Yoni Isenberg’s research while affiliated with Rambam Medical Center and other places

Background: Low body mass index (LBMI) was associated with longer colonoscopy procedure time and procedural failure, and commonly considered to be a risk factor for post-endoscopic adverse events, but evidence is lacking. Aim: We aimed to assess the association between serious adverse events (SAE) and LBMI. Methods: A single center retrospective cohort of patients with LBMI (BMI ≤ 18.5) undergoing an endoscopic procedure was matched (1:2 ratio) to a comparator group (19 ≤ BMI ≤ 30). Matching was performed according to age, gender, inflammatory bowel disease or malignancy diagnoses, previous abdomino-pelvic surgery, anticoagulation therapy and type of endoscopic procedure. The primary outcome was SAE, defined as bleeding, perforation, aspiration or infection, following the procedure. The attribution between each SAE and the endoscopic procedure was determined. Secondary outcomes included each complication alone and endoscopy-attributed SAEs. Univariate and multivariate analyses were applied. Results: 1986 patients were included (662 in the LBMI group). Baseline characteristics were mostly similar between the groups. The primary outcome occurred in 31/662 (4.7%) patients in the LBMI group and in 41/1324 (3.1%) patients in the comparator group (p = 0.098). Among the secondary outcomes, infections (2.1% vs. 0.8%, p = 0.016) occurred more frequently in the LBMI group. Multivariate analysis revealed an association between SAE and LBMI (OR 1.76, 95% CI 1.07-2.87), male gender, diagnosis of malignancy, high-risk endoscopic procedure, age > 40 years, and ambulatory setting. Conclusion: Low BMI was associated with higher post-endoscopic serious adverse events. Special attention is required when performing endoscopy in this fragile patient population.

Background: The risk for bacteremia following endoscopic procedures varies among studies. A low neutrophil count is considered as a risk factor. Objective: To assess risk factors for bacteremia following endoscopic procedures, focusing on neutropenia. Methods: This was a retrospective analysis of all inpatients undergoing endoscopic procedures between 2005 and 2018 with neutrophil count taken within 72 hours before the procedure in a tertiary center in Israel. The primary outcome was positive blood culture within 48 hours following the procedure of bacteria that was not cultured before. Risk factors for bacteremia were assessed and multivariate logistic regression models were built. In neutropenic patients, comparator groups were used to assess the risk related to the procedure and neutropenia. Results: Of 13,168 patients included, postprocedural bacteremia was recorded in 103 (0.8%). Neutropenia, low albumin level, male gender, older age, preprocedure fever, and admitting department were associated with increased risk for bacteremia in both univariate and multivariate analyses. A multivariate model including these factors was found to be predictive of bacteremia (area under the curve 0.82; 95% confidence interval, 0.78-0.88). In neutropenic patients, the risk of postendoscopic bacteremia (4.2%) was not significantly different compared with neutropenic patients undergoing bronchoscopy (1.8%, P=0.14) or from the rate of bacteremia-to-neutropenic episodes ("background risk") in neutropenic patients in general (6.3%, P=0.33). Conclusions: Postendoscopic bacteremia is a rare event among inpatients. Although neutropenia was found to be a risk factor for bacteremia, it was not higher than the background risk in these patients. Models highly predictive of bacteremia were developed and should be validated.

COVID-19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short term strenuous workout. This was a multiple cross-over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ±4 years and 28.72 ±3.78 kg/m2, respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end-tidal carbon-dioxide (EtCO2 ) levels. The differences were more prominent as the load increased, reaching 8mmHg at exhaustion (none vs. N95, p=0.001). In conclusion, in healthy subjects, short term moderate-strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO2 . Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with significant mortality, morbidity and increased risk for further exacerbations. Therefore, appropriate measures for prevention of further exacerbations should be initiated before discharge. Unfortunately, this opportunity for treatment review and change in disease course is often missed. We designed a decision support tool to automatically generate discharge recommendations for COPD patients based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report. A pre- and post-intervention study was conducted including data from 24 months before and 18 months after the implementation of the tool. The rate of adherence of the discharge recommendations to the report was measured. Overall, 536 patients were included in the pre-intervention cohort and 367 in the intervention cohort. Demographic and clinical features were similar between the two groups. After introduction of the tool, the percentage of patients discharged with long-acting medications increased from 42% to 84%, recommendations for smoking cessation increased from 32% to 91%, for vaccination from 13% to 92%, and for follow-up visit in a pulmonology clinic from 72% to 98%. Of the patients given prescriptions for long-acting bronchodilators, 54% purchased these after discharge versus 20% of the patients without such prescriptions. Decision-support tools can significantly improve adherence to guidelines among patients discharged after hospitalization due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) and potentially improve their clinical course.

Objectives: The objectives of our study were to determine the effect of strenuous physical training on the prevalence of iron deficiency anemia (IDA), iron deficiency (ID) with normal hemoglobin (Hb), and anemia without ID. Methods: Our study was a prospective observational study. We followed 115 healthy male recruits in the Israel Defense Forces elite units during 15 months of training. Blood samples were collected at recruitment and at 6-, 9- and 15-month follow-ups. Results: Upon recruitment, anemia (Hb < 14 g/dL), ID, and ID anemia (IDA) were diagnosed in 28, 31, and 9% of individuals, respectively. Sixty-three subjects (54%) were followed for 6 months; 9 of them (14%) developed new-onset IDA. Among them, the prevalence of anemia rose from 19 to 52%, and ID from 33 to 35%. At the 15-month follow-up, 29% had developed new-onset IDA and 65% showed evidence of ID. Conclusion: We report a high prevalence of anemia, ID, and IDA among young healthy males participating in prolonged strenuous training programs. These findings can be partly explained by the physiological changes associated with strenuous physical activity. Further investigations aiming to develop specific diagnostic guidelines for this unique population are warranted.