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Article ; Online: Chlorhexidine bathing in a tertiary care neonatal intensive care unit: A pilot study.

Bar-Meir, Maskit / Bendelac, Shoshana / Shchors, Irina

2023 Volume 18, Issue 3, Page(s) e0283132

Abstract: Background: Concerns regarding potential risk of dermal irritation have led to the exclusion of NICU patients from the recommendation regarding the use of 2% chlorhexidine gluconate (CHG) wash for daily skin cleansing to reduce bloodstream infections. ... ...

Abstract	Background: Concerns regarding potential risk of dermal irritation have led to the exclusion of NICU patients from the recommendation regarding the use of 2% chlorhexidine gluconate (CHG) wash for daily skin cleansing to reduce bloodstream infections. Our aim was to assess the safety of 2% CHG bathing in NICU patients. Methods: The regulator required a stepwise study enrollment to three successive groups: term infants, followed by near-term and pre-term infants. For comparison, we used a cohort of matched controls. A propensity score-adjusted regression model was used to compare the groups. Intervention: Infants were bathed thrice-weekly with 2% CHG-impregnated washcloths. Participant's skin was examined daily. Results: Over a total of 661 days of treatment: 384,129, and 148 days for the term, near-term and pre-term groups, respectively, no skin reactions were observed. The intervention group was generally sicker, however, bloodstream infections were similar between the groups. Conclusion: For infants >30 weeks and >3 days old, 2% CHG bathing was safe. Large multicenter studies are urgently needed to establish the effectiveness of this practice in the NICU.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; Chlorhexidine/adverse effects ; Intensive Care Units, Neonatal ; Anti-Infective Agents, Local/therapeutic use ; Pilot Projects ; Tertiary Healthcare ; Cross Infection/prevention & control ; Sepsis ; Baths ; Intensive Care Units
Chemical Substances	chlorhexidine gluconate (MOR84MUD8E) ; Chlorhexidine (R4KO0DY52L) ; Anti-Infective Agents, Local
Language	English
Publishing date	2023-03-23
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0283132
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Time from symptom onset may influence C-reactive protein utility in the diagnosis of bacterial infections in the NICU.

Borowski, Shelley / Shchors, Irina / Bar-Meir, Maskit

BMC pediatrics

2022 Volume 22, Issue 1, Page(s) 715

Abstract: Background: Taking into account the timing of C-reactive protein (CRP) testing may improve the performance of the test in diagnosing bacterial infections in the neonatal intensive care unit (NICU). We aimed to examine the yield of CRP, relative to time ... ...

Abstract	Background: Taking into account the timing of C-reactive protein (CRP) testing may improve the performance of the test in diagnosing bacterial infections in the neonatal intensive care unit (NICU). We aimed to examine the yield of CRP, relative to time from symptoms onset. Methods: Enrolled were all NICU patients, for whom CRP was obtained as part of a sepsis workup. The time of symptoms onset and of blood draw was recorded. Patients were classified into bacterial and non-bacterial groups according to the National Healthcare Safety Network (NHSN) guidelines. The performance of CRP, CRP velocity, and CRP obtained before or after 6 hours from symptoms onset, was evaluated by receiver-operating characteristic (ROC) curve. Test characteristics were calculated using formulas based on Bayes' theorem. Results: Of 129 infants enrolled in the study, 21(16%) had a bacterial infection. A single CRP test and CRP velocity performed similarly in diagnosing bacterial infection, with area under ROC curve of 0.75 (95%CI: 0.61-0.89) and 0.77 (95% CI:0.66-0.88), respectively. The optimal cut-off value for a CRP test obtained <= 6 hours from symptoms onset was 1 mg/dL, whereas the optimal cut-off > 6 hours was 1.5 mg/dL. Using the optimal cut-off values increased the pre-test probability of 16%, to a post-test probability of 35-38%. For infants whose birth weight was < 1000 g, CRP performed poorly. Conclusions: The optimal CRP cut-off used in the diagnosis of bacterial infections in NICU patients varies by the time from symptom onset. A "negative" CRP may support a clinical decision to stop empiric antimicrobial therapy, for infants whose blood cultures remain sterile.
MeSH term(s)	Infant, Newborn ; Infant ; Humans ; C-Reactive Protein/analysis ; Intensive Care Units, Neonatal ; Bayes Theorem ; Bacterial Infections/diagnosis ; Sepsis/diagnosis ; ROC Curve ; Biomarkers
Chemical Substances	C-Reactive Protein (9007-41-4) ; Biomarkers
Language	English
Publishing date	2022-12-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2041342-7
ISSN	1471-2431 ; 1471-2431
ISSN (online)	1471-2431
ISSN	1471-2431
DOI	10.1186/s12887-022-03783-4
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Article ; Online: Chlorhexidine bathing in a tertiary care neonatal intensive care unit

Maskit Bar-Meir / Shoshana Bendelac / Irina Shchors

PLoS ONE, Vol 18, Iss

A pilot study

2023 Volume 3

Abstract: ... weekly with 2% CHG-impregnated washcloths. Participant’s skin was examined daily. Results Over a total ...

Abstract	Background Concerns regarding potential risk of dermal irritation have led to the exclusion of NICU patients from the recommendation regarding the use of 2% chlorhexidine gluconate (CHG) wash for daily skin cleansing to reduce bloodstream infections. Our aim was to assess the safety of 2% CHG bathing in NICU patients. Methods The regulator required a stepwise study enrollment to three successive groups: term infants, followed by near-term and pre-term infants. For comparison, we used a cohort of matched controls. A propensity score-adjusted regression model was used to compare the groups. Intervention Infants were bathed thrice-weekly with 2% CHG-impregnated washcloths. Participant’s skin was examined daily. Results Over a total of 661 days of treatment: 384,129, and 148 days for the term, near-term and pre-term groups, respectively, no skin reactions were observed. The intervention group was generally sicker, however, bloodstream infections were similar between the groups. Conclusion For infants >30 weeks and >3 days old, 2% CHG bathing was safe. Large multicenter studies are urgently needed to establish the effectiveness of this practice in the NICU.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Mild to Moderate Crohn’s Disease: Still Room for Step-Up Therapies?

Bar-Meir, Simon

Digestive Diseases

2009 Volume 27, Issue 3, Page(s) 347–350

Abstract: Step-up therapy in Crohn’s disease refers to the classic therapeutic approach resulting ... Crohn’s disease patients. The benefit of mesalazine in small bowel disease is limited and should be considered ... to prednisone for mild active Crohn’s disease because it is associated with fewer side effects. Active mild ...

Institution	Sackler School of Medicine, Tel Aviv University, Tel Aviv, and Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Israel
Abstract	Step-up therapy in Crohn’s disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where biologicals together with thiopurines were used as first-line therapy. Several arguments exist against the top-down therapy. The current ECCO recommendation is in favor of the step-up therapy. ECCO recommended budesonide 9 mg daily as the preferred treatment in mild to moderate Crohn’s disease patients. The benefit of mesalazine in small bowel disease is limited and should be considered clinically no more effective than placebo. Antibiotics cannot be recommended unless septic complications are suspected. No treatment is an option for some patients with mild symptoms. Budesonide is preferred to prednisone for mild active Crohn’s disease because it is associated with fewer side effects. Active mild colonic disease may be treated with sulfasalazine and when needed with systemic corticosteroids as well. Topical treatment should be considered for distal disease. The national cooperative Crohn’s disease study and the European co-operative Crohn’s disease study established corticosteroids as an effective therapy for inducing remission in Crohn’s disease. Remission is achieved in 60–83% of the patients. A Cochrane review of the efficacy of azathioprine and 6-mercaptopurine for inducing remission in active Crohn’s disease showed a benefit for thiopurine therapy compared with placebo. Methotrexate is another effective medication that has been confirmed in a systematic review. Once remission has been achieved with systemic corticosteroids, maintenance with azathioprine should be considered. For patients with extensive colitis, long-term treatment with mesalazine is an option as this may reduce the risk of colon cancer, although this is still unproved in Crohn’s disease. In conclusion, the natural course of most patients with Crohn’s disease is relatively mild and there is a room for step-up therapy. The efficacy of most medications is similar to the efficacy of infliximab but with less adverse effects. Infliximab should be reserved only for patients where other therapies failed.
Keywords	Immunosuppression ; Crohn’s disease ; Infliximab ; Step-up therapy ; Top-down therapy
Language	English
Publishing date	2009-09-24
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Tailored Therapy for Specific Subgroups?
ZDB-ID	632798-9
ISBN	978-3-8055-9253-6 ; 978-3-8055-9254-3 ; 3-8055-9253-1 ; 3-8055-9254-X
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000228572
Database	Karger publisher's database

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Article ; Online: Hepatitis B Virus Revaccination With Standard Versus Pre-S Vaccine in Previously Immunized Patients With Celiac Disease.

Heshin-Bekenstein, Merav / Turner, Dan / Shamir, Raanan / Bar-Meir, Maskit / Dagan, Ron / Zevit, Noam / Silbermintz, Ari

Journal of pediatric gastroenterology and nutrition

2015 Volume 61, Issue 4, Page(s) 400–403

Abstract: ... immunogenic in individuals with celiac disease (CD). A pre-S vaccine (Sci-B-Vac) has demonstrated superior ... of a pre-S vaccine with a HBV vaccine (Engerix B) for repeat vaccination of seronegative, previously ... 10 mIU/mL). Patients were randomized to receive either Engerix B or pre-S vaccine. HBs-Ab ...

Abstract	Objective: Previous studies have suggested that hepatitis B virus (HBV) vaccines may be less immunogenic in individuals with celiac disease (CD). A pre-S vaccine (Sci-B-Vac) has demonstrated superior immunogenicity compared with standard HBV vaccines in several diseases. We compared the short-term immunogenicity of a pre-S vaccine with a HBV vaccine (Engerix B) for repeat vaccination of seronegative, previously immunized patients with CD. Methods: Participants were 1 to 18-year-old children with CD who despite standard HBV vaccines in infancy had nonprotective hepatitis B surface antibody (HBs-Ab) concentrations (≤10 mIU/mL). Patients were randomized to receive either Engerix B or pre-S vaccine. HBs-Ab concentrations were measured 1 month after the first dose. For those who had not responded after 1 dose, measurement was repeated after the third dose. Results: Children (n = 82) were analyzed (42 pre-S vaccine and 40 Engerix B). Baseline characteristics were similar for both groups, including gluten-free diet status. Both arms showed high response rates following the first injection: 41 (98%) versus 35 (87%) for pre-S vaccine and Engerix B recipients, respectively (P = 0.08). All other patients responded when measured after dose 3. HBs-Ab concentrations (mIU/mL) were higher in the pre-S vaccine group (median 925, interquartile range [IQR] 424-1000) than the Engerix B group (median 363, IQR 106-996, P = 0.005). Twenty (48%) of the pre-S vaccine recipients were "high responders" (>1000 mIU/mL) versus 10 (25%) in Engerix B recipients (P = 0.008). Conclusions: Both vaccines elicited adequate booster responses in most previously vaccinated patients with CD with nonprotective HBs-Ab concentrations. Pre-S vaccine administration resulted in higher Hbs-Ab concentrations. Our data suggest that a single dose of either vaccine is sufficient to raise titers to protective levels in most patients with CD.
MeSH term(s)	Academic Medical Centers ; Adolescent ; Antibody Formation/drug effects ; Capsid Proteins/adverse effects ; Capsid Proteins/genetics ; Capsid Proteins/metabolism ; Capsid Proteins/therapeutic use ; Celiac Disease/blood ; Celiac Disease/complications ; Celiac Disease/immunology ; Child ; Child, Preschool ; Double-Blind Method ; Hepatitis B/complications ; Hepatitis B/immunology ; Hepatitis B/prevention & control ; Hepatitis B Antibodies/analysis ; Hepatitis B Surface Antigens/adverse effects ; Hepatitis B Surface Antigens/genetics ; Hepatitis B Surface Antigens/metabolism ; Hepatitis B Surface Antigens/therapeutic use ; Hepatitis B Vaccines/adverse effects ; Hepatitis B Vaccines/genetics ; Hepatitis B Vaccines/metabolism ; Hepatitis B Vaccines/therapeutic use ; Humans ; Immunity, Active/drug effects ; Immunization, Secondary ; Immunocompromised Host/drug effects ; Infant ; Israel ; Lost to Follow-Up ; Protein Precursors/adverse effects ; Protein Precursors/genetics ; Protein Precursors/metabolism ; Protein Precursors/therapeutic use ; Vaccines, Synthetic/adverse effects ; Vaccines, Synthetic/genetics ; Vaccines, Synthetic/metabolism ; Vaccines, Synthetic/therapeutic use
Chemical Substances	Capsid Proteins ; Engerix-B ; Hepatitis B Antibodies ; Hepatitis B Surface Antigens ; Hepatitis B Vaccines ; Pre-S vaccine ; Protein Precursors ; Vaccines, Synthetic ; presurface protein 1, hepatitis B surface antigen ; presurface protein 2, hepatitis B surface antigen
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	603201-1
ISSN	1536-4801 ; 0277-2116
ISSN (online)	1536-4801
ISSN	0277-2116
DOI	10.1097/MPG.0000000000000856
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Article ; Online: Metabolic syndrome does not influence the phenotype of LRRK2 and GBA related Parkinson’s disease

Avner Thaler / Shani Shenhar-Tsarfaty / Yanay Shaked / Tanya Gurevich / Nurit Omer / Anat Bar-Shira / Mali Gana-Weisz / Orly Goldstein / Meir Kestenbaum / Jesse M. Cedarbaum / Avi Orr-Urtreger / Nir Giladi / Anat Mirelman

Scientific Reports, Vol 10, Iss 1, Pp 1-

2020 Volume 8

Abstract: ... and GBA Parkinson’s disease (PD), and on the prevalence of prodromal features among individuals ...

Abstract	Abstract In order toevaluate the influence of the metabolic syndrome (MS) (obesity, hypertension, elevated triglycerides, reduced levels of HDL cholesterol and glucose impairment) on the phenotype of LRRK2 and GBA Parkinson’s disease (PD), and on the prevalence of prodromal features among individuals at risk, we collected, laboratory test results, blood pressure, demographic, cognitive, motor, olfactory and affective information enabling the assessment of each component of MS and the construction of the MDS prodromal probability score. The number of metabolic components and their levels were compared between participants who were separated based on disease state and genetic status. One hundred and four idiopathic PD, 40 LRRK2-PD, 70 GBA-PD, 196 healthy non-carriers, 55 LRRK2-NMC and 97 GBA-NMC participated in this study. PD groups and non manifesting carriers (NMC) did not differ in the number of metabolic components (p = 0.101, p = 0.685, respectively). LRRK2-PD had higher levels of triglycerides (p = 0.015) and higher rates of prediabetes (p = 0.004), while LRRK2-NMC had higher triglyceride levels (p = 0.014). NMC with probability rates for prodromal PD above 50% had higher frequencies of hypertriglyceridemia and prediabetes (p < 0.005, p = 0.023 respectively). While elevated triglycerides and prediabetes were more frequent among LRRK2 carriers, MS does not seem to influence GBA and LRRK2-PD phenotype.
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2020-06-01T00:00:00Z
Publisher	Nature Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Does Acute Otitis Media in the First Month of Life Increase the Risk for Recurrent Otitis?

Megged, Orli / Abdulgany, Suzan / Bar-Meir, Maskit

Clinical pediatrics

2017 , Page(s) 9922817691822

Abstract: Acute otitis media (AOM) is a common childhood illness. The aim of this study was to assess whether AOM in the first month of life predicts recurrent AOM (rAOM) in early childhood. The medical records of all neonates with AOM and isolation of bacterial ... ...

Abstract	Acute otitis media (AOM) is a common childhood illness. The aim of this study was to assess whether AOM in the first month of life predicts recurrent AOM (rAOM) in early childhood. The medical records of all neonates with AOM and isolation of bacterial pathogen from middle-ear fluid during 2005-2010 were reviewed. Neonates without AOM admitted during the same period for neonatal fever workup were included as controls. Information regarding rAOM and possible risk factors were collected through a phone interview with the parents. A total of 84 neonates with AOM were enrolled; 25 (30%) had rAOM compared with 8/79 (10%) in the control group. Neonatal AOM increases 4-fold the odds of rAOM later in childhood (odds ratio = 4; 95% CI = 1.44-11.42; P = .008), independent of smoke exposure, numbers of siblings, AOM in siblings, breastfeeding, day care attendance, or use of pacifier. Neonatal AOM is a significant risk factor for rAOM during infancy.
Language	English
Publishing date	2017-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	207678-0
ISSN	1938-2707 ; 0009-9228
ISSN (online)	1938-2707
ISSN	0009-9228
DOI	10.1177/0009922817691822
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Article: Risk Factors Regarding the Need for a Second Operation in Patients with Crohn’s Disease

Avidan, B. / Sakhnini, E. / Lahat, A. / Lang, A. / Koler, M. / Zmora, O. / Bar-Meir, S. / Chowers, Y.

Digestion

2005 Volume 72, Issue 4, Page(s) 248–253

Abstract: Background/Aims: The majority of Crohn’s disease patients undergo surgery. However, the factors ... for Crohn’s disease were retrospectively studied. Recurrence was defined as the need for a second operation ... for Crohn’s disease patients who undergo surgery is related to the presence of perforating disease and smoking ...

Institution	Departments of Gastroenterology Surgery C and Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Abstract	Background/Aims: The majority of Crohn’s disease patients undergo surgery. However, the factors that predict post-operative recurrence remain controversial. The aim of the present study was to shed light on the potential predictors of such recurrence. Methods: 86 patients who underwent operative procedures for Crohn’s disease were retrospectively studied. Recurrence was defined as the need for a second operation. Life table and multivariate analysis were performed to find the predictors of recurrence. Results: In 26/86 (30%) of the patients, post-operative recurrence was diagnosed within a mean of 42 months of the follow-up. Logistic regression analysis revealed that smoking (OR 3.69, 95% CI 2.06–11.52) and perforating disease (OR 4.09, 95% CI 1.31–12.65) were associated with a risk of recurrence. However, survival analysis showed that only perforating disease was associated with an early post-operative recurrence (log-rank test, p < 0.001). Neither resected surgical specimen characteristics, nor the duration and the location of the disease were found to predict the need for a second operation. Conclusion: The risk for Crohn’s disease patients who undergo surgery is related to the presence of perforating disease and smoking, which predict the need for a second operation. The former is associated with an even earlier recurrence.
Keywords	Perforating disease ; Smoking ; Crohn’s disease ; Crohn’s disease, surgery
Language	English
Publishing date	2005-12-16
Publisher	S. Karger AG
Publishing place	Basel, Switzerland
Document type	Article
Note	Original Paper
ZDB-ID	1712-7
ISSN	1421-9867 ; 0012-2823
ISSN (online)	1421-9867
ISSN	0012-2823
DOI	10.1159/000089960
Database	Karger publisher's database

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Article ; Online: Mild to moderate Crohn's disease: still room for step-up therapies?

Bar-Meir, Simon

Digestive diseases (Basel, Switzerland)

2009 Volume 27, Issue 3, Page(s) 347–350

Abstract: Step-up therapy in Crohn's disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where ... ...

Abstract	Step-up therapy in Crohn's disease refers to the classic therapeutic approach resulting in progressive increase of therapies with the increasing severity of the disease. This approach has been recently challenged by the top-down strategy, where biologicals together with thiopurines were used as first-line therapy. Several arguments exist against the top-down therapy. The current ECCO recommendation is in favor of the step-up therapy. ECCO recommended budesonide 9 mg daily as the preferred treatment in mild to moderate Crohn's disease patients. The benefit of mesalazine in small bowel disease is limited and should be considered clinically no more effective than placebo. Antibiotics cannot be recommended unless septic complications are suspected. No treatment is an option for some patients with mild symptoms. Budesonide is preferred to prednisone for mild active Crohn's disease because it is associated with fewer side effects. Active mild colonic disease may be treated with sulfasalazine and when needed with systemic corticosteroids as well. Topical treatment should be considered for distal disease. The national cooperative Crohn's disease study and the European co-operative Crohn's disease study established corticosteroids as an effective therapy for inducing remission in Crohn's disease. Remission is achieved in 60-83% of the patients. A Cochrane review of the efficacy of azathioprine and 6-mercaptopurine for inducing remission in active Crohn's disease showed a benefit for thiopurine therapy compared with placebo. Methotrexate is another effective medication that has been confirmed in a systematic review. Once remission has been achieved with systemic corticosteroids, maintenance with azathioprine should be considered. For patients with extensive colitis, long-term treatment with mesalazine is an option as this may reduce the risk of colon cancer, although this is still unproved in Crohn's disease. In conclusion, the natural course of most patients with Crohn's disease is relatively mild and there is a room for step-up therapy. The efficacy of most medications is similar to the efficacy of infliximab but with less adverse effects. Infliximab should be reserved only for patients where other therapies failed.
MeSH term(s)	Antibodies, Monoclonal/therapeutic use ; Azathioprine/therapeutic use ; Clinical Trials as Topic ; Crohn Disease/drug therapy ; Crohn Disease/pathology ; Humans ; Infliximab ; Methotrexate/therapeutic use ; Remission Induction
Chemical Substances	Antibodies, Monoclonal ; Infliximab (B72HH48FLU) ; Azathioprine (MRK240IY2L) ; Methotrexate (YL5FZ2Y5U1)
Language	English
Publishing date	2009
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	632798-9
ISSN	1421-9875 ; 0257-2753
ISSN (online)	1421-9875
ISSN	0257-2753
DOI	10.1159/000228572
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Article ; Online: Video capsule endoscopy or double-balloon enteroscopy: are they equivalent?

Bar-Meir, Simon

Gastrointestinal endoscopy

2009 Volume 69, Issue 4, Page(s) 875–876

MeSH term(s)	Capsule Endoscopy ; Endoscopes, Gastrointestinal ; Endoscopy, Gastrointestinal/methods ; Humans ; Intestinal Diseases/diagnosis ; Intestine, Small
Language	English
Publishing date	2009-04
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2008.07.051
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