Assaf Harofeh Medical Center


Assaf Harofeh Medical Center

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Ahmed Z.,University College London | Algom A.A.,Assaf Harofeh Medical Center | Tsuboi Y.,Fukuoka University | Josephs K.A.,Mayo Medical School
Current Opinion in Neurology | Year: 2010

Purpose of review: Neurodegenerative tauopathies, of which progressive supranuclear palsy (PSP) is one of the most common, are clinically heterogeneous, reflecting differences in distribution and biochemical composition of tau pathology. This review highlights the range of clinical and pathologic presentations of PSP and its variants. Recent findings: Progressive supranuclear palsy is a 4R tauopathy with neuronal and glial tau-immunoreactive lesions in neuroanatomically specific nuclei in the basal ganglia, diencephalon, brainstem and cerebellum, with restricted involvement of the neocortex. Hierarchical cluster analyses of clinical and pathologic features of PSP indicate that there are distinct clinicopathologic variants of PSP. In variants of PSP presenting with focal cortical syndromes, such as frontotemporal dementia, corticobasal syndrome and apraxia of speech, there is greater cortical pathology than in typical PSP. In variants of PSP presenting with levodopa-responsive Parkinsonism, as well as pure akinesia and gait failure, there is less cortical pathology and more severe degeneration in the cardinal nuclei-globus pallidus, subthalamic nucleus and substantia nigra-than in typical PSP. Summary: Clinical variants in PSP reflect varying anatomical distribution of tau pathology, but they share histopathologic, biochemical and genetic features with typical PSP. The basis for anatomical selective vulnerability in PSP and its variants remains to be determined. © 2010 Wolters Kluwer Health | Lippincott Williams and Wilkins.

News Article | February 15, 2017

A new Tel Aviv University study finds outdoor challenge-based interventions may be effective in reducing the overall severity of Autism Spectrum Disorder (ASD) symptoms. The research found significant improvements in the social cognition, social motivation, and autistic mannerisms of the young subjects after outdoor adventure activities and describes a new path for enhancing the social and communication skills of children with ASD. The study was published in Developmental Medicine and Child Neurology and led by Prof. Ditza Antebi-Zachor of the Pediatric Department at TAU's Sackler Faculty of Medicine and Director of Assaf Harofeh Medical Center's Autism Center, together with Prof. Esther Ben Itzchak of Ariel University. One in 68 children in the US is diagnosed each year with ASD, a neurodevelopmental disorder characterized by socio-communicative impairments and restricted and repetitive behaviors and interests. The developmental disorder takes a deep social, emotional and economic toll on the child and his/her family. But research has also shown that the early diagnosis and early treatment of ASD can lead to vast improvements in the cognitive functioning and socio-communicative skills of children on the spectrum. Getting out of the classroom Fifty-one children from seven special-education kindergartens in Tel Aviv participated in the study, which was conducted in collaboration with ALUT, the National Israeli Association for Children with Autism, and ETGARIM, a nonprofit that sponsors outdoor activities for disabled people. The children, aged 3-7, all followed the same educational protocols, but the intervention group, comprising 30 students, also participated in an outdoor adventure program (OAP). The intervention group underwent 13 weekly sessions of challenge-based activities with instructors. Each 30-minute session took place in urban parks near the participants' kindergartens and kicked off with a song. Afterward, the children used the outdoor fitness equipment, moving from one to another throughout the session. The activities required the children to communicate with the instructors and with their peers, to ask for assistance or be noticed, for example. Prior to the adventure program, the children's cognitive and adaptive skills were assessed by the kindergarten instructors using the Social Responsiveness Scale (SRS), a questionnaire that assesses autism severity in different domains, and the Teachers' Perceived Future Capabilities questionnaire. The information was obtained prior to and after completing the program. "Outdoor adventure programs are designed to improve intrapersonal skills and interpersonal relationships by using adventurous activities to provide individual and group problem-solving and challenge tasks," says Prof. Zachor. "The necessary tools for a successful OAP include establishing individual and group goals, building trust among participants, and providing activities that challenge and evoke stress but are nevertheless enjoyable. "Our study shows that outdoor adventure activities benefit children with autism and improve their social communication skills. We suggest including these fun activities in special education kindergartens and in communication classrooms at school in addition to traditional treatments. Parents of children with ASD can also enroll their kids in afterschool activities based on the principles of our research. It will allow the children to have fun during their leisure time while improving their communication skills." According to Prof. Zachor, future studies should examine the contribution of this type of intervention over longer periods of time and encourage other researchers to explore new treatments that improve social communication skills in an entertaining, engaging way. "We're interested in studying the long-term effect of this intervention, not just on ASD symptoms but on functioning in different domains, including behavioral problems, language skills, and attention span," she says. Tel Aviv University (TAU) is inherently linked to the cultural, scientific and entrepreneurial mecca it represents. It is one of the world's most dynamic research centers and Israel's most distinguished learning environment. Its unique-in-Israel multidisciplinary environment is highly coveted by young researchers and scholars returning to Israel from post-docs and junior faculty positions in the US. American Friends of Tel Aviv University (AFTAU) enthusiastically and industriously pursues the advancement of TAU in the US, raising money, awareness and influence through international alliances that are vital to the future of this already impressive institution.

Pogue J.M.,Wayne State University | Kaye K.S.,Wayne State University | Cohen D.A.,Assaf Harofeh Medical Center | Marchaim D.,Assaf Harofeh Medical Center | Marchaim D.,Tel Aviv University
Clinical Microbiology and Infection | Year: 2015

The past decade has brought a significant rise in antimicrobial resistance, and the ESKAPE pathogens have become a significant threat to public health. Three epidemiological features that negatively impact patients, which are consistently seen with the ESKAPE pathogens, are the following: 1) there has been a rise in incidence of these organisms as causative human pathogens, 2) there has been a significant increase in antimicrobial resistance in these bacterial species, and 3) the infections caused by these resistant strains are associated with worse outcomes when compared with infections caused by their susceptible counterparts. Significant delays in time to appropriate antimicrobial therapy of up to 5 days have been reported in infections due to these organisms and this is the strongest predictor of mortality with ESKAPE pathogens, particular in critically ill patients, where every hour delay has an incremental survival disadvantage for patients. Strategies to decrease these delays are urgently needed. Although routine broad-spectrum empiric coverage for these organisms would ideally limit this delay, agents with activity against these organisms are sometimes less effective, have significant toxicity risk, and their use can result in the development of resistance. Therefore, strategies to optimize therapy, although limiting unnecessary use of broad-spectrum antimicrobials, are urgently needed. This review will discuss potential strategies to optimize empiric therapy in the age of multi-drug resistance, the limitations of these strategies, and will discuss future directions and opportunities. © 2015 European Society of Clinical Microbiology and Infectious Diseases.

Bogan C.,Wayne State University | Marchaim D.,Assaf Harofeh Medical Center | Marchaim D.,Tel Aviv University
Future Microbiology | Year: 2013

Antimicrobial resistance is a continuing, growing, worldwide iatrogenic complication of modern medical care. Carbapenem resistance among certain pathogens poses a significant challenge. In order to reduce the spread of these nearly untreatable pathogens, preventative efforts should be directed at reducing patient-to-patient transmission and preventing the emergence of resistance among susceptible strains. One theoretical intervention to reduce the emergence of resistance is establishing and strictly adhering to an antimicrobial stewardship program. However, data pertaining to the direct effect of stewardship in curtailing carbapenem resistance among epidemiologically significant organisms are scarce. In this report, we review the potential biases associated with data interpretation in this research field, and we review the data pertaining to the impact of stewardship in curbing carbapenem resistance in three significant groups of pathogens: Pseudomonas aeruginosa, Enterobacteriaceae and Acinetobacter baumannii.

Jauniaux E.,University College London | Ben-Ami I.,Assaf Harofeh Medical Center | Maymon R.,Assaf Harofeh Medical Center
Reproductive BioMedicine Online | Year: 2013

Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women <45 years of age are not associated with a notable increase in antenatal complication rates and thus do not require additional antenatal care compared with spontaneous twins. The risks of maternal and fetal morbidity and mortality associated with assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are obviously at higher risk of perinatal complications than singletons due to a natural increase in the incidence of fetal anomalies, antenatal disorders and obstetric and neonatal complications associated with the development of two fetuses instead of one. Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, and the transfer of more than one embryo should be avoided in women with a pre-existing maternal medical condition. © 2012, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Nasser C.K.,Assaf Harofeh Medical Center
Journal of refractive surgery (Thorofare, N.J. : 1995) | Year: 2012

To assess measurement repeatability of corneal curvature, minimal corneal thickness, and anterior chamber depth obtained with the Sirius imaging system (Costruzioni Strumenti Oftalmici) and to assess its agreement with the Pentacam HR imaging system (Oculus Optikgeräte GmbH). Healthy individuals were prospectively recruited. To assess repeatability, eight consecutive measurements were performed in the right eye of healthy individuals with the Sirius. A single measurement was then performed consecutively with both systems. The anterior and posterior corneal radii (antR and posR, respectively), anterior chamber depth, and minimal corneal thickness were evaluated. Repeatability of Sirius was evaluated by calculating coefficients of variation (CoV). Agreement between Sirius and Pentacam was assessed by calculating 95% limits of agreement (LoA) and plotting Bland-Altman graphs. Forty-five eyes from individuals (21 men, 24 women) aged 20 to 61 years were evaluated. The mean CoV was 0.37% and 1.32% for antR and posR at 3 mm, respectively, and 0.36% and 1.28% for antR and posR at 7 mm, respectively. For anterior chamber depth and minimal corneal thickness, the CoV was 0.56% and 1.69%, respectively. Calculated 95% LoA were -0.1 to 0.12 mm (mean difference: 0.018 mm) and -0.54 to 0.33 mm (mean difference: 0.1 mm) for antR and posR at 3 mm, respectively. For anterior chamber depth, 95% LoA was -0.23 to 0.09 mm (mean difference: 0.068 mm) and -9.61 to 33.44 μm (mean difference: 11.91 μm) for minimal corneal thickness. The Sirius showed good to excellent repeatability for all measured parameters. Agreement analysis suggests that Sirius and Pentacam should not be used interchangeably. Copyright 2012, SLACK Incorporated.

Fridin M.,Ariel University | Belokopytov M.,Assaf Harofeh Medical Center
Computers in Human Behavior | Year: 2014

This study examined the first-time acceptance of (SAR) by preschool and primary school teachers. A modified Unified Theory of Acceptance and the Use of Technology model was applied using the questionnaires filled out by 18 teachers following interactions with a robot. The participants demonstrated positive reactions and acceptance accompanied by a variety of answers. The lack of consolidated views in the tested population of teachers and the need for an adaptation of the model are suggested. The future intensive research of teacher-acceptance of SAR will avoid the gap between technology and the end-user. © 2013 Elsevier Ltd. All rights reserved.

Or L.,Assaf Harofeh Medical Center
Ophthalmic Plastic and Reconstructive Surgery | Year: 2016

PURPOSE:: The purpose of this study is to describe a new complication of a xanthelasma-like reaction which appeared after dermal filler injection in the lower eyelid region. METHODS:: A retrospective case analysis was performed on 7 patients presenting with xanthelasma-like reaction after filler injection to the lower eyelids. RESULTS:: Seven female subjects with no history of xanthelasma presented with xanthelasma-like reaction in the lower eyelids post filler injection. Fillers included hyaluronic acid (2 patients), synthetic calcium hydroxyapatite (4 patients), and polycaprolactone microspheres (one patient). Average time interval between filler injection and development of xanthelasma-like reaction was 12 months (range: 6–18 months). Treatment included steroid injections, 5FU injections, ablative or fractionated CO2 laser, and direct excision. Pathology confirmed the lesion was a true xanthelasma in one patient. In treated patients, there was subtotal resolution after laser. Xanthelasma-like reaction resolved completely after direct excision. Three patients elected to have no treatment. CONCLUSIONS:: Previously there has been one reported case of xanthelasma after filler injection. This case series is the largest to date. Furthermore, this series is notable because xanthelasma-like reactions appeared after injection with 3 different types of fillers. None of the patients had evidence of xanthelasma prefiller injection. The precise mechanism by which filler injection can lead to the formation of xanthelasma-like reaction is unclear. A possible mechanism may be related to binding of low-density lipoprotein and internalization by macrophages. Further investigation is required. Nevertheless, physicians performing filler injections should be aware of this new complication and treatment options. © 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Rubinstein Y.,Assaf Harofeh Medical Center
Cornea | Year: 2016

PURPOSE:: This study reports the presentation of 2 families with macular corneal dystrophy (MCD). The aim of this study was to show whether ultrasound biomicroscopy (UBM) can, based on posterior changes of the cornea in MCD, assist in the choice of surgery, either anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK), compared with optical coherence tomography (OCT) and Scheimpflug. METHODS:: Six patients with MCD were examined for their best-corrected visual acuity, slit-lamp, OCT, UBM, and Scheimpflug findings. Blood samples for DNA and exons of the CHST6 gene were screened for mutations. RESULTS:: All 6 patients showed typical MCD signs at the slit lamp. Corneal transplantation was required in 2 patients in both eyes. Recurrence of MCD was observed in 2 eyes after the DALK procedure (patient A5, age 48 years, right eye and B1, 51 years, left eye), whereas the 2 eyes after PK (patient A5, age 48 years, left eye and patient B1, 51 years, right eye) remained clear (for 10 years of follow-up in patient A5 and 4 years in patient B1). In 2 patients (A1 and A3), corneal thinning could be evaluated by OCT. In 3 patients (A2, 3, and 4), UBM disclosed deeper pathologies including opacities, loss of continuity, and focal protrusions of the posterior cornea, which were not evident by other devices. In family A, a novel mutation was identified. CONCLUSIONS:: Our UBM examination of MCD shows alterations of the corneaʼs posterior layer and confirms the known clinical and histological findings of MCD that PK represents the therapy of choice, contrary to DALK. The novel CHST6 mutation shows the heterogeneity of MCD. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

Rabin I.,Assaf Harofeh Medical Center
The Israel Medical Association journal : IMAJ | Year: 2011

Gastric stump cancer is often described as a tumor with a poor prognosis and low resectability rates. To compare the pathological characteristics of gastric stump cancer patients with those of patients with proximal gastric cancer. This retrospective study was based on the demographic and pathological data of patients diagnosed with gastric cancer and treated at Assaf Harofeh Medical Center during an 11 year period. The patients were divided into two groups: those undergoing proximal gastrectomy for proximal gastric cancer and those undergoing total gastrectomy for gastric stump cancer. Patients with gastric stump cancer were predominantly male, older (P = 0.202, not significant), and had a lower T stage with less signet-ring type histology, fewer harvested and fewer involved lymph nodes (P = 0.03, statistically significant) and less vascular/lymphatic involvement than patients with proximal gastric cancer. The lower incidence of involved lymph nodes and lymphovascular invasion in gastric stump cancer as compared to proximal gastric cancer in this study may imply that the prognosis of gastric stump cancer may be better than that of proximal gastric cancer. However, to verify this assumption a study comparing patient survival is required.

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