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עמוד בית
Mon, 26.02.24

Search results


March 2023
Eyal Leibovitz MD, Mona Boaz PhD, Israel Khanimov MD, Gary Mosiev MD, Mordechai Shimonov MD

Background: Despite its wide use, evidence is inconclusive regarding the effect of percutaneous endoscopic gastrostomy (PEG) in patients with chronic diseases and dementia among hospitalized patients with malnutrition.

Objectives: To examine the effect of PEG insertion on prognosis after the procedure.

Methods: This retrospective analysis of medical records included all adult patients who underwent PEG insertion between 1 January 2009 and 31 December 2013 during their hospitalization. For each PEG patient, two controls similar in age, sex, referring department, and underlying condition were randomly selected from the entire dataset of patients admitted. The effect of PEG on mortality and repeated admissions was examined.

Results: The study comprised 154 patients, 49 referred for PEG insertion and 105 controls (mean age 74.8 ± 19.8 years; 72.7% females; 78.6% admitted to internal medicine units). Compared to controls, the PEG group had a higher 2-year mortality rate (59.2% vs. 17.1%, P < 0.001) but the 2-year readmission rate did not differ significantly (44.9% vs. 56.2% respectively, P = 0.191). Regression analysis showed PEG was  associated with increased risk of the composite endpoint of death or readmission (hazard ratio 1.514, 95% confidence interval 1.016–2.255, P = 0.041). No specific characteristic of admission was associated with increased likelihood of death or readmission. Among readmitted patients, reasons for admission and baseline laboratory data, including albumin and cholesterol, did not differ between the PEG patients and controls.

Conclusions: In-hospital PEG insertion was associated with increased mortality at 2 years but had no effect on readmissions.

November 2021
Yaniv Faingelernt MD, Eugene Leibovitz MD, Baruch Yerushalmi MD, Eytan Damari MD, Eyal Kristal MD, Raouf Nassar MD, and Dana Danino MD
June 2020
Lior Leibou MD, Tomer Perlok MD, Rivi Haiat Factor MD, Eyal Leibovitz MD, Jacob Frand MD, Stav Leibou, Dror Sadan MD and Mordechai Shimonov MD

Background: The effect of weight reduction following bariatric surgery is already well known.

Objectives: To investigate the effects of abdominoplasty on metabolic markers indicative of weight loss.

Methods: The authors prospectively enrolled consecutive obese patients after laparoscopic sleeve gastrectomy. They were candidates for post-bariatric surgery abdominoplasty. The authors measured metabolic markers one day prior to surgery, 24 hours after, and 3 months following surgery. They recorded medical and demographic parameters.

Results: Sixteen patients were recruited for participation in the study. Mean age was 47 years and 88% of the patients were female. Bariatric surgery achieved a mean decline in body mass index of 13.8 kg/m2. All patients underwent abdominoplasty. Leptin and insulin levels were slightly increased at 3 months postoperative. No significant changes were observed in glucose, hemoglobin, or triglycerides throughout the study.

Conclusions: In a cohort of obese patients undergoing laparoscopic sleeve gastrectomy followed by abdominoplasty, no significant changes were noted in a patient’s metabolic profiles. The results suggest that abdominoplasty has no effect on the metabolic markers tested in contrast to other reports; however, the cosmetic, behavioral, and psychological advantages of abdominoplasty are well established.

March 2020
Ori Hassin MD, Dana Danino MD, Ruth Schreiber MD, Eugene Leibovitz MD and Nahum Amit, MD
May 2019
Shahar Blechman MD, Yariv Fruchtman MD, Zvi H. Perry MD PhD, Julia Mazar PhD, Miriam Ben Harosh MD, Abuquidar Abed MD, Nurit Rozenberg PhD, Gila Kenet MD and Eugene Leibovitz MD

Background: Congenital factor VII deficiency is a rare recessive autosomal bleeding disorder with a wide spectrum of clinical manifestations.

Objectives: To compare the clinical and laboratory findings in Jewish and Bedouin patients with factor VII deficiency.

Methods: The clinical and laboratory findings of patients with factor VII deficiency treated at Soroka Medical Center, a tertiary hospital in Israel, from 2005 to 2015 were analyzed regarding blood factor levels, illness severity, treatment administration, and disease outcome.

Results: Seventy-eight patients were enrolled (1:13,000 of the population in southern Israel) of whom 26 were diagnosed with severe factor VII deficiency (1:40,000). Sixty (76.9%) patients were Jewish and 18 (23.1%) were Bedouin. In univariable analysis, Bedouin patients exhibited a more severe illness, with significantly higher complication and fatality rates, and required more preventive treatment than the Jewish patients.

Conclusions: The prevalence of congenital factor VII deficiency (including severe deficiency) in the Jewish and Bedouin populations of southern Israel is higher than previously reported. The clinical spectrum of the disease was found to be more severe in the Bedouin population.

April 2017
Eliyahu H. Mizrahi MD MHA, Emilia Lubart MD, Anthony Heymann PhD and Arthur Leibovitz MD

Background: Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors.

Objective: To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation.

Methods: A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. 

Results: Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (β = -0.17, P = 0.004).

Conclusion: Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation. 

 

February 2017
Avishay Tzur MD,Yair Sedaka MD, Yariv Fruchtman MD, Eugene Leibovitz, MD, Yuval Cavari MD, Iris Noyman MD, Shalom Ben-Shimol MD, Ilan Shelef MD and Isaac Lazar MD
July 2016
Mordechai Shimonov MD, Lior Leibou MD, Eduard Davidov MD, Olga Bernadsky MD, Julio Wainstein MD and Eyal Leibovitz MD

Background: Helicobacter pylori (HP) infection of the gastric mucosa may be involved in the development of insulin resistance (IR). 

Objectives: To investigate the association between HP status in stomach biopsies and weight reduction in patients who underwent laparoscopic sleeve gastrectomy (LSG). 

Methods: In this retrospective analysis of medical charts, all patients who underwent LSG for weight reduction and had at least 1 year of follow-up were included. HP status was ascertained by two to four biopsies of the removed stomach. 

Results: The study group comprised 70 patients; their mean age was 45.9 ± 11.9 years and 31.9% were males. Fourteen patients (20%) tested positive for HP colonization in gastric mucosa. HP status was not associated with age or smoking status. No difference was noted in the rate of diabetes mellitus (DM) or hypertension, but patients with HP had lower rates of hyperlipidemia (0 vs. 29 patients, 52%, P < 0.001). Patients lost an average of 10.5 kg/m2 after 12 months of follow-up, and no difference was noted between HP-positive and HP-negative patients. The rate of DM control was also similar between HP-positive and HP-negative patients at baseline (33.3 vs. 29.4, P = NS) and at 12 months of follow-up (70% vs. 50%, P = NS). 

Conclusions: HP status was not associated with changes in metabolic profiles and co-morbidity status, or in the efficacy of LSG. 

 

June 2015
Emily Lubart MD, Alexandra Yarovoy MD, Gilad Gal PhD, Ricardo Krakover MD and Arthur Leibovitz MD

Background: QT segment prolongation is a high risk factor for fatal arrhythmias. Several studies have indicated a possible relation between low testosterone levels and QT interval prolongation. 

Objectives: To compare the QT interval length in elderly patients with prostate carcinoma who were on anti-testosterone treatment and those who were not.

Methods: We screened the electrocardiograms (ECGs) of 100 prostate cancer patients divided into two groups: 50 patients on anti-testosterone drug treatment and 50 patients not. QT interval length was measured according to the accepted methods.

Results: The mean QTc 12 leads in the entire group was 0.45 ± 0.04 sec, which is close to the upper limit. Mean QTc was actually longer in the control group and there was no QTc difference between the groups after adjustment for possible confounders. Prolonged QTc 12-lead ECG (48% in treated and 54% in non-treated) and lead L2 QT interval (50% in treated and 56% in non-treated) did not differ significantly between the groups. The analysis of QTc 12-lead ECG indicated no significant effects of anti-testosterone drug treatment. Only the use of furosemide was associated with QT prolongation. 

Conclusions: The results of this preliminary study do not support our initial concern of an alarmingly prolonged QT interval in the anti-testosterone treated group. However, further prospectively designed studies are needed. In the meanwhile we call for a close follow-up of the QT interval length in patients receiving anti-testosterone treatment. 

 

July 2014
Igor Rabin MD, Uri Shpolanski PhD, Allon Leibovitz MD and Arie Bass MD

Background: Claudication is one of the sequelae of peripheral arterial disease (PAD). To date, no effective treatment has been found for this condition.

Objectives: To investigate a new device to treat PAD. The device administers pre-programmed protocols of oscillations to the foot.

Methods: Fifteen patients aged 40–70 years who suffered from intermittent claudication secondary to PAD were recruited to an open prospective study. Each patient was treated once for 30 minutes. The following parameters were evaluated: pain-free and maximal walking distances, skin blood flux by laser-Doppler, skin temperature, ankle-brachial and toe-brachial indices, transcutaneous oxygen pressure (tcpO2) and transcutaneous carbon dioxide pressure (tcpCO2). Non-parametric signed-rank test was applied for testing differences between baseline assessment and post-treatment assessments for quantitative parameters.

Results: Mean pain-free walking distance was 122 ± 33 m and increased to 277 ± 67 m, after the treatment session (P = 0.004). Mean maximal walking distance was 213 ± 37 m and it increased to 603 ± 77 m (P < 0.001). Foot skin perfusion also improved, as demonstrated by an increase in tcpO2 by 28.6 ± 4.1 mmHg (P < 0.001), a decrease in tcpCO2 by 2.8 ± 1.3 (P = 0.032), and up to twofold improvement in blood flux parameters, and an increase in skin temperature by 1.9 ± 0.5°C (P < 0.001). Ankle-brachial index increased by 0.06 ± 0.01 (P = 0.003) and toe-brachial index by 0.17 ± 0.02 (P < 0.001).

Conclusions: Preprogrammed oscillations applied to the foot had a positive effect on microcirculation, tissue oxygenation and CO2 clearance; they had a smaller though significant effect on arterial blood pressure indices, and the change in the arterial-brachial index correlated with the change in the pain-free walking distance. 

January 2014
Emily Lubart, Arthur Leibovitz, Vadim Shapir and Refael Segal
Background: Musculoskeletal and joint disorders are extremely common in the elderly. They directly affect mobility, gait stability, quality of life, and independence.

Objectives: To assess the nature of joint problems encountered in a geriatric inpatient population and evaluate the contribution of a rheumatologist.

Methods: We reviewed the rheumatology consultations that were conducted in a geriatric medical center over a 10 year period.

Results: A total of 474 consultations were held; most of these patients (86%) were hospitalized in the acute geriatric departments, 10% in the rehabilitation ward and 4% in the long-term care wards. Some patients were seen more than once. The rheumatologic joint problem was the main reason for hospitalization in 53% of these patients. Monoarthritis was the most frequent complaint (50%), followed by pauci-articular arthritis (two to five joints) in 30% of patients. Arthrocentesis, diagnostic and therapeutic, was performed in 225 patients, most of them on knee joints (81%). The most frequent diagnosis was osteoarthritis with acute exacerbation (28%), followed by gout (18%), pseudo-gout (9%) and rheumatoid arthritis (9%). In 86 cases (18%) the diagnosis was a non-specific rheumatologic problem: arthralgia, non-specific generalized pain, or fibromyalgia.

Conclusions: Prompt and appropriate evaluation, as well as arthrocentesis and treatment initiation, including local injections, were made possible by the presence of an in-house rheumatologist. 

July 2012
S. Giryes, E. Leibovitz, Z. Matas, S. Fridman, D. Gavish, B. Shalev, Z. Ziv-Nir, Y. Berlovitz and M. Boaz
Background: Depending on the definition used, malnutrition is prevalent among 20¨C50% of hospitalized patients. Routine nutritional screening is necessary to identify patients with or at increased risk for malnutrition. The Nutrition Risk Screening (NRS 2002) has been recommended as an efficient tool to identify the risk of malnutrition in adult inpatients.

Objectives: To utilize the NRS 2002 to estimate the prevalence of malnutrition among newly hospitalized adult patients, and to identify risk factors for malnutrition.

Methods: During a 5 week period, all adult patients newly admitted to all inpatient departments (except Maternity and Emergency) at Wolfson Medical Center, Holon, were screened using the NRS 2002. An answer of yes recorded for any of the Step 1 questions triggered the Step 2 screen on which an age-adjusted total score ¡Ý 3 indicated high malnutrition risk.

Results: Data were obtained from 504 newly hospitalized adult patients, of whom 159 (31.5%) were identified as high risk for malnutrition. Malnutrition was more prevalent in internal medicine than surgical departments: 38.6% vs. 19.1% (P < 0.001). Body mass index was within the normal range among subjects at high risk for malnutrition: 23.9 ¡À 5.6 kg/m2 but significantly lower than in subjects at low malnutrition risk: 27.9 ¡À 5.3 kg/m2 (P < 0.001). Malnutrition risk did not differ by gender or smoking status, but subjects at high malnutrition risk were significantly older (73.3 ¡À 16.2 vs. 63.4 ¡À 18.4 years, P < 0.001). Total protein, albumin, total cholesterol, low density lipoprotein-cholesterol, hemoglobin and %lymphocytes were all significantly lower, whereas urea, creatinine and %neutrophils were significantly higher in patients at high malnutrition risk.

Conclusions: Use of the NRS 2002 identified a large proportion of newly hospitalized adults as being at high risk for malnutrition. These findings indicate the need to intervene on a system-wide level during hospitalization.
April 2012
E. Lubart, R. Segal, S. Megid, A. Yarovoy and A. Leibovitz

Background: The QT interval reflects the total duration of ventricular myocardial repolarization. Disturbed QT – either prolonged or shortened – is associated with arrhythmia and is life-threatening.

Objectives: To investigate an elderly population for disturbed QT interval.

Methods: We conducted a cross-sectional study on residents of long-term care wards in a geriatric hospital. Excluded were those with pacemaker, atrial fibrillation or bundle branch block. The standard 12 lead and lead 2 electrocardiograms in the patients’ files were used for the evaluation of QT interval.

Results: We screened the ECGs of 178 residents. QTc prolongation based on the mean 12 ECG leads was detected in 48 (28%), while 45 (25%) had prolonged QTc based on lead L2. Factors associated with QT prolongation were male gender, chronic renal failure and diabetes mellitus. Short QT was found in 7 residents (4%) and was not related to any parameter.

Conclusions: About one-third of the elderly long-term care residents in our study had QT disturbances. Such a considerable number warrants close QT interval follow-up in predisposed patients.

 

February 2012
A. Zabari, E. Lubart, F. DeKeyser Ganz and A. Leibovitz

Background: Pain following hip fracture and internal fixation is a major factor during the treatment of elderly patients on rehabilitation programs. A proactive pain management program was instituted in our geriatric rehabilitation ward in 2005.

Objectives: To compare retrospectively two groups of patients, one before and one after implementation of the proactive pain management program.

Methods: The study group comprised 67 patients and the control group 77 patients. Pain in the study group was evaluated daily by the visual analogue scale (VAS) and the outcome of the rehabilitation process by the Functional Independence Measure (FIM). During the study period (2003–2006) no changes were made in the rehabilitation team, methods or facilities other than introduction of the pain control program. We compared the FIM scores between admission and discharge in both groups.

Results: Improvement in FIM scores between admission and discharge was significantly higher in the study group than in the control group (11.07 ± 7.9 vs. 8.4 ± 7.3, P < 0.03). There was no significant difference between the average lengths of stay.

Conclusions: These data support the view that the proactive monitoring of pain in surgical hip fracture patients is associated with a better outcome of the rehabilitation process.

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