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Biomedical subjects

Ami Schattner

Publications and source records attributed to Ami Schattner.

At least 19 recordsLinked to original sources
PubMed2006

Clinical paradigms revisited.

Despite astounding advances in scientific knowledge and technological capabilities, modern medicine is not free of significant problems. A persistent high rate of diagnostic errors, the prevalence of medical (iatrogenic) harm and the growing demand for complementary and alternative medicine indicate an urgent need for improvement. An important step is a return to three quintessential clinical paradigms that have become neglected with the advent of high-technology medicine: the need to emphasise prevention and early, presymptomatic diagnosis; the crucial role in decision making of skillful history taking and examination, backed by evidence; and enhanced attention to patient autonomy and emotional factors. Possible reasons for the current neglect of these Altneuparadigms ("old-new" paradigms) are considered, and techniques for restoring their primacy in medicine are discussed.

Clinical Competence↗
PubMed2006

Information and shared decision-making are top patients' priorities.

BACKGROUND: The profound changes in medical care and the recent stress on a patient-centered approach mandate evaluation of current patient priorities. METHODS: Hospitalized and ambulatory patients at an academic medical center in central Israel were investigated. Consecutive patients (n = 274) indicated their first and second priority for a change or improvement in their medical care out of a mixed shortlist of 6 issues, 3 related to patient-physician relationship (being better informed and taking part in decisions; being seen by the same doctor each time; a longer consultation time) and 3 issues related to the organizational aspect of care (easier access to specialists/hospital; shorter queue for tests; less charges for drugs). RESULTS: Getting more information from the physician and taking part in decisions was the most desirable patient choice, selected by 27.4% as their first priority. The next choices - access and queue - also relate to more patient autonomy and control over that of managed care regulations. Patients studied were least interested in continuity of care, consultation time or cost of drugs. Demographic or clinical variables were not significantly related to patients' choices. CONCLUSION: Beyond its many benefits, being informed by their doctor and shared decision making is a top patient priority.

Academic Medical Centers↗
PubMed2006

Characterization of T-cell large granular lymphocyte leukemia associated with Sjogren's syndrome-an important but under-recognized association.

OBJECTIVE: Patients with T-cell (CD3+) large granular lymphocyte (LGL) leukemia have a high prevalence of autoantibodies and associated autoimmune diseases. Sjogren's syndrome may not be diagnosed unless specifically looked for. We set to determine the prevalence of Sjogren's syndrome in LGL leukemia and its cytokine profile. METHODS: Every patient with a confirmed diagnosis of LGL leukemia diagnosed at a single academic medical center over the last 15 years was evaluated for Sjogren's syndrome by questioning about sicca symptoms. In symptomatic patients, Schirmer's test, rose bengal corneal staining, salivary flow rate measurement, autoantibody screening, and minor salivary gland biopsy were performed. Supernatants obtained from T-LGL leukemic cells following phytohemagglutinin (PHA) activation were analyzed for cytokine production by enzyme-linked immunosorbent assay and patients with or without Sjogren's syndrome were compared with controls. RESULTS: Of 48 patients, 21 reported sicca symptoms and were enrolled in the study. In 8 patients Sjogren's syndrome was ruled out. Thirteen patients had clear evidence of Sjogren's syndrome according to accepted criteria (27%). None had rheumatoid arthritis, but 1 had limited scleroderma. Thus, 12/48 patients had primary Sjogren's syndrome. Other autoimmune diseases were frequently present, in particular, immune cytopenias (n=7) or thyroid autoimmunity (n=6). Supernatants of T-LGL leukemia cells incubated with PHA revealed markedly increased levels of multiple cytokines (especially soluble interleukin 2 receptor, tumor necrosis factor alpha, IL-6, IL-8) compared with healthy controls. However, this increase was common to LGL leukemia patients with or without Sjogren's syndrome. CONCLUSIONS: Sjogren's syndrome was commonly identified in the patients with T-cell LGL leukemia in this study. Upregulated cytokine production by the neoplastic cells may underlie some of the immune-mediated disorders common in these patients.

Adult↗
PubMed2005

Aspergillus peritonitis in a lupus patient on chronic peritoneal dialysis.

A woman on continuous ambulatory peritoneal dialysis (CAPD) due to renal failure in systemic lupus erythematosus (SLE) developed fungal peritonitis and survived following treatment with amphotericin B and removal of the dialysis catheter. The causative organism, Aspergillus fumigatus is very rare in fungal peritonitis and may be related in this case to the combination of SLE, end-stage renal disease (ESRD) and their treatment.

Amphotericin B↗
PubMed2005

Polycystic ovary syndrome in post-menopausal women--marker of the metabolic syndrome.

OBJECTIVES: To determine among post-menopausal women, the prevalence of polycystic ovary syndrome (PCOS) and to evaluate the endocrine and metabolic profile of these women in comparisons to women without PCOS. METHODS: All women attending two post-menopausal outpatient clinics, fulfilling the inclusion criteria, were evaluated by physical examination, detailed questionnaire and laboratory measurements of glucose, lipids and sex-hormone levels. RESULTS: Among 104 women 7 (6.7%) were diagnosed with PCOS. As compared to women without PCOS, central obesity was more common in the PCOS group (p=0.004), 4/7 had type 2 diabetes compared to 8/97 in the non-PCOS group (p=0.003) and 6/7 versus 31/97 had the characteristic dyslipidemia of the metabolic syndrome (p=0.047). CONCLUSIONS: PCOS is common in post-menopausal women attending outpatient's clinics, and is a marker for a metabolic profile that is associated with a high-risk for cardiovascular diseases (CVD).

Biomarkers↗
PubMed2005

Consequence or coincidence? The occurrence, pathogenesis and significance of autoimmune manifestations after viral vaccines.

BACKGROUND: Viruses and virus-induced lymphokines may have an important role in the pathogenesis of autoimmunity (Schattner A. Clin Immunol Immunopathol; 1994). The occurrence and significance of autoimmune manifestations after the administration of viral vaccines remain controversial. METHODS: Medline search of all relevant publications from 1966 through June 2004 with special emphasis on search of each individual autoimmune manifestation and vaccination, as well as specifically searching each viral vaccine for all potential autoimmune syndromes reported. All relevant publications were retrieved and critically analyzed. RESULTS: The most frequently reported autoimmune manifestations for the various vaccinations, were: hepatitis A virus (HAV)--none; hepatitis B virus (HBV)--rheumatoid arthritis, reactive arthritis, vasculitis, encephalitis, neuropathy, thrombocytopenia; measles, mumps and rubella vaccine (MMR)--acute arthritis or arthralgia, chronic arthritis, thrombocytopenia; influenza--Guillain-Barre syndrome (GBS), vasculitis; polio--GBS; varicella--mainly neurological syndromes. Even these 'frequent' associations relate to a relatively small number of patients. Whenever controlled studies of autoimmunity following viral vaccines were undertaken, no evidence of an association was found. CONCLUSIONS: Very few patients may develop some autoimmune diseases following viral vaccination (in particular - arthropathy, vasculitis, neurological dysfunction and thrombocytopenia). For the overwhelming majority of people, vaccines are safe and no evidence linking viral vaccines with type 1 diabetes, multiple sclerosis (MS) or inflammatory bowel disease can be found.

Adult↗