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עמוד בית
Thu, 18.07.24

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August 2023
Shimrit Yaniv-Salem MD, Lianne Dym MD, Lior Nesher MD, Doron Zahger MD, Aryeh Shalev MD, Hezzy Shmueli MD

Background: Peripartum cardiomyopathy (PPCM) is a rare but potentially devastating complication of pregnancy. Although the pathophysiology of PPCM is not fully understood, there are known risk factors for developing PPCM, which are maternal and gestation related. In the first wave of the coronavirus disease 2019 (COVID-19) pandemic, we witnessed an elevated incidence of PPCM among COVID-19 survivors.

Objectives: To present a single-center case series of three patients diagnosed with peripartum cardiomyopathy after recovered from COVID-19 during the index pregnancy.

Methods: In this single center case study, all patients diagnosed with PPCM at our institute during the examined time frame were included. Electronic medical records were studied.

Results: Three patients previously diagnosed with asymptomatic or mildly symptomatic COVID-19 disease during pregnancy presented with PPCM before or shortly after delivery. Patients underwent testing to rule out residual COVID-19 myocarditis, were treated pharmacologically and with wearable defibrillators as needed, and were examined in follow-up 1–9 months after delivery.

Conclusions: Residual endothelial damage due to COVID-19 disease, even if originally mild in presentation, could predispose pregnant patients to PPCM and should be considered as a risk factor when assessing patients with new onset symptoms of heart failure. Further research is needed to confirm this hypothesis and fully determine the underlying pathophysiology. These preliminary findings warrant a high index of suspicion for PPCM in COVID-19 recoverers.

September 2017
Aref Elnasasra MD, Hilmi Alnsasra MD, Rozalia Smolyakov MD, Klaris Riesenberg MD and Lior Nesher MD

Background: Little is known about the incidence of urinary tract infections (UTI) in the dispersed Bedouin population. UTIs are routinely treated empirically according to local resistance patterns, which is important when evaluating the risk factors and antibiotic resistance patterns in the Bedouin population.

Objectives: To analyze risk factors, pathogens, and antibiotic resistance patterns of UTIs in the Bedouin population compared to the general population in southern Israel. To compare data from this study to that from a previous study conducted at our center.

Methods: We prospectively followed all patients hospitalized with community acquired UTIs during a 4 month period at Soroka Medical Center. We also compared results from this study to those from a study conducted in 2000.

Results: The study comprised 223 patients: 44 Bedouin (19.7%), 179 (80.3) non-Bedouin; 158 female (70.9%), 65 male (29.1). The Bedouin were younger (51.7 vs. 71.1 years of age, P < 0.001) and had a lower Charlson Comorbidity Index (2.25 vs. 4.87, P < 0.001). Enterobacteriaceae were the most common pathogens identified, and Escherichia coli (E. coli) was the most common with 156 (70%) strains identified, followed by Klebsiella spp. with 29 (13%), Proteus spp. with 18 (8%), pseudomonas with 9 (4%), and other bacteria including enterococci with 11 (5%). The prevalence of E. coli increased significantly from 56% in 2000 to 70% in this study. We also noted an increase in community acquired extended spectrum beta lactamase (ESBL) pathogens from 4.5% in 2000 to 25.5% in the present study. No statistically significant difference was observed between the Bedouin and general populations in the causal pathogens, resistance to antibiotics, length of therapy, and readmission rate within 60 days. 

Conclusions: The Bedouin population hospitalized for UTIs is younger and presents with fewer co-morbidities. Isolated pathogens were similar to those found in the general population as was the presence of drug resistant infections. Overall, a substantial percentage of pathogens were resistant to standard first-line antibiotics, driving the need to change from empiric therapy to aminoglycoside therapy. 

 

December 2013
Oleg Pikovsky, Maly Oron, Arthur Shiyovich, Zvi H. Perry and Lior Nesher
 Background: Prolonged working hours and sleep deprivation can exert negative effects on professional performance and health.

Objectives: To assess the relationship between sleep deprivation, key metabolic markers, and professional performance in medical residents.

Methods: We compared 35 residents working the in-house night shift with 35 senior year medical students in a cross-sectional cohort study. The Epworth Sleepiness Scale (ESS) questionnaire was administered and blood tests for complete blood count (CBC), blood chemistry panel, lipid profile and C-reactive protein (CRP) were obtained from all participants.

Results: Medical students and medical residents were comparable demographically except for age, weekly working hours, reported weight gain, and physical activity. The ESS questionnaires indicated a significantly higher and abnormal mean score and higher risk of falling asleep during five of eight daily activities among medical residents as compared with medical students. Medical residents had lower high density lipoprotein levels, a trend towards higher triglyceride levels and higher monocyte count than did medical students. CRP levels and other laboratory tests were normal and similar in both groups. Among the medical residents, 5 (15%) were involved in a car accident during residency, and 63% and 49% reported low professional performance and judgment levels after the night shift, respectively.

Conclusions: Medical residency service was associated with increased sleepiness, deleterious lifestyle changes, poorer lipid profile, mild CBC changes, and reduced professional performance and judgment after working the night shift. However, no significant changes were observed in CRP or in blood chemistry panel. Larger prospective cohort studies are warranted to evaluate the dynamics in sleepiness and metabolic factors over time.

October 2013
L. Avisar, A. Shiyovich, L. Aharonson-Daniel and L. Nesher
 Background: Sudden cardiac death is the most common lethal manifestation of heart disease and often is the first and only indicator. Prompt initiation of cardiopulmonary resuscitation (CPR) undoubtedly saves lives. Nevertheless, studies report a low competency of medical students in CPR, mainly due to deterioration of skills following training.

Objectives: To evaluate the retention of CPR skills and confidence in delivering CPR by preclinical medical students.

Methods: A questionnaire and the Objective Structured Clinical Examination (OSCE) were used to assess confidence and CPR skills among preclinical, second and third-year medical students who had passed a first-aid course during their first year but were not retrained since.

Results: The study group comprised 64 students: 35 were 1 year after training and 29 were 2 years after training. The groups were demographically similar. Preparedness, recollection and confidence in delivering CPR were significantly lower in the 2 years after training group compared to those 1 year after training (P < 0.05). The mean OSCE score was 19.8 ± 5.2 (of 27) lower in those 2 years post- training than those 1 year post-training (17.8 ± 6.35 vs. 21.4 ± 3.4 respectively, P = 0.009). Only 70% passed the OSCE, considerably less in students 2 years post-training than in those 1 year post-training (52% vs. 86%, P < 0.01). Lowest retention was found in checking safety, pulse check, airway opening, rescue breathing and ventilation technique skills. A 1 year interval was chosen by 81% of the participants as the optimal interval for retraining (91% vs. 71% in the 2 years post-training group vs. the 1 year post- training group respectively, P = 0.08).

Conclusions: Confidence and CPR skills of preclinical medical students deteriorate significantly within 1 year post-training, reaching an unacceptable level 2 years post-training. We recommend refresher training at least every year.

 

February 2012
L. Nesher, K. Riesenberg, L. Saidel-Odes, F. Schlaeffer and R. Smolyakov
Background: The southern region of Israel has recently experienced an influx of African refugees from the Eastern Sub-Sahara desert area. These influxes led to a significant increase in incidence of tuberculosis (TB) in that region.

Objectives: To review the data of African refugees diagnosed with TB between January 2008 and August 2010 at a tertiary care regional hospital.

Results: Twenty-five TB cases were diagnosed, 22 of which presented with pulmonary TB, 3 with  extra-pulmonary TB (EPTB), and 7 with combined pulmonary and EPTB. Only one case had concomitant human immunodeficiency virus (HIV) infection and multidrug-resistant TB. Fifteen patients underwent extensive radiological investigations including chest, abdominal and spine computed tomography, 1 was reviewed by magnetic resonance imaging, and 9 underwent tissue biopsy. Eighteen patients were admitted as suspected TB and 4 as suspected pneumonia or pulmonary infiltrates that could have been defined as suspected TB. All 24 HIV-negative cases were sensitive to first-line drugs for TB except one case that was resistant to streptomycin and one to rifampicin. All patients responded well to first-line therapy. The average duration of hospitalization was 8.7 days (range 1–36). Following diagnosis 23 patients were transferred to a quarantine facility.

Conclusions: We identified overutilization of medical resources and invasive procedures. For African refugees from the eastern Sub-Sahara who were HIV-negative and suspected of having TB, a sputum acid-fast smear and culture should have been the primary investigative tools before initiating treatment with four drugs (first-line), and further investigations should have been postponed and reserved for non-responders or for patients for whom the culture was negative. Physicians should maintain a high index of suspicion for EPTB in this population.
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