Rambam Maimonides Medical Journal最新文献

{"title":"An Approach to Nasopharyngeal Mass in Newborns: Case Series and Systematic Literature Review.","authors":"Roee Noy,&nbsp;Liron Borenstein-Levin,&nbsp;Arie Gordin","doi":"10.5041/RMMJ.10463","DOIUrl":"https://doi.org/10.5041/RMMJ.10463","url":null,"abstract":"<p><strong>Objective: </strong>Congenital nasopharyngeal masses (CNMs) are rare. Presenting symptoms vary, and the differential diagnoses cover a wide spectrum of possibilities. As it is uncommon, most examples discussed in literature are described as case reports or series. Guidelines on CNM patient management do not exist. In this study, we present two (2) cases of neonates with CNMs that were encountered at our tertiary center. Additionally, to best elaborate a comprehensive, case-based approach to CNM management, we offer an up-to-date, diagnosis-to-treatment review of current literature.</p><p><strong>Methods: </strong>Case series and systematic literature review.</p><p><strong>Results: </strong>Twenty-eight (28) studies are included since January 2000 to October 2021, with a total of 41 cases. Most common diagnosis was teratoma (78%). Female-to-male ratio was 2.5:1. Twenty percent of cases presented prenatally with polyhydramnios or elevated alpha-fetoprotein. Postnatally, the presenting symptoms most frequently encountered were respiratory distress (78%), oral mass (52%), and feeding difficulties (29%). Seventy-five percent of affected newborns showed symptoms within the first 24 hours of life. Forty percent of cases had comorbidities, especially in the head and neck region.</p><p><strong>Conclusions: </strong>Congenital nasopharyngeal masses can be detected antenatally, or symptomatically immediately after birth. Airway protection is a cornerstone in the management. Selecting the right imaging modality and convening a multidisciplinary team meeting are important toward the planning of next steps/therapeutic approach. Typically, a transnasal or transoral surgical approach will be deemed sufficient to address the problem, with a good overall prognosis.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866620","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":"The Changing Epidemiology of Carbapenemase-Producing Enterobacterales.","authors":"Khetam Hussein,&nbsp;Yuval Geffen,&nbsp;Orna Eluk,&nbsp;Sigal Warman,&nbsp;Worood Aboalheja,&nbsp;Tamar Alon,&nbsp;Ibrahim Firan,&nbsp;Mical Paul","doi":"10.5041/RMMJ.10461","DOIUrl":"https://doi.org/10.5041/RMMJ.10461","url":null,"abstract":"<p><strong>Objective: </strong>Israeli hospitals were confronted with a major national outbreak of carbapenemase-producing Enterobacterales (CPE) starting in 2006, caused predominantly by monoclonal Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae. Our hospital, Rambam Health Care Campus (RHCC), was one of the medical centers affected by this outbreak. We aimed to investigate the changing epidemiology of CPE at RHCC since 2006.</p><p><strong>Methods: </strong>This was a retrospective observational cohort study performed in Northern Israel (Haifa) at RHCC, which is a primary tertiary acute care academic hospital. The study included all patients who had acquired CPE at RHCC between January 2005 and December 2020.</p><p><strong>Results: </strong>The proportion of patients infected with K. pneumoniae dropped from 100% of all CPE in the first years to 28% (37/134) in 2020. In 2014, the carbapenemase in 94% of all CPE patients (89/95) was KPC. This decreased to 56% in 2020, while New Delhi metallo-β-lactamase (NDM) and OXA-48 carbapenemases increased from 4% and 2% to 29% (39/134) and 12.7% (17/134) of CPE, respectively.</p><p><strong>Conclusions: </strong>The CPE epidemic evolved from KPC-producing K. pneumoniae to involve different Enterobacterales and carbapenemases. Our results are a microcosm of the current global epidemiology attesting to globalization in bacteriology. The results have implications for infection control and antibiotic treatment of CPE infections.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39866618","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":"Eosinophil Cell Count Predicts Mortality in the Intensive Care Unit after Return of Spontaneous Circulation.","authors":"İlhan Korkmaz,&nbsp;Yusuf Kenan Tekin,&nbsp;Gülaçan Tekin,&nbsp;Erdal Demirtaş,&nbsp;Sefa Yurtbay,&nbsp;Naim Nur","doi":"10.5041/RMMJ.10458","DOIUrl":"https://doi.org/10.5041/RMMJ.10458","url":null,"abstract":"<p><strong>Background: </strong>Eosinophils constitute 1%-5% of peripheral blood leukocytes, less in the presence of acute infections (referred to as eosinopenia). Studies indicate that eosinopenia can be used as a prognostic predictor for chronic obstructive pulmonary disease exacerbation, sepsis, or acute myocardial infarction disease. There are only a few studies about predicting mortality in emergency departments and intensive care units (ICUs). Prognostic studies about patients in ICUs are generally carried out using different scoring systems. We aimed to analyze if the eosinophil count can estimate the prognosis among non-traumatic patients who underwent cardiopulmonary resuscitation and were hospitalized in ICU thereafter.</p><p><strong>Methods: </strong>The data were evaluated of 865 non-traumatic adult patients (>18 years of age) who were admitted with cardiopulmonary arrest or developed cardiopulmonary arrest during clinical follow-ups. Admission venous blood sample tests, complete blood count, and biochemical laboratory results were recorded. Arterial blood gas results were also evaluated. The mean results of the recorded laboratory results were compared between the surviving and non-surviving patients groups.</p><p><strong>Results: </strong>There was a significant difference between the two groups in regard to platelet, eosinophil count, pH, PaO₂, SaO₂, and HCO₃^- (P<0.001 for all). In the multiple linear regression analysis, eosinophil counts were found to be an independent factor (odds ratio=0.03, 95% confidence interval 0.33-0.56, P<0.001) associated with the mortality after cardiopulmonary resuscitation.</p><p><strong>Conclusion: </strong>Because admission eosinophil counts can be measured easily, they are inexpensive biomarkers that can be used for predicting the prognosis among the patients who have return of spontaneous circulation and are treated in ICUs.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39964487","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: \"First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke\".","authors":"Murat Alpua,&nbsp;Bahar Say,&nbsp;Ilknur Yardimci,&nbsp;Ufuk Ergün,&nbsp;Ucler Kisa,&nbsp;Ozlem Doğan Ceylan","doi":"10.5041/RMMJ.10457","DOIUrl":"https://doi.org/10.5041/RMMJ.10457","url":null,"abstract":"We have carefully read and evaluated the letter writ¬ten by Drs Mungmunpuntipantip and Wiwanitkit regarding our article published in the July issue of Rambam Maimonides Medical Journal.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39565127","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":"Teaching Shared Decision Making to Undergraduate Medical Students.","authors":"Meira Tidhar,&nbsp;Jochanan Benbassat","doi":"10.5041/RMMJ.10453","DOIUrl":"https://doi.org/10.5041/RMMJ.10453","url":null,"abstract":"<p><p>Despite the wide endorsement of shared decision making (SDM), its integration into clinical practice has been slow. In this paper, we suggest that this integration may be promoted by teaching SDM not only to residents and practicing physicians, but also to undergraduate medical students. The proposed teaching approach assumes that SDM requires effective doctor-patient communication; that such communication requires empathy; and that the doctor's empathy requires an ability to identify the patient's concerns. Therefore, we suggest shifting the focus of teaching SDM from how to convey health-related information to patients, to how to gain an insight into their concerns. In addition, we suggest subdividing SDM training into smaller, sequentially taught units, in order to help learners to elucidate the patient's preferred role in decisions about her/his care, match the patient's preferred involvement in these decisions, present choices, discuss uncertainty, and encourage patients to obtain a second opinion.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39566815","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":"Loneliness, Depression, and Anxiety Experienced by the Israeli Population During the First COVID-19 Lockdown: A Cross-sectional Survey.","authors":"Jason Brafman,&nbsp;Robert Lubin,&nbsp;Revital Naor-Ziv,&nbsp;Sarah Rosenberg,&nbsp;Tzvi Dwolatzky","doi":"10.5041/RMMJ.10449","DOIUrl":"https://doi.org/10.5041/RMMJ.10449","url":null,"abstract":"This research letter presents our study, which sought to evaluate the differences in the prevalence of self-reported symptoms of depression, anxiety, and loneliness between younger and older generations at the time of the COVID-19 pandemic. Since the younger generation is generally less accustomed to facing and dealing with adversity and illness, we hypothesized that adolescents and younger adults would have a higher prevalence of depression, anxiety, and loneliness as compared to the older generation. It must be emphasized that this survey was conducted during the first COVID-19 lockdown that occurred in Israel from mid-March 2020 to early May 2020. This was a time when businesses were closed, individuals and families were isolated at home with very limited social contact, and feelings of fear and panic were fueled by the electronic media.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39338808","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":"Factors Associated with Catch-up Growth in Term, Asymmetrical Small-for-Gestational Age Infants in the First Year of Life.","authors":"Sundar Sivakumar,&nbsp;Thasma Santhanakrishnan Arunprasath,&nbsp;Padmasani Venkat Ramanan","doi":"10.5041/RMMJ.10452","DOIUrl":"https://doi.org/10.5041/RMMJ.10452","url":null,"abstract":"<p><strong>Introduction: </strong>Catch-up growth (CUG) in small-for-gestational age (SGA) infants is essential for their overall development. Knowledge about the factors influencing CUG might be critical in their effective management. Hence this study was performed with the aim of identifying factors that may influence CUG in SGA infants.</p><p><strong>Methods: </strong>Asymmetrical SGA infants born at term were included in the study as per defined criteria, and their demographic details were recorded. Anthropometric data, feeding practice details, and intercurrent illnesses data were collected on follow-up at 6 weeks, 6 months, and 12-15 months of age. Catch-up growth weight was defined as improvement of weight to the normal range of -2 to +2 weight-for-age Z score (WAZ). Analysis was carried out using SPSS Expand 17 software. Chi-square test was used to find association between variables. Logistic regression analysis was used to measure effect. A P value of less than 0.05 was taken as significant.</p><p><strong>Results: </strong>Out of 324 SGA infants born at term, 119 completed 12-15-month follow-up, of which 69.7% had achieved CUG weight. Exclusive breastfeeding >4 months, continued breastfeeding until 12-15 months, and absence of diarrheal episodes were positively associated with CUG. Pregnancy-induced hypertension, gestational diabetes, and maternal overweight/obesity were negatively associated with CUG. Maternal education status, conception age, gravida status, mode of delivery, vitamin D and iron supplementation, and intercurrent respiratory infections were not associated with CUG. On multivariate analysis, continued breastfeeding and absence of diarrheal episodes were independent factors associated with CUG.</p><p><strong>Conclusion: </strong>Breastfeeding practice, especially continued breastfeeding, and the absence of diarrheal illness are the key determinants for achieving CUG weight in term SGA infants, particularly in settings where resources are limited.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39566813","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":"Deep Epicardial Laceration after Cardiopulmonary Resuscitation: A Case Report.","authors":"Noa Fried Regev,&nbsp;Tzachi Slutsky,&nbsp;Oren Lev-Ran,&nbsp;Yaron Ishai,&nbsp;Dan Schwarzfuchs","doi":"10.5041/RMMJ.10455","DOIUrl":"https://doi.org/10.5041/RMMJ.10455","url":null,"abstract":"<p><p>Effective chest compressions have been proven to be a key element in a successful cardiopulmonary resuscitation (CPR). However, unintended injuries have been described in the medical literature for decades, including major intrathoracic injuries. We present a case of an 80-year-old man after a successful CPR who was later diagnosed with deep epicardial laceration as a result of effective chest compressions.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39565125","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 Regarding First Admission Neutrophil-Lymphocyte Ratio and Ischemic Stroke.","authors":"Rujittika Mungmunpuntipantip,&nbsp;Viroj Wiwanitkit","doi":"10.5041/RMMJ.10456","DOIUrl":"https://doi.org/10.5041/RMMJ.10456","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39565126","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":"Human Papilloma Virus and Cancer Stem Cell markers in Oral Epithelial Dysplasia-An Immunohistochemical Study.","authors":"Prasanth Thankappan,&nbsp;Madhavan Nirmal Ramadoss,&nbsp;Tharmasahayam Isaac Joseph,&nbsp;Percy Ida Augustine,&nbsp;Isaacjoseph Bevin Shaga,&nbsp;Jashree Thilak","doi":"10.5041/RMMJ.10451","DOIUrl":"https://doi.org/10.5041/RMMJ.10451","url":null,"abstract":"<p><strong>Objectives: </strong>To study the correlation between the putative cancer stem cell (CSC) markers aldehyde dehydrogenase 1 (ALDH1), cluster of differentiation 44 (CD44), sex-determining region Y-box 2 (SOX2), and octamer-binding protein 4 (OCT4) and human papilloma virus (HPV) infection using p16, the surrogate marker of HPV in oral epithelial dysplasia (OED) and normal mucosa.</p><p><strong>Methods: </strong>Five sections each from 40 histopathologically diagnosed cases of different grades of OED and 10 cases of normal oral mucosa without dysplasia were immunohistochemically stained with p16, ALDH1, CD44, SOX2, and OCT4, respectively.</p><p><strong>Results: </strong>Expression of ALDH1 and SOX2 was significantly increased in OED cases, whereas CD44 and OCT4 expression was increased in normal mucosa. P16-positive OED cases showed upregulation of ALDH1 and OCT4 expression as compared to p16-negative cases, while CD44 and SOX2 expression was downregulated in p16-positive OED cases; however, the results were not statistically significant.</p><p><strong>Conclusion: </strong>The present study indicated a suggestive link between p16 and cancer stem cell marker expression in HPV-associated OED, and that p16 has a significant role in CSC progression in OED. This is the first study to evaluate the expression of putative CSC markers in HPV-associated OED. However, low study numbers are a potential limiting factor in this study.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39566812","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}