Nadir E.,Hillel Yaffe Medical Center |
Kassem E.,Hillel Yaffe Medical Center |
Foldi S.,Hillel Yaffe Medical Center |
Hochberg A.,Hillel Yaffe Medical Center |
Feldman M.,Hillel Yaffe Medical Center
Journal of Perinatology | Year: 2014
Objective:To determine the effectiveness of paracetamol in closing patent ductus arteriosus (PDA) in preterm infants of our population.Study Design:Infants with symptomatic PDA who failed or could not get ibuprofen treatment, and who were candidates for surgical ligation, were administered oral paracetamol 15 mgkg-1 every 6h, for up to 7 days and were monitored for clinical, echocardiographic and laboratorial courses.Result:Seven infants, between 24-27 weeks' gestation, were included. In four the DA was closed while treated by paracetamol-in one of them the DA reopened, treated with paracetamol again, and closed. In one infant, the DA almost closed, symptoms disappeared, and the DA subsequently closed spontaneously later. Two needed surgical ligation. There were no hematologic or biochemical abnormalities.Conclusion:Although there is the possibility that PDA may have closed spontaneously, it is proposed that paracetamol could contribute to the closure of PDA in preterm infants. © 2014 Nature America, Inc. All rights reserved.
Maher C.M.,Royal Brisbane and Wesley Hospitals Brisbane |
Feiner B.,Hillel Yaffe Medical Center |
Baessler K.,Charité - Medical University of Berlin |
Glazener C.M.A.,University of Aberdeen
International Urogynecology Journal and Pelvic Floor Dysfunction | Year: 2011
Introduction and hypothesis A previous version of the Cochrane review for prolapse surgery in 2008 provided two conclusions: abdominal sacrocolpopexy had lower recurrent vault prolapse rates than sacrospinous colpopexy but this was balanced against a longer time to return to activities of daily life. An additional continence procedure at the time of prolapse surgery might be beneficial in reducing post-operative stress urinary incontinence; however, this was weighed against potential adverse effects. The aim of this review is to provide an updated summary version of the current Cochrane review on the surgical management of pelvic organ prolapse. Methods We searched the Cochrane Incontinence Group Specialised Register and reference lists of randomised or quasi-randomised controlled trials on surgery for pelvic organ prolapse. Trials were assessed independently by two reviewers. Results We identified 40 trials including 18 new and three updates. There were no additional studies on surgery for posterior prolapse. Native tissue anterior repair was associated with more anterior compartment failures than polypropylene mesh repair as an overlay (RR 2.14, 95% CI 1.23-3.74) or armed transobturator mesh (RR 3.55, 95% CI 2.29-5.51). There were no differences in subjective outcomes, quality of life data, de novo dyspareunia, stress urinary incontinence, reoperation rates for prolapse or incontinence, although some of these data were limited. Mesh erosions were reported in 10% (30/293). Including new studies on the impact of continence surgery at the time of prolapse surgery, meta-analysis revealed that concurrent continence surgery did not significantly reduce the rate of post-operative stress urinary incontinence (RR 1.39, 95% CI 0.53-3.70; random-effects model). Conclusion The inclusion of new randomised controlled trials showed that the use of mesh at the time of anterior vaginal wall repair reduced the risk of recurrent anterior vaginal wall prolapse on examination. However, this was not translated into improved functional or quality of life outcomes. The value of a continence procedure in addition to a prolapse operation in women who are continent preoperatively remains uncertain. Adequately powered randomised controlled trials are needed and should particularly include women's perceptions of prolapse symptoms and functional outcome. © 2011 The International Urogynecological Association.
Abu-Mouch S.,Liver Unit |
Fireman Z.,Hillel Yaffe Medical Center |
Jarchovsky J.,Hillel Yaffe Medical Center |
Zeina A.-R.,Liver Unit |
Assy N.,Technion - Israel Institute of Technology
World Journal of Gastroenterology | Year: 2011
AIM: To determine whether adding vitamin D, a potent immunomodulator, improves the hepatitis C virus (HCV) response to antiviral therapy. METHODS: Seventy-two consecutive patients with chronic HCV genotype 1 were randomized into two groups: the treatment group (n = 36, 50% male, mean age 47 ± 11 years) received Peg-α-2b interferon (1.5 μg/kg per week) plus ribavirin (1000-1200 mg/d) together with vitamin D3 (2000 IU/d, target serum level > 32 ng/mL), and the control group (n = 36, 60% male, mean age 49 ± 7 years) received identical therapy without vitamin D. HCV-RNA was assessed by real-time polymerase chain reaction (sensitivity, 10 IU/mL). The sustained virologic response (SVR) was defined as undetectable HCV-RNA at 24 wk post-treatment. RESULTS: Clinical characteristics were similar in both groups. The treatment group had a higher mean body mass index (27 ± 4 kg/m2 vs 24 ± 3 kg/m2, P < 0.01), viral load (50% vs 42%, P < 0.01), and fibrosis score (> F2: 42% vs 19%, P < 0.001) than the controls. At week 4, 16 (44%) treated patients and 6 (17%) controls were HCV-RNA negative (P < 0.001). At week 12, 34 (94%) treated patients and 17 (48%) controls were HCV-RNA negative (P < 0.001). At 24 wk post-treatment (SVR), 31 (86%) treated patients and 15 (42%) controls were HCV-RNA negative (P < 0.001). Viral load, advanced fibrosis and vitamin D supplementation were strongly and independently associated with SVR (multivariate analysis). Adverse events were mild and typical of Peg-α-2b/ribavirin. CONCLUSION: Adding vitamin D to conventional Peg-α-2b/ribavirin therapy for treatment-naïve patients with chronic HCV genotype 1 infection significantly improves the viral response. © 2011 Baishideng.
Nimer A.,Ziv Medical Center |
Nimer A.,Technion - Israel Institute of Technology |
Mouch A.,Hillel Yaffe Medical Center |
Mouch A.,Technion - Israel Institute of Technology
World Journal of Gastroenterology | Year: 2012
AIM: To examine whether vitamin D improved viral response and predicted treatment outcome in patients with hepatitis C virus (HCV) genotype 2-3. METHODS: Fifty patients with chronic HCV genotype 2-3 were randomized consecutively into two groups: Treatment group [20 subjects, age 48 ± 14 years, body mass index (BMI) 30 ± 6, 65% male], who received 180 μg pegylated α-interferon-2a plus oral ribavirin 800 mg/d (Peg/RBV), together with oral vitamin D3 (Vitamidyne D drops; 2000 IU/d, 10 drops/d, normal serum level > 32 ng/mL) for 24 wk; and control group (30 subjects, age 45 ± 10 years, BMI 26 ± 3, 60% male), who received identical therapy without vitamin D. HCV RNA was assessed by reverse transcription polymerase chain reaction. Undetectable HCV RNA at 4, 12 and 24 wk after treatment was considered as rapid virological response, complete early virological response, and sustained virological response (SVR), respectively. Biomarkers of inflammation were measured. RESULTS: The treatment group with vitamin D had higher BMI (30 ± 6 vs 26 ± 3, P < 0.02), and high viral load (> 400 000 IU/mL, 65% vs 40%, P < 0.01) than controls. Ninety-five percent of treated patients were HCV RNA negative at week 4 and 12. At 24 wk after treatment (SVR), 19/20 (95%) treated patients and 23/30 (77%) controls were HCV RNA negative (P < 0.001). Baseline serum vitamin D levels were lower at baseline (20 ± 8 ng/mL) and increased after 12 wk vitamin D treatment, to a mean level of (34 ± 11 ng/mL). Logistic regression analysis identified vitamin D supplement [odds ratio (OR) 3.0, 95% CI 2.0-4.9, P < 0.001], serum vitamin D levels (< 15 or > 15 ng/mL, OR 2.2, P < 0.01), and BMI (< 30 or > 30, OR 2.6, P < 0.01) as independent predictors of viral response. Adverse events were mild and typical of Peg/RBV. CONCLUSION: Low vitamin D levels predicts negative treatment outcome, and adding vitamin D to conventional Peg/RBV therapy for patients with HCV genotype 2-3 significantly improves viral response. © 2012 Baishideng. All rights reserved.
Folman Y.,Hillel Yaffe Medical Center |
Shabat S.,Spinal Care Unit
Israel Medical Association Journal | Year: 2011
Background: Cement vertebroplasty has been performed for over a decade to treat painful osteoporotic vertebral compression fractures (OVCFs). Kyphoplasty is considered a further step in the evolution of vertebral augmentation. Objectives: To evaluate the efficiency and safety of two systems to treat OVCF: Confidence Vertebroplasty (CV) compared to Sky Kyphoplasty (SK). Methods: This prospective study included 45 patients with OVCF. Fourteen were treated with CV and 31 with SK. An imaging evaluation using a compression ratio (height of anterior vs. posterior wall) and local kyphotic deformity (Cobb angle) was performed prior to the procedure and 12 months later. Evaluation of pain was carried out using a visual analogue scale. Results: The mean compression repair was 12% in the CV group compared to 25% in the SK group. Mean kyphotic deformity restoration achieved using CV was 41% compared to 67% using SK. In both groups the pain severity was equally reduced by a mean of 43%. Conclusions: The SK system is technically superior in restoring the vertebral height and repairing the kyphotic deformity, an advantage that was not manifested in pain relief - the most important variable. Both systems have a high level of safety. The cost-benefit balance clearly favors the CV system.
Amitai-Lange A.,Technion - Israel Institute of Technology |
Altshuler A.,Technion - Israel Institute of Technology |
Bubley J.,Technion - Israel Institute of Technology |
Dbayat N.,Hillel Yaffe Medical Center |
And 2 more authors.
Stem Cells | Year: 2015
Accumulating evidence supports the dogma that the corneal epithelium is regenerated by stem cells located exclusively in the limbal niche, at the corneal periphery. Accordingly, limbal stem cells (LSCs) give rise to progenitors that proliferate and migrate centripetally to repopulate the corneal epithelium, which has a short turnover. Moreover, LSC loss leads to corneal opacity and blindness, while limbal grafting restores patients' vision. However, contradicting data suggested that the limbus does not participate in corneal homeostasis and that the cornea contains stem cells. As of today, only indirect evidence for limbal cell migration under homeostasis or injury has been demonstrated. Here, we performed lineage tracing experiments using R26R-Confetti mice to follow K14+ limbal/corneal epithelial cells stochastically induced to express one out of four fluorescent genes. In homeostasis, radial limbal stripes of slow migrating cells proceeded toward the corneal center while, infrequently, slow cycling limbal clones resembling quiescent stem cells were observed. Additionally, rare corneal clones that did not migrate centripetally, but survived for over 4 months, were inspected. In contrast to limbal stripes, corneal clusters had minor contribution to tissue replenishment in homeostasis. Corneal cells, however, significantly contributed to mild wound repair while large limbal streaks appeared within a week following severe wounding that coincided with partial loss of corneal transparency. This data suggest that the mouse limbus largely contributes to corneal renewal while corneal progenitor cells have a long turnover and, therefore, may be able to maintain the corneal epithelium for several months. Stem Cells 2015;33:230-239 © 2014 The Authors. STEM CELLS Published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.
Martinez M.R.,Hillel Yaffe Medical Center |
Ophir A.,Hillel Yaffe Medical Center
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2011
Background: To present extrafoveal vitreous traction membranes, and their prevalence and association with diffuse macular oedema in eyes with retinal vein occlusion (RVO), using 3-D spectral-domain optical coherence tomography (SD-OCT). Methods: In a retrospective institutional observational study, charts and qualified SD-OCT findings of consecutive patients with either central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO) associated with macular oedema were analyzed. Exclusion criteria covered eyes that had: 1) another retinopathy that could affect the data analysis, 2) vitreoretinal adherence without signs of retinal traction, 3) undergone vitreoretinal surgery, or 4) been treated by intravitreal administration of medication(s). An age-matched control group (n=72) afforded the normal central subfield thickness. Results: Twenty-six eyes (of 26 patients) with either CRVO (n=12) or BRVO (n=14) were analyzed. Four eyes were excluded because they had a lack of macular oedema (n=2), had an earlier pars plana vitrectomy (n=1), or had previous treatment by intravitreal bevacizumab (n=1). Of the 22 remaining eyes, both the SD-OCT B-mode video clip and the 3-D image reconstruction enabled a detection of extrafoveal traction membranes, either unifocally or multifocally, in nine eyes: four (of 11; 36.4 %) in CRVO, and five eyes (of 11; 45.5%) in BRVO. The retinal oedema in these nine eyes, which underlined at least one of the traction sites per eye, and the accompanied subretinal fluid in four of these nine eyes, were in continuum in each eye with the diffuse macular oedema and serous macular detachment respectively. During follow-up, a spontaneous release of a traction membrane coupled with resolution of the macular oedema occurred in one eye with BRVO. Of the four eyes that were excluded, two eyes had extrafoveal vitreous traction membranes. Conclusions: The SD-OCT B-mode video clip and its 3-D image reconstruction enabled relatively frequent detection of extrafoveal vitreous traction membranes in RVO and their association with diffuse macula oedema and macular detachment. A larger cohort is required to validate these findings and to compare the efficacy of early release of such traction membranes, either surgically or possibly by pharmacologic vitreolysis, with the current therapeutic modalities. © 2011 Springer-Verlag.
Ophir A.,Hillel Yaffe Medical Center |
Martinez M.R.,Hillel Yaffe Medical Center
Investigative Ophthalmology and Visual Science | Year: 2011
PURPOSE. To present the vitreoretinal interface in diabetic macular edema (DME) associated with both epiretinal membrane (ERM) and incomplete posterior vitreous detachment (PVD), as detected by spectral-domain optical coherence tomography (SD-OCT). METHODS. In a retrospective study, findings were analyzed in one eye in consecutive patients. Excluded were eyes that had undergone vitreoretinal intervention or that had complete PVD or complete vitreous attachment. RESULTS. Of 44 eyes with DME and ERM, incomplete PVD was apparent in 23 (52.2%) eyes. A hyperreflective unified ERM/ posterior vitreous cortex (PViC) membrane, or EVi membrane, was apparent in various sizes in 20 (87.0%) of the 23 eyes. This unified membrane (n = 20) was associated with vitreopapillary adherence in 19 (82.6%) of 23 eyes. Two major OCT presentations (n = 23) were encountered: incomplete vitreopapillary detachment (n = 11; 25% of 44), with attachment to the macular ERM, and posterior vitreous detachment from the macula, associated with vitreopapillary adhesion (n = 10; 22.7%), in four different manifestations. In the remaining two eyes, there was no association between the ERM and the PViC. CONCLUSIONS. In eyes with DME, ERM, and incomplete PVD, the posterior cortical vitreous and ERM appeared as one united EVi membrane in various lengths in most eyes, typically associated with vitreopapillary adhesion. These findings may have clinical importance in the context of epimacular membrane characteristics and its removal in DME. © Association for Research in Vision and Ophthalmology.
Ben Natan M.,Hillel Yaffe Medical Center
Nursing management (Harrow, London, England : 1994) | Year: 2010
This article discusses the effects of long-term care facility traits on the maltreatment of older people. Participants in this quantitative, descriptive study were staff working at 24 of the 300 long-term facilities for older people in Israel. Slightly more than half of the sample reported abuse of older residents in the previous 12 months, manifesting in one or more types of maltreatment. High staff turnover was associated with a greater risk of mental or physical neglect, and the total number of maltreatment incidents.
Walfisch A.,Hillel Yaffe Medical Center |
Beloosesky R.,Hillel Yaffe Medical Center |
Shrim A.,Hillel Yaffe Medical Center |
Hallak M.,Hillel Yaffe Medical Center
American Journal of Obstetrics and Gynecology | Year: 2014
In spite of the recognized occurrence of cesarean-attributable adhesions, its clinical significance is uncertain. The presence of adhesions during a repeat cesarean section can make fetal extraction lengthy and the procedure challenging and may increase the risk of injury to adjacent organs. Two methods for adhesion prevention are discussed, peritoneal closure and use of adhesion barriers. Peritoneal closure appears to be safe in the short term. In the long term, conflicting evidence arise from reviewing the literature for possible adhesion reduction benefits. A systematic review of the literature on the use of adhesion barriers in the context of cesarean section yielded only a few studies, most of which are lacking in methodology. For now, it appears that the available evidence does not support the routine use of adhesion barriers during cesarean delivery. © 2014 Elsevier Inc.