L. Sasson, I. Cohen, A. Tamir, A. Raucher Sternfeld, Y. Berlowitz, O. Lenczner and S. Houri
Background: The use of extracorporeal membrane oxygenation (ECMO) in children after cardiac surgery is well established. ECMO support is becoming an integral tool for cardiopulmonary resuscitation in specified centers.
Objectives: To review our use of ECMO over a 10 year period.
Methods: All children supported with ECMO from 2000 to 2010 were reviewed. Most of these children suffered from cardiac anomalies. The patients were analyzed by age, weight, procedure, RACHS-1 when appropriate, length of support, and outcome.
Results: Sixty-two children were supported with ECMO; their median age was 3 months (range 0–216 months) and median weight 4.3 kg (range 1.9–51 kg). Thirty-four patients (52.3%) needed additional hemofiltration or dialysis due to renal failure. The children requiring ECMO support represented a wide spectrum of cardiac lesions; the most common procedure was arterial switch operation 27.4% (n=17). ECMO was required mainly for failure to separate from the heart-lung machine (n=55). The median duration of ECMO support was 4 days (range 1–14 days); 29 (46.7%) patients were weaned successfully from ECMO during this time period, and 5 of them died during hospitalization, yielding an overall hospital survival rate of 38.7%.
Conclusions: ECMO support has significant survival benefit for patients with post-cardiotomy heart failure. Its early deployment should be considered in cardiopulmonary resuscitation.
U. Yoel, T. Abu-Hammad, A. Cohen, A. Aizenberg, D. Vardy and P. Shvartzman
Background: The rate of adherence to treatment for diabetes mellitus (DM), hypertension (HTN) and lipid metabolic disorder (LMD) is significantly lower in the Bedouin population compared with the Jewish population in southern Israel.
Objectives: To investigate the reasons for non-adherence associated with cardiovascular risk factors among Bedouins.
Methods: We identified Bedouin patients with HTN, DM or LMD from medical records and randomly selected 443 high adherent and 403 low adherent patients. Using trained interviewers we conducted in-depth structured interviews regarding knowledge and attitudes to chronic illness and its treatment, health services evaluation, and socio-demographic factors.
Results: The study population included 99 high and 101 low adherent patients. More low adherent patients agreed that traditional therapy can replace prescribed medications for DM, HTN or LMD (47% vs. 26%, P < 0.01), and 10% used only traditional medications. Also, more low adherent patients believed that the side effects of prescribed drugs are actually worse than the disease itself (65% vs. 47%, P < 0.05), and 47% cited this as a reason for discontinuing drug treatment (47% vs. 31%, P < 0.05).
Conclusions: Our findings suggest that in this minority population the basis for non-adherence derives directly from patients' perceptions of chronic disease and drug treatment. A focused intervention should emphasize the importance of early evidence-based drug therapy with open patient-physician dialogue on the meaning of chronic disease and the side effects of prescribed drugs.
L. Ashkenazi-Hoffnung, P. Merlob, B. Stahl and G. Klinger
Background: Diclectin (pyridoxine 10 mg and doxylamine 10 mg) has traditionally been used to treat nausea and vomiting of pregnancy (NVP); however, this drug is unavailable in many countries.
Objectives: To evaluate the efficacy and safety of a simple bi-daily treatment regimen with the combination of pyridoxine (50 mg twice daily) and doxylamine (25–50 mg) as an alternative treatment for NVP.
Methods: A prospective case-controlled observational study of mother-infant pairs was conducted between February 2008 and December 2010. All women who contacted the Beilinson Teratology Information Service (BELTIS) regarding treatment of NVP were eligible for inclusion. Using data on NVP severity, treatment efficacy and outcomes, we compared the two groups of women: those treated with the combination of pyridoxine and doxylamine (treatment group, n=29) and those treated with metoclopramide (control group, n=29).
Results: Moderate to severe symptoms were present in 97% of the treatment group women vs. 69% of control group women (P < 0.01). Despite increased symptom severity in the treatment group, the combination regimen was efficacious: 20/29 (69%) vs. 18/25 (72%) in the treatment vs. control women respectively (P = 0.65). There were no congenital anomalies in the treatment group. Follow-up was normal for all infants.
Conclusions: Bi-daily combination therapy with pyridoxine and doxylamine for NVP is safe, has comparable efficacy to metoclopramide, and is a treatment alternative in countries where Diclectin is not available. Despite symptoms warranting counseling by a teratology information service, more than a third of women do not take the suggested treatment.
O. Megged, M. Assous, G. Weinberg and Y. Schlesinger
M. Weyl Ben-Arush, A. Ben Barak, R. Bar-Deroma, S. Ash, G. Goldstein, H. Golan, H. Houri, D. Waldman, N. Nevo, R. Bar Shalom, A. Berniger, A. Nevelsky, A. Toren, I. Yaniv and A. Kuten
Background: Palliative treatment of refractory neuroblastoma remains a significant clinical problem.
Objectives: To retrospectively determine the clinical response to 131I-MIBG therapy at low doses in patients with refractory neuroblastoma.
Methods: We performed a retrospective chart review of 10 patients with neuroblastoma treated with 131I-MIBG at Rambam Health Care Campus from 1994 to 2012. Clinical data, number of 131I-MIBG courses delivered, toxicities, and clinical responses were reviewed. MIBG scan was performed after each course.
Results: Twenty-one courses of 131I-MIBG were delivered to 10 patients (3 girls, 7 boys). Their mean age was 3.8 years (range 1.5–6 years). All patients received several protocols of chemotherapy including the high dose form. Three patients received three courses of 131I-MIBG with a minimum of 6 weeks between each course, five patients received two courses, and two patients received only one course. An objective response to the first course was obtained in nine patients and to the second course in six of eight, and in three children who underwent the third course the pain decreased. One patient has no evidence of disease, four are alive with disease, and five died of the disease. No unanticipated toxicities were observed.
Conclusions: Low dose 131I-MIBG is an effective and relatively non-toxic treatment in neuroblastoma disease palliation. Rapid and reproducible pain relief with 131I-MIBG was obtained in most of the children. Treatment with systemic radiotherapy in the form of low dose 131I-MIBG was easy to perform and effective in cases of disseminated neuroblastoma, demonstrating that this primary therapy can be used for palliative purposes.
S. Kacker and A.A R. Tobian
A.Z. Zivotofsky and A. Jotkowitz
M. Michael, A. Shimoni and A. Nagler
Acute graft-versus-host disease (GVHD) is a major source of morbidity and mortality after allogeneic stem cell transplantation. Therapy of established acute GVHD depends heavily on corticosteroids, which have limited efficacy and are considerably toxic. It is still a matter of debate whether there is an alternative therapy to corticosteroids. Second-line treatment for acute GVHD after failure of steroids is not well substantiated due to the lack of controlled studies. This review examines the current treatment for acute GVHD, as well as novel therapeutics, such as cellular approaches (e.g., adoptive transfer of mesenchymal stem cells) and enhancement of regulatory T cells (e.g., photopheresis). These approaches avoid the toxicity of generalized immunosuppression and are likely to play a prominent future role in acute GVHD therapy.
D.M. Behar, L. Adler and L. Basel-Vanagaite
D. Yakubovitch, M. Halak, M. Khaikin and D. Silverberg
M. Swissa, R. Brauner, S. Shimoni, O. Paz and B. Belhassen
A.J. Jacobs
Infant circumcision has recently attracted controversy, with professional groups recommending it and various individuals trying to criminalize it. Circumcision is beneficial in the prevention of certain diseases, causing minimal tangible harm to those circumcised. This article argues that government should affirmatively adopt policies tolerating minority practices. Such activities should be banned only if they cause substantial damage to society or its members, or if they engender risks or injuries to which no reasonable person would consent. The benefits and risks of circumcision are outlined. Circumcision of male infants does not trigger cause for government to abolish it, and should be permitted if parents desire it. This article also summarizes common arguments against circumcision and attempts to refute them. These arguments are based on a desire for gender equality as well as a belief that minors should not undergo elective bodily alteration. If there are no unusual risks, parents can ethically authorize, and physicians ethically perform, elective infant circumcision for prophylaxis of disease, ritual purposes, or aesthetic reasons. Furthermore, the state should permit this.