[THE COMPLIANCE AND ADHERENCE TO DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH A TRIAL FIBRILLATION AFTER HOSPITALIZATION].

INTRODUCTION: Guidelines recommend direct oral anticoagulants (DOACs) for the treatment of non-valvular atrial fibrillation. The heads of the medicine wards in Beilinson Hospital were nominated for regulatory approval of these agents for Clalit Health Services (CHS) patients. OBJECTIVES: To estimate the short and long term compliance and adherence to DOACs, and their association with the approval during hospitalization. METHODS: A retrospective study was conducted on patients hospitalized at the medical wards of Beilinson Hospital during 2017 and the first 6 months of 2018. Inclusion criteria: age>18 years, members of CHS, have non-valvular atrial fibrillation and DOACs were started during their hospitalization. Data was evaluated for: the rate of approvals during hospitalization, the time needed for it after discharge, the 30 days and 12 months compliance and adherence to DOACs agents and their association with approval during hospitalization. RESULTS: During the study period DOACs were started in 373 patients; 263 (71%) of them were included in the study: 59 patients (23%) received the approval during hospitalization, while 204 (77%) received it after discharge within a median of 3 days (range 1-10). There were no significant differences between the two groups concerning demographic, clinical parameters or length of stay. The DOACs 30-days compliance was 60% and 12-months adherence was 57%. There was a slight association between 30 days compliance and in-hospital approval (63% vs. 57%, p=0.3), while the 12 months adherence revealed the opposite (54% vs. 61%, p=0.5). CONCLUSIONS: The short and long term compliance and adherence to DOACs is poor, regardless of the timing of the regulatory approval. DISCUSSION: These findings represent the real world situation, other studies revealed different results according to the study populations and methods.

Transfer factor of 137Cs and 90Sr to various crops in semi-arid environment.

This study focuses on evaluating the transfer factor (Fv) of 137Cs and 90Sr from two basic soil types in the country, i.e. Aridisol and Inceptisol, to 18 common crops belong to six groups, i.e. cereals, leafy, non-leafy vegetables, tubers, leguminous fodder and leguminous vegetables. In addition, the variation of Fvs of 137Cs and 90Sr with crop components, growth stages of plants and the influence of mineral fertilisation were investigated. The experiments were performed in an open field and the results were expressed as geometric means. The data revealed that Fvs of both radionuclides were higher in Aridisol than Inceptisol for all crops by about 1.03-4.86 fold. Fvs of 90Sr were more enhanced than those of 137Cs by one or two orders of magnitude despite plant group and soil type, e.g. Fvs ranged 0.12-5.2 for 90Sr and 0.0035-0.26 for 137Cs in the vegetative portion of the crops. Among the six crop groups investigated, cereals gave the lowest Fvs for both radionuclides, which is compatible with the data reported worldwide. The average Fvs observed in cereal grains reached 0.001 for 137Cs and 0.017 for 90Sr, in Inceptisol. However, Jew-mallow (one of the major leafy vegetables in the country that is consumed throughout the year) reflected the highest Fvs for 137Cs and 90Sr, i.e. 0.11 and 2.44 in Inceptisol, respectively. Comparing Fvs of the radionuclides through the growing stages of the plants indicated enhanced values at the mid-season than harvest as a consequence of the decrease of the physiological activity of the plants towards maturation and dilution made by the increase of plant biomass; e.g. Fvs dropped to about 3.0 fold for 137Cs and 2.2 for 90Sr, in Aridisol. Mineral fertilisation of soil (for four crops, i.e. sorghum, barley, spinach and alfalfa) reduced Fvs for both radionuclides to an extent of 30% probably because of the competing action of their stable nutrient analogues NH4+, K+ or Ca2+ or because of growth dilution. The data presented herein would form a baseline when decision of land-investment or phytoremediation is the preferable countermeasure for the management of 137Cs and 90Sr-contaminated soil in semi-arid environment.

Assessment of muscle fatigue associated with prolonged standing in the workplace.

OBJECTIVES: The objectives of this study were to determine the psychological fatigue and analyze muscle activity of production workers who are performing processes jobs while standing for prolonged time periods. METHODS: The psychological fatigue experienced by the workers was obtained through questionnaire surveys. Meanwhile, muscle activity has been analyzed using surface electromyography (sEMG) measurement. Lower extremities muscles include: erector spinae, tibialis anterior, and gastrocnemius were concurrently measured for more than five hours of standing. Twenty male production workers in a metal stamping company participated as subjects in this study. The subjects were required to undergo questionnaire surveys and sEMG measurement. RESULTS: Results of the questionnaire surveys found that all subjects experienced psychological fatigue due to prolonged standing jobs. Similarly, muscle fatigue has been identified through sEMG measurement. Based on the non-parametric statistical test using the Spearman's rank order correlation, the left erector spinae obtained a moderate positive correlation and statistically significant (r(s) = 0.552, p < 0.05) between the results of questionnaire surveys and sEMG measurement. CONCLUSION: Based on this study, the authors concluded that prolonged standing was contributed to psychological fatigue and to muscle fatigue among the production workers.

Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study.

OBJECTIVE: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. DESIGN: Prospective, randomized study. SETTING: Ghodran General Hospital, Kingdom of Saudi Arabia. PATIENT(S): One hundred sixty-two infertile male patients with varicocele. INTERVENTION(S): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). MAIN OUTCOME MEASURE(S): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. RESULT(S): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed ≥50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. CONCLUSION(S): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men.

Bilateral versus posterior injection of botulinum toxin in the internal anal sphincter for the treatment of acute anal fissure.

AIM: Comparison of bilateral versus posterior injection of botulinum toxin into the internal anal sphincter for treatment of acute anal fissure. METHODS: Forty patients with acute anal fissure were randomly divided into two equal groups. Group 1 was treated by injecting 20 units of botulinum toxin into each side of the internal anal sphincter, and group 2 by injecting 25 units of botulinum toxin into the midline posteriorly. RESULTS: The mean time to pain relief was 8.45 (standard deviation (SD) 7.41) days in group 1 and 7.20 (SD 7.19) days in group 2. Healing took place in a mean of 5.20 (SD 1.85) weeks in group 1 and 5.40 (SD 2.01) weeks in group 2. Fissures failed to heal in 2 patients in group 1 and 3 in group 2, and recurred in 4 patients in group 1 and 3 in group 2. CONCLUSION: Botulinum toxin injection is effective in treating acute anal fissure. A single posterior injection is easier and less painful than bilateral injection, and is as effective in pain relief.

Skin glue improves outcome after excision and primary closure of sacrococcygeal pilonidal disease.

Evaluating the effect of Histoacryl on the outcome and recurrence rate after excision and primary closure of sacrococcygeal pilonidal disease. Forty patients with sacrococcygeal pilonidal sinus were randomly divided into 2 equal groups through computer randomization program. Group I was operated by complete excision of sinus with wound closure using Histoacryl. Group II was operated with primary wound closure by interrupted inverting sutures. Mean operative time was 31.5 ± 5.6 minutes in group I and 35.9 ± 5.1 minutes in group II. Mean healing time was 13.4 ± 2.7 days in group I and 18.0 ± 8.9 days in group II. Wound infection occurred in 2 patients (10%) in Group II. Delayed wound healing occurred in 3 patients (15%) in group I and 4 patients (20%) in group II. Recurrence occurred in 1 patient (5%) in group I and 3 patients (15%) in group II. Histoacryl improves outcome (significantly decreases operative and healing times and increases patient satisfaction score, insignificantly decreases rates of complications and recurrence) after excision and primary closure of sacrococcygeal pilonidal disease.

Architectural analysis of oral cancer, dysplastic, and normal epithelia.

BACKGROUND: We present a novel, automated, and quantitative approach to evaluate local epithelial tissue architecture based on mathematical graph theory. METHODS: Four hundred forty-one images of three diagnostic classes of oral epithelium (normal, dysplastic, and neoplastic) were analysed. The epithelial compartment was partitioned into exclusive areas associated with each nucleus to approach the theoretical cell extents. The spatial arrangement of cells in neighbourhoods of two sizes was characterised by constructing graph networks based on the cell centroids and recording 29 statistical properties. We analysed 104,627 and 67,590 neighbourhoods of diameters 37.5 and 75 microm, respectively. RESULTS: The discrimination power of the architectural descriptors was evaluated by using discriminant analysis. The best neighbourhood discrimination rate was 75% for normal versus carcinoma. For the pooled data, discrimination into three classes based on largest number of neighbourhoods associated with each class was 100% correct. Case-wise, discrimination rates were 67%, 100%, and 80% correct for normal, premalignant, and malignant. When considering two classes, discrimination rates was 89% (normal) and 100% (malignant) correct, with 71% of premalignant cases assigned to the malignant class. CONCLUSIONS: The results indicate that unbiased and reproducible quantification of tissue architectural features is possible and may provide valuable morphological information for diagnostic purposes.