Israel Medical Association Journal

The potential influence of seasonal variations on vasculitis is unclear. Emerging evidence has suggested that seasonal factors may play a role in the onset of vasculitis. We extracted data from the electronic medical records at Clalit Health Services (CHS), Israel's largest health maintenance organization. We identified patients older than 18 years of age with new onset of giant cell arteritis (GCA), ANCA-associated vasculitis, immunoglobulin A (IgA) vasculitis, and Behçet's disease from 2007 to 2021. We constructed a time series of new vasculitis cases per month and explored the potential impact of seasonality on the disease onset. Our cohort included 4847 patients, including 2445 with GCA, 749 with ANCA-associated vasculitis (AAV), 547 with IgA vasculitis, and 1106 with Behçet's disease. We observed a decreased risk of GCA in September (relative risk [RR] 0.84, [95% confidence interval] 95%CI 0.72–0.98) and a significant reduction in AAV incidence in August (RR 0.68, 95%CI 0.48–0.96). For IgA vasculitis, an elevated risk was noted in February (RR 1.58, 95%CI 1.02–2.45), while Behçet's disease showed an increased risk in January (RR 1.25, 95%CI 1.02–1.55). No association was found between any specific season and the onset of vasculitis for any of the studied conditions. Our study results indicate that the onset of vasculitis conditions may be influenced by environmental factors associated with seasonality.

Background: Younger patient age and relatively good prognosis have been described as factors that may increase caregiver motivation in treating patients with septic shock in the intensive care unit (ICU).

Objectives: To examine whether clinical teams tended to achieve unnecessarily higher map arterial pressure (MAP) values in younger patients.

Methods: We conducted a population-based retrospective cohort study of patients presenting with septic shock who were treated with noradrenaline and hospitalized in a general ICU between 2006 and 2018. The patients were classified into four age groups: 18-45 (n=129), 46-60 (n=96), 61-75 (n=157), and older than 75 years (n=173). Adjusted linear mixed models and locally weighted scatterplot smoothing (LOWESS) curves were used to assess associations and potential non-linear relationships, respectively, of age group with MAP and noradrenaline dosage.

Results: The cohort included 555 patients. An inverse relation was observed between average MAP value and age. Among patients aged 18–45 years, the average MAP was 4.7 mmHg higher (95% confidence interval 3.4–5.9) than among patients aged > 75 years (P-value <0.001) after adjustment for sex, death in the intensive care unit, and Sequential Organ Failure Assessment scores.

Conclusions: Among patients with septic shock, the titration of noradrenaline by staff led to a higher average MAP for younger patients. Although the MAP target is equal for all age groups, staff may administer noradrenaline treatment according to a higher target of MAP due to attitudes toward patients of different ages, despite any evidence that such practice is beneficial.