Rambam Maimonides Medical Journal最新文献

{"title":"Three Decades of Cannabis Research: What are the Obstacles?","authors":"Michael Dor","doi":"10.5041/RMMJ.10486","DOIUrl":"10.5041/RMMJ.10486","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40496001","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":"Comparing Sublingual and Inhaled Cannabis Therapies for Low Back Pain: An Observational Open-Label Study.","authors":"Dror Robinson,&nbsp;Sivan Ritter,&nbsp;Mustafa Yassin","doi":"10.5041/RMMJ.10485","DOIUrl":"https://doi.org/10.5041/RMMJ.10485","url":null,"abstract":"<p><strong>Background and objective: </strong>Medical cannabis is becoming an acceptable treatment modality in medicine, especially for pain relief. Concurrently, cannabis use is becoming more prevalent worldwide, a public demand-driven trend despite the lack of established scientific basis. This observational open-label study sought to investigate the effectiveness of cannabis therapy for alleviating low back pain symptoms.</p><p><strong>Methods: </strong>Two types of cannabis treatment modalities were sequentially administered to chronic low back pain patients. After an initial 1-month washout period (WO1), the first modality was cannabidiol (CBD)-rich sublingual extract treatment administered for 10 months. Following another washout period, the second modality, Δ⁹-tetrahydrocannabinol (THC)-rich smoked inflorescence (whole dried cannabis flowers) was administered for 12 months.</p><p><strong>Results: </strong>Enrolled in the study were 24 patients whose advanced imaging studies (i.e. computerized tomography or magnetic resonance imaging of the lumbar spine) revealed disc herniation or spinal stenosis. Three patients dropped out of extract therapy treatment but resumed study participation to receive THC-rich smoking therapy. After a minimum of 2 years, cannabis therapy had reduced lower back pain symptoms, as assessed by Oswestry Disability Index, the SF-12 patient-reported outcome questionnaire, and the visual analogue scale. Pain reduction was not significant during the extract treatment part of the study; however, pain reduction was significant during the inhaled therapy part of the study.</p><p><strong>Conclusions: </strong>Our findings indicate that inhaled THC-rich therapy is more effective than CBD-rich sublingual extract therapy for treating low back pain and that cannabis therapy is safe and effective for chronic low back pain.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40496002","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":"Biomarkers in External Apical Root Resorption: An Evidence-based Scoping Review in Biofluids.","authors":"Priyanka Kapoor, Aman Chowdhry, Dinesh Kumar Bagga, Deepak Bhargava","doi":"10.5041/RMMJ.10482","DOIUrl":"10.5041/RMMJ.10482","url":null,"abstract":"<p><strong>Background: </strong>External apical root resorption (EARR), an unwanted sequela of orthodontic treatment, is difficult to diagnose radiographically. Hence, the current scoping review was planned to generate critical evidence related to biomarkers in oral fluids, i.e. gingival crevicular fluid (GCF), saliva, and blood, of patients showing root resorption, compared to no-resorption or physiologic resorption.</p><p><strong>Methods: </strong>A literature search was conducted in major databases along with a manual search of relevant articles in the library, and further search from references of the related articles in March 2021. The initial search was subjected to strict inclusion and exclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.</p><p><strong>Results: </strong>Following PRISMA guidelines, 20 studies were included in the final review. The studies included human clinical trials and cross-sectional and prospective studies with/without control groups with no date/language restriction. Various biomarkers identified in EARR included dentinal proteins, enzymes, cytokines, and salivary proteins. Severe resorption had higher dentin sialoprotein (DSP) and resorption protein concentrations as well as lower granulocyte-macrophage colony-stimulating factor (GM-CSF) as compared with mild resorption. Increased DSP and dentin phosphophoryn (DPP) expression was found in physiologic resorption. Compared to controls, resorbed teeth showed a higher receptor activator of nuclear factor kappa B ligand/osteoprotegerin (RANKL/OPG) ratio. In contrast, levels of anti-resorptive mediators (IL-1RA, IL-4) was significantly decreased. Differences in force levels (150 g and 100 g) showed no difference in resorption, but a significant rise in biomarkers (aspartate transaminase [AST] and alkaline phosphatase [ALP]) for 150 g force. Moderate to severe resorption in young patients showed a rise in specific salivary proteins, requiring further validation. Limitations of the studies were heterogeneity in study design, biomarker collection, sample selection, and confounding inflammatory conditions.</p><p><strong>Conclusions: </strong>Various biomarkers in biofluids indicate active resorption, while resorption severity was associated with DSP and GM-CSF in GCF, and a few salivary proteins. However, a robust study design in the future is mandated.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363348","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":"Multimodal Imaging in Rhinoorbitocerebral Mucormycosis Associated with Type 2 Diabetes After COVID-19.","authors":"Pavel Mikhailovich Zelter,&nbsp;Olesya Vladimirovna Zeleva,&nbsp;Egor Andreevich Sidorov,&nbsp;Dmitriy Vyacheslavovich Solovov,&nbsp;Evgeniy Nikolaevich Surovtsev","doi":"10.5041/RMMJ.10483","DOIUrl":"https://doi.org/10.5041/RMMJ.10483","url":null,"abstract":"<p><strong>Purpose: </strong>This case series analyzed the appropriateness of computed tomography (CT) and magnetic resonance imaging (MRI) for visualization of rhinoorbitocerebral mucormycosis (ROCM) patterns associated with type 2 diabetes (T2D) post-recovery from coronavirus disease 2019 (COVID-19).</p><p><strong>Methods: </strong>The study included 24 patients with invasive ROCM after having recovered from COVID-19. All patients underwent CT examinations and microbiological and histological verification; 5 patients underwent MRI.</p><p><strong>Results: </strong>The CT and MRI patterns noted in our patients revealed involvement of skull orbits, paranasal sinuses, large arteries, and optic nerves, with intracranial spread and involvement of the cranial base bones. Using brain scan protocol for CT provided better soft-tissue resolution. We found that extending the MRI protocol by T2-sequence with fat suppression or STIR was better for periantral fat and muscle evaluations.</p><p><strong>Conclusion: </strong>Computed tomography of the paranasal sinuses is the method of choice for suspected fungal infections, particularly mucormycosis. However, MRI is recommended if there is suspicion of orbital, vascular, or intracranial complications, including cavernous sinus extension. The combination of both CT and MRI enables determination of soft tissue invasion and bony destruction, thereby facilitating the choice of an optimal ROCM treatment strategy. Invasive fungal infections are extremely rare in Europe; most of the related data are provided from India and Middle Eastern or African nations. Hence, this study is notable in its use of only diagnosed ROCM cases in Russia.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40692862","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":"Outcomes of Open Fronto-Facial Resection for Fungal Osteomyelitis of Frontal Bone.","authors":"Rupa Mehta,&nbsp;Karthik Nagaraga Rao,&nbsp;Nitin M Nagarkar,&nbsp;Anil Sharma,&nbsp;Badal Kumar,&nbsp;P Karthik","doi":"10.5041/RMMJ.10484","DOIUrl":"https://doi.org/10.5041/RMMJ.10484","url":null,"abstract":"<p><strong>Introduction: </strong>The second wave of coronavirus disease 2019 (COVID-19) led to the resurgence of opportunistic infections due to the injudicious use of steroids. Sinonasal mucormycosis was declared an epidemic in India during the pandemic. Mucormycosis was managed effectively by surgical debridement along with systemic amphotericin B. Currently, a resurgence of mucormycosis following initial treatment, in the form of fungal osteomyelitis of the frontal bone, is being seen in India.</p><p><strong>Methods: </strong>This prospective study included 10 patients with fungal osteomyelitis of the frontal bone due to mucormycosis. All patients underwent surgical debridement of the sequestrum and involucrum, with systemic antifungal pharmacotherapy.</p><p><strong>Results: </strong>The average duration of time until mucormycosis recurrence was 22 days following initial treatment (range 10-33 days). Patients presented with extracranial bossing following outer frontal cortex erosion (n=3), bicortical erosion (n=3), bifrontal involvement (n=2), dural involvement (n=3), and involvement of the brain parenchyma and prefrontal cortex (n=2). All cases underwent debridement of the entire sequestrous bone and involucrum until normal bone could be identified. The mean admission duration was 4 weeks (range 3-6 weeks). All treated patients are currently alive and without disease, confirmed by contrast-enhanced computed tomography.</p><p><strong>Conclusion: </strong>Based on our experience, the successful treatment of fungal osteomyelitis due to mucormycosis requires a four-pronged approach: early detection, multidisciplinary management of comorbidities, surgical debridement of necrotic bone, and adequate systemic antifungal therapy.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40692861","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":"A Unique Case of Myositis.","authors":"Noa Hurvitz,&nbsp;Ariel Kenig,&nbsp;Asa Kessler,&nbsp;Narmine Elkhateeb,&nbsp;Yossef Lerner,&nbsp;Michal Zamir,&nbsp;Fadi Kharouf","doi":"10.5041/RMMJ.10481","DOIUrl":"https://doi.org/10.5041/RMMJ.10481","url":null,"abstract":"Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare systemic small-vessel disease, with heterogeneous clinical manifestations. While arthralgia and myalgia are common in the disease course, frank myositis is exceedingly rare. Immune-mediated necrotizing myopathy (IMNM) is a subtype of idiopathic inflammatory myopathies (IIMs), characterized by severe myositis. We report herein a case of prominent diffuse myositis with shared features of AAV and IMNM.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40363874","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":"CRISPR Technology: A Jewish Legal Perspective.","authors":"John D Loike,&nbsp;Rabbi Tzvi Flaum","doi":"10.5041/RMMJ.10487","DOIUrl":"https://doi.org/10.5041/RMMJ.10487","url":null,"abstract":"<p><p>Clustered regularly interspaced short palindromic repeats (CRISPR) gene editing is an innovative and potentially game-changing biotechnology that can potentially reverse DNA mutations in a tissue-specific manner. In addition, CRISPR is being targeted for xenotransplantation, for increasing human longevity, in animal breeding, and in plant science. However, there are many ethical challenges that emerge from CRISPR technology. This article discusses several positions that relate to these ethical challenges from a Jewish legal perspective. In addition, we present several other applications of CRISPR technology that lack a defined Jewish legal precedent and require rabbinical scholars to address and resolve them in the future.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"13 4","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9622389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40692860","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":"Secondary Prevention of Osteoporosis: If Not Now, When?","authors":"Tzvi Dwolatzky","doi":"10.5041/RMMJ.10478","DOIUrl":"https://doi.org/10.5041/RMMJ.10478","url":null,"abstract":"EDITORIAL: The time has come for us to work together in a concerted effort to decrease the related suffering and consequences of osteoporotic fractures. And if not now, when?","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40688916","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 Antibacterial Action of Safranin and Gentian Violet.","authors":"Falah Al-Khikani,&nbsp;Aalae Ayit","doi":"10.5041/RMMJ.10475","DOIUrl":"https://doi.org/10.5041/RMMJ.10475","url":null,"abstract":"<p><strong>Background: </strong>The increasing resistance of many bacterial pathogens against antibiotic measures urgently requires new or repurposing therapeutic strategies. Gentian violet is a triarylmethane dye used as a histological stain and for Gram's method of classifying bacteria. It also exerts an antimicrobial effect against certain pathogens, especially dermatological infections. Safranin is the most popular counterstain used in medical laboratories due to its low cost and safe laboratory usage. However, few studies have been conducted on the antimicrobial activity of safranin.</p><p><strong>Objective: </strong>With the growing prevalence of multidrug-resistant bacteria, this study aimed to evaluate the antibacterial efficacy of gentian violet and safranin against multidrug-resistant Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa).</p><p><strong>Methods: </strong>All tested bacteria were multidrug-resistant (MDR) bacteria isolated from skin infections (abscesses and wounds). Using gentian violet and safranin, antibacterial effects were studied using the well-diffusion method against 20 samples of clinically isolated bacteria, 10 diagnosed as S. aureus, and 10 as P. aeruginosa. Bacteria were diagnosed using the VITEK 2 automated system (bioMérieux, Marcy-l'Étoile, France). Iodine served as the control agent, since both Gram-positive and Gram-negative bacteria are sensitive to it.</p><p><strong>Results: </strong>Gentian violet dye has been shown to be 100% sensitive to both Gram-positive and Gram-negative bacterial isolates. Although safranin also had high sensitivity (100%) to S. aureus isolates, its sensitivity to P. aeruginosa was only 20%. Staphylococcus aureus was more resistant to iodine (40% sensitivity) compared to P. aeruginosa, which was 100% sensitive to iodine.</p><p><strong>Conclusions: </strong>Gentian violet and safranin are low-cost and better tolerated topical agents that have potential for use in dermatological applications. Gentian violet had good antibacterial activity against both Gram-positive and Gram-negative bacteria, making it useful for treating bacterial skin pathogens such as S. aureus and P. aeruginosa especially for MDR bacteria. While safranin has good efficacy against Gram-positive bacteria (S. aureus), its effect against Gram-negative bacteria (e.g. P. aeruginosa) is poor.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40688917","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":"Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty.","authors":"Alexey Vladimirovich Lychagin,&nbsp;Andrey Anatolyevich Gritsyuk,&nbsp;Nahum Rosenberg","doi":"10.5041/RMMJ.10476","DOIUrl":"https://doi.org/10.5041/RMMJ.10476","url":null,"abstract":"<p><strong>Background and objective: </strong>Postoperative (post-op) pain control has an important impact on post-op rehabilitation. The logistics of its maintenance challenge the effect of peripheral nerve block on post-op pain control, with the risk for post-op complications. We hypothesized that perioperative use of local infiltration analgesia (LIA) is comparable to post-op pain control by peripheral nerve block.</p><p><strong>Materials and methods: </strong>We evaluated three groups of patients treated with primary total knee arthroplasty (TKA) due to symptomatic end-stage osteoarthritis with post-op pain control by LIA (LIA group, n=52), femoral plus sciatic nerve block (FSNB) (FSNB group, n=54), and without local or regional analgesia as controls (Control group, n=53). The primary outcome variable was the post-op pain level intensity as measured by the visual analog scale (VAS). Secondary outcome variables were knee function measured by the Knee Society Score (KSS) and the quadriceps muscle strength recovery profile.</p><p><strong>Results: </strong>Up to 4 hours post-op, pain intensity was significantly lower in FSNB patients (P<0.05). This effect of the peripheral nerve block on the pain level disappeared 6 hours post-op. The LIA and FSNB patients showed a significant decrease in pain intensity on days 2 and 3 post-op (P<0.05) with no mutual differences (P>0.05). This effect disappeared on day 4 post-op (P>0.05). The KSS score showed similar significant improvement of functional abilities (P<0.001) in all three groups. There was no difference in KSS scores among the groups 6 months after surgery (P>0.05). Quadriceps muscle recovery profile was similar in the LIA and Control groups, but significantly poorer in the FSNB group (P<0.001).</p><p><strong>Conclusion: </strong>The value of very short-term and improved pain relief of post-op FSNB over LIA of the surgical wound should be carefully weighed against its cost, logistics, and potential complication threat.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9345765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40578106","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}