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Silbermann M.,Technion - Israel Institute of Technology | Arnaout M.,King Hussein Cancer Center | Daher M.,University of Balamand | Nestoros S.,The Cyprus Anti Cancer Society | And 8 more authors.
Annals of Oncology | Year: 2012

Background: In larger parts of the Middle East palliative care is still misunderstood among health professionals, cancer patients and the public at large. One reason to that is because the term does not obviously communicate the intent of this clinical discipline, which is lending better quality of life while combating cancer. Further, culture, tradition and religion have contributed to this misgiving and confusion especially at the terminal stage of the disease. Methods: The Middle East Cancer Consortium jointly with the American Society of Clinical Oncology, the American Oncology Nursing Society, the San Diego Hospice Center for Palliative Medicine and the Children's Hospital & Clinicsof Minnesota initiated a series of training courses and workshops in the Middle East to provide updated training to physicians, nurses, social workers and psychologists from throughout the region with basic concepts of palliative care and pain managements in adults and children cancers. Results: During the past 6 years hundreds of professionals took part in these educational and training activities, thereby creating the core of trained caregivers who start to make the change in their individual countries. Conclusions: The outcome of consecutive training activities can overcome geopolitical instabilities, and yield a genuine change in approach of both regulators, medical administrators, medical staff and the public; as to the important contribution of palliative care services to the welfare of the patient and his/her family. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Bar-Sela G.,University of Sfax | Avisar A.,Haifa University | Batash R.,Bar - Ilan University | Schaffer M.,Bar - Ilan University | Schaffer M.,Baruch Padeh Medical Center
Current Medicinal Chemistry | Year: 2014

The use of the cannabis plant for various medical indications by cancer patients has been rising significantly in the past few years in several European countries, the US and Israel. The increase in use comes from public demand for the most part, and not due to a scientific basis. Cannabis chemistry is complex, and the isolation and extraction of the active ingredient remain difficult. The active agent in cannabis is unique among psychoactive plant materials, as it contains no nitrogen and, thus, is not an alkaloid. Alongside inconclusive evidence of increased risks of lung and head and neck cancers from prolonged smoking of the plant produce, laboratory evidence of the anti-cancer effects of plant components exists, but with no clinical research in this direction. The beneficial effects of treatment with the plant, or treatment with medicine produced from its components, are related to symptoms of the disease: pain, nausea and vomiting, loss of appetite and weight loss. The clinical evidence of the efficacy of cannabis for these indications is only partial. However, recent scientific data from studies with THC and cannabidiol combinations report the first clinical indication of cancer-related pain relief. The difficulties of performing research into products that are not medicinal, such as cannabis, have not allowed a true study of the cannabis plant extract although, from the public point of view, such studies are greatly desirable. © 2014 Bentham Science Publishers.


Abozaid S.,Baruch Padeh Medical Center
Harefuah | Year: 2013

Actinomyces is an anaerobic, gram positive, rod shape bacteria that doesn't create spores. Actinomyces is part of the mouth, intestines, vagina and upper respiratory system flora. The infection appears mostly on the face, neck, abdomen and pelvis in cases of mucosa injury and most common in immunosuppressed patients. The spread of Actinomyces through the blood system is rare. In this article we present a 9 year old male patient with no history of diseases who was diagnosed with prolonged bacteremia of A. naeslundii without specific infection excluding severe caries. Characterization of bacteria from the blood culture was performed by molecular biology and the patient was treated with Ampicillin and tooth extraction that led to the disappearance of the bacteremia.


Barak S.,Baruch Padeh Medical Center | Kushnir A.,Baruch Padeh Medical Center | Chulski E.,Baruch Padeh Medical Center | Miron D.,Baruch Padeh Medical Center
American Journal of Perinatology | Year: 2010

Influenza is an uncommon illness among premature infants in developed modern neonatal intensive care units (NICUs), but if infants do manifest symptoms of this significant illness, they commonly present with an abrupt onset, with temperature instability and upper respiratory tract involvement and, commonly, clinical features similar to bacterial sepsis. Additionally, frequent manifestations include bronchiolitis and pneumonia. Influenza infection in premature infants is likely a result of reduced levels of passively transferred protective maternal antibodies. Timely supportive therapy, antiviral agents, and isolation of affected infants to prevent spread of infection may be sufficient protective measures in the NICU. We report a case of a 50-day-old very low-birth-weight premature infant with novel A/H1N1 influenza virus (swine flu). There were no obvious epidemiological conditions in the NICU among patients and staff. The unique presenting symptom was apnea, which required respiratory support by nasal intermittent positive pressure ventilation. Due to the current pandemic, neonatologists should be aware of possible infection of neonates with novel A/H1N1 influenza virus. © Georg Thieme Verlag Stuttgart · New York.


Paritsky M.,Baruch Padeh Medical Center | Pastukh N.,Bar - Ilan University | Brodsky D.,Bar - Ilan University | Isakovich N.,Bar - Ilan University | Peretz A.,Bar - Ilan University
World Journal of Gastroenterology | Year: 2015

AIM: To prospectively examine the association between presence of Streptococcus bovis (S. bovis ) in colonic suction fluid and the endoscopic findings on colonoscopy. METHODS: From May 2012 to March 2013, 203 consecutive patients who underwent colonoscopy for any reason were enrolled in the study. Exclusion criteria included: antibiotic use in the previous month, age younger than 18 years, and inadequate preparation for colonoscopy. The colonoscopy was performed for the total length of the colon or to the occluding tumor. The endoscopic findings were registered. Samples were obtained proximal to the colonoscopic part of the suction tube from each patient and sent to the clinical microbiology laboratory for isolation and identification of S. bovis . Samples were incubated in enrichment media with addition of antibiotic disks for inhibition of growth of Gram-negative rods. The samples were seeded on differential growth media; suspected positive colonies were isolated and identified with Gram staining, catalase, and pyrrolidonyl arylamidase tests, and further identified using a VITEK2 system. Statistical analyses were performed using the Student's t and χ 2 tests. RESULTS: Of the 203 patients recruited, 49 (24%) patients were found to be S. bovis carriers; of them, the endoscopic findings included: 17 (34.7%) cases with malignant tumors, 11 (22.4%) with large polyps, 5 (10.2%) with medium-sized polyps, 6 (12.2%) with small polyps, 4 (8.1%) with colitis, and 6 (12.2%) normal colonoscopies. Of 154 patients found negative for S. bovis , the endoscopic findings included: none with malignant tumors, 9 (5.8%) cases with large polyps, 11 (7.1%) with medium-sized polyps, 26 (16.9%) with small polyps, 7 (4.5%) with colitis, and 101 (65.6%) normal colonoscopies. S. bovis (Grampositive coccus) is considered part of the normal intestinal flora. There is an association between S. bovis bacteremia and colonic neoplasia. It is not well understood whether the bacterium has a pathogenetic role in the development of neoplasia or constitutes an epiphenomenon of colorectal neoplasms. There was a clear relationship between positivity for S. bovis in colonic suction fluid and findings of malignant tumors and large polyps in the colon. CONCLUSION: There is an association between S. bovis bacteremia and malignant colonic lesions; this should prompt for development of a reliable screening method for advanced colonic lesions. © The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.


Peleg D.,Bar - Ilan University | Warsof S.,Eastern Virginia Medical School | Wolf M.F.,Bar - Ilan University | Perlitz Y.,Baruch Padeh Medical Center | Shachar I.B.,Bar - Ilan University
American journal of perinatology | Year: 2015

CONCLUSION: The policy of discussing the risk of macrosomia with SEFW ≥ 4,000 g to women is not justified. A higher SEFW to trigger counseling for shoulder dystocia and CS, more consistent with American College of Obstetrics and Gynecology (ACOG) guidelines, should be considered.OBJECTIVE: Because of the known complications of fetal macrosomia, our hospital's policy has been to discuss the risks of shoulder dystocia and cesarean section (CS) in mothers with a sonographic estimated fetal weight (SEFW) ≥ 4,000 g at term. The present study was performed to determine the effect of this policy on CS rates and pregnancy outcome.STUDY DESIGN: We examined the pregnancy outcomes of the macrosomic (≥ 4,000 g) neonates in two cohorts of nondiabetic low risk women at term without preexisting indications for cesarean: (1) SEFW ≥ 4,000 g (correctly suspected macrosomia) and (2) SEFW < 4,000 g (unsuspected macrosomia).RESULTS: There were 238 neonates in the correctly suspected group and 205 neonates in the unsuspected macrosomia group, respectively. Vaginal delivery was accomplished in 52.1% of the suspected group and 90.7% of the unsuspected group, respectively, p < 0.001. There was no difference in the rates of shoulder dystocia. The odds ratio for CS was 9.0 (95% confidence interval, 5.3-15.4) when macrosomia was correctly suspected. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.


Blum A.,Baruch Padeh Medical Center | Socea D.,Baruch Padeh Medical Center | Ben-Shushan R.S.,Israel Center for Disease Control | Keinan-Boker L.,Israel Center for Disease Control | And 3 more authors.
European Cytokine Network | Year: 2012

Diabetic retinopathy is the most severe ocular complication of diabetes mellitus (DM), is associated with micro-vascular damage. The more advanced stage, proliferative diabetic retinopathy, has been linked to an increased risk of cardiovascular morbidity and mortality. Our hypothesis was that inflammatory and angiogenic markers will detect the different stages of type 2 diabetes, and may predict development of micro-vascular damage. Methods. Seventy three type II diabetic patients were randomly assigned to three groups (A - 25 patients {12 males], no diabetic retinopathy\; B - 25 patients {19 males], non-proliferative retinopathy\; and C - 23 patients {13 males], proliferative retinopathy),when they came for a routine follow-up visit in the ophthalmologic outpatient clinic. Twenty-three healthy subjects (14 males) served as controls. High-sensitivity C reactive protein (hs-CRP), soluble vascular cell adhesion molecule 1(sVCAM-1) and vascular endothelial growth factor (VEGF) were studied. Results. The duration of type II diabetes differed between group A (9 ± 6 years) and B (17 ± 9 years) patients (p \= 0.001). No such difference was revealed between groups B and C (19 ± 6 years) (p \= 0.30). A difference in hemoglobin A1C (HBgA1C) levels was detected between groups A (7.1 ± 2.7%) and B (8.5 ± 1.5%) (p \= 0.02), but none was found between groups B and C (8.5 ± 1.6%) (p \= 0.98). Only six patients (out of 23) used insulin treatment in group A, compared with 16 in group B (out of 25) and 17 in group C (out of 25) (p \= 0.004). All three groups of diabetic patients were older (62.8 ± 10.8, 61.9 ± 9.4, 59.2 ± 10.3 years, respectively) than the controls(44.3 ± 11.6 years) (p≤0.001). Hs-CRP levels were higher in diabetic patients (4,391 ± 4,175, 4,109 ± 4,533, 3,005 ± 3,842 ng/mL, respectively) than in controls (1,659 ± 1,866 ng/mL)\; however, only the levels in patients of groups A (p \= 0.01) and B (p \= 0.03) were significantly different from those of the controls, in contrast to group C, which did not differ (p \= 0.180). Similar findings were observed for sVCAM-1 (706 ± 347, 746 ± 328, 638 ± 208 ng/mL, respectively, vs. controls {552 ± 143 ng/mL])\; sVCAM-1 levels of groups A and B, but not C, differed from the controls (p \= 0.05, p \= 0.01 and p \= 0.125, respectively). With the exception of group B (p \= 0.03), soluble VEGF DM type II levels (493 ± 353, 625 ± 342, 368 ± 223 pg/mL, respectively) did not vary from those of the controls (392 ± 355 pg/mL, p≥0.05). However, as the disease progressed, there was a significant decrease in VEGF levels, accompanied by a significant difference between groups B and C (p \= 0.006). Conclusions. Patients with diabetes type 2with no-retinopathy and with non-proliferative retinopathy had high levels of inflammatory and angiogenic markers, which decreased in patients with diabetic proliferative retinopathy. Biomarkers of inflammation and angiogenesis may detect the progression of diabetic vascular disease and may lead towards earlier interventions that would prevent systemic complications.


Perlitz Y.,Baruch Padeh Medical Center | Perlitz Y.,Technion - Israel Institute of Technology | Izhaki I.,Haifa University | Ben-Ami M.,Baruch Padeh Medical Center | Ben-Ami M.,Technion - Israel Institute of Technology
Prenatal Diagnosis | Year: 2010

Objective To determine the normal level of the conus medullaris (CM) of the spinal cord of normal fetuses at 20 to 24 weeks' gestation using abdominal sonography. Methods Using a 4 to 8 MHz ultrasound abdominal transducer, CM was imaged in the midsagittal plane with the fetal spine facing toward the transducer. The CM ending level was located by counting the vertebrae caudal starting at T12, which was identified by lowest fetal rib. The CM locations were defined according to their positions relative to the vertebrae. Results One hundred and ten consecutive pregnant women were included in the study. The CM was clearly demonstrated in 78 (71%) of these cases. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 inter-space and L3 (73/78, 93%). The L1-2, L2, L2-3, and L3 vertebral groups did not differ in mean gestational weeks, maternal age, or fetal gender. Conclusion The level of the CM can be determined at 20 to 24 weeks' gestation in about 70% of fetuses. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 vertebral space, and L3 (73/78, 93%). When detected lower than the third lumbar vertebra it should prompt prenatal and postnatal surveillance. Copyright © 2010 John Wiley & Sons, Ltd.


Ben-Shlomo I.,Baruch Padeh Medical Center | Ben-Shlomo I.,Zefat Academic College | Younis J.S.,Baruch Padeh Medical Center | Younis J.S.,Bar - Ilan University
Reproductive BioMedicine Online | Year: 2014

Polycystic ovarian syndrome (PCOS) is the leading cause for anovulatory infertility. It is diagnosed by two of the following three clinical criteria: oligomenorrhoea, hyperandrogenism and polycystic appearance of the ovaries. Weight loss and physical activity can lead to ovulation and conception. Lowering of serum insulin normalizes androgen concentrations whereas ovulation induction often causes ovarian hyperstimulation. Theca cells from PCOS ovaries may be more responsive to insulin than cells from non-PCOS ovaries. Herein we review the research efforts at the genomic and cell function levels, as well as animal models, which have been made to elucidate the underlying mechanism that leads to PCOS. It appears that, despite the impressive amount of data that have been generated in these studies, the mechanism of this syndrome is still only partially understood. Polycystic ovarian syndrome (PCOS) is the leading cause for infertility, which is caused by anovulation. It is diagnosed by two of the following three clinical criteria: irregular and prolonged menstrual cycles, overt symptoms of excess androgens, which is revealed by acne and excess hair, and ultrasonographic appearance of the ovaries with multiple small follicles spread mainly near the ovarian surface, which gave it its name. Intentional weight loss and physical activity can lead to resumption of ovulation and not infrequently to conception as well. It was shown that lowering of serum insulin accounts for normalization of serum androgen levels, whereas ovulation induction with FSH often causes ovarian hyperstimulation. It is suggested that theca cells from PCOS ovaries may be more responsive to insulin than cells from non-PCOS ovaries. In this article we review the efforts to define the genes responsible for the syndrome and the studies at the cell function level, as well as animal models, which have been done to elucidate the underlying mechanism that leads to PCOS. Overall, it appears that despite the impressive amount of data that have been generated in these studies, the mechanism of this syndrome is still only partially understood.© 2014, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.


Graffi S.,Baruch Padeh Medical Center | Peretz A.,Baruch Padeh Medical Center | Jabaly H.,Baruch Padeh Medical Center | Koiefman A.,Baruch Padeh Medical Center | Naftali M.,Baruch Padeh Medical Center
British Journal of Ophthalmology | Year: 2013

Background: Acanthamoeba keratitis (AK) is not a notifiable disease in Israel, so there are no accurate incidence rates for this condition in Israel. The aim of this study was to estimate the incidence of AK in Israel for the years 2008-2012. Methods: We distributed a survey questionnaire to laboratory managers in Israel. The laboratories were affiliated to medical institutes that either provided ophthalmology services or served community ophthalmology clinics. Our questionnaire requested survey respondents to provide information regarding the methods used to diagnose AK, and the number of positive and negative cultures for Acanthamoebae species performed for each of the years from 2008 to 2012. Results: Six laboratories used non-nutrient agar with Escherichia coli as the culture medium, one used calcofluor-white staining with fluorescent microscopy, and two used PCR for diagnosing AK. Twenty-three AK cases were identified, to give an estimated incidence of 1/1 668 552. Conclusions: AK is mostly attributable to the use of contact lenses. As contact lenses are popular in Israel, we expected a higher incidence rate. A lower than expected incidence rate may indicate insufficient awareness of AK in Israel.

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