Adherence to liraglutide among individuals with overweight and obesity: Patient characteristics and clinical measures.

AIM: To identify the sociodemographic, clinical and laboratory determinants relating to patient adherence to liraglutide treatment among individuals with overweight or obesity. METHODS: We retrospectively analysed patients with overweight or obesity who were treated with liraglutide between 2019 and 2022. Over a 6-month follow-up period, measurements of body mass index, sociodemographic characteristics, clinical and laboratory data, and prescription records for liraglutide were collected. Treatment adherence was assessed using the proportion of days covered (PDC) measure, with a PDC ≥80% indicating high adherence. RESULTS: The study population included 1890 participants (78.1% female, mean age 46 ± 12 years). At the end of the follow-up period, 84.9% of the participants exhibited low adherence to liraglutide treatment. Adherence to treatment improved with age (p = 0.04, odds ratio [OR] 1.013, confidence interval [CI] 1.001-1.025). Significant weight loss during treatment increased the likelihood of high adherence (p < 0.001, OR 1.251, CI 1.167-1.341). Individuals with a higher socioeconomic status displayed greater adherence (p = 0.023, OR 1.906, CI 1.091-3.328). Greater adherence was also seen in non-smokers (p = 0.047, OR 0.725, CI 0.528-0.996). CONCLUSIONS: Only 15.1% of study participants exhibited high adherence to treatment (PDC ≥80%) after 6 months of follow-up. Further research is needed to explore approaches to enhance adherence to liraglutide, including strategies to educate and support patients in their efforts to achieve and maintain weight loss with the use of this drug.

Liver cirrhosis in elderly patients: clinical characteristics, complications, and survival-analyses from a large retrospective study.

BACKGROUND: Liver cirrhosis (LC) is a common disease diagnosed in all ages. With the increasing population age, LC is noticeable more in the clinics. AIM: To distinguish the clinical characteristics, complications, and survival of patients with liver cirrhosis. METHODS: A retrospective study enrolled patients diagnosed with liver cirrhosis at Soroka University Medical Center. Patients with cirrhosis diagnosed at an age older than 65 years (group 1) were compared with patients diagnosed at an age younger than 65 years (group 2). RESULTS: We included 1046 patients; 411 (39.3%) in group 1 and 635 (60.7%) in group 2. Fatty liver and cryptogenic liver disease were found to cause cirrhosis at a significantly higher rate in the elderly (23.4% vs. 13.9%, p < 0.001, 15.3% vs. 6.3%, p < 0.001, respectively). A higher rate of non-hepatocellular carcinoma cancers and mortality (17.5% vs. 9.1%, p < 0.001, 76.6% vs. 57%, respectively) was found among cirrhotic elderly patients, but a lower rate of oesophageal varices (47.7% vs. 60.1%, p = 0.002). Twenty-year follow-up Kaplan-Meier survival analysis for mortality estimated poor survival in the elderly (log-rank p < 0.001). The adjusted Cox proportional hazards regression model showed an association of age > 65 with an all-cause mortality hazard ratio of 2.26 (95% CI 1.89-2.69). CONCLUSION: Higher rates of fatty liver, cryptogenic cirrhosis, non-HCC cancers, and mortality were found among patients diagnosed with cirrhosis in the elderly.

The Association Between Pain and In-Hospital Complications and Duration of Stay After Colorectal Surgery.

BACKGROUND: Pain is a subjective and multidimensional experience often inadequately managed following surgery. Postoperative pain has been shown to correlate with hospital length of stay (HLOS) and hospital complications. Given advancements in preemptive pain management approaches, reevaluation is necessary. AIMS: The purpose of this study was to examine the association between postoperative pain intensity and HLOS and in-hospital complications among patients who underwent colorectal surgery, adjusted by sociodemographic and underlying medical variables. SETTING AND PATIENTS: We used electronic medical records. Data were collected from patients who underwent colorectal surgery at a large general hospital in Israel from January 2012 to December 2018. DESIGN AND METHODS: This is a retrospective cohort study. Information on HLOS, medical diagnoses, pain intensity, use of analgesics, postoperative infections, patient sociodemographic data, chronic diseases, functionality status, and source of admission were extracted from medical records. Logistic regression analysis was used for the final model, and HLOS and in-hospital complications were the major outcomes. RESULTS: We enrolled 1,073 patients. Of them, 554 males (51.6%) with a mean age of 62.54 ± 16.55 years. The median postoperative pain score was 1.54 (interquartile range, 0.84; 2.16), and an in-hospital complication rate of 1.3% (n = 14). Postoperative pain was not associated with prolonged HLOS with adjustment to relevant independent variables (odds ratio, 1.399; 95% confidence interval, 0.759-2.578; p = .282). Contrarily, age, malignancy, assistance needed in activities of daily living, use of analgesic agents, and postoperative infection were risk factors for prolonged HLOS. Additionally, postoperative pain was not related to a higher risk of in-hospital complications. CONCLUSIONS: Pain intensity post colorectal surgery was not a risk factor for extended HLOS or in-hospital complications. In contradistinction, tending to patient needs, adequate analgesic use, and reducing infection rates can shorten HLOS, improve health outcomes, and economize health care resources.

Thyroid dysfunction and survival in cancer patients treated with immune checkpoint inhibitors: analyses from a large single tertiary cancer center database.

PURPOSE: We aimed to assess the incidence, clinical and biochemical course of immunotherapy-induced thyroiditis and its implication on patients' survival, based on an extensive clinical experience from a tertiary cancer center. METHODS: Analyses were based on data from the electronic medical records of cancer patients treated with CPIs. Data included demographic characteristics, cancer type, Thyroid function tests (TFT), and survival. RESULTS: Thyroid function tests were available for 934 patients. After excluding patients with impaired baseline TFT or levothyroxine treatment, 754 euthyroid patients were included in the core analyses. Of those, 301 (39.9%) patients developed thyroid dysfunction ('thyroiditis'). Thyroiditis was more prevalent in patients with renal cell carcinoma than other types of cancer. Survival rates were comparable in patients who developed thyroiditis and in those who did not. during the 5 years follow-up period, there was a non-significant trend toward improved survival in patients who developed TD in four predefined groups: melanoma, lung cancer, renal cell carcinoma, and transitional cell carcinoma. Nevertheless, we observed a highly significant survival benefit for patients with renal cell carcinoma who developed TD (HR = 0.19, 95% CI 0.06-0.60; p = 0.005). CONCLUSIONS: Thyroiditis is common, often asymptomatic, and is more prevalent in patients treated with combinations of nivolumab and PD-L1 inhibitors, and in patients with renal cell carcinoma. Thyroiditis was associated with a trend for a survival benefit, particularly in patients with renal cell carcinoma.

The association between exposure to radiation and the incidence of cataract.

OBJECTIVE: To examine the association between exposure to radiation from computed tomography (CT) studies and the incidence of cataract. METHODS: In a nested case-control study, all cataract cases and their matched controls were sampled from a retrospective cohort of Israeli residents who underwent CT scans or ultrasonic tests in Soroka Medical Center, Beer-Sheva, Israel, between the years 1996 and 2014. The risk of cataract associated with head, neck or the rest of the body CT was assessed using Poisson survival analysis. RESULTS: The nested matched sample included 3841 cataract cases and their age- and sex-matched controls (n = 228,743). CT radiation exposure was more frequent in the cataract group, with 9.7% head CT, 1.2% neck CT and 6.6% other CT, compared to 5%, 0.7% and 3.7% among person-years without cataract (p < 0.001). In a multivariate analysis, a similar increased risk of cataract associated with head (hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.11; 1.38) and other CT (HR: 1.25, 95% CI: 1.10; 1.43) was found. No association with neck CT (HR: 1.07, 95% CI: 0.80; 1.43) was observed. CONCLUSION: In our study population, a similar risk of cataract with head, neck or the rest of the body CT was detected.

Endogenous α1-antitrypsin levels in the perilymphatic fluid correlates with severity of hearing loss.

OBJECTIVES: To determine the levels of endogenous α1-antitrypsin in the perilymph of patients undergoing cochlear implant (CI), and its reverse association with the severity of hearing loss. STUDY DESIGN: Retrospective study. SETTING: Tertiary care university hospital. PARTICIPANTS: The study includes 38 patients undergoing CI surgery, 11 patients diagnosed with congenital deafness and 27 non-congenital deafness, eight patients diagnosed with moderate hearing loss (N = 8; PTA = 70 dB), severe hearing loss (N = 11; PTA 70-90 dB) and profound hearing loss (N = 19; PTA > 90 dB). MAIN OUTCOME AND MEASURE: 1 to 12 µL perilymphatic fluids were collected by micropipette. α1-antitrypsin levels were determined, and current and historic audiological parameters were obtained. RESULTS: The congenital and non-congenital group exhibited AAT concentrations of 2.5 ± 1.9 × 106 LFQ and 3.2 ± 1.2 × 106 LFQ, respectively (mean ± SD; P = .38). Mean levels of α1-antitrypsin in the perilymph fluid within the moderate group was 3.64 × 106  ± 2.1 × 106 LFQ vs 3.5 × 106  ± 1.2 × 106 in severe hearing loss (P = .81) and 2.4 × 106  ± 1.1 × 106 LFQ in the profound hearings loss group (P = .06). The difference in levels of AAT in samples from the severe hearings loss group vs the profound hearings loss group reached statistical significance (P = .04). CONCLUSION: Insufficiency in α1-antitrypsin levels in the perilymph fluid of the inner ear appears to display a relationship with the severity of hearing loss. The prospect of introducing clinical-grade plasma-purified α1-antitrypsin directly onto the site of cochlear injury deserves thorough investigation.

ASCA and ANCA among Bedouin Arabs with inflammatory bowel disease, the frequency and phenotype correlation.

BACKGROUND: Serological markers used for diagnostic purposes and disease stratification in inflammatory bowel disease. We aimed to investigate the frequency of ASCA and ANCA among Arab Bedouin IBD patients and its relationship to disease phenotype and course. METHODS: From cohort of 68, 25 Crohn's disease (CD) and 25 Ulcerative colitis (UC) patients were recruited (72%). ASCA IgG was determined by ELISA assay. Immunofluorescence analysis of ANCA was performed. RESULTS: The IgG ASCA was detected in 13 (52%) of the CD patients and in three (12%) UC patients. The prevalence of ANCA among UC patients was positive with 76%, sub-grouped, atypical ANCA in 9 patients (36%), pANCA in six patients (24%) and cANCA in 4 patients (16%). The detection of ASCA among CD patients was found not to be a reliable predictor of young age at diagnosis, gender, ileal involvement, anti-TNF treatment or surgery. UC patients with positive ANCA were younger, mean age 40.2 ± 11.9 compared with 57.3 ± 21.2 (p = 0.03), and diagnosed at a younger age, 29.2 ± 11.8 compared with 43.5 ± 15.3 (p = 0.05). CONCLUSION: The frequency of ASCA among Bedouin CD patients and ANCA among UC patients was high, however ASCA was not found to have a predictive value for disease phenotype or course. Positive ANCA in UC patients was predictive for younger age and age at diagnosis.

NOD2/CARD15 Mutations among Bedouin Arabs with Inflammatory Bowel Disease: Frequency and Phenotype Correlation.

BACKGROUND: Inflammatory bowel disease (IBD) prevalence is increasing among Bedouin Arabs in Israel. This population is known to have a high rate of consanguinity. NOD2/CARD15 mutations are well-studied in IBD. OBJECTIVES: To investigate the frequency of NOD2/CARD15 mutations in IBD Bedouin patients and their relevance to disease phenotype. METHODS: The IBD-Arab cohort in southern Israel included 68 patients, of which 25 Crohn's disease (CD) patients and 25 ulcerative colitis (UC) patients consented to participate (72%). Blood samples were obtained from all participants who were genotyped for NOD2/CARD15 variants Arg702Trp, Gly908Arg, and Leu1007fsinsC. RESULTS: The NOD2/CARD15 mutation frequency was higher in Crohn's disease than in ulcerative colitis patients. Carrier frequency for the Gly908Arg mutation in CD and UC patients was 8/25 (32%) and 3/25 (12%), respectively (P = 0.08). Neither the Arg702Trp nor Leu1007fsinsC mutation was found in our cohort. No homozygous/compound heterozygote mutations were found. Genotype-phenotype analysis revealed that CD patients carrying the Gly908Arg mutation were younger at diagnosis, 22.8 ± 4.5 vs. 28.82 ± 9.1 years (P = 0.04). All carriers were males, compared with 41.2% in non-carriers (P = 0.005). NOD2/CARD15 mutation carriers with UC were older, 67.0 ± 24.5 years compared with 41.2 ± 12.3 years (P = 0.006). No other associations regarding disease localization or other clinical parameter were found. CONCLUSIONS: The frequency of NOD2/CARD15 gene mutations is high in CD and UC among Bedouin Arab IBD patients and is associated with younger age at onset in CD and male gender.

Clinical characteristics and survival of patients with diabetes mellitus following non-traumatic lower extremity amputation.

BACKGROUND: Diabetes mellitus-related lower extremity amputation is a major complication severely affecting patient survival and quality of life. OBJECTIVES: To analyze epidemiological and clinical trends in the incidence and survival of lower extremity amputations among diabetes patients. METHODS: We conducted a retrospective observational cohort study of 565 consecutive diabetes patients who underwent their first non-traumatic lower extremity amputation between January 2002 and December 2009. RESULTS: Major amputations were performed in 316 (55.9%) patients: 142 above the knee (25.1%) and 174 below (30.8%); 249 (44.1%) had a minor amputation. The incidence rates of amputations decreased from 2.9 to 2.1 per 1000 diabetes patients. Kaplan-Meier survival analysis showed that first year mortality rates were lower among patients with minor amputations (31.7% vs. 39.6%, P = 0.569). First year mortality rates following below-knee amputation were somewhat lower than above-knee amputation (33.1 vs. 45.1%, respectively). Cox regression model of survival at 1 year after the procedure found that age (HR 1.06 per year, 95% CI 1.04-1.07, P < 0.001), above-knee amputation (HR 1.36, 95% CI 1.01-1.83, P = 0.045) and ischemic heart disease (HR 1.68, 95% CI 1.26-2.24, P < 0.001) significantly increased one year mortality risk. CONCLUSIONS: In this population-based study the incidence rate of non-traumatic amputations in diabetes patients between January 2002 and December 2009 decreased slightly. However, one year mortality rates after the surgery did not decline and remained high, stressing the need for a multidisciplinary effort to prevent amputations in diabetes patients.

Colorectal cancer among inflammatory bowel disease patients: risk factors and prevalence compared to the general population.

Background: Colorectal cancer (CRC) is a feared complication of inflammatory bowel disease (IBD). We aimed to investigate the prevalence and risk factors of CRC among a large cohort of IBD patients. Methods: Data on IBD patients free of CRC at baseline was extracted using the MDClone platform of the Clalit health maintenance organization in Israel. We investigated the frequency rate of CRC among IBD patients compared to a control group without IBD. Possible risk factors, including comorbidities and IBD-related medications, were investigated in a multivariate analysis. Results: During a follow-up of 139,448 years among Crohn's disease (CD) patients and 139,533 years among ulcerative colitis (UC) patients, a frequency rate of CRC was 1.5% (191) among 12,888 CD patients and 2.1% (261) among 12,381 UC patients compared to 1.2% among 57,334 controls. In a multivariate analysis of UC patients, age at diagnosis (OR 1.030, p < 0.001), primary sclerosing cholangitis (OR 2.487, p = 0.005), diabetes mellitus (OR 2.01, p < 0.001), and glucocorticoids treatment (OR 1.465, p = 0.008) were found to be predictors of CRC. For CD patients, age at diagnosis (OR 1.035, p < 0.001), primary sclerosing cholangitis (OR 2.25, p = 0.029), and glucocorticoids treatment (OR 2.07, p < 0.001) were found to be predictors for CRC, but not diabetes mellitus. Conclusion: Despite the continuously decreasing rates of CRC among IBD patients, these are still higher in IBD patients compared to the general population. IBD patients, particularly those with risk factors, require special consideration in follow-up for CRC.

A prospective cohort study of dynamic cell-free DNA elevation during cardiac surgery with cardiopulmonary bypass.

Cardiac surgery and cardiopulmonary bypass (CPB) are associated with a systemic inflammatory reaction that occasionally induces a life-threatening organ dysfunction caused by the dysregulated host response to the damage-associated molecular patterns (DAMPs). In severe inflammation, cell-free DNA (cfDNA) and histones are released by inflammatory cells and damaged tissue and act as DAMPs. We sought to characterize the changes in circulating cell-free DNA (cfDNA) levels during CPB. Primary outcomes were renal failure, ventilation time (>18 hr), length of stay (LOS) in the intensive care unit (ICU) (>48hr), hospital LOS (>15 days), and death. We looked for associations with blood tests and comparison to standard scores. In a prospective cohort study, we enrolled 71 patients undergoing non-emergent coronary artery bypass grafting. Blood was drawn at baseline, 20 and 40 minutes on CPB, after cross-clamp removal, and 30 minutes after chest closure. cfDNA was measured by our fast fluorescent method. Baseline cfDNA levels [796 (656-1063) ng/ml] increased during surgery, peaked after cross-clamp removal [2403 (1981-3357) ng/ml] and returned to baseline at recovery. The difference in cfDNA from 20 to 40 minutes on CPB (ΔcfDNA 40-20) inversely correlated with peripheral vascular disease (PVD), longer ventilation time, and longer ICU and hospital length of stay (LOS). Receiver operating characteristic (ROC) curve of ΔcfDNA 40-20 for long ICU-LOS (>48hr) was with an area under the curve (AUC) of 0.738 (p = 0.022). ROC AUC of ΔcfDNA 40-20 to long Hospital LOS (>15 days) was 0.787 (p = 0.006). Correction for time on CPB in a multivariate logistic regression model improved ROC-AUC to 0.854 (p = 0.003) and suggests that ΔcfDNA 40-20 is an independent risk factor. To conclude, of measured parameters, including STS and Euroscore, the predictive power of ΔcfDNA 40-20 was the highest. Thus, measurement of ΔcfDNA 40-20 may enable early monitoring of patients at higher risk. Further studies on the mechanism behind the negative association of ΔcfDNA 40-20 with PVD and outcomes are warranted.

COVID-19 Vaccination Among the Arab Bedouin Population: Lessons Learned From a Minority Population.

Objectives: We investigated the causes of low COVID-19 vaccination rates among a minority population and highlighted interventions for increasing the vaccination rate. Methods: We reviewed the experience during the mass vaccination campaign period among the Arab Bedouin (AB) in Israel, attempting to determine important causes of low vaccination rates and gathered information from real-life experience and through direct contact with the population during the campaign. Results: Causes for low vaccination rates in the AB are related to the health system infrastructure, crisis management strategies, and population characteristics. Long-standing socioeconomic inequalities, limited resources, and language and culture barriers present special challenges to the task of COVID-19 vaccination campaigns. Key interventions for increasing vaccination rates among minority populations include raising awareness, improving vaccination access, and directly targeting risk-groups. To maximize the effectiveness of these interventions they should be culturally adapted and executed according to the needs of each individual target community. Conclusion: Culturally adapted awareness campaigns, interventions, and improved access to vaccines can be accomplished by cooperation between relevant governing and community bodies to increase COVID-19 vaccination rates among minorities.

Ocular manifestations of congenital insensitivity to pain: a long-term follow-up.

AIM: To describe ocular manifestations in children with congenital insensitivity to pain with and without anhidrosis (CIPA and CIP). METHODS: We reviewed records of eye examinations of 39 children diagnosed with CIPA or CIP. We collected clinical data, with particular attention to ocular surface findings. Corneal sensitivity was tested by presence of a blink reflex upon touching the cornea. Statistical analysis assessed differences in manifestations between the two conditions, and relationships among corneal sensitivity, presence of corneal opacities and visual acuity (VA). RESULTS: CIPA was diagnosed in 32 children and CIP in 7. The median follow-up periods were 50 months (CIPA group) and 94 months (CIP group). Corneal opacities were present in 23% of CIPA eyes and in 57% of CIP eyes. A blink reflex was positive in 52% of CIPA eyes and in 33% of CIP eyes. We recorded VA ≥20/25 in 36% of CIPA eyes, whereas all patients with CIP had VA ≤20/30. For the whole cohort, we found a negative correlation between a preserved blink reflex and the presence of corneal opacities, and a positive correlation between a preserved blink reflex and VA ≥20/25. CONCLUSION: Children with congenital insensitivity to pain are prone to develop corneal scarring. Patients with CIP tend to have more severe ocular surface disease than those with CIPA, probably due to more prevalent loss of corneal sensation. In both groups, a preserved blink reflex correlated with good vision. Affected children should have close follow-up to promptly treat ocular surface disease and prevent vision loss.

Risk factors and outcome of acute myocardial infarction in Bedouins living in permanent compared to unrecognized villages in southern Israel.

BACKGROUND: The incidence and prevalence of coronary heart disease (CHD) among Bedouins living in the Negev region were very low until the 1960s. During the past 50 years this pattern has changed: in parallel to the changes in lifestyle and nutrition in the Bedouin population, a rapid increase in incidence and mortality from CHD occurred. The relationship between the rise in CHD incidence and the degree of urbanization in this population has not been investigated to date. The study hypothesis was that the prevalence of risk factors and the outcome of myocardial infarction in Bedouins differ between those settled in permanent villages and those remaining in unrecognized villages. OBJECTIVES: To compare the prevalence of cardiovascular risk factors, clinical characteristics, and in-hospital management of a first acute myocardial infarction (AMI) in two Bedouin groups: those residing in permanent villages versus those residing in unrecognized villages. METHODS: We conducted a retrospective analysis of in-hospital data of 352 patients admitted with a first AMI during the period 1997-2003 to Soroka Medical Center, the only medical facility in the region. RESULTS: There were no differences between the two groups regarding the major cardiovascular risk factors and outcome. A relatively greater number of patients from urban areas underwent catheterization of any sort during their hospitalization (primary, rescue, and risk stratification; P = 0.038). No significant difference was found between the two groups in the type of catheterization performed (P = 0.279). CONCLUSIONS: We found no differences in the clinical characteristics and in-hospital management of patients with AMI between Bedouins residing in permanent villages versus unrecognized villages.

Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery.

OBJECTIVE: to estimate the association between preoperative hemoglobin A1c (HbA1c) levels below and above 7%, and the rate of all-cause mortality (ACM) in diabetes mellitus (DM) patients after coronary artery bypass grafting (CABG) within a ten-year follow-up period. METHODS: we collected data on patient HbA1c levels that were measured up to 3 months prior to isolated CABG in consecutive patients with DM, and analyzed the rates of ACM over a median of a 5.9-year post-operative period. RESULTS: preoperative HbA1c levels were collected in 579 DM patients. The mean HbA1c was 8.0 ± 1.7%, where 206 (35.6%) patients had an HbA1c ≤ 7% and 373 (64.4%) had an HbA1c > 7%. During the follow-up period, mortality rates were 20.4% and 28.7% in the HbA1c ≤ 7% and HbA1c > 7% groups, respectively (Kaplan-Meier estimates, log-rank p = 0.01). Multivariable Cox proportional hazards regression, adjusted for age, gender, smoking status, chronic obstructive pulmonary disease, hypertension, chronic renal failure, old myocardial infarction, number of coronary artery bypass surgeries, and post-operative glycemic control, showed a hazard ratio of 2.67 for long-term ACM (p = 0.001) in patients with HbA1c > 7%. CONCLUSIONS: DM patients with high HbA1c levels prior to CABG are at higher risk for long-term complications, especially late ACM.

Accelerated CXL Versus Accelerated Contact Lens-Assisted CXL for Progressive Keratoconus in Adults.

PURPOSE: To compare the clinical and tomographic properties of adult patients with keratoconus treated with accelerated corneal cross-linking (A-CXL) versus accelerated contact lens-assisted corneal cross-linking (A-CACXL). METHODS: Patients who underwent A-CXL and A-CACXL due to progressive keratoconus were enrolled from January 2015 to January 2018 in this retrospective case-control study. The treatment group (minimum corneal thickness of less than 400 µm after epithelium removal; 30 patients, 30 eyes) was treated with A-CACXL; the control group (minimum corneal thickness of 400 µm or greater, 32 patients, 32 eyes) was treated with A-CXL. Assessments occurred before treatment and 12 months postoperatively. Demographic, clinical, and tomographic data were obtained from outpatient clinic reports. RESULTS: Significant improvement in visual acuity was evident at 12-month follow-up for the control group in uncorrected distance visual acuity (0.62 ± 0.42 vs 0.43 ± 0.31 logMAR, P = .01) and the treatment group in corrected distance visual acuity (0.51 ± 0.30 vs 0.40 ± 0.49 logMAR, P = .03). Progression of keratoconus was halted at similar rates for both groups (76.7% treatment, 84.4% control, P = .21). Mean minimum corneal thickness showed minor but significant thinning at the 12-month follow-up visit compared to baseline (control group = 463 ± 31 vs 450 ± 35 µm, P > .01; treatment group = 398 ± 32 vs 388 ± 41 µm, P = .02). CONCLUSIONS: A-CACXL halted keratoconus progression in 76.7% of eyes and achieved regression in 33.3% of eyes, with rates comparable to A-CXL. Visual outcomes improved for both groups, with similar keratometry changes. A-CACXL is an effective and safe option for patients with keratoconus and thin corneas, with results similar to A-CXL treatment in patients with a minimum corneal thickness of 400 µm or greater. [J Refract Surg. 2021;37(9):623-630.].

Heterogenicity of diabetes as a risk factor for all-cause mortality after acute myocardial infarction: Age and sex impact.

AIM: Type 2 diabetes mellitus (T2DM) is a risk factor for mortality after acute myocardial infarction (AMI). We studied the impact of T2DM related to sex and age on post-AMI long-term mortality. METHODS: A retrospective study included post-AMI patients. Data were obtained from electronic medical records. We defined the study groups by T2DM, stratified by age-sex. OUTCOME: up-to-10 years post-discharge all-cause mortality. RESULTS: 16,168 patients were analyzed, 40.3% had T2DM. Ten-year mortality rates were 50.3% with T2DM vs. 33.1% without T2DM, adjHR = 1.622 (p < 0.001). Females (adjHR = 1.085, p = 0.052) and increased age (adjHR = 1.056 for one-year increase, p < 0.001) were associated with a higher risk of mortality (borderline statistical significance for sex). The relationship between T2DM and mortality was stronger in females than in males at < 50 and 60-69 years (p-for-interaction 0.025 and 0.009 respectively), but not for other age groups. CONCLUSIONS: The study implies heterogeneity in the impact of T2DM on mortality of post-AMI patients, being greater among young patients, particularly females, and no significant impact in octogenarians. That implies that young women with T2DM should have advanced measures for early detection of coronary artery disease and tight control of cardiovascular risk factors to lower the propensity to develop AMI.

Intravitreal bevacizumab treatment for neovascular age-related macular degeneration and thromboembolic events.

BACKGROUND: Systemic complications of intravitreal anti-vascular endothelial growth factor agents are relatively uncommon but highly significant. OBJECTIVES: Primary objective: To assess the risk for thromboembolic events following intravitreal bevacizumab injection in neovascular age-related macular degeneration patients by a large population-based study. Secondary objective: To analyze the association between injection frequency and the risk for thromboembolic events, the time interval between the injection and the thromboembolic events, and the influence of chronic diseases on complications rate. DESIGN: A retrospective cohort study. METHODS: Consecutive neovascular age-related macular degeneration patients receiving intravitreal bevacizumab at Soroka University Medical Center from December 2005 to December 2013 were included. Thromboembolic events analyzed included acute coronary syndrome, acute myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism. The thromboembolic event rate was compared 2 years prior and 2 years after the initial intravitreal bevacizumab injection. RESULTS: A total of 2102 patients were included. Acute coronary syndrome and stroke rate were higher 2 years after intravitreal bevacizumab (p = 0.03 and p = 0.01, respectively). No statistical significant difference was found for the rest of thromboembolic events. Patients older than 80 years and patients receiving less than six intravitreal bevacizumab injections were more likely to experience stroke. Patients with known cardiovascular risk factors before starting injections did not develop significant more thromboembolic events. CONCLUSION: In our study population, patients treated with intravitreal bevacizumab were significantly more likely to experience stroke during 2 years after first injection.

Adherence to Anti-Viral Treatment for Chronic Hepatitis B.

Adherence to treatment of chronic Hepatitis B Virus (HBV) is an important issue and can affect the complication rate. Nucleos(t)ide analogue as oral treatments are used for patients with necro-inflammatory activity and high viral load, with the goal of decline the complication rate such cirrhosis and hepatic cancer. We aimed to investigate the adherence to chronic HBV treatment. Chronic HBV patients with dispensing medication rates (DMR) of at least 80% were defined as high adherence group (HAG) and those who dispensed less than 80% as low adherence group (LAG). The study included 273 patients. 90 patients (33%) were in the LAG and 183 (67%) in the HAG. The All-cause mortality in the LAG was 15.6%, and 8.7% among the HAG (p-value = 0.09). 185 patients were of Jewish origin (mean age of 52.96 ±14.6 years, 30% women) and 88 patients of Arab Bedouin (AB) origin (mean age of 40.86 ± 13.96 years (p-value < 0.001), 42% women). The proportion of Jewish patients with high adherence was 71% (131 patients) versus 59% (52 patients) in AB patients (p-value = 0.054). The all-causes mortality was 14.6% among Jewish origin and 3.4% of AB (p-value = 0.01). We conclude that, two third of HBV carriers are with high level adherence to treatment in southern Israel, with lower but marginally significant all-cause mortality. No-significant differences in adherence patterns were noted between Arab Bedouin and Jews.

Long-term control of Paget's disease of bone with low-dose, once-weekly, oral bisphosphonate preparations, in a "real world" setting.

PURPOSE: Bisphosphonates are the mainstay of the treatment of Paget's disease of bone (PDB). Clinical practice guidelines recommend treatment with intravenous zoledronic acid or high-dose oral nitrogen bisphosphonates (N-BPs). We present our long-term experience treating PDB patients with lower than recommended oral doses of N-BPs, equivalent to once-weekly doses used for treating osteoporosis. METHODS: PDB patients were seen, between 1990 and 2015 at the endocrine clinic of an academic medical center. Diagnosis was established according to accepted criteria. Patients were initially treated with alendronate 70 mg/week or risedronate 35 mg/week. Whenever the initial dose failed to produce remission, the dosage was increased to twice a week the respective dose. RESULTS: Patients were followed for a mean of 11.9 years (range: 1.7-24.8). Out of 96 treatment courses with N-BPs, 89% were with alendronate and 11% with risedronate. Remission was achieved in 84% of the courses with alendronate 70 mg/week. 90% of those who did not achieve remission subsequently responded to 140 mg/week. Out of the 8 treatment courses with risedronate 35 mg/week, 87% achieved remission, and the 2 patients who did not achieve remission subsequently responded to 70 mg/week. The median duration of remissions following 3-4 months courses of alendronate 70 mg/week or risedronate 35 mg/week was 8.8 months (IQR: 5.5, 14.8). CONCLUSION: In a large proportion of "real world" PDB patients, remission can be achieved with once-weekly, "osteoporosis doses" of alendronate or risedronate.