Rambam Maimonides Medical Journal最新文献

{"title":"The Enigmatic Odontogenic Keratocyst: A Cross-sectional Study of Odontogenic Cysts and Tumors Using Ki-67.","authors":"Pretty Prince Panakkal, Pramod Philip Matthews, Soma Susan, Nivia Mahadoon, Pinky Varghese, Afshan Pallikkalakathu","doi":"10.5041/RMMJ.10549","DOIUrl":"10.5041/RMMJ.10549","url":null,"abstract":"<p><strong>Background: </strong>An odontogenic keratocyst is presently considered a cyst by the 2017 World Health Organization (WHO) classification, even though, at times, it shows highly aggressive behavior and a high recurrence rate. Ki-67 is a protein associated with the proliferative activity of the intrinsic cell populations. In tumors, Ki-67 is associated with tumor aggressiveness. This study aimed to compare the Ki-67 expression rates of odontogenic keratocysts to those of other odontogenic cysts and normal mucosa.</p><p><strong>Materials and methods: </strong>A retrospective cross-sectional study was conducted using pathology samples retrieved from the archives of a tertiary care center to evaluate Ki-67 expression. Histopathologically confirmed cases of odontogenic keratocysts, radicular cysts, dentigerous cysts, and ameloblastomas were selected. The standardized immunohistochemistry streptavidin-biotin detection system HRP-DAB method was employed for analysis.</p><p><strong>Results: </strong>All the odontogenic keratocysts pathology samples demonstrated some degree of Ki-67 expression: mild, moderate, and severe Ki-67 expressions were identified in 26.7%, 53.3%, and 20.0% of the samples, respectively. Compared to the odontogenic keratocyst samples, the samples from dentigerous cysts, periapical cysts, ameloblastomas, and normal mucosa demonstrated no Ki-67 expression in 33.3%-66.7% of the samples, mild expression in 13.3%-40.0%, moderate expression in 0%-33.3%, and severe expression in none of the samples (P<0.001).</p><p><strong>Conclusions: </strong>Ki-67 was either moderately or severely overexpressed in the majority of odontogenic keratocyst samples. The 2017 WHO classification, which reclassifies keratocystic odontogenic tumors as cysts, conflicts with our findings.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Status of Parental Caregivers of Special Needs Children in Puducherry.","authors":"Philip Felix Priya, Ananda Balayogi Bhavanani, Meena Ramanathan, Karthick Subramanium, Sukanto Sarkar, Anandraj Lokeshmaran","doi":"10.5041/RMMJ.10551","DOIUrl":"10.5041/RMMJ.10551","url":null,"abstract":"<p><strong>Background: </strong>Parental caregivers of children with special needs manage their child's daily tasks, taking on responsibilities such as making health and financial decisions, assisting with routine activities, and ensuring their safety from self-harm. The level of a child's disability determines the amount of time and effort a caregiver must invest, with higher disability levels meaning greater dependency and thus requiring greater support. While rewarding, caregiving may also be highly demanding. The parental caregiver's physical and mental health can decline due to stress, potentially leading to anxiety and depression, and may worsen pre-existing conditions. This research aimed to provide insights into the psychological well-being of parental caregivers, shedding light on their challenges and needs for better support and intervention.</p><p><strong>Methods: </strong>This study examined the psychological health of parental caregivers of special needs children at a special education school in Puducherry, India. Following an orientation program, 66 parental caregivers volunteered and provided informed consent to participate. The mean age of the parents was 38.4 years (±6.6). Demographic details were collected, and psychological parameters were assessed using standardized scales: Zarit Burden Interview-Caregiver Burden Scale (ZBI-CBS), Depression Anxiety Stress Scale (DASS-21), Pittsburgh Sleep Quality Index (PSQI), World Health Organization Quality of Life-brief form (WHOQOL-BREF).</p><p><strong>Results: </strong>The study findings revealed that most parents experienced caregiver burden and poor sleep quality, consistent with previous studies. Specifically, 93.9% of parents had poor sleep, while 84.8% reported caregiver burden. Additionally, 89.4% of the parents experienced depression, 89.4% have anxiety, and 86.4% have stress. Quality of life was low across all domains.</p><p><strong>Conclusion: </strong>The stress of managing their child's needs can negatively impact parental caregivers' physical and psychological health. Providing counseling and promoting healthy lifestyle choices can significantly enhance caregivers' overall well-being.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Recovery in Oral Flap Surgeries: The Undervalued Role of Physiotherapy.","authors":"Srivatsan Munusamy, Shenbaga Sundaram Subramanian, Tamil Ponni Sivamani, Surya Vishnuram","doi":"10.5041/RMMJ.10552","DOIUrl":"10.5041/RMMJ.10552","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Childhood Trauma Meets War: Emotional Eating Through the Lens of PTSD.","authors":"Zohar Spivak-Lavi, Yael Latzer, Orna Tzischinsky","doi":"10.5041/RMMJ.10550","DOIUrl":"10.5041/RMMJ.10550","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the interplay between childhood trauma, war exposure, and maladaptive coping mechanisms, with a focus on post-traumatic stress disorder (PTSD) as a mediator and war exposure as a potential moderator in the relationship between childhood trauma and emotional eating.</p><p><strong>Methods: </strong>Participants completed validated measures of childhood trauma, PTSD, and emotional eating. Statistical analyses included Pearson correlations, stepwise linear regression, and moderated mediation models, adjusting for age and gender.</p><p><strong>Results: </strong>The study included 426 Hebrew-speaking Israeli adults (52.8% female, 47.2% male, mean age 40). Childhood trauma, particularly emotional abuse, was significantly associated with PTSD and emotional eating. The relationship between childhood trauma and emotional eating was fully mediated by PTSD, with a stronger effect observed for emotional abuse. War exposure significantly predicted PTSD but did not moderate the link between PTSD and emotional eating. Sex differences emerged, with female participants exhibiting higher PTSD levels than males.</p><p><strong>Conclusions: </strong>The findings emphasize the enduring impact of childhood trauma, particularly emotional abuse, on maladaptive coping mechanisms like emotional eating, mediated by PTSD. While war exposure intensified PTSD symptoms, it did not significantly influence emotional eating. These results highlight the differential effects of early- and later-life traumas, offering insights for targeted interventions in trauma recovery.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Padua Score and D-dimer for Pulmonary Embolism Exclusion in the Elderly.","authors":"Ramon Cohen, Shay Nemet, Marina A Fradkin, Tal Schiller, Alena Kirzhner, Haitham Abu Khadija, Meital Deitch, Daniel Elbirt","doi":"10.5041/RMMJ.10548","DOIUrl":"10.5041/RMMJ.10548","url":null,"abstract":"<p><strong>Purpose: </strong>This study was aimed at identifying biomarkers that could help exclude pulmonary embolism (PE) in patients aged 65 years and older, considering age-related challenges such as atypical clinical presentations and the presence of comorbidities.</p><p><strong>Methods: </strong>This single-center cohort study retrospectively collected data on 28 potential markers from patients aged 65 years and older who underwent computed tomography scans for PE diagnosis in emergency or internal wards over a 2.5-year period.</p><p><strong>Results: </strong>The study included 157 patients after exclusions, with 35 diagnosed with PE. Patients with PE exhibited higher D-dimer levels, lower platelet counts, and higher Padua scores. Six markers were selected based on likelihood ratio, each with an area under the curve above 0.7 and P-value below 0.05. Multiplying D-dimer levels with the Padua score (PaDd) improved specificity from 9% to 32% while maintaining 100% sensitivity in identifying PE. Further refinement by incorporating activated partial thromboplastin time (aPTT) into the Padua score multiplied by D-dimer (PaDd/aPTT) resulted in improved sensitivity and specificity.</p><p><strong>Conclusion: </strong>The Padua score multiplied by D-dimer is a simple yet effective tool that enhances specificity while maintaining high sensitivity, potentially reducing computed tomography utilization in elderly patients. Prospective, multicenter studies are needed to validate these findings and integrate them into routine clinical practice.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Letter to the Editor.","authors":"Poonam Joshi, Manasi Bavaskar","doi":"10.5041/RMMJ.10553","DOIUrl":"10.5041/RMMJ.10553","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 3","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316867/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying Settler Colonial Determinants of Health (SCDH) as the Upstream Cause of Palestinian Ill Health Is Both Incorrect and Harmful.","authors":"Linda Young Landesman, Maya Korin, Stacey Plichta, Brian Englander, Ora Paltiel","doi":"10.5041/RMMJ.10544","DOIUrl":"https://doi.org/10.5041/RMMJ.10544","url":null,"abstract":"<p><p>Extremism, displacement, and ongoing conflict have affected Palestinians and Israelis personally and collectively, endangering their health and lives. A theory circulating in public health publications posits that settler colonial determinants of health (SCDH) are the root cause of health inequities in the region. We argue that this assertion is misleading, ignores key facts, and exacerbates polarization, thus harming health. Public health is an evidence-based, scientific discipline based on hypotheses, research, and analysis. Throughout the scientific process, careful assessments of bias are essential. Knowledge is subsequently translated into policy and action. The SCDH theory rejects this approach as tainted by \"colonialism.\" We also argue that the SCDH concept, as applied to health disparities in Israel-Palestine, is an ideologically driven theory in search of evidence. Rather than developing testable hypotheses, the promoters of SCDH use selective evidence to support its relevance to health in the region. The theory collapses when examined against relevant facts related to regional history and the health status of Israelis and Palestinians. It invokes one-sided racism as a driver of health inequities in a context-inappropriate manner, and ignores many upstream determinants including actions of the Palestinian leadership, and their role as drivers of health. It denigrates peace-building and collaboration which are key to future health and wellbeing in the region, and which have a proven record in improving health outcomes. We call on public health professionals to distance themselves from unfounded rhetoric that polarizes the communities, and undermines the discipline's scientific integrity, while contributing nothing to promote health in the region.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: There Should Be a Clear Distinction Between Legitimate Protest and Antisemitism.","authors":"Yasmeen Abu Fraiha, Akiva Leibowitz","doi":"10.5041/RMMJ.10546","DOIUrl":"https://doi.org/10.5041/RMMJ.10546","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Breathlessness to Better Living: Transforming COPD Care with Home-based Pulmonary Rehabilitation.","authors":"Abins Thozhuthinkal Kasim, Ravi Gaur, Nitesh Manohar Gonnade, Nagma Sheenam, Chinchu Kolakkanni, Sarankumar Ganesan, Adharshna Thangamalai Kannan","doi":"10.5041/RMMJ.10543","DOIUrl":"https://doi.org/10.5041/RMMJ.10543","url":null,"abstract":"<p><strong>Background: </strong>Chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), significantly impact patients' quality of life by limiting physical function, mobility, and overall well-being. Pulmonary rehabilitation (PR), particularly home-based programs, has emerged as a vital non-pharmacological intervention to address these limitations. However, comprehensive assessments of the impact of home-based PR on both lung function and disability in COPD patients remain limited.</p><p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of a 12-week home-based PR program on pulmonary function and disability in COPD patients, using pulmonary function tests (PFTs) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) to assess outcomes across multiple domains.</p><p><strong>Methods: </strong>A prospective, single-arm pre-post interventional study was conducted among 62 COPD patients at All India Institute of Medical Sciences, Jodhpur. Participants completed a 12-week home-based PR program, which included endurance exercises, breathing techniques, and self-management education. Pulmonary function tests were conducted, and disability levels were assessed using WHODAS 2.0 at baseline and after completing the program.</p><p><strong>Results: </strong>Improvements were observed in pulmonary function, with forced vital capacity (FVC), and forced expiratory volume in one second (FEV1), showing substantial increases (FVC: 2.50±0.43 L to 2.85±0.59 L; FEV1: 1.53±0.33 L to 1.63±0.34 L; P<0.001). The WHODAS 2.0 scores demonstrated notable reductions in disability, particularly in the life activities and participation domains (P<0.001). Cognitive and self-care scores remained stable, while improvements in mobility were observed but not significant. Regression analysis revealed a strong negative correlation between increases in FVC and reductions in WHODAS 2.0 total scores (r=-0.65), highlighting FVC as a key predictor of disability reduction.</p><p><strong>Conclusion: </strong>The 12-week home-based PR program improved lung function and reduced disability in COPD patients. These findings support the role of home-based PR as a viable, patient-centered alternative to traditional rehabilitation, addressing both physical and social dimensions of health. Future research should focus on long-term outcomes, the potential for broader implementation, and expanding access to underserved populations.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Ethnicity and Treatment Preferences in Patients with Irritable Bowel Syndrome.","authors":"Vered Richter, Efrat Broide, Tzippora Shalem, Daniel L Cohen, Tawfik Khoury, Atallah Mansour, Timna Naftali, Amir Mari","doi":"10.5041/RMMJ.10542","DOIUrl":"https://doi.org/10.5041/RMMJ.10542","url":null,"abstract":"<p><strong>Background and aims: </strong>Irritable bowel syndrome (IBS) poses a significant healthcare challenge, characterized by chronic gastrointestinal and extraintestinal symptoms impacting individuals' well-being. Treatment preferences may vary among patients from different ethnic groups, such as Arab and Jewish Israelis, necessitating tailored approaches.</p><p><strong>Methods: </strong>A bilingual (Hebrew/Arabic) questionnaire assessing patients' preferences regarding treatment goals was developed. It was administered online in Israeli IBS Facebook groups, as well as in two hospital gastroenterology clinics.</p><p><strong>Results: </strong>The study included 267 IBS patients (91 Arabs and 176 Jews). Demographic analysis revealed a higher proportion of females in both groups, with a significantly greater percentage among Jews compared to Arabs (84% versus 64.8%, respectively, P<0.001). The median age was 32 years for both Arabs and Jews (interquartile ranges of 26-42 and 24-62, respectively). Arabs exhibited higher rates of mixed-type IBS and constipation, while Jews had a higher prevalence of predominant diarrhea IBS. Arabs reported more bloating, higher rates of IBS-related comorbidities, and more medication usage. When asked to rate the importance of treatment goals, both populations preferred improvement in abdominal pain, bloating, and regular defecation, while assigning lower importance to improving difficulty in mental and/or physical aspects of intercourse, as well as arthralgia and myalgia. Arab patients assigned lower importance scores to various symptoms compared to their Jewish counterparts.</p><p><strong>Conclusion: </strong>This study highlights the impact of ethnicity on patients' treatment goals. Understanding patients' preferences will enable tailoring an individual approach to each IBS patient.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 2","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}