{"title":"Utilizing 2D Strain in Routine Echocardiography Examinations: Position paper of the Israeli Society of Echocardiography.","authors":"Marina Leitman, Shemy Carasso","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"7-10"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392368","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}
{"title":"Internal Medicine at Home: Three Years of Experience with a Novel Model.","authors":"Jamal Qarawany, Yoav Weber, Zivit Zalts, Carmit Steinberg, Doron Cohn-Schwartz, Eyal Braun, Zaher S Azzam, Avi Magid, Henda Darawsha, Rizan Sakhnini, Gidon Berger","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Hospital-at-Home (HaH) programs offer medical services in the patient's home as an alternative to hospitalization across various medical fields. Previous studies have demonstrated that HaH provides several benefits for patients and the healthcare system. Rambam Health Care Center was the pioneer hospital in introducing HaH in Israel. Since April 2021, in collaboration with Maccabi Healthcare Services, the center has been providing home hospitalization services for patients with acute internal medicine illnesses based on an innovative model.</p><p><strong>Objectives: </strong>To describe demographic data, background diseases, indications for HaH admissions, length of stay (LOS), 1-month and 1-week readmission rates, home mortality, and 1-month mortality.</p><p><strong>Results: </strong>The study included 262 patients (135 men, 127 women), mean age 69.7 years (range 24-98, median 73). Patients had significant co-morbidities, with a Charlson Comorbidity Index score of 6.7. Among the patients, 170 were independent, 61 were incapacitated, and the remainder had various functional limitations. Most admissions were from internal medicine departments, 39 originating from the emergency department and the rest from other acute care wards. The primary indications for HaH admission included pneumonia, urinary tract infections, and cellulitis. The average hospital LOS was 48.9 hours, while the HaH LOS was 3.43 days. Readmission rates for the same initial conditions were 10% within 1 week and 14% within 1 month. Twenty-one patients died within 1 month of discharge from HaH, including one death during the HaH period.</p><p><strong>Conclusions: </strong>This study highlighted the feasibility of home hospitalization as a viable alternative to traditional inpatient care in internal medicine.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"49-53"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392350","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}
Yigal Helviz, Frederic S Zimmerman, Daniel Belman, Yaara Giladi, Imran Ramlawi, David Shimony, Meira Yisraeli Salman, Nir Weigert, Mohammad Jaber, Shai Balag, Yaniv Hen, Raed Jebrin, Daniel Fink, Eli Ben Chetrit, Michal Shitrit, Ramzi Kurd, Phillip D Levin
{"title":"Lack of Clinical Prognostic Power for Ventilated Critical COVID-19 Patients in the Intensive Care Unit.","authors":"Yigal Helviz, Frederic S Zimmerman, Daniel Belman, Yaara Giladi, Imran Ramlawi, David Shimony, Meira Yisraeli Salman, Nir Weigert, Mohammad Jaber, Shai Balag, Yaniv Hen, Raed Jebrin, Daniel Fink, Eli Ben Chetrit, Michal Shitrit, Ramzi Kurd, Phillip D Levin","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prognostication is complex in patients critically ill with coronavirus disease 2019 (COVID-19).</p><p><strong>Objectives: </strong>To describe the natural history of ventilated critical COVID-19 patients.</p><p><strong>Methods: </strong>Due to our legal milieu, active withdrawal of care is not permitted, providing an opportunity to examine the natural history of ventilated critical COVID-19 patients. This retrospective cohort included COVID-19 ICU patients who required mechanical ventilation. Respiratory and laboratory parameters were followed from initiation of mechanical ventilation for 14 days or until extubation, death or tracheostomy.</p><p><strong>Results: </strong>A total of 112 patients were included in the analysis. Surviving patients were younger than non-survivors (62 years [range 54-69] vs. 66 years [range 62-71], P = 0.01). Survivors had a shorter time to intubation, shorter ventilation duration, and longer hospital stay. Respiratory parameters at intubation were not predictive of mortality. Nevertheless, on ventilation day 10, many of the ventilatory parameters were significantly better in survivors. Regarding laboratory parameters, neutrophil counts were significantly higher in non-survivors on day 1 and C-reactive protein levels were significantly lower in survivors on day 10. Modeling using a generalized estimating equation showed small dynamic differences in ventilatory parameters predictive of survival.</p><p><strong>Conclusions: </strong>In ventilated COVID-19 patients when there is no active care withdrawal, prognostication may be possible after a week; however, differences between survivors and non-survivors remain small.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"34-41"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392353","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}
Efrat Wertheimer, David Maiershon, Jonathan Giron, Yehuda Shoenfeld, Arnon Afek, Miri Mizrahi Reuveni
{"title":"Advancing Preclinical Education: A New Model for Medical Education. The Experience of the Dina Recanati School of Medicine at Reichman University.","authors":"Efrat Wertheimer, David Maiershon, Jonathan Giron, Yehuda Shoenfeld, Arnon Afek, Miri Mizrahi Reuveni","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"23-27"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392346","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}
{"title":"Development and Validation of a Clinical Protocol in COVID-19 Patients to Assess Disease Severity and Outcomes.","authors":"Milena Tocut, Yousef Abuleil, Mona Boaz, Amos Gilad, Gisele Zandman-Goddard","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic showed the need to evaluate disease severity promptly at the time of hospital admission.</p><p><strong>Objectives: </strong>To establish an admission protocol, which included clinical and laboratory findings.</p><p><strong>Methods: </strong>We conducted a retrospective study at Wolfson Medical Center, Israel, for a period of 19 months (2020-2021). We established a protocol for patients who were admitted with COVID-19 infection. The protocol parameters included demographic data, co-morbidities, immune status, oxygen level at room air on admission, oxygen demand, lymphopenia, C-reactive protein (CRP) level, lactate dehydrogenase, D-DIMER, creatinine, aspartate transferase, alanine aminotransferase, and ferritin. Based on this protocol, we defined the severity of COVID-19 at the beginning of hospitalization and started treatment without delay. This protocol included ferritin levels as a guide to severity and outcome of patients. A database was established for all the parameters of the patients included in the study.</p><p><strong>Results: </strong>The study included 407 patients; 207 males (50.9%), 200 females (49.1%). The age range was 18-101 years. Hyperferritinemia (> 1000 ng/dl) was one of the strongest and most significant predictors for severe disease in these patients (P < 0.001). Lymphopenia, high levels of CRP, alanine aminotransferase, aspartate transferase, lactate dehydrogenase, and creatinine also correlated with severe disease, complications, and death.</p><p><strong>Conclusions: </strong>Abnormal ferritin levels were a very significant and clear indicator of the development of severe COVID-19. The addition of ferritin levels to our protocol aided in finding which patients were at increased risk for morbidity and mortality.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"28-33"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392348","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}
Isca Hershkowitz, Joshua Moss, Jacob Sosna, Eyal Netser, Avivit Cahn, Alon Y Hershko
{"title":"Iodinated Contrast Media Allergy and Its Management in a Large Cohort in the Hospital Setting.","authors":"Isca Hershkowitz, Joshua Moss, Jacob Sosna, Eyal Netser, Avivit Cahn, Alon Y Hershko","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Management of patients with reported iodinated contrast media (ICM) allergy is not supported by sufficient data. It is assumed that these patients are at risk for severe reactions, and that premedication provides protection.</p><p><strong>Objectives: </strong>To examine current practice and prognosis in hospitalized patients with ICM allergy.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed data of 17,356 patients who were hospitalized between 2018 and 2022 and referred for imaging. No-allergy and allergy groups were matched by age, sex, co-morbidities, and indications for imaging. Statistical analysis compared demographic, clinical, and imaging-related parameters.</p><p><strong>Results: </strong>Our study included records of 501 patients with ICM allergy and 16,855 with no allergy. Patients with allergy were older (70.92 ± 16.25 vs. 59.02 ± 23.74 years, P < 0.001), female preponderance (male proportion 42.5% vs. 54%, P < 0.001), and those with increased cardiovascular and metabolic co-morbidities. The rate of ICM injection was similar among patients with ICM allergy (34%) and no allergy (36%). Most patients with ICM allergy did not receive premedication. Allergic patients demonstrated increased mortality (25.9% vs. 16.5%, P < 0.001); however, this result was not associated with the diagnosis of allergy, anaphylactic reactions, or premedication.</p><p><strong>Conclusions: </strong>ICM allergy is mostly reported in patients with advanced age and multiple co-morbidities. Mortality was not increased when compared to matched non-allergic individuals. Among patients with reported allergy who were injected with ICM, anaphylaxis was not a cause of death, although fewer than half received premedication. Prospective trials are warranted to revise the clinical approach to ICM allergy.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"42-48"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392351","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}
Gassan Moady, Tameemi Abdallah Moady, Alexander Shturman, Shaul Atar
{"title":"Pulmonary Embolism in Peripartum Cardiomyopathy: An Unusual Complication.","authors":"Gassan Moady, Tameemi Abdallah Moady, Alexander Shturman, Shaul Atar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"54-56"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392354","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}
{"title":"Surgery in Mauthausen Concentration Camp: Therapy or Practice?","authors":"George M Weisz","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"11-16"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392355","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}
{"title":"Educating the Physicians of the Future: The Dina Recanati School of Medicine at Reichman University.","authors":"Arnon Afek","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"27 1","pages":"5-6"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392349","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}