Liora Ore

One year of pomegranate juice intake decreases oxidative stress, inflammation, and incidence of infections in hemodialysis patients: a randomized placebo-controlled trial.

Increased systemic inflammation and oxidative stress are well established as nontraditional key players in the pathogenesis of atherosclerosis and are also involved in the innate immunity dysregulation in hemodialysis (HD) patients. The study aim was to investigate the effect of 1-year intake of pomegranate juice, an antioxidant source, on oxidative stress, inflammation, and long-term clinical outcomes. A randomized placebo controlled double-blind trial was designed, enrolling 101 chronic HD patients to receive during each dialysis 100 cc of pomegranate juice, or matching placebo, three times a week for 1 year. The primary endpoints were levels of oxidative stress and inflammation biomarkers. Secondary endpoints were hospitalization due to infections and the progression of atherosclerotic process based on a composite of variables of the carotid arteries: intima media thickness (IMT), number, and structure of plaques. Pomegranate juice intake yielded a significant time response reduction in polymorphonuclear leukocyte priming, protein oxidation, lipid oxidation, and inflammation biomarkers levels. These beneficial effects were abolished 3 months postintervention. Pomegranate juice intake resulted in a significantly lower incidence rate of the second hospitalization due to infections. Furthermore, 25% of the patients in the pomegranate juice group had improvement and only 5% progression in the atherosclerotic process, while more than 50% of patients in the placebo group showed progression and none showed any improvement. Prolonged pomegranate juice intake improves nontraditional CV risk factors, attenuates the progression of the atherosclerotic process, strengthens the innate immunity, and thus reduces morbidity among HD patients.

The association between breastfeeding and breast cancer occurrence among Israeli Jewish women: a case control study

PurposeBreast cancer remains the major malignant disease among Israeli women, with about 4,000 new cases diagnosed annually, and a steadily increasing incidence rates. Early in this century investigators noted that nulliparity and a history of never having breastfed were more common in women with breast cancer than without the disease. Epidemiological evidence on those issues remains controversial. The purpose of this study was to clarify those controversial.MethodsA hospital-based case control study was carried out at Nahariya hospital (North of Israel) to assess the risk of breast cancer in relation to breastfeeding history. A total of 256 recent cases of breast cancer (diagnosed between January 1999 and February 2005) and 536 controls were included. Detailed information regarding breastfeeding, menstruation, reproductive factors and confounders was collected. Adjusted odds ratios and 95% confidence intervals were calculated.ResultsShort duration of lifetime breastfeeding, late age at first breastfeeding and experience of insufficient milk were found to increase breast cancer risk. When women who had ever breastfed their infants were compared with females who had not, breastfeeding was found to be protective (OR of 0.39; 95% CI 0.26–0.59).ConclusionsThese findings may have significant impact on intervention planning aimed towards breast cancer reduction among Israeli Jewish women.

Does Pomegranate intake attenuate cardiovascular risk factors in hemodialysis patients

BackgroundAtherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality among hemodialysis (HD) patients. It has been attributed, among other causes, to hypertension and dyslipidemia. The aim of the present study was to investigate the effect of a year-long consumption of Pomegranate juice (PJ), on two traditional cardiovascular (CV) risk factors: hypertension and lipid profile, as well as on cardiovascular events.Methods101 HD patients were randomized to receive 100xa0cc of PJ (0.7xa0mM polyphenols) or matching placebo juice, three times a week for one year. The primary endpoints were traditional CV risk factors; blood pressure and lipid profile. Systolic, diastolic and pulse pressure, plasma levels of triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and total cholesterol were monitored quarterly during the study year. Secondary endpoint was incidence of cardiovascular events.ResultsPJ consumption yielded a significant time response improvement in systolic blood pressure, pulse pressure, triglycerides and HDL level; an improvement that was not observed in the placebo intake group. These beneficial outcomes were more pronounced among patients with hypertension, high level of triglycerides and low levels of HDL.ConclusionRegular PJ consumption by HD patients reduced systolic blood pressure and improved lipid profile. These favorable changes may reduce the accelerated atherosclerosis and high incidence of CVD among HD patients.Trial registrationClinicalTrials.gov registry, Identifier number: NCT00727519

Is Anemia at Hospital Admission Associated with In-Hospital Acute Kidney Injury Occurrence?

Background: The effect of acute kidney injury (AKI) on anemia has been well-documented. However, the effect of ‘preexisting’ anemia on AKI has been less addressed. The aims of the present study were to investigate (1) the association between anemia at hospital admission and AKI occurrence, and (2) the effect of ‘preexisting’ anemia on the clinical outcomes of AKI. Methods: A retrospective cohort study was undertaken among patients aged ≧17 years who were admitted to our hospital during the year 2006 (n = 34,802). Anemia at hospital admission and AKI occurrences were determined using the WHO definition and the RIFLE criteria, respectively. A subgroup of patients with an estimated glomerular filtration rate ≧60 ml/min/1.73 m2 was analyzed separately to control for the effect of chronic kidney disease on anemia. Results: The cumulative incidence of AKI was 11.2% in anemic patients at hospital admission, compared to 5.5% in nonanemic subjects. The association between anemia at admission and AKI occurrence remained statistically significant after controlling for potential confounders (odds ratio 1.5, 95% CI 1.4–1.6). In addition, an association between anemia at hospital admission and clinical outcomes of AKI was observed. Conclusion: Anemia at hospital admission should be recognized as a potential risk factor for in-hospital AKI occurrence.

Pomegranate juice intake attenuates the increase in oxidative stress induced by intravenous iron during hemodialysis.

The hemodialysis (HD) procedure induces oxidative stress (OS), which is further aggravated by intravenous (IV) iron administration, aimed at correcting anemia of patients with HD. We have recently shown that 1 year of pomegranate juice (PJ) intake attenuated OS and inflammation in patients with HD. In the current study, we hypothesized that a single dose of PJ can attenuate the enhanced OS and inflammation induced by both the dialysis procedure and IV iron administration during HD session. Twenty-seven patients with HD were randomized to receive PJ or placebo during 1 dialysis session with IV iron. Blood samples were drawn before and after the session to asses OS biomarkers such as advanced oxidation protein products and myeloperoxidase (MPO), whereas polymorphonuclear leukocyte (PMNL) counts served as an indirect measure of inflammation. At the end of the dialysis session, an increase in advanced oxidation protein products and MPO levels as well as a decrease in PMNLs counts were observed in the placebo group, whereas no significant changes occurred in the PJ group. The postdialysis increase in MPO levels in the placebo group is a direct result of PMNL degranulation, associated with postdialysis decrease in PMNL counts. Degranulation of PMNLs leads to the release of other cell moieties, such as inflammatory mediators and proteases that enhance inflammation. We conclude that PJ intake attenuated the increase in systemic OS and inflammation induced by IV iron administration during the dialysis session. These beneficial effects illuminate the previously observed attenuation in OS and inflammation in patients with HD on prolonged PJ intake.

Prognostic factors predicting ischemic wound healing following hyperbaric oxygenation therapy

Identifying patients who benefit from hyperoxygenation therapy is important, because treatment is time‐consuming and involves high costs and complications (minor). Our objective was to develop a model for predicting therapy outcome based on population of patients with and without diabetes. A retrospective cohort study was carried out in a major hospital in Israel. All 385 patients treated between 1/1/1998 and 1/1/2007 for ischemic nonhealing lower extremities wounds were included. Data on medical history, demographic, transcutaneous oximetry, wounds, treatment, and outcome characteristics were collected. Eight factors were identified to optimally predict wound healing: (1) number of hyperbaric oxygenation treatments (odds ratio [OR]u2009=u20091.034, pu2009<u20090.001), (2) transcutaneous oximetry values at hyperbaric conditions (ORu2009=u20091.001, pu2009=u20090.019), (3) wound duration (ORu2009=u20090.988, pu2009=u20090.022), (4) absence of heart disease (ORu2009=u20093.304, pu2009<u20090.001), (5) being employed (ORu2009=u20093.16, pu2009=u20090.008), (6) low socioeconomic status (ORu2009=u20092.50, pu2009=u20090.004), (7a) good/partial granulation wound appearance (ORu2009=u20092.73, pu2009=u20090.022), (7b) wounds covered with fibrin (ORu2009=u20093.16, pu2009=u20090.015), and (8) absence of anemia (ORu2009=u20092.13, pu2009=u20090.016). The models sensitivity is 78.7%, specificity is 62.9%, and accuracy is 71.8%. We suggest using our model as an adjunct to patients clinical evaluation. Also, we recommend initiating hyperoxygenation therapy no later than 2 months after wound appearance.

Factors associated with iatrogenesis in neonatal intensive care units: an observational multicenter study

The objective of our study was to assess factors associated with iatrogenic events in Neonatal Intensive Care Units (NICUs). This was a retrospective analysis based on a cohort of patients who participated in our previous prospective study (Pediatrics 122:550–555, 2008), conducted in four tertiary university-affiliated NICUs in Israel, that included all consecutive infants (nu2009=u2009615) hospitalized during the study period. Ongoing monitoring of iatrogenic events was performed by designated “iatrogenesis advocates.” The main outcome measures were the association of individual infant characteristics and NICUs’ environmental characteristics with iatrogenic events assessed by univariate and multiple logistic regression analysis. We found that four infant characteristics were significantly (pu2009<u20090.001) associated with iatrogenic events in a univariate analysis: gestational age, birth weight, severity of initial illness as assessed by the Score for Neonatal Acute Physiology and Perinatal Extension (SNAPPE II), and length of stay (LOS). All four factors demonstrated a significant (pu2009<u20090.001) dose–response relationship with iatrogenic events. Univariate analysis for environmental characteristics showed that type of shift, but not nursing workload, was significantly associated with iatrogenic events (pu2009<u20090.001). In a multiple logistic regression analysis, only LOS (adjusted OR 1.02 [95xa0% CI, 1.01–1.03]) and type of shift, morning vs. evening (adjusted OR 3.44 [95xa0% CI, 2.33–5.08]) and morning vs. night (adjusted OR 6.07 [95xa0% CI, 3.86–9.56]), remained independently associated with iatrogenic events (pu2009<u20090.001). Prolonged LOS and morning shifts were found to be significantly associated with iatrogenic events. Further prospective research is warranted to identify the specific causes for iatrogenic events in order to target active interventions to prevent them.

Reliability of Vision Screening Tests for School Children

PURPOSEnEstimate the reliability of the E-chart as used with Israeli school children.nnnDESIGNnCross-sectional, population-based study conducted among 751 Israeli students of the Northern District, aged 6- and 7-year-olds and 13- and 14-years-old in 30 schools in 2003.nnnMETHODSnEach student was screened separately by two public health nurses using the illiterate E-chart. Collected data included the students vision and demographic characteristics, the nurses professional background, and whether they referred students for medical testing. The reliabilities of vision testing and of the recommendations were determined using total, positive, and negative percentages of agreement and Kappa coefficients.nnnFINDINGSnTotal percentage of agreement on vision (combined findings for both eyes) was 78.2% (Kappa 0.47, 95%CI 0.41-0.53). Logistic regression models to predict agreement on vision abnormality showed a higher percentage of agreement among females and 13- and 14-year-old students than among males and 6- and 7-year old students. Total agreement of 85.8% was found in referral recommendations (Kappa 0.58, 95%CI 0.51-0.65). Significant relationships were noted with student age, ethnicity, subdistrict of residence, nurse seniority, and agreement on vision findings.nnnCONCLUSIONSnImprovement in school vision-screening reliability is needed, especially among 6- and 7-year-old students. To this end, the determinants of fair reliability should be investigated and training programs planned. Reasons for differences in the reliability of nurses recommendations detected among subdistricts must be further studied, together with careful supervision, to ensure better performance and adherence to PHS guidelines. Implications for nurses and nursing should be considered.nnnCLINICAL RELEVANCEnDemographic characteristics were found to predict reliability, which can guide nurses in selecting students who need more careful attention or closer supervision during vision testing.