עמוד בית
Sun, 26.06.22

December 2020 ...................... (Issue 48)


Introduction
Articles
Col. Dr. Erez Karp, Lt. Col. Dr. Ariel Furer, Lt. Col. Dr. Avi Benov, Lt. Col. Prof. Gilad Twig, Maj. Dr. David Segal, Maj. Keti Burlak, Dr. Michael Halbertal, Col. Dr. Noam Fink, Brig. Gen. Prof. Elon Glassberg
Maj. Dr. Inbal Galor, Maj. Dr. Vered Molina-Hazan, Lt. Col. Dr. Manor Shpriz
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Mumps is a highly infectious vaccine-preventable viral disease. In recent years, a number of mumps outbreaks have been reported, in which it was noted that they included individuals who had previously received two doses of MMR vaccine. Vaccination within 72 hours of exposure has prevented transmission of the disease through contact. Moreover, it was observed, especially in highly crowded settings, that two doses of vaccine did not always prevent disease.
Our article describes the management and containment of a mumps outbreak, in which at least one of the cases had received two vaccine doses in their childhood, occurring in the unusual and crowded setting of a special military unit. Besides the challenge of effective management of the outbreak itself, in this case, preservation of the combat personnel's capabilities was also critical. Thus, the characteristic clinical manifestation of mumps disease, together with the epidemiologic connection, has resulted in the launch of a unique vaccination campaign for post- exposure vaccination of the unit. This fast and targeted intervention, with post- exposure prophylaxis, by vaccination of a wide circle of contacts, regardless of their previous MMR vaccination status and before laboratory verification of the diagnosis, successfully stopped the outbreak. The patients recovered with no complications and the military capability of the unit was preserved. Lab results that came later verified the diagnosis of mumps.


Keywords: Mumps, epidemiological investigations, infectious diseases, post-exposure prophylaxis, military- personnel.
Master Sgt. Roee Yehidi, Sgt. Maj. Mori Hay-Levy, Maj. Idan Nakdimon, Maj. Aviad Bar, Dr. Liat Korn
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After near eradication from the Western world, the prevalence of bedbugs )Cimex lectularius( has grown significantly in the past two decades.
The rapid dissemination of bedbugs, in addition to the public’s low awareness of their existence and the limited capabilities of pest control in regards to them, make it harder to cope with the problem.
This study examines the characteristics of bedbugs, their prevalence, their impact on human health, and ways of coping with the problem.
Another important goal is expanding medical staffs’ knowledge about this species and raising public awareness to the extent of this problem in the world, in Israel and in IDF units.
Beyond its review of the biology of bedbugs, this article discusses the existing methods of prevention and treatment of bedbugs, while emphasizing the importance of public awareness of the phenomenon.
As one of the offered solutions, pesticides applied through steam is described. This kind of pest control has been recommended lately by the Ministry of Environmental Protection as a complementary action to traditional pesticidse.
The main advantage of this method is that it offers a solution in every stage of bedbugs' life cycle through exposure to high temperatures, without any human exposure to toxicity.
In the presentation of the data, the study examines the extent of infestation of bedbugs in different IDF units in the years 2012-2015.

Keywords: bedbug, pest control, prevention, IDF.
Adam Konstantinovsky, Dr. Ben Aviner, Maj. Mirit Einan,Prof. Pinchas Halpern
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The exceptional diving events described in the present article fall into two categories: 1. Clinical. 2. Equipment failure. The first case report is of a cardiac event in one of a group of 5 divers who descended to an average depth of 20 meters. Fifteen minutes after the start of the dive, he began to feel chest pain. He ascended to the surface accompanied by his partner and swam back to the beach, where he was treated by a defibrillator and evacuated to a hospital by M.D.A.. Treatment of this kind of problem and preventive measures that should be taken to avoid the occurrence of such incidents are discussed. in this paper.
The two cases of diving equipment failure are both connected with the breathing gas cylinder. The first of these concerns a diver who began to feel unwell about five minutes after the start of a dive using Nitrox, at a depth of 15 meters. He carried out a controlled ascent together with his partner and swam to the beach, where he appeared to be panting and confused. He was given oxygen for an hour, with gradual improvement in his condition. When the quality of the gas in the cylinder was examined, it was found that it had been contaminated with CO. In the second case, a very experienced diver went diving in Eilat with his equally experienced partner. When they reached a depth of 42 meters, the diver felt difficulty breathing when he was in the vertical position, with a sensation of resistance to his increased breathing. The diver noticed that on transition to a horizontal position, the resistance decreased and breathing became easier. The two divers immediately made a slow ascent to the surface. On checking the gas cylinder, a considerable quantity of water was found blocking the air passage from the tank to the diver when it was in the vertical position. The reasons why the incidents occurred and the measures that can be taken to prevent failure of the gas containers are discussed. in this paper.

Keywords: Diving, CO, diving tank, diving Accidents
Case Reports
Capt. Dr. Netta Bar-Ilan, Dr. Dmitry Danny Epstein, Capt. Dr. Galina Shapiro
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Euglycemic diabetic ketoacidosis (eDKA) is a known complication of sodium- glucose transport protein-2 inhibitors (SGLTS2i). The risk of eDKA in patients treated with SGLTS2i is known to increase in the presence of infection and sepsis, yet. The mechanisms linking coronavirus disease 2019 (COVID-19) and eDKA require further investigation. Here, we describe the case of a 57-year-old male patient who presented to our emergency department with respiratory distress, cough and fever. His past medical history was significant due to poorly-controlled diabetes mellitus, treated with insulin and SGLT2i.
At presentation he was febrile, markedly tachypneic, desaturated and hemodynamically stable. Severe COVID-19 pneumonia and eDKA were diagnosed. We suggest physicians keep in mind that respiratory distress in COVID-19 patients may be secondary to metabolic acidosis and specifically eDKA.

Keywords: COVID-19, ketoacidosis, diabetes
Capt. Dr. Noga Lev Kolnik, Capt. Dr. Galina Shapiro
SARS-CoV-2 disease (COVID-19) presentations range from a mild upper respiratory disease to acute respiratory distress syndrome. At this time, it is unknown whether immunocompromised hosts, specifically kidney transplant patients, are at higher risk of systemic COVID-19 disease. We present the case of a 21-year-old, COVID-19 positive, kidney transplant patient, who was admitted to our ward with fever and dysuria. Initial workup indicated acute kidney injury and pneumonia. During her hospitalization, the patient was treated with IV fluids and antibiotics, resolving the acute kidney injury but not the patient’s fever, which remained unexplained.

Keywords: COVID-19, kidney transplant, fever.
Capt. Dr. Asaf Berman, Dr. Danny Epstein, Capt. Dr. Galina Shapiro
Pneumothorax is common among novel coronavirus disease 2019 )COVID-19( patients. Early reports found pneumothorax to be associated with severe COVID but not necessarily poor prognosis. We present a case of a 26-year-old patient with severe COVID-19 pneumonia. The patient was intubated and mechanically ventilated due to severe respiratory failure. A week after being extubated, the patient developed a simple pneumothorax which was treated via chest tube drainage. The patient initially improved and the drain was removed. A few days later, the patient developed a tension pneumothorax requiring chest drain re- insertion. We recommend considering pneumothorax a potential cause of respiratory distress in COVID patients throughout their illness.

Keywords: COVID-19, pneumothorax, chest tube.
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