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Biomedical subjects

S Melamed

Publications and source records attributed to S Melamed.

At least 19 recordsLinked to original sources
PubMed2006

Diurnal IOP control with bimatoprost versus latanoprost in exfoliative glaucoma: a crossover, observer-masked, three-centre study.

AIM: To evaluate the diurnal intraocular pressure (IOP) control and safety of bimatoprost versus latanoprost in exfoliative glaucoma (XFG). METHODS: One eye of 129 consecutive patients with XFG (mean (SD) age 66.5 (8.3) years) was included in this prospective, observer-masked, three-centre, crossover comparison. After a 4-6 week medicine-free period patients were randomised to bimatoprost or latanoprost monotherapy for 3 months. Patients were then switched to the opposite treatment for another 3 months. At the end of the washout and the treatment periods diurnal IOP was measured at 0800, 1300, and 1800. RESULTS: At baseline the IOP (mean (SD)) was 28.0 (4.0), 26.9 (3.6), and 25.9 (3.6) mm Hg, at the three time points, respectively. Both treatments significantly reduced mean diurnal IOP at month 3. Mean diurnal IOP was 26.9 (3.5) mm Hg at baseline, 17.6 (3.3) mm Hg with bimatoprost, and 18.6 (3.6) mm Hg with latanoprost (p<0.0001). Furthermore, lower IOP values were obtained with bimatoprost at all time points (17.9 (3.4), 17.3 (3.3), and 17.6 (3.5) mm Hg, respectively) compared with latanoprost (18.7 (3.6), 18.5 (3.6), and 18.6 (4.1) mm Hg, respectively). The corresponding mean differences (0.8, 1.1, and 1.0 mm Hg, respectively) were all significant (p<0.001 for each comparison). Significantly more patients with XFG obtained a target diurnal IOP <17 mm Hg with bimatoprost than with latanoprost, 55/123 (45%) v 34/123 (28%); (p = 0.001), and significantly fewer patients were non-responders with bimatoprost than with latanoprost (5 v 13, p = 0.021). More patients reported at least one adverse event with bimatoprost than with latanoprost (58 v 41 at 3 months; p = 0.0003). CONCLUSION: This crossover study suggests that better diurnal IOP control is obtained with bimatoprost than with latanoprost in patients with XFG.

Adult↗
PubMed2006

Skin test results and self-reported symptom severity in allergic rhinitis: The role of psychological factors.

BACKGROUND: In allergic conditions, the degree of skin test reactivity does not always correlate with the severity of clinical symptoms. Additional factors may contribute to the reported symptom severity. OBJECTIVES: To investigate the association between the magnitude of the skin prick test (SPT) response and the reported symptom severity in patients with allergic rhinitis and the possible modifying role of psychological factors. METHODS: One hundred four patients with allergic rhinitis and 23 with non-allergic rhinitis, classified according to their SPT response to 19 aeroallergens, were asked to rate the severity of five symptoms and to indicate whether their symptoms intensified on exposure to five common aeroallergens. They also completed a psychological questionnaire. Results Reported symptom severity of allergic rhinitis did not correlate with weal size for any of the aeroallergens tested or with the number of positive responses on SPT. It was not related to patient age, sex, or education. The reported symptoms severity correlated positively (0.29, P < 0.01) with reported symptom intensification on exposure to allergens. Moreover, both outcomes were positively associated with the psychological factors of hypochondriasis (0.20, P < 0.05 and 0.18, P < 0.05, respectively), and somatic awareness (0.24, P < 0.05 and 0.33, P < 0.01, respectively), but not with neuroticism. CONCLUSIONS: The severity of symptoms experienced by patients with allergic rhinitis is apparently not related to the magnitude of SPT response, but rather to psychological factors of hypochondriasis and somatic awareness. Physicians should be aware of the contribution of psychological factors to patient perceptions of the intensity of symptoms and of the intensification of symptoms on their exposure to allergens.

Adult↗
PubMed2005

Increased erythropoiesis and subclinical inflammation as part of the metabolic syndrome.

Recent studies have suggested the insulin resistance might be accompanied by enhanced erythropoiesis. We have examined this association in individuals with the metabolic syndrome (MS) who in addition to insulin resistance harbor a chronic low grade inflammation. This study is relevant because chronic inflammation might have a suppressive effect on erythropoiesis. 280 and 554 non-smoking women and men with respective age of 46.4+/-9.3 (mean+/-S.D.) and 44.0+/-11.0 years are included. A significant correlation was noted between the numbers of the components of the MS and the inflammatory biomarkers including the white blood cell count, high sensitivity C-reactive protein, fibrinogen concentrations and the erythrocyte sedimentation rate. In addition, a significant correlation (r=0.157, p=0.008) was noted between the number of components of the MS and the number of red blood cells in the peripheral blood in women. The same was true for men (r=0.192, p<0.0005). We conclude that enhanced erythropoiesis could be a new, hitherto unrecognized component of the MS. The enhanced erythropoiesis could give an erroneous impression of general "good" health in these individuals.

Adult↗
PubMed2005

Oral temperature in daily life. A new look in the era of microinflammation.

It has been repeatedly shown that apparently healthy individuals and those with atherothrombotic risk factors harbor a low grade subclinical internal inflammation (microinflammation). This low grade acute phase response is relevant for the presence of atherothrombosis and future vascular events. Since these events are associated with a febrile response, we thought that it is relevant to clarify whether the microinflammatory response has an influence on the oral temperature. Included were 2,340 men and 1,280 women in whom the white blood cell count (WBCC) and differential, as well as the erythrocyte sedimentation rate (ESR), quantitative fibrinogen and high sensitivity C-reactive protein (hs-CRP) were determined in addition to the oral temperature in quiescent conditions. There was no association between these inflammatory biomarkers, except from a weak association with the absolute number of polymorphonuclear leukocytes. This association could be, however, related to the stress of the examination itself. Thus, it is unlikely that the microinflammatory response in daily life is associated, to a significant degree, with an enhanced oral temperature. The results are relevant for the findings of elevated oral temperature during conditions of acute ischemia/infarction where the temperature is probably related to the event itself and not to the patient's background microinflammation.

Acute-Phase Reaction↗
PubMed2005

Obesity-related correlation between C-reactive protein and the calculated 10-y Framingham Coronary Heart Disease Risk Score.

OBJECTIVE: To clarify the role of body mass index (BMI, kg/m(2)) adjustment in predictive models for cardiovascular events that add high-sensitivity C-reactive protein (hs-CRP) to the 10-y Framingham Coronary Heart Disease Risk Score (FCRS). DESIGN: A cross-sectional study in a group of apparently healthy individuals. SUBJECTS: In all, 1512 apparently healthy individuals (955 men and 557 women) at a respective age of 49.7+/-10.6 and 50.6+/-9.6 y. RESULTS: The Pearson correlation between hs-CRP and the calculated 10-y FCRS was lower when adjusted for BMI. This reduction was especially noted in women where it dropped from 0.247 to 0.09. The dominant role of hs-CRP concentrations was also noted in a linear regression model, again, especially noted in women (drop of the standardized coefficient from 0.517 for BMI to 0.08 for the FCRS). CONCLUSIONS: The correlation between hs-CRP and the 10-y FCRS is partly related to the presence of obesity. We raise the possibility that the addition of BMI to the predictive model of FCRS might attenuate the cost-effectiveness of CRP measurements for this specific risk assessment.

Biomarkers↗
PubMed2004

Pingelapese achromatopsia: correlation between paradoxical pupillary response and clinical features.

AIM: To evaluate the paradoxical pupillary constriction in darkness in patients with Pingelapese achromatopsia (PA), and to describe a connection between this phenomenon and the clinical features. METHODS: 27 patients with PA were examined. All underwent a full ophthalmic examination which included Snellen visual acuity and ophthalmoscopy. Colour vision examination was performed with Ishihara pseudoisochromatic plates and also with a colour plate consisting of five basic colours (red, green, purple, yellow, and orange). Paradoxical pupillary response was examined and documented with a special infrared video camera. Pupils' images were analysed using the Scion Image program and the ratio of pupil size in darkness to its size in light was calculated and recorded. RESULTS: Mean visual acuity was 20/400 (range 20/80-20/800). Colour vision examination showed a mean of 3.2 (SD 1.5) (range 1-5) of Ishihara colour plates, and 0.5 (0.75) (0-3) of basic colour plates. 23 patients (85%) had paradoxical pupillary constriction in darkness. Mean dark/light ratio of pupillary area was 0.86 (range 0.5-1.6). In patients with marked paradoxical pupillary constriction there was a significant correlation of visual acuity and Ishihara score. CONCLUSIONS: Clinical manifestations of achromatopsia include total colour blindness, low visual acuity (mean of 20/400), horizontal pendular or rotatory nystagmus, and photophobia. Most patients have paradoxical pupillary constriction in darkness. When this response is brisk it seems to correlate with lower visual acuity and lower Ishihara score.

Adolescent↗
PubMed2002

Neuroprotective properties of a synthetic docosanoid, unoprostone isopropyl: clinical benefits in the treatment of glaucoma.

The characteristic loss of visual field due to glaucoma is directly associated with retinal ganglion cell (RGC) death. The process of RGC death is thought to be biphasic, starting with a primary injury, followed by a slow secondary degeneration. Retinal ischemia may establish the cellular conditions that create a fatal biochemical cascade; hypoxia, followed by high excitotoxic levels of glutamate cause pathologically elevated levels of intracellular calcium resulting in neuronal cell death via apoptosis or necrosis. Impaired ocular perfusion, primarily due to abnormal autoregulation and/or vasoconstriction caused by endothelin-1, probably contributes to the ischemic milieu. Neuroprotection, the preservation of neurons that were either not damaged or only slightly damaged during the primary insult, has become important for the clinician when considering treatment options. Unoprostone, the first synthetic docosanoid, has been demonstrated to exhibit neuroprotective properties. In an ischemic animal model, unoprostone protected RGCs in a dose-dependent manner. Unoprostone inhibits glutamate stimulation and opens maxi-K channels, which are potassium channels that reach an activation threshold only during depolarization and/or at high intracellular Ca2+ concentrations. The resultant large efflux of K+ hyperpolarizes the cell, thereby closing voltage-gated Ca2+ channels and limiting neuronal damage by decreasing influx of intracellular Ca2+. Unoprostone has also been shown to protect rat photoreceptors from constant light-induced damage. Lastly, unoprostone has vasorelaxant properties, evidenced by increased choroidal blood flow and inhibition of vasoconstrictors such as endothelin-1. These findings indicate that a substantial clinical benefit of unoprostone is neuroprotection of RGCs.

Animals↗
PubMed2001

Low job satisfaction predicts delayed return to work after laparoscopic cholecystectomy.

We studied 102 consecutive employed patients treated by elective laparoscopic cholecystectomy to determine job characteristics and psychological factors that predict delay in return to work after their procedure. Median sick leave was 13 days, and five variables significantly added to a model predicting sick leave of at least 20 days (31.4% of the workers): low job satisfaction (odds ratio [OR], 12.56; 95% confidence interval [CI], 3.34 to 47.2); physical effort at work (OR, 4.99; 95% CI, 1.46 to 17.04); pain at 7 days (OR, 5.55; 95% CI, 1.56 to 19.76); patient's expectation of slow recovery (> 7 days) (OR, 6.12; 95% CI, 1.82 to 20.55); and patient's expectation of no financial loss (OR, 3.85; 95% CI, 1.14 to 12.50). The model was excellent (area under the receiver operating characteristic curve, 89.6%). We conclude that low job satisfaction is a major predictor of delayed return to work.

Adult↗
PubMed2001

The interactive effect of chronic exposure to noise and job complexity on changes in blood pressure and job satisfaction: a longitudinal study of industrial employees.

The hypothesis of this study was that noise exposure level and job complexity interact to affect changes in blood pressure (BP) levels and job satisfaction over 2-4 years of follow-up. Results showed that among workers exposed to high noise, those with complex jobs showed increases in BP that were more than double shown by those with simple jobs. Under low noise exposure, there was a small increase in BP for workers with complex jobs but about a 3-fold increase in workers with simple jobs. The prevalence of elevated BP showed a similar trend. Job satisfaction increased among workers with complex jobs but was much less in those exposed to high noise. It was concluded that exposure to occupational noise has a greater negative impact on changes in BP and job satisfaction over time among those performing complex jobs. In contrast, job complexity had a clear beneficial effect for workers exposed to low noise.

Adult↗
PubMed2000

[Early detection of glaucoma by a mobile unit--results from 10,000 examinees].

Glaucoma, the third leading cause of blindness in the western world, is characterized by painless, gradual loss of visual fields which may lead to severe visual impairment or even blindness. In 4 years of operation of a mobile glaucoma unit for screening and early diagnosis of glaucoma, 10,037 subjects aged 18-95 years were screened (4504 women, 45%); 55% were under 50 years (Graph 1). Ocular hypertension was diagnosed in 8.0%; primary open angle glaucoma (POAG) in 0.8%, with 2/3 already under treatment, the rest newly diagnosed. Pseudo-exfoliative glaucoma was diagnosed in 0.2%; only 2 cases had closed angle glaucoma; 91% of those screened were normal (Fig. 4; age stratification, Graph 3). POAG increased with age, from 0.2% in those under 40 years to 10% in those over 80; POAG was more common in men, but OHT was similar in both sexes (6.0% vs. 5.3%). There was no correlation between incidence of POAG and place of work except in the Sorek Nuclear Center (1.9% vs. 0.8%, p = 0.11). Other conditions significantly more frequent in POAG than normals were diabetes mellitus (x 2.5), systemic hypertension (x 4), myopia (x 2) and history of intraocular surgery (x 6).

Adolescent↗
PubMed2000

Ongoing clinical assessment of the safety profile and efficacy of brimonidine compared with timolol: year-three results. Brimonidine Study Group II.

OBJECTIVE: We compared the safety profile and efficacy of brimonidine 0.2% BID with those of timolol 0.5% BID over 3 years in patients with ocular hypertension and glaucoma. METHODS: Ninety-four eligible patients from an ongoing multicenter, interventional, double-masked clinical trial were followed through year 3, 48 receiving brimonidine 0.2% and 46 receiving timolol 0.5%. Study visits occurred at months 24, 27, 30, 33, and 36. The primary efficacy variable was mean reduction from baseline intraocular pressure (IOP) at trough. Visual acuity, visual fields, and safety variables (adverse events, ocular symptoms, heart rate, blood pressure, and laboratory test results) were monitored throughout the study. RESULTS: The 2 treatment groups were well matched, with no significant differences in demographic or clinical characteristics. Both drug regimens caused significant mean reductions from baseline IOP at trough during year 3 (P < 0.001), with no significant differences between groups at any study visit. The overall mean reduction from baseline IOP at trough was 5.02 mm Hg with brimonidine and 5.57 mm Hg with timolol (P = 0.383). Brimonidine caused reductions in IOP at trough that were equivalent to those with timolol at months 30 and 36 (within the 95% CI). Visual fields were unchanged or improved in 95% of patients in both treatment groups. Both drug regimens appeared to be safe and were well tolerated. Ocular allergy occurred in 2 brimonidine-treated patients (4.2%). There were no statistically significant differences in adverse-event reports and no clinically significant effects on any ocular or systemic safety variable in either group. CONCLUSIONS: Brimonidine 0.2% BID continues to appear to be safe, well tolerated, and effective in the long-term management of ocular hypertension and glaucoma. Over 3 years, it provided sustained IOP-lowering efficacy and visual-field preservation equal to those with timolol 0.5% BID.

Adrenergic alpha-Agonists↗
PubMed2000

The relationships among objective and subjective environmental stress levels and serum uric acid: the moderating effect of perceived control.

This study was designed to investigate the effects of objective and subjective stress levels and perceived control on serum uric acid (SUA). Respondents were 2,504 male and 1,176 female manufacturing employees. Objective job-related stress was assessed by the Ergonomic Stress Level (ESL) inventory (S. Melamed, D. Yekutieli, P. Froom, E. Kristal-Boneh, & J. Ribak, 1999). As expected, ESL was positively associated with SUA, but among male respondents only. The measure of subjective stress, environmental annoyance, was negatively related with SUA for male respondents, thus not confirming the hypothesis. Perceived control was not found to have a direct effect on SUA, after controlling for the ESL measure. For male respondents only, perceived control moderated the relationship between ESL and SUA: This relationship was negative for those reporting above-average control and positive for those reporting below-average control.

Adult↗
PubMed2000

Association of physical activity at work with mortality in Israeli industrial employees: the CORDIS study.

The objective of this study was to evaluate the association of physical activity at work with the risk of all-cause cardiovascular disease and cancer mortality. The cohort consisted of 3488 male, Israeli, industrial employees who participated in an 8-year follow-up study. During this period 129 deaths were recorded: 54 from cardiovascular disease, 47 from cancer, and 28 from other causes. Physical activity at work was assessed at entry on a 4-point scale (none, light, medium, and high). Potential confounding demographic, anthropometric, and socioeconomic variables, and health habits including leisure time physical activity were accounted for. We found that the hazard ratio of all-cause mortality in workers with a high physical workload was 1.82 (95% confidence interval, 1.18 to 2.81) compared with workers having a low workload. A similar trend was noted for cardiovascular disease and cancer mortality. We concluded that a high physical workload is associated with increased mortality rates. Future studies should differentiate between leisure time and work time physical activity.

Adult↗
PubMed2000

Tonsillar pain mimicking glossopharyngeal neuralgia as a complication of vagus nerve stimulation: case report.

An adolescent girl presented with severe, lancinating tonsillar pain exacerbated by swallowing 6 weeks after initiation of left vagus nerve stimulation for intractable epilepsy. Her symptoms mimicked those seen in glossopharyngeal neuralgia and were relieved by temporary cessation of stimulation. Gradual reinstitution of therapy with alteration in stimulus parameters resulted in improved seizure control as well as cessation of pain symptoms. Direct stimulation of the vagus nerve may result in vagoglossopharyngeal neuralgia, which, in this case, was amenable to stimulus modification.

Adolescent↗
PubMed2000

Serum total cholesterol and cardiovascular mortality in Israeli males: the CORDIS Study. Cardiovascular Occupational Risk Factor Determination in Israeli Industry.

BACKGROUND: The degree to which serum total cholesterol predicts cardiovascular disease is uncertain. While most authors have placed TC among the most powerful risk indicators of CVD, some have claimed that it predicted CVD in women only, or even not at all. OBJECTIVE: To determine the predictive value of serum total cholesterol relative to diabetes, smoking, systolic blood pressure and body mass index (kg/m2), for cardiovascular disease mortality in 3,461 occupationally active Israeli males. METHODS: A prospective follow-up was carried out for the years 1987-1998 to determine the effect of age, smoking habits, a history of diabetes, SBP, BMI and TC, at entry, on CVD mortality. RESULTS: There were 84 CVD deaths during a total of 37,174 person-years follow up. The hazard ratios (95% confidence intervals) for CVD mortality with respect to variables at entry were: diabetes 5.2 (2.1-13.2), age 2.2 (1.7-2.9), smoking 1.3 (1.0-1.8), SBP 1.4 (1.1-2.0), TC 1.5 (1.0-2.1) and BMI 1.2 (0.7-2.2). Among non-obese, non-diabetic, normotensive subjects the hazard ratio of TC adjusted for age and smoking was 1.16 (1.09-1.22) per 10 mg/dl. In the remaining subjects it was 1.04 (0.98-1.12) only. There was a significant interaction between TC and diabetes, hypertension or obesity (P = 0.003). CONCLUSIONS: In this population of Israeli males we found an interaction between TC and other risk indicators for CVD. Confirmation is required for the unexpected finding that the predictive value of TC for CVD mortality among non-diabetic, non-obese and normotensive subjects exceeded that among subjects with either of these risk factors.

Adult↗