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עמוד בית Tue, 22.10.19

April 2013


Focus
S. Sclarovsky
 In acute myocardial ischemic syndrome the electrocardiogram is capable of providing sophisticated information on coronary artery anatomy (the culprit artery, the level of obstruction, the arterial dimension), along with the hemodynamics, molecular biological characteristics and ionic changes that occur in the involved and uninvolved ischemic musculature. In acute myocardial ischemia, during a sudden obstruction of a distal co-dominant right coronary artery the ECG may be able to discriminate between physiological and pathological remodeling, providing predictive information to differentiate low from high risk cases during acute inferior wall infarction.

 

Perspective
Original Articles
N. Yanculovich, Z.H. Perry, R. Gurfinkel and L. Rosenberg

 Background: Burn injuries are extremely common and may impose a serious load on public health around the world.

 Objectives: To compare mortality rates and length of hospitalization according to the identified risk factors, extent of burn, gender and age.

Methods: In this retrospective study, data from 558 archive files of hospitalization due to burns as the diagnosis in patients of all ages, between the years 2001 and 2002, were analyzed to identify the risk factors for mortality and length of hospitalization.

Results: Males comprised 62.4% of the hospitalized burn patients. The mortality rate was 3.2% (n=18) and among them 55.6% were women. Fifty percent of the fatality cases were over 48 years old, with statistically significant correlation of mortality rate and age. Most of the fatality cases (66.7%) had burns with total burn surface area (TBSA) larger than 40%. The multiple logistic regression model showed that leukocyte count on admission, TBSA, and age are the most important predictors of mortality. Smoke inhalation was not found to be an independent risk factor.

Conclusions: Using a statistical model for estimating the mortality rate, this study found that white blood cell count at admission, TBSA, and age were the most significant predictors of mortality. 

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. 

S. Golan, S. Maslovitz, M.J. Kupferminc and A. Kesler
 Background: The effects of consecutive pregnancies on the course of idiopathic intracranial hypertension (IIH) are unclear in view of the scarce published data.

Objectives: To evaluate the course and management of visual and pregnancy outcomes of consecutive pregnancies with IIH.

Methods: The medical records of women with IIH in consecutive pregnancies were reviewed for neuro-ophthalmological findings, management, and visual and pregnancy outcomes.

Results: The study group comprised eight women with at least two consecutive pregnancies (mean age 27.3 ± 5.3 years). The mean duration of IIH prior to the first pregnancy was 3.4 ± 3.16 years. One woman with IIH pre-pregnancy symptoms and three women with clinical features of IIH during the second trimester of pregnancy (gestational week 21.7 ± 4.04) were treated with acetazolamide (250 mg every 8 hours). Symptoms resolved, resulting in uncomplicated first deliveries for all four. The first deliveries of four other women were by cesarean section due to obstetric indications. Only one woman developed symptoms and signs of IIH during her second pregnancy and was thus treated with acetazolamide. Two women who completed three pregnancies had no IIH symptoms during their pregnancies. The course and outcome of those pregnancies were normal.

Conclusions: IIH apparently does not worsen or even become symptomatic in consecutive pregnancies. The appropriate management of IIH in pregnant women is similar to management for non-pregnant women; neither the course nor the obstetric outcome of first and consecutive pregnancies is influenced by the presence of IIH.

J.H. Spungen, R. Goldsmith, Z. Stahl and R. Reifen
 Background: Desalination of seawater and brackish water (mixed seawater and freshwater) provides an increasing portion of the Israeli drinking water supply. However, desalinated water contains little calcium (Ca) and magnesium (Mg), and consumers may be at risk for deficiencies of these essential minerals.

Objectives: To assess intakes of Mg and Ca from water, other beverages, and food in communities with different water supplies, and assess the proportion of individuals with intakes below the estimated average requirement (EAR).

Methods: Telephone interviews were conducted using a food frequency questionnaire to assess Mg and Ca intakes by adults in four communities. The proportion of individuals with Mg and Ca intakes below the EAR were evaluated based on current intakes and on potential intakes assuming that desalinated water had been introduced countrywide.

Results: The proportion of individuals with Mg intake below the EAR was higher in Kibbutz Maagan Michael (30.6%), an agricultural settlement supplied with desalinated water, than in Hadera (16.7%), a city supplied by the National Water Carrier (NWC) (P < 0.01). The proportion of individuals with Ca intake below the EAR was higher in Maagan Michael (15.3%) than in the communities supplied with water from the NWC or mixed water (27.7%–33.8%), P < 0.02.

Conclusions: Returning Mg and Ca to desalinated water may be beneficial for raising intakes in Israeli communities supplied with desalinated water. Individuals with intake of Mg and/or Ca below the EAR may be at risk for cardiac abnormalities and other medical conditions.

I. Abu-Kishk, B. Klin, N. Gilady-Doron, I. Jeroukhimov and G. Eshel
 Background: Horse riding and horse handling are dangerous. There is a lack of knowledge concerning the incidence of hospitalization due to horse-related injuries and types of injuries in Israel. During the last two decades we have observed an increasing incidence of hospitalizations due to horse-related injuries at our medical center and noticed the frequent involvement of pediatric patients.

Objectives: To investigate these injuries with respect to type, incidence and modes of prevention.

Methods: A retrospective study of medical records was performed for all patients admitted to Assaf Harofeh Medical Center due to horse-related injury between January 1984 and December 2008. A telephone questionnaire was used to complete the data.

Results: Eighty-nine subjects (267 injuries) were included in the study. Most of them were not professional horse riders or horse handlers. Helmet use was reported in only 28% of the participants. The number of subjects with horse-related injuries and the percentage of pediatric involvement increased during the study period. Falling from a horse was the most frequent cause of injury (60.67%), followed by being kicked (13.4%). Head and extremities were the most affected areas. On admission, 33.7% had a potential severe injury score. Forty-two participants (47%) had underlying fractures, mostly in the upper extremities. In the pediatric population, 16.2% (vs. 0% adults) rode horses for therapeutic reasons. Seventeen subjects reported having long-term consequences.

Conclusions: The findings are similar to those described in other parts of the world. Horseback riding-related injuries are increasing, which emphasizes the need for safety education programs in Israel.

 

P.R. Criado, R.F.J. Criado, C.F.H. Takakura, C. Pagliari, J.F. de Carvalho, M.N. Sotto and C. Vasconcellos
 Background: Few studies have addressed the ultrastructure of vascular permeability in urticaria.

Objectives: To describe the types of endothelial cell organelles involved in vascular permeability in drug-induced acute urticaria (DIAU).

Methods: Seven patients with DIAU were enrolled in the study. Biopsies of urticarial lesions and apparently normal skin were performed. The 14 collected fragments were processed with immunogold electron microscopy using single stains for tryptase and factor XIIIa (FXIIIa) and double immunogold labeling for both tryptase and FXIIIa.

Results: Some sections demonstrated mast cells in the degranulation process, in both anaphylactic and piecemeal degranulation. After double immunogold staining, 10 nm (FXIIIa) and 15 nm (tryptase) gold particles were both present, covering the granules in the mast cells, indicating that both tryptase and FXIIIa were localized within the granules of these cells. Interestingly, we found strong evidence of the presence of caveolae and vesico-vacuolar organelles (VVOs) in the endothelial cells of the biopsies. In addition to these findings, we were able to demonstrate the presence of tryptase and FXIIIa in the endothelial cells, in urticarial lesions and in apparently normal skin.

Conclusions: VVOs are present in the endothelial cells of post-capillary venules in DIAU. This is the first report on the expression of FXIIIa and tryptase in the cytoplasm of endothelial cells in urticaria. 

Reviews
B. Haviv, S. Bronak and R. Thein
 Osteoarthritis of the knee is a common joint disease that can cause substantial pain and disability. The manifestation of pain, however, is highly variable with a poor correlation to plain radiographs. The source of pain in gonarthrosis is elusive. Pain receptors have been found in the synovium, ligaments, capsule, subchondral bone and surrounding tissues with the exception of articular cartilage. The perception of pain is regulated at the spinal and cortical level and is often influenced by psychosocial conditions. There is no definitive treatment modality to relieve the pain and surgery does not necessarily guarantee improvement. Understanding and careful clinical assessment of the sore osteoarthritic knee together with better imaging such as magnetic resonance may improve treatment strategies.

S. Graffi, A. Peretz, H. Jabaly and M. Naftali
Case Communications
M. Naffaa, Y. Mazor, Z.S. Azzam, M. Yigla, L. Guralnik and A. Balbir-Gurman
הבהרה משפטית: כל נושא המופיע באתר זה נועד להשכלה בלבד ואין לראות בו ייעוץ רפואי או משפטי. אין הר"י אחראית לתוכן המתפרסם באתר זה ולכל נזק שעלול להיגרם. כל הזכויות על המידע באתר שייכות להסתדרות הרפואית בישראל. מדיניות פרטיות
ז'בוטינסקי 35 רמת גן, בניין התאומים 2 קומות 10-11, ת.ד. 3566, מיקוד 5213604. טלפון: 03-6100444, פקס: 03-5753303