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Mor O, Wax M, Arami SS, Yitzhaki M, Kriger O, Erster O, Zuckerman NS. Parvovirus B19 Outbreak in Israel: Retrospective Molecular Analysis from 2010 to 2023. Viruses 2024; 16:480. [PMID: 38543845 PMCID: PMC10974090 DOI: 10.3390/v16030480] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 05/23/2024] Open
Abstract
This study presents an analysis of the epidemiological trends of parvovirus B19 (B19V) in Israel from 2010 to 2023, with particular emphasis on the outbreak in 2023. The analysis utilized molecular diagnostic data from individual patients obtained at the Central Virology Laboratory. Between 2010 and 2022, 8.5% of PCR-tested samples were positive for B19V, whereas in 2023, this percentage surged to 31% of PCR-tested samples. Throughout the study period, annual cycles consistently peaked in early spring/summer, with the most recent prominent outbreak occurring in 2016. Predominantly, diagnoses were made in children and women aged 20-39. Despite the notable surge in 2023, over 80% of positive cases continued to be observed in children and young women, with a decrease in cases during winter months. Furthermore, genotype 1a of the virus remained the predominant strain circulating during the outbreak. In light of these circumstances, consideration should be given to implementing screening measures, particularly among high-risk groups such as pregnant women.
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Affiliation(s)
- Orna Mor
- Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
| | - Shoshana-Shani Arami
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
| | - Maya Yitzhaki
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
| | - Or Kriger
- Clinical Microbiology and Pediatric Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel;
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
| | - Neta S. Zuckerman
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (M.W.); (S.-S.A.); (M.Y.); (O.E.); (N.S.Z.)
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Azuri E, Wax M, Gozlan Y, Wagner T, Mor O. Recent HIV-1 infection in Israel 2017-2021: Evaluation of geenius and HIV-1/2 combo assays for identifying recent infection detected by Sedia assay and assessment of factors related to recent infection: Recent HIV-1 infection in Israel. J Clin Virol 2024; 170:105624. [PMID: 38118239 DOI: 10.1016/j.jcv.2023.105624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Estimating HIV-1 recency of infection for incidence and local outbreaks detection usually involves specifically designed assays. Here, we established an approach to identify recent infections, estimate their rate, and assess potential risk factors. METHODS Randomly selected HIV-1 positive samples (n = 382) collected in 2017-2021 were tested by Sedia and compared to the results of Geenius recency algorithm and the S/CO values of the HIV-1/2 Combo assay. Using Geenius and Combo recency verdict, we assessed all cases diagnosed in 2017-2021. Related factors were further assessed. RESULTS While Geenius and Combo had a sensitivity of 65.9 % and 89.30 %, respectively, and specificity of 96 % and 90 %, respectively, compared to Sedia, higher concordance (97.2 %) and kappa (>0.9) were observed when the verdict of both assays together was compared to Sedia. Using this approach, 15.3 % (238/1548) of individuals diagnosed in 2017-2021 were defined as recently infected. In multivariate analysis, recent diagnosis was mainly associated with men who have sex with men (MSM) and with birthplace in Israel, Western/Central Europe, or North America. CONCLUSIONS Only 15.3 % of infections in 2017-2021, mainly in MSM and Israeli/Western countries-born individuals, were diagnosed early. Regular diagnostic assays have a potential to identify and monitor trends in recent infections.
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Affiliation(s)
- Eyal Azuri
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Marina Wax
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel
| | - Yael Gozlan
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel
| | - Tali Wagner
- Faculty of Medicine, Tel-Aviv University, Israel
| | - Orna Mor
- Faculty of Medicine, Tel-Aviv University, Israel; National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ministry of Health, Ramat Gan, Israel.
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Wagner T, Levy I, Elbirt D, Shahar E, Olshtain-Pops K, Elinav H, Chowers M, Istomin V, Riesenberg K, Geva D, Zuckerman NS, Wax M, Shirazi R, Gozlan Y, Matus N, Girshengorn S, Marom R, Mendelson E, Mor O, Turner D. Factors Associated with Virological Failure in First-Line Antiretroviral Therapy in Patients Diagnosed with HIV-1 between 2010 and 2018 in Israel. Viruses 2023; 15:2439. [PMID: 38140680 PMCID: PMC10748212 DOI: 10.3390/v15122439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/30/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
Despite the progress in contemporary antiretroviral therapy (ART) and the continuous changes in treatment guidelines, virological failure (VF) is still an ongoing concern. The goal of this study was to assess factors related to VF after first-line ART. A longitudinal cohort retrospective study of individuals on first-line ART diagnosed with HIV-1 in 2010-2018 and followed-up for a median of two years was conducted. Demographics, baseline and longitudinal CD4 counts, treatment regimens, adherence and VF were recorded. The Cox proportional hazards regression and mixed models were used. A cohort of 1130 patients were included. Overall, 80% were males and 62% were Israeli-born individuals. Compared to individuals diagnosed in 2010-2014, when treatment was initiated according to CD4 levels, those diagnosed in 2015-2018 were older and had lower baseline CD4 counts. VF was recorded in 66 (5.8%) patients. Diagnosis with CD4 <200 cells/mmᶟ with AIDS-defining conditions (HR = 2.75, 95%CI:1.52-4.97, p < 0.001) and non-integrase strand transfer inhibitor regimens (non-INSTI, HR = 1.80, 95%CI:1.01-3.24, p = 0.047) increased VF risk. No impact of baseline resistance was observed. We concluded that the early detection of HIV-1 infection and usage of INSTI-based regimens are recommended to reduce VF.
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Affiliation(s)
- Tali Wagner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Itzchak Levy
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Daniel Elbirt
- Faculty of Medicine, Hadassah Braun School of Public Health & Community Medicine, The Hebrew University, Jerusalem 9112102, Israel; (D.E.); (H.E.)
- Immunology, Kaplan Medical Center, Rehovot 76100, Israel
| | - Eduardo Shahar
- Immunology Unit, Rambam Health Care Campus, Haifa 3109601, Israel;
- Rappaport Faculty of Medicine, Institute of Technology, Technion, Haifa 3109601, Israel
| | | | - Hila Elinav
- Faculty of Medicine, Hadassah Braun School of Public Health & Community Medicine, The Hebrew University, Jerusalem 9112102, Israel; (D.E.); (H.E.)
- Hadassah Medical Center, Jerusalem 9112102, Israel;
| | - Michal Chowers
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Infectious Diseases, Meir Medical Center, Kfar Saba 4428164, Israel
| | | | - Klaris Riesenberg
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 8410501, Israel;
- Infectious Disease Institute, Soroka Medical Center, Beersheba 84101, Israel
| | - Dikla Geva
- Integristat Ltd., Tel Aviv 69051, Israel;
| | - Neta S. Zuckerman
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Marina Wax
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Rachel Shirazi
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Yael Gozlan
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Natasha Matus
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (N.M.); (S.G.); (R.M.)
| | - Shirley Girshengorn
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (N.M.); (S.G.); (R.M.)
| | - Rotem Marom
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (N.M.); (S.G.); (R.M.)
| | - Ella Mendelson
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Orna Mor
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- National HIV-1 and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Dan Turner
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Ichilov Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (N.M.); (S.G.); (R.M.)
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Zuckerman NS, Schwartz E, Pandey P, Erster O, Halpern O, Bucris E, Morad-Eliyahu H, Wax M, Lustig Y. Dengue Types 1 and 3 Identified in Travelers Returning from Kathmandu, Nepal, during the October 2022 Outbreak Are Related to Strains Recently Identified in India. Viruses 2023; 15:2334. [PMID: 38140575 PMCID: PMC10921925 DOI: 10.3390/v15122334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Phylogenetic analysis of dengue serotypes 1 and 3, which were diagnosed in travelers and Nepalese infected in Kathmandu during the October 2022 outbreak, revealed that both serotypes were clustered closest to the sequences sampled in India. This suggests both serotypes may have originated in India.
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Affiliation(s)
- Neta S. Zuckerman
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Eli Schwartz
- The Center for Travel and Tropical Medicine, Sheba Medical Center, Tel Hashomer 52621, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - Prativa Pandey
- CIWEC Hospital and Travel Medicine Center, Kathmandu 44600, Nepal;
| | - Oran Erster
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Osnat Halpern
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Efrat Bucris
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Hagar Morad-Eliyahu
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; (O.E.); (O.H.); (E.B.); (H.M.-E.); (M.W.); (Y.L.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
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Zuckerman NS, Bar-Or I, Sofer D, Bucris E, Morad H, Shulman LM, Levi N, Weiss L, Aguvaev I, Cohen Z, Kestin K, Vasserman R, Elul M, Fratty IS, Geva M, Wax M, Erster O, Yishai R, Hecht-Sagie L, Alroy-Preis S, Mendelson E, Weil M. Emergence of genetically linked vaccine-originated poliovirus type 2 in the absence of oral polio vaccine, Jerusalem, April to July 2022. Euro Surveill 2022; 27. [PMID: 36111556 PMCID: PMC9479469 DOI: 10.2807/1560-7917.es.2022.27.37.2200694] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report an emergence and increase in poliovirus type 2 detection via routine wastewater surveillance in three non-overlapping regions in the Jerusalem region, Israel, between April and July 2022. Sequencing showed genetic linkage among isolates and accumulation of mutations over time, with two isolates defined as vaccine-derived polioviruses (VDPV). This demonstrates the emergence and potential circulation of type 2 VDPV in a high-income country with high vaccine coverage and underscores the importance of routine wastewater surveillance during the polio eradication.
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Affiliation(s)
- Neta S Zuckerman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Itay Bar-Or
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Danit Sofer
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Efrat Bucris
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Hagar Morad
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Lester M Shulman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Nofar Levi
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Leah Weiss
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Irina Aguvaev
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Zvi Cohen
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Klil Kestin
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Rinat Vasserman
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Michal Elul
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ilana S Fratty
- The Israel Center for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Miranda Geva
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Marina Wax
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Oran Erster
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Ruth Yishai
- Department of Laboratories, Public Health Services, Ministry of Health, Jerusalem, Israel
| | | | | | - Ella Mendelson
- School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Merav Weil
- Central Virology Laboratory, Public Health Services, Ministry of Health, Chaim Sheba Medical Center, Ramat Gan, Israel
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Wagner T, Zuckerman NS, Wax M, Shirazi R, Gozlan Y, Girshengorn S, Marom R, Mendelson E, Turner D, Mor O. HIV-1 Circulating Recombinant Forms (CRFs) and Unique Recombinant Forms (URFs) in Israel, 2010-2018. Viruses 2022; 14:v14091970. [PMID: 36146776 PMCID: PMC9502407 DOI: 10.3390/v14091970] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Monitoring HIV-1 circulating recombinant forms (CRFs) and unique recombinant forms (URFs) is important for disease surveillance. Recombination may affect prevention efforts and interfere with the diagnosis and treatment of HIV-1 infection. Here, we characterized the epidemiology of HIV-1 CRFs and URFs in Israel. Partial pol sequences from treatment naïve patients diagnosed in 2010−2018 were assessed using the recombinant identification program (RIP), the recombinant detection program (RDP5), and using the maximum-likelihood phylogenetic method, using 410 reference sequences obtained from the Los Alamos database. CRFs and URFs were identified in 11% (213/1940) of all sequenced cases. The median age at diagnosis was 38 (30−47) years, 61% originated from Israel, and 82% were male. The most common were CRF02_AG (30.5%), CRF01_AE (16.9%), and the more complex forms CRF01_AE/CRF02_AG/A3 (10.8%) and B/F1 (7%). A significant increase in their overall proportion was observed in recent years (8.1% in 2010−2012, 20.3% in 2016−2018, p < 0.001). This increase was most prominent in individuals carrying CRF02_AG (2.5% in 2010−2015, 9.8% in 2016−2018, p < 0.001). Men who have sex with men (MSM) was the most common risk group; however, those infected with the secondary recombinant CRF02_AG/A6 were mainly injecting drug users (IDUs). The most common resistance mutations were K103N (5/213, 2.3%) and E138A (18/213, 8.5%) in the reverse transcriptase. Only E138A was more frequent in the recombinants compared with the classic subtypes and was significantly associated with a specific secondary CRF, CRF02_AG/A4. We concluded that CRFs and URFs were mainly detected in Israeli-born MSM and that an increase in the overall proportion of such HIV-1 sequences could be observed in more recent years.
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Affiliation(s)
- Tali Wagner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
- Correspondence: (T.W.); (O.M.); Tel.: +972-3-5302458 (T.W. & O.M.)
| | - Neta S. Zuckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Rachel Shirazi
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Yael Gozlan
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Shirley Girshengorn
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Rotem Marom
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Ella Mendelson
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
| | - Dan Turner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel
| | - Orna Mor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan 5262112, Israel
- Correspondence: (T.W.); (O.M.); Tel.: +972-3-5302458 (T.W. & O.M.)
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Szwarcwort M, Wax M, Halutz O, Mendelson E, Mor O. Evaluation of Biotrin, Serion and Euroimmun Commercial Assays for the Detection of Parvovirus B19-Specific IgM and IgG Antibodies. Diagn Microbiol Infect Dis 2022; 103:115723. [DOI: 10.1016/j.diagmicrobio.2022.115723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
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Wagner T, Zuckerman NS, Halperin T, Chemtob D, Levy I, Elbirt D, Shachar E, Olshtain-Pops K, Elinav H, Chowers M, Itsomin V, Riesenberg K, Wax M, Shirazi R, Gozlan Y, Matus N, Girshengorn S, Marom R, Mendelson E, Turner D, Mor O. Epidemiology and Transmitted HIV-1 Drug Resistance among Treatment-Naïve Individuals in Israel, 2010-2018. Viruses 2021; 14:v14010071. [PMID: 35062274 PMCID: PMC8779053 DOI: 10.3390/v14010071] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 01/22/2023] Open
Abstract
Despite the low prevalence of HIV-1 in Israel, continuous waves of immigration may have impacted the local epidemic. We characterized all people diagnosed with HIV-1 in Israel in 2010–2018. The demographics and clinical data of all individuals (n = 3639) newly diagnosed with HIV-1 were retrieved. Subtypes, transmitted drug-resistance mutations (TDRM), and phylogenetic relations, were determined in >50% of them. In 39.1%, HIV-1 transmission was through heterosexual contact; 34.3% were men who have sex with men (MSM); and 10.4% were people who inject drugs. Many (>65%) were immigrants. Israeli-born individuals were mostly (78.3%) MSM, whereas only 9% of those born in Sub-Saharan Africa (SSA), Eastern Europe and Central Asia (EEU/CA), were MSM. The proportion of individuals from SSA decreased through the years 2010–2018 (21.1% in 2010–2012; 16.8% in 2016–2018) whereas those from EEU/CA increased significantly (21% in 2010–2012; 27.8% in 2016–2018, p < 0.001). TDRM were identified in 12.1%; 3.7, 3.3 and 6.6% had protease inhibitors (PI), nucleotide reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI) TDRM, respectively, with the overall proportion remaining stable in the studied years. None had integrase TDRM. Subtype B was present in 43.9%, subtype A in 25.2% (A6 in 22.8 and A1 in 2.4%) and subtype C in 17.1% of individuals. Most MSM had subtype B. Subtype C carriers formed small clusters (with one unexpected MSM cluster), A1 formed a cluster mainly of locally-born patients with NNRTI mutations, and A6 formed a looser cluster of individuals mainly from EEU. Israelis, <50 years old, carrying A1, had the highest risk for having TDRM. In conclusion, an increase in immigrants from EEU/CA and a decrease in those from SSA characterized the HIV-1 epidemic in 2010–2018. Baseline resistance testing should still be recommended to identify TDRM, and improve surveillance and care.
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Affiliation(s)
- Tali Wagner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Neta S. Zuckerman
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Tami Halperin
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (T.H.); (N.M.); (S.G.); (R.M.)
| | - Daniel Chemtob
- Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; (D.C.); (D.E.); (H.E.)
- Tuberculosis and AIDS Department, Ministry of Health, Jerusalem 9101002, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Chaim Sheba Medical Center, Infectious Disease Unit, Ramat Gan 5262112, Israel
| | - Daniel Elbirt
- Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; (D.C.); (D.E.); (H.E.)
- Immunology, Kaplan Medical Center, Rehovot 76100, Israel
| | - Eduardo Shachar
- Immunology Unit, Rambam Health Care Campus, Haifa 3109601, Israel;
- Rappaport Faculty of Medicine, Institute of Technology, Technion, Haifa 3200003, Israel
| | | | - Hila Elinav
- Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem 9112102, Israel; (D.C.); (D.E.); (H.E.)
- Hadassah Medical Center, Jerusalem 9112102, Israel;
| | - Michal Chowers
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Infectious Diseases, Meir Medical Center, Kfar Saba 4428164, Israel
| | | | - Klaris Riesenberg
- Faculty of Health Sciences, Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel;
- Soroka Medical Center, Infectious Disease Institute, Beer-Sheva 84101, Israel
| | - Marina Wax
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Rachel Shirazi
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Yael Gozlan
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Natasha Matus
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (T.H.); (N.M.); (S.G.); (R.M.)
| | - Shirley Girshengorn
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (T.H.); (N.M.); (S.G.); (R.M.)
| | - Rotem Marom
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (T.H.); (N.M.); (S.G.); (R.M.)
| | - Ella Mendelson
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
| | - Dan Turner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Tel-Aviv Sourasky Medical Center, Crusaid Kobler AIDS Center, Tel Aviv 6423906, Israel; (T.H.); (N.M.); (S.G.); (R.M.)
| | - Orna Mor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel; (T.W.); (I.L.); (M.C.); (E.M.); (D.T.)
- Chaim Sheba Medical Center, National HIV-1 and Viral Hepatitis Reference Laboratory, Ramat Gan 5262112, Israel; (N.S.Z.); (M.W.); (R.S.); (Y.G.)
- Correspondence: ; Tel.: +972-3-530-2458
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Shirazi R, Pozzi P, Gozlan Y, Wax M, Lustig Y, Linial M, Mendelson E, Bardenstein S, Mor O. Identification of Hepatitis E Virus Genotypes 3 and 7 in Israel: A Public Health Concern? Viruses 2021; 13:v13112326. [PMID: 34835132 PMCID: PMC8625709 DOI: 10.3390/v13112326] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Hepatitis E (HEV) is an emerging cause of viral hepatitis worldwide. Swine carrying hepatitis E genotype 3 (HEV-3) are responsible for the majority of chronic viral hepatitis cases in developed countries. Recently, genotype 7 (HEV-7), isolated from a dromedary camel in the United Arab Emirates, was also associated with chronic viral hepatitis in a transplant recipient. In Israel, chronic HEV infection has not yet been reported, although HEV seroprevalence in humans is ~10%. Camels and swine are >65% seropositive. Here we report on the isolation and characterization of HEV from local camels and swine. Methods: Sera from camels (n = 142), feces from swine (n = 18) and blood from patients suspected of hepatitis E (n = 101) were collected during 2017–2020 and used to detect and characterize HEV sequences. Results: HEV-3 isolated from local swine and the camel-derived HEV-7 sequence were highly similar to HEV-3f and HEV-7 sequences (88.2% and 86.4%, respectively) related to viral hepatitis. The deduced amino acid sequences of both isolates were also highly conserved (>98%). Two patients were HEV-RNA positive; acute HEV-1 infection could be confirmed in one of them. Discussion: The absence of any reported HEV-3 and HEV-7 infection in humans remains puzzling, especially considering the reported seroprevalence rates, the similarity between HEV sequences related to chronic hepatitis and the HEV genotypes identified in swine and camels in Israel.
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Affiliation(s)
- Rachel Shirazi
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
| | - Paolo Pozzi
- Department of Veterinary Sciences, University of Torino, 10095 Grugliasco, Italy;
| | - Yael Gozlan
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Michal Linial
- Institute of Life Sciences, The Hebrew University of Jerusalem, Jerusalem 91904, Israel;
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | | | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Public Health Services, The Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan 52620, Israel; (R.S.); (Y.G.); (M.W.); (Y.L.); (E.M.)
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Correspondence: ; Tel.: +972-3-530-2458
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10
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Wagner T, Olshtain-Pops K, Wax M, Horwitz O, Shirazi R, Gozlan Y, Volnowitz H, Mendelson E, Levy I, Mor O. HIV-1 infection among women in Israel, 2010-2018. BMC Infect Dis 2020; 20:660. [PMID: 32894102 PMCID: PMC7487961 DOI: 10.1186/s12879-020-05389-6] [Citation(s) in RCA: 4] [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: 05/10/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Although women comprise 33% of the HIV-1-carriers in Israel, they have not previously been considered a risk group requiring special attention. Immigration waves from countries in Africa and in East Europe may have changed the local landscape of women diagnosed with HIV-1. Here, we aimed to assess viral and demographic characteristics of HIV-1-positive women identified in Israel between 2010 and 2018. METHODS All > 16 year-old, HIV-1-infected women, diagnosed in Israel in 2010-2018, (n = 763) registered in the National HIV reference laboratory were included in this cross-sectional study. Demographic and clinical characteristics were extracted from the database. Viral subtypes and transmitted drug resistance mutations (TDRM) were determined in 337 (44.2%) randomly selected samples collected from treatment-naive women. RESULTS Median age at diagnosis was 38 years. Most (73.3%) women were immigrants from the former Soviet Union (FSU) (41.2%, 314) or sub-Saharan Africa (SSA) (32.2%, 246) and carried subtype A (79.7%) or C (90.3%), respectively. Only 11.4% (87) were Israeli-born women. Over the years, the prevalence of women from SSA decreased while that of women from FSU increased significantly (p < 0.001). The median CD4+ cell count was 263 cells/mm3, and higher (391 cells/mm3) in Israeli-born women. TDRM were identified in 10.4% of the tested samples; 1.8, 3 and 7.1% had protease inhibitors (PI), nucleotide reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) TDRM, respectively. The prevalence of women with NNRTI TDRM significantly increased from 4.9% in 2010-2012 to 13.3% in 2016-2018. Israeli-born women had the highest prevalence (16.3%) of NNRTI TDRM (p = 0.014). NRTI A62 (5.6%), NNRTI E138 and K103 (5.6 and 4.2%, respectively) were the most prominent mutated sites. CONCLUSIONS Most HIV-1-positive women diagnosed in Israel in 2010-2018 were immigrants, with the relative ratio of FSU immigrants increasing in recent years. The high proportion of women diagnosed with resistance mutations, particularly, the yearly increase in the frequency of NNRTI mutations, support the national policy of resistance testing at baseline.
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Affiliation(s)
- Tali Wagner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel.,National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | | | - Marina Wax
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Olivia Horwitz
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Rachel Shirazi
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Yael Gozlan
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Hadar Volnowitz
- National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Ella Mendelson
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel.,National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
| | - Itzchak Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel.,Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Orna Mor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel. .,National HIV and Viral Hepatitis Reference Laboratory, Chaim Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
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11
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Shirazi R, Pozzi P, Wax M, Bar-Or I, Asulin E, Lustig Y, Mendelson E, Ben-Ari Z, Schwartz E, Mor O. Hepatitis E in pigs in Israel: seroprevalence, molecular characterisation and potential impact on humans. ACTA ACUST UNITED AC 2019; 23. [PMID: 30621824 PMCID: PMC6290533 DOI: 10.2807/1560-7917.es.2018.23.49.1800067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IntroductionThe zoonotic hepatitis E virus (HEV) genotype 3 (HEV-G3) has become a common cause of acute and chronic hepatitis among humans worldwide. In Israel, while HEV-3 sequences have previously been detected in sewage, only the non-zoonotic HEV-G1 genotype has been found in samples from human patients.AimIn this pilot study, we aimed to assess the status of HEV in a sample of the swine population and among swine farm workers in Israel.MethodsPig blood (n = 141) and faecal samples (n = 39), pig farm sewage samples (n = 8) and blood from farm workers (n = 24) were collected between February 2016 and October 2017. Anti-HEV IgG was detected using the Wantai assay. HEV RNA was analysed with the RealStar HEV kit. HEV open reading frame 1 fragments amplified from representative HEV RNA-positive samples were used for phylogenetic analysis.ResultsOverall prevalence of HEV antibodies in pigs was 75.9% (107/141). HEV RNA was detected in plasma (2.1%, 3/141), faecal (22.8%, 18/79) and pig sewage (4/8) samples. Pig and sewage-derived viral sequences clustered with previously identified human sewage HEV-G3 sequences. Most pig farms workers (23 of 24) were HEV-seropositive; none was viraemic or reported previous clinical signs.ConclusionsThis study showed that domestic pigs in Israel are infected with HEV-G3. The high HEV seropositivity of the farm workers together with the previous identification of this virus in human sewage suggests circulation to humans. The clinical impact of these findings on public health should be further explored.
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Affiliation(s)
- Rachel Shirazi
- These authors contributed equally to this article.,Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Paolo Pozzi
- Israel Ministry of Agriculture and Rural Development Plant Protection and Inspection Services, Veterinary Services Beit Dagan, Beit Dagan, Israel.,These authors contributed equally to this article
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Itay Bar-Or
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Efrat Asulin
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yaniv Lustig
- Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- School of Public Health, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Ziv Ben-Ari
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Liver Diseases Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Eli Schwartz
- Center for Geographic Medicine and Tropical Diseases, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Mor
- School of Public Health, Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel.,Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
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12
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Stoyanov E, Gozlan Y, Wax M, Levin E, Shvartz L, Shinar E, Mendelson E, Mor O. HIV-1/2 screening in blood centers: implementing a two-step serological screening assay approach to reduce donor deferral. Transfusion 2019; 59:2054-2060. [PMID: 30893485 DOI: 10.1111/trf.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening blood donations for human immunodeficiency virus 1/2 (HIV-1/2) infection in blood centers is often done with a highly sensitive 3rd-generation immunoassay which may cause false-positive results. Donations found repeatedly reactive (RR) are discarded regardless of negative HIV-1/2 nucleic acid testing (NAT) and confirmatory assays results. These donors are notified and deferred if RR in a subsequent donation. We evaluated the introduction of a secondary 4th-generation serological assay to the overall algorithm performance. METHODS All donations collected between January 2016 and May 2018 (574,338) were screened using 3rd-generation immunoassay (PRISM HIV O Plus) and NAT (Procleix Ultrio/Ultrio Elite). Serology RR donations were tested with 4th-generation Architect HIV Ag/Ab Combo and Vidas HIV Duo Ultra and a confirmatory assay (Geenius HIV-1/2). RESULTS The two 4th-generation assays found that 86% (179/209 on Architect) and 94% (182/193 on Vidas) of the 3rd-generation immunoassay RR were negative for HIV-1/2, which were also negative by confirmatory assay. Only 14% (30/209 on Architect) and 6% (11/193 on Vidas) that were 3rd-generation HIV-1/2 RR required confirmation, of which eight donors were confirmed as HIV positive. The probability of missing an HIV-1 infected donor by this algorithm is one in a million RR cases. CONCLUSION The introduction of a two-step serological screening algorithm in blood centers whereby 4th-generation assay will be performed for all 3rd-generation RR blood donors will reduce the number of donations requiring confirmation, save time and money, and most importantly, reduce the number of discarded blood donations and allow re-entry processes.
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Affiliation(s)
- Evgeniy Stoyanov
- National Blood Services Center, Magen David Adom, Ramat-Gan, Israel
| | - Yael Gozlan
- Central Virology Laboratory, Sheba Medical Center, Ministry of Health, Ramat-Gan, Israel
| | - Marina Wax
- Central Virology Laboratory, Sheba Medical Center, Ministry of Health, Ramat-Gan, Israel
| | - Evelina Levin
- National Blood Services Center, Magen David Adom, Ramat-Gan, Israel
| | - Lea Shvartz
- National Blood Services Center, Magen David Adom, Ramat-Gan, Israel
| | - Eilat Shinar
- National Blood Services Center, Magen David Adom, Ramat-Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Sheba Medical Center, Ministry of Health, Ramat-Gan, Israel
- School of Public Health, Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Orna Mor
- Central Virology Laboratory, Sheba Medical Center, Ministry of Health, Ramat-Gan, Israel
- School of Public Health, Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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13
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Moscona R, Ram D, Wax M, Bucris E, Levy I, Mendelson E, Mor O. A17 Transmitted drug-resistant mutations among recently infected HIV-1 patients in Israel, 2000–2014. Virus Evol 2018. [PMCID: PMC5905448 DOI: 10.1093/ve/vey010.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Roy Moscona
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Daniela Ram
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Efrat Bucris
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- School of Public Health, Tel Aviv University, Ramat-Aviv, Israel
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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14
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Rakovsky A, Gozlan Y, Bassal R, Wax M, Shirazi R, Bakhanashvili M, Kra-Oz Z, Radian-Sade S, Ben-Zvi H, Schreiber L, Wolf DG, Shemer-Avni Y, Chemtob D, Mendelson E, Mor O. Diagnosis of HIV-1 infection: Performance of Xpert Qual and Geenius supplemental assays in fourth generation ELISA-reactive samples. J Clin Virol 2018; 101:7-10. [PMID: 29414189 DOI: 10.1016/j.jcv.2018.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/11/2018] [Accepted: 01/14/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Architect (AR) and Vidas (VD) fourth generation HIV screening immunoassays, which identify early stages of HIV infections, could have false positive results especially at low signal/cutoff (S/C) AR values. Geenius HIV1/2 (GS) is a specific confirmation line immunoassay that is not highly sensitive to early HIV infections. An HIV-1 RNA assay may better detect such infections. OBJECTIVES To evaluate all AR-VD reactive samples with GS results, and to assess Xpert Qual HIV-1 RNA assay (XQ) as an alternative to GS, in the first low S/C AR-VD-reactive samples from a tested individual. STUDY DESIGN First AR-VD-reactive-GS-tested results from all individuals with resolved HIV status, collected between March 2015 and March 2017 (n = 749), were retrospectively assessed. Samples with AR-VD-reactive-GS-discordant results and those with low S/C AR-VD-reactive results, were tested by XQ. Receiver operating characteristic (ROC) analysis of GS and XQ sensitivity/specificity was performed. RESULTS Overall, 94.1% (705/749) of AR-VD-reactive results were true HIV-1 positive. All samples with <3 S/C AR values were false positive. XQ resolved all first samples with AR-VD-reactive-GS-discordant results. The diagnostic accuracy of XQ in low (≤33 S/C) AR-VD-reactive samples was better than that of GS (97.6%, 81/83 versus 73.5%, 61/83, p < 0.01). ROC analysis for low S/C AR samples was optimal for pooled XQ and GS results. CONCLUSIONS Incorporating XQ in the current screening algorithm for the first AR-VD-reactive-GS-discordant samples may significantly reduce overall turn-around time of HIV-1 diagnosis.
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Affiliation(s)
- Aviya Rakovsky
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Gozlan
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Ravit Bassal
- Israel Center for Disease Control, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Marina Wax
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Rachel Shirazi
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Mary Bakhanashvili
- HIV Laboratory, Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Zipi Kra-Oz
- Virology Laboratory, Rambam Medical Center, Haifa, Israel
| | | | - Haim Ben-Zvi
- Virology Laboratory, Rabin Medical Center, Petach Tikva, Israel
| | | | - Dana G Wolf
- Virology Laboratory, Hadassah Medical Center, Jerusalem, Israel; Hadassah University Medical School, Jerusalem, Israel
| | | | - Daniel Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel; Faculty of Medicine, Braun School of Public Health & Community Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Ella Mendelson
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Orna Mor
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel; School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel.
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15
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Moscona R, Ram D, Wax M, Bucris E, Levy I, Mendelson E, Mor O. Comparison between next-generation and Sanger-based sequencing for the detection of transmitted drug-resistance mutations among recently infected HIV-1 patients in Israel, 2000-2014. J Int AIDS Soc 2017; 20:21846. [PMID: 28799325 PMCID: PMC5577736 DOI: 10.7448/ias.20.1.21846] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/22/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Transmitted drug-resistance mutations (TDRM) may hamper successful anti-HIV-1 therapy and impact future control of the HIV-1 epidemic. Recently infected, therapy-naïve individuals are best suited for surveillance of such TDRM. In this study, TDRM, detected by next-generation sequencing (NGS) were compared to those identified by Sanger-based population sequencing (SBS) in recently infected HIV-1 patients. METHODS Historical samples from 80 recently infected HIV-1 patients, diagnosed between 2000 and 2014, were analysed by MiSeq (NGS) and ABI (SBS). DeepChek-HIV (ABL) was used for interpretation of the results. RESULTS Most patients were males (80%); Men who have sex with men (MSM) was the major transmission group (58.8%). Overall, TDRM were detected in 31.3% of patients by NGS and 8.8% by SBS, with SBS TDRM restricted to persons infected with subtype B. All SBS-detected TDRM were identified by NGS. The prevalence of TDRM impacting protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI) was 11.3, 26.2 7.5%, respectively, in NGS analyses and 0, 3.8 and 5%, respectively, in SBS analyses. More patients with NGS and SBS TDRM were identified in 2008-2014 (37.2% or 13.9%, respectively) compared to 2000-2007 (24.3% or 2.7%, respectively), and a significantly greater number of these patients had multiple NGS TDRM. The most abundant, albeit, minor-frequency RT TDRM, were the K65R and D67N, while K103N, M184V and T215S were high-frequency mutations. Minor TDRM did not become a major variant in later samples and did not hinder successful treatment. CONCLUSIONS NGS can replace SBS for mutation detection and allows for the detection of low-frequency TDRM not identified by SBS. Although rates of TDRM in Israel continued to increase from 2000 to 2014, minor TDRM did not become major species. The need for ongoing surveillance of low-frequency TDRM should be revisited in a larger study.
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Affiliation(s)
- Roy Moscona
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Daniela Ram
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Marina Wax
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Efrat Bucris
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
| | - Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Ella Mendelson
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
- School of Public Health, Tel Aviv University, Ramat-Aviv, Israel
| | - Orna Mor
- Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat-Gan, Israel
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Michaeli M, Wax M, Gozlan Y, Rakovsky A, Mendelson E, Mor O. Evaluation of Xpert HIV-1 Qual assay for resolution of HIV-1 infection in samples with negative or indeterminate Geenius HIV-1/2 results. J Clin Virol 2015; 76:1-3. [PMID: 26761545 DOI: 10.1016/j.jcv.2015.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 12/22/2015] [Accepted: 12/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Diagnosis of HIV infection is a multistage algorithm. Following screening with 4(th) generation combination immunoassay, confirmation of HIV infection is performed with an antibody assay that differentiates HIV-1 from HIV-2 infection. In the newly updated algorithm, samples that are nonreactive or indeterminate in the differentiation assay are to be tested with an HIV-1 nucleic acid amplification (NAAT) test for resolution. Xpert HIV-1 Qual is a new NAAT assay approved for the identification of HIV infection in whole and dried blood. OBJECTIVES To assess the performance of Xpert HIV-1 Qual supplementary assay in resolving the clinical status of serum samples reactive by 4(th) generation immunoassays and indeterminate or negative by Geenius HIV-1/2 confirmatory assay. STUDY DESIGN In a retrospective study, samples from 97 individuals for whom the true HIV-1 status was already known (by follow-up samples) and which were negative or indeterminate by HIV-1/2 Geenius assay were tested with Xpert Qual HIV-1 assay. RESULTS Xpert Qual assay correctly classified all 97 samples from HIV-1 positive (n=49) and negative (n=48) individuals. The sensitivity and specificity of Xpert Qual when using the true HIV status as a reference were 100% (92.7-100% at 95% confidence interval [CI] and 92.6-100% at 95% CI, respectively). CONCLUSIONS Applying Xpert Qual HIV-1 assay in the new HIV multi-stage diagnostic algorithm correctly classified 100% of HIV-1 infections including 49 from HIV-1 carriers who have not yet seroconverted. With this assay the total time required for acute HIV diagnosis could be significantly reduced.
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Affiliation(s)
- Michal Michaeli
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Marina Wax
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Yael Gozlan
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Aviya Rakovsky
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel
| | - Ella Mendelson
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Orna Mor
- National HIV Reference Laboratory, Central Virology Laboratory, Ministry of Health, Tel-Hashomer, Ramat-Gan, Israel.
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Mor O, Bassal R, Michaeli M, Wax M, Ram D, Cohen-Ezra O, Cohen D, Mendelson E, Ben-Ari Z, Shohat T. Prevalence of hepatitis E virus antibodies, Israel, 2009-2010. Emerg Infect Dis 2015; 21:692-4. [PMID: 25811302 PMCID: PMC4378505 DOI: 10.3201/eid2104.140245] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We investigated prevalence of hepatitis E virus in a sample of the population of Israel. The overall seroprevalence of antibodies to the virus was 10.6% (95% CI 8.4%-13.0%); age-adjusted prevalence was 7.6%. Seropositivity was associated with age, Arab ethnicity, low socioeconomic status, and birth in Africa, Asia, or the former Soviet Union.
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Petrisor D, Pittman A, Wax M, Steele E, Chamberlain W. Submandibular Gland Transfer in the Treatment of Severe Dry Eye Syndrome. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.009] [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: 10/26/2022]
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Janne P, Wax M, Leach J, Engelman J. 552 POSTER Targeting MET with XL184 to reverse EGFR tyrosine kinase inhibitor (TKI) resistance in NSCLC: impact of preclinical studies on clinical trial design. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)72486-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Cohen J, Stock M, Chan B, Meininger M, Wax M, Andersen P, Everts E. Microvascular reconstruction and tracheotomy are significant determinants of resource utilization in head and neck surgery. Arch Otolaryngol Head Neck Surg 2000; 126:947-9. [PMID: 10922225 DOI: 10.1001/archotol.126.8.947] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Successful "critical pathway" design and implementation are dependent on appropriate patient stratification according to those factors that are primary determinants of resource utilization. OBJECTIVES To test the validity of our previously reported critical pathway design and to determine whether tracheotomy and microvascular reconstruction (MR) are primary determinants of resource utilization. DESIGN Cost-effectiveness analysis. SETTING Tertiary referral academic institution. METHODS Retrospective analysis of data from 133 head and neck surgery cases in which the treatment regimen was based on critical pathways over a 26-month period. OUTCOME MEASURES Length of stay and total patient charges were used as indices of resource utilization. One-way analysis of variance and t tests were used for statistical analysis of significance. RESULTS Ninety patients (67.7%) underwent MR; 43 (32. 3%) did not. Seventy-five patients (56.4%) underwent tracheotomy; 58 (43.6%) did not. Four patient groups were constructed in decreasing order of complexity as follows: group 1, patients who underwent both tracheotomy and MR (n = 58); group 2, patients who underwent MR alone (n = 32); group 3, patients who underwent tracheotomy alone (n = 17); and group 4, patients who did not undergo either procedure (n = 26). Both tracheotomy and MR were found to be independent determinants of resource utilization and were additive when both were present. The length of stay varied from 8.4 days (in patients who underwent both procedures) to 6.7 days (in patients who did not undergo either procedure), with intermediate values in cases in which only 1 procedure was performed. The total charges varied in a similar manner from a high of $33,371 to a low of $19,994. Subanalysis with respect to intensive care unit, ward, and operating room charges showed a similar stratification. CONCLUSION Tracheotomy and MR are both significant determinants of charges and length of stay in head and neck surgery cases and must be considered in the design of strategies to promote efficient resource utilization.
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Affiliation(s)
- J Cohen
- Department Of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA.
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Salerian AJ, Deibler WE, Vittone BJ, Geyer SP, Drell L, Mirmirani N, Mirczak JA, Byrd W, Tunick SB, Wax M, Fleisher S. Sildenafil for psychotropic-induced sexual dysfunction in 31 women and 61 men. J Sex Marital Ther 2000; 26:133-140. [PMID: 10782445 DOI: 10.1080/009262300278533] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Ninety-two outpatients (31 women, 61 men) who were treated with oral sildenafil for psychotropic-induced sexual dysfunction (PISD) completed ratings of their sexual functioning pre- and posttreatment. Both women and men reported significant improvements (p = .001) in all domains of sexual functioning, with 88% reporting improvement in overall sexual satisfaction. Significant improvements were reported regardless of psychotropic medication type. However, patients taking selective serotonin re-uptake inhibitors reported less improvement in arousal, libido, and overall sexual satisfaction than did other patients, whereas patients taking benzodiazepines reported significantly more improvement in libido and overall sexual satisfaction. Oral sildenafil may be an effective treatment for PISD.
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Affiliation(s)
- A J Salerian
- Washington Psychiatric Center, Psychiatric Institute of Washington, DC 20016, USA.
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Adams J, Heintz P, Gross N, Andersen P, Everts E, Wax M, Cohen J. Acid/pepsin promotion of carcinogenesis in the hamster cheek pouch. Arch Otolaryngol Head Neck Surg 2000; 126:405-9. [PMID: 10722017 DOI: 10.1001/archotol.126.3.405] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE While clinical observation has suggested an association between gastroesophageal reflux and laryngeal carcinoma, the nature of this relationship has yet to be defined. The purpose of this study is to determine the carcinogenic potential of acid and pepsin mixtures in the hamster cheek pouch animal model. DESIGN A blinded intervention study. SUBJECTS One hundred male Syrian hamsters aged approximately 5 weeks. INTERVENTIONS A control group of 20 hamsters received application of the carcinogen 9,10-dimethyl-1,2-henzanthracene (DMBA) to their cheek pouch mucosa. One experimental group (n = 20) received applications of DMBA plus hydrochloric acid, and another (n = 20) received DMBA plus an acid and pepsin solution. Latency to squamous cell tumor production, size of tumors, and numbers of tumors were compared among groups. RESULTS Latency to tumor production and size of tumor were similar among groups, with both experimental and control groups developing tumors of comparable size after 12 weeks of chemical application. However, the number of tumors produced was significantly higher in the DMBA/acid and DMBA/acid/ pepsin groups than in the DMBA only group at 18 weeks, with 23, 27, and 10 tumors in these groups, respectively (P<.02). Likewise, a cumulative dysplasia score was different among groups at 18 weeks with the DMBA/acid and DMBA/acid/pepsin groups scoring higher degrees of dysplasia than the DMBA only group. CONCLUSION These results suggest that application of acid and acid/pepsin mixtures may promote experimental carcinogenesis in the hamster cheek pouch.
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Affiliation(s)
- J Adams
- Department of Otolaryngology, Oregon Health Sciences University, Portland 97201-3098, USA
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Wax M. Steroid-induced glaucoma in a young woman. J Glaucoma 1998; 7:353-8. [PMID: 9786566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- M Wax
- Department of Ophthalmology, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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Abstract
Lemierre syndrome, otherwise known as postanginal sepsis or necrobacillosis, is an illness that originates as an acute pharyngitis or tonsillitis which progresses to sepsis, usually fusobacterial, due to suppurative thrombophlebitis of the internal jugular vein. Septic thromboemboli then seed various organs, resulting in multiple organ system pathology, most commonly affecting pulmonary and hepatic systems and joints. Although rare in the age of antibiotics, this disease typically affects previously healthy adolescents with varied clinical manifestations depending upon organ system involvement (A. Lemierre, Lancet March (1936) 701-703; J. Barker, H.T. Winer-Muram, S. Grey, Southern Med. J. 89 (1996) 1021-1023). Prompt diagnosis based on clinical presentation, radiologic findings, particularly CT scanning with contrast and a high index of suspicion, is necessary in order to institute often life saving therapy (J. Barker, H.T. Winer-Muram, S. Grey, Southern Med. J. 89 (1996) 1021-1023). We will present two cases of Lemierre syndrome, review it's clinical presentation, anatomic considerations, particularly it's relationship to the parapharyngeal space, radiographic findings, potential life threatening complications and finally, a unique approach to therapy.
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Affiliation(s)
- A Williams
- Department of Otolaryngology at the State University of New York, Buffalo, USA
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Sledz K, Ortiz O, Wax M, Bouquot J. Tumoral calcinosis of the temporomandibular joint: CT and MR findings. AJNR Am J Neuroradiol 1995; 16:782-5. [PMID: 7611040 PMCID: PMC8332277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In this article, the CT, three-dimensional CT, and MR findings are reviewed in a 59-year-old woman with tumoral calcinosis involving the temporomandibular joint.
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Affiliation(s)
- K Sledz
- Department of Radiology, West Virginia University Hospital, Morgantown 26506, USA
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Abstract
One of the mainstays of glaucoma treatment is the use of drugs that decrease the secretion of aqueous humor fluid from the ciliary epithelium. Unfortunately, many currently available drugs that decrease aqueous humor production such as beta-adrenergic antagonists, may cause serious systemic side effects such as cardiac arrhythmias and arrest, pulmonary dysfunction, and CNS side effects such as decreased libido and depression. Efforts to develop effective aqueous suppressants that offer decreased morbidity and mortality in comparison to those currently available will likely rely on the ability to alter the function of specific cellular events which underlie aqueous humor production by the ciliary epithelium. However, the secretory process which results in aqueous humor production is incompletely understood and the identification of precise cellular mechanisms which underlie this process remain to be established. We will present a rationale for genetic approaches to regulate gene expression so that aqueous humor production may be specifically targeted in glaucoma patients. Techniques of gene transfer including homologous exchange recombination, and expression of antisense genes, will be discussed.
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Affiliation(s)
- M Wax
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Adenosine and ATP have been shown to activate separate cell surface purinergic receptors which have been designated P1 for adenosine and P2 for ATP. The pharmacological characterization of P1 and P2 purinergic receptor-mediated signal transduction has been performed in cultured cell lines of the ciliary epithelium. In ODM Clone-2, a cell line derived from human nonpigmented ciliary epithelium (NPE) and in a clone derived from bovine pigmented ciliary epithelium (PE), we observed that adenosine inhibits adenylate cyclase activity at high potency (nM) and stimulates adenylate cyclase activity at low potency (microM) suggesting the presence of P1 subtypes on these cell membranes. The selective agonist cyclopentyladenosine (CPA) was effective at inhibiting forskolin-stimulated adenylate cyclase in these cells. The IC50 for CPA in both NPE and PE was approximately 1 nM in the absence, and 11 nM in the presence of 3-isobutyl-1-methylxanthine (IBMX). In NPE, the selective agonist 2-[p-(2-carboxyethyl)phenethylamino]-5'-N-ethylcarboxamido adenosine (CGS 21680) stimulated adenylyl cyclase with an EC50 of 11 +/- 4 nM in the presence of 4-(3-butoxy-4-methyoxybenzyl)-2-imidazolidinone (RO-20-1724), a phosphodiesterase inhibitor devoid of adenosine receptor antagonism, and 61 +/- 8 microM in the presence of IBMX. In PE cells, EC50 value of RO-20-1724 was 19 +/- 5 nM (n = 3). The characterization of P2 receptors based upon the ability of ATP and its related analogues to stimulate inositol phosphate production reveal the presence of a putative P2u receptor in both cell types.
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Affiliation(s)
- M Wax
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO
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Wax M, Tarshis L. Post-parotidectomy fistula. J Otolaryngol 1991; 20:10-3. [PMID: 2030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Today parotidectomy is a common, safe surgical procedure. With the increase in the number of parotidectomies being performed there have been many reviews of both the immediate and delayed operative complications. Postoperative salivary fistula, although a common occurrence, is usually glossed over or barely mentioned in most reviews. The present study reviews the parotid experience at a major teaching hospital, The Wellesley Hospital, University of Toronto, over a 10-year period. This information was used to draw general conclusions concerning the incidence, etiology and treatment of salivary fistulas as well as their prevention.
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Affiliation(s)
- M Wax
- General Hospital, Oshawa, Ontario, Canada
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