Biomedical subjects

Raanan Shamir

Publications and source records attributed to Raanan Shamir.

57 records · Page 4Linked to original sources

PubMed2002

Interferon treatment in children with chronic hepatitis B: an Israeli experience.

OBJECTIVE: To summarize the experience of two pediatric gastroenterology centers in northern Israel using interferon alpha to treat children with chronic hepatitis B. PATIENTS AND METHODS: We retrospectively reviewed the medical records of 59 children with chronic HBV. Forty-nine children were treated with subcutaneous IFN alpha at dosages of 10 MU/m (n = 12) or 5 MU/m (n = 37) three times a week for 6 months. Children treated with 5 MU/m IFN alpha were a heterogeneous group with regard to their alanine aminotransferases levels: 11/37 (group 1) had ALT twice above the upper limit of normal and 26/37 (group 2) had normal or less than twice ULN elevations of ALT. Ten children were observed without treatment. RESULTS: Sustained biochemical and virologic response occurred in 9/12 children (75%) treated with 10 MU/m IFN alpha, 3/11 (27%) in group 1 given 5 MU/m (P = 0.0315) and 4% (1/26) in group 2 treated with 5 MU/m. After 4 years follow-up, similar seroconversion rates were present in children who had baseline ALT higher than twice ULN, whether they were treated with 10 or 5 MU/m IFN alpha (83 vs. 73%). Children with normal or slightly abnormal baseline ALT also had a similar anti-hepatitis B e antigen seroconversion rate at the end of follow-up, whether they had been treated with IFN alpha or not (2/26, 8%, in group 2 and 4/10, 40%, in the untreated children, not significantly different). CONCLUSIONS: The results of IFN alpha treatment in this group of Israeli children are similar to these reported in the literature and reinforce the current consensus, which recommends INF alpha only for children with chronic HBV and significantly elevated liver enzymes.

Adolescent↗

PubMedDate not supplied

Resting energy expenditure in children with cyanotic and noncyanotic congenital heart disease before and after open heart surgery.

BACKGROUND: Failure to thrive is a common problem in children with congenital heart disease (CHD). Resting energy expenditure (REE) in cyanotic and noncyanotic children with CHD before and after open heart surgery has hardly been investigated. METHODS: Twenty-nine children younger than 3 years of age with CHD (14 cyanotic and 15 noncyanotic CHD) who were referred for open heart surgery were enrolled. Data on dietary intake, anthropometric measurements, and indirect calorimetry parameters were measured 24 hours before the surgery, (day -1), and on day 5 after surgery. The measured REE was compared with the Schofield and World Health Organization (WHO) REE prediction equations. RESULTS: The mean +/- SD measured REE was similar in the cyanotic and noncyanotic children before and after surgery (before surgery: 57 +/- 13 and 58 +/- 9 kcal/kg per day, respectively; 5 days after surgery: 59 +/- 10 and 62 +/- 10 kcal/kg per day, respectively). Oxygen consumption (VO2) and carbon dioxide production (VCO2) did not change significantly before and after surgery and were similar in both groups. The measured REE for all children on day -1 and day 5 was similar to the calculated REE using the Schofield equation but was significantly different from the calculated REE using the WHO equation (p < .01). CONCLUSIONS: Significant changes in REE, VCO2, and VO2 were not observed before and 5 days after open heart surgery in children with CHD. These parameters (REE, VCO2, and VO2) were also similar in children with cyanotic versus noncyanotic CHD. The Schofield equation is more accurate than the WHO equation in predicting energy needs of children with CHD, but measurement of REE is preferred over calculation of REE.

Calorimetry, Indirect↗

PubMedDate not supplied

Cost-effectiveness analysis of screening for celiac disease in the adult population.

BACKGROUND: Celiac disease (CD) is common and, when undiagnosed, may result in increased mortality, suggesting that mass screening could be justified. The authors examined the cost-effectiveness (CE) of such an approach, assuming a higher mortality rate in undiagnosed CD and that adhering to a gluten-free diet (GFD) reduces the mortality rate. METHODS: The authors developed a state transition Markov model, evaluating the CE of screening an entire population at the age of 18. Screening strategies included no screening v. screening by IgA antiendomysial antibodies (EMA), IgA human antitissue transglutaminase antibodies (TTG), and TTG verified by EMA. All strategies were examined with and without evaluation for IgA deficiency, and they all included an intestinal biopsy. Effects of variables were examined using sensitivity analysis. Effectiveness was assessed by life expectancy for each strategy and the incremental average CE ratio for each. RESULTS: Base-case analysis revealed US$49,491 and US$572,616 per life year gained for screening compared to no screening using EMA or TTG, respectively. The CE of screening with EMA was most influenced by the prevalence of CD and the standardized mortality ratio (SMR) for untreated CD patients. Screening was cost-effective in populations with a relatively high prevalence of CD or when the SMR for untreated CD patients was higher than 1.5. The model was insensitive to changes in the cost of serological markers and diagnostic endoscopy. CONCLUSION: Assuming an SMR of 1.5 or higher for untreated CD patients, mass screening for CD is cost-effective in populations with a relatively high prevalence of CD over a wide range of ages at screening. From a CE perspective, EMA is the preferred serological marker for mass screening. Screening for CD would be justified only if the uncertainties regarding the validity of our assumptions are substantiated.

Adolescent↗