Ilan Youngster | Assaf Harofeh Medical Center (original) (raw)

Papers by Ilan Youngster

JAMA

On January 18, 2020, the Centers for Disease Control and Prevention (CDC) reported the first conf... more On January 18, 2020, the Centers for Disease Control and Prevention (CDC) reported the first confirmed case of COVID-19 in the US. 1 Since then, in only 2.5 years, the global pandemic has resulted in 588 757 628 confirmed cases of COVID-19 and 6 433 794 deaths (as of August 8, 2022). 2 While the world is (once again) gradually reopening, the lingering social and economic effects of the pandemic are clearly felt, with national lockdowns and school closures still ongoing in 23 countries. Furthermore, the World Health Organization (WHO) recently forecasted a new wave of COVID-19, predicted to peak in the autumn and winter months, suggesting the potential need to reinstate disruptive measures in the northern hemisphere. Preparing for the future, the WHO released its autumn/ winter strategy for COVID-19, emphasizing the central role of diagnostics in counteracting the pandemic. Specifically, the organization recommended that countries should strengthen "laboratory capacities to ensure reliable rapid diagnostic SARS-CoV-2 detection and tracking of variants, complemented by continued population use of rapid diagnostic testing; [integrate] population-based surveillance systems for influenza, SARS-CoV-2 and other respiratory viruses to monitor the spread and intensity of respiratory viruses; [and prioritize] contact tracing and quarantining based on WHO recommendations for individuals, high-risk settings and situations of concern." 3 While reliable innovative diagnostic tests to detect SARS-CoV-2 were rapidly developed in the past 2 years, sampling has remained a major limiting factor, especially in settings where large-scale testing of symptomatic and asymptomatic populations are needed. The need for dedicated health care workers (HCWs), fitted with personal protective equipment, some of which has to be discarded between patients, has hampered implementation of mass screening. Sampling is time consuming, expensive, and exposes the HCW to potential transmission from patients. To address this barrier, several studies in adults have evaluated the use of self-collected samples for SARS-CoV-2 molecular testing and have demonstrated 93% to 97% concordance rates with standard swabs obtained by HCWs. 4-7 In this issue of JAMA, the study by Waggoner et al 8 further expands this knowledge by showing that school-aged children are capable of reliable selfsampling using nasal swabs. The authors enrolled children from kindergarten through eighth grade who were referred for SARS-CoV-2 testing due to symptoms compatible with COVID-19. The participants were shown a short instructional video demonstrating how to selfswab and were provided with an instructional pictorial hand

The Israel Medical Association journal : IMAJ, 2020

MMWR. Morbidity and Mortality Weekly Report, 2021

On February 26, 2021, this report was posted as an MMWR Early Release on the MMWR website (https:... more On February 26, 2021, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). The availability of COVID-19 vaccines represents an opportunity to mitigate the effects of the global pandemic. Achieving high vaccination coverage through intensive vaccination campaigns has the potential to substantially reduce COVID-19-associated morbidity and mortality. Clinical trials have demonstrated the efficacy of COVID-19 vaccines in preventing mild and severe COVID-19 in a controlled setting. However, clinical trials are not designed to assess the population impact of vaccination in a real-world setting (1,2). Israel initiated a national vaccination campaign using the Pfizer-BioNTech BNT162b2 (Pfizer-BioNTech) vaccine in December 2020, prioritizing persons aged >60 years, health care workers, and persons with underlying medical conditions. By February 2021, 2-dose vaccination coverage among persons aged ≥70 years was 84%. To assess the effect of COVID-19 vaccination on the occurrence of severe disease, an ecological study was conducted. Requiring mechanical ventilation was used as a proxy for severe COVID-19. The number of COVID-19 patients aged ≥70 years (who had the highest 2-dose vaccination coverage, 84.3%) requiring mechanical ventilation was compared with that of patients aged <50 years, who had the lowest 2-dose vaccination coverage (9.9%). Since implementation of the second dose of the vaccination campaign, the ratio of COVID-19 patients requiring mechanical ventilation aged ≥70 years to those aged <50 years has declined 67%, from 5.8:1 during October-December 2020 to 1.9:1 in February 2021. These findings provide preliminary evidence of the effectiveness of vaccines in preventing severe cases of COVID-19 at the national level in Israel. Receipt of COVID-19 vaccines by eligible persons can help limit spread of disease and potentially reduce the occurrence of severe disease. The first case of COVID-19 in Israel, a country with a population of approximately 9 million, was reported in February 2020. As of February 9, 2021, approximately 700,000 cases and 5,200 deaths had been reported (3). Nonpharmaceutical interventions have included three national stay-at-home orders, † multiple rounds of school closures, restrictions on commercial activity and travel, and a mask mandate, among others. The most recent

Heart, 2020

BackgroundA Mediterranean diet is favourable for cardiometabolic risk.ObjectiveTo examine the res... more BackgroundA Mediterranean diet is favourable for cardiometabolic risk.ObjectiveTo examine the residual effect of a green Mediterranean diet, further enriched with green plant-based foods and lower meat intake, on cardiometabolic risk.MethodsFor the DIRECT-PLUS parallel, randomised clinical trial we assigned individuals with abdominal obesity/dyslipidaemia 1:1:1 into three diet groups: healthy dietary guidance (HDG), Mediterranean and green Mediterranean diet, all combined with physical activity. The Mediterranean diets were equally energy restricted and included 28 g/day walnuts. The green Mediterranean diet further included green tea (3–4 cups/day) and a Wolffia globosa (Mankai strain; 100 g/day frozen cubes) plant-based protein shake, which partially substituted animal protein. We examined the effect of the 6-month dietary induction weight loss phase on cardiometabolic state.ResultsParticipants (n=294; age 51 years; body mass index 31.3 kg/m2; waist circumference 109.7 cm; 88% men...

Gut, 2021

ObjectiveTo examine the effectiveness of green-Mediterranean (MED) diet, further restricted in re... more ObjectiveTo examine the effectiveness of green-Mediterranean (MED) diet, further restricted in red/processed meat, and enriched with green plants and polyphenols on non-alcoholic fatty liver disease (NAFLD), reflected by intrahepatic fat (IHF) loss.DesignFor the DIRECT-PLUS 18-month randomized clinical trial, we assigned 294 participants with abdominal obesity/dyslipidaemia into healthy dietary guidelines (HDG), MED and green-MED weight-loss diet groups, all accompanied by physical activity. Both isocaloric MED groups consumed 28 g/day walnuts (+440 mg/day polyphenols provided). The green-MED group further consumed green tea (3–4 cups/day) and Mankai (a Wolffia globosa aquatic plant strain; 100 g/day frozen cubes) green shake (+1240 mg/day total polyphenols provided). IHF% 18-month changes were quantified continuously by proton magnetic resonance spectroscopy (MRS).ResultsParticipants (age=51 years; 88% men; body mass index=31.3 kg/m2; median IHF%=6.6%; mean=10.2%; 62% with NAFLD) h...

BackgroundInfluenza vaccination aims to prevent infection by influenza virus and reduce associate... more BackgroundInfluenza vaccination aims to prevent infection by influenza virus and reduce associated morbidity and mortality; however, vaccine effectiveness (VE) can be modest, especially for subtype A/H3N2. Failure to achieve consistently high VE has been attributed both to mismatches between the vaccine and circulating influenza strains and to the vaccine's elicitation of protective immunity in only a subset of the population. The low H3N2 VE in 2012-13 was attributed to egg-adaptive mutations that created antigenic mismatch between the intended (A/Victoria/361/2011) and actual vaccine strain (IVR-165).MethodsWe investigate the basis of the low VE in 2012-2013 by evaluating whether vaccinated and unvaccinated individuals were infected by different viral strains and assessing the serologic responses to A/Victoria/361/2011 and the IVR-165 vaccine strain in an adult cohort before and after vaccination.ResultsWe found no significant genetic differences between the strains that infec...

Acta Paediatrica, 2020

Aim: To investigate whether there are common clinical findings in bacteremic children that were d... more Aim: To investigate whether there are common clinical findings in bacteremic children that were discharged from the emergency department (ED) and to follow their clinical outcome. Methods: A retrospective chart review of children above one month old with positive blood cultures obtained in Shamir Medical Center's ED between January 2011 and December 2019 was conducted. Results: 250 cases were analysed, of which 68 discharged after first evaluation. Streptococcus pneumonia was the most commonly isolated pathogen. Compared to children that were admitted when first evaluated in the ED, discharged children had lower C-reactive protein (mean 50.5 ±62.8 vs 121.7 ±113.2 mg/L, p<0.001). Dyspnoea and being ill-looking were less prevalent among the latter (6.7% versus 35.1%, p=<0.001, 3.0% versus 22.2% p<0.001, respectively), as were presence of Kingella kingae and other gram-negative bacteria. Of the children hospitalised in our institution, the duration of hospitalization was significantly lower than in those admitted during the first visit (6.3± 4.3 vs 9.0±7.4 days, p=0.002). None of the discharged children were admitted to paediatric intensive care unit. Conclusion: Children with bacteraemia who were discharged home before knowing their positive blood cultures results had lower C-reactive protein and better outcome compared to those admitted on first evaluation in emergency department.

Genome Medicine, 2022

Background Previous studies have linked the Mediterranean diet (MED) with improved cardiometaboli... more Background Previous studies have linked the Mediterranean diet (MED) with improved cardiometabolic health, showing preliminary evidence for a mediating role of the gut microbiome. We recently suggested the Green-Mediterranean (Green-MED) diet as an improved version of the healthy MED diet, with increased consumption of plant-based foods and reduced meat intake. Here, we investigated the effects of MED interventions on the gut microbiota and cardiometabolic markers, and the interplay between the two, during the initial weight loss phase of the DIRECT-PLUS trial. Methods In the DIRECT-PLUS study, 294 participants with abdominal obesity/dyslipidemia were prospectively randomized to one of three intervention groups: healthy dietary guidelines (standard science-based nutritional counseling), MED, and Green-MED. Both isocaloric MED and Green-MED groups were supplemented with 28g/day walnuts. The Green-MED group was further provided with daily polyphenol-rich green tea and Mankai aquatic p...

Additional file 1: Figure S1. Allergic patients have specific significant bacteria. Bacteria clas... more Additional file 1: Figure S1. Allergic patients have specific significant bacteria. Bacteria classified by higher taxonomic order (genus level), associating with the allergic or non-allergic groups. Figure S2. Each allergy type has specific significant bacteria.

Additional file 2: Table S1. Differential abundance statistics of KEGG pathways in FA and non-all... more Additional file 2: Table S1. Differential abundance statistics of KEGG pathways in FA and non-allergic; Table S2. Taxonomic contributions to shifts in acetate-related pathways enriched in non-allergic compared to FA; Table S3. Taxonomic contributions to shifts in acetate-related pathway enriched in FA compared to non-allergic; Table S4. Taxonomic contributions to shifts in acetate-related pathways enriched in peanut FA compared to milk FA; Table S5. Taxonomic contributions to shifts in acetate-related pathway enriched in milk FA compared to peanut FA; Table S6. Taxonomic contributions to shifts in acetate-related pathways enriched in sesame FA compared to milk FA; Table S7. Taxonomic contributions to shifts in acetate-related pathway enriched in sesame FA compared to tree nuts FA.

Toxicon, 2022

INTRODUCTION The most common venomous snake in Israel, both in geographic spread and in number of... more INTRODUCTION The most common venomous snake in Israel, both in geographic spread and in number of snakebite incidents, is Daboia (Vipera) palaestinae. The clinical presentation of D. palaestinae envenomation varies and includes both local and systemic symptoms. Studies conducted on D. palaestinae revealed different amounts of venom in the snakes' glands in different seasons, however little is known regarding the potential impact of this finding on the clinical presentation after D. palaestinae bites during different seasons. OBJECTIVE To evaluate whether there is a difference in the severity of the clinical presentation of D. palaetinae bites in different seasons. MATERIAL AND METHODS A retrospective chart review study including all patients diagnosed with D. palaestinae bites treated at Shamir Medical Center from 2006 through 2020. Patients were divided into two groups: early bite season - spring and early summer, and late bite season - late summer and autumn. Variables examined included demographic features, admission details and treatment administrated. RESULTS One hundred and seven D. palaestinae bite victims were included, forty-five were bitten during the early season and sixty-two during the late season. Four patients in the early season (8.9%) and one patient (1.6%) in the late season presented with decreased level of consciousness, and four patients, all from the early season group, required mechanical ventilation (p < 0.05) Vasopressors were used in six patients (13.3%) during the early season and two (3.2%) during the late season; (p = 0.06). There were no other differences between the groups, except for a lowest platelet count during hospitalization (mean 161.5 ± 51 K/μl during early season and 196.9 ± 77 K/μl during late season (p < 0.01). CONCLUSIONS D. palaestinae bite victims more often present as critically ill patients during the spring and early summer compared to late summer and autumn. Hospitals should be prepared with appropriate staff training and medications for treating such patients, especially during the early season. However, in general, D. palaestinae bites are as dangerous during the late season as they are during the early season, and all snake bite victims should be treated with a high index of suspicion regardless of the season.

The Human Microbiome in Early Life, 2021

Abstract The early gastrointestinal microbiome plays a critical role in the future health status ... more Abstract The early gastrointestinal microbiome plays a critical role in the future health status of infants and young children, and early dysbiosis has been associated with the development of several chronic diseases. First, we discuss the potential link between the gut microbiome and the development of type 1 diabetes (T1D) and celiac disease (CeD), as representative autoimmune disorders. Data is presented showing several factors contributing to disruption of the intestinal homeostasis, including delivery mode, infant feeding modality, antibiotic use, geography and hygiene, and their role in the development of T1D, followed by a discussion of factors that have been shown to contribute to the development of CeD, such as early gut colonization, antibiotic use, and early feeding patterns. In the second part, we review factors that have been associated with alterations in the gut microbiome and consequently the aberrant immune responses of patients with inflammatory bowel diseases, including maternal exposures, antibiotics, feeding patterns, and other environmental exposures.

International Journal for Quality in Health Care, 2021

Objective Needlestick and sharps injuries (NSIs) are known occupational risks among health-care w... more Objective Needlestick and sharps injuries (NSIs) are known occupational risks among health-care workers. Reporting these injuries is important for early prevention and management of blood-borne infections. We investigated the prevalence and characteristics of NSIs and underreporting among hospital workers (HWs) from different sectors. Methods A single-center cross-sectional study, involving an anonymous survey delivered to 2205 HWs. The survey included demographic information about the worker and information about training, injuries and reporting. Results Of the 844 HWs respondents (40%), NSIs occurred in 443 of them (53%); the majority were from needles (68%) and at bedside (51%). Significantly higher prevalences of injuries (P < 0.001) were noted among physicians (75%) and workers in their 40s (61%) and in the emergency and surgical departments (66% and 55%, respectively). NSIs were reported among 28% of workers who did not directly use needles. Underreporting was found in 46%,...

Frontiers in Pediatrics, 2021

Objectives: A correct diagnosis of urinary tract infection in young infants requires an uncontami... more Objectives: A correct diagnosis of urinary tract infection in young infants requires an uncontaminated urine culture, commonly obtained by urethral catheterization. In the current study, we examined the rates and factors associated with contaminations of catheter-obtained urine cultures in very young infants.Methods: This prospective cohort study included 143 catheter-obtained urine cultures of infants ≤2 months of age admitted to the pediatric ward of a tertiary hospital in Israel from April 2019 to September 2020. Patient's and operator's study variables were documented at the time of catheter insertion. Positive urine cultures were reviewed by a pediatric nephrologist and a pediatric infectious disease specialist and designated as infection or contamination. The study variables were compared between those with or without contamination.Results: The contamination rate in our cohort was 29%. Females were more than twice as likely to have a contaminated urine culture (37 vs. ...

Acta Paediatrica, 2021

Minimal data exist regarding the severity of COVID‐19 in febrile infants under 60 days old. This ... more Minimal data exist regarding the severity of COVID‐19 in febrile infants under 60 days old. This multicentre prospective study explored the clinical course and outcomes of this hospitalised patient population, as, to date, the best approach has not been specifically addressed.

Clinical Microbiology and Infection, 2020

Objective: It was recently suggested that ibuprofen might increase the risk for severe and fatal ... more Objective: It was recently suggested that ibuprofen might increase the risk for severe and fatal coronavirus disease 2019 (COVID-19) and should therefore be avoided in this patient population. We aimed to evaluate whether ibuprofen use in individuals with COVID-19 was associated with more severe disease, compared with individuals using paracetamol or no antipyretics. Methods: In a retrospective cohort study of patients with COVID-19 from Shamir Medical Centre, Israel, we monitored any use of ibuprofen from a week before diagnosis of COVID-19 throughout the disease. Primary outcomes were mortality and the need for respiratory support, including oxygen administration and mechanical ventilation. Results: The study included 403 confirmed cases of COVID-19, with a median age of 45 years. Of the entire cohort, 44 patients (11%) needed respiratory support and 12 (3%) died. One hundred and seventynine (44%) patients had fever, with 32% using paracetamol and 22% using ibuprofen, for symptom-relief. In the ibuprofen group, 3 (3.4%) patients died, whereas in the non-ibuprofen group, 9 (2.8%) patients died (p 0.95). Nine (10.3%) patients from the ibuprofen group needed respiratory support, compared with 35 (11%) from the non-ibuprofen group (p 1). When compared with exclusive paracetamol users, no differences were observed in mortality rates or the need for respiratory support among patients using ibuprofen. Conclusions: In this cohort of COVID-19 patients, ibuprofen use was not associated with worse clinical outcomes, compared with paracetamol or no antipyretic.

Epidemiology and Infection, 2021

The possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission by f... more The possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission by fomites or environmental surfaces has been suggested. It is unclear if SARS-CoV-2 can be detected in outdoor public areas. The objective of the current study was to assess the presence of SARS-CoV-2 in environmental samples collected at public playgrounds and water fountains, in a country with high disease prevalence. Environmental samples were collected from six cities in central Israel. Samples were collected from drinking fountains and high-touch recreational equipment at playgrounds. Sterile pre-moistened swabs were used to collect the samples, put in viral transfer media and transferred to the laboratory. Viral detection was achieved by real-time reverse transcriptase–polymerase chain reaction, targeting four genes. Forty-three samples were collected from playground equipment and 25 samples from water fountains. Two of the 43 (4.6%) samples from playground equipment and one (4%) samp...

Genome Medicine, 2020

Background Multiple studies suggest a key role for gut microbiota in IgE-mediated food allergy (F... more Background Multiple studies suggest a key role for gut microbiota in IgE-mediated food allergy (FA) development, but to date, none has studied it in the persistent state. Methods To characterize the gut microbiota composition and short-chain fatty acid (SCFAs) profiles associated with major food allergy groups, we recruited 233 patients with FA including milk (N = 66), sesame (N = 38), peanut (N = 71), and tree nuts (N = 58), and non-allergic controls (N = 58). DNA was isolated from fecal samples, and 16S rRNA gene sequences were analyzed. SCFAs in stool were analyzed from patients with a single allergy (N = 84) and controls (N = 31). Results The gut microbiota composition of allergic patients was significantly different compared to age-matched controls both in α-diversity and β-diversity. Distinct microbial signatures were noted for FA to different foods. Prevotella copri (P. copri) was the most overrepresented species in non-allergic controls. SCFAs levels were significantly highe...

Communications Biology, 2020

Fusarium oxysporum is a cross-kingdom fungal pathogen that infects plants and humans. Horizontall... more Fusarium oxysporum is a cross-kingdom fungal pathogen that infects plants and humans. Horizontally transferred lineage-specific (LS) chromosomes were reported to determine host-specific pathogenicity among phytopathogenic F. oxysporum. However, the existence and functional importance of LS chromosomes among human pathogenic isolates are unknown. Here we report four unique LS chromosomes in a human pathogenic strain NRRL 32931, isolated from a leukemia patient. These LS chromosomes were devoid of housekeeping genes, but were significantly enriched in genes encoding metal ion transporters and cation transporters. Homologs of NRRL 32931 LS genes, including a homolog of ceruloplasmin and the genes that contribute to the expansion of the alkaline pH-responsive transcription factor PacC/Rim1p, were also present in the genome of NRRL 47514, a strain associated with Fusarium keratitis outbreak. This study provides the first evidence, to our knowledge, for genomic compartmentalization in two...