Israel Medical Association Journal最新文献

Epidural Abscess Caused by Aggregatibacter Aphrophilus. Aggregatibacter Aphrophilus 引起的硬膜外脓肿。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Meir Mouallem, Alon Fridlander, Shai Shrot, Yehuda Shoenfeld

引用次数: 0

Cholesterol Levels and Lipid Lowering Treatment in Coronary Heart Disease Patients Hospitalized Because of Anginal Syndrome. 因心绞痛综合征住院的冠心病患者的胆固醇水平和降脂治疗。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Ahmad Raiyan, Avishay Elis

{"title":"Cholesterol Levels and Lipid Lowering Treatment in Coronary Heart Disease Patients Hospitalized Because of Anginal Syndrome.","authors":"Ahmad Raiyan, Avishay Elis","doi":"","DOIUrl":"","url":null,"abstract":"Background: Coronary heart disease (CHD) patients are considered high cardiovascular risks. Guidelines recommend low-density lipoprotein cholesterol (LDL-C) target levels below 55 mg/dl with > 50% reduction from baselines. These levels can be reached by a combination of statins, ezetimibe, and anti-protein convertase subtilisin/kexin type 9 (anti-PCSK9) agents. Our clinical impression was that CHD patients do not reach LDL-C target levels, despite the wide availability.Objectives: To evaluate whether hospitalization would result in changes in lipid lowering regimens and short-term compliance.Methods: We conducted a retrospective cohort study using data of CHD patients who were admitted to internal medicine wards at Clalit Health Services medical centers because of anginal syndrome during 2020-2022. The data were evaluated for demographic and clinical characteristics; LDL-C level at admission, 6 months previously, and 3 months and 6-9 months after discharge; rates of reaching LDL-C target levels; and lipid lowering treatment at admission, discharge, and 6-9 months after.Results: The cohort included 10,540 patients. One-third and three-quarters did not have lipids level measurements up to 6 months before and during hospitalization, respectively. Only one-fifth of the patients reached LDL-C values before and during admission (median LDL-C 72 mg/dl; range 53-101). Approximately half were treated with high-dose potent statins. Only 10% were treated with ezetimibe. Hospitalization did not have a clinically significant effect on short-term lipid lowering treatment or LDL-C levels.Conclusions: Gaps were noted between guidelines and clinical practice for reaching LDL-C target levels. Further education and strict policy are needed.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Novelties in the Hyperferritinemic Syndrome: New Insights from Systemic Sclerosis. 高铁蛋白血症综合征的新发现：系统性硬化症的新发现

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Piero Ruscitti

引用次数: 0

Term Breech Presentation and Timing of Delivery. 临产阵痛和分娩时间。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Noa Leybovitz-Haleluya, Alla Saban, Adi Yariv, Reli Hershkovitz

{"title":"Term Breech Presentation and Timing of Delivery.","authors":"Noa Leybovitz-Haleluya, Alla Saban, Adi Yariv, Reli Hershkovitz","doi":"","DOIUrl":"","url":null,"abstract":"Background: Breech presentation is a major indication for cesarean delivery (CD); however, the ideal timing of breech CD is debatable.Objectives: To study the influence of gestational age at the time of CD in breech presentation on maternal and fetal complications.Methods: We conducted a retrospective study including term singleton CDs of breech presentation between February 2020 and January 2022 at a tertiary medical center. Maternal and neonatal outcomes were compared by gestational age at the time of CD. Logistic regression models were constructed to adjust for confounders.Results: The study population included 468 CDs, 227 (48.5%) were at 37 + 0 to 38 + 6 weeks, 168 (36%) were at 39 + 0 to 39 + 6 weeks (comparison group), and 73 (15.5%) were at ≥ 40 weeks at the time of delivery. The rate of emergent CDs was significantly higher in both study groups. The composite of maternal adverse outcomes was also significantly higher at ≥ 40 weeks of gestation. Using logistic regression model, associations remained significant. The adjusted odds ratios (OR) for emergent CDs at 37 + 0 to 38 + 6 weeks and at ≥ 40 weeks were 1.65 (P = 0.018) and 2.407 (P = 0.004), respectively. Adjusted OR for maternal adverse outcomes at ≥ 40 weeks was 2.094 (P = 0.018). Higher rates of emergent CDs in both study groups compared to the comparison group was noted. A composite of maternal adverse outcomes was significantly higher at ≥ 40 weeks of gestation. This association remained significant after controlling for potential confounders.Conclusions: CDs at 39 + 0 to 39 + 6 weeks are associated with better maternal outcomes and lower rates of emergent CDs.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hospitalization Outcomes of Patients with Type 2 Diabetes Mellitus Complicated with Diabetic Ketoacidosis. 并发糖尿病酮症酸中毒的 2 型糖尿病患者的住院治疗结果。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Maly Keler, Pavel Vlasov, Matan Elkan, Shlomit Koren, Ronit Koren

{"title":"Hospitalization Outcomes of Patients with Type 2 Diabetes Mellitus Complicated with Diabetic Ketoacidosis.","authors":"Maly Keler, Pavel Vlasov, Matan Elkan, Shlomit Koren, Ronit Koren","doi":"","DOIUrl":"","url":null,"abstract":"Background: Diabetic ketoacidosis (DKA) poses a significant medical emergency in both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) patients. Recent attention has focused on the emergence of euglycemic DKA associated with sodium-glucose cotransporter-2 (SGLT2) inhibitors.Objectives: To understand the epidemiology and outcomes of DKA, particularly in T2DM patients.Methods: We conducted a retrospective cohort analysis of 204 patients admitted with DKA to Shamir Medical Center (2013-2021). We assessed demographics, clinical characteristics, and outcomes. Patients were stratified by diabetes type and SGLT2 inhibitor treatment status.Results: Among the 204 patients with DKA, 38.2% had T2DM. Patients with T2DM exhibited older age, higher co-morbidity burden, and greater prevalence of microvascular complications compared to T1DM patients. Mortality rates were notably higher among T2DM patients, despite similar DKA severity at presentation, including in-hospital mortality rates of 6.4% vs. 0%, P < 0.05, and 90-day mortality rates of 7.7% vs. 0%, P < 0.05. T2DM was independently associated with adverse hospitalization outcomes, including a composite of rehospitalization, prolonged hospital stays, and mortality (odds ratio 2.68, 95% confidence interval 1.302-5.557). SGLT2 inhibitor treatment did not affect hospitalization outcomes of patients with T2DM.Conclusions: Our findings underscore the importance of recognizing DKA as a substantial complication in diabetic patients, particularly those with T2DM. Vigilance in management, adherence to DKA guidelines, and awareness of triggers such as SGLT2 inhibitors are crucial for improving outcomes in this population.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Introduction of a New Toxicology Consult Service in a Large Tertiary Care Teaching Hospital. 在一家大型三级教学医院引入新的毒理学咨询服务。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Or Segev, Christopher Hoyte, Nicole Taylor, Amanda Katz, Dennis Scolnik, Efrat Zandberg, Eyal Hassoun, Miguel Glatstein

{"title":"Introduction of a New Toxicology Consult Service in a Large Tertiary Care Teaching Hospital.","authors":"Or Segev, Christopher Hoyte, Nicole Taylor, Amanda Katz, Dennis Scolnik, Efrat Zandberg, Eyal Hassoun, Miguel Glatstein","doi":"","DOIUrl":"","url":null,"abstract":"Background: Clinical toxicology is not a certified specialty in Israel, consequently there are a limited number of toxicologists and toxicology services available for consultation.Objectives: To establish a medical toxicology consultation service focusing on bedside consultations, which had not previously been available in Israel.Methods: This single-center, retrospective chart review of toxicology consults was conducted during the first years after the initiation of a new toxicology service.Results: From September 2017 to December 2021, 1703 toxicology consultations were conducted. The most common exposures and reasons for consultation included psychotropic medications (427, 23%), analgesics and anti-inflammatory medications (353, 19%), household products (312, 17%), substances of abuse (240, 13%), and natural toxins (142, 8%). Bedside medical toxicology consultations were performed in 1036 cases (62%) during daytime and night shifts. The number of consultation requests increased steadily over the study period.Conclusions: The new toxicology service led to a significant change in the institution's approach to toxicological patients. A bedside toxicology service could help reduce the healthcare burden on national poison centers and can offer readily available, personalized, medical toxicology care.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Association Between Serum Ferritin Levels and Main Systemic Sclerosis Features: A Retrospective Study from a Tertiary Center. 血清铁蛋白水平与系统性硬化症主要特征之间的关系：来自一家三级医疗中心的回顾性研究

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Shirley Markovich Sholomon, Sami Giryes, Vika Shataylo, Yolanda Braun-Moscovici, Alexandra Balbir-Gurman

{"title":"The Association Between Serum Ferritin Levels and Main Systemic Sclerosis Features: A Retrospective Study from a Tertiary Center.","authors":"Shirley Markovich Sholomon, Sami Giryes, Vika Shataylo, Yolanda Braun-Moscovici, Alexandra Balbir-Gurman","doi":"","DOIUrl":"","url":null,"abstract":"Background: Serum ferritin is a sensitive inflammatory biomarker reflecting cell damage and oxidative stress in inflammatory rheumatic diseases. The use of ferritin for assessment of systemic sclerosis (SSc) activity, severity, and prognosis has not been fully elucidated.Objectives: To assess the correlation between serum ferritin levels and SSc disease parameters, complications, and outcome.Methods: Demographic, clinical, and laboratory data, including blood levels of ferritin, were collected from files of patients with SSc who were treated at the Rheumatology Institute at Rambam Health Care Campus from January 2004 to July 2021. The study compared SSc patients with elevated levels of ferritin to those with normal levels.Results: We extracted data of 241 SSc patients (80% female, 60% with diffuse SSc, mean age 54 ± 15.4 years, mean disease duration 6.8 ± 4.5 years). During follow-up, 39% died. Elevated ferritin levels positively correlated with male sex; short disease duration; lung, heart, and kidney involvement; higher modified Rodnan skin score; anemia; elevated levels of creatinine kinase, C-reactive protein, creatinine, and troponin; reduced pulmonary function tests (forced vital capacity and diffusion capacity of the lung for carbon monoxide); and left ventricular ejection fraction. There were no correlations between ferritin levels and pulmonary hypertension or gastrointestinal involvement. Levels of ferritin negatively correlated with anti-centromere antibodies.Conclusions: In SSc, ferritin can serve as a marker for ongoing systemic inflammation and prognosis, particularly in patients with lung and heart involvement. Further studies on serial ferritin measurement in the management of SSc patients are warranted.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluation of Vitamin K Antagonists Management and Control in Patients with Mechanical Prosthetic Heart Valves during the COVID-19 Pandemic. 评估 COVID-19 大流行期间机械人工心脏瓣膜患者的维生素 K 拮抗剂管理和控制情况。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Ilana Gilboa, Keren Rodrig, Tzipi Hornik-Lurie, David Pereg

{"title":"Evaluation of Vitamin K Antagonists Management and Control in Patients with Mechanical Prosthetic Heart Valves during the COVID-19 Pandemic.","authors":"Ilana Gilboa, Keren Rodrig, Tzipi Hornik-Lurie, David Pereg","doi":"","DOIUrl":"","url":null,"abstract":"Background: Patients with mechanical prosthetic heart valves must be treated with vitamin K antagonists (VKA) due to an increased risk of valve thrombosis and systemic embolism.Objectives: To assess the effects of the COVID-19 pandemic on VKA treatment control in patients with mechanical prosthetic heart valves.Methods: We conducted a retrospective nationwide cohort study using the Clalit Health Services database. The cohort included patients who underwent either aortic or mitral valve replacement using a prosthetic mechanical valve. The primary outcomes included the overall time in therapeutic range (TTR) and the percent of patients with a TTR < 50% during the first year of the COVID-19 pandemic compared to preceding year.Results: The cohort included 2381 patients. The percentage of patients who had at least two international normalized ratio (INR) tests during the first year of the COVID-19 pandemic was significantly lower compared to the year preceding the pandemic (81% and 87%, respectively, P < 0.001). In both years, the percentage of patients without any documented INR test was high (31.5% in the first COVID-19 pandemic year and 28.9% in the preceding year, P < 0.001). TTR was significantly lower during the 1st year of the COVID-19 pandemic compared to the preceding year (68.1% ± 26 and 69.4% ± 24, P = 0.03). A TTR > 50% was demonstrated in 78% and 81% during the pandemic and the preceding year, P = 0.009.Conclusions: We noted overall poor VKA control in patients with mechanical heart valves. During the COVID-19 pandemic, VKA control became even worse as reflected by significantly lower TTR and INR tests rates.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Novel CLCN1 Gene Mutation Associated with Hypokalemic Periodic Paralysis in a Pregnant Woman. 与一名孕妇低钾血症性周期性麻痹有关的新型 CLCN1 基因突变

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Jawad Atrash, Omar Abu Libdeh, Bashar Fteiha, Marwan Abu Sneineh, Alon Bnaya, Linda Shavit

引用次数: 0

Introducing Cloacagram in Israel: Advancing Anatomical Assessment and Surgical Planning for Cloacal Malformations. 在以色列引入 Cloacagram：推进泄殖腔畸形的解剖评估和手术规划。

IF 1.8 4区医学

Israel Medical Association Journal Pub Date : 2024-10-01

Maya Paran, Osnat Konen, Tal May, Moussa Totah, Michael Levinson, Michael Segal, Dragan Kravarusic, Inbal Samuk

{"title":"Introducing Cloacagram in Israel: Advancing Anatomical Assessment and Surgical Planning for Cloacal Malformations.","authors":"Maya Paran, Osnat Konen, Tal May, Moussa Totah, Michael Levinson, Michael Segal, Dragan Kravarusic, Inbal Samuk","doi":"","DOIUrl":"","url":null,"abstract":"Background: Cloacal malformation represents the rarest and most complex congenital anorectal malformation in females and is characterized by the convergence of urinary, gynecological, and intestinal systems within a single common channel. Three-dimensional computed tomography reconstruction (3D CT cloacagram) has emerged as a valuable method for anatomical assessment and preoperative planning.Objectives: To evaluate our experience with 3D CT cloacagram and assess its results.Methods: This retrospective case series included all patients with cloacal malformation who underwent preoperative 3D CT cloacagram at a single institution during 2019-2023. Collected data included patient characteristics, timing of the 3D CT cloacagram, results of the 3D CT cloacagram, comparison with endoscopic results, surgical procedures, and postoperative outcome.Results: Six patients with cloacal malformation were included in this study, including two with posterior cloaca. The median common channel length on 3D CT cloacagram was 24.5 mm (range 9-48 mm) and the median urethral length was 15.5 mm (range 13-24 mm). The surgical approach involved a combined abdominoperineal approach in three patients and posterior sagittal anorectal vaginal urethral plasty in one patient. Two patients were awaiting surgical reconstruction at the time of publication.Conclusions: Our implementation of 3D cloacagram has facilitated precise measurements of both the urethra and common channel lengths, two key factors in formulating surgical strategies for cloacal reconstruction. Moreover, this technique has markedly improved our capacity for surgical planning contributing to colorectal, gynecological, and urological perspectives.","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0