Israel Medical Association Journal

Background: The implantable loop recorder (ILR) is an important tool for the evaluation of unexplained syncope, particularly in cases of rarely occurring arrhythmia.

Objectives: To review the clinical experience of two Israeli medical centers with the ILR. Methods: We reviewed the medical records of patients with unexplained syncope evaluated with the ILR at Rabin Medical Center (2006–2010) and Wolfson Medical Center (2000–2009).

Results: The study group included 75 patients (44 males) followed for 11.9 ± 9.5 months after ILR implantation. Patients’ mean age was 64 ± 20 years. The ILR identified an arrhythmic mechanism of syncope in 20 patients (17 bradyarrhythmias, 3 tachyarrhythmias) and excluded arrhythmias in 12, for a diagnostic yield of 42.7%. It was not diagnostic in 17 patients (22.7%) at the time of explant 26 patients (34.7%) were still in follow-up. In two patients ILR results that were initially negative were reversed by later ILR tracings. The patients with bradyarrhythmias included 9 of 16 (56.3%) with surface electrocardiogram conduction disturbances and 2 of 12 (16.7%) with negative findings on carotid sinus massage. All bradyarrhythmic patients received pacemakers the seven patients for whom post-intervention data were available had no or mild symptoms.

Conclusions: The ILR has a high diagnostic yield. Pre-ILR findings correlating with the ILR results are conduction disturbances (positive predictor of arrhythmia) and negative carotid sinus massage results (negative predictor of arrhythmia). Proper patient instruction is necessary to obtain accurate results. Caution is advised when excluding an arrhythmia on the basis of ILR tracings, and long-term follow-up is warranted.

Chronic myeloid leukemia (CML) is a clonal hematological disease that represents 15–20% of all adult leukemia cases. The study and treatment of CML has contributed pivotal advances to translational medicine and cancer therapy. The discovery that a single chromosomal abnormality, the Philadelphia (Ph) chromosome, is responsible for the etiology of this disease was a milestone for treating and understanding CML. Subsequently, CML became the first disease for which allogeneic bone marrow transplantation is the treatment of choice. Currently, CML is one of the few diseases where treatment targeted against the chromosomal abnormality is the sole frontline therapy for newly diagnosed patients. The use of directed therapy for CML challenged disease monitoring during treatment and led to the development of definitions that document response and predict relapse sooner than the former routine methods. These methods relied on classical cytogenetics through molecular cytogenetics (FISH) and, finally, on molecular monitoring assays. This review discusses the laboratory tools used for diagnosing CML, for monitoring during treatment, and for assessing remission or relapse. The advantages and disadvantages of each test, the common definition of response levels, and the efforts to standardize molecular monitoring for CML patient management are discussed.

Background: Infants with severe intraventricular-periventricular hemorrhage (IVH) have higher absolute nucleated red blood cell counts (aNRBC) at birth (a marker of intrauterine hypoxia) than controls. Periventricular leukomalacia (PVL) is known to be associated with prenatal and postnatal events. Whether PVL is also linked to intrauterine hypoxia is unknown.

Objectives: To test the hypothesis that infants with PVL have higher aNRBC counts at birth than controls.

Methods: We studied 14 very low birth weight infants with PVL and compared them with 14 pair-matched controls without PVL. Head ultrasound scans were performed in all infants on days 3–5 and 21–25 of life. Paired tests, Fisher exact tests and stepwise logistic regression were performed for analysis.

Results: Groups were similar for gestational age (GA), birth weight (BW), prolonged rupture of membranes (PROM), Apgar scores, IVH, and aNRBC counts. PVL correlated significantly with low partial pressure of CO2 (pCO2) and IVH (P < 0.01). In logistic regression, when GA, gender, PROM, antenatal steroid therapy, 1 (or 5) minute Apgar scores, IVH grade, nosocomial sepsis, patent ductus arteriosus, necrotizing enterocolitis (NEC), need for pressors, aNRBC counts and lowest pCO2 were used as independent variables, pCO2 (P = 0.002), IVH grade (P = 0.001), GA (P = 0.038), NEC (P = 0.061) and use of dopamine (P = 0.010) remained in the analysis (total R2 = 68.2%).

Conclusions: In contrast to severe IVH, aNRBC counts do not predict the development of PVL.

The “Israeli Paradox“ (1996) of low national health rankings despite adequate diet – attributed to high dietary n-6 polyunsaturated fatty acids (PUFA) – coincided with long-observed dichotomies between women’s worse international status vs. men’s advantage. This raised the assumption of a gender link to high n-6 risk as an explanation for both national phenomena. Israeli women’s disadvantage was shown by worse international rankings, i.e., life expectancy (LE), 11th vs. men’s 3rd-best/22 countries (2000), and 14th vs. 6th/34 (2010) all-cause and all-cancer mortality both 15th vs. 2nd-best/22 (2000), and 15th vs. 6th/22 and 12th vs. 2nd-best/22 (2010). Breast cancer mortality rates were +21.8%, vs. prostate -30.4%, compared to Eur-A (27 country) averages (2005). Gender gaps/ratios were smaller than European Union-15, i.e., LE at birth by 34.4–26.4% (2000–2010), respectively, and at 65 years 45.9–35.3% all-cause mortality by 43.3–33.4%, and all-cancer 65.2–58.7%. The Israeli diet was mostly close to guidelines, but n-6 intake (10–12% kcal) was much higher than both recommended and traditional “Mediterranean diet“ levels. Research showing females’ greater potential for conversion of PUFA to long-chain PUFA (LCPUFA) may suggest their potentially increased production of n-6 eicosanoids with known pro-inflammatory/oxidative/carcinogenic potential. An “N-6 Gender Nutrition Paradox“ hypothesis is suggested here, for the first time, associating women’s higher risk and lead in the national “paradox“ with greater potential for n-6 conversion to pro-inflammatory/oxidative/carcinogenic eicosanoids compared to men. This may also exacerbate women’s risk associated with genetic predisposition (i.e., BRCA) and/or sociopolitical stress. Global abandonment of traditional diets/foods together with increasing n-6 consumption and western disease rates emphasize the importance of considering gender in nutritional epidemiology and preventive strategies.