Israel Medical Association Journal最新文献

{"title":"The Efficacy of Echocardiography-guided Cardiac Implantable Electronic Devices Implantation to reduce Device Related Tricuspid Regurgitation: Long-term Follow-up.","authors":"Tamar Slobodov, Gergana Marincheva, Michael Rahkovich, Andrei Valdman, Yonatan Kogan, Avishag Laish-Farkash","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cardiac implantable electronic devices (CIEDs) with endocardial leads crossing the tricuspid valve can lead to or worsen tricuspid regurgitation (TR), causing substantial morbidity and mortality. Despite a recent randomized controlled study revealing a low short-term incidence of device-related TR (DRT) post-CIED implantation, uncertainties persist regarding the efficacy of intra-procedural 2-dimensional transthoracic echocardiography (2DTTE) in preventing long-term TR.</p><p><strong>Objectives: </strong>To conduct a long-term follow-up study on patients with CIED implants based on a previous study conducted at our hospital.</p><p><strong>Methods: </strong>In a retrospective study at Assuta Ashdod Medical Center (2018-2019), patients undergoing de-novo CIED implantation with (n=39, group 1) or without (n=51, group 2) intra-procedural 2DTTE were analyzed. Clinical, demographic, and long-term (> 1 year) echocardiographic data were collected and compared.</p><p><strong>Results: </strong>The study included 90 patients (mean age 72.3 ± 11.0 years, 63% male, 23% ICD, 50% active leads, follow-up 32.8 ± 11 months). TR aggravation was found in 25% of patients (13 in group 1, 10 in group 2), with no statistical difference between groups. Multivariate analysis identified a history of atrial fibrillation (AF) as the sole significant factor in long-term TR deterioration (OR=3.44, 95%CI 1.13-10.43, P = 0.029). Other clinical, demographic, echocardiographic, and device-related factors did not significantly contribute to long-term DRT.</p><p><strong>Conclusions: </strong>After one-year post-CIED implantation, the incidence of DRT significantly increases. Intra-procedural 2DTTE does not effectively reduce long-term DRT, suggesting that implantation-related mechanisms are less likely the primary cause. AF likely plays a major role in the pathogenesis of long-term TR in this subset post-CIED implantation.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"621-629"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631852","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":"Cardiac and Pleural Involvement in Systemic Light Chain Amyloidosis: A Case Report.","authors":"Ela Giladi, Hadas Gilboa-Sagy, Liaz Zilberman, Olga Zyabkin, Abid Assali, Sagee Tal, Osnat Jarchowsky","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"660-662"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631835","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":"Resilience Unveiled: Myxedema Coma in a Hostage Survivor.","authors":"Noa Fried-Regev, Tzachi Slutsky, Amit Frenkel, Moti Klein, Shlomi Codish, Dan Schwarzfuchs","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"613-615"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631848","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":"Does This Image Reveal a Fourth Cranial Nerve Palsy?","authors":"Daniel M Gelfman","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"663-664"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631837","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":"The Challenges of Forensic Medicine in Victim Identification in the Wake of the October 7th (2023) Mass Casualty Event.","authors":"Chen Kugel, Ricardo P Nachman, Itai Katz, Arad Dotan, Gisele Zandman-Goddard, Yehuda Shoenfeld","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The massive terrorist attack on a mixed population of civilians, soldiers, and foreigners on October 7, 2023, resulted in 1200 casualties and led to many major personal identification issues. At the Israel National Center for Forensic Medicine (INCFM), addressing the mass casualty incidents required precision that included technical, ethical, and humanitarian dimensions. Many obstacles arose that were attributable to the vast number and diversity of victims and the heavy workload in the setting of a small forensic team.</p><p><strong>Objectives: </strong>To define the various methods utilized for victim identification.</p><p><strong>Methods: </strong>The different types of identification were visual, primary, and circumstantial. Primary methods compared unique and stable characters of the human body, including fingerprints, comparisons of dental data, X-rays, and medical databases. We implemented other methods (anthropology, genetics) and novel creative strategies (digital photography taken by random individuals using mobile phones) and computed tomography (CT) scan at another designated site other than at the INCFM.</p><p><strong>Results: </strong>Often, visual recognition and extraction of DNA were impossible because of burnt human remains. Hence, a comparison method of antemortem and postmortem CT findings became imperative for many unidentified victims. The more complex cases included the finding of body parts of more than one individual in different body bags (comingled remains). In such situations, we matched the body parts by utilizing DNA methods. We present seven case challenges.</p><p><strong>Conclusions: </strong>We utilized various known and novel methods for victim identification in the aftermath of the events of 7 October 2023 while addressing ethical issues in a case series.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"603-607"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631850","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":"Using Urine Output Trending for the Management of Acute Cardiorenal Syndrome.","authors":"Anna Rozenfeld, Aliza Goldman, Tal Stern, Shmuel Banai, Yacov Shacham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>One-third of patients with acute decompensated heart failure (ADHF) develop worsening kidney function, known as type I cardiorenal syndrome (CRS). CRS is linked to higher mortality rates, prolonged hospital stays, and increased readmissions.</p><p><strong>Objectives: </strong>To explore the impact of real-time monitoring of urinary output (UO) trends on personalized pharmacologic management, fluid balance, and clinical outcomes of patients with ADHF admitted to a cardiac intensive care unit.</p><p><strong>Methods: </strong>Our study comprised 35 patients who were hospitalized with ADHF and continuously monitored for UO (UOelec). Standard diuretic and fluid protocols were implemented after 2 hours of oliguria, and patient outcomes were compared to a historical matched control (HMC) group. Patients were assessed for daily and cumulative fluid balance (over 72 hours) as well as for the occurrence of acute kidney injury (AKI).</p><p><strong>Results: </strong>Significantly more patients in the UOelec group demonstrated negative fluid balance daily and cumulatively over time in the intensive care unit compared to the HMC group: 91% vs. 20%, respectively (P < 0.0001 for 72-hour cumulative fluid balance). The incidence of AKI was significantly lower in the UOelec monitoring cohort compared to the HMC: 23% vs. 57%, respectively (P = 0.003). Moreover, higher AKI resolution, and lower peak serum creatinine levels were demonstrated in the UOelec group vs. the HMC group.</p><p><strong>Conclusions: </strong>Implementing real-time monitoring of UO in ADHF patients allowed for early response to oliguria and goal-directed adjustment to treatment. This finding ultimately led to reduced congestion and contributed to early resolution of AKI.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"643-649"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631857","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":"Lower Limbs Arterial Discrepancy in Poliomyelitis Patients.","authors":"Sagi Levental, Isabella Schwartz, Jonathan Lorber, Jakob Nowotny, Ron Karmeli","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Isolated peripheral artery aneurysms are very rare, appearing in fewer than 2% of the general population. The literature reports a few case reports of poliomyelitis patients presenting with unilateral leg paralysis that presented with peripheral aneurysms in the contralateral leg.</p><p><strong>Objectives: </strong>To compare lower limb arterial diameters in poliomyelitis patients and screen these patients for peripheral aneurysms.</p><p><strong>Methods: </strong>Poliomyelitis patients older than 55 years of age with unilateral leg paralysis since childhood were prospectively screened by ultrasound duplex during scheduled visits to the outpatient rehabilitation center. These results were compared to the control group. The control groups consisted of healthy adults and patients with childhood poliomyelitis without lower limb paralysis or symmetric bilateral limb paralysis. We measured the diameter of nine arteries in each participant (aorta, bilateral common iliac artery, bilateral common femoral artery, bilateral superficial femoral artery, and bilateral popliteal artery).</p><p><strong>Results: </strong>The study cohort included 77 participants: 40 poliomyelitis patients with unilateral leg paralysis, 18 poliomyelitis patients with bilateral leg paralysis or without leg paralysis, and 19 non-poliomyelitis patients without leg paralysis. We demonstrated a significant difference between averaged arterial diameters of lower limb arteries in poliomyelitis patients, favoring the strong leg. We were unable to demonstrate an arterial aneurysm in any of the patients.</p><p><strong>Conclusions: </strong>There is a significant difference between arterial diameters of lower limb arteries in poliomyelitis patients with unilateral leg paralysis in favoring the strong leg.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"650-654"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631844","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":"Decolonization of Staphylococcus aureus Prior to Cardiac Implantable Electronic Device Implantation: Evaluating Preoperative Yield.","authors":"Yana Kakzanov, Yamama Alsana, Tal Brosh-Nissimov, Emanuel Harari, Michael Rahkovich, Yonatan Kogan, Emma Shvets, Gergana Marincheva, Lubov Vasilenko, Avishag Laish-Farkash","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cardiac implantable electronic devices (CIEDs) are associated with risks of device-related infections (DRI) impacting major adverse outcomes. Staphylococcus aureus (SA) is a leading cause of early pocket infection and bacteremia. While studies in other surgical contexts have suggested that nasal mupirocin treatment and chlorhexidine skin washing may reduce colonization and infection risk, limited data exist for CIED interventions.</p><p><strong>Objectives: </strong>To assess the impact of SA decolonization on DRI rates.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center observational study on consecutive patients undergoing CIED interventions (March 2020-March 2022). All patients received pre-procedure antibiotics and chlorhexidine skin washing. Starting in March 2021, additional pre-treatment with mupirocin for SA decolonization was administered. DRI rates within 6 months post-implantation were compared between patients treated according to guidelines (Group 1) and those receiving mupirocin in addition to the recommended guidelines (Group 2).</p><p><strong>Results: </strong>The study comprised 276 patients (age 77 ± 10 years; 60% male). DRI occurred in five patients (1.8%);80% underwent cardiac resynchronization therapy procedures. In Group 1 (n=177), four patients (2.2%) experienced DRI 11-48 days post-procedure; three with pocket infection (two with negative cultures and one with local Pseudomonas) and one with methicillin-sensitive SA endocarditis necessitating device extraction. In Group 2 (n=99), only one patient (1%) had DRI (Strep. dysgalactiae endocarditis) 135 days post-procedure (P = NS).</p><p><strong>Conclusions: </strong>The routine decolonization of SA with mupirocin, in addition to guideline-directed protocols, did not significantly affect DRI rates. Larger prospective studies are needed to evaluate the preventive role of routine SA decolonization in CIED procedures.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"636-642"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631836","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":"The Utility and Clinical Implications of Calcium Score Measurement: Experience of a Lipids Clinic.","authors":"Ronit Lev Kolnik, Idan Bergman, Avishay Elis","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Agatston coronary artery calcium (CAC) score is a decision-guiding aid for risk assessment and personalized management in the primary prevention of atherosclerotic cardiovascular disease.</p><p><strong>Objectives: </strong>To explore the real-life clinical experience of CAC testing by characterizing its indications, significance of scores, and corresponding lipid-lowering treatments.</p><p><strong>Methods: </strong>A retrospective descriptive study of patients treated at the lipids clinic at Rabin Medical Center (Beilinson Campus), who underwent CAC score evaluation between 2017 and 2022 was conducted. The data collected from electronic medical files included demographics, co-morbidities, indications for the test, CAC score levels, and the recommended therapeutic regimen.</p><p><strong>Results: </strong>The study cohort included 88 patients. The main indication was assessment of the existence of atherosclerosis in cases where there was no clear indication for lipid lowering treatment (65, 74%). In most patients, there was no evidence of atherosclerosis (CAC = 0 AU, n=30) or only mild disease (CAC=1-99 AU, n=35). As the CAC score increased, more patients were prescribed lipid lowering treatments, from very few prescriptions in those with a CAC score of 0 AU and almost 100% among those with score of ≥ 400 AU. The factors that predicted CAC > 0 AU were male sex and older age.</p><p><strong>Conclusions: </strong>CAC scores should be used more often to determine risk assessment. Further analysis of the implications of scores between 0-400 AU is needed.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"630-635"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631854","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":"Perspectives on Half-Century of Combat Casualty Care in the Israel Defense Forces Medical Corps.","authors":"Moshe Salai, Michael Malkin, Amir Shlaifer, Itay Fogel, Avi Shina, Liron Gershowitz, Elon Glasberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Military medicine has evolved significantly over the past 50 years, advancing from basic treatments and limited evacuations to sophisticated combat casualty care. Innovations such as hemorrhage control, early blood product administration, and telemedicine have greatly improved battlefield care. Rapid evacuation systems and skilled medical teams have reduced mortality and morbidity rates.</p><p><strong>Objectives: </strong>To review the transformation of the Israel Defense Forces Medical Corps (IDF-MC) in combat casualty care over the past 50 years, focusing on recent applications during the Iron Swords war.</p><p><strong>Methods: </strong>Data were collected from the personal experiences of IDF-MC doctors, IDF archives, and relevant military medical literature, with an emphasis on life-saving strategies, personnel, equipment, mental health support, and civil-military cooperation.</p><p><strong>Results: </strong>Rapid evacuation and immediate care have improved survival rates, while increased front-line deployment of medical staff has enhanced response capabilities. Modern medical tools and techniques, such as tourniquets and blood products, have been widely adopted. Improved psychological support strategies ensure better mental health outcomes for soldiers. Enhanced coordination with civilian trauma systems optimizes care and resource allocation, leading to more efficient and effective casualty treatment.</p><p><strong>Conclusions: </strong>The IDF-MC's advancements in rapid evacuation and front-line medical support have significantly improved combat casualty outcomes. Continued innovation and collaboration with civilian systems are essential for further progress in military medicine. Future technological advancements are anticipated to further enhance military medical care.</p>","PeriodicalId":50268,"journal":{"name":"Israel Medical Association Journal","volume":"26 10","pages":"608-612"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631846","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}