23 results on '"Yitshak Kreiss"'
Search Results
2. Humoral Immunity of Unvaccinated COVID-19 Recovered vs. Naïve BNT162b2 Vaccinated Individuals: A Prospective Longitudinal Study
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Gili Joseph, Carmit Cohen, Carmit Rubin, Havi Murad, Victoria Indenbaum, Keren Asraf, Yael Weiss-Ottolenghi, Gabriella Segal-Lieberman, Yitshak Kreiss, Yaniv Lustig, and Gili Regev-Yochay
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immunoglobulin G ,antibodies ,neutralizing ,immunity ,humoral ,COVID-19 ,Biology (General) ,QH301-705.5 - Abstract
To study the differences in the immune response to SARS-CoV-2 infection compared to the response to vaccination, we characterized the humoral immune kinetics of these situations. In this prospective longitudinal study, we followed unvaccinated COVID-19-recovered individuals (n = 130) and naïve, two-dose BNT162b2-vaccinated individuals (n = 372) who were age- and BMI-matched for six months during the first pandemic year. Anti-RBD-IgG, neutralizing antibodies (NAbs), and avidity were assessed monthly. For recovered patients, data on symptoms and the severity of the disease were collected. Anti-RBD-IgG and NAbs titers at peak were higher after vaccination vs. after infection, but the decline was steeper (peak log IgG: 3.08 vs. 1.81, peak log NAbs: 5.93 vs. 5.04, slopes: −0.54 vs. −0.26). Peak anti-RBD-IgG and NAbs were higher in recovered individuals with BMI > 30 and in older individuals compared to individuals with BMI < 30, younger population. Of the recovered, 42 (36%) experienced long-COVID symptoms. Avidity was initially higher in vaccinated individuals compared with recovered individuals, though with time, it increased in recovered individuals but not among vaccinated individuals. Here, we show that while the initial antibody titers, neutralization, and avidity are lower in SARS-CoV-2-recovered individuals, they persist for a longer duration. These results suggest differential protection against COVID-19 in recovered-unvaccinated vs. naïve-vaccinated individuals.
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- 2023
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3. Remote ischemic preconditioning improves tissue oxygenation in a porcine model of controlled hemorrhage without fluid resuscitation
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Gal Yaniv, Arik Eisenkraft, Lilach Gavish, Linn Wagnert-Avraham, Dean Nachman, Jacob Megreli, Gil Shimon, Daniel Rimbrot, Ben Simon, Asaf Berman, Matan Cohen, David Kushnir, Ruth Shaylor, Baruch Batzofin, Shimon Firman, Amir Shlaifer, Michael Hartal, Yuval Heled, Elon Glassberg, Yitshak Kreiss, and S. David Gertz
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Medicine ,Science - Abstract
Abstract Remote ischemic preconditioning (RIPC) involves deliberate, brief interruptions of blood flow to increase the tolerance of distant critical organs to ischemia. This study tests the effects of limb RIPC in a porcine model of controlled hemorrhage without replacement therapy simulating an extreme field situation of delayed evacuation to definitive care. Twenty-eight pigs (47 ± 6 kg) were assigned to: (1) control, no procedure (n = 7); (2) HS = hemorrhagic shock (n = 13); and (3) RIPC + HS = remote ischemic preconditioning followed by hemorrhage (n = 8). The animals were observed for 7 h after bleeding without fluid replacement. Survival rate between animals of the RIPC + HS group and those of the HS group were similar (HS, 6 of 13[46%]-vs-RIPC + HS, 4 of 8[50%], p = 0.86 by Chi-square). Animals of the RIPC + HS group had faster recovery of mean arterial pressure and developed higher heart rates without complications. They also had less decrease in pH and bicarbonate, and the increase in lactate began later. Global oxygen delivery was higher, and tissue oxygen extraction ratio lower, in RIPC + HS animals. These improvements after RIPC in hemodynamic and metabolic status provide essential substrates for improved cellular response after hemorrhage and reduction of the likelihood of potentially catastrophic consequences of the accompanying ischemia.
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- 2021
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4. Author Correction: Immunogenicity and efficacy of fourth BNT162b2 and mRNA1273 COVID-19 vaccine doses; three months follow-up
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Michal Canetti, Noam Barda, Mayan Gilboa, Victoria Indenbaum, Michal Mandelboim, Tal Gonen, Keren Asraf, Yael Weiss-Ottolenghi, Sharon Amit, Ram Doolman, Ella Mendelson, Dror Harats, Laurence S. Freedman, Yitshak Kreiss, Yaniv Lustig, and Gili Regev-Yochay
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Science - Published
- 2023
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5. Sleep Difficulties Among COVID-19 Frontline Healthcare Workers
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Rony Cleper, Nimrod Hertz-Palmor, Mariela Mosheva, Ilanit Hasson-Ohayon, Rachel Kaplan, Yitshak Kreiss, Arnon Afek, Itai M. Pessach, Doron Gothelf, and Raz Gross
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sleep ,sleep difficulties ,COVID-19 ,health care workers (HCW) ,COVID-19 outbreak ,sleep disorders ,Psychiatry ,RC435-571 - Abstract
ObjectiveTo identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association.MethodsA cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death.ResultsCompared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15–2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11–2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model.Conclusion and RelevanceCOVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.
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- 2022
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6. The Use of Rapid COVID-19 Antigen Test in the Emergency Department as a Decision-Support Tool
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Lilac Meltzer, Sharon Amit, Mayan Gilboa, Ilana Tal, Bella Mechnik, Avi Irony, Hindi Engelrad, Avi Epstein, Yael Frenkel-Nir, Yuval Levy, Yitshak Kreiss, and Gili Regev-Yochay
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COVID-19 ,SARS-CoV-19 ,antigen ,rapid tests ,emergency department ,triage ,Biology (General) ,QH301-705.5 - Abstract
The emergency department (ED) is the initial point of contact between hospital staff and patients potentially infected with SARS-CoV-2, thus, prevention of inadvertent exposure to other patients is a top priority. We aimed to assess whether the introduction of antigen-detecting rapid diagnostic tests (Ag-RDTs) to the ED affected the likelihood of unwanted SARS-CoV-2 exposures. In this retrospective single-center study, we compared the rate of unwarranted exposure of uninfected adult ED patients to SARS-CoV-2 during two separate research periods; one before Ag-RDTs were introduced, and one with Ag-RDT used as a decision-support tool. The introduction of Ag-RDTs to the ED significantly decreased the relative risk of SARS-CoV-2-negative patients being incorrectly assigned to the COVID-19 designated site (“red ED”), by 97%. There was no increase in the risk of SARS-CoV-2-positive patients incorrectly assigned to the COVID-19-free site (“green ED”). In addition, duration of ED admission was reduced in both the red and the green ED. Therefore, implementing the Ag-RDT-based triage protocol proved beneficial in preventing potential COVID-19 nosocomial transmission.
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- 2023
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7. Reduced Neutralization Efficacy against Omicron Variant after Third Boost of BNT162b2 Vaccine among Liver Transplant Recipients
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Yana Davidov, Victoria Indenbaum, Michal Mandelboim, Keren Asraf, Tal Gonen, Keren Tsaraf, Oranit Cohen-Ezra, Mariya Likhter, Ital Nemet, Limor Kliker, Orna Mor, Ram Doolman, Carmit Cohen, Arnon Afek, Yitshak Kreiss, Gili Regev-Yochay, Yaniv Lustig, and Ziv Ben-Ari
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BNT162b2 vaccine ,neutralizing antibody ,third vaccine dose ,liver transplant recipients ,Omicron ,Microbiology ,QR1-502 - Abstract
The immune responses of liver transplant (LT) recipients after the third boost of the BNT162b2mRNA vaccine improved. This study evaluates the durability of the immune response of LT recipients after the third boost, its predictors, and the impact of emerging variants. The receptor-binding domain IgG was determined at median times of 22 (first test) and 133 days (second test) after the administration of the third boost. IgG antibody titers > 21.4 BAU/mL were defined as a positive response. The neutralization efficacies of the vaccine against the wild-type, Omicron, and Delta variants were compared in the first test. The 59 LT recipients were of a median age of 61 years (range 25–82); 53.5% were male. Following administration of the third dose, the positive immune response decreased from 81.4% to 76.3% between the first and second tests, respectively, (p < 0.0001). The multivariate analysis identified CNI monotherapy (p = 0.02) and hemoglobin > 12 g/dL (p = 0.02) as independent predictors of a maintained positive immune response 133 days after the third dose. The geometric mean titers of Omicron neutralization were significantly lower than the wild-type and Delta virus (21, 137, 128, respectively; p < 0.0001). The immune response after the third BNT162b2mRNA vaccine dose decreased significantly in LT recipients. Further studies are required to evaluate the efficacy of the fourth vaccine dose and the durability of the immune response.
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- 2023
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8. High Immune Response Rate to the Fourth Boost of the BNT162b2 Vaccine against the Omicron Variants of Concern among Liver Transplant Recipients
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Yana Davidov, Victoria Indenbaum, Nofar Atari, Limor Kliker, Keren Tsaraf, Keren Asraf, Oranit Cohen-Ezra, Mariya Likhter, Orna Mor, Ram Doolman, Yael Weiss-Ottolenghi, Tammy Hod, Arnon Afek, Yitshak Kreiss, Yaniv Lustig, Gili Regev-Yochay, Michal Mandelboim, and Ziv Ben-Ari
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BNT162b2 mRNA ,fourth dose ,liver transplant recipients ,breakthrough infection ,immune response ,side effects BNT162b2 mRNA vaccine ,Microbiology ,QR1-502 - Abstract
The immune response of liver transplant (LT) recipients to a third dose of the BNT162b2 mRNA vaccine significantly waned after four months. We aimed to evaluate the immune response and breakthrough infection rates of a fourth dose against the Omicron variants among LT recipients. LT recipients who had no past or active SARS-CoV-2 infection and received three doses of the BNT162b2mRNA vaccine were included. Of the 73 LT recipients, 50 (68.5%) received a fourth dose. The fourth dose was associated with a significantly higher positive immune response than the third dose. Receptor-binding domain (RBD) IgG and Omicron BA.1 and BA.2 neutralizing antibodies were determined at a median of 132 and 29 days after the third and fourth vaccines. They were 345 binding antibody units per milliliter (BAU/mL) vs. 2118 BAU/mL (p < 0.0001), 10 vs. 87 (p < 0.0001), and 15 vs. 149 (p = 0.001), respectively. Breakthrough infections were documented among nine (18%) LT recipients after the fourth dose and among seven (30.4%) patients following the third dose (p = 0.2); 93.5% of breakthrough infections were mild. The infection rate after the fourth dose was higher among diabetic vs. nondiabetic recipients (33.3% vs. 6.9%, respectively; p = 0.02). Further studies are needed to evaluate additional factors influencing the breakthrough infection rate among LT recipients.
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- 2022
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9. Real-World Immunogenicity and Reactogenicity of Two Doses of Pfizer-BioNTech COVID-19 Vaccination in Children Aged 5–11 Years
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Gili Joseph, Elisheva Klein, Yaniv Lustig, Yael Weiss-Ottolenghi, Keren Asraf, Victoria Indenbaum, Sharon Amit, Or Kriger, Mayan Gilboa, Yuval Levy, Itai M. Pessach, Yitshak Kreiss, Gili Regev-Yochay, and Michal Stein
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COVID-19 ,antibodies ,children ,vaccines ,immunogenicity ,reactogenicity ,Medicine - Abstract
There are limited data concerning the immunogenicity and reactogenicity of COVID-19 vaccines in children. A total of 110 children, 5–11 years old were vaccinated with two doses (with a 3-week interval between doses) of the Pfizer-BioNTech COVID-19 vaccine and were followed for 21, 90, and 180 days after vaccination for immunogenicity, adverse events, and breakthrough infections. Ninety days after the first vaccine dose, the GeoMean (CI 95%) of IgG ascended to 1291.0 BAU (929.6–1790.2) for uninfected children and 1670.0 BAU (1131.0–2466.0) for Infected children. One hundred and eighty days after receiving the first dose of the vaccine, the titers decreased to 535.5 BAU (288.4–993.6) for the uninfected children, while only a small decline was detected among infected children—1479.0 (878.2–2490.0). The neutralizing antibodies titer almost did not change over time in the uninfected children, and even elevated for the infected children. Of the 110 vaccinated children, 75.5% were infected, with only mild COVID-19 infection symptoms. Child vaccination was found to be safe, with mild, mostly local, and of short duration, reported AEs. No serious adverse events (SAEs) were reported after vaccination. The durability of two doses of vaccine in children is longer, thus a booster may not be needed as early as in adults.
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- 2022
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10. Decreased infectivity following BNT162b2 vaccination: A prospective cohort study in Israel
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Gili Regev-Yochay, Sharon Amit, Moriah Bergwerk, Marc Lipsitch, Eyal Leshem, Rebecca Kahn, Yaniv Lustig, Carmit Cohen, Ram Doolman, Arnona Ziv, Ilya Novikov, Carmit Rubin, Irena Gimpelevich, Amit Huppert, Galia Rahav, Arnon Afek, and Yitshak Kreiss
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Public aspects of medicine ,RA1-1270 - Abstract
Background: BNT162b2 was shown to be 92% effective in preventing COVID-19. Prioritizing vaccine rollout, and achievement of herd immunity depend on SARS-CoV-2 transmission reduction. The vaccine's effect on infectivity is thus a critical priority. Methods: Among all 9650 HCW of a large tertiary medical center in Israel, we calculated the prevalence of positive SARS-CoV-2 qRT-PCR cases with asymptomatic presentation, tested following known or presumed exposure and the infectious subset (N-gene-Ct-value
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- 2021
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11. Buying Time with COVID-19 Outbreak Response, Israel
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Eyal Leshem, Arnon Afek, and Yitshak Kreiss
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containment ,Israel ,COVID-19 ,travel restrictions ,respiratory infections ,severe acute respiratory syndrome coronavirus 2 ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February–April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.
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- 2020
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12. Anxiety and Depression Symptoms in COVID-19 Isolated Patients and in Their Relatives
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Shirel Dorman-Ilan, Nimrod Hertz-Palmor, Ayelet Brand-Gothelf, Ilanit Hasson-Ohayon, Noam Matalon, Raz Gross, Wendy Chen, Ayelet Abramovich, Arnon Afek, Amitai Ziv, Yitshak Kreiss, Itai M. Pessach, and Doron Gothelf
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anxiety ,depression ,COVID-19 ,patients ,relatives ,children ,Psychiatry ,RC435-571 - Abstract
Background: While focusing on the management and care of COVID-19 patients, the mental health of these patients and their relatives is being overlooked. The aim of the current study was to measure anxiety and depression, and to assess their association with socio-demographic and pandemic-related stress factors in COVID-19 patients and their relatives during the initial stage of hospitalization.Methods: We assessed isolated hospitalized patients (N = 90) and their relatives (adults and children, N = 125) by phone, 25–72 h following patients' admission. The quantitative measures included the Anxiety and Depression modules of the Patient-Reported Outcomes Measurement Information System (PROMIS) and pandemic-related stress factors. Qualitative measures included questions exploring worries, sadness, and coping modes.Results: Both patients and relatives suffer from high levels of anxiety and related pandemic worries, with lower levels of depressive symptoms. Compared to adult relatives, child relatives reported significantly lower anxiety. The multivariable logistic regression analysis revealed an increased risk for anxiety among females and a decreased risk among ultra-orthodox participants. While increased anxiety among patients was associated with feelings of isolation, increased anxiety among relatives was associated with a feeling of not being protected by the hospital.Conclusions: Patients and relatives experience similar high anxiety levels which are more robust in women and lower in ultra-orthodox participants. Our findings indicate that anxiety symptoms of both patients and adult relatives should be addressed.
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- 2020
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13. Qual a Contribuiçao do Tilt Training (treinamento postural) na Prevençao da Síncope Vasovagal?
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Osnat GUREVITZ, Alon BARSHESHET, David BAR-LEV, Eyal ZIMLICHMAN, Gail F. ROSENFELD, Michal BENDERLY, David LURIA, Howard AMITAL, Yitshak KREISS, Michael ELDAR, and Michael GLIKSON
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clinico, técnicas nao-invasivas - teste de head-up tilt, síncope vasovagal, síncope, prevençao, treinamento postural ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Histórico: A síncope vasovagal é um dos quadros clínicos mais comuns em adultos jovens. Estudos anteriores demonstram a eficiência do tilt training (treinamento postural) no tratamento desse transtorno clínico. Realizou-se um estudo prospectivo e randomizado com o objetivo de avaliar a contribuiçao do tilt training no tratamento de adultos jovens acometidos pela síncope vasovagal. Métodos: Quarenta e seis soldados, 25 dos quais do sexo masculino, média de idade de 19,4 ± 0,8 anos e diagnóstico clínico de síncope vasovagal pelo tilt test, foram divididos aleatoriamente em dois grupos: um grupo controle e outro submetido a tilt training diariamente, por três meses. Nos dois grupos, os participantes foram instruídos a aumentar a ingestao de líquidos e sal e evitar situaçoes indutoras da síncope, tais como permanecer em pé por períodos longos. Resultados: A adesao ao programa de treinamento, caracterizada pela realizaçao de 50% ou mais das sessoes diárias de tilt training, foi de 91% durante o primeiro mês, caindo para 58% nos três meses. Os que realizaram o treinamento apresentaram uma média (distância interquartílica) de 5,0 episódios de síncope (0,5 a 16,0) durante um ano de acompanhamento, enquanto o grupo controle apresentou média de 2,0 episódios (0 a 6,0; P = 0,737). Após a randomizaçao, nao houve diferença significativa no tempo de ocorrência do primeiro episódio de síncope entre os dois grupos: média de 1,0 por mês (0,5 a 2,0) no grupo em tratamento e 0,8 (0,5 a 2,0) no grupo controle (P = 0,336). Conclusoes: A realizaçao diária do tilt training, aliada às modificaçoes de estilo de vida, nao produziu melhora no resultado do tratamento de adultos jovens com síncope vasovagal. Verificou-se ainda a dificuldade de obter boa adesao ao programa de treinamento postural.
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- 2008
14. Humoral Immunity of Unvaccinated COVID-19 Recovered vs. Naïve BNT162b2 Vaccinated Individuals: A Prospective Longitudinal Study
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Regev-Yochay, Gili Joseph, Carmit Cohen, Carmit Rubin, Havi Murad, Victoria Indenbaum, Keren Asraf, Yael Weiss-Ottolenghi, Gabriella Segal-Lieberman, Yitshak Kreiss, Yaniv Lustig, and Gili
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immunoglobulin G ,antibodies ,neutralizing ,immunity ,humoral ,COVID-19 ,infection ,BNT162b2 vaccine - Abstract
To study the differences in the immune response to SARS-CoV-2 infection compared to the response to vaccination, we characterized the humoral immune kinetics of these situations. In this prospective longitudinal study, we followed unvaccinated COVID-19-recovered individuals (n = 130) and naïve, two-dose BNT162b2-vaccinated individuals (n = 372) who were age- and BMI-matched for six months during the first pandemic year. Anti-RBD-IgG, neutralizing antibodies (NAbs), and avidity were assessed monthly. For recovered patients, data on symptoms and the severity of the disease were collected. Anti-RBD-IgG and NAbs titers at peak were higher after vaccination vs. after infection, but the decline was steeper (peak log IgG: 3.08 vs. 1.81, peak log NAbs: 5.93 vs. 5.04, slopes: −0.54 vs. −0.26). Peak anti-RBD-IgG and NAbs were higher in recovered individuals with BMI > 30 and in older individuals compared to individuals with BMI < 30, younger population. Of the recovered, 42 (36%) experienced long-COVID symptoms. Avidity was initially higher in vaccinated individuals compared with recovered individuals, though with time, it increased in recovered individuals but not among vaccinated individuals. Here, we show that while the initial antibody titers, neutralization, and avidity are lower in SARS-CoV-2-recovered individuals, they persist for a longer duration. These results suggest differential protection against COVID-19 in recovered-unvaccinated vs. naïve-vaccinated individuals.
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- 2023
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15. Decreased infectivity following BNT162b2 vaccination: A prospective cohort study in Israel
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Amit Huppert, Arnon Afek, Yaniv Lustig, Galia Rahav, Arnona Ziv, Sharon Amit, Eyal Leshem, Yitshak Kreiss, Carmit Rubin, Ilya Novikov, Ram Doolman, Rebecca Kahn, Gili Regev-Yochay, Moriah Bergwerk, Irena Gimpelevich, Carmit Cohen, and Marc Lipsitch
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Infectivity ,medicine.medical_specialty ,business.industry ,Transmission (medicine) ,Health Policy ,Incidence (epidemiology) ,Asymptomatic ,Herd immunity ,Vaccination ,Oncology ,Internal medicine ,Internal Medicine ,medicine ,Viral shedding ,medicine.symptom ,Public aspects of medicine ,RA1-1270 ,Prospective cohort study ,business ,Research Paper - Abstract
Background: BNT162b2 was shown to be 92% effective in preventing COVID-19. Prioritizing vaccine rollout, and achievement of herd immunity depend on SARS-CoV-2 transmission reduction. The vaccine's effect on infectivity is thus a critical priority. Methods: Among all 9650 HCW of a large tertiary medical center in Israel, we calculated the prevalence of positive SARS-CoV-2 qRT-PCR cases with asymptomatic presentation, tested following known or presumed exposure and the infectious subset (N-gene-Ct-value
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- 2021
16. BNT162b2 COVID-19 vaccine and correlates of humoral immune responses and dynamics: a prospective, single-centre, longitudinal cohort study in health-care workers
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Laurence S. Freedman, Carmit Cohen, Amit Huppert, Sharon Amit, Liraz Olmer, Ram Doolman, Yitshak Kreiss, Gili Regev-Yochay, Ella Mendelson, Einav Sapir, Arnona Ziv, Victoria Indenbaum, Michal Mandelboim, Ronen Fluss, Carmit Rubin, and Yaniv Lustig
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Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,COVID-19 Vaccines ,Adolescent ,Health Personnel ,medicine.medical_treatment ,Antibodies, Viral ,Serology ,Young Adult ,03 medical and health sciences ,Immunogenicity, Vaccine ,0302 clinical medicine ,Immunity ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Prospective Studies ,030212 general & internal medicine ,Israel ,Young adult ,Prospective cohort study ,Pandemics ,BNT162 Vaccine ,Aged ,Aged, 80 and over ,biology ,SARS-CoV-2 ,business.industry ,Vaccination ,Comment ,COVID-19 ,Immunosuppression ,Articles ,Middle Aged ,Antibodies, Neutralizing ,Immunity, Humoral ,Policy ,030228 respiratory system ,biology.protein ,Population study ,Female ,Antibody ,business ,Follow-Up Studies - Abstract
Summary Background Concurrent with the Pfizer–BioNTech BNT162b2 COVID-19 vaccine roll-out in Israel initiated on Dec 19, 2020, we assessed the early antibody responses and antibody kinetics after each vaccine dose in health-care workers of different ages and sexes, and with different comorbidities. Methods We did a prospective, single-centre, longitudinal cohort study at the Sheba Medical Centre (Tel-Hashomer, Israel). Eligible participants were health-care workers at the centre who had a negative anti-SARS-CoV-2 IgG assay before receiving the first dose of the intramuscular vaccine, and at least one serological antibody test after the first dose of the vaccine. Health-care workers with a positive SARS-CoV-2 PCR test before vaccination, a positive anti-SARS-CoV-2 IgG serology test before vaccination, or infection with COVID-19 after vaccination were excluded from the study. Participants were followed up weekly for 5 weeks after the first vaccine dose; a second dose was given at week 3. Serum samples were obtained at baseline and at each weekly follow-up, and antibodies were tested at 1–2 weeks after the first vaccine dose, at week 3 with the administration of the second vaccine dose, and at weeks 4–5 (ie, 1–2 weeks after the second vaccine dose). Participants with comorbidities were approached to participate in an enriched comorbidities subgroup, and at least two neutralising assays were done during the 5 weeks of follow-up in those individuals. IgG assays were done for the entire study population, whereas IgM, IgA, and neutralising antibody assays were done only in the enriched comorbidities subgroup. Concentrations of IgG greater than 0·62 sample-to-cutoff (s/co) ratio and of IgA greater than 1·1 s/co, and titres of neutralising antibodies greater than 10 were considered positive. Scatter plot and correlation analyses, logistic and linear regression analyses, and linear mixed models were used to investigate the longitudinal antibody responses. Findings Between Dec 19, 2020, and Jan 30, 2021, we obtained 4026 serum samples from 2607 eligible, vaccinated participants. 342 individuals were included in the enriched comorbidities subgroup. The first vaccine dose elicited positive IgG and neutralising antibody responses at week 3 in 707 (88·0%) of 803 individuals, and 264 (71·0%) of 372 individuals, respectively, which were rapidly increased at week 4 (ie, 1 week after the second vaccine dose) in 1011 (98·4%) of 1027 and 357 (96·5%) of 370 individuals, respectively. Over 4 weeks of follow-up after vaccination, a high correlation (r=0·92) was detected between IgG against the receptor-binding domain and neutralising antibody titres. First-dose induced IgG response was significantly lower in individuals aged 66 years and older (ratio of means 0·25, 95% CI 0·19–0·31) and immunosuppressed individuals (0·21, 0·14–0·31) compared with individuals aged 18·00–45·99 years and individuals with no immunosuppression, respectively. This disparity was partly abrogated following the second dose. Overall, endpoint regression analysis showed that lower antibody concentrations were consistently associated with male sex (ratio of means 0·84, 95% CI 0·80–0·89), older age (ie, ≥66 years; 0·64, 0·58–0·71), immunosuppression (0·44, 0·33–0·58), and other specific comorbidities: diabetes (0·88, 0·79–0·98), hypertension (0·90, 0·82–0·98), heart disease (0·86, 0·75–1·00), and autoimmune diseases (0·82, 0·73–0·92). Interpretation BNT162b2 vaccine induces a robust and rapid antibody response. The significant correlation between receptor-binding domain IgG antibodies and neutralisation titres suggests that IgG antibodies might serve as a correlate of neutralisation. The second vaccine dose is particularly important for older and immunosuppressed individuals, highlighting the need for timely second vaccinations and potentially a revaluation of the long gap between doses in some countries. Antibody responses were reduced in susceptible populations and therefore they might be more prone to breakthrough infections. Funding Sheba Medical Center, Israel Ministry of Health.
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- 2021
17. Anxiety and Depression Symptoms in COVID-19 Isolated Patients and in Their Relatives
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Arnon Afek, Itai M. Pessach, Wendy Chen, Yitshak Kreiss, Amitai Ziv, Doron Gothelf, Nimrod Hertz-Palmor, Raz Gross, Noam Matalon, Ilanit Hasson-Ohayon, Ayelet Brand-Gothelf, Ayelet Abramovich, and Shirel Dorman-Ilan
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relatives ,Coping (psychology) ,Coronavirus disease 2019 (COVID-19) ,Hospitalized patients ,lcsh:RC435-571 ,media_common.quotation_subject ,Logistic regression ,patients ,03 medical and health sciences ,0302 clinical medicine ,children ,lcsh:Psychiatry ,Medicine ,media_common ,Psychiatry ,business.industry ,COVID-19 ,Brief Research Report ,anxiety ,Mental health ,030227 psychiatry ,Sadness ,Psychiatry and Mental health ,Feeling ,depression ,Anxiety ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Clinical psychology - Abstract
Background: While focusing on the management and care of COVID-19 patients, the mental health of these patients and their relatives is being overlooked. The aim of the current study was to measure anxiety and depression, and to assess their association with socio-demographic and pandemic-related stress factors in COVID-19 patients and their relatives during the initial stage of hospitalization. Methods: We assessed isolated hospitalized patients (N = 90) and their relatives (adults and children, N = 125) by phone, 25-72 h following patients' admission. The quantitative measures included the Anxiety and Depression modules of the Patient-Reported Outcomes Measurement Information System (PROMIS) and pandemic-related stress factors. Qualitative measures included questions exploring worries, sadness, and coping modes. Results: Both patients and relatives suffer from high levels of anxiety and related pandemic worries, with lower levels of depressive symptoms. Compared to adult relatives, child relatives reported significantly lower anxiety. The multivariable logistic regression analysis revealed an increased risk for anxiety among females and a decreased risk among ultra-orthodox participants. While increased anxiety among patients was associated with feelings of isolation, increased anxiety among relatives was associated with a feeling of not being protected by the hospital. Conclusions: Patients and relatives experience similar high anxiety levels which are more robust in women and lower in ultra-orthodox participants. Our findings indicate that anxiety symptoms of both patients and adult relatives should be addressed.
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- 2020
18. Anxiety, pandemic‐related stress and resilience among physicians during the COVID‐19 pandemic
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Shirel Dorman Ilan, Itai M. Pessach, Doron Gothelf, Yitshak Kreiss, Arnon Afek, Nimrod Hertz-Palmor, Raz Gross, Mariela Mosheva, Noam Matalon, and Amitai Ziv
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Male ,Coronavirus disease 2019 (COVID-19) ,media_common.quotation_subject ,Health Personnel ,Pneumonia, Viral ,Anxiety ,03 medical and health sciences ,Betacoronavirus ,stress ,0302 clinical medicine ,COVID‐19 ,Physicians ,Pandemic ,Sleep difficulties ,Stress (linguistics) ,Medicine ,Humans ,Pandemics ,resilience ,Research Articles ,media_common ,business.industry ,Depression ,SARS-CoV-2 ,Potential effect ,COVID-19 ,Workload ,Resilience, Psychological ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Female ,Psychological resilience ,medicine.symptom ,business ,Coronavirus Infections ,030217 neurology & neurosurgery ,mental health ,Clinical psychology ,Research Article - Abstract
Background Physicians play a crucial frontline role in the COVID‐19 pandemic, which may involve high levels of anxiety. We aimed to investigate the association between pandemic‐related stress factors (PRSF) and anxiety and to evaluate the potential effect of resilience on anxiety among physicians. Methods A self‐report digital survey was completed by 1106 Israeli physicians (564 males and 542 females) during the COVID‐19 outbreak. Anxiety was measured by the 8‐item version of the Patient‐Reported Outcomes Measurement Information System. Resilience was evaluated by the 10‐item Connor–Davidson Resilience Scale. Stress was assessed using a PRSF inventory. Results Physicians reported high levels of anxiety with a mean score of 59.20 ± 7.95. We found an inverse association between resilience and anxiety. Four salient PRSF (mental exhaustion, anxiety about being infected, anxiety infecting family members, and sleep difficulties) positively associated with anxiety scores. Conclusions Our study identified specific PRSF including workload burden and fear of infection that are associated with increased anxiety and resilience that is associated with reduced anxiety among physicians.
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- 2020
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19. Military Medicine Publications: What has Happened in the Past Two Decades?
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Moshe Pinkert, Michael Huerta-Hartal, Nirit Yavnai, David Dagan, Yitshak Kreiss, and Francis B. Mimouni
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Original Paper ,Operations research ,business.industry ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Medical information ,Phase (combat) ,publication types ,Military medicine ,law.invention ,Systematic review ,trend ,Randomized controlled trial ,law ,Medical technology ,Medicine ,R855-855.5 ,Scholarly work ,business ,military medicine ,Medical literature ,Demography ,Publication types - Abstract
Background: Military medical personnel, like all other physician specialists, face the challenge of keeping updated with developments in their field of expertise, in view of the great amount of new medical information published in the literature. The availability of the Internet has triggered tremendous changes in publication characteristics, and in some fields, the number of publications has increased substantially. The emergence of electronic open access journals and the improvement in Web search engines has triggered a significant change in the publication processes and in accessibility of information. Objective: The objective of this study was to characterize the temporal trends in the number and types of publications in military medicine in the medical literature. Methods: We searched all PubMed-registered publications from January 1, 1990 to December 31, 2010 using the keywords “military” or “army”. We used the publication tag in PubMed to identify and examine major publication types. The trends were tested using the Mann-Kendall test for trend. Results: Our search yielded 44,443 publications in military medicine during the evaluation period. Overall, the number of publications showed two distinct phases over time: (1) a moderate increase from 1990 to 2001 with a mean annual increase of 2.78% ( r 2 =.79, P
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- 2014
20. Smoking habits in adolescents with mild to moderate asthma.
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Eyal Zimlichman, Dror Mandel, Francis B. Mimouni, Tzippora Shochat, Itamar Grotto, and Yitshak Kreiss
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- 2004
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21. Quality assessment program in primary care clinics: a tool for quality improvement.
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Dror Mandel, Howard Amital, Eyal Zimlichman, Robert Wartenfeld, Lilach Benyamini, Tzippora Shochat, Francis B. Mimouni, and Yitshak Kreiss
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- 2004
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22. Effective medical leadership in times of emergency: a perspective
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Yitshak Kreiss, Oded Hershkovich, David Gilad, and Eyal Zimlichman
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business.industry ,media_common.quotation_subject ,Perspective (graphical) ,Poison control ,Human factors and ergonomics ,030208 emergency & critical care medicine ,Review ,Public relations ,Power (social and political) ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Perception ,Conceptual model ,Medicine ,030212 general & internal medicine ,Personal experience ,business ,Set (psychology) ,media_common - Abstract
Leadership, and more specifically medical leadership, is an unmeasured potential that has the power to influence every aspect of a person’s professional life and its challenges and is more evident in times of emergency. Medical leadership is receiving increasing recognition especially in discussing actions to be taken in times of stress and emergency. We propose a comprehensive conceptual model that examines the elements that build successful medical leadership, especially during emergency scenarios. The model is based on two sets of medical leadership capabilities and skills, while the first set is more relevant to everyday challenges, the second set represents abilities and characteristics that arise mostly during emergencies. The model gathers together the characteristics and abilities of the medical leader based on our unique personal experiences during conflicts, terror, civilian challenges and numerous humanitarian missions. This article suggests a framework for the foundations on which the medical leader’s education should be built and describes our perception of how to establish medical leadership, its unique elements and the processes leading to outstanding performance in times of emergency.
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23. Augmentation of point of injury care: Reducing battlefield mortality-The IDF experience.
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Benov Avi, null, Elon, Glassberg, Baruch, Erez Nissim, Avi, Shina, Gilad, Twig, Moran, Levi, Itay, Zoarets, Ram, Sagi, Tarif, Bader, David, Dagan, Avraham, Yitzhak, Yitshak, Kreiss, and Benov Avi
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BATTLEFIELDS , *TRAUMATOLOGY , *WOUNDS & injuries , *MEDICAL care , *PUBLIC health , *WOUND care , *CIVIL defense , *CLINICAL medicine , *DISASTERS , *INFORMATION storage & retrieval systems , *MEDICAL databases , *MASS casualties , *MEDICAL protocols , *MILITARY medicine , *MILITARY personnel , *TRAUMA severity indices - Abstract
Study Objective: In 2012, the Israel Defense Forces Medical Corps (IDF-MC) set a goal of reducing mortality and eliminating preventable death on the battlefield. A force buildup plan entitled "My Brother's Keeper" was launched addressing: trauma medicine, training, change of Clinical Practice Guidelines (CPGs), injury prevention, data collection, global collaboration and more. The aim of this article is to examine how military medical care has evolved due "My Brother's Keeper" between Second Lebanon War (SLW, 2006) to Operation Protective Edge (OPE, 2014).Methods: Records of all casualties during OPE and SLW were extracted and analyzed from the I.D.F Trauma Registry. Noncombat injuries and civilian injuries from missile attacks were excluded from this analysis.Results: The plans main impacts were; incorporation of a physician or paramedic as an integral part of each fighting company, implementation of new CPGs, introduction of new approaches for extremity haemorrhage control and Remote Damage Control Resuscitation at point of injury (POI) using single donor reconstituted freeze dried plasma (25 casualties) and transexamic acid (98 casualties). During OPE, 704 soldiers sustained injuries compared with 833 casualties during SLW. Fatalities were 65 and 119, respectively, cumulating to Case Fatality Rate of 9.2% and 14.3%, respectively.Conclusions: Significant changes in the way the IDF-MC provides combat casualty care have been made in recent years. It is the transformation from concept to doctrine and integration into a structured and Goal-Oriented Casualty Care System, especially POI care that led to the unprecedented survival rates in IDF as shown in this conflict. [ABSTRACT FROM AUTHOR]- Published
- 2016
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