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עמוד בית
Sat, 23.11.24

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August 2012
T. Tohami, A. Nagler and N. Amariglio

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.

July 2012
I. Potasman, G. Naftali and M. Grupper
Background: Overuse and abuse of antibiotics is a major cause of microbial resistance. Within the hospital setting such overuse necessitates real-time supervision by infectious diseases (ID) specialists.

Objectives: To evaluate the impact of a recently introduced computerized antibiotic authorization system on the pharmacy budget.

Methods: The study was performed in a 400 bed university hospital. With the new system, antibiotic requests are entered electronically by the ward physician and reviewed within minutes to hours by ID specialists. The feedbacks are seen in the wards and pharmacy. Successive years, one before and the other after introduction of the system, were compared.

Results: During the first year with the new system 7167 antibiotic requests were entered 20% of them were rejected, mainly for improper indication (43% of the rejections). During that year the antibiotic expenditure was reduced by 17%, compared to the previous year (~equal to 200,000 US$), and was against the trend of the last 5 years. Of the 35 antibiotics under the control of the ID team, the use of 7 was probably curtailed by the supervision. Pareto analysis revealed that four drugs constituted > 50% of the pharmacy’s expenses. The mortality rate (per 1000 hospitalization days) during those 2 years fell from 4.0 to 3.8.

Conclusions: Computerized antibiotic control by ID specialists is a feasible cost-saving new modality that may help reduce unnecessary antibiotic prescriptions.
R. Nevzorov, T. Ben-Gal, B. Strasberg and M. Haim
G. Yahalom, A. Yagoda, C. Hoffmann, O. Dollberg and N. Gadoth
June 2012
P. Codner, R. Nevzorov, J. Kusniec, M. Haim, R. Zabarski and B. Strasberg

Background: Defibrillation threshold (DFT) testing at the time of implantable cardioverter defibrillator (ICD) insertion is performed routinely. Recently this practice is being reconsidered due to doubts about its ability to improve ICD efficacy and evidence that survival may not be affected by the test.

Objectives: To compare the outcome of ICD recipients who underwent DFT testing and those in whom no testing was performed.

Methods: A total of 213 eligible patients were implanted with an ICD between 2004 and 2009. DFT testing was performed in 80. We compared total mortality, appropriate and inappropriate ICD shocks, and anti-tachycardia pacing (ATP) events between DFT and non-DFT patients during a follow-up of 2 years.

Results: On comparing the DFT and non-DFT groups, we found a 2 year mortality rate of 7.5% versus 8.3%, respectively (P = 0.8). Furthermore, 20.7% of patients in the DFT group and 12.4% in the non-DFT group had at least one episode of ICD shock (P = 0.15). With regard to ICD treatment (ICD shocks or ATP events), 57.7% in the DFT group and 64.2% in the non-DFT group received appropriate treatments (P = 0.78).

Conclusions: No significant differences in the incidence of 2 year mortality or percentage of ICD treatment emerged between the DFT and non-DFT groups.
 

April 2012
U. Arad, E. Niv, D. Caspi and O. Elkayam

Monogenic periodic fever syndromes are characterized by recurrent episodes of fever, accompanied by localized inflammatory manifestations. Among them, familial Mediterranean fever (FMF) is the most studied and is by far the most prevalent periodic fever syndrome in Israel. We present a diagnostic workup of a patient suffering from a periodic fever syndrome, initially thought to be FMF and characterized by attacks of fever, severe abdominal pain, a migratory erythematous rash and conjunctivitis. The development of periorbital edema presenting as diplopia led to consideration of tumor necrosis factor receptor-1-associated periodic syndrome (TRAPS). Genetic tests confirmed the diagnosis. This case should alert us that even in Israel, a patient with periodic fever, not fully consistent with the typical features of FMF, should be evaluated for other periodic fever syndromes.

A. Achiron, B.-Z. Garty, S. Menascu, D. Magalashvili, M. Dolev, B. Ben-Zeev and O. Pinhas-Hamiel
Background: Multiple sclerosis (MS) occurs in young adults and infrequently appears in childhood.

Objectives: To determine the incidence of MS and describe the clinical, cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings at onset MS in children in Israel.

Methods: Incidence and case-specific data were obtained through the MS Center Database and Israeli Health Statistics Census Data over 15 years, from 1995 to 2009, and compared between patients with childhood (< 12 years), juvenile (> 12 years, < 18 years) and adult (> 18 years) onset MS.

Results: Of 1129 eligible MS patients, we identified 10 (0.89%) with childhood-onset MS, 74 (6.55%) with juvenile-onset MS, and 1045 (92.56%) with adult-onset MS. There were 0 to 3 incident childhood cases/year, leading to an annual incidence of 0.1/100,000 among Israeli children the incidence of juvenile and adult MS was 2.6 and 5.4/100,000, respectively. Neurological presentation among children with MS was optic neuritis, motor weakness or brainstem involvement. CSF oligoclonal immunoglobulin (IgG) were positive in 62.5%. The most frequent MRI finding was the occurrence of ¡Ý 3 periventricular white matter lesions followed by corpus callosum lesions, with 71% co-occurrence. Cervical and thoracic lesions occurred in 33% and 43%, respectively. Time to second neurological event ranged from 0.3 to 4.2 years and none of the patients with childhood MS reached EDSS=6.0 within a mean follow-up period of 8.4 years.

Conclusions: Childhood-onset MS is rare, with an incidence of 0.1/100,000 Israeli children. Childhood MS does not differ significantly from juvenile and adult-onset MS in terms of clinical, laboratory and imaging findings.
February 2012
A. Farfel, E. Derazne, D. Tzur, N. Linder and Z. Laron

Background: Measurements of adolescents who at birth were large (long and/or heavy) for gestational age are scant.

Objectives: To determine the correlation between birth length and weight in female and male neonates born long and/or overweight for gestational age, with their height and weight at age 17.

Methods: We reviewed the records of the Rabin Medical Center for birth data of 96 full-term neonates born long and overweight for gestational age (FT-lo,ow), 33 full-term neonates born long but with normal weight for gestational age (FT-lo,nw), 148 full-term neonates born overweight but with normal length for gestational age (FT-nl,ow), and 401 full-term neonates born with normal birth length and weight (FT- nl,nw).

Results: Neonates of both genders born long and overweight at birth (FT-lo,ow) were taller and heavier at age 17 years than those born FT-nl,nw: females: 167.8 ± 5.1 cm and 64.6 ± 10.3 kg vs. 162.6 ± 5.5 cm and 59.3 ± 11.1 kg (P < 0.001 for height and P = 0.026 for weight) and males: 182.4 ± 8.1 cm and 80.6 ± 20.4 kg vs. 174.5 ± 6.2 cm and 67.4 ± 12.3 kg (P < 0.001). The correlations between birth length and height at age 17 for both genders were statistically significant (P < 0.001), as were those between birth weight and the weight and body mass index (BMI) at age 17 for both genders (P < 0.001). There was no correlation between birth length and weight or BMI at age 17.

Conclusions: Full-term neonates of both genders born large for gestational age become tall adolescents and weigh more at age 17 than children with a normal birth length and weight.

N. Shoenfeld, O. Rosenberg, M. Kotler and P.N. Dannon

The phenomenon of hair pulling has been recognized for centuries, yet the true prevalence of trichotillomania (TTM) is largely unknown and the topic has been sparsely studied. TTM is classified as an impulse-control disorder despite much debate about its etiology. In this review we summarize the different hypotheses, including impulse-control disorders, obsessive-compulsive disorders, behavioral problems and addiction, and the appropriate treatment methods. The combination of selective serotonin reuptake inhibitors and antipsychotic medications are shown to be most effective. Treatment with anti-addiction drugs seems relevant. Further research is needed to increase our knowledge regarding the etiology of TTM.

D. Boltin and Y. Niv
Eradication of Helicobacter pylori is accompanied by an array of metabolic and hormonal changes in the host. Weight gain following H. pylori eradication is a poorly understood phenomenon and probably results from an interaction between multiple factors. Ghrelin, a peptide hormone secreted by the stomach, is involved in the regulation of food intake and appetite and may account for some of these changes. Although several observational studies have demonstrated that H. pylori infection suppresses circulating ghrelin levels, it has yet to be proven that ghrelin levels increase following eradication. On the other hand, gastric expression of ghrelin, also suppressed by H. pylori, clearly increases following eradication. The determinants of plasma ghrelin levels remain elusive, as do the effects of eradication on these levels. Weight gain following H. pylori eradication may be attributable to changes in plasma and gastric ghrelin however, this hypothesis needs to be further investigated.
N. Moustafa-Hawash, T. Smolkin, A. Ilivitzki, A. Zimberg-Bossira, A. Gildish, R. Gershoni-Baruch and I.R. Makhoul
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