Background: The two cerebral hemispheres influence the immune response differently. While the lef... more Background: The two cerebral hemispheres influence the immune response differently. While the left hemisphere enhances cellular immunity, the right hemisphere inhibits it. Objectives: To determine whether immune and inflammatory markers correlated with stroke severity and hospitalization duration as a function of stroke side. Methods: The study included 137 patients with unilateral ischemic stroke. The medical records were reviewed for demographic and clinical laboratory data, including C-reactive protein (CRP), white blood cell (WBC) count, its differential stroke side and stroke severity according to the National Institute of Health Stroke Scale (NIHSS), and length of hospital stay (LOS). We examined differences between right side (RS) and left side (LS) stroke on immune and inflammatory markers and compared correlations between these markers and NIHSS and LOS as a function of stroke side. Results: RS stroke patients had higher CRP and monocytes than LS stroke patients. In RS stroke patients, CRP, total WBC, and lymphocyte levels positively correlated with both NIHSS and LOS, whereas levels of neutrophils were positively correlated with NIHSS alone. No correlations were found for LS stroke patients. Conclusions: Immune-inflammatory markers correlated with stroke severity and LOS only in patients with RS stroke. Neuroimmunological processes influence short-term clinical outcomes after stroke, especially considering the differential effects of the hemispheres on immunity. Prospective studies that evaluate long-term clinical outcomes are needed. Testing the effects of anti-inflammatory treatments on prognosis of RS stroke patients should be considered.
Background and purpose: This study aimed to investigate the differences in intracerebral hemorrha... more Background and purpose: This study aimed to investigate the differences in intracerebral hemorrhage (ICH) between Jews and Arabs residing in northern Israel, focusing on risk factors, hemorrhage volume, and functional outcome. Methods: A retrospective analysis was conducted utilizing a population-based registry to investigate intracerebral hemorrhage (ICH) characteristics, risk factors, and outcomes. The registry consisted of inpatients diagnosed with hemorrhagic stroke. Due to the wide variation in data on ICH characteristics and the limited availability of population-based data on predictors of ICH survival and functional outcomes, we collected retrospective data on all adult patients admitted to the Galilee Medical Center with a diagnosis of ICH. Data were obtained from the registry covering the period from 2013 to 2019. Ethnic differences and risk factors associated with intracranial hemorrhage (ICH) were examined within a diverse population of 241 patients, comprising 52.70% Je...
Stroke is a leading cause of death worldwide. Multiple factors influence the severity of stroke. ... more Stroke is a leading cause of death worldwide. Multiple factors influence the severity of stroke. Normal functional and biological differences seen between the hemispheres may also be related to stroke severity. In the present study, we examined the differences in the severity of stroke as a function of stroke side, and whether patients’ vagal nerve activity moderated such differences. We included 87 patients with an ischemic stroke, whose medical records were retrospectively examined for background information (age, gender), stroke side and severity by NIHSS, length of stay in hospital, inflammation such as C-reactive protein, and vagal nerve activity. The vagal activity was indexed by patients’ heart-rate variability (HRV), fluctuations in the intervals between normal heartbeats, derived from patients’ ECG. Results revealed that patients with left-side stroke had significantly worse NIHSS scores (10.6) than those with right-sided stroke (7.6, p < 0.05). However, when dividing th...
Shmuel Levit 1,2 Shmuel Giveon, Ildar Musin , Royi Barnea , Ifat Korek-Abadi , Vyacheslav Levit ,... more Shmuel Levit 1,2 Shmuel Giveon, Ildar Musin , Royi Barnea , Ifat Korek-Abadi , Vyacheslav Levit , Darian Ryder , Chen Hanna Ryder 8,9,10 1 Institute of Endocrinology, Diabetes & Metabolism, Assuta Medical Center, Tel-Aviv, Israel National Research Technological University, Kazan, Russia Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel National Research Technological University, Kazan, Russia Assuta Research Institute, Assuta Medical Center, Tel-Aviv, Israel Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel. Department of Disease prevention, City Clinical Hospital No8, Chelyabinsk, Russia Virtual-Reality & Neuro Cognition Lab, Technion – Israel Institute of Technology, Haifa, Israel Brain Research Laboratory, Department of Neurology, Ziv Medical Center, Safed, Israel Faculty of Medicine, Bar-Ilan University, Safed, Israel
This study is the proof-of-concept of our "Gravicentric" theory. This concept is based ... more This study is the proof-of-concept of our "Gravicentric" theory. This concept is based on several fundamental points: obesity as the main foe; rapid reversibility of the disease; as well as a new perspective on the roles different pharmacological classes play in general, and the role of insulin and GLP-1 analogs, in particular. The paper presents and discusses our experience of the implementation of insulin and GLP-1 analogs. The possibility of "insulin weaning"; the therapeutic approach for over-treated patients; and physiological dosing of insulin is also discussed therein. Objectives Primary: To evaluate the long-term efficacy of GLP-1 analogs in insulin-treated Type 2 Diabetes Mellitus (T2DM) patients. Secondary: To analyze which patient would most likely benefit from this combined treatment. Methods In 54 T2DM patients with a mean disease duration of 17.5 years and a mean extent of insulin therapy of 4.5 years, additional GLP-1 analogs therapy was prescribed...
Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 i... more Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 inhibitors (SGLT2i) to reduce cardiovascular morbidity and mortality. However, real-life data and the results of several other studies seem to contradict these outcomes, pointing out possibilities of serious side effects. Ketoacidosis (KA) remains one of the most dangerous complications, yet, not fully understood. All of the above urgently requires real-practice data, which may shed some light on side effects of this novel anti-diabetic drug family. Aims: To investigate the real-life rates of hypoglycemia and ketosis (K) in SGLT2i treated patients, using Continuous Glucose Monitoring (CGM) and capillary blood -hydroxybutyrate measurements. Methods: We report the results of a two-year retrospective analysis of 136 Type 2 Diabetes (T2DM) patients, all (100%) treated with a SGLT2i, combined with Metformin or Metformin with Incretin-Based therapy (MT-IBT). CGM recordings were done in 52 perso...
There is a growing body of evidence pointing at several types of motor abnormalities found in att... more There is a growing body of evidence pointing at several types of motor abnormalities found in attention-deficit/hyperactivity disorder (ADHD). In this article we review findings stemming from different paradigms, and suggest an interweaving approach to the different stages involved in the motor regulation process. We start by reviewing various aspects of motor abnormalities found in ADHD and related brain mechanisms. Then, we classify reported motor impairments associated with ADHD, into four classes of motor stages: Attention to the task, motion preparation, motion execution and motion monitoring. Motor abnormalities and corresponding neural activations are analyzed in the context of each of the four identified motor patterns, along with the interactions among them and with other systems. Given the specifications and models of the role of the four motor impairments in ADHD, we ask what treatments correspond to the identified motor impairments. We analyze therapeutic interventions t...
OBJECTIVE: This study was an initial attempt to distinguish between anxiety and depressive PTSD s... more OBJECTIVE: This study was an initial attempt to distinguish between anxiety and depressive PTSD subtypes, according to the dominant symptoms. BACKGROUND: Post-traumatic stress disorder (PTSD), as defined in the DSM-IV which was used for diagnosis of mental disorders during the preparation of the study, belongs to the anxiety disorders spectrum, but often accompanied by depression following stressful and traumatic events. This definition lacks a formal distinction between anxiety and depressive dominant symptoms. Scientific evidence suggests that subjects with comorbid PTSD and depression differ clinically and biologically from subjects exhibiting PTSD or depression alone. This raises the question of whether PTSD and depression are comorbid in the aftermath of trauma or if patients who are diagnosed with both disorders, may in fact exhibit depressive PTSD subtype, compared to subjects presenting anxiety dominant symptoms and therefore should be diagnosed with anxiety PTSD subtype. Accordingly, the current study constructed models for predicting depressive and anxiety PTSD subtypes. DESIGN/METHODS: 62 subjects participated in current study. 23 were diagnosed as having chronic PTSD (of whom 6 were classified with anxiety subtype and 17 with depressive subtype), 14 subjects enrolled in the MDD control group and 25 in the healthy control group, according to a preliminary psychiatric diagnosis. Models classification to the various groups was based on subjects9 responses in a diagnostic battery including questionnaires, neurocognitive tests, as well as skin conductance response and reaction measures in two emotional computerized tasks. RESULTS: Flexible Discriminate Analysis revealed 3 different models supporting the preliminary psychiatric classification. Models prediction accuracy of this classification was 92% to 96.77% in the different models. CONCLUSIONS: The findings support the need to create a separate diagnosis definition of depressive and anxiety PTSD subtypes. This differentiation may help to adjust a unique mental and pharmacological treatment to each subtype of PTSD. Study Supported by: Disclosure: Dr. Ryder has nothing to disclose. Dr. Richter-Levin has nothing to disclose. Dr. Shahien has nothing to disclose.
A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three... more A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three months was referred to our facility. On admission, the patient was dysphasic and had tonic-clonic seizures. Neurological examination showed mental confusion, euphoric mood, mania, paranoia, and mild motor dysphasia. Magnetic resonance imaging (MRI) was performed twice but no abnormalities were revealed. His acute confusional state, elevated cerebrospinal fluid (CSF) protein, epileptic seizure and electroencephalogram showing intermittent frontal slowness were all suggestive of encephalitis. The patient was treated with acyclovir without significant improvement in his condition. Testing for herpes simplex virus and human immunodeficiency virus was negative. Limbic encephalitis was suspected and the patient was treated with intravenous immunoglobulin (IVIG) for five days. Venereal disease research laboratory and Treponema pallidum hemagglutination assay were both tested positive in serum ...
Background: The two cerebral hemispheres influence the immune response differently. While the lef... more Background: The two cerebral hemispheres influence the immune response differently. While the left hemisphere enhances cellular immunity, the right hemisphere inhibits it. Objectives: To determine whether immune and inflammatory markers correlated with stroke severity and hospitalization duration as a function of stroke side. Methods: The study included 137 patients with unilateral ischemic stroke. The medical records were reviewed for demographic and clinical laboratory data, including C-reactive protein (CRP), white blood cell (WBC) count, its differential stroke side and stroke severity according to the National Institute of Health Stroke Scale (NIHSS), and length of hospital stay (LOS). We examined differences between right side (RS) and left side (LS) stroke on immune and inflammatory markers and compared correlations between these markers and NIHSS and LOS as a function of stroke side. Results: RS stroke patients had higher CRP and monocytes than LS stroke patients. In RS stroke patients, CRP, total WBC, and lymphocyte levels positively correlated with both NIHSS and LOS, whereas levels of neutrophils were positively correlated with NIHSS alone. No correlations were found for LS stroke patients. Conclusions: Immune-inflammatory markers correlated with stroke severity and LOS only in patients with RS stroke. Neuroimmunological processes influence short-term clinical outcomes after stroke, especially considering the differential effects of the hemispheres on immunity. Prospective studies that evaluate long-term clinical outcomes are needed. Testing the effects of anti-inflammatory treatments on prognosis of RS stroke patients should be considered.
Background and purpose: This study aimed to investigate the differences in intracerebral hemorrha... more Background and purpose: This study aimed to investigate the differences in intracerebral hemorrhage (ICH) between Jews and Arabs residing in northern Israel, focusing on risk factors, hemorrhage volume, and functional outcome. Methods: A retrospective analysis was conducted utilizing a population-based registry to investigate intracerebral hemorrhage (ICH) characteristics, risk factors, and outcomes. The registry consisted of inpatients diagnosed with hemorrhagic stroke. Due to the wide variation in data on ICH characteristics and the limited availability of population-based data on predictors of ICH survival and functional outcomes, we collected retrospective data on all adult patients admitted to the Galilee Medical Center with a diagnosis of ICH. Data were obtained from the registry covering the period from 2013 to 2019. Ethnic differences and risk factors associated with intracranial hemorrhage (ICH) were examined within a diverse population of 241 patients, comprising 52.70% Je...
Stroke is a leading cause of death worldwide. Multiple factors influence the severity of stroke. ... more Stroke is a leading cause of death worldwide. Multiple factors influence the severity of stroke. Normal functional and biological differences seen between the hemispheres may also be related to stroke severity. In the present study, we examined the differences in the severity of stroke as a function of stroke side, and whether patients’ vagal nerve activity moderated such differences. We included 87 patients with an ischemic stroke, whose medical records were retrospectively examined for background information (age, gender), stroke side and severity by NIHSS, length of stay in hospital, inflammation such as C-reactive protein, and vagal nerve activity. The vagal activity was indexed by patients’ heart-rate variability (HRV), fluctuations in the intervals between normal heartbeats, derived from patients’ ECG. Results revealed that patients with left-side stroke had significantly worse NIHSS scores (10.6) than those with right-sided stroke (7.6, p < 0.05). However, when dividing th...
Shmuel Levit 1,2 Shmuel Giveon, Ildar Musin , Royi Barnea , Ifat Korek-Abadi , Vyacheslav Levit ,... more Shmuel Levit 1,2 Shmuel Giveon, Ildar Musin , Royi Barnea , Ifat Korek-Abadi , Vyacheslav Levit , Darian Ryder , Chen Hanna Ryder 8,9,10 1 Institute of Endocrinology, Diabetes & Metabolism, Assuta Medical Center, Tel-Aviv, Israel National Research Technological University, Kazan, Russia Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel National Research Technological University, Kazan, Russia Assuta Research Institute, Assuta Medical Center, Tel-Aviv, Israel Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel. Department of Disease prevention, City Clinical Hospital No8, Chelyabinsk, Russia Virtual-Reality & Neuro Cognition Lab, Technion – Israel Institute of Technology, Haifa, Israel Brain Research Laboratory, Department of Neurology, Ziv Medical Center, Safed, Israel Faculty of Medicine, Bar-Ilan University, Safed, Israel
This study is the proof-of-concept of our "Gravicentric" theory. This concept is based ... more This study is the proof-of-concept of our "Gravicentric" theory. This concept is based on several fundamental points: obesity as the main foe; rapid reversibility of the disease; as well as a new perspective on the roles different pharmacological classes play in general, and the role of insulin and GLP-1 analogs, in particular. The paper presents and discusses our experience of the implementation of insulin and GLP-1 analogs. The possibility of "insulin weaning"; the therapeutic approach for over-treated patients; and physiological dosing of insulin is also discussed therein. Objectives Primary: To evaluate the long-term efficacy of GLP-1 analogs in insulin-treated Type 2 Diabetes Mellitus (T2DM) patients. Secondary: To analyze which patient would most likely benefit from this combined treatment. Methods In 54 T2DM patients with a mean disease duration of 17.5 years and a mean extent of insulin therapy of 4.5 years, additional GLP-1 analogs therapy was prescribed...
Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 i... more Background: Latest studies have shown the remarkable ability of sodium-glucose co-transporter-2 inhibitors (SGLT2i) to reduce cardiovascular morbidity and mortality. However, real-life data and the results of several other studies seem to contradict these outcomes, pointing out possibilities of serious side effects. Ketoacidosis (KA) remains one of the most dangerous complications, yet, not fully understood. All of the above urgently requires real-practice data, which may shed some light on side effects of this novel anti-diabetic drug family. Aims: To investigate the real-life rates of hypoglycemia and ketosis (K) in SGLT2i treated patients, using Continuous Glucose Monitoring (CGM) and capillary blood -hydroxybutyrate measurements. Methods: We report the results of a two-year retrospective analysis of 136 Type 2 Diabetes (T2DM) patients, all (100%) treated with a SGLT2i, combined with Metformin or Metformin with Incretin-Based therapy (MT-IBT). CGM recordings were done in 52 perso...
There is a growing body of evidence pointing at several types of motor abnormalities found in att... more There is a growing body of evidence pointing at several types of motor abnormalities found in attention-deficit/hyperactivity disorder (ADHD). In this article we review findings stemming from different paradigms, and suggest an interweaving approach to the different stages involved in the motor regulation process. We start by reviewing various aspects of motor abnormalities found in ADHD and related brain mechanisms. Then, we classify reported motor impairments associated with ADHD, into four classes of motor stages: Attention to the task, motion preparation, motion execution and motion monitoring. Motor abnormalities and corresponding neural activations are analyzed in the context of each of the four identified motor patterns, along with the interactions among them and with other systems. Given the specifications and models of the role of the four motor impairments in ADHD, we ask what treatments correspond to the identified motor impairments. We analyze therapeutic interventions t...
OBJECTIVE: This study was an initial attempt to distinguish between anxiety and depressive PTSD s... more OBJECTIVE: This study was an initial attempt to distinguish between anxiety and depressive PTSD subtypes, according to the dominant symptoms. BACKGROUND: Post-traumatic stress disorder (PTSD), as defined in the DSM-IV which was used for diagnosis of mental disorders during the preparation of the study, belongs to the anxiety disorders spectrum, but often accompanied by depression following stressful and traumatic events. This definition lacks a formal distinction between anxiety and depressive dominant symptoms. Scientific evidence suggests that subjects with comorbid PTSD and depression differ clinically and biologically from subjects exhibiting PTSD or depression alone. This raises the question of whether PTSD and depression are comorbid in the aftermath of trauma or if patients who are diagnosed with both disorders, may in fact exhibit depressive PTSD subtype, compared to subjects presenting anxiety dominant symptoms and therefore should be diagnosed with anxiety PTSD subtype. Accordingly, the current study constructed models for predicting depressive and anxiety PTSD subtypes. DESIGN/METHODS: 62 subjects participated in current study. 23 were diagnosed as having chronic PTSD (of whom 6 were classified with anxiety subtype and 17 with depressive subtype), 14 subjects enrolled in the MDD control group and 25 in the healthy control group, according to a preliminary psychiatric diagnosis. Models classification to the various groups was based on subjects9 responses in a diagnostic battery including questionnaires, neurocognitive tests, as well as skin conductance response and reaction measures in two emotional computerized tasks. RESULTS: Flexible Discriminate Analysis revealed 3 different models supporting the preliminary psychiatric classification. Models prediction accuracy of this classification was 92% to 96.77% in the different models. CONCLUSIONS: The findings support the need to create a separate diagnosis definition of depressive and anxiety PTSD subtypes. This differentiation may help to adjust a unique mental and pharmacological treatment to each subtype of PTSD. Study Supported by: Disclosure: Dr. Ryder has nothing to disclose. Dr. Richter-Levin has nothing to disclose. Dr. Shahien has nothing to disclose.
A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three... more A previously healthy 35-year-old man suffering from behavioral and mental deterioration for three months was referred to our facility. On admission, the patient was dysphasic and had tonic-clonic seizures. Neurological examination showed mental confusion, euphoric mood, mania, paranoia, and mild motor dysphasia. Magnetic resonance imaging (MRI) was performed twice but no abnormalities were revealed. His acute confusional state, elevated cerebrospinal fluid (CSF) protein, epileptic seizure and electroencephalogram showing intermittent frontal slowness were all suggestive of encephalitis. The patient was treated with acyclovir without significant improvement in his condition. Testing for herpes simplex virus and human immunodeficiency virus was negative. Limbic encephalitis was suspected and the patient was treated with intravenous immunoglobulin (IVIG) for five days. Venereal disease research laboratory and Treponema pallidum hemagglutination assay were both tested positive in serum ...
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