Rambam Maimonides Medical Journal最新文献

{"title":"Fibromatoses of Head and Neck: Case Series and Literature Review.","authors":"Muddasir Bhati,&nbsp;Gurukeerthi Balakrishna,&nbsp;Kamaldeep Joshi,&nbsp;Kajari Bhattacharya,&nbsp;Munita Bal,&nbsp;Sarbani Ghosh Laskar,&nbsp;Shwetabh Sinha,&nbsp;Amit Joshi,&nbsp;Poonam Joshi,&nbsp;Sudhir Nair,&nbsp;Pankaj Chaturvedi","doi":"10.5041/RMMJ.10444","DOIUrl":"https://doi.org/10.5041/RMMJ.10444","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to retrospectively review clinical data, management protocols, and clinical outcomes of patients with fibromatoses of head and neck region treated at our tertiary care center.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 11 patients with confirmed histopathological diagnosis of fibromatosis registered in the Department of Head and Neck Surgery at Tata Memorial Centre, India, between 2009 and 2019. Various clinical and pathological features and treatment modalities were evaluated.</p><p><strong>Results: </strong>Age at diagnosis ranged between 18 and 74 years, with a median age of 36 years. The female-to-male ratio was 5:6. Supraclavicular fossa (n=4) was the most common subsite of origin in the neck (n=8). The lateral (n=2) and posterior cervical regions (n=2) were other common neck subsites. Less commonly involved sites were the mandible (n=1), maxilla (n=1), and thyroid (n=1). A total of eight patients underwent surgery at other centers before being referred to us for further management. Out of a total 11 patients, nine patients had unresectable disease at presentation. Six of the patients with unresectable disease received a combination of weekly doses of vinblastine 6 mg/m² and methotrexate 30 mg/m² for a median duration of 6 months (range 6-18 months) followed by hormonal therapy with tamoxifen. Three patients received metronomic chemotherapy followed by hormonal therapy. One treatment-naive patient with fibromatosis of posterior cervical (suboccipital) region underwent R2 resection (excision of bulk of the tumor with preservation of critical structures) at our center along with adjuvant radiotherapy. One pregnant patient reported to us after undergoing surgery outside and defaulting radiotherapy. During median follow-up of 29 months (range 1-77 months), six patients had stable disease, and four patients had disease reduction. Disease progression was seen in one patient. The two-year progression-free survival (PFS) was 90% (95% CI 70%-100%).</p><p><strong>Conclusion: </strong>Gross residual resection (R2) was the mainstay of surgical treatment in our series, as obtaining clear surgical margins is seldom possible in these locally aggressive tumors. Radiotherapy, chemotherapy, and hormonal therapy are the other preferred and more conservative treatment modalities. The goal of surgery should be preserving function with minimal or no morbidity. As fibromatoses in the head and neck region are extremely rare, their treatment awaits the development of standard treatment protocols.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191783","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":"Bone Involvement in Hyperphosphatemic Familial Tumoral Calcinosis: A New Phenotypic Presentation.","authors":"J Daniel Freedman,&nbsp;Rostislav Novak,&nbsp;Sharon Bratman Morag,&nbsp;Emily Avitan-Hersh,&nbsp;David Nikomarov","doi":"10.5041/RMMJ.10445","DOIUrl":"https://doi.org/10.5041/RMMJ.10445","url":null,"abstract":"Mutations in FGF23, KL, and GALNT3 have been identified as the cause for the development of hyperphosphatemic familial tumoral calcinosis (HFTC). Patients with HFTC typically present in childhood or adolescence with periarticular soft tissue deposits that eventually progress to disrupt normal joint articulation. Mutations in the GALNT3 gene were shown to account for the hyperphosphatemic state in both HFTC and hyperostosis-hyperphosphatemia syndrome (HHS), the latter characterized by bone involvement. We present the case of a patient of a Druze ethnic origin with known HFTC that presented to our department with the first documented case of pathologic fracture occurring secondary to the disease. Our report introduces this new phenotypic presentation, suggests a potential role for prophylactic bone screening, and highlights the need for preconception genetic screening in selected populations.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191784","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":"Non-immune Hemolysis in Gaucher Disease and Review of the Literature.","authors":"Eliyakim Hershkop,&nbsp;Idan Bergman,&nbsp;Alina Kurolap,&nbsp;Najib Dally,&nbsp;Hagit Baris Feldman","doi":"10.5041/RMMJ.10446","DOIUrl":"https://doi.org/10.5041/RMMJ.10446","url":null,"abstract":"<p><p>Gaucher disease (GD) is an autosomal recessive disease characterized by the buildup of glucocerebrosides in macrophages, resulting in the formation of \"Gaucher cells.\" These cells predominantly infiltrate the liver, spleen, and bone marrow leading to hepatosplenomegaly, cytopenia, and bone pain. Anemia in GD is typically considered to result from non-hemolytic processes. Although rare, a higher rate of hemolytic anemia of the autoimmune type has been reported in GD than in the general population. The literature on non-immune hemolytic anemia in GD is scarce. We review the literature on hemolytic anemia in GD and report on a case of non-immune hemolytic anemia secondary to GD. We believe this is the first description of a patient with confirmed GD and symptomatic non-immune hemolytic anemia that responded to GD-specific treatment.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191785","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: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children.","authors":"Klaus Rose,&nbsp;Oishi Tanjinatus,&nbsp;Jane Grant-Kels,&nbsp;Earl B Ettienne,&nbsp;Pasquale Striano","doi":"10.5041/RMMJ.10447","DOIUrl":"https://doi.org/10.5041/RMMJ.10447","url":null,"abstract":"We read with interest the report about four minors who were diagnosed late with non-COVID-19 diseases during the COVID-19 pandemic. We would like to emphasize that, firstly, such delays are not limited to minors, and secondly, that also in minors should we distinguish the administrative and the physiological meanings of the term “child” and hence distinguish administratively defined “children” who bodily are already mature from those young patients who bodily are indeed still children. The 16-year-old patient that was presented to the emergency room with endocarditis was bodily no longer a child, although administratively and probably also psychologically, due to his Down syndrome, he was still a child. Two of the other patients, one with hemolytic anemia (2.5 years old) and one with Ewing sarcoma (4 years old), were still pre-pubertal children, while the 13-year-old minor with a septic hip was already adolescent. The author of the cited paper works in a pediatric department and reports those patients that he has seen during his work. However, in our view there is nothing specifically pediatric in his observations. Several recent papers discuss delays of diagnosis and treatment of non-COVID-19 diseases during the pandemic, including head and neck cancer, appendicitis, heart failure and septicemia, pulmonary thromboembolism,6 pyelonephritis, and cancer in general.8 Some patients in these papers are administratively still “children,” some are adults, and appendicitis is discussed in both.3,4 The delay the COVID-19 pandemic has caused in the timely diagnosis of various diseases is not a “pediatric” challenge, but a challenge for medicine in general.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191786","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":"Jewish Values in Medical Decision-making for Unrepresented Patients: A Ritualized Approach.","authors":"Jason Weiner","doi":"10.5041/RMMJ.10441","DOIUrl":"https://doi.org/10.5041/RMMJ.10441","url":null,"abstract":"<p><p>Determining appropriate care for patients who cannot speak for themselves is one of the most challenging issues in contemporary healthcare and medical decision-making. While there has been much discussion relating to patients who left some sort of instructions, such as an advance directive, or have someone to speak on their behalf, less has been written on caring for patients who have nobody at all available to speak for them. It is thus crucial to develop clear and rigorous guidelines to properly care for these patients. The Jewish tradition offers an important perspective on caring for unrepresented patients and determining approaches to guide care providers. This article develops an understanding of fundamental Jewish principles that can provide clear guidance in navigating this challenge. It applies those values to a specific set of suggested behaviors, one of which adds a novel ritualized component to what has been recommended by bioethicists in the past.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39239726","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":"Clinical Characteristics and Prognosis of Idiopathic Acute Pancreatitis.","authors":"Tzvika Porges,&nbsp;Tali Shafat,&nbsp;Iftach Sagy,&nbsp;Dan Schwarzfuchs,&nbsp;Ilan Rahmani Tzvi-Ran,&nbsp;Alan Jotkowitz,&nbsp;Leonid Barski","doi":"10.5041/RMMJ.10442","DOIUrl":"https://doi.org/10.5041/RMMJ.10442","url":null,"abstract":"<p><strong>Objective: </strong>Acute pancreatitis is a serious diagnosis with an increasing incidence in the Western world. In this study we sought to investigate the incidence of idiopathic AP and to compare clinical and prognostic characteristics of idiopathic cases with cases of AP with known etiology.</p><p><strong>Methods: </strong>In this retrospective study of adult hospitalized patients diagnosed with acute pancreatitis between 2012 and 2015, a comparison was made between admissions of patients with known etiology and those for whom no cause was found. Primary outcome was defined as composite outcome of 30-day mortality and complications.</p><p><strong>Results: </strong>Among 560 admissions of 437 patients with a primary diagnosis of acute pancreatitis, the main factors identified were gallstones (51.2%) and idiopathic pancreatitis (35.9%), with alcohol ranked third at only 4.8%. Mortality rate within 30 days of hospitalization was 2.9% and within one year was 7.1%. Use of lipid-lowering, anti-hypertensive, and anti-diabetic medications was more frequent among patients with \"idiopathic\" disease (70%, 68%, and 33% versus 59%, 56%, and 27%, respectively). Patients admitted with idiopathic AP, in comparison to patients with known AP etiology, had milder disease with shorter hospital stay (3 days versus 4, respectively), and less re-admission in 30 days (7.5% versus 21.2%). Idiopathic AP patients had better prognosis in terms of 30-day death and complication (HR 0.33, 95% CI 0.08-0.40, P<0.001).</p><p><strong>Conclusion: </strong>Idiopathic disease is common among acute pancreatitis patients; the two study groups differed in severity of disease and prognosis. Common use of medications with doubtful value suggests possible under-diagnosis of drug-induced acute idiopathic pancreatitis.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191343","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":"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.10440","DOIUrl":"https://doi.org/10.5041/RMMJ.10440","url":null,"abstract":"<p><strong>Objectives: </strong>Our study aimed to determine the relationship between serum periostin levels, and the neutrophil-lymphocyte ratio (NLR) with ischemic stroke subtypes, clinical stroke scales, and acute prognosis in patients with acute ischemic stroke.</p><p><strong>Materials and methods: </strong>Forty-two ischemic stroke patients and 39 age- and sex-matched healthy volunteers were included in our study. Demographic characteristics including age and gender were recorded. Blood serum periostin and NLR values were evaluated in the first 24 hours after admission. Serum periostin levels were compared with healthy controls of similar age and sex. Lesion localization was determined by cranial CT or diffusion MRI of the patients. Stroke scales were recorded on days 1 and 7 of hospitalization in the study group.</p><p><strong>Results: </strong>The mean serum periostin levels were higher than in the control group, but no statistically significant difference was found. There was no correlation between serum periostin levels and prognosis of stroke. First admission NLRs were statistically higher than in the control group. The first admission NLRs were positively correlated with the first admission National Institute of Health Stroke Scale score and the day 7 modified Rankin score.</p><p><strong>Conclusion: </strong>Our study is the first study to evaluate both NLR and serum periostin levels in all types of acute ischemic stroke. While our study did not show that first admission serum periostin levels can be used as a biomarker in ischemic stroke, it did indicate that the first admission NLR can be used for acute prognosis of ischemic stroke.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39241230","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: Delayed Presentation of Non-COVID-19 Patients During the COVID-19 Pandemic Is Not Limited to Children.","authors":"Yonatan Yeshayahu","doi":"10.5041/RMMJ.10448","DOIUrl":"https://doi.org/10.5041/RMMJ.10448","url":null,"abstract":"I read with interest the letter by Klaus Rose et al. regarding the article about delayed diagnosis of severe medical conditions during the coronavirus disease 2019 (COVID-19) pandemic.1 The authors stressed the importance of recognizing that delayed presentation of patients, during the COVID-19 pandemic, was not limited to the pediatric population. I agree with this important point, and the article does not claim otherwise. The presented cases are pediatric, given that they took place in a pediatric department, but it is reasonable to assume that adults have faced the same challenges.","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191787","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":"Circulating Proprotein Convertase Subtilisin/Kexin Type 9 Levels Predict Future Cardiovascular Event Risks in Hemodialyzed Black African Patients.","authors":"François-Pantaléon Musungayi Kajingulu,&nbsp;François Bompeka Lepira,&nbsp;Aliocha Natuhoyila Nkodila,&nbsp;Jean-Robert Rissassy Makulo,&nbsp;Vieux Momeme Mokoli,&nbsp;Pepe Mfutu Ekulu,&nbsp;Justine Busanga Bukabau,&nbsp;Yannick Mayamba Nlandu,&nbsp;Augustin Luzayadio Longo,&nbsp;Nazaire Mangani Nseka,&nbsp;Ernest Kiswaya Sumaili","doi":"10.5041/RMMJ.10443","DOIUrl":"https://doi.org/10.5041/RMMJ.10443","url":null,"abstract":"<p><strong>Context and objective: </strong>Cardiovascular diseases are the leading cause of mortality in patients. In this context, proprotein convertase subtilisin/kexin type 9 (PCSK9) appears to be the new biomarker identified as interfering in lipid homeostasis. This study aimed to investigate the association between PCSK9, dyslipidemia, and future risk of cardiovascular events in a population of black Africans.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between August 2016 and July 2020 in six hemodialysis centers in the city of Kinshasa, Democratic Republic of the Congo. Serum PCSK9 was measured by ELISA; lipid levels of 251 chronic kidney disease grade 5 (CKD G5) hemodialysis patients and the Framingham predictive instrument were used for predicting cardiac events.</p><p><strong>Results: </strong>Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were significantly increased in the tertile with the highest PCSK9. By contrast, high-density lipoprotein cholesterol (HDL-c) was significantly decreased in the same tertile. A strong positive and significant correlation was found between PCSK9 and TC, TG, and LDL-c. Negative and significant correlation was observed between PCSK9 and HDL-c. The levels of PCSK9, smoking, overweight, and atherogenic dyslipidemia were associated with future risks for cardiovascular events in univariate analysis. After adjustment, all these variables persisted as independent determinants of future risk for cardiovascular events. The probability of having a cardiovascular event in this population was independently associated with PCSK9 levels. Compared to the patients in the lowest PCSK9 tertile, patients with PCSK9 levels in the middle (aOR 5.9, 95% CI 2.06-17.3, P<0.001) and highest tertiles (aOR 8.9, 95% CI 3.02-25.08, P<0.001) presented a greater risk of cardiac event.</p><p><strong>Conclusion: </strong>Increased PCSK9 serum levels are associated with higher levels of TC, LDL-c, and TG and lower levels of HDL-c in black African hemodialysis patients. Serum PCSK9 levels in these patients predict increased risk of cardiovascular events, independent of traditional potential confounders.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 3","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39191344","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":"Incidence of Cardiac Manifestations in Children with Dengue Fever: A Cross-sectional Study.","authors":"Janakiraman Abhinayaa,&nbsp;Saji James,&nbsp;Rathinasamy Jebaraj,&nbsp;Ponnurangam Nagarajan Vinoth","doi":"10.5041/RMMJ.10436","DOIUrl":"https://doi.org/10.5041/RMMJ.10436","url":null,"abstract":"<p><strong>Objective: </strong>The aim of our study was to explore the incidence of cardiac involvement in children with dengue infection admitted in a tertiary care hospital and to evaluate the features of cardiac involvement with the severity of dengue fever.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted from September 2014 to August 2016. A total of 130 patients with confirmed dengue NS1 antigen or IgM antibody positivity between the ages of 1 month and 18 years were evaluated. On the third day of admission, blood samples for cardiac markers were collected, and electrocardiograms (ECG) and echocardiograms were performed for each patient.</p><p><strong>Results: </strong>Of the 130 dengue patients in the study, 60 (46.2%) were males and 70 (53.8%) were females (male to female ratio, 1:1.16). Cardiac involvement was present in 60 (46.2%) children and was more prominent in children with severe dengue (72.7%), followed by dengue with warning symptoms (53.8%) and dengue fever (28.6%). There was no significant correlation between cardiac involvement and primary/secondary dengue. Both ECG and echocardiography changes were significantly correlated with dengue severity, as opposed to cardiac markers.</p><p><strong>Conclusions: </strong>Cardiac involvement was present in children with dengue. Evaluation with ECG, echocardiography, and cardiac markers such as creatine phosphokinase-myocardial band (CPK-MB) are required for the management of cardiac complications in children with dengue. Our study showed an association between cardiac involvement and the severity of dengue. Further studies should be framed, and follow-up of dengue patients with cardiac involvement is necessary for therapeutic management.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"12 2","pages":""},"PeriodicalIF":1.5,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38862320","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}