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Biomedical subjects

Arnon D Cohen

Publications and source records attributed to Arnon D Cohen.

At least 19 recordsLinked to original sources
PubMed2006

The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study.

BACKGROUND: Previous reports demonstrated an association between psoriasis and other diseases including heart failure and diabetes mellitus. OBJECTIVES: Our aim was to describe the association between psoriasis, diabetes mellitus, and atherosclerosis in Israel. METHODS: A cross-sectional study was performed utilizing the database of Maccabi Healthcare Services (MHS), a large health provider organization in Israel. Case patients were defined as subjects who were diagnosed with psoriasis. Patients with diabetes and atherosclerosis were identified by using the MHS diabetes and cardiovascular registries, respectively. The control group included MHS enrollees without psoriasis. The proportion of diabetes and atherosclerosis among case and control groups was compared. Chi-square tests were used to compare categorical parameters. Logistic regression models were used for multivariate analyses. RESULTS: The study included 46,095 patients with psoriasis (case patients) and 1,579,037 subjects without psoriasis (control patients). The age-adjusted proportion of diabetes was significantly higher in psoriasis patients as compared with the control group (odds ratio [OR] 1.27, 95% confidence interval [CI] 1.1-1.48). The age-adjusted proportion of atherosclerosis was significantly higher in psoriasis patients as compared with the control group (OR 1.28, 95% CI 1.04-1.59). In patients with psoriasis, a multivariate logistic regression model demonstrated an association between diabetes and the multiple use of very potent topical steroids (P < .05) or use of systemic medication for psoriasis (methotrexate, cyclosporine or acitretin) (P < .001). A similar model demonstrated an association between atherosclerosis and the use of phototherapy (P < .001). LIMITATIONS: Our study was based on a computerized database. The diagnosis of psoriasis was based on digitally transmitted data. Therefore overestimation (false-positive cases) and underestimation (false-negative cases) of psoriasis patients may exist, thereby being a source for information bias. A second limitation is selection bias that may occur due to the possibility that reporting of both psoriasis and associated illnesses is higher in individuals who are seeking medical care. A third limitation concerns the causal effect between occurrence of psoriasis and atherosclerosis or diabetes. The dataset of MHS records diagnoses only from 1997 and does not record the date of disease onset. CONCLUSIONS: Our study supports previous reports for an association between psoriasis and atherosclerosis and psoriasis and diabetes. Further study is needed to support this observation.

Adolescent↗
PubMed2006

Dermatitis artefacta in soldiers.

BACKGROUND: Dermatitis artifacta is not an uncommon disease in military settings. Soldiers may intentionally produce skin lesions to achieve sick leave from military duties. The aim of this work was to describe a series of soldiers with dermatitis artifacta. METHODS: A prospective study was conducted among soldiers of the Israel Defense Force. RESULTS: Fourteen soldiers from the Israel Defense Force were included in the study. There were 13 men and one woman. The ages of the patients ranged between 19 and 26 years. For all patients, dermatitis artifacta was characterized by the acute appearance of a pruritic rash located on readily accessible areas of the limbs and abdomen. The rash was associated with systemic symptoms for 12 (85.7%) of 14 patients. None of the patients admitted to intentionally inflicting the skin lesions. The rash consisted of erythematous patches with numerous papules and pustules arranged in a linear pattern. All patients were treated with topical corticosteroids, four patients were treated with antibiotics, and three patients were treated with systemic corticosteroids. For all patients, the eruption resolved completely within 1 to 3 weeks. CONCLUSIONS: In the context of soldiers standing to gain sick leave by assuming the sick role, dermatitis artifacta can be reliably diagnosed by noting the characteristic location and morphological features of the skin lesions.

Adrenal Cortex Hormones↗
PubMed2005

Depression in dermatological patients identified by the Mini International Neuropsychiatric Interview questionnaire.

BACKGROUND: Early diagnosis and treatment of depression are of vital importance in dermatological patients. OBJECTIVE: Our purpose was to evaluate the prevalence of depression among patients visiting a dermatology clinic in southern Israel. METHODS: Patients who visited the dermatology clinic were interviewed using the Mini International Neuropsychiatric Interview screening tool. RESULTS: The study included 384 patients. The screening questionnaire identified 37 patients (9.6%) with major depression, 3 patients (0.8%) with minor depression, and 74 patients (19.3%) with depressive symptoms. Higher prevalence of depression was found among widowers, among divorced or separated patients, and in unemployed patients. Depression was significantly associated with the perception of severity and suffering induced by the skin diseases. LIMITATIONS: The study was conducted in a cross-sectional design. To confirm causality, a longitudinal study should be conducted. CONCLUSION: Depression should be a consideration by dermatologists in the effective management of skin diseases.

Adult↗
PubMed2005

Diabetes control in the Bedouin population in southern Israel.

BACKGROUND: The Bedouins in the Negev are a population in transition from traditional nomadic to a western sedentary lifestyle, characterized by changes in dietary habits and reduction in physical activity, with substantial changes in morbidity patterns. To describe the current state of diabetes prevalence and control among the Bedouin population in the Negev and to compare it to the non-Bedouin population. MATERIAL/METHODS: A cross-sectional study was performed utilizing the database of Clalit Health Services. In patients with a confirmed diagnosis of diabetes, the following variables were extracted from the laboratory records: hemoglobinA1c (HgA1C) level, urine microalbumin level and low density lipoprotein (LDL) level. Chi-square test was used to compare categorical parameters between the groups. RESULTS: Age-adjusted prevalence of diabetes was 5.1% in the Bedouin population as compared to 3.7% in the non-Bedouin population (p<0.001). Diabetes was more prevalent in urban as compared to rural settlements (5.5% vs. 3.9%, respectively, p<0.001). The proportion of Bedouins patients with controlled diabetes (HgA1C<7) was significantly lower in Bedouin patients (29.3%) as compare to Non-Bedouin patients (46.7%) (p<0.001). CONCLUSIONS: Age-adjusted prevalence of diabetes is increased in the Bedouin population as compared to the Non-Bedouin population in southern Israel. Despite similar performance status of laboratory tests and similar treatment regimens, the overall control of diabetes is poorer in the Bedouin population as compared to the Non-Bedouin population. These findings support previous observations that diabetes has become a major public health problem among Bedouins.

Adolescent↗
PubMed2005

Neuropathic scrotal pruritus: anogenital pruritus is a symptom of lumbosacral radiculopathy.

BACKGROUND: Anogenital pruritus is defined as an itch localized to the anus, perianal, and genital skin. Anogenital pruritus is usually a symptom of an underlying disorder of the skin or mucosa or a consequence of anorectal pathology. When no demonstrable cause is found, anogenital pruritus is often described as "idiopathic". OBJECTIVE: To investigate the role of lumbosacral radiculopathy in the pathogenesis of anogenital pruritus. METHODS: Included in the study were consecutive patients with anogenital pruritus. Radiographs and nerved conduction studies were performed in all patients. Needle electromyography studies and computerized tomography were performed when necessary. Nerve conduction studies included measurement of distal sensory and motor latency, conduction velocity, and F-responses of the peroneal and tibial nerves. Patients with confirmed radiculopathy were treated with paravertebral injection of a mixture of triamcinolne acetonide and lidocaine. Response to the injections was assessed using visual analogue scales by the patients. Mean scores before and after treatment were compared using paired t tests. RESULTS: Included in the study were 20 patients with anogenital pruritus. There were 18 men (90%) and 2 (10%) women. The mean age was 52.7 years (standard deviation [SD] 11.7 years). In 16 patients (80%), radiographs demonstrated degenerative changes of the lower spine. In 16 patients (80%) the presence of lumbosacral radiculopathy was confirmed by nerve conduction studies. Fifteen patients (75%) were treated with paravertebral injections, with significant decrease in mean pruritus score as assessed by the patients (6.3 [+/-2.8]; 4.5 [+/-2.7], before and after treatment, respectively, P = .033). CONCLUSION: "Idiopathic" anogenital pruritus may be attributable to lumbosacral radiculopathy. Paravertebral blockade may be used for alleviation of symptoms in patients with anogenital pruritus.

Anal Canal↗
PubMed2005

Clinical implications of in vitro drug-induced interferon gamma release from peripheral blood lymphocytes in cutaneous adverse drug reactions.

BACKGROUND: Drug-specific T cells are involved in the pathogenesis of cutaneous adverse drug reactions (CADRs). OBJECTIVE: We sought to evaluate the diagnostic role of in vitro drug-induced release of interferon gamma in CADRs. METHODS: The study group consisted of 36 patients with CADRs after intake of 106 drugs that were classified into 3 categories of drug suspicion: high, possible, and low. The control group consisted of 22 individuals taking a similar profile of 54 drugs, without CADRs. In vitro drug-induced interferon gamma release was determined by enzyme-linked immunosorbent assay in culture supernatants after incubation of peripheral blood lymphocytes with parent drug compounds. The in vitro tests were conducted after the acute phase of the CADRs. In vitro tests were compared with in vivo withdrawal and/or challenge drug tests. RESULTS: Positive interferon gamma tests were recorded in 77.8% of the patients for 49.0% of the drugs. The proportion of positive interferon gamma tests was directly associated with the degree of drug suspicion (64.4%, 36.4%, and 27.8% for high, possible, and low, respectively). There were significantly more positive tests for high- compared with low-suspicion drugs (P=.001). The degree of agreement between the results of the in vitro interferon gamma release tests and the in vivo tests was intermediate to good (kappa=0.47). CONCLUSION: In vitro drug-induced interferon gamma release may help to identify the responsible drug in CADRs.

Adolescent↗
PubMed2005

Drug exposure and psoriasis vulgaris: case-control and case-crossover studies.

Intake of drugs is considered a risk factor for psoriasis. The aim of this study was to investigate the association between drugs and psoriasis. A case-control study including 110 patients who were hospitalized for extensive psoriasis was performed. A control group (n = 515) was defined as patients who had undergone elective surgery. A case-crossover study included 98 patients with psoriasis. Exposure to drugs was assessed during a hazard period (3 months before hospitalization) and compared to a control period in the patient's past. Data on drug sales were extracted by data mining techniques. Multivariate analyses were performed by logistic regression and conditional logistic regression. In the case-control study, psoriasis was associated with benzodiazepines (OR 6.9), organic nitrates (OR 5.0), angiotensin-converting enzyme (ACE) inhibitors (OR 4.0) and non-steroidal anti-inflammatory drugs (NSAIDs) (OR 3.7). In the case-crossover study, psoriasis was associated with ACE inhibitors (OR 9.9), beta-blockers (OR 9.9), dipyrone (OR 4.9) and NSAIDs (OR 2.1). Extensive psoriasis may be associated with intake of ACE inhibitors, NSAIDs or beta-blockers.

Adrenergic beta-Antagonists↗
PubMed2005

Effectiveness of climatotherapy at the Dead Sea for psoriasis vulgaris: A community-oriented study introducing the 'Beer Sheva Psoriasis Severity Score'.

BACKGROUND: Climatotherapy at the Dead Sea (CDS) is a therapeutic modality for moderate to severe psoriasis vulgaris. OBJECTIVE: To evaluate the effectiveness of CDS in patients with psoriasis, using the PASI score and a novel simplified tool for the assessment of psoriasis - the Beer Sheva Psoriasis Severity Score (BPSS). METHODS: A total of 70 patients with psoriasis vulgaris were treated by CDS. In all patients, the severity of psoriasis was assessed before and after CDS using PASI score and BPSS. BPSS includes eight items that are recorded by the physician (total severity of the disease, and seven items relating to the physical distribution of the disease) and eight items that are recorded by the patient (total severity, physical and psychological severity, pruritus and assessment of involvement in the face, nails, palms and soles and genital regions). RESULTS: The study included 70 patients (40 men, 30 women; age 19-78 years). There was a 75.9% reduction in PASI score, from a mean of 16.6+/-11.0 before treatment to 4.0+/-4.2 after treatment (p<0.001). There was a 57.5% reduction in BPSS, from a mean of 72.8+/-19.6 before treatment to 31.0+/-21.2 after treatment (p<0.001). PASI score significantly correlated with BPSS before CDS treatment (r = 0.59, p<0.001) and after CDS treatment (r = 0.53, p<0.001). CONCLUSION: CDS is an effective therapy for patients with psoriasis, as evaluated by either PASI score or BPSS. BPSS was considered shorter and more user-friendly by the participating physicians.

Adult↗
PubMed2005

Risk factors for incomplete excision of squamous cell carcinomas.

OBJECTIVE: The aim of this study was to identify risk factors for incomplete excision of squamous cell carcinomas (SCCs). PATIENTS AND METHODS: A cross-sectional study of 369 patients who underwent a primary excision of SCCs was performed within an outpatient and a hospital plastic surgery department setting. RESULTS: Incomplete excision occurred in 25 of 369 primary excisions of SCC (6.8%). Location of the tumors on the forehead, temples, peri-auricular region, ears, cheeks, nose, lips or neck was significantly associated with incomplete excision of the tumors. In particular, high incomplete excision proportions were observed for tumors located on the ears (16.7%), neck (16.7%), temples (11.1%), nose (10.8%) or lips (7.1%). Incomplete excision of SCC was associated with the setting of the operation in the hospital as compared to ambulatory settings (p = 0.046) and was inversely associated with the specimen thickness (p = 0.002). There was no statistically significant association between incomplete excision of SCC and gender, age, clinical appearance of the lesion (suspected SCC vs other diagnoses), differentiation pattern, diameter of the tumor, length or width of the excised specimen, solar changes or ulceration. CONCLUSION: We recommend that in patients with SCCs located in the forehead, temples, periauricular region, ears, cheeks, nose, lips or neck surgeons should commence particular surgical measures to avoid inadequate excisions of the tumors. In particular, surgeons should use wider excisional margins in tumors located in the embryonic fusion planes (e.g. eyelids and naso-labial folds).

Aged↗
PubMed2005

Health provider determinants of nonattendance in pediatric otolaryngology patients.

INTRODUCTION: Nonattendance for otolaryngology appointments disrupts the management of medical care and leads to ineffective use of resources. The determinants of nonattendance in pediatric otolaryngology patients have not been well documented. OBJECTIVES: To investigate health provider determinants of nonattendance in pediatric otolaryngology patients. STUDY DESIGN: We assessed the effects of waiting time for an appointment and the timing of the appointment (during the day, week, and year) on nonattendance proportions during a 1 year period. Chi square tests were used to analyze statistically significant differences of categorical variables. Logistic regression was used for multivariate analyses. RESULTS: A total of 2,628 pediatric visits were included in the study. The overall proportion of nonattendance at the pediatric otolaryngology clinic was 33.0%. Nonattendance proportions were 32.7% between 7 AM and 9 AM; 28.3% between 9 AM and 2 PM, and 36.5% between 2 PM and 8 PM (P < .001). The proportion of nonattendance was 24.1% when there was a short waiting time for an appointment (0-7 days), and 36.3% when there was an intermediate waiting time (7-15 days), and 36.6% when there was a long waiting time (15 days and above)(P < .001, P < .012, respectively). CONCLUSIVE: Health provider determinants of nonattendance in pediatric otolaryngology clinic appointments include the waiting time for an appointment and the hour of the appointment within the day.

Adolescent↗
PubMed2004

Risk factors for incomplete excision of basal cell carcinomas.

Incomplete excision of basal cell carcinomas (BCCs) may be followed by recurrence of the tumor. In order to detect risk factors for incomplete excision of BCCs we performed a cross-sectional study of 1278 patients who underwent a primary excision of BCCs, during a four-year period, within an ambulatory and hospital plastic surgery department setting. Incomplete excision occurred in 159 of 1478 primary excisions of BCCs (10.8%) and was significantly associated with location of the tumors in the eyelids (OR 3.64, 95% CI 1.96-6.71), ears (OR 2.51, 95% CI 1.25-4.94), naso-labial folds (OR 2.26, 95% CI 0.99-5.04) and nose (OR 1.88, 95% CI 1.30-2.71). There was an inverse association with location of the tumors in the upper limbs (OR 0.44, 95% CI 0.21-0.90), back (OR 0.12, 95% CI 0.02-0.48) or chest (OR 0.09, 95% CI 0.00-0.57). Baso-squamous differentiation was associated with incomplete excision of BCCs (p = 0.03). No association was observed between incomplete excision of BCCs and gender, age, setting of the operation (ambulatory vs. hospital), clinical appearance of the lesion (suspected BCCs vs. other diagnoses) or diameter of the lesions. In conclusion, incomplete excision of BCCs was associated with location of the tumors in the eyelids, ears, naso-labial folds and nose. We recommend that in patients with BCCs located in these sites, surgeons should commence particular surgical measures to avoid inadequate excisions of the tumors.

Aged↗
PubMed2004

A randomized controlled trial of silver sulfadiazine, biafine, and saline-soaked gauze in the treatment of superficial partial-thickness burn wounds in pigs.

UNLABELLED: Silver sulfadiazine 1% cream (SSD) and biafine (an oil-in-water emulsion containing alginate) are used for the treatment of superficial partial-thickness burns, but comparative effectiveness studies are lacking. OBJECTIVES: To compare the uses of SSD, Biafine (Labortoires Medix, Houdan, France), and saline-soaked gauze in the treatment of superficial partial-thickness burns in pigs. METHODS: This was a randomized controlled trial in four anesthetized young pigs. Four equal sets of partial-thickness contact burns were inflicted on the pigs. Each burn was randomly assigned to treatment with biafine, SSD, or saline-soaked gauze with dressing changes every other day. Assessment of wound re-epithelialization was performed every other day, for a total of two weeks. The treatment groups were compared by univariable and multivariable analyses of variance (ANOVAs), controlling for the pig and the location of the burns on each pig. RESULTS: Thirty-two burns were inflicted on the pigs. Time to re-epithelialization of the burns was 13.5 days (SD +/- 0.9 days) in pigs treated with biafine, 13.3 days (+/-1.3 days) in pigs treated with SSD, and 13.5 days (+/-1.0 days) in pigs treated with saline-soaked gauze (p = not significant [NS]). The decreases in burn area from day 2 to day 12 were 21.4 cm(2) (+/-6.0 cm(2)) in pigs treated with biafine, 20.0 cm(2) (+/-6.3 cm(2)) in pigs treated with SSD, and 19.8 cm(2) (+/-5.9 cm(2)) in pigs treated with saline-soaked gauze (p = NS). A multivariable ANOVA showed a similar decrease in burn area between the treatment arms (p = NS) and a significant difference between the pigs (p = 0.015). CONCLUSION: Partial-thickness porcine burns treated with SSD, biafine, and soaked saline gauze re-epithelialize at similar rates.

Administration, Topical↗
PubMed2003

Brachioradial pruritus: a symptom of neuropathy.

BACKGROUND: Brachioradial pruritus (BRP) is a localized pruritus of the dorsolateral aspect of the arm. BRP is an enigmatic condition with a controversial cause; some authors consider BRP to be a photodermatosis whereas other authors attribute BRP to compression of cervical nerve roots. OBJECTIVE: We sought to investigate the presence of neuropathy in patients with BRP. METHODS: We performed electrophysiologic studies of the median, ulnar, and radial nerves in consecutive patients with BRP, including measurement of sensory and motor distal latency, conduction velocity and F responses of the median and ulnar nerves, and sensory distal latency of the radial nerves in both upper limbs. RESULTS: Included in the study were 7 patients, 5 men and 2 women, with an average age of 58.3 years (range: 42-72 years). Of the patients, 4 (57%) had abnormal F responses that were diagnostic for cervical radiculopathy, and 3 of these patients had prolonged distal latencies of the nerves tested, which may be interpreted as sensory motor neuropathy secondary to chronic radiculopathy. The fourth patient had polyneuropathy secondary to diabetes mellitus. CONCLUSION: BRP may be attributed to a neuropathy, such as chronic cervical radiculopathy. The possibility of an underlying neuropathy should be considered in the evaluation and treatment of all patients with BRP.

Adult↗
PubMed2003

Multiple agminated trichodiscomas in the earlobe.

Trichodiscomas are hamartomas of the hair disk and appear as multiple, firm, well-circumscribed papules measuring a few millimeters. In most cases, trichodiscomas are distributed on the face and neck. Trichodiscomas may occur as isolated tumors or in association with other follicular tumors. In some cases, multiple trichodiscomas appear in association with fibrofolliculomas or acrochordons. We herein describe multiple agminated trichodiscomas in the earlobe.

Adult↗
PubMed2003

Appropriateness of soldiers' referrals to the emergency department.

BACKGROUND: Emergency departments (ED) in Israel deal with a large number of referrals from the Israel Defense Force. In a recent study, we observed that only 3% of soldiers referred to the ED in Soroka Medical Center were hospitalized. OBJECTIVES: The purpose of this study was to determine the appropriateness of soldier referrals to the ED, using a proposed set of criteria for ED appropriateness. METHODS: A retrospective assessment of 707 discharge letters of soldiers from the ED was performed. A set of criteria to assess the appropriateness of soldier's referrals to the ED was developed. The criteria were as follows: (1) resuscitation, (2) hospitalization, (3) laboratory examination, (4) X-ray examination, (5) medical treatment, and (6) specialist consultation. A referral was considered appropriate if at least one criterion was positive. RESULTS: According to the proposed criteria of ED military appropriateness, 586 of 707 referrals (83%) were considered as appropriate. Appropriateness of the referrals according to sections of the ED was as follows: orthopedics (97%), internal medicine (63%), ophthalmology (100%), and neurosurgery (100%). CONCLUSIONS: A discrepancy exists between the high proportion of appropriate soldiers' referrals to the ED and the low hospitalization proportion. Organizational steps should be undertaken in the Israel Defense Force to decrease excess military use of civilian ED services.

Adult↗