Biomedical subjects

Ada Tamir

Publications and source records attributed to Ada Tamir.

At least 19 recordsLinked to original sources

PubMed2007

Failure of Synbiotic 2000 to prevent postoperative recurrence of Crohn's disease.

Complications of Crohn's disease (CD) lead to surgery in about 70-90% of patients. The majority of patients suffer from relapse of the disease. Colonic bacteria are essential to the development of CD. Therefore, a rationale exists in trying to prevent relapse by manipulation of gut microflora. This is feasible by treatment with probiotics or antibiotics. Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics. It is rational to pursue that it could be effective in preventing postoperative disease. We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD. This was a prospective multicenter, randomized study. Patients were randomized to active treatment or placebo in a 2:1 ratio. Follow-up consisted of endoscopic, clinical, and laboratory parameters. Thirty patients were enrolled. No differences were found between the 2 treatment groups regarding gender, age at diagnosis, age at surgery, weight, smoking status, type of disease, length of the resected segment, or medical treatment prior to surgery. No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo. In our small study, Synbiotic 2000 had no effect on postoperative recurrence of patients with CD. Larger studies in patients with the inflammatory type of CD undergoing surgery, using higher doses of probiotics cocktail might prove effective.

Adult↗

PubMed2007

Antithrombotic therapy for prevention of stroke in clinical practice in the ED.

OBJECTIVE: The objective of this study was to analyze the emergency medicine department's practice of recommending anticoagulation medication for stroke prevention, its compliance with clinical guidelines, and the role of the emergency physician in recommending anticoagulation medication. We also determined the occurrence of thromboembolic events in patients with atrial fibrillation (AF) during a follow-up period of up to 8 months after their discharge from the ED. MATERIALS AND METHODS: Over a 6-month period, patients presenting to the ED with AF were registered using a predesigned 2-part questionnaire. The first part considered the management of the patients with AF at the ED; the second part evaluated data on patients who returned to the ED and their treatment follow-up, based on the drug supply registry. RESULTS: This study included 102 ED visits by patients with AF, of whom 38 were hospitalized and 64 were discharged. Thirty-six of the discharged patients required anticoagulation according to American College of Cardiology/American Heart Association Task Force on Practice Guidelines/European Society of Cardiology guidelines. Of these patients, 28 (78%) were recommended anticoagulation medication and 8 (25%) were not: 5 because of contraindications and 3 because of unknown reasons. No patient returned to the ED with a thromboembolic event during the 8-month follow-up period. CONCLUSION: The prevalence of anticoagulation recommendation for stroke prevention and compliance with clinical guidelines were found to be greater than previously reported. Our data show that most of the patients with AF and risk factors for stroke were recommended anticoagulation medication. This study illustrates the importance of applying clinical guidelines in daily practice and integrating them into patients' medical files in the ED.

Aged↗

PubMed2006

Pain catastrophizing, response to experimental heat stimuli, and post-cesarean section pain.

UNLABELLED: This prospective study assessed the relation between pain catastrophizing, response to experimental pain stimuli, and pain perceived by women after elective cesarean sections. Forty-seven women who were scheduled for elective cesarean section were enrolled in the study. Magnitude estimation to suprathreshold phasic and tonic heat pain stimuli was assessed 1 or 2 days before surgery. Women completed the Pain Catastrophizing Scale after the heat stimuli and again on the first postoperative day. During the first and second postoperative days, perception of pain intensity was assessed by visual analog scale at each analgesia request. A multiple regression analysis revealed that pain on the first postoperative day was predicted by patient response to preoperative tonic heat stimuli (r(2) = .167, P = .008). Pain on the second postoperative day was predicted by preoperative pain catastrophizing (r(2) = .139, P = .021). No significant association was observed between preoperative response to heat stimuli or pain catastrophizing and the patient's analgesic consumption in the obstetrical ward. It is concluded that pain catastrophizing and response to experimental tonic heat pain correlate with post-cesarean section pain. PERSPECTIVE: This article presents psychological and psychophysical measures that may be of help in the prediction of post-cesarean section pain. It may therefore contribute to the treatment of the sequelae of the most common major surgical procedure performed in women in their reproductive years.

Adult↗

PubMed2006

Risk-adapted BEACOPP regimen can reduce the cumulative dose of chemotherapy for standard and high-risk Hodgkin lymphoma with no impairment of outcome.

Therapy of Hodgkin disease (HD) is designed to prolong progression-free survival and minimize toxicity. The best regimen to achieve this has not yet been defined. A total of 108 patients with newly diagnosed HD and adverse prognostic factors were prospectively studied between 1999 and 2004. They were assigned to therapy according to defined risk stratification. Patients were defined depending on the International Prognostic Score (IPS). Those with IPS of 3 or higher received 2 cycles of escalated therapy, including bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [EB]). All others received 2 cycles of standard BEACOPP (SB). Subsequent therapy was prospectively assigned following 2 cycles according to results of early interim 67Ga or positron emission tomography/computed tomography (PET/CT). Following a positive interim scan, 4 cycles of EB were administered, whereas 4 cycles of SB were given to patients with a negative scan. The complete remission rate, the 5-year event-free survival (EFS), and overall survival (OS) rates were 97%, 85% and 90%, respectively. Relapse or progression occurred in 27% of patients with interim positive PET/CT versus 2.3% of negative scans (P<.02). Early interim fluorine-18 2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT is a useful tool for adjustment of chemotherapy on an individual basis. Similar EFS and OS rates were observed for patients in both risk groups.

Adult↗

PubMed2006

Preferences of Israeli adolescents in regard to health services: a pilot study.

This pilot study surveyed Israeli adolescents' preferences regarding health services as a preliminary step for a national survey. A total of 444 students filled a questionnaire including demographics, personal health data, and preferences regarding 31 statements on health care, based on a Philadelphia questionnaire. Factors of most significant impact in seeking health care were cleanliness, integrity, respectfulness, knowledge, and competence. The 10 top statements important to Israeli teens included 9 of the 11 top statements of the Philadelphia teens. Future research may demonstrate change in outcome if adolescents' desires were attended based on a cultural adapted questionnaire.

Adolescent↗

PubMed2006

Efficacy of suppository analgesia in postabortion pain reduction.

PURPOSE: Termination of pregnancy is a painful procedure. Currently, there are no sufficient data regarding the best mode to reduce this pain. The aim of the study was to evaluate postabortion pain levels and to examine the analgesic effect of three different generic types of suppositories provided at the end of the surgical procedure prior to awakening from general anesthesia. METHOD: Two hundred seventeen women were randomly assigned to four groups: indomethacin (100 mg), paracetamol (1000 mg), tramadol (100 mg), and control group with no suppository treatment. Pain levels were evaluated by VAS five times--15, 30, 60, 90 and 120 min after abortion. The number of doses of rescue analgesia with dipyrone (1 g po) was recorded. RESULTS: There was a significant difference in pain levels between the four groups during the 2-h study (p<.05). Indomethacin always had the lowest VAS rank. Rescue analgesia was requested by 22/55 women in the control group, 10/55 in the tramadol group, 7/54 in the paracetamol group and 5/53 in the indomethacin group (chi(2)=19.0, p<.0001). CONCLUSION: The application of a single suppository of an analgesic drug, especially indomethacin, is a simple, inexpensive and safe mode to reduce postabortion pain.

Acetaminophen↗

PubMed2006

Ferrus calcium citrate is absorbed better than iron bisglycinate in patients with Crohn's disease, but not in healthy controls.

Our purpose was to compare the absorption of iron bisglycinate and ferrous calcium citrate in volunteers using an oral iron tolerance test. Twenty volunteers, 10 healthy controls and 10 with stable Crohn's disease, agreed to participate in the study. All were given 50 mg of elemental iron as iron bisglycinate or ferrous calcium citrate. Serum iron levels were monitored for 4 hr. After a week, each received the other regimen. Using the area under the curve as indicator, the oral iron absorption test revealed that absorption of iron post-ingestion of ferrous calcium citrate was better than after ingestion of iron bisglycinate for the group as a whole (P < 0.03). Volunteers with Crohn's disease absorbed ferrous calcium citrate better than iron bisglycinate (P=0.005). No difference was noted in the absorption of either preparation by healthy volunteers. Ferrus calcium citrate is apparently more effective than iron bisglycinate in patients with Crohn's disease.

Adult↗

PubMed2006

Changing patterns of abnormal vascular wall F-18 fluorodeoxyglucose uptake on follow-up PET/CT studies.

BACKGROUND: Fluorine 18 fluorodeoxyglucose (FDG) uptake may be increased in atherosclerotic plaques in asymptomatic patients. Repeat positron emission tomography (PET)/computed tomography (CT) studies were assessed for changes in patterns of FDG uptake and CT calcifications. METHODS AND RESULTS: Fifty consecutive cancer patients (mean age, 68 +/- 8 years) had repeat PET/CT studies 8 to 26 months apart. PET, CT, and PET/CT images were retrospectively evaluated for vascular wall abnormalities and for interval changes in the thoracic and abdominal aortas, as well as in carotid and iliac arteries, classified as PET+/CT+, PET+/CT-, and PET-/CT+. There were 485 abnormal sites in the first study and 495 in the second. CT calcifications were found in 46 patients (92%) in the first study and in 47 (94%) in the second. Vascular wall FDG uptake was found in both studies in 37 patients (74%). The pattern changed in 57 of 119 PET+ sites (48%) in the second study compared with 15 of 366 PET- sites (4%) (P < .0001). In the second study new PET+ sites were observed in 36 of 111 sites (32%) versus new PET-/CT+ sites in 19 of 384 sites (5%) (P < .0001). CONCLUSIONS: Changes in vascular FDG activity and CT calcifications can be assessed by repeat PET/CT. FDG-avid foci may represent a dynamic process, transient inflammation, whereas CT calcifications may indicate stable atherosclerosis. These preliminary results support the need for further research.

Aged↗

PubMed2006

Results of a well-defined protocol for a trial of labor after prior cesarean delivery.

OBJECTIVE: It has been claimed that a trial of labor after cesarean carries higher maternal and fetal risks than planned cesarean delivery. Because the management of such patients in our department differs from that described in some studies, and is perhaps more cautious, we hypothesized that the outcome may be better. METHODS: We identified women with 1 previous low uterine segment cesarean who had delivered a cephalic singleton infant at gestational age 34 weeks or more from January 2000 through May 2005. Our policy is to encourage such women to undergo a trial of labor unless cesarean delivery is indicated. Unless otherwise indicated, our policy is to wait for spontaneous labor. We do not use prostaglandins, and recommend cesarean delivery if the cervix is unripe.(Bishop score < 6). We compared the outcome between women who underwent a trial of labor and women who underwent planned cesarean delivery. RESULTS: A trial of labor was attempted by 841 women (80% successful), and 467 underwent planned cesarean delivery. Uterine rupture was observed in 1 woman 18 hours after vaginal delivery. There was no difference in major or minor maternal morbidity. There was no serious neonatal morbidity. Among the planned cesarean patients, hospital stay was longer, and there were more admissions to the neonatal intensive care unit. CONCLUSION: With our well-defined protocol, a trial of labor after cesarean seems to be as safe for the mother and infant as planned cesarean delivery, and the hospital stay is shorter. LEVEL OF EVIDENCE: II-2.

Adult↗

PubMed2006

Ileal lymphonodular hyperplasia is not associated with NOD2/CARD15 mutations.

INTRODUCTION: Lymphonodular hyperplasia (LNH) is a mass of lymphoid tissue that has been described in the terminal ileum, colon and duodenum mainly in children. Controversy exists regarding the benign nature of LNH. The combination of chronic abdominal pain and hematochezia leads many of these patients to undergo investigations for inflammatory bowel diseases. NOD2/CARD15 on chromosome 16 has been identified as a susceptibility gene for Crohn disease (CD). No study has yet examined the possible association of NOD2/CARD15 mutations with patients with LNH. The purpose of this study was to investigate the presence of NOD2/CARD15 mutations in patients with clinically proven LNH. METHODS: Children and young adults with gastrointestinal symptoms diagnosed as having terminal ileum LNH were eligible for the study. RESULTS: The study group consisted of 32 patients (15 males and 17 females), age range 3-23 years, mean 13.1 +/- 5 years. Twenty-seven (84%) had abdominal pain, 3 (9%) had rectal bleeding. The duration of symptoms ranged from 1-60 months (17.9 +/- 14.5). Only 2 patients (6.2%) were found to be heterozygote for the NOD2/CARD15 mutation (1007 fs), whereas all of the others did not carry any of the 3 common mutant alleles. This number is significantly lower (P < 0.001) than the mutation prevalence demonstrated in both pediatric and adult Israeli CD patients. CONCLUSIONS: NOD2/CARD15 mutations are not associated with LNH. This may strengthen the lack of association between CD and LNH that has been previously reported. We suggest that genotyping NOD2/CARD15 may help to distinguish LNH from inflammatory bowel diseases in selected patients.

Adolescent↗

PubMed2006

Quality assessment in primary military clinics of the Israel Defense Forces Northern Command.

OBJECTIVE: To assess the quality of care provided in primary military clinics. METHODS: A standardized assessment tool was used, with medical record audits and tracers (minimal clinical criteria for proper care of common conditions), peer-review observations of medical encounters, assessments of organization and administration, and patient satisfaction and physicians' occupational stress questionnaires. RESULTS: Forty-three clinics and 113 physicians were assessed. Tracers were high for management of upper respiratory infections and low for low back pains and mental problems. The average encounter time was 9 minutes, and 25% of medical encounters resulted in referrals to specialists. Regular physicians performed better than reservists. Surgeons performed worst as primary health care providers. Female physicians did better than male physicians. The integration of new immigrant physicians was successful, and they expressed less occupational stress. Smaller clinics were better, with longer encounter times and better patient satisfaction scores. CONCLUSIONS: Quality assessment of primary health care is feasible in the military system, providing useful information for future improvement.

Female↗

PubMed2006

[Predictors and empiric anti-microbial therapy of late-onset sepsis in the neonatal intensive care unit].

BACKGROUND: Whenever suspicion of late-onset sepsis (LOS) is raised, sepsis workup is performed and empiric anti-microbial therapy (AMT) is initiated. However, the prescribed AMT may often be inappropriate for the eradication of the causative pathogen. STUDY AIM: To evaluate the clinical, interventional and laboratory predictors of LOS, and to evaluate the appropriateness of empiric AMT in late-onset neonatal sepsis. PATIENTS AND METHODS: The medical records of all neonates admitted to a tertiary NICU during a 1-year period were retrospectively reviewed. Out of 352 infants admitted, 84 neonates developed 96 suspected septic events beyond 3 days of age and comprised the study population. LOS was defined as clinical signs of sepsis accompanied with positive blood and/or urine and/or CSF cultures obtained at the onset of the septic event. For each infant, we collected demographic and perinatal characteristics, neonatal diagnoses and interventions, clinical signs and laboratory abnormalities at onset of sepsis, the AMT instituted, and microbiological data. RESULTS: Of the 96 events of suspected LOS, 26 (27.0%) positive blood cultures, w ith coagulase-negative St aphylococcus (CoNS), Klebsiella and Candida accounting for 22/ 26 (84.7%) of these events. In four out of 75 events (5.3%), urine culture was positive. Logistic regression multivariate analysis showed that birth weight (OR=0.9, 95% CI: 0.82-0.99; p=0.031), apnea/bradycardia (OR=3.16, 95% CI: 1.08-9.25; p=0.036), and platelet count < 100,000/mm3 (OR=7.04, 95% CI: 1.21-40.9; p=0.03) were significantly associated with LOS. Out of 29 proven septic events, 14 (48.3%) had received AMT within 3 days prior to onset of LOS. In 26/29 (89.7%) of proven septic events, empirical AMT was started after sepsis work-up, mostly vancomycin 18/29 (62.0%), imipenem 14/29 (48.3%), and amphotericin B 9/29 (31.0%). Out of the 26 proven septic events treated with empiric AMT, the causative pathogen was sensitive to the prescribed AMT in 24 (92.3%) of the cases. CONCLUSIONS: Significant predictors of LOS include lower birth weight, apnea/bradycardia and thrombocytopenia. Empirical AMT was initiated in 90% of proven septic events and was appropriate in 92.3% of these cases. When confronted with suspected LOS in the NICU setting, empiric coverage of CoNS, Klebsiella and fungi should be considered, based on the infant's condition and on local microbiological data.

Age of Onset↗

PubMed2006

[Hypophosphatemia in the hospitalized patient].

BACKGROUND: Phosphate is an obligatory component of cellular function. Serum, levels are maintained within narrow levels by regulatory mechanisms. The normal range of phosphate concentration is 2.5-4.5 mg/dL. In certain clinical situations these mechanisms are insufficient and hypophosphatemia ensues. AIM: This study aimed to compare hospitalization course and clinical outcome of patients with moderate hypophosphatemia (1.0-2.0 mg/dl) with patients with extreme hypophosphatemia (< 1.0 mg/dL). METHODS: Patients who had at least one measurement of serum phosphate level of 1.0 mg/dL or less comprised the extreme hypophosphatemic group. Patients with at least one serum, phosphate level of between 1.0 and 2.0 mg./dL, but never had a phosphate level of less than 1.0 mg/dL comprised the moderate hypophosphatemic group. Files of 50 consecutive patients who had extreme hypophosphatemia and 100 consecutive patients with moderate hypophosphatemia were retrieved and analyzed. RESULTS: The two groups of patients were similar with reference to age, gender ratio, background disease and indication for hospitalization. There was a higher proportion of obese patients in the moderate hypophosphatemia group. There was a higher proportion of patients who consumed alcohol on a regular basis before hospitalization in the extreme hypophosphatemic group. Patients suffering from extreme hypophosphatemia were more likely to be hospitalized in the intensive care unit and ventilated on hospitalization. Length of hospitalization was longer for the extreme hypophosphatemia group than for the moderate hypophosphatemia group. When comparing the group outcomes it was found that more patients with severe hypophosphatemia died. CONCLUSION: Severe hypophosphatemia is a severe metabolic derangement. It appears in critically sick patients, who should be followed closely and treated properly. The clinical relevance of moderate hypophosphatemia was not checked in this study.

Adult↗

PubMed2006

[Open access colonoscopy: do primary care physicians use it properly?].

BACKGROUND: Open access endoscopy facilitates the performance of colonoscopy on a physician's request, without a prior consultation with a gastroenterologist. OBJECTIVES: To investigate: (1) the rates of relevant endoscopic findings in patients referred by family physicians compared to other specialists; (2) whether there is overuse of open-access colonoscopy in our country where the examination is free of charge for the patient; (3) whether a high rate of pre-malignant and malignant incidental findings might justify a more liberal approach to the indications of colonoscopy. METHODS: Prospective study including all consecutive ambulatory patients referred for open access colonoscopy. The indication for the examination was tabulated according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines. Endoscopic findings were classified into relevant or normal; each relevant finding was correlated with the indication for which the examination was performed. RESULTS: A total of 34.2% of patients had a colonoscopy performed for an inappropriate indication; family physicians had a slightly higher rate of appropriate indications compared with the other specialists. However, a relevant endoscopic finding was diagnosed only in 14.0% of their referred cases, compared with 22.8% of the other specialists (p = 0.032). Polyps larger than 5 mm or a malignant tumor were diagnosed in 20.7% of the colonoscopies; 19 out of the 83 cases (23%) were diagnosed in examinations performed for inappropriate indications. CONCLUSION: It was found that 34% of the colonoscopies were performed for inappropriate indications. A higher proportion of relevant endoscopic findings was diagnosed among patients referred by surgeons, oncologists and internists as compared with those referred by family physicians. Considering that as much as 23% of polyps and malignant tumors were found in cases performed for inappropriate indications, we suggest that a liberal approach to the indications for colonoscopy--probably age over 50 years--may benefit the patients.

Colonic Neoplasms↗

PubMed2005

Short- and long-term outcome of lung volume reduction surgery. The predictive value of the preoperative clinical status and lung scintigraphy.

The NETT study assessed the benefits of lung volume reduction surgery (LVRS) versus medical treatment. However, data is available only on the early outcome of LVRS (24 months). We evaluate the factors affecting the outcome at one-year and up to 6 years after LVRS. Thirty-seven patients underwent LVRS. Thirty-five patients, who survived the operation for at least one-year, were followed up to 6 years. Patients' laboratory, clinical and scintigraphic data before surgery were reviewed retrospectively, and follow-up at one-year and at the end of data collection. Successful LVRS with improvement of FEV(1)30% at one-year was observed in 13 of 35 patients. Five of these patients had initial FEV(1) values of <20% of the predicted. The group of patients with improvement was younger as compared to the 22 patients without improvement (P<0.005). The younger age group used less supplemental oxygen and had a PDiff of >23%. Combinations of age under 60 years and PDiff >23% were a favorable factor (P<0.002) for successful LVRS. Thirty-four patients were followed up to 6 years. Fifteen of the 34 patients (44.1%) remained well. Use of supplemental oxygen before surgery, and FEV(1) improvement of 30% at one-year after surgery were good prognostic factors. We concluded that the long-term success of LVRS is affected by non-dependence on oxygen supplementation before surgery, and the one-year post-surgical improvement of FEV(1) (30%). Based on our findings, the subgroup of patients below 60 years old with severe disease (FEV(1)<20%) and heterogeneous upper lobe emphysema (Pdiff>23%) has improved outcome.

Adult↗

PubMed2005

Fast bedside measurement of blood count and C-reactive protein in neonates with suspected late-onset sepsis.

UNLABELLED: Conventional and fast complete blood count (CBC) and C-reactive protein (CRP) measurements were compared in 56 neonates with suspected sepsis. Mean differences between pairs (conventional minus fast) of the corresponding CBC and CRP values were significant for the six CBC parameters tested (p<0.02), but not for CRP (p=0.18). CONCLUSION: In neonatal sepsis, conventional and fast methods are comparable only for CRP but not for CBC variables.

Blood Cell Count↗

PubMed2005

PCR-based diagnosis of neonatal staphylococcal bacteremias.

We compared PCR with blood cultures in the diagnosis of neonatal staphylococcal sepsis. Significant association was observed between PCR-based and culture-based diagnosis of staphylococcal bacteremia. Positive and negative predictive values for PCR were 100% and 98%, respectively. These data indicate that PCR may serve as a useful adjunct for the rapid diagnosis of staphylococcal sepsis.

Bacteremia↗

PubMed2005

Nomogram of maxillary bone length in normal pregnancies.

OBJECTIVE: The aim of this study was to define normal ultrasonographic growth of the fetal maxillary bone throughout pregnancy as a basis for further studies and as normative data for assessing deviations in growth. METHODS: A prospective cross-sectional study was performed. Consecutive routine biometric measurements and fetal organ scans were obtained from patients undergoing elective fetal anatomic surveys. Special attention was paid to the profile view of the fetal face, and the maxillary bone was identified and measured. RESULTS: Three hundred twenty-seven fetuses between 13 and 40 weeks' gestation were scanned. The maxillary bone is seen as a rodlike structure; it is a part of the facial skeleton that allows the opening and closing of the pharynx. A linear growth function was observed across gestational age (GA), and first-degree correlation was found to exist between GA and the maxillary bone (r = .645; P < .0001; y = 7.78 + 0.18 x GA). Significant correlation was also found between the maxillary bone and biparietal diameter (BPD) (r = 0.652; P > .0001; y = 8.36 + 0.66 x BPD), head circumference (HC) (r = .645; P < .0001; y = 8.39 + 0.18 x HC), femoral bone length (FBL) (r = .640; P < .0001; y = 9.28 + 0.7 x FBL), and abdominal circumference (AC) (r = .640; P < .0001; y = 8.91 + 0.17 x AC). CONCLUSIONS: Normative data for ultrasonographic measurements of the fetal maxillary bone throughout pregnancy are provided. These data potentially allow the prenatal diagnosis of abnormal maxillary bone length.

Biometry↗