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Tel Aviv, Israel

Bezalel T.,Maccabi Health Care Services | Kalichman L.,Ben - Gurion University of the Negev
Journal of Bodywork and Movement Therapies

Background: Scheuermann's disease is the most common cause of hyperkyphosis of the thoracolumbar spine. Few case reports have demonstrated the effectiveness of Schroth therapy in improving the thoracic angle curve in Scheuermann's patients; however, additional verification is needed. Case description: A 14-year-old female patient presented with Scheuermann's disease. On X-ray, thoracic kyphosis was 55° and lumbar lordosis 55°. The self-rated cosmetic disturbance was graded 10/10 on a verbal numeric scale. The patient received a course of seven weekly Schroth therapy sessions, in addition to daily home exercises tailored specifically for the patient's posture. Five months later, follow-up X-rays revealed thoracic kyphosis of 27° and lumbar lordosis 35°. The patient graded the degree of her cosmetic disturbance as 3/10. Conclusions: Schroth therapy seems to be able to decrease the thoracic curve angle of Scheuermann's patients; however, efficacy and effectiveness of this method should be investigated in future prospective controlled clinical trials. © 2014 Elsevier Ltd. Source

Hazan-Molina H.,Technion - Israel Institute of Technology | Reznick A.Z.,Technion - Israel Institute of Technology | Kaufman H.,Maccabi Health Care Services | Aizenbud D.,Technion - Israel Institute of Technology
Archives of Oral Biology

Objective: This study aimed to investigate PDL's cytokine concentration fluctuations after induction of orthodontic force with and without extracorporeal shock wave therapy in a rat model. Materials and methods: An orthodontic appliance was fabricated and applied between the molars and the incisors of rats. The rats were treated by a single episode of 1000 shock waves and gingival crevicular fluid was collected for 3 days. The expression and concentration of IL-1β and VEGF were evaluated by ELISA assay. On day 3 all rats were sacrificed and histologic and immunohistochemical assays were applied. Results: IL-1β concentration rose in both the treated and non treated shockwave groups on the first day, however it was statistically significantly higher in the treated group on day 2. No statistically significant difference was detected between the groups on day 3. The number/area of TRAP positive cells was higher in the non shockwave group than in the treated group. The percentage of cells expressing VEGF displayed the opposite trend. The findings regarding the immunohistochemical assay for IL-1β corresponded with those of the ELISA assay on day 3. Conclusion: The application of shockwaves during orthodontic tooth movement influences the expression of IL-1β and VEGF and may alternate the periodontal remodelling expected rate. © 2012 Elsevier Ltd. All rights reserved. Source

Hirsch D.,Institute of Endocrinology | Hirsch D.,Tel Aviv University | Kopel V.,Maccabi Health Care Services Central Laboratory | Nadler V.,Maccabi Health Care Services Central Laboratory | And 6 more authors.
Journal of Clinical Endocrinology and Metabolism

Objective: Primary hyperparathyroidism (PHPT) during pregnancy may pose considerable risks to mother and fetus. This study examined pregnancy outcomes in women with gestational PHPT in relation to clinical and laboratory parameters. Design: This study was designed as a retrospective case series. Methods: The study group included 74 women aged 20-40 years who were diagnosed with PHPT after a finding of serum calcium ≥ 10.5 mg/dL on routine screening at a health maintenance organization (2005-2013) and who became pregnant during the time of hypercalcemia (124 pregnancies). Clinical and laboratory data were collected from the files. Pregnancy outcomes were compared with 175 normocalcemic pregnant women (431 pregnancies) tested during the same period. Results: The cohort represented 0.03% of all women of reproductive age tested for serum calcium during the study period. Abortion occurred in 12 of 124 pregnancies (9.7%), and other complications occurred in 19 (15.3%) with no statistically significant differences from controls. Hypercalcemia was first detected during pregnancy in 14 of 74 women (18.9%) and before pregnancy (mean, 33.4 ± 29 mo) in 60. Serum calcium was measured antenatally in 57 of 124 pregnancies (46%); the mean level was 10.7 ± 0.6 mg/dL (median, 10.6 mg/dL). Measurement of the serum PTH level (with consequent diagnosis of PHPT) was performed during the first studied pregnancy in 17 of 74 women (23%), before pregnancy (mean, 37.8 ± 25.5 mo; median, 34 mo) in 23 (31.1%), and after delivery (mean, 54.7 ± 45.7 mo; median, 35 mo) in 34 (45.9%). Forty-three women (58.1%) underwent parathyroidectomy, six during pregnancy, without maternal or fetal complications. No difference was found in abortion or any pregnancy-related complication between patients who subsequently underwent parathyroidectomy and those who did not. No significant correlation was found between calcium level during pregnancy and pregnancy outcomes. Conclusions: Serum calcium levels are usually only mildly elevated during pregnancy in women with PHPT. A significant proportion of cases go undiagnosed. Mild hypercalcemia in gestational PHPT is generally not associated with an increased risk of obstetrical complications. Copyright © 2015 by the Endocrine Society. Source

Schiff E.,Bnai Zion Hospital | Schiff E.,Haifa University | Frenkel M.,University of Texas M. D. Anderson Cancer Center | Shilo M.,Leumit Health Services | And 6 more authors.
Patient Education and Counseling

Objective: Our study aimed to develop a framework to improve communication between physicians and CAM practitioners regarding mutual patients. Methods: Following a modified Delphi process, we developed preliminary recommendations regarding communication between physicians and CAM practitioners. We then surveyed 473 physicians and 781 CAM practitioners regarding their opinions on these recommendations. Results: High reliability and validity of the survey were found among the physicians and CAM practitioners (Cronbach's alpha score of .94 and .83, respectively). Physicians and CAM practitioners considered communication regarding mutual patients important (80% and 97%, respectively; P< .001). A medical/referral letter was the preferred communication mode. Physicians and CAM practitioners concurred on four elements that should be included in such a referral letter: conventional-CAM diagnosis with coherent terminology, possible conventional-CAM treatment interactions, description of the treatment plan and its goals, and quality issues regarding CAM supplements. Conclusions: A practical framework for advancing physician-CAM practitioner communication is feasible, and may be applied in daily medical care with the goal of bridging the patient-physician-CAM practitioner communication gap. Practice implications: Communication between physicians and CAM practitioners regarding mutual patients is important. Establishing a framework for the mode and content of such communication is feasible. © 2010 Elsevier Ireland Ltd. Source

Endevelt R.,Haifa University | Ben-Assuli O.,Ono Academic College | Klain E.,Maccabi Health Care Services | Zelber-Sagi S.,Haifa University | Zelber-Sagi S.,Tel Aviv Sourasky Medical Center
Surgery for Obesity and Related Diseases

Background: A growing number of patients have been undergoing bariatric surgery in recent years. The role of adherence with regular dietician follow-up in successful long-term weight reduction has yet to be determined, and there are no studies characterizing the utilization of nutritional services after bariatric surgery. The objective of this study was to determine whether dietary counseling by a dietician can contribute to weight reduction after surgery in a follow-up of morbidly obese adult patients who underwent bariatric surgery. Methods: Inclusion criteria were age 20-70 at the time of the bariatric surgery and available body mass index (BMI) measurements before and at least 1 month after the surgery. Medical history and blood test results (triglycerides, cholesterol, and glucose) were recorded. Furthermore, data were collected on the utilization of healthcare services. Results: The final study sample consisted of 1680 patients. Only 681 (40.54%) patients in the cohort attended dietician counseling in Maccabi, and only 471 (28%) patients received such counseling at least twice. Patients attending significant diet counseling had significantly higher proportions of at least 5% reduction in BMI. Two or more visits to dietician counseling were significantly and independently associated (odds ratio = 1.56, 1.02-2.38, 95% CI, P =.04) with a BMI reduction of at least 5%, adjusting for age, gender, number of expert counseling sessions, additional surgery, type of operation, and the interval between BMI measurements. Conclusion: Structured nutritional counseling after bariatric surgery can help in achieving clinically significant weight reduction. © 2013 American Society for Metabolic and Bariatric Surgery. All rights reserved. Source

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