1
|
Goldbart AD, Abuhasira R, Shiloh A, Even-Tsur J, Tarasiuk A. Childhood Adenotonsillectomy Does Not Increase the Risk of Being Overweight in Adulthood. Am J Respir Crit Care Med 2024; 209:1261-1263. [PMID: 38417070 DOI: 10.1164/rccm.202311-2175le] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/28/2024] [Indexed: 03/01/2024] Open
Affiliation(s)
| | | | | | | | - Ariel Tarasiuk
- Sleep-Wake Disorders Unit, Soroka University Medical Center, and
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
2
|
Shafat T, Grupel D, Porges T, Abuhasira R, Belkin A, Deri O, Oster Y, Zahran S, Horwitz E, Horowitz NA, Khatib H, Batista MV, Cortez AC, Brosh‐Nissimov T, Segman Y, Ishay L, Cohen R, Atamna A, Spallone A, Chemaly RF, Ramos‐Ramos JC, Chowers M, Rogozin E, Oren NC, Keske Ş, Barchad OW, Nesher L. An international multicenter study comparing COVID-19 omicron outcomes in patients with hematological malignancies treated with obinutuzumab versus rituximab. Cancer Med 2024; 13:e6997. [PMID: 38400683 PMCID: PMC10891459 DOI: 10.1002/cam4.6997] [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: 10/18/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES Hematological malignancy (HM) patients treated with anti-CD20 monoclonal antibodies are at higher risk for severe COVID-19. A previous single-center study showed worse outcomes in patients treated with obinutuzumab compared to rituximab. We examined this hypothesis in a large international multicenter cohort. METHODS We included HM patients from 15 centers, from five countries treated with anti-CD20, comparing those treated with obinutuzumab (O-G) to rituximab (R-G) between December 2021 and June 2022, when Omicron lineage was dominant. RESULTS We collected data on 1048 patients. Within the R-G (n = 762, 73%), 191 (25%) contracted COVID-19 compared to 103 (36%) in the O-G. COVID-19 patients in the O-G were younger (61 ± 11.7 vs. 64 ± 14.5, p = 0.039), had more indolent HM diagnosis (aggressive lymphoma: 3.9% vs. 67.0%, p < 0.001), and most were on maintenance therapy at COVID-19 diagnosis (63.0% vs. 16.8%, p < 0.001). Severe-critical COVID-19 occurred in 31.1% of patients in the O-G and 22.5% in the R-G. In multivariable analysis, O-G had a 2.08-fold increased risk for severe-critical COVID-19 compared to R-G (95% CI 1.13-3.84), adjusted for Charlson comorbidity index, sex, and tixagevimab/cilgavimab (T-C) prophylaxis. Further analysis comparing O-G to R-G demonstrated increased hospitalizations (51.5% vs. 35.6% p = 0.008), ICU admissions (12.6% vs. 5.8%, p = 0.042), but the nonsignificant difference in COVID-19-related mortality (n = 10, 9.7% vs. n = 12, 6.3%, p = 0.293). CONCLUSIONS Despite younger age and a more indolent HM diagnosis, patients receiving obinutuzumab had more severe COVID-19 outcomes than those receiving rituximab. Our findings underscore the need to evaluate the risk-benefit balance when considering obinutuzumab therapy for HM patients during respiratory viral outbreaks.
Collapse
Affiliation(s)
- Tali Shafat
- Infectious Diseases Institute, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Clinical Research Center, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Daniel Grupel
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Tzvika Porges
- Hematology Department, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Ana Belkin
- Internal Medicine D and Infectious Diseases UnitSheba Medical CenterRamat‐GanIsrael
- Sackler Faculty of MedicineTel Aviv UniversityRamat‐AvivIsrael
| | - Ofir Deri
- Internal Medicine TSheba Medical CenterRamat‐GanIsrael
| | - Yonatan Oster
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Shadi Zahran
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Ehud Horwitz
- Department of Clinical Microbiology and Infectious DiseasesHadassah Medical CenterJerusalemIsrael
- Faculty of MedicineHebrew UniversityJerusalemIsrael
| | - Netanel A. Horowitz
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
| | - Hazim Khatib
- Department of Hematology and Bone Marrow TransplantationRambam Health Care CampusHaifaIsrael
| | - Marjorie Vieira Batista
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Department of Infectious DiseasesAC Camargo Cancer CenterSão PauloSão PauloBrazil
| | - Anita Cassoli Cortez
- Department of Hematology and Cell TherapyAC Camargo Cancer CenterSão PauloSão PauloBrazil
| | - Tal Brosh‐Nissimov
- Infectious Diseases UnitSamson Assuta Ashdod University HospitalAshdodIsrael
- The Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
| | - Yafit Segman
- The Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- Hematology InstituteSamson Assuta Ashdod University HospitalAshdodIsrael
| | - Linor Ishay
- Rappaport Faculty of MedicineTechnionHaifaIsrael
- Hillel Yaffe Medical CenterHaderaIsrael
| | - Regev Cohen
- Rappaport Faculty of MedicineTechnionHaifaIsrael
- Hillel Yaffe Medical CenterHaderaIsrael
| | - Alaa Atamna
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Infectious Diseases Unit, Rabin Medical CenterBeilinson HospitalPetah TikvaIsrael
| | - Amy Spallone
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | - Juan Carlos Ramos‐Ramos
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Infectious Disease UnitInternal Medicine Service. CIBERINFEC. Hospital Universitario La PazMadridSpain
| | - Michal Chowers
- Meir Medical CentreKfar SabaIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Evgeny Rogozin
- Infectious Diseases unitShamir (Assaf Harofeh) Medical CenterBe'er Ya'akovIsrael
| | - Noga Carmi Oren
- Infectious Diseases unitShamir (Assaf Harofeh) Medical CenterBe'er Ya'akovIsrael
| | - Şiran Keske
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
- Department of Infectious DiseasesVKV American HospitalIstanbulTurkey
| | | | - Lior Nesher
- Infectious Diseases Institute, Soroka University Medical Center, and the Faculty of Health SciencesBen‐Gurion University of the NegevBeer‐ShevaIsrael
- European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Respiratory Viruses (ESGREV)BaselSwitzerland
| | | |
Collapse
|
3
|
Frenkel A, Abuhasira R, Fisher L, Bichovsky Y, Zlotnik A, Novack V, Klein M. Vasopressors and Mean Arterial Pressure in Septic Shock: Do We Bend the Rules for Young Adults? Isr Med Assoc J 2023; 25:741-746. [PMID: 37980619] [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: 11/21/2023]
Abstract
BACKGROUND Younger patient age and relatively good prognosis have been described as factors that may increase caregiver motivation in treating patients with septic shock in the intensive care unit (ICU). OBJECTIVES To examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients. METHODS We conducted a population-based retrospective cohort study of patients presenting with septic shock who were treated with noradrenaline and hospitalized in a general ICU between 2006 and 2018. The patients were classified into four age groups: 18-45 (n=129), 46-60 (n=96), 61-75 (n=157), and older than 75 years (n=173). Adjusted linear mixed models and locally weighted scatterplot smoothing (LOWESS) curves were used to assess associations and potential non-linear relationships, respectively, of age group with MAP and noradrenaline dosage. RESULTS The cohort included 555 patients. An inverse relation was observed between average MAP value and age. Among patients aged 18-45 years, the average MAP was 4.7 mmHg higher (95% confidence interval 3.4-5.9) than among patients aged > 75 years (P-value <0.001) after adjustment for sex, death in the intensive care unit, and Sequential Organ Failure Assessment scores. CONCLUSIONS Among patients with septic shock, the titration of noradrenaline by staff led to a higher average MAP for younger patients. Although the MAP target is equal for all age groups, staff may administer noradrenaline treatment according to a higher target of MAP due to attitudes toward patients of different ages, despite any evidence that such practice is beneficial.
Collapse
Affiliation(s)
- Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Fisher
- Joyce and Irving Goldman Medical School, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yoav Bichovsky
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alexander Zlotnik
- Department of Anesthesiology, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel, Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| |
Collapse
|
4
|
Bieber A, Brikman S, Novack L, Abuhasira R, Fawaz A, Abu-Shakra M, Zeller L, Ling E, Mader R, Sagy I. Fourth dose of BNT162b2 vaccine for patients with autoimmune rheumatic diseases in a nationwide setting. Rheumatology (Oxford) 2023; 62:3332-3338. [PMID: 36762825 DOI: 10.1093/rheumatology/kead064] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/01/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE The effectiveness of COVID-19 vaccinations wanes due to immune evasion by the B.1.1.529 (Omicron) variant and diminished antibody titres over time. We aimed to evaluate the benefit of a fourth vaccination dose in patients with autoimmune rheumatic diseases (ARDs). METHODS This retrospective analysis included ARD patients aged 18 years or older and members of Clalit Health Services in Israel (which at the time of the study insured 52% of the entire population), and covered the period from 16 January 2022 to 31 March 2022, when the predominant SARS-CoV-2 variant was Omicron. We compared patients without previous COVID-19 infection who had received three doses of the BNT162b2 vaccine (the control group) with those who had received the fourth dose. The primary outcome was COVID-19 infection, which was analysed using multivariate Cox regression in the entire cohort and within ARD subgroups. Secondary outcomes were COVID-19-related hospitalizations and COVID-19-related death. RESULTS We included 43 748 ARD patients, of whom 27 766 and 15 982 were in the control and fourth vaccination groups, respectively. COVID-19 infection occurred in 6942 (25.0%) of the control group and 1754 (11.0%) of the fourth dose group (P < 0.001). Patients vaccinated with the fourth dose had a lower risk of COVID-19 infection than the entire cohort [Hazard Ratio (HR) 0.54, 95% CI 0.52, 0.58] and throughout every subgroup regardless of the baseline characteristic or medical treatment, except for rituximab. A similar association was observed for risk of COVID-19-related hospitalization (HR 0.36, 95% CI 0.22, 0.61) and of COVID-19-related death (HR 0.41, 95% CI 0.24, 0.71). CONCLUSION A fourth BNT162b2 vaccination of ARD patients was associated with favourable outcomes compared with three doses among patients with no history of COVID-19 infection.
Collapse
Affiliation(s)
- Amir Bieber
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
| | - Shay Brikman
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ran Abuhasira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Medicine B, Rabin Medical Centre, Beilinson Campus, Petah Tikva, Israel
| | - Abdallah Fawaz
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
| | - Mahmoud Abu-Shakra
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Zeller
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Eduard Ling
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reuven Mader
- Rheumatic Diseases Unit, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Rheumatology Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
5
|
Abuhasira R, Schwartz L, Novack V. Medical Cannabis Is Not Associated with a Decrease in Activities of Daily Living in Older Adults. Biomedicines 2023; 11:2697. [PMID: 37893071 PMCID: PMC10604566 DOI: 10.3390/biomedicines11102697] [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] [Received: 08/28/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023] Open
Abstract
The proportion of older adults using medical cannabis is rising. Therefore, we aimed to assess the effects of herbal medical cannabis on the functional status of older adults. We conducted a prospective observational study of patients aged 65 years or older that initiated cannabis treatment for different indications, mostly chronic non-cancer pain, during 2018-2020 in a specialized geriatric clinic. The outcomes assessed were activities of daily living (ADL), instrumental activities of daily living (IADL), pain intensity, geriatric depression scale, chronic medication use, and adverse events at six months. A cohort of 119 patients began cannabis treatment: the mean age was 79.3 ± 8.5 and 74 (62.2%) were female. Of the cohort, 43 (36.1%) experienced adverse effects due to cannabis use and 2 (1.7%) required medical attention. The mean ADL scores before and after treatment were 4.4 ± 1.8 and 4.5 ± 1.8, respectively (p = 0.27), and the mean IADL scores before and after treatment were 4.1 ± 2.6 and 4.7 ± 3, respectively (p = 0.02). We concluded that medical cannabis in older adults has a number of serious adverse events, but was not associated with a decrease in functional status, as illustrated by ADL and IADL scores after six months of continuous treatment.
Collapse
Affiliation(s)
- Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Be’er-Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva 8410501, Israel
| | - Lihi Schwartz
- Clalit Health Services, Department of Family Medicine, Dan-Petah Tikva District, Petah Tikva 5239530, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv 6139001, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Be’er-Sheva 8410501, Israel;
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er-Sheva 8410501, Israel
| |
Collapse
|
6
|
Abuhasira R, Burrack N, Nesher L, Ostrovsky D, Novack V. Characteristics and clinical outcomes of patients with COVID-19 recurrent infection during the omicron variant predominance. Eur J Intern Med 2023; 114:131-134. [PMID: 37198012 PMCID: PMC10183632 DOI: 10.1016/j.ejim.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Nitzan Burrack
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Lior Nesher
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel; Infectious Disease Institute, Soroka University Medical Center, Be'er Sheva, Israel
| | - Daniel Ostrovsky
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| |
Collapse
|
7
|
Klein M, Hassan L, Katz R, Abuhasira R, Boyko M, Gabay O, Frank D, Binyamin Y, Novack V, Frenkel A. Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion. J Clin Med 2023; 12:3912. [PMID: 37373614 DOI: 10.3390/jcm12123912] [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] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.
Collapse
Affiliation(s)
- Moti Klein
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Lior Hassan
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Rivka Katz
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Matthew Boyko
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Ohad Gabay
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Dmitry Frank
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
- Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 7747629, Israel
| |
Collapse
|
8
|
Abuhasira R, Grossman A. Glucose variability is a marker for COVID-19 severity and mortality. Archives of Endocrinology and Metabolism 2022; 66:856-862. [PMID: 36219202 PMCID: PMC10118757 DOI: 10.20945/2359-3997000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective We aimed to investigate the association between glucose coefficient of variation (CV) and mortality and disease severity in hospitalized patients with coronavirus disease-19 (COVID-19). Subjects and Methods Retrospective cohort study in a tertiary center of patients with COVID-19 admitted to designated departments between March 11th, 2020, and November 2nd, 2020. We divided patients based on quartiles of glucose CV after stratification to those with and without diabetes mellitus (DM). Main outcomes were length of stay and in-hospital mortality. Results The cohort included 565 patients with a mean age of 67.71 ± 15.45 years, and 62.3% were male. Of the entire cohort, 44.4% had DM. The median glucose CV was 32.8% and 20.5% in patients with and without DM, respectively. In patients with DM, higher glucose CV was associated with a longer hospitalization in the unadjusted model (OR = 2.7, 95% CI [1.3,5.6] for Q4), and when adjusted for age, sex, comorbidities, and laboratory markers, this association was no longer statistically significant (OR = 1.3, 95% CI [0.4,4.5] for Q4). In patients with and without DM, higher glucose CV was associated with higher rates of in-hospital mortality in the unadjusted model, but adjustment for comorbidities and laboratory markers eliminated the association (OR = 0.5, 95% CI [0.1,3.4] for Q4 in patients with DM). Conclusion Higher glucose CV was associated with increased in-hospital mortality and length of stay, but this association disappeared when the adjustment included laboratory result data. Glucose CV can serve as a simple and cheap marker for mortality and severity of disease in patients with COVID-19.
Collapse
|
9
|
Karny-Epstein N, Abuhasira R, Grossman A. Current use of D-dimer for the exclusion of venous thrombosis in hospitalized patients. Sci Rep 2022; 12:12376. [PMID: 35859105 PMCID: PMC9300739 DOI: 10.1038/s41598-022-16515-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 01/14/2023] Open
Abstract
D-dimer assay’s utility for excluding venous thromboembolism (VTE) in hospitalized patients is debatable. We aimed to assess the current use of D-dimer as a diagnostic tool for excluding VTE in hospitalized patients and examine a mandatory age-adjusted D-dimer (AADD) threshold for diagnostic imaging. Retrospective cohort study between 2014 to 2019 that included patients from medical and surgical wards with a positive AADD result drawn during their hospitalization. The outcomes were determining a D-dimer threshold requiring further evaluation and assessing the prognostic value of D-dimer in predicting clinically relevant VTE in hospitalized patients. The cohort included 354 patients, 56% of them underwent definitive diagnostic imaging, and 7.6% were diagnosed with VTE after a positive AADD within 90 days of follow-up. Mortality rates were higher in patients diagnosed with VTE (33.3% vs. 15.9%, p = 0.03). Patients with pneumonia and other infectious etiologies were less likely to be further evaluated by definitive imaging (p = 0.001). Patients with a respiratory complaint (p = 0.02), chest pain (p < 0.001), or leg swelling (p = 0.01) were more likely to undergo diagnostic imaging. Patients with D-dimer levels > X2 the AADD were at increased risk of VTE [OR 3.87 (1.45–10.27)]. At 90 days of follow-up, no excess mortality was observed for patients without diagnostic evaluation following elevated AADD. D-dimer may be used in hospitalized patients to exclude VTE using the traditional AADD thresholds, with a high negative predictive value. D-dimer levels > X2 the AADD usually mandates further diagnostic imaging, while lower levels, probably do not require additional workup, with a sensitivity of almost 80% and no excess mortality.
Collapse
Affiliation(s)
- Nitzan Karny-Epstein
- Internal Medicine B, Rabin Medical Center, Beilinson Campus, Jabotinsky 39 St., Petah-Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ran Abuhasira
- Internal Medicine B, Rabin Medical Center, Beilinson Campus, Jabotinsky 39 St., Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Grossman
- Internal Medicine B, Rabin Medical Center, Beilinson Campus, Jabotinsky 39 St., Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
10
|
Bieber A, Sagy I, Novack L, Brikman S, Abuhasira R, Ayalon S, Novofastovski I, Abu-Shakra M, Mader R. BNT162b2 mRNA COVID-19 vaccine and booster in patients with autoimmune rheumatic diseases: a national cohort study. Ann Rheum Dis 2022; 81:1028-1035. [PMID: 35418481 PMCID: PMC9023845 DOI: 10.1136/annrheumdis-2021-221824] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/26/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Emerging evidence supports the immunogenic response to mRNA COVID-19 vaccine in patients with autoimmune rheumatic diseases (ARD). However, large-scale data about the association between vaccination, and COVID-19 outcomes in patients with ARD is limited. METHODS We used data from Clalit Health Services, which covers more than half of the population in Israel. Patients with ARD older than 18 were included between 20 December 2020 and 30 September 2021, when the BNT162b2 mRNA COVID-19 vaccine, and later a third booster dose, were available. The primary outcome was a documented positive SARS-CoV-2 PCR test. We used a Cox regression models with vaccination status as time-dependent covariate and calculated the HR for the study outcome. RESULTS We included 127 928 patients with ARD, of whom, by the end of the study follow-up, there were 27 350 (21.3%) unvaccinated patients, 31 407 (24.5%) vaccinated patients and 69 171 (54.1%) patients who also received a third booster-dose. We identified 8470 (6.6%) patients with a positive SARS-CoV-2 PCR test during the study period. The HR for SARS-CoV-2 infection among the vaccination group was 0.143 (0.095 to 0.214, p<0.001), and among the booster group was 0.017 (0.009 to 0.035, p<0.001). Similar results were found regardless of the type of ARD group or antirheumatic therapy. CONCLUSION Our results indicate that both the BNT162b2 mRNA COVID-19 vaccine and the booster are associated with better COVID-19 outcomes in patients with ARD.
Collapse
Affiliation(s)
- Amir Bieber
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Rheumatology, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Shay Brikman
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Ran Abuhasira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department Medicine B, Rabin Medical Center Beilinson Hospital, Petah Tikva, Israel
| | - Snait Ayalon
- Reseach Authority, Emek Medical Center, Afula, Northern, Israel
| | | | - Mahmoud Abu-Shakra
- Rheumatology, Soroka Medical Center, Beer Sheva, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Reuven Mader
- Rheumatology, Emek Medical Center, Afula, Northern, Israel
- Technion Israel Institute of Technology The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
11
|
Abuhasira R, Anstey M, Novack V, Bose S, Talmor D, Fuchs L. Intensive care unit capacity and mortality in older adults: a three nations retrospective observational cohort study. Ann Intensive Care 2022; 12:20. [PMID: 35244803 PMCID: PMC8897522 DOI: 10.1186/s13613-022-00994-x] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Background Intensive care unit (ICU) admissions among older adults are expected to increase, while the benefit remains uncertain. The availability of ICU beds varies between hospitals and between countries and is an important factor in the decision to admit older adults in the ICU. We aimed to assess if a non-restrictive approach to ICU older adults admission is associated with a corresponding change in survival. Methods Retrospective cohort study that included patients ≥ 80 years who were admitted to each of the three participating hospitals in Australia, Israel, and the United States (USA), between the years 2006–2015, each with distinct ICU capacities and admission criteria. The primary outcomes were in-hospital mortality and all-cause mortality at 6, 12, 18, and 24 months following index hospitalization. Results The cohort included 62,866 patients with a mean age of 85.9 ± 4.6 years and 58.8% were women. The ICU admission rates were 22.5%, 2.6% and 2.3% in USA, Australia, and Israel, respectively. We constructed a model for ICU admissions based on the USA cohort (highest availability of ICU beds) and then calculated the expected probabilities for the Israeli and Australian cohorts. For the patients in the highest quintile of the admission model, actual ICU admission rates were 67.6% in USA, 22.1% in Australia and 6.0% in Israel. Of these, in-hospital death rates were 52.3% in Israel, 29.8% in Australia, and 22.1% in USA. Two years after hospital discharge, the survival rates in the USA and Australia were 53%, while in Israel 48%. Conclusion ICU admission of adults ≥ 80 years is associated with increased in-hospital survival compared to ward admission, but survival rates 2 years later are similar. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-00994-x.
Collapse
Affiliation(s)
- Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Matthew Anstey
- Sir Charles Gairdner Hospital, Perth, Australia.,School of Public Health, Curtin University, Perth, Australia.,School of Medicine, University of Western Australia, Perth, Australia
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Somnath Bose
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Center for Anesthesia Research Excellence (CARE), Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. .,Medical Intensive Care Unit, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
12
|
Ketterer AR, Lewis JJ, Ellis JC, Hall MM, Abuhasira R, Ullman EA, Dubosh NM. A Simulation-Based Prospective Cohort Study on Teaching Best Practices in Firearms Safety. Simul Healthc 2021; 16:e116-e122. [PMID: 32701864 DOI: 10.1097/sih.0000000000000490] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gun violence in the United States is a significant public health concern. The high rate of weapons carriage by Americans places medical providers at risk for exposure to firearms in the workplace and provides an opportunity for patient safety counseling. Few curricular interventions have been published on teaching firearms safety principles to medical providers. Given the risk of encountering firearms in the workplace and the opportunity to engage patients in firearms safety counseling, providers may benefit from dedicated training on safely handling firearms. METHODS This was a prospective cohort pilot study of a simulation-based educational intervention for third- and fourth-year medical students enrolled in an emergency medicine subinternship and emergency medicine bootcamp elective. Before undergoing the educational intervention, students completed a preintervention simulation case during which they discovered a model firearm in the patient's belongings and were asked to remove it. Students then received the intervention that included a discussion and demonstration on how to safely remove a firearm in the clinical setting. Two weeks later, the students were presented with a model firearm in a different simulation case, which they needed to remove. During the preintervention and postintervention simulations, students were evaluated on their performance of the critical actions in firearm removal using an 8-item checklist. Students' scores on this checklist were compared. RESULTS Fifty-three students participated in the study, 25 of whom completed the postintervention assessment. The median number of correctly performed critical actions preintervention was 5 (interquartile range = 4-6) and postintervention was 7 (interquartile range = 6-8, P < 0.001). Students showed particular improvement in 4 steps: holding the firearm by the grip only, pointing the firearm in a safe direction at all times, removing the firearm from the immediate patient care area and placing it in a safe area, and ensuring that the firearm is monitored and untouched until police or security personnel arrive to secure it. CONCLUSIONS This educational intervention is the first to formally teach students about the safe handling of firearms found in the clinical care space. This low-cost pilot project is easily transferrable to other training centers for teaching principles of safe firearms handling.
Collapse
Affiliation(s)
- Andrew R Ketterer
- From the Department of Emergency Medicine (A.R.K., J.J.L., J.C.E., M.M.H., E.A.U., N.M.D.), Beth Israel Deaconess Medical Center, Boston, MA, and Clinical Research Center (R.A.), Soroka University Medical Center, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | | | | | | | | | | |
Collapse
|
13
|
Segal A, Zlotnik Y, Moyal-Atias K, Abuhasira R, Ifergane G. Fecal microbiota transplant as a potential treatment for Parkinson's disease - A case series. Clin Neurol Neurosurg 2021; 207:106791. [PMID: 34237681 DOI: 10.1016/j.clineuro.2021.106791] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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: 03/16/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We aimed to determine whether fecal microbiota transplant (FMT) is safe and possibly efficacious in treating constipation, motor, and non-motor symptoms in Parkinson's disease (PD) patients. METHODS Patients with PD, constipation and an indication for screening colonoscopy were treated with FMT. The study was conducted from December 2017 to November 2019, and clinical outcomes assessing motor, non-motor and constipation symptoms were compared at baseline (week 0) and at 2, 4, 8, 12, 16, 20, and 24 weeks after the FMT. RESULTS Six patients (3 men, age range 47-73, median age 52) were treated with FMT. Four weeks following the FMT, motor, non-motor and constipation scores were improved in 5 of 6 patients. At week 24, compared to before the FMT, the changes in motor scores ranged from - 13-7 points, in non-motor scores from - 2 to - 45 points, and in constipation scores from - 12-1 point. One patient had a serious adverse event requiring admission for observation only, and no adverse events were observed in all other patients. CONCLUSIONS In this preliminary uncontrolled case series of 6 PD patients, a treatment with donor FMT infused via colonoscopy, was safe and resulted in improvement of PD motor and non-motor symptoms, including constipation, at 6 months. Further research is needed to assess longer-term maintenance of efficacy and safety, including in large scale randomized controlled trials. TRIAL REGISTRATION ClinicalTrials.gov - NCT03876327.
Collapse
Affiliation(s)
- Arik Segal
- Department of Gastroenterology, Soroka University Medical Center, Ben Gurion University, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 8410501, Israel.
| | - Yair Zlotnik
- Department of Neurology, Soroka University Medical Center, Ben Gurion University, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 8410501, Israel.
| | - Keren Moyal-Atias
- Department of Gastroenterology, Soroka University Medical Center, Ben Gurion University, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 8410501, Israel
| | - Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Ben Gurion University, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 8410501, Israel.
| | - Gal Ifergane
- Department of Neurology, Soroka University Medical Center, Ben Gurion University, Faculty of Health Sciences, Ben Gurion University, Beer Sheva 8410501, Israel
| |
Collapse
|
14
|
Abuhasira R, Haviv YS, Leiba M, Leiba A, Ryvo L, Novack V. Cannabis is associated with blood pressure reduction in older adults - A 24-hours ambulatory blood pressure monitoring study. Eur J Intern Med 2021; 86:79-85. [PMID: 33483174 DOI: 10.1016/j.ejim.2021.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/26/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Medical cannabis use is increasing rapidly in the past several years, with older adults being the fastest growing group. Nevertheless, the evidence for cardiovascular safety of cannabis use is scarce. The aim of this study was to assess the effect of cannabis on blood pressure, heart rate, and metabolic parameters in older adults with hypertension. METHODS We conducted a prospective study of patients aged 60 years or more with hypertension and a new prescription of cannabis. We have performed the following assessments: 24-hours ambulatory blood pressure monitoring, ECG, blood tests, and anthropometric measurements prior to the initiation of cannabis therapy and 3 months afterward. The primary outcome was change in mean 24-h blood pressure at 3 months. RESULTS Twenty-six patients with a mean age of 70.42 ± 5.37 years, 53.8% females completed the study. At 3 months follow-up, the mean 24-hours systolic and diastolic blood pressures were reduced by 5.0 mmHg and 4.5 mmHg, respectively (p<0.001 for both). The nadir for the blood pressure and heart rate was achieved at 3 hours post-administration. The proportion of normal dippers changed from 27.3% before treatment to 45.5% afterward. No significant changes were seen in the different metabolic parameters assessed by blood tests, anthropometric measurements, or ECG exam. CONCLUSION amongst older adults with hypertension, cannabis treatment for 3 months was associated with a reduction in 24-hours systolic and diastolic blood pressure values with a nadir at 3 hours after cannabis administration.
Collapse
Affiliation(s)
- Ran Abuhasira
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Yosef S Haviv
- Department of Nephrology, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Merav Leiba
- Division of Hematology, Assuta Ashdod Academic Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Adi Leiba
- Division of Nephrology and Hypertension, Assuta Ashdod Academic Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel; Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Larisa Ryvo
- Division of Oncology, Assuta Ashdod Academic Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Victor Novack
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center, and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
15
|
Abuhasira R, Ayalon-Dangur I, Zaslavsky N, Koren R, Keller M, Dicker D, Grossman A. A Randomized Clinical Trial of Linagliptin vs. Standard of Care in Patients Hospitalized With Diabetes and COVID-19. Front Endocrinol (Lausanne) 2021; 12:794382. [PMID: 35002970 PMCID: PMC8727772 DOI: 10.3389/fendo.2021.794382] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/30/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To assess the effect of linagliptin vs. standard therapy in improving clinical outcomes in patients hospitalized with diabetes and coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS We did an open-label, prospective, multicenter, randomized clinical trial in 3 Israeli hospitals between October 1, 2020, and April 4, 2021. Eligible patients were adults with type 2 diabetes mellitus and a diagnosis of COVID-19. A total of 64 patients, 32 in each group, were randomized to receive linagliptin 5 mg PO daily throughout the hospitalization or standard of care therapy. The primary outcome was time to clinical improvement within 28 days after randomization, defined as a 2-point reduction on an ordinal scale ranging from 0 (discharged without disease) to 8 (death). RESULTS The mean age was 67 ± 14 years, and most patients were male (59.4%). Median time to clinical improvement was 7 days (interquartile range (IQR) 3.5-15) in the linagliptin group compared with 8 days (IQR 3.5-28) in the standard of care group (hazard ratio, 1.22; 95% CI, 0.70-2.15; p = 0.49). In-hospital mortality was 5 (15.6%) and 8 (25.0%) in the linagliptin and standard of care groups, respectively (odds ratio, 0.56; 95% CI, 0.16-1.93). The trial was prematurely terminated due to the control of the COVID-19 outbreak in Israel. CONCLUSIONS In this randomized clinical trial of hospitalized adult patients with diabetes and COVID-19 who received linagliptin, there was no difference in the time to clinical improvement compared with the standard of care. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT04371978.
Collapse
Affiliation(s)
- Ran Abuhasira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
- *Correspondence: Ran Abuhasira,
| | - Irit Ayalon-Dangur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Neta Zaslavsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Ronit Koren
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Mally Keller
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Dror Dicker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D, Rabin Medical Center, Hasharon Campus, Petah Tikva, Israel
| | - Alon Grossman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine B, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| |
Collapse
|
16
|
Affiliation(s)
- Ran Abuhasira
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Victor Novack
- Cannabis Clinical Research Institute and Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| |
Collapse
|
17
|
Ketterer AR, Poland S, Ray K, Abuhasira R, Aldeen AZ. Emergency Providers' Familiarity with Firearms: A National Survey. Acad Emerg Med 2020; 27:185-194. [PMID: 31957230 DOI: 10.1111/acem.13849] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Emergency providers (EPs) are uniquely placed to advocate for firearm safety and have been shown to be at risk of exposure to firearms in the emergency department (ED). We sought to characterize EPs' knowledge of firearms, frequency of encountering firearms in the ED and level of confidence with safely removing firearms from patient care settings. METHODS This was a survey study of EPs representing medical centers in 22 states. A 15-item questionnaire was e-mailed to all EPs at all included institutions. Questions pertained to EPs' knowledge of firearms, experience with handling firearms, and exposure to firearms while at work. We calculated response proportions with p-values and conducted association analyses among survey items. RESULTS Of 2,192 survey recipients, 1,074 (49.0%) completed the survey. A total of 635 (59.1%) reported encountering firearms in the ED or its immediate environment at least once per year, and 582 (54.2%) were not confident in their ability to safely handle a firearm found in a patient's possession. Frequency of handling firearms was significantly higher in states in the top quartile for firearm ownership, with 21.5% of respondents reporting handling firearms daily or weekly, compared to 10.9% in bottom-quartile states. Level of firearms training also differed significantly: 42.1% of respondents in top-quartile states reported formal training compared to 33.0% in bottom-quartile states. Increased regional firearm ownership rates were associated with decreased rates of feeling unsafe at work. CONCLUSIONS The majority of surveyed EPs reported little experience with handling firearms. Firearm experience was associated with comfort with managing firearms found in patients' possession. Regional differences were found regarding personal firearm experience and perceptions of workplace safety, both of which were associated with regional variations in firearm ownership. Despite this, no regional differences were found in encountering firearms in or around the ED. EPs may benefit from training on safely handling firearms.
Collapse
Affiliation(s)
- Andrew R. Ketterer
- Department of Emergency Medicine Beth Israel Deaconess Medical Center Boston MA
| | - Scott Poland
- Summa Health System AkronOH
- US Acute Care Solutions Canton OH
| | - Kaitlin Ray
- Department of Emergency Medicine Feinberg School of Medicine–McGaw Medical CenterNorthwestern University Chicago IL
| | - Ran Abuhasira
- Clinical Research Center Soroka University Medical Center and Ben‐Gurion University of the Negev Beersheba Israel
| | | |
Collapse
|
18
|
Abuhasira R, Zlotnik Y, Horev A, Ifergane G. Fibromyalgia-Like Syndrome Associated with Parkinson's Disease-A Cohort Study. J Clin Med 2019; 8:jcm8081118. [PMID: 31357683 PMCID: PMC6723151 DOI: 10.3390/jcm8081118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/19/2022] Open
Abstract
Parkinson’s disease (PD) and fibromyalgia (FM) are two relatively common disorders that are considered distinct diagnoses. The aim of this study was to investigate the epidemiological characteristics of patients with both PD and FM, as well as their comorbidities and medication use. We performed a population-based retrospective cohort study in Israel from 2000 to 2015. We identified patients with PD according to a refined medication tracer algorithm and patients with FM according to their medical records. Using the algorithm, we identified 2606 patients diagnosed with PD, 60 of them (2.3%) were also diagnosed with FM. Most of the patients were females (88.3%) and the mean age of FM diagnosis was 63.95 ± 12.27 years. These patients had a higher prevalence of depression, anxiety, and dementia. Of the patients diagnosed with PD + FM, 46 (76.7%) were diagnosed with FM after the diagnosis of PD. Patients with PD + FM used analgesics of distinct kinds in higher rates, as well as more anti-PD medications. We suggest that patients with PD + FM represent a distinct subgroup with a fibromyalgia-like syndrome associated with Parkinson’s disease (FLISPAD). Their PD is more treatment resistant, and they take more medications, both analgesics and anti-PD.
Collapse
Affiliation(s)
- Ran Abuhasira
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Yair Zlotnik
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel
| | - Anat Horev
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
- Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel
| | - Gal Ifergane
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
- Department of Neurology, Soroka University Medical Center, Beer Sheva, Israel.
| |
Collapse
|
19
|
Bar-Lev Schleider L, Abuhasira R, Novack V. Medical cannabis: aligning use to evidence-based medicine approach. Br J Clin Pharmacol 2018; 84:2458-2462. [PMID: 29859014 DOI: 10.1111/bcp.13657] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/22/2022] Open
Abstract
During the past decade we have been witnessing a rise in medical cannabis use, yet the evidence for the safety and efficacy of the various cannabinoid compounds is scarce. The State of Israel has always been at the forefront of clinical and translational research in support of Evidence Based Medicine. With respect to cannabis Israel has created a medical and regulatory environment that enables clinical studies with cannabis which may lead to improved Evidence Based use of these compounds. This opinion paper discusses selected studies into the safety and effects of cannabis derived products.
Collapse
Affiliation(s)
- Lihi Bar-Lev Schleider
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Ran Abuhasira
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Victor Novack
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| |
Collapse
|
20
|
Abuhasira R, Shbiro L, Landschaft Y. Medical use of cannabis and cannabinoids containing products - Regulations in Europe and North America. Eur J Intern Med 2018; 49:2-6. [PMID: 29329891 DOI: 10.1016/j.ejim.2018.01.001] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [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: 12/04/2017] [Accepted: 01/01/2018] [Indexed: 12/15/2022]
Abstract
In 1937, the United States of America criminalized the use of cannabis and as a result its use decreased rapidly. In recent decades, there is a growing interest in the wide range of medical uses of cannabis and its constituents; however, the laws and regulations are substantially different between countries. Laws differentiate between raw herbal cannabis, cannabis extracts, and cannabinoid-based medicines. Both the European Medicines Agency (EMA) and the United States Food and Drug Administration (FDA) do not approve the use of herbal cannabis or its extracts. The FDA approved several cannabinoid-based medicines, so did 23 European countries and Canada. However, only four of the reviewed countries have fully authorized the medical use of herbal cannabis - Canada, Germany, Israel and the Netherlands, together with more than 50% of the states in the United States. Most of the regulators allow the physicians to decide what specific indications they will prescribe cannabis for, but some regulators dictate only specific indications. The aim of this article is to review the current (as of November 2017) regulations of medical cannabis use in Europe and North America.
Collapse
Affiliation(s)
- Ran Abuhasira
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
| | - Liat Shbiro
- Cannabis Clinical Research Institute, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Yuval Landschaft
- Israel Medical Cannabis Agency, Ministry of Health, Jerusalem, Israel
| |
Collapse
|
21
|
Abuhasira R, Schleider LBL, Mechoulam R, Novack V. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. Eur J Intern Med 2018; 49:44-50. [PMID: 29398248 DOI: 10.1016/j.ejim.2018.01.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION There is a substantial growth in the use of medical cannabis in recent years and with the aging of the population, medical cannabis is increasingly used by the elderly. We aimed to assess the characteristics of elderly people using medical cannabis and to evaluate the safety and efficacy of the treatment. METHODS A prospective study that included all patients above 65 years of age who received medical cannabis from January 2015 to October 2017 in a specialized medical cannabis clinic and were willing to answer the initial questionnaire. Outcomes were pain intensity, quality of life and adverse events at six months. RESULTS During the study period, 2736 patients above 65 years of age began cannabis treatment and answered the initial questionnaire. The mean age was 74.5 ± 7.5 years. The most common indications for cannabis treatment were pain (66.6%) and cancer (60.8%). After six months of treatment, 93.7% of the respondents reported improvement in their condition and the reported pain level was reduced from a median of 8 on a scale of 0-10 to a median of 4. Most common adverse events were: dizziness (9.7%) and dry mouth (7.1%). After six months, 18.1% stopped using opioid analgesics or reduced their dose. CONCLUSION Our study finds that the therapeutic use of cannabis is safe and efficacious in the elderly population. Cannabis use may decrease the use of other prescription medicines, including opioids. Gathering more evidence-based data, including data from double-blind randomized-controlled trials, in this special population is imperative.
Collapse
Affiliation(s)
- Ran Abuhasira
- Cannabis Clinical Research Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Lihi Bar-Lev Schleider
- Cannabis Clinical Research Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel; Research Department, Tikun Olam LTD, Israel
| | - Raphael Mechoulam
- Institute for Drug Research, Medical Faculty, Hebrew University, Jerusalem, Israel
| | - Victor Novack
- Cannabis Clinical Research Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel.
| |
Collapse
|
22
|
Abuhasira R, Mizrakli Y, Shimony A, Novack V, Shnaider A, Haviv YS. Atrial Fibrillation Characteristics in Patients on Haemodialysis vs. Peritoneal Dialysis. Sci Rep 2018; 8:2976. [PMID: 29445225 PMCID: PMC5813026 DOI: 10.1038/s41598-018-21229-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/31/2018] [Indexed: 01/19/2023] Open
Abstract
Atrial fibrillation (AF) is highly prevalent in dialysis patients, however whether its impact differs between patients on haemodialysis (HD) vs. peritoneal dialysis (PD) is unknown. We aimed to compare the association of AF and clinical outcomes in different dialysis modalities. We performed a population based retrospective cohort study, including adult patients who initiated dialysis between the years 2002 and 2015. Clinical, echocardiographic and laboratory data were reviewed and correlated with outcomes in HD vs. PD. During the study period, 1,130 patients began dialysis. Of the 997 patients without AF before dialysis initiation, 17% developed new-onset AF after the initiation of dialysis (17.3% of HD vs. 13.7% of PD patients, p = 0.27). Using multivariate analysis, only enlarged left atrium at dialysis initiation (hazard ratio (HR) 2.82, CI95% 2.00–3.99) and age (HR 1.04, CI95% 1.03–1.06) were significantly associated with AF. Dialysis modality was not a significant predictor of AF in either univariate or multivariate analysis. In conclusion, our study demonstrated that AF is common in dialysis patients irrespective of modality. In our cohort, the risk factors associated with AF were older age and enlarged left atrium. AF was associated with increased rates of heart failure and mortality, but not stroke.
Collapse
Affiliation(s)
- Ran Abuhasira
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel. .,Clinical Research Centre, Soroka University Medical Centre, Beer-Sheva, Israel.
| | - Yuval Mizrakli
- The Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.,Clinical Research Centre, Soroka University Medical Centre, Beer-Sheva, Israel
| | - Avi Shimony
- Department of Cardiology, Soroka University Medical Centre, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Victor Novack
- Clinical Research Centre, Soroka University Medical Centre, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Alla Shnaider
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Yosef S Haviv
- Department of Nephrology, Soroka University Medical Centre, Beer-Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| |
Collapse
|