCPEs. Patients with NCPEs were older (77 vs. 69 years) and more likely to have comorbidities. The most prevalent event was infection (35%, n = 922). During a median follow-up of 30 months, 2529 patients died. Patients with NCPEs were 43% more likely to die during follow-up in a multivariable model (95% CI: 1.31-1.55). Invasive strategy was associated with a 55% lower mortality among patients without NCPE and only 44% among patients with NCPE (P for interaction < 0.001). Dual antiplatelet therapy (DAPT) was associated with a 20% lower mortality in patients without NCEP and a non-significant mortality difference among patients with NCPE (P for interaction = 0.014). Sub-analysis by the specific NCPE showed the highest mortality risk among patients with infectious precipitant. The lower mortality associated with invasive strategy was not observed in this subgroup. CONCLUSION Among NSTEMI patients, the presence of an NCPE is associated with poor survival and modifies the effect of management strategies.
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Affiliation(s)
- Amir Sharon
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boris Fishman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eias Massalha
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel
| | - Meir Mouallem
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel M Barbash
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- The Olga & Lev Leviev Heart Center, Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fishman B, Goitein O, Berkovitch A, Rahav G, Matetzky S. First report of myocarditis in two patients with COVID-19 Omicron variant: case report. Eur Heart J Case Rep 2022; 6:ytac407. [PMID: 36285226 PMCID: PMC9581207 DOI: 10.1093/ehjcr/ytac407] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/14/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 infection is responsible for the coronavirus disease 2019 (COVID-19) pandemics. Omicron (B.1.1.529) variant is the cause for the surge of the COVID-19 pandemics of the end of 2021 and the beginning of 2022, although its subvariants are responsible for the following daily increase of COVID-19 cases in July 2022. Early reports of Omicron variant confirmed patients indicated less severe disease course compared with the disease caused by previously encountered variants with absence of data regarding cardiac involvement by Omicron. Case summary A 42-year-old male who tested positive for Omicron was admitted on January 2022 with chest pain and ST-segment elevation in the inferior leads. Coronary angiography revealed non-significant coronary artery disease. Cardiac magnetic resonance imaging demonstrated features consistent with myocarditis with involvement of 22% of the left ventricular mass by late gadolinium enhancement involving both the lateral and the septal walls. The second patient is a 60-year-old male presented following syncope and palpitations after he was confirmed with Omicron infection. Upon emergency department arrival he had ventricular tachycardia of 250 beats/minute and underwent urgent cardioversion. During his hospitalization, there was no recurrence of malignant arrhythmia, coronary angiography revealed non-obstructive disease. Cardiac magnetic resonance imaging demonstrated imaging features suggesting acute myocarditis with involvement of 19% of the left ventricular mass. Discussion This is the first report of myocarditis cases as a possible complication associated with Omicron variant. Despite preliminary reports of less severe disease clinicians should be vigilant for potential deleterious cardiac complications of Omicron.
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Affiliation(s)
- Boris Fishman
- Corresponding author: Tel: +972 0546540227, Fax: 97235302644, Derech Sheba 3, Ramat Gan, Israel, 5265601,
| | | | - Anat Berkovitch
- Sheba Medical Center, Tel Hashomer, affiliated to Sackler Medical School, Tel Aviv University, Israel
| | - Galia Rahav
- Sheba Medical Center, Tel Hashomer, affiliated to Sackler Medical School, Tel Aviv University, Israel
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8
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Goldman A, Fishman B, Raschi E, Cukierman-Yaffe T, Dankner R, Ben-Zvi I, Maor E. The real-world safety profile of SGLT2 inhibitors among adults 75 years or older: a retrospective, pharmacovigilance study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.973] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
As indications for sodium-glucose co-transporter-2 (SGLT2) inhibitors treatment are expanding, more older adults become candidates for treatment. However, data regarding the treatment's safety profile in the older population are limited.
Methods
A retrospective, pharmacovigilance study of the FDA's global database of safety reports (7/1/2014–6/30/2021). To assess reporting of pre-specified adverse events following SGLT2-inhibitors treatment among adults (18≥age<75) and older adults (age≥75), we performed disproportionality analysis using the reporting odds ratio (ROR).
Results
Of 10,526,408 patients in the full database, 279,619 eligible patients with non-insulin-dependent diabetes mellitus were identified (mean age 63.4 [SD 13.0] years, 54,791 [19.6%] aged ≥75 years), among whom 29,431 receiving SGLT-2 inhibitors. Compared to other non-insulin anti-diabetics, SGLT2-inhibitors were significantly associated with amputations (ROR=127.87 [95% CI: 111.31–146.90] vs ROR=74.91 [49.99–112.25]), Fournier gangrene (ROR=53.27 [44.38–63.92] vs ROR=33.33 [20.33–54.64]), diabetes ketoacidosis (ROR=39.25 [37.20–41.42] vs ROR=58.46 [49.41–69.1]), genitourinary infections (ROR=4.36 [4.12–4.61] vs ROR=5.08 [4.45–5.79]), nocturia (ROR=2.81 [2.13–3.73] vs ROR=3.51 [1.84–6.68]), and dehydration (ROR=2.22 [2.05–2.40] vs ROR=2.33 [1.93–2.81]) in both adults and older adults, respectively. The relative reporting of these safety signals was consistent between age groups (all P interaction >0.05). Acute kidney injury was associated with SGLT2-inhibitors treatment in adults (ROR=1.47 [1.40–1.54]) but not older adults (ROR=0.84 [0.72–0.98]). No new safety signals were observed in older adults. Falls, fractures, hypotension, and syncope were not associated with SGLT2-inhibitors among either adults or older adults.
Conclusion
In this global post-marketing study, treatment with SGLT-2 inhibitors in older adults was associated with increased reporting of amputations, Fournier gangrene, DKA, genitourinary infections, and dehydration. Nevertheless, the relative reporting was consistent between adults and older adults, and no new safety signals were found in the older population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Goldman
- The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - B Fishman
- The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - E Raschi
- Alma Mater Studiorum, University of Bologna, Pharmacology Unit, Department of Medical and Surgical Sciences , Bologna , Italy
| | | | - R Dankner
- Gertner Institute for Epidemiology and Health Policy Research , Ramat Gan , Israel
| | - I Ben-Zvi
- The Chaim Sheba Medical Center , Tel Hashomer , Israel
| | - E Maor
- The Chaim Sheba Medical Center , Tel Hashomer , Israel
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9
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Sharon A, Massalha E, Fishman B, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Early Invasive Strategy and Outcome of Non–ST-Segment Elevation Myocardial Infarction Patients With Chronic Kidney Disease. JACC Cardiovasc Interv 2022; 15:1977-1988. [DOI: 10.1016/j.jcin.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
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10
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Fishman B, Sharon A, Itelman E, Tsur AM, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Invasive Management in Older Adults (≥80 Years) With Non-ST Elevation Myocardial Infarction. Mayo Clin Proc 2022; 97:1247-1256. [PMID: 35787854 DOI: 10.1016/j.mayocp.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/08/2022] [Accepted: 03/15/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the association of invasive management (coronary angiogram) with all-cause mortality among older adult (≥80 years of age) patients presenting with non-ST elevation myocardial infarction (NSTEMI) by frailty status. PATIENTS AND METHODS This study used a retrospective cohort of consecutive older adult patients who were hospitalized with NSTEMI as their primary clinical diagnosis between August 1, 2008, and December 31, 2019. Cox regression models were applied with stratification by frailty status (low, medium, and high). Extensive sensitivity analyses were conducted including propensity score matching and inverse probability treatment weighting models. RESULTS The study population included 2317 patients with median age of 86 years (IQR, 83-90 years) of whom 1243 (53.6%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs 44%, P<.001). During the follow-up (median, 19 months, IQR, 4-41 months), 1599 (69%) patients died. In a multivariable Cox model, invasive approach was associated with adjusted hazard ratio (HR) of 0.61 (95% CI, 0.53 to 0.71) for the risk of death. The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 (95% CI, 0.58 to 0.93), 0.65 (95% CI, 0.50 to 0.85), and 0.52 (95% CI, 0.34 to 0.78), respectively (P for interaction = 0.48). Results were consistent with propensity score matching and inverse probability treatment weighting analyses (HR, 0.6; 95% CI, 0.50 to 0.71 and HR, 0.67; 95% CI, 0.55 to 0.82, respectively). Sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results. CONCLUSION Invasive approach is associated with improved survival among older adults with NSTEMI irrespective of frailty status.
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Affiliation(s)
- Boris Fishman
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Department of Medicine D and the Hypertension Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Sharon
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Itelman
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine T, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avishai M Tsur
- Department of Medicine B, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel; Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel
| | - Paul Fefer
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Moshe Barbash
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Matetzky
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Department of Medicine D and the Hypertension Unit, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Olga and Lev Leviev Heart Center, Sheba Medical Center, Tel-Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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11
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Segev A, Fishman B, Wasserstrum Y, Beinart R, Arad M, Sabbag A. Failed shocks in hypertrophic cardiomyopathy patients: prevalence, predictors and outcome. Europace 2022. [DOI: 10.1093/europace/euac053.394] [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
Funding Acknowledgements
Type of funding sources: None.
Introduction
An implantable cardioverter-defibrillator (ICD) is used in selected high-risk hypertrophic cardiomyopathy (HCM) patients in order to prevent sudden arrhythmic death. The unique features of this population raise concerns regarding the reliability of successful defibrillation.
Purpose
To describe the rate and discover potential predictors of failed shocks in HCM patients.
Methods
We retrospectively evaluated all HCM patients with an ICD from a single tertiary medical center. Clinical, electrocardiographic and echocardiographic data were collected and compared among patients with and without failed shocks.
Results
A total of 99 patients (77% male, 45±17 years old) were analyzed. Over a median follow up of 6.3 years (IQR 2.6-10.7), 20 patients developed sustained ventricular arrhythmia (VTA). Of those, 18 patients received appropriate shocks from their ICD. VTA was associated with younger age at diagnosis, history of syncope and thicker maximal LV width. Six patients experienced at least one failed shock. The likelihood of failed shocks was similar when single or dual coil electrodes were used (dual coils in 67% of patients with failed shocks and 50% in those without), and the only predictor was increased wall thickness [OR 1.2 (1.07-1.38) per 1 mm]. All-cause mortality was low and similar in patients with an without failed shocks (0% vs 8%, P=0.5)
Conclusions
Failed shocks are a rare entity in HCM patients. Increased maximal LV width was the only predictor of those events. Our findings support avoiding defibrillation threshold testing routinely, but may indicate its need in patients with extreme LV wall thickening (≥23 mm).
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Affiliation(s)
- A Segev
- Sheba Medical Center, Ramat Gan, Israel
| | - B Fishman
- Sheba Medical Center, Ramat Gan, Israel
| | | | - R Beinart
- Sheba Medical Center, Ramat Gan, Israel
| | - M Arad
- Sheba Medical Center, Ramat Gan, Israel
| | - A Sabbag
- Sheba Medical Center, Ramat Gan, Israel
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12
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Tsur AM, Akavian I, Derazne E, Tzur D, Vivante A, Grossman E, Rotem RS, Fishman B, Afek A, Coresh J, Chodick G, Twig G. Adolescent Blood Pressure and the Risk for Early Kidney Damage in Young Adulthood. Hypertension 2022; 79:974-983. [PMID: 35253445 DOI: 10.1161/hypertensionaha.121.18748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent guidelines classified blood pressure above 130/80 mm Hg as hypertension. However, outcome data were lacking. OBJECTIVE To determine the association between blood pressure in adolescence and the risk for early kidney damage in young adulthood. METHODS In this nationwide cohort study, we included 629 168 adolescents aged 16 to 20 who underwent medical examinations before mandatory military service in Israel. We excluded 30 466 adolescents with kidney pathology, hypertension, or missing blood pressure or anthropometric data at study entry. Blood pressure measurements at study entry were categorized according to the Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents: group A (<120/<80 mm Hg; Reference group), group B (120/<80-129/<80 mm Hg), group C (130/80-139/89 mm Hg), and group D (≥140/90 mm Hg). Early kidney damage in young adulthood was defined as albuminuria of ≥30 mg/g with an estimated glomerular filtration rate of 60 mL/(min·1.73 m2) or over. RESULTS Of 598 702 adolescents (54% men), 2004 (0.3%) developed early kidney damage during a mean follow-up of 15.1 (7.2) years. The adjusted hazard ratios for early kidney damage in blood pressure group C were 1.17 (1.03-1.32) and 1.51 (1.22-1.86) among adolescents with lean (body mass index <85th percentile) and high body mass index (body mass index ≥85th percentile), respectively. Corresponding hazard ratios for kidney disease in group D were 1.49 (1.15-1.93) and 1.79 (1.35-2.38) among adolescents with lean and high body mass index, respectively. CONCLUSIONS Blood pressure of ≥130/80 mm Hg was associated with early kidney damage in young adulthood, especially in adolescents with overweight and obesity.
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Affiliation(s)
- Avishai M Tsur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel (A.M.T., I.A., E.D., D.T., G.T.).,Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel (A.M.T., I.A., G.T.).,Department of Medicine, Sheba Medical Center, Tel-Hashomer, Israel. (A.M.T., E.G., B.F.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.)
| | - Inbal Akavian
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel (A.M.T., I.A., E.D., D.T., G.T.).,Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel (A.M.T., I.A., G.T.)
| | - Estela Derazne
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel (A.M.T., I.A., E.D., D.T., G.T.)
| | - Dorit Tzur
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel (A.M.T., I.A., E.D., D.T., G.T.)
| | - Asaf Vivante
- Department of Pediatrics B and Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel. (A.V.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.)
| | - Ehud Grossman
- Department of Medicine, Sheba Medical Center, Tel-Hashomer, Israel. (A.M.T., E.G., B.F.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.)
| | - Ran S Rotem
- Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (R.S.R., G.C.).,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA (R.S.R.)
| | - Boris Fishman
- Department of Medicine, Sheba Medical Center, Tel-Hashomer, Israel. (A.M.T., E.G., B.F.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.)
| | - Arnon Afek
- Central Management, Sheba Medical Center, Tel-Hashomer, Israel. (A.A.)
| | - Josef Coresh
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.C.)
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.).,Maccabitech Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel (R.S.R., G.C.)
| | - Gilad Twig
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel (A.M.T., I.A., E.D., D.T., G.T.).,Department of Military Medicine, Hebrew University of Jerusalem Faculty of Medicine, Jerusalem, Israel (A.M.T., I.A., G.T.).,Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel. (G.T.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (A.M.T., A.V., E.G., B.F., G.C., G.T.)
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13
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Massalha E, Sharon A, Oren D, Fishman B, Segev A, Matetzky S, Maor E. A GRADIENT BOOSTING MACHINE LEARNING MODEL ENHANCES MORTALITY PREDICTION IN NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Sharon A, Massalha E, Fishman B, Fefer P, Barbash I, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. EARLY INVASIVE STRATEGY AND OUTCOME OF NON-ST- ELEVATION MYOCARDIAL INFARCTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Sharon A, Fishman B, Itelman E, Mouallem M, Barbash I, Fefer P, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. MANAGEMENT AND OUTCOME OF PATIENTS WITH NON-ST ELEVATION MYOCARDIAL INFARCTION AND INTERCURRENT NONCORONARY PRECIPITATING EVENTS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Bleier J, Pickovsky J, Apter S, Fishman B, Dotan Z, Tirosh A, Shlomai G. The association between adrenal adenoma size, autonomous cortisol secretion and metabolic derangements. Clin Endocrinol (Oxf) 2022; 96:311-318. [PMID: 34877671 DOI: 10.1111/cen.14651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/13/2021] [Accepted: 11/26/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Autonomous cortisol secretion (ACS) is common in patients with adrenal incidentalomas (AI). ACS is associated with increased cardiovascular morbidity and mortality. Data regarding the association between radiological characteristics of adrenal adenomas, their hormonal functionality and metabolic outcomes, are scarce and inconclusive. In this study, we aim to delineate the association between radiological characteristics of AI, ACS and metabolic status. METHODS A cross-sectional study of 77 patients with AI who underwent a comprehensive hormonal evaluation. Radiological assessments were performed by an independent radiologist blinded to the clinical and hormonal phenotype of each case. Linear regression models were used to evaluate the association between post dexamethasone suppression test (DST) cortisol levels, metabolic indices and radiological measurements. RESULTS Mean maximal adenoma diameter was greater in patients with versus without ACS (20.35 ± 6 vs. 27.09 ± 9.3 mm, respectively, p < .01). Maximal adenoma diameter was found to be positively and linearly correlated with post-DST morning cortisol levels across their entire range (R = .474, p < .01). Linear correlations between maximal adenoma diameter and indices of glycemic control showed a correlation coefficient (R) of .481 and .463 for fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c), respectively, p < .01. When analysis included only patients with ACS, an R = .584 and R = .565 was observed for FPG and HbA1c, respectively (p < .01 for both). The association between maximal adenoma diameter and both FPG and post-DST morning cortisol intensified in patients with metabolic syndrome. CONCLUSION There is a quantitative positive mild correlation between AI size and both cortisol autonomy and metabolic parameters.
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Affiliation(s)
- Jonathan Bleier
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jana Pickovsky
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Sara Apter
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Radiology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Boris Fishman
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar Dotan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Gadi Shlomai
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
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17
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Maizels L, Wasserstrum Y, Fishman B, Segev A, Ben-Nun D, Younis A, Freimark D, Mazin I, Grupper A. Characterization of heart failure patients with reverse left ventricular remodelling post-angiotensin receptor blockers/neprilysin inhibitors therapy. ESC Heart Fail 2022; 9:1682-1688. [PMID: 35178886 PMCID: PMC9065862 DOI: 10.1002/ehf2.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 12/13/2021] [Accepted: 12/18/2021] [Indexed: 11/22/2022] Open
Abstract
Aims To assess the effect of angiotensin receptor blockers/neprilysin inhibitors (ARNI) on left ventricular (LV) ejection fraction (LVEF) and LV dimensions in a real‐life cohort of heart failure and reduced ejection fraction (HFrEF) patients, while analysing patient characteristics that may predict reverse LV remodelling. Methods and results The ARNI‐treated HFrEF patients followed at a single tertiary medical centre HF‐outpatient clinic were included in the study. Clinical and echocardiographic parameters were evaluated prior to ARNI initiation, and while on ARNI therapy, assessing patient characteristics associated with reverse LV remodelling. The cohort included 91 patients (mean age 60.5 years, 90% male) and 47 (52%) patients exhibited ARNI responsiveness, defined as an increase in LVEF during therapy. Overall, LVEF increased by 19% post‐ARNI (23.8 to 28.4%, P < 0.001). Subgroup analysis revealed several parameters associated with significant LVEF improvement, including baseline LVEF <30%, non‐ischaemic HF aetiology, lack of cardiac resynchronization therapy (CRT), better initial functional class and ARNI initiation within 3 years from HF diagnosis (P ≤ 0.001 for all). Significant reduction in LV dimensions was noted in patients with lower initial LVEF, non‐ischaemic HF and no CRT. Further combined subgrouping of the study population demonstrated that patients with both LVEF <30% and a non‐ischaemic HF gained most benefit from ARNI with an average of 51% improvement in LVEF (19.9 to 30%, P < 0.001). Conclusions The ARNI treatment response is not uniform among HFrEF patient subgroups. More pronounce reverse LV remodelling is associated with early ARNI treatment initiation in the course of HFrEF, and in those with LVEF <30%, non‐ischaemic HF and no CRT.
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Affiliation(s)
- Leonid Maizels
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Talpiot Sheba Medical Leadership Program, Tel-Aviv, Israel
| | - Yishay Wasserstrum
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Fishman
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Talpiot Sheba Medical Leadership Program, Tel-Aviv, Israel
| | - Amitai Segev
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Ben-Nun
- The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anan Younis
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dov Freimark
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Israel Mazin
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Avishay Grupper
- Division of Cardiology, Leviev Center of Cardiovascular medicine, Sheba Medical Center in Tel-HaShomer, Sheba Rd. 2, Ramat-Gan, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Fishman B, Zloof Y, Orr O, Tsur AM, Furer A, Omer Gilon M, Chodick G, Leiba A, Derazne E, Tzur D, Afek A, Grossman E, Twig G. The opposing trends of body mass index and blood pressure during 1977-2020; nationwide registry of 2.8 million male and female adolescents. Cardiovasc Diabetol 2021; 20:242. [PMID: 34963457 PMCID: PMC8715587 DOI: 10.1186/s12933-021-01433-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background Elevated blood pressure among adolescents has been shown to be associated with future adverse cardiovascular outcomes and early onset diabetes. Most data regarding systolic and diastolic blood pressure trends are based on surveys of selected populations within 10–20-year periods. The goal of this study was to characterize the secular trend of blood pressure given the rising prevalence of adolescent obesity. Methods This nationwide population-based study included 2,785,515 Israeli adolescents (41.6% females, mean age 17.4 years) who were medically evaluated and whose weight, height and blood pressure were measured, prior to mandatory military service between 1977 and 2020. The study period was divided into 5-year intervals. Linear regression models were used to describe the P for trend along the time intervals. Analysis of covariance was used to calculate means of blood pressure adjusted for body mass index. Results During the study period, the mean body mass index increased by 2.1 and 1.6 kg/m2 in males and females, respectively (P for trend < 0.001 in both sexes). The mean diastolic blood pressure decreased by 3.6 mmHg in males and by 2.9 mmHg in females (P < 0.001 in both sexes). The mean systolic blood pressure increased by 1.6 mmHg in males and decreased by 1.9 mmHg in females. These trends were also consistent when blood pressure values were adjusted to body mass index. Conclusion Despite the increase in body mass index over the last four decades, diastolic blood pressure decreased in both sexes while systolic blood pressure increased slightly in males and decreased in females. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01433-0.
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Affiliation(s)
- Boris Fishman
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Division of Cardiology, The Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Talpiot Sheba Medical Leadership Program, Ramat Gan, Israel
| | - Yair Zloof
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Orr
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Orthopedic Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Avishai M Tsur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Medicine 'B', Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Ariel Furer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Division of Cardiology, The Leviev Heart Center, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ma'ayan Omer Gilon
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Maccabitech, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Adi Leiba
- Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center affiliated to Ben Gurion University, Beer Sheva, Israel.,Harvard Medical School, Boston, MA, USA
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Hypertension Unit and the Internal Division, The Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
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19
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Sharon A, Fishman B, Itelman E, Fefer P, Barbash I, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. The effect of early invasive strategy on mortality outcome in patients with chronic kidney disease presenting with non-ST segment elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1447] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current guidelines recommend an early invasive strategy for patients with non-ST segment elevation myocardial infarction (NSTEMI).
Purpose
To evaluate whether early invasive strategy is associated with better outcome among patients with chronic kidney disease (CKD).
Methods
Retrospective cohort analysis of consecutive patients with NSTEMI between 2008 and 2021. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. Invasively treated patients were dichotomized into early (<24 hours) and non-early groups. Mortality data was available for all patients from a national registry. Multivariate Cox regression models with interaction analysis were applied.
Results
Final study population comprised 7,107 NSTEMI patients, of whom 3,172 (45%) had eGFR <60 ml/min/1.73m2. 1,988 (28%) and 973 (14%) patients had eGFR under 45 and 30 ml/min/1.73m2, respectively. 3,529 (50%) patients were treated invasively, among them 1837 (52%) underwent early invasive strategy. Patients in the early invasive group were younger (64 vs. 68 years, p<0.001) and were less likely to have comorbidities including kidney disease. During a median follow-up of 3 years (IQR 1.2–5.2), 2,552 (36%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death was 50%, 15%, and 6% among patients in the conservative, non-early, and early invasive groups respectively (p Log-rank <0.001). Subgroup analysis of invasively managed patients showed that early invasive strategy was associated with a significant 32% reduced risk of death in a multivariate model (95% CI 0.56–0.82, p<0.001), but this associated benefit was modified by eGFR (p for interaction 0.045). The modification effect of CKD on the association of early invasive strategy with outcome was most pronounced among invasively treated patients with eGFR <45 ml/min/1.73m2, with no survival benefit for early invasive approach in these patients (HR 0.8, 95% CI 0.57–1.14, p=0.221 vs. HR 0.6 95% CI 0.45–0.72, p<0.001; p for interaction=0.046).
Conclusion
Among invasively treated NSTEMI patients, the benefit of early invasive strategy is modified by CKD, and limited to those with eGFR ≥45 ml/min/1.73m2.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Sharon
- Sheba Medical Center, Tel Aviv, Israel
| | - B Fishman
- Sheba Medical Center, Tel Aviv, Israel
| | - E Itelman
- Sheba Medical Center, Tel Aviv, Israel
| | - P Fefer
- Sheba Medical Center, Tel Aviv, Israel
| | - I Barbash
- Sheba Medical Center, Tel Aviv, Israel
| | - A Segev
- Sheba Medical Center, Tel Aviv, Israel
| | | | - V Guetta
- Sheba Medical Center, Tel Aviv, Israel
| | - E Grossman
- Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Maor
- Sheba Medical Center, Tel Aviv, Israel
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20
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Fishman B, Sharon A, Itelman E, Tsur AM, Fefer P, Barbash IM, Segev A, Matetzky S, Guetta V, Grossman E, Maor E. Invasive management in elderly patients with non-ST elevation myocardial infarction is beneficial regardless of frailty status. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2822] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Elderly patients are underrepresented in clinical trials evaluating the management of non-ST elevation myocardial infarction (NSTEMI) patients. Moreover, frailty status is often not reported in these trials.
Purpose
To evaluate the association of invasive management with outcome among elderly (≥80) patients presenting with NSTEMI by frailty status.
Methods
Retrospective cohort of consecutive elderly patients who were hospitalized with NSTEMI as a primary clinical diagnosis between 2008 to 2019. Primary outcome was all-cause mortality. Frailty status was estimated as a continuous variable as well as categorized to low, medium, and high. Cox regression models were applied with stratification by frailty status. Additional sensitivity analyses were conducted including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) models.
Results
Study population included 2,317 patients with median age of 86 years (IQR 83–90) of whom 1,243 (54%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs. 44%, p<.001). During the follow up (median of 19 months, [IQR 4–41]), 1,599 (69%) patients died. Kaplan Meier survival curves (Figure 1) show that the cumulative probability of death at 19 months was 50% among patients who were managed conservatively compared with 21% among invasively managed patients (p Log rank <.001). In the multivariable Cox model, invasive approach was associated with a significant 39% decrease in the risk of death (95% CI 0.53–0.71). The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 [0.58–0.93], 0.65 [0.50–0.85] and 0.52 [0.34–0.78], respectively; p for interaction NS). Results were consistent with PSM and IPTW analyses (HR of 0.6 [0.50–0.71] and 0.67 [0.55–0.82], respectively). Additional sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results.
Conclusions
Invasive approach is associated with improved survival among elderly patients with NSTEMI irrespective of frailty status. Our results support and extend recent ESC recommendations for the management of elderly patients with NSTEMI
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- B Fishman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A Sharon
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Itelman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A M Tsur
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - P Fefer
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - I M Barbash
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - A Segev
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - S Matetzky
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - V Guetta
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Grossman
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
| | - E Maor
- Sheba Medical Center, Heart Center, Ramat Gan, Israel
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21
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Zilberman DE, Drori T, Shlomai G, Mazeh H, Fishman B, Golan S, Hendel H, Laniado M, Dotan ZA. Adrenal ganglioneuroma resected for suspicious malignancy: multicenter review of 25 cases and review of the literature. Ann Surg Treat Res 2021; 101:79-84. [PMID: 34386456 PMCID: PMC8331556 DOI: 10.4174/astr.2021.101.2.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/14/2021] [Accepted: 06/05/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose We reviewed the experience with adrenal ganglioneuroma (AGN) pathologically confirmed following adrenalectomy in medium- to high-volume medical centers. Methods The medical records of all adrenalectomy cases in 4 medical centers between 2006 and 2020 were retrospectively reviewed for demographics, clinical, radiological and laboratory findings, surgical treatment, pathology results, and outcomes. Results Twenty-five out of 875 adrenalectomy cases (2.9%) were pathologically confirmed as AGN. Those patients' average age was 40.5 years (range, 4-76 years), 13 (52.0%) were males, and 18 lesions (72.0%) were right-sided. One patient had a family history of neurofibromatosis, and another had a succinate dehydrogenase gene mutation. Abdominal/back pain attributed to mass effect was the most common symptom. All 25 patients underwent abdominal computerized tomography scanning in which the average maximal tumor diameter was 6.61 cm. The mean pre- and postcontrast Hounsfield units (HU) values were 35.2 and 59, respectively; and the mean late-phase HU value was 71.1. Twenty-two patients (88.0%) underwent minimally invasive surgery. The average tumor diameter recorded in the final pathology report was 7 cm. Isolated AGN was diagnosed in 21 cases (84.0%), and the additional components reported for the remaining 4 cases included pheochromocytoma (2), ganglioneuroblastoma (1), and neurofibroma (1). The average follow-up length was 16.8 months (range, 1-136 months), during which there was no recurrence or death. Conclusion AGN is a rare, slow-growing, large benign tumor with radiological characteristics similar to those seen in malignant tumor. Final diagnosis is established by pathology after surgical resection, preferably minimally invasive, with an overall excellent prognosis.
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Affiliation(s)
- Dorit Esther Zilberman
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tomer Drori
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gadi Shlomai
- Institute of Endocrinology, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Internal Medicine D, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel
| | - Haggi Mazeh
- Department of Surgery, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
| | - Boris Fishman
- Department of Internal Medicine D, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, TelAviv University, Tel-Aviv, Israel
| | - Shay Golan
- Department of Urology, Rabin Medical Center, Petah Tikva affiliated to the Sackler School of Medicine, Tel-Aviv University, TelAviv, Israel
| | - Hen Hendel
- Department of Urology, Rabin Medical Center, Petah Tikva affiliated to the Sackler School of Medicine, Tel-Aviv University, TelAviv, Israel
| | - Monica Laniado
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | - Zohar A Dotan
- Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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22
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Lerman TT, Fishman B, Reitblat O, Reitblat T, Goldberg E, Krause I. Global Academic Productivity in the Field of Internal Medicine and Its Correlation to National Economic Indicators: A Bibliometric Analysis of 24 Years. Am J Med Sci 2021; 362:480-485. [PMID: 34033808 DOI: 10.1016/j.amjms.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/25/2020] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have demonstrated a correlation between national economic indicators and academic productivity. However, such a relationship has not been studied in the field of internal medicine (IM). METHODS The number of documents published, number of citable documents, number of citations, citations per document and the h index between 1996 and 2019 in the field of IM among the Organisation for Economic Co-operation and Development (OECD) countries were analysed. Data were derived from the The Scimago Journal and Country rank source. We analysed the correlation between these indicators to the gross domestic product (GDP) per capita, health spending as percent of GDP and gross domestic expenditure on research and development as percent of GDP (GERD). Economic data were collected from the OECD websites. RESULTS A significant correlation was found between health expenditure and h index (r = 0.75, P < 0.001), number of citations (r = 0.72, P < 0.001), number of documents (r = 0.62, P < 0.001) and number of citable documents (r = 0.61, P < 0.001); between GERD and number of citations (r = 0.6, P < 0.001), h index (r = 0.6, P < 0.001), number of documents published (r = 0.53, P = 0.001) and citable documents (r = 0.51, P = 0.001); between the GDP per capita and number of citations (r = 0.46, P = 0.005), citations per document (r = 0.54, P = 0.001) and h index (r = 0.5, P = 0.002). CONCLUSIONS This study demonstrated a positive correlation between academic productivity in the field of IM and economic indicators of the OECD countries, mainly health expenditure, implying the advantage of domestic investment in health.
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Affiliation(s)
- Tsahi T Lerman
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Boris Fishman
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Olga Reitblat
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Ophthalmology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Tatiana Reitblat
- Rheumatology Unit, Barzilai Medical Center, Ashqelon, Israel; Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Elad Goldberg
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ilan Krause
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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23
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Bardugo A, Fishman B, Libruder C, Tanne D, Ram A, Hershkovitz Y, Zucker I, Furer A, Gilon R, Chodick G, Tiosano S, Derazne E, Tzur D, Afek A, Pinhas-Hamiel O, Bendor CD, Yaniv G, Rotem RS, Twig G. Body Mass Index in 1.9 Million Adolescents and Stroke in Young Adulthood. Stroke 2021; 52:2043-2052. [PMID: 33980044 DOI: 10.1161/strokeaha.120.033595] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Boris Fishman
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,Hypertension Unit, Internal Medicine D (B.F.), Sheba Medical Center, Ramat Gan, Israel.,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Carmit Libruder
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - David Tanne
- Rambam Health Care Campus and Rappaport Faculty of Medicine, Haifa, Israel (D. Tanne)
| | - Amit Ram
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Yael Hershkovitz
- Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.).,Israel Center for Disease Control, Ministry of Health, Ramat Gan (C.L., A.R., Y.H., I.Z.)
| | - Ariel Furer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Roy Gilon
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Gabriel Chodick
- Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.).,Maccabitech (G.C.), Maccabi Healthcare Services, Tel Aviv, Israel
| | - Shmuel Tiosano
- Division of Cardiology, Leviev Heart and Vascular Center (S.T.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Estela Derazne
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Arnon Afek
- Central Management (A.A.), Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital (O.P.-H.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Cole Daniel Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.)
| | - Gal Yaniv
- The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Department of Diagnostic Imaging (G.Y.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
| | - Ran Shmuel Rotem
- Kahn-Sagol-Maccabi Research and Innovation Institute (R.S.R.), Maccabi Healthcare Services, Tel Aviv, Israel.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA (R.S.R.)
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan (A.B., B.F., A.F., R.G., E.D., D. Tzur, C.D.B., G.T.).,The Dr. Pinchas Bornstein Talpiot Medical Leadership Program (B.F., G.Y., G.T.), Sheba Medical Center, Ramat Gan, Israel.,Institute of Endocrinology (G.T.).,Sackler Faculty of Medicine, Tel Aviv University, Israel (B.F., I.Z., G.C., S.T., E.D., A.A., O.P.-H., G.Y., G.T.)
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Bleier J, Shlomai G, Fishman B, Dotan Z, Rosenzweig B, Tirosh A. The Quantitative Relationship Between Autonomous Cortisol Secretion, Dysglycemia and the Metabolic Syndrome. Endocr Pract 2021; 26:974-982. [PMID: 33471702 DOI: 10.4158/ep-2020-0111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/29/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Autonomous cortisol secretion (ACS) is the most common endocrine abnormality in the evaluation of adrenal incidentalomas. The categorization of ACS is derived from a 1 mg dexamethasone suppression test (DST). Impaired DST is associated with several metabolic derangements. In this study we analyzed the association between post-DST cortisol level, analyzed as a continuous parameter, and indices of glycemic metabolism. METHODS We prospectively collected data of 1,976 patients evaluated for adrenal incidentalomas in a large tertiary medical center between December 1, 2017, and August 31, 2019. Seventy-three patients completed the evaluation process. Post-DST cortisol levels were analyzed for correlation with various metabolic parameters, including fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) among the general cohort and for subgroups stratified by the number of metabolic syndrome (MS) criteria. RESULTS Post-DST cortisol demonstrated a linear association with FPG and HbA1c across its entire cortisol range (R = 0.51 and 0.41, respectively; P≤.01). The association between post-DST cortisol and FPG was strengthened with an increased number of metabolic syndrome criteria. Patients with 4 MS criteria show a stronger association (R = 0.92) compared to patients with only a single criterion (R = 0.509). Furthermore, mean post-DST cortisol levels increased as the number of MS criteria accumulated. CONCLUSION Post-DST cortisol should be viewed as a continuous parameter in risk stratification algorithms for the development of MS and particularly dysglycemia.
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Affiliation(s)
- Jonathan Bleier
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Gadi Shlomai
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel; The Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Boris Fishman
- Department of Internal Medicine D, Sheba Medical Center, Tel-Hashomer, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Zohar Dotan
- Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel; Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Barak Rosenzweig
- Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel; Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Tirosh
- Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel; The Institute of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel.
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25
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Fishman B, Grossman E, Zucker I, Orr O, Lutski M, Bardugo A, Bendor CD, Leiba Y, Cukierman-Yaffe T, Derazne E, Mosenzon O, Tzur D, Beer Z, Pinhas-Hamiel O, Fishman T, Afek A, Tirosh A, Raz I, Gerstein HC, Twig G. Adolescent Hypertension and Risk for Early-Onset Type 2 Diabetes: A Nationwide Study of 1.9 Million Israeli Adolescents. Diabetes Care 2021; 44:e6-e8. [PMID: 33148634 DOI: 10.2337/dc20-1752] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/02/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Boris Fishman
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Internal Medicine D Department and Hypertension Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Internal Medicine D Department and Hypertension Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Omri Orr
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Miri Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Yoav Leiba
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Mosenzon
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Zivan Beer
- Department of Military Medicine, Hebrew University, Jerusalem, Israel.,The Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| | - Tamar Fishman
- Pharmacy Services, Meir Medical Center, Kfar-Saba, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel
| | - Itamar Raz
- Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem, Israel .,The Israel Defense Forces Medical Corps, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Endocrinology, Sheba Medical Center, Ramat Gan, Israel
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26
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Bardugo A, Bendor CD, Zucker I, Lutski M, Cukierman-Yaffe T, Derazne E, Mosenzon O, Tzur D, Beer Z, Pinhas-Hamiel O, Ben-Ami M, Fishman B, Ben-Ami Shor D, Raz I, Afek A, Gerstein HC, Häring HU, Tirosh A, Levi Z, Twig G. Adolescent Nonalcoholic Fatty Liver Disease and Type 2 Diabetes in Young Adulthood. J Clin Endocrinol Metab 2021; 106:e34-e44. [PMID: 33075820 DOI: 10.1210/clinem/dgaa753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT The long-term risk of type 2 diabetes in adolescents with nonalcoholic fatty liver disease (NAFLD) is unclear. OBJECTIVE To assess type 2 diabetes risk among adolescents with NAFLD. DESIGN AND SETTING A nationwide, population-based study of Israeli adolescents who were examined before military service during 1997-2011 and were followed until December 31, 2016. PARTICIPANTS A total of 1 025 796 normoglycemic adolescents were included. INTERVENTIONS Biopsy or radiographic tests were prerequisite for NAFLD diagnosis. Data were linked to the Israeli National Diabetes Registry. MAIN OUTCOME MEASURES Type 2 diabetes incidence. RESULTS During a mean follow-up of 13.3 years, 12 of 633 adolescents with NAFLD (1.9%; all with high body mass index [BMI] at baseline) were diagnosed with type 2 diabetes compared with 2917 (0.3%) adolescents without NAFLD. The hazard ratio (HR) for type 2 diabetes was 2.59 (95% confidence interval [CI], 1.47-4.58) for the NAFLD vs. the non-NAFLD group after adjustment for BMI and sociodemographic confounders. The elevated risk persisted in several sensitivity analyses. These included an analysis of persons without other metabolic comorbidities (adjusted HR, 2.75 [95% CI, 1.48-5.14]) and of persons with high BMI; and an analysis whose outcome was type 2 diabetes by age 30 years (adjusted HR, 2.14 [95% CI, 1.02-4.52]). The results remained significant when a sex-, birth year-, and BMI-matched control group was the reference (adjusted HR, 2.98 [95% CI, 1.54-5.74]). CONCLUSIONS Among normoglycemic adolescents, NAFLD was associated with an increased adjusted risk for type 2 diabetes, which may be apparent before age 30 years.
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Affiliation(s)
- Aya Bardugo
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Cole D Bendor
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Inbar Zucker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Miri Lutski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Tali Cukierman-Yaffe
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofri Mosenzon
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Dorit Tzur
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Zivan Beer
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Michal Ben-Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Boris Fishman
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Internal Medicine D and Hypertension Unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Dana Ben-Ami Shor
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Itamar Raz
- The Diabetes Unit, Department of Internal Medicine, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | | | - Hans-Ulrich Häring
- Department of Internal Medicine IV, University Hospital Tübingen, Tübingen, Germany
- Institute of Diabetes Research and Metabolic Diseases, Helmholtz Center Munich, University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research, Tübingen, Germany
| | - Amir Tirosh
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Zohar Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Gastroenterology Department, Rabin Medical Center, Petach Tikva, Israel
| | - Gilad Twig
- Department of Military Medicine, Hebrew University, Jerusalem and the Israel Defense Forces Medical Corps, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
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27
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Golani T, Fishman B, Sharabi Y, Olswang-Kutz Y, Leibowitz A, Grossman E, Shlomai G. The association between systolic blood pressure reduction during clonidine suppression testing and the decrease in plasma catecholamines and metanephrines. J Clin Hypertens (Greenwich) 2020; 22:1924-1931. [PMID: 32882089 DOI: 10.1111/jch.14014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 11/29/2022]
Abstract
Borderline isolated norepinephrine (NE) and normetanephrine (NMT) elevation is common among patients with suspected pheochromocytoma and paraganglioma (PPGL). The clonidine suppression test (CST) may help establish the etiology in these cases. Prolonged laboratory processing and/or paucity of reliable biochemical assays may limit the utility of CST. The aim of this study was to evaluate whether blood pressure (BP) reduction during CST is associated with alterations in plasma NMT/NE, thereby potentially providing an immediate indication of CST results. In this cross-sectional study, the authors included all consecutive patients with suspected PPGL who underwent CST from January 1, 2014, to December 31, 2019. Linear regression models were conducted to evaluate the association between BP reduction and decrease in plasma NMT/NE. The final analysis included 36 patients (17 males). The decrease in systolic BP (SBP) 90 minutes postclonidine was associated with a decrease in plasma NMT (R = 0.668, P = .025) and NE (R = 0.562, P = .005). A 40% decrease in NMT and NE correlated with a 9.74% and 7.16% decrease in SBP, respectively. Subgroup analyses demonstrated that the association between SBP reduction and the decrease in plasma NMT (R = 0.764, P = .046) and NE (R = 0.714, P = .003) strengthens among patients with hypertension and among those with diabetes mellitus (R = 0.974, P = .026 for NMT). In conclusion, SBP reduction during CST is associated with plasma NMT and NE decrease. Therefore, the decrease in SBP 90 minutes postclonidine may serve as an immediate complementary clinical tool for PPGL diagnosis.
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Affiliation(s)
- Tiran Golani
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Fishman
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehonatan Sharabi
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Olswang-Kutz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Metabolic Lab, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Avshalom Leibowitz
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ehud Grossman
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gadi Shlomai
- Department of Internal Medicine D and Hypertension unit, The Chaim Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Institute of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
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28
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Leiba A, Fishman B. P0233ISOLATED MICROHEMATURIA IN ADOLESCENTS IS NOT ASSOCIATED WITH RENAL OR URINARY TRACT CANCER IN MIDDLE AGE. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0233] [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 and Aims
Chronic or persistent isolated microhematuria (microhematuria without proteinuria) is not as benign as originally thought. It has been associated with an almost 20-fold risk of developing ESRD ( End Stage Renal Disease) in adulthood. It is still unclear if this chronic glomerular bleed increases the risk of renal or urinary tract tumors, secondary to ongoing irritation and inflammation. This is a valid question, especially as an adult with long standing isolated “glomerular” microhematuria can appear with an event of macrohematuria. In order to answer these questions, we studied the association between adolescent microhematuria and renal or urinary tract tumors in adulthood.
Method
A retrospective study based on a cohort of 2,172,866 Jewish adolescents (60% men) aged 16-19 who underwent a mandatory physical examination between ages of 16 and 19 years from 1967 to 2007 prior to their conscription. Urothelial Transitional cell carcinoma (TCC) and Renal cell carcinoma (RCC) incidence through December 31, 2012 was identified by linkage to the national cancer registry. Multivariable-adjusted Cox regression models were used to estimate hazard ratios (HRs) for RCC and TCC among adolescents who were diagnosed with persistent asymptomatic isolated hematuria after comprehensive medical evaluation. The models were adjusted for: Sex, age, year of birth, socio-economic status, BMI, years of education and country of origin.
Results
Over a median of 22 years (interquartile range of 13-31 years) of follow-up, 2007 and 1112 incident cases of TCC and RCC, respectively, occurred amongst the study population. Persistent hematuria was not associated with TCC with crude HR 1.15 (95% CI, 0.37-3.57) and adjusted HR of 1.08 (95% CI, 0.35-3.36), nor with RCC with crude HR 1.11 (95% CI, 0.28-4.457) and adjusted HR of 0.93 (95% CI, 0.23-3.75).
Conclusion
Isolated persistent microhematuria, while carrying a small risk of kidney disease progression, is not associated with either renal or urinary tract tumors. Screening guidelines among these patients should follow the general age and sex- matched approach.
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Affiliation(s)
- Adi Leiba
- Samson Assuta Ashdod University Hospital, Nephrology and Hypertension Institute, Ashdod, Israel
| | - Boris Fishman
- Tel HaShomer Hospital, Department of Medicine D, Ramat Gan, Israel
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29
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Fishman B, Leiba A, Twig G, Shlomai G, Orr O, Landau R, Derazne E, Grossman E. Ethnic Variability Among Jews is Associated With Hypertension: Results of a Nationwide Study of 1.44 Million Adolescents. Am J Hypertens 2020; 33:175-181. [PMID: 31777921 DOI: 10.1093/ajh/hpz167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/17/2019] [Accepted: 10/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Adolescent hypertension is a major cardiovascular risk factor that may be related to ethnic variability. Contemporary Jews can be divided into three distinct ethnic groups: Ashkenazi, Oriental, and Sephardi origins. The aim of our study was to investigate the association of ethnicity and hypertension among Israeli adolescents. METHODS We conducted a population retrospective cohort study of males and females, aged 16-19, eligible for mandatory military service in the Israeli Defense Forces (IDF) between 1994 and 2013. Medical and sociodemographic data, including body mass index (BMI), age, years of education, residential socioeconomic status, and parents' country of birth, were retrieved. Ethnicity of the parents was based upon their country of birth. The examinees were assigned to a certain ethnicity only if both parents had the same ethnicity. Logistic regression models were applied to compute the odds ratio (OR) and 95% confidence intervals (95% CI) for hypertension among the different Jewish ethnicities. RESULTS The final cohort included 1,445,176 adolescents, of whom 716,289 were born to parents of the same Jewish ethnicity. Ashkenazi ethnicity was associated with an increased risk of hypertension compared to Sephardi and Oriental ethnicities (adjusted OR of 2.93 (95% CI, 2.52-3.41) and 1.56 (1.38-1.77), respectively). Oriental ethnicity was associated with an increased risk of hypertension compared with the Sephardi ethnicity (OR of 1.91 (1.60-2.27)). Similar results were observed in a sub-analysis, which included only Israeli-born examinees. CONCLUSIONS Our results indicate that ethnicity is significantly associated with hypertension among Jewish adolescents. Ashkenazi Jews had the highest risk of hypertension.
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Affiliation(s)
- Boris Fishman
- Israel Defense Forces Medical Corps, Israel
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Leiba
- Israel Defense Forces Medical Corps, Israel
- Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ben Gurion University, Beer Sheva, Israel
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gilad Twig
- Israel Defense Forces Medical Corps, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, The Faculty of Medicine, The Hebrew University, of Jerusalem, Jerusalem, Israel
| | - Gadi Shlomai
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Institute of Endocrinology, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Omri Orr
- Israel Defense Forces Medical Corps, Israel
| | - Regev Landau
- Israel Defense Forces Medical Corps, Israel
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Fishman B, Shlomai G, Twig G, Derazne E, Tenenbaum A, Fisman EZ, Leiba A, Grossman E. Renal glucosuria is associated with lower body weight and lower rates of elevated systolic blood pressure: results of a nationwide cross-sectional study of 2.5 million adolescents. Cardiovasc Diabetol 2019; 18:124. [PMID: 31554505 PMCID: PMC6760097 DOI: 10.1186/s12933-019-0929-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022] Open
Abstract
Background Gene coding mutations found in sodium glucose co-transporters (SGLTs) are known to cause renal glucosuria. SGLT2 inhibitors have recently been shown to be effective hypoglycemic agents as well as possessing cardiovascular and renal protective properties. These beneficial effects have to some extent, been attributed to weight loss and reduced blood pressure. The aim of the current study was to evaluate the prevalence of renal glucosuria amongst a large cohort of Israeli adolescents and to investigate whether renal glucosuria is associated with lower body weight and lower blood pressure values. Methods Medical and socio-demographic data were collected from the Israeli Defense Force’s conscription center’s database. A cross-sectional study to evaluate the association between conscripts diagnosed as overweight [BMI percentiles of ≥ 85 and < 95 and obesity (≥ 95 BMI percentile)] and afflicted with renal glucosuria was conducted. In addition, we assessed the association of renal glucosuria with elevated diastolic and systolic blood pressure. Multinomial regression models were used. Results The final study cohort comprised 2,506,830 conscripts of whom 1108 (0.044%) were diagnosed with renal glucosuria, unrelated to diabetes mellitus, with males twice as affected compared to females. The adjusted odds ratio for overweight and obesity was 0.66 (95% CI 0.50–0.87) and 0.62 (95% CI 0.43–0.88), respectively. Adolescents afflicted with renal glucosuria were also less likely to have an elevated systolic blood pressure of 130–139 mmHg with an adjusted odds ratio of 0.74 (95% CI 0.60–0.90). Conclusions Renal glucosuria is associated with lower body weight and obesity as well as with lower rates of elevated systolic blood pressure.
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Affiliation(s)
- Boris Fishman
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Internal Medicine D and Hypertension Unit, Sheba Medical Center, 2 Derech Sheba, Migdal Ishpuz, 1st Floor, Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Gadi Shlomai
- Internal Medicine D and Hypertension Unit, Sheba Medical Center, 2 Derech Sheba, Migdal Ishpuz, 1st Floor, Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,The Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, 5265601, Ramat Gan, Israel
| | - Gilad Twig
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Department of Military Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Alexander Tenenbaum
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.,Cardiac Rehabilitation Institute, Sheba Medical Center, Tel Hashomer, 5265601, Ramat Gan, Israel
| | - Enrique Z Fisman
- Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Adi Leiba
- Israel Defense Forces, Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, 7747629, Ashdod, Israel.,Faculty of Health sciences, Ben Gurion University, Beer Sheva, Israel.,Department of Medicine, Mount Auburn Hospital, 330 Mt Auburn St, Cambridge, MA, 02138, USA.,Department of Medicine, Harvard Medical School, Boston, USA
| | - Ehud Grossman
- Internal Medicine D and Hypertension Unit, Sheba Medical Center, 2 Derech Sheba, Migdal Ishpuz, 1st Floor, Tel Hashomer, 5265601, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel.
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Daniel S, Doron M, Fishman B, Koren G, Lunenfeld E, Levy A. The safety of amoxicillin and clavulanic acid use during the first trimester of pregnancy. Br J Clin Pharmacol 2019; 85:2856-2863. [PMID: 31486528 DOI: 10.1111/bcp.14118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 08/13/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022] Open
Abstract
AIMS The goal of the current study was to assess the risk for major congenital malformations following first-trimester exposure to amoxicillin, or amoxicillin and clavulanic acid (ACA). METHODS A population-based retrospective cohort study was conducted, by linking 4 computerized databases: maternal and infant hospitalization records, drug dispensing database of Clalit Health Services in Israel and data concerning pregnancy terminations. Multivariate negative-binomial regression was used to assess the risk for major malformations following first-trimester exposure, adjusted for mother's age, ethnicity (Bedouin vs Jewish), parity, diabetes mellitus, lack of perinatal care, and the year of birth. RESULTS The study included 101 615 pregnancies, of which 6919 (6.8%) were exposed to amoxicillin: 1045 (1.0%) to amoxicillin only and 6041 (5.9%) to ACA. No significant association was found, in the univariate and multivariate analyses, between first-trimester exposure to amoxicillin or ACA and major malformations in general (crude relative risk, 1.05 95% confidence interval 0.95-1.16; adjusted relative risk 1.09, 95% confidence interval 0.98-1.20), or for major malformations according to organ systems. No dose-response relationship was found between exposure in terms of the defined daily dose and major malformations. CONCLUSION Exposure to amoxicillin and ACA during the first trimester of pregnancy was not associated with an increased risk of major congenital malformations.
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Affiliation(s)
- Sharon Daniel
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services (Southern District), Beer-Sheva, Israel
| | - Maya Doron
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Boris Fishman
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Eitan Lunenfeld
- Department of Obstetrics and Gynecology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel
| | - Amalia Levy
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
INTRODUCTION Opioids constitute a cornerstone of pain relief treatment. However, opioid safety during pregnancy has not been well established. Recent studies reported an association between in utero opioid exposure and spina bifida. METHODS In order to further evaluate the association of opioids exposure during pregnancy with adverse pregnancy outcomes, we conducted a large historical cohort by linking four databases: medications dispensations, births, pregnancy terminations for medical reasons and infant hospitalizations during the years of 1999-2009. Confounders that were controlled for included maternal age, ethnicity, maternal diabetes, smoking status, parity, obesity, year and folic acid intake. A secondary analysis for total major malformations and for spina bifida was performed using propensity score matching for first trimester exposure. RESULTS Of the 101,586 women included in the study, 3003 were dispensed opioids during the first trimester. Intrauterine exposure to opioids was not associated with overall major malformations (adjusted odds ratio (aOR) 0.97, 95% CI 0.83-1.13), cardiovascular malformations (aOR = 0.89, 95% CI 0.70-1.13) other malformations by systems or spina bifida in particular. However, the risk for spina bifida among newborns and abortuses who were exposed to codeine was four times higher than that of the unexposed (aOR = 4.42, 95% CI 1.60-12.23). This association remained significant in a secondary analysis using propensity score matching. Third trimester exposure to opioids was not associated with low birth weight (aOR = 1.08, 95% CI 0.77-1.52), perinatal death (aOR = 1.38, 95% CI 0.64-2.99) and other adverse pregnancy outcomes. CONCLUSIONS These findings suggest that opioids exposure (as a homogenous group) is not a significant risk factor for overall major malformations. Exposure to codeine during the first trimester was found to be associated with increased risk of spina bifida. However, this finding was based on a small number of cases and need to be verified in future work.
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Affiliation(s)
- Boris Fishman
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sharon Daniel
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Gideon Koren
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Motherisk Israel, Tel Aviv, Israel
- Maccabi Health Services, Tel Aviv, Israel
| | - Eitan Lunenfeld
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - Amalia Levy
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Leiba A, Fishman B, Twig G, Gilad D, Derazne E, Shamiss A, Shohat T, Ron O, Grossman E. Association of Adolescent Hypertension With Future End-stage Renal Disease. JAMA Intern Med 2019; 179:517-523. [PMID: 30801616 PMCID: PMC6450304 DOI: 10.1001/jamainternmed.2018.7632] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Hypertension is a leading risk factor of cardiovascular morbidity and mortality. The role of nonmalignant hypertension as the sole initiating factor of end-stage renal disease (ESRD) in non-African American populations has recently been questioned. OBJECTIVE To investigate the association between hypertension and future ESRD in otherwise healthy adolescents. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study examined the data of 16- to 19-year-old healthy candidates for military service in the Israel Defense Forces between January 1, 1967, and December 31, 2013. Data were obtained from the central conscription registry of the Israel Defense Forces and the ESRD registry of the Israel Ministry of Health. Participants underwent a comprehensive medical assessment prior to their military service. Individuals with evidence of renal damage or kidney-related risk factors were excluded. The data analysis was conducted from February 12, 2017, to October 16, 2018. MAIN OUTCOMES AND MEASURES End-stage renal disease as recorded by the Israeli ESRD registry, including hemodialysis, peritoneal dialysis, renal transplant diagnosed between January 1, 1990, and December 31, 2014. RESULTS The cohort included 2 658 238 adolescents (1 596 709 [60.1%] male with a mean [SD] age of 17.4 [0.5] years), of whom 7997 (0.3%) had an established hypertension diagnosis. Half of the individuals in the hypertensive group were overweight (1559 [20.1%]) or obese (2243 [28.9%]), and most (7235 [90.5%]) were male. During a median follow-up of 19.6 years (52 287 945 person-years), 2189 individuals developed ESRD, with an incidence rate of 3.9 per 100 000 person-years. Adolescent hypertension was found to be associated with future ESRD (crude hazard ratio [HR], 5.07; 95% CI, 3.73-6.88). In a multivariable model adjusted for sex, age, years of education, body mass index, and other sociodemographic variables, the HR was 1.98 (95% CI, 1.42-2.77). When excluding participants with severe hypertension, the association with ESRD remained statistically significant (HR, 1.93; 95% CI, 1.37-2.70). In the subanalysis of nonoverweight adolescents, the association between hypertension and ESRD was statistically significant as well (HR, 2.11; 95% CI, 1.05-4.24). CONCLUSIONS AND RELEVANCE Hypertension appears to be associated with a doubling of the risk of future ESRD in an otherwise healthy adolescent population.
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Affiliation(s)
- Adi Leiba
- Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, Ben Gurion University, Beer Sheva, Israel.,IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Boris Fishman
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gilad Twig
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - David Gilad
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tamar Shohat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Center for Disease Control, Israel Ministry of Health, Tel Hashomer, Israel
| | - Ofir Ron
- IDF Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Ehud Grossman
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rotem R, Fishman B, Daniel S, Koren G, Lunenfeld E, Levy A. Risk of major congenital malformations following first-trimester exposure to vaginal azoles used for treating vulvovaginal candidiasis: a population-based retrospective cohort study. BJOG 2018; 125:1550-1556. [PMID: 29790255 DOI: 10.1111/1471-0528.15293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the risk for major malformations following first-trimester exposure to vaginal azoles. DESIGN A population-based retrospective cohort study of women exposed to vaginal azoles from the first day of the last menstrual period until the 90th gestational day. SETTING A combination of four computerised databases: medications, birth, infant hospitalizations, and pregnancy terminations. POPULATION All women who gave birth or underwent a pregnancy termination at Soroka Medical Center, Beer-Sheva, Israel, between 1999 and 2009. METHODS Crude and adjusted relative risks for major congenital malformations and for specific malformations according to organ systems were calculated using a multivariate negative binomial regression. Potential confounders were assessed and controlled for included parity, maternal age, ethnicity, maternal diabetes, smoking, and year of birth or pregnancy termination. Additional analysis using propensity score matching was performed for selected malformations. MAIN OUTCOME MEASURES Major malformations as well as specific malformations according to organ systems. RESULTS Of 101 615 pregnancies, 1993 (1.96%) were exposed to clotrimazole vaginal tablets and 313 (0.31%) to miconazole vaginal tablets during the first trimester of pregnancy. No association was found between first-trimester exposure to clotrimazole and major or specific malformations. An association was found between miconazole exposure and musculoskeletal malformation in general and other congenital musculoskeletal anomalies in particular. However, no association was detected when propensity score matching was used. CONCLUSIONS Intrauterine exposure to vaginal azoles during the first trimester of pregnancy was not associated with either major or specific malformations according to organ systems. TWEETABLE ABSTRACT First-trimester exposure to vaginal azoles is not associated with either major or specific malformations.
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Affiliation(s)
- R Rotem
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - B Fishman
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - S Daniel
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Southern District, Beer-Sheva, Israel
| | - G Koren
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | - E Lunenfeld
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clalit Health Services, Southern District, Beer-Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel
| | - A Levy
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Shlomo M, Gorodischer R, Daniel S, Wiznitzer A, Matok I, Fishman B, Koren G, Levy A. The Fetal Safety of Enoxaparin Use During Pregnancy: A Population-Based Retrospective Cohort Study. Drug Saf 2018; 40:1147-1155. [PMID: 28733971 DOI: 10.1007/s40264-017-0573-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Enoxaparin is widely used during pregnancy as pregnancy is a hypercoagulable state; however, its fetal safety has scarcely been investigated. OBJECTIVE Our study aimed to examine fetal safety following enoxaparin exposure during pregnancy. METHODS A population-based, retrospective cohort study was performed by linking computerized databases, including the drug dispensing registries of Clalit Health Services in Israel and maternal and infant hospital records, between 1998 and 2009. Multivariate logistic regression models were used to examine associations between first- and third-trimester exposure to enoxaparin, major malformations, and other adverse birth outcomes, adjusted for confounders. RESULTS From a total of 109,473 singleton pregnancies, 418 and 572 were exposed to enoxaparin during the first and third trimesters, respectively. Exposure to enoxaparin during the first trimester of pregnancy was not associated with an increased risk of major congenital malformations [adjusted odds ratio (aOR) 1.1, 95% confidence interval (CI) 0.8-1.6], while exposure during the third trimester was not associated with an increased risk of low birth weight (aOR 1.1, 95% CI 0.8-1.4), low Apgar score (aOR 0.9, 95% CI 0.4-1.8), or risk of perinatal mortality (aOR 0.6, 95% CI 0.1-2.9). CONCLUSION Exposure to enoxaparin during pregnancy was not associated with an increased risk of major malformations in general or according to organ systems. Nonetheless, risk for specific malformations cannot be ruled out.
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Affiliation(s)
- Meital Shlomo
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105, Israel.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Rafael Gorodischer
- Department of Pediatrics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel.,Clalit Health Services (Southern District), Beer-Sheva, Israel.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Sharon Daniel
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105, Israel.,Department of Pediatrics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Arnon Wiznitzer
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Soroka Medical Center, Beer-Sheva, Israel.,Clalit Health Services (Southern District), Beer-Sheva, Israel
| | - Ilan Matok
- The Motherisk Program, Division of Clinical Pharmacology-Toxicology, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Boris Fishman
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105, Israel.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Gideon Koren
- The Motherisk Program, Division of Clinical Pharmacology-Toxicology, Department of Pediatrics, The Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada.,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel
| | - Amalia Levy
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105, Israel. .,BeMORE Collaboration (Ben-Gurion Motherisk Obstetric Registry of Exposure Collaboration), Beer-Sheva, Israel.
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Rotem R, Fishman B, Koren G, Daniel S, Lunenfeld E, Levy A. Risk of Major Congenital Malformations after First Trimester Exposure to Topical Azoles. Clin Ther 2017. [DOI: 10.1016/j.clinthera.2017.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The objective of this paper was to identify predictors of attrition in a study designed to assess whether cognitive behavioural therapy (CBT) was more helpful than supportive therapy (SP) in reducing pain associated with peripheral neuropathy in HIV-positive patients. Sixty-one subjects were randomized into either CBT or SP for six weekly one-hour sessions. Twenty-eight subjects dropped out before week six. Demographic variables such as age, gender, ethnicity, socioeconomic status and level of education were not predictive of attrition. However, higher scores on the Hamilton Depression Inventory (HAM-D, 17-item) (t (59) = - 0.09, p<0.05) were predictive. These findings suggest that while dropouts were not more physically ill (e.g. CD4 counts, viral loads and opportunistic infections were not statistically higher), they reported greater psychological distress.
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Affiliation(s)
- L Davis
- Weill Medical College of Cornell University, New York, USA.
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Abstract
OBJECTIVE To investigate the relationship between health locus of control (HLOC), distress, and protease inhibitor (PI) utilization in gay/bisexual men in all stages of HIV illness. METHOD A total of 173 men participating in a longitudinal study of the psychological effects of HIV illness were administered a number of psychological distress measures and the HLOC scale. The association between the HLOC subscales, distress, and PI utilization was evaluated. RESULTS In addition to physical symptoms, the attribution of health status to chance or fate significantly predicted depressive symptoms, feelings of hopelessness, and recent life stress. Results also demonstrated a significant relationship between strong, positive beliefs in doctors and other health care professionals and PI utilization. CONCLUSION The results of this study point to a strong association between beliefs that health status is related to chance or fate and distress. In addition, beliefs in physicians and other health care providers appear to contribute to decisions to initiate PI therapy.
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Affiliation(s)
- S Evans
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Goggin K, Sewell M, Ferrando S, Evans S, Fishman B, Rabkin J. Plans to hasten death among gay men with HIV/AIDS: relationship to psychological adjustment. AIDS Care 2000; 12:125-36. [PMID: 10827853 DOI: 10.1080/09540120050001805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 10/27/2022]
Abstract
This study assessed the prevalence and nature of thoughts and future plans to end one's life in a group of gay men with HIV/AIDS over an 18-month period. HIV-positive men (n = 167) participated in a series of clinical interviews which measured current health status, current and past psychiatric disorders, current levels of distress, and thoughts and plans about ending their lives currently or at some future point. A small number of HIV-positive men (17%) reported serious thoughts or plans to end their lives at some point in the future which were stable over an 18-month period. No differences in psychiatric or medical measures were observed among men with and without thoughts/plans at either assessment point. In the absence of current psychiatric disorders, such thoughts or plans about the future may represent one way to maintain control and independence in the face of the uncertainty of life with HIV illness.
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Affiliation(s)
- K Goggin
- Department of Psychology, University of Missouri-Kansas City 64110, USA.
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40
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Porter RW, Steinglass R, Kaiser J, Olkhovsky P, Rasmuson M, Dzhatdoeva FA, Fishman B, Bragina V. Role of health communications in Russia's diphtheria immunization program. J Infect Dis 2000; 181 Suppl 1:S220-7. [PMID: 10657218 DOI: 10.1086/315566] [Citation(s) in RCA: 12] [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: 11/04/2022] Open
Abstract
As part of a broader program in health communication assistance, project staff from Basic Support for Institutionalizing Child Survival worked with staff from Russia's oblast (regional) public health agencies to design and implement communication activities supporting local diphtheria immunization efforts. Because aggressive community outreach efforts and strong administrative sanctions had already achieved impressive adult coverage rates for first doses of diphtheria toxoid vaccine, communication interventions emphasized the need for second and third doses. Outcomes were assessed through vaccination coverage data and more qualitative measures. In one project site, the increase in adult coverage (two or more doses) was very modest. In a second site, with a stronger communications component, coverage increased significantly (from 20% to 80%). Although it is not possible to disentangle completely the effects of communications from other aspects of oblast immunization programs, these and other outcome data suggest that health communications can play an important role in Russia's ongoing mass immunization efforts.
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Affiliation(s)
- R W Porter
- Academy for Educational Development, Washington, DC 20009-5721, USA
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Markowitz JC, Spielman LA, Sullivan M, Fishman B. An exploratory study of ethnicity and psychotherapy outcome among HIV-positive patients with depressive symptoms. J Psychother Pract Res 2000; 9:226-31. [PMID: 11069135 PMCID: PMC3330614] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Few data address the relationship between ethnic status and psychotherapy outcome. This study reports data from a four-cell, 16-week controlled clinical trial for HIV-positive patients with depressive symptoms. Patients (N = 101) were randomized to 16 weeks of treatment with interpersonal psychotherapy, cognitive-behavioral therapy (CBT), supportive psychotherapy, or imipramine plus supportive psychotherapy. Analyses found an ethnicity-by-treatment interaction wherein African-American subjects (n = 18) assigned to CBT (n = 4) had significantly poorer outcomes than other patients. This is the first study to uncover an ethnicity-by-specific psychotherapy interaction. Its meaning is unclear. This charged topic requires cautious treatment, particularly given the small sample size in this study, but warrants further research.
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Affiliation(s)
- J C Markowitz
- Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Abstract
OBJECTIVE This study was conducted to investigate the prevalence of clinical fatigue reported by gay/bisexual men at all HIV illness stages, and whether fatigue, while associated with depression, independently contributes to limitations in physical function and disability. METHOD HIV- men, HIV+ men with CD4 counts >500, HIV+ men with CD4 counts 200 to 500, and men with AIDS were compared on prevalence of clinical fatigue, as defined by a standardized instrument. Among HIV+ men, the relationships among fatigue, depressed mood, major depressive disorder, HIV illness markers (including CD4 count and HIV RNA viral load), physical limitations, and disability were assessed at baseline and after 1 year. RESULTS The prevalence of clinical fatigue in men with CD4 counts <500 was 14%, significantly higher than HIV- men and HIV+ men with CD4 counts >500. However, fatigue was not directly correlated with CD4 count or HIV RNA. Fatigue was a chronic symptom that was associated with depressed mood, major depressive disorder, physical limitations, and disability. After 1 year, an increase in depressive symptoms predicted a small amount of variance in fatigue; however, depressive symptoms were not associated with physical limitations or disability after controlling for fatigue. CONCLUSION Fatigue is a chronic symptom that is more prevalent in advanced HIV illness, and which, although associated with depression, does not seem to be merely a symptom of depression. Because fatigue contributes independently to physical limitations and disability, it should be assessed and treated.
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Affiliation(s)
- S Ferrando
- Department of Psychiatry, Cornell University Medical College, New York, New York, USA.
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Abstract
The purpose of this study was to examine the relationship among pain and depression, hopelessness, and quality of life in human immunodeficiency virus (HIV)-infected gay men, taking into account the role of HIV symptoms. One hundred sixty-one HIV+ gay men were assessed, with 40 men endorsing HIV-related pain. The HIV+ men with pain had a modal rating of pain within the mild range. They had significantly more advanced disease, more physical and depressive symptoms, and reported less life satisfaction than the men without pain. However, when HIV illness variables are accounted for, the higher depression scores in the men with pain were largely accounted for by somatic rather than cognitive symptoms. While pain is associated with greater physical distress in this cohort of HIV-seropositive gay men, it does not appear to be independently associated with cognitive symptoms of depression. These findings apply to HIV-infected men with mild pain and may not apply to those who experience more severe pain. Nonetheless, these observations highlight the overlap between symptoms of depression and pain and the challenge that clinicians face in assessing patients suffering from pain.
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Affiliation(s)
- S Evans
- Department of Psychiatry, Cornell University Medical College, New York, NY, USA.
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Markowitz JC, Kocsis JH, Fishman B, Spielman LA, Jacobsberg LB, Frances AJ, Klerman GL, Perry SW. Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry 1998; 55:452-7. [PMID: 9596048 DOI: 10.1001/archpsyc.55.5.452] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND This randomized clinical trial compared 16-week interventions with interpersonal psychotherapy, cognitive behavioral therapy, supportive psychotherapy, and supportive psychotherapy with imipramine for human immunodeficiency virus (HIV)-positive patients with depressive symptoms. METHODS Subjects (N = 101; 85 male, 16 female) with known HIV seropositivity for at least 6 months were randomized to 16 weeks of treatment. Inclusion criteria were 24-item Hamilton Depression Rating Scale score of 15 or higher, clinical judgment of depression, and physical health sufficient to attend outpatient sessions. Therapists were trained in manualized therapies specific for HIV-positive patients. Treatment adherence was monitored. RESULTS Subjects randomized to interpersonal psychotherapy (n = 24) and supportive psychotherapy with imipramine (n = 26) had significantly greater improvement on depressive measures than those receiving supportive psychotherapy (n = 24) or cognitive behavioral therapy (n = 27). Similar results appeared in the completer subsample. CONCLUSIONS Depressive symptoms appear treatable in HIV-positive patients. Interpersonal psychotherapy may have particular advantages as a psychotherapy for patients who have experienced the significant life events of HIV infection.
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Affiliation(s)
- J C Markowitz
- Cornell University Medical College, New York, NY 10021, USA.
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Ferrando S, Goggin K, Sewell M, Evans S, Fishman B, Rabkin J. Substance use disorders in gay/bisexual men with HIV and AIDS. Am J Addict 1998; 7:51-60. [PMID: 9522007] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The authors conducted a longitudinal study of psychological adaptation to AIDS in subjects with and without lifetime and current substance use disorders (SUD), in a cohort of HIV+ gay/bisexual subjects. A sample of HIV+ gay/bisexual men (n = 183) and an HIV- comparison group (n = 84) were assessed for SUD, depression, and anxiety disorders. Among HIV+ men, combined lifetime (42%) but not current (11.5%) SUDs were more prevalent than in HIV- men (27% and 10%, respectively). HIV+ men with current SUD reported more depression, distress and diminished quality of life than HIV+ men with no SUD, but HIV-illness severity did not differ. HIV+ men in recovery did not differ from men with no lifetime history. Most HIV+ gay/bisexual men with SUD discontinue or reduce substance use before or subsequent to knowledge of their HIV infection, probably in an attempt to adopt a healthier lifestyle. However, for some HIV+ men, persistent substance abuse/dependence is accompanied by higher levels of distress and diminished quality of life, underscoring their need for treatment intervention.
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Affiliation(s)
- S Ferrando
- HIV Clinical Research Program, Cornell University Medical College, New York, New York, USA.
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Gluhoski VL, Fishman B, Perry SW. The impact of multiple bereavement in a gay male sample. AIDS Educ Prev 1997; 9:521-531. [PMID: 9451480] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The effect of experiencing multiple close losses on a variety of psychological symptoms was examined in a sample of HIV positive and HIV negative gay men over 1 year. Symptoms assessed included depression, intrusive and avoidant thoughts and images, anxiety, and general distress. It was found that on average, experiencing two or more losses in the year prior to the initial interview was associated with significantly higher levels of distress in follow-up assessment over 1 year. Comparisons between subjects with two or fewer losses versus three or more losses produced the largest differences in emotional symptoms. HIV positive subjects showed higher levels of distress symptoms on all measures, except for intrusive and avoidant thoughts and images. These findings indicate that the experience of multiple close losses, which is rather common among HIV-infected gay men, chronically exacerbates their emotional distress.
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Affiliation(s)
- V L Gluhoski
- New York State Psychiatric Institute, Unit 13, New York, NY 10032, USA
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Abstract
The primary purpose of this study was to assess the prevalence of major psychiatric disorders in human immunodeficiency virus-positive (HIV+) men with acquired immune deficiency syndrome (AIDS)-defining conditions. Secondary goals were to identify correlates of distress and psychopathology, and to determine whether there is a gradient of distress associated with progressive HIV illness. One hundred twelve men with AIDS-defining conditions, 61 HIV+ men without AIDS, and 84 HIV-seronegative gay men were assessed. Measures included the Structured Clinical Interview for DSM-IV (SCID), Hamilton Rating Scale for Depression (HAM-D), and other dimensional measures of distress and outlook, as well as laboratory markers of HIV stage, including HIV RNA viral load assays. Rates of major depression, consistent with other findings, were in the 5% to 10% range. Mean scores on dimensional measures of distress and outlook were within the "not depressed" range and did not increase despite increasing HIV illness severity. However, rates of dysthymia were elevated among men with CD4 cell counts less than 500, and the cumulative rates of any current axis I depressive disorder for three of the four study groups were in the range of 15% to 20%. The strongest correlates of dimensional measures of distress were current HIV symptoms and social support, and to a lesser extent, a lifetime history of major depression and current use of antidepressants and/or anxiolytics. Overall, most men displayed effective adaptation to illness, but a significant minority experienced moderate psychological distress, which warrants consideration by health providers who serve this population.
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Affiliation(s)
- J G Rabkin
- Department of Psychiatry, Cornell University Medical College, NY, USA
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Abstract
The Patient Needs Assessment Tool (PNAT) is an interviewer-rated scale that may be completed through a simple structured interview and screens cancer patients for potential problems in physical and psychosocial functioning. The instrument provides separate scores for physical, psychological, and social status, and can potentially clarify the types of interventions needed to address specific areas of dysfunction. Reliability and validity was tested in two studies that used prescreened patient videotapes and other materials to assess the performance of the PNAT in groups of oncology nurses, physicians, and social workers. The data demonstrate that subscale scores for the physical, psychological, and social dimensions have good inter-rater reliability and internal consistency (intraclass correlation coefficients of 0.71-0.97). Criterion and construct validity was suggested through high correlations of each subscale with the evaluation of expert raters (correlation coefficients of 0.85-0.95) and with scores on validated patient-rated instruments appropriate to the functional area. These analyses suggest that the PNAT is a valid scale for the assessment of a range of functional disturbances in the cancer population.
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Affiliation(s)
- N Coyle
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Abstract
In an attempt to assess the influence of standardized diagnostic interviews on psychological distress in research volunteers, the Visual Analogue Scale (VAS) was used to measure anxiety and depression during the Structured Clinical Interview for DSM-III-R, Non-patient version (SCID). Subjects were 50 adults with concerns related to the human immunodeficiency virus who were seeking testing and treatment in research trials. Repeated measures analysis of variance showed significant decreases in distress by the end of the interview: 72% of subjects reported diminished anxiety, and 54% reported diminished depression. Thus, the SCID appeared to provide a positive interview experience, a finding that may serve to reassure subjects, their families, and review boards regarding participation in studies that employ structured interviews.
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Affiliation(s)
- P A Scarvalone
- Department of Psychiatry, Cornell University Medical Center, New York 10021, USA
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Markowitz JC, Klerman GL, Clougherty KF, Spielman LA, Jacobsberg LB, Fishman B, Frances AJ, Kocsis JH, Perry SW. Individual psychotherapies for depressed HIV-positive patients. Am J Psychiatry 1995; 152:1504-9. [PMID: 7573591 DOI: 10.1176/ajp.152.10.1504] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The authors present preliminary data from two treatment modalities of a randomized clinical trial in which they compared 16-week interventions of interpersonal psychotherapy to supportive psychotherapy. METHOD HIV-positive patients who were not acutely medically ill and had scores of 15 or higher on the Hamilton Depression Rating Scale were randomly assigned to one of four treatment modalities. They were assessed by the Hamilton scale and Beck Depression Inventory at 8 and 16 weeks. Most subjects who underwent either interpersonal psychotherapy (N = 16) or supportive psychotherapy (N = 16) were male, gay or bisexual, white, and college educated. RESULTS Results of last-observation-carried-forward and completer analyses showed that scores on the Hamilton scale and Beck Depression Inventory decreased significantly for both treatments. Differential improvement for interpersonal psychotherapy appeared by midtreatment (week 8) and persisted at termination. CONCLUSIONS This is the first controlled study of individual psychotherapies for depressed HIV-positive patients. Results suggest that a specific antidepressant psychotherapy, interpersonal psychotherapy, has advantages over a supportive therapy.
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Affiliation(s)
- J C Markowitz
- Department of Psychiatry, Cornell University Medical College, New York, NY 10021, USA
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