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Biomedical subjects

Adi Cohen

Publications and source records attributed to Adi Cohen.

10 recordsLinked to original sources
PubMed2006

Discontinuing antiresorptive therapy one year after cardiac transplantation: effect on bone density and bone turnover.

BACKGROUND: We have previously reported that subjects randomized to alendronate or calcitriol immediately after cardiac transplantation sustained minimal bone loss during the first year, significantly less than a concurrently transplanted reference group that received calcium and parent vitamin D. In this extension, we evaluated the effect of discontinuing alendronate or calcitriol on bone loss and biochemical markers of bone turnover during the second year. We hypothesized that subjects who discontinued alendronate, which has a long half-life in bone, would not sustain significant bone loss. As the half-life of calcitriol is short, we hypothesized that there would be significant bone loss after discontinuing calcitriol. METHODS: We measured bone density (BMD), calciotropic hormones and bone turnover markers at 12, 18, and 24 months after transplantation in adherent subjects who completed the randomized trial on alendronate or calcitriol, and in reference subjects who had received no preventive therapy. RESULTS: In all, 75 subjects (34 alendronate, 25 calcitriol, 16 reference) participated. During the second year, the bone resorption marker, serum N-telopeptide, rose by 27% in the calcitriol group (P< or =0.001). Bone alkaline phosphatase, a bone formation marker, increased by 54% in the calcitriol group (P< or =0.001) and by 32% in the alendronate group (P< or =0.001). BMD did not change significantly at any site in either randomized group. CONCLUSIONS: After discontinuing alendronate or calcitriol, BMD remained stable during the second year after cardiac transplantation, despite a significant increase in a biochemical marker of bone resorption in the calcitriol group. This suggests that antiresorptive therapy may be discontinued at the end of the first posttransplantation year in cardiac transplant recipients without resumption of rapid bone loss. However, as increased bone turnover may predict future bone loss and fractures, such patients warrant observation to ensure that BMD remains stable long-term.

Adult↗
PubMed2005

Osteoporosis in adult survivors of adolescent cardiac transplantation may be related to hyperparathyroidism, mild renal insufficiency, and increased bone turnover.

BACKGROUND: Osteoporosis is common in adults who undergo cardiac transplantation. We hypothesized that adolescent cardiac transplant recipients also develop osteoporosis, which would persist into adulthood. METHODS: We evaluated 9 adult survivors of adolescent cardiac transplantation, aged 21-32, in a cross-sectional, case-control study comparing bone mineral density, indices of mineral metabolism, and bone turnover markers. RESULTS: Osteoporosis (Z score < or = -2.0) was present in 56% of transplant recipients at the lumbar spine, 33% at the femoral neck, and 100% at the one-third radius. Subjects had mean bone mineral density Z scores of -2.3 +/- 0.9 at the spine, -1.6 +/- 0.7 at the femoral neck, and -3.2 +/- 0.7 at the one-third radius, significantly lower than controls at all sites (p < 0.001). Serum creatinine and vitamin D metabolites were normal and did not differ between subjects and controls. Serum calcium was lower, blood urea nitrogen was elevated, and creatinine clearance tended to be lower in transplant recipients. Parathyroid hormone (PTH) levels were 3-fold higher in subjects than controls, and 75% of subjects had elevated PTH levels. Markers of bone turnover were significantly higher in subjects than controls. CONCLUSIONS: Adult survivors of adolescent cardiac transplantation have mild renal insufficiency, secondary hyperparathyroidism, and biochemical evidence of increased bone turnover. Osteoporosis is common in these patients, particularly at the one-third radius, a site sensitive to the catabolic effects of sustained excessive PTH secretion. We conclude that adult survivors of adolescent cardiac transplantation should be evaluated for hyperparathyroidism and osteoporosis.

Adolescent↗
PubMed2005

[Food allergy--effect of physician attitude on the diagnosis and reported prevalence].

BACKGROUND: There is great variation in the reported incidence of food allergies, especially the estimated cross allergy to cow's milk and soy. OBJECTIVE: To assess the attitude of allergists, pediatric gastroenterologists, chief pediatricians and physicians working in the community to cross-sensitivity to cow's milk and soybean. Sesame allergy was used to assess the physician's familiarity with food allergy. METHODS: Questionnaires were mailed to 186 physicians of different disciplines. The opinions of primary physicians in the community were assessed according to 171 questionnaires completed at a food allergy conference. RESULTS: A total of 54% of the allergists estimated that less than 5% of children with cow's milk allergy are allergic to soy, significantly lower than pediatric gastroenterologists and community physicians. On the other hand, only 15% of the pediatric gastroenterologists reported that they encountered patients allergic to sesame, significantly less than allergists (65%) and chief pediatricians (44%). Only half (51%) of the allergists encountered patients allergic to both cow's milk and soy, significantly less than pediatric-gastroenterologists (88%) and chief pediatricians (80%). Although the community physicians felt that the incidence of cross-sensitivity to cow's milk and soy was high, 94% of them were familiar with only a few such patients. CONCLUSIONS: There is significant variability in the attitude and judgment of physicians from different specialties regarding food allergy. It seems that the physician's opinion is influenced by "general knowledge" more than by his own experience. We suggest emphasizing through education that there are two distinct entities of cow's milk intolerance: IgE-mediated allergy and non-IgE-mediated.

Animals↗
PubMed2004

Management of bone loss after organ transplantation.

Organ transplant recipients experience rapid bone loss and high fracture rates, particularly during the early post-transplant period. Early rapid bone loss occurs in the setting of uncoupled bone turnover with increased bone resorption and decreased bone formation. Because there are no clinical factors that reliably predict post-transplant bone loss and fractures in the individual patient, all transplant recipients should be considered candidates for early preventive therapy for osteoporosis. Long-term transplant recipients with densitometric osteoporosis and/or fractures should also receive treatment. Although active metabolites of vitamin D and bisphosphonates have both shown efficacy, data from clinical trials suggest that bisphosphonates are the safest and most consistently effective agents for the prevention and treatment of post-transplantation osteoporosis in adults. Kidney transplant recipients represent a special population, and more research is needed to delineate the risks and benefits of treating bone disease in these patients.

Bone Density↗
PubMed2004

Growth and skeletal maturation after pediatric cardiac transplantation.

To examine the effects of cardiac transplantation on skeletal maturation and linear growth, we retrospectively evaluated annual bone age determinations and growth parameters of pediatric cardiac transplant recipients followed at our center. Included in the analysis were records of 86 patients (32 females) who had received a cardiac transplant at our institution between 1984 and 1998. Bone age delay of > or =12 months was apparent in 38.5% at the time of transplantation. At some point in their post-transplant course, 23 patients (29%) had one or more bone age measurements that were > or =36 months delayed with respect to chronological age. Children transplanted before age seven and those with a pretransplantation diagnosis of cardiomyopathy experienced the most significant decrement in skeletal maturation after transplantation. High cyclosporin A levels and low body mass index were the only parameters found to be associated with delayed bone age. Although the majority of children grew at a normal rate after transplantation, height Z scores and height age were adversely affected regardless of the type of heart disease or the age at transplantation. The pathogenesis of both delayed skeletal maturation and growth retardation in this population warrant further investigation.

Adolescent↗
PubMed2004

The impact of environmental tobacco smoke on women's risk of dying from heart disease: a meta-analysis.

OBJECTIVE: To review systematically and analyze the association between environmental tobacco smoke (ETS) exposure and the risk of dying from heart disease in women. METHODS: We searched the English-language literature using MEDLINE (1966-April 2004), CINAHL, PsychInfo, and bibliographies of selected studies. We included studies that specifically addressed the association of ETS and heart disease mortality in women and had adequate controls and retrievable risk estimates. We looked for either cohort studies or randomized controlled trials. Studies were evaluated independently by two of the authors. Nine cohort studies were finally selected for analysis. We estimated the summary relative risk (RR) and associated 95% confidence intervals (95% CI) using a random-effects model. RESULTS: Mean follow-up periods for these cohorts ranged from 6 to 39 years. Among non-smoking women, exposure to ETS was associated with a 15% increase in the risk of dying from heart disease compared with nonsmoking women not exposed to ETS (RR = 1.15, 95% CI 1.03-1.28, p < 0.05). CONCLUSIONS: Among nonsmoking women, exposure to passive smoke increases the risk of dying from heart disease. In accordance with the newly developed guidelines by the American Heart Association for prevention of cardiovascular disease (CVD) in women, we recommend counseling women on reducing or avoiding ETS exposure.

Cohort Studies↗
PubMed2003

Osteoporosis after solid organ and bone marrow transplantation.

Organ transplantation has become increasingly common as a therapy for end-stage renal, liver, cardiac and pulmonary disease. The population of patients who have survived organ transplantation has grown dramatically over the last 2 decades. Although organ transplant recipients now benefit from greatly improved survival, long-term complications of organ transplantation, such as osteoporosis, adversely affect quality of life and must be addressed. In the early post-transplantation period, the effects of high dose glucocorticoids, combined with other immunosuppressive drugs such as cycosporine A and tacrolimus, cause rapid bone loss particularly at the spine and proximal femur. In this setting, fracture incidence rates as high as 25-65% have been reported. Treatment and prevention strategies must target this early post-transplant period, as well as the patient awaiting transplantation and the long-term transplant recipient. This review will discuss the clinical features of transplantation osteoporosis, the pathophysiology of post-transplantation bone loss and prevention and therapy of this unique bone disease.

Bone Marrow Transplantation↗
PubMed2002

Calcimimetics: therapeutic potential in hyperparathyroidism.

Calcium homeostasis is essential for the normal function of many organ systems. The recently cloned extracellular calcium-sensing receptor plays a central role in this process and thus represents an important target for therapeutic agents aimed at treating disorders of calcium metabolism. Compounds, such as the phenylalkylamines NPS 568 and AMG 073, act as agonists of calcium at this receptor. These calcimimetic agents hold promise as potential treatments for diseases of parathyroid hyperfunction, such as primary and secondary hyperparathyroidism.

Aniline Compounds↗
PubMedDate not supplied

Number of children and risk of metabolic syndrome in women.

BACKGROUND: In the United States, there is a high prevalence of metabolic syndrome, as defined by The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III). The relationship between reproductive factors and metabolic syndrome in women is unknown. METHODS: We examined the association of number of children and breastfeeding history with metabolic syndrome risk among women. We used nationally representative data from the Third National Health and Nutrition Examination Survey (NHANES III). A total of 4699 (age > or = 20) nonpregnant women were included in this report. Metabolic syndrome was defined according to ATP III. RESULTS: Overall, 22.6% of women were determined to have metabolic syndrome. The rate of metabolic syndrome was significantly higher with increasing numbers of children, demonstrating a dose-response relationship (p < 0.0001). After controlling for age, race/ethnicity, income, education, and other sociodemographic, reproductive, and behavioral risk factors, the odds of metabolic syndrome increased 13% (95% CI, 6%-20%) with each additional child. In a similarly controlled analysis in parous women, the odds of metabolic syndrome decreased 22% (95% CI, 1%-39%) in women with a history of breastfeeding for >1 month. However, both effects were no longer significant after inclusion of body mass index (BMI) categories. CONCLUSIONS: In a national sample of women, increasing number of children was associated with higher rates of metabolic syndrome, and history of breastfeeding was associated with decreased rates of metabolic syndrome. The strength of these relationships was decreased after additional adjustment for BMI, suggesting that weight or weight changes may be an important mediator of the effects of parity and breastfeeding on the risk of metabolic syndrome.

Adult↗