Pre-operative Very Low Calorie Ketogenic Diet (VLCKD) vs. Very Low Calorie Diet (VLCD): Surgical Impact.

BACKGROUND: Pre-operative diet may play an important role as far as patients' fitness for surgery, post-operative outcomes, and successful weight loss. Our aim was to compare surgical outcome and weight loss in two groups of patients who were offered two different pre-operative kinds of diet: very low calorie diet (VLCD) and very low calorie ketogenic diet (VLCKD). METHODS: Patients candidate for bariatric surgery (laparoscopic sleeve gastrectomy) were registered and assessed according to pre- and post-diet BMI, operative time, hospital stay, drainage output, and hemoglobin (Hb) levels. Patients' preference influenced the type of diet. RESULTS: From January to December 2016, 178 patients (139 F and 39 M) were enrolled in this study. The mean age was 43 years. In total, 72 patients were on VLCKD while 106 patients on VLCD. Pre-diet mean BMI was 46.3 ± 6.3 kg/m2 for VLCKD group and 43.1 ± 6.9 kg/m2 for VLCD group, while immediately pre-op BMI were 43.9 ± 5.9 kg/m2 and 41.9 ± 6.8 kg/m2, respectively. Drainage output and hemoglobin levels after surgery resulted significantly correlated with diet induced BMI reduction (141.2 ± 75.8 vs. 190.7 ± 183.6 ml, p = 0.032; 13.1 ± 1.2 vs. 12.7 ± 1.5 g/l, p = 0.04). The percentage of patients requiring a hospital stay longer than anticipated (> 3 days) was 2.8% in the VLCKD group and 10.4% in the VLCD group (p = 0.048). CONCLUSIONS: In our experience, VLCKD showed better results than VLCD on surgical outcome, influencing drainage output, post-operative hemoglobin levels, and hospital stay.

Prevalence of anti-hepatitis B surface antibodies among children and adolescents vaccinated in infancy and effect of booster dose administered within a pilot study.

We determined the prevalence of anti-hepatitis B surface antibodies (anti-HBs) among children and adolescents vaccinated for hepatitis B virus in infancy as part of the routine vaccination programme. A representative serum sample of the Israeli population age 0-19 was tested. In a separate pilot study, a booster dose of hepatitis B vaccine was administered to 31 candidates for national service, who were fully vaccinated in infancy and tested negative for hepatitis B surface antibodies at age 17-19 years and anti-HBs antibodies were assessed 8 weeks later. Of the 1273 samples tested, 631 (49·6%) were positive to anti-HBs antibodies. Seropositivity rates were 89·5% among infants aged 6-12 months and declined significantly with age to 20·7% at age 19 years. No differences in seropositivity rates were observed between Jews and Arabs, males and females and those born in Israel and in other countries. Seroconversion rate among the 31 individuals who received a booster dose was 90·3% (95% CI: 75·1-96·6%). We recommend a booster dose for healthcare personnel before starting to work at the health care facility.

Seroepidemiology of Toxoplasma gondii infection in the Israeli population.

Toxoplasmosis seroprevalence varies considerably between countries. We studied the seroprevalence of Toxoplasma gondii IgG antibodies in a national sample of the Israeli population; 2794 sera were tested. The highest age-adjusted seroprevalence rate was in Arabs (non-Bedouins) (60.4%), significantly higher compared to the rate in Jews (19.9%) and Bedouins (27.5%) (P < 0.01). There were no significant gender differences. Seropositivity increased with age in all population groups. For Jews, seropositivity was associated with place of birth and socioeconomic status. A finding of low seroprevalence rate in Bedouins despite their poor living conditions and close contact with livestock is surprising, and might be attributed to the dry and hot climate conditions in their area of residence. In women of reproductive age the seroprevalence was 15.1% in Jews, 25.4% in Bedouins and 72.3% in Arabs (non-Bedouins). Thus, the majority of pregnant women are susceptible to primary infection with T. gondii, and the risk for congenital toxoplasmosis remains high.

An epidemiologic study of episodes of back pain care.

STUDY DESIGN: This was a prospective community-based, observational design. OBJECTIVE: To describe the epidemiology and risk/prognostic factors for back pain episodes of care in a population representing the nonelderly in the United States. SUMMARY OF BACKGROUND DATA: Previous United States studies of the epidemiology of back pain care have used defined industrial populations or have relied on the patient's recall of symptoms and care. METHODS: Claims forms from the RAND Health Insurance Experiment, a randomized controlled trial of the use of health services, were analyzed. Claims forms were selected if one of the patient-designated reasons for the visit was back pain. Visits were grouped into episodes of care. Descriptive statistics were calculated for episodes. Multivariate logistic regression was used to calculate adjusted odds ratios for independent explanatory sociodemographic and health status variables associated with back pain episodes of care. RESULTS: The 3105 adults in the Health Insurance Experiment had a combined 11,171 person-years of exposure. Six-hundred-eighty-six persons (22%) had a total 1020 episodes of back pain care, representing 8825 visits. Seventy-one percent of persons had a single episode during the Health Insurance Experiment, and 40% of these episodes consisted of a single visit. There were 9.1 episodes per 100 person-years. Insurance status, geographic site, white race, lesser education, poorer physical functioning, and greater pain at base-line all were independently associated with having a back pain episode of care. CONCLUSIONS: Back pain episodes of care occur commonly in the adult U.S. population, but usually are brief and recur infrequently.

Factors associated with choosing a chiropractor for episodes of back pain care.

Back pain is a common illness and chiropractors provide a large proportion of back pain care in the United States. This is the first study to systematically compare chiropractic patients with those who saw other providers for back pain. The authors analyzed data from the RAND Health Insurance Experiment, a community-based study of the use of health services. Insurance claims forms were examined for all visits specified by the patient as occurring for back pain. Visits were grouped into episodes using decision rules and clinical judgment. The primary provider of back pain care was defined as the provider who delivered most of the services. Sociodemographic and health status and attitudes variables of patients were examined for association with the choice of chiropractor. Multivariate logistic regression models were constructed to calculate adjusted odds ratios for independent predictors. There were 1020 episodes of back pain care made by 686 different persons and encompassing 8825 visits. Results indicated that chiropractors were the primary provider for 40% of episodes, and retained as primary provider a greater percentage of their patients (92%) who had a second episode of back pain care than did medical doctors. Health insurance experiment site, white race, male sex, and high school education were independent predictors of choosing a chiropractor. Conclusions suggested that chiropractors were the choice of one third of all patients who sought back pain care, and provided care for 40% of all episodes of care. Geographic site, education, gender, and income were independent patient factors predicting chiropractic use.

Comparing the costs between provider types of episodes of back pain care.

STUDY DESIGN: This study was a prospective, community-based, observational design. OBJECTIVES: The authors compared the costs of episodes of back pain care between different provider types in a population representative of the U.S. SUMMARY OF BACKGROUND DATA: Previous comparisons between provider types of the costs for back pain care have been restricted to the worker's compensation population or have used something other than the episode as the unit of analysis. METHODS: Data from the RAND Health Insurance Experiment (HIE) were analyzed. Insurance claims forms were examined for all visits specified by the patient as occurring for back pain. Visits were grouped into episodes using decision rules and clinical judgment. The primary provider was defined as the provider who delivered most of the care. Comparisons of costs between provider types were made. RESULTS: There were 1020 episodes of back pain care made by 686 different persons and encompassing 8825 visits. Chiropractors and general practitioners were the primary providers for 40% and 26% of episodes, respectively. Chiropractors had a significantly greater mean number of visits per episode (10.4) than did other practitioners. Orthopedic physicians and "other" physicians were significantly more costly on a per visit basis. Orthopedists had the highest mean total cost per episode, and general practitioners the lowest. Chiropractors had the highest, and general practitioners the lowest mean outpatient cost per episode. CONCLUSIONS: These are economically significant differences in the costs of back pain care of persons seeing chiropractors, general practitioners, internists, and orthopedists.

[The thrombocytolysis phenomenon in patients with myocardial infarct]. / Fenomen trombotsitoliza u bol'nykh infarktom miokarda.

The studies have revealed that the platelets of myocardial infarction patients are lysed when in vitro exposed to the necrotic myocardial antigen or to actomyosin proteins within this antigen, this lysis correlating with the disease clinical course. The reaction is specific. High antigen platelet lysis (greater than 14%) in the first day of myocardial infarction frequently aggravates the course of the disease. The prognosis based on this test helps single out the patients with an aggravated condition among those with myocardial infarction.

[Competition of antibacterial drugs for binding sites of human serum albumin]. / Izuchenie konkurentsii nekotorykh protivobakterial'nykh lekarstvennykh veshchestv za tsentry sviazyvaniia syvorotochnogo al'bumina cheloveka.

Simultaneous binding of two drugs to human serum albumin (HSA) was studied by flow microcalorimetry. The following drug pairs were used: sulfadimethoxine and cefazolin. Sulfadimethoxine and dicloxacillin, sulfadimethoxine and chlortetracycline. A procedure for estimating the calorimetric titration curves in competing binding of the drugs to the HSA homogeneous active site is described. Comparison of the theoretical and experimental titration curves enabled detection of the ligand competition for the biopolymer binding site. It was shown that sulfadimethoxine displaced cefazolin in the HSA active site, the nature of the HSA association with dicloxacillin and sulfadimethoxine was independent and binding of doxycycline or chlortetracycline to HSA had no influence on sulfadimethoxine interaction with protein.

[Species differences in the interaction of serum albumin with antibiotics]. / Vidovye razlichiia vo vzaimodeistvii syvorotochnogo al'bumina s nekotorymi antibiotikami.

Interaction of oxacillin, cloxacillin, dicloxacillin, phenoxymethylpenicillin, methicillin, nafcillin and benzylpenicillin with human serum albumin (HSA) was studied with flow microcalorimetry and differential scanning calorimetry. The measured thermodynamic parameters of complex formation between the penicillins and HSA were compared with similar characteristics of their binding to bovine serum albumin. It was shown that there were species differences between these two globular proteins in their interaction with the above antibiotics in relation to both the number of the biopolymer active sites and the nature of the molecular forces in the complex formation. The effect of the first bound molecule of oxacillin, cloxacillin, dicloxacillin, nafcillin, phenoxymethylpenicillin and benzylpenicillin on HSA conformation was observed. It was demonstrated that there was thermostabilization of HSA on its interaction with the above drugs with preserving cooperative nature of thermal denaturation of the complexes in relation to HSA melting.

[Microcalorimetric study of the parameters of dicloxacillin binding with human serum albumin at different temperatures]. / Mikrokalorimetricheskoe izuchenie parametrov sviazyvaniia dikloksatsillina s syvorotochnym al'buminom cheloveka pri razlichnykh temperaturakh.

The thermodynamic parameters of human serum albumin (HSA) binding with dicloxacillin, an antibiotic widely used in clinical practice, were determined with the method of differential flow microcalorimetry at 18, 25, 30, 37 and 45 degrees C. The experiments were performed at two ionic strengths: 0.02 and 0.15. Two hypothetic models of interaction in the HSA-drug system were considered in processing the data for the curves of calorimetric titration. The first model implies the presence of independent homogeneous active sites on the protein. In accordance with the second model there are one primary and secondary independent homogeneous active sites on the biopolymer molecule. It is shown that dicloxacillin association with HSA proceeds according to the mechanism suggesting the presence of one primary and one secondary active sites on the protein molecule. The binding process in the system studied is exothermic, the enthalpy increasing at the temperature change from 18 to 45 degrees C. At the same time the binding constant and enthropy of the system decrease. The influence of the solution ionic strength on the binding process was practically lacking. On the basis of the analysis of the thermodynamic data it is concluded that the character of the binding in the HSA-dicloxacillin system at 18-30 degrees C is hydrophobic. With an increase in the temperature the hydrophoby level decreases.

[Role of health education in the secondary prevention of hypertension]. / Rol' sanitarnogo prosveshcheniia vo vtorichnoi profilaktike gipertonicheskoi bolezni.

Questionnaires were used to examine the extent of hypertensive patients' knowledge of the measures needed to prevent crises and complications of essential hypertension (EH), attitudes to physicians' prescriptions and recommendations and certain elements of hygienic behavior. Male EH patients below 40-50 years of age were found to follow the "I-know-it-is-needed-but-don't-do-it" principle with respect to their health. Many of the older men and the majority of women with EH demonstrated a different health credo: "It is needed, so I am doing it", or "It is needed, so I am trying to do it". Young and middle-aged male hypertensive patients were shown to require medical education to be of convincing or, at some points, even threatening modality, with short and clear-cut health recommendations, while hypertensive females and older males would benefit more from explanatory aids with detailed recommendations on diets, exercise, daily routines, etc.

[Microcalorimetric study of the effect of temperature on methicillin binding with human serum albumin]. / Mikrokalorimetricheskoe izuchenie vliianiia temperatury na sviazyvanie metitsillina s syvorotochnym al'buminom cheloveka.

The curves of the calorimetric titration of human serum albumin (HSA) with methicillin at different temperatures were plotted. Unlike the widely used serial continuous flow calorimeters, the presented modification of a differential continuous flow microcalorimeter provided its application at wider temperature ranges and higher sensitivity. The possibility of obtaining equilibrium characteristics of the complexing at diverse temperatures, including the temperature of 37 degrees C allowed a more profound investigation of the molecular mechanism of the drug binding to the carrier protein. Methicillin interacted with 4 active sites of the HSA, the entropy factor part in changing of the process free energy being the main. With increase of the temperature the association constant and entropy of the system lowered in an insignificant increase of the exothermal heat effect. The analysis of the thermodynamic association parameters suggested that the hydrophobic interactions were predominating in the system.

[Microcalorimetry study of pharmacological complexes. The binding of cephalosporins with human serum albumin]. / Mikrokalorimetricheskoe izuchenie farmakologicheskikh kompleksov. Sviazyvanie s chelovecheskim syvorotochnym al'buminom tsefalosporinov.

Binding of cephazolin, cephalotin and cephamandol to human serum albumin (HSA) was studied by differential scanning calorimetry. It was shown that the binding resulted in an increase in the protein thermostability, while the cooperative character of the biopolymer solution melting was preserved. The constants of association of the above antibiotics with the primary active site of HSA were estimated, with flow microcalorimetry. The complex formation between cephazolin and the protein carrier was mainly due to the ionic forces. Formation of the hydrogen bond was not excluded. The predominating role of hydrophobic interactions in cephalotin and cephamandol binding was shown.

[Molecular mechanism of oxacillin interaction with human serum albumin studied by microcalorimetry]. / Issledovanie molekuliarnogo mekhanizma vzaimodeistviia oksatsillina ssyvorotochnym al'buminom cheloveka metodom mikrokalorimetrii.

Interaction of oxacillin, a semisynthetic penicillin, with human serum albumin (HSA) was studied by means of reaction isothermal and differential scanning microcalorimetry. The antibiotic bound with one primary and two secondary active protein sites. The first bound molecule of the drug had a significant effect on conformation of the biopolymer, which was evident from increased enthalpy and denaturation temperature of the complex as compared to pure HSA. However, the increased thermostability of the serum albumin on its association with oxacillin did not impair the cooperative nature of the thermal denaturation of globular protein. Analysis of the thermodynamic parameters of the complex formation suggested the presence of hydrophobic and electrostatic interactions. The role of electrostatic interaction increased with a decrease in the solution ionic strength.

[Autoimmune reactions to myoglobin in myocardial infarct patients]. / Autoimmunnye reaktsii k mioglobinu u bol'nykh infarktom miokarda.

Autoimmune responses to myoglobin were studied in patients with myocardial infarction at different disease stages. It was revealed that during myocardial infarction, the clone of lymphocytes reacting with myoglobin was activated. Besides, these patients showed sensitized T lymphocytes with high cytotoxic activity, lymphotoxins and leukocyte migration inhibition factor, attesting to the development of the delayed type hypersensitivity to myoglobin. It was demonstrated that lymphotoxin assay in the blood might be of importance for differential diagnosis of acute myocardial infarction and angina pectoris with a long-term painful syndrome.

Studies of the thermodynamics and nature of interaction between serum albumin and penicillins.

The possibility of a calorimetric determination of the number of homogeneous independent binding sites on the protein molecule surface is presented, together with the possibility of the determination of interaction heat and association constants for the binding of small molecules to one such site. Thermodynamic characteristics of interaction of 10 penicillins and methyl orange with primary and secondary binding sites of bovine serum albumin have been obtained using this technique. The data show that hydrogen bonds between the component parts of the complexes studied are absent. The main contribution to free energy change at forming these complexes is made by hydrophobic interactions. Electrostatic forces are also of some importance, their contribution into the complex formation is more significant in the case of quinacillin and carbenicillin which have an additional charged carboxyl group.