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עמוד בית
Sun, 02.06.24

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August 2013
M.W. Moloi, F. Zhou, K. Baliki, M.K. Kayembe, F. Cainelli and S. Vento
April 2013
T. Silberstein, A. Burg, J. Blumenfeld, B. Sheizaf, T. Tzur and O. Saphier
 Background: Breast milk is well established as the ideal source of nutrition for infants. Mature human breast milk generally contains 3.5–4.5% lipids comprising mostly triacylglycerols. In general, the fat composition of maternal human milk in developing countries shows higher levels of saturated fats, reflecting diets rich in carbohydrates.

Objectives: To determine the profile of unsaturated fatty acids in the breast milk of two populations in southern Israel, Jewish and rural tent-dwelling Bedouin women.

Methods: This study involved 48 lactating Israeli mothers, 29 Jewish and 19 Bedouin (16–20 weeks postpartum), whose full-term infants were fed exclusively with breast milk. Total milk lipid extracts were transmethylated and analyzed by using an improved gas chromatographic method.

Results: The breast milk of the Bedouin women contained significantly higher levels of total major saturated fatty acids, lauric acid and palmitic acid (45.2 ± 4.7% vs. 41.0 ± 5.6%, P = 0.005; 5.2 ± 2.1 vs. 6.8 ± 2.0%, P = 0.03; and 22.7 ± 2.4 vs. 20.6 ± 3.8%, P = 0.02) respectively. No difference was found in the myristic acid level between the groups. The level of stearic acid was significantly higher in the Jewish group compared to the Bedouin group (5.7 ± 1.1 vs. 5.1 ± 1.1%, P = 0.04). There was a linear correlation between the levels of C14:0 and C12:0 in the Bedouin and Jewish groups respectively (R = 0.87, R = 0.82, P < 0.001).

Conclusions: Higher levels of saturated fatty acids were measured in the breast milk of Bedouin women, an economically weaker population. The results emphasize the importance of diet among lactating women and its influence on milk quality. 

January 2013
A.J. Jacobs
 Infant circumcision has recently attracted controversy, with professional groups recommending it and various individuals trying to criminalize it. Circumcision is beneficial in the prevention of certain diseases, causing minimal tangible harm to those circumcised. This article argues that government should affirmatively adopt policies tolerating minority practices. Such activities should be banned only if they cause substantial damage to society or its members, or if they engender risks or injuries to which no reasonable person would consent. The benefits and risks of circumcision are outlined. Circumcision of male infants does not trigger cause for government to abolish it, and should be permitted if parents desire it. This article also summarizes common arguments against circumcision and attempts to refute them. These arguments are based on a desire for gender equality as well as a belief that minors should not undergo elective bodily alteration. If there are no unusual risks, parents can ethically authorize, and physicians ethically perform, elective infant circumcision for prophylaxis of disease, ritual purposes, or aesthetic reasons. Furthermore, the state should permit this.

 

December 2012
F. Sweet and R.M. Csapó-Sweet

Scientific journals are ethically bound to cite Professor Dr. Carl Clauberg's Nazi medical crimes against humanity whenever the eponym Clauberg is used. Modern articles still publish the eponym citing only the rabbit bioassay used in developing progesterone agonists or antagonists for birth control. Clauberg’s Nazi career is traced to his having subjected thousands of Jewish women at the Ravensbruck and Auschwitz-Birkenau death camps to cruel, murderous sterilization experiments that are enthusiastically described by incriminating letters (reproduced here) between him and the notorious Nazi Reichsführer-SS Heinrich Himmler. The experiments were carried out in women’s Block 10 in Auschwitz-Birkenau where Clauberg’s colleague Dr. Josef Mengele worked alongside. After Germany lost World War II in 1945 Mengele fled to South America, where he lived to an old age. Clauberg was caught by Russian soldiers, put on trial in the Soviet Union for his crimes against humanity, and imprisoned in 1948. In 1955 he was repatriated to Germany, once again imprisoned for his crimes, and belatedly expelled from the German Medical Association. To estimate the contemporary usage of the names Mengele and Clauberg, Internet hits were recorded for Clauberg C or Mengele J (with and without adding the term Auschwitz) with the Google and Scirus search engines. The ratios of hits for combinations of these terms reveal that relative to Mengele, Clauberg’s name is barely known. We propose that journals and books printing the eponym Clauberg cite its derivation and reference to the convicted Nazi criminal. The present article can serve for such citations.

October 2012
August 2012
S. Ben Shimol, L. Dukhan, I. Belmaker, S. Bardenstein, D. Sibirsky, C. Barrett and D. Greenberg

Background: Human brucellosis is common in southern Israel among the semi-nomadic Bedouin, a population that consumes unpasteurized dairy products. Though camel milk ingestion is a known mechanism for brucellosis acquisition, only a few reports of sporadic cases have been published in the medical literature.

Objectives: To describe a local brucellosis outbreak in 15 extended Bedouin family members, following ingestion of infected camel milk.

Methods: Data regarding patient’s clinical manifestations, laboratory findings, treatment and outcome were collected from the hospital and the health fund clinics’ computerized database. Camel’s blood and milk were tested for Brucella serology and culture. Cases were defined by positive Rose Bengal test, symptoms correlating with brucellosis, and consumption of infected camel milk.

Results: Fifteen patients were diagnosed with acute brucellosis from March to June 2011. Sixty percent of cases had serum agglutination test titers of 1:160 or higher and 4/8 (50%) had positive blood culture for Brucella melitensis. Arthralgia and fever were the most consistent clinical manifestations. Blood and milk serology and milk culture taken from the female camel were positive for Brucella melitensis.

Conclusions: The treating physicians must consider the possibility of infected camel milk ingestion as the mode of infection, both in sporadic cases and in outbreaks of brucellosis.

March 2012
Z. Mor, T. Shohat, Y. Goor and M. Dan
Background: The increase in human immunodeficiency virus (HIV) among men who have sex with men (MSM) in Israel during the last decade raises concerns regarding other sexually transmitted diseases (STD) in MSM, which are yet undetermined.

Objectives: To evaluate the STD burden in MSM and heterosexuals visiting the Tel Aviv walk-in STD clinic.

Methods: Records of all male patients who attended the clinic once were reviewed to identify demographic characteristics, behavioural attributes, and test results.

Results: Between 2002 and 2008, 1064 MSM (22%) and 3755 heterosexuals (78%) visited the clinic once. Positivity rates in MSM for HIV, urethral Neisseria gonorrhoea and infectious syphilis were higher than in heterosexuals (2.5%, 2.5%. 0.7% vs. 0.6%, 1.3%, 0.3%, respectively), while urethral Chlamydia trachomatis was higher in heterosexuals than in MSM (2.7% and 1.4%, respectively). MSM tested in our clinic were younger than heterosexuals (P < 0.001), more commonly circumcised (P = 0.03) and Israeli-born (P < 0.001), used substances during sex (P = 0.04), and had prior STD (P < 0.001), a greater number of sexual partners (P < 0.001), and earlier sexual debut (P = 0.02). The final multivariate results for MSM to be diagnosed with HIV/STD were greater number of sexual contacts, previous diagnosis with STD, and infrequent use of condom during anal intercourse.

Conclusions: MSM visiting the Levinsky Clinic had higher rates of HIV/STD than heterosexual males, which correlated with their higher-risk behaviors. The unique characteristics of MSM found in our study, such as sex work, substance use, previous diagnosis of STD, multiple partners and inconsistent use of condom during anal sex should be addressed with innovative interventions to prevent STD/HIV in the gay community in Israel.
T. Brosh-Nissimov, Z. Mor, E. Avramovich, E. Katchman, B. Avidor, O. Mor and D. Turner
Background: Outbreaks of syphilis have been described among men who have sex with men (MSM) in many western urban communities in the last few years.

Objectives: To describe the first reported outbreak of syphilis among MSM in Israel within a decade of a constant increase in human immunodeficiency virus (HIV) prevalence.

Methods: All patients diagnosed with syphilis were contacted and asked about their sexual behavior, substance use and previous infections. All were tested for HIV and a phylogenetic analysis was performed. 

Results: A total of 23 (59%) of all 39 male patients diagnosed with primary or secondary syphilis between August 2008 and August 2009 were interviewed. All were MSM and performed anal intercourse, while 13 (55%) reported unprotected anal intercourse. Most participants (21, 91%) practiced unprotected oral intercourse. Nine participants (39%) reported unprotected oral intercourse while using condoms during anal intercourse. Ten participants (43%) reported sexual contacts while traveling abroad in the previous few months. Most participants (96%) were co-infected with HIV, and 15 (68%) were already aware of their HIV infection. Fifteen (66%) reported the use of recreational drugs, alcohol, or both before or during sex. No common source or core transmitters were identified.

Conclusions: This syphilis outbreak included MSM who were co-infected with HIV and were characterized by risky sexual behavior including multiple partners, unprotected anal intercourse and substance use. Future targeted interventions should focus on HIV-infected MSM for secondary prevention.
February 2012
D. Bendayan, A. Hendler, K. Litman and V. Polansky
Background: Interferon-gamma release tests are appealing alternatives to the tuberculin skin test (TST) for latent tuberculosis infection.

Objectives: To determine the yield of the Quantiferon TB Gold test (QFT-G) in the diagnosis of active tuberculosis disease, with a focus on elderly patients, human immunodeficiency virus (HIV) co-infection, and extra-pulmonary tuberculosis (EPTB).

Methods: The QFT-G test was performed in 98 patients suspected of having active tuberculosis. The results were evaluated for each subgroup of patients and compared to the results of the TST.

Results: Active tuberculosis was diagnosed in 92 of the 98 patients. Sixteen (17.3%) were elderly patients (over age 70), 15 (16%) were co-infected with HIV, and 14 (15%) had EPTB. QFT-G was positive in 49 patients (53%) and indeterminate in 4. The results were not significantly affected by HIV co-infection (P = 0.17), old age (P = 0.4), or the presence of EPTB (P = 0.4). There was a good correlation between the TST and the QFT-G test (P < 0.001). In EPTB and in the elderly, the QFT-G test appears to be better than the TST.

Conclusions: The QFT-G test is suboptimal in its ability to detect active tuberculosis and should not be used to exclude it.
January 2012
Ronit Lubetzky, MD, Galit Zaidenberg-Israeli, MD, Francis B. Mimouni, MD, Shaul Dollberg, MD, Eyal Shimoni, PhD, Yael Ungar, PhD and Dror Mandel, MD

Background: Human milk produced during prolonged lactation (> 1 year) is extraordinarily rich in fat and has a higher energy content than human milk produced during short lactation.

Objectives: To estimate the fatty acid (FA) profile of human milk and to test the hypothesis that the proportion of C12 and C14 (two dietary saturated FA known to most promote hypercholesterolemia) in human milk during prolonged lactation is similar to that in short lactation.

Methods: We conducted a cross-sectional study of 30 mothers of term infants lactating for more than 1 year as compared with 25 mothers of full-term infants who lactated for 2–6 months. Milk was collected by manual expression in mid-breastfeeding.

Results: The two groups did not differ in maternal height, weight, body mass index, diet, infant birth weight and gestational age, but mothers in the prolonged lactation group were significantly older. There was a significant correlation between lactation duration and C12 or C14. The percentage of all FA combined (except for C12 and C14) decreased significantly over time. In contrast, C12:0 and C14:0 combined increased significantly during lactation (R2 = 10.0%, P < 0.03).

Conclusions: Women who lactated for more than 1 year had higher C12 and C14 FA percentages in their milk than women who lactated for 2–6 months.

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