Publications by authors named "Moshe Garty"

36 Publications

Triglyceride levels and risk of type 2 diabetes mellitus: a longitudinal large study.

J Investig Med 2016 Feb;64(2):383-7

Department of Internal Medicine, F-Recanati Institute, Petach Tikva, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

The relationship between triglyceridemia and diabetes mellitus remains unclear. This study evaluated the risk of diabetes and impaired fasting glucose associated with a wide range of triglyceride levels. A longitudinal retrospective study was carried out employing data from a screening center between the years 2000 and 2012. Inclusion criteria were absence of diabetes at baseline and attendance at the center at least twice over a 5-year period. Participants were divided by fasting blood glucose level (normal/impaired) at the first visit. A total of 5085 participants were eligible for the study. Of the 4164 normoglycemic participants at baseline, 40 (0.96%) had diabetes and 998 (24%) had impaired fasting glucose by the end of the study. On stepwise logistic regression analysis, every 10 mg/dL increase in triglyceride level significantly increased the risk of diabetes by 4% and of impaired fasting glucose by 2% (p<0.001). This association held true even when rising triglyceride levels remained within the accepted normal range (<150 mg/dL, p<0.001). Sustained increments in serum triglyceride level, even within the accepted normal range, are an independent risk factor for diabetes mellitus and impaired fasting glucose in normoglycemic participants.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/jim-2015-000025DOI Listing
February 2016

Relationship Between Body Mass Index and Intraocular Pressure in Men and Women: A Population-based Study.

J Glaucoma 2016 05;25(5):e509-13

Departments of *Medicine F-Recanati §Ophthalmology †Clinical Pharmacology Unit ∥Recanati Center for Preventive Medicine, Rabin Medical Center, Petah Tikva ‡Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.

Purpose: To assess the possibility of a relationship between body mass index (BMI) and intraocular pressure (IOP) in both men and women.

Materials And Methods: A retrospective cross-sectional analysis of a database from a screening center in Israel which assessed 18,575 subjects, within an age range 20 to 80 years.

Results: The mean (±SD) age of the study sample was 46 (±10) years, 68% were men. A positive linear correlation was found between BMI and IOP for both men and women (r=0.166, P<0.0001 in men and r=0.202, P<0.0001 in women). Mean (95% confidence interval) IOP in subjects with BMI<25 kg/m(2) was 12.8 mm Hg (range, 12.7 to 12.9 mm Hg) and increased significantly to 13.4 (range, 13.3 to 13.5 mm Hg); 13.9 mm Hg (range, 13.8 to14.0 mm Hg), and 14.3 mm Hg (range, 14.1 to 14.5 mm Hg) for BMI subcategories 25 to 29.9, 30 to 35, and >35 kg/m(2), respectively (P<0.0001). These differences remained significant after multivariate adjustment for age, hypertension, and diabetes mellitus (P<0.0001). Similar multivariate adjustments showed that the coefficient factors for BMI (95% confidence interval) affecting IOP were 0.087 (range, 0.076 to 0.098) P<0.0001 and 0.070 (range, 0.058 to 0.082) P<0.0001 for men and women respectively, indicating that in men and women, the changes in IOP associated with a 10 kg/m(2) increase in BMI were 0.9 and 0.7 mm Hg, respectively. Subjects with abnormal BMI compared with subjects with normal BMI had increased odds ratio of having IOP≥18 mm Hg after adjusting for confounding factors (P<0.001).

Conclusions: This study shows that obesity is an independent risk factor for increasing IOP in both men and women. We consider this finding particularly pertinent in the context of the current obesity epidemic.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000000374DOI Listing
May 2016

Predicting the emergence of anemia--A large cohort study.

Eur J Intern Med 2015 Jun 23;26(5):338-43. Epub 2015 Apr 23.

Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Tel-Aviv University, Israel; Sacker Faculty of Medicine, Tel-Aviv University, Israel.

Background And Objectives: We aimed to find predictors for development of anemia in a large cohort of adults.

Patients And Methods: Cohort study of a large health database from a screening center at the Rabin Medical Center in Israel, between the years 2000-2013. We asked which variables, known at the first visit, would predict anemia at the last visit. Multivariable analysis was conducted using stepwise logistic regression analysis. Odds ratios (ORs) for anemia with 95% confidence intervals (CIs) were calculated.

Results: Our cohort included 10,577 people. At baseline 4.4% were diagnosed with anemia and excluded. Therefore, 10,093 subjects, with a mean age of 42.3 ± 9 years comprised our study sample. At the end of follow-up of 4.7 ± 3.1 years, 307 developed anemia (3%). In men, independent predictors for development of anemia were diabetes mellitus (OR 3.00, 95% CI 1.41-6.39), age (OR 1.03, 95% CI 1.03-1.05, for 1 year increment), low MCV (OR 0.92, 95% CI 0.89-0.96, for every 1 fL unit increment) and elevated platelet count (OR 1.004, 95% CI 1.00-1.01 for 1000/μL unit increment). For women, high total serum protein level was a strong predictor for anemia (OR 3.44, 95% CI 2.33-5.08 for 1mg/dL increment) as well as low triglycerides (OR 0.996, 95% CI 0.993-1.000 for 1mg/dL increment).

Conclusions: Subgroups who are prone to develop anemia include men with diabetes, and women with an elevated serum protein level and low triglycerides.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejim.2015.04.010DOI Listing
June 2015

Assessment of a possible link between hyperhomocysteinemia and hyperuricemia.

J Investig Med 2015 Mar;63(3):534-8

From the *Department of Medicine F. Recanati, and †Clinical Pharmacology Unit, Rabin Medical Center, Beilinson Campus, Petah Tikva; ‡Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv; and §Recanati Center for Preventive Medicine, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

Background/aim: Hyperhomocysteinemia and hyperuricemia are both considered risk factors for coronary artery disease. However, the relationship between the 2 has not yet been thoroughly investigated. This study aimed to evaluate this relationship more closely.

Material And Methods: This study is a retrospective cross-sectional analysis of data from a screening center in Israel assessing 16,477 subjects, within an age range of 20 to 80 years.

Results: The mean age of the study sample was 46 years, and 68% were males. Hyperuricemia was found in 24.9% and 14.6% of subjects with elevated and normal homocysteine serum levels, respectively (P < 0.001). A positive association was found between homocysteine serum levels and uric acid serum levels. Compared with subjects with normal homocysteine serum levels, those with hyperhomocysteinemia had an odds ratio (OR) for hyperuricemia of 1.7 (95% confidence interval [CI], 1.5-1.9) and 1.6 (95% CI, 1.1-2.5) for males and females, respectively. After multivariate adjustment for age, hypertension, body mass index, estimated glomerular filtration rate, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and thiazide use, the association remained significant in males (OR, 1.5; 95% CI, 1.3-1.7; P < 0.001) but not in females (OR, 0.9; 95% CI, 0.6-1.6; P = 0.82).

Conclusions: This large cohort showed a significant association between hyperhomocysteinemia and hyperuricemia. Sex differences were observed. This study suggests that accelerated atherosclerosis may be a consequence of the combined effect of these 2 factors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JIM.0000000000000152DOI Listing
March 2015

Elevated serum homocysteine is a predictor of accelerated decline in renal function and chronic kidney disease: A historical prospective study.

Eur J Intern Med 2014 Dec 27;25(10):951-5. Epub 2014 Oct 27.

Department of Internal Medicine F - Recanati, Rabin Medical Center, Beilinson Hospital, Petah-Tiqva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:

Objective: To estimate the effect of elevated serum homocysteine level on renal function decline and on the incidence of chronic kidney disease (CKD) in the general population.

Methods: A historical prospective study on 3602 subjects attending a screening center in Israel between the years 2000 and 2012. Only subjects with normal estimated glomerular filtration rate (eGFR) and without proteinuria were included. Subjects were divided to two groups according to mean total serum homocysteine level (≤ 15, >15μmol/l). Linear mixed effect model was used to estimate the annual eGRF decline in respect to homocysteine group. Cox proportional hazards models were used to estimate hazard ratios for CKD in the normal compared to the elevated homocysteine group.

Results: Annual eGFR decline was 25% higher in subjects with elevated versus normal mean homocysteine level (0.90 ± 0.16 ml/min/1.37 m(2) vs. 0.72 ± 0.14 ml/min/1.37 m(2), p<0.001). In a median follow up of 7.75 years, 38 subjects developed CKD (1.05%). Elevated mean homocysteine level was highly associated with developing CKD (HR 4.85, 95% CI 2.48-9.49, p<0.001). In a multivariate analysis which adjusted for age, baseline kidney function, HDL cholesterol, BMI, vitamin B12 and folic acid levels, these relationships remained substantially unchanged.

Conclusions: Elevated mean serum homocysteine level is associated with an accelerated decline in renal function in both men and women, and is an independent risk factor for the development of CKD in the general population. Further prospective randomized clinical trials are needed to clarify whether the reduction in serum homocysteine concentrations will result in an improved renal prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejim.2014.10.014DOI Listing
December 2014

C reactive protein and long-term risk for chronic kidney disease: a historical prospective study.

J Nephrol 2015 Jun 1;28(3):321-7. Epub 2014 Jul 1.

Department of Medicine F, Recanati Center, Rabin Medical Center (Beilinson Hospital), 49100, Petah Tikva, Israel.

Introduction: C reactive protein (CRP) is an acute phase reactant that primarily produced by hepatocytes yet may be locally expressed in renal tubular cells. We assessed the association of CRP and the risk for chronic kidney disease (CKD) development.

Methods: Historical prospective cohort study was conducted on subjects attending a screening center in Israel since the year 2000. Subjects with an estimated GFR (eGFR) above 60 ml/min/1.73 m(2) at baseline were included, and high sensitive (hs) CRP levels as well as eGFR were recorded for each visit. Follow up continued for at least 5 years for each subject until 2013. Risk for CKD at end of follow up was assessed in relation to mean hs-CRP levels of each subject. The confounding effects of other predictors of CKD were examined. A logistic regression model treating CRP as a continuous variable was further applied.

Results: Out of 4,345 patients, 42 (1%) developed CKD in a mean follow up of 7.6 ± 2 years. Elevated levels of CRP were associated with greater risk for CKD (crude OR 4.17, 95% CI 1.46-11.89). The OR for the association of CRP with CKD when controlling for age and gender was 5.2 (95% CI 1.7-16.2). When controlling for established renal risk factors, elevated CRP levels remained significantly associated with greater risk for CKD (OR 5.42, 95% CI 1.76-16.68). When applying logistic regression models treating CRP as a continuous variable, for patients with diabetes mellitus (DM), hypertension (HTN) or eGFR between 60-90 ml\min\1.73 m(2), the predictive role of CRP for CKD was highly significant.

Conclusion: Elevated CRP level is an independent risk factor for CKD development. In patients with DM, HTN or baseline eGFR between 60-90 ml\min\1.73 m(2) its predictive role is enhanced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40620-014-0116-6DOI Listing
June 2015

A longitudinal assessment of the natural rate of decline in renal function with age.

J Nephrol 2014 Dec 19;27(6):635-41. Epub 2014 Mar 19.

Department of Medicine F-Recanati, Rabin Medical Center (Beilinson Campus), 49100, Petah Tikva, Israel.

Background: Cross-sectional studies have long suggested that renal function declines with age. Longitudinal studies regarding this issue are limited.

Methods: We retrospectively analyzed a database of subjects attending a screening center in Israel between the years 2000-2012. Only subjects with normal estimated glomerular filtration rate (eGFR) were included. eGFR was assessed consequently at 5 or more yearly visits. The rate of decline in GFR with age was assessed in healthy subjects and in subjects with comorbidities.

Results: The cohort included 2693 healthy subjects and 230 subjects with different comorbidities. Mean (±standard error) annual rate of decline in eGFR in healthy subjects was 0.97 ± 0.02 ml/min/year/1.73 m(2). This decline increased significantly from 0.82 ± 0.22 in age-group 20-30 years to 0.84 ± 0.08, 1.07 ± 0.08 and 1.15 ± 0.12 ml/min/year/1.73 m(2) in age groups 31-40, 41-50 and 50 years and older respectively (p < 0.001). No correlation was found between the annual decline in eGFR and body mass index. In subjects with hypertension, diabetes mellitus, impaired fasting glucose or combined comorbidity the decline in eGFR was 1.12 ± 0.12, 0.77 ± 0.16, 0.85 ± 0.17, and 1.18 ± 0.26 ml/min/year/1.73 m(2) respectively.

Conclusions: This large longitudinal study provides new data on the decrease in eGFR with age. Accurate prediction of the natural rate of GFR decline might be used to distinguish between normally aging kidneys and those with chronic disease. This approach could avoid unnecessary diagnostic procedures in the former and facilitate appropriate treatment in the latter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s40620-014-0077-9DOI Listing
December 2014

The degree of asymptomatic hyperuricemia and the risk of gout. A retrospective analysis of a large cohort.

Clin Rheumatol 2014 Apr 13;33(4):549-53. Epub 2014 Feb 13.

Department of Internal Medicine F - Recanati, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

This study was conducted to examine the relationship between the degree of asymptomatic hyperuricemia and the development of gout, in men and women. The database of a screening center was searched for all subjects with asymptomatic hyperuricemia (>7.0 mg/dl men, >5.6 mg/dl women) during 2000-2012. We included men and women without previous diagnosis of gout, and a follow-up of at least 5 years. The risk of gout was analyzed in relation to the degree of hyperuricemia at the first visit. Of the 5,234 subjects who matched the inclusion criteria, 4,241 were normouricemic at their first visit and 993 were hyperuricemic. The mean follow up period was 7.5 years. Gout was diagnosed at the last visit in 34 subjects; four in the normouricemia group and 30 in the hyperuricemia group (0.1 % vs. 3.0 %, p < 0.001). Only one woman developed gout. The odds ratio (OR) for developing gout was 32 times higher in the hyperuricemic group than in the normouricemic group. The OR to develop gout was 11.2 (confidence interval [CI] 3.6-35.2) in men with mild hyperuricemia compared to 107.1 (CI 34.2-334.9) in men with moderate hyperuricemia, and 624.8 (CI 134.0-2,913.1) in men with severe hyperuricemia. Multivariate analysis of uric acid levels, thiazide use, regular alcohol consumption and estimated glomerular filtration rate (eGFR) showed that only the level of uric acid retained statistically significant for increasing the risk of gout. There is a strong association between the absolute level of uric acid and the risk to develop gout, strikingly so for men with severe hyperuricemia. Monitoring is recommended for that group, which poses the greatest risk to develop gout.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10067-014-2520-7DOI Listing
April 2014

Association between the body mass index and chronic kidney disease in men and women. A population-based study from Israel.

Nephrol Dial Transplant 2013 Nov;28 Suppl 4:iv130-5

Department of Medicine F-Recanati,Rabin Medical Center, Campus Beilinson, Petah Tiqwa, Israel.

Background: Any association between the body mass index (BMI) and chronic kidney disease (CKD) has so far proved inconclusive. Most studies have estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) equation. This has recently been replaced by the more accurate Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

Methods: In a cross-sectional study, data from a screening centre in Israel, n = 21880 (32% women) were used to assess the prevalence of CKD defined as eGFR < 60 mL/min/1.73 m(2) in relation to BMI categories. The CKD-EPI equation was used to assess the eGFR.

Results: CKD was found in 167 men and 45 women. Subjects with a BMI of 25-29.9 kg/m(2), compared with those with a BMI of <25 kg/m(2), had an odds ratio (OR; 95% confidence intervals) for CKD of 1.8 (1.2-2.7) and 3.4 (1.5-7.7) for men and women, respectively. Subjects with a BMI of 30-35 kg/m(2) had an OR of 2.5 (1.6-4.0) and 4.5 (1.7-11.7) for men and women, respectively. In comparable data, for subjects with a BMI > 35 kg/m(2) the OR was 2.7 (1.3-5.5) and 15.4 (6.4-36.7) for men and women, respectively. After multivariate adjustment for age, hypertension and diabetes mellitus, no association was found in men yet it persisted for women. This correlation in women, between the BMI and CKD, was attributed to the subcategory of severely obese women with a BMI of >35 kg/m(2).

Conclusions: Our study is the first to suggest that morbid obesity may be an independent factor related to CKD in women.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ndt/gft072DOI Listing
November 2013

Hyperuricemia and metabolic syndrome: lessons from a large cohort from Israel.

Isr Med Assoc J 2012 Nov;14(11):676-80

Recanati Center for Medicine and Research, Petah Tikva, Israel.

Background: There is a striking increase in the number of people with metabolic syndrome (MetS) as a result of the global epidemic of obesity and diabetes. Increasing evidence suggests that uric acid may play a role in MetS.

Objectives: To assess the prevalence of MetS in a large cohort from Israel and its association with hyperuricemia using the latest three definitions of MetS.

Methods: We conducted a retrospective analysis of the database from a screening center in Israel, using the revised National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the International Diabetes Federation (IDF) and the Harmonizing definitions of MetS, to assess 12,036 subjects with an age range of 20-80 years.

Results: The mean age of the study sample was 46.1 +/- 10.2 years and 69.8% were male. The prevalence of MetS was 10.6%, 18.2% and 20.2% in the revised NCEP ATP III, the IDF and the Harmonizing definitions respectively. The prevalence of hyperuricemia in subjects with MetS, for all three MetS definitions, was similar: 20.0%, 19.9% and 19.1% respectively. There was a graded increase in the prevalence of MetS among subjects with increasing levels of uric acid. The increasing trend persisted after stratifying for age and gender and after multivariate analysis (P for trend (0.001).

Conclusions: This large cohort shows a high prevalence of MetS in Israel, but is still lower than the prevalence in western countries. Hyperuricemia is common in those subjects and might be considered a potential clinical parameter in the definition of MetS.
View Article and Find Full Text PDF

Download full-text PDF

Source
November 2012

Use of intravenous morphine for acute decompensated heart failure in patients with and without acute coronary syndromes.

Acute Card Care 2011 Jun;13(2):76-80

Department of Cardiology, Rabin Medical Center, Beilinson Hospital and the Lea Weissman Cardiology Research Institute, Petah Tikva, Israel.

Background: Current guidelines regarding the use of intravenous morphine (IM) in the management of patients with acute decompensated heart failure (ADHF) are discordant; whereas the American guidelines reserve IM for terminal patients, the European guidelines recommend its use in the early stage of treatment. Our aim was to determine the impact of IM on outcomes of ADHF patients.

Methods: Stepwise logistic regression and propensity score analysis of ADHF patients with and without use of IM was performed in a national heart failure survey.

Results: Of the 4102 enrolled patients, we identified 2336 ADHF patients, of whom 218 (9.3%) received IM. IM patients were more likely to have acute coronary syndromes, acute rather than exacerbation of chronic heart failure, and diabetes mellitus and dyslipidemia. They had higher heart rate, were less likely to receive diuretics and more likely to receive aspirin and statins. Unadjusted in-hospital mortality rates were 11.5% versus 5.0% for patients who did or did not receive IM, and the adjusted odds ratio (OR) for in-hospital death was: 2.0 (1.1 – 3.5, P = 0.02). Using propensity analysis, we identified 218 matched pairs of patients who did or did not receive IM. In multivariable analysis accounting for the propensity score (c-statistic 0.82), IM was not associated with increased in-hospital death (OR: 1.2 (0.6 – 2.4), P = 0.55).

Conclusion: IM was used sparingly in our ADHF cohort, and was independently associated with increased in-hospital death in multivariable analysis, but not in propensity score analysis. Thus, IM may be used in ADHF, but with caution. Further randomized trials are warranted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/17482941.2011.575165DOI Listing
June 2011

Outcomes of acute heart failure associated with acute coronary syndrome versus other causes.

Acute Card Care 2011 Jun 28;13(2):87-92. Epub 2011 Apr 28.

Lea Wiessman Clinical Cardiology Research Center, Department of Cardiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

Background: By and large, prior registries and randomized trials have not distinguished between acute heart failure (AHF) associated with acute coronary syndrome (ACS) versus other causes.

Aims: To examine whether the treatments and outcomes of ACS-associated AHF are different from non-ACS-associated AHF.

Methods: We examined in a prospective, nationwide hospital-based survey the adjusted outcomes of AHF patients with and without ACS as its principal cause.

Results: Of the 4102 patients in our national heart failure survey, 2336 (56.9%) had AHF, of whom 923 (39.5%) had ACS-associated AHF. These patients were more likely to receive intravenous inotropes and vasodilators and to undergo coronary angiography and revascularization, but less likely to receive intravenous diuretics. The unadjusted in-hospital, 30-day, one-year, and four-year mortality rates for AHF patients with or without ACS were 6.5% versus 5.0% (P = 0.13), 10.3% versus 7.5% (P = 0.02), 26.6% versus 31.0% (P = 0.02), and 55.3% versus 63.3% (P = 0.0001), respectively. In the multivariate analysis, the adjusted mortality risk for patients with ACS at the respective time points were 1.46 (0.99-2.10), 1.67 (1.22-2.30), 1.02 (0.86-1.20), and 0.93 (0.82-1.04).

Conclusions: Patients with ACS-associated AHF seem to have a unique clinical course and perhaps should be distinguished from other AHF patients in future trials and registries.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/17482941.2011.567284DOI Listing
June 2011

Comparison of outcome of recurrent versus first ST-segment elevation myocardial infarction (from national Israel surveys 1998 to 2006).

Am J Cardiol 2011 Jun 12;107(12):1730-7. Epub 2011 Apr 12.

Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.

Patients with recurrent acute myocardial infarction (AMI), who represent ≤35% of hospitalized patients with AMI, are at an increased risk of complications and death. Our study purpose was to compare the treatment and outcome of patients hospitalized with recurrent acute ST-segment elevation myocardial infarction (STEMI) from 1998 to 2006 with those of patients with a first STEMI. We performed 5 biennial nationwide 2-month surveys during 1998 to 2006, collecting data prospectively from all patients hospitalized for AMI or acute coronary syndrome in all 25 coronary care units in Israel. The present cohort included 4,543 patients with STEMI, 3,679 (76%) with first and 864 (24%) with recurrent STEMI. The patients with recurrent STEMI were older (66 ± 13 vs 62 ± 13 years), had greater rates of diabetes, hypertension, and previous angina, had a worse Killip class on admission, and experienced more in-hospital complications. The all-cause hospital crude mortality rate was 8.1% in patients with recurrent STEMI versus 5.5% in those with a first STEMI (adjusted odds ratio 1.71 95% confidence interval 1.19 to 2.44), and the 1-year mortality rate was 18.9% versus 10.9%, respectively (hazard ratio 1.85, 95% confidence interval 1.41 to 2.43). From 1998 to 2006, an insignificant trend toward a 1-year mortality reduction among patients with recurrent STEMI was seen and those with a first STEMI had a significant mortality decrease. In conclusion, patients admitted for recurrent STEMI have worse in-hospital and 1-year outcomes that did not improve during the study period. An improved therapeutic approach is needed for these high-risk patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2011.02.332DOI Listing
June 2011

Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure.

Am J Cardiol 2011 Feb 22;107(4):540-4. Epub 2010 Dec 22.

Cardiology Division, University of Rochester Medical Center, New York, USA.

There is controversy regarding type of bundle branch block (BBB) that is associated with increased mortality risk in patients with heart failure (HF). The present study was designed to explore the association between BBB pattern and long-term mortality in hospitalized patients with systolic HF. Risk of 4-year all-cause mortality was assessed in 1,888 hospitalized patients with systolic HF (left ventricular ejection function <50%) without a pacemaker in a prospective national survey. Cox proportional hazards regression modeling was used to compare mortality risk in patients with right BBB (RBBB; 10%), left BBB (LBBB; 14%), and no BBB (76%) on admission electrocardiogram. At 4 years of follow up, mortality rates were highest in patients with RBBB (69%), intermediate in those with LBBB (63%), and lowest in those without BBB (50%, p <0.001). Multivariate analysis demonstrated a significant 36% increased mortality risk in patients with RBBB versus no BBB (p = 0.002) but no significant difference in mortality risk for patients with LBBB versus no BBB (hazard ratio 1.04, p = 0.66). RBBB versus LBBB was associated with a 29% (p = 0.035) increased risk for 4-year mortality in the total population and with a 58% (p = 0.015) increased risk in patients with ejection fraction <30%. In conclusion, RBBB but not LBBB on admission electrocardiogram is associated with a significant increased long-term mortality risk in hospitalized patients with systolic HF. Deleterious effects of RBBB compared to LBBB appear to be more pronounced in patients with more advanced left ventricular dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2010.10.007DOI Listing
February 2011

Predictors of long-term (4-year) mortality in elderly and young patients with acute heart failure.

Eur J Heart Fail 2010 Aug 21;12(8):833-40. Epub 2010 May 21.

Heart Institute, Sheba Medical Center, Tel Hashomer and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Aims: The present study was designed to identify and compare predictors of short- and long-term mortality in elderly and young patients hospitalized with acute heart failure (HF).

Methods And Results: The risk of in-hospital, 1- and 4-year mortality was assessed among 2336 acute HF patients in a prospective national survey. Interaction-term analysis was utilized to identify and compare independent risk factors between elderly (>75 years [n = 1182]) and younger (< or =75 years [n = 1154]) study patients. Elderly patients exhibited a 1.8-fold (P = 0.004), 1.4-fold (P < 0.001), and 1.7-fold (P < 0.001) increase in the adjusted risk of in-hospital, 1-year, and 4-year mortality, respectively, as compared with younger patients. Independent risk factors for 4-year mortality among elderly patients included NYHA functional Class III-IV before admission (HR = 1.46, P < 0.001), systolic blood pressure <115 mmHg (HR = 1.45, P = 0.002), renal dysfunction ([eGFR < 60 mL/min/1.73 m(2)] HR = 1.35, P = 0.002), diabetes mellitus (HR = 1.28, P = 0.006), and anaemia (HR = 1.25, P = 0.012). In the young group, but not in the elderly group, left ventricle ejection fraction (LVEF) <50% and hyponatraemia (sodium <136 mmol/L) were significant predictors of 4-year mortality. (LVEF <50%, HR = 1.47 for the young and 1.04 for the elderly, P for interaction = 0.025; hyponatraemia HR = 1.59 for the young and 1.17 for the elderly, P for interaction = 0.035).

Conclusion: Elderly patients exhibit different risk factors for long-term mortality as compared with young patients with acute HF. In contrast to younger patients, mortality risk in the older population is not decreased among those with preserved LVEF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurjhf/hfq079DOI Listing
August 2010

Atrial fibrillation and long-term prognosis in patients hospitalized for heart failure: results from heart failure survey in Israel (HFSIS).

Eur Heart J 2010 Feb 15;31(3):309-17. Epub 2009 Oct 15.

Heart Institute, Hillel Yaffe Medical Center, Hadera 38100, Israel.

Aims: Atrial fibrillation (AF) and heart failure (HF) commonly coexist, and each adversely affects the other. The aim of the study was to prospectively evaluate the impact of AF and its subtypes on management, and early and long-term outcome of hospitalized HF patients.

Methods And Results: Data were prospectively collected on HF patients hospitalized in all public hospitals in Israel as part of a national survey (HFSIS). Atrial fibrillation patients were subdivided into intermittent and chronic AF subgroups. During March-April 2003, we enrolled 4102 HF patients, of whom 1360 (33.2%) had AF [600 (44.1%) intermittent, 562 (41.3%) chronic]. Patients with AF were older (76.9 +/- 10.5 vs. 71.7 +/- 12.6 years, P = 0.0001), males, with preserved LV systolic function. Crude mortality rates for AF patients were progressively and consistently higher during hospitalization and during the 4-year follow-up period, especially in the chronic AF group (P = 0.0001). After covariate adjustment, AF was associated with increased 1-year mortality [HR 1.19, 95% CI (1.03-1.36)].

Conclusion: AF was present in a third of hospitalized HF patients, and identified a population with increased mortality risk, largely due to co-morbidities.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehp422DOI Listing
February 2010

Blood transfusion for acute decompensated heart failure--friend or foe?

Am Heart J 2009 Oct;158(4):653-8

Recanati Center for Medicine and Research, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.

Background: In acute coronary syndromes (ACSs), blood transfusion (BT) has been associated with worse outcomes. The impact of BT among patients with acute decompensated heart failure (ADHF) remains unknown.

Methods: Propensity score analysis of patients with ADHF with and without BT in a national heart failure (HF) survey was used in this study.

Results: Of the 4,102 enrolled patients, 2,335 had ADHF, of whom 166 (7.1%) received BT. These patients were older (75.6% vs 73.6%, P = .04), more likely to be females (54.8% vs 43.9%, P = .007), more likely to have diabetes (59.0% vs 51.1%, P = .04) and renal dysfunction (59.0% vs 40.2%, P < .001), and more likely to receive inotropes (16.9% vs 8.0%, P < .001), but they had similar rates of ACS (41.0% vs 39.4%, P = .69) and prior HF (64.5% vs 70.0%, P = .23). Nadir hemoglobin levels were commonly <10 g/dL in BT patients (92.7% vs 8.0%); 15 BT patients had bleeding complications, of which 10 are major bleeding. Major predictors for BT were ACS (OR 1.85, 95% CI 1.15-2.96), inotropes use (OR 2.36, 95% CI 1.22-4.55), and nadir hemoglobin (OR 0.18 per 1 g/dL increase, 95% CI 0.14-0.22). In-hospital, 30-day, 1-year, and 4-year unadjusted mortality rates were higher for BT patients (10.8% vs 5.2%, P = .02; 11.0% vs 8.5%, P = .27; 39.6% vs 28.5%, P = .03; 69.5% vs 59.5%, P = .01, respectively). However, in 103 propensity-matched pairs (c-statistic 0.97), short-term mortality tended to be lower with BT (8.7% vs 14.6%, P = .20; 9.7% vs 18.4%, P = .08; 38.8% vs 42.7%, P = .59; and 72.8% vs 76.7%, P = .52, respectively).

Conclusions: Acute decompensated HF patients receiving BT had worse clinical features and unadjusted outcomes, but BT per se seemed to be safe and perhaps even beneficial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ahj.2009.08.001DOI Listing
October 2009

Effect of bundle branch block patterns on mortality in hospitalized patients with heart failure.

Am J Cardiol 2008 May 7;101(9):1303-8. Epub 2008 Mar 7.

Heart Institute, Sheba Medical Center, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

A widened QRS interval is associated with increased mortality in patients with heart failure (HF). However, the prognostic significance of the type of bundle branch block (BBB) pattern in these patients is unclear. The data of 4,102 patients with HF hospitalized during a prospective national survey were analyzed to investigate the association between BBB type and 1-year mortality in 3,737 patients without pacemakers. Right BBB (RBBB) was present in 381 patients (10.2%) and left BBB (LBBB) in 504 patients (13.5%). RBBB and LBBB were associated with increased 1-year mortality on univariate analysis (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.15 to 1.81, and OR 1.20, 95% CI 0.97 to 1.47, respectively). In patients with systolic HF, after adjusting for multiple risk factors, only RBBB was found to be an independent predictor of mortality (RBBB vs no BBB OR 1.62, 95% CI 1.12 to 2.33, and RBBB vs LBBB OR 1.71, 95% CI 1.09 to 2.69). This correlation was stronger in patients with lower left ventricular ejection fractions and was also maintained in patients without acute myocardial infarctions. Analyzing the data for all patients with HF, there was a trend for increased mortality in the RBBB group only (adjusted OR 1.21, 95% CI 0.94 to 1.56). LBBB was not related to mortality in patients with either systolic HF or preserved ejection fractions. In conclusion, RBBB rather than LBBB is an independent predictor of mortality in hospitalized patients with systolic HF. This prognostic marker could be used for risk stratification and the selection of treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.amjcard.2007.12.035DOI Listing
May 2008

Prevalence and significance of unrecognized renal insufficiency in patients with heart failure.

Eur Heart J 2008 Apr 12;29(8):1029-36. Epub 2008 Mar 12.

Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Aviv University, Tel Hashomer 52621, Israel.

Aims: Renal insufficiency (RI) is a strong predictor of adverse outcome in patients with heart failure (HF). We aimed to determine the prevalence of RI being unrecognized and its significance in patients hospitalized with HF.

Methods And Results: We analysed data from a prospective survey of 4102 hospitalized patients with HF. RI [defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2] was present in 2145 (57%) patients but, based on medical records, was unrecognized in 872 [41%, 95% confidence interval (CI) 39-43%] of them. Patients with unrecognized RI were more likely to be women, elderly, and with better functional class, compared with patients with recognized RI. In-hospital and 1 year mortality was significantly higher among patients with recognized and unrecognized RI compared with patients without RI: 6.5 and 7.1 vs. 2.1%, and 38.8 and 30.9 vs. 18.8% (P < 0.001), respectively. After adjustment, recognized and unrecognized RI comparably predicted increased in-hospital mortality: odds ratio (OR) and 95% CI of 2.34 (1.43-3.87), P < 0.001, and 2.30 (1.45-3.72), P < 0.001. After 1 year, recognized RI remained an independent predictor for mortality: OR 1.79 (1.45-2.20), P < 0.001, whereas there was a trend for increased mortality predicted by unrecognized RI: OR 1.22 (0.97-1.53), P = 0.08.

Conclusion: A high proportion of RI remains unrecognized among hospitalized patients with HF. As co-morbid RI has important prognostic and therapeutic implications, patients with HF may benefit from routine assessment of GFR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurheartj/ehn102DOI Listing
April 2008

Severe methemoglobinemia and syncope in a patient with glucose-6-phosphate dehydrogenase deficiency.

Isr Med Assoc J 2007 Sep;9(9):684-5

Heart Institute, Kaplan Medical Center, Rehovot, Israel.

View Article and Find Full Text PDF

Download full-text PDF

Source
September 2007

Morbidity associated with systemic corticosteroid preparation for coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a case control study.

J Cardiothorac Surg 2007 Jun 4;2:25. Epub 2007 Jun 4.

Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Coronary artery bypass grafting (CABG) is associated with high morbidity in patients with chronic obstructive pulmonary disease (COPD).We examine the effect of preoperative systemic corticosteroids on morbidity in this setting.

Methods: Ninety candidates for elective CABG participated in a prospective, open randomized trial, including 30 patients with COPD who received a single injection of a long-acting corticosteroid, 30 with COPD who received placebo, and 30 without COPD who served as controls. Primary end-points were postoperative pulmonary and nonpulmonary complications. Secondary end-points were length of hospital stay (LOS), ICU stay of less than 24 hours and more than 48 hours, duration of mechanical ventilation, and time to walking and sitting.

Results: The rate of pulmonary complications was similar in the two COPD groups and in the COPD patients and controls. The placebo group had more major nonpulmonary complications than the treatment group, but the difference was not statistically significant (26% vs. 17%, P = NS). The non-COPD control group had significantly fewer nonpulmonary complications than the COPD patients (treatment+placebo) (33% vs 70%, P = 0.014) and a similar rate of pulmonary complications. There was a statistically significant difference between the treated and placebo COPD groups in ICU stay less than 24 hours (P < or = 0.001) and more than 48 hours (P = 0.03) and hospital stay (P = 0.013). On stepwise analysis, only age and number of coronary grafts were predictors of pulmonary complications.

Conclusion: The use of preoperative systemic corticosteroids in patients with COPD undergoing CABG may shorten ICU and hospital stay.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1749-8090-2-25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892551PMC
June 2007

Late mortality and determinants in patients with heart failure and preserved systolic left ventricular function: the Israel Nationwide Heart Failure Survey.

Isr Med Assoc J 2007 Apr;9(4):234-8

Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.

Background: Heart failure with preserved systolic left ventricular function is a major cause of cardiac disability.

Objectives: To examine the prevalence, characteristics and late clinical outcome of patients hospitalized with HF-PSF on a nationwide basis in Israel.

Methods: The Israel nationwide HF survey examined prospectively 4102 consecutive HF patients admitted to 93 internal medicine and 24 cardiology departments in all 25 public hospitals in the country. Echocardiographic LV function measurements were available in 2845 patients (69%). The present report relates to the 1364 patients who had HF-PSF (LV ejection fraction > or = 40%).

Results: Mortality of HF-PSF patients was high (in-hospital 3.5%, 6 months 14.2%, 12 months 22.0%), but lower than in patients with reduced systolic function (all P < 0.01). Mortality was higher in patients with HF as the primary hospitalization diagnosis (16.0% vs. 12.5% at 6 months, P = 0.07 and 26.2% vs. 18.0% at 12 months, P = 0.0002). Patients with HF-PSF who died were older (78 +/- 10 vs. 71 +/- 12 years, P < 0.001), more often female (P = 0.05) and had atrial fibrillation more frequently (44% vs. 33%, P < 0.01). There was also a relationship between mortality and pharmacotherapy: after adjustment for age and co-morbid conditions, mortality was lower in patients treated with angiotensin-converting enzyme inhibitors (P = 0.0003) and angiotensin receptor blockers (P = 0.002) and higher in those receiving digoxin (P = 0.003) and diuretic therapy (P = 0.009).

Conclusions: This nationwide survey highlights the very high late mortality rates in patients hospitalized for HF without a decrease in systolic function. The findings mandate a focus on better evidence-based treatment strategies to improve outcome in HF-PSF patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2007

The management, early and one year outcome in hospitalized patients with heart failure: a national Heart Failure Survey in Israel--HFSIS 2003.

Isr Med Assoc J 2007 Apr;9(4):227-33

Recanati Center, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.

Background: Despite improved management of heart failure patients, their prognosis remains poor.

Objectives: To characterize hospitalized HF patients and to identify factors that may affect their short and long-term outcome in a national prospective survey.

Methods: We recorded stages B-D according to the American College of Cardiology/American Heart Association definition of HF patients hospitalized in internal medicine and cardiology departments in all 25 public hospitals in Israel.

Results: During March-April 2003, 4102 consecutive patients were recorded. Their mean age was 73 +/- 12 years and 57% were males; 75.3% were hypertensive, 50% diabetic and 59% dyslipidemic; 82% had coronary artery disease, 33% atrial fibrillation, 41% renal failure (creatinine > or = 1.5 mg/dl), and 49% anemia (hemoglobin < or = 12 g/dl). Mortality rates were 4.7% in-hospital, 7.6% at 30 days, 18.7% at 6 months and 28.1% at 12 months. Multiple logistic regression analysis revealed that increased 1 year mortality rate was associated with NYHA III-IV (odds ratio 2.07, 95% confidence interval 1.78-2.41), age (for 10 year increment) (OR 1.41, 95% CI 1.31-1.52), renal failure (1.79, 1.53-2.09), anemia (1.50, 1.29-1.75), stroke (1.50, 1.21-1.85), chronic obstructive pulmonary disease (1.25, 1.04-1.50) and atrial fibrillation (1.20, 1.02-1.40).

Conclusions: This nationwide heart failure survey indicates a high risk of long-term mortality and the urgent need to develop more effective management strategies for patients with heart failure discharged from hospitals.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2007

Assessment of orthostatic hypotension in the emergency room.

Blood Press 2006 ;15(5):263-7

Recanati Center for Medicine and Research and Clinical Pharmacology Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.

The study sought to determine the duration of standing needed to detect most cases of orthostatic hypotension (OH) in the emergency room (ER) and to correlate OH with symptoms, hospitalization and survival. Patients attending a tertiary-center ER within a 2-month period underwent orthostatic tests after 1, 3 and 5 min of standing. OH was defined as a drop of > or = 20 mmHg in systolic pressure or > or = 10 mmHg in diastolic pressure on assuming an upright posture. Of the 814 patients tested (402 men, mean age 56.6 +/- 19.9 years), 206 (25.3%) had OH, detected in most cases (83.5%) after 3 min of standing. OH was associated with significantly higher supine systolic (p = 0.013) and diastolic (p = 0.004) blood pressure, symptoms of syncope (r = 0.11, p < 0.001) or dizziness (r = 0.14, p < 0.0001) and risk of hospitalization (50.9% vs 22.9%, p < 0.0001). Crude mortality was similar between patients with and without OH (13.8% vs 8.7%, p = 0.06). However, on age-adjusted analysis, patients older than 75 years with OH had significantly increased mortality (p = 0.04). In conclusion, 3 min of standing is apparently sufficient for the diagnosis of most cases of OH. Considering the high rate of OH and its predictive value for hospitalization, it should be routinely assessed in all ER patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08037050600912070DOI Listing
May 2007

Infective endocarditis due to Actinomyces neuii.

Scand J Infect Dis 2007 ;39(2):180-3

Recanati Centre for Internal Medicine and Research, Clinical Pharmacology Unit, Petah Tikva, Israel.

Actinomyces endocarditis is very rare. At present the only Actinomyces species identified causing endocarditis are A. israelii, A. bovis, A. viscosus, A. pyogenes, A. meyeri and A. funkei. We here report the first case of endocarditis caused by Actinomyces neuii.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/00365540600802007DOI Listing
April 2007

Adherence to guidelines for patients hospitalized with heart failure: a nationwide survey.

Isr Med Assoc J 2006 Dec;8(12):875-9

Department of Internal Medicine F, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.

Background: Despite significant advances in the therapy of heart failure, many patients still do not receive optimal treatment.

Objectives: To document the standard of care that patients hospitalized with HF in Israel received during a 2 month period.

Methods: The Heart Failure Survey in Israel 2003 was a prospective 2 month survey of patients admitted to all 25 public hospitals in Israel with a diagnosis of HF.

Results: The mean age of the 4102 patients was 73 years and 43% were female. The use of angiotensin-converting enzyme/angiotensin receptor blockers and beta blockers both declined from NYHA class I to IV (68.8% to 50.6% for ACE-inhibitor/ARB and 64.1% to 52.9% for beta blockers, P < 0.001 for comparisons). The percentage of patients by NYHA class taking an ACE-inhibitor or ARB and a beta blocker at hospital discharge also declined from NYHA class I to IV (47.5% to 28.8%, P < 0.002 for comparisons). The strongest predictor of being discharged with an ACE-inhibitor or ARB was the use of these medications at hospital admission. Negative predictors for their usage were age, creatinine, disease severity class, and functional status.

Conclusions: Despite the dissemination of guidelines many patients did not receive optimal care for HF. Reasons for this discrepancy need to be identified and modified.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2006

Underuse of standard care and outcome of patients with acute myocardial infarction and chronic renal insufficiency.

Cardiology 2007 7;108(3):193-9. Epub 2006 Nov 7.

Neufeld Cardiac Research Institute, Tel-Aviv University, Tel-Hashomer, Israel.

Objectives: To investigate characteristics, management and outcome of patients with acute myocardial infarction (AMI) and chronic renal insufficiency (CRI).

Background: Patients with AMI and CRI are considered to be at high risk of complications and death. Physicians may be reluctant to prescribe life-saving medications to patients with concomitant CRI.

Methods: We compared clinical characteristics, management and outcome of 1,683 consecutive AMI patients in three categories of renal function: (1) normal renal function (<1.5 mg/dl) (n = 1,559), (2) mild to moderate CRI (1.5-3.5 mg/dl) (n = 77), and (3) severe CRI (>3.5 mg/dl) (n = 47).

Results: CRI patients were older and were more likely to have other co-morbidities such as hypertension, diabetes mellitus, prior AMI, stroke, angina and heart failure. Compared with patients with normal renal function, standard therapy for AMI including thrombolysis, aspirin, angiotensin-converting-enzyme inhibitors, beta-blockers and lipid lowering agents was underutilized in CRI patients and these patients were more likely to have in-hospital complications such as heart failure, atrial or ventricular fibrillation, cardiogenic shock, sepsis, worsening of renal function and death within 30 days [odds ratio (OR) = 3.3; 95% confidence interval (CI) = 2.0-4.8]. After adjustment for age and co-morbidities, the association between mild to moderate CRI and 30-days mortality declined, whereas severe CRI remained an independent determinant of mortality (OR = 4.8; 95% CI = 2.0-11.4). Adjustment for aspirin, angiotensin-converting-enzyme inhibitors and beta-blocker therapy weakened the association between CRI and death within 30 days after AMI.

Conclusions: CRI patients are more likely to experience serious complications and death early after AMI. Underutilization of standard care, particularly beta-blocker therapy, contributes to increased mortality risk in these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000096777DOI Listing
October 2007

Admission blood glucose level and mortality among hospitalized nondiabetic patients with heart failure.

Arch Intern Med 2006 Aug 14-28;166(15):1613-9

Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer 52621, Israel.

Background: The significance of admission blood glucose level in nondiabetic patients with heart failure (HF) is unknown. We examined the possible association between admission glucose levels and outcome in a large cohort of hospitalized patients with HF.

Methods: We analyzed the data of 4102 patients with HF, who were hospitalized during a prospective national survey. The present study focuses on a subgroup of 1122 nondiabetic patients with acute HF who were admitted because of acute HF or exacerbation of chronic HF.

Results: In-hospital mortality was twice as high in patients with admission blood glucose levels in the third tertile (7.2%) compared with the first (3%) and second (4%) tertiles (P = .02). Furthermore, mortality risk was correlated with admission glucose levels; each 18-mg/dL (1-mmol/L) increase in glucose level was associated with a 31% increased risk of in-hospital mortality (adjusted odds ratio, 1.31; 95% confidence interval, 1.10-1.57; P = .003) and a 12% increase in 60-day mortality (adjusted hazard ratio, 1.12; 95% confidence interval, 1.01-1.25; P = .04). Admission blood glucose levels remained an independent predictor of in-hospital and 60-day mortality even after the exclusion of 315 patients (28%) with acute myocardial infarction and HF. The 6- and 12-month mortality rates were similar in patients with and without abnormal admission blood glucose levels.

Conclusions: Elevated admission blood glucose levels are associated with increased in-hospital and 60-day mortality, but not 6-month or 1-year mortality, in nondiabetic patients hospitalized because of HF.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/archinte.166.15.1613DOI Listing
September 2006

Antimicrobial resistance of Clostridium difficile isolates in a tertiary medical center, Israel.

Diagn Microbiol Infect Dis 2006 Feb 9;54(2):141-4. Epub 2006 Jan 9.

Infectious Diseases Unit, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel.

The antimicrobial susceptibilities of 49 Clostridium difficile isolates obtained from patients with C. difficile-associated diarrhea to metronidazole, vancomycin, rifampicin, fusidic acid, doxycycline, and linezolid were determined by the disc diffusion and Etest (Biodisk, Solna, Sweden). Random amplification of polymorphic DNA-PCR amplification assay was performed for studying clonality of isolates. Resistance to metronidazole was found in 2% (1/49 isolates; MIC > or = 256 microg/mL) of isolates and resistance to linezolid in 2% (1/49 isolates; MIC = 24 microg/mL). One isolate showed combined resistance to fusidic acid (by disc diffusion test) and rifampicin (MIC > or = 32 microg/mL). All isolates were sensitive to doxycycline and vancomycin. Molecular typing revealed an absence of clonality among the resistant isolates, whereas the sensitive isolates were monoclonal. Resistance of C. difficile to metronidazole and other antimicrobials including linezolid exists in our institution. This finding should promote exploration of this problem in Israel and clarify the impact of resistance on outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diagmicrobio.2005.09.008DOI Listing
February 2006

A case of Langerhans'-cell histiocytosis with membranous nephropathy.

Am J Kidney Dis 2004 Feb;43(2):e3-9

Recanati Center for Internal Medicine and Research, Tel Aviv, Israel.

A 26-year-old man with a history of Langerhans'-cell histiocytosis (LCH) of the bone presented with nephrotic-range proteinuria. Renal biopsy results showed changes characteristic of membranous nephropathy. During the current hospitalization, the patient had 2 episodes of pulmonary embolism. LCH at this time was documented in the lymph nodes. The patient was treated with repeated courses of vinblastine and high doses of corticosteroids to achieve remission of the basic disease and the renal involvement. After 2 years, complete remission of both the lymphadenopathy and the nephrotic syndrome was achieved. The association of membranous nephropathy with LCH might be attributable to an underlying abnormality in the immune system, a paraneoplastic manifestation, or both. This is the first report of LCH associated with severe nephrotic syndrome caused by membranous nephropathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1053/j.ajkd.2003.10.030DOI Listing
February 2004