Gal Puris, Dean Nachman, Arik Eisenkraft
Introduction: Organ failure is a common complication of
hemorrhagic shock due to trauma. Balanced fluid resuscitation
of critical patients can improve tissue damage and prevent
multiple system failure. Existing means of measuring
hemodynamic status are invasive, expensive, complex to use
and associated with complications. In light of the necessity a
number of technologies have been developed for non-invasive
monitoring of advanced hemodynamic values.
Objective: Evaluating the reliability of an innovative noninvasive
photoplethysmography device (PPG) for hemodynamic
monitoring and comparing it to the invasive gold standard.
Methods: Hemorrhagic shock was induced in ten swines by
controlled bleeding of 35% of blood volume. Animals were
continuously monitored by the PPG device and a Swan Ganz
Catheter. Readings of Systolic and diastolic blood pressure
(SBP, DBP), Heart Rate (HR), cardiac output (CO) and Oxygen
Saturation (SO2) were compared.
Results: 290 data points were collected for each of the
parameters at different baseline and different stages of
hemodynamic shock. A significant correlation was found
between the two monitoring devices (a slope not different
from 1, p<0.05) for all four parameters. In all parameters,
the average difference between the devices readings were
insignificant (p<0.05), with the exception of CO for which a
borderline difference was found. In addition, the total of all
measurements which diverged from the standard deviation for
all parameters was between 4.1% and 5.8%.
Discussion: There is a clear need for a technology capable
of monitoring advanced hemodynamic signs. In this study
we have found that the novel PPG device offers a high level of
reliability comparable to the existing invasive standard device.
Pursuant to further trials, a device like this can offer a simple
and reliable monitoring in a variety of clinical settings even in
prehospital care.
Ariel Drori, Dean Nahman, Arik Eisenkraft,
Introduction: Tube Thoracostomy (TT) is a potentially lifesaving
medical procedure, both in the Pre- and In-Hospital
surgical skill for all ״ setting. Although considered as a „basic
caregivers, it is a complicated procedure, requiring training,
skill and time to perform properly, and is often unjustified
avoided by physicians and paramedics in the pre-hospital
setting.
Objective: To evaluate the reasons and incidence for the
underuse of TT in the pre-hospital setting.
Methods: A survey was e-mailed to all members of The
Israeli Paramedic Organization (IPO), regarding their previous
training, skills and experience in pre-hospital TT.
Results: 80 paramedics replied the survey (~10% of IPO
members). 39% of those who replied the survey think they
are under-skilled or under-trained at TT, and only 49% feel
confident in their ability to perform TT. Most (71%) performed
Needle Thoracostomy (NT) at least once and 45% performed TT
at least once. 37% reported that in most or all cases in which
NT was performed – TT was not followed by the caregivers at
the field. Of those who performed TT in the past, 72% evaluate
procedure time between 5 to 10 minutes and 14% evaluate TT
took more than 10 minutes. 28% think that lack of skills is the
reason (or one of the reasons) for the underuse of TT in the
pre-hospital setting, along with close proximity to a hospital
(78%), prompt evacuation (39%) and lack of equipment (33%).
54% believe that the presence of an assistance-device for TT
will improve their ability and competence, 18% believe it will
increase the number of TT in the field and 20% believe it will
improve the wounded’s chances of survival.
Discussion: TT is underused in the pre-hospital setting,
according to a representative sample of Israeli paramedics,
in-line with published data worldwide. Many paramedics feel
they are under-skilled and under-trained to properly perform
TT. There is an obvious medical need for a change in the way
we perform TT, especially in the pre-hospital setting, either
by a better training of medical personal or by the use of a
simpler surgical technique or tools, which are unfortunately
still unavailable.
Yael Frenkel Nir, Barak Gordon
Introduction: The health of aircrews is critical to maintaining
their fitness for flight. The prevalence of overweight among the
general adult population in Israel is estimated as 54%, and
the rate of obesity is 15.7%. Since the Israeli military air force
population is an elected population required for good physical
fitness for flight, we can assume that the rates of excess
weight and obesity in this population will be lower. Studies
comparing the rate of obesity among civil pilots to their rate
in the general population found different findings in different
countries. To date, no study has been conducted to examine
the rate of obesity and other risk factors for cardiovascular
disease among the IDF Air Force population.
Methods: A cross-section study based on databases. We
examined the following data among the aircrew population
examined for five years: height and weight, blood pressure,
blood lipid levels, fasting glucose levels and liver enzyme
levels, service status and flying platform.
Results: The population examined consisted of 98% men versus
2% women. 51% of the participants are career, compared to
49% in the reserves and regarding the platform 40% were
fighter pilots, 20% transportation, 20% of the helicopter system
and the rest could not be defined. 31% were overweight, 3%
were obese, 4.3% were hypertensive, 0.3% were diabetic,
3.5% were pre-diabetic, 15% had low HDL and 19% had high
cholesterol. 3.4% showed liver enzyme abnormalities. Among
the reserve population, there was a significantly higher level of
hypertriglyceridemia, hypercholesterolemia, and elevated liver
enzymes than career patients. Transportation aircrews had
significantly lower HDL values than in the aircrews of other
platforms. Women were less likely to be overweight or obese
and no diabetes, or elevated liver enzymes were found in this
population.
Conclusions: Aircrews had overweight, obese and
hyperlipidemia in a significant prevalence, but less than the
general population. As expected, blood pressure and diabetes
were significantly lower in this population too. Weight loss
programs should be advised in this population in order to
reduce risk factors that may endanger their health and impair
their fitness to fly.
Dean Nachman, Noy Mark, Rafi Gerasi, Sagie Meshulam,
Lin Wagnert Avraham, Chen Orenshtein, Arik Eisenkraft
care, bleeding continues to be the leading cause of death
in trauma. Previous studies have shown that applying a low
electrical current on blood induces coagulation by catalyzing
the transformation of fibrinogen to fibrin. We have used an
innovative biocompatible fiber to develop a novel hemostatic
dressing that uses low electrical current to induce coagulation.
Objective: Evaluating the coagulation capability of the first
prototype of the hemostatic dressing in vitro.
Methods: Dressings were introduced to fresh swine blood,
anticoagulated with Citrate. Electrical current was applied
for different periods of times, using several prespecified
voltages. Fibrinogen levels were evaluated as a surrogate for
coagulation.
Results: In the control measurements, with no applied
electrical current, fibrinogen levels were 623.46±68.5 mg%,
there was no correlation with time of measurement. Applying
9V of electrical energy, haven’t induced a significant change
in fibrinogen levels in comparison to 0V (612.76±105.92 mg%,
p>0.05), but a trend for reduced levels with time was noticed,
and after 10 minutes fibrinogen levels were significantly lower
(496.5 mg% vs. 628.3 mg%, p<0.05). Applying 37.8V led to a
significant reduction in fibrinogen levels with respect to both
0V and 9V (298.37±118.79 mg%), and after 10 minutes in more
than half of the cases fibrinogen levels reached 0 mg%.
Discussion: In this preliminary study, we have demonstrated
that applying low electrical current via our novel dressing
induces coagulation in an anticoagulated blood. Furthermore,
a positive correlation of electrical power and coagulation
was noticed. Additional studies and device development are
planned.
Noy Mark, Dror Ofir, Erez Baruch, Ariel Forer, Avi Izhack, Rafi Gerasi
Introduction: Pulse oximetry is widely used by the IDF to get
fast and noninvasive information about the hemoglobin oxide
percentage in a patient’s blood. This information must be
as accurate as possible due to its massive influence on the
clinical condition of the patient and the treatment the patient
should get. At the medical corps there is a variety of pulse
oximetry (finger, handle and a part of a monitor) from different
manufactures but their reliability under variety of physiological
and environmental conditions has yet to be tested.
Objective: Examination of the performance of different
pulse oximetry in variety of physiological and environmental
conditions to get the most accurate vital signs information for
the best treatment in the battle field.
Methods: Six different pulse oximetry (3 finger, 3 handle)
from four different manufactures were examined in a variety
of physiological and environmental conditions which best
describe the possible conditions of the battle field. The
examination was performed using ProSim8 simulator which
enables alternation of the values and the quality of the signal.
Results: The examination of the finger pulse oximetry
revealed that in motion, the accuracy of the pulses was:
(Nonin, Masimo and Contec respectively) the examination of
the influence of finger covered with sand revealed accuracy
of: (Nonin, Masimo and Contec respectively (insignificant).
Yet, the amount of errors that was found in Contec is ~2.5, ~4
times greater than Masimo and Nonin respectively. In general,
the amount of errors has been found in Contec significantly
greater (~2) than the amount of errors in Nonin and Masimo.
The examination of the accuracy of the handle pulse oximetry
didn’t reveal significant differences of the performance in
static and motion conditions, except for the performance of
BCI (aged technology). The performance of Nonin and Masimo
handle pulse oximetry were better than the performance of
BCI. The two types of pulse oximetry (finger and handle) had
significant difficulties to measure the SpO2% when the finger
was covered with sand in all of the different manufactures. For
dark skinned patient, it was found that the amount of errors in
finger pulse oximetry is greater than the amount of errors in
handle pulse oximetry from the same manufacturer (~2.5 and
~8 for Masimo and Nonin respectively).
Conclusions: There is a difference between the variety of
pulse oximetry of different manufacturers and types (finger
and handle). There is a need to match the best type of pulse
oximetry to the exact need.
Ori Eliyahu, Idan Nakdimon, Anna Levkovsky, Shani Sarfati, Barak
Gordon,
Introduction: Hypobaric chamber trainings (HCT) that take
place in the IAF are meant to expose air-crew, in an audited
manner, to hypoxia conditions, which can occur to them midflight.
The known influencing factors on the pilot’s resistance
to hypoxia include: age, gender, smoking and physical fitness.
Objective: Examining whether men and women have a
different cardiac response to HCT.
Methods: During the HCT the trainees are exposed to 25,000ft
conditions, at that height they’re requested to remove their
oxygen mask and to perform a simple cognitive motoric task
on paper, they’re also requested to point out the symptoms
that they’re having due to the lack of oxygen. The trainee’s
blood oxygen saturation (BOD) and heart rate (HR) are being
monitored through the HCT, using a pulse-oxymeter. The
groups were sampled in t-0, 30, 60, 90 and 120 seconds and
at the end of the drill. Statistical analysis was done using
SPSS. The data was analyzed using t-test and Mann Whitney.
Variables were tested using Chi Square or Fisher.
Results: Out of 161 subjects, 17 were women, the women
were younger than the men (25.0±5.1 to 2.1±21.3, pv=0.003),
There weren’t any significant differences in BOD, final HR,
smoking status and physical fitness. Women’s HR was higher
during all stages of measurement (p≤0.015). Women are more
associated to non-combat arrays (p=0.001).
Conclusions: Women’s elevated HR can indicate that they
had a heightened sympathetic response, which isn’t linked
to smoking or physical fitness. The lack of experience as
well as the association to different arrays, might explain this
phenomenon. However, the final BOD and the performance
duration were not reduced, which can indicate a better
vascular response in women. Future studies should consider
using stress related questionnaires and measuring starting
blood pressure values in order to get a better understanding
on the matter.
Ilan Green, Nir Popel, Tal Yemini, Gil Zlotnik, Yaniv Alzam, Riki Bezalel
Introduction: Community-acquired pneumonia is a common
disease in about 1% of the population with significant clinical,
epidemiological and economic consequences. Only 5% of
patients are diagnosed with bacterial pneumonia requiring
antibiotic treatment. The diagnosis of pneumonia is based
on a complaint of symptoms of lower respiratory infection
(such as fever, cough, shortness of breath, chest pain) and
the presence of appropriate physical findings (wheezing,
increased fremitus, extended expirium). The classical findings
in physical examination appear in less than 25% of patients
with pneumonia. In most cases, chest x-rays are unnecessary
to diagnose pneumonia unless the diagnosis is unclear. In
practice, patients are often sent by the primary physician for
chest imaging without need. This causes many unnecessary
chest X rays and unnecessary exposure to radiation.
Objective: A. An examination of the proportion of chest x-ray
findings among patients who were sent for chest x-ray imaging
on suspicion of pneumonia.
B. Examination of symptoms and findings in the physical
examination predicting the presence of filtrate in chest
imaging.
Methods: Chest x-ray findings of 500 patients aged 18-50
were examined and compared with the findings of history
and physical examination. All data were taken from the
computerized record of the Imaging Institute (RIS).
Results: Of the 500 chest x-rays reviewed, 10% demonstrated
infiltration. Auscultations findings had the highest predictive
value of all physical examination findings and were 29%. A
combination of fever and auscultation finding increased the
positive predictive value to 36%. No symptom or combination
of symptoms could predict pneumonia satisfactorily.
Discussion & Conclusions: The findings indicate the difficulty
of diagnosing pneumonia according to complaints and physical
examination only. Auscultation finding reduces the need for
chest imaging. The fact that the predictive value of symptoms
to pneumonia is so low raises a question about the clinical
directive not to perform a chest x-ray to diagnose pulmonary
infection. Additional criteria are needed to diagnose pneumonia
such as CRP.
Arik Eisenkraft, Mor Rittblat, Ruth Shaylor, Charles Weissman,
Lilach Gavish
Introduction: Emergency field ventilation is usually performed
using bag-valve mask devices, which is difficult to handle for
a long period, particularly with lack of skilled personnel. We
have developed a Bag-Valve-Guedel Adaptor (BVGA), allowing
to ventilate without a facemask, with no need to perform chin
lift or jaw thrust maneuvers, and using one hand only.
Objective: To test the efficacy and safety of the BVGA in healthy
bearded young volunteers.
Methods: This study was a prospective, randomized, selfcontrolled
clinical study, in 25 healthy bearded males. They
were breathing through a facemask for 3 minutes room air,
followed by 3 minutes 100% oxygen. The mask was then
taken off and after a 5-minute washout period in room air, the
procedure was repeated with the BVGA. All the procedures were
carried out while the subjects were awake and spontaneously
breathing. Throughout the study, physiological and respiratory
parameters were continuously monitored. At the end of the
study, the investigator filled a questionnaire regarding the
handling of the BVGA.
Results: Both TV and EtCO2 were significantly higher using
the BVGA as compared to the mask, both during inspiration
of air or during inspiration of 100% oxygen. Finally, the on-site
investigator reported that the BVGA was more comfortable and
resulted in less fatigue compared to the mask in all cases.
Conclusions: The results of this study show that BVGA is more
effective and comfortable compared to the facemask. The
physiological parameters were better when using the BVGA
rather than with the facemask. Future study is planned in
anesthetized volunteers in ambulatory setting.
Uria Moran, Uri Gottlieb. Evgeni Rozenfeld,
Introduction: Nowadays there are 55 physiotherapy clinics
across Israel while the accent is on combatant units and
training bases. As part of the perception that early access to a
physiotherapist who is an integral part of the unit increases the
quality of care, improves patient satisfaction, enhance recovery
time and prevents future injuries.
Objective: To evaluate the efficacy of physical therapy services
expansion to distant units.
Design: Cohort study.
Methods: A review of the military medical file (CPR) was
done for the years 2004-2016 and included combatant units
and training bases in which a physical therapy clinic was
established. The outcome measures were lost training
days, sick leave, musculoskeletal complaints, orthopedic
procedures, physiotherapy referral and change in medical
profile. Study population included combatants and training
soldiers only (support troops and staff were excluded).
Outcomes from two periods were compared - first, from the
two years prior to the physical therapist arrival (group A) and
second, from the two years after his arrival (group B). Results
were divided by the unit type and by gender.
Results: No significant differences were found in the results
of the comparison between the two periods. There was a
trend of an increase in the number of soldiers who emerged
from fighting, who had undergone orthopedic surgery, and a
downward trend in receiving exemptions.
Conclusions: It is possible that the presence of a
physiotherapist in the unit may raise the medical awareness
of soldiers and commanders, increase the amount of medical
treatment that soldiers receive, and cause faster decision
making when it comes to orthopedic surgery when necessary.
However, since the data of the control group have not yet been
obtained, it is not possible to determine whether the change
in the measures examined was related to the beginning of the
work of the physiotherapist in the unit, or whether it is a rising
trend in the IDF as a whole.
Michal Zilberberg, Barak Gordon, Evgeny Zinger, Yifat Erlich-Shoam,
Introduction: Occupational sampling time period assessment
is based on specific standard techniques (usually NIOSH or
OSHA). Minimal sampling time is a function of some parameters
like occupational threshold limit, minimal detection amount
and others. Measurements of substances controlled by the
TLV-Ceiling threshold are 15 minutes long. This threshold is
defined as the maximum level one must not be exposed to for
any time period. Our calculations show that the measurement
time might be reduced up to 5.5 minutes. However, the
measurement is an averaging method, thus not allowing
recognition of anomalous levels in shorter time periods.
Sometimes a necessity appears to assess rapidly changing
concentration levels. We propose a serial measurement method,
temporal maximal ,״ peaks ״ which will allow measurement of
concentrations, in very short time periods. We presented our
method in a measurement of Formaldehyde concentrations
jets, F-16I. ״ Sufa ״ in oxygen delivering systems in the
Methods: The serial sampling method uses the conventional
NIOSH-2016 method, which is based on sampling with silica
gel coated with 2,4 – dinitrophenylhydrazone cartridge. In
addition, mathematical models were used to assess the
exposure measured in the serial sampling. Using our method,
we calculated temporal maximal concentrations during
jets, during phases in which rapid ״ Sufa ״ test-runs of the
changes in concentration levels of pollutants were present.
Results: The results succeeded in pointing to concentration
levels which exceed the threshold in a case which
conventional measurement methods failed to detect.
Discussion & Conclusion: The methods today allow
measurements of pollutants only in long time periods. This can
lead to masking of a short-term abnormality which exceeds
the threshold. Due to this international shortage, a need has
arisen to develop a method for measurement of pollutants in
shorter periods of time. This method, which was developed and
,״ Sufa ״ successfully examined in test-runs on the fighting jet
allows the determination whether a short-term outbreak of
pollutants happens, and thus helps minimizing health risks.
This method is applicable for usage in fast, sharp and short
operating scenarios, such as shooting, jet test-running and
missile launching.
Evgeni Rozenfeld, Aharon S. Finestone, Uria Moran, Elad Damri,
Leonid Kalichman
Introduction: Anterior knee pain (AKP) is a very common
problem among adolescents, young athletes and soldiers.
There are many theories attempting to explain the etiology
of AKP but there is very little reference to myofascial trigger
points (MTrPs) as a possible cause of AKP.
Objective: To evaluate the association between prevalence of
active and latent MTrPs in hip and thigh muscles and soldiers
with symptoms of AKP.
Design: Observational exploratory – case control study.
Methods: 65 soldiers and officers (42 men and 23 women)
that were referred to physical therapy due to various medical
conditions. Half of the subjects (N=33) were referred to physical
therapy with a diagnosis of AKP and the other half (N=32) were
referred with upper limb complaints. Each subject underwent
a physical evaluation by a blinded examiner. The evaluation
was performed on rectus femoris (proximal), vastus medialis
(middle and distal), vastus lateralis (middle and distal) and
gluteus medius (anterior, posterior and distal). Dichotomous
findings included a palpable taut band, tenderness, pain
radiation, and relevance of referred pain to patient’s complaint.
Based on these, diagnosis of latent or active MTrP was
established.
Results: In six out of eight areas, the cases had higher
prevalence of total active and latent MTrPs than the controls.
The strongest difference was in mid VMO and distal VL, half
of the cases had MTrPs in those areas. When summarizing
MTrPs by muscles, cases have significantly more MTrPs than
controls in all evaluated muscles. 78.8% of cases had at least
one MTrP in the evaluated limb whereas only 6.3% of controls
had any MTrP in the evaluated limb.
Conclusions: Subjects with AKP have greater prevalence
of MTrPs in their thigh and hip muscles than controls. This
indicates that there is a connection between MTrPs to AKP.
Yael Frenkel-nir, Noam Kahana, Michael Murgraff, Barak Gordon,
Yair Barzilay
Introduction: Neck pain and cervical spine injuries are
common in military aircrew. It has a dramatic influence on both
the individual and the air force. The main purpose of this study
is to examine whether the series of treatments performed on
the MCRU for the aircrew population has led to strengthening
of neck muscles and increased range of motion compared to
their baseline before the treatment and compared to patients
who are not aircrew.
Methods: Retrospective research based on medical files in
the Aeromedical Unit, as well as in the clinic where they were
treated using the MCRU. The study group: 33 male Israeli
aviators (29-fighter pilots, 2 transport pilots and 2 helicopter
pilots) who referred to rehabilitation therapy with MCRU
during the years 2008-2017.The control group: 34 non-aviator
patients who underwent identical treatment series during the
same years. Matching the study groups’ age and sex they were
selected from the database of same MCRU clinic.
Results: Significant pre/post treatments improvement was
achieved in all 6 AROM directions approximately 12%-19%
in the study group and approximately 7-16% in the control
group and in all 4 measured directions of cervical isometric
strength, 59% flexion, 65% extension, 59% left rotation, and
52% right rotation improvement in the study group and 53%,
65%, 51%, 45% respectively in the control group. Baseline
AROM was better in the study group in right rotation and
was not significantly different between the groups in all other
directions. The study group displayed significantly better
baseline isometric strength values on extension and right
lateral flexion. No significant differences were found on flexion
and left lateral flexion. Following MRCU treatments, the study
group displayed significantly better AROM values in extension,
right and left rotation ROM, and in all 4 isometric muscle
strength directions compared to the control group.
Conclusions: This study shows that MCRU improves range of
cervical motion and strengthens neck muscles in patients with
neck pain, both pilots and non-pilots. And that the end result
in aircrew was significantly better, especially in isometric
strength, after treatment. We assume that it can be due to
a high motivation to improve for the purpose of returning to
fitness or due to the personality characteristics and lifestyle of
this population.
Shmuel Springer, Uri Gottlieb
Introduction: Ankle sprains are most common among soldiers.
Recurrent ankle sprains occur in up to 40% of individuals who
have previously experienced a lateral ankle sprain. The residual
symptoms, which include repetitive episodes of ‘giving way’
and subjective feeling of ankle joint instability, are also termed
as chronic ankle instability (CAI). Recent evidence suggests
that impaired central sensorimotor integration may contribute
to deficits in movement control experienced by people CAI.
Objective: To compare the effects of dual-task and walking
speed on gait variability in individuals with and without CAI.
Methods: Sixteen soldiers with CAI and 16 age- and gendermatched,
able-bodied controls participated in this study. Stride
time variability and stride length variability were measured on
a treadmill under four different conditions: self-paced walking,
self-paced walking with dual-task, fast walking, and fast
walking with dual-task.
Results: Under self-paced walking (without dual-task) there
was no difference in stride time variability between CAI and
control groups (p=0.346). In the control group, compared to
self-paced walking, stride time variability decreased in all
conditions: self-paced walking with dual-task, fast speed,
and fast speed with dual-task (p=0.011, p=0.016, p=0.001,
respectively). However, in the CAI group, compared to
self-paced walking, decreased stride time variability was
demonstrated only in the fast speed with dual-task condition
(p=0.008). Stride length variability did not change under any
condition in either group.
Conclusions: Soldiers with CAI and healthy controls reduced
their stride time variability in response to challenging walking
conditions; however, the pattern of change was different. A
higher level of gait disturbance was required to cause a change
in walking in the CAI group compared to healthy individuals,
which may indicate lower adaptability of the sensorimotor
system. Clinicians may use this information and employ
activities to enhance sensorimotor control during gait, when
designing intervention programs for soldiers with CAI.
Naama Dar, Tamir Tsohar, Koby Goren, Salem Hanhan, Faris Saba,
Shai Luria, Dan Deutsch, Anat Blumenfeld, Amir Haze
ntroduction: Injury to the nervous system is often associated
with permanent impairment. Spontaneous regeneration
leading to recovery of function rarely occurs. Previously, we
have shown that in-vivo application of the recombinant human
amelogenin (rHAM+), brought about significant regeneration
of various injured mesenchymal tissues. During amelogenin
induced regeneration of transected skeletal ligament, correct
orientation of the proprioceptive nerve endings was detected,
which might indicate regeneration of the proprioceptive
sensation.
Objective: Evaluation of the ability of rHAM+ to induce
structural and functional regeneration of fully transected rat
sciatic nerve.
Methods: The right sciatic nerve of 8 weeks old female rats
was transected sharply and repaired immediately. 1μg/μl of
rHAM+ dissolved in its carrier propylene glycol alginate (PGA)
was applied onto the repair site of the experimental groups.
To the control group PGA carrier alone was applied. Rats were
followed for three months, during this time functional recovery
was evaluated using footprint analysis. Three months after
operation the ratios between the weights of right and left (nonoperated
side) gastrocnemius-soleus muscles was calculated.
The sciatic nerve was harvested and prepared for histological
and immunohistochemical analyses, using a monoclonal
antibody against neurofilaments.
Results: Three months after injury, footprint analysis
improved and gastrocnemius- soleus muscle weight ratio
were significantly higher in experimental groug treated with
1μg/μl rHAM+ (0.91), compared to the control group (0.67).
Neurofilaments staining indicated Wallerian degeneration
changes with fibrotic tissue filling the transition zone in the
control, in the experimental (1μg/μl rHAM+) many more
bundles of exons passed through the transected area, and
fewer nuclei were evident.
Conclusions: Our preliminary results indicate that three
months after application of 1μg/μl rHAM+ onto acute sciatic
nerve transection, there is partial functional and structural
healing of the nerve, significantly better than in the control
group. We are currently evaluating other concentrations of
rHAM+.
Shai Shahar, Tal Brosh-Nissimov, Ronit Calderon-Margalit
Introduction: Urinary tract infections (UTI) are highly common
in young women, however, there is no data on the incidence in
Israeli women. Furthermore, data is lacking on risk factors for
UTI in young healthy women, and more specifically, in female
soldiers.
Objective: We aimed to estimate the incidence of UTI in female
soldiers of the IDF. Additionally, we wished to determine
potential risk factors and identify subpopulations at risk.
This study was the first step in a mixed method study aimed
at identification of risk factors for UTI and planning and
implementing an intervention program for the prevention of
UTI.
Methods: We conducted a historical cohort study based on
computerized medical records of all the 389,254 female soldiers
who served in the IDF in 2000-2015. Participants were divided
into 5 military-profession groups: combatants, vocational work
(frontline), vocational work (backline), office work and officers.
The association between profession and UTI, as diagnosed by a
primary physician in the medical record, was estimated using
COX survival analyses, controlling for sociodemographic and
personal factors and utilization of medical services.
Results: During their service, 34.2% of participants were
diagnosed at least once with UTI, of whom 43.7% had recurrent
UTI. Compared with combatants, all but backline vocational
workers were negatively associated with UTI (frontline
vocational workers: HR=0.86, 95% CI:0.84-0.90; office workers:
HR=0.71, 95% CI:0.68-0.73; and officers: HR=0.23, 95% CI:0.22-
0.25).
Discussion & Conclusions: One third of the female soldiers
suffered from UTI during compulsory service, with differences
between professions. These differences may be caused by
service characteristics, work routine, motivation to serve and
accessibility to medical care. Future studies are needed to
further explore these plausible explanations.
Daniel Gelman, Dean Nahman, Shunit Coppenhagen-Glazer, Arik
Eisenkraft, Shaul Beyth, Ronen Hazan
Introduction: The rapid evolution of bacterial resistance to
most currently available antibiotics is a worldwide problem,
representing a significant threat in military medicine, from
battlefield injuries, to humanitarian missions, and down to the
military public health care systems. Thus, an urgent need for
supplementary anti-infective modalities has arisen. One of the
most promising developments for this threat is Phage Therapy,
the administration of bacteriophages, viruses specifically
targeting bacteria, as bio-therapies. Bacteriophages have
been widely clinically administered in Eastern Europe for a
century, where they were found highly efficient, and today are
becoming a leading research direction worldwide.
Objective: We hereby present the potential of Phage Therapy
to mitigate severe bacterial infections in the context of military
medicine, including penetrating trauma injuries, foodborne
illnesses, and against biological warfare agents. We will
highlight its efficacy using a traumatic mouse peritonitis
model.
Methods: A novel cocktail of two lytic bacteriophages which
were isolated, characterized and sequenced, was used to
evaluate the therapeutic efficacy of phage therapy in mouse
septic peritonitis, carried out by a high inoculum (10*LD50) of
Vancomycin-Resistant Enterococcus faecalis. The mice were
treated using the bacteriophage cocktail, both, individually or
in combination with standard antibiotic regimen, and evaluated
by clinical and laboratory findings.
Results: A single intraperitoneal injection of the bacteriophages
was sufficient to resolve 100% of the fatal peritonitis cases,
while standard antibiotic treatment rescued only 60% of the
mice. Phage therapy revealed an advantage in the clinical and
bacteriological evaluation of the mice over antibiotic regimen,
and their combination presented the highest therapeutic
efficacy.
Conclusions: Our data supplies an in-vivo proof for the ability
of phage therapy to resolve severe bacterial infections using
single therapeutic dose. We suggest that integrating Phage
Therapy in military medicine is a required step in preparedness
for the approaching post-antibiotic era.
Noam Dinur, Joe Ben-Yitzchak, Michael Solomonov
Objective: Performing long-term tracking of teeth diagnosed
and examination of (״ pulpar caries ״) with deep caries cavities
the efficacy of treatment.
Methods: This is a retrospective study of medical records.
The research was conducted by checking computerized
records between 2011-2014 of soldiers examined close to
the date of their induction. The data was collected from all
soldiers diagnosed with deep caries cavities. Subsequently,
their treatment charts were reviewed to see if treatment
was performed on these teeth or if additional treatment was
deemed necessary during the soldiers’ service. Only soldiers
treated in the military clinic during their three years of service
(and not in civilian clinics) were included in this study. If no
additional treatment was prescribed or performed within the
soldiers’ three years of service, the treatment was considered
successful.
Results: The study included 1,131 teeth that were diagnosed
with pulpar caries. Conservative treatment with deep
restoration with or without pulp capping was performed on
291 teeth and 840 teeth were not treated around the time of
the caries cavity diagnosis.
Of the 291 teeth treated conservatively, within the three year
follow-up period, six teeth subsequently underwent RCT
and no teeth were extracted. Of the 840 untreated teeth, 152
underwent RCT (18%) and 13 teeth (1.5%) were extracted (four
of which previously underwent root canals).
Discussion & Conclusions: In the great majority of cases,
conservative treatment of pulpar caries at an early stage
successfully preserved the pulp tissue and the tooth structure
and thereby enabled the soldier to be free of dental pain during
his service.
It is necessary to promote good oral hygiene among new
recruits by mandatory dental checkups and treatments.
Primary dental treatment of deep caries cavities will increase
dental health, preserve tooth function and save time and
resources.
Galit Almoznino, Avraham Zini, Ronit Turgeman, Ron Kedem
Introduction: The link between periodontal disease and
systemic/metabolic diseases has been studied extensively in
the literature.
Objective: To characterize demographic, clinical dental and
periodontal parameters in patients with diabetes in the IDF.
Methods: This study is part of the Dental Oral Scale (DOS)
project. Demographic, dental and medical records of all
patients attending IDF dental clinics in 2014 were recorded.
These data were compared between patients suffering from
(״ Diabetes Machar ״) diabetes according to the medical record
and a control group of IDF general military personnel with no
recorded diabetes.
Results: There were 694 medical records with a diagnosis of
diabetes, of those 532 (76.7%) were males and 162 (23.3%)
were females. The mean age was 11.04±30.94 and the age
range was 18-73.The following parameters were positively
associated with a diagnosis of diabetes: male sex (p<0.001),
age (OR=1.13, p<0.001), patients who were born in Israel and
West Europe (p<0.001), increased BMI (OR=1.17, p<0.001),
smoking (p<0.0001), presence of periodontal disease (OR=
2.19, p<0.001,(more missing teeth (OR=1.16, p<0.001), brushing
teeth less than once a day (OR=0.39, p<0.001), less decayed
teeth (2.41 vs. 3.04, p=0.001), more general medical visits
(17.53 vs.12.16, p<0.001), more dental clinic visits (16.2 vs.7.6
,p<0.001) and more canceled scheduled dental appointments
(5.2 vs. 3.14, p<0.001).
Conclusions: Diabetes was positively associated with age
and with common risk factors for metabolic syndrome and
periodontal disease, but was negatively associated with the
number of decayed teeth. These patients exhibited increased
consumption of both medical and dental services, but also
higher rates of canceled scheduled dental appointments.
Military health authorities should be aware of the high
periodontal morbidity in patients with diabetes and refer these
patients to evaluation by a dentist.
Yoni Yosef, Alexander kiderman, David Chinitz, Amnon lahad
Introduction: More than 50 years have passed since White
of medical care. He showed that ״ ecology ״ initially described the
approximately 75% of the population in the United States and
England felt ill during a given month, a third sought medical
attention and only a few were hospitalized. Similar results were
shown in a 2001 study, despite marked changes that occurred
in medicine during the years. This paper describes for the first
time the ecology of medical care in Israel.
Methods: A telephone survey among a representative sample
of the general adult population (>15y) in Israel was conducted.
The subjective morbidity rate in the month preceding the
survey, the rate of those considering medical assistance and of
those who got assistance was calculated. Influence of Sociodemographic
factors over morbidity and consumption was
examined using the t-test for quantitative continuous variables
and X² for qualitative variables. Logistic regression was used
for multivariate analysis.
Results: 1,862 respondents participated in 11 consecutive
monthly samples. 49.5%
reported not having suffered from any illness during
the previous month, 45% considered asking for medical
assistance, 35.2% got medical assistance and only 1.5% were
hospitalized. Respondents living in the periphery gave up
medical assistance 42% more than others (P value 0.026),
Residents of the Southern district gave up even more than that
(OR 1.52, P value 0.029). Availability, accessibility and cost of
visit (including cost of arrival) were mentioned as important
factors influencing consumption of medical assistance.
Involvement of a family physician in patients’ lives, his ability of
helping with a wide range of problems and accessibility were
found to be encouraging factors for consumption. 58% chose
to seek for a family physician assistance and 28.9% asked for
another specialist consultation. 80% of the cases treated by a
family physician were contained in a primary care setting, 17%
were referred to a consultant physician, 2% were referred to
the ER and 1% were hospitalized.
Discussion & Recommendations: Subjective morbidity
in Israel is significantly lower than in literature (50% and
75%, respectively) On the other hand, a larger percentage
of the population in Israel is considering receiving medical
assistance during a given month, and the actual consumption
of medical services is higher than in the world (35% and 25%,
respectively). Waiver of medical assistance was related only to
one parameter, center versus periphery. Therefore, it seems
that the existing health system enables the Israeli public to
receive assistance when necessary, but in an unequal manner.
Family medicine, as suggested by the study, may help narrow
this gap.
Galit Almoznino, Avraham Zini, Dana Levi
Introduction: The IDF nutrition clinic provides nutritional
counseling for patients suffering from eating disorders (e.g
anorexia, bulimia, obesity) as well as for patients suffering
from systemic diseases (e.g. cardiovascular disease, diabetes,
hyperlipidemia etc.). Health-related quality of life (HRQoL) is
known to be impaired in these patients.
Objective: To evaluate the Oral Health Related Quality of Life
(OHRQoL) and the influencing factors of patients attending
nutritional counseling due to eating disorders (Group 1) or
due to systemic diseases (Group 2) compared to healthy
patients who presented for routine dental care (control group).
Methods: Case-control study which was based on Oral health
impact profile (OHIP-14) and nutritional questionnaires that
were filled by 198 military personnel aged 18-50 in compulsory
military service or career military service in the IDF.
Results: The study groups included 98 individuals attending
the nutritional clinic, composed of 63 persons suffering
from eating disorders (including: overweight, obesity,
underweight, anorexia, bulimia) and 35 persons suffering
from systemic diseases (inflammatory bowel disease-IBD,
diabetes mellitus, hypertension, hyperlipidemia, anemia).
The control group included 100 military personnel attending
dental clinic for conservative dental treatment.
Analysis revealed that the global OHIP-14 score was worse in
patients with eating disorders compared to both the control
and systemic diseases group (eating disorders: 21.59±10.38,
systemicdiseases: 18.43±5.91andcontrols: 18.05±4.67; p=0.008).
Conceptual hierarchical multiple regression model for the
median OHIP-14 global score demonstrated that physical
activity (p=0.002) and pain (p=0.002) were mediators in
the relationship between eating disorders and OHIP-14.
Eating disorders also had a direct statistically significant
negative association with the OHIP-14 global score.
Conclusions: There is a need for education programs aimed at
enhancing awareness among medical and dental practitioners
regarding the consequences of eating disorders. Treatment
of eating disorders requires a multidisciplinary team that
includes a physician, a nutritionist and a dentist in order to
evaluate the dental-oral health.
Asaf Harel, Shirly Gordon, Anna Levkovsky, Oren Shriki
Introduction: Sleep Deprivation is known to adversely affect
basic cognitive abilities such as object recognition and
decision-making. It affects the dynamics of neuronal networks
in the brain and can even lead to hallucinations and epileptic
seizures. Several lines of evidence indicate that it modifies the
balance of excitation and inhibition in neural circuits, and it is
hypothesized that the functional role of sleep is to restore this
balance. Assessing the effects of sleep deprivation using noninvasive
measurements of brain activity provides novel insights
into the dynamical changes that take place in the brain.
Objective: Research the effects of sleep deprivation on EEG
measures using analytical tools taken from complex systems
studies in physics. Furthermore, test the correlation of EEG
metrics to behavioral performance (cognitive task) in order to
validate real-time, objective, individual cognitive metrics.
Methods: During an integral part of their training, pilots and
drone operators underwent a sleep deprivation exercise in
which EEG measurements were taken under a rest condition
(eyes open) and under a cognitive task condition every few
hours and after recovery sleep. The measurements were taken
using 2 different EEG headsets (a gTec gel-based system and
a dry Cognionics system), both using 64 electrodes. Signal
analysis is based on Multiscale Entropy algorithms to infer
signal complexity and Neuronal Avalanches Analysis to
characterize critical dynamics.
Results: Significant changes in both entropy-based and
critical measurements were founded in correlation to the
sleep deprivation states. Furthermore, correlation between
the proposed metrics and the behavioral performances was
also found.
Discussion: The results form a promising potential for these
metrics to be used to monitor sleep deprivation effects and
alerts. It seems that the age of the participants has a positive
effect on the corrosive outcome of sleep deprivation, and
we expect that in an older population the changes will be
more profound. The current algorithms are computationally
expensive, thus making real-time analysis difficult. More
research is required to lead to more effective algorithms.
Conclusions: The stated metrics and the correlation to
behavioral performance, measured through the different sleep
deprivation stages, pave the way for both military and civilian
applications in fields that require vigilance and high cognitive
capabilities, and potentially deeper insight into sleep deprived
brain dynamics.
Meital Zur, Racheli Magnezi, Shirley Portuguese,
Inbal Reuveni, Eyal Fruchter
Introduction: ADHD is a neuro-developmental disorder
prevalent in 5.9-7.1% of children and adolescents, and 5% of
adults. It results in poor academic, occupational, and social
functioning. Pharmacotherapy improves core symptoms;
however, average adherence levels are low and decrease
at 16-17 years of age, just before the recruitment age for
Israel Defense Forces (IDF).This study evaluated the effect
of adherence to ADHD pharmacotherapy on occupational
performance among soldiers.
Methods: Retrospective data were collected for the study
cohort, which included all soldiers serving in the IDF from
2008 through 2012 (n>500,000). Each soldier in the cohort was
categorized based on adherence to treatment, as measured
by prescriptions filled monthly: (1) no treatment, (2) low (<2/
year), (3) medium (2-6/year) and (4) high adherence (>6/year).
Occupational performance was evaluated by 3 indicative
parameters: (1) number of sick days, (2) number of exemptions
from daily activities, and (3) military profession disqualification,
including sub-analysis to military profession groups.
Results: ADHD pharmacotherapy adherence correlated
inversely with occupational performance, as exhibited by more
sick days and exemptions from daily activities. All soldiers
pharmacologically treated for ADHD had higher professional
disqualification rates compared to soldiers who did not
require ADHD treatment. In contrast to the general trend, in
the military drivers group, higher rates of ADHD adherence
correlated with lower professional disqualification rates.
Conclusions: Our hypothesis that greater adherence would
correlate positively with better occupational performance
was refuted. We speculate that increased adherence levels
are indicative of more severe ADHD and thus, accompanied
by lower occupational performance. The correlation between
increased adherence and improved driving ability could be
attributed to the nature of driving professions, which require a
high level of concentration. Interventions designed to enhance
adherence to treatment for ADHD among drivers could
have a broad effect on driving consequences, and should be
considered by policymakers
Dror Garbi, Oren Shriki, Anna Levkovski, Leah Shelef, Shirley Gordon
Introduction: Full sleep deprivation (FSD) or chronic sleep
restriction (CSR) result in fatigue and sleepiness, deteriorated
mood, impairment in cognitive and behavioral functioning,
and increased accident-proneness. Nevertheless, some
individuals are required to function optimally under acute or
chronic sleep loss conditions, at times with high responsibility
and risk for the individual or their surroundings, including
aviators and Remotely Piloted Aircraft (RPA) officers. Young
pilots and RPA operators participated in a seminar aimed to
expose them to the subjective and objective effects of fatigue.
Objective: In this training seminar, the pilots and RPA
operators learned about the effects of fatigue on their cognitive
and general functioning and the importance of adhering to an
orderly and sufficient sleep routine during operational activity.
Methods: Study 1 participants were high-functioning
Israeli RPA operators (N = 30; 100% male) aged 19-25 (M =
21.26, SD = 1.33) who underwent 36 hours of FSD. Study 2
participants were Israeli Air Force pilots (98.2% male, N =
57), aged 21-26 (M = 22.52, SD = 1.25) who underwent two
consecutive nights of CSR - 3 hours of sleep every night,
and then one night of recovery in order to return to flight
level without sleep deprivation. Additionally, the pilots were
required to complete subjective fatigue questionnaires
(SFQ, GSQ). They performed cognitive battery measuring
executive functions and underwent EEG recording
Results: In study I, we found a negative correlation between
the hours of continues wakefulness and the performance on
the cognitive battery. Moreover, we also found indication for
deterioration in EEG indices that reinforce the behavioral findings.
In study II, the deterioration in the behavioral task was found only
in prolonged fatigue. However no EEG deterioration was found.
Conclusions: FSD and CSR influence differently on behavioral
results, EEG recordings and time to recover. To enhance
performance in the battlefield it is important for participants
to experience sleep deprivation beforehand and to develop real
time measuring tool for fatigue.
Leah Fostick, Michal Icht, Gil Zukerman, Shir Hershkovich, Yuval
Heled, Nir Fink,
Introduction: Sleep deprivation and environmental noise
both negatively affect personal communication. Both cause
difficulties in speech comprehension and production. During
combat, soldiers might be affected by both conditions, but to
date the effect of each was studied separately.
Objective: To test the combined effect of sleep deprivation and
environmental noise on personal communication.
Methods: Forty-five young, healthy participants were tested
twice in random order: after nocturnal sleep or after 24 hours
sleep deprivation. In each test, they were asked to repeat words
and sentences that were delivered with or without background
noise of armored fighting vehicle, in signal to noise ratio of 0
or -5 dB.
Results: Data collection has been completed. Primary
results confirm previous findings of the detrimental effect of
environmental noise on speech perception. Further analyses
will be conducted and their results will be presented.
Discussion & Conclusions: Environmental noise affects
personal communication and can cause hearing disability.
The established use of hearing protections in IDF is supported
by the research findings. Further data analysis will provide
conclusions regarding the quality of personal communication
under both environmental noise and sleep deprivation. In
addition, conclusions regarding the combined effect of sleep
deprivation and environmental noise on speech perception and
production will be presented