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Beersheba, Israel

Cukierman-Yaffe T.,Endocrinology Institute | Cukierman-Yaffe T.,Tel Aviv University | Cukierman-Yaffe T.,Hamilton Health Sciences | Anderson C.,Royal Prince Alfred Hospital | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: Avoidance of death, disability, dementia, and cognitive dysfunction (DDCD) are high priorities for people in aging societies. Evidence is mounting that these conditions are associated with impaired glycemic control. Objective: The aim of this study was to assess the strength of relationship between the degree of glucose elevation and the development of the composite elements of DDCD that impede successful/ healthy aging in a population at high risk for cardiovascular disease. Design, Setting, Participants, and Main Outcome Measure: The relationship between baseline fasting plasma glucose values and DDCD was determined among 31 227 participants of the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE intolerant Subjects With Cardiovascular Disease studies followed up for a median of 4.7 years. Several statistical models were used for the entire cohort and for those with and without normal fasting plasma glucose (ie, 5.6 mmol/L) or a history of diabetes mellitus. Results: After adjusting for age and sex, a diagnosis of diabetes mellitus was associated with an approximately 1.6 greater odds of DDCD; every 1 mmol/L higher baseline fasting plasma glucose value was associated with a 1.09 (95% confidence interval 1.07, 1.10) greater odds. These associations persisted in the multivariate models (a 1.08 95% confidence interval 1.07, 1.1 greater odds after adjustment for age, sex, education, and depression). Conclusion: In individuals with high cardiovascular risk, a direct relationship exists between levels of dysglycemia and the risk of DDCD. Further research is needed to understand the mechanisms underlying such an association and whether benefits can be derived from preventative strategies. (J Clin Endocrinol Metab 100: Copyright © 2015 by the Endocrine Society. Source

Ratzon R.,Tel Aviv University | Reshef A.,Allergy and Immunology Unit | Efrati O.,Tel Aviv University | Efrati O.,Sheba Medical Center | And 9 more authors.
Annals of Allergy, Asthma and Immunology

Background Drug provocation tests (DPTs) are the gold standard in the diagnosis of β-lactam hypersensitivity. However, no consensus exists on the need for extended provocation tests, even though the effectiveness of the short DPT is relatively low and there has been an increase in the relative incidence of nonimmediate hypersensitivity reactions. Objective To evaluate the effectiveness of a 7-day (extended) DPT compared with a 1-day-only (short) DPT in the management of hypersensitivity reactions to β-lactam antibiotics. Methods Patients referred to the allergy clinic of the Sheba Medical Center for suspected β-lactam hypersensitivity from January 2008 to December 2012 underwent in vivo skin tests and an immediate short DPT with the culprit drug. Unless an immediate reaction was clearly documented, patients were offered a 7-day, extended DPT. Long-term effectiveness, calculated as the subsequent use of the tested antibiotic, and satisfaction levels were assessed with a telephone questionnaire. Results Of 49 negative DPT results, 26 (53%) were long and 23 (47%) were short. A total of 78% of the patients who underwent the long DPT reported that they used the drug compared with 61% of those who underwent only the short DPT (P =.049). Most patients were very satisfied with the drug allergy evaluation process. Conclusions An extended DPT protocol increased the effectiveness of the allergy workup in our center without compromising patient satisfaction and safety, and it should be recommended to patients with a history of nonimmediate reaction to β-lactam. © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved. Source

Elhayany A.,Meir Medical Center | Elhayany A.,Tel Aviv University | Lustman A.,Central District Clalit Health Services | Lustman A.,Tel Aviv University | And 5 more authors.
Diabetes, Obesity and Metabolism

Background: The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus (DM2) is unclear. Trials comparing the effectiveness of diets are frequently limited by short follow-up times and high dropout rates.Aim: The effects of a low carbohydrate Mediterranean (LCM), a traditional Mediterranean (TM), and the 2003 American Diabetic Association (ADA) diet were compared, on health parameters during a 12-month period.Methods: In this 12-month trial, 259 overweight diabetic patients (mean age 55 years, mean body mass index 31.4 kg/m2) were randomly assigned to one of the three diets. The primary end-points were reduction of fasting plasma glucose, HbA1c and triglyceride (TG) levels.Results: 194 patients out of 259 (74.9%) completed follow-up. After 12 months, the mean weight loss for all patients was 8.3 kg: 7.7 kg for ADA, 7.4 kg for TM and 10.1 kg for LCM diets. The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet (-2.0 and -1.6%, respectively, p < 0.022). HDL cholesterol increased (0.1 mmol/l ± 0.02) only on the LCM (p < 0.002). The reduction in serum TG was greater in the LCM (-1.3 mmol/l) and TM (-1.5 mmol/l) than in the ADA (-0.7 mmol/l), p = 0.001.Conclusions: An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups. Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control. © 2010 Blackwell Publishing Ltd. Source

Fried M.,OB Klinika a.s. | Fried M.,Charles University | Dolezalova K.,OB Klinika a.s. | Sramkova P.,OB Klinika a.s. | Sramkova P.,Endocrinology Institute
Surgery for Obesity and Related Diseases

Background The intended purpose of gastrogastric imbrication sutures in laparoscopic adjustable gastric banding is to reduce band-related complications; however, evidence demonstrating imbrication suture utility has been lacking. A 3-year randomized controlled trial on the safety and efficacy of laparoscopic adjustable gastric banding with and without imbrication sutures was undertaken. We performed a prospective investigation of the outcomes using the Swedish adjustable gastric band (SAGB) with and without imbrication sutures. Methods From January to September 2006, 100 patients undergoing SAGB placement were randomized to group 1 (n = 50, <2 imbrication sutures) or group 2 (n = 50, no imbrication sutures). The SAGB was implanted in both groups using a standardized pars flaccida technique. The mean operative time, hospitalization time, percentage of excess weight loss, body mass index, band fill volume, and complications were recorded. The Fisher exact test for categorical data, the independent samples t test for continuous data, and the paired t test to assess the body mass index reduction were performed. All tests were 2-tailed, and statistical significance was set at P <.05. Results The mean operative time was 75 ± 7 minutes (range 5092) and 48 ± 4 minutes (range 3275) for groups 1 and 2, respectively (P <.001). The mean hospitalization time was 26 ± 12 hours (range 2096) and 23 ± 9 hours (range 2048) for groups 1 and 2, respectively (P <.17). The 3-year percentage of excess weight loss was 55.7% ± 3.4% and 58.1% ± 4.1% for groups 1 and 2, respectively (95% confidence interval -4.0% to -.8%, P <.01). The body mass index at 3 years was 34.0 ± 5.8 kg/m2 and 30.3 ± 6.4 kg/m2 (range 1.26.2) for groups 1 and 2, respectively (P <.01). The fill volume at 3 years was 3.6 ± 1.2 mL (range 1.05.5) and 4.5 ± 0.5 mL (range .05.0) for groups 1 and 2, respectively (P <.01). Finally, slippage occurred in 1 patient (2.2%) and 1 patient (2.0%) and migration in 1 patient (2.2%) and 1 patient (2.0%) in groups 1 and 2, respectively (P = NS). No patient died in either group. Conclusion The results of our randomized controlled trial have demonstrated that SAGB combined with a conservative approach to band adjustments and limited retrogastric dissection is effective and safe with and without imbrication sutures. Not using imbrication sutures results in significant benefits in operative speed with comparable clinical weight loss and intermediate term safety. These randomized controlled trial data suggest that imbrication sutures are not indispensable to laparoscopic adjustable gastric banding and their use can be left to the surgeon's discretion. © 2011 American Society for Metabolic and Bariatric Surgery. All rights reserved. Source

Kalich-Philosoph L.,Fertility Preservation Research Laboratory | Kalich-Philosoph L.,Bar - Ilan University | Roness H.,Fertility Preservation Research Laboratory | Carmely A.,Fertility Preservation Research Laboratory | And 12 more authors.
Science Translational Medicine

Premature ovarian failure and infertility are major side effects of chemotherapy treatments in young cancer patients. A more thorough understanding of the mechanism behind chemotherapy-induced follicle loss is necessary to develop new methods to preserve fertility in these patients. We show that the alkylating agent cyclophosphamide (Cy) activates the growth of the quiescent primordial follicle population in mice, resulting in loss of ovarian reserve. Despite the initial massive apoptosis observed in growing, though not in resting, follicles of Cy-treated mice, differential follicle counts demonstrated both a decrease in primordial follicles and an increase in early growing follicles. Immunohistochemistry showed that granulosa cells were undergoing proliferation. Analysis of the phosphatidylinositol 3-kinase signaling pathway demonstrated that Cy increased phosphorylation of proteins that stimulate follicle activation in the oocytes and granulosa cells. Coadministration of an immunomodulator, AS101, reduced follicle activation, thereby increasing follicle reserve and rescuing fertility after Cy, and also increased the efficacy of Cy against breast cancer cell lines. These findings suggest that the mechanism in Cy-induced loss of ovarian reserve is accelerated primordial follicle activation, which results in a "burnout" effect and follicle depletion. By preventing this activation, AS101 shows potential as an ovarian-protective agent, which may be able to preserve fertility in female cancer patients. Source

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