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עמוד בית
Sat, 15.06.24

December 2021 (Issue 52)

Editorial (Hebrew)
Articles & Reviews
Ariella Wiener, Eitan Giat, MD, Yael Shinar, PhD, Merav Lidar, MD, Tomer Ziv-Baran, PhD, Yitshak Kreiss, MD, Elon Pras, MD
Download Abstract

Background: Familial Mediterranean Fever (FMF) is one of the most common
genetic diseases in Israel. FMF is characterized by acute fever attacks accompanied
by peritonitis, pleurisy and erysipelas-like erythema. These attacks tend to occur in
stressful situations, such as military service. Patients homozygous for the M694V
mutation experience a more severe form of the disease. This study's objective was
to observe the disease's course throughout the patients’ service in the IDF, with an
emphasis on patients homozygous for the M694V mutation.

Methods: The study was conducted on 100 FMF patients who had completed
military service. The patients filled out a questionnaire regarding their military
service and disease.

Results: The average number of attacks increased from 7.1 per month prior to
recruitment to 16.9 during service, and decreased to 7.5 following discharge. The
increase was similar in the homozygous for M694V mutation group and in the
patients with other mutations.
The average dose of colchicine increased from 1.2 mg/day to 1.7 and did not
decrease following discharge; no significant difference between the two groups
was observed in this respect. The participants rated their satisfaction with their
military service 6.8 on average on a scale of 1 to 10, and the military doctors’
knowledge on the subject of FMF – 3.6 on the same.

Conclusions: FMF tends to worsen significantly during military service, with
an increase in the number of attacks and in the dose of colchicine needed for
treatment. The patients gave the military doctors’ knowledge regarding their
disease a low rating.

Keywords: Familial Mediterranean Fever, military service, FMF, MEFV, M694V, colchicine.
Yoram Epstein, PhD, Neri Ereli, MA, Haim Gibli, MA, Chen Kugel, MD
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The burial of soldiers killed in action (KIA) is a core value in Israeli society, a tribute
we pay to the soldiers and their families. This principle is embedded in the Israel
Defense Forces’ (IDF) code of ethics and ethos, as well as in Jewish law. Accordingly,
even if it takes many years, every effort will be made to locate the body of a soldier
who is missing in action (MIA) in order to give them a proper burial. Today, 96
soldiers from the War of Independence are still defined as MIA, their burial places
unknown. All of these cases are under investigation by the 1948-section of the
MIA Unit of the IDF. One such case is the identification of two casualties from the
Palmach intelligence unit, Gideon Ben-David (Be’eri) from Kibbutz Be’eri and David
Shemesh from Kibbutz Beit HaShita A-H, both of whom fell in Jaffa in December
1947 and were classified as MIA. Anthropometric measurements and DNA samples
helped to confirm their identity, after their fate had been unknown for fifty years.
This paper highlights the complexity in identifying soldiers who are MIA, the
ongoing efforts to identify soldiers buried as John Does, and the importance of
properly opening a grave in order to obtain scientific evidence.

Keywords: DNA, mtDNA, anthropometry, MIA, missing in action, MIA unit.
Daniel Levi-Waintraub, BSW, Yoray Barak, MA, Dolev Avni, MA
Download Abstract

Background: As part of a Dialectic Behavioral Therapy (DBT) group protocol
intervention approach, 23 Israel Defense Forces (IDF) soldiers with personality
disorder traits and difficulties in emotion regulation participated in an emotion
regulation skills group. The 14-week program was intended to assess the efficacy of
the intervention. The participants filled out pre and post-treatment reportsassessing
emotion regulation difficulties and symptoms.

Methods: 23 IDF mandatory service soldiers who have emotional regulation
difficulties participated in two separate DBT skills groups, in which emotional
regulation skills were taught. The groups were held sequentially in 2018 and 2019
at the Central Mental Health Clinic at Tel HaShomer base. The groups received
weekly DBT instruction from two DBT-trained therapists. Participants filled out the
Mental Wellbeing Questionnaire – ERQ and Mental Health Questionnaire (MHI) preand

Results: Participants showed improvement in emotion regulation difficulties and
symptoms post-treatment, suggesting that the DBT skills group is an effective
intervention, resulting in stronger emotional regulation skills for these soldiers.

Conclusions: IDF soldiers with personality disorder traits and emotion regulation
difficulties complied with the DBT skill group intervention, attended it regularly and
benefited from it, as reflected in the changes in their emotion regulation difficulties
and symptoms. These difficulties, naturally, not only affect these soldiers' wellbeing
and military functioning, but also take a significant toll on the IDF’s mental health
care system, and often result in early discharge. Thus, the implementation of the
DBT skills group could benefit both soldiers with emotion regulation difficulties
and IDF mental health care providers.

Keywords: DBT, psychotherapy, army, personality disorders, emotion regulation, skills training.
Aviv Schupper, MD, Inbal Galor, MD, Paz Sasson, Yuval Ran, MD, Noam Fink, MD, Tarif Bader, MD, MA, Eva Avramovich, MD, MPH
Download Abstract

Introduction: This work aims to describe the features of COVID-19 in young adult
military personnel. Though many confirmed COVID-19 cases are young adults, little
was initially published regarding their clinical manifestations. Our study depicts all
confirmed cases in the Israel Defense Forces (IDF) population during the first wave
of the pandemic, aiming to define the disease characteristics in this age group and
the outbreak development.

Methods: This is a retrospective, observational cohort study of the first 208
confirmed COVID-19 cases in the IDF. Clinical and epidemiologic data about all
confirmed cases in the IDF between February 29th, 2020 and April 26th, 2020 was
collected and analyzed. Specific risk factors for longer disease duration were
analyzed by t-test.

Results: Among IDF cases, median age was 21 years and 71% were male. All patients
had a relatively benign course. 17.3% had a comorbidity. 74.9% had respiratory
symptoms and only 41.5% had a fever. Incubation time was 5.3 days on average and
time until recovery was 15.6 days. Myalgia and having a known source of infection
were significantly associated with longer illness. Gradually, the proportions of
personnel infected abroad decreased compared to those infected in the army.

Conclusions: Healthy young adult COVID-19 cases had a different clinical
presentation and a better clinical course, but no shorter duration of disease,
compared to data regarding older adults with COVID-19. This information and
comprehension of the outbreak evolution later served as important factors in
decision-making and policy revisions made in subsequent COVID-19 waves. This
data may also aid in better IDF preparedness for future pandemics.

Keywords: Coronavirus, military health, military personnel, young adult
Yael Arbel, DMD, Lev Vinogradsky, DMD, Or Yan Slav, DMD, Noam E. Protter, DMD
Download Abstract

Background: As one of the measures taken by the IDF in order to contain the
COVID-19 spread in its ranks, all non-emergency dental procedures were stopped
by March 1st 2020, only to gradually return under strict infection control measures
by the beginning of May 2020. Previous reports, regarding otolaryngologists,
painted a dark picture concerning the future of the dental profession. It was
our aim to shed light on the transmission rates of COVID-19 amongst IDF dental
practitioners and patients when personal protective equipment and measures
were appropriately used.

Methods: 33 COVID-19-positive patients were treated in IDF dental clinics by a total
of 64 dental staff members. Dental procedures performed included routine dental
examinations (36.36%), dental restorations (30.3%), dental hygiene procedures
(15.15%), extractions (12.12%), extirpation (3%) and impressions (3%) with a mean
treatment duration of 32.58±2.51 minutes. Appropriate and identical sterilization
and surface disinfection methods were implemented in all cases, but different
types of personal protective gear (PPG) were used.

Results: While continuing to perform aerosol-producing dental procedures (with a
potentially increased risk of transmission) and with a relatively long mean exposure
time, yet complying with the instructed infection control measures, not even one
confirmed case of patient-to-dental staff infection was reported in the IDF.

Conclusions: This report may indicate that when appropriate safety measures are
implemented, the COVID-19 transmission risk is lower than previously thought

Keywords: COVID-19, Protective Personal Equipment (PPE), Dentistry, Nosocomial Infection.
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